Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study.

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

[Wilson's disease in Spain: validation of sources of information used by the Rare Diseases Registries]. / Enfermedad de Wilson en España: validación de fuentes utilizadas por los Registros de Enfermedades Raras.

OBJECTIVE: To evaluate the sources of information used by the Regional Population-based Registries of Rare Diseases (RRD) for Wilson's Disease identification in Spain; to calculate its prevalence and mortality; and to describe the sociodemographic characteristics of those affected. METHOD: Cross-sectional epidemiological study, period 2010-2015. Possible cases were identified by codes 275.1 (ICD-9-CM), E83.0 (ICD-10) and 905 (ORPHAcode) in: 15 participating RRD and the Rare Disease Patients Registry of the Carlos III Health Institute. The diagnoses were confirmed through a clinical documentation review. The positive predictive value (PPV) of the sources of information used by RRD and their combinations were obtained. The prevalence, mortality and the distribution of sociodemographic characteristics were calculated. RESULTS: The Hospital Discharge Database (HDD) was the most used source by the RRD (PPV=39.4%), followed by the Orphan Drugs Registry (ODR) (PPV=81.9%). The Clinical History of Primary Care (PC) obtains PPV=55.9%. The combinations with highest PPV were the ODR with HDD (PPV=95.8%) and the ODR with PC (PPV=92.9%). 514 cases were confirmed, 57.2% men, with a median age of diagnosis of 21.3 years. The prevalence was 1.64/100,000 inhabitants in 2015 and mortality rate was 3.0%, being both higher in men. CONCLUSIONS: Incorporation of ODR and PC into the RRD is recommended, as its combination and ODR with HDD could be used as an automatic validation criterion for Wilson's disease. The prevalence obtained was similar to that of countries close to Spain.

Lifestyle interventions for cancer prevention in primary care: Differences between family physicians and nursing professionals.

RATIONALE, AIMS, AND OBJECTIVES: Prevention offers the most cost-effective long-term strategy for cancer control. The objective of this study was to ascertain opinions, attitudes, and professional practices towards cancer prevention among primary care professionals and to assess differences between family physicians (FP) and nursing professionals (NP). METHOD: A cross-sectional study was performed in 2012 in the Community of Madrid. A random sample of 3586 professionals received an online questionnaire about opinions/attitudes, training, and interventions in cancer prevention. The chi-square test was used to analyse the association of the profession with all the variables. Factors associated with the usual practice of individual, group, and community interventions were analysed using multivariate logistic regression, with separate models for FP and NP. RESULTS: The response rate was 39.4% (N = 1413). Approximately 90% of the participants attributed "sufficient/high" utility to individualized counselling. NP attributed higher utility to group and community interventions than FP (70.1% vs 60.1% and 64.9% vs 57.7%, respectively, P-value < 0.01). The usual practice of group and community interventions was more frequent among NP. The practice of group and community interventions was associated with knowledge of resources for prevention, specific training in group interventions, and the utility attributed to these methods. Among FP, the ability to dispense effective health advice and the utility attributed to this advice were associated with the usual practice of the three interventions. CONCLUSIONS: Group and community interventions are rarely practised, especially among FP. Actions targeting improved ability and knowledge could lead to higher involvement in the promotion of health. It would also be necessary to intervene in the examination of the utility of such interventions.

Epidemiological situation of yaws in the Americas: A systematic review in the context of a regional elimination goal.

BACKGROUND: Yaws is targeted for eradication by 2020 in the WHA66.12 resolution of the World Health Assembly. The objective of this study was to describe the occurrence of yaws in the Americas and to contribute to the compilation of evidence based on published data to undertake the certification of yaws eradication. METHODOLOGY: A systematic review of the epidemiological situation of yaws in the Americas was performed by searching in MEDLINE, Embase, LILACS, SCOPUS, Web of Science, DARE and Cochrane Database of Systematic Reviews. Experts on the topic were consulted, and institutional WHO/PAHO library databases were reviewed. PRINCIPAL FINDINGS: Seventy-five full-text articles published between 1839 and 2012 met the inclusion criteria. Haiti and Jamaica were the two countries with the highest number of papers (14.7% and 12.0%, respectively). Three-quarters of the studies were conducted before 1970. Thirty-three countries reported yaws case count or prevalence data. The largest foci in the history were described in Brazil and Haiti. The most recent cases reported were recorded in eight countries: Suriname, Guyana, Colombia, Haiti, Martinique, Dominica, Trinidad and Tobago, and Brazil. Gaps in information and heterogeneity were detected in the methodologies used and outcome reporting, making cross-national and chronological comparisons difficult. CONCLUSIONS: The lack of recent yaws publications may reflect, in the best-case scenario, the interruption of yaws transmission. It should be possible to reach the eradication goal in the region of the Americas, but it is necessary to collect more information. We suggest updating the epidemiological status of yaws, especially in two countries that need to assess ongoing transmission. Twenty-four countries need to demonstrate the interruption of transmission and declare its status of yaws endemicity, and sixteen countries should declare if they are yaws-free. It is necessary to formally verify the achievement of this goal in Ecuador.

Coverage and predictors of influenza vaccination in patients with cystic fibrosis in a campaign with a mobile phone text messaging intervention.

Annual influenza vaccination is considered the best protection against influenza infection. We analyzed the influenza vaccine coverage (IVC) in cystic fibrosis (CF) patients and evaluated the factors associated with the IVC, including the effect of text-message/SMS reminders. We performed a cross-sectional study in the Community of Madrid (Spain) in 2015. The target population was people with CF older than 6 months of age at the beginning of the flu vaccination campaign. The IVC was calculated according to the study variables. A total of 445 CF patients were analyzed. In 2015, IVC reached 67.9% and was higher in children and women. The main factor associated with flu vaccination was having been vaccinated in the previous campaign (aOR 14.36; IC95%: 8.48-24.32). The probability of being vaccinated after receiving the SMS was more than twice than for those who did not receive it, although no statistical significance was reached. In conclusion the IVC of patients with CF is high, but it still has room for improvement. SMS reminders sent to CF patients might improve influenza vaccine uptake.

Injuries Among Immigrants Treated in Primary Care in Madrid, Spain.

This study compared the injury incidence rates by sex in adult immigrant and native population attended in primary care in the Community of Madrid, Spain. Cross-sectional study of injuries registered in the primary care electronic medical record in 2012. Crude and age-adjusted incidence rates by sex, region of birth and type of injury were calculated. Poisson regression was performed. In both sexes, the highest crude injury incidence rate was found in immigrants from North Africa, followed by the native population. After controlling for age and socioeconomic-status, the highest risk of injury in immigrants was observed in burns in women from North-African (79%) and in foreign body injuries in men from Latin America and Caribbean, Sub-Saharan and North Africa and Central and Eastern Europe (61-123%). The analysis by region of origin has identified people from North Africa as a particularly vulnerable group.

Main causes of hospitalization in people with Angelman syndrome.

BACKGROUND: The objective was to describe the main causes of hospitalization in people with Angelman syndrome (AS). METHOD: Population-based cross-sectional study in the Community of Madrid (CM), Spain. The information source for AS cases was the information system for rare diseases in the CM. Variables related to hospitalization, for the period 2006-2014, were the following: number of episodes, outcome, main cause, length of stay and type of admission. Main causes of hospitalization were described by age group and sex. RESULTS: The most frequent causes of hospitalization were the following: oral-dental care (28.9%), seizures (19.6%), orthopaedic problems (14.4%) and acute respiratory disorders (12.4%). The percentage of hospitalizations was higher for oral-dental care in women and for orthopaedic problems in men (p-value <.05). Hospitalizations for an acute respiratory disorder were higher in adults (p-value <.05). CONCLUSIONS: Some differences in the causes of hospitalization of people with AS were observed by sex and age.

A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project).

RATIONALE AND OBJECTIVES: Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. METHODS: We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. RESULTS: Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies. CONCLUSION: Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.

Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain.

Background: Socioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age. Methods: This was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed. Results: A statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15-44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group. Conclusion: People with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age.

Schistosomiasis Prevalence and Intensity of Infection in Latin America and the Caribbean Countries, 1942-2014: A Systematic Review in the Context of a Regional Elimination Goal.

BACKGROUND: In 2012 the World Health Assembly adopted resolution WHA65.21 on elimination of schistosomiasis, calling for increased investment in schistosomiasis control and support for countries to initiate elimination programs. This study aims to analyze prevalence and intensity of Schistosoma mansoni infection in children in Latin America and the Caribbean countries and territories (LAC), at the second administrative level or lower. METHODOLOGY: A systematic review of schistosomiasis prevalence and intensity of infection was conducted by searching at PubMed, LILACS and EMBASE. Experts on the topic were informally consulted and institutional web pages were reviewed (PAHO/WHO, Ministries of Health). Only SCH infection among children was registered because it can be a 'proxi-indicator' of recent transmission by the time the study is conducted. PRINCIPAL FINDINGS: One hundred thirty two full-text articles met the inclusion criteria and provided 1,242 prevalence and 199 intensity of infection data points. Most of them were from Brazil (69.7%). Only Brazil published studies after 2001, showing several 'hot spots' with high prevalence. Brazil, Venezuela, Suriname and Saint Lucia need to update the epidemiological status of schistosomiasis to re-design their national programs and target the elimination of Schistosoma mansoni transmission by 2020. In Antigua and Barbuda, Dominican Republic, Guadeloupe, Martinique, Montserrat and Puerto Rico schistosomiasis transmission may be interrupted. However the compilation of an elimination dossier and follow-up surveys, per WHO recommendations, are needed to verify that status. Hence, the burden of subtle SCH chronic infection may be still present and even high in countries that may have eliminated transmission. Heterogeneity in the methodologies used for monitoring and evaluating the progress of the schistosomiasis programs was found, making cross-national and chronological comparisons difficult. CONCLUSIONS: There is a need for updating the schistosomiasis status in the historically endemic countries and territories in LAC to address the required public health interventions for control and elimination programs or to verify the elimination of transmission of Schistosoma mansoni. Improved reporting and standardization of the monitoring and evaluation methodologies used are recommended, while using available WHO guidelines. Meeting a regional elimination goal will require additional and improved epidemiological data by age group and sex.

Place of death and associated factors among patients with amyotrophic lateral sclerosis in Madrid (Spain).

Our objectives were to analyse the place of death, its temporal trend and associated sociodemographic factors among patients with amyotrophic lateral sclerosis (ALS) resident in the Autonomous Community of Madrid. This was a population based cross-sectional study of deaths from ALS (ICD-10 code G12.2) from 2003 to 2011, included in regional death statistics. The sociodemographic variables were age, gender, marital status, place of residence and socioeconomic level. Logistic regressions were performed to identify factors associated with death in hospital, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Joinpoint models were used to analyse annual trends for death in hospital. Of 1035 patients who died of ALS, 56.1% died in a hospital, 30.4% at home, 8.3% in a residential home and it was unknown for 5.1%. The percentage of deaths in hospital was lower in older and in single people than in married ones (55.0% and 61.9%, respectively; ORa 0.74, 95% CI 0.57-0.97). This percentage increased progressively as socioeconomic level fell (66.3% in Q5 compared to 49.6% in Q1, ORa 2.03, 95% CI 1.36-3.02). A significant increase in the percentage of deaths in hospital was observed. In conclusion, factors such as age, marital status or socioeconomic level play a part in the place of death of those with ALS.

[Mobility Exposure Measures in Serious Road Traffic Injuries in Madrid, Spain]. / Medidas de exposición a la movilidad en las lesiones graves por tráfico en la Comunidad de Madrid.

BACKGROUND: The search of suitable indicators for estimating the risk of road traffic injuries is nowadays a relevant topic. The objective of this study was to carry out a comparative description of mortality and inhospital morbidity by age and sex, using population rates and mobility exposure related indicators. METHODS: Cross sectional study in the Community of Madrid, 2003-2005. Population rates and mortality and morbidity rates per billion of persons-kilometers travelled and per million of persons-hours travelled were estimated and compared by age and sex. The Minimum Basic Hospital Discharge Data Set, the 2004 Mobility House Survey of the Community of Madrid and the mortality register of the Statistic Institute of the Community of Madrid were used as information sources. RESULTS: 7,413 hospital discharges and 1,046 deaths were identified. Morbidity and mortality population rates in men were 62.24 and 9.20 respectively, and in women 23.80 and 2.97 per 100,000 inhabitants, being the highest rates those for men aged 16-24 years (119.27 hospital discharges and 12.00 deaths per 100,000 inhabitants). Women of 65 years and older showed the highest mobility related rates: 649.78 hospital discharges and 96.72 deaths per 10(9) km, and 13.11 hospital discharges and 1.95 deaths per 10(6) travelled hours. CONCLUSIONS: Morbidity and mortality were higher in men for the three indicators. Rates referred to mobility exposure, faced to population rates, decrease mortality and morbidity due to road traffic injuries in men and young ages and increase both in advanced ages.

Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica / Injuries treated in primary care in the Community of Madrid: analyses of electronic medical records

Objetivo Describir la incidencia de lesiones atendidas en atención primaria y analizar su distribución según el tipo de lesión por sexo y edad en la Comunidad de Madrid en el año 2011.MétodosEstudio descriptivo transversal a partir de la historia clínica electrónica de atención primaria, del sistema sanitario público de la Comunidad de Madrid, en 2011. Se calcularon la incidencia de las lesiones, las tasas específicas de lesiones (fracturas, esguinces, heridas, quemaduras, lesiones por cuerpo extraño, intoxicaciones y contusiones) y las razones de tasas con un intervalo de confianza del 95%, todas estratificadas por sexo y edad. Resultados En 2011 se registraron 707.800 episodios de lesiones (3,5% del total de los episodios atendidos en atención primaria). La mayoría afectaron a mujeres (54,0%) y a mayores de 34 años (58,0%). Las más frecuentes fueron las heridas en los hombres (35,3%) y las contusiones en las mujeres (30,6%). Globalmente, las mujeres presentaron tasas más altas de lesiones en edades avanzadas y los hombres se lesionaron más por debajo de los 15 años de edad. Por tipo de lesión, las tasas más altas de fracturas, quemaduras y contusiones se observaron en la población de mayor edad, las de lesiones por cuerpo extraño y heridas en la infancia, las luxaciones en jóvenes y las intoxicaciones en las edades extremas. Conclusiones La vulnerabilidad especial de varones menores de 5 años y de las ancianas sugiere que las intervenciones tienen que dirigirse a las necesidades específicas de estos grupos (AU)

Objective To describe the incidence of injuries treated in primary care by type of injury, age groups, and sex in the publicly-funded health system of the region of Madrid in Spain. Methods A descriptive cross sectional study was performed of injury episodes registered in the primary care electronic medical records of the health system of Madrid in 2011. We calculated the global incidence of injuries, injury-specific rates for fractures, sprains, wounds, burns, foreign body injuries, poisoning and bruises, and their rate ratios with 95% confidence intervals, all of which were stratified by sex and age groups. Results In 2011 there were 707,800 injury episodes (3.5% of all episodes treated in primary care). Most of the injuries occurred in women (54.0%) and in persons older than 34 years (58.0%). The most common injuries were wounds in men (35.3%) and bruises in women (30.6%). Overall, women had higher rates of injuries among the elderly and men had more injuries in the group younger than 15 years. By type of injury, the highest rates of fractures, burns and bruises were observed in the older population, foreign body injuries and wounds in children, sprains in youth, and poisonings in extreme ages. Conclusions The special vulnerability of boys younger than 5 years and elderly women suggests that intervention strategies should be targeted to the specific needs of these groups (AU)

[Injuries treated in primary care in the Community of Madrid: analyses of electronic medical records]. / Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica.

OBJECTIVE: To describe the incidence of injuries treated in primary care by type of injury, age groups, and sex in the publicly-funded health system of the region of Madrid in Spain. METHODS: A descriptive cross sectional study was performed of injury episodes registered in the primary care electronic medical records of the health system of Madrid in 2011. We calculated the global incidence of injuries, injury-specific rates for fractures, sprains, wounds, burns, foreign body injuries, poisoning and bruises, and their rate ratios with 95% confidence intervals, all of which were stratified by sex and age groups. RESULTS: In 2011 there were 707,800 injury episodes (3.5% of all episodes treated in primary care). Most of the injuries occurred in women (54.0%) and in persons older than 34 years (58.0%). The most common injuries were wounds in men (35.3%) and bruises in women (30.6%). Overall, women had higher rates of injuries among the elderly and men had more injuries in the group younger than 15 years. By type of injury, the highest rates of fractures, burns and bruises were observed in the older population, foreign body injuries and wounds in children, sprains in youth, and poisonings in extreme ages. CONCLUSIONS: The special vulnerability of boys younger than 5 years and elderly women suggests that intervention strategies should be targeted to the specific needs of these groups.

Syphilis in the most at-risk populations in Latin America and the Caribbean: a systematic review.

OBJECTIVE: To describe syphilis prevalence in men who have sex with men (MSM), the transgender population, and sex workers and their clients, identifying critical geographical areas, trends, and data gaps in Latin America and the Caribbean. METHODS: A systematic review of syphilis prevalence was conducted by searching PubMed, LILACS, EMBASE, conference records, and other sources (2000-2010). RESULTS: Forty-eight articles were included in the review, from which 84 data points were identified relating to MSM and female sex workers and only 10 relating to the transgender population, male sex workers, and clients of sex workers. Most studies were from Latin America (83%), with fewer from the Caribbean (17%). Critical 'hotspot' cities were Sao Paulo, Buenos Aires, Guatemala, Puerto Barrios, San José, San Pedro, Managua, San Salvador, and Acajutla, with high syphilis prevalence in more than one study population. Gaps in the availability of information on syphilis prevalence were identified for Ecuador, Uruguay, and Bolivia, and most countries in the Caribbean. Chronological trends showed that syphilis infection is well-established among the study populations. CONCLUSIONS: Consistently high levels of syphilis among the investigated populations throughout the study period show that there is a need to improve monitoring, surveillance, and evaluation of sexually transmitted infection control interventions among these populations. Improved reporting and standardization of syphilis testing is recommended, as well as a heightened focus on more effective syphilis control strategies.

The impact of medication reconciliation program at admission in an internal medicine department.

BACKGROUND: Medication reconciliation process has proved to be an effective tool to improve the safety of drug use. The objective of this study was to assess the impact of an intervention aimed to decrease unintended discrepancies between patient's usual treatment and medications prescribed on admission to the Department of Internal Medicine. METHODS: A quasi-experimental study was carried out from June 2009 to May 2010, analyzing discrepancies between home medication and drugs prescribed in a tertiary care hospital, before (first phase) and after (second phase) an electronic reconciliation tool was introduced at admission. This tool connected patients' usual medication with the electronic prescription program. The research team was made up of two hospital pharmacists, two nurses and three physicians from the Internal and Preventive Medicine Departments. RESULTS: During the two phases of the study, 162 patients were included with a total of 1,959 medicines reconciled. The incidence of unintended discrepancies decreased from 3.5% to 1.8% after the intervention (p value 0.03). The proportion of patients with at least one unintended discrepancy was 23.7% in the first phase and 14.6% in the second phase (p value 0.20). Omission was the most common unintended discrepancy. Asthmatic patients showed 6 times higher risk of being affected by an unintended discrepancy (OR 6.37, 95%CI 1.6-25.5; p value 0.009). CONCLUSIONS: Implementing a computerized tool integrated into the electronic prescribing program could be very helpful to develop a medication reconciliation process. It is essential to involve all hospital staff in this process.

Developing a programme for medication reconciliation at the time of admission into hospital.

The aim of this article is to describe the methods used to develop the medication reconciliation programme implemented in a tertiary care hospital, and to discuss the main problems encountered and lessons learned during the process. A quasi-experimental study was carried out, analysing discrepancies between routine medication and drugs prescribed in the hospital, before and after an electronic reconciliation tool was introduced at admission. This tool was integrated into the computerized provider order entry system. The implementation of the electronic reconciliation tool has shown a reduction of the rate of discrepancies, decreasing from 7.24% (CI 95% 6.0-8.5) before the intervention to 4.18% (CI 95% 3.2-5.1) afterwards. Projects like this are costly, but this study has made it possible to detect numerous areas where interventions could be useful and proved the importance of a medication reconciliation programme.