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Castilla J.,Institute Salud Publica Of Navarra | Guevara M.,Institute Salud Publica Of Navarra | Martinez-Baz I.,CIBER ISCIII | Ezpeleta C.,CIBER ISCIII | And 3 more authors.
Medicine (United States) | Year: 2015

Mortality is a major end-point in the evaluation of influenza vaccine effectiveness. However, this effect is not well known, since most previous studies failed to show good control of biases. We aimed to estimate the effectiveness of influenza vaccination in preventing allcause mortality in community-dwelling seniors. Since 2009, a population-based cohort study using healthcare databases has been conducted in Navarra, Spain. In 2 late influenza seasons, 2011/2012 and 2012/2013, all-cause mortality in the period January to May was compared between seniors (65 years or over) who received the trivalent influenza vaccine and those who were unvaccinated, adjusting for demographics, major chronic conditions, dependence, previous hospitalization, and pneumococcal vaccination. The cohort included 103,156 seniors in the 2011/2012 season and 105,140 in the 2012/2013 season (58% vaccinated). Seniors vaccinated in the previous season who discontinued vaccination (6% of the total) had excess mortality and were excluded to prevent frailty bias. The final analysis included 80,730 person-years and 2778 deaths. Vaccinated seniors had 16% less all-cause mortality than those unvaccinated (adjusted rate ratio [RR]=0.84; 95% confidence interval 0.76-0.93). This association disappeared in the post-influenza period (adjusted RR=0.96; 95% confidence interval 0.85-1.09). A similar comparison did not find an association in January to May of the 2009/2010 pandemic season (adjusted RR=0.98; 95% confidence interval 0.84-1.14), when no effect of the seasonal vaccine was expected. On average, 1 death was prevented for every 328 seniors vaccinated: 1 for every 649 in the 65 to 74 year age group and 1 for every 251 among those aged 75 and over. These results suggest a moderate preventive effect and a high potential impact of the seasonal influenza vaccine against all-cause mortality. This reinforces the recommendation of annual influenza vaccination in seniors. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Morales Asencio J.M.,University of Malaga | Rivas Ruiz F.,Red de Investigacion en Servicios de Salud en Enfermedades Cronicas REDISSEC
Anales del Sistema Sanitario de Navarra | Year: 2015

Background. To identify factors related to the people, the process and the context that determine patient compliance with their appointments in the ambulatory outpatient services in the Costa del Sol Health Care Agency; and to obtain the profile of patients who fail to keep their appointments, the reasons for this failure and an estimation of its economic cost. Methods. Observational multicenter case-control study, through a survey carried out on patients with an appointment in the ambulatory outpatient services during 2013 and 2014, and analysis of the cost per appointment. Results. In total, 882 patients participated in the study (294 cases and 588 controls). The main reasons for missing an appointment were forgetting about it (29, 6%; n=87), and failure in communication (16%; n=47). A shorter time period before the appointment and older age were significantly associated with fewer absences, as well as the fact of having attended more consultations in the past year. The economic cost was more than 3 million euros for a non-attendance rate of 13.8%. Conclusions. Young patients who usually do not visit outpatient clinics are at greatest risk of absence from scheduled appointments in our health area. The main reasons for absenteeism are preventable and interventions such as improved communication procedures or appointment reminder systems could be beneficial. © 2015, Gobierno de Navarra. All rights reserved. Source

Fernandez-Morano T.,University of Granada | De Troya-Martin M.,Costa del Sol Hospital | Rivas-Ruiz F.,Red de Investigacion en Servicios de Salud en Enfermedades Cronicas REDISSEC | Blazquez-Sanchez N.,Costa del Sol Hospital | Buendia-Eisman A.,University of Granada
BMC Public Health | Year: 2015

Background: Health questionnaires must present accredited measurement properties such as validity, reliability and sensitivity to change, the latter being essential for interventions to be planned and for evaluating their effectiveness. The aim of this study was to evaluate the sensitivity to change of a Beach Questionnaire. Methods: Quasi-experimental before-after study carried out in 2011, for a study population of adolescents attending schools in the Costa del Sol. First, the questionnaire was administered to the adolescents, after which a multicomponent educational intervention was carried out; finally, three months later, the same questionnaire was re-administered to the same adolescents. Changes were assessed in the categories of each item, using the McNemar test, and the changes in the scores, standardised to a range of 0-100, using the Student t test for paired samples, and including the mean of the differences and the 95% confidence interval. The level of statistical significance was set at p∈<∈0.05. Results: 228 adolescents, aged 14-17 years, and 55.3% were girls. Statistically significant changes were observed in sunburn experiences, exposure to the sun at mid-day and attitudes to sun exposure and suncreams. For the seven items related to knowledge about sun exposure, a higher rate of correct answers was observed. The analysis of changes, within the standardised range, revealed a significant improvement in the scores for sun exposure habits (MD 4.33; CI 95% 2.2-6.5), attitudes to sun exposure (MD 2.22; CI 95% 1.2-3.2) and knowledge (MD 9.10; CI 95% 7.1-11.1), but not in those for sun-protection practices (MD 0.23; CI 95% -1.2-1.7). Conclusions: The Beach Questionnaire on behaviour, attitudes and knowledge related to sun exposure is the first such instrument in Spanish language to provide sufficient sensitivity to change. It constitutes a useful tool for epidemiologic research into photoprotection and for skin cancer prevention programmes. © 2015 Fernández-Morano et al. Source

Moljord I.E.O.,Norwegian University of Science and Technology | Lara-Cabrera M.L.,Norwegian University of Science and Technology | Perestelo-Perez L.,Canary Health | Perestelo-Perez L.,Center for Biomedical Research of the Canary Islands | And 6 more authors.
Patient Education and Counseling | Year: 2015

Objective: The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined. Methods: A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n= 60) and to analyze the sensitivity to change (n= 51). Results: The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α= 0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p< 0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85). Conclusion: PAM has appropriate and acceptable psychometric properties in mental health settings. Practice implications: Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health. © 2015 The Authors. Source

De Burgos-Lunar C.,Charles III University of Madrid | Jimenez-Garcia R.,Rey Juan Carlos University | Salinero-Fort M.A.,Red de Investigacion en Servicios de Salud en Enfermedades Cronicas REDISSEC | Salinero-Fort M.A.,Charles III University of Madrid | And 7 more authors.
PLoS ONE | Year: 2014

In patients with type 2 diabetes, the prevalence of hypertension is higher than in non-diabetic subjects. Despite the high cardiovascular risk involving hypertension in these patients, its prevalence and control are not well known. The aims of this study were: to estimate the hypertension prevalence, awareness, treatment and control in Spanish adults with type 2 diabetes attended in Primary Care; and to analyse its time trend from 2003 to 2009. A serial cross-sectional study from 2003 to 2009 was performed in 21 Primary Care Centres in Madrid. The study population comprised all patients with diagnosed type 2 diabetes in their computerised medical history. Overall annual prevalence during the period 2003-2009 was calculated from and according to sex and age groups. Linear trend tests, regression lines and coefficients of determination were used. In 2003 89.78% (CI 87.92-91.64) of patients with type 2 diabetes suffered hypertension and 94.76% (CI: 92.85-96.67) in 2009. This percentage was greater for women and for patients over 65 years old. 30% of patients suffered previously undiagnosed hypertension in 2003 and 23.1% in 2009. 97% of diagnosed patients received pharmacological treatment and 28.79% reached the blood pressure objective in 2009. The average number of antihypertensive drugs taken was 2.72 in 2003 and 3.27 in 2009. Only 5.2% of patients with type 2 diabetes show blood pressure levels below 130/80 mmHg. Although significant improvements have been achieved in the diagnosis and control of hypertension in people with type 2 diabetes, these continue to remain far from optimum. © 2014 de Burgos-Lunar et al. Source

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