Pathway towards an ideal and sustainable framework agreement for the public procurement of vaccines in Spain: a multi-criteria decision analysis.

Objective: To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods: A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results: Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions: Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.

Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE / Costs resulting from premature mortality due to cardiovascular causes: a 20-year follow-up of the DRECE study

Objetivos. Las enfermedades cardiovasculares permanecen todavía como la principal causa de muerte en España. El estudio Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) se basa en una cohorte representativa de la población general española en la que se analizan los hábitos nutricionales y de vida estudiando su asociación con los patrones de morbimortalidad. Hemos estimado el impacto, en términos de pérdida de productividad, de la mortalidad prematura atribuida a las enfermedades cardiovasculares. Métodos. La pérdida de productividad atribuida a mortalidad prematura se calculó desde 1991, basándose en los años de vida y de vida laboral potencialmente perdidos. Resultados. Durante el seguimiento de 20años de una cohorte de 4.779 sujetos se produjeron 225 fallecimientos (hombres, 152). El 16% de las defunciones se atribuyó a enfermedades cardiovasculares. Los costes por pérdidas de productividad por mortalidad prematura superaron los 29 millones de euros. De ellos, 4 millones de euros (14% del coste total) se debieron a causas cardiovasculares. Conclusiones. La mortalidad prematura cardiovascular en la cohorte DRECE ha supuesto un importante coste social por pérdidas de productividad laboral (AU)

Objectives. Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. Methods. The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. Results. During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. Conclusions. Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity (AU)

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

Factores determinantes de plomo en sangre en niños de 7-8 años de la Comunidad de Madrid / Determinant factors of blood lead levels in children of 7-8 years old in the Autonomous Community of Madrid, Spain

Fundamento: El plomo es un metal pesado toxico. La exposición al mismo se ha visto reducida por la prohibición de las gasolinas con plomo, y hoy en día son más relevantes otras fuentes, como el agua de bebida. El objeto de este estudio es determinarlos niveles de plomo en sangre que presentan los niños de segundo curso de Educación Primaria que residen en la Comunidad de Madrid, y establecer la relación entre dichos niveles y la concentración de plomo en el agua de bebida que ingieren. Métodos: Estudio transversal, para el que se seleccionaron 515 niños de 23 colegios públicos y/o concertados de la Comunidad de Madrid. Los niños de cada colegio eran trasladados en autobus a un centro hospitalario, donde se procedía a una extracción sanguínea y a una exploración clínica basica. Los padres rellenaban una encuesta autocumplimentada y recogían una muestra de agua del domicilio, siguiendo unas directrices determinadas. También se muestreo el agua del colegio. Resultados: Los valores de plomo en sangre de los niños se situaron entre 1,0 y 11,5 ƒÊg/dL, con una media geométrica de3,8 ƒÊg/L (con una desviación estandar de 0,1). Los niveles de plomo en sangre estuvieron asociados de forma significativa a la edad, a ciertos hábitos de oralidad, al sector de trabajo de los padres, al consumo de tabaco de las madres, a la ubicación geográfica y la antigüedad de las viviendas, y a la presencia de mascotas en el domicilio. Conclusiones: La concentración de plomo en sangre en los niños de la Comunidad de Madrid presento una media geométrica de 3,8 !g/dL, nivel que se situá por debajo de los 10 !g/dL definidos por los Centers for Diseases Control and Prevention. Dos niños tuvieron niveles de 11,5 ƒÊg/dL. Resulta significativa la relación existente entre el plomo en sangre, el consumo del agua de bebida y otras variables sociodemograficas (AU)

Background: Lead is a toxic heavy metal. Exposure to it has been reduced by the ban on leaded petrol and, now, other sources such as drinking water are more relevant. The aims of this study are to determine the blood lead levels of children in the second year of primary education living within the Autonomous Community of Madrid, and to establish the relationship between these levels and the lead concentration in the drinking water consumed by the children. Methods: A cross-sectional study including 515 children selected from public primary schools and those private ones that received partial public funding in the Autonomous Community of Madrid. The children of each primary school were transferred by bus to a hospital, where blood collection and a basic clinical examination were carried out. Parents filled out a self-completion questionnaire and, following certain guidelines, collected a water sample from home. Water samples were also taken at each primary school. Results: The values for the blood lead levels of the children ranged between 1.0 ƒÊg/dL and 11.5 ƒÊg/dL, with a geometric mean of 3.8 ƒÊg/dL (standard deviation: 0.1 ƒÊg/L). Blood lead levels were significantly associated with age, certain oral habits, business sector of the father, smoking by the mother, geographical location and age of the family residence, and the presence of certain pets. Conclusions: The geometric mean of blood lead concentrations in children in the Autonomous Community of Madrid is 3.8 !g/dL, below that of 10 !g/dL defined by the Centers for Disease Control. Two children had levels of 11.5 ƒÊg/dL. The relationship between the blood lead level, consumption of drinking water and other socioeconomic factors is statistically significant (AU)

La financiación de los tratamientos farmacológicos del tabaquismo, ¿es, realmente, un problema? / Financing smoking cessation treatments. Is it really a problem?

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Plan Regional de Prevención y Control del Tabaquismo. Dos años de experiencia / Regional Plan of Prevention and Control of Smoking. Two years of experience (2005-2006)

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