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INTRODUCTION: During the surge of the SARS-CoV-2 pandemic, studies revealed high complication and morbidity rates following surgical procedures in COVID-19 positive patients. Anesthetic and surgical societies swiftly developed strategies to mitigate these risks, including a recommended postponement of elective surgeries for a minimum of 7 weeks post-COVID infection. Nowadays, with a predominantly vaccinated population, it has become crucial to discern the influencing factors on post-COVID morbidity and mortality and a reevaluation of the existing recommendations pertaining to elective surgery. METHODS: A single-center case-control study was conducted, including patients who underwent surgery between November 2021 and March 2022 and met the inclusion criteria. Eighty COVID-19 positive patients were matched 1:1 with 80 controls, each undergoing an identical intervention within a 2-week time frame. The primary outcome was 30-day postoperative mortality and secondary outcome postoperative complications (respiratory and thromboembolic). RESULTS: At the time of surgery, 88.8% of patients in the case group and 92.5% in the control group had received at least one vaccine dose. Mortality and morbidity did not show a significant difference when comparing the case and control groups (7.5% vs 6.2%, p = 0.755; 11.3% vs 8.9%, p = 0.541 respectively). In the COVID-positive group, mortality was significantly associated with age over 70 years, ASA score over III, RCRI over 1, emergency procedures, and absence of thromboembolic prophylaxis. CONCLUSIONS: In contrast to previously reported findings, we did not observe an increased morbi-mortality in patients with perioperative COVID-19 infection. It may not be necessary to delay elective interventions, except in cases with a high-risk.

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Objetivo: Conocer el consumo de tabaco en el último trimestre de la gestación por parte de las mujeres embarazadas, los factores asociados al mantenimiento, la exposición al humo ambiental del tabaco (HAT) en el hogar y la actitud de los/las profesionales durante el seguimiento del embarazo.Sujetos y método: Estudio descriptivo transversal realizado mediante entrevista personal a las gestantes, a partir de la semana 32, que acudieron a consultas de control prenatal a 10 centros de atención primaria de Cantabria durante el periodo comprendido entre junio de 2018 y junio de 2019. El cuestionario diseñado ad hoc constaba de 6 preguntas. Se compararon variables sociodemográficas, obstétricas y relacionadas con el consumo.Resultados: La muestra fue de 274 gestantes, y la prevalencia de fumadoras antes de la gestación del 31,4% (n= 86). Dejó de fumar el 60,5% (n= 52), y el 28,8% (n= 15) abandonó el consumo en la etapa preconcepcional o al conocer el embarazo. Logró la abstinencia sin ayuda profesional el 94,2% (n= 49).En el tercer trimestre continuaba fumando el 12,4% de las mujeres (n= 34), y al 23,5% de ellas no se les ofertó ayuda para dejar de fumar.Fueron predictores de abstinencia un nivel de estudios universitarios superior (p <0,001) y que la pareja no fumara (p <0,01). En los hogares de las fumadoras, la exposición al HAT fue mayor (p <0,001).Conclusiones: La mayoría de las gestantes que dejan de fumar lo hacen sin ayuda. El nivel de estudios es un predictor de abstinencia. Las que no han logrado dejarlo tienen el riesgo añadido de estar más expuestas al HAT. Si la pareja fuma, la embarazada tiene menos probabilidades de abandonar el consumo; por tanto, las estrategias de ayuda durante el embarazo se deberían potenciar y revisar, incluyendo en los programas de deshabituación a parejas y convivientes fumadores para incrementar su eficacia y disminuir los daños asociados al tabaquismo.  (AU)

Objective: To know the tobacco consumption in the last trimester of pregnancy, the factors associated with maintenance, exposure to environmental tobacco smoke in the home and the attitude of the professionals during the follow-up of the pregnancy.Subjects and method: Descriptive cross-sectional study carried out, by means of a personal interview with pregnant women, starting at week 32, who attended prenatal check-ups at 10 Primary Health Care Centers in Cantabria (Spain) during the period June 2018-June 2019. The ad hoc designed questionnaire consisted of 6 questions. Sociodemographic, obstetric and consumption-related variables were compared. Results: The sample consisted of 274 women, and the prevalence of smokers before pregnancy was 31.4% (86). 60.5% (n= 52) stopped smoking, of which 28.8% (n= 15) abandoned consumption in the preconception stage or when knowing the pregnancy. 94.2% (n= 49) achieved abstinence without professional help. In the third trimester, 12.4% (n= 34) continued to smoke; 23.5% of them were not offered help to quit smoking. Predictors of abstinence were a higher level of university studies (p <0.001) and that the couple wouldn’t smoke (p <0.01). Exposure to environmental tobacco smoke was higher in smokers’ homes (p <0.001).Conclusions: Most pregnant women who quit smoking do so without help. Educational level is a predictor of abstinence. Those who have not been able to quit smoking have the added risk of being more exposed to second-hand smoke. If the couple is a smoker, the pregnant woman is less likely to quit smoking, so the strategies to help them during pregnancy should be strengthened and reviewed, including smoking couples and cohabitants in smoking cessation programs to increase their effectiveness and decrease the harms associated with smoking. (AU)

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OBJECTIVE: Adequate physical activity levels and a healthy lifestyle may prevent all kinds of non-communicable diseases, promote well-being and reduce health-care costs among perimenopausal women. This study assessed an exercise programme for perimenopausal women. METHOD: A total of 150 women (aged 45-64 years) not engaged in regular physical activity were randomly assigned to either a 16 week exercise intervention or to the control group. The study was conducted from the perspective of the National Health System. Health outcomes were quality-adjusted life years (QALYs), measured by the EuroQol-5D-5L questionnaire. The total direct costs of the programme were the costs of visits to primary care, specialty care, emergency, medicines, instructor cost and infrastructure cost. The results were expressed as the incremental cost-effectiveness ratio. Sensitivity analysis was undertaken to test the robustness of the analysis. RESULTS: Mean QALYs over 16 weeks were.228 in the control group and.230 in the intervention group (mean difference: .002; 95% confidence interval [95%CI]: -0.005 to 0.009). Improvements from baseline were greater in the intervention group in all dimensions of the EuroQol-5D-5L but not statistically significant. The total costs at the end of the intervention were 160.38 € in the control group and 167.80 € in the intervention group (mean difference: 7.42 €; 95%CI: -47 to 62). The exercise programme had an incremental cost-effectiveness ratio of 4,686 €/QALY. CONCLUSIONS: The programme could be considered cost-effective, although the overall difference in health benefits and costs was very modest. Longer term follow-up is needed

OBJETIVO: El ejercicio físico puede promover el bienestar y reducir los costes de atención médica en las mujeres perimenopáusicas. Este estudio evalúa un programa de ejercicio físico en mujeres perimenopáusicas. MÉTODO: Un total de 150 mujeres (de edades comprendidas entre 45 y 64 años) fueron asignadas aleatoriamente al grupo de intervención o al grupo de control. El estudio ha tenido una duración de 16 semanas. Los resultados en salud se han medido en años de vida ajustados por calidad (AVAC) mediante el cuestionario EuroQol-5D-5L. Se ha considerado el total de costes directos del programa, integrado por los costes de las visitas en atención primaria, atención especializada y urgencias, medicamentos, coste del monitor y coste de las instalaciones. Los resultados se han expresado como ratio coste-efectividad incremental. La robustez del modelo se ha contrastado con un análisis de sensibilidad. RESULTADOS: Al final de la intervención, los AVAC fueron 0,228 en el grupo de control y 0,230 en el grupo de intervención (diferencia media: 0,002; intervalo de confianza del 95% [IC95%]: -0,005 a 0,009). La mejoría fue mayor en el grupo de intervención en todas las dimensiones del EuroQol-5D-5L, pero sin significación estadística. Los costes totales al finalizar la intervención han sido de 160,38 € en el grupo de control y 167,80 € en el de intervención (diferencia media: 7,42 €; IC95%: -47 a 62). El programa de ejercicio físico ha tenido una ratio coste-efectividad incremental de 4686 €/AVAC. CONCLUSIÓN: El programa debe considerarse coste-efectivo, aunque la diferencia en resultados de salud y costes ha sido muy moderada. Se necesita un seguimiento a más largo plazo

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Objetivos: Evaluar la incidencia en nuestro medio de citologías con resultado de atipia de células glandulares (ACG), así como analizar la conducta llevada a cabo ante estos resultados, el diagnóstico final y su relación con enfermedad ginecológica oncológica. Material y métodos: Estudio longitudinal, observacional, retrospectivo y descriptivo. Se revisaron las citologías realizadas en el Área 7 del Hospital Clínico San Carlos de Madrid, entre mayo de 2006 y agosto de 2016, seleccionando las informadas como ACG. Resultados: De 162.988 citologías realizadas durante 10 años y 3 meses, 40 fueron informadas como ACG. Desglosándolas, 11 fueron informadas como ACG-H, 6 como ACG-NOS, 22 como ACG endocervicales y una como ACG endometrial. El 75% de las pacientes con ACG presentaron enfermedad: 25% benigna, 15% displasia cervical y el 35% neoplasia. Si se desglosan y revisan los resultados, de 22 pacientes con ACG endocervicales, una presentó neoplasia, 4 displasia cervical, 9 enfermedad benigna y 8 negativas. De 11 ACG-H, 10 desarrollaron neoplasias y una fue negativa. De entre las 6 ACG-NOS, en 2 se encontraron neoplasias, en 2 displasia cervical, en una enfermedad benigna y una fue negativa. La citología ACG endometrial presentó un adenocarcinoma de endometrio. Conclusión: La incidencia en nuestro medio de citología con resultado de ACG es muy baja (0,025%). La probabilidad de presentar enfermedad detrás de esta alteración citológica es alta, lo que debe llevar a realizar un estudio exhaustivo de estas pacientes de acuerdo con las normas dictadas por las sociedades científicas, dado que un porcentaje no desdeñable puede traducir la existencia de enfermedad severa neoplásica no solo cervical, también endometrial u ovárica

Objectives: To evaluate the incidence of cytology reporting atypical glandular cells (AGC) in an area of Madrid, as well as to analyse the action taken on these results, the final diagnosis, and its relationship with gynaecological-oncological disease. Material and methods: A longitudinal, observational, retrospective and descriptive study was carried out on the cytology analysis performed in Area 7 of the HCSC of Madrid, between May 2006 and August 2016, was revised, selecting those reported as AGC. Results: Of the 162,988 cytologies performed during a period of 10 years and 3 months, 40 were reported as AGC. These included 11 reported as AGC-H, 6 AGC-NOS, 22 endocervical AGC, and one endometrial AGC. Of the 75% of patients with AGC that had a disease, 25% were benign, 15% with cervical dysplasia, and 35% with a neoplasm. On analysing the results of 22 patients with endocervical AGC, one had a neoplasm, 4 an intracervical neoplasm, 9 with benign disease, and 8 negative. Of the 11 AGC-H, 10 developed neoplasms and one was negative. Among the 6 AGC-NOS, 2 neoplasms were found as cervical intraepithelial neoplasia, one benign, and one negative. Endometrial AGC cytology showed an endometrial adenocarcinoma. Conclusion: The incidence of cytology in our area with AGC result is very low (0.025%). The probability of having an underlying cytological alteration is high, which in turn should lead to an exhaustive study of these patients according to the recommendations of the scientific societies, since a non-negligible percentage can translate into the existence of severe malignant diseases, not only cervical, but also endometrial or ovarian

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OBJECTIVE: Adequate physical activity levels and a healthy lifestyle may prevent all kinds of non-communicable diseases, promote well-being and reduce health-care costs among perimenopausal women. This study assessed an exercise programme for perimenopausal women. METHOD: A total of 150 women (aged 45-64 years) not engaged in regular physical activity were randomly assigned to either a 16 week exercise intervention or to the control group. The study was conducted from the perspective of the National Health System. Health outcomes were quality-adjusted life years (QALYs), measured by the EuroQol-5D-5L questionnaire. The total direct costs of the programme were the costs of visits to primary care, specialty care, emergency, medicines, instructor cost and infrastructure cost. The results were expressed as the incremental cost-effectiveness ratio. Sensitivity analysis was undertaken to test the robustness of the analysis. RESULTS: Mean QALYs over 16 weeks were.228 in the control group and.230 in the intervention group (mean difference: .002; 95% confidence interval [95%CI]: -0.005 to 0.009). Improvements from baseline were greater in the intervention group in all dimensions of the EuroQol-5D-5L but not statistically significant. The total costs at the end of the intervention were 160.38 € in the control group and 167.80 € in the intervention group (mean difference: 7.42 €; 95%CI: -47 to 62). The exercise programme had an incremental cost-effectiveness ratio of 4,686 €/QALY. CONCLUSIONS: The programme could be considered cost-effective, although the overall difference in health benefits and costs was very modest. Longer term follow-up is needed.

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PURPOSE: We analyze the influence of the dramatic changes in the Spanish labor market during the crisis on the perceived health of the Spanish population. METHODS: We use the longitudinal Living Conditions Survey database and multilevel longitudinal logistic models between 2007 and 2011, before and during the economic crisis in one of the European countries most affected by its consequences. RESULTS: Unemployment (OR 1.75; p < 0.001), job insecurity (OR 1.38; p < 0.001), and being part of a household with severe material deprivation (OR 1.87; p = 0.004) increase the risk of having worsened perceived health. Available income, on the other hand, is a protective factor (OR 0.72; p < 0.001). Public expenditure policies have little impact on the perceived health. Labor market reforms reducing the degree of job insecurity and unemployment, together with income transfers to those at greater risk of social deprivation, can be more effective in improving the health of the population than the increase of aggregated social or health care expenditure. CONCLUSIONS: This study provides evidence of the influence that unemployment, job insecurity, and poverty exert on the perceived health of individuals, with data collected in Spain after the onset of the financial crisis. In addition, after analyzing public social expenditure, only expenditure on FPS seems to influence self-reported health, although to a very limited degree.

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BACKGROUND: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. OBJECTIVE: The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies against the alternative of having their medication dispensed normally. METHODS: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Cost-utility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. RESULTS: A total of 1403 older adults, aged between 65 and 94 years, were enrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28 ± 1.25 drugs; p < 0.001) than in the CG (0.07 ± 0.95 drugs; p = 0.063). Older adults in the IG saw their quality of life improved by 0.0528 ± 0.20 (p < 0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022 ± 0.24 (p = 0.815). The mean total cost was 977.57 ± 1455.88 for the IG and 1173.44 ± 3671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of -250.51 ± 148.61 (95 % CI -541.79 to 40.76) and a mean incremental QALY of 0.0156 ± 0.004 (95 % CI 0.008-0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. CONCLUSION: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective.

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OBJECTIVES: To compare the cost-effectiveness of a pharmacotherapy follow-up for elderly nursing home (NH) residents with that of usual care. DESIGN: Prospective observational study with a concurrent control group conducted over 12 months. SETTING: Fifteen NHs in Andalusia assigned to control (n = 6) or intervention (n = 9). PARTICIPANTS: Residents aged 65 and older. INTERVENTION: Pharmacotherapy follow-up. MEASUREMENTS: Negative outcomes associated with medication, health-related quality of life, cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER). ICERs were estimated for three scenarios: unadjusted cost per QALY (first scenario), costs adjusted for baseline prescribed medication and QALYs adjusted for baseline utility score (second scenario), and costs and QALYs adjusted for a fuller set of baseline characteristics (third scenario). RESULTS: Three hundred thirty-two elderly residents were enrolled: 122 in the control group and 210 in the intervention group. The general practitioner accepted 88.7% (274/309) of pharmacist recommendations. Pharmacist interventions reduced the average number of prescribed medication by 0.47 drugs (P < .001), whereas the average prescribed medication increased by 0.94 drugs in the control group (P < .001). Both groups reported a lower average EuroQol-5D utility score after 12 months (intervention, -0.0576, P = .002; control, -0.0999, P = .003). For the first scenario, usual care dominated pharmacotherapy follow-up (was less effective and more expensive). Adjusted ICERs were € 3,899/QALY ($5,002/QALY) for the second scenario and € 6,574/QALY ($8,433/QALY) for the third scenario. For a willingness to pay of € 30,000/QALY ($38,487/QALY), the probabilities of the pharmacotherapy follow-up being cost-effective were 35% for the first scenario, 78% for the second, and 76% for the third. CONCLUSION: Pharmacotherapy follow-up is considered cost-effective for elderly NH residents in Spain.

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INTRODUCTION: The medical records are key documents for the patient's diagnosis, treatment and follow-up. Thus, the clinical histories must be made with high technical quality. Although some studies relate the quality of the clinical history with better control of a disease, as far as we know, there are few that evaluate the quality of the medical record itself. This study aims to analyze the quality of the clinical histories of our Internal Medicine Department and then evaluate the improvement achieved. MATERIAL AND METHODS: A descriptive and intervention study with a before and after design was conducted. It included 186 medical records elaborated by the physicians of our Internal Medicine Department. A 16-item Likert-like scale was designed for the evaluation. The items were analyzed item by item and a score combining them was elaborated. A baseline analysis and a second analysis 3 months after making several interventions were made. RESULTS: Weak points were detected in the baseline analysis (described) and after the interventions. There was an improvement in almost all the items, this being very significant in the recording of allergies and habits. The global score also improved significantly. CONCLUSION. The study has allowed us to learn our weak points in the elaboration of the medical records. We have improved their quality with the interventions. We estimate that this intervention has also been useful for the training of internal medicine physicians, residents and students.

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Introducción: Las historias clínicas son documentos clave en el diagnóstico, tratamiento y seguimiento de los pacientes. Por ello es necesario realizar historias clínicas de elevada calidad técnica. Aunque hay estudios que relacionan la calidad de la historia clínica con un mejor control de una determinada enfermedad, conocemos pocos que evalúen la calidad intrínseca de las historias. El objetivo de este trabajo fue analizar la calidad de las historias clínicas de nuestro Servicio de Medicina Interna y, tras intervenir, valorar la mejoría conseguida. Material y métodos: Estudio de intervención antes/después que incluyó 186 historias clínicas elaboradas por los médicos de nuestro Servicio de Medicina Interna. Se diseñó una plantilla para evaluar 16 contenidos de ellas mediante una escala tipo Likert. Se analizaron las variables ítem por ítem y con un score combinándolos. Se realizó un análisis basal y otro tres meses después, tras realizar varias intervenciones. Resultados: Se detectaron las insuficiencias de las historias al inicio (que se describen) y tras las intervenciones. Con ellas se obtuvo mejoría en prácticamente todos los ítems seleccionados, destacando la mejor cumplimentación de las alergias y los hábitos vitales. El score global mejoró también de manera significativa. Conclusión: El estudio nos ha permitido conocer nuestras insuficiencias en la elaboración de las historias clínicas. Con las intervenciones hemos aumentado su calidad. Estimamos que esta actuación ha resultado formativa para los médicos de plantilla, residentes y estudiantes de nuestro Servicio, y creemos que ha mejorado la calidad de nuestras actuaciones (AU)

Introduction: The medical records are key documents for the patient's diagnosis, treatment and follow-up. Thus, the clinical histories must be made with high technical quality. Although some studies relate the quality of the clinical history with better control of a disease, as far as we know, there are few that evaluate the quality of the medical record itself. This study aims to analyze the quality of the clinical histories of our Internal Medicine Department and then evaluate the improvement achieved. Material and methods: A descriptive and intervention study with a before and after design was conducted. It included 186 medical records elaborated by the physicians of our Internal Medicine Department. A 16-item Likert-like scale was designed for the evaluation. The items were analyzed item by item and a score combining them was elaborated. A baseline analysis and a second analysis 3 months after making several interventions were made. Results: Weak points were detected in the baseline analysis (described) and after the interventions. There was an improvement in almost all the items, this being very significant in the recording of allergies and habits. The global score also improved significantly. Conclusion The study has allowed us to learn our weak points in the elaboration of the medical records. We have improved their quality with the interventions. We estimate that this intervention has also been useful for the training of internal medicine physicians, residents and students (AU)

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OBJECTIVE: To find the prevalence of flu vaccination and factors affecting the likelihood of being vaccinated. DESIGN: Observational, descriptive and cross-sectional study. SETTING: A district in Health Area III, Asturias, Spain. PARTICIPANTS: People of 65 and over selected by simple random sampling from the health card data base. The size of the sample was 386 users, of whom 326 agreed to take part. MAIN MEASUREMENTS: By means of a survey of our own design, conducted by phone interview, the variables gathered were social and personal details, accessibility, personal view of vaccination and attitude to it. A descriptive analysis and population estimates were made, with logistic regression used to identify associated variables. RESULTS: A 70.6% (95% CI, 65.9-75.2) of the population under study had been vaccinated. The main arguments for non-vaccination were: "don't want to" (35.5%; 95% CI, 25.8-45.2) and enjoyment of good health (34.4%; 95% CI, 24.8-44); 25% (95% CI, 19-30) of the elderly with some chronic pathology were not vaccinated; 92.3% (95% CI, 89.6-95) of those surveyed said they had not been contacted by their Health Centre; 35.7% (95% CI, 30.7-40.7) thought they would catch the flu the same if they were vaccinated; 41.6% (95% CI, 36.6-46.6) did not think so. Logistic regression showed positive association of vaccination and belief in its use (OR=338; 95% CI, 4.48-25084). CONCLUSIONS: Vaccination coverage in our health district was higher than that found by other studies and matched the figures stated in the programme record system. Raising awareness of the usefulness of vaccination is a strategy to be assessed in relation to increased coverage. We could not show that active phone recruitment affects vaccination at all.

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Objetivo. Conocer la prevalencia de la vacunación antigripal y los factores implicados en la probabilidad de vacunarse. Diseño. Observacional, descriptivo y transversal. Emplazamiento. Una zona básica de salud (ZBS) del Área Sanitaria III de Asturias. Participantes. Personas >= 65 años seleccionadas por muestreo aleatorio simple a partir de base de datos de la tarjeta sanitaria. El tamaño de la muestra fue de 386 usuarios, de los cuales aceptaron participar 326. Mediciones principales. Mediante un cuestionario de elaboración propia realizado a través de entrevista telefónica. Se recogen variables sociodemográficas, de accesibilidad, de opinión personal y actitud frente a la vacunación. Se realiza un análisis descriptivo y estimaciones poblacionales mediante el análisis de regresión logística para identificar las variables asociadas. Resultados. El 70,6% (intervalo de confianza [IC] del 95%, 65,9-75,2) de la población en estudio ha sido vacunada. Como principales argumentos para no vacunarse refieren: «no querer» en el 35,5% (IC del 95%, 25,8-45,2) y gozar de buena salud en el 34,4% (IC del 24,8-44). El 25% (IC del 95%, 19-30) de los ancianos con alguna enfermedad crónica no es vacunado. El 92,3% (IC del 95%, 89,6-95) de los encuestados refiere no haber sido contactado por su centro de salud. El 35,7% (IC del 95%, 30,7-40,7) considera que tiene la gripe igual aunque se vacune, y el 41,6% (IC del 95%, 36,6-46,6) opina que no. Al aplicar el análisis de regresión logística se observa que la creencia en la utilidad de la vacuna se asocia positivamente con la vacunación (odds ratio = 338; IC del 95%, 4,48-25084). Conclusiones. La cobertura vacunal en nuestra ZBS es más elevada que la recogida en otros estudios y se ajusta a las cifras declaradas por el sistema de registro del programa. La sensibilización respecto a la utilidad de la vacuna sería una estrategia que se debería valorar en relación con el incremento de las coberturas. No hemos podido demostrar que la captación telefónica activa posea alguna influencia sobre la vacunación

Objective. To find the prevalence of flu vaccination and factors affecting the likelihood of being vaccinated. Design. Observational, descriptive and cross-sectional study. Setting. A district in Health Area III, Asturias, Spain. Participants. People of 65 and over selected by simple random sampling from the health card data base. The size of the sample was 386 users, of whom 326 agreed to take part. Main measurements. By means of a survey of our own design, conducted by phone interview, the variables gathered were social and personal details, accessibility, personal view of vaccination and attitude to it. A descriptive analysis and population estimates were made, with logistic regression used to identify associated variables. Results. A 70.6% (95% CI, 65.9-75.2) of the population under study had been vaccinated. The main arguments for non-vaccination were: "don't want to" (35.5%; 95% CI, 25.8-45.2) and enjoyment of good health (34.4%; 95% CI, 24.8-44); 25% (95% CI, 19-30) of the elderly with some chronic pathology were not vaccinated; 92.3% (95% CI, 89.6-95) of those surveyed said they had not been contacted by their Health Centre; 35.7% (95% CI, 30.7-40.7) thought they would catch the flu the same if they were vaccinated; 41.6% (95% CI, 36.6-46.6) did not think so. Logistic regression showed positive association of vaccination and belief in its use (OR=338; 95% CI, 4.48-25084). Conclusions. Vaccination coverage in our health district was higher than that found by other studies and matched the figures stated in the programme record system. Raising awareness of the usefulness of vaccination is a strategy to be assessed in relation to increased coverage. We could not show that active phone recruitment affects vaccination at all

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Objetivo. Conocer la prevalencia de la vacunación antigripal y los factores implicados en la probabilidad de vacunarse. Diseño. Observacional, descriptivo y transversal. Emplazamiento. Una zona básica de salu (ZBS) del Área Sanitaria III de Asturias. Participantes. Personas ≥ 65 años seleccionadas por muestreo aleatorio simple a partir de base de datos de la tarjeta sanitaria. El tamaño de la muestra fue de 386 usuarios, de los cuales aceptaron participar 326. Mediciones principales. Mediante un cuestionario de elaboración propia realizado a través de entrevista telefónica. Se recogen variables sociodemográficas, de accesibilidad, de opinión personal y actitud frente a la vacunación. Se realiza un análisis descriptivo y estimaciones poblacionales mediante el análisis de regresión logística para identificar las variables asociadas. Resultados. El 70,6 por ciento (intervalo de confianza [IC] del 95 por ciento, 65,9-75,2) de la población en estudio ha sido vacunada. Como principales argumentos para no vacunarse refieren: «no querer» en el 35,5 por ciento (IC del 95 por ciento, 25,8-45,2) y gozar de buena salud en el 34,4 por ciento (IC del 24,8-44). El 25 por ciento (IC del 95 por ciento, 19-30) de los ancianos con alguna enfermedad crónica no es vacunado. El 92,3 por ciento (IC del 95 por ciento, 89,6-95) de los encuestados refiere no haber sido contactado por su centro de salud. El 35,7 por ciento (IC del 95 por ciento, 30,7-40,7) considera que tiene la gripe igual aunque se vacune, y el 41,6 (IC del 95 por ciento, 36,6-46,6) opina que no. Al aplicar el análisis de regresión logística se observa que la creencia en la utilidad de la vacuna se asocia positivamente con la vacunación (odds ratio = 338; IC del 95 por ciento, 4,48-25084). Conclusiones. La cobertura vacunal en nuestra ZBS es más elevada que la recogida en otros estudios y se ajusta a las cifras declaradas por el sistema de registro del programa. La sesibilización respecto a la utilidad de la vacuna sería una estrategia que se debería valorar en relación con el incremento de las coberturas. No hemos podido demostrar que la captación telefónica activa posea alguna influencia sobre la vacunación.(AU)

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Los autores aportan un caso de recidiva duodenal por hipernefroma que cursó con clínica digestiva alta en forma de úlcera gigante duodenal hemorrágica, cuya biopsia endoscópica informó de tejido neoplásico de origen renal. Como tratamiento se pudo realizar una duodenopancreatectomía cefálica en cuya pieza de resección se objetivó una afectación duodenopancreática por tumor de células claras compatible con hipernefroma (AU)

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