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Joan A Caylà

Publications and source records attributed to Joan A Caylà.

8 recordsLinked to original sources
PubMed2006

Socioeconomic position and excess mortality during the heat wave of 2003 in Barcelona.

The objective of this study is to determine whether the excess of mortality which occurred in Barcelona during the summer of 2003 was dependent on age, gender and educational level. We included all deaths among Barcelona residents 20 years of age and older that occurred in the city during the months of June, July and August of 2003 and also during the same months of the five preceding years. Poisson regression models were fitted to obtain the risk of death in 2003 with respect to the period 1998-2002. The relative risk (RR) of mortality during the summer of 2003, compared to the summers of the previous 5 years, was higher for women than for men and among older ages. Although an increase among women was observed in all educational groups, in some age groups the increase was larger for people with less than primary education. The excess number of deaths was higher for those with less education. These results suggest that age, gender and educational level were important determinants of excess mortality in the 2003 Barcelona heat wave.

Adult↗
PubMed2006

Group A streptococcal infections in injection drug users in Barcelona, Spain: epidemiologic, clinical, and microbiologic analysis of 3 clusters of cases from 2000 to 2003.

An unexplained resurgence of Group A streptococci (GAS) infections has been observed since the mid-1980s in the United States and Europe, particularly among intravenous drug users (IDUs). Several risk factors have been identified. Mutations in the capsule synthesis regulator genes (csrRS) have been associated with an increase in virulence. From January 1998 to December 2003, we conducted a prospective and retrospective descriptive analysis of invasive GAS soft-tissue infections in IDUs in Barcelona, Spain. Clinical features were collected, and we conducted a surveillance study to identify risk factors associated with GAS soft-tissue infections. We analyzed chromosomal DNA by low cleavage restriction enzymes and used pulsed-field gel electrophoresis (PFGE) and variable gene sequence typing (VGST) of the emm gene to disclose the epidemiologic relationship between the strains. We analyzed the influence of clonality (M-type) and mutations in csrRS genes of these strains on clinical features. We identified 44 cases, all of which were grouped in 3 clusters: fall 2000, fall 2002, and fall 2003. Cellulitis with or without abscesses (75%) and fever (90.9%) were the most common clinical manifestations. Distant septic complications were infrequent (18.2%). Although all patients had severe infections (mainly bacteremic needle abscesses), their outcome with antibiotic therapy, usually beta-lactam, was successful in all cases. However, surgery was needed in 40.9% of patients. Through the surveillance study we found that infected patients had a higher number of drug injections per day (odds ratio [OR], 18.84; 95% confidence interval [CI], 4.83-79.4; p<0.00001), shared paraphernalia for drug use more frequently (OR, 11.11; 95% CI, 3.24-39.04; p<0.0001), were in a higher proportion both currently unemployed and homeless (OR, 4.22; 95% CI, 1.5-12.15; p<0.0001), were not in a methadone maintenance program (OR, 0.03; 95% CI, 0-0.19; p<0.00001), and more often bought drugs at a specific site (OR, 33.92; 95% CI, 7.44-174.93; p<0.00001) and from a specific dealer (OR, 72; 95% CI, 8-3090; p<0.00001), compared with patients not infected. The fall 2000 cluster was polyclonal, whereas the other 2 clusters were mainly due to the same strain of GAS (emm 25.2), and were defined as epidemic outbreaks. Clinically, the cases due to the clonal strain presented abscesses and needed surgery more frequently (p<0.001 and p=0.005, respectively). On the other hand, mutations in the csrRS genes were not associated with invasive GAS soft-tissue infection. There has been an increase in the number of cases of invasive GAS soft-tissue infections in IDUs in Barcelona, which seems to be related to drug users' habits and their socioeconomic status. Clonality (emm 25.2) but not mutations in the csrRS genes was associated with more severe GAS soft-tissue infections.

Adolescent↗
PubMed2003

[Effectiveness of Spanish tuberculosis control programmes].

BACKGROUND AND OBJECTIVE: An assessment of tuberculosis programmes was carried out in Spain in 1996. The present article looks at trends in tuberculosis control since then. MATERIAL AND METHOD: A questionnaire asking about indicators, referred to year 2000, was sent to Spain's 17 autonomous regions, as well as to the autonomous cities of Ceuta and Melilla. Results were compared with those obtained in 1996. RESULTS: Improvements, i.e. implementation of more activities, were observed in 77.8% of operative programmes. However, 16.7% of regions have no program yet, while in 27.8% of them, control activities remain scarce. Castilla-León, Catalunya, Ceuta, Madrid, Murcia, Valencia and Galicia were the regions exhibiting more control activities. CONCLUSIONS: Although the trend is positive, many programmes still have a limited effectiveness.

Humans↗
PubMed2002

Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients.

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 (<200 cells/microL: RH = 5.89; CI: 3.44-10.10), type of treatment (monotherapy: RH = 9.76; CI: 4.56-20.90; bi-therapy: RH = 9.12; CI: 4.23-19.64), and adherence (nonadherence: RH = 3.87; CI: 1.77-8.46). CONCLUSIONS: The modifiable factors most strongly associated with survival were type of treatment and adherence. It would be desirable to accompany therapy with intervention strategies intended to improve adherence.

Adolescent↗
PubMed2002

[Imported tuberculosis: an emerging disease in industrialised countries].

BACKGROUND: The aim of this study was to describe the characteristics of imported tuberculosis (TB) in Barcelona during 1999 and 2000. MATERIAL AND METHOD: Epidemiological surveillance questionnaire. RESULTS: 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. CONCLUSIONS: The emergence of imported TB cases in Barcelona over 1999 and 2000 suggests that current preventive guidelines must be reviewed.

Adult↗