Quantitative risk assessment of introduction of BVDV and BoHV-1 through indirect contacts based on implemented biosecurity measures in dairy farms of Spain.

A stochastic quantitative risk assessment model was developed to estimate the annual probability of introduction of bovine viral diarrhea virus (BVDV) and bovine herpesvirus 1 (BoHV-1) on 127 dairy farms through indirect contacts. Vehicles transporting calves, cattle to slaughterhouse, dead animals, and mixture of feed, as well as visits by veterinarians and hoof trimmers, farm workers and contacts with neighbors were considered in the model. Data from biosecurity questionnaires of each farm, scientific literature and expert opinion from field veterinarians, animal vehicle drivers, hoof trimmers and personnel from rendering transport companies were used to estimate values for input parameters. Results showed that the annual probability of introducing BVDV or BoHV-1 through indirect contacts was very heterogeneous. The overall distribution of median values for each farm ranged from 0.5 to 14.6% and from 1.0 to 24.9% for BVDV and BoHV-1, respectively. The model identified that providing protective clothing and boots to visits, not allowing the animal vehicle driver to come into contact with animals present on the farm and ensuring that calf vehicles arrived empty, were the measures with the highest impact on the probability of infection for most farms. This model could be a useful tool to show the impact of the measures to farmers and veterinarians, thus increasing their awareness on biosecurity. In addition, it could support decision making on which measures should be prioritized in dairy cattle herds to reduce the probability of introduction of diseases.

Ingestion of foreign materials by odontocetes along the Catalan coast: causes and consequences.

Ingestion of abnormal materials by cetaceans has been reported worldwide, but few studies have investigated the causes of foreign material ingestion. We retrospectively analysed necropsies performed between 2012 and 2019 on 88 cetaceans stranded along the coast of Catalonia, Spain, and evaluated the association of abnormal ingested materials with 2 risk factors, namely disease of the central nervous system (CNS) and maternal separation. Abnormal materials were found in the digestive tract in 19 of 88 (21.6%) cetaceans; of these, 13 (60%) had lesions in the CNS, such as morbilliviral encephalitis, neurobrucellosis or encephalomalacia, and 3 were diagnosed as having experienced maternal separation. In a logistic regression model, CNS lesions and maternal separation were identified as risk factors for ingestion of foreign material, but with wide confidence intervals, probably due to the small sample size. In contrast, abnormal ingestion was not identified in any of the 25 (28%) cetaceans whose cause of death was attributed to interaction with humans. Abnormal ingestion should be interpreted with caution, and efforts should be made at necropsy to exclude CNS diseases through pathologic and microbiologic investigations. If disease of the CNS is a significant risk factor for ingestion of marine debris by small odontocetes, results of monitoring programmes may be biased by the prevalence of CNS disease in a specific area or population.

Short communication: Risk factors associated with Mycobacterium avium ssp. paratuberculosis introduction into dairy herds in Galicia, northwestern Spain.

This study assessed potential risk factors associated with introduction of Mycobacterium avium ssp. paratuberculosis (MAP) into dairy cattle herds in the Galicia region, northwestern Spain. The study was carried out with data collected from 93 dairies enrolled in a voluntary MAP control program. Information on potential risk factors was obtained through personal interviews with the farmers and veterinarians in charge of the control program of each farm. In addition, blood samples were taken annually over 2 years from cows on the farms in the program, and analyzed with a commercial ELISA to detect antibodies to MAP. Fecal samples of all ELISA-positive cows were analyzed using PCR. Based on χ2 test and Fisher's exact test, purchase practices, shared manure truck, shared materials, and visitors per month who contacted animals were found to be significantly associated with farm MAP infection status. Multiple logistic regression indicated that purchase practices and herd size (included as a potential confounder) are the variables that best predict MAP status.

Development of a quantitative risk assessment of bovine viral diarrhea virus and bovine herpesvirus-1 introduction in dairy cattle herds to improve biosecurity.

A quantitative risk assessment model was developed to estimate the annual probability of introducing bovine viral diarrhea virus (BVDV) and bovine herpesvirus 1 (BoHV-1) at the farm level through animal movements. Data from 2017 official animal movements, biosecurity questionnaires, scientific literature, and expert opinion from field veterinarians were taken into consideration for model input parameters. Purchasing or introducing cattle, rearing replacement heifers offsite, showing cattle at competitions, sharing transport vehicles with other herds, and transporting cattle in vehicles that have not been cleaned and disinfected were considered in the model. The annual probability of introducing BVDV or BoHV-1 through infected animals was very heterogeneous between farms. The median likelihoods of BVDV and BoHV-1introduction were 12 and 9%, respectively. Farms that purchased cattle from within their region (i.e., local movements) and shared transport with other farms had a higher probability for BVDV and BoHV-1 introduction. This model can be a useful tool to support decision-making on biosecurity measures that should be prioritized to reduce the probability of introduction of these 2 diseases in dairy herds.

Biosecurity assessment of Argentinian pig farms.

The pig industry is growing very fast in Argentina with an increasing need for replacement animals, feedstuff and transportation of animals. One of the main competitive advantages of the Argentinian pig industry is its being free of most major pig diseases. Within this context, applying measures aimed to reduce the risk of introduction and spread of pathogens is critical. The aim of the present study was to assess the biosecurity of Argentinian pig farms. Two types of farms were assessed: firstly, all official suppliers of high-genetic-value (n = 110) and secondly, a sample from commercial farms (n = 192). Data on the external and internal biosecurity practices applied on the farms was collected with a questionnaire. Data was analysed using a correspondence analysis and a hierarchical clustering analysis, which allowed identification of types of farms with regard to the biosecurity measures applied. Key variables characterizing the clusters were identified through an indicator value analysis. In addition, the external biosecurity of the farms was evaluated by using risk assessment tools with respect to the potential introduction of porcine epidemic diarrhoea virus. Results made evident three clusters: the first one which, amongst other measures, applied several barriers to prevent the entry of people, trucks and other vehicles, and could be considered as a group of high biosecurity, and the two other groups which applied a lower number of external and internal biosecurity measures. The results of the risk assessment showed that the routes with the highest risk of disease introduction were: replacement animals, vehicles transporting feed or animals, and visitors. The assessment of the external biosecurity showed that most Argentinian farms were not prepared for the contingency of a pathogen such as porcine epidemic diarrhoea virus. Special efforts should be made in official suppliers of high-genetic-value farms with poor biosecurity scores since they are at the top of the pig production chain and can be key for the spread of diseases.

Development of a risk assessment tool for improving biosecurity on pig farms.

In the present study a risk assessment tool was developed for improving biosecurity on pig farms as part of a voluntary program for PRRS control on farms located in NE Spain. The arrival of the PRRS virus through different routes was estimated based on their likelihood of harbouring the virus and the estimation of a score for the probability of introduction. For each possible route of introduction or spread within the herds, single or combined biosecurity measures aimed at reducing the probability of PRRS virus transmission were selected. Results showed that the scores for the probability of introduction and spreading were related to a highly variable application of biosecurity measures. The tool developed in the present study may be suitable for identifying where efforts should be focused in biosecurity actions forming part of disease control programs.

Assessing the variability in transmission of bovine tuberculosis within Spanish cattle herds.

In Spain, despite years of efforts to eradicate bovine tuberculosis (bTB), the disease is still endemic, with some areas of high prevalence. In this context, the surveillance and control plans may need to be re-evaluated, and understanding the dynamics of bTB spread within Spanish herds may help to develop new strategies for reducing the time for detection of infected herds and for the elimination of bTB from the herds already infected. Here, we developed a compartmental stochastic model to simulate bTB within-herd transmission, fed it with epidemiological data from 22 herds (obtained from a previous work) and carried out parameter inference using Approximate Bayesian Computing methods We also estimated the "Within-herd transmission potential Number" (Rh), i.e. the average number of secondary cases generated by a single animal infected introduced into a totally susceptible herd, considering different scenarios depending on the frequency of controls. The median global values obtained for the transmission parameters were: for the transmission coefficient (ß), 0.014 newly infected animals per infectious individual per day (i.e. 5.2 per year), for the rate at which infected individuals become infectious (α), 0.01 per day (equivalent to a latent period of 97 days), and for the rate at which infected individuals become reactive to the skin test (α1), 0.08 per day (equivalent to a period of 12 days for an infected animal to become reactive). However, the results also evidenced a great variability in the estimates of those parameters (in particular ß and α) among the 22 herds. Considering a 6-month interval between tests, the mean Rh was 0.23, increasing to 0.82 with an interval of 1 year, and to 2.01 and 3.47 with testing intervals of 2 and 4 years, respectively.

Serological Follow-up of Tuberculosis in a Wild Boar Population in Contact with Infected Cattle.

There is an increasing concern in several European countries over the role that tuberculosis (TB)-infected wild boar may play in the progress of bovine TB eradication campaigns. In 2004, as a consequence of the detection of a TB focus in wild boar from a National Game Reserve (NGR) located in southern Catalonia, a surveillance programme based on post-mortem inspection for detection of macroscopic TB-like lesions (TBLL) was initiated in the affected area. The source of infection for wild boar was linked to a tuberculous cattle herd located in the same area. Besides, the results of the surveillance programme in wild boar were used for the validation of an indirect enzyme-linked immunosorbent assay (ELISA) specific for Mycobacterium tuberculosis complex (MTBC) IgG antibodies. Using this ELISA, a seven-year serological study of MTBC in wild boar from the NGR was conducted in 173 animals (93 adults, 44 juveniles-yearlings and 36 piglets) culled between 2004 and 2010. ELISA results and presence of TBLL showed excellent agreement for adult and juvenile wild boar (Kappa index = 0.85; 95% CI: 0.76-0.95). Of the thirty-eight adults, yearlings and juveniles classified as positives by the ELISA, 34 (89%) showed TBLL at necropsy. In contrast, none of the ELISA-positive wild boar piglets (n = 20) showed TBLL, suggesting the detection of early antibody responses to the infection. Overall, this study contributes to the knowledge of wild boar humoral responses to MTBC. The results also highlight the usefulness of this serological test for wild boar TB surveillance.

Understanding Spatio-Temporal Variability in the Reproduction Ratio of the Bluetongue (BTV-1) Epidemic in Southern Spain (Andalusia) in 2007 Using Epidemic Trees.

Andalusia (Southern Spain) is considered one of the main routes of introduction of bluetongue virus (BTV) into Europe, evidenced by a devastating epidemic caused by BTV-1 in 2007. Understanding the pattern and the drivers of BTV-1 spread in Andalusia is critical for effective detection and control of future epidemics. A long-standing metric for quantifying the behaviour of infectious diseases is the case-reproduction ratio (Rt), defined as the average number of secondary cases arising from a single infected case at time t (for t>0). Here we apply a method using epidemic trees to estimate the between-herd case reproduction ratio directly from epidemic data allowing the spatial and temporal variability in transmission to be described. We then relate this variability to predictors describing the hosts, vectors and the environment to better understand why the epidemic spread more quickly in some regions or periods. The Rt value for the BTV-1 epidemic in Andalusia peaked in July at 4.6, at the start of the epidemic, then decreased to 2.2 by August, dropped below 1 by September (0.8), and by October it had decreased to 0.02. BTV spread was the consequence of both local transmission within established disease foci and BTV expansion to distant new areas (i.e. new foci), which resulted in a high variability in BTV transmission, not only among different areas, but particularly through time, which suggests that general control measures applied at broad spatial scales are unlikely to be effective. This high variability through time was probably due to the impact of temperature on BTV transmission, as evidenced by a reduction in the value of Rt by 0.0041 for every unit increase (day) in the extrinsic incubation period (EIP), which is itself directly dependent on temperature. Moreover, within the range of values at which BTV-1 transmission occurred in Andalusia (20.6°C to 29.5°C) there was a positive correlation between temperature and Rt values, although the relationship was not linear, probably as a result of the complex relationship between temperature and the different parameters affecting BTV transmission. Rt values for BTV-1 in Andalusia fell below the threshold of 1 when temperatures dropped below 21°C, a much higher threshold than that reported in other BTV outbreaks, such as the BTV-8 epidemic in Northern Europe. This divergence may be explained by differences in the adaptation to temperature of the main vectors of the BTV-1 epidemic in Andalusia (Culicoides imicola) compared those of the BTV-8 epidemic in Northern Europe (Culicoides obsoletus). Importantly, we found that BTV transmission (Rt value) increased significantly in areas with higher densities of sheep. Our analysis also established that control of BTV-1 in Andalusia was complicated by the simultaneous establishment of several distant foci at the start of the epidemic, which may have been caused by several independent introductions of infected vectors from the North of Africa. We discuss the implications of these findings for BTV surveillance and control in this region of Europe.

Six-Year Follow-up of Slaughterhouse Surveillance (2008-2013): The Catalan Slaughterhouse Support Network (SESC).

Meat inspection has the ultimate objective of declaring the meat and offal obtained from carcasses of slaughtered animals fit or unfit for human consumption. This safeguards the health of consumers by ensuring that the food coming from these establishments poses no risk to public health. Concomitantly, it contributes to animal disease surveillance. The Catalan Public Health Protection Agency (Generalitat de Catalunya) identified the need to provide its meat inspectors with a support structure to improve diagnostic capacity: the Slaughterhouse Support Network (SESC). The main goal of the SESC was to offer continuing education to meat inspectors to improve the diagnostic capacity for lesions observed in slaughterhouses. With this aim, a web-based application was designed that allowed meat inspectors to submit their inquiries, images of the lesions, and samples for laboratory analysis. This commentary reviews the cases from the first 6 years of SESC operation (2008-2013). The program not only provides continuing education to inspectors but also contributes to the collection of useful information on animal health and welfare. Therefore, SESC complements animal disease surveillance programs, such as those for tuberculosis, bovine cysticercosis, and porcine trichinellosis, and is a powerful tool for early detection of emerging animal diseases and zoonoses.

Estimation of the individual slaughterhouse surveillance sensitivity for bovine tuberculosis in Catalonia (North-Eastern Spain).

The achievement of the Officially Tuberculosis Free (OTF) status in regions with low bovine Tuberculosis (bTB) herd prevalence, as is the case of North-Eastern Spain (Catalonia), might be a likely option in the medium term. In this context, risk-based approaches could be an alternative surveillance strategy to the costly current strategy. However, before any change in the system may be contemplated, a reliable estimate of the sensitivity of the different surveillance components is needed. In this study, we focused on the slaughterhouse component. The probability of detection of a bTB-infected cattle by the slaughterhouses in Catalonia was estimated as the product of three consecutive probabilities: (P1) the probability that a bTB-infected animal arrived at the slaughterhouse presenting Macroscopically Detectable Lesions (MDL); (P2) the probability that MDL were detected by the routine meat inspection process and (P3) the probability that the veterinary officer suspected bTB and sent the sample for laboratory confirmation. The first probability was obtained from data collected through the bTB eradication program carried out in Catalonia between 2005 and 2008, while the last two were obtained through the expert opinion of the veterinary officers working at the slaughterhouses who fulfilled a questionnaire administered during 2014. The bTB surveillance sensitivity of the different cattle slaughterhouses in Catalonia obtained in this study was 31.4% (CI 95%: 28.6-36.2), and there were important differences among them. The low bTB surveillance sensitivity was mainly related with the low probability that a bTB-infected animal arrived at the slaughterhouse presenting MDL (around 44.8%). The variability of the sensitivity among the different slaughterhouses could be explained by significant associations between some variables included in the survey and P2. For instance, factors like attendance to training courses, number of meat technicians and speed of the slaughter chain were significantly related with the probabilities that a MDL was detected by the meat inspection procedure carried out in the slaughterhouse. Technical and policy efforts should be focused on the improvement of these factors in order to maximize the slaughterhouse sensitivity.

Human migration and pig/pork import in the European Union: What are the implications for Taenia solium infections?

Taenia solium taeniasis/cysticercosis is a neglected zoonotic disease complex occurring primarily in developing countries. Though claimed eradicated from the European Union (EU), an increasing number of human neurocysticercosis cases is being detected. Risk factors such as human migration and movement of pigs/pork, as well as the increasing trend in pig rearing with outside access are discussed in this review. The entry of a tapeworm carrier into the EU seems a lot more plausible than the import of infected pork. The establishment of local transmission in the EU is presently very unlikely. However, considering the potential changes in risk factors, such as the increasing trend in pig farming with outdoor access, the increasing human migration from endemic areas into the EU, this situation might change, warranting the establishment of an early warning system, which should include disease notification of taeniasis/cysticercosis both in human and animal hosts. As currently human-to-human transmission is the highest risk, prevention strategies should focus on the early detection and treatment of tapeworm carriers, and should be designed in a concerted way, across the EU and across the different sectors.

Risk factors for foot-and-mouth disease in Tanzania, 2001-2006.

We developed a model to quantify the effect of factors influencing the spatio-temporal distribution of foot-and-mouth disease (FMD) in Tanzania. The land area of Tanzania was divided into a regular grid of 20 km × 20 km cells and separate grids constructed for each of the 12-month periods between 2001 and 2006. For each year, a cell was classified as either FMD positive or negative dependent on an outbreak being recorded in any settlement within the cell boundaries. A Bayesian mixed-effects spatial model was developed to assess the association between the risk of FMD occurrence and distance to main roads, railway lines, wildlife parks, international borders and cattle density. Increases in the distance to main roads decreased the risk of FMD every year from 2001 to 2006 (ORs ranged from 0.43 to 0.97). Increases in the distance to railway lines and international borders were, in general, associated with a decreased risk of FMD (ORs ranged from 0.85 to 0.99). Increases in the distance from a national park decreased the risk of FMD in 2001 (OR 0.80; 95% CI 0.68-0.93) but had the opposite effect in 2004 (OR 1.06; 95% CI 1.01-1.12). Cattle population density was, in general, positively associated with the risk of FMD (ORs ranged from 1.01 to 1.30). The spatial distribution of high-risk areas was variable and corresponded to endemic (2001, 2002 and 2005) and epidemic (2003, 2004 and 2006) phases. Roads played a dominant role in both epidemiological situations; we hypothesize that roads are the main driver of FMD expansion in Tanzania. Our results suggest that FMD occurrence in Tanzania is more related to animal movement and human activity via communication networks than transboundary movements or contact with wildlife.

Epidemiological survey of brucellosis in sheep and goats in selected pastoral and agro-pastoral lowlands of Ethiopia.

An epidemiological survey was conducted in pastoral regions of Ethiopia to investigate the distribution of brucellosis in sheep and goats. Between November 2004 and December 2007, a total of 6,201 serum samples were collected from 67 randomly selected peasant associations, 25 districts and eight pastoral zones of Ethiopia. The Rose Bengal plate test (RBPT) and complement fixation test were used in series. Samples for bacteriology were collected from three export abattoirs, where 285 goats were randomly selected and tested by RBPTthree days before slaughter. Tissue samples were collected from 14 strongly positive goats and cultured in dextrose agar and Brucella agar base. To confirm and subtype the isolates, staining, biochemical tests and polymerase chain reaction were used. The overall standardised seroprevalence of brucellosis was 1.9%, ranging from 0.07% in Jijiga zone to 3.3% in Borena zone. There was statistically significant variation among the studied regions, zones, districts and peasant associations (p < 0.05). Male goats and sheep were twice as likely to test positive as females (relative risk [RRJ: 2.04; 95% confidence interval [CI]:1.7-3.4; x2 = 21.05, p < 0.05). Adults (older than 1.5 years) were three times more likely to test positive than younger animals (RR: 2.76; 95% CI: 1.14-6.73; chi2 = 5.18, p < 0.05). Goats were around four times more likely to be infected than sheep (RR: 3.8; 95% CI: 2.4-6.1; chi2 = 36.99, p < 0.05). Brucella melitensis was isolated from 2 of the 14 samples analysed. The widespread distribution of brucellosis in goats and sheep in these areas justifies the use of control measures to minimise the economic losses and public health hazards.

Risk factors for bovine tuberculosis persistence in beef herds of Southern and Central Spain.

In order to assess risk factors related to bovine tuberculosis (bTB) persistence, a case-control study, comparing persistent versus transient bTB infected beef farms from Central and Southern Spain, was conducted. Farms were matched by herd size and geographical location (county). A questionnaire administered by personal interview was conducted on 150 herds (80 controls and 70 cases) from Andalucia and Castilla La Mancha regions. The questionnaire included questions related to the personnel involved in routine diagnostics, structure of the farm and of the herd, management, presence of other domestic species and of wildlife reservoirs. According to the results of our study, farms with large pasture areas and bTB infected neighbors had more difficulties in eradicating the disease, and therefore, were more likely to suffer a persistent bTB infection. The odds of bTB persistence were between 1.2 and 5.1 (i.e., 95% confidence interval of the OR) times higher in those herds that had a neighbor infected herd. Farms with large pasture areas had odds between 1.2 and 12.7 (i.e., 95% confidence interval of the OR) times higher of having a persistent bTB episode than farms with small pasture areas.

Risk factors for foot-and-mouth disease in Zambia, 1981-2012.

The aim of this study was to describe the spatial distribution of foot-and-mouth disease (FMD) outbreaks in Zambia for the period January 1981-December 2012 and to quantify the association between geographical features (proximity to roads, national parks, wetland areas) and the spatial distribution of FMD using a Poisson point process model. Details of FMD outbreaks retrieved from the Zambian Department of Veterinary and Livestock Development included the date of onset of clinical signs and the name of the ward in which the index case enterprise was located. A total of 62 FMD outbreaks occurred throughout the study period. Outbreaks occurred in the south of the Southern province along the border with Namibia and Botswana (n=5), in the Western province (n=2), in the Southern and Central provinces on the Kafue flood plains (n=44), and in the north east of the country close to the border with Tanzania (n=11). Increases in distance to the nearest major international border crossing, distance to the nearest major road, distance to the wetland area of the Kafue flood plain, wetness index and elevation were all associated with a decrease in FMD-outbreak ward intensity. Our analyses support the hypothesis that in drier areas of the country cattle are more likely to aggregate around communal drinking pools. Aggregation of cattle provides conditions suitable for FMD spread and detection.

Ecological surveillance for West Nile in Catalonia (Spain), learning from a five-year period of follow-up.

To enhance early detection of West Nile virus (WNV) transmission, an integrated ecological surveillance system was implemented in Catalonia (north-eastern Spain) from 2007 to 2011. This system incorporated passive and active equine surveillance, periodical testing of chicken sentinels in wetland areas, serosurveillance wild birds and testing of adult mosquitoes. Samples from 298 equines, 100 sentinel chickens, 1086 wild birds and 39 599 mosquitoes were analysed. During these 5 years, no acute WNV infection was detected in humans or domestic animal populations in Catalonia. WNV was not detected in mosquitoes either. Nevertheless, several seroconversions in resident and migrant wild birds indicate that local WNV or other closely related flaviviruses transmission was occurring among bird populations. These data indicate that bird and mosquito surveillance can detect otherwise silent transmission of flaviviruses and give some insights regarding possible avian hosts and vectors in a European setting.

Factores relacionados con la calidad de vida al año de la artroplastia total de cadera y rodilla: estudio multicéntrico en Cataluña / Quality of life-associated factors at one year after total hip and knee replacement: a multicentre study in Catalonia

Objetivo. Evaluar la calidad de vida relacionada con la salud (CVRS) de los pacientes antes y después de su artroplastia total de rodilla (ATR) y cadera (ATC), y los factores relacionados al año. Metodología. Estudio prospectivo cuasi-experimental. Se seleccionaron hospitales de diferente nivel de complejidad y volumen en Cataluña y los pacientes con indicación de ATC o ATR. Se administraron el SF-36 y el WOMAC, variables demográficas, psicosociales y una pregunta sobre percepción de cambio a los pacientes por entrevista telefónica. Se calcularon las diferencias estandarizadas en las puntuaciones del SF-36 y WOMAC antes y después de la cirugía (tamaños del efecto [TE]) según percepción de cambio. Se analizaron los factores relacionados con la CVRS al año, a partir de modelos lineales generales ajustados. Resultados. A pesar de que a nivel global, los pacientes (n = 672) presentaron mejoría en la mayoría de dimensiones de CVRS, un 9% percibió poca mejoría al año, siendo sus puntuaciones muy parecidas en el basal y seguimiento (TE pequeñas: 0,0-0,4). Las mujeres, pacientes con bajo apoyo social, con puntuaciones más bajas (peores) en la salud mental percibida y CVRS basal, y que declaran que su enfermedad es más grave, percibieron peor CVRS al año (p < 0,05). Conclusiones. Se han identificado los factores relacionados con el peor pronóstico de la artroplastia consistentes con otros estudios publicados. La valoración de la CVRS puede ser un instrumento clave para identificar casos de posible no mejoría, y poder valorar las alternativas o aplicar alguna intervención previa y mejorar así la eficiencia del proceso asistencial(AU)

Aims. To assess the health related quality of life (HRQOL) and associated factors of patients before, and one year after, total knee (TKA) and hip (THA) arthroplasty. Methods. A quasi-experimental prospective study conducted in hospitals with different levels of complexity and volume in Catalonia, and on patients with an indication of a TKA or THA. Demographic and psychosocial variables were recorded, and the SF-36 and WOMAC, and a question on perception of change after surgery were administered to patients by telephone interview. The standardised differences (effect size) of perceived change using the SF-36 and WOMAC scores before and after surgery were calculated. The factors associated with HRQOL one year after surgery were analysed using adjusted general linear models. Results. Although there was an overall improvement in most HRQOL domains of patients (n=672), 9% saw little improvement after surgery, with their scores at baseline and follow-up being very similar (small size effect: 0.0-0.4). Women, patients with low social support, with lower scores (worse) in perceived mental health and baseline HRQOL, and who declared that their condition was more severe, perceived a poorer HRQOL one year after surgery (P<.05). Conclusions. Factors associated to a worse prognosis one year after an arthroplasty have been identified and are consistent with other published studies. The assessment of HRQOL can be a key instrument for identifying possible patients without improvement, in order to assess alternatives to an intervention, or apply other interventions in order to improve the efficiency of the healthcare process(AU)

[Quality of life-associated factors at one year after total hip and knee replacement: a multicentre study in Catalonia]. / Factores relacionados con la calidad de vida al año de la artroplastia total de cadera y rodilla: estudio multicéntrico en Cataluña.

AIMS: To assess the health related quality of life (HRQOL) and associated factors of patients before, and one year after, total knee (TKA) and hip (THA) arthroplasty. METHODS: A quasi-experimental prospective study conducted in hospitals with different levels of complexity and volume in Catalonia, and on patients with an indication of a TKA or THA. Demographic and psychosocial variables were recorded, and the SF-36 and WOMAC, and a question on perception of change after surgery were administered to patients by telephone interview. The standardised differences (effect size) of perceived change using the SF-36 and WOMAC scores before and after surgery were calculated. The factors associated with HRQOL one year after surgery were analysed using adjusted general linear models. RESULTS: Although there was an overall improvement in most HRQOL domains of patients (n=672), 9% saw little improvement after surgery, with their scores at baseline and follow-up being very similar (small size effect: 0.0-0.4). Women, patients with low social support, with lower scores (worse) in perceived mental health and baseline HRQOL, and who declared that their condition was more severe, perceived a poorer HRQOL one year after surgery (P<.05). CONCLUSIONS: Factors associated to a worse prognosis one year after an arthroplasty have been identified and are consistent with other published studies. The assessment of HRQOL can be a key instrument for identifying possible patients without improvement, in order to assess alternatives to an intervention, or apply other interventions in order to improve the efficiency of the healthcare process.