Coordinación para el abordaje de la viruela del mono con perspectiva de diversidad afectiva y sexual / Coordination for an affective and sexual diversity approach to monkeypox

En mayo de 2022 se detectaron las primeras cadenas de transmisión de la viruela del mono fuera de los países endémicos. Este brote presenta características clínicas y epidemiológicas diferentes de las observadas en los brotes anteriores, con un mayor impacto en el grupo de hombres que tienen sexo con hombres. El abordaje de brotes epidémicos que conlleva intervenciones sobre comunidades o poblaciones en riesgo de estigmatización resulta un desafío. La independencia y la capacidad profesional de las sociedades científicas permiten adoptar iniciativas para dar respuestas rápidas a este tipo de desafíos. Mediante el trabajo colaborativo y la iniciativa profesional se elaboró un documento orientado a evitar la estigmatización a la vez que se promovían la prevención y el control de la enfermedad. Para su divulgación se emplearon distintos canales y se contó con los agentes de interés. El trabajo en equipo, dentro de las estructuras de participación de una sociedad científica, permite impulsar acciones rápidas basadas en recomendaciones técnicas. (AU)

In May 2022, the first monkeypox transmission chains were detected outside endemic countries. This outbreak presents clinical and epidemiological characteristics different from those observed in previous outbreaks, with a greater impact among the group of men who have sex with other men. The approach of epidemic outbreaks that requires interventions on communities or populations at risk of stigmatization is a major public health challenge. The independence and professional capacity of scientific societies allow to be take initiatives to provide rapid responses to this type of challenges. Through collaborative work and professional initiative, a document was issued aimed at avoiding stigmatization while promoting the prevention and control measures. For its dissemination, different channels were used counting with key partners. Teamwork, within the participation structures of a scientific society, allows to promote rapid public health actions based on technical recommendations. (AU)

[Coordination for an affective and sexual diversity approach to monkeypox]. / Coordinación para el abordaje de la viruela del mono con perspectiva de diversidad afectiva y sexual.

In May 2022, the first monkeypox transmission chains were detected outside endemic countries. This outbreak presents clinical and epidemiological characteristics different from those observed in previous outbreaks, with a greater impact among the group of men who have sex with other men. The approach of epidemic outbreaks that requires interventions on communities or populations at risk of stigmatization is a major public health challenge. The independence and professional capacity of scientific societies allow to be take initiatives to provide rapid responses to this type of challenges. Through collaborative work and professional initiative, a document was issued aimed at avoiding stigmatization while promoting the prevention and control measures. For its dissemination, different channels were used counting with key partners. Teamwork, within the participation structures of a scientific society, allows to promote rapid public health actions based on technical recommendations.

Age-Dependent Serotype-Associated Case-Fatality Rate in Invasive Pneumococcal Disease in the Autonomous Community of Madrid between 2007 and 2020.

The aim of this study was to investigate the serotype-associated fatality rate in cases of invasive pneumococcal disease (IPD) in the Spanish region of Madrid between 2007 and 2020. Serotyping was performed by Pneumotest Latex and the Quellung reaction using commercial antisera. Case-fatality rate was estimated as the ratio between the number of deaths at hospital discharge and the number of cases attributable to each serotype. To evaluate the association measures, the odds ratios with a 95% confidence interval were calculated. Twenty five pneumococcal serotypes were associated to mortality and comprised 87.8% of the total number of isolates characterized. Serotypes 8, 3, 19A, 1, 7F, 22F, 12F, and 11A were the most prevalent (≥3% each). Serotypes 31, 11A, and 19F were significantly associated to high case-fatality rates (>20% each). The lower significantly associated case-fatality rate (<10% each) was found in serotypes 5, 1, 12B, 7F, 12F, 8, 33, and 10A. The serotypes with higher mortality levels (≥0.04 per 100,000 population) were 11A (fatality 24.0%), 3 (fatality 18.7%), 19A (fatality 12.5%), and 8 (fatality 7.2%). Serotype 3 was worrisome because it is associated with important fatality levels combined with very high incidence and mortality rates. Serotype 11A also showed a high fatality with marked incidence and mortality levels. Some few frequent serotypes as 31, 19F, and 15A despite its high fatality had low levels of mortality. By contrast other serotypes as 8 showing low fatality had high mortality ranges because it shows a wide extended distribution. Finally, common serotypes, such as 1 and 5, presented small mortality length, due to their low case-fatality rates.

Reduction in hepatitis C-related hospitalizations after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System: regional level differences.

This work evaluates the potential impact at territorial level of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System on hepatitis C virus (HCV)-associated hospitalizations. Chronic HCV-related hospitalization discharges from 2014 to 2018 were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalizations was performed for all chronic, advanced liver disease and non-advanced liver disease. Hospitalization rates were calculated at national and regional level. Year 2015 and period 2016-2018 hospitalization rates were compared to 2014 hospitalization rates using a Poisson model. Municipal standardized hospitalization rates ratios adjusted by age-group were calculated for 2016-2018 period (2014 hospitalization rates as reference). From 2014 to 2018, there were 22,352 chronic HCV-related hospitalizations. In-hospital fatality rate was 4.3% for non-advanced liver disease and 11.7% for advanced liver disease patients. National hospitalization rate decreased 22% (95% CI: 21%-22%), 16% (95% CI: 15%-17%) and 34% (95% CI: 33%-35%) in 2016-2018 compared to 2014 for all chronic, non-advanced and advanced liver disease, respectively. During 2016-2018 period, 11/19 Spanish regions achieved >20% decrease in the hospitalization rates (p < .001) for non-advanced liver disease and 19/19 (except Melilla, the rest with p < .001) for advanced liver disease. At municipal level, 84.8% and 90.2% municipalities had <20% of chronic HCV-related hospitalization need compared to 2014 adjusted by age-group. Based on the data analysed, a high impact on reducing chronic HCV-associated hospitalizations have been achieved after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System. However, small differences between regions and rural/urban areas were noticed.

Hepatitis C and hepatitis C-related advanced liver disease hospitalisation trends before and after the Strategic Plan for Tackling Hepatitis C in the National Health System.

INTRODUCTION: This work evaluates the burden and trends of hepatitis C virus (HCV)-associated hospitalisations in Spain before and after the implementation of the Strategic Plan for Tackling Hepatitis C in the National Health System in 2015. METHODS: HCV-related hospitalisation discharges from 2005 to 2017 were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalisations was performed. RESULTS: From 2005 to 2017, there were 674 067 HCV-related hospitalisations: 1.2%, 29.9%, 63.9% and 5% of them due to acute, carriers, chronic and unspecified hepatitis C. Average age of the patients was 57.7 years (SD: 16.4), average hospital stay was 9.1 days (SD: 12.2) and intra-hospital case-fatality rate was 6.5%. Hospitalisation rates decreased notably (P < 0.05) in 2016-2017 compared to 2005-2015 for all [hospitalisation rate ratio (HRR): 0.77], males (HRR: 0.80), females (HRR: 0.74), chronic hepatitis C (HRR: 0.84), non-advanced liver disease (N-AdLD) (HRR: 0.80) and AdLD (HRR: 0.73). Acute HCV (HRR: 0.54) and carriers (HRR: 0.49) show decreases in 2016-2017 vs. 2005-2015, although their rates started to decrease in 2008/2009. Unspecified HCV hospitalisation rates increased (P < 0.05) in 2016-2017 (HRR: 2.02) vs. 2005-2015. From 2015 to 2017, cost per patient increased from 5981 euros to 6349 euros, but overall cost decreased, as hospitalisations rates decreased from 302 to 264 million euros. DISCUSSION: HCV-related hospitalisation rates decreased notably in 2016 and 2017 after the strategic plan for tackling hepatitis C was launched. Although cost per AdLD patient increased in 2016 and 2017, globally costs were reduced around 35 million euros per year.

Absence of IgG antibodies among high-risk contacts of two confirmed cases of Crimean-Congo haemorrhagic fever in the autonomous region of Madrid (Spain).

Crimean-Congo haemorrhagic fever (CCHF) is a widely distributed tick-borne disease. In Spain, the disease has emerged as outbreak associated with high-risk exposures. Our goal was to evaluate the prevalence of antibodies against the CCHF virus (CCHFV) in high-risk contacts. A cross-sectional study was conducted. Three hundred eighty-six high-risk contacts were identified comprising family contacts and hospital workers who had attended the cases. Fifty-seven cases with closer exposure were selected. However, forty-nine cases participated in the study. IgG antibodies were detected by immunoenzymatic techniques. All determinations tested negative for anti-CCHFV IgG antibodies. Most of the responders were women (73.5%), and belong to the intensive care department (53.1%). In relation to other possible sources of exposures, 18.4% travelled to countries with CCHF transmission risk. No CCHF positivity was recorded among selected high-risk contacts. This highlights the importance of standard precautions which might have protected healthcare workers and care providers from CCHF infection.

Comparación de las causas de ingreso y la morbilidad hospitalaria según la identidad de género de las personas atendidas en la Comunidad de Madrid / Causes of hospital admission and morbidity according to gender identity in the Autonomous Community of Madrid

El objetivo fue identificar las diferencias en causas de ingreso y morbilidad entre las personas transgénero (trans) y cisgénero (cis) mediante el registro de altas hospitalarias de la Comunidad de Madrid. Se describieron sus características, causas de ingreso y morbilidades, comparándolas mediante razón de prevalencias e intervalo de confianza al 95% (IC95%). Las 112 altas trans se diferenciaron de las 1.043.621 altas cis en que más frecuentemente se atendieron en un solo centro (55,4 vs 9,3%), eran menores de 49 años (75,9 vs 37,1%) y se financiaron de forma privada (2,7 vs 0,4%). Los ingresos por salud mental (23,96; IC95%: 17,41-32,78), y la morbilidad por VIH (11,26; IC95%: 5,46-20,93) fueron más frecuentes entre las altas trans. La información es limitada más allá de la modificación corporal, la salud mental y el VIH. Es necesario ampliar el conocimiento respecto a la salud de este colectivo

The objective was to identify differences in health between transgender (trans) and cisgender (cis) people using the hospital discharge survey from the Autonomous Community of Madrid. Their characteristics, causes of admission and morbidities were described, comparing them by prevalence ratio and confidence interval (95% CI). One hundred and twelve trans vs 1,043,621 cis discharges were studied. The main differences were that more frequently trans people had been attended in a single center (55.4 vs. 9.3%), were under 49 years old (75.9 vs. 37.1%) and had used private health services (2.7 vs. 0.4%). Admissions related to mental health problems (23.96; 95% CI: 17.41-32.78) and HIV morbidity (11.26 95% CI: 5.46-20.93) were more frequent among trans discharges. Information is limited beyond body modification, mental health, and HIV. It is necessary to improve the knowledge about trans population's health

Impacto de la vacuna triple vírica sobre la incidencia de la parotiditis en la Comunidad de Madrid y evaluación de la efectividad de la cepa Jeryl-Lynn entre 1998 y 2016 / Impact of the MMR vaccine on the incidence of mumps in the Community of Madrid and evaluation of the effectiveness of the Jeryl-Lynn strain. Years 1998-2016

Introducción y objetivo: La parotiditis se caracteriza por la inflamación de la glándula parótida y fiebre, y es prevenible mediante vacunación con triple vírica (TV). El objetivo es evaluar el impacto y la efectividad vacunal (EV). Material y métodos: Se seleccionaron los casos notificados al Sistema de Enfermedades de Declaración Obligatoria entre 1998 y 2016. La EV se calculó en cohortes vacunadas con 2 dosis de Jeryl-Lynn, y el impacto comparando las incidencias por edad y por cohortes Rubini (1995-1998) y Jeryl-Lynn (1999-2002) en los periodos 1998-2004, 2005-2009 y 2010-2015. Las estimaciones por grupo de edad y período se compararon con las del período anterior y las estimaciones por cohortes se compararon entre sí dentro de cada período mediante razones de incidencia (RI) empleando modelos de Poisson. La EV se estimó empleando el método de cribado mediante modelos de regresión logística. Resultados: Se notificaron 13.816 casos. La incidencia en 2005-2009 fue superior a la de 1998-2004 (RI: 1,46; IC 95%: 1,40-1,53), y en 2010-2015 se mantuvo estable (RI: 0,99; IC 95%: 0,95-1,03). La incidencia anual media de las cohortes Rubini fue de 69,43 casos por 100.000 habitantes y la de las cohortes Jeryl-Lynn de 32,24. La RI fue de 0,25 (IC 95%: 0,22-0,29), 0,55 (IC 95%: 0,49-0,61) y 0,88 (IC 95%: 0,76-1,00) para cada periodo, respectivamente. Se incluyeron 2.574 casos en el estudio de EV. La EV disminuyó con el tiempo al alcanzar valores no significativos tras 7 años de seguimiento (EV: 55%; IC 95%: 82 a -12%). Conclusiones: El comportamiento de la parotiditis se caracteriza por presentar fluctuaciones, cambios en la presentación etaria y una disminución de la EV

Introduction: Mumps is characterised by parotid inflammation and fever and is preventable by vaccination with MMR vaccine. The objective of the study is to assess the impact and effectiveness of the vaccine. Material and methods: Cases notified to the Notifiable Disease System between 1998 and 2016 were used for the study. The vaccine effectiveness (VE) was calculated in cohorts vaccinated with two doses of Jeryl-Lynn, and the impact was calculated by comparing incidences by age and by Rubini (1995-1998) and Jeryl-Lynn (1999-2002) cohorts during the periods 1998-2004, 2005-2009 and 2010-2015. The incidences for age group and period were compared with the previous period and the incidences for cohorts were compared within a period with incidence ratios (IR) using Poisson models. The VE was estimated using the screening method using logistic regression models. Results: 13,816 cases were reported. The incidence in 2005-2009 was higher than in 1998-2004 (IR: 1.46, 95% CI: 1.40-1.53), and it remained stable in 2010-2015 (IR: 0.99, 95% CI: 0.95-1.03). The average incidence rate of the Rubini cohort was 69.43 and the Jeryl-Lynn cohort was 32.24. The IR was 0.25 (95% CI: 0.22-0.29), 0.55 (95% CI: 0.49-0.61) and 0.88 (95% CI: 0.76-1.00) for each period respectively. 2,574 cases were included in the VE study. EV decreased over time reaching not significant values after seven years of follow-up (VE: 55%, 95% CI: 82 to -12%). Conclusions: Parotiditis behavior is characterised by fluctuations, changes in presentation and a decrease in VE

Terapias de conversión en España: entre la LGTB-fobia y la iatrogenia / Conversion therapies in Spain: between LGBT-phobia and iatrogenesis

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Impact of the MMR vaccine on the incidence of mumps in the Community of Madrid and evaluation of the effectiveness of the Jeryl-Lynn strain. Years 1998-2016. / Impacto de la vacuna triple vírica sobre la incidencia de la parotiditis en la Comunidad de Madrid y evaluación de la efectividad de la cepa Jeryl-Lynn entre 1998 y 2016.

INTRODUCTION: Mumps is characterised by parotid inflammation and fever and is preventable by vaccination with MMR vaccine. The objective of the study is to assess the impact and effectiveness of the vaccine. MATERIAL AND METHODS: Cases notified to the Notifiable Disease System between 1998 and 2016 were used for the study. The vaccine effectiveness (VE) was calculated in cohorts vaccinated with two doses of Jeryl-Lynn, and the impact was calculated by comparing incidences by age and by Rubini (1995-1998) and Jeryl-Lynn (1999-2002) cohorts during the periods 1998-2004, 2005-2009 and 2010-2015. The incidences for age group and period were compared with the previous period and the incidences for cohorts were compared within a period with incidence ratios (IR) using Poisson models. The VE was estimated using the screening method using logistic regression models. RESULTS: 13,816 cases were reported. The incidence in 2005-2009 was higher than in 1998-2004 (IR: 1.46, 95% CI: 1.40-1.53), and it remained stable in 2010-2015 (IR: 0.99, 95% CI: 0.95-1.03). The average incidence rate of the Rubini cohort was 69.43 and the Jeryl-Lynn cohort was 32.24. The IR was 0.25 (95% CI: 0.22-0.29), 0.55 (95% CI: 0.49-0.61) and 0.88 (95% CI: 0.76-1.00) for each period respectively. 2,574 cases were included in the VE study. EV decreased over time reaching not significant values after seven years of follow-up (VE: 55%, 95% CI: 82 to -12%). CONCLUSIONS: Parotiditis behavior is characterised by fluctuations, changes in presentation and a decrease in VE.

Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination.

BACKGROUND: Pneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies. METHODS: For each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011-2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 - IRR)*100. RESULTS: After five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI -4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes included in PCV13 and not in PCV10 decreased 37% (95% CI 22% to 50%) in six PCV13 sites and increased by 50% (95% CI -8% to 146%) in the four sites using PCV10 (alone or with PCV13). In 2015, PCV13 serotypes represented 20-29% and 32-53% of IPD cases in PCV13 and PCV10 sites, respectively. CONCLUSION: Overall IPD incidence in older adults decreased moderately after five childhood PCV10/13 years in 13 European sites. Large declines in PCV10/13 serotype IPD, due to the indirect effect of childhood vaccination, were countered by increases in non-PCV13 IPD, but these declines varied according to the childhood vaccine used. Decision-making on pneumococcal vaccination for older adults must consider the indirect effects of childhood PCV programmes. Sustained monitoring of IPD epidemiology is imperative.

Información accesible y de calidad para una elección informada en la residencia de Medicina Preventiva y Salud Pública / Accessible and quality information for an informed choice in the Preventive Medicine and Public Health specialty

INTRODUCCIÓN: La elección de especialidad y unidad docente (UD) es un momento importante en la trayectoria profesional médica. La Asociación de Residentes de Medicina Preventiva y Salud Pública detectó necesidades de información de los aspirantes no cubiertas por las UD. Por este motivo se evaluó la accesibilidad y la calidad de las páginas web de las UD. MÉTODOS: La accesibilidad se consideró como el orden de aparición de la página de cada UD entre los resultados de las búsquedas realizadas en Google. La calidad se midió mediante un cuestionario ad hoc realizado a partir del análisis de las consultas a la Asociación de Residentes de Medicina Preventiva y Salud Pública de los aspirantes, cuya puntuación varía de 0, mínima calidad, a 100, máxima calidad. RESULTADOS: De las 24 UD 13 presentan página web accesible. La mediana de calidad es 30,5 puntos y solamente una UD tiene una puntuación superior a 50 puntos. CONCLUSIONES: Las necesidades de los opositores están parcialmente cubiertas. Es necesario aumentar la accesibilidad y mejorar la calidad de la información de las webs de las UD

INTRODUCTION: Choosing a specialty and a teaching unit (TU) is an important time in a medical career. The Association of Preventive Medicine and Public Health Residents has detected the information needs of candidates that are not met by TUs. The aim of this article is to evaluate the accessibility and quality of TU websites. METHODS: Accessibility was measured by the order of appearance of the TU website in the results of a Google search. Quality was measured by an ad hoc questionnaire based on the analysis of queries made by candidates to Association of Preventive Medicine and Public Health Residents. The scores in this questionnaire ranged from 0, minimum quality, to 100, maximum quality. RESULTS: Of the 24 TUs evaluated, only 13 had websites. The median of the quality questionnaire was 30.5 points, and only one TU had a score higher than 50 points. CONCLUSION: The needs of candidates are partly met, but it is necessary to improve the accessibility and the quality of the information in TU websites

Inclusión de la orientación afectivo-sexual y de las identidades de género como determinantes sociales de la salud / Inclusion of affective-sexual orientation and gender identities as social determinants of health

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Effectiveness and impact of a single-dose vaccine against chickenpox in the community of Madrid between 2001 and 2015.

BACKGROUND: Chickenpox is a contagious airborne disease. Immunization by varicella vaccine is an effective preventive measure. The objective of this study is to evaluate the impact and effectiveness of a single-dose vaccination against chickenpox at 15 months of age. METHODS: Observational study based on data from the Epidemiological Surveillance System of the Autonomous Community of Madrid from 2001 to 2015. The years were grouped into 4 periods according to epidemic cycles and vaccination schedule: 2001-06, 2007-10, 2011-13 and 2014-15. The impact was calculated as Relative Risk (RR) between the incidence of chickenpox in children between 15 months and 13 years of age between 2011-13 and 2001-06 through Poisson regression using notifications made to the Diseases of Compulsory Declaration (DCD) system, the Sentinel Physicians Network (SPN) and hospital discharge records noted as Minimum Basic Data Set (MBDS). The vaccine effectiveness (VE) was calculated using the screening method and a 1:2 case-control study paired by age and paediatrician in population from 15 months to 13 years and between 2007 and 2015 using SPN source data. RESULTS: The RR2011-13/2001-06 using data from the DCD was 0.14 (95% CI: 0.14 to 0.15), 0.07 (95% CI: 0.06 to 0.08) from SPN and 0.17 (95% CI: 0.15 to 0.20) from MBDS. A total of 338 cases were included in the VE screening obtaining an overall of 76.7% (IC 95%: 71.9 to 80.7%). For a case-control study, 120 cases and 247 controls were recruited obtaining a VE of 92.4% (IC 95%: 80.8 to 97.0%). CONCLUSIONS: The single-dose vaccination against chickenpox at 15 months of age has high impact and effectiveness.

La identidad de género, factor de desigualdad olvidado en los sistemas de información de salud de España / Gender identity, a factor of inequality forgotten by Spanish health information systems

El Sistema de Información Sanitaria (SIS) español recoge información sobre la salud. Las personas trans tienen peor estado de salud. El objetivo de este trabajo ha sido valorar la adecuación del SIS para recoger las necesidades de salud de las personas trans. Se revisaron las fuentes de información del SIS disponibles en el Portal Estadístico del Sistema Nacional de Salud con datos sobre la población. Se buscaron las variables «sexo» e «identidad de género». Se incluyeron 19 fuentes. En todas estaba la variable «sexo» y en ninguna la variable «identidad de género». En dos, la variable «sexo» permitía valores de «transexual». El SIS contiene escasa información respecto a la identidad de género. Esto conduce a la invisibilidad de las personas trans en las estadísticas de salud. La obtención de esta información permitiría conocer las barreras de acceso y las necesidades de salud de uno de los colectivos más discriminados de nuestra sociedad (AU)

The Spanish Health Information System (HIS) collects health information. Trans people have poorer health status. This paper aimed to assess the adequacy of the HIS to collect the health data on trans individuals. The HIS sources available in the Statistical Portal of the National Health System were reviewed. The sources containing population health data were selected. The variables "sex" and "gender identity" were searched. Nineteen sources were identified. In all of them the variable "sex" was found, whereas "gender identify" did not appear in any of the 19. In two sources, the variable "sex" allowed values of "transsexual". The SIS contains little information regarding gender identity. This leads to the invisibility of trans people in Spanish health statistics. Obtaining this information would allow for a better understanding of the barriers to health care access, and the health needs of one of the most discriminated groups in our society (AU)

[Gender identity, a factor of inequality forgotten by Spanish health information systems]. / La identidad de género, factor de desigualdad olvidado en los sistemas de información de salud de España.

The Spanish Health Information System (HIS) collects health information. Trans people have poorer health status. This paper aimed to assess the adequacy of the HIS to collect the health data on trans individuals. The HIS sources available in the Statistical Portal of the National Health System were reviewed. The sources containing population health data were selected. The variables "sex" and "gender identity" were searched. Nineteen sources were identified. In all of them the variable "sex" was found, whereas "gender identify" did not appear in any of the 19. In two sources, the variable "sex" allowed values of "transsexual". The SIS contains little information regarding gender identity. This leads to the invisibility of trans people in Spanish health statistics. Obtaining this information would allow for a better understanding of the barriers to health care access, and the health needs of one of the most discriminated groups in our society.