Hospital admissions due to suicide attempts during the COVID-19 pandemic, a 3-year longitudinal study.

The appearance of the SARS CoV-2 virus and the associated COVID-19 pandemic has been associated with the onset of mental disorders in healthy people and the worsening in those with pre-existing mental conditions. One of the areas that has raised the greatest concern is that of suicidality. Most of the published studies have been carried out cross-sectional or with small samples, without stratifying by age and gender. Thus, the aim of this longitudinal research is to study, in a large population sample of around 6,700,000 inhabitants belonging to the entire region of Madrid (Spain), the admissions in psychiatric hospitalization units due to suicidal attempts along 2019, 2020 and 2021. No clear increase in the number of admissions due to suicidality in the total population have been found. In addition, a higher prevalence in admissions among women is verified. Moreover, stratifying by age and gender, a striking and significant increase in hospital admissions due to suicidality has been observed in the group up to 17 years old, from September 2020 until the end of the study. These results highlight the special vulnerability of children and adolescents, specifically girls, and the need for preventive measures in the face of future pandemics.

Características de la conducta suicida y factores asociados a su mortalidad en el ámbito hospitalario / Suicidal behaviour characteristics and factors associated with mortality in the hospital setting

Introducción: El suicidio es un importante problema de salud pública mundial, de necesario abordaje por su alto potencial preventivo. Este trabajo estudia las principales características de las personas ingresadas en hospitales de la Comunidad de Madrid (España) con conducta suicida y los factores asociados a su mortalidad intrahospitalaria. Material y métodos: Se estudian los códigos E950-E959 de suicidio y lesiones autoinfligidas de la Clasificación Internacional de Enfermedades, Novena Revisión, Modificación Clínica, contenidos en los campos diagnósticos del conjunto mínimo básico de datos al alta hospitalaria entre 2003 y 2013. Se describen variables sociodemográficas, clínicas y asistenciales mediante análisis uni y multivariante de regresión logística en la valoración de factores asociados a la mortalidad intrahospitalaria. Resultados: La conducta suicida hospitalizada predomina en mujeres (58,7%) y en edades medias. La mortalidad intrahospitalaria es del 2,2% (1,6% en mujeres y 3,2% en hombres), aumentando con la edad. Los trastornos mentales se detectan 3-4 veces más en diagnósticos secundarios. El diagnóstico principal mayoritario (>74%) es el envenenamiento por sustancias, con una mortalidad inferior (∼1%) a la de las lesiones por ahorcamiento y precipitación (≥12%), que presentan las cifras más elevadas. Otros factores asociados con una mayor mortalidad son diversas comorbilidades médicas y la gravedad de la lesión, mientras que la estancia y los trastornos mentales son factores protectores en ambos sexos. El tipo de hospital, el envenenamiento con sustancias y el índice de Charlson se asocian a la mortalidad de forma diferencial en hombres y mujeres. Conclusiones: Los actos suicidas hospitalizados presentan una baja mortalidad, la cual está principalmente relacionada con las comorbilidades y la gravedad de las lesiones

Introduction: Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality. Material and methods: A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality. Results: Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women. Conclusions: Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries

Suicidal behaviour characteristics and factors associated with mortality in the hospital setting. / Características de la conducta suicida y factores asociados a su mortalidad en el ámbito hospitalario.

INTRODUCTION: Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality. MATERIAL AND METHODS: A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality. RESULTS: Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women. CONCLUSIONS: Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries.

Main causes of hospitalization in people with Angelman syndrome.

BACKGROUND: The objective was to describe the main causes of hospitalization in people with Angelman syndrome (AS). METHOD: Population-based cross-sectional study in the Community of Madrid (CM), Spain. The information source for AS cases was the information system for rare diseases in the CM. Variables related to hospitalization, for the period 2006-2014, were the following: number of episodes, outcome, main cause, length of stay and type of admission. Main causes of hospitalization were described by age group and sex. RESULTS: The most frequent causes of hospitalization were the following: oral-dental care (28.9%), seizures (19.6%), orthopaedic problems (14.4%) and acute respiratory disorders (12.4%). The percentage of hospitalizations was higher for oral-dental care in women and for orthopaedic problems in men (p-value <.05). Hospitalizations for an acute respiratory disorder were higher in adults (p-value <.05). CONCLUSIONS: Some differences in the causes of hospitalization of people with AS were observed by sex and age.

Tabaquismo y trastorno mental grave: conceptualización, abordaje teórico y estudios de intervención / Smoking and severe mental disorders: conceptualization, theoretical approach and intervention studies

El hábito tabáquico es un grave problema de salud en los pacientes con trastorno mental grave. Este trabajo realiza una revisión actualizada de sus bases neurofisiológicas y abordaje terapéutico. Existe una vinculación conocida entre neurotransmisión nicotínica y esquizofrenia sin una propuesta de modelo etiológico. El abordaje terapéutico del tabaquismo en enfermos psiquiátricos requiere formación específica y unidades de tabaquismo o servicios de salud mental preparados. La asociación con consumo de sustancias tóxicas, psicofármacos, comorbilidad psiquiátrica y falta de motivación profesional constituyen factores limitantes. La intervención breve aprovecha el contacto sanitario para explorar la presencia de tabaquismo y valorar la predisposición del paciente a dejar de fumar. El tratamiento utiliza terapia sustitutiva con nicotina, antidepresivos, agonistas del receptor nicotínico y/o intervenciones psicosociales. El tratamiento con bupropion es el más efectivo y seguro, mientras la terapia sustitutiva con nicotina y la vareniclina son también útiles. En la práctica clínica la utilización de farmacoterapia y psicoterapia puede ser la opción más razonable (AU)

Smoking is a serious health problem in patients with severe mental disorder. This paper is an updated review of its neurophysiological basis and therapeutic approach. There is a known link between nicotinic neurotransmission and schizophrenia without a proposed etiological model. The therapeutic approach of smoking in psychiatric patients requires specific training and smoking units or prepared mental health services. The association with substance abuse, psychiatric drugs, psychiatric comorbidity and lack of professional motivation are limiting factors. Brief intervention uses the health contact to explore smoking status and assess the preparation of the patient to stop smoking. Treatment uses nicotine replacement therapy, antidepressants, nicotine receptor agonist and/or psychosocial interventions. Treatment with bupropion is the most effective and safe, while nicotine replacement therapy and varenicline are also useful. In clinical practice the use of pharmacotherapy and psychotherapy may be the most reasonable option (AU)

Asistencia psiquiátrica ambulatoria en la población inmigrante de Segovia (2001-2008): estudio descriptivo / Outpatient psychiatric care in the immigrant population of Segovia (2001-2008): descriptive study

Introducción. La inmigración es un fenómeno con una repercusión importante en la salud mental. Los objetivos de este estudio fueron describir características asistenciales, evolución temporal, diferencias entre inmigrantes, y diagnósticos asociados a las nuevas consultas psiquiátricas ambulatorias en inmigrantes en Segovia. Material y métodos. Se realizó un estudio descriptivo de nuevas consultas con variables sociodemográficas, asistenciales y clínicas procedentes del registro informático del Centro de Salud Mental «Antonio Machado» para 2001-2002 y 2008 comparando población inmigrante y española. Se calcularon incidencias poblacionales por sexo, regiones geográficas y países de origen. Mediante análisis multivariante de regresión logística se estudió la asociación entre los diagnósticos CIE-10 y la inmigración. Resultados. Los inmigrantes tuvieron una edad media 10 años menor que los españoles. La tasa de incidencia de nuevas consultas fue siempre más alta en mujeres, disminuyó en inmigrantes y aumentó en españoles entre 2001 y 2008. Centro-suramericanos y europeos orientales presentaron las mayores y menores tasas de nuevas consultas, respectivamente. Bulgaria, Marruecos, Rumania y Polonia fueron los países más representativos en 2008, con bajas incidencias. Los trastornos neuróticos y somatomorfos fueron los más frecuentes con independencia del origen del paciente. Los trastornos psicóticos y de personalidad se asociaron positivamente a la inmigración en el análisis multivariante. Conclusiones. La atención de inmigrantes en salud mental en Segovia se caracteriza por una edad joven, una menor incidencia de nuevas consultas con diferencias importantes entre regiones, y una asociación diagnóstica con procesos más graves, lo que puede reflejar fenómenos de infrautilización e infradiagnóstico(AU)

Introduction. Immigration is a phenomenon with a significant impact on mental health. The aims of this study were to describe health care characteristics, time trends, differences among inmigrant, and diagnoses associated with new outpatient psychiatric consultation inmigrants in Segovia. Methods. A descriptive study of new consultations with sociodemographic, health care and clinical variables computerized records from the «Antonio Machado» Mental Health Center for 2001-2002 and 2008 comparing immigrant and Spanish population. Population incidences were calculated by sex, geographic regions and countries of origin. By multivariate logistic regression assessed the relationship between ICD-10 diagnoses and immigration. Results. Immigrants had an average age 10 years younger than the Spanish. Incidence rate of new consultation was always higher in women, decreased in immigrants and increased in the Spanish between 2001 and 2008. South Central Americans and Eastern Europeans had the highest and lowest rates of new visits, respectively. Bulgaria, Morocco, Romania and Poland were the countries most representative in 2008, with low incidences. Neurotic and somatoform disorders were the most common regardless of the origin of the patient. Psychotic and personality disorders were positively associated with immigration in the multivariate analysis. Conclusions. The attention of mental health immigrants in Segovia is characterized by young age, lower incidence of new queries with important variations between regions, and diagnostic association with processes more severe, which may reflect underdiagnosis and underutilization phenomena(AU)

[Outpatient psychiatric care in the immigrant population of Segovia (2001-2008): descriptive study]. / Asistencia psiquiátrica ambulatoria en la población inmigrante de Segovia (2001-2008): estudio descriptivo.

INTRODUCTION: Immigration is a phenomenon with a significant impact on mental health. The aims of this study were to describe health care characteristics, time trends, differences among Immigrant, and diagnoses associated with new outpatient psychiatric consultation Immigrant in Segovia. METHODS: A descriptive study of new consultations with sociodemographic, health care and clinical variables computerized records from the «Antonio Machado¼ Mental Health Center for 2001-2002 and 2008 comparing immigrant and Spanish population. Population incidences were calculated by sex, geographic regions and countries of origin. By multivariate logistic regression assessed the relationship between ICD-10 diagnoses and immigration. RESULTS: Immigrants had an average age 10 years younger than the Spanish. Incidence rate of new consultation was always higher in women, decreased in immigrants and increased in the Spanish between 2001 and 2008. South Central Americans and Eastern Europeans had the highest and lowest rates of new visits, respectively. Bulgaria, Morocco, Romania and Poland were the countries most representative in 2008, with low incidences. Neurotic and somatoform disorders were the most common regardless of the origin of the patient. Psychotic and personality disorders were positively associated with immigration in the multivariate analysis. CONCLUSIONS: The attention of mental health immigrants in Segovia is characterized by young age, lower incidence of new queries with important variations between regions, and diagnostic association with processes more severe, which may reflect underdiagnosis and underutilization phenomena.

Modelos de ajuste de riesgo para la evaluación de la mortalidad hospitalaria / Risk-adjustment models for in-hospital mortality assessment

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Características clinicoasistenciales y factores asociados a la mortalidad intrahospitalaria por cáncer de pulmón en España / Clinical care characteristics and factors associated with in-hospital mortality for lung cancer in Spain

Background and objective: Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality. Material and method: Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions. Results: Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain. Conclusions: Differential clinical characteristics, health care and overall results appear to exist depending on individuals’ gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system (AU)

Fundamento y objetivo: El cáncer de pulmón produce elevada morbimortalidad en España, con un notable incremento actual en las mujeres. El objetivo de este estudio es describir, en función del sexo, las características clínicas y asistenciales, así como los factores asociados y las diferencias geográficas de la mortalidad intrahospitalaria en pacientes con cáncer de pulmón. Material y método: Se estudiaron descriptivamente los episodios del conjunto mínimo básico de datos al alta hospitalaria nacional de 2005 por tipo de ingreso y sexo. Se construyeron dos modelos de regresión logística según sexo para explicar la influencia individual de las variables de interés en la mortalidad intrahospitalaria. Mediante las predicciones resultantes se obtuvieron razones de mortalidad estandarizadas para estudiar las comunidades autónomas. Resultados: Las mujeres presentan menor edad media, tabaquismo y mortalidad intrahospitalaria, y en mayor grado adenocarcinomas, atención en centros de alto volumen, cirugía en reingresos y quimioterapia en nuevos ingresos que los varones. El adenocarcinoma en varones y la localización no especificada en mujeres se asocian a mayor mortalidad. El tabaquismo y las pruebas diagnósticas pulmonares en varones, y la localización en lóbulo medio y la broncoscopia en mujeres están asociados a una menor mortalidad. El patrón geográfico de mortalidad detectado es similar en ambos sexos en algunas comunidades, pero difiere en otras. Conclusiones: Existen características diferenciales clínicas, asistenciales y de resultados en función del sexo del paciente. Su reconocimiento es crucial para conseguir mejorar la efectividad y equidad de nuestro sistema sanitario (AU)

[Clinical care characteristics and factors associated with in-hospital mortality for lung cancer in Spain]. / Características clinicoasistenciales y factores asociados a la mortalidad intrahospitalaria por cáncer de pulmón en España.

BACKGROUND AND OBJECTIVE: Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality. MATERIAL AND METHOD: Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions. RESULTS: Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain. CONCLUSIONS: Differential clinical characteristics, health care and overall results appear to exist depending on individuals' gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system.

[Hospital management of pancreatic cancer in Spain and assessment of factors associated with in-hospital mortality]. / Manejo hospitalario del cáncer de páncreas en España y estudio de los factores asociados a la mortalidad intrahospitalaria.

BACKGROUND: Pancreatic cancer is becoming an increasingly important health problem in Spain. This study aimed to analyze the hospital management of this process and the factors associated with mortality by using an administrative data base. MATERIAL AND METHOD: We performed a descriptive study. Socio-demographic, clinical, diagnostic, and therapeutic variables of episodes registered in the national Hospital Discharge Minimum Data Set for 2004 were gathered. Comorbidity was assessed with the Charlson index. A logistic regression model was built to explain the individual influence of variables on in-hospital mortality. Mortality in the 17 autonomous regions of Spain was analyzed by using standardized mortality rates, through predicted mortality obtained from the multivariate model. RESULTS: The mean age was 68 years and men represented 56%. Readmissions accounted for 80% of the cases. The most frequent localization was in the pancreatic head and the most frequently employed procedures were computed tomography and surgery. In-hospital mortality was 25%, was higher in men, and increased with age. Mortality was higher in new admissions than in readmissions. Factors associated with higher mortality in the multivariate analysis were male sex, age, unspecified location or location in the tail, emergency admission, hospital stay, and comorbidity. Observed mortality was higher than expected in the Canary Islands and Madrid and was lower than expected in Catalonia and the Valencian Community. DISCUSSION: Future studies with more detailed information should be performed to allow the factors associated with in-hospital mortality from pancreatic cancer to be confirmed and to clarify the reasons for the geographical differences identified.

Manejo hospitalario del cáncer de páncreas en España y estudio de los factores asociados a la mortalidad intrahospitalaria / Hospital management of pancreatic cancer in Spain and assessment of factors associated with in-hospital mortality

Introducción: El cáncer de páncreas es un proceso de salud de importancia creciente en España. El objetivo de este estudio es explorar su manejo y los factores asociados a su mortalidad en el hospital mediante una base de datos administrativa. Material y método: Se realiza un estudio descriptivo con variables sociodemográficas y clínicas, y procedimientos diagnósticos y terapéuticos de episodios contenidos en el Conjunto Mínimo Básico de Datos al alta hospitalaria nacional del año 2004. La comorbilidad se valora mediante el índice de Charlson. Se construye un modelo de regresión logística para explicar la influencia individual de las variables de interés en la mortalidad intrahospitalaria. Mediante razones de mortalidad estandarizadas, a través de las predicciones de mortalidad del modelo multivariante, se estudian las 17 comunidades autónomas españolas. Resultados: La edad media es de 68 años y los varones representan el 56%. Los reingresos representan el 80%. La localización predominante es la cabeza del páncreas, y los procedimientos más empleados, la tomografía computarizada y la cirugía. La mortalidad intrahospitalaria es del 25%, superior en varones, y aumenta con la edad. La mortalidad es mayor en los nuevos ingresos que en los reingresos. Los factores asociados a mayor mortalidad en el análisis multivariante son: sexo masculino, edad, localización en la cola del páncreas o no especificada, ingreso urgente, estancia y comorbilidad. Canarias y Madrid presentan una mortalidad observada superior a la esperada; en cambio, en Cataluña y la Comunidad Valenciana sucede lo contrario. Discusión: Es necesario abordar futuros estudios con información más detallada que permitan confirmar los factores involucrados en la mortalidad intrahospitalaria del cáncer de páncreas y clarificar las razones de las diferencias geográficas encontradas

Background: Pancreatic cancer is becoming an increasingly important health problem in Spain. This study aimed to analyze the hospital management of this process and the factors associated with mortality by using an administrative data base. Material and method: We performed a descriptive study. Socio-demographic, clinical, diagnostic, and therapeutic variables of episodes registered in the national Hospital Discharge Minimum Data Set for 2004 were gathered. Comorbidity was assessed with the Charlson index. A logistic regression model was built to explain the individual influence of variables on in-hospital mortality. Mortality in the 17 autonomous regions of Spain was analyzed by using standardized mortality rates, through predicted mortality obtained from the multivariate model. Results: The mean age was 68 years and men represented 56%. Readmissions accounted for 80% of the cases. The most frequent localization was in the pancreatic head and the most frequently employed procedures were computed tomography and surgery. In-hospital mortality was 25%, was higher in men, and increased with age. Mortality was higher in new admissions than in readmissions. Factors associated with higher mortality in the multivariate analysis were male sex, age, unspecified location or location in the tail, emergency admission, hospital stay, and comorbidity. Observed mortality was higher than expected in the Canary Islands and Madrid and was lower than expected in Catalonia and the Valencian Community. Discussion: Future studies with more detailed information should be performed to allow the factors associated with in-hospital mortality from pancreatic cancer to be confirmed and to clarify the reasons for the geographical differences identified

Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis.

BACKGROUND: Intragastric balloons have been used since 1985 to treat obesity, but an evidence-based systematic review had not been previously performed. The objective of this study is to determine the safety, efficacy, and effectiveness of the most widely used balloon, BioEnterics Intragastric Balloon (BIB), to treat obesity. METHODS: Systematic literature review of Medline, Embase, and other information sources from inception to March 2006. The quality of selected studies was assessed. Meta-analysis of weighted mean difference was made using the inverse variance method. RESULTS: We pooled 15 articles (3,608 patients) to estimate BIBs effectiveness. The estimates for weight lost at balloon removal for BIB were the following: 14.7 kg, 12.2% of initial weight, 5.7 kg/m(2), and 32.1% of excess weight. However, data were scant after balloon removal. Yet, efficacy at balloon removal was estimated with a meta-analysis of two randomized controlled trials (75 patients) that compared balloon versus placebo, indicating the balloon group lost more weight than the placebo group. These differences in weight lost were 6.7 kg, 1.5% of initial weight, 3.2 kg/m(2), and 17.6% of excess weight. Regarding BIB safety, the majority of complications were mild and the early removal rate was 4.2%. CONCLUSION: The use of the BIB, within a multidisciplinary weight management program, is a short-term effective treatment to lose weight, but it is not yet possible to verify its capacity to maintain the weight lost over a long period of time.

[Development of an acute myocardial infarction risk adjustment model for Spain: comparison to the Charlson model and the ICES model. Application for gauging care results]. / Desarrollo de un modelo de ajuste por el riesgo para el infarto agudo de miocardio en españa: comparación con el modelo de Charlson y el modelo ICES. Aplicaciones para medir resultados asistenciales.

BACKGROUND: Acute myocardial infarction has a major bearing on morbimortality in developed countries. This study is aimed at developing a risk adjustment model for assessing the results of managing this disease and comparing how this management is carried out with other models. METHODS: A risk adjustment model is developed for acute myocardial infarction by means of logistic regression with the information from an administrative database including various Spanish hospitals, taking the intrahospital mortality rate as the response variable and variables inherent to the patient proper as predictive variables. The predictability thereof is compared to the Charlson Model and the ICES model. These models are applied for assessing the intrahospital mortality rate. RESULTS: The age (OR: 1.07), the anterolateral location (OR: 2.32) and inferoposterior location (OR: 1.91), cardiogenic shock (OR: 39.99), arrhythmia (OR: 94.43), cerebrovascular disease (OR: 2.15) and kidney failure (OR: 1.87) are shown to be related to a higher risk of death. The model developed provides a better predictability (-2LL: 2240) than the Charlson model (-2LL: 3073) and the ICES model (-2LL: 2366). There are no significant differences in the risk-adjusted death rate for the 23 hospitals studied, nor any differences between public and private hospitals nor the care volume or technological level. Coronariography (RMAR: 0.66) and percutaneous coronary interventions (RMAR: 0.69) are procedures having a protective effect. CONCLUSIONS: The model developed may be a useful tool for assessing the hospital care provided for myocardial infarction.

Desarrollo de un modelo de ajuste por el riesgo para el infarto agudo de miocardio en España: comparación con el modelo de Charlson y el modelo Ices. Aplicaciones para medir resultados asistenciales / Development of an acute myocardial infarction risk adjustment model for Spain: comparison to the Charlson model and the Ices model. Application for gauging care results

Fundamento: El infarto agudo de miocardio representa unaimportante carga de morbimortalidad en los países desarrollados. Elobjetivo de este trabajo es desarrollar un modelo de ajuste por el riesgopara evaluar los resultados del manejo de esta patología y compararsu desempeño con otros modelos.Métodos: Se desarrolla un modelo de ajuste de riesgo para elinfarto agudo de miocardio mediante regresión logística con la informaciónde una base de datos administrativa de hospitales españoles,considerando la mortalidad intrahospitalaria como variable respuestay variables propias del paciente como predictoras. Se compara sucapacidad predictiva con la del modelo de Charlson y el modelo ICES.Los modelos se aplican para evaluar la mortalidad intrahospitalaria.Resultados: La edad (OR: 1,07); la localización anterolateral(OR: 2,32) e inferoposterior (OR:1,91); el shock cardiogénico(OR:39,99), las arritmias (OR: 94,43), la enfermedad cerebrovascular(OR:2,15) y la insuficiencia renal (OR:1,87) aparecen asociadoscon un mayor riesgo de mortalidad. El modelo desarrollado ofrecemejor capacidad predictiva (-2LL: 2240) que el modelo de Charlson(-2LL: 3073) y el modelo ICES (-2LL: 2366). No hay diferenciassignificativas en la mortalidad ajustada por el riesgo de los 23 hospitalesestudiados, ni diferencias entre centros públicos y privados, nipor volumen de atención o nivel tecnológico. La coronariografía(RMAR: 0,66) y las intervenciones coronarias percutáneas (RMAR:0,69) son procedimientos con efecto protector.Conclusiones: El modelo desarrollado puede constituir unaherramienta útil para evaluar la práctica asistencial del infarto encentros hospitalarios(AU)

Background: Acute myocardial infarction has a major bearingon morbimortality in developed countries. This study is aimed atdeveloping a risk adjustment model for assessing the results ofmanaging this disease and comparing how this management iscarried out with other models.Methods: A risk adjustment model is developed for acute myocardialinfarction by means of logistic regression with the informationfrom an administrative database including various Spanish hospitals,taking the intrahospital mortality rate as the response variableand variables inherent to the patient proper as predictive variables.The predictability thereof is compared to the Charlson Model and theICES model. These models are applied for assessing the intrahospitalmortality rate.Results: The age (OR: 1.07), the anterolateral location (OR:2.32) and inferoposterior location (OR:1.91), cardiogenic shock(OR:39.99), arrhythmia (OR: 94.43), cerebrovascular disease(OR:2.15) and kidney failure (OR:1.87) are shown to be related to ahigher risk of death. The model developed provides a better predictability(-2LL: 2240) than the Charlson model (-2LL: 3073) and theICES model (-2LL: 2366). There are no significant differences in therisk-adjusted death rate for the 23 hospitals studied, nor any differencesbetween public and private hospitals nor the care volume ortechnological level. Coronariography (RMAR: 0.66) and percutaneouscoronary interventions (RMAR: 0.69) are procedures having aprotective effect.Conclusions: The model developed may be a useful tool forassessing the hospital care provided for myocardial infarction(AU)

Evolución de la enfermedad meningocócica en la Comunidad de Madrid. Efectividad de la vacunación antimeningocócica A+C / Evolution of meningococcal disease in the community of Madrid. Efficacy of A+C meningococcal vaccination

FUNDAMENTO: En el año 1997 (entre el 22 de septiembre y el 14 de noviembre) se efectuó una campaña de vacunación antimeningocócica A+C en la Comunidad de Madrid, en el grupo de edad de 18 meses a 19 años, ante el aumento del número de casos de enfermedad meningocócica por serogrupo C presentado en la temporada 1996-97. Este estudio forma parte de la evaluación de dicha campaña. MÉTODOS: Se ha valorado la evolución de la incidencia de la enfermedad meningocócica, mediante la comparación de tasas; y se ha determinado la efectividad de la vacunación al año (temporada 1997-98) y a los dos años (temporadas 1997-98 y 1998-99) de seguimiento. La efectividad vacunal se ha calculado como (1-(Tasa en vacunados/Tasa en no vacunados))*100. RESULTADOS: Se ha producido un descenso significativo en la incidencia de enfermedad meningocócica por serogrupo C al comparar las temporadas 1997-98 y 1998-99 con la temporada epidémica (1996-97). La efectividad vacunal a los dos años de seguimiento tras la campaña de vacunación ha sido de un 76,9 por ciento para la población global de 18 meses a 19 años y de un 88,5 por ciento en el grupo de vacunados entre 15 y 19 años. CONCLUSIONES: La efectividad vacunal obtenida es compatible con lo descrito en la literatura. La disminución significativa de la incidencia de enfermedad meningocócica por serogrupo C ha sido debida a la efectividad vacunal obtenida (AU)