Influencia del criterio de selección de pacientes para la toma de frotis en la estimación de la efectividad de la vacuna antigripal

Objective

To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing.

Method

A case-control study was performed of laboratory-confirmed cases (n = 909) and negative controls for influenza (n = 732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week.

Results

The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p = 0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician.

Conclusion

The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed.     

Evaluación del Observatorio de Salud de Asturias: métricas de web y redes sociales,y opinión de los profesionales de la salud

Objective

To evaluate the Health Observatory of Asturias (Observatorio de Salud de Asturias [OBSA]), which collects and disseminates health data from Asturias through a website and social networks.

Method

A cross-sectional study was conducted between 2012 and 2013. The study included a process evaluation that analyzed the reach of the OBSA's website, Facebook and Twitter accounts through web metrics and the use made by health professionals in Asturias of these media. Satisfaction was assessed through an online questionnaire. To estimate the potential effects of the OBSA, the study also included an evaluation of the results with a non-experimental design.

Results

The total number of visits to the website increased in 2012, with more than 37,000 visits. The questionnaire (n = 43) showed that 72.1% of the health professionals knew of the OBSA and that 81.5% of them had used it. Most health professionals reported they were satisfied with the OBSA and believed that it encouraged cooperation among professionals (51.6%).

Conclusion

The OBSA is known and consulted by most health professionals and is achieving some of its main objectives: to inform health staff and stimulate discussion. According to the results, information and communication technologies could play an important role in the presentation of health data in a more interactive and accessible way.     

Inmigración y salud: desigualdades entre la población autóctona e inmigrante en el País Vasco

Objective

To analyze health inequalities between native and immigrant populations in the Basque Country (Spain) and the role of several mediating determinants in explaining these differences.

Methods

A cross-sectional study was performed in the population aged 18 to 64 years in the Basque Country. We used data from the Basque Health Survey 2007 (n = 4,270) and the Basque Health Survey for Immigrants 2009 (n = 745). We calculated differences in health inequalities in poor perceived health between the native population and immigrant populations from distinct regions (China, Latin America, the Maghreb and Senegal). To measure the association between poor perceived health and place of origin, and to adjust this association by several mediating variables, odds ratios (OR) were calculated through logistic regression models.

Results

Immigrants had poorer perceived health than natives in the Basque Country, regardless of age. These differences could be explained by the lower educational level, worse employment status, lower social support, and perceived discrimination among immigrants, both in men and women. After adjustment was performed for all the variables, health status was better among men from China (OR: 0.18; 95% confidence interval [CI95%]: 0.04-0.91) and Maghreb (OR: 0.26; 95% CI: 0.08-0.91) and among Latin American women (OR: 0.36; 95% CI: 0.14-0.92) than in the native population.

Conclusions

These results show the need to continue to monitor social and health inequalities between the native and immigrant populations, as well as to support the policies that improve the socioeconomic conditions of immigrants.     

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.     

Evaluación de la efectividad de un programa de mindfulness en profesionales de atención primaria

Objectives

To determine the long-term effects of a mindfulness program on burnout, mood states, empathy, and mindfulness in primary care professionals.

Methods

A repeated measures before-after study was performed in 87 participants working in primary care. The variables evaluated were scores of the Burnout Inventory (Maslach), mood states (Profile of Mood States [POMS]), empathy (Jefferson Scale of Physician Empathy [JSPE]) and mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), adherence to the intervention, and changes in attitudes. Evaluations were performed at baseline, at 8 weeks, and at 6 and 12 months. The intervention lasted for 1 year and consisted of two training phases, an intensive first phase lasting 28 hours, spread over 8 weeks, and a second, maintenance phase of 25 hours spread over 10 months. The effect of the intervention was assessed through observed change, standardized response mean (SRM), and linear mixed-effects models on repeated measures.

Results

The scores of all the scales improved significantly during the follow-up compared with baseline scores. The greatest differences were obtained at 12 months, especially in the the FFMQ (SRM: 1.4), followed by the POMS (SRM: 0,8). The greatest improvement in the maintenance phase was found in the difference between consecutive scores. The only scale that showed major changes in all phases was the FFMQ scale. At the end of the intervention, 89% of participants practiced the exercises of the program on their own and 94% reported improvements in self-care and greater professionalism.

Conclusions

A psychoeducational program based on mindfulness reduces burnout and improves mood states, empathy, and mindfulness, while encouraging better self-care.     

Efectividad de un programa multicomponente para dejar de fumar aplicado en atención primaria

Objective

To evaluate the effectiveness of a multicomponent program applied by nurses in primary care.

Method

A non-experimental pre-post study was carried out in 145 smokers from Area V of Asturias (Spain). The intervention consisted of a multicomponent group treatment program, applied for 7 weeks by primary care nurses.

Results

The mean age was 52 years. Men accounted for 39.73% of the study population. The abstinence rate at post-treatment was 51.1% (95% CI: 42.4 to 59.6). At 12 months, the abstinence rate was 41.1% (95% CI: 32.6 to 49.6). The change between the end of the intervention and follow-up at 6 and 12 months was statistically significant at both time points (p = 0.035 and p = 0.013, respectively). Among participants who had stopped smoking, there was a statistically significant decline in daily cigarette consumption. Factors that were statistically significantly associated with continued smoking at 12 months were heavier smoking before the intervention, higher scores on the Fagerström test, and a lower number of sessions attended.

Conclusions

The multicomponent treatment program was highly effective. The results suggest the desirability of specific training for health professionals to implement this type of intervention in primary care as an alternative to medical advice for smokers who need it.     

Variación espacial de la exposición a contaminación atmosférica en la ciudad de Valencia y su relación con un índice de privación

Objective

To evaluate spatial variation in exposure to nitrogen dioxide (NO₂) air pollution in the city of Valencia, Spain, and its association with socioeconomic deprivation and age.

Methods

Census tract population data were obtained from the National Statistics Institute of Spain. Outdoor NO₂ was monitored in 100 sites in the study area, through the use of passive samplers, in three campaigns between 2002 and April 2004. Land use regression (LUR) was used to obtain a map of NO₂ levels. The LUR predictions were compared with the NO₂ level obtained by: a) the nearest sampler of the monitoring network, b) the nearest passive sampler, c) the mean distance-weighted levels of the samplers in the neighborhood, and d) the NO₂ level obtained by using Kriging. For each census tract, the NO₂ levels were obtained. The association of NO₂ air pollution exposure with population age (≥65 years) and the 5-category deprivation index was analyzed.

Results

The LUR models showed less error than the other prediction methods. The safety levels proposed by the World Health Organization were exceeded in more than 99% of the population. An inverse relationship was found between NO₂ levels and the deprivation index (β = –2.01 μg/m³ in the most deprived quintile compared with lower deprivation, 95%CI: –3.07; –0.95) and a direct relationship was found with age (β = 0.12 μg/m³ per unit increase in percentage of the population ≥ 65 years, 95%CI: 0.08; 0.16).

Conclusions

The method allowed pollution maps to be obtained and the association between NO₂ levels and sociodemographic characteristics to be described.     

Consumo de riesgo de alcohol y factores asociados en adolescentes de 15 a 16 años de la Cataluña Central: diferencias entre ámbito rural y urbano

Objective

To determine the prevalence of risky alcohol consumption and associated risk factors among adolescents living in Central Catalonia (Spain) during the 2011-2012 academic year, depending on their area of residence.

Method

A cross-sectional study was carried out in a sample of 1268 10th grade students (4 th grade of secondary education) in Central Catalonia.

Results

Risky alcohol consumption was higher among adolescents in rural areas than in urban areas (59.6% versus 49.8%). Associated risk factors were drunkenness in siblings and friends, having positive expectations of alcohol consumption, and buying alcohol. Not living with both parents and poorer academic achievement were associated risk factors in rural areas, while higher socioeconomic status was a risk factor in urban areas.

Conclusions

Risky alcohol consumption was much higher among adolescents living in rural areas. The main associated factor was alcohol consumption among family and friends.     

Necesidades de información y uso de Internet en pacientes con cáncer de mama en España

Objective

To analyze information needs and search strategies among women with breast cancer in Spain. An additional aim was to explore how the internet, as a source of health information, influences the autonomy and active management of this disease among patients. The research was conducted in 2010 and 2011.

Method

This study forms part of a broader qualitative study that focuses on describing patients’ experiences of breast cancer and the trajectory of the disease, with the aim of creating a platform of integrated information resources for patients, relatives and healthcare professionals (PyDEsalud: http://www.pydesalud.com). We carried out 41 in-depth, semi-structured interviews with breast cancer patients in different stage of the disease, who were aged between 32 and 69 years. The interviewees’ were selected by intentional sampling, which included 15 Spanish regions. The field work was carried out from June to August, 2010. The interviews were recorded on videotape or audio. Based on patients’ narratives of their disease, a thematic-inductive analysis was performed of the information gathered.

Results

The findings show the importance of the internet as a source of health information. Moreover, the internet is a resource that is able to promote the empowerment process among patients and, consequently, to aid improvement in disease management.

Conclusions

Users need access to web sites with high quality health information, adapted to their needs and objectives.     

La voz de las mujeres sometidas a mutilación genital femenina en la Región de Murcia

Objective

To explore the perceptions of a group of women who underwent female genital mutilation on the impact of this practice on their sexual and reproductive health.

Methods

We performed a phenomenological qualitative study in a sample of 9 sub-Saharan Africa women, whose mean age was 30 years old and who had lived in Spain for 1 to 14 years. These women underwent genital mutilation in their countries of origin. Data was collected using a socio-demographic survey and an in-depth, structured personal interview. Subsequently, we performed a thematic discourse analysis.

Results

The discourses were grouped into four categories related to participants’ perceptions of female genital mutilation. These categories were intimate relationships, pregnancy, childbirth, and social impact.

Conclusions

The practice of female genital mutilation is maintained due to social and family pressure, transmitted from generation to generation and silenced by women themselves. This practice affects their sexual and reproductive health, as demonstrated by anorgasmia and dyspareunia. The women were satisfied with the healthcare received during pregnancy and childbirth. Nevertheless, most of them were not satisfied with family planning.     

Determinantes asociados a la participación de mujeres primíparas en el programa de educación prenatal

Objectives

To determine the factors associated with participation in a prenatal education program among primiparous mothers.

Methods

A multicenter observational study was carried out in four Andalusian hospitals (Spain) in primiparous women in 2010. Sociodemographic characteristics, obstetric history, and previous diseases were collected through an interview and from the clinical charts. Crude and adjusted odds ratios were calculated.

Results

The study population consisted of 520 women. According to multivariate analysis, the factors associated with participation in the program were educational level (p <0.001), higher income levels (p <0.001), birth in Spain (p <0.001) and viewing the program as useful (p <0.001). After adjusting for these variables, no other variable was related to participation. The main reason given by women for not attending prenatal education was lack of an invitation to attend.

Conclusions

Participation in the prenatal education program was favored by a higher educational level and income, birth in Spain, and viewing the program as useful.     

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).     

Participación y representatividad de la población inmigrante en la Encuesta Nacional de Salud de España 2011-2012

Objective

Population health surveys have been the main data source for analysis of immigrants’ health status in Spain. The aim of this study was to analyze the representation of this population in the Spanish National Health Survey (SNHS) 2011-2012.

Methods

We analyzed methodological publications and data from the SNHS 2011-2012 and the population registry. Differences in the participation rate between the national and foreign populations and the causes for these differences were analyzed, as well as the representation of 11 countries of birth in the survey with respect to the general population, with and without weighting.

Results

Households with any foreign person had a lower participation rate, either due to a higher error in the sampling frame or to a higher non-response rate. In each country of birth, the sample was smaller than would be expected according to the population registry, especially among the Chinese population. When we applied the sample weights to the 11 countries of birth, the estimated population volume was closer to the estimated volume of the population registry for all the countries considered, although globally both the underrepresentation and the intranational bias remained.

Conclusions

The lower participation of the immigrant population and differences in participation depending on the country of origin suggest the existence of a potential bias in the SNHS, which should be taken into account in studies analyzing the health of this population. The lower participation rate should be studied in greater depth in order to take appropriate measures to increase the representativeness of health surveys.     

Concentración de cloro en el aire de las piscinas cubiertas y sus efectos en la salud de los trabajadores a pie de piscina

Objective

To describe chlorine levels in the air of indoor swimming pools in Castilla-La Mancha (Spain) and relate them to other chemical parameters in the installation and to the health problems perceived by swimming pool workers.

Methods

We analyzed 21 pools with chlorine as chemical treatment in Castilla-La Mancha. The iodometry method was applied to measure chlorine concentrations in the air. The concentrations of free and combined chlorine in water, pH and temperature were also evaluated. Health problems were surveyed in 230 swimming pool workers in these facilities.

Results

The mean chlorine level in the air of swimming pools was 4.3 ± 2.3 mg/m³. The pH values were within the legal limits. The temperature parameters did not comply with regulations in 17 of the 21 pools analyzed. In the pools where chlorine values in the air were above the legal regulations, a significantly higher percentage of swimming pool workers perceived eye irritation, dryness and irritation of skin, and ear problems.

Conclusions

Chlorine values in the air of indoor swimming pools were higher than those reported in similar studies. Most of the facilities (85%) exceeded the concentration of 1.5 mg/m³ established as the limit for the risk of irritating effects. The concentration of chlorine in indoor swimming pool air has a direct effect on the self-perceived health problems of swimming pool workers.     

Desarrollo de IEMAC,un Instrumento para la Evaluación de Modelos de Atención ante la Cronicidad

Objective

To present the context, aim and process of designing the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]), which was developed to make the conceptual framework of the chronic care model operational in the Spanish national health system.

Methods

The IEMAC was developed by a series of national experts with distinct profiles of expertise using qualitative research techniques. A matrix was built with the dimensions selected as basic for the new model. In each dimension, actions were identified and categorized, creating a taxonomy of components and interventions. The clarity and appropriateness of each intervention, and the degree of evidence to support it, were assessed. The resulting questionnaire was validated by other experts from diverse disciplines and settings. Finally, the IEMAC 1.0 was piloted at macro, meso and micro levels.

Results

The IEMAC is a tool to be self-administered by health organizations at macro, meso and micro levels. This instrument is composed of six dimensions, 27 components and 80 interventions, whose implementation is assessed with the aid of a scale that combines deployment, systematic evaluation, and orientation improvement. The IEMAC uses a systemic, population-based approach and integrates promotion, prevention, and coordination with social services.

Conclusions

The IEMAC contains a set of interventions that can be used as a road map by decision makers, managers and clinicians interested in building a state-of-the-art chronic care model. At the same time, the IEMAC allows healthcare organizations to identify their baseline score and the progress achieved after improvement interventions.     

Características sociodemográficas de la interrupción voluntaria del embarazo en Andalucía: diferencias entre población autóctona y extranjera

Objectives

To describe the variables associated with induced abortions in Andalusia (Spain) and the differences between native and foreign populations.

Material and methods

A cross-sectional population-based study was carried out. The files on deliveries and induced abortions were combined to create a single file for the period 2007-2010. A binary logistic regression model was employed. The dependent variable was whether the pregnancy ended in delivery or induced abortion. The independent variables were the year, province of residence, number of previous children, schooling, cohabitation and nationality. The raw and adjusted odds ratios and the 95% confidence intervals were calculated for native and foreign women.

Results

Of 460,716 pregnancies, 17% ended in an induced abortion and 83% in delivery. The variables most closely associated with the risk of an induced abortion among native and foreign women in Andalusia were having three or more previous children (OR = 23.06), being under 25 years old (OR = 19.53), living alone (OR = 10.04) and being an immigrant (OR = 3.95), especially in African women. The rates of abortions, fecundity and fertility were higher in foreigners than in native women, with an increase in abortions and a decrease in fertility and fecundity.

Conclusions

The women at greatest risk of having an abortion in Andalusia are young foreign women, especially those from Africa, who live alone, have previous children and secondary education and reside in the province of Huelva.