Direccion General de Salud Publica

Palma, Spain

Direccion General de Salud Publica

Palma, Spain

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Morel N.,Comision Nacional de Zoonosis | Morel N.,Institute Higiene | Lassabe G.,Institute Higiene | Elola S.,Comision Nacional de Zoonosis | And 5 more authors.
PLoS Neglected Tropical Diseases | Year: 2013

Cystic echinococcosis is still a major concern in South America. While some regions show advances in the control of the disease, others have among the highest incidence in the world. To reverse this situation the Pan American Health Organization (PAHO) has launched a regional project on cystic echinococcosis control and surveillance. An early concern of the program was the lack of a standardized diagnostic tool to monitor infection in dogs, a key target of control programs. Under this premise, we have developed a new copro-ELISA test after extensive screening of a large panel of monoclonal antibodies (MAbs) and polyclonal sera, which performs with high standards of sensitivity (92.6%) and specificity (86.4%) as established by necropsy diagnosis of dogs. The key component of the test, MAbEg9 has a convenient IgG isotype and reacts with a periodate-resistant epitope found in high molecular weight components of the worm. Time-course analysis of experimentally infected dogs showed that even animals with a very low number of parasites could be detected as early as day 20 post infection. The test was formulated in a ready-to-use kit format with proven stability of each component for a minimum of 3 months at room temperature. This characteristic facilitates its standardized use and shipping to other laboratories, which was demonstrated by the identical results obtained by two different laboratories in Peru and our own laboratory when a large number of field samples were analyzed independently in a blind fashion. © 2013 Morel et al.


Sahuquillo-Arce J.M.,Hospital la Fe | Selva M.,Direccion General de Salud Publica | Perpinan H.,University of San Pablo - CEU | Perpinan H.,University of Valencia | And 5 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2011

Escherichia coli and the antimicrobial pressure exerted on this microorganism can be modulated by factors dependent on the host. In this paper, we describe the distribution of antimicrobial resistance to amikacin, tobramycin, ampicillin, amoxicillin clavulanate, cefuroxime, cefoxitin, cefotaxime, imipenem, ciprofloxacin, fosfomycin, nitrofurantoin, and trimetoprim-sulfametoxazole in more than 100,000 E. coli isolates according to culture site and patient age, gender, and location. Bayesian inference was planned in all statistical analysis, and Markov chain Monte Carlo simulation was employed to estimate the model parameters. Our findings show the existence of a marked difference in the susceptibility to several antimicrobial agents depending on from where E. coli was isolated, with higher levels of resistance in isolates from medical devices, the respiratory system, and the skin and soft tissues; a higher resistance percentage in men than in women; and the existence of a clear difference in antimicrobial resistance with an age influence that cannot be explained merely by means of an increase of resistance after exposure to antimicrobials. Both men and women show increases in resistance with age, but while women show constant levels of resistance or slight increases during childbearing age and greater increases in the premenopausal age, men show a marked increase in resistance in the pubertal age. In conclusion, an overwhelming amount of data reveals the great adaptation capacity of E. coli and its close interaction with the host. Sex, age, and the origin of infection are determining factors with the ability to modulate antimicrobial resistances. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Otero M.J.,Complejo Asistencial Universitario Of Salamanca | Moreno-Gomez A.M.,Hospital Santos Reyes | Agra Y.,Direccion General de Salud Publica
European Journal of Internal Medicine | Year: 2014

Background Patients with chronic diseases often receive multiple medications and are associated with increased vulnerability to medication errors. Identifying high-alert medications for them would help to prioritize the interventions with greatest impact for improving medication safety. The aim of this study was to develop a list of high-alert medications for patients with chronic illnesses (HAMC list) that would prove useful to the Spanish National Health Service strategies on chronicity.Methods The RAND/UCLA appropriateness method was used. Drug classes/drugs candidates to be included on the HAMC list were identified from a literature search in MedLine, bulletins issued by patient safety organizations, incidents recorded in Spanish incident reporting systems, and previous lists. Eighteen experts in patient/medication safety or in chronic diseases scored candidate drugs for appropriateness according to three criteria (evidence, benefit and feasibility of implementing safety practices). Additionally they rated their priority of inclusion on a Likert scale.Results The final HAMC list includes 14 drug classes (oral anticoagulants, narrow therapeutic range antiepileptics, antiplatelets - including aspirin -, antipsychotics, β-blockers, benzodiazepines and analogues, corticosteroids long-term use, oral cytostatics, oral hypoglycemic drugs, immunosuppressants, insulins, loop diuretics, nonsteroidal anti-inflammatory drugs, and opioid analgesics), and 4 drugs or pairs of drugs (amiodarone/ dronedarone, digoxin, oral methotrexate and spironolactone/eplerenone).Conclusions An initial list of high-alert medications for patients with chronic diseases has been developed, which can be built into the medication management strategies for chronicity to guide the implementation of efficient safety strategies and to identify those patients at greater risk for preventable adverse drug events. © 2014 European Federation of Internal Medicine.


Vega T.,Direccion General de Salud Publica | Lozano J.E.,Direccion General de Salud Publica | Meerhoff T.,Radboud University Nijmegen | Snacken R.,Centers for Disease Control and Prevention | And 2 more authors.
Influenza and other Respiratory Viruses | Year: 2013

Background Timely influenza surveillance is important to monitor influenza epidemics. Objectives (i) To calculate the epidemic threshold for influenza-like illness (ILI) and acute respiratory infections (ARI) in 19 countries, as well as the thresholds for different levels of intensity. (ii) To evaluate the performance of these thresholds. Methods The moving epidemic method (MEM) has been developed to determine the baseline influenza activity and an epidemic threshold. False alerts, detection lags and timeliness of the detection of epidemics were calculated. The performance was evaluated using a cross-validation procedure. Results The overall sensitivity of the MEM threshold was 71·8% and the specificity was 95·5%. The median of the timeliness was 1week (range: 0-4·5). Conclusions The method produced a robust and specific signal to detect influenza epidemics. The good balance between the sensitivity and specificity of the epidemic threshold to detect seasonal epidemics and avoid false alerts has advantages for public health purposes. This method may serve as standard to define the start of the annual influenza epidemic in countries in Europe. © 2012 John Wiley & Sons Ltd.


Lopez-Villarrubia E.,Direccion General de Salud Publica | Lopez-Villarrubia E.,CIBER ISCIII | Iniguez C.,CIBER ISCIII | Iniguez C.,Center for Public Health Research | And 5 more authors.
Environmental Research | Year: 2012

Most of the studies differentiating the effect of size-classified particulate matter (PM) exposure have been carried out in cities where the average levels of fine particles (PM2.5) were higher than those of coarse particles (PM10-2.5). These studies have suggested that PM2.5 is associated with daily mortality, but there is only limited evidence that PM10-2.5 is independently associated with mortality. The citizens of the Canary Islands are exposed to PM which is highly influenced by mineral dust because of the islands' proximity to the Western Coast of Morocco. This offers an excellent opportunity to analyze in detail the short-term association between PM size fractions and total, respiratory and heart disease mortality. A time-series study from 2001 to 2004 was carried out. For each PM size fraction and mortality outcome, Generalized Additive Poisson Model was performed controlling for potential confounding. Different lag structures, unconstrained distributed lag models and two-pollutant models were examined. After assessing the linearity in the relationship, a piecewise linear analysis for exploring the existence of different slopes for different ranges of PM was carried out. The 10μg/m3 increase in PM2.5 and PM10-2.5 levels was associated with a 7.5% (95% confidence interval=0.4-15.0) and a 7.4 (95% CI=1.5-13.7) increase in heart and respiratory disease mortality, respectively. Spline curves were quite linear over the PM concentrations seen on most days (dominated by combustion sources) in these cities, meanwhile on days with higher particulate levels (natural sources) a risk increase above certain PM levels was found, suggesting a curvilinear association and that, at least in some locations, PM10-2.5 can play an important role in PM-related toxicity. The overall findings suggest that the establishment of new air quality standards for the short-term effect of PM2.5 and PM10-2.5 and further limiting levels of PM10 in European Union is advisable. © 2011 Elsevier Inc.


Van Den Block L.,Vrije Universiteit Brussel | Onwuteaka-Philipsen B.,VU University Amsterdam | Meeussen K.,Vrije Universiteit Brussel | Giusti F.,Cancer Prevention and Research Institute | And 7 more authors.
BMC Family Practice | Year: 2013

Background: Although end-of-life care has become an issue of great clinical and public health concern in Europe and beyond, we lack population-based nationwide data that monitor and compare the circumstances of dying and care received in the final months of life in different countries. The European Sentinel GP Networks Monitoring End of Life Care (EURO SENTIMELC) study was designed to describe and compare the last months of life of patients dying in different European countries. We aim to describe how representative GP networks in the EURO SENTIMELC study operate to monitor end of life care in a country, to describe used methodology, research procedures, representativity and characteristics of the population reached using this methodology. Methods. Nationwide representative Networks of General Practitioners (GPs) - ie epidemiological surveillance systems representative of all GPs in a country or large region of a country - in Belgium, the Netherlands, Italy and Spain continuously registered every deceased patient (>18 year) in their practice, using weekly standardized registration forms, during two consecutive years (2009-2010).All GPs were asked to identify patients who had died "non-suddenly". The last three months of these patients' lives was surveyed retrospectively. Several quality control measures were used to ensure data of high scientific quality. Results: A total of 6858 deaths were registered of which two thirds died non-suddenly (from 62% in the Netherlands to 69% in Spain), representative for the GP populations in the participating countries. Of all non-sudden deaths, between 32% and 44% of deaths were aged 85 or older; between 46% and 54% were female, and between 23% and 49% died at home. Cancer was cause of death in 37% to 53% of non-sudden death cases in the four participating countries. Conclusion: Via the EURO SENTI-MELC methodology, we can build a descriptive epidemiological database on end-of-life care provision in several EU countries, measuring across setting and diseases. The data can serve as baseline measurement to compare and monitor end-of-life care over time. The use of representative GP networks for end-of-life care monitoring has huge potential in Europe where several of these networks are operational. © 2013 Van den Block et al.; licensee BioMed Central Ltd.


Calatayud M.,CSIC - Institute of Agricultural Chemistry and Food Technology | Devesa V.,CSIC - Institute of Agricultural Chemistry and Food Technology | Virseda J.R.,Direccion General de Salud Publica | Barbera R.,University of Valencia | And 2 more authors.
Food and Chemical Toxicology | Year: 2012

This study evaluates Hg and Se concentrations and bioaccessibility (element solubilised after simulated gastrointestinal digestion) in 16 raw seafood species consumed in Spain. The concentrations varied greatly (Hg, 3.8-1621. ng/g wet weight, ww; Se, 84-1817. ng/g ww). Only one sample of swordfish exceeded the Hg limit permitted in Spain (1. mg/kg), and for this sample the Hg/Se molar ratio and Se Health Benefit Value food safety criteria also indicated the presence of a risk. Bioaccessibility of Hg (35-106%) and Se (17-125%) was very variable and the Hg/Se molar ratio in the bioaccessible fraction was less than one for all samples. Transport by Caco-2 cells, an intestinal epithelium model, was also evaluated from the swordfish bioaccessible fraction. Hg and Se transport from the food was less than 14%, and cell retention was much greater for Hg (49-69%) than Se (8-12%). © 2012 Elsevier Ltd.


Diez-Domingo J.,Centro Superior Of Investigacion En Salud Publica | Ridao-Lopez M.,Centro Superior Of Investigacion En Salud Publica | Ridao-Lopez M.,Instituto Aragones Of Ciencias Of La Salud | Gutierrez-Gimeno M.V.,Centro Superior Of Investigacion En Salud Publica | And 3 more authors.
Vaccine | Year: 2011

Background: Heptavalent pneumococcal conjugate vaccine (PCV-7) was licensed to provide immunity against pneumococcal disease caused by seven serotypes of S. pneumoniae. Thirteen-valent pneumococcal conjugate vaccine (PCV-13) includes 6 additional serotypes for preventing invasive pneumococcal disease. Objective: The objective of this study was to estimate the potential health benefits, costs, and cost-effectiveness of vaccination with PCV-13 in the Community of Valencia and to generate valuable information for policy makers at regional and country levels. Methods: A decision tree was designed to determine the health and economic outcomes in hypothetical cohorts of vaccinated and unvaccinated children followed over their lifetime. Information about disease incidence and serotype distribution were gathered from local databases and from published and unpublished local records. PCV-13 effectiveness was extrapolated from PCV-7 efficacy data. A 5% of herd effect and a serotype replacement of 25% were considered for the base case scenario. Only direct costs were taken into account and results were expressed in terms of life-years gained (LYG) and quality adjusted life years (QALY). Results: Implementing a universal PCV-13 vaccination program in the Community of Valencia would decrease the number of hospital admitted pneumonia to less than 4571 cases while avoiding 310 cases of IPD and 82,596 cases of AOM throughout the cohort lifetime. A total of 190 S. pneumoniae related deaths would be averted over the same period. Total medical costs of non-vaccinating the cohort of newborns would reach up to 403,850.859 € compared to 438,762.712 € that would represent vaccinating the cohort. The incremental cost of vaccinating the children was estimated in 12,794 €/LYG and 10,407 €/QALY, respectively. Conclusions: A universal PCV-13 vaccination program in the Community of Valencia would be a cost-effective intervention from the payer perspective after preventing for pneumococcal infections and for decreasing its associated mortality and morbidity. © 2011.


Ortiz de Lejarazu Leonardo R.,University of Valladolid | Tamames GoMez S.,Direccion General de Salud Publica
Pediatria de Atencion Primaria | Year: 2014

Approximately two out of 10 children get flu every year. Children are more susceptible to influenza infection contributing to spread the disease in the home and school-setting, by eliminating larger amount of virus during longer period than adults. The most common complications include otitis media, tracheobronchitis, laryngotracheitis, bronchiolitis and bronchitis, most commonly seen in naïve patients. The more severe complication is viral pneumonia, more frequent in infections by influenza A virus. Influenza causes health services burden, particularly in pediatric primary health care, having impact on mortality rates. In the United States during the 2010-11 epidemic there were 115 deaths in children, of whom only 23% were vaccinated. United States and Canada have implemented the recommendation on universal vaccination with particular emphasis on children, in Europe this occurs only in the UK. Currently different types of inactivated virus vaccines are marketed in Spain. Attenuated virus vaccines are used in the United States and Russia. Vaccines with live attenuated influenza virus have been more effective in children <4 years because that population has had less prior exposure to influenza than adults. Most inactivated influenza vaccines are made of complete or split virion. Recent research establishes the possibility of using adjuvanted vaccines in children. Also this research includes quadrivalent vaccines that protect against both lineages of B viruses that can circulate every year. Influenza vaccination of children is a medical necessity not properly covered in Spain. Seasonal epidemics have shown that influenza vaccination of children have a protective effect on other vulnerable groups. While scientific consensus for universal children vaccination is achieved, it is the responsibility of the pediatrician to strongly recommend influenza vaccination of children and adolescents with underlying diseases as well as their household contacts. © 2014, Rev Pediatr Aten Primaria. All right reserved.


Salas D.,Direccion General de Salud Publica
Revista española de sanidad penitenciaria | Year: 2013

Cancer is one of the main health problems. It includes a set of diseases with multi-causal origins. The tumours with the greatest impact on the health of men are lung, prostate and colorectal cancers, while for women they are breast and colorectal tumours. The best strategies for preventing cancer are ones based on primary prevention and early diagnosis. It is estimated that about to 80-90% of cancers are preventable. As regards primary prevention, there is considerable evidence to suggest that not smoking, regular physical exercise and a diet rich in fruit and vegetables, along with the control of some environmental and occupational risk factors can reduce the incidence of cancer. The early diagnosis of breast, colorectal and cervical cancer is recommended for some groups of the population in a context of organised programs with adequate quality guarantees.

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