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Objective: The aim of this study was to evaluate reader variability in screening mammograms according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) assessment and breast density categories. Methods: A stratified random sample of 100 mammograms was selected from a population-based breast cancer screening programme in Barcelona, Spain: 13 histopathologically confirmed breast cancers and 51 with true-negative and 36 with false-positive results. 21 expert radiologists from radiological units of breast cancer screening programmes in Catalonia, Spain, reviewed the mammography images twice within a 6-month interval. The readers described each mammography using BI-RADS assessment and breast density categories. Inter- and intraradiologist agreement was assessed using percentage of concordance and the kappa (κ) statistic. Results: Fair interobserver agreement was observed for the BI-RADS assessment [κ = 0.37, 95% confidence interval (CI) 0.36-0.38]. When the categories were collapsed in terms of whether additional evaluation was required (Categories III, 0, IV, V) or not (I and II), moderate agreement was found (κ = 0.53, 95% CI 0.52-0.54). Intra-observer agreement for BI-RADS assessment was moderate using all categories (κ = 0.53, 95% Cl 0.50-0.55) and substantial on recall (κ = 0.66, 95% Cl 0.63-0.70). Regarding breast density, inter- and intraradiologist agreement was substantial (κ = 0.73, 95% CI 0.72- 0.74 and κ = 0.69, 95% Cl 0.68-0.70, respectively). Conclusion: We observed a substantial intra-observer agreement in the BI-RADS assessment but only moderate interobserver agreement. Both inter- and intra-observer agreement in mammographic interpretation of breast density was substantial. Advances in knowledge: Educational efforts should be made to decrease radiologists' variability in BI-RADS assessment interpretation in population-based breast screening programmes. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the use of clinical-epidemiological profiles for classifying non-laboratory-confirmed outbreaks of foodborne disease (FBD) in Catalonia between 2002 and 2006 and for elucidating associations among factors contributing to these outbreaks. A total of 275 nonfamily outbreaks were studied, of which 190 (69.1%) were laboratory confirmed and 85 (30.9%) were not. In 176 (92.6%) of laboratory-confirmed outbreaks and 69 (81.2%) of non-laboratory-confirmed outbreaks, information was obtained on contributing factors (P = 0.009). In 72% of non-laboratory-confirmed outbreaks, the etiology was assigned by using clinical-epidemiological profiles; thus, 93% of outbreaks eventually were associated with an etiology. In laboratory-confirmed outbreaks, poor personal hygiene was positively associated with norovirus (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.47 to 4.89; P = 0.0007) and negatively associated with Salmonella and Campylobacter (OR, 0.54; 95% CI, 0.33 to 0.89; P = 0.01), and an unsafe source was positively associated with Salmonella and Campylobacter (OR, 4.07; 950 CI, 1.72 to 10.09; P = 0.001) and negatively associated with norovirus (OR, 0.14; 95% CI, 0.04 to 0.58; P = 0.001). No differences were found among contributing factors associated with outbreaks with a laboratory-confirmed etiology and those associated with outbreaks with an etiology assigned according to the clinical-epidemiological profiles. Clinical-epidemiological profiles are useful for determining what prevention and control strategies are appropriate to the agents involved in each community and for designing outbreak investigations. [ABSTRACT FROM AUTHOR]

Foodborne diseases (FBD) are a major cause of disease and death, but their etiologies are not always known. Factors associated with determination of the etiologic agent of FBD outbreaks reported to the Department of Health in Catalonia (Spain) during 2002 to 2005 were studied. For each outbreak, the year, number of persons affected, hospitalization, and availability of samples from patients, food handlers, and foods were collected. The delay between the date of onset of symptoms of the second case and the report to the surveillance unit was calculated. The relationship between explanatory variables and determination of the cause of each outbreak was studied by logistic regression. The causal agent was identified in 242 (73.3%) of 330 outbreaks. Factors associated with determining the etiologic agent of the outbreak in the univariate analysis were availability of samples from cases (odd ratio [OR] of 6.0, 95% confidence interval [CI] of 3.2 to 11.1), hospitalization (OR of 5.1, 95% CI of 2.6 to 11.1), availability of samples from food handlers (OR of 2.7, 95% CI of 1.6 to 4.5), size ≥ 10 cases (OR of 2.2, 95% CI of 1.3 to 3.2), availability of samples from food (OR of 1.8, 95% CI of 1.1 to 3.0), and the last year (2005) of the study period (OR of 1.9, 95% CI of 1.0 to 3.6). In the multivariate analysis, hospitalization (adjusted OR of 5.1, 95% CI of 2.4 to 11.2), size ≥ 10 cases (adjusted OR of 2.1, 95% CI of 1.2 to 3.7), and the year 2005 (OR of 2.1,95% CI of 1.1 to 4.0) remained associated. Collection and processing of clinical samples from cases and appropriate laboratory diagnoses of all possible etiologies of FBD, including viruses, are very important. Efforts by physicians and public health services to coordinate and improve their activity in these areas may help provide more accurate knowledge concerning the etiologies of FBD outbreaks and lead to more effective preventive procedures. [ABSTRACT FROM AUTHOR]

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Abstract Hepatitis B is a viral disease of global importance. In Catalonia in the 1980s, the seroepidemiological pattern of HBV infection was low-intermediate. In 1990, the Expert Committee on Vaccinations of the Department of Health of the Generalitat of Catalonia evaluated the systematic introduction of hepatitis B vaccination in preadolescents, maintaining the vaccination of risk groups. The objective of this study was to estimate the effectiveness and impact of the systematic hepatitis B vaccination programme in preadolescents in Catalonia 21 years after its introduction. A retrospective cohort study was conducted, comparing the disease incidence in vaccinated and unvaccinated cohorts. Cases of hepatitis B were defined as those reported by the General Subdirectorate of Surveillance and Response to Public Health Emergencies between 2000 and 2014. The incidence rate was 2.5 per 100,000 persons in 1991 and 1.2 per 100,000 persons in 2014, a reduction of 52%. During the study period, 388 cases of hepatitis B infection were notified, of which three were classified as vaccine failures. Vaccine effectiveness was 99.30% (95% CI: 97.83–99.78) and the population prevented fraction in the cohorts of preadolescents studied was 64.56% (95% CI: 60.45–68.66). The effectiveness and impact of the hepatitis B vaccination program in preadolescents in Catalonia is high, with the consequent benefits for the population. [ABSTRACT FROM AUTHOR]

As shown in this report, the integration of a research project with a monitoring program improves the detection and management of Ostreopsis blooms in Catalonia. The research project benefits from information previously obtained from several localities by the monitoring program, which in turn profits from the specific findings and conclusions contributed by the research project. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Pertussis has been a preventable disease in Catalonia since 1965, but the annual number of cases remains high. The aim of this study was to analyze the epidemiology of pertussis in Catalonia and its implications for control purposes. Methods: An epidemiological study was carried out in Catalonia between 2004 and 2008. Pertussis cases reported to the Department of Health were collected and disease reports were filled out with the case information. Incidence rates, rate ratios (RR) and their 95% confidence intervals (CI) were calculated. Results: 963 cases were reported: 555 (57.6%) were confirmed and 408 (42.4%) were suspected cases. The reported incidence rate was 2.01×10−5 person years in 2004 and 4.34 in 2008. The biggest increase in cases between 2004 and 2008 was observed in the ≥35 years age group (RR: 6.98; 95%CI: 2.11–36.36). 303 (31.5%) patients were hospitalized, of whom 93.7% were aged <1 year. Clinical differences were observed in paroxysmal cough (83.8% in suspected and 76.4% in confirmed cases, p =0.005), posttussive vomiting (47.1% and 36.1%, respectively, p =0.001), apnoea (13.7% and 21.3%, respectively, p =0.003) and fever (20.1% and 12.4%, respectively, p =0.001). Conclusion: Pertussis incidence rates increased during the study period, with the greatest increase occurring in the ≥35 years age group. A booster dose of vaccine in young people could reduce the circulation of B. pertussis in adolescents and adults and indirectly reduce the incidence in children. [Copyright &y& Elsevier]

Abstract: Mumps is a vaccine-preventable disease candidate for elimination. Positive predictive value (PPV) of clinical case definition was assessed. During 2007, 410 suspected cases were reported in Catalonia: 348 fulfilled clinical case definition and 159 were laboratory confirmed. Incidence rate was 4.8 per 100,000 for cases that fulfilled the clinical definition, and 2.2 for laboratory confirmed cases. Global PPV was 44.5%; 38.5% in <15 years and 50% in ≥15 years (p =0.04). Most laboratory confirmed cases (72.3%) received at least one MMR dose. With sustained high MMR coverage, laboratory confirmation is necessary to control the disease and assess vaccine failure. [Copyright &y& Elsevier]

Summary: Objectives: To describe the characteristics of community outbreaks of legionellosis in Catalonia, Spain from 1990 to 2004, to compare two time periods (1990–1996 and 1997–2004), and to assess the influence of outbreak characteristics on the case fatality rate (CFR). Methods: This is a descriptive analysis of the outbreaks detected by epidemiological surveillance units in Catalonia. Variables potentially related to the CFR were analyzed by logistic regression. Results: Of the 118 outbreaks involving 690 patients (overall CFR 4.5%), the urinary antigen test (UAT) was used for first case diagnosis in 80.5%. The origin of the outbreak was identified as a cooling tower in 35.6%, as a water distribution system in a public building in 14.4%, and a water distribution system at other sites in 7.6%. Statistically significant differences were found in the CFR (12.2% vs. 3.9%; p =0.018) and detection of the first case by UAT (0.0% vs. 87.2%; p <0.001) between the two time periods investigated. Logistic regression showed an increase in the CFR according to outbreak size (adjusted odds ratio (aOR) 1.18; 95% confidence interval (CI) 1.05–1.33) that was significantly lower in the second period (aOR 0.09; 95% CI 0.04–0.20). Conclusions: Since the UAT was introduced, early diagnosis and treatment has helped to improve the outcomes and CFR of cases involved in outbreaks of legionellosis. [Copyright &y& Elsevier]