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Lorda P.S.,Campus Universitario Of Cartuja
Revista Espanola de Salud Publica | Year: 2012

The experience of the Netherlands in relation with the legalization and practice of euthanasia is better known in Spain than the Belgian experience in this matter. But the historical process of social debate in Belgium has many specific details which should be known by Spanish healthcare professionals, bioethicists, politicians and lawyers. This paper begins with a comparative analysis of both countries: Spain and Belgium and follows with a description of the milestones of the historical process of debating and, finally, passing the Belgian Law on Euthanasia in 2002. The next chapter consists of a description of themain contents of this important Law. The paper continues then with an approach to the epidemiology of the practice of euthanasia in Belgium and finishes with a description of the different positions of the actors of the process. Two positions are described more in depth: the opinion of the specialists in palliative care, and the opinion of the Catholic Church. The paper ends underlining the reason for the incorporation of the Belgian experience on euthanasia to the debate about the possibility of legalizing euthanasia in Spain.

Escolano-Margarit M.V.,University of Granada | Ramos R.,CIBER ISCIII | Beyer J.,Ludwig Maximilians University of Munich | Csabi G.,University of Pécs | And 7 more authors.
Journal of Nutrition | Year: 2011

Beneficial effects of perinatal DHA supply on later neurological development have been reported. Weassessed the effects of maternal DHA supplementation on the neurological development of their children. Healthy pregnant women from Spain, Germany, and Hungary were randomly assigned to a dietary supplement consisting of either fish oil (FO) (500 mg/d DHA + 150 mg/d EPA), 400 mg/d 5-methyltetrahydrofolate, both, or placebo from wk 20 of gestation until delivery. Fatty acids in plasma and erythrocyte phospholipids (PL) were determined in maternal blood at gestational wk 20 and 30 and in cord and maternal blood at delivery. Neurological development was assessed with the Hempel examination at the age of 4 y and the Touwen examination at 5.5 y. Minor neurological dysfunction, neurological optimality score (NOS), and fluency score did not differ between groups at either age, but the odds of children with the maximal NOS score increased with every unit increment in cord blood DHA level at delivery in plasma PL (95% CI: 1.094-2.262), erythrocyte phosphatidylethanolamine (95% CI: 1.091-2.417), and erythrocyte phosphatidylcholine (95% CI: 1.003-2.643). We conclude that higher DHA levels in cord blood may be related to a better neurological outcome at 5.5 y of age. © 2011 American Society for Nutrition.

PubMed | University of Oxford, University of Granada, University of Montréal and Campus Universitario Of Cartuja
Type: Journal Article | Journal: Gaceta sanitaria | Year: 2016

To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level.12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) >7% (53.01mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted.The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference.In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.

Molina-Montes E.,Campus Universitario Of Cartuja | Molina-Montes E.,CIBER ISCIII | Pollan M.,CIBER ISCIII | Pollan M.,Institute Salud Carlos III | And 7 more authors.
Gynecologic Oncology | Year: 2013

Objective The higher risk of developing new cancers in breast cancer survivors is a public health concern. Our aim was to examine risk of second primary cancers among women diagnosed with breast cancer. Methods We studied two cohorts of female cancer patients identified in a population-based cancer registry in Granada (Spain): women first diagnosed with a primary breast cancer (n = 5897) and those with a primary cancer in another site (n = 22,814), followed during 1985-2007 for second cancers and breast cancer occurrence, respectively. We used Standardized Incidence Ratios (SIRs) to estimate second cancer risk by age (< 50 y, ≥ 50 y), time since diagnosis (≤ 5 y, > 5 y) and calendar periods (≤ 1995, > 1996). SIR for breast cancer was calculated in the second cohort. Results The risk of developing second cancers (n = 314) was 39% higher (95% CI = 1.23-1.54) among breast cancer patients, and particularly high among women under 50 (SIR = 1.96, 95% CI = 1.48-2.44). Excess risk for endometrial cancer (SIR = 3.04, 95% CI = 2.14-3.94) was statistically significant and remained so in women over 50. Younger women were at higher risk of second ovarian cancer (SIR = 4.90, 95% CI = 1.27-8.53). Increased SIRs were observed during the first five years after breast cancer diagnosis, whereas SIRs decreased thereafter. Breast cancer incidence (n = 171) was not higher among women previously diagnosed with other cancer types (SIR = 0.86, 95% CI = 0.74-1.00). Conclusion Women diagnosed with breast cancer have a higher incidence of second primary cancers, particularly of endometrial cancer in women over 50 at diagnosis, and ovarian cancer in younger women. These findings may be explained by treatment-related effects or shared risk factors. © 2013 Elsevier Inc. All rights reserved.

Garcia-Jerez A.,Campus Universitario Of Cartuja | Luzon F.,Campus Universitario Of Cartuja | Luzon F.,University of Almeria | Sanchez-Sesma F.J.,National Autonomous University of Mexico | And 4 more authors.
Journal of Geophysical Research: Solid Earth | Year: 2013

The reliability of usual assumptions regarding the wavefield composition in applications of the Diffuse Field Approach (DFA) to passive seismic prospecting is investigated. Starting from the more general formulation of the DFA for full wavefield (FW), the contribution of each wave to the horizontal- and vertical-component power spectra at surface are analyzed for a simple elastic waveguide representing the continental crust-upper mantle interface. Special attention is paid to their compositions at low and high frequencies, and the relative powers of each surface wave (SW) type are identified by means of a semianalytical analysis. If body waves are removed from the analysis, the high-frequency horizontal asymptote of the H/V spectral ratio decreases slightly (from 1.33 for FW to around 1.14 for SW) and shows dependence on both the Poisson's ratio of the crust and the S wave velocity contrast (while FW-H/V asymptote depends on the former only). Experimental tests in a local broadband network provide H/V curves compatible with any of these values in the band 0.2-1 Hz, approximately, supporting the applicability of the DFA approximation. Coexistence of multiple SW modes produces distortion in the amplitudes of vertical and radial component Aki's coherences, in comparison with the usual predictions based on fundamental modes. At high frequencies, this effect consists of a decrement by a constant scaling factor, being very remarkable in the radial case. Effects on the tangential coherence are severe, including a - π/4 phase shift, slower decay rate of amplitude versus frequency, and contribution of several velocities for large enough distances. Key Points Expressions for power spectra of diffuse fields in a layered half-space are found High-frequency ambient noise coherences are studied for a simple crustal model Ambient noise H/V ratio on rock is experimentally and theoretically investigated ©2013. American Geophysical Union. All Rights Reserved.

Ocana-Riola R.,Campus Universitario Of Cartuja | Ocana-Riola R.,Institute Investigacion Biosanitaria Of Granada
Statistics in Biosciences | Year: 2016

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. © 2016 International Chinese Statistical Association

Saletti-Cuesta L.,Escuela Andaluza de Salud Publica | Delgado A.,Escuela Andaluza de Salud Publica | Delgado A.,Campus Universitario Of Cartuja | Ortiz-Gomez T.,University of Granada | Lopez-Fernandez L.A.,Escuela Andaluza de Salud Publica
Revista Espanola de Salud Publica | Year: 2013

Background: The concept of achievement is important to study the professional development. In medicine there are gender inequalities in career. The purpose was to know and compare the professional achievement's perceptions and attributions of female and male primary care physicians in Andalusia. Method: Qualitative study with 12 focus groups (October 2009 to November 2010). Population: primary care physicians. Sample: intentionally segmented by age, sex and health care management. Were conducted by sex: two groups with young physicians, two groups with middle aged and two with health care management. Total: 32 female physician and 33 male physicians. Qualitative content analysis with Nuddist Vivo. Results: Female and male physicians agree to perceive internal achievements and to consider aspects inherent to the profession as external achievements. The most important difference is that female physician related professional achievement with affective bond and male physician with institutional merit. Internal attributions are more important for female physician who also highlight the importance of family, the organization of working time and work-family balance. Patients, continuing education, institutional resources and computer system are the most important attributions for male physician. Conclusions: There are similarities and differences between female and male physicians both in the understanding and the attributions of achievement. The differences are explained by the gender system. The perception of achievement of the female physicians questions the dominant professional culture and incorporates new values in defining achievement. The attributions reflect the unequal impact of family and organizational variables and suggest that the female physicians would be changing gender socialization.

Romero-Frias E.,University of Granada | Del-Barrio-Garcia S.,Campus Universitario Of Cartuja
Profesional de la Informacion | Year: 2014

Digital humanities (DH) have adopted various institutional forms in academia (centres, networks, projects, etc.). This study addresses the current state of the discipline through an analysis of DH centres, as reported by CenterNet. We analysed websites, missions, and the social media presence of the centres in order to provide an overall picture. Results show a remarkable heterogeneity in DH organisation. Finally, some of the most debated issues are discussed, such as the borders of the field, inclusion and exclusion issues, or a new cultural colonialism.

In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. Clinical Trials U.S. National Institutes of Health, NCT01849731.

Ocana-Riola R.,Campus Universitario Of Cartuja
Geospatial Health | Year: 2010

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.

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