Three double-dose reinforced hepatitis B revaccination scheme for patients with cirrhosis unresponsive to the standard regimen: an open-label randomised clinical trial.

OBJECTIVE: We aimed to compare the response rates between two different hepatitis B virus vaccination schedules for cirrhotic subjects who were non-responders to the first three 40 µg doses (month 0-1-2), and identify factors associated with the final response. DESIGN: A total of 120 cirrhotic patients (72.5% decompensated) were randomised at a 1:1 ratio to receive a single 40 µg booster vaccination at month 6 (classical arm) versus an additional round of three new 40 µg doses administered at monthly intervals (experimental arm). The main outcome was the rate of postvaccinal anti-hepatitis B surface antibodies levels ≥10 mIU/mL. RESULTS: Efficacy by ITT analysis was higher in the experimental arm (46.7%) than in the classical one (25%); OR 2.63, p=0.013. The experimental arm increased response rates compared with the classical one from 31% to 68% (OR 4.72; p=0.007), from 24.4% to 50% (OR 3.09; p=0.012) and from 24.4% to 53.8% (OR 3.62; p=0.007), in Child A, Model for End-Stage Liver Disease (MELD) <15 and MELD-Na<15 patients, respectively. Patients with more advanced liver disease did not benefit from the reinforced scheme. Both regimens showed similar safety profiles. Multivariable analysis showed that the experimental treatment was independently response associated when adjusted across three logistic regression models indicating equivalent cirrhosis severity. CONCLUSION: For cirrhotic patients, the revaccination of non-responders to the first three dose cycle, with three additional 40 µg doses, achieved significantly better response rates to those obtained with an isolated 40 µg booster dose. TRIAL REGISTRATION NUMBER: NCT01884415.

Estudio sobre la utilización y adecuación de absorbentes para la incontinencia urinaria en un distrito de atención primaria / The use and suitability of absorbent products for urinary incontinence in a primary health care district

Objetivo: Calcular el consumo de absorbentes en pacientes con incontinencia urinaria pertenecientes al Distrito Sanitario de Atención Primaria Sevilla (DSAPS) y comparar la evolución a lo largo de los años 2005-2009, así como, calcular el gasto sanitario que supone dicho consumo y su variación en el periodo estudiado. Método. Estudio observacional descriptivo transversal sobre la utilización de absorbentes de incontinencia urinaria (AIU) en el DSAPS entre 2005 y 2009. La población de estudio fueron los pacientes registrados a los que se les dispensó AIU durante dicho periodo. Indicadores principales: número de envases de absorbentes/número de tarjetas ajustadas por edad del paciente y por tipo de aportación (TAFE) y gasto sanitario en AIU/TAFE. Resultados. Entre los años 2005 y 2009 se observa un crecimiento de prescripción en absorbentes ajustado por TAFE del 0,71%. Por áreas, el incremento fue del 1,06% en el área Virgen del Rocío y del 1,28% en el área hospitalaria Virgen de Macarena. El gasto sanitario empleado en el consumo de AIU durante el total de los cinco años fue de 4.100.765€. Ésto supuso un crecimiento del gasto sanitario del 17,8%. Conclusiones. Ha habido un incremento en el consumo de absorbentes a lo largo del tiempo, lo que se traduce también en un aumento del gasto sanitario. Ante esto, cabe quizás plantearse una intervención dirigida a los prescriptores que potencie el tratamiento escalonado y multifactorial de la IU (AU)

Objective: To calculate the use of absorbent products in patients with urinary incontinence in the Seville District Primary Health Care, and to compare the use over time, and to calculate the health costs and their variation during the period 2005-2009. Method. A cross-sectional and descriptive observational study was conducted on the use of urinary incontinence absorbents in the Seville District Primary Health Care, from 2005 and 2009. Patients registered as using urinary incontinence absorbents (UIA) during that period were included as the study population. Main variables: number of absorbent packages/number of healthcare cards by patient age and by type of contribution, and cost of UIA/number of cards by patient age and by type of social security contribution. Results. There was an increase of 0.71% in the prescription of absorbents by healthcare card, patient age and by type of contribution. When comparing the different Health Areas, there was an increase of 1.06% within the Virgen del Rocío Hospital Area and an increase of 1.28% within Virgen de Macarena Hospital Area. The health expense incurred in the use of UIA during these five years was 4,100,765 €, which is an increase of 17.8%. Conclusions. There is a high increase in the use of UIA with time, causing an increase in the health costs. There was also a high frequency in the use of special beds. Therefore, it would be reasonable to train the prescribers to promote progressive and multidisciplinary treatment of UI (AU)

[The use and suitability of absorbent products for urinary incontinence in a primary health care district]. / Estudio sobre la utilización y adecuación de absorbentes para la incontinencia urinaria en un distrito de atención primaria.

OBJECTIVE: To calculate the use of absorbent products in patients with urinary incontinence in the Seville District Primary Health Care, and to compare the use over time, and to calculate the health costs and their variation during the period 2005-2009. METHOD: A cross-sectional and descriptive observational study was conducted on the use of urinary incontinence absorbents in the Seville District Primary Health Care, from 2005 and 2009. Patients registered as using urinary incontinence absorbents (UIA) during that period were included as the study population. MAIN VARIABLES: number of absorbent packages/number of healthcare cards by patient age and by type of contribution, and cost of UIA/number of cards by patient age and by type of social security contribution. RESULTS: There was an increase of 0.71% in the prescription of absorbents by healthcare card, patient age and by type of contribution. When comparing the different Health Areas, there was an increase of 1.06% within the Virgen del Rocío Hospital Area and an increase of 1.28% within Virgen de Macarena Hospital Area. The health expense incurred in the use of UIA during these five years was 4,100,765 €, which is an increase of 17.8%. CONCLUSIONS: There is a high increase in the use of UIA with time, causing an increase in the health costs. There was also a high frequency in the use of special beds. Therefore, it would be reasonable to train the prescribers to promote progressive and multidisciplinary treatment of UI.