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1.
María del Mar Martín-Rodríguez José Antonio Díaz-Berenguer José Luis Alonso-Bilbao Antonio Cabeza-Mora Francisco Navarro-Vázquez Alberto Espiñeira-Francés Lidia Nuez-Herrera 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(5):300-309
Objective
To estimate the effect of the influenza vaccination in Primary Healthcare workers and the general population vaccinated during the 2015/2016 campaign.Design
Cross-sectional study.Setting
All the Primary Healthcare centres within the Gran Canaria healthcare region.Participants
A total of 1,868 Primary Healthcare workers (33.5% men; 66.5% women) and 795,605 individuals from the general population (49.4% men; 50.6% women).Principal measurements
The outcome variables in Primary Healthcare workers were: influenza cases reported to the Epidemiological Surveillance System, and the sick leave days due to illness. In the general population: reported flu cases and vaccination coverage in connection with the vaccination status of the healthcare professional. The magnitude of association between vaccination and morbidity was estimated applying logistic regression models.Results
Although not statistically significant, healthcare professionals that were not vaccinated had 1.7-fold increase in the risk of having influenza than those vaccinated. In the general population the association was significant in the female population (OR: 1.3; 95% CI: 1.1-1.5). Population coverage was significantly higher when both the doctor and nurse were vaccinated (OR: 1.3; 95% CI: 1.3-1.3), and reported flu cases decreased when the nurse was vaccinated (OR: 0.9; 95% CI: 0.9-0.9).Conclusion
A possible protective effect of influenza vaccination was observed in the general population, as well as an influence of Primary Healthcare workers on the patients regarding this. Even so, the low coverages registered point to a need to implement measures that may lead to a more favourable attitude towards influenza vaccination. 相似文献2.
Miguel Ángel Cantero-Braojos Andrés Cabrera-León María Angeles López-González Luís Angel Saúl 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):162-171
Objective
To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms.Design
A randomized clinical trial with a control group, taking three measurements over three months.Setting
Granada, Spain.Participants
A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM).Interventions
Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3 h was planned and the total of the program was developed during five weeks.Main measurements
Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM).Results
Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were ‘very important’ on intensity of pain (d = –1.01, d = –0.97) and interference of pain (d = –0.85, d = –0.74), with an improvement percentage from 21% to 30%.Conclusions
Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life. 相似文献3.
David Monterde Emili Vela Montse Clèries Luis García Eroles Pol Pérez Sust 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):153-161
Objective
To compare the performance in terms of goodness of fit and explanatory power of 2 morbidity groupers in primary care (PC): adjusted morbidity groups (AMG) and clinical risk groups (CRG).Design
Cross-sectional study.Location
PC in the Catalan Institute for the Health (CIH), Catalonia, Spain.Participants
Population allocated in primary care centers of the CIH for the year 2014.Main measurements
Three indicators of interest are analyzed such as urgent hospitalization, number of visits and spending in pharmacy. A stratified analysis by centers is applied adjusting generalized lineal models from the variables age, sex and morbidity grouping to explain each one of the 3 variables of interest. The statistical measures to analyze the performance of the different models applied are the Akaike index, the Bayes index and the pseudo-variability explained by deviance change.Results
The results show that in the area of the primary care the explanatory power of the AMGs is higher to that offered by the CRGs, especially for the case of the visits and the pharmacy.Conclusions
The performance of GMAs in the area of the CIH PC is higher than that shown by the CRGs. 相似文献4.
5.
Cristina Domingo Fernando Aros Agurtzane Otxandategi Idoia Beistegui Ariadna Besga Pedro María Latorre 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):142-152
Objective
To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate.Desing
Quasi-experimental research with control group.Settings
Twelve primary health care centres and 3 hospitals from the Basque Country.Participants
Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV.Interventions
Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care.Main measurements
The rate of readmission for HF and health-related quality of lifeResults
One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio = 0.59, CI 95%: 0.36-0.98; P = .049). There were significant differences in specific quality of life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up.Conclusions
ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables 相似文献6.
J. Gaudelus R. Cohen B. Leboucher J.P. Stahl F. Denis P. Pujol L. Longfier A. Martinot 《Médecine et maladies infectieuses》2019,49(3):180-186
Objectives
Meningococcal C (MenC) vaccination was introduced in the French vaccination calendar in 2010 to reduce the incidence of invasive meningococcal C disease (IMD C), mainly through herd immunity. The Vaccinoscopie survey helps follow vaccination coverage rates (VCRs) of children.Methods
This annual survey is based on a self-administered online questionnaire. In 2017, 4500 mothers of children completed the questionnaire and reported all vaccinations recorded in their child's health record.Results
MenC vaccination was deemed indispensable or useful by 77% to 84% of mothers. The main barrier mentioned by mothers considering the vaccination useless/not very useful, was fear of adverse effects. VCR was estimated at 77% among 24-35-month-old infants, 79% among 6-year-old children, and 50% among 14-15-year-old adolescents. VCR strongly varied depending on the physician's advice for vaccination and on the type of follow-up. Six months after publication of the new French vaccine calendar in April 2017, with a MenC vaccine recommendation for all 5-month-old infants, 43% of infants had received a dose at 6 months of age.Conclusions
VCRs are insufficient to reach herd immunity. Between 2011 and 2017 more than 100 deaths could have been avoided in France if optimal VCRs had been achieved. Faced with this vaccine strategy failure, the new vaccine recommendation at 5 months of age seems well-accepted. This recommendation and the implementation of infant mandatory vaccination in 2018 should have a major impact on IMD C incidence in this age group. 相似文献7.
8.
Francisco Javier Formigo Couceiro Marta Pena Seijo Antonio Pose Reino José Manuel Mayán Santos Francisco Javier Ayape Amigot Jesús Sueiro Justel 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(5)
Objective
To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs.Design
Transversal observational study.Location
Primary care unit, Santiago de Compostela.Participants
Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded.Main measurements
Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver.Results
In 26.76% of patients the systolic blood pressure fell by 20 mmHg or more and/or the diastolic blood pressure fell by 10 mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P = .412), not existing differences for arterial hypertension (P = .881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P = .033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P = .026)].Conclusion
OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered. 相似文献9.
E. Chanzy M. Gentile M. Nahon A.-C. Paty O. Stibbe J.-P. Tourtier T. Petrovic L. Goix F. Adnet F. Lapostolle 《Revue d'épidémiologie et de santé publique》2019,67(3):201-204
Introduction
The United Nations Climate Conference (COP21) gathered in France for delegations from all around the world, with 20,000 delegates from 195 countries every day, including 150 heads of states during the first 48 hours. A specific medical cover was organized in a particular “post-attacks” context and with harsh constraints due to delimitation of an inner zone under the sole UN authority (“blue zone”).Objective
To evaluate medical means involved and medical activity.Methods
Medical cover was managed by SAMU 93 in collaboration with zonal SAMU and regional health agency for the entire site including the “blue zone”. End-points: engaged workforce, number of visits, including transfers and medicalized transfers.Results
In “France zone” (operational headquarters): an emergency physician dispatcher and an assistant for 20 days. In “blue zone”: 20 rescuers, mobile intensive care unit H24 and two emergency physicians (consultations) 12/24 hours for 16 days. A total of 47 doctors, 25 nurses, 25 paramedics and 20 assistants participated in the medical service. This corresponded to three emergency physician full medical time equivalents (FMTE) for 16 days. Consultations performed: 1238 or 97/day resulting in 34 (3%) transfers including seven medicalized. Patients were 706 (57%) men and 495 (43%) women, with mean age of 43 ± 1 years. Trauma patients were most numerous (20%).Conclusion
Medical means involved were consistent for 16 days. The medical activity was sustained, but medicalized transfer rarely required. 相似文献10.
11.
Abdinasir Abubakar Nada Melhem Mamunur Malik Ghassan Dbaibo Wasiq Mehmood Khan Hassan Zaraket 《Vaccine》2019,37(12):1601-1607
Background
The World Health Organization recommends annual influenza vaccination, especially in high-risk groups. Little is known about the adoption and implementation of influenza vaccination policies in the Eastern Mediterranean Region.Methods
A survey was distributed to country representatives at the ministries of health of the 22 countries of the Region between December 2016 and February 2017 to capture data on influenza immunization policies, recommendations, and practices in place.Results
Of the 20 countries that responded to the survey, 14 reported having influenza immunization policies during the 2015/2016 influenza season. All countries with an influenza immunization policy recommended vaccination for people with chronic medical conditions, healthcare workers and pilgrims. Two of the 20 countries did not target pregnant women. Eight countries used the northern hemisphere formulation, one used the southern hemisphere formulation and nine used both. Vaccination coverage was not monitored by all countries and for all target groups. Where reported, coverage of a number of target groups (healthcare workers, children) was generally low. Data on the burden of influenza and vaccine protection are scarce in the Region.Conclusions
Despite widespread policy recommendations on influenza vaccination, attaining high coverage rates remains a challenge in the Eastern Mediterranean Region. Tackling disparities in influenza vaccine accessibility and strengthening surveillance systems may increase influenza vaccine introduction and use. 相似文献12.
C. Lepez W. Mehtelli J. Azuar F. Bellivier F. Vorspan 《Revue d'épidémiologie et de santé publique》2019,67(3):175-180
Aim
Cannabis use, as well as the prevalence of cannabis use disorder, are not known among the population attending general practices in France. We wanted to describe the characteristics of current cannabis users, estimate cannabis use disorder and self-rating of cannabis dependence, and describe medical conditions associated with cannabis use in a general practice in Paris.Methods
An anonymous questionnaire was proposed to every patient aged 18–65 in a general practice during three months from June to August 2014. Cannabis use in the last six months was recorded and cannabis use disorder was assessed according to three different means: answering yes to the question: do you feel like you are dependent on cannabis? or answering yes to the question: do you smoke cannabis in the first 5 minutes after awakening? or CUDIT score ≥ 8 points.Results
Two hundred and fifty-eight questionnaires were analyzed. Cannabis use in the past six months was found in 54 subjects (21%). Subjective feeling of cannabis dependence was endorsed by 18 subjects (6.9%). Cannabis use in the first 5 minutes after awakening was found in five subjects (1.9%) and 23 (8.9%) had a CUDIT score ≥ 8 points. Cannabis smokers had more often addictive and psychiatric associated medical conditions.Conclusion
General practitioners could ask about cannabis use and self-rated cannabis use disorder because it is frequent and patients with cannabis use disorder deserve specific care. 相似文献13.
Magdalena Millá Perseguer Natividad Guadalajara Olmeda David Vivas Consuelo 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(4)
Objective
To analyze the prevalence of Cardiovascular Risk Factors (CVRF) in the context of a Basic Health Area and the impact they generate on morbidity and consumption of healthcare resources in the stratified population according to the Clinical System Risk Groups (CRG) in Primary Care, with the purpose of identifying the population with multimorbidity to apply preventive measures, as well as the one that generates the highest care burden and social needs.Design
Observational, cross-sectional and population-based study for a basic health area during 2013.Location
Department of Health 2 (Castellón), Comunidad Valenciana (CV). Includes outpatient care in Primary Care and specialized.Participants
All citizens registered in the Population Information System, N = 32,667.Measurements
From the computerized system Abucasis we obtained the demographic, clinical and consumption variables of health resources. We consider the prevalence of CVRF based on the presence or absence of the ICD.9.MC diagnostic codes. The relationship of the CVRF with the 9 CRG health states was analyzed and a predictive analysis was performed with the logistic regression model to evaluate the explanatory capacity of each variable. In addition, an explanatory model of ambulatory pharmaceutical expenditure was obtained through multivariate regression.Results
The population of health status CRG 4 and above had multimorbidity. The CRG 7 and 6 health states have a higher prevalence of CVRF; it was predictive that the higher the morbidity, the greater the consumption of resources through OR above the mean, p < 0.05 and the 95% confidence intervals. It was observed that 59.8% of ambulatory pharmaceutical expenditure was explained by the CRG system and all the CVRF (p < 0.05 and R2 corrected = 0.598). Regarding the effect of the CVRF on the CRG health states, there was a significant association (p < 0.05) for the alteration of blood glucose, dyslipidemia and HBP in all the CRG states.Conclusions
The study of CVRF in a stratified population using the CRG system identifies and predicts where the greatest impact on morbidity and consumption of healthcare resources is generated. It allows us to know the groups of patients where to develop prevention and chronicity strategies. At the level of clinical practice, a new concept of multimorbidity is provided, defined from the state of health CRG 4 and above. 相似文献14.
15.
Fangjun Zhou Jing Xu Carla L. Black Helen Ding Bo-Hyun Cho Peng-Jun Lu Megan C. Lindley 《Vaccine》2019,37(14):1972-1977
Background
Infants younger than 6?months are at increased risk of complications and mortality from pertussis infection. In October 2012, the Advisory Committee on Immunization Practices revised its recommendation to include a Tdap dose during each pregnancy, ideally between 27 and 36?weeks gestation.Objective
Assess trends in Tdap vaccination coverage among privately insured pregnant women from 2009 to 2016 including timing of Tdap vaccination (before, during, or after pregnancy), trimester of vaccination for women vaccinated during pregnancy, and missed vaccination opportunities for unvaccinated women. Identify factors associated with vaccination during the optimal period of 27–36?weeks gestation.Study design
Retrospective analysis of privately insured women 15–49?years who delivered live births during 2009–2016 conducted using 2009–2016 MarketScan data. Tdap vaccination coverage and the timing of Tdap vaccine administration were assessed for women continuously enrolled from 6?months before pregnancy to 1?month after delivery. Multivariable logistic regression was performed to identify factors independently associated with receipt of Tdap vaccine at 27–36?weeks gestation.Results
Tdap vaccination coverage during pregnancy increased from 0.4% in 2009 to 6.2% in 2012 and to 53.2% in 2016. The proportion of vaccinated women receiving Tdap at 27–36?weeks gestation increased from <10% in 2009 to nearly 90% in 2016, with most vaccination occurring at 27–32?weeks gestation. Women of older age, residing in a metropolitan statistical area, residing outside the South, and having a capitated health insurance plan were more likely to receive Tdap at 27–36?weeks gestation than their counterparts. Among women not vaccinated during pregnancy, 77.7% had a pregnancy-related medical claim between 27 and 36?weeks gestation.Conclusion
Tdap vaccination coverage during pregnancy increased significantly from 2009 to 2016, with the greatest increase occurring after the revised Advisory Committee on Immunization Practices recommendation. Most women who did not receive Tdap vaccine had a missed vaccination opportunity during pregnancy, indicating potential for much higher vaccination coverage and consequent infant protection against pertussis. 相似文献16.
B. Davido R. Batista H. Fessi H. Michelon L. Escaut C. Lawrence M. Denis C. Perronne J. Salomon A. Dinh 《Médecine et maladies infectieuses》2019,49(3):214-218
Objective
A rapid and worrying emergence of vancomycin-resistant enterococci (VRE) gut colonization is occurring worldwide and may be responsible for outbreaks, especially in healthcare facilities. While no efficient decolonization strategies are recommended, we assessed fecal microbiota transplantation (FMT) to eradicate VRE colonization.Patients and method
Our main objective was to measure the impact of FMT on decolonization of VRE carriers, confirmed by at least two consecutive negative rectal swabs at one-week interval during a 3-month follow-up period. Patients received no antibiotic prior to the FMT.Results
After a month only three patients remained colonized with VRE. Decolonization was associated with 87.5% (n = 7) of success after three months as only one patient remained colonized.Conclusion
Our first results confirm that the FMT seems to be safe, with an impact on VRE colonization over time that may help control outbreaks. 相似文献17.
18.
Ferrán Catalá-López Manuel Ridao Enrique Bernal-Delgado David Moher José R. Repullo 《Gaceta sanitaria / S.E.S.P.A.S》2019,33(3):255-258
Objective
To examine the endorsement of reporting guidelines for economic evaluation studies, such as the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) statement, by Spanish biomedical journals.Method
Cross-sectional analysis of the instructions to authors of Spanish biomedical journals included in the Journal Citation Reports 2017. Two authors examined and extracted the following information: mention of any reporting guideline, the CHEERS statement, the recommendations of the International Committee of Medical Journal Directors (ICMJE) and the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network.Results
Of the 28 journals included, 23 (82.1%; 95% confidence interval [95%CI]: 63.1-93.9%) mentioned at least one reporting guideline in the instructions to authors. Only one journal mentioned the CHEERS statement for health economic evaluations. Twenty-four journals (85.7%; 95%CI: 67.3-96.0%) mentioned the ICMJE recommendations and 8 (28.6%; 95%CI: 13.2-48.7%) mentioned the EQUATOR network. The CONSORT (Consolidated Standards of Reporting Trials) statement for clinical trials was the most- mentioned reporting guideline (n = 21; 75.0%; 95%CI: 55.1-89.3%).Discussion
Most of the instructions to authors do not provide guidance on how to report economic evaluations. Journals should support compliance with reporting guidelines by authors and peer-reviewers. 相似文献19.
K. Mensah J.M. Heraud S. Takahashi A.K. Winter C.J.E. Metcalf A. Wesolowski 《Vaccine》2019,37(18):2511-2519