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The health, economic, and social impact of COVID-19 has been significant across the world. Our objective was to evaluate the association between air pollution (through NO2 and PM2.5 levels) and COVID-19 mortality in Spanish provinces from February 3, 2020, to July 14, 2020, adjusting for climatic parameters. An observational and ecological study was conducted with information extracted from Datadista repository (Datadista, 2020). Air pollutants (NO2 and PM2.5 levels) were analyzed as potential determinants of COVID-19 mortality. Multilevel Poisson regression models were used to analyze the risk of mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Models were adjusted by four climatic variables (hours of solar radiation, precipitation, daily temperature and wind speed) and population size. The mean levels of PM2.5 and NO2 across all provinces and time in Spain were 8.7 μg/m3 (SD 9.7) and 8.7 μg/m3 (SD 6.2), respectively. High levels of PM2.5 (IRR = 1.016, 95% CI: 1.007–1.026), NO2 (IRR = 1.066, 95% CI: 1.058–1.075) and precipitation (IRRNO2 = 0.989, 95% CI: 0.981–0.997) were positively associated with COVID-19 mortality, whereas temperature (IRRPM2.5 = 0.988, 95% CI: 0.976–1.000; and IRRNO2 = 0.771, 95% CI: 0.761–0.782, respectively) and wind speed (IRRNO2 = 1.095, 95% CI: 1.061–1.131) were negatively associated with COVID-19 mortality. Air pollution can be a key factor to understand the mortality rate for COVID-19 in Spain. Furthermore, climatic variables could be influencing COVID-19 progression. Thus, air pollution and climatology ought to be taken into consideration in order to control the pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11869-021-01062-2.

Background Childhood is considered the most important phase of human development; within it the period from birth to 5 years of age is particularly critical, given the speed at which changes occur. The context where children live can influence early childhood developmnent (ECD) by providing or limiting opportunities to learn, play and establish social interactions. This study explored the associations between characteristics of the urban environment and ECD in 2,194 children aged 36 to 59 months living in urban municipalities in Mexico Methods We obtained ECD information from the 2015 Survey of Boys, Girls, and Women (ENIM, for its Spanish acronym), measured with the Early Childhood Development Index. The urban environment was evaluated at the municipal level, considering variables from five environment domains: physical, social, service, socioeconomic, and governance. Multilevel logistic models were fitted to assess the association between urban environment characteristics and the inadequacy of ECD in general and by specific development domains: learning, socio-emotional, physical, and alpha-numeric. Results Inadequate ECD was inversely associated with the availability of libraries (OR = 0.55, 95% CI: 0.43, 0.72), and positively associated with population density (OR = 1.01, 95% CI: 1.01–1.02). For the specific ECD domains, inadequate socio-emotional development was inversely associated with the availability of libraries (OR = 0.66, 95% CI: 0.51, 0.85). Inadequate literacy-numeracy knowledge was associated inversely with the availability of daycare centers (OR = 0.56, 95% CI: 0.32, 0.97), and directly associated with the number of hospitals and clinics (OR = 1.87, 95% CI: 1.29, 2.72). Finally, the marginalization index was positively associated with inadequacy in the learning domain (OR = 1.80, 95% CI: 1.06, 3.03). Conclusions Some aspects of the urban environment associated with ECD, suggest that intervening in the urban context could improve overall child development. Investment in resources oriented to improve socio-emotional development and literacy (such as libraries and daycare), could foster ECD in Mexico.

Objetivos. Estimar la satisfacción con la atención en salud recibida en los establecimientos del Ministerio de Salud (MINSA) en el Perú y determinar sus factores asociados en adultos peruanos. Materiales y métodos. Estudio analítico de corte transversal empleando datos de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2018. La satisfacción con la atención en salud recibida fue calificada como: muy mala, mala, buena, y muy buena. Se describieron las características de la población en estudio mediante frecuencias y proporciones ponderadas. Para determinar los factores asociados a la satisfacción con la atención recibida, se estimó un modelo logístico ordinal generalizado. Resultados. Se incluyó un total de 14 206 adultos (población expandida: 7 684 602) que reportaron haber sido atendidos en algún establecimiento de salud del MINSA. A nivel nacional, el 74,3% de usuarios reportó una satisfacción con el servicio recibido como «bueno o muy bueno». Padecer una enfermedad crónica, tener una lengua materna nativa o vivir en aglomeraciones poblacionales mayores a 2000 personas se asoció con una menor satisfacción con la atención recibida. Vivir en la selva se asoció con un reporte de mayor satisfacción con la atención. Conclusiones. Tres de cada cuatro usuarios externos califican como buena o muy buena la atención recibida en establecimientos del MINSA. Existen subgrupos poblacionales con una menor satisfacción de la atención recibida. Incidir en la mejora de la satisfacción de estos usuarios mejoraría la calidad de la atención en el MINSA, el mayor prestador en salud en Perú.

Background: Pandemic has arised differences on COVID-19 outcomes among racial and ethnic groups. The objective was to assess differences in mortality by race and ethnic among patients with coronavirus disease 2019 (COVID-19) in the United States (US). Methods: This is a retrospective case series study with information extracted from the U.S. Centers for Disease Control and Prevention between January 20 and December, 2020. Clinical and sociodemographic data were analysed from non-hospitalized and hospitalized patients with COVID-19 by race and ethnic. Binary logistic models were fitted to evaluate factors associated with COVID-19-related mortality. Findings: A total of 434,076 patients with COVID-19 were characterised; 284,574 cases were Non-Hispanic White, 10,468 cases were Non-Hispanic Asian, 949,022 cases were Non-Hispanic Black, and 89,407 cases were Hispanic/Latino. For non-hospitalized patients, Hispanic/Latino with pneumonia (OR 3.34, 95%CI: 1.70-6.58), and Non-Hispanic Asian with comorbidities (OR 3.88, 95%CI: 0.99-15.2) had the highest odds for mortality. For hospitalized patients, Non-Hispanic Black with comorbidities (OR 3.02, 95%CI: 2.24-4.08), and Non-Hispanic Asian and Non-Hispanic Black with pneumonia (OR 2.98, 95%CI: 2.09-4.26; and OR 2.97, 95%CI: 2.60-3.38, respectively) had the highest odds for mortality. Interpretation: Racial/ethnic disparities on mortality persist among patients with COVID-19 in the US. These findings support the assertion that racial and ethnic minorities are disproportionately affected by COVID-19 in the US. Funding Information: This work did not receive funds. Declaration of Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: This study was an analysis of secondary data. The approval of an institutional ethics committee was not required.

Epidemiology of RMD Financiado para publicación en acceso aberto: Universidade da Coruña/CISUG [Abstract] Objective. Axial osteoarthritis (OA) is a common cause of back and neck pain, however, few studies have examined its prevalence. The aim was to estimate the prevalence and the characteristics of symptomatic axial OA in Spain. Methods. EPISER2016 is a cross-sectional multicenter population-based study of people aged 40 years or older. Subjects were randomly selected using multistage stratified cluster sampling. Participants were contacted by telephone to complete rheumatic disease screening questionnaires. Two phenotypes were analyzed, patients with Non-exclusive axial OA (NEA-OA) and Exclusive axial OA (EA-OA). To calculate the prevalence and its 95% confidence interval (CI), the sample design was considered and weighting was calculated according to age, sex and geographic origin. Results. Prevalence of NEA-OA by clinical or clinical-radiographic criteria was 19.17% (95% CI: 17.82–20.59). The frequency of NEA-OA increased with age (being 3.6 times more likely in patients aged 80 s or more than in those between 40 and 49 years) and body mass index. It was significantly more frequent in women, as well as in the center of Spain. It was less frequent in those with a higher level of education. Lumbar OA was more frequent than cervical OA. This difference grew with increasing age and was not associated with gender. It was also greater in overweight and obese subjects. Conclusions. This is the first study on the prevalence of axial OA phenotypes in Europe describing the associated socio-demographic, anthropometric, and lifestyle variables. Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. EPISER2016 was supported by Celgene, Gebro Pharma, Merck Sharp & Dohme in Spain, Pfizer, and Sanofi-Aventis, none of whom had any role in the study design, data collection, data analysis, interpretation, or writing of this manuscript. MS was financed via the Rio Hortega Contract—Health Research Fund (CM17/00101), the Sanitary Research Fund integrated in the National Plan of Scientific Program, Technological Development and Innovation 2013–2016 and funded by the ISCIII-Subdirectorate General Evaluation and Promotion of Research-European Regional Development Fund (ERDF) "A way of making Europe"

Objectives: The aim of this study was to assess potential environmental factors associated to COVID-19 mortality in children and adolescents in Mexico. Methods: This cross-sectional study analyzed the official data of 131,001 children under 10 years of age and adolescents between 10 and 19 years of age with COVID-19 disease, in Mexico diagnosticated between March 2020 and June 13, 2021. The environmental variables such as malnutrition, vaccination coverage and social lag index were evaluated at entity level. Multilevel models were fitted to evaluate the association between contextual factors and Covid-19 mortality. Results: A total of 773 (0.6%) children and adolescents died due to COVID-19. Younger patients (OR= 0.874), immune-mediated disease (OR= 1.022, CI95% 1.007-1.037) and obesity (OR= 3.144, CI95% 2.444-4.045) were associated with mortality. Other comorbidities were no associated with fatality. Social Lag Index was positively associated to COVID-19 mortality (ORvery high = 2.886). Children and adolescents with different malnutrition levels showed a high risk of COVID-19 mortality (ORsevere = 1.436; ORmoderate = 1.412; ORmild = 1.404; ORsevere+moderate+mild = 1.421; ORsevere+moderate = 1.438). A low education level was associated with a higher risk of COVID-19 fatality, incomplete education (OR = 1.046, CI95% 1.010-1.082), children of school age of 6-14 years who do not attend school (OR = 1.275, CI95% 1.034-1.572) and population aged 15 and over that are illiterate (OR = 1.087, CI95% 1.001-1.183). Conclusions: Malnutrition and education level are key factors to understand COVID-19 mortality in children and adolescents. Age, obesity, immune-mediated diseases and population density were also associated to a worst COVID-19 prognosis. Funding: Funding Declaration of Interest: We declare no competing interests.

Background. Highly urbanized and rapidly urbanizing countries are facing critical air pollution problems. In Latin American cities, the impact of ambient PM2·5 on child health has not been extensively explored. Objectives. To examine association between ambient PM2·5 and under-5 mortality (U5MR) infant mortality (IMR) and child mortality (CMR) in Latin American cities. Methods. We estimated U5MR, IMR, and CMR from 2010 to 2015 for 1,152 sub-city units clustered in 337 cities from Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, and Mexico. We retrieved satellite annual PM2·5 for each sub-city unit. Using linear mixed-effects models, we estimated the percent change in U5MR, IMR, and CMR associated with a 1 μg/m3 increase in annual PM2·5, adjusted for city and municipality-level predictors (population growth, GDP, living conditions, service provision, population educational attainment, and mass transit availability). Results. Over the study period, mean annual PM2·5 was 12·7 μg/m3 (SD 6·3), U5MR and IMR were 14·2 and 12·1 deaths per 1,000 live births, respectively. CMR was 4·8 deaths per 10,000 children. A 1 μg/m3 annual increase in PM2·5 was associated with 0·4% increase in U5MR (95% CI 0.1 to 0.7) and 0·5% increase in IMR (95% CI 0.2 to 0.9) We found no significant association between PM2·5 increases and changes in CMR. Interpretation. Infants appear to be particularly vulnerable to the deleterious effect of PM2·5. Assuring a clean air environment is important to promote infant survival and health. Funding: The project is funded by Wellcome Trust Funds, Grant 205177/Z/16/Z. Declaration of Interest: We declare no competing interests. Ethical Approval: The SALURBAL study protocol has ethical approval from the Drexel University IRB with ID # 161 200 5035.

Background: Little is known about the potential impact of climate change on food systems and diet. We aimed to estimate the association of changes in rainfall and temperatures with consumption of unprocessed and processed foods among residents of Mexican cities by climate region.Methods: We analyzed 3,312 participants of the 2012 Mexican National Health and Nutrition Survey with dietary intake and sociodemographic information linked to historical rainfall and temperature data collected by the Mexican National Weather Service. We classified foods as unprocessed, processed, or ultra-processed. We performed multilevel linear regression to estimate the association of annual change in rainfalls (for each 0.5 mm decrease) and temperatures (for each 0.1°C increase) at municipality level over the past 5 years with consumption of processed and unprocessed foods measured as the contribution to total energy intake. We investigated whether associations differed by climate region (tropical, temperate, and arid).Results: Each 0.5 mm annual decrease in precipitation was associated with lower consumption of unprocessed foods and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake −0.009% (95% CI: −0.019, < −0.001) and 0.011% (95% CI: 0.001, 0.021), respectively]. Each 0.1 degree Celsius annual increase in temperature was also associated with lower consumption of unprocessed and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake was −0.03 (95% CI: −0.05, −0.01) and 0.03% (95% CI: Conclusions: Decreases in rainfalls and increases in temperature were associated with lower consumption of unprocessed foods but higher consumption of ultra-processed foods, especially in tropical regions. Previous studies have established how food production affects the climate, our study suggests that climate change could, in turn, reinforce modern food production, closing a vicious circle with clear negative implications for planetary health.

In modern health systems, emergency services (ES) constitute one of the cornerstones of health care, and they have an essential role in the conception of current health services. The objective of this work was to analyze the effect of sociodemographic characteristics and clinical factors in the use of ES.A cross-sectional study was carried out with data from the National Health Survey of Spain (2017) in which 23,089 adults (15 years or more) participated. Three population profiles were defined to analyze visits to ES (young people between 15 and 24 years of age; people aged 75 or over and with multiple pathologies; the general population). Descriptive analyses were performed by population profile, and logistic regression models by population profile and type of service (public hospital, public non-hospital emergency center, and private health center) were applied to evaluate the association between the use of ES and the independent variables.The percentage of use of ES was higher in the elderly population with multiple pathologies (41.1%) compared to young people (35.7%) and the general population (28.4%). Young people between 15 and 24 years of age used ES more in private centers, and the associated factors were female sex (OR=2.862; 95% CI=1.139-7.191), the use of diagnostic tests (OR=9.401; 95% CI=3.183-27.760), belonging to the lowest social classes (OR=0.207; 95% CI=0.073-0.585) and residing in municipalities with more than 50,000 inhabitants and capitals (OR=5.985; 95% CI=1.143-31.330). The elderly population with multiple pathologies presented a worse state of health than the other two population groups and with a higher demand for ES in public hospitals. In addition, in the elderly population group, the factors associated with the use of ES in public hospitals were having been hospitalized (OR=2.229; 95% CI=1.333-3.730), belonging to the lowest social classes (social class III: OR=2.794; 95% CI=1.154-6.768/social class IV-V- VI: OR=3.767; 95% CI=2.236-6.344), residing in municipalities with more than 50,000 inhabitants and capitals (OR=1.679; 95% CI=1.042-2.704) and having had at least one visit to the PC doctor (OR=0.603; 95% CI=0.396-0.918). Finally, in the general population the variables associated with increased use of ES in public hospitals were age (OR=1.009; 95% CI=1.001-1.016), the highest number of visits to the PC doctor (OR=1.550; 95% CI=1.180-2.170), the use of diagnostic tests (OR=1.480; 95% CI=1.236-1.773) and belonging to the lowest social classes (social class IV-V-VI: OR=1.581; 95% CI=1.229-2.033).The characteristics associated with the use of ES, both public and private, as well as hospital and extra-hospital, differ according to socioeconomic characteristics and clinical factors. The results of this study suggest redirecting interventions to improve care outcomes, as well as achieving a more rational use of ES.En los sistemas sanitarios modernos, los Servicios de Urgencias (SU) constituyen una de las piedras angulares de la atención sanitaria y tienen una importancia esencial en la concepción de los servicios sanitarios actuales. El objetivo de este trabajo fue analizar el efecto de las características sociodemográficas y los factores clínicos en la utilización de los SU en España.Se realizó un estudio transversal con los datos de la Encuesta Nacional de Salud de España (2017), en el que participaron 23.089 personas adultas (15 años o más). Se definieron tres perfiles poblacionales para analizar las visitas a los SU (jóvenes entre 15 y 24 años; personas con 75 años o más y con pluripatología; población general). Se realizaron análisis descriptivos por perfil poblacional, y se aplicaron modelos de regresión logística por perfil poblacional y tipo de servicio (hospital público, centro público de Urgencias no hospitalario y centro sanitario privado) para evaluar la asociación entre la utilización de los SU y distintas variables clínicas y sociodemográficas.El porcentaje de utilización de los SU fue mayor en población anciana con pluripatología (41,1%) en comparación con los jóvenes (35,7%) y la población en general (28,4%). Las personas jóvenes utilizaron más los SU en centros privados, y los factores asociados fueron el sexo femenino (OR=2,862; IC 95%=1,139-7,191), la realización de pruebas diagnósticas (OR=9,401; IC 95%=3,183-27,760), pertenecer a una clase social menos favorecida (OR=0,207; IC 95%=0,073-0,585) y residir en municipios de más de 50.000 habitantes y capitales (OR=5,985; IC 95%=1,143-31,330). La población anciana con pluripatología presentó un peor estado de salud que los otros dos grupos poblacionales y con mayor demanda de los SU en hospitales públicos. Además, en el grupo de población anciana, los factores asociados a la utilización de los SU en hospitales públicos fueron haber sido hospitalizado (OR=2,229; IC 95%=1,333-3,730), pertenecer a una clase social menos favorecida (clase social III: OR=2,794; IC 95%=1,154-6,768/clase social IV-V-VI: OR=3,767; IC 95%=2,236-6,344), residir en municipios de más de 50.000 habitantes y capitales (OR=1,679; IC 95%=1,042-2,704) y tener sólo una consulta al médico de Atención Primaria (AP) (OR=0,603; IC 95%=0,396-0,918). Finalmente, en la población general se observó que las variables asociadas con mayor utilización de los SU en hospitales públicos fueron la edad (OR=1,009; IC 95%=1,001-1,016), un mayor número de consultas al médico de Atención Primaria (OR=1,550; IC 95%=1,180-2,170), la realización de pruebas diagnósticas (OR=1,480; IC 95%=1,236-1,773) y pertenecer a la clase social menos favorecida (clase social IV-V-VI: OR=1,581; IC 95%=1,229-2,033).Las características asociadas con la utilización de los SU, tanto públicos como privados, así como hospitalarios y extrahospitalarios, difieren según las características socioeconómicas y los factores clínicos. Los resultados de este estudio sugieren reconducir las intervenciones para mejorar los resultados de la atención, así como conseguir un uso más racional de los SU.

Our objective was to describe the prevalence and changes in tobacco use and tobacco control policies in Latin American countries and cities before and after ratification of the 2003 Framework Convention on Tobacco Control (FCTC). Country-level tobacco policy data came from reports on the global tobacco epidemic (World Health Organization, 2007&ndash, 2014). Global Youth Tobacco Survey data, 2000&ndash, 2011, came from six countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru), 31 cities and 132,065 students. Pre- and post-FCTC prevalence and relative changes were estimated. All countries showed improvements in tobacco control policies but Mexico and Peru showed the smallest improvements. In general, adolescents reduced their tobacco use, reported less exposure to smoking at home, more tobacco education, and more retailer refusals to sell them cigarettes. Adolescents reported smaller reductions in secondhand smoke exposure outside the home and no change in exposure to tobacco media/promotions. Pre-FCTC prevalence and relative changes during the post-FCTC period were more heterogeneous across cities than across countries. Despite overall improvements in tobacco policies and the decline in exposure to tobacco, policies related to media/promotions and secondhand smoke need strengthening. There was wide variation in adolescent exposure to tobacco between cities (within countries), which suggested major heterogeneity of policy implementation at the local level.

Objectives This study aimed to evaluate the association of chronic diseases and Indigenous ethnicity on the poor prognosis of coronavirus disease 2019 (COVID-19) outpatients and hospitalised patients in Mexico. Study design Observational study of consecutive COVID-19 cases that were treated in Mexican health care units and hospitals between February 27 and April 27, 2020. Methods Epidemiological, clinical and sociodemographic data were analysed from outpatients and hospitalised patients. Cox regression models were used to analyse the risk of mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Results In total, 15,529 COVID-19 patients were characterised; 62.6% were aged over 40 years, 57.8% were male and 1.4% were of Indigenous ethnicity. A high proportion had a history of diabetes (18.4%), hypertension (21.9%) and obesity (20.9%). Among hospitalised patients, 11.2% received health care in the intensive care unit. Advanced age, being male, Indigenous ethnicity and having a history of chronic diseases, such as hypertension, diabetes and obesity, were significantly associated with a high risk of death following SARS-CoV-2 infection. Diabetes and obesity were the comorbidities most highly associated with death through the models used in this study. Moreover, living in Mexico City and Mexico State (where there is easy access to medical services) and walking (rather than driving or getting public transport), were negatively associated with mortality after SARS-CoV-2 infection. Conclusions Diabetes, hypertension and obesity, combined with older age, being male and Indigenous ethnicity increase the risk of death following SARS-CoV-2 infection in the Mexican population. It is recommended that the incidence of COVID-19 is monitored in Indigenous communities and access to health services is increased nationwide., Highlights • Chronic diseases and Indigenous ethnicity increase the risk of death following SARS-CoV-2 infection in the Mexican population. • Living in Mexico City-State of Mexico (a city with easy access to medical services) was negatively associated with mortality. • Walking (rather than driving or talking public transport) was negatively associated with mortality. • Surveillance of COVID-19 in Indigenous communities and increased coverage of health services is necessary.

UNSTRUCTURED This work explores the effect on number of deaths after the introduction of lockdown in Spain, taking account an estimated 24 day lag between social mobility indicators (t) and date of death (t+24). There are significant associations between number of deaths calculated by possible day of infection (t+24) connected with the changes in certain types of mobility (t): negatively with car use, and positively with public transportation, and with mobility in grocery stores and pharmacy.

Background : Inhibition of quorum sensing systems (QSS-I) is a novel strategy in the treatment of bacterial infections. To date, plants are the major source of metabolites with this inhibitory activity. Thus, species of Mexican flora can be important resources for obtaining metabolites with QSS-I activity. Hypothesis : We hypothesized that extracts from species of the genus Ceiba have metabolites with inhibitory activity against bacterial quorum sensing systems. Species studied : Ceiba pentandra (L.) Gaertn. and Ceiba aesculifolia ( Kunth) Britten & Baker f. (Malvaceae). Study site and years of study : We collected Ceiba bark in the municipalities of Tierra Blanca, Veracruz, and Acatlan, Oaxaca, in August 2013. Methods : We determined the effect of extracts from C. aesculifolia and C. pentandra against QSS-regulated phenotypes of Chromobacterium violaceum and Pseudomonas aeruginosa . Extracts were fractionated and the main metabolites were identified. As support in the identification of the species, we carried out an anatomical study of the bark. Results : Hexane and dichloromethane extracts of both species of Ceiba exhibited QSS-I activity. We identified four fractions rich in terpene and sterol compounds with the ability to attenuate virulence factors in P. aerugiosa . The histological analysis appears to support the presence of some differences in the barks that can facilitate identification of the two species. Conclusions : The extracts and fractions of the two species of Ceiba are sources of phytochemicals with the ability to regulate bacterial quorum sensing systems positively or negatively.

Seed oils from oleaginous plants are rich in fatty acids (FAs) that play important roles in the health of the consumers. Recent studies indicate that FA also can play an important role in communication and regulation of virulence in bacteria. Nevertheless, evidence demonstrating protection against bacterial infections mediated by their quorum sensing inhibition (QSI) activity is scarce. In this study, sunflower, chia, and amaranth oils, were assayed for their QSI capacity by inhibiting violacein production and alkaline exoprotease activity of Chromobacterium violaceum. In vitro assays revealed that the oils exhibited QSI activities, whereas in vivo they delayed death of mice inoculated intraperitoneally with the bacterium. Gas chromatography coupled with mass spectrometry analysis of the oils indicated the presence of saturated FA (SAFA) and unsaturated FA as main components. Through a structure-activity relationship study of free FAs, bactericidal effect was identified mainly for polyunsaturated FAs, whereas QSI activity was restricted to SAFA of chains 12-18 carbon atoms in length. These data correlate with a possible interaction suggested by molecular docking analysis of lauric, myristic, and stearic acids with the CviR protein. Our study highlights the antiquorum sensing potential of SAFA, which may be future antivirulence therapeutic agents for the treatment of bacterial infections.

Children’s early development is influenced by characteristics of the child, family, and environment, including exposure to substance abuse. The aim was to examine the association of early childhood development (ECD) with the prevalence of psychoactive substance use in Mexican municipalities. We obtained ECD data from the 2015 Survey of Boys, Girls, and Women (ENIM, for its Spanish acronym), measured with the ECD Index. The prevalence of psychoactive substance use was estimated at the municipal level, using the 2016 National Survey of Drug, Alcohol, and Tobacco Use (ENCODAT, for its Spanish acronym). Multilevel logistic models were fitted to evaluate the association between drug use and inadequacies in ECD overall and in four specific ECD domains: socio-emotional, literacy-numeric, learning, and physical. Inadequate ECD was directly associated with illegal drug use (OR = 1.10, 95% CI: 1.03, 1.17). For the specific ECD domains, inadequate socio-emotional development was directly associated with illegal drug use (OR = 1.08, 95% CI: 1.01, 1.15). These findings suggest that exposure to illegal drug use may influence ECD, and especially can lead to socio-emotional problems, although this cannot be considered the unanimous determinant of the problems presented. The implementation of evidence-based interventions to prevent drug abuse is necessary.

Background Heart failure (HF) is a serious health-care problem. The aim of this study is to evaluate the effect of the first acute episode of decompensated HF that requires a hospitalization on the survival of newly diagnosed cases of HF with follow-up for 5 years in primary care (PC). Methods This was a longitudinal observational study of a retrospective cohort of patients with information extracted from electronic medical records of PC. Incident cases of HF from 2006 to 2010 or until death were studied through a survival analysis with Kaplan-Meier and Cox proportional hazards multivariate regression, after applying the propensity score matching technique (PSM). Results A total of 3061 new cases of HF were identified. The PSM analysis was performed with 529 couples, with a total of 1058 patients. 5-year survival was 65% in no hospitalized and 53% in hospitalized patients. Factors with an increased risk of mortality were having prescribed nitrates (heart rate [HR] = 1.56; 1.08-2.24). Factors with protective effect were having received the annual influenza vaccine (HR = 0.04; 0.01-0.15) and having been indicated X-rays by PC physician (HR = 0.76; 0.67-0.88). Conclusions The findings indicate that hospitalizations are associated with a significant increase in mortality in patients recently diagnosed with HF. It is important to reinforce the need for the prevention of acute decompensated HF and for strategies to improve post-discharge outcomes.

Heart failure (HF) is a serious health-care problem. The aim of this study is to evaluate the effect of the first acute episode of decompensated HF that requires a hospitalization on the survival of newly diagnosed cases of HF with follow-up for 5 years in primary care (PC).This was a longitudinal observational study of a retrospective cohort of patients with information extracted from electronic medical records of PC. Incident cases of HF from 2006 to 2010 or until death were studied through a survival analysis with Kaplan-Meier and Cox proportional hazards multivariate regression, after applying the propensity score matching technique (PSM).A total of 3061 new cases of HF were identified. The PSM analysis was performed with 529 couples, with a total of 1058 patients. 5-year survival was 65% in no hospitalized and 53% in hospitalized patients. Factors with an increased risk of mortality were having prescribed nitrates (heart rate [HR] = 1.56; 1.08-2.24). Factors with protective effect were having received the annual influenza vaccine (HR = 0.04; 0.01-0.15) and having been indicated X-rays by PC physician (HR = 0.76; 0.67-0.88).The findings indicate that hospitalizations are associated with a significant increase in mortality in patients recently diagnosed with HF. It is important to reinforce the need for the prevention of acute decompensated HF and for strategies to improve post-discharge outcomes.La insuficiencia cardiaca (IC) es un serio problema de asistencia médica. El objetivo de este estudio es evaluar el efecto del primer episodio de IC aguda descompensada que requiere una hospitalización en la supervivencia de los casos de IC recientemente diagnosticados con un seguimiento de 5 años en Atención Primaria (AP).Estudio observacional longitudinal de una cohorte retrospectiva de pacientes con información extraída de la historia clínica electrónica de AP. Se estudiaron los casos incidentes de IC desde 2006 a 2010 o hasta su fallecimiento con un análisis de supervivencia de Kaplan-Meier y un modelo de regresión de Cox, después de aplicar la técnica del Propensity Score Matching (PSM).Se identificaron 3.061 casos nuevos de IC. El análisis PSM se realizó con 529 pareja, con un total de 1.058 pacientes. La supervivencia a los cinco años fue del 65% en pacientes no hospitalizados y del 53% en pacientes hospitalizados. Los factores con mayor riesgo de mortalidad fueron tener prescritos nitratos (HR = 1,56; 1,08-2,24). Los factores con efecto protector fueron haber recibido la vacuna anual de la gripe (HR = 0,04; 0,01-0,15) y haber sido indicadas radiografías por el médico de AP (HR = 0,76; 0,67-0,88).Los hallazgos indican que las hospitalizaciones se asocian con un aumento significativo de la mortalidad en pacientes diagnosticados recientemente con IC. Es importante reforzar la necesidad de prevenir la IC descompensada aguda y las estrategias para mejorar los resultados posteriores al alta.

Background Persistence of latent, replication-competent provirus in CD4+ T cells of human immunodeficiency virus (HIV)-infected individuals on antiretroviral treatment (ART) is the main obstacle for virus eradication. Methylation of the proviral 5′ long terminal repeat (LTR) promoter region has been proposed as a possible mechanism contributing to HIV latency; however, conflicting observations exist regarding its relevance. We assessed 5′-LTR methylation profiles in total CD4+ T cells from blood of 12 participants on short-term ART (30 months) followed up for 2 years, and a cross-sectional group of participants with long-term ART (6–15 years), using next generation sequencing. We then looked for associations between specific 5′-LTR methylation patterns and baseline and follow-up clinical characteristics. Results 5′-LTR methylation was observed in all participants and behaved dynamically. The number of 5′-LTR variants found per sample ranged from 1 to 13, with median sequencing depth of 16270× (IQR 4107×-46760×). An overall significant 5′-LTR methylation increase was observed at month 42 compared to month 30 (median CpG Methylation Index: 74.7% vs. 0%, p = 0.025). This methylation increase was evident in a subset of participants (methylation increase group), while the rest maintained fairly high and constant methylation (constant methylation group). Persons in the methylation increase group were younger, had higher CD4+ T cell gain, larger CD8% decrease, and larger CD4/CD8 ratio change after 48 months on ART (all p < 0.001). Using principal component analysis, the constant methylation and methylation increase groups showed low evidence of separation along time (factor 2: p = 0.04). Variance was largely explained (21%) by age, CD4+/CD8+ T cell change, and CD4+ T cell subpopulation proportions. Persons with long-term ART showed overall high methylation (median CpG Methylation Index: 78%; IQR 71–87%). No differences were observed in residual plasma viral load or proviral load comparing individuals on short-term (both at 30 or 42 months) and long-term ART. Conclusions Our study shows evidence that HIV 5′-LTR methylation in total CD4+ T cells is dynamic along time and that it can follow different temporal patterns that are associated with a combination of baseline and follow-up clinical characteristics. These observations may account for differences observed between previous contrasting studies.

Objectives To examine the factors associated with satisfaction with healthcare services provided to patients with diabetes, hypertension, and/or dyslipidemia in the Mexican population. Methods In a cross-sectional, retrospective study, we used data from the 2016 Half-Way National Health and Nutrition Survey in Mexico (ENSANUT MC 2016). This contained self-reported information about patient satisfaction and use of healthcare services by 2529 adults. An ordinal regression model was performed to identify predictors of overall patient satisfaction. Results Good or very good satisfaction was reported by 85.2% of the respondents. Patient satisfaction was positively associated with the quality of medical care (very good, odds ratio [OR] = 29.71, 95% confidence interval [CI] 9.04-97.62; good, OR = 13.24, 95% CI 5.07-34.57; and regular, OR = 6.56, 95% CI 2.49-17.30) and having been attended by a medical specialist (OR = 2.42, 95% CI 1.01-5.83). Patient satisfaction was negatively associated with a worse perception of health status (OR = 0.07, 95% CI 0.02-0.25), no change in health status (OR = 0.377, 95% CI 0.15-0.98), time in the waiting room (OR = 0.99, 95% CI 0.99-1.01), and poor conditions of the health center (OR = 0.09, 95% CI 0.04-0.18). Conclusion There are several elements of organization, structure, and delivery of healthcare that are associated with patient satisfaction, although our findings need to be confirmed using longitudinal designs. Governments could use these findings to strengthen actions for improving patient satisfaction.

Background Highly urbanised and rapidly urbanising countries are facing critical air pollution problems. In Latin American cities, the effect of ambient PM2·5 on child health has not been extensively explored. We examined associations between ambient PM2·5 and under-5 mortality (deaths in those younger than 5 years per 1000 livebirths) infant mortality (deaths in those younger than 1 year per 1000 livebirths), and child mortality (deaths in those aged 1–4 years per 10 000 children) in Latin American cities. Methods In this longitudinal analysis, we estimated under-5 mortality, infant mortality, and child mortality for the period Jan 1, 2010, to dec 12, 2015, for 1152 subcity units clustered in 337 cities in Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, and Mexico. We retrieved mean annual PM2·5 for each subcity unit. Using linear mixed-effects models, we estimated the percentage change in under-5 mortality, infant mortality, and child mortality associated with a 1 μg/m3 increase in annual PM2·5, adjusted for city-level and subcity-level predictors (population growth, gross domestic product, living conditions, water and sanitation provision, population education, and mass transit availability). Findings Over the study period, mean annual PM2·5 was 12·7 μg/m3 (SD 6·3), under-5 mortality was 14·2 deaths per 1000 livebirths, infant mortality was 12·1 deaths per 1000 livebirths, and child mortality was 4·8 deaths per 10 000 children. A 1 μg/m3 annual increase in PM2·5 was associated with 0·4% (95% CI 0·1 to 0·7) increase in under-5 mortality and 0·5% (95% CI 0·2 to 0·9) increase in infant mortality We found no significant association between PM2·5 increases and changes in child mortality (–0·1% [95% CI −0·8 to 0·6]). Interpretation Our findings support the need for environmental protection in the Latin American region for improving both planetary and population health. Transdisciplinary strategies at local levels, including public health practitioners and policy stakeholders involved in urban development, are key for implementing these changes. Funding The Wellcome Trust initiative Our Planet, Our Health.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading etiological agent of acute respiratory tract infections and hospitalizations in children. However, little information is available regarding RSV infections in Latin American countries, particularly among adult patients. OBJECTIVE: To describe the epidemiology of RSV infection and to analyze the factors associated with severe infections in children and adults in Mexico. METHODS: Patients ≥1 month old, who presented with an influenza-like illness (ILI) to six hospitals in Mexico, were eligible for participation in the study. Multiplex reverse-transcriptase polymerase chain reaction identified viral pathogens in nasal swabs from 5629 episodes of ILI. Patients in whom RSV was detected were included in this report. RESULTS: Respiratory syncytial virus was detected in 399 children and 171 adults. RSV A was detected in 413 cases and RSV B in 163, including six patients who had coinfection with both subtypes; 414 (72.6%) patients required hospital admission, including 96 (16.8%) patients that required admission to the intensive care unit. Coinfection with one or more respiratory pathogens other than RSV was detected in 159 cases. Young age (in children) and older age (in adults) as well as the presence of some underlying conditions were associated with more severe disease. CONCLUSIONS: This study confirms that RSV is an important respiratory pathogen in children in Mexico. In addition, a substantial number of cases in adults were also detected highlighting the relevance of this virus in all ages. It is important to identify subjects at high risk of complications who may benefit from current or future preventive interventions. La Red is funded by the Mexico Ministry of Health and the U.S. National Institute of Allergy and Infectious Diseases. This project has been funded in part by funding provided by CONACYT (Fondo Sectorial SSA/IMSS/ISSSTE, Projects No. 71260 and No. 127088); National Institute of Allergy and Infectious Diseases, National Institutes of Health, through its Intramural Research Programs and a contract with Westat, Inc., Contract Number: HHSN2722009000031, Task Order Number: HHSN27200002; and through the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, or Westat, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. Sí

To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults.Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method.. Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance.. Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system.Estimar el gasto de bolsillo en salud (GBS) e identificar sus factores asociados en adultos mayores peruanos.Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2017. Se consideró como adulto mayor a todo individuo de 60 y más años y el GBS como variable principal de estudio. Se estimaron razones de prevalencia (RP) y razones de prevalencia ajustada (RPa) para cada uno de los factores asociados a GBS. Las medias del GBS fueron estimadas mediante un modelo lineal generalizado con distribución gamma y función de enlace log. Todos los intervalos de confianza (95 %) de los estimadores fueron calculados mediante bootstrapping con el método basado en la normal.Se incluyeron 18 386 adultos mayores, de los cuales en el 56,5 % se reportó GBS. La media y mediana del GBS es de 140,8 (USD 43,2) y 34,5 (USD 10,6) soles, respectivamente. Factores como procedencia urbana, mayor nivel de educación, padecer enfermedades crónicas y mayores gastos per cápita aumentan hasta 1,6 veces la probabilidad de GBS. En los afiliados al Seguro Integral de Salud (SIS) se reduce el GBS en 63,0 soles (USD 19,3) comparado con aquellos sin ningún seguro de salud.Seis de cada diez adultos mayores peruanos reportó GBS para atender su salud. Esto genera inequidad en el acceso a los servicios de salud, principalmente para los grupos socialmente vulnerables. Se sugiere investigar el impacto económico de los seguros sanitarios y el abordaje preventivo-promocional de las enfermedades crónicas, en aras de reducir el GBS y mejorar la eficiencia del sistema de salud peruano.

Objetivos. Estimar el gasto de bolsillo en salud (GBS) e identificar sus factores asociados en adultos mayores peruanos. Materiales y métodos. Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2017. Se consideró como adulto mayor a todo individuo de 60 y más años y el GBS como variable principal de estudio. Se estimaron razones de prevalencia (RP) y razones de prevalencia ajustada (RPa) para cada uno de los factores asociados a GBS. Las medias del GBS fueron estimadas mediante un modelo lineal generalizado con distribución gamma y función de enlace log. Todos los intervalos de confianza (95 %) de los estimadores fueron calculados mediante bootstrapping con el método basado en la normal. Resultados. Se incluyeron 18 386 adultos mayores, de los cuales en el 56,5 % se reportó GBS. La media y mediana del GBS es de 140,8 (USD 43,2) y 34,5 (USD 10,6) soles, respectivamente. Factores como procedencia urbana, mayor nivel de educación, padecer enfermedades crónicas y mayores gastos per cápita aumentan hasta 1,6 veces la probabilidad de GBS. En los afiliados al Seguro Integral de Salud (SIS) se reduce el GBS en 63,0 soles (USD 19,3) comparado con aquellos sin ningún seguro de salud. Conclusiones. Seis de cada diez adultos mayores peruanos reportó GBS para atender su salud. Esto genera inequidad en el acceso a los servicios de salud, principalmente para los grupos socialmente vulnerables. Se sugiere investigar el impacto económico de los seguros sanitarios y el abordaje preventivo-promocional de las enfermedades crónicas, en aras de reducir el GBS y mejorar la eficiencia del sistema de salud peruano. Objectives. To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults. Materials and Methods. Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method. Results. Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance. Conclusions. Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system.

Associations between HLA class I alleles and HIV progression in populations exhibiting Amerindian and Caucasian genetic admixture remain understudied. Using univariable and multivariable analyses we evaluated HLA associations with five HIV clinical parameters in 3,213 HIV clade B-infected, ART-naïve individuals from Mexico and Central America (MEX/CAM cohort). A Canadian cohort (HOMER, n = 1622) was used for comparison. As expected, HLA allele frequencies in MEX/CAM and HOMER differed markedly. In MEX/CAM, 13 HLA-A, 24 HLA-B, and 14 HLA-C alleles were significantly associated with at least one clinical parameter. These included previously described protective (e.g. B*27:05, B*57:01/02/03 and B*58:01) and risk (e.g. B*35:02) alleles, as well as novel ones (e.g. A*03:01, B*15:39 and B*39:02 identified as protective, and A*68:03/05, B*15:30, B*35:12/14, B*39:01/06, B*39:05~C*07:02, and B*40:01~C*03:04 identified as risk). Interestingly, both protective (e.g. B*39:02) and risk (e.g. B*39:01/05/06) subtypes were identified within the common and genetically diverse HLA-B*39 allele group, characteristic to Amerindian populations. While HLA-HIV associations identified in MEX and CAM separately were similar overall (Spearman’s rho = 0.33, p = 0.03), region-specific associations were also noted. The identification of both canonical and novel HLA/HIV associations provides a first step towards improved understanding of HIV immune control among unique and understudied Mestizo populations.

Cardiac involvement (CI) is a known complication of SSc associated with increased mortality. Our objective was to describe a cohort of patients with SSc and CI and to assess the differences between cutaneous subsets regarding their presentation and survival. Three hundred and ninety-three Spanish patients from a single center, diagnosed with SSc, were retrospectively studied for evidence of CI using noninvasive and invasive tests from 1976 to 2011. Clinical, epidemiological, immunological and therapeutic features of patients with CI were compared to those without it and within the different cutaneous subsets of SSc. CI was present in 173 (44 %) patients. Mitral regurgitation (67 %), conduction alterations (45 %) and left ventricle diastolic dysfunction (40 %) were the most common findings. Pericardial involvement and heart failure were more frequent in diffuse SSc (dcSSc) than in limited or sine scleroderma SSc. CI accounted for 20 % of deaths, and it was an independent mortality risk factor (HR 2.1, P = 0.02), but once CI was established, classical dcSSc mortality risk factors determined mortality. Patients with dcSSc developed CI faster than limited (HR 1.9, P = 0.003) or sine SSc patients (HR 2.5, P = 0.002), specially during the first year after SSc onset. We found statistically significant differences between the 3 SSc subsets in the presentation of pericardial involvement and heart failure. CI increased the mortality and appeared at a higher rate, especially during the first year after SSc onset. Screening for heart involvement should be performed at diagnosis and during follow-up.

The objective was to evaluate the effect of influenza vaccine on all-cause mortality in a cohort of patients with heart failure followed up in primary care centres of the Community of Madrid, Spain, during the period 2006-10. Results of the Cox proportional-hazard model were adjusted for age and sex and, after 1:1 nearest neighbour matching, for propensity score. The analysis was further stratified by season. Having received annual influenza vaccine was associated with a decreased risk of death during the influenza season (hazard ratio = 0.59, 95% CI = 0.41-0.84), but no protective effect was observed before or after the influenza season.

[EN] To evaluate the efficacy of natriuretic peptide (NP)-guided therapy compared to clinically-guided therapy in reducing mortality and hospital admissions in chronic heart failure (HF) patients. Randomised clinical trials (RCT) were selected through a systematic review. Four meta-analyses were conducted for the outcomes of overall mortality, HF-related mortality, overall hospital admissions, and HF-related hospital admissions. Heterogeneity between studies and publication bias were also assessed. Nine RCTs were found with a total of 1914 patients. NP-guided therapy significantly reduced overall mortality and HF-related hospital admissions. No significant results were found for HF-related mortality and overall hospital admissions. Some clinical heterogeneity regarding interventions performed was found between studies. Publication bias was found for HF-related and overall hospital admissions. NP-guided therapy seems to improve outcomes compared to clinically-guided therapy. However, heterogeneity found between interventions might reduce the generalisation of these results. Specific interventions of the clinical trials should be examined when making recommendations regarding NP-guided therapy. [ES] Evaluar la eficacia de la terapia guiada por el péptido natriurético (PN) en comparación con la terapia guiada clínicamente para reducir la mortalidad y la hospitalización de la insuficiencia cardiaca (IC) crónica. Los ensayos clínicos aleatorizados fueron seleccionados a través de una revisión sistemática. Cuatro metaanálisis se realizaron para los resultados de mortalidad general, mortalidad por IC, hospitalización general y la hospitalización por IC. Se evaluó la heterogeneidad entre los estudios y el sesgo de publicación. Nueve ensayos clínicos aleatorizados se encontraron con un total de 1,914 pacientes. La terapia guiada con el PN reduce significativamente la mortalidad general y la hospitalización por IC. No se encontraron resultados significativos para la mortalidad por IC y la hospitalización general. El sesgo de publicación se encontró para las hospitalizaciones por IC y globales. La terapia guiada por PN parece mejorar los resultados en comparación con la terapia guiada clínicamente. Sin embargo, la heterogeneidad encontrada entre las intervenciones podría reducir la generalización de estos resultados. Las intervenciones específicas de los ensayos clínicos deben ser analizadas al hacer recomendaciones con respecto a la terapia de guiada por PN. Sí

Heart failure (HF) is an important public health problem due to its increasing prevalence, and the decompensation associated with hospital admission represents an increased risk of death. The objective of this study was to compare several methods to model the variable hospitalizations and to determine the effect of factors associated with hospital admissions in incident cases of HF.Study of a retrospective cohort of patients with information extracted from electronic medical records of PC was performed. Patients 24 year and older with at least 1 visit to PC in 2006 were included. Registered hospital admissions of HF incident cases between 2006 and 2010 or until death were analyzed and comparison of Poisson, Negative Binomial (NB), zero-inflated and Hurdle regression models were conducted to identify factors associated con hospitalizations.3,061 patients were identified in a cohort of 227,984. Regarding the factors associated with hospitalizations and according to the zero inflated NB regression model, patients who presented valvular disease (OR=2.01; CI95% 1.22-3.30), or were being treated with antithrombotics (OR=3.45; CI95%: 1.61-7.42) or diuretics (OR=2.28; CI95% 1.13-4.58) had a lower likelihood of hospitalization. Factors associated with a higher rate of hospital admissions were having valvular disease (IRR=1.37; CI95% 1.03-1.81) or diabetes (IRR=1.38; 1.07-1.78), and being treated with calcium antagonists (IRR=1.35; CI95% 1.05- 1.73) or ACE inhibitors (IRR=1.43; CI95% 1.06- 1.92). Having being referred to a cardiologist had a protective effect (IRR=0.86; CI95% 0.76- 0.97).The regression model that obtained the best adjustment was the zero inflated NB. According to this model, the factors associated with an increase in hospital admissions were valvulopathies, diabetes and treatment with calcium antagonists.La insuficiencia cardiaca (IC) es un importante problema de salud pública debido a su creciente prevalencia y la descompensación que conlleva un ingreso hospitalario representa un aumento del riesgo de muerte. El objetivo de este trabajo fue comparar varios métodos para modelizar la variable hospitalizaciones y determinar el efecto de los factores asociados con los ingresos hospitalarios en casos incidentes de IC.Se realizó un estudio de cohortes restrospectivo con información extraída de la historia clínica electrónica de Atención Primaria (AP). Se incluyeron pacientes mayores de 24 años que habían realizado al menos 1 consulta en AP durante el año 2006. Se analizaron las hospitalizaciones registradas de casos incidentes de IC entre 2006 y 2010 o hasta su fallecimiento y se compararon modelos de regresión de Poisson, Binomial Negativa (BN), inflados con ceros y de Hurdle para identificar factores asociados a las hospitalizaciones.Se identificó a 3.061 personas con IC en una cohorte de 227.984 pacientes. Respecto a los factores asociados con las hospitalizaciones y según el modelo de regresión BN inflado con ceros, los pacientes con valvulopatías (OR=2,01; IC95%: 1,22-3,30) o en tratamiento con antitrombóticos (OR=3,45; IC95%: 1,61-7,42) o diuréticos (OR=2,28; IC95%:1,13-4,58) tuvieron mayor probabilidad de hospitalización. Los factores asociados a una mayor tasa de ingresos fueron tener valvulopatías (IRR=1,37; IC95%: 1,03-1,81) o diabetes mellitus (IRR=1,38, 1,07-1,78) y estar en tratamiento con calcioantagonistas (IRR=1,35; IC95%: 1,05-1,73) o IECAS (IRR=1,43; IC95%:1,06-1,92). Haber tenido derivaciones a cardiología tuvo efecto protector (IRR=0,86; IC95%: 0,76-0,97).El modelo de regresión que tiene mejor ajuste es el BN inflado con ceros. Según este modelo los factores asociados con un incremento en los ingresos hospitalarios son las valvulopatías, la diabetes mellitus y el tratamiento con calcioantagonistas.

BACKGROUND: Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine. OBJECTIVES: This study explored factors associated with professional satisfaction in seven European countries. METHODS: A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians. RESULTS: A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR = 1.01), integrated network of primary care centres (OR = 2.8), patients having direct access to specialists (OR = 1.3) and professionals having access to data on patient satisfaction (OR = 1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR = 0.8). CONCLUSION: Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction. Seventh Framework Programme. Sí

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[ES] Objetivo Describir la supervivencia de los pacientes con insuficiencia cardiaca (IC) con seguimiento en atención primaria (AP) y analizar el efecto del sexo, edad, factores clínicos, de utilización de servicios y nivel de renta, en la supervivencia. Diseño Estudio observacional longitudinal de una cohorte retrospectiva de pacientes a partir de la historia clínica electrónica. Emplazamiento Área 7 de AP de la Comunidad de Madrid. Participantes Pacientes mayores de 24 años con una consulta en AP en el año 2006. Mediciones principales Casos incidentes de IC desde 2006 a 2010 o hasta su fallecimiento. Análisis de supervivencia de Kaplan-Meier y de regresión multivariante de riesgos proporcionales de Cox. Resultados Se identificaron 3.061 pacientes en una cohorte de 227.984. Su supervivencia fue del 65% a los 5 años. Fallecieron 519 pacientes con una supervivencia media de 49 meses. Los factores asociados a mayor riesgo de mortalidad fueron la edad (HR = 1,04; 1,03-1,05) y tener diagnóstico de cardiopatía isquémica (HR = 1,45; 1,15-1,78) o de diabetes (HR = 1,52; 1,17-1,95). Los factores con un efecto protector fueron ser mujer (HR = 0,72; 0,59-0,86), no pensionista (HR = 0,43; 0,23-0,84), haber recibido la vacunación de la gripe anualmente (HR = 0,01; 0,00-0,06), tener prescritos hipolipidemiantes (HR = 0,78; 0,61-0,99) o IECA (HR = 0,73; 0,60-0,88), así como que se le hubieran solicitado analíticas (HR = 0,98; 0,95-1), radiografías (HR = 0,81; 0,74-0,88) y electrocardiogramas (HR = 0,90; 0,81-0,99) en AP. Conclusiones Los datos de los pacientes con IC seguidos en AP indican que su supervivencia es mejor que la obtenida en otros países, apoyando el argumento de la mejor evolución de la IC en los países mediterráneos. [EN] To describe survival of patients with chronic heart failure (HF) followed up in primary care (PC) and analyse the effect of sex, age, clinical and health services factors, and income levels on survival. Longitudinal observational study of a retrospective cohort of patients with information extracted from electronic medical records. PC Area 7 of the Community of Madrid. Patients 24 year and older with at least one visit to PC in 2006. Incident cases of HF followed up from 2006 to 2010 or until death. Survival analysis with Kaplan-Meier and Cox proportional hazard multivariate regression. A total of 3,061 cases were identified in a cohort of 227,984 patients. The survival rate was 65% at 5 years, with 519 patients dying with a median survival of 49 months. Factors associated with increased risk of mortality were, age (HR=1.04, 1.03-1.05), and having a diagnosis of ischemic heart disease (HR=1.45, 1.15- 1.78), or diabetes (HR=1.52, 1.17-1.95). Factors with a significant protective effect were: female sex (HR=0.72, 0.59-0.86), non-pensioner (HR=0.43, 0.23-0.84), having received the influenza vaccine annually (HR=0.01, 0.00-0.06), prescribed lipid-lowering drugs (HR=0.78, 0.61-0.99) or ACE inhibitors (HR=0.73, 0.60-0.88), and blood tests having been requested (HR=0.97, 0.95-1.00), X-rays (HR=0.81, 0.74-0.88), or electrocardiograms (HR=0.90, 0.81-0.99) in PC. Data from patients with HF followed up in PC indicate that their survival is better than that obtained in other countries, supporting the argument of a better evolution of HF in Mediterranean countries. Este trabajo se ha realizado con la financiación de la RETIC RD12/0001, y de los proyectos del FIS PI 06/1122 y PI09/1362. Sí

OBJECTIVE: EUprimecare is a study funded by the 7th Framework Programme of the European Union aimed at analyzing the quality of the different models of primary care (PC) in Europe. The objective of this study was to describe and analyze the determinants associated with patient satisfaction with the listening skills of their PC physicians.METHODS: Telephone population survey in each EUprimecare consortium countries (Germany, Spain, Estonia, Finland, Hungary, Italy and Lithuania) among PC users. The questionnaire included sociodemographic variables, health status, use and satisfaction with PC services. The survey was conducted in 3020 patients. It was developed descriptive analysis, bivariate correlations and ordinal regression model to study the direct relation between levels of satisfaction and the explanatory variables on demographics, state and health services for patients. We show the regression coefficients (β) with 95% confidence interval and statistical significance associated.RESULTS: We found significant relation between the level of satisfaction and age (β = 0.016), visits to specialist (β = ‑0.040), having a general practitioner (GP) (β = 0.619), having a chronic disease (β = 0.255), measuring weight, cholesterol and blood pressure (β = 0.650), countries (β1 Estonia= 0.938; β2 Germany = 0.469; β3 Lithuania = 0.483; β5 Italy = 0.544 and β6 Hungary = 1.010) and a better perception of health status (β = 0.388). Specialist visits have a negative influence with the higher degree of satisfaction.CONCLUSIONS: Overall, the results indicate some areas that may be related to greater doctor‑patient satisfaction. Different factors are converging to explain satisfaction with listening skills.

EUprimecare is a study funded by the Seventh Framework Programme of the European Union, aimed at analysing the quality of the different models of primary care in Europe. The objective of this study was to describe and analyse the determinants associated with patient satisfaction in primary care in Europe.We conducted telephone population surveys among primary care users in each EUprimecare consortium country (Germany, Spain, Estonia, Finland, Hungary, Italy and Lithuania). The survey was conducted with 3020 patients and the questionnaire included sociodemographic variables, health status, and use and satisfaction with primary care services. We undertook descriptive analyses, bivariate correlations and an ordinal regression model to study the direct relationship between levels of satisfaction and the explanatory variables for demographics, health status and health services for patients. We present the regression coefficients (β) with 95% confidence intervals and associated tests of statistical significance.The mean age of the respondents was 51 years (SD 14.1). We found significant associations between the level of satisfaction and age (β = 0.008), specialist visits (β = -0.030), not having a general practitioner (β = 0.70), not measuring weight, cholesterol and blood pressure (β = 0.52), country (β1 Germany = -1.08 and β2 Lithuania = -0.60; β3 Hungary = 0.50 and β4 Italy = 0.53) and a better perception of health status (β = 0.33). Specialist visits had a negative association with satisfaction.Overall, the results indicate factors that may be related to greater satisfaction with primary care services: age, visits to a specialist, having a doctor assigned to primary care and measurement of control parameters are associated with a better perception of the care received.