Oral health profile status and treatment needs in the Salvadoran elderly population: a cross-sectional study.

INTRODUCTION: Older adults are a highly vulnerable group in their general health condition, including oral health that can be influenced by different factors, among them, changes in oral tissues inherent to the physiological processes of aging and by systemic condition. In El Salvador, it is a group that has received little attention at the public health level. OBJECTIVE: To determine the profile of the oral health status and treatment needs of the elderly population in El Salvador. MATERIALS AND METHODS: Secondary cross-sectional analysis of data from the last oral health survey in 471 Salvadorans aged 60 years and older. The variables under study were: sociodemographics, brushing frequency, oral hygiene according to simplified oral hygiene index (OHI-S), caries experience according to decayed, missing, and filled teeth index (DMFT) modified with international caries detection and assessment system (ICDAS) criteria, periodontal status through the community periodontal index of treatment needs (CPITN), edentulism and treatment needs. Statistical analysis was conducted using chi-square test, ANOVA, z-test and linear regression (p < 0.05). RESULTS: The older adults presented poor oral hygiene, low brushing frequency, high tooth loss with an average of 16 missing teeth while one third presented total edentulism. Most of the older adults were categorized as having "poor or very Poor" oral hygiene. Almost all respondents presented some degree of periodontal disease and required restorative intervention. CONCLUSION: The oral health status of elderly Salvadoran is poor. Furthermore, the development of public policies and specific oral health strategies aimed at this population is urgent.

Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean.

BACKGROUND: Maternal and child health have shown important advances in the world in recent years. However, national averages indicators hide large inequalities in access and quality of care in population subgroups. We explore wealth-related inequalities affecting health coverage and interventions in reproductive, maternal, newborn, and child health in Latin America and the Caribbean. METHODS: We analyzed representative national surveys from 15 countries conducted between 2001 and 2016. We estimated maternal-child health coverage gaps using the Composite Coverage Index - a weighted average of interventions that include family planning, maternal and newborn care, immunizations, and treatment of sick children. We measured absolute and relative inequality to assess gaps by wealth quintile. Pearson's correlation coefficient was used to test the association between the coverage gap and population attributable risk. RESULTS: The Composite Coverage Index showed patterns of inequality favoring the wealthiest subgroups. In eight countries the national coverage was higher than the global median (78.4%; 95% CI: 73.1-83.6) and increased significantly as inequality decreased (Pearson r = 0.9; p < 0.01). CONCLUSIONS: There are substantial inequalities between socioeconomic groups. Reducing inequalities will improve coverage indicators for women and children. Additional health policies, programs, and practices are required to promote equity.

The public health value of vaccination for seniors in Europe.

Longer life expectancy and decreasing fertility rates mean that the proportion of older people is continually increasing worldwide, and particularly in Europe. Ageing is associated with an increase in the risk and severity of infectious diseases. These diseases are also more difficult to diagnose and manage in seniors who often have at least one comorbid condition (60% of seniors have two or more conditions). Infectious diseases increase the risk of hospitalization, loss of autonomy and death in seniors. Effective vaccines are available in Europe for infectious diseases such as influenza, pneumococcal diseases, herpes zoster, diphtheria, tetanus and pertussis. Their effectiveness has been demonstrated in terms of reducing the rates of hospitalization, disability, dependency and death. The prevention of diseases in seniors also results in savings in healthcare and societal costs each year in Europe. Despite the availability of vaccines, vaccine-preventable diseases affect millions of European citizens annually, with the greatest burden of disease occurring in seniors, and the medical and economic benefits associated with are not being achieved. Vaccination coverage rates must be improved to achieve the full benefits of vaccination of seniors in Europe.

Epidemiology of leishmaniasis in Spain based on hospitalization records (1997-2008).

All the records from the Spanish information system for hospital data of patients diagnosed with leishmaniasis during a 12-year period (1997-2008) were studied. The 2,028 individuals were hospitalized because of leishmaniasis, as indicated by the principal diagnostic code. The average hospitalization rate was 0.41/100,000 inhabitants. One-third of them were co-infected with human immunodeficiency virus (HIV). The incidence of hospitalization in the adult population with leishmaniasis co-infected with HIV increased with age, peaked at 35-39 years of age and subsequently declined. In the pediatric population, all leishmaniasis cases occurred in HIV-negative children. Incidence of hospitalizations was highest in Madrid and in the Mediterranean coast. The cost per inpatient hospital care was $9,601 corresponding to an annual direct cost of more than $1.5 million for inpatient care alone. The economical burden of leishmaniasis is not neglectable and in the 12-year study period it represented more than $19 million.

Changes in the epidemiology of hepatitis A in Spain (2005­2008): trends of acute hepatitis A hospitalizations, comorbidities, and costs associated with the hospitalization.

INTRODUCTION: The objective of this study is to analyze data related to hospitalization, comorbidities, median stays and costs associated with the hospitalization cases of hepatitis A in Spain, during the 2005-2008 periods. METHODS: A retrospective study of the characteristics of acute hepatitis A patients admitted to Spanish hospitals was performed using the minimum basic dataset. Costs were calculated using the diagnosis-related groups for the disease. RESULTS: The total number of hospitalized patients diagnosed with acute hepatitis A was 2395 (2.66/100,000 inhabitants); 61.5% were diagnosed in men. The highest rate corresponds to the group aged 20-39 years (4.01/100,000 inhabitants). When compared with year 2005 ascending tendencies in hospitalization was found for the year 2008 (incidence rate ratio 1.36 confidence interval 95% 1.32-1.39). Twenty-four deaths (1%) were reported out of the total of hospitalized patients. The median hospital stay was 5 days. An increase of cost from euro 1.272.608 in the year 2005 to euro 2.586.657 in 2008 was observed. Therefore, the total cost derived from these hospitalizations, above the retail price index, has increased by 90%. CONCLUSION: The incidence of hospitalized patients diagnosed with acute hepatitis A in Spain has remained stable from 2005 to 2007 and increased significantly in the year 2008. Therefore, a change in the epidemiology of hepatitis A may be taking place in Spain and this disease could become a public problem in the young adult population. It is necessary to conduct a cost-effectiveness study to assess the need for including hepatitis A in the universal immunizations schedule.

The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings.

BACKGROUND: To evaluate the influence of heart disease on clinical characteristics, quality of life, use of health resources, and costs of patients with COPD followed at primary care settings under common clinical practice conditions. METHODS: Epidemiologic, observational, and descriptive study (EPIDEPOC study). Patients > or = 40 years of age with stable COPD attending primary care settings were included. Demographic, clinical characteristics, quality of life (SF-12), seriousness of the disease, and treatment data were collected. Results were compared between patients with or without associated heart disease. RESULTS: A total of 9,390 patients with COPD were examined of whom 1,770 (18.8%) had heart disease and 78% were males. When comparing both patient groups, significant differences were found in the socio-demographic characteristics, health profile, comorbidities, and severity of the airway obstruction, which was greater in patients with heart disease. Differences were also found in both components of quality of life, physical and mental, with lower scores among those patients with heart disease. Higher frequency of primary care and pneumologist visits, emergency-room visits and number of hospital admissions were observed among patients with heart diseases. The annual total cost per patient was significantly higher in patients with heart disease; 2,937 +/- 2,957 vs. 1,749 +/- 2,120, p < 0.05. Variables that were showed to be independently associated to COPD in subjects with hearth conditions were age, being inactive, ex-smokers, moderate physical exercise, body mass index, concomitant blood hypertension, diabetes, anxiety, the SF-12 physical and mental components and per patient per year total cost. CONCLUSION: Patients with COPD plus heart disease had greater disease severity and worse quality of life, used more healthcare resources and were associated with greater costs compared to COPD patients without known hearth disease.

Significant differences in the use of healthcare resources of native-born and foreign born in Spain.

BACKGROUND: In the last decade, the number of foreign residents in Spain has doubled and it has become one of the countries in the European Union with the highest number of immigrants There is no doubt that the health of the immigrant population has become a relevant subject from the point of view of public healthcare. Our study aimed at describing the potential inequalities in the use of healthcare resources and in the lifestyles of the resident immigrant population of Spain. METHODS: Cross-sectional, epidemiological study from the Spanish National Health Survey (NHS) in 2006, from the Ministry of Health and Consumer Affairs. We have worked with individualized secondary data, collected in the Spanish National Health Survey carried out in 2006 and 2007 (SNHS-06), from the Ministry of Health and Consumer Affairs. The format of the SNHS-06 has been adapted to the requirements of the European project for the carrying out of health surveys. RESULTS: The economic immigrant population resident in Spain, present diseases that are similar to those of the indigenous population. The immigrant population shows significantly lower values in the consumption of alcohol, tobacco and physical activity (OR = 0.76; CI 95%: 0.65-0.89, they nonetheless perceive their health condition as worse than that reported by the autochthonous population (OR = 1.63, CI 95%: 1.34-1.97). The probability of the immigrant population using emergency services in the last 12 months was significantly greater than that of the autochthonous population (OR = 1.31, CI 95%: 1.12-1.54). This situation repeats itself when analyzing hospitalization data, with values of probability of being hospitalized greater among immigrants (OR = 1.39, CI 95%: 1.07-1.81). CONCLUSION: The economic immigrants have better parameters in relation to lifestyles, but they have a poor perception of their health. Despite the fact that immigrant population shows higher percentages of emergency attendance and hospitalization than the indigenous population, with respect to the use of healthcare resources, their usage of healthcare resources such as drugs, influenza vaccinations or visits to the dentist is lower.

Epidemiology of hospital-treated Salmonella infection; data from a national cohort over a ten-year period.

OBJECTIVE: The aim of this study was to describe the clinical and economic burden of hospital admissions related to Salmonella infections amongst the population of Spain over the course of 10 years (1997-2006). METHODS: Data provided by the National Epidemiology Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos; CMBD) were analysed. This database included information about Salmonella infection-related hospital incidence rates, patient demographics, length of stay, mortality, case-fatality rates and associated costs. RESULTS: During the period 1997-2006, 65,100 infections due to Salmonella were recorded, indicating an annual incidence rate of 16.18 cases/100,000 people/year (95% confidence interval [CI] 16.05-16.30). The average length of hospital stay for patients with Salmonella infection was of 7.6 days (SD 8.9), and the average patient age was 31 years old (SD 29). The mortality rate was 0.23/100,000 people (95% CI 0.22-0.24 per 100,000 people), and the case-fatality rate was 1.40% (95% CI 1.33-1.51%). The incidence rate was significantly higher in those <14 and >65 years old (maximum of 89.12 cases/100,000 people <4 years old; 95% CI 87.80-90.45 cases/100,000). The mortality and case-fatality rates increased significantly with age, reaching 2.05 deaths per 100,000 people (95% CI 1.70-2.37 cases/100,000) or 7.53% (95% CI 6.34-8.73%) in people >85 years old. The total cost of Salmonella infection was 124 million Euros during the study period, with children up to 4 years of age being the most prominent consumers of resources. CONCLUSIONS: Salmonella infection remains an important cause of hospitalization of children up to 4 years old, but the main mortality and case-fatality rates are observed in persons older than 65 years.

Characteristics of chronic obstructive pulmonary disease in Spain from a gender perspective.

BACKGROUND: The objective of this study was to analyze the clinical and management characteristics of chronic obstructive pulmonary disease (COPD) in men and women, to determine possible gender-associated differences between the two groups of patients. METHODS: An observational and descriptive epidemiological study (EPIDEPOC study). The study included patients with stable COPD and aged >or= 40 years, evaluated in primary care. Data were collected relating to sociodemographic variables, clinical characteristics, quality of life (SF-12), severity of disease and treatment. The results obtained in men and women were compared. RESULTS: A total of 10,711 patients (75.6% males and 24.4% females) were evaluated. Significant differences were found between males and females in relation to the following parameters: age (67.4 +/- 9.2 years in men vs 66.1 +/- 10.8 in women, p < 0.05), smoking (91.9% of the men were smokers or ex-smokers vs 30% of the women), comorbidity (the frequency of hypertension, diabetes, anxiety and depression was greater in women, while ischemic heart disease was more common in men), mental component of quality of life (49.4 +/- 10.3 in men vs 44.6 +/- 11.9 in women, p < 0.05) and severity of disease (56.5 +/- 13.3% in men vs 60.7 +/- 3.2 in women, p < 0.05). As regards treatment, the percentage use of long-acting b2-adrenergic agonists, anticholinergic agents, theophyllines and mucolytic agents was significant greater in men. The total annual cost of COPD was greater in males than in females (1989.20 +/- 2364.47 euro vs 1724.53 +/- 2106.90, p < 0.05). CONCLUSION: The women with COPD evaluated in this study were younger, smoked less and have more comorbidity, a poorer quality of life, and lesser disease severity than men with COPD. However, they generated a lesser total annual cost of COPD than men.

Hospitalizations associated with rotavirus gastroenteritis in Spain, 2001-2005.

BACKGROUND: This study aims to describe and analyze hospital admissions in Spain due to rotavirus infections among children aged 5 years or under during the period 2001-2005, along with the associated health cost. METHODS: To update estimates of rotavirus hospitalizations rates in Spain, we conducted a retrospective study of 5 years of national hospitalization data associated with acute gastroenteritis using the Minimum Basic Data Set. RESULTS: During the study period, a total of 17.1% of all admissions due to acute gastroenteritis of any etiology in children aged < or = 5 years were attributable to rotavirus infection as determined by the rotavirus-specific International Classification of Diseases, ninth revision, Clinical Modification code. A mean incidence of 135 hospital admissions attributable to rotavirus per 100,000 children aged < or = 5 years was found. Hospitalizations associated with rotavirus had a marked winter-time seasonality. The estimated cost of hospital admission attributable to rotavirus has risen from 3 million euros estimated for 2001 to almost 7 million euros estimated in 2005. CONCLUSION: Rotavirus gastroenteritis remains an important cause of hospitalizations in Spanish children, mostly during the winter season.

Coverages and factors associated with influenza vaccination among subjects with chronic respiratory diseases in Spain.

BACKGROUND: The main influenza complications particularly affect patients over the age of 65 years and those with associated chronic diseases, such as respiratory disorders. This study aims to assess vaccination coverage among Spanish children and adults with chronic respiratory diseases (CRDs), and to describe the factors associated with vaccination in 2003. METHODS: We analysed 28,113 records of individuals (6869 children and 21,244 adults) included in the Spanish National Health Survey (NHS) for 2003. As a dependent variable, we used the reply ('yes' or 'no') to the question: 'Did you have a 'flu shot in the latest campaign?' We calculated influenza vaccine coverage as the percentage of individuals with a respiratory disorder (asthma and/or chronic bronchitis and/or emphysema) who reported having been vaccinated against influenza in the most recent campaign. We analysed the influence of sociodemographic, health-status, medical visits and lifestyle variables on vaccination. RESULTS: Vaccination coverage was 19.9% in children and 54.7% in adults suffering CRD. In both age groups, coverages were significantly higher than those observed for non-CRD sufferers. Among adults, older age, not smoking and medical visits to their physician in the preceding 2 weeks were the variables independently and significantly associated with a higher likelihood of receiving the vaccine. Among children, financial factors influence vaccination. CONCLUSIONS: Vaccination coverage among children with CRDs is very low. Also among adult CRD sufferers, vaccination remains below the desired level, thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine.

Estimates of influenza vaccination target population sizes in Spain for the 2006-2007 season.

This study sought to estimate influenza vaccination target population sizes in Spain for the 2006-2007 season, based firstly on current vaccine recommendations, and secondly, on the hypothetical assumption that Advisory Committee on Immunization Practices (ACIP) recommendations were to be implemented. We estimate that under present Spanish guidelines, 41% of the population should be vaccinated against influenza in the 2006-2007 season. Of those eligible for vaccination, 41% are aged >or=65 years, 16% are aged <65 years and suffer from a chronic condition, and 36% are healthy household contacts aged <65 years. If the ACIP recommendations were implemented in Spain, the target population size would increase to 26,761,506 persons (61%), and of those eligible for vaccination, 57% would fall within the age-based recommendations (ages 6-59 months or >or=50 years), 29% would come under the healthy household contacts category, and only 5% would qualify due to suffering from a medical condition. We thus conclude that approximately 18 million persons, 41% of the Spanish population, should receive influenza vaccination in the 2006-2007 season under present Spanish guidelines. With the estimated number of doses to be distributed during this season (10 million), compliance with current recommendations would amount to only 56% at best. Extending universal vaccination to the 50-64 age group should be considered as an option for improving influenza vaccination coverage, particularly among high-risk patients, because a greater proportion of persons would receive the recommended dose by becoming eligible for the more effective age-based strategies.

Epidemiologic intervention framework of a prehospital emergency medical service.

OBJECTIVES: To describe and analyze the characteristics of prehospital medical assistance provided by the Madrid Municipal Emergency and Civil Rescue & Protection Service (SAMUR); and, based on the epidemiologic knowledge so gained, to prioritize public health intervention strategies. METHODS: A retrospective cross-sectional analysis of all medical services performed by the SAMUR-Protección Civil in 2001 and 2002. Study variables included causes, response times, hour, day of the week, month, mobile resource, Municipal District, and pathology. For analysis purposes, the relevant data were linked to Access 97 via Open Database Connectivity. Statistical analysis was performed using the SPSS computer software package, with Spearman's correlation coefficient and analysis of variance. Values were deemed statistically significant at p < 0.05. RESULTS: The study population comprised the 97,937 and 101,438 interventions undertaken in 2001 and 2002, respectively. Mean daily activity in 2002 involved 278 alerts (standard deviation: 46), 95% confidence interval: 273-282. Distributions of the interventions were similar for 2001 and 2002, with peak activity from 1 to 2 pm and 8 to 9 pm, and minimum activity from 6 to 7 am. Activity was at its most intense on Saturdays. The magnitude of the association between the two years by day of the week was 96% (p < 0.001). The Central Municipal District (Centro) triggered 17,875 emergency actions. The prevalent pathology was traumatologic, followed by cardiovascular. CONCLUSIONS: Epidemiologic description enabled the characteristics of the prehospital assistance procedure to be comprehensively ascertained and quantified. False alarms assume special relevance due to their implications. Emergency medical alerts with a psychosocial component are on the increase, something that must be controlled.

Influenza vaccination coverage and related factors among Spanish patients with chronic obstructive pulmonary disease.

This study sought: to describe influenza vaccination coverages among COPD patients treated in a primary-care setting; and to analyse the factors linked to compliance with vaccination recommendations. This was a descriptive study in a primary-care (PC) setting. Each of the 2422 randomly selected medical practitioners included in the study was required to recruit five COPD patients. Information was drawn from patients' clinical histories and personal interviews. As the dependent variable, we took the answer (yes or no) to the question, "did you have an influenza vaccination in the most recent campaign?"; and as independent variables, we analysed socio-demographic data, health-status related variables, lifestyles and history of pneumococcal vaccination. A total of 10,711 patients were enrolled 87.2% reported having been vaccinated in the most recent campaign. In conclusion, Spanish COPD patients treated in a primary-care setting can be said to enjoy good vaccine coverages against the influenza virus. More frequent contact with the general practitioner and a history of pneumococcal vaccination increase the likelihood of being vaccinated considerably, and measures should be implemented with the aim of improving coverages among younger subjects and those who lead less healthy lifestyles.

Influence of sociodemographic variables on use of dental services, oral health and oral hygiene among Spanish children.

OBJECTIVES: To analyse the possible influence of sociodemographic variables on use of dental services, oral health and oral hygiene among Spanish children. METHODS: Descriptive cross-sectional study based on 1,676 interviews conducted with parents or guardians of children ages 3-15 years. The dependent variables analysed were: use of dental services in the preceding 12 months; self-reported caries ever; and daily dental hygiene measured as toothbrushing frequency. Independent variables were sex, age, size of town or city, educational level, and monthly income of the family unit. RESULTS: A total of 60% of the study children had not visited a dental professional in the preceding 12 months. Children having parents or guardians with the lowest educational level were 1.592 times more likely to have received no dental care than those with the highest educational level. The likelihood of not having made use of such dental services rose 2.232-fold in cases where income was < 600 versus >1200 per month. Overall prevalence of self-reported caries for the sample as a whole was 34.4%. Subjects in the lowest income bracket (< 600 per month) were 1.497 times more likely to have caries than those in the highest income bracket. In all, 68.5% brushed their teeth every night, but the percentage rose significantly with age, size of town or city, and income. CONCLUSION: There is considerable social inequality in the use of dental services, oral health and oral hygiene among Spanish children.