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.

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.

[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.

Injuries Among Immigrants Treated in Primary Care in Madrid, Spain.

This study compared the injury incidence rates by sex in adult immigrant and native population attended in primary care in the Community of Madrid, Spain. Cross-sectional study of injuries registered in the primary care electronic medical record in 2012. Crude and age-adjusted incidence rates by sex, region of birth and type of injury were calculated. Poisson regression was performed. In both sexes, the highest crude injury incidence rate was found in immigrants from North Africa, followed by the native population. After controlling for age and socioeconomic-status, the highest risk of injury in immigrants was observed in burns in women from North-African (79%) and in foreign body injuries in men from Latin America and Caribbean, Sub-Saharan and North Africa and Central and Eastern Europe (61-123%). The analysis by region of origin has identified people from North Africa as a particularly vulnerable group.

[Injuries treated in primary care in the Community of Madrid: analyses of electronic medical records]. / Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica.

OBJECTIVE: To describe the incidence of injuries treated in primary care by type of injury, age groups, and sex in the publicly-funded health system of the region of Madrid in Spain. METHODS: A descriptive cross sectional study was performed of injury episodes registered in the primary care electronic medical records of the health system of Madrid in 2011. We calculated the global incidence of injuries, injury-specific rates for fractures, sprains, wounds, burns, foreign body injuries, poisoning and bruises, and their rate ratios with 95% confidence intervals, all of which were stratified by sex and age groups. RESULTS: In 2011 there were 707,800 injury episodes (3.5% of all episodes treated in primary care). Most of the injuries occurred in women (54.0%) and in persons older than 34 years (58.0%). The most common injuries were wounds in men (35.3%) and bruises in women (30.6%). Overall, women had higher rates of injuries among the elderly and men had more injuries in the group younger than 15 years. By type of injury, the highest rates of fractures, burns and bruises were observed in the older population, foreign body injuries and wounds in children, sprains in youth, and poisonings in extreme ages. CONCLUSIONS: The special vulnerability of boys younger than 5 years and elderly women suggests that intervention strategies should be targeted to the specific needs of these groups.