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Pamplona, Spain

Castilla J.,Institute Salud Publica Of Navarra | Castilla J.,CIBER ISCIII | Moran J.,Direccion de Atencion Primaria | Martinez-Artola V.,Complejo Hospitalario de 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. Source

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. Source

Chatenoud L.,Istituto di Ricerche Farmacologiche Mario Negri | Bertuccio P.,Istituto di Ricerche Farmacologiche Mario Negri | Bertuccio P.,University of Milan | Bosetti C.,Istituto di 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. Source

Castilla J.,Institute Salud Publica Of Navarra | Castilla J.,CIBER ISCIII | Martinez-Artola V.,PamplonaComplejo Hospitalario de Navarra | Salcedo E.,PamplonaComplejo Hospitalario de 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. Source

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. Source

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