Moral de la Reina, Spain
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Garjan F.J.,Servicio Navarro de Salud | Azparren A.,Servicio Navarro de Salud | Azaola B.,Servicio Navarro de Salud
BMC Health Services Research | Year: 2012

Abstract. Background: New drugs often substitute others cheaper and with a risk-benefit balance better established. Our aim was to analyse the diffusion of new drugs during the first months of use, examining the differences between family physicians and specialists. Methods. Prescription data were obtained of cefditoren, duloxetine, etoricoxib, ezetimibe, levocetirizine, olmesartan, pregabalin and tiotropium 36 months after their launching. We obtained the monthly number of prescriptions per doctor and the number prescribers of each drug by specialty. After discarding those with less than 10 prescriptions during this period, physicians were defined as adopters if the number of prescriptions was over the 25th percentile for each drug and level (primary or secondary care). The diffusion of each drug was studied by determining the number of adopter family physicians throughout the study period. Among the group of adopters, we compared the month of the first prescription by family physicians to that of other specialists using the Kaplan-Meier method. Results: The adoption of the drugs in primary care follows an exponential diffusion curve that reaches a plateau at month 6 to 23. Tiotropium was the most rapidly and widely adopted drug. Cefditoren spread at a slower rate and was the least adopted. The diffusion of etoricoxib was initially slowed down due to administrative requirements for its prescription. The median time of adoption in the case of family physicians was 4-6 months. For each of the drugs, physicians of a specialty other than family physicians adopted it first. Conclusions: The number of adopters of a new drug increases quickly in the first months and reaches a plateau. The number of adopter family physicians varies considerably for different drugs. The adoption of new drugs is faster in specialists. The time of adoption should be considered to promote rational prescribing by providing timely information about new drugs and independent medical education. © 2012 Garján et al; licensee BioMed Central Ltd.


Castilla J.,Institute Salud Publica Of Navarra | Castilla J.,CIBER ISCIII | Moran J.,Direccion de Atencion Primaria | Martinez-Artola V.,Complejo Hospitalario Of Navarra | And 13 more authors.
Vaccine | Year: 2011

We defined a population-based cohort (596,755 subjects) in Navarre, Spain, using electronic records from physicians, to evaluate the effectiveness of the monovalent A(H1N1)2009 vaccine in preventing influenza in the 2009-2010 pandemic season. During the 9-week period of vaccine availability and circulation of the A(H1N1)2009 virus, 4608 cases of medically attended influenza-like illness (MA-ILI) were registered (46 per 1000 person-years). After adjustment for sociodemographic covariables, outpatient visits and major chronic conditions, vaccination was associated with a 32% (95% CI: 8-50%) reduction in the overall incidence of MA-ILI. In a test negative case-control analysis nested in the cohort, swabs from 633 patients were included, and 123 were confirmed for A(H1N1)2009 influenza. No confirmed case had received A(H1N1)2009 vaccine versus 9.6% of controls (p< 0.001). The vaccine effectiveness in preventing laboratory-confirmed influenza was 89% (95% CI: 36-100%) after adjusting for age, health care setting, major chronic conditions and period. Pandemic vaccine was effective in preventing MA-ILI and confirmed cases of influenza A(H1N1)2009 in the 2009-2010 season. © 2011 Elsevier Ltd.


Castilla J.,Institute Salud Publica Of Navarra | Castilla J.,CIBER ISCIII | Martinez-Artola V.,Pamplonacomplejo Hospitalario Of Navarra | Salcedo E.,Pamplonacomplejo Hospitalario Of Navarra | And 12 more authors.
Vaccine | Year: 2012

We evaluated the 2010-2011 seasonal influenza vaccine effectiveness in preventing hospitalizations. Using healthcare databases we defined the target population for vaccination in Navarre, Spain, consisting of 217,320 people with major chronic conditions or aged 60 years and older. All hospitalized patients with influenza-like illness (ILI) were swabbed for influenza testing.A total of 269 patients with ILI were hospitalized and 61 of them were found positive for influenza virus: 58 for A(H1N1)2009 and 3 for B virus. The incidence rates of hospitalization with laboratory-confirmed influenza were compared by vaccination status. In the Cox regression model adjusted for sex, age, children in the household, urban/rural residence, comorbidity, pandemic vaccination, pneumococcal vaccination, outpatient visits and hospitalization in the previous year, the seasonal vaccine effectiveness was 58% (95% CI: 16-79%). The nested test-negative case-control analysis gave an adjusted estimate of 59% (95% CI: 4-83%).These results suggest a moderate effect of the 2010-2011 seasonal influenza vaccine in preventing hospitalization in a risk population. The close estimates obtained in the cohort and the test-negative case-control analyses suggest good control of biases. © 2011 Elsevier Ltd.


PubMed | State Institute for Drug Control, ULSS, Geneesmiddelenbulletin, Toulouse University Hospital Center and 4 more.
Type: | Journal: Health policy (Amsterdam, Netherlands) | Year: 2017

To evaluate the framework of drug information produced by public health and regulatory institutions in Europe.We carried out a short survey asking editors of ISDB bulletins of the European region to indicate the main sources of drug information provided by public health and regulatory authorities in their countries, the specific kind of information produced and their opinions about strengths and weaknesses of such information. The availability of evaluations about the added therapeutic value of drugs and of tools facilitating the implementation of such information were particularly addressed and checked on the websites of those institutions.Answers pertaining to eight countries were available. Regulatory information and safety alerts are generally available, but just UK and Germany stand out by showing quite an advanced framework of evidence-based, comparative drug information for health professionals, decision-makers and for the general public. National plans to implement evidence-based drug information seem lacking.More efforts are warranted to develop sharp formats to make evidence-based drug information easier to access, understand and put in context, showing the place in therapy of medicines and their added therapeutic value. Harmonization of different sources, also at European level, would be important to favor their access and limit dispersion. Appropriate tools and specific plans are then necessary to favor implementation of information materials.


Sarries A.G.,Servicio Navarro de Salud | Lopez-Goni J.J.,Public University of Navarra | Granados-Rodriguez D.,Servicio Andaluz de Salud | Gonzalez-Jimenez A.,Hospital San Juan Of Dios
Anales de Psicologia | Year: 2015

Introduction. The Verbal (VF), Semantic (SF) and Phonemic Fluency (PF) tests are commonly used in clinical practice. Having different alternative tests, that could also allow for the effect of demographic varia-bles, would improve their use as screening tests, making it possible to dif-ferentiate patients with or without Alzheimer´s disease (AD). Aims. (1) To compare the discriminatory ability of the SF tasks “things in a house” and “food” versus the task “animals” among patients with the AD (n = 50) and healthy subjects (n = 50). (2) To compare the use of the phonemes such as “P”, “M” and “R” as an alternative and/or parallel task to the phonemes “F”, “A” and “S”. (3) To assess the combined use of both tasks with the demographic variables for the screening of AD patients and the healthy ones. Results. Both semantic and phonemic categories indicate similar re-sults, high correlation, support the criteria validity and allow for their use in a parallel way. Among all the different roles assessed, the most successful in screening correctly 91% of the evaluated subjects is the one that includes tasks such as “things in a house”, the phonemes “A” and “S” and the age and schooling time variables. Conclusion. The parallel use of VF and PF, plus the demographic variables improve the discriminatory ability of the VF tests. © 2015: Servicio de Publicaciones de la Universidad de Murcia. Murcia (España).


Chatenoud L.,Instituto Of Ricerche Farmacologiche Mario Negri | Bertuccio P.,Instituto Of Ricerche Farmacologiche Mario Negri | Bertuccio P.,University of Milan | Bosetti C.,Instituto Of Ricerche Farmacologiche Mario Negri | And 5 more authors.
International Journal of Cancer | Year: 2013

Although therapeutic advancements have made Hodgkin's lymphoma (HL) a largely curable disease, trends in HL mortality have been variable across countries. To provide updated information on HL mortality in the Americas, overall and 20-44 years age-standardized (world population) mortality rates from HL were derived for the 12 Latin American countries providing valid data to the World Health Organization database and with more than two million of inhabitants. For comparative purpose, data for the United States and Canada were also presented. Trends in mortality over the 1997 to 2008 period are based on joinpoint regression analysis. Declines in HL mortality were registered in all Latin American countries except in Venezuela. In most recent years, HL mortality had fallen to about 0.3/100,000 men and 0.2/100,000 women in Argentina, Brazil, Chile, Colombia, Ecuador and Guatemala, that is, to values similar to North America. Despite some declines, rates remained high in Cuba (1/100,000 men and 0.7/100,000 women), Costa Rica and Mexico as well as in Venezuela (between 0.5 and 0.6/100,000 men and between 0.3 and 0.5/100,000 women). In young adults, trends were more favorable in all Latin American countries except Cuba, whose rates remained exceedingly high (0.8/100,000 men and 0.6/100,000 women). Thus, appreciable declines in HL mortality were observed in most Latin America over the last decade, and several major countries reached values comparable to North America. Substantial excess mortality was still observed in Cuba, Costa Rica, Mexico and Venezuela, calling for urgent interventions to improve HL management in these countries. What's new? Mortality from Hodgkin's lymphoma differs between developed and less-developed regions of the world, with mortality rates having declined markedly in the former but less so in the latter. In this study of Hodgkin's lymphoma mortality in 12 Latin American countries, selected based on population size and completeness of mortality data, appreciable declines were registered for the period 1997-2008 in most of the countries assessed, with rates reaching those observed in North America. However, substantial excesses remained in Cuba, Mexico, and Venezuela, calling for urgent intervention in these middle-income countries. Copyright © 2013 UICC.


Objective To identify the «theory in the action», according to the concept of Argyris and Schon, in a group of Family Doctors and to examine whether this «theory» seems to be a valid representation of their behaviour, as well as a comparison with results of other studies. Design Descriptive, cross-sectional study. Setting Primary Care. Participants Ten Family Doctors with a minimum of 10 years experience in Health Centres of a city and its surrounding area. Method Intentional sampling was used to select the participants, according to age, sex, characteristics of the Health Centre, and style of practice style. Data was collected from recordings and transcription of self-recordings, as well as from observations in the consulting room. Inductive formulation and grouping of the propositions was performed from the identification of the behaviours in the consulting room and as well as their context following the proposals of Argyris and Schon. A comparison was also made of the propositions of the participants of this study and with those in the literature. Results and discussion The 84 propositions from the interviews were grouped into 9 topical categories, which in order of weight were: confidence / interest, prescribing medications, subjective dimension, direction, negotiation, distance, and information. The propositions of the first two topics are basically similar, while differences appear in the «theory in action» of various doctors. The propositions were comparable with the results of other studies. Conclusion It is possible to formulate the theory in action of Family Doctors that appears to be an overall and coherent representation of their behaviour in the consulting room. © 2014 Elsevier España, S.L.U.


PubMed | Servicio Navarro de Salud
Type: | Journal: BMC health services research | Year: 2012

New drugs often substitute others cheaper and with a risk-benefit balance better established. Our aim was to analyse the diffusion of new drugs during the first months of use, examining the differences between family physicians and specialists.Prescription data were obtained of cefditoren, duloxetine, etoricoxib, ezetimibe, levocetirizine, olmesartan, pregabalin and tiotropium 36 months after their launching. We obtained the monthly number of prescriptions per doctor and the number prescribers of each drug by specialty. After discarding those with less than 10 prescriptions during this period, physicians were defined as adopters if the number of prescriptions was over the 25th percentile for each drug and level (primary or secondary care). The diffusion of each drug was studied by determining the number of adopter family physicians throughout the study period. Among the group of adopters, we compared the month of the first prescription by family physicians to that of other specialists using the Kaplan-Meier method.The adoption of the drugs in primary care follows an exponential diffusion curve that reaches a plateau at month 6 to 23. Tiotropium was the most rapidly and widely adopted drug. Cefditoren spread at a slower rate and was the least adopted. The diffusion of etoricoxib was initially slowed down due to administrative requirements for its prescription. The median time of adoption in the case of family physicians was 4-6 months. For each of the drugs, physicians of a specialty other than family physicians adopted it first.The number of adopters of a new drug increases quickly in the first months and reaches a plateau. The number of adopter family physicians varies considerably for different drugs. The adoption of new drugs is faster in specialists. The time of adoption should be considered to promote rational prescribing by providing timely information about new drugs and independent medical education.


PubMed | Servicio Navarro de Salud.
Type: Journal Article | Journal: Anales del sistema sanitario de Navarra | Year: 2016

To describe demographic factors and voice quality parameters of patients with unilateral vocal fold paralysis (UVFP) after a voice therapy protocol.Forty-seven patients with a diagnosis of UVFP by video-laryngoscopy were included. Voice therapy was applied to all patients during 15 sessions that were structured in three progressive stages. The objective was to train patients in vocal techniques, phonic-breathing coordination,blow control, vocal exercises for glottic closure and vocal setting. Glottal closure, Voice Handicap Index-10 for perception of voice impairment and GRBAS scale were used before and after the speech therapy.The average age was 51 years (range 20-80), 60%women. Surgery was the most frequent cause (72%), and 40% had a profession related to voice use. Median time from diagnosis to treatment was 5 months (2-12). After voice therapy, 80% had complete glottal closure, previously this had been 34% (p<0.001), the score of VHI-10 decreased from 24.24 to 16.09 points (p<0.001) and GRBAS values improved in all the qualities of voice (p<0.001).Only 8.5% of the patients required surgical intervention after treatment.Voice therapy is effective as first line therapy in patients with UVFP, reserving medialization with non-absorbable material or thyroplasty surgery for those with a poor outcome. However, it is necessary to reduce the time it takes the patient to reach the Voice Unit after laryngoscopic diagnosis.


PubMed | Servicio Navarro de Salud, Public University of Navarra and Francisco de Vitoria University
Type: Journal Article | Journal: Atencion primaria | Year: 2015

To identify the theory in the action, according to the concept of Argyris and Schon, in a group of Family Doctors and to examine whether this theory seems to be a valid representation of their behaviour, as well as a comparison with results of other studies.Descriptive, cross-sectional study.Primary Care.Ten Family Doctors with a minimum of 10 years experience in Health Centres of a city and its surrounding area.Intentional sampling was used to select the participants, according to age, sex, characteristics of the Health Centre, and style of practice style. Data was collected from recordings and transcription of self-recordings, as well as from observations in the consulting room. Inductive formulation and grouping of the propositions was performed from the identification of the behaviours in the consulting room and as well as their context following the proposals of Argyris and Schon. A comparison was also made of the propositions of the participants of this study and with those in the literature.The 84 propositions from the interviews were grouped into 9 topical categories, which in order of weight were: confidence / interest, prescribing medications, subjective dimension, direction, negotiation, distance, and information. The propositions of the first two topics are basically similar, while differences appear in the theory in action of various doctors. The propositions were comparable with the results of other studies.It is possible to formulate the theory in action of Family Doctors that appears to be an overall and coherent representation of their behaviour in the consulting room.

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