Sex matters in the association between cardiovascular health and incident dementia: evidence from real world data.

BACKGROUND: Cardiovascular health has been associated with dementia onset, but little is known about the variation of such association by sex and age considering dementia subtypes. We assessed the role of sex and age in the association between cardiovascular risk and the onset of all-cause dementia, Alzheimer's disease, and vascular dementia in people aged 50-74 years. METHODS: This is a retrospective cohort study covering 922.973 Catalans who attended the primary care services of the Catalan Health Institute (Spain). Data were obtained from the System for the Development of Research in Primary Care (SIDIAP database). Exposure was the cardiovascular risk (CVR) at baseline categorized into four levels of Framingham-REGICOR score (FRS): low (FRS < 5%), low-intermediate (5% ≤ FRS < 7.5%), high-intermediate (7.5% ≤ FRS < 10%), high (FRS ≥ 10%), and one group with previous vascular disease. Cases of all-cause dementia and Alzheimer's disease were identified using validated algorithms, and cases of vascular dementia were identified by diagnostic codes. We fitted stratified Cox models using age parametrized as b-Spline. RESULTS: A total of 51,454 incident cases of all-cause dementia were recorded over a mean follow-up of 12.7 years. The hazard ratios in the low-intermediate and high FRS groups were 1.12 (95% confidence interval: 1.08-1.15) and 1.55 (1.50-1.60) for all-cause dementia; 1.07 (1.03-1.11) and 1.17 (1.11-1.24) for Alzheimer's disease; and 1.34 (1.21-1.50) and 1.90 (1.67-2.16) for vascular dementia. These associations were stronger in women and in midlife compared to later life in all dementia types. Women with a high Framingham-REGICOR score presented a similar risk of developing dementia - of any type - to women who had previous vascular disease, and at age 50-55, they showed three times higher risk of developing dementia risk compared to the lowest Framingham-REGICOR group. CONCLUSIONS: We found a dose‒response association between the Framingham-REGICOR score and the onset of all dementia types. Poor cardiovascular health in midlife increased the onset of all dementia types later in life, especially in women.

Axes of social inequities in COVID-19 clinical trials: A systematic review.

Objective: The representativeness of participants is crucial to ensure external validity of clinical trials. We focused on the randomized clinical trials which assessed COVID-19 vaccines to assess the reporting of age, sex, gender identity, race, ethnicity, obesity, sexual orientation, and socioeconomic status in the results (description of the participants' characteristics, loss of follow-up, stratification of efficacy and safety results). Methods: We searched the following databases for randomized clinical trials published before 1st February 2022: PubMed, Scopus, Web of Science, and Excerpta Medica. We included peer-reviewed articles written in English or Spanish. Four researchers used the Rayyan platform to filter citations, first reading the title and abstract, and then accessing the full text. Articles were excluded if both reviewers agreed, or if a third reviewer decided to discard them. Results: Sixty three articles were included, which assessed 20 different vaccines, mainly in phase 2 or 3. When describing the participants' characteristics, all the studies reported sex or gender, 73.0% race, ethnicity, 68.9% age groups, and 22.2% obesity. Only one article described the age of participants lost to follow-up. Efficacy results were stratified by age in 61.9%, sex or gender in 26.9%, race and/or, ethnicity in 9.5%, and obesity in 4.8% of the articles. Safety results were stratified by age in 41.0%, and by sex or gender in 7.9% of the analysis. Reporting of gender identity, sexual orientation or socioeconomic status of participants was rare. Parity was reached in 49.2% of the studies, and sex-specific outcomes were mentioned in 22.9% of the analysis, most of the latter were related to females' health. Conclusions: Axes of social inequity other than age and sex were hardly reported in randomized clinical trials that assessed COVID-19 vaccines. This undermines their representativeness and external validity and sustains health inequities.

Impact of residential greenness on myocardial infarction in the population with diabetes: A sex-dependent association?

Living in urban areas with abundant greenness might provide health benefits in general population. Literature suggests that sex/gender plays a role in the association between greenness and health outcomes. But the impact of greenness in populations with moderate to high cardiovascular risk, such as persons with diabetes, is still unknown. Our aim was to evaluate the relationship between urban greenness and myocardial infarction incidence in persons with type 2 diabetes in Barcelona (Catalonia, Spain), and seek potential gender/sex differences in this association. This retrospective cohort study is based on data from the System for the Development of Research in Primary Care (SIDIAP database). We used Cox models to estimate if a 0.01 increase in Normalized Difference Vegetation Index (NDVI) at census tract level was associated to reduced risk of developing a myocardial infarction. Models were adjusted by demographic and clinical characteristics at individual level, and by environmental and socioeconomic variables at census tract level. Amongst 41,463 persons with diabetes and 154,803.85 person-years of follow-up, we observed 449 incident cases of acute myocardial infarction. For each 0.01 increment in NDVI the risk of developing a myocardial infarction decreased by 6% (Hazard Ratio, HR = 0.94; 95%CI, 0.89-0.99) in the population with diabetes. When stratifying by sex, we observed a significant association only in men (HR = 0.91; 95%CI, 0.86-0.97). People with diabetes living in urban greener areas might benefit from reduced cardiovascular risk, specially men. We observed sex/gender disparities, which could be related to different exposures and activities performed in green spaces between men and women. Further studies are needed to confirm sex/gender disparities between greenness exposure and cardiovascular outcomes. Our findings contribute to improve the health of people with diabetes who should be recommended to spent time and exercise in green areas.

Validation Of Cancer Diagnoses In Electronic Health Records: Results From The Information System For Research In Primary Care (SIDIAP) In Northeast Spain.

BACKGROUND: Electronic health records are becoming an increasingly valuable resource for epidemiology but their data quality needs to be quantified. We aimed to validate twenty-five types of incident cancer cases in the Information System for Research in Primary Care (SIDIAP) in Catalonia with the population-based cancer registries of Girona and Tarragona as the gold-standard. METHODS: We calculated the sensitivity, positive predictive values (PPV), and the time-difference between the date of diagnosis entered into the SIDIAP and into the registries. We added hospital discharge cancer diagnoses to the SIDIAP to assess sensitivity changes. RESULTS: We identified 27,046 incident cancer diagnoses in the SIDIAP from 2009-2015 among the 949,841 residents of Girona and Tarragona. The cancer types with the highest sensitivity were breast (89%, 95% CI: 88-90%), colorectal (81%, 95% CI: 80-82%), and prostate (81%, 95% CI: 80-83%). Trachea, bronchus and lung cancers had the highest PPV (76%, 95% CI: 74%-78%) followed by stomach (72%, 95% CI: 68-75%) and pancreas (71%, 95% CI: 67-75%). Most cancer diagnoses were reported with less than three months of difference between the SIDIAP and the registries. More cases were registered first in the registries than in the SIDIAP. By adding cancer diagnoses based on hospital discharge data, sensitivity increased for all cancers, especially for gallbladder and biliary tract for which the sensitivity increased by 21%. CONCLUSION: The SIDIAP includes 76% of the cancer diagnoses in the cancer registries but includes a considerable number of cases that are not in the registries. The SIDIAP reports most of the cancer diagnoses within a three-month period difference from the date of diagnosis in the cancer registries. Our results support the use of the SIDIAP cancer diagnoses for epidemiological research when cancer is the outcome of interest. We recommend adding hospital discharge data to the SIDIAP to increase data quality, particularly for less frequent cancer types.

Air Pollution, Noise, Blue Space, and Green Space and Premature Mortality in Barcelona: A Mega Cohort.

Introduction: Cities often experience high air pollution and noise levels and lack of natural outdoor environments, which may be detrimental to health. The aim of this study was to evaluate the effects of air pollution, noise, and blue and green space on premature all-cause mortality in Barcelona using a mega cohort approach. Methods: Both men and women of 18 years and above registered on 1 January 2010 by the Sistema d'Informació pel Desenvolupament de la Investigació en Atenció Primària (SIDIAP) and living in the city of Barcelona were included in the cohort and followed up until 31 December 2014 or until death (n = 2,939,067 person years). The exposure assessment was conducted at the census tract level (n = 1061). We assigned exposure to long term ambient levels of nitrogen dioxides (NO2), nitrogen oxides (NOx), particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5), between 2.5 µm and 10 µm (PM2.5⁻10, i.e., coarse particulate matter), less than 10 µm (PM10) and PM2.5 light absorption (hereafter referred to as PM2.5 absorbance) based on land use regressions models. Normalized Difference Vegetation Index (NDVI) was assigned based on remote sensing data, percentage green space and blue space were calculated based on land use maps and modelled road traffic noise was available through the strategic noise map for Barcelona. Results: In this large prospective study (n = 792,649) in an urban area, we found a decreased risk of all-cause mortality with an increase in green space measured as NDVI (hazard ratio (HR) = 0.92, 95% CI 0.89⁻0.97 per 0.1) and increased risks of mortality with an increase in exposure to blue space (HR = 1.04, 95% CI 1.01⁻1.06 per 1%), NO2 (HR = 1.01, 95% CI 1.00⁻1.02 per 5 ug/m³) but no risk with noise (HR = 1.00, 95% CI 0.98⁻1.02 per 5 dB(A)). The increased risks appeared to be more pronounced in the more deprived areas. Results for NDVI, and to a lesser extent NO2, remained most consistent after mutual adjustment for other exposures. The NDVI estimate was a little attenuated when NO2 was included in the model. The study had some limitations including e.g., the assessment of air pollution, noise, green space and socioeconomic status (SES) on census tract level rather than individual level and residual confounding. Conclusion: This large study provides new insights on the relationship between green and blue space, noise and air pollution and premature all-cause mortality.

Asociación de los factores de riesgo cardiovascular y estilos de vida clásicos con el índice vascular corazón-tobillo en población general mediterránea / Association of classic cardiovascular risk factors and lifestyles with the cardio-ankle vascular index in a general mediterranean population

Introducción y objetivos: El índice vascular corazón-tobillo (CAVI) evalúa la rigidez arterial. El objetivo es describir la distribución del CAVI en una población mediterránea, determinar la proporción de CAVI ≥ 9 según las categorías de riesgo coronario, y evaluar la asociación del CAVI con los factores de riesgo cardiovascular y estilos de vida clásicos. Métodos: Estudio transversal en la provincia de Girona. El CAVI se ha medido utilizando el VaSera VS-1500. Resultados: Se incluyó a 2.613 individuos. La prevalencia de CAVI ≥ 9 fue del 46,8% en varones y el 36,0% en mujeres y aumentó significativamente con el riesgo coronario: del 21,1 y el 24,8%, respectivamente, en el grupo con bajo riesgo al 76,7 y el 61,9% en el de alto riesgo. El CAVI aumentó con la edad en ambos sexos y resultó superior en varones. En estos, el CAVI ≥ 9 se asoció con hipertensión (OR = 2,70; IC95%, 1,90-3,87), diabetes (OR = 2,38; IC95%, 1,52-3,78), índice de masa corporal (IMC) ≤ 25 a < 30 (OR = 0,44; IC95%, 0,27-0,72), IMC ≥ 30 (OR = 0,28; IC95%, 0,14-0,58) y actividad física (OR = 0,66; IC95%, 0,47-0,92). En mujeres, se asoció con hipertensión (OR = 2,22; IC95%, 1,59-3,09), hipercolesterolemia (OR = 1,40; IC95%, 1,01-1,94) e IMC ≥ 30 (OR = 0,38; IC95%, 0,20-0,71). Conclusiones: El CAVI aumenta con la edad y es mayor en varones que en mujeres, y se asocia con factores de riesgo clásicos y con el riesgo coronario. Podría ser un buen biomarcador predictivo, aunque hacen falta estudios que evalúen su relevancia en la estratificación del riesgo cardiovascular

Introduction and objectives: The cardio-ankle vascular index (CAVI) assesses arterial stiffness. We aimed to describe the distribution of CAVI in a Mediterranean population, to determine the proportion of CAVI ≥ 9 by sex and coronary risk level, and to assess the association of CAVI with classic cardiovascular risk factors and lifestyle patterns. Methods: This cross-sectional study was based on the population of Girona province. The CAVI was measured using the VaSera VS-1500. Results: Of 2613 individuals included in this study, the prevalence of CAVI ≥ 9 was 46.8% in men and 36.0% in women and significantly increased with coronary risk: from 21.1% and 24.8%, respectively to 76.7%, in the low-risk group, and 61.9% in the high-risk group. The CAVI increased with age in both sexes, being higher in men across all age groups. In men, CAVI ≥ 9 was associated with hypertension (OR, 2.70; 95%CI, 1.90-3.87) and diabetes (OR, 2.38; 95%CI, 1.52-3.78), body mass index (BMI) ≤ 25 to < 30 (OR, 0.44; 95%CI, 0.27-0.72) and BMI ≥ 30 (OR, 0.28; 95%CI, 0.14-0.58), and physical activity (OR, 0.66; 95%CI, 0.47-0.92). In women, CAVI ≥ 9 was associated with hypertension (OR, 2.22; 95%CI, 1.59-3.09), hypercholesterolemia (OR, 1.40; 95%CI, 1.01-1.94), and BMI ≥ 30 (OR, 0.38; 95%CI, 0.20-0.71). Conclusions: The CAVI increases with age and is higher in men than in women. This index is associated with classic risk factors and coronary risk. It could be a good predictive biomarker, but further follow-up studies are required to assess its added value to cardiovascular risk stratification

Association of Classic Cardiovascular Risk Factors and Lifestyles With the Cardio-ankle Vascular Index in a General Mediterranean Population.

INTRODUCTION AND OBJECTIVES: The cardio-ankle vascular index (CAVI) assesses arterial stiffness. We aimed to describe the distribution of CAVI in a Mediterranean population, to determine the proportion of CAVI ≥ 9 by sex and coronary risk level, and to assess the association of CAVI with classic cardiovascular risk factors and lifestyle patterns. METHODS: This cross-sectional study was based on the population of Girona province. The CAVI was measured using the VaSera VS-1500. RESULTS: Of 2613 individuals included in this study, the prevalence of CAVI ≥ 9 was 46.8% in men and 36.0% in women and significantly increased with coronary risk: from 21.1% and 24.8%, respectively to 76.7%, in the low-risk group, and 61.9% in the high-risk group. The CAVI increased with age in both sexes, being higher in men across all age groups. In men, CAVI ≥ 9 was associated with hypertension (OR, 2.70; 95%CI, 1.90-3.87) and diabetes (OR, 2.38; 95%CI, 1.52-3.78), body mass index (BMI) ≤ 25 to < 30 (OR, 0.44; 95%CI, 0.27-0.72) and BMI ≥ 30 (OR, 0.28; 95%CI, 0.14-0.58), and physical activity (OR, 0.66; 95%CI, 0.47-0.92). In women, CAVI ≥ 9 was associated with hypertension (OR, 2.22; 95%CI, 1.59-3.09), hypercholesterolemia (OR, 1.40; 95%CI, 1.01-1.94), and BMI ≥ 30 (OR, 0.38; 95%CI, 0.20-0.71). CONCLUSIONS: The CAVI increases with age and is higher in men than in women. This index is associated with classic risk factors and coronary risk. It could be a good predictive biomarker, but further follow-up studies are required to assess its added value to cardiovascular risk stratification.

Differences in cardio-ankle vascular index in a general Mediterranean population depending on the presence or absence of metabolic cardiovascular risk factors.

BACKGROUND AND AIMS: The main aim of this study is to describe the differences in the cardio-ankle vascular index (CAVI) in individuals with metabolic cardiovascular risk factors or a previous history of vascular diseases (WCVRF) compared to healthy individuals (free of risk factors and previous history of vascular diseases; FCVRF) in a general Mediterranean population. The secondary aim is to describe the proportion of CAVI≥9 depending on the cardiovascular risk category in both CVRF groups by sex. METHODS: The study is a descriptive analysis of 2613 participants randomly selected in the Girona province (Catalonia, Spain). RESULTS: CAVI mean differences between sexes and age categories in both CVRF groups followed the same pattern, the FCVRF group (men 25.2%; women 14.4%) in turn had a lower prevalence of CAVI≥9 than the WCVRF group (men 57.9%; women 51.8%). The percentage of men and women with CAVI≥9 with low risk was 13.9% and 11.3% in the FCVRF group, and 31.8% and 42.0% in the WCVRF group; with moderate risk, it was 55.8% and 10.0% in the FCVRF group and 60.3% and 49.0% in the WCVRF group. CONCLUSIONS: In both sexes, FCVRF groups had a lower prevalence of CAVI≥9 as well as lower mean CAVI scores, across all 10 year-age categories from 40 to 69 years, than WCVRF groups. Moreover, CAVI≥9 was frequent in individuals with low and moderate coronary risk in the WCVRF group but also in the FCVRF group. These results suggest that CAVI assessment to detect asymptomatic arteriosclerosis could be a useful tool to improve cardiovascular risk stratification.

Reducing health inequities affecting immigrant women: a qualitative study of their available assets.

BACKGROUND: Immigrant women often experience health inequities, whether for reasons of gender, country of origin, or socioeconomic status. The view of immigrant women has always focussed on their needs, without taking into account their available assets. A salutogenic approach incorporating an assets analysis could provide a new perspective on the design of health promotion interventions to reduce health inequities. The study objective was to identify the assets of this group of women as a necessary first step in changing the paradigm used in such health promotion interventions. METHODS: This qualitative study combined focus groups, in-depth interviews, and a photovoice session. The aim was to describe the assets of this group, based on Antonovsky's salutogenic approach and assets model. Qualitative results were interpreted with a phenomenological focus, identifying each individual's internal, community, and institutional assets. RESULTS: The self awareness of skills was linked to a person's description of herself as being optimistic, having religious beliefs, and having motivations and objectives in life, for herself, her family or her children. Being motivated helped the women to persist in doing or learning things that could be useful in confronting difficult situations. Another selfawareness skill was feeling useful to others, whether this was due to religious beliefs about their role in life or to the importance of the mutual support of interpersonal relationships. CONCLUSIONS: High optimism, strong capacity for struggle and self-initiative, the importance of religious beliefs, social support, and concern for their children's future were described as assets of immigrant women. Identification of these assets allows us to develop more in-depth knowledge and better tools for health promotion programs and policies intended to reduce health inequities in this population of immigrant women.

La enfermedad de Alzheimer y otras demencias en el Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP) / Alzheimer's disease and other dementias in the InformationSystem for Primary Care Research Development (SIDIAP)

La informatización de la historia clínica en el ámbito de la Atención Primaria proporciona un gran potencial para la investigación, particularmente en estudios de prevalencia e incidencia, en estudios de evaluación de servicios de salud y en estudios de farmacoepidemiología. El Institut Català de la Salut y el IDIAP Jordi Gol crearon SIDIAP en el año 2010. Esta base de datos contiene la información clínica registrada por profesionales de atención primaria de la salud (médicos y enfermeras) y personal administrativo de los registros médicos electrónicos, incluyendo las características sociodemográficas, la morbilidad (Clasificación Inter - nacional de Enfermedades, CIE-10), variables clínicas y de estilos de vida, pruebas de laboratorio y tratamientos (prescripciones médicas, medicamentos dispensados en la farmacia), y también información de las altas hospitalarias. La base de datos contiene esta información de cerca de cinco millones de personas, lo que representa aproximadamente el 80 % de la población total mayor de 15 años de edad de Cataluña. Las bases de datos de atención primaria como SIDIAP presentan unas claras ventajas en relación con otras fuentes de información: contienen grandes muestras, permiten seguimientos de larga duración, tienen bajo coste, permiten relación con múltiples fuentes de información, no interfieren en la práctica clínica, y aportan representatividad de la práctica real. La demencia de Alzheimer (DA) es un claro ejemplo de patología para la que la información adicional que pueden proporcionar estudios realizados en la base de datos SIDIAP puede ser de gran utilidad. SIDIAP permite diseñar estudios transversales para el análisis de patrones de tratamientos o comorbilidades asociadas a las demencias; estudios de cohortes con largos períodos de seguimiento o estudios de caso y control para evaluar factores de riesgo asociados a la aparición de las distintas demencias y estudios de efectividad de los tratamientos y las intervenciones preventivas (AU)

Computerized databases of primary care clinical records are widely used for epidemiological research, particularly in studies of disease prevalence and incidence, studies of health services and in pharmacoepidemiological research. The Information System for the Development of Research in Primary Care (SIDIAP) was created in 2010 by the Catalan Institute of Health (ICS) and the Jordi Gol Primary Care Research Institute (IDIAP Jordi Gol). SIDIAP comprises clinical information recorded by primary care health professionals (GPs and nurses) and administrative staff in electronic medical records, including sociodemographic characteristics, morbidity (International Classification of Diseases, ICD-10), clinical and lifestyle variables, laboratory tests and treatments (drug prescriptions, drugs purchased at the community pharmacy) and also hospital discharge information. The database contains this information for almost five million people, representing approximately 80% of the total population aged over 15 years old in Catalonia (north-east Spain). The fact that these databases can provide large sample sizes at a comparatively low cost and that they permit long follow-up periods without directly requiring the participation of the subjects, whilst minimizing biases such as the Healthy Worker and the Hawthorne effects, has made them especially interesting for public health research. Alzheimer's dementia is a clear example of pathology in which the information provided by SIDIAP can be very useful for research purposes. SIDIAP allows cross-sectional studies for the analysis of treatment patterns or co-morbidities associated with dementia; cohort studies with long follow- up periods or case-control study to evaluate risk factors associated with the onset of various dementias and also permit studies of effectiveness of treatments and preventive interventions (AU)

Programa para facilitar la detección precoz de trastornos mentales graves en el medio escolar: lecciones aprendidas de una experiencia piloto / A program to provide early detection of mental disorders in school setting: learning from a pilot project

Los síntomas prodrómicos del trastorno mental grave debutan en la adolescencia y la juventud. La adolescencia es una etapa clave en el desarrollo biopsicosocial del individuo. La posibilidad de la detección y abordaje precoz del Trastorno Mental Grave (TGM) y la identificación de Estados Mentales de Alto Riesgo (EMAR), podría disminuir el impacto de la enfermedad en el desarrollo psicosocial del adolescente. Una importante limitación en la intervención precoz de adolescentes y jóvenes con TMG es que entre los Institutos de Educación Superior (IES) y los Centros de Salud Mental (CSM) no existe una vía directa, rápida y efectiva de derivación. Nuestro objetivo fue evaluar un programa específico de formación para la detección de EMAR y TMG en 7 Institutos de Educación Superior de Alcalá de Henares. Se utilizaron cuestionarios para evaluar el nivel de conocimientos del personal docente antes y después de realizar talleres formativos diseñados por profesionales de salud mental. Los profesionales de los IES tienen un nivel de conocimiento adecuado sobre la psicosis. La disposición de un sistema de derivación rápido, directo y efectivo entre los IES y los CSM favorece la detección de TMG. A pesar de los conocimientos del profesorado acerca de la psicosis, existen dificultades en la detección de EMAR. No impresiona la tendencia al estigma entre el personal docente, sin embargo el estigma social, familiar e individual dificultan las estrategias de intervención (AU)

The early symptoms of severe mental disorders appear in adolescence and youth. Adolescence is a critical time for the biopsychosocial development of an individual. The possibility of early detection of mental disorders and the identification of individuals at high risk of psychosis, could lessen the impact of the disease on the psychosocial development of adolescents. A major limitation of early intervention in adolescents and young adults with a severe mental disorder is that there are no direct referral pathways between colleges and Mental Health Network. Our main goal was to evaluate a specific training program for detection of individuals at high risk of psychosis and severe mental disorders in 7 colleges of Alcala de Henares. The questionnaires designed for mental health professionals were used to assess the level of knowledge of teachers before and after training workshops. Higher education teachers have adequate knowledge about psychosis. The provision of a bypass system, fast and direct, between colleges and community mental health centers facilitates the detection of severe mental disorders. Although teacher knowledge about psychosis, there are difficulties in detecting individuals at high risk of psychosis. The data obtained suggest that teachers have little or no stigma, however, social stigma, family stigma and personal stigma, limited early intervention strategies (AU)

Estudio comparativo de supervivencias entre la actual y la antigua clasificación del carcinoma broncogénico / Comparative survival study between the old and new bronchogenic carcinoma classification

La nueva clasificación del carcinoma broncogénico ha sido realizada por la Association for the Study of Lung Cancer (IASLC) y publicada por Frank C. Detterbeck et al en la revista Chest (2009). En el Servicio de Cirugía Torácica del Hospital Universitario de Gerona se ha re-estadificado la serie quirúrgica de pacientes intervenidos de carcinoma broncogénico con intención curativa con el objetivo de comparar la supervivencia (supervivencia por T, supervivencia por M y supervivencia por estadios patológicos) entre la antigua y la actual clasificación y además objetivar si estos cambios de supervivencia son estadísticamente significativos. Otro de los objetivos del trabajo es el de establecer la concordancia entre la supervivencia actual de nuestra serie quirúrgica y la publicada por la IASLC. Pacientes y métodos Se introdujeron en una base de datos 855 pacientes intervenidos con intención curativa de carcinoma broncogénico. Fueron estadificados radiológica, clínica y patológicamente según la antigua y la nueva estadificación. Se calculó la supervivencia según la T, la N, la M y los estadios patológicos. Se realizó un estudio estadístico con el programa SPSS, con el que se analizaron los cambios de supervivencia entre ambas clasificaciones. Resultados Se objetivaron cambios de supervivencia no estadísticamente significativos (p=0,58) con la nueva estadificación en el estadio IIA y cambios de supervivencia estadísticamente significativos (p=0,001) en el estadio IIIB. Discusión El estudio confirma que la actual clasificación TNM es útil ya que muestra cambios de supervivencia en 2 estadios patológicos (uno de ellos estadísticamente significativo). Actualmente, los datos de supervivencia de nuestra serie se adecuan mejor a los que aporta la IASLC(AU)

Introduction: A new classification of bronchogenic carcinoma has been made by the International Association for the Study of Lung Cancer (IASLC) and published by Frank C.Detterbeck et al in the journal Chest (2009). The Thoracic Surgery Department of the Gerona(Spain) University Hospital has re-staged a series of patients with bronchogenic carcinoma who had attempted curative surgery, with the aim of comparing the survival (survival for T, survival for M, and survival by disease staging) between the old and new classification, and also to determine whether these changes in survival are statistically significant. Anotherone of the objectives of the study is to see whether there is agreement between the currentsurvival of our surgical series and that published by the IASLC. Patients and methods: Data on 855 patients who had attempted bronchogenic carcinomacurative surgery were entered into a data base. They were radiologically, clinically and histologically staged according to the new and old staging. Survival was calculated according to the T, M, N, and histology stages. A statistical analysis was performed using the SPSS program and the changes in survival between both classifications were analysed. Results: No statistically significant changes were observed in survival (P = .58) with the new classification in stage IIA, but there were statistically significant changes in survival(P = .0001) in stage IIIB. Discussion: The study confirms that the current TNM classification is useful, since it shows changes in survival in 2 histological stages (one of them statistically significant). The survival data of our series now fits better with those provided by the IASLC (AU)

[Comparative survival study between the old and new bronchogenic carcinoma classification]. / Estudio comparativo de supervivencias entre la actual y la antigua clasificación del carcinoma broncogénico.

INTRODUCTION: A new classification of bronchogenic carcinoma has been made by the International Association for the Study of Lung Cancer (IASLC) and published by Frank C. Detterbeck et al in the journal Chest (2009). The Thoracic Surgery Department of the Gerona (Spain) University Hospital has re-staged a series of patients with bronchogenic carcinoma who had attempted curative surgery, with the aim of comparing the survival (survival for T, survival for M, and survival by disease staging) between the old and new classification, and also to determine whether these changes in survival are statistically significant. Another one of the objectives of the study is to see whether there is agreement between the current survival of our surgical series and that published by the IASLC. PATIENTS AND METHODS: Data on 855 patients who had attempted bronchogenic carcinoma curative surgery were entered into a data base. They were radiologically, clinically and histologically staged according to the new and old staging. Survival was calculated according to the T, M, N, and histology stages. A statistical analysis was performed using the SPSS program and the changes in survival between both classifications were analysed. RESULTS: No statistically significant changes were observed in survival (P=.58) with the new classification in stage IIA, but there were statistically significant changes in survival (P=.0001) in stage IIIB. DISCUSSION: The study confirms that the current TNM classification is useful, since it shows changes in survival in 2 histological stages (one of them statistically significant). The survival data of our series now fits better with those provided by the IASLC.

Continuity of care and monitoring pain after discharge: patient perspective.

AIM: This paper is a report of a study conducted to evaluate, from the patients' perspective, a Liaison and Continuity of Care Programme coordinating care provision between a hospital and primary care centres. BACKGROUND: Promoting continuity of care between hospitals and primary care improves quality of care, patient satisfaction and decreases further hospitalizations. However, inadequate pain management is common after discharge. METHOD: A sample of patients from the Liaison and Continuity of Care Programme were included in a longitudinal study in 2007. We conducted standardized telephone interviews at 24 hours, 7 days, 1 and 3 months after discharge. Outcome measures included readmission, time between hospital discharge and readmission, information level at discharge, patient satisfaction, queries about care and information related to perceived state of health and pain. RESULTS: Eighty-three adult patients (average age 69.3, 50.6% males) who needed continued care at discharge were followed. Ten participants died during follow-up, and seven required readmission. A total of 49.4% of patients stated that they had understood the information given at discharge very well or perfectly. At 24 hours after discharge, 30% already had doubts about their state of health and the management of their condition. In relation to perceived health, only 25.3% stated that this was good or very good. Prevalence of pain 24-hours after discharge was 58.3% in surgical patients and 17.1% in other patients. CONCLUSION: The preparation and education of patients and family members should be improved before discharge, and appropriate written information must be given, especially if a patient has pain or requires complex care.

Reparación laparoscópica de las úlceras pépticas perforadas. Experiencia en la provincia de Girona durante el año 2002 / Laparoscopic repair of perforated peptic ulcers. Experience in the province of Girona (Spain) in 2002

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Intestinal parasites in children, in highly deprived areas in the border region of Chiapas, Mexico.

OBJECTIVE: To assess the prevalence of intestinal parasitic infections among children in highly deprived areas, and its possible association with demographic and socioeconomic indicators. MATERIAL AND METHODS: From March to September 1998 in a convenience sample of 32 communities of the border region of Chiapas, Mexico, selected at random based on the level of poverty and distance from the community to the nearest health care unit (< 1 hour; 1 hour or more), one of every four households with children under 15 years of age was randomly selected to provide three stool samples from their children (n 1478). Bivariate and multivariate (generalized linear models for correlated binary data), analysis were performed. RESULTS: The global prevalence of intestinal parasitosis was 67% (95% confidence interval [CI] 64-70%). Sixty percent had multiple parasites. The prevalence of Entamoeba histolytica/E dispar was 51.2%, that of Giardia lamblia 18.3%, and that of Ascaris lumbricoides 14.5%. Multivariate analysis showed that age and speaking an indigenous language were significantly associated with the presence of E histolytical E dispar and Giardia lamblia. Source of water and lacking a refrigerator and electricity were associated with the presence of Ascaris lumbricoides. CONCLUSIONS: Measures should be taken to improve water quality, sewage disposal, and domestic hygiene. Furthermore, health programs should be established to promote breast-feeding, and education policies aimed at reinforcing the use of indigenous languages by physicians in the health services.

Intestinal parasites in children, in highly deprived areas in the border region of Chiapas, Mexico

OBJETIVO: Estimar la prevalencia de parasitosis intestinal en niños de zonas de alta marginación y su asociación con indicadores demográficos y socioeconómicos de interés. MATERIAL Y MÉTODOS: En una muestra de 1478 menores de edad, de entre 1 a 14 años, provenientes de 32 comunidades de la región fronteriza de Chiapas, México, de marzo a septiembre de 1998, se recolectaron tres muestras de heces fecales, seleccionadas aleatoriamente a partir del grado de marginación (alto y muy alto) del municipio al que pertenecen, y distancia de la unidad de salud más cercana a la comunidad (<1 hora; 1 hora o más). En una de cada cuatro viviendas con niños menores de 15 años de edad, seleccionadas aleatoriamente, se obtuvieron tres muestras de heces fecales de éstos. Se efectuaron análisis bivariados con la prueba de ji cuadrada y multivariados con modelos lineales generalizados. RESULTADOS: La prevalencia global de parasitosis fue de 67 por ciento (intervalo de confianza IC 95 por ciento 64-70 por ciento). Sesenta por ciento de los niños estaban multiparasitados. La prevalencia de Entamoeba histolytica/E dispar fue de 51.2 por ciento, de Giardia lamblia, 18.3 por ciento y de Ascaris lumbricoides, 14.5 por ciento. La mayor prevalencia de E histolytica/E dispar se asoció con la edad y hablar algún idioma indígena; la de Ascaris lumbricoides con el sitio de obtención de agua y la carencia de refrigerador y electricidad. CONCLUSIONES: Es necesario hacer intervenciones locales de salud (calidad del agua, sistemas de desagüe), programas de educación sanitaria (promoción de la lactancia materna y medidas higiénicas) y promoción del habla de idiomas indígenas entre los médicos de la región

Bienestar social y servicios de salud en la Región Frayseca de Chiapas: el uso de servicios de atención prenatal / Social welfare and health services in the Fraylesca Region in Chiapas: The use of antenatal care services

Objetivo. Analizar el uso de servicios de atención prenatal (AP) en la región Fraylesca de Chiapas, México, e identificar grupos con menor probabilidad de recibir AP. Material y métodos. En 1994 se realizó una encuesta en una muestra aleatoria de 1100 viviendas en la que se recopiló información sociodemográfica y sobre AP del último embarazo ocurrido en los dos años previos al estudio (n=297 mujeres de 15 a 49 años). La identificación de grupos con menor probabilidad de recibir AP adecuada (cinco o más consultas) se realizó mediante un modelo log-lineal. Resultados. Cuarenta y dos por ciento de las mujeres recibió AP inadecuada (0 a 4 consultas). Las mujeres en "mejor situación socioeconómica" fueron las de mayor probabilidad de recibir AP adecuada: RM 2.47 (IC 95 por ciento 1.12 - 5.44), respecto a las mujeres ubicadas en "peor condición socioeconómica". Conclusiones. Es menester aumentar la calidad de la atención de los servicios, apoyar la labor de las parteras y mejorar las condiciones socioeconómicas de la población

Objective. To analyze the use of antenatal care services (ACS) in the Fraylesca Region of Chiapas, Mexico, and to identify groups with lower probability of receiving ACS. Material and methods. In 1994, a health survey was performed on a random sample of 1 100 households, which compiled sociodemographic information and on the use of ACS during the last pregnancy within the two years previous to the study (n= 297 women from 15 to 49 years of age). The groups with lower probability of receiving adequate ACS (5 or more visits) were identified with a log-linear model. Results. Forty-two percent of women received inadequate ACS (0 to 4 visits). Women with better socioeconomic status had higher probability of using ACS adequately than women with lower socioeconomic status: OR 2.47 (CI 95% 1.12-5.44). Conclusions. Results provide evidence of the need to improve the quality of ACS, to support the traditional midwives and to improve living conditions of the population.