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Gatta G.,Fondazione IRCSS Instituto Nazionale dei Tumori | Botta L.,Fondazione IRCSS Instituto Nazionale dei Tumori | Rossi S.,Instituto Superiore Of Sanita | Aareleid T.,National Institute for Health Development | And 19 more authors.
The Lancet Oncology | Year: 2014

Background: Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. Methods: We analysed survival data for 157499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. Findings: We analysed 59579 cases. For all cancers combined for children diagnosed in 2000-07, 1-year survival was 90·6% (95% CI 90·2-90·9), 3-year survival was 81·0 % (95% CI 80·5-81·4), and 5-year survival was 77·9% (95% CI 77·4-78·3). For all cancers combined, 5-year survival rose from 76·1% (74·4-77·7) for 1999-2001, to 79·1% (77·3-80·7) for 2005-07 (hazard ratio 0·973, 95% CI 0·965-0·982, p<0·0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65·2% (95% CI 63·1-67·3) in 1999-2001, to 70·2% (67·9-72·3) in 2005-07. Europe-wide average yearly change in mortality (hazard ratio) was 0·939 (95% CI 0·919-0·960) for acute lymphoid leukaemia, 0·959 (0·933-0·986) for acute myeloid leukaemia, and 0·940 (0·897-0·984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005-07). Interpretation: Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. Funding: Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation. © 2014 Elsevier Ltd.

Barrio I.M.,Hospital Of Baza | Simon-Lorda P.,Escuela Andaluza de Salud Publica | Molina A.,Fundacion para Investigacion Biosanitaria Alejandro Otero
Anales del Sistema Sanitario de Navarra | Year: 2011

Background. To identify the most relevant aspects that guarantee the readability, clarity and simplicity of written health education materials. Material and methods. Delphi methodology in order to reach a state of consensus among health education experts on criteria of legibility in the design and publication of informative material and literature. Results. Seventeen experts reached agreement on the principal recommendations for ensuring the legibility of health education materials. They were as follows: a) text content and layout: to structure the text using a title or subtitle, message explanation and conclusion; b) text construction: to use simple and concise sentences, diagrams and examples, and graphically highlighting the principal ideas; c) lexical comprehension: to use simple words and avoid technical language and abbreviations; d) typography: to use an easyto- read font. Conclusions. There is a high degree of consensus regarding the way health education materials should be drawn up. This list of recommendations could be used as an instrument for reviewing and improving the design of health education materials. In general, it is recommended to identify the users of the leaflets and involve them in the writing and design.

Molina-Montes E.,Escuela Andaluza de Salud Publica | Molina-Montes E.,CIBER ISCIII | Donadio D.,University of California at Davis | Hernandez-Laguna A.,University of Granada | And 2 more authors.
Journal of Physical Chemistry C | Year: 2013

We have investigated one of the most controversial aspects of the dehydroxylation-rehydroxylation process of dioctahedral 2:1 phyllosilicates, that is the release of water from the internal structure of the mineral. We simulate the release of water from a periodic crystal model of pyrophyllite by Car-Parrinello molecular dynamics based on Density Functional Theory. The metadynamics algorithm is employed to accelerate activated processes and compute free energy surfaces. We found that, in spite of the strong hydrogen bonds anchoring water molecules in the tetrahedral cavity, the energy barrier for water release is lower than that for the chemical formation of water molecules from the hydroxyl groups. We then conclude that water release is not the rate-limiting step of the dehydration mechanism. © 2013 American Chemical Society.

Sanchez-Cruz J.-J.,Escuela Andaluza de Salud Publica | Jimenez-Moleon J.J.,University of Granada | Jimenez-Moleon J.J.,CIBER ISCIII | Fernandez-Quesada F.,Hospital Universitario San Cecilio | And 2 more authors.
Revista Espanola de Cardiologia | Year: 2013

Introduction and objectives: Obesity is a major cardiovascular risk factor. In Spain, few studies have physically measured height and weight to estimate the magnitude of the problem. The aim of this study was to determine the prevalence of child and adolescent obesity in Spain in 2012. Methods: We performed a cross-sectional probability sample of 1018 children, representative of the Spanish population aged between 8 and 17 years old, with objectively measured height and weight, along with other sociodemographic variables. We calculated the prevalence of overweight and obesity according to the criteria of the World Health Organization, the International Obesity Task Force, and the enKid study. Results: In the group aged 8 to 17 years old, the prevalence of overweight and obesity was 26% and 12.6%, respectively; 4 in 10 young people were overweight or obese. Excess weight was found in 45% of the group aged 8 to 13 years and in 25.5% of that aged 14 to 17 years. This cardiovascular risk factor was associated with lower social class and lower educational level. Conclusions: The prevalence of overweight and obesity in children and adolescents in Spain remains high (close to 40%), but has not increased in the last 12 years. © 2012 Sociedad Española de Cardiología. Publicado por Elsevier España, S.L. Todos los derechos reservados.

Garcia-Mochon L.,Escuela Andaluza de Salud Publica | Olry De Labry Lima A.,Escuela Andaluza de Salud Publica | Olry De Labry Lima A.,CIBER ISCIII | Espin Balbino J.,Escuela Andaluza de Salud Publica
Avances en Diabetologia | Year: 2014

Objective To estimate the cost, outcome and economic impact, of the use of a Blood Glucose Monitoring System (BGMS) with pattern alert technology compared with standard BGMS, for the prevention of severe hypoglycemia (SH) in the insulin-treated type 1 and type 2 diabetes populations. Material and methods A short term model has been constructed from literature data. It has been assumed that the cost of both BGMS and their corresponding strips are identical between alternatives, including only the direct cost of the severe hypoglycemia event caused by poor metabolic control. Results BGMS shows low sensitivity and positive predictive value, and high specificity and negative predictive value. With a baseline risk of hypoglycemia of around 9% for the insulin-treated DM1 and DM2 population, and 17% for DM1 population < 17 years, the trend detector algorithm could prevent between 20% and 35% of severe hypoglycemias. Cost saving per patient would be between € 12 and € 39, respectively. Moreover, this monitoring system could save costs of around € 7.7 million € for the Health System in a baseline analysis. Conclusions BGMS with pattern alert technology is effective in preventing severe hypoglycemia and can be cost saving for Spanish health system. Nevertheless, empirical data on the probability of reducing Severe Hypoglycemia is necessary in order to reach any firm conclusions. © 2013 Sociedad Española de Diabetes. Published by Elsevier Españá, S.L. All rights reserved.

Garcia Calvente M.,Escuela Andaluza de Salud Publica | Garcia Calvente M.,CIBER ISCIII | del Rio Lozano M.,Escuela Andaluza de Salud Publica | Marcos Marcos J.,CIBER ISCIII
Gaceta Sanitaria | Year: 2011

Objectives: To analyze differences in the characteristics of care provided by women and men to dependent persons, and their association with the perception of health deterioration in both sexes. Methods: We performed a nationwide cross-sectional study with data obtained from the 2008 Spanish Survey on Disability, Personal Autonomy and Dependence, based on a sample size of 7,512 principal caregivers. A descriptive analysis was performed of the characteristics of the care provided (tasks performed, intensity, frequency and duration) by sex. A multivariate logistic regression analysis was carried out to explore the association between the caregivers' perceptions of deteriorated health and the variables related to care, adjusted by sociodemographic characteristics. Results: Most (74%) of the caregivers in the sample were women. Women more frequently perceived a deterioration in their health as a result of providing care than did men (37% and 21%, respectively). Women provided care with greater intensity and more frequently performed the tasks most associated with deteriorated health (personal hygiene, assistance in feeding, etc.). Men more frequently carried out tasks related to care outside the home (going to the doctor, shopping, etc.), all of which acted as a protective factor against health deterioration. The intensity of care was a risk factor for the perception of health deterioration in both sexes, while frequency and duration were also risk factors in women. Conclusions: The greater health deterioration perceived by women is related to gender inequalities in the characteristics of the care provided. Interventions in informal caregivers should be sensitive to these gender inequalities. © 2011 SESPAS.

PubMed | Institute Investigacion Biosanitaria Of Granada, Escuela Andaluza de Salud Publica, University of Granada and University of Jaén
Type: | Journal: Gaceta sanitaria | Year: 2017

To analyse the technical efficiency and productivity of general hospitals in the Spanish National Health Service (NHS) (2010-2012) and identify explanatory hospital and regional variables.230 NHS hospitals were analysed by data envelopment analysis for overall, technical and scale efficiency, and Malmquist index. The robustness of the analysis is contrasted with alternative input-output models. A fixed effects multilevel cross-sectional linear model was used to analyse the explanatory efficiency variables.The average rate of overall technical efficiency (OTE) was 0.736 in 2012; there was considerable variability by region. Malmquist index (2010-2012) is 1.013. A 23% variability in OTE is attributable to the region in question. Statistically significant exogenous variables (residents per 100 physicians, aging index, average annual income per household, essential public service expenditure and public health expenditure per capita) explain 42% of the OTE variability between hospitals and 64% between regions. The number of residents showed a statistically significant relationship. As regards regions, there is a statistically significant direct linear association between OTE and annual income per capita and essential public service expenditure, and an indirect association with the aging index and annual public health expenditure per capita.The significant room for improvement in the efficiency of hospitals is conditioned by region-specific characteristics, specifically aging, wealth and the public expenditure policies of each one.

Espin J.,Escuela Andaluza de Salud Publica | Oliva J.,University of Castilla - La Mancha | Oliva J.,CIBER ISCIII | Rodriguez-Barrios J.M.,Ortho Clinical Diagnostics a Johnson and Johnson Company
Gaceta Sanitaria | Year: 2010

The incorporation of new treatments, procedures and technologies into the services' portfolio of healthcare providers should aim to improve three areas equally: patient access to innovative solutions, the sustainability of the health system and compensation for innovation. However, traditional schemes based on fixed prices that fail to consider the product's appropriacy of use or its results in terms of effectiveness may lead to inefficient decision-making processes. Recently, risk-sharing agreements have appeared as new access schemes based on results that aim to reduce the uncertainty of the distinct health care players involved in reaching an agreement on new health technology financing and conditions of use. Key elements in the debate on these instruments are the huge variety of instruments available (especially those based on results), the implications for different players involved in their design and supervision, and their possible implementation in Spain. Our main conclusion is that risk-sharing agreements should be used in highly limited cases when standard conditions of access cannot be applied due to uncertainty about long-term effectiveness. These measures are aimed not only at regulating price but also at acting on the appropriate use of new technology. However, because international experience is limited, drawing a solid conclusion on the final results of the application of risk-sharing agreements would be premature. © 2010 SESPAS.

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.

Bermudez-Tamayo C.,Escuela Andaluza de Salud Publica
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2013

This exploratory study has two aims: (1) to find out if and how social media (SM) applications are used by hospitals in Spain and (2) to assess hospital managers' perception of these applications in terms of their evaluation of them, reasons for use, success factors, and difficulties encountered during their implementation. A cross-sectional survey has been carried out using Spanish hospitals as the unit of analysis. Geographical differences in the use of SM were found. Social networks are used most often by larger hospitals (30% by medium-size, 28% by large-size). They are also more frequently used by public hospitals (19%, p<0.01) than by private ones. Respondents with a negative perception of SM felt that there is a chance they may be abused by healthcare professionals, whereas those with a positive perception believed that they can be used to improve communication both within and outside the hospital. Reasons for the use of SM include the idea of maximizing exposure of the hospital. The results show that Spanish hospitals are only just beginning to use SM applications and that hospital type can influence their use. The perceptions, reasons for use, success factors, and difficulties encountered during the implementation of SM mean that it is very important for healthcare professionals to use SM correctly and adequately.

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