Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias / Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks

INTRODUCCIÓN: El deterioro cognitivo es una entidad clínica en la que las funciones intelectuales están parcial o totalmente alteradas y supone un problema de salud pública y un reto para los servicios sanitarios y sociales. El objetivo de este trabajo es estimar la prevalencia de estos trastornos en la población mayor de 65 años que consulta en atención primaria en 5 redes centinelas sanitarias. MÉTODO: Se realizó el test Mini-Cog de cribado de deterioro cognitivo en una muestra de pacientes que acudieron a su médico de familia en 4 días seleccionados al azar. La confirmación se hizo con el test Mini-Mental y el Alzheimer's Questionnaire. Se estimaron tasas brutas y ajustadas por las variables demográficas y sociales. RESULTADOS: Se estudiaron 4.624 pacientes, que representan a una población de 1.723.216 personas de 5 comunidades autónomas. La prevalencia ajustada para el conjunto de la población estudiada fue del 18,5% (IC 95% 17,3-19,7), con diferencias entre las redes centinelas. Las mujeres presentan tasas ajustadas significativamente más elevadas que los hombres: 18,5 y 14,3%, respectivamente. La prevalencia por grupo de edad alcanza el 45,3% por encima de los 85 años y presenta diferencias por nivel de estudios alcanzado y tipo de convivencia. CONCLUSIONES: El deterioro cognitivo es un motivo de consulta frecuente en atención primaria. Es mayor en mujeres y aumenta exponencialmente con la edad. Tanto la sospecha como la confirmación del deterioro cognitivo pueden realizarse por el médico de familia con instrumentos sensibles y validados, lo que permite iniciar un tratamiento precoz

INTRODUCTION: Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD: A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS: We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7), with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS: Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients

Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks. / Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias.

INTRODUCTION: Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD: A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS: We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7], with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS: Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients.

Situación actual y factores que condicionan la lactancia materna en Castilla y León / Current situation and factors conditioning the start of breastfeeding in Castilla y León

Objetivos: conocer la prevalencia de inicio de lactancia materna exclusiva en la comunidad de Castilla y León y los factores que influyen en su inicio y duración. Métodos: estudio descriptivo observacional realizado en la comunidad de Castilla y León (España) de enero a diciembre 2007, en niños entre seis y 12 meses de vida que acudían por cualquier motivo a las consultas de algún miembro del Programa de Pediatría de la Red Centinela Sanitaria de Castilla y León. Resultados: el porcentaje de mujeres que eligieron lactancia materna exclusiva después del parto fue del 81,2%, el 10,7% optó por la lactancia mixta y el 8,1% por la lactancia artificial. El abandono de la lactancia natural fue progresivo mes a mes llegando al sexto mes solo el 36,5% de los niños que la habían iniciado. Conclusiones: los índices de lactancia materna exclusiva, y sobre todo su mantenimiento hasta los seis meses de vida, continúan alejados de los estándares propuestos a nivel mundial. Es imprescindible una mayor implicación en el fomento de la lactancia natural no solo del personal sanitario sino de la sociedad en general (AU)

Objectives: to describe the prevalence of exclusive breastfeeding in the community of Castilla y León, and to determine the factors that condition its duration. Methods: descriptive, observational study carried out in Castilla y León (Spain) in children aged 6 to 12 months attending the consultation of any member of the Health Sentinel Network of Castilla y Leon in 2007. Results: the percentage of women choosing exclusive postpartum breastfeeding was 81.2%, 10.7% mixed feeding and 8.1% artificial feeding. The drop-out of breastfeeding was progressive month by month and only 36.5% of children who initiated it reached six months. Conclusions: the rates of exclusive breastfeeding and the maintenance up to the six months of life are still away from the proposed global standards. It is essential to improve the involvement of health personnel and general society in encouraging breastfeeding (AU)

[Social and economic impact of chicken pox vaccine at 15 months of age. Castile and Leon, Spain, 2004]. / Impacto social y económico de la vacunación frente a la varicela a los 15 meses de edad en Castilla y León en 2004.

BACKGROUND: Chicken pox is a mainly childhood contagious disease caused by the Varicella Zoster Virus which gives rise to major healthcare and social costs. In 2005, Castile and Leon added chicken pox vaccine injections to its childhood vaccination schedule for eleven year-olds subject to coming down with this disease. This strategy does not modify the major mobility generated thereby at younger ages. This study is aimed at evaluating the profitability of systematic vaccination for chicken pox in infants 15 months of age in Castile and Leon. METHODS: An economic cost-benefit evaluation has been set out by jeans of a decision-making tree. A fictitious cohort of 100,000 children in Castile and Leon having reached 15 months of age in 2004 is studied, to whom the chicken pox vaccine would be administered in conjunction with the mumps, measles, rubella vaccines. This study is approached from the social standpoint. The time horizon selected was that of up until the study cohort was to reach 15 years of age, applying a 3% discount rate. A sensitivity analysis was made for evaluating the uncertainty of some variables... RESULTS: The cost-benefit ratio of adding this vaccine to the childhood vaccination schedule amounts to 1.23. CONCLUSIONS: From the social standpoint, administering chicken pox vaccine in conjunction with the mumps, measles, rubella vaccines show itself to be profitable. The profitability is modified both if a second dose of vaccine is added as well as if only the direct healthcare costs are analyzed.

Impacto social y económico de la vacunación frente a la varicela a los 15 meses de edad en Castilla y León en 2004 / Social and economic impact of chickem pox vaccine at 15 months of age. Castile and Leon, Spain, 2004

Fundamento: La varicela es una enfermedad infecciosa fundamentalmente infantil producida por el virus Herpes Varicela Zoster que produce importantes costes sanitarios y sociales. En 2005 Castilla y León introdujo en su calendario de vacunación infantil la vacuna de la varicela a los niños de once años susceptibles de padecerla. Dicha estrategia no modifica la importante morbilidad que genera en edades inferiores. El objetivo de este trabajo es valorar la rentabilidad de la vacunación sistemática frente a la varicela a los niños de 15 meses de edad en Castilla y León. Métodos: Se ha planteado una evaluación económica de coste-beneficio a través de un árbol de decisión. Se estudia una cohorte ficticia de 100.000 niños castellano-leoneses que en el año 2004 cumplieran 15 meses, a los que se les administraría junto a la vacuna triple vírica la de la varicela. El estudio se plantea desde la perspectiva social. El horizonte temporal elegido ha sido hasta que la cohorte de estudio cumpliera 15 años, aplicando una tasa de descuento del 3%. Para valorar la incertidumbre de algunas variables se ha desarrollado un análisis de sensibilidad. Resultados: El coste-beneficio de la introducción de la vacuna en el calendario de vacunación infantil se cifra en 1,23. Conclusiones: Desde la perspectiva social la estrategia de vacunación frente a la varicela, junto a la triple vírica se muestra rentable. La rentabilidad se ve modificada tanto si se introduce una segunda dosis de vacuna como si se analizan sólo los costes directos sanitarios (AU)

Background: Chicken pox is a mainly childhood contagious disease caused by the Varicella Zoster Virus which gives rise to major healthcare and social costs. In 2005, Castile and Leon added chicken pox vaccine injections to its childhood vaccination schedule for eleven year-olds subject to coming down with this disease. This strategy does not modify the major mobility generated thereby at younger ages. This study is aimed at evaluating the profitability of systematic vaccination for chicken pox in infants 15 months of age in Castile and Leon. Methods: An economic cost-benefit evaluation has been set out by jeans of a decision-making tree. A fictitious cohort of 100,000 children in Castile and Leon having reached 15 months of age in 2004 is studied, to whom the chicken pox vaccine would be administered in conjunction with the mumps, measles, rubella vaccines. This study is approached from the social standpoint. The time horizon selected was that of up until the study cohort was to reach 15 years of age, applying a 3% discount rate. A sensitivity analysis was made for evaluating the uncertainty of some variables... Results: The cost-benefit ratio of adding this vaccine to the childhood vaccination schedule amounts to 1.23. Conclusions: From the social standpoint, administering chicken pox vaccine in conjunction with the mumps, measles, rubella vaccines show itself to be profitable. The profitability is modified both if a second dose of vaccine is added as well as if only the direct healthcare costs are analyzed (AU)

[Incidence and clinical characteristics of maculopapular exanthemas of viral aetiology]. / Incidencia y características clínicas de los exantemas maculopapulares de etiología viral.

OBJECTIVE: To estimate the incidence of maculo-papular viral exanthemas and to describe the epidemiological and clinical patterns. DESIGN: Observational descriptive study with a sample design. PARTICIPANTS AND SETTING: 154 practitioners from the Castilla y León Sentinel Network with a surveilled population of 23 237 people-year under 15 years old, notified in 2002 the cases of diseases by means of a standard form with the variables and inclusion and exclusion criteria. MAIN MEASUREMENTS: It was included the maculo-papular exanthemas associated to a presumable systemic virus disease in patients under 15 years old. It was excluded the infectious mononucleose, the chickenpox, and other non viral infections or exanthemas. RESULTS: 368 cases were notified which represent a incidence rate of 158.37 cases per 10 000 (95% CI, 142.31-174.42). The incidence was maximum under four years old, more than 350 per 10 000, decreasing significantly in children over this age. Erythema infectiousum presented the highest rate, followed by exanthema subitum. The exanthemas caused by measles or rubella were insignificants. CONCLUSIONS: Childhood exanthematous diseases of presumable viral etiology have an important incidence in primary care, although the majorities are banal and self-limited diseases. Clinical characteristics supported the suspicion diagnosis, which was consistent with the observed epidemiological description and expected presentations of each disease. Although serological analysis could diminish the uncertainly on notification and control of diseases submited to especial programs of vaccination and eradication, they would not improve substantially the diagnosis and treatment of these patients.

Incidencia y características clínicas de los exantemas maculopapulares de etiología viral / Incidence and clinical characteristics of maculopapular exanthemas of viral aetiology

Objetivo. Estimar la incidencia de exantemas maculopapulares de presumible etiología viral y describir las características epidemiológicas y clínicas. Diseño. Estudio observacional, descriptivo, de diseño muestral. Participantes y emplazamiento. Ciento cincuenta y cuatro médicos integrantes de la Red de Médicos Centinelas de Castilla y León, en una población vigilada de 23.237 personas-año menores de 15 años, notificaron durante el año 2001 los casos de la enfermedad a través de una ficha estándar que contenía las variables requeridas y los criterios de inclusión y exclusión.Mediciones principales. Se incluyeron los exantemas maculopapulares asociados a enfermedad sistémica de presumible etiología viral en menores de 15 años. Se excluyeron la mononucleosis infecciosa, la varicela y otras infecciones o exantemas no virales. Resultados. Se notificaron 368 casos, que suponen una tasa de incidencia de 158,37 casos por 10.000 (IC del 95 por ciento, 142,31174,42). La incidencia fue máxima en los menores de 4 años, superior a 350 por 10.000, reduciéndose significativamente en los niños mayores de esa edad. El eritema infeccioso presentó la tasa más elevada, seguido del exantema súbito. Los exantemas ocasionados por sospecha de sarampión o rubéola fueron insignificantes. Conclusiones. Las enfermedades exantemáticas en la infancia de presumible etiología viral tienen una incidencia importante en atención primaria, si bien la mayoría son enfermedades leves y autolimitadas. Las características clínicas fundamentaron el diagnóstico de sospecha etiológico, que fue coherente con la descripción epidemiológica observada y las manifestaciones esperadas para cada enfermedad. Si bien los análisis serológicos permitirían disminuir la incertidumbre en la notificación y el control de enfermedades sometidas a programas especiales de vacunación y eliminación, no mejorarían sustancialmente el diagnóstico y tratamiento de estos pacientes (AU)

Trastornos de la conducta alimentaria. Un estudio descriptivo en atención primaria / Eating disorders. A descriptive study in Primary Care

El objetivo del presente trabajo es estimar la frecuencia y describir modelos de presentación de los trastornos de la conducta alimentaria en Castilla y León. El protocolo de estudio incluía los criterios de definición de la CIE-10, una ficha de notificación del caso y el cuestionario EAT-40 para la valoración de riesgo de enfermedad. La frecuencia estimada (casos incidentes y prevalentes) se situó en 41,9 casos por cada 100.000 habitantes; 76,0 en mujeres y 8,6 en varones. La incidencia fue de 23,5 casos por cada 100.000 habitantes, 44,2 en mujeres y 3,4 en varones. Las mujeres de 15 a 19 años y de 20 a 30 presentan las frecuencias más elevadas, de 640,2 y 178,8 casos por 100.000, respectivamente. Tres de cada cuatro mujeres presentan comorbilidad psiquiátrica. Este trabajo confirma la alta frecuencia de este problema en nuestra comunidad. Las mujeres jóvenes son las más afectadas, y en ellas es frecuente encontrar comorbilidad psiquiátrica (AU)

[Anxiety disorders. The variability and determinants of the therapeutic approach of primary care physicians]. / Trastornos de ansiedad. Variabilidad y condicionantes de la actitud terapéutica de los médicos de atención primaria.

OBJECTIVES: To analyse the influence of independent factors, relating to the characteristics of primary care doctors, patients and the illness, on therapeutic attitudes and their variability before anxiety disorders. DESIGN: Observational study of people attending primary care family medicine clinics who are identified as suffering anxiety disorders. SETTING: The autonomous Communities of Castilla and Leon, the Basque Country and the Valencian Community. PARTICIPANTS: 3247 patients over 18 classified by their doctors as suffering an anxiety disorder. MEASUREMENTS AND RESULTS: During 1995, 317 primary care doctors collected information from patients with anxiety disorders (CIE codes F40 and F41). The information was gathered with the same questionnaire in the three communities. The data were validated monthly before the final analysis. Women doctors gave less medical advice than male doctors (OR: 0.48, 95% CI: 0.36-0.65). Patients with anxiety in Castilla and Leon were at greater "risk" of receiving drugs treatment than those in the Basque Country (OR: 1.64, CI: 1.31-2.06). When the consultation was for any mental symptom or when the kind of anxiety was a panic disorder (OR: 2.39, CI: 1.53-3.65), phobic disorder (OR: 2.17, CI: 1.52-3.08) or mixed anxiety disorder (OR: 2.20, CI: 1.77-2.73), patients were more likely to be referred for specialist treatment. If it was decided to prescribe drugs treatment, women doctors used more often than their male colleagues a mixed treatment with anti-depressants, anxiolytic drugs and drugs for psychosis (OR: 1.60, CI: 160-4.28). Castilla and Leon, and the Valencian Community were less likely to use mixed treatment than the Basque Country reference group. CONCLUSIONS: This study shows the variability in the difficulties encountered in diagnosis and finding a common standard of conduct for primary care doctors faced with patients suffering anxiety disorders. Although the treatment used for anxiety can be considered adequate in most cases, there is high variability, which depends mainly on the type and other characteristics of the process, the patient and the professional.

[Demand and HIV testing prescription in primary care. Registry of the network of sentinel physicians from Castilla y León in 1991, 1992, and 1993]. / Demanda y prescripción de test VIH en atención primaria. Registro de la red de médicos centinelas de Castilla y León en 1991, 1992 y 1993.

OBJECTIVE: the objective of this descriptive study is to improve the knowledge about the use and demand of HIV test in general population in Primary Health Care, as well as to detect lacks in general medicine related to HIV/AIDS. METHOD: from 1991 to 1993, the Red de Médicos Centinelas de Castilla y León, a voluntary sample of general practitioners and pediatrics has collected HIV test data from a covered population representative of the general population. RESULTS: one of the most important findings is the ascending frequency in tests done: On 65,107 and 125 per 100,000 inhabitants in 1991, 1992 and 1993 respectively. Intravenous drug users are the more important group risk in the register, 24%, followed by pregnant women, 17%, and the multiple heterosexual contacts, 9%. Among all the tests, 5.2% were positive. CONCLUSIONS: the comparison with other countries shows differences in frequency, cause and results, whose most probable explanation could be related to the different Health Care System and practice in general medicine and the patterns of risk infection in different populations.

[A sentinel physicians network in Castile and León: the use of cluster analysis to obtain a representative population]. / La Red de Médicos Centinelas de Castilla y León: aplicación del análisis de conglomerados para la obtención de una población representativa.

In order to establish a sentinel physicians network in Castilla y León to collect systematically population-based morbidity data, a random sample of general practitioners (GP's) whose covered population was representative of the regional population was obtained. A cluster analysis with the ZBS (Zonas Básicas de Salud) was performed according to a list of variables considered important in the diseases incidence. Five clusters were obtained in the urban areas and twenty in the rural areas, where, after stratification, the GP's random sample was selected. The outcome of the distribution, within each cluster, between all Castilla y León GP's and the sentinel GP's did not show statistically significant differences. The statistically significant difference found between the age of all GP's and the 127 sentinel GP's, due to the voluntary participation, was not found in the comparison of the two populations covered by them, confirming the efficacy of this method in the selection of a representative population from a random sampling of population groups.