Toenail zinc and risk of prostate cancer in the MCC-Spain case-control study.

BACKGROUND: Some researchers have suggested that zinc (Zn) could reduce the risk of prostate cancer (PC). However, research from observational studies on the relationship between PC risk and biomarkers of Zn exposure shows conflicting results. OBJECTIVES: To evaluate the association between toenail Zn and PC, considering tumour extension and aggressiveness, along with a gene-environment approach, exploring the interaction of individual genetic susceptibility to PC in the relationship between toenail Zn and PC. METHODS: In MCC-Spain study we invited all incident PC cases diagnosed in the study period (2008-2013) and recruited randomly selected general population controls. In this report we included 913 cases and 1198 controls with toenail Zn determined by inductively coupled plasma mass spectrometry. To measure individual genetic susceptibility, we constructed a polygenic risk score based on known PC-related single nucleotide polymorphisms. The association between toenail Zn and PC was explored with mixed logistic and multinomial regression models. RESULTS: Men with higher toenail Zn had higher risk of PC (OR quartile 4 vs.1: 1.41; 95% CI: 1.07-1.85). This association was slightly higher in high-grade PC [(ISUP≤2 Relative risk ratio (RRR) quartile 4 vs.1: 1.36; 1.01-1.83) vs. (ISUP3-5 RRR quartile 4 vs.1: 1.64; 1.06-2.54)] and in advanced tumours [(cT1-cT2a RRR quartile 4 vs.1: 1.40; 95% CI: 1.05-1.89) vs. (cT2b-cT4 RRR quartile 4 vs.1: 1.59; 1.00-2.53)]. Men with lower genetic susceptibility to PC were those at higher risk of PC associated with high toenail Zn (OR quartile 4 vs.1: 2.18; 95% CI: 1.08-4.40). DISCUSSION: High toenail Zn levels were related to a higher risk for PC, especially for more aggressive or advanced tumours. This effect was stronger among men with a lower genetic susceptibility to PC.

Association Between Assisted Reproductive Technology and Cerebral Palsy: A Meta-Analysis.

BACKGROUND: Since 1978 many children are born thanks to assisted reproductive technology (ART). However, the long-term effects of these therapies are still not fully known. Our objective is to evaluate the risk of cerebral palsy (CP) after ART compared with that in those spontaneously conceived (SC) and to examine this risk in single, multiple, and preterm births and the evolution of the risk over the years. METHODS: PubMed, Embase, and Web of Science databases were searched until December 2022. Studies were included if they studied CP cases in children born through ART. 16 studies were finally selected. Quality of studies was assessed using Newcastle Ottawa Scale. Pooled OR was estimated by weighting individual OR/RR by the inverse of their variance. A random-effect model was applied. To assess the causes of heterogeneity, we performed meta-regression analyses. RESULTS: A significantly high risk of CP was found (OR = 1.27; 95% CI 1.12 to 1.43) in children born through ART compared with those SC. This risk increased in singletons (OR = 1.48; 95% CI 1.23 to 1.79) but disappeared in multiple (OR = 1.05; 95% CI 0.93 to 1.18) and preterm births (OR = 1.09; 95% CI 0.87 to 1.37). We found a higher risk of CP in children born before the year 2000 (OR = 3.40; 95% CI 2.49 to 4.63). CONCLUSIONS: ARTs slightly increase the risk of CP once the effect of multiple gestation is controlled. Further studies are needed to clarify whether the techniques themselves, fertility problems, or associated maternal comorbidities are responsible for this risk.

The impact of the COVID-19 pandemic on childhood vaccination rates and the role of sociodemographic factors: A cohort study.

OBJECTIVE: This study examines the impact of the COVID-19 pandemic on both routine and non-routine vaccinations in infants during their initial 18 months of life, concurrently exploring the complex influence of sociodemographic factors. METHODS: A cohort study was conducted, involving 2007 children in two distinct periods: pre-pandemic (January-June 2018) and pandemic (March 2020-May 2021). Participants were classified into two cohorts: 962 children in the 2018 group and 1045 children in the 2020-21 group. Utilizing unconditional logistic regression, the association between vaccination (complete or non-routine) and socioeconomic factors was examined, with adjustments for potential confounding variables such as age, breastfeeding, gestational age, and twins. RESULTS: The study's analysis reveals that in the post-pandemic period, mothers were three times more likely to opt for non-routine vaccines (95% CI 2.25-4.23). However, no significant alterations were observed in routine vaccination rates. Protective factors for complete vaccination included having an employed mother, higher education, and a medium-to-high income. Conversely, a higher income was associated with a reduced likelihood of complete vaccination (OR 0.34, 95% CI 0.20-0.59). CONCLUSION: Contrary to initial expectations, this study concludes that the COVID-19 pandemic did not have a substantial impact on childhood complete vaccination rates. Nevertheless, a noticeable increase in the choice of non-routine vaccination was observed. Sociodemographic factors, such as maternal education, income, and employment status, emerged as key influencers, particularly in the context of deciding on non-routine vaccinations.

Characteristics of patients who died in the hospital emergency service during the SARS-CoV-2 pandemic: a retrospective cohort study in a tertiary hospital in Spain.

The objective of this study is to analyze the characteristics of patients who died in the Hospital Emergency Department (HED) of a Spanish third-level hospital, with a special focus on those who died due to SARS-CoV-2. A retrospective cohort study was conducted, including all patients over 18 years old who died in the Hospital Emergency Department (HED) of a Spanish third-level hospital located in Badalona, Spain, from Jun 2019 to Dec 2020. Various sociodemographic, clinical, and diagnostic variables of the patients were analyzed to identify potential risk factors associated with mortality. During the first wave of the COVID-19 pandemic, a total of 72 patients died in the HED, representing a 42% increase compared to the pre-pandemic period. Of the deceased patients, 11% were attributed to SARS-CoV-2. Furthermore, it was found that patients who died from SARS-CoV-2 during the first wave were significantly younger than those in the second wave, with an average age of 78.6 ± 3.1 years in the first wave and 91.8 ± 4.8 years in the second wave. No significant differences were found regarding gender or associated comorbidities. Overall, the mortality rate at the HED in relation to COVID-19 was low, and infected patients died at younger ages during the first wave compared to the second wave.

Risk of prostate cancer in the proximity of industrial installations: A multicase-control study in Spain (MCC-Spain).

BACKGROUND: Prostate cancer (PC) is the second most frequent tumor in men worldwide; however, its etiology remains largely unknown, with the exception of age and family history. The wide variability in incidence/mortality across countries suggests a certain role for environmental exposures that has not yet been clarified. OBJECTIVE: To evaluate the association between risk of PC (by clinical profile) and residential proximity to pollutant industrial installations (by industrial groups, groups of carcinogens, and specific pollutants released), within the context of a Spanish population-based multicase-control study of incident cancer (MCC-Spain). METHODS: This study included 1186 controls and 234 PC cases, frequency matched by age and province of residence. Distances from participants' residences to the 58 industries located in the study area were calculated and categorized into "near" (considering different limits between ≤1 km and ≤ 3 km) or "far" (>3 km). Odds ratios (ORs) and 95 % confidence intervals (95%CIs) were estimated using mixed and multinomial logistic regression models, adjusted for potential confounders and matching variables. RESULTS: No excess risk was detected near the overall industries, with ORs ranging from 0.66 (≤2 km) to 1.11 (≤1 km). However, positive associations (OR; 95%CI) were found, by industrial group, near (≤3 km) industries of ceramic (2.54; 1.28-5.07), food/beverage (2.18; 1.32-3.62), and disposal/recycling of animal waste (2.67; 1.12-6.37); and, by specific pollutant, near plants releasing fluorine (4.65; 1.45-14.91 at ≤1.5 km) and chlorine (5.21; 1.56-17.35 at ≤1 km). In contrast, inverse associations were detected near industries releasing ammonia, methane, dioxins+furans, polycyclic aromatic hydrocarbons, trichloroethylene, and vanadium to air. CONCLUSIONS: The results suggest no association between risk of PC and proximity to the overall industrial installations. However, some both positive and inverse associations were detected near certain industrial groups and industries emitting specific pollutants.

Historia del suero salino / Saline solutions in history

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Impacto de una campaña de mejora de la higiene de manos sobre el consumo de soluciones hidroalcohólicas en un hospital de tercer nivel / Impact of a hand hygiene campaign on alcoholic hand rub consumption in a tertiary hospital

ObjetivoValorar la influencia sobre el consumo de preparados de base alcohólica de una campaña de mejora de la higiene de manos, y más concretamente del desarrollo de talleres prácticos sobre higienización de manos en un hospital de tercer nivel del Servicio Cántabro de Salud.MétodosSe realizó un estudio ecológico con datos de enero de 2005 a diciembre de 2008. La variable dependiente fue el consumo de preparados de base alcohólica (ml/día). Como variable independiente se utilizó la campaña de mejora de la higiene de manos desarrollada en el Servicio Cántabro de Salud. Para valorar la relación del consumo con la campaña se utilizó un análisis de regresión lineal múltiple.Resultados y conclusionesDestaca la asociación entre la formación recibida sobre higiene de manos en las unidades de hospitalización y el consumo de preparados de base alcohólica, que mejora al consolidarse la campaña (año 2008) y demuestra un efecto positivo de ésta, en especial de sus aspectos formativos (AU)

ObjectiveTo evaluate the influence of a hand hygiene program on consumption of alcoholic hand rub, and specifically the impact of the development of hand washing training in a tertiary hospital belonging to the Cantabrian Health Service in Spain.MethodsWe performed an ecological study from January 2005 to December 2008. The dependent variable was consumption of alcoholic hand rub (ml/day). As the independent variable, we used the hand hygiene campaign developed by the Cantabrian Health Service. The relationship between alcoholic hand rub consumption and the campaign was evaluated using multiple linear regression.Results and conclusionsThe training received in hand hygiene in hospital wards was associated with consumption of alcoholic hand rub, which improved as the campaign became consolidated (in 2008) and showed a positive effect, particularly its training aspects (AU)

Respuesta: Análisis coste-efectividad de los tratamientos utilizando el «número de pacientes necesario a tratar» / Reply: Cost-effectiveness analysis of treatment options using the «number-needed-to-treat»

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Número necesario de tratamientos: interpretación y estimación en análisis multivariables y con datos censurados / Number needed to treat: Interpretation and estimation in multivariable analyses and censored data

El número necesario de tratamientos se ha recomendado como una forma sencilla de transmitir los resultados de un estudio, especialmente de un ensayo clínico. La mayor parte de las publicaciones lo estiman a partir de una tabla 2 × 2, como el inverso de la reducción absoluta de riesgos. No obstante, se ha llamado la atención sobre algunas limitaciones: la interpretación no resulta tan sencilla como se había pretendido, frecuentemente se ignora la estimación del intervalo de confianza, y los estudios en los que se estima una medida de efecto ajustado por factores de confusión no pueden utilizar las tablas 2 × 2 en el cálculo del número necesario de tratamientos. En este trabajo revisamos la forma de obtener la estimación puntual y el intervalo confianza en 4 situaciones: tablas 2 × 2, regresión logística, método de Kaplan-Meier y regresión de Cox (AU)

Number needed to treat has been recommended as an easy way to transmit results from a trial, especially controlled clinical trials. Most articles estimate it from a 2 × 2 table, as the inverse of the absolute risk reduction. However, some limitations have been pointed out: The interpretation is not as easy as claimed, confidence intervals are frequently not estimated, and the estimation from 2 × 2 tables is inadequate when the main effect measure has been estimated adjusting for confounding factors. In this paper, we revise how to obtain point estimations and confidence intervals of number needed to treat in 4 situations: 2 ×2 tables, logistic regression, Kaplan-Meier method, and Cox regression (AU)

Riesgos competitivos de muerte y equilibrio de Hardy-Weinberg en estudios de casos y controles sobre asociación entre genes y enfermedades / Competing risks of death and Hardy-Weinberg equilibrium in case-control studies of gene-disease association

Objetivo: Estudiar el impacto de los riesgos competitivos sobre el equilibrio de Hardy-Weinberg y sus consecuencias en los estudios de casos y controles sobre la relación gen-enfermedades de comienzo tardío. Métodos: A partir de una población que, respecto de un determinado gen, se encuentre en equilibrio de Hardy-Weinberg al nacer, se deduce la composición genética cuando el gen está asociado con una enfermedad letal de aparición precoz, y sus consecuencias sobre una enfermedad de comienzo tardío. Cuando se realiza un estudio de casos y controles con muestreo por densidad se obtiene una estimación no sesgada de la odds ratio, a pesar de que los controles no estén en equilibrio de Hardy-Weinberg. Resultados: Se presenta un ejemplo en el que el gen mutante se asocia con una mayor mortalidad precoz al romper el equilibrio de Hardy-Weinberg y da lugar a que en un estudio realizado en edades más avanzadas los controles se encuentren en desequilibrio, con una odds ratio de 1,61. Conclusión: Aunque las principales causas de desequilibrio de Hardy-Weinberg en los controles son un sesgo de selección o un error de genotipificación, un riesgo competitivo de muerte asociado con el gen mutante puede ocasionar que la muestra de controles esté en desequilibrio de Hardy-Weinberg

Objective: To study the impact of competing risks on Hardy-Weinberg equilibrium and their consequences in case-control studies of gene-late onset disease association. Methods: Based on a population born in Hardy-Weinberg equilibrium for a particular gene, the genetic composition when the gene is associated with a lethal early-onset disease and its consequences on a late-onset disease can be deduced. Odds ratios estimates are unbiased in case-control studies when controls are sampled by density, even if the controls are in Hardy-Weinberg disequilibrium. Results: An example in which a mutant gene is associated with early mortality is presented, producing a departure from Hardy-Weinberg equilibrium; as a result, controls in later ages are in disequilibrium, producing an odds ratio equal to 1.61. Conclusion: Although the main causes of Hardy-Weinberg disequilibrium in controls are selection bias or genotyping error, a competing risk of death associated with the mutant gene would also result in Hardy-Weinberg disequilibrium among controlsObjective: To study the impact of competing risks on Hardy-Weinberg equilibrium and their consequences in case-control studies of gene-late onset disease association. Methods: Based on a population born in Hardy-Weinberg equilibrium for a particular gene, the genetic composition when the gene is associated with a lethal early-onset disease and its consequences on a late-onset disease can be deduced. Odds ratios estimates are unbiased in case-control studies when controls are sampled by density, even if the controls are in Hardy-Weinberg disequilibrium. Results: An example in which a mutant gene is associated with early mortality is presented, producing a departure from Hardy-Weinberg equilibrium; as a result, controls in later ages are in disequilibrium, producing an odds ratio equal to 1.61. Conclusion: Although the main causes of Hardy-Weinberg disequilibrium in controls are selection bias or genotyping error, a competing risk of death associated with the mutant gene would also result in Hardy-Weinberg disequilibrium among controls

Riesgos competitivos de muerte y equilibrio de Hardy-Weinberg en estudios de casos y controles sobre asociación entre genes y enfermedades / Competing risks of death and Hardy-Weinberg equilibrium in case-control studies of gene-disease association

Objetivo: Estudiar el impacto de los riesgos competitivos sobre el equilibrio de Hardy-Weinberg y sus consecuencias en los estudios de casos y controles sobre la relación gen-enfermedades de comienzo tardío. Métodos: A partir de una población que, respecto de un determinado gen, se encuentre en equilibrio de Hardy-Weinberg al nacer, se deduce la composición genética cuando el gen está asociado con una enfermedad letal de aparición precoz, y sus consecuencias sobre una enfermedad de comienzo tardío. Cuando se realiza un estudio de casos y controles con muestreo por densidad se obtiene una estimación no sesgada de la odds ratio, a pesar de que los controles no estén en equilibrio de Hardy-Weinberg. Resultados: Se presenta un ejemplo en el que el gen mutante se asocia con una mayor mortalidad precoz al romper el equilibrio de Hardy-Weinberg y da lugar a que en un estudio realizado en edades más avanzadas los controles se encuentren en desequilibrio, con una odds ratio de 1,61. Conclusión: Aunque las principales causas de desequilibrio de Hardy-Weinberg en los controles son un sesgo de selección o un error de genotipificación, un riesgo competitivo de muerte asociado con el gen mutante puede ocasionar que la muestra de controles esté en desequilibrio de Hardy-Weinberg

Objective: To study the impact of competing risks on Hardy-Weinberg equilibrium and their consequences in case-control studies of gene-late onset disease association. Methods: Based on a population born in Hardy-Weinberg equilibrium for a particular gene, the genetic composition when the gene is associated with a lethal early-onset disease and its consequences on a late-onset disease can be deduced. Odds ratios estimates are unbiased in case-control studies when controls are sampled by density, even if the controls are in Hardy-Weinberg disequilibrium. Results: An example in which a mutant gene is associated with early mortality is presented, producing a departure from Hardy-Weinberg equilibrium; as a result, controls in later ages are in disequilibrium, producing an odds ratio equal to 1.61. Conclusion: Although the main causes of Hardy-Weinberg disequilibrium in controls are selection bias or genotyping error, a competing risk of death associated with the mutant gene would also result in Hardy-Weinberg disequilibrium among controls

Variables relacionadas con la satisfacción laboral: un estudio transversal a partir del modelo EFQM / Variables related to job satisfaction. Cross-sectional study using the European Foundation for Quality Management [EFQM] model

Objetivos: Identificar la influencia de las dimensiones del apartado personas y características sociodemográficas del modelo EFQM en la alta satisfacción de los trabajadores de un hospital comarcal. Métodos: Estudio transversal realizado en noviembre de 2003. Se ha utilizado la encuesta de satisfacción de las personas del País Vasco. Variable resultado: alto grado de satisfacción (percentil 75 o mayor). Variables independientes: características sociodemográficas de las personas y las organizacionales. Para cuantificar el grado de asociación se ha utilizado la odds ratio (OR) y su intervalo de confianza del 95% (IC del 95%). Los factores de confusión se ajustaron mediante regresión logística no condicional. Resultados: En una escala del 0 al 10, la satisfacción general obtuvo una puntuación media (desviación estándar) de 5,95 (2). El 25% de los trabajadores valoró su satisfacción general con el clima organizacional como >= 8. Los aspectos mejor considerados fueron: el plan medioambiental, la relación jerárquica, la promoción y el desarrollo profesional. Los apartados peor valorados han sido la retribución, el conocimiento y la identificación con los objetivos, y la formación. Las variables más relacionadas con el efecto fueron la percepción favorable de la formación (OR ajustada = 5,04; IC del 95%, 2,16-11,77), y el reconocimiento del trabajo realizado (OR ajustado = 4,68; IC del 95%, 2,20-10,08). Los factores sociodemográficos presentaron menor influencia sobre la satisfacción. Conclusiones: En nuestro hospital casi la mitad de las personas se consideran satisfechas/muy satisfechas con el clima organizacional. La satisfacción está fuertemente asociada a la valoración positiva de características propias de la organización

Objectives: To identify the influence of the dimensions of people items and sociodemographic characteristics included in the EFQM model on high satisfaction of healthcare workers in a district hospital. Methods: We performed a cross-sectional study in November 2003. The questionnaire used was the personal satisfaction survey of the Basque Country (Spain). The outcome measure was a high degree of satisfaction (75th percentile or higher). Independent variables were sociodemographic and organizational characteristics. The association among variables was assessed using odds ratios (OR) and their 95% confidence interval (CI). Adjustment for confounders was performed by unconditional logistic regression. Results: On a scale from 0 to 10, the mean general satisfaction score was 5.95 (standard deviation, 2). Twenty-five percent of workers gave their general satisfaction with the organizational climate a score of 8 or more points. The most positively considered features were the environmental policy, hierarchical relations, promotion, and professional development. The most negatively viewed items were salary, knowledge and identification of objectives, and training. The variables most closely related to outcome were a favorable perception of training (adjusted OR = 5.04; 95% CI, 2.16-11.77) and recognition of the work performed (adjusted OR = 4.68; 95% CI, 2.20-10.08). Sociodemographic factors had less influence on satisfaction. Conclusions: Almost half of the staff surveyed in our hospital were satisfied or highly satisfied with the organizational climate. Satisfaction was strongly associated with positive evaluation of organizational characteristics

Observancia del lavado de manos entre los profesionales sanitarios / Hand hygiene adherence among health service workers of Cantabria, Spain

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Factores asociados a la técnica correcta en la higiene de manos / Factors related with the performance of a proper hand hygiene

Objetivo: Identificar factores asociados a la higienización de manos con técnica correcta en el contexto de una campaña de mejora. Material y método: Se realizaron 2 estudios transversales en 15 unidades asistenciales. La variable dependiente fue la técnica de higienización y las de exposición fueron aspectos asistenciales (grupo profesional, etc.) y relacionados con la campaña (formación en higiene de manos). Análisis estadístico: como medida de asociación se utilizó la odds ratio (OR) y su intervalo de confianza al 95% (IC 95%). El análisis ajustado se realizó mediante regresión logística.Resultados: El 12% de las higienizaciones se realizaron con técnica correcta. Entre los factores asociados destacan las unidades de cuidados intensivos (OR 4,07, IC 95% 1,95–8,51) y servicios quirúrgicos (OR 3,24, IC 95% 1,52–6,92), actividades de alto riesgo de transmisión de infección (OR 2,56, IC 95% 1,34–4,70) y el grupo de médicos (OR 2,52, IC 95% 0,93–6,85). La formación aumentó un 21% la probabilidad de higienización correcta por cada incremento de un 10% de profesionales formados (OR 1,21, IC 95% 1,01–1,45). Conclusiones: La formación incide positivamente en la técnica de higienización de manos especialmente en servicios quirúrgicos y profesionales médicos (AU)

Objetive: To identify factors related with the performance of a proper hand hygiene technique in a hand hygiene campaign. Methods: We developed two cross-sectional studies on 15 hospital units. The outcome variable was complied HH with proper technique and the exposures variables were care factors (unit, professional group, etc) and other factors related with the HH campaign (training on hand washing). Statistical analysis: The strength of association was measured using odds ratios (OR) with their 95% confidence interval (CI). Adjusting for confounders was performed using multiple logistic regression. Results: 12% of the observed 1241 hand hygiene were performed with proper technique. The strongest associated factors were ICUS (OR: 4.07 (CI 95% (1.95–8.51)), surgical wards (OR: 3.24 (CI 95% (1.52–6.92), procedures with high risk of contamination (OR: 2,56 CI 95% (1.34–4.70)), and physicians (OR: 2.52 CI 95% (0.93–6.85)). Training increased by 21% the probability of hand hygiene with proper technique for every 10% increase in trained health care workers (OR: 1.21 CI 95% (1.01–1.45). Conclusions: Hand Washing Training was associated with proper technique especially in surgical services and physicians (AU)

Influencia de la población estándar sobre las tasas de mortalidad ajustadas por edad: el ejemplo del cáncer de cérvix en España / No disponible

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Diferencias en la satisfacción percibida según el sexo en los pacientes ingresados en los hospitales del Servicio Cántabro de Salud / Differences in patient satisfaction by gender in users of hospitals in the Cantabrian Health Service

Objetivo: Estudiar diferencias en la calidad percibida, en función del sexo, por los pacientes hospitalizados en alguno de los hospitales del Servicio Cántabro de Salud, para modificar, en el caso de encontrar diferencias, las políticas organizativas de los centros y mejorar la calidad de la asistencia. Métodos: Estudio de corte transversal realizado en octubre de 2006, mediante el cuestionario SERVQHOS, telefónicamente. La base de datos del cuestionario se fusionó con la base del CMBD, de la que se extrajeron los datos sobre estancia media e intervención quirúrgica. Los datos se analizaron mediante la prueba de la t de Student-Fisher para las variables de tipo cuantitativo y la prueba de la χ2 para las variables dicotómicas, y se ajustó mediante regresión lineal. Resultados: La satisfacción percibida por los pacientes del Servicio Cántabro de Saludes similar en varones y mujeres. Los varones están más satisfechos en cuanto a la información a familiares y acompañantes sobre el lugar y los horarios de información clínica(el 92 frente al 85,2%; p < 0,01), la entrega de informe médico al alta (el 95,5 frente al90,9%; p = 0,01) y la proporción de pacientes que recibieron el informe de alta definitivo (el 71,6 frente al 64,7%; p = 0,02).Conclusiones: Las diferencias que se han encontrado en cuanto a la satisfacción percibida entre los varones y las mujeres en los hospitales del Servicio Cántabro de Salud no justifican que se tomen medidas organizativas a la hora de mejorar la calidad asistencial (AU)

Objective: To study differences in patient satisfaction by gender, among users of hospitalsin the Cantabrian Health Service, and if differences were found, to modify organizationalpolicies of the centers in order to improve the quality of care. Methods: A cross-sectional study was performed in October 2006, using the SERVQHOS questionnaire by telephone. The database of the questionnaire was merged with CMBD database, from which we extracted the length of stay and surgical data. The Student-Fisher t-test was used for quantitative variables and the χ2 test for qualitative variables. Adjustment was carried out by linear regression. Results: The patient satisfaction is similar in male and female users of the hospitals in the Cantabrian Health Service. Although men are more satisfied on the information to relatives on the place and times for clinical information (92% vs 85.2%; p < 0.01), the handing over of the discharge report (95.5% vs 90.9%; p = 0.01), and that the report was the definitive (71.6% vs 64.7%; p = 0.02).Conclusions: The differences we found in patient satisfaction by gender do not justify changes in hospital organization to try and improve the quality of care (AU)

Comparación entre varias poblaciones estándar para el ajuste por edades / Comparison betwen several standard populations for age-adjusting

FUNDAMENTO: Analizar el efecto que tiene la elección de una población de referencia sobre diferentes indicadores derivados de las tasas de mortalidad ajustadas por edad. MÉTODOS: Las tasas de mortalidad por diferentes causas de muerte en España de 1971 a 1992 son ajustadas empleando cuatro poblaciones de referencia: poblaciones españolas de 1971 y 1992, población estándar europea y población estándar mundial. Los resultados obtenidos con las cuatro poblaciones se comparan empleando tres indicadores: diferencia entre las tasas de 1992 y 1971, razón entre las tasas de 1992 y 1971y cambio anual porcentual entre 1971 y 1992. RESULTADOS: En la mayor parte de las causas de muerte estudiadas incluyendo el total de causas, la cardiopatía isquémica y casi todos los tumores, la razón de tasas y el porcentaje de cambio anual son similares con independencia de cuál sea la población estándar empleada. En cambio, la diferencia de tasas es muy diferente en función de la población de referencia. En las enfermedades infecciosas y el cáncer de testículo se produce la situación contraria: la diferencia de tasas es robusta mientras que la razón de tasas varía con la población estándar. Finalmente, la mortalidad por neumonía, enfermedad de Parkinson y cáncer de encéfalo muestra cambios en los tres indicadores utilizados. CONCLUSIONES: Es necesario realizar un análisis de las tasas específicas por edad antes de proceder a su ajuste. Este análisis permite averiguar si el ajuste por edades es correcto y qué indicador (diferencia, razón o cambio porcentual) será adecuado para realizar comparaciones (AU)

En busca de la excelencia: el perfil del paciente "supersatisfecho" / In search of excellence: profile of the "extremely satisfied" patient

Objetivo: La satisfacción con la atención sanitaria se consigue cuando el usuario descubre que el servicio le proporciona algo que no esperaba y supera sus expectativas. A través de este estudio, pretendemos identificar factores asociados a la "supersatisfacción", y valorar sus características sociodemográficas y asistenciales. Material y métodos: Estudio transversal realizado entre septiembre y noviembre de 2002. Se ha utilizado el cuestionario SERQVHOS, que se remitió por correo postal. Se consideró como variable resultado el alto grado de satisfacción y como variables independientes las características sociodemográficas de los pacientes, y las asistenciales de la atención agrupadas en bienestar, trato, organización, información y recursos. Para cuantificar el grado de asociación entre variables se ha utilizado el riesgo relativo (RR) y su intervalo de confianza (IC) del 95 por ciento. El análisis ajustado se realizó mediante regresión logística no condicional. Resultados: El 98 por ciento de los pacientes reconocen encontrarse "satisfechos o muy satisfechos" y casi la mitad (45,7 por ciento) "supersatisfechos" con la atención sanitaria recibida. La percepción favorable del bienestar destaca como variable asistencial más fuertemente asociada al efecto, multiplicándolo prácticamente por 12 (RR = 11,7; IC del 95 por ciento, 3,9-35,3). Entre los factores sociodemográficos destaca la influencia del sexo femenino (RR = 2,5; IC del 95 por ciento, 1,1-5,5).Conclusiones: En nuestro hospital, casi la mitad de los encuestados se consideran muy satisfechos con el nivel de atención recibido. La "supersatisfacción" resulta fuertemente asociada a características asistenciales de la atención (la percepción del bienestar durante el ingreso, la organización de la asistencia, la valoración de los recursos, el trato personal y la información recibida) (AU)