Knowledge about the best practice guidelines in the nursing degree: A non-randomized post-test design.

AIM: To compare knowledge of Nursing Degree students about Best Practice Guidelines when there are included as teaching content in a subject vs knowledge through having the usual internship experience without teaching specific guidelines contents. DESIGN: Non-randomized post-test-only design with a comparison group. METHODS: 143 students of the nursing degree at the Autonomous University of Barcelona were recruited. The intervention group received a classroom training in three Best Practice Guidelines with Problem-Based Learning methodology. The comparison group only attended internship, without specific guidelines contents. Knowledge was evaluated with an ad hoc post intervention questionnaire. The information was collected between 2016 and 2018. RESULTS: The average score of knowledge was low, 5.1 out of 10, and differs between guides. The best results were obtained by the students with internships and that had consulted the guides on some occasions. Synchronized effort and leadership in Academia and Healthcare are needed to favour evidence-based practice. The combination of the consultation of the Best Practice Guidelines in theoretical learning combined with the practice, increases the knowledge of the Best Practice Guidelines and will favour the implementation of evidence-based practice. Some students were involved in questionnaire design.

Expert patients leading activities on social justice: towards patient-centered education.

BACKGROUND: Social justice is recognized by reputable international organizations as a professional nursing value. However, there are serious doubts as to whether it is embodied in Catalan nursing education. OBJECTIVES: To explore what nursing students take away from two teaching activities led by expert patients (one presentation and three expert patient illness narratives) on the topics of social justice, patient rights, and person-centered care. RESEARCH DESIGN: Qualitative study using a content analysis approach. The research plan included (1) think-pair-share activities (additional faculty-assisted presentation and three faculty-assisted, semi-structured scripted narratives); (2) paired reflections; (3) focus groups; and (4) content analysis of paired reflections and focus groups. PARTICIPANTS AND RESEARCH CONTEXT: Fourth-year nursing degree students at the Autonomous University of Barcelona (UAB), Spain. Convenience sampling was used. ETHICAL CONSIDERATIONS: The UAB Research Ethics Committee did not deem it necessary to apply any specific measures. We fully explained to patients that they could decide what medical information they would share with the students that was relevant to their learning, and we provided students with guidelines about patient confidentiality, dignity, and respect. FINDINGS/RESULTS: The students engaged in reflection about their education (recognizing that it had been centered on the professional and not the patient) and their relationship with the patient, in which they reproduced low-involvement patient care by modeling behaviors of their nurse educator. Moreover, they valued a person-centered care model with an emphasis on the emotional part but left out decision-making as an individual right of people. CONCLUSIONS: The think-pair-share activities were useful to spark self-reflection among students, who identified aspects to change in their own practice, and reflected about their own education process, both of which promote change.

Implementation of web-based respondent driven sampling in epidemiological studies.

BACKGROUND: Respondent-driven sampling (RDS) is a peer chain-recruitment method for populations without a sampling frame or that are hard-to-reach. Although RDS is usually done face-to-face, the online version (WebRDS) has drawn a lot of attention as it has many potential benefits, despite this, to date there is no clear framework for its implementation. This article aims to provide guidance for researchers who want to recruit through a WebRDS. METHODS: Description of the development phase: guidance is provided addressing aspects related to the formative research, the design of the questionnaire, the implementation of the coupon system using a free software and the diffusion plan, using as an example a web-based cross-sectional study conducted in Spain between April and June 2022 describing the working conditions and health status of homecare workers for dependent people. RESULTS: The application of the survey: we discuss about the monitoring strategies throughout the recruitment process and potential problems along with proposed solutions. CONCLUSIONS: Under certain conditions, it is possible to obtain a sample with recruitment performance similar to that of other RDS without the need for monetary incentives and using a free access software, considerably reducing costs and allowing its use to be extended to other research groups.

Exploring the Decision-Making Process of People Living with HIV Enrolled in Antiretroviral Clinical Trials: A Qualitative Study of Decisions Guided by Trust and Emotions.

The informed consent is an ethical and legal requirement for potential participants to enroll in a study. There is ample of evidence that understanding consent information and enrollment is challenging for participants in clinical trials. On the other hand, the reasoning process behind decision-making in HIV clinical trials remains mostly unexplored. This study aims to examine the decision-making process of people living with HIV currently participating in antiretroviral clinical trials and their understanding of informed consent. We conducted a qualitative socio-constructivist study using semi-structured interviews. Eleven participants were selected by purposive sampling in Argentina until data saturation was reached. A content analysis was performed. The findings highlight the fact that some participants decided to enroll on the spot, while others made the decision a few days later. In all cases, the decision was based on different aspects of trust (in doctors, in the clinical research site, in the clinical trials system) but also on emotions associated with HIV and/or treatment. Moreover, while people living with HIV felt truly informed after the consent dialogue with a researcher, consent forms were unintelligible and unfriendly. The immediacy of patient decision-making has rarely been described before. Enrollment in an HIV clinical trial is mainly a trust-based decision but this does not contradict the ethical values of autonomy, voluntariness, non-manipulation, and non-exploitation. Thus, trust is a key issue to be included in reshaping professional practices to ensure the integrity of the informed consent process.

Assessing the Underestimation of HIV Risk Infection among Young Men Who Have Sex with Men in Argentina.

The aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5-11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161-121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1-3.5]) and using LSD (aOR = 5.44 [CI 95:1.32-30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.

Knowledge, Perceptions, Attitudes and Practices of Midwives Regarding Maternal Influenza and Pertussis Vaccination: A Qualitative Study.

The coverage of maternal vaccination against pertussis and, particularly, influenza is lower than expected. The lack of recommendation from healthcare providers conditions non-vaccination in pregnant women. The purpose was to determine the knowledge, perceptions, attitudes and practices of midwives regarding maternal influenza and pertussis vaccination. A qualitative descriptive study based on semi-structured, face-to-face interviews with seventeen midwives was conducted, including purposive sampling and thematic analyses. Midwives had disparate knowledge and perceptions about the severity of influenza and pertussis in pregnant women, and influenza was not considered very serious. The vaccines were generally considered safe. However, because midwives did not have enough information about the safety of the influenza vaccine, there was a tendency not to recommend it. While most midwives had a positive attitude toward vaccination, their advocation for vaccination against influenza was not as clear as it was for pertussis. Not wanting to influence the decision and assuming an informative-facilitating role also led providers to recommend the influenza vaccine less frequently. Midwives are among the main sources of professional advice for pregnant women. Addressing their understanding and professional practices regarding maternal vaccination is key to change the attitude of pregnant women and thus increase vaccine uptake among them, particularly for influenza.

Transformative learning experience among nursing students with patients acting as teachers: Mixed methods, non-randomized, single-arm study.

AIM: To examine the effects of expert HIV patients acting as teachers to Spanish nursing students both on their HIV-related knowledge, attitudes and practices and on their approach to the care model as well as to explore their learning experience. DESIGN: Non-randomized, single-arm study with quantitative before and after measurements and qualitative data. METHODS: The intervention consisted of five 90-min workshops led by two women living with HIV. Thirty-four nursing students participated, and quantitative and qualitative data were gathered from February to June 2018. We used the Patient-Practitioner Orientation Scale (PPOS) and the KAP questionnaire on HIV/AIDS to collect quantitative data. RESULTS: Statistically significant differences were found in the global score for care orientation and its two dimensions, caring and sharing. About the changes resulting from the workshops, the quantitative results-more patient-centred care perception and better attitudes towards people living with HIV-match the qualitative findings in all the aspects studied, except in sharing. CONCLUSION: Incorporating expert patients as teachers in the nursing bachelor's degree resulted in more patient-centred care and improved knowledge, attitudes and practices. The workshops conducted by qualified expert patients showed transformative learning power, as the participants improved professional and personal aspects.

Relación entre exposición a riesgos psicosociales y salud: un estudio de cohorte mediante el COPSOQ-Istas21 / Relationship between psychosocial risks exposure and health: a cohort study using the COPSOQ-Istas21

Objetivo: Estimar las relaciones prospectivas entre la exposición a las dimensiones de riesgos psicosociales incluidas en el COPSOQ-Istas21 y el deterioro de la salud general, la salud mental y los problemas del sueño entre personas trabajadoras residentes en España. Método: Cohorte cuya línea base corresponde a la Encuesta de Riesgos Psicosociales de 2016, con una nueva medición al cabo de 1 año. Resultados: Las dimensiones de capital social y de relaciones interpersonales y liderazgo, así como el conflicto trabajo-vida, se relacionaron con todas las variables de salud. Las de organización y contenido del trabajo lo hicieron especialmente con la salud mental, las exigencias cuantitativas con la salud general y las emocionales con la salud mental. Las dimensiones relacionadas con la inseguridad laboral no mostraron relación con la salud. Conclusiones: Los resultados obtenidos refuerzan el papel del COPSOQ-Istas21 como un instrumento útil para la evaluación y la prevención de los riesgos psicosociales en el trabajo. (AU)

Objective: To estimate the prospective relationships between exposure to psychosocial risks dimensions included in the COPSOQ-Istas21 and the deterioration of general and mental health and sleep problems among workers residing in Spain. Method: Social capital and interpersonal relations and leadership dimensions, as well as work-Cohort whose baseline corresponds to the 2016 Psychosocial Risks Survey with a new measurement after one year. Results: life conflict, were related to all health variables. Dimensions of work organization and job contents did it especially with the mental health, the quantitative demands with the general health and the emotional ones with the mental health. The dimensions related to job insecurity did not show relationships with health. Conclusions: The results obtained reinforce the role of the COPSOQ-Istas21 as a useful instrument for the evaluation and prevention of psychosocial risks at work. (AU)

Influenza and Pertussis Maternal Vaccination Coverage and Influencing Factors in Spain: A Study Based on Primary Care Records Registry.

The purpose was to determine the coverage of maternal vaccination against influenza and pertussis, and the characteristics associated with being vaccinated, in a health area of Catalonia, Spain. Some 36,032 anonymized and computerized clinical records registries of pregnant women from Primary Care Centres (e-CAP database) were analysed, from between 2015 and 2018. Vaccination coverage and the association with sociodemographic variables and clinical conditions were estimated using a Poisson regression model. Maternal vaccination coverage against influenza ranged between 11.9% in 2015 and 6.8% in 2018, following a decreasing trend (p < 0.001). Coverage with the tetanus toxoid, diphtheria toxoid, and acellular pertussis vaccine varied between 49.8% in 2016 and 79.4% in 2018, following an increasing trend (p < 0.001). Having living children and suffering from obesity were factors associated with not being vaccinated against both infections. The predictive variables of vaccination against influenza were diabetes (IRR: 2.17, 95% CI: 1.42−3.30) and asthma (IRR: 2.05, 95% CI: 1.76−2.38); and for pertussis, it was asthma (IRR: 1.10, 95% CI: 1.03−1.17). Different socio-demographic factors and chronic conditions in pregnant women were associated with maternal vaccination, and which will have to be taken into account in clinical practice when implementing strategies to improve the coverage of the programme.

[Relationship between psychosocial risks exposure and health: a cohort study using the COPSOQ-Istas21]. / Relación entre exposición a riesgos psicosociales y salud: un estudio de cohorte mediante el COPSOQ-Istas21.

OBJECTIVE: To estimate the prospective relationships between exposure to psychosocial risks dimensions included in the COPSOQ-Istas21 and the deterioration of general and mental health and sleep problems among workers residing in Spain. METHOD: Cohort whose baseline corresponds to the 2016 Psychosocial Risks Survey with a new measurement after one year. RESULTS: Social capital and interpersonal relations and leadership dimensions, as well as work̶life conflict, were related to all health variables. Dimensions of work organization and job contents did it especially with the mental health, the quantitative demands with the general health and the emotional ones with the mental health. The dimensions related to job insecurity did not show relationships with health. CONCLUSIONS: The results obtained reinforce the role of the COPSOQ-Istas21 as a useful instrument for the evaluation and prevention of psychosocial risks at work.

Health outcomes and psychosocial risk exposures among healthcare workers during the first wave of the COVID-19 outbreak.

The aim is to describe the health and psychosocial risk factors of Spanish healthcare workers during the COVID-19 pandemic. METHODS: A cross-sectional study by means of an online questionnaire (April-May 2020). The data comes from the database resulting from the COTS project "Working conditions, insecurity, and health in the context of the COVID-19 pandemic". The sample consisted of 1989 health care workers. RESULTS: Women, young people (doctors and nurses) and the middle-aged (assistants) had poorer health and greater exposure to psychosocial risks. Geriatric assistants were the most-affected occupational group. CONCLUSIONS: gender, occupation, and age are focuses of inequality in the exposure of health care workers to psychosocial risks.

Understanding factors that influence the decision to be vaccinated against influenza and pertussis in pregnancy: A qualitative study.

AIMS AND OBJECTIVES: To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. BACKGROUND: Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient. DESIGN: We conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. METHODS: We carried out 18 semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. RESULTS: We identified an overarching theme, 'factors that influenced participants' decision to be vaccinated or not', which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants' decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests. CONCLUSIONS: The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women. RELEVANCE TO CLINICAL PRACTICE: Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse-midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns.

Emotion management and stereotypes about emotions among male nurses: a qualitative study.

BACKGROUND: Nursing requires a high load of emotional labour. The link between nursing, emotional labour and the female sex, complicates the figure of the male nurse, because masculinity is associated with physical or technical (rather than emotional) and moreover is defined in contrast to femininity. Our objective was to understand how emotion management is described by male nurses who work in the paediatrics department of a Spanish tertiary hospital. METHODS: Qualitative descriptive study. The participants were selected through intentional sampling in the paediatrics department of a Spanish tertiary hospital. We conducted semi-structured interviews until reaching data saturation. We carried out a content analysis, using Lincoln and Guba's definition of scientific rigour. RESULTS: We identified two key themes in the data: 1) Stereotypes related to the emotional aspects of care: Participants took for granted some gender stereotypes while questioning others and defended alternative ways of managing emotions related to care. 2) Emotion management strategies: Participants described keeping an emotional distance, setting boundaries, relativising problems and using distraction and humour. DISCUSSION: Nursing care is conditioned by gender roles and stereotypes that present men as less capable than women of feeling and managing emotions. However, emotion management is necessary in nursing care-especially in paediatrics-and our participants reported using strategies for it. Although participants continued to interpret care in terms of traditional roles, they contradicted them in adapting to the emotional labour that their job requires. CONCLUSIONS: New behaviours are emerging among male nurses, in which care and emotion management are not exclusively the purview of women. Our participants reproduced some gender stereotypes while disrupting others, and they tended to cling to the stereotypes that were favourable to them as male nurses. As we work towards a gender-neutral profession, these results represent a first step: male participants reported that they provide care and manage their emotions as well as (or better than) women. However, because they substantiated their claims by drawing on negative stereotypes of women, further progress must be made.

The Bachelor's thesis in nursing: Characteristics and students' approach and satisfaction.

AIM: The aim of the study was to describe the characteristics of the Bachelor's thesis of fourth-year nursing students at a Spanish public university, the criteria that students used to choose a topic and students' degree of satisfaction after completing the Bachelor's thesis. DESIGN: Quantitative study. METHODS: We examined 420 Bachelor's theses carried out from 2013 to 2018 and conducted an online survey among fourth-year students in the 2017-18 and 2018-19 academic years (81 completed questionnaires). RESULTS: The Bachelor's thesis took the form of a research proposal. The most frequent proposal type was a qualitative hospital-based study whose objective was to understand the experiences of adult or adolescent patients, close family members, or nurses. Students chose topics for personal reasons. Most participants reported feeling satisfied with the knowledge and skills acquired. CONCLUSIONS: Students completing a Bachelor's thesis in the form of a research proposal have the potential to transfer their research skills to their nursing practice.

Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power.

There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz's approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication.

Psychological Distress and Somatization in Immigrants in Primary Health Care Practices.

The process of international migration causes a situation of vulnerability in people's health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from four communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the primary care centers of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the Sub-Saharan community. Psychological distress showed a mean value of 0.66, with the Sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the Sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.

Cobertura vacunal frente a tos ferina en gestantes de Cataluña en el primer año de implantación del programa de inmunización / Vaccination coverage against pertussis in pregnant women of Catalonia in the first year of implementation of the immunisation program

Introducción: La reemergencia de la tos ferina y la gravedad de sus complicaciones en lactantes menores de 3 meses de edad determinó el inicio del programa de vacunación de las mujeres embarazadas en el tercer trimestre de gestación, en Cataluña en febrero del 2014, la primera comunidad autónoma que la introdujo de España. El objetivo del estudio fue estimar la cobertura del programa en su primer año de implementación. Métodos: Se analizaron de forma retrospectiva los registros médicos informatizados de los Centros de Atención Primaria de embarazadas atendidas en centros de Asistencia de Salud Sexual y Reproductiva del área Metropolita Nord de la provincia de Barcelona, dependientes del Institut Català de la Salut. Se estimó la cobertura global y según variables sociodemográficas de vacunación con dTpa de las mujeres que tenían registrado un parto de un recién nacido vivo entre agosto del 2014 y agosto del 2015. Resultados: Se registraron 6.697 partos de nacidos vivos y 1.713 mujeres embarazadas fueron vacunadas, lo que representó una cobertura global del 25,6% (IC del 95%: 24,1-26,1). La cobertura de vacunación fue mayor en las mujeres embarazadas menores de 18 años y las nativas (p=0,018 y p=0,036, respectivamente). Conclusión: La estimación de cobertura vacunal frente a tos ferina de embarazadas en el tercer trimestre de gestación, tras el primer año de implementación del programa en un área sanitaria de Cataluña, ha resultado inferior al objetivo marcado. Será necesario diseñar estrategias dirigidas a mejorar la cobertura del programa (AU)

Introduction: The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. Methods: A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015. Results: A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively). Conclusion: The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage (AU)

Vaccination coverage against pertussis in pregnant women of Catalonia in the first year of implementation of the immunisation program. / Cobertura vacunal frente a tos ferina en gestantes de Cataluña en el primer año de implantación del programa de inmunización.

INTRODUCTION: The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. METHODS: A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015. RESULTS: A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively). CONCLUSION: The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage.

Cost-benefit of the introduction of new strategies for vaccination against pertussis in Spain: cocooning and pregnant vaccination strategies.

BACKGROUND: Pertussis remains a public health problem in countries with high vaccination coverage. Classic vaccination approaches have failed to effectively control the infection. The incidence of pertussis hospitalizations in infants is high, especially in those younger than 3 months who are in high risk of a severe disease and death. Additional strategies are recommended for short-term protection of this vulnerable population. In this study, we estimated the impact of 2 strategies for pertussis prevention in infants younger than 1 year of age-a cocoon vaccination strategy and the vaccination of pregnant women (VPW)-and the cost-benefit of these approaches relative to the current vaccination policy in Spain. METHODS: A cost-benefit analysis was conducted from the perspective of the publically-funded Spanish healthcare system, based on the yearly number of hospitalizations during the period of 2009 to 2011. We calculated the absolute risk reduction, the number of parents that would need to be vaccinated to prevent 1 hospitalization or death in infants <1 year, and the net benefit-to-cost ratio of each strategy. RESULTS: From 2009 to 2011, the incidence of pertussis in Spain was 153.44 hospitalizations per 100,000 infants <1 year. The absolute risk reduction for hospitalization would be 42.1/100,000 with cocooning and 75.2/100,000 with VPW. The number of parents needed to vaccinate with the cocoon strategy to prevent 1 pertussis hospitalization would be 4752 and to prevent 1 death, more than 900,000. With VPW, 1331 pregnant women would have to be vaccinated to prevent 1 hospitalization and 200,000 to prevent 1 death. The benefit-to-cost ratio was 0.04 for cocooning and 0.15 for VPW.

Hospitalización por tos ferina en España (1997-2011) / Hospitalization due to whooping cough in Spain (1997-2011)

INTRODUCCIÓN: La tos ferina ha aumentado su incidencia en los últimos años en países con elevadas coberturas de vacunación. El objetivo del estudio ha sido conocer el impacto sanitario de la tos ferina en España en el período 1997-2011 en relación con hospitalizaciones, la mortalidad y los costes asociados. MÉTODOS: Se analizaron de forma retrospectiva las altas hospitalarias incluidas en el Conjunto Mínimo Básico de Datos (CMBD) en España del periodo 1997-2011, con diagnóstico principal o secundarios relacionados con tos ferina. Se calcularon las tasas de incidencia de hospitalización por tos ferina (por 100.000 habitantes) por año, por grupo de edad y por comunidad autónoma, así como las tasas de mortalidad y de letalidad. RESULTADOS: Entre 1997 y 2011 se registraron en España 8.331 altas hospitalarias con diagnóstico de tos ferina. La incidencia global de hospitalizaciones por tos ferina fue de 1,3 casos por 100.000 habitantes. El 92% de las hospitalizaciones correspondieron a niños menores de un año de edad, con una incidencia de 115,2 hospitalizaciones por 100.000 nacidos. Se registraron 47 defunciones, 37 (79%) en el grupo de menores de un año y 6 (13%) en el grupo de mayores de 65 años. El coste estimado de una hospitalización por tos ferina fue de 1.841 euros. CONCLUSIÓN: La epidemiología de los casos graves de tos ferina y su impacto clínico y económico confirman la necesidad de modificar las estrategias de vacunación en España para lograr un control más efectivo en los grupos más vulnerables

INTRODUCTION: Pertussis incidence has increased in recent years in countries with high vaccination coverage. The aim of this study was to determine the health impact of pertussis in Spain in the period 1997-2011 in relation to hospitalizations, mortality, and associated costs. METHODS: We retrospectively analyzed hospital discharges included in the Minimum Data Set (MDS) in Spain for the period 1997-2011, with a primary or secondary diagnosis related to pertussis. We calculated incidence rates of hospitalization for pertussis (per 100,000) per year, by age group and by Autonomous Region, along with the mortality and lethality rates. RESULTS: A total of 8,331 hospital discharges with a diagnosis of pertussis were recorded in Spain between 1997 and 2011. The overall incidence of pertussis hospitalizations was 1.3 cases per 100,000 inhabitants. The large majority (92%) of hospitalizations occurred in children under one year of age, with an incidence of 115.2 hospitalizations per 100,000. There were 47 deaths, 37 (79%) in the group of children under 1 year and 6 (13%) in the group older than 65 years. The estimated cost of hospitalization for pertussis was 1,841 euros. CONCLUSION: The epidemiology of severe cases of pertussis, and its clinical and economic impact, confirms the need to modify the vaccination strategies for Spain to achieve more effective control in the most vulnerable groups