RECERCAT - Articles publicats en revistes (Salut Pública)

Health Services Utilization, Work Absenteeism and Costs of Pandemic Influenza A (H1N1) 2009 in Spain: A Multicenter-Longitudinal Study

Health Services Utilization, Work Absenteeism and Costs of Pandemic Influenza A (H1N1) 2009 in Spain: A Multicenter-Longitudinal Study Galante, M.; Garin, O.; Sicuri, E.; Cots, F.; García-Altés, A.; Ferrer, M.; Domínguez García, Àngela; Alonso, J. Background: The aim of this study was to estimate healthcare resource utilization, work absenteeism and cost per patient with pandemic influenza (H1N1)2009, from its beginning to March 2010, in Spain. We also estimated the economic impact on healthcare services. Methods and Findings: Longitudinal, descriptive,multicenter study of in- and outpatients with confirmed diagnosis of influenza A (H1N1) in Spain. Temporal distribution of cases was comparable to that in Spain. Information of healthcare and social resources used from one week before admission (inpatient) or index-medical visit (outpatient) until recovery was gathered. Unit cost was imputed to utilization frequency for the monetary valuation of use. Mean cost per patient was calculated. A sensitivity analysis was conducted, and variables correlated with cost per patient were identified. Economic impact on the healthcare system was estimated using healthcare costs per patient and both, the reported number of confirmed and clinical cases in Spain. 172 inpatients and 224 outpatients were included. Less than 10% were over 65 years old and more than 50% had previous comorbidities. 12.8% of inpatients were admitted to the Intensive Care Unit. Mean length of hospital stay of patients not requiring critical care was 5 days (SD =4.4). All working-inpatients and 91.7% working-outpatients went on sick leave. On average, work absenteeism was 30.5 days (SD=20.7) for the first ones and 9 days (SD= 6.3) for the latest. Caregivers of 21.7% of inpatients and 8.5% of outpatients also had work absenteeism during 10.7 and 4.1 days on average respectively. Mean cost was J6,236/inpatient (CI95%=1,384
14,623) and J940/outpatient (CI95% =66
3,064). The healthcare economic burden of patients with confirmed influenza was J144,773,577 (IC95% 13,753,043
383,467,535). More than 86% of expenditures were a result of outpatients" utilization. Conclusion: Cost per H1N1-patient did not defer much from seasonal influenza estimates. Hospitalizations and work absenteeism represented the highest cost per patient.

Sociodemographic Factors and Clinical Conditions Associated to Hospitalization in Influenza A (H1N1) 2009 Virus Infected Patients in Spain, 2009-2010

Sociodemographic Factors and Clinical Conditions Associated to Hospitalization in Influenza A (H1N1) 2009 Virus Infected Patients in Spain, 2009-2010 Gonzalez-Candelas, F.; Astray, J.; Alonso, J.; Castro, A.; Cantón, R.; Galán, J.C.; Garin, O.; Sáez, M.; Soldevila, N.; Baricot, M.; Castilla, J.; Godoy, P.; Delgado-Rodríguez, M.; Martín, V.; Mayoral, J.M.; Pumarola Suñé, Tomás; Quintana, J.M.; Tamames, S.; Domínguez García, Àngela The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population.

Effect of refuge supplement on Audouin's gull chick survival

Effect of refuge supplement on Audouin's gull chick survival Prieto, Jordi; Jover Armengol, Lluís de; Ruiz, Xavier One of the main threats to Audouin´s gull (Larus audouinii) at Chafarinas Islands is predation on eggs and chicks by the yellow-legged gull (Larus cachinnans). During the 1999 and 2000 breeding seasons we tested the effects of supplementary refuge availability on chick survival. Well before the laying period, nine adjacent enclosures were erected inside Audouin´s gull´s breeding grounds and some of them were supplied with artificial refuges. Our results showed significantly greater chick survival in the enclosures with artificial refuges than in control ones. In 2000, an overall lower breeding success of Audouin´s gull and a dilution of the refuge effect were observed. These results were probably related to food-shortage that year. We suggest that, along with other factors, an increase in refuge availability may significantly enhance Audouin´s gull chick survival.

Differences in diet between the two largest breeding colonies of Audouin's gulls: the effects of fishery activities

Differences in diet between the two largest breeding colonies of Audouin's gulls: the effects of fishery activities Pedrocchi Rius, Vittorio; Oro, Daniel; González-Solís, Jacob; Ruiz Gabriel, Xavier; Jover Armengol, Lluís de We analysed and compared the diet of Audouin´s gulls Larus audouinii between their two largest breeding sites in the world: the Ebro Delta and the Chafarinas Islands (western Mediterranean). These two localities showed marked differences in the features of the commercial fishing fleet: in the Ebro Delta area a large fishing fleet produced large amounts of discards, while in the Chafarinas the fleet discarded smaller amounts of fish and marine invertebrates, due to the smaller number of vessels. It is also likely that the percentage of discards from total catches is also lower around the Chafarinas than at the Ebro Delta. We distinguished two types of fishing to compare diet compositions: diurnal (only trawling activity) and diurnal and nocturnal (trawling and purse-seine activity, respectively). We also differentiated regurgitates from young nestlings (up to 20 days old) and from older nestlings or adult birds. At the two localities, fish was the main food of Audouin´s gulls, with epipelagic prey (mainly clupeoids) being more important when both diurnal and nocturnal fisheries were operating. This confirms that epipelagic prey either caught actively by the gulls or linked to fisheries was particularly important in the feeding habits of Audouin´s gulls. Nevertheless, differences between the two colonies appear mainly when only trawlers operated: while at the Ebro Delta gulls showed higher consumption of benthic-mesopelagic prey (probably linked to a higher trawler discard availability), gulls from the Chafarinas Islands consumed higher biomass of epipelagic prey probably caught actively at night. When both fleets operated around the two colonies, the average biomass of prey in a regurgitate of younger chicks was significantly higher at the Ebro Delta than at Chafarinas, and the opposite trend was recorded for older nestlings and adults. Niche width was broader in Chafarinas than in the Ebro Delta for both age classes and for any fishing fleet schedule, suggesting again that the exploitation of discards was higher at the Ebro Delta than at the Chafarinas, where gulls showed a more varied diet. Despite the fact that availability of discards was probably higher at the Ebro Delta than at Chafarinas, the per capita availability was not so different at both localities due to the increasing seabird community population at the Ebro Delta, which ca. doubled that at Chafarinas in the last decade.

L'ensenyament de la Toxicologia a Farmàcia. Els seminaris com una eina per a l'avaluació continuada.

L'ensenyament de la Toxicologia a Farmàcia. Els seminaris com una eina per a l'avaluació continuada. Gómez Catalán, Jesús; Barenys Espadaler, Marta; Teixidó Condomines, Elisabet; Piqué Benages, Maria Esther; Boix Sabria, Núria; Llobet Mallafré, Joan M. (Joan Maria); Rodamilans Pérez, Miguel Con la finalidad de adaptarnos al EEES, desarrollamos una herramienta que nos permitiera realizar un proceso de evaluación continua de la asignatura troncal de Toxicología. En el presente trabajo presentamos los resultados de este modelo en el que utilizamos los seminarios como elementos básicos de este proceso. Describimos cómo se estructuran y desarrollan estos seminarios, así como el modelo de evaluación de los mismos. Los seminarios fueron evaluados con una puntuación máxima del 30 % sobre la nota final de la signatura, y la participación en los mismos con un máximo del 10 %. Algunos de estos seminarios incorporaban evaluaciones realizadas antes del desarrollo de los mismos, que denominábamos «pre», y otras justo al final del desarrollo de los mismos, que denominábamos «post». Esta herramienta de evaluación continua se ha mostrado muy eficaz en lo que respecta al grado de participación y preparación de los alumnos. Además, ha supuesto un cambio significativo en el grado de implicación de los profesores, y una mejora de la comunicación alumno-profesor.

La enseñanza de la Toxicología en Farmacia: los seminarios como herramienta para la evaluación continuada

La enseñanza de la Toxicología en Farmacia: los seminarios como herramienta para la evaluación continuada Gómez Catalán, Jesús; Barenys Espadaler, Marta; Teixidó Condomines, Elisabet; Piqué Benages, Maria Esther; Boix Sabria, Núria; Llobet Mallafré, Joan M. (Joan Maria); Rodamilans Pérez, Miguel Con la finalidad de adaptarnos al EEES, desarrollamos una herramienta que nos permitiera realizar un proceso de evaluación continua de la asignatura troncal de Toxicología. En el presente trabajo presentamos los resultados de este modelo en el que utilizamos los seminarios como elementos básicos de este proceso. Describimos cómo se estructuran y desarrollan estos seminarios, así como el modelo de evaluación de los mismos. Los seminarios fueron evaluados con una puntuación máxima del 30 % sobre la nota final de la signatura, y la participación en los mismos con un máximo del 10 %. Algunos de estos seminarios incorporaban evaluaciones realizadas antes del desarrollo de los mismos, que denominábamos «pre», y otras justo al final del desarrollo de los mismos, que denominábamos «post». Esta herramienta de evaluación continua se ha mostrado muy eficaz en lo que respecta al grado de participación y preparación de los alumnos. Además, ha supuesto un cambio significativo en el grado de implicación de los profesores, y una mejora de la comunicación alumno-profesor.

Immunoglobulin A and C reactive protein levels in ankylosing spondylitis.

Immunoglobulin A and C reactive protein levels in ankylosing spondylitis. Collado Cruz, Antonio; Sanmartí Sala, Raimon; Brancós Cunill, Ma. Antonia; Kanterewicz Binstock, Eduardo; Gallart, T.; Rotés Querol, J. (Jaume), 1921-2008; Cobos Carbó, Alberto

Validity of an adaptation of the Framingham Cardiovascular Risk Function: the VERIFICA Study.

Validity of an adaptation of the Framingham Cardiovascular Risk Function: the VERIFICA Study. Marrugat, Jaume, 1954-; Subirana Cachinero, Isaac; Comín, Eva; Cabezas, Carmen; Vila, Joan; Elosúa Ramo, Roberto; Nam, Byung-Ho; Ramos, Rafel; Sala Montero, Joan; Solanas Saura, Pascual; Cordón Granados, Ferran; Gené Badia, Joan; D'Agostino, Ralph B.

Monitoring mortality as an indicator of influenza in Catalonia, Spain.

Monitoring mortality as an indicator of influenza in Catalonia, Spain. Domínguez García, Àngela; Muñoz, Pilar; Martínez i Mateo, Anna Isabel; Orcau i Palau, Àngels This study aimed to investigate the behaviour of two indicators of influenza activity in the area of Barcelona and to evaluate the usefulness of modelling them to improve the detection of influenza epidemics. DESIGN: Descriptive time series study using the number of deaths due to all causes registered by funeral services and reported cases of influenza-like illness. The study concentrated on five influenza seasons, from week 45 of 1988 to week 44 of 1993. The weekly number of deaths and cases of influenza-like illness registered were processed using identification of a time series ARIMA model. SETTING: Six large towns in the Barcelona province which have more than 60,000 inhabitants and funeral services in all of them. MAIN RESULTS: For mortality, the proposed model was an autoregressive one of order 2 (ARIMA (2,0,0)) and for morbidity it was one of order 3 (ARIMA (3,0,0)). Finally, the two time series were analysed together to facilitate the detection of possible implications between them. The joint study of the two series shows that the mortality series can be modelled separately from the reported morbidity series, but the morbidity series is influenced as much by the number of previous cases of influenza reported as by the previous mortality registered. CONCLUSIONS: The model based on general mortality is useful for detecting epidemic activity of influenza. However, because there is not an absolute gold standard that allows definition of the beginning of the epidemic, the final decision of when it is considered an epidemic and control measures recommended should be taken after evaluating all the indicators included in the influenza surveillance programme.

Dramatic decline of serogrup C meningococcal disease incidence in Catalonia (Spain) 24 months after a mass vaccination programme of children and young people

Dramatic decline of serogrup C meningococcal disease incidence in Catalonia (Spain) 24 months after a mass vaccination programme of children and young people Salleras i Sanmartí, Lluís; Domínguez García, Àngela; Prats, Guillem, 1942-; Parrón, I.; Muñoz, Pilar STUDY OBJECTIVES The objective of this study was to evaluate the effectiveness of a mass vaccination programme carried out in Catalonia (Spain) in the last quarter of 1997 in response to an upsurge of serogroup C meningococcal disease (SCMD). DESIGN Vaccination coverage in the 18 month to 19 years age group was investigated by means of a specific vaccination register. Vaccination effectiveness was calculated using the prospective cohort method. Cases of SCMD were identified on the basis of compulsory reporting and microbiological notification by hospital laboratories. Vaccination histories were investigated in all cases. Unadjusted and age adjusted vaccination effectiveness referred to the time of vaccination and the corresponding 95% confidence intervals (CI) were estimated at 6, 12, 18 and 24 months of follow up. SETTING All population aged 18 months to 19 years of Catalonia. MAIN RESULTS A total of seven cases of SCMD were detected at six months of follow up (one in the vaccinated cohort), 12 cases at 12 months (one in the vaccinated cohort), 19 cases at 18 months (two in the vaccinated cohort) and 24 at 24 months (two in the vaccinated cohort). The age adjusted effectiveness was 84% (95%CI 30, 97) at six months, 92% (95%CI 63, 98) at 12 months, 92% (95% CI 71, 98) at 18 months and 94% (95%CI 78, 98) at 24 months. In the target population, cases have been reduced by more than two thirds (68%) two years after the vaccination programme. In the total population the reduction was 43%. CONCLUSION Vaccination effectiveness has been high in Catalonia, with a dramatic reduction in disease incidence in the vaccinated cohort accompanied by a relevant reduction in the overall population. Given that vaccination coverage was only 54.6%, it may be supposed that this vaccination effectiveness is attributable, in part, to the herd immunity conferred by the vaccine.

Prevalence of articular chondrocalcinosis in elderly subjects in a rural area of Catalonia

Prevalence of articular chondrocalcinosis in elderly subjects in a rural area of Catalonia Sanmartí Sala, Raimon; Pañella, Domingo; Brancós Cunill, Ma. Antonia; Canela Soler, Joan; Collado Cruz, Antonio; Brugués Tarradellas, Joan The occurrence of rheumatic disorders did not differ significantly between subjects with articular chondrocalcinosis and those without. CONCLUSIONS--Articular chondrocalcinosis is an age related disorder, which could partly explain the discrepancies in its prevalence reported in previous studies. In most subjects with articular chondrocalcinosis recruited from an unselected population the clinical manifestations are probably mild or even absent.

Auditing the management of vaccine-preventable disease outbreaks: the need for a tool

Auditing the management of vaccine-preventable disease outbreaks: the need for a tool Torner Gràcia, Núria; Carnicer-Pont, Dolors; Castilla, Jesus; Caylà i Buqueras, Joan A.; Godoy i García, Pere; Domínguez García, Àngela Public health activities, especially infectious disease control, depend on effective teamwork. We present the results of a pilot audit questionnaire aimed at assessing the quality of public health services in the management of VPD outbreaks. Audit questionnaire with three main areas indicators (structure, process and results) was developed. Guidelines were set and each indicator was assessed by three auditors. Differences in indicator scores according to median size of outbreaks were determined by ANOVA (significance at p (greater than or equal to) 0.05). Of 154 outbreaks; eighteen indicators had a satisfactory mean score, indicator "updated guidelines" and "timely reporting" had a poor mean score (2.84±106 and 2.44±1.67, respectively). Statistically significant differences were found according to outbreak size, in the indicators "availability of guidelines/protocol updated less than 3 years ago" (p = 0.03) and "days needed for outbreak control" (p = 0.04). Improving availability of updated guidelines, enhancing timely reporting and adequate recording of control procedures taken is needed to allow for management assessment and improvement.

Procalcitonin and C-Reactive Protein for invasive bacterial pneumonia diagnosis among children in Mozambique, a malaria-endemic area

Procalcitonin and C-Reactive Protein for invasive bacterial pneumonia diagnosis among children in Mozambique, a malaria-endemic area Díez-Padrisa, Núria; Bassat Orellana, Quique; Machevo, Sonia; Quintó, Llorenç; Morais, Luis; Nhampossa, Tacilta; O'Callaghan-Gordo, Cristina; Torres Martí, Antoni; Alonso, Pedro; Roca i Aparicio, Anna Background: Pneumonia is the major cause of mortality and morbidity in children worldwide. Procalcitonin (PCT) and C-reactive protein (CRP) are used in developed countries to differentiate between viral and bacterial causes of pneumonia. Validity of these markers needs to be further explored in Africa. Methodology and Principal Findings: We assessed the utility of PCT and CRP to differentiate viral from invasive bacterial pneumonia in children &5 years hospitalized with clinical severe pneumonia (CSP) in rural Mozambique, a malaria-endemic area with high HIV prevalence. Prognostic capacity of these markers was also evaluated. Out of 835 children with CSP, 87 fulfilled definition of viral pneumonia and 89 of invasive bacterial pneumonia. In absence of malaria parasites, levels of PCT and CRP were lower in the viral group when compared to the invasive bacterial one (PCT: median = 0.21 versus 8.31 ng/ml, p&0.001; CRP: 18.3 vs. 185.35 mg/l, p&0.001). However, in presence of malaria parasites distribution between clinical groups overlapped (PCT: median = 23.1 vs. 21.75 ng/ml, p = 0.825; CRP: median = 96.8 vs. 217.4 mg/l, p = 0.052). None of the two markers could predict mortality. Conclusions: Presence of malaria parasites should be taken into consideration, either for clinical or epidemiological purposes, if using PCT or CRP to differentiate viral from invasive bacterial pneumonia in malaria-endemic areas.

Hospitalizations due to rotavirus gastroenteritis in Catalonia, Spain, 2003-2008

Hospitalizations due to rotavirus gastroenteritis in Catalonia, Spain, 2003-2008 Garcia-Basteiro, Alberto L.; Bosch, Anna; Sicuri, Elisa; Bayas Rodríguez, José María; Trilla, Antoni; Hayes, Edward B. Background Rotavirus is the most common cause of severe gastroenteritis among young children in Spain and worldwide. We evaluated hospitalizations due to community and hospital-acquired rotavirus gastroenteritis (RVGE) and estimated related costs in children under 5 years old in Catalonia, Spain. Results We analyzed hospital discharge data from the Catalan Health Services regarding hospital admissions coded as infectious gastroenteritis in children under 5 for the period 2003-2008. In order to estimate admission incidence, we used population estimates for each study year published by the Statistic Institut of Catalonia (Idescat). The costs associated with hospital admissions due to rotavirus diarrhea were estimated for the same years. A decision tree model was used to estimate the threshold cost of rotavirus vaccine to achieve cost savings from the healthcare system perspective in Catalonia. From 2003 through 2008, 10655 children under 5 years old were admitted with infectious gastroenteritis (IGE). Twenty-two percent of these admissions were coded as RVGE, yielding an estimated average annual incidence of 104 RVGE hospitalizations per 100000 children in Catalonia. Eighty seven percent of admissions for RVGE occurred during December through March. The mean hospital stay was 3.7 days, 0.6 days longer than for other IGE. An additional 892 cases of presumed nosocomial RVGE were detected, yielding an incidence of 2.5 cases per 1000 child admissions. Total rotavirus hospitalization costs due to community acquired RVGE for the years 2003 and 2008 were 431,593 and 809,224 €, respectively. According to the estimated incidence and hospitalization costs, immunization would result in health system cost savings if the cost of the vaccine was 1.93 € or less. At a vaccine cost of 187 € the incremental cost per hospitalization prevented is 195,388 € (CI 95% 159,300; 238,400). Conclusions The burden of hospitalizations attributable to rotavirus appeared to be lower in Catalonia than in other regions of Spain and Europe. The relatively low incidence of hospitalization due to rotavirus makes rotavirus vaccination less cost-effective in Catalonia than in other areas with higher rotavirus disease burden.

RTS,S/AS02A malaria vaccine does not induce parasite CSP T cell epitope selection and reduces multiplicity of infection

RTS,S/AS02A malaria vaccine does not induce parasite CSP T cell epitope selection and reduces multiplicity of infection Enosse, Sonia; Dobano, Carlota; Quelhas, Diana; Aponte, John J.; Lievens, Marc; Leach, Amanda; Sacarlal, Jahit; Greenwood, Brian; Milman, Jessica; Dubovsky, Filip; Cohen, Joe; Thompson, Ricardo; Ballou, W. Ripley; Alonso, Pedro; Conway, David J.; Sutherland, Colin J. Objective: The candidate malaria vaccine RTS,S/AS02A is a recombinant protein containing part of the circumsporozoite protein (CSP) sequence of Plasmodium falciparum, linked to the hepatitis B surface antigen and formulated in the proprietary adjuvant system AS02A. In a recent trial conducted in children younger than age five in southern Mozambique, the vaccinedemonstrated significant and sustained efficacy against both infection and clinical disease. In a follow-up study to the main trial, breakthrough infections identified in the trial were examined to determine whether the distribution of csp sequences was affected by the vaccine and to measure the multiplicity of infecting parasite genotypes. Design: P. falciparum DNA from isolates collected during the trial was used for genotype studies. Setting: The main trial was carried out in the Manhiça district, Maputo province, Mozambique, between April 2003 and May 2004. Participants: Children from the two cohorts of the main trial provided parasite isolates as follows: children from Cohort 1 who were admitted to hospital with clinical malaria; children from Cohort 1 who were parasite-positive in a cross-sectional survey at study month 8.5; children from Cohort 2 identified as parasite-positive during follow-up by active detection of infection. Outcome: Divergence of DNA sequence encoding the CSP T cell-epitope region sequence from that of the vaccine sequence was measured in 521 isolates. The number of distinct P. falciparum genotypes was also determined. Results: We found no evidence that parasite genotypes from children in the RTS,S/AS02A arm were more divergent than those receiving control vaccines. For Cohort 1 (survey at studymonth 8.5) and Cohort 2, infections in the vaccine group contained significantly fewer genotypes than those in the control group, (p 1/4 0.035, p 1/4 0.006), respectively, for the two cohorts. This was not the case for children in Cohort 1 who were admitted to hospital (p 1/4 0.478). Conclusions: RTS,S/AS02A did not select for genotypes encoding divergent T cell epitopes in the C-terminal region of CSP in this trial. In both cohorts, there was a modest reduction in the mean number of parasite genotypes harboured by vaccinated children compared with controls, but only among those with asymptomatic infections.

Foodborne norovirus outbreak: the role of an asymptomatic food handler

Foodborne norovirus outbreak: the role of an asymptomatic food handler Barrabeig i Fabregat, Irene; Rovira, Ariadna; Buesa, Javier; Bartolomé, Rosa; Pintó Solé, Rosa María; Prellezo, Hortensia; Domínguez García, Àngela Background: In July 2005 an outbreak of acute gastroenteritis occurred on a residential summer camp in the province of Barcelona (northeast of Spain). Forty-four people were affected among residents and employees. All of them had in common a meal at lunch time on 13 July (paella, round of beef and fruit). The aim of this study was to investigate a foodborne norovirus outbreak that occurred in the residential summer camp and in which the implication of a food handler was demonstrated by laboratory tests. Methods: A retrospective cohort study was designed. Personal or telephone interview was carried out to collect demographic, clinical and microbiological data of the exposed people, as well as food consumption in the suspected lunch. Food handlers of the mentioned summer camp were interviewed. Ten stool samples were requested from symptomatic exposed residents and the three food handlers that prepared the suspected food. Stools were tested for bacteries and noroviruses. Norovirus was detected using RT-PCR and sequence analysis. Attack rate, relative risks (RR) and its 95% confidence intervals (CI) were calculated to assess the association between food consumption and disease. Results: The global attack rate of the outbreak was 55%. The main symptoms were abdominal pain (90%), nausea (85%), vomiting (70%) and diarrhoea (42.5%). The disease remitted in 24-48 hours. Norovirus was detected in seven faecal samples, one of them was from an asymptomatic food handler who had not eaten the suspected food (round of beef), but cooked and served the lunch. Analysis of the two suspected foods isolated no pathogenic bacteria and detected no viruses. Molecular analysis showed that the viral strain was the same in ill patients and in the asymptomatic food handler (genotype GII.2 Melksham-like). Conclusions: In outbreaks of foodborne disease, the search for viruses in affected patients and all food handlers, even in those that are asymptomatic, is essential. Health education of food handlers with respect to hand washing should be promoted.

The Total Deviation Index estimated by Tolerance Intervals to evaluate the concordance of measurement devices

The Total Deviation Index estimated by Tolerance Intervals to evaluate the concordance of measurement devices Escaramís Babiano, Geòrgia; Ascaso Terrén, Carlos; Carrasco Jordan, Josep Lluís Background In an agreement assay, it is of interest to evaluate the degree of agreement between the different methods (devices, instruments or observers) used to measure the same characteristic. We propose in this study a technical simplification for inference about the total deviation index (TDI) estimate to assess agreement between two devices of normally-distributed measurements and describe its utility to evaluate inter- and intra-rater agreement if more than one reading per subject is available for each device. Methods We propose to estimate the TDI by constructing a probability interval of the difference in paired measurements between devices, and thereafter, we derive a tolerance interval (TI) procedure as a natural way to make inferences about probability limit estimates. We also describe how the proposed method can be used to compute bounds of the coverage probability. Results The approach is illustrated in a real case example where the agreement between two instruments, a handle mercury sphygmomanometer device and an OMRON 711 automatic device, is assessed in a sample of 384 subjects where measures of systolic blood pressure were taken twice by each device. A simulation study procedure is implemented to evaluate and compare the accuracy of the approach to two already established methods, showing that the TI approximation produces accurate empirical confidence levels which are reasonably close to the nominal confidence level. Conclusions The method proposed is straightforward since the TDI estimate is derived directly from a probability interval of a normally-distributed variable in its original scale, without further transformations. Thereafter, a natural way of making inferences about this estimate is to derive the appropriate TI. Constructions of TI based on normal populations are implemented in most standard statistical packages, thus making it simpler for any practitioner to implement our proposal to assess agreement.

"Pelas lentes do cinema. Bioética e ética em pesquisa". Dirce Guilhem, Debora Diniz, Fabio Zicker (Eds. ) . Letras Livres, Universidade de Brasí l i a , Brasília 2007, 216 páginas.

"Pelas lentes do cinema. Bioética e ética em pesquisa". Dirce Guilhem, Debora Diniz, Fabio Zicker (Eds. ) . Letras Livres, Universidade de Brasí l i a , Brasília 2007, 216 páginas. Lecuona Ramírez, Itziar de Comentario de un libro que está directamenterelacionado con el binomio Bioética y Cine. Bajo el título "Pelas lentes do Cinema. Bioética e Ética em Pesquisa" subyace una interesante e innovadora propuesta pedagógica, sobre todo, desde el punto devista metodológico, para la enseñanzade la Bioética a través de las películasy los documentales.

La regulación española de los Comités de Ética y las novedades introducidas por la nueva Ley de Investigación Biomédica

La regulación española de los Comités de Ética y las novedades introducidas por la nueva Ley de Investigación Biomédica Lecuona Ramírez, Itziar de El objetivo de este artículo es constatar que, actualmente, los Comités de Bioética no sólo tienen una plasmación en el ordenamientojurídico sino que pueden considerarse medios de regulación social que ayudan a la reflexión moral de los avances, a dilucidar los límites de actuación y sobre todo a proteger los derechos fundamentales de las personas.

Effects of erythropoietin on muscle O2 transport during exercise in patients with chronic renal failure.

Effects of erythropoietin on muscle O2 transport during exercise in patients with chronic renal failure. Marrades Sicart, Ramon Ma.; Roca Torrent, Josep, 1952-; Campistol Plana, Josep Ma.; Díaz, Orlando; Barberà i Mir, Joan Albert; Torregrosa, Josep V.; Masclans, Joan R.; Cobos Carbó, Alberto; Rodríguez-Roisin, Robert; Wagner, Peter D. Erythropoietin (rHuEPO) has proven to be effective in the treatment of anemia of chronic renal failure (CRF). Despite improving the quality of life, peak oxygen uptake after rHuEPO therapy is not improved as much as the increase in hemoglobin concentration ([Hb)] would predict. We hypothesized that this discrepancy is due to failure of O2 transport rates to rise in a manner proportional to [Hb]. To test this, eight patients with CRF undergoing regular hemodialysis were studied pre- and post-rHuEPO ([Hb] = 7.5 +/- 1.0 vs. 12.5 +/- 1.0 g x dl-1) using a standard incremental cycle exercise protocol. A group of 12 healthy sedentary subjects of similar age and anthropometric characteristics served as controls. Arterial and femoral venous blood gas data were obtained and coupled with simultaneous measurements of femoral venous blood flow (Qleg) by thermodilution to obtain O2 delivery and oxygen uptake (VO2). Despite a 68% increase in [Hb], peak VO2 increased by only 33%. This could be explained largely by reduced peak leg blood flow, limiting the gain in O2 delivery to 37%. At peak VO2, after rHuEPO, O2 supply limitation of maximal VO2 was found to occur, permitting the calculation of a value for muscle O2 conductance from capillary to mitochondria (DO2). While DO2 was slightly improved after rHuEPO, it was only 67% of that of sedentary control subjects. This kept maximal oxygen extraction at only 70%. Two important conclusions can be reached from this study. First, the increase in [Hb] produced by rHuEPO is accompanied by a significant reduction in peak blood flow to exercising muscle, which limits the gain in oxygen transport. Second, even after restoration of [Hb], O2 conductance from the muscle capillary to the mitochondria remains considerably below normal.

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain Martinez, Ana; Domínguez García, Àngela; Torner Gràcia, Núria; Ruiz, Laura; Camps, Neus; Barrabeig i Fabregat, Irene; Arias, César; Álvarez, Josep; Godoy i García, Pere; Balaña, Pilar Jorgina; Pumares, Analía; Bartolomé, Rosa; Ferrer, Dolors; Pérez, Unai; Pintó Solé, Rosa María; Buesa, Javier; Catalan Viral GastroenteritisStudy Group Background: Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain.Methods: In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005.Results: Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ¿10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p & 0.001)Conclusion: Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions.

Probe-specific mixed-model approach to detect copy number differences using multiplex ligation-dependent probe amplification (MLPA)

Probe-specific mixed-model approach to detect copy number differences using multiplex ligation-dependent probe amplification (MLPA) González, Juan R.; Carrasco Jordan, Josep Lluís; Armengol, Lluís; Villatoro, Sergi; Jover Armengol, Lluís de; Yasui, Yutaka; Estivill, Xavier, 1955- Background: MLPA method is a potentially useful semi-quantitative method to detect copy number alterations in targeted regions. In this paper, we propose a method for the normalization procedure based on a non-linear mixed-model, as well as a new approach for determining the statistical significance of altered probes based on linear mixed-model. This method establishes a threshold by using different tolerance intervals that accommodates the specific random error variability observed in each test sample.Results: Through simulation studies we have shown that our proposed method outperforms two existing methods that are based on simple threshold rules or iterative regression. We have illustrated the method using a controlled MLPA assay in which targeted regions are variable in copy number in individuals suffering from different disorders such as Prader-Willi, DiGeorge or Autism showing the best performace.Conclusion: Using the proposed mixed-model, we are able to determine thresholds to decide whether a region is altered. These threholds are specific for each individual, incorporating experimental variability, resulting in improved sensitivity and specificity as the examples with real data have revealed.