Disability, support and long-term social care of an elderly Spanish population, 2008-2009: an epidemiologic analysis.

BACKGROUND: Though poorly known, relationships between disability, need of help (dependency) and use of social services are crucial aspects of public health. The objective of this study was to describe the links between disability, officially assessed dependency, and social service use by an industrial population, and identify areas of inequity. METHODS: We took advantage of a door-to-door survey conducted in the Cinco Villas district, Spain, in 2008-2009, which provided data on disability, morbidity, and service use among 1216 residents aged ≥50 years, and officially assessed dependency under the 2006 Dependency Act (OAD). Using logistic regression, we combined data collected at homes/residences on 625 disability screened-positive participants, and administrative information on degree of OAD and benefits at date of visit. RESULTS: Based on 163 disabled persons, the prevalence of residential/community-care users was 13.4% overall, with 6.0% being market-provided, 2.5% supported by the 2006 Act, and 4.9% supported by other public funds. Of 111 OAD applicants, 30 had been assigned an OAD degree; in 29 cases this was the highest OAD degree, with 12 receiving direct support for residential care and 17 receiving home care. Compared to unassessed dependency, the highest OAD degree was linked to residential care (OR and 95% CI) 12.13 (3.86-38.16), declared non-professional care 10.99 (1.28-94.53), and publicly-funded, non-professional care 26.30 (3.36-205.88). In contrast, 43 persons, 58% of the severely/extremely disabled, community-dwelling sample population, 81% of whom were homebound, including 10 persons with OAD but no implemented service plan, made no use of any service, and of these, 40% lacked a non-professional carer. CONCLUSIONS: Formal service use in the Cinco Villas district attained ratios observed for established welfare systems but the publicly-funded proportion was lower. The 2006 Act had a modest, albeit significant, impact on support for non-professional carers and residential care, coexisting with a high prevalence of non-use of social services by severely disabled persons.

Analysis of disability using WHODAS 2.0 among the middle-aged and elderly in Cinco Villas, Spain.

BACKGROUND: The prevalence of disability, as defined by the International Classification of Functioning, Disability and Health (ICF), among the middle-aged and elderly population is poorly known. OBJECTIVE: To determine disability prevalence in a resident population sample aged ≥50 years, in the Cinco Villas district, Spain, from June 2008 through June 2009. METHODS: We used the WHODAS 2.0 36-item questionnaire to quantify the prevalence of disability, globally and by domain, together with a 13-item combined measure of three domains, Getting around, Self-care and Life activities, claimed to reflect the need of integrated services. In addition, we performed exploratory analyses of the relationship between disability and different variables using ordinal logistic regression. RESULTS: Disability was detected by global WHODAS score in 604 of a total of 1214 persons, i.e., a prevalence of 49.8% 95% CI (46.9-52.5), with the corresponding figures for mild, moderate, severe, and extreme disability being 26.8%, 16.0%, 7.6% and 0.1%, respectively. Disability increased with age, was higher among women, and for specific domains. Prevalence of severe/extreme disability among women vs. men was as follows: Getting around, 26.8% vs. 12.1%; Life activities, 25.2% vs. 6.8%; and Self-care, 9.5% vs. 6.0%. Disability was more frequent among subjects diagnosed with dementia, chronic liver disease, severe mental disease, and stroke. The abovementioned 13-item measure yielded prevalence figures for disability levels quite similar to those obtained using 36-item scores. CONCLUSIONS: For the first time, this study furnishes detailed disability prevalence figures and data on associated variables in a middle-aged and elderly Western population.

Capture-recapture as a potentially useful procedure for assessing prevalence of multiple sclerosis: methodologic exercise using Portuguese data.

BACKGROUND: Capture-recapture methods (CRMs) are well established in epidemiologic surveillance and considered useful for the task of correcting for case-finding limitations in multiple sclerosis (MS) prevalence surveys. To date, however, CRMs have been exclusively applied to crude prevalence figures. This study therefore sought to explore an age-specific application of this method to an urban Portuguese population of 229,342. METHODS: We used a CRM to correct for the age-specific prevalence of MS obtained from two data sources, i.e. general practitioners in three primary-care districts and a neurology unit at the referral hospital. The corrected figures were adjusted for age using the European standard population as reference. RESULTS: When applied to 95 MS patients, the CRM impact was highest at ages 50-59 years, with a 110% increase in cases where the corrected prevalence was highest, i.e. 181.8 (95% CI 75.7-287.9) per 100,000, and lowest, nil, at ages ≥70 years, with an unchanged corrected prevalence of 13.8. The crude prevalence of 41.4 per 100,000 increased by 36% to 56.20 per 100,000 when it was CRM- and age-adjusted. Source independence was poor. CONCLUSIONS: CRMs can be differentially applied to MS counts. Valid comparisons may require simultaneous adjustment for age and other variables, such as diagnostic delay and diagnostic criteria. CRM applications to crude figures and dependent sources should be approached with caution.

Health professions and risk of sporadic Creutzfeldt-Jakob disease, 1965 to 2010.

In 2009, a pathologist with sporadic Creutzfeldt-Jakob Disease (sCJD) was reported to the Spanish registry. This case prompted a request for information on health-related occupation in sCJD cases from countries participating in the European Creutzfeldt Jakob Disease Surveillance network (EuroCJD). Responses from registries in 21 countries revealed that of 8,321 registered cases, 65 physicians or dentists, two of whom were pathologists, and another 137 healthcare workers had been identified with sCJD. Five countries reported 15 physicians and 68 other health professionals among 2,968 controls or non-cases, suggesting no relative excess of sCJD among healthcare professionals. A literature review revealed: (i) 12 case or small case-series reports of 66 health professionals with sCJD, and (ii) five analytical studies on health-related occupation and sCJD, where statistically significant findings were solely observed for persons working at physicians' offices (odds ratio: 4.6 (95 CI: 1.2-17.6)). We conclude that a wide spectrum of medical specialities and health professions are represented in sCJD cases and that the data analysed do not support any overall increased occupational risk for health professionals. Nevertheless, there may be a specific risk in some professions associated with direct contact with high human-infectivity tissue.

Alteraciones metabólicas en niños infectados por VIH en tratamiento antirretroviral / Metabolic disorders in HIV- infected children receiving antiretroviral therapy

El objetivo es estudiar las alteraciones morfológicas y metabólicas secundarias al empleo de antirretrovirales en niños infectados por VIH. En 29 niños infectados por VIH entre 5-17 años se analiza la presencia de síndrome de lipodistrofia (SLPD) secundario al tratamiento antirretroviral; 21 con combinación de inhibidores de transcriptasa (IT) + inhibidores de proteasas (IP), 4 con combinación de IT y 4 sin tratamiento. Se realiza una valoración clínica de la distribución anómala de la grasa según 3 patrones: I: lipoatrofia periférica; II: lipohipertrofia central; III: patrón mixto I + II. Se determina en sangre estudio lipídico completo, insulina y péptido C. Se realiza estudio estadístico mediante test ANOVA para analizar la relación entre las alteraciones lipídicas encontradas y el tratamiento con antirretrovirales. Resultados: Se halla SLPD clínico en 10 niños (34 por ciento), con una distribución: 6 (60 por ciento) lipohipertrofia central y 4 (40 por ciento) patrón mixto. Ningún niño presenta lipoatrofia periférica aislada. De los casos más graves con LPD mixta, el 75 por ciento son niños púberes. Se encuentra hipercolesterolemia en el 58 por ciento, aumento de cLDL en el 38 por ciento e hipertrigliceridemia en el 31 por ciento, con incremento de lípidos sanguíneos sin manifestaciones clínicas de LPD en el 34 por ciento de los niños. El 5 por ciento de los casos presentaba hiperinsulinemia y el 7 por ciento aumento del péptido C. Se demuestra asociación estadísticamente significativa entre hipercolesterolemia y cualquier tratamiento antirretroviral (p= 0,03) y aumento de eLDL y cualquier tratamiento antirretroviral (p= 0,01). La hipertrigliceridemia se asoció sólo al tratamiento con IP (p= 0,04). Se encuentra SLPD asociado significativamente con trata miento con IP (p= 0,04), y SLPD asociado a mayor duración del tratamiento antirretroviral (p= 0,01). Conclusiones: En nuestra experiencia, el SLPD aparece en los niños infectados por VIH asociado a tratamiento con IP. El patrón clínico más frecuente es de lipohipertrofia central. Un patrón lipídico descrito previamente en los adultos como de riesgo aterogénico se describe también en los niños, secundario a la terapia antirretroviral, lo cual puede tener importantes implicaciones futuras que justifiquen cambios terapéuticos (AU)

Differential features of motor neuron disease mortality in Spain.

BACKGROUND: The objective of this study was to describe the temporal and spatial patterns of motor neuron disease (MND) in Spain. METHODS: We studied data where MND was stated as the principal cause of death in official statistics from Spain. Time trends were analysed for age-, sex-specific and age-adjusted rates for the period 1951-1990. Age-adjusted mortality and relative risk, obtained by Poisson regression adjusting for age, were calculated for each province from deaths during the period 1975-1988. Maps were constructed using log transformed rates. Statistical significance of spatial aggregation was assessed using the Ohno et al. test. RESULTS: The 1951-1990 mortality rate, age- and sex-adjusted to the European population, for the population aged > or = 40 years was 1.49 per 100,000; 1.90 and 1.21 for males and females respectively. In general, mortality increased with age. Age-adjusted rates rose until 1960, dropped by 70% during the 1960s and declined slightly over the 1951-1990 period as a whole. From 1970 onwards MND mortality rose evenly, particularly in the 60-69 age group. A North-South gradient was suggested for both sexes with statistically significant clustering in the Northern coastal regions and--for males alone--in the Midwest provinces. CONCLUSIONS: Mortality from MND in Spain displayed a magnitude and recently rising temporal trend similar to that described in several other countries. Specific traits were: a decrease during the 1960s, which has been described for Japan only, as well as spatial heterogeneity and a predominant recent increase among the 60-69 age group. The determinants of these unusual MND mortality patterns are unknown.

[Mortality from ischemic cardiopathy in Spain: the trends and geographic distribution]. / Mortalidad por cardiopatía isquémica en España: tendencia y distribución geográfica.

INTRODUCTION: In order to obtain epidemiological information for health planification, age-adjusted time series and provincial distribution of ischaemic heart disease mortality have been constructed. MATERIAL AND METHODS: Analysis of time trends includes data from 1901 to 1989. Trends have been identified by linear regression analysis. For the period 1976-1986 age-adjusted and age and sex specific mortality rates have been calculated for each province. 1984 and 1989 levels have been compared to those of the European Union countries. RESULTS: After the sharp rise of the curve in the 50-70 decades, since 1976 mortality falls with an statistically significant negative slope. This change in trends cannot be explained by time variations in prevalence of the main risk factors. Although in many European countries mortality began to fall much earlier, Spain still remains between the lowest mortality rates in Europe. Provinces showing the highest rates are the islands, Andalucia, Badajoz, Murcia, Alicante and Asturias. This clear north-south pattern is maintained after stratifying by age and sex, thus indicating that geographical distribution is related more to environmental or socio-economic factors and to accessibility to qualified health care, than to the geographical distribution of age and sex related risk factors. CONCLUSIONS: Additional studies including other variables are needed to explain these time and spatial variations. Allocation of specialized health care resources can be an effective intervention, mostly in the above mentioned provinces.

Spatial distribution of stroke mortality in Spain, 1975-1986.

Cerebrovascular diseases (CVDs) constitute the most frequent cause of death in Spain. In order to identify the geographical pattern of CVD mortality, age- and sex-specific as well as age-adjusted mortality rates (ICD-8,9 rubrics 430-438) were calculated for the period 1975-1986 for each province in the country. Maps were constructed after categorization of mortality rates by quintile levels. In general, the geographical pattern was similar for the different age and sex strata. While most provinces in the northern half presented low or medium mortality, geographical areas located in the south, displayed rates in the uppermost quintiles. These results suggest that the spatial distribution of CVD mortality in Spain is not random and that the potential determinants underlying this geographical distribution, such as type of stroke, incidence, fatality, diagnostic or certification practices and competing causes of death, have an impact that is independent of age and sex and strongly associated with spatial location. Furthermore, these results can help in identifying high-risk populations.

Stroke mortality in Spain, 1901-1986.

We studied the mortality from stroke as the underlying cause of death in Spain during the period 1901-1986. The age-adjusted mortality in 1986 was 114.4 per 100,000 among males and 100.6 per 100,000 for females. From 1901 to 1986, the SMR from stroke in Spain decreased by approximately 2/3, levelling off during the period 1950-1970, and again falling from 1973 on. A new plateau might have been initiated in the early 1980s. Since 1950, a marked continuous decrease is seen for hemorrhagic stroke and, since 1973, for ischemic stroke. In spite of difficulties in interpreting death record data, this study confirms that stroke mortality in Spain ranks on a medium level when compared with data from other European countries and that it conforms to the patterns reported for industrial countries. The drop in stroke mortality since 1973 preceded the widespread use of antihypertensive drugs.