Cross-cultural adaptation of the Zurich Claudication Questionnaire.Validation study of the Spanish version.

BACKGROUND: In the last few years, instruments that measure outcomes and quality of life as perceived by the patient have become tools of great clinical value. The Zurich Claudication Questionnaire is one of the main instruments for the assessment of patients suffering from lumbar spinal stenosis. Nonetheless, no valid version has been published for use in the Spanish population. METHODS: The Zurich Claudication Questionnaire was translated and cross-culturally adapted to Spanish and the psychometric characteristics of the new version were then studied. Seventy-six patients were selected who were to undergo epidural steroid injection or were seen in the Hospital Complex of Navarre Spinal Unit. RESULTS: The Spanish version of the Zurich Claudication Questionnaire shows high Cronbach alpha internal consistency values, high reproducibility, a good correlation with the most important low back condition questionnaires used worldwide and good sensitivity for detecting clinical change in patients who undergo epidural steroid injection. CONCLUSION: This study resulted in a version of the Zurich Claudication Questionnaire or Swiss Spinal Stenosis Questionnaire translated and cross-culturally adapted to Spanish, with highly reliable, valid and sensitive psychometric characteristics. These proven properties make the Zurich Claudication Questionnaire available for the Spanish population, to evaluate outcomes and health status as perceived by patients with spinal stenosis and claudication syndrome.

Cross-cultural adaptation of the Zurich Claudication Questionnaire. Validation study of the Spanish versión / Adaptación transcultural de Cuestionario de Claudicación Zurich. Estudio de validación de la versión española

Background: In the last few years, instruments that measure outcomes and quality of life as perceived by the patient have become tools of great clinical value. The Zurich Claudication Questionnaire is one of the main instruments for the assessment of patients suffering from lumbar spinal stenosis. Nonetheless, no valid version has been published for use in the Spanish population. Methods: The Zurich Claudication Questionnaire was translated and cross-culturally adapted to Spanish and the psychometric characteristics of the new version were then studied. Seventy-six patients were selected who were to undergo epidural steroid injection or were seen in the Hospital Complex of Navarre Spinal Unit. Results: The Spanish version of the Zurich Claudication Questionnaire shows high Cronbach alpha internal consistency values, high reproducibility, a good correlation with the most important low back condition questionnaires used worldwide and good sensitivity for detecting clinical change in patients who undergo epidural steroid injection. Conclusion: This study resulted in a version of the Zurich Claudication Questionnaire or Swiss Spinal Stenosis Questionnaire translated and cross-culturally adapted to Spanish, with highly reliable, valid and sensitive psychometric characteristics. These proven properties make the Zurich Claudication Questionnaire available for the Spanish population, to evaluate outcomes and health status as perceived by patients with spinal stenosis and claudication sindrome (AU)

Introducción: En los últimos años, los instrumentos de medida de resultados y calidad de vida percibida por el paciente, se han convertido en herramientas de gran utilidad clínica. El Cuestionario de Claudicación de Zurich es uno de los principales instrumentos para el estudio de los pacientes afectos de estenosis del canal lumbar. Actualmente, no se ha publicado una versión validada para su uso en la población española. Métodos: El Cuestionario de Claudicación de Zurich ha sido traducido y adaptado transculturalmente al español, y se han estudiado las características psicométricas de la nueva versión. Se seleccionaron 76 pacientes a los que se les iba a realizar una infiltración epidural de esteroides o que eran vistos en consultas de la Unidad de Raquis Quirúrgico del Complejo Hospitalario de Navarra. Resultados: La versión española del Cuestionario de Claudicación de Zurich muestra altos valores de consistencia interna alfa de Cronbach, alta reproducibilidad, una buena correlación con los cuestionarios de patología lumbar más importantes a nivel mundial, y una buena sensibilidad para detectar cambios clínicos en pacientes a los que se les realiza una infiltración epidural de corticoides. Conclusión: Se ha obtenido una versión del Cuestionario de Claudicación de Zurich traducida y adaptada transculturalmente al español, con altos valores en las características psicométricas de fiabilidad, validez y sensibilidad. Esto permite, en la población española, evaluar los resultados y el estado de salud percibido por los pacientes con estenosis de canal y síndrome de claudicación (AU)

Costes del ictus desde la perspectiva social. Enfoque de incidencia retrospectiva con seguimiento a tres años / Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at three years

Introducción. El coste del ictus es importante desde el punto de vista social, pues se trata de una enfermedad con gran impacto individual, familiar y social. Los estudios de coste de la enfermedad aportan una descripción total de los aspectos económicos del ictus. La perspectiva más amplia es la social, donde se incluyen todos los costes y consecuencias. La aproximación deseable es la denominada bottom-up. Objetivos. Calcular el coste del ictus desde la perspectiva social en la población de una zona básica de salud (12.000 habitantes) mediante un enfoque de incidencia retrospectiva (seguimiento a tres años) y una aproximación ‘de abajo a arriba’. Calcular la fracción atribuible a la atención primaria, la hospitalaria y la social. Pacientes y métodos. Todos los ictus diagnosticados entre el desde el 1 de enero de 1999 hasta el 31 de diciembre de 2003, pertenecientes a una zona básica de salud de Navarra (n = 91). Recogida de datos: cuestionario ad hoc –cuestionario CACV (costes del accidente cerebrovascular)–, que valora el coste ‘incremental’ provocado por el ictus y sus complicaciones. Resultados. El coste medio se sitúa en 5.759,50 € para el primer año, 3.596,60 € para el segundo y 4.671,30 € para el tercero. El coste en el primer año viene determinado por la atención hospitalaria, que supone el 50% de los costes. A partir del segundo año los costes de la atención ambulatoria adquieren una gran importancia, ya que suponen un 70% del total. Conclusiones. El coste del ictus en los tres primeros años se aproxima a los 5.000 €/año. Se necesitan más estudios de coste de la enfermedad cerebrovascular desde la perspectiva social, que debería incluir, por tanto, el coste del cuidado informal

Introduction. The costs deriving from strokes are important from a social point of view because this is a pathology with a substantial individual, familial and social impact. Cost-of-illness studies provide an overall description of the economic aspects of strokes. The widest perspective is the social one, where all the costs and consequences are included. If possible, it is wise to take a bottom-up approach. Aims. To calculate the costs deriving from strokes from the social perspective in the population of a district health service (12,000 inhabitants) by means of a retrospective incidence approach (follow-up at three years) and a bottom-up procedure. We also intended to calculate the fractions that can be attributed to primary care, hospital care and social care. Patients and methods. Our study included all the cases of stroke diagnosed between 1st January 1999 and 31st December 2003 within a basic health care district in Navarre (n = 91). Data collection: an ad hoc questionnaire –the CACV (cerebrovascular accident cost) questionnaire– which assessed the ‘incremental’ costs due to strokes and their complications. Results. The average cost was found to be 5,759.50 € for the first year, 3,596.60 € for the second and 4,671.30 € for the third. The cost in the first year is marked by the hospital care, which accounts for 50% of the total. From the second year onwards the costs of outpatient care become very important, since they represent 70% of the overall costs. Conclusions. The costs deriving from strokes in the first three years amount to almost 5,000 €/year. More cerebrovascular cost-of-illness studies need to be conducted from the social perspective and should therefore include the costs of informal care

[Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at three years]. / Costes del ictus desde la perspectiva social. Enfoque de incidencia retrospectiva con seguimiento a tres años.

INTRODUCTION: The costs deriving from strokes are important from a social point of view because this is a pathology with a substantial individual, familial and social impact. Cost-of-illness studies provide an overall description of the economic aspects of strokes. The widest perspective is the social one, where all the costs and consequences are included. If possible, it is wise to take a bottom-up approach. AIMS: To calculate the costs deriving from strokes from the social perspective in the population of a district health service (12,000 inhabitants) by means of a retrospective incidence approach (follow-up at three years) and a bottom-up procedure. We also intended to calculate the fractions that can be attributed to primary care, hospital care and social care. PATIENTS AND METHODS: Our study included all the cases of stroke diagnosed between 1st January 1999 and 31st December 2003 within a basic health care district in Navarre (n = 91). DATA COLLECTION: an ad hoc questionnaire -the CACV (cerebrovascular accident cost) questionnaire- which assessed the 'incremental' costs due to strokes and their complications. RESULTS: The average cost was found to be 5,759.50 euro for the first year, 3,596.60 euro for the second and 4,671.30 euro for the third. The cost in the first year is marked by the hospital care, which accounts for 50% of the total. From the second year onwards the costs of outpatient care become very important, since they represent 70% of the overall costs. CONCLUSIONS: The costs deriving from strokes in the first three years amount to almost 5,000 euro/year. More cerebrovascular cost-of-illness studies need to be conducted from the social perspective and should therefore include the costs of informal care.

[Analysis of the efficiency of the screening of anti-HVA IgG antibodies before active or passive immunization]. / Analisis de la eficiencia de la detección de anticuerpos anti-hepatitis A IgG previa a la inmunización activa o pasiva.

BACKGROUND: The epidemiological patron of hepatitis A has changed in the last few years and a decrease of the anti-hepatitis A antibodies IgG (Anti-HVA) have been observed at early ages, which will accompany in the future an increase of symptomatic hepatitis. The prevention of hepatitis A requires a strict application of the norms of personal and environmental hygiene and the administration of vaccines or immunoglobulins. In order to determine the convenience of immunization actively or passively with or without the previous detection of Anti-HVA, requires the knowledge of with strategy is more efficient. METHODS: An analysis is carried out to determine the threshold of prevalence, where the reason of efficiency is established by comparing the unit cost of immunization either actively or passively of the population, with a cost of immunizing only the negative Anti-HVA by previous screening, with the formula: the unit cost of the active or passive immunization (unit cost of screening + cost of active or passive (in specific immunoglobuline) immunization in the negative Anti-HVA). The results correlate with the prevalence of Anti-HVA in age group founded in sero-epidemiological studies published by Salleras (1992 and Pérez-Trallero (1994). RESULTS: The threshold of prevalence, the reason of efficiency equals 1, it's situated in 18% and 65% respectively for the active and passive immunization, which corresponds to the age group of 10-19 years and 20-29 years based on sero-epidemiological studies used. CONCLUSIONS: With prevalence of Anti-HVA equal to or above 18% of the population the most efficient strategy is to determine the Anti-HVA before the active immunization; This threshold of prevalence move to up to 65% with passive immunization. Beneath these prevalence it's more efficient to immunize actively or passively without prior screening.