[Vaccination against the herpes zoster virus]. / Vacunación frente al virus del herpes zóster.

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.

[Infectious Disease Prevention Group: Update on vaccines, 2022]. / Prevención de las enfermedades infecciosas. Actualización en vacunas PAPPS 2022.

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).

[Infectious Disease Prevention Group. Update on vaccines, 2020]. / Prevención de las enfermedades infecciosas. Actualización en vacunas, 2020.

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.

[Inappropriate actions in adult vaccination]. / Actuaciones inadecuadas en vacunación de adultos.

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.

[Effect of non-pharmacological preventive measures on the incidence of respiratory and gastrointestinal pathologies]. / Efecto de las medidas preventivas no farmacológicas en la incidencia de patología respiratoria y gastrointestinal.

OBJECTIVE: The use of non-pharmacological preventive measures during the COVID-19 pandemic has helped to reduce the incidence of multiple airborne or contact diseases. The objective of this paper was to evaluate the impact that all preventive measures have had on the transmission of different microorganisms, both by respiratory and contact transmission. METHODS: We compared the incidence of different infectious episodes coded with the CIAP-2 code (International Classification of Primary Care second edition of the WONCA International Classification Committee) collected from the computerized history of primary care, both with respiratory tract and digestive tract involvement, in the period from March 2018 to February 2020 (pre-pandemic period) and from March 2020 to February 2022 (pandemic period). The data corresponded to the entire region, with an estimated average population for the four years of 650,000 people. The statistical treatment of the data consisted of a descriptive analysis with the calculation of absolute values and percentages. Rates were calculated and compared using data provided by the National Institute of Statistics as a denominator. The P was obtained by statistical comparison by the exact method. A comparison of rates was made. RESULTS: The incidence in the number of CIAP-2 episodes studied, both corresponding to respiratory and gastrointestinal pathologies, comparing the period March 2018-February 2020 with the period March 2020-February 2022 decreased by 65.81%, from 534,439 cases to 182,707. CONCLUSIONS: The preventive measures applied during the pandemic produce a significant decrease in pathology involving the respiratory or the digestive tract.

OBJETIVO: El uso de medidas preventivas no farmacológicas durante la pandemia de la COVID-19 ayudó a reducir la incidencia de múltiples enfermedades de transmisión aérea o por contacto. El objetivo de este trabajo fue evaluar el impacto que habían tenido todas las medidas preventivas en la transmisión de diferentes microorganismos, tanto por transmisión respiratoria como por contacto. METODOS: Comparamos la incidencia de diferentes episodios infecciosos codificados con el código CIAP-2 (Clasificación Internacional de Atención Primaria, segunda edición, del Comité de Clasificación Internacional WONCA-World Organization of Family Doctors) recogidos de la historia informatizada de Atención Primaria, tanto con afectación del tracto respiratorio como del tracto digestivo, en el período de marzo de 2018 a febrero de 2020 (período prepandemia) y de marzo de 2020 a febrero de 2022 (período de pandemia). Los datos correspondieron a toda la región, con una población media estimada para los cuatro años de 650.000 personas. El tratamiento estadístico de los datos consistió en un análisis descriptivo con el cálculo de valores absolutos y porcentajes. Se calcularon y compararon tasas tomando como denominador los datos proporcionados por el Instituto Nacional de Estadística. La P fue obtenida mediante comparación estadística por el método exacto. Se realizó una comparación de tasas. RESULTADOS: La incidencia en el número de episodios CIAP-2 estudiados, tanto correspondientes a patología respiratoria como gastrointestinal, comparando el periodo de marzo de 2018-febrero de 2020 con el periodo marzo de 2020-febrero de 2022, disminuyó en un 65,81%, pasando de 534.439 casos a 182.707. CONCLUSIONES: Las medidas preventivas aplicadas durante la pandemia producen una disminución significativa de la patología del tracto respiratorio o digestivo.

Prevalence of polypharmacy and associated factors in older adults in Spain: Data from the National Health Survey 2017. / Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017.

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.

Vacunación frente al virus del herpes zóster / Vaccination against the herpes zoster virus

Objetivo: Revisar las últimas evidencias publicadas respecto a la vacuna utilizada en nuestro país frente al virus del herpes zóster, desglosadas por eficacia, eficiencia, efectividad y seguridad vacunal. Incluir las recomendaciones vacunales actuales. Diseño: Revisión secundaria. Revisión cualitativa descriptiva. Revisión con el término de búsqueda de «vacuna herpes zóster» y «vacuna recombinante adyuvada de subunidades HZ/su». Estudio observacional retrospectivo. Fuentes de datos: Embase, Medline y Google Scholar. Selección de estudios: Criterio de búsqueda con los términos «Shingrix vaccine» y «Adjuvanted Herpes Zoster Subunit Vaccine». Periodo de búsqueda 2013-2023. Se seleccionaron los estudios tipificados como ensayos clínicos o ensayos clínicos randomizados. Se evaluaron 21 estudios publicados. No hubo exclusiones. Resultados: Los estudios evaluados se mostraron coherentes y en todos ellos la eficacia en personas adultas tanto para prevenir la reactivación viral como para evitar complicaciones estuvo por encima del 80%. La efectividad vacunal con 2 dosis también se mostró estar por encima del 80%. Los estudios coste/efectividad fueron siempre favorables en personas adultas, pacientes inmunodeprimidos y personas con enfermedad crónica. La seguridad de la vacuna fue evaluada en los estudios pivotales y en los estudios poscomercialización realizados (aún escasos por el corto periodo de tiempo estudiado). El perfil de seguridad de la vacuna es muy alto, y en el caso de los efectos adversos graves su frecuencia fue similar a placebo. Conclusiones: Disponemos de una vacuna efectiva y segura frente al virus del herpes zóster, que nos permite proteger a los grupos de población más vulnerables frente al virus.(AU)

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.(AU)

Assessing variability in compliance with recommendations given by the International Diabetes Federation (IDF) for patients with type 2 diabetes in primary care using electronic records. The APNA study.

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.

Multimorbidity Patterns in Hospitalized Older Patients: Associations among Chronic Diseases and Geriatric Syndromes.

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.

Prevención de las enfermedades infecciosas. Actualización PAPPS en vacunas 2018 / No disponible

No disponible

Actuaciones inadecuadas en vacunación de adultos / Inappropriate actions in adult vaccination

Las vacunas constituyen uno de los pilares fundamentales de salud pública, mejorando la calidad y la esperanza de vida de las personas. El calendario vacunal debe extenderse a toda la vida de una persona y en los últimos años la vacunación del adulto se ha hecho más compleja y requiere un mayor conocimiento del mismo. El papel del personal sanitario de atención primaria resulta fundamental para conseguir mejorar las coberturas vacunales dada la cercanía y confianza del paciente. Es importante conocer las recomendaciones en materia de vacunación por motivos de edad, patología de base, circunstancias laborales o cualquier otro factor que pueda poner en riesgo la salud y sea prevenible mediante vacunación y a la vez tener criterios claros de qué no se debe hacer en este campo. Un exceso en vacunación puede suponer un riesgo para la salud del paciente y un despilfarro de recursos

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

Prevención de las enfermedades infecciosas / No disponible

No disponible

Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017 / Prevalence of polypharmacy and associated factors in older adults in Spain: Data from the National Health Survey 2017

Fundamento y objetivo: Estimar la prevalencia de polifarmacia e hiperpolifarmacia en adultos mayores no institucionalizados en España y analizar los factores asociados. Material y métodos: Estudio transversal a partir de datos de la Encuesta Nacional de Salud de España 2017, con participantes de 65 años o más. Se estimó la prevalencia de polifarmacia (≥5 medicamentos) e hiperpolifarmacia (≥10), y la asociación con diversos factores mediante regresión logística multivariante. Se realizó un análisis de sensibilidad considerando el posible consumo de más de un fármaco para la misma indicación (politerapia). Resultados: Se incluyeron 7.023 participantes, con edad media de 76,0 (desviación estándar [DE] 7,6) años, 59,4% mujeres y consumo medio de 3,3 (DE 2,2) medicamentos por persona. La prevalencia de polifarmacia fue de 27,3% (intervalo de confianza del 95%: 26,2-28,3) y la de hiperpolifarmacia de 0,9% (intervalo de confianza del 95%: 0,7-1,1). El análisis de sensibilidad estimó que la prevalencia podría ascender al menos a un 37,5% y la media a 3,9 (DE 2,5) al considerar la politerapia. Los factores que más se asocian a la polifarmacia fueron el número de enfermedades crónicas, el grado de dependencia para las actividades básicas de la vida diaria, el estado de salud percibido o los contactos con el sistema sanitario; y de forma inversa los déficits sensoriales y la incontinencia. Conclusiones: La prevalencia de polifarmacia en adultos mayores en atención primaria continúa aumentando, y podría estar ampliamente infraestimada. Además de la pluripatología, factores como la capacidad funcional o los síndromes geriátricos, fundamentales en personas mayores, modulan los hábitos de consumo y prescripción de medicamentos en esta población

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

Prevención de las enfermedades infecciosas / Prevention of infectious diseases

No disponible