Health professions and risk of sporadic Creutzfeldt-Jakob disease, 1965 to 2010.

In 2009, a pathologist with sporadic Creutzfeldt-Jakob Disease (sCJD) was reported to the Spanish registry. This case prompted a request for information on health-related occupation in sCJD cases from countries participating in the European Creutzfeldt Jakob Disease Surveillance network (EuroCJD). Responses from registries in 21 countries revealed that of 8,321 registered cases, 65 physicians or dentists, two of whom were pathologists, and another 137 healthcare workers had been identified with sCJD. Five countries reported 15 physicians and 68 other health professionals among 2,968 controls or non-cases, suggesting no relative excess of sCJD among healthcare professionals. A literature review revealed: (i) 12 case or small case-series reports of 66 health professionals with sCJD, and (ii) five analytical studies on health-related occupation and sCJD, where statistically significant findings were solely observed for persons working at physicians' offices (odds ratio: 4.6 (95 CI: 1.2-17.6)). We conclude that a wide spectrum of medical specialities and health professions are represented in sCJD cases and that the data analysed do not support any overall increased occupational risk for health professionals. Nevertheless, there may be a specific risk in some professions associated with direct contact with high human-infectivity tissue.

Non-hospital consumption of antibiotics in Spain: 1987-1997.

Spain has one of the highest incidences of bacterial resistance to antimicrobials, possibly linked to drug consumption patterns. Using Ministry of Health and Consumer Affairs records, data were obtained on non-hospital sales of antibiotics for the period 1987-1997, and equivalents calculated in weight of active drug ingredient and defined daily doses per 1000 population per day (DDD/1000/day). The number of packages sold declined from 75 million in 1987 to 55 million in 1997. None the less, there was a gradual yet steady rise in consumption in tonnage terms (249 to 275 tonnes). Furthermore, in terms of DDD/1000/day, consumption rose sharply until 1995 and then held steady at 21 DDD/1000/day, a level comparable to the mean for other developed countries. Penicillins were the group to register the highest consumption in Spain, followed-in the latter years of the study-by macrolides, cephalosporins and quinolones. The marked rise in these latter three groups was noteworthy. Despite the decrease in the number of packages sold, antibiotic consumption in Spain has risen. This consumption pattern is different from that of other European countries and might serve to explain differences in the generation of resistance.

Brain cancer incidence in the provinces of Zaragoza and Navarre (Spain): effect of age, period and birth cohort.

Several studies have detected increases in malignant brain tumour incidence and mortality rates particularly among the elderly. We analyzed time trends in malignant brain tumors incidence in Zaragoza over the period 1973-1990 and Navarre over the period 1973-1991, two Spanish provinces that have been collecting data through their respective Cancer Registries for the last 20 years, using Poisson regression analysis of age, period of diagnosis and cohort. In general, age-adjusted rates showed a steady rise in both registries, except in the case of females in Navarre, for whom a decrease in risk was observed for the last period, 1988-1991. This increase is a reflection of the rise in incidence experienced by the elderly, since the cohorts successively register rates that are stable over time, and even downward in the case of females in Navarre. The risk run by generations born circa 1920-1930 was the highest encountered. Rates were higher in Navarre in both sexes and for all but the last period in females, when rates on the two registers stood level. Increasingly generalised use of CT scanning and magnetic resonance in the 1980s in Spain, coupled with better and more effective health care access for the elderly, are factors that may well have some bearing on these findings.

[Epidemiology of malignant tumors of the nervous system in Spain]. / Epidemiología de los tumores malignos del sistema nervioso en España.

INTRODUCTION: Increasing incidences or mortality rates from brain malignant tumors have been reported in several countries. OBJECTIVE: This is a review of the studies published by the Cancer Epidemiology Unit of Carlos III Health Institute on incidence and mortality from these tumors in adults and children in Spain. RESULTS: During the period 1952-1986 mortality in adults has increased in both sexes. An ascending effect in cohorts born up to 1920 is detected, probably due to improvements in diagnosis and registration. A positive, progressive, cohort effect in males born post-1920 was detected probably because of a true increase in incidence of brain glioma or brain metastases. The incidence analysis in Navarre and Zaragoza (two Spanish provinces with population-based Cancer Registries working for more than 20 years) shows an increase in all age groups rates, reater among the older age groups. In Navarre we detected a decrease cohort effect in 1978-82 and 1988-91. A more than 50% decrease in mortality is observed among children and adolescent, probably due to treatment improvements. Great geographic differences have been observed in mortality, associated to industry development. Incidence in children, according to the Navarre and Zaragoza Registries, has increased in part due to better diagnostic methods. Incidence is 75% greater in Navarre than in Zaragoza.

Childhood and adolescent cancer in Spain: mortality time trends 1956-1990.

Using log-linear Poisson modelling, trends in childhood cancer mortality among the population under 20 years of age in Spain are described over the 35-year period from 1956 to 1990. Overall cancer mortality and seven specific sites were considered: all leukaemias, Hodgkin's disease, non-Hodgkin's lymphomas, malignant brain tumours, kidney cancer, malignant bone neoplasms, and a broad category of ill-defined tumours. An age-period-cohort model was used to analyse the influence of age, period of death and birth cohort. Recent trends were estimated by restricting analysis to the last three 5-year periods. In general, mortality began to decline at the beginning of the 1970s, with reductions of 36% in males and 45% in females being registered between 1966-1970 and 1986-1990. The use of age-period-cohort models revealed an initially rising period effect attributable to diagnostic advances. The decline in mortality in post-1965 generations and the final downturn in the period effect are both most certainly a consequence of the remarkable progress achieved in the treatment of such tumours. During the final 15 years, there was a relative decline in mortality of approximately 20% every 5 years. However, in the case of malignant renal tumours in males and malignant bone tumours and non-Hodgkin's lymphomas in both sexes the situation remained stable.

Time-trend analysis of mortality from malignant tumors of the nervous system in Spain, 1952-1986.

We analyzed time trends in mortality from malignant tumors of the nervous system (MTNS) in the adult Spanish population during the period 1952-1986, using Poisson regression analysis of age at death, year of birth and year of death. During such period, mortality rose especially in the elderly as well as among young and middle-aged men. We found two modest period effects, in both sexes attributed to changes in certification practice. An ascending effect in cohorts born up to 1920 in males and females was attributed to improvements in ascertainment. A positive, progressive, cohort effect in males born post-1920 was detected. Mortality from MTNS in Spain was medium-high with a tendency to rise, most likely due to improvements in diagnosis and registration. From this analysis, the existence of a true increase in incidence of brain glioma among young and middle-aged male adults during recent decades is suggested.

[Cancer in Spain (1977-1987): an analysis of the Hospital Morbidity Survey]. / El cáncer en España (1977-1987): análisis de la Encuesta de Morbilidad Hospitalaria.

The aim of the present work is to evaluate the usefulness of the Hospital Morbidity Survey for the study of cancer morbidity in Spain. The study covers the period 1977-1987. Age-standardized rates for the following groups have been estimated: "hospital admissions by sex, age and final diagnosis" and "hospital admissions (new cases) by age, sex and final diagnosis". During the period 1983-84 an important increase in the frequency of all malignant tumours has coincided with an equivalent decrease in the non-specified category, leading to the conclusion that an information bias is present. This bias limits the study of temporal series of cancer morbidity in Spain and suggests that a modification of the Spanish Hospital Morbidity Survey is urgently needed.