1
|
Mazagatos C, Mendioroz J, Rumayor M, Gallardo García V, Álvarez Río V, Cebollada Gracia A, Batalla Rebollo N, Barranco Boada M, Pérez‐Martínez O, Lameiras Azevedo A, López González‐Coviella N, Castrillejo D, Fernández Ibáñez A, Giménez Duran J, Ramírez Córcoles C, Ramos Marín V, Larrauri A, Monge S. Estimated Impact of Nirsevimab on the Incidence of Respiratory Syncytial Virus Infections Requiring Hospital Admission in Children < 1 Year, Weeks 40, 2023, to 8, 2024, Spain. Influenza Other Respir Viruses 2024; 18:e13294. [PMID: 38716791 PMCID: PMC11077568 DOI: 10.1111/irv.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/11/2024] [Accepted: 03/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Data from the sentinel surveillance system of severe acute respiratory infections in Spain were used to estimate the impact of administration of nirsevimab to children born from 1 April 2023 onwards. METHODS Estimated RSV hospitalisations in < 1-year-olds during weeks 40, 2023, to 8, 2024, were compared to the number that would be expected after accounting for the background change in RSV circulation in the 2023/24 season, compared to 2022/23. RESULTS We estimated 9364-9875 RSV hospitalisations less than expected, corresponding to a 74%-75% reduction.
Collapse
Affiliation(s)
- Clara Mazagatos
- National Centre of EpidemiologyInstitute of Health Carlos IIIMadridSpain
- CIBER Epidemiology and Public HealthMadridSpain
| | - Jacobo Mendioroz
- Sub‐direcció General de Vigilància i Resposta a Emergències de Salut Pública, Departament de SalutGeneralitat de CatalunyaBarcelonaSpain
| | - Mercedes Belén Rumayor
- Área de Enfermedades Transmisibles, Subdirección General de Vigilancia en Salud PúblicaMadridSpain
| | - Virtudes Gallardo García
- Servicio de Vigilancia y Salud LaboralDirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y ConsumoAndalucíaSpain
| | - Virginia Álvarez Río
- Servicio de Epidemiología, Consejería de Sanidad, Dirección General de Salud PúblicaJunta de Castilla y LeónValladolidSpain
| | | | - Noa Batalla Rebollo
- Subdirección de Epidemiología de la Dirección General de Salud PúblicaServicio Extremeño de SaludMéridaSpain
| | - María Isabel Barranco Boada
- Servicio de Epidemiología (Sección Vigilancia Epidemiológica)Consejería de Salud‐Región de MurciaMurciaSpain
| | - Olaia Pérez‐Martínez
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de SanidadeXunta de GaliciaSantiagoSpain
| | - Ana Sofía Lameiras Azevedo
- Subdirecció General d'Epidemiologia i Vigilància de la Salut, Direcció General de Salut PúblicaGeneralitat ValencianaValenciaSpain
| | | | - Daniel Castrillejo
- Vigilancia Epidemiológica, Consejería de Políticas Sociales y Salud Pública de MelillaDirección General de Salud PúblicaMelillaSpain
| | - Ana Fernández Ibáñez
- Dirección General de Salud Pública y Atención a la Salud MentalConsejería de Sanidad, Principado de AsturiasOviedoSpain
| | - Jaume Giménez Duran
- Servicio de Epidemiología, Consellería de SalutGobierno de las Islas BalearesPalmaSpain
- Instituto de Investigación Sanitaria Illes Balears (IdISBa)PalmaSpain
| | | | - Violeta Ramos Marín
- Servicio de EpidemiologíaConsejería de Sanidad y Servicios Sociales de CeutaCeutaSpain
| | - Amparo Larrauri
- National Centre of EpidemiologyInstitute of Health Carlos IIIMadridSpain
- CIBER Epidemiology and Public HealthMadridSpain
| | - Susana Monge
- National Centre of EpidemiologyInstitute of Health Carlos IIIMadridSpain
- CIBER Infectious DiseasesMadridSpain
| |
Collapse
|
2
|
Guadalupe-Fernández V, Martínez-Solanas E, Sabrià-Sunyé A, Ferrer-Mikoly C, Martínez-Mateo A, Ciruela-Navas P, Mendioroz J, Basile L. Investigating epidemiological distribution (temporality and intensity) of respiratory pathogens following COVID-19 de-escalation process in Catalonia, September 2016-June 2021: Analysis of regional surveillance data. PLoS One 2024; 19:e0285892. [PMID: 38335176 PMCID: PMC10857536 DOI: 10.1371/journal.pone.0285892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/03/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Following the low incidence rates of non-SARS-CoV-2 respiratory viruses registered during the strict lockdown enforced in the pandemic, a resurgence of several endemic viruses in Catalonia (Spain) was noted during the early summer of 2021. OBJECTIVES In this study, we investigated whether the circulation of non-SARS-CoV-2 respiratory viruses in Catalonia, assessed by Microbiological Reporting System of Catalonia (MRSC) and the Epidemiological Surveillance Network of Catalonia, was affected by the strict lockdown measures, as well as, the implication of the Coronavirus Disease 19 (COVID-19) de-escalation process in the late season outbreaks registered during the 2020-2021 season. STUDY DESIGN A retrospective comparison of epidemic patterns in the respiratory viruses' incidence, using regional public health surveillance data from MRSC, was performed between weeks 26/2016 to week 27/2021. Data were expressed as the weekly total number of test positivity for individual viruses. A segmented negative binomial regression model was conducted, with two parameters included (level and trend) for each segment of the time series (2020 pre-lockdown, 2020 post-lockdown and 2021). Results were reported as a unit changed in the strict lockdown. RESULTS A total of 51588 confirmed cases of the different respiratory viruses were included in the analysis, the majority were influenza cases (63.7%). An immediate reduction in the weekly number of cases was observed in 2020 after the COVID-19 outbreak for human adenovirus virus (HAdV) (β2 = -2.606; P <0.01), human parainfluenza virus (HPIV) (β2 = -3.023; P <0.01), influenza virus (IFV) (β2 = -1.259; P <0.01), but not for respiratory syncytial virus (RSV), where the number of cases remained unchanged. During 2020, a significant negative trend was found for RSV (β3 = -0.170, P <0.01), and a positive trend for HAdV (β3 = 0.075, P <0.01). During 2021, a significant reduction in the weekly number of cases was also observed for all respiratory viruses, and a borderline non-significant reduction for HPIV (β3 = -0.027; P = 0.086). Moreover, significant positive trends were found for each viral pathogen, except for influenza during 2020-2021 season, where cases remained close to zero. The respiratory viruses increased activity and their late season epidemic start particularly affected children under 6 years old. CONCLUSIONS Our data not only provides evidence that occurrence of different respiratory virus infections was affected by the strict lockdown taken against SARS-CoV-2 but it also shows a late resurgence of seasonal respiratory viruses' cases during the 2020-2021 season following the relaxation of COVID-19-targeted non-pharmaceutical interventions.
Collapse
Affiliation(s)
- Víctor Guadalupe-Fernández
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
- Research Support Unit of Central Catalonia, University Institute for Research in Primary Health Care Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Erica Martínez-Solanas
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Aurora Sabrià-Sunyé
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Carol Ferrer-Mikoly
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Ana Martínez-Mateo
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto Salud Carlos III, Madrid, Spain
| | - Pilar Ciruela-Navas
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto Salud Carlos III, Madrid, Spain
| | - Jacobo Mendioroz
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
- Research Support Unit of Central Catalonia, University Institute for Research in Primary Health Care Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Luca Basile
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | | |
Collapse
|
3
|
Vidal MJ, Martínez-Solanas È, Mendoza S, Sala N, Jané M, Mendioroz J, Ciruela P. Impact of SARS-CoV-2 infection in pregnant women and their babies: clinical and epidemiological features. Gac Sanit 2023; 37:102332. [PMID: 38007961 DOI: 10.1016/j.gaceta.2023.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/02/2023] [Accepted: 08/29/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Assess the risk associated with COVID-19 in pregnant women on maternal and neonatal outcomes in Catalonia (Spain) in 2020, before the beginning of COVID-19 vaccination campaign. METHOD Cross-sectional descriptive study with all pregnant women (41,560) and their live newborns (42,097) (1st March to 31st December 2020). Women were classified: positive and negative COVID-19 diagnosis during pregnancy. The outcomes analysed were complications during pregnancy, gestational age, admission of newborns to neonatal intensive care unit (NICU) and birth weight. Associations among positive COVID-19 and maternal and infant variables were measured with logistic regression models. Results were expressed as odds ratios and 95% confidence intervals. Models were adjusted for nationality, maternal age, socioeconomic status, type of pregnancy and type of centre where the delivery occurred (public or private management hospital). RESULTS A total of 696 women (1.7%) were diagnosed with COVID-19 during pregnancy. Women with COVID-19 were 4.37 times more likely to have complications during pregnancy (4.37; 3.52-5.40). A total of 713 newborns (1.7%) were from mothers with COVID-19. A positive diagnosis of COVID-19 increased the risk of preterm birth (1.41; 1.03-1.89), admission to NICU (1.40; 1.06-1.82) and low birth weight (1.35; 0.99-1.80) in babies. CONCLUSIONS Pregnant women with COVID-19 had higher risk of developing complications during pregnancy and their newborns were more likely to be admitted to NICU and had prematurity.
Collapse
Affiliation(s)
- María José Vidal
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain.
| | - Èrica Martínez-Solanas
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Sergi Mendoza
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Núria Sala
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Mireia Jané
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jacobo Mendioroz
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Pilar Ciruela
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| |
Collapse
|
4
|
Coma E, Pino D, Mora N, Fina F, Perramon A, Prats C, Medina M, Planella A, Mompart A, Mendioroz J, Cabezas C. Mortality in Catalonia during the summer of 2022 and its relation with high temperatures and COVID-19 cases. Front Public Health 2023; 11:1157363. [PMID: 37275503 PMCID: PMC10235629 DOI: 10.3389/fpubh.2023.1157363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Purpose To analyse the association between the mortality during the summer 2022 and either high temperatures or the COVID-19 wave with data from the Catalan Health Care System (7.8 million people). Methods We performed a retrospective study using publicly available data of meteorological variables, influenza-like illness (ILI) cases (including COVID-19) and deaths. The study comprises the summer months of the years 2021 and 2022. To compare the curves of mortality, ILI and temperature we calculated the z-score of each series. We assessed the observed lag between curves using the cross-correlation function. Finally, we calculated the correlation between the z-scores using the Pearson correlation coefficient (R2). Results During the study period, 33,967 deaths were reported in Catalonia (16,416 in the summer of 2021 and 17,551 in the summer of 2022). In 2022, the observed lag and the correlation between the z-scores of temperature and all-cause deaths was 3 days and R2 = 0.86, while between ILI and all-cause deaths was 22 days and R2 = 0.21. This high correlation between temperature and deaths increased up to 0.91 when we excluded those deaths reported as COVID-19 deaths, while the correlation between ILI and non-COVID-19 deaths decreased to -0.19. No correlation was observed between non-COVID deaths and temperature or ILI cases in 2021. Conclusion Our study suggests that the main cause of the increase in deaths during summer 2022 in Catalonia was the high temperatures and its duration. The contribution of the COVID-19 seems to be limited.
Collapse
Affiliation(s)
- Ermengol Coma
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - David Pino
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Núria Mora
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Francesc Fina
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Aida Perramon
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Manuel Medina
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Antoni Planella
- Department of Health, Generalitat de Catalunya, Direcció General de Planificació i Recerca en Salut, Barcelona, Spain
| | - Anna Mompart
- Department of Health, Generalitat de Catalunya, Direcció General de Planificació i Recerca en Salut, Barcelona, Spain
| | - Jacobo Mendioroz
- Department of Health, Public Health Secretariat, Generalitat de Catalunya, Barcelona, Spain
| | - Carmen Cabezas
- Department of Health, Public Health Secretariat, Generalitat de Catalunya, Barcelona, Spain
| |
Collapse
|
5
|
Herrero M, Broner S, Cruells A, Esteve S, Ferré L, Mendioroz J, Jané M, Ciruela P. Epidemiology and antimicrobial resistance profile of Neisseria gonorrhoeae in Catalonia, Spain, 2016-2019. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04601-0. [PMID: 37162616 DOI: 10.1007/s10096-023-04601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Antimicrobial resistance data for Neisseria gonorrhoeae is globally sparse and resistant strains are emerging in Catalonia. We aim to describe epidemiological and antimicrobial resistance in all patients infected with N. gonorrhoeae during the period from 2016 to 2019, using available antimicrobial susceptibility data. We retrospectively analysed confirmed N. gonorrhoeae cases notified to Catalonia's microbiological reporting system. Antibiotic susceptibility testing (azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, spectinomycin, and tetracycline) was assessed using clinical breakpoints published by the European Committee on Antimicrobial Susceptibility Testing. Incidence rates were calculated and proportions were compared using the χ2 test or Fisher's exact test, and analysed using the Statistical Package for Social Sciences (SPSS 18.0). A total of 14,251 confirmed cases of N. gonorrhoeae were notified. Incidence increased from 30.7 cases/100,000 person-years (p < 0.001) in 2016 to 64.7 in 2019. Culture was available in 6,292 isolates (44.2%), of which 5,377 (85.5%) were resistant to at least one of the antibiotics tested. Azithromycin resistance rose from 6.1% in 2016 to 16% in 2019 (p < 0.001). Only 1.0% (45 cases) were resistant to ceftriaxone. Multidrug-resistant N. gonorrhoeae increased from 0.25% in 2016 to 0.42% in 2019 (p = 0.521). One case presented extensively drug-resistant N. gonorrhoeae. In Catalonia, 10% of the N. gonorrhoeae isolates were resistant to azithromycin in the 2016-2019 period. According to World Health Organization guidelines, resistance above 5% indicates an alert to review treatment guidelines. Antimicrobial susceptibility testing in clinical practice followed by surveillance and interventions are essential to monitor trends and prevent the spread of antimicrobial resistance.
Collapse
Affiliation(s)
- Mercè Herrero
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain.
| | - Sonia Broner
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Adrià Cruells
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Silvia Esteve
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Lourdes Ferré
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Jacobo Mendioroz
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
- Research Support Unit of Central Catalonia, Jordi Gol i Gurina University Research Institute for Primary Health Care, 08272, Sant Fruitós de Bages, Spain
| | - Mireia Jané
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Carlos III Health Institute, 28029, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Carlos III Health Institute, 28029, Madrid, Spain
| |
Collapse
|
6
|
Forcadell-Díez L, Rius C, Salobral R, Sánchez-Valdivia N, Mendioroz J, Godoy P, Badiella Jarque E, Ferrandiz-Mont D, Moreno Cervera D, Jordan Suriñach B, Vilalta-Carrera A, Guadalupe-Fernández V, Mateo Basilio J, Farràs Tapiol S, Pérez G. A large outbreak of COVID-19 linked to an end of term trip to Menorca (Spain) by secondary school students in summer 2021. PLoS One 2023; 18:e0280614. [PMID: 36735702 PMCID: PMC9897546 DOI: 10.1371/journal.pone.0280614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/20/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in young people from Catalonia (Spain) who travelled to Menorca (Spain) in summer 2021. This outbreak appeared when governments relaxed Covid-19 preventive measures: the mask usage and the opening of nightlife. It was related to a super-disseminating mass event: Sant Joan festivities in Ciutadella. The aim of this article is to describe an outbreak of COVID-19 in young people aged 17-19 years from Catalonia travelling to Menorca. METHODS This is an observational study of a COVID-19 outbreak. The study population comprised Catalonian youth aged 17-19 years who travelled to Menorca from 15 June to 10 July. Epidemiological descriptive indicators were obtained. Descriptive and geographical statistics were carried out. Bivariate Moran's I test was used to identify spatial autocorrelation between the place of residence and deprivation. The outbreak control method was based on identifying and stopping chains of transmission by implementing the test-trace-isolate-quarantine (TTIQ) strategy. RESULTS We identified 515 confirmed cases infected in Menorca, 296 (57.5%) in girls and 219 (42.5%) in boys, with a total of 2,280 close contacts. Of them, 245 (10.7%) were confirmed as cases. The cases were diagnosed between 15 June and 10 July. None of the persons with confirmed infection died or required hospitalisation. The attack rate was 27.2%. There was an inverse relationship between deprivation and number of confirmed cases (p<0.005), there were clusters of confirmed cases in the most socioeconomic favoured areas. DISCUSSION The outbreak is related with young people from socioeconomic favoured areas who travelled to Menorca in summer 2021. Failure to comply with preventive measures in binge-drinking events and during holidays may have favoured SARS-CoV-2 transmission. The interauthority coordination and establishment of a clear line of leadership allowed continuous communication between institutions, which were key to managing this complex COVID-19 outbreak.
Collapse
Affiliation(s)
- Lluís Forcadell-Díez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- * E-mail:
| | - Cristina Rius
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Madrid, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Raúl Salobral
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Jacobo Mendioroz
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Pere Godoy
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Elisabet Badiella Jarque
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - David Ferrandiz-Mont
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Daniel Moreno Cervera
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Berta Jordan Suriñach
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Alba Vilalta-Carrera
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Víctor Guadalupe-Fernández
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Julia Mateo Basilio
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Sergi Farràs Tapiol
- Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Gloria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Madrid, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
7
|
Ganem F, Bordas A, Folch C, Alonso L, Montoro-Fernandez M, Colom-Cadena A, Mas A, Mendioroz J, Asso L, Anton A, Pumarola T, González MV, Blanco I, Soler-Palacín P, Soriano-Arandes A, Casabona J. The COVID-19 Sentinel Schools Network of Catalonia (CSSNC) project: Associated factors to prevalence and incidence of SARS-CoV-2 infection in educational settings during the 2020-2021 academic year. PLoS One 2022; 17:e0277764. [PMID: 36395191 PMCID: PMC9671345 DOI: 10.1371/journal.pone.0277764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
The Sentinel Schools project was designed to monitor and evaluate the epidemiology of COVID-19 in Catalonia, gathering evidence for health and education policies to inform the development of health protocols and public health interventions to control of SARS-CoV-2 infection in schools. The aim of this study was to estimate the prevalence and incidence of SARS-CoV-2 infections and to identify their determinants among students and staff during February to June in the academic year 2020-2021. We performed two complementary studies, a cross-sectional and a longitudinal component, using a questionnaire to collect nominal data and testing for SARS-CoV-2 detection. We describe the results and perform a univariate and multivariate analysis. The initial crude seroprevalence was 14.8% (95% CI: 13.1-16.5) and 22% (95% CI: 18.3-25.8) for students and staff respectively, and the active infection prevalence was 0.7% (95% CI: 0.3-1) and 1.1% (95% CI: 0.1-2). The overall incidence for persons at risk was 2.73 per 100 person-month and 2.89 and 2.34 per 100 person-month for students and staff, respectively. Socioeconomic, self-reported knowledge, risk perceptions and contact pattern variables were positively associated with the outcome while sanitary measure compliance was negatively associated, the same significance trend was observed in multivariate analysis. In the longitudinal component, epidemiological close contact with SARS-CoV-2 infection was a risk factor for SARS-CoV-2 infection while the highest socioeconomic status level was protective as was compliance with sanitary measures. The small number of active cases detected in these schools suggests a low transmission among children in school and the efficacy of public health measures implemented, at least in the epidemiological scenario of the study period. The major contribution of this study was to provide results and evidence that help analyze the transmission dynamic of SARS-CoV-2 and evaluate the associations between sanitary protocols implemented, and measures to avoid SARS-CoV-2 spread in schools.
Collapse
Affiliation(s)
- Fabiana Ganem
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Anna Bordas
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Cinta Folch
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Lucia Alonso
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Marcos Montoro-Fernandez
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
| | - Andreu Colom-Cadena
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Ariadna Mas
- Direcció Assistencial d’Atenció Primària i Comunitària, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Jacobo Mendioroz
- Subdirecció general de Vigilància i Resposta a Emergències de l’Agència de Salut Pública de Catalunya, Departament de Salut, Catalonia, Spain
| | - Laia Asso
- Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Catalonia, Spain
| | - Andres Anton
- Microbiology Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Tomàs Pumarola
- Microbiology Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Maria Victoria González
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Institut D’Investigació en Ciències de La Salut Germans Trias i Pujol (IGTP), Badalona, Catalonia, Spain
| | - Ignacio Blanco
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Institut D’Investigació en Ciències de La Salut Germans Trias i Pujol (IGTP), Badalona, Catalonia, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | |
Collapse
|
8
|
Herrero M, Ciruela P, Mallafré-Larrosa M, Mendoza S, Patsi-Bosch G, Martínez-Solanas È, Mendioroz J, Jané M. SARS-CoV-2 Catalonia contact tracing program: evaluation of key performance indicators. BMC Public Health 2022; 22:1397. [PMID: 35858841 PMCID: PMC9299963 DOI: 10.1186/s12889-022-13695-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/20/2022] [Indexed: 11/11/2022] Open
Abstract
Background Guidance on SARS-CoV-2 contact tracing indicators have been recently revised by international public health agencies. The aim of the study is to describe and analyse contact tracing indicators based on Catalonia’s (Spain) real data and proposing to update them according to recommendations. Methods Retrospective cohort analysis including Catalonia’s contact tracing dataset from 20 May until 31 December 2020. Descriptive statistics are performed including sociodemographic stratification by age, and differences are assessed over the study period. Results We analysed 923,072 contacts from 301,522 SARS-CoV-2 cases with identified contacts (67.1% contact tracing coverage). The average number of contacts per case was 4.6 (median 3, range 1–243). A total of 403,377 contacts accepted follow-up through three phone calls over a 14-day quarantine period (84.5% of contacts requiring follow-up). The percentage of new cases declared as contacts 14 days prior to diagnosis evolved from 33.9% in May to 57.9% in November. All indicators significantly improved towards the target over time (p < 0.05 for all four indicators). Conclusions Catalonia’s SARS-CoV-2 contact tracing indicators improved over time despite challenging context. The critical revision of the indicator’s framework aims to provide essential information in control policies, new indicators proposed will improve system delay’s follow-up. The study provides information on COVID-19 indicators framework experience from country’s real data, allowing to improve monitoring tools in 2021–2022. With the SARS-CoV-2 pandemic being so harmful to health systems and globally, is important to analyse and share contact tracing data with the scientific community. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13695-8.
Collapse
Affiliation(s)
- Mercè Herrero
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain.
| | - Pilar Ciruela
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto Salud Carlos III, 28029, Madrid, Spain
| | - Meritxell Mallafré-Larrosa
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain
| | - Sergi Mendoza
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain
| | - Glòria Patsi-Bosch
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain
| | - Èrica Martínez-Solanas
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain
| | - Jacobo Mendioroz
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain.,Research Support Unit of Central Catalonia, University Institute for Research in Primary Health Care Jordi Gol i Gurina, 08272, Sant Fruitós de Bages, Spain
| | - Mireia Jané
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, 08005, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto Salud Carlos III, 28029, Madrid, Spain.,Public Health, Barcelona University, Barcelona, Spain
| | | |
Collapse
|
9
|
Sentís A, Torán P, Esperalba J, Agustí C, Ángel M, Fernández MG, Dopico E, Salvador-González B, González MV, Bordas A, Antón A, Violan C, Montoro-Fernández M, Aceiton J, Egea-Cortés L, Alonso L, Dacosta-Aguayo R, Calatayud L, Lejardi Y, Mendioroz J, Basora J, Reyes-Urueña J, Casabona J. Monitoring of SARS-CoV-2 seroprevalence among primary healthcare patients in the Barcelona Metropolitan Area: the SeroCAP sentinel network protocol. BMJ Open 2022; 12:e053237. [PMID: 35140153 PMCID: PMC8829838 DOI: 10.1136/bmjopen-2021-053237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION SARS-CoV-2 seroprevalence studies are currently being recommended and implemented in many countries. Forming part of the COVID-19 monitoring and evaluation plan of the Catalan Government Health Department, our network aims to initiate a primary healthcare sentinel monitoring system as a surrogate of SARS-CoV-2 exposure in the Barcelona Metropolitan Area. METHODS AND ANALYSIS The seroCAP is a serial cross-sectional study, which will be performed in the Barcelona Metropolitan Area to estimate antibodies against SARS-CoV-2. From February 2021 to March 2022, the detection of serum IgG antibodies against SARS-CoV-2 trimeric spike protein will be performed on a monthly basis in blood samples collected for diverse clinical purposes in three reference hospitals from the three Barcelona healthcare areas (BCN areas). The samples (n=2588/month) will be from patients attended by 30 primary healthcare teams at 30 basic healthcare areas (BHA). A lab software algorithm will systematically select the samples by age and sex. Seroprevalence will be estimated and monitored by age, sex, BCN area and BHA. Descriptive and cluster analysis of the characteristics and distribution of SARS-CoV-2 infections will be performed. Sociodemographic, socioeconomic and morbidity-associated factors will be determined using logistic regression. We will explore the association between seroprevalence, SARS-CoV-2 confirmed cases and the implemented measures using interrupted time series analysis. ETHICS AND DISSEMINATION Ethical approval was obtained from the University Institute Foundation for Primary Health Care Research Jordi Gol i Gurina ethics committee. An informed consent is not required regarding the approval of the secondary use of biological samples within the framework of the COVID-19 pandemic. A report will be generated quarterly. The final analysis, conclusions and recommendations will be shared with the stakeholders and communicated to the general public. Manuscripts resulting from the network will be submitted for publication in peer-reviewed journals.
Collapse
Affiliation(s)
- Alexis Sentís
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
- Departament de Medicina, Universitat de Girona, Girona, Spain
| | - Juliana Esperalba
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Agustí
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Ángel
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- IDIAP Jordi Gol, Barcelona, Spain
| | - Munoz Gema Fernández
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Eva Dopico
- Microbiology Department, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Betlem Salvador-González
- Unitat de Suport a la Recerca Costa de Ponent, Direcció Atenció Primària Costa de Ponent, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Maria Victoria González
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Bordas
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
| | - Andrés Antón
- Microbiology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Concepció Violan
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Mataró, Spain
| | - Marcos Montoro-Fernández
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
| | - Jordi Aceiton
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
| | - Laia Egea-Cortés
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
| | - Lucía Alonso
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
| | | | - Laura Calatayud
- Microbiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Yolanda Lejardi
- Direcció Assistencial Atenció Primària, Institut Catala De La Salut, Barcelona, Spain
| | - Jacobo Mendioroz
- Subdirecció general de Vigilància i Resposta a Emergències. Agència de Salut Pública de Catalunya, Departament de Salut, Barcelona, Spain
| | | | - Juliana Reyes-Urueña
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalunya (CEEISCAT). Department of Health, Generalitat of Catalunya, Badalona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
10
|
Dobaño C, Ramírez-Morros A, Alonso S, Vidal-Alaball J, Ruiz-Olalla G, Vidal M, Rubio R, Cascant E, Parras D, Rodrigo Melero N, Serra P, Carolis C, Santamaria P, Forcada A, Mendioroz J, Aguilar R, Moncunill G, Ruiz-Comellas A. Persistence and baseline determinants of seropositivity and reinfection rates in health care workers up to 12.5 months after COVID-19. BMC Med 2021; 19:155. [PMID: 34183003 PMCID: PMC8237770 DOI: 10.1186/s12916-021-02032-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
We assessed the duration and baseline determinants of antibody responses to SARS-CoV-2 spike antigens and the occurrence of reinfections in a prospective cohort of 173 Spanish primary health care worker patients followed initially for 9 months and subsequently up to 12.5 months after COVID-19 symptoms onset. Seropositivity to SARS-CoV-2 spike and receptor-binding domain antigens up to 149-270 days was 92.49% (90.17% IgG, 76.3% IgA, 60.69% IgM). In a subset of 64 health care workers who had not yet been vaccinated by April 2021, seropositivity was 96.88% (95.31% IgG, 82.81% IgA) up to 322-379 days post symptoms onset. Four suspected reinfections were detected by passive case detection, two among seronegative individuals (5 and 7 months after the first episode), and one low antibody responder. Antibody levels significantly correlated with fever, hospitalization, anosmia/hypogeusia, allergies, smoking, and occupation. Stable sustainment of IgG responses raises hope for long-lasting COVID-19 vaccine immunity.
Collapse
Affiliation(s)
- Carlota Dobaño
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain.
| | - Anna Ramírez-Morros
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain.
| | - Selena Alonso
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Gemma Ruiz-Olalla
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Rocío Rubio
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Emma Cascant
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Daniel Parras
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Natalia Rodrigo Melero
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Pau Serra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Carlo Carolis
- Biomolecular Screening and Protein Technologies Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Pere Santamaria
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Julia McFarlane Diabetes Research Centre (JMDRC) and Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Anna Forcada
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Jacobo Mendioroz
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- COVID-19 Response Unit, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Ruth Aguilar
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Carrer Roselló 153 (CEK building), E-08036, Barcelona, Catalonia, Spain
| | - Anna Ruiz-Comellas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Centre d'Atenció Primària (CAP) Sant Joan de Vilatorrada, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| |
Collapse
|
11
|
Abstract
Background Molar-incisor hypomineralisation is a disturbance in dental development that involves first permanent molars as well as permanent incisors with a prevalence that ranges from 2.5% to 40%. Aim The objective of this study was to investigate the effect of atopic diseases on the development of molar-incisor hypomineralisation. Material and methods The study was based on the review of the medical records of a group of 102 children whose age was between eight and 12 years and 11 months and who had previously been diagnosed with MIH. Results An association (χ2, p≤0.05) has been found between molar-incisor hypomineralisation in children's mouths and the existence of: atopic dermatitis (OR=2.504; 1.54-4.05 CI 95%), food allergies (OR=2.171; 1.03-4.56 CI 95%), allergic rhinitis (OR=0.17; 0.02-1.27 CI 95%), and asthmatic bronchitis/asthma (OR=1.707; 1.05-2.76 CI 95%). When analyzing the pathologies by location, we found that atopic dermatitis, food allergies, allergic rhinitis and asthma were more frequent in children who had (p≤0.05) #12, #11, #21, #22, #36, #31, #41 and #42 affected. Conclusions The association between molar-incisor hypomineralisation and the presence of atopic diseases in the first 36 months of life underlines the convenience of approaching this problem from a multidisciplinary perspective.
Collapse
Affiliation(s)
| | - Jacobo Mendioroz
- Research Suport Unit. University Institute for Research in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| |
Collapse
|
12
|
Aznar ML, Rando-Segura A, Moreno MM, Soley ME, Igual ES, Bocanegra C, Olivas EG, Eugénio AN, Zacarias A, Katimba D, Gabriel E, Mendioroz J, García MTL, Suñe TP, Fernández MTT, Romero IM. Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study. Int J Tuberc Lung Dis 2019; 23:67-72. [PMID: 30674377 DOI: 10.5588/ijtld.18.0231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multidrug-resistant TB (MDR-TB) situation is unknown. MATERIAL AND METHODS Patients aged 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert® MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. RESULTS A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95%CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95%CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95%CI 1.57-37.43, P = 0.012) and duration of illness >4 months (OR 3.34, 95%CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. CONCLUSIONS The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.
Collapse
Affiliation(s)
- M L Aznar
- Infectious Disease Department, Vall d'Hebron University Hospital, Programa de Salut Internacional de l'Institut Català de la Salut Barcelona, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, Hospital Nossa Senhora da Paz, Cubal, Angola
| | - A Rando-Segura
- Infectious Disease Department, Vall d'Hebron University Hospital, Programa de Salut Internacional de l'Institut Català de la Salut Barcelona, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, Hospital Nossa Senhora da Paz, Cubal, Angola, Microbiology Department, Vall d'Hebron University Hospital, Programme de Salut Internacional de l'Institut Català de la Salut Barcelona, Universitat Autònoma de Barcelona, Barcelona
| | - M M Moreno
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - M E Soley
- Microbiology Department, Vall d'Hebron University Hospital, Programme de Salut Internacional de l'Institut Català de la Salut Barcelona, Universitat Autònoma de Barcelona, Barcelona
| | - E S Igual
- Microbiology Department, Vall d'Hebron University Hospital, Programme de Salut Internacional de l'Institut Català de la Salut Barcelona, Universitat Autònoma de Barcelona, Barcelona
| | - C Bocanegra
- Infectious Disease Department, Vall d'Hebron University Hospital, Programa de Salut Internacional de l'Institut Català de la Salut Barcelona, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, Hospital Nossa Senhora da Paz, Cubal, Angola
| | - E G Olivas
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | | | - A Zacarias
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - D Katimba
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - E Gabriel
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - J Mendioroz
- Support Research Unit, Territorial Health Management of Central Catalonia, Barcelona, Spain
| | | | - T P Suñe
- Microbiology Department, Vall d'Hebron University Hospital, Programme de Salut Internacional de l'Institut Català de la Salut Barcelona, Universitat Autònoma de Barcelona, Barcelona
| | - M T Tórtola Fernández
- Microbiology Department, Vall d'Hebron University Hospital, Programme de Salut Internacional de l'Institut Català de la Salut Barcelona, Universitat Autònoma de Barcelona, Barcelona
| | - I Molina Romero
- Infectious Disease Department, Vall d'Hebron University Hospital, Programa de Salut Internacional de l'Institut Català de la Salut Barcelona, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
13
|
Bocanegra C, Pintar Z, Mendioroz J, Serres X, Gallego S, Nindia A, Aznar ML, Soriano-Arandes A, Salvador F, Gil E, Sikaleta N, Moreno M, Molina I. Ultrasound Evolution of Pediatric Urinary Schistosomiasis after Treatment with Praziquantel in a Highly Endemic Area. Am J Trop Med Hyg 2019; 99:1011-1017. [PMID: 30141396 DOI: 10.4269/ajtmh.18-0343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Urinary schistosomiasis causes damage to the urological system. Ultrasound is a method that detects the burden of secondary disease, individually and in epidemiological studies. In this study, the Schistosoma haematobium-associated urinary tract pathology is analyzed before and after treatment in a short period of time. Seventy children who had previously participated in an epidemiological study on schistosomiasis in the city of Cubal, Angola, and had also performed urinary ultrasound between August 2013 and February 2014 were cited 6-8 months later to assess the possible reinfection and repeat new urinary ultrasound, analyzing changes at the level of urinary pathology. The presence of hematuria and proteinuria was also analyzed. Of the 70 children analyzed, 29 (41.4%) were girls, with an average age of 10.4 years (standard deviation 2.3). Fifty-three (75.7%) had an improvement in their bladder and/or kidney scores, whereas 12 (17.1%) had no change and five (7.1%) had progression of the disease. None of the parameters analyzed completely disappeared. After one single course of treatment with praziquantel, all the analyzed parameters showed regression. Improvement was greater in the urinary bladder than in the upper urinary tract, though these lesions also reversed; the reversion of all parameters was greater among children older than 10 years old than the younger ones. Proteinuria was the parameter with a smaller reduction. Ultrasound should be a usual tool for diagnosis and follow-up in urinary schistosomiasis, particularly in children; more accurate recommendations about follow-up in the case of children whose lesions do not reverse should be established.
Collapse
Affiliation(s)
- Cristina Bocanegra
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes PROSICS Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Jacobo Mendioroz
- Support Research Unit, Territorial Health Management of Central Catalonia, Catalonia, Spain
| | | | | | | | | | - Antoni Soriano-Arandes
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes PROSICS Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Salvador
- University Hospital Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain
| | - Eva Gil
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | | | | | - Israel Molina
- University Hospital Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Aznar ML, Rando Segura A, Moreno MM, Espasa M, Sulleiro E, Bocanegra C, Gil Olivas E, Eugénio AN, Zacarias A, Katimba D, Gabriel E, Mendioroz J, López García MT, Pumarola T, Tórtola MT, Molina I. Treatment Outcomes and Adverse Events from a Standardized Multidrug-Resistant Tuberculosis Regimen in a Rural Setting in Angola. Am J Trop Med Hyg 2019; 101:502-509. [PMID: 31333153 DOI: 10.4269/ajtmh.19-0175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Treatment for multidrug-resistant tuberculosis (MDR TB) is associated with adverse events (AE). Patients treated with an MDR TB regimen in Hospital Nossa Senhora da Paz, Cubal, Angola, were prospectively enrolled from May 2013 to July 2015. Baseline characteristics, AE, and clinical and microbiological outcomes were recorded. A total of 216 patients were treated with an MDR TB regimen and 179 (82.9%) patients developed at least one AE. The most common AE were elevation of liver enzymes (46.8% of patients), elevated creatinine (44.4% of patients), and ototoxicity (40.7% of patients). Previous TB treatment was associated with the occurrence of AE (OR 4.89, 95% CI: 2.09-11.46, P < 0.001) and months on treatment was associated to severe AE (OR 1.11 95% CI: 1.04-1.18, P = 0.001). Successful treatment was achieved in 117 (54.2%) patients. Incidence of AE was associated with an unsuccessful outcome (OR 1.23, 95% CI: 1.09-1.40, P = 0.001). Patients treated with MDR TB treatment frequently experience AE, and these are related with previous TB treatment and duration of treatment. Given the high percentage of patients experiencing AE and the low treatment success rates, more effective and less toxic drugs to treat MDR TB are urgently needed.
Collapse
Affiliation(s)
- María Luisa Aznar
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes PROSICS Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital Nossa Senhora da Paz, Cubal, Angola
| | - Ariadna Rando Segura
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Mateu Espasa
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Bocanegra
- Hospital Nossa Senhora da Paz, Cubal, Angola.,Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes PROSICS Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Jacobo Mendioroz
- Support Research Unit, Territorial Health Management of Central Catalonia, Catalonia, Spain
| | | | - Tomas Pumarola
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Teresa Tórtola
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes PROSICS Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
15
|
Casañas R, Martín Royo J, Fernandez-San-Martín MI, Raya Tena A, Mendioroz J, Sauch Valmaña G, Masa-Font R, Casajuana-Closas M, Fernandez Linares EM, Cols-Sagarra C, Gonzalez Tejón S, Foguet-Boreu Q, Martín Lopez LM. Effectiveness of a psychoeducation group intervention conducted by primary healthcare nurses in patients with depression and physical comorbidity: study protocol for a randomized, controlled trial. BMC Health Serv Res 2019; 19:427. [PMID: 31242892 PMCID: PMC6595681 DOI: 10.1186/s12913-019-4198-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depressive disorders are the third leading cause of consultation in primary care, mainly in patients with chronic physical illnesses. Studies have shown the effectiveness of group psychoeducation in reducing symptoms in depressive individuals. Our primary aim is to evaluate the effectiveness of an intervention based on a psychoeducational program, carried out by primary care nurses, to improve the remission/response rate of depression in patients with chronic physical illness. Secondarily, to assess the cost-effectiveness of the intervention, its impact on improving control of the physical pathology and quality of life, and intervention feasibility. METHODS/DESIGN A multicenter, randomized, clinical trial, with two groups and one-year follow-up evaluation. Economic evaluation study. SUBJECTS We will assess 504 patients (252 in each group) aged > 50 years assigned to 25 primary healthcare centers (PHC) from Catalonia (urban, semi-urban, and rural). Participants suffer from major depression (Beck depression inventory: BDI-II 13-28) and at least one of the following: type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma, and/or ischemic cardiopathy. Patients with moderate/severe suicide risk or severe mental disorders are excluded. Participants will be distributed randomly into the intervention group (IG) and control (CG). INTERVENTION The IG will participate in the psychoeducational intervention: 12 sessions of 90 min, once a week led by two Primary Care (PC) nurses. The sessions will consist of health education regarding chronic physical illness and depressive symptoms. MAIN MEASUREMENTS Clinical remission of depression and/or response to intervention (BDI-II). SECONDARY MEASUREMENTS Improvement in control of chronic diseases (blood test and physical parameters), drug compliance (Morinsky-Green test and number of containers returned), quality of life (EQ-5D), medical service utilization (appointments and hospital admissions due to complications), and feasibility of the intervention (satisfaction and compliance). Evaluations will be blinded, and conducted at baseline, post-intervention, and 12 months follow-up. DISCUSSION Results could be informative for efforts to prevent depression in patients with a chronic physical illness. TRIAL REGISTRATION NCT03243799 (registration date August 9, 2017).
Collapse
Affiliation(s)
- Rocío Casañas
- Research Department, Associació Centre Higiene Mental Les Corts, Barcelona, Spain. .,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| | - Jaume Martín Royo
- Centre d'Urgències d'Atenció Primària (CUAP) Casernes, Institut Català de la Salut, Barcelona, Spain.,Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria Isabel Fernandez-San-Martín
- Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Unitat Docent Multiprofesional Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Antonia Raya Tena
- Centre d'Atenció Primària Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Jacobo Mendioroz
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Sant Fruitós de Bages, Barcelona, Spain
| | - Glòria Sauch Valmaña
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Sant Fruitós de Bages, Barcelona, Spain
| | - Roser Masa-Font
- Centre d'Atenció Primària Besos, Institut Català de la Salut, Barcelona, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autónoma de Barcelona, Bellaterra, Cerdanyola del Valles, Spain
| | | | - Cèlia Cols-Sagarra
- Centre d'Atenció Primària Martorell Rural, Institut Català de la Salut, Barcelona, Martorell, Spain
| | | | - Quintí Foguet-Boreu
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Luis Miguel Martín Lopez
- Instituto de Neuropsiquiatria y Adicciones del Parc de Salut del Mar (INAD), Consorci Parc de Salut Mar, Barcelona, Spain.,Universitat Autónoma de Barcelona, Bellaterra, Cerdanyola del Valles, Spain
| |
Collapse
|
16
|
Rando-Segura A, Aznar ML, Moreno MM, Espasa M, Sulleiro E, Bocanegra C, Gil E, Eugénio ANE, Escartin C, Zacarias A, Vegue J, Katimba D, Vivas MC, Gabriel E, Marina MC, Mendioroz J, López MT, Pumarola T, Molina I, Tórtola MT. Drug Resistance of Mycobacterium tuberculosis Complex in a Rural Setting, Angola. Emerg Infect Dis 2019; 24:569-572. [PMID: 29460748 PMCID: PMC5823346 DOI: 10.3201/eid2403.171562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We found high prevalence rates of multidrug-resistant tuberculosis among retreatment patients (71.1%) and persons with new cases (8.0%) in Angola. These findings are of concern but should be interpreted with caution. A national drug-resistance survey is urgently needed to determine the actual prevalence of multidrug-resistant tuberculosis in Angola.
Collapse
|
17
|
Marin-Gomez FX, Garcia Cuyas F, Reig-Bolano R, Mendioroz J, Roura-Poch P, Pico-Nicolau M, Vidal-Alaball J. Social Networking App Use Among Primary Health Care Professionals: Web-Based Cross-Sectional Survey. JMIR Mhealth Uhealth 2018; 6:e11147. [PMID: 30578175 PMCID: PMC6320407 DOI: 10.2196/11147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 01/16/2023] Open
Abstract
Background Several studies have been conducted to analyze the role social networks play in communication between patients and health professionals. However, there is a shortage of studies in relation to communication among primary health professionals, in a professional context, using the various mobile phone apps available. Objective The objective of our study was to explore mobile phone social networking app use among primary health care professionals for work-related purposes, by comparing the most widely used apps in the market. Methods We undertook a cross-sectional study using an anonymous Web survey among a convenience sample of 1635 primary health care professionals during August and September 2017. Results Of 483 participants in the survey, 474 (98.1%, 95% CI 97.1%-99.4%) were health professionals who commonly accessed social networking sites and 362 (74.9%, 95% CI 71.1%-78.8%) accessed the sites in a work-related context. Of those 362 respondents, 219 (96.7%, 95% CI 94.8%-98.5%) preferred WhatsApp for both personal and professional uses. Of the 362 respondents who used social networking sites in a work-related context, 276 (76.2%, 95% CI 71.9%-80.6%) rated social networking sites as useful or very useful to solve clinical problems, 261 (72.1%, 95% CI 67.5%-76.7%) to improve their professional knowledge, and 254 (70.2%, 95% CI 65.5%-74.9%) to speed up the transmission of clinical information. Most of them (338/362, 94.8%, 95% CI 92.5%-97.0%) used social networking sites for interprofessional communications, and 204 of 362 (56.4%, 95% CI 51.2%-61.5%) used them for pharmacological-related consultations. Conclusions Health professionals frequently accessed social networking sites using their mobile phones and often for work-related issues. This trend suggests that social networking sites may be useful tools in primary care settings, but we need to ensure the security of the data transfer process to make sure that social networking sites are used appropriately. Health institutions need to increase information and training activities to ensure the correct use of these tools.
Collapse
Affiliation(s)
- Francesc X Marin-Gomez
- Servei d'Atenció Primària d'Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Vic, Spain.,Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Digital Care Research Group, Centre for Health and Social Care Research, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Francesc Garcia Cuyas
- Digital Care Research Group, Centre for Health and Social Care Research, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain.,Department of Information and Communications Technology in Health, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Ramon Reig-Bolano
- Digital Care Research Group, Centre for Health and Social Care Research, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain.,Department of Engineering, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Jacobo Mendioroz
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Pere Roura-Poch
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain
| | - Margalida Pico-Nicolau
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Centre d'Atenció Primària Sant Quirze de Besora, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Quirze de Besora, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| |
Collapse
|
18
|
Essadek HO, Mendioroz J, Guiu IC, Barrabeig I, Clotet L, Álvarez P, Rodés A, Gómez I Prat J. Community strategies to tackle tuberculosis according to the WHO region of origin of immigrant communities. Public Health Action 2018; 8:135-140. [PMID: 30271730 DOI: 10.5588/pha.18.0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/20/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Tuberculosis (TB) control requires the proper identification and treatment of affected patients and investigation of their contacts. In certain vulnerable immigrant groups, however, these tasks may be hindered due to their ethnic and sociocultural characteristics. Objective: To analyse the results of a community programme designed to locate hard-to-reach immigrants with TB. Design: Descriptive study of all cases diagnosed with confirmed TB referred to the Public and Community Health team of the Drassanes International Health Unit in Barcelona during 2012-2014 due to difficulties in tracing these patients. Both cases and contacts were categorised based on their World Health Organization region of origin. The sociodemographic characteristics of each group and the community interventions carried out during the tracing period are described. Results: A total of 122 cases and 316 contacts were detected. As a result of community-based strategies, 73% of the initial cases completed treatment; 3.8% of the contacts were diagnosed with TB, 91.7% of whom were treated appropriately; 17.1% contacts had latent infection, 79.3% of whom completed chemoprophylaxis. Conclusions: Intervention strategies with a community approach for follow-up and control of TB in certain immigrant communities seem to be effective.
Collapse
Affiliation(s)
- H O Essadek
- Public and Community Health, Drassanes International Health Unit, Vall d'Hebron University Hospital, International Health Program of the Catalan Health Care Institute (PROSICS), Barcelona, Spain
| | - J Mendioroz
- Research Support Unit of Central Catalonia, Catalan Health Institute, Department of Healthcare, Catalan Regional Government, Barcelona, Spain
| | - I C Guiu
- Public and Community Health, Drassanes International Health Unit, Vall d'Hebron University Hospital, International Health Program of the Catalan Health Care Institute (PROSICS), Barcelona, Spain
| | - I Barrabeig
- Epidemiological Surveillance and Public Health Emergency Response Service in Southern Barcelona, Barcelona, Spain
| | - L Clotet
- Epidemiological Surveillance and Public Health Emergency Response Service in Vallés Occidental and Vallés Oriental, Barcelona, Spain
| | - P Álvarez
- Epidemiological Surveillance and Public Health Emergency Response Service in Barcelonès Nord i Maresme, Barcelona, Spain
| | - A Rodés
- Tuberculosis Control and Prevention Plan, Public and Community Health Agency of Catalonia, Barcelona, Spain
| | - J Gómez I Prat
- Public and Community Health, Drassanes International Health Unit, Vall d'Hebron University Hospital, International Health Program of the Catalan Health Care Institute (PROSICS), Barcelona, Spain
| | | |
Collapse
|
19
|
Rando-Segura A, Aznar ML, Moreno MM, Espasa M, Sulleiro E, Bocanegra C, Gil E, Eugénio AN, Escartin C, Zacarias A, Vegue J, Katimba D, Vivas MC, Gabriel E, Marina MC, Mendioroz J, López MT, Pumarola T, Molina I, Tórtola MT. Drug Resistance of Mycobacterium tuberculosis Complex in a Rural Setting, Angola. Emerg Infect Dis 2018. [DOI: 10.3201/eid2403171562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
20
|
Bocanegra García C, Pintar Z, Serres X, Mendioroz J, Moreno M, Gallego S, López T, Soriano-Arandes A, Aznar ML, Sikaleta N, Gil E, Salvador F, Molina I. Ultrasound findings and associated factors to morbidity in Schistosoma haematobium infection in a highly endemic setting. Trop Med Int Health 2017; 23:221-228. [PMID: 29205689 DOI: 10.1111/tmi.13020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the usefulness of the WHO classification of ultrasound pathological changes and to establish risk factors for morbidity in a highly endemic setting. METHODS One hundred and fifty-seven ultrasounds were performed on school-aged children previously diagnosed with urinary schistosomiasis in Cubal, Angola. The findings were analysed according to the WHO guidelines. Factors for morbidity were studied. RESULTS Mean age of the children was 8.7 (SD 3.2) years. Pathological changes were found in 85.3% (84.7% in the bladder, 34.4% the ureter and 6.3% kidney lesions). The global score according to the WHO classification was 5.74. Male gender [OR 2.61 (1.04-6.58); P 0.043] and older age [OR 2.96 (1.17-7.46); P 0.023] were associated with a higher risk of developing any kind of urinary abnormality. Proteinuria was present in 61.7% of the children. Macroscopic haematuria [OR 2.48 (1.11-5.58); P = 0.02)] and a high level of proteinuria > 300 mg/dl [OR 5.70 (2.17-14.94); P 300 mg/dl)] were associated with abnormalities of the upper urinary tract and showed good positive and negative predictive values for the detection of pathology in the upper urinary tract (65.5% and 71.1%, respectively). CONCLUSIONS Severe urinary tract pathology was found in a high percentage of the children in our setting. Microhaematuria and proteinuria were good markers of morbidity, proteinuria being more precise for severe alterations of the upper urinary tract. We suggest initial and evolutive ultrasound in children diagnosed with schistosomiasis, and close monitoring including periodic controls. As schistosomiasis control efforts are currently focused on reducing morbidity, tests that detect the presence or degree of morbidity are essential for targeting treatment and tracking the progress of control campaigns.
Collapse
Affiliation(s)
- Cristina Bocanegra García
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, PROSICS Barcelona. Universitat Autònoma de Barcelona
| | | | - Xavier Serres
- Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Jacobo Mendioroz
- Support Research Unit, Territorial Health Management of Central Catalonia, Catalonia, Spain
| | | | | | | | - Antoni Soriano-Arandes
- Paediatrics Department, Tropical Medicine and International Health Unit, Vall d'Hebron-Drassanes, PROSICS Barcelona, Barcelona, Spain
| | | | | | - Eva Gil
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - Fernando Salvador
- Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Israel Molina
- Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
21
|
Bocanegra C, Gallego S, Mendioroz J, Moreno M, Sulleiro E, Salvador F, Sikaleta N, Nindia A, Tchipita D, Joromba M, Kavaya S, Sánchez Montalvá A, López T, Molina I. Epidemiology of Schistosomiasis and Usefulness of Indirect Diagnostic Tests in School-Age Children in Cubal, Central Angola. PLoS Negl Trop Dis 2015; 9:e0004055. [PMID: 26474169 PMCID: PMC4608768 DOI: 10.1371/journal.pntd.0004055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Schistosomiasis remains a public health major problem and little is known in many areas, mainly in Sub-Saharan Africa. OBJECTIVES To assess the burden and risk factors of schistosomiasis and intestinal parasitic helminthes in the children of Cubal, Angola, and to compare different diagnostic approaches for urinary schistosomiasis under field conditions. METHODS A cross-sectional study was conducted. Urine and faeces samples of school children were microscopically studied. A random sample of children was obtained from an alphabetically arranged list of children, taking one of two children. Urine dipstick, colorimetric test and macrohaematuria were considered as indirect diagnostic methods and compared to direct urine examination. Possible risk factors for the infection were sex, age, distance to the river and previous treatment with praziquantel; the assessment was performed using Chi-square test. RESULTS A total of 785 (61.18%) children showed S. haematobium eggs in urine; children living within 500 meters from the river had a higher odds for infection: Odds ratio 1.97 (1.45-2.7 CI 95%); urine dipstick showed sensitivity of 96% and specificity of 61.3%, with a positive predictive value; colorimetric test showed sensitivity of 52.5%, specificity of 74.6% and a positive predictive value of 77%. Proteinuria was present in 653 (51.1%) children, being more frequent in children with S. haematobium in urine (75.2%); 32 of 191 stool samples (16%) showed the presence of other intestinal parasites and 8 (4%) for S. haematobium. CONCLUSIONS Prevalence of urinary schistosomiasis in our study area is much higher than the national average, considering it as a high-risk community. Proximity to a source of water was a risk factor for the infection. Indirect tests, as urine dipstick and colorimetric test, were useful tools for diagnosis, due to ease of use and low cost. Proteinuria was a common finding, probably showing an early structural damage due to schistosomiasis in this group of children.
Collapse
Affiliation(s)
- Cristina Bocanegra
- Special Program for Infectious Diseases Drassanes-Vall d’Hebron. PROSICS Barcelona, Spain/Hospital Nossa Senhora da Paz, Cubal, Angola
- * E-mail:
| | | | - Jacobo Mendioroz
- EpidemiologyDepartment. University Hospital Vall d’Hebron, Barcelona, Spain
| | | | - Elena Sulleiro
- Microbiology Department. University Hospital Vall d’Hebron. PROSICS Barcelona, Spain
| | - Fernando Salvador
- Infectious Diseases Department. University Hospital Vall d’Hebron. PROSICS Barcelona, Spain
| | | | | | | | | | | | | | | | - Israel Molina
- Infectious Diseases Department. University Hospital Vall d’Hebron. PROSICS Barcelona, Spain
| |
Collapse
|
22
|
Salvador F, Cossio Y, Riera M, Sánchez-Montalvá A, Bocanegra C, Mendioroz J, Eugenio AN, Sulleiro E, Meredith W, López T, Moreno M, Molina I. Changes in malaria epidemiology in a rural area of Cubal, Angola. Malar J 2015; 14:21. [PMID: 25604647 PMCID: PMC4308942 DOI: 10.1186/s12936-014-0540-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/29/2014] [Indexed: 11/20/2022] Open
Abstract
Background Scarce information about malaria epidemiology in Angola has been published. The objective of this study is to describe the epidemiology of malaria at the Hospital Nossa Senhora da Paz (Cubal, Angola) and the fatality rate due to malaria (total and in children under five years) in the last five years. Methods A retrospective, observational study was performed at the Hospital Nossa Senhora da Paz, a 400-bed rural hospital located in Benguela Province of Angola. The study population included all patients who attended the hospital from January 2009 to December 2013. Outcome variables were calculated as follows: the percentage of malaria cases (number of positive thick blood films, divided by the total thick blood films performed); the percentage of in-patients for malaria (number of in-patients diagnosed with malaria, divided by the total number of in-patients); and, the fatality rate (number of deaths due to malaria divided by the number of positive thick blood films). Results Overall, 23,106 thick blood films were performed, of which 3,279 (14.2%) were positive for Plasmodium falciparum infection. During this five-year period, a reduction of 40% (95% CI 37-43%, p < 0.001) in the malaria-positive slides was detected. Distribution of positive-malaria slides showed a seasonal distribution with a peak from December to March (rainy season). An average annual reduction of 52% (95% CI 50-54%, p < 0.001) in the admissions due to malaria was observed. The overall fatality rate due to malaria was 8.3%, and no significant differences in the annual fatality rate were found (p = 0.553). Conclusions A reduction in the number of malaria cases and the number of admissions due to malaria has been observed at the Hospital Nossa Senhora da Paz, during the last five years, and incidence along the study period showed a seasonal distribution. All this information could be useful when deciding which malaria control strategies have to be implemented in this area.
Collapse
Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Mendioroz J, Bermejo E, Marshall JD, Naggert JK, Collin GB, Martínez-Frías ML. Presentación de un caso con síndrome de Alström: aspectos clínicos, moleculares y guías diagnósticas y anticipatorias. Med Clin (Barc) 2008; 131:741-6. [DOI: 10.1016/s0025-7753(08)75490-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
24
|
Rouhani P, Fleming LE, Frías J, Martínez-Frías ML, Bermejo E, Mendioroz J. Pilot study of socioeconomic class, nutrition and birth defects in Spain. Matern Child Health J 2007; 11:403-5. [PMID: 17318404 DOI: 10.1007/s10995-007-0186-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
Research has indicated that the appropriate intake of folic acid, a B vitamin, before and during early pregnancy has been shown to prevent 50-70% of neural-tube defects. Increased NTD incidence has long been reported to occur more frequently among women of lower socioeconomic (SES). Since consumption of the folate-rich Mediterranean diet in Spain does not vary by socio-economic status (SES), we hypothesized that there would be no social class effect on NTD occurrence. Using data from a Spanish hospital-based birth defects registry, we studied the risk of Neural Tube Defects (NTDs) in 980 cases and 774 controls between 1980 and 2003. Our analysis showed that the risk of NTDs did not vary by SES. This finding suggests that increased access to folate and nutrition education might benefit women of lower SES in the US.
Collapse
Affiliation(s)
- Panta Rouhani
- Department of Epidemiology & Public Health, University of Miami Miller School of Medicine, Suite 200, Miami, FL 33136, USA
| | | | | | | | | | | |
Collapse
|
25
|
Martínez-Frías ML, Cormier-Daire V, Cohn DH, Mendioroz J, Bermejo E, Mansilla E. [Dyggve-Melchior-Clausen syndrome: presentation of a case with a mutation of possible Spanish origin]. Med Clin (Barc) 2007; 128:137-40. [PMID: 17288936 DOI: 10.1157/13098019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The Dyggve-Melchior-Clausen syndrome is a progressive spondyloepimetaphyseal dysplasia characterized by a short trunk dwarfism, barrel chest, sternal protrusion, kyphoscoliosis, severe platyspondyly, with a central constriction, irregular iliac wings with a lacy appearance, rhizomelic shortening of the limbs, microcephaly, coarse face, and variable mental retardation. This condition is extremely rare and the diagnosis is difficult without any previous experience on it. It is inherited as an autosomal recessive condition, its gene (DYM) having been mapped in the 18q12-21.1 chromosomal region. At least 21 different mutations of this gene have been reported. MATERIAL AND METHODS We describe an affected Spanish child and include his molecular analysis. We also review the current knowledge on this syndrome. RESULTS The diagnosis of this patient, based on his clinical and radiological features, was later confirmed by analysis of the DYM gene mutations. The patient had two different mutations, one inherited from the mother and the other inherited from the father. CONCLUSIONS One of the mutations of this patient (exon 8) is extremely rare and has mostly been reported in patients with Spanish ancestors (from Chile, Argentina, Guam islands and a French patient with Spanish ancestors). These observations, together with that of the patient described here, led us to consider this mutation as having a possible Spanish/Portuguese origin. This condition may be more frequent in Spain than previously thought, especially due to misdiagnosis. This is important in order to undertake quaternary prevention, which is quite necessary for rare syndromes with polysystemic affectation.
Collapse
Affiliation(s)
- María Luisa Martínez-Frías
- ECEMC, Centro de Investigación sobre Anomalías Congénitas (CIAC), Instituto de Salud Carlos III, Madrid, España.
| | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Mendioroz J, Fernández-Toral J, Suárez E, López-Grondona F, Kjaer KW, Bermejo E, Martínez-Frías ML. Sensorineural deafness, abnormal genitalia, synostosis of metacarpals and metatarsals 4 and 5, and mental retardation: description of a second patient and exclusion of HOXD13. Am J Med Genet A 2005; 135:211-3. [PMID: 15887301 DOI: 10.1002/ajmg.a.30728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In 1988 Pfeiffer and Kapferer reported on a patient with sensorineural deafness, psychomotor delay, hypospadias, cerebral manifestations, and bilateral synostosis of the 4th and 5th metacarpals and metatarsals. Synostosis of the 4th and 5th metacarpals and metatarsals is a very rare defect that has been described as an isolated Mendelian defect, as part of multiple congenital anomaly (MCA) patterns, and in different syndromes. Among a total of 2,023,155 liveborn infants in the Spanish Collaborative Study of Congenital Malformations (ECEMC), we observed only two cases with this type of metacarpal fusion, for a frequency of 1/1,011,577. One had the isolated defect, and the other one that we are describing here, had an MCA pattern similar to that described by Pfeiffer and Kapferer [1988]. We tested HOXD13 but did not find any mutations in exons and intron-exon boundaries. To our knowledge this case is the second one reported with this syndrome.
Collapse
Affiliation(s)
- Jacobo Mendioroz
- Centro de Investigación sobre Anomalías Congénitas (CIAC), Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
28
|
Martínez-Frías ML, Toral JF, López-Grondona F, Mendioroz J, Bermejo E. Growth deficiency, facial anomalies, and brachydactyly (Frías syndrome): A second family. Am J Med Genet A 2005; 137A:288-91. [PMID: 16088912 DOI: 10.1002/ajmg.a.30875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A second family with the condition first described by Frías et al. in 1975 is presented. Those authors examined a mother and her son affected with short stature, facial anomalies (epicanthic folds, downward palpebral fissures, hyperthelorism, and eyelid ptosis), cup-shaped and posteriorly rotated ears, hand and foot defects, and delayed bone age. In the family we are presenting here, a girl, her mother, the mother's brother, and the propositus' maternal grandmother, were affected. This supports autosomal dominant inheritance, as proposed by (Frías et al. [1975] BDOAS 11:30-33), although with variable expressivity.
Collapse
Affiliation(s)
- María Luisa Martínez-Frías
- Centro de Investigación sobre Anomalías Congénitas (CIAC), Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Madrid, Spain.
| | | | | | | | | |
Collapse
|