Waning protection of influenza vaccination during four influenza seasons, 2011/2012 to 2014/2015.

BACKGROUND: Concerns have been raised about intraseasonal waning of the protection conferred by influenza vaccination. METHODS: During four influenza seasons, we consecutively recruited individuals aged 18years or older who had received seasonal influenza vaccine and were subsequently admitted to the hospital for influenza infection, asassessed by reverse transcription polymerase chain reaction. We estimated the adjusted odds ratio (aOR) of influenza infection by date of vaccination, defined by tertiles, as early, intermediate or late vaccination. We used a test-negative approach with early vaccination as reference to estimate the aOR of hospital admission with influenza among late vaccinees. We conducted sensitivity analyses by means of conditional logistic regression, Cox proportional hazards regression, and using days between vaccination and hospital admission rather than vaccination date. RESULTS: Among 3615 admitted vaccinees, 822 (23%) were positive for influenza. We observed a lower risk of influenza among late vaccinees during the 2011/2012 and 2014/2015A(H3N2)-dominant seasons: aOR=0.68 (95% CI: 0.47-1.00) and 0.69 (95% CI: 0.50-0.95). We found no differences in the risk of admission with influenza among late versus early vaccinees in the 2012/2013A(H1N1)pdm09-dominant or 2013/2014B/Yamagata lineage-dominant seasons: aOR=1.18 (95% CI: 0.58-2.41) and 0.98 (95% CI: 0.56-1.72). When we restricted our analysis to individuals aged 65years or older, we found a statistically significant lower risk of admission with influenza among late vaccinees during the 2011/2012 and 2014/2015A(H3N2)-dominant seasons: aOR=0.61 (95% CI: 0.41-0.91) and 0.69 (95% CI: 0.49-0.96). We observed 39% (95% CI: 9-59%) and 31% (95% CI: 5-50%) waning of vaccine effectiveness among participants aged 65years or older during the two A(H3N2)-dominant seasons. Similar results were obtained in the sensitivity analyses. CONCLUSION: Waning of vaccine protection was observed among individuals aged 65years old or over in two A(H3N2)-dominant influenza seasons.

Trends in gastrointestinal bleeding in the Region of Valencia (2000-2005). Relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medication

Objective Describe 2000-2005 time trends of prescription for NSAIDs, proton pump inhibitors (PPIs) and hospital admissions for gastrointestinal (GI) bleeding. Methods Time series analysis of gastrointestinal (GI) bleeding admission and drugs’ Defined Daily Dose per 1000 people per day (DDD/1000/day) in the Region of Valencia, Spain, from January 2000 to December 2005.ResultsDispensation of NSAIDs went from 42.7 DDD/1000 people/day in 2000 to 58.3 DDD/1000 people/day in 2005. During the same period, dispensation of PPIs went from 26.3 DDD/1000 people/day to 68.5 DDD/1000 people/day (both are statistically significant). The rate of hospitalisations for gastrointestinal bleeding during this period oscillated between 142 and 126 admission per 100 000 inhabitants/year. No year showed significant differences compared to 2000.ConclusionA substantial increase in the NSAID use from 2000 to 2005 was not accompanied by changes in GI bleeding hospitalisation rates in Valencia, but GI bleeding rates continued to be high, suggesting a need to improve NSAIDs use (AU)

Objetivo Describir las tendencias temporales durante el periodo 2000-2005 de la prescripción de AINE, inhibidores de la bomba de protones (IBP) y los ingresos hospitalarios por hemorragia gastrointestinal (GI).Métodos Análisis de series cronológicas de ingresos por hemorragia GI y de las dosis diarias definidas (DDD) de medicamento por cada 1.000 personas y día (DDD/1.000/día) en la Comunidad Valenciana desde enero de 2000 hasta diciembre de 2005.ResultadosLa dispensación de AINE ha aumentado desde 42,7 DDD/1.000/día en 2000 a 58,3 DDD/1.000/día, y la de IBP pasó de 26,3 DDD/1.000/día a 68,5 DDD/1000/día (ambos son cambios estadísticamente significativos). La tasa de ingresos por hemorragias GI durante este periodo pasó de 142 a 126 por cada 100.000 habitantes/año. En relación a 2000, ninguno de los años analizados muestra diferencias significativas. Conclusiones El aumento sustancial del uso de AINEs entre 2000 y 2005 no se vio acompañado de cambios en la tasa de ingresos hospitalarios en Valencia, pero la tasa de hemorragias GI siguieron siendo altas, lo que sugiere que es necesario mejorar la utilización de los AINE (AU)

Trends in gastrointestinal bleeding in the Region of Valencia (2000-2005). Relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medication.

OBJECTIVE: To describe 2000-2005 time trends of prescription for NSAIDs, proton pump inhibitors (PPIs) and hospital admissions for gastrointestinal (GI) bleeding. METHODS: Time series analysis of gastrointestinal (GI) bleeding admission and drugs' Defined Daily Dose per 1000 people per day (DDD/1000/day) in the Region of Valencia, Spain, from January 2000 to December 2005. RESULTS: Dispensation of NSAIDs went from 42.7 DDD/1000 people/day in 2000 to 58.3 DDD/1000 people/day in 2005. During the same period, dispensation of PPIs went from 26.3 DDD/1000 people/day to 68.5 DDD/1000 people/day (both are statistically significant). The rate of hospitalisations for gastrointestinal bleeding during this period oscillated between 142 and 126 admission per 100 000 inhabitants/year. No year showed significant differences compared to 2000. CONCLUSION: A substantial increase in the NSAID use from 2000 to 2005 was not accompanied by changes in GI bleeding hospitalisation rates in Valencia, but GI bleeding rates continued to be high, suggesting a need to improve NSAIDs use.

[Avoidable hospitalization using ambulatory surgery in the Community of Valencia: a Delphi study]. / Hospitalizaciones evitables por cirugía sin ingreso en la Comunidad Valenciana: un estudio Delphi.

BACKGROUND: To estimate the number of hospital admittance's avoidable by means of ambulatory surgery, according to surgeons and anaesthetists who currently work with the National Health System (NHS). METHOD: By means of a Delphi procedure of 25 surgeons or anaesthetists of the Valencia Health Survey (AServei Valencià de la Salut-SVS), a consensus was reached as to the objective criteria for excluding patients that could be treated outside a hospital and the percentage of certain operations that could be performed under day surgery. These criteria were applied to the Minimum Basic Data Set on hospital discharge within the Autonomous Region of Valencia in order to estimate the figure of hospital admittance and stays avoidable by means of ambulatory surgery in a selection of 29 surgery processes. RESULTS: 83% of medical personnel responded to the Delphi questionnaires. The median of the surveyed group's estimation on the proportion of cases that could be treated by means of external surgery varied from 40% for abdomen wall hernias or laparoscopic cholecystectomy and 90% for perianal tissue excision, anastomosis for dialysis or ganglionectomy. Application of the results of the Delphi survey would have meant that the SVS could have avoided 12,558 admittances in 1994, 75% of the operations surveyed, which is almost the same figure resulting from applying the medical personnel's opinion of the CMBD. CONCLUSIONS: SVS professionals consider it feasible to perform a much higher number of ambulatory operations than those currently carried out, and that it is likely that the causes for the lack of such operations lie in SNS financing and incentive criteria, rather than medical issues.

[Validity of the municipality of residence in mortality statistics: findings based on municipality census update in 2 municipalities of the Valencian community]. / La validez del municipio de residencia en las estadísticas de mortalidad: hallazgos a partir de la actualización de los padrones municipales en dos municipios de la comunidad Valenciana.

This study was designed to assess the validity of the variable "city of residence" in mortality statistics in relation to the information available in municipal census. Monthly record-linkages between mortality register and two municipal population census corresponding to the period 1991-1992 have been studied. The population census belong to Benidorm, an important Spanish coastal tourist centre, and Alcoi, a traditional industrial city. Results show that of those listed in the Alcoi mortality statistics (602 deaths), 83% were registered in its municipal population census. In Benidorm (282 deaths), this percentage was 54%; in this last city, having a private address (in contrast with hotel, apartment or clinic address...) was positively related with being registered (66.2% versus 8.8%). Likewise, deceased with Spanish names were in more likely to be registered names in municipal population census: 70.2% versus 11.9%, respectively. The evidence obtained shows that tourist area mortality statistics could be unreliable due to the incorrect reporting of the city of residence on the death certificate, and suggests actions to improve it, which should take into account the town authorities and funeral services.

[An analysis of mortality in small areas: the problem of residency]. / Análisis de la mortalidad en áreas pequeñas: el problema de la residencia.

This study was designed to assess the influence of residence misclassification in small areas mortality analysis. Data from a health area in the Valencian Community, which has high mortality from coronary diseases (ICD410-414) has been used. Deaths occurred during 1988 (n = 190) have been divided, using the information reported in the Boletín Municipal de Defunción in two groups: with (n = 109) and without (n = 81) private residence in the area. The Standardized Mortality Ratio (SMR) for the studied diseases was 219.8 (CI 95%: 257.6; 182) for males and 174.8 (CI 95%: 218.7; 130.9) for females. When deaths of persons without residence in the area subtracted from the numerator a change in the SMRs is observed to 120.8 (CI 95%: 149.3; 92.3) in males and 135.9 (CI 95%: 175; 96.2) in females. The excess in coronary heart diseases observed in the area could be partially explained by the "Benidorm-Effect" produced by an important volume of foreign residents with a high risk of dying from these diseases which are not included in the area census.

[Statistics on medical cause of death: historical coordinates, current tools]. / Las estadisticas de causa medica de muerte: coordenadas historicas, herramientas actuales.

"This work places the production of death causes statistics and its problems in the 19th century, with the appearance of modern statistics....[The author discusses ways] to make the most of the information being analyzed (studies of multiple causes), to improve the quality of medical performance, and to eliminate the variability produced by the codification process." (SUMMARY IN ENG AND FRE)