[Tuberculosis in the elderly in a general hospital in the Region of Madrid, 1994-2003]. / Tuberculosis en ancianos en un hospital general de la Comunidad de Madrid, 1994-2003.

INTRODUCTION: Tuberculosis in the elderly is a health problem that is on the increase nowadays in industrialised countries. The aim of this study is to describe epidemiological, clinical and microbiological characteristics of tuberculosis in elderly patients in a general hospital in the Region of Madrid from 1994 to 2003. METHODS: Only microbiologically and/or histopathologically confirmed tuberculosis were studied. Epidemiological, clinical and microbiological variables were analyzed. Microbiological and histopathological laboratory results and medical records were collected. RESULTS: The proportion of cases occurring among the elderly rose from 12.4% between 1994 and 1998 to 17.8% between 1999 and 2003 (p <0.05). A total of 160 tuberculosis cases were studied: 92.5% were microbiologically (culture) confirmed and 7.5% histopathologically confirmed. The average time to culture positivity was 18.8 days (SD: 6.5). 88.7% isolates were susceptible to streptomycin, isoniazid, rifampin, ethambutol, and pyrazinamide. The main locations of tuberculosis were pulmonary (59.4%), ganglionary (11.9%) and genitourinary (10.0%). A positive smear in the sputum was discovered for 52.6% of pulmonary tuberculosis. The most prevalent risk factors were immunosuppression (14.8%) and diabetes mellitus (12.3%). Neither of them were VIH, intravenous drug users or immigrants. 50.7% cases were hospitalized. CONCLUSIONS: Tuberculosis in the elderly is on the increase in our region nowadays. The epidemiological pattern of tuberculosis in the elderly differs from that observed in younger patients. Therefore specific control and prevention strategies are needed in order to reduce tuberculosis incidence in aged populations.

Tuberculosis en ancianos en un hospital general de la Comunidad de Madrid, 1994-2003 / Tuberculosis in the elderly in a general hospital in the Region of Madrid, 1994-2003

Introducción: La tuberculosis en ancianos constituye un problema de salud pública en países industrializados. El objetivo es describir las características de la tuberculosis en ancianos en un hospital de la Comunidad de Madrid entre 1994 y 2003. Métodos: Se estudiaron las tuberculosis confirmadas por cultivo y/o histopatología. Se analizaron variables epidemiológicas, clínicas y microbiológicas. Las fuentes de recogida de información fueron las historias clínicas y los resultados del laboratorio de micobacterias y de anatomía patológica. Resultados: La tuberculosis en ancianos ha pasado de representar el 12,4% del total de tuberculosis entre 1994 y 1998, al 17,8% entre 1999 y 2003, siendo la diferencia estadísticamente significativa (p < 0,05). De los 160 casos analizados el 92,5% se confirmaron por cultivo y el 7,5% por histopatología. El tiempo medio de crecimiento del cultivo fue de 18,8 días (DE: 6,5). El 88,7% de las cepas en las que se estudiaron resistencias fueron sensibles a estreptomicina, isoniacida, rifampicina, etambutol y pirazinamida. Las localizaciones pulmonar (59,4%), linfática (11,9%) y genitourinaria (10%) fueron las más frecuentes. El 52,6% de las formas pulmonares eran bacilíferas. Los factores de riesgo más prevalentes fueron inmunosupresión (14,8%) y diabetes (12,3%). No se encontraron pacientes VIH, ni ADVP, y en todos los casos se trataba de población autóctona. El 50,7% de los casos precisó ingreso hospitalario. Conclusiones: La tuberculosis en ancianos presenta una ligera tendencia creciente en nuestro medio. El patrón epidemiológico de esta población difiere del observado en cohortes jóvenes. Sería necesario plantear estrategias específicas de prevención y control para lograr una reducción en la incidencia de tuberculosis en esta población

Introduction: Tuberculosis in the elderly is a health problem that is on the increase nowadays in industrialised countries. The aim of this study is to describe epidemiological, clinical and microbiological characteristics of tuberculosis in elderly patients in a general hospital in the Region of Madrid from 1994 to 2003. Methods: Only microbiologically and/or histopathologically confirmed tuberculosis were studied. Epidemiological, clinical and microbiological variables were analyzed. Microbiological and histopathological laboratory results and medical records were collected. Results: The proportion of cases occurring among the elderly rose from 12.4% between 1994 and 1998 to 17.8% between 1999 and 2003 (p <0.05). A total of 160 tuberculosis cases were studied: 92.5% were microbiologically (culture) confirmed and 7.5% histopathologically confirmed. The average time to culture positivity was 18.8 days (SD: 6.5). 88.7% isolates were susceptible to streptomycin, isoniazid, rifampin, ethambutol, and pyrazinamide. The main locations of tuberculosis were pulmonary (59.4%), ganglionary (11.9%) and genitourinary (10.0%). A positive smear in the sputum was discovered for 52.6% of pulmonary tuberculosis. The most prevalent risk factors were inmunosuppression (14.8%) and diabetes mellitus (12.3%). Neither of them were VIH, intravenous drug users or inmigrant. 50.7% cases were hospitalized. Conclusions: Tuberculosis in the elderly is on the increase in our region nowadays. The epidemiological pattern of tuberculosis in the elderly differs from that observed in younger patients. Therefore specific control and prevention strategies are needed in order to reduce tuberculosis incidence in aged populations

[Mortality from cancer in children and adolescents in Madrid, 1977-2001]. / Mortalidad por cáncer en niños y adolescentes de la Comunidad de Madrid, 1977-2001.

INTRODUCTION: In the last few decades mortality from cancer among children and adolescents has not decreased homogeneously in industrialized countries. The aim of this study was to determine the epidemiological pattern and temporal trend of mortality from cancer in individuals aged less than 20 years old living in the Autonomous Community of Madrid from 1977 to 2001. MATERIAL AND METHODS: Data on deaths from cancer among children and adolescents were obtained from Spain's National Institute of Statistics and from the Mortality Registry of Madrid. Populations were obtained from official publications of the Institute of Statistics of Madrid. Variables analyzed were sex, 5-year age groups, 5-year death periods and underlying cause of death. The epidemiological pattern was studied and a Poisson's regression model was used to analyze cancer mortality trends in children and adolescents from 1977 to 2001. RESULTS: Cancer mortality among children and adolescents decreased by 41 % from 1977 to 2001. The decrease in mortality differed according to sex (46 % in boys and 33 % in girls) and type of cancer (leukemias: 38 %, non-Hodgkin's lymphomas: 58 %, malignant brain tumors: 45 %, malignant bone tumors: 19 %, ill-defined malignant tumors: 78 %). Moreover, the annual decrease was much greater in the last 5 years (4. 7 %) than during the entire period (2. 2 %). CONCLUSIONS: Cancer mortality among children and adolescents decreased between 1977 and 2001 and our results are similar to those observed in other European and North American regions. To improve knowledge of the epidemiology of cancer among children and adolescents in the Autonomous Community of Madrid, future assessments including mortality, incidence, and survival indicators are required.

Mortalidad por cáncer en niños y adolescentes de la Comunidad de Madrid, 1977-2001 / Mortality from cancer in children and adolescents in Madrid, 1977-2001

Introducción: La mortalidad por cáncer en niños y adolescentes ha disminuido de modo desigual en los diferentes países desarrollados en las últimas décadas. El objetivo del estudio es conocer el patrón y la tendencia de la mortalidad por cáncer en menores de 20 años residentes en la Comunidad de Madrid entre 1977 y 2001. Material y métodos: Las defunciones fueron cedidas por el Instituto Nacional de Estadística y por el Registro de Mortalidad de la Comunidad de Madrid y las poblaciones se tomaron a partir de publicaciones oficiales del Instituto de Estadística de la Comunidad de Madrid. Las variables estudiadas fueron: sexo, grupo quinquenal de edad, período quinquenal de defunción y causa básica de defunción. Se describe el patrón epidemiológico y se analiza la evolución temporal de la mortalidad por cáncer infantil entre 1977 y 2001 mediante el ajuste de un modelo de Poisson log-lineal. Resultados: La mortalidad por cáncer infantil ha disminuido un 41 % a lo largo del período de estudio. El descenso ha sido desigual para los distintos sexos (varones: 46%; mujeres: 33%) y tipos tumorales (leucemias: 38 %; linfomas no hodgkinianos: 58 %; tumores malignos encefálicos: 45 %; tumores malignos osteoarticulares: 19 %; tumores malignos mal definidos: 78 %). El porcentaje de disminución anual de la mortalidad ha sido mucho mayor para el último quinquenio (4,7 %) que para el período completo (2,2 %). Conclusiones: La mortalidad infantil por cáncer ha descendido entre 1977 y 2001, acercando la situación de nuestra región a la de otras regiones europeas y norteamericanas. Serán necesarias futuras evaluaciones que integren indicadores de mortalidad, incidencia y supervivencia para un mejor conocimiento de la epidemiología del cáncer infantil en la Comunidad de Madrid

Introduction: In the last few decades mortality from cancer among children and adolescents has not decreased homogeneously in industrialized countries. The aim of this study was to determine the epidemiological pattern and temporal trend of mortality from cancer in individuals aged less than 20 years old living in the Autonomous Community of Madrid from 1977 to 2001. Material and methods: Data on deaths from cancer among children and adolescents were obtained from Spain’s National Institute of Statistics and from the Mortality Registry of Madrid. Populations were obtained from official publications of the Institute of Statistics of Madrid. Variables analyzed were sex, 5-year age groups, 5-year death periods and underlying cause of death. The epidemiological pattern was studied and a Poisson’s regression model was used to analyze cancer mortality trends in children and adolescents from 1977 to 2001. Results: Cancer mortality among children and adolescents decreased by 41% from 1977 to 2001. The decrease in mortality differed according to sex (46 % in boys and 33 % in girls) and type of cancer (leukemias: 38 %, non-Hodgkin’s lymphomas: 58 %, malignant brain tumors: 45 %, malignant bone tumors: 19 %, ill-defined malignant tumors: 78 %). Moreover, the annual decrease was much greater in the last 5 years (4. 7 %) than during the entire period (2. 2 %). Conclusions: Cancer mortality among children and adolescents decreased between 1977 and 2001 and our results are similar to those observed in other European and North American regions. To improve knowledge of the epidemiology of cancer among children and adolescents in the Autonomous Community of Madrid, future assessments including mortality, incidence, and survival indicators are required