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Objective: The avoidable hospital admissions for heart failure are a problem for health systems worldwide, as they waste resources, generate additional morbidities and high mortality. The objective of this study was to determine the risk factors in patients hospitalized for heart failure., Methods: A group of medical from Hospital and Primary Care was established. We realized an audit of a sample of 110 patients from Aljarafe towns with highest hospital admissions for heart failure. The analysis used Student T test and Mann Whitney for quantitative variables; Chi-square test and Fisher exact test for qualitative variables., Results: Patients admitted for HF had a mean age of 78.1 years (SD: 9.56); 73 (66.4%) were women; Barthel Index was 45.0 on average; 53.5% had New York Health Association (NYHA) class III and 17 (15.5%) were institutionalized, 70% had between 3 and 5 comorbidities, mainly hypertension (87.3%), dyslipidemia (60.0%), diabetes (57.3%), chronic kidney disease (56.4%), anemia (53.2% ) or atrial fibrillation (52.7%). During hospitalization, 23 patients (20.9%) died. They were mostly women, elderly, had a previous admission and without beta-blockers treatment. The admission in the last 12 months was associated with identification of the primary caregiver; ischemic HF; re-vascularization; inclusion in the COMPARTE Program; treatment change decompensation., Conclusions: The hospital admissions were more frequently an aging population with multiple diseases (hypertension, diabetes, COPD, renal disease) and low capacity for basic activities of daily life. The hospital mortality associated with elderly, women, less use of beta-blockers and the non-inclusion of the patient in the care process.

Background: Studies of siblings and twins suggest a genetic component of autism that does not fully explain its current increase. The aim is to investigate whether environmental factors such as exposure to occupational hazards (night work, handling of solvents and/or electromagnetic fields) increases the likelihood of autism spectrum disorders (ASD) in children., Methods: Observational case control study by analyzing the records of 206 children (age between 16 and 36 months) evaluated in the Early Intervention Service of Ciudad Real (70 with ASD and 136 unaffected children). To assess the risk of ASD associated with night work, handling of solvents and/or electromagnetic fields, odds ratio (OR) were calculated with 95% confidence intervals (CI)., Results: The risk of ASD is multiplied by 2.22 when one parent works in the studied occupations (OR=2.22, 95% CI=1.42-3.48), highlighting work with solvents (OR=2.81, 95% CI=1.28-6.17) and night work (OR=2.18, 95% CI=1.21-3.93). It is multiplied by 3 if the mother's job is one of these occupations (OR=3, 95% CI=1.44-6.26), standing out night work (OR=3.47, 95% CI=1.39-8.63), and handling of solvents (OR=2.88, 95% CI=1.28-6.17); whereas it is multiplied by 1.94 if the father works in these occupations (OR=1.94, 95% CI=1.07-3.53), standing out handling of solvents (OR=2.81, 95% CI=1.01-7.86). A positive association between the educational level of parents and ASD is found., Conclusions: The results show a significant relationship between the exposure of the parents to occupational hazards and ASD in the children, suggesting the involvement of genetic alterations caused by environmental factors in the origin of the disorder.

Background: In April 2009, the World Health Organization declared the emergence of human cases by a new influenza virus H1N1 as a Public Health Emergency of International Importance. Our objective was to analyze the characteristics of the cases investigated and to assess the compliance of the subjects studied with the indications and recommendations of the Health Regional Ministry of Health Castilla y León., Methods: A descriptive epidemiological study of all positive cases and every requests made to Castilla y León, from epidemiological weeks 44 to 50, both included., Results: 588 requests were made to test for influenza A H1N1 (58% males). The mean age was 34.8 years (27.1% between 15 and 44 years). 42% fulfilled criteria for severity. Chronic respiratory disease was the most common risk factor found (18.9%). Antiviral treatment was found in 19.1% (54.5% within the first 48 hours). 27.4% of the requests were positive (53.4% males). The mean age of the positive cases was 34.52 years was positive (33.1% between 15 and 44 years). 47.8% of them fulfilled criteria for severity and chronic respiratory disease was also the most common risk factor found also in the positive (26.7%). Only 6.8% were morbidly obese. 28.9% of positives received antiviral treatment (61.4% within the first 48 hours)., Conclusion: Most cases did not fulfil severity criteria, which illustrates the low compliance of monitoring protocols in sanitary care system.

Background: Non-lineal temperature-mortality relationship varies depending on the characteristics of the designated study geographic zone. In given places, a growing level of economic development has led to lesser influence of environmental variables on mortality. This paper analyzes trends in the association between maximum temperatures and organic-cause mortality from 1975 to 2003 in Castile-La Mancha (Spain)., Methods: Daily maximum temperatures and organic-cause mortality data were divided into 3 time period: 1975-1984, 1985-1994 and 1995-2003. After data pre-whitening by applying ARIMA model estimated for the daily maximum temperature series, we calculate cross-correlation functions between residuals of temperature and mortality, 7 days lagged for summer, 15 for cold months, and comparing its correlation coefficients., Results: We observe an increasing number of significant lags during the warm season (p < 0.05) between first and second decades studied in regional overall but with some provincial differences. In the third study period the number of significant lags varies slightly, although cross correlation coefficients were significantly upward (p < 0.05) at lag 3 in the entire region and Toledo in particular., Conclusions: Maximum temperature and mortality by organic cause association became more extensive and intense since 1975-1984 decade in Castile-La Mancha. The aging of regional population could offset the probable beneficial effect of economic growth on this relationship. No appreciable time trends are found in cold months.

Background: Numerous articles relate atmospheric variables to health indicators. In large regions, such as Castilla-La Mancha, it may be necessary to divide the region into areas in terms of the atmospheric variables available by selecting a representative weather station for each zone. This article focuses on analyzing the daily temperature data from numerous Castilla La Mancha observatories and reducing the number thereof to a few representative stations for being used in studies relating atmospheric variables to health indicators in this region., Methods: Castilla-La Mancha weather stations were selected in terms of the number of years available and missing data. After filling in the gaps in the selected series, to detect any possible discontinuities and to homogenize the series, the daily temperature data is used in hierarchical cluster and factorial analyses by principal components., Results: Factorial analyses extract one single factor by using the maximum, mean or minimum temperature series. For the maximum temperatures, this factor explains 93.45% of the variance, with an eigenvalue of 39.249. The "Compuesta" station in Toledo shows correlation coefficients in the principal components matrix of 0.987, 0.991 and 0.981 respectively for the maximum, mean and minimum temperature series., Conclusions: Castilla-La Mancha is an isoclimatic region in terms of the temperature, the "Compuesta" station in Toledo being selected as the representative station for the region for public health studies. The results afford the possibility of conducting studies broken down into small units such as the provinces, with the stations in the government capitals as a reference.

Background: Smoking is an important public health problem and is one of the main avoidable causes of morbidity and early mortality. The aim of this work was to describe the mortality attributable to tobacco consumption in Castilla la Mancha between 1987 and 1997., Method: Deaths in relation to age, sex and cause of death were obtained from the Death's Register of Castilla la Mancha. From the National Health Surveys of 1987 and 1997, the percentages of non-smokers, smokers and ex-smokers in the population in relation to age and sex were recorded. The relative risks of death were obtained from the Cancer Prevention Study II, carried out in the United States. The proportion of deaths attributable to smoking was calculated for each year, and according to sex and age group, from the etiological fraction of the population. Likewise, loss of potential life in years and the mean number of years of potential life lost were also calculated., Results: During the study period, 18% of all the deaths in Castilla la Mancha can be attributed to tobacco consumption. Mortality is higher in males than in females, and the most important diagnostic categories were tracheobronchopulmonary cancer (24.3%) in males and diseases of the cardiovascular system (24.28%) in females. These were also the conditions most responsible for years of potential life lost., Conclusions: Every day, in Castilla la Mancha, 8 people die from smoking-related conditions. The measures currently in practise to control tobacco consumption are insufficient.