[Geographic distribution of avoidable mortality in the community of Valencia (1975-1990)]. / Distribución geográfica de la mortalidad evitable en la Comunidad Valenciana (1975-1990).

BACKGROUND: Avoidable mortality (AM) has been proposed as the indicator of the quality and the efficacy of health care services and a parameter useful to distribute health care resources. The aim of this study was to analyze the size and geographic variability of AM in the Community of Valencia, Spain (1975-1990). METHODS: The causes of AM were analyzed by the classification of Holland divided into indicators of medical care (IMC) and indicators on national health care policy (INHCP) in addition to the causes of the Charlton classification. Standard rates for Spain and the European Community, the rate of masculinity and contribution to total mortality were calculated. Geographic distribution by areas and provinces was analyzed by the rate of standardized mortality. RESULTS: According to the Holland classification AM was 30% of the deaths from 5 to 64 years of age. Out of these cases, 18.5% corresponded to INHCP and 11.1% to IMC. According to the Charlton classification, this percentage was 3.6%. A considerable variation was observed among the 20 areas analyzed due to many causes. The geographic distribution by groups (IMC, INHCP and the Charlton classification) is quite homogeneous. The worse results corresponded to the city of Valencia and to the area 21 (area of the city of Alicante). CONCLUSIONS: A great variation was found in the results regarding geographic distribution for individual causes of death while the distribution was quite homogeneous for all of the groups of mortality with the worst results being observed in large urban centers.

[The trends in cancer mortality, especially lung cancer, in Spain compared with other developed countries]. / Tendencias de la mortalidad por cáncer en España, en especial del cáncer de pulmón, en comparación con otros países desarrollados.

In this paper we study the general mortality trends by cancer in Spain (1951-1987), and also by sex and age groups. We focus on lung cancer, establishing comparisons with USA, England and Wales. We appreciate on the general mortality trend that only young age groups show a higher decrease, while in other countries this decrease was also in old age groups. We observed a lower mortality trend in Spain by lung cancer than in the other countries, however increasing the rates in both sexes and more in males. That evolution could be related with the evolution of cancer risk factors and especially lung cancer. On concluded that the general mortality trend in Spain is the same than other developed countries but with some delay in the evolution, when comparing lung cancer. Spain is now in an increasing phase and USA, England and Wales have stabilized their rates and begin to decrease their trends.

[Vasectomy and prostatic cancer]. / Vasectomía y cáncer de próstata.

Considering the growing of vasectomy worldwide, its likely association with several conditions, mainly prostate cancer, has been studied in recent years with sometimes contradictory results. In the light of recent epidemiological studies, it appears that the increased risk derived from a previous vasectomy is limited, and it is influenced by whether the operation is performed during puberty and with a long "latency period". It is acknowledged that there is no scientifically proven reasons to appraise the current methods, although there is some insistence on the need to carry out analytical studies, most specially in developmental areas.

[Nutritional factors and geographic differences in pancreatic cancer mortality in Spain]. / Factores alimentarios y diferencias geogräficas de la mortalidad por cáncer de páncreas en España.

BACKGROUND: The relationship between diet and cancer of the pancreas was assessed in a ecological study by calculating the intakes of foods and nutrients in the different Spanish provinces, during the period 1964-65, and relating these to the provincial pattern of death from pancreatic cancer 20 years after (1984-86). METHODS: The geographical pattern of mortality was evaluated by calculating the Standardized Mortality Ratios (SMR) for each province. Intake of foods was obtained from the National Institute of Statistics. Nutrients intakes were calculated from these consumption figures, by reference to tables of food composition. Simple and multiple linear regression studies with these variables were carried out. RESULTS: Regression coefficients obtained with foods and nutrients in the univariate analyses were in general low. In the separate multivariate models, consumption of milk and cheese were constantly positively correlated with pancreatic cancer mortality rates in males. For females, consumption of eggs was positively associated, and fruit consumption was negatively correlated. Analyses of nutrient intake adjusted for total energy showed that proteins were the most strongly correlated of the variables considered in both sexes. Animal fat, cholesterol and saturated fat were statistically significant positively correlated with pancreatic cancer mortality. CONCLUSIONS: The results obtained are consistent with the hypothesis that diet can play a role in the etiology of the cancer of the pancreas. Further studies are needed to obtain empirical evidence for (or against) the associations found.

[Survey of satisfaction among health center users]. / Encuesta de satisfacción a los usuarios de un centro de salud.

OBJECTIVES: To find out the satisfaction's level of the Nazaret (Valencia) Health Center's users; To detect the deficiencies in the areas under study; To find out whether or not there are differences with previous studies in primary care. DESIGN: Transversal study, results evaluation with no equivalent control group. SETTING: (site). Primary health care. Neighborhood of Valencia with 6749 people. With a regressive Sundbarg index, and the 42.6% of the population that are older than nine years are illiterate or with incomplete primary education, the income level index by neighborhood in 1986 is -5.6 (range: 13.4; -8.1). TARGET POPULATION: all the Nazaret Health Center users. The inclusion criteria were: 1. Eighteen years old (or older) users. 2. That had contacted previously for whatever reason (administrative or sanitary) with the health center at least in one occasion during the prior 6 months. The random sample was selected for a 5% maximum error, a 95.5% confidence level, and a p < or = 30% for the negative answers from the scale, its size was 323 patients, with a 20% increase for forecasted no cooperation/no answers (n = 388). INTERVENTION AND RESULTS: The average age of the interviewed was 42 years. The total adding score was 98.1 (theoretical range: 27-135). The score by areas (theoretical range 9-45) was: personal quality area 35.5 professional competence 32.4 and the relationship cost-comfort 30.5. A total (overall) satisfaction item had an average of 7.2 on a 1 to 10 scale, with P10 = 5, P50 = 7, P90 = 10. The analysis of variance shows that satisfaction increases with age, with the attachment to the same doctor, with feminine sex, with unemployment and, with low educational level, being more critic the young people and the people with educational level (not significative difference). CONCLUSION: We consider that users have a good degree of satisfaction, that the ratio cost-comfort should be improved, there is a significative improvement compared with previous studies done with the former primary health care model.

Testing a new health indicator: using avoidable causes of death and life expectancy for Spain between 1975-1986.

The concept of avoidable cause of death serves as the basis for measuring the quality and diversity of a health care system. In this study the authors propose a new way to use this kind of mortality by combining with the concept of life expectancy to obtain what they call "life expectancy free of avoidable mortality" (LEFAM). This indicator was 76.9 in 1986 in Spain while life expectancy was 75.83. If these deaths were avoidable there would be a gain of 1.09 years per person born. There is an important difference between the would-be male gain of 1.76 years and the would-be female gain of 0.6. In the ecological study, LEFAM would better explain the year to year changes of the resources in the health sector, measured in terms of the human resources (R = 0.96), the hospital beds per thousand persons (R = -0.86), and would also increase the relation with other health indicators such as infant mortality rate (R = 0.98) and mortality rate (R = 0.59) as compared with life expectancy alone.

Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968-1986.

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional "Mediterranean diet", with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years. It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.

Job absenteeism and arterial hypertension: results of a hypertension control program.

This study reports the findings of one of the stages of a programme for the detection and control of arterial hypertension, started in 1980 in an automobile company with a workforce of 9,782. In the initial screening, 522 hypertensive males were found using epidemiological criteria and 206 of these fulfilled the criteria of definite hypertension. The objective of this study consisted of evaluating, 9 years after the start of the program, the indirect cost in terms of the reduction in the morbidity indicator-temporary work incapacity (TWI). Analysis is based on a comparison of the prevalence of hypertension in the population when the program was begun (6%) and in 1989 (9.8%). It can be observed that the TWI rate of the hypertensive population was significantly higher than that of the rest of the workforce, and that this remained true for the reference group (RG) hypertensives a year after the study was initiated. In contrast, the intervention group (IG) showed significantly lower TWI levels, not only in comparison with the RG but also with the rest of the workers. The estimated reduction in TWI for 1989 was 4.500 days/year, which corresponds to an estimated saving of 76.500.000 pesetas/year.

[Current changes in the predominant mechanisms of the transmission of brucellosis in the province of Valencia]. / "Cambios actuales en los mecanismos de transmisión predominantes de la brucelosis en la provincia de Valencia".

A descriptive epidemiological study of brucellosis in the province of Valencia was carried out over the period 1985-1988. In this report predominant transmission mechanisms and their relation with sex, age and profession variables are described. Moreover, the results obtained were compared with those from other brucellosis epidemiologies which were previously carried out in the province of Valencia. It can be seen that there is a relative increase in the direct contagion mechanism and a decrease in the indirect contagion mechanism with respect to the previous periods, which has effects on the variations of sex and profession distribution of the disease. The changes observed could be attributed to a better sanitary control of milk and diary products, mainly fresh cheese, which are very important in the transmission of the disease in the province of Valencia.

[Epidemiological course of rheumatic fever and rheumatic heart disease in Spain (1951-1986)]. / Evolución epidemiológica de la fiebre reumática y cardiopatía reumática en España (1951-1986).

A study has been made of the death rate due to Rheumatic Fever (R.F.) and Rheumatic Heart Disease (R.H.D.) in Spain (1951-1985) as well as the disease rate due to Rheumatic Fever (1951-1988). It has been found that the death rate due to R.F. and R.H.D. has clearly decreased over the past 20 years, whilst it is important to note that disease rate due to R.F' has shown a noticeable increase over the past 10 years. And on comparing the death rate due to R.F. in Spain and in the United States, one finds that the U.S. death rate began to drop prior to that in Spain, it currently being minimal in both countries. Stress is placed on the need to increase the control of streptococcus infections, specially throat infections, in our environment.

Algunos factores determinantes de la mortalidad infantil en España / Some factors determinants of the infant mortality in Spain

Se presenta un estudio ecológico realizado para España entre los años 1975 y 1979 intentando explicar la variación de la mortalidad infantil. Los factores socioeconómicos, tales como la renta familiar disponible (R2=0.44) y la renta per cápita, juegan un papel importante, mientras que los sanitarios representan un papel menor; las variables de utilización de recursos sanitarios son las que más relevancia han tenido de este grupo, tales como las consultas por habitante (coeficiente de regresión parcial de -0.15 y 0.14 en 1977 y 1978 respectivamente) y las actividades quirúrgicas; todo ello refleja a un país en cambio.

We introduce an ecological research for Spain between the 1975 and 1979, triyng to explain the variation of childhood mortality. The social-economical factor had an important weight, as the disponible familiar rent (R2=0.44) and the per capita rent, while the health factors had a least important influence. From this last group, the health resources utilization were the most important, as the consultation per habitant (partial regretion coeficient -0.15 and -0.14 in 1977 and 1978 respectively) and the surgery activities. Every this reflect a country in change.

[Factors determining infant mortality in Spain]. / Algunos factores determinantes de la mortalidad infantil en España.

We introduce an ecological research for Spain between the 1975 and 1979, trying to explain the variation of childhood mortality. The social-economical factor had an important weight, as the disposable familiar rent (R2 = 0.44) and the per capita rent, while the health factors had a least important influence. From this last group, the health resources utilization were the most important, as the consultation per habitant (partial regression coefficient -0.15 and -0.14 in 1977 and 1978 respectively) and the surgery activities. Every this reflect a country in change.

[Comparison of mortality in Spain and France, following the method of "potential years of life lost"]. / Datos comparativos de la mortalidad en Espana y Francia, segun el metodo del "nivel potencial de anos de vida perdidos".

PIP: Mortality trends in Spain from 13 major causes of death are analyzed for the period 1972-1982 and compared with trends for the same period in France. Increases in mortality in Spain are noted for three causes--malignant tumors, cardiac diseases, and suicides and homicides--whereas significant declines in mortality are noted for pneumonia, influenza, chronic bronchitis, and asthma. Excess mortality for males is common to both countries. (SUMMARY IN ENG)^ieng

[Iodine levels in water for public consumption in the province of Valencia]. / Niveles de iodo en las aguas de consumo público en la provincia de Valencia.

A descriptive study has been carried out on the iodine content in the drinking water of the Valencia province, where very low levels were found in almost all the public water supplies of the province. The levels of iodine are similar in water originating from the different types of water sources. A slightly higher level is observed in industrialized areas, the same as in the water supplies that are near solid and liquid waste dumps located on land which is vulnerable to contamination and in areas close to the ocean.

[Comparative epidemiologic study of mortality caused by leukemia in Spain and the U.S.A. (1951-1983)]. / Estudio epidemiológico comparativo de la mortalidad por leucemias en España y en EE.UU. (1951-1983).

A study of the mortality due to leukaemias in Spain between 1951 and 1983 was performed. A clearly increasing trend was appreciated, with progressive higher affectation of males in the last four years, the mortality rates being constantly higher for this sex. When cytological types of the leukaemias, sex, and the different age groups were taken into account, and after comparing these findings with data reported from the United States of America, it was found that our mortality rates are in general much lower than those of the USA. Although the clinical course of the disease is similar for both countries as regards the four major groups of leukaemias, a striking increase of mortality in childhood (5-9 years) was found here in acute lymphoblastic leukaemia, which suggests, in accordance with our previous reports, high affectation of children in Spain. It seems advisable to improve the techniques and means of treating and preventing complications, especially infectious ones, in childhood.

[Fluoride levels in water for public use in the province of Valencia]. / Niveles de fluor en las aguas de consumo público de la provincia de Valencia.

It has been realized a description study about the fluorine content in the drinking waters from the province of Valencia and it has been looked for the relation with distinct variables in order to prevent possible risks for health. The fluoride level is very low in all the public consumption waters of the province. It has been recommended the fluoridation in order to get prophylaxis of the caries teeth. The structural and geological characteristics of the aquifer don't influence about the fluoride levels in it's water supplies. Fluorine level is lightly industrialized zones and supplies near dumping places of solid and liquid residues situated over vulnerable terrenes to contamination on account of porosity, immediately afterwards fissured zones and finally the mixed terrenes.

[Bladder cancer: study of mortality in Spain (1968-1982)]. / Cáncer de vejiga: Estudio de la mortalidad en España (1968-1982).

In review of the rising bladder cancer mortality rate in Spain and its involvement in connection with other "risk factors", according to recent contributions, we proceeded to review these factors involved and to carry out an epidemiological study describing its mortality from 1968 to 1982, through specific mortality rates per hundred thousand in males and females, as well as the study by age groups from 50 upwards, concentrating on more highly affected ages. We also carried out transverse studies for the three years 1968, 1975 and 1982 and reviewed the evolution of mortality in accordance with the chorts of births. On the whole, we observe a continual rise in mortality due to this cancer, at a much higher level in the masculine sex, and we make interpretation as to its association with "risk factors" connected with life style.