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Vaccine safety surveillance is essential in vaccination programs. We accomplished a descriptive study of surveillance AEFI-reporting rate in human papillomavirus (HPV) vaccine administered in the Valencian Community, Spain. Data were obtained from Spanish Pharmacovigilance Adverse Reactions Data (FEDRA). Reporting rates were calculated using local net doses distributed as the denominator. Trends were assessed using joinpoint regression with annual percent change (APC) reported. The AEFI-reports decreased between 2008 and 2018 in two periods, a fast decreasing rate from 2009 to 2011 (from 192.2 to 24.93 per 100000 doses; APC, −54.9%; 95%CI [−75.2; −17.7]), followed by a stable trend (−13% APC, 95%CI [−26.1; 2.4]). For the age group analysis, only the group aged 14–15 years old followed the same trend with -58.4% (95%CI [−73.9; −33.8]) APC during 2008–2011, and −8.8% (95%CI [−27.7; 15]) APC during 2011-2018. The majority of the reports (73.82%) were nonserious, involving reactions at or near the vaccination site, headache, and dizziness events. No death was reported. AEFI-reporting rates for HPV immunization in the Valencian Community have decreased considerably with two trend periods observed for girls aged 14–15 years old. Currently, the AEFI reporting rate shows a decreasing trend, perhaps following the Weber effect, and it could also be affected by media attention and coverage.

Fundamento. Conocer el lugar de fallecimiento por causas susceptibles de cuidados paliativos de personas residentes en España de 15 o más años de edad según la comunidad autónoma (CA), y cómo influyen las causas (oncológicas y no oncológicas). Método. Estudio transversal de base poblacional con análisis de los certificados médicos de defunción entre 2012 y 2015. Los efectos ajustados de las variables sociodemográficas, la CA y las causas sobre el lugar de fallecimiento se estimaron mediante las odds de fallecimiento en hospital frente a domicilio (OH/D) y en residencia frente a domicilio (OR/D), y las odds ratio (ORH/D y ORR/D) obtenidas por regresión logística multinomial. Resultados. Se produjeron 1.611.767 muertes de las que 64,8% correspondieron a la población diana. La defunción en hospital fue un 77% más frecuente que en domicilio, y en residencia un 53% menor. Sexo masculino, menor edad, bajo nivel de estudios, lugar de nacimiento fuera de España, tamaño de municipio grande y estado civil no casado se asociaron a fallecimiento en hospital, y las mismas excepto sexo femenino y mayor edad a residencia. Las OH/D ajustadas fueron > 1 en todas las CA y las OR/D < 1, excepto Cataluña. Para las causas oncológicas, las ORH/D ajustadas disminuyeron y fueron significativamente <1 en casi la mitad de CA, y todas las ORR/D permanecieron <1. Conclusiones. El fallecimiento se produjo mayoritariamente en hospital y menos en residencia, aunque las causas oncológicas aumentan la probabilidad de fallecer en domicilio en vez de en hospital (efecto ajustado)., Background. Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. Methods. Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (OH/H) and in a nursing home vs. at home (ON/H), and odds ratio (ORH/H and ORN/H) by multinomial logistic regression models. Results. During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted OH/H > 1 and ON/H < 1 were observed in all AC, except Catalonia. Oncological causes made OH/H < 1 in almost 50% of AC, while ON/H continue to be < 1. Conclusions. Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

Several studies have described a decreasing trend in amenable mortality, as well as the existence of socioeconomic inequalities that affect it. However, their evolution, particularly in small urban areas, has largely been overlooked. The aim of this study is to analyse the socioeconomic inequalities in amenable mortality in three cities of the Valencian Community, namely, Alicante, Castellon, and Valencia, as well as their evolution before and after the start of the economic crisis (2000–2007 and 2008–2015). The units of analysis have been the census tracts and a deprivation index has been calculated to classify them according to their level of socioeconomic deprivation. Deaths and population were also grouped by sex, age group, period, and five levels of deprivation. The specific rates by sex, age group, deprivation level, and period were calculated for the total number of deaths due to all causes and amenable mortality and Poisson regression models were adjusted in order to estimate the relative risk. This study confirms that the inequalities between areas of greater and lesser deprivation in both all-cause mortality and amenable mortality persisted along the two study periods in the three cities. It also shows that these inequalities appear with greater risk of death in the areas of greatest deprivation, although not uniformly. In general, the risks of death from all causes and amenable mortality have decreased significantly from one period to the other, although not in all the groups studied. The evolution of death risks from before the onset of the crisis to the period after presented, overall, a general pro-cyclical trend. However, there are population subgroups for which the trend was counter-cyclical. The use of the deprivation index has made it possible to identify specific geographical areas with vulnerable populations in all three cities and, at the same time, to identify the change in the level of deprivation (ascending or descending) of the geographical

Hay evidencias de que la gestión por procesos puede mejorar el funcionamiento de los sistemas sanitarios. La cultura sobre seguridad se perfila como uno de los requisitos fundamentales para evitar la aparición de efectos adversos y ofrecer a nuestros pacientes una asistencia más segura. Además, la calidad percibida por los pacientes debe ser evaluada para mejorar continuamente el funcionamiento del sistema. Por otro lado es de vital importancia notificar y estudiar aquellos efectos adversos que se producen durante la asistencia sanitaria para así, establecer medidas correctoras y de prevención. El objetivo general de la presente investigación es evaluar los beneficios en cultura de seguridad y calidad percibida de aplicar una gestión por procesos en una unidad de cardiología. Los objetivos específicos son: Evaluar y analizar la cultura de seguridad de los trabajadores de la Unidad de Cardiología de Alcoi; Evaluar y analizar la calidad y seguridad percibida por los pacientes de la Unidad de Cardiología de Alcoi; Evaluar y analizar los efectos adversos derivados de la asistencia sanitaria en la Unidad de Cardiología de Alcoi. Dentro de la metodología podemos distinguir tres subestudios. En el primero de ellos evaluamos la cultura de seguridad de los profesionales, en un segundo evaluamos la calidad y seguridad percibida por los pacientes, y por último se analiza la evolución de los errores de medicación y otros aspectos relacionados con la seguridad en nuestra Unidad. El primer estudio en el que se evalúa la cultura de seguridad, consistió en un estudio observacional trasversal en dos años consecutivos utilizando la encuesta “Hospital Survey on Patient Safety Culture” de la “Agency for Healthcare Research and Quality” en su versión española (42 ítems agrupados en 12 dimensiones). Se comparó el porcentaje de respuestas positivas de cada dimensión en 2014 y 2015, así como con los datos a nivel nacional y en Estados Unidos, siguiendo las recomendaciones establecidas. Glo

Propósito: Analizar si la adición de un espaciador interespinoso o la fusión intersomática ofrece ventajas en relación con la microdiscetomía aislada en el tratamiento de la hernia discal lumbar. Métodos: Pacientes con hernia de disco lumbar que iban a someterse a cirugía fueron elegidos para participar. En este estudio de cohorte los pacientes se dividieron en 3 grupos; Microdiscectomía sola (MD), microdiscectomía más espaciador interespinoso (IS) y fusión intersomática lumbar posterior (PLIF). La medida de resultado primaria fue la eficacia clínica mediante el índice de discapacidad de Oswestry (ODI). También evaluamos varios otros parámetros de resultado, entre los que se incluyeron: escala analógica visual para el dolor (EVA) de espalda y piernas, duración de la estancia, coste desde el ingreso hasta el alta hospitalaria, tasa de complicaciones de 90 días y tasa de reoperación tras 1 año. Resultados: Se incluyeron un total de 103 pacientes cuya edad media fue de 39,1 (± 8,5) años. En los 3 grupos se detectó una mejora significativa de la puntuación inicial del dolor de espalda y piernas con ODI y EVA. Las puntuaciones del ODI cambiaron de 62.66 a 13.77 en el grupo MD, 62.93 a 13.50 en el grupo IS, y 59.62 a 17.62 en el grupo PLIF (p <0.001). Después de 1 año, no se encontraron diferencias significativas en el ODI, ni en la EVA de espalda y piernas entre los 3 grupos. Hubo un aumento del 169% en el coste hospitalario en el grupo IS y del 287% en el grupo PLIF, en relación con la MD (p <0,001). La duración de la estancia fue un 86% mayor en el grupo IS y un 384% más en el grupo PLIF en comparación con MD (p <0,001). Las tasas de reoperación a 1 año fueron de 5,6%, 10% y 16,2% (p = 0,33) en los grupos MD, IS y PLIF respectivamente. Conclusión: La mejoría clínica parece deberse a la microdiscectomía, sin que el implante (interespinoso o fusión) agregue ningún beneficio. La adición de espaciador interespinoso o fusión no protegió contra la reoperación, y aumentó la d

El treball que es presenta constitueix una tesi doctoral per conveni de publicacions, la línia d’investigació de la qual s'emmarca és l'estudi de l'impacte dels Programes de Prevenció de Càncer Colorectal (PPCCR). Els PPCCR han tingut una ràpida implantació a la Unió Europea des de l'any 2003 (Union, 2003), i, concretament a Espanya, s’han implantat en les diverses comunitats autònomes. Els PPCCR a Espanya van dirigits a homes i dones entre 50 i 69 anys, utilitzen com a prova de cribratge el test de sang oculta en femta (TSOF) i com a prova de confirmació diagnòstica la colonoscòpia. Aquests programes poden tenir un gran impacte en la població perquè van dirigits a un gran nombre de persones, i aquest impacte es pot traduir en beneficis i en efectes adversos. Els principals indicadors per mesurar el benefici dels PPCCR són la reducció de la mortalitat i la incidència per aquest tumor. No obstant això, per a mesurar l'impacte en terminis de reducció de mortalitat i incidència, cal que passe un llarg període amb aplicació continuada de PPCCR. L’impacte en la població està directament relacionat amb la participació, i augmentant la participació es poden augmentar els beneficis. L’impacte també es pot traduir en possibles efectes adversos del programa, la qual cosa fa que establir mecanismes que minimitzen els efectes adversos sigui fonamental. Un dels efectes adversos més greus són les complicacions en la colonoscòpia, que tenen una taxa baixa, però que cal minimitzar al màxim. Per tant, conèixer els factors que estan relacionats amb la participació i amb l'aparició de complicacions en la colonoscòpia és essencial. Aquesta investigació forma part d’un projecte d’investigació anomenat CRIBEA, en què participen 6 PPCCR implantats a les comunitats autònomes de Canàries, Catalunya, Cantabria, Comunitat Valenciana, País Basc i Regió de Múrcia. El projecte té com a objectiu analitzar el balanç entre els indicadors predictors de beneficis i d'efectes adversos dels PPCCR a Esp

Background: Although studies suggest that most people prefer to die at home, not enough is known about place of death patterns by cause of death considering sociodemographic factors. The objective of this study was to determine the place of death in the population and to analyze the sociodemographic variables and causes of death associated with home as the place of death. Methods: Cross-sectional population-based study. All death certificate data on the residents in Spain aged 15 or over who died in Spain between 2012 and 2015 were included. We employed multinomial logistic regression to explore the relation between place of death, sociodemographic variables and cause of death classified according to the International Classification of Diseases, 10th revision, and to conditions needing palliative care. Results: Over half of all deaths occurred in hospital (57.4%), representing double the frequency of deaths that occurred at home. All the sociodemographic variables (sex, educational level, urbanization level, marital status, age and country of birth) were associated with place of death, although age presented the strongest association. Cause of death was the main predictor with heart disease, neurodegenerative disease, Alzheimer’s disease, dementia and senility accounting for the highest percentages of home deaths. Conclusions: Most people die in hospital. Cause of death presented a stronger association with place of death than sociodemographic variables; of these latter, age, urbanization level and marital status were the main predictors. These results will prove useful in planning end-of-life care that is more closely tailored to people’s circumstances and needs.

Objetivo: Identificar factores de los profesionales que se relacionan con el grado de orientación de la atención primaria de salud en el control de la lepra. Método: Estudio realizado en 70 unidades de la Estrategia de Salud Familiar de una capital de Brasil, entre julio y septiembre de 2014. Se utilizó un instrumento de evaluación aplicado a 408 profesionales de la salud. Se aplicó el modelo de regresión lineal múltiple-bootstrap para analizar la asociación de la puntuación general, esencial y derivada con los factores explicativos de los profesionales (tiempo de trabajo en la unidad y en servicios de atención primaria, realización de acciones de control, atención de caso y formación en lepra). Resultados: En el análisis descriptivo, la mayoría de los profesionales no atendieron casos y no recibieron formación para realizar acciones contra la lepra. Se observó una fuerte orientación en la puntuación esencial y general de la atención primaria y la asociación con la formación en lepra. En la puntuación derivada, se observó una débil orientación y asociación con la formación de la enfermedad para médicos y agentes comunitarios de salud. Conclusión: La experiencia profesional en la Estrategia de Salud Familiar y en la asistencia a la lepra es determinante para que el servicio sea proveedor de acciones de control orientadas según los atributos esenciales y derivados de la atención primaria de salud. Aunque Brasil ha avanzado en la reducción de la incidencia de la lepra, hay que aumentar la eficacia de la vigilancia en salud como forma de detección precoz y formación de los profesionales., Objective: To identify factors of professionals that relate to the degree of primary health care orientation in the control of leprosy. Method: Study carried out in 70 units of Family Health Strategy of a capital of Brazil, between July and September 2014. An evaluation instrument applied to 408 health professionals was used. The multiple linear regression-bootstrap model was applied to analyze the association of the general, essential and derived score with the explanatory factors of the professionals (work time in the unit and in primary care services, control actions, case care and leprosy training). Results: In the descriptive analysis most of the professionals did not attend cases and did not receive training to perform leprosy actions. A strong orientation was observed in the essential and general score of primary care and the association with leprosy education. In the derived score, weak orientation and association were observed with training in the disease for doctors and community health agents. Conclusion: Professional experience in the Family Health Strategy and leprosy care is crucial for the service to be a provider of control actions oriented according to the essential and derived attributes of primary health care. Brazil has made progress in reducing the incidence of leprosy; however, it is necessary to increase the effectiveness of health surveillance, as a means of early detection and training of professionals.

Background: Pregnant women should receive two vaccines during pregnancy due to maternal-foetal complications and risks as well as the influenza and pertussis vaccinations. The goal was to evaluate vaccination coverage against influenza and pertussis in pregnant women, following midwife professional advice during the pregnancy follow-up; Methods: Prospective cohort study of 1017 pregnancies during the vaccination campaign in 2015–2016. To estimate the degree of consistency between the coverage declared by mothers and that registered in the Nominal Vaccination Registry (NVR), we used the Cohen’s kappa index (k); Results: 95.4% were registered in the NVR. Vaccination coverage recorded against influenza was 64.2% (95% CI: 61.2–67.2), and 89.8% (95% CI: 87.9–91.7) against pertussis. The coverage of the pregnant women interviewed was 61.7% (95% CI: 58.1–67.3)) for influenza and 92.3% (95% CI: 91.4–95.3) for pertussis. Subsequent interviews of 67.2% of the women produced a kappa agreement index between the data obtained from interviews and those recorded in the NVR of 0.974 (IC95%: 98.0–99.6) for influenza, and 0.921 (IC95%: 98.1–99.7) for pertussis. The women identified midwives as the main source of vaccination information and advice 88.4% (IC95%: 85.8–90.9); Conclusions: The NVR is an effective platform for estimating immunisation coverage in pregnant women. The degree of agreement between declared vaccinations and registered vaccinations was high for both vaccines.

Severe complications (SC) in colonoscopy represent the most important adverse effect of colorectal cancer screening programs (CRCSP). The objective is to evaluate the risk factors for SC in colonoscopy indicated after a positive fecal occult blood test in population-based CRCSP. The SC (n = 161) identified from 48,730 diagnostic colonoscopies performed in a cohort of all the women and men invited from 2000 to 2012 in 6 CRCSP in Spain. A total of 318 controls were selected, matched for age, sex and period when the colonoscopy was performed. Conditional logistic regression models were estimated. The analysis was performed separately in groups: immediate-SC (same day of the colonoscopy); late-SC (between 1 and 30 days after); perforation; and bleeding events. SC occurred in 3.30‰ of colonoscopies. Prior colon disease showed a higher risk of SC (OR = 4.87). Regular antiplatelet treatment conferred a higher risk of overall SC (OR = 2.80) and late-SC (OR = 9.26), as did regular anticoagulant therapy (OR = 3.47, OR = 7.36). A history of pelvic-surgery or abdominal-radiotherapy was a risk factor for overall SC (OR = 5.03), immediate-SC (OR = 8.49), late-SC (OR = 4.65) and perforation (OR = 21.59). A finding of adenoma or cancer also showed a higher risk of overall SC (OR = 8.71), immediate-SC (OR = 12.67), late-SC (OR = 4.08), perforation (OR = 4.69) and bleeding (OR = 17.02). The risk of SC doesn't vary depending on the type of preparation or type of anesthesia. Knowing the clinical history of patients such as regular previous medication and history of surgery or radiotherapy, as well as the severity of the findings during the colonoscopy process could help to focus prevention measures in order to minimize SC in CRCSP.

Objetivo: Describir la evolución de los riesgos de mortalidad por complicaciones debidas a la atención médica o la cirugía entre los periodos anterior (2002-2007) y posterior (2008-2013) al inicio de la crisis económica, en España y por comunidades autónomas, y analizar la relación entre los cambios en los riesgos de muerte y el impacto socioeconómico de la crisis y la variación del gasto sanitario. Método: Estudio ecológico basado en tasas de mortalidad estandarizadas por edad, índice sintético de vulnerabilidad como indicador socioeconómico y variación del gasto sanitario como indicador del gasto en salud. Se estimó el riesgo relativo de muerte entre periodos con modelos de regresión de Poisson. Resultados: El número de muertes aumentó para España en el periodo estudiado. Aunque la relación entre el incremento en la inversión pública en salud y la disminución de la mortalidad por esta causa no ha quedado claramente demostrada, sí ha podido determinarse que aquellas comunidades autónomas con menor incremento del gasto sanitario presentaron mayores tasas que el resto a lo largo de todo el periodo, y que las más vulnerables a la crisis y con menor incremento del gasto presentaron un mayor incremento de riesgo de muerte entre periodos. Conclusión: Dado el incremento de las muertes debidas a fallos evitables del sistema, es necesario seguir investigando sobre esta causa de mortalidad., Objective: To describe the evolution of mortality risks for complications due to medical care or surgery between the periods prior to (2002-2007) and after (2008-2013) the beginning of the economic crisis for Spain and by autonomous region, and to analyse the relationship between the changes in the risks of death and the socioeconomic impact of the crisis and the variation in health spending. Method: Ecological study based on age-standardized mortality rates, synthetic index of vulnerability as a socioeconomic indicator and variation in health expenditure as an indicator of health expenditure. The relative risk of death between periods was estimated with Poisson regression models. Results: The number of deaths increased for Spain in the period studied. Although the relationship between the increase in public investment in health and the decrease in mortality due to this cause has not been clearly demonstrated, it was possible to determine that the autonomous regions with the lowest increase in health expenditure had rates higher than the rest throughout the period, and that the most vulnerable to the crisis and with the lowest increase in spending presented the greatest increase in the risk of death between the periods. Conclusions: Given the increase in these deaths, due to avoidable failures of the system, it is necessary to continue investigating this cause of mortality.

Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002–2007 (before the economic crisis) and 2008–2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002–2007 and 2008–2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002–2007, and 6.93% in 2008–2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: A

Previous research suggests that the economic crisis can affect mental health. The purpose of this study was to analyse the association of risk of poor mental health with various socioeconomic, demographic, health, quality of life, and social support variables; and to evaluate the contribution of socioeconomic variables most affected by the beginning of the economic crisis (employment situation and income) on the changes in the prevalence of the risk of poor mental health between 2005 and 2010. A study of prevalence evolution in adult population residents of the Valencian Community in the Spanish Mediterranean was conducted. We studied 5781 subjects in 2005 and 3479 in 2010. Logistic regression models have been adjusted to analyse the association between variables. A standardisation procedure was carried out to evaluate which part of the changes in overall prevalence could be attributed to variations in the population structure by age, sex, employment status, and income between the years under study. The prevalence of GHQ+ increased from 2005 to 2010, in both men and women. Several variables were closely associated with the risk of poor mental health (sex, age, country of birth, number of nonmental chronic diseases, social support, disability, cohabitation in couple, employment status, and income). The changes produced as a result of the onset of the economic crisis in income and unemployment (increase in low income and in unemployment rates) contributed to the increase of poor mental health risk. This could confirm the sensitivity of mental health to the economic deterioration caused by the crisis.

Background. To study influenza vaccination uptake in pregnant women from three Health Departments in the Valencian Community (Spain) during the 2014-15 flu season, to identify degree of knowledge, sources of information and attitudes toward immunization against influenza. Methods. Multicentre cross-sectional descriptive study during the 2014-15 vaccination campaign. Vaccine coverage was determined using the Nominal Vaccination Registry (NVR). Subsequently, a telephone survey was carried out on a sample of vaccinated and unvaccinated postpartum women. Results. The NVR had information on 934 (59.5%) out of 1,569 postpartum women; distribution per Health Departments was: 420 (44.9%), 161 (17.2%) and 353 (37.8%) in La Ribera, Torrevieja and Elx-Crevillent respectively. Vaccine uptake was 27.9% (n = 261). According to the “Country of Origin” variable, 77.5% (n = 724) of women were Spanish, with a vaccination rate of 26.7% (n = 193), compared to 22.5% (n = 210) who were non-Spanish, with a rate of 32.4% (n = 68). The main source of information was midwives for 83.7% (n = 159) of vaccinated pregnant women and for 44.6% (n = 127) of non-vaccinated women. The main reasons for vaccine refusal were lack of awareness (29.5%, n = 84) and not considering it necessary (25.6%, n = 73). Conclusion. Despite their high willingness to be vaccinated after receiving information about the flu vaccine, the vaccination coverage in pregnant women studied is still low and can be improved. Health professionals need new information strategies to extend vaccine uptake to a larger number of pregnant women in Spain. Midwife advice plays an essential role in transmitting information on influenza vaccination in pregnant women and has a significant impact on uptake., Objetivos. Investigar la cobertura de la vacunación antigripal en gestantes en tres Departamentos de Salud de la Comunidad Valenciana (España) durante la temporada 2014-15, y evaluar su aceptabilidad, fuentes de información y motivos de rechazo hacia la inmunización contra la gripe. Métodos. Estudio descriptivo transversal multicéntrico en la campaña vacunal 2014-15. La cobertura vacunal se identificó a través del Registro Nominal de Vacunas (RVN). Posteriormente, se realizaron 2 encuestas telefónicas a un mínimo muestral de puérperas vacunadas y no vacunadas. Resultados. De 1.569 puérperas, 934 (59,5%) disponen de información en el RVN; la distribución por Departamentos: 420 (44,9%), 161 (17,2%) y 353 (37,8%) en La Ribera, Torrevieja y Elx-Crevillent respectivamente. Se obtuvo una cobertura vacunal del 27,9% (n=261). Según la variable “País de Origen”, el 77,5% (n=724) es española, con una tasa vacunal del 26,7% (n=193), frente al 22,5% (n=210) extranjera, con el 32,4% (n=68). La principal fuente de información fue la matrona en el 83,7% (n=159) de gestantes vacunadas y el 44,6% (n=127) en no vacunadas. Los principales motivos de rechazo fueron el desconocimiento (29,5%; n=84) y el no considerarse imprescindible (25,6%; n=73). Conclusiones. A pesar de su alta predisposición a vacunarse después de recibir información sobre la vacuna contra la gripe, la cobertura de vacunación en mujeres embarazadas estudiadas es aún baja y puede mejorarse. Son necesarias nuevas estrategias de formación e información por parte de los profesionales sanitarios para obtener un mayor número de gestantes vacunadas. El consejo de la matrona es un factor esencial en la emisión de la información sobre la vacunación antigripal recibida por las gestantes estudiadas.

Background: We explored the impact of 2008 recession on the prevalence of mental health problems in Spain. Methods: Repeated cross-sectional survey design. Datasets from 2006 and 2011 were used, and temporal change was examined. The study was conducted on the economically active population (16–64 years old). The two surveys included 29,478 and 21,007 people, obtaining a 96 and 89.6% response rate, respectively. Multiple logistic regression models were adjusted to identify poor mental health risk factors. A standardisation analysis was performed to estimate the prevalence of people at risk of poor mental health (GHQ+). Results: The prevalence of GHQ+ following the crisis increased in men and decreased in women. Two logistic regression analyses identified GHQ+ risk factors. From 2006 to 2011, unemployment rose and income fell for both men and women, and there was a decline in the prevalence of somatic illness and limitations, factors associated with a higher prevalence of GHQ+. After controlling for age, the change in employment and income among men prompted an increase in the prevalence of GHQ+, while the change in somatic illness and limitations tended to mitigate this effect. After the recession, unemployed men showed a better level of somatic health. The same effects were not detected in women. Conclusions: The economic recession exerted a complex effect on mental health problems in men. The reduction of prevalence in women was not associated with changes in socioeconomic factors related to the economic crisis nor with changes in somatic health.

La mortalidad evitable prevenible es un buen indicador para medir los resultados de las políticas de salud en ámbitos geográficos a lo largo del tiempo e identificar zonas geográficas necesitadas de intervención.

Aim: To adapt the Neonatal Skin Risk Assessment Scale to the Spanish context and to test its validity and reliability. Background: Currently, in Spain there are no validated scales to evaluate the risk of pressure ulcers in infants. Method: The research was performed in 10 neonatal units. Overall, we use an observational study design, but divided it in to three stages. In the first stage, the transcultural adaptation of the scale and its content validation was performed. For the second stage, the inter‐rater/intra‐rater agreement and construct validity were evaluated using a cross‐sectional design. Finally, in the third stage, a cohort study to analyse pressure ulcers’ incidence, diagnostic tests and the cut‐off points of the scale was performed. Results: In the first phase, the content validity index was 0.93. In the second phase (336 neonates), the intra‐rater reliability was 0.93 and the inter‐rater reliability was 0.97. The construct validity has shown a two‐dimensional model that fits better, representing “pressure duration and intensity” and “skin immaturity.” In the third phase (268 neonates) the best values were those presented by the score 17: receiver operating characteristic curve was 0.84, showing a sensitivity of 91.18%, specificity of 76.50%, positive predictive value of 36.05% and negative predictive value of 98.35%. Conclusion: The scale has shown evidence of validity and reliability to measure the neonatal risk of pressure ulcers in the Spanish context. Implications for Nursing Management: Pressure ulcers are an adverse event recognised in paediatric units and specifically in neonatal units. The intent of the Spanish Neonatal Skin Risk Assessment Scale is to identify hospitalised neonates requiring prevention measures and their specific risk factors, to provide useful diagnostic information to improve the neonatal skin care into Spanish speaking countries. The Neonatal Skin Risk Assessment Scale could ensure the efficient and effective allocation of

L’anàlisi espacial pot contemplar-se, en el context epidemiològic, com una ferramenta per a l’estudi de la distribució geogràfica d’un determinat problema de salut. Els estudis geogràfics sobre resultats en salut de la població són importants perquè poden contribuir a detectar diferències entre distintes regions, a establir patrons de distribució al llarg de la geografia d’un determinat territori o a localitzar unitats geogràfiques en situació de risc extrem o altres resultats d’interés.

Objetivo: Describir las propiedades psicométricas y el nivel de comprensión del cuestionario de alfabetización en salud HLS-EU-Q16 en español, implementado en la Encuesta de Salud de la Comunitat Valenciana de 2016. Método: Estudio descriptivo transversal para describir la comprensión, la fiabilidad, la estructura y la consistencia interna del cuestionario sobre la muestra de 5485 sujetos, de 15 o más años de edad, participantes en la encuesta. Resultados: Los porcentajes de comprensión sin mucha dificultad fueron elevados. La fiabilidad fue alta (coeficiente de correlación intraclase: 0,923; kappa: 0,814). El análisis factorial sugirió una estructura unifactorial (79,1% de variabilidad explicada por el factor común), con altas cargas factoriales. La consistencia fue alta (alfa de Cronbach: 0,982). Conclusiones: El HLS-EU-Q16 en español es un instrumento breve, adecuado y válido para medir el nivel de alfabetización en salud de la población., Objective: To describe the psychometric properties and the level of understanding of the health literacy questionnaire HLS-EU-Q16 in Spanish, implemented in the Health Survey of the Valencian Region (Spain) of 2016. Method: Descriptive cross-sectional study to describe understanding, reliability, structure and internal consistency of the questionnaire on a sample of 5485 subjects, aged 15 or over, who participated in the survey. Results: The percentages of understanding without much difficulty were high. Reliability was high (intraclass correlation coefficient:.923; kappa:.814). The factorial analysis suggested a unifactorial structure (79.1% of variability explained by the common factor), with high factorial loads. The consistency was high (Cronbach's alpha: 0.982). Conclusions: The HLS-EU-Q16 in Spanish is a short, adequate and valid instrument to measure the level of health literacy in the population.

Background: Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system (IDSS) in association with disc excision to prevent pain and re-operation, remains controversial. Methods: Patients (age 18–50 years) presenting with lumbago/sciatica (ICD-10-CM M54.3, M54.4) due to voluminous lumbar disc herniation were eligible for participation. Patients underwent microdiscectomy plus IDSS. The primary outcome measure was the clinical efficacy using Owestry disability index(ODI) and visual analogue pain scale (VAS). We also evaluated several other outcome parameters including: length of stay and costs during hospital admission, 90-day complication rate, and 1-year re-operation rate. This prospective observational study was carried out from January 2015 to August 2016. Results: A total of 30 patients whose mean age was 38.6(±9.2) years were included. ODI score dropped from 62.93(±16.45) to 13.50(±16.67), representing 78.54% (95% C.I 68.07–88.66%) improvement of the baseline score after one year (p < 0.001). Patients had 90 day re-admission and 1 year re-operation rates of 4/30(13.3%) and 3/30(10%) respectively. Length of stay was 2.1 ± 1.2 days. In-Hospital cost was 1069.8 ± 288.4 € (not including 1500€ of the implant). Implant related complications were common 12/30(40%), although they did not have any clinical consequences. Conclusion: Our short-term experience indicates that microdiscectomy plus interspinous device is safe and it shows good clinical results, although the clinical improvement seems to be due to microdiscectomy, without the implant adding any extra benefit. The addition of IDSS did not protect against re-operation, and it increased the surgical expenses.

The analysis of spatio-temporal patterns of disease or death in urban areas has been developed mainly from the ecological studies approach. These designs may have some limitations like the ecological fallacy and instability with few cases. The objective of this study was to apply the point process methodology, as a complement to that of aggregated data, to study HIV/AIDS mortality in men in the city of Alicante (Spain). A case-control study in residents in the city during the period 2004-2011 was designed. Cases were men who died from HIV/AIDS and controls represented the general population, matched by age to cases. The risk surfaces of death over the city were estimated using the log-risk function of intensities, and we contrasted their temporal variations over the two periods. High risk significant areas of death by HIV/AIDS, which coincide with the most deprived areas in the city, were detected. Significant spatial change of the areas at risk between the periods studied was not detected. The point process methodology is a useful tool to analyse the patterns of death by HIV/AIDS in urban areas.

Aim: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. Methods: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996–2001; 2002–2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. Results: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996–2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32–15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25–7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). Conclusions: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.

Antecedentes y objetivos: El mes de nacimiento puede reflejar exposiciones a factores durante el embarazo y en los primeros meses de vida que pueden influir en la aparición de enfermedades crónicas en edades adultas. Se pretende evaluar la asociación entre el mes de nacimiento y la presencia de enfermedades crónicas en la población española, analizando la Encuesta Nacional de Salud del año 2006. Pacientes y métodos: Se ha medido la asociación entre 27 enfermedades crónicas comunes con el mes de nacimiento mediante la estimación de odds ratios e intervalos de confianza al 95%, con modelos logísticos multivariantes, ajustando el mes de nacimiento y variables potencialmente confusoras. Resultados: El tamaño muestral fue de 29.478 personas, que representaron aproximadamente a 44,7 millones de españoles residentes a 1 de enero de 2007. Se han encontrado asociaciones significativas entre el mes de nacimiento y tener diversas enfermedades cónicas. Hay un patrón de riesgo de presentar enfermedades crónicas según el mes de nacimiento diferenciado por sexos, detectándose más asociaciones significativas y con mayor magnitud en varones que en mujeres. Conclusiones: Las asociaciones detectadas pueden reflejar exposiciones tempranas en el útero y en los primeros meses de vida a factores medioambientales. Son necesarios estudios más específicos para ahondar en estas asociaciones., Background and objectives: Patients’ month of birth can reflect exposure to certain factors during pregnancy and the first few months of life, which could influence the onset of chronic diseases during adulthood. The aim of this study is to evaluate the association between a patient's month of birth and the presence of chronic diseases in the Spanish population, by analysing the National Health Survey for the year 2006. Patients and methods: We measured the association between 27 common chronic diseases and the month of birth, estimating the odds ratios and confidence intervals at 95%, using multivariate logistical models and adjusting the results for month of birth and potentially confounding variables. Results: The sample population was made up of a total of 29,478 individuals, representing approximately 44.7 million Spanish residents on 1 January 2007. Significant associations were found between the month of birth and several chronic diseases. There is a gender-differentiated risk pattern of developing chronic diseases according to the month of birth, with more significant associations and of greater magnitude being detected among men compared to women. Conclusions: The associations detected might reflect early exposure to environmental factors in the uterus and during the first few months of life. More specific studies are required to gain a more in-depth understanding of these associations.

La cultura sobre seguridad se perfila como uno de los requisitos para evitar la aparición de efectos adversos, sin embargo no se ha estudiado en el ámbito de la cardiología. El objetivo es evaluar la cultura de seguridad en una unidad de cardiología que tiene implantado y certificado un sistema integrado de gestión de calidad y riesgos para la seguridad del paciente. Método: Se realizó un estudio observacional trasversal en 2 años consecutivos utilizando la encuesta Hospital Survey on Patient Safety Culture de la «Agency for Healthcare Research and Quality» en su versión española (42 ítems agrupados en 12 dimensiones) sobre todo el personal. Se comparó el porcentaje de respuestas positivas de cada dimensión en 2014 y 2015, así como con los datos a nivel nacional y en EE. UU., siguiendo las recomendaciones establecidas. Resultados: La valoración global, sobre un máximo de 5, fue de 4.5 en 2014 y de 4.7 en 2015. Identificamos 7 dimensiones como fortaleza. Las peor valoradas fueron: Dotación de personal, Apoyo de la gerencia y Trabajo en equipo entre unidades. La comparación mostró superioridad en todas las dimensiones a nivel nacional, y en 8 respecto a los datos del registro americano. Conclusiones: La cultura de seguridad en una unidad de cardiología con un sistema integrado de gestión de calidad y riesgos y seguridad del paciente es elevada, superior a la nacional en todas sus dimensiones y en la mayoría de ellas respecto al registro de EE. UU., The safety culture is one of the requirements to prevent the occurrence of adverse effects, however has not been studied in the field of cardiology. The objective is to evaluate the safety culture in a cardiology unit has implemented and certified an integrated quality and risk management for patient safety system. Methods: A transversal observational study was made in 2 consecutive years using the survey “Hospital Survey on Patient Safety Culture” of the “Agency for Healthcare Research and Quality” in its Spanish version (42 items grouped into 12 dimensions) in all staff. The percentage of positive responses in each dimension in 2014 and 2015 were compared, as well as national data and United States data, following the established rules. Results: The overall assessment of a possible 5, was 4.5 in 2014 and 4.7 in 2015. We identified seven dimensions as a fortress. The worst rated were: staffing, management support and teamwork between units. The comparison showed superiority in all dimensions respect to national data, and 8 respect to American data. Conclusions: The safety culture in a Cardiology Unit with an integrated quality and risk management and patient safety system is high, higher than the national in all its dimensions and in most of them respect to the United States.

Este documento pretende presentar de forma sintética y abreviada una serie de elementos y conceptos básicos en la investigación en Ciencias de la Salud. La perspectiva adoptada es fundamentalmente estadística, es decir, atiende especialmente a aquellos aspectos relacionados con la aplicación de métodos de estadística en la investigación. Al tratarse de un material de uso docente en el aula, pretende ser interactivo y proponer al alumno que vaya introduciéndose en los elementos a través de algún o algunos ejemplos de su entorno de interés. Así, partiendo de los elementos clave para situar la investigación, como son la pregunta a investigar y las hipótesis y objetivos concretos de la investigación, se revisan elementos fundamentales de la investigación, como son las variables a estudio y su tipo, el diseño, el plan muestral, los medios de medición y observación y los procedimientos estadísticos para el análisis de los datos. El documento finaliza con una guía abreviada para un protocolo de investigación.

Background: The number of lumbar spine surgeries has been increasing during the last 20 years, which also leads to an increase in hospital costs and complications related to surgery. Therefore, there is a greater concern about the costs and safety of the techniques and implants used. Methods: Patients (aged from 18 to 50 years) presenting with lumbago /sciatica (ICD-10-CM M54.3, M54.4) due to lumbar disc herniation lasting more than 12 weeks, were included. Patients with disc herniation larger than size-2 or size-3 according to the MSU Classification were eligible for participation. Intervention was divided in two groups. In Group 1, patients underwent microdiscectomy and Interspinous Dynamic Stabilization System (IDSS). Meanwhile, in Group 2, patients received discectomy and posterior lumbar interbody fusion (PLIF). The primary outcome measure was the length of stay and costs during hospital admission. We also evaluated several other outcome parameters, including 90- day readmission rate, 90-day complication rate, and re-operations rate. The study was an observational prospective cohort study carried out from January 2015 to August 2016 in which two surgical techniques were compared. Our hypothesis was that a less aggressive procedure, such as discectomy and DSS, will decrease the length of stay and costs, and that it will also reduce the rate of complications with respect to PLIF. Results: A total of 67 patients (mean age 39.8 ± 8.4 years) were included. Patients in the PLIF group had a length of stay increase of 109% (4.52 ± 1.76 days vs 2.16 ± 1.18 days p < 0.001) and an in-hospital cost increase of 71% (1821.97 ± 460.41€ vs. 1066.20 ± 284.34€ p < 0.001). The reduction of one day of stay is equivalent to a reduction of total in-hospital costs of 12.5%. Patients in the IDSS cohort had no significant differences regarding PLIF cohort in the 90-day readmission rate (12.9% vs 11.1% € p > 0.999, respectively), 90-day re-operation rate (12.9% vs 11.1% € p > 0.999) and

To analyze the sociodemographic and organizational factors influencing participation in population-based colorectal cancer screening programs (CRCSP) in Spain, a retrospective study was conducted in a cohort of people invited to participate in the first 3 screening rounds of 6 CRCSP from 2000 to 2012. Mixed logistic regression models were used to analyze the relationship between sociodemographic and organizational factors, such as the type of fecal occult blood test (FOBT) used and the FOBT delivery type. The analysis was performed separately in groups (Initial screening-first invitation, Subsequent invitation for previous never-responders, Subsequent invitation-regular, Subsequent invitation-irregular intervals). The results showed that, in the Initial screening-first invitation group, participation was higher in women than in men in all age groups (OR 1.05 in persons aged 50–59 years and OR 1.12 in those aged 60–69 years). Participation was also higher when no action was required to receive the FOBT kit, independently of the type of screening (Initial screening-first invitation [OR 2.24], Subsequent invitation for previous never-responders [OR 2.14], Subsequent invitation-regular [OR 2.03], Subsequent invitation-irregular intervals [OR 9.38]) and when quantitative rather than qualitative immunological FOBT (FIT) was offered (Initial screening-first invitation [OR 0.70], Subsequent invitation for previous never-responders [OR 0.12], Subsequent invitation-regular [OR 0.20]) or guaiac testing (Initial screening-first invitation [OR 0.81], Subsequent invitation for previous never-responders [OR 0.88], Subsequent invitation-regular [OR 0.73]). In conclusion, the results of this study show that screening participation could be enhanced by inclusion of the FOBT kit with the screening invitation and the use of the quantitative FIT.