Streptococcus pneumoniae Infection in Patients with Asplenia: A Spanish Perspective over a 25-Year Period.

Anatomical or functional asplenia constitutes a risk factor for Streptococcus pneumoniae (SP) infection, being more frequent in children and the elderly and in people with multiple comorbidities. We aimed to describe the impact of invasive pneumococcal disease (IPD) on the clinical features and outcomes of patients hospitalized for asplenia in Spain. Discharge reports from the Spanish Minimum Basic Data Set were used to retrospectively analyze hospital discharge data with a diagnosis of asplenia from 1997 to 2021. A total of 132,257 patients with asplenia (splenectomized/non-splenectomized) were identified from the Spanish database. Among the cases, 177 (37.5%) patients with splenectomy and 295 (62.5%) patients without splenectomy developed IPD. The clinical presentations (non-infection vs. infection) did not significantly differ between the two reference groups, except for patients with COPD, rheumatoid disease, AIDS, other neurological disorders, metastatic cancer, and drug abuse. The risk factors for IPD were also more frequently reported in patients without splenectomy (p < 0.001) and with comorbidities (p = 0.005). The study of patients with asplenia provides relevant information about the state of SP infection. This epidemiological tracking can serve to better understand the comorbidities that affect them, the risk factors for the disease, the prediction of antibiotic use, and vaccination in public health, among other factors.

Hospitalization burden related to herpes zoster infection during the COVID-19 pandemic in Spain (2020-2021).

Varicella-Zoster Virus (VZV) belongs to the family Herpesviridae. Herpes zoster (HZ) is caused by reactivation of latent VZV. It is associated with risk factors such as immunosenescence, immunosuppressive pathologies and pharmacological treatments. Patients with these risk factors are more likely to be hospitalized. Increases in HZ hospitalizations have been reported in many countries in recent years. The objective of this study is to estimate hospitalization rates, mortality rates and costs due to HZ during the worst years of the COVID-19 pandemic in Spain (2020-2021). This is a descriptive study based on an analysis of information from the Minimum Basic Dataset and coded according to the Spanish version of the 10th International Classification of Diseases (ICD-10-CM). Hospitalization, mortality and case-fatality rates, and median length of hospitalization were calculated.. The hospitalization rate was 14.4 cases per 100,000 inhabitants, and the mortality rate was 1.3 cases per 100,000 inhabitants. Both increased considerably with age. In this time period, 92.3% of the registered cases were people over 50 years of age. Nevertheless, during the COVID-19 pandemic period, hospitalization rate decreased and the mortality rate increased from previous years. HZ hospitalization and mortality rates are relevant issues in the public health of older people. It is highly recommended to evaluate new vaccination strategies against VZV to include the HZ vaccine for health care for elderly people, as well as to reduce the disease burden and associated risk factors. The estimation of HZ disease hospitalization costs were €100,433,904.

Legionellosis-Associated Hospitalization in Spain from 2002 to 2021.

Legionellosis is a respiratory disease of bacterial and environmental origin that usually presents two distinct clinical entities, "Legionnaires' disease" (LD) and "Pontiac fever". LD is an important cause of hospital-acquired pneumonia (HAP). The objective of this study is to describe the epidemiology of legionellosis-associated hospitalization (L-AH) in Spain from 2002 to 2021 and the burden of hospitalization due to legionellosis. Discharge reports from the Minimum Basic Data Set (MBDS) were used to retrospectively analyze hospital discharge data with a diagnosis of legionellosis, based on the ICD-9-CM and ICD-10-CM diagnosis codes, from 2002 to 2021. 21,300 L-AH occurred throughout the year during 2002-2021. The incidence of hospitalization associated per 100,000 inhabitants by month showed a similar trend for the 2002-2011, 2012-2021, and 2002-2021 periods. In Spain, during 2002-2021, the hospitalization rate (HR) in the autonomous communities ranged from 4.57 (2002-2011) to 0.24 (2012-2021) cases per 100,000 inhabitants. The HR of legionellosis in Spain has substantially increased across the 2002-2021 period, and the estimate is consistent with available European data. It is considered that in-depth epidemiological surveillance studies of legionellosis and improvements in the prevention and control of the disease are required in Spain.

Respiratory syncytial virus-associated hospitalization in children aged <2 years in Spain from 2018 to 2021.

Respiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in children. In many countries, changes in RSV hospitalizations have occurred during COVID-19 restriction, with alterations in annual pre-pandemic trends. The objective of this retrospective study was to describe the epidemiology of RSV during the pandemic in Spain (2018-2021) through population-based estimates of hospitalization in children <2 years old. A total of 56,741 hospital discharges were identified with a 2.2% decrease between the beginning and the end of the COVID-19 pandemic resulting in a hospitalization rate of 1,915.89 (95% CI = 1,900.13-1,931.65) hospitalizations per 100,000 children. During the four-year period, a total of 34 deaths were recorded (males 63%, females 37%). The average annual cost to the National Health-Care System of bronchiolitis requiring hospitalization was €49,6 million with an average hospitalization cost per case of €3,054. RSV is a very frequent virus associated with community-acquired pneumonia (CAP) in children under 2 years old, so future preventive interventions should target this age group including vaccination programs.

Effectiveness of Pelvic Floor Muscle Training on Quality of Life in Women with Urinary Incontinence: A Systematic Review and Meta-Analysis.

Background and Objectives: Urinary incontinence (UI) is a condition that is more common in women than men and has an increasing prevalence with age. It provides a range of psychological and physical burdens that negatively affect the patient's quality of life (QoL). However, the economic burden for the healthcare system is being augmented due to the increasing life expectancy of the population. This article aims to identify the effectiveness of pelvic floor muscle training (PFMT) on the QoL in women with UI. Materials and Methods: A systematic review and meta-analysis were conducted in the PubMed, EMBASE, ProQuest medicine, Cochrane Library, and Google Scholar databases. The terms selected according to components of PICOS were women with urinary incontinence, pelvic floor muscle training, watchful or other types of therapies, quality of life, randomized controlled trials, and interventional or observational studies. The articles included were those published between November 2018 and November 2022. Ten articles were found for the systematic review and eight for the meta-analysis. Results: The QoL moderately increased when PFMT was used on women with UI, the results indicating an overall small effect on the QoL across the controlled studies and a moderate effect on the QoL across the one-group pre-post-studies. Conclusions: Specific QoL domains, such as social activities and general health, also demonstrated benefits from PFMT interventions. This study confirmed the effectiveness of PFMT on the QoL in women with UI, mainly for patients with stress urinary incontinence.

Análisis retrospectivo de perfil microbiológico y resistencia antimicrobiana en infección urinaria pediátrica de hospitales públicos de Quito-Ecuador

Objetivo: Determinar el perfil microbiológico y resistencia antimicrobiana en infección urinaria en niños. Materiales y métodos: Estudio descriptivo, transversal, observacional y multicéntrico. Se estudiaron 445 urocultivos procesados y los resultados de antibiogramas en tres hospitales públicos de Quito (Ecuador). En relación con los agentes causales se establecieron frecuencias absolutas y proporciones. En el análisis bivariable entre el antecedente de malformación renal o de la vía urinaria y el riesgo de infección, se aplicó el test Chi2 (p < 0,05) y la RP [IC 95 %; p < 0,05]. Resultados: Se evidenció una resistencia ante aminopenicilinas del 73,5 %; ampicilina más sulbactam 31,8 %; trimetoprim-sulfametoxazol 55,5 %; cefalosporinas de primera y segunda generación hasta 33 %; cefalosporinas de tercera y cuarta generación del 21,3 al 47 %. Ante malformación urinaria y aislamiento de bacterias diferentes a Escherichia coli, se identificó a Klebsiella pneumoniae RP 2,66 [IC 95 %, 1,9-3,6; p < 0,05] y Pseudomonas aeruginosa RP 2,07 [IC 95 %, 1,2-3,5; p < 0,05]. Conclusiones: En nuestro medio, ante el diagnóstico de infección urinaria, no parece adecuado iniciar tratamiento antibiótico con aminopenicilinas, trimetoprim-sulfametoxazol ni cefalosporinas de primera a cuarta generaciones por su elevada resistencia. La presencia de malformación urinaria se asocia a infección por bacterias diferentes de Escherichia coli.

Objective: Determine the microbiological profile and antimicrobial susceptibility in urinary infection in children. Materials and methods: Descriptive, cross-sectional, observational, and multicenter study. 445 urine cultures and the results of antibiograms were studied in three public hospitals in Quito (Ecuador). In relation to the causal agents, absolute frequencies and proportions were established. In the bivariate analysis, Chi-squared test (p < 0.05) and PR [CI 95 %; p < 0.05] were applied between history of kidney or urinary tract malformation and risk of infection. Results: There was evidence of resistance to aminopenicillins of 73.5 %; ampicillin plus sulbactam 31.8 %; trimethoprim-sulfamethoxazole 55.5 %; first and second generation cephalosporins up to 33 %; resistance to third and fourth generation cephalosporins from 21.3 to 47%. In relation to urinary malformation and the isolate of a bacteria different from Escherichia coli, Klebsiella pneumoniae PR 2,66 [CI 95 %, 1.9-3.6; p < 0.05] and Pseudomonas aeruginosa PR 2.07 [CI 95 %, 1.2-3.5; p < 0.05] were identified. Conclusions: In our locality it wouldn't be appropriate to start antibiotic treatment with aminopenicillins, trimethoprim-sulfamethoxazole or first to fourth generation cephalosporins in urinary tract infection due to their resistance. The presence of urinary malformation is associated with infection by bacteria other than Escherichia coli.

Legionella pneumophila Risk from Air-Water Cooling Units Regarding Pipe Material and Type of Water.

Legionellosis is a respiratory disease related to environmental health. There have been manifold studies of pipe materials, risk installations and legionellosis without considering the type of transferred water. The objective of this study was to determine the potential development of the causative agent Legionella pneumophila regarding air-water cooling units, legislative compliance, pipe material and type of water. Forty-four hotel units in Andalusia (Spain) were analysed with respect to compliance with Spanish health legislation for the prevention of legionellosis. The chi-square test was used to explain the relationship between material-water and legislative compliance, and a biplot of the first two factors was generated. Multiple correspondence analysis (MCA) was performed on the type of equipment, legislative compliance, pipe material and type of water, and graphs of cases were constructed by adding confidence ellipses by categories of the variables. Pipe material-type of water (p value = 0.29; p < 0.05) and legislative compliance were not associated (p value = 0.15; p < 0.05). Iron, stainless steel, and recycled and well water contributed the most to the biplot. MCA showed a global pattern in which lead, iron and polyethylene were well represented. Confidence ellipses around categories indicated significant differences among categories. Compliance with Spanish health legislation regarding the prevention and control of legionellosis linked to pipe material and type of water was not observed.

Risk Factors Associated with Epilepsy Related to Cerebrovascular Disease: A Systematic Review and Meta-Analysis.

Background and Objective: Stroke is one of the most frequent neurological syndromes in the adult population and the cause of 10% of all diagnosed epilepsies. It is attributed to the origin of up to 50% of them in adults >60 years of age. Although a few risk factors have been described and considered when modeling predictive tools, this aspect is still clinically complex. The objective of this study is to describe and compare predictor scales of post stroke epilepsy (PSE) in adult patients with better performance. Methods: A systematic review and meta-analysis were performed of studies published between 2010 and 2020 and found in PubMed, Scopus, EMBASE, LILACS, BVS, Google Scholar, and CENTRAL databases. Sixteen studies were included with a total of 298,694 patients with a diagnosis of stroke, 5590 presented late seizures (LS). Results: Hemorrhage, cortical involvement, and early seizure were the elements most associated with the risk of presenting late seizures. The SeLECT score demonstrated a low risk of bias with a high predictive ability in patients with ischemic stroke (AUC: 0.77 [95% CI: 0.71-0.82]). In patients with hemorrhagic stroke, the CAVE score demonstrated adequate predictive ability (AUC: 0.81 [95% CI: 0.76-0.86]), but an uncertain risk of bias. Research has established risk factors for post ictal epilepsy; however, the numerous ways of assessing data in studies and the difference in their designs make the task of producing a predictive scale that covers the most important risk factors and is reliable for application in the clinical setting, regardless of stroke etiology, very arduous. Conclusion: Hemorrhage, cortical involvement, and early seizure are associated with an increased risk of post ictal epilepsy. Also, elements such as age, traditional vascular risk factors, and functional assessment failed to reflect statistical significance. Finally, further research is required to refine the available predictive tools.

Carga de hospitalización y comorbilidades relacionadas con la enfermedad neumocócica en España (2019-2021) / Burden of hospitalisation and comorbidities related to pneumococcal disease in Spain (2019-2021

Introducción: La enfermedad neumocócica (EN) presenta una sustancial morbimortalidad en España, con gran impacto asistencial y económico en el sistema sanitario español. Objetivos: El objetivo del presente trabajo es describir la carga hospitalaria de la EN y comorbilidades asociadas. Metodología: Estudio descriptivo transversal con base en el conjunto mínimo básico de datos y serie 2019-2021. En el análisis de las comorbilidades potencialmente asociadas a EN se empleó el Índice de Comorbilidad de Charlson (CCI). Resultados: La edad media fue 67 años con una tasa total de hospitalización de 10,65 × 10.000 habitantes y tasa de letalidad de 14,90 × 10.000 habitantes, con valores mayores en el sexo masculino. Se identificó un descenso en el caso de las hospitalizaciones y un aumento de la letalidad. El 58,34% de los pacientes ingresó por neumonía. Las enfermedades más prevalentes relacionadas con los ingresos por EN fueron: la enfermedad pulmonar obstructiva crónica, la insuficiencia cardiaca congestiva, el cáncer y la diabetes. La estancia media fue de 13 días y el coste medio total 8533 euros por episodio. El coste anual fue de 370, 455 y 462 millones de euros en 2019, 2020 y 2021, respectivamente. Conclusiones: Debido a la gran carga que continúa suponiendo para el sistema sanitario de España, la EN y las comorbilidades más frecuentes asociadas a la misma deben abordarse desde un punto de vista preventivo, considerando medidas esenciales como la vacunación y una correcta vigilancia epidemiológica de la enfermedad.(AU)

Introduction: Pneumococcal disease (PCD) has a substantial morbidity and mortality in Spain, with a large health care and economic impact on the Spanish health care system. Objectives: The aim of this study is to describe the hospital burden of pneumococcal disease and associated comorbidities. Methodology: Cross-sectional descriptive study based on the minimum basic data set and series 2019-2021. The Charlson Comorbidity Index (CCI) was used in the analysis of comorbidities potentially associated with invasive pneumococcal disease. Results: The mean age was 67 years with a total hospitalisation rate of 10.65 × 10,000 population and case fatality rate of 14.90 × 10,000 population, with higher values in males. A decrease in hospitalisations and an increase in case fatality was identified. Pneumonia accounted for 58.34% of patients admitted. The most prevalent diseases associated with invasive pneumococcal disease admissions were: chronic obstructive pulmonary disease, congestive heart failure, cancer and diabetes. The average length of stay was 13 days and the average total cost was 8533 euros per episode. The annual cost was €370m, €455m and €462m in 2019, 2020 and 2021, respectively. Conclusions: Due to the large burden it continues to place on Spain’s healthcare system, pneumococcal disease and the most frequent comorbidities associated with it must be approached from a preventive standpoint, considering essential measures such as vaccination and proper epidemiological surveillance of the disease.(AU)

Vigilancia epidemiológica de la legionelosis en España: 2005-2015 / Epidemiological surveillance of legionellosis in Spain: 2005-2015

Introducción: La legionelosis es una enfermedad de declaración obligatoria en España. Uno de sus mecanismos de prevención y control es el sistema de vigilancia epidemiológica y, en particular, la investigación epidemiológica. Entre 2005 y 2010 se reportó en Europa un aumento de la carga de la enfermedad no descrita en España. Objetivo: Determinar la evolución de los casos de legionelosis en España en la serie 2005-2015. Métodos: Estudio descriptivo de series temporales relativo al recuento de casos notificados a través del Centro Nacional de Epidemiología de España. Se incluyeron variables sociodemográficas del paciente, antecedentes personales y clínicos, síntomas y signos, datos de laboratorio y epidemiológicos. Se determinó la tasa de incidencia por 100 000 habitantes (2005-2010) y la tasa ajustada (población europea) por 100 000 habitantes según sexo (2005-2015), así como según grupo de edad y sexo para la serie 2010-2015. Resultados: España mantiene una tendencia estable respecto a la tasa de incidencia por 1100 000 habitantes (3,5 a 2,5), se produce un incremento relevante en la tasa ajustada a partir de los 50 años, con mayor impacto en los hombres. Conclusión: se evidencia la necesidad de la vigilancia epidemiológica de la legionelosis, la mejora en las medidas de prevención y control, y la consideración de nuevos factores de riesgo(AU)

Introduction: Legionellosis is a notifiable disease in Spain. One of its prevention and control mechanisms is epidemiological surveillance, particularly epidemiological research. An increase in legionellosis disease burden was reported in Europe from 2005 to 2010 which was not described in Spain. Objectives: Determine the evolution of legionellosis cases in Spain in the period 2005-2015. Methods: A descriptive time series analysis was performed based on the cases notified to the Spanish National Epidemiology Center. The variables considered were the patients' sociodemographic characteristics, personal and clinical antecedents, signs and symptoms, laboratory results and epidemiological data. Determination was made of the incidence rate per 100 000 inhabitants (2005-2010) and the adjusted rate per 100 000 inhabitants (European population) by sex (2005-2015) and by age group and sex for the series (2010-2015). Results: Incidence per 100 000 inhabitants has remained stable (3.5 to 2.5) in Spain, which has led to a relevant increase in the adjusted rate as of age 50 years, with a higher impact among men. Conclusion: Evidence was found of the need for epidemiological surveillance of legionellosis, improvement of prevention and control measures, and consideration of new risk factors(AU)

[Pneumonia and legionellosis mortality in Spain: a time series study]. / Mortalidad por neumonía y legionelosis en España: un estudio de series temporales.

BACKGROUND: Pneumonia is a disease with great relevance in public health, as a leading individual cause of infant mortality worldwide. Legionellosis is a respiratory disease with a bacterial origin and two different clinical forms. AIM: To determine pneumonia and legionellosis mortality in Spain. MATERIAL AND METHODS: Time series study of pneumonia and legionellosis in Spain in two periods, from 1997 to 2001 and from 2011 to 2015. Mortality was calculated according to disease and sex, number of deaths and rates per 100,000 inhabitants. RESULTS: Pneumonia mortality in the first period shows a relatively stable and similar tendency according to sex, preferably affecting males. In the second period, pneumonia mortality increased significantly in recent years. Although pneumonia mortality in Spain decreased in both sexes in some age groups (especially < 5 years), it remained relatively stable in patients aged > 75 years. Deaths due to legionellosis were relevant in 1997, 1998 and 2000 and increased in the last period. CONCLUSIONS: A higher mortality due to pneumonia along the years was identified. Strategies to reduce the incidence and improve the diagnosis of pneumonia, especially in children and older people elderly, are encouraged.

[Legionelosis en España, 2010-2015]. / Legionelosis en España, 2010-2015

Introduction: Legionellosis is a bacterial respiratory disease with an environmental origin in the community or in hospitals; it is usually associated with devices, facilities, and buildings. The most common clinical form is the pneumonic, known as legionnaires' disease. Objective: To determine the evolution of legionellosis cases in Spain from 2010 to 2015. Materials and methods: This was a descriptive study of time series with an analysis of the legionellosis cases notified to the Centro Nacional de Epidemiología (Government of Spain). Case distribution was determined according to sex, the autonomous community of origin, month, and age groups differentiating in the latter between men and women. Results: Case count in men was more than double compared to that in women. The cases notified by nine of the autonomous communities showed an increase at the end of the period, especially in Castilla y León, Navarra, and the Basque Country but also notable in Castilla-La Mancha. A seasonal pattern was identified with an epidemic peak in July-September and a greater number of cases among 50-years old people from both sexes. Conclusion: Despite its low prevalence compared to other respiratory diseases, legionellosis has a great impact on public health. Its distribution in Spain is global and heterogeneous with cases increasing in the last two years. Therefore, better disease prevention and control measures are recommended.

Introducción. La legionelosis es una enfermedad respiratoria bacteriana de origen ambiental que puede ser adquirida en el ámbito comunitario u hospitalario, y suele estar asociada con equipos, instalaciones y edificios. La forma clínica más conocida es la neumónica, conocida como enfermedad del legionario. Objetivo. Determinar la evolución de los casos de legionelosis en España en el periodo de 2010 a 2015. Materiales y métodos. Se hizo un estudio descriptivo de series temporales y se analizaron los casos de legionelosis notificados al Centro Nacional de Epidemiología del Gobierno de España. Se determinó la distribución de los casos según el sexo, la comunidad autónoma, el mes y los grupos de edad. Para el último se diferenció entre hombres y mujeres. Resultados. El recuento de casos en hombres fue superior al doble con respecto a las mujeres. La distribución en las comunidades autónomas presentó un aumento de los casos notificados al final del periodo en nueve de ellas, siendo notable en Castilla y León, Navarra y el País Vasco, y muy relevante en Castilla-La Mancha. Se estableció un patrón estacional con un pico epidémico en julio-septiembre y un mayor número de casos en torno a los 50 años de edad en ambos sexos. Conclusiones. A pesar de mostrar una prevalencia baja con respecto a otras enfermedades respiratorias, la legionelosis tiene gran impacto en la salud pública. Presenta una distribución global y heterogénea en el territorio español, con un aumento de casos en los dos últimos años.

Mortalidad por neumonía y legionelosis en España: un estudio de series temporales / Pneumonia and legionellosis mortality in Spain: a time series study

Background: Pneumonia is a disease with great relevance in public health, as a leading individual cause of infant mortality worldwide. Legionellosis is a respiratory disease with a bacterial origin and two different clinical forms. Aim: To determine pneumonia and legionellosis mortality in Spain. Material and Methods: Time series study of pneumonia and legionellosis in Spain in two periods, from 1997 to 2001 and from 2011 to 2015. Mortality was calculated according to disease and sex, number of deaths and rates per 100,000 inhabitants. Results: Pneumonia mortality in the first period shows a relatively stable and similar tendency according to sex, preferably affecting males. In the second period, pneumonia mortality increased significantly in recent years. Although pneumonia mortality in Spain decreased in both sexes in some age groups (especially 75 years. Deaths due to legionellosis were relevant in 1997, 1998 and 2000 and increased in the last period. Conclusions: A higher mortality due to pneumonia along the years was identified. Strategies to reduce the incidence and improve the diagnosis of pneumonia, especially in children and older people elderly, are encouraged.

Legionelosis en España, 2010-2015 / Legionellosis in Spain, 2010-2015

Resumen | Introducción. La legionelosis es una enfermedad respiratoria bacteriana de origen ambiental que puede ser adquirida en el ámbito comunitario u hospitalario, y suele estar asociada con equipos, instalaciones y edificios. La forma clínica más conocida es la neumónica, conocida como enfermedad del legionario. Objetivo. Determinar la evolución de los casos de legionelosis en España en el periodo de 2010 a 2015. Materiales y métodos. Se hizo un estudio descriptivo de series temporales y se analizaron los casos de legionelosis notificados al Centro Nacional de Epidemiología del Gobierno de España. Se determinó la distribución de los casos según el sexo, la comunidad autónoma, el mes y los grupos de edad. Para el último se diferenció entre hombres y mujeres. Resultados. El recuento de casos en hombres fue superior al doble con respecto a las mujeres. La distribución en las comunidades autónomas presentó un aumento de los casos notificados al final del periodo en nueve de ellas, siendo notable en Castilla y León, Navarra y el País Vasco, y muy relevante en Castilla-La Mancha. Se estableció un patrón estacional con un pico epidémico en julio-septiembre y un mayor número de casos en torno a los 50 años de edad en ambos sexos. Conclusiones. A pesar de mostrar una prevalencia baja con respecto a otras enfermedades respiratorias, la legionelosis tiene gran impacto en la salud pública. Presenta una distribución global y heterogénea en el territorio español, con un aumento de casos en los dos últimos años, por lo que se requiere una mejor prevención y control de la enfermedad.

Abstract | Introduction: Legionellosis is a bacterial respiratory disease with an environmental origin in the community or in hospitals; it is usually associated with devices, facilities, and buildings. The most common clinical form is the pneumonic, known as legionnaires' disease. Objective: To determine the evolution of legionellosis cases in Spain from 2010 to 2015. Materials and methods: This was a descriptive study of time series with an analysis of the legionellosis cases notified to the Centro Nacional de Epidemiología (Government of Spain). Case distribution was determined according to sex, the autonomous community of origin, month, and age groups differentiating in the latter between men and women. Results: Case count in men was more than double compared to that in women. The cases notified by nine of the autonomous communities showed an increase at the end of the period, especially in Castilla y León, Navarra, and the Basque Country but also notable in Castilla-La Mancha. A seasonal pattern was identified with an epidemic peak in July-September and a greater number of cases among 50-years old people from both sexes. Conclusion: Despite its low prevalence compared to other respiratory diseases, legionellosis has a great impact on public health. Its distribution in Spain is global and heterogeneous with cases increasing in the last two years. Therefore, better disease prevention and control measures are recommended.

COPD in the major nonsmoking adult: A systematic review and meta-analysis.

Chronic Obstructive Pulmonary Disease (COPD) main cause is attributed to active smokers, but there's a small percentage that comes from risk factors that have been less considered. The aim of this research was to identify the risk factors and the clinical presentation of the population over 64 years of age that lead to the development of COPD. A systematic review and a meta-analysis was performed. From the 92 studies interpreted, we identified seven studies on the presence of COPD in nonsmokers older adults, having a universe of 14,920 patients. The primary risk factor to trigger the development of COPD was secondhand smoking. The study defined the most common risk factors that currently trigger COPD development among nonsmokers and provided an insight into the potential clinical differences between nonsmokers and smokers.

Biological risk of Legionella pneumophila in irrigation systems / Riesgo biológico por Legionella pneumophila en sistemas de riego

ABSTRACT Objective The goal of this study is to determine the risk of exposure to Legionella pneumophila in hotel golf courses located in the province of Malaga (Spain). Method Spray irrigation systems were analyzed as sources for spreading the Legionella bacterium. Spanish legislation requires that irrigation systems be monitored for their water quality as well as for reasons related to health and hygiene. Based on an observational study and non-parametric tests (Goodman-Kruskal Tau and uncertainty coefficient), this study states the regulatory enforcement among the systems and contributed to announce Legionella prevention. The quality criteria for recycled water, waste water treatment plant and well water were analyzed in relationship to the hotels' categories. Results Deficiencies were found in the preventive maintenance of irrigation systems, but no relationship exists between the type of water and the risk detected. Conclusions The study suggests that aerosolized water used in golf course watering systems could pose risk to the population by exposing them to Legionella.

RESUMEN Objetivo El propósito de este trabajo es determinar el riesgo de exposición a Legionella pneumophila en campos de golf de hoteles ubicados en la provincia de Málaga (España). Método Se realizó un estudio de los sistemas de riego por aspersión como fuentes de dispersión de la bacteria Legionella. El análisis de las condiciones higiénico-sanitarias de las instalaciones y la calidad del agua es una actividad de obligado cumplimiento contemplada en la legislación sanitaria española. Mediante un estudio observacional y el empleo de pruebas no paramétricas (Tau de Goodman-Kruskal y coeficiente de incertidumbre) se expresó el cumplimiento de la reglamentación en los sistemas estudiados y la prevención de Legionella. Los criterios de calidad para el agua reciclada, procedente de la estación depuradora de agua residual y de pozo, fueron analizados en relación con la categoría de los hoteles. Resultados Se encontraron deficiencias en el mantenimiento preventivo de los sistemas de riego, pero no hubo relación entre el tipo de agua y el riesgo identificado. Conclusiones El estudio sugiere que el agua aerosolizada proveniente de los sistemas de riego de los campos de golf presenta un riesgo de infección por Legionella para la población expuesta.

Biological risk of Legionella pneumophila in irrigation systems.

OBJECTIVE: The goal of this study is to determine the risk of exposure to Legionella pneumophila in hotel golf courses located in the province of Malaga (Spain). METHOD: Spray irrigation systems were analyzed as sources for spreading the Legionella bacterium. Spanish legislation requires that irrigation systems be monitored for their water quality as well as for reasons related to health and hygiene. Based on an observational study and non-parametric tests (Goodman-Kruskal Tau and uncertainty coefficient), this study states the regulatory enforcement among the systems and contributed to announce Legionella prevention. The quality criteria for recycled water, waste water treatment plant and well water were analyzed in relationship to the hotels' categories. RESULTS: Deficiencies were found in the preventive maintenance of irrigation systems, but no relationship exists between the type of water and the risk detected. CONCLUSIONS: The study suggests that aerosolized water used in golf course watering systems could pose risk to the population by exposing them to Legionella.

Legionelosis asociada con viajes en España, serie 1997-2002 / Travel-associated legionellosis in Spain, 1997-2002

Objetivo: analizar el desarrollo de la legionelosis en España durante los años 1997-2002, mediante números crudos, y su relación con el European Surveillance Scheme for Travel Associated Legionnaires' Disease. La legionelosis es una enfermedad respiratoria que puede resultar mortal. En España es considerada como de declaración obligatoria desde 1995. En 1986 se creó The European Working Group for Legionella Infections y al año siguiente el European Surveillance Scheme for Travel Associated Legionnaires' Disease. Materiales y métodos: estudio de carácter descriptivo mediante la recopilación de los casos, brotes y defunciones por legionelosis, para la serie indicada, a través de las notificaciones efectuadas al Centro Nacional de Epidemiología. Resultados: se determina la implicación en el ámbito comunitario, nosocomial y el European Surveillance Scheme for Travel Associated Legionnaires' Disease. Esta afecta al número total en todos los ámbitos y, en especial, en los brotes, casos y defunciones en los años 1997, 1998 y 2000; mientras que los mayores registros para estos eventos en la serie estudiada acontecieron en los años 2002 (62), 2001 (772) y 2000 (25), respectivamente. Conclusiones: la vigilancia epidemiológica constituye una herramienta muy valiosa para la prevención y control de la enfermedad. El análisis de las series temporales puede arrojar información relevante del comportamiento de la legionelosis y de las fuentes de desarrollo del agente inductor de la enfermedad..(AU)

Objective: analyze the development of the disease in Spain during the years 1997-2002, by raw numbers, and their relationship with the European Surveillance Scheme for Travel Associated Legionnaires' Disease. Legionellosis is a respiratory disease that can be fatal. In Spain it is considered notifiable since 1995. In 1986 The European Working Group for Legionella Infections was established and following year the European Surveillance Scheme for Travel Associated Legionnaires' Disease. Materials and methods: descriptive study by cases, outbreaks and deaths collection (period 1997-2002) from the reports of the National Epidemiology Center. Results: community exposure, nosocomial infection and travel-acquired infection is determined. The last affects at total value in all scenes and especially outbreaks, cases and deaths in 1997, 1998 and 2000. Great records for the disease in the period occurred at 2002 (62 outbreaks), 2001 (772 cases) and 2000 (25 deaths). Conclusions: epidemiological surveillance is a valuable tool for the prevention and control of legionellosis. Time series analysis can display significant information about the evolution of disease and sources of development of biological agent..(AU)

Mortalidad por neumonía en Andalucía / Pneumonia mortality in Andalusia

ResumenLa neumonía es una enfermedad respiratoria con alcance mundial. En particular, es en niños menores de cinco años donde se presenta como primera causa de muerte.Objetivo:Determinar la mortalidad por neumonía en España para la Comunidad Autónoma de Andalucía y serie 1992-2001.Metodología:Revisión de la mortalidad por neumonía a partir de los datos aportados por el Instituto de Salud Carlos III (Gobierno de España, Ministerio de Economía y Competitividad).Resultados:En España y Andalucía la tasa ajustada para la población europea de altas por neumonía por 100 000 habitantes se incrementa a lo largo de los años. La mortalidad por neumonía en España para la serie indicada muestra una tendencia relativamente estable y similar según sexo, aunque en Andalucía es llamativo el incremento en el femenino. En lo relativo a la mortalidad por neumonía según el sexo y tasa ajustada por edad, por población europea por 100 000 habitantes, los valores de Andalucía superan a los de España.Conclusión:Los datos epidemiológicos sirven para la mejora de la protección de la salud, así como el planteamiento de intervenciones sanitarias para la prevención y el control de la enfermedad.

AbstractPneumonia is a respiratory disease with global scope. Specially, in children under five years it appears as the first cause of death.Objective: Determine pneumonia mortality in Spain and Autonomous Community of Andalusia from 1992 to 2001.Methodology: Review of pneumonia mortality from data provided by the Institute of Health Carlos III (Government of Spain, Ministry of Economy and Competitiveness).Results:In Spain and Andalusia adjusted rate for European population of pneumonia discharges per 100,000 persons increases over the years. Pneumonia mortality in Spain for the indicated period shows a relatively steady trend and similar by sex, although in Andalusia there is a striking increase in the female. Regarding pneumonia mortality by sex and age-adjusted rate for European population per 100,000 inhabitants, Andalusia surpasses values of Spain.Conclusion: Epidemiological data can be used to improve the protection of health and the approach of health interventions for disease prevention and control.