Childhood and Adolescent Central Nervous System Tumours in Spain: Incidence and Survival over 20 Years: A Historical Baseline for Current Assessment.

BACKGROUND: Central nervous system (CNS) neoplasms are highly frequent solid tumours in children and adolescents. While some studies have shown a rise in their incidence in Europe, others have not. Survival remains limited. We addressed two questions about these tumours in Spain: (1) Is incidence increasing? and (2) Has survival improved? METHODS: This population-based study included 1635 children and 328 adolescents from 11 population-based cancer registries with International Classification of Childhood Cancer Group III tumours, incident in 1983-2007. Age-specific and age-standardised (world population) incidence rates (ASRws) were calculated. Incidence time trends were characterised using annual percent change (APC) obtained with Joinpoint. Cases from 1991 to 2005 (1171) were included in Kaplan-Meier survival analyses, and the results were evaluated with log-rank and log-rank for trend tests. Children's survival was age-standardised using: (1) the age distribution of cases and the corresponding trends assessed with Joinpoint; and (2) European weights for comparison with Europe. RESULTS: ASRw 1983-2007: children: 32.7 cases/106; adolescents: 23.5 cases/106. The overall incidence of all tumours increased across 1983-2007 in children and adolescents. Considering change points, the APCs were: (1) children: 1983-1993, 4.3%^ (1.1; 7.7); 1993-2007, -0.2% (-1.9; 1.6); (2) adolescents: 1983-2004: 2.9%^ (0.9; 4.9); 2004-2007: -7.7% (-40; 41.9). For malignant tumours, the trends were not significant. 5-year survival was 65% (1991-2005), with no significant trends (except for non-malignant tumours). CONCLUSIONS: CNS tumour incidence in Spain was found to be similar to that in Europe. Rises in incidence may be mostly attributable to changes in the registration of non-malignant tumours. The overall malignant CNS tumour trend was compatible with reports for Southern Europe. Survival was lower than in Europe, without improvement over time. We provide a baseline for assessing current paediatric oncology achievements and incidence in respect of childhood and adolescent CNS tumours.

La mortalidad de los pacientes en hemodiálisis está asociada con su situación clínica al comienzo del tratamiento / Mortality of hemodialysis patients is associated with their clinical situation at the start of treatment

Introducción: Estudios previos han demostrado una elevada mortalidad de los pacientes en tratamiento con hemodiálisis, aunque en pocos de ellos se analiza la supervivencia de los que reciben exclusivamente este tratamiento. Nuestro objetivo fue analizar la mortalidad de los pacientes que recibieron tratamiento con hemodiálisis. Métodos: Se analizó la cohorte de pacientes que iniciaron tratamiento sustitutivo entre los años 2010 y 2012 en la comunidad de Castilla-La Mancha y permanecieron en tratamiento con hemodiálisis. Se estudiaron las variables edad, sexo, enfermedad renal primaria, acceso vascular, hemoglobina, índice de Charlson y albúmina sérica al comienzo del tratamiento y se realizó un seguimiento hasta final de 2017. Resultados: La mortalidad fue del 63,4% a los 5 años y del 76% al final del periodo de seguimiento, sin diferencias entre varones y mujeres, y se relacionó con una mayor edad, el comienzo urgente o en aquellos con enfermedad renal reagudizada, la utilización de catéteres o una albúmina inferior a 3,5g/dl. Conclusiones: La mortalidad en los pacientes que permanecen en diálisis es muy elevada y se asocia a factores no modificables como la edad pero también a otros que podemos prevenir o tratar, como el tipo de acceso vascular o el estado de nutrición al comienzo del tratamiento. (AU)

Introduction: Previous reports have shown very high mortality among hemodialyisis patients. Our goal was to analyze the mortality of patients in the Renal Registry of Patients who remained exclusively on hemodialysis treatment. Methods: The cohort of patients who started treatment in the community of Castilla-La Mancha between 2010 and 2012 and remained on hemodialysis treatment was analysed until the end of 2017. Age, sex, primary kidney disease, vascular access, hemoglobin, Charlson index and serum albumin were included. Results: Mortality rate was 63.4% after 5 years and 76% at the end of the study, with no difference between males and females, and was linked to an older age, urgent onset or in those with acute deterioration of chronic kidney disease, the use of catheters or albumin less than 3.5g/dl. Conclusions: Mortality in patients who remain on hemodialysis is very high and is associated with non-modifiable factors such as age but also others that we can prevent or treat such as type of vascular access or nutrition status at the beginning of treatment. (AU)

Breast cancer mortality after eight years of an improved screening program using digital breast tomosynthesis.

OBJECTIVES: To assess screening quality metrics and to describe mortality rates eight years after redesign of breast cancer screening and diagnosis pathways, and the introduction of digital breast tomosynthesis. SETTING: Breast Unit of the Toledo Health Area in the region of Castilla-La Mancha (Spain). METHODS: We recorded screening metrics and mortality data following the introduction of digital breast tomosynthesis in 2011 for screening and diagnosis pathways. We then compared the mortality between Toledo Health Area and the rest of Castilla-La Mancha, where digital breast tomosynthesis is not available. RESULTS: All screening quality metrics improved following the introduction of digital breast tomosynthesis. The cancer detection rate significantly increased from 2.3 (95% confidence interval (CI): 1.9-3.6) to 4.5 per 1000 women (95% CI: 3.2-5.2) on average between the periods 2005-2009 and 2015-2018, while the recall rate significantly decreased from 7.0% (95% CI: 6.8%-8.2%) to 2.6% (95% CI: 2.0%-3.6%). Comparing breast cancer mortality rates for 2014-2018 in the Toledo Health Area with the rest of Castilla-La Mancha, which had similar cancer treatment access and management protocols but without digital breast tomosynthesis, the crude mortality rate was 17.79 (95% CI: 15.38 -20.19) vs. 24.76 per 100,000 (95% CI: 26.12-23.39), respectively. The cumulative risk of death was also significantly lower for the Toledo Health Area than for Castilla-La Mancha. CONCLUSION: The introduction of digital breast tomosynthesis improved screening quality indicators. Breast cancer mortality simultaneously decreased with respect to the rest of Castilla-La Mancha. Further research is needed to assess the long-term results, and the role that the redesign may have played in reducing mortality.

Encuentros y desencuentros entre salud comunitaria y sistema sanitario español. Informe SESPAS 2018 / Agreements and disagreements between community health and the Spanish health system. SESPAS Report 2018

A través de un recorrido histórico por la relación del Sistema Nacional de Salud español y la Salud Comunitaria, se describen las diferentes etapas de auge o declive de la Atención Primaria -y en concreto de su orientación comunitaria-, los acercamientos y distanciamientos en su relación con la Salud Pública y la influencia de las ideologías políticas dominantes. Considerando la salud comunitaria como parte esencial de la Atención Primaria, y de acuerdo con la estrategia de Alma Ata y los principios de la Carta de Ottawa, se defiende una reorientación comunitaria de los servicios de salud y se propone retomar la Atención Primaria como eje estratégico del Sistema Nacional de Salud, dada su capacidad para un abordaje integral de los procesos salud-enfermedad, sus posibilidades de reducir desigualdades y enfrentar determinantes sociales, así como de superar inequidades en salud, con la participación de la población y en coordinación con otros sectores. Los desafíos del futuro inmediato, así como las consecuencias de la crisis económica y de los recortes y debilitamiento del Estado de Bienestar, hacen evidente la necesidad de promover procesos participativos que impliquen al conjunto de actores sociales y, sobre todo, a la ciudadanía, considerada no como destinataria y 'usuaria' o consumidora, sino como sujeto activo y colaborativo. Se señala la imperiosa necesidad de incorporar procesos participativos dirigidos a crear una nueva cultura colectiva respecto a la sostenibilidad y universalidad de los recursos públicos de salud existentes

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and 'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources

[Agreements and disagreements between community health and the Spanish health system. SESPAS Report 2018]. / Encuentros y desencuentros entre salud comunitaria y sistema sanitario español. Informe SESPAS 2018.

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources.

Cognitive Performance across 3 Frailty Phenotypes: Toledo Study for Healthy Aging.

INTRODUCTION: Frailty is a strong predictor of adverse health events, but its impact on cognitive function is poorly understood. AIM: To assess cognitive performance in frailty and to identify the frailty stage where cognitive impairment begins. METHODS: Data were taken from 2044 people aged ≥65 years without cognitive impairment selected from the Toledo Study for Healthy Aging, a population-based cohort of older adults. Frailty status was assessed by 3 different scales: Frailty Phenotype (FP), Frailty Trait Scale (FTS), and Frailty Index (FI). Neuropsychological assessments of different cognitive domains included the Mini-Mental State Examination, Short and Long-Term Memory Recalling Test, the Boston Naming Test, Verbal Fluency Test, Digit Span Forward, Go/No-go Test, Luria Orders Test, Clock Drawing Test, and Serial Word Learning Test. The relationships between the score of the scales and frailty status (robust, prefrail, and frail for FP and quartiles for FTS and FI) were analyzed using multivariate linear regression models including age, sex, and educative level as possible confounders. RESULTS: Participants classified as the worst degree of frailty (frail in FP and fourth quartile of FTS and FI) presented more cognitive domains affected and to a higher extent than moderate frail (prefrail and second quartile and third quartile of FTS and FI) and robust (and first quartile of FTS and FI) participants. CONCLUSIONS: Cognitive performance progressively declined across the frailty state, regardless of the instrument used to assess frailty. In prefrail participants, cognitive impairment may be an early marker of frailty-dependent cerebral involvement and could be already subject to interventions aimed at reducing the transition to frailty.

Association of regional muscle strength with mortality and hospitalisation in older people.

BACKGROUND: the association between muscular strength, mortality and hospitalisation with ageing can change depending on sex and the body region analysed (e.g. upper and lower limb muscles). OBJECTIVE: to determine the effect of measuring lower and upper extremities muscular strength on the relationship between strength, mortality and hospitalisation risk in elder men and women. DESIGN: a population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). METHODS: a Spanish population sample of 1,755 elders aged ≥65 years participated in this study. Upper (handgrip and shoulder) and lower limbs (knee and hip) maximal voluntary isometric strength was obtained using standardised techniques and equipment. Cox proportional hazards model was used to examine mortality and hospitalisation over 5.5 and 3 years of follow-up, respectively. RESULTS: after adjustment for potential confounding factors, including co-morbidities and BMI, hazard ratio of death and hospitalisation was significantly lower in the stronger women and men, but showing regional- and sex-specific differences. That is shoulder, knee and hip muscle regions in women and handgrip and shoulder in men (all P < 0.05). There was a cumulative effect of measuring several muscle strengths over the risk of health events (P < 0.05), so that mortality hazard ratio increased by 45% in women and 25% in men per muscular strength (shoulder, grip, knee and hip) in the weaker strength quartile increase (P < 0.01). CONCLUSIONS: regional muscle strength is a predictor of medium-term mortality and hospitalisation in elder men and women. Multiple strength measures including lower and upper body limb muscles are better predictors than a single strength measurement.

Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report.

BACKGROUND: This article summarizes the 2012 European Renal Association-European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as ≥65 years). METHODS: Data provided by 45 national or regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. Individual patient level data were received from 31 renal registries, whereas 14 renal registries contributed data in an aggregated form. The incidence, prevalence and survival probabilities of patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT) and renal transplantation rates for 2012 are presented. RESULTS: In 2012, the overall unadjusted incidence rate of patients with ESRD receiving RRT was 109.6 per million population (pmp) (n = 69 035), ranging from 219.9 pmp in Portugal to 24.2 pmp in Montenegro. The proportion of incident patients ≥75 years varied from 15 to 44% between countries. The overall unadjusted prevalence on 31 December 2012 was 716.7 pmp (n = 451 270), ranging from 1670.2 pmp in Portugal to 146.7 pmp in the Ukraine. The proportion of prevalent patients ≥75 years varied from 11 to 32% between countries. The overall renal transplantation rate in 2012 was 28.3 pmp (n = 15 673), with the highest rate seen in the Spanish region of Catalonia. The proportion of patients ≥65 years receiving a transplant ranged from 0 to 35%. Five-year adjusted survival for all RRT patients was 59.7% (95% confidence interval, CI: 59.3-60.0) which fell to 39.3% (95% CI: 38.7-39.9) in patients 65-74 years and 21.3% (95% CI: 20.8-21.9) in patients ≥75 years.

Prevalencia de diabetes y diabetes oculta en adultos de Castilla-La Mancha / Prevalence of known diabetes mellitus and unknown diabetes in adults from Castilla-La Mancha, Spain

Fundamento y objetivo: Los objetivos de este estudio fueron estimar la prevalencia de diabetes mellitus (DM) conocida, diabetes oculta (DO) y alteraciones del metabolismo de los hidratos de carbono en la población de Castilla-La Mancha de edad ≥ 30 años, y valorar los factores de riesgo cardiovascular asociados con diabetes. Pacientes y método: Para estimar la prevalencia se realizó un estudio poblacional trasversal con fecha de referencia del 01-06-2007. Fueron seleccionados 3.092 sujetos, de los que participaron 1.181 (38,1%). Se realizó cuestionario, exploración y sobrecarga oral de glucosa (SOG). Se utilizaron los criterios diagnósticos establecidos por la Asociación Americana de Diabetes (ADA) y se compararon los resultados con los criterios de la Organización Mundial de la Salud (OMS). Resultados: La prevalencia de diabetes en sujetos de edad ≥ 30 años fue del 17,9% (DM 10,7%, DO 7,2%, razón DO/DM 0,7), la de intolerancia a la glucosa (ITG) del 5,6% y la de glucosa basal alterada (GBA) del 22,3% según criterios ADA y 7,2% según criterios OMS. La DM, ITG y GBA aumentaron con la edad. Se observó una mayor prevalencia de diabestes en global en varones (20,9%) frente a mujeres (14,5%), pero a partir de los 75 años es más prevalente en sexo femenino. Se encontró asociación con la obesidad, el género masculino, la edad y la presencia de antecedentes familiares de diabetes.Conclusiones: La prevalencia de diabetes en la población adulta de Castilla-La Mancha es muy elevada, es mayor en varones y aumenta con la edad. Un alto porcentaje de personas con diabetes o con alteración en el metabolismo de los hidratos de carbono desconoce su condición, lo que pone de manifiesto la necesidad de implantar estrategias de detección precoz (AU)

Background and objetive: To estimate the prevalence of known diabetes mellitus (KD), unknown diabetes (UD), and carbohydrate metabolism disturbances in a population of Castilla-La Mancha (CLM) older than 30 years old; To study the cardiovascular risk factors related with diabetes.Patients and methods: A transversal study was performed in order to determine these prevalence data. Reference date: 2007/06/01. 3,092 subjects were selected, and 1,181 of them (38.1%) participated in the study. A questionnaire, physical exploration and glucose tolerance test were performed. The diagnostic criteria of diabetes were those established by the American Association of Diabetes (ADA) and were compared with the World Health Organization criteria (WHO).Results: Prevalence of diabetes in individuals younger than 30 years: 17.9% (DM 10.7%, DO 7.2%). Ratio UD/KD: 0.7. Prevalence of impaired glucose tolerance (IGT) 5.6% and impaired fasting glucose (IFG) 22.3% based on ADA criteria and 7.2% if WHO criteria applied. KD, IFT and IFG increased with age. Global prevalence was higher in males (20.9%) than females (14.5%), but the prevalence was higher in females older than 74 years. A positive relationship was found with obesity, male sex, age and familiar history of diabetes.Conclusions: Prevalence of diabetes in the adult population of CLM is very high, higher in males and increase with age. A great percentage of diabetic people or with carbohydrate metabolism alterations do not know that condition. This situation makes necessary to create early detection strategies (AU)

[Prevalence of known diabetes mellitus and unknown diabetes in adults from Castilla-La Mancha, Spain]. / Prevalencia de diabetes y diabetes oculta en adultos de Castilla-La Mancha.

BACKGROUND AND OBJECTIVE: To estimate the prevalence of known diabetes mellitus (KD), unknown diabetes (UD), and carbohydrate metabolism disturbances in a population of Castilla-La Mancha (CLM) older than 30 years old; To study the cardiovascular risk factors related with diabetes. PATIENTS AND METHODS: A transversal study was performed in order to determine these prevalence data. Reference date: 2007/06/01. 3,092 subjects were selected, and 1,181 of them (38.1%) participated in the study. A questionnaire, physical exploration and glucose tolerance test were performed. The diagnostic criteria of diabetes were those established by the American Association of Diabetes (ADA) and were compared with the World Health Organization criteria (WHO). RESULTS: Prevalence of diabetes in individuals younger than 30 years: 17.9% (DM 10.7%, DO 7.2%). Ratio UD/KD: 0.7. Prevalence of impaired glucose tolerance (IGT) 5.6% and impaired fasting glucose (IFG) 22.3% based on ADA criteria and 7.2% if WHO criteria applied. KD, IFT and IFG increased with age. Global prevalence was higher in males (20.9%) than females (14.5%), but the prevalence was higher in females older than 74 years. A positive relationship was found with obesity, male sex, age and familiar history of diabetes. CONCLUSIONS: Prevalence of diabetes in the adult population of CLM is very high, higher in males and increase with age. A great percentage of diabetic people or with carbohydrate metabolism alterations do not know that condition. This situation makes necessary to create early detection strategies.

Tres brotes de brucelosis investigados en un año de vigilancia de salud laboral en Ciudad Real / Three outbreaks of brucellosis in a one-year period investigated by the occupational health service in Ciudad Real (Spain)

Presentamos 3 brotes investigados por nuestro servicio de salud laboral en el periodo de 1 año. Dos de ellos, con 2 casos cada uno, en sendas queserías industriales, y el tercero en un laboratorio pecuario perteneciente a la administración autonómica, también con 2 casos. En las 2 queserías se encontraron numerosas oportunidades para que los trabajadores pudieran haberse infectado; se consideró como de mayor riesgo la zona de descarga de leche, y la no utilización de equipos de protección individual por los trabajadores, las deficiencias en los laboratorios y la falta de separación efectiva de las dependencias fueron también potenciale factores de riesgo. Respecto al laboratorio pecuario, se hallaron al menos 13 deficiencias importantes que permitían la fácil transmisión del agente infeccioso. En España, el riesgo de adquirir una infección por Brucella en laboratorios o industrias queseras es importante, y las condiciones y medidas para evitarlo que actualmente existen no son efectivas (AU)

We describe 3 outbreaks of brucellosis investigated by our Occupational Health Service in a 1–year period. Two of these outbreaks, with 2 cases each, occurred in 2 cheese factories and the third outbreak, also with 2 cases, occurred in a cattle laboratory belonging to the local government. In both cheese factories, numerous opportunities for the workers to become infected were found. The greatest risk was considered to be the area for unloading milk, while failure to use personal protection equipment by workers, deficiencies in the laboratories, and the lack of effective separation between areas were also potential risk factors. In the cattle laboratory, we found at least 13 major risk factors that could allow brucellosis transmission. In Spain, there is a substantial risk of Brucella infection in laboratories or dairy factories and current preventive measures are ineffective (AU)

[Three outbreaks of brucellosis in a one-year period investigated by the occupational health service in Ciudad Real (Spain)]. / Tres brotes de brucelosis investigados en un año de vigilancia de salud laboral en Ciudad Real.

We describe 3 outbreaks of brucellosis investigated by our Occupational Health Service in a 1-year period. Two of these outbreaks, with 2 cases each, occurred in 2 cheese factories and the third outbreak, also with 2 cases, occurred in a cattle laboratory belonging to the local government. In both cheese factories, numerous opportunities for the workers to become infected were found. The greatest risk was considered to be the area for unloading milk, while failure to use personal protection equipment by workers, deficiencies in the laboratories, and the lack of effective separation between areas were also potential risk factors. In the cattle laboratory, we found at least 13 major risk factors that could allow brucellosis transmission. In Spain, there is a substantial risk of Brucella infection in laboratories or dairy factories and current preventive measures are ineffective.

[Dialysis and transplant. Spain in 2005]. / Informe de Situación de Diálisis y Trasplante en España, 2005.

In 2005, renal replace treatment (dialysis and transplant) was necessary for about 40,000 people, without being known the number accurate and either their basic characteristics, such as: time in treatment, modality or treatment changes. The presented data cover the 76% of the Spanish population and are the result of the cooperation among technicians of registries, nephrologists and transplant coordinations. 4,125 people started RRT in 2005, the total estimated acceptance rate for renal replacement therapy in adults in Spain was 126 pmp and regarding other European countries it locates us in an intermediate area. The incidence rate seems to keep stable in the last years although there were some differences among communities (from 104 pmp in Castile and Leon to 186 pmp in Canary Islands). Diabetes Mellitus is the most diagnosed cause of renal failure in 2005, more than 20% of patients, followed by vascular diseases. The estimated prevalence of renal replacement therapy in Spain at the end of 2005 was 903 pmp, with important variations among communities (from 806 pmp in Cantabria to 1056 pmp in Valencia Region). The 47% of prevalent RRT patients had a functioning transplant. Mortality on haemodialysis and peritoneal dialysis was 13.7% and 10.8% respectively. Mortality on transplant was 1.3%, one of the lowest values registered so far. Mortality on renal replacement therapy was around 5% among patients from 45 to 64 years, 11% between 65 and 74 years and 19% among the patients older than 75 years.

[Shigellosis outbreak with 146 cases related to a fair]. / Brote de shigellosis con 146 casos relacionado con una feria.

BACKGROUND: On September 3, 2005, the Ciudad Real Public Health Service (Spain) received a report of 20 cases of gastroenteritis in the municipality of Daimiel. We conducted an investigation to determine the cause or causes of the outbreak and to implement control measures. Most of the cases involved young people who visited the municipality's fair. METHODS: We carried out a descriptive study and an analytic case-control study. In the descriptive study, all variables of interest available in the medical records were included. In the case-control study, each case was matched with a control by age (plus or minus 5 years), gender, and attendance at the fair. Sixty-five cases and 65 controls were finally included in the study. Samples of foods and stools from food handlers were taken. RESULTS: We found 196 cases, 146 of which were confirmed. The epidemic curve suggested a common source of infection with a short period of activity. The case-control study showed an association between infection and eating potatoes with a sauce at any of the fair's five food stalls (OR = 20.56; 95%CI, 6.15-75.93; p < 0.0001). Logistic regression analysis showed an association with eating potatoes in food stall number 2 (OR = 6.38; 95%CI, 1.70-23.90; p < 0.0059). Neither samples of foods nor stools from food handlers yielded any positive results. However, Shigella sonnei was isolated from stool samples from 20 cases. CONCLUSIONS: The epidemiological study suggested that the most probable cause of the outbreak was a sauce, handmade with garlic, milk, and oil and served with the potatoes.

Brote de shigellosis con 146 casos relacionado con una feria / Shigellosis outbreak with 146 cases related to a fair

Fundamento: El 3 de septiembre de 2005, el Servicio de Salud Pública de Ciudad Real conoció la existencia de 20 casos de gastroenteritis en el municipio de Daimiel. Se inició una investigación, con los objetivos de determinar las causas y establecer medidas de control. La mayor parte de los afectados eran jóvenes que habían visitado la feria de la localidad. Métodos: Se llevó a cabo un estudio descriptivo y otro analítico de casos y controles. En el descriptivo se incluyeron todas las variables de interés disponibles en las historias clínicas de los pacientes. Se diseñó un estudio de casos y controles apareado por edad (más o menos 5 años), sexo y asistencia a la feria, que incluyó a 65 casos y a 65 controles. Se llevaron a cabo inspecciones de establecimientos y toma de muestras clínicas y de alimentos. Resultados: Se notificaron 196 casos, de los cuales 146 fueron confirmados. La curva epidémica sugiere una fuente común de corta duración. El estudio de casos y controles apareado muestra una asociación con el consumo de patatas con salsa en uno de los chiringuitos (odds ratio [OR] = 20,56; intervalo de confianza [IC] del 95%, 6,15-75,93; p < 0,0001). La regresión logística mostró una asociación únicamente con haber comido patatas en el chiringuito dos (OR = 6,38; IC del 95%, 1,70-23,90; p < 0,0059). De las muestras obtenidas de salsas, heces de enfermos y manipuladores, se obtuvieron 20 coprocultivos positivos para Shigella sonnei en los enfermos, mientras que el resto fueron negativas. Conclusiones: El estudio epidemiológico sugiere que una salsa de elaboración artesanal y clandestina, compuesta de ajo, leche y aceite, fue la probable fuente de la infección

Background: On September 3, 2005, the Ciudad Real Public Health Service (Spain) received a report of 20 cases of gastroenteritis in the municipality of Daimiel. We conducted an investigation to determine the cause or causes of the outbreak and to implement control measures. Most of the cases involved young people who visited the municipality's fair. Methods: We carried out a descriptive study and an analytic case-control study. In the descriptive study, all variables of interest available in the medical records were included. In the case-control study, each case was matched with a control by age (plus or minus 5 years), gender, and attendance at the fair. Sixty-five cases and 65 controls were finally included in the study. Samples of foods and stools from food handlers were taken. Results: We found 196 cases, 146 of which were confirmed. The epidemic curve suggested a common source of infection with a short period of activity. The case-control study showed an association between infection and eating potatoes with a sauce at any of the fair's five food stalls (OR = 20.56; 95%CI, 6.15-75.93; p < 0.0001). Logistic regression analysis showed an association with eating potatoes in food stall number 2 (OR = 6.38; 95%CI, 1.70-23.90; p < 0.0059). Neither samples of foods nor stools from food handlers yielded any positive results. However, Shigella sonnei was isolated from stool samples from 20 cases. Conclusions: The epidemiological study suggested that the most probable cause of the outbreak was a sauce, handmade with garlic, milk, and oil and served with the potatoes

[Treatment and temperature series study for use in public health. The case of Castilla-La Mancha, Spain]. / Tratamiento y estudio de series de temperatura para su aplicación en salud pública. El caso de Castilla- La Mancha.

BACKGROUND: Numerous articles relate atmospheric variables to health indicators. In large regions, such as Castilla-La Mancha, it may be necessary to divide the region into areas in terms of the atmospheric variables available by selecting a representative weather station for each zone. This article focuses on analyzing the daily temperature data from numerous Castilla La Mancha observatories and reducing the number thereof to a few representative stations for being used in studies relating atmospheric variables to health indicators in this region. METHODS: Castilla-La Mancha weather stations were selected in terms of the number of years available and missing data. After filling in the gaps in the selected series, to detect any possible discontinuities and to homogenize the series, the daily temperature data is used in hierarchical cluster and factorial analyses by principal components. RESULTS: Factorial analyses extract one single factor by using the maximum, mean or minimum temperature series. For the maximum temperatures, this factor explains 93.45% of the variance, with an eigenvalue of 39.249. The "Compuesta" station in Toledo shows correlation coefficients in the principal components matrix of 0.987, 0.991 and 0.981 respectively for the maximum, mean and minimum temperature series. CONCLUSIONS: Castilla-La Mancha is an isoclimatic region in terms of the temperature, the "Compuesta" station in Toledo being selected as the representative station for the region for public health studies. The results afford the possibility of conducting studies broken down into small units such as the provinces, with the stations in the government capitals as a reference.

Tratamiento y estudio de series de temperatura para su aplicación en salud pública. El caso de Castilla- La Mancha / Treatment and temperature series study for use in public health. The case of Castilla-La Mancha, Spain

Fundamento: Numerosos trabajos relacionan variables atmosféricascon indicadores sanitarios. En regiones extensas, como Castilla-La Mancha, puede ser necesario dividirla en áreas en función delas variables atmosféricas disponibles, eligiendo una estación meteorológicarepresentativa para cada zona. El objetivo de este artículoes analizar los datos diarios de temperaturas de numerosos observatoriosde Castilla- La Mancha y su reducción a unas pocas estacionesrepresentativas para ser utilizadas en estudios que relacionen variablesatmosféricas con indicadores sanitarios de esta región.Métodos: Se seleccionaron estaciones meteorológicas de Castilla-La Mancha en función del número de años disponibles y de datosperdidos. Tras rellenar las lagunas de las series elegidas, detectarposibles discontinuidades y homogeneizar las series, los datos diariosde temperaturas se utilizan en análisis de conglomerados jerárquicoy factorial mediante componentes principales.Resultados: El análisis factorial extrae un solo factor utilizandolas series de temperaturas máximas, medias o mínimas. En las máximas,ese factor explica el 93,45% de la varianza, con autovalor39,249. La estación Toledo «Compuesta» tiene coeficientes decorrelación en la matriz de componentes principales de 0,987; 0,991y 0,981 para las series de temperaturas máximas, medias y mínimasrespectivamente. Conclusiones: Castilla-La Mancha es una región isoclimática enfunción de la temperatura y la estación Toledo «Compuesta» la elegidacomo representativa regional para estudios en salud pública.Los resultados permiten la realización de estudios desagregados enunidades menores como las provincias, con las estaciones de lascapitales administrativas como referencia

Background: Numerous articles relate atmospheric variablesto health indicators. In large regions, such as Castilla-La Mancha, itmay be necessary to divide the region into areas in terms of theatmospheric variables available by selecting a representativeweather station for each zone. This article focuses on analyzing thedaily temperature data from numerous Castilla La Mancha observatoriesand reducing the number thereof to a few representative stationsfor being used in studies relating atmospheric variables tohealth indicators in this region.Methods: Castilla-La Mancha weather stations were selected interms of the number of years available and missing data. After fillingin the gaps in the selected series, to detect any possible discontinuitiesand to homogenize the series, the daily temperature data is usedin hierarchical cluster and factorial analyses by principal components.Results: Factorial analyses extract one single factor by using themaximum, mean or minimum temperature series. For the maximumtemperatures, this factor explains 93.45% of the variance, with aneigenvalue of 39.249. The «Compuesta» station in Toledo showscorrelation coefficients in the principal components matrix of 0.987,0.991 and 0.981 respectively for the maximum, mean and minimumtemperature series. Conclusions: Castilla-La Mancha is an isoclimatic region interms of the temperature, the «Compuesta» station in Toledo beingselected as the representative station for the region for public healthstudies. The results afford the possibility of conducting studies brokendown into small units such as the provinces, with the stations inthe government capitals as a reference

Prevalencia de demencia y de sus subtipos principales en sujetos mayores de 65 años: efecto de la educación y ocupación. Estudio Toledo / The prevalence of dementia and its wain subtypes in subjects older than 65 years: the effects of occupation and education. Toledo Study

FUNDAMENTO: Determinar la prevalencia de demencia y sus subtipos en una población de bajo nivel educativo, y evaluar si existe asociación entre la ocupación, la educación y la demencia. POBLACIÓN Y MÉTODO: Estudio transversal poblacional en una muestra de 3.214 personas representativa de la población de Toledo, de 65 o más años, extraída mediante muestreo aleatorio polietápico. En la primera fase se utilizó el Mini-Mental State Examination (MMSE) para detectar a las personas con deterioro cognitivo. La segunda fase consistió en la realización de una entrevista clínica semiestructurada y de una evaluación neuropsicológica. La demencia y sus subtipos se determinaron utilizando criterios diagnósticos bien establecidos. El proceso se realizó mediante un algoritmo que optimó el acuerdo diagnóstico. RESULTADOS: La prevalencia de demencia global, enfermedad de Alzheimer y demencia vascular alcanzó el 7,6, el 4,6 por ciento y el 1,8 por ciento, respectivamente. Se observó una relación directa entre estas tres entidades y la edad. La prevalencia de demencia fue mayor en mujeres, analfabetos y quienes tenían ocupaciones que requerían un menor nivel de instrucción. Tras el ajuste por otras variables sociodemográficas, sólo la edad se asoció con la presencia de demencia. CONCLUSIONES: La prevalencia de la demencia global, demencia tipo Alzheimer y demencia vascular aumenta con la edad. No se ha encontrado una asociación clara entre la educación, la ocupación y la demencia (AU)