Excess mortality in Spain during transmission of pandemic influenza in 2009

Fundamento: El sistema español de monitorización de la mortalidad y el "Programa Europeo de monitorización de excesos de mortalidad para la acción en salud pública" detectaron dos excesos de mortalidad en España en noviembre y diciembre de 2009. El objetivo de este trabajo es valorar su posible asociación con la transmisión de gripe pandémica. Métodos: Se analizó la evolución de la mortalidad en España en los meses citados utilizando métodos de análisis de series temporales basados en las series históricas de mortalidad y se comparó en el tiempo con la transmisión de gripe. Resultados: La mortalidad observada en la población total fue mayor de lo esperado en dos periodos: semanas 46-47/2009 con 5,75% de exceso y las semanas 51-52/2009 con 7,35% de exceso. También se registró un exceso de mortalidad en niños de 5 a 14 años en las semanas 46-48/2009 con 41 defunciones vs las 21 esperadas. El exceso de mortalidad en noviembre fue concomitante con las mayores tasas de gripe. El exceso de diciembre se observó 5 semanas después del pico de gripe y coincidió con un descenso dramático de las temperaturas. El virus sincitial respiratorio y los accidentes de tráfico fueron descartados como factores asociados. Conclusiones: Mientras que las temperaturas podrían explicar la mayoría del exceso de mortalidad observado en diciembre, ningún factor por si solo podría explicar el exceso de noviembre. BACKGROUND: The Spanish daily mortality monitoring system and the program «European monitoring of excess mortality for public health action» found two excesses of mortality in Spain in November and December 2009. METHODS: We analyzed the evolution of mortality in Spain during those months using time-series analysis methods based on historical mortality series and compared it in the time with influenza transmission. RESULTS: Observed mortality for the total population was higher than expected in two periods: weeks 46-47/2009 with 5.75% excess and weeks 51-52/2009 with 7.35% excess. Observed mortality higher than expected, was also observed in children 5-14 years old during weeks 46-48/2009 with 41 deaths vs 21 expected. Exces mortality in November occurred before or was concomitant with highest influenza incidence rates. Excess mortality in December occurred five weeks after the influenza incidence peak and along with dramatic drop in temperatures. RSV and traffic accidents were ruled out as factor associated to these excesses. CONCLUSIONS: While temperatures could explain most of the excess mortality observed in December, no single factor could be associated with observed excess mortality in November

Spatial analysis of road traffic accidents with fatalities in Spain, 2008-2011.

Objetivo Estimar las áreas de mayor densidad de accidentes de tráfico en carretera con víctimas mortales a 24 horas por km2/año en la España peninsular, en el periodo de 2008 a 2011, utilizando un sistema de información geográfica. Métodos Se geocodificaron los accidentes según la carretera y el punto kilométrico donde ocurrieron. Se calculó el promedio del vecino más cercano para detectar posibles clusters y obtener el ancho de banda necesario para calcular la densidad de Kernel. Resultados Se analizaron 4775 accidentes, de los cuales el 73,3% se produjeron en carreteras secundarias. La distancia media estimada entre los accidentes fue de 1242 metros, y la distancia media esperada fue de 10.738 metros. El índice del vecino más cercano fue de 0,11, lo que significa que existen agregaciones de accidentes en el espacio. Se obtuvo un mapa con la densidad de Kernel, con una resolución de 1 km2, que permite conocer aquellas áreas donde la densidad es mayor. Conclusiones Esta metodología permite obtener una mayor aproximación al origen de los riesgos de los accidentes de tráfico al tener en cuenta el punto kilométrico. El mapa obtenido permite visualizar aquellas áreas donde hubo una mayor densidad de accidentes. Esto puede ser una ventaja a la hora de tomar decisiones por parte de las autoridades competentes. To estimate the areas of greatest density of road traffic accidents with fatalities at 24 hours per km(2)/year in Spain from 2008 to 2011, using a geographic information system. Accidents were geocodified using the road and kilometer points where they occurred. The average nearest neighbor was calculated to detect possible clusters and to obtain the bandwidth for kernel density estimation. A total of 4775 accidents were analyzed, of which 73.3% occurred on conventional roads. The estimated average distance between accidents was 1,242 meters, and the average expected distance was 10,738 meters. The nearest neighbor index was 0.11, indicating that there were aggregations of accidents in space. A map showing the kernel density was obtained with a resolution of 1 km(2), which identified the areas of highest density. This methodology allowed a better approximation to locating accident risks by taking into account kilometer points. The map shows areas where there was a greater density of accidents. This could be an advantage in decision-making by the relevant authorities.S

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events