Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study.

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

Utilisation of primary healthcare services by Sjögren's syndrome patients in the Community of Madrid and associated factors: a population-based cross-sectional study.

OBJECTIVES: To describe the utilisation of primary health care (PHC) services and factors associated with its use by patients diagnosed with Sjögren's syndrome (SS). METHODS: Population-based cross-sectional cohort of SS patients in Madrid, Spain (SIERMA). Sociodemographic, diagnostic, clinical and PHC service utilisation variables were studied by bivariate analyses and regression models. RESULTS: A total of 4,778 SS patients were included, 65.2% classified as primary SS (pSS), while 34.8% associated with another autoimmune disease (associated SS). Mean age was 64.3 years, and 92.8% of the patients were women. A total of 87.5% used PHC services, with a mean of 19.8 consultations/year. The general practitioner was the most visited health professional, with a mean of 10.9 consultations/year, followed by the nurse, with a mean of 5.7. Characteristics associated with a greater use of PHC services in SS patients were associated SS, higher adjusted morbidity groups (AMG) risk level and older age. Additional factors included symptoms such as dry mouth, fatigue, dry vagina and joint and muscle pain; comorbidities such as atrial fibrillation, diabetes, hypertension, solid malignant neoplasms, coronary heart disease and chronic obstructive pulmonary disease; and treatments such as sterile saline solution, corticosteroids, opioids and biologic disease-modifying anti-rheumatic drugs. CONCLUSIONS: Most SS patients used PHC services during the study period, and the mean number of consultations was remarkably high. Utilisation was mainly associated with AMG risk level, ageing, glandular and extra-glandular symptoms, substantial comorbidities and various treatments. An optimised design of PHC policies will facilitate early diagnosis, improved management and better quality of life for SS patients.

Socioeconomic Inequalities in Small-for-Gestational-Age Births Before and During the Economic Crisis: An Ecologic Study of Trends in 13 Spanish Cities.

Economic recessions can increase socioeconomic inequalities in health. The objective of this study was to analyze socioeconomic inequalities in small-for-gestational-age (SGA) births before and during the Spanish economic crisis. We conducted an ecological study of trends based on 2 periods before the crisis (1999-2003 and 2004-2008) and another during the crisis (2009-2013). The study population was Spanish women resident in 13 cities who had given birth during 1999-2013. The prevalence of SGA was calculated for each census tract. A hierarchical Bayesian model was used to obtain the prevalence ratio (PR) and 95% credible intervals (CI). We analyzed the association between SGA and socioeconomic deprivation in each period for each city and for 3 age groups. The PR was above 1 and statistically significant for all 3 time periods in most of the 13 cities. The differences in PR between periods were only statistically significant for Madrid (PR = 1.56, 95% CI 1.48-1.65 for 1999-2003; PR = 1.28, 95% CI 1.19-1.38 for 2004-2008) and Barcelona (PR = 0.99, 95% CI 0.87-1.12 for 2004-2008; PR = 1.20, 95% CI 1.05-1.36 for 2009-2013). Socioeconomic inequalities in SGA births in small areas (census tracts) of most Spanish cities studied remained stable before and during the economic crisis.

[Deprivation index by enumeration district in Spain, 2011]. / Índice de privación en España por sección censal en 2011.

OBJECTIVE: To present the methodology used in the design and implementation of a deprivation index by enumeration district, and to describe the socioeconomic situation of Spain in 2011. METHOD: The unit of analysis was the enumeration district (N=35,960). Data came from the 2011 Population and Housing Census of Spain. Given both the sampling nature of the Census and the regulatory limitations of data confidentiality, variables were calculated indirectly by using the complement of the available variables. Checks were made to ensure reliability. The selection of the indicators took into account comparability with the MEDEA index. The inclusion of additional information was explored. A deprivation index was built using Principal Component Analysis. Sensitivity analysis of the index was performed for urban areas and the rest of the regions. RESULTS: Using the census information, 22 indicators were calculated for 35,917 enumeration districts. The deprivation index was based on six indicators: manual and temporary workers, unemployment, insufficient education overall and in young people (aged 16 to 29 years), and dwellings without access to the internet. The map of Spain shows a gradient of decreasing deprivation from south-west to north-east. CONCLUSIONS: The socioeconomic information of the 2011 census by enumeration district was used systematically. The drafted index, similar to the MEDEA, will facilitate the updated study of health inequalities for Spain overall following the economic recession that began in 2008.

Decline in fertility induced by economic recession in Spain.

OBJECTIVE: To describe trends in fertility in Spain before (pre-recession; 1998-2008) and during (recession period; 2009-2013) the economic crisis of 2008, taking into account women's age and regional unemployment in 2010. METHOD: The study consisted of a panel design including cross-sectional ecological data for the 17 regions of Spain. We describe fertility trends in Spain in two time periods, pre-recession (1998-2008) and recession (2009-2013). We used a cross-sectional, ecological study of Spanish-born women to calculate changes in fertility rates for each period using a linear regression model adjusted for year, period, and interaction between them. RESULTS: We found that compared to the pre-recession period, the fertility rate in Spain generally decreased during the economic recession. However, in some regions, such as the Canary Islands, this decrease began before the onset of the recession, while in other regions, such as the Basque country, the fertility rate continued to grow until 2011. The effects of the recession on the fertility rate are clearly observed in women aged 30-34 years. CONCLUSIONS: The current economic recession has disrupted the positive trend in fertility that began at the start of this century. Since Spain already had very low fertility rates, the further decline caused by the economic recession could jeopardize the sustainability of welfare-state systems.

Injuries Among Immigrants Treated in Primary Care in Madrid, Spain.

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.

[Contextual indicators to assess social determinants of health and the Spanish economic recession]. / Indicadores contextuales para evaluar los determinantes sociales de la salud y la crisis económica española.

OBJECTIVE: To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. METHODS: Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organisations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. RESULTS: We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. CONCLUSIONS: We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions.

Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain.

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.

Influenza vaccination coverages among high risk subjects and health care workers in Spain. Results of two consecutive National Health Surveys (2011-2014).

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.

Lung cancer and urbanization level in a region of Southern Europe: influence of socio-economic and environmental factors.

BACKGROUND: This study analysed the distribution of lung cancer deaths in areas with different urbanization levels in the Madrid Region and whether such differences persisted when deprivation and air pollution were considered. METHODS: This was a population-based cross-sectional study covering lung cancer deaths (2001-07). The exposure indicators were: a deprivation index based on 2001 census data; and the daily mean NO2 measurement (2002-07), both at the census tract level. Analysis was stratified by sex and age group and the Poisson regression models were applied to obtain rate ratios (RRs). RESULTS: After adjustment for age, deprivation index and NO2, mortality was similar in the city and Greater Madrid areas and lower in the rural area for the over-64 age group (RR: 0.84 in men and RR: 0.66 in women, with respect to the city of Madrid), and significantly lower in the Greater Madrid area (RR: 0.84 in men and RR: 0.74 in women) and in the rural area (RR: 0.73 in men and RR: 0.51 in women) with respect to the city of Madrid for the under-65 age group. CONCLUSIONS: The most urbanized areas of the Madrid Region are characterized by higher lung cancer mortality.

Dealing with Ebola virus disease in Spain: epidemiological inquiries received by the Department of Public Health Alerts, April to December 2014.

We describe the inquiries regarding Ebola virus disease (EVD) received by the Department of Public Health Alerts of the Community of Madrid between April and December 2014. A total of 242 inquiries were received. Consultations were initiated most frequently by hospital clinicians (59 inquiries, 24%), private citizens (57 inquiries, 24%) and primary care physicians (53 inquiries, 22%). The most frequent topic of inquiry was possible EVD in a patient (215 inquiries, 89%). Among these, 31 persons (14%) presented both EVD-compatible symptoms and epidemiological risk factors, and 11 persons (5%) fulfilled the criteria for a person under investigation. Recent travel abroad was reported in 96 persons (45%), but only 32 (15%) had travelled to an EVD-affected area. Two high-risk and one low-risk contact were identified through these inquiries. Low specificity of the EVD symptoms led to many difficulties in protocol application. Ineffective communication with healthcare professionals and unfamiliarity with the EVD protocols caused many case classification errors. A rapid consultation service by telephone is essential for providing qualified advice during emergencies. Our experience may help other countries dimension their activities and resources for managing similar exceptional outbreaks in the future.

[Mobility Exposure Measures in Serious Road Traffic Injuries in Madrid, Spain]. / Medidas de exposición a la movilidad en las lesiones graves por tráfico en la Comunidad de Madrid.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Use of area-level socioeconomic indicators in epidemiological research: experience in Spain and advancement opportunities]. / Uso de indicadores socioeconómicos del área de residencia en la investigación epidemiológica: experiencia en España y oportunidades de avance.

OBJECTIVE: To determine the use of area-level socioeconomic indicators in epidemiological studies in Spain. METHODS: We included studies analyzing the association of area-level socioeconomic indicators and health indicators in Spain published in peer-reviewed journals. An electronic search was conducted in PubMed-Medline, SCI-Expanded, SSCI, Embase, and the Spanish Medical Index (until December 31, 2012). A manual search was also conducted of the references of the selected studies. Each of the articles initially selected on the basis of the title and abstract was reviewed by two investigators. Information was obtained on the publication and methodology (design and study areas, information sources, health and socioeconomic indicators, and statistical analysis). RESULTS: We included 142 studies published since 1988 (58.4% since 2005). More than half (59.9%) were in English. The level of analysis was ecological in 73.2% and multilevel in 19.0%. The areas most frequently analyzed were census tracts (35 studies), especially within cities or autonomous regions, followed by the provinces (30 studies), mostly concerning Spain overall. The dependent variable most frequently analyzed was mortality and the socioeconomic dimension most commonly used was employment (71.1%). CONCLUSIONS: In the last decade in Spain, there has been an increase in the number of studies examining the association of area-level socioeconomic and health indicators, as well as in the complexity of design and analysis.

Comparison of self-report influenza vaccination coverage with data from a population based computerized vaccination registry and factors associated with discordance.

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.

Negative trends from 2008/9 to 2011/12 seasons in influenza vaccination coverages among high risk subjects and health care workers in Spain.

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.

[Injuries treated in primary care in the Community of Madrid: analyses of electronic medical records]. / Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica.

OBJECTIVE: To 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. METHODS: A 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. RESULTS: In 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. CONCLUSIONS: The 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.

Coverage and predictors of influenza vaccine uptake among adults aged 16 to 59 years suffering from a chronic condition in Madrid, Spain.

Based on data drawn from the 2007 Madrid Regional Health Survey (MRHS), we sought to: estimate influenza vaccination coverage among people ages 16-59 years old suffering from chronic conditions (cardiovascular diseases, diabetes, respiratory diseases, kidney diseases, malignant neoplasm and fibromyalgia) living in the region of Madrid and to determine which socio-demographic and health-related variables were associated with the likelihood of being vaccinated. We analyzed data from 8,337 subjects. The reply to the question "Were you vaccinated against influenza in the last vaccination campaign?" was taken as the dependent variable. Coverage was calculated for different specific diseases that constitute an indication for vaccination. Independent variables included socio-demographics, health-related and use of health care services variables. The proportion of vaccinated adults suffering from any chronic condition in 2007 was 23.5%. Very low coverages were found among kidney diseases (16.1%), malignant neoplasm (10.9%) and fibromyalgia (14.2%) sufferers. The variables which increased the likelihood of being vaccinated among adults suffering any chronic condition were: higher age, being Spanish, absence of a smoking habit and having primary studies. We conclude that influenza vaccination coverage among people living in Madrid and suffering from a chronic condition is unacceptably low, thereby making it necessary for strategies to be urgently implemented aimed at improving the use of influenza vaccine.

[Community transmission of pandemic influenza (H1N1) 2009 from School Outbreaks in the Madrid region, Spain: May-June 2009]. / Transmisión comunitaria de gripe pandémica (H1N1) 2009 a partir de brotes en centros escolares de la Comunidad de Madrid: Mayo-junio de 2009.

BACKGROUND: The first pandemic influenza (H1N1) 2009 confirmed case acquired in the Madrid Region was diagnosed in May 20th. This was the index case of the first outbreak in a school in the Madrid Region (MR). The aim of this paper is to describe school outbreaks that took place during the spring in 2009, the control measures implemented and the beginning of the community transmission of this virus in the Region. METHODS: Descriptive observational study of school outbreaks due to pandemic (H1N1) 2009 virus reported between May 20th and June 27th, and total investigated cases in this period. It was used the definition of cluster of influenza cases adopted by National Authority (three or more cases). Clinical, epidemiological and microbiological data of cases were analyzed. RESULTS: There were identified 1.349 cases of pandemic (H1N1) 2009. They were associated with 77 school centres with three or more reported cases, 47,4% of total cases in this period (n = 2.844). 36 outbreaks were detected in Leganés (more than one third of all schools in the municipality), generating the highest cumulative incidence rates in the Basic Health Zone. There were differences by symptoms according to age. During this period, 949 samples were analyzed and 555 (58.5%) tested positive. CONCLUSIONS: The transmission of pandemic (H1N1) 2009 virus in the MR occurred steadily during the spring of 2009 due to schools outbreaks, meaning the onset of community transmission in Spain.