Partial contributions and temporal trends of leading causes of death during the last four decades in Spain.

OBJECTIVES: The study was conducted to assess time trend shifts of leading causes of death and their partial contributions over the years 1975-2016 in Spain. STUDY DESIGN: A longitudinal ecological epidemiologic design was conducted to analyse linear trend period shifts using joinpoint regression as the annual percentage of change (APC) in the period 1975-2016. The partial contributions were illustrated as the rate ratio of a singular-cause to their major-cause shift periods. RESULTS: HIV/AIDS shaped the increasing trend period of infectious diseases in 1989-1995 (APC = 25.3, P < 0.05) and the decreasing trend in 1995-1999 and 1999-2016. Lung cancer fell gradually from 1994 in men (-0.4, P < 0.05); however, in women, the condition continued increasing from 1990 (P < 0.05). Dementia types influenced mental and neurological disease drifts. The recent trend for circulatory periods (1980-2016) was mainly modulated by cardiac ischaemia, with increased partial contributions (25%, 32% and 30%). Traffic accidents defined the descending tendency of external causes. CONCLUSIONS: Spain showed a Western pattern in descended rates, including non-decreasing trends in mental and neurological diseases, pancreatic cancer, drug abuse and suicide. Trend shifts and partial contributions illustrated targets for further mortality reduction.

Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review.

The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.

Vacuna contra el virus del papiloma humano: reflexiones acerca del proceso de difusión, la evidencia científica y las incertidumbres / No disponible

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Cancer surveillance based on imaging techniques in carriers of BRCA1/2 gene mutations: a systematic review.

We have systematically reviewed the literature focusing on the performance of surveillance programmes and imaging techniques for the early diagnosis of breast and ovarian cancer in women carrying mutations in BRCA1/2 genes. A search for relevant articles published between 1996 and 2005 (inclusive) was run on Medline, Embase and other databases. Of the 749 articles retrieved, only 13 met the inclusion criteria. Of these, 12 provided information on breast cancer surveillance, 1 on ovarian cancer surveillance and a further study addressed both cancer types. A critical appraisal of the studies was performed using a tool for the quality assessment of diagnostic accuracy studies (QUADAS). The synthesis of results is qualitative. All studies on imaging techniques for the diagnosis of breast cancer indicated that screening MRI had the highest sensitivity (between 77% and 100%). Breast cancer surveillance programmes, including MRI, achieved the highest diagnostic performance (between 83% and 95%) for all women. However, it must be taken into account that biases that may affect the validity of the outcomes were seen in the evaluated studies. Also, MRI is an expensive test with a low positive predictive value and, to date, MRI screening has not been proven to reduce mortality rates in women carrying BRCA1/2 gene mutations. As a result of the scant information and low quality of the papers reviewed, no definitive conclusion could be drawn on the performance of ovarian cancer surveillance in women carrying BRCA1/2 mutations.

[Applications of proteomic techniques in clinical practice: present situation and perspectives]. / Aplicaciones de las técnicas proteómicas en medicina asistencial: situación actual y perspectivas.

Study of the human proteome has given rise to the appearance of abundant and increasing scientific literature. This has resulted in the proposal to use proteomic techniques in the management of some diseases and the suggestion of its future use in clinical laboratories. In order to identify which proteomic techniques are being used or may be used in the near future in the clinical practice, a survey was made to experts in proteomics and the bibliometric study was done. Concordance between this study and a survey was observed. However, in general, standardized uses of proteomic techniques in the current clinical practice were not found. In regards to possible applications in the short-middle term, the experts have different opinions, from those who mention specific techniques (coinciding with the most repeated aspects of the bibliometric study) to those who think that its use in a near future is unlikely.

Aplicaciones de las técnicas proteómicas en medicina asistencial: situación actual y perspectivas / Applications of proteomic techniques in clinical practice: present situation and perspectives

El estudio del proteoma humano ha dado lugar a la aparición de abundante y creciente literatura, llegándose a plantear el uso de técnicas proteómicas en el manejo de algunas enfermedades y sugiriéndose su futura utilización en laboratorios clínicos. A fin de identificar técnicas proteómicas en uso o de previsible uso próximo en medicina asistencial, se realizó una encuesta a expertos en el ámbito de la proteómica y un estudio bibliométrico. Se observó concordancia entre dicho estudio y la encuesta: no se hallaron, en general, usos estandarizados de la proteómica en medicina asistencial. En cuanto a posibles aplicaciones a corto-medio plazo hay diversidad de pareceres entre expertos, desde los que citan técnicas concretas (coincidentes con los aspectos más iterativos del estudio bibliométrico), hasta los que piensan que es poco probable que se usen en un futuro cercano (AU)

Study of the human proteome has given rise to the appearance of abundant and increasing scientific literature. This has resulted in the proposal to use proteomic techniques in the management of some diseases and the suggestion of its future use in clinical laboratories. In order to identify which proteomic techniques are being used or may be used in the near future in the clinical practice, a survey was made to experts in proteomics and the bibliometric study was done. Concordance between this study and a survey was observed. However, in general, standardized uses of proteomic techniques in the current clinical practice were not found. In regards to possible applications in the short-middle term, the experts have different opinions, from those who mention specific techniques (coinciding with the most repeated aspects of the bibliometric study) to those who think that its use in a near future is unlikely (AU)

Effectiveness of preventive interventions in BRCA1/2 gene mutation carriers: a systematic review.

A systematic review of the literature was conducted to assess the outcomes of preventive interventions (prophylactic surgery, intensive cancer screening, and chemoprevention) in women who carry mutations in BRCA1/2 genes, in terms of reducing breast and gynaecological cancer incidence and/or mortality. A search for relevant articles published between 1996 and 2005 (inclusive) was run on Medline, Embase and other databases. From the 749 journal articles retrieved from this search strategy, 18 studies were eligible for this review (2 systematic reviews, 10 cohort studies and 6 case-control studies). The critical appraisal of the studies was performed by two independent reviewers with a list of ad hoc selected criteria. The synthesis of results was qualitative. Mastectomy and prophylactic gynaecological surgery (oophorectomy or salpingo-oophorectomy) reduced breast and gynaecological cancer incidence in carriers of BRCA mutations, by comparison to surveillance. However, all the studies presented flaws in internal and external validity, none of these preventive interventions is risk-free, and protection against breast and gynaecological cancer, as well as other cancers linked to BRCA mutations, is incomplete. No studies comparing surveillance programmes of varying intensity were found. Exposure to drugs (tamoxifen, and oral contraceptives) in women carrying BRCA mutations was assessed through a limited number of papers. All of these were case-control studies with prevalent cases and presented major methodological flaws.

La incertidumbre sobre la efectividad y seguridad de los fármacos. Relevancia de los estudios de utilización de medicamentos / Uncertainty on drug effectiveness and safety. Relevance of studies on drug use

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Rehabilitación respiratoria: aproximación a la situación en España / Respiratory rehabilitation: situation in Spain

Objetivo. Estimar la implantación y la coberturade los programas de rehabilitación respiratoria en el sistemasanitario público español, describir las características delos programas existentes y explorar las barreras para la ampliaciónde su implantación.Métodos. Se realizó una entrevista semiestructurada, caraa cara, a seis informadores clave, elegidos por destacar comoinvestigadores en el campo de la rehabilitación respiratoria ocomo representantes de las sociedades científicas, siendoclínicos al mismo tiempo.Resultados. Los informadores clave están de acuerdo enque la rehabilitación respiratoria entendida como fisioterapiarespiratoria está bien difundida por los hospitales de primernivel y que se dirige principalmente a pacientes con enfermedadpulmonar obstructiva crónica (EPOC). Sin embargo,sólo una minoría de centros públicos incluye en el programade rehabilitación el entrenamiento al esfuerzo, que es el componentede beneficio mejor demostrado y la rehabilitaciónrespiratoria sólo llega a una pequeña proporción de los pacientesque la necesitan. La enseñanza de técnicas de relajacióny el apoyo para dejar de fumar no son constantes.Conclusiones. Actualmente, la atención al paciente conEPOC, con una correcta rehabilitación respiratoria, está lejosde quedar garantizada en el sistema sanitario público español

Objective. To consider the implantation andthe cover of the programs of respiratory rehabilitation in theSpanish Health System; to describe the characteristics ofthe existing programs and to explore the barriers for theextension them. Methods. Semistructured interview, to six key informants,chosen by prestige criteria in the field of the respiratory rehabilitationresearch or by the scientific societies, being clinicalat the same time.Results. The informants agree in which the respiratory fisiotherapyas a component of RR programs is extended bythe first level hospitals and that mainly goes to patients withchronic obstructive pulmonary disease (COPD). Nevertheless,the exercise training, the more effective intervention, isinclude in only a minority of public centers (hospitals) withrehabilitation program, and only a small proportion of the patientswho need RR are provided. The relax techniques andthe smoking cessation support are not always included.Conclusions. At the moment, the attention to the patientwith COPD with a correct respiratory rehabilitation is farfrom being guaranteed in the Spanish Health System