Evaluating the Impact of the Diabetes Mellitus Strategy for the National Health System: An Interrupted Time Series Analysis

Background: Diabetes mellitus is a significant public health problem. Macrovascular complications (stroke, acute myocardial infarction (AMI) and lower limb amputations (LLAs) represent the leading cause of morbi-mortality in DM. This work aims to evaluate the impact of the approval of the Diabetes Mellitus Strategy of the National Health System (SDM-NHS) on hospitalizations for those macrovascular complications related to DM. Methods: Interrupted time series applying segmented regression models (Negative Binomial) adjusted for seasonality to data from hospital discharge records with a primary or secondary diagnosis of DM (code 250 ICD9MC). Results: Between 2001 and 2015, there have been 7,302,750 hospital discharges with a primary or secondary diagnosis of DM. After the approval of the SDM-NHS, all the indicators showed a downward trend, modifying the previous trend in the indicators of AMI and LLA. The indicators of stroke and AMI also showed an immediate reduction in their rates. Conclusions: After the approval of the SDM-NHS, an improvement has been observed in all the indicators of macrovascular complications of DM evaluated, although it is difficult to establish a causal relationship between the strategy and the effects observed. Interrupted time series is applicable for evaluating the impact of interventions in public health when experimental designs are not possible.This research was partially funded by the Nazarbayev University #080420FD1916.S

Enfermedad Meningocócica. Temporada 2020-2021

[ES] La enfermedad meningocócica invasiva (EMI) es una enfermedad producida por la bacteria Neisseria meningitidis. Esta enfermedad es de declaración obligatoria desde 1.901 y debe notificarse a la Red Nacional de Vigilancia Epidemiológica (RENAVE). Este boletín muestra los resultados obtenidos durante la temporada 2020-2021. La incidencia de casos notificados durante la temporada 2020/2021 disminuyó un 75 % respecto a la temporada anterior 2019/2020. Esta reducción tan significativa se debe a la suma de varios factores; la reducción de la transmisión debido a las medidas de contención de la difusión del SARSCoV-2, el aumento de coberturas de vacunación de la vacuna conjugada tetravalente (Men ACWY) en adolescentes (12 años) y el catch-up realizado en otras edades y, por último, a otras limitaciones de la vigilancia durante esta temporada que pudieron afectar a la disminución. La incidencia descendió en todos los serogrupos y en todos los grupos de edad. [EN] Invasive meningococcal disease (IMD) is a disease caused by Neisseria meningitidis. This disease has been notifiable since 1,901 and must be notified to the National Epidemiological Surveillance Network (RENAVE). This study shows the results obtained during the 2020-2021 season. The incidence of cases reported during the 2020/2021 season decreased by 83.3% compared to the previous 2019/2020 season. This significant reduction is due to the sum of several factors; the reduction of transmission due to measures to contain the spread of SARS-CoV-2, the increase in vaccination coverage of the quadrivalent conjugate vaccine (Men ACWY) in adolescents (12 years) and the catch-up carried out at other ages and, finally, other limitations of surveillance during this season that could affect the decrease. The incidence decreased in all serogroups and in all age groups

Enfermedad Meningocócica. Temporada 2018-2019, 2019-2020

[ES] La enfermedad meningocócica invasiva (EMI) es una enfermedad producida por Neisseria meningitidis. Esta enfermedad es de declaración obligatoria desde 1901 y debe notificarse a la Red Nacional de Vigilancia Epidemiológica (RENAVE). Este estudio muestra los resultados obtenidos durante las temporadas 2018-2019 y 2019-2020. Durante la temporada 2018-2019 la incidencia de la enfermedad meningocócica invasiva continuó la tendencia creciente observada durante las cinco temporadas anteriores. Fundamentalmente, debido al incremento de los serogrupos W e Y. La incidencia de casos notificados durante la temporada 2019/2020 disminuyó un 31,3% respecto a la temporada anterior 2018/2019. Descendió la incidencia en todos los serogrupos y en todos los grupos de edad. Esta disminución podría deberse a la suma de varios factores. En primer lugar, esta temporada coincidió, en parte, con el inicio de la pandemia de COVID-19, y las medidas de contención de la difusión del SARS-CoV-2 afectaron a su transmisión. En segundo lugar, se introdujo en el calendario de vacunación la vacuna conjugada tetravalente (Men ACWY) en adolescentes (12 años) y, por último, otras limitaciones de la vigilancia durante este año pudieron afectar a la disminución. [EN] Invasive meningococcal disease (IMD) is a disease caused by Neisseria meningitidis. IMD has been notifiable since 1901 and must be reported to the National Epidemiological Surveillance Network (RENAVE). This study shows the results obtained during the 2018-2019 and 2019-2020 seasons. During the 2018-2019 season, the incidence of invasive meningococcal disease continued the increasing trend observed during the previous five seasons. Mainly due to the increase of cases of serogroup W and Y. The incidence of cases reported during the 2019/2020 season decreased by 31,3% compared to the previous 2018/2019 season. Incidence decreased in all serogroups and in all age groups. This decrease could be due to the addition of several factors. First, this season coincided, in part, with the onset of the COVID pandemic, and measures to contain the spread of SARS-CoV-2 affected its transmission. Second, the tetravalent conjugate vaccine (Men ACWY) was introduced into the vaccination schedule in adolescents (12 years old) and finally, other limitations of surveillance during this year could affect the decrease.N

A systematic review of the use of health services by immigrants and native populations

Background: Changes in migration patterns that have occurred in recent decades, both quantitative, with an increase in the number of immigrants, and qualitative, due to different causes of migration (work, family reunification, asylum seekers and refugees) require constant u pdating of the analysis of how immigrants access health services. Understanding of the existence of changes in use patterns is necessary to adapt health services to the new socio-demographic reality. The aim of this study is to describe the scientific evidence that assess the differences in the use of health services between immigrant and native populations. Methods: A systematic review of the electronic database MEDLINE (PubMed) was conducted with a search of studies published between June 2013 and February 2016 that addressed the use of health services and compared immigrants with native populations. MeSH terms and key words comprised Health Services Needs and Demands/Accessibility/Disparities/Emigrants and Immigrants/Native/Ethnic Groups. The electronic search was supplemented by a manual search of grey literature. The following information was extracted from each publication: context of the study (place and year), characteristics of the included population (definition of immigrants and their sub-groups), methodological domains (design of the study, source of information, statistical analysis, variables of health care use assessed, measures of need, socio-economic indicators) and main results. Results: Thirty-six publications were included, 28 from Europe and 8 from other countries. Twenty-four papers analysed the use of primary care, 17 the use of specialist services (including hospitalizations or emergency care), 18 considered several levels of care and 11 assessed mental health services. The characteristics of immigrants included country of origin, legal status, reasons for migration, length of stay, different generations and socio-demographic variables and need. In general, use of health services by the immigrants was less than or equal to the native population, although some differences between immigrants were also identified. Conclusions: This review has identified that immigrants show a general tendency towards a lower use of health services than native populations and that there are significant differences within immigrant sub-groups in terms of their patterns of utilization. Further studies should include information categorizing and evaluating the diversity within the immigrant population.The study was funded by the Institute of Health Carlos III and REDISSEC Thematic NetworkS

Geographical variation in relative risks associated with cold waves in Spain: The need for a cold wave prevention plan

In general, there are few studies that analyse the impact of low temperatures on mortality and fewer still that use cold-wave-definition thresholds based on epidemiological and non-climatological criteria. Such a threshold definition, which took into account population features such as socio-economic and demographic characteristics, made it possible for a specific threshold temperature to be obtained for each of Spain's 52 provincial capitals in this study. Using generalised linear models with the Poisson regression link, and controlling for trend, autocorrelations and seasonalities of the series, and influenza epidemics, we obtained the impact of low temperatures on mortality in each provincial capital by calculating the relative risks (RRs) and attributable risks (ARs) for natural as well as circulatory and respiratory causes. The study showed higher minimum temperature thresholds in coastal areas, and an overall impact of cold on mortality in Spain due to natural causes RR=1.13 (95% CI: 1.11-1.16), circulatory causes RR=1.18 (95% CI: 1.15-1.22) and respiratory causes RR=1.24 (95% CI: 1.20-1.29) slightly greater than that obtained to date for heat. From a public health standpoint, there is a need for specific cold wave prevention plans at a regional level which would enable mortality attributable to low temperatures to be reduced. These plans have shown themselves to be effective in decreasing heat-related mortality, and we feel that they are essential for reducing cold-related effects on morbidity and mortality.This study was supported by grants: FIS ENPY 1001/13 & SEPY 1037/14 from Spain's Health Research FundS

Surveillance and epidemiology of Herpes Zoster in Spain

[ES] Fundamentos: El herpes zóster (HZ) aparece debido a la reactivación de la infección latente por el virus de la varicela-zóster y está asociado a la inmunosupresión y al envejecimiento. El HZ es de creciente importancia en las sociedades avanzadas. La vacunación se vislumbra como una potente herramienta para reducir el zóster y su principal complicación: la neuralgia postherpética. El objetivo de este estudio fue describir la tendencia temporal y la distribución por grupos de edad y sexo de los casos, hospitalizaciones y muertes por HZ en España entre 1998 y 2018. Métodos: Se analizaron los casos de HZ notificados a la Red Nacional de Vigilancia Epidemiológica entre 2014-2018, las hospitalizaciones por HZ del registro RAE-CMBD entre 1998-2018 y las muertes por HZ de la Estadística de Mortalidad del INE entre 1999-2018. Se calcularon: tasas de incidencia, hospitalización (TH) y mortalidad (TM) anual y de periodo; tasas globales y por grupos de edad y sexo, así como porcentaje y porcentaje acumulado de casos y hospitalizaciones por grupos de edad. Resultados: La incidencia global de HZ se estimó en 351,6 por cada 100.000 habitantes y en 625,5 por cada 100.000 habitantes en personas de 50 años o más. La incidencia se incrementó con la edad, sobre todo a partir de los 50-54 años (incremento del 41% respecto al grupo de 45-49 años) y fue siempre más alta en mujeres. La TH global por HZ fue 6,75 por cada 100.000 habitantes y 15,7 por cada 100.000 habitantes en personas de 50 años o más. La TH fue creciendo con la edad, sobre todo a partir de los 60-64 años (incremento del 50% respecto al grupo de 54-59 años) y resultó siempre más alta en hombres. El 68,8% de casos y el 80,2% de hospitalizaciones por HZ ocurrieron a partir de los 50 años. Conclusiones: En España, el HZ es una entidad frecuente y grave en adultos y personas mayores, que requiere intervenciones en Salud Pública. Los cambios demográficos y la incorporación de la vacunación exigen seguir monitorizando estrechamente el comportamiento del HZ en términos de incidencia y gravedad. [EN] Background: Herpes Zoster (HZ) results from reactivation of latent varicella-zoster virus infection and is associated with immunosuppression and ageing. HZ is of increasing importance in advanced societies. Vaccination appears as a powerful tool to reduce HZ as well as postherpetic neuralgia, the main zoster complication. This study aims to describe the temporal trend, the age and sex distribution of cases, hospitalisations and deaths by zoster occurred in Spain between 1998 and 2018. Methods: The available information for zoster in Spain were used: cases from National Surveillance System (2014-2018), registries from Spanish hospitalisation database (1998-2018) and deaths from the Spanish mortality statistics (1999-2018). Incidence, hospitalization (HR) and mortality (MR) rates per year and period were calculated. Rates by age group and sex as well as percentage and cumulative percentage for cases and hospitalisations by age group, were also calculated. Results: The global HZ incidence was 351.6/100,000 inhabitants and 625.5/100,000 among population aged 50 and over. The incidence increases with age, especially from the age of 50-54 years (41% increase over the 45-49 age group) and is always higher in women. The global HR was 6.75/100,000 and 15.7/100,000 in persons aged 50 and over; HR increases with age, especially from 60-64 years onwards (50% increase over 54-59 age group) and is always higher in men. The 68.8% of cases and 80.2% of hospitalisations for HZ occurred from the age of 50. Conclusions: In Spain HZ is a frequent and severe entity in adults and elderly people requiring public health interventions. The demographic changes and the introduction of vaccination require continued monitoring of HZ behaviour in terms of incidence and severity.S

Mortality attributable to extreme temperatures in Spain: A comparative analysis by city

BACKGROUND: The Low Temperature Days (LTD) have attracted far less attention than that of High Temperature Days (HTD), though its impact on mortality is at least comparable. This lower degree of attention may perhaps be due to the fact that its influence on mortality is less pronounced and longer-term, and that there are other concomitant infectious winters factors. In a climate-change scenario, the studies undertaken to date report differing results. The aim of this study was to analyse mortality attributable to both thermal extremes in Spain's 52 provinces across the period 2000-2009, and estimate the related economic cost to show the benefit or "profitability" of implementing prevention plans against LTD. METHODS: Previous studies enabled us: to obtain the maximum daily temperature above which HTD occurred and the minimum daily temperature below which LTD occurred in the 52 provincial capitals analysed across the same study period; and to calculate the relative and attributable risks (%) associated with daily mortality in each capital. These measures of association were then used to make different calculations to obtain the daily mean mortality attributable to both thermal extremes. To this end, we obtained a summary of the number of degrees whereby the temperature exceeded (excess °C) or fell short (deficit °C) of the threshold temperature for each capital, and calculated the respective number of extreme temperatures days. The economic estimates rated the prevention plans as being 68% effective. RESULTS: Over the period considered, the number of HTD (4373) was higher than the number of LTD (3006) for Spain as a whole. Notwithstanding this, in every provincial capital the mean daily mortality attributable to heat was lower (3deaths/day) than that attributable to cold (3.48deaths/day). In terms of the economic impact of the activation of prevention plans against LTD, these could be assumed to avoid 2.37 deaths on each LTD, which translated as a saving of €0.29M. Similarly, in the case of heat, 2.04 deaths could be assumed to be avoided each day on which the prevention plan against HTD was activated, amounting to a saving of €0.25M. While the economic cost of cold-related mortality across the ten-year period 2000-2009 was €871.7M, that attributable to heat could be put at €1093.2M. CONCLUSION: The effect of extreme temperatures on daily mortality was similar across the study period for Spain overall. The lower number of days with LTD meant, however, that daily cold-related mortality was higher than daily heat-related mortality, thereby making prevention plans against LTD more "profitable" prevention plans against HTD in terms of avoidable mortality.This study was supported by grants FIS ENPY 1001/13 & SEPY 1037/14 from Spain's Health Research Fund.S

Geographical variation in relative risks associated with heat: Update of Spain's Heat Wave Prevention Plan

A decade after the implementation of prevention plans designed to minimise the impact of high temperatures on health, some countries have decided to update these plans in order to improve the weakness detected in these ten years of operation. In the case of Spain, this update has fundamentally consisted of changing the so-called "threshold" or "trigger" temperatures used to activate the plan, by switching from temperature values based on climatological criteria to others obtained by epidemiological studies conducted on a provincial scale. This study reports the results of these "trigger" temperatures for each of Spain's 52 provincial capitals, as well as the impact of heat on mortality by reference to the relative risks (RRs) and attributable risks (ARs) calculated for natural as well as circulatory and respiratory causes. The results obtained for threshold temperatures and RRs show a more uniform behaviour pattern than those obtained using temperature values based on climatological criteria; plus a clear decrease in RRs of heat-associated mortality due to the three causes considered, at both a provincial and regional level as well as for Spain as a whole. The updating of prevention plans is regarded as crucial for optimising the operation of these plans in terms of reducing the effect of high temperatures on population health.This study was supported by grants FIS ENPY 1001/13 & SEPY 1037/14 from Spain's Health Research Fund.S

Toxoplasmosis in Spain, analysis of hospitalizations during the period 1997-2018

[ES] Fundamentos: La toxoplasmosis es una enfermedad infecciosa sistémica. Se contrae principalmente por ingestión de quistes y/o quistes de Toxoplasma gondii o por afectación fetal tras la primoinfección de la madre embarazada (toxoplasmosis congénita). La prevalencia en España presenta una gran variabilidad, dependiendo de la región y el estudio. La incidencia en otros países europeos refleja un descenso en los últimos años. El objetivo de este estudio fue caracterizar la presencia y el patrón epidemiológico de la enfermedad en la población española a partir de los casos hospitalizados con un diagnóstico de toxoplasmosis al alta. Métodos: A través de la plataforma interactiva del Registro de Atención Sanitaria Especializada (RAE-CMBD) del Ministerio de Sanidad se obtuvieron los datos de altas hospitalarias con diagnóstico “toxoplasmosis”. Se calcularon frecuencias y tasas de altas hospitalarias (TH) según sexo, grupos de edad, comunidad autónoma y diagnóstico al alta. Se analizó la evolución temporal del número de hospitalizaciones a través de gráficos de secuencia. Las tendencias y las pendientes de las TH se analizaron mediante modelos de regresión “joinpoint”, estimándose el porcentaje de cambio anual medio (PCAM) en las TH y su intervalo de confianza al 95%. Resultados: Se contabilizaron 13.704 casos con diagnóstico toxoplasmosis al alta, el 58% hombres. La tasa de hospitalización (TH) más elevada se dio en hombres, en el grupo de 15-44 años (5.804 altas y TH=2,52). Se observa un descenso del 76,8% en el número de altas a lo largo del periodo estudiado, éste fue progresivo y afectó a todas las comunidades autónomas; siendo más acusado en hombres (81,9% vs 63,9%). Conclusiones: El número de hospitalizaciones por toxoplasmosis en España se redujo notable- mente a lo largo del periodo estudiado (1997-2018), mostrando una tendencia similar a la referida en otros estudios europeos. El descenso en los ingresos fue progresivo y afectó fundamentalmente a hombres de 15 a 44 años. [EN] Background: Toxoplasmosis is a systemic infectious disease. Infection is acquired by ingestion of Toxoplasma gondii cysts or by vertical transmission mother-to-child during pregnancy (congenital toxoplasmosis). In Spain, the prevalence shows wide variability depending on the region and the study. The incidence in other European countries evidences a decline in recent years. The aim of this study was to characterize the presence and the epidemiological patterns of the disease in the Spanish population with information obtained of hospitalized cases with a diagnosis of toxoplasmosis at discharge. Methods: The interactive platform of the Specialized Registry (RAE-MBD) of the Ministry of Health was used to obtain data on hospital discharges with “toxoplasmosis” diagnosis. Frequencies and rates of hospital discharges were calculated according to sex, age groups, region and diagnosis at discharge. Sequence graphs were generated to analysed the temporal evolution of the number of hospitalizations. The trends and slopes of the RHs were analyzed using “joinpoint” regression models, estimating the mean annual percentage change (PCAM) in the RHs and its 95% confidence interval. Results: There were 13,704 cases with toxoplasmosis diagnosis at discharge, (58%) were men. The highest hospitalization rate (RH) was in the 15-44-year-old men group (5,804 discharges and HT=2.52). During the period studied a decrease in the number of discharges was observed, it was progressive and affected all the autonomous regions, being more pronounced in men (81.9% vs 63.9%). Conclusions: The number of hospitalizations in Spain decreased substantially during the studied period (1997-2018), similar to other European studies reported. The decrease was progressive and mainly affected men between 15-44 years.S

Patrón epidemiológico de la Toxoplasmosis congénita en España 2010-2018: hospitalización y notificación

[ES] La toxoplasmosis es una zoonosis sistémica causada por Toxoplasma gondii. Es una enfermedad de gran relevancia cuando la infección ocurre durante el embarazo y conlleva daño fetal (toxoplasmosis congénita) o cuando se produce en personas inmunocomprometidas. La toxoplasmosis congénita es un problema de salud pública. Sus efectos en la población podrían reducirse mediante políticas de educación sanitaria y exámenes de detección durante el embarazo. Se necesitan estudios para describir la situación epidemiológica en el territorio (incluidos estudios coordinados dentro del enfoque One Health) y mejorar los sistemas de vigilancia epidemiológica y notificación. El objetivo de este trabajo es mostrar una estimación de la incidencia real de esta enfermedad en España en los últimos años utilizando datos proporcionados por la plataforma interactiva del Registro de Atención Sanitaria Especializada (RAE-CMBD, Ministerio de Sanidad) y su comparación con los datos de notificación a la Red Nacional de Vigilancia Epidemiológica (RENAVE). [EN] Toxoplasmosis is a systemic zoonosis caused by Toxoplasma gondii. It is a major disease when the infection occurs during pregnancy and has foetal damage (congenital toxoplasmosis) or when it occurs in immunocompromised people. Congenital toxoplasmosis is a public health problem. Its impact on the population could be reduced through health education policies and pregnancy screening. Studies are needed to describe the epidemiological situation in the territory (including studies coordinated with the One Health approach) and to improve epidemiological surveillance and reporting systems. The objective of this work is to show an estimate of the actual incidence of this disease in Spain in recent years, using data provided by the interactive platform of the Registry of Specialized Healthcare (RAE-CMBD, Ministry of Health) and its comparison with the data of notification to the National Epidemiological Surveillance Network (RENAVE).N