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Recent studies revealed that children who are overweight have a higher risk of iron deficiency, although the etiology of this relationship remains unclear. The aim of the study was to evaluate the association between changes in obesity status between 4 and 9 years of age and iron deficiency.This population-based cohort study included 1347 children from the ELOIN study, conducted in Madrid, Spain. Follow-up with physical examinations and a computer-assisted telephone interview were carried out at 4, 6 and 9 years of age, and a blood test was performed at 9 years.Changes in obesity were estimated based on body mass index and waist circumference, according to the persistence or variation in obesity rates at 4, 6 and 9 years and were classified as follows: (1) Stable without obesity; (2) Remitting obesity at 9 years; (3) Incident obesity or relapse at 9 years; and (4) Stable with obesity. Iron deficiency was defined as transferrin saturation value below 16%. Odds ratios (ORs) for iron deficiency were estimated according to obesity status using logistic regression and adjusted for confounding variables, including C-reactive protein (CRP).The prevalence of iron deficiency in the stable general obesity (GO) and abdominal obesity (AO) groups was 38.2% and 41.2%, versus 23.6% and 23.4% in the stable without obesity groups, respectively. The ORs for iron deficiency were 1.85 (95% CI: 1.03-3.32) in the stable GO group and 2.34 (95% CI: 1.29-4.24) in the stable AO group. This association disappeared when CRP was included in the analysis.An extended state of obesity during the first stages of life is associated with iron deficiency, and this association may be mediated by CRP. Prevention and early detection of obesity in children should be a priority to avoid a double burden of malnutrition.

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.

Background The objective was to estimate the prevalence of household food insecurity (HFI) depending on sociodemographic factors and its association with lifestyle habits and childhood overweight and obesity. Methods Data was collected from 1,938 children aged 2 to 14 years who participated in the “Study about Malnutrition” of the Community of Madrid. Weight and height were obtained through physical examination. Body mass index was calculated as weight/height2 (kg/m2) and the criteria of the WHO were used for determining conditions of overweight and obesity. The participants’ parents answered a structured questionnaire about their diet, lifestyle (physical activity and screen time), and food insecurity. The diet quality was assessed with the Healthy Eating Index in Spain and food insecurity, defined as the lack of consistent access to sufficient food for a healthy life, was measured via three screening questions and the Household Food Insecurity Access Scale (HFIAS). Odds Ratios (ORs) and Relative Risk Ratios (RRRs) were estimated using logistic regression models and adjusted for confounding variables. Results The overall prevalence of HFI was 7.7% (95% CI: 6.6‒9.0), with lower values in children 2 to 4 years old (5.7%, 95% CI: 4.0‒8.1) and significantly higher values in households with low family purchasing power [37.3%; OR: 8.99 (95% CI: 5.5‒14.6)]. A higher prevalence of overweight (33.1%) and obesity (28.4%) was observed in children from families with HFI, who presented a lower quality diet and longer screen time compared to those from food-secure households (21.0% and 11.5%, respectively). The RRR of children in families with HFI relative to those from food-secure households was 2.41 (95% CI: 1.5‒4.0) for overweight and 1.99 (95% CI: 1.2‒3.4) for obesity. Conclusion The prevalence of HFI was high in the paediatric population, especially in households with low family purchasing power. HFI was associated with lower diet quality and higher prevalence of childhood overweight and obesity. Our results suggest the need for paediatric services to detect at-risk households at an early stage to avoid this dual burden of child malnutrition.

Background. The objective was to estimate the prevalence of household food insecurity (HFI), associated sociodemographic factors and their relationship with childhood overweight and obesity.Methods. The data come from 1,938 children aged 2 to 14 years who participated in the Malnutrition Study of the Community of Madrid. Weight and height were obtained through physical examination. Body mass index was calculated as weight in kilograms divided by height in meters squared, and for the definition of overweight and obesity, the criteria of the World Health Organization (WHO) were used. The parents of the participants answered a structured questionnaire about the diet, lifestyle (physical activity and use of TV and computer screens) and food insecurity. The diet quality was assessed by the Healthy Eating Index (HEI) in Spain. The HFI was evaluated with the Household Food Insecurity Access (HFIAS) survey. Odds Ratios (ORs) and Relative Risk Ratios (RRRs) were estimated using logistic regression models adjusted for confounding variables.Results. The prevalence of HFI was 7.7% (95% CI: 6.6-9.0). The prevalence was lower in children 2 to 4 years (5.7%, 95% CI: 4.0-8.1) and higher in households with low family purchasing power (37.3%; OR: 8.99 (95% CI: 5.5-14.6). Children who were at HFI had a lower diet quality and spent more time in front of screens, and had a higher prevalence of overweight (33.1%) and obesity (28.4%) than those who lived in household food security (HFS) (21.0% and 11.5%, respectively). Compared with children in HFS, those who lived in HFI had RRRs of overweight of 2.41 (95% CI: 1.5-4.0) and 1.99 (95% CI: 1.2-3.4) of obesity.Conclusions. HFI reaches a high prevalence among children, especially in households with low family purchasing power. HFI probably is associated with lower diet quality and an increase in the prevalence of childhood overweight and obesity. Our results suggest the need to detect early, in paediatric services, at-risk households to avoid this double burden of child malnutrition.

Background Studies have shown that overweight and obesity conditions tend to be stable from childhood and adolescence to adulthood. Unfortunately, little is known about the evolution of abdominal obesity during childhood. The aim of this study was to evaluate the temporal variations and risk of general and abdominal obesity between 4, 6, and 9 years of age. Methods Measurements of children in the ELOIN study taken at the three follow-ups of 4, 6, and 9 years of age were included (N = 1,902). Body mass index and waist circumference were recorded via physical examination. General obesity was determined according to the criteria of the World Health Organization (WHO) and abdominal obesity according to the cut-off points proposed by the International Diabetes Federation (IDF). Prevalence ratios (PRs) were estimated by sex and family affluence using generalized estimating equation models and relative risks (RRs) of obesity were obtained via Poisson regression. Results The prevalence of general obesity was 5.1%, 9.1%, and 15.6% at 4, 6, and 9 years, respectively, yielding a PR of 3.05 (95%CI: 2.55–3.60) (9 years old relative to 4 years). The prevalence of abdominal obesity was 6.8%, 8.4%, 14.5% at 4, 6, and 9 years, respectively, and the PR was 2.14 (95%CI: 1.82–2.51) (9 years old relative to 4 years). An inverse correlation was observed between both general and abdominal obesity and socioeconomic status. Among participants with general or abdominal obesity at 4 years of age, 77.3% and 63.6% remained in their obesity classification at 9 years, respectively, and 3.4% and 3.5% presented general or abdominal obesity also at 6 and 9 years of age, respectively. The RRs of general and abdominal obesity at 9 years were 4.61 (95%CI: 2.76–7.72) and 4.14 (95%CI: 2.65–6.48) for children classified with obesity at 4 years of age, increased to 9.36 (95%CI: 7.72–11.35) and 9.56 (95%CI: 7.79–11.74) for children who had obesity at 6 years, and up to 10.27 (95%CI: 8.52–12.37) and 9.88 (95%CI: 8.07–12.11) for children with obesity at both 4 and 6 years, respectively. Conclusions General and abdominal obesity begin at an early age and increase over time, showing an inverse correlation with socioeconomic status. In addition, general and abdominal obesity at 9 years are strongly associated with being classified with obesity at 4 and 6 years, so preventive interventions should be established at very early ages.

This article presents a novel mathematical model to describe the spread of an infectious disease in the presence of social and health events: it uses 15 compartments, 7 convolution integrals and 4 types of infected individuals, asymptomatic, mild, moderate and severe. A unique feature of this work is that the convolutions and the compartments have been selected to maximize the number of independent input parameters, leading to a 56-parameter model where only one had to evolve over time. The results show that 1) the proposed mathematical model is flexible and robust enough to describe the complex dynamic of the pandemic during the first three waves of the COVID-19 spread in the region of Madrid (Spain) and 2) the proposed model allows us to calculate the number of asymptomatic individuals and the number of persons who presented antibodies during the first waves. The study shows that the following results are compatible with the reported data: close to 28% of the infected individuals were asymptomatic during the three waves, close to 29% of asymptomatic individuals were detected during the subsequent waves and close to 26% of the Madrid population had antibodies at the end of the third wave. This calculated number of persons with antibodies is in great agreement with four direct measurements obtained from an independent sero-epidemiological research. In addition, six calculated curves (total number of confirmed cases, asymptomatic who are confirmed as positive, hospital admissions and discharges and intensive care units admissions) show good agreement with data from an epidemiological surveillance database.

Background The use of electronic media is widespread among young people and is a potential tool for the perpetration of intimate-partner violence (IPV) towards women. The aim of this study is to validate two questions focused on harassment and control by electronic tools (HCE-2) as a screening tool for the detection of IPV in young women. Methods The data source was the third Community of Madrid IPV survey in 2014. The screening tool consisted of two questions with five possible answers prepared by a group of experts. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The validity indices (with 95% confidence intervals) were compared between two age groups: 18–24 and 25–29 years. Results Six hundred ninty-four women were sampled. The response rate was 68.7%, and 477 surveys were analyzed. The prevalence of IPV was 10.7% (95% CI: 8.2–13.8). HCE-2 was positive in 5.9% (95% CI: 4.1–8.4). The overall efficiency of the test was 93.5% (95% CI: 91.1–96.7), sensitivity 47.1% (95% CI: 33.7–60.8), specificity 99.1% (95% CI: 97.5–99.6), and positive predictive value 85.7% (95% CI: 67.1–94.6). The best validity indices of the questionnaire were observed in women aged 18 to 24 years: overall efficiency of the test 95.1% (95% CI: 92.6–97.7), sensitivity 62.5% (95% CI: 44.5–77.6), specificity 99.6% (95% CI: 97.0–99.9), and positive predictive value 95.2% (95% CI: 71.7–99.4). Conclusions The existing need to improve the detection of IPV in young women and the good validity indices observed here justify the recommendation of the HCE-2 questionnaire as a screening tool in young women.

Background A relationship between obesity early life has been reported. The aim of this study was to evaluate the variations in general (GO) and abdominal (AO) obesity between 4 and 9 years of age. Methods Children who participated in all three follow-ups at 4, 6 and 9 years participating in ELOIN study (N = 1902). Measurements of BMI and waist circumference were taken by physical examination. Prevalence ratios (PRs) were estimated by sex and family affluence by generalized estimation equation models, and the relative risks (RRs) of obesity by Poisson regression. Results The prevalence of GO was 5.1%, 9.1%, and 15.6% at 4, 6, and 9 years, yielding a PR between 9 − 4 years of 3.05 (95%CI: 2.58–3.60). The prevalence of AO was 6.8%, 8.4%, 14.5%, and the PR (9 vs 4y) was 2.14 (95%CI: 1.85–2.48). GO and AO presented an inverse correlation with family affluence. Among participants who were in GO or AO at 4 years, 77.3% and 63.6% remained in obesity after 5 years. The RRs of GO and AO at 9 years were 4.6 and 4.1 if they were obese at 4 years (p

BackgroundPrevious studies investigating the relationship of influenza with acute myocardial infarction (AMI) have not distinguished between AMI types 1 and 2. Influenza and cold temperature can explain the increased incidence of AMI during winter but, because they are closely related in temperate regions, their relative contribution is unknown. Methods and ResultsThe temporal relationship between incidence rates of AMI with demonstrated culprit plaque (type 1 AMI) from the regional primary angioplasty network and influenza, adjusted for ambient temperature, was studied in Madrid region (Spain) during 5 influenza seasons (from June 2013 to June 2018). A time‐series analysis with quasi‐Poisson regression models and distributed lag‐nonlinear models was used. The incidence rate of type 1 AMI according to influenza vaccination status was also explored. A total of 8240 cases of confirmed type 1 AMI were recorded. The overall risk ratio (RR) of type 1 AMI during epidemic periods, adjusted for year, month, and temperature, was 1.23 (95% CI, 1.03–1.47). An increase of weekly influenza rate of 50 cases per 100 000 inhabitants resulted in an RR for type 1 AMI of 1.16 (95% CI, 1.09–1.23) during the same week, disappearing 1 week after. When adjusted for influenza, a decrease of 1ºC in the minimum temperature resulted in an increase of 2.5% type 1 AMI. Influenza vaccination was associated with a decreased risk of type 1 AMI in subjects aged 60 to 64 years (RR, 0.58; 95% CI, 0.47–0.71) and ≥65 years (RR, 0.53; 95% CI, 0.49–0.57). ConclusionsInfluenza and cold temperature were both independently associated with an increased risk of type 1 AMI, whereas vaccination was associated with a reduced risk among older patients., This work has been partially funded by unrestricted research grants from the Fundación para la Investigación Biomédica, University Hospital “Príncipe de Asturias” (Servicio Madrileño de Salud, Madrid, Spain) (to Drs García‐Lledó and de Abajo) and funding from Sanofi‐Pasteur S.A., a manufacturer of influenza vaccines (to Dr de Abajo). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing the report. Dr Tobías received support from the Japanese Society for the Promotion of Science in its invitation‐to‐research fellowship program in Japan (S18149).

INTRODUCTION: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. MATERIAL AND METHODS: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. RESULTS: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. CONCLUSION: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.

The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.

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: Objetivo: Realizar una validación concurrente de la versión corta del Woman Abuse Screening Tool (WAST), un instrumento utilizado en la detección de violencia de pareja hacia la mujer, estimando los índices de validez en población general. Método: La fuente de información fue la tercera Encuesta de violencia de pareja hacia la mujer de la Comunidad de Madrid de 2014, realizada a mujeres de 18 a 70 años. Como referencia se utilizó la definición de violencia de pareja hacia la mujer basada en un cuestionario de 26 preguntas. La versión corta del WAST incluye dos preguntas con tres respuestas posibles. Se calculan y comparan la prevalencia de violencia de pareja hacia la mujer y los índices de validez del cuestionario según dos criterios de puntuación con intervalos de confianza del 95% (IC95%). Resultados: La tasa de respuesta fue del 60%. Se analizaron 2979 encuestas. La prevalencia de violencia de pareja hacia la mujer fue del 7,6% (IC95%: 6,6-8,5%). Se encontró un 21,1% (IC95%: 19,6-22,5) de test positivos según el criterio 1 y un 11,0% (IC95%: 9,9-12,1) según el criterio 2. El criterio 2 presentó una mayor eficiencia global del test (81,5% [IC95%: 80,1-82,9] para el criterio 1 vs. 88,8% [IC95%:87,7-89,9] para el criterio 2). Los mejores índices se obtuvieron en mujeres a partir de 30 años de edad. Conclusiones: La versión reducida del cuestionario WAST presentó índices de validez aceptables para ser utilizados como cuestionario de cribado de violencia de pareja hacia la mujer. Recomendamos utilizar el criterio 2 de puntuación en la estimación de la prevalencia de violencia de pareja hacia la mujer en encuestas dirigidas a población general. Abstract: Objective: To perform a concurrent validation of the short version of the Woman Abuse Screening Tool (WAST), used to detect intimate partner violence, estimating the validity indexes in the general population. Method: The information source was the third Intimate partner violence survey in the Region of Madrid (Spain) conducted on women aged 18-70 in 2014. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The short version of WAST includes two questions with three possible answers. The prevalence of intimate partner violence and the validity indexes were calculated and compared according to two scoring criteria with 95% confidence intervals (95%CI). Results: The response rate was 60.0%, and 2979 surveys were analysed. The prevalence of intimate partner violence was 7.6% (95%CI: 6.6-8.5). We showed 21.1% (95%CI: 19.6-22.5) positive test results according to WAST criterion 1 and 11.0% (95%CI: 9.9-12.1) according to criterion 2. Criterion 2 presented higher overall efficiency of the test (81.5% [95%CI: 80.1-82.9] criterion 1 vs. 88.8% [95%CI: 87.7-89.9] criterion 2). The best indexes were obtained in women ≥30 years old. Conclusions: The short version of the WAST showed acceptable validity indexes for use as a screening tool of intimate partner violence in the general population. We recommend using scoring criterion 2 to estimate prevalence of intimate partner violence in surveys on the general population.

Resumen Introduccion Streptococcus pneumoniae es una causa importante de morbilidad, y la vacuna es la medida mas eficaz para prevenirla. El objetivo de este estudio es analizar la evolucion de la enfermedad neumococica invasora (ENI). Material y metodos Estudio observacional de los casos de ENI residentes en la Comunidad de Madrid notificados a la Red de Vigilancia Epidemiologica entre los anos 2008 y 2015. El caso de ENI se definio como la enfermedad producida por Streptococcus pneumoniae, con aislamiento, deteccion de ADN o deteccion de antigeno, en muestras procedentes de sitios normalmente esteriles. Las cepas aisladas se enviaron al Laboratorio Regional de Salud Publica para la identificacion del serotipo. Los serotipos se clasificaron segun su inclusion en la vacuna heptavalente (VCN7), en la vacuna trecevalente pero no en la heptavalente (VCN13 adicional) y no incluidos en la VCN13 (no VCN). Se calcularon las razones de incidencia (RI) comparando los periodos 2011-2012 y 2013-2015 con el periodo 2008-2010. Resultados Se notificaron 4.307 casos. El 86,6% fueron serotipados. La RI de ENI para todos los serotipos fue de 0,67 y de 0,67; la RI para los serotipos VCN7 fue de 0,43 y de 0,45; la RI para los VCN13 adicional fue de 0,46 y de 0,25, y la RI para los no VCN fue de 1,01 y de 1,32 en los periodos 2011-2012 y 2013-2015. Los serotipos 8, 9 N, 10A, 23B, 24F y el serogrupo 33 incrementaron su incidencia de manera significativa en el periodo 2013-2015. Los serotipos 15B y 24F supusieron el 24% de los casos no VCN13 en menores de 5 anos, los serotipos 8 y 9 N el 51% en poblacion de 5 a 59 anos y los serotipos 8 y 22F el 25% en mayores de 59 anos. Conclusiones La incidencia de serotipos no incluidos en vacunas conjugadas ha aumentado, especialmente en menores de 5 anos, pero la incidencia total de ENI ha disminuido. Es imprescindible continuar con los programas de vigilancia epidemiologica y microbiologica para valorar el efecto de la vacunacion sobre la incidencia de la ENI.

Introduction: Breastfeeding has important benefits for population health. The aims of this study are: (i) to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii) analyse the reasons for not starting or abandoning of breastfeeding, and (iii) describe the factors associated with the initiation and duration of exclusive breastfeeding. Material and methods: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2627 children born in 2008–2009 from the Community of Madrid was studied. Logistic regression models were used. Results: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6 months 25.4%, and prevalence of breastfeeding at 2 years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35 years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. Conclusions: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008–2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring. Resumen: Introducción: La lactancia materna tiene importantes beneficios para la salud poblacional. Los objetivos de este estudio son: a) conocer la prevalencia y duración de la lactancia materna y lactancia materna exclusiva; b) analizar las razones de no inicio y de abandono de la lactancia materna, y c) describir los factores asociados a la lactancia materna exclusiva y con su mantenimiento durante 6 meses. Material y métodos: Estudio transversal a partir de datos basales de la cohorte ELOIN, obtenidos por cuestionario epidemiológico. Se estudió una muestra de 2.627 niños de 4 años nacidos en 2008-2009 de la Comunidad de Madrid. Se utilizaron modelos de regresión logística. Resultados: La prevalencia de lactancia materna exclusiva y lactancia materna fue del 77,6 y del 88%, respectivamente; la lactancia materna exclusiva a los 6 meses fue del 25,4%, y la lactancia materna a los 2 años, del 7,7%. Las razones principales de finalización de la lactancia fueron la producción insuficiente de leche (36%) y la incorporación al trabajo (25,9%). Las variables asociadas con el inicio o mantenimiento de la lactancia materna exclusiva fueron: madre de más de 35 años, estatus económico medio-alto, extranjera con menos de 10 años de residencia en España y haber participado en taller de lactancia tras el parto. Conclusiones: La prevalencia de lactancia materna en la Comunidad de Madrid no alcanzó en 2008-2009 las recomendaciones internacionales. Es necesario intensificar estrategias de promoción, protección y apoyo a la lactancia materna, incluyendo su monitorización periódica.

Resumen: Introducción: La lactancia materna tiene importantes beneficios para la salud poblacional. Los objetivos de este estudio son: a) conocer la prevalencia y duración de la lactancia materna y lactancia materna exclusiva; b) analizar las razones de no inicio y de abandono de la lactancia materna, y c) describir los factores asociados a la lactancia materna exclusiva y con su mantenimiento durante 6 meses. Material y métodos: Estudio transversal a partir de datos basales de la cohorte ELOIN, obtenidos por cuestionario epidemiológico. Se estudió una muestra de 2.627 niños de 4 años nacidos en 2008-2009 de la Comunidad de Madrid. Se utilizaron modelos de regresión logística. Resultados: La prevalencia de lactancia materna exclusiva y lactancia materna fue del 77,6 y del 88%, respectivamente; la lactancia materna exclusiva a los 6 meses fue del 25,4%, y la lactancia materna a los 2 años, del 7,7%. Las razones principales de finalización de la lactancia fueron la producción insuficiente de leche (36%) y la incorporación al trabajo (25,9%). Las variables asociadas con el inicio o mantenimiento de la lactancia materna exclusiva fueron: madre de más de 35 años, estatus económico medio-alto, extranjera con menos de 10 años de residencia en España y haber participado en taller de lactancia tras el parto. Conclusiones: La prevalencia de lactancia materna en la Comunidad de Madrid no alcanzó en 2008-2009 las recomendaciones internacionales. Es necesario intensificar estrategias de promoción, protección y apoyo a la lactancia materna, incluyendo su monitorización periódica. Abstract: Introduction: Breastfeeding has important benefits for population health. The aims of this study are: (i) to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii) analyse the reasons for not starting or abandoning of breastfeeding, and (iii) describe the factors associated with the initiation and duration of exclusive breastfeeding. Material and methods: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2,627 children born in 2008-2009 from the Community of Madrid was studied. Logistic regression models were used. Results: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6 months 25.4%, and prevalence of breastfeeding at 2 years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35 years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. Conclusions: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008-2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring.

Background: Chickenpox is a contagious airborne disease. Immunization by varicella vaccine is an effective preventive measure. The objective of this study is to evaluate the impact and effectiveness of a single-dose vaccination against chickenpox at 15 months of age. Methods: Observational study based on data from the Epidemiological Surveillance System of the Autonomous Community of Madrid from 2001 to 2015. The years were grouped into 4 periods according to epidemic cycles and vaccination schedule: 2001–06, 2007–10, 2011–13 and 2014–15. The impact was calculated as Relative Risk (RR) between the incidence of chickenpox in children between 15 months and 13 years of age between 2011–13 and 2001–06 through Poisson regression using notifications made to the Diseases of Compulsory Declaration (DCD) system, the Sentinel Physicians Network (SPN) and hospital discharge records noted as Minimum Basic Data Set (MBDS). The vaccine effectiveness (VE) was calculated using the screening method and a 1:2 case-control study paired by age and paediatrician in population from 15 months to 13 years and between 2007 and 2015 using SPN source data. Results: The RR(2011–13/2001–06) using data from the DCD was 0.14 (95% CI: 0.14 to 0.15), 0.07 (95% CI: 0.06 to 0.08) from SPN and 0.17 (95% CI: 0.15 to 0.20) from MBDS. A total of 338 cases were included in the VE screening obtaining an overall of 76.7% (IC 95%: 71.9 to 80.7%). For a case-control study, 120 cases and 247 controls were recruited obtaining a VE of 92.4% (IC 95%: 80.8 to 97.0%). Conclusions: The single-dose vaccination against chickenpox at 15 months of age has high impact and effectiveness.

La prevención y control de las enfermedades cardiovasculares constituyen actualmente un gran desafío. Ello se refleja en el conjunto de iniciativas para el desarrollo de acciones intersectoriales de promoción de la salud. Se ha demostrado que al menos el 80% de las enfermedades del corazón, ictus y diabetes mellitus tipo 2, pueden ser evitadas. La diferencia en su prevalencia entre poblaciones indica la posible ganancia en salud por intervenciones preventivas. Los determinantes de la salud que explican esas diferencias son complejos, incluyendo factores individuales y sociales. Estos últimos constituyen uno de los predictores de morbilidad y mortalidad prematura más potentes.

Resumen Objetivo La vacuna frente a la varicela se recomendo en la Comunidad de Madrid (CM) a los 15 meses de edad entre noviembre de 2006 y diciembre de 2013. El objetivo fue describir el impacto de la vacunacion sobre la incidencia de la varicela en la CM durante el periodo 2001-2015. Diseno Estudio descriptivo de los casos de varicela notificados a la Red de Medicos Centinela de la CM y de los casos registrados en el Conjunto Minimo Basico de Datos al alta hospitalaria. Se calculo la incidencia de casos y de ingresos de varicela, total y especifica por edad y sexo. Resultados La incidencia fue un 94,0% menor en el periodo 2012-2013 que en el periodo 2001-2003. En el periodo 2014-2015 la incidencia fue un 61,8% superior que en el periodo 2012-2013. La incidencia mas alta se aprecio en los ninos de 0-4 anos excepto en el periodo 2010-2014, en el que fue superada por la del grupo de 5-9 anos. La tendencia de los ingresos hospitalarios tambien fue decreciente, siendo el grupo de menores de un ano el de mayor incidencia. Conclusiones La recomendacion de vacunar a los 15 meses de edad ha producido un importante descenso de la incidencia de casos y de ingresos por varicela en todos los grupos de edad, lo que es compatible con la efectividad de una dosis y su capacidad para producir inmunidad de grupo. La retirada de esta recomendacion en 2014 y 2015 ha conllevado un incremento de la incidencia.

Resumen Fundamento y objetivo En la Comunidad de Madrid se incluyo la vacuna frente a varicela en el calendario infantil en noviembre del 2006 a los 15 meses de edad. Dicha recomendacion se retiro en enero del 2014. Se estima la seroprevalencia de anticuerpos frente al virus tras los 2-3 primeros anos desde la inclusion de la vacuna y su evolucion desde 1999. Material y metodo Estudio descriptivo transversal. La poblacion diana son los residentes en la Comunidad de Madrid entre 2 y 60 anos. La medicion de anticuerpos IgG se realizo mediante tecnicas de ELISA. Se estima la seroprevalencia segun caracteristicas sociodemograficas mediante regresion logistica multiple. Los resultados se comparan con encuestas previas. Asimismo, se presentan la seroprevalencia y la media geometrica de anticuerpos segun el estado vacunal y los antecedentes de la enfermedad. El nivel de confianza utilizado es del 95%. Resultados Participaron 4.378 sujetos, con una tasa de respuesta del 69%. La seroprevalencia estimada es del 95,3% (IC del 95%, 94,6%-95,9%). Mas del 90% de los ninos a partir de los 10 anos de edad presentan anticuerpos. La seroprevalencia fue mayor en personas con menor nivel educativo. La seroprevalencia de inmunidad vacunal supera el 90% en el primer ano tras la vacunacion pero en el segundo ano desciende hasta el 82,6% (IC del 95%, 56,0-94,7). Se encontraron diferencias significativas con las encuestas anteriores atribuibles a la vacunacion universal. Discusion Es necesario continuar la vigilancia epidemiologica para valorar el impacto de la retirada de la recomendacion de vacunar a los 15 meses de edad.

To perform a concurrent validation of the short version of the Woman Abuse Screening Tool (WAST), used to detect intimate partner violence, estimating the validity indexes in the general population.The information source was the third Intimate partner violence survey in the Region of Madrid (Spain) conducted on women aged 18-70 in 2014. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The short version of WAST includes two questions with three possible answers. The prevalence of intimate partner violence and the validity indexes were calculated and compared according to two scoring criteria with 95% confidence intervals (95%CI).The response rate was 60.0%, and 2979 surveys were analysed. The prevalence of intimate partner violence was 7.6% (95%CI: 6.6-8.5). We showed 21.1% (95%CI: 19.6-22.5) positive test results according to WAST criterion 1 and 11.0% (95%CI: 9.9-12.1) according to criterion 2. Criterion 2 presented higher overall efficiency of the test (81.5% [95%CI: 80.1-82.9] criterion 1 vs. 88.8% [95%CI: 87.7-89.9] criterion 2). The best indexes were obtained in women ≥30 years old.The short version of the WAST showed acceptable validity indexes for use as a screening tool of intimate partner violence in the general population. We recommend using scoring criterion 2 to estimate prevalence of intimate partner violence in surveys on the general population.

Together with AIDS, the burden of hepatitis C virus (HCV) in Spain heads the list of communicable diseases in terms of impact on public health. The aim of this study was to estimate the prevalence of HCV antibodies in the Community of Madrid, assess changes in recent years and analyse associated risk factors. Descriptive cross-sectional study of a target population consisting of Community of Madrid residents aged 16–80 years old. Two-stage cluster sampling was performed, with stratification by socioeconomic status and percentage immigrant population. The sampling frame consisted of public blood extraction centers attached to the Madrid Health Service. Seroprevalence of HCV antibodies, prevalence ratios by age groups in comparison with 1999 survey data and prevalence association with risk factors were assessed using a logistic regression model. Prevalence of HCV antibodies for the age group 16–80 years was 1.8% (95% CI: 1.3–2.5). The age group with the highest prevalence was 41–60 years. In comparison with the 1999 survey, prevalence fell for the age groups 21–30 and 31–40 years and increased for the age group 41–60. Statistically significant associations were found for age, education, history of hepatitis C and consultation regarding liver problems. Seroprevalence of HCV antibodies in the Community of Madrid is similar to that shown in other regions of Spain. It is increasing in older age groups as the population at risk ages. Incidence of hepatitis C may be decreasing considering the decrease in the seroprevalence in the population younger than 40 related to the previous serosurvey. J. Med. Virol. 87:1697–1701, 2015. © 2015 Wiley Periodicals, Inc.

Asthma is an important public health issue. The goal of this study is to analyse the trends in self-reported asthma prevalence in the Madrid Region and its association with socio-demographic and health factors.Data from the "Non-Communicable Disease Risk Factor Surveillance System" in adult population (SIVFRENT-A) 1996-2013 were used. Prevalences and 95% CI were estimated for: current asthma, cumulative prevalence of asthma and asthma attack in the last 12 months, in five periods. Changes in inter-period prevalence were estimated by calculating prevalence ratios (PR) with 95% CI by Poisson regression. The association between asthma prevalence socio-demographic and health variables was evaluated by multivariate logistic regression.Current prevalence of asthma and cumulative prevalence of asthma increased per study period an average of 14%. Asthma attack prevalence in the last 12 months increased an average of 19%. It was associated (statistically significant) to an increase of current prevalence of asthma, cumulative prevalence of asthma and asthma attack prevalence in the last 12 months: being a woman, ORa: 1.55; ORa: 1.35 and ORa: 1.46 respectively; have poor self-perceived health, ORa: 3.09; ORa: 2.63 and ORa: 2.89; and intense physical activity, ORa: 1.48; ORa: 1.32 and ORa: 1.49. In the case of current prevalence of asthma and cumulative prevalence of asthma also be studying, ORa: 1.34 and ORa: 1.46 respectively.Self-reported asthma prevalence increased in the last decades. The prevalence was higher in woman, persons with poor self-perceived health and adults with intense physical activity.El asma representa un importante problema de salud pública. El objetivo de este estudio fue analizar la evolución de la prevalencia de asma autopercibido en la Comunidad de Madrid y su asociación con factores sociodemográficos y de salud.Se incluyó a la población de 18 a 64 años de la Comunidad de Madrid. La fuente de información fue el Sistema de Vigilancia de Factores de Riesgo de Enfermedades No transmisibles (SIVFRENT-A). El período de estudio fue de 1996 a 2013 dividido en cinco etapas. Se estimaron las prevalencias y sus intervalos de confianza al 95% (IC95%) para prevalencia de asma actual, prevalencia acumulada de asma y crisis asmática en los últimos 12 meses en cinco períodos. Los cambios en la prevalencia interperiodo se estimaron calculando razones de prevalencia (RP) y su IC95% mediante regresión de Poisson. Mediante regresión logística multivariante se evaluó la asociación entre la prevalencia de asma y las variables sociodemográficas y las de salud.La prevalencia actual y la acumulada de asma aumentaron de media por periodo de estudio un 14%. La prevalencia de crisis asmática en los últimos 12 meses aumentó un 19%. Se asociaron de forma estadísticamente significativa a mayor prevalencia de asma actual, mayor prevalencia acumulada de asma y mayor prevalencia de crisis asmática en los últimos 12 meses ser mujer (prevalencia actual: ORa: 1,55; ORa: 1,35 y ORa: 1,46 respectivamente), tener mala salud autopercibida (ORa: 3,09; ORa: 2,63 y ORa: 2,89 respectivamente) y realizar actividad física intensa (ORa: 1,48; ORa: 1,32 y ORa: 1,49 respectivamente) y ser estudiante se asoció con mayor prevalencia de asma actual y prevalencia acumulada de asma (ORa: 1,34; ORa: 1,46 respectivamente).La prevalencia de asma autopercibida es mayor en las últimas décadas. Ser mujer, tener una mala salud autopercibida y realizar actividad física intensa se asocian a una mayor prevalencia.

a b s t r a c t Objective: To estimate the prevalence of hepatitis B virus (HBV) infection and vaccine-induced immunity in the region of Madrid, and to analyze their evolution over time. Methods: An observational, analytical, cross-sectional study was carried out in the population aged 16- 80 years between 2008 and 2009. This was the last of four seroprevalence surveys in the region of Madrid. The prevalence of HBV infection and vaccine-induced immunity was estimated using multivariate logistic models and were compared with the prevalences in the 1989, 1993 and 1999 surveys. Results: In the population aged 16-80 years, the prevalence of HBV infection was 11.0% (95% CI: 9.8-12.3) and that of chronic infection was 0.7% (95% CI: 0.5-1.1). The prevalence of vaccine-induced immunity in the population aged 16-20 years was 73.0% (95% CI: 70.0-76.0). Compared with previous surveys, there was a decrease in the prevalence of HBV infection. Conclusions: Based on the prevalence of chronic infection (

In November 2006, the Community of Madrid included the chickenpox vaccine into the immunisation schedule for children from 15 months of age. This was withdrawn in January 2014. Seroprevalence of antibodies to the virus is estimated after the first 2-3 years from the inclusion of the vaccine, and as well as its evolution since 1999.A cross-sectional study was conducted on the target population consisting of residents in the Community of Madrid between 2 and 60 years of age. Measurement of IgG antibodies was performed using an ELISA technique. Seroprevalence was estimated according to sociodemographic characteristics using multiple logistic regressions. The results are compared with previous surveys. Also, the seroprevalence and geometric mean of the antibody according immunisation status and history of the disease are presented. The confidence level used is 95%.A total of 4,378 subjects were included, with a response rate of 69%. The estimated seroprevalence was 95.3% (95% CI: 94.6% - 95.9%). Over 90% of children from the age of 10 have antibodies. The seroprevalence was higher in people with less education. The seroprevalence of immunity vaccine exceeds 90% in the first year after vaccination, but in the second year decreased to 82.6% (95% CI 56.0 - 94.7). Significant differences, attributable to universal vaccination, were found compared to previous surveys.Continued surveillance is needed in order to assess the impact of the withdrawal of the recommendation to vaccinate at 15 months.

Together with AIDS, the burden of hepatitis C virus (HCV) in Spain heads the list of communicable diseases in terms of impact on public health. The aim of this study was to estimate the prevalence of HCV antibodies in the Community of Madrid, assess changes in recent years and analyse associated risk factors. Descriptive cross-sectional study of a target population consisting of Community of Madrid residents aged 16-80 years old. Two-stage cluster sampling was performed, with stratification by socioeconomic status and percentage immigrant population. The sampling frame consisted of public blood extraction centers attached to the Madrid Health Service. Seroprevalence of HCV antibodies, prevalence ratios by age groups in comparison with 1999 survey data and prevalence association with risk factors were assessed using a logistic regression model. Prevalence of HCV antibodies for the age group 16-80 years was 1.8% (95% CI: 1.3-2.5). The age group with the highest prevalence was 41-60 years. In comparison with the 1999 survey, prevalence fell for the age groups 21-30 and 31-40 years and increased for the age group 41-60. Statistically significant associations were found for age, education, history of hepatitis C and consultation regarding liver problems. Seroprevalence of HCV antibodies in the Community of Madrid is similar to that shown in other regions of Spain. It is increasing in older age groups as the population at risk ages. Incidence of hepatitis C may be decreasing considering the decrease in the seroprevalence in the population younger than 40 related to the previous serosurvey.

Resumo Revisão integrativa da literatura, que teve como objetivo identificar evidências acerca da avaliação de desempenho de programas de controle de tuberculose no contexto brasileiro e espanhol. Foram selecionados materiais produzidos no Brasil e na Espanha indexados em bases de dados, diretórios de busca e bibliotecas virtuais, publicados entre 2002-2013. Para a análise foram incluídas 17 produções (9 brasileiras e 8 espanholas). Foi feita a identificação de conceitos relacionados à avaliação de programas, assim como métodos e indicadores utilizados para avaliação de programas de controle de tuberculose em ambos os países. No contexto espanhol identifica-se uma preocupação com a gestão orientada por resultados e o desenvolvimento de indicadores amplos para avaliação de uma série de programas em saúde, incluindo o de tuberculose. Já as produções brasileiras apresentaram maior proximidade com o método da pesquisa avaliativa clássica, e uma maior variedade de objetos de investigação dentro das atividades de controle da doença. Os resultados refletem a complexidade da avaliação de programas que envolvem múltiplas atividades e diversos atores, apontam para a necessidade da integração de indicadores epidemiológicos e operacionais em tuberculose. Abstract This is an integrative review of the literature, which sought to locate evidence regarding the evaluation of the performance of tuberculosis control programs in the Brazilian and Spanish contexts. Articles indexed in databases, search directories and virtual libraries produced in Brazil and Spain from 2002 to 2013 were selected. A total of 17 articles (9 Brazilian and 8 Spanish) were included for analysis. The intention was to identify program evaluation concepts, methodologies and indicators for TB control program evaluation in both countries. In the Spanish context, a concern with results-oriented management and the attempt to develop broader indicators for the assessment of a series of health programs, including those related to tuberculosis control, was identified. The Brazilian references showed greater proximity to the classic methods of evaluation research, and a greater variety of objects of study regarding the activities expected in a control program. The findings highlight the complexity of program evaluation activities, which involve multiple and diverse stakeholders, and point to the need for integration of epidemiological and operational indicators in tuberculosis.

Leishmaniasis is an endemic zoonotic disease in Spain. The purpose of this study is to conduct a spatial analysis of the key elements of this disease’s cycle–vectors, reservoirs and human cases–during a community outbreak in four towns in the southern corner of Madrid’s metropolitan area: Fuenlabrada, Getafe, Humanes de Madrid and Leganés.A total of 485 cases of leishmaniasis, registered in the Community of Madrid’s Epidemiological Surveillance System were analyzed; symptoms were reported between July 1, 2009 and June 30, 2013.Most cases were reported in northern Fuenlabrada. The results of spatial analysis revealed that, during the study period, the areas with the highest concentration of cases were peripheral residential areas bordering green zones with high densities of sandflies and a relatively high prevalence of leishmaniasis in lagomorphs. This shows that the main exposure occurred at home or close to home.This study shows that road and railway infrastructures could have played a decisive role in the spatial pattern of the outbreak by acting as territorial barriers somewhat isolating several urban centers from exposure to the pathogen, as routes of entry for the vector into other urban centers, or as generators of an environment (slopes on roadside) of suitable habitats for reservoirs and vectors.The spatial analysis of the outbreak has guided the actions for preventing and controlling the outbreak in these towns and is still useful to study its evolution. GISs are tools that help to understand the genesis and evolution of infectious disease outbreaks and to design the appropriate environmental interventions. La leishmaniasis es una enfermedad zoonótica endémica en España. El objetivo de este estudio es realizar un análisis espacial de los elementos claves del ciclo de la enfermedad, vectores, reservorios y casos humanos, en un brote comunitario declarado en cuatro municipios del sur del Área metropolitana de Madrid: Fuenlabrada, Getafe, Humanes de Madrid y Leganés.Se analizaron 485 casos de leishmaniasis, declarados en el Sistema de Vigilancia Epidemiológica de la Comunidad de Madrid, con fecha de inicio de síntomas entre el 1 de julio de 2009 y el 30 de junio de 2013.La mayor parte de los casos se localizaron en el norte de Fuenlabrada. Los resultados del análisis espacial pusieron de manifiesto que, durante el periodo de estudio, la zona con mayor concentración de casos coincidió espacialmente con áreas residenciales periféricas inmediatas a espacios verdes con alta densidad de flebotomos y prevalencia relativamente elevada de leishmaniasis en lagomorfos. Esto informa de que la exposición principal ocurre en su entorno domiciliario o peridomiciliario.El estudio parece indicar que las infraestructuras viarias podrían haber tenido un papel decisivo en la distribución espacial del brote comportándose de diferentes maneras: barreras territoriales que aíslan en cierta medida a varios núcleos urbanos de la exposición al patógeno, vías de penetración del vector en el interior de otros núcleos o generadores de un entorno de hábitats idóneos para reservorios y vectores.El análisis espacial ha permitido orientar las actuaciones de prevención y control del brote y continúa siendo de gran utilidad en la evolución del mismo. Los sistemas de información geográfica son herramientas que ayudan a la comprensión de la génesis y evolución de los brotes de enfermedades infecciosas, así como al diseño de las intervenciones ambientales. A leishmaniose é uma zoonose endémica em Espanha. O objetivo deste estudo é realizar uma análise espacial dos elementos-chave do ciclo da doença: vetores, reservatórios e casos humanos num surto declarado em quatro municípios da região metropolitana do Sul de Madrid: Fuenlabrada, Getafe, Humanes de Madrid e Leganés.Foram analisados 485 casos de leishmaniose declarados através do Sistema de Vigilância Epidemiológica da Comunidade de Madrid, com data de início de sintomas entre 1 de julho de 2009 e 30 de junho de 2013.A maioria dos casos foi encontrada no norte de Fuenlabrada. A análise espacial revelou que, durante o período de estudo, as áreas com a maior concentração de casos foram áreas residenciais periféricas perto de zonas verdes com alta densidade de flebótomo e prevalência relativamente alta de leishmaniose em lagomorfos, indicando que a exposição ocorre principalmente no domicílio ou no peridomicílio.O estudo sugere que as infraestruturas rodoviárias e ferroviárias poderiam ter desempenhado um papel decisivo no comportamento espacial do surto de diferentes formas: como uma barreira territorial isolando vários centros urbanos da exposição ao agente patogénico; como uma via de entrada do vetor noutros nos centros urbanos; ou como geradores de habitats adequados para reservatórios e vetores (encostas na beira da estrada).A análise espacial do fenómeno tem norteado as ações de prevenção e controle do surto nos municípios afetados e continua a ser útil no seguimento da evolução do mesmo. Os sistemas de informação geográfica são ferramentas que ajudam à compreensão da génese e evolução dos surtos de doenças infeciosas, assim como à definição das intervenções ambientais.

Fundamento y objetivo: La disponibilidad de vacunas antineumococicas hace necesario profundizar en el conocimiento de la enfermedad neumococica. El objetivo del estudio ha sido describir la magnitud y la evolucion de la enfermedad por Streptococcus pneumoniae en la Comunidad de Madrid durante 1998-2006. Material y metodo: Se ha realizado un estudio retrospectivo del Conjunto Minimo Basico de Datos de Altas Hospitalarias en el periodo 1998-2006. Se calcularon las tasas de incidencia por 100.000 habitantes y la letalidad, y se analizo la evolucion temporal. Resultados: En el periodo estudiado se registraron 20.813 casos de enfermedad neumococica (incidencia media anual: 41,87 casos/ 100.000 habitantes). La incidencia fue de 40,65 para neumonia y de 0,77 para meningitis. La mayor incidencia se presento en personas mayores de 64 anos (185,04) y en menores de 1 ano (67,22). La letalidad fue del 10,1% (el 15,8% para meningitis). La incidencia fue menor en 2004-2006 que en 1998-2000 (antes de la autorizacion de la vacuna conjugada). La evolucion de la incidencia muestra una ligera tendencia descendente. Conclusiones: La incidencia obtenida es superior a la de algunos estudios debido a que se incluyen sospechas clinicas. La incidencia de meningitis es similar a la descrita.

In this study results against measles, rubella and mumps obtained in the III Sero-epidemiological Survey of the Autonomous Region of Madrid, performed in 1999-2000, were related to the posterior evolution of these diseases in this Region. The prevalence of antibodies against measles, rubella and mumps was90%,95% and90 %, respectively. Despite of the good results obtained for rubella and measles, in 2005 and 2006 two important outbreaks of these diseases occurred in Madrid. The rubella outbreak in 2005 (450 cases) affected especially to immigrants of both sexes (mainly from Central and South America) and Spanish adults males. The 2006 measles outbreak (174 cases) was imported, a high proportion of cases were adults and most of the patients were unvaccinated. No differences according to sex were observed. In Madrid mumps virus circulation has continued from 1999 to present. Two epidemic waves in the periods 2000-2001 and 2006-2007 have been detected. During 2006-2007, an important proportion of cases showed antecedents of vaccination. Each one of these three diseases has typical characteristics. However, the three has in common the change in the age of apparition, with a growing frequency of cases among young adults.

Immigration from countries having a high prevalence of tuberculosis to other more highly-developed countries has a bearing on the overall evolution of tuberculosis in the latter. This study is aimed at describing the influence of the cases of tuberculosis among foreign individuals on the incidence of this disease in the Autonomous Community of Madrid during the 1996-2004 period.The data was taken from the Regional Tuberculosis Case Registry and from the 1996 census and the continuous censuses from 1998 to 2004. The tuberculosis incidence was estimated by country of origin from 1996 to 2004, by gender and by age groups. A calculation was made of the c2 for the linear trend, reasons for incidence and proportion of cases among foreign individuals.The incidence of tuberculosis went from 34.3 cases per 105 inhabitants in 1996 to 16.9 cases per 105 inhabitants in 2004. For those born in Spain, it changed from 33.2 cases per 105 inhabitants in 1996 to 12.7 cases per 105 inhabitants in 2004; and for foreign individuals, from 50.5 cases per 105 inhabitants in 1996 to 42.9 cases per 105 inhabitants in 2004. The reason for the incidence between foreign and Spanish individuals was greater than 1 for all years, the maximum figure having been in 2003, when 4.2 cases were detected among foreigners for every case among Spanish individuals (95% CI 3.7-4.7). The percentage of foreign cases went from 5.2% in 1996 to 35.1% in 2004.The incidence of tuberculosis among foreigners was greater than among Spanish individuals and did not significantly decrease in the 1996-2004 period, which is contributing to tuberculosis having stabilized. This situation and the characteristics of this population must be taken into account in the efforts for controlling this disease.

The availability of antipneumococcal vaccines makes it necessary to go deeply into the knowledge of pneumococcal disease. This study aims at describing the magnitude and incidence of pneumococcal disease in the Region of Madrid from 1998 to 2006.Retrospective study of Computerized Hospital Discharge Data registered from 1998 to 2006. Incidence per 100,000 inhabitants and lethality were calculated. Temporal evolution was analyzed.20,813 cases of pneumococcal disease were registered (annual average incidence 41.87/100,000 inhabitants). Incidence was 40.65 for pneumoniae and 0.77 for meningitis. People over 64 years old (185.04) and under 1 year of age (67.22) showed the highest incidence. Lethality was 10.1% (15.8% for meningitis). Incidence in 2004--2006 was lower than 1998--2000 (before the introduction of conjugate vaccine). Incidence trend has declined slightly.The incidence is higher than that shown by other studies. Selected source of data can explain this difference, since our data included suspected cases. However, pneumococcal meningitis incidence is similar to that described by others.