182 research outputs found
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
Weed harrowing in winter cereal under semi-arid conditions
Five field experiments on barley and wheat have been carried out in North-Eastern Spain on the same field during the
cropping seasons 1999-00 to 2003-04 to compare the effect of different harrowing adjustments on weed control, weed biomass
and cereal yield. The variables considered were harrowing timing (pre- or early post-emergence), one or two passes,
travelling direction, harrowing depth and speed compared with an untreated control and herbicide. Excepting year 2001,
with very little weed emergence, mechanical control as a whole caused a significant weed plant reduction compared to the
untreated plots in all years. No influence of harrowing depth and travelling speed and of pre-emergence harrowing were
found in the trials. A single harrowing treatment conducted across the sowing direction gave the same or less control compared
to harrowing along the sowing direction. Two harrowing passes achieved a higher efficacy than one single pass and
little differences were detected if the second pass was conducted the same day, across the sowing direction or 15 days later.
Despite herbicide had generally a higher efficacy than the harrowing treatments, in three out of five years it was found a
mechanical control with the same control than herbicide. The effect of the different treatments on weed biomass was lower
than on weed number and no significant differences were found for grain yield. Considering that an herbicide treatment in
the present conditions is three times more expensive than harrowing, a single post-emergence harrowing can be considered
a valid option for low and medium-infested cereal fields.En este trabajo se muestran los resultados de cinco experimentos de campo localizados en el noreste de España desde
1999-00 hasta 2003-04. En ellos se comparó el efecto de distintas formas de control mecánico de la flora arvense con grada
de varillas flexibles sobre la densidad y biomasa de la misma y sobre la producción de cereal comparado con un control
sin tratar y el uso de herbicidas. Las variables consideradas fueron: momento y número de pases de grada, profundidad,
dirección y velocidad de los pases. Excepto en 2001, con una baja infestación, el control mecánico redujo la densidad de
arvenses en comparación con las parcelas sin tratar. La profundidad y la velocidad de la labor no tuvieron influencia clara
y realizar el pase en preemergencia del cereal resultó ineficaz probablemente debido a la falta de humedad. Dos pases
resultaron más eficaces que uno y se encontraron pocas diferencias si el segundo se hacÃa en el mismo dÃa, perpendicular
o 15 dÃas después. Aunque el herbicida tuvo generalmente mayor eficacia que los tratamientos mecánicos, en tres años se
encontró un tratamiento mecánico con eficacia similar. El efecto de los distintos tratamientos sobre la biomasa de arvenses
fue menor que sobre el número de las mismas y no hubo diferencias significativas sobre la producción. Dado que el
tratamiento herbicida en las condiciones del ensayo fue tres veces más caro que el tratamiento mecánico, un único pase en
post-emergencia puede ser una opción válida con infestaciones medias o bajas de malas hierbas
¿Se puede comprar la prevención?
Sr. Director: Existen múltiples reflexiones sobre ética y salud pública, pero la respuesta a la pregunta de cómo combinar la autonomÃa de las personas con la efectividad y la justicia distributiva en las intervenciones preventivas sigue siendo un reto de todos los involucrados en la toma de decisiones: desde las autoridades sanitarias hasta los ciudadanos. A las intervenciones preventivas de carácter poblacional deben exigirse los requerimientos que se exigen a toda actividad clÃnica, pero además, dado que se ofertan a toda la población, los de precaución, sostenibilidad, transparencia y rendimiento de cuentas..
La participación del paciente en su seguridad
El enfoque de atención centrada en el paciente y los avances normativos desarrollados en los últimos años han promovido la implicación del paciente en la toma de decisiones sobre pruebas diagnósticas y tratamientos. En otros aspectos, como la participación en su seguridad, aún queda mucho por hacer. Hasta hace poco tiempo se ha considerado al paciente como mero receptor de los servicios sanitarios, no como parte activa del sistema, ni mucho menos como barrera de seguridad frente a los fallos y errores que acontecen durante la asistencia. Algunos pacientes se han activado con base en sus experiencias. Pero muchos otros no. Por eso es necesario sensibilizar, informar y formar al paciente de forma proactiva para que participe en su seguridad. No se trata de traspasarle la responsabilidad, sino de facilitar y promover su participación reforzando su seguridad durante el proceso asistencial. El sistema sanitario debe estar comprometido, y el paciente informado y formado. Aportamos herramientas y recursos online para su aplicación en atención primaria
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
Evaluación de la efectividad de una intervención para mejorar las coberturas vacunales en pacientes esplenectomizados
Fundamentos:
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.
Métodos:
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 especÃfica 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) asà como especÃficamente 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
Background:
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
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
Vacunación antigripal en estudiantes de medicina y enfermerÃa en la era covid-19: ¿cómo mejorarla?
Background: 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.
Fundamentos: 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 enfermerÃa, podrÃan contribuir a mejorar dichas tasas de vacunación. Métodos: Estudio transversal que incluyó a los alumnos de medicina y enfermerÃa 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 devacunación. Conclusiones: Este estudio ha identificado medidas a aplicar especÃficamente en los estudiantes de medicina y enfermerÃa 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. Palabras clave: Estudiantes de medicina, Estudiantes de enfermerÃa, Vacuna antigripal, Cobertura de vacunación, COVID-19, Españ
Higher incidence of adverse events in isolated patients compared with non-isolated patients: A cohort study
Objective
To determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability.
Design
Prospective cohort study with isolated and non-isolated patients.
Setting
One public university hospital in the Valencian Community (southeast Spain).
Participants
We consecutively collected 400 patients, 200 isolated and 200 non-isolated, age =18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. Exclusion criteria: patients age <18 years old and/or reverse isolation patients.
Primary and secondary outcome measures
The primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated.
Results
The incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000?days/patient (95%?CI 7.8 to 15.9) compared with 4.3 per 1000?days/patient (95%?CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients).
Conclusions
AEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient
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