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Torner N.,CIBER ISCIII | Torner N.,Public Health Institute of Navarre | Carnicer-Pont D.,CIBER ISCIII | Carnicer-Pont D.,Public Health Agency of Barcelona | And 4 more authors.
PLoS ONE | Year: 2011

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≤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. © 2011 Torner et al.

Espejo-Herrera N.,Center for Research in Environmental Epidemiology | Espejo-Herrera N.,IMIM Hospital del Mar Research Institute | Kogevinas M.,Center for Research in Environmental Epidemiology | Kogevinas M.,IMIM Hospital del Mar Research Institute | And 41 more authors.
Gaceta Sanitaria | Year: 2013

Objectives: To describe levels of nitrate and trace elements in drinking water from the study areas of a multicase-control study of cancer in Spain (MCC-Spain). Methods: A total of 227 tap water samples were randomly collected from 67 municipalities in 11 provinces and the nine most frequently consumed bottled water brands were sampled to measure levels of nitrate, arsenic, nickel, chromium, cadmium, lead, selenium and zinc. Results: The median nitrate level was 4.2mg/l (range<1-29.0), with similar levels in rural and urban municipalities (p=0.86). Trace elements were unquantifiable in 94% of tap water samples. Differences between areas were significant for nitrate (p<0.001) and arsenic (p=0.03). Only nitrate was quantifiable in bottled water (range 2.3-15.6mg/l). Conclusions: Nitrate levels in municipal water differed between regions and were below the regulatory limit in all samples, including bottled water. Trace element levels were low and mainly unquantifiable in tap and bottled water. © 2011 SESPAS.

Dominguez A.,University of Barcelona | Dominguez A.,CIBER ISCIII | Torner N.,CIBER ISCIII | Castilla J.,CIBER ISCIII | And 12 more authors.
Vaccine | Year: 2010

The aim of the study was to investigate effectiveness of mumps MMR component in communities with high MMR coverage. Outbreak-related cases of mumps born between 1995 and 2005 notified to Navarre and Catalonia public health services during the period 2005-2007 were studied. Vaccine effectiveness (VE) and their 95%CI were calculated using the screening method. Of 47 confirmed, 85.1% immunized with at least one dose (1MMR) and 44.9% with two (2MMR). Estimated VE was 85.4% (95%CI: 67.3-93.4) for 1MMR and 88.5% (95%CI: 78.1-93.9) for 2MMR. High 2MMR coverage, improved confirmation techniques and further VE studies with all confirmed cases are needed to prevent further outbreaks. © 2010 Elsevier Ltd. All rights reserved.

Aguilar I.,Public Health Institute of Navarre | Reyes M.,Public Health Institute of Navarre | Martinez-Baz I.,Public Health Institute of Navarre | Guevara M.,Public Health Institute of Navarre | Castilla J.,Public Health Institute of Navarre
Eurosurveillance | Year: 2012

People aged 65 and older have a high risk of suffering from complications of influenza, therefore it is recommended that they receive annual influenza vaccination. However, vaccination coverage falls far short of the target of 75%. In this study we use the vaccination register to evaluate the coverage of influenza vaccine in non-institutionalised persons aged 65 and over in Navarre, Spain, in the 2010/11 season (104,427 persons). Vaccination coverage was 58.6%, lower than the 62.7% coverage in the 2009/10 season. In the mul-tivariate analysis, lower coverage was associated with being female, age under 80 or over 94 years, immigrant status and hospitalisation in the previous year. In contrast, persons with major chronic conditions, high level of dependence or those with more visits to the general practitioner in the previous year had higher vaccination coverage. Influenza vaccination in the previous season was a strong predictor of vaccination in the current season (odds ratio: 37.0, 95% confidence interval: 35.7-38.4). The vaccination register has been shown to be useful to monitor the coverage of influenza vaccination in seniors and may help guide strategies to improve coverage.

Castilla J.,Public Health Institute of Navarre | Martinez-Artola V.,Navarre Hospital Complex | Reina G.,University of Navarra | Martinez-Baz I.,Public Health Institute of Navarre | And 5 more authors.
Eurosurveillance | Year: 2011

We defined a cohort of people with major chronic conditions (152,585 subjects) in Navarre, Spain, using electronic records from physicians, to obtain 2010/11 mid-season estimates of influenza vaccine effectiveness. The adjusted estimates of the effectiveness of the 2010/11 trivalent influenza vaccine were 31% (95% confidence interval (CI): 20-40%) in preventing medically attended influenza-like illness, and 58% (95% CI: 11-80%) in preventing laboratory-confirmed influenza. Having received the monovalent influenza A(H1N1)2009 vaccine in the 2009/10 season had an independent preventive effect against medically attended influenza-like illness (17%, 95% CI: 1-30%), and having received both vaccines had 68% (95% CI: 23-87%) effectiveness in preventing laboratory-confirmed influenza.

Castilla J.,Public Health Institute of Navarre | Martinez-Baz I.,Public Health Institute of Navarre | Martinez-Artola V.,Hospital complex of Navarre | Reina G.,University of Pamplona | And 9 more authors.
Eurosurveillance | Year: 2013

This study evaluates the influenza vaccine effectiveness (VE) in preventing laboratory-confirmed cases in Navarre, Spain, in the 2011/12 season in which the peak was delayed until week 7 of 2012. We conducted a test-negative case-control study. Patients with influenza-like illness in hospitals and primary healthcare were swabbed for testing by reverse transcription-polymerase chain reaction. Influenza vaccination status and other covariates were obtained from healthcare databases. The vaccination status of confirmed cases and negative controls was compared after adjusting for potential confounders. VE was calculated as (1-odds ratio)×100. The 411 confirmed cases (93% influenza A(H3)) were compared with 346 controls. Most characterised viruses did not match the vaccine strains. The adjusted estimate of VE was 31% (95% confidence interval (CI): -21 to 60) for all patients, 44% (95% CI: -11 to 72) for those younger than 65 years and 19% (95% CI: -146 to 73) for those 65 or older. The VE was 61% (95% CI: 5 to 84) in the first 100 days after vaccination, 42% (95% CI: -39 to 75) between 100 and 119 days, and zero thereafter. This decline mainly affected people aged 65 or over. These results suggest a low preventive effect of the 2011/12 seasonal influenza vaccine, and a decline in VE with time since vaccination.

Castilla J.,Public Health Institute of Navarre | Martinez-Baz I.,Public Health Institute of Navarre | Martinez-Artola V.,Hospital Complex of Navarre | Fernandez-Alonso M.,University of Pamplona | And 7 more authors.
Eurosurveillance | Year: 2013

We present estimates of influenza vaccine effectiveness (VE) in Navarre, Spain, in the early 2012/13 season, which was dominated by influenza B. In a population-based cohort using electronic records from physicians, the adjusted VE in preventing influenza-like illness was 32% (95% confidence interval (CI): 15 to 46). In a nested test-negative case-control analysis the adjusted VE in preventing laboratory-confirmed influenza was 86% (95% CI: 45 to 96). These results suggest a high protective effect of the vaccine.

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