Importancia de la investigación epidemiológica de un brote de Salmonella en un entorno escolar / Importance of the epidemiological investigation of a Salmonella outbreak in a school setting

Introducción: se describe un brote de gastroenteritis por Salmonella en un centro de educación infantil y un colegio público vecino en una localidad del sur de la Comunidad de Madrid (España) entre octubre y noviembre de 2019. Objetivos: describir las características epidemiológicas de un brote de salmonelosis, analizar el mecanismo de transmisión, reforzar la importancia de la declaración sanitaria. Material y métodos: estudio descriptivo bidireccional de casos de salmonelosis notificados por diversas fuentes relacionados con un colectivo escolar. Análisis de variables de los ingresados. Investigación epidemiológica y caracterización microbiológica. Resultados: se registraron 38 casos (entre 7 meses y 8 años; media: 2,7 años). Pertenecían a dos centros educativos: el 57,9% eran alumnos de una escuela infantil; el resto, del colegio vecino, acudían a ella para comer o como ludoteca. Ingresaron 12 (3 hospitales). No hubo complicaciones graves. En el Centro Nacional de Microbiología se identificó en coprocultivos Salmonella entérica, typhimurium monofásica 4,5,12:i:-. En la inspección se evidenció que el origen no era alimentario y, en cambio, que sí existía riesgo de transmisión fecal-oral de persona a persona y por contaminación de superficies; no había separación física óptima entre zonas. Se hicieron propuestas de mejora. No se registraron casos posteriormente. Conclusiones: el brote fue de origen no alimentario; su análisis permitió tomar medidas para evitar casos secundarios posteriormente. Se considera de gran importancia la notificación de casos para tomar medidas de salud pública adecuadas (AU)

Introduction: we describe an outbreak of Salmonella gastroenteritis in an early childhood education centre and a neighbouring public school in a town in the south of the Community of Madrid (Spain) in October and November 2019. Objectives: to describe the epidemiological characteristics of an outbreak of salmonellosis, analyse the mechanism of transmission and underscore the importance of health reporting.Methods: retrospective and prospective descriptive study of salmonellosis cases reported by different sources related to a school community. Analysis of variables in hospitalised patients. Epidemiological investigation and microbiological characterization.Results: there were 38 reported cases (age range, 7 months-8 years; mean, 2.7 years). They were enrolled in 2 educational centres: 57.9% attended a nursery school and the rest were students of a neighbouring school who came to the nursery for lunch or recreation activities. Twelve were hospitalised (3 hospitals). There were no serious complications. The National Microbiology Centre identified Salmonella Typhimurium 4,5,12:i:-, a monophasic variant of S. enterica, in stool cultures. The inspection showed that food was not the source of transmission, but that there was a risk of faecal-oral was not alimentary; on the other hand, there was a risk of transmission through the faecal-oral route and fomites; the physical separation between different areas was suboptimal. Proposals for improvement were made. No more cases were reported thereafter.Conclusions: the outbreak was not related to food, and its analysis allowed the implementation of measures to avoid secondary cases later on. Case reporting is considered of utmost importance to take appropriate public health measures. (AU)

Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022.

Up to 22 June 2022, 508 confirmed cases of monkeypox (MPX) have been reported in the Madrid region of Spain, 99% are men (n = 503) with a median age of 35 years (range: 18-67). In this ongoing outbreak, 427 cases (84.1%) reported condomless sex or sex with multiple partners within the 21 days before onset of symptoms, who were predominantly men who have sex with men (MSM) (n = 397; 93%). Both the location of the rash, mainly in the anogenital and perineal area, as well as the presence of inguinal lymphadenopathy suggest that close physical contact during sexual activity played a key role in transmission. Several cases reported being at a sauna in the city of Madrid (n = 34) or a mass event held on the Spanish island of Gran Canaria (n = 27), activities which may represent a conducive environment for MPX virus spread, with many private parties also playing an important role. Because of the rapid implementation of MPX surveillance in Madrid, one of the largest outbreaks reported outside Africa was identified. To minimise transmission, we continue to actively work with LGBTIQ+ groups and associations, with the aim of raising awareness among people at risk and encouraging them to adopt preventive measures.

[Tuberculosis trend in Madrid region in native and foreign population (2009-2018).] / Tendencia de la tuberculosis en la Comunidad de Madrid en población autóctona y extranjera (2009-2018).

OBJECTIVE: Tuberculosis is a major public health problem and most cases are concentrated in vulnerable populations. The objective was to describe the incidence rates trend in native and foreign population (2009-2018) in Madrid Region. METHODS: Retrospective analysis of cases from the Tuberculosis Regional Registry of cases of Madrid Region 2009-2018. Annual incidence rates were calculated by country of birth (Spain, other), sex and age group (<15, 15-34, 35-44, 45-64, >64), using the annual January 1st continuous register population. The infection rate trend and the annual percentage change (APC) were calculated, along with the best jointpoint adjustment using Jointpoint regression. RESULTS: 7,696 cases were analyzed, 48.2% were foreign-born individuals. Average age in native population was 50 years old (SD: 23.96) and 35 (DS: 36.64) in foreign-born individuals (p<0.001). The overall incidence rate decreased from 17.30 in 2009 to 9.00 per 100,000 in 2018 and was higher in men. Pulmonary tuberculosis reduced from 11.90 to 6.55. Among native population, the incidence of TB fell from 10.29 to 5.24 with an APC of -7.3% (95%IC: -8.9; -5.7) (p<0.05), no jointpoint was identified. Among foreign-born individuals the incidence of tuberculosis declined from 46.54 to 25.49, a joint point was identified in 2013, observing an incidence decrease for the period 2009-2013 and APC of -13.8% (IC95%: -17.5; -10.0). CONCLUSIONS: The global incidence rate in this period has decreased by approximately 7% per year. However, this reduction occurred mainly in native population. In foreign-born individuals the incidence decreased by approximately 14% during the 2009-2013 period, after this period there have been no significant incidence changes.

OBJETIVO: La tuberculosis (TB) continúa siendo un problema importante de salud pública, debido a que la mayoría de los casos se concentran en población vulnerable. El objetivo de este trabajo fue describir la tendencia de las tasas de incidencia en población autóctona y extranjera (2009-2018) en la Comunidad de Madrid (CM). METODOS: Se realizó un análisis retrospectivo de casos del Registro Regional de casos de Tuberculosis de la CM en el período 2009-2018. Se calcularon tasas de incidencia anual por cada 100.000 habitantes, por país de nacimiento (España, fuera de España), sexo y grupo de edad (<15, 15-34, 35-44, 45-64, >64), utilizando las poblaciones de padrón continuo a 1 de enero de cada año. Se calculó la tendencia de las tasas de incidencia y el porcentaje anual de cambio (APC), así como el mejor ajuste del punto de inflexión utilizando la regresión de Jointpoint. RESULTADOS: Se analizaron 7.696 casos, siendo el 48,2% en personas nacidas fuera de España. La edad media en población autóctona fue de 50 años (DS: 23,96) y 35 (DS: 36,64) en inmigrante (p<0,001). La tasa de incidencia global pasó de 17,30 por cada 100.000 habitantes en 2009 a 9 en 2018, siendo superior en hombres. La incidencia de tuberculosis pulmonar pasó de 11,90 a 6,55. En población autóctona, la incidencia de TB pasó de 10,29 a 5,24, con un APC de -7,3% (IC95%: -8,9; -5,7; p<0,05), y no se identificó ningún punto de inflexión. En población extranjera la incidencia de tuberculosis pasó de 46,54 a 25,49, identificándose un punto de inflexión en 2013, con una disminución más acusada de la incidencia para el periodo 2009-2013 debido a un APC de -13,8% (IC95%: -17,5; -10,0). CONCLUSIONES: La tasa de incidencia global en este periodo disminuye cerca de un 7% anual; sin embargo, esta disminución de la incidencia se produce fundamentalmente en población autóctona. En población extranjera la incidencia desciende cerca de un 14% durante el periodo 2009-2013. Tras este periodo no hay cambios significativos en la incidencia.

Tendencia de la tuberculosis en la Comunidad de Madrid en población autóctona y extranjera (2009-2018) / Tuberculosis trend in Madrid region in native and foreign population (2009-2018)

OBJETIVO: La tuberculosis (TB) continúa siendo un problema importante de salud pública, debido a que la mayoría de los casos se concentran en población vulnerable. El objetivo de este trabajo fue describir la tendencia de las tasas de incidencia en población autóctona y extranjera (2009-2018) en la Comunidad de Madrid (CM). MÉTODOS: Se realizó un análisis retrospectivo de casos del Registro Regional de casos de Tuberculosis de la CM en el período 2009-2018. Se calcularon tasas de incidencia anual por cada 100.000 habitantes, por país de nacimiento (España, fuera de España), sexo y grupo de edad (<15, 15-34, 35-44, 45-64, >64), utilizando las poblaciones de padrón continuo a 1 de enero de cada año. Se calculó la tendencia de las tasas de incidencia y el porcentaje anual de cambio (APC), así como el mejor ajuste del punto de inflexión utilizando la regresión de Jointpoint. RESULTADOS: Se analizaron 7.696 casos, siendo el 48,2% en personas nacidas fuera de España. La edad media en población autóctona fue de 50 años (DS: 23,96) y 35 (DS: 36,64) en inmigrante (p < 0,001). La tasa de incidencia global pasó de 17,30 por cada 100.000 habitantes en 2009 a 9 en 2018, siendo superior en hombres. La incidencia de tuberculosis pulmonar pasó de 11,90 a 6,55. En población autóctona, la incidencia de TB pasó de 10,29 a 5,24, con un APC de -7,3% (IC95%: -8,9; -5,7; p < 0,05), y no se identificó ningún punto de inflexión. En población extranjera la incidencia de tuberculosis pasó de 46,54 a 25,49, identificándose un punto de inflexión en 2013, con una disminución más acusada de la incidencia para el periodo 2009-2013 debido a un APC de -13,8% (IC95%: -17,5; -10,0). CONCLUSIONES: La tasa de incidencia global en este periodo disminuye cerca de un 7% anual; sin embargo, esta disminución de la incidencia se produce fundamentalmente en población autóctona. En población extranjera la incidencia desciende cerca de un 14% durante el periodo 2009-2013. Tras este periodo no hay cambios significativos en la incidencia

OBJECTIVE: Tuberculosis is a major public health problem and most cases are concentrated in vulnerable populations. The objective was to describe the incidence rates trend in native and foreign population (2009-2018) in Madrid Region. METHODS: Retrospective analysis of cases from the Tuberculosis Regional Registry of cases of Madrid Region 2009-2018. Annual incidence rates were calculated by country of birth (Spain, other), sex and age group (<15, 15-34, 35-44, 45-64, >64), using the annual January 1st continuous register population. The infection rate trend and the annual percentage change (APC) were calculated, along with the best jointpoint adjustment using Jointpoint regression. RESULTS: 7,696 cases were analyzed, 48.2% were foreign-born individuals. Average age in native population was 50 years old (SD: 23.96) and 35 (DS: 36.64) in foreign-born individuals (p < 0.001). The overall incidence rate decreased from 17.30 in 2009 to 9.00 per 100,000 in 2018 and was higher in men. Pulmonary tuberculosis reduced from 11.90 to 6.55. Among native population, the incidence of TB fell from 10.29 to 5.24 with an APC of -7.3% (95%IC: -8.9; -5.7) (p < 0.05), no jointpoint was identified. Among foreign-born individuals the incidence of tuberculosis declined from 46.54 to 25.49, a joint point was identified in 2013, observing an incidence decrease for the period 2009-2013 and APC of -13.8% (IC95%: -17.5; -10.0). CONCLUSIONS: The global incidence rate in this period has decreased by approximately 7% per year. However, this reduction occurred mainly in native population. In foreign-born individuals the incidence decreased by approximately 14% during the 2009-2013 period, after this period there have been no significant incidence changes

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.

Factores asociados a mal estado de salud percibido o a mala calidad de vida en personas mayores de 65 años / Factors Related to Perceived Poor Health Condition or Poor Quality of Life among those over Age 65

Fundamento: Hoy en día, en los países desarrollados, llegar a una edad avanzada ha dejado de ser algo excepcional, sin embargo muchas personas no logran envejecer con una buena calidad de vida. El presente trabajo tiene como objetivos, contribuir a un mejor conocimiento de los principales factores que influyen en la calidad de vida y la percepción de la salud de los mayores de 65 años, así como determinar qué ventajas y desventajas presenta cada uno de los tres instrumentos de medida de la salud y la calidad de vida frente a los otros dos instrumentos utilizados. Métodos: A partir de 911 encuestas a personas mayores de 65 años no institucionalizadas, realizadas a domicilio, se hizo un análisis multivariante mediante regresión logística, poniendo en relación los resultados obtenidos en el Perfil de Salud de Nottingham (PSN), el Euroqol y el EAS con las caracterísiticas sociodemográficas, el nivel de recursos económicos, el grado de apoyo sociofamiliar, el estado de salud física y mental y la capacidad funcional. Resultados: Los principales factores que se asocian con la percepción de un mal estado de salud y mala calidad de vida en el Euroqol y el PSN son los trastornos de ansiedad (Odd Ratios entre 1,8 (IC:1,2-2,8) para movilidad y 7,9 (IC:4,5-13,9) para perfil distinto de 11111), trastornos depresivos (OR:1,8 (IC:1,3-2,6) para dolor/malestar -3,3 (IC:2,1-5,1) para aislamiento social), falta de ejercicio (OR:1,4 (IC:1-2,1) para ansiedad/depresión -3,9 (IC:2,5-6,2) para actividades cotidianas), dependencia para las actividades básicas de la vida diaria (OR:0,5 (IC:0,3-0,9) para reacción emocional -4,8 (IC:3-7,6) para actividades cotidianas) y dependencia para las actividades instrumentales de la vida diaria (OR:1,5 (IC:1,1-2,1) para Escala Visual Analógica < 70 - 7,1 (IC:2,9-17,2) para cuidado personal). Conclusiones: La salud mental y la capacidad funcional son los factores que más influyen en la percepción del estado de salud y la calidad de vida de las personas mayores. Dado que los tres instrumentos utilizados han obtenido resultados semejantes, el Euroqol ofrece ventajas por su brevedad, incluyendo una valoración global y por dimensiones (AU)

Background: Nowadays, in the developed countries, a long lifespan is no longer the exception to the rule, however there are still many people who even today do not manage to age with a good quality of life. The objectives of this study are, first of all, to contribute to a better knowledge of the main factors which have an impact on the quality of life and the perceived health condition of those over age 65 and, secondly, to determine what advantages and disadvantages involved in each one of the tools for gauging health and quality of life as compared to the other two tools employed. Methods: Based on 911 home surveys of non-institutionalized individuals over age 65, a multivariate analysis was made using Logistic regression, relating the results obtained in the Nottingham Health Profile (NHP), the EuroQol and the Self Perceived Health Status to the socio-demographic characteristics, the level of economic resources, the degree of social-family support, the physical and mental health condition and the functional capacity. Results: The main factors related to the perception of a poor health condition and a poor quality of life in the EuroQol and the NHP are anxiety disorders (Odds Ratio ranging from 1.8(IC:1.2-2.8) for mobility and 7.9(IC:4.5-13.9) for Profile*11111), depressive disorders (OR:1.8(IC:1.3-2.6) for pain/discomfort- 3.3(IC:2.1-5.1) for social isolation), lack of exercise (OR:1.4 (IC:1-2.1) for anxiety/depression -3.9(IC:2.5-6.2) for everyday activities), dependence for basic everyday living activities (OR:0.5(IC:0.3-0.9) for emotional reaction - 4.8(IC:3-7.6) for everyday activities) and dependence for the instrumental daily living activities (OR:1.5(IC:1.1-2.1) for Analog Visual Scale c<70 - 7.1(IC:2.9-17.2) for personal care). Conclusions: Mental health and functioning capacity are the factors which have the greatest bearing on the perception of health condition and quality of life of individuals over age 65. Given that the three tools used have led to similar results, the EuroQol has advantages to offer due to its short length, including an overall evaluation by dimensions (AU)

[Factors related to perceived poor health condition or poor quality of life among those over 65 years of age]. / Factores asociados a mal estado de salud percibido o a mala calidad de vida en personas mayores de 65 años.

BACKGROUND: Nowadays, in the developed countries, a long lifespan is no longer the exception to the rule, however there are still many people who even today do not manage to age with a good quality of life. The objectives of this study are, first of all, to contribute to a better knowledge of the main factors which have an impact on the quality of life and the perceived health condition of those over age 65 and, secondly, to determine what advantages and disadvantages involved in each one of the tools for gauging health and quality of life as compared to the other two tools employed. METHODS: Based on 911 home surveys of non-institutionalized individuals over age 65, a multivariate analysis was made using Logistic regression, relating the results obtained in the Nottingham Health Profile (NHP), the EuroQol and the Self Perceived Health Status to the socio-demographic characteristics, the level of economic resources, the degree of social-family support, the physical and mental health condition and the functional capacity. RESULTS: The main factors related to the perception of a poor health condition and a poor quality of life in the EuroQol and the NHP are anxiety disorders (Odds Ratio ranging from 1.8(IC:1.2-2.8) for mobility and 7.9(IC:4.5-13.9) for Profile*11111), depressive disorders (OR:1.8(IC:1.3-2.6) for pain/discomfort-3.3(IC:2.1-5.1) for social isolation), lack of exercise (OR:1.4 (IC:1-2.1) for anxiety/depression -3.9(IC:2.5-6.2) for everyday activities), dependence for basic everyday living activities (OR:0.5(IC:0.3-0.9) for emotional reaction -4.8(IC:3-7.6) for everyday activities) and dependence for the instrumental daily living activities (OR:1.5(IC:1.1-2.1) for Analog Visual Scale c < 70-7.1(IC:2.9-17.2) for personal care). CONCLUSIONS: Mental health and functioning capacity are the factors which have the greatest bearing on the perception of health condition and quality of life of individuals over age 65. Given that the three tools used have led to similar results, the EuroQol has advantages to offer due to its short length, including an overall evaluation by dimensions.