Effects of COVID-19 vaccination on disease activity in patients with rheumatoid arthritis and psoriatic arthritis on targeted therapy in the COVIDSER study.

OBJECTIVE: To investigate the influence of COVID-19 vaccination on disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients under targeted therapies. PATIENTS AND METHODS: 1765 vaccinated patients COVID-19, 1178 (66.7%) with RA and 587 (33.3%) with PsA from the COVID-19 registry in patients with rheumatic diseases (COVIDSER) project, were included. Demographics, disease characteristics, Disease Activity Score in 28 joints (DAS28) and targeted treatments were collected. DAS28-based flare rates and categorised disease activity distribution prevaccination and post vaccination were analysed by log-linear regression and contingency analyses, respectively. The influence of vaccination on DAS28 variation as a continuous measure was evaluated using a random coefficient model. RESULTS: The distribution of categorised disease activity and flare rates was not significantly modified by vaccination. Log-linear regression showed no significant changes in the rate of flares in the 6-month period after vaccination compared with the same period prior to vaccination in neither patients with RA nor patients with PsA. When DAS28 variations were analysed using random coefficient models, no significant variations in disease activity were detected after vaccination for both groups of patients. However, patients with RA treated with Janus kinase inhibitors (JAK-i) (1) and interleukin-6 inhibitor (IL-6-i) experienced a worsening of disease activity (1.436±0.531, p=0.007, and 1.201±0.550, p=0.029, respectively) in comparison with those treated with tumour necrosis factor inhibitor (TNF-i). Similarly, patients with PsA treated with interleukin-12/23 inhibitor (IL-12/23-i) showed a worsening of disease activity (4.476±1.906, p=0.019) compared with those treated with TNF-i. CONCLUSION: COVID-19 vaccination was not associated with increased rate of flares in patients with RA and PsA. However, a potential increase in disease activity in patients with RA treated with JAK-i and IL-6-i and in patients with PsA treated with IL-12/23-i warrants further investigation.

Short-term influence of environmental factors and social variables COVID-19 disease in Spain during first wave (Feb-May 2020).

This study aims to identify the combined role of environmental pollutants and atmospheric variables at short term on the rate of incidence (TIC) and on the hospital admission rate (TIHC) due to COVID-19 disease in Spain. This study used information from 41 of the 52 provinces of Spain (from Feb. 1, 2021 to May 31, 2021). Using TIC and TIHC as dependent variables, and average daily concentrations of PM10 and NO2 as independent variables. Meteorological variables included maximum daily temperature (Tmax) and average daily absolute humidity (HA). Generalized linear models (GLM) with Poisson link were carried out for each provinces The GLM model controlled for trend, seasonalities, and the autoregressive character of the series. Days with lags were established. The relative risk (RR) was calculated by increases of 10 µg/m3 in PM10 and NO2 and by 1 °C in the case of Tmax and 1 g/m3 in the case of HA. Later, a linear regression was carried out that included the social determinants of health. Statistically significant associations were found between PM10, NO2, and the rate of COVID-19 incidence. NO2 was the variable that showed greater association, both for TIC as well as for TIHC in the majority of provinces. Temperature and HA do not seem to have played an important role. The geographic distribution of RR in the studied provinces was very much heterogeneous. Some of the health determinants considered, including income per capita, presence of airports, average number of diesel cars per inhabitant, average number of nursing personnel, and homes under 30 m2 could explain the differential geographic behavior. As findings indicates, environmental factors only could modulate the incidence and severity of COVID-19. Moreover, the social determinants and public health measures could explain some patterns of geographically distribution founded.

Short-term associations of air pollution and meteorological variables on the incidence and severity of COVID-19 in Madrid (Spain): a time series study.

BACKGROUND: There are studies that analyze the role of meteorological variables on the incidence and severity of COVID-19, and others that explore the role played by air pollutants, but currently there are very few studies that analyze the impact of both effects together. This is the aim of the current study. We analyzed data corresponding to the period from February 1 to May 31, 2020 for the City of Madrid. As meteorological variables, maximum daily temperature (Tmax) in ºC and mean daily absolute humidity (AH) in g/m3 were used corresponding to the mean values recorded by all Spanish Meteorological Agency (AEMET) observatories in the Madrid region. Atmospheric pollutant data for PM10 and NO2 in µg/m3 for the Madrid region were provided by the Spanish Environmental Ministry (MITECO). Daily incidence, daily hospital admissions per 100.000 inhabitants, daily ICU admissions and daily death rates per million inhabitants were used as dependent variables. These data were provided by the ISCIII Spanish National Epidemiology Center. Generalized linear models with Poisson link were performed between the dependent and independent variables, controlling for seasonality, trend and the autoregressive nature of the series. RESULTS: The results of the single-variable models showed a negative association between Tmax and all of the dependent variables considered, except in the case of deaths, in which lower temperatures were associated with higher rates. AH also showed the same behavior with the COVID-19 variables analyzed and with the lags, similar to those obtained with Tmax. In terms of atmospheric pollutants PM10 and NO2, both showed a positive association with the dependent variables. Only PM10 was associated with the death rate. Associations were established between lags 12 and 21 for PM10 and between 0 and 28 for NO2, indicating a short-term association of NO2 with the disease. In the two-variable models, the role of NO2 was predominant compared to PM10. CONCLUSIONS: The results of this study indicate that the environmental variables analyzed are related to the incidence and severity of COVID-19 in the Community of Madrid. In general, low temperatures and low humidity in the atmosphere affect the spread of the virus. Air pollution, especially NO2, is associated with a higher incidence and severity of the disease. The impact that these environmental factors are small (in terms of relative risk) and by themselves cannot explain the behavior of the incidence and severity of COVID-19.

Do Clinical Trials Meet Current Care Needs? Views of Digestive Oncology Specialists in Galicia (Spain) Using the Delphi Method.

Background: In recent years, abundant scientific evidence has been generated based on clinical trials (CT) in the field of oncology. The general objective of this paper is to find out the extent to which decision making is based on knowledge of the most recent CT. Its specific objectives are to pinpoint difficulties with decision making based on the CT performed and find out the motivations patients and clinicians have when taking part in a CT. Methodology: Combined, prospective study, based on the Delphi method. A lack of correspondence between the people who take part in CT and patients who come for consultation has been identified. A need for training in analysing and interpreting CT has also been identified and a lack of trust in the results of CT financed by the pharmaceutical industry itself has been perceived. Conclusions: There is a difficulty in selecting oncological treatment due to the lack of correspondence between the patients included in the CT and patients seen in consultation. In this process, real world data studies may be highly useful, as they may provide this group with greater training in interpreting CT and their results.

Use of fourth-generation rapid combined antigen and antibody diagnostic tests for the detection of acute HIV infection in a community centre for men who have sex with men, between 2016 and 2019.

OBJECTIVE: To assess the use of fourth-generation rapid diagnostic tests in identifying acute infection of Human Immunodeficiency Virus (HIV). METHODS: BCN Checkpoint promotes sexual health among men who have sex with men (MSM), with a focus on diagnosing HIV early, initiating combined antiretroviral treatment (cART) promptly, and recommending regular repeat testing for those who have tested negative. This cross-sectional study included all test results obtained at the centre between 25 March 2016 and 24 March 2019. The Alere™ HIV Combo (now rebranded to Determine™ HIV Ultra, from Abbott) was used to detect p24 antigen (p24 Ag) and/or immunoglobulin M (IgM) and G (IgG) antibodies to HIV-1/HIV-2 (HIV Ab). Rapid polymerase chain reaction (PCR) confirmatory testing and Western blot (WB) were performed for clients with a positive rapid test result. Confirmed HIV cases were promptly referred to the HIV unit for care and cART prescription. RESULTS: A total of 12,961 clients attended BCN Checkpoint during the study and 27,298 rapid tests were performed. 450 tests were found to be reactive, of which 430 confirmed as HIV-positive, representing a prevalence of 3.32%. Four confirmed cases (0.93%) were detected as "p24 Ag only", nine (2.09%) as "both p24 and HIV Ab" and 417 (96.98%) as "HIV Ab only". The "p24 Ag only" group had a 1-log higher viral load than the other groups and initiated treatment on the following working day. Overall, there were 20 false-positive results (0.07% and 4.44% of total and reactive tests, respectively), of which 10 positive for "p24 Ag only" and 10 for "HIV Ab only". CONCLUSIONS: Four Acute HIV Infections (AHI), with very high viral loads, have been detected with the "p24 Ag only" while the HIV Ab were still absent. Referral to the HIV unit and initiation of cART on the following working day contributed to improving persons' health and to reduce HIV transmission chain.

Impact of environmental factors and Sahara dust intrusions on incidence and severity of COVID-19 disease in Spain. Effect in the first and second pandemic waves.

Scientific evidence suggests that Saharan dust intrusions in Southern Europe contribute to the worsening of multiple pathologies and increase the concentrations of particulate matter (PM) and other pollutants. However, few studies have examined whether Saharan dust intrusions influence the incidence and severity of COVID-19 cases. To address this question, in this study we carried out generalized linear models with Poisson link between incidence rates and daily hospital admissions and average daily concentrations of PM10, NO2, and O3 in nine Spanish regions for the period from February 1, 2020 to December 31, 2020. The models were adjusted by maximum daily temperature and average daily absolute humidity. Furthermore, we controlled for trend, seasonality, and the autoregressive nature of the series. The variable relating to Saharan dust intrusions was introduced using a dichotomous variable, NAF, averaged across daily lags in ranges of 0-7 days, 8-14 days, 14-21 days, and 22-28 days. The results obtained in this study suggest that chemical air pollutants, and especially NO2, are related to the incidence and severity of COVID-19 in Spain. Furthermore, Saharan dust intrusions have an additional effect beyond what is attributable to the variation in air pollution; they are related, in different lags, to both the incidence and hospital admissions rates for COVID-19. These results serve to support public health measures that minimize population exposure on days with particulate matter advection from the Sahara.

Does exposure to noise pollution influence the incidence and severity of COVID-19?

Research that analyzes the effect of different environmental factors on the impact of COVID-19 focus primarily on meteorological variables such as humidity and temperature or on air pollution variables. However, noise pollution is also a relevant environmental factor that contributes to the worsening of chronic cardiovascular diseases and even diabetes. This study analyzes the role of short-term noise pollution levels on the incidence and severity of cases of COVID-19 in Madrid from February 1 to May 31, 2020. The following variables were used in the study: daily noise levels averaged over 14 days; daily incidence rates, average cumulative incidence over 14 days; hospital admissions, Intensive Care Unit (ICU) admissions and mortality due to COVID-19. We controlled for the effect of the pollutants PM10 and NO2 as well as for variables related to seasonality and autoregressive nature. GLM models with Poisson regressions were carried out using significant variable selection (p < 0.05) to calculate attributable RR. The results of the modeling using a single variable show that the levels of noise (leq24 h) were related to the incidence rate, the rate of hospital admissions, the ICU admissions and the rate of average cumulative incidence over 14 days. These associations presented lags, and the first association was with incidence (lag 7 and lag 10), then with hospital admissions (lag 17) and finally ICU admissions (lag 22). There was no association with deaths due to COVID-19. In the results of the models that included PM10, NO2, Leq24 h and the control variables simultaneously, we observed that only Leq24 h went on to become a part of the models using COVID-19 variables, including the 14-day average cumulative incidence. These results show that noise pollution is an important environmental variable that is relevant in relation to the incidence and severity of COVID-19 in the Province of Madrid.

Demographic and health attributes of the Nahua, initial contact population of the Peruvian Amazon.

We present the case of the Nahua population of Santa Rosa de Serjali, Peruvian Amazon's population, considered of initial contact. This population consists of human groups that for a long time decided to live in isolation, but lately have begun living a more sedentary lifestyle and in contact with Western populations. There are two fully identified initial contact groups in Peru: the Nahua and the Nanti. The health statistics of the Nahua are scarce. This study offers an interpretation of demographic and epidemiological indicators of the Nahua people, trying to identify if a certain degree of health vulnerability exists. We performed a cross sectional study, and after analyzing their health indicators, as well as the supplemental qualitative analysis of the population, brought us to conclude that in 2006, the Nahua, remained in a state of health vulnerability.

Demographic and health attributes of the Nahua, initial contact population of the Peruvian Amazon / Características demográficas y de salud de la población Nahua: población en contacto inicial de la Amazonía Peruana

Abstract We present the case of the Nahua population of Santa Rosa de Serjali, Peruvian Amazon's population, considered of initial contact. This population consists of human groups that for a long time decided to live in isolation, but lately have begun living a more sedentary lifestyle and in contact with Western populations. There are two fully identified initial contact groups in Peru: the Nahua and the Nanti. The health statistics of the Nahua are scarce. This study offers an interpretation of demographic and epidemiological indicators of the Nahua people, trying to identify if a certain degree of health vulnerability exists. We performed a cross sectional study, and after analyzing their health indicators, as well as the supplemental qualitative analysis of the population, brought us to conclude that in 2006, the Nahua, remained in a state of health vulnerability.

Resumen Presentamos el caso de la población Nahua de Santa Rosa de Serjali, una población de la región Amazonica del Perú, considerada en contacto inicial. Esta población está compuesta por grupos humanos que durante mucho tiempo han decidido vivir en aislamiento, pero últimamente han comenzado a vivir un estilo de vida más sedentario y en contacto con la población occidental. Hay dos grupos de contacto iniciales plenamente identificados en el Perú: Los Nahuas y los Nantis . Las estadísticas de salud de los nahuas son escasas. Este estudio ofrece una interpretación de los indicadores demográficos y epidemiológicos del pueblo Nahua, tratando de identificar si existe un cierto grado de vulnerabilidad de la salud . Se realizó un estudio transversal, y después de analizar sus indicadores de salud, así como el análisis cualitativo complementario de la población, nos llevó a la conclusión de que en el año 2006, los nahuas, aún presentaban un estado de vulnerabilidad en salud.

Análisis del patrón epidemiológico de la shigelosis en Barcelona entre 1988 y 2012: ¿es una infección de transmisión sexual emergente? / Analysis of the epidemiological pattern of Shigellosis in Barcelona between 1988 and 2012: is it an emerging sexually transmitted infection?

INTRODUCCIÓN: El objetivo de este estudio fue describir la evolución y las características epidemiológicas de los pacientes con shigelosis durante 25 años en una gran ciudad. MÉTODOS: La shigelosis es una enfermedad de declaración obligatoria en España desde 1988. Se analizan los casos de residentes en Barcelona incluidos en el registro entre 1988-2012. Se presenta un análisis descriptivo según sexo, edad, vía de transmisión y especies de Shigella. Se realizó un análisis de tendencias y de series temporales. RESULTADOS: De los 559 casos analizados, el 60,15% correspondían a hombres. Se observó un incremento sostenido de la tendencia en hombres desde 2008 (p < 0,05), sobre todo a expensas de los de hombres que no tenían antecedentes de toXIInfección alimentaria ni de viajes a zonas endémicas. El incremento de la tendencia fue mayor en hombres de 21 a 60 años, tanto para S. flexneri (desde 2009) como para S. sonnei (desde 2003). En 2012 se observó que, en los hombres con S. flexneri, el 63% tenían sexo con hombres. CONCLUSIONES: Se detectó un incremento de la tendencia en los casos en hombres que no tenían antecedentes de toXIInfección alimentaria ni de viajes a zonas endémicas. Este incremento apunta a un cambio en el patrón de la shigelosis, pasando a ser predominantemente masculina, y cuyo mecanismo principal serían las relaciones sexuales

INTRODUCTION: The aim of the study was to analyze the incidence, management and cost associated to hematological and dermatological adverse effects (AE) in chronic hepatitis C patients on triple therapy (TT) with telaprevir (TVR) or boceprevir (BOC). METHODS: An analysis was made on the data recorded on patients who started treatment with TVR or BOC associated with peginterferon alfa and ribavirin in a 12-week follow-up period. RESULTS: Fifty-three patients were included (TVR n = 36; BOC n = 17). Thrombocytopenia (83% TVR vs. 88% BOC) followed by neutropenia (89% TVR vs. 82% BOC) were the most common AE. Dermatological AE were observed in 32% of patients. Eleven patients required treatment discontinuation (all of them received TVR), and toxicity was the main reason for discontinuation (64%). The percentage of patients who required supportive treatment for management of AE was 66%. The most used supportive treatment was erythropoietin. Eight patients required emergency health care, and 2 were hospitalized due to AE. Total cost of additional supportive resources was 32,522 Euros (625 [SD = 876] Euros/patient) (TVR 759 [SD = 1,022] Euros/patient vs. BOC 349 [SD = 327] Euros/patient; P > .05). Patients with grade iii-iv toxicity required greater supportive care with higher costs, compared to patients with grade i-ii toxicity (849 [SD = 1,143] Euros/patient vs. 387 [SD = 397] Euros/patient; P = .053). CONCLUSION: The addition of new protease inhibitors to conventional treatment leads to a higher incidence of hematological AE in our study, compared to data described in clinical trials. The elevated incidence of AE involves the use of supportive care, increasing total costs of therapy

Epidemiología de las hospitalizaciones por tuberculosis en España: análisis del conjunto mínimo básico de datos 1999-2009 / Epidemiology of hospitalizations for tuberculosis in Spain: analysis of minimum data set 1999-2009

INTRODUCCIÓN: El conjunto mínimo básico de datos es una base clínico-administrativa sobre altas hospitalarias, de mucha utilidad en el nivel autonómico como fuente complementaria a la vigilancia. Existen escasos estudios de ámbito nacional sobre tuberculosis (TB) con el conjunto mínimo básico de datos, por lo que se consideró de interés estudiar las características y la tendencia de los casos hospitalizados por tuberculosis en España. MÉTODOS: Estudio descriptivo de las principales variables del conjunto mínimo básico de datos (sexo, edad, diagnóstico principal, tipo de alta, tiempo de estancia), y análisis de tendencia de las tasas de hospitalización por 100.000 habitantes, según diagnóstico principal, por sexo, grupo de edad y tipo de TB (TB pulmonar [TBP]/TB extrapulmonar [TBEP]), para el periodo 1999-2009 en España. RESULTADOS: Se incluyeron en el estudio 65.609 hospitalizaciones (66% hombres, 66% TBP, 52% entre 15-44 años). La tasa global de TB para todo el periodo fue de 13,93 hospitalizaciones por 100.000 habitantes, siendo de 18,83 en hombres y de 9,18 en mujeres. Las tasas de hospitalización por TBP y TBEP disminuyeron en el periodo 1999-2009 en ambos sexos (TBP en hombres, de 18 a 13, y en mujeres, de 8 a 6; TBEP en hombres, de 4 a 3, y en mujeres, de 3 a 2 hospitalizaciones/100.000 habitantes). En TBP, los niños son los que presentan un menor descenso, y en la TBEP, en hombres hay un incremento en todos los grupos de edad desde 2005. CONCLUSIONES: Los resultados obtenidos son coherentes con los procedentes de la vigilancia. La lenta disminución de las tasas en niños y el aumento de las formas extrapulmonares en hombres podrían estar relacionados con la inmigración, por lo que es necesario mejorar el control de la TB en estos grupos

INTRODUCTION: The National Hospital Discharge Registry is a clinical-administrative database on hospital discharges, which is very useful at a regional level as a complementary source for surveillance. There are few national studies on tuberculosis (TB) using the National Hospital Discharge Registry, thus it was considered of interest to study the characteristics and trends of hospital discharges for TB in Spain. METHODS: A descriptive study was performed using the main variables in the National Hospital Discharge Registry (sex, age, main diagnosis, type of discharge, length of stay), and trend analysis of hospitalization rates per 100,000 population, as well as primary diagnosis, by sex, age group, and type of TB (pulmonary [TBP]/extrapulmonary [TBEP]), for the period 1999-2009 in Spain. RESULTS: A total of 65,609 hospital discharges were included in the study (66% male, 66% TBP, and 52% between 15-44 years). The overall rate of TB for the entire hospitalization period was 13.93 per 100,000 inhabitants, being 18.83 in males and 9.18 in females. The hospitalization rates for TBP and TBEP decreased in the period 1999-2009 in both sexes (TBP in males, from 18 to 13, and in females, from 8 to 6; TBEP in males from 4 to 3, and from 3 to 2 in female hospitalizations/100,000 habitants). In TBP, children are those with a smallest decline, and in TBEP there is an increase in males in all age groups from 2005. CONCLUSIONS: The results are consistent with those from surveillance. The slow decline in rates in children and the increase in extrapulmonary forms in males may be related to immigration, so it is necessary to improve TB monitoring in these groups

[Analysis of the epidemiological pattern of Shigellosis in Barcelona between 1988 and 2012: Is it an emerging sexually transmitted infection?]. / Análisis del patrón epidemiológico de la shigelosis en Barcelona entre 1988 y 2012: ¿es una infección de transmisión sexual emergente?

INTRODUCTION: The aim of this study was to describe the evolution and epidemiologic characteristics of shigellosis patients over a 25 year period in a large city. METHODS: Shigellosis is a notifiable disease in Spain since 1988. Cases are analyzed in Barcelona residents included in the registry between 1988-2012. A descriptive analysis by sex, age, mode of transmission and Shigella species is presented. Trend analysis and time series were performed. RESULTS: Of the 559 cases analyzed, 60.15% were males. A sustained increase was observed in the trend since 2008 in males (p<0,05), especially at the expense of males who had no history of food poisoning or travel to endemic areas. The increasing tendency was greater in males from 21 to 60 years, both for S. flexneri (since 2009), and for S. sonnei (since 2004). In 2012 it was noted that in the men with S. flexneri, the 63% were men who have sex with men. CONCLUSIONS: An increased trend was detected in men who had no history of food poisoning or travel to endemic areas. This increase points to a change in the pattern of shigellosis, becoming predominantly male and its main mechanism probably by sexual transmission.

[Epidemiology of hospitalizations for tuberculosis in Spain: analysis of minimum data set 1999-2009]. / Epidemiología de las hospitalizaciones por tuberculosis en España: análisis del conjunto mínimo básico de datos 1999-2009.

INTRODUCTION: The National Hospital Discharge Registry is a clinical-administrative database on hospital discharges, which is very useful at a regional level as a complementary source for surveillance. There are few national studies on tuberculosis (TB) using the National Hospital Discharge Registry, thus it was considered of interest to study the characteristics and trends of hospital discharges for TB in Spain. METHODS: A descriptive study was performed using the main variables in the National Hospital Discharge Registry (sex, age, main diagnosis, type of discharge, length of stay), and trend analysis of hospitalization rates per 100,000 population, as well as primary diagnosis, by sex, age group, and type of TB (pulmonary [TBP]/extrapulmonary [TBEP]), for the period 1999-2009 in Spain. RESULTS: A total of 65,609 hospital discharges were included in the study (66% male, 66% TBP, and 52% between 15-44 years). The overall rate of TB for the entire hospitalization period was 13.93 per 100,000 inhabitants, being 18.83 in males and 9.18 in females. The hospitalization rates for TBP and TBEP decreased in the period 1999-2009 in both sexes (TBP in males, from 18 to 13, and in females, from 8 to 6; TBEP in males from 4 to 3, and from 3 to 2 in female hospitalizations/100,000 habitants). In TBP, children are those with a smallest decline, and in TBEP there is an increase in males in all age groups from 2005. CONCLUSIONS: The results are consistent with those from surveillance. The slow decline in rates in children and the increase in extrapulmonary forms in males may be related to immigration, so it is necessary to improve TB monitoring in these groups.

Group A ß-hemolytic streptococcal pharyngotonsillitis outbreak.

The aim was to describe an outbreak of group A ß-hemolytic streptococcal pharyngotonsillitis in health care professionals. This is a cross-sectional descriptive study of 17 clients who dined at the same table in a restaurant in Barcelona in July 2012. The frequency, timing and severity of symptoms were analyzed, as were demographic variables and others concerning the food ingested. The attack rate was 58.8%. Six of the 10 clients were positive for group A ß-hemolytic streptococcal. Six of the 13 individuals who handled the food involved in the dinner had symptoms. No association was identified with the food consumed. There is epidemiological evidence of foodborne group A ß-hemolytic streptococcal transmission, but respiratory transmission could not be ruled out.

Evaluation of the plan for surveillance and controlling of the effects of heat waves in Madrid.

This paper presents evaluation of a plan for surveillance of and controlling the effects of heat-related mortality (PSCEHW), implemented in Madrid in 2004 through a time series analysis conducted with ARIMA modeling. From the public health point of view, prevention plans should be implemented as adaptive measures to heat waves. In 2003, the impact attributable to the heat wave was an increase in mortality per °C of 22.39 %. All heat waves since 2003 have been of lower intensity, and yet, in 2005 there was a heat wave of lower intensity that had a greater impact, i.e. an increase in mortality per °C of 45.71 %. With the methodology used here, we cannot say whether implementation of PSCEHW has resulted in a decrease of mortality attributable to high temperatures in the city of Madrid.

[Impact of the effects of heat waves on mortality in the city of Madrid, Spain during the period 1990-2009]. / Análisis del impacto de las olas de calor sobre la mortalidad de la ciudad de Madrid durante el período 1990-2009.

BACKGROUND: After the heat wave of 2003, many European countries have implemented plans for monitoring and controlling the effects of heat waves (PMSEHW) to mitigate the effects of heat on health and few countries have assessed their impact. The aim of study was to evaluate the PMSEHW impact in the mortality attributed to heat. METHOD: To evaluate the mortality attributed to heat during the period 1990-2009, we conducted a time series analysis using ARIMA models with exogenous variables (temperature). We examined the impact of high temperatures on mortality before and after the year 2004, year of the implementation of PVCEOC. RESULTS: The impact attributable to the heat wave in 2003 was 22.39% increase in mortality per degree ºC, with an intensity of 8.2 ºC. Some heat waves prior to 2003 were higher in intensity, so in the years 1991, 1992 and 1995 the intensity of heat waves was 25.9 ºC, 8.3 ºC and 12.5 ºC respectively. Heat waves subsequent to 2003 had lower intensity, and the 2005, with a heat wave intensity of 4.5 ºC greater impact was observed, which was 45.71% increase in mortality per degree ºC. CONCLUSIONS: Finally, we can not say, that, in the city of Madrid, the implementation of PVEOC results in a decrease of the mortality attributable to high temperatures.

Análisis del impacto de las olas de calor sobre la mortalidad de la ciudad de Madrid durante el período 1990-2009 / Impact of the effects of heat waves on mortality in the city of Madrid, Spain during the period 1990-2009

Fundamentos: Después de la ola de calor del año 2003 muchos países europeos implementaron planes para la vigilancia y control de los efectos de las olas de calor (PVCEOC), sin embargo, son pocos los países que han evaluado su impacto. El objetivo de trabajo es evaluar el impacto del PVEOC en la mortalidad atribuida al calor. Método: Para evaluar en la ciudad de Madrid la mortalidad atribuida al calor durante el período 1990-2009 se realizó un análisis de series temporales utilizando modelos ARIMA con una variable exógena, la temperatura. Se analizó el impacto de las altas temperaturas sobre la mortalidad antes y después de 2004, año de la implementación del PVCEOC. Resultados: El impacto atribuible a la ola de calor en el año 2003 fue del 22,39 % de incremento de mortalidad por cada oC que se superó la temperatura umbral, con una intensidad de 8,2 oC. Algunas olas de calor previas al 2003 fueron superiores en intensidad, así durante los años 1991, 1992 y 1995 la intensidad de las olas de calor fue de 25,9 oC, 8,3 oC y 12,5 oC respectivamente. Las olas de calor posteriores al 2003 presentaron menor intensidad y en 2005 con una ola de calor de 4,5 oC de intensidad se observó un impacto de 45,71% de incremento de la mortalidad por cada oC en que se superó la temperatura umbral. Conclusiones: Con la metodología utilizada no se puede afirmar que en Madrid la puesta en marcha del PVEOC se traduzca en una disminución de la mortalidad atribuible a las altas temperaturas(AU)

Background:After the heatwave of 2003,many European countries have implemented plans for monitoring and controlling the effects of heat waves (PMSEHW) to mitigate the effects of heat on health and few countries have assessed their impact. The aim of study was to evaluate the PMSEHW impact in the mortality attributed to heat. Method: To evaluate the mortality attributed to heat during the period 1990-2009, we conducted a time series analysis using ARIMA models with exogenous variables (temperature).We examined the impact of high temperatures on mortality before and after the year 2004, year of the implementation of PVCEOC. Results: The impact attributable to the heat wave in 2003 was 22.39% increase in mortality per degree oC, with an intensity of 8.2 oC. Some heat waves prior to 2003 were higher in intensity, so in the years 1991, 1992 and 1995 the intensity of heat waves was 25.9 oC, 8.3 oC and 12.5 oC respectively. Heat waves subsequent to 2003 had lower intensity, and the 2005, with a heat wave intensity of 4.5 oC greater impact was observed, which was 45.71% increase in mortality per degree oC. Conclusions: Finally, we can not say, that, in the city of Madrid, the implementation of PVEOC results in a decrease of themortality attributable to high temperatures(AU)

Factores asociados al abandono de tratamiento antituberculoso convencional en Perú / Factors Associated With the Non-Completion of Conventional Anti-Tuberculosis Treatment in Peru

Antecedentes: El abandono del tratamiento antituberculoso se asocia a mayor contagio, resistencia antibiótica, aumento de costes y muerte. Nuestro objetivo fue identificar factores asociados al abandono del tratamiento antituberculoso convencional en Perú. Pacientes y métodos: Estudio de casos y controles no pareado en pacientes diagnosticados de tuberculosis durante 2004-2005 y que finalizaron tratamiento hasta septiembre de 2006. Se definieron como casos los pacientes que abandonaron el tratamiento por ≥ 30 días consecutivos, y como controles los que completaron el tratamiento sin interrupción. Los factores se identificaron mediante regresión logística, calculándose las odds ratios (OR) y los intervalos de confianza al 95% (IC). Resultados: Se estudiaron 265 casos y 605 controles. El abandono del tratamiento en nuestro estudio se asoció al sexo masculino (OR=1,62; IC: 1,07-2,44), al hecho de sentir malestar durante el tratamiento (OR=1,76; IC: 1,19-2,62), al antecedente de abandono previo (OR=7,95; IC: 4,76-13,27) y al consumo de drogas recreativas (OR=3,74; IC: 1,25-11,14). Así mismo, si tenemos en cuenta la interacción antecedente de abandono previo y pobreza, el riesgo de abandono aumenta (OR=11,24; IC: 4-31,62). Por el contrario, recibir buena información sobre la enfermedad (OR=0,25; IC: 0,07-0,94) y poder acceder al sistema sanitario en los horarios ofertados (08.00-20.00h) (OR=0,52; IC: 0,31-0,87) se asociaron a un mejor cumplimiento. Conclusiones: El abandono del tratamiento antituberculoso se asoció a factores no modificables (sexo masculino, abandono previo) y a otros cuyo control mejoraría el cumplimiento (malestar durante el tratamiento, consumo de drogas recreativas y pobreza). Así mismo, es prioritario facilitar el acceso al sistema sanitario y mejorar la información recibida sobre tuberculosis(AU)

Background: The non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru. Patients and methods: An unmatched case-control study in patients diagnosed with tuberculosis from 2004-2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥ 30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). Results: We studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR=1.62; CI: 1.07-2.44), having felt discomfort during treatment (OR=1.76; CI: 1.19-2.62), a prior history of non-compliance (OR=7.95; CI: 4.76-13.27) and illegal drug use (OR=3.74; CI: 1.25-11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR=11.24; CI: 4-31.62). Conversely, having been properly informed about the disease (OR=0.25; CI: 0.07-0.94) and being able to access health-care services within office hours (8am-8pm) (OR=0.52; CI: 0.31-0.87) were associated with better adherence. Conclusions: The non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be priorities(AU)

Factors associated with the non-completion of conventional anti-tuberculosis treatment in Peru.

BACKGROUND: The non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru. PATIENTS AND METHODS: An unmatched case-control study in patients diagnosed with tuberculosis from 2004-2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR=1.62; CI: 1.07-2.44), having felt discomfort during treatment (OR=1.76; CI: 1.19-2.62), a prior history of non-compliance (OR=7.95; CI: 4.76-13.27) and illegal drug use (OR=3.74; CI: 1.25-11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR=11.24; CI: 4-31.62). Conversely, having been properly informed about the disease (OR=0.25; CI: 0.07-0.94) and being able to access health-care services within office hours (8 am-8 pm) (OR=0.52; CI: 0.31-0.87) were associated with better adherence. CONCLUSIONS: The non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be priorities.