Activos de salud, calidad de vida y morbimortalidad de la población en Asturias.

INTRODUCCIÓN: n promoción de la salud se ha detectado en los últimos años un incremento de investigaciones con enfoques teóricos basados en activos de salud. Pese a los estudios identificados, no se dispone de suficiente evidencia sobre los efectos que diferentes tipos de activos pueden tener en la calidad de vida y en la morbimortalidad de la población. OBJETIVO: analizar la relación entre los activos de salud disponibles con indicadores de morbilidad, mortalidad y calidad de vida de la población asturiana en el año 2018. METODOLOGÍA: diseño ecológico a partir de datos agregados municipales procedentes de los 78 municipios de Asturias (1.034.960 habitantes). Tras aplicar la definición de activos de salud como aquellas variables que pudieran redundar en una mejora de la salud y del bienestar de los individuos y de las comunidades, se seleccionaron 19 variables de activos agrupados en cuatro categorías: individuales, socioeconómicas, comunitarias e infraestructura. Una vez controladas las variables relacionadas con las características demográficas de la población, se analizó la asociación de los activos con las tasas de morbimortalidad y de calidad de vida. Se desarrollaron 5 modelos predictivos a partir de modelos de regresión lineal múltiple para las variables dependientes: calidad de vida, enfermedades crónicas, mortalidad por todas las causas, mortalidad por enfermedades cardiovasculares (ECV) y por cáncer. RESULTADOS: la disponibilidad de recursos sanitarios (beta = 0.474), coberturas sociales (beta = 0.305) y redes de apoyo social (beta = 0.225) constituyen los activos de salud con mayor peso explicativo en los resultados de salud de la población asturiana. Las variables incluidas en los modelos predictivos de calidad de vida (R2 = 0.650) y de mortalidad por ECV (R2 = 0.544) son las que mostraron una mayor capacidad explicativa. CONCLUSIONES: la inversión en recursos sociosanitarios y la mejora de redes de apoyo social impulsados desde el ámbito de la salud pública pueden producir importantes mejoras en la salud de la población asturiana.

Priority issues, study designs and geographical distribution in nutrition journals.

INTRODUCTION: The increased number of articles published in nutrition is a reflection of the relevance to scientific community. The characteristics and quality of nutritional studies determine whether readers can obtain valid conclusions from them, as well as their usefulness for evidence-based strategic policies. OBJECTIVE: To determine the characteristics of papers published in nutrition journals. METHOD: Descriptive study design. We reviewed 330 original papers published between January-June 2007. From: American Journal of Clinical Nutrition (AJCN), Journal of Nutrition, European Journal Nutrition, European Journal of Clinical Nutrition and Public Health Nutrition. We classified them according to the subjects studied; risk factors, study design and country of origin. RESULTS: Almost half the papers studied healthy people (53.3%). The most frequent illness was obesity (13.9%). Food consumption is the most frequent risk factor (63.3%). Social factors appear exclusively only in 3.6% of the papers. Clinical trials were the most common analytical design (31.8%), mainly in the AJCN (45.6%). Cross-sectional studies were the most frequent type of observational design (37.9%). Ten countries produced over half of the papers (51.3%). The US publishes the highest number of papers (20.6%), whilst developing countries make only scarce contributions to scientific literature on nutrition. CONCLUSIONS: Most of the papers had inferential power. They generally studied both healthy and sick subjects, coinciding with the aims of international scientific policies. However, the topics covered reflect a clear bias, prioritizing problems pertaining to developed countries. Social determinants of health should also be considered, along with behavioral and biological risk factors.

Influencia de la cirugía mayor ambulatoria y de corta estancia en las diferencias por sexo de las hernias inguinocrurales / No disponible

Objetivo: El objetivo del presente estudio es valorar en que medida la cirugía mayor ambulatoria (CMA) y de corta estancia mantienen, aumentan o disminuyen las desigualdades por sexo en la asistencia sanitaria de las intervenciones quirúrgicas practicadas por hernia inguinocrural (HIC). Material y métodos: Estudio transversal sobre 3.834 reparaciones(3.076 hombres/758 mujeres) de HIC practicadas en el Hospital General Universitario de Alicante entre 1995 y 2004.Fuente: conjunto mínimo básico de datos (CMBD). Variables: edad, sexo, diagnóstico principal, procedimiento quirúrgico, fechas de intervención y de alta. Cálculo de frecuencias y tasas por sexo, edad y tipo de admisión: contraste de proporciones. Estancia media (EM) mediante Contraste Mann-Whitney. Resultados: El 78% de las HIC fueron operadas en régimen de CMA o corta estancia, el resto con estancia de tres días o mayor. El 50% de todas las reparaciones se practicaron en niños menores de 14 años, siendo la indicación de CMA mayor en las niñas. A los pacientes mayores de 55 años se les tiende a admitir menos en CMA, con mayor proporción de mujeres. RatioH/M de todas las HIC = 4,06. En CMA: 0-14 ratioH/M= 3,25; > 55 años ratio H/M = 6,87 (p < 0,001). En hospitalización convencional: > 55 ratioH/M = 3,65.EM total: > 55 = 3,66H y 4,09M (p < 0,001); EM CMA: > 55= 1,04H y 1,27M (p < 0,001). Conclusiones: La CMA representa la forma idónea de tratamiento quirúrgico para la HIC no complicada tanto en hombres como en mujeres, sobretodo en la infancia, adolescencia, jóvenes y adultos. La atención de las HIC en mayores de 55 años presenta sesgo de género: a las mujeres se las ingresa 3 días o más en mayor proporción que a los hombres, con menor EM, mientras que siendo casi 7 veces menor el número de casos de mujeres que de hombres en CMA, estas presentan mayor EM. Resulta pues una diferente atención médica por sexo para igual proceso patológico y edad. (AU)

Objective: This study is intended to evaluate in what way ambulatory and short stay surgery maintain, increase or reduce sexinequities on inguinal and femoral hernia (I&FH) repair. Method: Transversal study on 3834 I&FH operations (3076men/ 758 women) between 1995 and 2004. Source: hospital’s minimal basic data set. Variables: age, sex, main diagnosis, surgical procedure, operation and discharge dates. Frequency andrates of hernia procedures by sex, age and admission type: proportion contrast. Length of stay (LOS): Mann-Whitney contrast. Results: 78% of I&FH were operated on an ambulatory or short stay basis (AMB) vs. 22% that stayed in hospital 3 or more days (STAY). 50% of all repairs were done on children 0 to 14 years old, the indication for AMB was higher in girls. In the group of patients older than 55, rate of AMB is lower than in younger patients, being higher in women than in men. RatioM/W for allI&FH = 4.06. In AMB: ratio M/W for 0-14 = 3.25; ratioM/W for> 55 = 6.87 (p < 0.001). In STAY: ratioM/W for > 55 = 3.65.LOS in > 55 (AMB and Stay): 3.66 M 4.09W (p < 0,001).LOS for AMB in > 55: 1.04 M 1.27W (p < 0,001).Conclusions: AMB is the most suitable way for repairing uncomplicated I&FH in men as well as in women, and even more so for children, adolescents, young people and adults. Nevertheless, gender bias in patients older than 55 is revealed: a greater proportion of women are admitted for 3 or more days as compared to men. However LOS is shorter in women. On the other hand, the amount of women treated as AMB is seven times smaller than men, being LOS longer for women in this group. That shows a difference in medical attention depending on sex for the same pathological process and age (AU)

Women's health and gender-based clinical trials on etoricoxib: methodological gender bias.

BACKGROUND: The aim of this study was to determine compliance with published good practice guidelines for gender and clinical trials using etoricoxib. The rationale for choosing etoricoxib was that it is widely used by women and there is evidence of potential interaction with contraceptives and hormone replacement therapy as highlighted in the product characteristics. METHODS: The study reviewed 58 etoricoxib published trials (54 papers) to determine if they met the gender recommendations of the Guidelines of Food and Drug Administration (1993) and the Sex, Gender and Pain Special Interest Group Consensus Working Group Report (2007). RESULTS: Women formed 70% of a total of 49 835 subjects included in the etoricoxib trials, but only 31% of the subjects were in Phase I. About 85.7% of trials did not show sex-stratified data. About 90.6 and 93.3% did not provide efficacy and adverse effects data by sex, respectively. There is scarce information about the influence of issues that specifically affect women. Discussion Women are under-represented in the published etoricoxib trials, specifically, in Phase I. Sex-stratified data on efficacy and adverse effects are scarce in etoricoxib trials. Together with the lack of data on women-specific issues, this suggests that etoricoxib may pose the same potential problems for women as other cyclooxygenase-2 inhibitors.

How political epidemiology research can address why the millennium development goals have not been achieved: developing a research agenda.

The Millennium Development Goals (MDG) progress targets have not been met. Nevertheless, the United Nations (UN) has not yet undertaken in-depth review in order to discover the reasons behind this lack of progress in achieving the MDG. From a political epidemiology perspective, the intention here is to identify the political elements affecting the social factors impeding MDG fulfilment and, at the same time, to suggest future public policies and appropriate proposals that are both more coherent and supported by broader, empirical knowledge of the relevant issues.

[Public policies of research]. / Las políticas públicas de investigación.

With its present configuration, the Spanish public device of research in health sciences has limited possibilities to achieve properly the aims of the Ley General de Sanidad, due to its reduced financial importance as well as its thematic and lack of mechanisms of interterritorial compensation. These limitations are effective according to its small capacity to provide information for the development of a health system, oriented to the overcoming of territorial and social imbalance as well as the promotion of health and prevention of diseases. The capacity of public policies of research in Spain to affect the work of researchers is very small due to the importance of the widespread practice of not using funds which are not specifically dedicated to research of the institutions employing the researchers, among other reasons. Most of the public resources of research are concentrated in Madrid and Barcelona. This situation can seriously jeopardize in a near future the development and quality of the attention given in Regional Health Services transferred to Autonomic Communities without big cities. The funds are mostly used to finance researches of basic sciences, medical specialties and clinic laboratories. Investigation in Public Health is only 0.8% of the research budgets, and the funds dedicated to research in Health Primary Care are also very small. The present predominant thematic and methodological orientation of health research in our country, with medicalized research aims, subindividual observation units, experimental designs, and analysis which are basically quantitative, can endanger the possibilities of Spain to achieve the health aims established by the OMS.