Ricardo Ocaña-Riola

2012 American Geriatrics Society Beers Criteria: Enhanced Applicability for Detecting Potentially Inappropriate Medications in European Older Adults? A Comparison with the Screening Tool of Older Person's Potentially Inappropriate Prescriptions

To determine the prevalence of potentially inappropriate medications (PIMs) and related factors through a comparative analysis of the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP), the 2003 Beers criteria, and the 2012 AGS update of the Beers criteria.

Population-based study of cutaneous malignant melanoma in the Granada province (Spain), 1985-1992

Cutaneous melanoma has received substantial attention during the last years because of the increase in its incidence which has been registered in many countries. This paper aims at describing the incidence and characteristics of all new cutaneous malignant melanoma cases during 1985–1992 reported to the Granada Cancer Registry (Spain) in the context of Mediterranean populations. A population-based study with 247 cutaneous melanoma cases was carried out. The variables used were: sex, age, anatomic site, hystological type, level of invasion and tumour thickness. The Age-Standardised incidence Rate per World population (ASRW) was 2.9 for males and 3.7 for females in the whole period. An increasing incidence trend for both males and females was found. The ASRW in 1985–1987, 1988–1990 and 1991–1992 was respectively 2.2, 2.9 and 3.2 for males and 3, 3.4, 4.7 for females. The most frequent location was trunk for males (36%) and lower extremities for females (44%). The most frequent hystological type for both males and females was superficial spreading melanoma. Seventy-six percent of males and 60% of females were diagnosed Clarks level III or over. Average tumour thickness was 3.3 mm for males and 2.4 mm for females. The results of this study can be a guidance for the setting up of health policies which would contribute to the prevention of the disease and to an improvement in care. Because of the increase in incidence rates and the high percentage of cases which were diagnosed at advanced stages, it is advised that prevention campaigns are addressed to the Granada population.

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.

Métodos para la suavización de indicadores de mortalidad: aplicación al análisis de desigualdades en mortalidad en ciudades del Estado español (Proyecto MEDEA)

Aunque la experiencia en el estudio de las desigualdades en la mortalidad en las ciudades espanolas es amplia, quedan grandes nucleos urbanos que no han sido investigados utilizando la seccion censal como unidad de analisis territorial. En este contexto se situa el proyecto coordinado «Desigualdades socioeconomicas y medioambientales en la mortalidad en ciudades de Espana. Proyecto MEDEA», en el cual participan 10 grupos de investigadores de Andalucia, Aragon, Cataluna, Galicia, Madrid, Comunitat Valenciana y Pais Vasco. Cabe senalar cuatro particularidades: a) se utiliza como area geografica basica la seccion censal; b) se emplean metodos estadisticos que tienen en cuenta la estructura geografica de la region de estudio para la estimacion de riesgos; c) se aprovechan las oportunidades que ofrecen 3 fuentes de datos complementarias (informacion sobre contaminacion atmosferica, informacion sobre contaminacion industrial y registros de mortalidad), y d) se emprende un analisis coordinado de gran alcance, favorecido por la implantacion de la redes tematicas de investigacion. El objetivo de este trabajo es explicar los metodos para la suavizacion de indicadores de mortalidad en el proyecto MEDEA. El articulo se centra en la metodologia y los resultados del modelo de mapa de enfermedades de Besag, York y Mollie (BYM). Aunque en el proyecto se han suavizado, mediante el modelo BYM, las razones de mortalidad estandarizadas (RME) correspondientes a 17 grandes grupos de causas de defuncion y 28 causas especificas, aqui se aplica esta metodologia a la mortalidad por cancer de traquea, de bronquios y de pulmon en ambos sexos en la ciudad de Barcelona durante el periodo 1996-2003. Como resultado se aprecia un diferente patron geografico en las RME suavizadas en ambos sexos. En los hombres se observan unas RME mayores que la unidad en los barrios con mayor privacion socioeconomica. En las mujeres este patron se observa en las zonas con un mayor nivel socioeconomico.

Socio-economic level, farming activities and risk of cancer in small areas of Southern Spain

An ecological design was used to study the relationship between cancer incidence and both socio-economic and environmental features in Southern Spain. Twenty-four sites and 26,380 cases diagnosed in 1985–1996 were analysed. Generalised Additive Models were used for data analysis. Except for lip cancer, the urban areas showed an increase in cancer risk for all sites. The relative risks among urban and rural municipalities ranges between 1.09 for skin non-melanoma (95% CI: 1.00–1.18) and 1.64 for cervix cancer (95% CI: 1.28–2.12). The relative risk among areas with high and low unemployment was 1.29 for stomach cancer (95% CI: 1.07–1.57), 1.45 for oral cavity cancer (95% CI: 1.10–1.93) and 1.77 for oesophagus cancer (95% CI: 1.02–3.05). Areas with highest unemployment showed the lowest incidence of melanoma. Risk for leukaemia, gall bladder, breast and prostate cancer showed a significant decreases by approximately 28% in the municipalities with the highest illiteracy score. A high percentage of land under cultivation was related to uterine tumours, larynx, rectum, lung, skin non-melanoma and brain cancers. For these sites, the risk had a significant increase by between 23%(skin non-melanoma) and 70%(rectum). Areas with high intensive farming showed a significant increase in cancer risk for lip, oral cavity, larynx, oesophagus, colon, lung, and bladder cancer. The relative risks ranges between 1.16 for colon cancer (95% CI: 1.04–1.29) and 1.47 for oesophagus cancer (95% CI: 1.15–1.87). The results of this study reveal how important socio-economic and environmental factors are for the analysis of cancer incidence in small areas of Southern Spain.

Common errors in disease mapping

Many morbid-mortality atlases and small-area studies have been carried out over the last decade. However, the methods used to draw up such research, the interpretation of results and the conclusions published are often inaccurate. Often, the proliferation of this practice has led to inefficient decision-making, implementation of inappropriate health policies and negative impact on the advancement of scientific knowledge. This paper reviews the most frequent errors in the design, analysis and interpretation of small-area epidemiological studies and proposes a diagnostic evaluation test that should enable the scientific quality of published papers to be ascertained. Nine common mistakes in disease mapping methods are discussed. From this framework, and following the theory of diagnostic evaluation, a standardised test to evaluate the scientific quality of a small-area epidemiology study has been developed. Optimal quality is achieved with the maximum score (16 points), average with a score between 8 and 15 points, and low with a score of 7 or below. A systematic evaluation of scientific papers, together with an enhanced quality in future research, will contribute towards increased efficacy in epidemiological surveillance and in health planning based on the spatio-temporal analysis of ecological information.

Spatio-temporal trends of mortality in small areas of Southern Spain

BackgroundMost mortality atlases show static maps from count data aggregated over time. This procedure has several methodological problems and serious limitations for decision making in Public Health. The evaluation of health outcomes, including mortality, should be approached from a dynamic time perspective that is specific for each gender and age group. At the moment, researches in Spain do not provide a dynamic image of the populations mortality status from a spatio-temporal point of view. The aim of this paper is to describe the spatial distribution of mortality from all causes in small areas of Andalusia (Southern Spain) and evolution over time from 1981 to 2006.MethodsA small-area ecological study was devised using the municipality as the unit for analysis. Two spatio-temporal hierarchical Bayesian models were estimated for each age group and gender. One of these was used to estimate the specific mortality rate, together with its time trends, and the other to estimate the specific rate ratio for each municipality compared with Spain as a whole.ResultsMore than 97% of the municipalities showed a diminishing or flat mortality trend in all gender and age groups. In 2006, over 95% of municipalities showed male and female mortality specific rates similar or significantly lower than Spanish rates for all age groups below 65. Systematically, municipalities in Western Andalusia showed significant male and female mortality excess from 1981 to 2006 only in age groups over 65.ConclusionsThe study shows a dynamic geographical distribution of mortality, with a different pattern for each year, gender and age group. This information will contribute towards a reflection on the past, present and future of mortality in Andalusia.

Methods to smooth mortality indicators: application to analysis of inequalities in mortality in Spanish cities (the MEDEA Project)

Although there is some experience in the study of mortality inequalities in Spanish cities, there are large urban centers that have not yet been investigated using the census tract as the unit of territorial analysis. The coordinated project <<Socioeconomic and environmental inequalities in mortality in Spanish cities. The MEDEA project>> was designed to fill this gap, with the participation of 10 groups of researchers in Andalusia, Aragon, Catalonia, Galicia, Madrid, Valencia, and the Basque Country. The MEDEA project has four distinguishing features: a) the census tract is used as the basic geographical area; b) statistical methods that include the geographical structure of the region under study are employed for risk estimation; c) data are drawn from three complementary data sources (information on air pollution, information on industrial pollution, and the records of mortality registrars), and d) a coordinated, large-scale analysis, favored by the implantation of coordinated research networks, is carried out. The main objective of the present study was to explain the methods for smoothing mortality indicators in the context of the MEDEA project. This study focusses on the methodology and the results of the Besag, York and Mollié model (BYM) in disease mapping. In the MEDEA project, standardized mortality ratios (SMR), corresponding to 17 large groups of causes of death and 28 specific causes, were smoothed by means of the BYM model; however, in the present study this methodology was applied to mortality due to cancer of the trachea, bronchi and lung in men and women in the city of Barcelona from 1996 to 2003. As a result of smoothing, a different geographical pattern for SMR in both genders was observed. In men, a SMR higher than unity was found in highly deprived areas. In contrast, in women, this pattern was observed in more affluent areas.

Los modelos multinivel o la importancia de la jerarquía

Una parte importante de la investigacion sanitaria proporciona bases de datos en las que se puede establecer alguna estructura jerarquica. Asi, los individuos estudiados, unidades muestrales de nivel 1, pueden pertenecer a grupos o unidades mayores, por ejemplo, la zona geografica donde viven, el medico que los atiende, el hospital que los asiste, etc., las unidades de nivel 2. La posible mayor homegeneidad entre individuos de un mismo grupo respecto a individuos de distintos grupos invalidaria la hipotesis de independencia necesaria para poder utilizar los modelos tradicionales de regresion. Los modelos multinivel, tambien denominados modelos jerarquicos, permiten solventar esta dificultad al distinguir los distintos niveles jerarquicos de las predictoras, separando la variabilidad de los individuos objeto de estudio de la de los grupos a los que pertenecen. Aunque estos modelos se desarrollaron en la pasada decada, especialmente en el campo de la educacion, en los ultimos anos se ha puesto en evidencia su aplicabilidad en la investigacion sanitaria. Este trabajo describe algunos modelos multinivel sencillos, discute sus ventajas sobre los metodos clasicos y presenta algunos ejemplos de aplicacion tanto en la investigacion epidemiologica como en la de servicios sanitarios.

Variations in health services utilization by primary care patients

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.