Genetic diversity and cross-species transmissibility of bat-associated picornaviruses from Spain.

BACKGROUND: Emerging zoonotic diseases arise from cross-species transmission events between wild or domesticated animals and humans, with bats being one of the major reservoirs of zoonotic viruses. Viral metagenomics has led to the discovery of many viruses, but efforts have mainly been focused on some areas of the world and on certain viral families. METHODS: We set out to describe full-length genomes of new picorna-like viruses by collecting feces from hundreds of bats captured in different regions of Spain. Viral sequences were obtained by high-throughput Illumina sequencing and analyzed phylogenetically to classify them in the context of known viruses. Linear discriminant analysis (LDA) was performed to infer likely hosts based on genome composition. RESULTS: We found five complete or nearly complete genomes belonging to the family Picornaviridae, including a new species of the subfamily Ensavirinae. LDA suggested that these were true vertebrate viruses, rather than viruses from the bat diet. Some of these viruses were related to picornaviruses previously found in other bat species from distant geographical regions. We also found a calhevirus genome that most likely belongs to a proposed new family within the order Picornavirales, and for which genome composition analysis suggested a plant host. CONCLUSIONS: Our findings describe new picorna-like viral species and variants circulating in the Iberian Peninsula, illustrate the wide geographical distribution and interspecies transmissibility of picornaviruses, and suggest new hosts for calheviruses.

Comparing temporal changes and predictors of different types of mental health and socio-emotional wellbeing outcomes during COVID-19: an overlapping panel study of Spanish residents.

OBJECTIVES: Few panel studies have investigated how different types of mental health (MH) and socio-emotional wellbeing (SEW) outcomes have changed during the pandemic and if their burden has been equally distributed at the population-level. We aimed to examine temporal changes in these outcomes and their socio-ecological predictors using panel data. STUDY DESIGN: Longitudinal population-based survey with overlapping panels. METHODS: Analyses were carried out using four measurements of data from the Health and Social Survey (April 2020 to April 2021). Participants included Andalusian (Spanish) residents aged 16 years or older who participated in all four measurements (n = 1223). Seven dichotomous MH and SEW outcomes, as well as several socio-ecological predictors informed by a conceptual model, were examined in descriptive and multivariate analyses. RESULTS: Unadjusted odds of regular/bad perceived mental health (vs. excellent/very good/good), low socio-emotional wellbeing (vs. regular), low happiness (vs. regular), and feeling anxious (vs. not feeling anxious) decreased significantly from the first to the second measurement; however, in the fourth, low socio-emotional wellbeing significantly increased while low optimism decreased. Considering varying coefficients, objectively measured COVID-19 status and self-reported severity levels of the infection were statistically significant. Health status, social support, and household financial difficulty predicted higher adjusted odds in most of the seven assessed outcomes. CONCLUSIONS: Significant temporal variations in MH and SEW outcomes, along with their predictors, were observed during the first year of the pandemic. Some of these outcomes worsened as the pandemic progressed, whereas others improved. Findings also suggest that some individuals such as those experiencing poor health, limited social support, and low socioeconomic status are disproportionately impacted.

Association between ultraprocessed food consumption and excess adiposity in children and adolescents: A systematic review.

Ultraprocessed foods (UPF) consumption is associated with excess adiposity in adults, but this linkage remains unclear among children and adolescents. The present systematic review sought to address this research gap. Publications up to November 2023 were retrieved from PubMed, Web of Science, and Scopus databases. Outcomes included overweight/obesity anthropometric and body composition indicators; the exposure was UPF consumption based on the NOVA classification system. The review included 23 studies (i.e., 8 cohort and 15 cross-sectional); approximately half were carried out in Brazil. Inconclusive and heterogeneous evidence exists as few cohort studies found positive/mixed associations between UPF consumption and excess adiposity in pediatric populations, whereas most cross-sectional studies reported null associations. Such inconsistencies may be attributed to underlying methodological issues, especially heterogeneity in the outcomes assessed and UPF consumption operationalization and/or categorization. Future studies should adopt longitudinal designs with sufficiently extended follow-up periods, account for relevant confounding factors, employ validated and standardized measurement tools to assess dietary exposure, ensure consistent operationalization of variables, and encompass diverse geographic contexts. Ultimately, strengthening the quality of existing research evidence may better inform current and forthcoming policy and practice interventions aimed at mitigating the increasing prevalence of overweight/obesity in childhood and across the life course.

Impacts of COVID-19 on clinical indicators and mortality in patients with chronic conditions in Catalonia, Spain: A retrospective population-based cohort study.

Background: The reallocation of health care services during the coronavirus disease 2019 (COVID-19) pandemic disrupted the continuity of primary care. This study examines the repercussions of the COVID-19 pandemic on clinical indicators within the Catalan population, emphasising individuals with chronic conditions. It provides insights into mortality and transfer rates considering intersectional perspectives. Methods: We designed a retrospective, observational population-based cohort study based on routinely collected data from January 2015 to June 2021 for all individuals available in the Information System for Research in Primary Care (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP)), the largest public primary care database in Catalonia, Spain. We included 6 301 095 individuals, constituting 81.6% of Catalonia's population in 2020. To perform a repeated measurements analysis of the indicators, we focussed on individuals who had one or more indicators in both the pre-pandemic (January 2015 to March 2020) and pandemic periods (March 2020 to June 2021), and those diagnosed with type 2 diabetes mellitus (T2D), high blood pressure, and heart failure. We selected key clinical indicators for analysis, including systolic and diastolic blood pressure, body mass index (BMI), cholesterol (total, high, and low-density lipoprotein), triglycerides, glycosylated haemoglobin, the Barthel index, and cardiovascular risk (Registre Gironí del cor (REGICOR) index). Results: Mortality and transfer rates increased during the pandemic, contributing to a decline in the active population in the public health system. We also observed a reduction in pandemic period prevalence of patients with chronic conditions: -26.7% for heart failure, -15.1% for high blood pressure, and -14.6% for T2D. In both pre-pandemic and pandemic periods, 1 632 013 subjects had at least one clinical indicator record. Clinical indicators worsened in patients diagnosed with chronic conditions during the pandemic. Most indicators worsened, with differences between men and women (+9.4% vs +3.7% for the REGICOR index and -14.1% vs -16.6% for the Barthel index in men and in women, respectively), and to a similar extent (or greater in some cases) in individuals without these conditions. Conclusions: We used longitudinal data to assess the repercussions of the COVID-19 pandemic on population health while considering a wide range of clinical indicators and socioeconomic determinants. Our analysis shows a deterioration in clinical indicators during the pandemic, particularly in cardiometabolic factors, underscoring the importance of continuous primary care for individuals with chronic conditions.

Air pollution and children's mental health in rural areas: compositional spatio-temporal model.

Air pollution stands as an environmental risk to child mental health, with proven relationships hitherto observed only in urban areas. Understanding the impact of pollution in rural settings is equally crucial. The novelty of this article lies in the study of the relationship between air pollution and behavioural and developmental disorders, attention deficit hyperactivity disorder (ADHD), anxiety, and eating disorders in children below 15 living in a rural area. The methodology combines spatio-temporal models, Bayesian inference and Compositional Data (CoDa), that make it possible to study areas with few pollution monitoring stations. Exposure to nitrogen dioxide (NO2), ozone (O3), and sulphur dioxide (SO2) is related to behavioural and development disorders, anxiety is related to particulate matter (PM10), O3 and SO2, and overall pollution is associated to ADHD and eating disorders. To sum up, like their urban counterparts, rural children are also subject to mental health risks related to air pollution, and the combination of spatio-temporal models, Bayesian inference and CoDa make it possible to relate mental health problems to pollutant concentrations in rural settings with few monitoring stations. Certain limitations persist related to misclassification of exposure to air pollutants and to the covariables available in the data sources used.

Multimorbidity patterns and disability and healthcare use in Europe: do the associations change with the regional socioeconomic status?

Multimorbidity, the concurrence of several chronic conditions, is a rising concern that increases the years lived with disability and poses a burden on healthcare systems. Little is known on how it interacts with socioeconomic deprivation, previously associated with poor health-related outcomes. We aimed to characterize the association between multimorbidity and these outcomes and how this relationship may change with socioeconomic development of regions. 55,915 individuals interviewed in 2017 were drawn from the Survey of Health, Ageing and Retirement in Europe, a population-based study. A Latent Class Analysis was conducted to fit multimorbidity patterns based on 16 self-reported conditions. Physical limitation, quality-of-life and healthcare utilization outcomes were regressed on those patterns adjusting for additional covariates. Those analyses were then extended to assess whether such associations varied with the region socioeconomic status. We identified six different patterns, labelled according to their more predominant chronic conditions. After the "healthy" class, the "metabolic" and the "osteoarticular" classes had the best outcomes involving limitations and the lowest healthcare utilization. The "neuro-affective-ulcer" and the "several conditions" classes yielded the highest probabilities of physical limitation, whereas the "cardiovascular" group had the highest probability of hospitalization. The association of multimorbidity over physical limitations appeared to be stronger when living in a deprived region, especially for metabolic and osteoarticular conditions, whereas no major effect differences were found for healthcare use. Multimorbidity groups do differentiate in terms of limitation and healthcare utilization. Such differences are exacerbated with socioeconomic inequities between regions even within Europe.

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain.

OBJECTIVE: To determine if a 4-week manual therapy treatment restores normal functioning of central pain processing mechanisms in non-specific chronic neck pain (NSCNP), as well as the existence of a possible relationship between changes in pain processing mechanisms and clinical outcome. DESIGN: Cohort study. METHODS: Sixty-three patients with NSCNP, comprising 79% female, with a mean age of 45.8 years (standard deviation: 14.3), received four treatment sessions (once a week) of manual therapy including articular passive mobilizations, soft tissue mobilization and trigger point treatment. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and temporal summation of pain (TSP) were evaluated at baseline and after treatment completion. Therapy outcome was measured using the Global Rating of Change Scale (GROC), the Neck disability Index (NDI), intensity of pain during the last 24 hours, Tampa Scale of Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS). Two sets of generalized linear mixed models with Gaussian response and the identity link were employed to evaluate the effect of the intervention on clinical, psychological and psychophysical measures and the association between psychophysical and clinical outcomes. RESULTS: Following treatment, an increased CPM response (Coefficient: 0.89; 95% credibility interval = 0.14 to 1.65; P = .99) and attenuated TSP (Coefficient: -0.63; 95% credibility interval = -0.82 to -0.43; P = 1.00) were found, along with amelioration of pain and improved clinical status. PPTs at trapezius muscle on the side of neck pain were increased after therapy (Coefficient: 0.22; 95% credibility interval = 0.03 to 0.42; P = .98), but not those on the contralateral trapezius and tibialis anterior muscles. Only minor associations were found between normalization of TSP/CPM and measures of clinical outcome. CONCLUSION: Clinical improvement after manual therapy is accompanied by restoration of CPM and TSP responses to normal levels in NSCNP patients. The existence of only minor associations between changes in central pain processing and clinical outcome suggests multiple mechanisms of action of manual therapy in NSCNP.

Cell type-specific adaptation of the SARS-CoV-2 spike.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can infect various human tissues and cell types, principally via interaction with its cognate receptor angiotensin-converting enzyme-2 (ACE2). However, how the virus evolves in different cellular environments is poorly understood. Here, we used experimental evolution to study the adaptation of the SARS-CoV-2 spike to four human cell lines expressing different levels of key entry factors. After twenty passages of a spike-expressing recombinant vesicular stomatitis virus (VSV), cell-type-specific phenotypic changes were observed and sequencing allowed the identification of sixteen adaptive spike mutations. We used VSV pseudotyping to measure the entry efficiency, ACE2 affinity, spike processing, TMPRSS2 usage, and entry pathway usage of all the mutants, alone or in combination. The fusogenicity of the mutant spikes was assessed with a cell-cell fusion assay. Finally, mutant recombinant VSVs were used to measure the fitness advantage associated with selected mutations. We found that the effects of these mutations varied across cell types, both in terms of viral entry and replicative fitness. Interestingly, two spike mutations (L48S and A372T) that emerged in cells expressing low ACE2 levels increased receptor affinity, syncytia induction, and entry efficiency under low-ACE2 conditions. Our results demonstrate specific adaptation of the SARS-CoV-2 spike to different cell types and have implications for understanding SARS-CoV-2 tissue tropism and evolution.

Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol.

INTRODUCTION: The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health. METHODS AND ANALYSIS: DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration. ETHICS AND DISSEMINATION: The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Comparabilidad de las ediciones 2006/07 y 2011/12 de la Encuesta Nacional de Salud en España / Comparability of the editions 2006/07 and 2011/12 of the Spanish health survey

Fundamentos: La Encuesta Nacional de Salud de España (ENSE) es una de las fuentes principales sobre determinantes sociales de la salud. Los objetivos de este trabajo fueron describir el procedimiento de fusión de las ediciones 2006/07 y 2011/12 de la ENSE, y proporcionar acceso libre a las bases de datos y directorio de variables. Métodos: Identificamos las variables comparables a partir de los cuestionarios, construyendo otras nuevas para conseguir la comparabilidad o para proporcionar nuevos indicadores de interés. Obtuvimos dos bases de datos fusionadas y dos directorios de variables con sus diccionarios (muestra de adultos y de menores). Resultados: Identificamos 188 variables potencialmente comparables. Un 36,7% tuvieron algún problema para su comparabilidad y un 8% tuvieron que ser eliminadas, fundamentalmente en la muestra de adultos. El ámbito con peores consecuencias de la falta de comparabilidad fue el de condiciones de trabajo y empleo en la muestra de adultos. Conclusión: La fusión de ambas ediciones de la ENSE tuvo muchas incidencias en la muestra de adultos, afectando de manera importante a su comparabilidad. Este trabajo es útil para evaluar, diseñar y fusionar estas y otras ediciones de la ENSE, e incluso sirve como modelo para la fusión de otras encuestas transversales de base poblacional (AU)

Background: The Spanish Health Survey (SHS) is one of the main sources on social determinants of health. The objectives were to describe the data merging process of the 2006/07 and 2011/12 SHS editions, as well as to provide the merged databases and the directory of the variables. Methods: The comparable variables were identified from the questionnaires. Other new variables were created to achieve comparability or to provide new indicators of interest. We obtained two completed merged databases, as well as two variable directories with their dictionaries (each one for the adults and children samples). Results: 188 variables were identified as potentially comparable ones. 36,7% of them had difficulties for being comparable and 8% had to be removed. The topic with the worst consequences due to the lack of comparability was the working conditions and employment from the adult sample. Conclusion: The merging of both SHS editions had a lot of problems, especially in the adult’s sample. That affects to its comparability. This work may be useful to assess, design and merge these and other editions of the SHS, as well as to serve as a model to be applied in other cross-sectional population-based surveys (AU)

Indicadores contextuales para evaluar los determinantes sociales de la salud y la crisis económica española / Contextual indicators to assess social determinants of health and the Spanish economic recession

Objetivo: Proporcionar indicadores para evaluar, en España y en sus comunidades autónomas, el impacto sobre la salud, sus determinantes sociales y las desigualdades en salud del contexto social y de la crisis económica más reciente. Métodos: Basándonos en el marco conceptual de los determinantes de las desigualdades sociales en salud en España, identificamos indicadores secuencialmente a partir de documentos clave, Web of Science y organismos con estadísticas oficiales. La información recopilada dio lugar a un directorio amplio de indicadores que fue revisado por un panel de expertos. Posteriormente seleccionamos un conjunto de esos indicadores según un criterio geográfico y otro temporal: disponibilidad de datos según comunidades autónomas y al menos desde 2006 hasta 2012. Resultados: Identificamos 203 indicadores contextuales sobre determinantes sociales de la salud y seleccionamos 96 (47%) según los criterios anteriores. De los indicadores identificados, el 16% no cumplieron el criterio geográfico y el 35% no cumplieron el criterio temporal. Se excluyó al menos un 80% de los indicadores relacionados con la dependencia y los servicios de salud. Los indicadores finalmente seleccionados cubrieron todas las áreas de los determinantes sociales de la salud. El 62% de estos no estuvieron disponibles en Internet. Alrededor del 40% de los indicadores se extrajeron de fuentes relacionadas con el Instituto Nacional de Estadística. Conclusiones: Proporcionamos un amplio directorio de indicadores contextuales sobre determinantes sociales de la salud y una base de datos que facilitarán la evaluación, en España y sus comunidades autónomas, del impacto de la crisis económica sobre la salud y las desigualdades en salud (AU)

Objective: To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. Methods: Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organizations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. Results: We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. Conclusions: We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions (AU)

Análisis de datos de pacientes subagudos con información registrada en el Conjunto Mínimo Básico de Datos Sociosanitarios (CMBD-RSS) / Data analysis of subacute patients with registered Information in Minimum Basic Data set for Social-Healthcare (CMBD-RSS), Spain

Fundamentos: Es necesario profundizar en el conocimiento del conjunto mínimo básico de datos (CMBD-RSS) de la línea sociosanitaria de pacientes subagudos (con patología crónica asociada y frecuentes ingresos). El objetivo de este estudio fue conocer las características sanitarias de este tipo de pacientes. Métodos: Muestra de 660 pacientes que ingresaron en camas de subagudos del Hospital Santa Caterina (Región Sanitaria Girona), de octubre de 2013 a diciembre de 2014. La fuente de información fue el CMBD-RSS. Se realizó análisis estadístico descriptivo y se verificó la relación entre variables: número de días de estancia y edad, procedencia del paciente y días de estancia (Significación de Mann-Whitney); diagnóstico principal y días de estancia (Kruskal-Wallis). Se contrastaron la procedencia y el diagnóstico principal mediante χ2 de Pearson y el coeficiente V de Cramer). Resultados: La edad media de las personas de la muestra fue de 83 años, el 55% eran mujeres. Los cinco grupos de enfermedades que concentraron el 80% de los diagnósticos de los pacientes fueron trastorno mental, enfermedades del sistema nervioso, cardiovasculares, respiratoria e infecciones genitourinarias). Los pacientes que procedieron del hospital, tuvieron una estancia media 8 días inferior a los procedentes de domicilio (9 días). En el 80% de los casos se retornó al domicilio al alta. Conclusiones: Las personas con patología crónica asociada con frecuentes ingresos hospitalarios configuran un grupo de riesgo importante. La elevada edad y la descompensación clínica añaden complejidad. Una correcta valoración del paciente al inicio del episodio facilita la asignación del recurso más adecuado. En la muestra estudiada se plasman las patologías más prevalentes, la procedencia, la estancia media y el destino al alta (AU)

Background: It is necessary to deepen in the knowledge of the Basic Minimum Set of Data (CMBD-RSS) of patients with chronic pathology associated and frequent hospitalisations (the subacute care). The aim of this study was to analyse the sanitary information of these patients, once initiated the subacute program. Methods: We used data of 660 patients hospitalised in the subacute care unit at the Santa Caterina Hospital, sanitary region of Girona, from October 2013 to December 2014. The CMBD data base was analysed using SPSS Statistics 15.0. We verified the relationship between variables i.e. length of stay and age; origin of the patient admission and length of stay (Mann- Whitney U Test); main diagnosis and length of stay (Kruskal-Wallis). We also studied the relationship between origin of the patient admission and main diagnosis (Chi-square test and Cramer’s V). Results: The average age of patients was 83 years old, and mainly female profile (55%). Five illnesses concentrated 80% of all patients’ diagnosed diseases (mental health problems, nervous system diseases, circulatory problems, respiratory system problems and genitourinary infections). Patients admitted from hospitals had a shorter length of stay (8 days) than patients admitted from home (9 days). 80% of cases patients come back home after the hospital discharge. Conclusions: People with chronic pathology associated and frequent hospitalisations are an important group of risk. Elderly and clinical decompensations add complexity to these cases. The evaluation of these patients at the admission and discharge procedures optimise the use of the resources (AU)

A common error in the ecological regression of cancer incidence on the deprivation index / Un error frecuente en los modelos de regresión ecológica de la incidencia de cáncer con respecto al índice de carencia

OBJECTIVE: To determine if introducing age as another explanatory variable in an ecological regression model relating crude rates of cancer incidence and a deprivation index provides better results than the usual practice of using the standard incidence ratio (SIR) as the response variable, introducing the non-standardized index, and not including age in the model. METHODS: Relative risks associated with the deprivation index for some locations of cancer in Spain's Girona Health Region were estimated using two different models. Model 1 estimated relative risks with the indirect method, using the SIR as the response variable. Model 2 estimated relative risks using age as an explanatory variable and crude cancer rates as the response variable. Two scenarios and two sub-scenarios were simulated to test the properties of the estimators and the goodness of fit of the two models. RESULTS: The results obtained from Model 2's estimates were slightly better (less biased) than those from Model 1. The results of the simulation showed that in all cases (two scenarios and two sub-scenarios) Model 2 had a better fit than Model 1. The probability density for the parameter of interest provided evidence that Model 1 leads to biased estimates. CONCLUSIONS: When attempting to explain the relative risk of incidence of cancer using ecological models that control geographic variability, introducing age as another explanatory variable and crude rates as a response variable provides less biased results.

OBJETIVO: Determinar si la introducción de la edad como otra variable independiente en un modelo de regresión ecológica que relaciona las tasas brutas de incidencia de cáncer con un índice de carencia, ofrece mejores resultados que la práctica corriente del uso de la razón de incidencia normalizada como criterio de valoración, con introducción del índice sin normalización y sin incluir la edad en el modelo. MÉTODOS:Se calcularon los riesgos relativos asociados con el índice de carencia de algunos tipos de cáncer en la Región Sanitaria de Girona en España, mediante dos modelos diferentes. En el modelo 1 se calcularon los riesgos relativos con el método indirecto, usando la razón de incidencia normalizada como criterio de valoración. En el modelo 2 se calcularon los riesgos relativos introduciendo la edad como una variable independiente y las tasas brutas de cáncer como criterio de valoración. Se simularon dos hipótesis y dos subhipótesis con el fin de verificar las propiedades de los estimadores y la bondad del ajuste de ambos modelos. RESULTADOS: Los resultados obtenidos a partir de las estimaciones con el modelo 2 fueron un poco mejores (menos sesgados) que los resultados obtenidos con el modelo 1. Los resultados de la simulación indicaron que en todos los casos (las dos hipótesis y las dos subhipótesis) el modelo 2 exhibió un mejor ajuste que el modelo 1. La función de densidad del parámetro de interés puso en evidencia que el modelo 1 da lugar a estimaciones sesgadas. CONCLUSIONES: Cuando se intenta explicar el riesgo relativo de incidencia de cáncer mediante modelos de regresión ecológica que tienen en cuenta la variabilidad geográfica, se obtienen resultados menos sesgados cuando se introduce la edad como una de las variables independientes y se utilizan las tasas brutas de incidencia como criterio de valoración.

Influence of the introduction of the ICD-10 on tendencies of mortality by causes (1980–2004)

Objective: To evaluate the influence of the tenth revision of the International Statistical Classification of Diseases (ICD-10) on tendencies of annual mortality rates, corrected and uncorrected to the ICD-9. Methods: Starting with the causes with a significant comparability ratio, we calculated the annual age adjusted rates from 1980 to 2004. The comparability ratio was applied to the rates for 1999–2004, obtaining the corrected series for the whole period. This series was then compared with the uncorrected series using join point regression. Results: Mortality decreased between 1999 and 2004. Differences were found in blood diseases, hypertensive diseases, cancer of ill defined sites, respiratory insufficiency, and myelodys plastic syndrome. Conclusions: The tendency of the main causes of mortality has been largely unaffected by the revisions in the ICD-10, except in infrequent or less specific diseases (AU)

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Fundamentos y aplicaciones del diseño de casos cruzados / Case-crossover design: Basic essentials and applications

El diseño de casos cruzados es un diseño epidemiológico observacional propuesto por Maclure en 1991 para valorar si alguna exposición intermitente o inusual ha desencadenado un evento agudo a muy corto plazo. En este trabajo se presentan los fundamentos de los diseños de casos cruzados, con sus aplicaciones y limitaciones. El diseño de casos cruzados se basa en seleccionar sólo sujetos caso. Para calcular el riesgo relativo se compara la exposición durante el periodo de tiempo previo al evento (periodo caso) con la exposición del mismo sujeto en uno o varios periodos control. Este método únicamente es adecuado cuando las exposiciones son cambiantes en el tiempo, con efectos a corto plazo, y el efecto es agudo. Para exposiciones en que no existe tendencia, el planteamiento unidireccional es el más frecuente, y consiste en seleccionar uno o varios periodos control previos al momento caso. Cuando la exposición tiene una tendencia temporal (por ejemplo las de contaminación atmosférica), el planteamiento unidireccional proporciona estimaciones sesgadas, por lo que se utilizan diseños de casos cruzados bidireccionales, que seleccionan periodos de tiempo control anteriores y posteriores al del evento. Es un método que cuenta con una creciente utilización en amplios campos: desencadenantes de accidentes de tráfico, laborales y domésticos, o de infarto agudo de miocardio, contaminación atmosférica y salud, farmacoepidemiología, etc. Para el análisis de datos, generalmente se pueden considerar los diseños de casos cruzados como estudios de casos y controles emparejados, por lo que se aplica regresión logística condicional. Finalmente, en este trabajo se analizan ejemplos prácticos de diferentes aplicaciones del diseño de casos cruzados (AU)

Case-crossover analysis is an observational epidemiological design that was proposed by Maclure in 1991 to assess whether a given intermittent or unusual exposure may have triggered an immediate short-term, acute event. The present article outlines the basics of case-crossover designs, as well as their applications and limitations. The case-crossover design is based on exclusively selecting case subjects. To calculate relative risk, exposure during the period of time prior to the event (case period) is compared against the same subject's exposure during one or more control periods. This method is only appropriate when the exposures are transient in time and have acute short-term effects. For exposures in which there is no trend, a unidirectional approach is the most frequent and consists of selecting one or more control periods prior to the case period. When the exposure displays a time trend (e.g., air pollution), a unidirectional approach will yield biased estimates, and therefore bidirectional case-crossover designs are used, which select control time intervals preceding and subsequent to that of the event. The case-crossover design is being increasingly used across a wide range of fields, including factors triggering traffic, occupational and domestic accidents and acute myocardial infarction, and those involved in air pollution and health and pharmacoepidemiology, among others. Insofar as data-analysis is concerned, case-crossover designs can generally be regarded as matched case-control studies and consequently conditional logistic regression can be applied. Lastly, this study analyzes practical examples of distinct applications of the case-crossover design (AU)

Accurately estimating breast cancer survival in Spain: cross-matching local cancer registries with the National Death Index / Estimación precisa de la supervivencia de cáncer de mama en España: emparejamiento de los registros locales de cáncer con el Índice Nacional de Defunciones

OBJECTIVES: To assess the impact of using data from the National Death Index (NDI) of Spain to estimate breast cancer survival rates among residents of Girona and Zaragoza diagnosed in 1995-1999. METHODS: This was an observational, longitudinal epidemiologic study, using two population- based cancer registries. Data collected were of female residents of Girona or Zaragoza who had been diagnosed with breast cancer in 1995-1999. Observed and relative 5-year survival rates were estimated, first using the information available from the Girona and Zaragoza cancer registries, and then with the inclusion of NDI data. The 5-year relative survival rate and corresponding 95 percent Confidence Intervals were estimated using the Hakulinen method. The Kaplan-Maier method and Log Rank test were used to compare survival curves. RESULTS: No statistically significant difference in survival curves was observed in Girona for the data obtained before and after cross-matching with the NDI. However, there was a significant difference in Zaragoza. A comparison of the relative survival rates of each of the two registries before NDI cross-matching showed differences of 3.9 percent (5-year) and 16.1 percent (10-year) between the two, whereas after the cross-match, the difference was only 0.5 percent (5-year) and 1.2 percent (10-year). CONCLUSIONS: In Spain it is imperative that there be systematic use of NDI data to supplement cancer registries, so that comparisons of relative survival rates between registries can be improved.

OBJETIVO: Evaluar el efecto de utilizar los datos del Índice Nacional de Defunciones (IND) de España para estimar las tasas de supervivencia de cáncer de mama en las mujeres residentes en Girona y Zaragoza que recibieron el diagnóstico de cáncer de mama en 1995-1999. MÉTODOS: Se realizó un estudio epidemiológico observacional y longitudinal basado en el empleo de los registros de cáncer de mujeres residentes en Girona y Zaragoza que habían recibido el diagnóstico de cáncer de mama en 1995-1999. Se estimaron las tasas de supervivencias observada y relativa a 5 años, primero según la información disponible en los registros de cáncer de Girona y Zaragoza y luego con la inclusión de los datos del IND. Se calcularon las tasas de supervivencia relativa a 5 años y sus correspondientes intervalos de confianza de 95 por ciento por el método de Hakulinen. Las curvas de supervivencia se compararon por el método de Kaplan-Maier y la prueba de rangos logarítmicos. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre las curvas de supervivencia de Girona antes y después de emparejar lo datos locales con los del IND; sin embargo, hubo diferencias significativas entre las curvas de Zaragoza. Al comparar las tasas de supervivencia relativa de cada uno de los registros antes de emparejarlos con los datos del IND se encontraron diferencias de 3,9 por ciento (a 5 años) y 16,1 por ciento (a 10 años), mientras que después del emparejamiento, la diferencia entre ellas fue solamente de 0,5 por ciento (a 5 años) y 1,2 por ciento (a 10 años). CONCLUSIONES: En España es imperativo el empleo sistemático de los datos del IND para complementar los registros de cáncer de manera de mejorar las comparaciones de las tasas de supervivencia relativa cuando se utilizan diferentes registros.

Métodos para la suavización de indicadores de mortalidad: aplicación al análisis de desigualdades en mortalidad en ciudades del Estado español (Proyecto MEDEA) / Methods to smooth mortality indicators: application to analysis of inequalities in mortality in Spanish cities [the MEDEA Project]

Aunque la experiencia en el estudio de las desigualdadesen la mortalidad en las ciudades españolas es amplia, quedangrandes núcleos urbanos que no han sido investigadosutilizando la sección censal como unidad de análisis territorial.En este contexto se sitúa el proyecto coordinado ®Desigualdadessocioeconómicas y medioambientales en la mortalidaden ciudades de España. Proyecto MEDEA», en el cualparticipan 10 grupos de investigadores de Andalucía, Aragón,Cataluña, Galicia, Madrid, Comunitat Valenciana y PaísVasco. Cabe señalar cuatro particularidades: a) se utiliza comoárea geográfica básica la sección censal; b) se emplean métodosestadísticos que tienen en cuenta la estructura geográficade la región de estudio para la estimación de riesgos; c) seaprovechan las oportunidades que ofrecen 3 fuentes de datoscomplementarias (información sobre contaminación atmosférica,información sobre contaminación industrial y registrosde mortalidad), y d) se emprende un análisis coordinado degran alcance, favorecido por la implantación de la redes temáticasde investigación. El objetivo de este trabajo es explicarlos métodos para la suavización de indicadores de mortalidaden el proyecto MEDEA. El artículo se centra en lametodología y los resultados del modelo de mapa de enfermedadesde Besag, York y Mollié (BYM). Aunque en el proyectose han suavizado, mediante el modelo BYM, las razonesde mortalidad estandarizadas (RME) correspondientesa 17 grandes grupos de causas de defunción y 28 causasespecíficas, aquí se aplica esta metodología a la mortalidadpor cáncer de tráquea, de bronquios y de pulmón en ambossexos en la ciudad de Barcelona durante el período 1996-2003(AU)

Como resultado se aprecia un diferente patrón geográfico enlas RME suavizadas en ambos sexos. En los hombres se observanunas RME mayores que la unidad en los barrios conmayor privación socioeconómica. En las mujeres este patrónse observa en las zonas con un mayor nivel socioeconómico(AU)

Although there is some experience in the study of mortalityinequalities in Spanish cities, there are large urban centersthat have not yet been investigated using the census tract asthe unit of territorial analysis. The coordinated project ®Socioeconomicand environmental inequalities in mortality in Spanishcities. The MEDEA project» was designed to fill this gap,with the participation of 10 groups of researchers in Andalusia,Aragon, Catalonia, Galicia, Madrid, Valencia, and the BasqueCountry. The MEDEA project has four distinguishing features:a) the census tract is used as the basic geographicalarea; b) statistical methods that include the geographical structureof the region under study are employed for risk estimation;c) data are drawn from three complementary data sources(information on air pollution, information on industrialpollution, and the records of mortality registrars), and d) a coordinated,large-scale analysis, favored by the implantation ofcoordinated research networks, is carried out. The main objective of the present study was to explain the methods for smoothingmortality indicators in the context of the MEDEA project.This study focusses on the methodology and the resultsof the Besag, York and Mollié model (BYM) in disease mapping.In the MEDEA project, standardized mortality ratios(SMR), corresponding to 17 large groups of causes of deathand 28 specific causes, were smoothed by means of the BYMmodel; however, in the present study this methodology wasapplied to mortality due to cancer of the trachea, bronchi andlung in men and women in the city of Barcelona from 1996 to2003. As a result of smoothing, a different geographical patternfor SMR in both genders was observed. In men, a SMRhigher than unity was found in highly deprived areas. In contrast,in women, this pattern was observed in more affluentareas(AU)

A vueltas con el aseguramiento sanitario privado / Apropos of private health insurance

No disponible

Análisis de conglomerados de cáncer. El caso del barrio de Campdorà, Girona / Cancer Cluster Analysis. the Case of the Campdorà District in Girona, Spain

Un conglomerado de casos puede definirse como la aparición deun número de casos de una enfermedad en una cantidad superior a laque se esperaría para un determinado grupo de población, un áreageográfica y un período de tiempo determinado. En el caso del cáncerel estudio de conglomerados presenta una serie de característicasespecíficas respecto a otras agrupaciones de enfermedades. El objetivode este trabajo es proponer un protocolo que permita desarrollarel estudio de conglomerados de cáncer en el tiempo y/o en el espacio.Ilustramos la nota con una aplicación práctica en el caso del barrio deCampdorà, Girona. Tras proponer un protocolo para el estudio deconglomerados, describimos varios instrumentos estadísticos quepermiten contrastar la existencia de agrupaciones temporales, asícomo el riesgo asociado. Durante el período considerado, 1994-2002, no pareció haber ocurrido de forma estadísticamente significativa,un exceso de casos de cáncer en el barrio de Campdorà de Girona

A conglomerate of cases may be defined as the onset of a numberof cases of a disease larger than would be expected for a certainpopulation group, geographical area or a certain timeframe. In thecase of cancer, the study of conglomerates entails a number of specificcharacteristics as compared to other groups of diseases. Thiswork is aimed at proposing a protocol affording the possibility ofconducting the study of cancer conglomerates in time and/or space.This article is illustrated with a practical application in the case ofthe Campdorà District in Girona. Following a proposed protocolfor the study of conglomerates, a description is provided of severalstatistical tools making it possible to draw a comparison among theexistence of time-related groupings, as well as the related risk.During the period studied (1994-2002), no excessive statisticallysignificant number of cancer cases seemed to have occurred inthe Campdorà District in Girona