ABSTRACT
BACKGROUND: There was a need for a solid asthma guideline in Mexico to update and unify asthma management. Because high-quality asthma guidelines exist worldwide, in which the latest evidence on asthma management is summarized, the ADAPTE approach allows for the development of a national asthma guideline based on evidence from already existing guidelines, adapted to national needs. OBJECTIVE: To fuse evidence from the best asthma guidelines and adapt it to local needs with the ADAPTE approach. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II asthma guidelines were evaluated by a core group to select 3 primary guidelines. For each step of asthma management, clinical questions were formulated and replied according to (1) evidence in the primary guidelines, (2) safety, (3) Cost, and (4) patient preference. The Guidelines Development Group, composed of a broad range of experts from medical specialties, primary care physicians, and methodologists, adjusted the draft questions and replies in several rounds of a Delphi process and 3 face-to-face meetings, taking into account the reality of the situation in Mexico. We present the results of the pediatric asthma treatment part. RESULTS: Selected primary guidelines are from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), Global Initiative for Asthma (GINA), and Spanish Guidelines on the Management of Asthma (GEMA) 2015, with 2016 updates. Recommendations or suggestions were made for asthma treatment in Mexico. In this article, the detailed analysis of the evidence present in the BTS/SIGN, GINA, and GEMA sections on the (non) pharmacologic treatment of pediatric asthma, education, and devices are presented for 2 age groups: children 5 years or younger and children 6 to 11 years old with asthma. CONCLUSION: For the pediatric treatment and patient education sections, applying the AGREE II and Delphi methods is useful to develop a scientifically sustained document, adjusted to the Mexican situation, as is the Mexican Guideline on Asthma.
Subject(s)
Anti-Asthmatic Agents/therapeutic use , Asthma/therapy , Disease Management , Asthma/physiopathology , Child , Child, Preschool , Drug Administration Schedule , Drug Dosage Calculations , Female , Humans , Infant , Male , Mexico , Monitoring, Physiologic , Practice Guidelines as TopicABSTRACT
BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.
Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.
Subject(s)
Asthma/therapy , Adolescent , Adult , Age Factors , Airway Obstruction/etiology , Airway Obstruction/physiopathology , Anti-Asthmatic Agents/therapeutic use , Asthma/classification , Asthma/diagnosis , Asthma/physiopathology , Bronchial Thermoplasty , Child , Child, Preschool , Combined Modality Therapy , Diagnosis, Differential , Disease Management , Evidence-Based Medicine , Female , Humans , Infant , Mexico , Oxygen Inhalation Therapy , Patient Education as Topic , Pregnancy , Pregnancy Complications/therapy , Respiration, Artificial , Self Care , Spirometry , Status Asthmaticus/therapyABSTRACT
El objetivo del trabajo ha sido evaluar el programa de vacunación antigripal en personal sanitario en la temporada 2011-2012. La campaña incluyo actuaciones novedosas (tríptico informativo, recomendación de utilizar mascarilla en no vacunados, cartas de agradecimiento, etc.). Se comparó la cobertura y las características de los profesionales vacunados con la de la temporada previa con la prueba de la Ji cuadrado. La cobertura vacunal en la temporada 2011-2012, fue del 26,5%, frente al 24,5% del 2010-2011 (p=0,052). La mejora encontrada en la cobertura vacunal está en el límite de la significación estadística pero sigue siendo muy baja. Para mejorar las bajas coberturas vacunales, habría que plantearse otro tipo de estrategias, tales como políticas de incentivos o de obligatoriedad
The objective was to evaluate the healthcare personnel seasonal influenza immunization program in the 2011-2012 flu season. The campaign included several innovative actions (informational brochure, recommendations for unvaccinated staff to wear a mask, acknowledgement letters, etc). Coverage and characteristics of the health personnel were compared with the previous season using the chi-square test. Vaccination coverage for the 2011-12 flu season was 26.5%, compared to 24.5% achieved in 2010-2011 (p=0.052). The improvement in vaccination coverage approached statistical significance but remains very low. To improve these low vaccination levels, we recommend developing other strategies, such as incentive policies or making vaccination mandatory
Subject(s)
Humans , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Mass Vaccination/statistics & numerical data , Health Personnel/statistics & numerical data , Motivation , Cross Infection/prevention & controlABSTRACT
The purpose of this study was to evaluate the coverage rates for influenza vaccination among health-care personnel (HCP), and if the reasons for accepting influenza vaccine by HCP and the frequency of vaccine-related adverse events (AEs) in 2010-2011 were different compared to 2009-2010. The AEs were detected by telephoning the worker one week after the vaccination. The coverage for seasonal vaccination in 2009-2010 was 31.0%, whereas that for 2009 pandemic influenza (H1NI) was 22.2% and 24.4% (p<0.05) in 2010-2011. The most frequent reason for being vaccinated during the three campaigns was to "protect my health". Over 80.5% of the HCP reported 2009 pandemic influenza (H1N1) vaccine-related AEs compared to the 25.3% and 25.4% reporting seasonal vaccine-related AEs in 2009-2010 and 2010-2011 respectively (p<0.05). None of the AEs were severe. Specific measures should be implemented in our country to recover and improve poor vaccination coverage.
Subject(s)
Health Personnel , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics , Patient Acceptance of Health Care/statistics & numerical data , Vaccination/statistics & numerical data , Adult , Cross-Sectional Studies , Female , Humans , Influenza, Human/virology , Interviews as Topic , Male , Middle AgedABSTRACT
OBJECTIVES: To determine vaccination coverage against seasonal influenza and the new A (H1N1) influenza virus among healthcare personnel during the 2009-2010 season and to identify its determining factors. METHODS: We performed a cross-sectional study among healthcare staff at the General University Hospital in Alicante (Spain) during the 2008-2009 and 2009-2010 influenza vaccination campaigns. The 2009-2010 vaccination campaign was subdivided into two phases. In the first phase, from 1st October to 19th November, 2009, the seasonal influenza vaccine was administered; in the second phase, from 16th November to 30th December, 2009, vaccination against the new A (H1N1) influenza virus was performed. Each of the vaccine programs was preceded by a specific vaccination promotion campaign. Healthcare staff were asked to complete a brief self-administered questionnaire containing a list of reasons for being vaccinated. Coverage during both vaccination campaigns was calculated, and the results, both overall and for each profession, were then compared using a Chi-square test. RESULTS: Coverage against seasonal influenza was 31% and that against the new A (H1N1) influenza virus was 22.2% (p<0.05); these percentages were 36% and 34% respectively in medical personnel (NS), 33% and 24% respectively in nursing personnel (p<0.001), and 21% and 12% respectively in nursing assistants (p<0.001). The main reason given for being vaccinated was self-protection. CONCLUSIONS: The low coverage achieved is a public health problem. Specific intervention programs should be implemented.
Subject(s)
Disease Outbreaks , Influenza A Virus, H1N1 Subtype , Influenza Vaccines , Influenza, Human/prevention & control , Personnel, Hospital/statistics & numerical data , Vaccination , Cross-Sectional Studies , Female , Health Promotion , Hospitals, General/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Influenza A Virus, H1N1 Subtype/immunology , Influenza Vaccines/immunology , Influenza, Human/epidemiology , Influenza, Human/virology , Male , Medical Staff, Hospital/psychology , Medical Staff, Hospital/statistics & numerical data , Motivation , Nursing Assistants/psychology , Nursing Assistants/statistics & numerical data , Nursing Staff, Hospital/psychology , Nursing Staff, Hospital/statistics & numerical data , Occupational Exposure , Personnel, Hospital/psychology , Spain/epidemiology , Vaccination/psychology , Vaccination/statistics & numerical dataABSTRACT
Objetivos: Determinar las coberturas vacunales frente a la gripe estacional y frente a la nueva gripe A(H1N1) en la temporada 2009-2010 en trabajadores sanitarios y conocer sus factores determinantes.Métodos: Estudio transversal realizado en el Hospital General Universitario de Alicante en trabajadoressanitarios durante las campanas de vacunación antigripal 2008-2009 y 2009-2010. La campana 2009-2010 se subdividió en dos fases: entre el 1-10-09 y el 13-11-09 se administró la vacuna de la gripeestacional 2009-2010; desde el 16-11-09 hasta el 30-12-09 se administró la vacuna frente al nuevo virusde la gripe A (H1N1). Cada fase estuvo precedida por una campana promocional específica. En el momentode la vacunación, el trabajador sanitario cumplimentó un cuestionario que incluía un listado de motivospara vacunarse. Se calculó la frecuencia de vacunación y se compararon las coberturas vacunales de cadacampana, de manera global y por estamentos, utilizando la prueba de ji cuadrado.Resultados: La cobertura frente a la gripe estacional 2009-2010 fue del 31%, y frente a la nueva gripe A(H1N1) fue del 22,2% (p < 0,05). En personal facultativo la cobertura fue del 36% y del 34%, respectivamente(NS); en personal de enfermería fue del 33% y del 24% (p < 0,001); en auxiliares de enfermería fue del 21%y del 12% (p < 0,001). El principal motivo para vacunarse en ambas campanas fue «proteger mi salud».Conclusiones: Las bajas coberturas alcanzadas constituyen un problema de salud pública que hace necesarioel desarrollo de programas de intervención específicos para mejorarlas (AU)
Objectives: To determine vaccination coverage against seasonal influenza and the new A (H1N1)influenza virus among healthcare personnel during the 2009-2010 season and to identify its determiningfactors.Methods: We performed a cross-sectional study among healthcare staff at the General University Hospitalin Alicante (Spain) during the 2008-2009 and 2009-2010 influenza vaccination campaigns. The2009-2010 vaccination campaign was subdivided into two phases. In the first phase, from 1st October to19th November, 2009, the seasonal influenza vaccine was administered; in the second phase, from 16thNovember to 30th December, 2009, vaccination against the new A (H1N1) influenza virus was performed.Each of the vaccine programs was preceded by a specific vaccination promotion campaign. Healthcarestaff were asked to complete a brief self-administered questionnaire containing a list of reasons for beingvaccinated. Coverage during both vaccination campaigns was calculated, and the results, both overalland for each profession, were then compared using a Chi-square test.Results: Coverage against seasonal influenza was 31% and that against the new A (H1N1) influenza viruswas 22.2% (p < 0.05); these percentages were 36% and 34% respectively in medical personnel (NS), 33%and 24% respectively in nursing personnel (p < 0.001), and 21% and 12% respectively in nursing assistants(p < 0.001). The main reason given for being vaccinated was self-protection.Conclusions: The low coverage achieved is a public health problem. Specific intervention programsshould be implemented (AU)
Subject(s)
Humans , Influenza Vaccines/pharmacokinetics , Influenza, Human/epidemiology , Communicable Disease Control/methods , Health Personnel , Epidemiological Monitoring/trends , Influenza A Virus, H1N1 Subtype/isolation & purificationABSTRACT
Fundamentos: El temor a las reacciones adversas (RA) constituye un motivo frecuente por el que los trabajadores sanitarios (TS) deciden no vacunarse de la gripe. Con los objetivos de conocer la frecuencia de RA y los factores asociados con las mismas tras la administración de las vacunas antigripales en la temporada 2009-2010 en TS se realizó esta investigación. Métodos: Estudio de cohortes que incluyó a los 969 trabajadores vacunados frente a la gripe estacional y a los 693 trabajadores vacunados frente al nuevo virus influenza en la temporada 2009-2010 en un hospital de tercer nivel. Resultados: Para detectar RA se telefoneó a las persoans vacunadas una semana después de la vacunación. La frecuencia de RA osciló entre el 24,5% de los TS que recibieron exclusivamente la vacuna de la gripe estacional y el 82,6% de los que recibieron la vacuna frente al nuevo virus influenza (H1N1) 2009. Las RA más frecuentes fueron dolor y malestar general. Ninguna RA fue considerada grave. La edad y el hecho de que la vacuna contuviera adyuvante se asociaron con la aparición de RA tras la administración de la vacuna frente al nuevo virus influenza (H1N1) 2009. Conclusiones: Las vacunas de la gripe estacional y del nuevo virus influenza (H1N1) 2009 son seguras: La frecuencia de RA relacionadas con esta última vacuna fue alta, especialmente si contenía adyuvante(AU)
Backgraund: Fear of adverse effects (AE) represents a frequent reason among healthcare workers (HCW) for not deciding to receive influenza vaccine. This investigation is carried out with the objectives of knowing the frequency of AE and the factors associated with them after the administration of influenza vaccines in the 2009-2010 season in HCW. Methods: Cohort study that included the 969 HCW vaccinated against seasonal influenza and the 693 HCW vaccinated against new influenza A (H1N1) virus during the 2009-2010 season in a tertiary hospital. To detect adverse effects, HCW was telephoned one week after vaccination. Results: Frequency of AE ranged between 24.5% of HCW who received only seasonal influenza vaccine and 82.6% of those who received vaccine against new influenza A (H1N1) virus. The most frequent AE were pain and general discomfort. None of the adverse effects was considered serious. Age and presence of an adjuvant in the vaccine were associated with appearance of AE after administration of vaccine against new influenza A (H1N1) virus. Conclusions: Vaccines against seasonal influenza and new influenza A (H1N1) are safe; frequency of AE related to this one was high, especially if it contained an adjuvant. Since none of the AE detected was serious, HCW can not justify his rejection of vaccination because of suffering the above-mentioned AE(AU)
Subject(s)
Humans , Male , Female , Influenza Vaccines/immunology , Influenza Vaccines/therapeutic use , Influenza, Human/immunology , Health Personnel/statistics & numerical data , Health Personnel , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Influenza Vaccines/adverse effects , Cohort Studies , Vaccination/adverse effects , Vaccination/methods , Logistic Models , 28599 , Odds Ratio , Confidence IntervalsABSTRACT
UNLABELLED: BACKGRAUND: Fear of adverse effects (AE) represents a frequent reason among healthcare workers (HCW) for not deciding to receive influenza vaccine. This investigation is carried out with the objectives of knowing the frequency of AE and the factors associated with them after the administration of influenza vaccines in the 2009-2010 season in HCW. METHODS: Cohort study that included the 969 HCW vaccinated against seasonal influenza and the 693 HCW vaccinated against new influenza A (H1N1) virus during the 2009-2010 season in a tertiary hospital. To detect adverse effects, HCW was telephoned one week after vaccination. RESULTS: Frequency of AE ranged between 24.5% of HCW who received only seasonal influenza vaccine and 82.6% of those who received vaccine against new influenza A (H1N1) virus. The most frequent AE were pain and general discomfort. None of the adverse effects was considered serious. Age and presence of an adjuvant in the vaccine were associated with appearance of AE after administration of vaccine against new influenza A (H1N1) virus. CONCLUSIONS: Vaccines against seasonal influenza and new influenza A (H1N1) are safe; frequency of AE related to this one was high, especially if it contained an adjuvant. Since none of the AE detected was serious, HCW can not justify his rejection of vaccination because of suffering the above-mentioned AE.
