Sex and age differences in the achievement of control targets in patients with type 2 diabetes: results from a population-based study in a South European region.

BACKGROUND: We aimed to determine the degree to which control targets of glycaemia and cardiovascular risk factors were achieved among patients with type 2 diabetes and to investigate sex- and age-related differences in this population. METHODS: This cross-sectional, population-based study was conducted in Spain. Glycated hemoglobin (HbA1c), blood pressure, LDL-c, HDL-c, triglycerides, BMI, and smoking history were obtained from electronic clinical primary care records (n = 32,638 cases). The proportions of patients who met control targets were determined according to sex and age groups. Comparisons between groups were conducted with t-tests for continuous variables, tests for trends in proportions for categorical and ordinal variables, and Pearson's chi-square tests and binary logistic regression models for categorical variables. RESULTS: The overall proportions of patients with type 2 diabetes who met the target objectives for HbA1c (<7 %, 53 mmol/mol), blood pressure (130/80 mmHg), and LDL-cholesterol (100 mg/dl) were 60, 40 and 41 %, respectively. Women were less likely than men to meet the control targets of HbA1c (59 vs 61 %), LDL (35 vs 45 %), and HDL (58 vs 78 %). Patients under 65 years of age presented poorer control than older age groups. Only a minority of patients with type 2 diabetes met the composite target objectives for glycemic control, blood pressure, and LDL. CONCLUSIONS: There are differential gaps in the control results of female patients and younger patients, which should prompt improvements in case management and care. There is room for further improvement in the cardiometabolic control of patients with type 2 diabetes.

Intake of total omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid and risk of coronary heart disease in the Spanish EPIC cohort study.

BACKGROUND AND AIMS: The evidence about the benefits of omega-3 fatty acid intake on coronary heart disease (CHD) is not consistent. We thus aimed to assess the relation between dietary intake of total omega-3 fatty acids (from plant and marine foods) and marine polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on the risk of CHD in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS AND RESULTS: The analysis included 41,091 men and women aged 20-69 years, recruited from 1992 to 1996 and followed-up until December 2004. Omega-3 fatty acid intake was estimated from a validated dietary questionnaire. Only participants with definite incident CHD event were considered as cases. Cox regression models were used to assess the association between the intake of total omega-3 fatty acids, EPA or DHA and CHD. A total of 609 participants (79% men) had a definite CHD event. Mean intakes of total omega-3 fatty acids, EPA and DHA were very similar in the cases and in the cohort, both in men and women. In the multivariate adjusted model, omega-3 fatty acids, EPA and DHA were not related to incident CHD in either men or women. The hazard ratios (HR) for omega-3 were 1.23 in men (95% CI 0.94-15.9, p = 0.20); and 0.77 in women (95% CI 0.46-1.30, p = 0.76). CONCLUSION: In the Spanish EPIC cohort, with a relatively high intake of fish, no association was found between EPA, DHA and total omega-3 fatty acid intake and risk of CHD.

Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: the EPIC-Spain cohort study.

BACKGROUND AND AIM: No previous study has assessed the association between major dietary patterns and the risk of coronary heart disease (CHD) in a large cohort from a Mediterranean country. METHODS AND RESULTS: We studied prospectively 40,757 persons, aged 29-69 years, participating in the Spanish cohort of the EPIC study. Food consumption was collected between 1992 and 1996 with a validated history method. Individuals were followed-up until 2004 through record linkage with hospital discharge registers, population-based registers of myocardial infarction, and mortality registers to ascertain CHD events (fatal and non-fatal acute myocardial infarction or angina requiring revascularization). Two major dietary patterns were identified from factor analysis. The first pattern was labeled as Westernized, because of the frequent consumption of refined cereals and red meat; the second was called the evolved Mediterranean pattern, because of the frequent intake of plant-based foods and olive oil. During a median follow-up of 11 years, 606 CHD events were ascertained. No association was found between the Westernized pattern and CHD risk. In contrast, the score for the evolved Mediterranean pattern was inversely associated with CHD risk (p for trend = 0.0013); when compared with the lowest quintile of the evolved Mediterranean pattern score, the multivariable hazard ratios for CHD were 0.77 (95% confidence interval 0.61-0.98) for the second quintile, 0.64 (95% CI 0.50-0.83) for the third quintile, 0.56 (95% CI 0.43-0.73) for the fourth quintile, and 0.73 (95% CI 0.57-0.94) for the fifth quintile. CONCLUSION: A Mediterranean diet, as consumed in this study population, was associated with a lower risk of CHD.

[First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020].

BACKGROUND: The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). METHODS: Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. RESULTS: A total of 10,358 persons (1.6?% of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1?% in people over 85 years. 58?% of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9?%) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7?% (n?=?44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3?% had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. CONCLUSIONS: The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.

Association of plasma markers of cholesterol homeostasis with metabolic syndrome components. A cross-sectional study.

BACKGROUND AND AIMS: Increased plasma phytosterols, which reflect enhanced cholesterol absorption, have been related to an increased risk of cardiovascular disease (CVD). However, high CVD risk conditions, such as obesity, diabetes and the metabolic syndrome (MetS) have been associated with reduced cholesterol absorption. We investigated associations between plasma noncholesterol sterols and MetS components. METHODS AND RESULTS: With a cross-sectional design, we related MetS components to plasma noncholesterol sterol-to-cholesterol ratios measured by gas chromatography in 674 dyslipidemic patients and 361 healthy subjects participating in a prospective cohort study. Plasma phytosterol-to-cholesterol ratios were inversely associated with all components of the MetS. In the dyslipidemic group, multivariable analyses showed that a 1-SD increase in sitosterol-to-cholesterol ratio was associated with a reduced risk for any MetS feature, ranging from 0.57 (95% CI, 0.45 to 0.71) for visceral adiposity to 0.82 (95% CI, 0.69 to 0.98) for high blood pressure. The risk of having MetS was nearly halved, with ORs of 0.49 (95% CI, 0.38 to 0.64) or 0.56 (95% CI, 0.44-0.70), depending on the definition. Results were opposed for plasma lathosterol, a marker of cholesterol synthesis. Most findings were reproduced in the healthy cohort. ApoE genotype was unrelated to plasma noncholesterol sterols. CONCLUSION: In both dyslipidemic and healthy populations, MetS is associated with increased plasma lathosterol, a cholesterol synthesis marker, and decreased plasma sitosterol, a marker of cholesterol absorption. Elevated plasma phytosterols related to a lower frequency of cardiometabolic risk factors, suggesting that they are associated with a reduced CVD risk.

Social mobility and healthy behaviours from a gender perspective in the Spanish multicase-control study (MCC-Spain).

There is evidence for the influence of socioeconomic status (SES) on healthy behaviours but the effect of social mobility (SM) is not yet well known. This study aims to analyse the influence of origin and destination SES (O-SES and D-SES) and SM on healthy behaviours and co-occurrence, from an integrated gender and age perspective. Data were obtained from the controls of MCC-Spain between 2008-2013 (3,606 participants). Healthy behaviours considered: healthy diet, moderate alcohol consumption, non-smoking and physical activity. SM was categorized as stable high, upward, stable medium, downward or stable low. Binary and multinomial logistic regression models were adjusted. Those aged <65, with a low O-SES, D-SES and stable low SM are less likely to have healthy behaviours in the case of both women (physically active: OR = 0.65 CI = 0.45-0.94, OR = 0.71 CI = 0.52-0.98, OR = 0.61 CI = 0.41-0.91) and men (non-smokers: OR = 0.44 CI = 0.26-0.76, OR = 0.54 CI = 0.35-0.83, OR = 0.41 CI 0.24-0.72; physically active: OR = 0.57 CI = 0.35-0.92, OR = 0.64 CI = 0.44-0.95, OR = 0.53 CI = 0.23-0.87). However, for those aged ≥65, this probability is higher in women with a low O-SES and D-SES (non-smoker: OR = 8.09 CI = 4.18-15.67, OR = 4.14 CI = 2.28-7.52; moderate alcohol consumption: OR = 3.00 CI = 1.45-6.24, OR = 2.83 CI = 1.49-5.37) and in men with a stable low SM (physically active: OR = 1.52 CI = 1.02-1.26). In the case of men, the same behaviour pattern is observed in those with a low O-SES as those with upward mobility, with a higher probability of co-occurring behaviours (three-to-four behaviours: OR = 2.00 CI = 1.22-3.29; OR = 3.13 CI = 1.31-7.48). The relationship of O-SES, D-SES and SM with healthy behaviours is complex and differs according to age and gender.

[Differences by sex and income level in mortality from causes directly related to alcohol in Navarre, 1993-2017]. / Diferencias por sexo y nivel de renta en la mortalidad por causas directamente relacionadas con el alcohol en Navarra, 1993-2017.

BACKGROUND: Alcohol consumption is a risk factor for many health problems. Mortality from causes of death wholly attributable to alcohol consumption by sex and income level was studied and trends in the 1993-2017 period were analyzed in Navarre (Spain). METHODS: Deaths due to alcohol-induced mental disorders, dependence and abuse, alcoholic cardiomyopathy, alcoholic cirrhosis and other alcoholic liver diseases, and accidental alcohol poisoning were selected through codes ICD-9 and ICD-10. Annual income that determines copayment level was used as an indicator of socioeconomic status. Mortality rates adjusted to the European standard population were calculated using the direct method and joinpoint regression was used to evaluate the temporal trend. RESULTS: A total of 441 deaths were recorded in the population aged 35-79 years. It highlights liver cirrhosis as the most common cause (77,5%). Death rates in men were ten and five times higher than in women in 1993-1997 and 2013-2017 periods, respectively. Compared to men with incomes above 18,000 €, mortality rates were five times higher in the population with incomes below 18,000 €. No statistically significant changes were observed in the trend of mortality rates throughout the period studied. CONCLUSIONS: Mortality by causes of death wholly attributable to alcohol has not decreased in Navarre in the last three decades, it is higher in men than in women and in the population with lower incomes.

Prostate cancer incidence and mortality in Navarre (Spain).

BACKGROUND: Prostate cancer is one of the most commonly diagnosed malignancies among males worldwide. In this study, overall and age-specific incidence and mortality trends are analyzed in order to present the past and current epidemiological situation of the disease in Navarre (Spain). METHODS: Population-based incidence data from the 1975-2010 period, provided by the Cancer Registry of Navarre and prostate cancer specific mortality data for 1975-2013, provided by the Spanish Statistical Office, were used in the analysis. Age-standardized incidence and mortality rates, change-points and annual percentage changes (APC) were estimated by joinpoint regression analysis. One-dimensional P-spline models were used to estimate projections up to 2016. RESULTS: Considerable increases of cancer incidence rates in men aged 45-74 years were observed, with APC of +4.5% (p<0.001), +9.5% (p<0.001) and +2.4% (p<0.05) in the 1975-1990, 1990-2000 and 2000-2010 periods, respectively. In the older than 74 age-group, an increase of incidence rates in the 1975-1999 period was registered (APC +3.3%, p<0.001), followed by a significant decrease up to 2010 (APC -4.0%, p<0.01). Mortality rates rose until 1995 (APC +2.2%, p<0.001) whereas a decline occurred afterwards up to 2013 (APC -3.4%, p<0.001). CONCLUSION: Even though overall prostate cancer incidence rates seem to have stabilized in 2002-2010 in Navarra, trends were different by age groups: increased in men 45-74 years old and decreased in the 75+ year age-group. A decline in mortality rates was observed in both age groups since about 1995. Changes in the use of prostate specific antigen test for screening in oncoming years could affect future prostate cancer trends.

Changes in breast cancer mortality in Navarre (Spain) after introduction of a screening programme.

OBJECTIVE: The aim of this study was to assess changes in the trend of breast cancer mortality in Navarre, and the effect that a screening programme may have had on these changes. METHODS: A breast cancer screening programme targeting women aged 45-65 years was launched in Navarre in September 1990. Breast cancer deaths between 1975 and 2004 were identified from the Navarre Mortality Registry, and the date of diagnosis was obtained by linkage with the population-based Navarre Cancer Registry. We compared breast cancer mortality during the pre-screening (1987-89) and screening (2002-04) periods, and with the estimated rate in the last period calculated by a linear model with a Poisson distribution. The long-term trends (from 1975 through 2004) were described by joinpoint regression analysis. Prevalent cases (those diagnosed before 1991) were excluded to minimize dilution of the benefit in the post-screening period due to deaths from tumours diagnosed before screening began. RESULTS: The joinpoint analysis showed a rising trend in breast cancer mortality rates until 1994, followed by a continual decrease of just over 5% per year. A comparison of mortality rates between the last pre-screening and the screening periods showed a decrease of 36% (95% confidence interval [CI] 21-48%), with the largest reduction in the 50-69 years age group (52%; CI: 33-65%). In this age group, mortality in the 2002-04 period was 62% lower than that projected from extrapolation of the pre-screening trend, while in unscreened age groups (30-44 and > or =75 years), mortality was only 22% lower. When prevalent tumours were excluded, the 50-69 years age group presented a further decrease in mortality than when all tumours were considered. CONCLUSIONS: Fourteen years after the introduction of a screening programme, a major reduction in breast cancer mortality has been observed.

[Incidence and mortality due to cancer in Navarre, 1998-2002. Trends in the last 30 years]. / Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años.

Between 1998-2002, 16,952 new cases of cancer were registered in Navarre. In men, the most frequently diagnosed cancers were in the following order: prostate, lung, colon and rectum, bladder and stomach, which accounted for 63.2%. In women, the sites were breast, colon and rectum, corpus uteri, stomach and ovary, which accounted for 57.6% of the cases. In the same period, 1998-2002, 4,127 men and 2,470 women died from cancer. Sixty percent of all deaths due to malign tumours in men were due to cancer of the lung, prostate, colon and rectum, stomach and bladder. In women this was due to cancers of colon and rectum, breast, stomach, pancreas and lung, which accounted for 49% of the cases. In men in Navarre there has been an increase in the incidence rates of cancer of the prostate, kidney and non-Hodgkin lymphoma. Avoidable cancers such as those related to smoking (lung, oral cavity and pharynx or pancreas) continue to rise, and represent a greater global risk of dying from cancer in the latest period studied than in the decades of the 1970s and 1980s. From 1995 up to the present, mortality due to cancer has moved from occupying the second place to become the first cause of death among men in Navarre. The global risk of death due to cancer in men is now equal to the first period studied, 1975-1977. Amongst women the global risk of death due to cancer fell by 25% between 1975 and 2002, basically at the cost of breast and stomach cancer. Tumours related to smoking increased both in mortality and in incidence and appear as a significant health problem amongst women in Navarre. Breast cancer has increased in incidence, with lower mortality figures than those of the first period 1975-1977. Invasive cancer of the cervix remains at very low rates in comparison with many European countries, including Spain. In both sexes colorectal and skin cancer has increased, while the incidence and mortality of stomach cancer continues to fall.

[Recent trends of the main causes of death in Navarre. 1995-2004]. / Tendencias recientes de las principales causas de muerte en Navarra. 1995-2004.

UNLABELLED: We present the statistics for mortality in Navarre for the 1995-2004 period by sex, age and cause of death. METHODS: The data proceeds from the statistical bulletins on death. The 1995-1999 period is compared with the 2000-2004 period, using adjusted rates to the population of Navarre for the year 2001 and the rate of potential years of life lost between 0-70 years adjusted to the European population. RESULTS: Life expectancy at birth in the 2000-2004 period was 77.9 years in men and 85 years in women, the latter being one of the highest registered at the world level. Infant mortality fell to 3.3 per 1,000 living newborn infants. The risk of death has fallen in practically all age groups, with a notable fall in mortality of 40% in the 25-34 group at the cost of AIDS. There has been a significant increase of mortality due to lung cancer amongst women under 65 years of age (46%) in the 2000-2004 period with respect to the previous five year period and a sharp fall in mortality due to breast cancer (45.4%). In both sexes there has been a continued fall of mortality due to cerebrovascular diseases, ischaemic heart diseases, cardiac failure and arteriosclerosis and of mortality due to ulcer and cirrhosis. The rates of mortality in Navarre in all the main groups of causes are lower than those of Europe, except for the rate of mortality due to external causes. CONCLUSIONS: The increase of mortality due to lung cancer and other cancers related to smoking, due to the spread of consumption in recent decades, could have a negative influence on the life expectancy of women in Navarre in coming years. The prevention of mortality due to external causes and the prevention of deaths linked to tobacco consumption are the two priorities that emerge from the data on mortality in this autonomous community.

Trends in transport accident mortality from 1999 to 2013 in Navarra. Characteristics of people and vehicles involved / Evolución de la mortalidad por accidentes de transporte en Navarra durante 1999-2013. Características de las personas y vehículos involucrados.

Objective. To analyze transport accident mortality trends in Navarra, a region in the North of Spain, between 1999 and 2013 and assess the effect of the Demerit Point System. Methods. Cause of death coding was done according to ICD-10 with information from the medical death certificate and forensic reports. Mortality rates by age, sex, type of victim and residence (urban/rural) were calculated. We performed an ARIMA Box and Jenkins analysis to estimate the effect on mortality rates due to transport accidents of the Demerit Point System, which had been introduced in Spain in July 2006. Results. From January 1st 1999 to December 31st 2013, 1,052 deaths were registered, 1,044 of which were from accidents involving ground transport vehicles (1,020 from road traffic accidents and 24 from non-road traffic accidents). Mortality rates were higher in men and people aged 18-24 and 65-84. Most of the deaths amongst younger men and adults occurred in drivers, while fatalities occurring in those older than 84 years were mostly in pedestrians. Men and women living in rural areas had a mortality risk from transport accident 33% and 21% higher than people living in urban areas. Since the introduction of the Demerit Point System, mortality rates have fallen by 51%. Conclusions. Mortality statistics for Navarra show the effectiveness of preventive strategies designed in Spain during recent years.

Unprocessed red meat and processed meat consumption and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC).

BACKGROUND/OBJECTIVES: High intakes of unprocessed red or processed meat may increase the risk of stroke. We aimed to examine the association between unprocessed red meat, processed meat and total red meat consumption and risk of total stroke and ischaemic stroke. SUBJECTS/METHODS: Cox proportional hazards regression analyses were conducted based on the data for 41,020 men and women aged 29-69 years at baseline. RESULTS: During a mean follow-up of 13.8 years, 674 incident cases of stroke (531 ischaemic strokes, 79 haemorrhagic strokes, 42 subarachnoid haemorrhages and 22 mixed or unspecified events) were identified. After multiple adjustment, unprocessed red meat, processed meat and total red meat consumption were not correlated with incidence of total stroke or ischaemic stroke in either men or women. The hazard ratios (HRs) for unprocessed red meat and processed meat and risk of total stroke comparing the highest with the lowest quintiles were, respectively, 0.81 (95% confidence interval (CI) 0.54-1.21; P-trend=0.15) and 0.92 (95% CI 0.64-1.32; P-trend=0.82) in men and 1.21 (95% CI 0.79-1.85; P-trend=0.10) and 0.81 (95% CI 0.51-1.27; P-trend=0.17) in women. The HRs for unprocessed red meat and processed meat and risk of ischaemic stroke were, respectively, 0.80 (95% CI 0.51-1.25; P-trend=0.51) and 0.86 (95% CI 0.57-1.29; P-trend=0.77) in men and 1.24 (95% CI 0.74-2.05; P-trend=0.13) and 0.82 (95% CI 0.47-1.42; P-trend=0.31) in women. CONCLUSIONS: In the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, unprocessed red meat and processed meat consumption were not associated with risk of stroke in men or women.

Brain and central nervous system cancer incidence in navarre (Spain), 1973-2008 and projections for 2014.

Different studies have pointed out Navarre as one of the regions of Spain with the highest incidence rates of brain and other central nervous system (CNS) cancer. Trend analysis for cancer incidence rates for long periods of time, might help determining risk factors as well as, assessing prevention actions involved in this disease. The objective of this study was to describe the incidence of brain and CNS cancer using data from the population-based cancer registry of Navarre, (Spain) during the period 1973-2008 and provide forecast figures up to-2014. Crude and age-standardized (world population) incidence rates of brain cancer per 100,000 person-years were calculated by the direct method separately by gender, area (Pamplona and others), and age-groups. Penalized splines for smoothing rates in the temporal dimensions were applied in order to estimate and forecast cancer incidence rates. Age-adjusted incidence rates showed an increase over the study and forecast periods in both sexes more marked in women than in men. Higher incidence rates were observed in men compared with women but the differences became smaller with time. The increase was due to the rise of rates in the oldest age groups since the rates for younger age groups remained stable or decreased over time. As the entire aetiology of brain and other CNS cancer is not still clear, keep promoting healthful lifestyles for cancer primary prevention among the whole population is necessary.

[Variability in the in-hospital management of acute myocardial infarction in Spain. IBERICA Study (Investigación, Búsqueda Específica y Registro de Isquemia Coronaria Aguda)]. / Variabilidad en el manejo hospitalario del infarto agudo de miocardio en España. Estudio IBERICA (Investigación, Búsqueda Específica y Registro de Isquemia Coronaria Aguda)

Introduction and objective. Although some in-hospital studies have described the management of acute myocardial infarction (MI) patients in Spain, none has been able to guarantee the exhaustiveness of patient registry. This study sought to determine the clinical characteristics and in-hospital management of patients with MI in eight Spanish population registries.Methods. The IBERICA study is a population-based MI registry carried out in the 25 to 74 year-old population, in eight Spanish regions in 1997. A standardized methodology was used to register and investigate all MI arriving alive to a hospital. Clinical characteristics, cardiovascular risk factors prevalence, pharmacological treatment, invasive and non-invasive procedures performed and complications at 28 days of evolution were recorded. A descriptive analysis was performed and the variation coefficient (VC) was calculated.Results. In 1997, 4,041 MI patients were registered, 79.9% were men with a mean age of 61.1 years. Although 10.9% (95% CI: 9.9-11.9%) were not admitted to the coronary care unit, a large variability existed among different areas (VC = 53%). There was a high variability in the utilization and performance of non-invasive and invasive procedures among regions, as well as in the use of pharmacological treatment. Only the use of antiaggregants (91.5%) and thrombolytic therapy (41.8%) showed a low variability (VC < 10%). Twenty-eight day mortality was 16.2% (95% CI: 15.1-17.4%) with a high variability being observed among the different regions (VC = 20.6%).Conclusion. Patient characteristics vary among the different Spanish regions. The differences in management and prognosis suggest a lack of equality in the health care provided to MI patients in the different regions in Spain.

[The validity of infant mortality statistics in Navarra]. / Validez de las estadísticas de mortalidad infantil en Navarra.

In order to explore the validity of official infant mortality statistics, the number of infant deaths registered in the cohort of live births and resident in Navarra (Spain) from 1985 to 1989, according to data supplied by the Department of Statistics of Navarra, has been compared with that obtained in a retrospective search into the information of the hospitals. Among 24,383 live births of the cohort, 291 were certified as infant deaths. An over-register of 13 cases (4.5%) and an under-register of 26 cases (8.9%) was detected. By excluding those live births with less than six months of gestation, as done by the National Institute of Statistics, the validity is altered, because apart from the errors mentioned, one must add those resulting from the incorrect filling-in of the "number of weeks pregnant"= variable. When correcting these deficiencies, the final statistics (Infant Mortality Risk = 11.17 per 1000 live births) did not differ much from the official figures (IMR = 11.48 per 1000 live births).

[Magnitude of human immunodeficiency virus (HIV) infection. Navarre, 1992]. / Magnitud de la infección por el virus de la immunodeficiencia humana (VIH). Navarra 1992.

The information available from public laboratories in Navarra (Spain) on tests for detecting anti-HIV antibodies enabled to find out the number of HIV seropositive subjects from 1985 to June 1992, as well as their demographic characteristics and risk habits. 1205 subjects were found to be HIV seropositive, out of a population of 512,512 inhabitants which means an accumulated incidence of a 2.35 cases per thousand inhabitants. Higher rates were observed in young males (13.57 per thousand), and in urban areas (3.7 per thousand). The most frequent risk habit among HIV seropositive is the use drugs by intravenous injection (93.7%) followed by sexual transmission (3.5%). This methodology provides the minimum number of HIV seropositive cases in Navarra, since it does not include those not diagnosed, on diagnosed in private centres in Navarra and/or in other autonomous regions.

[Approximation to the prevalence of heroin users in Navarre in 1990]. / Aproximación a la prevalencia de usuarios de heroína en Navarra en 1990.

Intensive multi-agency case finding is a methodology developed to make an estimation of the number and sociodemographic characteristics of known heroin users in a given community. It basically consists of collecting information from services and/or sanitary, social and penal institutions which in the course of their activities contact, or are contacted by persons who are described as heroin users. With the aim of estimating the magnitude of heroin use in Navarra, information about heroin users was requested from public treatment centers for drug-dependences, therapeutic communities, psychiatric emergencies, general hospitals, hepatitis case registry, HIV+ case registry, prisons, forensic and various social services. The study covered the whole Autonomous Community (512,512 residents) during the year of 1990. Overall 1231 persons were counted as heroin users representing a prevalence rate of 2.4 cases/1000 residents. They were mainly male (3 to 1), and a 72% of cases were aged between 20 and 29. The demographic distribution was mainly urban (3.4 to 1) and there were large differences among the different urban zones.

[Nosocomial and community outbreak of epidemic keratoconjunctivitis in Navarra in 1996]. / Brote nosocomial y communitario de queratoconjuntivitis epidémica en Navarra en el año 1996.

BACKGROUND: Epidemic keratoconjunctivitis is an acute, generally bilateral infection, that appears sporadically or in outbreaks from a source of common infection which may be a visit to the ophthalmologist or a swimming pool. Keratitis may evolve to form sub-epithelial injuries in the cornea lasting as much as several months. METHODS: Description of an outbreak of epidemic keratoconjunctivitis that took place in Navarra (Spain) between April and August 1996 and which affected at least 266 people. RESULTS: The epidemiological research highlights the existence of two ophthalmologist consulting rooms as the transmission mechanism for the infection in 46 of the 116 patients researched. The spread of the infection in the environment of the patients was recorded in 119 cases, 62 of which are considered secondary cases. The aetiological diagnosis of the outbreak was carried out 11 days after the start of the microbiological research, isolating adenovirus in conjunctival samples of 8 of the 19 patients researched. CONCLUSIONS: The preventive measures taken to control the outbreak and their effectiveness was highlighted by the gradual reduction in cases.

[Progress in the control of HIV infection and AIDS in Navarre, 1985-2003]. / Progresos en el control de la infección por el VIH y el sida en Navarra, 1985-2003.

The epidemiological situation of HIV infection and AIDS in Navarre in 2003 is reviewed. Up until December 2003, 1,610 HIV infections had been diagnosed in residents of Navarre, of whom 41% had died. The new diagnoses of HIV fell by some 81% between 1993 and 2003, a year in which 28 cases were diagnosed (4.8 per 100,000 inhabitants). The fall basically occurred in infections in injection drug users, since the cases due to sexual transmission had remained stable. Over half of the infections diagnosed in the period 2000-2003 (58%) were attributable to heterosexual transmission, 18% occurred in parenteral drug users and 12% in homosexual men. Thirty-three percent were persons originally from other countries. The incidence of AIDS fell from 75 cases in 1996 to 20 in 2003, and mortality from 65 to 8 cases, respectively. In the 2000-2003 period, the average annual incidence of AIDS was 4.2 per 100,000 inhabitants and the average annual rate of mortality was 1.6 per 100,000 inhabitants. At the end of 2003, there were 902 living persons with a diagnosis of HIV monitored by the health system (1.6 known infections per 1,000 inhabitants). In 2003, 65% of the youths aged between 15 and 29 referred to coital sexual relations, a higher percentage than in previous years, but their level of information on the prevention of AIDS was acceptable. It is necessary to insist on prevention and to adapt this to the new situation.