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Background Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difculties associated with therapeutic adherence. Methods An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identifed. Results Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions. The main themes identifed were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system. Conclusions Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difcult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Background Disability is frequently associated with contextual or lifestyle factors. Some health conditions may affect the prevalence of disability differently, especially for some minority groups. This study aims to assess the impact and contribution of different health conditions to disability burden in Spain in Roma and immigrant populations, compared to the general population. Methods This is a cross-sectional study. We have used data from the Spanish National Survey of 2017 and the National Health Survey of the Roma Population 2014. We have calculated frequencies of demographic variables and prevalence of health conditions grouped by body function. We also have fitted binomial additive hazard models, using the attribution method, to assess disabling impact and contribution of health conditions to disability burden. The software R was used for the computations. Results Roma and immigrant populations had worse socioeconomic status than the general population, although the gap was more heavily marked among Roma. Roma population showed a higher prevalence in all health conditions, with a disability prevalence of 57.90%, contrary to the immigrant population, that showed a lower prevalence in all health conditions, including disability (30.79%), than the general population (40.00%). However, all health conditions were more disabling in the immigrant population. Neurological and cardiovascular diseases, and accidents among Roma, were the most disabling conditions. Nevertheless, musculoskeletal, chronic pain, and sensory diseases among Roma, had a greater contribution to disability burden, mainly due to a combination of a great prevalence and a great impact in functions of those health conditions. Conclusion Both ethnicity and migrant status have shown differences in the burden of disability. While in the general population, musculoskeletal problems have the greatest contribution to the disability burden, in immigrants it was chronic pain and in the Roma population it

Objective This cross-sectional study aims to analyse the relationship between sedentary behaviour and breast cancer (BC) risk from a social perspective. Methods Women aged 45–70 who participated in the Valencia Region Breast Cancer Screening Programme (2018–2019) were included, with a total of 121,359 women analysed, including 506 with cancer and 120,853 without cancer. The response variable was BC (screen-detected) and the main explanatory variable was sedentary behaviour (≤2 / >2-≤3 / >3-≤5 / >5 hours/day, h/d). Nested logistic regression models (M) were estimated: M1: sedentary behaviour adjusted for age and family history of BC; M2: M1 + hormonal/reproductive variables (menopausal status, number of pregnancies, hormone replacement therapy; in addition, months of breastfeeding was added for a subsample of women with one or more live births); M3: M2 + lifestyle variables (body mass index, smoking habits); M4: M3 + socioeconomic variables (educational level, occupation); Final model: M4 + gender variables (childcare responsibilities, family size). Interaction between sedentary behaviour and educational level was analysed in the Final model. Moreover, for the whole sample, postmenopausal women and HR+ BC, the Final model was stratified by educational level. Results Sedentary behaviour was associated with an increased risk of BC with a nearly statistically significant effect in the Final model (>2-≤3 h/d: OR = 1.22 (0.93–1.61); >3-≤5 h/d: OR = 1.14 (0.86–1.52); >5: OR = 1.19 (0.89–1.60)). For women with a low educational level, sitting more than 2 h/d was associated with an increased risk of BC in the whole sample (>2-≤3 h/d OR = 1.93 (1.19–3.21); in postmenopausal women (>2-≤3 h/d, OR = 2.12 (1.18–2.96), >5h/d OR = 1.75 (1.01–3.11)) and in HR+ BC (>2-≤3h/d, OR = 2.15 (1.22–3.99)). Similar results were observed for women with one or more live births. Conclusions Sitting >2 h/d is associated with BC risk in women with low educational level, especially in postmenopausa

Introduction and objectives Only about 50% of chronic patients in high-income countries adhere to their treatment. There are methods to measure medication adherence but none of them can be considered optimal. This study will aim to design and validate a questionnaire to measure medication adherence in patients with ischaemic heart disease using a direct method as a gold-standard adherence measure and taking into account the gender perspective. Moreover, the profile of low adherence in these patients will be determined. Methods and analysis First study phase consists on the questionnaire design following the next steps: identification of the dimensions, definition of the target population, questionnaire items and order, response coding, questionnaire instructions, content validity by experts and understandability. In the second phase, a cross-sectional study will be performed to end the questionnaire development and validate it. Four hundred and forty patients (50% female) with acute coronary syndrome receiving treatment within the previous 12 months will be included. Patient will answer the initial questionnaire and adherence to aspirin and statin will be measured using a direct method (drug concentration analysis in blood) and other questionnaires. From the set of preselected questionnaire items, those most closely associated with the gold standard measure will be selected using multivariate statistics. Ethics and dissemination All participants gave their written informed consent before participating in the study. The study protocol follows the recommendations of the Declaration of Helsinki and was approved by the ethics committees of the three participating centres. The results of this study will be displayed at national and international conferences and in peer-reviewed scientific journals.

Antecedentes: Desde el inicio de este siglo, se comienza a observar un incremento exponencial de la población inmigrante en España, situándose progresivamente como uno de los principales países del mundo con mayor proporción de inmigrantes. Esto ha ocasionado un nuevo perfil epidemiológico y demográfico en el país que debe ser estudiado. Numerosos estudios han analizado las desigualdades socioeconómicas y su asociación con la mortalidad en áreas urbanas. Sin embargo, pocos de ellos han diferenciado entre población nativa e inmigrante. Objetivos: Esta tesis doctoral presenta como objetivo general analizar las diferencias en la población nativa e inmigrante residente en España en las tendencias de mortalidad por cáncer y las desigualdades socioeconómicas en mortalidad en áreas pequeñas de grandes ciudades. Para ello se establecen un total de dos objetivos específicos. El primero de ellos es analizar la tendencia de mortalidad por cáncer en la población inmigrante y nativa residente en España desde el año 2000 al 2016. El segundo es analizar las desigualdades socioeconómicas en mortalidad entre la población nativa e inmigrante en áreas pequeñas de las mayores ciudades de la Comunidad Valenciana (Alicante, Castellón y Valencia) durante el periodo después del inicio de la crisis económica, desde el 2009 hasta el 2015. Metodología: Esta tesis doctoral se presenta con el formato de tesis por compendio de publicaciones. Ambos artículos incluidos en esta tesis doctoral se tratan de estudios ecológicos de corte transversal relacionadas con la mortalidad en la población inmigrante y nativa a nivel nacional (objetivo específico 1) y autonómico (objetivo específico 2). Todas las fuentes de información utilizadas fueron del tipo secundaria. Respecto a las defunciones ocurridas durante el periodo de estudio, proceden del Boletín Estadístico de Defunciones (objetivo específico 1) y el registro de mortalidad de la Comunidad Valenciana (objetivo específico 2). En ambos estudios las c

Background: Health literacy (HL) is the set of social and cognitive skills that determine person’s level of motivation and the ability to access, understand and use information to promote and maintain good health. The aim of this study is to assess the level of health literacy, and to analyze its relationship with sociodemographic variables, state of health, and use of health services in the population aged 15 and over in the Valencian Community (Spain). Methods: Cross-sectional study based on a sample of 5,485 subjects participating in the Health Survey of the Valencia Community. The HLS-EU-Q16 was used. As outcome variables we considered HL categorized into 2 levels: Inadequate or Problematic HL and Sufficient HL and the standardized literacy index. Prevalence rates and HL means were estimated and OR were calculated to analyze the association between variables. Results: A total of 12.8% of the subjects surveyed presented an inadequate or problematic degree of HL. This percentage was higher in people >85 years (63.1%), with a low level of education (46.5%), in retired people (27.4%) or in other work situations (25.0%), in foreigners (18.1%), in low-income people (16.2%), with a perception of poor health status (26.9%), chronic disease (18.5%) or with activity limitations (56.4% severe, 19.7% not severe). Significant differences were found. With the exception of chronic disease, all the variables analyzed were associated with HL. Low HL was associated with a lower consumption of medicines, a greater use of health services, general medical consultations, poorer knowledge of new health technologies and fewer preventive health visits. Conclusion: The percentage of inadequate or problematic HL was globally not very high, but certain population subgroups notably presented a high degree of inadequate or problematic HL. Raising the HL level of such groups should be regarded as a priority. HL was shown to be associated with the service use and new health technology use. Enh

Objective: To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP). Methods: Cross-sectional study of men and women aged between 50 and 75 at the time of the study (2020) that were selected from the target population of the Region of Valencia CRCSP. (study sample 1,150,684). First, a multiple correspondence analysis was performed to aggregate information from the Population Information System of the Region of Valencia into an ISESI. Second, data from the 2016 Region of Valencia Health Survey were used for validation, and finally the relationship between CRCSP participation and the ISESI was analysed by logistic regression models. Results: The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757–0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347–1.390) and Q3 OR = 1.156 (1.137–1.175). Conclusions: An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.

Objectives: This study aimed to assess the validity and psychometric properties of the Spanish version of the Second Victim Experience and Support Tool (SVEST-E) questionnaire. Methods: This was a cross-sectional study aimed at midwives and obstetricians in Spain. An online survey was conducted consisting of 2 parts: the first part collected different variables, and the second part collected the SVEST-E. The temporal stability of the instrument was evaluated using the test-retest method. For the construct validity and reliability, an exploratory factor analysis and a confirmatory factor analysis were performed using FACTOR program v.10 with a polychoric correlation matrix. Results: A total of 689 professionals participated in the study (323 obstetrician physicians/366 midwives). The mean (SD) score on the SVEST-E for the total sample was 3.09 (0.50). The parallel analysis of the exploratory factor analysis suggested a 5-factor solution, with a total explained variability of 61.8%. The goodness-of-fit indices of the model were the following: root mean square error of approximation = 0.038 (95% confidence interval [CI], 0.031–0.042) and comparative fit index = 0.989 (95% CI, 0.988–0.992). The factor model obtained was confirmed by confirmatory factor analysis, obtaining the values of root mean square error of approximation = 0.038 (95% CI, 0.026–0.053) and comparative fit index = 0.989 (95% CI, 0.969–1.000). The intraclass correlation coefficient was 0.97 (95% CI, 0.94–0.99). Conclusions: The SVEST-E instrument maintains the same items as the original questionnaire but introduces changes in the organization of its dimensions. The Spanish version maintains adequate construct validity, reliability, and temporal stability, so it is a valid tool to evaluate the second victim experience in Spanish health professionals.

Esta publicación persigue introducir en la utilización de algunos procedimientos y técnicas de análisis estadístico de datos a aquellas personas que requieran por los objetivos de su investigación de la utilización de modelos de análisis multivariante. Los procedimientos descritos en este trabajo guardan relación con aquellas situaciones en las que la variable principal a estudio (o variable respuesta) es de tipo continuo, mientras que el resto de variables implicadas en el análisis son cuantitativas o cualitativas. En esta situación, los métodos epidemiológicos clásicos tienden a abordar el estudio de las interrelaciones entre variables (asociaciones, confusiones, interacciones, etc.) sugiriendo la categorización de las variables cuantitativas, con la consiguiente pérdida de información, y la utilización de medidas o modelos para datos categóricos, para estimar y cuantificar la asociación entre variables. Como se verá, los conceptos de asociación, confusión o interacción tienen pleno sentido con variables cuantitativas y los procedimientos aquí descritos tienen capacidad para su detección y cuantificación. Aunque no es imprescindible, resulta conveniente que el lector se encuentre familiarizado, al menos a nivel básico, con los conceptos de asociación, confusión e interacción entre variables. Es igualmente deseable que el lector disponga de conocimientos básicos sobre regresión lineal. En la estructura seguida en la presentación de los procedimientos se parte de una introducción a la situación de análisis, se establece el objetivo y los posibles modelos alternativos que pueden producirse en esa situación, se formula las pruebas de hipótesis para identificar la situación y por último se aplica sobre un ejemplo (los resultados han sido obtenidos utilizando para ello el paquete de aplicaciones estadísticas SPSS.

The geographical distribution of mortality has frequently been studied. Nevertheless, those studies often consider isolated causes of death. In this work, we aim to study the geographical distribution of mortality in urban areas, in particular, in 26 Spanish cities. We perform an overall study of 16 causes of death, considering that their geographical patterns could be dependent and estimating the dependence between the causes of death. We study the deaths in these 26 cities during the period 1996–2015 at the census tract level. A multivariate disease mapping model is used in order to solve the potential small area estimation problems that these data could show. We find that most of the geographical patterns found show positive correlations. This suggests the existence of a transversal geographical pattern, common to most causes of deaths, which determines those patterns to a higher/lower extent depending on each disease. The causes of death that exhibit that underlying pattern in a more prominent manner are chronic obstructive pulmonary disease (COPD), lung cancer, and cirrhosis for men and cardiovascular diseases and dementias for women. Such findings are quite consistent for most of the cities in the study. The high positive correlation found between geographical patterns reflects the existence of both high and low-risk areas in urban settings, in general terms for nearly all the causes of death. Moreover, the high-risk areas found often coincide with neighborhoods known for their high deprivation. Our results suggest that dependence among causes of death is a key aspect to be taken into account when mapping mortality, at least in urban contexts.

Este documento pretende guiarle de forma estructurada y secuencial a lo largo de un curso de introducción a algunos métodos de análisis estadístico multivariante con variable respuesta cuantitativa, particularmente de los procedimientos conocidos como Análisis de la varianza y covarianza. Dispondrá de 4 sesiones teórico-prácticas (sesiones 0 a 3) en las que se prevee que realizando las actividades previstas debe alcanzar los objetivos formulados para la sesión. Se contempla revisión de conceptos teóricos con cuestiones, y teórico-prácticos con actividades de análisis de datos. Después puede realizar dos actividades prácticas adicionales (sesiones 4 y 5). Las sesiones requieren disponer del cuadernillo de trabajo: Analisis de datos continuos_ANOVA-ANCOVA.pdf que puede Vd. obtener en la dirección: http://hdl.handle.net/10045/113344. En el anexo dispone Vd. de las bases de datos necesarias para la realización de las actividades prácticas propuestas. Todas las actividades están pensadas para ser resueltas con SPSS® y deberá convertir los datos a este formato.

Objetivo: Diseñar y validar una escala clínica para predecir el riesgo sufrir eventos adversos a los 90 días del alta de urgencias en pacientes con fibrilación auricular (FA). Métodos: Estudio observacional, prospectivo que incluyó pacientes con FA que acudieron a urgencias. Durante el seguimiento, registramos la incidencia de cualquier evento adverso. Se llevó a cabo un análisis de regresión logística multivariante para investigar variables asociadas de manera independiente con la presencia de eventos adversos. El 66% de los pacientes (seleccionados al azar) conformaron la cohorte de derivación y los restantes la cohorte de validación interna. Resultados: 645 pacientes (50,2% mujeres, mediana de edad de 76 [RIC 67-81] años) fueron finalmente incluidos. A los 90 días, 165 (25,6%) pacientes presentaron al menos un evento adverso (114 en la cohorte de derivación y 51 en la de validación interna). La edad ≥70 años, enfermedad vascular, insuficiencia cardíaca, EPOC, enfermedad renal, obesidad, síntomas mal controlados (EHRA III-IV), uso de oxígenoterapia, digoxina y otros antiarrítmicos en urgencias, y el mal control de la frecuencia cardiaca, se asociaron de manera independiente con el riesgo de evento adversos. Con estas variables se diseñó la escala CoSTuM, que mostró una óptima capacidad predictiva tanto en la cohorte de derivación (estadístico c: 0,901, IC 95% 0,869-0,928; p<0,001) como en la de validación (estadístico c: 0,850, IC 95% 0,796-0,894; p<0,001). Conclusiones: En pacientes con FA atendidos en urgencias, la escala CoSTuM demostró tener una buena capacidad de predicción de eventos adversos a los 90 días tras el alta., Objective: To design and validate a clinical scheme to predict the risk of adverse events 90 days after hospital discharge in patients with atrial fibrillation (AF). Methods: Observational and prospective study including patients with AF who attended the emergency department. During the follow-up, we recorded the incidence of any adverse event. A multivariate logistic regression analysis was performed to investigate variables independently associated with the presence of adverse events. 66% of the patients (randomly selected) composed the derivation cohort and the rest composed the internal validation cohort. Results: 645 patients (50.2% women, median age of 76 [IQR 67-81] years) were finally included. At 90 days, 165 (25.6%) patients presented at least one adverse event (114 in the derivation cohort and 51 in the internal validation cohort). Age ≥70 years, vascular disease, heart failure, COPD, renal impairment, obesity, poorly-controlled symptoms (EHRA III-IV), use of oxygen therapy, digoxin and other antiarrhythmics in the emergency room, and poor control of heart rate, were independently associated with the risk of adverse events. Using these variables, the CoSTuM score was designed, which showed an optimal predictive ability in both the derivation cohort (c-index: 0.901, 95% CI 0.869-0.928; p<0.001) and the internal validation cohort (c-index: 0.850, CI 95% 0.796-0.894; p<0.001). Conclusions: In AF patients who attend the emergency department, the CoSTuM score showed an appropriate predictive performance for adverse events at 90 days after discharge.

Some population groups could be especially vulnerable to the effects of population ageing. The Global Activity Limitation Indicator (GALI) has been proposed as a measure of disability, but it has not been used in minority groups. The aim of this study is to estimate the prevalence of disability using the GALI and to analyse its determinants in immigrant and Roma populations. Data from the Spanish National Health Survey 2017 and the National Health Survey of the Roma Population 2014 were used, including adults aged 50 and above. Prevalence of disability was estimated, and odds ratios were calculated using logistic regression models to assess the association between disability and demographic, socioeconomic, and health variables. The prevalence of disability was estimated at 39.4%, 30.6%, and 58.7% in the native, immigrant, and Roma populations, respectively. Gender was a common determinant for the native and Roma populations. On the other hand, among immigrants, the risk of disability increased over the time residing in Spain. There were significant interactions with age and gender in the native population. Disability has different determinants in the three population groups. Public health measures to protect the Roma population and immigrants’ health should be considered.

Background: Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system or instrumented fusion in association with disc excision to prevent pain and re-operation remains controversial. In this study, we analyzed if adding interspinous spacer or fusion, offers advantages in relation to microdiscetomy alone. Methods: Patients with lumbar disc herniation were divided in 3 groups; microdiscectomy alone (MD), microdiscectomy plus interspinous spacer (IS) and open discectomy plus posterior lumbar interbody fusion (PLIF). The clinical efficacy was measured using the Owestry Disability Index (ODI). Other outcome parameters including visual analogue scale for pain (VAS) back and legs, length of stay, direct in-hospital cost, 90-day complication rate, and 1-year re-operation rate were also evaluated. Results: A total of 103 patients whose mean age was 39.1 (±8.5) years were included. A significant improvement of the ODI and VAS back and legs pain baseline score was detected in the 3 groups. After 1 year, no significant differences in ODI, VAS back and legs pain were found between the 3 groups. There was an increase of 169% of the total direct in- hospital cost in IS group and 287% in PLIF group, in relation to MD (p < 0.001). Length of stay was 86% higher in the IS group and 384% longer in the PLIF group compared to MD (p < 0.001). The 1 year re-operation rates were 5.6%, 10% and 16.2% (p = 0.33). Discectomy seems to be the main responsible for the clinical improvement, without the interspinous spacer or fusion adding any benefit. The addition of interspinous spacer or fusion increased direct in-hospital cost, length of stay, and did not protect against re-operation.