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L Salleras

Publications and source records attributed to L Salleras.

At least 37 records · Page 2Linked to original sources
PubMed2001

Estimated varicella incidence on the basis of a seroprevalence survey.

Varicella is a disease caused by varicella-zoster virus. It is transmitted via the respiratory route, is highly communicable and mainly affects young children. An effective vaccine is now available, whose routine use is advised by health authorities in the USA and which can prevent severe disease, although breakthrough infections do occur. In deciding whether or not to include a vaccine in the routine vaccination schedule, knowledge of the morbidity of the disease in question is fundamental. Although reporting of varicella is compulsory in Catalonia, doctors only have to report the weekly number of cases diagnosed, and not their age distribution. Given that recent data on the prevalence of the infection in Catalonia according to age groups is available, it was considered that, using these data, an estimation of age-related incidence could be made. The objective of the present study was to estimate the incidence of varicella in Catalonia on the basis of the available seroprevalence data. A curve was fitted to the observed prevalence and point prevalence estimates for all ages were obtained. The incidence was derived by smoothed prevalence for each of these age groups. Estimated variance of the estimated incidence was obtained by the delta method. Predicted prevalence in the 0-4 years age group was calculated by the smoothed prevalence. The model that best fitted the sample prevalence was the exponential function. The estimated number of varicella cases in this study was 46,419 (95% CI 40,507-52,270). As the population in Catalonia in 1996 was 6,090,040, the previous results give an incidence rate of 762.2 per 100,000 persons/year with their 95% CI (666.1-858.3). The method described may be applied to the study of incidence rates in relation to the prevalence of diseases if we accept that the infection produces permanent immunity; the risk of mortality is the same for infected and non-infected subjects and that the disease incidence and population remain constant in time.

Adolescent↗
PubMed2001

Review of the utilisation of a university hospital in Barcelona (Spain): evolution 1992-1996.

BACKGROUND: To test the applicability of the appropriateness evaluation protocol (AEP) as a tool for reviewing hospital utilisation. To quantify and to compare the rate of inappropriate admissions and amount of in-hospital days, emphasising the main causes and factors in the hospital associated with inappropriateness during the studied periods of time. PATIENTS AND METHODS: Two retrospective studies were carried out, the first one in 1992, when 2048 clinical histories were analysed, and the second in 1996, with 1099 reviewed histories. The tool used for the evaluation of the level of hospital utilisation is the AEP. RESULTS: The proportion of admissions considered to be inappropriate was 25% (95% CI: 20.8-24.5) in 1992, and 16% (95% CI: 13.8-18.2) in 1996. Premature admission was the most frequent cause of inappropriateness in both periods. The logistic regression model built for the dependent variable admission showed the following variables to be associated to inappropriateness: scheduled admission (OR: 15; 95% CI: 10.8-20.7) and (OR: 10; 95% CI: 6-16.5), weekend admission (OR: 2; 95% CI: 1.3-1.2) and (OR: 2; 95% CI: 1.2-2.3), for 1992 and 1996, respectively. The rate of inappropriate in-hospital stays in 1992 was 29% (95% CI: 28.3-29.6), and 13.5% (95% CI: 12.7-14.3) in 1996. Hospital organisational problems were the main cause of inappropriate in-hospital days in 1992, and diagnostic/ therapeutical tests that could be performed ambulatorily ranked first in 1996. The logistic regression model built for the dependent variable in-hospital days had the following independent variables associated to its inappropriateness: discharge on weekdays (OR: 1.4; 95% CI: 1.2-1.8) and (OR: 0.6; 95% CI: 0.5-0.8) and length of stay (OR: 2; 95% CI: 1.8-2.4) and (OR: 2.4; 95% CI: 2.3-2.5), for 1992 and 1996 respectively, among other variables. CONCLUSION: Periodic checking of the utilisation levels with the application of methods such as the AEP will contribute towards adapting hospital management in the more competitive current setting.

Female↗
PubMed2001

East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme.

BACKGROUND: Differences have been reported in life expectancy and mortality between Eastern and Western European countries. Also, disparities have been found among different European countries or populations concerning the implementation of preventive practices by health professionals. This study analysed the patterns of reported preventive practices in three Eastern European areas and three Western ones. METHODS: Health surveys were carried out in particular geographical area of six countries participating in the project (three Eastern European countries; Russia, Poland and Hungary and three Western European countries; Finland, Germany and Spain). All of them are partners in the WHO-CINDI (Countrywide Integration Non-communicable Diseases Intervention) Programme. Three preventive practices are analysed: reported blood pressure and blood cholesterol measurements and reported antismoking counseling during the last year. Data are presented separately for the general population and for people reporting specific chronic conditions (cardiovascular disease, respiratory disease and/or diabetes mellitus). RESULTS: Blood pressure measurement and antismoking counseling are more frequently reported to be carried out by primary health care physicians in the Eastern European areas while blood cholesterol measurement is more frequently reported in Western European countries. All these preventive activities are more frequently reported to be done among people with chronic conditions than in the population as a whole. CONCLUSIONS: Major differences have been found in reported preventive practices between Eastern and Western European countries. Great potential exists for chronic disease prevention among them.

Blood Pressure↗
PubMed2001

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

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.

Adolescent↗
PubMed2001

Confirmed interruption of indigenous measles transmission in Catalonia.

From November 1998 to December 2000, 84 suspected measles cases were reported in Catalonia (6 090 040 inhabitants). Of the 73 laboratory tested cases (87%), 20 showed IgM antibodies specific to measles and 3 were epidemiologically linked to a confirmed case. Among these 23 confirmed cases, 13 were indigenous, the last two cases reported dating back from June 1999 and July 2000. These results confirm the success of the measles elimination programme implemented in 1998 in Catalonia.

Antibodies, Viral↗
PubMed2000

Hepatitis A and B in children and adolescents--what can we learn from Puglia (Italy) and Catalonia (Spain)?

Viral hepatitis remains a major contributor to the global disease burden. Mass immunisation strategies against hepatitis B have been adopted by more than 90 developing and industrialised countries. Countries with low hepatitis A endemicity are experiencing cyclical outbreaks and an epidemiological shift, with larger numbers of individuals at risk of infection at an older age, resulting in increased morbidity. The high cost of outbreaks in these countries has made immunisation strategies cost-effective. The development of a vaccine against hepatitis A and a combined vaccine against hepatitis A and hepatitis B offers potentially exciting opportunities for a preventative approach in areas of both low and high endemicity. Existing mass immunisation programmes against hepatitis B will facilitate the adoption of joint strategies illustrated by the examples of Puglia (Italy) and Catalonia (Spain).

Adolescent↗
PubMed2000

Seroepidemiology of varicella-zoster virus infection in Catalonia (Spain). Rationale for universal vaccination programmes.

With the aim of designing a strategy for vaccination against varicella-zoster virus (VZV), the results of a seroepidemiological survey on VZV infection carried out in a sample of the population of Catalonia are presented. Representative samples from schoolchildren (30 schools) and adults (97 municipal areas) were obtained by random cluster sampling. In the study, 883 children and 1253 adults were included. Age, gender, place of birth, place of residence, educational level and occupation were investigated in the study subjects. An ELISA test was used to measure varicella antibodies. The prevalence of varicella antibodies increased with age, being 85% in the 5-9 years age group, 92% in the 10-14 years age group, 94% in the 15-34 years age group and almost 100% in people over 35. No association was found between sociodemographic variables studied and prevalence levels of antibodies. These results suggest that the best vaccination strategy in Catalonia would be to add a temporary vaccination programme of pre-adolescents at 12 years to routine vaccination at 15 months.

Adolescent↗
PubMed2000

[Norwalk virus-like food poisoning after eating oysters].

BACKGROUND: The aim of this study was to conduct a clinical-epidemiological and microbiological investigation into an outbreak of food-borne disease due to the consumption of oysters. PATIENTS AND METHODS: A historic cohort study was conducted into the consumption of 15 food items and clinical symptoms. The influence of each foodstuff was assessed by Mantel-Haenzel stratified relative risk (RRM-H) at 95% confidence intervals, and was confirmed by dose-response analysis with a chi 2 test tendency. We investigated sample stools from 5 patients and 2 food-handlers. RESULTS: The overall attack rate was 38.0% (19/50). The median period of incubation was 39.0 h (maxim 62 and minimum 3 h). The symptoms were: fever 17.6% (3/17), diarrhoea 57.9% (11/19), vomits 84.2% (16/19), nausea 89.5% (17/19) and abdominal pain 89.5% (17/19). In stratified analysis, the Mantel-Haenzel method revealed a statistically risk for oysters (RRM-H = 3.3; IC 95%: 1.1-8.7), while the RRM-H value for sea snails was not significant (RRM-H = 2.8; IC 95%: 0.9-41.1). For oyster consumption, the dose-response test was statistically significant (p = 0.005). Examination by electron microscopy revealed small round structured viruses compatible with Norwalk-like virus. The oyster contamination was reported to the public health authority. CONCLUSIONS: This research highlights the usefulness of dose-response analysis in presenting epidemiological evidence, reveals the potential role of oyster consumption in food-borne disease such us Norwalk-like virus and show the need for monitoring production centres and oyster beds in order to prevent further cases of contamination.

Adult↗
PubMed2000

Changes in the seroepidemiology of hepatitis B infection in Catalonia 1989-1996.

The objective of this study was to investigate the prevalence of hepatitis B markers in a representative sample of 2142 subjects in Catalonia, Spain, and to compare it with previous studies. Multiple logistical regression analysis was carried out to determine variables associated with the markers studied. The prevalence of anti-HBc and HBsAg was 9.1% and 1.2%, respectively. Male gender, urban habitat, birth place outside Catalonia and lower social class were associated with the presence of anti-HBc. Carrier status was only associated with male gender. Between 1989 and 1996 there was a decrease of 46% in the prevalence of serum HBV markers mainly in the 25-44 (P<0.0001) and 35-64 year (P=0.0002) age groups, in those born in Catalonia (P=0.003) and in those in the higher social classes (P<0.0001). These decreases can be explained by the improved socioeconomic conditions and, partially, by the routine pre-adolescent and risk group programmes of immunization.

Adolescent↗
PubMed2000

[Prevalence and factors associated to the presence of fatty liver in apparently healthy adult men].

BACKGROUND: Alcohol intake in one of the factors associated with fatty liver, although its contribution as well as other factors have not been completely established. Therefore the aim of this study was to assess the prevalence and associated factors for fatty liver diagnosed by ultrasonography. SUBJECTS AND METHODS: 1,801 presumably healthy male workers (age range 18-60 years). A complete physical and laboratory investigations, including HBsAg and anti-HCV antibodies, a detailed interview on alcohol intake, and an abdominal ultrasound examination were performed in all cases. Diagnosis of fatty liver was based on defined ultrasonographic criteria. RESULTS: Eighty eight cases were excluded because of the HBsAg or anti-HCV positivity or incomplete ultrasonography. Among the remaining 1,713 cases, 236 (13.8%; 12.2-15.4) had fatty liver. Logistic regression analysis disclosed age (RR: 1.04; CI 95%; 1.03-1.05), ethanol intake > 40 g/d (2.19; 1.81-2.65), gamma-glutamyl-transferase > 40 U/l (3.51; 2.95-4.18), body mass index > 30 (3.87; 3.22-4.66) and glycemia > 120 mg/dl (2.69; 1.85-3.90) as the risk factors for fatty liver. Fatty liver was present in 8.8% of cases who did not have obesity, diabetes or hypercholesterolemia. When the subjects with obesity, hyperglycemia or hypercholesterolemia were excluded, regression analysis confirmed age, ethanol intake and gamma-glutamyl-transferase as independent factors associated with fatty liver. CONCLUSIONS: Age, alcohol intake, obesity, and increased serum levels of glucose, cholesterol and gammaglutamyl transferase are the main factors associated with fatty liver in presumably healthy adult men.

Adolescent↗
PubMed2000

Prospects for vaccination against hepatitis A and B in Catalonia (Spain).

Catalonia is in an area of intermediate endemicity for hepatitis A virus (HAV) infection. An Expert Committee has recently proposed the implementation of universal hepatitis A vaccination for 12-year-olds, based on the fact that no risk factors can be identified for hepatitis A in 50% of cases, and also that selective vaccination targeted at high-risk groups has a limited potential to reduce the incidence of hepatitis A. The well-established programme of hepatitis B vaccination of pre-adolescents in Catalonian schools has high levels of vaccination coverage. This will provide a means to introduce hepatitis A vaccination in a cost-effective way in schools, by replacing the single vaccine with the combined hepatitis A and B vaccine. High-risk groups will also continue to be targeted. A pilot programme has commenced in the 1998/1999 school year and will be evaluated after 3 years. If it is successful, it will be extended indefinitely.

Adolescent↗
PubMed2000

Prevalence of Haemophilus influenzae pharyngeal carriers in the school population of Catalonia. Working Group on invasive disease caused by Haemophilus influenzae.

The objective of this study was to determine the prevalence of healthy Haemophilus influenzae (Hi) pharyngeal carriers in a representative sample of the Catalonian school population, as well as the factors associated. A two-stage cluster sampling was carried out. Parents were given a questionnaire to collect information on sociodemographic and epidemiological variables. A pharyngeal swab was performed on children when informed consent was given by parents, and was cultured on chocolate agar with 260 microg/ml bacitracin. Of the 1212 children studied, 316 (26%) H. influenzae carriers were detected: 5 (0.4%) serotype b, 1 (0.08%) serotype c, 6 (0.5%) serotype e, 5 (0.4%) serotype f, and 299 (24.7%) non-typable. Age, gender and geographical location were the only variables associated with H. influenzae carrier status. The prevalence of non-typable H. influenzae carriers was similar to that of studies carried out in other countries, while that of serotype b carriers was similar to the remainder of H. influenzae capsulates, and lower than that described in previous studies. These data are in accordance with the low incidence of the disease observed in our context, although the possibility that the vaccine coverage may have affected the results of this study cannot be dismissed.

Adolescent↗
PubMed1999

[Excess length of stay attributable to nosocomial bacteremia: usefulness of the Hospitalization Appropriateness Protocol].

BACKGROUND: To evaluate the usefulness of the Appropriateness Evaluation Protocol (AEP) for assessing the extra length of stay attributable to nosocomial bacteremia. PATIENTS AND METHODS: Retrospective review of the medical records (1989, 1990 and 1991) of all patients, who developed Staphylococcus aureus nosocomial bacteremia. Evaluation of hospital stay was performed using the AEP. Calculation of the kappa index and intraclass correlation coefficient. RESULTS: A total of 158 patients were included S. aureus nosocomial bacteremia is responsible for a mean excess length of stay of 4.3 days per patient. Kappa index for the method used was 76%, and intraclass correlation coefficient was 61%. CONCLUSIONS: The AEP has been shown to be a reliable tool for assessing the extra days of stay attributable to nosocomial bacteremia in the Spanish National Health System. The use of AEP should be extended to assess the extra stay attributable to other types of nosocomial infections.

Adult↗
PubMed1999

[Changes in seroepidemiology of hepatitis A virus infection in Catalonia in the period 1989-1996. Implications for new vaccination strategy].

BACKGROUND: The aim of this study was to investigate the prevalence of the risk factors of hepatitis A virus infection (HAV) in a representative sample of a Catalonian population obtained from 1995 to 1996 and the changes in the prevalence of this infection over the period of 1989-1996. SUBJECTS AND METHODS: The prevalence of anti-HAV was determined by an ELISA test in a randomized sample of 2,142 individuals, 884 from 6 to 14 years of age and 1,248 over the age of 15 years. The results were related to sociodemographic variables and multiple logistic regression analysis was performed to establish which variables were related to the risk of infection. RESULTS: The global prevalence of HAV infection was 67.8%. The prevalence of HAV infection increased from 3.5% in the group from 5-14 years of age to 99% in that over the age of 64 years (p < 0.001). A higher prevalence was observed in those born outside of Catalonia (odds ratio [OR] = 3.97; 95% CI, 2.4-6.4) and in those with a lower level of education (OR = 2.60; 95% CI, 1.9-3.5). In the period 1989-1996 the prevalence of the infection has decreased in the population under the age of 45, the differences being statistically significant in the age groups 10-14 (p < 0.0001) and 25-34 (p < 0.0001). CONCLUSIONS: The prevalence of HAV infection has progressively decreased in Catalonia while it proportionally increases the susceptible population under the age of 45 years. These findings may be important in the design of strategies for the prevention of HAV infection with universal vaccination programs against this disease.

Adolescent↗
PubMed1999

Measles immunity and vaccination policy in Catalonia.

The prevalence of antibodies against measles in a representative sample of the school population in Catalonia was established and the results compared with previous studies. The study was carried out in 1996 using blood samples obtained from schoolchildren aged 6-7 years, 10-11 years, 13 14 years and 15-16 years. 1231 schoolchildren were studied. The global prevalence of antibodies was 96.3%, and a considerable increase was observed with respect to the prevalence in 1986 (89.4%). The level of antibodies was 94% at 6-7 years and 10-11 years, 99.7% at 13-14 years and 98.3% at 15 16 years. These data would suggest the advancement of the administration of the second dose of measles-mumps rubella vaccine to 4 6 years instead of at 11 years.

Adolescent↗
PubMed1999

[Haemophilus influenzae type b invasive disease in Catalonia (1996)].

BACKGROUND: The purpose of this study was to find out the incidence and characteristics of H. influenzae type b invasive disease (HibID) in Catalonia, Spain. MATERIAL AND METHODS: An active surveillance of H. influenzae isolated from normally sterile sites was carried out during 1996. Microbiology laboratories of hospitals of Catalonia were periodically contacted by telephone. The serotype of all the strains was studied. RESULTS: The incidence of H. influenzae invasive disease (HIID) was 7.1 per 100,000 in children under 5 years and 1.0 per 100,000 in those over 5 years. The incidence of serotype b was 6.4 per 100,000 children under 5 years and 0.2 above this age. Only three strains belonged to types other than b (d, e and f). CONCLUSIONS: The incidence of HIbID is uncommon in Catalonia, lower than that registered in the prevaccine era in other countries and regions of the same geographical area.

Adolescent↗