Effectiveness of environmental interventions to reduce entomological indices of dengue, Zika, and chikungunya vector.

Vector-borne diseases are a major public health problem. Amongst them, dengue, Zika and chikungunya illnesses are increasing their incidence and geographical expansion. Since vector control is the main measure to prevent these diseases, this systematic review aims to determine the effectiveness of environmental interventions for the prevention of the transmission of these three diseases, as well as for the reduction of their burden. Experimental studies of environmental management interventions aimed at vector control were included. The outcome variables of interest were disease burden indicators and entomological indicators. Of the 923 references initially retrieved, after discarding those that were duplicated or didn't comply with the inclusion criteria, a total of 7 articles were included. All included studies carried out environmental manipulation interventions and only 1 carried out an environmental modification intervention. Regarding the outcome variables, all used entomological indicators (larval or pupae indices). Of those, pupae indices are better indicators of vector abundance. In 4 out of the 6 studies, there was a statistically significant reduction of the pupae indices related to the elimination of small containers, manipulation of large tanks and cleaning outdoor spaces. These interventions are easy to implement and involve little resources, which acquires special importance regarding areas with limited resources. Although it is assumed that a reduction of mosquitoes would lead to a reduction or the risk of transmission, a little evidence proving this has been published. It would be advisable that, in addition to entomological indicators, epidemiological, environmental and sociodemographic factors would be taken into consideration, bearing in mind that mosquito density is one of the many factors that influence the transmission of these viruses. None of the papers included used disease indicators, not allowing to demonstrate if environmental interventions contribute to reduce disease burden.

Feasibility of the SINERGIAPS ("Sinergias entre profesionales y pacientes para una Atención Primaria Segura") intervention for improving patient safety in primary care.

AIM: The primary aim was to examine the feasibility of intervention delivery and of trial procedures. Secondary aims were to study the intervention uptake; its acceptability and perceived utility; and its potential to improve safety culture and avoidable hospital admissions. METHODS: We conducted a 3-month, single-arm feasibility study in 10 primary care (PC) centres in Spain. Centres received information regarding patients' experiences of safety (through the Patient Reported Experiences and Outcomes of Safety in Primary Care [PREOS-PC] questionnaire), and were instructed to plan safety improvements based on that feedback. We used a bespoke online tool to recruit PC professionals, collect patient feedback, and deliver it to the centres, and to collect outcome data (patient safety culture [Medical Office Survey on Patient Safety Culture, MOSPSC questionnaire]). We measured recruitment and follow-up rates and intervention uptake (based on the number of safety improvement plans registered). We conducted semistructured interviews with 9 professionals to explore the intervention acceptability and perceived utility. RESULTS: Of 256 professionals invited, 120 (47%) agreed to participate, and 97 completed baseline and postintervention measures. Of 780 patients invited, 585 (75%) completed the PREOS-PC questionnaire. Five of 10 centres (50%) designed an improvement plan, providing 27 plans in total (range per centre, 1-14). The intervention was perceived as a novel strategy for improving safety, although the healthcare professionals identified several factors limiting its acceptability and utility: lack of feedback at the individual professional level; potentially unrepresentative sample of patients providing feedback; and number of educational materials deemed overwhelming. DISCUSSION: It is feasible to deliver the proposed intervention so long as the identified limitations are addressed.

Cross-Cultural Adaptation, Validation, and Piloting of the Patient Reported Experiences and Outcomes of Safety in Primary Care Questionnaire for Its Use in Spain.

OBJECTIVE: This study aimed to cross-culturally adapt, validate, and pilot the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire for its use in Spain. METHODS: After setting up an expert panel to determine its content validity, the questionnaire was translated and back-translated, and subjected to cognitive testing. The questionnaire was piloted in a cross-sectional study in 10 primary health care centers in Spain. Fifty patients per center completed the questionnaire while waiting for an appointment. We estimated (i) the acceptability of the questionnaire (response rate), (ii) scores distribution (floor and ceiling effects), (iii) internal consistency (Cronbach α), and (iv) construct validity (exploratory factor analyses and correlation between scales). To examine patients' evaluations of patient safety, we followed a mixed-methods approach: (i) statistical analyses at the scale and item levels based on responses to standardized items and (ii) qualitative content analysis based on responses to open-ended questions. RESULTS: Complete data were collected from 493 patients (participation rate, 77%). A ceiling effect was observed for 3 scales ("safety problems," "harm severity," "harm needs"). The internal consistency was adequate (α > 0.7) for the majority of scales. Exploratory factor analysis and correlation between scales suggested an appropriate construct validity. Two hundred twenty-six (45.8%) respondents experienced at least 1 safety problem, and 109 (23.2%) reported harm in the previous 12 months. CONCLUSIONS: The multidimensional primary health care patient safety instrument Patient Reported Experiences and Outcomes of Safety in Primary Care is now available for its use in Spain. Initial testing demonstrates its potential for use in primary care. Future developments will further address its use in actual clinical practice.

Mapping capacity to conduct health technology assessment in Central, Eastern and South-Eastern Europe.

AIM: To provide insights into the capacity to conduct health technology assessment (HTA) in Central, Eastern, and South-Eastern Europe (CESEE), taking account of technical, financial, networking, and human resources. METHODS: An e-mail survey of 257 CESEE key informants involved in HTA was undertaken between March and April 2014. Contact e-mail addresses were identified from the internet. The survey questionnaire consisted of 3 sections: i) characteristics of the organization performing HTA, (ii) networking in HTA, and (iii) resources allocated for HTA. RESULTS: The survey was completed by 41 respondents representing a wide range of institutions from CESEE countries (response rate of 19.8%). Less than a quarter of respondents reported that their institutions had HTA-specific budgets, whereas the majority indicated that their institutions participated in HTA networks either at domestic or international levels. Although almost half of respondents indicated that their institutions offered HTA training, a shortage in skills training was suggested as the main barrier to HTA. CONCLUSION: This is the first survey to thoroughly assess the state of HTA capacity in the CESEE region. To strengthen HTA capacity, CESEE countries should increase financial, technical, and training resources. To strengthen collaboration, the European Union and other international bodies should assist existing HTA networks in fulfilling their regional activities through leadership, advocacy to local policymakers, funding, and technical assistance.

Adherence to antiretroviral treatment in prisons.

The effectiveness of antiretroviral drugs is closely linked to the degree of adherence. The prison environment has specific characteristics that may affect adherence in HIV-positive patients, so that it may not be possible to extrapolate factors associated with nonadherence in HIV+ patients outside prison. The objective was to analyze the prevalence of nonadherence to antiretroviral treatment in three Spanish prisons, and to examine the relation between a large group of factors and nonadherence to the medication. A cross-sectional study of all patients receiving antiretroviral treatment was done. Adherence was evaluated using a validated questionnaire (SMAQ). The prevalence of nonadherence was 54.8%, and the factors independently associated with nonadherence were having difficulties in taking the medication, feeling completely or largely unable to follow the medication, classifying the food as "bad", mentioning not having anyone concerned for them outside prison, suffering anxiety or depression in the last week, and having the flexibility of the prison staff opening their cell in the event of them forgetting their medication.