Use of the moving epidemic method (MEM) to assess national surveillance data for respiratory syncytial virus (RSV) in the Netherlands, 2005 to 2017.

BackgroundTo control respiratory syncytial virus (RSV), which causes acute respiratory infections, data and methods to assess its epidemiology are important.AimWe sought to describe RSV seasonality, affected age groups and RSV-type distribution over 12 consecutive seasons in the Netherlands, as well as to validate the moving epidemic method (MEM) for monitoring RSV epidemics.MethodsWe used 2005-17 laboratory surveillance data and sentinel data. For RSV seasonality evaluation, epidemic thresholds (i) at 1.2% of the cumulative number of RSV-positive patients per season and (ii) at 20 detections per week (for laboratory data) were employed. We also assessed MEM thresholds.ResultsIn laboratory data RSV was reported 25,491 times (no denominator). In sentinel data 5.6% (767/13,577) of specimens tested RSV positive. Over 12 seasons, sentinel data showed percentage increases of RSV positive samples. The average epidemic length was 18.0 weeks (95% confidence intervals (CI): 16.3-19.7) and 16.5 weeks (95% CI: 14.0-18.0) for laboratory and sentinel data, respectively. Epidemics started on average in week 46 (95% CI: 45-48) and 47 (95% CI: 46-49), respectively. The peak was on average in the first week of January in both datasets. MEM showed similar results to the other methods. RSV incidence was highest in youngest (0-1 and >1-2 years) and oldest (>65-75 and > 75 years) age groups, with age distribution remaining stable over time. RSV-type dominance alternated every one or two seasons.ConclusionsOur findings provide baseline information for immunisation advisory groups. The possibility of employing MEM to monitor RSV epidemics allows prospective, nearly real-time use of surveillance data.

Pacientes que reciben atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio. Estudio APASO, mediante Redes Centinelas Sanitarias / Patients receiving palliative and supportive care from primary health care teams at home. APASO study through Health Sentinel Networks

OBJETIVO: Describir las características clínicas y los problemas de salud que afectan a la población que recibe cuidados paliativos y de soporte en su domicilio prestados por los equipos de atención primaria. MÉTODO: Estudio observacional prospectivo realizado por profesionales pertenecientes a 5 Redes Centinelas Sanitarias (Asturias, Castilla y León, Extremadura, La Rioja, Comunitat Valenciana) mediante un cuestionario por cada paciente que recibió atención paliativa con participación del equipo de atención primaria, durante un periodo de 3 meses, utilizando una definición y unos criterios comunes basados en el tipo de atención recibida y no en el diagnóstico clínico. Se recogieron problemas de salud causantes de la situación, los síntomas y el estado funcional del paciente además de otras variables relacionadas con su proceso clínico y entorno de apoyo. RESULTADOS: Se recogieron 1.192 casos, de los que 1.043 respondían a la definición de incapacidad funcional y 149 eran enfermos terminales. La mayor proporción correspondía a mujeres en situación de incapacidad. Ambos tipos de pacientes presentaban como media 3 o más problemas de salud que justificaban la atención paliativa o de soporte, aunque existen diferencias entre los problemas que tenían un tipo y otro de pacientes. La mitad recibía cuidados por 4 o menos síntomas, pero un 10% tenían 8 o más síntomas, con diferencias significativas en los síntomas más prevalentes entre los 2 tipos de pacientes. CONCLUSIONES: Los cuidados paliativos en atención primaria se prestan a pacientes con problemas de salud que provocan incapacidad. Las Redes Centinelas son una herramienta útil en la investigación en cuidados paliativos

OBJECTIVE: The aim of this paper is to describe the clinical characteristics and health problems affecting the population receiving palliative care and support at home by primary care teams. METHOD: A prospective observational study was conducted by professionals from 5 Sentinel Health Networks (Asturias, Castile and Leon, Extremadura, La Rioja, and the Community of Valencia) who completed a questionnaire for each patient receiving palliative care involving a primary care team during a period of 3 months, and using a common definition and criteria for the type of care, rather than the clinical diagnosis. This questionnaire addressed the health problems that caused the situation, the symptoms, the patient's functional status, and other variables related to the clinical process and supportive environment. RESULTS: Data were collected on a total of 1,192 cases, of which 149 were terminally patients, and 1,043 meet the definition of functional disability. The large majority were women with functional disability. Both types of patients had a mean of 3 or more health problems that justified palliative or supportive care, although there were differences between the problems presented by each type of patient. Half of them received care for 4 or fewer symptoms, but 10% had 8 or more symptoms. There were significant differences in the most prevalent symptoms between the 2 types of PATIENTS: CONCLUSIONS: Palliative care in primary care is provided to patients with health problems that cause disability. The Sentinel Networks are a useful tool for research in palliative care

Influenza surveillance in Europe: comparing intensity levels calculated using the moving epidemic method.

OBJECTIVES: Although influenza-like illnesses (ILI) and acute respiratory illnesses (ARI) surveillance are well established in Europe, the comparability of intensity among countries and seasons remains an unresolved challenge. The objective is to compare the intensity of ILI and ARI in some European countries. DESIGN AND SETTING: Weekly ILI and ARI incidence rates and proportion of primary care consultations were modeled in 28 countries for the 1996/1997-2013/2014 seasons using the moving epidemic method (MEM). We calculated the epidemic threshold and three intensity thresholds, which delimit five intensity levels: baseline, low, medium, high, and very high. The intensity of 2013/2014 season is described and compared by country. RESULTS: The lowest ILI epidemic thresholds appeared in Sweden and Estonia (below 10 cases per 100 000) and the highest in Belgium, Denmark, Hungary, Poland, Serbia, and Slovakia (above 100 per 100 000). The 2009/2010 season was the most intense, with 35% of the countries showing high or very high intensity levels. The European epidemic period in season 2013/2014 started in January 2014 in Spain, Poland, and Greece. The intensity was between low and medium and only Greece reached the high intensity level, in weeks 7 to 9/2014. Some countries remained at the baseline level throughout the entire surveillance period. CONCLUSIONS: Epidemic and intensity thresholds varied by country. Influenza-like illnesses and ARI levels normalized by MEM in 2013/2014 showed that the intensity of the season in Europe was between low and medium in most of the countries. Comparing intensity among seasons or countries is essential for understanding patterns in seasonal epidemics. An automated standardized model for comparison should be implemented at national and international levels.

[Palliative and support care at home in primary care]. / Atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio.

OBJECTIVES: To estimate the proportion of people requiring palliative and support care at home in primary care and to describe their characteristics. METHODS: A descriptive study was carried out by five Spanish sentinel networks between October 2007 and March 2008 in 282,216 people attended by 218 general practitioners and nurses. Patients receiving comprehensive, active and continued care at home were included if the aim was not to prolong life but to achieve the best quality of life for the patient, the family and the carers. A standard form was used to collect data on age, sex, type of patient, underlying diseases and other variables related to the process. Crude and age-adjusted rates were estimated. RESULTS: Of the 400 men and 792 women registered, 12% were strictly terminal. The mean age was 82.4 years and was higher in patients with functional disability (82.9 years) than in terminally-ill patients (78.9 years) (p<0.01). The estimated prevalence was 422.3 per 100,000 inhabitants aged 14 years or more (95% CI: 398.7-447.0) and was much higher in women than in men (553.9 versus 287.3, p<0.01). The estimate for the entire Spanish population was 309.0 per 100,000 inhabitants (95% CI: 286.0-332.0). CONCLUSIONS: The prevalence of palliative and support care in Spain is around three cases per 1,000 inhabitants and is higher in elderly populations. More than 85% of patients needing palliative or support care have a life expectancy of over 6 months and thus represent the majority of persons using this type of medical and social support. The most susceptible groups are women and the oldest-old.

Adjustment of hemodialysis dose for residual renal urea clearance: a two year study of impact on dialysis time.

Urea kinetic modeling suggests that significant time reductions may be realized in hemodialysis patients with residual renal urea clearance (K(r)t/V urea). However, the actual impact of a strategy that integrates such function into the dialysis prescription is not clear, because of both uncertainty regarding the rate of decay of K(r)t/V urea, as well as potential clinical constraints upon dose reduction. To examine this issue, we retrospectively reviewed data from 51 patients with K(r)t/N urea after initiation of maintenance hemodialysis. In 31 cases, there were no clinical barriers to adjustment of the dialysis prescriptions. Regression analysis revealed that each 0.10 increment in K(r)t/V urea yielded an actual dialysis time reduction of 12 minutes per week with average cumulative reduction of 80 minutes per week per patient. At approximately 1 year after initiation of dialysis, there were still 10 patients whose dialysis prescriptions were being adjusted on the basis of K(r)t/V urea. In conclusion, our results suggest that the incorporation of K(r)t/V urea in the hemodialysis prescription allows for substantial and enduring reductions in dialysis time in a significant minority of patients. Larger prospective studies are needed to evaluate the long-term safety of this strategy in modifying the dose of hemodialysis.