Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis.

Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effectiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influenza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; applied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, publication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed using a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017-2018 influenza season. The arVE was 3% (-2% to 7%) in the 2018-2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.

Tularemia Outbreaks in Spain from 2007 to 2020 in Humans and Domestic and Wild Animals.

In this study, tularemia outbreaks associated with humans and several domestic and wild animals (Iberian hares, wild rabbits, voles, mice, grey shrews, sheep, dogs, foxes, wolves, ticks, and river crayfish) are reported in Spain from 2007 to 2020. Special attention was paid to the outbreaks in humans in 2007-2009 and 2014-2015, when the most important waves occurred. Moreover, positive rates of tularemia in lagomorphs were detected in 2007-2010, followed by negative results in 2011-2013, before again returning to positive rates in 2014 and in 2017 and in 2019-2020. Lagomorphs role in spreading Francisella tularensis in the epidemiological chain could not be discarded. F. tularensis is described for the first time infecting the shrew Crocidura russula worldwide, and it is also reported for the first time infecting wild rabbits (Oryctolagus cuniculus) in Spain. Serological positives higher than 0.4% were seen for sheep only from 2007-2009 and again in 2019, while serological rates greater than 1% were revealed in dogs in 2007-2008 and in wild canids in 2016. F. tularensis were detected in ticks in 2009, 2014-2015, 2017, and 2019. Lastly, negative results were achieved for river crayfish and also in environmental water samples from 2007 to 2020.

Social Distancing, Lockdown and the Wide Use of Mask; A Magic Solution or a Double-Edged Sword for Respiratory Viruses Epidemiology?

The use of non-pharmaceutical interventions (NPIs), such as social distancing, lockdowns and the massive use of masks, have not only largely prevented the spread of SARS-CoV-2, but also of other respiratory viruses such as influenza or respiratory syncytial virus (RSV). This decrease has been so high that, in most countries, the influenza and RSV epidemic has not occurred. Far from being a beneficial fact, this can be problematic, since the absence of circulation of certain pathogens can lead to a decrease in herd immunity against them. This can promote the rise of more serious, longer-lasting epidemics that start sooner. To alleviate the collateral effects that may occur due to the decrease in circulation of viruses such as influenza, it is necessary to increase the production of influenza vaccines, carry out mass vaccination campaigns and focus on vaccinating the main drivers of this virus, children.

Tendencia y distribución municipal de la incidencia de cáncer colorrectal en el área de salud de León (1994-2008) / Municipal distribution and trends in the incidence of colorectal cancer in the health area of Leon (1994-2008)

Fundamento Se ha puesto de manifiesto un exceso de incidencia y mortalidad por cáncer colorrectal (CCR) en el área de salud de León (ASL). El objeto del presente trabajo es conocer su tendencia y distribución geográfica. Métodos Fueron incluidos los casos del Registro Hospitalario de Tumores del Centro Asistencial Universitario de León, entre 1994-2008 y con residencia en el ASL. Las tendencias temporales se evaluaron con un modelo de regresión de Poisson. Para el análisis de la distribución espacial se estimaron los riesgos relativos (RR) municipales suavizados mediante el ajuste del modelo de Besag, York y Mollié y sus probabilidades posteriores de que los RR fuesen > 1 (PP), utilizando métodos bayesianos. Resultados Se incluyeron 4.136 casos. Las tasas estandarizadas a población europea ascendieron de 49,6 (1994-1996) a 63,5 casos nuevos por 100.000 habitantes en los hombres (2006-2008) y de 29,6 a 33,8 en las mujeres. Se observó un incremento anual del 2% para todas las localizaciones, oscilando desde el 1,8% en el recto al 3,6% en el colon proximal. En todas las localizaciones el incremento fue mayor en hombres que en mujeres. Varios municipios del ASL presentaron un exceso de riesgo. El patrón geográfico observado obedecía sobre todo a la distribución del cáncer de colon. Conclusiones Las tasas de incidencia observadas son elevadas y en ascenso. Debe prestarse una especial atención al CCR en el ASL, principalmente a los municipios con exceso de riesgo (AU)

Background There is an excess incidence of colorectal cancer (CRC) and mortality from this disease in the health area of Leon. The aim of the present study was to determine trends in CRC and its geographical distribution. Methods Cases included in the Hospital Registry of Tumors of the Centro Asistencial Universitario de León from 1994-2008 and occurring in patients residing in the health area of Leon were studied. Time trends were evaluated with a Poisson regression model. To analyze geographical distribution, the smoothed relative risks (RR) of the municipalities adjusted by the Besag, York and Mollié model were calculated, and their subsequent probability of an RR>1 (PP) was calculated using Bayesian methods. Results A total of 4,136 cases were included. Rates standardized to the European standard population ranged from 49.6 (1994-6) to 63.5 new cases per 100,000 inhabitants in men (2006-8) and from 29.6 to 33.8 in women. An annual 2% increase was found for all localizations, ranging from 1.8% in the rectum to 3.6% in the proximal colon. In all localizations, the increase was greater in men than in women. Several municipalities in the health area of Leon showed an excess risk. The geographical pattern observed was due especially to the distribution of colon cancer. Conclusions The incidence rates observed were high and were increasing. Special attention should be paid to CRC in the health area of Leon, mainly in the municipalities with excess risk (AU)

[Municipal distribution and trends in the incidence of colorectal cancer in the health area of Leon (1994-2008)]. / Tendencia y distribución municipal de la incidencia de cáncer colorrectal en el área de salud de León (1994-2008).

BACKGROUND: There is an excess incidence of colorectal cancer (CRC) and mortality from this disease in the health area of Leon. The aim of the present study was to determine trends in CRC and its geographical distribution. METHODS: Cases included in the Hospital Registry of Tumors of the Centro Asistencial Universitario de León from 1994-2008 and occurring in patients residing in the health area of Leon were studied. Time trends were evaluated with a Poisson regression model. To analyze geographical distribution, the smoothed relative risks (RR) of the municipalities adjusted by the Besag, York and Mollié model were calculated, and their subsequent probability of an RR>1 (PP) was calculated using Bayesian methods. RESULTS: A total of 4,136 cases were included. Rates standardized to the European standard population ranged from 49.6 (1994-6) to 63.5 new cases per 100,000 inhabitants in men (2006-8) and from 29.6 to 33.8 in women. An annual 2% increase was found for all localizations, ranging from 1.8% in the rectum to 3.6% in the proximal colon. In all localizations, the increase was greater in men than in women. Several municipalities in the health area of Leon showed an excess risk. The geographical pattern observed was due especially to the distribution of colon cancer. CONCLUSIONS: The incidence rates observed were high and were increasing. Special attention should be paid to CRC in the health area of Leon, mainly in the municipalities with excess risk.

Revisiones Sistemáticas Exploratorias / Scoping review

Debido al gran avance que se ha producido en los últimos años en el ámbito de la investigacióncientífica, no sólo disponemos cada vez de más información si no que esta es a su vez más compleja. Lasrevisiones exploratorias permiten sintetizar la evidencia existente respecto a un tema en salud incorporandodiferentes diseños de estudio, intervenciones y medidas de impacto con el fin de generar nuevas hipótesis,líneas de investigación o proponer métodos de trabajo más adecuados para futuras investigaciones. Esto esposible aplicando criterios de evaluación de la calidad de los documentos encontrados y del grado deevidencia científica (AU)

Due to the great progress that has occurred in recent years in the field of scientific research, theinformation is increasing not just in terms of amount but also in complexity. The scoping reviews allow tosynthesize the existing evidence regarding a health issue, incorporating different study designs, interventions and measures of impact in order to generate new hypotheses, lines of research or to propose most appropriateworking methods for future research. This is possible by applying criteria for assessing the quality of thedocuments found and the levels of scientific evidence (AU)

[Prevalence of dementia in institutionalized patients. The RESYDEM study]. / Prevalencia de demencia en pacientes institucionalizados: estudio RESYDEM.

INTRODUCTION: To determine the prevalence of dementia in nursing homes in Spain and to analyze the associated factors in an elderly population in the institutional setting. MATERIAL AND METHODS: We performed a multicenter, cross-sectional, observational study of 852 residents of public, private and state-assisted nursing homes throughout Spain. Dementia was diagnosed according to the DSM-IV-TR clinical criteria. The Hughes Clinical Dementia Rating scale was used to measure global impairment or the global severity of dementia. Sociodemographic, clinical and neuropsychological variables, together with the pharmacological treatments prescribed to the participants, were recorded. RESULTS: The overall prevalence of dementia was 61.7% (95% CI 58.4-65.1) and that of Alzheimer's disease was 16.9% (95% CI 14.3-19.5). Vascular dementia was found in 7.3% (95% CI 5.5-9.1). Female sex was independently associated with a greater frequency of dementia. The prevalence of dementia increased with age. Only 18.8% (95% CI 15.4-22.3) of the patients diagnosed with dementia received specific treatment for the disorder. CONCLUSIONS: Two-thirds of the elderly persons living in nursing homes in Spain have dementia. Undertreatment of this disease is common. Increased awareness among health care professionals is important for the early diagnosis and appropriate management of dementia, which would represent a radical change in the approach to this disease.

Prevalencia de demencia en pacientes institucionalizados: estudio RESYDEM / Prevalence of dementia in institutionalized patients. The RESYDEM study

Introduccióndeterminar la prevalencia de demencia en residencias de ancianos de España y analizar los factores asociados a ella.Material y métodosestudio transversal, observacional y multicéntrico. Residencias pertenecientes a todas las Comunidades Autónomas del Estado español de titularidad pública, privada y concertada. Se incluyó a un total de 852 ancianos institucionalizados, participantes en el estudio RESYDEM.El diagnóstico de demencia se estableció sobre la base de los criterios clínicos del DSM-IV-TR. Como medida del deterioro global o valoración global de la gravedad de la demencia se utilizó la escala Clinical Dementia Rating (CDR) de Hughes. Se recogieron variables sobre características clínicas y sociodemográficas, y los tratamientos farmacológicos de los participantes.Resultadosla prevalencia global de demencia hallada en este estudio fue del 61,7% (intervalo de confianza [IC] del 95%, 58,4–65,1). La enfermedad de Alzheimer se presentó con una prevalencia del 16,9% (IC del 95%, 14,3–19,5). La demencia vascular supone el 7,3% (IC del 95%, 5,5–9,1). El género femenino se asoció de forma independiente con una mayor frecuencia de demencia. Se evidenció una mayor prevalencia de esta afección a medida que aumentaba la edad. Sólo el 18,8% (IC del 95%, 15,4–22,3) de los pacientes con diagnóstico de demencia reciben tratamiento específico para ésta.Conclusionesdos terceras partes de las personas mayores que viven en residencias de ancianos en España presentan demencia. Existe una elevada tasa de infratratamiento de este proceso. Es importante la sensibilización de los profesionales sanitarios para la identificación precoz y para conocer la existencia de tratamientos específicos para la demencia, lo cual debe suponer un cambio radical en el abordaje de la enfermedad (AU)

IntroductionTo determine the prevalence of dementia in nursing homes in Spain and to analyze the associated factors in an elderly population in the institutional setting.Material and methodsWe performed a multicenter, cross-sectional, observational study of 852 residents of public, private and state-assisted nursing homes throughout Spain. Dementia was diagnosed according to the DSM-IV-TR clinical criteria. The Hughes Clinical Dementia Rating scale was used to measure global impairment or the global severity of dementia. Sociodemographic, clinical and neuropsychological variables, together with the pharmacological treatments prescribed to the participants, were recorded.ResultsThe overall prevalence of dementia was 61.7% (95% CI 58.4–65.1) and that of Alzheimer's disease was 16.9% (95% CI 14.3–19.5). Vascular dementia was found in 7.3% (95% CI 5.5–9.1). Female sex was independently associated with a greater frequency of dementia. The prevalence of dementia increased with age. Only 18.8% (95% CI 15.4–22.3) of the patients diagnosed with dementia received specific treatment for the disorder.ConclusionsTwo-thirds of the elderly persons living in nursing homes in Spain have dementia. Undertreatment of this disease is common. Increased awareness among health care professionals is important for the early diagnosis and appropriate management of dementia, which would represent a radical change in the approach to this disease (AU)

[Factors determining inappropriate days of stay in a third-level hospital]. / Factores determinantes de la estancia inadecuada en un hospital de tercer nivel.

BACKGROUND: To identify the factors associated with a higher risk of inappropriate days of stay. MATERIAL AND METHOD: Crude and adjusted inappropriateness rates were calculated using negative binomial regression to obtain information about the relative risk of each variable. The Appropriateness Evaluation Protocol (AEP) was applied to collect information about patients' hospital stays. RESULTS: A total of 34.17% (95%CI, 33.28-35.08) of the stays were inappropriate. Women, age older than 65 years, elective admission, and stays in medical services showed the highest inappropriateness risk. Lack of correct patient follow-up in the medical record increased the risk of inappropriateness to 36%. CONCLUSIONS: Lack of continual registration of the patient's clinical course increased the risk of inappropriate days of stay in the hospital. The use of the negative binomial is a valid and simple option for analysis of this type of phenomenon.

Factores determinantes de la estancia inadecuada en un hospital de tercer nivel / Factors determining inappropriate days of stay in a third-level hospital

Introducción: Identificar los factores asociados a un mayor riesgo de estancias inadecuadas. Material y método: Se calcularon las tasas crudas y ajustadas de inadecuación mediante regresión binomial negativa, obteniéndose los riesgos relativos para distintas variables. La recogida de datos se realizó mediante el Appropriateness Evaluation Protocol. Resultados: El 34,17% (intervalo de confianza del 95%, 33,28-35,08) de las estancias fueron inadecuadas. Las mujeres, los mayores de 65 años, los ingresos programados y las estancias en servicios médicos tuvieron más riesgo de inadecuación. La ausencia en la historia clínica de un seguimiento continuado del paciente incrementa el riesgo de inadecuación un 36%. Conclusiones: La ausencia de un registro continuado de la evolución clínica del paciente es un factor que incrementa el riesgo de estancias inadecuadas. La utilización de la binomial negativa es una alternativa válida y sencilla para el análisis de este tipo de fenómenos

Background: To identify the factors associated with a higher risk of inappropriate days of stay. Material and method: Crude and adjusted inappropriateness rates were calculated using negative binomial regression to obtain information about the relative risk of each variable. The Appropriateness Evaluation Protocol (AEP) was applied to collect information about patients' hospital stays. Results: A total of 34.17% (95%CI, 33.28-35.08) of the stays were inappropriate. Women, age older than 65 years, elective admission, and stays in medical services showed the highest inappropriateness risk. Lack of correct patient follow-up in the medical record increased the risk of inappropriateness to 36%. Conclusions: Lack of continual registration of the patient's clinical course increased the risk of inappropriate days of stay in the hospital. The use of the negative binomial is a valid and simple option for analysis of this type of phenomenon

[Viral gastroenteritis. Application of a protocol for astrovirus detection in childhood gastroenteritis]. / Gastroenteritis de etiología vírica. Aplicación de un protocolo para el diagnóstico de astrovirus en casos de gastroenteritis infantil.

BACKGROUND AND OBJECTIVE: Diagnosis of viral gastroenteritis is an important subject in clinical virology which is mainly determined by the availability of reagents in laboratories, such as in the case of astrovirus. The aim of this study was to estimate the increase in the diagnostic performance achieved after the incorporation of astrovirus search in the diagnosis protocol of acute viral gastroenteritis. We also analyzed the trend of infections in other more commonly searched virus, such as rotavirus and enteric adenovirus. MATERIAL AND METHODS: Retrospective study during 20 years that included 12,980 stool samples processed for gastroenteritis virus diagnosis. Since 1997 an enzyme immunoassay for astrovirus has been applied to those samples that are negative for rotavirus and adenovirus. The study was divided in two periods (1986-1996 and 1997-2005, without and with astrovirus diagnosis) and the percentage of patients diagnosed in each period was compared. The trend of positive results as well as the percentage of positive results over all patients studied was modelled using the least squares method. RESULTS: The percentages of positive patients for rotavirus, adenovirus and astrovirus were 10.3%, 2.3% and 6.0% respectively, and there were uncommon co-infections by rotavirus and adenovirus (0.2%). The protocol applied to the astrovirus diagnosis increased the diagnosis rate up to 16.8% of the studied cases. Significant statistical differences were observed between the 2 study periods. A quadratic growth was observed in the results of positive diagnosis of viral gastroenteritis during the study period. CONCLUSIONS: The search of astrovirus in gastroenteritis cases by a selective protocol increased the diagnostic performance of gastrointestinal virus by 6%. In view of these results, it would be useful to implement astrovirus diagnosis in faeces with liquid or semi-liquid consistency when rotavirus and adenovirus detection is negative.

Gastroenteritis de etiología vírica. Aplicación de un protocolo para el diagnóstico de astrovirus en casos de gastroenteritis infantil / Viral gastroenteritis. Application of a protocol for astrovirus detection in childhood gastroenteritis

Fundamento y objetivo: El diagnóstico de gastroenteritis víricas es un importante capítulo en la virología clínica que está fundamentalmente condicionado por la disponibilidad de reactivos en los laboratorios, como en el caso del astrovirus. El objetivo de este estudio es estimar el incremento del rendimiento diagnóstico alcanzado tras la incorporación de la búsqueda de astrovirus en el protocolo de gastroenteritis víricas agudas y analizar la tendencia de la infección por otros virus de búsqueda más general, como son rotavirus y adenovirus entéricos. Material y método: Se trata de un estudio retrospectivo de 20 años en el que se procesaron 12.980 muestras de heces para diagnóstico de virus de gastroenteritis. Desde 1997 se ha aplicado a las muestras negativas para rotavirus y adenovirus un enzimoinmunoanálisis para astrovirus. Se ha dividido el tiempo de estudio en 2 períodos (1986-1996 y 1997-2005, sin y con diagnóstico de astrovirus, respectivamente) y se ha comparado el porcentaje de pacientes en los que se obtiene un diagnóstico etiológico de virus de gastroenteritis. Se han modelizado el componente de tendencia de la serie de resultados positivos y el porcentaje que suponen del total de pacientes estudiados mediante mínimos cuadrados. Resultados: El porcentaje de pacientes positivos para rotavirus, adenovirus y astrovirus fue del 10,3, el 2,3 y el 6,0%, respectivamente, y fue infrecuente la aparición de coinfecciones entre rotavirus y adenovirus (0,2%). El protocolo aplicado para el diagnóstico de astrovirus permite aumentar el rendimiento diagnóstico hasta un 16,8% de los casos estudiados, existiendo diferencias estadísticamente significativas entre los 2 períodos. Se ha observado un crecimiento cuadrático en el diagnóstico de gastroenteritis víricas durante el período de estudio. Conclusiones: La búsqueda de astrovirus en casos de gastroenteritis mediante un protocolo selectivo ha demostrado aumentar la rentabilidad diagnóstica de los virus enteropatógenos en un 6%. A la vista de los resultados, sería de utilidad ampliar la búsqueda de astrovirus en pacientes con heces de consistencia líquida o semilíquida cuando la detección de rotavirus y adenovirus sea negativa

Background and objective: Diagnosis of viral gastroenteritis is an important subject in clinical virology which is mainly determined by the availability of reagents in laboratories, such as in the case of astrovirus. The aim of this study was to estimate the increase in the diagnostic performance achieved after the incorporation of astrovirus search in the diagnosis protocol of acute viral gastroenteritis. We also analyzed the trend of infections in other more commonly searched virus, such as rotavirus and enteric adenovirus. Material and methods: Retrospective study during 20 years that included 12,980 stool samples processed for gastroenteritis virus diagnosis. Since 1997 an enzyme immunoassay for astrovirus has been applied to those samples that are negative for rotavirus and adenovirus. The study was divided in two periods (1986-1996 and 1997-2005, without and with astrovirus diagnosis) and the percentage of patients diagnosed in each period was compared. The trend of positive results as well as the percentage of positive results over all patients studied was modelled using the least squares method. Restults: The percentages of positive patients for rotavirus, adenovirus and astrovirus were 10.3%, 2.3% and 6.0% respectively, and there were uncommon co-infections by rotavirus and adenovirus (0.2%). The protocol applied to the astrovirus diagnosis increased the diagnosis rate up to 16.8% of the studied cases. Significant statistical differences were observed between the 2 study periods. A quadratic growth was observed in the results of positive diagnosis of viral gastroenteritis during the study period. Conclusions: The search of astrovirus in gastroenteritis cases by a selective protocol increased the diagnostic performance of gastrointestinal virus by 6%. In view of these results, it would be useful to implement astrovirus diagnosis in faeces with liquid or semi-liquid consistency when rotavirus and adenovirus detection is negative