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Purpose Aspirin (acetylsalicylic acid) has been reported to protect against certain cancers. However, patient-related risk factors may moderate protective effects, including excess weight, smoking, risky alcohol use, and diabetes. We explore the cancer-risk relationship between aspirin intake and those four factors. Methods Retrospective cohort study of cancers, aspirin intake, and four risk factors in persons aged ≥50 years. Participants received medication during 2007–2016, and cancers were diagnosed in 2012–2016. Adjusted hazard ratios (aHR) for 95% confidence intervals (95%CI) were calculated for aspirin intake and risk factors using Cox proportional hazard modeling. Results Of 118,548 participants, 15,793 consumed aspirin, and 4003 had cancer. Results indicated a significant protective effect of aspirin against colorectal (aHR: 0.7; 95%CI: 0.6–0.8), pancreatic (aHR: 0.5; 95%CI: 0.2–0.9), prostate (aHR: 0.6; 95%CI: 0.5–0.7) cancers and lymphomas (aHR: 0.5; 95%CI: 0.2–0.9), and also, although not significantly, against esophageal (aHR: 0.5; 95%CI: 0.2–1.8), stomach (aHR: 0.7; 95%CI: 0.4–1.3), liver (aHR: 0.7; 95%CI: 0.3–1.5), breast (aHR: 0.8; 95%CI: 0.6–1.0), and lung and bronchial (aHR: 0.9; 95%CI: 0.7–1.2) cancers. Aspirin intake was not significantly protective against leukemia (aHR: 1.0; 95%CI: 0.7–1.4) or bladder cancer (aHR: 1.0; 95%CI: 0.8–1.3). Conclusions Our results suggest that aspirin intake is associated with a reduced incidence of colorectal, pancreatic, and prostate cancers and lymphomas. This work was supported by contract 2019-DI-43 of the Industrial Doctorate Programme of the Generalitat de Catalunya (Project PID2020-113614RB-C22 funded by MCIN/AEI/10.13039/ 501100011033). Some authors are members of the 2014-SGR163 research group, funded by the Generalitat de Catalunya. The author wishes to thank Arnau de Vilanova University Hospital, Santa Maria University Hospital, and the Catalan Health Service (CatSalut) in Lleida for research support and resources. The authors also acknowledge CSC – IT Center for Science in Finland for computing resources

We retrospectively assessed the effectiveness of azithromycin in preventing transmission of pertussis to a patient's household contacts. We also considered the duration between symptom onset in the primary patient and azithromycin administration. We categorized contacts into 4 groups: those treated within 21 days after illness onset in the primary patient. We studied 476 primary index patients and their 1,975 household contacts, of whom 4.5% were later identified as having pertussis. When contacts started chemoprophylaxis within 14 days after primary patient's symptom onset was less effective. We recommend that contacts of persons with pertussis begin chemoprophylaxis within

Fundamentos: El estudio de contactos constituye una de las principales actividades de vigilancia epidemiológica en salud pública. El objetivo principal de este estudio fue estimar el grado de su cumplimiento por parte de los profesionales que informaron sobre las infecciones de transmisión sexual (VIH/gonococia/sífilis/clamidia) en el año 2017 en las comarcas de Lleida. Métodos: Se realizó un estudio descriptivo de prevalencia sobre el cumplimiento del estudio de contactos. Se recogió la información de las encuestas epidemiológicas de las enfermedades citadas y se recuperó información de la realización del estudio de contactos mediante las historias clínicas y el contacto con los profesionales. Se estudiaron los factores asociados a la falta de estudio de contactos mediante un modelo multivariado de regresión logística y el cálculo de la odds ratio ajustada (ORa), con sus intervalos de confianza (IC) del 95%. Resultados: Se estudiaron 203 casos de ITS, con una edad media de 30,6 años (±11,1). El 32,5% eran mujeres. El porcentaje de casos diagnosticados sin estudio de contactos fue del 46,3%, causado principalmente por la falta de colaboración del paciente (23,4%). Las variables asociadas a la falta de estudio de contactos fueron el sexo masculino (ORa=3,5; IC95%=1,6–7,5), la infección gonocócica (ORa=4,9; IC95%=1,2-19,8), la infección por clamidia (ORa=3,9; IC95%=0,9-16,1) y la orientación sexual homosexual/bisexual (ORa=2,2; IC 95%=0,9-5,4). Conclusiones: El cumplimiento de los estudios de contactos es bajo y se relaciona con el sexo masculino, la orientación sexual (homosexual/bisexual) y el tipo de infección (gonococia/clamidia). Reducir el estigma asociado a la orientación sexual y mejorar la información de los profesionales podría favorecer su correcto cumplimiento. Background: The partner notification is one of the main activities of epidemiological surveillance in Public Health. The primary objective was to estimate the compliance of the partner notification by health professionals who reported sexually transmitted diseases (HIV, Gonorrhoea, Syphilis and Chlamydia) during 2017 in Lleida’s regions. Methods: We carried out a descriptive epidemiological study of prevalence about the compliance of partner notification. Data collection was done by epidemiological surveys of these notifiable diseases and additional information was recovered through medical record and interview with professionals. The factors associated with the lack of partner notification were studied through the odds ratio (OR) and its 95% confidence interval (CI). ORs were adjusted (ORa) with multivariate logistic regression models. Results: We studied 203 STD cases with an average age of 30.6 years (SD=11.1); 32.5% were women. There was 46.3% without partner notification. The main cause of this absence was the lack of patient cooperation (23.4%). The variables associated with the lack of partner notification were the male sex (aOR-3.5; CI95%=1.6–7.5), gonococcal infection (aOR-4.9; CI95%=1.2- 19.8), chlamydia infection (aOR-3.9; CI95%=0.9- 16.1) and homosexual/bisexual sexual orientation (aOR-2.2; CI95%=0.9-5.4). Conclusions: Compliance of partner notification is low and it is related to male sex, sexual orientation (homosexual/bisexual/transsexual) and type of infection (Gonorrhoea and Chlamydia). Reducing the social stigma associated with sexual orientation and improving the information of health professionals could favour the contact studies

Objetivo Conocer el perfil y las características de los enfermos diagnosticados de enfermedad pulmonar obstructiva crónica (EPOC) y que nunca han sido fumadores. Diseño Estudio descriptivo transversal. Emplazamiento Área Básica de Salud del Pla d’Urgell (Atención Primaria de Lleida, España). Participantes Se incluyeron los 512 pacientes mayores de 40 años diagnosticados de EPOC del Área Básica de Salud con una espirometría compatible al inicio del estudio [cociente < 0,7 entre el volumen de espiración forzada en el primer segundo (FEV1) y la capacidad vital forzada (FVC)]. Mediciones principales La variable dependiente fue la EPOC en no fumadores y las independientes fueron variables recogidas a partir de la información sobre la historia clínica respiratoria, los factores de riesgo del enfermo y sobre calidad vida. Se diseñó un modelo predictor de padecer EPOC en no fumadores en comparación con los fumadores. Resultados El 33,2% de los pacientes EPOC nunca habían sido fumadores y de estos, el 59,4% eran mujeres. La media del FEV1 de los no fumadores fue de 70,5 (DE = 17,1), superior a los 62,6 (DE = 18,5) en los fumadores/exfumadores (p < 0,001). La cobertura de la vacunación antineumocócica 23V era mejor en los no fumadores (75,3%), p < 0,001. Los EPOC en no fumadores (respecto a los fumadores/exfumadores) eran: mayormente mujeres (OR = 16,46), de mayor edad (OR = 1,1), con mejor FEV1 (OR = 1,1), mejor percepción de calidad de vida, EuroQoL-5D (OR = 0,8), con menor prevalencia de diabetes (OR = 0,5), menor nivel de estudios (OR = 0,2), y con menos hospitalizaciones previas (OR = 0,3). Conclusiones El estudio evidencia una alta proporción de no fumadores en enfermos EPOC. Nuestro trabajo objetiva que las mujeres de mayor edad y con menor gravedad se asociarían a un mayor riesgo de EPOC en no fumadores. Parece indicar que la EPOC en no fumadores aparecería en edades más tardías y sería más leve que la EPOC relacionada con el tabaquismo. Objective The objective of the study was to know the profile of patients diagnosed with chronic obstructive pulmonary disease (COPD) and who have never been smokers. Design A transversal study. Location Primary Care Centre of Pla d’Urgell (Primary care setting in Lleida, Spain). Participants 512 patients older than 40 years with COPD from Primary Care Centre of Pla d’Urgell with a compatible spirometry [forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio < 0.7) to the beginning of the study. Main measurements The dependent variable was de COPD in non-smokers and the independents were variables collected from the information on the respiratory clinical history, the risk factors of the patients and on quality of life. We designed a predictor model of COPD in non-smokers compared to smokers. Results 33.2% of COPD patients had never been smokers, 59.4% of whom were women. The average FEV1 for non-smokers was 70.5 (SD = 17.1), higher than 62.6 (SD = 18.5) for smokers/former smokers (p < 0.001). The coverage of pneumococcal vaccination 23V was better in non-smokers (75.3%), p < 0.001. COPD in non-smokers (compared to smokers/former smokers) were: mostly women (OR = 16.46), older (OR = 1.1), with better FEV1 (OR = 1.1), better perception of quality, EuroQoL-5D (OR = 0.8), with lower prevalence of diabetes (OR = 0.5), lower level of studies (OR = 0.2), and with fewer previous hospitalizations (OR = 0.3). Conclusions The study evidences a high proportion of non-smokers in COPD patients. Our study aims that older women with less severity would be associated with an increased risk of COPD in non-smokers. It seems to indicate that COPD in non-smokers would appear at later ages and would be milder than smoking-related COPD.

En la actualidad, la vigilancia epidemiológica sigue centrada, en España, en las enfermedades transmisibles incluidas en la lista de enfermedades de declaración obligatoria. Sin embargo, el patrón epidemiológico que dominó hasta las últimas décadas del siglo xx ha cambiado. Las enfermedades infecciosas, que eran las principales causas de morbimortalidad, han dado paso a un predominio de las enfermedades crónicas. En este sentido, se ha avanzado en la redacción y la aprobación de normativa específica sobre vigilancia de la salud pública. No obstante, tenemos pendiente el desarrollo de esta normativa que, entre otros puntos, recoge el mandato de organizar la vigilancia de las enfermedades no transmisibles en España. El objetivo de este trabajo es describir algunas características a tener en cuenta para desarrollar un sistema nacional de vigilancia de la salud pública vinculado a las estrategias ya existentes para la prevención y el control de las enfermedades crónicas. At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases.

BACKGROUND: Obesity is a world-wide epidemic whose prevalence is underestimated by BMI measurements, but CUN-BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) estimates the percentage of body fat (BF) while incorporating information on sex and age, thus giving a better match. Our aim is to compare the BMI and CUN-BAE in determining the population attributable fraction (AFp) for obesity as a cause of chronic diseases. METHODS: We calculated the Pearson correlation coefficient between BMI and CUN-BAE, the Kappa index and the internal validity of the BMI. The risks of arterial hypertension (AHT) and diabetes mellitus (DM) and the AFp for obesity were assessed using both the BMI and CUN-BAE. RESULTS: 3888 white subjects were investigated. The overall correlation between BMI and CUN-BAE was R(2) = 0.48, which improved when sex and age were taken into account (R(2) > 0.90). The Kappa coefficient for diagnosis of obesity was low (28.7 %). The AFp was 50 % higher for DM and double for AHT when CUN-BAE was used. CONCLUSIONS: The overall correlation between BMI and CUN-BAE was not good. The AFp of obesity for AHT and DM may be underestimated if assessed using the BMI, as may the prevalence of obesity when estimated from the percentage of BF. This study was supported by the Ministry of Science and Innovation, Carlos III Institute of Health, Programme of Research on Influenza A/H1N1 (Grant GR09/0030), and the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2009/ SGR 42). Yes

Vaccination of the elderly is an important factor in limiting the impact of influenza in the community. The aim of this study was to investigate the factors associated with influenza vaccination coverage in hospitalized patients aged ≥ 65 years hospitalized due to causes unrelated to influenza in Spain. We carried out a cross-sectional study. Bivariate analysis was performed comparing vaccinated and unvaccinated patients, taking in to account sociodemographic variables and medical risk conditions. Multivariate analysis was performed using multilevel regression models. We included 1038 patients: 602 (58%) had received the influenza vaccine in the 2013-14 season. Three or more general practitioner visits (OR = 1.61; 95% CI 1.19-2.18); influenza vaccination in any of the 3 previous seasons (OR = 13.57; 95% CI 9.45-19.48); and 23-valent pneumococcal polysaccharide vaccination (OR = 1.97; 95% CI 1.38-2.80) were associated with receiving the influenza vaccine. Vaccination coverage of hospitalized elderly people is low in Spain and some predisposing characteristics influence vaccination coverage. Healthcare workers should take these characteristics into account and be encouraged to proactively propose influenza vaccination to all patients aged ≥ 65 years. This study was funded by the National Plan of I+D+I 2008-2011 and ISCIII-Subdirección General de Evaluación y Fomento de la Investigación (Project PI12/02079) and cofounded by Fondo Europeo de Desarrollo Regional (FEDER. Unión Europea. Una manera de hacer Europa), and the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2014/ SGR 1403). Yes

Vaccination of the elderly is an important factor in limiting the impact of influenza in the com- munity. The aim of this study was to investigate the factors associated with influenza vacci- nation coverage in hospitalized patients aged 65 years hospitalized due to causes unrelated to influenza in Spain. We carried out a cross-sectional study. Bivariate analysis was performed comparing vaccinated and unvaccinated patients, taking in to account sociodemographic variables and medical risk conditions. Multivariate analysis was per- formed using multilevel regression models. We included 1038 patients: 602 (58%) had received the influenza vaccine in the 2013 - 14 season. Three or more general practitioner visits (OR = 1.61; 95% CI 1.19 - 2.18); influenza vaccination in any of the 3 previous seasons (OR = 13.57; 95% CI 9.45 - 19.48); and 23-valent pneumococcal polysaccharide vaccination (OR = 1.97; 95% CI 1.38 - 2.80) were associated with receiving the influenza vaccine. Vacci- nation coverage of hospitalized elderly people is low in Spain and some predisposing char- acteristics influence vaccination coverage. Healthcare workers should take these characteristics into account and be encouraged to proactively propose influenza vaccina- tion to all patients aged 65 years.

Las gastroenteritis agudas (GA) constituyen un problema de salud importante, pudiendo estar causadas por bacterias, parásitos y virus enteropatógenos, entre los que se han reconocido hasta la actualidad rotavirus, astrovirus, adenovirus y calicivirus . La frecuencia de rotavirus como causa de casos esporádicos de GA oscila entre el 17,3% y el 37,4%. Aunque se ha sugerido que la exposición común no tiene mucha importancia para la difusión de este virus, resulta difícil relacionar casos aparentemente esporádicos, por lo que probablemente haya brotes que no llegan a detectarse. Los astrovirus causan GA con una frecuencia que oscila entre un 2 y un 26% y se han descrito brotes en escuelas y guarderías, pero también en población adulta y en ancianos. La frecuencia con que se identifican los adenovirus 40 y 41 como causa de GA esporádica en niños no inmunodeprimidos oscila entre 0,7% y 31,5%, aunque probablemente haya subdetección debido a que la sensibilidad de las técnicas convencionales es baja. Los calicivirus se separan filogenéticamente en dos géneros: Norovirus y Sapovirus. Los Norovirus se asocian frecuentemente con brotes de GA transmitidos por agua y alimentos . Se estima que el 40% de los casos de GA por Norovirus están vehiculados por alimentos. En Suecia y en algunas zonas de Estados Unidos es la primera causa de brotes de toxiinfecciones alimentarias. Recientemente se han descrito en Canadà y Japón brotes de transmisión persona a persona y también de transmisión alimentaria causados por Sapovirus, afectando tanto a población infantil como adulta.

BACKGROUND: To assess the contribution of physician-related factors, especially their influenza vaccine status, in the vaccination coverage of their patients. METHODS: A study of vaccination coverage was carried out in Spain in 2011-12. The dependent variable (vaccination coverage in patients aged ≥ 65 years) was obtained from regional records. Information was gathered on the vaccination of physicians through an anonymous web survey. We compared the vaccination coverage of patients with the vaccination of their physicians using the Student t test. Associations were determined using a multilevel regression model. RESULTS: The coverage in patients aged ≥ 65 years was 56.3% and was higher (57.3%) in patients whose physician had been vaccinated than in those whose physician had not (55.2%) (p = 0.008). In the multilevel regression model, vaccination of the physician was associated (p = 0.049) with vaccination of their patients after controlling for the effects of age (p = 0.046), region (p = 0.089), and opinions on the effectiveness of the vaccine (p = 0.013). CONCLUSIONS: Vaccination of physicians together with their opinions on the effectiveness of the vaccine may be a predictor of vaccination coverage in their patients. Further studies are required to confirm this. This study was supported by the Ministry of Science and Innovation, Institute of Health Carlos III, Programme of Research on Influenza A/H1N1 (Grant GR09/0030), and the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2014/ SGR 421403).

Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2-1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders. This study was supported by the Ministry of Economy and Competitiveness, Institute of Health Carlos III (Grant GR09/0030), and the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2014/SGR 1403).

BACKGROUND: Whooping cough is a communicable disease whose incidence has increased in recent years in some countries with vaccination. Since 1981, in Catalonia (Spain), cases must be reported to the Public Health Department. In 1997, surveillance changed from aggregated counts to individual report and the surveillance system was improved after 2002. Catalan public health is universal with equal coverage geographically. The aim of this study was to determine whether there are differences in whooping cough incidence in rural and urban counties. METHODS: Cases in 1990-2010 were classified as rural or urban. Incidences and risk ratios (RR) between urban and rural counties and 95% CI were calculated. Associations between rural and urban counties and structural changes during the study period were analysed. RESULTS: Twelve years of the whole study period showed differences in incidence between rural and urban counties. The incidence was higher in urban counties in seven years and rural counties in five years. There was a positive association of whooping cough incidence in rural and urban counties in four-week periods. Structural changes were detected in the following four-week periods: 4th in 1993, 7th in 1996 and 3rd 2005 in rural counties and 5th 1993, 9th in 1996 and 8th in 2007 in urban counties. CONCLUSIONS: Differences in whooping cough between rural and urban counties were found. In most years, the incidence was higher in urban than in rural counties. Rural and urban counties show similar cyclic behaviour when four-week periods were considered.

The present study aimed to compare the main features of infection with pandemic influenza A virus in pregnant and nonpregnant women admitted to hospitals in Spain during the first waves of the 2009-2010 influenza pandemic. This was a prospective (November 2009 to June 2010), multicenter observational study. All cases were women of reproductive age who had not been vaccinated against seasonal or pandemic influenza A. Influenza infection was confirmed by reverse transcription-polymerase chain reaction (RT-PCR). The sociodemographic and clinical data of all cases were reviewed. A total of 219 inpatients, including 49 pregnant women and 170 nonpregnant women, were enrolled in the study upon admission to participating hospitals. The most substantially different symptoms between the groups were respiratory distress and unilobar consolidation, both of which were more frequent among nonpregnant women. Antibiotics and systemic corticosteroids were more frequently used in nonpregnant women; however, there were no differences in the rates of treatment with antivirals. Our findings indicated that the compared with nonpregnant women, pregnant women in this study did not have significantly different symptoms and were not at increased risk of complications from pandemic influenza virus infection.

Objetivo: Describir el censo y el estudio de contactos en un caso de tuberculosis laríngea. Métodos: A partir de un paciente con tuberculosis laríngea y mediante entrevistas e inspección se establecieron tres círculos de contactos. Se realizó la prueba de la tuberculina (positiva ≥5 mm) y a los positivos se les propuso realizarse una radiografía de tórax. La asociación con la infección se midió con la odds ratio. La relación dosis-respuesta se determinó con el test de 2 de tendencia lineal. Resultados: La prevalencia de infección fue del 39,9% (67/168). Entre los compa˜neros de trabajo con mayor convivencia fue del 60,0% (24/40), entre los del bar del 43,3% (13/30) y la tasa de virajes fue del 12,9%. Se observó relación con el grado de exposición (p < 0,0001). Conclusiones: La tuberculosis laríngea tuvo una alta transmisión en la empresa y en el bar. Deben realizarse estudios exhaustivos y buena comunicación a los expuestos.

Background: During the 2009 influenza pandemic, a change in the type of patients most often affected by influenza was observed. The objective of this study was to assess the role of individual and social determinants in hospitalizations due to influenza A (H1N1) 2009 infection. Methods: We studied hospitalized patients (cases) and outpatients (controls) with confirmed influenza A (H1N1) 2009 infection. A standardized questionnaire was used to collect data. Variables that might be related to the hospitalization of influenza cases were compared by estimation of the odds ratio (OR) and 95% confidence intervals (CI) and the variables entered into binomial logistic regression models. Results: Hospitalization due to pandemic A (H1N1) 2009 influenza virus infections was associated with non-Caucasian ethnicity (OR: 2.18, 95% CI 1.17 − 4.08), overcrowding (OR: 2.84, 95% CI 1.20 − 6.72), comorbidity and the lack of previous preventive information (OR: 2.69, 95% CI: 1.50 − 4.83). Secondary or higher education was associated with a lower risk of hospitalization (OR 0.56, 95% CI: 0.36 − 0.87). Conclusions: In addition to individual factors such as comorbidity, other factors such as educational level, ethnicity or overcrowding were associated with hospitalization due to A (H1N1) 2009 influenza virus infections. This study was supported by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Programa de Investigación sobre Gripe A/H1N1 (Grant GR09/0030), and Agency for the Management of Grants for University Research (AGAUR Grant number 2009/SGR 42)

BACKGROUND: The role of different risk exposures and preventive measures against influenza has not been well established. OBJECTIVE: The aim of this study was to evaluate risk factors and measures to prevent influenza infection in the community. METHODS: We conducted a multicenter case-control study. Cases were 481 outpatients aged 18 years or older with laboratory-confirmed influenza A(H1N1)09 in the 2009-2010 season in Spain. A control was selected for each case from outpatients from the same area matched by age and date of consultation. Information on risk situations, preventive measures and other variables was obtained by interview and review of the medical record. RESULTS: In the multivariate conditional logistic regression analysis, the risk of a diagnosis of influenza increased with the number of cohabitants (compared with

Even though hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. The aim of this study was to investigate the association between duration and characteristics of hepatitis A outbreaks. Hepatitis A (HA) outbreaks reported between 1991 and 2007 were studied. An outbreak was defined as ≥2 epidemiologically-linked cases with ≥1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Relationships between explanatory variables and outbreak duration were assessed by logistic regression. During the study period, 268 outbreaks (rate 2.45 per million persons-year) and 1396 cases (rate 1.28 per 105 persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95% CI: 0.94-0.98) and school setting (OR = 0.39; 95% CI: 0.16-0.92). In person-to-person transmission outbreaks only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95% CI: 0.95-0.98). The only variables associated with shorter outbreak duration were early administration of IG or vaccine and a school setting. Timely reporting HA outbreaks was associated with outbreak duration. Making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration.

Objetivos: Investigar un brote de gastroenteritis que afectó a la población de València d'Àneu (Lleida). Métodos: Estudio de cohortes sobre el consumo de agua de la red, de agua embotellada y de agua de manantiales. La cohorte se elaboró mediante contacto telefónico con todos los números privados del municipio. Se encuestó al 58,3% de la población censada (105/180) sobre diferentes consumos de agua, número de vasos consumidos diariamente y sintomatología. Se tomaron muestras de agua de la red municipal y de heces de diez enfermos. La implicación de cada agua consumida se estudió con el riesgo relativo (RR) y su intervalo de confianza del 95% (IC95%). Resultados: La tasa de ataque global fue del 64,8% (68/105). La curva epidémica fue concordante con una exposición de 6 días. Resultó implicado el consumo de agua de suministro público (RR=4,2; IC95%: 1,5-11,9). Además, se constató una relación dosis-respuesta (χ²=34,1; p

Public health activities, especially infectious disease control, depend on effective teamwork. We present the results of a pilot audit questionnaire aimed at assessing the quality of public health services in the management of VPD outbreaks. Audit questionnaire with three main areas indicators (structure, process and results) was developed. Guidelines were set and each indicator was assessed by three auditors. Differences in indicator scores according to median size of outbreaks were determined by ANOVA (significance at p#0.05). Of 154 outbreaks; eighteen indicators had a satisfactory mean score, indicator ‘‘updated guidelines’’ and ‘‘timely reporting’’ had a poor mean score (2.846106 and 2.4461.67, respectively). Statistically significant differences were found according to outbreak size, in the indicators ‘‘availability of guidelines/ protocol updated less than 3 years ago’’ (p = 0.03) and ‘‘days needed for outbreak control’’ (p = 0.04). Improving availability of updated guidelines, enhancing timely reporting and adequate recording of control procedures taken is needed to allow for management assessment and improvement.

Fundamentos. Las pandemias requieren una valoraci n de su nivel de gravedad. El objetivo fue determinar las caracter sticas de la gripe pand mica en Catalu a. Métodos. Se reali un estudio de vigilancia sobre la incidencia de s ndromes gripales y casos graves entre junio del 2009 y mayo del 2010. Una red de 55 m dicos notificaron los s ndromes gripales y recogieron frotis nasofar ngeos. La gravedad de la pandemia se valor a trav s de casos graves confirmados. Se calcularon la letalidad y las tasas de incidencia y de mortalidad. La existencia de diferencias se estudi con el Riesgo Relativo (RR) y su intervalo de confian a (IC) del 95%. Resultados: La incidencia de s ndromes gripales fue muy superior en el grupo de 5 a 14 y de 0 a 4 a os (1227,8 y 1048,4 respectivamente, en la semana de m xima incidencia). De las muestras positivas 477 (52,4%) fueron positivas a virus gripal y la mayor a, 456 (95,6%) lo fueron al virus gripal pand mico A (H1N1) 2009. La incidencia de casos graves fue de 10,3 por 105 y fue superior en ni os (14,5) y adultos menores de 65 a os (10,2) (p

Entre las medidas farmacológicas de posible utilidad para limitar el impacto de las pandemias gripales en la comunidad están los fármacos antivirales (inhibidores de la neuraminidasa) y las vacunas antigripales y antineumocócicas, ya que la gripe predispone a la neumonía bacteriana por Streptococcus pneumoniae. Entre las medidas no farmacológicas destacan la higiene de manos y la higiene respiratoria. La falta de conocimiento de la efectividad de dichas medidas en situación de pandemia justifica que en septiembre de 2009, ante la solicitud de proyectos de investigación por parte del Ministerio de Ciencia e Innovación en su Programa de Investigación sobre la gripe (H1N1) 2009 en España, el CIBER de Epidemiología y Salud Pública presentara un proyecto multicéntrico de casos y controles emparejados por edad, hospital y fecha de hospitalización para investigar sobre estos aspectos en 37 hospitales de 7 comunidades autónomas. Por cada caso hospitalizado confirmado de gripe pandémica se seleccionaba 1 caso confirmado ambulatorio y 3 controles (2 hospitalarios y 1 ambulatorio). En los casos y en los controles se recogían variables demográficas, condiciones médicas subyacentes, utilización de antivirales, vacunas recibidas y hábitos de higiene. En los casos hospitalizados se recogieron, además, información relativa al tratamiento antiviral y evolución de la enfermedad. Hasta octubre 2010 se habían reclutado un total de 3.750 pacientes y se está realizando la depuración de los datos y la recuperación de variables. La implicación de las Direcciones Generales de Salud Pública ha sido fundamental para la adecuación del proyecto a la evolución de la pandemia.

Fundamentos: Este estudio investiga, de forma prospectiva, la incidencia, la etiología y el perfil epidemiológico de la brucelosis humana en las comarcas del Pallars Jussà y Sobirà (Lleida), durante el período 1995-1998. Métodos: Fueron estudiados 55 pacientes diagnosticados de brucelosis. Se registró información sobre el sexo, edad, municipio de residencia, riesgo ocupacional, contacto con animales y consumo de productos lácticos no higienizados, y se obtuvieron muestras de sangre para hemocultivo. Resultados: Se registraron 10, 14, 15 y 16 casos para los años 1995, 1996, 1997 y 1998 respectivamente, y las tasas medias acumuladas fueron de 52 en el Pallars Jussà y de 129 en el Pallars Sobirà. El número de casos fue cuatro veces superior en hombres (81,8%) que en mujeres (18,2%) (RR: 4,4; IC95% 2,2-8,7). La incidencia máxima se produjo en los meses de Marzo-Abril y la mínima en los meses de verano. El 71% de los pacientes desarrollaba una actividad profesional de riesgo y hubo un claro predominio del mecanismo de contagio directo (71%). La especie animal más frecuentemente considerada fuente de infección fue la ovina (65%), seguida de la bovina (47%) y de la caprina (25%). En el Pallars Jussà hubo predominio ovino (OR: 0,3; IC95% 0,1 - 0,9) y en el Pallars Sobirà de bovino (OR: 6,6; IC95% 1,8 - 26,2). Se aislaron 27 cepas de Brucella sp, correspondiendo todas ellas a la especie melitensis. Conclusiones: La incidencia de la zoonosis en las comarcas estudiadas ha aumentado durante el período 1995-1998. Los resultados del estudio configuran un perfil epidemiológico característico de enfermedad profesional. El agente etiológico ha sido Brucella melitensis con claro predominio de la biovariedad 1.

The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population. Funding was provided by project GR09/0030 of the Instituto de Salud Carlos III/Ministerio de Ciencia e Innovación, Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

En la actualidad, la vigilancia epidemiológica sigue centrada, en España, en las enfermedades transmisibles incluidas en la lista de enfermedades de declaración obligatoria. Sin embargo, el patrón epidemiológico que dominó hasta las últimas décadas del siglo xx ha cambiado. Las enfermedades infecciosas, que eran las principales causas de morbimortalidad, han dado paso a un predominio de las enfermedades crónicas. En este sentido, se ha avanzado en la redacción y la aprobación de normativa específica sobre vigilancia de la salud pública. No obstante, tenemos pendiente el desarrollo de esta normativa que, entre otros puntos, recoge el mandato de organizar la vigilancia de las enfermedades no transmisibles en España. El objetivo de este trabajo es describir algunas características a tener en cuenta para desarrollar un sistema nacional de vigilancia de la salud pública vinculado a las estrategias ya existentes para la prevención y el control de las enfermedades crónicas. At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases. Sociedad Española de Epidemiología. Sí

Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011-2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72-6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83-3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56-3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine.

Pertussis causes a large number of cases and hospitalizations in Catalonia and Navarra. We made a study of household cases of pertussis during 2012 and 2013 in order to identify risk factors for hospitalization in pertussis cases. Each primary case reported triggered the study of their contacts. Close contacts at home and people who were in contact for >2 hours during the transmission period of cases were included. The adjusted OR and 95% confidence intervals (CI) was calculated using logistic regression. A total of 1124 pertussis cases were detected, of which 14.9% were hospitalized. Inspiratory whoop (aOR: 1.64; CI: 1.02–2.65), apnoea (aOR: 2.47; CI: 1.51–4.03) and cyanosis (aOR: 15.51; CI: 1.87–128.09) were more common in hospitalized than in outpatient cases. Hospitalization occurred in 8.7% of correctly-vaccinated cases, 41.1% of non-vaccinated cases and 9.4% of partially-vaccinated cases. In conclusion, inspiratory whoop, apnoea and cyanosis were associated factors to hospitalization while vaccination reduced hospitalizations due to pertussis. Ministry of Science and Innovation, Institute of Health Carlos III (Project PI11/02557) and Fondo Europeo de Desarrollo Regional (FEDER-Una manera de hacer Europa); the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2014/ SGR 1403).

Background During the 2009 influenza pandemic, a change in the type of patients most often affected by influenza was observed. The objective of this study was to assess the role of individual and social determinants in hospitalizations due to influenza A (H1N1) 2009 infection. Methods We studied hospitalized patients (cases) and outpatients (controls) with confirmed influenza A (H1N1) 2009 infection. A standardized questionnaire was used to collect data. Variables that might be related to the hospitalization of influenza cases were compared by estimation of the odds ratio (OR) and 95% confidence intervals (CI) and the variables entered into binomial logistic regression models. Results Hospitalization due to pandemic A (H1N1) 2009 influenza virus infections was associated with non-Caucasian ethnicity (OR: 2.18, 95% CI 1.17 − 4.08), overcrowding (OR: 2.84, 95% CI 1.20 − 6.72), comorbidity and the lack of previous preventive information (OR: 2.69, 95% CI: 1.50 − 4.83). Secondary or higher education was associated with a lower risk of hospitalization (OR 0.56, 95% CI: 0.36 − 0.87) Conclusions In addition to individual factors such as comorbidity, other factors such as educational level, ethnicity or overcrowding were associated with hospitalization due to A (H1N1) 2009 influenza virus infections.

Fundamentos: El cumplimiento del tratamiento de la Infección Tuberculosa Latente (ITL) es un factor determinante del control de la tuberculosis. El objetivo de este trabajo fue estimar la aceptación y el cumplimiento del tratamiento de la ITL y factores asociados en contactos de enfermos con tuberculosis en Lleida. Métodos: Estudio epidemiológico analítico observacional de seguimiento de una cohorte retrospectiva, desde el 1 de enero de 2015 al 31 de diciembre de 2016. Los participantes fueron los contactos de enfermos con tuberculosis de Lleida. Se estudiaron variables del caso índice y variables independientes y dependientes (aceptación y cumplimiento de la ITL) de los contactos, a través del análisis univariado y multivariado. La fuerza de asociación se estudió con el odds ratio (OR) y su intervalo de confianza (IC) del 95% y se ajustaron mediante modelos de regresión logística. Resultados: El 69,1% de los casos de tuberculosis poseían estudio de contactos, y el 47,5% tenían algún contacto con prescripción de tratamiento preventivo. El 94,5% de los contactos aceptó el tratamiento de la ITL, y éste fue finalizado por el 70,3%. El cumplimiento fue más frecuente en los pacientes que conocían el significado del tratamiento de la ITL (ORa: 2,0; IC: 95% 1,0-4,1). Conclusiones: En relación a la aceptación/cumplimiento del tratamiento de la ITL, destaca la influencia positiva de poseer conocimientos sobre la infección y su tratamiento. Los profesionales de Atención Primaria deberían proporcionar mayor educación sanitaria con el fin de mejorar el cumplimiento terapéutico de la ITL. Background: Compliance with the treatment of Latent Tuberculous Infection (ITL) is a determining factor in the control of tuberculosis. The objective of this study was to estimate the acceptance and compliance of the ITL treatment, and associated factors in contacts of patients with tuberculosis in Lleida. Design: Epidemiological analytical observational study, of a retrospective cohort follow-up, since the 1 January 2015 to 31 December 2016. The Participants were contacts of patients with tuberculosis in Lleida. Variables of the index case and independent and dependent variables (acceptance and compliance of the treatment) of contacts were studied through univariate and bivariate analysis. The strength of association was studied with odds ratio (OR) and confidence interval (IC) of 95% they were adjusted by a multivariate regression model. Results: 69.1% of tuberculosis cases had a contact study, and 47.5% had at least one contact with prescription of preventive treatment. The treatment was accepted by 94.5% of contacts, and only 70.3% finalized this treatment. The completion was more frequent in patients who knew the meaning of latent tuberculosis infection treatment (ORa: 2.0; CI: 95% 1.0-4.1). Conclusions: There was a positive influence of having knowledge of the meaning of the infection and its treatment. Primary Care should be involved in providing more and better health education in order to improve therapeutic compliance.

Introduction When influenza vaccination is ineffective in preventing influenza virus infection, it may still reduce the severity of influenza-associated disease. Here, we estimate the effect of influenza vaccination in preventing severe outcomes e.g. intensive care unit (ICU) admission and death, even though it did not prevent influenza virus infection and subsequent hospitalisation. Methods An observational case–case epidemiological study was carried out in 12 sentinel hospitals in Catalonia (Spain) over six influenza seasons 2010/11–2015/16. Cases were individuals with severe laboratory-confirmed influenza virus infection and aged 18 years and older. For each reported case we collected demographic, virological and clinical characteristics. Logistic regression was used to estimate the crude, adjusted odd ratios (aOR) and 95% confidence intervals (CI). Results Of 1,727 hospitalised patients included in the study, 799 were female (46.7%), 591 (34.2%) were admitted to the ICU and 223 (12.9%) died. Influenza vaccination uptake was lower in cases that required ICU admission or died (21.2% vs 29.7%, p Conclusions We found that influenza vaccination reduced the severity of disease even in cases where it did not prevent infection and influenza-associated hospitalisation. Therefore, increased vaccination uptake may reduce complications, ICU admission and death.

Fundamentos. Las pandemias de gripe pueden comportar una mayor gravedad. El objetivo fue determinar las características de los casos graves hospitalizados de gripe pandémica en Cataluña y estudiar factores de riesgo de ingreso en CI. Métodos: e realizó un estudio epidemiológico observacional y prospectivo de los casos nuevos de gripe pandémica hospitalizados por su gravedad en el período: junio del 2009 hasta mayo del 2010. e solicitó a los centros sanitarios la declaración de los casos que cumplieron la definición de caso grave y en los que se confirmó la presencia del virus pandémico. Mediante una encuesta epidemiológica se recogió información sobre variables demográficas, clínica, factores de riesgo, tratamiento y evolución clínica. Las diferencias entre los casos en CI respecto al resto de casos graves se estudiaron con la odds ratio ajustada (ORa) mediante un modelo de regresión logística no condicional. Resultados: e detectaron 773 casos graves de gripe pandémica; 465 (60,2%) presentaron al menos un factor de riesgo y los más prevalentes fueron: embarazo 19 (13%), asma 87 (12%); enfermedad pulmonar obstructiva crónica 87 (11,4%) y cardiopatías 80 (10,5%). Precisaron ingreso en una unidad de cuidados intensivos 293 pacientes (37,9%). Los factores asociados al ingreso en CI fueron la obesidad IMC>40 (ORa=2,5; IC 95% 1,4-4,5) y la enfermedad hepática crónica (ORa=2,3; IC 95% 1,1-4,8). Conclusiones: e confirma la alta prevalencia de embarazo, enfermedades respiratorias crónicas, diabetes y obesidad entre los casos graves. La obesidad mórbida se comporta como un factor de riesgo de ingreso en CI y por ello debe ser un indicador de vacunación antigripal.

Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case-control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22-47). VE was 51% (95% CI: 15-71) in patients without high-risk medical conditions and 30% (95% CI: 14-44) in patients with them. VE was 39% (95% CI: 20-53) in patients aged 65-79 years and 34% (95% CI: 11-51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals.

Objectius: Estudiar l’associació de factors de risc d’estenosi aòrtica (EA) greu i estimar l’impacte d’aquesta patologia en la qualitat de vida en pacients ≥65 anys de les comarques de Lleida en el període 11/02/2014 a 14/04/2018. Mètodes: Es va realitzar un estudi epidemiològic de casos i controls aparellat. Per cada cas incident d’EA greu es van seleccionar controls aparellats per edat, gènere i àmbit d’Atenció Primària. Es va realitzar una anàlisi descriptiva de la sèrie de casos i una anàlisi bivariada i multivariada de l’estudi de casos i controls. L’associació dels diferents factors es va estudiar amb l’odds ratio ajustada (ORa) i els seus intervals de confiança (IC) del 95% mitjançant models de regressió logística. Resultats: La supervivència acumulada dels pacients amb EA greu del grup de Tractament Mèdic estava significativament disminuïda. En l’anàlisi multivariant els factors de risc cardiovasculars associats amb l’EA greu van ser: el tabaquisme (ORa=2,60; IC95%:1,48–4,58), la hipertensió arterial (ORa=2,41; IC95%:1,23–4,72), la hipercolesterolèmia (ORa=2,67; IC95%:1,54–4,64) i els nivells baixos de colesterol HDL (ORa=2,20; IC95%:1,25–3,88). Les comorbiditats associades vas ser la insuficiència renal crònica (ORa=3,78; IC95: 1,88–9,21), l’accident vascular cerebral (ORa=4,14; IC95%: 1,20–14,2) i l’estenosi carotídia (ORa=14,5; IC95%: 1,61 – 129). El qüestionari de qualitat de vida EuroQol 5D-5L, va detectar una pitjor valoració de la realització d’activitats quotidianes (ORa=2,10; IC95%:1,50-3,01) i de l’escala analògica visual (EVA >70: ORa=0,40; IC95%:0,17-0,82) en els pacients amb EA greu. De la mateixa manera, el qüestionari de salut SF-12 va revelar una pitjor valoració de les components sumàries física (ORa=0,89; IC95%:0,83-0,92) i mental (ORa=0,80; IC95%:0,74-0,88) i del dolor com a limitant d’activitats (ORa=0.42; IC95%:0,24-0,76) i de les dimensions Funció Física (ORa=0.94; IC95%:0,90-0,98), Rol Físic (ORa=0.89; IC95%:0,79-1,00) i Funció Social (ORa=0.95; IC95%:0,91-0,98) . No es va observar associació amb el polimorfisme rs10455872. Conclusions: Els pacients amb EA greu tractats mèdicament presenten pitjor supervivència. El tabaquisme, la hipertensió arterial, la hipercolesterolèmia i les nivells baixos de colesterol HDL s’associen amb l’EA greu. Les comorbiditats que s’associen són la insuficiència renal crònica, l’accident vascular cerebral i l’estenosi carotídia. Els instruments de qualitat de vida (EuroQol 5D-5L i SF-12) detecten pitjors puntuacions en l’EA greu i poden ser d’utilitat en assistència i recerca clínica. Per a estudiar la implicació del polimorfisme genètic rs10455872 del gen de la lipoproteïna A en l’EA greu s’han de fer estudis amb suficient potència estadística. Objetivos: Estudiar la asociación de factores de riesgo de estenosis aórtica (EA) grave y estimar el impacto de esta patología en la calidad de vida en pacientes ≥65 años de las comarcas de Lleida en el periodo 11/02/2014 a 14/04/2018. Métodos: Se realizó un estudio epidemiológico de casos y controles apareado. Por cada caso incidente de EA grave fueron seleccionados controles apareados por edad, género y ámbito de Atención Primaria. Se realizó un análisis descriptivo de la serie de casos y un análisis bivariado y multivariado del estudio de casos y controles. La asociación de los diferentes factores fue estudiada con odds ratio ajustada (ORa) y sus intervalos de confianza (IC) del 95% mediante modelos de regresión logística. Resultados: La supervivencia acumulada de los pacientes con EA grave del grupo de Tratamiento Médico estaba significativamente disminuida. En el análisis multivariante los factores de riesgo cardiovasculares asociados a la EA grave fueron: el tabaquismo (ORa=2,60; IC95%:1,48–4,58), la hipertensión arterial (ORa=2,41; IC95%:1,23–4,72), la hipercolesterolemia (ORa=2,67; IC95%:1,54–4,64) y los niveles bajos de colesterol HDL (ORa=2,20; IC95%:1,25–3,88). Las comorbilidades asociadas fueron la insuficiencia renal crónica (ORa=3,78; IC95: 1,88–9,21), el accidente vascular cerebral (ORa=4,14; IC95%: 1,20–14,2) y la estenosis carotídea (ORa=14,5; IC95%: 1,61 – 129). El cuestionario de calidad de vida EuroQol 5D-5L, detectó una peor valoración de la realización de actividades cotidianas (ORa=2,10; IC95%:1,50-3,01) y de la escala analógica visual (EVA >70: ORa=0,40; IC95%:0,17-0,82) en los pacientes con EA grave. El cuestionario de salud SF-12 detectó una peor valoración de las componentes sumarias física (ORa=0,89; IC95%:0,83-0,92) y mental (ORa=0,80; IC95%:0,74-0,88) y del dolor como limitante de actividades (ORa=0.42; IC95%:0,24-0,76) y de las dimensiones Función Física (ORa=0.94; IC95%:0,90-0,98), Rol Físico (ORa=0.89; IC95%:0,79-1,00) y Función Social (ORa=0.95; IC95%:0,91-0,98). No se observó asociación con el polimorfismo rs10455872. Conclusiones: Los pacientes con EA grave tratados médicamente muestran peor supervivencia. El tabaquismo, la hipertensión arterial, la hipercolesterolemia y los niveles bajos de colesterol HDL se asocian con la EA grave. Las comorbilidades que se asocian son la insuficiencia renal crónica, el accidente vascular cerebral y la estenosis carotidea. Los instrumentos de calidad de vida (EuroQol 5D-5L y SF-12) detectan peores puntuaciones en la EA grave y pueden ser de utilidad en la asistencia y la investigación clínicas. Para estudiar la implicación del polimorfismo genético rs10455872 del gen de la lipoproteína A en la EA grave se deben hacer estudios con suficiente potencia estadística. Objectives: To study the association of risk factors with severe aortic stenosis (AS) and to estimate the impact of this pathology on quality of life in patients older than 65 years in the districts of Lleida, Spain from November 2, 2014 to April 14, 2018. Methods: A case-control study was carried out. Each incident case of severe AS was matched with controls in terms of age, gender, and primary care setting. Descriptive analysis of the cases was performed. Bivariate and multivariate analysis of the study of cases and controls was conducted. The association of different factors were investigated by calculating adjusted odds ratios (ORa) and their 95% confidence intervals (CIs) using logistic regression models. Results: Cumulative survival of patients with severe AS was significantly decreased in the medical treatment group. In multivariate analysis, the cardiovascular risk factors associated with severe AS were smoking (ORa = 2.60, 95% CI: 1.48–4.58), arterial hypertension (ORa = 2.41, 95% CI: 1.23–4.72), hypercholesterolemia (ORa = 2.67, 95% CI: 1.54–4.64), and a low high-density lipoprotein cholesterol level (ORa = 2.20, 95% CI: 1.25–3.88). Associated comorbidities were chronic renal failure (ORa = 3.78, 95% CI: 1.88–9.21), stroke (ORa = 4.14, 95% CI: 1.20–14.2), and carotid stenosis (OR = 14.5, 95% CI: 1.61–129). The EuroQol 5D-5L quality of life questionnaire revealed that performance of daily activities (ORa = 2.10, 95% CI: 1.50–3.01) and visual analog scale scores (EVA> 70: ORa = 0.40, 95% CI: 0.17–0.82) were worse in patients with severe AS. Similarly, the SF-12 quality of life questionnaire detected less scores of physical components (ORa = 0.89, 95% CI: 0.83–0.92), mental components (ORa = 0.80, 95% CI: 0.74–0.88), the extent to which pain limited activities (ORa = 0.42, 95% CI: 0.24–0.76), physical function dimensions (ORa = 0.94, 95% CI: 0.90–0.98), physical role (ORa = 0.89, 95% CI: 0.79–1.00), and social function (ORa = 0.95, 95% CI: 0.91–0.98). No association with the genetic polymorphism rs10455872 was found. Conclusions: Survival was worse for medical treated severe AS patients. Smoking, arterial hypertension, hypercholesterolemia, and a low level of high-density lipoprotein cholesterol were associated with severe AS. The comorbidities associated with severe AS were chronic renal failure, stroke, and carotid stenosis. Quality of life questionnaires (EuroQol 5D-5L and SF-12) revealed worse scores in severe AS patients and may be useful in clinical care and research. Studies with greater statistical power are required to study the association between the genetic polymorphism rs10455872, which is present in the lipoprotein A gene, and severe AS.

[cat] Aquest estudi va tenir com a objectiu analitzar l'existència d'una associació entre la classe social (categoritzats per tipus d'ocupació) i per analitzar les relacions entre l'exposició ocupacional i la infecció de la grip i l'hospitalització durant l'onada de pandèmia de 2009 a 2010 i l'epidèmia de grip de temporada 2010-2011 a Espanya. Aquest estudi multicèntric va comparar casos confirmats de manera ambulatòria de la grip A (H1N1) pmd09 mitjançant controls ambulatoris per mesurar el risc d'infecció, i amb casos confirmats de pacients hospitalitzats.. Les variables d'estudi van ser: edat, estat civil, tabac i alcohol, embaràs, malaltia pulmonar obstructiva crònica, insuficiència respiratòria crònica, malaltia cardiovascular, diabetis, malaltia hepàtica crònica, índex de massa corporal> 40, el tractament mitjançant corticosteroides i l’estat vacunal dels pacients. Es van registrar els casos de manera literal i es van agrupar segons la classe social i l’ocupació en el cas dels treballadors manuals i no manuals. Els llocs de treball es van classificar també pel que feia al seu alt, mitjà o baix risc d'exposició a la grip. Es va realitzar una anàlisi de regressió logística condicional. Hi havia 720 casos hospitalitzats de grip confirmada per transcripció inversa de la polimerasa-reacció en cadena (RT-PCR), 996 casos ambulatoris i 1062 controls ambulatoris inclosos en l'estudi. No s'ha trobat relació entre la classe social ocupacional i A (H1N1), la infecció pmd09 [quocient de probabilitats ajustat (ORA) 0 · 97, 95% interval de confiança (CI) 0,74-1,27], sinó una associació (ORA 1,53, IC del 95% 1.01- es va observar 2,31) entre la classe ocupacional i hospitalització per a pmd09 (H1N1). El grup d'alt risc d'exposició ocupacional es compon exclusivament de treballadors de la salut. Després d'ajustar per edat, sexe, estat de vacunació i les variables de predicció d'infecció per grip, els pacients amb un alt risc d'exposició ocupacional tenien un AOR de 2,14 (IC del 95%: 1,25-3,66) de ser un cas de grip ambulatòria i un AOR de 0,43 ( IC del 95%: 0,20 fins a 0,95) de ser un cas de la grip per a pacients hospitalitzats, en comparació amb aquells amb un baix risc. La vacunació contra la grip era un factor de protecció per a A (H1N1), la infecció pmd09 (ORA 0 · CI 41, 95% 0 · 23-0 · 73) però no per a l'hospitalització. Arribem a la conclusió que els treballadors manuals tenen el major risc d'hospitalització quan estan infectades per la grip que altres ocupacions, però que no tenen una probabilitat diferent d'estar infectats per la grip. Un alt risc d'exposició ocupacional és un factor de risc per a la infecció per influença, però no per a l'hospitalització. L'efectivitat ajustada de vacunació contra la grip va ser del 59% (IC del 95%: 27% -77%) quan es comparen els casos de grip ambulatòria amb els pacients ambulatoris sense símptomes de la grip i va aconseguir el 74% (IC 95%: 42% -88%) quan es consideren els riscos laborals., [eng] This study aimed to analyze the existence of an association between social class (categorized by type of occupation) and to analyze relationships between occupational exposure and influenza infection and hospitalization during the 2009-2010 pandemic wave and the 2010-2011 influenza seasonal epidemic in Spain. This multicentre study compared ambulatory A(H1N1)pmd09 confirmed cases with ambulatory controls to measure risk of infection, and with hospitalized A(H1N1)pmd09 confirmed cases to asses hospitalization risk. Study variables were: age, marital status, tobacco and alcohol use, pregnancy, chronic obstructive pulmonary disease, chronic respiratory failure, cardiovascular disease, diabetes, chronic liver disease, body mass index >40, systemic corticosteroid treatment and influenza vaccination status. Occupation was registered literally and coded into manual and non-manual worker occupational social class groups. Occupations were classified also as high, medium or low risk of influenza exposure. A conditional logistic regression analysis was performed. There were 720 hospitalized cases of influenza confirmed by reverse-transcription polymerase-chain-reaction (RT-PCR), 996 ambulatory cases and 1062 ambulatory controls included in the study. No relationship between occupational social class and A(H1N1)pmd09 infection was found [adjusted odds ratio (aOR) 0·97, 95% confidence interval (CI) 0.74–1.27], but an association (aOR 1.53, 95% CI 1.01–2.31) between occupational class and hospitalization for A(H1N1)pmd09 was observed. The high risk of occupational exposure group was composed only of health care workers. After adjustment for age, sex, vaccination status and predictive variables of influenza infection, patients with a high risk of occupational exposure had an aOR of 2.14 (95%CI: 1.25-3.66) of being an outpatient influenza case and an aOR of 0.43 (95%CI: 0.20-0.95) of being an inpatient influenza case, compared with those with a low risk. Influenza vaccination was a protective factor for A(H1N1)pmd09 infection (aOR 0·41, 95% CI 0·23–0·73) but not for hospitalization. We conclude that manual workers have the highest risk of hospitalization when infected by influenza than other occupations but they do not have a different probability of being infected by influenza. A high risk of occupational exposure is a risk factor for influenza infection but not for hospitalisation. The adjusted effectivity of influenza vaccination was 59% (95% CI: 27%-77%) when comparing outpatient influenza cases with outpatients without influenza symptoms and reached 74% (IC 95%: 42%-88%) when considering occupational risk.

INTRODUCCIÓ La MPOC és una patologia amb una elevada morbimortalitat. L’exacerbació és freqüent en la història natural de la malaltia i s’associa a una declinació irreversible de la capacitat pulmonar, a una pitjor qualitat de vida i a una disminució en la supervivència. L’objectiu de la tesi va ser estudiar la incidència i els factors de risc associats a l’exacerbació de la MPOC i determinar les efectivitats de les vacunacions antigripal i antipneumocòccica 23V. METODOLOGIA Es van realitzar quatre estudis observacionals: el primer va ser prospectiu i els tres següents retrospectius. El segon i el tercer estan fets en base a la mateixa població (2.501 malalts MPOC de la Regió Sanitària de Lleida). El primer en base a una mostra de 512 pacients diagnosticats de l’ABS Pla d’Urgell i el quart emprant una mostra de 1.323 de la mateixa ABS. Les variables depenents van ser la exacerbació, l’ingrés hospitalari i la mort. La resta de les variables recollides foren: demogràfiques, paràmetres espiromètrics, gravetat (GOLD), hàbit tabàquic, antecedent d’exacerbació, vacunacions (antigripal i antipneumocòccica 23V), comorbiditat associada (Charlson), BODEx, ansietat/sd depressiva (HAD), grau dispnea, qualitat de vida (EuroQOL 5D). A través de models de regressió logística s’han determinat les variables associades a l’exacerbació, a l’ingrés hospitalari i a la mortalitat global. Alhora, s’han dissenyat models score de predicció del risc. RESULTATS L’efectivitat de la vacunació antigripal per evitar l’ingrés per exacerbació va ser del 90,8% durant els 3 mesos de màxima activitat gripal; i per evitar la mortalitat global, del 33%. Tanmateix, la cobertura vacunal antigripal va ser del 55,3%, La incidència anual d’exacerbació de la MPOC va ser del 61,7%, la d’ingrés hospitalari anual per agudització del 10,8% i la de mortalitat global anual, del 4,2%. Es varen objectivar diferents factors associats sent els més rellevant l’antecedent d’agudització i el d’ingrés per exacerbació. CONCLUSIONS La cobertura de vacunació antigripal en la població és baixa. L’efectivitat de la vacunació antigripal és alta. L’antecedent d’exacerbació resultaria una variable clau a tenir en compte per part del metge i que discriminaria aquells pacients amb un risc major d’exacerbació., INTRODUCCIÓN La EPOC es una patología con una elevada morbimortalidad. La exacerbación es frecuente en la historia natural de la enfermedad y se asocia a una declinación irreversible de la capacidad pulmonar, a una peor calidad de vida y a una disminución en la supervivencia. El objetivo de la tesis fue estudiar la incidencia y los factores de riesgo asociados a la exacerbación de la EPOC y determinar las efectividades de las vacunaciones antigripal y antineumocócica 23V. METODOLOGÍA Se realizaron cuatro estudios observacionales: el primero fue prospectivo y los tres siguientes retrospectivos. El segundo y el tercero han utilizado la misma población (2.501 enfermos EPOC de la Región Sanitaria de Lleida). El primero está realizado en base a una muestra de 512 pacientes diagnosticados del ABS Pla d’Urgell y el cuarto utilizando una muestra de 1.323 pacientes de la misma ABS. Las variables dependientes fueron la exacerbación, el ingreso hospitalario y la muerte. Las demás variables recogidas fueron: demográficas, parámetros espirométricos, gravedad (GOLD), hábito tabáquico, antecedente de exacerbación, vacunaciones (antigripal y antineumocócica 23V), comorbilidad asociada (Charlson), Bodex, ansiedad/sd depresiva (HAD), grado de disnea, calidad de vida (EuroQOL 5D). A través de modelos de regresión logística se han determinado las variables asociadas a la exacerbación, al ingreso y a la mortalidad global. Al mismo tiempo se han diseñado modelos score de predicción del riesgo. RESULTADOS La efectividad de la vacunación antigripal para evitar el ingreso por exacerbación fue del 90,8% durante los 3 meses de máxima actividad gripal; y para evitar la mortalidad, del 33%. Sin embargo, la cobertura vacunal antigripal fue del 55,3%. La incidencia anual de exacerbación de la EPOC fue del 61,7%, la de ingreso hospitalario anual por exacerbación del 10,8% y la de mortalidad global anual del 4,2%. Se objetivaron diferentes factores asociados siendo los más relevantes el antecedente de agudización y el de ingreso por exacerbación. CONCLUSIONES La cobertura de vacunación antigripal en la población es baja. La efectividad de la vacunación es alta. El antecedente de exacerbación resultaría una variable clave a tener en cuenta y que discriminaría aquellos pacientes con un riesgo mayor de exacerbación., INTRODUCTION COPD is a disease with high morbidity and mortality. The exacerbation is common in the natural history of the disease, which is associated with an irreversible decline in lung capacity, a worse quality of life and a decrease in survival. The aim of the thesis was to study the incidence and risk factors associated with the exacerbation of COPD and to determine the effectiveness of flu vaccinations and antipneumococcal 23v. METHODS Four observational studies were conducted: the first was prospective and other three were retrospective. The second and third were carried out on the basis of the same population (2,501 COPD patients within the Lleida Health Care Region). The first was based on a sample of 512 patients diagnosed at the Pla d'Urgell Health Care Centre and the fourth using a sample of 1,323 at the same centre. The dependent variables were exacerbations, hospitalization and death. The remaining variables compiled were: demographics, spirometric parameters, severity (GOLD), smoking habit, a history of exacerbations, vaccination (flu and antipneumococcal 23v) associated comorbidity (Charlson) BODEx, anxiety/depressive ds (HAD), dyspnea level and quality of life (EuroQol 5D). Using logistic regression models we determined the variables associated with exacerbation, hospital admission and overall mortality. At the same time, models/score have been designed for predicting risk. RESULTS The effectiveness of flu vaccinations to prevent admission due to exacerbation was 90.8% during the three months of peak flu activity; and to prevent overall mortality, 33%. However, flu vaccination coverage was 55.3%, the annual incidence of COPD exacerbation was 61.7%, the annual hospitalization for deterioration was 10.8% and annual global mortality was 4.2%. We were able to interpret different factors associated with being the most important antecedent in the intensification and exacerbation of admission. CONCLUSIONS Flu vaccination coverage in the population is low. The effectiveness of the flu vaccine is high. The antecedent of exacerbation would be a key variable for the doctor to take into account, who would differentiate between patients with an increased risk of exacerbation.