Pediatric septic thrombosis of intracranial venous sinuses: from diagnosis to discharge. Twenty years of experience

INTRODUCTION

Septic thrombosis of intracranial venous sinuses (STSV) is a rare and severe complication of cranial infections.

MATERIALS AND METHODS

The main objective of this paper is to describe the clinical data, diagnostic procedures, treatment and evolution of a series of cases of STSV. In addition, the current literature is reviewed. Observational retrospective study by review of medical histories (January 1995-December 2016). The data collected were: clinical, analytical, epidemiological, microbiological, radiological, management and follow-up. A descriptive and statistical analysis of the data was done.

RESULTS

Twelve children were included (86,832 admissions studied). They have a median age of 4.5 years (range 1-13) with a median time of symptoms of 6 days (range 1-25). At admission, the clinical data were: fever (11/12), vomiting (9/12) and headache (8/12). They also showed bad general status 12/12, 7/12 acute otitis media and 5/12 VI cranial nerve paresis. The lumbar puncture was pathological in 4/12. The most frequently microorganism isolated was Streptococcus sp. Prothrombotic mutations were confirmed on 2/12. Cranial computed tomography allowed diagnosis in 9/12; the magnetic resonance imaging achieves that in 12/12. Previous neurological signs or time to diagnosis did not influence the appearance of other image complications. All received antibiotic treatment, heparin 10/12 and 11/12 surgery. There were no sequels.

CONCLUSION

In our series otitis, headache, vomiting and fever were prevalent. Complementary tests allowed the suspect but the definitive diagnosis was obtained by neuroimaging. There were no sequels and the therapies were mainly wide broad-spectrum antibiotics, heparin, and surgical.

Clostridium difficile-related hospitalizations and risk factors for in-hospital mortality in Spain between 2001 and 2015

AIMS

To examine trends in the incidence, characteristics and in-hospital outcomes of Clostridium difficile infection (CDI) hospitalizations from 2001 to 2015, to compare clinical variables among patients according to the diagnosis position (primary or secondary) of CDI, and to identify factors associated with in-hospital mortality (IHM).

METHODS

A retrospective study was performed using the Spanish National Hospital Discharge Database, 2001-2015. The study population included patients who had CDI as the primary or secondary diagnosis in their discharge report. Annual hospitalization rates were calculated and trends were assessed using Poisson regression models and Jointpoint analysis. Multi-variate logistic regression models were performed to identify variables associated with IHM.

FINDINGS

In total, 49,347 hospital discharges were identified (52.31% females, 33.69% with CDI as the primary diagnosis). The rate of hospitalization increased from 3.9 cases per 100,000 inhabitants in 2001-2003 to 12.97 cases per 100,000 inhabitants in 2013-2015. Severity of CDI and mean cost per patient increased from 6.36% and 3750.11€ to 11.19% and 4340.91€, respectively, while IHM decreased from 12.66% to 10.66%. Age, Charlson Comorbidity Index, severity, length of hospital stay and mean cost were significantly higher in patients with a primary diagnosis of CDI. Irrespective of the CDI diagnosis position, IHM was associated with male sex, older age, comorbidities, readmission and severity of CDI. Primary diagnosis of CDI was associated with lower IHM (odds ratio 0.60; 95% confidence interval 0.56-0.65).

CONCLUSION

CDI-related hospitalization rates are increasing, leading to a high cost burden, although IHM has decreased in recent years. Factors associated with IHM should be considered in strategies for the prevention and management of CDI.

Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study

Background

No studies that have measured the role of nursing care plans in patients with poorly controlled type 2 diabetes mellitus. Our objectives were firstly, to evaluate the effectiveness of implementing Standardized languages in Nursing Care Plans (SNCP) for improving A1C, blood pressure and low density lipoprotein cholesterol (ABC goals) in patients with poorly controlled type 2 diabetes mellitus at baseline (A1C ≥7%, blood pressure ≥ 130/80 mmHg, and low-density lipoprotein cholesterol≥100 mg/dl) compared with Usual Nursing Care (UNC). Secondly, to evaluate the factors associated with these goals.

Methods

A four-year prospective follow-up study among outpatients with type 2 diabetes mellitus: We analyzed outpatients of 31 primary health centers (Madrid, Spain), with at least two A1C values (at baseline and at the end of the study) who did not meet their ABC goals at baseline. A total of 1916 had A1C ≥7% (881 UNC versus 1035 SNCP). Two thousand four hundred seventy-one had systolic blood pressure ≥ 130 mmHg (1204 UNC versus 1267 SNCP). One thousand one hundred seventy had diastolic blood pressure ≥ 80 mmHg (618 UNC versus 552 SNCP); and 2473 had low-density lipoprotein cholesterol ≥100 mg/dl (1257 UNC versus 1216 SNCP). Data were collected from computerized clinical records; SNCP were identified using NANDA and NIC taxonomies.

Results

More patients cared for using SNCP achieved in blood pressure goals compared with patients who received UNC (systolic blood pressure: 29.4% versus 28.7%, p = 0.699; diastolic blood pressure: 58.3% versus 53.2%, p = 0.08), but the differences did not reach statistical significance. For A1C and low-density lipoprotein cholesterol goals, there were no significant differences between the groups. Coronary artery disease was a significant predictor of blood pressure and low-density lipoprotein cholesterol goals.

Conclusions

In patients with poorly controlled type 2 diabetes mellitus, there is not enough evidence to support the use of SNCP instead of with UNC with the aim of helping patients to achieve their ABC goals. However, the use of SNCP is associated with a clear trend of a achievement of diastolic blood pressure goals.

Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks

AIM

Repeated, ongoing exposure to pain influences the growth, cognitive and motor functions, behaviour, personality and neurodevelopment of preterm infants. We compared the analgesic effects of expressed breast milk (EBM) and 24% oral sucrose on preterm neonates during venipuncture.

METHODS

This multicentre randomised, noninferiority, crossover trial focused on five neonatal university units in Madrid, Spain, from October 2013 to October 2014. It comprised 66 preterm infants born at less than 37 weeks and randomly split into two groups. They received either EBM or sucrose two minutes before venepuncture, together with nonnutritive sucking and swaddling, then the opposite procedure at a later point. Pain was measured with the premature infant pain profile (PIPP) and crying was also measured.

RESULTS

There were no statistically significant differences between the groups. The PIPP scores were seven (4-9) with breast milk and six (4-8.25) with sucrose (p = 0.28). The 11 infants born at under 28 weeks of age showed higher median scores of nine (9-14) for breast milk and four (4-7) for sucrose (p = 0.009).

CONCLUSION

EBM and 24% sucrose had the same analgesic effect during venipuncture in most of the preterm neonates, but sucrose worked better in extremely preterm infants.

Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort

PURPOSE

To analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences.

METHODS

3443 T2DM outpatients were studied. At baseline and annually, patients were subjected to anamnesis, a physical examination, and biochemical tests. Data about demographic and clinical characteristics was also recorded, as was the treatment each patient had been prescribed. Mortality records were obtained from the Spanish National Institute of Statistics. Survival curves for BMI categories (Gehan-Wilcoxon test) and a multivariate Cox proportional hazard analysis were performed to identify adjusted Hazard Ratios (HRs) of mortality.

RESULTS

Mortality rate was 26.38 cases per 1000patient-years (95% CI, 23.92-29.01), with higher rates in men (28.43 per 1000patient-years; 95% CI, 24.87-32.36) than in women (24.31 per 1000patient-years; 95% CI, 21.02-27.98) (p=0.079). Mortality rates according to BMI categories were: 56.7 (95% CI, 40.8-76.6), 28.4 (95% CI, 22.9-34.9), 24.8 (95% CI, 21.5-28.5), 21 (95% CI, 16.3-26.6) and 23.7 (95% CI, 14.3-37) per 1000person-years for participants with a BMI of <23, 23-26.8, 26.9-33.1, 33.2-39.4, and >39.4kg/m², respectively. The BMI values associated with the highest all-cause mortality were <23kg/m², but only in males [HR: 2.78 (95% CI, 1.72-4.49; p<0.001)], since in females this association was not significant [HR: 1.14 (95% CI, 0.64-2.04; p=0.666)] (reference category for BMI: 23.0-26.8kg/m²). Higher BMIs were not associated with higher mortality rates.

CONCLUSIONS

In an outpatient T2DM Mediterranean population sample, low BMI predicted all-cause mortality only in males.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013)

OBJECTIVE

To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs.

DESIGN

A retrospective, descriptive, epidemiological study.

SETTING

This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period.

PARTICIPANTS

We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period.

MAIN OUTCOME MEASURES

We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI.

RESULTS

During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93).

CONCLUSIONS

The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

Coverage of and factors associated with pneumococcal vaccination in chronic obstructive pulmonary disease

SETTING

Patients aged ⩾ 40 years with a diagnosis of chronic obstructive pulmonary disease (COPD; codes R95, R79 and R91 in the International Classification for Primary Care) registered in primary care clinical records in the Autonomous Community of Madrid, Spain.

OBJECTIVE

To assess pneumococcal vaccination coverage in patients with COPD and to analyse factors associated with vaccination uptake.

DESIGN

Population-based cross-sectional study in which data were collected in September 2010.

RESULTS

We found that 93,797 patients (72.0% men and 28.0% women) had COPD. Overall coverage was 65.5% (67.5% men vs. 60.4% women, P < 0.001). In patients aged 40-59 years, coverage was 19.5%, reaching 75.8% in those aged ⩾ 60 years. In patients aged <60 years, uptake was associated with a higher number of comorbidities and appropriate adherence to seasonal influenza and pandemic vaccination schedules. In patients aged ⩾ 60 years, factors associated with uptake in both sexes were older age and appropriate adherence to seasonal influenza vaccination schedules. Factors associated with uptake in men were concomitant comorbidities and pandemic vaccination.

CONCLUSION

Vaccination coverage in individuals aged <60 years with COPD is less than acceptable in Madrid. Coverage was higher in men and in patients with another chronic condition.

Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004-2013)

Hip fracture is a serious public health problem. We used Spanish hospital discharge data to examine trends in 2004-2013 in the incidence of hip fracture among elderly patients. We found that hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men.

INTRODUCTION

This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without type 2 diabetes mellitus (T2DM) in Spain, 2004-2013.

METHODS

We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by diabetes status: Incidences were calculated overall and stratified by diabetes status and year. We analyzed surgical procedures, length of hospital stay (LOHS), and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year, comorbidity, and in-hospital complications (IHC).

RESULTS

From 2004 to 2013, 432,760 discharges with hip fracture were identified (21.3 % suffered T2DM). Incidence among diabetic men and women increased until year 2010 and then remained stable. Diabetic women have three times higher incidence than diabetic men. Incidences and IHC were higher among patients with diabetes beside sex. The proportion of patients that underwent internal fixation increased for all groups of patients and the arthroplasty repair decreased. After multivariate analysis, IHM has improved over the study period for all patients. Suffering diabetes was associated to higher IHM in women (odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.07-1.17).

CONCLUSIONS

Hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. In diabetic patients, incidence rates increased initially but have leveled from 2010 onwards. For all groups, the use of internal fixation has increased overtime and IHM and LOHS have decreased from 2004 to 2013.

Factors Associated to a Reactive Result of Rapid-HIV Test in Socio-culturally Adapted Services in Primary Care in Spain

The Services of Prevention and Early diagnosis of HIV in Madrid (Spain) are set in selected primary care centers. Cultural mediators targeted to vulnerable groups (economic immigrants, MSM, sex workers…) perform risk assessment and counselling. Between 2010 and 2014 they performed 6 039 rapid-HIV test, 27.8 % in MSM, 41.2 % in men who have sex exclusively with women (MSW) and 31.0 % in women; 35.7 % in immigrants, mainly from Latin America. A reactive result was more common among MSM (6.0 %) compared to women (0.6 %) and MSW (0.5 %). In MSM it was associated to being immigrant and to antecedents of sexually transmitted infections (STI). Among MSW the factors associated to a reactive result were: seropositivity of sexual partner and heroine consumption, and in women: infrequent use of condoms, seropositivity of sexual partner and antecedents of STI. Preventive interventions to reduce risk of HIV transmission and for early detection should be adapted and targeted to high risk population.

Trends in sepsis incidence and outcomes among people with or without type 2 diabetes mellitus in Spain (2008-2012)

AIMS

There is conflicting evidence on how type 2 diabetes mellitus (T2DM) influences in-hospital mortality (IHM) in sepsis. We aimed to compare trends in outcomes for sepsis in people with or without T2DM in Spain between 2008 and 2012.

METHODS

We identified all cases with any sepsis diagnosis using national hospital discharge data. We evaluated annual incidence rates for sepsis stratified by T2DM status. We calculated IHM and analyzed trends over time. In a multivariate analysis including potential confounding factors, we tested T2DM as an independent factor for IHM.

RESULTS

Overall, 217,280 cases of any-stage sepsis were diagnosed, of whom 50,611 (23.3%) had T2DM. The annual incidence of sepsis increased during the 5-year period (from 76.5 to 113.3cases/10(5) population). The incidence increase was higher for the population with T2DM (from 16.8 to 27.1 cases/10(5) population; 61.3% relative increment). People with T2DM were significantly older (75.8 ± 11.2 years vs. 71.0 ± 16.4 years) and suffered from more coexisting medical conditions. In the univariate analysis, mortality was higher for the population with T2DM only when septic shock was present (53.3% vs. 51.9%; P=0.002). IHM decreased over time both in participants with (from 45.7% to 38.1%) and without T2DM (from 46.1% to 39.5%). After accounting for all other potential confounders, T2DM was significantly associated with a lower IHM (odds ratio=0.88; 95% confidence interval, 0.86-0.90).

CONCLUSIONS

In Spain, the annual increase in sepsis incidence was higher in people with T2DM, but the risk of dying with sepsis during admission was moderately lower in people with T2DM.

Social disparities in access to breast and cervical cancer screening by women living in Spain

OBJECTIVES

To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys.

STUDY DESIGN

Cross-sectional study using data from the 2011 Spanish national health survey.

METHODS

Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle.

RESULTS

Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006.

CONCLUSION

Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.

Predictors of medication use in the Roma population in Spain: a population-based national study

OBJECTIVES

To describe the prevalence of prescribed and self-medicated use of medication in the Spanish Roma population, and identify the associated factors.

STUDY DESIGN

Descriptive cross-sectional study.

METHODS

Data from the first National Health Survey conducted on the Roma population in Spain were used. The sample comprised 1000 Spanish Roma adults of both sexes aged ≥16 years. Answers (yes/no) to the question, 'In the last two weeks have you taken the following medicines [in reference to a list of medicines that might be used by the population] and were they prescribed for you by a doctor?' were used to ascertain 'medication use'. 'Self-medication' referred to use of these medicines without medical prescription. Using multivariate logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to identify associated factors.

RESULTS

The overall prevalence of medication use in the Roma population for both sexes was 69.1%, and 38.7% was self-medicated. Females reported higher use of medication than males (75.1% vs 62.3%); however, self-medication was higher among males. Analgesics and antipyretics were used most often (35.8%). Among males, the variables that were independently and significantly associated with a higher probability of medication use were: age; negative perception of health; presence of chronic disease (OR 2.81; 95% CI 1.67-4.73); and medical visits (OR 4.51; 95% CI 2.54-8.01). The variables were the same among females, except for age.

CONCLUSION

A high percentage of the Spanish Roma population use medication, and a significant proportion of them self-medicate. The presence of chronic diseases, a negative perception of health and medical consultations were associated with increased use of medication in the study population.

Health Belief Model applied to non-compliance with HPV vaccine among female university students

OBJECTIVES

To investigate the reasons for refusal of human papillomavirus (HPV) vaccination, and to explore participants' perceptions and attitudes about Health Belief Model (HBM) constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) among a sample of female university students.

STUDY DESIGN

Cross-sectional. A self-administered questionnaire based on the HBM was used.

METHODS

Confirmatory factor analysis was applied to the data to examine the construct validity of the six factor models extracted from the HBM. The predictors of non-HPV vaccination were determined by logistic regression models, using non-HPV vaccination as the dependent variable.

RESULTS

The sample included 2007 students. The participation rate was 88.9% and the percentage of non-vaccination was 71.65%. Participants who had high scores for 'general perceived barriers', 'perceived barriers to vaccination', 'no perceived general benefits', 'no perceived specific benefits' and 'no general benefits' were more likely to report being unvaccinated.

CONCLUSIONS

The findings demonstrated the utility of HBM constructs in understanding vaccination intention and uptake. There is an urgent need to improve health promotion and information campaigns to enhance the benefits and reduce the barriers to HPV vaccination.

Coverage and predictors of adherence to influenza vaccination among Spanish children and adults with asthma

BACKGROUND

Influenza infections are frequently implicated in the exacerbation of asthma. The aim of this study was to assess vaccination coverage among Spanish children and adults with asthma and to describe the factors associated(predictors) with vaccination, using data from the 2006 Spanish National Health Survey.

PATIENTS AND METHODS

Subjects were classified as asthma sufferers if they answered affirmatively to the question, "Has your doctor told you that you (or your child) currently suffer from asthma?" Influenza vaccination status was assessed via the question, "Did you (or your child) have a flu shot in the latest campaign?" The following were analyzed as possible predictors of influenza vaccination: sociodemographic variables;health-related and lifestyle variables; variables linked to the use of healthcare services.

RESULTS

A total of 38,329 records of individuals aged over 6 months were analyzed, and of these, 2,337 were classified as asthmatics. Among asthmatics, overall influenza coverage was 32.6% (18.8% among children, and 38% among adults).Whereas the sole variable that predicted a higher coverage among children was parents' negative perception of their child's health, among adults positive predictors included older age, lower educational level, suffering from concomitant chronic disease, and non- or ex-smoker status.

CONCLUSIONS

The overall influenza vaccination coverage among subjects who suffer from asthma in Spain is very low. Special attention should be paid to children, younger adults, and smokers, since these subjects have the lowest adherence to vaccine recommendations. Strategies focused on health-care providers and patients must be urgently implemented to improve influenza vaccination coverage among asthma sufferers.

Patterns of medication use in the immigrant population resident in Spain: associated factors

PURPOSE

This study mainly aimed at to ascertain to ascertain the prevalence of the consumption of medications, prescribed and self-medicated, among the immigrant population (economic immigrants and not economic immigrants) resident in Spain, and to identify the factors associated with such consumption in this population.

METHODS

We have worked with individualized secondary data, collected in the Spanish National Health Survey carried out in 2006 and 2007 (SNHS-06), from the Ministry of Health and Consumer Affairs. A total of 2055 subjects born outside Spain, aged 16 years or over, were analysed. The independent variables were sociodemographic and health-related, and the dependent variable was medication use. Using logistic multivariate regression models we have estimated the independent effect of each of these variables on the medication consumption.

RESULTS

The 55.8% of immigrant population responded affirmatively to having consumed some type of medication. The drugs that registered the highest consumption prevalence were analgesics (53.09%). It should be stressed here that 8.75% of the not economic immigrant population has consumed antibiotics. The variables that were independently and significantly associated with a greater probability of medication consumption were: sex, age, presence of chronic disease, use of alternative medicines and a negative perception of health. The most strongly associated variable is medical consultation.

CONCLUSIONS

The prevalence of medication use higher among economic immigrant women. In our population, the use of alternative medicines use and medical visits to the physician are associated with higher consumption.

Trends of hepatitis A hospitalizations and costs associated with the hospitalization in Spain (2000-2005)

The objective of this study was to analyse data related to hospitalization, comorbidities, average stays and costs associated with the hospitalization cases of hepatitis A in Spain, during the period between 2000 and 2005. A retrospective, descriptive study of the epidemiological characteristics of hepatitis A patients admitted to Spanish hospitals was performed using, as an information source, the Minimum Basic Data Set. National hospitalization rates were calculated for hepatitis A. Comorbidities, mortality, average and median stays, and mean medical costs related to hospitalization were analysed. Costs were calculated using Diagnosis-Related Groups for the disease. The total number of hospitalized patients with hepatitis A diagnosis was 2351 subjects (rate 1.87/100,000 inhabitants). The highest rate corresponds to the group aged between 20 and 39 years (3.07/100,000 inhabitants). Some 60.1% of hospitalized hepatitis A cases were diagnosed in men. Twenty-two deaths (0.9%) out of the total of hospitalized subjects were reported. The average hospital stay caused by hepatitis A was 6.8 days. The trends in the rate of hospitalized hepatitis A cases in Spain, from the year 2000 to 2005, were not statistically significant. Differences were found neither in the hospitalization percentage, nor in the average length of stay. An increase of cost from 836,278 euro in the year 2000 to 1,272,608 euro in the year 2005 was observed. The rate of hospitalized hepatitis A subjects in Spain has not changed over the period 2000-2005. The total cost derived from these hospitalizations has increased by 52%.

Predictive factors of self-medicated drug use among the Spanish adult population

PURPOSE

Our study aimed at describing the prevalence of self-medicated drug use among the Spanish adult population and to identify the predictive factors of such self-medication in Spain.

METHODS

Descriptive, cross-sectional study covering the Spanish adult population, using data drawn from the 2003 Spanish National Health Survey (ENSS). A total of 19 514 subjects were analysed. The independent variables were socio-demographic and health-related, and the dependent variable was self-medicated drug use. Using logistic multivariate regression models we have estimated the independent effect of each of these variables on the self-medicated consumption.

RESULTS

The 18.1% of all Spaniards indulge in self-medication. Our study shows that 45% of all cold and influenza medication and 39.4% of analgesics consumed by the population involve self-medication. It should be stressed here that 17.7% of persons who took antibiotics did so in the form of self-medication. The variables that were independently and significantly associated with a greater probability of self-medicated consumption were: sex; lower age; higher educational level; consumption of alcohol; smoking habit; use of alternative medical products; absence of chronic disease and a positive perception of health.

CONCLUSIONS

In Spain, the prevalence of self-medicated drug use is higher in women than men. In our population, the influence of unhealthy lifestyles, such as alcohol and tobacco consumption, is related to a higher likelihood of self-medication.

Influenza vaccination coverage and related factors among Spanish children

OBJECTIVES

To ascertain anti-influenza vaccination coverage and factors associated with anti-influenza vaccination among Spanish children.

METHODS

We analyzed 6464 children (age under 16 years) included in the Spanish National Health Survey (ENS) for 2003. As a dependent variable, we used the reply ("yes" or "no") to the question: Was your child vaccinated against influenza during the last campaign? We calculated anti-influenza vaccine coverage for the whole population and depending on whether or not the vaccine is recommended due to the fact that the children present an associated chronic condition. We analyzed the influence of sociodemographic variables on vaccination.

RESULTS

Vaccination coverage in the Spanish infant population was 5.1%, in children with associated conditions it was 17.5%, and 4.4% in healthy children. The only factor significantly associated with anti-influenza vaccination in children with associated conditions was household income: those from homes with a higher level of income were more likely to be vaccinated (OR=4.26). In children for whom vaccination is not recommended, the probability of being vaccinated against influenza is greater in those whose parents had a lower educational level (OR=2.22).

CONCLUSIONS

Anti-influenza vaccination coverage in the Spanish infant population is very low. There seem to be socio-economic inequalities for receiving this vaccine in Spanish children.

Health profiles, lifestyles and use of health resources by the immigrant population resident in Spain

BACKGROUND

Our study aimed at describing the health profiles, life styles and use of health resources by the immigrant population resident in Spain.

METHODS

Cross-sectional, epidemiological study from the Spanish National Health Survey (NHS) in 2003. We analysed 1506 subjects of both sexes, aged > or =16 years, resident in Spain.

RESULTS

The immigrant population present diseases that are similar to those of the autochthonous population. The autochthonous population had significantly higher values for alcohol consumption and smoking (60.8 and 39.6%) than immigrants (39.6 and 27.5%). The percentage of immigrants hospitalized in the preceding 12 months was observed to be higher than that of the Spanish population (11.4 vs. 8.2%, P < 0.05). The immigrant population consumed fewer medical drugs than the Spanish population (42.6 and 49.9%, respectively).

CONCLUSIONS

Immigrants in Spain display better lifestyle-related parameters, in that they consume less alcohol and smoke less than the autochthonous population. As for the use of health-care resources, while immigrants register higher percentages of hospitalization compared with the Spanish population, there is no evidence of excessive and inappropriate use of other health-care resources.

Psychotropics use in the Spanish elderly: predictors and evolution between years 1993 and 2003

PURPOSE

This study mainly aimed at describing the prevalence of psychotropic medication consumption in the Spanish elderly population between the years 1993 and 2003.

METHODS

Descriptive, cross-sectional study covering the Spanish population aged 65 years and over, using data drawn from the 1993 and 2003 Spanish National Health Surveys (ENSS). A total of 9570 interviews were analysed (3436 from 1993 and 6134 from 2003). The independent variables were sociodemographic and health-related, and the dependent variable was total consumption of psychotropic medication. Using logistic multivariate regression models, we have analysed the temporal evolution of psychotropic medication consumption between 1993 and 2003.

RESULTS

The prevalence of consumption was significantly higher in women (6.7% from 1993 and 26.4 % from 2003) versus men (2.4% from 1993 and 10.6% from 2003) (p < 0.001). Multivariate analysis, highlighted the association between increased psychoactive drug intake and sex, nervous, depressive, sleep disorders and negative perception of health, displayed a strong association with consumption of psychoactive drugs across the 2 years.

CONCLUSIONS

In Spain, the prevalence of psychoactive drug consumption is higher among elderly women than men, and increases with negative perception of health. The prevalence of consumption was significantly higher in the year 2003.

Influenza Vaccination Coverages among Spanish Children, Adults and Health Care Workers

BACKGROUND

This study aimed at describing influenza vaccination coverage among Spanish children, adults and health care workers (HCWs).

PATIENTS AND METHODS

We analyzed 27,791 questionnaires on subjects aged 6 months or over, drawn from the 2003 Spanish National Health Survey. As the dependent variable, we took the answer to the question, "Did you (or your child) have a flu shot in the last campaign?". Independent variables were age group, gender, nationality, occupation (HCWs) and coexistence of chronic conditions.

RESULTS

Overall influenza vaccination coverage for the total sample was 19.58%. Coverage for the pediatric population was 5.55%, with 20.74% of those with and 4.67% of those without chronic condition being vaccinated. Vaccination coverages were: 63.7% among subjects aged > or = 65 years; 30.5% among high-risk subjects aged < 65 years; and 19.65% among HCWs.

CONCLUSIONS

We conclude that the available results show low levels of influenza vaccination coverage among high-risk subjects aged under 65 years, children in particular, and HCWs.

Safety and effectiveness of replacing standard doxazosin with doxazosin in the gastrointestinal therapeutic system (GITS) formulation in elderly hypertensive patients

The objective of this paper is to evaluate the safety and effectiveness of using doxazosin standard formulation in elderly hypertensive patients who were either uncontrolled or newly diagnosed, and replacing standard doxazosin with doxazosin in the gastrointestinal therapeutic system (GITS) formulation. We designed a postmarketing surveillance, open-label non-comparative, multicentre, clinical study covering primary care patients aged 65 years or older diagnosed with essential uncontrolled arterial hypertension. The study covered a period of 6-9 months, divided into two phases. Phase I involved a minimum of three and maximum of six months in treatment with standard doxazosin; phase II began with the changeover from standard doxazosin to the GITS formulation and lasted 12 weeks. Of the 1705 patients initially enrolled, 1292 (75.8%) completed the study. Reduction in systolic blood pressure was 22.3 mmHg (13.7%) in phase I, and 3.9 mmHg (2.77%) in phase II; reduction in diastolic blood pressure was 12.4 mmHg (13.2%) in phase I, and 2.4 mmHg (2.9%) in phase II. The percentage of controlled patients was 40.5% (691/1705) by the end of phase I and 45.3% (776/1705) by the end of phase II. A total of 154 patients suffered adverse events (AE), 127 during phase I and 27 in phase II. We conclude that doxazosin in its two formulations is effective and safe for the purpose of lowering blood pressure in elderly patients.

[Effectiveness of fissure sealants in child population at high risk of caries]

OBJECTIVES

To asses the effectiveness of fissure sealants in a high risk infant population and to evaluate the criteria to determine when to apply them.

DESIGN

Prospective cohort study.

SETTING

Primary care.

PARTICIPANTS

607 scholars that are included at the age of 6 years and followed for 4,5 years.Intervention. We have defined three groups. Groups I and II were included in a dental preventive program with and without fissure sealants in the first permanent molars, respectively, and group III received no preventive measures at all.

MAIN MEASUREMENTS

The dental explorations according to WHO recommendations were conducted before entering the study, at the age of six years, after the fissure sealant were applied, at the age of eight years and finally 4.5 years after the beginning.

RESULTS

After 4.5 years group I had a CAOD index of 0.59, group II 0.79 and group III 1.52 (P<.001). Group III has 2.57 times greater risk the group I of suffering caries in the permanent teeth.

CONCLUSIONS

The application of occlusive fissure sealant in the first permanent molar of an infant high risk population has a protective effect on dental caries. Therefore occlusive fissure sealant should be offered to all scholars because those without neither the preventive program nor occlusive fissure sealant had a significantly higher risk of caries.