Stroke in Spain: epidemiologic incidence and patterns; a health sentinel network study.

INTRODUCTION: Cerebrovascular disease is among the 4 main causes of mortality in Spain. The objective of this study was to estimate the incidence of stroke and to describe the principal risk factors and other clinical and epidemiologic patterns found in patients. METHODS: Doctors from the Spanish sentinel health network recorded the episodes of acute cerebrovascular diseases in 2005 in a population of 201,205 inhabitants older than 14 years. The information of the patients (age and sex) and the episode (e.g., duration, symptoms, origin, medical attention, risk factors) was collected on a standard form. RESULTS: The estimated incidence rate of stroke was 141 cases per 100,000 inhabitants (confidence interval [CI] 95%: 125-158), 134 (95% CI: 112-157) in women and 148 (95% CI: 124-172) in men. The incidence increases significantly from the age of 65 years and men younger than this have higher rates than women. In all, 12% of patients with stroke die within the first 24 hours. CONCLUSIONS: Incidence of cerebrovascular disease in Spain is below that recorded in other countries. There is no difference according to sex, but incidence among young and middle-aged men is greater than that among women. Significant variations from some population groups to others are observed, maybe because of the difference in the prevalence of risk factors.

Serologic evidence of human infection by Francisella tularensis in the population of Castilla y León (Spain) prior to 1997.

Prior to an outbreak in Castilla y León in December 1997, tularaemia was practically non-existent in Spain. In this paper we studied the prevalence of antibodies against Francisella tularensis in a representative sample of the population (4825 people) from Castilla y León (Spain) in samples collected before this outbreak. Antibodies against F. tularensis were detected in nine (0.19%) of the 4825 sera, with antibody titres ranging from 1/20 to 1/160. Of these nine sera, one was positive in seroagglutination against Brucella. Seroagglutination against other bacteria (Yersinia enterocolitica O:9 and O:3 and Proteus OX19) was negative in all sera. Seroprevalence of antibodies in females was 0.20% and 0.17% in males; no statistically significant differences were found in prevalence in terms of sex, age or province.

[Prevalence of antibodies against Francisella tularensis in Castilla y León (Spain) before 1997]. / Prevalencia de anticuerpos frente a Francisella tularensis en la población de Castilla y León con anterioridad a 1997.

BACKGROUND AND OBJECTIVES: The aim of this paper was determine the prevalence of antibodies against Francisella tularensis in the representative sample of people from Castilla-León (Spain) before epidemic outbreak of end 1997. SUBJECTS AND METHOD: We obtain 4,825 sera (between april-1996 and april-1997) of people from Castilla-León. All sera were tested by a microagglutination technique to detect antibodies against Francisella tularensis. The positive sera were tested to determine cross-reaction with Brucella, Yersinia enterocolitica and Proteus in the tube agglutination tests. RESULTS: We detected antibodies against Francisella tularensis in 9 (0,19%) of the 4,825 sera. Only one serum from the 9 seropositive was positive in the tube agglutination against Brucella. None of the 9 sera were positive against the remaining bacterial antigen tested. CONCLUSIONS: In the people of Castilla-León before 1997 the prevalence of antibodies against Francisella tularensis was 0,19%.

A seventeen-year epidemiological surveillance study of Borrelia burgdorferi infections in two provinces of northern Spain.

This paper reports a 17-year seroepidemiological surveillance study of Borrelia burgdorferi infection, performed with the aim of improving our knowledge of the epidemiology of this pathogen. Serum samples (1,179) from patients (623, stratified with respect to age, sex, season, area of residence and occupation) bitten by ticks in two regions of northern Spain were IFA-tested for B. burgdorferi antibodies. Positive results were confirmed by western blotting. Antibodies specific for B. burgdorferi were found in 13.3% of the patients; 7.8% were IgM positive, 9.6% were IgG positive, and 4.33% were both IgM and IgG positive. Five species of ticks were identified in the seropositive patients: Dermacentor marginatus (41.17% of such patients) Dermacentor reticulatus (11.76%), Rhiphicephalus sanguineus (17.64%), Rhiphicephalus turanicus (5.88%) and Ixodes ricinus (23.52%). B. burgdorferi DNA was sought by PCR in ticks when available. One tick, a D. reticulatus male, was found carrying the pathogen. The seroprevalence found was similar to the previously demonstrated in similar studies in Spain and other European countries.

[Palliative and support care at home in primary care]. / Atención sanitaria paliativa y de soporte de los equipos de atención primaria en el domicilio.

OBJECTIVES: To estimate the proportion of people requiring palliative and support care at home in primary care and to describe their characteristics. METHODS: A descriptive study was carried out by five Spanish sentinel networks between October 2007 and March 2008 in 282,216 people attended by 218 general practitioners and nurses. Patients receiving comprehensive, active and continued care at home were included if the aim was not to prolong life but to achieve the best quality of life for the patient, the family and the carers. A standard form was used to collect data on age, sex, type of patient, underlying diseases and other variables related to the process. Crude and age-adjusted rates were estimated. RESULTS: Of the 400 men and 792 women registered, 12% were strictly terminal. The mean age was 82.4 years and was higher in patients with functional disability (82.9 years) than in terminally-ill patients (78.9 years) (p<0.01). The estimated prevalence was 422.3 per 100,000 inhabitants aged 14 years or more (95% CI: 398.7-447.0) and was much higher in women than in men (553.9 versus 287.3, p<0.01). The estimate for the entire Spanish population was 309.0 per 100,000 inhabitants (95% CI: 286.0-332.0). CONCLUSIONS: The prevalence of palliative and support care in Spain is around three cases per 1,000 inhabitants and is higher in elderly populations. More than 85% of patients needing palliative or support care have a life expectancy of over 6 months and thus represent the majority of persons using this type of medical and social support. The most susceptible groups are women and the oldest-old.

Prevalencia de anticuerpos frente a Francisella tularensis en la población de Castilla y León con anterioridad a 1997 / Prevalence of antibodies against Francisella tularensis in Castilla y León (Spain) before 1997

FUNDAMENTO Y OBJETIVOS: Este trabajo pretende conocer la prevalencia de infección por Francisella tularensis en la población de Castilla y León previa al brote de tularemia humana de finales de 1997. SUJETOS Y MÉTODO: Se obtuvieron 4.825 sueros (entre abril de 1996 y abril de 1997) de residentes en Castilla y León. Se realizó una prueba de microaglutinación en placa para detectar anticuerpos anti-F. tularensis. En los sueros positivos se llevaron a cabo seroaglutinaciones en tubo frente a Brucella, Yersinia enterocolitica y Proteus. RESULTADOS: Se detectaron anticuerpos anti-F.tularensis en 9 (0,19 per cent) de los 4.825 sueros. De esos 9 sueros, uno fue positivo en la seroaglutinación frente a Brucella, siendo todos negativos frente a las otras bacterias. CONCLUSIONES: Antes de 1997 la seroprevalencia de anticuerpos anti-F. tularensis en la población de Castilla y León era baja (0,19 per cent) (AU)