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Background: In Europe, different studies forecast an increase in maternal mortality in the coming years, associated with advanced maternal age and delay in maternity. This study aims to analyse the age-related trend in the maternal mortality ratio among mothers in Spain for the decade 1996–2005, and to describe the causes of death and associated sociodemographic factors for the years with highest mortality. Methods: An ecological study on trends, for the age-related trend in the maternal mortality ratio; an indirect standardisation and Poisson regression model was used. For the description of the causes of death, a cross-sectional study was used. Results: Prevalence of live births among mothers aged 35 years and over was 15% higher in Spain than in Europe. The maternal mortality rate increased by 20% (standardised mortality ratio of 1.2, 95% CI 0.9 to 1.4) in 2005 with respect to 1996. The age-related risk of maternal mortality was three times higher (relative risk of 2.90, 95% CI 2.01 to 4.06) among mothers aged 35–44 years versus those aged under 35 years. The highest mortality was detected during 2003–2004. The risk of maternal mortality was higher in foreign mothers. Conclusion: This study confirms that there was a change in the maternal mortality trend characterised by an increase in deaths, associated with advanced maternal age, as well as an increase in the prevalence of live births among mothers aged 35 years and over. This change in pattern identifies the need to intensify maternal mortality surveillance by collecting the necessary set of variables that allows investigation of the causes and determinant factors underlying deaths.

An outbreak of acute gastroenteritis occurred in a nursing home for elderly in Majorca between 4 and 23 February 2008. To know its aetiology and mechanism of transmission a retrospective cohort study was conducted with a fixed cohort including 146 people (96 residents and 50 employees). The data were collected from clinical histories and through a survey by questionnaire. In total 71 cases were identified (53 residents, 18 employees), corresponding to an overall attack rate (AR) of 48.6%. The consumption of tap water, adjusted by age, sex and consumption of meals provided at the nursing home, presented a relative risk (RR) of 4.03 (95%CI, 1.4-11.4). The microbiological analyses confirmed the presence of norovirus and/or rotavirus in five of the seven stool samples submitted. The slow appearance of cases at the beginning of the outbreak is characteristic of a person to person transmission, while the sudden peak in the middle of the month suggests a common source such as the tap water. We therefore concluded that the outbreak likely originated from two sources: an infected employee of the nursing home and the tap water. The high number of dependent residents most probably facilitated the spread of the outbreak.