Lifestyle interventions for cancer prevention in primary care: Differences between family physicians and nursing professionals.

RATIONALE, AIMS, AND OBJECTIVES: Prevention offers the most cost-effective long-term strategy for cancer control. The objective of this study was to ascertain opinions, attitudes, and professional practices towards cancer prevention among primary care professionals and to assess differences between family physicians (FP) and nursing professionals (NP). METHOD: A cross-sectional study was performed in 2012 in the Community of Madrid. A random sample of 3586 professionals received an online questionnaire about opinions/attitudes, training, and interventions in cancer prevention. The chi-square test was used to analyse the association of the profession with all the variables. Factors associated with the usual practice of individual, group, and community interventions were analysed using multivariate logistic regression, with separate models for FP and NP. RESULTS: The response rate was 39.4% (N = 1413). Approximately 90% of the participants attributed "sufficient/high" utility to individualized counselling. NP attributed higher utility to group and community interventions than FP (70.1% vs 60.1% and 64.9% vs 57.7%, respectively, P-value < 0.01). The usual practice of group and community interventions was more frequent among NP. The practice of group and community interventions was associated with knowledge of resources for prevention, specific training in group interventions, and the utility attributed to these methods. Among FP, the ability to dispense effective health advice and the utility attributed to this advice were associated with the usual practice of the three interventions. CONCLUSIONS: Group and community interventions are rarely practised, especially among FP. Actions targeting improved ability and knowledge could lead to higher involvement in the promotion of health. It would also be necessary to intervene in the examination of the utility of such interventions.

Solicitud de serologías de VIH en atención primaria: encuesta a profesionales de Medicina y de Enfermería / Request for HIV serology in primary care: A survey of medical and nursing professionals

Introducción: En la Comunidad de Madrid existe un 42,7% de retraso diagnóstico de VIH. La atención primaria es la puerta de entrada al sistema sanitario y se desconoce la frecuencia de serologías solicitadas por estos profesionales. Los objetivos fueron conocer la frecuencia y factores asociados a la solicitud de serologías de VIH por profesionales de medicina y de enfermería de atención primaria de la Comunidad de Madrid. Método: Mediante encuesta on-line, se preguntó por la solicitud de serologías para VIH en los últimos 12 meses, a profesionales que participaron en el estudio de evaluación de estrategias de diagnóstico precoz de VIH en consultas de atención primaria de la Comunidad de Madrid (ESTVIH). La asociación entre la solicitud de serologías y las características sociodemográficas y de práctica clínica de los profesionales se cuantificó mediante odds ratio ajustadas (ORa) según regresión logística. Resultados: Se obtuvieron 264 encuestas (59,5% medicina). El 82,2% de profesionales medicina y el 18,7% de enfermería refirieron haber solicitado alguna serología de VIH en los últimos 12 meses (mediana de 15 y 2 serologías solicitadas, respectivamente). En medicina esta petición se asoció con sexo masculino (ORa: 2,95; IC95%: 0,82-10,56) y estar entrenado para dar consejo pre-post prueba de VIH (ORa: 2,42; IC95%: 0,84-6,93); en enfermería se asoció con edad (<50años; ORa: 2,75; IC95%: 0,97-7,75) y tiempo trabajado en atención primaria (>13años; ORa: 3,02; IC95%: 1,07-8,52). Conclusión: Es necesario promover la solicitud de pruebas de VIH y el entrenamiento pre-post prueba de VIH en profesionales de medicina y enfermería de atención primaria

Introduction: In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. Method: An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. Results: 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). Conclusion: It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres

Coverage and predictors of influenza vaccination in patients with cystic fibrosis in a campaign with a mobile phone text messaging intervention.

Annual influenza vaccination is considered the best protection against influenza infection. We analyzed the influenza vaccine coverage (IVC) in cystic fibrosis (CF) patients and evaluated the factors associated with the IVC, including the effect of text-message/SMS reminders. We performed a cross-sectional study in the Community of Madrid (Spain) in 2015. The target population was people with CF older than 6 months of age at the beginning of the flu vaccination campaign. The IVC was calculated according to the study variables. A total of 445 CF patients were analyzed. In 2015, IVC reached 67.9% and was higher in children and women. The main factor associated with flu vaccination was having been vaccinated in the previous campaign (aOR 14.36; IC95%: 8.48-24.32). The probability of being vaccinated after receiving the SMS was more than twice than for those who did not receive it, although no statistical significance was reached. In conclusion the IVC of patients with CF is high, but it still has room for improvement. SMS reminders sent to CF patients might improve influenza vaccine uptake.

Request for HIV serology in primary care: A survey of medical and nursing professionals. / Solicitud de serologías de VIH en atención primaria: encuesta a profesionales de Medicina y de Enfermería.

INTRODUCTION: In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. METHOD: An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. RESULTS: 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). CONCLUSION: It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres.

Características de la conducta suicida y factores asociados a su mortalidad en el ámbito hospitalario / Suicidal behaviour characteristics and factors associated with mortality in the hospital setting

Introducción: El suicidio es un importante problema de salud pública mundial, de necesario abordaje por su alto potencial preventivo. Este trabajo estudia las principales características de las personas ingresadas en hospitales de la Comunidad de Madrid (España) con conducta suicida y los factores asociados a su mortalidad intrahospitalaria. Material y métodos: Se estudian los códigos E950-E959 de suicidio y lesiones autoinfligidas de la Clasificación Internacional de Enfermedades, Novena Revisión, Modificación Clínica, contenidos en los campos diagnósticos del conjunto mínimo básico de datos al alta hospitalaria entre 2003 y 2013. Se describen variables sociodemográficas, clínicas y asistenciales mediante análisis uni y multivariante de regresión logística en la valoración de factores asociados a la mortalidad intrahospitalaria. Resultados: La conducta suicida hospitalizada predomina en mujeres (58,7%) y en edades medias. La mortalidad intrahospitalaria es del 2,2% (1,6% en mujeres y 3,2% en hombres), aumentando con la edad. Los trastornos mentales se detectan 3-4 veces más en diagnósticos secundarios. El diagnóstico principal mayoritario (>74%) es el envenenamiento por sustancias, con una mortalidad inferior (∼1%) a la de las lesiones por ahorcamiento y precipitación (≥12%), que presentan las cifras más elevadas. Otros factores asociados con una mayor mortalidad son diversas comorbilidades médicas y la gravedad de la lesión, mientras que la estancia y los trastornos mentales son factores protectores en ambos sexos. El tipo de hospital, el envenenamiento con sustancias y el índice de Charlson se asocian a la mortalidad de forma diferencial en hombres y mujeres. Conclusiones: Los actos suicidas hospitalizados presentan una baja mortalidad, la cual está principalmente relacionada con las comorbilidades y la gravedad de las lesiones

Introduction: Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality. Material and methods: A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality. Results: Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women. Conclusions: Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries

Suicidal behaviour characteristics and factors associated with mortality in the hospital setting. / Características de la conducta suicida y factores asociados a su mortalidad en el ámbito hospitalario.

INTRODUCTION: Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality. MATERIAL AND METHODS: A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality. RESULTS: Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women. CONCLUSIONS: Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries.

Main causes of hospitalization in people with Angelman syndrome.

BACKGROUND: The objective was to describe the main causes of hospitalization in people with Angelman syndrome (AS). METHOD: Population-based cross-sectional study in the Community of Madrid (CM), Spain. The information source for AS cases was the information system for rare diseases in the CM. Variables related to hospitalization, for the period 2006-2014, were the following: number of episodes, outcome, main cause, length of stay and type of admission. Main causes of hospitalization were described by age group and sex. RESULTS: The most frequent causes of hospitalization were the following: oral-dental care (28.9%), seizures (19.6%), orthopaedic problems (14.4%) and acute respiratory disorders (12.4%). The percentage of hospitalizations was higher for oral-dental care in women and for orthopaedic problems in men (p-value <.05). Hospitalizations for an acute respiratory disorder were higher in adults (p-value <.05). CONCLUSIONS: Some differences in the causes of hospitalization of people with AS were observed by sex and age.

A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project).

RATIONALE AND OBJECTIVES: Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. METHODS: We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. RESULTS: Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies. CONCLUSION: Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.

Protocolo del estudio sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en España / Study protocol on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain

Se presenta el protocolo de los dos subestudios sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en España. Subestudio 1: describir la evolución de la mortalidad y la salud reproductiva entre 1990 y 2013 mediante un estudio longitudinal ecológico en las comunidades autónomas. Se analizarán los cambios producidos por la crisis económica en la tendencia de los indicadores de mortalidad y salud reproductiva utilizando datos panel (17 comunidades autónomas por años de estudio) y ajustando modelos de Poisson de efectos aleatorios. Subestudio 2: analizar las desigualdades según la privación socioeconómica en la mortalidad y en la salud reproductiva en varias zonas de España. Se realizará un estudio ecológico de tendencias en el cual se analizará la precrisis (1999-2003 y 2004-2008) y la crisis (2009-2013). Se ajustarán modelos de efectos aleatorios según Besag York y Mollié para estimar los indicadores de mortalidad y de salud reproductiva suavizados en secciones censales (AU)

The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999-2003 and 2004-2008) and crisis (2009-2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts (AU)

[Monitoring social determinants of health]. / La vigilancia de los determinantes sociales de la salud.

Public health surveillance is the systematic and continuous collection, analysis, dissemination and interpretation of health-related data for planning, implementation and evaluation of public health initiatives. Apart from the health system, social determinants of health include the circumstances in which people are born, grow up, live, work and age, and they go a long way to explaining health inequalities. A surveillance system of the social determinants of health requires a comprehensive and social overview of health. This paper analyses the importance of monitoring social determinants of health and health inequalities, and describes some relevant aspects concerning the implementation of surveillance during the data collection, compilation and analysis phases, as well as dissemination of information and evaluation of the surveillance system. It is important to have indicators from sources designed for this purpose, such as continuous records or periodic surveys, explicitly describing its limitations and strengths. The results should be published periodically in a communicative format that both enhances the public's ability to understand the problems that affect them, whilst at the same time empowering the population, with the ultimate goal of guiding health-related initiatives at different levels of intervention.

[Study protocol on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain]. / Protocolo del estudio sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en España.

The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999-2003 and 2004-2008) and crisis (2009-2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts.

Nuestra experiencia en el Comité Editorial de GACETA SANITARIA. Sobre todo, muchas gracias / Our experience in the Editorial Board of GACETA SANITARIA. Especially, thank you

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Gaceta Sanitaria en 2015 / Gaceta Sanitaria in 2015

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Externalities and article citations: experience of a national public health journal (Gaceta Sanitaria).

PURPOSE: The purpose of the study was to analyze the determinants of citations such as publication year, article type, article topic, article selected for a press release, number of articles previously published by the corresponding author, and publication language in a Spanish journal of public health. METHODS: Observational study including all articles published in Gaceta Sanitaria during 2007-2011. We retrieved the number of citations from the ISI Web of Knowledge database in June 2013 and also information on other variables such as number of articles published by the corresponding author in the previous 5 years (searched through PubMed), selection for a press release, publication language, article type and topic, and others. RESULTS: We included 542 articles. Of these, 62.5% were cited in the period considered. We observed an increased odds ratio of citations for articles selected for a press release and also with the number of articles published previously by the corresponding author. Articles published in English do not seem to increase their citations. CONCLUSIONS: Certain externalities such as number of articles published by the corresponding author and being selected for a press release seem to influence the number of citations in national journals.

Characteristics of herpes zoster-associated hospitalizations in Madrid (SPAIN) before vaccine availability.

OBJECTIVES: This study aimed to estimate the frequency of hospitalizations due to herpes zoster (HZ) and to describe their clinical characteristics by sex and age group. METHODS: Descriptive population-based cross-sectional study of hospital admissions due to HZ from 2003 to 2013 among residents in the Autonomous Community of Madrid. Sex, age, comorbidities, length of stay and outcomes were collected and described. Crude and age-adjusted cumulative incidence rates, and stratified by sex and age, were estimated. Robust Poisson regression analysis was used to calculate the incidence rate ratios by age group. RESULTS: 2039 hospitalizations were identified (51.0% in women). Complicated HZ caused 48.7% of them (50.9% in women). The hospitalization rate was 2.98/100,000 person-years and 7.19/1000 cases of HZ in primary care. Both rates were significantly higher in men, except in the extreme age groups. An immunosuppression-associated comorbidity was identified in 32.8% of the cases and was less common in patients ≥75 years of age. The median length of stay was 6 days, and in-hospital mortality was 1.4%. CONCLUSIONS: Hospitalization rates due to HZ were higher in men and increased with age. In two out of every three cases, a comorbidity that potentially caused immunosuppression could not be identified. These cases could benefit from vaccination.

Place of death and associated factors among patients with amyotrophic lateral sclerosis in Madrid (Spain).

Our objectives were to analyse the place of death, its temporal trend and associated sociodemographic factors among patients with amyotrophic lateral sclerosis (ALS) resident in the Autonomous Community of Madrid. This was a population based cross-sectional study of deaths from ALS (ICD-10 code G12.2) from 2003 to 2011, included in regional death statistics. The sociodemographic variables were age, gender, marital status, place of residence and socioeconomic level. Logistic regressions were performed to identify factors associated with death in hospital, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Joinpoint models were used to analyse annual trends for death in hospital. Of 1035 patients who died of ALS, 56.1% died in a hospital, 30.4% at home, 8.3% in a residential home and it was unknown for 5.1%. The percentage of deaths in hospital was lower in older and in single people than in married ones (55.0% and 61.9%, respectively; ORa 0.74, 95% CI 0.57-0.97). This percentage increased progressively as socioeconomic level fell (66.3% in Q5 compared to 49.6% in Q1, ORa 2.03, 95% CI 1.36-3.02). A significant increase in the percentage of deaths in hospital was observed. In conclusion, factors such as age, marital status or socioeconomic level play a part in the place of death of those with ALS.

Las desigualdades de género en la ciencia: GACETA SANITARIA da un paso adelante / Gender inequalities in science: GACETA SANITARIA takes a step forward

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