Las Rozas de Madrid, Spain
Las Rozas de Madrid, Spain

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Alonso-Babarro A.,Hospital Universitario La Paz | Astray-Mochales J.,Direccion General de Atencion Primaria | Dominguez-Berjon F.,Direccion General de Atencion Primaria | Genova-Maleras R.,Direccion General de Atencion Primaria | And 2 more authors.
Palliative Medicine | Year: 2013

Background: The impact of palliative home care programs on in-patient admissions and deaths has not been appropriately established. Aim: The main objectives of this study have been to evaluate the frequency of in-patient hospital deaths and the use of hospital resources among cancer patients in two areas of the Madrid Region, as well as to assess differences between one area with and one without a palliative home care team (PHCT) in those variables. Design and setting: We conducted a population-based study comparing two adjacent metropolitan areas of approximately 200,000 inhabitants each in the Madrid Region, Spain, measuring in-patient deaths, emergency room admissions and in-patient days among cancer patients who died in 2005. Only one of the two areas had a fully established PHCT. Results: 524/549 cancer patients (95%) had an identified place of death: 74% died in hospital, 17% at home, 6% in an in-patient hospice and 3% in a nursing home. The frequency of hospital deaths was significantly lower among patients of the PHCT area (61% versus 77%, p < 0.001), as well as the number of patients using emergency and in-patient services (68% versus 79%, p = 0.004, and 66 versus 76%, p = 0.012, respectively). After adjusting for other factors, the risk of hospital death was lower among patients older than 80 (OR, 95% CI, 0.3, 0.1-0.5), higher among patients with hematological malignancies (OR 6.1, 2.0-18.9) and lower among patients of the PHCT area (OR 0.4, 0.2-0.6). Conclusions: Our findings suggest that a PHCT is associated with reduced in-patient deaths and overall hospitalization over the last two months of life. © The Author(s) 2012.


Rodriguez M.A.G.,Direccion General de Atencion Primaria | Gonzalez A.V.,Direccion General de Atencion Primaria | Gavin M.A.O.,Direccion General de Atencion Primaria | Martinez F.M.,Direccion General de Atencion Primaria | And 3 more authors.
Vaccine | Year: 2011

To ascertain the factors linked to invasive pneumococcal disease (IPD) caused by the different serotypes in the period 2007-2009, following the conjugate vaccine's inclusion in the childhood vaccination schedule, a total of 2013 IPD cases were reviewed. The mean annual incidence in this period was 10.74 cases per 100,000 inhabitans and the lethality was 8.8%. Overall serotype distribution displayed certain peculiarities, such as the high frequency of serotype 5. Serotype 3, male gender, sepsis and presence of risk factors were significantly associated with lethality. Vaccinated children under 5 years of age had a higher risk of disease due to serotype 19A. Serotype 8 was associated with the presence of underlying risk factors. © 2011 Elsevier Ltd.


PubMed | Direccion General de Atencion Primaria
Type: Journal Article | Journal: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin | Year: 2014

Invasive pneumococcal disease (IPD) is a notifiable disease in the Region of Madrid. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for children and adults aged two years or over with a high risk of disease, and for all adults aged 60 and over. We describe the evolution of IPD incidence from 2008 to 2011 in people aged 60 years and over and PPV23 vaccine effectiveness (VE). VE is estimated using both the screening method and indirect cohort method. The incidence of IPD varied from 20.0 in 2008 to 15.2 per 100,000 inhabitants in 2011 (RR: 0.8; 95% CI: 0.60.9). Adjusted VE estimated with the screening method was 68.2% (95% CI: 56.276.9). VE with the Broome method was 44.5% (95% CI: 23.859.6) for all PPV23 serotypes, and 64.4% (95% CI: 45.276.8) for PPV23 serotypes not included in conjugate vaccines. VE was lower in patients aged 80 years and older (25.5%; 95% CI:-23.2 to 55.0) and those with highrisk medical conditions (31.7%; 95% CI: -2.2 to -54.4). Adjusted VE was 44.5% (95% CI: 19.4-61.8) within 5 years of vaccination and 32.5% (95% CI: -5.6 to 56.9) after 5 years. These results are compatible with current recommendations for PPV23.


PubMed | Direccion General de Atencion Primaria
Type: Journal Article | Journal: Vaccine | Year: 2011

To ascertain the factors linked to invasive pneumococcal disease (IPD) caused by the different serotypes in the period 2007-2009, following the conjugate vaccines inclusion in the childhood vaccination schedule, a total of 2013 IPD cases were reviewed. The mean annual incidence in this period was 10.74 cases per 100,000 inhabitans and the lethality was 8.8%. Overall serotype distribution displayed certain peculiarities, such as the high frequency of serotype 5. Serotype 3, male gender, sepsis and presence of risk factors were significantly associated with lethality. Vaccinated children under 5 years of age had a higher risk of disease due to serotype 19A. Serotype 8 was associated with the presence of underlying risk factors.

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