Pathway towards an ideal and sustainable framework agreement for the public procurement of vaccines in Spain: a multi-criteria decision analysis.

Objective: To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods: A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results: Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions: Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.

MenB en el calendario regional de Castilla y León: por qué y cómo / No disponible

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Extirpación laparoscópica de quiste congénito del ligamento redondo (Teres) hepático / Laparoscopic resection of a congenital cyst of the round ligament (teres) of the liver

Los quistes del ligamento redondo (Teres) del hígado, son extremadamente raros. Son pocos los casos publicados hasta la actualidad. Se describe el caso de una paciente de 42 años de edad que consulta por molestias abdominales inespecíficas en hemiabdomen derecho y sensación de pesadez de 4 meses de evolución. La exploración física es normal. Los análisis de sangre no muestran alteraciones. La ecografía y la TAC de abdomen revelan una masa de densidad-agua adherida a la pared abdominal anterior. La endoscopia digestiva no muestra alteraciones. La citología tras realizar PAAF por ecoendoscopia es negativa para malignidad. El quiste es extirpado por vía laparoscópica tras aspirar el contenido del quiste. El curso postoperatorio transcurre sin incidencias y la paciente es dada de alta dos días después. El estudio anatomopatológico confirma la presencia de un quiste seroso del ligamento redondo. Se discuten los aspectos relacionados con las manifestaciones clínicas, el diagnóstico, el diagnóstico diferencial y el tratamiento de esta patología

The cysts of the round ligament (Teres) of the liver, are extremely rare. There are Few cases published to date. The case of a 42- year- old woman who complains of abdominal tenderness in right abdomen and heaviness 4 months of evolution is described. Clinical examination was normal. Blood tests showed no abnormalities. Ultrasound and CT scan of the abdomen revealed a water density mass adhering to the anterior abdominal wall. The endoscopy showed no abnormalities. Cytology after performing EUS-FNA was negative for malignancy. The cyst was removed laparoscopically after aspirating the contents of the it. The postoperative course was uneventful and the patient was discharged two days later. Pathologic examination confirmed the presence of a serous cyst of the round ligament. Aspects of the clinical manifestations, diagnosis, differential diagnosis and treatment of this condition are discussed

La gripe y las vacunas frente a la gripe. Presente y futuro / Flu and flu vaccines. Present and future

Aproximadamente dos de cada diez niños contraen la gripe cada año. Los niños son más susceptibles a la infección gripal y difunden la enfermedad en el hogar y los colegios, eliminando más cantidad de virus y durante más tiempo que los adultos. Las complicaciones más frecuentes son otitis media, traqueobronquitis, laringotraqueítis, bronquiolitis y bronquitis, frecuente en pacientes naïve. La más grave es la neumonía primaria viral, más frecuente con los virus A. La gripe sobrecarga los servicios sanitarios y especialmente los de Atención Primaria pediátrica, lo cual tiene repercusión sobre la mortalidad. En EE. UU., durante la epidemia de 2010-11 hubo 115 muertes en niños, de los cuales solo el 23% estaba vacunado. EE. UU. y Canadá han implementado la recomendación universal de vacunar haciendo especial énfasis en los niños, en Europa solo lo ha hecho el Reino Unido. Actualmente, distintas modalidades de vacunas con virus inactivados están comercializadas en España. Las vacunas con virus atenuados se emplean en EE. UU. y Rusia. Las vacunas de gripe con virus vivos atenuados han resultado más eficaces en niños <4 años debido a que esa población ha tenido menos exposiciones anteriores a la gripe que los adultos. La mayoría de vacunas gripales inactivadas son de virus completos o fraccionados. Recientes avances demuestran el posible uso de vacuna adyuvada en niños, y la existencia de vacunas tetravelentes que protejan frente a los dos linajes de virus B que pueden circular cada año. La vacunación gripal de los niños constituye una necesidad médica no cubierta adecuadamente en España. En epidemias estacionales se ha demostrado que la vacunación gripal de niños tiene un efecto protector sobre otros grupos más vulnerables. Mientras se logra un consenso científico, es responsabilidad del pediatra recomendar seriamente la vacunación gripal de niños y adolescentes con patologías de base y sus convivientes (AU)

Approximately two out of 10 children get flu every year. Children are more susceptible to influenza infection contributing to spread the disease in the home and school-setting, by eliminating larger amount of virus during longer period than adults. The most common complications include otitis media, tracheobronchitis, laryngotracheitis, bronchiolitis and bronchitis, most commonly seen in naïve patients. The more severe complication is viral pneumonia, more frequent in infections by influenza A virus. Influenza causes health services burden, particularly in pediatric primary health care, having impact on mortality rates. In the United States during the 2010-11 epidemic there were 115 deaths in children, of whom only 23% were vaccinated. United States and Canada have implemented the recommendation on universal vaccination with particular emphasis on children, in Europe this occurs only in the UK. Currently different types of inactivated virus vaccines are marketed in Spain. Attenuated virus vaccines are used in the United States and Russia. Vaccines with live attenuated influenza virus have been more effective in children <4 years because that population has had less prior exposure to influenza than adults. Most inactivated influenza vaccines are made of complete or split virion. Recent research establishes the possibility of using adjuvanted vaccines in children. Also this research includes quadrivalent vaccines that protect against both lineages of B viruses that can circulate every year. Influenza vaccination of children is a medical necessity not properly covered in Spain. Seasonal epidemics have shown that influenza vaccination of children have a protective effect on other vulnerable groups. While scientific consensus for universal children vaccination is achieved, it is the responsibility of the pediatrician to strongly recommend influenza vaccination of children and adolescents with underlying diseases as well as their household contacts (AU)

Incidencia del cáncer infantil en la Comunidad de Castilla y León (2003–2007) / Incidence of childhood cancer in the autonomous region of Castilla y León in Spain (2003–2007)

Antecedentes: En España desde 1980 se registran los tumores infantiles en el Registro Nacional (base hospitalaria) y desde 1990 cinco comunidades autónomas poseen registros de base poblacional. En la Comunidad de Castilla y León no existe un registro específico de incidencia de cáncer infantil. Objetivos: Estimar la incidencia de cáncer infantil en la Comunidad de Castilla y León y analizar la utilidad de los diagnósticos informatizados del alta hospitalaria como fuente de datos de un potencial registro autonómico. Métodos: A través del Conjunto Mínimo Básico de Datos (CMBD) al alta hospitalaria de los hospitales públicos de la comunidad autónoma, se obtuvo información de los pacientes menores de 15 años que fueron diagnosticados por primera vez de cáncer durante los años 2003–2007.ResultadosSe han detectado 220 casos nuevos de cáncer infantil en los cinco años del estudio, con predominio del sexo masculino (55,5%). El tumor más frecuente fue la leucemia (28,6%) seguida de los tumores del sistema nervioso central (19,5%) y los linfomas (15,9%). La incidencia anual de cáncer infantil fue de 152,8 casos por millón de niños. Los códigos diagnósticos informatizados no permitieron la clasificación según la variedad histológica del tumor en 74 casos (33,6%). Conclusiones: La incidencia por grupos diagnósticos de cáncer infantil en la Comunidad de Castilla y León se aproxima a las aportadas en series nacionales e internacionales. En un registro de tumores el CMBD podría ser útil en la captación de posibles nuevos casos, pero en un alto porcentaje no permite clasificar los tumores según su variedad histológica (AU)

Background: Since 1980, childhood cancer cases have been registered in Spain in the National Registry of Childhood Cancer (based on hospital cases) and since 1990, five autonomous regions have had a population based registry. There is no specific registry of childhood cancer in Castilla y Leon. Objectives: Our aim was to estimate the childhood cancer incidence in the autonomous region of Castilla y Leon and to assess the usefulness of the computerised diagnosis of hospital discharges as a source of data in a potential autonomous region population based registry. Methods: We included patients younger than 15 years old who were diagnosed, for the first time, of cancer during the years 2003–2007. The information collected was obtained through the Minimum Basic Data Set (MBDS) of the public hospitals in the autonomous region of Castilla y Leon. Results: In this period of 5 years (2003–2007), 220 cases of childhood cancer had been reported. The most frequent cancer detected was leukaemia (28.6%) followed by the central nervous system tumours (19.5%) and lymphoma (15.9%). The overall rate of childhood cancer incidence was 152.8 cases per million children. The diagnostics codes did not allow tumours to be classified by their histological type in 74 cases (33.6%). Conclusions: The overall incidence by diagnostic groups of childhood cancer in the autonomous region of Castilla y Leon was similar to those reported by other national and international registries. In a Cancer registry the MBDS could be useful as a data source in the capture of new cases, but in a high percentage of cases it does not allow tumours to be classified by their histological type (AU)

[HIV seroprevalence in the population treated in a hospital emergency department: analysis by pooled batches of serum]. / Seroprevalencia del VIH en población atendida en un Servicio de Urgencias: análisis por lotes de sueros.

INTRODUCTION: The current number of Human Immunodeficiency Virus (HIV) infected people is not known in Spain as there is no national registry. This study has aimed to estimate the prevalence of HIV infection in the population treated in a hospital emergency department (ER) as an epidemic and risk of exposure indicator during healthcare activity and to assess the differences observed regarding previous estimates. MATERIAL AND METHODS: We conducted a cross-sectional study of all the sera received in the ER anonymously. The final size of the pools was 5 sera. HIV antibody screening was performed using the 4th generation ELFA technique and confirmation was performed by Western Blot. RESULTS: Seven out of the 270 pools made from 1,347 sera obtained were reactive. The individualized analysis confirmed 6 sera to be positive and 1 serum to be false positive. The observed prevalence was 0.52% (95% CI 0.10-0.94). Prevalence fell 0.87% in comparison to the years 1990-1991, although this was not statistically significant (p = 0.08). DISCUSSION: The implementation of HIV antibodies detection through a system of pooled batches in samples collected in the ER make it possible to assess the prevalence of infection with this virus, decreasing costs with regard to individualized analysis of sera in both economic terms as well as samples handling.

Seroprevalencia del VIH en población atendida en un Servicio de Urgencias: análisis por lotes de sueros / HIV seroprevalence in the population treated in a hospital emergency department: analysis by pooled batches of serum

Introducción. En España no se conoce el número real de infectados por el virus de la inmunodeficiencia humana (VIH), al no existir un registro nacional. El objetivo de este estudio es estimar la prevalencia de infección por el VIH en la población atendida en un Servicio de Urgencias hospitalario (SUH) como indicador epidemiológico y de riesgo de exposición laboral durante la actividad asistencial, así como evaluar las diferencias observadas respecto a estimaciones previas. Material y métodos. Se realizó un estudio transversal de todos los sueros recibidos por el SUH de forma anónima. El tamaño final de los lotes confeccionados fue de 5 sueros. La detección de anticuerpos del VIH se realizó mediante la técnica de ELFA de cuarta generación y la confirmación mediante western blot. Resultados. De los 270 lotes confeccionados con los 1.347 sueros obtenidos, 7 lotes resultaron reactivos. El análisis individualizado de los sueros confirmó 6 sueros positivos y un suero falso positivo. La prevalencia observada fue del 0,52% (IC 95% 0,10-0,94). La caída en la prevalencia con respecto a los años 1990-1991 fue del 0,87%, aunque no resultó una diferencia estadísticamente significativa (p = 0,08).Discusión. La aplicación del estudio de lotes de sueros en la detección de anticuerpos frente al VIH en muestras recogidas en los SUH permite evaluar la prevalencia de infección por este virus disminuyendo los costes con respecto al análisis individualizado de sueros, tanto en términos económicos como de manipulación de muestras (AU)

Introduction. The current number of Human Immunodeficiency Virus (HIV) infected people is not known in Spain as there is no national registry. This study has aimed to estimate the prevalence of HIV infection in the population treated in a hospital emergency department (ER) as an epidemic and risk of exposure indicator during healthcare activity and to assess the differences observed regarding previous estimates. Material and methods. We conducted a cross-sectional study of all the sera received in the ER anonymously. The final size of the pools was 5 sera. HIV antibody screening was performed using the 4th generation ELFA technique and confirmation was performed by Western Blot. Results. Seven out of the 270 pools made from 1,347 sera obtained were reactive. The individualized analysis confirmed 6 sera to be positive and 1 serum to be false positive. The observed prevalence was 0.52% (95% CI 0.10-0.94). Prevalence fell 0.87% in comparison to the years 1990-1991, although this was not statistically significant (p = 0.08).Discussion. The implementation of HIV antibodies detection through a system of pooled batches in samples collected in the ER make it possible to assess the prevalence of infection with this virus, decreasing costs with regard to individualized analysis of sera in both economic terms as well as samples handling (AU)

Calidad del aire en ambientes hospitalarios. Nuevas tecnologías / Air quality in hospital environments. New technologies

En la actualidad existe interés en identificar y predecir los distintos contaminantes en el aire interior para reducir su influencia en la salud de sus ocupantes. Las características de los hospitales crean un ambiente en el que muchos gérmenes encuentran un medio adecuado para desarrollarse. Los sistemas de filtración que logran la eliminación de microorganismos se presentan como alternativa a los distintos instrumentos de descontaminación aérea. Así, el objetivo de este trabajo es valorar la efectividad de descontaminación bacteriana y fúngica del sistema de filtración Electromedia en una sala hospitalaria. Es un estudio de epidemiología ambiental cuasiexperimental antes-después. En los resultados se señala que entre los dos períodos de estudio, con y sin sistema de filtración, se han observado diferencias estadísticamente significativas del crecimiento de bacterias (diferencia de 1597,46 m3) y de hongos (6,21/m3). El modelo de regresión lineal multivariante ajustado por humedad relativa y número de personas en la sala muestra una reducción significativa del crecimiento de microorganismos. Se concluye objetivando que el sistema de filtración Electromedia reduce de forma significativa el crecimiento tanto de las bacterias como de los hongos, y se presenta como método efectivo para el control de las cargas microbianas de ambientes interiores hospitalarios

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[Ultrastructural study of the colon after massive intestinal resection in rats]. / Estudio ultraestructural del colon tras la resección intestinal masiva en ratas.

The modifications suffered by the colon after massive intestinal resection (RIM) have been barely studied, especially from the ultrastructural point of view. On the basis of optical microscope studies we planned this experimental study to evaluate fundamentally the ultrastructural changes in the colonic mucosa and its cellular elements. A total of 115 Wistar rats weighing 350 to 550 grams were used. Twenty animals constituted group 0 (controls), 30 underwent intestinal section (group I) and 65 were submitted to resection of 90% of the intestine (group II). After weighing, the animals were sacrificed by groups on days 15, 30, 45 and 60 of the operation to obtain histologic samples of the ascendant colon for study by transmission (MET) and scanning (MEB) electron microscopy. All the animals resected showed statistically significant weight loss (p less than 0.001), an expression of short intestine syndrome. Groups 0 (controls) and I (intestinal section) did not evidence important ultrastructural changes. In contrast, although in the initial electron microscopic scan the colonic mucosal surface offered a normal aspect, at 45 days it presented irregularities, without the appearance of villi. Days 60 there were deep folds and the mucosal surface had acquired a foliaceous aspect similar to that of the surface of the small intestine of the rat. The abundance of microorganisms adhered to the surface, constituting clumps of bacteria, was striking. Transmission electron microscopy confirmed the greater number and height of the enterocytes, covered by well-developed apical microvilli with dimensions that increased throughout the experiment. The cellular nuclei are voluminous and occasionally have various nucleoli. The cytoplasm showed changes that affected fundamentally the mitochondria.(ABSTRACT TRUNCATED AT 250 WORDS)