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Resumen: Introducción: El objetivo fue estimar la incidencia de diabetes tipo 1 (DM1) en la población infantil de la Comunidad de Madrid (CM) y su evolución entre 1997 y 2016, a partir de los datos médicos-administrativos del registro regional de DM1. Métodos: Fueron incluidos los casos de DM1 de menores de 15 años, notificados al registro regional o captados de fuentes secundarias: Asociación Diabéticos Españoles (1997-2013) y a partir de 2014 del conjunto mínimo básico de datos (CMBD) hospitalario. Se estimaron las tasas de incidencia anual por 100.000 personas-año. La comparación de las tasas se analizó mediante modelos de regresión de Poisson a través de razones de incidencia (RI). Resultados: Un total de 2658 casos fueron identificados como nuevos diagnósticos de DM1. La tasa de incidencia media de 1997-2013 fue de 13,7 casos por 100.000 personas-año. En el periodo 2014-2016, utilizando el CMBD se registraron 20,0 casos por 100.000. El grupo de edad con mayor incidencia fue el de 10-14 años en los 2 periodos (16,6 vs. 25,5). En los niños, la edad de mayor incidencia fue de 10 a 14 años en ambos periodos (17,9 vs. 30,4) y en las niñas el de 5 a 9 años (17,0 vs. 25,1). Las tasas de incidencia descendieron ligeramente en ambos sexos hasta 2013 (de 15,0 a 11,6); en 2014-2016 la tasa de incidencia anual varió entre 18,4 y 21,1 casos (RI: 1,77). La incidencia permaneció estable en menores de 5 años y aumentó de 5 a 14 años. Conclusiones: La CM se sitúa entre las regiones de alta incidencia de DM1. En su primera fase, el registro regional infraestimaba la incidencia de DM1. Con la incorporación del CMBD como fuente de información, las estimaciones del segundo periodo (2014-2016) son posiblemente más próximas a la incidencia real de DM1. Los datos que presentamos sugieren la necesidad de conocer la evolución real de la incidencia de la enfermedad incorporando los registros digitales sanitarios. Abstract: Introduction: The objective of this article was to estimate the type 1 diabetes mellitus (DM1) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of DM1. Methods: DM1 cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997-2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). Results: A total of 2658 cases were identified as new diagnoses of DM1. The mean incidence rate for 1997-2013 was 13.7 cases per 100 000 person-years. In the 2014-2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10-14 years in the 2 periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10 to 14 years in both periods (17.9 vs 30.4), and in girls, the age of 5 to 9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014-2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. Conclusions: The CM is among the regions with a high incidence of DM1. In its first phase, the regional registry underestimated the incidence of DM1, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014-2016) are possibly closer to the actual incidence of DM1. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records.

Objective:To assess the validity of self-reported height and weight by parents of 4-year-old children and subjective weight perception.Design:Descriptive cross-sectional study.Setting:Paediatric population living in the Autonomous Community of Madrid.Participants:Children born in 2008–2009 examined at 47–59 months of age. Data were collected by paediatricians of the Madrid Primary Care Physicians Sentinel Network. Parents reported weight and height data. Prevalence of weight status categories was calculated using WHO and International Obesity Task Force (IOTF) reference criteria. Sensitivity, specificity and positive predictive value (PPV) were estimated. The appraisal of their child’s weight perception and parental misperception were assessed.Results:For 2914 children, reported height was underestimated by −1·38 cm, weight by −0·25 kg and BMI was overestimated by +0·41 kg/m2on average. The prevalence of obesity estimated with reported data was 2·7 times higher than that calculated with measured data (16·2v. 6·0 %) according to WHO classification, and 3·6 times higher with IOTF classification. Sensitivity to identify obesity was 70·5 %, specificity was 87·3 % and PPV was 26·2 % (WHO classification). Half of the parents of pre-schoolers with obesity failed to identify their child’s weight status. Parental misperception among children classified as having overweight or obesity reached 93·0 and 58·8 %, respectively.Conclusions:Parents underestimated children’s height and weight, leading to an overestimation of the prevalence of obesity. Small inaccuracies in reported measures have an important effect for the estimation of population prevalences. Parents’ report of child weight status is unreliable. Parental awareness and acknowledgement of child weight status should be improved.

ObjectivesTo evaluate the association between excess weight and the demand of health services in preschool children compared with healthy weight.MethodsThe data come from the Longitudinal Study of Childhood Obesity cohort (1884 4-year-old children, residing in the Madrid region, Spain) who provided information through telephone questionnaire, physical examination and electronic medical records. We defined overweight, general and abdominal obesity based on body mass index, waist circumference and waist-to-height ratio. Using mixed models of multivariable negative binomial regression we calculated the incidence rate ratio (IRR) regarding primary care (PC) doctor visits, drug prescriptions and hospital admissions by weight status at the end of the 2-year follow-up.ResultsChildhood general obesity was associated with a higher demand for PC services related to psychological problems (IRR=1.53; 95% CI 1.02 to 2.28) and childhood abdominal obesity, according to waist-to-height ratio, was related to more frequent problems of the musculoskeletal system (IRR=1.27; 95% CI 1.00 to 1.62). Drugs were prescribed more frequently to children falling under all three definitions of excess weight, compared with healthy weight children. No differences in the number of hospital admissions were observed.ConclusionsThe demand of health services related to early childhood obesity was small. Nevertheless, obesity was associated with a slightly greater demand for drug prescriptions and for PC doctor visits related to psychological and musculoskeletal problems.

Resumen Introduccion En la Comunidad de Madrid existe un 42,7% de retraso diagnostico de VIH. La atencion primaria es la puerta de entrada al sistema sanitario y se desconoce la frecuencia de serologias solicitadas por estos profesionales. Los objetivos fueron conocer la frecuencia y factores asociados a la solicitud de serologias de VIH por profesionales de medicina y de enfermeria de atencion primaria de la Comunidad de Madrid. Metodo Mediante encuesta on-line, se pregunto por la solicitud de serologias para VIH en los ultimos 12 meses, a profesionales que participaron en el estudio de evaluacion de estrategias de diagnostico precoz de VIH en consultas de atencion primaria de la Comunidad de Madrid (ESTVIH). La asociacion entre la solicitud de serologias y las caracteristicas sociodemograficas y de practica clinica de los profesionales se cuantifico mediante odds ratio ajustadas (ORa) segun regresion logistica. Resultados Se obtuvieron 264 encuestas (59,5% medicina). El 82,2% de profesionales medicina y el 18,7% de enfermeria refirieron haber solicitado alguna serologia de VIH en los ultimos 12 meses (mediana de 15 y 2 serologias solicitadas, respectivamente). En medicina esta peticion se asocio con sexo masculino (ORa: 2,95; IC95%: 0,82-10,56) y estar entrenado para dar consejo pre-post prueba de VIH (ORa: 2,42; IC95%: 0,84-6,93); en enfermeria se asocio con edad ( 13 anos; ORa: 3,02; IC95%: 1,07-8,52). Conclusion Es necesario promover la solicitud de pruebas de VIH y el entrenamiento pre-post prueba de VIH en profesionales de medicina y enfermeria de atencion primaria.

Introduction In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. Method An ‘on-line’ survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. Results 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% C I: 0.82–10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84–6.93) and the nurses with: age ( 13 years; aOR: 3.02; 95% CI: 1.07–8.52). Conclusion It is necessary to promote HIV testing and training in pre–post HIV test counselling for medical and nursing professionals in primary care centres.

RATIONALE, AIMS, AND OBJECTIVES Prevention offers the most cost-effective long-term strategy for cancer control. The objective of this study was to ascertain opinions, attitudes, and professional practices towards cancer prevention among primary care professionals and to assess differences between family physicians (FP) and nursing professionals (NP). METHOD A cross-sectional study was performed in 2012 in the Community of Madrid. A random sample of 3586 professionals received an online questionnaire about opinions/attitudes, training, and interventions in cancer prevention. The chi-square test was used to analyse the association of the profession with all the variables. Factors associated with the usual practice of individual, group, and community interventions were analysed using multivariate logistic regression, with separate models for FP and NP. RESULTS The response rate was 39.4% (N = 1413). Approximately 90% of the participants attributed "sufficient/high" utility to individualized counselling. NP attributed higher utility to group and community interventions than FP (70.1% vs 60.1% and 64.9% vs 57.7%, respectively, P-value

Introduction: The objective of this article was to estimate the type 1 diabetes mellitus (T1DM) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of T1DM. Methods: T1DM cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997−2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). Results: A total of 2658 cases were identified as new diagnoses of T1DM. The mean incidence rate for 1997−2013 was 13.7 cases per 100 000 person-years. In the 2014−2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10−14 years in the two periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10–14 years in both periods (17.9 vs 30.4), and in girls, the age of 5–9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014−2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. Conclusions: The CM is among the regions with a high incidence of T1DM. In its first phase, the regional registry underestimated the incidence of T1DM, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014−2016) are possibly closer to the actual incidence of T1DM. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records. Resumen: Introducción: El objetivo fue estimar la incidencia de diabetes mellitus tipo 1 (DM1) en la población infantil de la Comunidad de Madrid (CM) y su evolución entre 1997 y 2016, a partir de los datos médicos-administrativos del registro regional de DM1. Métodos: Fueron incluidos los casos de DM1 de menores de 15 años, notificados al registro regional o captados de fuentes secundarias: Asociación Diabéticos Españoles (1997−2013) y a partir de 2014 del Conjunto Mínimo Básico de Datos hospitalario (CMBDS). Se estimaron tasas de incidencia anual por 100.000 personas-año. La comparación de las tasas se analizó mediante modelos de regresión de Poisson a través de razones de incidencia (RI). Resultados: Un total de 2658 casos fueron identificados como nuevos diagnósticos de DM1. La tasa de incidencia media de 1997−2013 fue de 13,7 casos por 100.000 personas-año. En el periodo 2014−2016, utilizando el CMBDS se registraron 20,0 casos por 100.000. El grupo de edad con mayor incidencia fue el de 10−14 años en los dos periodos (16,6 vs 25,5). En los niños, la edad de mayor incidencia fue de 10 a 14 años en ambos periodos (17,9 vs 30,4) y en las niñas el de 5 a 9 años (17,0 vs 25,1). Las tasas de incidencia descendieron ligeramente en ambos sexos hasta 2013 (de 15,0 a 11,6); en 2014–2016 la tasa de incidencia anual varió entre 18,4 y 21,1 casos (RI: 1,77). La incidencia permaneció estable en menores de 5 años y aumentó de 5 a 14 años. Conclusiones: La CM se sitúa entre las regiones de alta incidencia de DM1. En su primera fase, el registro regional infraestimaba la incidencia de DM1. Con la incorporación del CMBDS como fuente de información, las estimaciones del segundo periodo (2014−2016) son posiblemente más próximas a la incidencia real de DM1. Los datos que presentamos sugieren la necesidad de conocer la evolución real de la incidencia de la enfermedad incorporando los registros digitales sanitarios.

Resumen Introduccion y objetivos La epidemia de obesidad infantil es un problema de salud publica mundial que se inicia a edades muy tempranas. El objetivo del estudio es determinar la persistencia y la variacion del sobrepeso y la obesidad en una cohorte de ninos seguidos de los 4 a los 6 anos de edad. Metodos Los datos proceden del ELOIN (Estudio Longitudinal de Obesidad Infantil), cohorte de base poblacional de la Comunidad de Madrid, en el que participaron 2.435 ninos. Midieron el peso y la talla 31 pediatras, de manera objetiva y estandarizada, a los 4 anos (2012-2013) y a los 6 anos de edad (2014-2015). Se utilizaron 3 criterios de referencia para definir «sin exceso de peso», sobrepeso y obesidad: Organizacion Mundial de la Salud (OMS-2006), International Obesity Task Force (IOTF-2000) y tablas espanolas de la Fundacion Orbegozo-2004. Resultados La prevalencia de sobrepeso a los 4 y los 6 anos, segun los 3 criterios de clasificacion, aumento del 5,7-16,5% (intervalo de los 3 criterios) al 8,9-17,0% y la de obesidad, del 3,0-5,4% al 6,1-10,1%. De cada 4 ninos obesos a los 4 anos, 3 seguian con obesidad a los 6 anos, mientras que un 20,6-29,3% que tenian sobrepeso pasaron a ser obesos. Entre el 8,0 y el 16,1% mantuvieron el «exceso de peso» (sobrepeso/obesidad) entre los 4 y los 6 anos, un 7,9-11% fueron nuevos casos y un 2,2-5,9% remitieron. Conclusiones El exceso de peso aumento de los 4 a los 6 anos. Se observaron variaciones importantes en el estado ponderal susceptibles de intervencion en el control pediatrico del nino sano.

Resumen Introduccion El suicidio es un importante problema de salud publica mundial, de necesario abordaje por su alto potencial preventivo. Este trabajo estudia las principales caracteristicas de las personas ingresadas en hospitales de la Comunidad de Madrid (Espana) con conducta suicida y los factores asociados a su mortalidad intrahospitalaria. Material y metodos Se estudian los codigos E950-E959 de suicidio y lesiones autoinfligidas de la Clasificacion Internacional de Enfermedades, Novena Revision, Modificacion Clinica, contenidos en los campos diagnosticos del conjunto minimo basico de datos al alta hospitalaria entre 2003 y 2013. Se describen variables sociodemograficas, clinicas y asistenciales mediante analisis uni y multivariante de regresion logistica en la valoracion de factores asociados a la mortalidad intrahospitalaria. Resultados La conducta suicida hospitalizada predomina en mujeres (58,7%) y en edades medias. La mortalidad intrahospitalaria es del 2,2% (1,6% en mujeres y 3,2% en hombres), aumentando con la edad. Los trastornos mentales se detectan 3-4 veces mas en diagnosticos secundarios. El diagnostico principal mayoritario (> 74%) es el envenenamiento por sustancias, con una mortalidad inferior (∼1%) a la de las lesiones por ahorcamiento y precipitacion (≥ 12%), que presentan las cifras mas elevadas. Otros factores asociados con una mayor mortalidad son diversas comorbilidades medicas y la gravedad de la lesion, mientras que la estancia y los trastornos mentales son factores protectores en ambos sexos. El tipo de hospital, el envenenamiento con sustancias y el indice de Charlson se asocian a la mortalidad de forma diferencial en hombres y mujeres. Conclusiones Los actos suicidas hospitalizados presentan una baja mortalidad, la cual esta principalmente relacionada con las comorbilidades y la gravedad de las lesiones.

Objective To describe the population who self-reported perceiving information on vaccines provided by health professionals as inadequate, and to analyze factors associated. Methods A Spanish nationwide representative health survey conducted in individuals ≥18 in 2015 (N = 7 800) was used. Respondents were classified according to the question: ‘Do you think that health professionals inform adequately to patients about the advantages and risks of vaccines prior to their administration? (yes/no/non-responders). The association with socio-demographic and health-related characteristics and with opinions/attitudes regarding vaccines were analyzed. Results 33.7% of respondents felt not adequately informed. These individuals had lower influenza vaccination coverage (16.0% vs. 24.1%), and were more distrustful of vaccines in general (8.4% vs. 3.3%) as well as regarding on the influenza vaccine (11.9% vs. 7.6%). Inadequate information was associated with female gender (aOR:1.21,95%CI:1.08–1.35), autochthonous origin (aOR:1.54,95%CI:1.27-–1.87), household income ≤600€/month (aOR:1.45,95%CI:1.10–1.91), poor self-perceived health (aOR:3.17,95%CI:1.36–7.39), and a lower satisfaction with the National Health Service and nurses (aOR:0.92,95%CI:0.89–0.95 and aOR:0.85,95%CI:0.82–0.88). Conclusion A large proportion of the population considers that the information provided regarding vaccines is inadequate. This perception is associated with negative attitudes towards vaccination. Practice implications Further studies are required to deepen our understanding of the problem and to enhance communication provided by healthcare professionals.

BACKGROUND The objective was to describe the main causes of hospitalization in people with Angelman syndrome (AS). METHOD Population-based cross-sectional study in the Community of Madrid (CM), Spain. The information source for AS cases was the information system for rare diseases in the CM. Variables related to hospitalization, for the period 2006-2014, were the following: number of episodes, outcome, main cause, length of stay and type of admission. Main causes of hospitalization were described by age group and sex. RESULTS The most frequent causes of hospitalization were the following: oral-dental care (28.9%), seizures (19.6%), orthopaedic problems (14.4%) and acute respiratory disorders (12.4%). The percentage of hospitalizations was higher for oral-dental care in women and for orthopaedic problems in men (p-value

This study compared the injury incidence rates by sex in adult immigrant and native population attended in primary care in the Community of Madrid, Spain. Cross-sectional study of injuries registered in the primary care electronic medical record in 2012. Crude and age-adjusted incidence rates by sex, region of birth and type of injury were calculated. Poisson regression was performed. In both sexes, the highest crude injury incidence rate was found in immigrants from North Africa, followed by the native population. After controlling for age and socioeconomic-status, the highest risk of injury in immigrants was observed in burns in women from North-African (79%) and in foreign body injuries in men from Latin America and Caribbean, Sub-Saharan and North Africa and Central and Eastern Europe (61-123%). The analysis by region of origin has identified people from North Africa as a particularly vulnerable group.

Objectives To evaluate the association of general and abdominal obesity with high blood pressure in young children. Methods A longitudinal study including 1796 participants from the Madrid region (Spain) with baseline at age 4 years and a follow-up 2 years later. Blood pressure, body mass index and waist circumference were measured during a physical examination. We evaluated the association between obesity at baseline and weight changes between the ages of 4 and 6 years and high blood pressure. Data were analysed using linear and logistic regressions adjusted for covariates. Results Obese 4 year olds (general or abdominal obesity) experienced an average 4–5 mmHg increase in systolic blood pressure and a 2.5–3 mmHg increase in diastolic blood pressure by the age of 6 years. Compared to children maintaining a non-excess weight (based on body mass index) during follow-up incident and persistent cases of excess weight (overweight or obesity) had an odds ratio (OR) for high blood pressure of 2.49 (95% confidence interval (CI) 1.50–4.13) and OR 2.54 (95% CI 1.27–5.07), respectively. Regarding abdominal obesity we estimated OR 2.81 (95% CI 0.98–8.02) for incident cases and OR 3.42 (95% CI 1.38–8.49) for persistent cases. Similar estimates for the waist–height ratio were observed. Individuals who experienced remission to non-excess weight did not have an increased risk of high blood pressure. Conclusions We observed an increased risk for high blood pressure among 4-year-olds who presented with persistent or incident cases of excess weight (body mass index) or abdominal obesity after 2 years of follow-up. Children with excess weight or obesity at baseline who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.

Objectives We aim to describe influenza vaccination coverage for the Spanish population using data from two consecutive nation-wide representative health surveys. The data was analysed by high risk groups, health care workers (HCWs) and immigrants. Also, coverage trends were analysed. Material and methods The 2011/12 Spanish National Health Survey (N = 21,007) and the 2014 European Health Interview Survey for Spain (N = 22,842) were analysed. Influenza vaccination status was self-reported. Time trends for were estimated by a multivariate logistic regression model. Results Overall vaccination uptake was similar in 2011/12 and 2014, 19.1% and 18.9%, respectively, (p > 0.05). 47% of the subjects surveyed were in the groups for which vaccination was recommended with coverages of 41.1% in 2011/12 and 40% in 2014 (p > 0.05). In both surveys, uptake among subjects with a chronic disease was three times higher than uptake in subjects who did not have these diseases. In 2011/12 and 2014, 20% and 27.6% of health workers were vaccinated. Subjects born outside Spain were vaccinated less frequently than Spanish-born subjects (9.3% vs 20.4% and 8.9% vs 20%). Within the diseases studied, the best uptake was for patients with heart disease (52.5% in 2011/12 and 51.1% in 2014) and patients with diabetes (50.5% and 51.8%). Multivariate analysis showed that older age, having a chronic disease or being a HCW increases the possibility of being vaccinated whereas being born outside Spain decreased it. Conclusions Seasonal influenza vaccine uptake rates in the recommended target groups, patients with chronic conditions and health care workers, in Spain are unacceptably low and seem to be stable in the post pandemic seasons. This finding should alert health authorities to the need to work directly with health care providers on the indications for this vaccine and to study strategies that make it possible to increase vaccination uptake.

This study aimed to analyze temporal trends by gender and age in Clostridium difficile infection (CDI)-related hospitalization rates in the Autonomous Community of Madrid (Spain) over a 12-year period. A population-based cross-sectional study of all hospital admissions with a CDI diagnosis from 2003 to 2014 was carried out. Annual age-specific hospitalization rates were calculated by gender. All the analyses were performed separately for total hospitalizations and hospitalizations with CDI as the primary diagnosis. Joinpoint regression models were used to analyze time trends. A total of 13,526 hospital discharges were identified (26.8 % with CDI as the primary diagnosis). In both sexes, a gradient in age-specific rates was observed, ranging in 2014 from 5.92 hospitalizations per 100,000 person-years in patients

(1) Background: The aims of this study were to examine the incidence of lower extremity amputations (LEAs) among patients with type 2 diabetes mellitus (T2DM) and to compare the mortality risk of diabetic individuals who underwent LEA with age and sex-matched diabetic individuals without LEA. (2) Methods: We performed a descriptive observational study to assess the trend in the incidence of LEA and a retrospective cohort study to evaluate whether undergoing LEA is a risk factor for long-term mortality among T2DM patients. Data were obtained from the Hospital Discharge Database for the Autonomous Community of Madrid, Spain (2006&ndash, 2015). (3) Results: The incidence rates of major below-knee and above-knee amputations decreased significantly from 24.9 to 17.1 and from 63.9 to 48.2 per 100000 T2DM individuals from 2006 to 2015, respectively. However, the incidence of minor LEAs increased over time. Mortality was significantly higher among T2DM patients who underwent LEA compared with those who did not undergo this procedure (HR 1.75, 95% CI 1.65&ndash, 1.87). Male sex, older age, and comorbidity were independently associated with higher mortality after LEA. (4) Conclusions: Undergoing a LEA is a significant risk factor for long term mortality among T2DM patients, and those who underwent a major above-knee LEAs have the highest risk.

Summary Aims To examine trends in the incidence, characteristics and in-hospital outcomes of Clostridium difficile infection (CDI) hospitalizations from 2001 to 2015, to compare clinical variables among patients according to the diagnosis position (primary or secondary) of CDI, and to identify factors associated with in-hospital mortality (IHM). Methods A retrospective study was performed using the Spanish National Hospital Discharge Database, 2001–2015. The study population included patients who had CDI as the primary or secondary diagnosis in their discharge report. Annual hospitalization rates were calculated and trends were assessed using Poisson regression models and Jointpoint analysis. Multi-variate logistic regression models were performed to identify variables associated with IHM. Findings In total, 49,347 hospital discharges were identified (52.31% females, 33.69% with CDI as the primary diagnosis). The rate of hospitalization increased from 3.9 cases per 100,000 inhabitants in 2001–2003 to 12.97 cases per 100,000 inhabitants in 2013–2015. Severity of CDI and mean cost per patient increased from 6.36% and 3750.11€ to 11.19% and 4340.91€, respectively, while IHM decreased from 12.66% to 10.66%. Age, Charlson Comorbidity Index, severity, length of hospital stay and mean cost were significantly higher in patients with a primary diagnosis of CDI. Irrespective of the CDI diagnosis position, IHM was associated with male sex, older age, comorbidities, readmission and severity of CDI. Primary diagnosis of CDI was associated with lower IHM (odds ratio 0.60; 95% confidence interval 0.56–0.65). Conclusion CDI-related hospitalization rates are increasing, leading to a high cost burden, although IHM has decreased in recent years. Factors associated with IHM should be considered in strategies for the prevention and management of CDI.

OBJECTIVES Influenza vaccine is recommended in some chronic medical conditions, including several rare diseases. The objectives of the study were to assess the effect of text message reminders on influenza vaccination uptake of patients with selected rare diseases and delayed vaccination, and to describe their characteristics. METHODS Quasi-experimental pre-post intervention study performed along the 2016 influenza vaccination campaign in the Autonomous Community of Madrid. Unvaccinated patients diagnosed with a selected rare disease were targeted for intervention. SMS were sent to them at least one month after the beginning of the campaign, in four consecutive weeks. Those with no mobile phones available or no certainty of message reception, were assigned as controls. The association between the reception of the SMS and vaccination uptake was assessed using multiple poisson regression models. RESULTS Of 69.040 patients with delayed vaccination, 87.2% received an SMS reminder in the asigned contact mobile telephone. Global influenza vaccine coverage reached 41.3%. The uptake of influenza vaccine was significantly higher among those receiving the reminder (9.3% vs. 7.1% in the control group, p

Our objectives were to analyse the place of death, its temporal trend and associated sociodemographic factors among patients with amyotrophic lateral sclerosis (ALS) resident in the Autonomous Community of Madrid. This was a population based cross-sectional study of deaths from ALS (ICD-10 code G12.2) from 2003 to 2011, included in regional death statistics. The sociodemographic variables were age, gender, marital status, place of residence and socioeconomic level. Logistic regressions were performed to identify factors associated with death in hospital, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Joinpoint models were used to analyse annual trends for death in hospital. Of 1035 patients who died of ALS, 56.1% died in a hospital, 30.4% at home, 8.3% in a residential home and it was unknown for 5.1%. The percentage of deaths in hospital was lower in older and in single people than in married ones (55.0% and 61.9%, respectively; ORa 0.74, 95% CI 0.57-0.97). This percentage increased progressively as socioeconomic level fell (66.3% in Q5 compared to 49.6% in Q1, ORa 2.03, 95% CI 1.36-3.02). A significant increase in the percentage of deaths in hospital was observed. In conclusion, factors such as age, marital status or socioeconomic level play a part in the place of death of those with ALS.

SETTING Patients aged ⩾ 40 years with a diagnosis of chronic obstructive pulmonary disease (COPD; codes R95, R79 and R91 in the International Classification for Primary Care) registered in primary care clinical records in the Autonomous Community of Madrid, Spain. OBJECTIVE To assess pneumococcal vaccination coverage in patients with COPD and to analyse factors associated with vaccination uptake. DESIGN Population-based cross-sectional study in which data were collected in September 2010. RESULTS We found that 93,797 patients (72.0% men and 28.0% women) had COPD. Overall coverage was 65.5% (67.5% men vs. 60.4% women, P < 0.001). In patients aged 40-59 years, coverage was 19.5%, reaching 75.8% in those aged ⩾ 60 years. In patients aged

Rationale, aims and objectives Online surveys have several advantages, but a low response rate is common and it is uncertain how results are affected. Response inducement techniques can be used to overcome this problem. The objectives of this study were to describe the percentage of change in the response rate after reminders and to analyse the characteristics associated with non-response and late response based on the survey results, as well as by applying archival and extrapolation techniques. Method In the Autonomous Community of Madrid, an online questionnaire about cancer prevention was sent to a random sample of primary care health professionals (3586 physicians and nurses). Two reminders were sent later. The percentage of change in response rates after reminders, global and by demographic and health care characteristics of participants; and factors associated with non-response and late response were analysed using response rates and odds ratios (ORs). Results After the reminders, the response rate increased from 22.6% to 32.9% and to 39.4%. Non-response was associated with age [OR: 3.14; confidence interval (CI) 95%: 2.23–4.42 for aged >60 years], gender and functional area. Further, a higher response rate after reminders was observed in professionals with heavier workloads (OR: 1.46; CI 95%: 1.08–1.97) and in those who stated a lower relevance of cancer prevention in primary care. Conclusions After electronic reminders, the response rate increased, especially among professionals with the highest workloads and a minor interest in the survey topic. However, possible bias associated with non-response remains and the factors behind this should be examined in future research.

Fundamentos: La busqueda de indicadores apropiados para estimar el riesgo de lesiones por trafico es actualmente un area de interes relevante. El objetivo de este estudio fue realizar una descripcion de la morbilidad hospitalaria y la mortalidad por lesiones por trafico en la Comunidad de Madrid, segun edad y sexo, utilizando y comparando entre si tasas por poblacion, por personas-km y por personas-horas. Metodos: Estudio descriptivo transversal en la Comunidad de Madrid referido al periodo 2003-2005. Se estimaron y compararon por edad y sexo tasas de morbilidad y mortalidad por poblacion, por personas-km recorridos y por personas-horas de desplazamiento. Se utilizaron como fuentes de informacion el Conjunto Minimo Basico de Datos Hospitalarios de 2003-2005, la Encuesta Domiciliaria de Movilidad de 2004 en la Comunidad de Madrid y el registro de mortalidad del Instituto de Estadistica de la Comunidad de Madrid. Resultados: Se identificaron 7.413 altas hospitalarias y 1.046 defunciones. Las tasas poblacionales de morbilidad hospitalaria y mortalidad fueron de 62,24 y 9,20/100.000 habitantes respectivamente en hombres, y de 23,80 y 2,97/100.000 en mujeres, siendo las mas elevadas en varones de 16-24 anos (119,27 altas y 12,00 fallecidos por 100.000 habitantes). Las tasas por exposicion mas altas correspondieron a mujeres de 65 y mas anos: 649,78 altas y 96,72 fallecidas por 10(9) km, y 13,11 altas y 1,95 fallecidas por 10(6) horas de desplazamiento. Conclusiones: La morbi-mortalidad fue mayor en hombres en todos los indicadores. Los indicadores basados en la exposicion a la movilidad, frente a las tasas poblacionales, reducen la morbi-mortalidad de lesiones por trafico en hombres y en edades jovenes y aumentan la misma en edades avanzadas.

Introduction and objectives The childhood obesity epidemic is a worldwide public health problem which starts at very early ages. The aim of this study was to determine the persistence of and variation in overweight and obesity among a cohort of children followed up from 4 to 6 years of age. Methods The data were drawn from the ELOIN (Longitudinal Childhood Obesity Study), a population-based cohort in the Community of Madrid, Spain. A total of 2435 children were involved. Weight and height were objectively measured and standardised at 4 (2012-2013) and 6 years of age (2014-2015) by 31 purpose-trained pediatricians. Three reference criteria were used: the World Health Organization (WHO-2006), International Obesity Task Force (IOTF-2000), and Spanish tables of the Orbegozo Foundation 2004, were used to define “absence of excess weight”, overweight and obesity. Results According to the above three classification criteria, between the ages of 4 and 6 years the prevalence of overweight increased from 5.7%-16.5% (range of the 3 criteria) to 8.9%-17.0%, and obesity increased from 3.0%-5.4% to 6.1%-10.1%. Three out of every 4 obese children at age 4 years persisted with obesity at age 6 years, whereas 20.6%-29.3% who were overweight became obese. A total of 8.0% to 16.1% of children maintained “excess weight” (overweight/obesity), 7.9% to 11% were new cases, and 2.2% to 5.9% showed remission . Conclusions Excess weight increased between the ages of 4 and 6 years. Important variations were observed in weight status susceptible to intervention during well-child visits.

Rationale and objectives Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. Methods We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. Results Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value

The objectives of this study were to estimate incidence density rates (IDR) of herpes zoster (HZ) and to analyze the association with sociodemographic characteristics and selected chronic medical conditions. The study cohort consisted of the adult population included in the Public Health System of the Autonomous Community of Madrid, Spain on 1/10/2009 (5 244 402 persons). Data source were electronic medical records from primary care between 1/10/2009-31/12/2012. Individual socioeconomic status (SES) was inferred by geocoding. Poisson regression analyses were stratified by sex, to identify factors associated with HZ. We identified 81 541 incident cases of HZ (61.7% in women and 46.5% in the group aged 60 and over). IDR was 4.11 per 1000 person-years in men and 5.95 in women. IDR were higher with age, in autochthonous population, those with lower SES and in patients with immunodeficiencies. After adjustment, higher incidence rate ratios were found with age, autochthonous origin, lower SES, and in patients with HIV-infection/AIDS (3.20, CI95% 2.90-3.53 in men and 2.98, CI95% 2.58-3.45 in women), and other immunodeficiencies (1.57, CI95% 1.41-1.75 and 1.65, CI95% 1.50-1.80). COPD, asthma, DM, ischemic heart disease, other cardiovascular diseases, and cancer were also associated with an increased incidence of HZ. We conclude that older, autochthonous patients with lower SES and with certain underlying medical conditions had a higher probability of suffering HZ. Electronic databases are useful for estimating the incidence of HZ, and for finding associations with sociodemographic and clinical characteristics. Identifying unrecognized risk factors for HZ, such as asthma or cardiovascular diseases, is crucial to interpret the epidemiology of HZ, to target vaccination programs and to monitor their effect.

This study aimed to estimate total and age-specific incidence rates of HZ with data from electronic clinical records in primary care (ECRPC) and to analyze trends by sex and age.Descriptive cross-sectional study covering the incident HZ episodes registered in the ECRPC of the Madrid Regional Public Health System in 2005-2012. Annual crude and age-adjusted incidence rates were calculated. Differences by sex and age were assessed by poisson regression. The annual percentage of change (APC) of incidence rates and 'breakthrough points' of the time trends were determined with the Joinpoint Regression Program.211,650 episodes of HZ were identified (60.6% women, 52.2%55 years). The incidence rate increased from 363.21 to 481.92 per 100,000 person-year in 2005-2012. Rates were higher among women and increased with age. The APC for the period was 3.59% in men and 3.67% in women (p0.05). Age-specific rates increased in patients over 14 years. The APC in the 25-44 age group was 7.4% since 2007. The incidence rate ratio (women/men) was highest in this group.The incidence of HZ presents an upward trend in 2005-2012 in adults and the elderly. Monitoring the incidence and age-specific rates, will help to detect changes in trends.

The objectives of this investigation were to study the temporal trends in hospitalizations of patients with sepsis in the Region of Madrid (Spain) from 2003 to 2011 and analyze the factors associated with inpatient mortality. All sepsis hospitalizations from the minimum basic data set (MBDS) during 2003 to 2011 in the Region of Madrid were analyzed. Gender-specific crude and age-adjusted rates were calculated each year. Factors associated with death in these patients were studied with bivariate and multivariate analyses. Simultaneously, sepsis inpatients also underwent descriptive analysis. The study included 98,898 sepsis episodes. The incidence of sepsis hospitalizations per 100,000 habitants increased in males from 114.4 in 2003 to 262.2 in 2011, and in females from 91.2 to 209.1 between 2003 and 2011. The observed inpatient mortality was 23.2 %. There were 45,936 (46.4 %) episodes of severe sepsis (≥1 organ failure), revealing a clear upward trend, especially in multi-organ failure. Severe sepsis mortality showed a decreasing trend in both males (40.0 to 31.8 % from 2003 through 2011) and females (41.6 to 35.2 % from 2003 through 2011). Death was most frequent among the elderly and in patients with more organ failures and comorbidities. In a populous region of Southern Europe, an upward trend in sepsis incidence was observed between 2003 and 2011, as well as a decreasing trend in mortality for sepsis inpatients. Mortality increased with age, comorbidities, and organ failures.

Fundamentos: El primer caso confirmado de gripe pandémica (H1N1) 2009 adquirida en la Comunidad de Madrid (CM) se detectó el 20 de mayo, siendo el caso índice del primer brote escolar de la CM. Los objetivos son describir los brotes escolares ocurridos en la primavera de 2009, las medidas de control implementadas, así como el inicio de la transmisión comunitaria de este virus en la región. Métodos: Estudio observacional descriptivo de los brotes escolares de gripe pandémica (H1N1) 2009 ocurridos en la CM entre el 20 de mayo y el 27 de junio de 2009, y de los casos totales estudiados en ese periodo. Se utiliza la definición de agrupación de casos de gripe adoptada a nivel nacional (3 o más casos). Se analizan los datos clínicos, epidemiológicos y microbiológicos de los casos. Resultados: Se investigaron 1.349 casos asociados a 77 centros escolares de la CM con tres o más casos de gripe notificados durante la primavera de 2009, 47,4% del total de casos en ese periodo (n=2.844). Se detectaron 36 brotes en Leganés (más de un tercio de los centros del municipio), generando las mayores tasas de incidencia acumulada en la Zona Básica de referencia. Se detectaron diferencias en la sintomatología según la edad. Se analizaron 949 muestras por RT-PCR, resultando positivas 555 (58,5%). Conclusiones: La transmisión del virus pandémico en la CM ocurrió de manera sostenida durante la primavera de 2009 a consecuencia de los brotes en centros escolares, significando el inicio de la transmisión comunitaria en España.

AIM To examine incidence and in-hospital outcomes of Clostridium difficile infection (CDI) among patients with type 2 diabetes (T2DM); compare clinical variables among T2DM patients with matched non-T2DM patients hospitalised with CDI and identify factors associated with in-hospital mortality (IHM) among T2DM patients. METHODS We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients that had CDI as primary or secondary diagnosis in their discharge report. For each T2DM patient, we selected a gender, age, readmission status and year-matched non-diabetic patient. RESULTS We identified 44 695 patients with CDI (21.19% with T2DM). We matched 3040 and 5987 couples with a primary and secondary diagnosis of CDI, respectively. Incidence of CDI was higher in T2DM patients (IRR per hospital admission 1.12; 95% CI 1.09-1.14, IRR per population 1.26; 95% CI 1.22-1.29). IHM decreased over time in T2DM and non-T2DM patients (from 15.36% and 13.35%, in 2001-2003 to 10.36% and 11.73% in 2013-2015), despite a concomitant increase in CDI diagnoses overtime. Among those with CDI as secondary diagnosis IHM was higher in nondiabetic 16.17% than in T2DM patients 13.19% (P

Fundamentos: La pandemia de gripe A (H1N1) supuso la puesta en marcha en la Comunidad de Madrid (CM) de nuevas estrategias de vigilancia epidemiologica que diesen respuesta a las necesidades de inmediatez y exhaustividad. Los objetivos de este estudio son describir las caracteristicas de los casos recogidos por este sistema asi como mostrar las posibilidades de desagregacion geografica de estos datos. Metodos: Estudio descriptivo transversal entre el 1 de mayo de 2009 y el 22 de mayo de 2010. Se recabaron diariamente todos los episodios registrados y declarados como gripe en las historias clinicas electronicas de Atencion Primaria del Sistema Sanitario Publico de la CM. Se analizaron los datos por fecha, edad, sexo y zonificacion sanitaria, desagregando hasta profesional sanitario. Resultados: Se registraron 165.492 episodios de gripe (53,8% en mujeres). El mayor numero de casos fue en el grupo de 25 a 49 anos (70.691) y el grupo de 5 a 14 anos alcanzo la mayor tasa de incidencia semanal (1.618,65 por 100.000 en la semana 43). La tasa total semanal maxima fue 458,47 por 100.000 (semana 44). Los pediatras tuvieron el maximo de casos atendidos y de tasas acumuladas (12 de ellos atendieron a mas del 20% de su cupo). Conclusiones: La vigilancia de la gripe pandemica (H1N1) 2009 mediante la captura automatica diaria de datos de las historias clinicas electronicas de Atencion Primaria fue una fuente de informacion de especial utilidad en el seguimiento de la evolucion de la pandemia y la toma de decisiones estrategicas.

BACKGROUND: Socioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age. METHODS: This was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed. RESULTS: A statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15-44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group. CONCLUSION: People with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age. Language: en

The search of suitable indicators for estimating the risk of road traffic injuries is nowadays a relevant topic. The objective of this study was to carry out a comparative description of mortality and inhospital morbidity by age and sex, using population rates and mobility exposure related indicators.Cross sectional study in the Community of Madrid, 2003-2005. Population rates and mortality and morbidity rates per billion of persons-kilometers travelled and per million of persons-hours travelled were estimated and compared by age and sex. The Minimum Basic Hospital Discharge Data Set, the 2004 Mobility House Survey of the Community of Madrid and the mortality register of the Statistic Institute of the Community of Madrid were used as information sources.7,413 hospital discharges and 1,046 deaths were identified. Morbidity and mortality population rates in men were 62.24 and 9.20 respectively, and in women 23.80 and 2.97 per 100,000 inhabitants, being the highest rates those for men aged 16-24 years (119.27 hospital discharges and 12.00 deaths per 100,000 inhabitants). Women of 65 years and older showed the highest mobility related rates: 649.78 hospital discharges and 96.72 deaths per 10(9) km, and 13.11 hospital discharges and 1.95 deaths per 10(6) travelled hours.Morbidity and mortality were higher in men for the three indicators. Rates referred to mobility exposure, faced to population rates, decrease mortality and morbidity due to road traffic injuries in men and young ages and increase both in advanced ages.

Summary Objectives This study aimed to estimate the frequency of hospitalizations due to herpes zoster (HZ) and to describe their clinical characteristics by sex and age group. Methods Descriptive population-based cross-sectional study of hospital admissions due to HZ from 2003 to 2013 among residents in the Autonomous Community of Madrid. Sex, age, comorbidities, length of stay and outcomes were collected and described. Crude and age-adjusted cumulative incidence rates, and stratified by sex and age, were estimated. Robust Poisson regression analysis was used to calculate the incidence rate ratios by age group. Results 2039 hospitalizations were identified (51.0% in women). Complicated HZ caused 48.7% of them (50.9% in women). The hospitalization rate was 2.98/100,000 person-years and 7.19/1000 cases of HZ in primary care. Both rates were significantly higher in men, except in the extreme age groups. An immunosuppression-associated comorbidity was identified in 32.8% of the cases and was less common in patients ≥75 years of age. The median length of stay was 6 days, and in-hospital mortality was 1.4%. Conclusions Hospitalization rates due to HZ were higher in men and increased with age. In two out of every three cases, a comorbidity that potentially caused immunosuppression could not be identified. These cases could benefit from vaccination.

Objectives We aim to compare influenza vaccination coverages obtained using two different methods; a population based computerized vaccination registry and self-reported influenza vaccination status as captured by a population survey. Methods The study was conducted in the Autonomous Community of Madrid (ACM), Spain, and refers to the 2011/12 influenza vaccination campaign. Information on influenza vaccination status according to a computerized registry was extracted from the SISPAL database and crossed with the electronic clinical records in primary care (ECRPC). Self-reported vaccine uptake was obtained from subjects living in the ACM included in the 2011–12 Spanish National Health Survey (SNHS). Independent study variables included: age, sex, immigrant status and the presence of high risk chronic conditions. Vaccination coverages were calculated according to study variables. Crude and adjusted prevalence ratios were computed to assess concordance. Results The study population included 5,245,238 adults living in the ACM in year 2011 with an individual ECRPC and 1449 adult living the ACM and interviewed in the SNHS from October 2011 to June 2012. The weighted vaccination coverage for the study population according to self-reported data was 19.77% and 15.04% from computerized registries resulting in a crude prevalence ratio (cPR) of 1.31 (95% CI 1.20–1.44) so self-reported data significantly overestimated 31% the registry coverage. Self-reported coverages are always higher than registry based coverages when the study population is stratified by the study variables. Self-reported overestimation was higher among men than women, younger age groups, immigrants and those without chronic conditions. Both methods provide the most concordant estimations for the target population of the influenza vaccine. Conclusions Self-report influenza vaccination uptake overestimates vaccination registries coverages. The validity of self-report seems to be negatively affected by socio-demographic variables and the absence of chronic conditions. Possible strategies must be considered and implemented to improve both coverage estimation methods.

ResumenObjetivoDescribir la incidencia de lesiones atendidas en atención primaria y analizar su distribución según el tipo de lesión por sexo y edad en la Comunidad de Madrid en el año 2011.MétodosEstudio descriptivo transversal a partir de la historia clínica electrónica de atención primaria, del sistema sanitario público de la Comunidad de Madrid, en 2011. Se calcularon la incidencia de las lesiones, las tasas específicas de lesiones (fracturas, esguinces, heridas, quemaduras, lesiones por cuerpo extraño, intoxicaciones y contusiones) y las razones de tasas con un intervalo de confianza del 95%, todas estratificadas por sexo y edad.ResultadosEn 2011 se registraron 707.800 episodios de lesiones (3,5% del total de los episodios atendidos en atención primaria). La mayoría afectaron a mujeres (54,0%) y a mayores de 34 años (58,0%). Las más frecuentes fueron las heridas en los hombres (35,3%) y las contusiones en las mujeres (30,6%). Globalmente, las mujeres presentaron tasas más altas de lesiones en edades avanzadas y los hombres se lesionaron más por debajo de los 15 años de edad. Por tipo de lesión, las tasas más altas de fracturas, quemaduras y contusiones se observaron en la población de mayor edad, las de lesiones por cuerpo extraño y heridas en la infancia, las luxaciones en jóvenes y las intoxicaciones en las edades extremas.ConclusionesLa vulnerabilidad especial de varones menores de 5 años y de las ancianas sugiere que las intervenciones tienen que dirigirse a las necesidades específicas de estos grupos.AbstractObjectiveTo describe the incidence of injuries treated in primary care by type of injury, age groups, and sex in the publicly-funded health system of the region of Madrid in Spain.MethodsA descriptive cross sectional study was performed of injury episodes registered in the primary care electronic medical records of the health system of Madrid in 2011. We calculated the global incidence of injuries, injury-specific rates for fractures, sprains, wounds, burns, foreign body injuries, poisoning and bruises, and their rate ratios with 95% confidence intervals, all of which were stratified by sex and age groups.ResultsIn 2011 there were 707,800 injury episodes (3.5% of all episodes treated in primary care). Most of the injuries occurred in women (54.0%) and in persons older than 34 years (58.0%). The most common injuries were wounds in men (35.3%) and bruises in women (30.6%). Overall, women had higher rates of injuries among the elderly and men had more injuries in the group younger than 15 years. By type of injury, the highest rates of fractures, burns and bruises were observed in the older population, foreign body injuries and wounds in children, sprains in youth, and poisonings in extreme ages.ConclusionsThe special vulnerability of boys younger than 5 years and elderly women suggests that intervention strategies should be targeted to the specific needs of these groups.

We aim to determine 2012–13 seasonal influenza vaccination coverage. Data were analyzed by age group and by coexistence of concomitant chronic conditions. Factors associated with vaccine uptake were identified. We also analyze a possible trend in vaccine uptake in post pandemic seasons. We used computerized immunization registries and clinical records of the entire population of the Autonomous Community of Madrid, Spain (6 284 128 persons) as data source. A total of 871 631 individuals were vaccinated (13.87%). Coverage for people aged ≥ 65 years was 56.57%. Global coverage in people with a chronic condition was 15.7% in children and 18.69% in adults aged 15–59 years. The variables significantly associated with a higher likelihood of being vaccinated in the 2012–13 campaign for the age groups studied were higher age, being Spanish-born, higher number of doses of seasonal vaccine received in previous campaigns, uptake of pandemic vaccination, and having a chronic condition. We conclude that vaccination coverage in persons aged

Summary Objectives To describe the population targeted for the rapid HIV testing program delivered via socio-culturally adapted services in primary care centers and to assess factors associated with uptake of first-time testing. Methods This was a descriptive cross-sectional study. We analyzed consultations between April 29, 2010 and May 31, 2012. We assessed the differences in age, origin, education, and sexual history between men who have sex with men (MSM), heterosexual men (HM), and women, using a two-sided independent t -test and Chi-square statistics. Factors associated with first-time testing were analyzed by logistic regression. Results Of 1940 consultations, 45.1% were HM, 25.4% MSM, and 29.5% women; 35.4% were immigrants, 2.5% were or had been sex workers, and 15.4% had visited one. The test was reactive in 2.1%. Up to 44.2% had never been tested. The probability of being tested for the first time increased in HM, women, populations from the Indian Subcontinent, those with no casual sexual partners, those whose partner's serostatus was unknown, and those with no history of other sexually transmitted infections. Conclusions This program managed to reach a high proportion of vulnerable people. First time HIV testing rates were high.

Objectives We aim to describe influenza vaccination coverage for the Spanish population across four consecutive campaigns (2008/2009 to 2011/2012). The data was analyzed by high risk groups and health care workers (HCWs). Also, coverage trends were analyzed to assess uptake in post-pandemic seasons. Methods We used data from two nation-wide representative health surveys namely the 2009/10 European Health Interview Survey for Spain (N = 22,188) and the 2011–12 Spanish National Health Survey (N = 21,007) Influenza vaccination status was self-reported. We analyzed influenza vaccine coverage by age, sex, number of chronic conditions, being a heath care worker (HCWs) and nationality. Time trends for campaigns among high risk groups were estimated by a multivariate logistic regression model. Results We analyzed data from 43,072 subjects aged ≥16 years. As a whole, coverage decreased by 3.31% (22.57–19.26%) between the 2008/2009 and 2011/2012 campaigns with a significant decreasing trend (OR 0.92; 95% CI: 0.90–0.94). Coverage in people under 60 years with a chronic disease decreased significantly (OR 0.92: 95% CI: 0.85–0.99) during the analyzed period from 21.02% in 2008/2009 to 17.40% in 2011/2012. Among HCWs, the highest influenza vaccination coverage was achieved in 2009/2010 (31.08%) in the latest campaign coverage has almost halved (17.88%). For the 2011/2012 season and for all age groups the variables associated with a higher probability of having received the influenza vaccine were older age and presence of associated chronic conditions. Among those aged ≥60 years, immigrants had lower uptake (OR 0.60; 95% CI: 0.32–0.99). Conclusions Seasonal influenza vaccine uptake rates in the recommended target groups in Spain are unacceptably low and seem to be decreasing in the post pandemic seasons. Further studies are necessary to precisely identify reasons for non-compliance and barriers to influenza vaccination. Meanwhile urgent strategies to improve seasonal vaccination uptake must be discussed and implemented.

We appreciate the interest of Pigatto et al. in our review (Esteban-Vasallo et al. 2012). We understand their concern regarding mercury amalgams; however, the purpose of our review was to summarize the available information on total mercury, cadmium, and lead levels in human placental tissue, obtained from studies that reported original quantitative data. Published evidence suggests a possible association between mercury released from mercury-containing dental amalgam fillings and levels of this metal in diverse fetal tissues (kidney, brain, and cord blood) (Drasch et al. 1994). In contrast, studies focusing on human placenta and amalgams are scarce and their results inconsistent. The only two studies included in our review that assessed a possible relationship between dental fillings and total mercury—a small study in Taiwan (46 women) (Hsu et al. 2007) and another in Jamaica (52 women) (Grant et al. 2010)—found no association. Only Ask et al. (2002) reported higher mercury levels in mothers with a higher number of fillings, but they studied inorganic mercury and not total mercury. None of the studies mentioned by Pigatto et al. in their letter (Clarkson and Magos 2006; Gundacker and Hengstschlager 2012; Richardson et al. 2011) includes original data, although we did identify an additional reference from those articles that might provide more data on this issue, a symposium abstract by Ursinyova et al. (2006). In this abstract, the authors described a significant correlation between the number of amalgams and placental mercury levels in 409 women; however, these findings have not yet been published in a full report that would allow us to better evaluate the results. In addition, Wannag and Skjaerasen (1975) seemed to provide original information, but we were unable to find this paper for our review. In this context, we have to disagree with Pigatto et al.; in our opinion, the association between mercury exposure from dental amalgam fillings and levels of this metal in human placenta cannot yet be considered as well-established.

BACKGROUND: Placental tissue may furnish information on the exposure of both mother and fetus. Mercury (Hg), cadmium (Cd), and lead (Pb) are toxicants of interest in pregnancy because they are associated with alterations in child development. OBJECTIVES: The aim of this study was to summarize the available information regarding total Hg, Cd, and Pb levels in human placenta and possible related factors. METHODS: We performed a systematic search of PubMed/MEDLINE, EMBASE, Lilacs, OSH, and Web of Science for original papers on total Hg, Cd, or Pb levels in human placenta that were published in English or Spanish (1976-2011). Data on study design, population characteristics, collection and analysis of placenta specimens, and main results were extracted using a standardized form. RESULTS: We found a total of 79 papers (73 different studies). Hg, Cd, and Pb levels were reported in 24, 46, and 46 studies, respectively. Most studies included small convenience samples of healthy pregnant women. Studies were heterogeneous regarding populations selected, processing of specimens, and presentation of results. Hg concentrations > 50 ng/g were found in China (Shanghai), Japan, and the Faroe Islands. Cd levels ranged from 1.2 ng/g to 53 ng/g and were highest in the United States, Japan, and Eastern Europe. Pb showed the greatest variability, with levels ranging from 1.18 ng/g in China (Shanghai) to 500 ng/g in a polluted area of Poland. CONCLUSION: The use of the placenta as a biomarker to assess heavy metals exposure is not properly developed because of heterogeneity among the studies. International standardized protocols are needed to enhance comparability and increase the usefulness of this promising tissue in biomonitoring studies. We thank the librarians of the Móstoles Hospital and of the National Health Sciences Library (ISCIII). Sí

Background: Some immigrants and refugees might be more vulnerable than other groups to pandemic influenza because of pre-existing health and social disparities, migration history and living conditions. The objective of this study was to compare, between the immigrant and autochtonous population, the incidence and characteristics of influenza cases consulting in primary care (PC) and severe influenza cases. Methods: Descriptive cross-sectional study of influenza episodes registered in PC and severe influenza cases reported between 1 May 2009 and 22 May 2010, by gender and origin. Age-adjusted rates were calculated and the association between origin and chronic pathology, pregnancy, delay in admission to hospital and admission to intensive care units (ICU) was analyzed by logistic regression and generalized linear models. Results: The influenza rate in PC, adjusted by age, was lower for immigrant population (2396.3, 95% confidence interval (95% CI) 2362.5–2430.0 vs. 2795.9, 95% CI 2780.4–2811.5 per 100 000). The difference between severe influenza rates by origin was not statistically significant. Chronic conditions were less common in immigrant population. In severe influenza cases, pregnancy was more common in immigrant women, and the probability of admission to ICU was higher in men from Central and Eastern Europe (prevalence ratio (PR) 8.44, 95% CI 2.81–25.40) and North African women (PR 3.30, 95% CI 1.09–10.05). Conclusion: Differences in influenza rates were detected by origin. This information could be useful for new pandemic wave management purposes, in addition to targetting future investigations. Pandemic influenza preparedness and response plans should incorporate specific actions to improve immigrants’ access to health services and to decrease cultural barriers.