Lifting COVID-19 mitigation measures in Spain (May-June 2020).

Introduction: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. Methods: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. Results: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. Conclusion: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.

Introducción: El 14 de marzo de 2020 España declaró el estado de alarma por la pandemia por COVID-19 incluyendo medidas de confinamiento. El objetivo es describir el proceso de desescalada de estas medidas. Métodos: Un plan de transición hacia una nueva normalidad, del 28 de abril, incluía 4 fases secuenciales incrementando progresivamente las actividades socioeconómicas y la movilidad. Concomitantemente, se implementó una nueva estrategia de diagnóstico precoz, vigilancia y control. Se estableció un mecanismo de decisión bilateral entre Gobierno central y comunidades autónomas (CCAA), guiado por un panel de indicadores cualitativos y cuantitativos de la situación epidemiológica y las capacidades básicas. Las unidades territoriales evaluadas comprendían desde zonas básicas de salud hasta CCAA. Resultados: El proceso se extendió del 4 de mayo al 21 de junio y se asoció a planes de refuerzo de las capacidades en las CCAA. La incidencia disminuyó de una mediana inicial de 7,4 por 100.000 en 7 días a 2,5 al final del proceso. La mediana de pruebas PCR aumentó del 53% al 89% de los casos sospechosos, y la capacidad total de 4,5 a 9,8 pruebas semanales por 1.000 habitantes; la positividad disminuyó del 3,5% al 1,8%. La mediana de casos con contactos trazados aumentó del 82% al 100%. Conclusión: La recogida y análisis sistemático de información y el diálogo interterritorial logaron un adecuado control del proceso. La situación epidemiológica mejoró, pero sobre todo, se aumentaron las capacidades, en todo el país y con criterios comunes, cuyo mantenimiento y refuerzo fue clave en olas sucesivas.

Lifting COVID-19 mitigation measures in Spain (May-June 2020).

INTRODUCTION: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. METHODS: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. RESULTS: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. CONCLUSION: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.

[Comparison of the characteristics of tuberculosis cases detected by tuberculosis units by active finding and those declared passively by health professionals. Galicia 2014-2018]. / Comparativa de las características de los casos de tuberculosis detectados por las Unidades de Tuberculosis por búsqueda activa y los declarados de forma pasiva por los profesionales sanitarios. Galicia 2014-2018.

OBJECTIVE: The diseases' declaration is a fundamental tool in public health. It's essential to know the magnitude of the problem and decide properly how to solve it. The active finding of cases allows us to know cases that weren't registered by means of the passive declaration. In this study, we intend to analyze whether tuberculosis (TB) cases detected by Tuberculosis Units (TBU) by active finding are different to those reported passively by health professionals. METHODS: Data from the Galician Registry of Tuberculosis (SITUB) were collected analyzing the 2,753 TB cases detected between 2014 and 2018. Confidence intervals were compared and the data were analyzed with Chi square or T-Student tests as required. RESULTS: 44.67% of TB cases of were detected by TBU by active finding. A higher proportion was detected by active finding in bacilliferous, patients with positive culture, pulmonary location and alcoholism. It was lower in HIV (-) and in pediatric cases (under 15 years). Although the proportion of the type of declaration varied depending on the TBU or age, no changes were detected when segregating by TBU or in people over 15 years old. CONCLUSIONS: If active finding wasn't perform, almost half of the cases would be lost. We observed differences in the characteristics of the patients according to the way they have been detected, although we don't know their possible cause. Therefore, the detection of cases by active finding it's an important public health tool.

OBJETIVO: La declaración de enfermedades es una herramienta fundamental en salud pública, imprescindible para conocer la magnitud del problema y poder decidir adecuadamente la manera de resolverlo. La búsqueda activa de casos permite recuperar casos que no fueron registrados mediante la declaración pasiva. En este estudio pretendimos analizar si los casos de tuberculosis (TB) detectados por las Unidades de Tuberculosis (UTB) por búsqueda activa eran equiparables a los declarados de forma pasiva por los profesionales sanitarios o si bien presentaban diferencias. METODOS: Se recogieron los datos del Registro Gallego de Tuberculosis (SITUB), analizando los 2.753 casos de TB detectados entre 2014 y 2018. Se compararon los intervalos de confianza y se analizaron los datos con Ji cuadrado o pruebas T-Student, según fuese requerido. RESULTADOS: El 44,67% de los casos de TB fueron detectados por las UTB mediante búsqueda activa. Se detectó mayor proporción mediante búsqueda activa en bacilíferos, pacientes con cultivo positivo, localización TB pulmonar y alcoholismo, mientras que fue menor en VIH (-) y en casos en edad pediátrica (menores de 15 años). Aunque la proporción del tipo de declaración variaba dependiendo de la UTB o la edad, no se detectaron cambios desagregando por UTB ni al excluir a los menores de 15 años. CONCLUSIONES: De no realizar búsqueda activa, se perderían casi la mitad de los casos. Se observan diferentes características de los pacientes según como hayan sido detectados, aunque no conocemos su posible causa. Por ello, la detección de casos por búsqueda activa es una importante medida de salud pública.

Comparativa de las características de los casos de tuberculosis detectados por las unidades de tuberculosis por búsqueda activa y los declarados de forma pasiva por los profesionales sanitarios. Galicia 2014-2018 / Comparison of the characteristics of tuberculosis cases detected by tuberculosis units by active finding and those declared passively by health professionals. Galicia 2014-2018

OBJETIVO: La declaración de enfermedades es una herramienta fundamental en salud pública, imprescindible para conocer la magnitud del problema y poder decidir adecuadamente la manera de resolverlo. La búsqueda activa de casos permite recuperar casos que no fueron registrados mediante la declaración pasiva. En este estudio pretendimos analizar si los casos de tuberculosis (TB) detectados por las Unidades de Tuberculosis (UTB) por búsqueda activa eran equiparables a los declarados de forma pasiva por los profesionales sanitarios o si bien presentaban diferencias. MÉTODOS: Se recogieron los datos del Registro Gallego de Tuberculosis (SITUB), analizando los 2.753 casos de TB detectados entre 2014 y 2018. Se compararon los intervalos de confianza y se analizaron los datos con Ji cuadrado o pruebas T-Student, según fuese requerido. RESULTADOS: El 44,67% de los casos de TB fueron detectados por las UTB mediante búsqueda activa. Se detectó mayor proporción mediante búsqueda activa en bacilíferos, pacientes con cultivo positivo, localización TB pulmonar y alcoholismo, mientras que fue menor en VIH (-) y en casos en edad pediátrica (menores de 15 años). Aunque la proporción del tipo de declaración variaba dependiendo de la UTB o la edad, no se detectaron cambios desagregando por UTB ni al excluir a los menores de 15 años. CONCLUSIONES: De no realizar búsqueda activa, se perderían casi la mitad de los casos. Se observan diferentes características de los pacientes según como hayan sido detectados, aunque no conocemos su posible causa. Por ello, la detección de casos por búsqueda activa es una importante medida de salud pública

OBJECTIVE: The diseases' declaration is a fundamental tool in public health. It's essential to know the magnitude of the problem and decide properly how to solve it. The active finding of cases allows us to know cases that weren't registered by means of the passive declaration. In this study, we intend to analyze whether tuberculosis (TB) cases detected by Tuberculosis Units (TBU) by active finding are different to those reported passively by health professionals. METHODS: Data from the Galician Registry of Tuberculosis (SITUB) were collected analyzing the 2,753 TB cases detected between 2014 and 2018. Confidence intervals were compared and the data were analyzed with Chi square or T-Student tests as required. RESULTS: 44.67% of TB cases of were detected by TBU by active finding. A higher proportion was detected by active finding in bacilliferous, patients with positive culture, pulmonary location and alcoholism. It was lower in HIV (-) and in pediatric cases (under 15 years). Although the proportion of the type of declaration varied depending on the TBU or age, no changes were detected when segregating by TBU or in people over 15 years old. CONCLUSIONS: If active finding wasn't perform, almost half of the cases would be lost. We observed differences in the characteristics of the patients according to the way they have been detected, although we don't know their possible cause. Therefore, the detection of cases by active finding it's an important public health tool

[Tobacco use in pregnancy: prevalence and factors associated with maintenance of consumption]. / Consumo de tabaco en el embarazo: prevalencia y factores asociados al mantenimiento del consumo.

OBJECTIVE: Tobacco use during pregnancy is detrimental to pregnant women and to the fetus. In Galicia, the data regarding prevalence of tobacco use during pregnancy is outdated and the characteristics of women who continue to smoke during pregnancy are not known. The objectives of this work were to estimate, before and during pregnancy, the prevalence of tobacco use and characterize its consumption, and to identify factors associated with the maintenance of tobacco use during pregnancy. METHODS: A cross-sectional study was conducted in 2016 targeting women who had given birth within the previous 12 months (n=6.436) in Galicia. Information was collected regarding the mother's status before and during pregnancy, at the time of delivery and survey. Smoking prevalence was estimated both globally and by women related characteristics. Regression models were performed to identify variables associated with smoking maintenance. Prevalence and odds ratio are presented accompanied with 95% confidence interval. RESULTS: Smoking prevalence during pregnancy was 11.9% (11.1-12.8). Among women who maintain tobacco consumption during pregnancy, the percentage of cigarette smokers decreased, but prevalence of rolled tobacco remain stable. The maintenance of smoking during pregnancy was related to being Spanish, education or having been a daily smoker before pregnancy. CONCLUSIONS: Despite the fact that more than half of Galician women stop smoking during pregnancy, smoking prevalence remains at 12%. The different demographic factors identified in this study as predictors of smoking maintenance, should be kept in mind when intervention programs focused on pregnant women will be design.

OBJETIVO: El consumo de tabaco durante el embarazo es perjudicial para las mujeres embarazadas y el feto. En Galicia la prevalencia del consumo durante el embarazo no está actualizada y se desconocen las características de las mujeres que continúan fumando durante el embarazo. Los objetivos de este trabajo fueron estimar, antes y durante el embarazo, la prevalencia del uso del tabaco, caracterizar su consumo e identificar factores asociados al mantenimiento durante el embarazo. METODOS: Estudio transversal realizado en 2016 en mujeres que habían dado a luz en los 12 meses previos (n =6436) en Galicia. Se recogió información sobre la madre en diferentes momentos temporales. La prevalencia del consumo de tabaco se estimó a nivel global y en función de diferentes características. Se ajustaron modelos de regresión para identificar las variables asociadas al mantenimiento del consumo. Se presentan prevalencia y razones de odds acompañadas de intervalos de confianza al 95%. RESULTADOS: La prevalencia del consumo de tabaco durante el embarazo fue del 11,9% (11,1-12,8). Entre las mujeres que mantuvieron el consumo durante el embarazo, el porcentaje de fumadoras de cigarrillos disminuyó, el de tabaco de liar permaneció estable. Seguir fumando durante el embarazo estuvo relacionado con la nacionalidad, el nivel educativo, o con el consumo previo. CONCLUSIONES: A pesar de que más de la mitad de las mujeres dejan de fumar durante el embarazo, la prevalencia es del 12%. Los diferentes predictores de mantenimiento deben tenerse en cuenta cuando se diseñan programas de intervención orientados a mujeres embarazadas.

Consumo de tabaco en el embarazo: prevalencia y factores asociados al mantenimiento del consumo / Tobacco use in pregnancy: prevalence and factors associated with maintenance of consumption

OBJETIVO: El consumo de tabaco durante el embarazo es perjudicial para las mujeres embarazadas y el feto. En Galicia la prevalencia del consumo durante el embarazo no está actualizada y se desconocen las características de las mujeres que continúan fumando durante el embarazo. Los objetivos de este trabajo fueron estimar, antes y durante el embarazo, la prevalencia del uso del tabaco, caracterizar su consumo e identificar factores asociados al mantenimiento durante el embarazo. MÉTODOS: Estudio transversal realizado en 2016 en mujeres que habían dado a luz en los 12 meses previos (n =6436) en Galicia. Se recogió información sobre la madre en diferentes momentos temporales. La prevalencia del consumo de tabaco se estimó a nivel global y en función de diferentes características. Se ajustaron modelos de regresión para identificar las variables asociadas al mantenimiento del consumo. Se presentan prevalencia y razones de odds acompañadas de intervalos de confianza al 95%. RESULTADOS: La prevalencia del consumo de tabaco durante el embarazo fue del 11,9% (11,1-12,8). Entre las mujeres que mantuvieron el consumo durante el embarazo, el porcentaje de fumadoras de cigarrillos disminuyó, el de tabaco de liar permaneció estable. Seguir fumando durante el embarazo estuvo relacionado con la nacionalidad, el nivel educativo, o con el consumo previo. CONCLUSIONES: A pesar de que más de la mitad de las mujeres dejan de fumar durante el embarazo, la prevalencia es del 12%. Los diferentes predictores de mantenimiento deben tenerse en cuenta cuando se diseñan programas de intervención orientados a mujeres embarazadas

OBJECTIVE: Tobacco use during pregnancy is detrimental to pregnant women and to the fetus. In Galicia, the data regarding prevalence of tobacco use during pregnancy is outdated and the characteristics of women who continue to smoke during pregnancy are not known. The objectives of this work were to estimate, before and during pregnancy, the prevalence of tobacco use and characterize its consumption, and to identify factors associated with the maintenance of tobacco use during pregnancy. METHODS: A cross-sectional study was conducted in 2016 targeting women who had given birth within the previous 12 months (n=6.436) in Galicia. Information was collected regarding the mother's status before and during pregnancy, at the time of delivery and survey. Smoking prevalence was estimated both globally and by women related characteristics. Regression models were performed to identify variables associated with smoking maintenance. Prevalence and odds ratio are presented accompanied with 95% confidence interval. RESULTS: Smoking prevalence during pregnancy was 11.9% (11.1-12.8). Among women who maintain tobacco consumption during pregnancy, the percentage of cigarette smokers decreased, but prevalence of rolled tobacco remain stable. The maintenance of smoking during pregnancy was related to being Spanish, education or having been a daily smoker before pregnancy. CONCLUSIONS: Despite the fact that more than half of Galician women stop smoking during pregnancy, smoking prevalence remains at 12%. The different demographic factors identified in this study as predictors of smoking maintenance, should be kept in mind when intervention programs focused on pregnant women will be design

[How many kids are there with excess weight? What information should be published?] / ¿Cuántos niños hay con exceso de peso en Galicia? ¿Qué información debemos comunicar?

OBJECTIVE: In epidemiological studies, there is no consensus on which references should be used to characterize the weight status of schoolchildren after estimating their body mass index. The aim of this study is to evaluate the influence that different criteria have on the characterization of the weight status of Galician schoolchildren from 6 to 15 years old and to identify the criterion that best characterizes central obesity. METHODS: Cross-sectional study on a sample of 7.438 schoolchildren representative by sex and age of the Galician population of 6 to 15 year olds. The prevalence of central obesity and underweight, normal weight, overweight and obesity was estimated using the reference standards of the World Health Organization (WHO), Cole, Orbegozo-2011 and the Enkid study. In order to identify the criterion that best characterizes central obesity, the positive predictive values of obesity and the negative ones of overweight and obesity were calculated. RESULTS: The characterization of schoolchildren according to their weight status was different depending on the reference used with estimates that vary by 20.4 percentage points being prevalence of excess weight using WHO references 41.5% while with Enkid it is 21.1%. The reference with the best predictive capacity of central obesity was those proposed by Cole. CONCLUSIONS: The variability observed in the characterization of the weight status of schoolchildren asso- ciated with the use of different reference criteria is very important. If central obesity is a good indicator of excess of weight, the reference proposed by Cole would be the one with the best capacity to characterize the child and youth population, related to the best predictive capacity.

OBJETIVO: En los estudios epidemiológicos, no hay consenso sobre cuáles son las referencias que se deben emplear para caracterizar el estado ponderal de los escolares después de estimar su índice de masa corporal. El objetivo de este trabajo fue valorar como influyen diferentes criterios en la caracterización del estado ponderal de escolares gallegos de 6 a 15 años e identificar el criterio que mejor caracteriza la obesidad central. METODOS: Estudio transversal en una muestra de 7.438 escolares de 6 a 15 años representativa por sexo y edad. Se estimó la prevalencia de obesidad central y de bajo peso, normopeso, sobrepeso y obesidad utilizando los criterios de referencia de la Organización Mundial de la Salud (OMS), Cole, Orbegozo-2011 y del estudio Enkid. Para identificar el criterio que mejor caracteriza la obesidad central se calcularon valores predictivos positivos de obesidad y negativos de sobrepeso y obesidad. RESULTADOS: La caracterización de los escolares en función de su estado ponderal varió en función de la referencia empleada con estimaciones que oscilaban en 20,4 puntos porcentuales cuando se comparaba el exceso de peso según criterios de la OMS, 41,5%, y Enkid, 21,1%. El criterio que presentó mejor capacidad predictiva de obesidad central fue el propuesto por Cole. CONCLUSIONES: La variabilidad que se observa en la caracterización del estado ponderal de los escolares asociada al uso de distintos criterios de referencia es muy importante. Si se considera a la obesidad central como indicador de exceso de peso, la referencia de Cole es la que mejor caracteriza a los escolares, ya que es la que tiene mejor capacidad predictiva.

¿Cuántos niños hay con exceso de peso en Galicia? ¿Qué información debemos comunicar? / How many kids are there with excess weight? What information should be published?

Fundamentos: En los estudios epidemiológicos, no hay consenso sobre cuáles son las referencias que se deben emplear para caracterizar el estado ponderal de los escolares después de estimar su índice de masa corporal. El objetivo de este trabajo fue valorar como influyen diferentes criterios en la caracterización del estado ponderal de escolares gallegos de 6 a 15 años e identificar el criterio que mejor caracteriza la obesidad central. Métodos: Estudio transversal en una muestra de 7.438 escolares de 6 a 15 años representativa por sexo y edad. Se estimó la prevalencia de obesidad central y de bajo peso, normopeso, sobrepeso y obesidad utilizando los criterios de referencia de la Organización Mundial de la Salud (OMS), Cole, Orbegozo-2011 y del estudio Enkid. Para identificar el criterio que mejor caracteriza la obesidad central se calcularon valores predictivos positivos de obesidad y negativos de sobrepeso y obesidad. Resultados: La caracterización de los escolares en función de su estado ponderal varió en función de la referencia empleada con estimaciones que oscilaban en 20,4 puntos porcentuales cuando se comparaba el exceso de peso según criterios de la OMS, 41,5%, y Enkid, 21,1%. El criterio que presentó mejor capacidad predictiva de obesidad central fue el propuesto por Cole. Conclusiones: La variabilidad que se observa en la caracterización del estado ponderal de los escolares asociada al uso de distintos criterios de referencia es muy importante. Si se considera a la obesidad central como indicador de exceso de peso, la referencia de Cole es la que mejor caracteriza a los escolares, ya que es la que tiene mejor capacidad predictiva

Background: In epidemiological studies, there is no consensus on which references should be used to characterize the weight status of schoolchildren after estimating their body mass index. The aim of this study is to evaluate the influence that different criteria have on the characterization of the weight status of Galician schoolchildren from 6 to 15 years old and to identify the criterion that best characterizes central obesity. Methods: Cross-sectional study on a sample of 7.438 schoolchildren representative by sex and age of the Galician population of 6 to 15 year olds. The prevalence of central obesity and underweight, normal weight, overweight and obesity was estimated using the reference standards of the World Health Organization (WHO), Cole, Orbegozo-2011 and the Enkid study. In order to identify the criterion that best characterizes central obesity, the positive predictive values of obesity and the negative ones of overweight and obesity were calculated. Results: The characterization of schoolchildren according to their weight status was different depending on the reference used with estimates that vary by 20.4 percentage points being prevalence of excess weight using WHO references 41.5% while with Enkid it is 21.1%. The reference with the best predictive capacity of central obesity was those proposed by Cole. Conclusions: The variability observed in the characterization of the weight status of schoolchildren associated with the use of different reference criteria is very important. If central obesity is a good indicator of excess of weight, the reference proposed by Cole would be the one with the best capacity to characterize the child and youth population, related to the best predictive capacity

Implementation and impact of a meningococcal C conjugate vaccination program in 13- to 25-year-old individuals in Galicia, Spain.

BACKGROUND: In response to increased case numbers of meningococcal group C disease, catch-up vaccination strategies have been shown to be successful. This paper describes the results of a repeat vaccination program in Galicia, Spain, and the strategy used for it. METHODS AND RESULTS: Three vaccination waves were performed: first, in 1996/1997 with a meningococcal group A and C polysaccharide vaccine in individuals aged 18 months to 19 years; second, in 2000 with a conjugate serogroup C polysaccharide vaccine in children born since 1993 and all children and adolescents up to 19 years not previously vaccinated; third, a campaign in 2006 that became necessary because of the development of a new Neisseria strain and an increase in both the incidence and lethality of meningococcal C disease. The conjugate vaccine de-O-acetylated group C meningococcal polysaccharide coupled to tetanus toxoid was used (GCMP-TT; brand name, NeisVac-C). Results: Applying a strategy based on model calculations derived from the UK setting and focusing on a population aged 13-25 years, including students, employees of companies, and underage individuals, a total of 286,000 subjects were vaccinated, resulting in global vaccination coverage of 82.2% (all age groups over 74%). Only 17 adverse events in 17 individuals were reported, which all were mild. Incidence of meningococcal disease serogroup C by season was reduced from 0.84 cases per 100,000 in 2004/05 to 0.76 cases per 100,000 in 2005/2006 to 0.18/100,000 in 2007/08. In parallel, mortality was also decreased from 8 cases during 2005/06 (0.29 per 100,000) to 1 case in 2007/2008 (0.03 per 100,000). No cases of breakthrough disease occurred in the vaccinated population. CONCLUSION: In Galicia, a series of vaccination campaigns, particularly focusing on high-risk groups, has shown high effectiveness, with a marked reduction in the disease incidence in the vaccination cohort accompanied by a relevant reduction in the overall population.

Mortalidad atribuida al consumo de tabaco en Galicia, 1980-2007 / Mortality attributable to tobacco consumption in Galicia (Spain): 1980-2007

Fundamento y objetivo: La estimación de la mortalidad atribuida al consumo de tabaco proporciona una visión complementaria a la prevalencia de consumo y aproxima el impacto que el tabaco tiene en la salud a nivel poblacional. El objetivo de este estudio fue medir el impacto, en cifras de mortalidad, que el consumo de tabaco tuvo en la población gallega mayor de 34 años entre 1980 y 2007, e identificar posibles cambios de tendencia. Pacientes y método: La mortalidad atribuida se estimó aplicando un método independiente de prevalencia basado en el cálculo de fracciones atribuidas poblacionales. Los riesgos relativos y las tasas de mortalidad por cáncer de pulmón en fumadores y nunca fumadores proceden del Cancer Prevention Study-II. Se calcularon tasas anuales de mortalidad atribuida y se analizaron tendencias aplicando modelos de regresión joinpoint.Resultados: A lo largo del período estudiado (1980-2007), se estima que el tabaco ha producido en Galicia 93.308 muertes (87.674 en varones y 5.634 en mujeres). Las tasas de mortalidad atribuida en varones muestran una tendencia decreciente desde mediados de la década de 1990 (porcentaje de cambio anual: -1,8%). En las mujeres la tendencia es creciente desde el bienio 1988-1989 (porcentaje de cambio anual: 28,4%). Conclusiones: El consumo de tabaco ha supuesto en Galicia una importante carga de mortalidad en el período 1980-2007. La tendencia decreciente observada en la mortalidad atribuida al tabaco en varones es un resultado positivo, pero en mujeres jóvenes el aumento de la mortalidad atribuida es alarmante (AU)

Background and ojective: Tobacco attributable mortality offers a complementary view to smoking prevalence, giving an estimate of its impact at population level. The purpose of this study is to measure the impact, using mortality figures, of tobacco consumption in the Galician population over 34 years from 1980 to 2007, and identify any changes of trend. Patients and methods: Attributable mortality was estimated using a prevalence independent method that is based on population attributable fractions. Relative risks and mortality rates due to lung cancer in smokers and non-smokers came from the Cancer Prevention Study-II. Annual attributable mortality rates were calculated and the presence of any trends was tested using joinpoint regression models. Results: During the studied time period (1980-2007) it is estimated that tobacco use has caused 93,308 deaths in Galicia (87,674 in men and 5,634 in women). Attributable mortality rates in men show a decreasing tendency from the middle 90s onwards (annual percent change: -1.8%). However in women there is an increasing trend starting from the period 1988-1989 (annual percent change:28.4%). Conclusions: Tobacco consumption has entailed an important burden of mortality from 1980 to 2007. The decreasing tendency in attributable mortality rates in men is an encouraging result, but its increase in young women is rather alarming (AU)

El software libre en la investigación médica / The free software in medical research

No disponible

[Mortality attributable to tobacco consumption in Galicia (Spain): 1980-2007]. / Mortalidad atribuida al consumo de tabaco en Galicia, 1980-2007.

UNLABELLED: BACKGROUND AND OJECTIVE: Tobacco attributable mortality offers a complementary view to smoking prevalence, giving an estimate of its impact at population level. The purpose of this study is to measure the impact, using mortality figures, of tobacco consumption in the Galician population over 34 years from 1980 to 2007, and identify any changes of trend. PATIENTS AND METHODS: Attributable mortality was estimated using a prevalence independent method that is based on population attributable fractions. Relative risks and mortality rates due to lung cancer in smokers and non-smokers came from the Cancer Prevention Study-II. Annual attributable mortality rates were calculated and the presence of any trends was tested using joinpoint regression models. RESULTS: During the studied time period (1980-2007) it is estimated that tobacco use has caused 93,308 deaths in Galicia (87,674 in men and 5,634 in women). Attributable mortality rates in men show a decreasing tendency from the middle 90s onwards (annual percent change: -1.8%). However in women there is an increasing trend starting from the period 1988-1989 (annual percent change:28.4%). CONCLUSIONS: Tobacco consumption has entailed an important burden of mortality from 1980 to 2007. The decreasing tendency in attributable mortality rates in men is an encouraging result, but its increase in young women is rather alarming.

Vigilancia epidemiológica de la gripe (H1N1) 2009 sin red centinela / Epidemiological surveillance of influenza (H1N1) 2009 without sentinel system

Fundamento: En Galicia no existe red centinela de vigilancia epidemiológica por lo que se utilizan sistemas alternativos de vigilancia. El objetivo de este trabajo es describirlos y presentar los resultados observados durante la pandemia de gripe (H1N1) 2009. Métodos: Los sistemas utilizados fueron llamadas recibidas por gripe (H1N1) 2009 e infección respiratoria aguda en el 061, sistema de notificación de enfermedades obligatorias (SXNOE), vigilancia virológica, registros de atención primaria e ingresos hospitalarios. Los datos se analizaron con Excell. Resultados: La primera onda por virus A(H1N1)v se registró a través del 061 entre las semanas 39/2009 y 49/2009, alcanzando el pico en la 44/2009 con la mayor tasa de llamadas acumuladas en el grupo de 5-19 años. SXNOE proporcionó una onda (semanas 39/2009 a 49/2009) con pico en la 44/2009. Microbiológicamente se estudiaron con RT-PRC 6.181 muestras (31% positivas y pico en la semana 44/2009). Los registros de Atención Primaria proporcionaron una onda (semanas 39/2009 a 49/2009) con pico en la semana 44/2009 con la mayor tasa de consultas para los de 5-19 años. Entre las semanas 26/2009 y 17/2010, ingresaron 698 personas con gripe (H1N1) 2009, con mayor número de hospitalizaciones en la 44/2009. Conclusiones: Los sistemas descritos quedan avalados por la homogeneidad de los resultados, ya que dibujan la misma onda (semanas 39/2009 a 49/2009) y coinciden en el pico (semana 44/2009) donde se observa la mayor tasa de consultas entre 5-19 años. El 061 aparece como el sistema más operativo al proporcionar datos diarios(AU)

Background: The objective is to explain the Galician influenza surveillance system and to present the results observed during the pandemic flu, where due to the lack of sentinel surveillance practices, other alternatives are used. Method: Data was collected from: 061 phone calls for flu and acute respiratory illness; notifiable diseases usual reporting system (SXNOE); virological surveillance; primary care and hospital records and was analyzed with Excell. Results: The first epidemic wave for A(H1N1)v according to 061 data was between week 39/2009 and 49/2009, and it peaked in week 44/2009, with a greater rate of accumulated calls was in the 5-19 age group. SXNOE showed a wave (week 39/2009 to 49/2009) and peaked in week 44/09. Virological surveillance included 6.181 samples with PCR-RT (31% were positive and peaked in week 44/09). Primary care registers showed a wave (week 39/2009 to 49/2009) which peaked in week 44/09 with the greatest rate of con-sultations was in the 5-19 age group. Between week 26/09 and week 17/2010, 698 patients were admitted with A(H1N1)v, with the hig-hest hospitalization in week 44/09. Conclusions: The validity of the described surveillance systems is supported by the homogeneity of results, and they produced an equivalent wave (weeks 39/2009 to 49/2009) which peaked in week 44/2009 and showed the highest rate of consultations in the 5-19 age group. The 061 appears to be the most practical system to provide daily data(AU)

[Epidemiological surveillance of influenza (H1N1) 2009 without sentinel system]. / Vigilancia epidemiológica de la gripe (H1N1) 2009 sin red centinela.

BACKGROUND: The objective is to explain the Galician influenza surveillance system and to present the results observed during the pandemic flu, where due to the lack of sentinel surveillance practices, other alternatives are used. METHOD: Data was collected from: 061 phone calls for flu and acute respiratory illness; notifiable diseases usual reporting system (SXNOE); virological surveillance; primary care and hospital records and was analyzed with Excell. RESULTS: The first epidemic wave for A(H1N1)v according to 061 data was between week 39/2009 and 49/2009, and it peaked in week 44/2009, with a greater rate of accumulated calls was in the 5-19 age group. SXNOE showed a wave (week 39/2009 to 49/2009) and peaked in week 44/09. Virological surveillance included 6.181 samples with PCR-RT (31% were positive and peaked in week 44/09). Primary care registers showed a wave (week 39/2009 to 49/2009) which peaked in week 44/09 with the greatest rate of consultations was in the 5-19 age group. Between week 26/09 and week 17/2010, 698 patients were admitted with A(H1N1)v, with the highest hospitalization in week 44/09. CONCLUSIONS: The validity of the described surveillance systems is supported by the homogeneity of results, and they produced an equivalent wave (weeks 39/2009 to 49/2009) which peaked in week 44/2009 and showed the highest rate of consultations in the 5-19 age group. The 061 appears to be the most practical system to provide daily data.

Mortalidad y años de esperanza de vida perdidos a causa del tabaquismo en personas mayores de 35 años en Galicia en el período 2001-2006 / Mortality associated to tobacco consumption in Galicia, Spain. 2001-2006

Fundamento: El tabaquismo es el factor de riesgo susceptiblede ser prevenido que más mortalidad causa en los paísesdesarrollados. El objetivo de este estudio fue medir el impactoen cifras de mortalidad y años de esperanza de vida perdidosque el consumo de tabaco tuvo en la población gallega de 35años y más entre 2001 y 2006.Métodos: La mortalidad atribuida se estimó aplicando unmétodo dependiente de prevalencia basado en el cálculo defracciones atribuidas poblacionales. La prevalencia de consumode tabaco en Galicia se estimó para el periodo 2001-2006a partir de encuestas realizadas en población gallega y los riesgosrelativos proceden del Cancer Prevention Study-II. Se calcularonlos Años de Esperanza de Vida Perdidos por causa deltabaco empleando el método propuesto por Arriaga.Resultados: Entre 2001 y 2006 en Galicia se atribuyeron21.588 muertes al consumo de tabaco en la población de 35años y más, lo que supone el 12,5% de la mortalidad sucedidaen este periodo. El porcentaje de años de esperanza de vidaperdidos como causa del consumo de tabaco descendió del primeral segundo trienio en hombres (28,1% vs 26,8%) yaumentó en mujeres (9,9% vs 10,9%).Conclusiones: La mortalidad atribuida al consumo detabaco se mantiene estable en Galicia en los años estudiados.Esta estabilización podría suceder a expensas de un aumentoligero de la mortalidad en las mujeres jóvenes acompañado deun descenso en los hombres(AU)

Background: In developed countries tobacco smoke is thepreventable risk factor that causes more deaths. The objectiveof this study was to assess the impact of tobacco in the Galicianadult (aged 35 and over) population from 2001 to 2006.Methods: Attributable mortality was estimated by a prevalence-dependent method based on the population attributablefraction. Galician prevalence of tobacco consumption wasestimated for the period 2001-2006 based on local populationsurveys and relative risks derived from the Cancer PreventionStudy-II. Years of life expectancy lost related to tobacco consumptionwere calculated applying the method proposed byArriaga.Results: In Galicia, among 2001 and 2006, 21.588 deathswere attributed to tobacco consumption in the 35-year-oldpopulation and above, which supposes 12,5 % of the mortalityhappened across the period. The percentage of years of lifeexpectancy lost as reason of the consumption of tobacco decreasedfrom the first one to the second triennium in males (28,1% vs 26,8 %) and it increased in females (9,9 % vs 10,9 %).Conclusions: At general population level tobacco attributablemortality shows a stable pattern. This is probably relatedto a slight increase of mortality in young females and a decreasein males’ mortality(AU)