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Objetivo: Estimar las relaciones prospectivas entre la exposición a las dimensiones de riesgos psicosociales incluidas en el COPSOQ-Istas21 y el deterioro de la salud general, la salud mental y los problemas del sueño entre personas trabajadoras residentes en España. Método: Cohorte cuya línea base corresponde a la Encuesta de Riesgos Psicosociales de 2016, con una nueva medición al cabo de 1 año. Resultados: Las dimensiones de capital social y de relaciones interpersonales y liderazgo, así como el conflicto trabajo-vida, se relacionaron con todas las variables de salud. Las de organización y contenido del trabajo lo hicieron especialmente con la salud mental, las exigencias cuantitativas con la salud general y las emocionales con la salud mental. Las dimensiones relacionadas con la inseguridad laboral no mostraron relación con la salud. Conclusiones: Los resultados obtenidos refuerzan el papel del COPSOQ-Istas21 como un instrumento útil para la evaluación y la prevención de los riesgos psicosociales en el trabajo. Objective: To estimate the prospective relationships between exposure to psychosocial risks dimensions included in the COPSOQ-Istas21 and the deterioration of general and mental health and sleep problems among workers residing in Spain. Method: Cohort whose baseline corresponds to the 2016 Psychosocial Risks Survey with a new measurement after one year. Results: Social capital and interpersonal relations and leadership dimensions, as well as work̶life conflict, were related to all health variables. Dimensions of work organization and job contents did it especially with the mental health, the quantitative demands with the general health and the emotional ones with the mental health. The dimensions related to job insecurity did not show relationships with health. Conclusions: The results obtained reinforce the role of the COPSOQ-Istas21 as a useful instrument for the evaluation and prevention of psychosocial risks at work.

The aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5–11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161–121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1–3.5]) and using LSD (aOR = 5.44 [CI 95:1.32–30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.

The coverage of maternal vaccination against pertussis and, particularly, influenza is lower than expected. The lack of recommendation from healthcare providers conditions non-vaccination in pregnant women. The purpose was to determine the knowledge, perceptions, attitudes and practices of midwives regarding maternal influenza and pertussis vaccination. A qualitative descriptive study based on semi-structured, face-to-face interviews with seventeen midwives was conducted, including purposive sampling and thematic analyses. Midwives had disparate knowledge and perceptions about the severity of influenza and pertussis in pregnant women, and influenza was not considered very serious. The vaccines were generally considered safe. However, because midwives did not have enough information about the safety of the influenza vaccine, there was a tendency not to recommend it. While most midwives had a positive attitude toward vaccination, their advocation for vaccination against influenza was not as clear as it was for pertussis. Not wanting to influence the decision and assuming an informative–facilitating role also led providers to recommend the influenza vaccine less frequently. Midwives are among the main sources of professional advice for pregnant women. Addressing their understanding and professional practices regarding maternal vaccination is key to change the attitude of pregnant women and thus increase vaccine uptake among them, particularly for influenza.

The purpose was to determine the coverage of maternal vaccination against influenza and pertussis, and the characteristics associated with being vaccinated, in a health area of Catalonia, Spain. Some 36,032 anonymized and computerized clinical records registries of pregnant women from Primary Care Centres (e-CAP database) were analysed, from between 2015 and 2018. Vaccination coverage and the association with sociodemographic variables and clinical conditions were estimated using a Poisson regression model. Maternal vaccination coverage against influenza ranged between 11.9% in 2015 and 6.8% in 2018, following a decreasing trend (p < 0.001). Coverage with the tetanus toxoid, diphtheria toxoid, and acellular pertussis vaccine varied between 49.8% in 2016 and 79.4% in 2018, following an increasing trend (p < 0.001). Having living children and suffering from obesity were factors associated with not being vaccinated against both infections. The predictive variables of vaccination against influenza were diabetes (IRR: 2.17, 95% CI: 1.42–3.30) and asthma (IRR: 2.05, 95% CI: 1.76–2.38); and for pertussis, it was asthma (IRR: 1.10, 95% CI: 1.03–1.17). Different socio-demographic factors and chronic conditions in pregnant women were associated with maternal vaccination, and which will have to be taken into account in clinical practice when implementing strategies to improve the coverage of the programme.

To estimate the prospective relationships between exposure to psychosocial risks dimensions included in the COPSOQ-Istas21 and the deterioration of general and mental health and sleep problems among workers residing in Spain.Cohort whose baseline corresponds to the 2016 Psychosocial Risks Survey with a new measurement after one year.Social capital and interpersonal relations and leadership dimensions, as well as work̶life conflict, were related to all health variables. Dimensions of work organization and job contents did it especially with the mental health, the quantitative demands with the general health and the emotional ones with the mental health. The dimensions related to job insecurity did not show relationships with health.The results obtained reinforce the role of the COPSOQ-Istas21 as a useful instrument for the evaluation and prevention of psychosocial risks at work.

Background Nursing requires a high load of emotional labour. The link between nursing, emotional labour and the female sex, complicates the figure of the male nurse, because masculinity is associated with physical or technical (rather than emotional) and moreover is defined in contrast to femininity. Our objective was to understand how emotion management is described by male nurses who work in the paediatrics department of a Spanish tertiary hospital. Methods Qualitative descriptive study. The participants were selected through intentional sampling in the paediatrics department of a Spanish tertiary hospital. We conducted semi-structured interviews until reaching data saturation. We carried out a content analysis, using Lincoln and Guba’s definition of scientific rigour. Results We identified two key themes in the data: 1) Stereotypes related to the emotional aspects of care: Participants took for granted some gender stereotypes while questioning others and defended alternative ways of managing emotions related to care. 2) Emotion management strategies: Participants described keeping an emotional distance, setting boundaries, relativising problems and using distraction and humour. Discussion Nursing care is conditioned by gender roles and stereotypes that present men as less capable than women of feeling and managing emotions. However, emotion management is necessary in nursing care—especially in paediatrics—and our participants reported using strategies for it. Although participants continued to interpret care in terms of traditional roles, they contradicted them in adapting to the emotional labour that their job requires. Conclusions New behaviours are emerging among male nurses, in which care and emotion management are not exclusively the purview of women. Our participants reproduced some gender stereotypes while disrupting others, and they tended to cling to the stereotypes that were favourable to them as male nurses. As we work towards a gender-neutral profession, these results represent a first step: male participants reported that they provide care and manage their emotions as well as (or better than) women. However, because they substantiated their claims by drawing on negative stereotypes of women, further progress must be made.

Altres ajuts: acords transformatius de la UAB The aim is to describe the health and psychosocial risk factors of Spanish healthcare workers during the COVID-19 pandemic. Methods: A cross-sectional study by means of an online questionnaire (April-May 2020). The data comes from the database resulting from the COTS project "Working conditions, insecurity, and health in the context of the COVID-19 pandemic". The sample consisted of 1989 health care workers. Results: Women, young people (doctors and nurses) and the middle-aged (assistants) had poorer health and greater exposure to psychosocial risks. Geriatric assistants were the most-affected occupational group. Conclusions: gender, occupation, and age are focuses of inequality in the exposure of health care workers to psychosocial risks.

Altres ajuts: acords transformatius de la UAB Aims and Objectives: To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. Background: Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient. Design: We conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. Methods: We carried out 18 semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. Results: We identified an overarching theme, 'factors that influenced participants' decision to be vaccinated or not', which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants' decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests. Conclusions: The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women. Relevance to clinical practice: Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse-midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns.

There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz’s approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication.

The process of international migration causes a situation of vulnerability in people&rsquo, s health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from four communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the primary care centers of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the Sub-Saharan community. Psychological distress showed a mean value of 0.66, with the Sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the Sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.

Resumen Introduccion La reemergencia de la tos ferina y la gravedad de sus complicaciones en lactantes menores de 3 meses de edad determino el inicio del programa de vacunacion de las mujeres embarazadas en el tercer trimestre de gestacion, en Cataluna en febrero del 2014, la primera comunidad autonoma que la introdujo de Espana. El objetivo del estudio fue estimar la cobertura del programa en su primer ano de implementacion. Metodos Se analizaron de forma retrospectiva los registros medicos informatizados de los Centros de Atencion Primaria de embarazadas atendidas en centros de Asistencia de Salud Sexual y Reproductiva del area Metropolita Nord de la provincia de Barcelona, dependientes del Institut Catala de la Salut. Se estimo la cobertura global y segun variables sociodemograficas de vacunacion con dTpa de las mujeres que tenian registrado un parto de un recien nacido vivo entre agosto del 2014 y agosto del 2015. Resultados Se registraron 6.697 partos de nacidos vivos y 1.713 mujeres embarazadas fueron vacunadas, lo que represento una cobertura global del 25,6% (IC del 95%: 24,1-26,1). La cobertura de vacunacion fue mayor en las mujeres embarazadas menores de 18 anos y las nativas (p = 0,018 y p = 0,036, respectivamente). Conclusion La estimacion de cobertura vacunal frente a tos ferina de embarazadas en el tercer trimestre de gestacion, tras el primer ano de implementacion del programa en un area sanitaria de Cataluna, ha resultado inferior al objetivo marcado. Sera necesario disenar estrategias dirigidas a mejorar la cobertura del programa.

Aim The aim of the study was to describe the characteristics of the Bachelor’s thesis of fourth-year nursing students at a Spanish public university, the criteria that students used to choose a topic and students’ degree of satisfaction after completing the Bachelor’s thesis. Design Quantitative study. Methods We examined 420 Bachelor’s theses carried out from 2013 to 2018 and conducted an online survey among fourth-year students in the 2017–18 and 2018–19 academic years (81 completed questionnaires). Results The Bachelor’s thesis took the form of a research proposal. The most frequent proposal type was a qualitative hospital-based study whose objective was to understand the experiences of adult or adolescent patients, close family members, or nurses. Students chose topics for personal reasons. Most participants reported feeling satisfied with the knowledge and skills acquired. Conclusions Students completing a Bachelor’s thesis in the form of a research proposal have the potential to transfer their research skills to their nursing practice.

Pertussis remains a public health problem in countries with high vaccination coverage. Classic vaccination approaches have failed to effectively control the infection. The incidence of pertussis hospitalizations in infants is high, especially in those younger than 3 months who are in high risk of a severe disease and death. Additional strategies are recommended for short-term protection of this vulnerable population. In this study, we estimated the impact of 2 strategies for pertussis prevention in infants younger than 1 year of age-a cocoon vaccination strategy and the vaccination of pregnant women (VPW)-and the cost-benefit of these approaches relative to the current vaccination policy in Spain.A cost-benefit analysis was conducted from the perspective of the publically-funded Spanish healthcare system, based on the yearly number of hospitalizations during the period of 2009 to 2011. We calculated the absolute risk reduction, the number of parents that would need to be vaccinated to prevent 1 hospitalization or death in infants1 year, and the net benefit-to-cost ratio of each strategy.From 2009 to 2011, the incidence of pertussis in Spain was 153.44 hospitalizations per 100,000 infants1 year. The absolute risk reduction for hospitalization would be 42.1/100,000 with cocooning and 75.2/100,000 with VPW. The number of parents needed to vaccinate with the cocoon strategy to prevent 1 pertussis hospitalization would be 4752 and to prevent 1 death, more than 900,000. With VPW, 1331 pregnant women would have to be vaccinated to prevent 1 hospitalization and 200,000 to prevent 1 death. The benefit-to-cost ratio was 0.04 for cocooning and 0.15 for VPW.

Resumen Introduccion La tos ferina ha aumentado su incidencia en los ultimos anos en paises con elevadas coberturas de vacunacion. El objetivo del estudio ha sido conocer el impacto sanitario de la tos ferina en Espana en el periodo 1997-2011 en relacion con hospitalizaciones, la mortalidad y los costes asociados. Metodos Se analizaron de forma retrospectiva las altas hospitalarias incluidas en el Conjunto Minimo Basico de Datos (CMBD) en Espana del periodo 1997-2011, con diagnostico principal o secundarios relacionados con tos ferina. Se calcularon las tasas de incidencia de hospitalizacion por tos ferina (por 100.000 habitantes) por ano, por grupo de edad y por comunidad autonoma, asi como las tasas de mortalidad y de letalidad. Resultados Entre 1997 y 2011 se registraron en Espana 8.331 altas hospitalarias con diagnostico de tos ferina. La incidencia global de hospitalizaciones por tos ferina fue de 1,3 casos por 100.000 habitantes. El 92% de las hospitalizaciones correspondieron a ninos menores de un ano de edad, con una incidencia de 115,2 hospitalizaciones por 100.000 nacidos. Se registraron 47 defunciones, 37 (79%) en el grupo de menores de un ano y 6 (13%) en el grupo de mayores de 65 anos. El coste estimado de una hospitalizacion por tos ferina fue de 1.841 euros. Conclusion La epidemiologia de los casos graves de tos ferina y su impacto clinico y economico confirman la necesidad de modificar las estrategias de vacunacion en Espana para lograr un control mas efectivo en los grupos mas vulnerables.

Whooping cough is currently the worst controlled vaccine-preventable disease in the majority of countries. In order to reduce its morbidity and mortality, it is essential to adapt vaccination programmes to data provided by epidemiological surveillance. A population-based retrospective epidemiological study to estimate the minimum annual undernotification rate of pertussis in Spain from 1997 to 2010 was performed. The incidence of pertussis cases reported to the National Notifiable Disease Surveillance System was compared with the incidence of hospital discharges for pertussis from the National Surveillance System for hospital data, Conjunto Minimo Basico de Datos. The overall reported incidence and that of hospitalisation for whooping cough were 1.3 cases × 100,000 inhabitants in both cases. Minimum underreporting oscillated between 3.8 and 22.8 %, according to the year of the study. The greatest underreporting (50 %) was observed in children under the age of 1 year. Conclusion: Spanish epidemiological surveillance system of pertussis should be improved with complementary active systems to ascertain the real incidence. Paediatricians and general practitioners should be sensibilized to the importance of notification because this would be essential for adapting the prevention and control measures of this disease.

The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation.A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015.A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively).The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage.

Resumen Introduccion Estimar la susceptibilidad al sarampion y la varicela del personal sanitario segun caracteristicas demograficas y laborales en un hospital universitario y publico de tercer nivel en Cataluna. Metodos Estudio de prevalencia realizado de enero de 2006 a diciembre de 2008 en 2.752 trabajadores a los que se habia realizado determinacion de serologia frente a sarampion y/o varicela mediante test de ELISA en un examen de salud. Se analizaron los datos segun sexo, edad, categoria profesional y unidad de trabajo. Resultados Se detectaron 153 profesionales susceptibles a sarampion y 187 a varicela. La susceptibilidad de los trabajadores a sarampion fue del 6,04% (IC 95%: 5,78-6,30) y a varicela del 7,45% (IC 95%: 7,14-7,75). La susceptibilidad a sarampion mas elevada fue la de los medicos internos residentes (MIR), con un 14% (IC 95%: 10,8-18,5). En servicios de alto riesgo, que atienden a pacientes especialmente inmunocomprometidos, la susceptibilidad de los trabajadores fue ligeramente superior a la del resto, tanto para sarampion (6,32 vs 5,93%) como para varicela (8,34 vs 7,09%). Los trabajadores nacidos despues de 1980 tenian 20 veces (IC 95%: 11,0-37,2) mas probabilidad de ser susceptibles a sarampion y 2 veces (IC 95%: 1,2-3,2) mas de ser susceptibles a varicela que los nacidos antes de 1965. Conclusion La susceptibilidad frente a sarampion en el personal sanitario de nuestro centro es elevada en las cohortes mas jovenes, con cifras superiores a las esperadas en una comunidad con altas coberturas vacunales frente a triple virica en poblacion pediatrica desde hace muchos anos.

ResumenObjetivoEvaluar la eficiencia de sustituir algunos dispositivos médicos por otros diseñados para prevenir exposiciones percutáneas (EP).MétodosSe han estimado las relaciones coste-efectividad de sustituir algunos dispositivos por otros diseñados para prevenir EP: se han considerado los costes de adquisición y de la asistencia a una EP; el número de EP prevenibles por cada dispositivo se ha estimado a partir de las 252 exposiciones ocupacionales notificadas por el personal de un hospital de 1.300 camas de marzo de 2002 a febrero de 2003. Se ha calculado la relación entre el coste adicional de los dispositivos alternativos y el número de EP evitables de alto riesgo (las que cumplían 2 o más de los siguientes: EP moderadamente profunda o profunda, por objeto insertado en vaso, o por objeto expuesto a la sangre).ResultadosOrden de los dispositivos según la relación costeefectividad:aguja con resguardo para catéter implantado (−2,65 €/EP evitada), seguida por jeringa con resguardo (869,79 €/EP), aguja con aletas con resguardo, equipo de perfusion con válvulas y catéter endovenoso periférico con retracción del fiador. Orden según relación entre coste adicional y número de EP de alto riesgo evitadas: aguja para acceso a catéter implantado, seguida por aguja con aletas, jeringa para aguja hipodérmica, catéter endovenoso y equipo de infusion con válvulas.ConclusionesEl ahorro en asistencia a EP compensa el coste adicional de algunos dispositivos diseñados para prevenirlas. Un análisis coste-efectividad ayuda a establecer prioridades, pero debe tener en cuenta el riesgo de las EP asociadas con cada dispositivo.AbstractObjectiveTo assess the efficiency of the replacement of several medical devices by engineered sharp injury (SI) prevention devices (ESIPDs).MethodsThe cost-effectiveness ratios of the replacement of medical devices in use by ESIPDs were estimated: their purchasing costs and the direct costs of sharp injury care were taken into account; the number of SI avoidable by each ESIPD was estimated from the 252 occupational SI notified by healthcare workers at a 1,300 bed hospital from March 2002 to February 2003. The relationship between ESIPD additional costs and the number of high-risk SI was estimated (SI were classified as high-risk if they met two or more of the following criteria: moderately-deep or deep injury, injury with a device previously inserted in an artery or vein, or with a device exposed to blood).ResultsESIPDs order according to cost-effectiveness ratio: safety needle for implanted ports (−2.65 €/SI avoided), followed by syringes with protective shield (869.79 €/SI), resheathable winged steel needles, needleless administration sets, and short catheters with protective encasement. ESIPDs order according to relationship between additional costs and number of high-risk sharp injuries avoided: safety needles for implanted ports, followed by winged steel needles, hypodermic syringes,short catheter and needleless administration sets.ConclusionsSavings in SI care outweigh additional costs of certain ESIPDs. Cost-effectiveness analysis is useful in assigning priorities; however the risks of SI by every device must be taken into account.

Pertussis incidence has increased in recent years in countries with high vaccination coverage. The aim of this study was to determine the health impact of pertussis in Spain in the period 1997-2011 in relation to hospitalizations, mortality, and associated costs.We retrospectively analyzed hospital discharges included in the Minimum Data Set (MDS) in Spain for the period 1997-2011, with a primary or secondary diagnosis related to pertussis. We calculated incidence rates of hospitalization for pertussis (per 100,000) per year, by age group and by Autonomous Region, along with the mortality and lethality rates.A total of 8,331 hospital discharges with a diagnosis of pertussis were recorded in Spain between 1997 and 2011. The overall incidence of pertussis hospitalizations was 1.3 cases per 100,000 inhabitants. The large majority (92%) of hospitalizations occurred in children under one year of age, with an incidence of 115.2 hospitalizations per 100,000. There were 47 deaths, 37 (79%) in the group of children under 1 year and 6 (13%) in the group older than 65 years. The estimated cost of hospitalization for pertussis was 1,841 euros.The epidemiology of severe cases of pertussis, and its clinical and economic impact, confirms the need to modify the vaccination strategies for Spain to achieve more effective control in the most vulnerable groups.

To estimate the susceptibility to measles and varicella (chickenpox) in healthcare workers in a public tertiary level teaching hospital, in Catalonia.A prevalence study was conducted from January 2006 to December 2008 on 2,752 workers who had serology performed for the determination of measles or varicella by ELISA test during a health examination. Data were analysed by, sex, age, professional category and work unit.A total of 153 healthcare workers were susceptible to measles and 187 to varicella. The susceptibility of healthcare workers to measles was 6.04% (95% CI: 5.78 to 6.30), and to varicella it was 7.45% (95% CI: 7.14 to 7.75). The highest susceptibility to measles was in resident physicians with 14% (95% CI: 10.8 to 18.5). In high-risk services, where highly immunocompromised patients are attended, the susceptibility of workers was slightly higher than the rest to measles (6.32% vs 5.93%) and varicella (8.34% vs 7.09%). Healthcare workers born after 1980 were 20 times (95% CI: 11.0 to 37.2) more likely to be susceptible to measles, and 2 times (95% CI: 1.2 to 3.2) more likely to be susceptible to varicella than those those born before 1965.The susceptibility to measles in healthcare workers in our centre is higher in younger cohorts, with values higher than expected in a community with high vaccination coverage against measles, mumps, rubella vaccine (MMR) in the paediatric population for many years.

To assess the efficiency of the replacement of several medical devices by engineered sharp injury (SI) prevention devices (ESIPDs).The cost-effectiveness ratios of the replacement of medical devices in use by ESIPDs were estimated: their purchasing costs and the direct costs of sharp injury care were taken into account; the number of SI avoidable by each ESIPD was estimated from the 252 occupational SI notified by healthcare workers at a 1,300 bed hospital from March 2002 to February 2003. The relationship between ESIPD additional costs and the number of high-risk SI was estimated (SI were classified as high-risk if they met two or more of the following criteria: moderately-deep or deep injury, injury with a device previously inserted in an artery or vein, or with a device exposed to blood).ESIPDs order according to cost-effectiveness ratio: safety needle for implanted ports (-2.65 euro/SI avoided), followed by syringes with protective shield (869.79 euro/SI), resheathable winged steel needles, needleless administration sets, and short catheters with protective encasement. ESIPDs order according to relationship between additional costs and number of high-risk sharp injuries avoided: safety needles for implanted ports, followed by winged steel needles, hypodermic syringes, short catheter and needleless administration sets.Savings in SI care outweigh additional costs of certain ESIPDs. Cost-effectiveness analysis is useful in assigning priorities; however the risks of SI by every device must be taken into account.