Open Access
Cost efectiveness analysis of therapeutic strategies for patients with chronic hepatitis C previously non responders to interferon
(2003) San Miguel Elcano, Ramón; Mar, Javier; Cabasés Hita, Juan Manuel; Guillén Grima, Francisco; Butí, María; Economía; Ekonomia
Background: The efficacy of combination therapy in previous non responders to interferon (IFN) monotherapy with chronic hepatitis C is lower than in naïve patients, and there has been no economic evaluation in this population. Aim: To develop a cost-effectiveness analysis of therapeutic regimens with IFN alpha and ribavirin in previous interferon non-responders. Methods: A Markov simulation model was used to project the clinical and economic outcomes of five different therapeutic strategies including a “no treatment” alternative using the health care system perspective. The effectiveness data for the different doses and durations was obtained from a previously performed meta-analysis. A sensitivity analysis was performed to test robustness of the model, analysing changes in different variables. Results: Applying a 3% discount rate, the standard patient on combination therapy for 12 months showed an increase of 0.80 years and 1.55 quality adjusted life years (QALYs), when comparing combination therapy for 12 months vs. “no treatment” strategy. This option led to an incremental cost-effectiveness ratio of 11,767 euros per year of life gained and 6,073 euros per QALY. Conclusions: Combination therapy with interferon plus ribavirin in previous interferon non-responders shows an incremental cost-effectiveness ratio within the range of some well accepted medical interventions in our health care system.
Open Access
Med-health: the Mediterranean health alliance
(2016) Guillén Grima, Francisco; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Presentación del proyecto Med-health, de la acción K2, orientado a la formación de gestores de salud pública.
Open Access
Perceptions, barriers, and facilitators of maternal health service utilization in southern Ethiopia: a qualitative exploration of community members' and health care providers' views
(PLoS, 2024-12-19) Yoseph, Amanuel; Teklesilasie, Wondwosen ; Guillén Grima, Francisco; Astatkie, Ayalew; Ciencias de la Salud; Osasun Zientziak
Introduction. Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, evidence is scarce in designing efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and healthcare providers’ perceptions of MHS and barriers and facilitators of MHS use in southern Ethiopia. Methods. A phenomenological qualitative study was conducted in the month of November, 2022, in the northern zone of the Sidama region. There were sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQDA 2020 software and presented in narratives. Results. Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD) but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of road access, and women being busy with different household chores. Distance from health facilities, costs associated with HFD use, unpredicted labor, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women’s development teams, and pregnant women’s forums. Conclusions. Rural women still encounter challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labor continued to be fundamental barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address community and health facility barriers. The programs must emphasize the transportation arrangements during unpredictable labor and the needs of poor mothers and women with poor awareness of MHS at the community level.
Open Access
Effect of community health education on mothers' knowledge of obstetric danger signs and birth preparedness and complication readiness practices in southern Ethiopia: a cluster randomized controlled trial
(PLoS ONE, 2024-11-27) Yoseph, Amanuel; Teklesilasie, Wondwosen ; Guillén Grima, Francisco; Astatkie, Ayalew; Ciencias de la Salud; Osasun Zientziak
Introduction: Increasing knowledge of obstetric danger signs (ODS) and encouraging birth preparedness and complication readiness (BPCR) practices are strategies to increase skilled maternal health service utilization in low-income countries. One of the methods to increase mothers’ knowledge about ODS and promote BPCR practice is through health education intervention (HEI). However, the effect of context-specific community-based health education led by women’s groups on these outcomes has yet to be comprehensively studied, and the existing evidence is inconclusive. Thus, we aimed to evaluate the effect of a context-specific community-based HEI led by women’s groups on mothers’ knowledge regarding ODS and BPCR practices in southern Ethiopia. Methods: An open-label, two-arm parallel group cluster-randomized controlled trial was conducted from January to August 2023 on pregnant women from 24 clusters (kebeles) (12 interventions and 12 controls) in the northern zone of the Sidama region. The Open Data Kit smartphone application was utilized to collect data. The intention-to-treat analysis was used to compare outcomes between groups. We fitted multilevel mixed-effects modified Poisson regression with robust standard error to account for between and within cluster effects. Results: One thousand and seventy pregnant women (540 in the intervention and 530 in the control clusters) responded to this study, making the overall response rate 95.02%. Excessive vaginal bleeding (94.3% in the interventional group vs. 88.7% in the control group) was the commonest ODS mentioned during childbirth. Overall, 68.7% of women in the intervention group and 36.2% of mothers in the control group had good knowledge of ODS (P-value < 0.001). Saving money and materials (97.1% in the interventional group vs. 92.7% in the control group) was the most frequently practiced BPCR plan. Overall, 64.3% of women in the intervention group and 38.9% of mothers in the control group practiced BPCR (P-value < 0.001). HEI significantly increased overall knowledge of ODS (adjusted risk ratio [ARR]: 1.71; 99% CI: 1.14–2.57) and improved overall BPCR practice (ARR: 1.55; 99% CI: 1.02–2.39). Conclusions: A community-based HEI led by women’s groups improved mothers’ knowledge regarding ODS and BPCR practices in a rural setting in southern Ethiopia. Interventions designed to increase women’s knowledge of ODS and improve BPCR practice must implement context-specific, community-based HEI that aligns with World Health Organization recommendations. Trial registration: NCT05865873.
Open Access
Community-based health education led by women's groups significantly improved maternal health service utilization in southern Ethiopia: a cluster randomized controlled trial
(MDPI, 2024) Yoseph, Amanuel; Teklesilasie, Wondwosen ; Guillén Grima, Francisco; Astatkie, Ayalew; Ciencias de la Salud; Osasun Zientziak
Objective: This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. Methods: From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. Results: The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06¿1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48). Conclusion: A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. Trial registration number: NCT05865873.
Open Access
Trends, projections, and regional disparities of maternal mortality in Africa (1990-2030): an ARIMA forecasting approach
(MDPI, 2023) Onambele, Luc; Guillén Aguinaga, Sara; Guillén Aguinaga, Laura; Ortega-Leon, Wilfrido; Montejo, Rocío; Alas Brun, Rosa María; Aguinaga Ontoso, Enrique; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.
Open Access
Validación del Cuestionario de Orientación a la Vida (OLQ-13) de Antonovsky en una muestra de estudiantes universitarios en Navarra
(Gobierno de Navarra. Departamento de Salud, 2016) Lizarbe Chocarro, Marta; Guillén Grima, Francisco; Aguinaga Ontoso, Inés; Canga Armayor, Navidad; Ciencias de la Salud; Osasun Zientziak
Fundamento. El sentido de coherencia interna (SOC), concepto central del modelo salutogénico descrito por Aaron Antonovsky, se ha empleado como predictor de medidas de salud percibida y objetiva, se relaciona fuerte y positivamente con comportamientos saludables, y se desarrolla principalmente en la juventud y en la época de estudiante. Los universitarios son un grupo de jóvenes diana para aplicar medidas promotoras de salud en función de su nivel SOC, siendo necesario comprobar la calidad de la medición de la escala. El objetivo es validar y estudiar las propiedades psicométricas de la escala SOC en los estudiantes de la Universidad de Navarra, y conocer su evolución temporal. Sujetos y método. Se analizaron los estudiantes de nuevo acceso de la Universidad de Navarra. Estudio de cohortes con seguimiento a los tres años. Los instrumentos utilizados fueron el cuestionario de orientación a la vida (OLQ-13), la Escala del Estrés Percibido (EEP) y el Índice de malestar. Se estudiaron la calidad de los datos y viabilidad, asunciones escalares, estabilidad temporal, fiabilidad, validez de criterio concomitante y clínica, y estructura factorial y análisis confirmatorio de los datos obtenidos. Se utilizaron los paquetes estadísticos SPSS v. 19 y Amos v.7. Resultados. La muestra ha sido de 508 estudiantes, 33,5% varones y el 65,9% mujeres. Fiabilidad alta (Alfa de Cronbach de 0,814). Adecuada validez convergente con la EEP. Inadecuada validez clínica. Análisis de componentes principales con tres factores que explican el 50,73% de la varianza. Conclusiones. Instrumento válido que permite proponerlo como herramienta para aplicar medidas promotoras de salud en jóvenes
Open Access
Personal and perceived peer use and attitudes towards use of non-prescribed prescription sedatives and sleeping pills among university students in seven European countries
(Elsevier, 2018) Lehne, Gesa; Zeeb, Hajo; Pischke, Claudia R.; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Introduction: The use of non-prescribed prescription sedatives and sleeping pills (NPPSSP) among university students has been described as an important public health issue. However, the impact of perceived social norms on students' use and attitudes towards use of NPPSSP is still unclear. Our aim was to investigate whether perceptions of peer use and approval of use are associated with students' personal use and approval of NPPSSP use. Methods: Cross-sectional data from the Social Norms Intervention for the prevention of Polydrug Use (SNIPE) project containing 4482 university students from seven European countries were analyzed to investigate self-other discrepancies regarding personal use and attitudes towards NPPSSP use. Associations between personal and perceived peer use and between personal and perceived approval of use were examined using multivariable logistic regression. Results: The majority (51.0%) of students perceived their peers' NPPSSP use to be higher than their personal use. 92.6% of students perceived their peers' approval of NPPSSP use to be identical or higher than their personal approval. Students perceiving that the majority of peers had used NPPSSP at least once displayed higher odds for personal lifetime use (OR: 1.95, 95% CI: 1.49–2.55). Perceived peer approval of NPPSSP use was associated with higher odds for personal approval (OR: 5.49, 95% CI: 4.63–6.51). Conclusions: Among European university students, perceiving NPPSSP use and approval of use to be the norm was positively associated with students' personal NPPSSP use and approval of use, respectively. Interventions addressing perceived social norms may prevent or reduce NPPSSP use among university students.
Open Access
Effectiveness of copper as a preventive tool in health care facilities: a systematic review
(Elsevier, 2023) Aillón-García, Paula; Parga-Landa, Blanca; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Introduction: Hospital-acquired infections (HAIs) are a significant clinical and economic burden on health systems worldwide. Copper alloys have been certified by the US EPA as solid antimicrobial materials, but their effectiveness in reducing HAIs is not well established Objectives: This systematic review aimed to assess copper surfaces in situ efficacy in reducing health care’s microbial burden compared to control surfaces. Materials and Methods: A literature search was conducted using three electronic databases: Web of Science, PubMed, and Scopus, with the keywords “copper” and “surfaces” and “antimicrobial” and “antibacterial” and “infections.” Studies from 2010 to 2022 were included. The quality of the studies was independently screened and assessed using the Newcastle Ottawa Scale. Results: A total of 56 articles were screened, with 8 included in the review and 7, added from references. Two third of the studies report a significant reduction in the microbial burden on copper objects compared to control objects. The 2 studies with the highest scores on NOS evaluation indicated that using copper or copper alloys in healthcare settings can effectively decrease the number of bacterial contaminations on touch surfaces. Conclusions: The results suggest the potential effectiveness of copper as a preventive tool in healthcare facilities, but further studies and longer trials are needed to establish a relationship between copper and reduced nosocomial infections.
Open Access
Effects of nutrition interventions on athletic performance in soccer players: a systematic review
(MDPI, 2023) Aguinaga Ontoso, Inés; Guillén Aguinaga, Sara; Guillén Aguinaga, Laura; Alas Brun, Rosa María; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Background: More than 270 million participants and 128,893 professional players play soccer. Although UEFA recommendations for nutrition in elite football exist, implementing these guidelines among professional and semiprofessional soccer players remains suboptimal, emphasizing the need for targeted and individualized nutritional strategies to improve adherence to established recommendations. Methods: We conducted a comprehensive search in PubMed, Scopus, Web of Science, and clinical trial registers. Inclusion criteria focused on professional or semiprofessional soccer players, nutrition or diet interventions, performance improvement outcomes, and randomized clinical trial study types. We assessed quality using the Risk of Bias 2 (RoB 2) tool. We identified 16 eligible articles involving 310 participants. No nutritional interventions during the recovery period effectively improved recovery. However, several performance-based interventions showed positive effects, such as tart cherry supplementation, raw pistachio nut kernels, bicarbonate and mineral ingestion, creatine supplementation, betaine consumption, symbiotic supplements, and a high-carbohydrate diet. These interventions influenced various aspects of soccer performance, including endurance, speed, agility, strength, power, explosiveness, and anaerobic capacity. Conclusions: Specific strategies, such as solutions with bicarbonate and minerals, high carbohydrate diets, and supplements like creatine, betaine, and tart cherry, can enhance the performance of professional soccer players. These targeted nutritional interventions may help optimize performance and provide the competitive edge required in professional soccer. We did not find any dietary interventions that could enhance recovery.