Epidemiology of tuberculosis in Galicia, Spain, 16 years after the launch of the Galician tuberculosis programme.

SETTING: Galicia, Spain. OBJECTIVE: To describe changes in tuberculosis (TB) epidemiology and characteristics in Galicia, Spain, during the period 1996-2011. DESIGN: Retrospective observational descriptive study of data obtained from the Tuberculosis Information System. The Galician Tuberculosis Prevention and Control Programme, created in 1994, is based in seven tuberculosis units that actively collect data on case finding and follow-up of all cases of TB in the region. RESULTS: TB incidence fell from 72.9 cases per 100,000 population in 1996 to 24.6 in 2011 (respectively 40.5 and 14.2 in patients aged <15 years). In 2011, 49.8% (n = 343) of patients were aged between 25-54 years; 62.3% (n = 429) were male; 52.1% (n = 359) had pulmonary TB (PTB) alone, of whom 33.5% (n = 144) had cavitary lesions; 50.7% (n = 218 PTB cases) were sputum smear-positive and 80.5% (346 PTB cases) were culture-positive. The median diagnostic delay was 56 days; 4.6% (n = 32) were human immunodeficiency virus positive and 5.2% (n = 36) were immigrants. The treatment success rate was close to 90%. Contacts of 86.7% of the smear-positive index cases were evaluated. CONCLUSION: TB incidence in Galicia is progressively decreasing; however, it is still higher than that of neighbouring regions. A long diagnostic delay was observed, which may have contributed to the high incidence rate in children.

Definición de caso sospechoso de gripe A(H1N1) 2009: razones para la discordancia / No disponible

No disponible

[Factors determining the duration of temporary disability and return to work in a health district of Galicia]. / Determinantes de la duración de la incapacidad temporal y la vuelta al trabajo en un área sanitaria de Galicia.

OBJECTIVE: To determine the factors associated with the incidence and duration of temporary work incapacity (TWI) in a health district. DESIGN: Descriptive and retrospective study. SETTING: South health district of the province of Lugo, Spain. PARTICIPANTS: A random sample of 1513 cases was selected among the total of episodes of TWI, during 3 years period. MAIN MEASURES: The main factors analyzed are, on the one hand, the socio-demographic characteristics of the patient, his or her social security (SS) scheme, diagnosis that justifies the TWD, and the prescription date; and, on the other hand, the age, sex, specialised training, time in the post and years in practice of the physician who prescribes the TWI. The comparison of the means was carried out using variance analysis and the Kruskal-Wallis test. The relative effect of each variable on the probability of returning to the work was estimated through Cox regression models. RESULTS: The mean duration of the episodes of TWI was of 74+/-103 days. The most frequent diagnoses were those of the bones-muscles and joints (BMAJ), injuries and poisonings (IAP), and respiratory diseases (RD). The probability of returning to work is reduced with the increase of the age, with agrarian and autonomous SS affiliates, with diagnoses of mental disease or diagnoses of the circulatory system, and in cases prescribed by older doctors or less time in the post. CONCLUSIONS: The mean duration of the episodes of TWD is higher than that of other Spanish studies. The most influential factors in the return to work are the age of the patient, the SS scheme and the diagnosed illness.

Determinantes de la duración de la incapacidad temporal y la vuelta al trabajo en un área sanitaria de Galicia / Factors determining the duration of temporary disability and return to work in a health district of Galicia

Objetivo. Determinar los factores asociados con la incidencia y la duración de la incapacidad temporal (IT) en un área sanitaria. Diseño. Descriptivo, retrospectivo. Emplazamiento. Área Sanitaria Sur de la provincia de Lugo. Participantes. Una muestra de 1.513 episodios de IT seleccionada aleatoriamente entre el total de éstos, durante un período de 3 años. Mediciones principales. Se analizaron las características sociodemográficas del paciente, el régimen de la seguridad social (SS), el diagnóstico que justifica la IT y la fecha de la prescripción; del médico prescriptor se analizaron la edad, el sexo, la formación especializada, la antigüedad en la plaza y los años de ejercicio. La comparación de medias se realizó mediante el análisis de la varianza y el test de Kruskal-Wallis. El efecto relativo de cada variable sobre la probabilidad de volver al trabajo se estimó mediante modelos de regresión de Cox. Resultados. La duración media de los episodios de IT fue de 74 ± 103 días. Los diagnósticos más frecuentes fueron los del sistema osteomioarticular (SOMA), las lesiones y envenenamientos (LYE) y las enfermedades respiratorias (NML). Se reduce la probabilidad de volver al trabajo con el incremento de la edad, en los regímenes de seguridad social autónomos y agrarios por cuenta propia, en los diagnósticos de enfermedades mentales y del aparato circulatorio, y cuando el médico prescriptor es de mayor edad o menos antiguo en la plaza. Conclusiones. La duración media de los episodios de IT es superior a la de otros estudios españoles. Los factores que más influyen en la reincorporación al trabajo son la edad del paciente, el régimen de la seguridad social y la enfermedad diagnosticada

Objective. To determine the factors associated with the incidence and duration of temporary work incapacity (TWI) in a health district. Design. Descriptive and retrospective study. Setting. South health district of the province of Lugo, Spain. Participants. A random sample of 1513 cases was selected among the total of episodes of TWI, during 3 years period. Main measures. The main factors analyzed are, on the one hand, the socio-demographic characteristics of the patient, his or her social security (SS) scheme, diagnosis that justifies the TWD, and the prescription date; and, on the other hand, the age, sex, specialised training, time in the post and years in practice of the physician who prescribes the TWI. The comparison of the means was carried out using variance analysis and the Kruskal-Wallis test. The relative effect of each variable on the probability of returning to the work was estimated through Cox regression models. Results. The mean duration of the episodes of TWI was of 74±103 days. The most frequent diagnoses were those of the bones-muscles and joints (BMAJ), injuries and poisonings (IAP), and respiratory diseases (RD). The probability of returning to work is reduced with the increase of the age, with agrarian and autonomous SS affiliates, with diagnoses of mental disease or diagnoses of the circulatory system, and in cases prescribed by older doctors or less time in the post. Conclusions. The mean duration of the episodes of TWD is higher than that of other Spanish studies. The most influential factors in the return to work are the age of the patient, the SS scheme and the diagnosed illness

An evaluation of spatio-temporal models for the estimation of the mortality relative risk from breast cancer in Galicia, Spain.

BACKGROUND: Disease mapping is now a big focus of interest in the area of Public Health, and the geographical distribution of a disease has an important role in understanding its origin or its causes. The purpose of this work is to review and evaluate different techniques to map the mortality risk of a disease in small geographical areas. METHODS: Three different methods have been studied. The first one is a classical approach consisting of mapping SMRs, which are maximum likelihood estimates of the relative risk under a Poisson model of death counts. In a second step we consider Poisson and negative binomial regression to fit the rates and finally we use a Bayesian approach that assumes a hierarchical model where the death counts follow a Poisson distribution conditioned by the prior information. These methods have been applied to the study of geographical variation in female breast cancer mortality from 1976 to 1999 in the districts of Galicia, Spain. RESULTS: Mapping the SMRs using the first method has important drawbacks and there are difficulties to distinguish the mortality pattern. With the second method we achieved some improvements. The Bayesian methodology produces smoother maps with a clear mortality pattern. DISCUSSION: These methods are powerful tools for identifying areas with elevated risk. The Bayesian methodology has many advantages over the other methods that had been analysed in this work.

[Space-time distribution of suicide in Galicia, Spain [1976-1998]]. / Distribución geográfica y temporal del suicidio en Galicia (1976-1998).

OBJECTIVE: To study the space-time distribution of suicide in Galicia from 1976 to 1998, taking into account gender, age, season and method of suicide. METHODS: For each sex crude and age-adjusted rates per province and age-specific rates per period (1978-84, 1985-91, 1992-98) were calculated. To estimate mortality risk and time trends in the municipalities, a Bayesian hierarchical model was used. RESULTS: In the last few years mortality from suicide has increase considerably. Age-adjusted rates of 6 per 105 at the beginning of the study rose to 10 per 105 at the end. The increase was greatest among men. The higher rates were observed in the elderly, although in terms of time trends the highest increase occurred among adolescents and young adults. In both sexes the main method of suicide was hanging. Less common methods were jumping from a height and shooting. The greatest number of suicides took place during the spring and summer months. In terms of spatial distribution, a high number of suicides were committed in the province of Lugo; in the municipalities, mortality risk decreased from North to South and an inverse temporal trend was observed in both sexes. This differed from the space-time patterns of suicides committed using methods other than hanging. CONCLUSIONS: Suicide is an important health problem in Galicia not only because to its magnitude but also because of the increasing rates, especially among young people. Geographical and temporal analysis can identify priority areas where preventive policies should be implemented.

Distribución geográfica y temporal del suicidio en Galicia (1976-1998) / Space-time distribution of suicide in Galicia, Spain [1976-1998]

Objetivo: Estudiar la distribución geográfica y temporal de la mortalidad por suicidio en Galicia desde 1976 a 1998, teniendo en cuenta el sexo, la edad, la estacionalidad y el método empleado. Métodos: Para cada sexo se calcularon las tasas provinciales, brutas y ajustadas por edad y las tasas específicas por edad y período (1978-1984, 1985-1991, 1992-1998). Para la estimación del riesgo y la tendencia temporal en el ámbito municipal se utilizó un modelo jerárquico bayesiano. Resultados: La mortalidad por suicidio aumentó considerablemente en los últimos años, pasando de tasas ajustadas en torno al 6 por 105 en los primeros años de estudio a tasas del 10 por 105 en los últimos, siendo este aumento más acentuado en los varones. Las tasas más elevadas se observan en edades avanzadas, aunque al valorar la tendencia temporal, los mayores incrementos se presentan en adolescentes y adultos jóvenes. El principal método de suicidio, tanto en varones como en mujeres, ha sido el ahorcamiento, seguido a gran distancia por la caída de lugar elevado y el uso de armas de fuego. Los meses con mayor número de suicidios corresponden a la primavera y el verano. En cuanto a la (..) (AU)

Objective: To study the space-time distribution of suicide in Galicia from 1976 to 1998, taking into account gender, age, season and method of suicide. Methods: For each sex crude and age-adjusted rates per province and age-specific rates per period (1978-84, 1985-91,1992-98) were calculated. To estimate mortality risk and time trends in the municipalities, a Bayesian hierarchical model was used. Results: In the last few years mortality from suicide has increase considerably. Age-adjusted rates of 6 per 105 at the beginning of the study rose to 10 per 105 at the end. The increase was greatest among men. The higher rates were observed in the elderly, although in terms of time trends the highest increase occurred among adolescents and young adults. In both sexes the main method of suicide was hanging. Less common methods were jumping from a height and shooting. The greatest number of suicides took place during the spring (..) (AU)

[Meningococcal C disease epidemic in Galicia 1996: the decision making process]. / El procedimiento de toma de decisión para controlar la epidemia de meningitis C en Galicia en 1996.

In this article we describe the decision making process used to choose the best alternative for bringing under control an epidemic of meningococcal C disease, which occurred in Galicia in 1996. In the decision making process, we used a methodology which consisted on the identification and definition of a problem, in order to identify alternative solutions and to select one, and finally implement and evaluate it. The health problem was detected studying the data obtained from a survey conducted following an outbreak of meningococcal C disease in february 1995 and from the active epidemiological surveillance system created thereafter. Because this was a new, complex and severe problem, with far-reaching social consequences, critical for our organization, and with long-term implications, and because it was considered important to take the decision as objectively as possible and to clearly explain it, the methodology chosen to solve the problem was a non-programmed, multicriteria making decision process, carried out by a working group using a criterion weighting approach. This working group was created within the General Directorate of Public Health, composed of specialist and of people responsible for the different areas involved. The working group put into practice the different steps of the methodology. The assessment criteria and their respective weights were: effect (efficacy measured by the number of cases we could have prevented if the alternatives were applied in the previous season) 40%; cost (in millions of pesetas) 15%; acceptability (acceptance of and response to each strategy from different groups: general population, health care professionals, other Administrations with competency in Public Health) 30%; and coherence (adherence to the currently accepted strategies for disease control in other countries)15%. When these criteria were applied to the ten alternatives considered, a score was obtained for each one of them. The highest scoring alternative corresponded to the massive vaccination of the total population of Galicia between 18 months and 19 years of age.

[Oral health in Galician schoolchildren. 1995]. / La salud bucodental en los escolares gallegos. 1995.

BACKGROUND: To ascertain the condition of the oral hygiene of school children 6 and 12 years of age in Galicia and to assess the degree to which said condition meets the World Health Organization (WHO) oral hygiene objectives for the year 2000. METHODS: Observational cross-sectional study conducted in 1995 on a group of school children 6 and 12 years of age in Galicia selected by means of a multi-stage sampling by conglomerates, stratified by provinces and type of habitat. RESULTS: This study was conducted on 1,288 school age children, 643 in the 6-year-old group and 645 in the 12-year-old group. 46.7% of the 6 year-old children and 64.2% of the 12 year-olds were found to have cavities, which means an oc index of 1.84 and a AOC index of 1.60, respectively. CONCLUSIONS: A trend toward improvement in the oral hygiene of school-age children in Galicia has been found. The oral hygiene-related objectives recommended by the WHO for the year 2000 in the region of Europe have been accomplished, as a result of which further objectives are recommended.