Geographical and Temporal Variations in Female Breast Cancer Mortality in the Municipalities of Andalusia (Southern Spain).

The last published figures have shown geographical variations in mortality with respect to female breast cancer in European countries. However, national health policies need a dynamic image of the geographical variations within the country. The aim of this paper was to describe the spatial distribution of age-specific mortality rates from female breast cancer in the municipalities of Andalusia (southern Spain) and to analyze its evolution over time from 1981 to 2012. An ecological study was devised. Two spatio-temporal hierarchical Bayesian models were estimated. One of these was used to estimate the age-specific mortality rate for each municipality, together with its time trends, and the other was used to estimate the age-specific rate ratio compared with Spain as a whole. The results showed that 98% of the municipalities exhibited a decreasing or a flat mortality trend for all the age groups. In 2012, the geographical variability of the age-specific mortality rates was small, especially for population groups below 65. In addition, more than 96.6% of the municipalities showed an age-specific mortality rate similar to the corresponding rate for Spain, and there were no identified significant clusters. This information will contribute towards a reflection on the past, present and future of breast cancer outcomes in Andalusia.

Las enfermedades crónicas como prioridad de la vigilancia de la salud pública en España / Chronic diseases as a priority for the public health surveillance system in Spain

En la actualidad, la vigilancia epidemiológica sigue centrada, en España, en las enfermedades transmisibles incluidas en la lista de enfermedades de declaración obligatoria. Sin embargo, el patrón epidemiológico que dominó hasta las últimas décadas del siglo XX ha cambiado. Las enfermedades infecciosas, que eran las principales causas de morbimortalidad, han dado paso a un predominio de las enfermedades crónicas. En este sentido, se ha avanzado en la redacción y la aprobación de normativa específica sobre vigilancia de la salud pública. No obstante, tenemos pendiente el desarrollo de esta normativa que, entre otros puntos, recoge el mandato de organizar la vigilancia de las enfermedades no transmisibles en España. El objetivo de este trabajo es describir algunas características a tener en cuenta para desarrollar un sistema nacional de vigilancia de la salud pública vinculado a las estrategias ya existentes para la prevención y el control de las enfermedades crónicas (AU)

At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases (AU)

[Chronic diseases as a priority for the public health surveillance system in Spain]. / Las enfermedades crónicas como prioridad de la vigilancia de la salud pública en España.

At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases.

[Outbreaks of Measles in Andalusia, Spain, during the Period 2010-2015]. / Brotes epidémicos de sarampión en Andalucía durante el período 2010-2015.

The Andalusian Surveillance Epidemiological System (SVEA) controls and investigates any notification of measles or any other communicable disease. The aim of this article is to describe the epidemiological characteristics of measles outbreaks occurred in Andalusia in the last five years (2010-2015) and their control measures. In this period three outbreaks were reported: the first one started in Granada in 2010 in a community of objectors to vaccination. Control measures of measles protocol of SVEA were adopted (case isolation, identification and contacts immunization), including judicial measures among the group who refused the vaccination. The second outbreak started in Seville in 2011 in an "area in need of social transformation" and it spread throughout the region. The routine vaccination coverage review was introduced within the surveillance system after those outbreaks, identifying the most vulnerable people. During the first six months of 2015, a small outbreak, of 15 cases, occurred in Granada. The outbreak was controlled mainly due to the early intervention, the health measures adopted in the schools and health centres involved and the high vaccination coverage achieved in the population.

Brotes epidémicos de sarampión en Andalucía durante el período 2010-2015 / Outbreaks of measles in Andalusia, Spain, during the period 2010-2015

El Sistema de Vigilancia Epidemiológica de Andalucía (SVEA) es el encargado de vigilar e investigar urgentemente cualquier notificación de sospecha de sarampión y otras enfermedades de declaración obligatoria y alertas. El objetivo del artículo es describir las características epidemiológicas de los brotes de sarampión ocurridos en Andalucía en los últimos cinco años (2010-2015) así como las medidas de actuación llevadas a cabo durante los mismos. En el periodo estudiado se notificaron tres brotes. El primero de ellos comenzó en Granada en 2010 en población contraria a la vacunación. Las medidas de control adoptadas fueron las recogidas en el protocolo de sarampión del SVEA (aislamiento de casos, identificación e inmunización de contactos), entre las que se incluyeron acciones judiciales ante la negativa de un determinado colectivo a vacunar a sus hijos. El segundo brote comenzó en Sevilla en 2011 en una de las zonas denominadas 'con necesidades de transformación social' y se extendió por toda la provincia. A partir de aquel brote se introdujo de forma rutinaria la revisión de las coberturas vacunales dentro del sistema de vigilancia, identificando a los grupos más vulnerables. Durante el primer semestre de 2015 ha habido un pequeño brote en Granada con 15 casos. Se controló rápidamente debido a la actuación precoz en la mayoría de los casos, a la instauración de las medidas correspondientes en centros sanitarios y escolares y a la alta cobertura vacunal de la población (AU)

The Andalusian Surveillance Epidemiological System (SVEA) controls and investigates any notification of measles or any other communicable disease. The aim of this article is to describe the epidemiological characteristics of measles outbreaks occurred in Andalusia in the last five years (2010-2015) and their control measures. In this period three outbreaks were reported: the first one started in Granada in 2010 in a community of objectors to vaccination. Control measures of measles protocol of SVEA were adopted (case isolation, identification and contacts immunization), including judicial measures among the group who refused the vaccination. The second outbreak started in Seville in 2011 in an 'area in need of social transformation' and it spread throughout the region. The routine vaccination coverage review was introduced within the surveillance system after those outbreaks, identifying the most vulnerable people. During the first six months of 2015, a small outbreak, of 15 cases, occurred in Granada. The outbreak was controlled mainly due to the early intervention, the health measures adopted in the schools and health centres involved and the high vaccination coverage achieved in the population (AU)

Efectos de la edad, el periodo de defunción y la cohorte de nacimiento en la mortalidad por enfermedad isquémica del corazón en el sur de España / Age, period, and cohort effects on mortality from ischemic heart disease in southern Spain

Introducción y objetivos: La cardiopatía isquémica es la primera causa de muerte y una de las cuatro principales causas de carga de enfermedad en el mundo. El objetivo de este trabajo es evaluar los efectos edad-periodo-cohorte la mortalidad por cardiopatía isquémica en Andalucía (sur de España) y en cada una de sus provincias durante el periodo 1981-2008. Métodos: Se realizó un estudio ecológico poblacional. Se analizaron las 145.539 defunciones por cardiopatía isquémica ocurridas en Andalucía durante el periodo de estudio a edades comprendidas entre 30 y 84 años. Se estimó un modelo de regresión no lineal con funciones spline para cada sexo y área geográfica. Resultados: En la tasa de mortalidad masculina y femenina a partir de 30 años de edad se observa tendencia a aumentar. El riesgo de muerte para varones y mujeres fue descendiente para las cohortes nacidas después de 1920 y con una pendiente más pronunciada después de 1960 entre los varones. El análisis del efecto periodo mostró que el riesgo de mortalidad masculina y femenina se mantuvo estable desde 1981 hasta 1990, aumentó entre 1990 y 2000 y volvió a disminuir desde 2000 hasta 2008. Conclusiones: Los efectos edad-periodo-cohorte en la mortalidad fueron similares en todas las provincias de Andalucía y el conjunto de la comunidad autónoma. Si los efectos cohorte y periodo persisten, la mortalidad masculina y femenina por enfermedad isquémica cardiaca continuará disminuyendo (AU)

Introduction and objectives: Ischemic heart disease is the leading cause of death and one of the top 4 causes of burden of disease worldwide. The aim of this study was to evaluate age-period-cohort effects on mortality from ischemic heart disease in Andalusia (southern Spain) and in each of its 8 provinces during the period 1981-2008. Methods: A population-based ecological study was conducted. In all, 145 539 deaths from ischemic heart disease were analyzed for individuals aged between 30 and 84 years who died in Andalusia in the study period. A nonlinear regression model was estimated for each sex and geographical area using spline functions. Results: There was an upward trend in male and female mortality rate by age from the age of 30 years. The risk of death for men and women showed a downward trend for cohorts born after 1920, decreasing after 1960 with a steep slope among men. Analysis of the period effect showed that male and female death risk first remained steady from 1981 to 1990 and then increased between 1990 and 2000, only to decrease again until 2008. Conclusions: There were similar age-period-cohort effects on mortality in all the provinces of Andalusia and for Andalusia as a whole. If the observed cohort and period effects persist, male and female mortality from ischemic heart disease will continue to decline (AU)

Age, Period, and Cohort Effects on Mortality From Ischemic Heart Disease in Southern Spain.

INTRODUCTION AND OBJECTIVES: Ischemic heart disease is the leading cause of death and one of the top 4 causes of burden of disease worldwide. The aim of this study was to evaluate age-period-cohort effects on mortality from ischemic heart disease in Andalusia (southern Spain) and in each of its 8 provinces during the period 1981-2008. METHODS: A population-based ecological study was conducted. In all, 145 539 deaths from ischemic heart disease were analyzed for individuals aged between 30 and 84 years who died in Andalusia in the study period. A nonlinear regression model was estimated for each sex and geographical area using spline functions. RESULTS: There was an upward trend in male and female mortality rate by age from the age of 30 years. The risk of death for men and women showed a downward trend for cohorts born after 1920, decreasing after 1960 with a steep slope among men. Analysis of the period effect showed that male and female death risk first remained steady from 1981 to 1990 and then increased between 1990 and 2000, only to decrease again until 2008. CONCLUSIONS: There were similar age-period-cohort effects on mortality in all the provinces of Andalusia and for Andalusia as a whole. If the observed cohort and period effects persist, male and female mortality from ischemic heart disease will continue to decline.

Age-period-cohort effects on mortality from cerebrovascular disease in southern Spain.

BACKGROUND: The aim of this article is to evaluate the age-period-cohort effects on mortality from cerebrovascular disease in Andalusia (southern Spain) as a whole and in each of its 8 provinces during the period 1981-2008. METHODS: A population-based ecologic study was conducted. In all, 145,867 deaths were analyzed for individuals between the ages of 15 and 84 years who died in Andalusia in the period of study. A nonlinear regression model was estimated for each gender group and geographic area. The effects of age, year of death, and birth cohort were parameterized using spline smoothing functions. RESULTS: There is an upward trend in mortality from the age of 25 years. The risk of death was downward for cohorts born after 1896, decreasing after 1970 with steep slope. The analysis of the period effect showed that death rate first declined from 1981 to 1995 and then increased between 1995 and 2000, only to decrease again until 2008. CONCLUSIONS: There is a similar age-period-cohort effect on male and female mortality from cerebrovascular disease in all the provinces of Andalusia and for Andalusia as a whole. A significant reduction of male and female mortality has been observed during the last decade.

Características epidemiológicas y clínicas de la tos ferina en los lactantes hospitalizados en Sevilla durante el periodo 2007-2011 / Clinical and epidemiological features of pertussis among hospitalized infants in Seville during 2007-2011

Introducción A pesar de la vacunación sistemática, la tos ferina (TF) continúa produciendo una carga de enfermedad importante, especialmente entre los lactantes menores de 6 meses, El objetivo del estudio fue describir la epidemiología, las características clínicas y hematológicas y la duración de la estancia hospitalaria y la mortalidad de los pacientes ingresados por TF en uno de los principales centros terciarios pediátricos de la comunidad andaluza en el último quinquenio. Métodos Serie de casos de pacientes hospitalizados con TF entre los años 2007 y 2011, ambos inclusive. Resultados Hubo 39 casos de TF en el periodo de estudio, con un incremento significativo en la incidencia anual entre 2007 y 2011 (p = 0,0003). Se ingresaron en la UCI 11 pacientes, todos durante los años 2010 y 2011, y 2 de estos pacientes fallecieron. Los niños que requirieron ingreso en la UCI mostraron, comparados con el grupo de pacientes con hospitalización convencional, una enfermedad más atípica y con mayor incidencia al ingreso de apneas y distrés respiratorio, así como tos pertusoide menos frecuente, con menor porcentaje relativo de linfocitos y de sospecha diagnóstica inicial, mientras que los valores de la proteína C reactiva fueron más elevados y la estancia hospitalaria más prolongada. Conclusiones La incidencia de la TF se ha incrementado de forma muy importante en el último quinquenio entre los lactantes hospitalizados con morbilidad grave, incluyendo complicaciones inusuales y mortalidad asociada. En el contexto epidemiológico presente se debe tener un nivel de alerta elevado para el diagnóstico de la enfermedad entre los niños lactantes ingresados en las unidades de terapia intensiva porque pueden presentar manifestaciones más «atípicas» de la enfermedad que puede cursar con un curso desfavorable de muy rápida progresión(AU)

Introduction Despite routine pertussis immunization, pertussis burden remains high, especially among infants. The aim of this study was to describe epidemiologic, clinical and outcome features in pediatric patients admitted to a tertiary hospital in Andalusia (Southern Spain) with confirmed Bordetella pertussis infection. Methods Retrospective descriptive study based on a review of medical records for all pediatric patients admitted to Hospital Universitario Virgen del Rocío (Sevilla) between January 1, 2007 and December 31, 2011. Results Overall, 39 patients were diagnosed with pertussis during the study period with significant higher incidence rate in 2011 compared to 2007 (p = 0.0003). Eleven children were admitted to the pediatric intensive care unit (ICU) in 2010 and 2011 and two of them died. Patients who were admitted to ICU presented with more atypical disease compared to controls in a conventional ward. They were less likely to have pertussoid cough and clinical diagnosis at admission and had a smaller percentage of lymphocytes. C reactive protein values were higher and they had a longer duration of hospital stay. Conclusion The pertussis incidence rate increased significantly among hospitalized infants during the study period, and was associated with severe morbidity, including unusual complications, and mortality. A higher awareness of the clinical diagnosis of pertussis among infants admitted to ICU is required due to more atypical manifestations, and the risk of sudden deterioration associated to fatal outcome(AU)

Age-period-cohort effect on female breast cancer mortality in Southern Spain.

Breast cancer is the most common cancer in women worldwide. The analysis of breast cancer mortality is needed to plan healthcare systems. This study aims to evaluate the age-period-cohort effects on breast cancer mortality in Andalusia (Southern Spain) as a whole and in each of its eight provinces during the period 1981-2008. A population-based ecological study was conducted. In all, 19,707 deaths from breast cancer were analysed for individuals between the ages of 40 and 84 years who died in Andalusia in the period of study. A nonlinear regression model was estimated for each gender group and geographical area. The effects of age, year of death and birth cohort were parameterised using B-spline smoothing functions. There is an upward trend in mortality by age until around the age of 75 years, from which point the trend turned downwards. The analysis of the cohort effect reveals a steady fall in breast cancer mortality risk for female generations born after 1940. Death rates increased until 1995 and then declined until the end of the period. There is an age-period-cohort effect on breast cancer mortality similar in all the provinces of Andalusia and for Andalusia as a whole. If the current trends continue, it can be expected that these effects will continue to reduce female mortality.

[Clinical and epidemiological features of pertussis among hospitalized infants in Seville during 2007-2011]. / Características epidemiológicas y clínicas de la tos ferina en los lactantes hospitalizados en Sevilla durante el periodo 2007-2011.

INTRODUCTION: Despite routine pertussis immunization, pertussis burden remains high, especially among infants. The aim of this study was to describe epidemiologic, clinical and outcome features in pediatric patients admitted to a tertiary hospital in Andalusia (Southern Spain) with confirmed Bordetella pertussis infection. METHODS: Retrospective descriptive study based on a review of medical records for all pediatric patients admitted to Hospital Universitario Virgen del Rocío (Sevilla) between January 1, 2007 and December 31, 2011. RESULTS: Overall, 39 patients were diagnosed with pertussis during the study period with significant higher incidence rate in 2011 compared to 2007 (p=0.0003). Eleven children were admitted to the pediatric intensive care unit (ICU) in 2010 and 2011 and two of them died. Patients who were admitted to ICU presented with more atypical disease compared to controls in a conventional ward. They were less likely to have pertussoid cough and clinical diagnosis at admission and had a smaller percentage of lymphocytes. Creactive protein values were higher and they had a longer duration of hospital stay. CONCLUSION: The pertussis incidence rate increased significantly among hospitalized infants during the study period, and was associated with severe morbidity, including unusual complications, and mortality. A higher awareness of the clinical diagnosis of pertussis among infants admitted to ICU is required due to more atypical manifestations, and the risk of sudden deterioration associated to fatal outcome.

Infección en humanos por virus de la gripe A(H1N1): revisión al 30 de octubre de 2009 / Influenza a (H1N1) virus infection in humans: Review to 30th October 2009

Desde que en abril de 2009 se tuviera conocimiento de la infección humana por un nuevo virus de la gripe AH1N1 de origen porcino, éste se ha extendido de forma pandémica por los 5 continentes. En el hemisferio sur se ha producido la primera onda pandémica en coincidencia con el invierno austral. En el hemisferio norte se ha mantenido la transmisión sin alcanzar los umbrales epidémicos hasta las primeras semanas de octubre, cuando en algunos países, entre ellos España, las tasas de incidencia han empezado a sobrepasar estos umbrales epidémicos. En este trabajo se revisan las características diferenciales de este nuevo virus en cuanto a patogenia, clínica y epidemiología y cuáles son los principales procedimientos de diagnóstico, profilaxis y tratamiento de los que disponemos, información que consideramos relevante para minimizar en lo posible el impacto que esta nueva pandemia pueda tener en nuestro entorno (AU)

Since human infection by a novel influenza virus A H1N1 of swine origin was reported in April 2009, the virus has spread worldwide causing a pandemic. In the Southern Hemisphere, the first pandemic wave has taken place, coinciding with Austral Winter. In the Northern Hemisphere, transmission has been sustained under the basal level of epidemic until the first weeks of October, when incidence rates have risen up to the pidemic level in some countries, including Spain. This work reviews the differential characteristics of this novel virus in terms of pathogenicity, clinical syndrome and epidemiology, as well as the diagnostic, prophylactic and therapeutic procedures available; information we consider relevant to minimize the impact of this new pandemic in our area (AU)

[Measles outbreak in Campo de Gibraltar, Cádiz, Spain, during the Period February-July 2008]. / Brote de sarampión en Campo de Gibraltar, Cádiz, durante el período febrero-julio 2008.

BACKGROUND: On the 4th of February 2008, 2 cases of measles, epidemiologically linked (2 members of the crew of the Fast-Ferry Jaime I from the company Balearia, which performs the route Algeciras-Tangier), were notified to the Epidemiological Surveillance Network in Andalusia (SVEA). The aim of this paper is to epidemiologically characterize this population level outbreak detected in the area of Campo de Gibraltar, the vaccine effectiveness and the control measures implemented. METHODS: Descriptive observational study of reported cases. We have analysed the following variables: age, sex, municipality of residence, onset date, virus genotype, groups involved, previous immunization status, interventions, vaccine effectiveness. Information sources are SVEA records, vaccination program and individual digital story (Diraya). Rates 10(5) were calculated according to age group and frequency measurements. To compare vaccine effectiveness, the Chi(2) test was used. RESULTS: We confirmed 155 cases of measles, 88.4% by laboratory techniques. Most affected age groups under 2 years (19%) and from 21 to 40 (51%). The 54.2% male. The 72,14% were not vaccinated. Virus was isolated from imported measles genotype D4. The vaccine efficacy was greater than 99%. CONCLUSIONS: The outbreak of the imported measles virus was confirmed. More than half of the cases were not vaccinated. The decrease in the incidence in vaccinated individuals recommends the necessity of carrying out Catch-Up campaigns to increase the coverage therefore avoiding the appearance of these outbreaks.

Brote de sarampión en Campo de Gibraltar, Cádiz, durante el período febrero- julio 2008 / Measles outbreak in Campo de Gibraltar, Cadiz, Spain, during the period February-July 2008

Fundamento: El 4 de febrero de 2008 se notificó a la Red de VigilanciaEpidemiológica de Andalucía (SVEA), 2 casos de sarampiónvinculados epidemiológicamente, 2 tripulantes del Fast-Ferry Jaime Ide la Compañía Balearia, que realiza la línea de Algeciras - Tánger. Elobjetivo de este trabajo es caracterizar epidemiológicamente el brote deámbito poblacional detectado en la Comarca Campo de Gibraltar, lasmedidas de control implementadas y la efectividad vacunal.Método: Estudio observacional descriptivo de casos notificados.Se analizan las variables edad, sexo, municipio de residencia,sintomatología, fecha de inicio, colectivos implicados, estado vacunalprevio, intervenciones realizadas, genotipo del virus, y efectividadvacunal. Fuentes de información los registros del SVEA, programade vacunas e historia digital individual (Diraya). Se calcularontasas x 105 por grupo de edad y medidas de frecuencia. Para comparaciónde efectividad vacunal se utilizó test Chi2.Resultados: Se confirmaron 155 casos de sarampión, 88.4%por laboratorio. Grupos de edad mas afectados menores de 2 años(19%) y de 21 a 40 (51%). El 54.2% varones. El 72,14% no estabanvacunados. Se aisló virus sarampión Genotipo D4 importado. Laefectividad vacunal era superior al 99%.Conclusiones: Se confirma un brote por virus del sarampiónimportado. Mas de la mitad de los casos no estaban vacunados. Ladisminución de la incidencia en vacunados hace necesario recomendarcampañas de Cacht - Up que aumenten las coberturas para evitarla aparición de estos brotes vacunales(AU)

Background: On the 4th of February 2008, 2 cases of measles,epidemiologically linked (2 members of the crew of the Fast-FerryJaime I from the company Balearia, which performs the route Algeciras- Tangier), were notified to the Epidemiological SurveillanceNetwork in Andalusia (SVEA). The aim of this paper is to epidemiologicallycharacterize this population level outbreak detected inthe area of Campo de Gibraltar, the vaccine effectiveness and thecontrol measures implemented.Methods: Descriptive observational study of reported cases.We have analysed the following variables: age, sex, municipality ofresidence, onset date, virus genotype, groups involved, previousimmunization status, interventions, vaccine effectiveness. Informationsources are SVEA records, vaccination program and individualdigital story (Diraya). Rates 105 were calculated according to agegroup and frequency measurements. To compare vaccine effectiveness,the Chi2 test was used.Results: We confirmed 155 cases of measles, 88.4% by laboratorytechniques. Most affected age groups under 2 years (19%) andfrom 21 to 40 (51%). The 54.2% male. The 72,14% were not vaccinated.Virus was isolated from imported measles genotype D4. Thevaccine efficacy was greater than 99%.Conclusions: The outbreak of the imported measles virus wasconfirmed. More than half of the cases were not vaccinated. Thedecrease in the incidence in vaccinated individuals recommends thenecessity of carrying out Catch-Up campaigns to increase the coveragetherefore avoiding the appearance of these outbreaks(AU)

Spatio-temporal trends of mortality in small areas of Southern Spain.

BACKGROUND: Most mortality atlases show static maps from count data aggregated over time. This procedure has several methodological problems and serious limitations for decision making in Public Health. The evaluation of health outcomes, including mortality, should be approached from a dynamic time perspective that is specific for each gender and age group. At the moment, researches in Spain do not provide a dynamic image of the population's mortality status from a spatio-temporal point of view. The aim of this paper is to describe the spatial distribution of mortality from all causes in small areas of Andalusia (Southern Spain) and evolution over time from 1981 to 2006. METHODS: A small-area ecological study was devised using the municipality as the unit for analysis. Two spatio-temporal hierarchical Bayesian models were estimated for each age group and gender. One of these was used to estimate the specific mortality rate, together with its time trends, and the other to estimate the specific rate ratio for each municipality compared with Spain as a whole. RESULTS: More than 97% of the municipalities showed a diminishing or flat mortality trend in all gender and age groups. In 2006, over 95% of municipalities showed male and female mortality specific rates similar or significantly lower than Spanish rates for all age groups below 65. Systematically, municipalities in Western Andalusia showed significant male and female mortality excess from 1981 to 2006 only in age groups over 65. CONCLUSIONS: The study shows a dynamic geographical distribution of mortality, with a different pattern for each year, gender and age group. This information will contribute towards a reflection on the past, present and future of mortality in Andalusia.

[Infection by the pandemic virus (H1N1) 2009 in Andalusia]. / Infección por virus pandémico (H1N1) 2009 en Andalucía.

In April 2009, in response to the WHO's alert due to the existence of human infection cases with a new AH1N1 influenza virus, known as swine flu, Andalusian Health Authorities trigger an specific action plan. The surveillance actions developped provided us with appropriate clinical, epidemiological and virological characteristics of the disease. During the first few days, contingency plans were set up based on epidemiological surveillance and outbreak control measures were adopted through early alert and rapid response systems. After phase 6 was declared, influenza sentinel and severe cases surveillance were used in order to plan healthcare services, to reduce transmission and to identify and protect the most vulnerable population groups. Behaviour of pandemic influenza in Andalusia was similar to that observed in the rest of the world. Atack rate was similar to a seasonal flu and the peak was reached at the 46th/2009 week. Most of them were mild cases and affected particularly to young people. The average age of hospitalised patients was 32. Prior pulmonary disease, smoking and morbid obesity (BMI > 40) were the most common pathologies and risk factors in severe cases. An impact scenario of pandemic wave in Andalusia, with an expected attack rate from 2 to 5%, was prepared considering watt observed in the southern hemisphere. Characteristics of the epidemic concerning its extent, severity and mortality rate were adjusted to this scenario.

[Influenza a (H1N1) virus infection in humans: review to 30th October 2009]. / Infección en humanos por virus de la gripe A(H1N1): revisión al 30 de octubre de 2009.

Since human infection by a novel influenza virus A H1N1 of swine origin was reported in April 2009, the virus has spread worldwide causing a pandemic. In the Southern Hemisphere, the first pandemic wave has taken place, coinciding with Austral Winter. In the Northern Hemisphere, transmission has been sustained under the basal level of epidemic until the first weeks of October, when incidence rates have risen up to the pidemic level in some countries, including Spain. This work reviews the differential characteristics of this novel virus in terms of pathogenicity, clinical syndrome and epidemiology, as well as the diagnostic, prophylactic and therapeutic procedures available; information we consider relevant to minimize the impact of this new pandemic in our area.

Uncontrolled migrations as a cause of inequality in health and mortality in small-area studies.

Mortality is one of the most widely used indicators in small-area ecologic studies. Both accessibility to mortality data and advances in the development of new disease mapping techniques have contributed to an abundance of mortality maps and atlases over the last decade. Results may be biased in this kind of study if there has been unmeasured geographic mobility of the population. Most published papers tend to neglect this possibility. We use the theory of dynamics systems to demonstrate that migratory flows unmonitored by official population registers may lead to major errors in mortality rates and relative risks. Simulations in 4 scenarios showed more than 8% underestimation of the mortality rate and more than 11% underestimation of relative risk in areas with high uncontrolled emigration, and above 19% overestimation of mortality rate and above 15% overestimation of relative risk in areas with high uncontrolled immigration.Researchers conducting small-area epidemiologic studies should explore the reliability of population information in geographic areas before drawing hypothesis or conclusions on other possible causes of mortality differences.

[Interactive mortality atlas in Andalusia, Spain (AIMA)]. / Atlas interactivo de mortalidad en Andalucía (AIMA).

Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in www.demap.es. AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia.

Atlas interactivo de mortalidad en Andalucía (AIMA) / Interactive mortality atlas in Andalusia, Spain (AIMA)

Los atlas de mortalidad publicados hasta la fecha son estáticos. La mayoría describen la distribución geográfica de la mortalidad agrupando datos de varios años y usando razones de mortalidad estandarizadas que resumen la mortalidad de todos los grupos de edad. Sin embargo, esta metodología presenta limitaciones para estudiar cambios temporales en la distribución geográfica de la mortalidad o diferencias entre grupos etarios. Aplicando una metodología alternativa surge el Atlas Interactivo de Mortalidad en Andalucía (AIMA), un Sistema de Información Geográfica dinámico que permite visualizar en web-site más de 12.000 mapas y 338.000 gráficos de tendencias correspondientes a la distribución espacio-temporal de las principales causas de muerte en Andalucía por grupos de edad y sexo desde 1981. El objetivo de este trabajo es describir la metodología utilizada para el desarrollo de AIMA, dar a conocer sus características y especificaciones técnicas y mostrar las posibilidades interactivas que ofrece. El sistema está disponible en el hipervínculo productos de www.demap.es. AIMA es el primer SIG interactivo de estas características implementado en España. Para el análisis de datos se han utilizado modelos jerárquicos bayesianos espacio-temporales, integrando posteriormente los resultados en web-site utilizando entorno PHP y cartografía dinámica en formato Flash. La selección de mapas temáticos muestra el carácter dinámico de la distribución geográfica de la mortalidad, con un patrón diferente para cada año, grupo de edad y sexo. La información contenida actualmente en este sistema y las futuras actualizaciones contribuirán a la reflexión sobre el pasado, presente y futuro de la salud en Andalucía (AU)

Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in www.demap.es. AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia (AU)