Multicentre study of haemodialysis costs.

BACKGROUND: Previous studies to determine the cost of haemodialysis (HD) in Spain have significant limitations: they are outdated or used indirect methods. There is also a lack of analysis performed simultaneously on Public centres (PC), with direct HD services, and partially state-subsidised centres (SC). This is an important issue since the two systems coexist in Spain. OBJECTIVES: To estimate the cost of HD replacement therapy for chronic renal failure in several centres. METHODS: This is a prospective and publicly-funded study, which estimates the costs for 2008 using a cost accounting system with specific allocation criteria. We collected demographic and comorbidity data for each centre. RESULTS: Six centres participated, two PC and four SC. There were no significant differences between centres in terms of patient demographics, time on haemodialysis and the Charlson comorbidity index. The total cost per patient per year ranged between € 46, 254 and € 33,130. The cost per patient per year (excluding vascular access and hospital admission) for PC was € 42, 547 and € 39, 289 and for SC € 32 872, € 29, 786, € 35, 461 and € 35, 294 (23% more in PC than SC). Costs related to staff/patient/year and consumables/patient/year were 67% and 83% respectively, higher for PC than SC. The highest percentage cost was for staff (average 30.9%), which showed significant variability between centres, both in absolute numbers (staff cost per patient per year between € 18,151 and € 8504) and as a percentage (between 42.6 % and 25.4%). CONCLUSIONS: Cost variability exists among different HD centres, and this can be attributed primarily to staff and consumables costs, which is higher for PC than SC.

[Use of statistics and the accessibility of original articles published in 3 anesthesiology journals]. / Análisis comparativo de tres revistas de anestesiologia en cuanto al uso de la estadística y accesibilidad de los artículos originales publicados.

OBJECTIVES: To determine the use of various statistical analyses and the degree of analysis-dependent and article-dependent accessibility to the reader of publications in anesthesiology journals with impact factors (included in the Science Citation Index) in comparison with Revista Española de Anestesiología y Reanimación. MATERIAL AND METHODS: We analyzed original articles published in 2004 by 3 journals: Anesthesiology, the British Journal of Anaesthesia, and the Revista Españlola de Anestesiología y Reanimación. We found 1214 instances of use of statistics in 386 of the 412 articles analyzed. Twenty-six original articles did not use statistical analyses. RESULTS: Statistics were used in 93.7% of the articles. The mean (SD) number of statistical tests used per article was 3.16 (132). Readers able to understand only descriptive statistics would find only a quarter of the articles' analyses comprehensible in all 3 of the journals studied. A reader familiar with second-level statistics (after the classification of Emerson and Colditz), would have an overall understanding of the analyses in 61.94% of the articles. Such a reader would be able to understand a higher percentage (76.67%) of articles in the Spanish anesthesiology journal. CONCLUSIONS: As a result of marked advances in the use of statistics in anesthesiology journals, readers are seeing more applications of higher-level statistics. Readers must therefore acquire greater knowledge of statistics in order to understand the methods used in original research publications. The results we report for analysis-dependent accessibility show that Revista Española de Anestesiología y Reanimación is easier to understand for readers with knowledge of middle-level statistics. Both Anesthestiology and the British Journal of Anaesthesia publish articles that apply more complex statistical analyses.

Análisis comparativo de tres revistas de Anestesiología en cuanto al uso de la estadística y accesibilidad de los artículos originales publicados / Use of statistics and the accessibility of original articles published in 3 anesthesiology journals

OBJETIVOS: Conocer la utilización de distintas pruebas estadísticas y el grado de accesibilidad análisisdependiente y artículo-dependiente en revistas de impacto en Anestesiología según el Science Citation Index (SCI) en relación con la Revista Española de Anestesiología y Reanimación (REDAR). MATERIAL Y MÉTODOS: Se analizaron los artículos originales publicados durante 2004, en tres revistas seleccionadas: Anesthesiology, British Journal of Anaesthesia y Revista Española de Anestesiología y Reanimación, registrando 1.214 pruebas estadísticas en 386 artículos originales de 412 analizados, ya que 26 originales no utilizaron estadística. RESULTADOS: El porcentaje de artículos con estadística fue del 93,7%. El número de estadísticos total por artículo fue de 3,16 (1,32) [media (desviación estándar)]. DISCUSIÓN: Se aprecia que un lector que sólo comprenda estadística descriptiva, será capaz de entender una cuarta parte de los análisis estadísticos usados en los artículos estudiados, independientemente de la revista estudiada. Un lector familiarizado con estadística de Segundo Nivel (Clasificación de Emerson y Colditz), entenderá globalmente, desde el punto de vista estadístico, el 61,94%, siendo este porcentaje más elevado para REDAR, del 76,67%. CONCLUSIONES: Como consecuencia del gran progreso en la utilización de la estadística en las revistas en Anestesiología, nos encontramos ante un incremento en los últimos años en el uso de estadística de alto nivel. Esta circunstancia obligará a obtener y mejorar los conocimientos sobre estadística para una mejor comprensión de la metodología de los artículos originales de las publicaciones científicas. Los resultados obtenidos respecto de la accesibilidad análisis-dependiente demuestran que la Revista Española de Anestesiología y Reanimación es de más fácil comprensión por lectores con nivel de conocimiento estadístico medio, y que tanto Anesthesiology como British Journal of Anaesthesia publican artículos que usan pruebas de mayor complejidad(AU)

OBJECTIVES: To determine the use of various statistical analyses and the degree of analysis-dependent and article-dependent accessibility to the reader of publications in anesthesiology journals with impact factors (included in the Science Citation Index) in comparison with Revista Española de Anestesiología y Reanimación. MATERIAL AND METHODS: We analyzed original articles published in 2004 by 3 journals: Anesthesiology, the British Journal of Anaesthesia, and the Revista Española de Anestesiología y Reanimación. We found 1214 instances of use of statistics in 386 of the 412 articles analyzed. Twenty-six original articles did not use statistical analyses. RESULTS: Statistics were used in 93.7% of the articles. The mean (SD) number of statistical tests used per article was 3.16 (1.32). Readers able to understand only descriptive statistics would find only a quarter of the articles' analyses comprehensible in all 3 of the journals studied. A reader familiar with second-level statistics (after the classification of Emerson and Colditz), would have an overall understanding of the analyses in 61.94% of the articles. Such a reader would be able to understand a higher percentage (76.67%) of articles in the Spanish anesthesiology journal. CONCLUSIONS: As a result of marked advances in the use of statistics in anesthesiology journals, readers are seeing more applications of higher-level statistics. Readers must therefore acquire greater knowledge of statistics in order to understand the methods used in original research publications. The results we report for analysis-dependent accessibility show that Revista Española de Anestesiología y Reanimación is easier to understand for readers with knowledge of middle-level statistics. Both Anesthesiology and the British Journal of Anaesthesia publish articles that apply more complex statistical analyses(AU)

Valoración de la eficacia del uso de protectores auditivos en multiexposición a ruido y contaminación química en la industria del metal / Evaluation of the effectiveness of the use hearing protection devices in noise and chemical contamination multiexposure in metal industry

En el presente artículo analizamos la eficacia preventiva de los Equipos de Protección Auditiva (EPI´s) en trabajadores sometidos a multiexposición laboral caracterizada por ruido y agentes químicos asociados, fluidos de corte y humos metálicos. Observamos en contra de lo esperado, significativa igual probabilidad de alteración Trauma Acústico Avanzado (TAA), independientemente del uso de protección en sujetos expuestos a ruidos y fluidos de corte, siendo la probabilidad significativamente mayor, a partir de los 25 años, en aquellos individuos expuestos a ruidos y agente humos metálicos. Puesto que está comprobado que el uso adecuado de los EPI´s reduce el NPS al que se expone el individuo en una medida aproximada de 15 dB(A), hemos de tener en cuenta un aspecto a nuestro juicio esencial como es la presencia del agente químico humos metálicos (especialmente el componente ototóxico CO); lógicamente los EPI´s protegen contra el ruido, pero no contra la emisión de contaminantes químicos, auténtico factor influyente en los resultados obtenidos

We have analyzed the precentive efficacy of the hearing protection equipments (EPI´s) in metal sector workers exposed to noise and chemical agents associated to “cut fluids” and metallic smokes at the working place. We observe that is equal probability of TAA alteration, independently of the use of EPI´s. However, we also observe that probability of alterations is higher from the age of 25 in this group. Considering that it has been proven in other different studies that the appropriate use of EPI´s reduces the exposition to noises (NPS) of the individual in ca. 15 dB(A) we conclude that the presence of the metallic smokes (ototoxic component CO primarily) is the factor that drives TAA alterations

Adquisición de un trauma acústico por multiexposición a tabaco y ruido laboral en la industria del metal / No disponible

El presente artículo forma parte de un amplio estudio sobre pérdida auditiva laboral en condiciones de multiexposición, es decir, por influencia conjunta de agentes físicos y químicos. Se analiza la influencia del consumo de tabaco y exposición a ruido, si bien es cierto que parte de la población analizada también está sometida a la influencia de otros humos y de otros ruidos extralaborales. Se analiza esta población en exposición múltiple, partiendo de una metodología basada en las "técnicas de seguimiento estadístico", en nuestro caso de seguimiento-resistencia, basadas en la obtención y contraste de las distribuciones logísticas. En trabajadores expuestos a ruido industrial, el hábito de fumar parece potenciar la probabilidad de adquisición de las afecciones TAI y TAA. Teniendo los peores resultados los fumadores de mas de 20 cigarrillos diarios y 20 años o mas de exposición laboral

This paper is part of a large study on occupational hearing loss linked to multi-exposure environments, that is to say, due to both physical and chemical agents. The effect of cigarette consumption and noise exposure is evaluated, although it is quite clear that part of the study population is also under the influence of metal smoke cutting fluids and noise exposure out of their workplace too. The study is based on this population under multiple exposures conditions. It arises from a methodology based on "statistical follow up techniques", in our case follow-up-resistance techniques, based on the obtaining and contrast of logistics distributions. Smoking among workers exposed to industrial noise, seems to encourage the probability of acquisition of Acute Acoustic Trauma (AAT) and Initial Acoustic Trauma (IAT). The worst results are of those smoking over 20 cigarettes a day and undergoing 20 years or more of occupational exposure

[Hospital-based evaluation of knowledge about their illness in a diabetic population]. / Valoración del nivel de conocimientos sobre su enfermedad en una población diabética hospitalaria.

OBJECTIVE: To evaluate a group of diabetics' understanding of their illness, both generally and in detail in various ways. Their understanding was also assessed in relation to gender, age, educational level, the type and length of evolution of their diabetes mellitus and what sort of diabetes training they had received. DESIGN: The study was observational. A questionnaire completed at a personal interview was used to collect data. SETTING: Hospital out-patient endocrinology clinics. PATIENTS AND OTHER PARTICIPANTS: 520 diabetics who attended out-patient clinics were selected. 35 were excluded because of auditory, linguistic or psychological problems. One patient refused to take part. MEASUREMENTS AND MAIN RESULTS: Sufficient understanding was observed only in the area concerning "glucose in the blood" (79.08% of right answers). With the exception of the length of the illness, a certain relationship between patients' understanding (both in determined areas and in general) and the rest of the variables was revealed. CONCLUSIONS: Except for understanding about the level of "glucose in the blood" important educational deficiencies in the group under study were detected. This showed the need to prioritise improvements in diabetes training, so that patients can better monitor their condition.

[Evaluation of the type of education received by a diabetic population regarding the disease]. / Evaluación del tipo de educación recibida sobre su enfermedad en una población diabética.

OBJECTIVE: To determine the type of diabetic instruction (reading materials, talks and/or courses) received by a group of diabetics in relation to a series of personal variables such as gender, age, education, type of diabetes mellitus, length of time ill and type of treatment. DESIGN: This was an observation study. Data was collected by means of a questionnaire filled in at a personal interview with the patients. SETTING: Out-patient hospital endocrinology clinics. PATIENTS AND OTHER PARTICIPANTS: 520 diabetic patients monitored in the out-patient clinics were selected at random. 35 were excluded because of their hearing, linguistic or psychological deficiencies. Only one patient refused to answer the questionnaire. MEASUREMENTS AND MAIN RESULTS: It was found that 63.07% of the patients surveyed had not done any reading or attended a course of diabetes training; 16.73% had been instructed through reading material and the remaining 20.19% had attended organised talks and/or courses about their illness. Additionally, there was statistically significant dependence between the kind of training received and patients' age (p < 0.001), educational level (p < 0.0001), the type of diabetes mellitus (p < 0.001), the length of time ill (p < 0.001) and the kind of treatment (p < 0.0001). CONCLUSIONS: In general the diabetic patients studied were found to have a deficient level of training. Therefore it is extremely important to organise talks and/or educational courses on their condition with the aim of raising their level of understanding and thus improve their control of the illness.

[Adaptation and validation of a test on knowledge about diabetes mellitus]. / Adaptación y validación de un test de conocimientos sobre la diabetes mellitus.

OBJECTIVE: To adapt and validate a Spanish language medium test, of theoretical general knowledge of diabetes mellitus (questionnaire from the University of Michigan). To determine the validity of the concurrent and discriminatory content and establish reliability. DESIGN: The study was observational. Validity was verified prior to data collection. To analyse the concurrent and discriminatory validity, a questionnaire was used in personal interview with the patients, and the degree of knowledge evaluated on certain variables. SETTING: Hospital outpatient endocrinology consultations. PATIENTS: 167 diabetic patients were chosen at random, from the outpatient visits. 14 patients who had developed hearing, or language problems, or who had problems of a psychological nature, were excluded. Only 1 patient refused to answer the questionnaire. MAIN MEASUREMENTS AND RESULTS: Validity of the content was confirmed after careful analysis of the questions on the questionnaire by medical specialists in endocrinology. It was found that the test had adequate concurrence (p less than 0.01) when the average general knowledge levels of certain group of patients are compared. It also had acceptable discriminatory validity (r = 0.56: p less than 0.0001) and reliability (alpha: 0.84; p less than 0.45). CONCLUSIONS: Adaptation and validation has been obtained for a test of theoretical general knowledge on diabetes mellitus, and the test was found to be applicable to the population under study.