Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022.

Up to 22 June 2022, 508 confirmed cases of monkeypox (MPX) have been reported in the Madrid region of Spain, 99% are men (n = 503) with a median age of 35 years (range: 18-67). In this ongoing outbreak, 427 cases (84.1%) reported condomless sex or sex with multiple partners within the 21 days before onset of symptoms, who were predominantly men who have sex with men (MSM) (n = 397; 93%). Both the location of the rash, mainly in the anogenital and perineal area, as well as the presence of inguinal lymphadenopathy suggest that close physical contact during sexual activity played a key role in transmission. Several cases reported being at a sauna in the city of Madrid (n = 34) or a mass event held on the Spanish island of Gran Canaria (n = 27), activities which may represent a conducive environment for MPX virus spread, with many private parties also playing an important role. Because of the rapid implementation of MPX surveillance in Madrid, one of the largest outbreaks reported outside Africa was identified. To minimise transmission, we continue to actively work with LGBTIQ+ groups and associations, with the aim of raising awareness among people at risk and encouraging them to adopt preventive measures.

[Characteristics of COVID-19 cases and contacts reported in an area of Madrid during beginning of de-escalation.] / Características de los casos y contactos de COVID-19 identificados en un área de Madrid durante el inicio de la desescalada.

OBJECTIVE: Deescalation began in May 2020 increases social interaction, which has an influence on COVID-19 epidemiological surveillance. The aim of this study was the characterization of COVID-19 cases detected during this period. METHODS: We analyzed certain variables of interest coming from the epidemiological surveys carried out in an area of Madrid during May 2020, and stratified the results depending on its temporal relation with the deescalation. Prevalence for each category of response and average duration in minutes of the telephonic call were calculated. Confidence intervals were estimated at 95%. RESULTS: We included 167 cases, being 30.5% of them incident and 49.1% prevalent. The main source of infection was home (38.0%; CI 95% 31.4-46.2). Regarding healthcare and social care workers, the main source of infection was workplace (93.0%; 85.4-100). Average number of close contacts per case was 2.0 (1.8-2.2), being 1.5 (1.0-2.0) among pre-deescalation incident cases and 2.4 (1.8-3.0) among those post-deescalation. Average duration of each survey was 35.9 minutes (32.2-38.9), being 32.1 (24.4-39.8) among pre-deescalation incident cases and 37.0 (29.6-44.4) among those post-deescalation. Most of the contacts were household, both before and after beginning of deescalation. CONCLUSIONS: Home is the most prevalent place for the acquisition of the infection among general population, while workplace is the most prevalent among healthcare and social care workers. The initial phase of deescalation do not represents a change regarding sources of infection, but it may increase the number of close contacts.

OBJETIVO: La desescalada iniciada en mayo de 2020 aumenta las interacciones sociales, lo que influye en la vigilancia epidemiológica de la COVID-19. Este estudio tuvo como objetivo caracterizar los casos identificados durante este periodo. METODOS: Se analizaron parámetros de interés de las encuestas epidemiológicas realizadas en un área de Madrid durante mayo de 2020, estratificando los resultados según su relación temporal con la desescalada. Para las distintas opciones de respuesta, se calculó la prevalencia, y para la duración de la encuesta, la media en minutos. Los intervalos de confianza se estimaron al 95%. RESULTADOS: Se incluyeron 167 casos, siendo un 30,5% incidentes y un 49,1% prevalentes. El principal lugar de contagio fue el domicilio (38,8%; IC 95% 31,4-46,2). En el caso de los trabajadores sanitarios y sociosanitarios fue el centro de trabajo (93,0%; 85,4-100). El número medio de contactos por caso fue 2,0 (1,8-2,2), siendo 1,5 (1,0-2,0) en los casos incidentes predesescalada y 2,4 (1,8-3,0) en los postdesescalada. El tiempo medio por encuesta fue de 35,9 minutos (32,2-38,9), siendo 32,1 (24,4-39,8) en los incidentes predesescalada y 37,0 (29,6-44,4) en los postdesescalada. El principal ámbito de contacto fue el domicilio, tanto antes como después del inicio de la desescalada. CONCLUSIONES: Los contagios se producen principalmente en el domicilio en el caso de la población general y en el centro de trabajo en cuanto a los profesionales sanitarios y sociosanitarios. La fase inicial de la desescalada no supone un cambio en las fuentes de exposición, pero sí podría haber aumentado el número de contactos a investigar.

[Tuberculosis trend in Madrid region in native and foreign population (2009-2018).] / Tendencia de la tuberculosis en la Comunidad de Madrid en población autóctona y extranjera (2009-2018).

OBJECTIVE: Tuberculosis is a major public health problem and most cases are concentrated in vulnerable populations. The objective was to describe the incidence rates trend in native and foreign population (2009-2018) in Madrid Region. METHODS: Retrospective analysis of cases from the Tuberculosis Regional Registry of cases of Madrid Region 2009-2018. Annual incidence rates were calculated by country of birth (Spain, other), sex and age group (<15, 15-34, 35-44, 45-64, >64), using the annual January 1st continuous register population. The infection rate trend and the annual percentage change (APC) were calculated, along with the best jointpoint adjustment using Jointpoint regression. RESULTS: 7,696 cases were analyzed, 48.2% were foreign-born individuals. Average age in native population was 50 years old (SD: 23.96) and 35 (DS: 36.64) in foreign-born individuals (p<0.001). The overall incidence rate decreased from 17.30 in 2009 to 9.00 per 100,000 in 2018 and was higher in men. Pulmonary tuberculosis reduced from 11.90 to 6.55. Among native population, the incidence of TB fell from 10.29 to 5.24 with an APC of -7.3% (95%IC: -8.9; -5.7) (p<0.05), no jointpoint was identified. Among foreign-born individuals the incidence of tuberculosis declined from 46.54 to 25.49, a joint point was identified in 2013, observing an incidence decrease for the period 2009-2013 and APC of -13.8% (IC95%: -17.5; -10.0). CONCLUSIONS: The global incidence rate in this period has decreased by approximately 7% per year. However, this reduction occurred mainly in native population. In foreign-born individuals the incidence decreased by approximately 14% during the 2009-2013 period, after this period there have been no significant incidence changes.

OBJETIVO: La tuberculosis (TB) continúa siendo un problema importante de salud pública, debido a que la mayoría de los casos se concentran en población vulnerable. El objetivo de este trabajo fue describir la tendencia de las tasas de incidencia en población autóctona y extranjera (2009-2018) en la Comunidad de Madrid (CM). METODOS: Se realizó un análisis retrospectivo de casos del Registro Regional de casos de Tuberculosis de la CM en el período 2009-2018. Se calcularon tasas de incidencia anual por cada 100.000 habitantes, por país de nacimiento (España, fuera de España), sexo y grupo de edad (<15, 15-34, 35-44, 45-64, >64), utilizando las poblaciones de padrón continuo a 1 de enero de cada año. Se calculó la tendencia de las tasas de incidencia y el porcentaje anual de cambio (APC), así como el mejor ajuste del punto de inflexión utilizando la regresión de Jointpoint. RESULTADOS: Se analizaron 7.696 casos, siendo el 48,2% en personas nacidas fuera de España. La edad media en población autóctona fue de 50 años (DS: 23,96) y 35 (DS: 36,64) en inmigrante (p<0,001). La tasa de incidencia global pasó de 17,30 por cada 100.000 habitantes en 2009 a 9 en 2018, siendo superior en hombres. La incidencia de tuberculosis pulmonar pasó de 11,90 a 6,55. En población autóctona, la incidencia de TB pasó de 10,29 a 5,24, con un APC de -7,3% (IC95%: -8,9; -5,7; p<0,05), y no se identificó ningún punto de inflexión. En población extranjera la incidencia de tuberculosis pasó de 46,54 a 25,49, identificándose un punto de inflexión en 2013, con una disminución más acusada de la incidencia para el periodo 2009-2013 debido a un APC de -13,8% (IC95%: -17,5; -10,0). CONCLUSIONES: La tasa de incidencia global en este periodo disminuye cerca de un 7% anual; sin embargo, esta disminución de la incidencia se produce fundamentalmente en población autóctona. En población extranjera la incidencia desciende cerca de un 14% durante el periodo 2009-2013. Tras este periodo no hay cambios significativos en la incidencia.

A primary healthcare information intervention for communicating cardiovascular risk to patients with poorly controlled hypertension: The Education and Coronary Risk Evaluation (Educore) study-A pragmatic, cluster-randomized trial.

PURPOSE: Uncertainty exists regarding the best way to communicate cardiovascular risk (CVR) to patients, and it is unclear whether the comprehension and perception of CVR varies according to the format used. The aim of the present work was to determine whether a strategy designed for communicating CVR information to patients with poorly controlled high blood pressure (HBP), but with no background of cardiovascular disease, was more effective than usual care in the control of blood pressure (BP) over the course of a year. METHODS: A pragmatic, two-arm, cluster-randomized controlled trial was performed. Consecutive patients aged 40-65 years, all diagnosed with HBP in the last 12 months, and all of whom showed poor control of their condition (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg), were recruited at 22 primary healthcare centres. Eleven centres were randomly assigned to the usual care arm, and 11 to the informative intervention arm (Educore arm). At the start of the study, the Educore arm subjects were shown the "low risk SCORE table", along with impacting images and information pamphlets encouraging the maintenance of good cardiovascular health. The main outcome variable measured was the control of HBP; the secondary outcome variables were SCORE table score, total plasma cholesterol concentration, use of tobacco, adherence to prescribed treatment, and quality of life. RESULTS: The study participants were 411 patients (185 in the Educore arm and 226 in the usual care arm). Multilevel logistic regression showed that, at 12 months, the Educore intervention achieved better control of HBP (OR = 1.57; 1.02 to 2.41). No statistically significant differences were seen between the two arms at 12 months with respect to the secondary outcomes. CONCLUSIONS: Compared to usual care, the Educore intervention was associated with better control of HBP after adjusting for age, baseline SBP and plasma cholesterol, at 12 months.

Tuberculosis of the spine. A systematic review of case series.

PURPOSE: The objective of this systematic review was to characterise the methodological issues, as well as clinical, diagnosis, microbiological and treatment characteristics of patients with spinal tuberculosis. METHODS: We conducted a systematic review including prospective or retrospective case series written in English, Spanish, French, German and Italian published in the period from January 1980 to March 2011. RESULTS: Thirty-seven articles were included with a total of 1,997 patients; the median of the percentage of men was 53% (interquartile range [IQR] 48-64) and the median of the patients mean age was 43.4 (IQR 37-55). The most common symptom reported was back pain, and thoracic spine was the most frequent segment involved. Spinal plain radiography was done in 35 studies (94.6%), magnetic resonance imaging (MRI) in 26 (70.2%), computed tomography scan (CT-scan) in 13 (35%) and microbiological diagnosis in 29 (78.3%). Surgical treatment was reported in 28 articles 75.7%; finally, 24 articles reported follow-up, and in 15 of them at least 80% of patients improved. CONCLUSIONS: Spinal TB is still an important public health issue, it must be suspected in the presence of back pain or characteristic images and should be confirmed with microbiological procedures. Chemotherapy treatment is often used; in contrast, there is heterogeneity in the percentage of patients treated by surgery.

Effectiveness of an implementation strategy for a breastfeeding guideline in Primary Care: cluster randomised trial.

BACKGROUND: The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age. METHOD/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain). The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader) of a breastfeeding guideline in primary care is more effective than usual diffusion. The number of patients required will be 240 (120 in each arm). It will be included all the mothers of infants born during the study period (6 months) who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age..Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide's recommendations, clinical variability can be reduced and the care received by patients can be improved. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01474096.