Tendencia de la hospitalización por ictus isquémico en adultos jóvenes de la Región de Murcia durante el periodo 2006-2014 / Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014

Introducción: Estudios recientes en Europa y Estados Unidos muestran un posible aumento de la incidencia y la hospitalización por ictus isquémico en adultos jóvenes, sin embargo, en España la información disponible de la tendencia es escasa. Por ello planteamos analizar la tendencia de hospitalización por ictus isquémico en adultos menores de 50 años en la Región de Murcia entre 2006 y 2014. Método: Se realizó un estudio retrospectivo de las altas de hospitalización por enfermedad cerebrovascular (ECV) extraídas del Registro del conjunto mínimo de datos al alta hospitalaria. Se obtuvieron las tasas estandarizadas, desagregadas según edad y subtipo de ECV. La tendencia de los episodios fue analizada mediante regresión de joinpoint, obteniendo la tasa estandarizada anual calculada y el porcentaje de cambio anual (PCA). Resultados: Se identificaron un total de 27.064 altas por ECV en los 9 años del estudio. Los episodios generados por ictus isquémico fueron los más numerosos (61,0%), en pacientes entre 18 y 49 años; entre los años extremos, se registró un aumento del 26% de los episodios por ictus isquémico y del 29,2% de las tasas, mientras que en la regresión de joinpoint no se observó tendencia (PCA = 2,74%, p ≥ 0,05). Por el contrario, en mayores de 49 años esta tendencia fue descendente (PCA = –1,24%, p < 0,05). Conclusiones: No se ha identificado una tendencia en la hospitalización por ictus isquémico en adultos jóvenes a pesar del descenso en adultos de mayor edad. Sería importante identificar las causas de este comportamiento desigual para desarrollar medidas específicas dirigidas al grupo de menor edad. (AU)

Introduction: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. Method: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). Results: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC = 2.74%, P≥.05). By contrast, a downward trend was identified in individuals older than 49 (APC = –1.24%, P<.05). Conclusions: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults. (AU)

Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014.

INTRODUCTION: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. METHOD: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). RESULTS: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC = 2.74%, P ≥ .05). By contrast, a downward trend was identified in individuals older than 49 (APC = -1.24%, P < .05). CONCLUSIONS: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults.

Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014. / Tendencia de la hospitalización por ictus isquémico en adultos jóvenes de la Región de Murcia durante el periodo 2006-2014.

INTRODUCTION: Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. METHOD: We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). RESULTS: A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC=2.74%, P≥.05). By contrast, a downward trend was identified in individuals older than 49 (APC=-1.24%, P<.05). CONCLUSIONS: No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults.

Prevalencia de hábitos bucodentales saludables en la población infanto-juvenil residente en España / Prevalence of healthy oral habits in the child population resident in spain

Introducción: La salud bucodental es parte fundamental de la salud infantil. Para asegurarla, se precisa instaurar precozmente y mantener hábitos saludables como revisiones periódicas, cepillado dental correcto frecuente y dieta no cariogénica. Se investiga la prevalencia de dichos hábitos en niños españoles según estratos de edad (preescolar: 2-5 años y escolar: 6-15 años) y nivel de estudios maternos. Material y métodos: Estudio descriptivo transversal, basado en la última Encuesta Nacional de Salud de España (2006). Muestra representativa de 8.042 sujetos (2-15 años). Resultados: El 47,35% refiere haber acudido a los servicios dentales en el último año y el 69,09% alguna vez en su vida. El 22,68% se cepilla diariamente los dientes 3 o más veces y el 89,03% refiere ingerir una dieta de riesgo cariogénico. En el grupo escolar (6-15 años) el 29,87% de los hijos de madres universitarias se cepilla los dientes 3 o más veces frente al 25,83 y 20,89% de los de madres con estudios secundarios y hasta primarios respectivamente. Para la ingesta de dieta de riesgo cariogénico los porcentajes son 87,05; 91,11 y 90,44%. En ambos grupos etarios, y exceptuando la ingesta de dulces, existe una asociación estadísticamente significativa entre el nivel de estudios maternos y los hábitos saludables. Conclusiones: La prevalencia de estos hábitos saludables se aleja de las recomendaciones: menor uso de servicios y frecuencia de cepillado dental diario y alta ingesta de dieta de riesgo cariogénico. En ambos grupos de edad los resultados son más favorables cuando los estudios maternos son universitarios lo que puede servir para orientar las actividades de promoción de la salud(AU)

Introduction: Oral health is integral to children's health. To achieve this, it is essential establishing healthy habits early on them, such as regular check-ups, proper and frequent tooth brushing and a non-cariogenic diet. Prevalence of these habits are investigated in Spanish children by age group (pre-school: 2-5 years and school: 6-15 years) and by maternal educational level. Material and methods: A descriptive cross-sectional study was conducted, based on the last Spanish National Health Survey (2006). A representative sample of 8042 subjects (2-15 years) was obtained. Results: A total of 47.35% reported having gone to dental services during the last year and 69.09% having gone sometime during their lives. Only 22.68% of the sample reported daily tooth brushing three times or more and 89.03% reported eating a cariogenic risk diet. In the school group (6-15 years) 29.87% of children whose mothers were university level brushed their teeth three times or more compared to 25.83% and 20.89% of those whose mothers had secondary and even primary studies respectively. For the intake of cariogenic risk diet, the percentages were 87.05%, 91.11% and 90.44%. In both age groups, and except for the consumption of sweets, there was a statistically significant association between maternal educational level and healthy habits. Conclusions: The prevalence of these healthy habits is far lower than the recommendations: a lower use of services and a lower frequency of daily tooth brushing and higher intake of a cariogenic risk diet. The outcomes are more favourable in both age groups when the mother are university level, wich may serve as a guide to the promotion of oral health(AU)

[The introduction of the child health document in the Murcia area]. / Implantación del documento de salud infantil en la región de Murcia.

OBJECTIVE: To find the level of implantation and use of the Child Health Booklet (CHB) in the Murcia region and the prevalence of breast-feeding. DESIGN: A retrospective descriptive study. SETTING: Central services of the Health Board. Community level. PATIENTS AND OTHER PARTICIPANTS: A sample consisting of the mothers of 14-week old babies with a birth-date between 16/11 and 15/12/92 (n = 197). INTERVENTIONS: A telephone survey was carried out. A telegram was sent to those who did not answer or had no telephone. MEASUREMENTS AND MAIN RESULTS: 147 mothers answered (74.6 +/- 6.1%); 137 with a telephone (88.5 +/- 5%) and ten without (22 +/- 12.7%) (p < 0.001). 134 of these (91.2 +/- 4.6%) stated that they had received the CHB: 126 when leaving hospital. One had lost it after three months. We found no differences for different Maternity hospitals. Of the 134 mothers with the CHB, 90 (67.2%) used public health services, 27 (20.1%) private ones and 17 (12.7%) both. 87.4% of the mothers took their CHB to their consultations, where health professionals asked to see it on 68.2% of the occasions. Parameters with compliance over 90% were: personal data, the type of birth along with incidents at the birth, and somatometry at the birth. Neonatal status and psychomotor development showed under 10% compliance, though in hospital there was better compliance. 85 +/- 5.8% began breast-feeding, with 31.3% +/- 7.5% carrying on up to three months. We found no association between public or private care and commitment to breast-feeding. CONCLUSIONS: A high level of distribution of the CHB and an acceptable compliance level. It is important to promote the CHB as a recording instrument and to involve the family.

[Tuberculous infection in schoolchildren in the 1st year of basic general education in the Murcia region (1985-1992)]. / Infección tuberculosa en escolares de 1st de EGB de la región de Murcia (1985-1992).

OBJECTIVE: To find the evolution of the prevalence of tubercular infection. DESIGN: Study of the tendency of the findings from crossover surveys carried out during the last 7 years. SETTING: First-year EGB students from public and private schools in the Autonomous Community of Murcia. INTERVENTION: Performing the Mantoux intradermoreaction test with 2 UT of PPDRT23/TWEEN80 for the first 5 years and 5 UT of PPDCT68/TWEEN80 the last 2, with any induration over 5 mm. being considered positive. A clinical study of school students found positive and of their family contacts. RESULTS: Coverage was established at about 80% (71,520 tests studied), with prevalence diminishing from 0.97% to 0.44%, this establishing a downward tendency (p < 0.001). 6.5% of the tuberculin-test positive students (21) and 2.8% of the family contacts (34) were diagnosed with tuberculosis. CONCLUSIONS: At the moment we lack data to suggest an increase in endemic tuberculosis among the school population. The results mentioned justify tuberculosis surveys of school students, although low prevalence suggests that the age at which it is performed should be raised.

[Smoking addiction treatment, with nicotine chewing gum, in primary care. Double-blind study]. / Tratamiento del tabaquismo, con chicle de nicotina, en atención primaria. Estudio a doble ciego.

BASIS: Study of the efficacy of nicotine chewing gum in the treatment of smoking addiction in primary health care. METHODS: Three interventions groups are compared. Active group (37): treated with group psychotherapy and nicotine chewing gum; Placebo group (38): Treated exactly as first group, but with placebo chewing gum, and Outpatient Group (31): Individual psychotherapy in an outpatient basis, with nicotine chewing gum. RESULTS: Comparison of results, one year after intervention, between active group (35.1% success) and placebo group (13.2% success) showed the existence of statistically significant differences (p < 0.03). Outpatient group yielded 25.8% success rate, without finding any statistically significant differences in comparison with the active group. CONCLUSIONS: Nicotine chewing gum can be an effective support in the treatment of smoking addiction, in primary health care, in certain smokers, assuming that this treatment is accompanied with individual or group psychotherapy follow up, which reinforces the behavior and prevents relapses.

[Vaccination every time when an occasion arises: evaluation of an intervention in the Murcia Autonomous Community]. / Vacunar cada vez que se presenta una ocasión: evaluación de una intervención en la Comunidad Autónoma de Murcia.

This study evaluated the occasions for vaccination that are lost in a vaccination center by means of the systematic offer of tetanus vaccine to the adults which accompanied pediatric patients. The study was prospective and had three periods, of two weeks duration each. In the first period vaccination was offered through a questionnaire, in the second without questionnaire, and the third was used as control. The recorded accompanying persons were 298, 478 and 155 for the three periods. During the first period the overall number of administered doses increased by 22%. During the second it increased by 31% (p = NS). In both the number of administered tetanus vaccine doses was doubled. 68% of the nonvaccinated accompanying persons accepted the vaccine in the first period, and 63% in the second period (p = NS). We conclude that both intervention alternatives were equally effective. Through this intervention we increased the rate of adequately vaccinated accompanying persons form 30 +/- 3% to 75 +/- 3%. This approach may be effective to increase the level of tetanus immunization in the adult population when applied in primary care centers.

[Double-blind study of the efficacy of nicotine chewing gum for smoking cessation in the primary care setting]. / Estudio doble ciego de la eficacia del chicle de nicotina en la deshabituación tabáquica, dentro del ámbito de la atención primaria.

The results after 6 months of the treatment of three intervention groups with nicotine chewing gum to evaluate its effectiveness for the treatment of smoking addiction in primary care are reported. After random allocation, 106 individuals out of the 200 recruited in three health centers started the treatment. The active group (n = 37), treated with group sessions and nicotine chewing gum, was compared with a placebo group (n = 38) with an identical intervention. The success rate was 35.1 in the first group and 13.2 in the second (p less than 0.03), thus confirming the effectiveness of nicotine chewing gum. A third group, called consulting room group, (n = 31) was treated with nicotine chewing gum and follow up in the programmed usual consulting room. The rate of success in this group was 25.8%, without statistically significant difference with the first group.