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Background: This study compares the severity of SARS-CoV-2 infections caused by Alpha, Delta or Omicron variants in periods of co-circulation in Spain, and estimates the variant-specific association of vaccination with severe disease., Methods: SARS-CoV-2 infections notified to the national epidemiological surveillance network with information on genetic variant and vaccination status were considered cases if they required hospitalisation or controls otherwise. Alpha and Delta were compared during June-July 2021; and Delta and Omicron during December 2021-January 2022. Adjusted odds ratios (aOR) were estimated using logistic regression, comparing variant and vaccination status between cases and controls., Results: We included 5,345 Alpha and 11,974 Delta infections in June-July and 5,272 Delta and 10,578 Omicron in December-January. Unvaccinated cases of Alpha (aOR: 0.57; 95% CI: 0.46-0.69) or Omicron (0.28; 0.21-0.36) had lower probability of hospitalisation vs. Delta. Complete vaccination reduced hospitalisation, similarly for Alpha (0.16; 0.13-0.21) and Delta (June-July: 0.16; 0.14-0.19; December-January: 0.36; 0.30-0.44) but lower from Omicron (0.63; 0.53-0.75) and individuals aged 65+ years., Conclusion: Results indicate higher intrinsic severity of the Delta variant, compared with Alpha or Omicron, with smaller differences among vaccinated individuals. Nevertheless, vaccination was associated to reduced hospitalisation in all groups., (Copyright © 2022 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Background: This study compares the severity of SARS-CoV-2 infections caused by Alpha, Delta or Omicron variants in periods of co-circulation in Spain, and estimates the variant-specific association of vaccination with severe disease., Methods: SARS-CoV-2 infections notified to the national epidemiological surveillance network with information on genetic variant and vaccination status were considered cases if they required hospitalisation or controls otherwise. Alpha and Delta were compared during June-July 2021; and Delta and Omicron during December 2021-January 2022. Adjusted Odds Ratios (aOR) were estimated using logistic regression, comparing variant and vaccination status between cases and controls., Results: We included 5,345 Alpha and 11,974 Delta infections in June-July and, 5,272 Delta and 10,578 Omicron in December-January. Unvaccinated cases of Alpha (aOR: 0.57; 95% CI: 0.46-0.69) or Omicron (0.28; 0.21-0.36) had lower probability of hospitalisation vs. Delta. Complete vaccination reduced hospitalisation, similarly for Alpha (0.16; 0.13-0.21) and Delta (June-July: 0.16; 0.14-0.19; December-January: 0.36; 0.30-0.44) but lower from Omicron (0.63; 0.53-0.75) and individuals aged 65+ years., Conclusion: Results indicate higher intrinsic severity of the Delta variant, compared with Alpha or Omicron, with smaller differences among vaccinated individuals. Nevertheless, vaccination was associated to reduced hospitalisation in all groups., (© 2022 Published by Elsevier España, S.L.U. on behalf of Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica.)

Background and Objective: Hand hygiene (HH) is the simplest and most effective measure for the prevention of infection related to healthcare. Despite this, compliance in healthcare professionals continues to be suboptimal. The aim of this study is to assess the impact of an expanded World Health Organization (WHO) multimodal strategy on HH compliance in healthcare personnel., Material and Methods: A quasi-experimental before-after study was designed, carrying out the expanded WHO multimodal strategy in 2018, aimed at professionals in a tertiary hospital. In this strategy, apart from applying the 5 pillars of the WHO, a video was made, the administration of the WHO perceptions questionnaire and an incentive to the service/unit with better compliance, adding to the training a modality of practical workshops. The compliance percentages for 2017 and 2018 were compared., Results: In 2017, 1056 opportunities were observed, registering 631 HH actions, with global compliance of 60% (95% CI 56.7-62.7). In 2018, with 1481 opportunities observed and 1111 HH actions, compliance was 75% (95% CI 72.7-77.2) (P<.001). This compliance increased in all professional categories and in all indications., Conclusions: The application of an expanded multimodal strategy has a positive impact on HH compliance. Strategies should be directed to the categories with the worst compliance and continuously over time., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

Background and Objectives: Predominantly antibody deficiencies are the most prevalent primary immunodeficiency (PID) in adults. These are rare diseases difficult to diagnose. Therefore, they are diagnosed late. This study aims to evaluate whether an awareness campaign of PIDs among physicians is associated with an increase in number of diagnoses, a reduction in diagnostic delay and diagnosis at earlier stages., Patients and Methods: A single centre, interventional, quasi-experimental study was designed that included 2 periods, period 1 pre-intervention (1986-2008) and period 2 post-intervention (2009-2018). A descriptive comparative study of variables was carried out in both periods., Results: 116 patients were included [27 (23.3%) in period 1 and 89 (76.7%) in period 2]. The incidence rate increased significantly (0.204 and 1.236/100,000habs./year; P < 0.05), the diagnosis delay tended to be lower (4 vs. 3.73 years). The reasons for diagnostic suspicion were diverse and the burden disease at diagnosis (expressed by bronchiectasis, altered spirometry, ability to generate antibodies by thymus-independent mechanism and need for substitute treatment) tended to decrease in period 2., Conclusions: Given the potentially serious complications of patients with late diagnosis of PIDs, it is necessary to create specialized multidisciplinary units, to unify assistance protocols and to design interventions to increase the knowledge of these entities., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

Objectives: The objective of this research was to evaluate the effect of influenza vaccination on the prevention of influenza-related severe cases in adults treated in a third-level hospital during the 2017-2018 epidemic season., Methodology: A descriptive analysis was performed on the entire population of subjects with a laboratory-confirmed influenza test during the 2017-2018 season. A severe case was defined as a patient treated in one of the Intensive Care Units (ICUs) and/or death. The effect of the vaccine on the adult population was determined by multivariate logistic regression analysis., Results: Between epidemiological weeks 44/2017 and 19/2018, the hospital's laboratory detected 706 positive samples for influenza virus. Of the 551 confirmed patients aged 18 years or older, forty-three were admitted to one of the ICUs, and 26 died during admission. The explanatory multivariate model has shown that flu vaccination prior to or during the epidemic season was a protective factor for the development of severity [OR:0.27 (0.11-0.65, p=0.004)], adjusted by age [OR: 1.03 (1.01-1.06), p=.04], sex, type of virus (H1N1-pdm09, H3N2 or B virus), Chronic Complex Patient index or Advanced Chronic Disease index., Conclussions: Influenza vaccination is a protective factor against the development of severity associated with influenza infection in a season when vaccination did not contain the virus with higher epidemic circulation among the population. Flu vaccination should be recommended annually following the guidelines established by the health authorities., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

Introduction: It is known that infants with viral respiratory infections severe enough to require hospital admission have a high risk of developing recurrent wheezing. Few data have been published on unselected populations. The main aim of this study was to analyse symptomatic and asymptomatic respiratory viral infections during the first year of life in a cohort of infants, recruited at birth, and the development of recurrent wheezing., Patients and Methods: A total of 302 newborns were recruited. A nasopharyngeal aspirate was taken when the patients had a respiratory infection, as well as in the visits for vaccination at 2, 4, 6, and 12 months. RT-nested PCR assays were performed to detect 16 viruses., Results: A total of 1,293 samples were analysed (1,005 healthy controls and 288 respiratory infections). Samples taken during routine check-ups were positive in 30.8% of cases, while those with respiratory infection were positive in 77.8%, P<.001 (OR: 3, 95% CI: 2.4-3.8). A total of 239 (79%) infants had at least 1 positive respiratory viral infection detected. The most frequent virus (71%) was rhinovirus (RV). Recurrent wheezing was found in 27 (11%) children during their first year of life (1.2 episodes, SD 2.9). Recurrent wheezing was present in 58.3% of patients admitted to hospital during their first viral infection, vs. 8.6% of infants when the first infection was mild or who had asymptomatic viral detection, P<.001 (OR: 2.18; 95% CI: 1.05-4.5)., Conclusions: In our series, severe respiratory infections leading to hospitalisation in the first months of life are risk factors for developing wheezing, but not in the case of mild RV infections., (Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: This is the general methods describing paper of a cross-sectional study that aims to detect the prevalence of major mental disorders in Andalusia (Southern Spain), and their correlates or potential risk factors, using a large representative sample of community-dwelling adults., Materials and Methods: This is a cross-sectional study. We undertook a multistage sampling using different standard stratification levels and aimed to interview 4,518 randomly selected participants living in all 8 provinces of the Andalusian region utilizing a door-knocking approach. The Spanish version of the MINI International Neuropsychiatric Interview, a valid screening instrument ascertaining ICD-10/DSM-IV compatible mental disorder diagnoses was used as our main diagnostic tool. A large battery of other instruments was used to explore global functionality, medical comorbidity, personality traits, cognitive function and exposure to psychosocial potential risk factors. A saliva sample for DNA extraction was also obtained for a sub-genetic study. The interviews were administered and completed by fully trained interviewers, despite most tools used are compatible with lay interviewer use., Results: A total of 3,892 (70.8%) of 5,496 initially attempted households had to be substituted for equivalent ones due to either no response (37.7%) or not fulfilling the required participant quota (33%). Thence, out of 5,496 eligible participants finally approached, 4,507 (83.7%) agreed to take part in the study, completed the interview and were finally included in the study (n=4,507) and 4,286 (78%) participants also agreed and consented to provide a saliva sample for DNA study. On the other hand, 989 (16.3%) approached potential participants refused to take part in the study., Discussion: This is the largest mental health epidemiological study developed in the region of Spain (Andalusia). The response rates and representativeness of the sample obtained are fairly high. The method is particularly comprehensive for this sort of studies and includes both, personality and cognitive assessments, as well as a large array of bio-psycho-social risk measures., (Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.)

Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guide-line for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the Grading of Recommendations of Assessment Development and Evaluations methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health., (Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guideline for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the GRADE (Grading of Recommendations of Assessment Development and Evaluations) methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at the risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health., (Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Introduction: The aim of the study is to analyze the information on respiratory syncytial virus (RSV) obtained through the Spanish Influenza Surveillance System (SISS) and to study its usefulness as supplementary information for the characterization of influenza epidemics., Methods: The temporal patterns of both RSV and influenza viruses were analyzed by patterns comparing the weekly viral detection rates from 2006 to 2014., Results: In general, the RSV circulation was characterized by showing a peak between 52-1 weeks, and circulated from 2 to 8 weeks before/prior to influenza viruses., Conclusion: RSV information obtained from the SISS is useful for the characterization of influenza epidemics in Spain., (Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Tuberculosis remains one of the communicable diseases that cause increased morbidity and mortality worldwide. With an incidence rate of 13,04 per 100,000 population, Spain ranks third among the most affected European countries. These data show a tendency to decrease meaning that it may go unnoticed with the potential to miss the appropriate preventive measures in a suspected case. In centers where patients are treated with tuberculosis, health care worker presents risk of transmission. This risk is higher in some areas or work units. The Occupational health physicians' services, which monitorize the health of health care workers, use different strategies in order to prevent and detect tuberculosis infection. The national guidelines include the tuberculin skin test as a screening test for tuberculosis infection with mention of new diagnostic tests based on the in vitro detection of gamma interferon (IGRA) for certain cases. The purpose of this guide is to establish common criteria for IGRA tests, as a supplementary aid to the tuberculin skin test in health care workers, from the evidence available today. Recommendations for its use have been adapted to the different situations faced by the professionals involved in monitoring the health of health workers., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Introduction: Viral respiratory infections cause major morbidity and mortality in preterm infants. We have performed a prospective study in our neonatal intensive care unit (NICU) to determine the incidence of respiratory infections, their impact and the epidemiology and outcome in high risk neonates., Patients and Methods: From September 2011 to May 2013 a prospective study was conducted in all preterm infants < 32 weeks gestational age and in all term newborns admitted to NICU for any pathology that are anticipated to have an income exceeding two weeks. A nasopharyngeal aspirate (NPA) was collected the first day of life and weekly until discharge for virologic study with polymerase chain reaction. When these babies presented respiratory symptoms a new NPA was collected in this moment. A clinical form was filled by the physician., Results: A total of 60 infants were analyzed: 30 (50%) had a gestational age < 32 weeks and 36 (60%) weighing less than 1500 grams. We collected a total of 256 nasopharyngeal aspirate samples, 24 of them being positive (9.3%). These 24 positive samples corresponded to 13 infants in our cohort (21.6% of the patients). Of them, 9 were symptomatic and had 11 episodes of infection (2 patients had two different episodes with negative control between them). The most frequently identified virus was rhinovirus in (19) 79% of cases. The most frequent clinical data was the presence or increased of apneas (75%) and the needed of oxygenotherapy., Conclusions: HRV infections are prevalent in the NICU, and preterm infants have a high risk of infections with clinical relevance., (Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times., Methods: A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery., Results: A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8±7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications., Conclusion: None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds., (Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.)

Objectives: To describe the prevalence of influenza-like syndrome in winter 2009 and the factors associated with its occurrence., Methods: A cross-sectional study was carried out in 18 hospitals in Spain. Volunteers completed a health questionnaire in which they reported the occurrence of influenza-like syndrome and vaccination and demographic status., Results: A total of 1,289 healthcare workers participated. Of these, 72 (5.6%) reported influenza in their family, 195 (15.1%) had been vaccinated against the A/California/7/2009/H1N1 virus and 75 (5.8%, 95%CI: 4.5-7.1%) had been diagnosed with influenza like-syndrome. There were differences among regions. In logistic regression analysis, the following factors were associated with a higher prevalence of influenza-like syndrome: working in Madrid (OR=8.31, 95%CI: 1.05-65.39), the occurrence of cases of influenza in the family (OR=2.84, 95%CI: 1.41-5.73) and not having been vaccinated against influenza A (H1N1) (OR=2.68, 95% CI: 1.05-6.82)., Conclusions: Differences in the prevalence of influenza-like syndrome were due to the occurrence of familiar cases and region. Vaccination against influenza A (H1N1) was associated with a lower prevalence of the disease., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

From April 2009 to the present, the influenza A(H1N1)pdm09 virus has been evolving continuously, acquiring new amino acid changes that may alter its antigenic characteristics, virulence, and its antiviral drug susceptibility. Phylogenetic analysis of the hemagglutinin (HA) gene of A(H1N1)pdm09 viruses showed that it clustered into 8 genetic groups relative to A/California/7/2009, in addition to others reported by regional influenza surveillance networks. However, none were considered antigenically distinct from the vaccine virus A/California/7/2009, which was recommended for use during the 2012-2013 influenza season in the Northern Hemisphere. Amino acid substitution D222G in the HA1 subunit of HA was the first potential virulence marker of the influenza A(H1N1)pdm09 virus that was associated with severe clinical outcomes. The vast majority of influenza A(H1N1)pdm2009 viruses tested by the WHO-GISRS (World Health Organization-Global Influenza Surveillance and Response System) laboratories were sensitive to neuraminidase inhibitor (NAI) drugs, and during the 2011-2012 influenza season the resistance prevalence was low (1%) or undetectable in the United States and Europe. Resistance to NAIs was detected predominantly in patients with severe conditions, most of whom were immunosuppressed. The resistance was usually associated with the H275Y mutation in the NA protein sequence, although other amino acid substitutions were also reported to confer resistance or decreased susceptibility to 1 or more NAIs. Global virological surveillance should be strengthened for new influenza variants carrying new mutations or reassorted segments that may affect viral features such as virulence, transmission, or antiviral susceptibility., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Objective: Our aim was to study the proportion of healthcare workers with a positive serology for Influenza A(H1N1)2009 without having flu, in a Spanish hospital at the beginning of the pandemic., Methods: A survey study carried out during August 2009 (before the peak of the pandemic in Spain) in the Hospital Costa del Sol, a second level hospital with almost 300 beds in the South of Spain. The participants were workers in the following hospital units: Emergencies, Medical Area (Internal Medicine, Chest Diseases), Surgical Area (General Surgery and Anaesthesia) of any professional category. A study was made of the proportion of healthcare workers in our hospital with positive serology for the new influenza A (H1N1)2009 virus, as determined by the haemagglutination inhibition technique (≥1/40). The subjects completed a health status questionnaire, and provided a blood sample for serology testing., Results: A total of 239 workers participated, of whom 25.1% had positive serology. The hospital area in which most individuals had positive serology was the Emergency Department (36.6%), while the professional category in which most individuals with a positive serology worked was that of the orderlies (41.7%)., Conclusion: Around 25% of healthcare workers in our hospital had positive serology before the peak of the pandemic, none of them had received vaccine for Influenza A (H1N1) 2009 or had been diagnosed of influenza previously., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective: To estimate the prevalence of tuberculous infection (TI) in the health-care workers of a hospital over the course of a 20-year period and analyze the associated risk factors., Subjects and Methods: A cross-sectional, descriptive study of the workers of a general hospital from 1988 until 2007, using a tuberculin test (TT) and questionnaire., Results: 2,179 workers were studied (mean age 32.4 years (SD 8.4). 24.5% worked in areas at risk for tuberculosis (TB). 8.1% (174) were vaccinated with BCG. The prevalence of positive baseline TT was 25.7% (95% confidence interval: 23.8-27.4%). There was a greater percentage of positive TT in the 1988-1992 period (44.2%) and a smaller percentage (15.8%) in the 2003-2007 period (P<.0001). The prevalence of TI was 1.53 times greater in males and 1.89 in those vaccinated with BCG. When compared with resident physicians, the prevalence of TI was greater in the rest of the professional categories, while increasing 1.03 times per year that age increases and 1.05 times per year of professional activity., Conclusions: The data provide relevant information about the evolution of TI in hospital professionals over the course of a 20-year period. The prevalence decreased during the study period, probably due to a decrease in the incidence of TB in the reference community and to improved prevention measures and nosocomial control., (Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: The Spanish influenza surveillance system (SISS) maintained its activity during the summer of 2009 to monitor the influenza pandemic., Objectives: To describe pandemic influenza activity from May to September 2009 and to estimate the effectiveness of the 2008-9 seasonal influenza vaccine against laboratory-confirmed pandemic (H1N1) 2009 influenza., Methods: Data from the SISS were used to identify the trend of pandemic (H1N1) 2009 influenza outside the influenza season. For the effectiveness study, we compared the vaccination status of notified cases [influenza-like illnesses (ILI) laboratory confirmed as pandemic influenza] with that of the test-negative controls., Results: The first laboratory-confirmed case of the pandemic virus was notified in the system in week 20/2009. The ILI rate increased gradually in the study period, exceeding basic activity in week 38. The proportion of pandemic (H1N1) 2009 influenza viruses detected by the system represented 14% in week 20/2009 and rapidly increased to 90% in week 34. The adjusted vaccine effectiveness of the 2008-9 seasonal vaccine against laboratory-confirmed pandemic influenza was 12% (-30; 41)., Conclusions: The SISS became an essential tool for pandemic monitoring in Spain. The improved SISS will provide more accurate information on influenza activity in future seasonal or pandemic waves. Using surveillance data, we could not demonstrate the effectiveness of the seasonal 2008-9 vaccine against laboratory-confirmed pandemic influenza., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Introduction: The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure., Aim: The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain., Material and Methods: A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 degrees C, and Group 2: Baths with a water temperature above 30 degrees C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress., Results: Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar., Conclusion: There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water. (ISRCTN Number: 50105150).

Background and Objectives: We aimed to describe chemotherapy-induced neutropenic fever (NF) in patients with solid neoplasms (SN), to validate the Multinational Association of Support Treatment in Cancer (MASCC) scale, and to evaluate whether the use of the MASCC scale was useful for reducing hospital costs for this oncologic emergency and improving the quality of life., Patients and Method: We performed a prospective study on the incidence of chemotherapy-induced NF from December 2005 to November 2006 and calculated the sensitivity and specificity of the MASCC scale. We compared different parameters before and after (periods 1 and 2) the inclusion of the MASCC scale., Results: We included 80 episodes of NF, 48.8% being of low risk. The sensitivity and the specificity of the MASCC scale were 86.3% (19/22) and 62% (26/58), respectively. 16 patients were discharged early (<3 days). Hospital costs were significantly lower during period 2., Conclusions: The MASCC scale is a safe tool for stratifying the risk of cancer patients and chemotherapy-induced NF. However, greater specificity would allow a greater reduction in hospital costs and improve the quality of life of these patients.

Background and Objective: We aimed to identify cases of cancer diagnosis in hospital workers and to establish if an excess of cases exist., Material and Method: For cases occurring during 1990-2005 the following data about workers were checked: birth date, sex, location of the neoplasm, date of diagnosis of the neoplasm, working category, hospital service/unit and work duration at the hospital. The standard incidence ratio (SIR) was calculated for each type of cancer., Results: Fifty one neoplasms were registered (21 male and 30 women) Most frequent types of cancer were breast (19 cases), leukemia-lymphoma (7 cases), lung (4 cases) and prostate (4 cases). At the time of diagnosis the average age was 47,3 years (DE 9,2). 22 cases were detected in doctors, 18 in nurses and assistant nurses and 4 in assistants. An excess of cases was not found. Comparing data with cancer cases in the whole population, the prevalence of colon cancer was lower than the average (SIR: 0,25; CI 95%: 0,03-0,89) as well as the prevalence of gastric cancer (SIR: 0,19; CI 95%: 0,02-0,69)., Conclusions: An excess of cancer risk was not found in the studied group. Difficulties in obtaining information about people at risk and cancer incidence reveal the need to improve the sources of information for this kind of studies in Spain.

Acute respiratory infection is the most common disease occurring over a person's lifetime, with etiological variations determined mainly by age, environmental circumstances, the healthcare setting, and the underlying pathology. More than 200 different viruses distributed in six viral families have been implicated in the pathogenesis of respiratory tract infection. These facts are generating an increasing diagnostic demand that should be incorporated into the healthcare setting without delay. To meet this demand, the Spanish Society of Infectious Diseases and Clinical Microbiology has updated its Standard Procedure for the microbiological diagnosis of viral respiratory infection. This document contains an update primarily of infections caused by influenza viruses, and secondarily, infections due to other conventional and emerging respiratory viruses. In all cases, the methods for direct virological diagnosis (cell culture, and detection of antigens and nucleic acid) are reviewed, with special reference to techniques for molecular detection and genetic characterization.

Objective: To determine the incidence of adult-onset asthma, along with lung function and immunologic characteristics, causes, and clinical course of the disease., Patients and Methods: After identifying incident cases of asthma among adult residents of the district of North Barcelona, Spain, we proceeded to characterize the disease using a questionnaire, lung function tests, and skin allergy tests. Patients with an occupation associated with asthma, wheezing at work, and/or sensitization to workplace allergens were considered as having occupational asthma. The risk factors for developing chronic asthma were determined by multivariate analysis., Results: In the 2-year study period, 218 incident cases of adult-onset asthma were identified (in a population of 68 067 adults, corresponding to an annual incidence of 160 per 100 000 per year). In total, 152 patients agreed to participate in the study (response rate, 70%); 140 reported wheezing and/or asthma in the last year (92%). The skin tests showed atopy in 57 cases (41%). Occupational asthma was diagnosed in 19 cases (14%). Domestic mammals were identified as causal agents in 8 patients (6%), drugs in 7 (5%), and environmental allergens in 44 (31%). Household cleaning was the occupation most frequently associated with the disease (26%). Of the 102 patients examined again after 2 years, 70 had chronic asthma (69%). Atopy (odds ratio [OR], 3.39; 95% confidence interval [CI], 1.15-9.99) and risk occupation when the disease was diagnosed (OR, 5.54; 95% CI, 1.05-29.11) were the factors associated with development of chronic disease., Conclusions: Occupation was related to adult-onset asthma in a little over 10% of the cases and was the main determinant of the development of chronic symptoms.

To date, more than two hundred viruses, belonging to six different taxonomic families, have been associated with human respiratory tract infection. The widespread incorporation of molecular methods into clinical microbiology laboratories has not only led to notable advances in the etiological diagnosis of viral respiratory infections but has also increased insight into the pathology and epidemiological profiles of the causative viruses. Because of their high sensitivity, molecular techniques markedly increase the efficiency of viral detection in respiratory specimens, particularly those that fail to propagate successfully in common cell cultures, thus allowing more rapid etiologic diagnosis. However, there are also some disadvantages in the use of these new technologies such as detection of viruses that merely colonize the respiratory tract of healthy people, or those found in the nasopharyngeal secretions of patients who have recovered from respiratory infections, due to longterm viral shedding, when the viruses are unlikely to act as pathogens. Additionally, sequencing of the amplification products allows further characterization of detected viruses, including molecular epidemiology, genotyping, or detection of antiviral resistance, to cite only a few examples.

Beginning in the 1950s respiratory viruses have been gradually discovered by isolation in cell cultures The last were the coronaviruses in the 1960s. No new respiratory viruses were discovered until 2001 when human metapneumovirus was found in respiratory specimens from children with bronchiolitis. A year later, in November 2002, severe acute respiratory syndrome (SARS) suddenly appeared as atypical pneumonia. A novel virus belonging to the Coronaviridae family was found to be a cause of this infection. In 2004, a second coronavirus was discovered (CoV-NL63) and in 2005 a third new coronavirus was described (CoV-HKU1). In addition, several subtypes of the influenza A virus, previously known to infect only poultry and wild birds, were recently found to have been directly transmitted to humans. Respiratory infection has been a considerable problem for humans for centuries. Now, in the 21st century, with new associated viruses continuously emerging, it remains an important field for work.

Avian influenza affects most types of birds and occurs in epidemics on poultry farms. The fatal disease is named "highly pathogenic avian influenza" and is caused by influenza A virus subtypes H5 and H7. The natural reservoir is the migratory waterfowl that occasionally infects domestic poultry. In 1997 in Hong Kong, 18 persons were infected and 6 of them died. At the end of 2003 and the beginning of 2004, avian influenza H5N1 infected numerous farms in several South-Eastern Asian countries. The virus was transmitted to humans in close contact with infected birds. A total of 34 persons were infected and 23 of them died. There is currently a considerable concern about the H5N1 avian influenza that has infected humans: the high virulence, evolution rate, the possibility of recombination with other influenza viruses, how H5N1 variants that infect humans or different approaches to the development of influenza vaccines.

Objectives: (1) To determine the prevalence of joint hypermobility in children aged 4-14 years old without organic disease of the locomotor system; (2) to compare the prevalence of hypermobility in children with and without arthralgia and (3) to analyze the influence of certain variables on the development of arthralgia., Patients and Methods: We performed an observational study in a sample of children aged 4-14 years old living in Area 4 of the Community of Madrid (Spain). Joint hypermobility was evaluated using a goniometer. Hypermobility was defined using Beighton's criteria., Results: A total of 222 subjects were analyzed: 176 in the primary care setting and 46 in the emergency department of a referral hospital. Of the 222 children, 43 reported arthralgia. The prevalence of hypermobility (> or = 4 criteria) was 55 % (123/222), reaching 71 % (49/69) in children aged less than 8 years. No significant differences were found in the prevalence of hypermobility in children with and without arthralgia (65 % and 53 % respectively). Of the variables analyzed (age, sex, country of origin, primary care/emergency department setting) only differences in the absolute number of Beighton criteria present in children with and without arthralgia (4.34 +/- 2.47 and 3.48 +/- 2.35, p = 0.03) were detected, which disappeared when at least four criteria (definition of hypermobility) were required., Conclusions: Fifty-five percent of the population studied and 71 % of those younger than 8 years old met the criteria for joint hypermobility. In the sample analyzed, the presence of joint hypermobility did not seem to favor the development of arthralgias.

Background and Objective: Tuberculosis is an occupational disease in health care workers. The objective of our study was to review tuberculosis cases in health care professionals from a general hospital and to determine their incidence in relation to the general population., Patients and Method: This was a retrospective study of tuberculosis cases among health care workers in a university hospital from 1988 to 2002, evaluating the annual cumulative incidence., Results: 21 tuberculosis cases were found in health care workers. Pulmonary disease was the most frequent type (62%) followed by pleural effusion (28%). The most affected professional category were medical residents (38%) with the emergency service (48%) being the work place with the highest risk. The cumulative incidence in our hospital was higher in relation to the general population although there was a variability between both populations., Conclusions: There is risk of tuberculosis transmission among health care workers, principally in the emergency service and the pathology and microbiological departments. A concerted effort is needed to maintain prevention measures in the work place where there is a high risk of infection.

Background and Objective: Latex exposure at work has been related to sensitization in health care workers. The aim of the present study was to determine the prevalence of this sensitization in health care workers and its risk factors., Patients and Method: The occupation, prevalence of latex-related symptoms and sensitization was determined in a sample of health care workers by questionnaire and skin testing., Results: 461 subjects were studied during a year. 30.2% of them reported dermatitis symptoms, 23.2% rhinitis, 12.6% urticaria-like rashes, and 5.6% reported asthmatic symptoms. 17.6% of workers reported symptoms when using latex gloves and 5% after the contact or ingestion of tropical fruits. Sensitization to latex was indentified in 12 workers (2.6%, CI95% 1.2-4.0). Dermatitis, urticaria-like rashes, rhinitis and asthmatic symptoms upon exposure to latex products and/or tropical fruits were all significantly more prevalent in sensitized subjects. In the logistic regression analysis, dermatitis, urticaria-like rashes, and asthmatic symptoms after the ingestion of tropical fruits were related to latex sensitization., Conclusions: The prevalence of sensitization to latex in health workers is nearly 3% and it must be suspected in subjects reporting symptoms when using latex gloves or after the ingestion of tropical fruits.

Aim: To identify difficult (heartsink) patients (DP), describe their profile, and report the opinions and experiences they evoke in physicians who see them., Design: Descriptive, cross-sectional study based on quantitative and qualitative methods., Setting: Urban health care center., Participants: Difficult patients were selected daily from among all patients seen in six primary care practices during the period from March to May 2001. Patients were identified according to the diagnostic criteria of Ellis (patients who cause a knot in the stomach when their name appears on the list of patients with an appointment that day) and O'Dowd (patients who cause distress or discomfort)., Method: Information was obtained on the number of DP seen, number of visits made by DP, age, sex, type of DP, level of education, occupation, family structure and comorbidity. Type of DP was determined with a modification of the Groves classification (dependent clinger, entitled demander, manipulative help-rejecter, self-destructive denier, somatizer, emotive seducer). We analyzed the opinions DP generated by examining the discourse produced during a discussion group session with 9 physicians from the participating health center and a moderator., Results: A total of 82 DP were identified (prevalence.7%, i.e., 2.3% of all visits). Most (67.1%) were women. Mean age was 57.8 years (standard deviation 15.2 years). Dependent clinger patients predominated (41%). Most patients had primary-level education (62%), about one-third were retired (35%), and about one-third were married and had children (35%). Most had two or more medical diagnoses (74.4%), and many had at least one psychiatric diagnosis (40.2%).The feelings these patients evoked most often in physicians were irritability and frustration. Most physicians agreed that these patients are rare but have a severe emotional impact. Physicians believe that the skills and strategies they have to help them manage these patients are limited, and consider specific training necessary to improve them., Conclusions: Although DP are not a relevant problem in quantitative terms, they cause considerable emotional distress. Specific training in clinical interviewing is felt to be necessary given the difficulties in managing these patients.

Clinical diagnosis of cardiac tumours is often difficult. We present the case of a 17 year-old boy in whom a left ventricular tumour was discovered during on diagnostic work-up for a syncope. The tumour was removed and histology confirmed the diagnosis of myxoma.

Patients with severe angina pectoris, refractory to medical treatment, in which conventional revascularization (PTCA or bypass surgery) is not possible because they present advanced coronary artery disease with a poor distal bed, account for an important clinical problem due to an increasing incidence, combined with poor quality of life, an elevated risk of severe complications, repeated hospital admissions and high mortality rate. Laser transmyocardial revascularization provides a new therapeutic alternative for these patients. Although up to now there are only a few published series, with a small number of patients, the results obtained in the two ongoing multicentric studies in Europe and the United States (including more than 500 patients at present) are quite promising. It is a simple surgical procedure, but its associated mortality is not to be dismissed (in the beginning 12% and currently 5%), because patients are in an advanced evolutionary stage. In Spain this procedure has been available since April 1996 and the results have been encouraging. In our small series we have noted a significant symptomatic improvement and better quality of life.