Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study.

BACKGROUND: Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. METHODS: Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. DISCUSSION: Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.

Validation of a Questionnaire of Food Education Content on School Catering Websites in Spain.

The aim of this study was to design and validate a questionnaire on quality and food education on catering company websites. For the validation of the questionnaire, its reliability, feasibility and content validity characteristics were determined. For content validity, a panel of experts was used and the overall and item-wise Content Validity Index (CVI) of the experts' responses was calculated. Reliability was determined by the inter-judge agreement method with the analysis of 30 websites using the intraclass correlation coefficient (ICC) and the Bland and Altman plot. Adequate content validity was verified by obtaining a very high CVI (above 0.80) in the analysis of the expert panel's responses and excellent inter-observer agreement with a very high global ICC (above 0.90) value in the determination of test-retest reliability. The questionnaire is a valid instrument for the evaluation of the quality of school catering websites and their content in food education, as it has good feasibility, high content validity and excellent reliability.

Prevalence of Overweight and Obesity in Children of Immigrant Origin in Spain: A Cross-Sectional Study.

Social determinants of health are a major contributing factor to health inequalities and have important effects on the health of the population. The aim of the study was to estimate the prevalence of overweight/obesity in native and immigrant children aged 2-14 years residing in Spain, and to explore its relationship with socioeconomic factors, habits, and living and health conditions. This study used data from the 2017 Spanish National Health Survey, which collects health information on the population residing in Spain. Multivariate logistic regression models were fitted to estimate the risk of overweight/obesity controlling for the variables of interest. The final sample consisted of 2351 households. Children of immigrant origin had a significantly higher overall prevalence of overweight and/or obesity than natives, both in boys (40.5% vs. 29.5%) and girls (44.8% vs. 30.3%), and a higher adjusted risk of overweight/obesity (OR = 1.67). In addition, it has been observed that children of immigrant origin were at higher risk of consuming sugary soft drinks, exercising less, and using screens more. In conclusion, the increased risk of having different habits that may contribute to developing excess weight and of having overweight/obesity in children with a migrant background should guide public health policies and interventions, emphasizing those groups at higher risk and incorporating considerations of socioeconomic inequalities.

Development of the professional role of diabetes nurses in specialised diabetes and primary care in Catalonia / Desarrollo del rol profesional de la enfermera en diabetes en Cataluña en atención especializada y en atención primaria

OBJECTIVES: The aim of this study was to describe therapeutic education programmes in diabetes in Catalonia and the differences according to the healthcare setting in which the patients are attended (primary care [PC] and specialised diabetes care [SDC]). METHOD: We performed a descriptive, cross-sectional, comparative study of diabetes nurses (DN) in SDC and PC in Catalonia. The sample was obtained from all the DN in SDC and a randomised cluster sample of DN in PC. The questionnaire of the Study of European Nurses in Diabetes (SEND) validated in Spanish was used. RESULTS: A total of 287 questionnaires were analysed (24.3% SDC and 75.6% PC). More training in diabetes through masters, postgraduate courses and continuing education was observed in SDC (p < 0.001) as well as structured, written, education programmes and the combination of individual and group education strategies (p < 0.05). The roles of educator, consultant, researcher, manager, liaison or collaborator and innovator and the telematic follow-up of patients was also more developed in SDC (p < 0.05). The grade of work satisfaction was elevated in both groups. CONCLUSIONS: (1) Nursing professionals in SDC assume more roles of specialised clinical nursing and also have more training in diabetes and therapeutic education than PC professionals. (2) Professionals in SDC work with a greater proportion of structured diabetes therapeutic education programmes although this should improve in both settings. According to the results obtained and the scientific evidence currently available, the training of DN working in the care of people with diabetes should be accredited in order to increase the use of structured programmes and investigation by DNs in both healthcare settings

OBJETIVOS: Describir la educación terapéutica en diabetes en Cataluña y las diferencias según el ámbito asistencial donde esta se imparte (asistencia primaria [AP] y asistencia especializada [AE]). MÉTODO: Estudio descriptivo, transversal y comparativo en PE de AE y de AP en Cataluña. La muestra se obtuvo a partir de todos los PE de AE y una muestra aleatoria por conglomerados de PE de AP. Se utilizó el cuestionario del Study of European Nurses in Diabetes validado al español. RESULTADOS: Se analizaron 287 cuestionarios (24,3% AE y 75,6% AP). Se observó más formación en diabetes a nivel de máster, posgrado y formación continuada en AE (p < 0,001). Más programas de educación estructurada, escritos y que combinan las estrategias de educación individual y grupal en AE (p < 0,05). Los roles educador, asesor, investigador, director, colaborador e innovador así como el seguimiento de pacientes vía telemática están más desarrollados en AE (p < 0,05). En ambos grupos el grado de satisfacción laboral es elevado. CONCLUSIONES: 1) Los profesionales de enfermería de AE asumen más roles de enfermera clínica especialista, además de tener más formación en diabetes y educación terapéutica que los profesionales de AP. 2) En AE se trabaja en mayor proporción con programas de ETD estructurados pero en ambos ámbitos se debería mejorar. De acuerdo con los resultados obtenidos y la evidencia científica disponible sería necesario acreditar la formación de los PE que trabajan en la atención de personas con diabetes, aumentar la utilización de programas estructurados y la investigación propia en ambos ámbitos de asistencia

Development of the professional role of diabetes nurses in specialised diabetes and primary care in Catalonia.

OBJECTIVES: The aim of this study was to describe therapeutic education programmes in diabetes in Catalonia and the differences according to the healthcare setting in which the patients are attended (primary care [PC] and specialised diabetes care [SDC]). METHOD: We performed a descriptive, cross-sectional, comparative study of diabetes nurses (DN) in SDC and PC in Catalonia. The sample was obtained from all the DN in SDC and a randomised cluster sample of DN in PC. The questionnaire of the Study of European Nurses in Diabetes (SEND) validated in Spanish was used. RESULTS: A total of 287 questionnaires were analysed (24.3% SDC and 75.6% PC). More training in diabetes through masters, postgraduate courses and continuing education was observed in SDC (p<0.001) as well as structured, written, education programmes and the combination of individual and group education strategies (p<0.05). The roles of educator, consultant, researcher, manager, liaison or collaborator and innovator and the telematic follow-up of patients was also more developed in SDC (p<0.05). The grade of work satisfaction was elevated in both groups. CONCLUSIONS: (1) Nursing professionals in SDC assume more roles of specialised clinical nursing and also have more training in diabetes and therapeutic education than PC professionals. (2) Professionals in SDC work with a greater proportion of structured diabetes therapeutic education programmes although this should improve in both settings. According to the results obtained and the scientific evidence currently available, the training of DN working in the care of people with diabetes should be accredited in order to increase the use of structured programmes and investigation by DNs in both healthcare settings.

Changes in Socioeconomic Inequalities in Amenable Mortality after the Economic Crisis in Cities of the Spanish Mediterranean Coast.

Several studies have described a decreasing trend in amenable mortality, as well as the existence of socioeconomic inequalities that affect it. However, their evolution, particularly in small urban areas, has largely been overlooked. The aim of this study is to analyse the socioeconomic inequalities in amenable mortality in three cities of the Valencian Community, namely, Alicante, Castellon, and Valencia, as well as their evolution before and after the start of the economic crisis (2000-2007 and 2008-2015). The units of analysis have been the census tracts and a deprivation index has been calculated to classify them according to their level of socioeconomic deprivation. Deaths and population were also grouped by sex, age group, period, and five levels of deprivation. The specific rates by sex, age group, deprivation level, and period were calculated for the total number of deaths due to all causes and amenable mortality and Poisson regression models were adjusted in order to estimate the relative risk. This study confirms that the inequalities between areas of greater and lesser deprivation in both all-cause mortality and amenable mortality persisted along the two study periods in the three cities. It also shows that these inequalities appear with greater risk of death in the areas of greatest deprivation, although not uniformly. In general, the risks of death from all causes and amenable mortality have decreased significantly from one period to the other, although not in all the groups studied. The evolution of death risks from before the onset of the crisis to the period after presented, overall, a general pro-cyclical trend. However, there are population subgroups for which the trend was counter-cyclical. The use of the deprivation index has made it possible to identify specific geographical areas with vulnerable populations in all three cities and, at the same time, to identify the change in the level of deprivation (ascending or descending) of the geographical areas throughout the two periods. It is precisely these areas where more attention is needed in order to reduce inequalities.

Mortalidad por complicaciones médicas y quirúrgicas, impacto de la crisis y gasto sanitario en España, 2002-2013 / Mortality due to medical and surgical complications, economic crisis and health spending in Spain, 2002-2013

Objetivo: Describir la evolución de los riesgos de mortalidad por complicaciones debidas a la atención médica o la cirugía entre los periodos anterior (2002-2007) y posterior (2008-2013) al inicio de la crisis económica, en España y por comunidades autónomas, y analizar la relación entre los cambios en los riesgos de muerte y el impacto socioeconómico de la crisis y la variación del gasto sanitario. Método: Estudio ecológico basado en tasas de mortalidad estandarizadas por edad, índice sintético de vulnerabilidad como indicador socioeconómico y variación del gasto sanitario como indicador del gasto en salud. Se estimó el riesgo relativo de muerte entre periodos con modelos de regresión de Poisson. Resultados: El número de muertes aumentó para España en el periodo estudiado. Aunque la relación entre el incremento en la inversión pública en salud y la disminución de la mortalidad por esta causa no ha quedado claramente demostrada, sí ha podido determinarse que aquellas comunidades autónomas con menor incremento del gasto sanitario presentaron mayores tasas que el resto a lo largo de todo el periodo, y que las más vulnerables a la crisis y con menor incremento del gasto presentaron un mayor incremento de riesgo de muerte entre periodos. Conclusión: Dado el incremento de las muertes debidas a fallos evitables del sistema, es necesario seguir investigando sobre esta causa de mortalidad

Objective: To describe the evolution of mortality risks for complications due to medical care or surgery between the periods prior to (2002-2007) and after (2008-2013) the beginning of the economic crisis for Spain and by autonomous region, and to analyse the relationship between the changes in the risks of death and the socioeconomic impact of the crisis and the variation in health spending. Method: Ecological study based on age-standardized mortality rates, synthetic index of vulnerability as a socioeconomic indicator and variation in health expenditure as an indicator of health expenditure. The relative risk of death between periods was estimated with Poisson regression models. Results: The number of deaths increased for Spain in the period studied. Although the relationship between the increase in public investment in health and the decrease in mortality due to this cause has not been clearly demonstrated, it was possible to determine that the autonomous regions with the lowest increase in health expenditure had rates higher than the rest throughout the period, and that the most vulnerable to the crisis and with the lowest increase in spending presented the greatest increase in the risk of death between the periods. Conclusions: Given the increase in these deaths, due to avoidable failures of the system, it is necessary to continue investigating this cause of mortality

[Mortality due to medical and surgical complications, economic crisis and health spending in Spain, 2002-2013]. / Mortalidad por complicaciones médicas y quirúrgicas, impacto de la crisis y gasto sanitario en España, 2002-2013.

OBJECTIVE: To describe the evolution of mortality risks for complications due to medical care or surgery between the periods prior to (2002-2007) and after (2008-2013) the beginning of the economic crisis for Spain and by autonomous region, and to analyse the relationship between the changes in the risks of death and the socioeconomic impact of the crisis and the variation in health spending. METHOD: Ecological study based on age-standardized mortality rates, synthetic index of vulnerability as a socioeconomic indicator and variation in health expenditure as an indicator of health expenditure. The relative risk of death between periods was estimated with Poisson regression models. RESULTS: The number of deaths increased for Spain in the period studied. Although the relationship between the increase in public investment in health and the decrease in mortality due to this cause has not been clearly demonstrated, it was possible to determine that the autonomous regions with the lowest increase in health expenditure had rates higher than the rest throughout the period, and that the most vulnerable to the crisis and with the lowest increase in spending presented the greatest increase in the risk of death between the periods. CONCLUSIONS: Given the increase in these deaths, due to avoidable failures of the system, it is necessary to continue investigating this cause of mortality.

Contribution of the Economic Crisis to the Risk Increase of Poor Mental Health in a Region of Spain.

Previous research suggests that the economic crisis can affect mental health. The purpose of this study was to analyse the association of risk of poor mental health with various socioeconomic, demographic, health, quality of life, and social support variables; and to evaluate the contribution of socioeconomic variables most affected by the beginning of the economic crisis (employment situation and income) on the changes in the prevalence of the risk of poor mental health between 2005 and 2010. A study of prevalence evolution in adult population residents of the Valencian Community in the Spanish Mediterranean was conducted. We studied 5781 subjects in 2005 and 3479 in 2010. Logistic regression models have been adjusted to analyse the association between variables. A standardisation procedure was carried out to evaluate which part of the changes in overall prevalence could be attributed to variations in the population structure by age, sex, employment status, and income between the years under study. The prevalence of GHQ+ increased from 2005 to 2010, in both men and women. Several variables were closely associated with the risk of poor mental health (sex, age, country of birth, number of nonmental chronic diseases, social support, disability, cohabitation in couple, employment status, and income). The changes produced as a result of the onset of the economic crisis in income and unemployment (increase in low income and in unemployment rates) contributed to the increase of poor mental health risk. This could confirm the sensitivity of mental health to the economic deterioration caused by the crisis.

Economic Crisis and Amenable Mortality in Spain.

Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002⁻2007 (before the economic crisis) and 2008⁻2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002⁻2007 and 2008⁻2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002⁻2007, and 6.93% in 2008⁻2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect.

Is recession bad for your mental health? The answer could be complex: evidence from the 2008 crisis in Spain.

BACKGROUND: We explored the impact of 2008 recession on the prevalence of mental health problems in Spain. METHODS: Repeated cross-sectional survey design. Datasets from 2006 and 2011 were used, and temporal change was examined. The study was conducted on the economically active population (16-64 years old). The two surveys included 29,478 and 21,007 people, obtaining a 96 and 89.6% response rate, respectively. Multiple logistic regression models were adjusted to identify poor mental health risk factors. A standardisation analysis was performed to estimate the prevalence of people at risk of poor mental health (GHQ+). RESULTS: The prevalence of GHQ+ following the crisis increased in men and decreased in women. Two logistic regression analyses identified GHQ+ risk factors. From 2006 to 2011, unemployment rose and income fell for both men and women, and there was a decline in the prevalence of somatic illness and limitations, factors associated with a higher prevalence of GHQ+. After controlling for age, the change in employment and income among men prompted an increase in the prevalence of GHQ+, while the change in somatic illness and limitations tended to mitigate this effect. After the recession, unemployed men showed a better level of somatic health. The same effects were not detected in women. CONCLUSIONS: The economic recession exerted a complex effect on mental health problems in men. The reduction of prevalence in women was not associated with changes in socioeconomic factors related to the economic crisis nor with changes in somatic health.

Validation of the Spanish version of Mackey childbirth satisfaction rating scale.

BACKGROUND: The "Mackey Childbirth Satisfaction Rating Scale" (MCSRS) is a complete non-validated scale which includes the most important factors associated with maternal satisfaction. Our primary purpose was to describe the internal structure of the scale and validate the reliability and validity of concept of its Spanish version MCSRS-E. METHODS: The MCSRS was translated into Spanish, back-translated and adapted to the Spanish population. It was then administered following a pilot test with women who met the study participant requirements. The scale structure was obtained by performing an exploratory factorial analysis using a sample of 304 women. The structures obtained were tested by conducting a confirmatory factorial analysis using a sample of 159 women. To test the validity of concept, the structure factors were correlated with expectations prior to childbirth experiences. McDonald's omegas were calculated for each model to establish the reliability of each factor. The study was carried out at four University Hospitals; Alicante, Elche, Torrevieja and Vinalopo Salud of Elche. The inclusion criteria were women aged 18-45 years old who had just delivered a singleton live baby at 38-42 weeks through vaginal delivery. Women who had difficulty speaking and understanding Spanish were excluded. RESULTS: The process generated 5 different possible internal structures in a nested model more consistent with the theory than other internal structures of the MCSRS applied hitherto. All of them had good levels of validation and reliability. CONCLUSIONS: This nested model to explain internal structure of MCSRS-E can accommodate different clinical practice scenarios better than the other structures applied to date, and it is a flexible tool which can be used to identify the aspects that should be changed to improve maternal satisfaction and hence maternal health.

Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study.

BACKGROUND: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. METHODS: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. RESULTS: By the end of a 4-year follow-up period, 1,184 participants (22.4%) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. CONCLUSIONS: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project).

BACKGROUND: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996-2001 and 2002-2007. METHODS: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. RESULTS: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996-2001 and 10.9 in 2002-2007), though not so clearly among women (3.3% in 1996-2001 and 2.9% in 2002-2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. CONCLUSIONS: Preventable mortality decreased between the 1996-2001 and 2002-2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.

Trends in mortality due to motor vehicle traffic accident injuries between 1987 and 2011 in a Spanish region (Comunitat Valenciana).

OBJECTIVE: To analyse the time evolution of the rates of mortality due to motor vehicle traffic accidents (MVTA) injuries that occurred among the general population of Comunitat Valenciana between 1987 and 2011, as well as to identify trend changes by sex and age group. METHODS: An observational study of annual mortality trends between 1987 and 2011. We studied all deaths due to MVTA injuries that occurred during this period of time among the non-institutionalised population residing in Comunitat Valenciana (a Spanish Mediterranean region that had a population of 5,117,190 inhabitants in 2011). The rates of mortality due to MVTA injuries were calculated for each sex and year studied. These rates were standardised by age for the total population and for specific age groups using the direct method (age-standardised rate - ASR). Joinpoint regression models were used in order to detect significant trend changes. Additionally, the annual percentage change (APC) of the ASRs was calculated for each trend segment, which is reflected in statistically significant joinpoints. RESULTS: For all ages, ASRs decrease greatly in both men and women (70% decrease between 1990 and 2011). In 1990 and 2011, men have rates of 36.5 and 5.2 per 100,000 men/year, respectively. In the same years, women have rates of 8.0 and 0.9 per 100,000 women/year, respectively. This decrease reaches up to 90% in the age group 15-34 years in both men and women. ASR ratios for men and women increased over time for all ages: this ratio was 3.9 in 1987; 4.6 in 1990; and 5.8 in 2011. For both men and women, there is a first significant segment (p<0.05) with an increasing trend between 1987 and 1989-1990. After 1990, there are 3 segments with a significant decreasing APC (1990-1993, 1993-2005 and 2005-2011, in the case of men; and 1989-1996, 1999-2007 and 2007-2011, in the case of women). CONCLUSION: The risk of death due to motor vehicle traffic accidents injuries has decreased significantly, especially in the case of women, for the last 25 years in Comunitat Valenciana, mainly as of 2006. This may be a consequence of the road-safety measures that have been implemented in Spain and in Comunitat Valenciana since 2004. The economic crisis that this country has undergone since 2008 may have also been a contributing factor to this decrease. Despite the decrease, ASR ratios for men and women increased over time and it is still a high-risk cause of death among young men. It is thus important that the measures that helped decrease the risk of death are maintained and improved over time.

Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007.

BACKGROUND: While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996-99, 2000-2003 and 2004-2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). METHODS: All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson's Regression models, adjusted for age and study period, and distinguishing between genders. RESULTS: Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. CONCLUSIONS: Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.

[Comparison of Google and Yahoo applications for geocoding of postal addresses in epidemiological studies]. / Comparación de las aplicaciones de Google y Yahoo para la geocodificación de direcciones postales con fines epidemiológicos.

BACKGROUND: Geocoding is the assignment of geographic coordinates to spatial points, which often are postal addresses. The error made in applying this process can introduce bias in estimates of spatiotemporal models in epidemiological studies. No studies have been found to measure the error made in applying this process in Spanish cities. The objective is to evaluate the errors in magnitude and direction from two free sources (Google and Yahoo) with regard to a GPS in two Spanish cities. METHOD: 30 addresses were geocoded with those two sources and the GPS in Santa Pola (Alicante) and Alicante city. The distances were calculated in metres (median, CI95%) between the sources and the GPS, globally and according to the status reported by each source. The directionality of the error was evaluated by calculating the location quadrant and applying a Chi-Square test. The GPS error was evaluated by geocoding 11 addresses twice at 4 days interval. RESULTS: The overall median in Google-GPS was 23,2 metres (16,0-32,1) for Santa Pola, and 21,4 meters (14,9-31,1) for Alicante. The overall median in Yahoo was 136,0 meters (19,2-318,5) for Santa Pola, and 23,8 meters (13,6- 29,2) for Alicante. Between the 73% and 90% were geocoded by status as "exact or interpolated" (minor error), where Goggle and Yahoo had a median error between 19 and 23 metres in the two cities. The GPS had a median error of 13.8 meters (6,7-17,8). No error directionality was detected. CONCLUSIONS: Google error is acceptable and stable in the two cities, so that it is a reliable source for Para medir elgeocoding addresses in Spain in epidemiological studies.

Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis.

BACKGROUND: The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. METHODS: A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. RESULTS: Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer's disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer's disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. CONCLUSIONS: This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.

Comparación de las aplicaciones de Google y Yahoo para la geocodificación de direcciones postales con fines epidemiológicos / Comparison of Google and Yahoo Applications for Geocoding of Postal Addresses in Epidemiological Studies

Fundamentos: Geocodificar es asignar coordenadas geográficas a puntos del espacio, frecuentemente direcciones postales. El error cometido al aplicar este proceso puede introducir un sesgo en las estimaciones de modelos espacio-temporales en estudios epidemiológicos. No se han encontrando estudios que midan este error en ciudades españolas. El objetivo es evaluar los errores en magnitud y direccionalidad de dos recursos gratuitos (Google y Yahoo) respecto a GPS en dos ciudades de España. Método: Se geocodificaron 30 direcciones aleatorias con los dos recursos citados y con GPS en Santa Pola (Alicante) y en Alicante. Se calculó la mediana y su IC95% del error en metros entre los recursos y GPS, para el total y por el status reportado. Se evaluó la direccionalidad del error calculando el cuadrante de localización y aplicando un test Chi-Cuadrado. Se evaluó el error del GPS midiendo 11 direcciones dos veces en un intervalo de 4 días. Resultados: La mediana del error total desde Google-GPS fue de 23,2 metros (16,0-32,2) para Santa Pola y 21,4 metros (14,9-31,1) en Alicante. Para Yahoo fue de 136,0 (19,2-318,5) para Santa Pola y 23,8 (13,6-29,2) para Alicante. Por status, se geocodificó entre un 73% y 90% como "exactas o interpoladas" (menor error), tanto Google como Yahoo tuvieron una mediana del error de entre 19 y 22 metros en las dos ciudades. El error del GPS fue de 13,8 (6,7-17,8) metros. No se detectó direccionalidad. Conclusiones: El error de Google es asumible y estable en las dos ciudades, siendo un recurso fiable para geocodificar direcciones postales en España en estudios epidemiológicos (AU)

Background: Geocoding is the assignment of geographic coordinates to spatial points, which often are postal addresses. The error made in applying this process can introduce bias in estimates of spatiotemporal models in epidemiological studies. No studies have been found to measure the error made in applying this process in Spanish cities. The objective is to evaluate the errors in magnitude and direction from two free sources (Google and Yahoo) with regard to a GPS in two Spanish cities. Method: 30 addresses were geocoded with those two sources and the GPS in Santa Pola (Alicante) and Alicante city. The distances were calculated in metres (median, CI95%) between the sources and the GPS, globally and according to the status reported by each source. The directionality of the error was evaluated by calculating the location quadrant and applying a Chi-Square test. The GPS error was evaluated by geocoding 11 addresses twice at 4 days interval. Results: The overall median in Google-GPS was 23,2 metres (16,0-32,1) for Santa Pola, and 21,4 meters (14,9-31,1) for Alicante. The overall median in Yahoo was 136,0 meters (19,2-318,5) for Santa Pola, and 23,8 meters (13,6- 29,2) for Alicante. Between the 73% and 90% were geocoded by status as "exact or interpolated" (minor error), where Goggle andYahoo had a median error between 19 and 23 metres in the two cities. The GPS had a median error of 13.8 meters (6,7-17,8). No error directionality was detected. Conclusions: Google error is acceptable and stable in the two cities, so that it is a reliable source for Para medir elgeocoding addresses in Spain in epidemiological studies (AU)

Psychometric behaviour of the strengths and difficulties questionnaire (SDQ) in the Spanish national health survey 2006.

BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) is a tool to measure the risk for mental disorders in children. The aim of this study is to describe the diagnostic efficiency and internal structure of the SDQ in the sample of children studied in the Spanish National Health Survey 2006. METHODS: A representative sample of 6,773 children aged 4 to 15 years was studied. The data were obtained using the Minors Questionnaire in the Spanish National Health Survey 2006. The ROC curve was constructed and calculations made of the area under the curve, sensitivity, specificity and the Youden J indices. The factorial structure was studied using models of exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA). RESULTS: The prevalence of behavioural disorders varied between 0.47% and 1.18% according to the requisites of the diagnostic definition. The area under the ROC curve varied from 0.84 to 0.91 according to the diagnosis. Factor models were cross-validated by means of two different random subsamples for EFA and CFA. An EFA suggested a three correlated factor model. CFA confirmed this model. A five-factor model according to EFA and the theoretical five-factor model described in the bibliography were also confirmed. The reliabilities of the factors of the different models were acceptable (>0.70, except for one factor with reliability 0.62). CONCLUSIONS: The diagnostic behaviour of the SDQ in the Spanish population is within the working limits described in other countries. According to the results obtained in this study, the diagnostic efficiency of the questionnaire is adequate to identify probable cases of psychiatric disorders in low prevalence populations. Regarding the factorial structure we found that both the five and the three factor models fit the data with acceptable goodness of fit indexes, the latter including an externalization and internalization dimension and perhaps a meaningful positive social dimension.Accordingly, we recommend studying whether these differences depend on sociocultural factors or are, in fact, due to methodological questions.