Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional / Expert opinion on strategies to improve vaccination coverage against seasonal influenza

La gripe estacional sigue siendo un importante problema de salud pública, y la vacuna antigripal es la medida más efectiva para su prevención. En nuestro país, los datos de coberturas vacunales de las últimas temporadas muestran unas tasas de vacunación muy por debajo de los objetivos marcados por los organismos oficiales. Tras la pandemia de la COVID19, las coberturas vacunales para la gripe han experimentado una notable mejoría. Dado que resulta imperativo alcanzar y mantener unas elevadas tasas de vacunación con el fin de evitar el impacto clínico y económico de la gripe, un grupo multidisciplinar de expertos en el área de las vacunas hemos analizado cómo afectan las bajas coberturas en nuestro país y hemos diseñado una serie de medidas para incrementar la cobertura vacunal de la gripe, especialmente en los colectivos definidos como prioritarios. (AU)

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups. (AU)

Occupational cosmic radiation exposure in Portuguese airline pilots: study of a possible correlation with oxidative biological markers.

Several studies have sought to understand the health effects of occupational exposure to cosmic radiation. However, only few biologic markers or associations with disease outcomes have so far been identified. In the present study, 22 long- and 26 medium-haul male Portuguese airline pilots and 36 factory workers who did not fly regularly were investigated. The two groups were comparable in age and diet, were non-smokers, never treated with ionizing radiation and other factors. Cosmic radiation exposure in pilots was quantified based on direct monitoring of 51 flights within Europe, and from Europe to North and South America, and to Africa. Indirect dose estimates in pilots were performed based on the SIEVERT (Système informatisé d'évaluation par vol de l'exposition au rayonnement cosmique dans les transports aériens) software for 6,039 medium- and 1,366 long-haul flights. Medium-haul pilots had a higher cosmic radiation dose rate than long-haul pilots, that is, 3.3 ± 0.2 µSv/h and 2.7 ± 0.3 µSv/h, respectively. Biological tests for oxidative stress on blood and urine, as appropriate, at two time periods separated by 1 year, included measurements of antioxidant capacity, total protein, ferritin, hemoglobin, creatinine and 8-hydroxy-2-deoxyguanosine (8OHdG). Principal components analysis was used to discriminate between the exposed and unexposed groups based on all the biological tests. According to this analysis, creatinine and 8OHdG levels were different for the pilots and the unexposed group, but no distinctions could be made among the medium- and the long-haul pilots. While hemoglobin levels seem to be comparable between the studied groups, they were directly correlated with ferritin values, which were lower for the airline pilots.

Influence exerted on drug prescribing by patients' attitudes and expectations and by doctors' perception of such expectations: a cohort and nested case-control study.

RATIONALE, AIMS AND OBJECTIVES: Although demand for medication is regarded as one of the most important factors in pharmaceutical expenditure, little is known about patients' influence on drug prescribing. This study assesses the influence exerted on drug prescribing by patients' attitudes and expectations, and by doctors' perception of such expectations. METHOD: We conducted a population-based cohort study covering 937 subjects attending a health centre in the northwest of Spain. Prescription-drug advertising directly targeted at patients is banned in Spain. We conducted home-based interviews at the start of follow-up to assess patients' attitudes, and monthly telephone interviews during the 1-year follow-up period to assess consumption of medical drugs and medical visits. Using nested case-control study covering 127 of the cohort subjects who attended the health centre, we assessed patients' pre-consultation expectations for prescriptions, doctors' perception of such patients' expectations, and the drugs actually prescribed. RESULTS: Of the total sample, 69.3% answered the home-based questionnaire, 77.6% completed 11 or more months of follow-up, and 100% of cohort subjects who attended the health centre responded to the pre-consultation survey conducted in the waiting room. Patients' attitudes, though not associated with prescription (P > 0.1), were, however, associated with demand for medical consultation (P < 0.01), self-medication (P < 0.01) and prescription expectations (P < 0.01). Although doctors' perception of patients' expectations did indeed show an association with drug prescribing (P = 0.001), there was no association between patients' expectations and doctors' perception of such expectations (P > 0.1), as these tended to be overestimated by doctors. CONCLUSION: We conclude that, although doctors prescribe in accordance with what they believe their patients expect, in practice patients exert no influence on drug prescribing because their prescription expectations are misconstrued by doctors, who overestimate them.

An educational intervention to improve physician reporting of adverse drug reactions: a cluster-randomized controlled trial.

CONTEXT: Data on the adverse effects of newly marketed drugs are limited. Voluntary reporting is an important part of postmarketing surveillance but is underused by physicians. OBJECTIVE: To evaluate the effectiveness of educational outreach visits for improving adverse drug reaction (ADR) reporting by physicians. DESIGN, SETTING, AND PARTICIPANTS: A cluster-randomized controlled trial covering all National Health System physicians in the north of Portugal, with intervention in March 2004 through July 2004, and 13 to 16 months of follow-up. A total of 1388 physicians were assigned in 4 spatial clusters to the intervention group, and 5063 were assigned in 11 clusters to the control group. INTERVENTION: One-hour educational outreach visits tailored to training needs identified in a previous study. MAIN OUTCOME MEASURES: Change in total number of reported ADRs and number of serious, high-causality, unexpected, and new-drug-related ADRs, using generalized linear mixed models adjusted for baseline ADR reporting, age, specialty, and work setting. RESULTS: At baseline, ADR reporting rates (per 1000 physician-years) did not differ significantly between the intervention groups and the control groups in reporting ADRs overall (7.6 vs 11.3), nor did they differ significantly by category: serious, 4.3 vs 6.0; high-causality, 5.4 vs 7.6; unexpected, 1.6 vs 3.5; and new-drug-related ADRs, 3.7 vs 3.8. (P>.05 for all comparisons). The control group had no significant increase in ADR reports during follow-up. The adjusted increase in ADR reporting rates attributable to intervention was 90.19 for total ADRs (95% confidence interval [CI], 54.51-125.87; relative risk [RR], 10.23; 95% CI, 3.81-27.51), 30.16 for serious ADRs (95% CI, 18.84-41.47; RR, 6.32; 95% CI, 2.09-19.16), 64.90 for high-causality ADRs (95% CI, 38.38-91.42; RR, 8.75; 95% CI, 3.05-25.07), 28.04 for unexpected ADRs (95% CI, 16.25-39.83; RR, 30.21; 95% CI, 4.54-200.84), and 42.17 for new-drug-related ADRs (95% CI, 21.58-62.76; RR, 8.05; 95% CI, 2.10 -30.83). The greatest difference occurred during the first 4 months after intervention, but differences remained statistically significant for 12 months. CONCLUSION: A targeted outreach program may improve high-quality reporting of ADRs among physicians.

Physicians' attitudes and adverse drug reaction reporting : a case-control study in Portugal.

OBJECTIVES: Voluntary adverse drug reaction (ADR) reporting is fundamental to medical drug safety surveillance; however, substantial under-reporting exists and is the main limitation of the system. This study sought to identify the knowledge- and attitude-related factors associated with ADR reporting by physicians in Northern Portugal. METHODS: Case-control study covering a population of National Health Service medical practitioners. The 88 cases comprised physicians who had reported at least one ADR to the drug surveillance unit from the year 2000 to the date of enrolment in the study. The 771 controls were randomly selected from among the remaining physicians. All interviews were conducted using a self-administered questionnaire. Knowledge and attitudes regarding spontaneous ADR reporting were based on Inman's 'seven deadly sins'. Agreement with the questions included in the questionnaire was measured using a horizontal, continuous visual analogue scale, which was unnumbered. Recorded answers were read in a range from zero (total disagreement) to ten (total agreement). We used logistic regression to determine the ADR reporting adjusted odds ratio (ORadj) for a change in exposure corresponding to the interquartile range for each attitude. RESULTS: A total of 397 questionnaires were received from 731 eligible practitioners (54.3%). Physicians who worked in primary versus hospital care (ORadj 7.74 [95% CI 1.85, 32.30]) and in general medicine (ORadj 1.05 [95% CI 0.30, 3.69]) versus medical specialities were more likely to report ADRs. In contrast, physicians working in the medical-surgical/surgical fields were significantly less likely to report ADRs compared with medical specialists (ORadj 0.10 [95% CI 0.02, 0.46]). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by: (i) 87% (p < 0.05) for complacency (the belief that really serious ADRs are well documented by the time a drug is marketed); (ii) 109% (p < 0.01) for insecurity (the belief that it is nearly impossible to determine whether a drug is responsible for a particular adverse reaction); (iii) 143% (p < 0.001) for diffidence (the belief that one would only report an ADR if one were sure that it was related to the use of a particular drug); (iv) 220% (p < 0.001) for indifference (the belief that the one case an individual doctor might see could not contribute to medical knowledge); and (v) 71% (p < 0.05) for ignorance (the belief that it is only necessary to report serious or unexpected ADRs). CONCLUSION: This study shows that there are attitudes strongly associated with under-reporting. The implementation of purpose-designed educational interventions based on the attitudes identified in this study may serve to improve reporting substantially.

Influence of pharmacists' opinions on their dispensing medicines without requirement of a doctor's prescription.

OBJECTIVE: To assess the influence of pharmacists' opinions on their dispensing medicines with a "medical prescription only" label without requiring a doctor's prescription. METHODS: We performed a cross-sectional study of 166 community pharmacies in northwest Spain. The opinions of pharmacists on the following were collected as independent variables through personal interview: a) physicians' prescribing practices; b) the pharmacist's qualifications to prescribe; c) the responsibility of the pharmacist regarding the dispensed drugs; d) the customer' qualifications for self-medication; and e) the pharmacist's perception of his or her own work. The dependent variable was the pharmacist's demand for a medical prescription for 5 drugs, which in Spain require a prescription. Multiple linear regression models were constructed. RESULTS: The response rate was 98.8%. A total of 65.9% of pharmacists reported dispensing antibiotics without a prescription. This percentage was 83.5% for nonsteroidal anti-inflammatory drugs, 46.3% for angiotensin-converting enzyme inhibitors, 13.4% for benzodiazepines, and 84.8% for oral contraceptives. Further results showed that pharmacists with a heavier workload and those who underestimated the physicians' qualifications to prescribe but overestimated their own qualifications to prescribe less frequently demanded medical prescriptions. In contrast, pharmacists who stressed the importance of their duty in rationalizing the consumption of drugs more frequently demanded medical prescriptions. CONCLUSION: Our results suggest that to increase the quality of dispensing: a) the importance of the pharmacist's duty in controlling drug consumption should be stressed; b) pharmacies' workload should be optimized; and c) perceptions of physicians' prescribing practices among pharmacists should be improved.

Influence of pharmacists’ opinions on their dispensing medicines without requirement of a doctor’s prescription

Objetivo: Evaluar la influencia de las opiniones de los farmacéuticos que no solicitan receta médica para dispensar fármacos que la requieren para su venta. Métodos: Se ha llevado a cabo un estudio transversal sobre una muestra de 166 farmacéuticos de oficina de farmacia en la provincia de A Coruña. Las opiniones de los farmacéuticos, variables e independientes, fueron medidas mediante entrevista personal. Se valoraron las opiniones siguientes: a) prácticas prescriptoras de los médicos; b) cualificación de los farmacéuticos para prescribir; c) la responsabilidad de los farmacéuticos sobre los medicamentos dispensados; d) la cualificación de los clientes para automedicarse, y e) la percepción de los farmacéuticos sobre su trabajo. La exigencia de receta por parte del farmacéutico para 5 fármacos, que en España deben dispensarse con receta, fue la variable dependiente que se tuvo en cuenta. Se construyeron modelos de regresión múltiple. Resultados: La participación fue del 98,8%. Un total del 65,9%de los farmacéuticos afirmaron dispensar antibióticos sin receta. Este porcentaje fue del 83,5% para los antiinflamatorios no esteroideos, 46,3% para los inhibidores de la enzima de conversión de la angiotensina, 13,4% para las benzodiazepinas y 84,8% para los anticonceptivos orales. Además, los resultados muestran que los farmacéuticos con mayor carga de trabajo y los que califican peor la prescripción de los médicos, y que en mayor medida consideran que ellos mismos están capacitados para prescribir, exigen menos recetas médicas. Por el contrario, los farmacéuticos que otorgan mayor importancia a la racionalización en el consumo de fármacos exigen receta más frecuentemente. Conclusión: Nuestros resultados indican que para el incremento en la calidad de la dispensación el sistema debería lograr: a) incrementar la importancia que los farmacéuticos otorguen al control y la racionalización del consumo de fármacos; b) adecuar la carga de trabajo de las farmacias, y c) mejorar la percepción que los farmacéuticos tienen de las pautas prescriptoras de los médicos

Objective: To assess the influence of pharmacists’ opinions on their dispensing medicines with a «medical prescription only» label without requiring a doctor’s prescription. Methods: We performed a cross-sectional study of 166 community pharmacies in northwest Spain. The opinions of pharmacists on the following were collected as independent variables through personal interview: a) physicians’ prescribing practices; b) the pharmacist’s qualifications to prescribe; c) there sponsibility of the pharmacist regarding the dispensed drugs; d) the customer’ qualifications for self-medication; and e) the pharmacist’s perception of his or her own work. The dependent variable was the pharmacist’s demand for a medical prescription for 5 drugs, which in Spain require a prescription. Multiple linear regression models were constructed. Results: The response rate was 98.8%. A total of 65.9% of pharmacists reported dispensing antibiotics without a prescription. This percentage was 83.5% for non-steroidal anti-inflammatory drugs, 46.3% for angiotensin-converting enzyme inhibitors, 13.4% for benzodiazepines, and 84.8% for oral contraceptives. Further results showed that pharmacists with a heavier workload and those who under estimated the physicians’ qualifications to prescribe but overestimated their own qualifications to prescribe less frequently demanded medical prescriptions. In contrast, pharmacists who stressed the importance of their duty in rationalizing the consumption of drugs more frequently demanded medical prescriptions. Conclusion: Our results suggest that to increase the quality of dispensing: a) the importance of the pharmacist’s duty in controlling drug consumption should be stressed; b) pharmacies ’workload should be optimized; and c) perceptions of physicians’ prescribing practices among pharmacists should be improved

Impacto del tabaquismo sobre la mortalidad en España / Impact of smoking on mortality in Spain

Se pretende mostrar una visión panorámica del impacto que el consumo de tabaco tiene en la mortalidad mundial y española, así como actualizar la estimación de la mortalidad atribuida al consumo de tabaco en España para el año 2001. Se estima que en el año 2000 aproximadamente 4 millones de personas murieron en todo el mundo debido a enfermedades relacionadas con el consumo de tabaco, y que en el año 2030 esta cifra se elevará hasta los 10 millones anuales. En Europa el tabaquismo ocasionó más de 675 mil muertes en el año 2000 (4 veces más muertes que el alcoholismo y las drogas ilegales juntos). Se ha calculado la mortalidad atribuible al consumo de tabaco en España utilizando la fracción atribuible poblacional (FAP). Para ello los datos de mortalidad del año 2001 se han obtenido del INE, los riesgos relativos del Cancer Prevention Study-II y la prevalencia del tabaquismo de la Encuesta Nacional de Salud realizada en 2001. En el año 2001 49.072 personas murieron en España por enfermedades debidas al consumo de tabaco. De ellas 44.682 (91’1%) ocurrieron en varones y 4.390 (8’9%) en mujeres. Estas muertes supusieron el 24’5% del total de muertes en los varones y el 2’6% del total de muertes en las mujeres. La mortalidad atribuible al consumo de tabaco es muy elevada en nuestro país, sobre todo en los varones ya que 1 de cada 4 varones fallecidos en España lo es por enfermedades relacionadas con el consumo de tabaco (AU)

This article gives a overview of the impact of smoking on world and Spanish mortality and updates the smoking attributable mortality for Spain in 2001. It is estimated that 4 million people were died in the world by smoking-related diseases. That figure will raise to 10 millions in 2030. In Europe smoking habit caused more than 675 thousand deads in 2000 (four-fold more than alcohol and illegal drugs together). Smoking attributable mortality in Spain was calculated using an attributable-fraction formula. Mortality data for 2001 were obtain from National Statistics Institute (INE), relative risks from Cancer Prevention Study-II and smoking prevalence data from the 2001 National Health Survey. In 2001, 49.072 people died from tobacco-related diseases, 44.682 (91’1%) among men and 4.390 (8’9%) among women. That figures mean 24’5% of total mortality among men and 2’6% of mortality among women. Tobacco-attributable mortality is very high in Spain, mainly among males so long as 1 of each 4 males died from related tobacco diseases (AU)

Aspectos epidemiológicos de la intoxicación por toxina diarreica de los moluscos (DSP) / Epidemiological aspects of the diarrheic shellfish poisoning (DSP)

Tras un recuerdo histórico, se estudia la epidemiología de la intoxicación por DSP, destacando su importancia económica y sanitaria. Se revisa su incidencia en Europa, Asia y América, y la disminución de brotes en población tras el establecimiento de Programas de Vigilancia y Control. Se estudian las toxinas del grupo DSP (ácido okadaico y otras dinophysistoxinas; pectenotoxinas y yessotoxinas) y los principales dinoflagelados productores (Dinophysis y Prorocentrum), y el papel de los mejillones y vieiras en su transmisión, así como la dificultad y los factores que influyen en su detoxificación. Se describen y analizan los factores que influencian la aparición de mareas rojas: nutrientes, temperatura, luz solar, salinidad, materia orgánica, metales y quelantes, substancias promotoras del crecimiento, estado de la mar y vientos dominantes. Finalmente se estudian las medidas de prevención primaria (vigilancia en el mar y en el mercado) y secundarias (actuaciones ante un brote), describiendo el Programa de Control de Biotoxinas Marinas de Galicia, y la normativa Europea (AU)

Influence of commercial information on prescription quantity in primary care.

BACKGROUND: In the last few years we have witnessed many publicly-financed health services reaching a crisis point. Thus, drug expenditure is nowadays one of the main concerns of health managers, and its containment one of the first goals of health authorities in western countries. The objective of this study is to identify the effect of the perceived quality stated in commercial information, its uses, and how physicians perceive the influence it has on prescription amounts. METHODS: A cross-sectional study of 405 primary care physicians was conducted in Galicia (north-west Spain). The independent variables physician's education and speciality, physician's perception of the quality of available drug information sources, type of practice, and number of patients were collected, through a postal questionnaire. Environmental characteristics of the practice were obtained from secondary sources. Multiple regression models were constructed using as dependent variables two indicators of prescription volume. RESULTS: The response rate was 75.2%. Prescription amounts was found to be associated with perceived credibility of information provided by medical visitors, regulated physician training, and environmental characteristics of the practice (primary care team practice, urban environment). CONCLUSIONS: The study results suggest that in order to decrease prescription amounts it is necessary to limit the role of pharmaceutical companies in physician training, improve physician education and training, and emphasize more objective sources of information.