Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study.

Background: Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods: A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results: Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions: Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.

Quantifying the influence of urban biotic and abiotic environmental factors on great tit nestling physiology.

There is a long history of avian studies investigating the impacts of urbanization. While differences in several life-history traits have been documented, either between urban and rural populations or across generalized urbanization gradients, a detailed understanding of which specific environmental variables cause these phenotypic differences is still lacking. Here, we quantified several local environmental variables coupled to urbanization (air pollution, tree composition, ambient temperature, and artificial light at night [ALAN]) within territories of breeding great tits (Parus major). We linked the environmental variables to physiological measures of the nestlings (circulating fatty acid composition [FA], antioxidant capacity and an oxidative damage marker [malondialdehyde; MDA]), to garner a mechanistic understanding of the impact of urbanization. We found that the antioxidant capacity of nestlings decreased with higher numbers of oak trees and levels of PM2.5 (airborne particulate matter with a diameter < 2.5 µm). Furthermore, the ratio of ω6:ω3 polyunsaturated FAs, important for immune function, was positively correlated with PM2.5 concentration, while being negatively associated with ambient temperature and number of non-native trees in the territory. Body mass and wing length both increased with the number of local oak trees. We also show, through a principal component analysis, that while the environmental variables fall into an urbanization gradient, this gradient is insufficient to explain the observed physiological responses. Therefore, accounting for individual environmental variables in parallel, and thus allowing for interactions between these, is crucial to fully understand the urban ecosystem.

Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care: a pilot cluster-randomized-controlled trial.

BACKGROUND: There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). METHODS: A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). RESULTS: A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63-2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23-10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43-5.00); P = 0.02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60-3.57; P < 0.001). CONCLUSIONS: The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.

The Beginning of the Trend Change in Lung Cancer Mortality Trends in Spain, 1980-2018 / El comienzo del cambio de tendencia en las tasas de mortalidad por cáncer de pulmón en España, 1980-2018

BACKGROUND: Recently, some countries have shown stable trends in lung cancer death rates among women not yet described for Spain. We propose to update lung cancer mortality rates in Spain during the period of 1980-2018 by sex and region. METHODS: We used lung cancer mortality (International Classification of Diseases code 162 for the 9th edition, and codes C33 and C34 for 10th edition) and population data from the Spanish National Statistics Institute for the period 1980-2018. Age-standardised mortality rates (ASMRs), all ages and 30-64 years, by region and sex were assessed through joinpoint regression. RESULTS: During the study period lung cancer ASMRs (all ages) in men decreased -0.4% per annum and increased by 3.1% in women. Recently, ASMR (30-64 years) accelerated its decrease (1992-2007; −0.7 and 2007-2018; −3.5%) in men and slowed its increase (1990-2012; 5.7% and 2012-2018; 1.4%) in women. In men, joinpoint analysis detected an initial period in all Autonomous Communities (ACs) in which the rates significantly increased, followed by a second period in which the rates decreased significantly (12 ACs) or remained stable (4 ACs) since the late 1980s or early 1990s. In women, upward trends in ASMRs (all ages) were observed for the whole period in all the ACs. In 13 ACs, an initial period was detected with joinpoint in which the rates remained stable or significantly decreased, followed by a second period in which the rates increased significantly since the late 1980s or early 1990s. CONCLUSIONS: Our study shows gender differences in lung cancer mortality trends in Spain. These differences may be explained by the increased use of tobacco among women and the decreased use among men

ANTECEDENTES: Recientemente, algunos países han mostrado tendencias estables en las tasas de mortalidad por cáncer de pulmón entre las mujeres que aún no se han descrito para España. Proponemos actualizar las tasas de mortalidad por cáncer de pulmón en España durante el período 1980-2018 por sexo y región. MÉTODOS: Utilizamos la mortalidad por cáncer de pulmón (código 162 de la Clasificación Internacional de Enfermedades según la novena edición, y los códigos C33 y C34 según la décima edición) y los datos poblacionales del Instituto Nacional de Estadística de España para el período 1980-2018. Las tasas específicas de mortalidad por edad (TEME), para todas las edades y entre los 30 y 64 años, por región y sexo, se evaluaron mediante el análisis de regresión por segmentos. RESULTADOS: Durante el período de estudio, la TEME (todas las edades) de cáncer de pulmón disminuyó un −0,4% por año en hombres y aumentó un 3,1% en mujeres. Recientemente, la TEME (30-64 años) aceleró su descenso (1992-2007: −0,7% y 2007-2018: −3,5%) en los hombres y desaceleró su aumento (1990-2012: 5,7% y 2012-2018: 1,4%) en las mujeres. En los hombres, el análisis de regresión por segmentos detectó un período inicial en todas las comunidades autónomas (CA) en el que las tasas aumentaron significativamente, seguido de un segundo período en el que las tasas disminuyeron significativamente (12 CA) o se mantuvieron estables (4 CA) desde finales de la década de los ochenta o principios de los noventa. En las mujeres, las tendencias al alza en la TEME (todas las edades) se observaron durante todo el período en todas las CA. En 13 CA, se detectó con el análisis de regresión un período inicial en el que las tasas se mantuvieron estables o disminuyeron significativamente, seguido de un segundo período en el que las tasas aumentaron significativamente desde finales de los años ochenta o principios de los noventa. CONCLUSIONES: Nuestro estudio muestra diferencias de género en las tendencias de mortalidad por cáncer de pulmón en España. Estas diferencias pueden explicarse por el aumento del uso de tabaco en las mujeres y la disminución del uso entre los hombres

Regional differences in colorectal cancer mortality trends, Spain (1980-2018).

INTRODUCTION: the aim of this study was to describe the trends of colorectal cancer (CRC) mortality by autonomous communities (ACs) and gender in Spain (1980-2018). METHODS: the age-standardized mortality rates (ASMRs) for CRC (per 100,000) were calculated by direct standardization, using the world standard population. Mortality trends were described by ACs using a joinpoint regression model in both sexes. The annual percent changes and average annual percentage of change were computed for trends using the joinpoint regression analysis. RESULTS: during the most recent five-year period (2014-2018), the rates decreased among both males and females and were more pronounced in males (-2.3 %) than in females (-1.1 %), although with differences by ACs. ASMRs decrease in both sexes in the Basque Country, Canary Islands, Catalonia, Castile and Leon, Andalusia, Balearic Islands, Madrid, Murcia and Valencia. Whereas in other ACs, it only increases in males (Navarre, Castile-La Mancha, Extremadura and La Rioja) or females (Aragon, Asturias and Galicia). CONCLUSION: this updated analysis of temporal patterns of CRC mortality in Spain from 1980-2018, divided by ACs and sex, shows gender differences in CRC mortality trends. Despite the favorable trends in both sexes, the gender gap is widening.

The Beginning of the Trend Change in Lung Cancer Mortality Trends in Spain, 1980-2018.

BACKGROUND: Recently, some countries have shown stable trends in lung cancer death rates among women not yet described for Spain. We propose to update lung cancer mortality rates in Spain during the period of 1980-2018 by sex and region. METHODS: We used lung cancer mortality (International Classification of Diseases code 162 for the 9th edition, and codes C33 and C34 for 10th edition) and population data from the Spanish National Statistics Institute for the period 1980-2018. Age-standardised mortality rates (ASMRs), all ages and 30-64 years, by region and sex were assessed through joinpoint regression. RESULTS: During the study period lung cancer ASMRs (all ages) in men decreased -0.4% per annum and increased by 3.1% in women. Recently, ASMR (30-64 years) accelerated its decrease (1992-2007; -0.7 and 2007-2018; -3.5%) in men and slowed its increase (1990-2012; 5.7% and 2012-2018; 1.4%) in women. In men, joinpoint analysis detected an initial period in all Autonomous Communities (ACs) in which the rates significantly increased, followed by a second period in which the rates decreased significantly (12 ACs) or remained stable (4 ACs) since the late 1980s or early 1990s. In women, upward trends in ASMRs (all ages) were observed for the whole period in all the ACs. In 13 ACs, an initial period was detected with joinpoint in which the rates remained stable or significantly decreased, followed by a second period in which the rates increased significantly since the late 1980s or early 1990s. CONCLUSIONS: Our study shows gender differences in lung cancer mortality trends in Spain. These differences may be explained by the increased use of tobacco among women and the decreased use among men.

Is the pace of decline in cardiovascular mortality decelerating in Spain?

INTRODUCTION AND OBJECTIVES: To update the information on mortality from cardiovascular diseases and assess recent trends in Spain. METHODS: Deaths from cardiovascular diseases (codes I20-I25, I50, I05-I09, I00-I02, I26-I49, I51, I52, I60-I69, I10-I15, and I70-I79 of the 10th revision of the International Classification of Diseases and Causes of Death) were obtained from the National Statistics Institute. Trends were analyzed using Joinpoint regression models. The results revealed the years (periods) composing each trend, as well as the annual percent change for each of them. The direction and magnitude of recent trends (last available 5-year period) were assessed by using the average annual percent change. RESULTS: The decline in mortality rates from cardiovascular diseases slowed from -3.7% and -4.0% in 1999-2013 to -1.7% and -2.2% since 2013 in men and women, respectively. During the study period (1999-2018) all the analyzed causes decreased significantly. Nevertheless, recent trends differed according to age, sex, and the cause analyzed. Truncated rates (35-64 years) slowed (cardiovascular disease and stroke in men and ischemic heart disease in both sexes), stabilized (cardiovascular disease, stroke, and other heart diseases in women, and blood vessel disease in men), or increased (other diseases of the heart in men and diseases of the blood vessels in women). CONCLUSIONS: In Spain, as in other countries, the reduction in mortality rates from cardiovascular diseases slowed (overall rates for both sexes and truncated in men) or stabilized (truncated rates in women) from 2014 to 2018.

Tendencias divergentes en la mortalidad por suicidio según comunidad autónoma y sexo (1980-2016) / Divergent trends in suicide mortality by Autonomous Community and sex (1980-2016)

OBJETIVOS: Analizar los cambios en las tendencias de la mortalidad por suicidio según comunidad autónoma y sexo en España durante el período 1980-2016 utilizando modelos de regresión joinpoint. MÉTODOS: Los datos de mortalidad se obtuvieron del Instituto Nacional de Estadística. Para cada comunidad autónoma y sexo, se calcularon las tasas brutas y estandarizadas. El análisis de regresión joinpoint se utilizó para identificar los puntos más adecuados en los que se produjo un cambio estadísticamente significativo en la tendencia. RESULTADOS: El análisis joinpoint permite diferenciar comunidades en las que las tasas permanecen a lo largo de todo el periodo de estudio estables tanto en hombres (Cantabria, Castilla-La Mancha) como en mujeres (Canarias y Cantabria) y otras con un descenso continuado (Extremadura en hombres y mujeres y Castilla-La Mancha en mujeres). En aquellas comunidades en las que se observan cambios en la tendencia se aprecia, en casi todas ellas, un primer periodo de incremento en las tasas tanto en hombres como en mujeres. Las tendencias más recientes muestran divergencias entre las diferentes comunidades autónomas así, en los hombres, Andalucía, Canarias, Castilla-León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes significativas mientras que Cataluña y Madrid muestran incrementos significativos (2007-2016: 2,4% y 2010-2016: 18,7%, respectivamente). Algo similar se observa en las mujeres, para las que Andalucía, Castilla y León, Comunidad Valenciana, Galicia, Murcia, País Vasco y La Rioja muestran tendencias descendentes mientras que en Baleares, Cataluña y Madrid la tendencia es ascendente (2001-2016: 5,0%; 2006-2016: 4,2% y 2010-2016: 18,7% respectivamente). CONCLUSIONES: La mortalidad por suicidio varía ampliamente a nivel de comunidad autónoma, tanto en términos de nivel de mortalidad como de tendencias. Poco se sabe sobre los determinantes de las tendencias observadas y, por lo tanto, se necesitan más estudios

OBJECTIVES: To analyse the changes in mortality trends by suicide according to Autonomous Community and sex in Spain during the period 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the Instituo Nacional de Estadística. For each Spanish autonomous community and sex, crude and standardised rates were calculated. The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: The joinpoint analysis allows to differentiate areas in which the rates remain stable in men (Cantabria, Castilla-La Mancha) and women (Canary and Cantabria) throughout the study period and others with a continued decline (Extremadura in both men and women and Castilla-La Mancha in women). In those communities where changes in the trend are observed, in almost all of them, there is a first period of increase in rates in both men and women. The most recent trends show divergences between the different autonomous communities and, in men, Andalusia, the Canary Islands, Castilla-León, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends, while Catalonia and Madrid show significant increases (2007-2016: 2.4% and 2010-2016: 18.7% respectively). Something similar is observed in women where Andalusia, Castilla y León, Valencian Community, Galicia, Murcia, País Vasco and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001-2016: 5.0%; 2006-2016: 4.2% and 2010-2016: 18.7% respectively). CONCLUSIONS: Suicide mortality varies widely among the Spanish autonomous communities, both in terms of mortality level and trends. Little is known about the determinants of observed trends and, therefore, more studies are needed

Suicide mortality in Spain (1984-2018): age-period-cohort analysis. / Mortalidad por suicidio en España (1984-2018): análisis edad-período-cohorte.

OBJECTIVE: To assess the effects of age, period and cohort suicide mortality trend in Spain (1984-2018). METHODS: Mortality and population data were obtained from the National Institute of Statistics. The analysis of the effect of age, period of death and birth cohort on the evolution of suicide mortality in the period 1984-2018 was performed using a web tool for age-period-cohort analysis provided by the Division of Cancer Epidemiology and Genetics of the National Cancer Institute of the USA. RESULTS: Rates increase with age (age effect) in both sexes. The period effect shows, in males, an increase over the period 1984-1998 followed by a significant decrease until 2018. In females, rates remain stable over the period 1987-2002, decrease during 2007-2012 (p < 0.05) and eventually stabilise. In both males and females, the risk decreases in each successive birth cohort between 1904 and 1939. Subsequently, the risks increase until the birth cohort of the period 1964-1974 after which the risk decreases for males and remains stable for females. CONCLUSION: A better understanding of the effects of the birth cohort could open new doors in suicide prevention.

Tendencias de la mortalidad por suicidio en España, 1980-2016 / Suicide mortality trends in Spain, 1980-2016

OBJETIVOS: Analizar los cambios en las tendencias de la mortalidad por suicidio en España durante el periodo 1980-2016 utilizando modelos de regresión joinpoint. MÉTODOS: Los datos de mortalidad se obtuvieron del INE. Para cada sexo, las tasas específicas por grupo de edad y estandarizadas (general y truncada) (ASR) se calcularon por el método directo (utilizando la población estándar europea). El análisis joinpoint se utilizó para identificar los puntos más adecuados donde se produjo un cambio estadísticamente significativo en la tendencia. RESULTADOS: La tasa de mortalidad por suicidio ajustada por edad en hombres pasó en el periodo de estudio de 9,8/100.000 varones en 1980 a 11,8 en el año 2016, con un incremento anual medio del 0,8%. En las mujeres, las tasas se incrementaron un 1,0% anual pasando de 2,7/100.000 mujeres en 1980 a 3,7 en 2016. El análisis joinpoint identificó 3 puntos de inflexión en las tasas, tanto en hombres (1986, 2000 y 2010) como en mujeres (1986, 2004 y 2010), que identifican cambios en la tendencia. En el periodo 2010-2016 las tasas se incrementan en las mujeres, mientras que en los hombres las tasas permanecen estables. CONCLUSIONES: Nuestro trabajo muestra un marcado aumento en la mortalidad por suicidio en las mujeres españolas (2010-2016), mientras que en los hombres las tasas permanecen estables. Poco sabemos sobre los determinantes del aumento y, por ello, son necesarios más estudios

OBJECTIVES: To analyse changes in suicide mortality trends in Spain between 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the INE. For each gender, age-group-specific and standardised (overall and truncated) rates (ASR) were calculated by the direct method (using the European standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: Age adjusted mortality rates due to suicide in men was 9.8/100,000 males in 1980 and 11.8 in 2016, with an average annual increase of .8%. In women, the rates increased by 1.0% per year from 2.7 women per 100,000 in 1980 to 3.7 in 2016. The joinpoint analysis identified three turning points in the rates for both men (1986, 2000 and 2010) and women (1986, 2004 and 2010), which identify changes in the trend. In the period 2010-2016 the rates increase in women while in men the rates remain stable. CONCLUSIONS: Our work shows a marked increase in mortality by suicide in Spanish women (2010-2016) while in men the rates remain stable. Little is known about the determinants of the increase and, therefore, more studies are needed

Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study.

PURPOSE: Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). METHODS: Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. RESULTS: Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was "slight" (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). CONCLUSION: Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters.

¿Y si la oxigenoterapia de alto flujo no es el tratamiento idóneo para la bronquiolitis en las plantas de hospitalización? / What if high flow oxygen therapy is not the ideal treatment for bronchiolitis on hospital wards?

No disponible

Suicide mortality trends in Spain, 1980-2016. / Tendencias de la mortalidad por suicidio en España, 1980-2016.

OBJECTIVES: To analyse changes in suicide mortality trends in Spain between 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the INE. For each gender, age-group-specific and standardised (overall and truncated) rates (ASR) were calculated by the direct method (using the European standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: Age adjusted mortality rates due to suicide in men was 9.8/100,000 males in 1980 and 11.8 in 2016, with an average annual increase of .8%. In women, the rates increased by 1.0% per year from 2.7 women per 100,000 in 1980 to 3.7 in 2016. The joinpoint analysis identified three turning points in the rates for both men (1986, 2000 and 2010) and women (1986, 2004 and 2010), which identify changes in the trend. In the period 2010-2016 the rates increase in women while in men the rates remain stable. CONCLUSIONS: Our work shows a marked increase in mortality by suicide in Spanish women (2010-2016) while in men the rates remain stable. Little is known about the determinants of the increase and, therefore, more studies are needed.

Divergent trends in suicide mortality by Autonomous Community and sex (1980-2016). / Tendencias divergentes en la mortalidad por suicidio según comunidad autónoma y sexo (1980-2016).

OBJECTIVES: To analyse the changes in mortality trends by suicide according to Autonomous Community and sex in Spain during the period 1980-2016 using joinpoint regression models. METHODS: Mortality data were obtained from the Instituo Nacional de Estadística. For each Spanish autonomous community and sex, crude and standardised rates were calculated. The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred. RESULTS: The joinpoint analysis allows to differentiate areas in which the rates remain stable in men (Cantabria, Castilla-La Mancha) and women (Canary and Cantabria) throughout the study period and others with a continued decline (Extremadura in both men and women and Castilla-La Mancha in women). In those communities where changes in the trend are observed, in almost all of them, there is a first period of increase in rates in both men and women. The most recent trends show divergences between the different autonomous communities and, in men, Andalusia, the Canary Islands, Castilla-León, the Valencian Community, Galicia, Murcia, the Basque Country and La Rioja show significant downward trends, while Catalonia and Madrid show significant increases (2007-2016: 2.4% and 2010-2016: 18.7% respectively). Something similar is observed in women where Andalusia, Castilla y León, Valencian Community, Galicia, Murcia, País Vasco and La Rioja show downward trends while in the Balearic Islands, Catalonia and Madrid the trend is upward (2001-2016: 5.0%; 2006-2016: 4.2% and 2010-2016: 18.7% respectively). CONCLUSIONS: Suicide mortality varies widely among the Spanish autonomous communities, both in terms of mortality level and trends. Little is known about the determinants of observed trends and, therefore, more studies are needed.

Evolución espaciotemporal del riesgo de mortalidad por suicidio en la España peninsular (1999-2018) / Spatial-temporal evolution of suicide mortality risk in mainland Spain (1999-2018)

INTRODUCCIÓN: El suicidio es un importante problema de salud, cuyas razones subyacentes y patrones de riesgo espaciotemporales no se conocen bien. Este estudio ecológico tuvo como objetivo describir y caracterizar los patrones espaciotemporales del suicidio en la España peninsular durante el período 1999-2018. MÉTODOS: Los datos de mortalidad por suicidios y de población a nivel provincial se obtuvieron del Instituto Nacional de Estadística. Para cada año, provincia y sexo, analizamos los riesgos relativos suavizados (RRs) de mortalidad por suicidio utilizando modelos jerárquicos bayesianos. RESULTADOS: Durante el período de estudio se produjeron 63.307 muertes por suicidio, 47.849 en hombres y 15.458 en mujeres. El riesgo de suicidio durante todo el período de estudio estuvo por encima del promedio nacional para ambos sexos en las provincias de Granada, La Coruña, Lugo y Asturias. En los hombres, esto también ocurrió en Jaén. Los hombres en Madrid y Cantabria, y las mujeres en Madrid, Toledo y Badajoz, mostraron RRs menores de 1 (PP<0,05) durante los 20 años del estudio. El mapa de probabilidades posteriores indica que la mayoría de las provincias en la zona noroeste (Pontevedra, La Coruña, Lugo y Asturias en ambos sexos y León y Orense en mujeres) y el sudeste (Jaén, Málaga, Granada, Almería en ambos sexos, y Córdoba y Ciudad Real en hombres) presentaron riesgos significativamente altos (probabilidades posteriores mayores de 0,95). CONCLUSIONES: Nuestros hallazgos, al identificar áreas donde dirigir programas o estrategias para reducir o eliminar el riesgo de mortalidad por suicidio, muestran la importancia de este tipo de análisis para abordar los problemas de salud pública relacionados con este fenómeno

BACKGROUND: Suicide is a major health problem, whose underlying reasons and spatial-temporal risk patterns are not well understood. This ecological study aims to describe and characterize the spatiotemporal patterns of suicide in mainland Spain during the period 1999-2018. METHODS: Data on mortality from suicide and population at the provincial level were obtained from the National Institute of Statistics. For each year, province, and sex, we analysed the smoothed relative risks (RRs) of suicide mortality using Bayesian hierarchical models. RESULTS: During the study period there were 63,307 suicide deaths, 47,849 in men and 15,458 in women.The risk of suicide throughout the study period is above the national average for both sexes in the provinces of Granada, La Coruña, Lugo and Asturias. In men, this also happens in Jaen. Men in Madrid and Cantabria and women in Madrid, Toledo and Badajoz showed RRs less than 1 (PP<0.05) during the 20 years of the study. The posterior probabilities map indicates that most of the provinces in the Northwest zone (Pontevedra, La Coruña, Lugo and Asturias in both sexes and Leon and Orense in women) and Southeast (Jaen, Malaga, Granada, Almería in both sexes, and Cordoba and Ciudad Real in men) present significantly high risks (posterior probabilities greater than 0.95). CONCLUSIONS: Our findings, identifying areas where to direct programs or strategies to reduce or eliminate the risk of mortality by suicide, show the importance of this type of analysis in addressing public health problems

Prolonged slow expiration technique improves recovery from acute bronchiolitis in infants: FIBARRIX randomized controlled trial.

OBJECTIVE:: To examine the effect of prolonged slow expiration respiratory physiotherapy treatment on the acute bronchiolitis severity scale and O2 saturation at short-time and at medical discharge in infants and the hospital stay. DESIGN:: Randomized controlled trial. SETTING:: Infants' unit of university hospital. PARTICIPANTS:: Infants with acute bronchiolitis ( N = 80). INTERVENTION:: Infants were randomized into respiratory treatment (RT) with prolonged slow expiration or treatment as usual (control) for one-week period. MAIN OUTCOME MEASURES:: The primary outcomes were Acute Bronchiolitis Severity Scale score and O2 saturation, recorded shortly after each intervention during the stay and at medical discharge, and the hospital stay. RESULTS:: The RT had a significantly lower Acute Bronchiolitis Severity Scale 10-minute after the first intervention (mean difference -1.7 points, 95% confidence interval (CI) -3.0 to -0.38), 2 hours after (-2.0 points, 95% CI -3.2 to -0.86) and the last day before medical discharge (-1.3 points, 95% CI -2.1 to 0.51). No changes were detected in O2 saturation. The survival analysis of time at medical discharge showed decrease in the average number of days to achieve an Acute Bronchiolitis Severity Scale of less than 2 points (RT: 2.6 days, 95% CI 2.1-3.1; Control: 4.4 days, 95% CI 3.6-5.1). CONCLUSION:: A prolonged slow expiration physiotherapy reduces Acute Bronchiolitis Severity Scale scores and does not change O2 saturation. Infants in RT group stay less days in hospital than infants in control group and no adverse events were detected.

Pleurodesis con sangre autóloga: una solución, segura y eficaz para el tratamiento de neumotórax persistente / Autologous "blood patch" pleurodesis: A safe and useful treatment for persistent pneumothorax in children

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