Self-perceived body weight and weight status: analysis of concordance by age group and sex.

OBJECTIVES: Previous studies suggest that there is discordance between actual weight status and body-weight perception. This fact has implications when it comes to designing public health interventions. The aim of this study was to estimate the prevalence of the different categories of weight status and body-weight perception and to analyse their concordance in a representative Spanish population sample. STUDY DESIGN: Cross-sectional study. METHODS: Data were sourced from the 2018 Galician Risk Behaviour Data System, with the target population being all persons aged 16 years and above. We collected data on self-perceived body weight and assessed weight status on the basis of body mass index (BMI). BMI was estimated using self-reported measures of weight and height. To estimate concordance, Cohen's kappa coefficient, both unweighted and weighted with Cicchetti weights, was calculated. RESULTS: Data were obtained for 7853 individuals aged 16 years and above, whereas the overall unweighted concordance was 0.393 (95%CI: 0.377-0.409), with an agreement percentage of 61.6%, weighted concordance was 0.503 (0.490-0.517), with an agreement percentage of 86.6%. The highest concordance between self-perceived body weight and weight status was observed in women. By age group, the highest concordance was observed in the youngest group (16-24 years) for the BMI categories of underweight and overweight, and in the 45-64 age group for the category of obesity. CONCLUSIONS: The results highlight the existence of differences between self-perceived body weight and weight status, according to sex and age.

Hospitalizaciones por y con enfermedad pulmonar obstructiva crónica en Galicia: 20 años de evolución / Hospitalizations due to and with chronic obstructive pulmonary disease in Galicia: 20 years of evolution

Objetivo Analizar la evolución de las hospitalizaciones relacionadas con enfermedad pulmonar obstructiva crónica (EPOC) en Galicia en el período 1996-2018, tanto como causa principal del ingreso (POR EPOC) como si se codificaba en cualquier posición diagnóstica (CON EPOC), estudiando la influencia de la edad, el sexo, la estacionalidad u otras causas principales del ingreso. Metodología Se realizó un análisis del conjunto mínimo básico de datos (CMBD) de Galicia sobre el primer ingreso por EPOC entre 1996 y 2018. Se calcularon tasas brutas, específicas y estandarizadas tanto globales como por sexo y por grupos de edad. Resultados En el período 1996-2018 se produjeron en Galicia 310.883 primeros ingresos CON EPOC, de los que el 29,6% fueron POR EPOC. Las tasas de ingresos tanto CON EPOC como POR EPOC aumentaron, fundamentalmente en varones. Existe una clara estacionalidad de los ingresos, especialmente relevante POR EPOC. La razón de masculinidad media es aproximadamente 4 en ambos escenarios, si bien es inferior en los grupos etarios extremos, sin cambios a lo largo del tiempo. La edad media al ingreso ha aumentado tres años en este período en los varones; en las mujeres no hubo variaciones. Las causas principales del ingreso cuando no es POR EPOC son insuficiencia cardíaca y neumonía. Conclusión La evaluación combinada de los registros de ingresos hospitalarios CON y POR EPOC aporta información complementaria para un mejor conocimiento de las tendencias de esta enfermedad y establecer hipótesis que expliquen los resultados descritos, aportando información para una mejor planificación sanitaria (AU)

Objective This work aims to analyze the evolution of COPD-related hospitalizations in Galicia from 1996 to 2018 both as main cause of admission (DUE TO COPD) or when coded in any diagnostic order (WITH COPD), assessing the influence of age, sex, seasonality, and other main causes of the hospitalization. Methods An analysis was conducted of administrative healthcare database (CMBD) data on index COPD-related hospitalizations in Galicia from 1996 to 2018. Crude, specific, and standardized rates were calculated for the entire sample and according to age and sex groups. Results In the period from 1996 to 2018, there were 310,883 index admissions WITH COPD in Galicia, of which 29.6% were DUE TO COPD. Both WITH COPD and DUE TO COPD admission rates increased, mainly in men. There was a clear seasonality that was especially relevant in the DUE TO COPD group. The mean male-to-female ratio was approximately 4:1 in both groups, although it was lower in the extreme age groups, with no change over time. The mean age at admission increased three years in men during this period; there were no changes among women. The main causes of admission in those not hospitalized DUE TO COPD were heart failure and pneumonia. Conclusion The combined evaluation of records of hospital admissions WITH COPD and DUE TO COPD offers additional information for a better understanding of the trends of this disease and allows for establishing hypotheses that explain the results described, providing information for better healthcare planning (AU)

Hospitalizations due to and with chronic obstructive pulmonary disease in Galicia: 20 years of evolution.

OBJECTIVE: This work aims to analyze the evolution of COPD-related hospitalizations in Galicia from 1996 to 2018 both as main cause of admission (DUE TO COPD) or when coded in any diagnostic order (WITH COPD), assessing the influence of age, sex, seasonality, and other main causes of the hospitalization. METHODS: An analysis was conducted of administrative healthcare database (CMBD) data on index COPD-related hospitalizations in Galicia from 1996 to 2018. Crude, specific, and standardized rates were calculated for the entire sample and according to age and sex groups. RESULTS: In the period from 1996 to 2018, there were 310,883 index admissions WITH COPD in Galicia, of which 29.6% were DUE TO COPD. Both WITH COPD and DUE TO COPD admission rates increased, mainly in men. There was a clear seasonality that was especially relevant in the DUE TO COPD group. The mean male-to-female ratio was approximately 4:1 in both groups, although it was lower in the extreme age groups, with no change over time. The mean age at admission increased three years in men during this period; there were no changes among women. The main causes of admission in those not hospitalized DUE TO COPD were heart failure and pneumonia. CONCLUSION: The combined evaluation of records of hospital admissions WITH COPD and DUE TO COPD offers additional information for a better understanding of the trends of this disease and allows for establishing hypotheses that explain the results described, providing information for better healthcare planning.

Mortalidad atribuida al consumo de tabaco en las comunidades autónomas de España, 2017 / Smoking-attributable mortality in the autonomous communities of Spain, 2017

Introducción y objetivos: Estimar la mortalidad atribuida (MA) al consumo de tabaco en las comunidades autónomas (CCAA) de España en población de edad ≥ 35 años en 2017. Métodos: Se estimó la MA empleando un método dependiente de prevalencias basado en el cálculo de fracciones atribuidas poblacionales. La mortalidad observada procede del Instituto Nacional de Estadística; las prevalencias de consumo por sexo y edad, de la Encuesta Nacional de Salud de 2011 y 2017 y la Encuesta europea de 2014, y los riesgos relativos, del seguimiento de 5 cohortes norteamericanas. Se presentan estimaciones de MA y fracciones atribuidas poblacionales para cada comunidad autónoma por causa de muerte, sexo y edad y tasas de MA específicas y ajustadas. Resultados: El tabaco causó 53.825 muertes en España en la población de 35 o más años (el 12,9% de la mortalidad total). La carga de MA sobre la mortalidad observada varía del 10,8% en La Rioja al 15,3% en Canarias. Tras ajustar las tasas de MA por edad, las diferencias entre CCAA se mantienen, y las tasas más altas en los varones se observan en Extremadura y en las mujeres, en Canarias. Las tasas ajustadas de los varones se correlacionan negativamente con las de las mujeres. El porcentaje que suponen las enfermedades cardiovasculares sobre la MA total de cada comunidad autónoma oscila entre el 21,8% de Castilla-La Mancha y el 30,3% de Andalucía. Conclusiones: La carga de MA al consumo de tabaco varía entre las CCAA. Realizar un análisis detallado por regiones aporta información relevante para la implantación de políticas sanitarias dirigidas a frenar el impacto del tabaquismo (AU)

Introduction and objectives: To estimate smoking-attributable mortality (SAM) in the regions of Spain among people aged ≥ 35 years in 2017. Methods: SAM was estimated using a prevalence dependent method based calculating the population attributable fraction. Observed mortality was derived from the National Statistics Institute. The prevalence of smoking by age and sex was based on the Spanish National Health Survey for 2011 and 2017 and the European Survey for 2014. Relative risks were reported from the follow-up of 5 North American cohorts. SAM and population attributable fraction were estimated for each region by age group, sex, and causes of death. Cause-specific and adjusted SAM rates were estimated. Results: Smoking caused 53 825 deaths in the population aged ≥ 35 years (12.9% of all-cause mortality). SAM ranged from 10.8% of observed mortality in La Rioja to 15.3% in the Canary Islands. The differences remained after rates were adjusted by age. The highest adjusted SAM rates were observed in Extremadura in men and in the Canary Islands in women. Adjusted SAM rates in men were inversely correlated with those in women. The percentage of total SAM represented by cardiovascular diseases in each region ranged from 21.8% in Castile-La Mancha to 30.3% in Andalusia. Conclusions: The distribution of SAM differed among regions. Conducting a detailed region-by-region analysis provides relevant information for health policies aiming to curb the impact of smoking (AU)

Using the modified Dixon technique to evaluate incidental adrenal lesions on 3T MRI. / Valoración mediante Dixon modificado de las lesiones suprarrenales incidentales en RM 3T.

OBJECTIVES: To use the mDIXON-Quant sequence to quantify the fat fraction of adrenal lesions discovered incidentally on CT studies. To analyze the relation between the signal loss between in-phase and out-of-phase T1-weighted sequences and the fat fraction in mDIXON-Quant. To compare the sensitivity and specificity of the two methods for characterizing adrenal lesions. MATERIAL AND METHODS: This prospective descriptive study included 31 patients with incidentally discovered adrenal lesions evaluated with 3T MRI using in-phase and out-of-phase T1-weighted sequences and mDIXON-Quant; the fat fraction of the adrenal lesions was measured by mDIXON-Quant and by calculating the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences. RESULTS: The percentage of signal loss was significantly higher in the group of patients with adenoma (61.3% ± 20.4% vs. 5.1% ± 5.8% in the group without adenoma, p<0.005). The mean fat fraction measured by mDIXON-Quant was also higher for the adenomas (26.9% ±10.8% vs. 3.4% ± 3.0%, p<0.005).The area under the ROC curve was 0.99 (0.96 - 1.00) for the percentage of signal loss and 0.98 (0.94 - 1.00) for the fat fraction measured by mDIXON-Quant. The cutoffs obtained were 24.42% for the percentage of signal loss and 9.2% for the fat fraction measured by mDIXON-Quant. The two techniques had the same values for diagnostic accuracy: sensitivity 96% (79.6 - 99.9), specificity 100% (39.8 - 100.0), positive predictive value 100% (85.8 - 100.0), and negative predictive value 80% (28.4 - 99.5). CONCLUSION: The fat fraction measured by the modified Dixon technique can differentiate between adenomas and other adrenal lesions with the same sensitivity and specificity as the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences.

Impact of a comprehensive law on the prevalence of tobacco consumption in Spain: evaluation of different scenarios.

OBJECTIVES: Since 2011, smoking legislation was hardened in Spain, banning tobacco consumption in all hospitality venues. Law 42/2010 was the first comprehensive tobacco control policy enacted in Spain. The aim of this paper is to evaluate the effect that this intervention has had in reducing the prevalence of tobacco consumption, setting up three scenarios on the basis of different theoretical levels of effect of the law. METHODS: A predictive model based on Markov Chains was developed to distinguish the effect of tobacco control policies in different scenarios. STUDY DESIGN: The model developed uses population, smoking rates and smoking characteristics from a non-transmissible disease surveillance system developed in Galicia (namely SICRI). RESULTS: Results show that tobacco control policies hardly affect the predicted trend in a temporal frame of 10 years, with relative reduction in the predicted male smoking prevalence of 20.4% with no intervention, reaching a reduction of 26.1% under the maximum effect of the policies. CONCLUSIONS: In the global population the effects of the law in the predicted prevalence have been barely perceived. For people under 25 years of age, interventions have had an important and positive effect, which proves that policies affecting this age group should be hardened.

Usefulness of 1H magnetic resonance spectroscopy in human testes: preliminary study.

AIM: To identify and quantify the metabolites detected on proton magnetic resonance spectroscopy ((1)H-MRS) in human testes. MATERIALS AND METHODS: The institutional review board approved the study, and all patients provided informed consent. A total of 27 patients consulting the Urology Department underwent single-voxel (1)H-MRS (4000 ms repetition time [RT], 31 ms echo time [TE], 128 averages for each TE) at 1.5 T. Spectroscopy was not evaluable in one patient, and four patients had only one testis; thus, 48 testes were studied. Choline-containing compounds (Cho) and methylene lipid (Lip) values were measured and the Cho/Lip ratio was calculated. Testes were classified as normal or abnormal based on conventional magnetic resonance imaging (MRI) findings. The Mann-Whitney U-test was used for correlated data and bootstrapping to compare mean Cho/Lip ratios between normal and abnormal testes, and the area under the receiver operating characteristic curve (AUC) was calculated. RESULTS: Thirty testes were classified as normal and 18 as abnormal. The mean Cho/Lip ratio was 1.02±0.46 in normal testes and 0.45±0.36 in abnormal testes (Mann-Whitney U, p=0.001; bootstrapping mean difference, 0.57; 95% confidence interval (CI) 0.32-0.82; AUC=0.833). CONCLUSION: (1)H-MRS could be useful in routine clinical practice to identify the major metabolites in the testes and help discriminate between normal and abnormal testes.

Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project].

AIM: To evaluate the effect of an educational intervention among primary care physicians on several indicators of good clinical practice in diabetes care. METHODS: Two groups of physicians were randomly assigned to the intervention or control group (IG and CG). Every physician randomly selected two samples of patients from all type 2 diabetic patients aged 40 years and above and diagnosed more than a year ago. Baseline and final information were collected cross-sectionally 12 months apart, in two independent samples of 30 patients per physician. The educational intervention comprised: distribution of educational materials and physicians' specific bench-marking information, an on-line course and three on-site educational workshops on diabetes. External observers collected information directly from the physicians and from the medical records of the patients on personal and family history of disease and on the evolution and treatment of their disease. Baseline information was collected retrospectively in the control group. RESULTS: Intervention group comprised 53 physicians who included a total of 3018 patients in the baseline and final evaluations. CG comprised 50 physicians who included 2868 patients in the same evaluations. Measurement of micro-albuminuria in the last 12 months (OR = 1.6, 95% CI: 1.1-2.4) and foot examination in the last year (OR = 2.0, 95% CI: 1.1-3.6) were the indicators for which greater improvement was found in the IG. No other indicator considered showed statistically significant improvement between groups. CONCLUSIONS: The identification of indicators with very low level of compliance and the implementation of a simple intervention in physicians to correct them is effective in improving the quality of care of diabetic patients.

Quality of care of patients with type-2 diabetes in Galicia (NW Spain) [OBTEDIGA project].

AIMS: The aim of this study was to describe the degree of compliance of agreed practices with reference to primary care patients with Type 2 diabetes of 40 years old and older in Galicia (NW Spain). METHODS: A total of 108 primary care physicians were selected at random from the totality of doctors. Each physician selected 30 patients at random from their patients suffering from diabetes of 40 years old or older. External observers gathered information from each patient's medical record regarding their characteristics, condition and degree of compliance of selected indicators of good practice. RESULTS: Group of physicians participated in this study had a mean age of 50 years (standard deviation = 3.9); 48% of them were females; and 17.5% involved in medical residents training. A total of 3078 diabetic patients were included in the study: mean age = 69 years (SD = 10.9), 47.6% women, presence of high blood pressure (72%), hypercholesterolaemia (56%), and regular smokers (10.3%). Compliance with selected indicators such as foot examination (14%), ophthalmological examination (30.6%), abdominal circumference measurement (6.1%), measurement of total or LDL-cholesterol (78.1), blood pressure measurement (84.8), glycosylated haemoglobin measurement < 7% (54.3%) was observed. Adequate monitoring in cases of high blood pressure and hypercholesterolaemia were 34.2% and 27.4%, respectively. Variability between physicians differs according to the different indicators, with interquartile range for compliance of between 16.4 and 66%. CONCLUSIONS: There is a wide margin for improvement in the adaptation of clinical practice to recommendations for diabetic patients. The large variation existing in certain indicators would suggest that certain control objectives are less demanding than advisable in those that comply least, while low compliance and low variability in other indicators point to structural problems or unsatisfactory training of doctors.

Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey.

BACKGROUND: The Fagerström Test for Nicotine Dependence (FTND) is used for assessing nicotine dependence. A shorter test derived from the FTND used for the general population is the Heavy Smoking Index (HSI) (six questions vs. two). The objective of this study is to compare the validity of the HSI versus the FTND. METHODS: A survey of tobacco use in the general population was carried out in the northern Spanish region of Galicia using both the FTND and the HSI to study a representative sample of 1655 daily smokers. The HSI was compared with the FTND, considered the gold standard. Measures of sensitivity, specificity and predictive values were calculated. Concordance between the tests was also established (Cohen's kappa). RESULTS: Cohen's kappa showed good agreement between measures (Kappa = 0.7); specificity values were also high (Sp = 96.2%). Sensitivity analysis in females (Se = 62.3%) did not show good agreement. CONCLUSIONS: The HSI can be used as a reasonably good screening test in order to identify daily smokers with high nicotine dependence. Nevertheless, for populations or subpopulations having low nicotine dependence, such as women, the FTND is more reliable.

An evaluation of spatio-temporal models for the estimation of the mortality relative risk from breast cancer in Galicia, Spain.

BACKGROUND: Disease mapping is now a big focus of interest in the area of Public Health, and the geographical distribution of a disease has an important role in understanding its origin or its causes. The purpose of this work is to review and evaluate different techniques to map the mortality risk of a disease in small geographical areas. METHODS: Three different methods have been studied. The first one is a classical approach consisting of mapping SMRs, which are maximum likelihood estimates of the relative risk under a Poisson model of death counts. In a second step we consider Poisson and negative binomial regression to fit the rates and finally we use a Bayesian approach that assumes a hierarchical model where the death counts follow a Poisson distribution conditioned by the prior information. These methods have been applied to the study of geographical variation in female breast cancer mortality from 1976 to 1999 in the districts of Galicia, Spain. RESULTS: Mapping the SMRs using the first method has important drawbacks and there are difficulties to distinguish the mortality pattern. With the second method we achieved some improvements. The Bayesian methodology produces smoother maps with a clear mortality pattern. DISCUSSION: These methods are powerful tools for identifying areas with elevated risk. The Bayesian methodology has many advantages over the other methods that had been analysed in this work.

[Space-time distribution of suicide in Galicia, Spain [1976-1998]]. / Distribución geográfica y temporal del suicidio en Galicia (1976-1998).

OBJECTIVE: To study the space-time distribution of suicide in Galicia from 1976 to 1998, taking into account gender, age, season and method of suicide. METHODS: For each sex crude and age-adjusted rates per province and age-specific rates per period (1978-84, 1985-91, 1992-98) were calculated. To estimate mortality risk and time trends in the municipalities, a Bayesian hierarchical model was used. RESULTS: In the last few years mortality from suicide has increase considerably. Age-adjusted rates of 6 per 105 at the beginning of the study rose to 10 per 105 at the end. The increase was greatest among men. The higher rates were observed in the elderly, although in terms of time trends the highest increase occurred among adolescents and young adults. In both sexes the main method of suicide was hanging. Less common methods were jumping from a height and shooting. The greatest number of suicides took place during the spring and summer months. In terms of spatial distribution, a high number of suicides were committed in the province of Lugo; in the municipalities, mortality risk decreased from North to South and an inverse temporal trend was observed in both sexes. This differed from the space-time patterns of suicides committed using methods other than hanging. CONCLUSIONS: Suicide is an important health problem in Galicia not only because to its magnitude but also because of the increasing rates, especially among young people. Geographical and temporal analysis can identify priority areas where preventive policies should be implemented.