Short- and mid-term morbidity and primary-care burden due to infant respiratory syncytial virus infection: A Spanish 6-year population-based longitudinal study.

BACKGROUND: The morbidity burden of respiratory syncytial virus (RSV) in infants extends beyond hospitalization. Defining the RSV burden before implementing prophylaxis programs is essential for evaluating any potential impact on short- to mid-term morbidity and the utilization of primary healthcare (PHC) and emergency services (ES). We established this reference data using a population-based cohort approach. METHODS: Infants hospitalized for RSV from January 2016 to March 2023 were matched with non-hospitalized ones based on birthdate and sex. We defined the exposure as severe RSV hospitalization. The main study outcomes were as follows: (1) PHC and ES visits for RSV, categorized using the International Classification of Primary Care codes, (2) prescriptions for respiratory airway obstructive disease, and (3) antibacterial prescriptions. Participants were followed up from 30 days before hospitalization for severe RSV until the outcome occurrence or end of the study. Adjusted incidence rate ratios (IRRs) of the outcomes along with their 95% confidence intervals (CI) were estimated using Poisson regression models. Stratified analyses by type of PHC visit (nurse, pediatrician, or pharmacy) and follow-up period were undertaken. We defined mid-term outcomes as those taking place up to 24 months of follow-up period. RESULTS: The study included 6626 children (3313 RSV-hospitalized; 3313 non-hospitalized) with a median follow-up of 53.7 months (IQR = 27.9, 69.4). After a 3-month follow-up, severe RSV was associated with a considerable increase in PHC visits for wheezing/asthma (IRR = 4.31, 95% CI: 3.84-4.84), lower respiratory infections (IRR = 4.91, 95% CI: 4.34-5.58), and bronchiolitis (IRR = 4.68, 95% CI: 2.93-7.65). Severe RSV was also associated with more PHC visits for the pediatrician (IRR = 2.00, 95% CI: 1.96-2.05), nurse (IRR = 1.89, 95% CI: 1.75-1.92), hospital emergency (IRR = 2.39, 95% CI: 2.17-2.63), primary healthcare emergency (IRR: 1.54, 95% CI: 1.31-1.82), as well as with important increase in prescriptions for obstructive airway diseases (IRR = 5.98, 95% CI: 5.43-6.60) and antibacterials (IRR = 4.02, 95% CI: 3.38-4.81). All findings remained substantial until 2 years of post-infection. CONCLUSIONS: Severe RSV infection in infants significantly increases short- to mid-term respiratory morbidity leading to an escalation in healthcare utilization (PHC/ES attendance) and medication prescriptions for up to 2 years afterward. Our approach could be useful in assessing the impact and cost-effectiveness of RSV prevention programs.

Effectiveness and impact of universal prophylaxis with nirsevimab in infants against hospitalisation for respiratory syncytial virus in Galicia, Spain: initial results of a population-based longitudinal study.

BACKGROUND: Galicia (Spain) was one of the first regions worldwide to incorporate nirsevimab for universal respiratory syncytial virus (RSV) prophylaxis in infants into its immunisation programme. The NIRSE-GAL longitudinal population-based study aimed to assess nirsevimab effectiveness in preventing hospitalisations (ie, admittance to hospital). METHODS: The 2023-24 immunisation campaign with nirsevimab in Galicia began on Sept 25, 2023, and concluded on March 31, 2024. The campaign targeted three groups: infants born during the campaign (seasonal group), infants younger than 6 months at the start of the campaign (catch-up group), and infants aged 6-24 months with high-risk factors at the start of the campaign (high-risk group). Infants in the seasonal group were offered immunisation on the first day of life before discharge from hospital. Infants in the catch-up and high-risk groups received electronic appointments to attend a public hospital or health-care centre for nirsevimab administration. For this interim analysis, we used data collected from Sept 25 to Dec 31, 2023, from children born up to Dec 15, 2023. Data were retrieved from public health registries. Nirsevimab effectiveness in preventing RSV-associated lower respiratory tract infection (LRTI) hospitalisations; severe RSV-related LRTI requiring intensive care unit admission, mechanical ventilation, or oxygen support; all-cause LRTI hospitalisations; and all-cause hospitalisations was estimated using adjusted Poisson regression models. Data from five past RSV seasons (2016-17, 2017-18, 2018-19, 2019-20, and 2022-23), excluding the COVID-19 pandemic period, were used to estimate the number of RSV-related LRTI hospitalisations averted along with its IQR. The number needed to immunise to avoid one case in the 2023-24 season was then estimated from the averted cases. Nirsevimab safety was routinely monitored. The NIRSE-GAL study protocol was registered on ClinicalTrials.gov (NCT06180993), and follow-up of participants is ongoing. FINDINGS: 9408 (91·7%) of 10 259 eligible infants in the seasonal and catch-up groups received nirsevimab, including 6220 (89·9%) of 6919 in the seasonal group and 3188 (95·4%) of 3340 in the catch-up group. 360 in the high-risk group were offered nirsevimab, 348 (97%) of whom received it. Only infants in the seasonal and catch-up groups were included in analyses to estimate nirsevimab effectiveness and impact because there were too few events in the high-risk group. In the catch-up and seasonal groups combined, 30 (0·3%) of 9408 infants who received nirsevimab and 16 (1·9%) of 851 who did not receive nirsevimab were hospitalised for RSV-related LRTI, corresponding to an effectiveness of 82·0% (95% CI 65·6-90·2). Effectiveness was 86·9% (69·1-94·2) against severe RSV-related LRTI requiring oxygen support, 69·2% (55·9-78·0) against all-cause LRTI hospitalisations, and 66·2% (56·0-73·7) against all-cause hospitalisations. Nirsevimab effectiveness against other endpoints of severe RSV-related LRTI could not be estimated because of too few events. RSV-related LRTI hospitalisations were reduced by 89·8% (IQR 87·5-90·3), and the number needed to immunise to avoid one RSV-related LRTI hospitalisation was 25 (IQR 24-32). No severe adverse events related to nirsevimab were registered. INTERPRETATION: Nirsevimab substantially reduced infant hospitalisations for RSV-associated LRTI, severe RSV-associated LRTI requiring oxygen, and all-cause LRTI when given in real-world conditions. These findings offer policy makers and health authorities robust, real-world, population-based evidence to guide the development of strategies for RSV prevention. FUNDING: Sanofi and AstraZeneca. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Internet use and abuse in the adult population of Galicia: Prevalence and associated characteristics. / Uso y abuso de Internet en la población adulta de Galicia: Prevalencia y características asociadas.

Internet use has rapidly spread around the world becoming an indispensable part of daily life. Despite its advantages, the dysfunctional use or abuse of the Internet can lead to addiction problems. The main objectives established in this study were to assess the prevalence of Internet use in the general Galician population and the prevalence of problematic internet use (PIU) and at-risk of PIU in 2017. The Surveillance Information System on Risk Behavior is based on annual cross-sectional surveys among the population aged at least 16 years residing in Galicia, Spain. A total of 7,841 participants were recruited in 2017 using a stratified random sampling. Internet users were classified into three categories: normal use, maladaptive/at-risk of PIU and PIU, based on their score in the Internet-related experiences questionnaire. A total of 74.8%, 95% CI [73.8-75.8], of the Galician population aged 16 to 74 used the Internet in the month before the survey was performed, exceeding 95% in the population aged below 45 years. Most users use chat applications and social networks. The prevalence of PIU or at-risk of PIU in the population aged 16 to 74 was 1.0% [0.8-1.3], reaching 5.2% [4.2-6.2] in the population aged between 16 and 24. The prevalence of Internet use in Galicia is slightly lower than those obtained in Spain and Europe. Moreover, PIU is an emerging problem in the population with the youngest population being the most affected.

El uso de Internet se ha extendido rápidamente por todo el mundo convirtiéndose en una parte indispensable de la vida cotidiana. A pesar de sus ventajas, el uso disfuncional o el abuso de Internet puede conducir a problemas de adicción. Los principales objetivos de este estudio fueron evaluar la prevalencia de uso de Internet, de uso problemático de Internet (UPI) o de riesgo de UPI en la población general gallega en 2017. El Sistema de Información sobre Conductas de Riesgo de Galicia (SICRI) se basa en la realización de encuestas transversales con periodicidad cuasianual entre la población de 16 años y más residente en Galicia, España. En 2017, se incluyeron a 7.841 participantes mediante un muestreo aleatorio estratificado. Los usuarios de Internet se clasificaron en tres categorías: uso normal, inadaptado/en riesgo de UPI y UPI, en función de su puntuación en el cuestionario de experiencias relacionadas con Internet. El 74,8%, 95% IC [73,8-75,8], de la población gallega de 16-74 años utilizó Internet en el último mes, siendo esta prevalencia superior al 95% en la población menor de 45 años. La mayoría de los usuarios utilizan aplicaciones de chat y redes sociales. La prevalencia de UPI o riesgo de UPI en la población de 16 a 74 años fue del 1,0% 95% IC [0,8-1,3], alcanzando el 5,2% 95% IC [4,2-6,2] en la población de 16 a 24 años. La prevalencia de uso de Internet en Galicia es ligeramente inferior a las obtenidas en España y Europa. Además, el UPI es un problema emergente en la población, siendo la población más joven la más afectada.

Condicionantes del parto pretérmino en Galicia / Determinants of preterm birth in Galicia

Introducción: los recién nacidos prematuros tienen más riesgo de padecer complicaciones tras el nacimiento, siendo la prematuridad la principal causa de muerte en los recién nacidos. El objetivo principal del estudio es caracterizar los partos pretérmino en Galicia. Material y métodos: en 2016, se realizó en Galicia un estudio transversal enmarcado en el Sistema de Información sobre Conductas de Riesgo (SICRI). La población objetivo fue la de las mujeres de 18-49 años que dieron a luz en Galicia entre septiembre de 2015 y agosto de 2016 (n = 18 822) y sus hijos nacidos vivos (n = 19 204). La recogida de información se realizó entre noviembre de 2016 y enero de 2017 mediante entrevista telefónica asistida por ordenador (sistema CATI). Se estimó la prevalencia de parto pretérmino (<37 semanas) en global y en función de las variables de interés. Se ajustó un modelo de regresión logística para identificar las variables asociadas al parto pretérmino. Resultados: se obtuvo información de 6436 mujeres de 18 a 49 años. La tasa de respuesta fue del 76%. En 2016, el 7,9% de los partos en Galicia fueron pretérmino. La prevalencia aumentó con la edad de la mujer. La prevalencia más elevada se observó entre las mujeres con un embarazo múltiple. Se identificaron como factores que aumentan la probabilidad de parto pretérmino características obstétricas y conductas de riesgo para la salud. La asistencia a clases de preparación al parto y el aumento de más de 12 kg de peso durante el embarazo se identificaron como factores que disminuyen la probabilidad de tener un parto pretérmino. Conclusiones: en Galicia, 8 de cada 100 partos son pretérmino. Algunos de los factores identificados como condicionantes del parto pretérmino son modificables, por lo que los profesionales de la salud deberían tenerlos en cuenta en la atención al embarazo (AU)

ntroduction: premature infants are at higher risk of complications after birth, and prematurity is the leading cause of death in the neonatal period. The main objective of this study was to characterize preterm births in Galicia, Spain.Material and methods: in 2016, we carried out a cross-sectional study in Galicia using the Risk Behavior Information System, or SICRI. The study universe consisted of all Galician women aged 18 to 49 years who gave birth between September-2015 and August-2016 (n=18 822) and their liveborn infants (n=19 204). Data were collected between November 2016 and January 2017 through computer-assisted telephone interviews with participants. We estimated the prevalence of preterm birth (before 37 weeks of gestation), overall and based on different variables. We fitted a logistic regression model to identify variables associated with preterm birth.Results: we obtained information from 6436 women aged 18 to 49 years. The response rate was 76%. In 2016, 7.9% of births in Galicia were preterm. The prevalence increased with age. The highest prevalence was found in women with multiple pregnancies. Obstetric characteristics such as multiple pregnancy and primiparity and risk behaviours were identified as factors that increase the probability of preterm birth. Attendance to childbirth classes and a pregnancy weight gain greater than 12 kg were identified as protective factors.Conclusions: in Galicia, 8 out of 100 births are preterm. Some of the identified factors that increase the risk of preterm birth are modifiable, and health providers should take them into account in prenatal care. (AU)

Where Do Chronic Obstructive Pulmonary Disease Patients Die? 8-Year Trend, with Special Focus on Sex-Related Differences.

Background: To plan end-of-life care it is essential to ascertain where patients die. There is very little information on the place of death of chronic obstructive pulmonary disease (COPD) patients. Accordingly, this study set out to describe the place of death of all COPD-related deaths in a Spanish region across the period 2009-2017, taking into account the sex and age of the deceased. Methods: We analyzed COPD deaths, codes J41-44 of the International Classification of Diseases-10th revision, in the Galician Autonomous Region from 2009 to 2017. Using death certificate data furnished by the Galician Mortality Registry, information was extracted on place of death, categorized as "hospital", "nursing home", "patient's home", "other" or "not shown". Results: There were 10,274 deaths, with a male:female ratio of 2.52; 39.0% of deaths occurred in hospital and 41.4% at home, with these data varying according to sex and age. Across the study period, no reduction was observed in the number of deaths that occurred in hospital. For all the period analyzed, deaths among women occurred mostly at home, with an increase being seen in the number of deaths in nursing homes over the course of the study. Patients aged under 70 years tended to die more frequently in hospital, and those over this age died more frequently at home or in nursing homes. Conclusion: A very high percentage of COPD patients still die in hospital, a trend that has shown no decline in recent years. Even so, there are important variations by sex and age on the place of death of these patients.

[Evolution of the prevalence of electronic cigarette during 2014-2018 and IQOS use in 2018 in Galicia.] / Evolución de la prevalencia de consumo de cigarrillos electrónicos en el periodo 2014-2018 y consumo de IQOS en 2018 en Galicia.

OBJECTIVE: Despite the risks associated with the use of new forms of tobacco consumption, such as electronic cigarettes or heated tobacco products such as IQOS (I Quit Ordinary Smoking), few studies have estimated the prevalence of use at the population level. The aims of this study were to describe, in Galicia, the evolution of the prevalence of the use of electronic cigarettes and the reasons for its use in the period 2014-2018, and, the use and knowledge of IQOS in 2018. METHODS: The information analyzed comes from 4 cross-sectional surveys conducted in 2014 (n=7,874), 2015 (n=7,908), 2017 (n=7,841) and 2018 (n=7,853) within the framework of the Information System on Risk Behaviors (SICRI), being the target population Galicians aged 16 and over. Estimates of prevalence of consumption, the devices knowledge and reasons for use are shown accompanied with 95% confidence intervals (95% CI), globally, by gender, age group and tobacco consumption. RESULTS: In the period under study, the prevalence of electronic cigarette use remained stable. In 2018 it was estimated at 0.7% (0.5-0.9). In 2017, the only year in which changes were observed, it fell to 0.3% (0.2-0.4). Prevalence of electronic cigarette use among the population aged 16 to 24 increased from 0.8% in 2014 to 2.1% in 2018. The main reason for using electronic cigarettes was to quit smoking. The prevalence of the IQOS use at the time study (2018) was 0.1% (0.01-0.15) and 4.2% (3.7-4.7) of the Galicians knew what the IQOS was. CONCLUSIONS: In Galicia, the prevalence of electronic cigarette and IQOS use is low, although an increase was observed among the population aged 16-24 between 2014 and 2018. Surveillance of use at the population level should not be neglected.

OBJETIVO: A pesar de los riesgos asociados al uso de nuevas formas de consumo de tabaco, como los cigarrillos electrónicos o los productos de tabaco calentado como los IQOS (I Quit Ordinary Smoking), son pocos los estudios que han estimado su prevalencia de uso a nivel poblacional. Los objetivos de este trabajo fueron describir, en Galicia, la evolución de la prevalencia y las razones de uso de cigarrillos electrónicos en el periodo 2014-2018; y el uso y conocimiento del IQOS en 2018. METODOS: La información analizada procede de 4 estudios transversales que se realizaron en 2014 (n=7.874), 2015 (n=7.908), 2017 (n=7.841) y 2018 (n=7.853) en el marco del Sistema de Información sobre Conductas de Riesgo (SICRI), siendo la población objetivo la población gallega de 16 años y más. Se presentan estimaciones puntuales de prevalencia de consumo y de conocimiento de los dispositivos y razones de uso acompañadas de intervalos de confianza al 95% (IC95%), en global, en función del sexo, el grupo de edad y el consumo de tabaco. RESULTADOS: En el periodo a estudio la prevalencia de uso de cigarrillos electrónicos se mantuvo estable. En 2018 se estimó en el 0,7% (0,5-0,9). En 2017, único año en el que se observaron cambios, se redujo al 0,3% (0,2-0,4). La prevalencia de uso de cigarrillos electrónicos entre la población de 16 a 24 años pasó del 0,8% en 2014 al 2,1% en 2018. El principal motivo de su uso de cigarrillos electrónicos fue dejar de fumar. La prevalencia de uso de IQOS en el momento del estudio (2018) fue del 0,1% (0,01-0,15) y el 4,2% (3,7-4,7) de los gallegos sabían lo que era el IQOS. CONCLUSIONES: En Galicia, la prevalencia de uso de cigarrillos electrónicos e IQOS es baja, aunque se observó un aumento entre la población de 16 a 24 años entre 2014 y 2018. No se debe descuidar la vigilancia del uso a nivel poblacional.

Four Decades of COPD Mortality Trends: Analysis of Trends and Multiple Causes of Death.

There is little information on chronic obstructive pulmonary disease (COPD) mortality trends, age of death, or male:female ratio. This study therefore sought to analyze time trends in mortality with COPD recorded as the underlying cause of death from 1980 through 2017, and with COPD recorded other than as the underlying cause of death. We conducted an analysis of COPD deaths in Galicia (Spain) from 1980 through 2017, including those in which COPD was recorded other than as the underlying cause of death from 2015 through 2017. We calculated the crude and standardized rates, and analyzed mortality trends using joinpoint regression models. There were 43,234 COPD deaths, with a male:female ratio of 2.4. Median age of death was 82 years. A change point in the mortality trend was detected in 1996 with a significant decrease across the sexes, reflected by an annual percentage change of -3.8%. Taking deaths into account in which COPD participated or contributed without being the underlying cause led to an overall 42% increase in the mortality burden. The most frequent causes of death when COPD was not considered to be the underlying cause were bronchopulmonary neoplasms and cardiovascular diseases. COPD mortality has decreased steadily across the sexes in Galicia since 1996, and age of death has also gradually increased. Multiple-cause death analysis may help prevent the underestimation of COPD mortality.

Utilidad de la vigilancia microbiológica del virus respiratorio sincitial en Galicia (España): 2008-2017 / Usefulness of the microbiological surveillance of respiratory syncytial virus in Galicia (Spain): 2008-2017

OBJETIVO: Describir si la información microbiológica del virus respiratorio sincitial (VRS) facilitada semanalmente por cuatro hospitales captura adecuadamente la estacionalidad del VRS en toda la comunidad. MÉTODO: Estudio descriptivo retrospectivo. Se compararon las detecciones de VRS en muestras respiratorias de pacientes (ingresados y no), de todos los grupos de edad, de los cuatro hospitales que forman parte del sistema de vigilancia microbiológica (SVM), con datos del Conjunto Mínimo Básico de Datos de hospitalización por bronquiolitis causada por VRS u otro microorganismo infeccioso, en pacientes menores de 5 años ingresados en cualquier hospital público de Galicia (temporadas 2008/2009 a 2016/2017). Se consideró como periodo de onda epidémica cuando la positividad de detecciones de VRS en el total de muestras respiratorias del SVM superó el 10%. Se calculó la sensibilidad del SVM como el porcentaje de ingresos ocurridos en la onda epidémica. RESULTADOS: La sensibilidad del SVM fue del 92% (86-96%) para los ingresos por bronquiolitis por VRS en cada temporada y del 79% (75-84%) para los ingresos por bronquiolitis totales. CONCLUSIONES: El SVM del VRS, basado en información de solo cuatro hospitales, mostró muy buena sensibilidad para predecir el inicio y el final de la onda anual de VRS en toda la comunidad autónoma. Estos resultados respaldan la utilización de esta información para alertar a todo el sistema sanitario del inicio de la onda

OBJECTIVE: To describe whether the microbiological information of the respiratory syncytial virus (RSV), provided by four hospitals on a weekly basis, adequately captures the seasonality of the RSV in the entire community. METHOD: Retrospective descriptive study. We compared the detection of RSV in respiratory samples of patients (hospitalized and not) from all age groups, from the 4 hospitals that are part of the microbiological surveillance system (MSS), with data from the Minimum Basic Data Set of hospitalization for bronchiolitis by RSV or another infectious organism, in patients under 5 years of age, admitted to any public hospital in Galicia (seasons 2008/2009 to 2016/2017). An epidemic wave period was considered when the positivity of RSV detections in the total respiratory samples of the SVM exceeded 10%. The sensitivity of the MSS was calculated as a percentage of admissions occurring in the epidemic wave. RESULTS: MSS sensitivity was 92% (86%-96%) for RSV bronchiolitis admissions in each season and 79% (75%-84%) for total bronchiolitis admissions. CONCLUSIONS: The RSV microbiological surveillance system, based on data from only 4 hospitals, showed very good sensitivity to predict the start and end of the annual RSV wave throughout the Galician region. These results support the use of this information to alert the entire health system of the onset of the wave

De la vigilancia a la acción: modificando conductas terapéuticas en la infección gonocócica / From surveillance to action: Modifying therapeutic behaviours in gonococcal infections

OBJETIVOS: Evaluar la mejora en la prescripción del tratamiento ante una sospecha de infección gonocócica tras desarrollarse una intervención sanitaria específica; además, conocer la fracción de casos diagnosticados por cultivo y las resistencias antimicrobianas de las cepas de Neisseria gonorrhoeae que circulan en nuestra comunidad. Emplazamiento: Galicia, España. DISEÑO: Estudio antes-después de la adherencia al tratamiento recomendado para la infección gonocócica (ceftriaxona más azitromicina), tras una intervención de Salud Pública. PARTICIPANTES: Todos los médicos de atención primaria que identifican y tratan un caso de infección gonocócica. PERIODO DE ESTUDIO: Preintervención (2012-13) y postintervención (2014-17). INTERVENCIONES: Se facilitó el acceso en atención primaria al tratamiento recomendado (ceftriaxona y azitromicina) y se difundió toda la información a los médicos de atención primaria y microbiólogos a través de la publicación Venres Epidemiolóxico. Mediciones principales: Las variables a estudio fueron: año, tratamiento prescrito, realización de cultivo, sensibilidad a antibióticos. Se calcularon los porcentajes para cada una de ellas. RESULTADOS: El tratamiento recomendado se empleó en un 3% en 2012-2013, aumentando, después de las intervenciones, a un 58% de media. La frecuencia de cultivo se mantuvo relativamente constante después de las intervenciones. La sensibilidad a otros antibióticos mejoró al disminuir su uso. CONCLUSIONES: Las intervenciones realizadas supusieron una mejora en la adherencia al tratamiento recomendado para la infección gonocócica en Galicia

OBJECTIVES: To evaluate improvements in the prescriptions for gonococcal infection after developing a specific public health intervention. Furthermore, to ascertain the proportion of cases diagnosed by culture and current antimicrobial resistance. LOCATION: Galicia, Spain. DESIGN: Before-after study of adherence to the recommended treatment for gonococcal infection (ceftriaxone + azithromycin) after a Public Health intervention. PARTICIPANTS: All Primary Care physicians who had identified and treated a case of gonococcal infection. Study period: Preintervention (2012-13) and postintervention (2014-17). INTERVENTIONS: Access to the recommended treatment (ceftriaxone and azithromycin) was provided in Primary Care and all the information was disseminated to Primary Care physicians and microbiologists through the publication Venres Epidemiolóxico. MAIN MEASUREMENTS: The study variables were year, prescribed treatment, performing of culture, antibiotic susceptibility testing. The percentages for each of them were calculated. RESULTS: The recommended treatment was used in 3% in 2012-2013, and after the interventions it increased to a mean of 58%. The frequency of culture remained relatively constant after the interventions. Sensitivity to other antibiotics improved as their use decreased. CONCLUSIONS: The interventions carried out implied an improvement in the adherence to the recommended treatment for gonococcal infection in Galicia

[Usefulness of the microbiological surveillance of respiratory syncytial virus in Galicia (Spain): 2008-2017]. / Utilidad de la vigilancia microbiológica del virus respiratorio sincitial en Galicia (España): 2008-2017.

OBJECTIVE: To describe whether the microbiological information of the respiratory syncytial virus (RSV), provided by four hospitals on a weekly basis, adequately captures the seasonality of the RSV in the entire community. METHOD: Retrospective descriptive study. We compared the detection of RSV in respiratory samples of patients (hospitalized and not) from all age groups, from the 4 hospitals that are part of the microbiological surveillance system (MSS), with data from the Minimum Basic Data Set of hospitalization for bronchiolitis by RSV or another infectious organism, in patients under 5 years of age, admitted to any public hospital in Galicia (seasons 2008/2009 to 2016/2017). An epidemic wave period was considered when the positivity of RSV detections in the total respiratory samples of the SVM exceeded 10%. The sensitivity of the MSS was calculated as a percentage of admissions occurring in the epidemic wave. RESULTS: MSS sensitivity was 92% (86%-96%) for RSV bronchiolitis admissions in each season and 79% (75%-84%) for total bronchiolitis admissions. CONCLUSIONS: The RSV microbiological surveillance system, based on data from only 4 hospitals, showed very good sensitivity to predict the start and end of the annual RSV wave throughout the Galician region. These results support the use of this information to alert the entire health system of the onset of the wave.

[From surveillance to action: Modifying therapeutic behaviours in gonococcal infections]. / De la vigilancia a la acción: modificando conductas terapéuticas en la infección gonocócica.

OBJECTIVES: To evaluate improvements in the prescriptions for gonococcal infection after developing a specific public health intervention. Furthermore, to ascertain the proportion of cases diagnosed by culture and current antimicrobial resistance. LOCATION: Galicia, Spain. DESIGN: Before-after study of adherence to the recommended treatment for gonococcal infection (ceftriaxone + azithromycin) after a Public Health intervention. PARTICIPANTS: All Primary Care physicians who had identified and treated a case of gonococcal infection. STUDY PERIOD: Preintervention (2012-13) and postintervention (2014-17). INTERVENTIONS: Access to the recommended treatment (ceftriaxone and azithromycin) was provided in Primary Care and all the information was disseminated to Primary Care physicians and microbiologists through the publication Venres Epidemiolóxico. MAIN MEASUREMENTS: The study variables were year, prescribed treatment, performing of culture, antibiotic susceptibility testing. The percentages for each of them were calculated. RESULTS: The recommended treatment was used in 3% in 2012-2013, and after the interventions it increased to a mean of 58%. The frequency of culture remained relatively constant after the interventions. Sensitivity to other antibiotics improved as their use decreased. CONCLUSIONS: The interventions carried out implied an improvement in the adherence to the recommended treatment for gonococcal infection in Galicia.

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

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

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

Direct, indirect and total effectiveness of bivalent HPV vaccine in women in Galicia, Spain.

Bivalent human papillomavirus (HPV) vaccine was incorporated into the childhood vaccination calendar in Galicia, Spain in 2008. The objectives of this study were to estimate direct, indirect and total effectiveness of HPV vaccine and to identify sexual habits changes in the post-vaccination period in Galicia, Spain.Endocervical scrapings of 745 women attending 7 Health Areas of the Galician Public Health Service were collected in the post-vaccination period, from 2014-2017. Two groups were studied: women born between 1989 and 1993 (n = 397) and women born in 1994 or later (n = 348). Twelve high-risk human papillomavirus (HR-HPV) genotypes were detected by Cobas® 4800 HPV test (Roche Diagnostics, Mannheim, Germany). The Linear Array® HPV Genotyping Test (Roche Diagnostics) was used for HR-HPV genotype detection other than HPV 16/18. Information about sexual habits was collected by a self-filled questionnaire. Post-vaccination data were compared to previously published pre-vaccination data obtained between 2008 and 2010 in Galicia from women of the same age (18-26 years old, n = 523). The Stata 14.2 software was employed for statistical analyses.Data from 392 unvaccinated and 353 vaccinated women were compared. For unvaccinated and vaccinated women, HPV 16/18 prevalence was 9.2% and 0.8%, respectively, and HPV 31/33/45 prevalence was 8.4% and 1.1%, respectively. Direct, indirect and total effectiveness of the HPV vaccine were (%, 95% CI): 94 (72-99), 30 (-11-56) and 95 (79-99), respectively, for HPV 16/18 and 83 (46-94), -10 (-88-33) and 84 (54-94), respectively, for HPV 31/33/45. The number of women with first intercourse before 17 years old and 3 or more sexual partners along life was higher in the post-vaccination period (p < 0.05). A positive impact of bivalent HPV vaccine was observed, both on direct and cross protection. Sexual habits could have changed in the post-vaccination period.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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