Fracture energy threshold in parry injuries due to sharp and blunt force.

Blows with axes, machetes or blunt objects such as baseball bats, truncheons, etc. are often parried, resulting in typical parry injuries, or so-called nightstick fractures to the ulna. In this study, we sought to assess the impact energy required to break the ulna in such parry incidents in an experimental setting using semisynthetic and fully synthetic models. Twenty-seven sheep radii and 33 polyurethane synthetic bones were cast into gelatin prior to being fired at with missiles made of a section of an axe blade or steel rod at different firing velocities using a compressed-nitrogen cannon. Each model was then examined as to the presence of hair-line fractures or complete fractures. Sheep bones and synthetic bones displayed comparable results when struck by the axe missile; here, a clear fracture threshold was evident between 14.00 and 15.26 J. When struck by the rod missile, only the synthetic bones produced significant results, namely a fracture threshold between 20.15 and 23.59 J. In conclusion, our results show an ulnar fracture threshold of approximately 15 J when struck by an axe. The experiments regarding blows with a rod displayed a fracture threshold of around 22 J, but, as this could not be validated with biological bones, this result is questionable.

Combined use of daily and hourly data sets for the source apportionment of particulate matter near a waste incinerator plant.

A particulate matter (PM) source apportionment study was carried out in one of the most polluted districts of Tuscany (Italy), close to an old waste incinerator plant. Due to the high PM10 levels, an extensive field campaign was supported by the Regional Government to identify the main PM sources and quantify their contributions. PM10 daily samples were collected for one year and analysed by different techniques to obtain a complete chemical characterisation (elements, ions and carbon fractions). Hourly fine (<2.5 µm) and coarse (2.5-10 µm) aerosol samples were collected by a Streaker sampler for a shorter period and hourly elemental concentrations were obtained by PIXE. Positive Matrix Factorization (PMF) analysis of daily and hourly data allowed the identification of 10 main sources: six anthropogenic (Biomass Burning, Traffic, Secondary Nitrates, Secondary Sulphates, Incinerator, Heavy Oil combustion), two natural (Saharan Dust and Fresh Sea Salt) and two mixed sources (Local Dust and Aged Sea Salt). Biomass burning turned out to be the main source of PM, accounting for 30% of the PM10 mass as annual average, followed by Traffic (18%) and Secondary Nitrates (14%). Emissions from the Incinerator turned out to be only 2% of PM10 mass on average. PM10 composition and source apportionment have been assessed in a polluted area near a waste incinerator, by PMF analysis on daily and hourly compositional data sets.

Clostridium difficile-related hospitalizations and risk factors for in-hospital mortality in Spain between 2001 and 2015.

AIMS: To examine trends in the incidence, characteristics and in-hospital outcomes of Clostridium difficile infection (CDI) hospitalizations from 2001 to 2015, to compare clinical variables among patients according to the diagnosis position (primary or secondary) of CDI, and to identify factors associated with in-hospital mortality (IHM). METHODS: A retrospective study was performed using the Spanish National Hospital Discharge Database, 2001-2015. The study population included patients who had CDI as the primary or secondary diagnosis in their discharge report. Annual hospitalization rates were calculated and trends were assessed using Poisson regression models and Jointpoint analysis. Multi-variate logistic regression models were performed to identify variables associated with IHM. FINDINGS: In total, 49,347 hospital discharges were identified (52.31% females, 33.69% with CDI as the primary diagnosis). The rate of hospitalization increased from 3.9 cases per 100,000 inhabitants in 2001-2003 to 12.97 cases per 100,000 inhabitants in 2013-2015. Severity of CDI and mean cost per patient increased from 6.36% and 3750.11€ to 11.19% and 4340.91€, respectively, while IHM decreased from 12.66% to 10.66%. Age, Charlson Comorbidity Index, severity, length of hospital stay and mean cost were significantly higher in patients with a primary diagnosis of CDI. Irrespective of the CDI diagnosis position, IHM was associated with male sex, older age, comorbidities, readmission and severity of CDI. Primary diagnosis of CDI was associated with lower IHM (odds ratio 0.60; 95% confidence interval 0.56-0.65). CONCLUSION: CDI-related hospitalization rates are increasing, leading to a high cost burden, although IHM has decreased in recent years. Factors associated with IHM should be considered in strategies for the prevention and management of CDI.

Gunshot residue on dark materials: a comparison between infrared photography and the use of an alternative light source.

The pattern of gunshot residue (GSR) includes important information about muzzle-target distance since a larger GSR distribution diameter indicates a larger shooting distance. GSR may not be visible to the naked eye when, for example, it is located on dark textiles. In such cases, further procedures need to be performed in order to visualize the pattern of GSR. Besides chemical procedures, an alternative light source or infrared photography can be utilized for non-destructive GSR visualization. In the work presented, these two techniques are compared based on shooting experiments using 26 different dark textiles. Within the range of the alternative light source, the use of a 440-nm light in combination with an orange-colored filter led to the best visualization of GSR in the form of fluorescent particles. Infrared photography, on the other hand, visualized GSR as dark particles, whereas-ideally-the dark textile reflected the infrared light and appeared bright. The comparison of both techniques revealed that the GSR distribution visualized by infrared photography was not identical to the GSR distribution visualized with 440-nm illumination in combination with an orange-colored filter. We concluded that infrared photography visualizes the inner powder soot zone, whereas illumination at 440 nm leads to fluorescence of the outer powder soot zone, which can be visualized using an orange-colored filter. Knowledge of this difference in visualization of the two powder soot zones is important for forensic practitioners assessing firing distances. In the literature, however, this difference is not noted as clearly.

Detection of painted-over traces of blood and seminal fluid.

Dealing with a refurbished crime scene is a special challenge for forensic investigators. In such cases, a crime scene may not have only been cleaned in order to erase all traces but the walls of an indoor crime scene could also be painted over in order to mask traces of the crime. So far, very few publications have shown that painted-over traces of blood and seminal fluid can be detected using a forensic light source or infrared photography. To date, there have been no systematically executed research studies including guidelines on which settings to use depending on the color of the wall. Moreover, no comparative study has addressed the question of whether it is better to use infrared photography or a forensic light source to visualize painted-over bloodstains. The present study covers the aforementioned gaps and shows that painted-over bloodstains are most easily visualized by infrared photography, while traces of seminal fluid are most easily visualized at 440 nm in combination with a yellow filter-both independent of the color of the wall paint.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN: A retrospective, descriptive, epidemiological study. SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

[Perceived quality of life in the "healthy people" municipal community health promotion program in Ciudad Lineal-Madrid]. / Calidad de vida percibida en el programa municipal comunitario de promoción de la salud «Gente saludable¼. Ciudad Lineal-Madrid.

INTRODUCTION: The measurement of the health-related quality of life (HRQoL) is a comprehensive way to estimate the health of both the individual and the community. The aim of this study was to assess changes in health and HRQoL using the intervention strategies «healthy people¼ and «health promotion programs¼ of the City Council of Madrid-Madrid Health. The study was conducted in the Municipal Health Centre of Ciudad Lineal, in 2014, and included promotion of exercise, healthy eating, smoking cessation, psycho-hygiene, memory training, and health education for the elderly, with group interventions. MATERIAL AND METHODS: A before and after community trial, with the administration of questionnaire with COOP/WONCA HRQoL charts to 200 participants. RESULTS: The study population (n=87), included those who completed the first and second questionnaire. Positive changes were seen in the overall before and after COOP/WONCA scores, with a mean change from 23.16 to 21.94, with statistical significance, p≤0.002. In the psychology groups, it changed from 28.14 to 23.57 with a p≤0.05, and healthy eating from 22.81 to 20.85, with p≤0.03. In the health education groups it changed from 21 to 20.81 points, and in memory training from 23.31 to 22.45 points (both without significance). CONCLUSIONS: The significant improvement in scores reflects a positive change in self-perceived health of this community after the intervention and proper operation of programs. The areas directly related to health and interventions in psychology and nutrition-exercise, are those with the most significant changes.

EFECTO DEL SOMBRÍO SOBRE LA SIGATOKA NEGRA (Mycosphaerella fijiensis MORELET) EN CULTIVO DE PLÁTANO cv HARTÓN (Musa AAB SIMMONDS)

La sigatoka negra en el cultivo del plátano es considerada como una de las enfermedades más limitante de la producción, a nivel mundial, siendo manejada con fungicidas, ocasionando contaminaciones ambientales e incremento de los costos de producción. Como estrategia no contaminante, algunos investigadores recomiendan cultivar en condiciones de sombrío, para reducir la enfermedad. El objetivo de este trabajo fue evaluar el efecto de diferentes porcentajes de sombrío en la incidencia de la enfermedad y en la producción, bajo condiciones del Caribe húmedo colombiano. En condiciones de campo, se estableció el cultivar '˜Hartón', en un diseño de bloques completos al azar y cuatro porcentajes de sombrío, 20, 35 y 50%, teniendo como testigo plantas cultivadas a libre exposición solar 100%. Las evaluaciones, se realizaron durante el periodo de floración del cultivo, cuantificando el número de hojas funcionales NHF, la hoja más joven con síntomas HMJS, la hoja más joven enferma HMJE, el índice de severidad IS y rendimiento. Los tratamientos con 20, 35 y 50% de sombrío no presentaron diferencias estadísticas entre sí; más sí, con el testigo en las variables NHF, HMJE, IS y rendimiento. Los tratamientos con sombra manifestaron menor IS de la sigatoka negra, de 13 al 15%, mientras el testigo fue del 18%; además, los rendimientos se incrementaron en 400kg ha-1. Se concluye, que el cultivo de plátano '˜Hartón', manejado a partir del 20% de sombrío, fue suficiente para reducir la severidad de la sigatoka negra e incrementar significativamente los rendimientos.

Black sigatoka in plantain cultivation is considered one of the most limiting production diseases worldwide. It is managed with fungicides, causing environmental pollution and increased production costs. As a nonpolluting strategy, some researchers recommend cultivating shade conditions to reduce the disease. The aim of this study was to evaluate the effect of different shade percentages in the incidence of disease and production under the Caribbean Colombian humid conditions. Under field conditions it was established to cultivate the '˜Harton' in a completely randomized block design and four shade percentages 20, 35 and 50%, having as control plants growing in 100% sun exposure. Evaluations were performed during the flowering period of the crop, quantifying the number of functional leaves NFL, the youngest leaf with symptoms YLS, the youngest diseased leaf YDL, the severity index SI and yield. Treatments with 20, 35 and 50% shade were not statistically different from each other; but with the witness in the NFL, YLS, SI and yield. Treatments with shade had lower SI of black sigatoka, between 13 to 15%; while the witness was 18%; also the yield increased in 400kg ha-1. It is concluded that growing '˜Harton', managed from 20% shade was enough to reduce the severity of black sigatoka and significantly increase yields.

Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004-2013).

UNLABELLED: Hip fracture is a serious public health problem. We used Spanish hospital discharge data to examine trends in 2004-2013 in the incidence of hip fracture among elderly patients. We found that hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. INTRODUCTION: This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without type 2 diabetes mellitus (T2DM) in Spain, 2004-2013. METHODS: We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by diabetes status: Incidences were calculated overall and stratified by diabetes status and year. We analyzed surgical procedures, length of hospital stay (LOHS), and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year, comorbidity, and in-hospital complications (IHC). RESULTS: From 2004 to 2013, 432,760 discharges with hip fracture were identified (21.3 % suffered T2DM). Incidence among diabetic men and women increased until year 2010 and then remained stable. Diabetic women have three times higher incidence than diabetic men. Incidences and IHC were higher among patients with diabetes beside sex. The proportion of patients that underwent internal fixation increased for all groups of patients and the arthroplasty repair decreased. After multivariate analysis, IHM has improved over the study period for all patients. Suffering diabetes was associated to higher IHM in women (odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.07-1.17). CONCLUSIONS: Hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. In diabetic patients, incidence rates increased initially but have leveled from 2010 onwards. For all groups, the use of internal fixation has increased overtime and IHM and LOHS have decreased from 2004 to 2013.

Trends in sepsis incidence and outcomes among people with or without type 2 diabetes mellitus in Spain (2008-2012).

AIMS: There is conflicting evidence on how type 2 diabetes mellitus (T2DM) influences in-hospital mortality (IHM) in sepsis. We aimed to compare trends in outcomes for sepsis in people with or without T2DM in Spain between 2008 and 2012. METHODS: We identified all cases with any sepsis diagnosis using national hospital discharge data. We evaluated annual incidence rates for sepsis stratified by T2DM status. We calculated IHM and analyzed trends over time. In a multivariate analysis including potential confounding factors, we tested T2DM as an independent factor for IHM. RESULTS: Overall, 217,280 cases of any-stage sepsis were diagnosed, of whom 50,611 (23.3%) had T2DM. The annual incidence of sepsis increased during the 5-year period (from 76.5 to 113.3cases/10(5) population). The incidence increase was higher for the population with T2DM (from 16.8 to 27.1 cases/10(5) population; 61.3% relative increment). People with T2DM were significantly older (75.8 ± 11.2 years vs. 71.0 ± 16.4 years) and suffered from more coexisting medical conditions. In the univariate analysis, mortality was higher for the population with T2DM only when septic shock was present (53.3% vs. 51.9%; P=0.002). IHM decreased over time both in participants with (from 45.7% to 38.1%) and without T2DM (from 46.1% to 39.5%). After accounting for all other potential confounders, T2DM was significantly associated with a lower IHM (odds ratio=0.88; 95% confidence interval, 0.86-0.90). CONCLUSIONS: In Spain, the annual increase in sepsis incidence was higher in people with T2DM, but the risk of dying with sepsis during admission was moderately lower in people with T2DM.

Predictors of medication use in the Roma population in Spain: a population-based national study.

OBJECTIVES: To describe the prevalence of prescribed and self-medicated use of medication in the Spanish Roma population, and identify the associated factors. STUDY DESIGN: Descriptive cross-sectional study. METHODS: Data from the first National Health Survey conducted on the Roma population in Spain were used. The sample comprised 1000 Spanish Roma adults of both sexes aged ≥16 years. Answers (yes/no) to the question, 'In the last two weeks have you taken the following medicines [in reference to a list of medicines that might be used by the population] and were they prescribed for you by a doctor?' were used to ascertain 'medication use'. 'Self-medication' referred to use of these medicines without medical prescription. Using multivariate logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to identify associated factors. RESULTS: The overall prevalence of medication use in the Roma population for both sexes was 69.1%, and 38.7% was self-medicated. Females reported higher use of medication than males (75.1% vs 62.3%); however, self-medication was higher among males. Analgesics and antipyretics were used most often (35.8%). Among males, the variables that were independently and significantly associated with a higher probability of medication use were: age; negative perception of health; presence of chronic disease (OR 2.81; 95% CI 1.67-4.73); and medical visits (OR 4.51; 95% CI 2.54-8.01). The variables were the same among females, except for age. CONCLUSION: A high percentage of the Spanish Roma population use medication, and a significant proportion of them self-medicate. The presence of chronic diseases, a negative perception of health and medical consultations were associated with increased use of medication in the study population.

Social disparities in access to breast and cervical cancer screening by women living in Spain.

OBJECTIVES: To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. STUDY DESIGN: Cross-sectional study using data from the 2011 Spanish national health survey. METHODS: Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. RESULTS: Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. CONCLUSION: Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.

Health Belief Model applied to non-compliance with HPV vaccine among female university students.

OBJECTIVES: To investigate the reasons for refusal of human papillomavirus (HPV) vaccination, and to explore participants' perceptions and attitudes about Health Belief Model (HBM) constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) among a sample of female university students. STUDY DESIGN: Cross-sectional. A self-administered questionnaire based on the HBM was used. METHODS: Confirmatory factor analysis was applied to the data to examine the construct validity of the six factor models extracted from the HBM. The predictors of non-HPV vaccination were determined by logistic regression models, using non-HPV vaccination as the dependent variable. RESULTS: The sample included 2007 students. The participation rate was 88.9% and the percentage of non-vaccination was 71.65%. Participants who had high scores for 'general perceived barriers', 'perceived barriers to vaccination', 'no perceived general benefits', 'no perceived specific benefits' and 'no general benefits' were more likely to report being unvaccinated. CONCLUSIONS: The findings demonstrated the utility of HBM constructs in understanding vaccination intention and uptake. There is an urgent need to improve health promotion and information campaigns to enhance the benefits and reduce the barriers to HPV vaccination.

Inequalities in uptake of breast cancer screening in Spain: analysis of a cross-sectional national survey.

OBJECTIVES: Breast cancer remains a public health problem worldwide. Early detection through mammography practice has been shown to be effective in improving survival among women. Nevertheless, it is necessary to have high participation in mammography screening to achieve that goal. The aim of this study is to estimate the adherence to recommended preventive practices for breast cancer (mammography) in Spain and to identify predictors of uptake according to sociodemographic variables, health related variables and lifestyles. STUDY DESIGN: This is a descriptive cross-sectional study based on data from the European Health Interview Survey for Spain. Breast cancer screening included self-reported mammography in the last two years. The age target range was 40-69 years (n = 5771). The following independent variables were analysed: sociodemographic (marital status, educational level, monthly income, and nationality), visit to a general practitioner, chronic conditions and lifestyles. Predictors of mammography adherence were explored using multivariate logistic regression. RESULTS: The screening coverage in the target population was 67.7% (95% CI: 66.2-69.1). Mammography uptake was positively associated with being married, higher educational and income levels, Spanish nationality, having visited a general practitioner in the previous four weeks and suffering from musculoskeletal disease. Otherwise, the youngest age group studied (40-49 years) and obesity was associated with lower adherence to mammography. CONCLUSIONS: Compliance with mammography practice in Spain is acceptable to achieve the goal of reducing mortality from breast cancer among women. However significant inequalities in uptake of breast screening in Spain were found. Future campaigns must aim to improve participation especially among women with disadvantaged socio-economic situations and immigrants.

Adherence and factors associated with influenza vaccination among subjects with asthma in Spain.

PURPOSE: Influenza has a high morbidity and mortality rate and an increased risk of complications in vulnerable individuals. Children and adults with asthma have a high risk of complications, hospitalisation and even death. The objectives of this study were as follows: to compare influenza vaccination coverage in Spain in a population of asthmatics aged ≥ 16 years with an equivalent population of non-asthmatics; to identify the factors that influence vaccination coverage among patients with asthma; and to compare coverage during the period 2006/2007 with that of 2009/2010. METHODS: We used data from the 2009 European Health Survey (EHS), which included a population of 22,188 individuals (≥ 16 years of age), of whom 1,669 [7.5 %; 95 % confidence interval (CI), 7.13-7.98] had asthma. The dependent variable was the answer (yes/no) to a question asking whether or not the interviewed person had been vaccinated against seasonal (not pandemic) influenza in the previous season. As independent variables, we analysed socio-demographic characteristics, health-related variables and the use of health care services. RESULTS: Vaccination coverage was 35.2 % (95 % CI, 32.5-37.9) among asthmatics and 22.1 % (95 % CI, 21.4-22.7) among non-asthmatics (p < 0.001). The probability of being vaccinated is almost twice as high for asthmatics as it is for non-asthmatics [odds ratio (OR), 1.92; 95 % CI, 1.69-2.17]. Among asthmatics, vaccination coverage increased with age, worse self-rated health status and not smoking. No significant change in coverage was observed between the study periods. CONCLUSIONS: Seasonal influenza vaccination coverage among Spanish asthmatics is lower than desired and has not improved in recent years. Urgent strategies are necessary in order to increase vaccination coverage among asthmatics.

National trends (2003-2009) and factors related to psychotropic medication use in community-dwelling elderly population.

BACKGROUND: We aimed to analyze the prevalence of prescription anxiolytics and antidepressants in elderly individuals in Spain between the years 2003 and 2009, and to identify those factors associated with the likelihood of consumption of these drugs during the study period. METHODS: We used individualized secondary data retrieved from the 2003 and 2006 Spanish National Health Surveys (SNHS) and the 2009 European Health Interview Survey (EHIS) for Spain to conduct a nationwide, descriptive, cross-sectional pharmacoepidemiology study on psychotropic medication in the population aged 65 years and over in Spain. A total of 12,228 interviews were analyzed (5,117 from 2003; 7,084 from 2006; and 5,144 from 2009). The dichotomous dependent variables chosen were the answers "yes" or "no" to the question "In the last two weeks have you taken the following medicines and were they prescribed for you by a doctor?" referring to intake of anxiolytics and antidepressants. Independent variables were sociodemographic, comorbidity, and healthcare resources. RESULTS: Multivariate analysis highlighted the association between increased psychoactive drug intake and female gender, depression, polypharmacy, and negative perception of health. We observed a significant increase in the consumption of prescription anxiolytics (AOR, 1.08 [95% CI, 1.06-1.10]) and antidepressants (AOR, 1.11 [95% CI, 1.08-1.14]) in individuals aged ≥65 years in Spain between the years 2003 and 2009. CONCLUSIONS: The prevalence of anxiolytics and antidepressants consumption is higher in elderly women than men, and increases with negative perception of health. The Spanish elderly individuals taking antidepressants reported having problems to manage these medicines in their own homes.

[Determinants of poor mental health in people aged 16 to 64 residing in a large city]. / Factores que determinan la mala salud mental en las personas de 16 a 64 años residentes en una gran ciudad.

BACKGROUND: Know what factors determine the poor mental health in the city of Madrid. MATERIAL AND METHODS: Cross-sectional study Health Survey of the City of Madrid (ESCM'05), analyzed 5746, persons aged 16 to 64 years, in the years 2004-2005. Dependent variable was obtained from the General Health Questionnaire (GHQ-12), was considered score above 2. Independent variables included sociodemographic factors, lifestyle, health and environmental issues. The quality of life related to health (HRQOL) was measured with the questionnaire COOP / WONCA. RESULTS: The overall prevalence of poor mental health was 19.2%, p <0.05 for gender, age group 16 to 24 years and lower social classes. The predictors most strongly associated with poor mental health in the multiple regression are: women OR=1.48 (1.23-1.78), minors OR=3.21 (2.40-4.29), immigrant economic OR=1.33 (1.06-1.68), smoking or drinking alcohol OR=1.22 (1.02 -1.49) and 1.31 (1.09 -1.57), chronic disease OR=1.47 (1.21 -1.79), sleeping less 8 hours OR=1.41 (1.17 -1.68), having fair or poor health status perception OR=1.65 (1.22-2.22), self-perceived poor quality of life HRQOL OR=1.18 (1.15-1.22), and limited social activities OR=1.34 (1.07 -1.69) . CONCLUSIONS: The mental health problems are highly prevalent in this city. Being woman, young, economic migrant, worse lifestyles, poor quality of life refered or limited social activities are the factors that force to explain the association with poor mental health.

Adherence to breast and cervical cancer screening in Spanish women with diabetes: associated factors and trend between 2006 and 2010.

AIM: This study aimed to assess the adherence to breast and cervical cancer screening of women with diabetes mellitus (DM), and the associated factors and trend of use over time of these preventative services between 2006 and 2010 in Spain. METHODS: The study used data from a population of women aged greater or equal to 18 years (n=11,957) who participated in the European Health Interview Survey in Spain (EHISS, 2009). Diabetes status was self-reported and included those with type 2 DM. Adherence to screening for cancer prevention was assessed by asking women aged greater or equel to 40 years whether they had undergone mammography and a Papanicolaou (Pap) cervical smear (in those aged 18-69 years) within the previous 2 and 3 years, respectively. Independent variables included sociodemographic and health-related characteristics. Also, the age-standardized prevalences of mammography and Pap smear uptake were compared in women with diabetes between 2006 and 2010. RESULTS: Among the diabetic women, 37.9% underwent mammography and 49.1% had a Pap smear vs 53.8% and 64%, respectively, in women without diabetes, with corresponding adjusted odds ratios of 0.81 (95% CI: 0.68-0.97) and 0.74 (95% CI: 0.60-0.91). Among diabetic women, attending more "physician visits" was a positive predictor of having both screening tests. Also, a higher monthly income level was associated with mammography uptake, and a higher educational level with Pap smear uptake. There was also a significant decrease in mammography screening uptake between 2006 and 2010 compared with a stable rate of uptake of cervical cancer screening. CONCLUSION: Spanish women with diabetes consistently underuse breast and cervical cancer screening tests compared with non-diabetic women. The decline in mammography uptake rates needs to be carefully monitored and may even call for intervention.