Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients.

OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population.

OBJECTIVES: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

[Effect of the Omicron variant on cumulative incidence of infection and lethality during the sixth wave of the COVID-19 epidemic in Spain]. / Efecto de la variante Ómicron sobre la incidencia y la letalidad durante la 6.ª onda epidémica COVID-19 en España.

The COVID-19 pandemic has strained healthcare systems globally. The successive epidemic waves have shown different characteristics. The Omicron variant of SARS-CoV-2 modified the epidemic behavior that previous variants had followed. The aim of this analysis was to determine the epidemiological characteristics of COVID-19 during the sixth epidemic wave and its differences according to the predominance of the Delta or Omicron variants. The epidemiological data corresponding to the sixth wave of the epidemic published by official organizations were analyzed, and the cumulative incidence of infection (CI-I) and case fatality rates (CFR) were calculated, both for Spain as a whole and for the different Autonomous Communities, in the population as a whole and by age groups. The results showed that the CI-I was higher with the Ómicron variant (10.89% vs 0.75% with Delta) while the CFR was higher with the Delta variant (4.2‰ vs 1.3‰ with Ómicron), as well as a higher rate of hospitalization and ICU admission with the Delta variant.

Intensive Weight-Loss Lifestyle Intervention Using Mediterranean Diet and COVID-19 Risk in Older Adults: Secondary Analysis of PREDIMED-Plus Trial.

OBJECTIVES: We tested the effects of a weight-loss intervention encouraging energy-reduced MedDiet and physical activity (PA) in comparison to ad libitum MedDiet on COVID-19 incidence in older adults. DESIGN: Secondary analysis of PREDIMED-Plus, a prospective, ongoing, multicentre randomized controlled trial. SETTING: Community-dwelling, free-living participants in PREDIMED-Plus trial. PARTICIPANTS: 6,874 Spanish older adults (55-75 years, 49% women) with overweight/obesity and metabolic syndrome. INTERVENTION: Participants were randomised to Intervention (IG) or Control (CG) Group. IG received intensive behavioural intervention for weight loss with an energy-reduced MedDiet intervention and PA promotion. CG was encouraged to consume ad libitum MedDiet without PA recommendations. MEASUREMENTS: COVID-19 was ascertained by an independent Event Committee until December 31, 2021. COX regression models compared the effect of PREDIMED-Plus interventions on COVID-19 risk. RESULTS: Overall, 653 COVID-19 incident cases were documented (IG:317; CG:336) over a median (IQR) follow-up of 5.8 (1.3) years (inclusive of 4.0 (1.2) years before community transmission of COVID-19) in both groups. A significantly lowered risk of COVID-19 incidence was not evident in IG, compared to CG (fully-adjusted HR (95% CI): 0.96 (0.81,1.12)). CONCLUSIONS: There was no evidence to show that an intensive weight-loss intervention encouraging energy-reduced MedDiet and PA significantly lowered COVID-19 risk in older adults with overweight/obesity and metabolic syndrome in comparison to ad libitum MedDiet. Recommendations to improve adherence to MedDiet provided with or without lifestyle modification suggestions for weight loss may have similar effects in protecting against COVID-19 risk in older adults with high cardiovascular risks.

Case-fatality rate of SARS-CoV-2 infection during the third and fifth epidemic waves in Spain: Impact of vaccination.

INTRODUCTION: During the first and second epidemic waves in Spain, the SARS-CoV-2 case-fatality rates (CFRs) showed significant differences between Autonomous Communities (ACs). Comparing CFRs in the third and fifth epidemic waves can provide information on the impact of the different vaccination coverages in the ACs. OBJECTIVE: To evaluate the impact of vaccination on COVID-19 CFRs in the third and fifth epidemic waves in Spain, according to sex, age, and AC. METHODS: This work is an observational, descriptive study which uses data on COVID-19 infections, deaths, and vaccinees published by the Spanish Ministry of Health and the regional Health Departments of the ACs. The third epidemic wave was defined as the period from 26th December 2020 to 19th April 2021, and the fifth wave, from 19th July to 19th September 2021. The CFRs (deaths per 1000 infected [‰]) were calculated according to sex, age group, and AC. The standardized case-fatality ratio (SCFR) was adjusted for age and sex for each wave. We estimated the correlation between CFRs and their change between the two epidemic waves with the vaccination coverages reached at the beginning of the fifth wave. RESULTS: The CFR in the fifth wave (5.7‰) was lower than in the third wave (16.5‰). In addition, the CFR in both waves was significantly higher in men than in women, and in older people than in younger ones. A decrease in the CFR between both waves was only observed in those older than 49. A strong direct and positive correlation (R2a=0.8399) was found between vaccination coverage by age group and decrease in CFR between both epidemic waves. Significant differences were seen between ACs in the two waves, as regards both CFRs and SCFRs. When comparing ACs, a direct correlation was observed between vaccination coverage and CFRs in the fifth wave, and also - although weak - between vaccination coverage and decrease in CFR between both waves. CONCLUSION: The CFR significantly decreased in Spain between the third and the fifth epidemic waves in population aged 50 or older, probably due to the high vaccination coverage in that age group. Differences were observed between CFRs and SCFRs between ACs that are not explained by the differences in vaccination coverage, suggesting the need for further research and evaluation.

[Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain]. / Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España.

INTRODUCTION: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. MATERIAL AND METHODS: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. RESULTS: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%). The FRo and FRMo were significantly higher in the age group ≥ 65 years (55.4% and 72.2% respectively) than in the group <65 years (0.5% and 1.4% respectively). The Basque Country, Aragon, Andalusia and Castilla la Mancha presented SFR significantly higher than the global FR of Spain. The correlations between the prevalence of infection and the FRo were inverse. CONCLUSIONS: The case-fatality from COVID-19 during the second epidemic wave in Spain improved compared to the first wave. The case-fatality rates were higher in men and the elderly people, and varied significantly between AC. It is necessary to delve into the analysis of the causes of these differences.

[Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study]. / Factores asociados al control óptimo simultáneo de la diabetes, hipertensión arterial e hipercolesterolemia en la población diabética. Estudio BPC diabetes.

OBJECTIVES: To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. MATERIAL AND METHOD: Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. RESULTS: 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4-65.5), good control of HTA at 42.6% (95% CI: 40.0-45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4-63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2-18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). CONCLUSIONS: The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease.

[Factors associated with cardiovascular risk and cardiovascular and renal disease in the IBERICAN study: Final results]. / Factores asociados al riesgo cardiovascular y enfermedad cardiovascular y renal en el estudio IBERICAN (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal): resultados definitivos.

OBJECTIVE: To analyse the prevalence in clinical practice of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD), as well as their causal relationship, in the study inclusion visit. MATERIAL AND METHODS: Cross-sectional analysis of the study inclusion visit of 8,066 patients of 18 to 85years of age included in the IBERICAN study. By reviewing the medical history, analytics and medical visits, the patient's physician has collected socio-demographic information, personal and family history and prevalence of CVRF and CVD and renal disease. A multivariate analysis was carried out using a logistic regression that included the autonomous region variable as a random effect variable, in order to analyse the impact of certain variables on the development of each CVRF, metabolic syndrome, subclinical organ damage, renal disease, and CVD. RESULTS: Dyslipidaemia was 2.4 times more frequent in diabetics, and the risk was increased by 59% in hypertensive patients. Arterial hypertension was twice as frequent in diabetics, and increased 94% in hyperuricaemic patients and 62.1% in dyslipidaemia patients. Diabetes mellitus was 2.5 times higher in dyslipidaemia patients, and 2.2 times higher in hypertensive patients. CVD was four times more frequent in patients with a family history, and the risk in women was increased by 90.8% and by 53.8% in patients with renal disease. CONCLUSIONS: The Spanish population seen in Primary Care that were analysed in the IBERICAN study had a high prevalence of CVRF and CVD, which gives it a high CVR. The multivariate analysis performed shows a close causal relationship between the CVRF with each other, and with renal disease and CVD.

[Analysis of fatality rates case of SARS-CoV-2 infection in the Autonomous Communities of Spain]. / Análisis de las tasas de letalidad de la infección por SARS-CoV-2 en las comunidades autónomas de España.

INTRODUCTION: The SARS-CoV-2 pandemic has posed a real challenge to health systems. In Spain, the heterogeneous distribution of the virus infection and the different health strategies have conditioned the morbidity and fatality rate. The aim of this study was to analyse the lethality of the infection by sex and age range in the Autonomous Communities (AC) of Spain. MATERIAL AND METHODS: To perform the analysis, data were extracted from the Ministry of Health, Regional and Public Health Departments of the different AC. The infected population was estimated from the results of the ENE-COVID19 and the population registered on 1 January 2020 (INE) for the validity of the IgG antibody test with 80% sensitivity and 100% specificity. The case fatality rate (TL) (deaths/1000 estimated infected) by sex and age (<20years, 20-64 and ≥65years) was calculated for each AC. The standardized case fatality ratio (REL) was calculated by the exact method (EPIDAT). RESULTS: The estimated prevalence of SARS-CoV-2 infection in Spain was 6% (range, 1.4% [Ceuta] -14.1% [Community of Madrid]). The TL in Spain was 9,6/1000, ranged per AC from 1/1000 in Melilla to 26.6/1000 in La Rioja, with no correlation between case fatality and prevalence of infection. The TL was higher in men (10.2/1000, ratio 1.17 with respect to women), except in Cataluña (ratio 0.92), and especially high in those over 64years of age in La Rioja (143.5/1000), Asturias (69.2/1000) and Basque Country (46.6/1000). Overall excess REL was found to be over 30% in La Rioja (2.91; 95%CI: 2.36-3.57), Asturias (1.51; 95%CI: 1.27-1.80), Basque Country (1.42; 95%CI: 1.31-1.54) and Extremadura (1.37; 95%CI: 1.20-1.57) and in those over 64 years in Madrid and the Canary Islands. CONCLUSIONS: SARs-CoV-2 virus infection has been very unevenly distributed in the different ACs, with notably differences in TL between ACs, particularly high in La Rioja, Asturias and the Basque Country. Is important to study the excess in TL the population over 64years of age in the ACs of Madrid and the Canary Islands.

[Description of the sample, design and methods of the study for the identification of the Spanish population at cardiovascular and renal risk (IBERICAN)]. / Descripción de la muestra, diseño y métodos del estudio para la identificación de la población española de riesgo cardiovascular y renal (IBERICAN).

BACKGROUND AND OBJECTIVE: Cardiovascular diseases (CVD) are the leading cause of death in Spain, and although the incidence rates have been declining for years due to improvements in prevention and treatment, there is still room for further reduction. Primary Care has a leading role in the prevention and control of these diseases. Determining the prevalence and incidence of cardiovascular risk factors and cardiovascular diseases in the Spanish adult population attended in Primary Care is the objective of the study to identify the Spanish population at cardiovascular and renal risk (IBERICAN). MATERIAL AND METHODS: A prospective cohort study was conducted using a consecutive non-probabilistic sampling population between 18 and 85 years that attended Primary Care centres between April 1, 2014 and October 31, 2018. By reviewing the medical history, laboratory results, and medical visits, the Primary Care physicians collected socio-demographic information, personal and family history of the patients, as well as prevalence and incidence of cardiovascular risk factors and cardiovascular and renal disease. The incidents and associated factors will be estimated using proportional risk models of Cox and Kaplan-Meier Curves. RESULTS: A total of 8,066 patients have been recruited by 531 Primary Care physicians from all Autonomous Communities of Spain as part of the IBERICAN cohort, with the exception of Ceuta. The mean age of the cohort is 57.9 years with 54.5% women. Obesity, dyslipidaemia, and hypertension are the most prevalent cardiovascular risk factors. There was a history of CVD in16.3%, and 25.5% had a subclinical organ lesion. CONCLUSION: The IBERICAN study is a cohort of people treated in Primary Care that expects to provide relevant information on the factors that determine the incidence of cardiovascular and renal disease in Spain.

Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996-2010).

OBJECTIVE: Spain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. MATERIAL AND METHODS: the new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. RESULTS: 1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. CONCLUSIONS: bladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed.

[Concordance of tuberculin tests and Interferon gamma release assays in the prison population]. / Concordancia de las pruebas de tuberculina e Interferón gamma en población reclusa.

OBJECTIVE: To study the agreement of Tuberculin Skin Tests (TST) and Interferon Gamma Release Assays (IGRA) when screening tuberculosis infection amongst inmates recently admitted to prison. MATERIALS AND METHODS: Prospective study conducted in a prison during the months of May and June 2009. Inmates without a TB history, with previous TST negatives or without prior TSTs were included. Participants signed an informed consent form and the study was approved by an independent Ethical Committee. TST (positive 10 > or = mm) and IGRA (Quantiferon TB-Gold) were performed and standardized data collection was carried out. The agreement between both tests was analysed using the Kappa index. RESULTS: A total of 181 people were included. 62% were foreign-born, 17% had previous BCG vaccination, 8.4% were IDUs and 4% HIV-infected. Foreign born subjects were more frequently vaccinated and presented less drug use and HIV infection than people born in Spain. (p=0.02, p=0.02 and p=0.01 respectively). TST results were positive in 24% and IGRA in 26%. Both tests were performed in 149 people (82%). Discordant results were observed in 15.8%. Agreement of the Kappa coefficient was 0.6 (CI 0.4-0.7). Agreement was better in the native population (K=0.8) and worse in BCG vaccinated (K=0.4) and foreign-born subjects (K=0.8). CONCLUSION: Overall agreement was moderate and was less amongst vaccinated subjects and those born abroad. Extension of the study could be useful to evaluate which test better predicts the risk of progression to active TB and the cost-benefit of both tests among the prison population.

Effects of 2 physiotherapy programs on pain perception, muscular flexibility, and illness impact in women with fibromyalgia: a pilot study.

OBJECTIVE: This study assessed the effect of 2 physiotherapy programs designed to improve flexibility and to reduce the impact of the illness and pain perception in women with the fibromyalgia syndrome (FMS), and compared the effects of the 2 programs in the short and intermediate term. METHODS: Twenty FMS patients were randomly assigned to 2 training groups, one following a program of kinesiotherapy and active muscular stretching and one using techniques of Global Myofascial Physiotherapy, according to the Mézières method. Both groups met twice a week for 12 weeks, for a total of 150 minutes each week. Flexibility and illness impact were measured by means of a standard test, whereas pain was assessed by means of thumb palpation. Measurements were taken at the beginning and end of the program and 24 weeks after its end. RESULTS: Patients had achieved a statistically significant reduction in the severity of the disease and improved their flexibility level by the end of the program, but had returned to initial values after follow-up. Significant differences were not observed between the 2 treatment groups in the initial values or in the results at the end of the program or after the follow-up, so neither program proved better than the other. CONCLUSION: The FMS patients in this study improved their flexibility level and general well-being using both kinesiotherapy and stretching exercises techniques.

Effects of a resistance training program in multiple sclerosis Spanish patients: a pilot study.

CONTEXT: Physical exercise is regarded as a useful tool in the treatment of multiple sclerosis (MS). Generally, physical rehabilitation have been based on the prescription of aerobic exercises, while fewer programs have been aimed at developing muscular strength. OBJECTIVE: To establish whether the physical fitness of MS sufferers can be improved by a training program for developing muscular strength. DESIGN: Before and after study SETTING: University multipurpose room PARTICIPANTS: 36 patients, all able to walk, belonging to the Leon Multiple Sclerosis Association. INTERVENTIONS: The physical exercise programme consisted in resistance training sessions, based mainly on callisthenic, or bodyweight, exercises, during six weeks.

[Seroprevalence of hepatitis C virus infection at the time of entry to prison in the prison population in the north-east of Spain]. / Seroprevalencia de infección por virus C de la hepatitis en población reclusa del noroeste de España a su ingreso en prisión. Grupo Noroeste para el estudio de la Hepatitis por Virus C en el medio penitenciario.

BACKGROUND: Spanish prisons have a high number of inmates whose behaviour puts them at risk of being infected by hepatitis C virus (HCV). The object of this study was to establish the prevalence of this infection and its associated factors in the prison population of the north-east of Spain. METHODS: Inmates in seven prisons in the north-east of Spain were studied. Socio-demographic and prison variables were gathered, as well as risk factors for infection by HCV. Antibodies against HCV were determined (EIA and INNO-LIA HCV III), Hepatitis B virus (VHB) (EIA), and human immunodeficiency virus (HIV) (EIA and Western-Blott). The analysis of associated factors was based on logistic regression. RESULTS: Of the total number of inmates studied, 47.9% presented HCV antibodies. There was greater prevalence in the case of the following: UDVP (89.6%); those who shared needles (94%); those infected by HIV (92.7%); carriers of Australia antigen (65.1%) and antibodies to the HBV core antigen (79.8%); those who had been in prison before (60.9%); unmarried men (54.8%); gypsies (52%); unqualified workers (50.4%); those who had no basic school qualifications (50.9%); those with tattoos (66.7%); and those with a background of self-inflicted injuries (79.3%). In the logistic regression analysis the variables associated to infection by HCV were: UDVP (OR = 33.3; I.C. 95% = 25-50), HBcAc (+) (OR = 4.1; I.C. 95% = 1.1-5.3), age (OR = 0.98; I.C. 95% = 0.96-1.00), months in prison (OR = 1.011; I.C. 95% = 1.004-1.019) and a background of previous prison sentences (OR = 2.3; I.C. 95% = 1.5-3.6). CONCLUSIONS: The prevalence of infection by HCV in prison inmates is very high. It is therefore recommended that preventive measures be increased (harm reduction programmes) and that clinical and analysis protocols be drawn up for those infected and for treatment in cases of chronic active hepatitis in order to control this serious public health problem.

[Evaluation of the prevalence of HIV infection in prison inmates at the time of their imprisonment during the period 1991-1995]. / Evolución de la prevalencia de infección por virus de la inmunodeficiencia humana en población reclusa al ingreso en prisión durante el período 1991-1995.

BACKGROUND: Inmates of Spanish prisons include a high number of intravenous drug users (IVDUs) and other people whose practices entail the risk of infection with the human immunodeficiency virus (HIV). The aim of this work is to find out the evolution of the prevalence of HIV infection at the time of admission to prison and the factors associated with it in this population group. This may enable us to form an idea of the effectiveness of risk reduction strategies and help to improve them. METHODS: All those people who were placed in a provincial penal institution in the northwest of Spain between 1991 and 1995. Socio-demographic, penal and HIV risk factor variables were gathered. The HIV infection test (ELISA and Western-blot) was carried out with the consent of the subjects. RESULTS: Of the 1,663 people studied, 19.4% were HIV-positive. The prevalence HIV infection was particularly marked statistically in: women (26.0%), the 25-34 age group (29.1%), whites (20.9%), single people (22.8%), those people with a tattoo (29.9%), those people with a background in self-inflicted injuries (42.2%), IVDUs (46.3%), those who admitted sharing syringes (61.5%) and those with a prison record of one or more years (37.3%). Logistical regression analysis showed the following as predictors of HIV infection: IVDUs, those who went to prison in 1992, women, the 25-34 and 35-44 age group, tattooed men, those with a background in self-inflicted injuries and those with a prison record, of more than one year. The gypsy ethnic group revealed a lower probability of HIV infection. The HIV infection time trend, stratified according to the prison record showed an almost significant drop (P = 0.064). The infection trend per IVDU did not show any modification (P = 0.16). CONCLUSIONS: A high prevalence of HIV infection was detected in a prison located in a region which has not been particularly affected by AIDS. IVDUs and some characteristics that may be related to this population group have an enormous influence on this phenomenon. The time trend for this infection in this population group has decreased through the lower number of IVDUs that are admitted to prison although very high levels of prevalence of the infection were maintained in this group over the five years of the study. It is recommended that risk-reduction programmes in prisons be fostered (methadone maintenance programmes, syringe exchange pilot programmes).

Predictive factors of Mycobacterium tuberculosis infection and pulmonary tuberculosis in prisoners.

BACKGROUND: Tuberculosis currently represents a serious problem in prison populations. METHODS: With the aim of studying the predictive factors for, and the prevalence of, Mycobacterium tuberculosis infection and pulmonary tuberculosis in a Spanish prison, all those admitted during 1991 and 1992 were included (N = 1314). The tuberculin skin test, HIV serology, chest X-ray and bacteriological examination of sputum were carried out. Statistical analysis was done by univariant tests, stratified analysis and logistic regression. RESULTS: The prevalence of M. tuberculosis infection was 55.5% (95% confidence interval [CI] 52.5-58.5). An association was found with sex, imprisonment more than once, HIV infection and age. The co-infection rate (tuberculosis plus HIV) was 9.2%. Logistic regression showed a greater risk with age (4.4% per year), time spent in prison and for males. The prevalence of pulmonary tuberculosis was 1.26% and an association was found with M. tuberculosis infection, HIV infection (odds ratio [OR] = 13.7), intravenous drug users (OR = 17.2) and imprisonment more than once (OR = 7.3). Logistic regression showed an association with HIV co-infection (OR = 20.2). CONCLUSIONS: The prevalence of M. tuberculosis infection and pulmonary tuberculosis is high when compared with similar studies. The influence of age, time spent in prison and co-infection with HIV is relevant to recommendations for specific tuberculosis prevention programmes in correctional facilities.

[Effectiveness (accessibility and compliance) of a program of early diagnosis of pulmonary tuberculosis in a penitentiary population]. / Efectividad (accesibilidad y adherencia) de un programa de detección precoz de tuberculosis pulmonar en población reclusa.

The aim of the study was to determine the effectiveness of a pulmonary tuberculosis detection Program in a Spanish prison (280-320 inmates) with a high turn-over rate (500 entries annually). 754 prisoners without antituberculous chemotherapic or chemoprophylaxis were included. 642 (85.1%) had access to the Program; the highest percentage of access was obtained when tuberculin test was performed at the entrance (96.4%) versus 80.5% when it was differed (P < 0.000001). The compliance observed was 82.2%, with no evidence that a greater accessibility was influential al all. The effectiveness was 70%, greater when tuberculin test was performed at the entrance in prison (76.7%) versus 66.8% when it was differed (P < 0.000001). We conclude that since pulmonary tuberculosis rates in prisons are so high and since it is possible to obtain a high effectiveness in detection programs, if were generalize these programs in concurrence with an adequate treatment of tuberculosis cases we shall obtain high efficiency rates.