An outbreak of adenovirus type 8 keratoconjunctivitis in a nursing home in Madrid.

This work describes and analyses an outbreak of epidemic keratoconjunctivitis which occurred in 2001 and 2002 in a nursing home for the elderly in Leganes (an area of Madrid). This is the first such published case in Spain with these characteristics and this serotype identification. Sociodemographic characteristics, epidemic curve and attack rates are described. Comparisons of the data were carried out using a chi2 test for qualitative variable and t-test for quantitative. Factors associated with the illness are explored by means of contingency tables and logistic regression models. One hundred and two cases were detected, with an attack rate of 36.4% for residents, and 12.9% for workers, not considering spatial or professional differences. The epidemic curve showed an interpersonal transmission pattern. Multivariate analysis identified the following risk factors in the residents: able to wander freely through the building, urinary incontinence and use of shared bathroom. In 34.6% of the conjunctival samples, adenovirus serotype 8 was detected with identical genomic sequence. Establishment of hygienic sanitary guidance adapted for the cleaning of such establishments and contact with residents as well as early diagnosis and good coordination of human and material resources are key factors in the prevention and control of these outbreaks in closed communities.

[Evolution of meningococcal disease in the community of Madrid. Effectiveness of antimeningococcal A+C vaccination]. / Evolución de la enfermedad meningocócica en la Comunidad de Madrid. Efectividad de la vacunación antimeningocócica A + C.

BACKGROUND: In 1997 (between 22 September and 14 November) an A + C meningococcal mass vaccination campaign was carried out in Madrid, targeting the age group of from 18 months to 19 years of age, in the face of an increase in the number of cases of meningococcal disease caused by serogroup C occurring in the 1996-97 season. This study forms a part of the impact assessment of that campaign. METHODS: The evolution of the meningococcal disease, by means of the comparison of rates of incidence; and the efficacy of the vaccination campaign was determined after one year (1997-98 season) and after two years (1997-98 and 1998-99 seasons) of monitoring. The vaccine efficacy has been calculated as [1-(Incidence rate in vaccinated/Incidence rate in unvaccinated)]* 100. RESULTS: A significant drop was registered in the incidence of serogroup C meningococcal disease on comparing the 1997-98 and 1998-99 seasons with the epidemic season (1996-97). The vaccine efficacy after two years of monitoring subsequent to the vaccination campaign was 76.9% for the global population between 18 months and 19 years of age and 88.5% in the group of vaccinated individuals between 15 and 19 years of age. CONCLUSIONS: The vaccine efficacy obtained is compatible with that described in the relevant literature. The significant reduction in the incidence of meningococcal disease caused by serogroup C was due to the vaccine efficacy obtained.

Differential features of motor neuron disease mortality in Spain.

BACKGROUND: The objective of this study was to describe the temporal and spatial patterns of motor neuron disease (MND) in Spain. METHODS: We studied data where MND was stated as the principal cause of death in official statistics from Spain. Time trends were analysed for age-, sex-specific and age-adjusted rates for the period 1951-1990. Age-adjusted mortality and relative risk, obtained by Poisson regression adjusting for age, were calculated for each province from deaths during the period 1975-1988. Maps were constructed using log transformed rates. Statistical significance of spatial aggregation was assessed using the Ohno et al. test. RESULTS: The 1951-1990 mortality rate, age- and sex-adjusted to the European population, for the population aged > or = 40 years was 1.49 per 100,000; 1.90 and 1.21 for males and females respectively. In general, mortality increased with age. Age-adjusted rates rose until 1960, dropped by 70% during the 1960s and declined slightly over the 1951-1990 period as a whole. From 1970 onwards MND mortality rose evenly, particularly in the 60-69 age group. A North-South gradient was suggested for both sexes with statistically significant clustering in the Northern coastal regions and--for males alone--in the Midwest provinces. CONCLUSIONS: Mortality from MND in Spain displayed a magnitude and recently rising temporal trend similar to that described in several other countries. Specific traits were: a decrease during the 1960s, which has been described for Japan only, as well as spatial heterogeneity and a predominant recent increase among the 60-69 age group. The determinants of these unusual MND mortality patterns are unknown.

[Evolution of cesarean section rates in Spain: 1984-1988]. / Evolución de la tasa de cesáreas en España: 1984-1988.

The objective of this work is to describe the evolution of cesarean section rates in Spain from 1984 through 1988. National rates increased from 9.92% to 19.99%. Trend is significantly rising nationwide and in all Communities. Overall differences have decreased (CSV from 1.73 to 11.72) because there are two groups of regions: one with high rates, the other one with low rates. Rates are significantly higher in private hospitals (14.53%). These differences could show the controversy and uncertainty in the indications and the influence of organizational factors. Although new sources of information to obtain population rates and outcomes studies adjusted by women clinic and sociodemographic characteristics are due to be developed, these differences lead to suspect that there is a gap between the theoretic quality medical science could provide and the actual quality medical practice is providing, explained just by reasons out from clinical factors.

[Proposed method to estimate underreporting of induced abortion in Spain]. / Propuesta de un método para estimar la subnotificación del aborto inducido practicado en España.

In Spain, from 1987 to 1990 the rate of legal abortion reported to the health authorities has doubled; nevertheless, the observed geographical differences suggest to an underreporting of the number of voluntary pregnancy terminations. Based on information on several sociodemographic, economic and cultural characteristics, contraceptive use, availability of abortion services, fertility indices, and maternal and child health status, five homogenEous groups of autonomous region were identified applying factor and cluster analysis techniques. To estimate the level of underreporting, we assumed that all the regions which shape a cluster ought to have the same abortion rate that the region with the highest rate in each group. We estimate that about 18,463 abortions (33.2%) were not reported during 1990. The proposed method can be used for assessing the notification since it allows to identify geographical areas where very similar rates of legal abortion are expected.

[Estimation of AIDS morbidity and mortality in Spain]. / Estimación de la morbilidad y mortalidad por SIDA en España.

BACKGROUND: To obtain corrected estimates of the cumulative incidence and mortality, as well as prevalence of AIDS in Spain on June 1992. METHODS: The number of cases in the National Register of AIDS by December 1992 was adjusted for reporting delays to estimate the cumulative incidence by June 1992. The prevalence and mortality in this date were obtained using this figure and the probabilities of survival after diagnosis from the AIDS Register of Madrid. This methodology was used for Spain as all, and for each Autonomous Community. RESULTS: The estimated cumulative incidence of AIDS in Spain by June 1992 was 16,486 cases, 13.4% greater than that reported by the same date. The prevalent cases were 6,351 (95% CI, 5,996-6,708) and the remaining 10,135 (61.5%) would have died. This number of deaths is 69.6% greater than the reported figure. There were considerable differences among Autonomous Communities. Some of them exhibited rates more than six times greater than others. CONCLUSIONS: The adjusted estimations provide a view of the actual situation more accurate than the raw figures from the register. These great differences should be taken into account for appropriate allocation of health care resources.

[Regional differences in hospital utilization]. / Diferencias regionales en la utilización hospitalaria.

Many recent studies have demonstrated that hospital utilization rates vary widely among similar areas and regions. The objective of this study is to find out the variation among the hospitalization rates in Spain across the 17 Autonomic Communities in 1988. From the Hospital Morbidity Survey we calculate the general discharge rate and the rate for 14 diagnostics. To evaluate the degree of variation we calculate the coefficient of variation, the ratio of variation and the systematic component of variation, which ranges from 0.96 (hernia) to 8.45 (varicose veins). This substantial variations are consistent with studies performed in countries with different health systems. Although new information systems which allow to perform population based studies are due to establish, these variations are too large to ignore and have to be taken account in policy making.

[Loss of potential life years through AIDS in Spain 1981-1990]. / Años potenciales de vida perdidos por síndrome de immunodeficiencia adquirida en España, 1981-1990.

BACKGROUND: To know the importance of AIDS in premature mortality in Spain in relation to the remaining causes of deaths. METHODS: Deaths of patients with AIDS were obtained from the National AIDS Registry and deaths from other causes from the official mortality statistics. The potential years of life lost (PYLL) were compared from birth until the age of 65 in AIDS patients between 1981-1990 with those observed as the principal causes of premature death in 1980-1988. Similar comparisons were carried out for the three Autonomic Communities with the greatest incidence of AIDS (Catalonia, Madrid and the Basque Country). RESULTS: In 1988, there were 670 deaths (21,987 PYLL) in patients with AIDS and in 1990 this number almost doubled with 1312 (42,543 PYLL). In 1988 the PYLL in AIDS cases were situated at the ninth level for cause of premature death (eight in males) and in 1990 it was estimated to be in the eight place, near lung cancer, hepatic cirrhosis and cerebrovascular disease. In 1988, Madrid which has the highest rate adjusted by age of PYLL in AIDS cases, was placed in sixth place and was expected to reach second place in 1990. CONCLUSIONS: Death by AIDS has rapidly increased while death by the remaining cases has remained much more stable with AIDS nearing the level of the main causes of premature death. The need to consider AIDS as one of the health problems which takes priority is confirmed.