Dental Erosion Risk Factors in 6 to 12 Year Old children in Mexico City.

Objective: To assess the prevalence and dental erosion risk factors in Mexican schoolchildren. Study design: A transversal and analytical study was conducted on 411 children aged 6 to 12 years old in a public primary school of Mexico City. The children's parents answered a standardized questionnaire about their risk factors, and the Smith and Knight index was applied to assess their dental erosion degree. Results: The prevalence of dental erosion was 62%. The odds ratio and X2 tests revealed that probiotic beverage consumption (OR 1.658; CI 95%: 1.106-2.485; p = 0.014), sports beverages (OR: 2.807; CI 95%: 1.129-6.983; p = 0.021), natural juices (OR: 3.344; CI 95%: 1.556-7.184; p = 0.003), fruits and snacks with hot peppers and lemon (OR: 1.594; CI 95%: 1.066-2.382; p = 0.023), and syrups (OR: 1.869; CI 95%: 1.060-3.296; p = 0.029) were all risk factors for dental erosion. Conclusions: This study indicated that a high existence of dental erosion, which mainly affects the primary molars, is related to the frequent consumption of beverages and foods with acidic pH levels.

To what extent is climate change adaptation a novel challenge for agricultural modellers?

Modelling is key to adapting agriculture to climate change (CC), facilitating evaluation of the impacts and efficacy of adaptation measures, and the design of optimal strategies. Although there are many challenges to modelling agricultural CC adaptation, it is unclear whether these are novel or, whether adaptation merely adds new motivations to old challenges. Here, qualitative analysis of modellers' views revealed three categories of challenge: Content, Use, and Capacity. Triangulation of findings with reviews of agricultural modelling and Climate Change Risk Assessment was then used to highlight challenges specific to modelling adaptation. These were refined through literature review, focussing attention on how the progressive nature of CC affects the role and impact of modelling. Specific challenges identified were: Scope of adaptations modelled, Information on future adaptation, Collaboration to tackle novel challenges, Optimisation under progressive change with thresholds, and Responsibility given the sensitivity of future outcomes to initial choices under progressive change.

Implications of crop model ensemble size and composition for estimates of adaptation effects and agreement of recommendations.

Climate change is expected to severely affect cropping systems and food production in many parts of the world unless local adaptation can ameliorate these impacts. Ensembles of crop simulation models can be useful tools for assessing if proposed adaptation options are capable of achieving target yields, whilst also quantifying the share of uncertainty in the simulated crop impact resulting from the crop models themselves. Although some studies have analysed the influence of ensemble size on model outcomes, the effect of ensemble composition has not yet been properly appraised. Moreover, results and derived recommendations typically rely on averaged ensemble simulation results without accounting sufficiently for the spread of model outcomes. Therefore, we developed an Ensemble Outcome Agreement (EOA) index, which analyses the effect of changes in composition and size of a multi-model ensemble (MME) to evaluate the level of agreement between MME outcomes with respect to a given hypothesis (e.g. that adaptation measures result in positive crop responses). We analysed the recommendations of a previous study performed with an ensemble of 17 crop models and testing 54 adaptation options for rainfed winter wheat (Triticum aestivum L.) at Lleida (NE Spain) under perturbed conditions of temperature, precipitation and atmospheric CO2 concentration. Our results confirmed that most adaptations recommended in the previous study have a positive effect. However, we also showed that some options did not remain recommendable in specific conditions if different ensembles were considered. Using EOA, we were able to identify the adaptation options for which there is high confidence in their effectiveness at enhancing yields, even under severe climate perturbations. These include substituting spring wheat for winter wheat combined with earlier sowing dates and standard or longer duration cultivars, or introducing supplementary irrigation, the latter increasing EOA values in all cases. There is low confidence in recovering yields to baseline levels, although this target could be attained for some adaptation options under moderate climate perturbations. Recommendations derived from such robust results may provide crucial information for stakeholders seeking to implement adaptation measures.

International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data.

BACKGROUND: Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries. METHODS: Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1,355,910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries. RESULTS: Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29-3.17) and being married rather than divorced (ORs 1.17-2.54) were most consistently associated with home death across countries. CONCLUSIONS: A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.

Características demográficas de la mortalidad en los servicios de urgencias hospitalarios de Andalucía / Deaths in hospital emergency departments in Andalusia: patient characteristics

Objetivo: Describir las características de los pacientes que fallecen en el servicio de urgencias y compararlas con las de aquellos que fallecen en las áreas de hospitalización. Método: A partir del Conjunto Mínimo Básico de Datos (CMBD) hospitalarios se analizaron las defunciones ocurridas en el área de hospitalización y en el área de urgencias de los hospitales públicos de Andalucía. De ellas se obtuvieron la edad, sexo, estado civil, provincia de defunción, causa básica de defunción. Con estos datos se construyeron modelos de regresión logística y se estimaron las Odds Ratios crudas (ORc) y ajustadas (ORa) y sus intervalos de confianza al 95%. Resultados: De 23.295 defunciones de las que se tenía constancia que se habían producido en el hospital, 2.853 ocurrieron en las áreas de urgencias (47,7% mujeres). Se produjeron más fallecimientos en los grupos de viudos, de enfermos con cáncer y enfermedades isquémicas del corazón. Tras ajustar por las variables confusoras, el mayor riesgo de morir en las áreas de urgencias se produjo con el incremento de la edad y padecer una enfermedad isquémica del corazón (ORa: 1,56). Conclusiones: En las áreas de urgencia de los hospitales públicos andaluces fallecen personas muy mayores principalmente debido a enfermedades isquémicas del corazón (AU)

Objective: To describe the characteristics of patients who die in hospital emergency departments in Andalusia, Spain, in relation to patients who die after hospitalization. Methods: Deaths occurring in an emergency department or in other departments of Andalusian hospitals we reanalyzed; data were extracted from the hospitals’ minimum basic data sets. Age, marital status, province, and cause of death were recorded. From the data we constructed logistic regression models and estimated crude and adjusted odds ratios (ORs) and 95% CIs. Results: Of the 23 295 deaths registered, 2853 occurred in emergency departments; 47.7% of the deceased patients were females. More deaths occurred among widows or widowers and among patients with cancer or ischemic heart disease. After adjustment for confounders, the variables that remained associated with risk of death in the emergency department were older age and ischemic heart disease (OR, 1.56). Conclusion: Most deaths in Andalusian emergency departments are in elderly persons and the main cause of death is ischemic heart disease (AU)

COPD mortality rates in Andalusia, Spain, 1975-2010: a joinpoint regression analysis.

OBJECTIVES: To describe chronic obstructive pulmonary disease (COPD) mortality rates in Andalusia, Spain, between 1975 and 2010 using a joinpoint regression analysis. DESIGN: Mortality figures for Andalusian residents aged >40 years from 1975 to 2010 were obtained from the National Institute of Statistics. Causes of death were classified based on the 8th, 9th and 10th revisions of the International Classification of Diseases. Crude, standardised (SMR) and 40- to 70-year truncated mortality rates were calculated. Trends were analysed using joinpoint regression analysis to identify significant trend changes, and an annual percentage of change (APC) was computed from each trend. RESULTS: Mortality rates showed a downward trend for both sexes. The SMR ranged from 109.9 to 98.0 deaths/100 000 males, and between 35.8 and 12.0 deaths/100 000 females. An increase in the average age at death for men and women with COPD was also observed. Both sexes experienced an increase in SMR in the early 1980s, although female mortality rates began to decline in 1985 (APC -5.8% thereafter), whereas those for males remained high until 1998 (APC -4% thereafter). CONCLUSIONS: COPD mortality remains higher in male than female inhabitants of Andalusia. These rates have decreased following different sex- and age-dependent patterns.

[Place of death in Andalusia: influence of age, gender and cause of death]. / El lugar de la muerte en Andalucía: influencia de la edad, sexo y causa de defunción.

AIM: To know the place of death and its relationship to age, gender and causes of death. MATERIAL AND METHODS: A cross-sectional analysis of national population data using 31,463 deaths derived from Official Statistics on Mortality in Andalusia for the year 2009 was carried out. The variables studied were place of death (hospital, home or care home), age, gender and cause of mortality. Odds ratio adjusted by gender, age and cause of mortality using a multinomial logistic regression model. Place of death was chosen as dependent variable and age, gender and cause of death as independent ones. RESULTS: The place of death was hospital (61%), home (31%) and care home (8%). The higher the age, the higher the percentage of deaths at home and especially in care homes. Deaths in care homes are related to age (OR: 1,054; 95%CI: 1,049-1,059) and central nervous system (OR: 2,221; 95%CI: 1,826-2,071) and endocrine diseases (OR: 1,391; 95%CI: 1,141-1,697). There is a lower likelihood of dying at home due to digestive diseases (OR: 0,272; 95%CI: 0.23-0.32), genitourinary diseases (OR: 0.54; 95%CI: 0.44-0.65) and respiratory diseases (OR: 0.73; 95%CI: 0.64-0.82). CONCLUSIONS: Most Andalusians die in the hospital and increasing age has been found to be associated with higher probability of dying at home or in care homes. There are differences between death causes regarding place of death.

El lugar de la muerte en Andalucía: influencia de la edad, sexo y causa de defunción / Place of death in Andalusia: influence of age, gender and cause of death

Objetivo. Conocer el lugar de la muerte y su relación con la edad, sexo y causas de defunción. Material y método. Estudio transversal de base poblacional a partir de 31.463 defunciones procedentes de las estadísticas oficiales de mortalidad de Andalucía en el año 2009. Las variables estudiadas han sido: lugar donde ocurrió la muerte (hospital, domicilio o residencia socio-sanitaria), edad, sexo y causa de mortalidad. Se han calculado las odds ratio ajustadas por edad, sexo y causa de defunción mediante un modelo de regresión logística multinomial. Como variable dependiente se ha usado el lugar de fallecimiento y como independiente la edad, sexo y causa. Resultados. El lugar de fallecimiento fue: hospital (61%), domicilio (31%) y residencia socio-sanitaria (8%). A mayor edad aumenta el porcentaje de fallecidos en el domicilio y especialmente en las residencias respecto al hospital. Resultados. Las muertes en residencia se asocian con la edad (OR: 1,054; intervalo de confianza [IC] del 95%, 1,049-1,059) y las enfermedades del sistema nervioso central (OR: 2,221; IC del 95%, 1,826-2,701) y endocrinas (OR: 1,391; IC del 95%, 1,141-1,697). Resultados. Hay una menor probabilidad de morir en domicilio por las enfermedades digestivas (OR: 0,272; IC del 95%, 0,23-0,32), genitourinarias(OR: 0,54; IC del 95%, 0,44-0,65) y respiratorias (OR: 0,73; IC del 95%, 0,64-0,82). Conclusiones. La mayoría de los andaluces mueren en el hospital y a medida que aumenta la edad se incrementa la posibilidad de morir fuera del mismo. Hay diferencias significativas en la causa de defunción según el lugar de fallecimiento(AU)

Aim. To know the place of death and its relationship to age, gender and causes of death. Material and methods. A cross-sectional analysis of national population data using 31,463 deaths derived from Official Statistics on Mortality in Andalusia for the year 2009 was carried out. The variables studied were place of death (hospital, home or care home), age, gender and cause of mortality. Odds ratio adjusted by gender, age and cause of mortality using a multinomial logistic regression model. Place of death was chosen as dependent variable and age, gender and cause of death as independent ones. Results. The place of death was hospital (61%), home (31%) and care home (8%). The higher the age, the higher the percentage of deaths at home and especially in care homes. Results. Deaths in care homes are related to age (OR: 1,054; 95%CI: 1,049-1,059) and central nervous system (OR: 2,221; 95%CI: 1,826-2,071) and endocrine diseases (OR: 1,391; 95%CI: 1,141-1,697). Results. There is a lower likelihood of dying at home due to digestive diseases (OR: 0,272; 95%CI: 0.23-0.32), genitourinary diseases (OR: 0.54; 95%CI: 0.44-0.65) and respiratory diseases (OR: 0.73; 95%CI: 0.64-0.82). Conclusions. Most Andalusians die in the hospital and increasing age has been found to be associated with higher probability of dying at home or in care homes. There are differences between death causes regarding place of death(AU)

Supplementation of ascorbic acid and alpha-tocopherol is useful to preventing bone loss linked to oxidative stress in elderly.

OBJECTIVE: To determine the effect of ascorbic acid and alpha-tocopherol on oxidative stress and bone mineral density (BMD) in elderly people. DESIGN: A double-blind, controlled clinical assay was carried out in a sample of 90 elderly subjects divided into three age-paired random groups with 30 subjects in each group. Group Tx0 received placebo, group Tx1 received 500 mg of ascorbic acid and 400 IU of alpha-tocopherol, whereas group Tx2 received 1,000 mg of ascorbic acid and 400 IU of alpha-tocopherol, for a 12-month period. MEASUREMENTS: We measured thiobarbituric acid reactive substances (TBARS), total antioxidant status (TAS), superoxide dismutase (SOD), and glutation peroxidase (GPx); BMD was obtained on DXA of hip and spine before and after the 12-month treatment period with supplementation of vitamins C and E. RESULTS: We found a positive correlation between hip-BMD and SOD (r = 0.298, p < 0.05) and GPx (r = 0.214, p < 0.05). Also, a significantly lower decrease of LPO (p < 0.05) was observed as linked with hip bone loss in the Tx2 group than in the Tx0 group. CONCLUSIONS: Our findings suggest that that administration of 1,000 mg of ascorbic acid together with 400 IU of alpha-tocopherol could be useful in preventing or aiding in the treatment of age-related osteoporosis.

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain).

OBJECTIVE: To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain). METHODS: A small-area ecological study was devised using the census section as the unit for analysis. 188,983 Deaths occurring in the capital cities of the Andalusian provinces and 109,478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation. MAIN RESULTS: In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities. CONCLUSIONS: Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level.

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

[Changes in mortality associated with traffic accidents in Andalusia from 1975 to 2001 and forecast for 2004]. / Evolución de la mortalidad por accidentes de tráfico en Andalucía desde 1975 hasta 2001 y predicción.

OBJECTIVE: To describe the evolution of mortality due to traffic accidents in Andalusia between 1975 and 2001 and to predict the mortality rates for 2004. DESIGN: Ecological study with a population base. SETTING: Residents in Andalusia between 1975 and 2001. PARTICIPANTS: Deaths due to traffic accidents in Andalusia between 1975 and 2001. Main measurements and results. Mortality rates adjusted for age in men and women and in three groups: under-35s, from 35 to 64, and over 64. The evolution of rates over time was studied through trend analysis. Short-term predictions of the mortality rates were made. The adjusted rates for men fell from 21.20 per 100000 inhabitants in 2001 to 20.21 in 2001. The rate for women fell from 4.87 to 4.60 during the same period. The evolution of mortality was similar for both sexes. CONCLUSIONS: Traffic accident mortality evolved in an oscillating way, with an important fall in numbers starting in 1989. Mortality rates increased with age. The predictions formulated indicate that the stable trend starting in 1995 will remain the same in the coming years.

Gender differences in rising trends in cutaneous malignant melanoma in Spain, 1975-98.

BACKGROUND: Cutaneous malignant melanoma (CMM) morbidity and mortality rates have increased over the past several decades all around the world, but some developed countries have experienced recent declines in mortality from CMM among the young and middle-aged and even a reversal in the long-term increase in deaths attributable to CMM. OBJECTIVES: To describe CMM mortality trends, by age and gender, in Spain between 1975 and 1998. METHODS: Crude, age-adjusted, truncated, cumulative, age-specific and potential years of life lost rates of CMM mortality were calculated by gender. Age and period Poisson regression models were fitted to gender- and age-specific CMM mortality rates. RESULTS: In males there were marked increases in all CMM mortality rates between 1975 and 1994, followed by their decrease during 1995-98. In contrast, rates rose in females between 1975 and 1998. There were annual increases of 13% in the risk of dying among males and 33% among females. Relative risks of CMM mortality increased with age in both genders: (i) 21.75 (95% confidence interval, CI 17.32-27.30) in males, and (ii) 28.27 (95% CI 24.99-31.97) in females in the > or = 70-year-old group, when compared with those < 35 years. CONCLUSIONS: CMM mortality rates continue to rise in females while males have experienced a recent reversal of this trend in Spain. Emphasizing the danger of overexposure to ultraviolet radiation may be especially important in females.

Evolución de la mortalidad por melanoma maligno cutáneo en Andalucía / Mortality trends of cutaneous malignant melanoma in Andalucía

Propósito: Investigar la tendencia de la mortalidad por Melanoma cutáneo maligno (MCM) en Andalucía. Material y métodos: Análisis epidemiológico de las tasas crudas, estandarizadas, truncadas y específicas por edad y género a partir de las defunciones por MCM de residentes en Andalucía en 1975-1998. Ajuste de modelos de regresión de Poisson para valorar el riesgo relativo asociado a la edad y al periodo. Resultados: Todos los parámetros epidemiológicos analizados muestran un aumento de la mortalidad por MCM en Andalucía en ambos géneros, a lo largo del intervalo estudiado, que el modelo de Poisson cuantifica en el 6 por ciento promedio anual para varones y el 6,5 por ciento para mujeres. Conclusiones: Mientras que otros países de nuestro entorno han mostrado, a partir de mediados de los 80, una estabilización de la mortalidad por MCM, en Andalucía ésta ha seguido aumentando y se hace necesario insistir en las medidas de prevención tanto primaria como secundaria (AU)

Mortalidad por cáncer de estómago en Andalucía: tendencia y distribución espacial / Mortality due to gastric cancer in Andalusia: trends and geographic distribution

Objetivo. Describir la evolución de la mortalidad por cáncer de estómago en Andalucía y su distribución geográfica actual. Diseño. Estudio descriptivo de base poblacional. Emplazamiento. Andalucía durante el período 1975-1999.Participantes. Residentes en Andalucía. Mediciones. Tasas brutas, ajustadas por edad, truncadas (35-64 años), de años potenciales de vida perdidos (1-70 años) y acumuladas (0-74 años) de mortalidad por cáncer de estómago entre 1975 y 1999. Coeficientes de regresión lineal del modelo que mejor se ajusta a las tasas estandarizadas a lo largo de todo el período. Tasas ajustadas por edad del quinquenio 1995-1999 en los distritos sanitarios de atención primaria. Resultados. Se observa un descenso mantenido de la mortalidad por cáncer de estómago, y las tasas estandarizadas pasan de 15,9 a 5,8 en mujeres y de 33,9 a 14,5 en varones (por 100.000 individuos). Los distritos de las sierras norte de Sevilla, Huelva y Córdoba junto con Guadix, en Granada, presentaron las tasas más altas en el quinquenio 1995-1999 tras ajustar por edad. Los varones mantienen tasas más elevadas de mortalidad a lo largo del intervalo analizado, con razones de masculinidad siempre superiores a 2. Conclusiones. La mortalidad por cáncer de estómago ha descendido notablemente en Andalucía a lo largo del último cuarto del siglo XX, pero la distribución geográfica actual de la misma no es homogénea y se observan distritos de atención primaria con tasas 3 veces superiores a las tasas de los distritos de baja mortalidad. Se necesitan estudios analíticos que aclaren las posibles causas de estas notables diferencias (AU)

Mortality trends from oral cancer in Andalusia, Spain, 1975-1998.

Morbidity and mortality rates from oral cancer appear to be on the rise among developed countries throughout the world during the last decades. The object of the present study was to investigate the recent changes in the mortality from oral cancer in the more than seven million inhabitants of Andalusia, Spain. Data on the number of deaths by oral cancer from 1975 to 1998 were obtained from annual publications by the Statistics Institute. Crude, age-standardized, truncated, cumulative and age-specific rates of mortality were calculated by gender as well as potential years of life lost rates. Poisson regression models were fitted in order to quantify the influence of age and year of death on the mortality rates by gender.Age-adjusted mortality rates increased from 2.79 in 1975-79 to 3.41 in 1995-98 in males and from 0.39 to 0.45 in females during the same period. Increases were more marked when comparing the truncated age-adjusted rates. Relative risks increased with age from 2.35 to 23.12 in 55 to 64-y-old and 85-y-old males respectively, and from 2.91 to 21.50 in 55 to 64-y-old and 85-y-old females respectively, when comparing with the 35-54-y-old age group. There was an interaction between age at death and year of death in males but not in females. Mortality from oral cancer increased in males in Andalusia over the study period, simultaneous to an important change in the pattern of occurrence by age. There was a cohort effect in males and females across the studied time interval.

[Improving care for victims of domestic violence. Impact of a priority intervention]. / Mejora de la atención prestada a víctimas de violencia doméstica. Impacto de una intervención priorizada.

OBJECTIVE: To evaluate the impact of a priority intervention in the care given to women who are victims of domestic violence and their children. DESIGN: Non-randomised intervention study. SETTING: Urban health centre. PATIENTS: Women and children living at a reception centre for families suffering domestic violence and who had clinical records opened at the health centre. Pre-intervention group (December 1997-July 1999): 36 women, 70 children. Post-intervention group (August 1999-June 2000): 35 women and 41 children.Interventions. Allocation to a single family doctor and paediatrician. Elimination of bureaucratic obstacles and prioritised care. Social/family assessment by the social worker. Preferential inclusion in programmes: Women: family planning, hepatitis B vaccination, pregnancy control, early diagnosis of breast cancer (women > 50), same for cervical cancer. Children: child health (< 5) (priority activities: psychomotor development and somatometry) and vaccinations. This intervention started in August 1999. MEASUREMENTS AND MAIN RESULTS: Measurement of the impact of the intervention: bivariant analysis through Chi2 test for qualitative variables and Student's t test and U Mann-Whitney test for quantitative variables (alpha 0.05) in the pre- and post-intervention groups. Statistically significant differences in participation were detected between the pre- and post-intervention groups in the following activities: number of visits to programmes (0.49, SD 0.95; 1.01, SD 1.24, respectively), social and family assessment (83%/100%), family planning (14%/51.4%), hepatitis B vaccination (19%/48.7%), early cervical cancer diagnosis (0/25.7%), child health (33.4%/70%), vaccinations (26.34%/64%), somametric assessment (25%/100%) and psychomotor development assessment (41.6%/94%). CONCLUSIONS: Prioritised intervention in families that are victims of domestic violence improves their participation in preventive activities.