Spanish-born Patients Research Articles

Human Mycobacterium bovis infection in Castile and León (Spain), 2006–2015

IntroductionThe annual incidence of tuberculosis (TB) from Mycobacterium bovis in humans has considerably declined in industrialised countries since the early twentieth century. The objective of this study was to determine the epidemiological, clinical and microbiological characteristics of patients with this illness in Castile and León (CyL). MethodsRetrospective study of all M. bovis TB cases in CyL over a 10-year period, comparing the risk factors, the epidemiology and the clinical course between pulmonary (PTB) and extrapulmonary TB (EPTB). Results75 cases of TB were due to M. bovis: 45 PTB and 31 EPTB. The annual incidence of TB due to M. bovis was 0.3 cases per 100,000. It remained stable between the first and second five-year period (0.27 vs. 0.33, p=0.656). However, the overall incidence of TB fell in both five-year periods (13.58 vs. 10.71, p<0.0001). The mean age was 66.2+21.3 years, mainly men (63%) and Spanish patients (92%). PTB was significantly more frequent in men, aged over 66 years, with immunosuppressive conditions or who were smokers. Mortality was 9%, associated with higher age, immunosuppression or treatment different from that recommended by the WHO. ConclusionsThe incidence of M. bovis TB in CyL was higher than that for Spain and for other European countries, and remained stable despite the decreased the TB due to MTC. It affected mostly Spanish-born patients who lived in rural areas and with a high mean age.

Tuberculosis por Mycobacterium bovis en la población de Castilla y León (España), 2006-2015

IntroductionThe annual incidence of tuberculosis (TB) from Mycobacterium bovis in humans has considerably declined in industrialised countries since the early twentieth century. The objective of this study was to determine the epidemiological, clinical and microbiological characteristics of patients with this illness in Castile and León (CyL). MethodsRetrospective study of all M. bovis TB cases in CyL over a 10-year period, comparing the risk factors, the epidemiology and the clinical course between pulmonary (PTB) and extrapulmonary TB (EPTB). Results75 cases of TB were due to M. bovis: 45 PTB and 31 EPTB. The annual incidence of TB due to M. bovis was 0.3 cases per 100,000. It remained stable between the first and second five-year period (0.27 vs. 0.33, p=0.656). However, the overall incidence of TB fell in both five-year periods (13.58 vs. 10.71, p<0.0001). The mean age was 66.2+21.3 years, mainly men (63%) and Spanish patients (92%). PTB was significantly more frequent in men, aged over 66 years, with immunosuppressive conditions or who were smokers. Mortality was 9%, associated with higher age, immunosuppression or treatment different from that recommended by the WHO. ConclusionsThe incidence of M. bovis TB in CyL was higher than that for Spain and for other European countries, and remained stable despite the decreased the TB due to MTC. It affected mostly Spanish-born patients who lived in rural areas and with a high mean age.

Common mental disorders in primary health care: differences between Latin American-born and Spanish-born residents in Madrid, Spain

Our main objective was to estimate and compare the prevalence of the most common mental disorders between Latin American-born and Spanish-born patients in Madrid, Spain. We also analyzed sociodemographic factors associated with these disorders and the role of the length of residency for Latin American-born patients. We performed a cross-sectional study to compare Latin American-born (n=691) and Spanish-born outpatients (n=903) from 15 primary health care centers in Madrid, Spain. The Primary Care Evaluation of Mental Disorders was used to diagnose common mental disorders. Sociodemographic, psychosocial, and migration data were collected. We detected common mental disorders in 49.9% (95% CI=47.4-52.3%) of the total sample. Values were higher in Latin American-born patients than in Spanish-born patients for any disorder (57.8% vs. 43.9%, p<0.001), mood disorders (40.1 % vs. 34.8%, p=0.030), anxiety disorders (20.5 % vs. 15.3%, p=0.006), and somatoform disorders (18.1 % vs. 6.6%, p<0.001). There were no statistically significant differences in prevalence between Latin American-born patients with less than 5years of residency and Latin American-born residents with 5 or more years of residency. Finally, multivariate analysis shows that gender, having/not having children, monthly income, geographic origin, and social support were significantly associated with several disorders. The sample was neither population-based nor representative of the general immigrant or autochthonous populations. The study provides further evidence of the high prevalence of common mental disorders in Latin American-born patients in Spain compared with Spanish-born patients.

Epidemiological analysis of tuberculous lymphadenopathy in a District of Barcelona: proposal of a diagnostic algorithm

Barcelona (Spain) has experienced a dramatic change in its demography, which is reflected in the local epidemics of tuberculous lymphadenopathy (TL). The objective of the study is to analyze the associated risk factors to TL in a district of Barcelona with an incidence above 50 cases per 10,000 inhabitants/year, which will help to construct a diagnostic algorithm. single-centre retrospective cohort study of all cases of TL diagnosed between 1990 and 2009. Due to the demographic changes, we analyzed 2 separate study periods (1990-1999 and 2000-2009). Socio-demographic, clinical and diagnostic features were assessed and compared between both cohorts and the algorithm was constructed with these results. Data was obtained from all the patients diagnosed with TL in Hospital del Mar (Barcelona) and was sent to the Public Health Agency of Barcelona. in the first study period, 152 patients had TL (73.7% Spanish-born) and in the second study period 147 (70.7% immigrants). In the first period, the percentage of male immigrants was 70.5% and 57.1% were younger than 35 years old but in the second study period, there was a 58.1% of Spanish-born female patients and 69.8% above 35 years old. The percentage of HIV co-infection decreased from 69.9% to 44.2% in the second period but use of immunosuppressive treatment increased to 9.3% in Spanish-born patients. Multivariate analysis showed intravenous drug use (OR 8.2; 95%CI: 3.4-19.8) and immigrant status (OR 4.8; 95%CI: 2.7-8.3) as risk factors associated to TL. male immigrants arriving from areas with high burden of TB, younger than 35 years old and Spanish-born women, older than 35 years old, with HIV infection (although with a lower proportion than before year 2000) or receiving immunosuppressive treatment, are the groups with an increased risk of TL in our district.

Cumplimiento terapéutico para determinar la infranotificación de tuberculosis en una región sanitaria durante los años 2007-2009

IntroductionTo determine the annual incidence of tuberculosis (TB) in the health region of Lleida (RS) through the reported cases, and/or dispensing of the treatment drugs, as well as the level of compliance, based on the prescription drugs dispensed. MethodsDescriptive study of incidence based on reported cases of TB and TB drug dispensing (ATB) in the RS of Lleida, Catalonia in the period 2007-2009. ResultsThe incidence in the Health Region between 2007 and 2009 ranged between 38 to 29 cases per 100,000 population. The majority (72.6%) of cases were notified, while the rest were detected by identifying the treatment drugs dispensed in pharmacies. There was a higher incidence of TB among the immigrant population. Spanish-born patients had a higher percentage of compliance (75.8% versus 61.2%). Among the immigrant groups, those from North Africa had the lowest compliance (43.7%), and those from Latin America had the highest compliance (82.4%). ConclusionsThe incidence of TB in our health region has declined between 2007 and 2009, with the highest incidence among the immigrant population. There is a high amount of non-notified cases of tuberculosis. The Spanish-born population has a greater adherence to treatment. There is a lot of work to be done on disease notification, particularly among primary care doctors, as well as information on treatment adherence for the immigrant population. It would be interesting to study the socioeconomic factors that could determine the incidence and the poor adherence to treatment by immigrant populations.

¿Existen diferencias clínicas y metabólicas entre diabéticos inmigrantes y autóctonos?

AimTo determine the clinical features and the metabolic control in immigrant diabetic patients in two Primary Care centres in La Rioja, Spain. DesignDescriptive study. SettingTwo urban Primary Care centres which cover a population of 11,700 and 23,000 patients in Logroño. Primary outcomesSocio-demographic variables (age, sex, origin country of origin, age at onset of diabetes), clinical variables (blood pressure, waist circumference (WC), high, weight, BMI) and analytical variables (fasting blood glucose, HbA1c, lipid profile). The immunology of DM and baseline C-peptide were studied in patients younger than 40 years old. ParticipantsA total of 70 diabetic immigrants, aged between 18 and 70 years old and registered until December 31st 2009, and 70 Spanish-born diabetic patients were selected by consecutive sampling. ResultsThe final sample consisted of 140 patients (70 immigrants, 70 Spanish). Mean age of Spanish-born diabetics, 55.5 years, of immigrants 45.7 years (P=.002).Age at diagnosis 38.4 years in immigrants and 48.1 years in autochthonous (P=.004).WC in immigrants 104.1cm, in Spanish-born, 105.3cm (P=.56).BMI in immigrants 29, in Spanish-born 32.1 (P=.06).Mean glycated haemoglobin (HbA1c) in immigrants 8.4%, in Spanish-born 7.5% (P=.002). Blood pressure and lipid values were lower in Hindustani and North African patients than in Spanish-born and other immigrant groups. ConclusionsImmigrant diabetic patients are younger at diagnosis, have an unchanged baseline C-peptide secretion, higher HbA1c levels, higher WC with lower BMI compared to Spanish-born patients.

Late Initiation of HAART Among HIV-Infected Patients in Spain Is Frequent and Related to a Higher Rate of Virological Failure but not to Immigrant Status

Purpose: To determine whether immigrant status is associated with late initiation of highly active antiretroviral treatment (HAART) and/or poor response to antiretrovirals. Methods: GESIDA 5808 is a multicenter, retrospective cohort study (inclusion period January 2005 through December 2006) of treatment-naïve patients initiating HAART that compares HIV-infected patients who are immigrants with Spanish-born patients. A late starter (LS) was defined as any patient starting HAART with a CD4+ lymphocyte count <200 cells/μL and/or diagnosis of an AIDS-defining illness before or at the start of therapy. The primary endpoint was time to treatment failure (TTF), defined as virological failure (VF), death, opportunistic infection, treatment discontinuation/switch (D/S), or missing patient. Secondary endpoints were time to treatment failure as observed data (TTO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/S not due to VF). Results: LS accounted for 56% of the patients. Lower educational and socioeconomic level and intravenous drug use (IVDU) were associated with categorization as LS, but immigrant status was not. Cox regression analysis (hazard ratio [HR]; 95% CI) between LS and non-LS patients showed no differences in TTF (0.97; 0.78–1.20) or TTO (1.18; 0.88–1.58), although it did reveal a difference in TVF (1.97; 1.18–3.29). CD4+ lymphocyte recovery was equivalent for both LS and non-LS patients (159 vs 173). Conclusions: In our cohort, immigrant status was not shown to be related to late initiation of HAART. Although LS patients did not have a longer TTF for any reason, TVF was significantly shorter. Despite universal free access to HAART in Spain, measures to ensure early diagnosis and treatment of HIV infection are necessary.

Tuberculosis transmission patterns among Spanish-born and foreign-born populations in the city of Barcelona

During a 2-year period (2003–2004), tuberculosis (TB) transmission in Barcelona and the factors related to transmission among the Spanish- and foreign-born populations were studied by molecular epidemiology. Data were obtained from TB cases and Conventional Contact Tracing registries and genotyping was performed using restriction fragment length polymorphism (RFLP)-IS6110 and MIRU12 as a secondary typing method. Of the 892 TB cases reported, 583 (65.3%) corresponded to Spanish-born and 309 (34.6%) to foreign-born. Six hundred and eighty-seven cases (77%) were confirmed by culture. RFLP typing of 463/687 (67.4%) isolates was performed, revealing 280 (60.5%) unique and 183 (39.5%) shared patterns, which were grouped into 65 clusters. Spanish-born individuals were significantly more clustered than foreign-born individuals (44.6% vs. 28.8%; p 0.016). Clustering in foreign-born individuals was associated with HIV (p 0.051, odds ratio = 3.1, 95% confidence interval 1–10.9) and alcohol abuse (p 0.022), whereas, in the Spanish-born individuals, clustering was associated with age in the range 21–50 years, (p 0.024). Of the total clusters, 36/65 (55.3%) included only Spanish-born patients, whereas 22/65 (33.8%) included individuals from both populations. In mixed clusters, the index case was Spanish-born in 53% and foreign-born in 47%. Among the foreign-born, 2.8% were ill on arrival, 30% developed TB within the first year and 50.3% developed TB within the first 2 years; 58.3% were from South America. In conclusion, half of the foreign-born TB patients developed the disease during the first 2 years after arrival, which, in most cases, was the result of endogenous reactivation. Recent TB transmission among Spanish-born and foreign-born populations, as well as bidirectional transmission between communities, contributed significantly to the burden of TB in Barcelona, suggesting the need to improve Public Health interventions in both populations.

Análisis de la demanda asistencial en dermatología de la población inmigrante

ObjectiveTo determine the utilization rate of a dermatology service among the immigrant population and compare this rate with that among the autochthonous population. MethodsOver a 1-year period, data on all patients attended in the Dermatology Service of Health Department 19 in the autonomous community of Valencia were prospectively collected. ResultsOf 39,160 consultations, 1,625 were made by immigrants (4.1%). Attendance for dermatologic emergencies was greater in immigrants than in the autochthonous population (7.7% vs 3.0%; p < 0.001), while surgical activity was lower in immigrants than in Spanish-born patients (2.6% vs 5%; p < 0.001). Demand for consultation in the immigrant population was 5.7 visits per 100 immigrants, lower than that in the autochthonous population (16.2). The standardized rate ratio was 0.34. North Africans (5.6 per 100 immigrants), East Europeans (4.8), sub-Saharan Africans (5.3) and Asians (4.2) consulted less than Latin Americans (8.5; p < 0.001). ConclusionsDemand was lower in the immigrant than in the autochthonous population, and the utilization pattern differed according to country.

Loss to follow-up in HIV immigrant patients. Is it a relevant problem? Results of the Spanish COMESEM cohort

Methods COMESEM cohort is a prospective, population-based HIV-infected patient cohort of the south and east Greater Madrid (Spain). To analyze loss to of our patients, we collected the following data from our databases: age, year of diagnosis, gender, date of the last visit, risk group and AIDS diagnosis. We considered as loss to follow-up, patients who were alive in their last visit, had not requested transfer to another medical facility and were not registered as dead in the Mortality Registry of the Autonomous Community of Madrid. It was also required that at least 6 months had elapsed since their last visit. Loss to follow-up of immigrant and Spanish-born patients were compared by means of Kaplan-Meyer curves (long-rank test).

Drug resistance among Mycobacterium tuberculosis strains in immigrants: is there a real threat everywhere?

A study was performed to determine the impact of drug resistance in tuberculosis among immigrant patients in Madrid, Spain. During the period 1995-2001, the relative proportion of isolates from immigrant patients increased from 4.4% to 24.2%. No differences between immigrants and Spanish-born patients were detected for resistance to any first-line anti-tuberculous drug. More studies are required to determine the actual incidence of resistant tuberculosis in immigrants.