Patrón espacial de la legionelosis en España, 2003-2007

Objectives

To analyze the spatial pattern of legionellosis in Spain for men and women during the period 2003-2007 and to identify spatial clustering of risk.

Methods

We identified the spatial pattern of the distribution of legionellosis rates based on calculation of rates by municipality through the direct method. Smoothing of these rates was performed by the Empirical Bayes method for studying the spatial pattern of disease for both sexes. We used Morańs index to analyze spatial autocorrelation rates globally. To calculate local rates, the Local Moran's Index [known as local indicators of spatial association (LISA)], was used to analyze the clusters of municipalities with the highest risk.

Results

After smoothing the risk, the highest rates (over 50 per 100,000 inhabitants) were grouped in the eastern Mediterranean coastal areas and the north of the mainland, as well as in the Mediterranean islands. Moran's index smoothed rates were 0.15 for men and 0.23 for women. The spatial clusters of statistically significant higher rates calculated by the LISA index were distributed in the north and east for both sexes.

Conclusions

These methods of spatial analysis allow patterns of disease distribution to be identified. All the methods used yielded similar results. These techniques are a complementary tool for epidemiological surveillance of infectious diseases.     

Normas poblacionales de referencia de la versión española del SF-12V2 para la Región de Murcia

Objective

Questionnaires on perceived health provide information on health results. Reference values are needed to assess these results. Previous studies have provided Spanish population-based norms for the SF-12v1. The aim of this study was to obtain the population-based norms for the Spanish version of the SF-12v2 for Murcia.

Methods

A cross-sectional telephone survey was carried out in 3,486 community-dwelling persons aged over 18 years old in the region of Murcia. The central tendency, dispersion and percentiles were calculated for each of the eight scales and the physical and mental summary components (PCS and MCS) of the SF-12v2. Known groups were compared to evaluate construct validity (Student’s t-test and ANOVA).

Results

A total of 3, 381 persons took part in the study (50.5% men). The mean age was 43.6 years in men and 46.0 in women. The mean PSC was 48.6 (±10.6) and the mean MCS was 53.6 (±10.7). These scores were higher (more favorable) in men, the youngest age groups, in persons with higher education and in those no chronic illnesses (p=0.000). In all the dimensions and summary components, men had better scores than women. The dimension with the worst score in both men and women was general health and the PCS.

Conclusions

These results should be considered as the population-based norms for the Spanish version of the SF-12v2 for Murcia but may also be useful to establish health aims in similar populations.     

Estimación de la exposición al humo ambiental de tabaco: revisión de cuestionarios utilizados en España

Introduction

In the last few years, health surveys and epidemiological studies on smoking have introduced questions on environmental tobacco smoke (ETS) exposure. However, a standardized questionnaire is lacking.

Methods

Between January and May 2008, we reviewed surveys containing items on ETS exposure carried out in Spain by public administrations, scientific societies and research institutes. The wording of the questions was reviewed and classified according to the study type, target population, geographical setting and place of exposure.

Results

We identified 27 surveys that included questions on passive smoking. Most were health surveys (81.5%) and were aimed at the general population (70.4%). The most frequent geographical setting consisted of autonomous regions (48.1%) and the most common place of exposure was the home (88.9%)

Discussion

The results show wide variability in the questions used. Questionnaire items on ETS exposure should be homogenized to allow comparison of the results of surveys.     

Comparación de los resultados de la medición del trabajo reproductivo en la Encuesta Nacional de Salud y la Encuesta de Empleo del Tiempo

Objective

To compare time spent on unpaid work as measured by the Time Use Survey (TUS) 2002-2003 and the National Health Survey (NHS) 2006.

Methods

The time spent on childcare, care of dependent adults, and housework was studied. The proportion of caregivers and the average amount of time spent on each activity, as measured by both surveys, was compared by gender, age and household size.

Results

The estimated time spent on adult and childcare is four to six times higher in the NHS, whereas the TUS shows higher percentages of people devoted to housework and childcare. The results of the NHS and the TUS tend to converge only when they measure the proportion of people caring for dependent adults and the average amount of time spent on housework.     

Entorno de práctica de los profesionales de enfermería y competencia para la incorporación de la evidencia a las decisiones: situación en las Islas Baleares

Objectives

To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses’ characteristics and their occupational settings.

Methods

We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%.

Results

A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%. The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p < 0.001). These differences remained significant when the questionnaires were compared according to professional category and experience.

Conclusions

This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBCP and help to establish areas for improvement both at the individual and organizational level.     

Efecto de un programa de atención telefónica tras el alta hospitalaria de una unidad de cirugía traumatológica

Objective

To determine the impact of a 1-month telephone care program after hospital discharge from a trauma surgery unit on health services utilization and patient anxiety and to perform a budgetary analysis.

Methods

We carried out an experimental study in 604 patients who formed an experimental and a control group. The experimental group was offered telephone care to resolve doubts during the first month after discharge. After this period, data were collected from both groups on the following outcome variables: visits to the emergency department or family physician, hospital readmissions, and the results of an anxiety test. Data analyses included logistic and linear multivariate analyses and calculation of the budgetary impact of the program on the hospital, the Andalusian Health Service, and the National Health System.

Results

A total of 73 telephone consultations were conducted with 60 patients, almost half for doubts about the therapeutic regimen. For the outcome variable “visit to emergency department”, the group without telephone care had an odds ratio of 1.8 in the multivariate analysis adjusted for the other independent variables: days of hospital stay, patient anxiety and comprehension of discharge indications. No differences between groups were found in the remaining outcome variables. The budgetary analysis demonstrated the possibility of implementing the program at a cost of 1.65 € per patient.

Conclusions

This program proved effective in reducing visits to the emergency department at a low cost.     

Validación de la versión española de las formas cortas del Urogenital Distress Inventory (UDI-6) y del Incontinence Impact Questionnaire (IIQ-7) en mujeres embarazadas

Objective

To validate two measurement instruments, the UDI-6 and the IIQ-7, for the study of urinary incontinence and its impact on the quality of life of pregnant women.

Methods

We carried out a validation study of a diagnostic tool. A total of 181 pregnant women completed the UDI-6 and IIQ-7 questionnaires. Feasibility, internal consistency, reliability, and construct and criteria validity were analyzed.

Results

Self-administration of the short forms of the UDI-6 and IIQ-7 questionnaires took less than 5 minutes and the maximum rate of no answer per item was 3.3%. Cronbach's alpha was 0.667 for the UDI-6 and was 0.910 for the IIQ-7. The reliability of the UDI-6 in the diagnosis of urinary incontinence showed Kappa statistic values of between 0.856 and 0.966, and the intra-class correlation coefficients of the UDI-6 and IIQ-7 were 0.902 and 0.954, respectively. Average values of the UDI-6 and IIQ-7 were higher in women with mixed incontinence, were lower in women with stress incontinence and increased with daily losses (p < 0.01). The correlation between the UDI-6 and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) (CCI = 0.497; 95% CI: 0.326-0.625) and between the IIQ-7 and ICIQ-SF (CCI = 0.472; 95% CI: 0.268-0.619) was moderate. The sensitivity and specificity of the UDI-6 for the diagnosis of urinary incontinence was 98.9% and 86.5%, respectively.

Conclusions

The Spanish versions of the IIQ-7 and UDI-6 are feasible, reliable, consistent and valid in the measurement of symptoms and quality of life in pregnant Spanish women with urinary incontinence.     

Validación de una escala reducida de capacidad funcional del cuestionario WOMAC

Objective

The aim of this prospective study was to evaluate the validity, reliability and responsiveness of the Spanish version of the 7-item short-form of the function dimension of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Methods

We conducted a prospective 1-year cohort study that included 459 patients on the waiting list for total knee or hip replacement. The WOMAC and EQ-5D questionnaires were sent at four time points: baseline and at 3, 6 and 12 months post-surgery. Based on a previously shortened scale, we performed a validation process with Rasch analysis and agreement measured by Bland-Altman plots.

Results

The values of Spearman's rho and Lin concordance coefficients between the full and short-form ranged from 0.96 to 0.98. Differences were statistically significant (p < 0.001) among the three groups of severity measured by a item in the EQ-5D. The two Bland-Altman plots showed no systematic differences and agreement was not dependent on the severity score. The short form fitted the Rasch model. Cronbach's α coefficients were higher than 0.85. Responsiveness was higher than 1.27 and 1.72 in knee and hip replacement, respectively.

Conclusions

The Spanish 7-item short form of the WOMAC function dimension is valid, reliable and responsive for patients with total joint replacement. The use of this version will reduce the burden on patients in both clinical studies and clinical practice.     

Influencia de la inmigración en los patrones de transmisión de la tuberculosis en Castellón (2004-2007)

Background

This study aimed to identify tuberculosis transmission patterns in Castellón in a period of major demographic changes.

Methods

A prospective study of patients with positive culture in the province of Castellon over a 4-year period (2004-2007) was carried out. Cases were described by year and nationality and were compared with those reported to the Department of Public Health. We studied the population with available molecular patterns, identified through restriction fragment length polymorphism (RFLP) and analyzed the variables from patient clusters, based on data collected in surveys of the Department of Health and the Laboratory Management Program.

Results

According to data from the Department of Public Health, the overall rate of tuberculosis per 100,000 inhabitants in the province of Castellón was 15.7 in 2004, 19.9 in 2005, 18.2 in 2006 and 17.5 in 2007. In our laboratory, strains were identified from 301 patients, representing 77% (301/390) of reported cases and 94% (301/321) of reported cases with a positive culture. The percentage of tuberculosis among foreigners increased with age, exceeding 50% in 2007. Molecular studies were available in 95% of patients (286); 58% were Spanish and 42% were foreigners, of whom 54% were Romanians. The cluster percentage was 40%, with 30% of mixed clusters. According to conventional contact studies, 85% of patients in clusters had been considered isolated cases.

Conclusions

The increased rate of tuberculosis in Castellón was mainly due to the increasing number of cases among foreigners, mostly Romanians. The availability of molecular studies in all patients with a positive culture allowed us to analyze how and where tuberculosis is transmitted in our province. Forty percent of the patients were grouped into clusters; of these, mixed clusters accounted for one third, indicating the high integration of immigrants in our area.     

La auditoría energética: una herramienta de gestión en atención primaria

Objective

The aim of this study was to evaluate the viability of energy audit as a management tool in primary care to improve the energy efficiency and environmental performance of a health center by reducing its operating costs.

Method

We conducted 55 energy audits in health centers from 2005-2010. The health centers were sized between 500 and 3,500 m², were located in health areas with 3,500 to 25,000 users, and were built between 1985 and 2007.

Results

With an average investment of 11,601€ per site, energy consumption can be reduced by 10,801 kWh per year, saving 2,961€ with a mean payback period of 3.92 years, and preventing emission of 7,010 kg of CO₂.

Conclusions

Energy auditing is a practical tool to reduce the operating and maintenance costs of health centers and of improving the comfort of the facilities.     

Barreras para la normalización de la telemedicina en un sistema de salud basado en la concertación de servicios

Objective

Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers’ contracts.

Methods

We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations.

Results

The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability.

Conclusions

In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers’ contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer.     

Demandas y expectativas de la evaluación de tecnologías sanitarias en Galicia. Análisis cualitativo desde la perspectiva de decisores y clínicos

Objective

To explore perceptions of the use of health technology assessment (HTA) in the Galician public health system, identify opinions on the usefulness of the products and services developed by the Galician Health Technology Assessment Agency (avalia-t), and determine the barriers and facilitators to the transfer of results to clinical practice.

Method

We performed a qualitative study based on in-depth semi-structured interviews of 20 intentionally selected experts (10 health care professionals and 10 hospital decision makers). The interviews were tape recorded and transcribed for inductive thematic analysis.

Results

Interest in HTA activities was high, but most informants considered these activities to be underused as a tool to aid decision making in clinical practice. A series of key factors was identified to guarantee HTA use: greater dissemination of HTA activities and availability of the results, increased involvement and communication among health care professionals in the selection and prioritization of relevant research, contextualization and adaptation of results to the local context, increased organizational support and greater financial resources.

Conclusions

The present study allows end-user? opinions on the utility of the various products/services offered by HTA agencies to be contrasted in order to adapt HTA activity to their needs and requirements. The involvement of health care professionals in all HTA fields is perceived as one of the main lines of action for HTA agencies. Such involvement could be achieved by reinforcing personal contact and increasing feedback to collaborators.     

Validación de los componentes del síndrome metabólico autodeclarados en un estudio de cohortes

Objectives

To assess the accuracy of self-reported data needed to constitute the metabolic syndrome in the University of Navarra Follow-Up [Seguimiento Universidad de Navarra (SUN)] cohort.

Methods

The SUN project is a multi-purpose prospective cohort, formed by more than 20,000 university graduates, followed-up using surface mail questionnaires every 2 years. In a sample of 287 cohort participants, self-reported data on the criteria needed to define the metabolic syndrome (waist circumference, blood pressure, triglycerides, high-density lipoprotein-cholesterol and glucose) were compared with the same biometric data obtained by blood tests or measured by trained medical staff. Intra-class correlation coefficients with 95% confidence intervals (95% CI), relative mean error and agreement limits according to the method proposed by Bland and Altman were calculated for each variable studied.

Results

High intraclass correlations were found for the values of waist circumference (r = 0.86, 95% CI: 0.80-0.90) and triglycerides (r = 0.71, 95%CI: 0.61-0.79). Moderate intraclass correlations were found (between 0.46 and 0.63) for the other factors. Relative mean errors were always < 2.5%, and >91% of values were within the limits of agreement for all variables.

Conclusions

The results suggest that self-declared data on the criteria of metabolic syndrome obtained in the SUN cohort, though with some caution, are sufficiently accurate to be used in epidemiological studies.     

Tiempo de viaje y participación en el cribado del cáncer de mama en una región de alta dispersión poblacional

Objective

To analyze the association between travel time and participation in a breast cancer screening program adjusted for contextual variables in the province of Segovia (Spain).

Methods

We performed an ecological study using the following data sources: the Breast Cancer Early Detection Program of the Primary Care Management of Segovia, the Population and Housing Census for 2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December 2007. Dependent variables consisted of the municipal participation rate and the desired level of municipal participation (greater than or equal to 70%). The key independent variable was travel time from the municipality to the mammography unit. Covariables consisted of the municipalities’ demographic and socioeconomic factors. We performed univariate and multivariate Poisson regression analyses of the participation rate, and logistic regression of the desired participation level.

Results

The sample was composed of 178 municipalities. The mean participation rate was 75.2%. The desired level of participation (≥70%) was achieved in 119 municipalities (67%). In the multivariate Poisson and logistic regression analyses, longer travel time was associated with a lower participation rate and with lower participation after adjustment was made for geographic density, age, socioeconomic status and dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95% CI: 0.1-0.47), respectively.

Conclusion

Travel time to the mammography unit may help to explain participation in breast cancer screening programs.     

Análisis multinivel del uso de servicios de salud bucodental por población infanto-juvenil

Objectives

To analyze the variables associated with the use of oral health services in the last year by the population aged 6 to 15 years living in Spain and to determine whether there is variability in the use of these services among autonomous regions and, if so, whether this variability could be explained by variables related to the care model of the distinct autonomous regions.

Methods

A cross-sectional study of the Spanish National Health Survey (2006) was carried out. Independent variables were individual (sociodemographic, dental disease, habits and socioeconomic) and contextual (type of dental care model and prevalence of unemployment in the autonomous region). Association was estimated by multilevel logistic regression.

Results

Variance in the use of oral health services among autonomous regions was 0.16 (SE: 0.07), and 4.8% of the total variability was attributable to the autonomous region. The variables included in the model explained 83.11% of the variance. Individual variables associated with an increased likelihood of using dental services were the presence of disease and the frequency of brushing. Individual variables associated with a lower likelihood were age, origin, intake of sugary soft drinks and socioeconomic status. The contextual variables of being covered by a dental care model (of the type Childhood Dental Care Plan) older than 10 years doubled the likelihood of using oral health services compared with those without such coverage (OR = 2.47, CI = 2.04-2.99).

Conclusions

The use of oral health services during the last year by the pediatric population in Spain is lower than recommended. This use is associated with individual variables (demographic, dental health, habits and socioeconomic factors) and contextual variables (dental care model).