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According to WHO estimates, in 2010 there were 8.8 million new cases of tuberculosis (TB) and 1.5 million deaths. TB has been classically associated with poverty, overcrowding and malnutrition. Low income countries and deprived areas, within big cities in developed countries, present the highest TB incidences and TB mortality rates. These are the settings where immigration, important social inequalities, HIV infection and drug or alcohol abuse may coexist, all factors strongly associated with TB. In spite of the political, economical, research and community efforts, TB remains a major global health problem worldwide. Moreover, in this new century, new challenges such as multidrug-resistance extension, migration to big cities and the new treatments with anti-tumour necrosis alpha factor for inflammatory diseases have emerged and threaten the decreasing trend in the global number of TB cases in the last years. We must also be aware about the impact that smoking and diabetes pandemics may be having on the incidence of TB. The existence of a good TB Prevention and Control Program is essential to fight against TB. The coordination among clinicians, microbiologists, epidemiologists and others, and the link between surveillance, control and research should always be a priority for a TB Program. Each city and country should define their needs according to the epidemiological situation. Local TB control programs will have to adapt to any new challenge that arises in order to respond to the needs of their population.

Background: Little is known about recurrent tuberculosis (TB) among HIV-infected patients and the influence of highly active antiretroviral therapy (HAART). Methods: A population-based retrospective longitudinal study was conducted on all HIV-infected TB patients in Barcelona (Spain) notified in 1987-2003, and followed up until 2005. TB recurrence and HAART influence were analysed according to calendar period. Results: Patients with no-treatment and those in pre-HAART had more risk of TB recurrence (RR: 2.3; CI: 1-5.8 and RR: 4.8; Cl: 2-12). Conclusions: HAART decreases probability of TB recurrence and should be extended to all cases. (C) 2012 Elsevier Espana, S.L. All rights reserved.

ResumenObjetivoEvaluar un programa que ofertaba la prueba del VIH en el medio universitario, analizando la prevalencia de la infección, las conductas de riesgo, los antecedentes de infecciones de transmisión sexual (ITS) y la realización de la prueba.MétodosEn octubre-noviembre de 2008 y noviembre-diciembre de 2009, 1668 personas se realizaron la prueba rápida en un dispositivo móvil en campus universitarios de Madrid, Málaga y Salamanca, y cumplimentaron un breve cuestionario mientras esperaban el resultado.ResultadosEl 15,7% eran hombres que habían tenido relaciones sexuales con hombres, el 28,6% eran hombres exclusivamente heterosexuales y el 55,7% mujeres. El 73,3% eran menores de 25 años, el 8,5% habían nacido en el extranjero y sólo el 4% no tenía estudios secundarios. En los 12 meses previos, el 51% de los hombres heterosexuales, el 42% de las mujeres y el 6,3% de los hombres que habían tenido sexo con hombres tuvieron una pareja ocasional de distinto sexo sin haber usado siempre el preservativo. Un 41,5% de los hombres que habían tenido sexo con hombres refería este tipo de conducta con parejas masculinas. Al 24,7% de los hombres que habían tenido sexo con hombres, al 14,7% de las mujeres y al 5,6% de los hombres heterosexuales les habían diagnosticado alguna ITS. Se encontraron cuatro positivos, todos hombres que habían tenido sexo con hombres con prueba en los últimos 2 años, con una prevalencia entre ellos del 1,6% (intervalo de confianza del 95% [IC95%]: 0,43-3,95) y global del 0,2% (IC95%: 0,07-0,62).ConclusionesPese a la alta frecuencia de prácticas de riesgo, la baja prevalencia de la infección y los antecedentes de la prueba hacen pensar que los campus universitarios no son una localización prioritaria para el desarrollo de estos programas, que tendrían un mayor impacto y más eficiencia en otras poblaciones más vulnerables.AbstractObjectiveTo evaluate an HIV testing program in the university environment by analyzing the prevalence of infection, risk behaviors and history of sexually transmitted infections and by performing HIV tests.MethodsDuring October-November of 2008 and November-December of 2009, 1668 persons received rapid HIV testing in a mobile unit located in university campuses in the cities of Madrid, Málaga and Salamanca (Spain). While waiting for the test results, participants completed a brief questionnaire.ResultsA total of 15.7% were men who had sex with men (MSM), 28.6% were exclusively heterosexual men (HTX), and 55.7% were women. Nearly three-quarters (73.3%) were under 25 years of age, 8.5% were born abroad and only 4% had no secondary education. Fifty-one percent of HTX, 42% of women and 6.3% of MSM had casual sexual partners in the past 12 months without always using a condom. This behavior was also reported by 41.5% of MSM with same sex partners. A sexually transmitted infection had previously been diagnosed in 24.7% of MSMs, 14.7% of women and 5.6% of HTX. Four positive results were found, all in MSM who had been tested in the previous 2 years. The prevalence was 1.6% (95% CI: 0.43-3.95) within this group, and 0.2% overall (95% CI: 0.07-0.62).ConclusionsDespite the high frequency of risk behaviors, the low prevalence of HIV infection and the history of HIV testing suggest that university campuses are not a priority location to develop these programs, which would achieve greater impact and efficiency in more vulnerable populations.

Fundamento Describir las caracteristicas de la tuberculosis importada en Barcelona durante 1999 y 2000. Material y metodo Encuesta epidemiologica. Resultados En el ano 2000 se detectaron449 casos de tuberculosis en poblacion autoctona(incidencia 29,5/100.000) y 121 eninmigrantes (incidencia 555,9/100.000).Entre 1999 y 2000 la tuberculosis ha disminuidoun 7,9% en la poblacion autoctonade Barcelona, mientras que ha aumentadoun 47,2% en inmigrantes. Hubo tres brotesepidemicos: una comunidad hindu (11 casos),dos familias dominicanas (4 casos) yuna escuela (dos casos) cuyo caso indice fueuna cooperante. Las cepas de Mycobacteriumtuberculosis del primer brote fueron sensiblesa todos los farmacos, las del segundo resistentesa los de primera linea y las del terceroresistentes a isoniacida. Conclusiones La evolucion de la tuberculosisen Barcelona en el ultimo bienio confirma laemergencia de casos importados que demandanuna revision de las medidas de control.

Background Increasing international travel and migration is producing changes in trends in infectious diseases, especially in children from many European cities. The objective of this study was to describe the epidemiology and determine the trends of imported malaria in patients under 20 years old in the city of Barcelona, Spain, during an 18-year period. Methods The study included malaria cases that were laboratory confirmed and reported to the malaria register at the Public Health Agency of Barcelona from 1990 to 2008, residing in Barcelona and less than 20 years old. Patients were classified as natives (born in Spain) or immigrants. Differences in the distribution of demographic, clinical characteristics, and incidence per 100,000 person-year evolution were analysed. Natives and immigrants were compared by logistic regression by calculating the odds ratio (OR) with a 95% confidence interval (CI) and Chi-square for a linear trend (p < 0.05). Results Of the total 174 cases, 143 (82.1%) were immigrants, 100 (57.5%) were female, 121 (69.5%) Plasmodium falciparum, and 108 (62.1%) were visiting friends and relatives (VFR) as the reason for travel. Among the immigrants, 99 (67.8%) were from Equatorial Guinea. Immigrant cases more frequently travelled to Africa than natives (p = 0.02). The factors associated with imported malaria among immigrant residents was travelling for VFR (OR: 6.2 CI 1.9-20.2) and age 15-19 (OR: 3.7 CI 1-13.3). The incidence increased from 1990 to 1999 (p < 0.001) and decreased from 2000 to 2008 (p = 0.01), although the global linear trend was not statistically significant (p = 0.41). The fatality rate was 0.5%. Conclusions The majority of cases of malaria in population less than 20 years in Barcelona were immigrants, travelling to Africa for VFR and Plasmodium falciparum was most frequently detected. The trend analysis of the entire study period did not show a statistically significant decline. It is recommended to be aware of malaria, especially among children of immigrants who travel to their parent's home country for VFR. Better access to pre travel advice should be provided.

To evaluate an HIV testing program in the university environment by analyzing the prevalence of infection, risk behaviors and history of sexually transmitted infections and by performing HIV tests.During October-November of 2008 and November-December of 2009, 1668 persons received rapid HIV testing in a mobile unit located in university campuses in the cities of Madrid, Málaga and Salamanca (Spain). While waiting for the test results, participants completed a brief questionnaire.A total of 15.7% were men who had sex with men (MSM), 28.6% were exclusively heterosexual men (HTX), and 55.7% were women. Nearly three-quarters (73.3%) were under 25 years of age, 8.5% were born abroad and only 4% had no secondary education. Fifty-one percent of HTX, 42% of women and 6.3% of MSM had casual sexual partners in the past 12 months without always using a condom. This behavior was also reported by 41.5% of MSM with same sex partners. A sexually transmitted infection had previously been diagnosed in 24.7% of MSMs, 14.7% of women and 5.6% of HTX. Four positive results were found, all in MSM who had been tested in the previous 2 years. The prevalence was 1.6% (95% CI: 0.43-3.95) within this group, and 0.2% overall (95% CI: 0.07-0.62).Despite the high frequency of risk behaviors, the low prevalence of HIV infection and the history of HIV testing suggest that university campuses are not a priority location to develop these programs, which would achieve greater impact and efficiency in more vulnerable populations.

The use of potentially addictive substances may be influenced by the young person's place of residence.To determine the frequency and characteristics of tobacco, alcohol and cannabis use in secondary school pupils in a small urban area during the academic year 2008-09.Cross-sectional survey. Socio-demographic data related to tobacco, alcohol and cannabis use were gathered by means of a confidential self-administered questionnaire.The survey was responded to by 88% of the pupils (393). Prevalence of tobacco use was 48%, 16% of whom smoked every day. Forty four percent of third grade pupils and fifty two per cent of forth-graders, did consume alcohol on the week ends. Thirty-five percent said that they had been drunk on at least one occasion, while 30% of the pupils had tried cannabis, and 50% of third-graders. Among those who had used cannabis, 23% had done so in the previous month. At onset of cannabis use was 13 years. Almost 80% of those surveyed said they had not paid for the first drugs they used.The use of legal and illegal drugs for those in our sample begins between the ages of 12 and 14 years, representing slightly higher frequencies than those found in big cities. Despite the illegality of the sale of tobacco and alcohol to minors, Spanish teenagers continue to obtain them. It is essential for primary care professionals, educators and families to be aware of the importance of early detection of the use of psychoactive substances. The prevention of drug addiction is more effective the sooner the potential risk is detected.

The summer of 2003 was exceptionally hot, leading to an excess of mortality in Europe. Here, we assess the short-term effects of extreme hot summer temperatures on total daily mortality in Barcelona (Spain). Daily mortality from burial records, maximum temperature, relative humidity and photochemical pollutants, were collected for the period 1999-2003. Data was analysed using Poisson regression with generalised additive models. Mortality shows a considerable increase when maximum temperatures are over a threshold temperature of 30.5°C. The risk of death associated with an increase of 1°C above the threshold was 6%, 7% and 5% after 1, 2 and 3 days, respectively. Exposure to extreme hot temperatures leads to an significant increase in mortality. © 2009 ISB., The authors acknowledge the collaboration of the Instituto de Salud Carlos III, Red de Centros de Investigación en Epidemiología y Salud Pública (RCESP C03/09). A.T. was funded by grant SEPY 1106/07 of the Instituto de Salud Carlos III.

Background The objective of this study was to compare cases of imported malaria originating from the Spanish ex-colony of Equatorial Guinea (EG) with those originating from the rest of Africa (RA). Methods All the African cases detected in Barcelona between 1989 and 2007 were investigated in a retrospective analysis. Clinical-epidemiological variables such as sex, age, visiting friends and relatives (VFR), species, hospital admission and chemo-prophylaxis were compared. Data were analysed by logistic regression, calculating the Odds Ratio (OR) and 95% Confidence Intervals (95% CI). Results Of the 489 African patients, 279 (57,1%) had been born in EG and 210 (42,9%) in the rest of Africa. The cumulative incidence of imported malaria among those from EG was 179.6 per thousand inhabitants, while in those from the RA it was 33.7 per thousand (p < 0.001). Compliance with chemoprophylaxis (CP) was very low, but there were no differences between the two groups. Comparing those from EG to those from RA, the former were characterized by having more patients in the visiting friends and relatives (VFR) category, and more individuals younger than 15 years or older than 37 years, and more women. They also visited a traveller's health centre more often, had fewer hospital admissions and were less likely to reside in the inner city. Conclusion Cases of imported malaria originating in Africa, are more likely to come from the Spanish ex-colony of EG, and VFR are more likely to be affected. It is recommended that developed countries promote prevention programmes, such as CP advice directed at African immigrants, and develop programmes of cooperation against malaria in their ex-colonies.

An intervention in venues for interaction used by men who have sex with men in Valencia (Spain) was performed to prevent human immunodeficiency virus (HIV) infection or avoid delay in diagnosis and to facilitate contact with the health circuit. Information was provided on prevention and a rapid test for HIV and syphilis was performed. We contacted 500 men and the intervention was performed in 171; 37% of the subjects in saunas and one in four of those in prostitution apartments had never been tested. The prevalence of HIV was 1.6% (n=2) in the saunas, and 11% (n=5) in the apartments (n=5). For syphilis, these percentages were 5% and 2.3% respectively. The intervention revealed the existence of highly exposed population groups with low compliance and facilitated access to the health system in these groups.

Background International travel and migration have been related with an increase of imported malaria cases. There has been considerable immigration to Barcelona from low-income countries (LIC) in recent years. The objective is to describe the epidemiology and to determine the trends of the disease in Barcelona. Methods Analysis of the cases notified among city residents between 1989 and 2005. Patients were classified as: tourists, voluntary workers, resident immigrants (visiting friends and relatives, VFR) and recently arrived immigrants. An analysis was conducted using the chi2 test and comparison of means. As a measure of association we calculated the Relative Risk (RR) and Odds Ratio (OR) with a Confidence Interval of 95% (CI) and carried out a trends analysis. Results Of the total of 1,579 imported cases notified, 997 (63.1%) lived in Barcelona city, and 55.1% were male. The mean age of patients was 32.7 years. The incidence increased from 2.4 cases/100,000 in 1989 to 3.5 cases/100,000 in 2005 (RR 1.46 CI:1.36–1.55). This increase was not statistically significant (trends analysis, p = 0.36). In terms of reason for travelling, 40.7% were VFR, 33.6% tourists, 12.1% voluntary workers and 13.6% were recently arrived immigrants. The most frequent species found was Plasmodium falciparum (71.3%), mainly in visitors to Africa (OR = 2.3, CI = 1.7–3.2). The vast majority (82.2%) had had some contact with Africa (35.9% with Equatorial Guinea, a Spanish ex-colony) and 96.6% had not completed chemoprophylaxis. Six deaths were observed, all tourists who had travelled to Africa and not taken chemoprophylaxis (3.9% fatality rate). Conclusion Over the period studied there is an increase in malaria incidence, however the trend is not statistically significant. Lack of chemoprophylaxis compliance and the association between Africa and P. falciparum are very clear in the imported cases. Most of the patients with malaria did not take chemoprophylaxis.

Description of an outbreak of legionnaires' disease originating in one of the cooling towers of a hospital.This study included patients with confirmed pneumonia caused by Legionella pneumophila serogroup 1 and related to the Vallcarca neighborhood of Barcelona (Spain) in August 2004. Exposure was determined by a standardized questionnaire. An environmental investigation was carried out to identify the source of the outbreak. A descriptive analysis including incidence rates estimation was performed, as well as molecular study to document the genetic identity among human and environmental strains.Thirty-three cases of L. pneumophila pneumonia were detected. Median age was 68 years and 70% of the affected patients were men. Incidence rate among residents in less than 200 meters of the source and older than 65 was 888.9 cases/100,000 inhabitants. Lethality rate was 6%. Four seasonal cooling towers that were not registered with the authorities were identified in a health care center. L. pneumophila was isolated from all four and at least one colony in each tower had the same genetic profile as the strains isolated from patients.An association was demonstrated between a community outbreak of legionellosis and unregistered seasonal cooling towers located in a hospital. All risk facilities should be registered and inspected to ensure that they fulfill current legislation requirements.

OBJECTIVE To analyse incidence and determinants of tuberculosis in HIV-seroconverters before and after the introduction of HAART. METHODS Data from a multicenter cohort study of 2238 HIV-seroconverters between the 1980s and 2004 were analysed and censored by December 2004. Calendar year at risk intervals were pre-1992, 1992-1996 and 1997-2004. Incident tuberculosis was calculated as cases per 1000 person-years (p-y). Survival analyses using Kaplan-Meier and multivariate Cox regression allowing for late-entry were used. Proportional hazards assumptions were checked with tests based on Schoenfeld residuals. RESULTS Overall, 173 (7.7%) patients developed tuberculosis over 23 698 p-y at a rate of 7.3 cases per 1000 p-y [95% confidence interval (CI), 6.3-8.5]. Incident tuberculosis was higher in intravenous drug-users (IDUs), 12.3 per 1000 p-y compared with persons infected sexually, 3.8 per 1000 p-y (P < 0.001), and persons with clotting disorders (PCD), 2.7 per 1000 p-y (P < 0.001). A decreasing tuberculosis incidence trend was observed from 1995 in all categories. Highest tuberculosis rates, 44 per 1000 p-y, were observed prior to 1997 in IDUs infected with HIV for 11 years. In multivariable analyses women were less likely to develop tuberculosis [relative hazard (RH), 0.62; 95% CI, 0.41-0.96; P < 0.05) and IDUs were more likely to develop tuberculosis (RH, 3.0; 95% CI, 1.72-5.26, P < 0.001). In the HAART era, the hazard of developing tuberculosis was 70% lower (RH, 0.31; 95% CI, 0.17-0.54; P < 0.001). Before 1997, the risk of tuberculosis increased with time since HIV seroconversion, whereas it remained nearly constant in the HAART era. CONCLUSIONS Since the mid-1990s important decreases in tuberculosis have been observed in HIV-seroconverters that probably reflect the impact of both HAART and tuberculosis control programmes.

To analyze the prevalence of latent tuberculosis infection in immigrants.A review was performed of patients less than 35 years old who were seen in an imported disease unit in Barcelona (Spain).A total of 837 tuberculin tests were performed, 728 were read and 351 (48.2%) cases of latent tuberculosis infection were detected. Older patients and those from Africa showed the highest prevalence.Immigrants in our setting present a high prevalence of latent tuberculosis infection. Few patients follow all the indications, making it necessary to improve strategies directed toward screening and diagnosis, as well as prescription and compliance with preventive treatment.

To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone.Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia.Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences.The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification.

Background: Although the consensus is that gender does not influence HIV progression, its relevance may depend on the setting. Aim: To study gender differences in HIV progression to AIDS and death from 1986 to 2001 in a cohort of injecting drug user (IDU) seroconverters in Spain. Methods: Risk of AIDS and death in persons infected for the same length of time were compared through Kaplan-Meier, allowing for late entry, and Cox regression adjusting for gender, age, and calendar period (before 1992, 1992–1995, 1996–1998, 1999–2001) fitted as time dependent covariates. Results: Of 929 IDU, 24.7% were women. Median seroconversion year was 1993.3 for men and women. 44% of women and 34% of men received antiretroviral therapy. Risk of AIDS was lower in women in univariate (hazard ratio (HR) 0.72; 95%CI:0.51 to 1.01) and multivariate analyses (HR 0.73 95%CI:0.52 to 1.03). A 46% reduction in risk of AIDS for period 1999–2001 compared with 1992–1995 was seen in both men and women (HR: 0.56 (95%CI:0.36 to 0.87). As for mortality, women's risk of death was lower univariately (HR 0.67 95%CI:0.45 to 0.99) although compared with 1992–95, men experienced a 34% reduction in mortality during 1999–2001 (HR 0.66 95%CI:0.40 to 1.01), which was not statistically significant in women. Conclusions: HIV progression was lower in female IDU before and after 1997 and their uptake of antiretroviral therapy was higher than male IDU. The inability to detect a reduction in mortality for women during 1999–2001 is probably attributable to lack of power. Differences in severity of addiction, drug using patterns, and competing causes of death may explain these findings.

The new social and demographic framework in Spain that has appeared since the arrival of new migrant populations, raises the need to improve the knowledge of their health status and to identify preventive measures and priorities in heath services.A bibliographic review of the available information on migration and health in Spain is performed, together with an analysis of their contents from a Public Health point of view. The high proportion of new borns from foreign mothers, the mental needs, deficits in oral and dental health, and the increase of tuberculosis in migrants, together with limited vaccine coverage in children, define the main health needs of these populations. The analysis of health services, reveals a high use of pediatric, obstetric and gynecologic resources by migrant populations. Conclusions; although no particular health needs have been identified for migrants, special attention for tuberculosis, mother and child health and health promotion and prevention, have to be funded for specific migrant populations. Health resources and services have to be reinforced with health agents, human resources, and specialized education for health professionals.

Objectives: To assess the effect of antiretroviral therapy (ART) adherence on survival in HIV-infected patients. Design: Cohort study at a single hospital in Barcelona, Spain. Methods: Data on HIV-infected patients older than 18 years of age who began ART during the period 1990 to 1999 were analyzed. Patients were considered nonadherent if the total dose of antiretroviral drug was less than 90% of that prescribed. Adherence was assessed through self-report and hospital pharmacy appointments. Cox regression with time-dependent variables was used. Results: A total of 1219 patients were included. The first ART was with monotherapy in 23.7% of cases, with two drugs in 30.5%, and with triple therapy in 45.8%. In multivariate analysis, the variables that presented significant differences with respect to mortality were clinical stage at the beginning of treatment (AIDS: relative hazard (RH) = 2.97; 95% confidence interval [CI]: 2.14-4.13), CD4 cell count (

The aim of this study was to describe the characteristics of imported tuberculosis (TB) in Barcelona during 1999 and 2000.Epidemiological surveillance questionnaire.During 1999 and 2000, a 7.9% decrease in TB cases was observed among the native population in Barcelona, whereas cases among immigrants grew up to 47.2%. In 2000, 449 TB cases were detected among the native population (incidence, 29.5/100,000) and 121 among immigrants (incidence, 555.9/100,000). Three outbreaks were identified, involving one Indian community (11 cases), two Dominican families (4 cases) and one city school (2 cases) whose index case was a cooperant. Isolated strains of Mycobacterium tuberculosis at the first, second and third outbreak were multisensitive, multidrug-resistant and isoniazid-resistant, respectively.The emergence of imported TB cases in Barcelona over 1999 and 2000 suggests that current preventive guidelines must be reviewed.

FUNDAMENTO: En las personas con tuberculosis infectadas por el VIH, se ha observado una elevada letalidad durante las primeras semanas desde el inicio de la terapia antituberculosa. En el presente estudio se analiza la supervivencia de las mismas en el marco de un estudio de cohortes retrospectivo. MÉTODOS: Se incluyeron 1.135 individuos que correspondían a aquellos por el VIH mayores de quince años y residentes en Barcelona, registrados por el Programa de Prevención y Control de la Tuberculosis de Barcelona y que fueron diagnosticados entre 1988 y 1993. Las variables analizadas fueron edad, sexo, antecedentes de prisión, distrito municipal, grupo de riesgo, porcentaje de linfocitos T CD4+, prueba de la tuberculina, diagnóstico de sida (según criterio CDC-1987), patrón radiológico, bacteriología y localización anatómica de la tuberculosis. Se utilizó el método semiparamétrico de Cox, las curvas de Kaplan-Meier y la prueba de log-rank. RESULTADOS: La probabilidad de supervivencia a los nueve meses fue del 77%, con amplias variaciones en los diversos subgrupos. Las únicas variables significativas en el modelo multivariado de Cox fueron sida, porcentaje de linfocitos T CD4+ y su interacción. El riesgo de morir para un individuo sin SIDA y porcentaje de linfocitos T CD4+ inferior o igual al 14% fue 7.69 veces mayor que el riesgo de morir para un individuo sin SIDA y porcentaje de linfocitos T CD4+ superior al 14%. CONCLUSIONES: La supervivencia en las personas con tuberculosis infectadas por VIH es muy variable. Las que fallecieron a corto plazo fueron las diagnosticadas de sida al iniciar el tratamiento antituberculoso y que, además, tenían un porcentaje de linfocitos T CD4+ inferior o igual al 14%.

Background We analyse whether the tuberculin skin test is a good survival marker in a cohort of pulmonary tuberculosis patients with HIV infection (PTB/HIV). In all, 494 PTB/HIV patients were enrolled in Barcelona (Spain) between January 1992 and December 1994 in the Tuberculosis Program of Barcelona. The main data problem was the large proportion of missing values in the covariates percentage of T CD4+ lymphocytes and the tuberculin test results: only 157 patients (31.8%) had both covariates recorded. Methods Patients were dichotomized into two groups according to their level of immunosuppression (≤14 and >14% T CD4+ cells). First, we carried out the semiparametric and parametric complete case analysis. After this, we analysed the data assuming a missing at random non-response pattern. We developed a bootstrap approach where missing data in the markers are imputed via a two-way linear model. Using Weibull regression estimation, we used a multiple imputation scheme to estimate the parameters of interest. Results We found significative differences for the most immunosuppressed group when comparing positive tuberculin patients with those who were tuberculin negative. From a complete case approach and through a multivariate Cox analysis, we obtained a significant relative hazard of 0.3657 (95% CI: 0.13-1.02; P = 0.054). When a Weibull model was fitted, we estimated a constant relative percentile value of pR = 4.1329 (95% CI: 0.97-17.59). From a missing data approach, we obtain a higher constant relative percentile 5.48 (P= 0.079). Conclusions The imputation method allows Is to assess the protective character of positivity for the tuberculin test for the lowest CD4+ level. These findings strongly suggest the value of the tuberculin skin test as a qualitative measure of the immunological response and its interest for developing countries where specific laboratory tests are not affordable.

The objective of the study is to assess the sensitivity and specificity of four epidemiological AIDS-Case Definitions (CDC-87, CDC-93, Europe-93 and Revised Caracas) in HIV-infected intravenous drug users (IDU). The authors carried out a cross-sectional study with 136 IDUs, HIV-infected from a Men Penitentiary Center and from a drug addiction treatment center of Barcelona, Spain, between October/93 and April/94. A protocol, including demographic, clinical and laboratory variables was used by one doctor and the laboratory tests were done in the same institution. After that, the patients were classified in the four Epidemiological AIDS-Case Definitions used by this study. As gold standard we used the CD4 Cell Count (out point 200 or 14% CD4+). The number of AIDS cases varied between 31 and 84 according to the type of AIDS definition. The CDC-93 AIDS definition implied an increase of 170.9% in the number of cases in relation to CDC-87 AIDS-Case Definition. The sensitivities of the CDC-87, CDC-93, Europe-93 and Revised Caracas Epidemiological AIDS - Case Definitions were 34.2, 88.6, 45.6 and 56.9% while the specificities were 93.0, 75.4, 75.4 and 77.2%, respectively. The positive predictive values were between 72.0% (Europe-93) and 87.1% (CDC-87) and the negative predictive values were between 50.0% (Europe-93) and 82.7% (CDC-93). The authors concluded: the sensitivity and specificity of Caracas Revised Epidemiological AIDS-Case Definition was better than Europe-93 AIDS Case Definition. So this Definition can be very useful in countries and situations where the CD4 Cell Count is not available for technical or economical reasons.

BACKGROUND: Immigration from socioeconomically underdeveloped countries is relatively recent in our country. Analyzing the impact of diseases such as HIV/AIDS and tuberculosis among these populations is of particular interest with regard to public health. METHODS: Case study and tests conducted at the Male Prison Facility in Barcelona from January 1, 1996 to September 30, 1996, the cases being the foreign immigrants from socioeconomically underdeveloped countries, and the checks of the native prisoners paired by age (+/- 5 years). A description is provided of the epidemiological and sociodemographic characteristics of the immigrants, and a comparison is drawn between the two populations. RESULTS: 450 prisoners, 300 native and 150 immigrants. Sixty-three percent (63%) of the immigrants were from the Maghreb, 72% being in this country illegally, 55% having resided in our country for over 5 years and 53% not living with any family members. The immigrants used less injected drugs that the native prisoners (OR: 0.2; IC95% 0.09-0.41), had less HIV infection (OR: 0.2; IC95% 0.05-0.49) and lived to a lesser extent with family (OR: 0.2; IC95% 1.011-0.36). No differences were found to exist with regard to infection by Mycobacterium tuberculosis nor tubercular disease. The legal immigrants were older (OR: 1.07; IC95% 1.01-1.13) lived to a greater extent with family (OR: 2.7; IC95% 1.23-5.80) and drank more alcohol (OR: 1.7; IC95% 1.07-2.59) than the illegal residents. CONCLUSIONS: The native prisoners had HIV to a greater extent than the immigrants, the use of injected drugs, more common among the natives, bearing an influence on this aspect. As regards the immigrants, the high degree of illegal residence and the absence of a stable core family comprise indicators of a situation of being socially disadvantaged.

Antecedentes. El comportamiento frente al consumo de sustancias potencialmente adictivas puede estar influido por el lugar de residencia del joven. Objetivo. Conocer la frecuencia y las caracteristicas del consumo de tabaco, alcohol, cannabis en los alumnos de Educacion Secundaria Obligatoria (ESO) de un area urbana pequena durante el curso 2008-09. Metodos. Estudio transversal. Se administro un cuestionario autocumplimentado a los alumnos. Se escogieron variables sociodemograficas relacionadas con el consumo. Resultados. El 88% de los alumnos respondieron la encuesta (393). La prevalencia de consumo de tabaco fue del 48%, el 16 % declararon fumar diariamente. El 44% de los alumnos de tercero y el 52% de los de cuarto consumian alcohol los fines de semana, un 35% del total se habian emborrachado alguna vez. El 30% habia consumido cannabis, alcanzando mas del 50% en tercero. De estos, el 23% lo hizo en el ultimo mes. La media de edad de inicio en el consumo de cannabis se produjo a los 13 anos. El 80% de los encuestados refirieron no haber pagado para su consumo la primera vez. Conclusiones. El consumo de alcohol, tabaco y cannabis se inicia en nuestro medio entre los 12 y los 14 anos, y con frecuencias ligeramente superiores a las encontradas en grandes urbes. A pesar de la ilegalidad de la venta de tabaco y alcohol a menores, los adolescentes siguen adquiriendolos. Es fundamental que los profesionales de atencion primaria, educadores y la familia tomen conciencia de la importancia que tienen en la deteccion precoz del consumo de estas sustancias, ya que la prevencion de las drogodependencias es tanto mas eficaz cuanto antes se detecta el riesgo.

Background: Among men who have sex with men (MSM), the association between searching for sexual partners' on the Internet and increased risk of sexually transmitted infections (STIs)/HIV infection, together with current low levels of partner notification (PN), justifies a study to explore the intention to use new communication technologies for PN in Spain. Methods: Two cross-sectional surveys were performed: the first was administered online to visitors to web pages where the survey was advertised; the second was administered on paper to patients attending an STI Unit and centres similar to Community-Based Voluntary Counselling and Testing centres. Results: The study population comprised 1578 Spanish residents (median age, 34 years [range: 18 to 74]); 84% lived in urban areas, and 69% reported searching for sexual partners on the Internet. Thirty-seven per cent would be willing to use a website for PN, 26% did not know if they would use one, and 37% would not want to use one. The main reasons for not intending to notify STI/HIV were "shame or fear" (stable partner) and "not knowing how to contact them" (casual partner). The preferred method of notification was face to face (73%) for both stable and casual partners, although using new technologies (Short Messaging System, e-mail, web page, phone applications) was widely accepted for notifying casual partners. Conclusions: Fighting stigma and promoting alternative methods of PN among MSM and health professionals through new technologies could increase the frequency of PN. This approach will improve early detection and reduce transmission in Spain. (C) 2014 SESPAS. Published by Elsevier Espana, S.L.U. All rights reserved.

ResumenSe realizó una intervención en saunas y pisos para contactos sexuales entre hombres que mantienen relaciones sexuales con hombres de Valencia, cuyo objetivo era prevenir la infección por el virus de la inmunodeficiencia humana (VIH) o, en su caso, evitar el retraso en el diagnóstico y facilitar el contacto con los circuitos sanitarios. Se proporcionó información sobre prevención y se efectuó la prueba rápida para el VIH y la sífilis. Se habló con 500 hombres y se realizó la intervención en 171. El 37% de los sujetos en las saunas y de cada en los pisos nunca se había realizado una prueba. La prevalencia del VIH fue del 1,6% (n=2) en las saunas y del 11% en los pisos (n=5); para la sífilis estos porcentajes fueron del 5 y el 2,3%, respectivamente. La intervención permitió detectar la existencia de bolsas de población poco atendidas y muy expuestas, y facilitó el acceso de estos sujetos al sistema sanitario.AbstractAn intervention in venues for interaction used by men who have sex with men in Valencia (Spain) was performed to prevent human immunodeficiency virus (HIV) infection or avoid delay in diagnosis and to facilitate contact with the health circuit. Information was provided on prevention and a rapid test for HIV and syphilis was performed.We contacted 500 men and the intervention was performed in 171; 37% of the subjects in saunas and one in four of those in prostitution apartments had never been tested. The prevalence of HIV was 1.6% (n=2) in the saunas, and 11% (n=5) in the apartments (n=5). For syphilis, these percentages were 5% and 2.3% respectively. The intervention revealed the existence of highly exposed population groups with low compliance and facilitated access to the health system in these groups.

Progression to AIDS and death for 1129 HIV seroconverters from the GEMES cohort were analysed by calendar period (1996-1997, 1998-1999, 2000 onwards). A further hazard reduction was observed for a later period for both. Intravenous drug users (IDU) had a faster progression. The results highlighted the importance of monitoring the effectiveness of highly active antiretroviral therapy and to improve public health strategies directed to IDU to reduce inequity in HIV infection care.

Background: In Catalonia, a law was passed in 2010 to incorporate HIV infection as a mandatory disease and to reduce under-reporting, perform follow-up and to improve prevention. Currently, there are studies that describe the surveillance of new diagnoses of HIV infection. However, there are no studies that compare the change from voluntary to mandatory notification. This study evaluates the impact of mandatory notification on the registered cases of newly diagnosed HIV infections in a city with a concentrated epidemic. Methods: We analysed newly diagnosed HIV infections that were included in the city register. A descriptive analysis compared the number and the epidemiological characteristics of cases that were declared in two different periods (when notification was voluntary in 2001-2009 and when mandatory in 2010-2011). Time series analysis was conducted, evaluating trends and changes by fitting a Poisson regression model. The Epidemiology Service from the Public Health Agency was responsible for gathering and analyzing data and producing reports on communicable disease for the city. The data used in this study is openly available. Results: Overall, 4510 cases of HIV infection were registered, 81.9% were men and 74.5% of them aged over 30. Among men, 55.6% were men who had sex with men (MSM), and among women, the most common route of transmission was heterosexual (HTS) with 65.4%. An annual average of 560 cases was registered between 2010 and 2011. This represents an increase of 33% from the annual average over the previous period (p