Enfermedades infecciosas emergentes y reemergentes / Emerging and reemerging infectious diseases

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Epidemiología de la insuficiencia cardíaca congestiva en España, 1980-1993 / Epidemiology of congestive heart failure in Spain, 1980-1993

OBJETIVOS: Describir las tendencias en las tasas de hospitalización y de mortalidad por insuficiencia cardíaca congestiva (ICC) en España en el período 1980-1993. MÉTODOS: Se han analizado datos con diagnóstico primario de ICC de la Encuesta Nacional de Morbilidad Hospitalaria y de las Estadísticas Vitales Nacionales. RESULTADOS: El número de altas hospitalarias por ICC creció un 71 por ciento (de 42.961 en 1980 a 73.442 en 1993) y las tasas de hospitalización por ICC crecieron un 47 por ciento (de 348 por 100.000 en 1980 a 511 por 100.000 en 1993). El aumento de las hospitalizaciones se produjo sólo en personas 65 años, y fue mayor en las mujeres. La ICC fue la primera causa de hospitalización en personas 65 años, y fue responsable del 5 por ciento de todas las altas hospitalarias para ese grupo de edad. La mortalidad ajustada por edad por ICC ha descendido un 23 por ciento. El descenso ha afectado a todos los grupos de edad, excepto a los 80 años, en los que la mortalidad ha aumentado. Sin embargo, la ICC se mantiene como la tercera causa de muerte cardiovascular (25 por ciento de todas las muertes cardiovasculares en el período 1989-1993 en personas 45 años). CONCLUSIONES: La ICC representa un gran carga hospitalaria y demográfica para la población española. La carga hospitalaria ha crecido sustancialmente en el período 1980-1993, y continuará en el futuro al aumentar el número y la proporción de ancianos (AU)

La transición de la cardiopatía isquémica aguda a la crónica en España, 1980-1994 / The transition from acute to ischemic heart disease in Spain, 1980-1994

Objetivos. El gran aumento de las hospitalizaciones por insuficiencia cardíaca en España en los últimos años puede resultar paradójico porque coincide con una disminución de la mortalidad por cardiopatía isquémica, la causa más importante de la insuficiencia cardíaca. Una posible explicación es el aumento de la supervivencia de la cardiopatía isquémica producida por los últimos avances terapéuticos, que se traduciría en un aumento de las formas crónicas de la enfermedad. Por ello se estudia las tendencias en la mortalidad y en las hospitalizaciones por cardiopatía isquémica aguda y crónica en el período 1980-1994 en España. Métodos. Estudio poblacional de tendencias temporales con datos de diagnóstico primario de cardiopatía isquémica aguda (CIE-9: 410-411) y crónica (CIE-9: 412-414) obtenidos de las Estadísticas Vitales Nacionales y de la Encuesta Nacional de Morbilidad Hospitalaria. Resultados. El número de muertes por cardiopatía isquémica aguda ha aumentado un 8,3 por ciento, pasando de 18.559 en 1980 a 20.101 en 1994. Las muertes por cardiopatía isquémica crónica aumentaron un 49,3 por ciento, pasando de 4.703 en 1980 a 7.020 en 1994. Como consecuencia, las formas crónicas produjeron el 20,2 por ciento de todas las muertes por cardiopatía isquémica en 1980 y el 25,8 por ciento en 1994. Las tasas de mortalidad ajustadas por edad por cardiopatía isquémica aguda han descendido un 20,1 por ciento, mientras que las de la crónica han aumentando un 14,6 por ciento. El número y las tasas de hospitalización ajustadas por edad han crecido de forma muy importante para la cardiopatía isquémica aguda y crónica. Sin embargo, el crecimiento de la crónica ha sido mayor y ha pasado de representar el 39,4 por ciento de todas las hospitalizaciones por cardiopatía isquémica en 1980 al 58,4 por ciento en 1994. La cronificación de la cardiopatía isquémica es mayor en los varones y entre los más jóvenes. Conclusión. Se está produciendo una transición de la cardiopatía isquémica aguda a la crónica en España. Ello explica, en parte, el aumento de las necesidades de asistencia hospitalaria por enfermedades del corazón, en especial la cardiopatía isquémica y la insuficiencia cardíaca (AU)

[Geographical distribution of the male/female ratio of cardiovascular mortality in Spain]. / La distribución geográfica de la razón varón/mujer de la mortalidad cardiovascular en España.

OBJECTIVES: To describe the geographic distribution of the male/female ratio (MFR) of mortality from ischaemic heart disease (IHD) and cerebrovascular disease (CVD) in 1991-1995 in Spain, and to examine wether the differences between men and women in exposure to cardiovascular risk factors could explain such distribution. METHODS: Mortality data come from National Vital Statistics. Age-adjusted mortality rates for the period 1991-1995 were calculated for IHD and CVD using the direct method, in population aged 40 to 79 years. Data on tobacco and alcohol consumption, hypertension, hypercholesterolemia, diabetes, obesity, sedentariness, and health services use come from the 1993 Spanish National Health Survey, and socioeconomic data from the 1991 Population Census. Data were analyzed by correlation and Poisson regression methods. RESULTS: MFR of mortality from IHD and CVD are higher in the provinces of the north of Spain, and are correlated negatively with mortality from IHD and CVD. This negative association is stronger for mortality in women than in men. Among the risk factors examined, only MFR of alcohol consumption showed a significant (p < 0.05) association with MFR of mortality from IHD and CVD. MFR of alcohol consumption explains 23 and 14% of the provincial variation in MFR of mortality from IHD and CVD, respectively, and showed a U shaped relationship with MFR of mortality for both diseases. CONCLUSIONS: Provinces in the north of Spain, which register the lowest cardiovascular mortality, show the highest MFR of IHD and CVD mortality, because of the lower mortality in women than in men. As derived from the dose-response relationship between MFR of IHD and CVD mortality and the MFR of alcohol consumption, a higher alcohol consumption in men could contribute to a higher MFR of cardiovascular mortality in some Spanish provinces.

[Profiles of youths in modern society and health risks]. / Perfiles de los jóvenes en la sociedad actual y riesgos para la salud.

The youngsters are clearly conditioned by the society where they live, though they may feel apart. These youngsters have benefited from more educative and material resources than generations before, and their vital and social itinerary will depend, in great part, from the behaviours and attitudes acquired during adolescence and youth. They have not been formed in austerity and determination. They mainly value the near and the present. Courses of action more determined by the emotional than by the rational. While tolerant, they have selfish traits with self-contradictions between end- and instrumental values (effort, dedication, compromise), and certain indifference for the religion. Finally, they are demonstrate solidarity in specific situations.

[Smoking and subjective health in Spain]. / Consumo de tabaco y salud subjetiva en España.

BACKGROUND: To examine the relationship between smoking and subjective health in Spain. MATERIAL AND METHOD: Datacome from the 1993 National Health Survey. Analyses were performed with logistic regression, adjusting for the main confounding factors. RESULTS: Among those less than 25 years, there is a dose-response relationship (p = 0.0001)between cigarette consumption and suboptimal health (fair, pooror very poor health). CONCLUSIONS: Smoking controlactivities should inform on the worse subjective health of youngsmokers, for whom other effects of tobacco smoking are less relevant because they appear to happen in the distant future.

La distribución geográfica de la razón varón/mujer de la mortalidad cardiovascular en España / Geographical distribution of the male/female ratio of cardiovascular mortality in Spain

Objetivos: Describir la distribución geográfica de la razón varón/mujer (RVM) de mortalidad por enfermedad isquémica del corazón (EIC) y enfermedad cerebrovascular (ECV) en1991-1995 en España, y examinar si puede explicarse por las diferencias de exposición a factores de riesgo cardiovascular entre varones y mujeres. Métodos: Los datos de mortalidad proceden de las Estadísticas Vitales Nacionales. Se calcularon tasas, ajustadas por edad por el método directo, de mortalidad por EIC y ECV en la población de 40 a 79 años en el período 1991-1995. Los datos de consumo de tabaco y alcohol, hipertensión arterial, hipercolesterolemia, diabetes, obesidad, sedentarismo y uso de servicios sanitarios son de la Encuesta Nacional de Salud (..) (AU)

Objectives: To describe the geographic distribution of the male/female ratio (MFR) of mortality from ischaemic heart disease(IHD) and cerebrovascular disease (CVD) in 1991-1995in Spain, and to examine wether the differences between men and women in exposure to cardiovascular risk factors could explain such distribution. Methods: Mortality data come from National Vital Statistics. Age-adjusted mortality rates for the period 1991-1995 were calculated for IHD and CVD using the direct method, in population aged 40 to 79 years. Data on tobacco and alcohol consumption, hypertension, hypercholesterolemia, diabetes, obesity, sedentariness, and health services use come from the (..) (AU)

[The transition from acute to chronic ischemic heart disease in Spain, 1980-1994]. / La transición de la cardiopatía isquémica aguda a la crónica en España, 1980-1994.

BACKGROUND AND OBJECTIVES: The remarkable increase in hospital admissions from heart failure in Spain in the last few years may result paradoxical because it coincides with a decrease in ischemic heart disease mortality, the leading cause of heart failure. A plausible explanation is the increase in ischemic heart disease survival, derived from the recent therapeutic advances, which will translate into an increase in the chronic forms of disease. Thus, an analysis was made of mortality and hospital admission trends due to acute and chronic ischemic heart diseases in the 1980-1994 period in Spain. METHODS: Population-based study of temporal trends with data of primary diagnosis of acute (CIE-9: 410-411) and chronic (CIE-9: 412-414) ischemic heart disease obtained from the National Vital Statistics and the National Survey of Hospital Morbidity. RESULTS: The number of deaths due to acute ischemic heart disease has increased by 8.3%, from 18,559 in 1980 to 20,101 in 1994. Deaths due to chronic ischemic heart disease increased by 49.3%, from 4,703 in 1980 to 7,020 in 1994. As a result, chronic forms accounted for 20.2% of all deaths attributable to ischemic heart disease in 1980 and 25.8% in 1994. The age-adjusted acute ischemic heart disease mortality rates decreased by 20.1%, whereas those due to chronic increased by 14.6%. The number and rate of age-adjusted hospital admissions increased remarkably for both acute and chronic ischemic heart disease. Nevertheless, the increase observed with chronic form was higher, from 39.4% of all hospital admissions due to ischemic heart disease in 1980 to 58.4% in 1994. This classification of ischemic heart disease was more notorious among males and younger patients. CONCLUSION: Currently, we are witnessing a transition from acute to chronic ischemic heart disease. That partly explains the increase in hospital care for heart diseases, particularly ischemic heart disease and heart failure.

The association of tobacco and alcohol consumption with the use of health care services in Spain.

BACKGROUND: Information on the impact of tobacco and alcohol consumption on the use of health services is scant and partially inconsistent. This paper examines the relationship between tobacco and alcohol consumption and the use of health care services in Spain. METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a random 21,120-person representative sample of Spain's noninstitutionalized population ages 16 years and older. Information was obtained through home-based interviews. RESULTS: Compared with never smokers, male smokers of more than 20 cigarettes/day tend to be hospitalized more frequently (odds ratio (OR) 1.31; 95% confidence limits (CL) 0.89-1.93) and make greater use of hospital emergencies (OR 1.51; 95%CL 1.13-2.01; P < 0.01). Among female smokers of more than 20 cigarettes/day, hospitalizations (OR 1.62; 95%CL 0.80-3.26) and medical visits (OR 1. 35; 95%CL 0.79-2.30) are also higher than among never smokers, although the associations do not reach statistical significance. Compared with never smokers, ex-smokers of both sexes make greater use of health care services (P < 0.01 for most services). There is a negative dose-response relationship (P < 0.001) between alcohol consumption and utilization of hospital and ambulatory services, for both sexes. Results are reasonably consistent across all age groups and are observed after adjustment for the principal confounding factors. We have found no evidence of a tobacco-alcohol interaction with the use of health care services. CONCLUSIONS: Smokers and ex-smokers make greater use of health care services. Control of smoking might reduce the use of such services and the ensuing human and economic costs. However, as alcohol consumption increases, the use of health care services decreases. This finding should not be used to promote even the moderate consumption of alcoholic drinks.

The association between mortality from ischaemic heart disease and mortality from leading chronic diseases.

AIMS: Coronary risk factors raise the risk of other chronic disorders. We therefore tested the hypothesis that the geographic distribution of ischaemic heart disease mortality is associated with that of other chronic diseases with which it shares risk factors. METHODS AND RESULTS: For the 50 provinces of Spain, we collected mortality data for the period 1980-1995 from the national vital statistics. We calculated age-adjusted mortality rates for the leading causes of death in quintiles of provincial distribution of ischaemic heart disease mortality, and correlation coefficients with respect to provincial ischaemic heart disease mortality. As expected, because they share risk factors with ischaemic heart disease, mortality from cerebrovascular disease, malignant tumours, lung cancer, respiratory diseases, chronic obstructive pulmonary disease, diseases of the digestive system, cirrhosis of the liver and all causes, increase with the rise from lower to higher quintiles of ischaemic heart disease mortality. Ischaemic heart disease mortality registered correlations over 0.5 (P<0.001) with mortality from many of the above diseases in the periods 1980-1984 and 1991-1995. Expectations were similarly borne out for disorders not sharing risk factors with ischaemic heart disease, in that mortality from prostate and breast cancer, injury and poisoning, traffic accidents and ill-defined causes in most cases did not show a provincial association with ischaemic heart disease mortality. In general, these results were observed for both sexes and across all age groups. CONCLUSION: Ischaemic heart disease mortality is associated with mortality from chronic diseases which share coronary risk factors, across provinces of Spain over the period 1980-1995. This suggests that the geographic variation in such chronic diseases is due to common factors, potentially susceptible to similar preventive interventions.

[Popper and the problem of induction in epidemiology]. / Popper y el problema de la inducción en epidemiología.

In this article we are discussing a few of the contributions by the Austro-British philosopher Karl R. Popper, one of our most influential contemporary thinkers, whose epistemological and socio-political theories have also penetrated the sphere of epidemiology. We are focusing mainly on the so-called problem of induction. We sustain, in line with Popper, that the scientific method does not use inductive reasoning, but rather hypothetical-deductive reasoning. Although the movement from the data evaluating a hypothesis to a conclusion on the latter goes from the specific to the general, that is, in an inductive direction, the induction does not exist as a reasoning process or inference. That is, there is no method that enables us to infer or to verify hypotheses or theories (we cannot explore all of the possible situations to see whether the theory stands up), or even to render them very probable. Besides, scientists look for highly informative theories, not highly probable ones. What we actually do is to propose a hypothesis as a tentative solution to a problem, to confront the prediction deduced from the hypothesis with actual experience, and evaluate whether the hypothesis is rejected or not by the facts. As theories cannot be verified, we can only accept them if they withstand an attempt to reject them. Consequently, the test of a theory consists of criticism or a serious attempt at falsification, that is, the elimination of error within a theory, in order to reject it if it is false. The objective is, thus, the search for true theories. For this purpose, the scientific method uses a systematic set of methodological (not logical) rules, that is, decisions. These methodological rules or principles can be summed up in two: [symbol: see text]be inventive and critical!, that is, propose bold hypotheses and subject them to severe tests of experience. Logic plays its role mainly by allowing us to deduce from a hypothesis the predictions to be confronted with the facts or evidence. This is applicable both to statistical inference as well as to causal inference. We argue that the criteria of causality used in epidemiology are none other than rules of the method designed for the same purpose: they are concerned with eliminating or reducing errors (chance, bias...) on testing a causal hypothesis. Consequently, the so-called ausal inference, the step from evidence to causal theory, is not a logical inductive or probabilistic process but rather a decision based on the evaluation of a causal hypothesis thanks to methodological rules such as the criteria of causality. We believe that the interest of the debate between the Popperian and the inductivist epidemiologists is not merely a matter of words, as, if we are aware that we do not operate inductively, that we cannot establish firmly hypotheses, not even affirm them probabilistically, we will presumably adopt a humbler attitude and look more for the errors in our theories than for their facile examples of confirmation.

El conocimiento de los valores de la vacunación / Attitudes of Spanish parents to immunizing their children

Objetivos: Clasificar las actitudes de los padres de niños menores de 6 años frente a la vacunación de sus hijos con relación a su nivel socioeconómico y cultural.Material y métodos: Se realizó un estudio observacional de tipo transversal mediante una encuesta a padres y madres de niños menores de 6 años, de ámbito nacional, proporcional y representativa de dicho universo. Mediante un análisis multivariable se establecieron unos grupos actitudinales diferenciados por su actitud hacia la vacunación. Se utilizó una metodología cualitativa mediante la realización de clusters y se procedió a la elaboración de modelos de comunicación general y comunicación biyectiva en el entorno de la salud.Resultados: Se han obtenido 5 grupos clusters que reflejan la tipología de los padres españoles ante la vacunación. Estos grupos se agrupan con arreglo a actitudes tradicionales, modernas, críticas con la vacunación, y con y sin miedo a la vacunación. Siendo necesaria la elaboración de mensajes de refuerzo, una mayor información sobre las reacciones adversas de las vacunas y una formación más amplia en materia de vacunas por parte de los pediatras, todo ello dirigido hacia los padres.Conclusiones: Los pediatras sobre todo aquellos que trabajan en el ámbito de la atención primaria de salud juegan un papel vital en la formación que se trasmite a los padres en materia de vacunación. Deben elaborar mensajes dirigidos a reforzar la información existente, yendo dirigidos en gran parte hacia la aparición de reacciones adversas. Se debe informar también de la eficiencia de las vacunas en términos de coste-efectividad (AU)

[Geographic variation in hospitalizations and mortality related to congestive heart failure in Spain, 1980-1993]. / Variación geográfica en las hospitalizaciones y en la mortalidad por insuficiencia cardíaca congestiva en España, 1980-1993.

BACKGROUND AND OBJECTIVES: Geographical differences in hospitalizations and mortality for heart failure serve to estimate the potential for reducing the associated hospital and demographic burden on the population. Accordingly, the objective of this paper is to analyze the geographic variation in heart failure hospitalizations and mortality in Spain during the period of 1980-1993, and to examine their potential determinants. METHODS: Data on the primary diagnosis of heart failure were taken from the National Hospital Morbidity Survey and National Vital Statistics. Information on determinants of heart failure were obtained from large-scale nationally representative surveys conducted by the National Statistics Office. RESULTS: The period of 1980-1993 witnessed a decrease in geographical differences in heart failure hospitalizations and mortality. Theoretically, however, heart failure hospitalizations and mortality among persons aged > or = 45 years could still be further reduced by 60% and 30% respectively. In the period of 1989-1993 heart failure hospitalizations were correlated (p < 0.05) with ischaemic heart disease hospitalizations and the number of beds/1,000 inhabitants. Heart failure mortality showed a statistically significant correlation (p < 0.05) with ischaemic heart disease mortality, illiteracy and unemployed status. CONCLUSIONS: There is a great potential for a reduction in the hospital and demographic burden of heart failure in Spain. Control of ischaemic heart disease and a reduction in the geographical differences in socio-economic status would probably contribute to lessening the healthcare burden of heart failure in Spain.

[Current interest of antipneumococcal vaccination]. / Importancia actual de la vacunación antineumocócica.

Pneumonia acquired in Community (CAP) may be a primary disease occurring in healthy individuals or secondary to predisposing factors or comorbidity. Prevalence of CAP is 2.6 to 5% for all ages, in USA 12%, for over 65 years 30%. Streptococcus pneumoniae is the commonest pathogen 30-50%, H. influenzae in COPD, the atypical pneumonia Mycoplasma pn., M. catharralis, Legionella pn., Enterobacteria, anaerobics often in hospital survey. In children is different RSV, Parainfluenzae type 3, Rhinovirus in the first 2 years old. Others are S. pneumoniae, H. influenzae, Chlamydia sp., etc. Appropriate empiric antibiotic therapy choices are based in guidelines. The most common pathogen is S. pneumoniae, isolates raised resistance rates to Penicillin to 20-50%, 40% in our country and also to Macrolides, with potential clinical failure (21-40%). Specially in elderly people and with the comorbidity are recommended the 23 valent polysaccharide vaccine, effective in bacteremic pneumonia 70-80%. Is not effective in children under 2 years, for that is important conjugated vaccine Hib (toxoids T, D, CRM197, OMP Nm) to prevent carriers, otitis media and reduce exacerbation of these respiratory infections.

Adult men born in spring have lower blood pressure.

OBJECTIVE: To determine whether there is a relationship between season of birth and adult blood pressure, as a possible early determinant of later blood pressure. DESIGN: We studied 572 men, aged 45-64 years, whose blood pressure was measured in standardized manner as part of a nation-wide survey in Spain. To analyse the seasonal variation in blood pressure, a linear regression was performed, adjusting for age, height, body mass index, occupation and rural or urban residence. RESULTS: We found seasonal variation in mean systolic blood pressure, with maxima in adults born in autumn and winter, and minima in those born in spring and summer. The greatest difference in systolic blood pressure occurred between adults born in spring (134.1 mmHg) and those born in autumn (140.3 mmHg). After adjustment, the difference in means between spring and autumn was 5.9 mmHg (95% confidence interval 0.7 to 11.1 mmHg, P = 0.03). CONCLUSIONS: This study demonstrated differences in systolic blood pressures of adult men according to the season of their birth. Although this relationship is compatible with several hypotheses, the difference found between spring and autumn, partially independent of some other factors, might indicate that the extent of early exposure to sunlight is implicated in determining later blood pressure. This needs further investigation.

[The decline in moderate alcohol consumption has been associated with a decrease in heavy drinkers in Spain in the 1987-1993 period]. / La disminución del consumo moderado de alcohol se ha asociado a un descenso de los bebedores excesivos en España en el período 1987-1993.

BACKGROUND: To examine whether the decline in alcohol consumption among moderate drinkers, which has occurred in Spain in the period 1987-1993, has been associated with changes in the proportion of heavy drinkers and abstainers. SUBJECTS AND METHODS: The units of analysis have been the 17 administrative regions of Spain. Alcohol consumption data have been taken from the 1987 and 1993 National Health Interview Surveys. RESULTS: A decrease of 10 g/week in mean alcohol consumption among male moderate drinkers has been associated with a decrease of 1.2% (95% CI: 0.7-1.7%) in the proportion of heavy drinkers. The association was also observed among women, those over and below 45 years of age, and was stronger for wine than for other alcoholic beverages. CONCLUSION: The decrease in moderate consumption of alcohol has probably had a beneficial effect on the health of the Spanish population.

[Infectious disease trends]. / Consideraciones ante las perspectivas de las enfermedades infecciosas.

Infectious disease mortality has increased during the last decades: from a rate of 38.10(5) inhabitants in 1980-95 to 41, 5.10(5) in 1998. Demographic changes have modified susceptibility to infections, due to the increment of elderly people--who have less immunity--, and the increase in drug-abusers and HIV-infected subjects. Social and technological environmental factors have had some influence on emergent and re-emergent diseases. Key issues to be considered are problems with antimicrobial resistance, infectious related- to chronic diseases, infections in immunodeficient subjects, and new vaccines to use. Among the challenges to public health is the need for incorporating new and rapidly technologies as microarrays, strategies of planning, multisectorial approaches to detecting preventing and controlling emerging and re-emerging infectious diseases.

[Environmental factors during early life and socioeconomic status in the present: which is more important for cardiovascular mortality in Spain?]. / Factores ambientales en la vida temprana y nivel socioeconómico en la actualidad: cuál es más importante para la mortalidad cardiovascular en España?

BACKGROUND: To examine whether provincial mortality from ischaemic heart disease and cerebrovascular disease in Spain in 1991-1995 is associated with infant mortality in 1930-1934, independently of illiteracy (an estimator of socioeconomic status) in 1991. MATERIAL AND METHODS: Population-correlation study. RESULTS: Infant mortality is correlated with mortality from ischaemic heart disease (r = 0.38; p < 0.01) and cerebrovascular disease (r = 0.41; p < 0.01). When adjusting for illiteracy rate in 1991, the correlation of infant mortality with ischaemic heart disease mortality is r = 0.01 (p = 0.93), and with cerebrovascular disease mortality is r = 0.25 (p = 0.08). CONCLUSIONS: Ischaemic heart disease and cerebrovascular disease mortality are moderately associated with infant mortality during the 1930s. This association might be explained by present socioeconomic status.