Biomedical subjects

H Vanaclocha

Publications and source records attributed to H Vanaclocha.

8 recordsLinked to original sources

PubMed2006

Analysis of the renal transplant waiting list in the País Valencià (Spain).

In this paper we analyse the renal transplant waiting list of the País Valencià in Spain, using Queueing theory. The customers of this queue are patients with end-stage renal failure waiting for a kidney transplant. We set up a simplified model to represent the flow of the customers through the system, and perform Bayesian inference to estimate parameters in the model. Finally, we consider several scenarios by tuning the estimations achieved and computationally simulate the behaviour of the queue under each one. The results indicate that the system could reach equilibrium at some point in the future and the model forecasts a slow decrease in the size of the waiting list in the short and middle term.

Bayes Theorem↗

PubMed2005

Determinants of health system delay among confirmed tuberculosis cases in Spain.

BACKGROUND: Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients. METHODS: Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables. RESULTS: A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged. CONCLUSION: Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.

Adolescent↗

PubMed2004

Determinants of patient delay among tuberculosis cases in Spain.

BACKGROUND: Patient delay was investigated in a cohort of TB patients identified from May 1996 until April 1997 in 13 Autonomous Regions in Spain. The study covered almost 67% of the total Spanish population. METHODS: Data were collected from clinical records. Using unconditional logistic regression with two different cut-off points to define 'patient delay' (the median and 75th percentile), the association between patient delay and different factors was estimated. RESULTS: A total of 7,037 cases were included. Median and 75th percentile delays were 22 and 57 days respectively. Factors associated with patient delay greater than the median (p<0.05) were: non-respiratory symptoms of TB and age over 14 years, although the effect of age was not linear. Furthermore, an interaction was observed between intravenous drug user (IDU) and HIV status, in that, whereas patient delay was greater in IDUs than in non-IDUs among cases whose HIV status was either negative or unknown, among HIV-positive patients no such IDU-related differences were in evidence. Factors associated with extreme patient delay (greater than the 75th percentile) were essentially the same, but the above-described interaction disappeared, with IDU status showing no direct effect. In addition, likelihood of extreme patient delay increased in the case of alcoholism and female gender and decreased in the case of chronic renal failure, corticoid treatment, prison inmates and residents of old age homes. CONCLUSION: Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.

Adolescent↗

PubMed2002

Tuberculosis in Spain: epidemiological pattern and clinical practice.

SETTING: Thirteen Autonomous Regions in Spain. OBJECTIVE: To study the incidence of all forms of tuberculosis (TB) and investigate clinical practice in TB. DESIGN: Cases of all forms of tuberculosis diagnosed in the study setting from May 1986 to April 1997 were identified though active search of different databases. Clinical and epidemiological information on cases was collected from clinical records or by interview with physicians. RESULTS: The overall incidence of all forms of tuberculosis was 38.5/100,000 and the incidence of smear-positive disease was 13.83/100,000. Most cases (97.1%) were Spanish nationals, with rates higher in men than in women (52.7/100,000 vs. 24.87/100,000) and in groups aged 25-34 and 75 years and over (61.35/100,000 and 59.35/100,000, respectively). Disseminated forms were frequent (6.6%), and the most common risk factor was human immunodeficiency virus (HIV) infection (17.7% of cases). Hospitalisation was common (71.6%). Microbiological confirmation of diagnosis was sought for 87.7% of the cases (91.8% of pulmonary vs. 75.5% of extra-pulmonary cases), and 65.2% were culture-positive (73.8% of pulmonary vs. 39.7% of extra-pulmonary cases). HIV-infected patients were treated in almost equal proportions with three or four drugs (49.7% and 48.2%, respectively), while HIV-negative cases or those whose HIV status was unknown were usually treated with three drugs. CONCLUSION: The epidemiological pattern of TB in Spain is different to other industrialised countries in the age distribution of cases and the proportions of foreigners and cases with HIV infection. Microbiological confirmation of diagnosis is more common in pulmonary than in extra-pulmonary disease, and treatment with four drugs more frequent in HIV-positive cases.

Adolescent↗

PubMed2001

Human enteric viruses in Coquina clams associated with a large hepatitis A outbreak.

An outbreak of hepatitis A, affecting 183 people, occurred in Valencia (Spain). Epidemiological evidence pointed to an association of the outbreak with consumption of Coquina clams (Donax sp), imported frozen from Peru. Shellfish were analysed for the presence of hepatitis A virus (HAV), enteroviruses, rotaviruses, astroviruses, caliciviruses and hepatitis E virus. HAV was detected in 75% of assayed shellfish samples. Other enteric viruses were occasionally found in the same samples. Molecular epidemiological analysis of fragments of the VP1/2A and the 5' end of the genome from shellfish and sera isolates, revealed the presence of six variants belonging to a single genotype.

DNA, Viral↗

PubMed1989

[Predictive value of obligatory reporting of sexually transmitted diseases].

Sexually transmitted diseases (STD) were recently included in the Spanish reporting system, or Compulsory Reporting of Diseases (EDO). In the present study, the validity of this system is evaluated with the estimation of the positive predictive values of the EDO. A preestablished questionnaire was administered by phone to the reporting physicians of the 478 cases of STD that had been reported to the EDO system from August 1987 to May 1988 in the Alicante and Valencia provinces. In this survey, in addition to data related to the reporting physician (specialty and place of work) and to the patient (sex, clinical symptoms and signs), information permitting to classify each diagnosis as certain, likely and unlikely was collected (incubation time, laboratory tests). Considered as a whole, the results suggested an acceptable accuracy (positive predictive value 79.09%, confidence limits 76.7%-81.5%) for both diseases. This permits to consider STD statistics as fairly accurate. Among the factors influencing the diagnostic precision are the disease itself, the patient's sex, the qualification of the reporting physician and his place of work. The predictive value of the cases reported from centers of diagnosis of STD was higher. We think that, although these results are acceptable for the epidemiological survey, the quality of care could be enhanced by a better organization of services and an improved undergraduate and postgraduate education.

Attitude of Health Personnel↗

PubMedDate not supplied

[Avoidable years of life lost ratio: an indicator to identify excess mortality in health areas. Mortality workshop of the Valencia region].

Avoidable mortality has been proposed as an outcome indicator of health services. Until now the Standardized Mortality Ratio (SMR) has been the effect measure most used to detect excesses in avoidable mortality. We propose the use, as a complementary measure, of the Avoidable Years of Life Lost Ratio (AYLLR). We show that for tuberculosis, hypertension and for all avoidable deaths both measures provide complementary information, since in some areas where observed deaths are below the expected number (SMR less than 100) we detect an observed number of years of life lost higher than expected (AYLLR greater than 100), due to the occurrence of these deaths at younger ages. The AYLLR is a standardized effect measure that puts a higher weight to premature deaths.

Catchment Area, Health↗

PubMedDate not supplied

[A morbidity information system based on school absenteeism].

We present a pilot experience about the introduction of a information system designed for the knowledge of infant morbidity (4-15 years) in a 13 school week period in a representative sample of 60 schools of the Valencian Community. We studied school absences that lasted three days or longer. Reports of teachers and parents were the source of information (100% response rate). Medical certification was also requested to the pediatricians and general practitioners of the area of the schools (12.74% response rate). To test the validity of this information system, absences caused by hepatitis were compared with the registry of Notifiable Diseases System (NDS) for the same period. We recorded 3,968 absences, with a cumulative incidence of 100.68 per 1,000 (C.I., alpha = .05, +/- 4.97) for females, and 119.4 (C.I., alpha = .05, +/- 18.36) for males. These differences were statistically significant. There was a concordance of 80.25% of the hepatitis cases between the registry of absenteeism and that of the NDS (chi 2 goodness of fit test = 3.16, p = .754). Although absences shorter than 3 days were not taken into account, the information system provided relevant and valid estimates of morbidity. Moreover, collaboration of teachers was considered very positive, which led us to use this health information system in five health areas of the Valencian Community.

Absenteeism↗