Estudio y manejo de casos y contactos en el ámbito escolar, análisis del impacto de las medidas aplicadas al alumnado / Study and management of cases and contacts in the school environment, analysis of the impact of measures applied to students

Fundamento: Desde septiembre de 2020, los centros escolares permanecieron abiertos bajomedidas de prevención de la infección por COVID-19 y una estrecha vigilancia y control porparte de Salud Pública. Métodos: Se describió la organización y el procedimiento de rastreo escolar durante la pande-mia de COVID-19 en Navarra. Se estudió el alumnado rastreado, cuarentenas escolares, trans-misión en el aula, e impacto en la actividad educativa. Resultados: El rastreo fue desarrollado por el Departamento de Salud en coordinación con elDepartamento de Educación. Durante el curso 2020/21, la incidencia en escolares fue similar oinferior a la población general y las ondas epidémicas no mostraron relación con los periodoslectivos. El 26% del alumnado, mayormente de educación infantil y primaria, estuvo en cuaren-tena. La tasa de ataque secundaria (TAS) en las aulas fue inferior al 5%. En el curso 2021/22, laincidencia aumentó con la entrada de la variante Ómicron. Se indicó cuarentena en el 17% delalumnado de infantil y primaria durante el primer trimestre, y en el 11% durante el segundo. LaTAS ascendió al 18% en el primer trimestre, y la transmisión alcanzó niveles muy altos en el se-gundo, con grandes brotes. Las cuarentenas tuvieron un gran impacto en la actividad lectiva. Conclusiones: La gestión de casos y contactos en el ámbito escolar resultó de suma importan-cia para mantener un balance equilibrado entre la seguridad y el control de la pandemia en lasaulas, y asegurar las garantías pedagógicas y el bienestar de la infancia.(AU)

Hospitalizaciones por infarto agudo de miocardio e ictus durante el periodo de estado de alarma por la pandemia COVID-19 / Hospitalizations for acute heart attack myocardium and stroke during the period of state of alarm for the COVID-19 pandemic

Fundamento: Valorar los cambios en las hospitalizaciones por ictus e infarto agudo de miocardio entre el período de alarma por la pandemia de COVID-19 y un período equivalente de los tres años previos en Navarra, España. Métodos. Estudio descriptivo con datos del Registro Poblacional de Infarto de Miocardio y del Conjunto Mínimo Básico de Datos (CMBD) de los hospitales. Resultados. Las hospitalizaciones por infarto de miocardio e ictus descendieron un 21% y 19%, respectivamente, durante el periodo de alarma. En los pacientes hospitalizados por infarto de miocardio con elevación del segmento ST se observó un aumento no estadísticamente significativo en la mediana (rango intercuartílico) de tiempo entre el inicio de los síntomas y la búsqueda de atención médica: 80 [30-300] minutos en 2017-2019 vs 98 [34-435] minutos durante el confinamiento. La proporción de pacientes con infarto con elevación del segmento ST en los que se realizó reperfusión primaria no mostró cambios estadísticamente significativos en el período de estado de alarma (79,7%) en comparación a los tres años previos (73,4%), ni tampoco el intervencionismo coronario percutáneo al alta (83,4 vs 80,1%). No se encontraron diferencias significativas en la mortalidad a los 30 días en los pacientes ingresados por ictus e infarto de miocardio respecto a los tres años previos.Conclusiones. Durante la primera onda COVID-19 en Navarra y las medidas que se siguieron para afrontar la emergencia sanitaria (declaración del estado de alarma) se observó un descenso importante en las hospitalizaciones por ictus e infarto de miocardio en comparación con los tres años previos. La mortalidad a los 30 días fue similar a la registrada previamente y tampoco se registraron cambios en la estrategia de reperfusión en el infarto de miocardio.(AU)

Mortalidad en los dos primeros años de la pandemia de COVID-19 en Navarra / Mortality in the first two years of the COVID-19 pandemic in Navarra

Fundamento: El objetivo del estudio es evaluar el impacto de la pandemia de COVID-19 en lamortalidad de Navarra en 2020-2021. Método: Se han utilizado las bases de datos de causas de muerte por edad y sexo del Instituto Nacional de Estadística y, como indicadores del impacto, se calcularon la esperanza de vida al nacer y tasas de mortalidad ajustadas por edad (globales y estratificadas por edad y sexo). Resultados: En 2019, año previo a la pandemia de COVID-19, el descenso de la tasa de mortalidad estandarizada respecto a 2018 fue mayor que el registrado en los años anteriores, -9,3% (IC95%: -14,1%; -4,3%) en hombres y -3,4% (IC95%: -8,3%; +1,9%) en mujeres. Durante los dos primeros años de la pandemia, 2020-2021, la mortalidad aumentó +5,3% (IC95%: +1,4%; +9,2%) en hombres y +3,9% (IC95%: +0,2%; +7,8%) en mujeres en comparación con 2018-2019 y no mostró cambios respecto a 2016-2017 (-0,5 %, IC95%: -4,1%; +3,1% en hombres y -0,3%, IC95%: -3,9%; +3,4% en mujeres). Los hombres mayores de 74 años presentaron el mayor exceso de mortalidad mientras que en los menores de 50 años la mortalidad se mantuvo estable. La esperanza de vida previa a la pandemia se recuperó en 2021. Conclusión: El aumento de las tasas mortalidad en los hombres y mujeres mayores de 50 años en 2020 situó la mortalidad del bienio 2020-2021 en los niveles de mortalidad de 2016-2017.(AU)

[Excess of mortality and mortality from COVID-19 and other causes of death in 2020 in Navarra, Spain].

BACKGROUND: In this study, we aimed to present mortality indicators from a database of death causes by age and sex in Navarre (Spain) for 2020: life expectancy at birth, excess mortality, and mortality from COVID-19 and other causes. METHODS: A Poisson regression model, which accounts for temporal trends in the previous years, was used to estimate the expected deaths by sex and age for 2020. RESULTS: Life expectancy at birth in Navarre for 2020 was 80.6 and 85.9 years for men and women, respectively, 1.4 and 1.0 years lower than in 2019. Deaths in people aged <55 years were similar to those expected. The highest adjusted excess mortality rate occurred among men and women aged >85 years, were 61% of excess deaths was concentrated. The estimated number of excess deaths did not exceed the number of reported deaths from COVID-19. In individuals aged >75 years, around 9 out of 10 people died from COVID-19. Coinciding with the COVID-19 pandemic, there was a remarkable decrease in mortality in people affected by diseases where dementia is included. CONCLUSIONS: The first and second waves of the COVID-19 pandemic reduced life expectancy at birth to figures observed ten years ago. The increase in deaths in Navarre for 2020 is largely attributable to COVID-19.

Exceso de mortalidad, mortalidad por COVID-19 y por otras causasen el año 2020 en Navarra, España / Excess of mortality and mortality from COVID-19 and other causes of death in 2020 in Navarra, Spain

Fundamento: El objetivo del estudio fue presentar varios indicadores de mortalidad obtenidos de la base de datos de causas de muerte por edad y sexo de Navarra en 2020: esperanza de vida al nacer, exceso de mortalidad y mortalidad por COVID-19 y por otras causas de muerte. Material y métodos: Se utilizó un modelo de regresión de Poisson que tiene en cuenta las tendencias temporales en los años previos para estimar las muertes esperadas por sexo y edad en 2020. Resultados: La esperanza de vida al nacer en 2020 fue de 80,6 años en los hombres y 85,9 años en las mujeres, 1,4 y 1,0 años más baja, respectivamente, que en 2019. No se observó un exceso de mortalidad por debajo de los 55 años. Las tasas ajustadas de exceso de mortalidad más altas se registraron en los hombres y mujeres de 85 y más años entre los que se concentraron el 61% del exceso de muertes. Los fallecimientos por COVID-19 superaron el número de exceso de muertes estimado. Los mayores de 75 años fueron el subgrupo de población donde se produjeron aproximadamente 9 de cada 10 muertes por COVID-19. Coincidiendo con la pandemia de COVID-19 se produjo un llamativo descenso de las tasas de mortalidad por el grupo de enfermedades donde está incluida la demencia. Conclusión: La primera y segunda ondas de la pandemia de COVID-19 redujeron la esperanza de vida al nacer a las cifras observadas diez años atrás. El incremento de fallecimientos en 2020 en Navarra es en gran parte atribuible a COVID-19.(AU)

Background: In this study, we aimed to present mortality indicators from a database of death causes by age and sex in Navarre (Spain) for 2020: life expectancy at birth, excess mortality, and mortality from COVID-19 and other causes. Methods. A Poisson regression model, which accounts for temporal trends in the previous years, was used to estimate the expected deaths by sex and age for 2020. Results: Life expectancy at birth in Navarre for 2020 was 80.6 and 85.9 years for men and women, respectively, 1.4 and 1.0 years lower than in 2019. Deaths in people aged <55 years were similar to those expected. The highest adjusted excess mortality rate occurred among men and women aged ≥85 years, were 61% of excess deaths was concentrated. The estimated number of excess deaths did not exceed the number of reported deaths from COVID-19. In individuals aged >75 years, around 9 out of 10 people died from COVID-19. Coinciding with the COVID-19 pandemic, there was a remarkable decrease in mortality in people affected by diseases where dementia is included. Conclusions: The first and second waves of the COVID-19 pandemic reduced life expectancy at birth to figures observed ten years ago. The increase in deaths in Navarre for 2020 is largely attributable to COVID-19.(AU)

Bisphenol-A exposure and risk of breast and prostate cancer in the Spanish European Prospective Investigation into Cancer and Nutrition study.

BACKGROUND: Bisphenol A (BPA) is an endocrine disruptor that it is present in numerous products of daily use. The aim of this study was to assess the potential association of serum BPA concentrations and the risk of incident breast and prostate cancer in a sub-cohort of the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: We designed a case-cohort study within the EPIC-Spain cohort. Study population consisted on 4812 participants from 4 EPIC-Spain centers (547 breast cancer cases, 575 prostate cancer cases and 3690 sub-cohort participants). BPA exposure was assessed by means of chemical analyses of serum samples collected at recruitment. Borgan II weighted Cox regression was used to estimate hazard ratios. RESULTS: Median follow-up time in our study was 16.9 years. BPA geometric mean serum values of cases and sub-cohort were 1.12 ng/ml vs 1.10 ng/ml respectively for breast cancer and 1.33 ng/ml vs 1.29 ng/ml respectively for prostate cancer. When categorizing BPA into tertiles, a 40% increase in risk of prostate cancer for tertile 1 (p = 0.022), 37% increase for tertile 2 (p = 0.034) and 31% increase for tertile 3 (p = 0.072) was observed with respect to values bellow the limit of detection. No significant association was observed between BPA levels and breast cancer risk. CONCLUSIONS: We found a similar percentage of detection of BPA among cases and sub-cohort from our population, and no association with breast cancer risk was observed. However, we found a higher risk of prostate cancer for the increase in serum BPA levels. Further investigation is needed to understand the influence of BPA in prostate cancer risk.

Inverse-probability weighting and multiple imputation for evaluating selection bias in the estimation of childhood obesity prevalence using data from electronic health records.

BACKGROUND AND OBJECTIVES: Height and weight data from electronic health records are increasingly being used to estimate the prevalence of childhood obesity. Here, we aim to assess the selection bias due to missing weight and height data from electronic health records in children older than five. METHODS: Cohort study of 10,811 children born in Navarra (Spain) between 2002 and 2003, who were still living in this region by December 2016. We examined the differences between measured and non-measured children older than 5 years considering weight-associated variables (sex, rural or urban residence, family income and weight status at 2-5 yrs). These variables were used to calculate stabilized weights for inverse-probability weighting and to conduct multiple imputation for the missing data. We calculated complete data prevalence and adjusted prevalence considering the missing data using inverse-probability weighting and multiple imputation for ages 6 to 14 and group ages 6 to 9 and 10 to 14. RESULTS: For 6-9 years, complete data, inverse-probability weighting and multiple imputation obesity age-adjusted prevalence were 13.18% (95% CI: 12.54-13.85), 13.22% (95% CI: 12.57-13.89) and 13.02% (95% CI: 12.38-13.66) and for 10-14 years 8.61% (95% CI: 8.06-9.18), 8.62% (95% CI: 8.06-9.20) and 8.24% (95% CI: 7.70-8.78), respectively. CONCLUSIONS: Ages at which well-child visits are scheduled and for the 6 to 9 and 10 to 14 age groups, weight status estimations are similar using complete data, multiple imputation and inverse-probability weighting. Readily available electronic health record data may be a tool to monitor the weight status in children.

Epidemiological study and genetic characterization of inherited muscle diseases in a northern Spanish region.

BACKGROUND: Inherited muscle diseases are a group of rare heterogeneous muscle conditions with great impact on quality of life, for which variable prevalence has previously been reported, probably due to case selection bias. The aim of this study is to estimate the overall and selective prevalence rates of inherited muscle diseases in a northern Spanish region and to describe their demographic and genetic features. Retrospective identification of patients with inherited muscle diseases between 2000 and 2015 from multiple data sources. Demographic and molecular data were registered. RESULTS: On January 1, 2016, the overall prevalence of inherited muscle diseases was 59.00/ 100,000 inhabitants (CI 95%; 53.35-65.26). Prevalence was significantly greater in men (67.33/100,000) in comparison to women (50.80/100,000) (p = 0.006). The highest value was seen in the age range between 45 and 54 (91.32/100,000) years. Myotonic dystrophy type 1 was the most common condition (35.90/100,000), followed by facioscapulohumeral muscular dystrophy (5.15/100,000) and limb-girdle muscular dystrophy type 2A (2.5/100,000). CONCLUSIONS: Prevalence of inherited muscle diseases in Navarre is high in comparison with the data reported for other geographical regions. Standard procedures and analyses of multiple data sources are needed for epidemiological studies of this heterogeneous group of diseases.

Residential proximity to green spaces and breast cancer risk: The multicase-control study in Spain (MCC-Spain).

BACKGROUND: Breast cancer is the main cause of cancer mortality among women. Green spaces have been recently associated with reduced cancer mortality among women. Mechanisms explaining the beneficial effect of green spaces include increased levels of physical activity and reduced exposure to air pollution, which have been both associated with cancer development. OBJECTIVES: To investigate the associations between presence of urban green areas, presence of agricultural areas and surrounding greenness and risk of breast cancer, and to assess whether these associations are mediated by physical activity and/or air pollution levels. METHODS: We geocoded the current residence of 1129 breast cancer cases and 1619 controls recruited between 2008 and 2013 in ten provinces of Spain, as part of the MCC-Spain study. We assigned different indicators of exposure to green spaces in a buffer of 300 m, and in nested buffers of 100 m and 500 m around the residence: presence of urban green areas according to Urban Atlas, presence of agricultural areas according to CORINE Land Cover 2006, and surrounding greenness according to the average of the Normalized Difference Vegetation Index. We used logistic mixed-effects regression models with a random effect for hospital adjusting for potential confounders. We explored the effect of several potential effect modifiers. We assessed mediation effect by physical activity and levels of air pollution. RESULTS: Presence of urban green areas was associated with reduced risk of breast cancer after adjusting for age, socio-economic status at individual and at area level, education, and number of children [OR (95%CI) = 0.65 (0.49-0.86)]. There was evidence of a linear trend between distance to urban green areas and risk of breast cancer. On the contrary, presence of agricultural areas and surrounding greenness were associated with increased risk of breast cancer [adjusted OR (95%CI) = 1.33 (1.07-1.65) and adjusted OR (95%CI) = 1.27 (0.92-1.77), respectively]. None of the associations observed were mediated by levels of physical activity or levels or air pollution. CONCLUSIONS: The association between green spaces and risk of breast cancer is dependent on land-use. The confirmation of these results in other settings and the study of potential mechanisms for the associations observed are needed to advance the understanding on the potential effects of green spaces on health.

Comparison of influenza vaccine effectiveness in preventing outpatient and inpatient influenza cases in older adults, northern Spain, 2010/11 to 2015/16.

IntroductionWe compared trivalent inactivated influenza vaccine effectiveness (VE) in preventing outpatient and inpatient influenza cases in Navarre, Spain. Methods: During seasons 2010/11 to 2015/16, community-dwelling patients with influenza-like illness aged 50 years or older were tested for influenza when attended by sentinel general practitioners or admitted to hospitals. The test-negative design was used to estimate and compare the VE by healthcare setting. Results: We compared 1,242 laboratory-confirmed influenza cases (557 outpatient and 685 inpatient cases) and 1,641 test-negative controls. Influenza VE was 34% (95% confidence interval (CI): 6 to 54) in outpatients and 32% (95% CI: 15 to 45) in inpatients. VE in outpatients and inpatients was, respectively, 41% (95% CI: -1 to 65) and 36% (95% CI: 12 to 53) against A(H1N1)pdm09, 5% (95% CI: -58 to 43) and 22% (95% CI: -9 to 44) against A(H3N2), and 49% (95% CI, 6 to 73) and 37% (95% CI: 2 to 59) against influenza B. Trivalent inactivated influenza vaccine was not associated with a different probability of hospitalisation among influenza cases, apart from a 54% (95% CI: 10 to 76) reduction in hospitalisation of influenza A(H3N2) cases. Conclusions: On average, influenza VE was moderate and similar in preventing outpatient and inpatient influenza cases over six influenza seasons in patients above 50 years of age. In some instances of low VE, vaccination may still reduce the risk of hospitalisation in older adults with vaccine failure.

[Divergent Trends in Suicide Mortality in Navarra and Spain: 2000-2015]. / Tendencia divergente en las tasas de mortalidad por suicidio de Navarra y España durante el período 2000-2015.

BACKGROUND: The aim of this study was to know the suicide mortality rates in Navarra and Spain and to compare their time trends during the period 2000-2015. METHODS: Suicide data were obtained from the Instituto Nacional de Estadística [INE], Spain's National Statistics Institute. During all the period, the coding of cause of death in Navarra was carried out using data from forensic autopsies, while in some Spanish regions this process started after 2010. A Joinpoint time series regression model was used to assess the time trend and estimate the annual percent change [APC] of the rates by sex and 4 age groups. RESULTS: Suicide mortality in Spain showed a significant downward trend in the overall rate between 2000-2011 [APC of -1.93% in males and -2.19% in females] followed by a significant increase in 2012-2015 [APC: 3.65% in men and 7.60% in women]. No inflection points were observed in men aged 25-44 [APC:1.26%], 45-64 [APC: 1.63%], and women over 65 years [APC:-2.18%]. In Navarra, global rates in men showed a non significant decrease [APC:-1.56%] and a significant decrease in the group of men between 25-44 years [APC:-3.19%]. Among women we observed a non significant increase [APC: 0.74%]. CONCLUSIONS: The rise in overall suicide rates observed in Spain since 2011, that was not observed in Navarre, could be influenced by the improvements in coding methods in several Spanish regions. However, this could not explain the decrease observed during the all period in men aged 25-44, that was even larger in Navarra.

OBJETIVO: El suicidio es un importante problema de salud pública.El objetivo del estudio fue conocer las tasas de mortalidad por suicidio en Navarra y comparar su tendencia en Navarra y España durante el periodo 2000-2015. METODOS: Los datos procedieron de los ficheros de defunciones del Instituto Nacional de Estadística. En todo el periodo la codificación de la causa de muerte se realizó en Navarra con información de las autopsias judiciales mientras que en algunas comunidades autónomas este procedimiento se inició después de 2010. Se utilizó un modelo de regresión joinpoint de series temporales para evaluar los puntos de inflexión y el porcentaje anual de cambio (PAC) de las tasas globales por sexo y cuatro grupos de edad. RESULTADOS: En España las tasas globales de suicidio presentaron una tendencia descendente significativa entre los años 2000 y 2011 (PAC:-1,93% en hombres y -2,19% en mujeres) que se siguió de un aumento significativo en 2012-2015 (PAC:3,65% en hombres y 7,60% en mujeres). No se observaron puntos de inflexión en los hombres de 25 a 44 (PAC:-1,26%) y de 45 a 64 (PAC:1,63%) ni en las mujeres mayores de 65 años (PAC:-2,18%). En Navarra las tasas globales en hombres presentaron un descenso no significativo anual de -1,56% y disminuyeron significativamente en los hombres de 25 a 44 años a un ritmo de -3,19%. Entre las mujeres se observó un aumento no significativo anual de 0,74%. CONCLUSIONES: El incremento de las tasas globales de suicidio observado a partir de 2011 en España, que no se observó en Navarra, podría estar influido por los procesos de mejora de la codificación iniciados en algunas comunidades autónomas. No así el descenso observado entre los hombres de 25-44 años que con una magnitud todavía mayor, también se observó en Navarra.

Effect of Repeated Vaccination With the Same Vaccine Component Against 2009 Pandemic Influenza A(H1N1) Virus.

Background: The 2009 pandemic influenza A(H1N1) (A[H1N1]pdm09) vaccine component has remained unchanged from 2009. We estimate the effectiveness of current and prior inactivated influenza A(H1N1)pdm09 vaccination from influenza seasons 2010-2011 to 2015-2016. Methods: Patients attended with influenza-like illness were tested for influenza. Four periods with continued A(H1N1)pdm09 circulation were included in a test-negative design. Results: We enrolled 1278 cases and 2343 controls. As compared to individuals never vaccinated against influenza A(H1N1)pdm09, the highest effectiveness (66%; 95% confidence interval, 49%-78%) was observed in those vaccinated in the current season who had received 1-2 prior doses. The effectiveness was not statistically lower in individuals vaccinated in the current season only (52%) or in those without current vaccination and >2 prior doses (47%). However, the protection was lower in individuals vaccinated in the current season after >2 prior doses (38%; P = .009) or those currently unvaccinated with 1-2 prior doses (10%; P < .001). Current-season vaccination improved the effect in individuals with 1-2 prior doses and did not modify significantly the risk of influenza in individuals with >2 prior doses. Conclusion: Current vaccination or several prior doses were needed for high protection. Despite the decreasing effect of repeated vaccination, current-season vaccination was not inferior to no current-season vaccination.

Validity of type 2 diabetes diagnosis in a population-based electronic health record database.

BACKGROUND: The increasing burden of type 2 diabetes mellitus makes the continuous surveillance of its prevalence and incidence advisable. Electronic health records (EHRs) have great potential for research and surveillance purposes; however the quality of their data must first be evaluated for fitness for use. The aim of this study was to assess the validity of type 2 diabetes diagnosis in a primary care EHR database covering more than half a million inhabitants, 97% of the population in Navarra, Spain. METHODS: In the Navarra EPIC-InterAct study, the validity of the T90 code from the International Classification of Primary Care, Second Edition was studied in a primary care EHR database to identify incident cases of type 2 diabetes, using a multi-source approach as the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and the kappa index were calculated. Additionally, type 2 diabetes prevalence from the EHR database was compared with estimations from a health survey. RESULTS: The sensitivity, specificity, positive predictive value and negative predictive value of incident type 2 diabetes recorded in the EHRs were 98.2, 99.3, 92.2 and 99.8%, respectively, and the kappa index was 0.946. Overall prevalence of type 2 diabetes diagnosed in the EHRs among adults (35-84 years of age) was 7.2% (95% confidence interval [CI] 7.2-7.3) in men and 5.9% (95% CI 5.8-5.9) in women, which was similar to the prevalence estimated from the health survey: 8.5% (95% CI 7.1-9.8) and 5.5% (95% CI 4.4-6.6) in men and women, respectively. CONCLUSIONS: The high sensitivity and specificity of type 2 diabetes diagnosis found in the primary care EHRs make this database a good source for population-based surveillance of incident and prevalent type 2 diabetes, as well as for monitoring quality of care and health outcomes in diabetic patients.

Tendencia divergente de la mortalidad por suicidio en Navarra y España durante el período 2000-2015 / Divergent trends in suicide mortality in Navarra and Spain: 2000-2015

Fundamentos: El suicidio es un importante problema de salud pública. El objetivo del estudio fue caracterizar el suicidio en Navarra y comparar la tendencia de las tasas en Navarra y España en el periodo 2000-2015. Métodos: Los datos procedieron de los ficheros de defunciones del Instituto Nacional de Estadística. En todo el periodo la codificación de la causa de muerte en Navarra se realizó con información de las autopsias judiciales mientras que en algunas comunidades autónomas este procedimiento se inició después de 2010. Se utilizó un modelo de regresión joinpoint de series temporales para evaluar los puntos de inflexión y el porcentaje anual de cambio (PAC) de las tasas globales por sexo y cuatro grupos de edad. Resultados: En España las tasas globales de suicidio presentaron una tendencia descendente significativa entre los años 2000 y 2011 (PAC:-1,93% en hombres y -2,19% en mujeres) que se siguió de un aumento significativo en 2012-2015 (PAC:3,65% en hombres y 7,60% en mujeres). No se observaron puntos de inflexión en los hombres de 25 a 44 (PAC:-1,26%) y de 45 a 64 (PAC:1,63%) ni en las mujeres mayores de 65 años (PAC:-2,18%). En Navarra las tasas globales en hombres presentaron un descenso no estadísticamente significativo anual de -1,56% y disminuyeron significativamente en los hombres de 25 a 44 años a un ritmo de -3,19%. Entre las mujeres se observó un aumento no significativo anual de 0,74%. Conclusiones. El incremento de las tasas globales de suicidio observado a partir de 2011 en España, que no se observó en Navarra, podría deberse a los procesos de mejora de la codificación iniciados. No así el descenso observado entre los hombres de 25-44 años que con una magnitud todavía mayor, también se observó en Navarra (AU)

Background: The aim of this study was to know the suicide mortality rates in Navarra and Spain and to compare their time trends during the period 2000-2015. Methods: Suicide data were obtained from the Instituto Nacional de Estadística [INE], Spain’s National Statistics Institute. During all the period, the coding of cause of death in Navarra was carried out using data from forensic autopsies, while in some Spanish regions this process started after 2010. A Joinpoint time series regression model was used to assess the time trend and estimate the annual percent change [APC] of the rates by sex and 4 age groups. Results. Suicide mortality in Spain showed a significant downward trend in the overall rate between 2000-2011 [APC of -1.93% in males and -2.19% in females] followed by a significant increase in 2012-2015 [APC: 3.65% in men and 7.60% in women]. No inflection points were observed in men aged 25-44 [APC:1.26%], 45-64 [APC: 1.63%], and women over 65 years [APC:-2.18%]. In Navarra, global rates in men showed a non significant decrease [APC:-1.56%] and a significant decrease in the group of men between 25-44 years [APC:-3.19%]. Among women we observed a non significant increase [APC: 0.74%]. Conclusions. The rise in overall suicide rates observed in Spain since 2011, that was not observed in Navarre, could be influenced by the improvements in coding methods in several Spanish regions. However, this could not explain the decrease observed during the all period in men aged 25-44, that was even larger in Navarra (AU)

Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study.

PURPOSE: There is a debate on the role of adjuvant Radiotherapy (RT) in elderly breast cancer patients. The aim is to study Quality of Life (QL) throughout the treatment and follow-up periods in early stages breast cancer patients who have started radiotherapy, and to compare the QL of axillary surgery groups. METHODS: 173 patients, ≥65 years completed the EORTC QLQ-C30 and QLQ-BR23, and the Interview for Deterioration in Daily Living Activities in Dementia(IDDD) questionnaires three times throughout treatment and follow-up periods. Linear mixed effect models were used to evaluate longitudinal changes in QL, and whether these changes differed among axillary surgery groups. RESULTS: QL scores were high (>70/100 points) in most QL areas, with moderate limitations (>30) in sexual functioning and enjoyment, future perspective and global QL. In six areas there was a decline at the RT sessions end, that after 6 weeks was recovered. For three areas, there was an improvement in the follow-up measurement compared to the previous assessments. Changes in seven areas were <5 points. Axillary node dissection patients had a body image decrease (6 points) in the follow up period. The lymphadenectomy group had more fatigue (10 points, p = 0.078) than the other two axillary surgery groups. CONCLUSIONS: Results orientate towards good patients' adaptation to their disease and treatments, and to administering RT in early stages breast cancer patients. QL differences between the axillary surgery groups and in their evolutions were few but have appeared in key QL areas.

Enhanced Estimates of the Influenza Vaccination Effect in Preventing Mortality: A Prospective Cohort Study.

Mortality is a major end-point in the evaluation of influenza vaccine effectiveness. However, this effect is not well known, since most previous studies failed to show good control of biases. We aimed to estimate the effectiveness of influenza vaccination in preventing all-cause mortality in community-dwelling seniors.Since 2009, a population-based cohort study using healthcare databases has been conducted in Navarra, Spain. In 2 late influenza seasons, 2011/2012 and 2012/2013, all-cause mortality in the period January to May was compared between seniors (65 years or over) who received the trivalent influenza vaccine and those who were unvaccinated, adjusting for demographics, major chronic conditions, dependence, previous hospitalization, and pneumococcal vaccination.The cohort included 103,156 seniors in the 2011/2012 season and 105,140 in the 2012/2013 season (58% vaccinated). Seniors vaccinated in the previous season who discontinued vaccination (6% of the total) had excess mortality and were excluded to prevent frailty bias. The final analysis included 80,730 person-years and 2778 deaths. Vaccinated seniors had 16% less all-cause mortality than those unvaccinated (adjusted rate ratio [RR] = 0.84; 95% confidence interval 0.76-0.93). This association disappeared in the post-influenza period (adjusted RR = 0.96; 95% confidence interval 0.85-1.09). A similar comparison did not find an association in January to May of the 2009/2010 pandemic season (adjusted RR = 0.98; 95% confidence interval 0.84-1.14), when no effect of the seasonal vaccine was expected. On average, 1 death was prevented for every 328 seniors vaccinated: 1 for every 649 in the 65 to 74 year age group and 1 for every 251 among those aged 75 and over.These results suggest a moderate preventive effect and a high potential impact of the seasonal influenza vaccine against all-cause mortality. This reinforces the recommendation of annual influenza vaccination in seniors.

Exhautividad de la estadística de mortalidad de Navarra / Completeness of mortality statistics in Navarra, Spain

Fundamentos: La esperanza de vida al nacer de las mujeres de Navarra se encuentra entre las más altas de Europa. El objetivo del estudio es evaluar la exhaustividad de la estadística oficial de mortalidad de Navarra en 2009 y su impacto en la estimación de la esperanza de vida. Métodos: Se compara el número oficial de muertes del Instituto Nacional de Estadística (INE) con el obtenido mediante búsqueda en múltiples fuentes: historia clínica informatizada de atención especializada, Instituto Navarro deMedicina Legal e INE incluyendo defunciones recibidas con retraso. Resultados: Se contabilizaron 5.249 fallecimientos, de los cuales 103 no estaban incluidos en los datos oficiales del INE. Teniendo en cuenta únicamente las defunciones ocurridas en territorio español, que es a lo que hace referencia la estadística oficial de mortalidad, la exhaustividad fue del 98,4%. La esperanza de vida al nacer en el año 2009 descendió de de 86,6 a 86,4 años en las mujeres y de 80,0 a 79,6 años en los hombres tras corregir el subregistro. Conclusiones: Se descarta la existencia de un subregistro significativo en la estadística oficial de mortalidad y se confirma la elevada longevidad de las mujeres de Navarra que, con una esperanza de vida al nacer de 86,4 años, ocupan la primera posición en Europa (AU)

Background:Women in the region of Navarra, Spain, have one of the highest life expectancies at birth in Europe. The aim of this study is to assess the completeness of the official mortality statistics of Navarra in 2009 and the impact of the under-registration of deaths on life expectancy estimates. Methods: Comparison of the number of deaths in Navarra using the official statistics from the Instituto Nacional de Estadística (INE) and the data derived from a multiple- source case-finding: the electronic health record, Instituto Navarro de Medicina Legal and INE including data that they received late. Results: 5,249 deaths were identified, of which 103 were not included in the official mortality statistics. Taking into account only deaths that occurred in Spain, which are the only ones considered for the official statistics, the completeness was 98.4%. Estimated life expectancy at birth in 2009 descended from 86.6 years to 86.4 in women and from 80.0 to 79.6 years in men, after correcting for undercount. Conclusions: The results of this study ruled out the existence of significant under-registration of the official mortality statistics, confirming the exceptional longevity of women in Navarra, who are in the top position in Europe with a life expectancy at birth of 86.4 years (AU)

Programas de detección precoz de cáncer de mama en España: características y principales resultados / Breast cancer screening: characteristics and results of the Spanish programs

Fundamento y objetivo: Describir a nivel nacional y por Comunidades Autónomas (CCAA) indicadores de proceso y resultado de los programas de cribado de cáncer de mama españoles. Pacientes y método: Se describen los resultados globales y desagregados por CCAA correspondientes al período 2007-2008, de resultado (participación, tasa de detección de cáncer y características de los tumores detectados) y de proceso (pruebas adicionales y revisiones intermedias), clasificados por tipos de mujeres cribadas (iniciales y sucesivas regulares e irregulares) y por grupos de edad. Los resultados se comparan con los valores de referencia establecidos en la Guía Europea. Resultados: La cobertura del cribado de cáncer de mama es del 100% en el territorio nacional. La participación global fue del 69,68%, con una adherencia del 91,35%. Se realizaron pruebas adicionales de cualquier tipo en el 4,93% de mujeres y de carácter invasivo en un 0,66%. En el 3,56% se indicó una revisión intermedia. La tasa de detección fue del 3,49‰ (5,35‰ ajustada por edad). Un 14,29% de los tumores fueron intraductales. El 29,49% de los invasivos resultaron ≤ 1 cm y un 62,22% no presentaron afectación ganglionar axilar. Conclusiones: A pesar de evidenciarse la variabilidad en los datos aportados por las distintas CCAA, así como la necesidad de mejorar la homogeneidad de los sistemas de información, en su conjunto, los indicadores evaluados de los programas de cribado de cáncer de mama alcanzan los estándares especificados en las directrices europeas (AU)

Background and objective: To describe national and regional indicators of process and outcome of breast cancer screening programs in Spain. Patients and method: Overall results and broken down by regions are studied for the period 2007-2008. Outcome indicators (participation, cancer detection rate and characteristics of tumors detected) and process indicators (and intermediate mammograms), classified by types of women screened (initial and consequent regular and irregular) and age groups, are analyzed. Results are compared with reference values established in the European Guidelines. Results: Breast cancer screening coverage is 100% in the country. The overall participation was 69.68% with an adherence of 91.35%. Further assessments of any procedure were performed in 4.93% and invasive further assessments in 0.66%. Intermediate mammograms were indicated in 3.56%. The detection rate was 3.49‰ (5.35‰ age-adjusted); 14.29% of the tumors were intraductal. The 29.49% of the invasive tumors were ≤ 1 cm in diameter with 62.22% showing no axillary lymph node involvement. Conclusions: Despite the variability evident in the data provided by the different autonomous communities and the need to improve the homogeneity of information systems as a whole, the assessed indicators meet the standards specified in the European guidelines (AU)

[Completeness of mortality statistics in Navarra, Spain]. / Exhaustividad de la estadística de mortalidad de Navarra.

BACKGROUND: Women in the region of Navarra, Spain, have one of the highest life expectancies at birth in Europe. The aim of this study is to assess the completeness of the official mortality statistics of Navarra in 2009 and the impact of the under-registration of deaths on life expectancy estimates. METHODS: Comparison of the number of deaths in Navarra using the official statistics from the Instituto Nacional de Estadística (INE) and the data derived from a multiple-source case-finding: the electronic health record, Instituto Navarro de Medicina Legal and INE including data that they received late. RESULTS: 5,249 deaths were identified, of which 103 were not included in the official mortality statistics. Taking into account only deaths that occurred in Spain, which are the only ones considered for the official statistics, the completeness was 98.4%. Estimated life expectancy at birth in 2009 descended from 86.6 years to 86.4 in women and from 80.0 to 79.6 years in men, after correcting for undercount. CONCLUSIONS: The results of this study ruled out the existence of significant under-registration of the official mortality statistics, confirming the exceptional longevity of women in Navarra, who are in the top position in Europe with a life expectancy at birth of 86.4 years.

[Breast cancer screening: characteristics and results of the Spanish programs]. / Programas de detección precoz de cáncer de mama en España: características y principales resultados.

BACKGROUND AND OBJECTIVE: To describe national and regional indicators of process and outcome of breast cancer screening programs in Spain. PATIENTS AND METHOD: Overall results and broken down by regions are studied for the period 2007-2008. Outcome indicators (participation, cancer detection rate and characteristics of tumors detected) and process indicators (and intermediate mammograms), classified by types of women screened (initial and consequent regular and irregular) and age groups, are analyzed. Results are compared with reference values established in the European Guidelines. RESULTS: Breast cancer screening coverage is 100% in the country. The overall participation was 69.68% with an adherence of 91.35%. Further assessments of any procedure were performed in 4.93% and invasive further assessments in 0.66%. Intermediate mammograms were indicated in 3.56%. The detection rate was 3.49‰ (5.35‰ age-adjusted); 14.29% of the tumors were intraductal. The 29.49% of the invasive tumors were≤1cm in diameter with 62.22% showing no axillary lymph node involvement. CONCLUSIONS: Despite the variability evident in the data provided by the different autonomous communities and the need to improve the homogeneity of information systems as a whole, the assessed indicators meet the standards specified in the European guidelines.