La Morbiditat com a mesura dels trastorns crònics en una cohort representativa de la població de Catalunya (estudi COHESCA)

Títol obtingut de la portada digitalitzadaConsultable des del TDXIntroducció: La morbiditat entesa com la presència de múltiples trastorns crònics (TC) en una mateixa persona esdevé un problema de salut cada vegada més rellevant degut tant a l'envelliment que s'observa en les poblacions de països anomenats desenvolupats, com a l'augment de la prevalença dels TC en aquest sector de la població. La morbiditat es pot mesurar com a Multimorbiditat (sumatori del nombre de TC presents en un individu), com a Comorbiditat (co-occurrència de TC en individus ja diagnosticats d'una malaltia determinada) o com a Índex de comorbiditat (mesura que combina tant el nombre com la gravetat dels TC) Objectiu: Determinar les diferències de la supervivència d'una cohort representativa de la població no institucionalitzada de Catalunya entre els anys 1994 i 1998 segons la presència de morbiditat declarada. Mètodes: L'estudi COHESCA (Cohort de l'Enquesta de Salut de Catalunya 94) es va establir a partir del seguiment dels 15.000 participants des de la data realització de l'enquesta l'any 1994 fins el final del seguiment (data de defunció o 31.12.1998). L'estat vital es va obtenir mitjançant la connexió amb el Registre de Mortalitat de Catalunya. A l'anàlisi es van incloure aquells individus que a l'inici del seguiment tenien entre 40 i 84 anys (3.105 homes i 3.536 dones). Es va obtenir un índex de comorbiditat com el sumatori de tots els TC declarats multiplicat pel pes corresponent a cada risc relatiu de morir de cada un dels TC. Es van ajustar models de regressió logística per obtenir els riscos relatius (RR) de morir i els seus intervals de confiança del 95%(IC 95%) segons les categories de multimorbilitat i comorbilitat. Pel càlcul del RR i IC 95% segons les categories de l'índex de comorbiditat es va utilitzar un model de riscos proporcionals de Cox on l'escala de temps va ser l'edat (entrades retardades). La bondat d'ajust del model va ser valorada basant-nos en la calibració (a partir de la detecció de diferències no estadísticament significatives entre la mortalitat esperada i la observada mitjançant l'estadístic de Hosmer-Lemeshow) i la discriminació (analitzada usant l'àrea sota la corba ROC) tant en la cohort de desenvolupament com en la de validació (cohort de l'enquesta de salut de Barcelona-00). Es va ajustar per classe social, hàbit tabàquic, consum d'alcohol, activitat física i estat de salut autopercebut. Totes les anàlisis es van realitzar estratificades per sexe. Resultats: En les dades de l'estudi COHESCA després de 5 anys de seguiment, l'efecte del número de TC sobre la mortalitat en ambdós sexes no mostren un increment significatiu del risc de morir a mesura que augmenta el número de TC. En aquells individus ja diagnosticats d'embòlia s'ha obtingut un augment del risc de morir en ambdós sexes, per cada malaltia addicional i per cada any d'edat. A mesura que augmenta la puntuació de l'índex de comorbiditat, el risc de morir augmenta tant en homes com en dones. Aquest índex ha mostrat una bona calibració i discriminació en ambdós sexes. En la cohort de validació, l'índex de comorbiditat ha mostrat també una bona calibració en els homes, però no en les dones, i una bona discriminació en la cohort de validació en ambdós sexes. Discussió: En estudis de seguiment és necessari incloure la morbiditat per diversos motius: per controlar el seu efecte confusor i millorar la seva validesa interna, per detectar possibles modificacions sobre el risc de morir, per utilitzar-los com mesura resum millorant a la vegada l'eficiència estadística i pel seu paper clau com a mesura predictora del risc de morir. L'elecció d'una de les mesures dels trastorns crònics dependrà de diferents aspectes com són els objectius plantejats, el disseny de l'estudi, la font d'obtenció de les dades, la variable resultat d'interès, la validesa de la mesura i la seva capacitat predictiva. En concret, l'ús d'un índex de comorbiditat comporta diferents avantatges: usar una variable resum enlloc de diversos models per explicar l'efecte de cada trastorn crònic en la mortalitat incrementant l'eficiència de l'anàlisi, usar un instrument validat que simplifica el procés de selecció de les variables i a més permet la comparabilitat amb altres estudis. La discriminació del nostre índex és lleugerament millor a la de diferents índexs pronòstics basats en adaptacions de l'índex de comorbiditat de Charlson, malgrat que els diferents índexs consideren múltiples diagnòstics mèdics i marcadors bioquímics de malalties, diferents poblacions d'estudi, diferents metodologies i diferents variables d'ajustament.Introduction: The presence of multiple chronic diseases in the same individual has currently become a relevant public health problem for two reasons: the aging of population in developed countries and the increasing prevalence of chronic conditions related to older people. Morbidity could be measured as a multimorbidity (simple summing up of the number of chronic diseases present in one individual), as a comorbidity (co-occurrence of specific diseases in addition to an index disease of interest) or as a comorbidity index (a measure that summarizes the number and severity of chronic diseases in the same person) Objective: To determine survival differences in a representative cohort of the non-institutionalised population of Catalonia during the period 1994-1998 by the presence of self-reported morbidity, in both men and women, adjusting by demographics, life styles and selfperceived health. Methods: The COHESCA Study (Catalan Health Interview Survey Follow-up Study) was based on the 1994 Catalan Health Interview Survey. 15000 individuals were traced since the beginning of the follow-up (interview date) to the end of the follow-up (death date or December 31st 1998). The vital status was established by record-linkage with data from Mortality Register from 1994 to 1998. The analysis was restricted to subjects aged 40-84 years at the initial interview (3105 men and 3536 women) The co-morbidity index was obtained by means of addition of all self-declared chronic conditions multiplied by weight of each relative risk of death by each chronic condition. We adjusted a logistic regression model in order to obtain the relative risk of death (RR) and its 95% confidence interval (95%CI ) by the categories of multimorbidity and comorbidity. We fitted Cox proportional risk model with staggered entries for age (time scale) in order to calculate RR of death and 95% CI by the categories of comorbidity index. We assessed the predictive accuracy of the final model by looking at calibration (by comparing the predicted mortality with the actual mortality by means of the Hosmer- Lemeshow statistic) and discrimination (using the area under the ROC curves) in the development as well as in the validation cohort (Barcelona Health Interview Cohort 2000). All the analysis was stratified by sex and adjusted by social class, tobacco and alcohol consumption, physical activity and self-perceived health. Results: After 5 years follow-up, we have not detected an increase of the risk of death together with the number of chronic diseases (multimorbidity) in both sexes, in the sense that no more chronic conditions mean more mortality. In those individuals suffering from stroke we have obtained an increase in the risk of death, in both sexes, together with an increase of the risk of death for each additional selected disease and for each additional year of age. Moreover, the risk of death increases along with the co-morbidity index score in both sexes. The index shows a good calibration and discrimination in both sexes. In the validation cohort, we obtained a good calibration among men but not in women and a good discrimination in both sexes. Discussion: In follow-up studies, it is necessary to take the presence of chronic diseases into account for different reasons: to control as a potential confounder improving its internal validity; to detect possible effect modification on the risk of death; to increase statistical efficiency of the analysis; and finally for its key role as a mortality predictor. To choose one of the 3 morbidity measures could depend on different aspects as the objectives of the study, the study design itself, the source of data, the outcome variable, the validity of the measure and its predictive accuracy. Specifically, to use a comorbidity index implied different advantages: to use it as a summary variable and consequently to increase the analysis statistical efficiency; a more simplified variable selection process or an easier comparable tool with other existing studies. The discrimination of our index was slightly better than that of other adaptations of Charlson co-morbidity index. Those prognostic indices consider multiple medical diagnoses and biochemical markers of diseases, different target populations, different methodologies, and different adjusting variables

Behavior of hospitalized severe influenza cases according to the outcome variable in Catalonia, Spain, during the 2017-2018 season

Infuenza is an important cause of severe illness and death among patients with underlying medical conditions and in the elderly. The aim of this study was to investigate factors associated with ICU admission and death in patients hospitalized with severe laboratory-confrmed infuenza during the 2017-2018 season in Catalonia. An observational epidemiological case-to-case study was carried out. Reported cases of severe laboratory-confrmed infuenza requiring hospitalization in 2017-2018 infuenza season were included. Mixed-efects regression analysis was used to estimate the factors associated with ICU admission and death. A total of 1306 cases of hospitalized severe infuenza cases were included, of whom 175 (13.4%) died and 217 (16.6%) were ICU admitted. Age 65-74 years and≥ 75 years and having≥ 2 comorbidities were positively associated with death (aOR 3.19; 95%CI 1.19-8.50, aOR 6.95, 95%CI 2.76-1.80 and aOR 1.99; 95%CI 1.12-3.52, respectively). Neuraminidase inhibitor treatment and pneumonia were negatively associated with death. The 65-74 years and≥ 75 years age groups were negatively associated with ICU admission (aOR 0.41; 95%CI 0.23-0.74 and aOR 0.30; 95%CI 0.17-0.53, respectively). A factor positively associated with ICU admission was neuraminidase inhibitor treatment. Our results support the need to investigate the worst outcomes of hospitalized severe cases, distinguishing between death and ICU admission

Trends in the Epidemiology of Leishmaniasis in the City of Barcelona (1996-2019)

Background: Leishmaniasis is a neglected zoonosis produced by 20 different flagellated parasites of the Leishmania genus, a protozoan transmitted to humans and other vertebrates by the bite of dipteran insects of the Phlebotominae subfamily. It is endemic in Mediterranean countries and the number of cases is expected to increase due to climate change and migration. Prioritizing public health interventions for prevention and control is essential. The objective was to characterize the epidemiology and temporal trends in the incidence of human leishmaniasis in the city of Barcelona, between the years 1996 and 2019. Methods: A population-based, analytical observational study among residents in the city of Barcelona was conducted of all the cases of leishmaniasis reported between 1996 and 2019 to the Public Health Agency. The epidemiological survey contains clinical, diagnostic, and epidemiological data, including contact with suspicious mammals or insects. Annual incidence-rates were calculated by sex, age, and country of origin. Chi-square tests were used to assess association between studied risk factors, periods of time and type of leishmaniasis. Results: During the study period a total of 177 cases of leishmaniasis were reported in Barcelona, being 74.6% (n = 132) of the total cases in Spanish born, although within the foreign-born population the incidence was higher. Median age was 34 years (IQR = 10-48) and 121 (66.8%) were male. The main type was cutaneous (46%) followed by visceral (35.1%). The cumulative incidence was 0.47 per 100,000 inhabitants, with the highest incidence found in 2017 (1.60 per 100,000 inhabitants). A higher incidence was observed in the 0-4-year-old group (1.73 per 100,000 inhabitants), but increased during the study period for all age groups. There was an increase of foreign origin cases, and a decrease in the number of cases associated to any immunosuppression. Conclusion: In Barcelona, leishmaniasis incidence continues to be higher in people under 5 years of age, and 25-64 years old males, but it has also increased in population from foreign country of birth. There is an increase of the cases since 2016, probably due to the changes in the notification system, increasing the diagnosis of cutaneous leishmaniasis. Improvements in the current surveillance system are needed. Notification of the disease, vector, and reservoir control activities are also essential for the control of the disease

Epidemiological Characteristics and Spatio-Temporal Distribution of Hepatitis A in Spain in the Context of the 2016/2017 European Outbreak

Altres ajuts: The APC was funded by the Programme of Prevention, Surveillance, and Control of Transmissible Diseases (PREVICET), CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid (Spain).The aim of our study was to describe the results of the epidemiological surveillance of hepatitis A infections in Spain in the context of the 2016/2017 European outbreak, particularly of hepatitis A outbreaks reported in the MSM population, incorporating the results of a spatio-temporal analysis of cases. Hepatitis A cases and outbreaks reported in 2016-2017 to the National Epidemiological Surveillance Network were reviewed: outbreaks in which some of the cases belonged to the MSM group were described, and clusters of hepatitis A cases in men and women were analysed using a space-time scan statistic. Twenty-six outbreaks were identified, with a median size of two cases per outbreak, with most of the outbreak-related cases belonging to the 15-44 years-old group. Nearly 85% occurred in a household setting, and in all outbreaks, the mode of transmission was direct person-to-person contact. Regarding space-time analysis, twenty statistically significant clusters were identified in the male population and eight in the female population; clusters in men presented a higher number of observed cases and affected municipalities, as well as a higher percentage of municipalities classified as large urban areas. The elevated number of cases detected in clusters of men indicates that the number of MSM-related outbreaks may be higher than reported, showing that spatio-temporal analysis is a complementary, useful tool which may improve the detection of outbreaks in settings where epidemiological investigation may be more challenging

A large outbreak of COVID-19 linked to an end of term trip to Menorca (Spain) by secondary school students in summer 2021

Coronavirus SARS-CoV-2; COVID-19; 2019-nCov; Joves; BrotCoronavirus SARS-CoV-2; COVID-19; 2019-nCov; Jóvenes; BroteCoronavirus SARS-CoV-2; COVID-19; 2019-nCov; Youths; OutbreakBackground: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in young people from Catalonia (Spain) who travelled to Menorca (Spain) in summer 2021. This outbreak appeared when governments relaxed Covid-19 preventive measures: the mask usage and the opening of nightlife. It was related to a super-disseminating mass event: Sant Joan festivities in Ciutadella. The aim of this article is to describe an outbreak of COVID-19 in young people aged 17–19 years from Catalonia travelling to Menorca. Methods: This is an observational study of a COVID-19 outbreak. The study population comprised Catalonian youth aged 17–19 years who travelled to Menorca from 15 June to 10 July. Epidemiological descriptive indicators were obtained. Descriptive and geographical statistics were carried out. Bivariate Moran’s I test was used to identify spatial autocorrelation between the place of residence and deprivation. The outbreak control method was based on identifying and stopping chains of transmission by implementing the test-trace-isolate-quarantine (TTIQ) strategy. Results: We identified 515 confirmed cases infected in Menorca, 296 (57.5%) in girls and 219 (42.5%) in boys, with a total of 2,280 close contacts. Of them, 245 (10.7%) were confirmed as cases. The cases were diagnosed between 15 June and 10 July. None of the persons with confirmed infection died or required hospitalisation. The attack rate was 27.2%. There was an inverse relationship between deprivation and number of confirmed cases (p<0.005), there were clusters of confirmed cases in the most socioeconomic favoured areas. Discussion: The outbreak is related with young people from socioeconomic favoured areas who travelled to Menorca in summer 2021. Failure to comply with preventive measures in binge-drinking events and during holidays may have favoured SARS-CoV-2 transmission. The interauthority coordination and establishment of a clear line of leadership allowed continuous communication between institutions, which were key to managing this complex COVID-19 outbreak

Coordinated response to imported vaccine-derived poliovirus infection, Barcelona, Spain, 2019-2020

In 2019, the Public Health Agency of Barcelona, Spain, was notifi ed of a vaccine-derived poliovirus infection. The patient had an underlying common variable immunodefi ciency and no signs of acute fl accid paralysis. We describe the ongoing coordinated response to contain the infection, which included compassionate-use treatment with pocapavir

Lipoatròfia semicircular: protocol d'actuació 2015

Lipoatròfia semicircular; Prevenció; Procediments d'actuacióLipoatrophia semicircularis; Prevention; ProceduresLipoatrofia semicircular; Prevención; Procedimientos de actuaciónRecull detallat de les mesures preventives, de les actuacions en cas de lipoatròfia semicircular i tot allò relacionat amb l'obtenció de dades per a la notificació i seguiment de la malaltia

Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Ministerio de Ciencia e Innovación; Gerencia Regional de Salud de Castilla y León (SACYL, GRS COVID 32/A/20).Aims Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. Methods 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. Results 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. Conclusions Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT0455656

SARS-CoV-2 Catalonia contact tracing program : evaluation of key performance indicators

Background: Guidance on SARS-CoV-2 contact tracing indicators have been recently revised by international public health agencies. The aim of the study is to describe and analyse contact tracing indicators based on Catalonia's (Spain) real data and proposing to update them according to recommendations. Methods: Retrospective cohort analysis including Catalonia's contact tracing dataset from 20 May until 31 December 2020. Descriptive statistics are performed including sociodemographic stratification by age, and differences are assessed over the study period. Results: We analysed 923,072 contacts from 301,522 SARS-CoV-2 cases with identified contacts (67.1% contact tracing coverage). The average number of contacts per case was 4.6 (median 3, range 1-243). A total of 403,377 contacts accepted follow-up through three phone calls over a 14-day quarantine period (84.5% of contacts requiring follow-up). The percentage of new cases declared as contacts 14 days prior to diagnosis evolved from 33.9% in May to 57.9% in November. All indicators significantly improved towards the target over time (p < 0.05 for all four indicators). Conclusions: Catalonia's SARS-CoV-2 contact tracing indicators improved over time despite challenging context. The critical revision of the indicator's framework aims to provide essential information in control policies, new indicators proposed will improve system delay's follow-up. The study provides information on COVID-19 indicators framework experience from country's real data, allowing to improve monitoring tools in 2021-2022. With the SARS-CoV-2 pandemic being so harmful to health systems and globally, is important to analyse and share contact tracing data with the scientific community

Vigilància epidemiològica dels casos greus hospitalitzats confirmats de grip. Xarxa sentinella PIDIRAC (Catalunya 2010-2015)

Grip; Viigilància; Epidemiologia; Antivírics; VacunaGripe; Vigilancia; Epidemiología; Antivíricos; VacunaFlu; Surveillance; Epidemiology; Antivirals; VaccineIntroducció: el Pla d’informació de les infeccions respiratòries agudes a Catalunya (PIDIRAC) va incorporar la vigilància de casos greus hospitalitzats confirmats de grip (CGHCG) l’any 2009. L’objectiu de l’estudi és descriure les característiques clíniques, epidemiològiques i virològiques dels CGHCG registrats en 12 hospitals de la xarxa sentinella durant cinc temporades gripals. Mètode: la mostra consta dels CGHCG registrats durant les temporades que van de 2010-2011 a 2014-2015. La tècnica de confirmació emprada ha estat la PCR i/o l’aïllament viral en cultiu cel·lular a partir de mostra respiratòria. Resultats: es van registrar 1.400 CGHCG, dels quals un 33% van requerir ingrés a l’UCI i un 12% van ser èxitus. La mitjana d’edat dels casos va ser de 55,2 anys (DE: 26,7 anys), amb un rang de 0-101 anys. Un 70,8% no estaven vacunats; un 87% van rebre tractament antiviral en el 80,4% i el 24% dels casos abans de 48 hores d’ingrés i d’inici de símptomes, respectivament. En el 87,7% dels casos es va identificar el virus de la grip A (37,9% A(H1N1)pdm09 i 29,3% A(H3N2)). Conclusions: la vigilància de CGHCG proporciona una estimació de la gravetat de les epidèmies estacionals de grip i permet identificar i caracteritzar grups de risc per adoptar mesures preventives (vacunació) i tractament antiviral precoç.Introducción: el Plan de información de las infecciones respiratorias agudas en Cataluña (PIDIRAC) incorporó la vigilancia de casos graves hospitalizados confirmados de gripe (CGHCG) el año 2009. El objetivo del estudio es describir las características clínicas, epidemiológicas y virológicas de los CGHCG registrados en 12 hospitales de la red centinela durante cinco temporadas gripales. Método: la muestra consta de los CGHCG registrados durante las temporadas que van de 2010-2011 a 2014-2015. La técnica de confirmación utilizada ha sido la PCR y/o el aislamiento viral en cultivo celular a partir de muestra respiratoria. Resultados: se registraron 1.400 CGHCG, de los cuales un 33% requirieron ingreso a la UCI y un 12% fueron exitus. La media de edad de los casos fue de 55,2 años (DE: 26,7 años), con un rango de 0-101 años. Un 70,8% no estaban vacunados; un 87% recibieron tratamiento antiviral, en el 80,4% y el 24% de los casos antes de 48 horas de ingreso y de inicio de síntomas, respectivamente. En el 87,7% de los casos se identificó virus de la gripe A (37,9% A(H1N1)pdm09 y 29,3% A(H3N2)). Conclusiones: la vigilancia de CGHCG proporciona una estimación de la gravedad de las epidemias estacionales de gripe y permite identificar y caracterizar grupos de riesgo para adoptar medidas preventivas (vacunación) y tratamiento antiviral precoz.Introduction: the Information Plan for Acute Respiratory Infections in Catalonia (PIDIRAC) incorporated the surveillance of severe confirmed influenza hospitalized cases (CGHCG) in 2009. The objective of the study is to portray the clinical, epidemiological and virological features of the CGHCG registered in 12 sentinel hospitals during 5 influenza seasons. Method: the sample consists of the CGHCG registered during 2010-2011 to 2014-2015 influenza seasons. The confirmation technique used was PCR and/or viral isolation in cell culture from respiratory sample. Results: 1400 CGHCG were registered, of which 33% required admission to ICU and 12% were exitus. The mean age of cases was 55.2 years (SD: 26.7 years), range of 0-101 years. 70.8% were not vaccinated; 87% received antiviral treatment, in 80.4% and 24% of the cases before 48 hours of admission and of beginning of symptoms, respectively. 87,7% of the cases identified influenza virus A (37,9% AH1N1pdm09, 29,3% AH3N2). Conclusions: surveillance of CGHCG provides an estimation of the severity of seasonal influenza epidemics allows to identify and characterize at-risk groups to adopt preventive measures (vaccination) and early antiviral treatment