Heart Failure Is a Risk Factor for Suffering and Dying of Clostridium difficile Infection. Results of a 15-Year Nationwide Study in Spain.

BACKGROUND: We aimed to (1) analyze time trends in the incidence and in-hospital outcomes of heart failure (HF) patients suffering Clostridioides difficile infection (CDI); (2) compare clinical characteristics of CDI patients between those with HF and matched non-HF patients; and (3) identify predictors of in-hospital mortality (IHM) among HF patients suffering CDI. METHODS: Retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. Patients of age ≥40 years with CDI were included. For each HF patient, we selected a year, age, sex, and readmission status-matched non-HF patient. RESULTS: We found 44,695 patients hospitalized with CDI (15.46% with HF). HF patients had a higher incidence of CDI (202.05 vs. 145.09 per 100,000 hospitalizations) than patients without HF (adjusted IRR 1.35; 95%CI 1.31-1.40). IHM was significantly higher in patients with HF when CDI was coded as primary (18.39% vs. 7.63%; p < 0.001) and secondary diagnosis (21.12% vs. 14.76%; p < 0.001). Among HF patient's predictor of IHM were older age (OR 8.80; 95%CI 2.55-20.33 for ≥85 years old), those with more comorbidities (OR 1.68; 95%CI 1.12-2.53 for those with Charlson Comorbidity index ≥2), and in those with severe CDI (OR 6.19; 95%CI 3.80-10.02). CONCLUSIONS: This research showed that incidence of CDI was higher in HF than non-HF patients. HF is a risk factor for IHM after suffering CDI.

Influenza vaccination coverage and uptake predictors among Spanish adults suffering COPD.

The aim of this study is to compare influenza vaccination coverage among Spaniards aged 40 y or over who suffer from chronic obstructive pulmonary disease (COPD) with those without this illness to identify the factors that influence vaccination uptake among patients with COPD. Data was extracted from the European Health Survey performed in Spain in 2009/10, and analyzed data on 15,355 Spaniards (≥ 40 y of age), of whom 1,309 (8.2% 95%CI 7.7-8.7) had COPD was used. We considered the answer (yes/no) to the question about whether or not the interviewed person had been vaccinated against influenza in the previous flu season. We used the answer to this question as the dependent variable. For independent variables, we analyzed social demographic characteristics, health related variables, and the utilization of health care services. Vaccination coverage among patients with COPD is 49.4% (95% CI: 46.3-52.5%) and 21.3% (95% CI: 20.7-21.9) among people without (p < 0.001). The probability of being vaccinated is three times greater for COPD patients (crude OR = 3.0, 95% CI: 2.6-3.5). Among COPD patients the uptake of vaccination increased with age. Other factors associated with an increase in vaccination coverage were: being male, perceiving one's health as fair or poor, not smoking, and having seen a doctor during the previous month. The rate of flu vaccination among adult Spaniards with COPD is lower than desired. Urgent strategies for increasing vaccination coverage are necessary for COPD sufferers aged under 65 of age and those with unhealthy lifestyles.

Valor diagnóstico de la gammagrafía de perfusión miocárdica con 99mTc-tetrofosmina en mujeres con sospecha de cardiopatía isquémica / Diagnostic value of myocardial perfusion scintigraphy with 99mTc-tetrofosmin in women with suspected ischemic heart disease

Fundamento y objetivo: Se trata de un estudio transversal donde se han determinado los valores de sensibilidad y de especificidad del estudio de perfusión miocárdica con 99mTc-tetrofosmina en protocolo de un día tras estímulo farmacológico con dipiridamol en una población de mujeres, así como la relación con los territorios vasculares coronarios, tomando como referencia la coronariografía. Pacientes y método: Se han estudiado con carácter retrospectivo 202 historias clínicas de mujeres con sospecha de cardiopatía isquémica (CI) a las que se les realizó una prueba de perfusión miocárdica y una coronariografía. Resultados: Los valores de sensibilidad y de especificidad para la población fueron del 87,16 y del 81,48%, respectivamente. Por territorio arterial coronario, los valores de sensibilidad y de especificidad para la arteria descendente anterior fueron del 68,75 y del 77,78%, respectivamente; para la coronaria circunfleja fueron del 60,0 y del 81,51%, y para la coronaria derecha fueron del 69,88 y del 72,27%. Conclusiones: La prueba de perfusión miocárdica estimulación/reposo presenta una elevada validez diagnóstica para esta enfermedad en mujeres con sospecha de CI (AU)

Background and objective: This was a cross-sectional study in which the values of sensitivity and specificity of myocardial perfusion study with 99mTc-Tetrofosmina protocol in a day after stimulation with dipyridamole were determined in a population of women. We also assessed the relationship with coronary vascular territories, based on coronary angiography. Patients and method: We studied retrospective medical records of 202 women with suspected ischemic heart disease tested on myocardial perfusion who also underwent coronary angiography. Results: The values of sensitivity and specificity for the population were 87.16% and 81.48% respectively. For the coronary artery territory, the values of sensitivity and specificity for the DA artery were 68.75% and 77.78% respectively, while these were 60.0% and 81.51% for the Cx. Finally, the values for the CD were 69.88 and 72.27%, respectively. Conclusions: The myocardial perfusion test stimulation/rest has a high diagnostic validity for the disease in women with suspected ischemic heart disease (AU)

Effectiveness of the physical therapy Godelive Denys-Struyf method for nonspecific low back pain: primary care randomized control trial.

STUDY DESIGN: A simple blind, random controlled clinical trial. OBJECTIVE: To assess the effectiveness of physiotherapy treatment based on the muscular and articular chains Godelive Denys-Struyf (GDS) method for nonspecific low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA: Despite a systematic review by the European COST ACTION B13 "Low back pain: guidelines for its management," there are still many unresolved questions regarding the effectiveness of the different physical therapy treatments used for LBP. SETTING: 21 physicians and physiotherapists in 7 Primary Care Centers and 6 researches in the Complutense University of Madrid (Spain). PARTICIPANTS: 137 patients diagnosed with nonspecific LBP. METHODS: The control group underwent 15 sessions of conventional physiotherapy in Primary Care Centers, and the experimental group received 15 GDS treatment sessions. Pain was evaluated by Visual Analogical Scale (VAS), functional disability by Oswestry questionnaire, and quality of life by the physical and mental components of SF-36 questionnaire. Outcome measures were assessed before treatment (A1), at the end of treatment (A2), and at 3 months (A3), and 6 months (A4) of follow-up. RESULTS: Repeated measures analysis of variance revealed that at the end of treatment and 3 months later, subjects in both groups showed less pain, reduced functional disability, and an improved quality of life, though improvements were greater in the GDS group.Six months after treatment, patients in the GDS group continued to show reduced pain (VAS(A4-A1) = -3.54, 95% CI: -4.18 to -2.90) while VAS scores in the control group returned to initial values (VAS(A4-A1) = 0.15, 95% CI: -0.36 to 0.67). CONCLUSION: Treatment of nonspecific LBP using the GDS method provides greater improvements in the midterm (6 months) in terms of the pain, functional ability, and quality of life perceived by patients than the conventional treatment based administered in primary care.

[Diagnostic value of myocardial perfusion scintigraphy with (99m)Tc-tetrofosmin in women with suspected ischemic heart disease]. / Valor diagnóstico de la gammagrafía de perfusión miocárdica con (99m)Tc-tetrofosmina en mujeres con sospecha de cardiopatía isquémica.

BACKGROUND AND OBJECTIVE: This was a cross-sectional study in which the values of sensitivity and specificity of myocardial perfusion study with (99)mTc-Tetrofosmina protocol in a day after stimulation with dipyridamole were determined in a population of women. We also assessed the relationship with coronary vascular territories, based on coronary angiography. PATIENTS AND METHOD: We studied retrospective medical records of 202 women with suspected ischemic heart disease tested on myocardial perfusion who also underwent coronary angiography. RESULTS: The values of sensitivity and specificity for the population were 87.16% and 81.48% respectively. For the coronary artery territory, the values of sensitivity and specificity for the DA artery were 68.75% and 77.78% respectively, while these were 60.0% and 81.51% for the Cx. Finally, the values for the CD were 69.88 and 72.27%, respectively. CONCLUSIONS: The myocardial perfusion test stimulation/rest has a high diagnostic validity for the disease in women with suspected ischemic heart disease.

[Cold chain maintenance in vaccines: a systematic review]. / Mantenimiento de la cadena del frío para las vacunas: una revisión sistemática.

OBJECTIVE: Systematic immunization programmes mostly depend on the correct maintenance and manipulation of the vaccines to be used, i.e. perfect maintenance of the cold chain. Therefore, we decided to carry out a systematic review of the literature on the cold chain and vaccines, to identify daily practices in vaccine sites. METHODS: A literature search was performed in the main medical databases for documents published between 1990 and 2005, including those performed by means of a survey and/or inspection of vaccine sites that provided the following data: a designated health officer, availability of a thermometer with maximums and minimums, refrigerator temperature at the time of the visit, and temperature control and registration. For all the variables, the mean prevalence was calculated with a 95% confidence interval. RESULTS: Three hundred seventy-seven articles were found; 31 were initially selected and 13 were finally included. In 72.21% of the vaccine points, there was an officer responsible for the vaccines, but only 61.43% knew the optimal temperature range. Fifty-five percent of these points had a thermometer with maximums and minimums and only 26.88% carried out temperature controls and registrations at least once per day. CONCLUSION: Important shortfalls were detected in cold chain maintenance in all selected articles, jeopardizing the effectiveness and efficiency of immunization programs.

Mantenimiento de la cadena del frío para las vacunas: una revisión sistemática / Cold chain maintenance in vaccines: a systematic review

Objetivo: Los programas de inmunización sistemática dependen en gran medida del correcto mantenimiento y la manipulación de las vacunas que se aplican, es decir, del perfecto mantenimiento de la cadena del frío. Por ello, nos propusimos realizar una revisión sistemática de la literatura médica sobre la cadena del frío y las vacunas, con el objetivo de conocer las prácticas diarias en los puntos de vacunación. Métodos: Se efectuó una búsqueda bibliográfica en las principales bases médicas entre 1990 y 2005. Se incluyeron los estudios que, mediante encuesta y/o inspección a puntos de vacunación, aportaban datos sobre: designación de responsable sanitario, existencia de termómetro de máximas y mínimas, temperatura del frigorífico en el momento de la visita y control y registro de la temperatura. Para todas las variables se calculó la prevalencia media con su intervalo de confianza del 95%. Resultados: Se localizaron 377 artículos, se seleccionaron inicialmente 31 y se incluyeron 13 de ellos. El 72,21% de los puntos de vacunación tenía un responsable de vacunas, pero sólo el 61,43% de ellos conocían el rango óptimo de temperaturas. Por otro lado, el 55% de estos puntos tenía un termómetro de máxima y mínima y sólo el 26,88% realizaba controles y registros de temperaturas al menos una vez al día. Conclusión: En las publicaciones incluidas en el estudio se detectan deficiencias importantes en el mantenimiento de la cadena del frío de las vacunas, que ponen en riesgo la efectividad y la eficiencia de los programas de inmunización

Objetive: Systematic immunization programmes mostly depend on the correct maintenance and manipulation of the vaccines to be used, i.e. perfect maintenance of the cold chain. Therefore, we decided to carry out a systematic review of the literature on the cold chain and vaccines, to identify daily practices in vaccine sites. Methods: A literature search was performed in the main medical databases for documents published between 1990 and 2005, including those performed by means of a survey and/or inspection of vaccine sites that provided the following data: a designated health officer, availability of a thermometer with maximums and minimums, refrigerator temperature at the time of the visit, and temperature control and registration. For all the variables, the mean prevalence was calculated with a 95% confidence interval. Results: Three hundred seventy-seven articles were found; 31 were initially selected and 13 were finally included. In 72.21% of the vaccine points, there was an officer responsible for the vaccines, but only 61.43% knew the optimal temperature range. Fifty-five percent of these points had a thermometer with maximums and minimums and only 26.88% carried out temperature controls and registrations at least once per day. Conclusion: Important shortfalls were detected in cold chain maintenance in all selected articles, jeopardizing the effectiveness and efficiency of immunization programs

[Vaccine storage cold chain at primary care centers in one area of Madrid: keeping the chain intact and degree of knowledge]. / Cadena del frío para la conservación de las vacunas en los centros de atención primaria de un area de Madrid: mantenimiento y nivel de conocimientos.

BACKGROUND: Vaccines are heat-labile medications, and to guarantee their immunogenicity and safeguarding effectiveness as part of immunization programs, it is absolutely essential that the "Cold Chain" go unbroken. Fundamental thereto is the personnel responsible for the vaccines, who must know the stability-related characteristics of each preparation so as to prevent handling errors. The purpose of this study was that of ascertaining how the cold chain is kept intact in primary care systems in one healthcare area of the Autonomous Community of Madrid, as well as determining the degree of information possessed by those responsible for vaccines as far as their heat-stability is concerned. METHODS: A cross-sectional study has been made at 46 primary care vaccination points. The data was gathered by means of a personal interview by one single researcher. RESULTS: The participation rate was 93.5% (43/46). In all cases, there was a maximum and minimum thermometer and monthly temperature record. An unsuitable temperature was found in three cases (6.97%). The percentage of professionals who were aware of the effect freezing has on vaccines varied greatly: 53.5%, 51.2%, 44.2% and 53.5% for diphtheria-tetanus-pertussis (DTP), hepatitis B (HBV), oral polio (OPV) and measles-mumps-rubella (MMR) respectively. And only 32% were familiar with the shake test. CONCLUSION: The professionals were found to be properly trained regarding the effect which high temperatures have on vaccines, but it is necessary for their training with regard to the instability of adsorbed preparations when frozen must be further strengthened.

Cadena del frío para la conservación de las vacunas en los centros de atención primaria de un area de Madrid: mantenimiento y nivel de conocimientos / Vaccine Storage Cold Chain at Primary Care Centers in one Area of Madrid: Keeping the Chain Intact and Degree of Knowledge

Fundamento. Las vacunas son medicamentos termolábiles y para garantizar su inmunogenicidad y eficacia protectora, dentro de los programas de inmunización, es imprescindible mantener la cadena de frío. El elemento fundamental en esta cadena es el personal responsable de las vacunas, que debe conocer las características de estabilidad de cada preparado con el fin de evitar errores durante su manipulación. El objetivo de este trabajo fue conocer cómo se realiza el mantenimiento de la cadena del frío en equipos de atención primaria de un área sanitaria de la Comunidad Autónoma de Madrid, así como establecer el grado de información que poseen los responsables de las vacunas con respecto a la termoestabilidad de las mismas.Métodos. Se ha realizado un estudio transversal en 46 puntos de vacunación en atención primaria. La recogida de los datos se realizó mediante entrevista personal por un único investigador.Resultados. La tasa de participación fue del 93,5 per cent (43/46). En todos los casos existía termómetro de máxima y mínima y registro mensual de la temperatura. Se observó una temperatura inadecuada en tres ocasiones (6,97 per cent). El porcentaje de profesionales que conocía el efecto que la congelación producía sobre las vacunas fue muy diverso: 53.5 per cent, 51.2 per cent, 44.2 per cent y 53.5 per cent para difteria-tétanos-pertussis (DTP), hepatitis B (VHB), polio oral (VPO) y rubéola-sarampión-paperas (RSP) respectivamente. Y sólo el 32 per cent conocía el test de agitación.Conclusión. La formación de los profesionales sobre el efecto que las altas temperaturas ocasionan en las vacunas era correcta, pero es necesario reforzar su formación sobre la inestabilidad que presentan los preparados adsorbidos cuando se someten a congelación (AU)

Background: Vaccines are heat-labile medications, and to guarantee their immunogenicity and safeguarding effectiveness as part of immunization programs, it is absolutely essential that the «Cold Chain» go unbroken. Fundamental thereto is the personnel responsible for the vaccines, who must know the stability-related characteristics of each preparation so as to prevent handling errors. The purpose of this study was that of ascertaining how the cold chain is kept intact in primary care systems in one healthcare area of the Autonomous Community of Madrid, as well as determining the degree of information possessed by those responsible for vaccines as far as their heat-stability is concerned. Methods. A cross-sectional study has been made at 46 primary care vaccination points. The data was gathered by means of a personal interview by one single researcher. Results. The participation rate was 93.5% (43/46). In all cases, there was a maximum and minimum thermometer and monthly temperature record. An unsuitable temperature was found in three cases (6.97%). The percentage of professionals who were aware of the effect freezing has on vaccines varied greatly: 53.5%, 51.2%, 44.2% and 53.5% for diphtheria-tetanus-pertussis (DTP), hepatitis B (HBV), oral polio (OPV) and measles-mumps-rubella (MMR) respectively. And only 32% were familiar with the shake test. Conclusion. The professionals were found to be properly trained regarding the effect which high temperatures have on vaccines, but it is necessary for their training with regard to the instability of adsorbed preparations when frozen must be further strengthened (AU)

Características epidemiológicas relacionadas con el cáncer de mama en mujeres pre y posmenopáusicas / Epidemiological characteristics of breast cancer development in pre and postmenopausal women

Fundamento: Caracterizar la relación entre el cáncer de mama y distintas variables, personales, familiares y sociodemográficas. Para ello se analizó a todas las mujeres en conjunto, y clasificadas en dos grupos: pre y posmenopáusicas. Población y métodos: Se realizó un estudio de casos y controles, equiparando caso y control en función de la edad, el área sanitaria y la actividad hormonal. En total se estudiaron 274 casos y 274 controles. Las variables de estudio se obtuvieron mediante un cuestionario que recogía el nivel de estudios, la historia reproductiva, los antecedentes personales y familiares y los estilos de vida. Se realizó un análisis de regresión logística múltiple en los grupos de estudio. Resultados: En las mujeres consideradas en conjunto, la menarquia tardía se comportó como variable de riesgo, al igual que la primiparidad añosa y los antecedentes familiares maternos, y como factor de protección el menor nivel de estudios y el consumo de anticonceptivos orales. Este último patrón se repitió en la población posmenopáusica, con excepción del consumo de anticonceptivos, que no se mantuvo en el modelo final de regresión. En la población premenopáusica, se comportaron como factor de riesgo los antecedentes familiares maternos y los antecedentes personales de enfermedad mamaria. Así mismo, el nivel de estudios inferior apareció como factor de protección. Conclusiones: La presencia de antecedentes familiares maternos actuó como variable de riesgo en todas las poblaciones, constituyendo el primer factor en importancia en las mujeres premenopáusicas. En las dos categorías de estudio, el menor nivel de estudios apareció como factor protector (AU)