[The accuracy of the causes of death with judicial intervention in Catalonia in the period 2015-2020. Effect of declaration through IML-Web application]. / La precisión de las causas de defunción con intervención judicial en Cataluña en el periodo 2015-2020. Efecto de la declaración a través de la aplicación IML-Web.

OBJECTIVE: On January first, 2020, the Institutes of Legal Medicine and Forensic Sciences (IMLCF) began to inform the causes of death directly to the National Statistics Institute (INE) through a web application (IML-Web). The objective of this study was to evaluate the impact of the implementation of this application on the quality of the data collected. METHODS: A descriptive study using deaths data with judicial intervention that occurred in Catalonia was carried out. The data of the period 2015-2018 and 2019 was compared with 2020. The percentages, with confidence intervals, of the causes of death that were not specific, according to different classifications, were calculated on the total of cases by period and territory. RESULTS: The total percentage of non-specific deaths had decreased, not significantly, by 1.6 points between the period 2015-2018 and 2020. The same indicator between 2019 and 2020 had decreased by 13.4 points. The percentage of non-specific deaths from external causes showed significant drops between both periods and 2020. In general, the indicators displayed territorial differences. CONCLUSIONS: The roll-out of the IML-Web implies, compared to 2019, an improvement in the quality of the data. On the other hand, compared to the period 2015-2018, the data show a similar level of quality. Generally, it is assessed that the information provided by IMLCF of Catalonia through the IML-Web is accurate, but still has room for improvement.

OBJECTIVE: A partir del 1 enero de 2020, los Institutos de Medicina Legal y Ciencias Forenses (IMLCF) empezaron a declarar las causas de muerte directamente al Instituto Nacional de Estadística (INE) mediante una aplicación web (IML-Web). El objetivo de este trabajo fue evaluar el impacto de la implementación de esta aplicación en la calidad de los datos recogidos. METHODS: Se realizó un estudio descriptivo utilizando datos de las defunciones con intervención judicial ocurridas en Cataluña. Se comparó la información del período 2015-2018 y de 2019 con la de 2020. Se calcularon los porcentajes, con intervalo de confianza, de las causas de defunción poco específicas, según diferentes clasificaciones, sobre el total de causas por período y división judicial. RESULTS: El porcentaje total de causas de defunción poco específicas se redujo, de forma no significativa, 1,6 puntos entre el período 2015-2018 y el año 2020. El mismo indicador entre el año 2019 y 2020 se redujo 13,4 puntos. El porcentaje de defunciones poco específicas de causas externas mostró reducciones estadísticamente significativas entre ambos períodos. En general los indicadores mostraron diferencias territoriales. CONCLUSIONS: La implementación del IML-Web en el año 2020 supone, en comparación con 2019, una mejora en la calidad de la información notificada. En cambio, si se compara con el período 2015-2018, los datos muestran una calidad similar. A nivel general se valora que la información proporcionada por el IMLCF de Cataluña a través del IML-Web es precisa, pero todavía tiene margen de mejora.

La precisión de las causas de defunción con intervención judicial en Cataluña en el periodo 2015-2020. Efecto de la declaración a través de la aplicación IML-Web / The accuracy of the causes of death with judicial intervention in Catalonia in the period 2015-2020. Effect of declaration through IML-Web application

Fundamentos: a partir del 1 enero de 2020, los institutos de medicina legal y ciencias forenses (imlcf) empezaron a declarar las causas de muerte directamente al instituto nacional de estadística (ine) mediante una aplicación web (iml-web). El objetivo de este trabajo fue evaluar el impacto de la implementación de esta aplicación en la calidad de los datos recogidos. Métodos: se realizó un estudio descriptivo utilizando datos de las defunciones con intervención judicial ocurridas en cataluña. Se comparó la información del período 2015-2018 y de 2019 con la de 2020. Se calcularon los porcentajes, con intervalo de confianza, de las causas de defunción poco específicas, según diferentes clasificaciones, sobre el total de causas por período y división judicial. Resultados: el porcentaje total de causas de defunción poco específicas se redujo, de forma no significativa, 1,6 puntos entre el período 2015-2018 y el año 2020. El mismo indicador entre el año 2019 y 2020 se redujo 13,4 puntos. El porcentaje de defunciones poco específicas de causas externas mostró reducciones estadísticamente significativas entre ambos períodos. En general los indicadores mostraron diferencias territoriales. Conclusiones: la implementación del iml-web en el año 2020 supone, en comparación con 2019, una mejora en la calidad de la información notificada. En cambio, si se compara con el período 2015-2018, los datos muestran una calidad similar. A nivel general se valora que la información proporcionada por el imlcf de cataluña a través del iml-web es precisa, pero todavía tiene margen de mejora.(AU)

Background: on january first, 2020, the institutes of legal medicine and forensic sciences (imlcf) began to inform the causes of death directly to the national statistics institute (ine) through a web application (iml-web). The objective of this study was to evaluate the impact of the implementation of this application on the quality of the data collected.methods: a descriptive study using deaths data with judicial intervention that occurred in catalonia was carried out. The data of the period 2015-2018 and 2019 was compared with 2020. The percentages, with confidence intervals, of the causes of death that were not specific, according to different classifications, were calculated on the total of cases by period and territory.results: the total percentage of non-specific deaths had decreased, not significantly, by 1.6 points between the period 2015-2018 and 2020. The same indicator between 2019 and 2020 had decreased by 13.4 points. The percentage of non-specific deaths from external causes showed significant drops between both periods and 2020. In general, the indicators displayed territorial differences.conclusions: the roll-out of the iml-web implies, compared to 2019, an improvement in the quality of the data. On the other hand, compared to the period 2015-2018, the data show a similar level of quality. Generally, it is assessed that the information provided by imlcf of catalonia through the iml-web is accurate, but still has room for improvement.(AU)

Las muertes con intervención judicial y medicolegal y su impacto en la estadística de causas de muerte en Cataluña / Deaths with medicolegal intervention and its impact on the cause-of-death statistics in Catalonia, Spain

Introducción. Los boletines estadísticos correspondientes a las defunciones que requieren intervención judicial (DIJ) y actuación forense contienen un número elevado de causas de muerte mal definidas. El objetivo es presentar los resultados de la recuperación de datos a partir de las autopsias judiciales del año 2013 en Cataluña y analizar el impacto de esta información sobre la estadística de causas de muerte. Material y métodos. Se seleccionaron del Registro de Mortalidad de Cataluña las defunciones con intervención judicial que tenían como causa de muerte unas determinadas afecciones mal definidas, según criterios de codificación de la OMS. Se recuperó la información de los registros de autopsia de los centros de Patología Forense del Instituto de Medicina Legal y Ciencias Forenses de Cataluña (IMLCFC). Resultados. Las DIJ representan el 6% de la mortalidad total de Cataluña, el 42,9% de las causas externas y el 77% de las mal definidas. De los 3.639 casos de DIJ del año 2013 se revisó un 43,4% (n=1.578) y se obtuvo información que mejoró la causa de muerte del 78,4% de los revisados. La información recuperada aumentó un 61,3% las intoxicaciones accidentales, un 32,6% los suicidios, un 28,9% los homicidios, un 27,4% las caídas, un 22,7% los accidentes de tráfico y un 5,2% la cardiopatía isquémica, con el equivalente aumento de las tasas de mortalidad por estas causas. Conclusiones. La información de las autopsias judiciales tiene un gran impacto en las estadísticas de causa de muerte, especialmente en las causas externas y la cardiopatía isquémica. Un informe forense sobre la causa y las circunstancias de la muerte, de manera que permita fácilmente su codificación posterior, así como la transmisión directa de estos datos a la oficina estadística serían la mejor solución para evitar la pérdida de información que se produce actualmente (AU)

Introduction. The statistical forms corresponding to deaths that require judicial and forensic interventions contain a very high number of ill-defined causes of death. The objective is to show the results of data recovery from the forensic autopsies and to analyse the impact of this information on the cause-of-death statistics for the year 2013 in Catalonia (Spain). Material and methods. Deaths with judicial intervention with an ill-defined cause of death according to the WHO coding standards were selected from the Catalan Mortality Registry. Information was recovered from the autopsy registers of the Forensic Pathology centres of the Institute of Legal Medicine and Forensic Science of Catalonia (IMLCFC). Results. Deaths with judicial intervention represent 6% of total mortality in Catalonia, 42.9% due to external causes and 77% pertaining to ill-defined causes-of-death. There were 3,639 cases of death with judicial intervention, of which 43.4% (n=1,578) were reviewed, resulting in information that improved the cause of death in 78.4% of cases. The information retrieved increased accidental poisoning by 61.3%, suicides by 32.6%, homicides by 28.9%, falls by 27.4%, traffic accidents by 22.7% and ischaemic heart disease by 5.2%, with the equivalent increase in the mortality rates from these causes. Conclusions. The forensic autopsy information has a significant impact on cause-of-death statistics, especially external causes and ischemic heart disease. A forensic report concerning the cause and circumstances of death, structured to facilitate further coding and the direct transmission of data to the statistical office, would be the best solution to prevent the loss of information currently experienced (AU)

Rationale and Design of the "Safety and Efficacy of the Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure (CLOROTIC) Trial:" A Double-Blind, Randomized, Placebo-Controlled Study to Determine the Effect of Combined Diuretic Therapy (Loop Diuretics With Thiazide-Type Diuretics) Among Patients With Decompensated Heart Failure.

BACKGROUND: Fluid overload refractory to loop diuretic therapy can complicate acute or chronic heart failure (HF) management. The Safety and Efficacy of the Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure (CLOROTIC) trial (Clinicaltrials.gov identifier NCT01647932) will test the hypothesis that blocking distal tubule sodium reabsorption with hydrochlorothiazide can antagonize the renal adaptation to chronic loop diuretic therapy and improve diuretic resistance. METHODS: CLOROTIC is a randomized, placebo-controlled, double-blind, multicenter study. Three hundred and four patients with decompensated HF will be randomly assigned to receive hydrochlorothiazide or placebo in addition to a furosemide regimen. The main inclusion criteria are: age ≥18 years, history of chronic HF (irrespective of etiology and/or ejection fraction), admission for acute decompensation, and previous treatment with an oral loop diuretic for at least 1 month before randomization. The 2 coprimary endpoints are changes in body weight and changes in patient-reported dyspnea during hospital admission. Morbidity, mortality, and safety aspects will also be addressed. CONCLUSIONS: CLOROTIC is the first large-scale trial to evaluate whether the addition of a thiazide diuretic (hydrochlorothiazide) to a loop diuretic (furosemide) is a safe and effective strategy for improving congestive symptoms resulting from HF. This trial will provide important information and will therefore have a major impact on treatment strategies and future trials in these patients.

Evolución de la cirugía mayor ambulatoria en Cataluña, 2001-2011 / Trends in ambulatory surgical procedures in Catalonia (Spain), 2001-2011

Objetivo: Analizar la evolución de la cirugía mayor ambulatoria en los hospitales de Cataluña, en relación con la actividad del servicio de cirugía con hospitalización y la dotación estructural quirúrgica. Métodos: Estudio descriptivo con datos de la Estadística de Establecimientos Sanitarios con Régimen de Internamiento del Departament de Salut, Generalitat de Cataluña, durante el periodo 2001-2011. Se realizó para hospitales de agudos, agrupados en hospitales públicos y privados. Discusión: El porcentaje de cirugía ambulatoria aumentó un 63,2% y la actividad de cirugía con hospitalización disminuyó un 23,5% (de forma más marcada en los hospitales públicos). Esto coincide con una disminución de los recursos estructurales (camas y quirófanos) y con una mejora de los índices de actividad de cirugía con hospitalización (disminución de la estancia media y del índice de ocupación en todos los hospitales). Así mismo, se optimizaron los recursos estructurales y se mejoró la eficiencia en los servicios de cirugía hospitalaria (AU)

Objective: To analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery. Methods: A descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals. Discussion: The percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units (AU)

[Trends in ambulatory surgical procedures in Catalonia (Spain), 2001-2011]. / Evolución de la cirugía mayor ambulatoria en Cataluña, 2001-2011.

OBJECTIVE: To analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery. METHODS: A descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals. DISCUSSION: The percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units.

Prevalencia de la discapacidad en España por Comunidades Autónomas: el papel de los factores individuales y del entorno geográfico en su variabilidad / Prevalence of the disability in Spain for autonomous communities: the paper of the individual factors and the geographical environment in the variability

Fundamento: La prevalencia de discapacidad en la poblacióngeneral presenta una gran variabilidad geográfica, de manera queidentificar aquellos factores que pudieran explicarla será importantepara la planificación de políticas sociales. En este trabajo se analizala variabilidad de la discapacidad por comunidades autónomasdesde una doble vertiente, los factores individuales y del entorno.Métodos: Los datos proceden principalmente de la Encuestade Discapacidad, Deficiencias y Estado de Salud de 1999 y delInebase, ambas del Instituto Nacional de Estadística (INE). Secalculó la prevalencia de discapacidad simple y ajustada por edadde las CCAA. Se analizan los factores individuales asociados a ladiscapacidad mediante una regresión logística y los factores individualesy de la comunidad autónoma conjuntamente con unaregresión logística de dos niveles.Resultados: La prevalencia de discapacidad muestra una diferenciamáxima de 5,75 puntos entre las comunidades autónomas.En la regresión logística la comunidad de residencia fue estadísticamentesignificativa (OR: 3,35 en la de mayor prevalencia respectoa la de menor) junto con otras variables individuales: edad (ORde 40-64= 1,78 OR de 65-79= 1,87 y OR de >79= 3,34), sexo (ORmujer= 0,66), situación laboral (OR sin trabajo=2,25 OR amascasa/estudiante=1,39 y OR otros=2,03), estado de salud (OR regular=1,69 OR malo/muy malo= 2,05) y enfermedades crónicas (OR1-3=1,56 OR4-6=1,82 OR>6=2,59). En la regresión de dos niveleslas variables individuales explican poca varianza (s=0,261) y ningunade las variables relativas a las CCAA mejora el modelo.Conclusiones: Las características individuales no explicansuficientemente la variabilidad de la discapacidad entre CCAA yno se han identificado variables del entorno que sean significativas(AU)

Background: The prevalence of disability shows a highgeographical variability and the identification of factors that couldexplain these variations can be usuful to the heath and socialwelfare planning. Here the analysis of disability variations amongautonomous regions in Spain is made taking into accountindividual and geographical setting factors together.Methods: Data come from the Spanish Disability,Impairment and Health Status survey of 1999 and from Inebaseboth of the National Institute for Statistics. The prevalence ofdisability crude and adjusted by age was calculated for eachautonomous region. Individual factors related to disability areidentified by means of a logistic regression. The analysisaccounting for both, individual and geographical setting factorswas performed by means of a logistic regression of two levels.Results: Disability prevalence showed a maximum differenceof 5.75 points among regions. In a logistic regression the region ofresidence was statistically significant (OR: 3.35 in the highestrated region related to the lowest) beside several individual factors:age (OR 40-64= 1,78 OR 65-79= 1,87 and OR >79= 3,34), sex(OR women= 0,66), working status (OR unemployment=2,25 ORhousewife/student=1,39 y OR other=2,03), health status (ORregular= 1,69 OR bad/very bad= 2,05) and chronic diseases (OR1-3=1,56 OR 4-6=1,82 OR >6=2,59). Individual factors accountedfor a very few variance at the two levels regression model(s=0,261) and none of the regional variables improved the model.Conclusions: Individual factors do not explain enough theobserved disability variations among the regions and none factorrelated to the geographical setting has been identified asstatistically significant(AU)

Ten-year experience with acenocoumarol treatment in an ambulatory cohort of Spanish patients.

OBJECTIVE: To analyse incidence of hemorrhagic and thrombotic events in a series of ambulatory patients receiving acenocoumarol in a rural area of Spain (1997-2007). RESULTS: Out of 1,544 patients, 1,086 are receiving acenocoumarol at present (2% of our region's population). The total follow-up was 5,462 patients-years. Median age was 74 years. INR therapeutic range was 2.0-3.0 in 82.5%. Atrial fibrillation (AF) was the most frequent indication (73%). Incidence of hemorrhagic and thrombotic events was 2.27 and 0.2/100 patients-year, respectively. Gastrointestinal tract was the most frequent site of bleeding. In multivariate analysis, patients with AF and prosthetic heart valves (PHV) had increased risk of bleeding (OR 2.1 and 4.8, respectively). Age and therapeutic ranges of INR were not associated with increased risk of bleeding. CONCLUSIONS: 2% of our population is receiving acenocoumarol. Incidence of hemorrhagic and thrombotic events was low. Patients with AF and PHV had increased risk of bleeding.

[Differences in reproductive patterns between autochthonous and immigrant women living in Catalonia, Spain]. / Diferencias en el perfil reproductivo de mujeres autóctonas e inmigrantes residentes en Cataluña.

OBJECTIVE: To describe differences in reproductive patterns between autochthonous and immigrant women living in Catalonia (Spain). METHODS: Data on legal abortions were obtained from the abortions register in the Regional Ministry of Health, while data on births and the population were drawn from the Institute of Statistics of Catalonia. Depending on the source, the variables <> or <> were used to compose the groups. Rates of fertility and abortion by age were computed for 2005 and the women's sociodemographic characteristics were analyzed. RESULTS: A total of 20.8% of the 79,504 births and 37.8% of the 16,798 abortions involved immigrant women, while 14.2% of pregnancies in autochthonous women and 27.7% of those in immigrant women terminated in abortion. Crude fertility and abortion rates were 1.4 and 3 times higher, respectively, in immigrant women. CONCLUSIONS: There are important differences in abortion and fertility rates, as well as in social and demographic patterns, between autochthonous and immigrant women.

Diferencias en el perfil reproductivo de mujeres autóctonas e inmigrantes residentes en Cataluña / Differences in reproductive patterns between autochthonous and immigrant women living in Catalonia, Spain

Objetivo: Describir el perfil reproductivo en las mujeres autóctonase inmigrantes residentes en Cataluña.Métodos: Los abortos proceden del Registro de interrupciónvoluntaria del embarazo (IVE) del Departament de Salut, y losnacimientos y la población del Institut d’Estadística de Catalunya.Se han usado las variables ®país de nacimiento» o ®nacionalidad», según la fuente, para agrupar. Se analizan lastasas de fecundidad y aborto por edad, y las característicassociodemográficas de las mujeres para el año 2005.Resultados: El 20,8% de los 79.504 nacimientos y el 37,8%de las 16.798 IVE fueron de mujeres inmigrantes. El14,2% de los embarazos de mujeres autóctonas y el 27,7%de los de mujeres inmigrantes terminan en aborto. Las tasabruta de fecundidad y aborto es 1,4 y 3 veces superior, respectivamente,en las mujeres inmigrantes.Conclusiones: Hay importantes diferencias en las tasas y enlas características sociodemográficas entre las mujeres autóctonasy las inmigrantes(AU)

Objective: To describe differences in reproductive patternsbetween autochthonous and immigrant women living in Catalonia(Spain).Methods: Data on legal abortions were obtained from theabortions register in the Regional Ministry of Health, while dataon births and the population were drawn from the Institute ofStatistics of Catalonia. Depending on the source, the variables®country of birth» or ®nationality» were used to composethe groups. Rates of fertility and abortion by age were computedfor 2005 and the women’s sociodemographiccharacteristics were analyzed.Results: A total of 20.8% of the 79,504 births and 37.8% ofthe 16,798 abortions involved immigrant women, while 14.2%of pregnancies in autochthonous women and 27.7% of thosein immigrant women terminated in abortion. Crude fertility andabortion rates were 1.4 and 3 times higher, respectively, in immigrantwomen.Conclusions: There are important differences in abortion andfertility rates, as well as in social and demographic patterns,between autochthonous and immigrant women(AU)

[Perinatal mortality according to 2 information sources]. / La mortalidad perinatal según 2 fuentes de información.

OBJECTIVE: To evaluate differences in the number of cases of perinatal mortality in Catalonia (Spain) recorded in 2 health information systems, as well as trends in this phenomenon. METHODS: Data were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics) and the minimum data set (MDS) for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteria for reporting. RESULTS: The mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered. CONCLUSION: The differences between the two sources were related to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal mortality statistics.

La mortalidad perinatal según 2 fuentes de información / Perinatal mortality according to 2 information sources

Objetivo: Evaluar la diferencia en muertes perinatales (MP) ocurridas en Cataluña y su evolución según 2 fuentes de información sanitaria.Métodos: Los datos proceden de la estadística de mortalidad (Departament de Salut e Institut d’Estadística de Catalunya) y del Conjunto Mínimo Básico de Datos de Altas Hospitalarias (CMBDAH) del Servei Català de la Salut del período 2000-2003. Se describen las frecuencias totales de MP según si cumplen o no criterio legal de declaración.Resultados: La estadística de mortalidad registró un 27,2% menos de MP, un 44,77% menos de muertes fetales y un 13,5% más de muertes neonatales precoces que el CMBDAH. Estos porcentajes son menores considerando sólo los casos con criterios legales de declaración.Conclusión: Las diferencias de casos entre ambas fuentesestán relacionadas con características del recién nacido: bajo peso al nacer, prematuridad y lugar en que se produjo. Los datos hospitalarios podrían mejorar la estadística de mortalidad perinatal

Objective: To evaluate differences in the number of casesof perinatal mortality in Catalonia (Spain) recorded in 2 health information systems, as well as trends in this phenomenon.Methods: Data were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics) and the minimum data set (MDS) for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteriafor reporting.Results: The mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered.Conclusion: The differences between the two sources wererelated to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal mortality statistics

[Dependence profile in Spain: an analysis from the disability survey of 1999]. / El perfil de la dependencia en España: un análisis de la encuesta de discapacidades de 1999.

BACKGROUND: In the next future an important demographical ageing will imply a rise in the levels of co morbidity, disability and dependence of the population. The objective if this work was to estimate the dependences profile by means of assessing the levels of severity of the disability in the Spanish general population. METHODS: Data come from the disease, disability and health status survey of 1999 of the Spanish Institute for Statistics, which includes 36 limitations with an score of severity (from 0= absence to 4= unable). These limitations were grouped in five kinds of disability, the mean score of severity was computed for each one, and grouped in five levels of dependence. To check the relationship between limitations and severity an analysis of correspondence was performed. To identify the pattern of dependence a multiple correspondence and a clusters analysis were computed using the variables of age, sex, kind of disability and level of dependence. RESULTS: There is a relationship between severity and some limitations (being the limitation on daily activities associated to the highest severity). Five groups of dependent people were identified. Those with lower dependence were middle aged, men and having sensorial disabilities and those with higher dependence were mainly women, older than 80 and with disabilities on mobility and on the activities of daily living. CONCLUSIONS: There are five groups of dependent population and this study allows estimating its frequency among the general population what will be very useful to evaluate the amount of resources necessary to take care of them.

[Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001]. / Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001.

BACKGROUND: Many studies have proposed Avoidable Mortality (ME) to monitor the performance of health services although its usefulness is limited by the multiplicity of the avoidable mortality lists being used. Time trends from 1986-2001 and the geographical distribution of avoidable mortality by provinces, are presented for Spain. METHODS: An Avoidable Mortality consensus list is being used. It includes avoidable mortality through the intervention of health services (ISAS in Spanish) and through health policy interventions (IPSI in Spanish). Time trends are analyzed adjusting Poisson or Joinpoint regression models and the annual percentages of change (APC) are estimated. Changes in geographical distribution between the first half of the analysed period and the second are tested by means of standard mortality ratios (SMR) and comparative mortality rates (CMR) for each province. RESULTS: Between 1986 and 2001 avoidable mortality decreased (APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidable mortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction was observed for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) and an irregular trend for IPSI (between 1986-1990 increase APC: 4.86; CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72 and -2.40). CONCLUSIONS: Avoidable mortality decreased more than non avoidable mortality and important geographical variability can be observed among provinces which should be monitored in order to identify the health services weaknesses. The higher ISAS mortality was observed in southern provinces and the higher IPSI mortality in some areas on the coast. The pattern is somewhat similar for both analyzed periods.

Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001 / Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001

Fundamento: Muchos estudios proponen la mortalidad evitable(ME) como indicador para monitorizar los servicios de salud aunquesu generalización está limitada por el gran número de listas de causasutilizadas. El objetivo es analizar la evolución temporal del período1986-2001 y la distribución geográfica de la mortalidad evitable utilizandouna lista de causas consensuada.Métodos: Se analiza la mortalidad evitable global (ME) y agrupadaen causas ISAS (intervenciones de los servicios sanitarios) ycausas IPSI (políticas intersectoriales). Se analiza la evolución temporalajustando una recta de regresión de Poisson o un modelo deregresión de Joinpoint, según el caso, y se estima el porcentaje decambio anual (PCA). Para la distribución geográfica se calculan losíndices de mortalidad estandarizada (IME) por provincia y la razónde mortalidad comparativa (RMC) de cada provincia entre la primeray la segunda parte del periodo temporal.Resultados: Entre 1986-2001 la mortalidad evitable se redujo(PCA -1,68; IC:-1,99 a -1,38) algo más que la no-evitable (PCA -1,28; IC:-1,40 a -1,17). La mayor disminución se observó en la mortalidadpor causas ISAS (PCA del -2,77; IC: -2,89, -2,65) mientrasque la mortalidad por causas IPSI aumentó entre 1986-1990 (PCAdel 4,86; IC: 3,32 y 6,41), se mantiene constante de 1990-1995 (PCAdel -0,03; IC: -2,32 y 2,31) y disminuyó de 1995-2001 (PCA del -3,57; IC: -4,72 y -2,40). Conclusiones: Durante el período estudiado la mortalidad evitableha tenido una reducción mayor que la no evitable y se observandiferencias importantes entre provincias que sería necesario monitorizarpara tratar de identificar posibles disfunciones en los serviciossanitarios. La mortalidad es superior por causas ISAS en la zona surde España y por causas IPSI en algunas provincias costeras y estepatrón no varió mucho en el período analizado

Background: Many studies have proposed Avoidable Mortality(ME) to monitor the performance of health services although itsusefulness is limited by the multiplicity of the avoidable mortalitylists being used. Time trends from 1986-2001 and the geographicaldistribution of avoidable mortality by provinces, are presented forSpain.Methods: An Avoidable Mortality consensus list is being used.It includes avoidable mortality through the intervention of healthservices (ISAS in Spanish) and through health policy interventions(IPSI in Spanish). Time trends are analyzed adjusting Poisson orJoinpoint regression models and the annual percentages of change(APC) are estimated. Changes in geographical distribution betweenthe first half of the analysed period and the second are tested bymeans of standard mortality ratios (SMR) and comparative mortalityrates (CMR) for each province.Results: Between 1986 and 2001 avoidable mortality decreased(APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidablemortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction wasobserved for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) andan irregular trend for IPSI (between 1986-1990 increase APC: 4.86;CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72and -2.40). Conclusions: Avoidable mortality decreased more than nonavoidable mortality and important geographical variability can beobserved among provinces which should be monitored in order toidentify the health services weaknesses. The higher ISAS mortalitywas observed in southern provinces and the higher IPSI mortality insome areas on the coast. The pattern is somewhat similar for bothanalyzed periods