Effect of the 2008 economic crisis on oral health in Spain: analysis of serial cross-sectional, population-based health surveys.

OBJECTIVES: To evaluate the impact of the economic crisis on the oral health of individuals in Spain based on variables including sex, unemployment, social class and educational level. DESIGN: This was an analysis of serial cross-sectional, population-based health surveys conducted before the crisis (2003 and 2006) and during the crisis (2011, 2014 and 2017). SETTING: National Health Surveys of Spain and the European Health Survey in Spain.ParticipantsA total of 189 543 participants were recruited. OUTCOME MEASURES: The independent variables were sex, employment, social class and educational level. The dependent variables were related to oral health. Descriptive statistics, χ2 tests and the Cochran-Mantel-Haenszel test were performed. RESULTS: The results showed that there were differences (p<0.001) in all oral health indicators before and after the crisis. Compared with the precrisis period, men had a higher probability of tooth extractions (OR 1.41, 95% CI 1.37 to 1.45), dental fillings (OR 1.30, 95% CI 1.27 to 1.34), prostheses (OR 1.04, 95% CI 1.01 to 1.07) and missing teeth (OR 1.35, 95% CI 1.31 to 1.39). Unemployed individuals were more likely to have dental caries (OR 1.08, 95% CI 1.00 to 1.16) and missing teeth (OR 1.36, 95% CI 1.27 to 1.46). Working class individuals had a higher probability of tooth extractions (OR 1.63, 95% CI 1.59 to 1.67), bleeding gums (OR 1.04, 95% CI 1.01 to 1.07), prostheses (OR 1.05, 95% CI 1.02 to 1.07) and missing teeth (OR 1.36, 95% CI 1.33 to 1.39). Participants with a basic or intermediate level of education had a higher probability of dental mobility (OR 1.13, 95% CI 1.07 to 1.19), prostheses (OR 1.11, 95% CI 1.08 to 1.14) and missing teeth (OR 1.42, 95% CI 1.38 to 1.46). CONCLUSIONS: The economic crisis affected the oral health of the Spanish population, with a more significant deterioration among men, working class individuals and unemployed individuals.

Trends in hospitalization and in-hospital mortality rates among patients with lung cancer in Spain between 2010 and 2020.

BACKGROUND: Lung cancer is the third most frequent tumor and the main cause of death by tumor in Spain. Although the incidence and mortality are still significantly higher in men than in women, the disparity between the sexes is decreasing. The objective of this study was to analyze the evolution of lung cancer hospitalization and in-hospital mortality rates in Spain from 2010 to 2020. METHODS: The reports of the Minimum Basic Data Set (MBDS) at hospital discharge were used to retrospectively analyze the data of all patients with a primary diagnosis of lung cancer, according to the International Classification of Diseases (ICD-9-CM and ICD-10-CM). RESULTS: Between 2010 and 2020, there were 315,263 hospitalizations and 70,490 deaths from lung cancer in Spain, the majority (~ 80%) in men. Overall, the rates of hospitalization and in-hospital mortality from lung cancer showed a downward trend throughout the period, although the number of new diagnoses and the absolute number of deaths in women increased. Due to the aging of the population, the degree of comorbidity in patients with lung cancer, although it remains relatively low, is also on the rise. CONCLUSION: Lung cancer represents a substantial clinical and economic burden for patients and for the National Health System, so it is necessary to promote primary prevention campaigns, as well as to develop more effective population screening measures to detect cancers early and increase the patient survival.

Burden of pneumonia in patients with viral and bacterial coinfection in Spain during six consecutive influenza seasons, from 2009-10 to 2014-15.

PURPOSE: Lower respiratory infections remain the most lethal communicable disease worldwide. Viral and bacterial coinfections (VBC) are common complications in patients with seasonal influenza and are associated with around 25% of all influenza-related deaths. The burden of pneumonia in patients with VBC in Spain is poorly characterized. To address this question, we aimed to provide population data over a period of six consecutive influenza seasons, from 2009-10 to 2014-15. METHODS: We used the discharge report from the Minimum Basic Data Set (MBDS), published annually by the Spanish Ministry of Health, to retrospectively analyse hospital discharge data in individuals aged ≥60 years with a diagnosis of pneumonia and influenza, based on the International Classification of Diseases (ICD-9-CM codes 480-486 and 487-488, respectively), from 1 October 2009 to 30 September 2015. RESULTS: In total, 1933 patients ≥60 years old were hospitalized for pneumonia and influenza, of whom 55.2% were male. The median age was 74 years (interquartile range [IRQ] 15); half of the patients were ≥75 years old. Influenza was the main diagnosis in 64.4% of the patients, and all-cause pneumonia in 15.8%, half of whom were assigned a diagnostic code for pneumococcal pneumonia. The mean annual hospitalization rate was 2.99 per 100,000 population (95% CI 2.9-3.1) throughout the study period, while the highest rate, 5.6 per 100,000 population (95% CI 5.2-6.0), was observed in the 2013-14 season. The mean annual mortality rate was 0.5 deaths per 100,000 population (95% CI 0.4-0.6) and in-hospital case fatality rate was 16.1% (95% CI 14.5-17.8). CONCLUSIONS: In Spain, community-acquired pneumonia and influenza continue to be an important cause of hospitalization and mortality in patients over 60 years of age. There is an urgent need to further develop prevention strategies such as joint vaccination for both pathologies.

Social Restrictions versus Testing Campaigns in the COVID-19 Crisis: A Predictive Model Based on the Spanish Case.

The global COVID-19 spread has forced countries to implement non-pharmacological interventions (NPI) (i.e., mobility restrictions and testing campaigns) to preserve health systems. Spain is one of the most severely impacted countries, both clinically and economically. In an effort to support policy decision-making, we aimed to assess the impacts of different NPI on COVID-19 epidemiology, healthcare costs and Gross Domestic Product (GDP). A modified Susceptible-Exposed-Infectious-Removed epidemiological model was created to simulate the pandemic evolution. Its output was used to populate an economic model to quantify healthcare costs and GDP variation through a regression model which correlates NPI and GDP change from 42 countries. Thirteen scenarios combining different NPI were consecutively simulated in the epidemiological and economic models. Both increased testing and stringency could reduce cases, hospitalizations and deaths. While policies based on increased testing rates lead to higher healthcare costs, increased stringency is correlated with greater GDP declines, with differences of up to 4.4% points. Increased test sensitivity may lead to a reduction of cases, hospitalizations and deaths and to the implementation of pooling techniques that can increase throughput testing capacity. Alternative strategies to control COVID-19 spread entail differing economic outcomes. Decision-makers may utilize this tool to identify the most suitable strategy considering epidemiological and economic outcomes.

Self-reported prevalence of periodontal disease among the Spanish population and immigrants: 2006, 2011/12 and 2017: a population-based study.

BACKGROUND: Periodontal disease is one of the most common pathologies in the population. Self-reporting has been used as a diagnostic tool in large populations, among other reasons, to detect the needs of potentially vulnerable groups. This study evaluated the prevalence of periodontal disease in people of Spanish nationality and immigrants in Spain. METHODS: This population-based, cross-sectional study was carried out using data obtained from National Health Interview Surveys (NHSs) carried out in 2006, 2011/2012 and 2017 in Spain. Subjects aged 16 years and older were included in the NHS-2006 and aged 15 years and older were included in the other NHSs. The following variables were self-reported by the participants: gum bleeding, tooth mobility, tooth extraction and missing teeth. Chi-square homogeneity tests were performed to assess the main associations between the independent variable (nationality) and the dependent variables (bleeding gums, tooth mobility, tooth extraction and missing teeth). Multinomial logistic regression models were constructed to evaluate the influences of the variables age and sex and their interactions on the main associations. RESULTS: A total of 115,123 participants were included in the NHS-2006 (n = 37,327, 11.38% immigrants), NHS-2011/12 (n = 38,727, 14.39% immigrants) and NHS-2017 (n = 39,069, 13.71% immigrants). The variables directly related to periodontal disease were gum bleeding and tooth mobility. These were significantly associated with nationality in the NHS-2006 and NHS-2017 cohorts. In the NHS-2011/12 cohort, only tooth mobility was associated with nationality. After adjustments for sex, age, and their interactions, immigrant status was associated with increased odds of bleeding in only the NHS-2006 cohort (RR = 1.65, 95% CI 1.38-1.99, p = 0.000). CONCLUSION: Immigrants in Spain have a lower probability of developing signs associated with periodontal disease than the Spanish population. Among the immigrant cohort, females and those in adult age groups had lower prevalence rates than their counterparts.

Is the Association between Postpartum Depression and Early Maternal-Infant Relationships Contextually Determined by Avoidant Coping in the Mother?

This study analyzes the moderating role of avoidant coping (in early pregnancy) in the relationship between postpartum depressive (PPD) symptoms and maternal perceptions about mother-baby relations and self-confidence. Participants were 116 low-risk obstetric mothers (mean age = 31.2 years, SD = 3.95, range 23-42) who received care and gave birth at a Spanish public hospital. Measurements were made at two points in time: at first trimester of pregnancy (maternal avoidance coping) and four months after childbirth (PPD and maternal perceptions). Avoidant coping was associated with the perception of the baby as irritable and unstable (p = 0.003), including irritability during lactation (p = 0.041). Interaction effects of avoidant coping and postpartum depression were observed on the perception of the baby as irritable (p = 0.031) and with easy temperament (p = 0.002). Regarding the mother's self-confidence, avoidant coping was related to a lack of security in caring for the baby (p < 0.001) and had a moderating effect between PPD and mother's self-confidence (i.e., lack of security in caring for the baby, p =0.027; general security, p = 0.007). Interaction effects showed that the use of avoidant coping in the mother exacerbated the impact of PPD on the early mother-infant relationship.

Influenza hospitalizations in children under 1 year old in Spain: the importance of maternal immunization.

This study estimates the burden of influenza in infants up to 12 months of age in Spain over 8 seasons (2009/10-2016/17). The survey was conducted by reviewing the Spanish Surveillance System for Hospital Data. Over the eight seasons, 5,618 hospital admissions were recorded for patients younger than 12 months that included codes related to influenza in any diagnostic position (487-488 ICD-9-CM and J9, J10 and J11 CIE 10). In total, 2,363 admissions (42.1%) were female patients whose median age was 3.05 months. Patients younger than 6 months accounted for 3,856 admissions (68.6%). Among them, 59.2% were male, and 40.8% were female (p < .05). Overall, 37.1% (2,084 patients) were younger than 2 months. The hospitalization rate for the entire period studied was 156.09 admissions per 100,000 children under 12 months of age (95% CI: 152.4-160.6). The average duration of hospitalization was 6.6 days (95% CI: 6.4-6.8). Eighteen deaths were recorded for hospitalized patients over the entire period. Of these, 12 patients (66.7%) were younger than 6 months. There is a significant burden of influenza disease in children under 1 year of age in Spain, mainly in children under 6 months of age. Improvements to prevention strategies through increased vaccination coverage in family environments and vaccination strategies involving pregnant woman can contribute decisively and effectively to reducing these hospitalizations.

Utility of lateral flow tests in SARS-CoV-2 infection monitorization / Utilidad de los test lateral Flow en la monitorización de la infección por SARS-CoV-2

INTRODUCTION: The diagnosis of SARS-CoV-2 infection is crucial for medical and public health reasons, to allow the best treatment of cases and the best control of the pandemic. Serology testing allows for the detection of asymptomatic infections and 19-COVID cases once the virus has been cleared. We analyzed the usefulness of the SARS-CoV-2 rapid test of Autobio and tried to correlate its pattern with the severity of COVID19 infection. MATERIAL AND METHOD: We analyzed the accuracy and clinical usefulness of a point-of-care IgM and/or IgG test for SARS-CoV-2 in 35 COVID-19 patients [12 (34.3%) mild-moderate and 23 (65.7%) severe-critical] admitted to a field hospital in Madrid, as well as in 5 controls. RESULTS: The mean time from the first day of symptoms to the antibody test was 28 days (SD: 8.7), similar according to the severity of the disease. All patients with SARS-CoV-2 PCR+ showed the corresponding IgG positivity, while these results were negative in all control individuals. A total of 26 (74%) cases also presented with positive IgM, 19 (83%) were severe-critical cases and 7 (58%) were mild-moderate cases. The IgM response lasted longer in the severe critical cases (mean: 29.7 days; SD: 8.4) compared to the moderate cases (mean: 21.2 days; SD: 2.0). CONCLUSIONS: Rapid serology tests are useful for the diagnosis of patients with COVID-19 (mainly IgG detection) and may also be correlated with the severity of the infection (based on IgM detection)

INTRODUCCIÓN: El diagnóstico de la infección por SARSCoV-2 es crucial por razones médicas y de salud pública, para permitir el mejor tratamiento de los casos y el mejor control de la pandemia. Las pruebas de serología permiten la detección de infecciones asintomáticas y de casos de COVID-19 una vez que se ha logrado la eliminación del virus. El objetivo fue analizar la utilidad del test rápido SARS-CoV-2 de Autobio e intentar correlacionar su patrón con la gravedad de la infección por COVID19. MATERIAL Y MÉTODOS: Hemos analizado la precisión y la utilidad clínica de un test de IgM y/o IgG en el punto de atención para el SARS-CoV-2 en 35 pacientes COVID-19 [12 (34,3%) leves-moderados y 23 (65,7%) severos-críticos] ingresados en un hospital de campaña en Madrid, así como en 5 controles. RESULTADOS: El tiempo medio desde el primer día de síntomas hasta la prueba de anticuerpos fue de 28 días (DE: 8,7), similar según la gravedad de la enfermedad. Todos los pacientes con SARS-CoV-2 PCR+ mostraron la correspondiente positividad de IgG, mientras que estos resultados fueron negativos en todos los individuos de control. Un total de 26 (74%) casos también se presentaron con IgM positiva, 19 (83%) fueron casos severos-críticos y 7 (58%) fueron casos leves-moderados. La respuesta a la IgM duró más tiempo en los casos críticos severos (media: 29,7 días; DE: 8,4) en comparación con los casos moderados (media: 21,2 días; DE: 2,0). CONCLUSIONES: Las pruebas de serología rápida son de utilidad para el diagnóstico de los pacientes con COVID-19 (principalmente la detección de IgG) y también pueden estar correlacionadas con la gravedad de la infección (basada en la detección de IgM)

Paediatric hospitalizations due to whooping cough in Spain (1997-2017).

This epidemiological survey estimates the burden of whooping cough in infants up to 12 months old in Spain during a twenty-one-year period (1997-2017). The survey was conducted by reviewing data from the Spanish Surveillance System for Hospital Data. All hospitalizations due to whooping cough for infants, reported during the 1997-2017 period, were analysed. Codes were selected from the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 033.0-033.9. To explore the latest national outbreak and the implementation of vaccination in pregnant women, analyses were stratified to compare the following periods: 1997-2010, 2011-2015 and 2016-2017. A total of 13,352 hospital discharges for whooping cough in infants up to 12 months old were reported. A total of 6850 discharges in the period 1997-2010, 5271 in the period 2011-2015 and 1231 in 2016-2017 were identified. The annual hospitalization rate prior to 2011 was 131.02 cases per 100,000 infants; in 2011-2015, the rate was significantly higher (250.13 cases per 100,000 infants) and in 2016-2017 it decreased (157.69 cases per 100,000 infants). Most of the cases (n = 11,446) occurred in infants under 4 months of age, with hospitalization rates of 328.80, 670.81 and 385.84 cases per 100,000 infants up to 4 months of age in the periods 1997-2010, 2011-2015 and 2016-17, respectively. Thirty-four deaths occurred in the period 1997-2010, 36 in the period 2011-2015 and 4 in 2016-2017. All of the deaths occurred in infants under 4 months old. The case fatality rate did not vary significantly across the study periods. Whooping cough infections concentrate in infants up to 4 months of age in Spain. Public health measures such as vaccination of pregnant women, caregivers, health care professionals and relatives, especially young parents, could reduce the hospitalization burden during the current outbreak.

Adherencia a la higiene de manos con soluciones hidroalcohólicas en estudiantes de medicina. Estudio descriptivo transversal / Hand hygiene compliance with hydroalcoholic solutions in medical students. Cross-sectional study

OBJETIVOS: Evaluar de forma cegada la adherencia a la higiene de manos de los estudiantes de medicina en un Hospital Universitario. MATERIAL Y MÉTODOS: Estudio descriptivo transversal. Se evaluó la adherencia a la higiene de manos de estudiantes de medicina en los servicios de Neonatología, Pediatría, Neurología y Traumatología. Se observaron de forma encubierta los cinco momentos para realizarla y la técnica de higiene. La adherencia a la higiene de manos se describió con la distribución de frecuencias de los diferentes momentos en los que está indicada. RESULTADOS: Se evaluaron 456 lavados de manos. La adherencia global a la higiene de manos fue del 44,3%. El servicio más evaluado fue Traumatología (59,6%). La adherencia global, según los diferentes momentos, fue mayor después del contacto con el paciente (60,2%). El servicio con mayor adherencia a la higiene de manos fue Neonatología (60%). La adherencia a la higiene de manos fue mayor en los diferentes servicios de hospitalización (50%) que en las consultas externas (33%) (p < 0,05) y el tiempo medio de duración de la higiene de manos fue de 22 segundos. CONCLUSIONES: La mayor parte de los momentos se registraron en el servicio de Traumatología y el momento en que hubo más adherencia a la higiene de manos ha sido el momento "después del contacto con el paciente". El mayor porcentaje de adherencia a la higiene de manos se produjo en Neonatología. La adherencia a la higiene de manos fue moderada pero se puede y se debe mejorar

OBJECTIVES: To assess hand hygiene compliance covertly in medical students in a university teaching hospital. MATERIAL AND METHODS: Cross-sectional study. Hand hygiene compliance in medical students was assessed in the units of Neonatology, Paediatrics, Neurology and Orthopaedic surgery. The five moments were covertly observed so as the hand rub technique. Hand hygiene compliance was described with the compliance percentages of the five moments. RESULTS: We studied 456 opportunities of hand hygiene. Global compliance was 44.3%. The most registered unit was Orthopaedic surgery (59.6%). According to the different moments, global compliance was better "after touching a patient" (60.2%). The unit with the highest hand hygiene compliance was Neonatology (60%). Hand hygiene compliance was better in the different hospitalisation units (50%) than in the office rooms (33%) (p < 0.05) and the mean duration of hand hygiene was 22 seconds. CONCLUSIONS: Most of the moments were registered in the unit of Orthopaedic surgery and the moment with the highest hand hygiene compliance was "after touching a patient". The most hand hygiene compliance percentage was observed in Neonatology. Hand hygiene compliance was moderate, and it could and must be improved

Epidemiología de las hospitalizaciones por tosferina en España (1997-2015) / No disponible

La tosferina ha aumentado su incidencia en los últimos 10 años en países con altas coberturas vacunales. El objetivo del presente trabajo es estudiar la epidemiología de las hospitalizaciones por tosferina, como indicador grave de la enfermedad, en las distintas Comunidades Autónomas y ver su evolución en un periodo de 19 años. Para ello, se analizó retrospectivamente la información recogida en el Conjunto Mínimo Básico de Datos sobre las altas hospitalarias relacionadas con un diagnóstico de tosferina y se calculó la tasa de hospitalización anual, el tiempo de estancia en el hospital y la tasa de letalidad. Se registraron un total de 13.312 hospitalizaciones relacionadas con tos ferina. Más del 91% se produjeron en menores de un año (n = 12.127). La estancia media hospitalaria fue de 7,9 días. La tasa media anual de hospitalización durante el periodo fue de 1,6 hospitalizaciones por 100.000 habitantes y 149, 6 hospitalizaciones por 100,000 niños menores de 1 año. Se produjeron 88 muertes, de las cuales 70 fueron en menores de 4 meses. Las tasas de hospitalización aumentaron de forma significativa durante el periodo en la mayoría de las Comunidades Autónomas. En este estudio todavía no se observan los efectos de las nuevas medidas preventivas que incluyen la vacunación en la mujer embarazada, que deberán ser seguidos con detenimiento en la actual situación epidemiológica

Despite high vaccination coverage, whooping cough has increased its incidence in the last decade. The aim of this study is to analyze the epidemiology of the hospitalizations due to whooping cough as an indicator of severe disease in the different regions of Spain over a period of 19 years. Information on hospital discharges related to a diagnosis of whooping cough from the National System of Hospital Data was retrospectively analyzed. Annual hospitalization rates, case-fatality rates and average length of hospitalization were calculated. A total of 13,312 hospitalizations related to whooping cough were recorded. More than 91% of them occurred in infants up to 12 months of age (n = 12,127). Average length of hospitalization was 7.86 days. Annual hospitalization rate during the period was 1.629 hospitalizations per 100,000 population and 149.601 hospitalizations per 100,000 infants up to 12 months of age. Eighty-eight deaths occurred in the study period, of those 70 were in infants younger than 4 months old. Hospitalization rates significantly increased during the study period in most of the regions. New preventive measures, such as vaccination of pregnant women cannot be evaluated in this study, but epidemiology of whooping cough in this specific group should be monitored in the current epidemiological situation

Vigilancia epidemiológica y factores de riesgo de infección de sitio quirúrgico en cirugía cardiaca: estudio de cohortes prospectivo / Epidemiological surveillance of surgical site infection and its risk factors in cardiac surgery: a prospective cohort study

Introducción y objetivos: La infección de sitio quirúrgico es poco frecuente en cirugía cardiaca. El objetivo es estudiar su incidencia, compararla con datos nacionales e internacionales y evaluar sus factores de riesgo. Métodos: Estudio de cohortes prospectivo que incluyó a pacientes intervenidos de cirugía cardiaca valvular y revascularización coronaria durante 6 años consecutivos. Se estudió la incidencia de infección de sitio quirúrgico. Se evaluó la asociación entre los factores de riesgo y la infección con la odds ratio (OR). Las tasas de infección se han comparado con las de España y Estados Unidos usando la razón estandarizada de infección. Resultados: Se incluyó a 1.557 pacientes. La incidencia de infecciones acumulada total fue del 4% (intervalo de confianza del 95% [IC95%], 3,6-5,6%), el 3,6% (IC95%, 2,5-4,7%) en cirugía valvular y el 4,3% (IC95%, 2,3-6,3%) en revascularización coronaria. La diabetes mellitus (OR = 2,8; p < 0,05) y la obesidad (OR = 6,6; p < 0,05) resultaron factores de riesgo de infección de sitio quirúrgico de la cirugía valvular. La diabetes mellitus (OR = 2,9; p < 0,05) y la reintervención por hemorragia (OR = 8,8; p < 0,05) son factores de riesgo de infección de sitio quirúrgico en revascularización coronaria. Conclusiones: La diabetes mellitus y la obesidad favorecen la infección de sitio quirúrgico en cirugía valvular. La diabetes mellitus y la reintervención por hemorragia favorecen la infección de sitio quirúrgico en revascularización coronaria. Los sistemas de vigilancia y control de infección permiten evaluar y comparar las tasas de infección en cirugía cardiaca (AU)

Introduction and objectives: Surgical site infection in cardiac surgery is uncommon. The aim of the present study was to examine the incidence of this infection, compare it with national and international data, and evaluate its risk factors. Methods: This prospective cohort study included patients who underwent valve surgery or coronary revascularization during a 6-year period. The incidence of surgical site infection was studied. Associations between risk factors and infection were evaluated using odds ratios (OR). The infection rate was compared with Spanish and American data using the standardized infection ratio. Results: A total of 1557 patients were included. The overall cumulative incidence of infection was 4% (95% confidence interval [95%CI], 3.6%-5.6%), 3.6% in valve surgery (95%CI, 2.5%-4.7%) and 4.3% in coronary revascularization (95%CI, 2.3%-6.3%). Risk factors for surgical site infection in valve surgery were diabetes mellitus (OR = 2.8; P < .05) and obesity (OR = 6.6; P < .05). Risk factors for surgical site infection in coronary revascularization were diabetes mellitus (OR = 2.9; P < .05) and reoperation for bleeding (OR = 8.8; P < .05). Conclusions: Diabetes mellitus and obesity favor surgical site infection in valve surgery, whereas diabetes mellitus and reoperation for bleeding favor surgical site infection in coronary revascularization. Infection surveillance and control programs permit evaluation and comparison of infection rates in cardiac surgery (AU)

Epidemiological Surveillance of Surgical Site Infection and its Risk Factors in Cardiac Surgery: A Prospective Cohort Study.

INTRODUCTION AND OBJECTIVES: Surgical site infection in cardiac surgery is uncommon. The aim of the present study was to examine the incidence of this infection, compare it with national and international data, and evaluate its risk factors. METHODS: This prospective cohort study included patients who underwent valve surgery or coronary revascularization during a 6-year period. The incidence of surgical site infection was studied. Associations between risk factors and infection were evaluated using odds ratios (OR). The infection rate was compared with Spanish and American data using the standardized infection ratio. RESULTS: A total of 1557 patients were included. The overall cumulative incidence of infection was 4% (95% confidence interval [95%CI], 3.6%-5.6%), 3.6% in valve surgery (95%CI, 2.5%-4.7%) and 4.3% in coronary revascularization (95%CI, 2.3%-6.3%). Risk factors for surgical site infection in valve surgery were diabetes mellitus (OR=2.8; P<.05) and obesity (OR=6.6; P<.05). Risk factors for surgical site infection in coronary revascularization were diabetes mellitus (OR=2.9; P<.05) and reoperation for bleeding (OR=8.8; P<.05). CONCLUSIONS: Diabetes mellitus and obesity favor surgical site infection in valve surgery, whereas diabetes mellitus and reoperation for bleeding favor surgical site infection in coronary revascularization. Infection surveillance and control programs permit evaluation and comparison of infection rates in cardiac surgery.

Measuring the Burden of Hospitalization in Patients with Parkinson´s Disease in Spain.

INTRODUCTION: This epidemiological survey estimates the hospitalization burden related to Parkinson´s Disease in Spain. METHODS: This observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalizations of patients with Parkinson´s disease that were reported from 1997-2012 were analyzed. Codes were selected using the 9th International Classification of Diseases: ICD-9-CM: 332.0. RESULTS: A total of 438,513 hospital discharges of patients with Parkinson´s Disease were reported during the study period. The annual hospitalization rate was 64.2 cases per 100,000. The average length of hospital stay was 10 days. The trend for the annual hospitalization rate differed significantly depending on whether Parkinson´s disease was the main cause of hospitalization (n = 23,086, 1.14% annual increase) or was not the main cause of hospitalization (n = 415,427, 15.37% annual increase). The overall case-fatality rate among hospitalized patients was 10%. The case fatality rate among patient´s hospitalized with Parkinson´s disease as the main cause of hospitalization was 2.5%. The hospitalization rate and case-fatality rate significantly increased with age. The primary causes of hospitalization when Parkinson´s disease was not coded as the main cause of hospitalization were as follows: respiratory system diseases (24%), circulatory system diseases (19%), injuries and poisoning, including fractures (12%), diseases of the digestive system (10%) and neoplasms (5%). The annual average cost for National Health Care System was € 120 M, with a mean hospitalization cost of €4,378. CONCLUSIONS: Parkinson´s disease poses a significant health threat in Spain, particularly in the elderly. While hospitalizations due to Parkinson´s Disease are relatively stable over time, the number of patients presenting with Parkinson´s disease as an important comorbidity has increased dramatically. Medical staff must be specifically trained to treat the particular needs of hospitalized patients suffering from Parkinson´s disease as an important comorbidity.

Lp-PLA2 levels in HIV-infected patients.

INTRODUCTION: HIV-infected patients show an increased risk of cardiovascular disease (CVD). In the general population, lipoprotein-associated phospholipase A2 (Lp-PLA2) appears to be an independent predictor of CVD. We aimed to study associations between Lp-PLA2 plasma levels and other risk factors for CVD in HIV patients. MATERIALS AND METHODS: A cross-sectional, comparative study of two series of cases (HIV patients, n=116 and age-matched non-HIV healthy controls, n=113) was conducted. Eighty-seven percent HIV patients on antiretroviral therapy (ART), 72.4% with HIV-1 viral load <50 cop/mL. Inflammatory biomarkers (CRP, Lp-PLA2) and internal carotid intima-media thickness (IMT) were measured and CVD risk (Framingham and SCORE algorithms) was calculated. Univariate and multivariable associations between these variables were performed. RESULTS: HIV patients presented higher Lp-PLA2 levels [276.81 ng/mL (209.71-356.58)] than uninfected healthy controls [220.80 ng/mL (172.70-256.90)], p≤0.01. In univariate analysis of the global sample, only cigarette smoking was associated with higher Lp-PLA2 levels, p≤0.001. In HIV group, female and smoker patients showed higher Lp-PLA2 levels, p≤0.05. No significant association was found between Lp-PLA2 levels and another CVD risk factors, carotid IMT, Framingham and SCORE algorithms, ART, HIV-1 viral load neither and CD4+ T lymphocyte count. In multivariate analysis, cigarette smoking remained significantly associated with Lp-PLA2 levels [ß=64.8 (95% CI 10.8-118.9) ng/mL, p=0.020]. CONCLUSIONS: HIV-infected patients present higher Lp-PLA2 levels than healthy controls, and in this population, tobacco smoking is significantly associated with increased Lp-PLA2 levels. Smoking cessation should be a priority in CVD prevention in HIV-infected patients.

Microarray analysis of gene expression in vestibular schwannomas reveals SPP1/MET signaling pathway and androgen receptor deregulation.

Vestibular schwannomas are benign neoplasms that arise from the vestibular nerve. The hallmark of these tumors is the biallelic inactivation of neurofibromin 2 (NF2). Transcriptomic alterations, such as the neuregulin 1 (Nrg1)/ErbB2 pathway, have been described in schwannomas. In this study, we performed a whole transcriptome analysis in 31 vestibular schwannomas and 9 control nerves in the Affymetrix Gene 1.0 ST platform, validated by quantitative real-time PCR (qRT-PCR) using TaqMan low density arrays. We performed a mutational analysis of NF2 by PCR/denaturing high-performance liquid chromatography (dHPLC) and multiplex ligation-dependent probe amplification (MLPA), as well as a microsatellite marker analysis of the loss of heterozygosity (LOH) of chromosome 22q. The microarray analysis demonstrated that 1,516 genes were deregulated and 48 of the genes were validated by qRT-PCR. At least 2 genetic hits (allelic loss and/or gene mutation) in NF2 were found in 16 tumors, seven cases showed 1 hit and 8 tumors showed no NF2 alteration. MET and associated genes, such as integrin, alpha 4 (ITGA4)/B6, PLEXNB3/SEMA5 and caveolin-1 (CAV1) showed a clear deregulation in vestibular schwannomas. In addition, androgen receptor (AR) downregulation may denote a hormonal effect or cause in this tumor. Furthermore, the osteopontin gene (SPP1), which is involved in merlin protein degradation, was upregulated, which suggests that this mechanism may also exert a pivotal role in schwannoma merlin depletion. Finally, no major differences were observed among tumors of different size, histological type or NF2 status, which suggests that, at the mRNA level, all schwannomas, regardless of their molecular and clinical characteristics, may share common features that can be used in their treatment.

DNA copy gains of tumor-related genes in vestibular schwannoma.

DNA copy gains are a common event in tumor growth. This study determines the gene dosage/amplification of seven tumor-related genes in patients undergoing vestibular schwannoma (VS) surgery and analyzes its clinical implications. Thirty-three patients undergoing surgery for VS were studied. Seven genes (EGFR, ERBB2, ERBB3, ERBB4, MDM2, MDM4, and NMYC) were analyzed by Quantitative real-time PCR. Copy gains were correlated with demographic, clinical and radiological data. Of the 33 samples, 48 % were positive for copy gains in at least one gene. There were no positive samples for gene amplification. A clinical correlation between tumor size and copy gains of ERBB2 was found. Patients with copy gains of this gene had larger tumors measured by diameter (p = 0.027) and volume (p = 0.005). Copy gains of EGFR, ERBB2, ERBB4, and MDM4 were associated with preoperative tinnitus. Contrary to other tumors of the central nervous system, development of VS does not appear to involve gene amplification. However, copy gains of certain tumor-related genes may play a role in the biological behavior of these neoplasms. Our findings support the role of ERBB2 in VS development and growth.

Trends in incidence and outcomes of revision total hip arthroplasty in Spain: a population based study.

BACKGROUND: To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain. METHODS: We selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends. RESULTS: 32,280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01).The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire period. The crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008.After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively). CONCLUSIONS: The crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.

Asociación entre la carga herpética y la enfermedad isquémica crónica del corazón: estudio de casos y controles / Association between herpetic burden and chronic ischemic heart disease: Matched case-control study

Fundamento y objetivo: Estudios previos plantean una verosímil asociación entre la carga herpética y la cardiopatía isquémica. El objetivo es analizar esta hipótesis en un contexto seroepidemiológico español. Pacientes y método: Estudio de casos y controles emparejados por edad y sexo (1:1) que incluyó a pacientes con enfermedad isquémica crónica del corazón y controles sanos. Se definió carga herpética como el número total de virus herpes para los que el sujeto fue seropositivo (IgG), considerando los virus Epstein-Barr, citomegalovirus, varicela-zóster, herpes simple tipo 1 y tipo 2. Resultados: El 90,7% de los casos y el 70,7% de los controles (p=0,002) fueron seropositivos para 4 o más virus herpes (alta carga herpética). Dentro del grupo control, los sujetos con hipercolesterolemia tuvieron mayor proporción de alta carga (88,5% frente a 61,2%, p=0,02). La alta carga herpética se asoció a la enfermedad tras ajustar por diabetes, tabaco, hipertensión, y nivel educativo (odds ratio [OR] 4,5, intervalo de confianza del 95% [IC 95%] 1,23-16,53), pero no al incluir la hipercolesterolemia en el modelo (OR 2,2, IC 95% 0,45-10,62).Conclusión: La asociación es independiente de la mayoría, pero no de todos los factores de riesgo cardiovascular clásicos (AU)

Background and objectives: revious studies showed a plausible association between herpetic burden and ischemic heart disease. Our aim is to test this hypothesis in an spanish seroepidemiological context. Patients and methods: Sex and age matched case-control study (1:1) including patients with chronic ischemic heart disease and healthy controls. Herpetic burden was defined as the aggregate number of antibody seropositivities (IgG) for Epstein Barr Virus, cytomegalovirus, varicella zoster virus, Herpes simplex type 1 and type 2.Results: We found that 90.7% of cases and 70,7% of controles (P=.002), were seropositive to 4 or more herpesvirus (high herpetic burden). Within control group, hypercholesterolemic subjects had a higher proportion of high burden (88,5% vs. 61,2%, P=.02). High herpetic burden was associated with ischemic heart disease, even after adjusting for diabetes, smoking, hypertension and literacy level, (OR: 4,5 [1,23-16,53]), but not when hypercholesterolemia was included in the model (OR 2,2 [0,45-10,62]).Conclusion: The hypothesized relationship is independent from most but not all classical cardiovascular risk factors (AU)

[Association between herpetic burden and chronic ischemic heart disease: matched case-control study]. / Asociación entre la carga herpética y la enfermedad isquémica crónica del corazón: estudio de casos y controles.

BACKGROUND AND OBJECTIVES: Previous studies showed a plausible association between herpetic burden and ischemic heart disease. Our aim is to test this hypothesis in an spanish seroepidemiological context. PATIENTS AND METHODS: Sex and age matched case-control study (1:1) including patients with chronic ischemic heart disease and healthy controls. Herpetic burden was defined as the aggregate number of antibody seropositivities (IgG) for Epstein Barr Virus, cytomegalovirus, varicella zoster virus, Herpes simplex type 1 and type 2. RESULTS: We found that 90.7% of cases and 70,7% of controles (P=.002), were seropositive to 4 or more herpesvirus (high herpetic burden). Within control group, hypercholesterolemic subjects had a higher proportion of high burden (88,5% vs. 61,2%, P=.02). High herpetic burden was associated with ischemic heart disease, even after adjusting for diabetes, smoking, hypertension and literacy level, (OR: 4,5 [1,23-16,53]), but not when hypercholesterolemia was included in the model (OR 2,2 [0,45-10,62]). CONCLUSION: The hypothesized relationship is independent from most but not all classical cardiovascular risk factors.