[Perinatal mortality underreporting in obstetrics and neonatology]. / Subcertificación de las muertes perinatales en obstetricia y neonatología.

INTRODUCTION: Perinatal mortality has been decreasing in Spain; nevertheless completeness of death certificates was questioned because of the underreporting observed. OBJECTIVE: To quantify perinatal mortality reporting of birth and infant-death certificates and obstetrics and neonatal hospital records of the Autonomous Community of Murcia in 2003. MATERIAL AND METHODS: Newborns with a weight of at least 500 g or 22 weeks gestation, who died before the 8th day, were included. The dates came from birth certificates (stillbirths and infants died before one day of life) and death certificates (more than one day, and obstetrics-neonatal hospital records. Detection rates were calculated for death certificates and hospital registrations. RESULTS: One hundred fifty WHO-cases, of which 72 agreed with both sources. Sixty one percent of coincident cases were stillbirths. The underreporting was 26 % in Obstetrics and 10 % in Neonatology. Only 16 % of deaths were reported in the Official Statistics. CONCLUSIONS: Medical perinatal mortality reporting remains inadequate. Official Statistics and Obstetrics - Neonatology records add independent and complementary information.

Subcertificación de las muertes perinatales en obstetricia y neonatología / Perinatal mortality underreporting in obstetrics and neonatology

Introducción: La mortalidad perinatal desciende en España, pero varios estudios cuestionan su exhaustividad por la subdeclaración detectada. Objetivo: Cuantificar y comparar la mortalidad perinatal detectada por los boletines estadísticos de parto (BEP) y de defunción (BED) frente a los registros de obstetricia y neonatología de la Región de Murcia en 2003. Material y métodos: Se incluyen los nacidos de al menos 500 g o 22 semanas de gestación que fallecen antes del día 8. Los datos provienen del BED, BEP, paritorio o neonatología. Se calculan las tasas de detección de boletines y registros sanitarios. Resultados: Se obtienen 150 casos-OMS, de los cuales 72 coinciden en ambas fuentes. El 61 % de los casos coincidentes son nacidos muertos. La subcertificación es del 26 % en obstetricia y del 10 % en neonatología. El 16 % de las defunciones sólo constan en los boletines estadísticos. Conclusiones: La certificación médica de la mortalidad perinatal sigue siendo insuficiente. La estadística oficial y los registros obstétrico-pediátricos aportan información independiente y complementaria

Introduction: Perinatal mortality has been decreasing in Spain; nevertheless completeness of death certificates was questioned because of the underreporting observed. Objective: To quantify perinatal mortality reporting of birth and infant-death certificates and obstetrics and neonatal hospital records of the Autonomous Community of Murcia in 2003. Material and methods: Newborns with a weight of at least 500 g or 22 weeks gestation, who died before the 8th day, were included. The dates came from birth certificates (stillbirths and infants died before one day of life) and death certificates (more than one day, and obstetrics-neonatal hospital records. Detection rates were calculated for death certificates and hospital registrations. Results: One hundred fifty WHO-cases, of which 72 agreed with both sources. Sixty one percent of coincident cases were stillbirths. The underreporting was 26 % in Obstetrics and 10 % in Neonatology. Only 16 % of deaths were reported in the Official Statistics. Conclusions: Medical perinatal mortality reporting remains inadequate. Official Statistics and Obstetrics - Neonatology records add independent and complementary information

[Principal requirements in medical training for certification of deaths in Spain]. / Necesidades prioritarias en formación médica en certificación de defunciones en España.

OBJECTIVE: To know the training need priorities in Spanish physicians in death certification. DESIGN: Study of needs by consensus technique Delphi. SETTING: Health care and medical-legal institutions in Spain. PARTICIPANTS: Physicians who ask for information in death certification, after reading an article in a medical magazine (n=38), and agree to participate (n=33). METHODS: Priorities were established by means of a list of items, based on teaching experience and professional advice. The scores obtained for each priority were hierarchized, and the participants professional profiles were described. An analysis of hierarchical clusters was done to determine profiles of training. RESULTS: The median age of the participants was 42 years, with 18 years experience in general/family, emergency or forensic medicine, which usually certified in median 8 death a year (rank from 0 to 50). The maximum training priorities were how to register a death and which doctor should make out the official documents. Intermediate priorities included the role of doctors in violent or accidental deaths. In the main three grouping needs were, in one, include certification as a degree subject and learn how different documents are made out; although in the others two, were how to register a death, which physician make out the documents, and when it should certify the family doctor and when the coroner. CONCLUSIONS: The priorities in certification training are how to register a death and who should make out the documents, pointing out that the shortcoming continues in medical training in death certification.

Validez de la certificación de la muerte por cáncer en la Comunidad de Murcia / Accuracy of cancer death certification in Murcia Community, Spain

Evaluamos la exactitud del diagnóstico de cáncer en la certificación de defunción (CD) de los habitantes de la Región de Murcia en 1992, comparándolo con la información clínica del registro de cáncer, para obtener la concordancia por edad y sexo, y la sensibilidad y el valor predictivo positivo. En el 79,4 por ciento de los 1.351 fallecidos coincide el cáncer del CD con la documentación clínica. La concordancia es algo mayor en hombres (79,0 por ciento) que en mujeres (76,1 por ciento), y en los casos sin confirmación histológica (83,5 por ciento) que con microscopía (77,1 por ciento), sin ser significativos. La concordancia es significativamente mayor en los menores de 80 años frente a los de más edad. Las localizaciones bien certificadas son el cáncer de estómago, pulmón, melanoma, mama de la mujer, ovario, próstata, encéfalo, mieloma múltiple y las leucemias linfoides; y las peor certificadas el cáncer de hueso, el de tejido conjuntivo y los de sitio primario desconocido. Los resultados son semejantes a otras áreas españolas, aunque con algunas diferencias por localizaciones anatómicas (AU)

Necesidades prioritarias en formación médica en certificación de defunciones en España / Priorities in medical training in death certification of Spanish physicians

Objetivo. Conocer las necesidades prioritarias en formación de certificación de defunciones en los médicos españoles. Diseño. Estudio de necesidades por la técnica de consenso Delphi. Emplazamiento. Centros sanitarios y de medicina legal en España. Participantes. Médicos lectores de un artículo de divulgación, que solicitan materiales sobre certificación de defunciones (n = 38) y aceptan participar (n = 33).Método. Establecimiento de prioridades mediante una lista de ítems basada en la experiencia docente y la asesoría de expertos. Jerarquizamos las puntuaciones de prioridades, caracterizamos a los participantes y realizamos un análisis de clusters jerárquicos para determinar perfiles de formación. Resultados. Los informantes tienen una mediana de edad de 42 años, con 18 años de ejercicio en medicina general/familiar, urgencias o legal y certifican/informan una mediana de 8 muertes-año (rango, 0-50).Las necesidades más priorizadas son conocer cómo hay que declarar y saber qué médico debe cumplimentar los documentos. En posiciones intermedias se ubica el papel de los médicos en las muertes violentas o accidentales. En los tres principales agrupamientos observamos que las prioridades son, en uno, incluir la certificación como materia docente en la licenciatura, conocer las diferencias de cumplimentación entre los documentos, y en los otros dos conocer cómo declarar la defunción, qué médico debe cumplimentarla y cuándo debe certificar el médico de cabecera y cuándo el médico forense. Conclusión. Las prioridades de formación son conocer cómo declarar una defunción y saber qué médico debe certificarla, señalando que se mantiene el déficit de formación médica en la certificación de defunciones (AU)

Consumption of added fats and oils in the European Prospective Investigation into Cancer and Nutrition (EPIC) centres across 10 European countries as assessed by 24-hour dietary recalls.

OBJECTIVE: To evaluate the consumption of added fats and oils across the European centres and countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: 24-Hour dietary recalls were collected by means of standardised computer-guided interviews in 27 redefined EPIC centres across 10 European countries. SUBJECTS: From an initial number of 36 900 subjects, single dietary recalls from 22 924 women and 13 031 men in the age range of 35-74 years were included. RESULTS: Mean daily intake of added fats and oils varied between 16.2 g (Varese, Italy) and 41.1 g (Malmö, Sweden) in women and between 24.7 g (Ragusa, Italy) and 66.0 g (Potsdam, Germany) in men. Total mean lipid intake by consumption of added fats and oils, including those used for sauce preparation, ranged between 18.3 (Norway) and 37.2 g day-1 (Greece) in women and 28.4 (Heidelberg, Germany) and 51.2 g day-1 (Greece) in men. The Mediterranean EPIC centres with high olive oil consumption combined with low animal fat intake contrasted with the central and northern European centres where fewer vegetable oils, more animal fats and a high proportion of margarine were consumed. The consumption of added fats and oils of animal origin was highest in the German EPIC centres, followed by the French. The contribution of added fats and oils to total energy intake ranged from 8% in Norway to 22% in Greece. CONCLUSIONS: The results demonstrate a high variation in dietary intake of added fats and oils in EPIC, providing a good opportunity to elucidate the role of dietary fats in cancer aetiology.

¿Son la ocupación y la educación intercambiables como indicadores sociales en salud comunitaria? Un estudio en población ocupada / ¿Are education and occupation interchangeable as social indicators in community health? a study on employed people

Objetivo. Los estudios epidemiológicos y las intervenciones para reducir las desigualdades en salud en la comunidad requieren la asignación de indicadores socioeconómicos exhaustivos y fáciles de obtener. Dos de los más utilizados son la ocupación y la educación. En este estudio pretendemos evaluar la asociación entre educación y ocupación en población adulta ocupada, por si, en ausencia de una variable, fuera posible utilizar la otra con la menor pérdida posible de información sobre nivel socioeconómico. Diseño. A partir de una muestra representativa (n = 3.091) de población general (18-65 años), tomada de una encuesta de prevalencia sobre factores de riesgo de enfermedades crónicas realizada en la Región de Murcia, se ha realizado un análisis (log)lineal entre educación y ocupación en la población ocupada (65,8 por ciento varones y 34,2 por ciento mujeres de la muestra total). Resultados. Los varones presentan una asociación significativa entre las posiciones directivas y la educación universitaria. La asociación se reduce entre la ocupación en tareas administrativas y la categoría de estudios secundarios, para incrementarse en los trabajadores manuales con estudios primarios o sin estudios. En las mujeres, con un menor número de efectivos, la asociación educación-ocupación describe el mismo patrón, incluso con mayor magnitud en las asociaciones entre las clases directivas y el nivel educativo universitario. En varones y mujeres las mayores asociaciones se encuentran en ambas diagonales de las tablas de educación por ocupación, indicando: a mejor ocupación, mayor educación, y lo contrario. Conclusión. La clasificación de la gente con trabajo de acuerdo con la educación y la ocupación presenta: asociación, consistencia interna y gradiente. En ausencia de información exhaustiva sobre ocupación, la educación puede ser una alternativa como indicador de nivel socioeconómico (AU)

Seroconversion and duration of immunity after vaccination against group C meningococcal infection in young children.

An increase in the incidence of group C meningococcal disease was observed in the Murcia Region (Spain) during 1996-1997. In September 1997, a massive vaccination campaign was implemented among the population aged 18 months to 19 years. The aim of this study was to assess the seroconversion rate of children aged 18-59 months and the persistence of immune response 1 year after vaccination. A total of 296 children were included. Blood samples were obtained before vaccination and 1 month and 1 year after vaccination. Three point seven percent of the children had bactericidal antibody titres of >/=1:8 before vaccination. One month after vaccination seroconversion was 63.7%, with a growing trend related to age at vaccination (p<0.0001). The increase in antibody titres was shown to be quantitatively greater above the age of 36 months (p<0.0001). One year after vaccination only 4.3% of the children who initially seroconverted still had bactericidal activity. Seroconversion in children under 5 increases with age but antibodies decline rapidly in the year following vaccination.

[Are occupation and education interchangeable as social indicators in community health? A study in an employed population]. / Son la ocupación y la educación intercambiables como indicadores sociales en salud comunitaria? Un estudio en población ocupada.

OBJECTIVE: Epidemiological studies and interventions to reduce inequalities in community health require the assignation of exhaustive and easy-to-obtain social indicators. Occupation and education are two of the most often used. In this study we attempt to evaluate the association between education and occupation among adult working population because if, in the absence of one of these two variables, it will be feasible to use the remaining with the lesser lost of socio-economic information. DESIGN: From a representative sample (n = 3091) of general population (18-65 years old) drawn out from a prevalence survey on chronic disease risk factors performed in the Region of Murcia, a log-lineal analysis has been made between education and occupation among working people (65.8% of males and 34.2% of females from the original sample). RESULTS: Men present significant association between managerial positions and university education. The association drops between clerks and high school graduates to increase among all manual workers with or without primary schooling education. Among women--with a lesser number of participants--the education/occupation association describes the same pattern but with higher magnitudes in the positive associations between managerial positions and university education. For both genders, the greatest associations are found in both diagonals of the education by occupation tables indicating: better occupation, more education, and the opposite. CONCLUSIONS: The classification of working people according to education and occupation presents association, internal consistency and gradient. In absence of comprehensive information regarding occupation, education could be an alternative as socio-economic indicator.

[Learning and satisfaction in the workshops of pre- and post-graduate medicine for the improvement of the accuracy of certifications of causes of death 1992-1996]. / Aprendizaje y satisfacción de los talleres de pre y postgrado de medicina para la mejora en la certificación de las causas de defunción, 1992-1996.

BACKGROUND: To broaden the experiences of evaluation of the learning and satisfaction of the workshops of pre and postgraduates of medicine for the improvement in the certification of the causes of death with contributions from the Region of Murcia, 1992-1996. METHODS: With a quasi-experimental pre-posttest epidemiological design, a workshop is given, being both theoretical and practical of 2 hours addressed to students of medicine, interns in Family and Community Medicine and doctors in the course of obtaining said specialty. The goal of the workshop is to teach the usefulness of Mortality Statistics and the International WHO norms of certification. At start and finish we evaluated the formation by research, using indicators of formal quality, concept and result of the completion. Also, we administrate a questionnaire of satisfaction. RESULTS: In five years 23 workshops with 646 assistants were given, including 472 pairs of exercises and 586 satisfaction's questionnaires. In the pretest, more than 78% of the individual indicators were correct and 52.3% of the participants completed everything well. There were statistically significant improvements in the groups of indicators of concept and result, but not that of form, which showed a high qualification from the beginning (77.5%). The assignation of cause of death has improve more with the students (24.6%) than in physicians (14.4%). The contents of the course are very adequate/adequate (92.7%), without difference among the types of helpers. There is an equilibrium between theory and practice (64.7%). Eighty-one point three of physicians and 80.2% of the students stated that the workshop was useful for correctly certifying a death, independent of the previous background. CONCLUSIONS: The good initial qualifications were improved after the educational intervention. In accordance with workshops demonstrated efficacy, we propose their generalization and to follow its impact on Mortality Statistics.

[Cardiovascular risk factors in the region of Murcia, Spain]. / Factores de riesgo cardiovascular en la región de Murcia, España.

BACKGROUND: The Region of Murcia is an area, within the Spanish context, of high coronary and stroke mortality. Moreover, the trend in ischaemic heart disease mortality, decreasing for almost all geographical Spanish areas, has suffered in Murcia a slight increase during the period 1985-1991. In this study the population prevalences to different cardiovascular risk factors are evaluated. METHODS: Survey of a random sample of adult population (aged 18-65) with a response rate of 61%. Standardised measurement of arterial blood pressure, obesity and serum lipids besides a questionnaire of tobacco consume, physical activity and diabetes. Presentation of standardised results for overall age groups and for the truncated 35-64 age group. The field work were from november 1991 to march 1993. RESULTS: Tobacco smoking prevalence rises up to 54.4% in men and 31.3% in women. Figures for hypertension are less favourable in men (32.3% prevalence, 16.4% treatment, 2.6% hypertension control among all hypertensives, and 15.6% control among only treated hypertensives) that among women (23.7%, 34.3%, 9.5% y 27.8%, respectively). The average serum concentrations of cholesterol are low in both sexes, as high are the HDL-cholesterol concentrations. Mean Body Mass Index is 26.7 for both sexes, although women present wider variability in the measurements. The prevalence of self informed diabetes is around 3-4%. CONCLUSIONS: Comparing these figures, for the corresponding age groups, with those offered by the MONICA study and with other studies on Spanish adult population it is possible to observe that, exception made for the high tobacco consumption and Body Mass Index seen in the Region of Murcia, the overall figures of cardiovascular risk factors are located in the lowest end of the distribution of MONICA centres ranked according their prevalence of cardiovascular risk factors. It might exist, therefore, differences in the management of the coronary patient that could explain at least part of the unfavourable coronary heart mortality trends observed in the Region of Murcia.

[Validity of a questionnaire on recent physical activity]. / Validez de un cuestionario de actividad física reciente.

This study aims to validate a frequency questionnaire for categorically ranking people according to recent physical activity (PA) (previous two weeks), applicable to both sexes. Seven one-day PA records were collected for 30 males and 32 females during two weeks. After, the frequency questionnaire was administered covering the same period. The differences (paired-test) between the means obtained by both methods were globally significant for females and for some subgroups of activities in both sexes. The Pearson's correlation coefficient between both methods was 0.78 for males and 0.65 for females. The degree of agreement among methods classifying the subjects on terciles of total PA was lower in males (weighted kappa kw = 0.35, p < 0.06) than in females (KW = 0.52, p < 0.004). Although the study size prevents to infer definitive conclusions, the questionnaire performs better when measuring basic, occupational and total PA than leisure time PA. Its use as a way of ranking individuals in three categories (terciles) of total PA will produce an approximated degree of misclassification of 30% in the lowest tercile of males meanwhile this degree will not go far beyond than 10% for other categories in both sexes.