Mental health in girls and boys exposed to intimate partner violence.

OBJECTIVES: Children of abused women have a greater risk of mental health problems. This study assesses the association between women's exposure to intimate partner violence (IPV) and the mental health of their children in the population of the Madrid Region. STUDY DESIGN: Cross-sectional. METHODS: Data were drawn from the '2014 Survey on Intimate Partner Violence against Women in the Madrid Region'. Women meeting the definition of IPV answered the Strengths and Difficulties Questionnaire (SDQ) on the mental health of one of their children aged 4-16 years. The comparison group was made up of mother-child dyads that had not been exposed to IPV. We used multivariate analysis to assess whether the children of abused women had a greater probability of having higher SDQ subscale and total scores. RESULTS: A total of 209 mother-child dyads were analyzed, 64 exposed (50% boys) and 145 unexposed to IPV (51% boys). Exposure to IPV was associated with a high SDQ score (greater risk of mental health problems), with a prevalence ratio of 3.6 (95% CI 1.2-10.3) in girls and 2.4 (95% CI 1.1-5.1) in boys. Among girls, moreover, exposure to IPV was significantly associated with behavioral and inattention/hyperactivity problems. In conclusion, exposure to IPV was associated with an increased frequency of mental health problems among children in general, and girls in particular. CONCLUSIONS: This study reinforces the recommendations to conduct studies with data disaggregated by sex and to address the impact of IPV in mothers and children jointly.

Effectiveness of acellular pertussis vaccine and evolution of pertussis incidence in the community of Madrid from 1998 to 2015.

INTRODUCTION: Pertussis is a communicable disease that primarily affects infants. Vaccination has led to an important reduction in the incidence of the disease, however, resurgence of the disease has been observed. This study aimed to analyze the incidence of pertussis and assess the vaccination effectiveness (VE) of different schedules of acellular pertussis vaccination in the community of Madrid. METHODS: Pertussis cases notified to the Mandatory Disease Reporting System from 1998 to 2015 were analyzed. Five comparison periods were created: 1998-2001 (reference), 2002-2005, 2006-2009, 2010-2012 and 2013-2015. The incidence ratio (IR) between inter-epidemic periods was analyzed using a Poisson regression. VE was calculated using the screening method. Vaccine status data were collected from the vaccine registry. RESULTS: In total, 3855 cases were notified. Inter-epidemic periods were observed every 3-4 years. The incidence increased (IR: 5.99, p < 0.05) in the 2013-2015 period, particularly among infants younger than 1 month (IR: 32.41, p < 0.05). Vaccination data were available in 89% of cases. For those receiving the last dose at ≤6-month VE was 89.9% (95% confidence interval (CI): 87.3-92.0) after one year of follow-up, and 85.5% (95% CI: 82.4-88.1) after 11 years of follow-up. For those receiving the last dose at 18-months VE decreased from 98.8% (95% CI: 98.3-99.1) to 85.1% (95% CI: 81.9-87.7) in the same period, and for those receiving the last dose at 4-year VE decreased from 99.6% (95% CI: 99.3-99.7) to 79.3% (95% CI: 74.6-83.1). CONCLUSIONS: B. pertussis is circulating in our population, as shown by the epidemic peaks and increased incidence of pertussis in recent years. VE increased with the number of doses and decreased with the follow-up period. The effect of this and other vaccination strategies must be monitored to control the disease.

Effectiveness of different vaccine schedules for heptavalent and 13-valent conjugate vaccines against pneumococcal disease in the Community of Madrid.

INTRODUCTION: The heptavalent pneumococcal conjugate vaccine (PCV-7) was added to the childhood routine vaccination program in the Community of Madrid in November of 2006 with 3+1 recommended doses and a catch-up for those under 2years old. In June 2010, PCV-7 was replaced by 13-valent vaccine (PCV-13) with 2+1 recommended doses. In July of 2012, the PCV-13 was removed from the funded program and reintroduced again (2+1 recommended doses) in December 2014. In between, children were vaccinated privately with 3+1 recommended doses of PCV-13. The aim of this study was to evaluate the effectiveness of each vaccination schedule used in the Community of Madrid. METHODS: We included all cases of invasive pneumococcal disease (IPD) reported between 2007 and 2015 to the Notifiable Diseases Surveillance System. Vaccination information was obtained from the Immunization Registry. Vaccine effectiveness (VE) was estimated using the indirect cohort design for cases with serotype information. RESULTS: A total 779 cases were included in the study. Among them 47.6% of the cases were primo-vaccinated with booster, 20% primo-vaccinated, 15.9% incompletely primo-vaccinated and 16.5% not vaccinated. The VE for ≥1 doses of any PCV was 82% (CI 95%: 67.8-89.9%): 91.9% (CI 95%: 76.5-97.2%) for PCV-7 and 77.2% (48.6-89.9%) for PCV-13. VE in those receiving the full 2+1 or 3+1 schedules was 100% for both vaccines. CONCLUSIONS: A high number of vaccine failures were reported in children before they had the opportunity to receive the booster dose, especially due to PCV-13-non-PCV-7 serotypes. VE was higher for PCV-7 compared to PCV-13, except for those that received the complete schedule with booster that achieved 100% of VE, which shows the relevance of the vaccines and complying with all doses scheduled.

[Trends and social inequalities in cervical cancer and breast cancer screening in Madrid: Non-Commumicable Disease Risk FactorSurveillance System (SIVFRENT-A) from 1995 to 2010]. / Tendencias y desigualdades sociales en el cribado de cáncer de cérvix y cáncer de mama en la Comunidad de Madrid duranteel periodo 1995-2010 a partir del Sistema de Vigilancia deFactores de Riesgo de enfermedades no transmisibles (SIVFRENT-A).

BACKGROUND: The assessment of preventive programs is necessary to support the decisions made in public health. There are few research studies that evaluate the degree of implementation and equity of cancer screening in Spain. The objective was to describe trends and inequalities in cervical and breast cancer screening according social determinants of health. METHODS: An analysis was carried out on the Behavioral Risk Factor Surveillance System of Community of Madrid data, obtained between 1995 and 2000 from telephone surveys conducted on a population between ages 18 to 65, were analyzed. The years were grouped into four periods: P1 to P4. The trends were estimated with prevalence ratios (PR) with 95% confidence intervals (95% CI), obtained through generalized linear models with binomial family and logarithmic link. The inequalities were estimated with differences of proportions (DP) with 95% CI. RESULTS: An increased in mammograms is seen especially in women with low education (PR P4/P1: 1.93; 95%CI 1.62 to 2.3), this trend more discreet in cytology (PR P4/P1: 1.28; 95%CI 1.11 to 1.47). However mammograms have not increased over in the past 5 years (PR P4/P3: 1.02; 95% CI 0.99 to 1.04). Inequalities get better, but show an increase in the last period. CONCLUSIONS: All groups increase in preventative behaviors and those who did not, had a high prevalence from the start.Itis worth mentioning the stagnation of mammography in disadvantaged women in the period 2007-2010. There was a social gradient for preventive preventative measures, which was lower in the population-basedscreening (mammography) than in the opportunistic one (cytology).

Tendencias y desigualdades sociales en el cribado de cáncer de cérvix y cáncer de mama en la Comunidad de Madrid durante el periodo 1995-2010 a partir del Sistema de Vigilancia de Factores de Riesgo de enfermedades no transmisibles (SIVFRENT-A) / Trends and social inequalities in cervical cancer and breast cancer screening in Madrid: non-Commumicable Disease Risk Factor Surveillance System (SIVFRENT-A) from 1995 to 2010

Fundamento: La evaluación de programas preventivos es necesaria para fundamentar las decisiones en salud pública. En España hay pocas investigaciones que evalúen el grado de implementación y equidad del cribado de cáncer. El objetivo fue describir tendencias y desigualdades en el cribado de cáncer de cérvix y cáncer de mama según determinantes sociales de la salud. Métodos: Se analizó el Sistema de Vigilancia de Factores de Riesgo asociados con enfermedades no transmisibles de la Comunidad de Madrid entre 1995 y 2010, basado en encuestas telefónicas a población de 18 a 65 años. Los años se agruparon en cuatrienios: P1 a P4. Se estimaron razones de prevalencia (RP) mediante modelos lineales generalizados con vínculo logarítmico y familia binomial y diferencias de proporciones (DP), con su IC 95% y su significación. Resultados: Se observa un incremento en las mamografías especialmente en mujeres con estudios bajos (RP P4/P1: 1,93; IC 95%: 1,62 a 2,3), siendo ésta más discreta en las citologías (RP P4/P1: 1,28; IC 95%: 1,11-1,47). Las mamografías no se incrementaron en los últimos 5 años (RP P4/P3: 1,02; IC 95%: 0,99-1,04). Las desigualdades mejoraron de P1 a P3 para empeorar en el último periodo. Conclusiones: Todos los grupos incrementan el cumplimiento de las prácticas preventivas y los que no lo hicieron es que ya poseían elevados cumplimientos de partida. En las mamografías cabe destacar el estancamiento en las mujeres desfavorecidas en el periodo 2007-2010. Se encontró un gradiente social para las prácticas preventivas que es menor en la práctica poblacional (mamografía) que en la oportunista (citología) (AU)

Background: The assessment of preventive programs is necessary to support the decisions made in public health. There are few research studies that evaluate the degree of implementation and equity of cancer screening in Spain. The objective was to describe trends and inequalities in cervical and breast cancer screening according social determinants of health. Methods: An analysis was carried out on the Behavioral Risk Factor Surveillance System of Community of Madrid data, obtained between 1995 and 2000 from telephone surveys conducted on a population between ages 18 to 65, were analyzed. The years were grouped into four periods: P1 to P4. The trends were estimated with prevalence ratios (PR) with 95% confidence intervals (95% CI), obtained through generalized linear models with binomial family and logarithmic link. The inequalities were estimated with differences of proportions (DP) with 95% CI. Results: An increased in mammograms is seen especially in women with low education (PR P4/P1: 1.93; 95%CI 1.62 to 2.3), this trend more discreet in cytology (PR P4/P1: 1.28; 95%CI 1.11 to 1.47). However mammograms have not increased over in the past 5 years (PR P4/P3: 1.02; 95% CI 0.99 to 1.04). Inequalities get better, but show an increase in the last period. Conclusions: All groups increase in preventative behaviors and those who did not, had a high prevalence from the start. It is worth mentioning the stagnation of mammography in disadvantaged women in the period 2007-2010. There was a social gradient for preventive preventative measures, which was lower in the population-basedscreening (mammography) than in the opportunistic one (cytology) (AU)

First secondary case of Ebola outside Africa: epidemiological characteristics and contact monitoring, Spain, September to November 2014.

On 6 October 2014, a case of Ebola virus disease (EVD) acquired outside Africa was detected in Madrid in a healthcare worker who had attended to a repatriated Spanish missionary and used proper personal protective equipment. The patient presented with fever <38.6 °C without other EVD-compatible symptoms in the days before diagnosis. No case of EVD was identified in the 232 contacts investigated. The experience has led to the modification of national protocols.

Vacunación frente a Herpes Zóster en la Comunidad de Madrid / No disponible

No disponible

Re-emergence of leishmaniasis in Spain: community outbreak in Madrid, Spain, 2009 to 2012.

Since July 2009, there has been a community outbreak of leishmaniasis in the south-west area of the Madrid autonomous community, Spain, affecting residents from four towns that are geographically close together and share extensive park areas. As of December 2012, 446 cases were reported (6 in 2009, 97 in 2010, 196 in 2011 and 147 in 2012), a mean incidence rate of 22.2 per 100,000 inhabitants during July 2009 and December 2012. The mean age was 44 years (range: 2 months to 95 years); 61.0% were male. A total of 68 (15.2%) had immunosuppressive conditions; 160 (35.9%) had visceral leishmaniasis and 286 (64.1%) cutaneous. A total of 421 (94.4%) cases were confirmed. Leishmania infantum was identified as the agent. Monitoring revealed high densities of the vector Phlebotomus perniciosus. The surveillance system for canine leishmaniasis did not detect any increase in prevalence during the period. Environmental control measures have been taken, such as improvements in sanitation and disinsection in the risk areas and control of the overpopulation of Leporidae, as xenodiagnosis studies have shown that hares play a role as active reservoirs. This is the largest reported community outbreak of leishmaniasis in Europe. The discovery of the new reservoir stands out in the multifactorial aetiology of the outbreak. Epidemiological research and environmental intervention measures are continuing.

Monitoring influenza activity in Europe with Google Flu Trends: comparison with the findings of sentinel physician networks - results for 2009-10.

The number of Internet searches has recently been used by Google to estimate the influenza incidence in the United States. We examined the correlation between the Google Flu Trends tool and sentinel networks estimates in several European countries during the 2009 influenza A(H1N1) pandemic and found a good correlation between estimates and peak incidence timing, with the highest peaks in countries where Internet is most frequently used for health-related searching. Although somehow limited, Google could be a valuable tool for syndromic surveillance.

Incidence trends in pertussis in the Autonomous Region of Madrid, Spain: 1982-2005.

The objective of this study was to describe the incidence (1982-2005) and epidemiologic characteristics of pertussis cases (1998-2005) in the Autonomous Region of Madrid using data drawn from the epidemiologic surveillance network and computerised hospital discharge data. In the 1990s, the trend in the pertussis incidence in the Autonomous Region of Madrid was clearly falling. The typical seasonal pattern of pertussis remained. A peak in incidence were observed in 2000, and another peak, 2.5 times higher, in 2003. They affected all age groups, but children under one year of age were the most frequent cases, followed by the five to nine year-olds. The greatest increase was seen in the age groups from 10 to 14 and from five to nine. Since 2002, the proportion of cases diagnosed serologically has increased. The incidence of hospital discharges among small children exceeded that of reported cases. More than half of the cases with known vaccination status had received at least three doses of vaccine. The upward trend observed since 2002 could be due to improved case detection, availability of serologic techniques, and a rise in the susceptible population aged five to 14 years. The fact that epidemic peaks continue to occur and that there is a seasonality to the disease seems to indicate that despite the vaccination programme the circulation of the bacteria has not been interrupted. The introduction of the acellular vaccine in 2000 does not appear to have played a significant role in the increase in disease incidence.

New features of rubella in Spain: the evidence of an outbreak.

In most of western Europe the rubella vaccine coverage is high. However, prior to the introduction of the vaccine in Latin America, rubella susceptibility in women of childbearing age was 10-25%. Forty one (93%) countries in Latin America have adopted the rubella vaccine since 2002. The adult immigrant population in Spain constitutes a group of susceptibles. In February 2003, the Madrid Community Measles Elimination Plan detected an increase in rubella notifications in women who had been born in Latin America. A descriptive study was undertaken to characterise the outbreak. A confirmed case was a person with fever or rash and a positive IgM serology, and living in Madrid, between 1 December 2002 and 31 March 2003. The secondary attack rate (SAR) per household was calculated. A total of 19 cases of rubella were identified, 15 were confirmed and 4 were probable cases. Fourteen (73.7%) cases were women at childbearing age. The mean age was 25.1 years. One pregnancy was diagnosed with a voluntary termination. Eleven (57.9%) cases were from Ecuador. The mean time of residence in Spain was 41 months. None of the cases or the 54 (78.3%) household contacts had been vaccinated against rubella. The SAR was 9.1%. This study showed the spread of rubella in the susceptible Latin American Community that is resident in Madrid. The interventions proposed were a vaccination programme towards immigrants, a health education campaign to prevent congenital rubella, and a health professional training programme case management.

New features of rubella in Spain: the evidence of an outbreak.

In most of western Europe the rubella vaccine coverage is high. However, prior to the introduction of the vaccine in Latin America, rubella susceptibility in women of childbearing age was 10-25%. Forty one (93%) countries in Latin America have adopted the rubella vaccine since 2002. The adult immigrant population in Spain constitutes a group of susceptibles. In February 2003, the Madrid Community Measles Elimination Plan detected an increase in rubella notifications in women who had been born in Latin America. A descriptive study was undertaken to characterise the outbreak. A confirmed case was a person with fever or rash and a positive IgM serology, and living in Madrid, between 1 December 2002 and 31 March 2003. The secondary attack rate (SAR) per household was calculated. A total of 19 cases of rubella were identified, 15 were confirmed and 4 were probable cases. Fourteen (73.7%) cases were women at childbearing age. The mean age was 25.1 years. One pregnancy was diagnosed with a voluntary termination. Eleven (57.9%) cases were from Ecuador. The mean time of residence in Spain was 41 months. None of the cases or the 54 (78.3%) household contacts had been vaccinated against rubella. The SAR was 9.1%. This study showed the spread of rubella in the susceptible Latin American Community that is resident in Madrid. The interventions proposed were a vaccination programme towards immigrants, a health education campaign to prevent congenital rubella, and a health professional training programme case management.

[Compliance of antituberculosis therapy among ex-inmates in the Madrid area]. / Cumplimiento del tratamiento antituberculoso en presos excarcelados en la Comunidad de Madrid.

BACKGROUND: The inmate population is not a tight compartment without communication with the community but there is a flow of persons and thus of health problems. The high incidence of tuberculosis among inmates is therefore of concern for the Public Health System. METHODS: The outcomes of antituberculosis treatment among ex-inmates released from prison in 1987 in the Madrid Area were evaluated and compared with those who remained in jail on treatment. Individuals who met the case definition of tuberculosis were included in the study. The outcome was defined as the individual status one year after the beginning of therapy. To determine the association between the study variables with outcome, odds ratios (OR) with their 95% confidence intervals were used. The Chi2 test was used to determine the statistical significance. RESULTS: Differences between outcomes of individuals in the two groups were observed: 69.7% of inmates had completed their therapy compared with 20.5% of ex-inmates. Treatment had to be prolonged in 15.2% of inmates compared with 46.2% in ex-inmates. The only predictor associated with therapy completion one year after the beginning was imprisonment, as OR for not having completed therapy for ex-inmates was almost 13 times higher (OR=12.94; 95% IC, 3.38-13.10) than those in jail. CONCLUSIONS: Special strategies should be developed that assure clinical cure of persons with factors related to non-compliance.

Influenza in Madrid, Spain, 1991-92: validity of the sentinel network.

OBJECTIVES: The aim was, firstly, to study the validity of the sentinel network data by analysing the correlation between the weekly influenza cases detected by the network and the number of cases notified to the compulsory disease notification system and, secondly, to describe the epidemiology of the period 1991-92 in terms of the sentinel network data. DESIGN: The study design was descriptive. SUBJECTS: The population resident in the city of Madrid. MAIN RESULTS: There was a high correlation between the cases notified to the compulsory disease notification system and those listed by the sentinel network (r = 0.91, p < 0.001, r2 = 0.82). The epidemic activity during the period 1991-92 was centred approximately on week 48 in 1991 and week 6 in 1992 (24 November 1991-8 February 1992). Altogether 913 cases of influenza were notified through the sentinel network. The greatest number of cases occurred in people aged between 20 and 39 years. CONCLUSION: For the epidemiological surveillance of influenza it is necessary to develop systems that can quickly detect epidemic periods and provide information about populations at risk, in addition to systems that isolate and identify seasonal epidemic viruses. Both types of data will help the development of adequate public health policies. Sentinel networks provide these data and offer additional advantages such as lower cost.

[A surveillance system for the study of the circulation of influenza in Madrid during the 1986-1991 quinquennium. The Influenza Surveillance Group of Madrid]. / Sistema de vigilancia para el estudio de la circulación gripal en Madrid durante el quinquenio 1986-1991. Grupo de Vigilancia de Gripe de Madrid.

BACKGROUND: The creation of a surveillance system allowing the study of the evolution of the tendency of influenza and act as an alert system for undertaking control measures is necessary due to the great variability characteristic of the circulation of influenza virus. The Madrid Influenza Surveillance Group was therefore designed. The activity carried out during its first five years of existence is evaluated. METHODS: The field work of the Group is based on the clinical study of patients with influenza, among which some are selected for virologic study with the aim to isolate and characterize the circulating virus. The data obtained by the work group itself are used as the dates of the System of Obligatory Disease Declaration and the System of Microbiologic Information as epidemiologic support to define the outbreaks observed. RESULTS: All the virus isolated were similar to those recommended by the World Health Organization for their inclusion in anti-influenza vaccination, with their circulation being largely reproduced throughout Europe. In three of the five seasons studied the type A virus prevailed leading to earlier outbreaks and a greater number of cases than in the two seasons with type B prevalence. CONCLUSIONS: The circulation of the influenza virus in Madrid coincides with that of the rest of Spain at both the maximum peak and relative incidence as well as the type of prevailing virus. The minor circulation detected by the Madrid Group is in concordance with the data provided by the other autonomic communities.