The early detection of the outbreaks of diseases is one of the most challenging objectives of epidemiological surveillance systems. In this paper, a Markov switching model is introduced to determine the epidemic and non-epidemic periods from influenza surveillance data: the process of differenced incidence rates is modelled either with a first-order autoregressive process or with a Gaussian white noise process depending on whether the system is in an epidemic or a nonepidemic phase. The transition between phases of the disease is modelled as a Markovian process. Bayesian inference is carried out on the former model to detect influenza epidemics at the very moment of their onset. Moreover, the proposal provides the probability of being in an epidemic state at any given moment. The methodology is evaluated on influenza illness data obtained from the Sanitary Sentinel Network of the Comunitat Valenciana, one of the 17 autonomous regions in Spain.

Objective: To estimate the association strength of dietary behaviour and sedentary habits in relation to childhood obesity in Spain. Design: A matched case-control study was carried out using data collected by sentinel network paediatricians in general practices. Setting: Five Spanish autonomous communities. Subjects: Cases were 437 children (2-14 years old) with BMI .95th percentile according to Spanish reference tables. Controls were 751 children (2-14 years old; two paired per case) with BMI ,84th percentile. Data were collected in two phases: individual (questionnaires filled in by sentinel paediatricians) and family (self-administered questionnaires filled in a family environment). Crude OR and adjusted OR (ORc and adj OR) for the given variables were calculated using a simple and multiple conditional logistic regression analysis. Results: The factors with the greatest effect on obesity were family history of obesity: both parents (adj OR 5 11?2), mother but not father (adj OR 5 9?1), father but not mother (adj OR 5 6?1), siblings (adj OR 5 2?7); and eating between meals (adj OR 5 2?5) and consumption of sweets and soft drinks .2 times/week (adj OR 5 2?0). The highest protection effect was found for five meals per day (adj OR 5 0?5), the regular consumption of breakfast (adj OR 5 0?5) and for eating fruit for dessert (adj OR 5 0?6). Factors related to sedentary habits did not appear as noteworthy. Conclusions: We have determined the association between certain dietary behaviour and family history with childhood obesity in several Spanish regions.

BackgroundThis is an international study across four European countries (Belgium[BE], the Netherlands[NL], Italy[IT] and Spain[ES]) between 2009 and 2011, describing and comparing care and care setting transitions provided in the last three months of life of cancer patients, using representative GP networks.MethodsGeneral practitioners (GPs) of representative networks in each country reported weekly all non-sudden cancer deaths (+18y) within their practice. GPs reported medical end-of-life care, communication and circumstances of dying on a standardised questionnaire. Multivariate logistic regressions (BE as a reference category) were conducted to compare countries.ResultsOf 2,037 identified patients from four countries, four out of five lived at home or with family in their last year of life. Over 50% of patients had at least one transition in care settings in the last three months of life; one third of patients in BE, IT and ES had a last week hospital admission and died there. In the last week of life, a treatment goal was adopted for 80-95% of those having palliation/comfort as their treatment goal. Cross-country differences in end-of-life care provision included GPs in NL being more involved in palliative care (67%) than in other countries (35%-49%) (OR 1.9) and end-of-life topics less often discussed in IT or ES. Preference for place of death was less often expressed in IT and ES (32-34%) than in BE and NL (49-74%). Of all patients, 88-98% were estimated to have distress from at least one physical symptom in the final week of life.ConclusionAlthough palliative care was the main treatment goal for most cancer patients at the end of life in all four countries, frequent late hospital admissions and the symptom burden experienced in the last week of life indicates that further integration of palliative care into oncology care is required in many countries.