Validación del poder predictivo de los Grupos de Morbilidad Ajustada (GMA) respecto de otras herramientas de estratificación de la población / Validity of predictive power of the Adjusted Morbidity Groups (AMG) with respect to others population stratification tools

OBJETIVO: Este trabajo se realizó con el objetivo de conseguir elementos objetivos de juicio que apoyasen la evolución de un estratificador de la población nacional desarrollado en base a los Grupos de Morbilidad Ajustada (GMA). Para ello se validó el poder predictivo de esta herramienta de estratificación sobre determinadas variables de resultado, mediante comparación con otros estratificadores como ACG® (Adjusted Clinical Groups) y CRG® (Clinical Risk Group), utilizados en algunas comunidades autónomas (CCAA) como Aragón, Canarias y Castilla y León. MÉTODOS: Se realizó un estudio analítico transversal en la población con derecho a la asistencia sanitaria. Se evaluó la capacidad predictiva del peso de complejidad obtenido con cada una de las herramientas de estratificación en el primer año, mediante un método de clasificación simple que comparó las áreas bajo las curvas ROC sobre las siguientes variables de resultado que sucedieron en el año siguiente: probabilidad de muerte; probabilidad de tener al menos un ingreso hospitalario urgente; número total de asistencias a urgencias hospitalarias; número total de visitas a Atención Primaria (AP); número total de consultas externas de Atención Hospitalaria (AH) y gasto farmacéutico. RESULTADOS: Los resultados obtenidos mostraron que los GMA® fueron buenos predictores de casi todas las variables analizadas (Resultados Curvas ROC AUC>0,7; p < 0,05) para las distintas comunidades autónomas, al comparar con los ACG® o los CRG®. Únicamente para la variable de asistencia a urgencias hospitalarias en el caso de Aragón y Canarias, y las derivaciones a AH en el caso de Aragón, la capacidad predictiva no fue adecuada con ninguna de las herramientas de estratificación comparadas. CONCLUSIONES: La herramienta GMA® es un sistema de estratificación de la población adecuado y tan útil como otras alternativas existentes

OBJECTIVE: This work was performed in order to get objective elements of judgment that support the improvement of a national population morbidity grouper based in the Adjusted Morbidity Groups (AMG). The study compared the performance in terms of predictive power on certain health and resource outcomes, in between the AMG and several existing morbidity groupers (ACG®, Adjusted Clinical Groups and CRG®, Clinical Risk Group) used in some Autonomous Regions in Spain (Aragón, Canarias y Castilla y León). METHODS: Cross-sectional analytical study in entitled/insured population with respect to rights of healthcare. Predictive capacity of the complexity weight obtained with the different stratification tools in the first year of the study period was evaluated using a simple classification method that compares the areas under the curves ROC for the following outcomes that occurred in the second year of the study period: Probability of death; probability of having at least one urgent hospital admission; total number of visits to hospital emergencies; total number of visits to primary care; total number of visits to hospital care and spending in pharmacy. RESULTS: The results showed that AMG complexity weight were good predictors for almost all the analyzed outcomes (AUC ROC>0.7; p < 0.05), for the different Autonomous Regions and compared to ACG® or CRG®. Only for the outcome of visits to hospital emergencies in Aragon and Canarias; and visits to specialized care in Aragon, the predictive power was weak for all the compared stratification tools. CONCLUSIONS: GMA® is a population stratification tool adequate and as useful as others existing morbidity groupers

Posible relación entre alopecia areata e infecciones por enterovirus / Possible relationship between alopecia areata and enterovirus infections

Introducción: la alopecia areata es una enfermedad autoinmune de etiología desconocida que se asocia a otras enfermedades autoinmunes. La enfermedad mano-pie-boca es una infección viral frecuente en la edad pediátrica, causada por diferentes serotipos de enterovirus y que en ocasiones asocia onicomadesis. El presente estudio pretende comprobar un incremento de los casos de alopecia areata tras un brote de enfermedad mano-pie-boca en nuestro entorno. Material y métodos: identificación de los pacientes menores de 14 años diagnosticados de enfermedad mano-pie-boca y/o alopecia areata en un área de salud entre el 1 de enero de 2011 y el 31 de diciembre de 2012. Revisión de historias clínicas, recogiendo fecha de nacimiento y diagnóstico, edad al diagnóstico y características clínicas. Resultados: se encontraron 49 pacientes diagnosticados de enfermedad mano-pie-boca y siete diagnosticados de alopecia areata. Se confirmó un brote de enfermedad mano-pie-boca con 42 casos en un periodo de ocho semanas. Se observó un incremento posterior de los casos de alopecia areata (cuatro casos en las cuatro semanas siguientes, frente a tres casos a lo largo de los 11 meses previos y ninguno durante el año anterior). Conclusiones: tras un brote de enfermedad mano-pie-boca se observó un incremento del número de casos de alopecia areata. Este hecho, unido a la asociación de la alopecia areata con otras enfermedades autoinmunes y a la relación encontrada entre infecciones por enterovirus y procesos autoinmunes como la diabetes mellitus tipo 1, plantea una posible relación causal entre infecciones por enterovirus y alopecia areata, así como un posible componente de autoinmunidad en la onicomadesis asociada a la enfermedad mano-pie-boca (AU)

Introduction: alopecia areata is an autoimmune disease of unknown etiology that is associated to other autoimmune diseases. Hand-foot-mouth disease is a common viral infection in children caused by several enterovirus serotypes, and it is sometimes associated to onychomadesis. This study intends to investigate an increase in cases of alopecia areata after an outbreak of hand-foot-mouth disease in our environment. Methods: identification of patients under 14 years old diagnosed with hand-foot-mouth disease and/or alopecia areata in a Primary Care Service Area between 1/1/2011 and 31/12/2012. Review of medical records, collecting date of birth and diagnosis, age at diagnosis and clinical characteristics. Results: forty-nine patients diagnosed with hand-foot-mouth disease and 7 diagnosed with alopecia areata were found. An outbreak of hand-foot-mouth disease was confirmed with 42 cases within a period of 8 weeks. A subsequent increase in cases of alopecia areata (4 cases within 4 weeks, compared with 3 cases over the 11 months before and none during the previous year) was observed. Conclusions: following an outbreak of hand-foot-mouth disease an increased number of cases of alopecia areata was observed. This fact, coupled with the association of alopecia areata with other autoimmune diseases, and the relationship found between enterovirus infections and autoimmune diseases such as type 1 diabetes mellitus poses a possible causal relationship between enterovirus infections and alopecia areata, and a possible component of autoimmunity in onychomadesis associated to hand-foot-mouth disease (AU)

[Epidemiology of type 1 diabetes mellitus in children in Spain]. / Epidemiología de la diabetes mellitus tipo 1 en menores de 15 años en España.

INTRODUCTION: Epidemiological studies in many regions and countries have contributed to determining the epidemiology of type 1 diabetes (T1DM) in children less than 15 years old. Studies in many regions of Spain have been published, but the national incidence is not really known. MATERIAL AND METHODS: A review was made of the publications on the epidemiology of T1DM in Spain, selecting the references on patients less than 15 years old. RESULTS: Many epidemiological studies on T1DM in almost all regions in Spain have been published. The methodology of these studies is heterogeneous, with variations in geographical definition, duration, period of study, limit of age, and data collection. The incidence rates are variable, from 11.5 cases per 100,000/year in Asturias to 27.6 in Castilla-La Mancha. Some studies report the percentage of diabetic ketoacidosis at the time of diagnosis, which is usually in the range of 25-40%. CONCLUSIONS: Although there have been various epidemiological studies on T1DM in almost all regions in Spain, the methodology is heterogeneous. The mean incidence of T1DM in children less than 15 years old in Spain, stimated from the selected studies is 17,69 cases per 100,000/year. T1DM registers need to be created and updated, using standardized methodology, to get more reliable data of the epidemiology of T1DM in Spain in the near future.

[Urolithiasis in the area III of Zaragoza: biochemistry and epidemiology]. / Litiasis renal en el área III de Zaragoza: bioquímica y epidemiología.

The urolithiasis is a very common disease that it causes, in addition to the suffering for the patients, an important cost sanitary partner. The composition of the renal stones that can influence in the treatment and later evaluation of the disease, varies in the different zones. In our work the composition of the renal stones received in the Biochemistry department of the H.C.U of Zaragoza studies during year 2002, with a brief approach to the epidemiology of the disease in the Area III of Zaragoza. The rate of incidence was of 0.35% with a clear predominance in men; the most frequent renal stones were those of pure calcium oxalate or calcium oxalate combined with apatite carbonate, although the percentage of samples gathered with respect to the total of diagnoses as soon as it surpassed 10%. Not found significant differences between the composition of the renal stones coming from the different zones from our Area, nor based on the sex of the patients. Given the influence of the composition of the urolithiasis for its treatment, we must insist on the collection of the greater number of samples for its analysis, although the epidemiologic data and the study of the urinary sediment can be used in the practice.