[Risk factors of influenza (H1N1) 2009 hospitalization and effectiveness of pharmaceutical and nonpharmaceutical interventions in its prevention: a case-control study]. / Factores de riesgo de hospitalización por gripe (H1N1) 2009 y efectividad de intervenciones farmacológicas y no farmacológicas en su prevención: Estudio de casos y controles.

Potentially useful pharmaceutical measures to limit the impact of pandemic influenza in the community include antiviral drugs (neuraminidase inhibitors) and the influenza and pneumococcal vaccines, as influenza predisposes to bacterial pneumonia caused by Streptococcus pneumoniae. Non-pharmaceutical measures include hand washing and respiratory hygiene. Due to the lack of knowledge of the effectiveness of these measures in a pandemic situation, in September 2009, CIBER de Epidemiología y Salud Pública presented a multicenter case-control study, with controls matched for age, hospital and date of hospitalization, to investigate these aspects in 37 hospitals in 7 Spanish autonomous communities, in response to the call for research projects by the Ministry of Science and Innovation Research Program on Influenza A (H1N1) in Spain. For each confirmed hospitalized case of pandemic influenza, 1 confirmed outpatient case and 3 controls (2 hospitalized and 1 outpatient) were selected. Demographic variables, underlying medical conditions, use of antiviral agents, vaccines received and hygiene habits were collected for all cases and controls. In hospitalized cases, information on antiviral therapy and disease progression was collected. A total of 3750 patients were recruited by October 2010. Data cleansing and the recovery of variables is now underway. The involvement of the Public Health Directorate has been instrumental in adapting the project to the evolution of the pandemic.

Factores de riesgo de hospitalización por gripe (H1N1) 2009 y efectividad de intervenciones farmacológicas y no farmacológicas en su prevención. Estudio de casos y controles / Risk factors of influenza (H1N1) 2009 hospitalization and effectiveness of pharmaceutical and nonpharmaceutical interventions in its prevention. A case-control study

Entre las medidas farmacológicas de posible utilidad para limitar el impacto de las pandemias gripales en la comunidad están los fármacos antivirales (inhibidores de la neuraminidasa) y las vacunas antigripales y antineumocócicas, ya que la gripe predispone a la neumonía bacteriana por Streptococcus pneumoniae. Entre las medidas no farmacológicas destacan la higiene de manos y la higiene respiratoria. La falta de conocimiento de la efectividad de dichas medidas en situación de pandemia justifica que en septiembre de 2009, ante la solicitud de proyectos de investigación por parte del Ministerio de Ciencia e Innovación en su Programa de Investigación sobre la gripe (H1N1) 2009 en España, el CIBER de Epidemiología y Salud Pública presentara un proyecto multicéntrico de casos y controles emparejados por edad, hospital y fecha de hospitalización para investigar sobre estos aspectos en 37 hospitales de 7 comunidades autónomas. Por cada caso hospitalizado confirmado de gripe pandémica se seleccionaba 1 caso confirmado ambulatorio y 3 controles (2 hospitalarios y 1 ambulatorio). En los casos y en los controles se recogían variables demográficas, condiciones médicas subyacentes, utilización de antivirales, vacunas recibidas y hábitos de higiene. En los casos hospitalizados se recogieron, además, información relativa al tratamiento antiviral y evolución de la enfermedad. Hasta octubre 2010 se habían reclutado un total de 3.750 pacientes y se está realizando la depuración de los datos y la recuperación de variables. La implicación de las Direcciones Generales de Salud Pública ha sido fundamental para la adecuación del proyecto a la evolución de la pandemia(AU)

Potentially useful pharmaceutical measures to limit the impact of pandemic influenza in the community include antiviral drugs (neuraminidase inhibitors) and the influenza and pneumococcal vaccines, as influenza predisposes to bacterial pneumonia caused by Streptococcus pneumoniae. Non-pharmaceutical measures include hand washing and respiratory hygiene. Due to the lack of knowledge of the effectiveness of these measures in a pandemic situation, in September 2009, CIBER de Epidemiología y Salud Pública presented a multicenter case-control study, with controls matched for age, hospital and date of hospitalization, to investigate these aspects in 37 hospitals in 7 Spanish autonomous communities, in response to the call for research projects by the Ministry of Science and Innovation Research Program on InfluenzaA(H1N1) in Spain. For each confirmed hospitalized case of pandemic influenza, 1 confirmed outpatient case and 3 controls (2 hospitalized and 1 outpatient) were selected. Demographic variables, underlying medical conditions, use of antiviral agents, vaccines received and hygiene habits were collected for all cases and controls. In hospitalized cases, information on antiviral therapy and disease progression was collected. A total of 3750 patients were recruited by October 2010. Data cleansing and the recovery of variables is now underway. The involvement of the Public Health Directorate has been instrumental in adapting the project to the evolution of the pandemic(AU)

Waiting time for cataract extraction: Predictive factors and influence on outcomes.

PURPOSE: To identify variables related to time spent on a waiting list for cataract extraction and the effect of waiting time on some outcomes. SETTING: Twelve ophthalmology units throughout Spain. DESIGN: Cohort study. METHODS: This study included consecutive patients scheduled to have cataract removal by phacoemulsification. Sociodemographic and clinical data, including visual acuity, and Visual Function Index 14 (VF-14) results were collected before and after cataract extraction. Univariate and multivariate linear regression was performed to identify variables related to time on the waiting list for cataract extraction and the influence of waiting time on postoperative visual acuity, visual function, and complications. RESULTS: The study comprised 3787 patients. Patients with social support spent significantly more time (1.04 times) on the waiting list (P = .0188), while those with contralateral visual acuity better than 0.5 and those with vision-related daily living difficulties spent less time on the waiting list. Patients who waited longer than 5 months for cataract extraction had smaller gains in visual acuity than those who waited fewer than 3 months (P = .0348). Time on the waiting list did not significantly influence changes in the VF-14 results or complications from surgery. CONCLUSIONS: The finding that some contradictory sociodemographic factors influence time spent on a waiting list for cataract extraction suggests that rational, explicit, and homogeneous appropriateness and priority criteria are not being applied to these patients. Use of such criteria could improve waiting times and order waiting lists so patients who need cataract extraction the most would receive it soonest. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Effect of hospital on variation in visual acuity and vision-specific quality of life after cataract surgery.

OBJECTIVE: To evaluate the contribution of hospital-to-hospital variability in changes in clinical and health-related quality of life outcomes among patients undergoing cataract extraction by phacoemulsification. METHODS: Prospective observational study of 14 public hospitals. We recruited consecutive patients on waiting lists for cataract extraction. Clinical data were collected prior to the intervention and 6 weeks afterward. Subjects completed the visual function index (VF-14) prior to the procedure and 3 months afterward. Univariate and multivariate analysis were performed for visual acuity and VF-14 scores. RESULTS: Substantial differences were observed across the 14 hospitals. At baseline, mean visual acuity ranged from 0.16 to 0.34, and mean VF-14 scores ranged from 48.06 to 75.89. Following cataract extraction, the mean improvement in visual acuity ranged from 0.35 to 0.57 and in VF-14 scores from 10.94 to 41.70. The ranges were even more pronounced among patients with low visual acuity or low VF-14 scores prior to the intervention. Significant differences remained in multivariate analysis. Within the multivariate analysis, the variable 'hospitals' had an R(2) of 0.069 for the visual acuity model and of 0.073 for the VF-14 model, 20% and 13%, respectively, of the total variability explained. Variation was also observed within geographic regions. CONCLUSIONS: Outcomes of patients undergoing cataract extractions vary widely from hospital to hospital, even within the same geographic region, explaining an important part of the results. Quality improvement efforts should concentrate on patients with low pre-intervention visual acuity or vision-related disability to reduce this variability in outcomes.

Individual and occupational risk factors for knee osteoarthritis: results of a case-control study in Germany.

INTRODUCTION: A number of occupational risk factors are discussed in relation to the development and progress of knee joint diseases (for example, working in a kneeling or squatting posture, lifting and carrying heavy weights). Besides the occupational factors, a number of individual risk factors are important. The distinction between work-related and other factors is crucial in assessing the risk and in deriving preventive measures in occupational health. METHODS: In a case-control study, patients with and without symptomatic knee osteoarthritis (OA) were questioned by means of a standardised questionnaire complemented by a semi-standardised interview. Controls were matched and assigned to the cases by gender and age. Conditional logistic regression was used in analysing data. RESULTS: In total, 739 cases and 571 controls were included in the study. In women and men, several individual and occupational predictors for knee OA could be described: obesity (odds ratio (OR) up to 17.65 in women and up to 12.56 in men); kneeling/squatting (women, OR 2.52 (>8,934 hours/life); men, 2.16 (574 to 12,244 hours/life), 2.47 (>12,244 hours/life)); genetic predisposition (women, OR 2.17; men, OR 2.37); and sports with a risk of unapparent trauma (women, OR 2.47 (>or=1,440 hours/life); men, 2.58 (>or=3,232 hours/life)). In women, malalignment of the knee (OR 11.54), pain in the knee already in childhood (OR 2.08), and the daily lifting and carrying of loads (>or=1,088 tons/life, OR 2.13) were related to an increased OR; sitting and smoking led to a reduced OR. CONCLUSIONS: The results support a dose-response relationship between kneeling/squatting and symptomatic knee OA in men and, for the first time, in women. The results concerning general and occupational predictors for knee OA reflect the findings from the literature quite well. Yet occupational risks such as jumping or climbing stairs/ladders, as discussed in the literature, did not correlate with symptomatic knee OA in the present study. With regards to occupational health, prevention measures should focus on the reduction of kneeling activities and the lifting and carrying of loads as well as general risk factors, most notably the reduction of obesity. More intervention studies of the effectiveness of tools and working methods for reducing knee straining activities are needed.

Decision trees for indication of cataract surgery based on changes in visual acuity.

OBJECTIVE: To develop decision trees based on prospectively collected data for determining the appropriateness of cataract extraction. DESIGN: Prospective observational cohort study. PARTICIPANTS: Consecutive patients with a diagnosis of cataract who are on waiting lists to undergo cataract extraction by phacoemulsification. METHODS: Patients were randomly assigned to 1 of 2 independent cohorts: The derivation cohort included 3691 patients, and the validation cohort included 2416 patients. Sociodemographic and clinical data, including visual acuity (VA) and the Visual Function Index 14 (VF-14), were collected before and after cataract extraction. Univariate and multivariate linear regression, and regression trees analysis were performed in the derivation cohort. Decision trees obtained in the derivation cohort were validated in the validation cohort. Final results were divided into appropriate or inappropriate indications and compared with a previously established benchmark of desirable VA and VF-14 gain in relation to preintervention VA classes. MAIN OUTCOME MEASURES: Preintervention VA and changes 6 weeks after the intervention. RESULTS: Among patients with simple cataract, predictors of significant improvement in VA after cataract extraction were preintervention VA and negative surgical complexity. Among patients with cataract and other ocular comorbidity, preintervention visual function and expected postintervention VA also predicted change in VA. When compared with a benchmark based on the minimal clinically important difference in VA after cataract extraction, sensitivity for the decision trees was 83% for both diagnostic groups and specificities ranged from 36.2 to 54.8. CONCLUSIONS: A simple decision tree based on changes in VA can help identify appropriate patients for cataract extraction and be used to evaluate clinical practice or for quality control.

Can an appropriateness evaluation tool be used to prioritize patients on a waiting list for cataract extraction?

OBJECTIVES: To determine whether a system originally developed to ascertain the appropriateness of cataract intervention may also be used to prioritize patients on cataract extraction waiting lists. METHODS: The IRYSS-appropriateness of indication for cataract surgery tool and the IRYSS-Cataract Priority Score were applied to a sample of 5448 patients consecutively placed on waiting lists for cataract surgery. Clinical data were gathered by ophthalmologists, and patients self-completed the Visual Function Index-14. The general linear model (GLM) was used to assign scores to the categories of the appropriateness and priority criteria. The relationship between both systems was evaluated by correlating scores. To assess the validity of the new appropriateness and priority scores, correlations with visual acuity (VA) and visual function were calculated. RESULTS: The GLM method generated highly similar scores for both appropriateness and prioritization systems. The correlation between scores was very strong (r=0.96). The appropriateness scoring system correlated 0.29 with VA and 0.21 with gain in visual function. The priority system correlated -0.54 with VA and -0.28 with preintervention visual function. CONCLUSIONS: The new appropriateness scoring system strongly correlates with the priority scoring system. This easy-to-use appropriateness rating could serve as a tool for simultaneously assessing the appropriateness of cataract surgery and assigning priority.