Influenza vaccination coverages among high risk subjects and health care workers in Spain. Results of two consecutive National Health Surveys (2011-2014).

OBJECTIVES: We aim to describe influenza vaccination coverage for the Spanish population using data from two consecutive nation-wide representative health surveys. The data was analysed by high risk groups, health care workers (HCWs) and immigrants. Also, coverage trends were analysed. MATERIAL AND METHODS: The 2011/12 Spanish National Health Survey (N=21,007) and the 2014 European Health Interview Survey for Spain (N=22,842) were analysed. Influenza vaccination status was self-reported. Time trends for were estimated by a multivariate logistic regression model. RESULTS: Overall vaccination uptake was similar in 2011/12 and 2014, 19.1% and 18.9%, respectively, (p>0.05). 47% of the subjects surveyed were in the groups for which vaccination was recommended with coverages of 41.1% in 2011/12 and 40% in 2014 (p>0.05). In both surveys, uptake among subjects with a chronic disease was three times higher than uptake in subjects who did not have these diseases. In 2011/12 and 2014, 20% and 27.6% of health workers were vaccinated. Subjects born outside Spain were vaccinated less frequently than Spanish-born subjects (9.3% vs 20.4% and 8.9% vs 20%). Within the diseases studied, the best uptake was for patients with heart disease (52.5% in 2011/12 and 51.1% in 2014) and patients with diabetes (50.5% and 51.8%). Multivariate analysis showed that older age, having a chronic disease or being a HCW increases the possibility of being vaccinated whereas being born outside Spain decreased it. CONCLUSIONS: Seasonal influenza vaccine uptake rates in the recommended target groups, patients with chronic conditions and health care workers, in Spain are unacceptably low and seem to be stable in the post pandemic seasons. This finding should alert health authorities to the need to work directly with health care providers on the indications for this vaccine and to study strategies that make it possible to increase vaccination uptake.

Comparison of self-report influenza vaccination coverage with data from a population based computerized vaccination registry and factors associated with discordance.

OBJECTIVES: We aim to compare influenza vaccination coverages obtained using two different methods; a population based computerized vaccination registry and self-reported influenza vaccination status as captured by a population survey. METHODS: The study was conducted in the Autonomous Community of Madrid (ACM), Spain, and refers to the 2011/12 influenza vaccination campaign. Information on influenza vaccination status according to a computerized registry was extracted from the SISPAL database and crossed with the electronic clinical records in primary care (ECRPC). Self-reported vaccine uptake was obtained from subjects living in the ACM included in the 2011-12 Spanish National Health Survey (SNHS). Independent study variables included: age, sex, immigrant status and the presence of high risk chronic conditions. Vaccination coverages were calculated according to study variables. Crude and adjusted prevalence ratios were computed to assess concordance. RESULTS: The study population included 5,245,238 adults living in the ACM in year 2011 with an individual ECRPC and 1449 adult living the ACM and interviewed in the SNHS from October 2011 to June 2012. The weighted vaccination coverage for the study population according to self-reported data was 19.77% and 15.04% from computerized registries resulting in a crude prevalence ratio (cPR) of 1.31 (95% CI 1.20-1.44) so self-reported data significantly overestimated 31% the registry coverage. Self-reported coverages are always higher than registry based coverages when the study population is stratified by the study variables. Self-reported overestimation was higher among men than women, younger age groups, immigrants and those without chronic conditions. Both methods provide the most concordant estimations for the target population of the influenza vaccine. CONCLUSIONS: Self-report influenza vaccination uptake overestimates vaccination registries coverages. The validity of self-report seems to be negatively affected by socio-demographic variables and the absence of chronic conditions. Possible strategies must be considered and implemented to improve both coverage estimation methods.

Negative trends from 2008/9 to 2011/12 seasons in influenza vaccination coverages among high risk subjects and health care workers in Spain.

OBJECTIVES: We aim to describe influenza vaccination coverage for the Spanish population across four consecutive campaigns (2008/2009 to 2011/2012). The data was analyzed by high risk groups and health care workers (HCWs). Also, coverage trends were analyzed to assess uptake in post-pandemic seasons. METHODS: We used data from two nation-wide representative health surveys namely the 2009/10 European Health Interview Survey for Spain (N=22,188) and the 2011-12 Spanish National Health Survey (N=21,007) Influenza vaccination status was self-reported. We analyzed influenza vaccine coverage by age, sex, number of chronic conditions, being a heath care worker (HCWs) and nationality. Time trends for campaigns among high risk groups were estimated by a multivariate logistic regression model. RESULTS: We analyzed data from 43,072 subjects aged ≥ 16 years. As a whole, coverage decreased by 3.31% (22.57-19.26%) between the 2008/2009 and 2011/2012 campaigns with a significant decreasing trend (OR 0.92; 95% CI: 0.90-0.94). Coverage in people under 60 years with a chronic disease decreased significantly (OR 0.92: 95% CI: 0.85-0.99) during the analyzed period from 21.02% in 2008/2009 to 17.40% in 2011/2012. Among HCWs, the highest influenza vaccination coverage was achieved in 2009/2010 (31.08%) in the latest campaign coverage has almost halved (17.88%). For the 2011/2012 season and for all age groups the variables associated with a higher probability of having received the influenza vaccine were older age and presence of associated chronic conditions. Among those aged ≥ 60 years, immigrants had lower uptake (OR 0.60; 95% CI: 0.32-0.99). CONCLUSIONS: Seasonal influenza vaccine uptake rates in the recommended target groups in Spain are unacceptably low and seem to be decreasing in the post pandemic seasons. Further studies are necessary to precisely identify reasons for non-compliance and barriers to influenza vaccination. Meanwhile urgent strategies to improve seasonal vaccination uptake must be discussed and implemented.

Coverage and predictors of vaccination against 2012/13 seasonal influenza in Madrid, Spain: analysis of population-based computerized immunization registries and clinical records.

We aim to determine 2012-13 seasonal influenza vaccination coverage. Data were analyzed by age group and by coexistence of concomitant chronic conditions. Factors associated with vaccine uptake were identified. We also analyze a possible trend in vaccine uptake in post pandemic seasons. We used computerized immunization registries and clinical records of the entire population of the Autonomous Community of Madrid, Spain (6,284,128 persons) as data source. A total of 871,631 individuals were vaccinated (13.87%). Coverage for people aged ≥ 65 years was 56.57%. Global coverage in people with a chronic condition was 15.7% in children and 18.69% in adults aged 15-59 years. The variables significantly associated with a higher likelihood of being vaccinated in the 2012-13 campaign for the age groups studied were higher age, being Spanish-born, higher number of doses of seasonal vaccine received in previous campaigns, uptake of pandemic vaccination, and having a chronic condition. We conclude that vaccination coverage in persons aged<60 years with chronic conditions is less than acceptable. The very low coverage among children with chronic conditions calls for urgent interventions. Among those aged ≥60 years, uptake is higher but still far from optimal and seems to be descending in post-pandemic campaigns. For those aged ≥65 years the mean percentage of decrease from the 2009/10 to the actual campaign has been 12%. Computerized clinical and immunization registers are useful tools for providing rapid and detailed information about influenza vaccination coverage in the population.

Hospitalizations from pandemic Influenza [A(H1N1)pdm09] infections among type 1 and 2 diabetes patients in Spain.

OBJECTIVES: To describe and analyze the clinical characteristics and outcomes for all patients with diabetes who were hospitalized with laboratory-confirmed A(H1N1)pdm09 infections in Spain during 2009. METHODS: Observational retrospective study using data collected by the Spanish National Hospital Discharge Database. We selected all admissions with diagnosis ICD-9-CM code 488·1 [A(H1N1)pdm09]. Discharges were grouped as follows: no diabetes, Type1 and Type 2 diabetes. Underlying medical conditions and risk factors included all those that constitute an indication for annual influenza vaccination, pregnancy, and obesity. The outcome variables analyzed were in-hospital case fatality risk, length of hospital stay, and costs. RESULTS: The total number of persons hospitalized with A(H1N1)pdm09 was 11,499. Of those, 97 suffered Type 1 and 936 Type 2, giving an overall prevalence of diabetes of 9%. The most common underlying medical condition among Type 2 subjects was obesity (26·8%), and for Type 1 renal disease (10·3%). In-hospital mortality was 2·1% among Type 1 patients, 3·8% among Type 2 patients, and 2·3% among non-diabetics; after multivariate analysis, diabetes was not a factor independently associated with dying during hospitalization for A(H1N1)pdm09. Independent factors increasing the risk of death among diabetic patients included age (OR 1·03; 95% CI1·01-1·05), hematological disorders (OR 3·49; 95% CI, 1·46-8·37), and obesity (OR 1·88; 95% CI1·07-3·92). CONCLUSIONS: Among individuals hospitalized in Spain with A(H1N1)pdm09 infections, the age-specific prevalence of diabetes was higher than the general population in most age groups. The results of multivariate analysis suggest that possibly concomitant conditions such as obesity increase the risk of dying from the infection, but not diabetes itself.

Are age-based strategies effective in increasing influenza vaccination coverage?: the Spanish experience.

We investigated the effectiveness of applying age-based strategies to improve influenza vaccination coverage in Spain. We described and compared influenza vaccination coverage from 2003 to 2010 between those Spanish autonomous regions (AR) that lowered the age limit to 60 y and those regions that maintained the limit at 65 y. We used data collected from two surveys covering a representative sample of the Spanish population aged ≥ 16 y [Spanish National Health Survey (SNHS) 2003/2004 and the European Health Survey for Spain (EHSS) 2009/2010]. The study population (persons aged ≥ 60 y) comprised 7,496 persons in the SNHS and 7,686 in the EHSS. In 2010, those AR which had reduced the age limit had higher coverage for all age groups analyzed-regardless of the presence of associated chronic conditions-than AR which continued vaccination for those ≥ 65 y. The greatest differences appeared in individuals aged 60 to 64 y (36.9% vs. 24.4% for individuals without chronic conditions, 59.1% vs. 52.9% for those with chronic conditions, and 43.3% vs. 32.3% for the entire age group). Multivariate analysis showed that those AR which lowered the age limit increased total coverage for all age groups, specifically among individuals with chronic conditions aged 60 to 64 y (IRR 1.18; 95% CI, 1.01-1.54) and ≥ 65 y (IRR 1.07; 95% CI, 1.00-1.14). No significant changes were observed over time for the AR that continued vaccinating people aged ≥ 65 y. Our results suggest that age-based strategies are effective for improving influenza vaccination coverage in Spain.

Pandemic influenza hospitalization in Spain (2009): incidence, in-hospital mortality, comorbidities and costs.

Based on data drawn from the national hospitalization discharge registry, we sought to describe the clinical and epidemiological characteristics of patients hospitalized with pandemic influenza H1N1 in Spain in 2009. Authors calculated national rates of hospitalization stratified by age and analyzed co-morbidities, in hospital mortality, average length of stay and associated medical costs. A total of 11,449 patients were hospitalized (24.9/100,000 inhabitants). Median age was 34 y and 50.28% were male. The highest incidence was observed in the group from 0 to 14 y (42.3/100000 inhabitants), 27.7% of hospitalized women of childbearing age were pregnant and overall in hospital mortality reached 2.46%. The average length of stay was 5 d, median costs per admission was €2,152 and total cost was €35.4 million. Among those patients, 5,791 (50.6%) had an underlying chronic disease: asthma (15.36%), diabetes (9.02%), obesity (8.47%), cancer (4.47%), epilepsy (2.24%), and HIV (2.22%). Suffering a chronic condition was an independent risk factor for dying (OR 13.31 95% for 0-14 y and OR 3.27 for 15-64 y). We conclude that hospitalization was higher in infants and in young adults with associated co-morbidities. Suffering a chronic condition increased the risk of dying as the age decreased. This information will be helpful to prepare vaccination strategies against next pandemic threats.

In-hospital mortality rates after CABG by autonomous regions in Spain.

PURPOSE: The paper's purpose is twofold: to provide a predictive model for estimating in-hospital mortality rates after coronary artery bypass grafting (CABG) in Spanish autonomous regions (AR) after adjusting relevant factors; and to determine whether there is a difference between expected and observed mortality rates. DESIGN/METHODOLOGY/APPROACH: All patients registered in a minimum basic data set (MSBD) undergoing CABG between 2000 and 2004 were selected. After bivariate analysis to explore associations between in-hospital death and other variables, a multivariate analysis using logistic regression was conducted. The predictive model was evaluated using calibration and discrimination techniques. Standardized mortality ratios by AR were calculated. FINDINGS: The expected Spanish in-hospital mortality rate after CABG was 7.68 and the observed rate was 7.69 deaths per 100 operations. Discrimination obtained with the model resulted in an area under the curve of 0.70 (95 per cent CI, 0.69-0.71). When each AR's mortality rate is calculated and compared with the observed rate, some ARs present an observed mortality rate higher or lower than the expected rate according to adjusted variables in the model. RESEARCH LIMITATIONS/IMPLICATIONS: The MSBD registry does not contain patients' critical data, such as arterial damage severity, or in which hospital procedures were performed. PRACTICAL IMPLICATIONS: There are factors related to individual patient variation, financial resources or healthcare quality in different ARs, which should be investigated in follow-up studies. ORIGINALITY/VALUE: The paper shows that, although the global expected mortality rate is almost the same as the observed Spanish mortality rate, this similarity disappears when AR rates are compared.

Developing a programme for medication reconciliation at the time of admission into hospital.

The aim of this article is to describe the methods used to develop the medication reconciliation programme implemented in a tertiary care hospital, and to discuss the main problems encountered and lessons learned during the process. A quasi-experimental study was carried out, analysing discrepancies between routine medication and drugs prescribed in the hospital, before and after an electronic reconciliation tool was introduced at admission. This tool was integrated into the computerized provider order entry system. The implementation of the electronic reconciliation tool has shown a reduction of the rate of discrepancies, decreasing from 7.24% (CI 95% 6.0-8.5) before the intervention to 4.18% (CI 95% 3.2-5.1) afterwards. Projects like this are costly, but this study has made it possible to detect numerous areas where interventions could be useful and proved the importance of a medication reconciliation programme.

Vaccination against 2008/2009 and 2009/2010 seasonal influenza in Spain: coverage among high risk subjects, HCWs, immigrants and time trends from the 2005/2006 campaign.

Influenza continues to be a very important cause of morbidity, mortality and a large number of hospitalizations each year, however the compliance with vaccine uptake is low and has barely varied over time among health care workers (HCWs) and people under 65 years of age suffering a chronic condition. Based on data from two nation-wide representative health surveys namely the 2006 Spanish National Health Survey and the 2009 European Health Interview Survey for Spain the aim of this study is to describe influenza vaccination coverage and time trends for the Spanish population as a whole and in recommended populations in four vaccination campaigns: 2005/2006, 2006/2007, 2008/2009 and 2009/2010. Our results show an increasing trend (OR 1.03) in seasonal influenza vaccine coverage for the total population from 2005/2006 to 2009/2010, especially in HCWs (21.8% in 2005/2006; 31.1% in 2009/2010). Coverage in people under 60 with a chronic disease remains low and did not vary significantly during the analyzed period. Immigrants presented a significantly lower probability of having received the influenza vaccine than indigenous people in the 2008/2009 campaign. Different strategies need to be implemented in order to achieve higher coverage levels in these at-risk populations.

Coverage and predictors of influenza vaccine uptake among adults aged 16 to 59 years suffering from a chronic condition in Madrid, Spain.

Based on data drawn from the 2007 Madrid Regional Health Survey (MRHS), we sought to: estimate influenza vaccination coverage among people ages 16-59 years old suffering from chronic conditions (cardiovascular diseases, diabetes, respiratory diseases, kidney diseases, malignant neoplasm and fibromyalgia) living in the region of Madrid and to determine which socio-demographic and health-related variables were associated with the likelihood of being vaccinated. We analyzed data from 8,337 subjects. The reply to the question "Were you vaccinated against influenza in the last vaccination campaign?" was taken as the dependent variable. Coverage was calculated for different specific diseases that constitute an indication for vaccination. Independent variables included socio-demographics, health-related and use of health care services variables. The proportion of vaccinated adults suffering from any chronic condition in 2007 was 23.5%. Very low coverages were found among kidney diseases (16.1%), malignant neoplasm (10.9%) and fibromyalgia (14.2%) sufferers. The variables which increased the likelihood of being vaccinated among adults suffering any chronic condition were: higher age, being Spanish, absence of a smoking habit and having primary studies. We conclude that influenza vaccination coverage among people living in Madrid and suffering from a chronic condition is unacceptably low, thereby making it necessary for strategies to be urgently implemented aimed at improving the use of influenza vaccine.

Effectiveness of age-based strategies to increase influenza vaccination coverage among high risk subjects in Madrid (Spain).

We aim to assess the effectiveness of age-based strategies to increase influenza vaccination coverage among high risk subjects. To do so, we describe and compare the influenza vaccination coverage in the 2006/2007 campaign between the Autonomous Community of Madrid (ACM), where in year 2005 the recommendation was extended by 5 years to cover all those aged 60 and over, and other regions of Spain where the universally recommended age was 65 years and above. We used individualized secondary data provided by two surveys carried out in 2007 in ACM and in the rest of Spain. The total number of subjects included in the study was 21,948. For the 60-64 years age group influenza vaccination coverage was significantly higher 40.1% (CI 95% 36.4-43.8) in ACM residents than among residents in the Rest of Spain 29.1% (CI 95% 24.5-33.7). The difference in vaccine uptake was even greater, 59% (CI 95% 51.8-66.2) vs. 43.5%(CI 95% 34.3-52.7), when we compared subjects who suffered a chronic condition, which represents an indication for the anti-influenza vaccination. The results of the multivariate analysis show that the probability of a subject aged 60-64 living in ACM of being vaccinated was almost two times higher (OR 1.95 CI 95% 1.46-2.61) than a person of the same age who lived in a region of Spain where the universal recommendation for influenza vaccine started at 65 years. In conclusion, the available evidence indicates the effectiveness of age-based strategies to increase influenza vaccination coverage among high risk subjects aged 60-64 years in our population.

Coverage and predictors of vaccination against 2009 pandemic H1N1 influenza in Madrid, Spain.

This study aimed to ascertain the coverage of vaccination against pandemic influenza in individuals aged over 6 months for whom vaccination is indicated due to a chronic health condition using as data source clinical information recorded in the primary care clinical history. Of all those for whom vaccination was indicated (1,114,632), 14.6% (162,616) finally received the vaccine. There were statistically significance differences in coverage for sex (16.5% for men and 13.1% for women), age groups (5% for people under 30 years and 20% for those over 60), number of chronic conditions (11.1% for one condition, 22.5% for two conditions, and 31.3% for three or more conditions) and depending on the chronic health condition considered. The probability of being vaccinated increased with male sex, age, number of indications, type of medical card (lower among no income) and having been vaccinated against 2009 season influenza. We concluded that the coverage finally reached for those people with an indication due to chronic health condition in the H1N1 campaign was much lower than expected and wished. It is essential to investigate the different factors that could have intervened in the behavior of the population so that more efficient approaches can be adopted in future influenza pandemics.

Development and validation of a questionnaire to assess satisfaction with hospital emergency care.

OBJECTIVE: To develop and validate a questionnaire to determine satisfaction with the hospital emergency department. DESIGN: Cross-sectional study to validate a telephone questionnaire designed in Spanish by a panel of experts. SETTING: The emergency department of Hospital Gregorio Marañón, a tertiary level hospital of the Spanish national health system. PARTICIPANTS: A sample of 651 emergency department patients completed the questionnaire. MAIN OUTCOME MEASURES: The psychometric properties of the questionnaire were evaluated; namely, construct, criterion validity, predictive validity and internal consistency. RESULTS: Two dimensions--comfortable service and personalised service--were identified from the exploratory factor analysis, and these accounted for 63% of the variance. Both factors showed a positive correlation with the global assessment items 'global satisfaction with the attention received in the emergency ward' and 'Would you recommend this emergency department?' The predictive validity of the questionnaire was assessed by means of discriminant analysis, which showed that 66.7% of patients were correctly classified. Internal consistency measured by Cronbach's alpha resulted in a value greater than 0.80 for both dimensions. CONCLUSIONS: This questionnaire fulfils the necessary psychometric properties to be considered a useful and reliable tool for measuring patient satisfaction with hospital emergency services.

Vaccination coverage against 2009 seasonal influenza in chronically ill children and adults: analysis of population registries in primary care in Madrid (Spain).

Using electronic clinical records in primary care (ECRPC) of the entire population living in the Autonomous Community of Madrid, Spain (5,102,568 persons) as a data source, this study aimed to ascertain seasonal anti-influenza vaccination coverage in the chronically ill at-risk children (aged 6 months to 14 years) and adults (15-59 years). Of the total population aged 6 months to 59 years with a medical card in the Autonomous Community of Madrid, 10.3% (n=528,095 patients) had a chronic condition for which anti-influenza vaccination was indicated. In children with chronic conditions, coverage was 27.1% and it was particularly high among diabetics (41.1%) and particularly low in children with "other pulmonary conditions" (15.2%). In adults with chronic conditions, coverage was 22.1% and in patients with diagnosed heart failure coverage reached 39.1%; with the lowest coverage was observed in patients suffering neuromuscular diseases (12.8%). The factors associated with vaccination among children and adults suffering a chronic condition included: having been vaccinated during the previous campaign, national origin (lower among immigrants), and having more than one chronic condition. In conclusion, our study shows that vaccination coverage for 2009 seasonal influenza in children and adults with chronic conditions living in Madrid (Spain) was less than acceptable.

La salud y sus determinantes en la población inmigrante de la Comunidad de Madrid / Health and its determinants in the immigrant population of the region of Madrid

ObjetivosDescribir el estado de salud y sus determinantes en los inmigrantes residentes en la Comunidad de Madrid y compararlos con los de la población autóctona.Material y métodosEstudio descriptivo transversal a partir de los datos de la Encuesta Regional de Salud de Madrid 2007 (n = 12.190). Se clasifica a los individuos en autóctonos o nacidos en países de renta media-baja con menos o más de 5 años de residencia en España. Los resultados se ajustan por edad. Las proporciones y las medias de las variables se comparan con el test de ji al cuadrado y regresión lineal.ResultadosComparados con los autóctonos, los inmigrantes son más jóvenes, desarrollan preferentemente trabajos manuales precarios que no se corresponden con su nivel educativo, y disponen de menos ingresos y menos espacio en sus viviendas. Tanto hombres como mujeres fuman y beben menos, pero las mujeres presentan mayores prevalencias de sobrepeso (un 10% más) y sedentarismo. La adherencia al cribado citológico y de la tensión arterial es hasta un 16% menor. Los hombres y las mujeres con menor tiempo de residencia acuden menos a las consultas de atención primaria y a urgencias, al contrario que los que llevan más tiempo en España. Las mujeres con 5 o más años de estancia tienen una salud autopercibida y salud mental algo peores. Los inmigrantes presentan enfermedades crónicas similares a las de la población autóctona, pero con menores prevalencias.ConclusionesEl estado de salud de la población inmigrante no es tan desfavorable como cabría esperar en función de la mayor prevalencia de determinantes de salud perjudiciales(AU)

ObjectivesTo describe health status and its determinants in immigrants living in the region of Madrid and to compare these factors with those in the native-born population.Material and methodsWe performed a descriptive, cross-sectional study based on data from the Madrid Regional Health Survey 2007 (n=12,190). Subjects were classified as native-born or immigrants born in medium-to-low-income countries and with less or more than 5 years of residence in Spain. The results were adjusted for age. Proportions and means were compared through the ji square test and linear regression.ResultsCompared with native-born residents, immigrants were younger, carried out mainly precarious manual jobs that did not match their educational level and had a lower income and less space in their dwellings. Both immigrant men and women smoked and drank less, but women showed a higher prevalence of overweight (10% more) and physical inactivity. Adherence to smear test and blood pressure screening was up to a 16% lower. Attendance at primary care and emergency facilities was less frequent in men and women with less residence time than in those with longer residence in Spain. Self-perceived health and mental health were worse in women with 5 or more years of residence. Chronic diseases were similar in both populations but were less prevalent in immigrants.ConclusionsImmigrants’ health status is not as unfavorable as could be expected from the higher prevalence of harmful determinants of health(AU)

[Health and its determinants in the immigrant population of the region of Madrid]. / La salud y sus determinantes en la población inmigrante de la Comunidad de Madrid.

OBJECTIVES: To describe health status and its determinants in immigrants living in the region of Madrid and to compare these factors with those in the native-born population. MATERIAL AND METHODS: We performed a descriptive, cross-sectional study based on data from the Madrid Regional Health Survey 2007 (n=12,190). Subjects were classified as native-born or immigrants born in medium-to-low-income countries and with less or more than 5 years of residence in Spain. The results were adjusted for age. Proportions and means were compared through the ji square test and linear regression. RESULTS: Compared with native-born residents, immigrants were younger, carried out mainly precarious manual jobs that did not match their educational level and had a lower income and less space in their dwellings. Both immigrant men and women smoked and drank less, but women showed a higher prevalence of overweight (10% more) and physical inactivity. Adherence to smear test and blood pressure screening was up to a 16% lower. Attendance at primary care and emergency facilities was less frequent in men and women with less residence time than in those with longer residence in Spain. Self-perceived health and mental health were worse in women with 5 or more years of residence. Chronic diseases were similar in both populations but were less prevalent in immigrants. CONCLUSIONS: Immigrants' health status is not as unfavorable as could be expected from the higher prevalence of harmful determinants of health.

Evolución de la mortalidad por cáncer de cérvix por regiones en España entre 1975 y 2004 / Temporal trends of cervical cancer mortality rates among regions in Spain: 1975–2004

Fundamento y objetivo: Estimar la tendencia temporal de las tasas de mortalidad por cáncer de cérvix en las diferentes comunidades autónomas (CC. AA.) de España. Material y método: Se utilizaron los registros individuales de defunciones certificadas como cáncer de cérvix, endometrio y útero inespecífico (UI) (códigos 180, 182 y 179 en la Clasificación Internacional de Enfermedades [CIE] octava y novena ediciones, y códigos C53, C54 y C55 en la CIE décima edición), así como las estimaciones anuales de población femenina por edad y las CC. AA. del Instituto Nacional de Estadística. Para corregir los sesgos debidos a la mejora de la certificación, se reasignaron las muertes de UI. Se calcularon tasas estandarizadas por edad, usando la población estándar europea, para cada año y CC. AA. Se estimó el porcentaje de cambio anual (PCA) y la presencia de puntos de cambio en las tendencias mediante un análisis de regresión joinpoint. Resultados: En general, la mortalidad sigue un patrón descendente en España, aunque hay importantes diferencias entre las CC. AA. Cataluña (PCA de −4,55; intervalo de confianza [IC] del 95%: −4,85 a −4,23) y Navarra (PCA de −4,31; IC del 95%: −5,85 a 2,75) han mostrado una reducción más acusada en sus cifras de mortalidad; mientras que el menor descenso se observa en Madrid (PCA de −2,32; IC del 95%: −2,93 a 1,70), Canarias (PCA de −2,36; IC del 95%: −3,00 a −1,72) y Galicia (PCA de −2,60; IC del 95%: −3,07 a −2,10). Conclusiones: La mortalidad por cáncer de cérvix está disminuyendo en España. La diferente velocidad de descenso en las CC. AA. podría relacionarse con la frecuencia de exposición al virus del papiloma humano, con diferencias en la implantación de los programas de cribado y con factores socioeconómicos (AU)

Background and objectives: To estimate the temporal trend of the cervical cancer mortality rates among Autonomous Communities (AACC) in Spain. Material and methods: Individual death cases recorded as “cervical cancer’, ‘corpus uteri cancer’ and ‘uterus, site unspecified’–codes 180,182 and 179 in ICD8 and 9 and codes C53, C54 and C55 in ICD 10- were obtained, as well as women population estimates broken down by age and AACC from the Spanish National Institute for Statistics (INE). To correct distortions due to increasing improvement in death certification, deaths from ‘uterus, site unspecified’ were reallocated. Using the European standard population, age-adjusted mortality rates were calculated per year and AACC. Annual percent change (APC) and joinpoints, if existed, were estimated using Joinpoint regression analysis for all women and two broad age-groups: younger and older than 50 years. Results: Cervical cancer mortality rates follow a decreasing trend, with important differences among AACC. Catalonia (PCA −4.55; IC95%: −4.85,−4.23), and Navarra (PCA −4.31; IC95% −5.85,−2.75) decreased more their annually mortality rates than Madrid (PCA −2.32; IC95%: −2.93, −1.70), Canarias (PCA -2,36; IC95% −3.00,−1.72) or Galicia (PCA −2.60; IC95% −3.07,−2.10), which showed the less marked decreased. Conclusions: Cervical cancer mortality is decreasing in Spain. Trend differences among CCAA could be related to organizational differences and coverages of their screening programs, disparities in exposure to HPV and socioeconomic level as well as to differences in socioeconomic factors (AU)

[Temporal trends of cervical cancer mortality rates among regions in Spain: 1975-2004]. / Evolución de la mortalidad por cáncer de cérvix por regiones en España entre 1975 y 2004.

BACKGROUND AND OBJECTIVES: To estimate the temporal trend of the cervical cancer mortality rates among Autonomous Communities (AACC) in Spain. MATERIAL AND METHODS: Individual death cases recorded as "cervical cancer', 'corpus uteri cancer' and 'uterus, site unspecified' -codes 180,182 and 179 in ICD8 and 9 and codes C53, C54 and C55 in ICD 10- were obtained, as well as women population estimates broken down by age and AACC from the Spanish National Institute for Statistics (INE). To correct distortions due to increasing improvement in death certification, deaths from 'uterus, site unspecified' were reallocated. Using the European standard population, age-adjusted mortality rates were calculated per year and AACC. Annual percent change (APC) and joinpoints, if existed, were estimated using Joinpoint regression analysis for all women and two broad age-groups: younger and older than 50 years. RESULTS: Cervical cancer mortality rates follow a decreasing trend, with important differences among AACC. Catalonia (PCA -4.55; IC95%: -4.85,-4.23), and Navarra (PCA -4.31; IC95% -5.85,-2.75) decreased more their annually mortality rates than Madrid (PCA -2.32; IC95%: -2.93, -1.70), Canarias (PCA -2,36; IC95% -3.00,-1.72) or Galicia (PCA -2.60; IC95% -3.07,-2.10), which showed the less marked decreased. CONCLUSIONS: Cervical cancer mortality is decreasing in Spain. Trend differences among CCAA could be related to organizational differences and coverages of their screening programs, disparities in exposure to HPV and socioeconomic level as well as to differences in socioeconomic factors.

LQAS usefulness in an emergency department.

PURPOSE: This paper aims to explore lot quality assurance sampling (LQAS) applicability and usefulness in the evaluation of quality indicators in a hospital emergency department (ED) and to determine the degree of compliance with quality standards according to this sampling method. DESIGN/METHODOLOGY/APPROACH: Descriptive observational research in the Hospital General Universitario Gregorio Marañón (HGUGM) emergency department (ED). Patients older than 15 years, diagnosed with dyspnoea, chest pain, urinary tract colic or bronchial asthma attending the HGUGM ED from December 2005 to May 2006, and patients admitted during 2005 with exacerbation of chronic obstructive pulmonary disease or acute meningitis were included in the study. Sample sizes were calculated using LQAS. Different quality indicators, one for each process, were selected. The upper (acceptable quality level (AQL)) and lower thresholds (rejectable quality level (RQL)) were established considering risk alpha = 5 per cent and beta = 20 per cent, and the minimum number of observations required was calculated. FINDINGS: It was impossible to reach the necessary sample size for bronchial asthma and urinary tract colic patients. For chest pain, acute exacerbation of chronic obstructive pulmonary disease, and acute meningitis, quality problems were detected. The lot was accepted only for the dyspnoea indicator. ORIGINALITY/VALUE: The usefulness of LQAS to detect quality problems in the management of health processes in one hospital's ED. The LQAS could complement traditional sampling methods.