Utilisation of primary healthcare services by Sjögren's syndrome patients in the Community of Madrid and associated factors: a population-based cross-sectional study.

OBJECTIVES: To describe the utilisation of primary health care (PHC) services and factors associated with its use by patients diagnosed with Sjögren's syndrome (SS). METHODS: Population-based cross-sectional cohort of SS patients in Madrid, Spain (SIERMA). Sociodemographic, diagnostic, clinical and PHC service utilisation variables were studied by bivariate analyses and regression models. RESULTS: A total of 4,778 SS patients were included, 65.2% classified as primary SS (pSS), while 34.8% associated with another autoimmune disease (associated SS). Mean age was 64.3 years, and 92.8% of the patients were women. A total of 87.5% used PHC services, with a mean of 19.8 consultations/year. The general practitioner was the most visited health professional, with a mean of 10.9 consultations/year, followed by the nurse, with a mean of 5.7. Characteristics associated with a greater use of PHC services in SS patients were associated SS, higher adjusted morbidity groups (AMG) risk level and older age. Additional factors included symptoms such as dry mouth, fatigue, dry vagina and joint and muscle pain; comorbidities such as atrial fibrillation, diabetes, hypertension, solid malignant neoplasms, coronary heart disease and chronic obstructive pulmonary disease; and treatments such as sterile saline solution, corticosteroids, opioids and biologic disease-modifying anti-rheumatic drugs. CONCLUSIONS: Most SS patients used PHC services during the study period, and the mean number of consultations was remarkably high. Utilisation was mainly associated with AMG risk level, ageing, glandular and extra-glandular symptoms, substantial comorbidities and various treatments. An optimised design of PHC policies will facilitate early diagnosis, improved management and better quality of life for SS patients.

Accuracy of anthropometric measurements and weight status perceptions reported by parents of 4-year-old children.

OBJECTIVE: To assess the validity of self-reported height and weight by parents of 4-year-old children and subjective weight perception. DESIGN: Descriptive cross-sectional study. SETTING: Paediatric population living in the Autonomous Community of Madrid. PARTICIPANTS: Children born in 2008-2009 examined at 47-59 months of age. Data were collected by paediatricians of the Madrid Primary Care Physicians Sentinel Network. Parents reported weight and height data. Prevalence of weight status categories was calculated using WHO and International Obesity Task Force (IOTF) reference criteria. Sensitivity, specificity and positive predictive value (PPV) were estimated. The appraisal of their child's weight perception and parental misperception were assessed. RESULTS: For 2914 children, reported height was underestimated by -1·38 cm, weight by -0·25 kg and BMI was overestimated by +0·41 kg/m2 on average. The prevalence of obesity estimated with reported data was 2·7 times higher than that calculated with measured data (16·2 v. 6·0 %) according to WHO classification, and 3·6 times higher with IOTF classification. Sensitivity to identify obesity was 70·5 %, specificity was 87·3 % and PPV was 26·2 % (WHO classification). Half of the parents of pre-schoolers with obesity failed to identify their child's weight status. Parental misperception among children classified as having overweight or obesity reached 93·0 and 58·8 %, respectively. CONCLUSIONS: Parents underestimated children's height and weight, leading to an overestimation of the prevalence of obesity. Small inaccuracies in reported measures have an important effect for the estimation of population prevalences. Parents' report of child weight status is unreliable. Parental awareness and acknowledgement of child weight status should be improved.

Incidence and in-hospital outcomes of Clostridium difficile infection among type 2 diabetes patients in Spain.

AIM: To examine incidence and in-hospital outcomes of Clostridium difficile infection (CDI) among patients with type 2 diabetes (T2DM); compare clinical variables among T2DM patients with matched non-T2DM patients hospitalised with CDI and identify factors associated with in-hospital mortality (IHM) among T2DM patients. METHODS: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients that had CDI as primary or secondary diagnosis in their discharge report. For each T2DM patient, we selected a gender, age, readmission status and year-matched non-diabetic patient. RESULTS: We identified 44 695 patients with CDI (21.19% with T2DM). We matched 3040 and 5987 couples with a primary and secondary diagnosis of CDI, respectively. Incidence of CDI was higher in T2DM patients (IRR per hospital admission 1.12; 95% CI 1.09-1.14, IRR per population 1.26; 95% CI 1.22-1.29). IHM decreased over time in T2DM and non-T2DM patients (from 15.36% and 13.35%, in 2001-2003 to 10.36% and 11.73% in 2013-2015), despite a concomitant increase in CDI diagnoses overtime. Among those with CDI as secondary diagnosis IHM was higher in nondiabetic 16.17% than in T2DM patients 13.19% (P < 0.001). In T2DM patients higher mortality rates were associated with older age, comorbidities, severe CDI, and readmission. Primary diagnosis of CDI was associated with lower IHM (OR 0.71; 95% CI 0.60-0.84) than secondary diagnosis. CONCLUSIONS: Incidence of CDI was higher in T2DM patients. IHM decreased over time, regardless of the existence or not of T2DM. IHM was significantly lower in T2DM patients with CDI as primary diagnosis than non diabetic patients.

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.

Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain.

Background: Socioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age. Methods: This was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed. Results: A statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15-44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group. Conclusion: People with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age.

Prevalence of Leber hereditary optic neuropathy in the Community of Madrid (Spain), estimation with a capture-recapture method.

BACKGROUND: Leber hereditary optic neuropathy (LHON) typically presents in young adults as bilateral painless subacute visual loss. Prevalence data are scarce. The aim of this study was to examine the validity of different ascertainment sources used in population-based rare diseases registries to detect cases, and to explore the impact of a capture-recapture method in the estimation of the prevalence of LHON in the Autonomous Community of Madrid (ACM) in 2022. METHODS: Descriptive cross-sectional population-based study. Potential LHON cases were detected by automatic capture from the healthcare information sources usually explored for the Regional Registry for Rare Diseases (SIERMA). Ophthalmologists provided data from their clinical registry. Positive predictive values (PPV) and sensitivity with 95% confidence intervals (CI) were estimated. Global and by sex prevalences were calculated with confimed cases and with those estimated by the capture-recapture method. RESULTS: A total of 102 potential LHON cases were captured from healthcare information sources, 25 of them (24.5%) finally were confirmed after revision, with an overall PPV of 24.5% (95%CI 17.2-33.7). By source, the electronic clinical records of primary care had the highest PPV (51.2, 95%CI 36.7-65.4). The ophthalmologists clinical registry provided 22 cases, 12 of them not detected in the automatic capture sources. The clinical registry reached a sensitivity of 59.5% (95%CI 43.5-73.6) and the combination of automatic capture sources reached a 67.6% (95%CI: 51.5-80.4). The total confirmed cases were 37, with a mean age of 48.9 years, and a men: women ratio of 2.4:1. Genetic information was recovered in 27 cases, with the m.3460 mutation being the most frequent (12 cases). The global prevalence was 0.55 cases/100,000 inhabitants (95%CI 0.40-0.75), and with the capture-recapture method reached 0.79 cases/100,000 (95%CI 0.60-1.03), a 43.6% higher, 1.15 cases/100,000 (95%CI 0.83-1.58) in men and 0.43 cases/100,000 (95%CI 0.26-0.70) in women. CONCLUSIONS: The prevalence of LHON estimated in the ACM was lower than in other European countries. Population-based registries of rare diseases require the incorporation of confirmed cases provided by clinicians to asure the best completeness of data. The use of more specific coding for rare diseases in healthcare information systems would facilitate the detection of cases. Further epidemiologic studies are needed to assess potential factors that may influence the penetrance of LHON.

Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study.

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

The effectiveness of nirsevimab in reducing the burden of disease due to respiratory syncytial virus (RSV) infection over time in the Madrid region (Spain): a prospective population-based cohort study.

Introduction: Respiratory syncytial virus (RSV) infection is one of the main causes of morbidity and mortality from lower respiratory tract infections in children under 5 years of age worldwide. Given that, the objective of this study was estimate the effectiveness of nirsevimab (a single-dose, long-acting, human recombinant monoclonal antibody against RSV) over time for the prevention of respiratory episodes treated at different levels of care. Methods: A prospective and dynamic population-based cohort study was performed including infants born between April 1 and December 31, 2023, in the Madrid region who resided there during the follow-up period from October 1, 2023, to February 29, 2024. Infants were considered immunized from the day after receiving one dose (50 or 100 mg) of nirsevimab or nonimmunized individuals if they did not receive any dose. Results: There were 4,100 episodes of primary care, 1,954 hospital emergencies, and 509 admissions, 82 of which required intensive care in the 33,859 participants analyzed. The adjusted effectiveness of nirsevimab in preventing hospitalization due to RSV infection was 93.6% (95% CI: 89.7 to 96.1) at 30 days and 87.6% (95% CI: 67.7 to 95.3) at 150 days. The number needed to treat to prevent one hospitalization were 314.19 (95% CI: 306.22 to 327.99) at 30 days and 24.30 (95% CI: 22.31 to 31.61) at 150 days. The adjusted effectiveness of nirsevimab in avoiding admission to an intensive care unit was 94.4% (95% CI: 87.3 to 97.5) at 30 days and 92.1% (95% CI: 64.0 to 98.3) at 90 days. The adjusted effectiveness of nirsevimab for avoiding primary care consultations and hospital emergency visits was lower. Discussion: Immunization with nirsevimab is an effective measure for reducing the burden of care related to RSV at all levels of care albeit it decreases throughout follow-up. At 150 days it remained high for preventing hospital admissions. Other articles already published have also demonstrated high effectiveness although with preliminary results, short follow-up periods and wide confidence intervals. None have detected a decrease in effectiveness over time. These results can be quite useful in individual infant prevention and in the design of immunization campaigns.

Vaccination against influenza: Coverage and adherence in children under 15 years with high-risk medical conditions in the Community of Madrid.

INTRODUCTION: Vaccination against influenza is indicated in children at risk of complications or severe disease. The objective of this study was to describe the percentage of children aged less than 15 years with risk conditions vaccinated against influenza in the Community of Madrid, and to analyze the factors associated with adherence to vaccination throughout 3 vaccination campaigns. MATERIALS AND METHODS: Population-based cross-sectional observational study of children aged 6 months to 14 years with conditions that indicated influenza vaccination at the beginning of the 2018-2019 campaign. Electronic population registers were used. We described the percentage of children vaccinated in 3 consecutive campaigns, and assessed the association of adherence to vaccination with demographic and socioeconomic variables and risk conditions using bivariate and multivariate analysis. RESULTS: The vaccination coverage was 15.6% in the 2018-2019 campaign. The adherence to vaccination was 65.9%. The variables associated with greater adherence were age greater than 2 years, especially in the 6-10 years group (aOR = 1.63; 95% CI, 1.43-1.85) and presenting more than one risk condition, especially 3 or more diseases (aOR = 1.80; 95% CI, 1.00-3.26). Diabetes mellitus was the disease associated most strongly with adherence (aOR = 2.15; 95% CI, 1.74-2.65). Adherence was lower in the immigrant population (aOR = 0.43; 95% CI, 0.36-0.51). We found no association between vaccination adherence and sex or socioeconomic status. CONCLUSIONS: Vaccination coverage and adherence were suboptimal. Adherence to vaccination against influenza is associated with demographic and clinical conditions. Strategies need to be established to increase vaccination in children, with greater involvement of professionals and education of parents.

Impact of hypertension diagnosis on morbidity and mortality: a retrospective cohort study in primary care.

BACKGROUND: Hypertension is responsible for a huge burden of disease. The aim of this study was to evaluate the impact of newly diagnosed hypertension on the occurrence of kidney or cardiovascular events (K/CVEs) and on mortality among community dwellers. METHODS: Retrospective cohort study, conducted from January, 2007, to December, 2018. All patients (age > 18) newly diagnosed with hypertension and no previous K/CVEs in 2007 and 2008, in the primary care centers of Madrid (Spain) (n = 71,770), were enrolled. The control group (n = 72,946) included patients without hypertension, matched by center, sex and age. The occurrence of kidney or CV events, including mortality from these causes and total mortality were evaluated using Cox regression and multistate models. Data were collected from three sources: personal data from administrative records, clinical data from medical records, and mortality data from regional and national databases. RESULTS: The median follow-up was 138.61 months (IQR: 124.68-143.97 months). There were 32,896 K/CVEs (including 3,669 deaths from these causes) and 12,999 deaths from other causes. Adjusted for sex, smoking, diabetes and socioeconomic status, K/CVEs HR was 4.36 (95% CI: 3.80-5.00) for diagnoses before 45 years of age, 2.45(95% CI: 2.28- 2.63) for diagnosis between 45 to 54 years, and HR decreased to 1.86 (95% CI: 1.64-210) for diagnoses over age 85. Total mortality risk was only higher for hypertension diagnosed before 55 years of age (HR: 2.47, 95% CI: 1.90-3.19 for ages 18 to 44; and HR: 1.14, 95% CI: 1.02-1.28 for ages 45 to 54). CONCLUSION: The diagnosis of hypertension in the community environment, in patients without evidence of previous kidney or CV disease, is associated with a large increase in the risk of K/CVEs, but especially in individuals diagnosed before the age of 55. This diagnosis is only associated with an increase in kidney or cardiovascular mortality or overall mortality when it occurs before age 55.

Pandemic influenza A (H1N1) 2009 in Madrid, Spain: incidence and characteristics in immigrant and native population.

BACKGROUND: Some immigrants and refugees might be more vulnerable than other groups to pandemic influenza because of pre-existing health and social disparities, migration history and living conditions. The objective of this study was to compare, between the immigrant and autochtonous population, the incidence and characteristics of influenza cases consulting in primary care (PC) and severe influenza cases. METHODS: Descriptive cross-sectional study of influenza episodes registered in PC and severe influenza cases reported between 1 May 2009 and 22 May 2010, by gender and origin. Age-adjusted rates were calculated and the association between origin and chronic pathology, pregnancy, delay in admission to hospital and admission to intensive care units (ICU) was analyzed by logistic regression and generalized linear models. RESULTS: The influenza rate in PC, adjusted by age, was lower for immigrant population (2396.3, 95% confidence interval (95% CI) 2362.5-2430.0 vs. 2795.9, 95% CI 2780.4-2811.5 per 100, 000). The difference between severe influenza rates by origin was not statistically significant. Chronic conditions were less common in immigrant population. In severe influenza cases, pregnancy was more common in immigrant women, and the probability of admission to ICU was higher in men from Central and Eastern Europe (prevalence ratio (PR) 8.44, 95% CI 2.81-25.40) and North African women (PR 3.30, 95% CI 1.09-10.05). CONCLUSION: Differences in influenza rates were detected by origin. This information could be useful for new pandemic wave management purposes, in addition to targetting future investigations. Pandemic influenza preparedness and response plans should incorporate specific actions to improve immigrants' access to health services and to decrease cultural barriers.

Evolution of the incidence of type 1 diabetes mellitus in the Community of Madrid, 1997-2016.

INTRODUCTION: The objective of this article was to estimate the type 1 diabetes mellitus (T1DM) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of T1DM. METHODS: T1DM cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997-2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). RESULTS: A total of 2658 cases were identified as new diagnoses of T1DM. The mean incidence rate for 1997-2013 was 13.7 cases per 100 000 person-years. In the 2014-2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10-14 years in the two periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10-14 years in both periods (17.9 vs 30.4), and in girls, the age of 5-9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014-2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. CONCLUSIONS: The CM is among the regions with a high incidence of T1DM. In its first phase, the regional registry underestimated the incidence of T1DM, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014-2016) are possibly closer to the actual incidence of T1DM. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records.

[Community transmission of pandemic influenza (H1N1) 2009 from School Outbreaks in the Madrid region, Spain: May-June 2009]. / Transmisión comunitaria de gripe pandémica (H1N1) 2009 a partir de brotes en centros escolares de la Comunidad de Madrid: Mayo-junio de 2009.

BACKGROUND: The first pandemic influenza (H1N1) 2009 confirmed case acquired in the Madrid Region was diagnosed in May 20th. This was the index case of the first outbreak in a school in the Madrid Region (MR). The aim of this paper is to describe school outbreaks that took place during the spring in 2009, the control measures implemented and the beginning of the community transmission of this virus in the Region. METHODS: Descriptive observational study of school outbreaks due to pandemic (H1N1) 2009 virus reported between May 20th and June 27th, and total investigated cases in this period. It was used the definition of cluster of influenza cases adopted by National Authority (three or more cases). Clinical, epidemiological and microbiological data of cases were analyzed. RESULTS: There were identified 1.349 cases of pandemic (H1N1) 2009. They were associated with 77 school centres with three or more reported cases, 47,4% of total cases in this period (n = 2.844). 36 outbreaks were detected in Leganés (more than one third of all schools in the municipality), generating the highest cumulative incidence rates in the Basic Health Zone. There were differences by symptoms according to age. During this period, 949 samples were analyzed and 555 (58.5%) tested positive. CONCLUSIONS: The transmission of pandemic (H1N1) 2009 virus in the MR occurred steadily during the spring of 2009 due to schools outbreaks, meaning the onset of community transmission in Spain.

[Daily Surveillance of Pandemic Influenza (H1N1) 2009 by primary care electronic clinical records in the Madrid region]. / Vigilancia diaria de la gripe pandémica (H1N1) 2009 mediante registros de la historia clínica electrónica de atención primaria en la Comunidad de Madrid.

BACKGROUND: Pandemic influenza (H1N1) 2009 led to implementation in the Madrid Region of new strategies of epidemiology surveillance in order to give response to the need of immediacy and exhaustiveness. METHODS: Descriptive cross-sectional study between May 1th 2009 and May 22th 2010. All disease episodes registered and reported as influenza disease were collected every day from electronic clinical records in primary care of Madrid Regional Public Health System. Data were analyzed by date, age, sex and health zoning, disaggregating into health professionals. RESULTS: 165.492 influenza episodes were registered (53,8% in women). The main number of cases was in the 25-49 years group (70.691), and the 5-14 years group reached the maximum weekly incidence rate (1.618,65/100.000 in the week 43). The highest weekly total incidence rate was 458,47/100.000 (week 44). Pediatricians reached the maximum of cases visited and of cumulated rates (12 pediatricians visited more than 20% of their total assigned population). CONCLUSIONS: Surveillance of pandemic influenza (H1N1) 2009 by automatic daily data collection from electronic clinical records in primary care has meant a specially useful information source for monitoring the development of pandemic influenza and for the strategic decision making.

Lifestyle interventions for cancer prevention in primary care: Differences between family physicians and nursing professionals.

RATIONALE, AIMS, AND OBJECTIVES: Prevention offers the most cost-effective long-term strategy for cancer control. The objective of this study was to ascertain opinions, attitudes, and professional practices towards cancer prevention among primary care professionals and to assess differences between family physicians (FP) and nursing professionals (NP). METHOD: A cross-sectional study was performed in 2012 in the Community of Madrid. A random sample of 3586 professionals received an online questionnaire about opinions/attitudes, training, and interventions in cancer prevention. The chi-square test was used to analyse the association of the profession with all the variables. Factors associated with the usual practice of individual, group, and community interventions were analysed using multivariate logistic regression, with separate models for FP and NP. RESULTS: The response rate was 39.4% (N = 1413). Approximately 90% of the participants attributed "sufficient/high" utility to individualized counselling. NP attributed higher utility to group and community interventions than FP (70.1% vs 60.1% and 64.9% vs 57.7%, respectively, P-value < 0.01). The usual practice of group and community interventions was more frequent among NP. The practice of group and community interventions was associated with knowledge of resources for prevention, specific training in group interventions, and the utility attributed to these methods. Among FP, the ability to dispense effective health advice and the utility attributed to this advice were associated with the usual practice of the three interventions. CONCLUSIONS: Group and community interventions are rarely practised, especially among FP. Actions targeting improved ability and knowledge could lead to higher involvement in the promotion of health. It would also be necessary to intervene in the examination of the utility of such interventions.

[Evolution of the incidence of type 1 diabetes mellitus in the Community of Madrid, 1997-2016]. / Evolución de la incidencia de diabetes mellitus tipo 1 (0-14 años) en la Comunidad de Madrid, 1997-2016.

INTRODUCTION: The objective of this article was to estimate the type 1 diabetes mellitus (DM1) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of DM1. METHODS: DM1 cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997-2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). RESULTS: A total of 2658 cases were identified as new diagnoses of DM1. The mean incidence rate for 1997-2013 was 13.7 cases per 100 000 person-years. In the 2014-2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10-14 years in the 2periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10 to 14 years in both periods (17.9 vs 30.4), and in girls, the age of 5 to 9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014-2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. CONCLUSIONS: The CM is among the regions with a high incidence of DM1. In its first phase, the regional registry underestimated the incidence of DM1, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014-2016) are possibly closer to the actual incidence of DM1. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records.

[Evaluation of a meningococcal ACWY catch-up vaccination program for adolescents on Community of Madrid.] / Evaluación de la vacunación de rescate frente a meningococo ACWY en adolescentes de la Comunidad de Madrid.

OBJECTIVE: In 2019 the Interterritorial Board of the Spanish National Health System approved the modification of the vaccination strategy against meningococcus. The objective of this study was to evaluate the meningococcal ACWY catch-up vaccination program in adolescents born in 2001 and 2002 in the Community of Madrid. METHODS: Cross-sectional population-based study. Vaccine coverage was estimated and factors associated with vaccination were assessed using logistic regression models. RESULTS: Vaccination coverage was 57.1% for those born in 2001 and 51.9% for those born in 2002. The probability of vaccination was higher in women (ORa=1.18), adolescents with chronic conditions (ORa=1.38), residents in rural areas (ORa=1.76) and in areas with lower socioeconomic level. Being born in 2002 (ORa=0.78) and abroad (ORa=0.35) were associated with a lower probability of vaccination. CONCLUSIONS: Coverage is high compared to similar campaigns in other settings, although there is significant room for improvement, so our study can contribute to the design of strategies to optimize results.

OBJETIVO: En 2019, el Consejo Interterritorial del Sistema Nacional de Salud aprobó la modificación de la estrategia de vacunación frente a meningococo. El objetivo de este estudio fue evaluar la vacunación de rescate frente a meningococo A, C, W, Y en adolescentes nacidos en 2001 y 2002 en la Comunidad de Madrid. METODOS: Se realizó un estudio transversal de base poblacional. Se determinó la cobertura vacunal y los factores asociados a la vacunación, utilizando modelos de regresión logística. RESULTADOS: La cobertura vacunal fue del 57,1% para nacidos en 2001 y del 51,9% para nacidos en 2002. La probabilidad de vacunación fue mayor en mujeres (ORa=1,18), adolescentes con alguna enfermedad crónica (ORa=1,38), residentes en el ámbito rural (ORa=1,76) y en zonas con menor nivel socioeconómico. Haber nacido en 2002 (ORa=0,78) y en el extranjero (ORa=0,35) se asociaron a una menor probabilidad de vacunación. CONCLUSIONES: La cobertura es elevada en comparación con campañas similares en otros entornos, aunque existe un importante margen de mejora, por lo que nuestro estudio puede contribuir al diseño de estrategias para optimizar los resultados.

Demand for health services and drug prescriptions among overweight or obese preschool children.

OBJECTIVES: To evaluate the association between excess weight and the demand of health services in preschool children compared with healthy weight. METHODS: The data come from the Longitudinal Study of Childhood Obesity cohort (1884 4-year-old children, residing in the Madrid region, Spain) who provided information through telephone questionnaire, physical examination and electronic medical records. We defined overweight, general and abdominal obesity based on body mass index, waist circumference and waist-to-height ratio. Using mixed models of multivariable negative binomial regression we calculated the incidence rate ratio (IRR) regarding primary care (PC) doctor visits, drug prescriptions and hospital admissions by weight status at the end of the 2-year follow-up. RESULTS: Childhood general obesity was associated with a higher demand for PC services related to psychological problems (IRR=1.53; 95% CI 1.02 to 2.28) and childhood abdominal obesity, according to waist-to-height ratio, was related to more frequent problems of the musculoskeletal system (IRR=1.27; 95% CI 1.00 to 1.62). Drugs were prescribed more frequently to children falling under all three definitions of excess weight, compared with healthy weight children. No differences in the number of hospital admissions were observed. CONCLUSIONS: The demand of health services related to early childhood obesity was small. Nevertheless, obesity was associated with a slightly greater demand for drug prescriptions and for PC doctor visits related to psychological and musculoskeletal problems.

Coverage and predictors of influenza vaccination in patients with cystic fibrosis in a campaign with a mobile phone text messaging intervention.

Annual influenza vaccination is considered the best protection against influenza infection. We analyzed the influenza vaccine coverage (IVC) in cystic fibrosis (CF) patients and evaluated the factors associated with the IVC, including the effect of text-message/SMS reminders. We performed a cross-sectional study in the Community of Madrid (Spain) in 2015. The target population was people with CF older than 6 months of age at the beginning of the flu vaccination campaign. The IVC was calculated according to the study variables. A total of 445 CF patients were analyzed. In 2015, IVC reached 67.9% and was higher in children and women. The main factor associated with flu vaccination was having been vaccinated in the previous campaign (aOR 14.36; IC95%: 8.48-24.32). The probability of being vaccinated after receiving the SMS was more than twice than for those who did not receive it, although no statistical significance was reached. In conclusion the IVC of patients with CF is high, but it still has room for improvement. SMS reminders sent to CF patients might improve influenza vaccine uptake.

Association between general and central adiposity and development of hypertension in early childhood.

OBJECTIVES: To evaluate the association of general and abdominal obesity with high blood pressure in young children. METHODS: A longitudinal study including 1796 participants from the Madrid region (Spain) with baseline at age 4 years and a follow-up 2 years later. Blood pressure, body mass index and waist circumference were measured during a physical examination. We evaluated the association between obesity at baseline and weight changes between the ages of 4 and 6 years and high blood pressure. Data were analysed using linear and logistic regressions adjusted for covariates. RESULTS: Obese 4 year olds (general or abdominal obesity) experienced an average 4-5 mmHg increase in systolic blood pressure and a 2.5-3 mmHg increase in diastolic blood pressure by the age of 6 years. Compared to children maintaining a non-excess weight (based on body mass index) during follow-up incident and persistent cases of excess weight (overweight or obesity) had an odds ratio (OR) for high blood pressure of 2.49 (95% confidence interval (CI) 1.50-4.13) and OR 2.54 (95% CI 1.27-5.07), respectively. Regarding abdominal obesity we estimated OR 2.81 (95% CI 0.98-8.02) for incident cases and OR 3.42 (95% CI 1.38-8.49) for persistent cases. Similar estimates for the waist-height ratio were observed. Individuals who experienced remission to non-excess weight did not have an increased risk of high blood pressure. CONCLUSIONS: We observed an increased risk for high blood pressure among 4-year-olds who presented with persistent or incident cases of excess weight (body mass index) or abdominal obesity after 2 years of follow-up. Children with excess weight or obesity at baseline who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.