COVID-19 Vaccination Coverage and Associated Factors in Patients with Multiple Sclerosis.

Our objective was to know the COVID-19 vaccination coverage in multiple sclerosis (MS) patients and its factors associated. A retrospective cohort study was carried out. Patients seen at the MS unit of the University Clinical Hospital of Zaragoza between 2017 and 2021 were included. Variables were obtained by reviewing the specialized and primary care records. Associations between receiving COVID-19 full primo-vaccination, as well as one booster dose since autumn 2022, and the other variables were analyzed using bivariate analysis and multiple logistic regression models. Of the 359 included patients, 90.3% received the COVID-19 full primo-vaccination. Having been born in Spain (aOR = 3.40) and having received the 2020-2021 influenza vaccine (aOR = 6.77) were associated with receiving the COVID-19 full primo-vaccination. Vaccination with a COVID-19 booster dose was detected in 141 patients (39.3%). Sex (man) (aOR = 2.36), age (60 years or over) (aOR = 6.82), type of MS (Primary Progressive/Secondary Progressive) (aOR = 3.94), and having received the 2022-2023 influenza vaccine (aOR = 27.54) were associated with receiving such a booster dose. The COVID-19 booster dose was administered at the same time as the 2022-2023 influenza vaccine in 57.8% (67/116) of the patients vaccinated with both vaccines. The COVID-19 full primo-vaccination coverage is higher than in other countries. However, the decrease in vaccination coverage with the booster dose makes it necessary to develop strategies to improve it that are not limited to administering the flu vaccine together with the COVID-19 booster dose. Such strategies should be in focus, especially for women under 60 years of age.

Influenza Vaccination among Multiple Sclerosis Patients during the COVID-19 Pandemic.

In the context of the COVID-19 pandemic, the co-circulation of influenza and SARS-CoV-2 viruses may have severe complications for vulnerable populations. For this reason, the World Health Organization pointed to the 2020-2021 anti-influenza campaign as being of special relevance. Our aim was to assess the 2020-2021 influenza vaccination coverage, and its associated factors, among patients in a Spanish multiple sclerosis (MS) unit. A cross-sectional study was conducted. People attending the MS unit of the Clinical Hospital of Zaragoza during 2020 were included. Variables were obtained by reviewing records. Associations with 2020-2021 influenza vaccination were analyzed using bivariate analysis and a multiple logistic regression model. A total of 302 patients were studied; 62.6% were women, whose mean age (standard deviation) was 47.3 (11.5) years. The 2020-2021 influenza vaccination coverage was 55.3% (59.8% in women and 47.8% in men). A total of 89.7% had at least one other indication for vaccination (e.g., immunosuppressive treatment in 225 patients). The variables associated with getting vaccinated were being female (adjusted odds ratio (95% confidence interval) (aOR (95%CI) = 2.12 (1.12-3.99)), having received the 2019-2020 influenza vaccine (aOR (95%CI) = 31.82 (14.71-68.86)) and being born in Spain (aOR (95%CI) = 12.91 (1.07-156.28)). Coverage is moderate compared to other countries. It is necessary to develop strategies to improve it, especially in men and those born outside Spain.

Influenza Vaccination Coverage among Multiple Sclerosis Patients: Evolution over Time and Associated Factors.

Our objective was to determine the influenza vaccination rate in a Spanish cohort of multiple sclerosis (MS) patients. A retrospective cohort study was carried out. Patients who attended the MS unit of the Lozano Blesa Hospital of Zaragoza between January 2015 and 2020 were included. The variables were obtained by reviewing the specialized and primary care records. Associations between receiving the vaccine in each flu season and the other variables were analyzed using bivariate analysis and multiple logistic regression models. A total of 260 patients were studied, with a median age of 31 years at the time of diagnosis. A total of 62.3% (162/260) were women. Vaccination coverage ranged from 20.4% in the 2015−2016 and 2016−2017 seasons to 41.5% in the 2019−2020 season (p = 0.000). Having been vaccinated in the previous season (ORa: 16.47−390.22; p = 0.000) and receiving a vaccination recommendation from the hospital vaccination unit (ORa: 2.44−3.96; p < 0.009) were associated with being vaccinated. The coverage is in an intermediate position compared to other countries. It is necessary to improve the referral system of these patients to the hospital vaccination unit because the information obtained by this service contributed to higher vaccination rates.

PPAR-γ Gene Expression in Human Adipose Tissue Is Associated with Weight Loss After Sleeve Gastrectomy.

BACKGROUND: The peroxisome proliferator-activated receptor (PPAR)-γ plays a key role in adipose tissue differentiation and fat metabolism. However, it is unclear which factors may regulate its expression and whether obese patients have changes in adipose tissue expression of PPAR-γor potential regulators such as miR-27. Thus, our aims were to analyze PPAR-γ and miR-27 expression in adipose tissue of obese patients, and to correlate their levels with clinical variables. SUBJECTS AND METHODS: We included 43 morbidly obese subjects who underwent sleeve gastrectomy (31 of them completed 1-year follow-up) and 19 non-obese subjects. mRNA expression of PPAR-γ1 and PPAR-γ2, miR-27a, and miR-27b was measured by qPCR in visceral and subcutaneous adipose tissue. Clinical variables and serum adipokine and hormone levels were correlated with PPAR-γ and miR-27 expression. In addition, a systematic review of the literature regarding PPAR-γ expression in adipose tissue of obese patients was performed. RESULTS: We found no differences in the expression of PPAR-γ and miR-27 in adipose tissue of obese patients vs. controls. The literature review revealed discrepant results regarding PPAR-γ expression in adipose tissue of obese patients. Of note, we described a significant negative correlation between pre-operative PPAR-γ1 expression in adipose tissue of obese patients and post-operative weight loss, potentially linked with insulin resistance markers. CONCLUSION: PPAR-γ1 expression in adipose tissue is associated with weight loss after sleeve gastrectomy and may be used as a biomarker for response to surgery.

[Influenza vaccination in medical and nursing students in the Covid-19 era: how to improve it?] / Vacunación antigripal en estudiantes de medicina y enfermería en la era Covid-19: ¿Cómo mejorarla?

OBJECTIVE: Influenza vaccination coverages among health care students are low. The aim of this study was to find out which measures, according to medical and nursing students, could contribute to improve these vaccination rates. METHODS: A cross-sectional study that included medical and nursing students of the University of Zaragoza who were doing internships in health centers during the 2020-2021 school year. The information was obtained in December 2020 by a self-administered online questionnaire, in which they were asked to describe the measures that, in their opinion, are necessary to increase their influenza vaccination coverage. A qualitative analysis of the content of the answers was carried out, extracting themes, sub-themes and selecting the most representative verbatims. RESULTS: The questionnaire was answered by 83 students (response rate: 5.9%); 64 (77.1%) were women, and 74.7% of them were studying medicine. The main measures proposed were improving the accessibility of the vaccine, improving the training on influenza vaccine, promoting vaccination by the teaching staff, and increasing the diffusion of information about the vaccination campaign. CONCLUSIONS: This study has found measures to be applied specifically to medical and nursing students to potentially improve their influenza vaccination coverage. For its implementation, collaboration between universities and health services is necessary.

OBJETIVO: Las coberturas de vacunación antigripal en estudiantes sanitarios son bajas. El objetivo de este estudio fue conocer las medidas que, según los estudiantes de medicina y enfermería, podrían contribuir a mejorar dichas tasas de vacunación. METODOS: Estudio transversal que incluyó a los alumnos de medicina y enfermería de la Universidad de Zaragoza que realizaban prácticas en centros sanitarios durante el curso académico 2020-2021. La información se obtuvo en diciembre 2020 utilizando un cuestionario on line auto-cumplimentado, en el que se solicitaba que describieran las medidas que, en su opinión, son necesarias para incrementar sus coberturas de vacunación antigripal. Se realizó un análisis cualitativo del contenido de las respuestas, extrayendo temas, subtemas y seleccionando los verbatims más representativos. RESULTADOS: 83 estudiantes respondieron el cuestionario (tasa de respuesta: 5,9%); 64 (77,1%) eran mujeres, cursando medicina el 74,7%. Las principales medidas propuestas estaban relacionadas con mejorar la accesibilidad de la vacuna, mejorar la formación sobre la vacuna antigripal, promover la vacunación por parte del personal docente y aumentar la difusión de la información sobre la campaña de vacunación. CONCLUSIONES: Este estudio ha identificado medidas a aplicar específicamente en los estudiantes de medicina y enfermería con las que potencialmente mejorar sus coberturas de vacunación antigripal. Para su implementación, es necesaria la colaboración entre las universidades y los servicios de salud.

Information in Spanish on YouTube about Covid-19 vaccines.

Our objective was to analyze the sources, characteristics, tone, and content of the most viewed YouTube videos in Spanish about Covid-19 vaccines. In February 2021, a search was carried out on YouTube using the terms "Vacuna Covid," "Vacuna coronavirus," and "Vacuna Covid19." Associations between tone, source, and others variables (e.g. number of views or dislikes) were studied with a Mann-Whitney U-test and a chi-square test. A total of 118 videos were analyzed; 63.6% were originated from Mexico and the USA; media created 57.6% of the videos. Positive tone was observed in 53.4%. The most discussed topics were target groups for vaccination (38.9%) and safety (43.2%). The 68 videos produced by media accumulated 31,565,295 views (55.0% of views), and the 19 videos created by health professionals obtained 10,742,825 views (18.7% of views). A significantly smaller number of likes was obtained in videos of media compared to those created by health professionals (p = .004). Videos made by health professionals, compared to those of media, showed a greater positive tone (OR = 3.09). Hoaxes/conspiracy theories were identified in 1.7% of the videos. Monitoring that the information on YouTube about Covid-19 vaccines is reliable should be a central part of Covid-19 vaccination campaigns.

YouTube as a Source of Influenza Vaccine Information in Spanish.

Our objective was to analyze the information in Spanish on YouTube about the influenza vaccine. In August 2020, a search was conducted on YouTube using the terms "Vacuna gripe", "Vacuna influenza", and "Vacuna gripa". Associations between the type of authorship, country of publication, and other variables (such as tone, hoaxes, and vaccination recommendations) were studied via univariate analysis. A total of 100 videos were evaluated; 57.0% were created in Mexico (24.0%), Argentina (17.0%), and Spain (16.0%), and 74.0% were produced by mass media or health professionals. Positive messages were detected in 65.0%. The main topics were the benefits of the vaccine (59.0%) and adverse effects (39.0%). Hoaxes were detected in 19 videos. User-generated content, compared to that of health professionals, showed a higher probability of hoaxes (odds ratio (OR) = 15.56), a lower positive tone (OR = 0.04), and less evidence of recommendations to vaccinate pregnant individuals (OR = 0.09) and people aged 60/65 or older. Videos published in Spain, in comparison with those from Hispanic America, presented significant differences in the positive tone of their messages (OR = 0.19) and in the evidence of the benefits of vaccination (OR = 0.32). A higher probability of hoaxes was detected in videos from Spain and the USA. Information in Spanish about the influenza vaccine on YouTube is usually not very complete. Spanish health professionals are urged to produce pro-vaccination videos that counteract hoaxes, and users in Hispanic America should be advised to consult videos produced in Hispanic American countries by health professionals to obtain reliable information.

Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone.

BACKGROUND: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. METHODS: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400-600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. RESULTS: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. CONCLUSIONS: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.

Effectiveness of an intervention to improve the vaccination coverage against Streptococcus pneumoniae in patients with chronic kidney disease.

Pneumococcal vaccination is recommended for chronic kidney disease (CKD) patients. We evaluated the impact of implementing a hospital vaccine consultation on their vaccination coverages. A sample was drawn from consecutive cases referred to our clinic between November 2014 and June 2018. 101 patients were analyzed: 4 had received the pneumococcal conjugated vaccine 13-valent at the time of the first appointment, whereas 93 had received it after being seen (RR (95%-CI) = 23.3 (8.88-60.85)). Moreover, 5 had received the pneumococcal polysaccharide vaccine 23-valent at the time of the first appointment, whereas 90 had received it after being seen (RR (95%-CI) = 18.0 (7.64-42.42)). Implementing a hospital-based vaccine consultation represents an effective intervention to improve pneumococcal vaccination coverage in these patients.

Association of Allelic Variants of the Reelin Gene with Autistic Spectrum Disorder: A Systematic Review and Meta-Analysis of Candidate Gene Association Studies.

Autistic spectrum disorder (ASD) is a complex neurodevelopmental disability with a genetic basis, and several studies have suggested a potential role of the reelin gene (RELN) in ASD susceptibility. Accordingly, genetic association studies have explored this potential association, but the results have been controversial thus far. For this reason, we assessed the association of four genetic variants of RELN (the 5'UTR CGG triplet repeat and polymorphisms rs736707, rs362691, and rs2229864) with ASD by means of a systematic review and meta-analysis. We retrieved studies comparing the distribution of the above-mentioned genetic variants between ASD patients and healthy controls. A meta-analysis was conducted using a random effects model, and calculations of the odds ratios (ORs) and confidence intervals (CIs) were performed. A sensitivity analysis and tests to determine the heterogeneity of the results were also performed. Eleven previous studies fulfilled the inclusion criteria and analyzed the association of the above-mentioned genetic variants and ASD. We did not find any significant association between the allele or genotype frequencies of the analyzed polymorphisms and ASD, and large heterogeneity was found for the rs736707 polymorphism. Moreover, no significant differences were found between the 5'UTR triplet repeat and this disorder. In light of current evidence, no single genetic variant within this gene is clearly associated with the development of ASD, and ethnic differences may explain part of the observed heterogeneity. Larger studies among different ethnic groups are needed to establish the role of specific genetic variants within RELN in the etiology of this disorder.

Information in Spanish on the Internet about the Prevention of COVID-19.

Objective. Our objective was to analyze the evolution of the information in Spanish online about the prevention of the coronavirus disease 2019 (COVID-19). Methods. On 1 March and 13 July 2020, two searches were conducted on Google with the terms "Prevencion COVID-19" and "Prevencion Coronavirus". In each stage, a univariate analysis was performed to study the association of the authorship and country of origin with the basic recommendations to avoid COVID-19 provided by the World Health Organization (WHO). Results. A total of 120 weblinks were evaluated. The recommendation found most frequently in both stages was "wash your hands frequently" (93.3% in March vs. 90.0% in July). There was a significant increase in the detection of the following recommendations: "avoid touching your face" (56.7% vs. 80.0%) and "stay at home if you feel unwell" (28.3% vs. 63.3%). Weblinks of official public health organizations more frequently provided the advice to "seek medical advice if you develop a fever/cough or have difficulty breathing". Furthermore, in July, such weblinks provided recommendations to "avoid touching your face" and "maintain a distance of one meter" more frequently than the mass media (OR = 11.5 and 10.5, respectively). In March, the recommendation to "maintain a distance of at least 1 m" was associated with the weblinks from countries with local transmission/imported cases (OR = 8.1). Different/ambiguous information regarding the WHO recommendations was detected in four weblinks. Conclusion. The availability of information in Spanish online on basic prevention measures has improved over time, although there is still room for improvement. It is necessary to promote the use of the websites of official public health organizations among Spanish-speaking users.

Characteristics of YouTube Videos in Spanish on How to Prevent COVID-19.

OBJECTIVE: To analyze the characteristics of YouTube videos in Spanish on the basic measures to prevent coronavirus disease 2019 (COVID-19). METHODS: On 18 March 2020, a search was conducted on YouTube using the terms "Prevencion Coronavirus" and "Prevencion COVID-19". We studied the associations between the type of authorship and the country of publication with other variables (such as the number of likes and basic measures to prevent COVID-19 according to the World Health Organization, among others) with univariate analysis and a multiple logistic regression model. RESULTS: A total of 129 videos were evaluated; 37.2% were produced in Mexico (25.6%) and Spain (11.6%), and 56.6% were produced by mass media, including television and newspapers. The most frequently reported basic preventive measure was hand washing (71.3%), and the least frequent was not touching the eyes, nose, and mouth (24.0%). Hoaxes (such as eating garlic or citrus to prevent COVID-19) were detected in 15 videos (10.9%). In terms of authorship, papers produced by health professionals had a higher probability of reporting hand hygiene (OR (95% CI) = 4.20 (1.17-15.09)) and respiratory hygiene (OR (95% CI) = 3.05 (1.22-7.62)) as preventive measures. CONCLUSION: Information from YouTube in Spanish on basic measures to prevent COVID-19 is usually not very complete and differs according to the type of authorship. Our findings make it possible to guide Spanish-speaking users on the characteristics of the videos to be viewed in order to obtain reliable information.

Measures to Improve Influenza Vaccination Coverage in Spanish Medical Students.

Objective: To find out what measures medical students believe could help improve their influenza vaccination coverage. Method: On 5 November, 2019, the Dean of the Zaragoza Medical School sent an e-mail to the students asking them to fill out a questionnaire through Google Forms, in which they were asked to describe, in an open field, the measures that they believed could contribute to improving their flu vaccination coverage. The content of the responses was analyzed in a classic way, extracting descriptors and selecting the most representative verbatim accounts. Results: The main measures proposed were to improve the training on influenza and its vaccine, to improve the accessibility of the vaccine in time and space, to provide incentives to get vaccinated, to create visible and positive attitudes towards the vaccine, and to increase the diffusion of information about the vaccination campaign. Conclusion: This qualitative study has found potential measures to be applied specifically to medical students to improve their vaccination coverage in our country.

Características de los vídeos de YouTube en castellano sobre la vacuna antigripal / Characteristics of YouTube videos in Spanish about the influenza vaccine

FUNDAMENTO: Analizar las características de los vídeos de YouTube en castellano sobre la vacuna antigripal. MÉTODO: En abril de 2019 se realizó una búsqueda en YouTube usando el término vacuna gripe. Se estudió la asociación del tipo de autoría y del país de publicación con el resto de variables (tono del mensaje, tipo de publicación, recomendaciones de vacunación según el Ministerio de Sanidad español, entre otras) mediante análisis univariante y un modelo de regresión logística múltiple. RESULTADOS: Se incluyeron 208 vídeos, el 26% publicados desde España y el 25% desde México; el 47,1% eran noticias, el 51,4% elaborados por canales de televisión, y el 79,8% apoyaban el uso de la vacuna antigripal (tono positivo). El contenido más frecuente fue considerar la vacuna antigripal como el método más eficaz de prevención (64,4%) y la recomendación de vacunar a partir de los 65 años (43,3%). La autoría por profesionales sanitarios se relacionó con un tono positivo hacia la vacunación (OR: 2,91; IC95%: 1,12-7,53; p = 0,028), y el país de publicación (España) con un tono no positivo (OR: 0,31; IC95%: 0,15-0,65; p = 0,002). CONCLUSIONES: La información en YouTube sobre la vacuna antigripal no suele ser muy completa, y difiere según autoría y país de publicación. Por tanto, los profesionales sanitarios en España deberían publicar información provacunación según las recomendaciones del Ministerio de Sanidad, y se debería promocionar la consulta de dichos vídeos entre los usuarios en España que buscan información fiable sobre esta vacuna en YouTube

BACKGROUND: To analyze the characteristics of YouTube videos in Spanish about the influenza vaccine. METHODS: In April 2019, a search was conducted on YouTube with the term vacuna gripe. We studied the association between the type of author, and country of publication, and the rest of the variables (tone of the message, type of publication, and vaccination recommendations according to the Spanish Ministry of Health, among others) with univariate analysis and a multiple logistic regression model. RESULTS: In total, 208 videos were assessed; 51.0% had been published from Spain and Mexico, and 79.8% of the videos supported the use of influenza vaccines. The main topics discussed in the videos were whether the vaccine should be considered the most effective method to prevent influenza (64.4%) and recommendations concerning the vaccination of people over 65 years old (43.3%). The variables type of authorship (healthcare professionals) and country of publication (Spain) were associated with a positive attitude towards vaccination (OR: 2.91; 95%CI: 1.12-7.53 and OR: 0.31; 95%CI: 0.15-0.65, respectively). CONCLUSIONS: The existing information on YouTube about the influenza vaccine is not generally very complete, and it varies depending on the authorship of the videos and the country of publication. It would be advisable for healthcare professionals to publish videos promoting vaccination based on the guidelines from the Spanish Ministry of Health, and it is necessary to promote those videos for Spanish users who search for reliable information about this vaccine on YouTube

Assessment of Health Information About COVID-19 Prevention on the Internet: Infodemiological Study.

BACKGROUND: The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. OBJECTIVE: The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. METHODS: On February 29, 2020, we performed a Google search with the terms "Prevention coronavirus," "Prevention COVID-19," "Prevención coronavirus," and "Prevención COVID-19". A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). RESULTS: In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was "wash your hands frequently" (n=65, 81%). A less frequent recommendation was to "stay home if you feel unwell" (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as "wash your hands frequently" (OR 9.82), "cover your mouth and nose with your bent elbow or tissue when you cough or sneeze" (OR 4.59), or "stay home if you feel unwell" (OR 0.31). CONCLUSIONS: It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

Characteristics of YouTube videos about the meningococcal B vaccine (4CMenB).

YouTube has become a large source of health information, and it has the capacity to influence users: for instance, regarding their vaccination habits. The aim of our study was to analyze the characteristics of the videos published on YouTube about the meningococcal B vaccine (4CMenB, Bexsero®). A search was made on YouTube using the keyword "Bexsero." The association between the authorship of videos (health professionals or others) and the rest of the variables (tone of the message and vaccination recommendations, among others) was evaluated using the Chi-square test. In total, 77 videos were analyzed; 74% supported the use of the vaccine, and the most frequently mentioned vaccination recommendations were in epidemic outbreaks (28.6%) and in children (18.2%). Depending on the type of authorship, significant differences were observed regarding the tone of the message and the frequency with which the videos discussed effectiveness, dosage, adverse effects, and vaccination recommendations. There is a difficulty in obtaining information on vaccination recommendations. Recommendations are very diverse since there is a great heterogeneity in the official recommendations for the use of this vaccine, depending on the country the information is from.

[Influenza vaccination coverages and related factors among splenectomy patients from a health sector in Zaragoza (Spain)]. / Cobertura de vacunación antigripal y factores asociados en pacientes esplenectomizados de un sector de salud de Zaragoza (España).

OBJECTIVE: Influenza vaccination coverage in risk groups has been put forward as a healthcare quality indicator. Our objective was to determine the vaccination rate in splenectomized patients. METHODS: We carried out a cross-sectional study that included splenectomized patients in the Zaragoza III Sector from January 2012 to December 2016. The patients were identified through the database of the Clinical Documentation and File Management Services of the Sector Hospital under code 41.5 of the ICD-9. The variables (sociodemographic and surgical variables, and having received information and advice regarding vaccination when they were admitted to the Immunization Unit) were obtained after a review of the patients' records in the Specialized and Primary Care Services. The association with being vaccinated during the campaign corresponding to the surgery date was studied with bivariate analysis and multiple logistic regression model. RESULTS: 81 patients were analyzed; 60.5% were men, with an average age of 56.3 years. Neoplasms and hematological diseases were the most common motives for surgery (64.2%). The vaccination rate was 58%. Having been advised to vaccinate (OR=6.53; 95%CI=1.88-22.69) and having been vaccinated in the previous season (OR=4.79; 95%CI= 1.48-15.57) were associated with vaccination. CONCLUSIONS: The coverage rate ranks in an intermediate position when compared with other countries. It is necessary to improve the referral system of these patients to the Immunization Unit because the information obtained by this service leads to better results.

OBJETIVO: La cobertura vacunal antigripal en grupos de riesgo ha sido postulada como un indicador de la calidad asistencial. El objetivo de este estudio fue conocer dicha tasa de vacunación en esplenectomizados. METODOS: Se realizó un estudio transversal que incluyó a los esplenectomizados del sector Zaragoza III entre enero de 2012 y diciembre de 2016. La identificación de los pacientes se realizó a través de la base de datos del Servicio de Archivos y Documentación Clínica del hospital del sector, utilizando el código 41.5 de la Clasificación Internacional de Enfermedades (9ª edición). Las variables (sociodemográficas, quirúrgicas y el haber recibido información y consejo para vacunarse al ser atendido en la consulta hospitalaria de vacunas) fueron obtenidas revisando las historias de atención especializada y primaria. Se analizó la asociación con la vacunación en la campaña correspondiente a la fecha de la cirugía mediante un análisis bivariado y un modelo de regresión logística múltiple. RESULTADOS: Fueron estudiados 81 pacientes. El 60,5% eran hombres, con una edad media de 56,3 años. Las neoplasias y las enfermedades hematológicas fueron los motivos más frecuentes de cirugía (64,2%). La tasa de vacunación fue del 58%. Recibir la recomendación de vacunación (OR=6,53; IC95%=1,88-22,69) y haber sido vacunado en la temporada anterior (OR=4,79; IC95%=1,48-15,57) se asociaron con la acción de vacunarse. CONCLUSIONES: La cobertura se encuentra en una posición intermedia comparada con otros países. Se ha de mejorar la sistemática de derivación de estos pacientes a la consulta hospitalaria de vacunas, dado que la información facilitada en ella contribuye a obtener mejores resultados.

[Impact of an intervention to improve the vaccination coverage against streptococcus pneumoniae in hiv patients]. / Evaluación del impacto de una intervención para mejorar las coberturas de vacunación frente a neumococo en pacientes con VIH.

OBJECTIVE: People affected by the human immunodeficiency virus (HIV) have a higher risk of invasive pneumococcal disease. Therefore, vaccination against streptococcus pneumoniae is recommended for that group. The objective of this study was to analyze the impact of implementing a hospital appointment to assess vaccination status as part of the vaccination schedule of HIV patients. METHODS: We carried out a quasi-experimental uncontrolled before and after study with a sampling of consecutive cases of HIV patients referred to our department from November 1, 2014 to June 30, 2018. The study compared the vaccination coverage on the date of the appointment for an assessment of their vaccination status in our department and after the appointment. The analysis used the chi-squared test and the values on the date of the first appointment were taken as a reference. RESULTS: 209 patients were analyzed, and a statistically significant improvement was observed regarding their vaccination coverage: 2.9% of the patients had been vaccinated on the date in which they made an appointment for assessment by our department, and 88.0% were vaccinated after they left (OR [95%CI]: 30.7 [13.92-67.58]) with the 13-valent pneumococcal conjugate vaccine; and 16.3% had been vaccinated on the date they made the first appointment vs. 83.7% after they came to the appointment (OR [95%CI]: 5.2 [3.76-7.04]) with the 23-valent polysaccharide pneumococcal vaccine. CONCLUSIONS: Implementing a hospital appointment for vaccination is an effective intervention to improve vaccination coverage against streptococcus pneumoniae in HIV patients.

OBJETIVO: Las personas infectadas por el virus de la inmunodeficiencia humana (VIH) presentan riesgo elevado de sufrir la enfermedad neumocócica invasiva, motivo por el que se recomienda su vacunación frente al neumococo. El objetivo de este trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en las coberturas de vacunación de estos pacientes. METODOS: Se elaboró un estudio cuasiexperimental sin grupo control, de tipo antes/después, en el que se realizó un muestreo de casos consecutivos de pacientes con VIH remitidos a nuestra consulta entre el 1 noviembre de 2014 y el 30 junio de 2018. Las coberturas en el momento de la fecha de la cita para la valoración de su estado vacunal (en nuestra consulta) y después de ser atendido se compararon usando la prueba chi-cuadrado. Como referencia se utilizaron las del momento de la fecha de la primera cita. RESULTADOS: Se analizaron 209 pacientes, en los que se obtuvieron mejoras estadísticamente significativas en sus coberturas vacunales: 2,9% en el momento de la fecha de la cita para la valoración en nuestra consulta y 88% después de ser atendidos en nuestra consulta (RR [IC95%]= 30,7 [13,92-67,58]) para la vacuna antineumocócica conjugada 13-valente, y 16,3% en el momento de la primera cita y 83,7% después de ser atendidos en nuestra consulta (RR [IC95%]=5,2 [3,76-7,04]) para la vacuna antineumocócica polisacárida 23-valente. CONCLUSIONES: Implementar una consulta hospitalaria de vacunas representa una intervención efectiva para mejorar las coberturas de vacunación frente al neumococo en pacientes con VIH.

[Assessment of the effectiveness of an intervention to improve immunization coverage in splenectomy patients]. / Evaluación de la efectividad de una intervención para mejorar las coberturas vacunales en pacientes esplenectomizados.

OBJECTIVE: Splenectomized patients have an increased risk of sepsis caused by encapsulated bacteria. Pneumococcal, meningococcal and Haemophilus influenzae B vaccination is recommended in this group. The aim of our study was to assess the impact of the introduction of an immunization hospital clinic on their immunization coverages. METHODS: Quasi-experimental study. The control group included patients splenectomized between January 2012-April 2014, and the intervention group included patients splenectomized between May 2014-December 2016. The global and specific immunization coverages were compared between both groups using a Chi-square test. RESULTS: 80 patients were analyzed. The most commonly administered vaccine was the 23-valent pneumococcal polysaccharide vaccine (65.0%). A significant improvement was observed both in the global immunization rate (17.1% in the pre-intervention study vs. 57.8% in the post-intervention study) (RR: 3.37; 95% CI: 1.56-7.27) and in the specific immunization rate for the Haemophilus influenzae B, meningococcal C and 13-valent pneumococcal conjugate vaccines. CONCLUSIONS: Introducing an immunization hospital clinic is an effective measure to improve the immunization coverage of splenectomy patients.

OBJETIVO: Los pacientes esplenectomizados presentan riesgo elevado de sepsis por bacterias encapsuladas, motivo por el que se recomienda vacunarles frente a neumococo, meningococo y Haemophilus infl uenzae B. El objetivo de nuestro trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en sus coberturas de vacunación. METODOS: Estudio cuasiexperimental. Constituyeron el grupo control los esplenectomizados entre enero 2012-abril 2014, y el grupo intervención los operados entre mayo 2014-diciembre 2016. Se compararon las coberturas vacunales global y específica para cada vacuna según grupo utilizando la prueba chi-cuadrado. RESULTADOS: Se analizaron 80 pacientes. La vacuna más administrada fue la antineumocócica polisacárida 23-valente (65,0%). Hubo una mejora significativa en la tasa de vacunación global (17,1% en el periodo preintervención versus 57,8% en el postintervención) (RR=3,37; IC95%:1,56-7,27) así como específicamente para las vacunas frente a Haemophilus influenzae de tipo B, antimeningocócica C y antineumocócica conjugada 13-valente. CONCLUSIONES: Implementar una consulta hospitalaria de vacunas representa una medida efectiva para mejorar las coberturas vacunales de estos pacientes.

Evaluación del impacto de una intervención para mejorar las coberturas de vacunación frente a neumococo en pacientes con VIH / Impact of an intervention to improve the vaccination coverage against streptococcus pneumoniae in hiv patients

OBJETIVO: Las personas infectadas por el virus de la inmunodeficiencia humana (VIH) presentan riesgo elevado de sufrir la enfermedad neumocócica invasiva, motivo por el que se recomienda su vacunación frente al neumococo. El objetivo de este trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en las coberturas de vacunación de estos pacientes. MÉTODOS: Se elaboró un estudio cuasiexperimental sin grupo control, de tipo antes/después, en el que se realizó un muestreo de casos consecutivos de pacientes con VIH remitidos a nuestra consulta entre el 1 noviembre de 2014 y el 30 junio de 2018. Las coberturas en el momento de la fecha de la cita para la valoración de su estado vacunal (en nuestra consulta) y después de ser atendido se compararon usando la prueba chi-cuadrado. Como referencia se utilizaron las del momento de la fecha de la primera cita. RESULTADOS: Se analizaron 209 pacientes, en los que se obtuvieron mejoras estadísticamente significativas en sus coberturas vacunales: 2,9% en el momento de la fecha de la cita para la valoración en nuestra consulta y 88% después de ser atendidos en nuestra consulta (RR [IC95%]= 30,7 [13,92-67,58]) para la vacuna antineumocócica conjugada 13-valente, y 16,3% en el momento de la primera cita y 83,7% después de ser atendidos en nuestra consulta (RR [IC95%]=5,2 [3,76-7,04]) para la vacuna antineumocócica polisacárida 23-valente. CONCLUSIONES: Implementar una consulta hospitalaria de vacunas representa una intervención efectiva para mejorar las coberturas de vacunación frente al neumococo en pacientes con VIH

OBJECTIVE: People affected by the human immunodeficiency virus (HIV) have a higher risk of invasive pneumococcal disease. Therefore, vaccination against streptococcus pneumoniae is recommended for that group. The objective of this study was to analyze the impact of implementing a hospital appointment to assess vaccination status as part of the vaccination schedule of HIV patients. METHODS: We carried out a quasi-experimental uncontrolled before and after study with a sampling of consecutive cases of HIV patients referred to our department from November 1, 2014 to June 30, 2018. The study compared the vaccination coverage on the date of the appointment for an assessment of their vaccination status in our department and after the appointment. The analysis used the chi-squared test and the values on the date of the first appointment were taken as a reference. RESULTS: 209 patients were analyzed, and a statistically significant improvement was observed regarding their vaccination coverage: 2.9% of the patients had been vaccinated on the date in which they made an appointment for assessment by our department, and 88.0% were vaccinated after they left (OR [95%CI]: 30.7 [13.92-67.58]) with the 13-valent pneumococcal conjugate vaccine; and 16.3% had been vaccinated on the date they made the first appointment vs. 83.7% after they came to the appointment (OR [95%CI]: 5.2 [3.76-7.04]) with the 23-valent polysaccharide pneumococcal vaccine. CONCLUSIONS: Implementing a hospital appointment for vaccination is an effective intervention to improve vaccination coverage against streptococcus pneumoniae in HIV patients