Social inequalities in HIV-TB and non-HIV-TB patients in two urban areas in southern Spain: multilevel analysis.

SETTING: Two towns in Campo de Gibraltar, southern Spain, with a small foreign population and higher tuberculosis (TB) incidence and human immunodeficiency virus (HIV) prevalence than the national average. OBJECTIVE: To determine the relationship between HIV-TB and non-HIV-TB incidence and social deprivation and other potential individual and contextual determinants. METHODS: In a cross-sectional longitudinal study, individual TB case variables were identified from three sources--routine surveillance, laboratory and hospital discharge records--from 1997 to 2007. Community variables were obtained at the census tract level. A deprivation index was calculated based on percentages of unemployment, low educational level and unskilled labour. Multilevel Poisson models were estimated for TB incidence rates for patients with and without HIV. RESULTS: A total of 490 TB cases were included. Sex and age at individual level and deprivation and residence in the port area at census tract level were associated both with HIV-related TB and with non-HIV-TB. Household crowding contextual variables were also associated with HIV-related TB incidence. Full models account for 78.9% and 51.7% reductions in second-level variance. CONCLUSION: Socio-economic deprivation is associated with higher rates of HIV-TB and non-HIV-TB. Diverse individual and contextual potential risk factors suggest different pathways of transmission. It is necessary to extend the framework for intervention beyond individual-based strategies to the socio-economic contexts in which people live.

Socioeconomic position and type 2 diabetes mellitus in Europe 1999-2009: a panorama of inequalities.

The aim of the present review is to synthesis findings from studies on the relationship between socioeconomic position (SEP) and incidence, prevalence and mortality of type 2 diabetes mellitus (T2DM) in Europe between the years 1999 and 2009. A systematic search was carried out in the National Library of Medicine's PubMed database. The search was limited to articles published between January 1999 and December 2009, in English or Spanish. Additional requirements for inclusion were: (i) presentation of empirical results directly related with SEP and the prevalence, incidence or mortality of diabetes, (ii) dealing with T2DM, (iii) carried out in Europe, and (iv) mainly focused only on diabetes. Of the 19 articles found, twelve studied the relationship between SEP and the prevalence of T2DM, two dealt with diabetes incidence, three with mortality and two studied both inequalities in mortality and prevalence. People with more deprived SEP have greater incidence, more prevalence and higher mortality due to T2DM, although the magnitude and significance of the associations varied from one study to another. Part of these inequalities is explained by SEP differences in the prevalence of the established T2DM risk factors. SEP inequalities in T2DM tended to be greater in women than in men. There is consistent evidence that SEP inequalities in T2DM incidence, prevalence and mortality are present in Europe, especially among women. Improving accessibility of physical activity in terms of both price and availability, access to healthy food, and access to health services, will be key to achieving a reduction of SEP related diabetes inequalities in Europe.

Mortality from colorectal cancer in Andalusia: findings in favor of mass screening.

OBJECTIVE: To describe mortality from colorectal cancer (CRC) in Andalusia from 1975 to 2001 in order to facilitate decision-making on mass screening. DESIGN: A population-based descriptive study. Considering mortality data from CRC and the resident population of Andalusia during the studied period, the main indicators of mortality by age and sex groups were calculated, and trends were estimated. RESULTS: There have been annual increases in mortality of 1.99% in men and 0.15% in women during the study period. In men, this is mainly due to increased mortality in those older than 65 years, and in women in those in the 35- to 64-year-old age group. In the younger age groups of both sexes, there has been a decline in mortality. The trend of mortality from colon cancer was positive in both men and women, but from rectal cancer was negative in women and slightly positive in men. CONCLUSIONS: Increased mortality from CRC in Andalusia may justify mass screening measures to potentially change mortality evolution, as has occurred in other countries.

[The mortality of prostate cancer in Andalusia. Contributions to mass screening]. / La mortalidad por cáncer de próstata en Andalucía: aportaciones al cribado poblacional.

BACKGROUND: To describe the mortality of prostate cancer in Andalusia from 1975 to 2001. METHODS: Estimation of crude rates, age-adjusted rates, Potential Years of Life Lost (PYLL) adjusted rates, risk of death and the changes produced in the adjusted rates. RESULTS: Prostate cancer deaths rise from 407 to 767. Crude rates increased from 13.54 to 21.35 per 100,000 persons-years. However, the age-adjusted rates showed a steady trend over the study period, with an annual percent change of -0.21%, and the premature mortality indicators declined. The cumulative risk of death increased with age, and presented an exponential increase after the age of 50 years, in both the periods, 1975-1979 as 1997-2001, with highest values in the second one. CONCLUSIONS: Prostate cancer mortality in Andalusia has increased in absolute values due to the ageing of the population. When adjusted for age, the mortality has remained stable, with a shift of deaths toward the more extreme age groups, as indicated by the decrease of premature deaths. The results of this study do not support the starting-up of mass screening programs.

Mortalidad por cáncer colorrectal en Andalucía: aportaciones al cribado poblacional / Mortality from colorectal cancer in Andalusia: findings in favor of mass screening

Objetivo: describir la mortalidad por cáncer colorrectal (CCR)en Andalucía desde 1975 a 2001 para ayudar a la toma de decisionessobre el cribado poblacional.Diseño: estudio descriptivo de base poblacional. Con los datosde mortalidad por CCR y la población de residentes en Andalucíadurante el periodo estudiado, se han calculado los principalesindicadores de mortalidad por grupos de edad y sexos y se han estimadolas tendencias.Resultados: se ha producido un aumento de 1,99% anual dela mortalidad en los hombres y un 0,15% en las mujeres en el periodode estudio. En los hombres debido principalmente al incrementode la mortalidad en los mayores de 65 años y en las mujeresen el grupo de edad de 35 a 64 años fue el que más creció, enlos grupos de edad jóvenes se ha producido un descenso de lamortalidad en ambos sexos. Las tendencias de la mortalidad porcáncer de colon fueron positivas en hombres y mujeres y la derecto negativas para las mujeres y ligeramente positiva para loshombres.Conclusiones: el incremento de la mortalidad por CCR enAndalucía podría plantear mediadas de cribado poblacional que,como ha ocurrido en otros países, cambien el signo de la evoluciónde la mortalidad

Objective: to describe mortality from colorectal cancer (CRC)in Andalusia from 1975 to 2001 in order to facilitate decisionmakingon mass screening.Design: a population-based descriptive study. Consideringmortality data from CRC and the resident population of Andalusiaduring the studied period, the main indicators of mortality by ageand sex groups were calculated, and trends were estimated.Results: there have been annual increases in mortality of1.99% in men and 0.15% in women during the study period. Inmen, this is mainly due to increased mortality in those older than65 years, and in women in those in the 35- to 64-year-old agegroup. In the younger age groups of both sexes, there has been adecline in mortality. The trend of mortality from colon cancer waspositive in both men and women, but from rectal cancer was negativein women and slightly positive in men.Conclusions: increased mortality from CRC in Andalusiamay justify mass screening measures to potentially change mortalityevolution, as has occurred in other countries

La mortalidad por cáncer de próstata en Andalucía: aportaciones al cribado poblacional / The mortality of prostate cancer in andalusian. Contributions to mass screening

Fundamento: Describir la mortalidad por cáncer de próstata en Andalucía desde 1975 al 2001. Métodos: Se han calculado tasas brutas, tasas ajustadas por edad, Años Potenciales de Vida Perdidos (APVP), el riesgo de morir por cáncer de próstata y estimado los cambios producidos en las tasas ajustadas. Resultados: El número de muertes por cáncer de próstata aumentó de 407 a 767. Las tasas brutas pasaron de 13,54 a 21,35 por 100.000 personas. Sin embargo, las tasas ajustadas por edad mostraron unos valores relativamente estables a lo largo de la serie, con un porcentaje anual de cambio de -0,21% y los indicadores de mortalidad prematura descendieron. El riesgo acumulado de morir por cáncer de próstata aumentó con la edad, experimentando a partir de los 50 años un incremento exponencial, tanto en el periodo de 1975-1979 como en el 1997-2001, con valores superiores en el segundo periodo respecto al primero. Conclusiones: El cáncer de próstata en Andalucía ha aumentado en valores absolutos debido al envejecimiento de la población. Al controlar la edad la mortalidad ha permanecido estable, con un desplazamiento de las muertes hacia los grupos más extremos de la vida, como señalan la disminución de las muertes prematuras. Los resultados de este trabajo no apoyan la puesta en marcha de programas de cribado poblacional

Background: To describe the mortality of prostate cancer in Andalusia from 1975 to 2001. Methods: Estimation of crude rates, age-adjusted rates, Potential Years of Life Lost (PYLL) adjusted rates, risk of death and the changes produced in the adjusted rates. Results: Prostate cancer deaths rise from 407 to 767. Crude rates increased from 13,54 to 21,35 per 100.000 persons-years. However, the age-adjusted rates showed a steady trend over the study period, with an annual percent change of –0,21%, and the premature mortality indicators declined. The cumulative risk of death increased with age, and presented an exponential increase after the age of 50 years, in both the periods, 1975-1979 as 1997-2001, with highest values in the second one. Conclusions: Prostate cancer mortality in Andalusia has increased in absolute values due to the ageing of the population. When adjusted for age, the mortality has remained stable, with a shift of deaths toward the more extreme age groups, as indicated by the decrease of premature deaths. The results of this study do not support the starting-up of mass screening programs

[Refusal of treatment]. / El abandono terapéutico.

UNLABELLED: The 25-50% of the outpatients who ask for medical assistance give up the treatment before the end for several reasons. The immediate consequences are the waste of economic and assistance resources, professional insatisfaction, phenomena like revolving door and bad results in prescribed treatments. These patients usually come back in the medium or long term. The authors considered to review the material published between 1992-1998 on the variables associated to the phenomena of noncompliance and dropout, as well as the strategies proposed by the different authors to face this problem. METHOD: A search was performed for original and review articles on the issue in the Medline database between 1992-1997. The key words used were: dropout, appointments, schedules, non attendance, premature termination, non compliance, medication compliance and their links with the key words: psychiatry, psychotherapy and mental disorder. The bibliographic references were classified according to the type of article, author, country of origin, journal and year. In relation with the contents, one classification has been carried out according to approach strategies, and another according to variables associated to dropout and non compliance. RESULTS: 144 bibliographic references were identified after the search on the Medline database. The selection for revision included 24 original articles, 5 review articles and a letter to the editor as a comment to a previous article. The total number of different journals was 27, and the authors were from 6 different nationalities.

El abandono terapéutico / The patient dropout. A review article

El 25-50 por ciento de los pacientes que solicitan asistencia sanitaria abandonan el tratamiento antes de su finalización por motivos diversos. El derroche de recursos monetarios y asistenciales, descontento de los profesionales, fenómenos como la 'puerta rotatoria' y malos resultados de los tratamientos prescritos son sus consecuencias inmediatas. A medio o largo plazo, estos pacientes vuelven a solicitar asistencia. Los autores se plantearon realizar una revisión del material publicado entre los años 1992-1998, sobre las variables asociadas a los fenómenos de no cumplimiento y abandono, así como de las estrategias propuestas por los distintos autores para hacer frente a este problema. Método: Se realizó una búsqueda de artículos originales y revisiones sobre el tema en la base de datos Medline entre los años 1992-1997. Las palabras clave utilizadas fueron: 'dropout', 'appointments', 'schedules', 'non attendance', 'premature termination', 'non compliance', 'medication compliance', y su intersección con las palabras clave: 'psychiatry', 'psycotherapy' y 'mental disorder'. Las referencias bibliográficas fueron clasificadas según tipo de artículo, autor, país de procedencia, revista y año. En relación con los contenidos, se ha realizado una clasificación de acuerdo con estrategias de abordaje y variables asociadas al abandono y el no cumplimiento. Resultados: Fueron identificadas 144 referencias bibliográficas tras la búsqueda realizada en la base de datos Medline. Se seleccionaron para su revisión 24 artículos originales, cinco artículos de revisión y una carta al director como comentario a un artículo anterior. El total de revistas diferentes fue de 27, los autores pertenecían a seis nacionalidades distintas (AU)

[Analysis criteria's influence on incidence and factors associated tuberculin conversion in health care workers]. / Influencia del criterio de análisis sobre la incidencia y los factores de riesgo de conversión tuberculínica en personal sanitario.

BACKGROUND: To know from two different criteria, CDC's and Spanish national consensus (NC), the tuberculin conversion rate and the factors associated to this phenomenon. PATIENTS AND METHODS: A retrospective cohort study was designed over 475 health care workers. Risk factors were identified by using a Cox's proportional hazards model for each criteria. RESULTS: Not being vaccinated with BCG appears to be a risk factor in NC model 5.37 (CI 95%: 2.21-13.00) and does not in CDC. There was a difference of 45% between both incidence density rates. CONCLUSIONS: We did not find a total concordance between the results from the two models.

Recursos de epidemiología en Internet para el médico de atención primaria / Epidemiological resources for primary care doctors on the Internet

No disponible

Coffee consumption and bladder cancer in nonsmokers: a pooled analysis of case-control studies in European countries.

BACKGROUND: Coffee consumption has been associated with an excess bladder cancer risk, but results from epidemiological studies are inconsistent. This association has been long debated, in part due to the potential confounding by smoking. We examined the risk associated with coffee consumption in nonsmokers in a pooled analysis of ten European bladder cancer case-control studies. METHODS: The pooled data set comprises 564 cases and 2929 hospital or population controls who had never smoked. They were enrolled in ten studies conducted in Denmark, Germany, Greece, France, Italy and Spain. Information on coffee consumption and occupation was re-coded following standard criteria. Unconditional logistic regression was applied adjusting for age, study center, occupation and gender. RESULTS: Seventy-nine percent of the study population reported having drunk coffee, and 2.4% were heavy drinkers, reporting having drunk on average ten or more cups per day. There was no excess risk in ever coffee drinkers (OR = 1.0, 95% CI 0.8-1.3) compared to never drinkers. The risk did not increase monotonically with dose but a statistically significant excess risk was seen for subjects having drunk ten or more cups per day (OR = 1.8, 95% CI 1.0-3.3). This excess was seen in both men and women. There was no evidence of an association of the risk with duration or type of coffee consumption. The pooled results were not dependent on the findings of any specific study, but they depended on the type of controls with an overall excess risk observed only for studies using hospital controls. CONCLUSION: Nonsmokers who are heavy coffee drinkers may have a small excess risk of bladder cancer. Although these results cannot be attributed to confounding by smoking, the possibility of bias in control selection cannot be discarded. On the basis of these results, only a very small proportion of cancers of the bladder among nonsmokers could be attributed to coffee drinking.

Underreporting of percutaneous exposure accidents in a teaching hospital in Spain.

The study's objectives were to determine the frequency of biological-risk accidents involving percutaneous exposure and to identify factors associated with underreporting. Two hundred fifty healthcare professionals from inpatient services at high risk for exposure at the Puerta del Mar University Hospital of Cádiz, Spain, participated in the study. A questionnaire was used to measure personal and work variables, the number of accidents suffered and reported in the last year, and the circumstances motivating the reporting or nonreporting. Two hundred thirty-two persons (92.8%) completed the questionnaire. The accident rate was 12 per 100,000 hours worked. Physicians were the most frequent accident victims (rate 22/100,000 hours). The general surgery and emergency services had higher rates than other services (rates 19.82 and 14.17, respectively). Sixty-six percent of the accidents were not reported to the register. The main predictors of the underreporting were length of professional service greater than 19 years, working in the surgery service, and the perception that the accidents did not involve health risk. The true accident rate was higher than that reflected in the Accident Register. Underreporting was high. The main variables associated with underreporting were length of professional service, work area or department, and perception of risk from the accident.

[Delay in the diagnosis of malignant tumors (breast, larynx, bladder)]. / Retraso en el diagnóstico de tumores malignos (mama, laringe y vejiga).

Cancer is the second leading cause of mortality in developed countries. Irrespective of its malignant degree, certain histological types and locations, there is a number of authors who hold the view that a delay in diagnosis can be one of the factors leading to a fatal outcome of the disease. In this study an assessment was made of diagnostic delay in three locations (breast, bladder, and larynx) in which the disease usually begins with evident alarm symptoms. The natural history of disease, from the first symptom to hospital admission and clinical diagnosis, was reconstructed by means of a questionnaire administered to patients from May, first, 1989, to April, 30th, 1990. It is concluded that patient's responsibility is great for the diagnostic delay of breast malignant tumors, whereas such a responsibility can be attributed to the Health Maintenance System for the other two types of cancer, bladder and larynx.

Bladder cancer and coffee consumption in smokers and non-smokers in Spain.

The association between coffee consumption and bladder cancer was investigated in a multi-centre case-control study conducted in Spain from 1983 to 1986. A total of 497 cases (438 male and 59 female) with histopathologically confirmed bladder cancer were used in the analysis along with 566 hospital controls and 547 population controls. Odds ratios (OR), adjusted for age, province of residence, occupations at risk, consumption of artificial sweeteners and cigarette smoking, did not show any association between coffee consumption and bladder cancer for either sex. However, in non-smokers and mainly in males, for current coffee drinkers the OR was 2.78 (95% [Cl]: 0.78-9.87), while for drinkers of 2-7, 8-14 and > or = 15 cups/week the respective OR were 2.22, 3.11 and 1.87 with a dose-response relationship for lifelong consumption and years of exposure to regular coffee consumption. The OR in male non-smokers and current coffee drinkers were 2.36 (95% Cl: 0.62-9.05) with population controls only and 1.94, 2.58 and 1.48 for the corresponding levels of intensity of consumption (cups/week). The associations observed in non-smokers suggest the existence of a possible association between coffee consumption and bladder cancer, but are based on small numbers and need to be confirmed in larger studies.