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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.

Objectives: The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability., Methods: Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses., Results: The sample was composed of 503 participants aged ≥ 75 years. Alzheimeŕs disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74)., Conclusions: Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF., Methods: Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2nd edition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100)., Results: The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32)., Conclusions: Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.

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.

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.