Tumor-associated autoantibodies as early detection markers for ovarian cancer? A prospective evaluation.

Immuno-proteomic screening has identified several tumor-associated autoantibodies (AAb) that may have diagnostic capacity for invasive epithelial ovarian cancer, with AAbs to P53 proteins and cancer-testis antigens (CTAGs) as prominent examples. However, the early detection potential of these AAbs has been insufficiently explored in prospective studies. We performed ELISA measurements of AAbs to CTAG1A, CTAG2, P53 and NUDT11 proteins, for 194 patients with ovarian cancer and 705 matched controls from the European EPIC cohort, using serum samples collected up to 36 months prior to diagnosis under usual care. CA125 was measured using electrochemo-luminiscence. Diagnostic discrimination statistics were calculated by strata of lead-time between blood collection and diagnosis. With lead times ≤6 months, ovarian cancer detection sensitivity at 0.98 specificity (SE98) varied from 0.19 [95% CI 0.08-0.40] for CTAG1A, CTAG2 and NUDT1 to 0.23 [0.10-0.44] for P53 (0.33 [0.11-0.68] for high-grade serous tumors). However, at longer lead-times, the ability of these AAb markers to distinguish future ovarian cancer cases from controls declined rapidly; at lead times >1 year, SE98 estimates were close to zero (all invasive cases, range: 0.01-0.11). Compared to CA125 alone, combined logistic regression scores of AAbs and CA125 did not improve detection sensitivity at equal level of specificity. The added value of these selected AAbs as markers for ovarian cancer beyond CA125 for early detection is therefore limited.

Dairy products and risk of hepatocellular carcinoma: the European Prospective Investigation into Cancer and Nutrition.

Intake of dairy products has been associated with risk of some cancers, but findings are often inconsistent and information on hepatocellular carcinoma (HCC) risk is limited, particularly from prospective settings. The aim of our study was to investigate the association between consumption of total and specific dairy products (milk/cheese/yogurt) and their components (calcium/vitamin D/fats/protein), with first incident HCC (N(cases) = 191) in the European Prospective Investigation into Cancer and Nutrition cohort, including a nested case-control subset (N(cases) = 122) with the assessment of hepatitis B virus/hepatitis C virus infections status, liver damage and circulating insulin-like growth factor (IGF)-I levels. For cohort analyses, multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI). For nested case-control analyses, conditional logistic regression was used to calculate odds ratios and 95% CI. A total of 477,206 participants were followed-up for an average of 11 years (person-years follow-up = 5,415,385). In the cohort study, a significant positive HCC risk association was observed for total dairy products (highest vs. lowest tertile, HR = 1.66, 95% CI: 1.13-2.43; p(trend) = 0.012), milk (HR = 1.51, 95% CI: 1.02-2.24; p(trend) = 0.049), and cheese (HR = 1.56, 95% CI: 1.02-2.38; p(trend) = 0.101), but not yogurt (HR = 0.94, 95% CI: 0.65-1.35). Dietary calcium, vitamin D, fat and protein from dairy sources were associated with increased HCC risk, whereas the same nutrients from nondairy sources showed inverse or null associations. In the nested case-control study, similar results were observed among hepatitis-free individuals. Results from this large prospective cohort study suggest that higher consumption of dairy products, particularly milk and cheese, may be associated with increased HCC risk. Validation of these findings in other populations is necessary. Potential biologic mechanisms require further exploration.

[Influence of double workload in perceived health and health services utilization of immigrants and Murcian natives, Spain]. / Influencia de la doble carga de trabajo en el estado de salud percibida y utilización de servicios sanitarios de las poblaciones inmigrante y autóctona de la región de Murcia.

BACKGROUND: Gender inequalities in health have been largely documented. The main objective of this study is to assess whether there are gender differences in perceived health and health services utilization, and their relation with double workload in a representative sample of immigrants and Murcian natives. METHODS: We used data from the NHS 2006 and Health and Culture Study, 1,303 immigrants and 1,303 Spanish, both residents in the Region of Murcia. With the combination of reproductive work and paid work we built up the variable 'double workload' (DW). We estimated the prevalence ratio (PR) for positive self-perceived health, chronic morbidity, activity limitation, doctor's visits, hospitalization, emergency and drug use, by origin, using regression methods. Two models were constructed by adding double burden to the basic model adjusted by sociodemographic variables. Analyses were performed between and within sex. RESULTS: After adjusting for DW, no changes were seen in the differences by gender [RP women/men of positive perception health: 0.70 (0.54-0.89) East European; 0.87 (0.79-0.95) autochthonous / chronic morbidity: 1.44 (1.14-1.82) Hispanic; 1.36 (1.19-1.55) autochthonous / activity limitation: 2.23 (1.29-3.83) Hispanic; 1.45 (1.01-2.10) autochthonous / doctor's visits: 1.93 (1.50-2.48) Hispanic; 1.74 (1.06-2.86) Moroccan; 1.32 (1.09-1.59) autochthonous / hospitalization: 1.80 (1.02-3.17) Hispanic], almost the same than unadjusted. Women used more drugs than men. Within sexes, both autochthonous men (1.19; 1.06-1.33) and women (1.18; 1.01-1.40) with shared DW had more positive self-perceived health than those without DW. Hispanic men with DW without assistance: 0.67 (0.47-0.94). CONCLUSIONS: Women have worse health indicators and greater use of health services regardless of origin. Consideration of the double workload does not explain gender inequalities in health.

Infuencia de la doble carga de trabajo en el estado de salud percibida y utilización de servicios sanitarios de las poblaciones inmigrante y utóctona de la Región de Murcia / Influence of double workload in perceived health and health services utilization of immigrants and Murcian natives, Spain

Fundamentos: Las desigualdades de género en salud han sido ampliamente documentadas. El principal objetivo es evaluar si existen diferencias de género en salud percibida y utilización de servicios sanitarios, y su relación con la doble carga de trabajo, en una muestra representativa de población inmigrante y autóctona de la Región de Murcia (RM). Métodos: Se utilizaron datos de la ENS 2006 y el Estudio Salud y Culturas, 1.303 inmigrantes y 1.303 españoles residentes en la RM. La combinación del trabajo reproductivo y remunerado se consideró «doble carga» (DC). Se estimó la razón de prevalencia (RP) de la percepción positiva de salud, morbilidad crónica, limitación de actividad, visitas al médico, hospitalización, visitas a urgencias y consumo de fármacos, en cada grupo de origen, mediante métodos de regresión. Se construyeron dos modelos, añadiendo el ajuste por DC al modelo ajustado por variables sociodemográficas. Se realizó análisis inter e intrasexo. Resultados: Al ajustar por DC no se observaron cambios en las diferencias entre sexos [RP mujeres/hombres de percepción positiva salud: 0,70 (0,54-0,89) europeos Este; 0,87 (0,79-0,95) autóctonos / morbilidad crónica: 1,44 (1,14-1,82) hispanoamericanos; 1,36 (1,19-1,55) autóctonos / limitación actividad: 2,23 (1,29-3,83) hispanoamericanos; 1,45 (1,01-2,10) autóctonos / consulta médico: 1,93 (1,50-2,48) hispanoamericanos; 1,74 (1,06-2,86) marroquíes; 1,32 (1,09-1,59) autóctonos / hospitalización: 1,80 (1,02-3,17) hispanoamericanos], casi los mismos que sin ajustar. Las mujeres consumieron más fármacos que los hombres. Entre sexos, hombres (1,19; 1,06-1,33) y mujeres (1,18; 1,01-1,40) de la RM con DC compartida declararon mayor percepción positiva de salud que aquellos sin DC; hombres hispanoamericanos con DC sin ayuda: 0,67 (0,47-0,94). Conclusiones: Las mujeres presentan peores indicadores de salud y mayor uso de servicios sanitarios independientemente del origen. La doble carga no modifica las desigualdades de género en salud(AU)

Background: Gender inequalities in health have been largely documented. The main objective of this study is to assess whether there are gender differences in perceived health and health services utilization, and their relation with double workload in a representative sample of immigrants and Murcian natives. Methods: We used data from the NHS 2006 and Health and Culture Study, 1,303 immigrants and 1,303 Spanish, both residents in the Region of Murcia. With the combination of reproductive work and paid work we built up the variable “double workload” (DW). We estimated the prevalence ratio (PR) for positive self-perceived health, chronic morbidity, activity limitation, doctor’s visits, hospitalization, emergency and drug use, by origin, using regression methods. Two models were constructed by adding double burden to the basic model adjusted by sociodemographic variables. Analyses were performed between and within sex. Results: After adjusting for DW, no changes were seen in the differences by gender [RP women/men of positive perception health: 0.70 (0.54-0.89) East European; 0.87 (0.79-0.95) autochthonous / chronic morbidity: 1.44 (1.14-1.82) Hispanic; 1.36 (1.19-1.55) autochthonous / activity limitation: 2.23 (1.29-3.83) Hispanic; 1.45 (1.01-2.10) autochthonous / doctor’s visits: 1.93 (1.50-2.48) Hispanic; 1.74 (1.06-2.86) Moroccan; 1.32 (1.09-1.59) autochthonous / hospitalization: 1.80 (1.02-3.17) Hispanic], almost the same than unadjusted. Women used more drugs than men. Within sexes, both autochthonous men (1.19; 1.06-1.33) and women (1.18; 1.01-1.40) with shared DW had more positive self-perceived health than those without DW. Hispanic men with DW without assistance: 0.67 (0.47-0.94). Conclusions: Women have worse health indicators and greater use of health services regardless of origin. Consideration of the double workload does not explain gender inequalities in health(AU)

[Review of mortality from hypertensive disease and diabetes mellitus after the error because of new death certificate: region of Murcia, Spain, 2009]. / Revisión de la mortalidad por diabetes mellitus y enfermedad hipertensiva tras el error detectado en el nuevo certificado de defunción: Región de Murcia en 2009.

BACKGROUND: The Medical Death Certificate and the Death Statistics Bulletin were unified and implemented in the year 2009 in Spain. National statistics detected an unusual increase for diabetes mellitus (DM) and hypertensive disease (HT) deaths in 2009, in relation to previous years trend.The objective is to study the documental causes of the increase, and describe the procedures and consequences in rates, after the revision and recodification of DM and HT. METHODS: All death certificates in 2009 for diabetes and hypertension in the Region of Murcia (cases=670) were revised, according to previous guidelines for direct recoding after consultation to the certifying physician. A telephone survey to certifying physician was designed to determine the accuracy of the pattern of recoding. Kappa index and 95% confidence intervals (95%CI) were performed between initial and recoded causes. Confirmation rate and 95%CI was estimated after phone inquiry to the certifying physician, and the annual age-adjusted and age-specific rates from 1999 to 2009 (uncorrected and corrected) for DM and HT were calculated. RESULTS: Simple agreement was 37% for DM and 30% for HT. The Kappa index between the initial and final causes was 49% (95%CI, 45 to 54%). Confirmation rates were 47% (95%CI, 43 to 52%) for DM and 38% (95%CI, 34 to 43%) for HT. The initial annual rates of 2009 for DM were corrected from 21.4 per 100,000 inhabitants to 17.1, and from 19.0 to 14.0 for hypertension. The respective specific age rates of 70 to 84 and older experienced similar reductions. CONCLUSIONS: The revision restored temporal trends in mortality of DM and HT in 2009, and identified no variations from previous years. It was detected that the erroneous fulfillment of DM AND HT came from the new death certificate.

Revisión de la mortalidad por diabetes mellitus y enfermedad hipertensiva tras el error detectado en el nuevo certificado de defunción. Región de Murcia en 2009 / Review of mortality from hypertensive disease and diabetes mellitus after the error because of new death certificate. Region of Murcia, Spain, 2009

Fundamentos: En el año 2009 se unificó el Certificado Médico de Defunción con el Boletín Estadístico de Defunción (CMD/BED). En la estadística nacional del año 2009 se detectó un aumento inusual en las defunciones por diabetes mellitus (DM) y enfermedad hipertensiva (HTA) en relación a la tendencia en años anteriores. El objetivo del trabajo es estudiar las causas documentales del aumento y describir los procedimientos y consecuencias en las tasas tras la revisión y recodificación de ambas causas. Métodos: Se revisaron todas las certificaciones de defunciones de 2009 por DM e HTA en la Región de Murcia (casos=670) según pautas previas de recodificación directa o tras consulta al médico certificador. Se diseñó una encuesta telefónica al médico certificador para determinar la exactitud de la pauta de recodificación. Se calculó el índice Kappa e intervalo de confianza (IC95%) entre las causas iniciales y recodificadas. Se estimó la tasa de confirmación e IC95% tras consulta telefónica; y las tasas totales y específicas por edad del año 1999 a 2009 con y sin corrección para DM e HTA. Resultados: Los casos concordantes fueron el 37% en DM y 29% HTA. El índice Kappa entre causas iniciales y finales fue del 49% (IC95%, 45-54%). Las tasas de confirmación fueron del 47% (IC95%, 43 a 52%) para DM y del 38% (IC95%, 34 a 43%) para HTA. Las tasas iniciales anuales del año 2009 para DM se corrigieron de 21,4 por cien mil habitantes a 17,1, y de 19,0 a 14,0 para HTA. Las respectivas tasas específicas por edad de 70 a 84 y más años presentaron reducciones similares. Conclusiones: La revisión restableció la tendencia temporal de la mortalidad por DM e HTAen 2009, e identificó que no tuvo variaciones respecto a años anteriores. Se detectó que la cumplimentación errónea de DM e HTA provenía del CMD/BED(AU)

Background: The Medical Death Certificate and the Death Statistics Bulletin were unified and implemented in the year 2009 in Spain. National statistics detected an unusual increase for diabetes mellitus (DM) and hypertensive disease (HT) deaths in 2009, in relation to previous years trend.The objective is to study the documental causes of the increase, and describe the procedures and consequences in rates, after the revision and recodification of DM and HT. Methods: All death certificates in 2009 for diabetes and hypertension in the Region of Murcia (cases=670) were revised, according toprevious guidelines for direct recoding after consultation to the certifying physician. A telephone survey to certifying physician was designed to determine the accuracy of the pattern of recoding. Kappa index and 95% confidence intervals (95%CI) were performed between initial and recoded causes. Confirmation rate and 95%CI was estimated after phone inquiry to the certifying physician, and the annual age-adjusted and agespecific rates from 1999 to 2009 (uncorrected and corrected) forDMand HT were calculated. Results: Simple agreement was 37% for DM and 30% for HT. The Kappa index between the initial and final causes was 49% (95%CI, 45 to 54%). Confirmation rates were 47% (95%CI, 43 to 52%) for DM and 38% (95%CI, 34 to 43%) for HT. The initial annual rates of 2009 forDM were corrected from 21.4 per 100,000 inhabitants to 17.1, and from 19.0 to 14.0 for hypertension. The respective specific age rates of 70 to 84 and older experienced similar reductions. Conclusions: The revision restored temporal trends in mortality of DM and HT in 2009, and identified no variations from previous years. It was detected that the erroneous fulfillment of DMAND HT came from the new death certificate(AU)

[Effect of weather temperature on hospital emergencies in the Region of Murcia, Spain, throughout the 2000-2005 and its use in epidemiological surveillance]. / Efecto del calor sobre el número de urgencias hospitalarias en la Región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica.

BACKGROUND: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. OBJECTIVE: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. METHODS: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38 degrees C and Min. 22.4 degrees C) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). RESULTS: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4 degrees C (RR: 1.016; 95% CI 1.0076-1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. CONCLUSIONS: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk.

Efecto del calor sobre el número de urgencias hospitalarias en la región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica / Effect of weather temperature on hospital emergencies in the region of Murcia, Spain, throught the 2000-2005 and its use in epidemiological surveillance

Fundamento: el efecto de las temperaturas sobre la mortalidad ha sido estudiado más en profundidad que el efecto sobre la morbilidad. En Murcia se monitorizan el número de urgencias diarias y los casos de golpes de calor atendidos en los hospitales de la Región. Objetivo: valorar el efecto de la temperatura sobre el número de urgencias hospitalarias y la utilidad de estos indicadores para vigilar la morbilidad por calor. Métodos: se ha estudiado el efecto de la temperatura sobre el número de urgencias en verano (periodo 2000-2005), estimando el incremento porcentual de urgencias cuando se superan los umbrales establecidos por el Ministerio de Sanidad y Consumo (Tª máxima 38ºC y Tª mínima 22,4ºC) y por cada grado de aumento de temperatura, expresado en Riesgo Relativo (RR) con un IC95%. Se han cotejado los golpes de calor comunicados con los ingresos registrados en el Conjunto Mínimo Básico de Datos al Alta Hospitalaria (CMBD). Resultados: En 2000-2005 las urgencias se incrementaron un 1,6% en los días con más de 22,4ºC de mínima (RR 1,016; IC95% 1,0076-1,0244), y un 0,21% por cada grado de aumento de la mínima (RR 1,0021; IC95% 1,0000-1,0044). El 38% de los golpes de calor ingresados no se notificaron, y el 40% de los notificados tenían exposición laboral. Conclusiones: La temperatura mínima podría tener un mayor efecto en Murcia que la máxima. Con los actuales umbrales, el número de urgencias diarias no parece un indicador adecuado para monitorizar el efecto de la temperatura, necesitándose información sobre el diagnóstico y la edad. Los golpes de calor aportan información parcial del impacto, pero resaltan grupos de población en riesgo menos considerados (AU)

Background: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. Objective: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. Methods: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38ºC and Min. 22.4ºC) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). Results: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4ªC (RR: 1.016; 95%CI 1.0076 - 1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. Conclusions: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk (AU)

[Validation of colorectal cancer diagnostic codes in a hospital administration data set]. / Validación de los códigos diagnósticos de cáncer de colon y recto del Conjunto Mínimo Básico de Datos.

OBJECTIVES: To validate the ability of a hospital administration data set (minimum data set [MDS]) to detect incident cases of colorectal cancer using the Murcia Cancer Registry (MCR) as the gold standard and to measure agreement between the MDS and registration of colorectal cancer. MATERIAL AND METHOD: A cross sectional validation study of the MDS of the main hospital in the region of Murcia (Spain) was conducted. The study population consisted of incident cases of colorectal cancer in 2000 obtained from the MCR and cases in the MDS of the above-mentioned hospital for the same year with an ICD-9 diagnostic code between 153.0 and 154.1, eliminating readmissions. During the process, two analyses were performed: one analysis with the principal diagnosis only and another with all the diagnostic codes. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and agreement was calculated with their 95% confidence intervals (CI). RESULTS: With the first diagnosis only, the MDS detected 80% of the incident cases of colorectal cancer with a PPV of 75%. With all the diagnoses, the MDS detected 85% of the cases with a PPV of 64%. The agreement in codification was high at three digits (kappa 88% [95% CI, 0.79-0.97] first diagnosis, 89% [95% CI, 0.80-0.97] all diagnoses) as well as at four digits (kappa 77% [IC, 0.68-0.85] first diagnosis, 78% [95% CI, 0.70-0.86] all diagnoses) in both analyses. CONCLUSIONS: Because of its high sensitivity, the MDS is a good source for detecting incident cases of cancer. The high agreement found in the site of colorectal cancer helps to consolidate the MDS as a data source for cancer registration.

Validación de los códigos diagnósticos de cáncer de colon y recto del Conjunto Mínimo Básico de Datos / Validation of colorectal cancer diagnostic codes in a hospital administration data set

Objetivo: Validar la capacidad del Conjunto Mínimo Básico de Datos (CMBD) para detectar casos incidentes de cáncer de colon y recto utilizando como estándar de referencia el Registro de Cáncer de Murcia (RCM) y medir la concordancia entre el CMBD y el registro de cáncer en tumores colorrectales. Material y método: Estudio de validación transversal del CMBD del Hospital Virgen de la Arrixaca de Murcia. La población de estudio son los casos incidentes de colon-recto del año 2000 del RCM y los casos del CMBD en el citado hospital para el mismo año con algún código diagnóstico CIE-9 entre 153.0 y 154.1 eliminando reingresos. Durante el proceso se van a realizar 2 análisis: sólo con el diagnóstico principal y con todos los diagnósticos. Se calcula la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y negativo (VPN) y la concordancia con sus intervalos de confianza (IC) del 95%. Resultados: Con sólo el primer diagnóstico, el CMBD detecta el 80% de los casos incidentes de cáncer colorrectal con un VPP del 75%; considerando todos los diagnósticos, detecta el 85% con un VPP del 64%. La concordancia en la codificación es elevada tanto con 3 dígitos (índice kappa del 88% [IC del 95%, 0,79-0,97] en primer diagnóstico, y del 89% [IC del 95%, 0,80-0,97] en todos los diagnósticos) como de 4 dígitos (índice kappa del 77% [IC del 95%, 0,68-0,85] en el primer diagnóstico, y del 78% [IC del 95%, 0,70-0,86] en todos diagnósticos) en ambos análisis. Conclusiones: El CMBD es una buena fuente para detectar casos incidentes de cáncer al presentar una elevada sensibilidad. La alta concordancia encontrada en las localizaciones tumorales de colon-recto contribuye a consolidar el CMBD como fuente de datos para los registros de cáncer

Objectives: To validate the ability of a hospital administration data set (minimum data set [MDS]) to detect incident cases of colorectal cancer using the Murcia Cancer Registry (MCR) as the gold standard and to measure agreement between the MDS and registration of colorectal cancer. Material and method: A cross sectional validation study of the MDS of the main hospital in the region of Murcia (Spain) was conducted. The study population consisted of incident cases of colorectal cancer in 2000 obtained from the MCR and cases in the MDS of the above-mentioned hospital for the same year with an ICD-9 diagnostic code between 153.0 and 154.1, eliminating readmissions. During the process, two analyses were performed: one analysis with the principal diagnosis only and another with all the diagnostic codes. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and agreement was calculated with their 95% confidence intervals (CI). Results: With the first diagnosis only, the MDS detected 80% of the incident cases of colorectal cancer with a PPV of 75%. With all the diagnoses, the MDS detected 85% of the cases with a PPV of 64%. The agreement in codification was high at three digits (kappa 88% [95% CI, 0.79-0.97] first diagnosis, 89% [95% CI, 0.80-0.97] all diagnoses) as well as at four digits (kappa 77% [IC, 0.68-0.85] first diagnosis, 78% [95% CI, 0.70-0.86] all diagnoses) in both analyses. Conclusions: Because of its high sensitivity, the MDS is a good source for detecting incident cases of cancer. The high agreement found in the site of colorectal cancer helps to consolidate the MDS as a data source for cancer registration

Correspondencias entre CIE-10 y CIE-9 para las listas de causas de muerte del Instituto Nacional de Estadística y de la región de Murcia / Correspondences from 10th to 9th revision of the International Classification of Diseases in the causes of death lists of the National Institute of Statistics and the regional health authority of Murcia in Spain

Fundamento: Diversos países han realizado estudios de comparabilidadentre las revisiones 10ª y 9ª de la Clasificación Internacionalde Enfermedades para listas agregadas de causas de muerte. EnEspaña el proyecto COMPARA pretende evaluar el impacto delcambio de revisión.Métodos: Estudio epidemiológico transversal descriptivo de88.048 defunciones inscritas en 1999 en España con la causa demuerte doblemente codificada en CIE-9 y 10. Se establecen lascorrespondencias teóricas entre CIE en las listas INE y Murcia. Secalculan las razones de comparabilidad e intervalos de confianza y elíndice kappa global.Resultados: Descienden las enfermedades infecciosas (-1,7%),las hepatitis víricas (-12,3%), mientras que aumenta el Sida (5,7%).Las neoplasias aumentan el 0,3% por la incorporación del síndromemielodisplásico (55,2%). Se incrementa la diabetes mellitus (2,1%).Se reducen los trastornos mentales al salir las demencias hacia laenfermedad de Alzheimer (28,6%). Las enfermedades cardiovascularesdescienden ligeramente (-1,4%), sin impacto sobre las cerebrovasculares,aunque el infarto agudo de miocardio decrece (-0,6%)con aumento de la enfermedad isquémica cardiaca (0,3%). La neumoníadecrece (-12,5%) y la cirrosis hepática se aumenta (4,3%).Las entidades mal definidas aumentan por la cesión de las insuficienciascardiorrespiratorias. Las causas externas no varían sin querecojan la precisión de la CIE-9. La lista INE - 102 grupos obtiene uníndice kappa del 95,4%, similar a las variantes de Murcia. Conclusiones: Aunque el impacto global de la CIE-10 es menor,se deberían tener en cuenta las razones de comparabilidad significativasde los grupos de causas de muerte con diferencias absolutasimportantes entre las revisiones

Background: Different countries have conducted comparabilitystudies between Revisions 10 and 9 of the International Classificationof Diseases for aggregate lists of causes of death. In Spain,the COMPARA project was aimed at evaluating the impact of therevision change.Methods: Descriptive cross-sectional epidemiological study of88,048 deaths recorded in Spain in 1999 with the underlying cause ofdeath doubled coded in ICD-9 and ICD-10. The theoretical correspondencesbetween the ICD on the lists of the National Institute ofStatistics and Murcia are established. The comparability rates andtheir confidence intervals, and the total kappa index were calculated.Results: A decline in infectious diseases (-1.7%) and viral hepatitis,(-12.3%) declined under Tenth revision, while AIDS showed anincrease (5.7%). Neoplasms increased a little (0.3%) with the inclusionof the Mielodisplasic Syndrome (55.2%). Diabetes mellitus isincreased (2.1%). Mental disorders declined on dementia being shiftedto Alzheimer's disease (28.6%). Cardiovascular diseases droppedslightly (-1.4%), without any impact on cerebrovascular diseases,although acute myocardial infarct decreased (-0.6%) while ischemicheart disease increased (0.3%). Pneumonia decreased (-12.5%) andhepatic cirrhosis grows (4.3%). Ill-defined conditions increased dueto cardiorespiratory insufficiencies. The external causes show nochange without including the accuracy of ICD-9. The National Instituteof Statistics 102 groups list obtained a total kappa index of95.4%, similar to the Murcia variants. Conclusions: Although ICD-10 has a lesser overall impact, thesignificant comparability rates of the causes of death groups betweenthe revisions with important absolute differences should be takeninto account

Técnica de plamaferesis en una unidad de Nefrología aplicada a enfermos a fectados de esclerosis multiple, encefalomielitis, y enfermedad de Crohn

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Guía de alimentación para el paciente en hemodiálisis. Estudio descriptivo sobre su eficacia / Nutritional guide for the patient under haemodyalisis. Descriptive study of efficiency

Dada la importancia de la alimentación en la insuficiencia renal crónica y debido a que en nuestro hospital carecíamos de alguna unidad didáctica que ofrecer al paciente para orientarlo al respecto, decidimos elaborar un breve manual, enfocado primordialmente al paciente en H.D., al que denominamos GUIA DE ALIMENTACION PARA EL PACIENTE EN HEMODIALISIS, caracterizado por ofrecer información básica, ser eminentemente práctico y por la metodología empleada en la elaboración de las tablas de alimentos. Antes de su edición y difusión decidimos comprobar si sería bien recibido por los pacientes y valorar si necesitaría alguna reforma o modificación. El objetivo del presente estudio es comprobar si mejoran los conocimientos sobre los alimentos por parte del paciente, tras la utilización de la guía de alimentación. Para ello decidimos realizar un estudio exploratorio descriptivo transversal con una muestra de 20 pacientes de nuestra unidad. Primeramente les facilitamos un CUESTIONARIO TIPO A donde valoramos sus conocimientos sobre alimentación. Tras su recogida, se les entregó un ejemplar de la GUIA DE ALIMENTACION. Transcurridos unos días les entregamos un CUESTIONARIO TIPO B en el que volvimos a valorar los conocimientos sobre alimentación previos a la presentación de la Guía y los posteriores a su presentación, además de su opinión sobre la misma y posibles reformas. Sólo fueron recogidos 18 cuestionarios, porque dos pacientes decidieron no acabar el estudio. Tras analizar y comparar los resultados obtenidos en ambas cuestionarios, podemos concluir diciendo que la Guía de Alimentación ha sido aceptada por la totalidad de los pacientes encuestados. Que la mayoría dicen estar conformes con el contenido de la misma, y que han mejorado sus conocimientos, a pesar de ciertas discrepancias constatadas en algunas respuestas (AU)