Analysis of age-period-cohort effects on overall mortality in Andalusia (Southern Spain).

OBJECTIVES: To evaluate the age-period-cohort effects on overall mortality in Andalusia (Spain). STUDY DESIGN: An ecological study was implemented with a Lexis diagram triangle comprising each annual age group, year of death and year of birth as the unit of analysis. METHODS: In all 1,384,899 deaths from all causes were analysed for individuals between the ages of 1 and 84 years who died in Andalusia in the period 1981-2008. A non-linear regression model was estimated for each gender group and geographical area. The effects of age, year of death and birth cohort were parameterized using B-spline smoothing functions. RESULTS: There is a downward trend in mortality by age to around the age of 15 years, from which point the trend turned upwards. For cohorts born between 1945 and 1965, the rate climbed steadily. From 1965, the rate turned downwards. Death rates increased between 1995 and 2000, only to turn down again until the end of the period. Broadly, these results were similar for both men and women, in all the provinces of Andalusia and for Andalusia as a whole. CONCLUSIONS: This study points to an age-period-cohort effect on deaths from all causes in all the geographic areas studied.

Community cluster of meningococcal disease by Neisseria meningitidis serogroup C in Andalusia, Spain, March to May 2011.

Between March and May of 2011, a cluster of three fatal cases of meningococcal sepsis occurred in Andalusia, Spain, in a municipality with a population of around 20,000 inhabitants. The cases were in their mid-teens to early thirties and were notified to the epidemiological surveillance system of Andalusia (Sistema de Vigilancia Epidemiológica de Andalucía, SVEA) during a 68-day period from March through May 2011. All three were infected with the same strain of Neisseria meningitidis serogroup C genosubtype VR1:5-1;VR2:10-8. None of the cases had been previously vaccinated against N. meningitidis serogroup C. Antibiotic post-exposure chemoprophylaxis was administered to close contacts of every diagnosed case. Once the cluster was confirmed, the local population was informed through the media about the control measures taken by the health authorities. The vaccination history against N. meningitidis serogroup C of the population under 25 years-old in the municipality was checked. Vaccination was offered to unimmunised individuals younger than 25 years of age and an additional dose of vaccine was offered to those who had been vaccinated between 2000 and 2006 with a vaccination schedule of three doses before the first year of age. No further cases occurred since the beginning of these actions.

Spotlight on measles 2010: An ongoing outbreak of measles in an unvaccinated population in Granada,Spain, October to November 2010: an ongoing outbreak of measles in an unvaccinated population in Granada, Spain, October to November 2010.

In September and October 2010, 13 primary measles cases were identified among unvaccinated persons aged between 9 and 32 years (median: 16.5) in 11 districts in Germany. All cases had attended meetings in Taizé, France. This outbreak illustrates the risk of long distance spread of infectious diseases associated with international mass gatherings, and underlines the importance of closing immunisation gaps against measles by vaccinating non-immune adolescents and young adults.

Behaviour of the pandemic H1N1 influenza virus in Andalusia, Spain, at the onset of the 2009-10 season.

In Andalusia, Spain, the pandemic influenza A(H1N1)v virus has spread throughout the community, being the dominant influenza strain in the season so far. The current objective of the Andalusia Health Service is focussed on the mitigation of the health and social impact by appropriate care of the patients at home or in health centres. The 2009-10 seasonal influenza epidemic started early compared with to previous seasons. This article analyses the influenza A(H1N1)v situation in Andalusia until the week 39/2009.

[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

La vigilancia de la salud de los trabajadores expuestos al amianto: ejemplo de colaboración entre el sistema de prevención de riesgos laborales y el sistema nacional de salud / Health surveillance of workers exposed to asbestos: an example of co-operation between the occupational prevention system and the national health system

El Ministerio de Sanidad y Consumo y las Comunidades Autónomashan diseñado y consensuado con los profesionales sanitariosy las organizaciones empresariales y sindicales representativas unPlan Integral de Vigilancia de la Salud de los Trabajadores que hanestado expuestos a Amianto, con el objetivo de garantizar una intervenciónadecuada, uniforme y armonizada de estos trabajadores entodo el territorio nacional. La elaboración del Programa partió delGrupo de Trabajo de Salud Laboral del Consejo Interterritorial, seenriqueció con las aportaciones del Grupo de Trabajo Amianto de laComisión Nacional de Seguridad y Salud en el Trabajo, fue consensuadocon los profesionales de la medicina y enfermería del trabajo,y fue aprobado por las autoridades sanitarias y laborales. El Programaconsta de siete grandes bloques de actividades. Dos años despuésde aprobado el Programa, el estado de implantación en las ComunidadesAutónomas es desigual. Las principales dificultades para supuesta en marcha se encuentran en la elaboración del Registro deexpuestos. Un total de 5.778 trabajadores están incluidos en el Registro.208 trabajadores tienen EPOC, 198 alteraciones pleurales benignas,8 cáncer de pulmón, 10 mesotelioma y 7 presentan otros cáncerescon posible relación con el amianto (gástrico, de laringe y colon). El consenso y la participación alcanzados alrededor de este Programaestán permitiendo lograr coberturas de las políticas de prevenciónde riesgos laborales muy superiores a las que se consiguen conla mera actuación institucional y elaboración de normativa, ya que ensólo los dos primeros años de implantación del Programa se ha duplicadoel número de trabajadores atendidos

The Ministry of Health and Consumer Affairs and the AutonomousGovernments of Spain have designed and agreed by consensuswith the sanitary professionals and major employer's organizationsand Unions a Integral Health Surveillance Programme ofasbestos-exposed workers, in order to assure appropriate, uniformand harmonized action throughout the national territory with relationto these workers. Program description: this initiative startedfrom the Occupational Health Working group of the InterterritorialCouncil, with inputs from the Asbestos Working Group of theNational Occupational Safety and Health Commission. It was agreedwith occupational medicine and infirmary professionals and wasapproved by the Health and Labour authorities. The program isorganised in seven main activities. Current Program status: twoyears after the Programme approval a total of 5,778 workers areincluded in the Registry of asbestos-exposed workers. 208 workershave COPD, 198 benign pleural disease, 8 lung cancer, 10 mesotheliomaand 7 workers have other cancers possibly related toasbestos (gastric, larynx and colon cancer). Remarks: the agreementand participation reached in this Programme allow achievingmuch higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see duringthe second year of implementation of the Programme in which thenumber of attended workers has doubled

Mortalidad por cáncer de estómago en Andalucía: tendencia y distribución espacial / Mortality due to gastric cancer in Andalusia: trends and geographic distribution

Objetivo. Describir la evolución de la mortalidad por cáncer de estómago en Andalucía y su distribución geográfica actual. Diseño. Estudio descriptivo de base poblacional. Emplazamiento. Andalucía durante el período 1975-1999.Participantes. Residentes en Andalucía. Mediciones. Tasas brutas, ajustadas por edad, truncadas (35-64 años), de años potenciales de vida perdidos (1-70 años) y acumuladas (0-74 años) de mortalidad por cáncer de estómago entre 1975 y 1999. Coeficientes de regresión lineal del modelo que mejor se ajusta a las tasas estandarizadas a lo largo de todo el período. Tasas ajustadas por edad del quinquenio 1995-1999 en los distritos sanitarios de atención primaria. Resultados. Se observa un descenso mantenido de la mortalidad por cáncer de estómago, y las tasas estandarizadas pasan de 15,9 a 5,8 en mujeres y de 33,9 a 14,5 en varones (por 100.000 individuos). Los distritos de las sierras norte de Sevilla, Huelva y Córdoba junto con Guadix, en Granada, presentaron las tasas más altas en el quinquenio 1995-1999 tras ajustar por edad. Los varones mantienen tasas más elevadas de mortalidad a lo largo del intervalo analizado, con razones de masculinidad siempre superiores a 2. Conclusiones. La mortalidad por cáncer de estómago ha descendido notablemente en Andalucía a lo largo del último cuarto del siglo XX, pero la distribución geográfica actual de la misma no es homogénea y se observan distritos de atención primaria con tasas 3 veces superiores a las tasas de los distritos de baja mortalidad. Se necesitan estudios analíticos que aclaren las posibles causas de estas notables diferencias (AU)

Incidence of pulmonary tuberculosis and HIV coinfection in the province of Seville, Spain, 1998.

Using the National Notifiable Disease Surveillance System (NNDSS) and Minimum Basic Data Set (MBDS) for hospital discharges we evaluated pulmonary tuberculosis (PTB) surveillance and estimated real PTB incidence and human immunodeficiency virus (HIV) coinfection in Seville in 1998. In addition, we assessed the sensitivity and the positive predictive value (PPV) of the surveillance system. Real incidence of pulmonary tuberculosis was estimated by the capture-recapture method. In 1998, the province of Seville reported 225 cases of pulmonary tuberculosis to the NNDSS, an incidence of 13.2 per 100,000 population. Of the 225 cases reported, 18.2% presented with HIV coinfection, while a total of 194 had confirmed diagnoses. The MBDS accounted for 106 new cases. Of these, 24.8% presented with HIV coinfection and were 58% less likely to be reported to the NNDSS (25-76%, p = 0.001). Applying the capture-recapture method, 426 cases were estimated, an overall incidence of 25.6 per 100,000 population (21.5-28.8). Completeness for each source was similar (47%), and for both jointly was 72.7%. The NNDSS had a sensitivity of 65.3% and a PPV of 89.3%. In conclusion, the NNDSS underestimates PTB and PTB-HIV coinfection in Seville. The high incidence observed in young adults suggests a high degree of tuberculosis endemicity. Hospital records provide a readily accessible, low-cost means of estimating disease incidence.

[Mortality caused by cancer in Andalusia: trends and geographic distribution]. / Mortalidad por cáncer de estómago en Andalucía: tendencia y distribución espacial.

AIMS: To describe the evolution of mortality due to gastric cancer in Andalusia and the current geographic distribution of mortality. DESIGN: Descriptive, population-based study. SETTING: Andalusia (Southern Spain) during the period from 1975 to 1999. PARTICIPANTS: Residents of the region of Andalusia. MEASUREMENTS: Crude rates adjusted for age (interval 35-64 years) of potential years of life lost (1-70 years), and cumulative rates (0-74 years), for mortality due to gastric cancer from 1975 to 1999. Linear regression coefficients were calculated from the model that best fit mortality rates standardized across the study period. Age-adjusted rates were calculated for the five-year period from 1995 to 1999 for primary health care districts. RESULTS: A sustained decrease in mortality (standardized rate per 100000 inhabitants) due to gastric cancer was seen in women (15.9 to 5.8) and men (33.9 to 14.5). The Sierra Norte (Seville province), Huelva and Córdoba districts, together with the Guadix district (Granada province), had the highest age-adjusted rates for the period from 1995 to 1999. Mortality rates were higher in men than in women throughout the period analyzed; the male:female ratio was consistently greater than 2. CONCLUSIONS: Mortality due to gastric cancer decreased notably in Andalusia during the last quarter of the twentieth century, but the current geographic distribution of mortality rates varies across the region. Mortality rates in some primary health care districts were threefold as high as in other districts where mortality was low. Further analytical studies are needed to clarify the possible causes of these marked local differences.

[Levels of bactericidal antibodies against meningococcus C after vaccination in 2- to 6-year-old children in Andalusia]. / Niveles de anticuerpos bactericidas frente a meningococo C tras la vacunación de niños de 2 a 6 años de edad en Andalucía.

BACKGROUND: In 1997, 18.5% of the cases of Meningococcal Disease caused b serogroup C in Andalusia were children between 2 and 4 years of age; ages where the initial immune response and the duration of the capsular A + C meningococcal polysaccharide vaccine is less than in older age groups. Research was designed in order to measure the immune response produced by this vaccine in children from 2 to 6 years of age and to compare it with the natural immunity present in unvaccinated children. METHODS: I. Dual monitoring study: a) groups of children vaccinated previously and control groups, b) groups of children who were going to be vaccinated, for pre and post-vaccination (1, 6 and 12 months) analysis and a control group. II. The bactericidal activity was measured according to the standardised protocol of the CDC with regard to the strain of N. meningitidis C-11. The sera with bactericidal activity (TAB) > 1:8 were considered to be protective. RESULTS: 1 and 2 months following vaccination, the proportion of TAB > 1:8 was significantly higher than that of the control group (65.6% and 73% in comparison to 2.2% and 12%). In the pre-vaccine and post-vaccine (after 6, 7, 12 and 13 months) verification, no significant difference between vaccinated individuals and controls was observed. CONCLUSIONS: The differences between vaccinated and unvaccinated individuals 1 and 2 months following vaccination indicate seroconversion in the vaccinated individuals. For the age group of between 2 to 6 years of age, the bactericidal activity acquired decline quickly, as, after 6 months, differences between this group and the control group are no longer observed.

[Outbreak of gastroenteritis at a home for the aged in Albacete]. / Brote de gastroenteritis en una residencia de ancianos de Albacete.

BACKGROUND: We describe the investigation of an acute gastroenteritis outbreak with an explosive beginning, probably waterborne, that occurred in an nursing home in Albacete, in November 1999 and affected 104 inmates and 35 employees. The dominant symptoms were diarrhea and vomiting. METHODS: A case-control study was designed. We carried out a descriptive analysis of facts and crossing of variables with the help of simple tables. A multivariant analysis, by models of logistic regression, was conducted both for the explosive phase and for that of transmission person-to-person. RESULTS: The attack rate for inmates was 45.8% and for employees, 33.7%. An association was found between the use of the main dining-room of the nursing home and the explosive beginning of the outbreak and between the previous presence of a case-patient in the shared bedrooms and the person-to-person transmission. Norwalk-like virus was isolated from faeces samples of four cases. CONCLUSIONS: The analysis of the clinical and epidemiological findings as well as the laboratory results proved the implication of a Norwalk-like virus in this outbreak.

[The short-term effects of air pollution on mortality. The results of the EMCAM project in the city of Seville, 1992-1996. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en la ciudad de Sevilla, 1992-1996

BACKGROUND: As part of the EMECAM Project, the objective of this study is that of assessing the impact of air pollution on the daily mortality in Seville throughout the 1992-1996 period. METHODS: During the 1992-1996 period, readings were taken daily of the amounts of SO2, particles in suspension (PM10) and NO2 present in the air in the city of Seville, in addition to the number of deaths daily due to different causes. For analyzing this data, a multivariable Poisson regression model was used for modeling each one of the causes of death in terms of the air immission readings, controlling other confusion-causing variables. RESULTS: A relationship was found to exist between the rises in the NO2 levels and the daily death rate throughout the months of May to October. For each 10 micrograms/m3 rise, the risk of death or all causes showed a 2% rise, the same rise in the NO2 levels leading to a 3% rise in the risk of death resulting from cardiovascular diseases. CONCLUSIONS: A relationship exists between the levels of NO2 air pollution and the daily death rate in Seville. The findings provide scientific knowledge and information which can be of use for preventing the impact of air pollution on human health.

[The short-term effects of air pollution on mortality: the results of the EMECAM project in the city of Huelva, 1993-96. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en la ciudad de Huelva, 1993-96.

BACKGROUND: The objective of this study was to estimate the relationship between the levels of air pollution and the daily mortality in the city of Huelva for the 1993-1996 period using the EMECAM methodology. METHODS: The number of daily deaths for all causes except external ones, the death rate of those over age 69, due to diseases of the circulatory system and for respiratory diseases were used as rate indicators. Four pollutants--SO2, PM10, NO2 and CO--were analyzed, the daily levels of which were furnished by the air pollution monitoring network in Huelva. Autoregressive Poisson regression models were constructed controlling by tendency, seasonality, temperature, humidity, flue and events out of the ordinary. RESULTS: For the mortality rate for all causes, a significant association impact was found to exist for the NO2 for the entire period (RR10 microgram/m3: 1.0414; CI95%: 1.0047-1.0794) and for the particles (PM10) for the cold half of the year (RR10 microgram/m3: 1.0358; CI95%: 1.007-1.0722). For the mortality in people over age 69, a significant relationship was found to exist for SO2 throughout the entire period (RR10 microgram/m3: 1.0606; CI95%: 1.0020-1.1227). A significant relationship to the mortality from respiratory disease particles (PM10) was found to exist for the cold half of the year (RR10 microgram/m3: 1.1412; IC95%: 1.0300-1.2644). There was no association of contaminants with cardiovascular mortality; also there was no association between levels of CO and mortality indicators. CONCLUSIONS: In Huelva, significant relationships have been found to exist between the current levels of air pollution resulting from particles, SO2 and NO2 and the daily mortality. The impact of these pollutants on the mortality is coherent with scientific literature, although in the case of Huelva, the extremely small number of daily deaths due to its small population and other factors limit the consistency thereof.