Spatial and temporal variations in Spain in the standardised ratio of in-hospital mortality due to colorectal cancer, 2008-2014.

BACKGROUND: Colorectal cancer (CRC) is the second cause of tumour mortality in Spain and Europe. To date, no studies have been conducted in Spain to evaluate the spatial and temporal distribution of the excess risk of death during hospitalisation for CRC. METHODS: A cohort was constructed of all episodes of hospitalisation in Spain due to CRC (codes 153 and 154 of the International Classification of Diseases, 9th edition, Clinical Modification) during the period 2008-2014, based on the minimum basic data set published by the Ministry of Health. Mortality ratios were calculated per region for each of the years analyzed (spatial or cross-sectional analysis) and during the overall study period, for each region independently (temporal or longitudinal analysis). In the first of these analyses, particular note was taken of the regions and years in which the limits of two and three standard deviations were exceeded. RESULTS: Two hundred and fifty eight thousand, nine hundred and twenty seven episodes of CRC were analysed. The patients were predominantly male (60.6%), with an average hospital stay of 13.16 days. Half underwent surgery during admission and on average presented more than six diagnoses at discharge. The spatial analysis revealed mortality ratios that deviated by at least three standard deviations in the following regions: Islas Canarias, Asturias, Valencia, Extremadura, País Vasco and Andalucía. The longitudinal analysis showed that most regions presented one or more years when CRC mortality was at least 15% higher than expected during the period; outstanding in this respect were Asturias, Navarra and La Rioja, where this excess risk was detected in at least 2 years. CONCLUSIONS: Geographic and temporal patterns of the distribution of the excess risk of mortality from CRC in Spain are described using SMRs. We conclude that during the study period, the geographic pattern of mortality in Spain did not coincide with the excess risk of mortality calculated using the SMR method described by Jarman and Foster. This method of risk estimation can be a useful tool for the study of mortality risk and its spatial variations.

[Is the permanent pacemaker implant more efficient in level 1 hospital?]. / ¿Es más eficiente el implante de marcapasos permanentes en hospitales de nivel I?

OBJECTIVE: To determine if permanent pacemaker implants (PPM) interventions and change of generator are more efficient in small hospitals. DESIGN: A cost-effective analysis and retrospective, cross-sectional and observational study of diagnostic related groups (DRG). SETTING: The data was obtained from the national Minimum Basic Data Set (MBDS) for the year 2007 provided by the Health Ministry. PATIENTS: This includes the total number of patients who required treatment in all national hospitals for 5 DRG: 115 - bradyarrhythmic complication during the acute coronary syndrome, heart failure or shock; 116 -symptomatic isolated conduction defects; 117 -revisions, but without changing the battery, 118- application of a new one, 549 - implementation or revision but with serious complications. PRINCIPAL VARIABLES OF INTEREST: demographic, clinical (number of secondary diagnoses (NSD) and procedures (NP), mortality) and management (total and preoperative length of stay (LOS), access, discharge, hospital size), defining inefficient stays as those exceeding 2 days on the average. RESULTS: 23,154 episodes, 5.3% small hospitals. The comparative bivariate study between small hospitals and the rest, not discriminated by DRG, showed a mean LOS of 7.87±8.78 days vs 11.01±12.95 (p=0.005, 95% CI for mean difference [0.17, 1.65]) and also lower than preoperatively (3.62±6.14 vs. 4.22±6.68 days (p=0.015)) without greater comorbidity, as measured by proxy through the NSD (5.23±2.88 vs 5.42±3.28 (p=0.055)) and NP as proxy of diagnostic and therapeutic effort (3.79±2.50 vs 3.55±2.69 (p=0.002)). A total of 24.1% were inefficient, there being an association with preoperative stay, NDS, NP and emergency access. CONCLUSION: Pacemaker implantation and generator change in small hospitals is more efficient, with internal consistency by subgroups.

Search of a topological pattern to evaluate toxicity of heterogeneous compounds.

Molecular connectivity has been applied to the search of mathematical models able to predict the carcinogenic and teratogenic activity of a wide group of structurally heterogeneous compounds. Through the linear discriminant analysis and the diagrams of distribution of pharmacological activity, the classification criteria that minimizes the percentage of error are established. The easiness and speed of the calculation of the descriptors used in this work make the models developed useful in data bases containing a huge number of compounds.

Cajal's first steps in scientific research.

More than 125 years ago, Santiago Ramón y Cajal was able to draft and prove the neuron doctrine, and later, to develop prophetic theories about neural function and plasticity, many of which have been proven by current neuroscience. It was chance that made Cajal, during his doctorate studies, have his first contact with histology and force him to study the then current theories about pathogenesis of inflammation. Thus, he gained knowledge of the vascular hypothesis, by Julius Cohnheim, a German pathologist who, opposing the opinion of his teacher and father of cellular pathology, Rudolf Virchow, made leukocytes the protagonists of inflammation, given their ability to develop ameboid movements directed by chemical signals. Cohnheim's chemotactic theory deeply influenced Cajal's conception of biology. So, the basic postulates of chemotaxis can be identified at different moments in Cajal's research, from the description of the "growth cone" in embryonic neuroblasts, the origin of the neurotrophic theory, to the proposal of the pathophysiological mechanisms of neuronal plasticity. From Cajal's point of view, the neurons move during their development and also adapt to different external circumstances. Chemical endogenous substances can stimulate this movement in a similar way to leukocytes during the process of inflammation.

[Economics and equity in urgency and emergency care]. / Economía y equidad en urgencias y emergencias.

The financial sustainability of public health systems (PHS) is currently threatened by population growth, increased prevalence of chronic conditions and disabilities, inequality in access and use of resources, zero cost delivery and global economic crisis. The emergency department (ED) is one for which demand is highest--without relation to the health model--because disease becomes established in disadvantaged socio-demographic areas and inequalities, hyperconsumption and decision making more closely linked to the user are maintained. The medical device of ED is a multiple one and its diverse product lines make it difficult to measure. This review discusses the need to deploy measurement tools in ED, where there are high direct costs--primarily structural--and other variables related to the activity, where the marginal cost is higher than the average and there is no economy of scale in such interventions. The possible mechanisms of private copayment in financing the supply of EDs are also studied, showing their advantages and disadvantages, with the conclusion that they are not recommendable--due to their scarce fund raising and deterrent capacity, which is why fundamental strategic changes in the management of these resources are needed.

[Prevalence of processes and pathologies in emergency hospital care]. / Prevalencia de procesos y patologías en la atención urgente hospitalaria.

OBJECTIVES: To study the behavioural differences between scheduled and emergency admissions in the processes most prevalent in Spanish hospitals and their relationship with the age of patients, comparing 2002 and 2007. METHODS: Observational and descriptive design for those years. Diagnostic related groups (DRGs) were classified into high prevalence (the 25 most frequent) and the rest; four subgroups were prepared according to this (high or low) and admission (elective or not). Mean length of stay was analyzed, together with relative weight, number of diagnoses and procedures and mortality by age, using the Student and/or ANOVA tests for quantitative variables and Pearson's chi(2) qualitative comparison of means and proportions for tabular data, assuming statistical significance at p <0.05. RESULTS: The high prevalence and emergency admission subgroup has higher age, ratio of males, mean length of stay, mortality, number of diagnoses and procedures (all p <0.0001), in both 2002 and 2007. The complexity and resource consumption measured by such variables peaks in the 65-69 and 70-74 cohorts respectively, with emergency admission. CONCLUSIONS: There are clear differences between the processes according to their prevalence and accessibility; priority must be given to knowledge and information on the most frequent and urgent admissions to improve the effectiveness, efficiency and quality.