COVID-19, social determinants of transmission in the home. A population-based study.

BACKGROUND: Studying transmission within the home is essential to understand the transmission dynamics of numerous infectious diseases. For Coronavirus Disease-2019 (COVID-19), transmission within the home constitutes the majority exposure context. The risk of infection in this setting can be quantified by the household/intra-family secondary attack rate (SAR). In the literature, there are discrepancies in these values and little information about its social determinants. The aim of this study was to investigate transmission in the home by analyzing the influence of occupational social class, country of origin and gender/sex. METHODS: This was a retrospective cohort study of a population registry of cohabiting contacts with COVID-19 cases diagnosed from 15 June to 23 December 2020, in the Murcia Region. The household SAR was analyzed considering the characteristics of the primary case (sex, age, symptoms, occupational social class, country of origin and number of people in the household) and contact (age and sex) using a multilevel binary logistic regression model. RESULTS: Among the 37 727 contacts included, the intra-family SAR was 39.1%. The contacts of confirmed primary cases in the migrant population (Africa and Latin America) had higher attack rates, even after adjusting for the other variables. Older age and female sex were independent risk factors for contracting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within the home. CONCLUSION: There was greater intra-domiciliary transmission among immigrants, likely related to the conditions of the home and situation of social vulnerability. Women were more likely to be infected by transmission from a cohabiting infected individual.

Effectiveness of a Meningococcal Group B Vaccine (4CMenB) in Children.

BACKGROUND: In September 2015, the four-component, protein-based meningococcal serogroup B vaccine (4CMenB; Bexsero) became available for private purchase in Spain. METHODS: We conducted a nationwide matched case-control study to assess the effectiveness of 4CMenB in preventing invasive meningococcal disease in children. The study included all laboratory-confirmed cases of invasive meningococcal disease in children younger than 60 months of age between October 5, 2015, and October 6, 2019, in Spain. Each case patient was matched with four controls according to date of birth and province. 4CMenB vaccination status of the case patients and controls was compared with the use of multivariate conditional logistic regression. RESULTS: We compared 306 case patients (243 [79.4%] with serogroup B disease) with 1224 controls. A total of 35 case patients (11.4%) and 298 controls (24.3%) had received at least one dose of 4CMenB. The effectiveness of complete vaccination with 4CMenB (defined as receipt of at least 2 doses, administered in accordance with the manufacturer's recommendations) was 76% (95% confidence interval [CI], 57 to 87) against invasive meningococcal disease caused by any serogroup, and partial vaccination was 54% (95% CI, 18 to 74) effective. Complete vaccination resulted in an effectiveness of 71% (95% CI, 45 to 85) against meningococcal serogroup B disease. Vaccine effectiveness with at least one dose of 4CMenB was 64% (95% CI, 41 to 78) against serogroup B disease and 82% (95% CI, 21 to 96) against non-serogroup B disease. With the use of the genetic Meningococcal Antigen Typing System, serogroup B strains that were expected to be covered by 4CMenB were detected in 44 case patients, none of whom had been vaccinated. CONCLUSIONS: Complete vaccination with 4CMenB was found to be effective in preventing invasive disease by serogroup B and non-serogroup B meningococci in children younger than 5 years of age.

[COVID-19 exposure setting, social and gender determinants in a mediterranean region.] / Características sociales y de género en el ámbito de contagio de COVID-19 en una región mediterránea.

OBJECTIVE: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies. METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables. RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%). CONCLUSIONS: The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class.

OBJETIVO: El conocimiento de los determinantes sociales y de género que influyen en el ámbito de exposición al SARS-CoV-2 puede ser relevante en el planteamiento de estrategias preventivas y de control de la transmisión. No se han encontrado estudios previos que evalúen cómo influyen la clase social ocupacional y el país de origen en el ámbito de exposición del SARS-CoV-2. El objetivo de este trabajo fue conocer el contexto en que se contagiaron los casos de COVID-19 (ámbito: hogar, trabajo, sanitario, sociosanitario y social-ocio) según país de origen, clase social ocupacional y género, lo cual es esencial para orientar estrategias de Salud Pública. METODOS: Se realizó un estudio descriptivo de un registro epidemiológico de 56.628 casos incidentes de COVID-19 en los que se estudió el ámbito de exposición/contagio en función de las variables anteriormente indicadas entre el 15 de junio y el 23 de diciembre de 2020 en la Región de Murcia. Se utilizó una prueba exacta de Fisher para el estudio de la distribución de los casos de COVID-19 en función de las variables anteriores. RESULTADOS: La incidencia acumulada fue mayor en personas procedentes de África (5.133,5 casos por cada 100.000 habitantes) y Latinoamérica (11.351,1) que en no inmigrantes (3.145,7) y superior en mujeres (3.885,6) que en hombres (3.572,6). Es destacable que el 53,3% de los casos COVID-19 con empleo registrado eran operarios en industria o construcción, artesanos, trabajadores agrarios o con ocupaciones elementales (15 de junio y el 23 de diciembre de 2020). En contraste, el 41,3% de la población ocupada en la Región de Murcia realizaba dichos empleos (promedio 3º y 4º trimestre de 2020). El hogar fue el principal ámbito de contagio (56,5% de los casos con ámbito conocido), seguido del social-ocio (20,7%) y el laboral (18,2%). Este último tuvo mayor peso en personas procedentes de África (28,4%) y Latinoamérica (35,7%) que en no inmigrantes (12%), a la inversa que el social-ocio. Fue más importante en mujeres (19,6%) que en hombres (16,5%) y en trabajadores manuales (44,1%) que en no manuales (26,6%). CONCLUSIONES: El contexto en el que los casos de COVID-19 se contagiaron es diferente en función de las desigualdades sociales relativas a país de origen, género y clase social ocupacional.

Características sociales y de género en el ámbito de contagio de COVID-19 en una región mediterránea / COVID-19 exposure setting, social and gender determinants in a mediterranean region

FUNDAMENTOS: El conocimiento de los determinantes sociales y de género que influyen en el ámbito de exposición al SARS-CoV-2 puede ser relevante en el planteamiento de estrategias preventivas y de control de la transmisión. No se han encontrado estudios previos que evalúen cómo influyen la clase social ocupacional y el país de origen en el ámbito de exposición del SARS-CoV-2. El objetivo de estetrabajo fue conocer el contexto en que se contagiaron los casos de COVID-19 (ámbito: hogar, trabajo, sanitario, sociosanitario y social-ocio) según país de origen, clase social ocupacional y género, lo cual es esencial para orientar estrategias de Salud Pública. MÉTODOS: Se realizó un estudio descriptivo de un registro epidemiológico de 56.628 casos incidentes de COVID-19 en los que seestudió el ámbito de exposición/contagio en función de las variables anteriormente indicadas entre el 15 de junio y el 23 de diciembre de 2020 en la Región de Murcia. Se utilizó una prueba exacta de Fisher para el estudio de la distribución de los casos de COVID-19 en función de las variables anteriores. RESULTADOS: La incidencia acumulada fue mayor en personas procedentes de África (5.133,5 casos por cada 100.000 habitantes) y Latinoamérica (11.351,1) que en no inmigrantes (3.145,7) y superior en mujeres (3.885,6) que en hombres (3.572,6). Es destacable que el 53,3% de los casos COVID-19 con empleo registrado eran operarios en industria o construcción, artesanos, trabajadores agrarios ocon ocupaciones elementales (15 de junio y el 23 de diciembre de 2020). En contraste, el 41,3% de la población ocupada en la Región de Murcia realizaba dichos empleos (promedio 3º y 4º trimestre de 2020). El hogar fue el principal ámbito de contagio (56,5% de los casos con ámbito conocido), seguido del social-ocio (20,7%) y el laboral (18,2%). Este último tuvo mayor peso en personas procedentes de África (28,4%) y Latinoamérica (35,7%) que en no inmigrantes (12%), a la inversa que el socialcio...(AU)

BACKGROUND: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies.METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables.RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%)...(AU)

Violence in adulthood and mental health: gender and immigrant status.

The aim of this study was to describe perceived abuse in adult Spanish and Ecuadorian women and men and to assess its association with mental health. A population-based survey was conducted in Spain in 2006. Data were taken from a probabilistic sample allowing for an equal number of men and women, Spaniards and Ecuadorians. Mental disorder was measured with the General Health Questionnaire-28. The nine questions on exposure to physical, sexual, and psychological abuse during the previous year were self-administered. Multivariate logistic regression was used to assess the association between exposure to abuse and poor mental health, adjusting for potential confounders. The sample was composed of 1,059 individuals aged 18 to 54, 104 of whom reported physical, psychological, or sexual abuse. Some 6% refused to answer the questions on abuse. Overall, reported abuse ranged from 13% in Ecuadorian women to 5% in Spanish men. Psychological abuse was the most frequent. Half the abused women, both Spanish and Ecuadorian, reported intimate partner violence (IPV), as did 22% of abused men. Poor mental health was found in 61% of abused Spanish women (adjusted Odds Ratio [ORa] = 5.1; 95% CI: 1.8-14.4), and 62% abused Ecuadorian women (ORa = 4; 95% CI: 2-7.9), in 36% of abused Spanish men (ORa = 3; 95% CI: 0.9-10.7) and in 30% abused Ecuadorian men (ORa = 2.8; 95% CI: 1-7.7). Interpersonal violence is frequent in relations with the partner, the family, and outside the family, and it seriously affects the mental health. Ecuadorian women stand out as the most vulnerable group.

Absence of protective ethnic density effect on Ecuadorian migrants' mental health in a recent migration setting: a multilevel analysis.

PURPOSE: We aimed to study the association between the Ecuadorians' ethnic density (EED) of the areas of residence (AR) with the mental health of Ecuadorians in Spain. METHODS: Multilevel study of 568 Ecuadorian adults in 33 AR randomly selected from civil registries and interviewed at home. Possible psychiatric case (PPC) was measured by scoring ≥5 in General Health Questionnaire-28. Ecuadorians' ethnic density was dichotomized in high and low EED (<6 %). Multilevel logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: Prevalence of PPC, 24 % (95 %CI 20-28 %), varied by area of residence. Ecuadorians' ethnic density varied by area of residence ranging from 0.9 to 19.5 %. PPC prevalence in High Ecuadorians' ethnic density AR was 29.5 and 20.4 % in low EED AR (p 0.013). Ecuadorians from High EED AR had higher odds of PPC than those from Low EED AR (OR 1.65 95 %CI 1.01-2.72). Adjusting for individual confounders (largely self-perceived discrimination), OR decreased to 1.48 (95 %CI 0.87-2.55). The final model, adjusted by area of residence and educational level, yielded an OR 1.37 (95 %CI 0.78-2.40). CONCLUSIONS: No protective association between the Ecuadorians' ethnic density of the Area of residence and Ecuadorian migrants' mental health was found. Mechanisms underlying beneficial ethnic density effects may be absent in recent migration settings.

Mental health in Ecuadorian migrants from a population-based survey: the importance of social determinants and gender roles.

PURPOSE: To describe the prevalence of and the risk factors for poor mental health in female and male Ecuadorian migrants in Spain compared to Spaniards. METHOD: Population-based survey. Probabilistic sample was obtained from the council registries. Subjects were interviewed through home visits from September 2006 to January 2007. Possible psychiatric case (PPC) was measured as score of ≥5 on the General Health Questionnaire-28 and analyzed with logistic regression. RESULTS: Of 1,122 subjects (50% Ecuadorians, and 50% women), PPC prevalence was higher in Ecuadorian (34%, 95% CI 29-40%) and Spanish women (24%, 95% CI 19-29%) compared to Ecuadorian (14%, 95% CI 10-18%) and Spanish men (12%, 95% CI 8-16%). Shared risk factors for PPC between Spanish and Ecuadorian women were: having children (OR 3.1, 95% CI 1.4-6.9), work dissatisfaction (OR 4.1, 95% CI 1.6-10.5), low salaries (OR 2.5, 95% CI 1.1-5.9), no economic support (OR 1.8, 95% CI 0.9-3.4), and no friends (OR 2.2, 95% CI 1.1-4.2). There was an effect modification between the nationality and educational level, having a confidant, and atmosphere at work. Higher education was inversely associated with PPC in Spanish women, but having university studies doubled the odds of being a PPC in Ecuadorians. Shared risk factors for PPC in Ecuadorian and Spanish men were: bad atmosphere at work (OR 2.4, 95% CI 1.3-4.4), no economic support (OR 3.5, 95% CI 1.3-9.5), no friends (OR 2.5, 95% CI 0.9-6.6), and low social support (OR 1.6, 95% CI 0.9-2.9), with effect modification between nationality and partner's emotional support. CONCLUSIONS: Mental health in Spanish and Ecuadorian women living in Spain is poorer than men. Ecuadorian women are the most disadvantaged group in terms of prevalence of and risk factors for PPC.

[Methodology and fieldwork logistics of a multilevel research study on the influence of neigbourdhood's characteristics on natives and Ecuadorian's mental health in Spain]. / Metodología y logística de campo de un estudio multinivel sobre la influencia en España de las características medioambientales en la salud mental de población autóctona y ecuatoriana inmigrante.

The methodological design, characteristics and fieldwork stage of a multilevel research study on the impact of the environmental characteristics on mental health in an autochthonous and immigrant population are described in this paper. Individual data were obtained using a core questionnaire 40 minutes length from home interviews of Spanish and Ecuadorian adults from September 2006 to January 2007. A random sample of 1186 people aged 18-55, with equal distribution of gender and nationality was obtained from Civil Registers of 33 areas (municipalities or neighbourhoods) of Madrid, Alicante, Almeria and Murcia, chosen by ethnic density and socioeconomic criteria. Previously, a pilot study was carried out. Socioeconomic indicators of neighbourhoods and selected communities were obtained from Municipal Registers and other secondary sources. Finally, 1144 people were interviewed (96%). Each person was contacted at home at two different times. The global response rate was 61%, higher among Ecuadorians (69%), who presented more problems of localisation (34%). Analyzing methods and fieldwork process the conclusion is that sample strategies for this type of population studies should be evaluated using feasibility criteria given time and money constraints, against the need to obtain representative samples of the target populations. There were serious shortcomings in the availability of social integration indicators at the neighbourhood level.

Metodología y logística de campo de un estudio multinivel sobre la influencia en España de las características medioambientales en la salud mental de población autóctona y ecuatoriana inmigrante / Methodology and fieldwork logistics of a multilevel research study on the influence of neigbourdhood’s characteristics on natives and ecuadorian’s mental health in Spain

Se realizó una investigación multinivel sobre el impacto de lascaracterísticas ambientales de la zona de residencia en la salud mentalde población autóctona e inmigrante. El objetivo de este artículo esdescribir el planteamiento metodológico de la investigación, el trabajode campo, las tasas de respuesta correspondientes y discutir el diseñometodológico y las dificultades derivadas de su puesta en práctica.Los datos individuales se obtuvieron aplicando un cuestionarioestructurado de aproximadamente 40 minutos, mediante entrevistadomiciliaria a personas españolas y ecuatorianas de 18 a 55 años. Eltrabajo se realizó de septiembre de 2006 a enero de 2007 en una muestraestimada de 1.186 personas equiparada por sexo y nacionalidad,obtenida aleatoriamente de los Padrones Municipales de 33 áreas(municipios o barrios) de Madrid, Alicante, Almería y Murcia, seleccionadassegún criterios de densidad étnica y socioeconómicos. Previamentese realizó un estudio piloto (n=113)Los indicadores sociodemográficosde las áreas se obtuvieron a partir de fuentes secundarias. Seentrevistó a 1.144 personas (96%). La tasa de respuesta global fue del61%, superior entre ecuatorianos (69%), colectivo que presentó másproblemas de localización (34%). Las negativas a colaborar fueron másaltas entre españoles (21%).Se concluye que en este tipo de estudios sería conveniente revisarlas estrategias de muestreo para combinar criterios de eficiencia con lanecesidad de obtener una muestra representativa de la población diana.Se constata la dificultad de obtener datos inframunicipales de integraciónsocial(AU)

The methodological design, characteristics and fieldwork stage ofa multilevel research study on the impact of the environmentalcharacteristics on mental health in an autochthonous and immigrantpopulation are described in this paper.Individual data were obtained using a core questionnaire 40minutes length from home interviews of Spanish and Ecuadorianadults from September 2006 to January 2007. A random sample of1186 people aged 18-55, with equal distribution of gender andnationality was obtained from Civil Registers of 33 areas(municipalities or neighbourhoods) of Madrid, Alicante, Almeria andMurcia, chosen by ethnic density and socioeconomic criteria.Previously, a pilot study was carried out. Socioeconomic indicators ofneighbourhoods and selected communities were obtained fromMunicipal Registers and other secondary sources.Finally, 1144 people were interviewed (96%). Each person wascontacted at home at two different times. The global response rate was61%, higher among Ecuadorians (69%), who presented more problemsof localisation (34%).Analyzing methods and fieldwork process the conclusion is thatsample strategies for this type of population studies should beevaluated using feasibility criteria given time and money constraints,against the need to obtain representative samples of the targetpopulations. There were serious shortcomings in the availability ofsocial integration indicators at the neighbourhood level(AU)

Hepatitis C and hepatitis B-related mortality in Spain.

BACKGROUND: Although hepatitis C and hepatitis B virus (HCV/HBV) infections are an important health problem worldwide, their burden of disease (BoD) taking into account their chronic consequences, cirrhosis, and hepatocellular carcinoma (HCC), is still unknown. Our aim was to assess the total number of deaths attributable to these viruses in Spain and the years of life lost, first component of the disability adjusted life years, a comparative index of BoD. METHODS: We selected the International Classification of Diseases-Tenth Revision specific codes related to HCV/HBV. For unspecified cirrhosis and HCC, the attributable fraction of mortality was assessed in two steps: literature review and expert panel. Deaths in Spain in 2000 were obtained from the National Statistics Institute. Years of life lost were calculated using the estimated mortality and life expectancies (Princeton Model Life Table). RESULTS: HCV could have caused around 70% of HCC deaths and 50% of cirrhosis mortality in Spain in 2000 (60% HCC, 40% cirrhosis with HCV lower estimate). For HBV these proportions are 10 and 13%, respectively. We estimated 4342 HCV-related deaths and 877 HBV-related deaths in Spain in 2000, globally 1.5% of total deaths in Spain that year. Mortality by cirrhosis and HCC represented most of these viral-related deaths. Attributable mortality in AIDS patients was also estimated. CONCLUSION: HCV leads the list of infectious disease-related mortality in Spain in 2000, doubling the AIDS mortality even if lower HCV attributable fractions are considered. Exclusion of cirrhosis and HCC-related mortality severely underestimates the BoD attributable to HCV/HBV. Improving early diagnosis and access to treatment could have an important impact on mortality because of hepatitis virus in the next decades.

[Effect of weather temperature on hospital emergencies in the Region of Murcia, Spain, throughout the 2000-2005 and its use in epidemiological surveillance]. / Efecto del calor sobre el número de urgencias hospitalarias en la Región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica.

BACKGROUND: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. OBJECTIVE: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. METHODS: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38 degrees C and Min. 22.4 degrees C) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). RESULTS: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4 degrees C (RR: 1.016; 95% CI 1.0076-1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. CONCLUSIONS: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk.

Efecto del calor sobre el número de urgencias hospitalarias en la región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica / Effect of weather temperature on hospital emergencies in the region of Murcia, Spain, throught the 2000-2005 and its use in epidemiological surveillance

Fundamento: el efecto de las temperaturas sobre la mortalidad ha sido estudiado más en profundidad que el efecto sobre la morbilidad. En Murcia se monitorizan el número de urgencias diarias y los casos de golpes de calor atendidos en los hospitales de la Región. Objetivo: valorar el efecto de la temperatura sobre el número de urgencias hospitalarias y la utilidad de estos indicadores para vigilar la morbilidad por calor. Métodos: se ha estudiado el efecto de la temperatura sobre el número de urgencias en verano (periodo 2000-2005), estimando el incremento porcentual de urgencias cuando se superan los umbrales establecidos por el Ministerio de Sanidad y Consumo (Tª máxima 38ºC y Tª mínima 22,4ºC) y por cada grado de aumento de temperatura, expresado en Riesgo Relativo (RR) con un IC95%. Se han cotejado los golpes de calor comunicados con los ingresos registrados en el Conjunto Mínimo Básico de Datos al Alta Hospitalaria (CMBD). Resultados: En 2000-2005 las urgencias se incrementaron un 1,6% en los días con más de 22,4ºC de mínima (RR 1,016; IC95% 1,0076-1,0244), y un 0,21% por cada grado de aumento de la mínima (RR 1,0021; IC95% 1,0000-1,0044). El 38% de los golpes de calor ingresados no se notificaron, y el 40% de los notificados tenían exposición laboral. Conclusiones: La temperatura mínima podría tener un mayor efecto en Murcia que la máxima. Con los actuales umbrales, el número de urgencias diarias no parece un indicador adecuado para monitorizar el efecto de la temperatura, necesitándose información sobre el diagnóstico y la edad. Los golpes de calor aportan información parcial del impacto, pero resaltan grupos de población en riesgo menos considerados (AU)

Background: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. Objective: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. Methods: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38ºC and Min. 22.4ºC) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). Results: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4ªC (RR: 1.016; 95%CI 1.0076 - 1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. Conclusions: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk (AU)

Mortalidad por suicidio en Castilla-La Mancha (1991-1998) / Death by suicide in Castilla-La Mancha, Spain (1991-1998)

INTRODUCCIÓN: El suicidio es un problema de salud pública, de importancia creciente en los países desarrollados. Nuestro objetivo es calcular las tasas de mortalidad por suicidio en Castilla-La Mancha en el período 1991-1998 y valorar su tendencia temporal. MATERIAL Y MÉTODOS: Cálculo de las tasas de mortalidad crudas y estandarizadas y su incremento porcentual medio anual, a partir de los datos del Registro de Mortalidad de Castilla-La Mancha, codificados según la CIE-9 (Códigos 950-959).RESULTADOS: Se han producido 1.096 suicidios en el período estudiado: 874 (79,7 por ciento) en varones y 222 (20,3 por ciento) en mujeres con una razón varón/mujer de 3,94 para todo el período. Las tasas crudas de mortalidad fueron de 9,75 y 8,13 por 100.000 habitantes en 1991 y 1998, respectivamente; el incremento porcentual es de -1,89 por ciento medio anual. Las tasas específicas por grupo de edad son más altas en edades más avanzadas, llegando a quintuplicar las de los más jóvenes. En su evolución temporal se ha producido un incremento en los grupos de edad más avanzada (65-80 años en varones y mayores de 80 años en mujeres). En los otros grupos de edad se produce, en general, un descenso con algunas variaciones por edad y sexo. CONCLUSIONES: Los datos sitúan a nuestra comunidad ligeramente por encima de las cifras nacionales pero por debajo de algunas comunidades como Andalucía. La distribución por edad y sexo concuerda con la bibliografía. Hallamos una tendencia descendente en la tasa global con diferencias entre edades y sexo. Asimismo, cabe destacar el aumento de las tasas en los ancianos, en el período estudiado. Estos datos son útiles para la planificación de los servicios sanitarios castellano-manchegos (AU)

Estimación de la prevalencia de hipotiroidismo en España a partir del consumo de hormonas tiroideas (1996-1999) / Thyroid hormone consumption-based estimate of hypothyroidism prevalence in Spain (1996-1999)

Fundamento: Ante la escasez de datos acerca de la prevalencia de hipotiroidismo en España, se decide estimarla a través del consumo de su tratamiento específico, las hormonas tiroideas, utilizando la metodología de los estudios de utilización de medicamentos. Métodos: Cálculo de la Dosis Habitante Día (DHD) de hor monas tiroideas (grupo terapéutico H03 de la Anatomical Therapeutic Chemical) a través de la Dosis Diaria Definida (DDD), durante 1996 y 1999, en las distintas provincias de las Comunidades Autónomas de todo el territorio nacional. Se han calculado los intervalos de confianza al 95 por ciento para las prevalencias estimadas en las comunidades autónomas y en el territorio nacional, así como los incrementos porcentuales de 1999 respecto a 1996. Los datos de las prescripciones han sido facilitados por el Ministerio de Sanidad y Consumo. Resultados: Se estima una prevalencia nacional de hipotiroidismo para 1996, de 3,19 casos por 1.000 habitantes y para 1999, de 4,33 casos por 1000 habitantes; el incremento porcentual es de 26,38 por ciento. Los resultados de la DHD muestran diferencias en la prevalencia entre provincias: Guadalajara presenta las cifras más altas en los dos años estudiados(5,02 y 7,01 casos por 1.000 habitantes/día en 1996 y 1999 respectivamente) y Melilla, las más bajas (1,07 y 1,60 casos por 1.000 habitantes/día). En todas las provincias y comunidades autónomas se ha producido un incremento de la DHD en el año 1999 respecto al 1996. El incremento menor fue para Asturias (9,62 por ciento) y el más alto para La Rioja (35,26 por ciento).Conclusiones: Los 3,19 y 4,33 DDD por 1.000 habitantes/día en 1996 y 1999 respectivamente, pueden ser interpretados como la prevalencia de hipotiroidismo diagnosticado y tratado. Estas cifras se hallan en el intervalo determinado por otros estudios, aunque las comparaciones entre estudios de diferente metodología deben hacerse con extremada precaución. El incremento observado en el consumo podría explicarse más por una mejora en el diagnóstico de la enfermedad que por un aumento real de su prevalencia (AU)