Impact of COVID-19 Pandemic in Antibiotic Consumption in Navarre (Spain): An Interrupted Time Series Analysis.

On 11 March 2020, the World Health Organization declared coronavirus disease 19 (COVID-19) a global pandemic. This exceptional situation changed the world not only in terms of mortality and morbidity, but also in terms of epidemiology and health system resources consumption. The objective of this work was to analyze the consumption of antibiotics during the period around the pandemic in our region. A drug utilization study was performed comparing the antibiotic consumption in the community during the years 2018, 2019, 2020, and 2021. Quarterly antibiotic use (defined daily doses (DDD) per 1000 inhabitants per day (DID)) and number of patients treated were the outcomes. Interrupted time series regression analysis was performed to estimate the statistical significance of the change in level of consumption before and after the COVID-19 pandemic. The drop of global antibiotic consumption was statistically significant, both in number of patients and in DID when analyzing pre-pandemic period versus pandemic period. The use of strategic antibiotics for respiratory infections such as amoxicillin, amoxicillin-clavulanic acid, and levofloxacin also decreased significantly. Seasonal pattern of use of antibiotics disappeared due to the global measures imposed over the world to work against COVID-19.

Factors associated with continued adherence to influenza vaccination in the elderly.

OBJECTIVE: We aimed to analyze the factors influencing continued adherence to influenza vaccination in elderly persons vaccinated in the preceding season. METHODS: Using a population-based vaccination registry, we evaluated the proportion of persons vaccinated against influenza in Navarre, Spain, in the 2010-11 season among non-institutionalized persons aged 65 years or over who had been vaccinated in the 2009-10 season. Logistic regression was used to analyze the influence of sociodemographic, clinical and health care factors. RESULTS: Of the 64,245 persons vaccinated against influenza in the 2009-10 season, 87% were vaccinated in the 2010-11 season. Continued adherence to vaccination increased with the number of physician visits per year. It was lower in women, in the 65-69 and ≥ 95 year age-groups, in those hospitalized or diagnosed with any major chronic condition in the previous year, and in persons with hematological cancer or dementia. Health districts and physicians with higher coverage in the previous season continued to have higher adherence in the following season. CONCLUSIONS: People vaccinated against influenza in one season tend to be vaccinated in the following one. Sociodemographic, clinical and health care factors have a moderate effect on the continuity of vaccination, with the most important factor being the treating physician.

Mortality by causes in HIV-infected adults: comparison with the general population.

BACKGROUND: We compared mortality by cause of death in HIV-infected adults in the era of combined antiretroviral therapy with mortality in the general population in the same age and sex groups. METHODS: Mortality by cause of death was analyzed for the period 1999-2006 in the cohort of persons aged 20-59 years diagnosed with HIV infection and residing in Navarre (Spain). This was compared with mortality from the same causes in the general population of the same age and sex using standardized mortality ratios (SMR). RESULTS: There were 210 deaths among 1145 persons diagnosed with HIV (29.5 per 1000 person-years). About 50% of these deaths were from AIDS. Persons diagnosed with HIV infection had exceeded all-cause mortality (SMR 14.0, 95% CI 12.2 to 16.1) and non-AIDS mortality (SMR 6.9, 5.7 to 8.5). The analysis showed excess mortality from hepatic disease (SMR 69.0, 48.1 to 78.6), drug overdose or addiction (SMR 46.0, 29.2 to 69.0), suicide (SMR 9.6, 3.8 to 19.7), cancer (SMR 3.2, 1.8 to 5.1) and cardiovascular disease (SMR 3.1, 1.3 to 6.1). Mortality in HIV-infected intravenous drug users did not change significantly between the periods 1999-2002 and 2003-2006, but it declined by 56% in non-injecting drug users (P = 0.007). CONCLUSIONS: Persons with HIV infection continue to have considerable excess mortality despite the availability of effective antiretroviral treatments. However, excess mortality in the HIV patients has declined since these treatments were introduced, especially in persons without a history of intravenous drug use.

Association between benzodiazepine use and development of dementia.

OBJECTIVE: To evaluate the association between use of benzodiazepines and incident dementia. METHODS: Analytical prospective nested case-control study for which the Spanish database for pharmacoepidemiological research in primary care (BIFAP) of the Spanish Agency of Medicines and Medical Devices (AEMPS) was used. A total of 15,212 subjects diagnosed with dementia of the Alzheimer type and 62,397 controls were identified. Exposure was retrieved retrospectively with a 3-year lag time before the index date. Adjusted odd ratios (OR) were calculated. RESULTS: Benzodiazepines use increased the risk of suffering Alzheimer's disease (OR=1.05, 95% CI, 1.01-1.10). No statistical differences were shown between short-acting and long-acting drugs. The risk is more evident with longer exposure times. CONCLUSIONS: There seems to be a weak association between benzodiazepine use and the development of dementia, the risk increases with greater exposure.

[Evaluation of the surveillance system for human immunodeficiency virus infections of Navarra, Spain, 1985-2003]. / Evaluación del sistema de información de Navarra sobre diagnósticos de infección por el VIH, 1985-2003.

BACKGROUND: Navarra has an information system of HIV diagnoses working since the beginning of the epidemic up to the present day. This study aims at describing and evaluating this system, focusing on its sensitivity. METHODS: The updated guidelines for evaluating public health surveillance systems from the CDC were used to describe the purpose and operation of the system and to analyse its attributes for the period 1985-2003. For the evaluation of the sensitivity the regional database of antiretrovirals distribution was used. RESULTS: The HIV surveillance system of Navarra is confidential and name-based, and includes all HIV-infection cases diagnosed each year. The information sources of the system are: (a) all the laboratories in the public health system that perform the western blot test, and (b) hospital discharge registries. The system covers the entire population of Navarre (584,734 inhabitants). It uses the HIV case definition proposed by the European Centre for the Epidemiological Monitoring of AIDS. The system is well-accepted by the community and by all the stakeholders, including those providing data. By the end of 2003 it included 2302 HIV cases, and 98.8% of all patients who had ever received antiretrovirals in Navarra. CONCLUSIONS: The HIV information system of Navarra is simple, useful, well-accepted and highly sensitive. The information about antiretroviral distribution was useful for this evaluation.

[Harmonisation of databases for the study of frailty in older people: INTAFRADE study]. / Armonización de bases de datos para el estudio de la fragilidad en personas mayores: Estudio INTAFRADE.

OBJECTIVES: The main objective of the present work is to evaluate the feasibility of harmonising the available information from different independent databases, in order to build an integrated database to study frailty. MATERIAL AND METHODS: This work is based on the European project, Integral Approach to the Transition between Frailty and Dependence on older adults: Patterns of occurrence, identification tools and model of care (INTAFRADE), developed by 4 groups, 3 in Spain and one in France. Each partner provided their databases related to the study of frailty. As a previous step to the creation of an integrated database the characteristics and variables included in each study were mapped, specifying whether their harmonisation was possible or not. RESULTS: A total of 30 different variables that corresponded to 8 dimensions were identified: Sociodemographic and social characteristics, health status, lifestyle habits, anthropometric measures, other physical measurements, use of health services, and adverse health results. Of them all, 28 (93%) variables were harmonisable, although only 20% were present in all databases, with 47% in 3 of them. In relation to the frailty instruments, all of them were lacking at least 50% of the items. The harmonisation process will allow us to jointly analyse information available on 2,361 people. CONCLUSIONS: The European INTAFRADE study will allow a deeper understanding of the frailty process in older people by harmonising information from heterogeneous databases.

Household transmission of influenza A(H1N1)pdm09 in the pandemic and post-pandemic seasons.

BACKGROUND: The transmission of influenza viruses occurs person to person and is facilitated by contacts within enclosed environments such as households. The aim of this study was to evaluate secondary attack rates and factors associated with household transmission of laboratory-confirmed influenza A(H1N1)pdm09 in the pandemic and post-pandemic seasons. METHODS: During the 2009-2010 and 2010-2011 influenza seasons, 76 sentinel physicians in Navarra, Spain, took nasopharyngeal and pharyngeal swabs from patients diagnosed with influenza-like illness. A trained nurse telephoned households of those patients who were laboratory-confirmed for influenza A(H1N1)pdm09 to ask about the symptoms, risk factors and vaccination status of each household member. RESULTS: In the 405 households with a patient laboratory-confirmed for influenza A(H1N1)pdm09, 977 susceptible contacts were identified; 16% of them (95% CI 14-19%) presented influenza-like illness and were considered as secondary cases. The secondary attack rate was 14% in 2009-2010 and 19% in the 2010-2011 season (p=0.049), an increase that mainly affected persons with major chronic conditions. In the multivariate logistic regression analysis, the risk of being a secondary case was higher in the 2010-2011 season than in the 2009-2010 season (adjusted odds ratio: 1.72; 95% CI 1.17-2.54), and in children under 5 years, with a decreasing risk in older contacts. Influenza vaccination was associated with lesser incidence of influenza-like illness near to statistical significance (adjusted odds ratio: 0.29; 95% CI 0.08-1.03). CONCLUSION: The secondary attack rate in households was higher in the second season than in the first pandemic season. Children had a greater risk of infection. Preventive measures should be maintained in the second pandemic season, especially in high-risk persons.

[Increased primary care consultations for upper respiratory tract infections and for fever coinciding with a wave of influenza]. / Aumento de consultas en atención primaria por infección respiratoria de vías altas y fiebre coincidiendo con la epidemia de gripe (H1N1) 2009.

BACKGROUND: A wave of influenza A (H1N1) 2009 was registered in the summer of 2009. We evaluated its repercussion on primary care consultations not diagnosed as influenza. METHODS: We analysed primary care consultations in the Navarre Health Service from 21 June to 21 September 2009 with a diagnosis of influenza (International Classification of Primary Care, code R80), febrile syndrome (code A03), acute upper respiratory tract infection (code R74), or acute bronchitis (code R78); these consultations were then compared with those occurring in the same period in the three previous years. RESULTS: In the summer of 2009, 3,417 cases of influenza syndrome (5.5 per 1000 population) were reported. An flu outbreak occurred between week 27 and 31, with over the mild (87/160) of swabs from patients with influenza syndrome positive for the virus A (H1N1), with no other influenza types detected. Coinciding with the wave of influenza syndromes, we observed increases in consultations for febrile syndrome and upper respiratory tract infection. In comparison with the mean for the three previous years, in the summer of 2009 consultations for febrile syndrome increased by 44% (3.6 to 5.3 per 1000; p<0.001), consultations for upper respiratory tract infection by 6% (13.2 to 14.1 per 1000; p<0.001), and consultations for bronchitis by 8% (6.3 to 6.9 per 1000; p<0.003). These diagnoses represented 3.2 additional consultations per 1000 population attributable to influenza, that is, 58% more consultations. CONCLUSIONS: Influenza gives rise to increased primary care consultations for influenza syndrome as well as for other less important processes.

[Trends in mortality and causes of death among persons with HIV infection, 1985-2004]. / Cambios en la mortalidad y en las causas de defunción en las personas con diagnóstico de infección por el VIH, 1985-2004.

OBJECTIVE: To describe the changes in causes of death among persons with HIV infection. METHODS: An analysis of mortality according to cause was performed in persons diagnosed with HIV infection and residing in the province of Navarre (Spain) from 1985 to 2004. RESULTS: Among 1,649 persons diagnosed with HIV infection up to 2004, 709 (43.0%) had died. Mortality reached the maximum in 1993-1996 with 83.1 deaths per 1,000 person-years (PY). Since that time and up to 2001-2004, mortality due to AIDS decreased from 68.3 to 14.1 per 1,000 PY (p = 0.0001). From 1989-1992 period to the 2001-2004 period, mortality due to drug overdose dropped from 9.2 to 3.6 per 1,000 PY (p = 0.0035) and mortality due to hepatic disease rose from 1.6 to 6.6 per 1000 PY (p = 0.0061), with no significant changes in all other causes. In 2001-2004, AIDS continued to be the first cause of death (44.4%) in this population, followed by hepatic disease (20.9%) and drug overdose (11.3%). In the era of potent antiretroviral therapy (1997-2004), death caused by AIDS (rate ratio = 0.63; p = 0.0344) and by all other causes (RR = 0.59; p = 0.0232) was lower among women. In addition, mortality due to causes other than AIDS was higher in persons 40 years of age and older (RR = 1.77; P = 0.0050) and mortality was lower in homosexual men (RR = 0.22; p = 0.0360). A simultaneous diagnosis of HIV infection and AIDS was associated with higher mortality by AIDS (RR, 3.39; p < 0.0001). CONCLUSIONS: AIDS continues to be the primary cause of death in HIV-infected people, and mortality due to hepatic diseases and drug overdose is high. Early diagnosis of HIV-infection would reduce the incidence of deaths due to AIDS.