Prediction of in-hospital mortality after pancreatic resection in pancreatic cancer patients: A boosting approach via a population-based study using health administrative data.

BACKGROUND: One reason for the aggressiveness of the pancreatic cancer is that it is diagnosed late, which often limits both the therapeutic options that are available and patient survival. The long-term survival of pancreatic cancer patients is not possible if the tumor is not resected, even among patients who receive chemotherapy in the earliest stages. The main objective of this study was to create a prediction model for in-hospital mortality after a pancreatectomy in pancreatic cancer patients. METHODS: We performed a retrospective study of all pancreatic resections in pancreatic cancer patients in Spanish public hospitals (2013). Data were obtained from records in the Minimum Basic Data Set. To develop the prediction model, we used a boosting method. RESULTS: The in-hospital mortality of pancreatic resections in pancreatic cancer patients was 8.48% in Spain. Our model showed high predictive accuracy, with an AUC of 0.91 and a Brier score of 0.09, which indicated that the probabilities were well calibrated. In addition, a sensitivity analysis of the information available prior to the surgery revealed that our model has high predictive accuracy, with an AUC of 0.802. CONCLUSIONS: In this study, we developed a nation-wide system that is capable of generating accurate and reliable predictions of in-hospital mortality after pancreatic resection in patients with pancreatic cancer. Our model could help surgeons understand the importance of the patients' characteristics prior to surgery and the health effects that may follow resection.

Mental health among adults with asthma and chronic bronchitis. A population-based study in Spain.

OBJECTIVES: To analyze the conditions of psychological dysfunction and positive mental health in patients with asthma and chronic bronchitis (CB), as compared to healthy individuals, and to identify the factors associated with these mental health indicators. METHODS: Cross-sectional study based on data obtained from the European Health Interview Survey for Spain (EHISS, 2009). We identified individuals with asthma and CB using a specific questionnaire. In order to assess mental health, two indicators extracted from questionnaire SF-36 were used: psychological dysfunction and positive mental health status. RESULTS: Out of 19,598 subjects included in the study, 8.3% were classified as asthmatic and 7.4% as CB. Healthy individuals had significantly higher psychological dysfunction scores than those with asthma and CB. The same occurred with positive mental health. The variables independently associated with lower scores out of these variables were gender female, a greater number of chronic diseases and obesity. On the contrary, alcohol consumption and physical exercise were associated with a higher score in the aforementioned variables. CONCLUSIONS: Healthy individuals have significantly higher scores in psychological dysfunction and positive mental health than patients with asthma and CB. This suggests that their mental health is much better. The variables related with lower scores out of these variables, and therefore with worse mental health, are: being female, having a greater number of chronic diseases and obesity. On the contrary, alcohol consumption and the practicing of physical exercise are associated with a higher score in the aforementioned variables, thus indicating a greater degree of mental health.

Use of dental care and prevalence of caries among immigrant and Spanish-born children.

PURPOSE: The purpose of this paper was to describe the use of dental services and the prevalence of dental caries in children living in Madrid, Spain. METHODS: A descriptive, cross-sectional study was conducted using data from the Madrid City Health Survey. The questions asked were: (1) When was the last time your child visited the dentist? (2) What was the reason for your child's last visit? and (3) Is your child currently suffering from caries, fillings, or bleeding from the gums when brushing? The independent variables included: sex; age; education level; and nationality. RESULTS: Data from 960 children (approximately 27% of whom were immigrants) were analyzed. Over the last year, approximately 59% of the children had received dental care and 28% suffered from caries. After multivariate analysis, we observed that 3- to 6-year-old children, immigrants, and children of parents with low education levels are more likely not to have received dental care during the last year. We also found that children are more likely to suffer from caries as they get older and if they are immigrants. CONCLUSIONS: Being an immigrant and from a lower education level typically results in a less frequent use of dental health services, and children of immigrants have a greater risk of suffering from dental caries. It is essential to investigate the reasons why and introduce strategies to reduce barriers to dental health access among immigrants.

Trends in primary total hip arthroplasty in Spain from 2001 to 2008: evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality.

BACKGROUND: Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain. METHODS: We selected all surgical admissions in individuals aged ≥ 40 years who had received a primary THA (ICD-9-CM procedure code 81.51) between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index.Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM. RESULTS: We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p < 0.001). In 2001, 81% of patients had a Charlson Index of 0, 18.4% of 1-2, and 0.6% > 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p < 0.001). The mean LOHS was 13 days in 2001 and decreased to 10.45 days in 2008 (p < 0.001). During the period studied, the mean cost per patient increased from 6,634 to 9,474 Euros. Multivariate analysis shows that from 2001 to 2008 the incidence of THA hospitalizations has significantly increased for both sexes and only men showed a significant reduction in IHM after THA. CONCLUSIONS: The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.

Breast and cervical cancer screening in Spain and predictors of adherence.

Gynecological cancers are an important cause of morbidity and mortality. Secondary prevention programmes attempt to improve their prognosis. High participation rates are needed to ensure the desired population impact. We sought to assess the use of mammography and Pap smear and analyze predictors of screening adherence. We included women surveyed in the Spanish National Health Survey 2006. Cancer screening included mammography in the last 2 years and Pap smear in the last 3 years. The target age range of the screening programmes was 50-69 years in breast cancer screening and 25-64 years in cervical cancer screening. Independent variables included: sociodemographics, chronic diseases and lifestyles. Predictors of mammography or Pap smear adherence were explored using logistic regression. The screening coverage for the target age range was 84.1% (95% confidence interval=82.9-85.2) in breast cancer and 67.4% (95% confidence interval=66.5-68.4) in cervical cancer. Mammography uptake was positively associated with age, being married, higher educational level, having visited a physician or gynecologist, supplementary private health coverage and osteomuscular disease. Some unhealthy lifestyles were associated with nonadherence to mammography. Positive predictors of Pap smear adherence behaved in the same way as for mammography and also higher monthly incomes and eating a healthy diet were associated with higher screening compliance. In conclusion, adherence to breast cancer screening in Spain is acceptable in the target age group; nevertheless Pap smear screening must be improved. In both cases, an effort must be made to recruit those women who are less likely to undergo screening, as they are those who are at higher risk of suffering these diseases.

Trends in cardiovascular risk factors and lifestyle behaviors among Spanish adults with diabetes (1993-2003).

UNLABELLED: Previous studies have observed high prevalences of high blood pressure (HBP), high blood cholesterol (HBC), obesity, and sedentary lifestyle among Spanish diabetic adults. These cardiovascular risk factors and unhealthy lifestyle behaviors occur more often in subjects with diabetes than in the general population. The aim of this study was to examine the trends in cardiovascular risk factors and lifestyle behaviors among Spanish adults with diabetes over the decade 1993-2003. METHODS: We used individualized data drawn from the 1993 (N=20,880) and 2003 (N=21,650) Spanish National Health Surveys. Subjects were classified as diabetes sufferers if they answered affirmatively to either or both of the following questions: "Has your doctor told you that you are currently suffering from diabetes?" and/or, "Have you taken any medication to treat diabetes in the last two weeks?" Cardiovascular risk factors analyzed included self-reported HBP and HBC. Lifestyle behaviors included obesity (body mass index >or=30), smoking status, and physical activity. We estimated and compared the prevalences and analyzed the time trends using logistic regression models. RESULTS: In both years studied, the prevalence of obesity and sedentary lifestyle was significantly higher among persons with than among those without diabetes, and current smoking was less frequent. The proportions of diabetes patients with HBP and obesity increased significantly from 39.5% and 20.1% in 1993 to 46.7% and 29.8% in 2003, with adjusted odds ratios of 1.32 (95% CI 1.07-1.62) for HBP and 1.88 (95% CI 1.44-2.46) for obesity. CONCLUSIONS: The overall prevalence of cardiovascular risk factors and unhealthy lifestyle behaviors among diabetes patients has shown no improvement in the decade 1993-2003, and there have been significant setbacks, in particular the rise in obesity and HBP.

Coverage and predictors of influenza vaccination among adults with diabetes in Spain.

Based on data drawn from the 2003 National Health Survey (NHS), we sought to: (1) estimate influenza vaccination coverages among Spanish diabetic adults; (2) analyze which sociodemographic, health-related, and use of health-care services variables were associated with the likelihood of Spanish diabetes sufferers being vaccinated; and (3) analyze the time-trend in coverage for the period 2001-2003. We analyzed data on the 1295 adults suffering diabetes included in the 2003 NHS. The reply to the question "Were you vaccinated against influenza in the last vaccination campaign?" was taken as the dependent variable. Vaccination coverage was calculated and the influence of sociodemographic, health-related, and use of health-care services variables assessed. The proportion of vaccinated diabetic adults in 2003 amounted to 57%. Multivariate adjustment showed that the variables which increased the likelihood of being vaccinated were: higher age; male gender; presence of respiratory or heart diseases; and physician visits in the last 2 weeks. Influenza coverages had significantly increased from 2001 (48.8%) to 2003. We conclude that influenza vaccination coverages among Spanish diabetic adults have improved but still remain below desirable levels and, thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine among diabetic patients, especially those less than 50 years, females and without other chronic conditions.

Influenza vaccination among the elderly Spanish population: trend from 1993 to 2003 and vaccination-related factors.

BACKGROUND: Influenza is an important public health problem that particularly affects elderly subjects and influenza vaccination is a safe, effective and efficient method for prevention of influenza-related complications in elderly individuals with or without underlying chronic conditions. This study aims to analyze adjusted time trends in the coverage of influenza vaccination among elderly Spanish subjects and to identify which variables were associated with the probability of having been vaccinated in 2003. METHODS: We undertook a cross-sectional study using data of individuals aged >/=65 years drawn from the 1993, 1995, 1997, 2001, and 2003 Spanish National Health Surveys. The answer to the question 'Did you have a 'flu shot in the latest campaign' was used as the dependent variable, and socio-demographic and health-related characteristics were analyzed as independent variables. Coverage of vaccination for each year was adjusted by the direct method for both age and gender. Multivariate logistic regression was used to estimate the independent effect of variables on the receipt of influenza vaccine. RESULTS: 15 989 records were analyzed. Adjusted influenza coverage increased from 50.1% in 1993 to 63.7% in 2003 (P < 0.001). The variables that were significantly associated with a higher likelihood of being vaccinated were older age, suffering a chronic disease, residence in towns with <10 000 inhabitants, 'worse' self-perceived health and non-smokers. CONCLUSIONS: Coverage among the Spanish elderly has increased significantly from 1993 to 2003. Still, there is room for improvement, particularly, among the subjects with 'good' self-perceived health, those with no concomitant medical conditions, and smokers.

Epidemiologic intervention framework of a prehospital emergency medical service.

OBJECTIVES: To describe and analyze the characteristics of prehospital medical assistance provided by the Madrid Municipal Emergency and Civil Rescue & Protection Service (SAMUR); and, based on the epidemiologic knowledge so gained, to prioritize public health intervention strategies. METHODS: A retrospective cross-sectional analysis of all medical services performed by the SAMUR-Protección Civil in 2001 and 2002. Study variables included causes, response times, hour, day of the week, month, mobile resource, Municipal District, and pathology. For analysis purposes, the relevant data were linked to Access 97 via Open Database Connectivity. Statistical analysis was performed using the SPSS computer software package, with Spearman's correlation coefficient and analysis of variance. Values were deemed statistically significant at p < 0.05. RESULTS: The study population comprised the 97,937 and 101,438 interventions undertaken in 2001 and 2002, respectively. Mean daily activity in 2002 involved 278 alerts (standard deviation: 46), 95% confidence interval: 273-282. Distributions of the interventions were similar for 2001 and 2002, with peak activity from 1 to 2 pm and 8 to 9 pm, and minimum activity from 6 to 7 am. Activity was at its most intense on Saturdays. The magnitude of the association between the two years by day of the week was 96% (p < 0.001). The Central Municipal District (Centro) triggered 17,875 emergency actions. The prevalent pathology was traumatologic, followed by cardiovascular. CONCLUSIONS: Epidemiologic description enabled the characteristics of the prehospital assistance procedure to be comprehensively ascertained and quantified. False alarms assume special relevance due to their implications. Emergency medical alerts with a psychosocial component are on the increase, something that must be controlled.