IFN-g response to vaccination against tuberculosis in dairy heifers under commercial settings.

The purpose was to determine IFN-g release as a response to vaccination against tuberculosis in dairy heifers under commercial settings. Four-hundred pregnant heifers from ten herds were randomly allocated into four groups: (1) unvaccinated, (2) BCG vaccinated, (3) BCG vaccinated plus a CFPP400 µg+polygen boost, and (4) BCG vaccinated plus a CFP200 µg+polygen boost, under a completely randomized blocks design. A dose of 106CFU of BCG was delivered SC in the neck, then blood samples were taken at days 0, 30, 120, 210, 300 and 720 to estimate IFN-g release in response to bovine-PPD antigen. No significant difference (P > 0.05) was observed in IFN-g release between groups at days 0 and 120. At days 30 and 210, vaccinated groups show higher IFN-g release than the control group but only difference of group 3 was significant (P < 0.05). At day 300, group 1 showed significantly higher IFN-g release. No significant difference was observed at day 720. Using IFN-g release as a surrogate for vaccine efficacy, BCG plus a boost with CFP or CFPP combined with an adjuvant that improves cellular immune response has the potential to protect cattle against tuberculosis for moderate periods of time in vaccinated cattle under commercial settings.

Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis.

UNLABELLED: Systematic review of adherence to bisphosphonates for the treatment of osteoporosis finds suboptimal levels of persistence and compliance. Poor bisphosphonate compliance increases fracture risk. INTRODUCTION: The objectives of the study were to measure the persistence and compliance with bisphosphonates for the treatment of osteoporotic patients, and to estimate the influence of compliance on fracture risk. METHODS: A systematic review of bisphosphonate adherence in clinical practise provided new evidence to perform a meta-analysis of the means of bisphosphonate persistence and compliance, with a subsequent meta-analysis of fracture risk comparing poorly versus highly compliant patients. RESULTS: Fifteen articles, totalling 704,134 patients, met our inclusion criteria. Most of the patients were postmenopausal women treated with bisphosphonates. The 3.95% of the patients received hormone replacement therapy, but the rest received bisphosphonates. The meta-analysis of five articles totalling 236,540 patients, who were followed for 1 year, provided a pooled persistence mean of 184.09 days. The meta-analysis of five articles, totalling 234,737 patients, who were also followed for 1 year, provided a pooled medication possession ratio mean of 66.93%. The meta-analysis of six articles, totalling 171,063 patients, who were followed for varying periods of time between 1 and 2.5 years, provided a pooled 46% increased fracture risk in non-compliant patients versus compliant patients. The increased fracture risk was lower for non-vertebral (16%) and hip (28%) than for clinical vertebral fractures (43%). CONCLUSIONS: Persistence and compliance are suboptimal for postmenopausal women undergoing bisphosphonate therapy for osteoporosis. The clinical consequence of this low compliance is an increased risk of fracture, which is lower for non-vertebral than for clinical vertebral fractures.

Análisis de la evidencia científica en el diagnóstico por la imagen / Analysis of scientific evidence in imaging diagnosis

Se realiza un análisis de la situación de las evidencias científicas en el área del Diagnóstico por la Imagen, se describen los principales tipos de estudios clasificados según su nivel de calidad, con especial atención a los estudios de exactitud diagnóstica, y se proporcionan una serie de herramientas y guías para la lectura crítica en este campo. Se observa que las investigaciones sobre la eficacia y utilidad de estas tecnologías presentan actualmente déficit en cuanto a la calidad y estandarización de los estudios. La aplicación de los principios de la medicina basada en la evidencia al Diagnóstico por la Imagen es un reto que está todavía por desarrollar

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Morbilidad, mortalidad y costes sanitarios evitables medianteuna estrategia de tratamiento del tabaquismo en España / The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs

Objetivo: Se valoran los efectos que tendría una intervención destinada a reducir el uso de tabaco en la población española de fumadores sobre la morbilidad, la mortalidad y los costes asociados al consumo de tabaco. Método: Se ha adaptado el modelo Health and Economic Consequences of Smoking patrocinado por la OMS y desarrollado por The Lewin Group. La intervención propuesta incluye el acceso a asistencia farmacológica de un 35% de los fumadores que intentan dejar de fumar, y obtienen una tasa global de cesación al año del 7,2%. Las enfermedades estudiadas son: cáncer de pulmón, enfermedad coronaria, enfermedad cerebrovascular, EPOC, asma y bajo peso al nacer. Se estiman los casos de enfermedad y muerte atribuibles al consumo de tabaco evitados y la reducción en el coste sanitario debidos a la intervención, proyectados a 20 años. Resultados: Sin intervención, en el año 1 del modelo 2.136.094 fumadores padecen alguna de las condiciones clínicas atribuibles al consumo de tabaco, el coste asistencial es de 4.286 millones de euros y las muertes atribuibles son 26.537. La intervención propuesta evita 2.613, 9.192, 17.415 y 23.837 casos de enfermedad atribuible al consumo de tabaco en los años 2, 5, 10 y 20 del modelo, respectivamente. Los costes asistenciales acumulados evitados son 3,5 millones de euros en el año 2 y 386 millones de (..) (AU)

Objective: We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and healthcare costs. Methods: We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed incluides pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in healthcare expenditure due to the intervention were estimated. Results: Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; healthcare expenditure would be 4,286 million € and deaths attributable to smoking would total 26,537. The proposed intervention (..) (AU)

[The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs]. / Morbilidad, mortalidad y costes sanitarios evitables mediante una estrategia de tratamiento del tabaquismo en España.

OBJECTIVE: We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and health care costs. METHODS: We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed includes pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in health care expenditure due to the intervention were estimated. RESULTS: Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; health care expenditure would be 4,286 million e and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated health care costs would amount to 3.5 million e at year 2 and 386 million e over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered. CONCLUSIONS: The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and health care costs associated with smoking in Spain.

Evaluación de las tecnologías sanitarias y ordenación de las prestaciones en los sistemas sociales avanzados / Evaluation of health technologies and benefits entitlement in advanced social systems

El presente trabajo parte de la consideración de la salud como un bien asegurable cuya protección se ha convertido en un derecho fundamental. En la misma línea, la asistencia sanitaria ha adquirido un carácter contractual, cuya "naturaleza" ha evolucionado de individual a colectiva, y que se expresa en términos de "seguro sanitario", sea público o privado. En tal contexto se hace necesaria la cuantificación de resultados para poder definir las variables del Sistema y, subsiguientemente, las condiciones de contratación Los resultados económicos son imprescindibles para conocer los costes y, en consecuencia, las necesidades financieras del Sistema; mientras que los resultados clínicos lo son para que el asegurado tenga unas expectativas realistas de los beneficios que puede esperar de la asistencia que se le ofrece. A su vez, el ritmo vertiginoso de innovación tecnológica que caracteriza la medicina moderna obliga a la continua revisión del estado del arte, encuadrado en un sector sanitario cuyo perfil multifactorial le confiere creciente complejidad. En conclusión, la evaluación de las tecnologías sanitarias se hace imprescindible para expresar la efectividad de la asistencia, posibilitar su gestión eficiente, definir responsabilidades y brindar garantías a los usuarios; todo lo cual ya forma parte de un cuerpo ético que, cada día con mayor nitidez, se va configurando en el Derecho y que, a su vez, es garantía de pervivencia del Sistema Asistencial (AU)

[Evaluation of health technologies and benefits entitlement in advanced social systems]. / Evaluación de las tecnologías sanitarias y ordenación de las prestaciones en los sistemas sociales avanzados.

In the present study, health is considered a subject of insurance whose protection has become a Fundamental Right. In the same line, health care has acquired a contractual character whose "nature" has evolved from individual to collective, expressed in terms of "health care insurance", public or private. In such context, outcome measurement becomes necessary to be able to define the variables of the System and, subsequently, the contracting conditions. Having an understanding of the economic impact is required to analyze the costs and, in consequence, the financial necessities of the System; as well as the clinical results in order for the insured to have some realistic expectations of the benefits that can be expected from the health care that is offered. In turn, the vertiginous rhythm of technological innovation that characterizes the modern medicine forces to the continuous revision of the state of the art framed in a health sector whose multifactorial profile confers it growing complexity. In conclusion, health technology assessment becomes indispensable to identify health care effectiveness, to facilitate its efficient management, to define responsibilities and to offer guarantees to the users; all which is already part of an ethical body that, day by day with more clarity, is being configured by the legislation and that, in turn, guarantees the survival of the Health Care System.

[Smoking-attributable deaths in Spain in 1998]. / Mortalidad atribuible al tabaquismo en España en 1998.

BACKGROUND: Between 1993 and 1997, smoking prevalence remained stable in Spain yet age-adjusted death rates by smoking-related diseases decreased. Our study aimed to estimate the burden of smoking-attributable mortality in Spain in 1998. POPULATION AND METHOD: Spain's smoking prevalence, mortality and relative risks for death from the Cancer Prevention Study II were used to estimate smoking-attributable mortality in the population aged 35 years and over. RESULTS: In 1998, 55,613 deaths were attributable to smoking. One out of 4 deaths in males and one out of 40 deaths in females were attributable to tobacco. Two thirds of the attributable mortality corresponded to deaths due to lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and stroke. CONCLUSIONS: Smoking actually represents a remarkable burden of avoidable deaths in Spain. Smoking-attributable mortality appears to continue increasing in the last years.

The association of tobacco and alcohol consumption with the use of health care services in Spain.

BACKGROUND: Information on the impact of tobacco and alcohol consumption on the use of health services is scant and partially inconsistent. This paper examines the relationship between tobacco and alcohol consumption and the use of health care services in Spain. METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a random 21,120-person representative sample of Spain's noninstitutionalized population ages 16 years and older. Information was obtained through home-based interviews. RESULTS: Compared with never smokers, male smokers of more than 20 cigarettes/day tend to be hospitalized more frequently (odds ratio (OR) 1.31; 95% confidence limits (CL) 0.89-1.93) and make greater use of hospital emergencies (OR 1.51; 95%CL 1.13-2.01; P < 0.01). Among female smokers of more than 20 cigarettes/day, hospitalizations (OR 1.62; 95%CL 0.80-3.26) and medical visits (OR 1. 35; 95%CL 0.79-2.30) are also higher than among never smokers, although the associations do not reach statistical significance. Compared with never smokers, ex-smokers of both sexes make greater use of health care services (P < 0.01 for most services). There is a negative dose-response relationship (P < 0.001) between alcohol consumption and utilization of hospital and ambulatory services, for both sexes. Results are reasonably consistent across all age groups and are observed after adjustment for the principal confounding factors. We have found no evidence of a tobacco-alcohol interaction with the use of health care services. CONCLUSIONS: Smokers and ex-smokers make greater use of health care services. Control of smoking might reduce the use of such services and the ensuing human and economic costs. However, as alcohol consumption increases, the use of health care services decreases. This finding should not be used to promote even the moderate consumption of alcoholic drinks.

Uso racional de rofecoxib / Rational use of rofecoxib

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[Levels of bactericidal antibodies against meningococcus C after vaccination in 2- to 6-year-old children in Andalusia]. / Niveles de anticuerpos bactericidas frente a meningococo C tras la vacunación de niños de 2 a 6 años de edad en Andalucía.

BACKGROUND: In 1997, 18.5% of the cases of Meningococcal Disease caused b serogroup C in Andalusia were children between 2 and 4 years of age; ages where the initial immune response and the duration of the capsular A + C meningococcal polysaccharide vaccine is less than in older age groups. Research was designed in order to measure the immune response produced by this vaccine in children from 2 to 6 years of age and to compare it with the natural immunity present in unvaccinated children. METHODS: I. Dual monitoring study: a) groups of children vaccinated previously and control groups, b) groups of children who were going to be vaccinated, for pre and post-vaccination (1, 6 and 12 months) analysis and a control group. II. The bactericidal activity was measured according to the standardised protocol of the CDC with regard to the strain of N. meningitidis C-11. The sera with bactericidal activity (TAB) > 1:8 were considered to be protective. RESULTS: 1 and 2 months following vaccination, the proportion of TAB > 1:8 was significantly higher than that of the control group (65.6% and 73% in comparison to 2.2% and 12%). In the pre-vaccine and post-vaccine (after 6, 7, 12 and 13 months) verification, no significant difference between vaccinated individuals and controls was observed. CONCLUSIONS: The differences between vaccinated and unvaccinated individuals 1 and 2 months following vaccination indicate seroconversion in the vaccinated individuals. For the age group of between 2 to 6 years of age, the bactericidal activity acquired decline quickly, as, after 6 months, differences between this group and the control group are no longer observed.

[Searching for evidence. A compilation of useful resources for health technology assessment]. / Búsqueda de evidencias. Una recopilación de recursos útiles en la evaluación de tecnologías sanitarias.

The spectacular growth in the produced volume of published scientific and technical information during the last years makes it difficult to discriminate and localize the information of greater quality. The parallel development of technologies for the fast handling of great volumes of single information has partially solved the problem of the access and use of the most advisable information. Health technology assessment tries to facilitate the decision making on the introduction, diffusion or use of health technologies, being based on the best evidences available. In order to improve the process of searching for evidences, needed in the process of health technology assessment, the Agency of Health Technology Assessment of the Institute of Salud Carlos III (AETS) made a compilation of information resources that can be useful for searching biomedical information in general. This article presents the above mentioned compilation along with the description of the process of elaboration and the criteria of selection applied.

[Report on the surgery for epilepsy]. / Informe sobre la cirugía de la epilepsia.

OBJECTIVE: We review the clinical indications and outcomes of surgical procedures in epilepsy which is resistant to medical treatment and the current situation and future possibilities of carrying out surgery for epilepsy in Spain. DEVELOPMENT: Search of the scientific literature included in the data base MEDLINE for the period 1995-1997, retrieval of reports in relation to agencies for the evaluation of health technology of the INAHTA network and the data base of the Cochrane library. The surgery of epilepsy reduces the frequency of seizures (the basic result analyzed) in all groups of patients, although in a very variable manner, depending on the clinical situation and type of operation. The results in patients with temporal lobe epilepsy and in those with localized lesions are particularly good (temporal lobe epilepsy and lesionectomy) (67-69% without seizures), with a follow up period of one to two years. It is estimated that in Spain between 75 and 300 new cases per year would benefit from surgery. The number of patients with drug-resistant epilepsy operated on in Spain is approximately 100-150 patients per year. CONCLUSIONS: Operations for epileptic syndromes, where there are surgically resectable lesions, should be justified by the gravity and impact of the disease on the psychosocial and functional development of the patient. Insufficiency resources are dedicated to the option of surgical treatment and perhaps they are also underused. These operations should be carried out in highly specialized centres, with adequate resources and an annual volume which guarantees excellence.

[Efficacy of the meningococcal vaccine from Group C capsular polysaccharide]. / Eficacia de la vacuna meningocócica de polisacárido capsular del grupo C.

BACKGROUND: This report is a systematic review of the effect intensity and duration of the immune response to meningococcal serogroup C vaccine. The vaccine safety, efficacy and effectiveness are also analyzed. METHODS: MEDLINE literature search in the period 1970-1996. Meningoccocal polysaccharide vaccine clinical trials and human prospective studies were specifically searched. Quality of the retrieved studies were analyzed. Information available was integrated. RESULTS: Group C meningoccal polysaccharide vaccine is a safe product. Its efficacy is over 85% among adults and children over 5 years old. 70% (CI 95%: 5-91%) under 5 years old, and 55% among children 2-3 years old. The vaccine is not effective under 2 years. The duration of protective antibody levels decrease with age. The proportion of vaccinated children effectively protected one year after vaccination is low. Vaccination does not affect the immune response to ulterior revaccination. CONCLUSIONS: Group C meningococcal polysaccharide vaccine is indicated in adults and children over 2 years old to protect them from meningococcal disease due to group C when exposed to high risk of infection. The outbreaks control is the main indication for the use of this vaccine. Routine immunization in not outbreak situation is not recommended due to the small vaccine protection in children under 2 years old, the limited efficacy in children under 5, and the short duration of the immunity in children.

[Trends in the mortality attributable to tobacco use in Spain, 1978-1992: 600,000 deaths in 15 years]. / Tendencia de la mortalidad atribuible al tabaquismo en España, 1978-1992: 600.000 muertes en 15 años.

BACKGROUND: The main objective is to describe time trends and evolution of mortality attributable to tobacco use in Spain in the period 1978-1992. MATERIAL AND METHODS: Spanish pevalences for never smokers, current smokers and former smokers estimated from national health surveys, and relative risks for death attributed to tobacco use from the Cancer Prevention Study II were used. The proportion and number of deaths attributed to tobacco use in the Spanish population of 35 years and over have been calculated by cause of death, sex and age. The trend in mortality attributable to tobacco use over the period 1978-1992 has also been calculated, expressed as the mean percentage change per year in the standardised mortality rates, estimated by a log-lineal model. RESULTS: Tobacco consumption caused 46,226 deaths in Spain in 1992. Most of them occurred in males (93.4%). One of every 4 deaths in males, and one of every 50 in females were attributable to tobacco consumption. One third of the deaths attributed to tobacco use were premature deaths (under 65 years). Lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and cerebrovascular disease caused 75% of deaths attributed to tobacco use. Lung cancer was the first specific cause in males, and chronic obstructive pulmonary disease was the main cause in females. A total of 621,678 deaths attributed to tobacco consumption were produced in the period (1978-1992). The main percentage change per year in the mortality rates shows a moderate increment of 0.1% (-0.2% in males +6.7% in females). CONCLUSIONS: Mortality attributable to tobacco use in Spain represents a high cost in terms of avoidable deaths and shows the limited impact of the interventions directed to tobacco control in Spain. One of every 4 deaths in males and a disturbing and rapidly increasing proportion in females are attributable to smoking.