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Guiriguet C, Alberny M, Mora N, Rebagliato O, Roca C, Fina F, Fàbregas M, Benítez M, de la Poza M, Medina M, Flayeh S, Pedrazas D, Sabatés M, Coma E. Sexually transmitted infections, the epidemic that persists after the COVID-19 pandemic: an analysis of the primary care electronic health records covering about 5 million people in Catalonia. BMC Prim Care 2024; 25:150. [PMID: 38704552 PMCID: PMC11069189 DOI: 10.1186/s12875-024-02395-4] [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: 08/07/2023] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The aim of our study is to analyse the trends in the diagnosis of sexually transmitted infections (STIs) during the COVID-19 pandemic. METHODS We conducted an observational retrospective population-based study using data from primary care electronic health records spanning from January 2016 to December 2022 (involving 5.1 million people older than 14 years). We described the daily number of new STI diagnoses from 2016 to 2022; as well as the monthly accumulation of new STI diagnoses for each year. We compared the monthly averages of new diagnoses in 2019, 2020, 2021 and 2022 using the T-test. Finally, we performed a segmented regression analysis of the daily number of STI diagnoses. RESULTS We analysed 200,676 new STI diagnoses. The number of diagnoses abruptly decreased coinciding with the lockdown. Overall in 2020, we observed a reduction of 15%, with higher reductions for specific STIs such as gonorrhoea (-21%), chlamydia (-24%), and HIV (-31%) compared to 2019. Following this drastic drop, which was temporarily associated with the lockdown, we observed a rapid rebound. In 2021, the number of STI diagnoses was similar to that of 2019. Notably, we found a considerable increase in 2022, particularly for non-specific STI, which lack laboratory confirmation (67% increase). HIV was the only STI with a reduction of up to -38% in diagnoses at the end of 2022 compared to 2019. CONCLUSIONS After a significant reduction in 2020, the number of STIs recorded in primary care rapidly rebounded, and the current trend is similar to that of 2019, except for HIV. These findings underscore the dynamic impact of the COVID-19 pandemic on STI diagnoses and highlight the importance of ongoing monitoring and public health interventions in the post-pandemic period.
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Affiliation(s)
- Carolina Guiriguet
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain.
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
| | - Mireia Alberny
- Medical Management of Primary Care Services, STI/HIV Area, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Núria Mora
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Oriol Rebagliato
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Carme Roca
- El Clot Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Francesc Fina
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Mireia Fàbregas
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Mència Benítez
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Mariam de la Poza
- University of Barcelona, Barcelona, Spain
- Doctor Carles Riba Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Manuel Medina
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Souhel Flayeh
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - David Pedrazas
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Montserrat Sabatés
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Ermengol Coma
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
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Fontán-Vela M, Hernando V, Olmedo C, Coma E, Martínez M, Moreno-Perez D, Lorusso N, Vázquez Torres M, Barbas del Buey JF, Roig-Sena J, Pastor E, Galmés Truyols A, Artigues Serra F, Sancho Martínez RM, Latasa Zamalloa P, Pérez Martínez O, Vázquez Estepa A, García Rojas AJ, Barreno Estévez AI, Sánchez-Migallón Naranjo A, Pérez Martín JJ, Peces Jiménez P, Morales Romero R, Castilla J, García Cenoz M, Huerta Huerta M, Boone ALD, Macías Ortiz MJ, Álvarez Río V, Rodríguez Recio MJ, Merino Díaz M, Berradre Sáenz B, Villegas-Moreno MT, Limia A, Diaz A, Monge S. Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study. Clin Infect Dis 2024; 78:476-483. [PMID: 37864849 PMCID: PMC10874271 DOI: 10.1093/cid/ciad645] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.
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Affiliation(s)
- Mario Fontán-Vela
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Community of Madrid, Spain
| | - Victoria Hernando
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Carmen Olmedo
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Ermengol Coma
- Primary Healthcare Information Systems, Health Institute of Catalonia, Catalonia, Spain
| | - Montse Martínez
- Preventive Medicine Service, General Sub-directorate for Health Promotion, Health Department, Secretariat of Public Health,Catalonia, Spain
| | - David Moreno-Perez
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - Nicola Lorusso
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - María Vázquez Torres
- Healthcare Department, General Sub-directorate of Health Prevention and Promotion, General Directorate of Public Health, Community of Madrid, Spain
| | - José Francisco Barbas del Buey
- General Sub-directorate of Public Health Surveillance, General Directorate of Public Health, Madrid, Community of Madrid, Spain
| | - Javier Roig-Sena
- Department of Universal Healthcare and Public Health, Epidemiological Surveillance Service, Valencian Community, Spain
| | - Eliseo Pastor
- Universal Healthcare and Public Health Department, Health Promotion and Prevention Programs Service, Valencian Community, Spain
| | - Antònia Galmés Truyols
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Francisca Artigues Serra
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Rosa María Sancho Martínez
- Epidemiology Unit, General Sub-directorate of Public Health and Addictions of Gipuzkoa, Basque Country, Spain
| | - Pello Latasa Zamalloa
- Epidemiology and Vaccination Service, General Directorate of Public Health, Basque Country, Spain
| | - Olaia Pérez Martínez
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Ana Vázquez Estepa
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Amós José García Rojas
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | - Ana Isabel Barreno Estévez
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | | | - Jaime Jesús Pérez Martín
- Vaccination Progamme, Prevention and Health Protection Service, Health Department, General Directorate of Public Health and Addictions, Murcia Region, Spain
| | - Pilar Peces Jiménez
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Raquel Morales Romero
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNA – CIBERESP, Pamplona, Spain
| | | | - Marta Huerta Huerta
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - An Lieve Dirk Boone
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - María José Macías Ortiz
- Vaccination Program, General Directorate of PublicHealth, Healthcare Service of Extremadura, Spain
| | - Virginia Álvarez Río
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla y León, Spain
| | | | - María Merino Díaz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | - Belén Berradre Sáenz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | | | - Aurora Limia
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Asuncion Diaz
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Susana Monge
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
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Cánovas Zaldúa Y, Coma E, Fina F, Dalmau-Matarrodona E. El atractivo de la especialidad de Medicina Familiar y Comunitaria en la elección de plazas MIR 2023. Aten Primaria 2023; 55:102699. [PMID: 37429094 PMCID: PMC10339114 DOI: 10.1016/j.aprim.2023.102699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Affiliation(s)
- Yoseba Cánovas Zaldúa
- Direcció d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, España; Equipo de Atención Primaria Passeig de Sant Joan, Institut Català de la Salut (ICS), Barcelona, España.
| | - Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España
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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.
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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
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Medina M, Mora N, Coma E, Mas A. [Evolution of the screening and control quality indicators of patients with type 2 diabetes mellitus over 16 years (2007-2022)]. Aten Primaria 2023; 55:102588. [PMID: 36889129 PMCID: PMC9992944 DOI: 10.1016/j.aprim.2023.102588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España
| | - Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España
| | - Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España.
| | - Ariadna Mas
- Direcció d'Atenció Primària, Institut Català de la Salut (ICS), Barcelona, España
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Pino R, Antoñanzas JM, Paredes-Carmona F, Perramon A, Rivière JG, Coma M, Martínez-Mejías A, Ripoll F, López N, Conti R, Sala-Castellví P, Ruiz M, Brio S, García-Lorenzo M, Esteller M, Carreras-Abad C, Herrero-Hernando C, Schneider SO, Gatell A, Aguilar I, Cantero J, Ruiz G, Fenollosa T, Lobato Z, Villalobos P, Mora E, Anton J, Visa-Reñé N, Soler-Palacin P, Calavia O, Esquirol-Herrero C, Guarch-Ibañez B, García-García JJ, Coma E, Fina F, Prats C, Soriano-Arandes A. Multisystem inflammatory syndrome in children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain. Eur J Pediatr 2023; 182:1897-1909. [PMID: 36801975 PMCID: PMC9937862 DOI: 10.1007/s00431-023-04862-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/20/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4-4.8) per 1,000,000 people, and 273 (95% CI: 230-316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7-11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4-11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05). Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic. What is Known: • Before our study, only two publications investigated the incidence of MIS-C regarding SARS-CoV-2 variants in Europe, one from Southeast England and another from Denmark. What is New: • To our knowledge, this is the first study investigating MIS-C incidence in Southern Europe, with the ability to recruit all MIS-C cases in a determined area and analyze the rate ratio for MIS-C among SARS-CoV-2 infections throughout variant periods. • We found a lower rate ratio of MISC/infections with SARS-CoV-2 in the Omicron period for all age groups, including those not eligible for vaccination, suggesting that the variant could be the main factor for this shift in the MISC trend.
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Affiliation(s)
- Rosa Pino
- Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Catalonia, Spain
| | - Jesús M Antoñanzas
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | | | - Aida Perramon
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Jacques G Rivière
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
| | - Maria Coma
- Hospital Universitari Joan XXII, Tarragona, Catalonia, Spain
| | | | - Francesc Ripoll
- Unitat d'Infectologia Pediàtrica de Girona ICS-IAS, Hospital Universitari Josep Trueta, Girona, Catalonia, Spain
| | - Núria López
- Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Romina Conti
- Consorci Sanitari Parc Taulí, Sabadell, Catalonia, Spain
| | - Pere Sala-Castellví
- Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Catalonia, Spain
| | - Montserrat Ruiz
- Hospital Universitari de Vic, Vic, Barcelona, Catalonia, Spain
| | - Sonia Brio
- Hospital Universitari de La Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | | | | | - Clara Carreras-Abad
- Paediatric Infectious Diseases Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - Carlos Herrero-Hernando
- Department of Pediatrics, Hospital de Barcelona, Societat Cooperativa d'Instal·Lacions Assistencials Sanitàries (SCIAS), Barcelona, Catalonia, Spain
| | | | - Anna Gatell
- Equip d'Atenció Primària de Pediatria Garraf, Institut Català de La Salut, Vilanova I La Geltrú, Catalonia, Spain
| | - Isabel Aguilar
- CAP Camps Blancs, Institut Català de La Salut, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Javier Cantero
- Corporació de Salut del Maresme I La Selva, Barcelona-Girona, Catalonia, Spain
| | - Gloria Ruiz
- Pediatria Dels Pirineus SCCLP, Lleida, Catalonia, Spain
| | | | - Zulema Lobato
- Althaia, Xarxa Assistencial Universitària de Manresa (Fundació Althaia), Catalonia, Barcelona, Spain
| | | | - Emiliano Mora
- Hospital Mútua de Terrassa, Barcelona, Catalonia, Spain
| | - Jordi Anton
- Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Catalonia, Spain
| | - Núria Visa-Reñé
- Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Pere Soler-Palacin
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
| | - Olga Calavia
- Hospital Universitari Joan XXII, Tarragona, Catalonia, Spain
| | | | - Borja Guarch-Ibañez
- Unitat d'Infectologia Pediàtrica de Girona ICS-IAS, Hospital Universitari Josep Trueta, Girona, Catalonia, Spain
| | - Juan-José García-García
- Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Catalonia, Spain
| | - Ermengol Coma
- Sistemes d'Informació Dels Serveis d'Atenció Primària (SISAP), Institut Català de La Salut (ICS), Barcelona, Catalonia, Spain
| | - Francesc Fina
- Sistemes d'Informació Dels Serveis d'Atenció Primària (SISAP), Institut Català de La Salut (ICS), Barcelona, Catalonia, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain.
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Mora N, Guiriguet C, Cantenys R, Méndez-Boo L, Marzo-Castillejo M, Benítez M, Fina F, Fàbregas M, Hermosilla E, Mercadé A, Medina M, Coma E. Cancer diagnosis in primary care after second pandemic year in Catalonia: a time-series analysis of primary care electronic health records covering about 5 million people. Fam Pract 2023; 40:183-187. [PMID: 35861148 PMCID: PMC9384533 DOI: 10.1093/fampra/cmac083] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the incidence of chronic disease had drastically been reduced due to health care interruptions. The aim of this study is to analyse cancer diagnosis during the last 2 years of the COVID-19 pandemic. METHODS Time-series study of cancer diagnoses recorded in primary care settings, using data from the primary care electronic health records from January 2014 to December 2021. We obtained the expected monthly rate per 100,000 inhabitants using a time regression adjusted by trend and seasonality. We additionally compared rates of cancer diagnoses in 2019 with those of 2020 and 2021 using the t-test. We performed the analysis globally, by sex and by type of cancer. RESULTS In 2020, the rate of cancer diagnoses had reduced by -21% compared to 2019 (P < 0.05). Greater reductions were observed during the lockdown in early 2020 (>40%) and with some types of cancers, especially prostate and skin cancers (-29.6% and -26.9%, respectively, P < 0.05). Lung cancers presented statistically non-significant reductions in both years. Cancer diagnosis returned to expected around March 2021, and the rate in 2021 was similar to that of 2019 (overall difference of 0.21%, P = 0.967). However, an 11% reduction was still found when comparing the pandemic months of 2020-2021 with pre-pandemic months. CONCLUSIONS Although primary care cancer diagnoses in 2021 have returned to pre-pandemic levels, missing diagnoses during the last 2 years have not been fully recovered.
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Affiliation(s)
- Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Carolina Guiriguet
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain.,Equip d'Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Roser Cantenys
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mercè Marzo-Castillejo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Unitat de Suport a la Recerca Metropolitana Sud, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, Spain
| | - Mència Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain.,Equip d'Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Eduardo Hermosilla
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Albert Mercadé
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
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8
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Coma E, Català M, Méndez-Boo L, Alonso S, Hermosilla E, Alvarez-Lacalle E, Pino D, Medina M, Asso L, Gatell A, Bassat Q, Mas A, Soriano-Arandes A, Fina Avilés F, Prats C. Unravelling the role of the mandatory use of face covering masks for the control of SARS-CoV-2 in schools: a quasi-experimental study nested in a population-based cohort in Catalonia (Spain). Arch Dis Child 2023; 108:131-136. [PMID: 35999036 DOI: 10.1136/archdischild-2022-324172] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the effectiveness of mandatory use of face covering masks (FCMs) in schools during the first term of the 2021-2022 academic year. DESIGN A retrospective population-based study. SETTING Schools in Catalonia (Spain). POPULATION 599 314 children aged 3-11 years attending preschool (3-5 years, without FCM mandate) and primary education (6-11 years, with FCM mandate). STUDY PERIOD From 13 September to 22 December 2021 (before Omicron variant). INTERVENTIONS A quasi-experimental comparison between children in the last grade of preschool (5 years old), as a control group, and children in year 1 of primary education (6 years old), as an interventional group. MAIN OUTCOME MEASURES Incidence of SARS-CoV-2, secondary attack rates (SARs) and effective reproductive number (R*). RESULTS SARS-CoV-2 incidence was significantly lower in preschool than in primary education, and an increasing trend with age was observed. Six-year-old children showed higher incidence than 5 year olds (3.54% vs 3.1%; OR 1.15 (95% CI 1.08 to 1.22)) and slightly lower but not statistically significant SAR (4.36% vs 4.59%; incidence risk ratio 0.96 (95% CI 0.82 to 1.11)) and R* (0.9 vs 0.93; OR 0.96 (95% CI 0.87 to 1.09)). Results remained consistent using a regression discontinuity design and linear regression extrapolation approaches. CONCLUSIONS We found no significant differences in SARS-CoV-2 transmission due to FCM mandates in Catalonian schools. Instead, age was the most important factor in explaining the transmission risk for children attending school.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Martí Català
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Sergio Alonso
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Eduardo Hermosilla
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain.,IDIAP Jordi Gol, Barcelona, Catalonia, Spain
| | - Enric Alvarez-Lacalle
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - David Pino
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Laia Asso
- Departament de Salut, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Anna Gatell
- Equip Pediatria Territorial Alt Penedès-Garraf, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues (Barcelona), Catalonia, Spain.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Catalonia, Spain
| | - Ariadna Mas
- Direcció Assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain .,Department of Infectious Diseases, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Francesc Fina Avilés
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
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9
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Mora N, Fina F, Méndez-Boo L, Cantenys R, Benítez M, Moreno N, Balló E, Hermosilla E, Fàbregas M, Guiriguet C, Cos X, Rodoreda S, Mas A, Lejardi Y, Coma E, Medina M. "Decline and uneven recovery from 7 common long-term conditions managed in the Catalan primary care after two pandemic years: an observational retrospective population-based study using primary care electronic health records". BMC Prim Care 2023; 24:9. [PMID: 36641483 PMCID: PMC9840158 DOI: 10.1186/s12875-022-01935-0] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The incidence of chronic diseases during the COVID-19 pandemic has drastically been reduced worldwide due to disruptions in healthcare systems. The aim of our study is to analyse the trends in the incidence of 7 commonly managed primary care chronic diseases during the last 2 years of the COVID-19 pandemic in Catalonia. METHODS We performed an observational retrospective population-based study using data from primary care electronic health records from January 2018 to August 2022 (5.1 million people older than 14 years). We divided the study period into two: a pre-pandemic period (before 14 March 2020) and a pandemic period. We performed a segmented regression analysis of daily incidence rates per 100,000 inhabitants of 7 chronic diseases: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), heart failure (HF), hypertension and hypercholesterolemia. In addition, we compared annual incidence between pandemic years (2020, 2021 and 2022) and 2019. Associated incidence rate ratios (IRR) were also calculated. Finally, we estimated the number of expected diagnoses during the pandemic period using data from 2019 and we compared it with the observed data. RESULTS We analysed 740,820 new chronic diseases' diagnoses. Daily incidence rates of all 7 chronic diseases were drastically interrupted on 14 March 2020, and a general upward trend was observed during the following months. Reductions in 2020 were around 30% for all conditions except COPD which had greater reductions (IRR: 0.58 [95% CI: 0.57 to 0.6]) and HF with lesser drops (IRR: 0.86 [95% CI: 0.84 to 0.88]). Some of the chronic conditions have returned to pre-pandemic diagnosis levels, except asthma, COPD and IHD. The return to pre-pandemic diagnosis levels compensated for the drops in 2020 for T2DM and HF, but not for hypertension which presented an incomplete recovery. We also observed an excess of hypercholesterolemia diagnoses of 8.5% (95%CI: 1.81% to 16.15%). CONCLUSIONS Although primary care has recovered the pre-pandemic diagnosis levels for some chronic diseases, there are still missing diagnoses of asthma, COPD and IHD that should be addressed.
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Affiliation(s)
- Núria Mora
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Francesc Fina
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Leonardo Méndez-Boo
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Roser Cantenys
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Mència Benítez
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain ,grid.22061.370000 0000 9127 6969Equip d’Atenció Primària de Gòtic, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Nemesio Moreno
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Elisabet Balló
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Eduardo Hermosilla
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain ,grid.452479.9Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Mireia Fàbregas
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Carolina Guiriguet
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain ,grid.22061.370000 0000 9127 6969Equip d’Atenció Primària de Gòtic, Institut Català de la Salut (ICS), Barcelona, Spain ,grid.5841.80000 0004 1937 0247Universitat de Barcelona, Barcelona, Spain
| | - Xavier Cos
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain ,grid.22061.370000 0000 9127 6969DAP_Cat Research Group, Gerència Territorial Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBERDEM, ISCIII , Madrid, Spain
| | - Sara Rodoreda
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Ariadna Mas
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Yolanda Lejardi
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Ermengol Coma
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Manuel Medina
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
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10
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Català M, Coma E, Alonso S, Andrés C, Blanco I, Antón A, Bordoy AE, Cardona PJ, Fina F, Martró E, Medina M, Mora N, Saludes V, Prats C, Prieto-Alhambra D, Alvarez-Lacalle E. Corrigendum: Transmissibility, hospitalization, and intensive care admissions due to omicron compared to delta variants of SARS-CoV-2 in Catalonia: A cohort study and ecological analysis. Front Public Health 2022; 10:1060328. [PMID: 36743167 PMCID: PMC9894245 DOI: 10.3389/fpubh.2022.1060328] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 01/20/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2022.961030.].
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Affiliation(s)
- Martí Català
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Ermengol Coma
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Sergio Alonso
- Physics Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Cristina Andrés
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain,Biomedical Research Networking Center in Infectious Diseases (CIBERINF), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Blanco
- Clinical Genetics Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain,Biomedical Research Networking Center in Infectious Diseases (CIBERINF), Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni E. Bordoy
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Pere-Joan Cardona
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain,Biomedical Research Networking Center in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Cerdanyola, Spain
| | - Francesc Fina
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain,Biomedical Research Networking Center in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Medina
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Núria Mora
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain,Biomedical Research Networking Center in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Prats
- Physics Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Enrique Alvarez-Lacalle
- Physics Department, Universitat Politècnica de Catalunya, Barcelona, Spain,*Correspondence: Enrique Alvarez-Lacalle
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11
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Català M, Coma E, Alonso S, Andrés C, Blanco I, Antón A, Bordoy AE, Cardona PJ, Fina F, Martró E, Medina M, Mora N, Saludes V, Prats C, Prieto-Alhambra D, Alvarez-Lacalle E. Transmissibility, hospitalization, and intensive care admissions due to omicron compared to delta variants of SARS-CoV-2 in Catalonia: A cohort study and ecological analysis. Front Public Health 2022; 10:961030. [PMID: 36033822 PMCID: PMC9412031 DOI: 10.3389/fpubh.2022.961030] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/11/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose We aim to compare the severity of infections between omicron and delta variants in 609,352 SARS-CoV-2 positive cases using local hospitalization, vaccination, and variants data from the Catalan Health Care System (which covers around 7. 8 million people). Methods We performed a substitution model to establish the increase in transmissibility of omicron using variant screening data from primary care practices (PCP) and hospital admissions. In addition, we used this data from PCP to establish the two periods when delta and omicron were, respectively, dominant (above 95% of cases). After that, we performed a population-based cohort analysis to calculate the rates of hospital and intensive care unit (ICU) admissions for both periods and to estimate reduction in severity. Rate ratios (RR) and 95% confidence intervals (95% CI) were calculated and stratified by age and vaccination status. In a second analysis, the differential substitution model in primary care vs. hospitals allowed us to obtain a population-level average change in severity. Results We have included 48,874 cases during the delta period and 560,658 during the omicron period. During the delta period, on average, 3.8% of the detected cases required hospitalization for COVID-19. This percentage dropped to 0.9% with omicron [RR of 0.46 (95% CI: 0.43 to 0.49)]. For ICU admissions, it dropped from 0.8 to 0.1% [RR 0.25 (95% CI: 0.21 to 0.28)]. The proportion of cases hospitalized or admitted to ICU was lower in the vaccinated groups, independently of the variant. Omicron was associated with a reduction in risk of admission to hospital and ICU in all age and vaccination status strata. The differential substitution models showed an average RR between 0.19 and 0.50. Conclusion Both independent methods consistently show an important decrease in severity for omicron relative to delta. The systematic reduction happens regardless of age. The severity is also reduced for non-vaccinated and vaccinated groups, but it remains always higher in the non-vaccinated population. This suggests an overall reduction in severity, which could be intrinsic to the omicron variant. The fact is that the RR in ICU admission is systematically smaller than in hospitalization points in the same direction.
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Affiliation(s)
- Martí Català
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Ermengol Coma
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Sergio Alonso
- Physics Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Cristina Andrés
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain,Biomedical Research Networking Center in Infectious Diseases (CIBERINF), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Blanco
- Clinical Genetics Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain,Biomedical Research Networking Center in Infectious Diseases (CIBERINF), Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni E. Bordoy
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Pere-Joan Cardona
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain,Biomedical Research Networking Center in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Cerdanyola, Spain
| | - Francesc Fina
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain,Biomedical Research Networking Center in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Medina
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Núria Mora
- Primary Care Services Information System (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain,Biomedical Research Networking Center in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Prats
- Physics Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Enrique Alvarez-Lacalle
- Physics Department, Universitat Politècnica de Catalunya, Barcelona, Spain,*Correspondence: Enrique Alvarez-Lacalle
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Biarnés-Martínez M, Fàbregas M, Coma E, Pera G, Fina F, Rivera-Arco A, Guiriguet C, Méndez-Boo L, Medina M. [SARS-CoV-2 infection in occupational settings in Catalonia.]. Rev Esp Salud Publica 2022; 96:e202205040. [PMID: 35506485] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE The aim of this paper was to estimate the SARS-CoV-2 infection incidence regarding the occupation in Catalonia, globally and in the different waves of the pandemic. METHODS We performed a retrospective cohort study. We included all people between 16 and 65 years old with an occupation identified from the sick leave recorded in the primary care electronic health records of the Institut Català de la Salut (ICS) (total n=2,199,745 people). The study period was from March 1st, 2020 to September 16th, 2021. RESULTS Healthcare workers had the highest incidence, with an age and sex adjusted cumulative rate of 27.7% [95% CI: 27.3%-28.1%]: 29.4% in nursing assistants, 27.3% in medical professions and 26.3% in nursing professionals; followed by the elementary occupations group with an adjusted incidence of 16.9% [95% CI: 16.7%-17%], such as the agricultural laborers (23% [95% CI: 21%-25.1%]) and rural occupations (19.1% [95% CI: 18.3%-19.8%) -especially during the 2020 summer period-, the domestic employees (20.5% [95% CI: 18.9%-22.2%]) and cleaning professionals (17.5% [95% CI: 17.2%-17.9%]). CONCLUSIONS Healthcare workers are the hardest hit during the pandemic. On the other hand, the less qualified professions have high incidences, highlighting the different inequities in access to telework, working conditions and other social determinants of health.
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Affiliation(s)
- Marta Biarnés-Martínez
- Unidad Docente de Medicina Preventiva y Salud Pública Parc de Salut Mar. Universitat Pompeu Fabra. Agència de Salut Pública de Barcelona. Barcelona. España
| | - Mireia Fàbregas
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Ermengol Coma
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord. Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol. Barcelona. España
| | - Francesc Fina
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Alejandro Rivera-Arco
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Carolina Guiriguet
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
| | - Manuel Medina
- Sistemes d'Informació dels serveis d'Atenció Primària (SISAP). Institut Català de la Salut (ICS). Barcelona. España
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Suñer C, Coma E, Ouchi D, Hermosilla E, Baro B, Rodríguez-Arias MÀ, Puig J, Clotet B, Medina M, Mitjà O. Association between two mass-gathering outdoor events and incidence of SARS-CoV-2 infections during the fifth wave of COVID-19 in north-east Spain: A population-based control-matched analysis. The Lancet Regional Health - Europe 2022; 15:100337. [PMID: 35237763 PMCID: PMC8883024 DOI: 10.1016/j.lanepe.2022.100337] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Many countries have resumed mass-gathering events like music festivals, despite the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. In this study, we aimed to assess the effect of two mass-gathering outdoor events, held during a peak of SARS-CoV-2 transmission, on COVID-19 incidence. Methods This was a retrospective, population-based control-matched analysis. The study population included attendees to two outdoor music festivals held in Catalonia (North-East Spain). The primary objective was to compare the incidence of COVID-19 within the 3-to-10 days following the event between attendees and a population-based control group. Findings The analysis included 18,275 and 27,347 attendees to the first and second festivals, respectively, and their corresponding controls. The post-festival 7-day cumulative COVID-19 incidence among attendees and controls was 4.14% (95% CI 3.86-4.44) vs. 1.69% (1.51-1.88) for the first festival (RR 2.46; 2.16-2.80), and 2.42% (2.35-2.61) and 1.10% (0.99-1.2) for the second festival (RR 2.19; 1.92-2.51). COVID-19 incidence among immunized individuals was also two-fold higher in attendees than in controls. Previous COVID-19 infection, vaccination, and adequate mask-wearing were significantly associated with a lower risk of COVID-19 infection after the events. Interpretation Despite the proven effectiveness of preventive measures such as Ag-RDT screening, mask-wearing and vaccination, caution should be taken when holding these events during a period of high community SARS-CoV-2 transmission. Funding Crowdfunding campaign YoMeCorono (https://www.yomecorono.com/) and the Generalitat de Catalunya.
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Coma E, Vila J, Méndez-Boo L, Antón A, Mora N, Fina F, Fàbregas M, Medina M. Respiratory Syncytial Virus Infections in Young Children Presenting to Primary Care in Catalonia During the COVID-19 Pandemic. J Pediatric Infect Dis Soc 2022; 11:69-72. [PMID: 34922377 DOI: 10.1093/jpids/piab121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/17/2021] [Indexed: 12/17/2022]
Abstract
We observed an unusual pattern of respiratory syncytial virus (RSV) in children under 5 years in Catalonia (Spain). We observed a near absence of RSV during winter months and a subsequent surge during the late spring. Primary care electronic health records combined with hospital RSV laboratory confirmation could be used to monitor trends of respiratory pathogens.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Jorgina Vila
- Hospitalization Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Andrés Antón
- Respiratory Virus Unit, Virology Section, Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
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Alonso S, Català M, López D, Álvarez-Lacalle E, Jordan I, García-García JJ, Fumadó V, Muñoz-Almagro C, Gratacós E, Balanza N, Varo R, Millat P, Baro B, Ajanovic S, Arias S, Claverol J, de Sevilla MF, Bonet-Carne E, Garcia-Miquel A, Coma E, Medina-Peralta M, Fina F, Prats C, Bassat Q. Individual prevention and containment measures in schools in Catalonia, Spain, and community transmission of SARS-CoV-2 after school re-opening. PLoS One 2022; 17:e0263741. [PMID: 35171936 PMCID: PMC8849486 DOI: 10.1371/journal.pone.0263741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite their clear lesser vulnerability to COVID-19, the extent by which children are susceptible to getting infected by SARS-CoV-2 and their capacity to transmit the infection to other people remains inadequately characterized. We aimed to evaluate the role of school reopening and the preventive strategies in place at schools in terms of overall risk for children and community transmission, by comparing transmission rates in children as detected by a COVID-19 surveillance platform in place in Catalonian Schools to the incidence at the community level. METHODS AND FINDINGS Infections detected in Catalan schools during the entire first trimester of classes (September-December 2020) were analysed and compared with the ongoing community transmission and with the modelled predicted number of infections. There were 30.486 infections (2.12%) documented among the circa 1.5M pupils, with cases detected in 54.0% and 97.5% of the primary and secondary centres, respectively. During the entire first term, the proportion of "bubble groups" (stable groups of children doing activities together) that were forced to undergo confinement ranged between 1 and 5%, with scarce evidence of substantial intraschool transmission in the form of chains of infections, and with ~75% of all detected infections not leading to secondary cases. Mathematical models were also used to evaluate the effect of different parameters related to the defined preventive strategies (size of the bubble group, number of days of confinement required by contacts of an index case). The effective reproduction number inside the bubble groups in schools (R*), defined as the average number of schoolmates infected by each primary case within the bubble, was calculated, yielding a value of 0.35 for primary schools and 0.55 for secondary schools, and compared with the outcomes of the mathematical model, implying decreased transmissibility for children in the context of the applied measures. Relative homogenized monthly cumulative incidence ([Formula: see text]) was assessed to compare the epidemiological dynamics among different age groups and this analysis suggested the limited impact of infections in school-aged children in the context of the overall community incidence. CONCLUSIONS During the fall of 2020, SARS-CoV-2 infections and COVID-19 cases detected in Catalan schools closely mirrored the underlying community transmission from the neighbourhoods where they were set and maintaining schools open appeared to be safe irrespective of underlying community transmission. Preventive measures in place in those schools appeared to be working for the early detection and rapid containment of transmission and should be maintained for the adequate and safe functioning of normal academic and face-to-face school activities.
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Affiliation(s)
- Sergio Alonso
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Martí Català
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Daniel López
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | | | - Iolanda Jordan
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan José García-García
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Victoria Fumadó
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Núria Balanza
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pere Millat
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Bàrbara Baro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Sara Ajanovic
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Sara Arias
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Fundació Sant Joan de Déu, Barcelona, Spain
| | - Mariona Fernández de Sevilla
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Elisenda Bonet-Carne
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Politècnica de Catalunya BarcelonaTech, Barcelona, Spain
| | - Aleix Garcia-Miquel
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Ermengol Coma
- Sistema d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Manuel Medina-Peralta
- Sistema d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Sistema d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Quique Bassat
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
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Marin-Gomez FX, Mendioroz-Peña J, Mayer MA, Méndez-Boo L, Mora N, Hermosilla E, Coma E, Vilaseca JM, Leis A, Medina M, Catalina QM, Vidal-Alaball J. Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study. Int J Environ Res Public Health 2022; 19:483. [PMID: 35010742 PMCID: PMC8744689 DOI: 10.3390/ijerph19010483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023]
Abstract
Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.
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Affiliation(s)
- Francesc X. Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- 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, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Jacobo Mendioroz-Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- COVID-19 Response Unit, Department of Health, Generalitat de Catalunya, 08005 Barcelona, Spain
| | - Miguel-Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Leonardo Méndez-Boo
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Núria Mora
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Eduardo Hermosilla
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Ermengol Coma
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Josep-Maria Vilaseca
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Manolo Medina
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Queralt Miró Catalina
- 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, 08772 St. Fruitós de Bages, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- 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, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
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Coma E, Miró Q, Medina M, Marin-Gomez FX, Cos X, Benítez M, Mas A, Fàbregas M, Fina F, Lejardi Y, Vidal-Alaball J. Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia. Diabetes Res Clin Pract 2021; 182:109127. [PMID: 34752800 PMCID: PMC8592525 DOI: 10.1016/j.diabres.2021.109127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Abstract
AIM To analyse the relation between face-to-face appointments and management of patients with type 2 diabetes mellitus (T2DM) visited in primary care practices (PCP). METHODS Retrospective study in 287 primary care practices (PCPs) attending>300,000 patients with T2DM. We analysed the results of 9 diabetes-related indicators of the Healthcare quality standard, comprising foot and retinopathy screening, blood pressure (BP) and glycemic control; and the incidence of T2DM. We calculated each indicator's percentage of change in 2020 with respect to the results of 2019. RESULTS Indicators' results were reduced in 2020 compared to 2019, highlighting the indicators of foot and retinopathy screening (-51.6% and -25.7%, respectively); the glycemic control indicator (-21.2%); the BP control indicator (-33.7%) and the incidence of T2DM (-25.6%). Conversely, the percentage of type 2 diabetes patients with HbA1c > 10% increased by 34%. PCPs with<11 weekly face-to-face appointments offered per professional had greater reductions than those PCPs with more than 40. For instance, a reduction of -60.7% vs -38.2% (p-value < 0.001) in the foot screening's indicator; -27.5% vs -12.5% (p-value < 0.001) in glycemic control and -40.2 vs -24.3% (p-value < 0.001) in BP control. CONCLUSIONS Reducing face-to-face visits offered may impact T2DM patients' follow-up and thus worsen their control.
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Affiliation(s)
- Ermengol Coma
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain.
| | - Queralt Miró
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain
| | - Manuel Medina
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Francesc X Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain; 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, Spain; Faculty of Medicine. University of Vic - Central University of Catalonia, Vic, Spain
| | - Xavier Cos
- DAP_Cat Research Group, Gerencia Territorial Barcelona Ciutat, Institut Català de la Salut, Spain; Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autonoma de Barcelona, Spain; Institut Català de la Salut, Spain
| | - Mència Benítez
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain; Equip d'Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | | | - Mireia Fàbregas
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | | | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain; 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, Spain; Faculty of Medicine. University of Vic - Central University of Catalonia, Vic, Spain
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González-Tampán A, Bellver M, Cuixart L, Choulli M, Hurtós L, Molina K, Coma E, Peiró I, Arribas L. Nutritional status and body composition in Covid-19 oncological inpatients. Clin Nutr ESPEN 2021. [PMCID: PMC8629575 DOI: 10.1016/j.clnesp.2021.09.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cabezas C, Coma E, Mora-Fernandez N, Li X, Martinez-Marcos M, Fina F, Fabregas M, Hermosilla E, Jover A, Contel JC, Lejardi Y, Enfedaque B, Argimon JM, Medina-Peralta M, Prieto-Alhambra D. Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study. BMJ 2021; 374:n1868. [PMID: 34407952 PMCID: PMC8371258 DOI: 10.1136/bmj.n1868] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 among nursing home residents, nursing home staff, and healthcare workers. DESIGN Prospective cohort study. SETTING Nursing homes and linked electronic medical record, test, and mortality data in Catalonia on 27 December 2020. PARTICIPANTS 28 456 nursing home residents, 26 170 nursing home staff, and 61 791 healthcare workers. MAIN OUTCOME MEASURES Participants were followed until the earliest outcome (confirmed SARS-CoV-2 infection, hospital admission or death with covid-19) or 26 May 2021. Vaccination status was introduced as a time varying exposure, with a 14 day run-in after the first dose. Mixed effects Cox models were fitted to estimate hazard ratios with index month as a fixed effect and adjusted for confounders including sociodemographics, comorbidity, and previous medicine use. RESULTS Among the nursing home residents, SARS-CoV-2 infection was found in 2482, 411 were admitted to hospital with covid-19, and 450 died with covid-19 during the study period. In parallel, 1828 nursing home staff and 2968 healthcare workers were found to have SARS-CoV-2 infection, but fewer than five were admitted or died with covid-19. The adjusted hazard ratio for SARS-CoV-2 infection after two doses of vaccine was 0.09 (95% confidence interval 0.08 to 0.11) for nursing home residents, 0.20 (0.17 to 0.24) for nursing home staff, and 0.13 (0.11 to 0.16) for healthcare workers. Adjusted hazard ratios for hospital admission and mortality after two doses of vaccine were 0.05 (0.04 to 0.07) and 0.03 (0.02 to 0.04), respectively, for nursing home residents. Nursing home staff and healthcare workers recorded insufficient events for mortality analysis. CONCLUSIONS Vaccination was associated with 80-91% reduction in SARS-CoV-2 infection in all three cohorts and greater reductions in hospital admissions and mortality among nursing home residents for up to five months. More data are needed on longer term effects of covid-19 vaccines.
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Affiliation(s)
- Carmen Cabezas
- Public Health Secretariat, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Ermengol Coma
- Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | - Nuria Mora-Fernandez
- Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | - Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Montse Martinez-Marcos
- Public Health Secretariat, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Francesc Fina
- Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | - Mireia Fabregas
- Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | | | - Angel Jover
- Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | - Juan Carlos Contel
- Chronic Care Program, Integrated Health and Social Care Plan, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Yolanda Lejardi
- Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | - Belen Enfedaque
- Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | | | - Manuel Medina-Peralta
- Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
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20
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Catala M, Coma E, Alonso S, Álvarez-Lacalle E, Cordomi S, López D, Fina F, Medina-Peralta M, Prats C, Prieto-Alhambra D. Risk Diagrams Based on Primary Care Electronic Medical Records and Linked Real-Time PCR Data to Monitor Local COVID-19 Outbreaks During the Summer 2020: A Prospective Study Including 7,671,862 People in Catalonia. Front Public Health 2021; 9:693956. [PMID: 34291033 PMCID: PMC8287173 DOI: 10.3389/fpubh.2021.693956] [Citation(s) in RCA: 6] [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: 04/12/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
Monitoring transmission is a prerequisite for containing COVID-19. We report on effective potential growth (EPG) as a novel measure for the early identification of local outbreaks based on primary care electronic medical records (EMR) and PCR-confirmed cases. Secondly, we studied whether increasing EPG precedes local hospital and intensive care (ICU) admissions and mortality. Population-based cohort including all Catalan citizens' PCR tests, hospitalization, intensive care (ICU) and mortality between 1/07/2020 and 13/09/2020; linked EMR covering 88.6% of the Catalan population was obtained. Nursing home residents were excluded. COVID-19 counts were ascertained based on EMR and PCRs separately. Weekly empirical propagation (ρ7) and 14-day cumulative incidence (A14) and 95% confidence intervals were estimated at care management area (CMA) level, and combined as EPG = ρ7 × A14. Overall, 7,607,201 and 6,798,994 people in 43 CMAs were included for PCR and EMR measures, respectively. A14, ρ7, and EPG increased in numerous CMAs during summer 2020. EMR identified 2.70-fold more cases than PCRs, with similar trends, a median (interquartile range) 2 (1) days earlier, and better precision. Upticks in EPG preceded increases in local hospital admissions, ICU occupancy, and mortality. Increasing EPG identified localized outbreaks in Catalonia, and preceded local hospital and ICU admissions and subsequent mortality. EMRs provided similar estimates to PCR, but some days earlier and with better precision. EPG is a useful tool for the monitoring of community transmission and for the early identification of COVID-19 local outbreaks.
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Affiliation(s)
- Marti Catala
- Computational Biology and Complex Systems (BIOCOM-SC), Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, Spain.,Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Sergio Alonso
- Computational Biology and Complex Systems (BIOCOM-SC), Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Enrique Álvarez-Lacalle
- Computational Biology and Complex Systems (BIOCOM-SC), Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Silvia Cordomi
- Direcció d'Estratègia i Qualitat, Institut Català de la Salut, Barcelona, Spain
| | - Daniel López
- Computational Biology and Complex Systems (BIOCOM-SC), Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Manuel Medina-Peralta
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Clara Prats
- Computational Biology and Complex Systems (BIOCOM-SC), Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, Spain.,Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
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21
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Solans O, Vidal-Alaball J, Roig Cabo P, Mora N, Coma E, Bonet Simó JM, Hermosilla Pérez E, Saigí-Rubió F, Olmos Domínguez C, Piera-Jiménez J, Abizanda González M, López Seguí F. Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study. J Med Internet Res 2021; 23:e28629. [PMID: 33970867 PMCID: PMC8163495 DOI: 10.2196/28629] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 03/09/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.
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Affiliation(s)
- Oscar Solans
- Health Department, Catalan Ministry of Health, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,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.,Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Pasqual Roig Cabo
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Núria Mora
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Ermengol Coma
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Josep Maria Bonet Simó
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Eduardo Hermosilla Pérez
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain.,Jordi Gol i Gurina Primary Health Care Research Institute Foundation, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | | | - Jordi Piera-Jiménez
- Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain.,Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Mercè Abizanda González
- Health Department, eHealth Unit, Barcelona, Spain.,Pere Virgili Health Park, Primary Care Management Control, Barcelona, Spain
| | - Francesc López Seguí
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain.,Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, Spain
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22
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Coma E, Guiriguet C, Mora N, Marzo-Castillejo M, Benítez M, Méndez-Boo L, Fina F, Fàbregas M, Mercadé A, Medina M. Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people. BMJ Open 2021; 11:e047567. [PMID: 34006554 PMCID: PMC8130761 DOI: 10.1136/bmjopen-2020-047567] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The objective of our study is to evaluate the impact of the pandemic on the incidence of cancer diagnoses in primary care. DESIGN Time-series study of malignant neoplasms and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020. SETTING Primary care, Catalonia, Spain. PARTICIPANTS People older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm. MAIN OUTCOME MEASURES We obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms was defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer and socioeconomic status. RESULTS Between March and September 2020 we observed 8766 (95% CI 4135 to 13 397) fewer malignant neoplasm diagnoses, representing a reduction of 34% (95% CI 19.5% to 44.1%) compared with the expected. This underdiagnosis was greater in individuals aged older than 64 years, men and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that). CONCLUSIONS Reduction in cancer incidence has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Carolina Guiriguet
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Catala De La Salut, Barcelona, Spain
| | - Nuria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Mercè Marzo-Castillejo
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Direcció d'Atenció Primària Costa de Ponent, ICS, Barcelona, Spain
| | - Mencia Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Catala De La Salut, Barcelona, Spain
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Albert Mercadé
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
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23
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Coma E, Mora N, Peremiquel-Trillas P, Benítez M, Méndez L, Mercadé A, Fina F, Fàbregas M, Medina M. Influence of organization and demographic characteristics of primary care practices on continuity of care: analysis of a retrospective cohort from 287 primary care practices covering about 6 million people in Catalonia. BMC Fam Pract 2021; 22:56. [PMID: 33761874 PMCID: PMC7992318 DOI: 10.1186/s12875-021-01414-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022]
Abstract
Background There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients’ sociodemographic characteristics play a role in its continuity of care. Methods Four indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut—ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices. Results Indices’ results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R2 ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship. Conclusion Study results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01414-y.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain.
| | - Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Unit of Molecular Epidemiology and Genetics in Infections and Cancer, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mència Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain.,Equip d'Atenció Primària Gòtic, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Leonardo Méndez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Albert Mercadé
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
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Coma E, Méndez-Boo L, Mora N, Guiriguet C, Benítez M, Fina F, Fàbregas M, Balló E, Ramos F, Medina M, Argimon JM. Divergences on expected pneumonia cases during the COVID-19 epidemic in Catalonia: a time-series analysis of primary care electronic health records covering about 6 million people. BMC Infect Dis 2021; 21:283. [PMID: 33740907 PMCID: PMC7979451 DOI: 10.1186/s12879-021-05985-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Pneumonia is one of the complications of COVID-19. Primary care electronic health records (EHR) have shown the utility as a surveillance system. We therefore analyse the trends of pneumonia during two waves of COVID-19 pandemic in order to use it as a clinical surveillance system and an early indicator of severity. METHODS Time series analysis of pneumonia cases, from January 2014 to December 2020. We collected pneumonia diagnoses from primary care EHR, a software system covering > 6 million people in Catalonia (Spain). We compared the trend of pneumonia in the season 2019-2020 with that in the previous years. We estimated the expected pneumonia cases with data from 2014 to 2018 using a time series regression adjusted by seasonality and influenza epidemics. RESULTS Between 4 March and 5 May 2020, 11,704 excess pneumonia cases (95% CI: 9909 to 13,498) were identified. Previously, we identified an excess from January to March 2020 in the population older than 15 years of 20%. We observed another excess pneumonia period from 22 october to 15 november of 1377 excess cases (95% CI: 665 to 2089). In contrast, we observed two great periods with reductions of pneumonia cases in children, accounting for 131 days and 3534 less pneumonia cases (95% CI, 1005 to 6064) from March to July; and 54 days and 1960 less pneumonia cases (95% CI 917 to 3002) from October to December. CONCLUSIONS Diagnoses of pneumonia from the EHR could be used as an early and low cost surveillance system to monitor the spread of COVID-19.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Carolina Guiriguet
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Equip d'Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Mència Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Equip d'Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Elisabet Balló
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Equip d'Atenció Primària de Salt, Institut Català de la Salut, Girona, Spain
| | - Francisa Ramos
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
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Moreno-González G, Mussetti A, Albasanz-Puig A, Salvador I, Sureda A, Gudiol C, Salazar R, Marin M, Garcia M, Navarro V, de la Haba Vaca I, Coma E, Sanz-Linares G, Dura X, Fontanals S, Serrano G, Cruz C, Mañez R. A Phase I/II Clinical Trial to evaluate the efficacy of baricitinib to prevent respiratory insufficiency progression in onco-hematological patients affected with COVID19: A structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:116. [PMID: 33546739 PMCID: PMC7862837 DOI: 10.1186/s13063-021-05072-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Baricitinib is supposed to have a double effect on SARS-CoV2 infection. Firstly, it reduces the inflammatory response through the inhibition of the Januse-Kinase signalling transducer and activator of transcription (JAK-STAT) pathway. Moreover, it reduces the receptor mediated viral endocytosis by AP2-associated protein kinase 1 (AAK1) inhibition. We propose the use of baricinitib to prevent the progression of the respiratory insufficiency in SARS-CoV2 pneumonia in onco-haematological patients. In this phase Ib/II study, the primary objective in the safety cohort is to describe the incidence of severe adverse events associated with baricitinib administration. The primary objective of the randomized phase (baricitinib cohort versus standard of care cohort) is to evaluate the number of patients who did not require mechanical oxygen support since start of therapy until day +14 or discharge (whichever it comes first). The secondary objectives of the study (only randomized phase of the study) are represented by the comparison between the two arms of the study in terms of mortality and toxicity at day+30. Moreover, a description of the immunological related changes between the two arms of the study will be reported. TRIAL DESIGN The trial is a phase I/II study with a safety run-in cohort (phase 1) followed by an open label phase II randomized controlled trial with an experimental arm compared to a standard of care arm. PARTICIPANTS The study will be performed at the Institut Català d'Oncologia, a tertiary level oncological referral center in the Catalonia region (Spain). The eligibility criteria are: patients > 18 years affected by oncological diseases; ECOG performance status < 2 (Karnofsky score > 60%); a laboratory confirmed infection with SARS-CoV-2 by means of real -time PCR; radiological signs of low respiratory tract disease; absence of organ dysfunction (a total bilirubin within normal institutional limits, AST/ALT≤2.5 X institutional upper limit of normal, alkaline phosphatase ≤2.5 X institutional upper limit of normal, coagulation within normal institutional limits, creatinine clearance >30 mL/min/1.73 m2 for patients with creatinine levels above institutional normal); absence of HIV infection; no active or latent HBV or HCV infection. The exclusion criteria are: patients with oncological diseases who are not candidates to receive any active oncological treatment; hemodynamic instability at time of study enrollment; impossibility to receive oral medication; medical history of recent or active pulmonary embolism or deep venous thrombosis or patients at high-risk of suffering them (surgical intervention, immobilization); multi organ failure, rapid worsening of respiratory function with requirement of fraction of inspired oxygen (FiO2) > 50% or high-flow nasal cannula before initiation of study treatment; uncontrolled intercurrent illness (ongoing or severe active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements); allergy to one or more of study treatments; pregnant or breastfeeding women; positive pregnancy test in a pre-dose examination. Patients should have the ability to understand, and the willingness to sign, a written informed consent document; the willingness to accept randomization to any assigned treatment arm; and must agree not to enroll in another study of an investigational agent prior to completion of Day +28 of study. An electronic Case Report Form in the Research Electronic Data Capture (REDCap) platform will be used to collect the data of the trial. Removal from the study will apply in case of unacceptable adverse event(s), development of an intercurrent illness, condition or procedural complication, which could interfere with the patient's continued participation and voluntary patient withdrawal from study treatment (all patients are free to withdraw from participation in this study at any time, for any reasons, specified or unspecified, and without prejudice). INTERVENTION AND COMPARATOR Treatment will be administered on an inpatient basis. We will compare the experimental treatment with baricitinib plus the institutional standard of care compared with the standard of care alone. During the phase I, we will define the dose-limiting toxicity of baricitinib and the dose to be used in the phase 2 part of the study. The starting baricitinib dose will be an oral tablet 4 mg-once daily which can be reduced to 2 mg depending on the observed toxicity. The minimum duration of therapy will be 5 days and it can be extended to 7 days. The standard of care will include the following therapies. Antibiotics will be individualized based on clinical suspicion, including the management of febrile neutropenia. Prophylaxis of thromboembolic disease will be administered to all participants. Remdesivir administration will be considered only in patients with severe pneumonia (SatO2 <94%) with less than 7 days of onset of symptoms and with supplemental oxygen requirements but not using high-flow nasal cannula, non-invasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). In the randomized phase, tocilizumab or interferon will not be allowed in the experimental arm. Tocilizumab can be used in patients in the standard of care arm at the discretion of the investigator. If it is prescribed it will be used according to the following criteria: patients who, according to his baseline clinical condition, would be an ICU tributary, interstitial pneumonia with severe respiratory failure, patients who are not on mechanical ventilation or ECMO and who are still progressing with corticoid treatment or if they are not candidates for corticosteroids. Mild ARDS (PAFI <300 mmHg) with radiological or blood gases deterioration that meets at least one of the following criteria: CRP >100mg/L D-Dimer >1,000μg/L LDH >400U/L Ferritin >700ng/ml Interleukin 6 ≥40ng/L. The use of tocilizumab is not recommended if there are AST/ALT values greater than 10 times the upper limit of normal, neutrophils <500 cells/mm3, sepsis due to other pathogens other than SARS-CoV-2, presence of comorbidity that can lead to a poor prognosis, complicated diverticulitis or intestinal perforation, ongoing skin infection. The dose will be that recommended by the Spanish Medicine Agency in patients ≥75Kg: 600mg dose whereas in patients <75kg: 400mg dose. Exceptionally, a second infusion can be assessed 12 hours after the first in those patients who experience a worsening of laboratory parameters after a first favourable response. The use of corticosteroids will be recommended in patients who have had symptoms for more than 7 days and who meet all the following criteria: need for oxygen support, non-invasive or invasive mechanical ventilation, acute respiratory failure or rapid deterioration of gas exchange, appearance or worsening of bilateral alveolar-interstitial infiltrates at the radiological level. In case of indication, it is recommended: dexamethasone 6mg/d p.o. or iv for 10 days or methylprednisolone 32mg/d orally or 30mg iv for 10 days or prednisone 40mg day p.o. for 10 days. MAIN OUTCOMES Phase 1 part: to describe the toxicity profile of baricitinib in COVID19 oncological patients during the 5-7 day treatment period and until day +14 or discharge (whichever it comes first). Phase 2 part: to describe the number of patients in the experimental arm that will not require mechanical oxygen support compared to the standard of care arm until day +14 or discharge (whichever it comes first). RANDOMISATION For the phase 2 of the study, the allocation ratio will be 1:1. Randomization process will be carried out electronically through the REDcap platform ( https://www.project-redcap.org/ ) BLINDING (MASKING): This is an open label study. No blinding will be performed. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) The first part of the study (safety run-in cohort) will consist in the enrollment of 6 to 12 patients. In this population, we will test the toxicity of the experimental treatment. An incidence of severe adverse events grade 3-4 (graded by Common Terminology Criteria for Adverse Events v.5.0) inferior than 33% will be considered sufficient to follow with the next part of the study. The second part of the study we will perform an interim analysis of efficacy at first 64 assessed patients and a definitive one will analyze 128 assessed patients. Interim and definitive tests will be performed considering in both cases an alpha error of 0.05. We consider for the control arm this rate is expected to be 0.60 and for the experimental arm of 0.80. Considering this data, a superiority test to prove a difference of 0.20 with an overall alpha error of 0.10 and a beta error of 0.2 will be performed. Considering a 5% of dropout rate, it is expected that a total of 136 patients, 68 for each study arm, will be required to complete study accrual. TRIAL STATUS Version 5.0. 14th October 2020 Recruitment started on the 16th of December 2020. Expected end of recruitment is June 2021. TRIAL REGISTRATION AEMPs: 20-0356 EudraCT: 2020-001789-12, https://www.clinicaltrialsregister.eu/ctr-search/search (Not publically available as Phase I trial) Clinical trials: BARCOVID19, https://www.clinicaltrials.gov/ (In progress) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol."
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Affiliation(s)
- G Moreno-González
- Intensive Care Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.
| | - A Mussetti
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - A Albasanz-Puig
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - I Salvador
- Immunology Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain
| | - A Sureda
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain.,Barcelona University, Barcelona, Spain
| | - C Gudiol
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,Barcelona University, Barcelona, Spain
| | - R Salazar
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Oncology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - M Marin
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Oncology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - M Garcia
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Trials Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - V Navarro
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Trials Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - I de la Haba Vaca
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Oncology Emergency Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - E Coma
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Oncology Emergency Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - G Sanz-Linares
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - X Dura
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain
| | - S Fontanals
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Pharmacology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - G Serrano
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Palliative Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - C Cruz
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Palliative Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - R Mañez
- Intensive Care Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain
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Prieto-Alhambra D, Balló E, Coma E, Mora N, Aragón M, Prats-Uribe A, Fina F, Benítez M, Guiriguet C, Fàbregas M, Medina-Peralta M, Duarte-Salles T. Filling the gaps in the characterization of the clinical management of COVID-19: 30-day hospital admission and fatality rates in a cohort of 118 150 cases diagnosed in outpatient settings in Spain. Int J Epidemiol 2021; 49:1930-1939. [PMID: 33118037 PMCID: PMC7665572 DOI: 10.1093/ije/dyaa190] [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] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Currently, there is a missing link in the natural history of COVID-19, from first (usually milder) symptoms to hospitalization and/or death. To fill in this gap, we characterized COVID-19 patients at the time at which they were diagnosed in outpatient settings and estimated 30-day hospital admission and fatality rates. METHODS This was a population-based cohort study. Data were obtained from Information System for Research in Primary Care (SIDIAP)-a primary-care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) tests and hospital emergency, inpatient and mortality registers. We included all patients in the database who were ≥15 years old and diagnosed with COVID-19 in outpatient settings between 15 March and 24 April 2020 (10 April for outcome studies). Baseline characteristics included socio-demographics, co-morbidity and previous drug use at the time of diagnosis, and polymerase chain reaction (PCR) testing and results. Study outcomes included 30-day hospitalization for COVID-19 and all-cause fatality. RESULTS We identified 118 150 and 95 467 COVID-19 patients for characterization and outcome studies, respectively. Most were women (58.7%) and young-to-middle-aged (e.g. 21.1% were 45-54 years old). Of the 44 575 who were tested with PCR, 32 723 (73.4%) tested positive. In the month after diagnosis, 14.8% (14.6-15.0) were hospitalized, with a greater proportion of men and older people, peaking at age 75-84 years. Thirty-day fatality was 3.5% (95% confidence interval: 3.4% to 3.6%), higher in men, increasing with age and highest in those residing in nursing homes [24.5% (23.4% to 25.6%)]. CONCLUSION COVID-19 infections were widespread in the community, including all age-sex strata. However, severe forms of the disease clustered in older men and nursing-home residents. Although initially managed in outpatient settings, 15% of cases required hospitalization and 4% died within a month of first symptoms. These data are instrumental for designing deconfinement strategies and will inform healthcare planning and hospital-bed allocation in current and future COVID-19 outbreaks.
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Affiliation(s)
- Daniel Prieto-Alhambra
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine, NDORMS, University of Oxford
| | - Elisabet Balló
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
- Equip d’Atenció Primària de Salt, Institut Català de la Salut, Girona, Spain
| | - Ermengol Coma
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Núria Mora
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - María Aragón
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Francesc Fina
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mència Benítez
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
- Equip d’Atenció Primària Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Carolina Guiriguet
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
- Equip d’Atenció Primària Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Manuel Medina-Peralta
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Weitzer J, Gonzalez-Viana A, Pérez-Hoyos S, Coma E, Mendez L, Violan M, Rubinat M, Cabezas C. Evaluation of the Catalan Physical Activity, Sports and Health Plan: a nested case-control study. Eur J Public Health 2020; 30:1084-1090. [PMID: 32594111 DOI: 10.1093/eurpub/ckaa090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical inactivity is one of the most important risk factors in modern society. Primary Health Care (PHC) interventions have been shown to be effective to increase physical activity (PA). This work evaluates the Catalan Physical Activity, Sport and Health Plan (PAFES). METHODS Nested case-control design with risk-set matching based on a retrospective cohort of 22 450 physically inactive people registered between 2010 and 2018 in the Catalan electronic medical record (EMR). Confounder adjusted conditional logistic regression was used to estimate the probability that participants who had received PA advice became active between 2010 and 2018 compared to those who did not receive it. RESULTS A lower probability to become active [odds ratio (OR) = 0.11, 95% confidence interval (CI) 0.10-0.13] was found for those people who had received PA advice only once. However, the probability to become active increased for people who had received advice two or more times (two times: OR = 1.43, 95% CI 1.32-1.55). A dose-response relationship was observed. CONCLUSIONS This is the first study evaluating a PA promotion real-life intervention in PHC using a large cohort based on data from an EMR with more than 2 years of follow-up.
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Affiliation(s)
- Jakob Weitzer
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Angelina Gonzalez-Viana
- Department of Health, Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain
| | | | - Ermengol Coma
- Department of Health, Sistema d'Informació dels Serveis d'Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | - Leonardo Mendez
- Department of Health, Sistema d'Informació dels Serveis d'Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | - Mariona Violan
- Department of Presidency, General Secretary of Sport and Physical Activity, Government of Catalonia, Barcelona, Spain
| | - Maica Rubinat
- Department of Presidency, General Secretary of Sport and Physical Activity, Government of Catalonia, Barcelona, Spain
| | - Carmen Cabezas
- Department of Health, Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain
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Coma E, Mora N, Méndez L, Benítez M, Hermosilla E, Fàbregas M, Fina F, Mercadé A, Flayeh S, Guiriguet C, Balló E, Martinez Leon N, Mas A, Cordomí S, Lejardi Y, Medina M. Primary care in the time of COVID-19: monitoring the effect of the pandemic and the lockdown measures on 34 quality of care indicators calculated for 288 primary care practices covering about 6 million people in Catalonia. BMC Fam Pract 2020; 21:208. [PMID: 33038926 PMCID: PMC7547821 DOI: 10.1186/s12875-020-01278-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. METHODS Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator's percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. RESULTS We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of - 2.69% (95%CI - 3.17% to - 2.23%) in March and - 3.41% (95%CI - 3.82% to - 3.01%) in April; and the control of blood pressure with a reduction of - 2.13% (95%CI - 2.34% to - 1.9%) and - 2.59% (95%CI - 2.8% to - 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of - 2.86% (95%CI - 3.33% to - 2.39%) and - 4.13% (95%CI - 4.55% to - 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. CONCLUSIONS The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
| | - Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Leonardo Méndez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Mència Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Eduardo Hermosilla
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Albert Mercadé
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Souhel Flayeh
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Equip d'Atenció Primària Gran Sol, Institut Català de la Salut, Badalona, Spain
| | - Carolina Guiriguet
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Elisabet Balló
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
- Equip d'Atenció Primària de Salt, Institut Català de la Salut, Girona, Spain
| | - Nuria Martinez Leon
- Direcció Assistencial Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | - Ariadna Mas
- Direcció Assistencial Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | - Sílvia Cordomí
- Direcció Assistencial Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | - Yolanda Lejardi
- Direcció Assistencial Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain
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Benito-Yagüe A, Garzón-Serrano C, Haba IDL, Coma E, Comabella R, Rodríguez M, Mestre R, Fernández-Ortega P. CN44 Thrombosis in cancer patients related to central venous catheter. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2153] [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: 10/23/2022] Open
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Coma E, Medina M, Méndez L, Hermosilla E, Iglesias M, Olmos C, Calero S. Effectiveness of electronic point-of-care reminders versus monthly feedback to improve adherence to 10 clinical recommendations in primary care: a cluster randomized clinical trial. BMC Med Inform Decis Mak 2019; 19:245. [PMID: 31783854 PMCID: PMC6884876 DOI: 10.1186/s12911-019-0976-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/05/2018] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have analyzed the effectiveness of electronic reminder interventions to improve different clinical conditions, and most have reported a small to moderate effect. Few studies, however, have analyzed reminder systems targeting multiple conditions, and fewer still have compared electronic point-of-care reminders systems with other forms of feedback designed to improve delivery of care. METHODS We performed an unblinded cluster randomized clinical trial to compare the effectiveness of an electronic point-of-care reminder system with that of a well-established system providing monthly feedback on adherence to clinical recommendations. The control group received monthly feedback only while the intervention group received monthly feedback in addition to on-screen point-of-care reminders for 10 clinical conditions. The study targeted all physicians and nurses at the 283 primary care centers managed by the Institut Català de la Salut (approximately 6600 professionals). RESULTS Following exclusions and randomization, 132 primary care centers (328,728 patients with reminders) were assigned to the intervention group while 137 centers (317,117 patients with reminders) were randomized to the control group. A 20.6% improvement (OR 1.29, 95% CI: 1.25-1.34) in reminder resolution rates was observed in the intervention group. Results varied according to the clinical condition. The most effective reminder was screening for diabetic retinopathy (OR 1.51, 95% CI:1.46-1.57) while the least effective reminders were measurement of glycated hemoglobin (OR: 1.10, 95% CI: 1.07-1.13) and smoking cessation encouragement (OR 1.12, 95% CI: 1.09-1.16). CONCLUSIONS Electronic point-of-care reminders were more effective than the existing monthly feedback system at resolving the 10 clinical situations. However, more studies are needed to investigate the variations of the effect observed. TRIAL REGISTRATION Current Controlled Trials ISRCTN42391639, 08/10/2012. Retrospectively registered.
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Affiliation(s)
- Ermengol Coma
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Manuel Medina
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Leonardo Méndez
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Eduardo Hermosilla
- Sistema de Informació pel Desenvolupament d'Investigació en Atenció Primària (SIDIAP), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manuel Iglesias
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Spain
| | - Carmen Olmos
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Spain
| | - Sebastian Calero
- UGEAP Hospitalet Nord. DAP Delta. Institut Català de la Salut, Barcelona, Spain
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Méndez Boo L, Coma E, Medina M, Hermosilla E, Iglesias M, Olmos C, Calero Muñoz S, Caro Mendivelso J. Effectiveness of computerized point-of-care reminders on adherence with multiple clinical recommendations by primary health care providers: protocol for a cluster-randomized controlled trial. Springerplus 2016; 5:1505. [PMID: 27652078 PMCID: PMC5014773 DOI: 10.1186/s40064-016-3124-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 08/23/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine the effectiveness of reminders compared to no reminders in improving adherence to multiple clinical recommendations measured as the resolution of the clinical condition that motivated the reminder, in a primary care setting with a well-established feedback system. METHODS/DESIGN A 12-month, cluster-randomized, controlled clinical trial was designed (randomized by primary care team) to evaluate the impact of computerized reminders. All study participants will continue to receive the usual feedback from the electronic health records system. The control group (well-established feedback) will be compared with reminders and a well-established feedback system. The study will include all general practitioners (3425) and nurses (3262) providing primary care for a population aged 14 years or older in the 282 primary care teams reporting to the Catalan Institute of Health. Up to 10 clinical reminders are offered for each patient, recommending action related to at least one of nine clinical conditions: arterial hypertension, elevated cardiovascular risk, type 2 diabetes mellitus, cerebrovascular accident, ischemic heart disease, heart failure, atrial fibrillation, smoking habit, and hepatitis C. The outcomes are the resolution of the clinical condition that motivated the reminder and the time elapsed between the first reminder message and implementation of the recommended action (months). Due to the obvious correlation between reminders about the same patient, the profile of patients assigned to a particular professional, and the professionals assigned to a particular centre, hierarchical modelling will be used to simultaneously estimate the effect of the study variables at these different levels of analysis. To estimate the impact of the intervention arm, an analysis of adherence to each type of reminder will be carried out, using multi-level logistical regression models at level of the primary care centre. Time to adherence will be estimated by the Kaplan-Meier method and comparisons will be done using the log-rank test. DISCUSSION The results of this study could provide new evidence on the impact of computerized reminders at the point of care on adherence to clinical guidelines in primary care with an established feedback system. Trial registration ISRCTN42391639. October 8, 2012.
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Affiliation(s)
- Leonardo Méndez Boo
- Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Ermengol Coma
- Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Manuel Medina
- Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Eduardo Hermosilla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, 08007 Barcelona, Catalonia Spain
| | - Manuel Iglesias
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Carmen Olmos
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Catalonia Spain
| | | | - Johanna Caro Mendivelso
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, 08007 Barcelona, Catalonia Spain
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Reyes C, García-Gil M, Elorza JM, Fina-Avilés F, Mendez-Boo L, Hermosilla E, Coma E, Carbonell C, Medina-Peralta M, Ramos R, Bolibar B, Díez-Pérez A, Prieto-Alhambra D. Socioeconomic status and its association with the risk of developing hip fractures: a region-wide ecological study. Bone 2015; 73:127-31. [PMID: 25542156 DOI: 10.1016/j.bone.2014.12.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the association between socioeconomic deprivation (SES) and hip fracture risk. METHODS Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area. MEASURES a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data. OUTCOME incident hip fracture rates as coded in medical records using ICD-10 codes. STATISTICS zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption. RESULTS Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age- and sex-adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age- and sex-adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95), respectively, compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference. CONCLUSION Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk.
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Affiliation(s)
- Carlen Reyes
- Primary Health Care Center Eap Sardenya, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya 466, Barcelona 08025, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Maria García-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain
| | - Josep Maria Elorza
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Francesc Fina-Avilés
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Leonardo Mendez-Boo
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Eduardo Hermosilla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Ermengol Coma
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Cristina Carbonell
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Manuel Medina-Peralta
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain; Primary Care Services, Girona, Catalan Institute of Health (ICS), Maluquer Salvador 11, Girona 17003, Spain
| | - Bonaventura Bolibar
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Adolfo Díez-Pérez
- Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain
| | - Daniel Prieto-Alhambra
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7HE, United Kingdom
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Fàbregas M, Berges I, Fina F, Hermosilla E, Coma E, Méndez L, Medina M, Calero S, Serrano E, Morros R, Monteagudo M, Bolíbar B. Effectiveness of an intervention designed to optimize statins use: a primary prevention randomized clinical trial. BMC Fam Pract 2014; 15:135. [PMID: 25027229 PMCID: PMC4112648 DOI: 10.1186/1471-2296-15-135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/08/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although hypercholesterolemia is considered a cardiovascular risk factor, in isolation it is not necessarily sufficient cause for a cardiovascular event. To improve event prediction, cardiovascular risk calculators have been developed; the REGICOR calculator has been validated for use in our population. The objective of this project is to develop an intervention with general practitioners (GPs) and evaluate its impact on prescription adequacy of cholesterol-lowering drugs in primary prevention of cardiovascular disease and in controlling the costs associated with this disease. METHODS This nonblinded, cluster-randomized clinical trial analyzes data from primary care electronic medical records (ECAP) and other databases. Inclusion criteria are patients aged 35 to 74 years with no known cardiovascular disease and a new prescription for cholesterol-lowering drugs during the 2-year study period. Dependent variables include the following: RETIRA, defined as new cholesterol-lowering drugs initiated during the year preceding the intervention, considered inadequate, and withdrawn during the study period; EVITA, defined as new cholesterol-lowering drugs initiated during the study period and considered inadequate; COST, defined as the total cost of inadequate new treatments prescribed; and REGISTER, defined as the recording of cardiovascular risk factors. Independent variables include the GP's quality-of-care indicators and randomly assigned study group (intervention vs control), patient demographics, and clinical variables. Aggregated descriptive analysis will be done at the GP level and multilevel analysis will be performed to estimate the intervention effect, adjusted for individual and GP variables. DISCUSSION The study objective is to generate evidence about the effectiveness of implementing feedback information programs directed to GPs in the context of Primary Care. The goal is to improve the prescription adequacy of lipid-lowering therapies for primary prevention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01997671. November 28, 2013.
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Affiliation(s)
- Mireia Fàbregas
- ABS La Marina, SAP Esquerra, Institut Català de la Salut, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Francesc Fina
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Eduardo Hermosilla
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Ermengol Coma
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Leonardo Méndez
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manuel Medina
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Sebastià Calero
- Àrea de Desenvolupament Clínic, Direcció Adjunta d’Afers Assistencials, Institut Català de la Salut, Institut Universitari d'investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Elena Serrano
- Centre d’Atenció Primària Baix a Mar, Consell comarcal del Garraf, Vilanova i la Geltrú, Barcelona, Spain
| | - Rosa Morros
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Mònica Monteagudo
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Bonaventura Bolíbar
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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Closas P, Coma E, Méndez L. Sequential detection of influenza epidemics by the Kolmogorov-Smirnov test. BMC Med Inform Decis Mak 2012; 12:112. [PMID: 23031321 PMCID: PMC3557152 DOI: 10.1186/1472-6947-12-112] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 01/30/2012] [Accepted: 08/24/2012] [Indexed: 11/10/2022] Open
Abstract
Background Influenza is a well known and common human respiratory infection, causing significant morbidity and mortality every year. Despite Influenza variability, fast and reliable outbreak detection is required for health resource planning. Clinical health records, as published by the Diagnosticat database in Catalonia, host useful data for probabilistic detection of influenza outbreaks. Methods This paper proposes a statistical method to detect influenza epidemic activity. Non-epidemic incidence rates are modeled against the exponential distribution, and the maximum likelihood estimate for the decaying factor λ is calculated. The sequential detection algorithm updates the parameter as new data becomes available. Binary epidemic detection of weekly incidence rates is assessed by Kolmogorov-Smirnov test on the absolute difference between the empirical and the cumulative density function of the estimated exponential distribution with significance level 0 ≤ α ≤ 1. Results The main advantage with respect to other approaches is the adoption of a statistically meaningful test, which provides an indicator of epidemic activity with an associated probability. The detection algorithm was initiated with parameter λ0 = 3.8617 estimated from the training sequence (corresponding to non-epidemic incidence rates of the 2008-2009 influenza season) and sequentially updated. Kolmogorov-Smirnov test detected the following weeks as epidemic for each influenza season: 50−10 (2008-2009 season), 38−50 (2009-2010 season), weeks 50−9 (2010-2011 season) and weeks 3 to 12 for the current 2011-2012 season. Conclusions Real medical data was used to assess the validity of the approach, as well as to construct a realistic statistical model of weekly influenza incidence rates in non-epidemic periods. For the tested data, the results confirmed the ability of the algorithm to detect the start and the end of epidemic periods. In general, the proposed test could be applied to other data sets to quickly detect influenza outbreaks. The sequential structure of the test makes it suitable for implementation in many platforms at a low computational cost without requiring to store large data sets.
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Affiliation(s)
- Pau Closas
- Centre Tecnològic de Telecomunicacions de Catalunya (CTTC), Av. Carl Friedrich Gauss 7, 08860 Castelldefels, Barcelona, Spain.
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Curran A, Falcó V, Crespo M, Martinez X, Ribera E, Villar del Saz S, Imaz A, Coma E, Ferrer A, Pahissa A. Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Med 2008; 9:609-15. [PMID: 18557951 DOI: 10.1111/j.1468-1293.2008.00603.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite a recent decrease, bacterial pneumonia (BP) is still the most common admission diagnosis in HIV patients. We analyse BP incidence, characteristics and prevention measures. METHODS Observational study of all patients hospitalized for BP in a tertiary hospital in Barcelona, Spain, from January 2000 to December 2005. Demographic and HIV-related data, BP risk factors, characteristics of BP and outcomes are analysed. RESULTS One hundred and eighty-six BP episodes in 161 patients were included; patients were mainly male (73.7%) and intravenous drug users (73.7%). A decrease in BP incidence was seen during the study period, especially in vaccinated patients. The most commonly isolated microorganism was Streptococcus pneumoniae (31.7%), followed by Legionella pneumophila (5.9%). Legionella pneumophila was more likely in patients with undetectable viral load, higher CD4 cell counts or prior vaccination. Highly active antiretroviral therapy, cotrimoxazole prophylaxis and pneumococcal vaccination did not have a significant influence on bacteraemia rate, in-hospital complications or BP mortality. High Pneumonia Severity Index (PSI) predicted mortality accurately [relative risk 15.2, 95% confidence interval 3.2-71.7; P=0.001]. Mortality was 9.1%, but was significantly higher in patients with CD4 counts under 200 cells/microL (P=0.022). CONCLUSIONS A decline in BP incidence was seen during the study period. Combining CD4 cell count and PSI score could become a good strategy in deciding which patients have to be hospitalized.
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Affiliation(s)
- A Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, P1 Valld'Hebron, Barcelona, Spain.
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Renaud B, Coma E, Hayon J, Gurgui M, Longo C, Blancher M, Jouannic I, Betoulle S, Roupie E, Fine MJ. Investigation of the ability of the Pneumonia Severity Index to accurately predict clinically relevant outcomes: a European study. Clin Microbiol Infect 2007; 13:923-31. [PMID: 17617186 DOI: 10.1111/j.1469-0691.2007.01772.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In order to confirm the validity of the Pneumonia Severity Index (PSI) for patients in Europe, data from adults with pneumonia who were enrolled in two prospective multicentre studies, conducted in France (Pneumocom-1, n = 925) and Spain (Pneumocom-2, n = 853), were compared with data from the original North American study (Pneumonia PORT, n = 2287). The primary outcome was 28-day mortality; secondary outcomes were subsequent hospitalisation for outpatients, and intensive care unit admission and length of stay for inpatients. All outcomes within individual risk classes, and mortality rates in low-risk (PSI I-III) and higher-risk patients, were compared across the three cohorts. Overall mortality rates were 4.7% in Pneumonia PORT, 6.3% in Pneumocom-2 and 10.6% in Pneumocom-1 (p <0.01), ranging from 0.4% to 1.6% (p 0.06) for low-risk patients and from 13.0% to 19.1% (p 0.24) for high-risk patients. Despite significant differences in baseline patient characteristics, none of the study outcomes differed within the low-risk classes. The sensitivity and negative predictive value of low-risk classification for mortality exceeded 93% and 98%, respectively. Thus, in two independent European cohorts, the PSI predicted patient outcomes accurately and reliably, particularly for low-risk patients. These findings confirm the validity of the PSI when applied to patients from Europe.
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Affiliation(s)
- B Renaud
- Department of Emergency Medicine, Centre Hospitalier--Universitaire Henri Mondor (AP-HP), Créteil, France.
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Pérez J, García S, Coma E. [Drug inhalation therapy. Therapy for patients with respiratory disorders]. Rev Enferm 1998; 21:21-5. [PMID: 9653330] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We detected a high number of patients suffering from respiratory ailments which require successive hospital stays due to acute setbacks in their chronic respiratory ailments. The majority of these patients receive outpatient clinic treatment based on use of an inhaler. Given the direct relationship between the correct use of an inhaler and its effectiveness, we designed our project with the goal to discover the adroitness these patients have with an inhaler. The results of our study showed that 67% of the patients tested did not correctly use their inhaler, there by annulling or diminished the effectiveness of its use.
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Affiliation(s)
- J Pérez
- Unidad de Corta Estancia, Hospital Municipal de Badalona, Barcelona
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Domingo P, Coma E, Muñiz-Díaz E. Lack of response of thrombocytopenia associated with human immunodeficiency virus to triple antiretroviral therapy. Arch Intern Med 1997; 157:2669-70. [PMID: 9580146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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