Factors involved in health-related transitions after curative resection for pancreatic cancer. 10-years experience: a multi state model.

BACKGROUND: Pancreatic cancer is one of the least common tumours, nevertheless it is one of the most lethal. This lethality is mainly due to the fact that the vast majority of patients are diagnosed in an advanced stage. The purpose of this study was to investigate how different covariates affect the transition to death or discharge with and without complications after pancreatic resection. METHODS: We analyse the impact of different factors on transitions after pancreatic resection based on a multi state model. RESULTS: Transitions of interest include the transition to death/discharge with/without complications after pancreatic resection. We consider presence of comorbidities, higher age (>60), gender-male, lower hospital volume (<10 cases per year), type of surgery, localization of tumour and transfusion received as covariates with a potentially negative effect on the transition intensities to death with or without complications. CONCLUSIONS: The multi-state model allows for a very detailed analysis of the impact of covariates on each transition, since effects of covariates may change depending on the current state of the patient, thus helping surgeons and patients throughout the surgical process and counselling patients if needed.

Impact of the most frequent chronic health conditions on the quality of life among people aged >15 years in Madrid.

BACKGROUND: This study sought to ascertain to what degree health-related quality of life (HRQL) in the City of Madrid was affected by each of the most frequent chronic health conditions, and the specific quality-of-life (QL) domains on which such health conditions had the greatest impact, taking co-morbidity and socio-demographic variables into account. METHODS: A descriptive, analytical, cross-sectional study was conducted covering 7341 subjects aged >or=16 years in the City of Madrid. Data were collected on self-reported diagnosed morbidity, including hypertension, hypercholesterolaemia, varicose veins, diabetes, chronic asthma/bronchitis, myocardial infarction/angina pectoris, stomach problems, allergy, arthrosis/arthritis or rheumatism, depression/anxiety, cataracts, cerebrovascular accidents (CVACs), chronic constipation, osteoporosis and Alzheimer's disease or dementia. HRQL was measured using the COOP/WONCA questionnaire. The effects of diagnosis, age, social class, gender and the co-morbidity were analysed using a multivariate analysis of covariance (ANCOVA). RESULTS: The chronic health conditions that registered the worst overall mean scores on the COOP/WONCA questionnaire were Alzheimer's disease or dementia, Parkinson's disease, fibromyalgia, CVACs and depression, with scores of over 26 points in all cases. After the introduction of socio-demographic variables in the model, the highest values of Snedecor's F-test corresponds to depression (F = 461.63), 'arthrosis/arthritis or rheumatism' (F = 175.41), Alzheimer's disease or dementia (F = 65.70), gastric disorders (F = 65.17), cancer (F = 43.08) and CVACs (F = 41.65). CONCLUSIONS: Depression and 'arthrosis/arthritis or rheumatism' are the two chronic health conditions, which have the greatest impact on HRQL in Madrid's citizens, therefore is mandatory to propose and implement public health strategies that would reduce the prevalence and morbidity of such disorders.

Coverage and predictors of adherence to influenza vaccination among Spanish children and adults with asthma.

BACKGROUND: Influenza infections are frequently implicated in the exacerbation of asthma. The aim of this study was to assess vaccination coverage among Spanish children and adults with asthma and to describe the factors associated(predictors) with vaccination, using data from the 2006 Spanish National Health Survey. PATIENTS AND METHODS: Subjects were classified as asthma sufferers if they answered affirmatively to the question, "Has your doctor told you that you (or your child) currently suffer from asthma?" Influenza vaccination status was assessed via the question, "Did you (or your child) have a flu shot in the latest campaign?" The following were analyzed as possible predictors of influenza vaccination: sociodemographic variables;health-related and lifestyle variables; variables linked to the use of healthcare services. RESULTS: A total of 38,329 records of individuals aged over 6 months were analyzed, and of these, 2,337 were classified as asthmatics. Among asthmatics, overall influenza coverage was 32.6% (18.8% among children, and 38% among adults).Whereas the sole variable that predicted a higher coverage among children was parents' negative perception of their child's health, among adults positive predictors included older age, lower educational level, suffering from concomitant chronic disease, and non- or ex-smoker status. CONCLUSIONS: The overall influenza vaccination coverage among subjects who suffer from asthma in Spain is very low. Special attention should be paid to children, younger adults, and smokers, since these subjects have the lowest adherence to vaccine recommendations. Strategies focused on health-care providers and patients must be urgently implemented to improve influenza vaccination coverage among asthma sufferers.

Hospital admissions for meningococcal infection in Spain (1997-2005).

OBJECTIVES: Spanish hospital surveillance system was analyzed to estimate the burden of hospital admissions for meningococcal infection in Spain during a nine-year period (1997-2005). METHODS: Data were obtained from the national surveillance system for hospital data (Conjunto Mínimo Básico de Datos) maintained by the Ministry of Health and covering more than 95% of Spanish hospitals. RESULTS: There were 9480 hospital admissions for meningococcal infection (ICD 9 CM 036; any listed diagnosis) during the study period. Annual incidence was 2.66 cases per 100,000 population. Rate of death and case-fatality rate were 0.17 per 100,000 population and 6.45%, respectively. The average length of hospitalization was 11.2 days. Youngest age group showed the highest incidence and rate of death (43.15 and 1.17 per 100,000 population respectively in 0-4 years old group), but case-fatality rate was higher in the oldest group (12.16%; more than 30 years old group). The cost of acute hospital care is estimated to be on average 4470 euro per case, which imposes an annual direct cost of 3-5 million euro to the Spanish health system. CONCLUSIONS: Meningococcal infection is still an important cause of hospital admissions in Spain and results in large cost to the Health Care System.

Health profiles, lifestyles and use of health resources by the immigrant population resident in Spain.

BACKGROUND: Our study aimed at describing the health profiles, life styles and use of health resources by the immigrant population resident in Spain. METHODS: Cross-sectional, epidemiological study from the Spanish National Health Survey (NHS) in 2003. We analysed 1506 subjects of both sexes, aged > or =16 years, resident in Spain. RESULTS: The immigrant population present diseases that are similar to those of the autochthonous population. The autochthonous population had significantly higher values for alcohol consumption and smoking (60.8 and 39.6%) than immigrants (39.6 and 27.5%). The percentage of immigrants hospitalized in the preceding 12 months was observed to be higher than that of the Spanish population (11.4 vs. 8.2%, P < 0.05). The immigrant population consumed fewer medical drugs than the Spanish population (42.6 and 49.9%, respectively). CONCLUSIONS: Immigrants in Spain display better lifestyle-related parameters, in that they consume less alcohol and smoke less than the autochthonous population. As for the use of health-care resources, while immigrants register higher percentages of hospitalization compared with the Spanish population, there is no evidence of excessive and inappropriate use of other health-care resources.

Psychotropics use in the Spanish elderly: predictors and evolution between years 1993 and 2003.

PURPOSE: This study mainly aimed at describing the prevalence of psychotropic medication consumption in the Spanish elderly population between the years 1993 and 2003. METHODS: Descriptive, cross-sectional study covering the Spanish population aged 65 years and over, using data drawn from the 1993 and 2003 Spanish National Health Surveys (ENSS). A total of 9570 interviews were analysed (3436 from 1993 and 6134 from 2003). The independent variables were sociodemographic and health-related, and the dependent variable was total consumption of psychotropic medication. Using logistic multivariate regression models, we have analysed the temporal evolution of psychotropic medication consumption between 1993 and 2003. RESULTS: The prevalence of consumption was significantly higher in women (6.7% from 1993 and 26.4 % from 2003) versus men (2.4% from 1993 and 10.6% from 2003) (p < 0.001). Multivariate analysis, highlighted the association between increased psychoactive drug intake and sex, nervous, depressive, sleep disorders and negative perception of health, displayed a strong association with consumption of psychoactive drugs across the 2 years. CONCLUSIONS: In Spain, the prevalence of psychoactive drug consumption is higher among elderly women than men, and increases with negative perception of health. The prevalence of consumption was significantly higher in the year 2003.