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ABSTRACT: A descriptive cross-sectional study was conducted for adults (aged ≥ 50 y) with diabetes. Data was obtained from the 2009 European Health Interview Survey for Spain and the 2003 and 2006 Spanish National Health Surveys. To assess influenza vaccination status, we considered the response (yes or no) to the question "Have you received the influenza vaccine in the previous season?" Both dependent and independent variables were based on the survey questionnaires. The independent variables analyzed included socio-demographic characteristics, health-related variables and use of health care services. The coverage among adults with diabetes in 2010 was 65.0% (95% CI: 62.1-67.7) compared with 41.2% (95% CI 40.0-42.4) for those without diabetes (p < 0.01) adjusted OR 1.67 (95% CI: 1.40-1.99). The positive predictors of vaccine uptake among diabetic adults were: higher age, being male, the presence of associated chronic conditions and physician visits in the last 2 wk. The vaccine uptake among adults with diabetes was 61.4% (95% CI: 57.9-64.8) in 2003 and 63.8% (95% CI: 60.7-66.8) in 2006.The adjusted OR of having been vaccinated in 2010 with respect to 2003 was not significant 1.18 (95% CI: 0.97-1.44). We conclude that the levels of influenza vaccination coverage are below desirable levels among adults with diabetes. Furthermore, trend analysis in influenza vaccination coverage indicates that influenza vaccination rates in adults with diabetes have not improved in recent years. Urgent strategies for increasing vaccination coverage among diabetes sufferers are necessary especially for those aged 50-59, women, those without chronic conditions and those who are not frequent users of health care services.
Human vaccines & immunotherapeutics. 02/2013; 9(6).
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ABSTRACT: The aims of the study were to assess the awareness and knowledge of HPV vaccination among female university and technological institutes students, and their association with vaccine uptake, and to identify the variables associated with higher levels of knowledge. We conducted a cross-sectional study among females (age 18-26 y) at institutions of higher education (universities and technological institutes) in Athens (Greece). Data was collected by way of a self-completed questionnaire that included questions on vaccine uptake and four questions about knowledge. A new variable was created by adding up the correct answers (range 0-4) and categorizing them as "low level" (0-2) and high level of knowledge (> 2). Independent variables included: Vaccine uptake, socio-demographic characteristics and health and sexual behavior variables. 3,153 female students took part in this research (participation rate 87%), 25.82% of whom were vaccinated against HPV. Most participants (97.15%) correctly answered the question about the existence of HPV, but only 28.41% knew at which age the vaccination is recommended. Overall, 59.1% of respondents had a high level of knowledge regarding the vaccine. The multivariate logistic model showed that being vaccinated was positively and significantly associated with a high level of knowledge. Positive predictors of higher levels of knowledge were: older age; being in a relationship; being a health sciences student; past HPV infection. In conclusion, the level of knowledge and vaccine uptake among female higher-education students in Greece was below desirable levels. A high level of knowledge is positively associated with vaccine uptake. Health education efforts are needed to improve knowledge among all higher education students in Greece.
Human vaccines & immunotherapeutics. 10/2012; 9(2).
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ABSTRACT: Please cite this paper as: Jiménez-García et al. (2012) Hospitalizations from pandemic Influenza [A(H1N1)pdm09] infections among type 1 and 2 diabetes patients in Spain. Influenza and Other Respiratory Viruses Doi: 10.1111/j.1750-2659.2012.00419.x. Objectives To describe and analyze the clinical characteristics and outcomes for all patients with diabetes who were hospitalized with laboratory-confirmed A(H1N1)pdm09 infections in Spain during 2009. Methods Observational retrospective study using data collected by the Spanish National Hospital Discharge Database. We selected all admissions with diagnosis ICD-9-CM code 488·1 [A(H1N1)pdm09]. Discharges were grouped as follows: no diabetes, Type1 and Type 2 diabetes. Underlying medical conditions and risk factors included all those that constitute an indication for annual influenza vaccination, pregnancy, and obesity. The outcome variables analyzed were in-hospital case fatality risk, length of hospital stay, and costs. Results The total number of persons hospitalized with A(H1N1)pdm09 was 11 499. Of those, 97 suffered Type 1 and 936 Type 2, giving an overall prevalence of diabetes of 9%. The most common underlying medical condition among Type 2 subjects was obesity (26·8%), and for Type 1 renal disease (10·3%). In-hospital mortality was 2·1% among Type 1 patients, 3·8% among Type 2 patients, and 2·3% among non-diabetics; after multivariate analysis, diabetes was not a factor independently associated with dying during hospitalization for A(H1N1)pdm09. Independent factors increasing the risk of death among diabetic patients included age (OR 1·03; 95% CI1·01-1·05), hematological disorders (OR 3·49; 95% CI, 1·46-8·37), and obesity (OR 1·88; 95% CI1·07-3·92). Conclusions Among individuals hospitalized in Spain with A(H1N1)pdm09 infections, the age-specific prevalence of diabetes was higher than the general population in most age groups. The results of multivariate analysis suggest that possibly concomitant conditions such as obesity increase the risk of dying from the infection, but not diabetes itself.
Influenza and Other Respiratory Viruses 08/2012; · 4.16 Impact Factor
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ABSTRACT: The aim of this study is to compare influenza vaccination coverage among Spaniards aged 40 y or over who suffer from chronic obstructive pulmonary disease (COPD) with those without this illness to identify the factors that influence vaccination uptake among patients with COPD. Data was extracted from the European Health Survey performed in Spain in 2009/10, and analyzed data on 15,355 Spaniards (≥ 40 y of age), of whom 1,309 (8.2% 95%CI 7.7-8.7) had COPD was used. We considered the answer (yes/no) to the question about whether or not the interviewed person had been vaccinated against influenza in the previous flu season. We used the answer to this question as the dependent variable. For independent variables, we analyzed social demographic characteristics, health related variables, and the utilization of health care services. Vaccination coverage among patients with COPD is 49.4% (95% CI: 46.3-52.5%) and 21.3% (95% CI: 20.7-21.9) among people without (p < 0.001). The probability of being vaccinated is three times greater for COPD patients (crude OR = 3.0, 95% CI: 2.6-3.5). Among COPD patients the uptake of vaccination increased with age. Other factors associated with an increase in vaccination coverage were: being male, perceiving one's health as fair or poor, not smoking, and having seen a doctor during the previous month. The rate of flu vaccination among adult Spaniards with COPD is lower than desired. Urgent strategies for increasing vaccination coverage are necessary for COPD sufferers aged under 65 of age and those with unhealthy lifestyles.
Human vaccines & immunotherapeutics. 07/2012; 8(7):938-45.
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ABSTRACT: Based on data drawn from the national hospitalization discharge registry, we sought to describe the clinical and epidemiological characteristics of patients hospitalized with pandemic influenza H1N1 in Spain in 2009. Authors calculated national rates of hospitalization stratified by age and analyzed co-morbidities, in hospital mortality, average length of stay and associated medical costs. A total of 11,449 patients were hospitalized (24.9/100,000 inhabitants). Median age was 34 y and 50.28% were male. The highest incidence was observed in the group from 0 to 14 y (42.3/100000 inhabitants), 27.7% of hospitalized women of childbearing age were pregnant and overall in hospital mortality reached 2.46%. The average length of stay was 5 d, median costs per admission was €2,152 and total cost was €35.4 million. Among those patients, 5,791 (50.6%) had an underlying chronic disease: asthma (15.36%), diabetes (9.02%), obesity (8.47%), cancer (4.47%), epilepsy (2.24%), and HIV (2.22%). Suffering a chronic condition was an independent risk factor for dying (OR 13.31 95% for 0-14 y and OR 3.27 for 15-64 y). We conclude that hospitalization was higher in infants and in young adults with associated co-morbidities. Suffering a chronic condition increased the risk of dying as the age decreased. This information will be helpful to prepare vaccination strategies against next pandemic threats.
Human vaccines & immunotherapeutics. 04/2012; 8(4):443-7.
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ABSTRACT: OBJECTIVES: To describe and compare sexuality between subjects with diabetes with matched non-diabetic controls. METHODS: Population based case control study using individual data from the Spanish National Sexual Health Survey. Diabetes status was self reported, we selected type 2 patients. We identified 461 diabetes sufferers. Two controls were matched by age, sex and sexual partner for each diabetic case. Sexuality measures included: sexual activity, importance of sex, satisfaction with partner, bothersome with one's sexual life and self-rated sexual health. Independent variables included: socio-demographics, physical health, chronic diseases and medications use. RESULTS: No differences were found in "Sexually activity", "Importance of sex" or "Bothersome" between those with and without diabetes. Dissatisfaction with partner was 25% in women with diabetes and 12.9% in non-diabetic controls (Adjusted-OR 1.82 95%CI 1.02-4.85). Diabetes sufferers reported sexual health as "fair/poor/very poor" more than their non-diabetic control, 58.1% vs. 45.1% for women (Adjusted-OR 1.74 95%CI 1.15-2.63) and 54.3% vs. 38% for men (Adjusted-OR 1.88 95%CI 1.29-2.75). Among diabetes sufferers "fair/poor/very poor" sexual health was associated with poorer physical health, not having a sexual partner and among men taking heart medications. CONCLUSIONS: Women and men with diabetes have significantly worse sexuality measures than non diabetic controls.
Primary care diabetes. 03/2012;
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ABSTRACT: We investigated the effectiveness of applying age-based strategies to improve influenza vaccination coverage in Spain. We described and compared influenza vaccination coverage from 2003 to 2010 between those Spanish autonomous regions (AR) that lowered the age limit to 60 y and those regions that maintained the limit at 65 y. We used data collected from two surveys covering a representative sample of the Spanish population aged ≥ 16 y [Spanish National Health Survey (SNHS) 2003/2004 and the European Health Survey for Spain (EHSS) 2009/2010]. The study population (persons aged ≥ 60 y) comprised 7,496 persons in the SNHS and 7,686 in the EHSS. In 2010, those AR which had reduced the age limit had higher coverage for all age groups analyzed-regardless of the presence of associated chronic conditions-than AR which continued vaccination for those ≥ 65 y. The greatest differences appeared in individuals aged 60 to 64 y (36.9% vs. 24.4% for individuals without chronic conditions, 59.1% vs. 52.9% for those with chronic conditions, and 43.3% vs. 32.3% for the entire age group). Multivariate analysis showed that those AR which lowered the age limit increased total coverage for all age groups, specifically among individuals with chronic conditions aged 60 to 64 y (IRR 1.18; 95% CI, 1.01-1.54) and ≥ 65 y (IRR 1.07; 95% CI, 1.00-1.14). No significant changes were observed over time for the AR that continued vaccinating people aged ≥ 65 y. Our results suggest that age-based strategies are effective for improving influenza vaccination coverage in Spain.
Human vaccines & immunotherapeutics. 02/2012; 8(2):228-33.
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ABSTRACT: To compare the prevalence of psychological distress and mental disorders between diabetes and non-diabetes sufferers and to identify associated factors.
Case-control study based on data from the 2006 to 2007 Spanish National Health Survey. We identified 2193 type 2 diabetic adults. Non-diabetic controls were 1:1 matched by age-and-sex. The presence of a mental disorder was considered if subjects answered yes to the questions: "Have you suffered depression and/or anxiety over the previous 12 months?" AND "Has your medical doctor confirmed the diagnosis?". The 12-item General Health Questionnaire was used to measure psychological distress. Independent covariables included socio-demographics and heath related variables.
Prevalence of mental disorders was 18.6% among diabetics and 16.4% among controls (adjusted OR 1.17 CI 95% 1.01-1.38). 26% of diabetics and 18.9% of the non-diabetic suffered psychological distress (adjusted OR 1.51 CI 95% 1.25-1.83). Among diabetics variables associated with suffering a mental disorder and psychological distress were: female sex, younger age, worse self rated health, comorbidity, GP visit in the last 4 weeks and ER attendance in last year.
Diabetic adults have significantly higher prevalence of diagnosed mental disorders and psychological distress than non-diabetic subjects. Programs targeted at preventing, monitoring and controlling these mental health problems at primary care should be implemented.
Primary care diabetes. 10/2011; 6(2):149-56.
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ABSTRACT: Abstract Background Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain. Methods We selected all surgical admissions in individuals aged ≥40 years who had received a primary THA (ICD-9-CM procedure code 81.51) between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index. Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM. Results We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p < 0.001). In 2001, 81% of patients had a Charlson Index of 0, 18.4% of 1-2, and 0.6% > 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p < 0.001). The mean LOHS was 13 days in 2001 and decreased to 10.45 days in 2008 (p < 0.001). During the period studied, the mean cost per patient increased from 6,634 to 9,474 Euros. Multivariate analysis shows that from 2001 to 2008 the incidence of THA hospitalizations has significantly increased for both sexes and only men showed a significant reduction in IHM after THA. Conclusions The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.
BMC Musculoskeletal Disorders. 01/2011;
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ABSTRACT: Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain.
We selected all surgical admissions in individuals aged ≥ 40 years who had received a primary THA (ICD-9-CM procedure code 81.51) between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index.Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM.
We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p < 0.001). In 2001, 81% of patients had a Charlson Index of 0, 18.4% of 1-2, and 0.6% > 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p < 0.001). The mean LOHS was 13 days in 2001 and decreased to 10.45 days in 2008 (p < 0.001). During the period studied, the mean cost per patient increased from 6,634 to 9,474 Euros. Multivariate analysis shows that from 2001 to 2008 the incidence of THA hospitalizations has significantly increased for both sexes and only men showed a significant reduction in IHM after THA.
The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.
BMC Musculoskeletal Disorders 01/2011; 12:43. · 1.58 Impact Factor
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ABSTRACT: This study aims to analyze gender differences in influenza vaccine coverage and predictors of vaccine uptake in Spain from year 1995 to 2006. We used data obtained from the Spanish National Health Surveys (NHSS) conducted in 1995, 1997, 2001, 2003 and 2006. Only subjects for whom the vaccine was recommended in Spain (age >or=65 years and <65 years with an associated chronic condition) during the entire study period were analyzed. Influenza vaccination status was self-reported. Independent variables included: year of survey, age, marital status, educational level, size of town, physician visits and chronic conditions. The study population included 26,653 (15,973 women and 10,680 men) individuals and 54.9% (CI 95% 54.3-55.5) were vaccinated. Vaccination coverage was higher among men than women in each and all of the NHSS analyzed. Positive predictors of vaccine uptake were the same among women and men including: higher age, being married, lower educational level, "Physician visits in last four weeks"; and the presence of associated chronic condition. Time trends 1995/1997-2006 showed that the coverage has improved for women (OR 1.12 CI 95% 1.09-1.16) and men (OR 1.11 CI 95% 1.06-1.15). Over the whole study period men had 12% greater probability of having received the vaccine. We conclude that in Spain there are significant gender differences in influenza vaccine uptake with lower coverage among women. These differences have remained throughout all years studied. We suggest that possible explanations for the lower uptake among women could include less social support, differences in the health status and provider bias.
Vaccine 08/2010; 28(38):6169-75. · 3.77 Impact Factor
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ABSTRACT: Influenza vaccination can reduce morbidity and mortality caused by cardiovascular diseases. This study sought to evaluate influenza vaccination coverage among adults with a history of heart attack and to determine which variables were associated with vaccine uptake.
A total of 716 adults reported having suffered a heart attack. The coverage among sufferers was 67.9% as against 35% for non sufferers. The variables that were significantly associated with a higher likelihood of receiving the vaccine among sufferers were: higher age; male gender, no smoking habit, "Physician visits in the preceding four weeks"; and, "Blood pressure control in the preceding three months".
A descriptive study was conducted using individual data from adults aged ≥40 years included in the year 2006/7 Spanish Health Survey and comparing subjects with a history of heart attack with those who had not suffered this event.
The number of participants surveyed was 20,060. Subjects were classified as heart attack sufferers if they answered affirmatively to the question: "Has your doctor told you that you have suffered a heart attack?" To assess influenza vaccination status we considered the response to the question, "Did you have a 'flu shot in the latest campaign?". Independent variables included sociodemographic, health-related, lifestyles and periodic control of cardiovascular risk factors.
Influenza vaccination coverage among subjects who have suffered a heart attack is below desirable levels. Multiple strategies focused on providers and patients are needed to improve influenza vaccination coverage among these high risk subjects, particularly now with the emerging H1N1 pandemic.
Human vaccines 07/2010; 6(7):566-71. · 3.58 Impact Factor
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ABSTRACT: Analyze clustering of unhealthy lifestyle behavior and its relationship with nonadherence to clinical preventive care services among Spanish diabetic adults.
Cross-sectional study including 2156 diabetic adults from the 2006 Spanish National Health Survey. Subjects were asked about their uptake of BP measurement, lipid profile, influenza vaccination, and dental examination. Lifestyle behaviors included smoking status, physical activity, alcohol consumption, and dieting. Binary logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of each preventive activity.
Almost 16% and 36% of the subjects had not undergone blood pressure (BP) and blood lipids measurements, respectively. Forty percent had not been vaccinated and 72% had not received dental examination. Fourteen percent of the subjects had three to four unhealthy behaviors and this increased the probability of not having BP check-up (OR 2.32, 95% CI 1.38-3.91), blood lipids testing (OR 1.63, 95% CI 1.14-2.33), and not being vaccinated (OR 1.99, 95% CI 1.37-2.89). Number of unhealthy lifestyle behaviors is linearly associated with number of preventive measures unfulfilled.
Adherence to recommended clinical preventive services is under desirable levels among Spanish diabetes sufferers. These preventive services are provided neither equitably nor efficiently, since subjects with unhealthier lifestyles are less likely to receive them.
Journal of diabetes and its complications 25(2):107-13. · 2.11 Impact Factor
