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The construction of Axel Hotel Barcelona , opened in , was the beginning of a project that in the 15 years of existence, became what is now a hotel chain. We defined ILI as the presence of at least one systemic symptom fever, malaise, headache or myalgia and at least one respiratory symptom cough, sore throat or shortness of breath.
Patients were screened for presence of ILI within the past seven days. In 16 hospitals, this screening applied to patients admitted at the emergency department for a range of pre-defined chief complaints Table 1. In the other five hospitals, all patients admitted in the participating services were screened.
All eligible patients who agreed to participated were swabbed and interviewed. The swabbing was performed by the hospital physicians in all study sites but Valencia where it was under the responsibility of dedicated study nurses. Data collected included demographics, information on the ILI episode dates of symptom onset, hospitalisation, laboratory testing and swabbing and treatment , presence of chronic diseases, number of hospital admissions in the past 12 months, number of GP consultations in the previous three months, smoking status, vaccination against influenza in —12 and in the last two seasons and for those aged 65 years and older functional status before onset using the Barthel score [18].
Individuals belonged to the target group for vaccination if they corresponded to the country specific recommendations for vaccination [19] — [21]. Patients were considered vaccinated if they had received a dose of the —12 seasonal vaccine more than 14 days before the date of onset of ILI symptoms.
They were considered as unvaccinated if they had received no vaccine or if the vaccine was given less than 15 days before the onset of ILI symptoms. Vaccination status was ascertained using registries in Valencia and Navarra, interview with patients in France and interview with patients and with their physician in Italy.
Influenza laboratory confirmation was done through reverse transcription polymerase chain reaction RT-PCR on nasopharyngeal swabs. Isolates underwent a molecular analysis for currently circulating influenza A viruses subtypes H3 and H1 , A H1N1 pdm09 and influenza B. In view of the dominance of Influenza H3N2 during the —12 season [22] , we restricted the case definition to those patients with a nasopharyngeal sample positive for influenza A H3N2.
Controls were patients with negative samples for any influenza virus.
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Study sites transmitted anonymised datasets to EpiConcept, the pooled analysis coordinator, through a secured web based system. We ran a complete case analysis, excluding records for which outcome, exposure or confounding variables were missing. To minimise potential misclassification, we restricted our analysis to those patients swabbed within four days after onset of ILI symptoms.
We then ran a sensitivity analysis on all patients swabbed within seven days. We assessed qualitative heterogeneity of the studies through site visits to document the recruitment approaches and the strategies set up to ensure the systematic screening and inclusion of ILI patients. We collected information on the vaccines used in the areas covered by the study sites.
We estimated the pooled IVE as 1- the odds ratio OR x, using a one-stage method with study site as a fixed effect in the model.
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To estimate adjusted IVE, we used a logistic regression model including potential confounding factors: time of symptom onset by pair of onset weeks , age group four categories , gender, number of GP visits in the previous three months more than one vs. We stratified IVE in four age groups 18—64, 65—74, 75—84 and 85 years and above and we confined the analysis to the patients belonging to the target group for vaccination.
We conducted all statistical analysis using Stata version 11 StataCorp. Stata Statistical Software: Release Overall, 9, patients were screened in the various hospitals Table 1. Of these records, 1, were outside the study period, 2, were younger than 18 years old or had no age information, 2, did not meet the ILI case definition and had been swabbed more than seven days after their symptoms onset. We excluded 10 records because of missing information vaccination status 6 , hospitalisation in the previous year 3 and cardiovascular disease 1. These 25 patients were excluded from the analysis.
The proportion of patients included among those screened ranged from 6. Overall, 1, patients swabbed within seven days after illness onset were eligible, including A H3N2 cases and negative controls. We restricted our analysis to the cases Based on influenza activities reported through GP sentinel network, the influenza season was earlier in Spain and Italy compared to France [24] — [27].
The inclusions per study site followed the same pattern Figure 1. In the pooled data, inclusion of cases was highest between the weeks 6 and 8 Figure 2. The —12 seasonal influenza vaccination coverage was Respectively The proportion of patients hospitalised in the previous year was Site visits and protocol review ensured a homogeneous implementation of the protocol within the participating hospitals. All hospitals systematically included all patients with ILI. In Valencia, dedicated study nurses screened patients for ILI and swabbed them. Elsewhere, clinicians swabbed the patients.
Due to low number of sites and small sample size, the statistical heterogeneity could not be assessed. The IVE point estimate was The 21 hospitals followed a common core protocol, allowing for pooling data sets. The systematic inclusion of ILI patients and the access to medical records ensured the collection of a good quality data.
We had very few missing values 0. The absolute difference between crude and adjusted IVE varied from 1. Ninety two percent of the ILI patients belonged to the target groups for vaccination. Estimating effectiveness against laboratory confirmed influenza in this population is particularly relevant since no efficacy measures are available [7]. Some biases may limit the interpretation of our study.
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High risk groups are more likely to be vaccinated and to develop a severe form of influenza. This may overestimate the number of vaccinated cases seen at the hospital and underestimate IVE. This would overestimate IVE. Previous image of the property Next image of the property. Number of days between onset of symptoms and swabbing. First time in Europe. Gay dating de orkoien September 6, Guidling Light. Time of year. My recommendations for the best dating sites are based primarily on my own experiences with online dating sites as a woman, with some word-of-mouth impressions from … Grupos para conocer gente porqueres Rebecca Fleenor People also ask Who is the best Asian dating site?
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