A. Gil de Miguel

Self-perception of health status, mental health and quality of life among adults with diabetes residing in a metropolitan area.

AIM The study aimed to compare the self-perception of health, physiological distress and health-related quality of life (HRQL) in subjects with and without diabetes residing in a large metropolitan area (the city of Madrid), and to identify the variables associated with the poorest HRQL among diabetes patients. METHODS In this case-control epidemiological study, we selected 358 patients with diabetes from the Madrid City Health Survey. For every patient, two controls without diabetes were randomly selected from the same database and matched for age, gender and health district. The resultant study population comprised 1074 subjects, who were analyzed according to their self-rated health status, with mental health assessed by the 12-item General Health Questionnaire (GHQ-12) and HRQL by the COOP/WONCA questionnaire. Independent variables included sociodemographic characteristics, lifestyle variables, associated chronic diseases and consumption of medications. Multivariate analyses were conducted using ANCOVA tests. RESULTS The prevalence of health perceived as fair or poor was 64.12% in those with diabetes vs 38.57% in those without diabetes (P<0.05). The GHQ-12 results showed that mental health was also significantly worse among diabetes sufferers, and the COOP/WONCA questionnaire results indicated significantly poorer HRQL in those with diabetes. The variables that determined a poorer perception of HRQL among diabetes sufferers were female gender, older age, obesity, lack of physical exercise, coexistence of depression, use of sleeping pills, and Alzheimers and cerebrovascular diseases. CONCLUSION Self-rated health and psychological well-being, and HRQL, are all considerably poorer among patients with diabetes vs those without diabetes. The poorest quality of life among those with diabetes associated with female gender, depression, lack of exercise and obesity.

Patterns of medication use in the immigrant population resident in Spain: associated factors.

This study mainly aimed at to ascertain to ascertain the prevalence of the consumption of medications, prescribed and self‐medicated, among the immigrant population (economic immigrants and not economic immigrants) resident in Spain, and to identify the factors associated with such consumption in this population.

Epidemiology of pneumococcal meningitis hospitalizations in pediatric population in Spain (1998-2006).

The burden of hospital admissions for pneumococcal meningitis in pediatric population in Spain during a 9-year period was estimated. Data were obtained from the national information system (computerized hospital discharge data). There were 770 hospital admissions with an annual incidence of 1.44 cases per 100,000 population. Rate of death and case-fatality rate were 0.11 per 100,000 population and 7.92%, respectively. The higher incidence and rate of death was found in children up to 12 months of age and the higher case-fatality rate in children of 10-14 years of age. Further studies assessing the incidence of pneumococcal meningitis in post-vaccination period are needed.

Ingresos hospitalarios atribuibles a rotavirus en niños de la Comunidad de Madrid, período 1999-2000

Objetivo Estudiar las hospitalizaciones atribuibles a infecciones por rotavirus en ninos de hasta 5 anos durante el periodo 1999-2000 en la Comunidad de Madrid. Material y metodo Estudio retrospectivo, utilizando como fuentes de informacion la base de datos hospitalaria Conjunto Minimo Basico de Datos (CMBD) y el Sistema de Informacion Microbiologica (SIM). Se analizaron los datos del CMBD correspondientes a hospitalizaciones en ninos de hasta 5 anos con un diagnostico principal al alta de enfermedad intestinal infecciosa (codigos CIE-9-MC 001-009) o gastroenteritis no infecciosa (codigo CIE-9-MC 558) y las notificaciones al SIM de los principales patogenos causantes de gastroenteritis aguda. Resultados La incidencia anual de hospitalizaciones por gastroenteritis aguda fue de 69 casos por 10.000 ninos de hasta 5 anos. El 14 % de los 32.541 casos de infeccion producidos por patogenos responsables de gastroenteritis agudas notificados al SIM fueron producidos por rotavirus. La proporcion de casos de infeccion por rotavirus confirmada en laboratorio, extrapolada al numero de hospitalizaciones por gastroenteritis aguda da como resultado una incidencia anual de hospitalizaciones atribuibles a rotavirus de 12 casos por 10.000 ninos de hasta 5 anos. La estancia media hospitalaria fue de 4,0 dias, el numero medio annual de dias de hospitalizacion fue de 1.382 dias y el coste de 565.907 euros. El exceso de hospitalizaciones durante los meses epidemicos para rotavirus (diciembre y enero) fue del 67 %. Conclusiones El rotavirus ocasiona una parte importante de los ingresos hospitalarios por gastroenteritis aguda en ninos de hasta 5 anos en la Comunidad de Madrid.OBJECTIVE To assess rotavirus infection requiring hospitalization in children aged < or = 5 years between 1999 and 2000 in the Autonomous Region of Madrid (Spain). MATERIAL AND METHOD A retrospective study was conducted, based on the hospital data surveillance system (Conjunto Minimo Basico de Datos [CMBD]) and on the Spanish national microbiological information system (Sistema de Informacion Microbiologica [SIM]). CMBD data for all hospital admissions in children aged < or = 5 years with a first-listed diagnosis of intestinal infectious disease (ICD-9-CM codes: 001-009) or non-infective gastroenteritis (ICD-9-CM code: 558) and the reports to the SIM of the major pathogen groups responsible for acute gastroenteritis were analyzed. RESULTS The annual incidence of hospitalizations for acute gastroenteritis was 69 cases per 10,000 children aged < or = 5 years. Fourteen percent of the 32,541 infections produced by pathogens responsible for acute gastroenteritis reported to the SIM were rotavirus. The estimated annual incidence of hospitalizations due to rotavirus infections was 12 cases per 10,000 children aged (3/4) 5 years. The mean length of stay was 4.0 days, the annual mean number of days of hospitalization was 1,382 days, and the annual cost was 565,907 J. During the rotavirus epidemic months (December and January), the percentage of excess hospitalizations was 67 %. CONCLUSIONS Rotavirus causes a significant proportion of hospital admissions due to acute gastroenteritis in children aged < or = 5 years in the Autonomous Region of Madrid.

Increased incidence of admissions for anaphylaxis in Spain 1998–2011

We report on trends in anaphylaxis admissions in the Spanish hospital system during the period 1998–2011. Data on admissions for anaphylaxis were obtained from the Spanish Information System for Hospital Data for the period 1998–2011. Patients were selected using the codes for anaphylaxis in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM). Poisson regression models were used to estimate incidence rate ratios. We recorded a 1.89‐fold increase in admissions for anaphylaxis in Spanish hospitals during the study period, particularly in patients aged 0–14 years (1.65‐ to 3.22‐fold until 2009 and 4.09‐ to 12.59‐fold until 2011) and in food anaphylaxis in all age groups (2.78‐fold until 2009 and 8.74‐fold until 2011). The incidence of anaphylaxis is perceived as having increased in recent years, especially anaphylaxis caused by food and anaphylaxis affecting the pediatric population.

Hospital admissions for meningococcal infection in Spain (1997-2005).

OBJECTIVES Spanish hospital surveillance system was analyzed to estimate the burden of hospital admissions for meningococcal infection in Spain during a nine-year period (1997-2005). METHODS Data were obtained from the national surveillance system for hospital data (Conjunto Mínimo Básico de Datos) maintained by the Ministry of Health and covering more than 95% of Spanish hospitals. RESULTS There were 9480 hospital admissions for meningococcal infection (ICD 9 CM 036; any listed diagnosis) during the study period. Annual incidence was 2.66 cases per 100,000 population. Rate of death and case-fatality rate were 0.17 per 100,000 population and 6.45%, respectively. The average length of hospitalization was 11.2 days. Youngest age group showed the highest incidence and rate of death (43.15 and 1.17 per 100,000 population respectively in 0-4 years old group), but case-fatality rate was higher in the oldest group (12.16%; more than 30 years old group). The cost of acute hospital care is estimated to be on average 4470 euro per case, which imposes an annual direct cost of 3-5 million euro to the Spanish health system. CONCLUSIONS Meningococcal infection is still an important cause of hospital admissions in Spain and results in large cost to the Health Care System.

Breast cancer mortality in Spain: Has it really declined for all age groups?

OBJECTIVES In recent years, the incidence of breast cancer has increased in Spain but mortality has decreased, particularly since 1992. Despite the general decrease in mortality, the intensity of this disease differs between age groups. The main objective of this study was to examine mortality due to breast cancer for different age groups in Spain from 1981 to 2007, and to forecast the mortality rate in 2023. STUDY DESIGN Ecological study. METHODS Trends in mortality due to breast cancer were analysed using the Lee-Carter model, which is the typical analysis for mortality in the general population but is rarely used to analyse specific causes of death. RESULTS This study found a decreasing trend in mortality due to breast cancer from 1993 to 2007, and it is predicted that this trend will continue. However, mortality rates varied between age groups: a decreasing trend was seen in younger and middle-aged women, whereas mortality rates remained stable in older women. CONCLUSIONS Preventive breast cancer practices should differ by patient age.

Efectividad de los selladores de fisuras en una población infantil con alto riesgo de presentar caries

Objetivo Conocer la efectividad de los selladores oclusales en una poblacion infantil y evaluar los criterios de inclusion para la aplicacion de los mismos. Diseno Estudio de cohortes prospectivo. Emplazamiento Atencion primaria. Participantes Seiscientos siete escolares que se incluyen a los 6 anos de edad y se siguen durante 4,5 anos. Intervencion Se definen tres grupos: expuestos a un programa preventivo de salud bucodental con y sin aplicacion de selladores oclusales en los primeros molares permanentes (grupos I y II, respectivamente), y no expuestos al programa preventivo (grupo III). Mediciones principales. Se realizaron tres exploraciones odontologicas, siguiendo los criterios de la Organizacion Mundial de la Salud, antes de comenzar el estudio (a la edad de 6 anos), al finalizar la aplicacion de los selladores (a la edad de 8 anos) y a la edad de 10,5 anos, transcurridos 4,5 anos del comienzo del estudio. Resultados Transcurridos 4,5 anos, el grupo I tiene un indice CAOD de 0,59, el grupo II de 0,79 y el grupo III de 1,52 (p Conclusion Los selladores oclusales en el primer molar permanente, aplicados en un grupo de alto riesgo, tienen un efecto protector frente a la caries dental. Debemos ofertar selladores oclusales en el primer molar permanente a todos los escolares, ya que los escolares sin programa preventivo y sin selladores oclusales presentan un riesgo significativamente mayor de deasarrollar caries.

Evolución en las coberturas vacunales antigripales en la Comunidad de Madrid entre los años 1993 y 2001

Resumen Introduccion La vacuna frente a la gripe es una medida de prevencion efectiva y segura. Los objetivos de este trabajo son calcular, para la Comunidad Autonoma de Madrid (CAM), las coberturas antigripales en 1993 y 2001, describir los factores asociados a la vacunacion y analizar la evolucion temporal entre estos anos. Sujetos y metodo Se han analizado los datos de los 1.985 y 1.998 adultos residentes en la CAM incluidos en las encuestas nacionales de salud (ENS) de los anos 1993 y 2001. Se calcularon las coberturas vacunales antigripales para cada ano y se analizo la influencia de la edad, el sexo y la presencia de enfermedades cronicas. Se ha empleado el analisis de regresion logistica para valorar cuales de estas variables tienen un efecto independiente en la vacunacion antigripal y para analizar la evolucion temporal de las coberturas. Resultados Para el total de la muestra se estima una cobertura vacunal en 1993 del 18,57% y en 2001 del 19,8%. En el modelo multivariable se observa una mejoria significativa entre 1993 y 2001 en las coberturas del grupo ≥ 65 anos. Sin embargo, no encontramos cambios significativos para el grupo Conclusiones Los sujetos con enfermedades de riesgo y edad

Incidencia de caries en una población infantil de Móstoles: evaluación de un programa preventivo transcurridos 2 años

Objetivo Conocer la eficacia y efectividad de un programa de salud bucodental transcurridos 2 anos. Diseno Estudio de cohortes prospectivas no aleatorizado. Poblacion y metodos La cohorte expuesta consta de 583 escolares, 296 ninas y 287 ninos; la cohorte no expuesta consta de 261 escolares, 132 ninas y 129 ninos. Realizamos una exploracion odontologica siguiendo los criterios de la OMS. Las medidas preventivas que llevamos a cabo son educacion sanitaria, colutorio semanal de FlNa al 0,2%, selladores oclusales en el primer molar permanente y fluor topico gel. Hemos medido y comparado diferentes indices de caries y variables sociodemograficas entre ambas cohortes; la significacion estadistica se ha determinado mediante el test de la «U» de Mann Whitney. Resultados Hemos encontrado diferencias estadisticamente significativas entre ambas cohortes, siendo los indices de caries en la cohorte expuesta: CAOD, 0,31; CAOM, 0,31, y CAOS, 0,4, y en la cohorte no expuesta: CAOD, 0,81; CAOM, 0,81, y CAOS: 1,09. Habiendo una asociacion epidemiologica entre el programa preventivo y la prevencion de caries dental con un riesgo relativo de 0,24 (IC del 95%, 0,17-0,33) y la fraccion prevenible del 76,3% (IC del 95%, 67-83). Conclusiones El programa preventivo transcurridos 2 anos es eficaz y tiene un claro efecto protector.