Search

Purpose: To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person's potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM. Methods: Cross-sectional study including 582 community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. Results: A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%. Conclusions: The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed. [ABSTRACT FROM AUTHOR]

Statistics plays a crucial role in research, planning and decision-making in the health sciences. Progress in technologies and continued research in computational statistics has enabled us to implement sophisticated mathematical models within software that are handled by non-statistician researchers. As a result, over the last decades, medical journals have published a host of papers that use some novel statistical method. The aim of this paper is to present a review on how the statistical methods are being applied in the construction of scientific knowledge in health sciences, as well as, to propose some improvement actions. From the early twentieth century, there has been a remarkable surge in scientific evidence alerting on the errors that many non-statistician researchers were making in applying statistical methods. Today, several studies continue showing that a large percentage of articles published in high-impact factor journals contain errors in data analysis or interpretation of results, with the ensuing repercussions on the validity and efficiency of the research conducted. Scientific community should reflect on the causes that have led to this situation, the consequences to the advancement of scientific knowledge and the solutions to this problem. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to estimate the prevalence of polypharmacy and potential prescribing omissions (PPO) and their related factors in community-dwelling elderly patients and to examine any possible relationship between these two concepts. Methods: A cross-sectional study was carried out including patients 65 years of age or over living on the island of Lanzarote (Spain). Sociodemographic, clinical and functional variables were collected, together with full data on drug therapy. The percentage of patients receiving ≥5 medications (polypharmacy) and the percentage of patients receiving at least one PPO according to Screening Tool to Alert doctors to Right Treatment (START) criteria (underprescription) were the two primary endpoints. Results: A total of 1844 medications were prescribed to the 407 patients included in our study. The overall prevalence of polypharmacy was 45 %. The risk factors associated with polypharmacy were comorbidity (OR 1.98, 95 % CI 1.63-2.44), limitations in activities of daily living (ADL; OR 3.0, 95 % CI 1.51-6.11), and being prescribed a drug in the Anatomical Therapeutic Chemical classification (ATC) C group (OR 7.92, 95 % CI 4.10-16.25) or in the N group (OR 3.80, 95 % CI 2.25-6.55). START criteria identified a total of 303 PPO in 170 (41.8 %) subjects. The risk of PPO increased by 60 % for every additional point in the Charlson Comorbidity Index (OR 1.60, 95 % CI 1.35-1.91). Polypharmacy also independently predicted the odds of at least one PPO according to START criteria (OR 2.19, 95 % CI 1.36-3.55). Conclusion: Our findings show high rates of polypharmacy and PPO, as well as a clear relationship between these two concepts. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cancer in women worldwide. The analysis of breast cancer mortality is needed to plan healthcare systems. This study aims to evaluate the age-period-cohort effects on breast cancer mortality in Andalusia (Southern Spain) as a whole and in each of its eight provinces during the period 1981-2008. A population-based ecological study was conducted. In all, 19,707 deaths from breast cancer were analysed for individuals between the ages of 40 and 84 years who died in Andalusia in the period of study. A nonlinear regression model was estimated for each gender group and geographical area. The effects of age, year of death and birth cohort were parameterised using B-spline smoothing functions. There is an upward trend in mortality by age until around the age of 75 years, from which point the trend turned downwards. The analysis of the cohort effect reveals a steady fall in breast cancer mortality risk for female generations born after 1940. Death rates increased until 1995 and then declined until the end of the period. There is an age-period-cohort effect on breast cancer mortality similar in all the provinces of Andalusia and for Andalusia as a whole. If the current trends continue, it can be expected that these effects will continue to reduce female mortality. [ABSTRACT FROM AUTHOR]

Nowadays, there is a wide debate about what rural means. An operational definition of rural concept is essential in order to measure health problems, optimize resource allocation and facilitate decision making aimed at closing the gap on inequity between areas. In 2005, the rurality index for Small Areas in Spain (IRAP) was developed using the 1991 Census of Population data. Nevertheless, the concept and definition of rurality may evolve through time. In order to capture these changes, the variables used to make up the rurality index should be reviewed and updated periodically. Along these lines, and within the context of the rural–urban continuum, the aim of this paper is to replicate and update the IRAP using the data provided by the 2001 Census of Population, as well as to describe the changes in rurality observed in each municipality between 1991 and 2001. The index was updated on a Principal Components Factor Analysis, giving rise to a single factor that is correlated to the aging of the population, economic dependency, farming, livestock or fishing-related employment, self-employment, second dwelling ratio, population density, immigration and perception of noises and atmospheric pollution in the surroundings of the residential area. Most variables that made up the 1991 IRAP remain as important components of the 2001 index, indicating the robust nature of the measure. Only 10% of the Spanish municipalities have changed their rurality status between the two Censuses. The 2001 rurality index can be considered a good updated approach to the concept of rurality in Spain as well as an important criterion to social policies. [ABSTRACT FROM AUTHOR]

An operational definition for “rural area” is pivotal if proposals, policies and decisions aimed at optimising the distribution of resources, closing the gap on inequity between areas and raising standards of living for the least advantaged populations are to be put in place. The concept of rurality, however, is often based on alternative and conflicting definitions, requiring clarification of the underlying theoretical model. Traditionally a geographical area has been classified as rural by taking into account either the number of inhabitants or population density. Two kinds of problem are raised with this approach, however, namely: it is inherently difficult to describe such a complex concept as rurality with a single variable; and reducing the concept down to a rural/urban dichotomy by setting a non-universal cut-off point does not usually provide an accurate account of reality. Within the context of the rural–urban continuum, this paper has devised a rurality index for Spanish municipalities based on the 1991 Population, Housing and Household Survey. The index was built on a principal components factor analysis, giving rise to a single factor that is correlated to the aging of the population, economic dependency, farming, livestock or fishing-related employment, habitability of housing and population density. A score to each municipality was allocated. This index can be regularly updated thus enabling the progress of the concept of rurality to be monitored in our setting over time and then compared with other countries using the same methods. [ABSTRACT FROM AUTHOR]

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 Clark's 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. [ABSTRACT FROM AUTHOR]