Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

<p>Abstract</p> <p>Background</p> <p>Mortality from invasive meningococcal disease (IMD) has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias.</p> <p>Methods</p> <p>A retrospective analysis was made of clinical reports of all patients (n = 848) diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables.</p> <p>Results</p> <p>Data were recorded on 848 patients, 49 (5.72%) of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93).</p> <p>Conclusion</p> <p>Pre-hospital oral antibiotherapy appears to reduce IMD mortality.</p

II Comprehensive Mental Health Plan For Andalusia 2008-2012 : Andalusian Public Health System

Este plan es la traducción del II Plan Integral de Salud Mental de Andalucía 2008-2012 publicado en la página web de la Consejería de Salud y Bienestar Social: www.juntadeandalucia.es/salud (Consejería de Salud y Bienestar Social / Ciudadanía / Quiénes somos / Planes y Estrategias)A Comprehensive Plan is a medium-term planning instrument. Its development alone does not guarantee the achievement of the goals laid out in it, but by defining the goals, establishing priorities and setting out courses of action and concrete activities it will allow for an overall vision of the objectives being aimed towards and the tasks that will need to be carried out. The first Comprehensive Mental Health Plan for Andalusia 2003-2007 (I PISMA, Plan Integral de Salud Mental de Andalucía) was developed using this approach. Nine courses of action were covered in this Plan, which over its duration lead to noticeable progress in various fields.The assessment of the I PISMA and the experience gained from its development have channelled into this second Comprehensive Mental Health Plan for Andalusia 2008-2012 (II PISMA). The main principles for this second Plan are quality improvements, equality and efficiency of health services, aimed at public awareness of mental health in the Andalusian population, prevention of the illnesses and improvements to the care of patients and their families.Ye

II Plan Integral de Salud Mental de Andalucía : 2008-2012

Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Ciudadanía / Quiénes somos / Planes y Estrategias). Nuevo plan: III Plan Integral de Salud Mental de Andalucía: 2016-2020 (disponible en http://hdl.handle.net/10668/2455)YesEl Plan Integral de Salud Mental de Andalucía se orienta a la consecución de 3 metas en salud y 8 objetivos generales, que se desarrollan a través de 15 estrategias, cada una de las cuales plantea sus propios objetivos específicos y las actividades para alcanzarlos. Para su elaboración se ha contado con las aportaciones provenientes del trabajo de diversos grupos expertos, en los que han participado alrededor de 150 personas, tanto profesionales de los diversos ámbitos relacionados con la salud mental, como pacientes y familiares. Este Plan Integral incorpora, de forma transversal, el principio de equidad y el enfoque género y asume igualmente el principio de la recuperación. Asimismo, reconoce la importancia de la acción intersectorial, promoviendo acciones que faciliten la cooperación entre los distintos sectores involucrados. Y todo ello teniendo en cuenta la evidencia científica disponible para la elaboración de las recomendaciones y la viabilidad financiera de las mismas

Tabla de equivalencias entre la Organización Diagnóstica de Atención Temprana (ODAT) y la Clasificación Internacional de Enfermedades (CIE)

Publicado en la página web de la Consejería de Salud y Bienestar Social: www.juntadeandalucia.es/salud (Consejería de Salud y Bienestar Social/ Profesionales / Salud Pública /Prevención / Atención Temprana /)YesLa Consejería de Salud de la Junta de Andalucía ha lanzado el Sistema de Información de Atención Temprana (alborada) que tiene la finalidad de ser una herramienta que favorezca la coordinación y continuidad de la Atención Temprana, poniendo en contacto a todos los actores relacionados con la intervención sobre menores con trastornos del desarrollo o riesgo de padecerlos y sus familias. Para poder conseguir los objetivos planteados en esta Sistema de Información ha sido necesario crear una tabla de equivalencias o una tabla de equivalencias entre la codificación diagnóstica utilizada en la Historia de Salud Digital del Servicio Andaluz de Salud (CIE 9 - CIE 10) y los diagnósticos ODAT, (Organización Diagnóstica de Atención Temprana)

Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias.

Background: Mortality from invasive meningococcal disease (IMD) has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods: A retrospective analysis was made of clinical reports of all patients (n = 848) diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and prehospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results: Data were recorded on 848 patients, 49 (5.72%) of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93). Conclusion: Pre-hospital oral antibiotherapy appears to reduce IMD mortality.FIS (00/0049-01/02/03), Junta de Andalucía (247/00) and, partially, the IRYSS network (G03/202).Ye