Validez y concordancia de la historia clínica electrónica de atención primaria (AP-Madrid) en la vigilancia epidemiológica de la diabetes mellitus. Estudio PREDIMERC

Objective

To assess the validity and concordance of diabetes data in the electronic health records of primary care (Madrid-PC) by comparing with those from the PREDIMERC study.

Methods

The sensitivity, specificity, positive predictive value, negative predictive value and kappa index of diabetes cases recorded in the health records of Madrid-PC were calculated by using data from PREDIMERC as the gold standard. The prevalence of diabetes was also determined according to each data source.

Results

The sensitivity of diabetes recorded in Madrid-PC was 74%, the specificity was 98.8%, the positive predictive value was 87.9%, the negative predictive value was 97.3%, and the kappa index was 0.78. The prevalence of diabetes recorded in Madrid-PC was 6.7% versus 8.1% by PREDIMERC, where known diabetes was 6.3%.

Conclusions

The electronic health records of primary care are a valid source for epidemiological surveillance of diabetes in Madrid.     

Variabilidad en el consumo de cigarrillos según la fuente de información en España (1993-2009)

Objectives

To assess the variability in the number of cigarettes smoked per person per day in Spain according to the information source (health surveys versus legal sales).

Methods

We compared cigarette consumption per person per day (population aged ≥16 years) obtained from the national health surveys in Spain and the official data on legal tobacco sales between 1993 and 2009.

Results

Cigarette consumption per person per day decreased between 1993 and 2009. Over the entire period, the number of cigarettes smoked per person per day according to legal sales exceeded that reported by national health surveys (up to 46.9%).

Conclusion

The difference in data on the number of cigarettes smoked between national health surveys and legal sales has increased in the last few years in Spain.     

Revisión sistemática de utilidades relacionadas con la salud en España: el caso de la salud mental

Objectives

Currently, there is no registry of utility values for the Spanish population that could potentially be used in economic evaluations. Consequently, a systematic review of utilities or preferences for health states in the Spanish population was conducted. The results related to mental health are reported.

Methods

A systematic review of the literature was conducted. The main databases searched were MEDLINE, CRD, Embase, PsycINFO, CINAHL, and Cochrane. The search strategy combined terms related to utilities and Spain. The inclusion criteria comprised the resident population in Spain, whether affected by any disease or not; the reported utilities had to be evaluated through a tool validated in Spain (i.e., EQ-5D, HUI, SF-6D) and/or following accepted techniques (e.g., time trade-off, standard gamble, or the visual analog scale). A narrative synthesis of articles was undertaken and the results related to mental health summarized.

Results

A total of 103 articles were finally included, from which 742 utility values were extracted. Sixty-nine utility values related to mental health and behavioral disorders were extracted from 12 studies. The most widely used tool was the E5-QD questionnaire. Most of the excluded articles evaluated quality of life but did not provide an estimation of utilities.

Conclusions

This review adds value to research on utilities in Spain by gathering values to be included in economic evaluations, as well as by identifying research gaps in this field. The utility values related to mental health identified in this study are similar to those reported in international publications.     

Cobertura del cribado de cáncer de cuello uterino en Cataluña (2008-2011)

Objective

To estimate cervical cytology coverage for the period 2008-2011 by age groups and health regions from data recorded in the medical records of women attending centers within the Catalan national health system.

Methods

The data used to estimate coverage were obtained from the primary care information system. This information was anonymous and included age, center, date, and the results of cytological smears for a total of 2,292,564 women aged 15 years or more.

Results

A total of 758,690 smears were performed in 595,868 women. Among women aged 25-65 years, the estimated coverage was 32.4% of the assigned population and was 40.8% in the population attended. Geographical variation was observed, with higher coverage among health regions closer to Barcelona. Abnormal Pap smears increased slightly from 2008 to 2011 (from 3% to 3.5%, respectively, p <0.001). In women with a negative first smear, the mean interval until the second smear was 2.4 years, but only 50% of women with a negative first smear in 2008 attended a second round during the study period.

Conclusions

Cervical screening coverage in the National Health Service of Catalonia includes one in three women. Second round participation was poor. Existing computer systems in primary care centers can ensure monitoring of population-based screening programs for cervical cancer. These systems could be used to plan an organized screening program to ensure wider coverage and better follow-up.     

Strengths and weaknesses of a cervical cancer detection and control program: a qualitative evaluation in San Luis Potosi, Mexico

Objective

To identify, from the perspective of the health staff, the strengths and weaknesses of the program for the detection and control of cervical cancer through a qualitative assessment implemented in three health centers in the city of San Luis Potosi, Mexico, from August 2008 to November 2009.

Methods

A qualitative evaluation was performed. Nine providers participated in the study. The providers were selected by purposeful sampling using a voluntary participation criterion. Initially, information on the characteristics and the context in which the program operates was obtained from the health centers. Later, 18 semi-structured interviews were conducted with nine informants to probe their perspective. A directed content analysis was used.

Results

The strengths reported by staff were the fact that the program is free of charge, the availability of material resources, and the strategies that helped encourage the recruitment of women and their access to screening. The main weaknesses consisted of limitations in human resources and physical infrastructure, inefficient organization of activities, the staff's poor technical training, limited promotion of activities, and limitations in monitoring women with positive results.

Conclusions

This study reveals the need for increased human resources, changes in regulations and reorganization of the program's actions in some health centers to ensure the quality of the service, meet women's needs, and promote coverage in all the program's actions.     

Systematic review of studies assessing the cost of adverse drug reactions

Objective

Adverse drug reactions (ADRs) are an important healthcare problem. The objective of this study was to review published articles analyzing the cost of ADRs in any healthcare setting.

Method

We conducted a search of articles published on the cost of ADRs in the bibliographic databases from 1970 to 2010. We identified 28 studies and selected 16 that included cases of ADR fitting the World Health Organization's definition of these events. The information on the characteristics of the study design, the types of costs analyzed and the reported results were reviewed.

Results

The design features and populations included in the studies were heterogeneous. Only two studies explicitly defined the perspective adopted. Only five studies compared cases of ADR with matched controls without ADRs. All studies analyzed direct healthcare costs, but none analyzed indirect or intangible costs. Fourteen publications analyzed the costs of length of hospital stay. The average (SD) percentage of ADRs was 3.04% (0.2) [median 2.4%, range 0.7% to 26.1%]. The median length of hospital stay in patients with ADRs was 8.8 days (range: 0.15 to 19.2 days). Accounting systems and monetary costs varied widely.

Conclusion

Studies on the costs of ADRs are highly heterogeneous and have evaluated direct healthcare costs in hospitals. Their results indicate that ADRs generate substantial costs. More studies using appropriate methodology are needed on the costs of ADRs.     

Use of Spanish proposals for measuring social class in health sciences

Objective

Recognizing the need for a consensus tool to measure social class in health sciences, in 1995 the Spanish Society of Epidemiology (Sociedad Española de Epidemiología [SEE]) made a proposal for such a measure. The aim of this article was to explore the bibliometric impact of the SEE's proposal.

Methods

Articles citing the SEE's report and those citing articles published as a result of the report were identified using Google Scholar and Scopus. The information extracted from these articles consisted of year, nationality and impact factor of the journal, self-citation, information source, subject area, city of the first author, type of publication, study design, use of social class as a variable, number of social class categories, and the use of education or occupation to determine social class.

Results

The number of citations progressively increased. Citations also showed heterogeneity in the subject. Generally, citations were found in original articles and articles with a cross sectional design, were published in journals with impact factor and were by researchers working in Barcelona or Madrid.

Conclusions

The SEE's proposal has proved to be an increasingly useful tool, applicable in different contexts. As suggested by the SEE, this proposal may need to be updated.     

Environmental attitudes and political partisanship

Objective

To explore the impact of political partisanship on environmental attitudes related to climate change in United States and its implications for public health.

Study design

An integrative literature review.

Methods

A literature review of English articles was performed from January 2013 to March 2013 using the following databases: CINAHL, PubMed, Academic Search Premier, Business Source Premier, ERIC, psychINFO, and Wiley Online Library. Empirical and review articles and Internet sources were included.

Results

Continued mass emission of carbon dioxide and other greenhouse gases will exacerbate the consequences of global warming and climate change. As one of the key global contributors of carbon emissions, the lack of climate change policy and regulatory practices at the federal level in the United States is of great concern. Political partisanship in the US is largely to blame for this inaction, as efforts for drastic remediation action is met with rejection from conservative groups who do not believe that global warming and climate change are a problem, despite scientific evidence to the contrary. To promote the health of the entire population, there needs to be a paradigm shift from consumption driven economic growth as advocated by the Republicans to a realization of true prosperity beyond growth in order to create a sustainable world.

Conclusion

This presents a critical challenge to public health professionals as political partisanship has the power to impact environmental attitudes and have serious implications for public health. Preserving the environment must take precedence over economic growth if we want a habitable planet low in carbon.     

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.     

Health effects of chronic noise exposure in pregnancy and childhood: A systematic review initiated by ENRIECO

Background

Chronic noise is an environmental pollutant and well-known to cause annoyance and sleep disturbance. Its association with clinical and subclinical adverse health effects has been discussed.

Objectives

This systematic review aimed to examine associations between chronic noise exposure during pregnancy or childhood and health outcomes in early and late childhood.

Methods

Following a systematic electronic literature search (MEDLINE, EMBASE), an additional hand search and a critical evaluation of potential articles by 2 independent reviewers, 29 studies were included: 12 on pregnancy/birth outcomes with samples ranging from 115 to 22,761 and 17 on cardiovascular and immune-mediated health outcomes in childhood with samples ranging from 43 to 1542. Evidence levels (3 to 2++) were rated according to the Scottish Intercollegiate Guidelines Network.

Results

Chronic noise exposure during pregnancy was not associated with birth weight, preterm birth, congenital anomalies, perinatal and neonatal death based on 6 cohort, 4 case–control, and 2 cross-sectional studies (highest evidence level 2+). There was some evidence supporting an association of chronic noise exposure with increased systolic blood pressure and stress hormone levels in urine and saliva in children evaluating 2 cohort and 15 cross-sectional studies (highest evidence level 2−).

Conclusions

There seemed to be no associations between chronic noise and pregnancy outcomes based on studies with evidence levels up to 2+. Associations between chronic noise and health in children were based mainly on cross-sectional studies. However, the studies included in this comprehensive systematic review showed a high variation in study design, outcome, exposure and confounder assessments.     

Risk factors of underutilization of childhood immunizations in ultraorthodox Jewish communities in Israel despite high access to health care services

Background

The risk factors of underutilization of childhood vaccines in populations with high access to health services are not fully understood.

Objectives

To determine vaccination coverage and factors associated with underutilization of childhood vaccines in a population with sub-optimal vaccination compliance, despite a high health care access.

Methods

The study was conducted among 430 children from ultraorthodox Jewish communities in the Bnei Brak city and Jerusalem district. Data on immunization status, socio-demographic factors and on parents’ attitudes regarding vaccines were obtained from medical records and through parents’ interviews.

Results

The proportion of fully vaccinated children was 65% in 2- to 5-year-old ultraorthodox children from Jerusalem district, and 86% in 2.5-year-old children from Bnei Brak city. The factors that were significantly associated with vaccines underutilization in Bnei Brak were having >6 siblings, maternal academic education, parental religious beliefs against vaccination, perceived risk of vaccine preventable diseases as low, and mistrust in the Ministry of Health (MOH). Similarly, in Jerusalem, religious beliefs against vaccination, and the perceived low risk of vaccine preventable diseases significantly increased the likelihood of under-immunization, while having a complementary health insurance was inversely related with vaccines underutilization.

Conclusions

The risk factors of under-immunization are in part modifiable, by means of health education on the risks of vaccine preventable diseases and by improving the trust in the MOH. The leaders of the ultraorthodox communities could play an important role in such interventions.     

‘The clock keeps ticking’ – the role of a community-based intervention in reducing delays in seeking emergency obstetric care in rural Bangladesh: a quasi-experimental study

Objective

To explore the role of a community-based intervention in reducing delays in accessing emergency obstetric care (EmOC) in rural Bangladesh, and the factors associated with delayed decision making, reaching the health facility and receiving treatment.

Study design

Quasi-experimental study.

Methods

Multistage random sampling was used to select 540 villages, from which 1200 women who reported obstetric complications in March–April 2010 were interviewed.

Results

The median time taken to make the decision to access health care was significantly lower in the intervention areas compared with the control areas (80 vs 90 min). In addition, the median time taken to reach the health facility was significantly lower in the intervention areas compared with the control areas (110 vs 135 min). However, no difference was found in the median time taken to receive treatment. Multiple linear regressions demonstrated that the community intervention significantly reduced decision making and time taken to reach the health facility when accessing EmOC in rural Bangladesh. However, for women experiencing haemorrhage, the delays were longer in the intervention areas. Protective factors against delayed decision making included access to television, previous medical exposure, knowledge, life-threatening complications during childbirth and use of a primary health facility. Financial constraints and traditional perceptions were associated with delayed decision making. Complications during labour, use of a motorized vehicle and use of a primary health facility were associated with faster access to EmOC, and poverty, distance, transportation difficulties and decision made by male guardian were associated with slower access to EmOC.

Conclusions

The intervention appeared to reduce the time taken to make the decision to access health care and the time taken to reach the health facility when accessing EmOC. This study provides support for a focus on emergency preparedness for timely referral from the community.     

Impacto económico de los eventos adversos en los hospitales españoles a partir del Conjunto Mínimo Básico de Datos

Objective

To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010.

Methods

A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project.

Results

This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure.

Conclusions

Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System.     

Intervenciones eficaces para reducir el absentismo del personal de enfermería hospitalario

Objectives

To select and summarize the interventions that have proved effective in reducing absenteeism among hospital nurses.

Methods

A scoping review was conducted through a literature search using Medline, Web of Science, Cinahl, Embase, Lilacs, Cuiden and Cochrane Library Plus databases. Of a total of 361 articles extracted, 15 were finally selected for this review.

Results

The implementation of multifaceted support or physical training programs can produce positive results in terms of reducing absenteeism among hospital nurses. Cognitive-behavioral type interventions require studies with larger samples to provide conclusive results. Establishing more flexible working shifts may also reduce absenteeism rates, although again studies with larger samples are needed. Programs aimed at managing change developed by nurses themselves, participatory management of professional relations, the support provided by supervisors who are opposed to hierarchical leadership styles, and wage supplements that reward the lack of absence can also reduce these types of indicators.

Conclusions

Absenteeism can be considered as a final result and a consequence of the level of job satisfaction. The effectiveness of interventions to reduce absenteeism among hospital nurses will no doubt largely depend on the ability of these interventions to increase the job satisfaction of these workers.     

Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: A systematic review

Background

Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions.

Methods

To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit).

Results

Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination.

Conclusions

This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.