RESUMO
OBJECTIVE: To review the latest published evidence on the vaccine used in our country against the herpes zoster virus, breaking down the results according to the efficacy, efficiency, effectiveness and safety of the vaccine. Include the current recommendations for vaccination. DESIGN: Secondary review. Descriptive qualitative review. Review using the search term "herpes zoster vaccine" and "Adjuvanted recombinant Herpes Zoster subunit vaccine". Retrospective observational study. DATA SOURCES: Embase, Medline and Google Scholar. Selection of studies Search criterion with the terms "Shingrix vaccine" and "Adjuvanted Herpes Zoster Subunit Vaccine". Search period 2013-2023. Studies classified as clinical trials or randomized clinical trials were selected. 21 published studies were evaluated. There were no exclusions. RESULTS: The evaluated studies were found to be coherent and in all of them efficacy in adult individuals in preventing viral reactivation and in preventing complications was higher than 80%. The effectiveness of the vaccine after two doses was also higher than 80%. Cost-effectiveness studies were always favourable in adults, immunodepressed patients and individuals with chronic pathology. The safety of the vaccine was evaluated in the pivotal studies and in the post-commercialization studies that were undertaken (although there were few of the latter due to the short period of time studied). The safety profile of the vaccine is very high and in the case of severe adverse effects, their frequency was similar to that of a placebo. CONCLUSIONS: We have a safe and effective vaccine against the herpes zoster virus that allows us to protect the most vulnerable population groups against this virus.
Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Adulto , Humanos , Herpesvirus Humano 3 , Herpes Zoster/prevenção & controle , Vacinação , Vacinas de Subunidades Antigênicas/efeitos adversosRESUMO
The update of the preventive activities for this year 2022 in the field of infectious diseases is of special relevance due to the importance that prevention has gained and more specifically, vaccination as a tool to control the pandemic caused by the SARS-CoV-2 virus declared on March 11, 2020. The pandemic has focused much of the prevention efforts on its containment, but the importance of maintaining high vaccination coverage of the rest of the recommended vaccines to maintain good control of vaccine-preventable diseases and avoid complications in particularly vulnerable patients should not be forgotten. In this year's review we present a practical document with the aim of providing tools to primary care professionals who work with adults, to make the indication of each vaccine whether it is systematically recommended or if it is because the patient belongs to some risk group due to their condition or underlying pathology. In this way, throughout the document, we will comment on the most innovative aspects of systematic vaccination (flu, pneumococcus, meningococcal vaccines and vaccines against the human papillomavirus [HPV]), the new vaccines (pandemic vaccines against COVID-19, vaccines against herpes zoster of subunits, vaccines against monkeypox) and the recommended vaccines according to risk condition (pregnancy and lactation, travelers, patients with immunosuppression or underlying pathology).
Assuntos
COVID-19 , Vacinas , Adulto , Gravidez , Feminino , Humanos , Vacinas contra COVID-19 , COVID-19/prevenção & controle , SARS-CoV-2 , VacinaçãoRESUMO
Vaccine development is one of the fastest growing sectors in medicine now and in the future, as we are living with the emergency health care for the SARS-CoV-2 coronavirus. The semFYC PAPPS program biannually publishes the recommendations of the group and, in this edition, special emphasis is placed on the common vaccination proposed by the Ministry of Health, where, at last, it no longer discriminates between paediatrics and adults, and proposes a calendar throughout life. The main novelties in the field of vaccinology today are focused on the consolidation of the nonavalent vaccine against the human papilloma virus and in the change of the dose of monovalent meningitis vaccine C for the tetravalent one, ACWY, at age 12. The pandemic we are experiencing has led to the postponement of most preventive activities. On the return to «normality¼, the vaccination calendar must be examined, and completed if necessary.
Assuntos
Esquemas de Imunização , Atenção Primária à Saúde/normas , Vacinação/normas , Vacinas/normas , Viroses/prevenção & controle , Adulto , COVID-19/prevenção & controle , Criança , Humanos , Atenção Primária à Saúde/métodos , Vacinação/métodos , Vacinas/administração & dosagemRESUMO
BACKGROUND AND OBJECTIVE: to estimate the prevalence of polypharmacy and hyperpolypharmacy in non-institutionalised older adults in Spain and assess the associated factors. MATERIAL AND METHODS: a cross-sectional study based on data from the National Health Survey of Spain 2017, with participants aged 65 and over. The prevalence of polypharmacy (≥5 medications) and hyperpolypharmacy (≥10) were estimated, as well as the association with several factors through multivariate logistic regression. A sensitivity analysis was carried out considering the possible consumption of more than one drug for the same indication (polytherapy). RESULTS: 7023 participants were included, with a mean age of 76.0 (SD 7.6), 59.4% female and average consumption of 3.3 (SD 2.2) drugs per person. The prevalence of polypharmacy was 27.3% (95% CI 26.2-28.3) and of hyperpolypharmacy 0.9% (95% CI 0.7-1.1). The sensitivity analysis showed that the prevalence could be at least 37.5% and the average 3.9 (SD 2.5) when considering polytherapy. The factors most associated with polypharmacy were the number of chronic diseases, degree of dependence for the basic activities of daily living, self-perceived health or contacts with the health system; and negatively, sensory deficits and incontinence. CONCLUSIONS: the prevalence of polypharmacy in the elderly in primary care continues to increase and could be widely underestimated. In addition to multimorbidity, factors such as functional capacity or geriatric syndromes, fundamental in elderly people, modulate the habits of consumption and prescription of drugs in this population.
Assuntos
Quimioterapia Combinada/estatística & dados numéricos , Polimedicação , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Intervalos de Confiança , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Vida Independente/estatística & dados numéricos , Modelos Logísticos , Masculino , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Sensibilidade e Especificidade , Distribuição por Sexo , EspanhaRESUMO
Vaccines constitute one of the main foundations of the public health system, improving the quality and life expectancy of people. The vaccination calendar must be extended to the whole life of a person and in recent years the vaccination of the adult has become more complex and requires a greater knowledge of it. The role of primary care health is essential in order to improve vaccination coverage given the patient's closeness and trust. It is important to know the recommendations on vaccination for reasons of age, underlying pathology, work circumstances or any other factor that may endanger health and be preventable by vaccination and at the same time have clear criteria of what should not be done in this countryside. An excess in vaccination can pose a risk to the health of the patient and a waste of resources.
Assuntos
Vacinação/normas , Vacinas/administração & dosagem , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Armazenamento de Medicamentos/métodos , Emigrantes e Imigrantes , Feminino , Hepatite A/imunologia , Hepatite B/imunologia , Humanos , Esquemas de Imunização , Masculino , Uso Excessivo dos Serviços de Saúde , Pessoa de Meia-Idade , Espanha , Tétano/prevenção & controle , Confiança , TrabalhoAssuntos
Infecções Bacterianas/prevenção & controle , Vacinas Bacterianas/administração & dosagem , Controle de Doenças Transmissíveis/métodos , Esquemas de Imunização , Vacinas Virais/administração & dosagem , Viroses/prevenção & controle , Adulto , Fatores Etários , Criança , Feminino , Pessoal de Saúde , Humanos , Hospedeiro Imunocomprometido , Masculino , ViagemRESUMO
OBJECTIVE: Assess compliance with the IDF recommendations for patients with Diabetes Type2 (DM2), and its variability, by groups of doctors and nurses who provide primary care services in Navarre (Spain). MATERIALS AND METHODOLOGIES: A cross-sectional study of a population of 462,568 inhabitants, aged ≥18 years in 2013, attended by 381 units of doctor/nurse (quota). Clinical data were collected retrospectively through electronic records. Using cluster analysis, we identified two groups of units according to the score for each indicator. We calculated the Odds Ratio, adjusted for age sex, BMI, socioeconomic status and smoking, for complying with each recommendation whether a patient was treated by one of the quota from the highest score to the lowest. 30,312 patients with DM2 were identified: prevalence: 6.39%; coefficient of variation between UDN: 22.8%; biggest cluster 7.7% and smallest 5.3%; OR=1.54 (1.50-1.58). The HbA1c control at ≤8% was 82.8% (82.2-83.3) and >9% was 7.6% (7.3-8.0), with OR 1.79 (1.69-1.89) and 2.62 (2.36-2.91) respectively. Control of BP and LDL-C show significant differences between the clusters. CONCLUSIONS: An important variability was identified according to the doctor treating patients. The average HbA1c control is acceptable being limited in BP and LDL-C.
Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Fidelidade a Diretrizes/normas , Hipoglicemiantes/uso terapêutico , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , Adolescente , Adulto , Anticolesterolemiantes/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea/efeitos dos fármacos , LDL-Colesterol/sangue , Análise por Conglomerados , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Hemoglobinas Glicadas/metabolismo , Fidelidade a Diretrizes/tendências , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Padrões de Prática Médica/tendências , Prevalência , Atenção Primária à Saúde/tendências , Estudos Retrospectivos , Comportamento de Redução do Risco , Espanha/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND/OBJECTIVES: The clinical status of older individuals with multimorbidity can be further complicated by concomitant geriatric syndromes. This study explores multimorbidity patterns, encompassing both chronic diseases and geriatric syndromes, in geriatric patients attended in an acute hospital setting. DESIGN: Retrospective observational study. SETTING: Unit of Social and Clinical Assessment (UVSS), Miguel Servet University Hospital (HUMS), Zaragoza (Spain). Year, 2011. PARTICIPANTS: A total of 924 hospitalized patients aged 65 years or older. MEASUREMENTS: Data on patients' clinical, functional, cognitive and social statuses were gathered through comprehensive geriatric assessments. To identify diseases and/or geriatric syndromes that cluster into patterns, an exploratory factor analysis was applied, stratifying by sex. The factors can be interpreted as multimorbidity patterns, i.e., diseases non-randomly associated with each other within the study population. The resulting patterns were clinically assessed by several physicians. RESULTS: The mean age of the study population was 82.1 years (SD 7.2). Multimorbidity burden was lower in men under 80 years, but increased in those over 80. Immobility, urinary incontinence, hypertension, falls, dementia, cognitive decline, diabetes and arrhythmia were among the 10 most frequent health problems in both sexes, with prevalence rates above 20%. Four multimorbidity patterns were identified that were present in both sexes: Cardiovascular, Induced Dependency, Falls and Osteoarticular. The number of conditions comprising these patterns was similar in men and women. CONCLUSION: The existence of specific multimorbidity patterns in geriatric patients, such as the Induced Dependency and Falls patterns, may facilitate the early detection of vulnerability to stressors, thus helping to avoid negative health outcomes such as functional disability.