Age-space-time CAR models in Bayesian disease mapping.

Mortality counts are usually aggregated over age groups assuming similar effects of both time and region, yet the spatio-temporal evolution of cancer mortality rates may depend on changing age structures. In this paper, mortality rates are analyzed by region, time period and age group, and models including space-time, space-age, and age-time interactions are considered. The integrated nested Laplace approximation method, known as INLA, is adopted for model fitting and inference in order to reduce computing time in comparison with Markov chain Monte Carlo (McMC) methods. The methodology provides full posterior distributions of the quantities of interest while avoiding complex simulation techniques. The proposed models are used to analyze prostate cancer mortality data in 50 Spanish provinces over the period 1986-2010. The results reveal a decline in mortality since the late 1990s, particularly in the age group [65,70), probably because of the inclusion of the PSA (prostate-specific antigen) test and better treatment of early-stage disease. The decline is not clearly observed in the oldest age groups. Copyright © 2016 John Wiley & Sons, Ltd.

Estimating the impact of the 2009 influenza A(H1N1) pandemic on mortality in the elderly in Navarre, Spain.

We analysed mortality among people aged 65 years or older in Navarre, Spain in 2009 and compared it with the mean for the same period of time in the previous three years. In the pandemic weeks 24 to 52 2009 we observed 4.9% more deaths than expected (p=0.0268). Excess mortality occurred during the circulation of seasonal influenza (8.0%, p=0.0367) and the first wave of pandemic influenza (9.9%, p=0.0079). In the second wave of pandemic influenza there was a non-significant excess of deaths (5.2%, p=0.1166). Surveillance of laboratory-confirmed severe influenza cases detected only one death in this age group.

Flexible Bayesian P-splines for smoothing age-specific spatio-temporal mortality patterns.

In this paper age-space-time models based on one and two-dimensional P-splines with B-spline bases are proposed for smoothing mortality rates, where both fixed relative scale and scale invariant two-dimensional penalties are examined. Model fitting and inference are carried out using integrated nested Laplace approximations, a recent Bayesian technique that speeds up computations compared to McMC methods. The models will be illustrated with Spanish breast cancer mortality data during the period 1985-2010, where a general decline in breast cancer mortality has been observed in Spanish provinces in the last decades. The results reveal that mortality rates for the oldest age groups do not decrease in all provinces.

[Characteristics and statistical methods used in original articles published in Public Health journals in Spain]. / Características y métodos estadísticos empleados en los artículos originales publicados en las revistas de Salud Pública en España.

BACKGROUND: To describe the characteristics and statistical methods used in the original articles published in Gaceta Sanitaria, Revista Española de Salud Pública y Anales del Sistema Sanitario de Navarra, the Spanish public health journals in Spain indexed in the 2016 JRC. METHODS: All articles published in these journals in 2007, 2012 and 2017 were reviewed. For each article, general aspects (year, journal, language, area) and statistical characteristics (design, purpose, method and software) were recorded. RESULTS: A total of 310 articles were reviewed, 73% of them were cross-sectional studies. Evaluation and health services (24%) and chronic diseases were the most frequent areas. During the 2007-2017 period there was an increase in both the number of works written in English (4 vs 20%, p<0.001) and by women as the main (46 vs 62%, p=0.028) or senior authors (27 vs 36%, p=0.029). Significant changes concerning type of analysis were not detected (p=0.933). CONCLUSIONS: The characteristics and statistical methods used in scientific publications have not been modified in recent years. However, publications written in English have increased and women are playing a more relevant role in authorship. KEYWORDS: Authorship. Statistical Analysis. Scientific research. Public Health. Spain.

Prostate cancer incidence and mortality in Navarre (Spain).

BACKGROUND: Prostate cancer is one of the most commonly diagnosed malignancies among males worldwide. In this study, overall and age-specific incidence and mortality trends are analyzed in order to present the past and current epidemiological situation of the disease in Navarre (Spain). METHODS: Population-based incidence data from the 1975-2010 period, provided by the Cancer Registry of Navarre and prostate cancer specific mortality data for 1975-2013, provided by the Spanish Statistical Office, were used in the analysis. Age-standardized incidence and mortality rates, change-points and annual percentage changes (APC) were estimated by joinpoint regression analysis. One-dimensional P-spline models were used to estimate projections up to 2016. RESULTS: Considerable increases of cancer incidence rates in men aged 45-74 years were observed, with APC of +4.5% (p<0.001), +9.5% (p<0.001) and +2.4% (p<0.05) in the 1975-1990, 1990-2000 and 2000-2010 periods, respectively. In the older than 74 age-group, an increase of incidence rates in the 1975-1999 period was registered (APC +3.3%, p<0.001), followed by a significant decrease up to 2010 (APC -4.0%, p<0.01). Mortality rates rose until 1995 (APC +2.2%, p<0.001) whereas a decline occurred afterwards up to 2013 (APC -3.4%, p<0.001). CONCLUSION: Even though overall prostate cancer incidence rates seem to have stabilized in 2002-2010 in Navarra, trends were different by age groups: increased in men 45-74 years old and decreased in the 75+ year age-group. A decline in mortality rates was observed in both age groups since about 1995. Changes in the use of prostate specific antigen test for screening in oncoming years could affect future prostate cancer trends.

Brain and central nervous system cancer incidence in navarre (Spain), 1973-2008 and projections for 2014.

Different studies have pointed out Navarre as one of the regions of Spain with the highest incidence rates of brain and other central nervous system (CNS) cancer. Trend analysis for cancer incidence rates for long periods of time, might help determining risk factors as well as, assessing prevention actions involved in this disease. The objective of this study was to describe the incidence of brain and CNS cancer using data from the population-based cancer registry of Navarre, (Spain) during the period 1973-2008 and provide forecast figures up to-2014. Crude and age-standardized (world population) incidence rates of brain cancer per 100,000 person-years were calculated by the direct method separately by gender, area (Pamplona and others), and age-groups. Penalized splines for smoothing rates in the temporal dimensions were applied in order to estimate and forecast cancer incidence rates. Age-adjusted incidence rates showed an increase over the study and forecast periods in both sexes more marked in women than in men. Higher incidence rates were observed in men compared with women but the differences became smaller with time. The increase was due to the rise of rates in the oldest age groups since the rates for younger age groups remained stable or decreased over time. As the entire aetiology of brain and other CNS cancer is not still clear, keep promoting healthful lifestyles for cancer primary prevention among the whole population is necessary.

Projections of cancer mortality risks using spatio-temporal P-spline models.

Cancer mortality risk estimates are essential for planning resource allocation and designing and evaluating cancer prevention and management strategies. However, mortality figures generally become available after a few years, making necessary to develop reliable procedures to provide current and near future mortality risks. In this work, a spatio-temporal P-spline model is used to provide predictions of mortality/incidence counts. The model is appropriate to capture smooth temporal trends and to predict cancer mortality/incidence counts in different regions for future years. The prediction mean squared error of the forecast values as well as an appropriate estimator are derived. Spanish prostate cancer mortality data in the period 1975-2008 will be used to illustrate results with a focus on cancer mortality forecasting in 2009-2011.

Gender-specific spatio-temporal patterns of colorectal cancer incidence in Navarre, Spain (1990-2005).

INTRODUCTION: In the last ten to twenty years, a stabilization or decline in colorectal cancer (CRC) incidence has been observed in some countries across the world but not in Spain. Our objective here is to assess the gender-specific CRC spatio-temporal pattern in the health areas of Navarre, a Spanish province, during the period 1990-2005. METHODS: For each gender, a model with spatio-temporal CAR (Conditional Autoregressive) distributions is used for smoothing the incidence risks. Smoothing is carried out in two dimensions: space and time, allowing for a different time evolution in each health area. An estimated incidence trend curve for each health area and the corresponding confidence bands are obtained. To analyze the evolution of the geographical patterns of CRC incidence risks, maps are also provided. RESULTS: In both genders, CRC shows an increasing trend in most of the areas. In the second half of the period 1998-2005 most of the areas have risks above one although not all statistically significant. In general females present equal or lower risks than males in all areas during the studied period. CONCLUSIONS: Colorectal cancer incidence risk is still increasing in the health areas of Navarre. Promoting healthful lifestyles for primary prevention and early detection programs could help to reverse the trend in the province.

[Incidence rate trends for colorectal cancer in Navarre (North of Spain) in the 1990-2005 period]. / Tendencias en las tasas de incidencia de cáncer colorrectal en Navarra en el periodo 1990-2005.

BACKGROUND: In Spain, an increase in the incidence of colorectal cancer (CRC) has been observed in both sexes in recent years, probably due to an improved diagnostic, the westernization of dietary habits, and worse obesity levels, among others factors. In this work, the CRC incidence rate trends in different health areas in Navarre (northern Spain) are studied during the 1990-2005 period. METHODS: An estimated incidence trend curve for each health area and the corresponding confidence bands were obtained for each gender using P-spline models. RESULTS: These results show an increasing trend of CRC in most of the areas in both sexes, being less pronounced in women than in men. In the central area of Pamplona (the capital) a decreasing trend has been observed for men during the period studied. CONCLUSIONS: Primary prevention is the best strategy to change the increasing trend observed in most areas of the province of Navarre. However, a healthy lifestyle has long-term results, so it is important to have an early detection program that would serve as a short-term prevention strategy.

[Inflammatory bladder pseudotumor]. / Pseudotumor inflamatorio de vejiga.

OBJECTIVE: To present a case of inflammatory pseudotumor of the urinary bladder, with special reference to the differential diagnosis. METHODS/RESULTS: A 26-year-old patient with a history of gross hematuria and voiding syndrome underwent partial cystectomy for a bladder tumor. Pathological analysis disclosed an inflammatory pseudotumor of the bladder. The patient's postoperative course has been satisfactory.

Resistance to apoptosis correlates with a highly proliferative phenotype and loss of Fas and CPP32 (caspase-3) expression in human leukemia cells.

Apoptosis induced by effector cells of the immune system or by cytotoxic drugs is a main mechanism mediating the prevention or elimination of tumoral cells. For instance, the human T-cell leukemia Jurkat is sensitive to Fas-induced apoptosis and to activation-induced cell death (AICD), and the promonocytic leukemia U937 is sensitive to Fas- and TNF-induced apoptosis. In this work, we have analyzed the mechanisms of resistance to physiological or pharmacological apoptosis in human leukemia by generating highly proliferative (hp) sub-lines derived from Jurkat and U937 cells. These hp sub-lines were resistant to Fas- and TNF-induced apoptosis, as well as to AICD. This was due to the complete loss of Fas and TNFR surface expression and, in the case of Jurkat-derived sub-lines, also of CD3, CD2 and CD59 molecules. The sub-lines also completely lacked the expression of the apoptotic protease CPP32, present in parental cells. Moreover, these sub-lines were no longer sensitive to doxorubicin-induced apoptosis, which was efficiently blocked by the general caspase inhibitor Z-VAD-fmk in the parental cell lines. These data suggest a molecular mechanism for the development of resistance of leukemic cells to physiological and pharmacological apoptosis inducers, giving rise to highly proliferative tumoral phenotypes. These results also indicate that Fas and CPP32 could be useful prognostic markers for the progression and/or therapy outcome of human leukemias.