COVID-19 dynamics in Madrid (Spain): A new convolutional model to find out the missing information during the first three waves.

This article presents a novel mathematical model to describe the spread of an infectious disease in the presence of social and health events: it uses 15 compartments, 7 convolution integrals and 4 types of infected individuals, asymptomatic, mild, moderate and severe. A unique feature of this work is that the convolutions and the compartments have been selected to maximize the number of independent input parameters, leading to a 56-parameter model where only one had to evolve over time. The results show that 1) the proposed mathematical model is flexible and robust enough to describe the complex dynamic of the pandemic during the first three waves of the COVID-19 spread in the region of Madrid (Spain) and 2) the proposed model allows us to calculate the number of asymptomatic individuals and the number of persons who presented antibodies during the first waves. The study shows that the following results are compatible with the reported data: close to 28% of the infected individuals were asymptomatic during the three waves, close to 29% of asymptomatic individuals were detected during the subsequent waves and close to 26% of the Madrid population had antibodies at the end of the third wave. This calculated number of persons with antibodies is in great agreement with four direct measurements obtained from an independent sero-epidemiological research. In addition, six calculated curves (total number of confirmed cases, asymptomatic who are confirmed as positive, hospital admissions and discharges and intensive care units admissions) show good agreement with data from an epidemiological surveillance database.

Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65 / Factores psicosociales en la adherencia al tratamiento farmacológico y el control de la diabetes mellitus en pacientes mayores de 65 años

Aim: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. Design: Cross-sectional study.Setting and participantsAdults over 65 years of age with T2DM treated at the Madrid Primary Care Service. Main measurements: Data collection: Electronic Health Record database. Variables: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. Results: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15–13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86–16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04–12.02). Conclusions: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.(AU)

Objetivo: Explorar la influencia de los síntomas de ansiedad/depresión y del riesgo social en pacientes mayores de 65 años con diabetes mellitus tipo 2 (DM2), tanto en la no adherencia al tratamiento farmacológico (no AdhT) como en el mal control de la DM2.Diseño: Estudio descriptivo transversal. Emplazamiento y participantesAdultos mayores de 65 años con DM2 atendidos en el Servicio de Atención Primaria de Madrid.Principales mediciones: Recogida de datos: base de datos de historia clínica electrónica. Variables: mal control de T2DM (HBA1c) y no AdhT (prueba de Morisky-Green); principales variables clínicas: síntomas de depresión/ansiedad y riesgo social. Se utilizaron modelos globales de regresión logística multivariante y desagregados por sexo para no AdhT y mal control de DM2. Resultados: Se obtuvieron datos de 884 sujetos. Prevalencia de no AdhT: 4,4%; prevalencia de mal control de DM2: 37,2%. Los modelos de regresión logística multivariante para no AdhT en hombres mostraron un mayor riesgo si tenían síntomas de ansiedad/depresión (OR: 3,88; IC del 95%: 1,15-13,07); y en mujeres, si tenían riesgo social (OR: 5,61; IC del 95%: 1,86-16,94). Los modelos de regresión logística multivariante para el control deficiente de la DM2 en los hombres revelaron un mayor riesgo si no tenían AdhT (OR: 3,53; IC del 95%: 1,04-12,02). Conclusiones: En personas mayores de 65 años con DM2, aunque la no AdhT es baja, la prevalencia de mal control de la DM2 es alta. Los síntomas de depresión o ansiedad son un factor de riesgo de no AdhT en los hombres, mientras que el riesgo social tiene el mismo efecto en las mujeres. La no AdhT en los hombres aumenta el riesgo de un control deficiente de la DM2. Desde una perspectiva de género, es importante detectar problemas de salud social y mental en adultos mayores con diabetes y reforzar estrategias para mejorar su adherencia al tratamiento farmacológico y control glucémico en estos pacientes.(AU)

Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65.

AIM: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Adults over 65 years of age with T2DM treated at the Madrid Primary Care Service. MAIN MEASUREMENTS: Data collection: Electronic Health Record database. VARIABLES: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. RESULTS: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15-13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86-16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04-12.02). CONCLUSIONS: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.

Validación de la versión corta del Woman Abuse Screening Tool (WAST) en población general / Validation of the short version of the Woman Abuse Screening Tool (WAST) in the general population

OBJETIVO: Realizar una validación concurrente de la versión corta del Woman Abuse Screening Tool (WAST), un instrumento utilizado en la detección de violencia de pareja hacia la mujer, estimando los índices de validez en población general. MÉTODO: La fuente de información fue la tercera Encuesta de violencia de pareja hacia la mujer de la Comunidad de Madrid de 2014, realizada a mujeres de 18 a 70 años. Como referencia se utilizó la definición de violencia de pareja hacia la mujer basada en un cuestionario de 26 preguntas. La versión corta del WAST incluye dos preguntas con tres respuestas posibles. Se calculan y comparan la prevalencia de violencia de pareja hacia la mujer y los índices de validez del cuestionario según dos criterios de puntuación con intervalos de confianza del 95% (IC95%). RESULTADOS: La tasa de respuesta fue del 60%. Se analizaron 2979 encuestas. La prevalencia de violencia de pareja hacia la mujer fue del 7,6% (IC95%: 6,6-8,5%). Se encontró un 21,1% (IC95%: 19,6-22,5) de test positivos según el criterio 1 y un 11,0% (IC95%: 9,9-12,1) según el criterio 2. El criterio 2 presentó una mayor eficiencia global del test (81,5% [IC95%: 80,1-82,9] para el criterio 1 vs. 88,8% [IC95%:87,7-89,9] para el criterio 2). Los mejores índices se obtuvieron en mujeres a partir de 30 años de edad. CONCLUSIONES: La versión reducida del cuestionario WAST presentó índices de validez aceptables para ser utilizados como cuestionario de cribado de violencia de pareja hacia la mujer. Recomendamos utilizar el criterio 2 de puntuación en la estimación de la prevalencia de violencia de pareja hacia la mujer en encuestas dirigidas a población general

OBJECTIVE: To perform a concurrent validation of the short version of the Woman Abuse Screening Tool (WAST), used to detect intimate partner violence, estimating the validity indexes in the general population. METHOD: The information source was the third Intimate partner violence survey in the Region of Madrid (Spain) conducted on women aged 18-70 in 2014. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The short version of WAST includes two questions with three possible answers. The prevalence of intimate partner violence and the validity indexes were calculated and compared according to two scoring criteria with 95% confidence intervals (95%CI). RESULTS: The response rate was 60.0%, and 2979 surveys were analysed. The prevalence of intimate partner violence was 7.6% (95%CI: 6.6-8.5). We showed 21.1% (95%CI: 19.6-22.5) positive test results according to WAST criterion 1 and 11.0% (95%CI: 9.9-12.1) according to criterion 2. Criterion 2 presented higher overall efficiency of the test (81.5% [95%CI: 80.1-82.9] criterion 1 vs. 88.8% [95%CI: 87.7-89.9] criterion 2). The best indexes were obtained in women ≥30 years old. CONCLUSIONS: The short version of the WAST showed acceptable validity indexes for use as a screening tool of intimate partner violence in the general population. We recommend using scoring criterion 2 to estimate prevalence of intimate partner violence in surveys on the general population

Efecto producido por la población institucionalizada en la estimación del riesgo de mortalidad en áreas pequeñas de Euskadi (España) / Effect of the population in collective dwellings on small-area mortality risk estimation in the Basque Country region (Spain)

OBJETIVO: Cuantificar el efecto que tiene la inclusión de la población institucionalizada en la estimación del riesgo de mortalidad en las secciones censales de Euskadi (España) para las principales causas de mortalidad en el periodo 1996-2003. MÉTODO: Estudio ecológico transversal por áreas pequeñas. Se analizaron las principales causas de mortalidad y por sexo. RESULTADOS: Al analizar el efecto general que tiene en todas las secciones con población institucionalizada se ha visto que no hay apenas ningún efecto reseñable en hombres ni en mujeres. En cambio, cuando se han seleccionado las áreas geográficas donde la población institucionalizada supone un porcentaje importante, más del 10% de la población de esa área, sí se ha observado un efecto incrementando la estimación del riesgo de mortalidad. CONCLUSIONES: El efecto que tiene la inclusión de la población institucionalizada se ve claramente en aquellas causas de mortalidad relacionadas con una mayor dependencia o fragilidad, y por lo tanto con estar en una residencia de personas mayores, como son las demencias y la enfermedad de Alzheimer, y la enfermedad pulmonar obstructiva crónica, sobrestimando el riesgo de mortalidad en torno a un 8% y un 4%, respectivamente, en esas áreas

OBJECTIVE: To quantify the effect of the inclusion of the population in collective dwellings on the estimation of mortality risk in the census areas of the Basque Country (Spain) for the main causes of mortality in the period 1996-2003. METHOD: Small-area ecological cross-sectional study. The main causes of mortality by sex were analyzed. RESULTS: When the general effect on all areas with a a population in collective dwellings was analyzed, hardly any noticeable effect was seen on either men or women. On the other hand, an effect was found when selecting the areas where the population in collective dwellings is more than 10% of the area's population. CONCLUSIONS: The effect of the inclusion of the population in collective dwellings clearly seen in causes of mortality, such as dementia and Alzheimer's disease, and in chronic obstructive pulmonary disease, related to greater dependence or frailty, and therefore related to being in a nursing or elderly persons' home, over-estimating the risk of mortality by approximately 8% and 4%, respectively, in these geographical areas

[Effect of the population in collective dwellings on small-area mortality risk estimation in the Basque Country region (Spain)]. / Efecto producido por la población institucionalizada en la estimación del riesgo de mortalidad en áreas pequeñas de Euskadi (España).

OBJECTIVE: To quantify the effect of the inclusion of the population in collective dwellings on the estimation of mortality risk in the census areas of the Basque Country (Spain) for the main causes of mortality in the period 1996-2003. METHOD: Small-area ecological cross-sectional study. The main causes of mortality by sex were analyzed. RESULTS: When the general effect on all areas with a a population in collective dwellings was analyzed, hardly any noticeable effect was seen on either men or women. On the other hand, an effect was found when selecting the areas where the population in collective dwellings is more than 10% of the area's population. CONCLUSIONS: The effect of the inclusion of the population in collective dwellings clearly seen in causes of mortality, such as dementia and Alzheimer's disease, and in chronic obstructive pulmonary disease, related to greater dependence or frailty, and therefore related to being in a nursing or elderly persons' home, over-estimating the risk of mortality by approximately 8% and 4%, respectively, in these geographical areas.

[Validation of the short version of the Woman Abuse Screening Tool (WAST) in the general population]. / Validación de la versión corta del Woman Abuse Screening Tool (WAST) en población general.

OBJECTIVE: To perform a concurrent validation of the short version of the Woman Abuse Screening Tool (WAST), used to detect intimate partner violence, estimating the validity indexes in the general population. METHOD: The information source was the third Intimate partner violence survey in the Region of Madrid (Spain) conducted on women aged 18-70 in 2014. As the gold standard we used the definition of intimate partner violence based on a 26- question survey. The short version of WAST includes two questions with three possible answers. The prevalence of intimate partner violence and the validity indexes were calculated and compared according to two scoring criteria with 95% confidence intervals (95%CI). RESULTS: The response rate was 60.0%, and 2979 surveys were analysed. The prevalence of intimate partner violence was 7.6% (95%CI: 6.6-8.5). We showed 21.1% (95%CI: 19.6-22.5) positive test results according to WAST criterion 1 and 11.0% (95%CI: 9.9-12.1) according to criterion 2. Criterion 2 presented higher overall efficiency of the test (81.5% [95%CI: 80.1-82.9] criterion 1 vs. 88.8% [95%CI: 87.7-89.9] criterion 2). The best indexes were obtained in women ≥30 years old. CONCLUSIONS: The short version of the WAST showed acceptable validity indexes for use as a screening tool of intimate partner violence in the general population. We recommend using scoring criterion 2 to estimate prevalence of intimate partner violence in surveys on the general population.

[Evolution of Asthma Prevalence and Sociodemographic and Health Factors Associated in Madrid Region (1996-2013)]. / Evolución de la prevalencia de asma y factores sociodemográficos y de salud asociados en población de 18 a 64 años de la Comunidad de Madrid (1996-2013).

OBJECTIVE: Asthma is an important public health issue. The goal of this study is to analyse the trends in self-reported asthma prevalence in the Madrid Region and its association with socio-demographic and health factors. METHODS: Data from the "Non-Communicable Disease Risk Factor Surveillance System" in adult population (SIVFRENT-A) 1996-2013 were used. Prevalences and 95% CI were estimated for: current asthma, cumulative prevalence of asthma and asthma attack in the last 12 months, in five periods. Changes in inter-period prevalence were estimated by calculating prevalence ratios (PR) with 95% CI by Poisson regression. The association between asthma prevalence socio-demographic and health variables was evaluated by multivariate logistic regression. RESULTS: Current prevalence of asthma and cumulative prevalence of asthma increased per study period an average of 14%. Asthma attack prevalence in the last 12 months increased an average of 19%. It was associated (statistically significant) to an increase of current prevalence of asthma, cumulative prevalence of asthma and asthma attack prevalence in the last 12 months: being a woman, ORa: 1.55; ORa: 1.35 and ORa: 1.46 respectively; have poor self-perceived health, ORa: 3.09; ORa: 2.63 and ORa: 2.89; and intense physical activity, ORa: 1.48; ORa: 1.32 and ORa: 1.49. In the case of current prevalence of asthma and cumulative prevalence of asthma also be studying, ORa: 1.34 and ORa: 1.46 respectively. CONCLUSIONS: Self-reported asthma prevalence increased in the last decades. The prevalence was higher in woman, persons with poor self-perceived health and adults with intense physical activity.

OBJETIVO: El asma representa un importante problema de salud pública. El objetivo de este estudio fue analizar la evolución de la prevalencia de asma autopercibido en la Comunidad de Madrid y su asociación con factores sociodemográficos y de salud. METODOS: Se incluyó a la población de 18 a 64 años de la Comunidad de Madrid. La fuente de información fue el Sistema de Vigilancia de Factores de Riesgo de Enfermedades No transmisibles (SIVFRENT-A). El período de estudio fue de 1996 a 2013 dividido en cinco etapas. Se estimaron las prevalencias y sus intervalos de confianza al 95% (IC95%) para prevalencia de asma actual, prevalencia acumulada de asma y crisis asmática en los últimos 12 meses en cinco períodos. Los cambios en la prevalencia interperiodo se estimaron calculando razones de prevalencia (RP) y su IC95% mediante regresión de Poisson. Mediante regresión logística multivariante se evaluó la asociación entre la prevalencia de asma y las variables sociodemográficas y las de salud. RESULTADOS: La prevalencia actual y la acumulada de asma aumentaron de media por periodo de estudio un 14%. La prevalencia de crisis asmática en los últimos 12 meses aumentó un 19%. Se asociaron de forma estadísticamente significativa a mayor prevalencia de asma actual, mayor prevalencia acumulada de asma y mayor prevalencia de crisis asmática en los últimos 12 meses ser mujer (prevalencia actual: ORa: 1,55; ORa: 1,35 y ORa: 1,46 respectivamente), tener mala salud autopercibida (ORa: 3,09; ORa: 2,63 y ORa: 2,89 respectivamente) y realizar actividad física intensa (ORa: 1,48; ORa: 1,32 y ORa: 1,49 respectivamente) y ser estudiante se asoció con mayor prevalencia de asma actual y prevalencia acumulada de asma (ORa: 1,34; ORa: 1,46 respectivamente). CONCLUSIONES: La prevalencia de asma autopercibida es mayor en las últimas décadas. Ser mujer, tener una mala salud autopercibida y realizar actividad física intensa se asocian a una mayor prevalencia.

Evolución de la prevalencia de asma y factores sociodemográficos y de salud asociados en población de 18 a 64 años de la Comunidad de Madrid (1996-2013) / Evolution of asthma prevalence and sociodemographic and heatlh factors associated in Madrid Region (1996-2013)

Fundamentos: El asma representa un importante problema de salud pública. El objetivo de este estudio fue analizar la evolución de la prevalencia de asma autopercibido en la Comunidad de Madrid y su asociación con factores sociodemográficos y de salud. Métodos: Se incluyó a la población de 18 a 64 años de la Comunidad de Madrid. La fuente de información fue el Sistema de Vigilancia de Factores de Riesgo de Enfermedades No transmisibles (SIVFRENT-A). El período de estudio fue de 1996 a 2013 dividido en cinco etapas. Se estimaron las prevalencias y sus intervalos de confianza al 95% (IC95%) para prevalencia de asma actual, prevalencia acumulada de asma y crisis asmática en los últimos 12 meses en cinco períodos. Los cambios en la prevalencia interperiodo se estimaron calculando razones de prevalencia (RP) y su IC95% mediante regresión de Poisson. Mediante regresión logística multivariante se evaluó la asociación entre la prevalencia de asma y las variables sociodemográficas y las de salud. Resultados: La prevalencia actual y la acumulada de asma aumentaron de media por periodo de estudio un 14%. La prevalencia de crisis asmática en los últimos 12 meses aumentó un 19%. Se asociaron de forma estadísticamente significativa a mayor prevalencia de asma actual, mayor prevalencia acumulada de asma y mayor prevalencia de crisis asmática en los últimos 12 meses ser mujer (ORa: 1,55; ORa: 1,35 y ORa: 1,46 respectivamente), tener mala salud autopercibida (ORa: 3,09; ORa: 2,63 y ORa: 2,89 respectivamente) y realizar actividad física intensa (ORa: 1,48; ORa: 1,32 y ORa: 1,49 respectivamente) y ser estudiante se asoció con mayor prevalencia de asma actual y prevalencia acumulada de asma (ORa: 1,34; ORa: 1,46 respectivamente). Conclusión: La prevalencia de asma autopercibida es mayor en las últimas décadas. Ser mujer, tener una mala salud autopercibida y realizar actividad física intensa se asocian a una mayor prevalencia (AU)

Background: Asthma is an important public health issue. The goal of this study was to analyse the trends in self-reported asthma prevalence in the Madrid Region and its association with socio-demographic and health factors. Methods: Data from the “Non-Communicable Disease Risk Factor Surveillance System” in adult population [SIVFRENT-A] 1996-2013 were used. Prevalences and 95% CI were estimated for: current asthma, cumulative prevalence of asthma and asthma attack in the last 12 months, in five periods. Changes in inter-period prevalence were estimated by calculating prevalence ratios [PR] with 95% CI by Poisson regression. The association between asthma prevalence socio-demographic and health variables was evaluated by multivariate logistic regression. Results: Current prevalence of asthma and cumulative prevalence of asthma increased per study period an average of 14%. Asthma attack prevalence in the last 12 months increased an average of 19%. It was associated [statistically significant] to an increase of current prevalence of asthma, cumulative prevalence of asthma and asthma attack prevalence in the last 12 months: being a woman [ORa: 1.55; ORa: 1.35 and ORa: 1.46 respectively]; have poor self-perceived health, [ORa: 3.09; ORa: 2.63 and ORa: 2.89]; and intense physical activity [ORa: 1.48; ORa: 1.32 and ORa: 1.49]. In the case of current prevalence of asthma and cumulative prevalence of asthma also be studying [ORa: 1.34 and ORa: 1.46 respectively]. Conclusion: Self-reported asthma prevalence increased in the last decades. The prevalence was higher in woman, persons with poor self-perceived health and adults with intense physical activity (AU)

[Nursing Workforce Characteristics and Control of Diabetes Mellitus in Primary Care: a Multilevel Analysis]. / Control de la diabetes mellitus en población adulta según las características del personal de enfermería de atención primaria de la comunidad de Madrid: análisis multinivel.

OBJECTIVE: Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults. METHODS: Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models. PRIMARY OUTCOME MEASURE: Poor DM control (figures equal or higher than 7% HbA1c). RESULTS: The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]). CONCLUSIONS: Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM control.

OBJETIVO: La actividad de enfermería está condicionada por las características de la plantilla. El objetivo fue determinar cómo afectan las características de la plantilla de enfermería de atención primaria (AP) al control de la diabetes mellitus (DM) en personas adultas. METODOS: Estudio analítico transversal. Instrumentos para la recogida de datos: sistemas de información de AP y cuestionario PES-Nursing Work Index. Participantes: 44.214 pacientes diabéticos en dos zonas de salud de la Comunidad de Madrid: Zona Noroeste (ZNO) con mejor situación socioeconómica y Zona Suroeste (ZSO) con peor situación socioeconómica y los 507 profesionales de enfermería de referencia. Se realizaron análisis multivariantes multinivel de regresión logística. La variable dependiente fue la DM estaba mal controlada (cuando los valores de Hb1Ac eran igual o mayor que 7%). RESULTADOS: La prevalencia DM mal controlada fue de 40,1% (IC95%:38,2-42,1). Existía un riesgo de un 25% más de peor control si el paciente cambiaba de centro de salud y de un 27% si cambiaba de pareja médico de cabaecera y enfermera. En los modelos de regresión logística multivariante multinivel: para la ZSO a mayor ratio de pacientes mayores de 65 años aumentaba el riesgo de mal control (OR=1,00008 [IC95%:1,00006-1,001]); a mayor proporción de pacientes sin seguimiento por centro de salud peor control (OR=5,1 [IC95%:1,6-15,6]). En los dos modelos por zona de salud, la condición de ser inmigrante económico aumentó el riesgo de mal control, ZSO (OR=1,3 [IC95%:1,03-1,7]); y ZNO (OR=1,29 [IC95%:1,03-1,6]). CONCLUSIONES: Son factores de riesgo de tener mal controlada la diabetes mellitus la mayor proporción de pacientes mayores de 65 años por enfermera, ser inmigrante y la proporción de pacientes sin seguimiento.

Control de las diabetes mellitus en población adulta según las características del personal de enfermería de atención primaria de la Comunidad de Madrid: análisis multinivel / Nursing workforce characteristics and control of diabetes mellitus in primary care: a multilevel analysis. Spain

Fundamentos: La actividad de enfermería está condicionada por las características de la plantilla. El objetivo fue determinar cómo afectan las características de la plantilla de enfermería de atención primaria (AP) al control de la diabetes mellitus (DM) en personas adultas. Método: Estudio analítico transversal. Instrumentos para la recogida de datos: sistemas de información de AP y cuestionario PES-Nursing Work Index. Participantes: 44.214 pacientes diabéticos en dos zonas de salud de la Comunidad de Madrid: Zona Noroeste (ZNO) con mejor situación socioeconómica y Zona Suroeste (ZSO) con peor situación socioeconómica y los 507 profesionales de enfermería de referencia. Se realizaron análisis multivariantes multinivel de regresión logística. La variable dependiente fue la DM estaba mal controlada (cuando los valores de Hb1Ac eran ≥ a 7%) Resultados: La prevalencia DM mal controlada fue de 40,1% (IC95%:38,2-42,1). Existía un riesgo de un 25% más de peor control si el paciente cambiaba de centro de salud y de un 27% si cambiaba de pareja médico de cabaecera y enfermera. En los modelos de regresión logística multivariante multinivel: para la ZSO a mayor ratio de pacientes mayores de 65 años aumentaba el riesgo de mal control (OR=1,00008 [IC95%:1,00006-1,001]); a mayor proporción de pacientes sin seguimiento por centro de salud peor control (OR=5,1 [IC95%:1,6-15,6]). En los dos modelos por zona de salud, la condición de ser inmigrante económico aumentó el riesgo de mal control, ZSO (OR=1,3 [IC95%:1,03-1,7]); y ZNO (OR=1,29 [IC95%:1,03-1,6]). Conclusiones: Son factores de riesgo de tener mal controlada la diabetes mellitus la mayor proporción de pacientes mayores de 65 años por enfermera, ser inmigrante y la proporción de pacientes sin seguimiento (AU)

Background: Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults. Method: Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models. Primary outcome measure: Poor DM control (figures ≥ 7% HbA1c) Results: The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]). Conclusions: Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM control (AU)

[Young people dating violence surveillance in Madrid, Spain]. / Violencia de pareja en jóvenes de 15 a 16 años de la Comunidad de Madrid.

BACKGROUND: Dating violence in young adults is an important public health issue because of its magnitude and impact on health. The goal of this study is to determine the prevalence 12 months before the survey by sex and its association with socio-demographic and health risk behavior. METHODS: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System in young people (Spanish acronym, SIVFRENT-J), on a representative sample of students of the fourth-year of secondary education (15 to 16 years) in Madrid Region. The students were asked whether they had ever suffered any physical violence (PV) and/or sexual violence (SV) dating episodes. Prevalence with 95% confidence intervals (CI95%) of the occurrence of such episodes were estimated; generalized linear models with binomial family and logarithmic link were used to estimate the association between physical and/or sexual violence (PSV) and health risk behavior through prevalence ratios (PR, CI95%). RESULTS: In 1713 dating girls and 1664 dating boys, the prevalence of PV was 2.9% (CI95%:2.0-3.9) and 4.0% (CI95%:2.9-5.0) (p>0.05), SV 5.3% (CI95%:4.1-6.5) and 2.4% (CI95%:1.6-3.2) (p< 0.001) and PSV 7.1% (CI95%:5.6-8.6) and 5.1% (CI95%:4.0-6.3) (p<0.05) in that order. In the girls explanatory model, PSV was associated with eating disorders PR:1.74 (CI95%:1.14-2.66), sexual risk behavior (SRB), PR:1.67 (CI95%:1.11-2.50), excessive alcohol consumption, PR:1.57 (CI95%:1.06-2.34) and worse perceived health, PR:1.67 (CI95%:1.08-2.57). In boys, PSV was associated with having been born in a country other than Spain, PR:2.05 (CI95%:1.32-3.18), eating disorders, PR:2.79 (CI95%:1.58-4.92), SRB, PR:2.22 (CI95%:1.34-3.66) and drug consumption, PR:2.14 (CI95%:1.39-3.28). CONCLUSION: VFS was higher in girls and was associated to others health risk factors with similar characteristics according to sex.

Violencia de pareja en jóvenes de 15 a 16 años de la Comunidad de Madrid / Young people dating violence surveillance in Madrid, Spain

Fundamentos: La violencia de pareja en jóvenes es un importante problema de salud pública por su magnitud y repercusiones. El objetivo fue estimar su prevalencia según sexo y su asociación con factores sociodemográficos y conductas de riesgo para la salud. Métodos: Se utilizó el Sistema de Vigilancia de Factores de Riesgo de Enfermedades No Transmisibles en población juvenil (SIVFRENT-J) 2011-2012 en una muestra representativa de estudiantes de 4º curso de la Enseñanza Secundaria Obligatoria (15 a 16 años) de la Comunidad deMadrid. Se preguntó por violencia física (VF) y violencia sexual (VS). Se calculó la prevalencia con intervalos de confianza al 95%(IC95%). La asociación entre violencia física y/o sexual (VFS) y conductas de riesgo para la salud se analizó con la razón de prevalencia (RP IC95%) mediante modelos lineales generalizados con vínculo logarítmico y familia binomial. Resultados: En 1.713 chicas y 1.664 chicos con pareja la prevalencia de VF fue respectivamente del 2,9% (IC95%:2,0-3,9) y del 4,0% (IC95%:2,9- 5,0) (p>0,05), la de VS fue del 5,3% (IC95%:4,1-6,5) y 2,4% (IC95%:1,6- 3,2) (p<0,001) y la de VFS 7,1% (IC95%:5,6-8,6) y 5,1%(IC95%:4,0-6,3) (p<0,05). En chicas, en los modelos explicativos, la VFS se asoció con desorden alimentario: RP:1,74 (IC95%:1,14-2,66), conducta sexual de riesgo (CSR): RP:1,67 (IC95%:1,11-2,50), consumo excesivo de alcohol, RP:1,57 (IC95%:1,06-2,34) y mala salud percibida, RP:1,67 (IC95%:1,08-2,57). En chicos, la VFS se asoció con ser extranjero: RP:2,05 (IC95%:1,32-3,18), desorden alimentario: RP:2,79 (IC95%:1,58-4,92), CSR: RP:2,22 (IC95%:1,34- 3,66) y consumo de drogas: RP:2,14 (IC95%:1,39-3,28). Conclusiones: La VFS predomina en chicas y se asocia a diferentesconductas de riesgo según el sexo (AU)

Background: Dating violence in young adults is an important public health issue because of itsmagnitude and impact on health. The goal of this study is to determine the prevalence 12 months before the survey by sex and its association with socio-demographic and health risk behavior. Methods: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance Systemin young people (Spanish acronym, SIVFRENT- J), on a representative sample of students of the fourth-year of secondary education (15 to 16 years) inMadrid Region. The students were asked whether they had ever suffered any physical violence (PV) and/or sexual violence (SV) dating episodes. Prevalence with 95% confidence intervals (CI95%) of the occurrence of such episodes were estimated; generalized linear models with binomial family and logarithmic link were used to estimate the association between physical and/or sexual violence (PSV) and health risk behavior through prevalence ratios (PR, CI95%). Results: In 1713 dating girls and 1664 dating boys, the prevalence of PV was 2.9% (CI95%:2.0-3.9) and 4.0% (CI95%:2.9-5.0) (p>0.05), SV 5.3% (CI95%:4.1-6.5) and 2.4% (CI95%:1.6-3.2) (p< 0.001) and PSV 7.1% (CI95%:5.6-8.6) and 5.1% (CI95%:4.0-6.3) (p<0.05) in that order. In the girls explanatory model, PSV was associated with eating disorders PR:1.74 (CI95%:1.14-2.66), sexual risk behavior (SRB), PR:1.67 (CI95%:1.11-2.50), excessive alcohol consumption, PR:1.57 (CI95%:1.06-2.34) and worse perceived health, PR:1.67 (CI95%:1.08-2.57). In boys, PSV was associated with having been born in a country other than Spain, PR:2.05 (CI95%:1.32-3.18), eating disorders, PR:2.79 (CI95%:1.58-4.92), SRB, PR:2.22 (CI95%:1.34- 3.66) and drug consumption, PR:2.14 (CI95%:1.39-3.28). Conclusion: VFS was higher in girls and was associated to others health risk factors with similar characteristics according to sex (AU)

Ingesta de alimentos, energía y nutrientes en la población de 5 a 12 años de la Comunidad de Madrid: resultados de la encuesta de nutrición infantil 2001-2002 / Food, energy and nutrient intake in children aged 5-12 in the autonomous community of Madrid, Spain: results of the 2001/2002 children’s nutrition survey

Fundamento: Para conocer la situación alimentaria y nutricionalen la población infantil, sobre la que no existía información actualizada,el Instituto de Salud Pública desarrolló la Encuesta de NutriciónInfantil de la Comunidad de Madrid 2001/2002 (ENICM). En estetrabajo se analiza la ENICM para describir y evaluar la ingesta de alimentos,energía y nutrientes en esta población.Métodos: Estudio transversal sobre una muestra representativa dela población de 5-12 años de la Comunidad de Madrid. La informaciónalimentaria se recogió en 2001 y 2002 mediante dos recuerdos de24 horas. Se ha estudiado la ingesta total diaria de alimentos, energíay nutrientes. Los análisis incluyen los 1.852 niños con informacióncompleta en los dos recuerdos (90,8% de las entrevistas realizadas).Resultados: La ingesta media total diaria de alimentos es1.460,7 gramos/persona/día. Salvo para los lácteos, huevos y aceites,la ingesta en los grupos alimentarios básicos es inadecuada, particularmentebaja en las frutas frescas, verduras y hortalizas. La ingestamedia energética y nutricional resultante es 1.905,9 kcal/persona/día;43,6% hidratos de carbono; 17,4% proteínas, 39,0% lípidos (13,3%grasas saturadas, 16,8% monoinsaturadas, 5,0% poliinsaturadas);363,8 mg de colesterol; 13,6 g de fibra e ingestas por debajo de lasrecomendadas de zinc, ácido fólico, vitaminas D y E (ambos sexos) yhierro y vitamina B6 (niñas).Conclusiones: La dieta de la población infantil de la Comunidadde Madrid presenta desequilibrios que es necesario mejorar: ingestainadecuada de alimentos básicos, exceso de proteínas, grasas saturadasy colesterol y déficit de hidratos de carbono, fibra y algunosmicronutrientes(AU)

Backgound: In order to ascertain the food intake and nutritionalsituation of the children of the Community of Madrid, on which noupdated information was available, the Institute of Public Healthconducted the 2001/2001 Children’s Nutrition Survey of theCommunity of Madrid (CNSCM). This study offers an analysis of theCNSCM that describes and evaluates the food, energy and nutrientintake of this segment of the population.Methods: Cross-sectional survey on a representative sample ofchildren aged 5-12 years from the Community of Madrid. Dietrelatedinformation was collected in 2001 and 2002 by means of two24-hour recalls. Total daily food, energy and nutrient intake werestudied. The analysis included only the 1852 children who hadcompleted both 24-h recalls (90.8% of all interviews).Results: The average daily food intake is 1460.7grams/person/day. Except for dairy products, eggs and oils, intakefrom the basic food groups is inadequate, and is particularly low forfresh fruits, green leafy vegetables and garden vegetables in general.The resulting average energy and nutrition intake is 1905.9kcal/person/day; 43.6% carbohydrates, 17.4% proteins, 39.0% fats(13.3% saturated fats, 16.8% monosaturated fats, 5.0%polyunsaturated fats); 363.8 mg cholesterol, 13.6 g of fiber and lowerthan recommended intakes of zinc, folic acid, vitamins D and E (bothsexes) and iron and vitamin B6 (girls).Conclusions: The diet of the children of the Community ofMadrid shows a number of imbalances that should be improved:inadequate intake from basic food groups; excess of proteins,saturated fats and cholesterol; and a deficit of carbohydrates, fiberand certain micronutrients(AU)

[Food, energy and nutrient intake in children aged 5-12 in the autonomous community of Madrid, Spain: results of the 2001/2002 Children's Nutrition Survey]. / Ingesta de alimentos, energía y nutrientes en la poblacion de 5 a 12 años de la comunidad de Madrid: resultados de la encuesta de nutricion infantil 2001-2002.

BACKGROUND: [corrected] In order to ascertain the food intake and nutritional situation of the children of the Community of Madrid, on which no updated information was available, the Institute of Public Health conducted the 2001/2001 Children's Nutrition Survey of the Community of Madrid (CNSCM). This study offers an analysis of the CNSCM that describes and evaluates the food, energy and nutrient intake of this segment of the population. METHODS: Cross-sectional survey on a representative sample of children aged 5-12 years from the Community of Madrid. Diet-related information was collected in 2001 and 2002 by means of two 24-hour recalls. Total daily food, energy and nutrient intake were studied. The analysis included only the 1852 children who had completed both 24-h recalls (90.8% of all interviews). RESULTS: The average daily food intake is 1460.7 grams/person/day. Except for dairy products, eggs and oils, intake from the basic food groups is inadequate, and is particularly low for fresh fruits, green leafy vegetables and garden vegetables in general. The resulting average energy and nutrition intake is 1905.9 kcal/person/day; 43.6% carbohydrates, 17.4% proteins, 39.0% fats (13.3% saturated fats, 16.8% monosaturated fats, 5.0% polyunsaturated fats); 363.8 mg cholegterol, 13.6 g of fiber and lower than recommended intakes of zinc, folic acid, vitamins D and E (both sexes) and iron and vitamin B6 (girls). CONCLUSIONS: The diet of the children of the Community of Madrid shows a number of imbalances that should be improved: inadequate intake from basic food groups; excess of proteins, saturated fats and cholesterol; and a deficit of carbohydrates, fiber and certain micronutrients.

Smoking attributable mortality in the community of Madrid: 1992-1998.

BACKGROUND: The proportion of smokers and the number of cigarettes consumed per person-year in Madrid is above the European average. To evaluate the impact of smoking in public health smoking attributable mortality was estimated for 1998 and for changes since 1992. METHODS: The number of smoking attributable deaths and years of potential life lost attributable to cigarette smoking for 1992 and 1998 by gender and age group were estimated, based on the population attributable fraction. The relative risks of the Cancer Prevention Study II were used. To compare the two periods of study, a Poisson regression analysis adjusted by age was applied. RESULTS: In 1998, 15.9% of total mortality in the population older than 34 years was attributable to smoking. Lung cancer and chronic obstructive pulmonary disease are the main causes of death in both genders. In the period studied, 1992-1998, the adjusted rates diminished in men in both age groups, while in women they increased in the age group 35 to 64 years. The mortality from lung cancer remained stable in men, increasing in women by 12%. The years of potential life lost decreased by 14% in men and increased by 42% in women. CONCLUSIONS: One in four deaths in men and one in 36 deaths in women are attributed to cigarette smoking. The smoking attributable mortality in males has tended to stabilize, while in women premature mortality is increasing. KEY POINTS: Smoking attributable mortality was estimated for 1998 and for changes since 1992 to evaluate the impact of smoking in the population older than 34 years. MAIN RESULTS: In the period studied, 1992-1998, the adjusted mortality rates attributable to smoking diminished in men, while in women they increased in the age group 35 to 64 years. The main causes of Smoking attributable mortality are Lung cancer and chronic obstructive pulmonary disease in both genders. The mortality from lung cancer remained stable in men, increasing in women by 12%. IMPLICATIONS FOR PUBLIC HEALTH: In the Community of Madrid, health promotion programmes to reduce cigarette smoking need to be intensified, specially in women.