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Background: Influenza is a seasonal infection with a huge impact on morbidity and mortality in older adults, for whom vaccination is recommended. New influenza vaccines for this population have been introduced in Spain in the past 5 years, and a number of cost-effectiveness analyses (CEA) have been published to aid healthcare decision-making. The objective of this study was to assess possible sources of uncertainty in the CEAs of influenza vaccines for the older adults in Spain., Methods: A systematic review was performed to identify Spanish CEAs published since 2016. Potential sources of structural, methodologic and parametric uncertainty in CEA results were systematically analysed using the TRansparent Uncertainty ASsessmenT (TRUST) Tool, quality assessment checklists, and the WHO guidance on economic evaluations of influenza vaccine strategies. The primary sources of efficacy/effectiveness were analysed in depth to ascertain whether they could support the conclusions of the respective CEAs., Results: Seven CEAs were included. Overall, they were designed and performed in accordance with the applicable guidelines; however, some critical sources of uncertainty were detected, mainly: (1) the choice and use of efficacy/effectiveness data (real-world single season studies, meta-analyses including studies with high risk of bias and/or high heterogeneity with biased interpretation); (2) use of fewer than 5 seasons to estimate influenza burden; (3) generalized use of influenza-like illness data to estimate effectiveness and burden, among others., Conclusions: Seemingly well-designed studies may conceal important sources of uncertainty that affect the results. This must be taken into account when interpreting results to support decision-making., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval does not apply to this study because there are no patients involved. Consent for publication: Not applicable, no personal data have been included in the publication. Competing interests: ROLL has received fees for academic services and grants to attend international meetings from Abbot, CSL, GSK, Moderna, MSD, Novavax, Pfizer, Roche and Sanofi. JDD reports personal fees/grants from GSK, Sanofi Pasteur and MSD and nonfinancial support from Sanofi Pasteur and MSD. AGM has received grants paid to his institutions by Sanofi, GSK, and Pfizer. He has also received personal consulting fees from Sanofi, MSD, and Moderna, as well as for lectures and congress presentations from GKS, HIPRA, Astra-Zeneca, Novavax, Pfizer and Jannsen. He has received support for attending meetigs/travel by Pfizer, MSD, GSK, and Sanofi. Finally, he declares having participated in safety monitory boards for Pfizer, Hipra and Novavax. ERM has participated in advisory boards, conferences, courses and lectures organized by Glaxo SmithKline, Sanofi Pasteur, MSD, GSK, Seqirus, Pfizer, Moderna, Takeda, and AstraZeneca. She has also participated in data safety or advisory boards from Pfizer, Sanofi, MSD, Moderna, Takeda and GSK. FMT has received honoraria and/or reimbursement for participation fees/travel expenses from GSK, Pfizer Inc, Sanofi Pasteur, MSD, Seqirus, Biofabri, and Janssen for taking part in advisory boards and expert meetings and for acting as a speaker in congresses outside the scope of the submitted work. He has also acted as principal investigator in randomized controlled trials sponsored by the above-mentioned companies as well as by Ablynx, Gilead, Regeneron, Roche, Abbott, Novavax, and MedImmune, with honoraria paid to his institution. JMAP declares having received consulting fees from Sanofi. JLLBC, PIPJ and JMFA are employees of Sanofi and may hold shares and/or stock options in the company., (© 2025. The Author(s).)

Background: Childhood overweight and obesity is a global concern and has increased in Spain over the last decades. Combinations of lifestyle behaviors (i.e., diet, sleep, and sedentarism) are highly related to weight status. Therefore, this study aimed to identify lifestyle patterns among children from Madrid City, and analyze associations with the prevalence of overweight, obesity, and abdominal obesity, considering socio-economic factors., Methods: A cross-sectional analysis was conducted on 4545 children from the ENPIMAD study with data on diet, sleep, anthropometric, and socio-economic variables. K-means cluster analysis was used to identify lifestyle clusters, and logistic regressions were used to examine the associations between socio-economic indicators and cluster membership, and between clusters and weight status., Results: Findings show three lifestyle clusters (healthy, mixed, and unhealthy), with boys and older children more represented in the unhealthy cluster. Food insecurity and low socio-economic status were associated with unhealthier clusters in boys and girls. Children in unhealthier clusters were more likely to have obesity and abdominal obesity. However, these associations disappeared in girls after controlling for food insecurity., Conclusion: These results provide insight into the combination of behaviors and socio-economic factors associated with childhood obesity that may aid in the design of future interventions.

Background: Mammographic density (MD) is the most important breast cancer biomarker. Ambient pollution is a carcinogen, and its relationship with MD is unclear. This study aims to explore the association between exposure to traffic pollution and MD in premenopausal women., Methodology: This Spanish cross-sectional study involved 769 women attending gynecological examinations in Madrid. Annual Average Daily Traffic (AADT), extracted from 1944 measurement road points provided by the City Council of Madrid, was weighted by distances (d) between road points and women's addresses to develop a Weighted Traffic Exposure Index (WTEI). Three methods were employed: method-1 (1dAADT), method-2 (1dAADT), and method-3 (e 1d AADT). Multiple linear regression models, considering both log-transformed percentage of MD and untransformed MD, were used to estimate MD differences by WTEI quartiles, through two strategies: "exposed (exposure buffers between 50 and 200 m) vs. not exposed (>200 m)"; and "degree of traffic exposure"., Results: Results showed no association between MD and traffic pollution according to buffers of exposure to the WTEI (first strategy) for the three methods. The highest reductions in MD, although not statistically significant, were detected in the quartile with the highest traffic exposure. For instance, method-3 revealed a suggestive inverse trend (e β Q1  = 1.23, e β Q2  = 0.96, e β Q3  = 0.85, e β Q4  = 0.85, p-trend = 0.099) in the case of 75 m buffer. Similar non-statistically significant trends were observed with Methods-1 and -2. When we examined the effect of traffic exposure considering all the 1944 measurement road points in every participant (second strategy), results showed no association for any of the three methods. A slightly decreased MD, although not significant, was observed only in the quartile with the highest traffic exposure: e β Q4  = 0.98 (method-1), and e β Q4  = 0.95 (methods-2 and -3)., Conclusions: Our results showed no association between exposure to traffic pollution and MD in premenopausal women. Further research is needed to validate these findings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Over the past few years, venereal or sexually transmitted infections (STIs) have been on the rise worldwide requiring additional specialized monographic consultations to specifically treat STIs. Therefore, the Spanish Academy of Dermatology and Venereology (AEDV) Research Working Group on STIs and HIV has drafted this document with the necessary requirements in terms of infrastructure, personnel, technology, specific materials for sample collection, and needs for current therapeutic options. Strict emphasis is placed on the protection of patient privacy. A health care circuit model is outlined too. Additionally, a section has been included on contact tracking and reporting, key elements for the effective prevention and control of STIs. These clinical practice guidelines seek to establish a clinical action framework adapted to the current challenges posed by STIs and HIV in the dermatology, venereology, and multidisciplinary settings., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Emerging pollutants (EPs) include a wide array of chemical compounds, as well as some microorganisms, which presence was unknown or unmeasurable until recently, or have recently started to be considered a threat towards the environment or animal and human health. No clear or homogeneous regulations exist for their measurement or control, and efforts should be made to assess their presence and offer solutions for their safe management, as well as to achieve an optimal protection of water resources. A previous study performed by our research group thoroughly studied a wide profile of EPs in El Hierro Island (Canary Islands) for the first time. Now, we present the study of the same panel of 70 EPs in La Palma Island (Canary Islands). 14 samples were collected in 2021, at different locations in La Palma island, representing seven municipalities (Los Llanos de Aridane, Santa Cruz de la Palma, El Paso, Breña Baja, Tazacorte, Barlovento and Fuencaliente) and four installation types (Piezometers/Wells, Wastewater Treatment Plant (WWTP), Water Gallery and Water Springs). High performance liquid chromatography-mass spectrometry (HPLC-MS) was performed to analyse the EP array, which included five chemical families: UV filters, UV blockers/stabilizers, parabens, Pharmaceutical Active Compounds (PhACs) and pesticides. Subsequently, a comprehensive descriptive and statistical analysis, including different tests was performed on the data obtained. Heterogeneous concentration levels of the EPs studied were found based on municipality and installation type among the island, with some of the PhACs and UV blockers/stabilizers showing very high levels, especially at Breña Baja and wastewater treatment plants (WWTPs). It is worth noting that some of the samples comprised within the WWTPs category were collected outside the treatment plant, after water has been treated, so they should not bear dangerous concentrations of any hazardous compound. The high presence of two pesticides, imidacloprid (ranging from 68.7 to 24,896.5 ng⋅L -1 ) and acetamiprid (ranging from 1010.7 to 5168.1 ng⋅L -1 ) was worth highlighting too. In addition, three EP concentration clusters were found to virtually divide the island based on mathematical percentiles of EP mean concentrations, which can help gain more insight into the contamination status of the island and measures that could be taken for their management. Finally, a comparison between La Palma results and the profile observed at El Hierro by our research group was presented. Altogether, the study performed calls for a need to take actions towards avoiding entrance of EPs in the water cycle, and not just focusing on remediation strategies once they have reached the groundwater, freshwater or soil., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study was to describe the use of the nursing diagnosis Risk for Falls in Primary Care System of the Community of Madrid., Methods: A retrospective review of the clinical histories was carried out in 262 health centers from January 2005 to December 2015. The study population are the patients who have recorded in their electronic health record the nursing diagnosis Risk for Falls., Findings: Frequency of use of the Risk for Falls ND in the Community of Madrid was 53,340 diagnoses, increasing from 650 nursing diagnosis in 2005 to 14,695 in 2015. NOC Nursing Outcomes total identified were 109,145, which represents an average of 2.05 NOC Nursing Outcomes per diagnosis. NOC Nursing Outcomes frequently appeared as follows: Fall Prevention Behavior (35.9%), Safe Home Environment (11.3%), and Risk Control (10.5%). NIC Nursing Interventions total identified were 104,293, representing an average of 1.96 NIC nursing interventions per diagnosis. NIC Nursing Interventions frequently appeared as follows: Fall Prevention (45.9%), Environmental Management: Safety (27%), and Risk Identification (5.8%)., Conclusions: Nursing diagnosis of Risk for Falls and the care process related to this diagnosis is starting to be used by the primary care nurses of the Community of Madrid., Implication for Nursing Practice: Risk factors related to the nursing diagnosis of risk for falls identified in our study can be addressed with activities that nurses must implement to prevent falls. Nursing methodology in general and specifically the diagnosis of risk for falls must be included in guides and protocols for the prevention of falls, and its use should be promoted by primary care nurses., (© 2023 NANDA International, Inc.)

Background: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors., Methods: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV)., Results: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations., Conclusions: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Visits for skin conditions are very common in pediatric primary care, and many of the patients seen in outpatient dermatology clinics are children or adolescents. Little, however, has been published about the true prevalence of these visits or about their characteristics., Material and Methods: Observational cross-sectional study of diagnoses made in outpatient dermatology clinics during 2 data-collection periods in the anonymous DIADERM National Random Survey of dermatologists across Spain. All entries with an International Classification of Diseases, Tenth Revision code related to dermatology in the 2 periods (84 diagnoses) were collected for patients younger than 18 years and classified into 14 categories to facilitate analysis and comparison., Results: In total, the search found 20 097 diagnoses made in patients younger than 18 years (12% of all coded diagnoses in the DIADERM database). Viral infections, acne, and atopic dermatitis were the most common, accounting for 43.9% of all diagnoses. No significant differences were observed in the proportions of diagnoses in the respective caseloads of specialist vs. general dermatology clinics or public vs. private clinics. Seasonal differences in diagnoses (January vs. May) were also nonsignificant., Conclusions: Pediatric care accounts for a significant proportion of the dermatologist's caseload in Spain. Our findings are useful for identifying opportunities for improving communication and training in pediatric primary care and for designing training focused on the optimal treatment of acne and pigmented lesions (with instruction on basic dermoscopy use) in these settings., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

The introduction of invasive birds into new ecosystems frequently has negative consequences for the resident populations. Accordingly, the increasing population of monk parakeets ( Myiopsitta monachus ) in Europe may pose a threat because we have little knowledge of the viruses they can transmit to native naïve species. In this study, we describe a new dependoparvovirus detected by metagenomic analysis of cloacal samples from 28 apparently healthy individuals captured in urban areas of Madrid, Spain. The genomic characterization revealed that the genome encoded the NS and VP proteins typical of parvoviruses and was flanked by inverted terminal repeats. No recombination signal was detected. The phylogenetic analysis showed that it was closely related to a parvovirus isolated in a wild psittacid in China. Both viruses share 80% Rep protein sequence identity and only 64% with other dependoparvoviruses identified in Passeriformes, Anseriformes, and Piciformes and are included in a highly supported clade, which could be considered a new species. The prevalence was very low, and none of the additional 73 individuals tested positive by PCR. These results highlight the importance of exploring the viral genome in invasive species to prevent the emergence of novel viral pathogenic species.

Objective: Patients with addiction are a vulnerable group in which there is little data on the infection and severity of COVID-19. The objective of this study was to analyze the seroprevalence against SARS-CoV-2 in users in treatment for addictions in Madrid and to describe the factors related to the infection in this group., Methods: Cross-sectional descriptive study (June-October 2020), in a non-probabilistic sample of 473 patients with Substance Use Disorder, from the 8 Addiction Care Centers (CAD) of the Madrid City Council. Their demographic, habits and health characteristics, IgM and IgG for SARS-CoV-2, previous PCR, presence of symptoms, contact with COVID-19 cases were described, and multivariate analysis was performed using binary logistic regression., Results: 5.1% of the users had positive serology for SARS-CoV-2 (5.8% in men and 2.7% in women). The patients with the highest percentage of seropositivity were between 50-59 years old (8.3%), being the most prevalent main substance consumed alcohol (7.4%). Having a previous positive CRP showed a significant odds ratio (OR) regarding being seropositive in the frequentist analysis., Conclusions: The highest seroprevalence rate occurred among men, epidemiologically known factors being the ones that showed the greatest strength of association. The CAD seropositive user profile was a man at the age of 50, an alcohol user and without comorbidities. No characteristic related to substance use was found to justify the difference in risk of infection with the general population., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: The humanitarian response to a cholera outbreak in a complex international crisis requires guaranteeing minimum conditions so that normalcy can be restored. Basic responses to a cholera outbreak include water and sanitation. The general objective of this systematic review was the analysis of the current evidence that addresses the effectiveness of different WASH measures to control cholera., Methods: A review and analysis of the literature available in the main databases (PubMed, WoS and Scopus) and in a specific meta-search engine for humanitarian aid was carried out (reliefweb.int). Based on the establishment of the PICO research question " Can beneficiaries of humanitarian aid benefit from water, hygiene and sanitation interventions for cholera reduction? ", the identification of keywords and databases to carry out the searches, as well as a selection process based on the established eligibility criteria: being studies in both English and Spanish where the WASH intervention was clearly defined, studies where health outcomes of cholera were presented, or data related to the function and use of the WASH intervention, was established., Results: The initial search provided 17,185 documents susceptible of analysis that were screened using the search criteria, up to 22 references that were read in full text and the 11 that were finally analyzed. These were coded based on the measures set out in their protocols, on the interventions carried out in the improvement of water and its supply, the improvement of sanitation, the measures aimed at better hygiene and those that evaluated the complete WASH intervention., Conclusions: All the measures offered positive results, their effectiveness was conditioned by the education of the beneficiaries, the simplicity of the activities and the involvement of local actors.

Objective: The advance of the pandemic in the large cities of the world with great virulence and the apparent heterogeneous distribution by factors of vulnerability, led us to propose this work. The objective of this study was to relate COVID-19 infection rates to the social vulnerability of the city of Madrid by district, in two different episodes, spring 2020 and summer 2020., Methods: Analytical cross-sectional study. Taking sociodemographic data of the entire population of the city of Madrid between the months of April and October 2020, together with the cumulative incidence rates of COVID-19, a linear regression analysis, correlation and factor analysis was carried out, relating the cumulative incidence rate of COVID-19 and the vulnerability indicator of the districts of the city of Madrid., Results: The results showed important differences between the two episodes of the pandemic: on one hand, the first had more relationship with health factors, while in the second, a relationship appeared with the groups of greater social vulnerability, territorially located in the South-East of the City and related in this case to social factors rather than health. Thus we see that the TIA x 100,000 in the first episode in Chamberí and Usera -two extreme districts in vulnerability- were 896 and 843 cases respectively, while in the second they were 3,708 and 6,258 cases., Conclusions: The territorial differences in the city become evident with the arrival of a generalised, universal event such as COVID-19, where vulnerability increases for everyone, with greater repercussions in those territories where it already had an impact., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: The normal ageing process is accompanied by immunosenescence and a progressive weakening of the immune system. High-dose inactivated influenza quadrivalent vaccine (HD-QIV) has shown greater immunogenicity, relative efficacy, and effectiveness than the standard-dose inactivated quadrivalent vaccine (SD-QIV). The aim of the study was to assess the cost-utility of an HD-QIV strategy compared with an adjuvanted trivalent inactivated vaccine (aTIV) strategy in the population above 65 years of age in Spain., Methods: We evaluated the public health and economic benefits of alternatives by using a decision-tree model, which included influenza cases, visits to the general practitioner (GP), visits to the emergency department (ED), hospitalisations, and mortality related to influenza. We performed deterministic and probabilistic sensitivity analyses to account for both epidemiological and economical sources of uncertainty., Results: Our results show that switching from aTIV strategy to HD-QIV would prevent 36,476 cases of influenza, 5,143 visits to GP, 1,054 visits to the ED, 9,193 episodes of hospitalisation due to influenza or pneumonia, and 357 deaths due to influenza - increasing 3,514 life-years and 3,167 quality-adjusted life-years (QALYs). Healthcare costs increase by €78,874,301, leading to an incremental cost-effectiveness ratio (ICER) of €24,353/QALY. The sensitivity analysis indicates that the results are rather robust., Conclusion: Our analysis shows that HD-QIV in people over 65 years of age is an influenza-prevention strategy that is at least cost-effective, if not dominant, in Spain. It reduces cases of influenza, GP visits, hospitalisations, deaths, and associated healthcare costs., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [ER reports other from SANOFI PASTEUR, during the conduct of the study; and I have received fees as a consultant / adviser and / or speaker, as well as a scholarship to attend lectures or courses by Sanofi Pasteur, MSD, Merck, Pfizer. AG has received funding for scientific consultancy and speaker fees from Sanofi Pasteur. GD, JLLB, JMG, HB and FPA are employees of Sanofi Pasteur. DC is an employee of IQVIA consulting, which received funding from Sanofi Pasteur to conduct the analysis.]., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The preventive measures to be taken in the face of a new epidemic require knowledge of the number of infected and which groups are most vulnerable. To know the cumulative incidence of COVID-19 in the city of Madrid and its 21 districts in the first 4 months of the epidemic and its relationship with some socioeconomic and demographic variables., Methods: Cross-sectional ecological study (39,270 cases). The 39,270 cases diagnosed from the beginning of the pandemic until June 26, 2020, published by the Comunidad de Madrid in were studied. In the districts, the distribution of gross and fair incidence is related to the ones of the independent variables (Municipal Statistics and Estudio de Salud 2018, Madrid Salud). The Incidence and the r and r 2 coefficients, obtained with the factors and the Multiple Linear Regression (MLR) model, are studied., Results: The city of Madrid presents a cumulative incidence of COVID-19, which is double the national one (100), with a Standardized Cumulative Incidence Ratio (RIAE) of 204.59 per 100. The districts with the most RIAE were those in the southeast, all>240 per 100. In the districts, the per capita household rate, the per capita income, and the mortality rate from infectious diseases in men reached high and inverse correlations with RIAE (all r>-0.3). The RLM model with these 3 indicators predicts 30% of the RIAES., Conclusions: The relationship between material wealth and the risk of COVID-19 infection is inverse. The knowledge in the districts of per capita income, household rate and mortality rate due to infectious diseases in men reduces the uncertainty about the accumulated incidence by 30%., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: To describe the professional training health professionals receive in community health engagement in Spain., Method: The identification and descriptive analysis of trainings developed between 2013-2018 offered by public universities, public administrations and the teaching units for the specialization of family and community health doctors and nurses., Results: Twenty eight trainings were included in the descriptive analysis. Most of them had been organized during 2018 in eight Autonomous Communities. Two of them were organized at a national level. Most trainings were attendance based and have been developed by teaching units in charge of training doctors and nurses specializing in family and community health, with an average duration of 10-25hours and no enrolment costs., Conclusion: There is a lack of training in community health engagement in the majority of autonomous communities in Spain which shows that it is scarce and not yet fully integrated in the training of health professionals. The trainings that have been analyzed are mainly part of wider specialization programs for doctors and nurses specializing in family and community health, and even so this training is not standardized and included in the specialization programs of all the Spanish regions. To develop a comprehensive health approach it is key to include community health engagement as part of the trainings professionals receive during their University degree, and to extend it to other health professions. The institutions responsible for the training of health professionals should include community health engagement as part of the different training itineraries of professionals., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective : To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods : A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results : Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions : Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.

Objective: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid., Methods: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05., Results: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity., Conclusions: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Purpose: Quadrivalent influenza vaccine (QIV) includes the same strains as trivalent influenza vaccine (TIV) plus an additional B strain of the other B lineage. The aim of the study was to analyse the public health and economic impact of replacing TIV with QIV in different scenarios in Spain., Methods: A dynamic transmission model was developed to estimate the number of influenza B cases prevented under TIV and QIV strategies (<65 years (high risk) and ≥65 years). This model considers cross-protective immunity induced by different lineages of influenza B. The output of the transmission model was used as input for a decision tree model that estimated the economic impact of switching TIV to QIV. The models were populated with Spanish data whenever possible. Deterministic univariate and probabilistic multivariate sensitivity analyses were performed., Results: Replacing TIV with QIV in all eligible patients with current vaccine coverage in Spain may have prevented 138,707 influenza B cases per season and, therefore avoided 10,748 outpatient visits, 3,179 hospitalizations and 192 deaths. The replacement could save €532,768 in outpatient visit costs, €13 million in hospitalization costs, and €3 million in costs of influenza-related deaths per year. An additional €5 million costs associated with productivity loss could be saved per year, from the societal perspective. The budget impact from societal perspective would be €6.5 million, and the incremental cost-effectiveness ratio (ICER) €1,527 per quality-adjusted life year (QALY). Sensitivity analyses showed robust results. In additional scenarios, QIV also showed an impact at public health level reducing influenza B related cases, outpatient visits, hospitalizations and deaths., Conclusions: Our results show public health and economic benefits for influenza prevention with QIV. It would be an efficient intervention for the Spanish National Health Service with major health benefits especially in the population ≥65-year., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: PC has received scientific consultancy from Sanofi Pasteur. ER has received funding for scientific consultancy and speaker fees, as well as congress attendance grants from Sanofi Pasteur, GlaxoSmithKline, Merck Sharp and Dohme and Pfizer. JD has received funding for scientific consultancy and speaker fees from Sanofi Pasteur and Seqirus. RO has received funding for scientific consultancy and speaker fees from Sanofi Pasteur, GlaxoSmithKline and Seqirus. FM and his institution have received funding for consultancy and research and speaker fees from Sanofi Pasteur, GlaxoSmithKline, Merck Sharp and Dohme, Pfizer, Astrazeneca, Janssen, Seqirus and Ablynx. AG has received funding for scientific consultancy and speaker fees from Sanofi Pasteur, GlaxoSmithKline, Merck Sharp and Dohme y Pfizer. JLLB, FPA and HB are employed by the commercial Sanofi Pasteur. MS is employed by the commercial IQVIA and works in consultancy projects with Sanofi Pasteur and other Pharmaceutical Companies. JLLB, FPA, HB and MS were involved in the design of the study, data collection and the decision to publish the results. The manuscript was reviewed by the study sponsor prior to submission. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products to declare.

Objective: Territoriality is configured as an important axis of inequality. The objective of this study was to determine the level of association between territory and vulnerability, specifying proposals for territorial intervention using key socio-health indicators., Methods: Analytical cross-sectional study, which combined the analysis of the Health Survey Madrid City 2017 (n=9,513) and the vulnerability-ranking indicator of the same year (n=2,780,197), popu-lation of the city of Madrid in 2017, from the Data Bank of the Madrid City Council), prepared with the hierarchical analysis technique. Sociodemographic and health variables were included, such as self-perception of health status, quality of life in relation to health, tobacco consumption, alcohol, obesity, sedentary lifestyle and mental health (GHQ-12). The relationships were assessed with DE, 95% CI, Spearman correlation, B and β coefficients of multiple linear regression and the pair-point technique., Results: The links between health and vulnerability were: in health-self-perceived and HRQL, as global health variables, p<0.01 for women with territory and vulnerability; sedentary lifestyle for both sexes, was interpreted with 60-80% by territory and vulnerability; obesity was slightly linked to the te-ritory in women and explained 77%; mental health was not territorially related for the group, but it was significantly related to women, due to 64% of the variance; in tobacco there was a significant territorial link in men and vulnerability in 57%; finally, alcohol had a significant difference in men at the territorial level and explained in 72% in both sexes, inverted., Conclusions: The results support the behavior of global and specific health indicators with vulnerability, with a disaggregation by sex, which will allow planning adapted to the territory., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Feral pigeons have increased in urban settings worldwide becoming a potential health risk for humans and other animals. Control and surveillance programs are essential to prevent the possible transmission of zoonotic pathogens carried by pigeons. A surveillance program was carried out in Madrid City (Spain) during 2005-2014 to determine the role of urban pigeons as carriers of zoonotic agents comparing these results with studies performed elsewhere in the last fifteen years. A total of 1372 pigeons were randomly captured and tested for detection of Antimicrobial susceptibility and genetic heterogeneity of Campylobacter and Salmonella isolates were determined. During the first phase (August 2005-July 2010), 428 animals were analyzed individually, while in the second period (August 2010-December 2014), 944 pigeons were analyzed in pools (n = 2-3 in 2010 and n = 5-6 in 2013 and 2014). The most prevalent pathogen during the first phase was Campylobacter spp., (6.57%, 95% confidence interval 3.05-12.10%) followed by Salmonella spp. (4.41%, 95% CI: 2.30-7.58%) and C. psittaci (2.56%, 95% CI: 0.70-6.53%)]. The PCR techniques, used during the 2010-2014 phase of the study, confirmed the presence of Campylobacter spp. (prevalence of 0-14.83%) and C. psittaci (0-12,94%) among pigeons of Madrid. Antimicrobial susceptibility testing suggested low levels of resistance. Presence of zoonotic agents in feral pigeons highlights the importance of surveillance programs on this species, although the relative low prevalence found suggests a limited risk to Public and Animal Health in Madrid., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Subjective memory complaints (SMC) are considered predictor of cognitive impairment, but are also associated with other factors; social and lifestyle have been the least studied., Aim: To evaluate SMC and their association with epidemiological, health, social and lifestyle variables., Subjects and Methods: Cross-sectional epidemiological study of the randomly selected population of Madrid. Telephone interview., Target Population: 1,775 over 55 years of age. We asked about QSM, social, economic, health and lifestyle aspects. The Goldberg General Health Questionnaire (GHQ) and the COOP-Wonca Quality of Life Questionnaire were administered., Results: We found statistically significant association of SMC with age, temporal orientation, all variables related to mental health (depression), anxiety, sleep, mental health/GHQ, and quality of life. Association was found with all pain variables and with loneliness. There was no association with specific diseases, except chronic allergy and those linked to pain. The predictors of the SMC were temporal orientation, multimorbidity, mental health/GHQ, anxiety, pain and feeling lonely., Conclusions: SMC is a multi-caused symptom. They are associated with lower memory performance, but also with variables related to health, social aspects and lifestyle. When faced with a patient with SMC, which may be due to cognitive impairment because of Alzheimer's disease, these associations should be taken into account to assess this risk and know when follow-up is most needed.

The role of vitamin D in mammographic density is still unclear. This study examines the association between serum 25-hydroxyvitamin D (25(OH)D) and mammographic density, overall and by specific women characteristics. DDM-Madrid is a cross-sectional study that recruited 1403 premenopausal women in a breast radiodiagnosis unit of Madrid City Council. Information was collected with a questionnaire and plasma 25(OH)D was measured by solid-phase extraction on-line coupled to liquid chromatography-tandem mass spectrometry. Percent mammographic density was assessed using a semi-automated computer tool (DM-Scan). Multivariable linear regression models were used to quantify the associations, categorizing 25(OH)D levels (nmol/L) into 3 groups according to the cut-offs established by the US Endocrine Society. Models were adjusted for age, education, body mass index, age at menarche, parity, previous breast biopsies, family history of breast cancer, physical activity, energy intake, use of corticoids, hypercholesterolemia and day of sample extraction. Mean serum 25(OH)D level was 49.4 + 18.9 nmol/L. Women with sufficient concentrations of 25(OH)D showed a slight decrease in mammographic density (β >75nmol/L =-3.40; p = 0.037). No differences were observed according to women characteristics except for parity, where the protective effect of 25(OH)D was only seen among nulliparous (β >75nmol/L =-13.00; p-heterogeneity = 0.006). In light of the protective effect of vitamin D on mammographic density and the high prevalence of vitamin D insufficiency in our population, improving these levels could be an effective measure for the prevention of health problems related to the lack of this essential vitamin., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice., (Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Municipalities and local government are an essential element to promote public policies that improve people's health, and impact the social determinants of health, through developing approaches which incorporate equity, community engagement and intersectoral partnership at their core. The objective of this article is to analyze the barriers and opportunities that can be encountered within local governments when interventions aimed at improving people's health are developed and implemented. The evolution of the city councils, their competence frameworks and the current socio-political context are described, and three key tools for local action are proposed: intersectorality, community engagement and working in partnership with other administrations. Global strategies such as the implementation of the "community health" and "health in all policies" approach through cross-sectoral networks/partnerships are described, emphasizing the importance of developing formal and informal structures or processes of community engagement and designing local health action plans in cooperation with other administrations, such as regional and national governing bodies. To continue supporting these forms of local governance, we propose adapting the local administrations to the new social realities, with more horizontal and flexible organization models and resource allocation, integrating efficiency and evaluation processes, reclaiming local autonomy, and building local governance through networks and alliances., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Four voices from around Spain discuss community health and networks. These voices understand that the networks are systems formed by interconnected people, with a common interest, that provide support. Networks require a common place and time, in order to generate trust and respect for horizontal work. Thus, networks are appropriate structures for health promotion, facilitating the exchange of knowledge, collaboration and innovation through the participation of those who form them. It is important that networks are evaluated by analysing their autonomy, leadership, quality of links, training, network projection, capacity for integrating groups and synergy., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The measurement of the health-related quality of life (HRQoL) is a comprehensive way to estimate the health of both the individual and the community. The aim of this study was to assess changes in health and HRQoL using the intervention strategies «healthy people» and «health promotion programs» of the City Council of Madrid-Madrid Health. The study was conducted in the Municipal Health Centre of Ciudad Lineal, in 2014, and included promotion of exercise, healthy eating, smoking cessation, psycho-hygiene, memory training, and health education for the elderly, with group interventions., Material and Methods: A before and after community trial, with the administration of questionnaire with COOP/WONCA HRQoL charts to 200 participants., Results: The study population (n=87), included those who completed the first and second questionnaire. Positive changes were seen in the overall before and after COOP/WONCA scores, with a mean change from 23.16 to 21.94, with statistical significance, p≤0.002. In the psychology groups, it changed from 28.14 to 23.57 with a p≤0.05, and healthy eating from 22.81 to 20.85, with p≤0.03. In the health education groups it changed from 21 to 20.81 points, and in memory training from 23.31 to 22.45 points (both without significance)., Conclusions: The significant improvement in scores reflects a positive change in self-perceived health of this community after the intervention and proper operation of programs. The areas directly related to health and interventions in psychology and nutrition-exercise, are those with the most significant changes., (Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The Prefrontal Symptoms Inventory (PSI) is a self-reported questionnaire, created in Spain, which asks about cognitive, emotional and behavioural alterations in activities of daily living and which can be applied in both the general population and in multiple clinical populations. There is a shorter 20-item version (PSI-20) with excellent psychomotor properties for screening., Aim: To study the convergent and divergent validity of the PSI and PSI-20, by analysing how their scales reflect the day-to-day consequences of real deficits found in neurological assessment performed by means of performance tests., Patients and Methods: A sample of 52 persons undergoing treatment for substance addiction (31 males and 21 females) were administered the PSI together with an abbreviated neuropsychological examination battery focused on describing attentional, mnemonic and executive processes., Results: Both versions of the PSI present optimal psychometric properties (0.78 > alpha > 0.94 for the complete 46-item version and 0.7 > alpha > 0.89 for the abbreviated 20-item version). The results confirm the hypotheses regarding their validity: the performance problems scale is related with the capacity to resolve tests that supposedly rate the executive functions of a prefrontal origin (convergent validity), whereas the scales of problems in emotional control and problems with social behaviour are not related with those cognitive capabilities (discriminant validity)., Conclusions: The PSI is a test that is clinically useful, psychometrically valid and applicable in multiple clinical populations.

Leishmaniasis is one of the most important neglected zoonosis and remains endemic in at least 88 developing countries in the world. In addition, anthropogenic environmental changes in urban areas are leading to its emergency world wide. Zoonotic leishmaniasis control might only be achieved by an integrated approach targeting both the human host and the animal reservoirs, which in certain sylvatic cycles are yet to be identified. Recently, hares have been pointed out as competent reservoirs of Leishmania infantum in Spain, but the role of other lagomorphs has not been clarified. Here, 69 rabbits (Oryctolagus cuniculus) from a natural area in Madrid in which a high density was present were analyzed using indirect (immunofluorescence antibody test, IFAT) and direct (PCR, culture) techniques. Fifty-seven (82.6%) of the animals were positive to at least one technique, with IFAT yielding the highest proportion of positive samples. L. infantum was isolated in 13% animals demonstrating the occurrence of infection in this setting. Our results suggest that rabbits could play a role of competent reservoir of L. infantum and demonstrate that the prevalence of infection is high in the analyzed area.

Introduction: One of the tests that is mostly widely used to evaluate aphasia in clinical practice is the Boston Naming Test (BNT), a classic test in which 60 black and white pictures are presented to subjects in order to evaluate their capacity to put a name to such pictures. Despite its psychometric goodness, the number of items in the test has to be reduced in order to lower the time required to apply it., Subjects and Methods: Researchers recruited a sample of 547 subjects over the age of 65, who were then administered a neuropsychological evaluation protocol, including the BNT, to determine their cognitive statuses. No relevant cognitive alterations were observed in 405 subjects versus 142 who were diagnosed with mild cognitive impairment., Results: The number of items was reduced in accordance with the premises of the item response theory. Since both age and level of schooling were found to have a significant effect on performance in the test, the two variables were used to find the cut-off points of the shortened version. This new version presented an adequate degree of reliability (alpha = 0.765) and a high correlation with the original test (r = 0.876)., Conclusions: The new shortened version consists of 15 items that are ordered according to the degree of difficulty. It is a task with a high level of discriminating power that is useful in day-to-day clinical practice for detecting alterations in the language of the elderly.

Background: Know what factors determine the poor mental health in the city of Madrid., Material and Methods: Cross-sectional study Health Survey of the City of Madrid (ESCM'05), analyzed 5746, persons aged 16 to 64 years, in the years 2004-2005. Dependent variable was obtained from the General Health Questionnaire (GHQ-12), was considered score above 2. Independent variables included sociodemographic factors, lifestyle, health and environmental issues. The quality of life related to health (HRQOL) was measured with the questionnaire COOP / WONCA., Results: The overall prevalence of poor mental health was 19.2%, p <0.05 for gender, age group 16 to 24 years and lower social classes. The predictors most strongly associated with poor mental health in the multiple regression are: women OR=1.48 (1.23-1.78), minors OR=3.21 (2.40-4.29), immigrant economic OR=1.33 (1.06-1.68), smoking or drinking alcohol OR=1.22 (1.02 -1.49) and 1.31 (1.09 -1.57), chronic disease OR=1.47 (1.21 -1.79), sleeping less 8 hours OR=1.41 (1.17 -1.68), having fair or poor health status perception OR=1.65 (1.22-2.22), self-perceived poor quality of life HRQOL OR=1.18 (1.15-1.22), and limited social activities OR=1.34 (1.07 -1.69) ., Conclusions: The mental health problems are highly prevalent in this city. Being woman, young, economic migrant, worse lifestyles, poor quality of life refered or limited social activities are the factors that force to explain the association with poor mental health.

The present research adapted the Strategic Approach to Coping Scale (SACS), developed by Hobfoll and colleagues, to the Spanish population. SACS is an instrument derived from Hobfoll's Conservation of Resources Theory, which emphasises the contribution of social factors to coping processes. This instrument assesses coping strategies in 9-subscales, organised in three dimensions: orientation to the problem (active/passive), use of social resources (prosocial/antisocial), and orientation to others involved (direct/indirect). The Spanish version, administered to a non-clinical sample (N= 767), found 7-subscales structured in prosocial/antisocial, active/passive and reflexive/intuitive dimensions, with adequate reliability and construct validity. To conclude, the Spanish SACS is a potentially useful and reliable instrument for research and clinical purposes, mainly in areas in which social components need to be explicitly considered.

Introduction: There is a rich body of literature on the coexistence of diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and substance abuse/dependence. Prevalence, however, varies considerably from one work to another., Aims: To apply an algorithm that takes into account all the criteria needed to reach an adequate diagnosis and to explore the conditions associated with false positives., Patients and Methods: The diagnostic algorithm was applied using several tests in the different phases, i.e. the Attention Deficit Hyperactivity Disorder Self-Report Scale was used for screening, the Wender-Utah Rating Scale and the Parents' Rating Scale were administered for the retrospective diagnosis, and the self-administered Spanish version of the frontal behaviour scale and the perceived stress scale were used to study false positives. Symptoms of other axis I disorders were also explored and a battery of classic neuropsychological tests was administered. All this was carried out with a sample of 696 subjects whose treatment began in a care centre for drug addicts., Results: The final prevalence was found to be 6.89%. The symptoms of the false positives in the screening test prior to consumption were similar to those of the true negatives, but in that moment those symptoms were similar to those of the true positives, with whom no differences were found in the neuropsychological performance. Generalised anxiety disorder was the one that showed the highest relation with false positives., Conclusions: The diagnostic category of ADHD is usually utilised indiscriminately to classify subjects with early-onset neurological disorders and those who present similar manifestations following the phase of active addiction to substances. There is a need for a neurological and neuropsychological study that goes beyond the mere symptoms so as to be able to carry out a suitable characterisation and treatment of a set of similar symptomatic manifestations, but with a very wide range of developmental and aetiopathogenic components.

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 Alzheimer's 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., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background: This study sought to ascertain to what degree health-related quality of life (HRQL) in the City of Madrid was affected by each of the most frequent chronic health conditions, and the specific quality-of-life (QL) domains on which such health conditions had the greatest impact, taking co-morbidity and socio-demographic variables into account., Methods: A descriptive, analytical, cross-sectional study was conducted covering 7341 subjects aged >or=16 years in the City of Madrid. Data were collected on self-reported diagnosed morbidity, including hypertension, hypercholesterolaemia, varicose veins, diabetes, chronic asthma/bronchitis, myocardial infarction/angina pectoris, stomach problems, allergy, arthrosis/arthritis or rheumatism, depression/anxiety, cataracts, cerebrovascular accidents (CVACs), chronic constipation, osteoporosis and Alzheimer's disease or dementia. HRQL was measured using the COOP/WONCA questionnaire. The effects of diagnosis, age, social class, gender and the co-morbidity were analysed using a multivariate analysis of covariance (ANCOVA)., Results: The chronic health conditions that registered the worst overall mean scores on the COOP/WONCA questionnaire were Alzheimer's disease or dementia, Parkinson's disease, fibromyalgia, CVACs and depression, with scores of over 26 points in all cases. After the introduction of socio-demographic variables in the model, the highest values of Snedecor's F-test corresponds to depression (F = 461.63), 'arthrosis/arthritis or rheumatism' (F = 175.41), Alzheimer's disease or dementia (F = 65.70), gastric disorders (F = 65.17), cancer (F = 43.08) and CVACs (F = 41.65)., Conclusions: Depression and 'arthrosis/arthritis or rheumatism' are the two chronic health conditions, which have the greatest impact on HRQL in Madrid's citizens, therefore is mandatory to propose and implement public health strategies that would reduce the prevalence and morbidity of such disorders.

ASRS v.1.1. is a self-applied brief instrument for the screening of individuals presenting symptoms of attention-deficit/hyperactivity disorder (ADHD), and proposed by the WHO. The purpose of the present work was to test the instrument and examine the results of its application to a sample of 280 individuals in treatment for substance-related disorders (cross-sectional descriptive study). We administered simultaneously in the initial phases of treatment the ASRS v.1.1. (short form) and the MCMI-II to the full sample and the Wender Utah Rating Scale (WURS), ADHD-Rating Scale-IV and ASRS v.1.1. (complete form) to various sub-samples. Diagnostic interviews were also carried out and the psychometric properties and factorial structure of ASRS v.1.1. were explored. Good convergent validity, sensitivity, specificity and diagnostic capability were obtained for the six-item version of ASRS v.1.1., even though 4 out of 6 items did not discriminate between Axis I and II disorders assessed through the MCMI-II and diagnostic interviews. According to DSM-IV-TR criteria the estimated prevalence of ADHD in the sample of addicts was 8.2%. ASRS v.1.1. is criticized as a specific instrument for ADHD detection, since most of its items appear to measure a non-specific dimension of compulsiveness/impulsiveness, common to Axis-I and Axis-II disorders. Other criticisms made in the discussion concern the lack of specificity of DSM criteria and the confusion they generate among the concepts of symptom, sign and trait (including the impact on study results), the general use of the A criterion but the omission of the B, C, D and E criteria of the DSM category, differences in samples (with regard to both severity and selection criteria), and the artifactual increases in prevalence found in many studies.

This paper analyses the relationship between extreme temperatures and mortality among persons aged 45-64 years. Daily mortality in Madrid was analysed by sex and cause, from January 1986 to December 1997. Quantitative analyses were performed using generalised additive models, with other covariables, such as influenza, air pollution and seasonality, included as controls. Our results showed that impact on mortality was limited for temperatures ranging from the 5th to the 95th percentiles, and increased sharply thereafter. During the summer period, the effect of heat was detected solely among males in the target age group, with an attributable risk (AR) of 13.3% for circulatory causes. Similarly, NO(2) concentrations registered the main statistically significant associations in females, with an AR of 15% when circulatory causes were considered. During winter, the impact of cold was exclusively observed among females having an AR of 7.7%. The magnitude of the AR indicates that the impact of extreme temperature is by no means negligible.

Introduction: In the last few years, the number of immigrant families in Spain has greatly increased, which has challenged healthcare services and posed new health problems., Objectives: To determine the main social risk factors present in an immigrant population group in order to take active measures to ensure the appropriate development of children in this population., Methods: A descriptive cross-sectional study consisting of interviews with 179 foreign women with children under 1 year of age attending a public healthcare program., Results: Most of the women were from Latin America (80 %), 11 % were from Morocco, and the remaining women were from other countries. A total of 14.5 % had university studies. In general, the women worked in domestic service and only 36 % had the documents required to live in Spain. Fifty-five percent of the women had lost their jobs because of their pregnancy. Most of the families lived in apartments with an average of 2.3 people per room, and 88 % shared their residence with other people. Twenty-five percent of the women had their first child before the age of 18 years. Pregnancy was unwanted in 50 % of the women. Seventy-one percent of deliveries were normal, and 83 % of the women breast-fed their children. Ninety-eight percent of the children were correctly vaccinated and 95 % visited a pediatrician regularly., Conclusions: The immigrant population is concentrated in the most disadvantaged social strata. Measures that provide adequate social support and healthcare to this population should be established to encourage the appropriate development of their children

Objectives: We analyze the risk factors which have an influence on osteoporosis. We study the relationship between the beginning of menopause and both ponderal index and tobacco consumption., Design: A two-year long prospective study., Setting: Hortaleza Council Health Center, Madrid., Patients: 504 women who took part in the Menopause Programa from may 1994 to may of 1996. All of them have had a quantitative computerized tomography., Measurements: We analyze the following risk factors: family background, tobacco consumption, calcium intake, physical exercise and ponderial index. We studied the risk factors frequency and its relation with osteoporosis. A statistical analysis of that relation has been made. We studied the relationship between both ponderal index and the tobacco consumption and the beginning of menopause., Main Results: Every risk factor we have studied has an influence on osteoporosis. However the lack of regular physical exercise together with a lower ponderial index seem to be the most outstanding risk factors: p = 0.024 for physical exercise and p = 0.05 for ponderal index. As to the age when menopause begins we have found out that among women who smoked menopause started 1.29 years earlier (p = 0.025). Meanwhile among women with a lower Quetelet rate menopause began 0.95 years earlier., Conclusions: The risk factors we have studied have an influence on the incidence of osteopenia/osteoporosis. The longer time of amenorrhea, the bigger influence. Prevention programs should start at an earlier age in order to avoid risk factors that depend on the patients behavior. Menopause begins earlier in women who smoke and those who have a lower ponderal index.

This study presents the results of a vaccination inquire in 2,078 schoolchildren: 807 students in the first year of General Basic Education (G.B.E.) and 1,227 students in the last year of G.B.E. attending public and private schools of the Council of Madrid. The presence of antibodies against the three polio-viruses was determined in 1,509 schoolchildren. About 68.3% of the students received the complete schedule of vaccinations, with 84.7% belonging the group of children in the first year of G.B.E. and 51.2% belonging to that in the last year of G.B.E. (p < 0.01). The percentage of children immunized against the three polioviruses was 92.7%, with 94% of the students in the first year of G.B.E. being immunized and 92% of those in the last year of G.B.E. (p < 0.01). We found differences in the immunization rate between those students receiving more or less than three doses of vaccine. We compared our study with other seroepidemiologic studies undertaken in our country.

This article develops a theoretical model on Health Education on an interesting subject in the workplace: the labor accidents. It is critical considering the Health Education as a strategy based only on information and directed to the individual, and proposes a new conception of Health Education as an interdisciplinary task of environmental design very closely related with Health Promotion and work organization. This model is very useful to guide the actions of Health Education and shows a practical case: the intoxication with CO some firemen of the Madrid Council.