Association between Hospital-Acquired Pneumonia and In-Hospital Mortality in Solid Organ Transplant Admissions: An Observational Analysis in Spain, 2004-2021.

(1) Background: To analyze the association between hospital-acquired pneumonia (HAP) and in-hospital mortality (IHM) during hospital admission for solid organ transplant in Spain during 2004-2021. (2) Methods: We used national hospital discharge data to select all hospital admissions for kidney, liver, heart, and lung transplants. We stratified the data according to HAP status. To examine time trends, we grouped data into three consecutive 6-year periods (2004-2009; 2010-2015; and 2016-2021). We assessed in-hospital mortality (IHM) in logistic regression analyses and obtained odds ratios (ORs) with their 95% confidence intervals (CIs). (3) Results: We identified a total of 71,827 transplants (45,262, kidney; 18,127, liver; 4734, heart; and 4598, lung). Two thirds of the patients were men. Overall, the rate of HAP during admission was 2.6% and decreased from 3.0% during 2004-2009 to 2.4% during 2016-2021. The highest rate of HAP corresponded to lung transplant (9.4%), whereas we found the lowest rate for kidney transplant (1.1%). Rates of HAP for liver and heart transplants were 3.8% and 6.3%, respectively. IHM was significantly lower during 2016-2021 compared to 2004-2009 for all types of transplants (ORs (CIs) = 0.65 (0.53-0.79) for kidney; 0.73 (0.63-0.84) for liver; 0.72 (0.59-0.87) for heart; and 0.39 (0.31-0.47) for lung). HAP was associated with IHM for all types of transplants (ORs (CIs) = 4.47 (2.85-9.08) for kidney; 2.96 (2.34-3.75) for liver; 1.86 (1.34-2.57) for heart; and 2.97 (2.24-3.94) for lung). (4) Conclusions: Rates of HAP during admission for solid organ transplant differ depending on the type of transplant. Although IHM during admission for solid organ transplant has decreased over time in our country, HAP persists and is associated with a higher IHM after accounting for potential confounding variables.

Sex-Related Disparities in the Prevalence of Depression among Patients Hospitalized with Type 2 Diabetes Mellitus in Spain, 2011-2020.

(1) Background: Recent reports suggest a decrease in the prevalence of depression among people with diabetes and important sex-differences in the association between these conditions, however data from Spain is sparse. We aim to assess trends in the prevalence of depression and in-hospital outcomes among patients with type 2 diabetes (T2DM) hospitalized (2011-2020) identifying sex-differences. (2) Methods: Using the Spanish national hospital discharge database we analysed the prevalence of depression globally, by sex, and according to the conditions included in the Charlson comorbidity index (CCI). We tested factors associated with the presence of depression and with in-hospital mortality (IHM). Time trends in the prevalence of depression and variables independently associated with IHM were analyzed using multivariable logistic regression. (3) Results: From 2011 to 2020, we identified 5,971,917 hospitalizations of patients with T2DM (5.7% involved depression). The prevalence of depression decreased significantly between 2011 and 2020. The adjusted prevalence of depression was 3.32-fold higher in women than in men (OR 3.32; 95%CI 3.3-3.35). The highest prevalence of depression among men and women with T2DM was found among those who also had a diagnosis of obesity, liver disease, and COPD. Older age, higher CCI, pneumonia, and having been hospitalized in 2020 increased the risk of IHM in patients with T2DM and depression. Obesity was a protective factor for IHM in both sexes, with no differences detected for IHM between men and women. Among patients hospitalized with T2DM, concomitant depression was associated with lower IHM than among patients without depression (depression paradox). (4) Conclusions: The prevalence of depression decreased over time in both sexes. The prevalence of depression was over three-fold higher in women. Female sex and depression were not associated with higher IHM. Based on our results we recommend that clinicians screen regularly for depression in patients with T2DM, particularly women, younger patients, and those with multiple comorbidities.

Group Membership and Social and Personal Identities as Psychosocial Coping Resources to Psychological Consequences of the COVID-19 Confinement.

The confinement imposed by measures to deal with the COVID-19 pandemic may in the short and medium term have psychological and psychosocial consequences affecting the well-being and mental health of individuals. This study aims to explore the role played by group membership and social and personal identities as coping resources to face the experience of the COVID-19 confinement and radical disruption of social, work, family and personal life in a sample of 421 people who have experienced a month of strict confinement in the Region of Madrid. Our results show that identity-resources (membership continuity/new group memberships, and personal identity strength) are positively related to process-resources (social support and perceived personal control), and that both are related to better perceived mental health, lower levels of anxiety and depression, and higher well-being (life satisfaction and resilience) during confinement. These results, in addition to providing relevant information about the psychological consequences of this experience, constitute a solid basis for the design of psychosocial interventions based on group memberships and social identity as coping resources.

Gender Differences in the Prevalence and Characteristics of Pain in Spain: Report from a Population-Based Study.

OBJECTIVE: To assess the prevalence and characteristics of chronic neck pain, chronic low back pain, and migraine or frequent headaches among Spanish adults in 2014 according to gender, to identify predictors for each of these types of pains, and to compare the prevalence with those found in 2009. DESIGN: Cross-sectional study. SETTING: Spain. METHODS: We used data collected from the 2014 European Health Interview Survey (N = 22,842). Sociodemographic features, self-rated health status, lifestyle habits, comorbid conditions, pain characteristics, and self-reported use of medications were analyzed. RESULTS: The prevalence of all types of pain was significantly higher among women than men. For chronic neck pain, the figures were 25.68% vs 12.54%, for chronic low back pain, 27.03% vs 18.83%, and for migraine or frequent headaches, 15.93% vs 6.74%, in women and men, respectively. Predictors of these types of pain included female gender, advanced age, poor self-rated health, psychological distress, comorbidities, and obesity. The prevalence of neck pain and low back pain increased from 2009 to 2014 for both sexes, and the prevalence of migraine or frequent headaches remained stable over time. CONCLUSIONS: The prevalence and intensity of all the forms of chronic pain were higher among women. Women experiencing pain used prescribed medications for pain, anxiety, and/or depression and sleeping pills more than men. The prevalence of chronic neck and low back has increased in the last five years in Spain, and the prevalence of migraine or frequent headaches has remained stable.

Is there an association between diabetes and neck pain and lower back pain? Results of a population-based study.

BACKGROUND: The objective of the study was to study the association between low back pain (LBP), neck pain (NP), and diabetes while controlling for many sociodemographic characteristics, comorbidities, and lifestyle variables. The study also aimed to identify which of these variables is independently associated with LBP and NP among diabetes sufferers. METHODS: A case-control study using data taken from the European Health Interview Surveys for Spain was conducted in 2009/2010 (n=22,188) and 2014 (n=22,842). We selected subjects ≥40 years of age. Diabetes status was self-reported. One non-diabetic control was matched by the year of survey, age, and sex for each diabetic case. The presence of LBP and NP was defined as the affirmative answer to both of the questions: "Have you suffered chronic LBP/NP over the last 12 months?" and "Has your physician confirmed the diagnosis?" Independent variables included demographic and socioeconomic characteristics, health status variables, lifestyles, and pain characteristics. RESULTS: The prevalence of NP (32.2% vs 26.8%) and LBP (37.1% vs 30.3%) was significantly higher among those suffering from diabetes. Multivariable analysis showed that diabetes was associated with a 1.19 (95% CI 1.04-1.36) and 1.20 (95% CI 1.06-1.35) higher risk of NP and LBP. Among diabetic subjects, being female, concomitant mental or respiratory disorders, being obese, and physically inactive are variables associated with suffering from these pains. Those suffering NP had 8 times higher risk of reporting LBP than those without NP and the same association is found among those suffering from LBP. CONCLUSION: The prevalence and intensity of NP and LBP are high among people with diabetes, affecting them significantly more than their age- and sex-matched non-diabetic controls. Specific preventive and educational strategies must be implemented to reduce the incidence, severity, and negative effect on the quality of NP and LBP among diabetic patients.

Effect of the economic crisis on the use of health and home care services among elderly Spanish diabetes patients.

AIMS: To describe the utilization of health and home care services among older people (≥65 years) with diabetes during the economic crisis; to identify the factors associated with changes in the utilization of these services; and to study the time trends (2009-2014). METHODS: We used the European Health Interview Surveys for Spain (EEHSS) for 2009/10 and 2014. The dependent variables included self-reported hospitalizations; general practitioner (GP) visits; 'other healthcare services' (OHS) used; and home care services (HCS) used. RESULTS: We identified 6026 and 6020 diabetic patients (EEHSS2009 and EEHSS2014, respectively). A significant decrease in the number of GP visits (OR 0.94; 95% CI 0.91-0.98) and the use of HCS (OR 0.95; 95% CI 0.91-0.99) was found; however, we found an increase in the use of OHS (OR 1.06; 95% CI 1.02-1.10). Multivariate models showed that factors associated with an increased use included chronic conditions, worse self-rated health, pain and mental disorders. Physical activity was a strong predictor of lower hospitalizations and HCS use. Female gender was associated with significantly lower hospitalizations and a higher use of OHC and HCS. CONCLUSION: We found a decrease in the number of GP visits and the use of HCS among elderly diabetic adults; however, we also observed an increase in the use of OHS, which may partly explain this decrease in the figures. Significant differences in the use of health services were found according to gender. The effect of the economic crisis, if any, seems to have had a small magnitude.

No evidence of morbidity compression in Spain: a time series study based on national hospitalization records.

OBJECTIVES: Compression of morbidity postulates that as the populations age, the age of onset of disease is postponed. The objective of this study is to test for evidence of compression of morbidity in Spain. METHODS: We calculated the age and sex-specific incidence of myocardial infarction, heart failure, cerebrovascular disease, as well as bladder, prostate, breast, lung, and colon cancer among hospital discharges covering 99.5 % of the Spanish population, approximately 40 million inhabitants for two non-overlapping periods, 1997-2000 and 2007-2010, and estimated the length of life spent with disease using the Sullivan method. RESULTS: We found that expansion of morbidity due to an earlier age-specific onset of incident disease and increase in life expectancy was the norm in Spain. Notable exceptions were cardiovascular disease in women (-0.2 % time spent with disease) and lung cancer for men (-0.9 % time spent with disease) from 1997-2000 to 2007-2010. CONCLUSIONS: Compression of morbidity is often cited by policy makers when discussing adjustments to the health-care system. If morbidity is measured by age at onset of disease, the burden of morbidity has increased in Spain.

Are healthcare workers' intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review.

BACKGROUND: The Summit of Independent European Vaccination Experts (SIEVE) recommended in 2007 that efforts be made to improve healthcare workers' knowledge and beliefs about vaccines, and their attitudes towards them, to increase vaccination coverage. The aim of the study was to compile and analyze the areas of disagreement in the existing evidence about the relationship between healthcare workers' knowledge, beliefs and attitudes about vaccines and their intentions to vaccinate the populations they serve. METHODS: We conducted a systematic search in four electronic databases for studies published in any of seven different languages between February 1998 and June 2009. We included studies conducted in developed countries that used statistical methods to relate or associate the variables included in our research question. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. The data were descriptively analyzed. RESULTS: Of the 2354 references identified in the initial search, 15 studies met the inclusion criteria. The diversity in the study designs and in the methods used to measure the variables made it impossible to integrate the results, and each study had to be assessed individually. All the studies found an association in the direction postulated by the SIEVE experts: among healthcare workers, higher awareness, beliefs that are more aligned with scientific evidence and more favorable attitudes toward vaccination were associated with greater intentions to vaccinate. All the studies included were cross-sectional; thus, no causal relationship between the variables was established. CONCLUSION: The results suggest that interventions aimed at improving healthcare workers' knowledge, beliefs and attitudes about vaccines should be encouraged, and their impact on vaccination coverage should be assessed.

Medical, environmental and personal factors of disability in the elderly in Spain: a screening survey based on the International Classification of Functioning / Factores médicos, ambientales y personales de discapacidad en las personas mayores en España: un estudio de detección basado en la Clasificación Internacional del Funcionamiento

Objectives: The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability. Methods: Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2nd ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses. Results: The sample was composed of 503 participants aged ≥ 75 years. Alzheimer¿s disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74). Conclusions: Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression (AU)

Objetivos: La Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) propone un enfoque multifactorial de la discapacidad. El presente estudio analiza los principales determinantes médicos, ambientales y personales de la discapacidad grave y extrema en población anciana española siguiendo una evaluación congruente con el modelo CIF. Métodos: Nueve poblaciones aportaron muestras probabilísticas o definidas geográficamente siguiendo un diseño de cribado. Se usaron el Minimental State Examination y el World Health Organization-Disability Assessment Schedule, 2nd ed. (WHO-DAS II, 12 ítems), como cribados cognitivo y de discapacidad, respectivamente. Se evaluaron la presencia de demencia y los grados de discapacidad de la CIF usando la escala WHO-DAS II (36 ítems) entre los positivos al cribado. Los datos se combinaron usando regresión logística, ajustando por edad y sexo en todos los análisis. Resultados: Participaron 503 sujetos de 75 y más años de edad. Los individuos con enfermedad de Alzheimer y/o depresión tenían una mayor probabilidad de presentar discapacidad grave o extrema (OR: 17,40, 3,71). El acceso a los servicios sociales tuvo un efecto protector (OR: 0,05 a 0,18), mientras que el acceso «muy difícil» y la presencia de demencia u otro trastorno psiquiátrico se asociaron a un incremento de la discapacidad (OR: 66,06). Hubo una interacción significativa entre acceso a servicios y diagnóstico neurológico (OR: 12,74). Conclusiones: La discapacidad es altamente prevalente entre los ancianos españoles y está muy asociada a factores médicos, sociales y personales. La accesibilidad a los servicios sociales, la prevención de la demencia y del infarto cerebral, y el tratamiento de la depresión, pueden reducir la discapacidad entre los ancianos españoles (AU)

Medical, environmental and personal factors of disability in the elderly in Spain: a screening survey based on the International Classification of Functioning.

OBJECTIVES: The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability. METHODS: Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses. RESULTS: The sample was composed of 503 participants aged ≥ 75 years. Alzheimers disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74). CONCLUSIONS: Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression.

Patrón espacial de la legionelosis en España, 2003-2007 / Spatial pattern of legionellosis in Spain, 2003-2007

Objetivos: Analizar el patron espacial de la legionelosis en Espa˜na para hombres y mujeres durante elperiodo 2003-2007, e identificar agrupamientos espaciales del riesgo.Métodos: Se identifico el patron espacial de la distribucion de las tasas de legionelosis a partir del calculode las tasas por municipio por el metodo directo. Se realizo el suavizado de estas tasas por el metodoEmpirical Bayes para estudiar el patron espacial de la enfermedad, para ambos sexos. Se utilizo el indicede correlacion espacial de Moran para analizar la autocorrelacion global de las tasas. Localmente se utilizoel indice local de Moran (LISA) para analizar los agrupamientos (clusters) de municipios con mayor riesgo.Resultados: Una vez suavizado el riesgo, las mayores tasas (mas de 50 por 100.000 habitantes) se agrupanen las zonas costeras del Mediterraneo oriental y en el norte de la Peninsula, asi como en los territoriosinsulares del Mediterraneo. El indice de Moran de las tasas suavizadas es 0,15 para los hombres y 0,23 paralas mujeres. Las agrupaciones espaciales de las tasas mas altas estadisticamente significativas calculadasmediante el LISA se distribuyen en el eje norte-levante para ambos sexos.Conclusiones: Estos metodos de analisis espacial permiten identificar los patrones de distribucion de laenfermedad. Los metodos empleados presentan resultados similares. Estas tecnicas son una herramientacomplementaria para la vigilancia epidemiologica de las enfermedades infecciosas(AU)

Objectives: To analyze the spatial pattern of legionellosis in Spain for men and women during the period2003-2007 and to identify spatial clustering of risk.Methods: We identified the spatial pattern of the distribution of legionellosis rates based on calculationof rates by municipality through the direct method. Smoothing of these rates was performed by theEmpirical Bayes method for studying the spatial pattern of disease for both sexes. We used Moran¢§©¥sindex to analyze spatial autocorrelation rates globally. To calculate local rates, the Local Moran¡¯s Index[known as local indicators of spatial association (LISA)], was used to analyze the clusters of municipalitieswith the highest risk.Results: After smoothing the risk, the highest rates (over 50 per 100,000 inhabitants) were grouped inthe eastern Mediterranean coastal areas and the north of the mainland, as well as in the Mediterraneanislands. Moran¡¯s index smoothed rates were 0.15 for men and 0.23 for women. The spatial clusters ofstatistically significant higher rates calculated by the LISA index were distributed in the north and eastfor both sexes.Conclusions: These methods of spatial analysis allow patterns of disease distribution to be identified. Allthe methods used yielded similar results. These techniques are a complementary tool for epidemiologicalsurveillance of infectious diseases (AU)

[Spatial pattern of legionellosis in Spain, 2003-2007]. / Patrón espacial de la legionelosis en España, 2003-2007.

OBJECTIVES: To analyze the spatial pattern of legionellosis in Spain for men and women during the period 2003-2007 and to identify spatial clustering of risk. METHODS: We identified the spatial pattern of the distribution of legionellosis rates based on calculation of rates by municipality through the direct method. Smoothing of these rates was performed by the Empirical Bayes method for studying the spatial pattern of disease for both sexes. We used Morans index to analyze spatial autocorrelation rates globally. To calculate local rates, the Local Moran's Index [known as local indicators of spatial association (LISA)], was used to analyze the clusters of municipalities with the highest risk. RESULTS: After smoothing the risk, the highest rates (over 50 per 100,000 inhabitants) were grouped in the eastern Mediterranean coastal areas and the north of the mainland, as well as in the Mediterranean islands. Moran's index smoothed rates were 0.15 for men and 0.23 for women. The spatial clusters of statistically significant higher rates calculated by the LISA index were distributed in the north and east for both sexes. CONCLUSIONS: These methods of spatial analysis allow patterns of disease distribution to be identified. All the methods used yielded similar results. These techniques are a complementary tool for epidemiological surveillance of infectious diseases.

Prevalence of disability in a composite ≥75 year-old population in Spain: a screening survey based on the International Classification of Functioning.

BACKGROUND: The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF. METHODS: Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2nd edition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100). RESULTS: The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32). CONCLUSIONS: Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.

Arsenic in public water supplies and cardiovascular mortality in Spain.

BACKGROUND: High-chronic arsenic exposure in drinking water is associated with increased cardiovascular disease risk. At low-chronic levels, as those present in Spain, evidence is scarce. In this ecological study, we evaluated the association of municipal drinking water arsenic concentrations during the period 1998-2002 with cardiovascular mortality in the population of Spain. METHODS: Arsenic concentrations in drinking water were available for 1721 municipalities, covering 24.8 million people. Standardized mortality ratios (SMRs) for cardiovascular (361,750 deaths), coronary (113,000 deaths), and cerebrovascular (103,590 deaths) disease were analyzed for the period 1999-2003. Two-level hierarchical Poisson models were used to evaluate the association of municipal drinking water arsenic concentrations with mortality adjusting for social determinants, cardiovascular risk factors, diet, and water characteristics at municipal or provincial level in 651 municipalities (200,376 cardiovascular deaths) with complete covariate information. RESULTS: Mean municipal drinking water arsenic concentrations ranged from <1 to 118 microg/L. Compared to the overall Spanish population, sex- and age-adjusted mortality rates for cardiovascular (SMR 1.10), coronary (SMR 1.18), and cerebrovascular (SMR 1.04) disease were increased in municipalities with arsenic concentrations in drinking water > 10 microg/L. Compared to municipalities with arsenic concentrations < 1 microg/L, fully adjusted cardiovascular mortality rates were increased by 2.2% (-0.9% to 5.5%) and 2.6% (-2.0% to 7.5%) in municipalities with arsenic concentrations between 1-10 and >10 microg/L, respectively (P-value for trend 0.032). The corresponding figures were 5.2% (0.8% to 9.8%) and 1.5% (-4.5% to 7.9%) for coronary heart disease mortality, and 0.3% (-4.1% to 4.9%) and 1.7% (-4.9% to 8.8%) for cerebrovascular disease mortality. CONCLUSIONS: In this ecological study, elevated low-to-moderate arsenic concentrations in drinking water were associated with increased cardiovascular mortality at the municipal level. Prospective cohort studies with individual measures of arsenic exposure, standardized cardiovascular outcomes, and adequate adjustment for confounders are needed to confirm these ecological findings. Our study, however, reinforces the need to implement arsenic remediation treatments in water supply systems above the World Health Organization safety standard of 10 microg/L.

Prevalence of dementia and major dementia subtypes in Spanish populations: a reanalysis of dementia prevalence surveys, 1990-2008.

BACKGROUND: This study describes the prevalence of dementia and major dementia subtypes in Spanish elderly. METHODS: We identified screening surveys, both published and unpublished, in Spanish populations, which fulfilled specific quality criteria and targeted prevalence of dementia in populations aged 70 years and above. Surveys covering 13 geographically different populations were selected (prevalence period: 1990-2008). Authors of original surveys provided methodological details of their studies through a systematic questionnaire and also raw age-specific data. Prevalence data were compared using direct adjustment and logistic regression. RESULTS: The reanalyzed study population (aged 70 year and above) was composed of Central and North-Eastern Spanish sub-populations obtained from 9 surveys and totaled 12,232 persons and 1,194 cases of dementia (707 of Alzheimer's disease, 238 of vascular dementia). Results showed high variation in age- and sex-specific prevalence across studies. The reanalyzed prevalence of dementia was significantly higher in women; increased with age, particularly for Alzheimer's disease; and displayed a significant geographical variation among men. Prevalence was lowest in surveys reporting participation below 85%, studies referred to urban-mixed populations and populations diagnosed by psychiatrists. CONCLUSION: Prevalence of dementia and Alzheimer's disease in Central and North-Eastern Spain is higher in females, increases with age, and displays considerable geographic variation that may be method-related. People suffering from dementia and Alzheimer's disease in Spain may approach 600,000 and 400,000 respectively. However, existing studies may not be completely appropriate to infer prevalence of dementia and its subtypes in Spain until surveys in Southern Spain are conducted.

Coverage and predictors of influenza vaccination among adults with diabetes in Spain.

Based on data drawn from the 2003 National Health Survey (NHS), we sought to: (1) estimate influenza vaccination coverages among Spanish diabetic adults; (2) analyze which sociodemographic, health-related, and use of health-care services variables were associated with the likelihood of Spanish diabetes sufferers being vaccinated; and (3) analyze the time-trend in coverage for the period 2001-2003. We analyzed data on the 1295 adults suffering diabetes included in the 2003 NHS. The reply to the question "Were you vaccinated against influenza in the last vaccination campaign?" was taken as the dependent variable. Vaccination coverage was calculated and the influence of sociodemographic, health-related, and use of health-care services variables assessed. The proportion of vaccinated diabetic adults in 2003 amounted to 57%. Multivariate adjustment showed that the variables which increased the likelihood of being vaccinated were: higher age; male gender; presence of respiratory or heart diseases; and physician visits in the last 2 weeks. Influenza coverages had significantly increased from 2001 (48.8%) to 2003. We conclude that influenza vaccination coverages among Spanish diabetic adults have improved but still remain below desirable levels and, thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine among diabetic patients, especially those less than 50 years, females and without other chronic conditions.

Riesgo de transmisión del VIH o de los virus de la hepatitis B o C a partir de un médico infectado. Medidas preventivas recomendadas / Risk of transmission of HIV or hepatitis B or C viruses from an infected physician. Preventive measures

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[Cross-cultural validation of Antonovsky's Sense of Coherence Scale (OLQ-13) in Spanish elders aged 70 years or more]. / Validación transcultural de la Escala de Sentido de Coherencia de Antonovsky (OLQ-13) en ancianos mayores de 70 años.

BACKGROUND AND OBJECTIVE: Sense of Coherence (SOC) is a construct relating to coping strategies in the face of traumatic events. SOC is defined as a personal disposition towards perceiving life experiences as understandable, manageable and meaningful. The construct has shown itself to be a predictor of self-reported and objective health in a variety of contexts. Although the SOC construct has been studied, among the elderly in particular, the scale has never been validated in the Spanish aged population. This paper reports on the cross-cultural validation of Antonovsky's Sense of Coherence Scale (OLQ-13) in a sample of Spanish senior citizens. SUBJECTS AND METHOD: We studied a sample of population from 8 locations across Spain, totaling 419 subjects aged 70 years or over. The psychometric attributes of the scale were studied. These included acceptability, scale assumptions, internal consistency, factor structure, construct validity (convergent validity, differential analyses, inter-domains correlation), and precision. RESULTS: The internal consistency of the scale was adequate (Cronbach = 0.80). SOC showed moderate correlations with self-reported indices of physical health, quality of life and depression. The scale was found valid in differential analyses conducted for gender, age groups, levels of disability and functional impact of diseases. Principal components analysis yielded four factors accounting for 65.59% of the variance. The Meaningfulness domain acted as an independent factor. CONCLUSIONS: The OLQ-13 is a valid and reliable instrument for use on Spanish elderly populations, including those with low educational level.

Validación transcultural de la Escala de Sentido de Coherencia de Antonovsky (OLQ-13) en ancianos mayores de 70 años / Cross-cultural validation of Antonovsky's Sense of Coherence Scale (OLQ-13) in Spanish elders aged 70 years or more

Fundamento y objetivo: El sentido de coherencia (SOC) es un constructo relacionado con el afrontamiento de situaciones traumáticas que se ha empleado extensamente como predictor de medidas de salud percibida y objetiva. El SOC es una disposición personal hacia la valoración de las experiencias vitales como comprensibles, manejables y significativas. Esta medida se ha mostrado especialmente informativa en poblaciones envejecidas, pese a lo cual la escala no se ha validado en población española anciana. En este trabajo presentamos la validación transcultural y el estudio de las propiedades métricas de la escala de SOC de Antonovsky, de 13 ítems (OLQ-13), en una muestra de población de ancianos españoles. Sujetos y método: La muestra estuvo compuesta por 419 personas de más de 70 años procedentes de 8 localidades españolas. Se estudiaron la aceptabilidad, asunciones escalares, consistencia interna, estructura factorial, validez de constructo (validez convergente, análisis diferenciales, correlación entre dominios) y precisión del instrumento. Resultados: La consistencia interna de la escala fue adecuada (* de Cronbach = 0,80). El SOC mostró validez convergente con medidas autorreferidas de salud física, calidad de vida y depresión. La escala también demostró ser válida en sucesivos análisis diferenciales según grupos de edad, sexo, niveles de discapacidad y de impacto funcional de enfermedades. El análisis de componentes principales ofreció una solución multifactorial con un porcentaje de la variancia explicada del 65,59%. La subescala de significación parece formar un factor independiente. Conclusiones: El OLQ-13 es una escala válida y fiable para su uso en poblaciones ancianas españolas, incluidos grupos con bajo nivel de instrucción

Background and objective: Sense of Coherence (SOC) is a construct relating to coping strategies in the face of traumatic events. SOC is defined as a personal disposition towards perceiving life experiences as understandable, manageable and meaningful. The construct has shown itself to be a predictor of self-reported and objective health in a variety of contexts. Although the SOC construct has been studied, among the elderly in particular, the scale has never been validated in the Spanish aged population. This paper reports on the cross-cultural validation of Antonovsky's Sense of Coherence Scale (OLQ-13) in a sample of Spanish senior citizens. Subjects and method: We studied a sample of population from 8 locations across Spain, totaling 419 subjects aged 70 years or over. The psychometric attributes of the scale were studied. These included acceptability, scale assumptions, internal consistency, factor structure, construct validity (convergent validity, differential analyses, inter-domains correlation), and precision. Results: The internal consistency of the scale was adequate (Cronbach = 0.80). SOC showed moderate correlations with self-reported indices of physical health, quality of life and depression. The scale was found valid in differential analyses conducted for gender, age groups, levels of disability and functional impact of diseases. Principal components analysis yielded four factors accounting for 65.59% of the variance. The Meaningfulness domain acted as an independent factor. Conclusions: The OLQ-13 is a valid and reliable instrument for use on Spanish elderly populations, including those with low educational level