Factores asociados al abandono del tratamiento de la tuberculosis en la provincia de Granada / Factors associated to dropout of tuberculostatic treatment in the province of Granada

Objetivos. Los factores asociados al abandono del tratamiento de la tuberculosis (TBC) pueden ser muy específicos de la población y de la organización sanitaria locales. Hemos examinado los factores asociados al abandono del tratamiento de la TBC en la provincia de Granada. Sujetos y métodos. Cohorte retrospectiva de los casos registrados en Granada y notificados en el Sistema de Vigilancia Epidemiológica de Andalucía durante los años 2003-2010. Se calculó la incidencia en la población nacional y extranjera. Se realizó un análisis univariante para describir las características en ambos colectivos y se creó un modelo de regresión logística para identificar los factores asociados al abandono terapéutico. Resultados. Observamos una tendencia decreciente en la incidencia de TBC (20,47 casos en el año 2007 y 11,00 en el 2010 por 100.000 habitantes; tasa de descenso de 9,47 casos por 100.000 habitantes). La edad media de los pacientes extranjeros fue menor que la de los enfermos nacionales (30,8 años vs 46,0 años; p<0,001). Los primeros residían de forma predominante en el distrito Granada, mientras que los nacionales habitaban en el distrito Metropolitano. El porcentaje de pacientes que abandonaron el tratamiento antituberculoso fue del 12,2% y fue algo superior en los enfermos extranjeros que entre los nacionales (14 vs 10%; p=0,062). Ser varón (OR: 1,65; IC del 95%: 1,04-2,60; p=0,033), extranjero (OR: 1,72; IC del 95%: 1,04-2,83; p=0,032), residente en el distrito Nordeste (OR: 3,64; IC del 95%: 1,76-7,52; p=0,005) y/o padecer TBC extrapulmonar (OR: 1,78; IC del 95%: 1,06-3,00; p=0,029) se asociaron de forma significativa con el abandono terapéutico. Conclusiones. La incidencia de TBC en la provincia de Granada se ha reducido alrededor de 10 casos por 100.000 habitantes y año. El porcentaje de enfermos que abandonan el tratamiento TBC es considerable, siendo superior en los pacientes extranjeros que en los nacionales. El abandono del tratamiento TBC se asoció a ser varón, residir en el distrito Nordeste de Granada y padecer TBC extrapulmonar(AU)

Objectives. The factors associated to tuberculosis (TB) treatment drop-out can be very specific to the population and the local health care organization. We have studied the factors associated to TB treatment drop out in the province of Granada. Subjects and methods. A retrospective cohort study of TB cases registered in the province of Granada by the Epidemiological Surveillance System of Andalusia (SVEA) between 2003 and 2010 was carried out. Incidence was calculated in the native and foreign population. An univariate analysis was performed to describe the characteristics in both groups and a logistic regression model was used to identify factors associated to therapeutic abandonment. Results. A decreasing trend in the incidence of TB was observed, (20.47 in 2007 to 11 cases per 100,000 inhabitants in 2010, respectively. Mean age of foreign patients was lower than that of the natives (30.8 years vs. 46.0 years, P<.001). The former predominately lived in the Granada district, while the natives lived in the Metropolitan district. The percentage of patients who abandoned antituberculous treatment was 12.2%, this being somewhat higher in the foreign patients than the national ones (14% vs 10%; P=.062). Being male (OR: 1.65; 95% CI: 1.04-2.60; P=.033), foreigner (OR: 1.72; 95% CI: 1.04-2.83; P=.032), resident in the North-east district (OR: 3.64; 95% CI: 1.76-7.52; P=.005) and/or having extrapulmonary TB (OR: 1.78; 95% CI: 1.06-3.00; P=.029) were associated significantly to therapeutic abandonment. Conclusions. The incidence of TB in the province of Granada has decreased to about 10 cases per 100,000 inhabitants/year. The percentage of patients who abandon TB treatment is significant, it being higher in foreign patients than in the natives. TB treatment abandonment was associated to being a man, living in the North-east district of Granada and having extrapulmonary TB(AU)

[Factors associated to dropout of tuberculostatic treatment in the province of Granada]. / Factores asociados al abandono del tratamiento de la tuberculosis en la provincia de Granada.

OBJECTIVES: The factors associated to tuberculosis (TB) treatment drop-out can be very specific to the population and the local health care organization. We have studied the factors associated to TB treatment drop out in the province of Granada. SUBJECTS AND METHODS: A retrospective cohort study of TB cases registered in the province of Granada by the Epidemiological Surveillance System of Andalusia (SVEA) between 2003 and 2010 was carried out. Incidence was calculated in the native and foreign population. An univariate analysis was performed to describe the characteristics in both groups and a logistic regression model was used to identify factors associated to therapeutic abandonment. RESULTS: A decreasing trend in the incidence of TB was observed, (20.47 in 2007 to 11 cases per 100,000 inhabitants in 2010, respectively. Mean age of foreign patients was lower than that of the natives (30.8 years vs. 46.0 years, P<.001). The former predominately lived in the Granada district, while the natives lived in the Metropolitan district. The percentage of patients who abandoned antituberculous treatment was 12.2%, this being somewhat higher in the foreign patients than the national ones (14% vs 10%; P=.062). Being male (OR: 1.65; 95% CI: 1.04-2.60; P=.033), foreigner (OR: 1.72; 95% CI: 1.04-2.83; P=.032), resident in the North-east district (OR: 3.64; 95% CI: 1.76-7.52; P=.005) and/or having extrapulmonary TB (OR: 1.78; 95% CI: 1.06-3.00; P=.029) were associated significantly to therapeutic abandonment. CONCLUSIONS: The incidence of TB in the province of Granada has decreased to about 10 cases per 100,000 inhabitants/year. The percentage of patients who abandon TB treatment is significant, it being higher in foreign patients than in the natives. TB treatment abandonment was associated to being a man, living in the North-east district of Granada and having extrapulmonary TB.

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain).

OBJECTIVE: To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain). METHODS: A small-area ecological study was devised using the census section as the unit for analysis. 188,983 Deaths occurring in the capital cities of the Andalusian provinces and 109,478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation. MAIN RESULTS: In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities. CONCLUSIONS: Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level.

[Review of published works on Spanish youth health promotion]. / Revisión de los trabajos publicados sobre promoción de la salud en jóvenes españoles.

The objective of this study is to review the health promotion interventions on spanish youths published in Spanish in the 1995-2000 period and to describe them in accordance with the scope within which they have been carried out, the topics addressed, the methodology, the evaluation design used and the results obtained. Two hundred and fourteen intervention were identified. Illegal drugs were the topic on which the largest number of interventions were focused (29.8%), followed by alcohol (15.9%), the risk-related sexual behaviours (14.6%) and leisure time (12.6%). The activities carried out most often were: participation-based educational methods (30.7%), explanatory education methods (11.5%) and the preparation of educational materials (11%). In 80.8% of the cases, some evaluation of the health promotion activities was found. The type of evaluation employed most often was the process evaluation (73.7%), and the medium-long term results evaluation being those employed the least (2.2%). The evaluation methodologies used most often were questionnaires (28.2%). A combination of qualitative and quantitative methods was employed in 13.2% of the cases. The four interventions in which the medium-long term impact was gauged had the purpose of preventing and reducing cigarette smoking and/or drinking and or marijuana smoking, all of these initiatives achieving a reduction in cigarette smoking. In conclusion, it seems necessary to improve the design of the evaluations of the health promotion initiatives addressed to young people in Spain and to increase the dissemination of the same by way of their publication.

[Health education in schools for adults: by a teacher or health education lecture?]. / Educación para la salud en escuelas de adultos: Por medio del profesor o mediante charla de educación sanitaria?

OBJECTIVE: To compare the results of two ways of teaching the rational use of medicines to students of centres of permanent education of adults (CPEA): one taught by the normal teachers (after training by health personnel) and one through a lecture given by the health staff. DESIGN: Intervention study without randomised distribution and with a control group. SETTING: Five CPEA in an urban centre. PARTICIPANTS: 385 students and 15 CPEA teachers. INTERVENTIONS: Three groups: a) "teachers" group: consisting of students who received education on medicines in the class-room through their teachers, who had been previously trained by health personnel; b) "lecture" group: students who had received a health education lecture on medicines given by health staff; c) non-intervention group. All three groups were administered a questionnaire before and after the intervention. Both questionnaires were paired. MEASUREMENTS AND MAIN RESULTS: 248 people completed the first questionnaire and 149 the second. Significant gains in knowledge were only found in the teachers intervention group (p < 0.01; 7.8% increase in score). Dividing the students into terciles made these gains significantly greater (11.7%) in the students of the teachers group who in the first questionnaire had intermediate scores than in the students in the other groups who had intermediate scores. CONCLUSIONS: Intervention with teachers seems more effective than either a health education lecture or no intervention, especially in the improvement in knowledge of students who already had beforehand intermediate knowledge.

Educación para la salud en escuelas de adultos: ¿por medio del profesor o mediante charla de educación sanitaria? / Health education in schools for adults: through the teacher or a health education lecture?

Objetivo. Comparar los resultados de dos modalidades de enseñanza sobre uso racional de medicamentos en alumnos de centros de educación permanente de adultos (CEPA): la realizada a través del profesorado (formado previamente por los sanitarios) o mediante charla de educación impartida por el personal sanitario. Diseño. Estudio de intervención sin distribución aleatoria, con grupo control. Emplazamiento. Cinco CEPA de un núcleo urbano. Participantes. Trescientos ochenta y cinco alumnos y 15 profesores de CEPA. Intervenciones. Tres grupos: a)grupo 'profesores', constituido por alumnos que recibieron educación sobre medicamentos en el aula, mediante sus profesores, los cuales habían sido formados previamente por los sanitarios; b)grupo 'charla': alumnos que recibieron una charla de educación sanitaria sobre medicamentos impartida por los sanitarios, y c)grupo no intervención. En los 3 grupos se realizó encuesta previa y posterior a la intervención. Ambas encuestas fueron apareadas. Mediciones y resultados principales. Doscientos cuarenta y ocho sujetos completaron la primera encuesta y 149 la segunda. Sólo se encontraron ganancias significativas de conocimiento en el grupo de intervención con profesores (p < 0,01; 7,8 por ciento de ganancia de puntos relativa). Si dividíamos a los alumnos en terciles, estas ganancias eran superiores (11,7 por ciento) significativamente en los alumnos del grupo 'profesores' con puntuaciones previas intermedias en la primera encuesta, en comparación con los alumnos de puntuación intermedia de los otros grupos. Conclusiones. La intervención mediante 'profesores' parece mostrarse más efectiva que la realizada mediante 'charla de educación sanitaria' o la 'no intervención', y se diferencia de éstas en la mejoría de conocimientos en los alumnos con conocimientos previos intermedios (AU)