[The prevalence of dementia and its main subtypes in subjects older than 65 years: impact of occupation and education. The Toledo Study]. / Prevalencia de demencia y de sus subtipos principales en sujetos mayores de 65 años: efecto de la educación y ocupación. Estudio Toledo.

BACKGROUND: To assess the prevalence of dementia and its subtypes in a population with a low level of education, and to determine whether there is any association between occupation, education and dementia. SUBJECTS AND METHOD: Cross-section study of the population, with a sample of 3,214 individuals representative of the population of Toledo, Spain, aged 65 years and older. The Mini-Mental State Examination (MMSE) was used in the first phase of the study to detect those individuals with cognitive deterioration. The second phase consisted of a semi-structured clinical interview and neuropsychological evaluation. Dementia and sub-types of dementia were determined using well-established diagnostic criteria. The process was applied using an algorithm to optimise diagnostic agreement. RESULTS: The overall prevalence of dementia, Alzheimer's disease and vascular dementia amounted to 7.6, 4.6 and 1.8%, respectively. A direct relationship was detected between these three entities and age. The prevalence of dementia was greater in women, illiterate persons and occupations which require less skill. Once adjustment had been made for other socio-demographic variables, only age was associated with the presence of dementia. CONCLUSIONS: The overall prevalence of dementia, Alzheimer's type dementia and vascular dementia increases with age. No clear association was found between education, occupation and dementia.

Factores de riesgo de ingreso hospitalario en mayores de 64 años / Risk factors for hospitalization among the elderly

Objetivo: Determinar los factores asociados al ingreso hospitalario en una muestra representativa de la población mayor de 64 años. Diseño y participantes: Estudio de cohorte sobre una muestra de 3.214 sujetos representativa de la población de 65 y más años del partido judicial de Toledo (Castilla-La Mancha).Método: Entrevista personal en el domicilio del sujeto donde se recogen: datos sociodemográficos, carga de enfermedad, situación funcional en actividades de autocuidado e instrumentales, presencia de deterioro cognitivo y trastorno del ánimo, salud autopercibida y utilización previa de recursos sanitarios. Se analiza la presencia de ingreso hospitalario en los 12 meses que siguen a la entrevista en cualquiera de los tres hospitales que atienden el mencionado área. Resultados: 342 (10,6 por ciento) de los sujetos ingresaron en una ocasión al menos en el año siguiente a la realización de la entrevista. En el modelo logístico resultaron factores de riesgo de ingreso hospitalario: la edad avanzada (OR: 1,02), el sexo masculino (OR: 1,37), la presencia de cardiopatía (OR: 1,97) o broncopatía (OR: 1,57), el déficit visual incapacitante (OR: 1,88), la pobre salud autopercibida (OR: 1,37), la dependencia en actividades de autocuidado (OR: 1,45) y haber utilizado previamente el hospital (OR: 3,45). La ingesta de alcohol resultó un factor protector (OR: 0,70). Conclusiones: Las circunstancias asociadas a precisar ingreso hospitalario son multifactoriales. El ingreso anterior es el factor de riesgo de mayor magnitud a la hora de predecir una nueva admisión (AU)

[Risk factors for hospital admission in persons older than 64-years of age]. / Factores de riesgo de ingreso hospitalario en mayores de 64 años.

OBJECTIVE: To determine factors associated with hospitalization in a representative sample of population older than 64 years. DESIGN AND PARTICIPANTS: Cohort study on a sample of 3,214 representative subjects of the population 65 years and older from the judicial district of Toledo (Spain). METHOD: Personal home interview collecting data on: sociodemographic factors, comorbidity, basic and instrumental activities of daily life, conigitive decline and depressive disorder, self-rated health and previous use of health services. Hospital discharge in the 12-month period after the interview in anyone of the three hospitals in the study area were analyzed. RESULTS: 342 (10.6%) of the subjects spent at least one night in the hospital in the year after the accomplishment of the interview. Risk factors for hospitalization in the logistical model were: advanced age (OR: 1.02), male sex (OR: 1.37), presence of cardiopathy (OR: 1.97) or chronic obstruction to airflow (OR: 1.57), visual deficit (OR: 1.88), worse self-rated health (OR: 1.37) and having used the hospital previously (OR: 3.45). Alcohol consumption was a protective factor (OR: 0.70). CONCLUSIONS: Risk factors for hospitalization are of diverse origin. The previous admission is the strongest predictive factor for new hospitalization.

[Wine consumption and ischemic heart disease mortality in Spain]. / El consumo de vino y la mortalidad por cardiopatía isquémica en España.

BACKGROUND: To identify the determinants of the geographic distribution of ischaemic heart disease (IHD) mortality in Spain. POPULATION AND METHODS: Ecological study at the provincial level. Data are obtained from the 1976-1980 vital statistics, the 1964-1965 Household Budget Survey and the 1970 Population Census. RESULTS: Consumption of wine, chicken, fish, and vegetables, as well as illiteracy, explain 47% of IHD mortality. Consumption of wine alone exhibits a statistically significant relationship (p < 0.05) with IHD mortality. Moderate consumption of wine is negatively associated with IHD mortality, whereas higher consumption reveals a positive association. CONCLUSION: Results are consistent with those from an earlier study in Spain for the 1983-1987 period.

[Mumps epidemic in the health area of Toledo with immunization intervention. Estimation of vaccine effectiveness]. / Epidemia de parotiditis en el área sanitaria de Toledo con intervención mediante inmunización. Estimación de la efectividad de la vacuna.

BACKGROUND: The aim of this study was to describe a mumps epidemic occurred among school children in Toledo, Spain, between 1993 and 1994 were vaccination was undertaken as control measure, and to estimate vaccine efficacy under field conditions. MATERIAL AND METHODS: Attack rates for vaccinated (at 15 months of age) and unvaccinated population were calculated. A retrospective cohort study was designed to estimate vaccine efficacy. RESULTS: A total of 19 outbreaks in different schools were declared. 216 cases and 4,059 contacts, between 10-17 years old, were investigated. The attack rate for the school population was 5.3%. By age, the highest attack rate was for those in the 12-13 age group (7.9%). Estimated vaccine efficacy was 76% (95% confidence interval 66-87%) for the whole study population: For children among 10-13 years old it was 87% (95% confidence interval 76-93%), and 46% (95% confidence interval 20-70%) for those aged 14-17 years. CONCLUSIONS: Vaccination is a good control measure in mumps outbreaks (the attack rate for the study population was 5.1%). Vaccine efficacy was high for the 10-13 age group and in agreement with the results of seroepidemiological studies.

Lower consumption of wine and fish as a possible explanation for higher ischaemic heart disease mortality in Spain's Mediterranean region.

BACKGROUND: There is an apparent paradox in the geographical distribution of ischaemic heart disease (IHD) mortality in Spain. The Mediterranean regions, those with the lowest consumption of total and saturated fats, register the highest mortality due to IHD. This paper seeks to explain this paradox by examining the provincial distribution of IHD mortality in Spain and their known risk factors, dietetic and non-dietetic. METHODS: The study was based on data aggregated by province. Mortality data were taken from official vital statistics, while data on diet and other lifestyle habits were obtained from representative, large-scale, sample-based population surveys. Correlation and multiple regression analyses were run on standardized IHD mortality ratios for the period 1983-1987 and potential dietetic and non-dietetic determinants in 1989-1981. RESULTS: Intake of total lipids, saturated and polyunsaturated fatty acids, fish and wine were lower in Spain's southern and eastern provinces. Consumption of wine, fish, chicken, dairy products, vegetables and blond cigarettes, as well as unemployment, explained 53% of the variation in IHD mortality. Consumption of fish and wine alone exhibited a statistically significant relationship (P < 0.05) with IHD mortality. Moderate consumption of wine was negatively associated with IHD mortality, whereas heavy consumption patterns revealed a positive association. CONCLUSIONS: Based on correlation analyses of ecological data, lower consumption of wine and fish may explain the apparent paradox of higher IHD mortality in the presence of a lower intake of saturated fats in Spain's Mediterranean regions.

[Study of 2 food poisoning outbreaks in Mora (Toledo) with the same source of infection]. / Investigación de dos brotes de toxiinfección alimentaria en Mora (Toledo) con una fuente de infección común.

BACKGROUND: The occurrence of an outbreak needs an immediate investigation, because on it depends the necessary measures to control the spread of the epidemic, and it is also the way of knowing the causal factor. We present the results of the investigation of two food poisoning outbreaks (outbreak A and outbreak B) occurred in Mora (Toledo). Both outbreaks were reported at the same time, the source of infection was the same and the total number of exposed people was 620. METHODS: A case-control study was carried out. A standardised questionnaire for food poisoning outbreaks was used to collect the data. Data were analysed using classic methods and also logistic regression models. RESULTS: A total of 236 individuals were interviewed (119 for outbreak A and 117 for outbreak B), 146 of them were cases (73 in each outbreak). The mean incubation period was of 26.18 (+/- 12.35) and 25.2 (+/- 19.9) hours respectively. The main symptoms were diarrhoea, fever and abdominal pain. The mean age of the cases was 43.42 (+/- 17.03) years old for outbreak A and 42.4 (+/- 19.9) for outbreak B. The statistical analysis showed a significant association between the intake of cake and the disease (adjusted odds ratio = 25.00; 95% confidence interval = 6,4996.15 for outbreak A and adjusted odds ratio = 64.62; 95% confidence interval = 8.10-515.3 for outbreak B). We also obtained a laboratory confirmation showing the presence of Salmonella Entérica I, Infantis 6.7:r:1.5 in samples of cases, cake and samples of the person who prepared the cake. CONCLUSIONS: The logistic regression model, used for the analysis was useful to detect and summarise data in a more efficient manner than simple stratified analysis. The collaboration of the Primary Health Care professionals contributed to the success of the investigation.

[An outbreak of trichinosis in Huerta del Marquesado (the Cañete-Cuenca basic health area). December 1992 to January 1993]. / Brote de triquinelosis en Huerta del Marquesado (ZBS Cañete-Cuenca). Diciembre-92 a enero-93.

BACKGROUND: A trichinellosis outbreak was investigated (December 1992-January 1993). It occurred in the village of Huerta del Marquesado among people who consumed sausages made with pork, meat. The aim of this study is to show the consequences of consuming meat without a sanitary control on human health. METHODS: A case-control study was carried out. Information was obtained using a standardized questionnaire for Foodbornes. A descriptive study was done and the relationship between the intake of sausages and disease was also investigated. RESULTS: 19 cases were reported, median frequency: 11 of January. The outbreak lasted 21 days. The mean incubation period was 26.47 days (SD 4.45 days). Most frequent symptoms were fever, myalgia, eyelid's edema. The age of the patients varied from 5 to 65 years old, being the mean 33 years old. Proportionally more women than men were diseased (58%). No cases died or were hospitalized. A significant statistic association was show between trichinellosis and intake of sausages (OR = 54; 95% Confidence interval 3.1- 2622.43; p < 0.0006). Trichinella spiralis larvae have been shown in samples of the pork meat which had been eaten. CONCLUSIONS: The disease did not last excessively and was not too severe, which suggest a low parasite density. After the laboratory confirmation the meat was confiscated and destroyed. The outbreak was controlled with the active collaboration of the public health veterinarians.