[COVID-19 in the city of Madrid and vulnerability. Analysis of the first two waves.] / COVID-19 en la ciudad de Madrid y vulnerabilidad. Análisis de las dos primeras olas.

OBJECTIVE: The advance of the pandemic in the large cities of the world with great virulence and the apparent heterogeneous distribution by factors of vulnerability, led us to propose this work. The objective of this study was to relate COVID-19 infection rates to the social vulnerability of the city of Madrid by district, in two different episodes, spring 2020 and summer 2020. METHODS: Analytical cross-sectional study. Taking sociodemographic data of the entire population of the city of Madrid between the months of April and October 2020, together with the cumulative incidence rates of COVID-19, a linear regression analysis, correlation and factor analysis was carried out, relating the cumulative incidence rate of COVID-19 and the vulnerability indicator of the districts of the city of Madrid. RESULTS: The results showed important differences between the two episodes of the pandemic: on one hand, the first had more relationship with health factors, while in the second, a relationship appeared with the groups of greater social vulnerability, territorially located in the South-East of the City and related in this case to social factors rather than health. Thus we see that the TIA x 100,000 in the first episode in Chamberí and Usera -two extreme districts in vulnerability- were 896 and 843 cases respectively, while in the second they were 3,708 and 6,258 cases. CONCLUSIONS: The territorial differences in the city become evident with the arrival of a generalised, universal event such as COVID-19, where vulnerability increases for everyone, with greater repercussions in those territories where it already had an impact.

OBJETIVO: El avance de la pandemia en las grandes ciudades del mundo con gran virulencia y la aparente distribución heterogénea por factores de vulnerabilidad, nos llevaron a plantear este trabajo. El objetivo de este estudio fue relacionar las tasas de infección por COVID-19 con la vulnerabilidad social de la ciudad de Madrid por distritos, en dos episodios distintos, primavera del 2020 y verano del 2020. METODOS: Estudio transversal analítico.Tomando los datos sociodemográficos de la totalidad de la población de la ciudad de Madrid entre los meses de abril y octubre de 2020, junto a las tasas de incidencia acumulada de la COVID-19, se realizó un análisis de regresión lineal, correlación y análisis factorial, relacionando la tasa de incidencia acumulada de la COVID-19 y el indicador de vulnerabilidad de los distritos de la ciudad de Madrid. RESULTADOS: Los resultados mostraron diferencias importantes entre los dos episodios de la pandemia: por una parte, el primero tuvo más relación con factores de salud, mientras en el segundo apareció una relación con los colectivos de mayor vulnerabilidad social, territorialmente localizados en la zona Sur-Este de la Ciudad y relacionándose en este caso con factores sociales más que de salud. Así vemos que las TIA x 100.000 en el primer episodio en Chamberí y Usera -dos distritos extremos en vulnerabilidad- fueron de 896 y 843 casos respectivamente, mientras que en el segundo fueron de 3.708 y 6.258 casos. CONCLUSIONES: Las diferencias territoriales de la ciudad de Madrid se hacen patentes ante la llegada de un suceso generalizado y universal como la COVID-19, dónde la vulnerabilidad se acrecienta para todo el mundo, repercutiendo en mayor medida en aquellos territorios donde ya incidía.

[Health, incidence and differences in the territorial vulnerability city of Madrid]. / Salud e incidencia y diferencias en vulnerabilidad territorial de la ciudad de Madrid.

OBJECTIVE: Territoriality is configured as an important axis of inequality. The objective of this study was to determine the level of association between territory and vulnerability, specifying proposals for territorial intervention using key socio-health indicators. METHODS: Analytical cross-sectional study, which combined the analysis of the Health Survey Madrid City 2017 (n=9,513) and the vulnerability-ranking indicator of the same year (n=2,780,197), popu-lation of the city of Madrid in 2017, from the Data Bank of the Madrid City Council), prepared with the hierarchical analysis technique. Sociodemographic and health variables were included, such as self-perception of health status, quality of life in relation to health, tobacco consumption, alcohol, obesity, sedentary lifestyle and mental health (GHQ-12). The relationships were assessed with DE, 95% CI, Spearman correlation, B and ß coefficients of multiple linear regression and the pair-point technique. RESULTS: The links between health and vulnerability were: in health-self-perceived and HRQL, as global health variables, p<0.01 for women with territory and vulnerability; sedentary lifestyle for both sexes, was interpreted with 60-80% by territory and vulnerability; obesity was slightly linked to the te-ritory in women and explained 77%; mental health was not territorially related for the group, but it was significantly related to women, due to 64% of the variance; in tobacco there was a significant territorial link in men and vulnerability in 57%; finally, alcohol had a significant difference in men at the territorial level and explained in 72% in both sexes, inverted. CONCLUSIONS: The results support the behavior of global and specific health indicators with vulnerability, with a disaggregation by sex, which will allow planning adapted to the territory.

OBJETIVO: La territorialidad se configura como un eje importante de desigualdad. El objetivo de este estudio fue determinar el nivel de asociación entre territorio y vulnerabilidad, concretando propuestas de intervención territorial mediante indicadores clave socio-sanitarios. METODOS: Se realizó un estudio transversal analítico, que combinó el análisis de la Encuesta de Salud de la Ciudad de Madrid de 2017 (n=9.513) y el indicador de vulnerabilidad-ranking del mismo año (n=2.780.197, población de la ciudad de Madrid en 2017, procedente del Banco de Datos del Ayuntamiento de Madrid), elaborado con la técnica de análisis jerárquico. Se incluyeron variables sociodemográficas y de salud, como autopercepción del estado de salud, calidad de vida en relación con la salud, consumo de tabaco, alcohol, obesidad, sedentarismo y salud mental (GHQ-12). Las relaciones se valoraron con DE, IC 95%, correlación de Spearman, coeficientes B y ß de regresión lineal múltiple y la técnica de pares de puntos. RESULTADOS: Los vínculos entre salud y vulnerabilidad fueron: en salud-autopercibida y CVRS, como variables globales de salud, p<0,01 para las mujeres con territorio y vulnerabilidad; en sedentarismo para ambos sexos, se interpretó con el 60-80% por el territorio y vulnerabilidad; la obesidad se vinculó levemente con el territorio en las mujeres y explicó el 77%; la salud mental no se relacionó territorialmente para el conjunto, pero sí de forma significativa en las mujeres, por el 64% de la varianza; en tabaco hubo vínculo significativo territorial en hombres y vulnerabilidad en el 57%; finalmente, el alcohol tuvo una diferencia significativa en hombres a nivel territorial y explicó en el 72% en ambos sexos, de forma invertida. CONCLUSIONES: Los resultados avalan el comportamiento de los indicadores globales y específicos de salud con la vulnerabilidad, con una desagregación por sexos, lo cual permitirá una planificación adaptada al territorio.

Salud e incidencia y diferencias en vulnerabilidad territorial de la ciudad de Madrid / Health, incidence and differences in the territorial vulnerability city of Madrid

OBJETIVO: La territorialidad se configura como un eje importante de desigualdad. El objetivo de este estudio fue determinar el nivel de asociación entre territorio y vulnerabilidad, concretando propuestas de intervención territorial mediante indicadores clave socio-sanitarios. MÉTODOS: Se realizó un estudio transversal analítico, que combinó el análisis de la Encuesta de Salud de la Ciudad de Madrid de 2017 (n=9.513) y el indicador de vulnerabilidad-ranking del mismo año (n=2.780.197, población de la ciudad de Madrid en 2017, procedente del Banco de Datos del Ayuntamiento de Madrid), elaborado con la técnica de análisis jerárquico. Se incluyeron variables sociodemográficas y de salud, como autopercepción del estado de salud, calidad de vida en relación con la salud, consumo de tabaco, alcohol, obesidad, sedentarismo y salud mental (GHQ-12). Las relaciones se valoraron con DE, IC 95%, correlación de Spearman, coeficientes B y beta de regresión lineal múltiple y la técnica de pares de puntos. RESULTADOS: Los vínculos entre salud y vulnerabilidad fueron: en salud-autopercibida y CVRS, como variables globales de salud, p < 0,01 para las mujeres con territorio y vulnerabilidad; en sedentarismo para ambos sexos, se interpretó con el 60-80% por el territorio y vulnerabilidad; la obesidad se vinculó levemente con el territorio en las mujeres y explicó el 77%; la salud mental no se relacionó territorialmente para el conjunto, pero sí de forma significativa en las mujeres, por el 64% de la varianza; en tabaco hubo vínculo significativo territorial en hombres y vulnerabilidad en el 57%; finalmente, el alcohol tuvo una diferencia significativa en hombres a nivel territorial y explicó en el 72% en ambos sexos, de forma invertida. CONCLUSIONES: Los resultados avalan el comportamiento de los indicadores globales y específicos de salud con la vulnerabilidad, con una desagregación por sexos, lo cual permitirá una planificación adaptada al territorio

OBJECTIVE: Territoriality is configured as an important axis of inequality. The objective of this study was to determine the level of association between territory and vulnerability, specifying proposals for territorial intervention using key socio-health indicators. METHODS: Analytical cross-sectional study, which combined the analysis of the Health Survey Madrid City 2017 (n=9,513) and the vulnerability-ranking indicator of the same year (n=2,780,197), popu-lation of the city of Madrid in 2017, from the Data Bank of the Madrid City Council), prepared with the hierarchical analysis technique. Sociodemographic and health variables were included, such as self-perception of health status, quality of life in relation to health, tobacco consumption, alcohol, obesity, sedentary lifestyle and mental health (GHQ-12). The relationships were assessed with DE, 95% CI, Spearman correlation, B and beta coefficients of multiple linear regression and the pair-point technique. RESULTS: The links between health and vulnerability were: in health-self-perceived and HRQL, as global health variables, p < 0.01 for women with territory and vulnerability; sedentary lifestyle for both sexes, was interpreted with 60-80% by territory and vulnerability; obesity was slightly linked to the te-ritory in women and explained 77%; mental health was not territorially related for the group, but it was significantly related to women, due to 64% of the variance; in tobacco there was a significant territorial link in men and vulnerability in 57%; finally, alcohol had a significant difference in men at the territorial level and explained in 72% in both sexes, inverted. CONCLUSIONS: The results support the behavior of global and specific health indicators with vulnerability, with a disaggregation by sex, which will allow planning adapted to the territory

El control de la vida personal, social y económica: desarrollo y estudio exploratorio de una escala de medida / The Control of Personal, Social and Economic Life: Development and Exploratory Study of a Scale of Measure

En este trabajo se presenta un estudio exploratorio sobre las características psicométricas de un instrumento sobre el control de de la vida personal, analizando su estructura factorial mediante un análisis exploratorio y confirmatorio de sus dimensiones. El tamaño del estudio final fue de 8.504 entrevistas y el criterio básico de estratificación fue el distrito municipal en 21 estratos. Los resultados encontrados señalan que los ítems en cada una de las dimensiones y sus pesos factoriales son aceptables y se relacionan con enunciados genéricos sobre la atribución de control. A su vez, los índices de bondad de ajuste encontrados de cada uno de los modelos propuestos, arrojan información interesante sobre las posibilidades que este cuestionario ofrece.

The purpose of this study was to examine the characteristics psychometrics of a scale on the control of the personal life, analyzing its factorial structure by means of an exploratory and confirmatory analysis of its dimensions. The size of the final study was 8.504 interviews and the basic criterion was of stratification was the municipal district in 21 strata. The results indicate that the items in each of the dimensions and his weight factorials are acceptable and are related to generic terms of reference on the attribution of control. Also, the opposing indexes of goodness of fit of each one of the proposed models, throw interesting information about the possibilities that this scale offers.

Predictors of breast and cervical cancer screening in a Spanish metropolitan area.

BACKGROUND: Gynecological cancers are an important cause of morbidity and mortality. Screening with mammography and Pap smear reduces breast and cervical cancer mortality. Neverthless, high participation rates are needed to ensure their effectiveness. We sought to assess the use of mammography and Pap smear and analyzed predictors of attendance at these cancer screenings in a large metropolitan area in Spain. METHODS: We included women surveyed in the Madrid City Health Survey 2005. Cancer screening included mammography in the last 2 years and Pap smear in the last 3 years. Independent variables included sociodemographics, chronic diseases, and lifestyles. Predictors of mammography or Pap smear attendance were explored using logistic regression. RESULTS: The number of women eligible for mammography, aged >or=40 years, was 2580, and the number eligible for Pap smear, aged 18-69 years, was 3200. Overall, 60.5% and 76.6%, respectively, had received a mammography and Pap smear. Mammography uptake was positively associated with age, higher educational level, and osteomuscular disease. Obesity and unhealthy lifestyle were associated with nonattendance to mammography. Predictors of Pap smear attendance were the same as for mammography. CONCLUSIONS: Attendance at gynecological cancer screening in a large metropolitan area in Spain is acceptable in the age group for which it is recommended. An effort must be made, however, to recruit those women who are less likely to undergo screening, as they are at the highest risk of having these diseases.

Relationship between tobacco consumption and health-related quality of life in adults living in a large metropolitan area.

The aim of this study was to analyze the relationship between health-related quality of life (HRQOL) and tobacco consumption in adult individuals (over the age of 15). The study was based on individual data from the City of Madrid Health Survey (ESCM05). Subjects were divided into three groups according to tobacco consumption: smokers, nonsmokers, and ex-smokers. HRQOL was measured using the COOP/WONCA quality-of-life vignettes. A multivariate adjustment with multinomial logistic regression was made, including the following as covariables: sociodemographic characteristics, comorbidities, drug use, and lifestyles. A total of 7341 individuals were interviewed (53.7% women), with an average age of 46.7 (SD = 19.02) years. The percentage of smokers was 27%, that of ex-smokers was 16.5%, and that of nonsmokers was 56.5%. There were no significant differences between smokers, ex-smokers, and nonsmokers in the raw scores obtained as totals from the COOP/WONCA questionnaire. Multivariate analysis revealed that smokers consume more antidepressant drugs (OR = 1.54, 95% CI = 1.09-2.16) and tranquilizers (OR = 1.91, 95% CI = 1.45-2.51), drink more alcohol (OR = 2.55, 95% CI = 2.11-3.08), get less physical exercise (OR = 1.33, 95% CI = 1.11-1.60), and have a lower quality of life (OR = 1.02, 95% CI = 1.00-1.04) than nonsmokers. Following adjustment for a significant number of covariables, sociodemographic as well as health-related, smokers consume more antidepressant drugs and tranquilizers, drink more alcohol, get less physical exercise, and demonstrate a lower HRQOL than nonsmokers.

Coverage and predictors of influenza vaccination among adults living in a large metropolitan area in Spain: a comparison between the immigrant and indigenous populations.

This study sought to evaluate influenza vaccination coverage in Madrid (Spain). Coverages were estimated for vaccine target groups and special attention was placed on the immigrant population. Individual data from 7341 adults included in the Madrid City Health Survey conducted in 2005 was used. Overall influenza vaccination coverage was 24%. Compliance with age-based influenza vaccine guidelines (>or=65 years) was 63.9%, among those<65 years who had an associated chronic condition, it was 37.9% and 24.1% among HCWs. Immigrants accounted for 12.4% of the sample. Overall crude coverage was significantly lower among immigrants than among the indigenous population (11.2% vs. 25.9%), but once the multivariate analysis had been performed, the association became non-significant. In conclusion, it must be said that all the available evidence indicates an inadequate level of influenza vaccination coverage among HCWs and high-risk subjects <65 years. On the other hand, coverages among subjects aged >or=65 years are acceptable and there is no observable difference in vaccine use between immigrants and indigenous subjects. Strategies that have demonstrated their effectiveness in enhancing vaccination coverages should be applied in Madrid.