Recession, employment and self-rated health: a study on the gender gap.

OBJECTIVES: Employment status and economic recession have been associated with negative effects on self-rated health, and this effect differs by gender. We analysed the effects of the Spanish economic recession in terms of self-rated health, its differential effect among genders and its influence on gender gap. STUDY DESIGN: Repeated cross-sectional study using Spanish health surveys (2001-2014). METHODS: Logistic regression models were conducted to explore the association between self-rated health and employment status and its evolution over time and gender. To test the impact of the economic recession, pooled data regression models were conducted. RESULTS: In this study, we considered 104,577 subjects. During the last 15 years, women have entered the labour market, leading to wide changes in the Spanish traditional family roles. Instead of an increasing proportion of women workers, gender employment differences persist. Therefore, in 2014, the prevalence of workers was 55.77% in men, whereas in women, it was 44.01%. Self-rated health trends during the economic recession differ by gender, with women improving slightly their self-rated health from a low self-rated health prevalence of 38.76% in 2001 to 33.78% in 2014. On the contrary, men seem more vulnerable to employment circumstances, which have led to substantial reduction in the gender gap. CONCLUSIONS: Although a gender gap persists, the change in socio-economic roles seems to increase women's self-rated health, reducing this gap. It is important to promote women's labour market inclusion, even in economic recession periods.

Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities.

AIM: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. METHODS: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. RESULTS: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). CONCLUSIONS: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.

[Antibiotic prescribing in acute respiratory tract infections in general practice]. / Prescripción antibiótica en infecciones respiratorias agudas en atención primaria.

INTRODUCTION: Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). METHODOLOGY: A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. RESULTS: Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. CONCLUSIONS: Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed.

Improving patient safety by detecting obstetric care-related adverse events: application of a new screening guide.

PURPOSE: Determining the magnitude and importance of patient safety-related incidents and the effectiveness of measures to improve patient safety (PS) are high-priority goals in efforts to improve the quality of obstetric care. The aim of this study was to evaluate the usefulness of the MRF1-OBST screening guide in detecting adverse events in women who received obstetric care. METHODS: This retrospective cohort study included 244 women who were hospitalized for delivery. All medical records were reviewed with the MRF1-OBST screening guide to identify adverse events and incidents. This tool is a modified form of the MRF1 screening guide regularly used in epidemiological studies of PS, to which we added items developed specifically for obstetric care. We calculated the positive predictive value and compared the ability of the MRF1 and MRF1-OBST guides to detect incidents related to PS in Obstetrics. RESULTS: The MRF1-OBST guide did not identify any additional complications during hospitalization or incidents related to PS that were not also identified by the MRF1 guide. CONCLUSIONS: The MRF1-OBST guide did not improve the detection of obstetric AE. The modified version of the guide required more work to use as a screening aid than the original MRF1 instrument. Efforts to improve the detection of incidents related to PS in obstetrics require complementary tools to be developed for information analysis.

Impacto de la diabetes en la carga hospitalaria / Impact of diabetes on hospital consumption

Objetivo: Analizar el impacto de la diabetes en el consumo de recursos hospitalarios. Método: Se analizaron todos los ingresos de un hospital terciario en 2006, registrados en el conjunto mínimo básico de datos (CMBD). Se estudiaron las características demográficas, de complejidad y de uso de servicios de pacientes con y sin diabetes. Resultados: En el 14,11 % constaba el diagnóstico de diabetes. El 66,4 % fueron ingresos urgentes y un 6,2 % fallecieron en el hospital. El 24 % tuvo más de un ingreso durante el año de estudio. La estancia media fue de 10,26 días frente a los 7,72 de los no diabéticos (p < 0,001). Complejidad, número de diagnósticos secundarios, sexo, tipo de ingreso y tipo de GRD influyeron en la duración de la estancia. Conclusiones: El diagnóstico de diabetes es frecuente en los pacientes hospitalizados (14 %) y estos pacientes presentan estancias más elevadas (AU)

Objective: To analyze the impact of diabetes on hospital resources utilization by inpatients. Method: We analyzed all the episodes of hospitalisation in the year 2006 of a tertiary hospital by means of the Basic Minimun data Set (CMBD).We studied demographic characteristics, case-mix, and use of hospital services for patients with and without diabetes. Results: A total of 28.383 episodes of hospitalisation wereregistered and out of these: 14.11 % were diabetic patients. Out of the total episodes, 66.4 % were emergency admissions with a hospital mortality rate of 6.2 %. Of these patients 24 % had more than one episode of hospitalisation during the study time period. The mean stay in the hospital was 10.26 days. Variables such as the complexity, the number of secondary diagnosis, sex, type of admission and the type of GRD’S affects the mean hospital stay in these patients. Conclusions: Diabetic patients account for more than 14 % of hospital admissions, and have a higher average stay than non-diabetics (AU)

Variability in the prescription of cholinesterase inhibitors and memantine.

BACKGROUND/AIM: To estimate the prevalence of Alzheimer's disease (AD) treatment in Aragon (Spain), analyzing differences according to age, gender and health area. METHODS: Retrospective study on AD treatment prevalence of cholinesterase inhibitors and memantine during 2005, using pharmaco-epidemiological data from prescription refunds transferred monthly from pharmacies to the Health Care Service. RESULTS: Differences between health areas were considerable, with adjusted prescription rates between 121.6 and 248.6/100,000 individuals. Treatment rates for women doubled those of men in each health area. Variability was greater among men than women. Drug prescription distribution was also different between health areas. CONCLUSION: Considerable variability in AD treatment has been detected. More consensus is needed to reduce variability in order to improve the quality of the pharmacotherapy for AD and assure equal treatment opportunities for every patient.

Systematic molecular characterization of multidrug-resistant Mycobacterium tuberculosis complex isolates from Spain.

We used spoligotyping and restriction fragment length polymorphism (RFLP) of the IS6110-insertion sequence to study the molecular epidemiology of multidrug-resistant (MDR) tuberculosis in Spain. We analyzed 180 Mycobacterium tuberculosis complex isolates collected between January 1998 and December 2000. Consecutive isolates from the same patients (n = 23) always had identical genotypes, meaning that no cases of reinfection occurred. A total of 105 isolates (58.3%) had unique RFLP patterns, whereas 75 isolates (41.7%) were in 20 different RFLP clusters. Characterization of the katG and rpoB genes showed that 14 strains included in the RFLP clusters did not actually cluster. Only 33.8% of the strains isolated were suggestive of MDR transmission, a frequency lower than that for susceptible strains in Spain (46.6%). We found that the Beijing/W genotype, which is prevalent worldwide, was significantly associated with immigrants. The 22 isolates in the largest cluster corresponded to the Mycobacterium bovis strain responsible for two nosocomial MDR outbreaks in Spain.

Evaluación de la utilización de heparinas de bajo peso molecularcomo profilaxis de tromboembolismo venoso en pacientes demedicina interna / No disponible

Introducción: Existe suficiente evidencia para recomendarla tromboprofilaxis rutinaria en pacientes médicos con factores de riesgo, siendo las heparinas de bajo peso molecular (HBPM) la opción más adecuada para realizarla. El objetivo es conocer el grado de riesgo de tromboembolismo venoso (TEV) en pacientes de medicina interna tratados con HBPM en profilaxis, los hábitos de prescripción y su adecuación al protocolo del hospital, así como detectar la prevalencia de pacientes no tratados con riesgo. Material y método: Estudio descriptivo y prospectivo de 2 meses de duración sobre los pacientes ingresados en medicina interna. Se reclutaron aquellos con prescripción profiláctica de HBPM y se determinó su grado de riesgo de TEV y la dosis de HBPM adecuada, según el “Protocolo de prevención de enfermedad tromboembólica” de nuestro hospital. Paralelamente se analizaron los pacientes no tratados para estimar si eran subsidiarios de profilaxis con HBPM. Resultados: Al 30% de los ingresados se le prescribió una HBPM profiláctica, de los que el 43,5% recibió una prescripción ajustada a su grado de riesgo. Sus factores de riesgo más destacados fueron: edad, encamamiento, HTA, cardiopatía de riesgo, diabetes mellitus, dislipemias y EPOC. El test c20,05 entre grado de riesgo y HBPM instaurada reveló que no existía asociación. Del grupo de pacientes no tratados, el 72% presentaron un nivel de riesgo moderado o alto. Conclusiones:1. Una gran proporción de los pacientes estudiados presentan nivel considerable de riesgo de TEV. 2. No se observa relación entre nivel de riesgo y profilaxis pautada (AU)

Background: Sufficient evidence exists to recommend routine thromboembolic disease prophylaxis for medical inpatients with risk factors -with low-molecular-weight- heparins being(LMWH) the most suitable treatment option. The objective is to determine the thromboembolic risk level of Internal Medicine patients with LMWH prophylaxis, prescription habits and the iradequacy to hospital’s standards, as well as prevalence of non treated patients at risk. Material and methods: Descriptive and prospective study of internal medicine patients for 2 months. Patients with prophylactic LMWH prescription were chosen, and their thrombo embolicrisk level and suitable LMWH dose was determined according to the hospital’s “thromboembolic disease prevention standards”.On the other hand, patients with no LMWH prophylaxis were analysed in order to judge their candidacy. Results: 30% of patients had a prophylactical LMWH prescription, with 43.5% of these prescriptions being adequate to the risk level. The main risk factors were: age, bed-stay, hypertension,cardiopathy with risk factors, diabetes mellitus, dislipemias and COPD. c20.05 test between risk level and prescribed LMWH revealed no association. 72% of patients without LMWH prescription had a moderate or high risk level. Conclusions:1. A high proportion of the patients studied have a considerable thromboembolic risk level.2. There is not a statistical relationship between thromboembolic risk level and LMWH prescription.3. There is a high percentage of patients with no LMWH prophylaxis which could be eligible for it.4. A pharmaceutical intervention would be useful to approachpharmacological prophylaxis to each patient’s risk (AU)

Anthropometric measurements in both sides of the body in the assessment of nutritional status in prepubertal children.

OBJECTIVE: To analyze the impact of choosing the left or the right side of the body on the anthropometric measurements and derived nutritional indices, in prepubertal children. DESIGN: Cross-sectional pilot nutrition survey. SETTING: General prepubertal school-age population. SUBJECTS: One-hundred and sixty-four children (97 boys and 67 girls) aged 7-9 y. INTERVENTIONS: None. RESULTS: The agreement between anthropometric measurements in both sides of the body showed that in males and in females, suprailiac skinfold thickness and arm circumference were significantly higher in the left than in the right side of the body. The agreement between body composition assessed by anthropometric measurements in both sides of the body showed that only in males was arm muscle area significantly higher in the left than in the right side, and arm fat percentage was higher in the right than in the left side of the body. Total body fat percentage calculated from skinfold thickness did not show statistically significant differences when skinfolds were obtained in the both sides of the body, either in boys and in girls. CONCLUSIONS: Our results show that differences between the sides of the body were lower than the technical error of measurement of the anthropometric measurements obtained and seem not to be biologically significant in this age group. It is necessary to standardize the method of anthropometric assessment of the nutritional status in terms of body side.

[Effects of air pollution on daily mortality in the city of Zaragoza, Spain, 1991-1995]. / Efectos de la contaminación atmosférica sobre la mortalidad diaria en la ciudad de Zaragoza, España, 1991-1995.

OBJECTIVE: To analyze the short-term impact of air pollution on daily mortality in the City of Zaragoza (Spain). MATERIAL AND METHODS: This ecologic study was conducted in Zaragoza, Spain, from 1991 to 1993. Poisson autoregressive models were constructed to assess the association between air particulate matter and sulphur dioxide SO2 and daily deaths. Four outcome variables were studied: overall mortality (excluding external deaths), mortality in subjects over 69 years of age, mortality due to respiratory disease, and mortality due to cardiovascular disease. A sample size was not obtained. Data analysis was conducted using the statistical software EGRET and SPSS. RESULTS: SO2 levels were significantly associated with cardiovascular deaths (RR = 1.018 IC 95%: 1.001-1.036) and particulate matter levels with respiratory deaths (RR = 1.028 IC 95%: 1.006-1.051). During the warm season, a significant relationship was found between particulate mater and cardiovascular deaths (RR = 1.020 IC 95%: 1.001-1.040). CONCLUSIONS: Low levels of air pollution were found in Zaragoza, with considerable variation in the concentration of air pollutant concentrations and daily respiratory and cardiovascular deaths, particularly during the warm season. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[Evolution of epidemiological methods in clinical research in Spain (1975-1994)]. / Evolución de los diseños epidemiológicos de la investigación clínica en España (1975-1994).

BACKGROUND: Previous studies have shown a sparing utilization of analytical and experimental designs in Spanish clinical research journals. The study aims are to compare among countries, the use of epidemiologic method in articles published in scientific journals, and to determine the extent to which this research has direct funding. METHODS: Cross-sectional study including all original papers published during 1994 in Medicina Clinica [(Med Clin (Barc)], Revista Clinica Española (Rev Clin Esp), The Lancet (Lancet) and New England Journal of Medicine (N Engl J Med). They were classified according to epidemiological design and we verified the financial support mention. RESULTS: 594 papers were included. Epidemiological studies without control group prevailed in Spanish journals. The most common designs were descriptive studies in Med Clin (Barc), with 45.5%, and clinical series in Rev Clin Esp, with 41.7%. The 33.6% of original papers published in Lancet and 28.4% of N England J Med were randomized trials. We found information about financial support in 73.7% of papers published in Lancet, in 77.4% of N Engl J Med, in 23.1% of Med Clin (Barc) papers and not one in the Rev Clin Esp studies. CONCLUSIONS: In Spanish clinical journals the use of epidemiological methods with control group is limited and direct financial support unusual. Wherefore these studies have a limited applicability.

The molecular epidemiology of tuberculosis in Zaragoza, Spain: a retrospective epidemiological study in 1993.

SETTING: The incidence of tuberculosis (TB) in Spain is one of the highest in Europe. In Zaragoza region the incidence rate of tuberculosis and the acquired immune deficiency syndrome (AIDS) are close to the national average. OBJECTIVE: To better define the molecular epidemiology of tuberculosis in an area of Europe where this has not been previously studied. DESIGN: A retrospective epidemiological study on tuberculosis was conducted in Zaragoza, a region of Spain, in 1993. The study population consisted of 226 patients from whom positive culture and complete clinical and demographic data were available. Mycobacterium tuberculosis strains were typed by standard restriction fragment length polymorphism (RFLP). A cluster was defined as two or more isolates with identical RFLP patterns when five or more copies of IS6110 are present. The 137 non-clustered patients were compared with the 89 clustered patients and studied by using univariate analysis. RESULTS: Thirty-nine percent of the patients were clustered, suggesting possible recent transmission. Infection with drug-resistant M. tuberculosis was associated with a decreased risk of being in a cluster. The strains isolated from human immunodeficiency virus (HIV)-positive patients were not associated with clustering. We found that immigration was not a major determinant in the total number of TB cases. CONCLUSION: Immigration, HIV and drug resistance were not associated with recent transmission. More than 50% of the clusters contained two or three patients, indicating that small outbreaks were responsible for most of the tuberculosis cases. Our RFLP typing results indicate that a TB control programme should be implemented in Spain in order to lower transmission of TB.