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Estevan-Vilar M, Parker LA, Caballero-Romeu JP, Ronda E, Hernández-Aguado I, Lumbreras B. Barriers and facilitators of shared decision-making in prostate cancer screening in primary care: A systematic review. Prev Med Rep 2024; 37:102539. [PMID: 38179441 PMCID: PMC10764268 DOI: 10.1016/j.pmedr.2023.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To identify barriers and facilitators of the implementation of shared decision-making (SDM) on PSA testing in primary care. Design Systematic review of articles. Data sources PubMed, Scopus, Embase and Web of Science. Eligibility criteria Original studies published in English or Spanish that assessed the barriers to and facilitators of SDM before PSA testing in primary care were included. No time restrictions were applied. Data extraction and synthesis Two review authors screened the titles, abstracts and full texts for inclusion, and assessed the quality of the included studies. A thematic synthesis of the results were performed and developed a framework. Quality assessment of the studies was based on three checklists: STROBE for quantitative cross-sectional studies, GUIDED for intervention studies and SRQR for qualitative studies. Results The search returned 431 articles, of which we included 13: five cross-sectional studies, two intervention studies, five qualitative studies and one mixed methods study. The identified barriers included lack of time (healthcare professionals), lack of knowledge (healthcare professionals and patients), and preestablished beliefs (patients). The identified facilitators included decision-making training for professionals, education for patients and healthcare professionals, and dissemination of information. Conclusions SDM implementation in primary care seems to be a recent field. Many of the barriers identified are modifiable, and the facilitators can be leveraged to strengthen the implementation of SDM.
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Affiliation(s)
- María Estevan-Vilar
- Pharmacy Faculty, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Lucy Anne Parker
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Juan Pablo Caballero-Romeu
- Department of Urology, Hospital General Universitario de Alicante, 03010 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Elena Ronda
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Public Health Research Group, Alicante University, 03690 San Vicente del Raspeig, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
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Lumbreras B, Parker LA, Caballero-Romeu JP, Gómez-Pérez L, Puig-García M, López-Garrigós M, García N, Hernández-Aguado I. Reply to Jue, J.S.; Alameddine, M. Role of PSA Density and MRI in PSA Interpretation. Comment on "Lumbreras et al. Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data. Cancers 2023, 15, 261". Cancers (Basel) 2023; 15:2685. [PMID: 37345022 DOI: 10.3390/cancers15102685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
We thank you and your co-authors for the comment [...].
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Affiliation(s)
- Blanca Lumbreras
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Juan Pablo Caballero-Romeu
- Department of Urology, University General Hospital of Alicante, 03010 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Luis Gómez-Pérez
- Urology Department, General University Hospital of Elche, 03203 Elche, Spain
- Pathology and Surgery Department, Miguel Hernández University of Elche, 03550 Alicante, Spain
| | - Marta Puig-García
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Maite López-Garrigós
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Clinical Laboratory Department, University Hospital of San Juan de Alicante, Sant Joan d'Alacant, 03550 Alicante, Spain
| | - Nuria García
- Department of Urology, University General Hospital of Alicante, 03010 Alicante, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Morales-Garzón S, Parker LA, Hernández-Aguado I, González-Moro Tolosana M, Pastor-Valero M, Chilet-Rosell E. Addressing Health Disparities through Community Participation: A Scoping Review of Co-Creation in Public Health. Healthcare (Basel) 2023; 11:healthcare11071034. [PMID: 37046961 PMCID: PMC10094395 DOI: 10.3390/healthcare11071034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND There is general agreement regarding the relevance of community involvement in public health policy, practice, and research to reduce health inequities. OBJECTIVE This review aims to analyse the experiences of community engagement in public health actions, with particular attention to methodologies used and how community participation is articulated. METHOD AND ANALYSIS We searched the Web of Science, EBSCO, and ProQuest for scientific articles published in peer-reviewed journals. We recorded methodological aspects, the approach to equity, actors that participated in the actions, and participation of the community in different phases (agenda setting, design, implementation, and evaluation). RESULTS Of 4331 records, we finally included 31 studies published between 1995 and 2021. Twelve studies referred to Community-Based Participatory Research as the framework used. The actions addressed equity, mainly by tackling economic vulnerability (n = 20, 64%) and racial discrimination (n = 18, 58%). Workshops were the most used method. Participation was frequently observed in the design and implementation phases of the action, but it was reduced to community feedback in the evaluation. CONCLUSIONS Co-created public health actions offer the opportunity to reduce health inequity and promote social change; yet, further effort is needed to involve communities in the entire cycle of decision making.
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Affiliation(s)
- Sergio Morales-Garzón
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
| | - Lucy Anne Parker
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
| | | | - María Pastor-Valero
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo 05508-220, Brazil
| | - Elisa Chilet-Rosell
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
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Barbaglia G, García-Abiétar D, Beltrán-Aguirre JL, García AM, García-Armesto S, Gutiérrez-Ibarluzea I, Segura-Benedicto A, Franco-Tejero M, Urbanos-Garrido R, Hernández-Aguado I. Strengthening National Public Health: first steps towards the Spanish Public Health Agency. Eur J Public Health 2022. [PMCID: PMC9619883 DOI: 10.1093/eurpub/ckac131.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Issue/Problem The social, ecological, health and economic crisis exacerbated by COVID-19 is a challenge of extraordinary magnitude and complexity for global public health. Part of the response to these challenges requires strong public health institutions. Description of the problem Component 18 of the Government of Spain’s Recovery, Transformation and Resilience Plan proposes the creation of a Spanish Agency of Public Health (SAPH), a centre of excellence to perform surveillance and health system preparedness functions in the face of new or emerging public health threats. The government has opened the debate on what design and functions it should have. Results SESPAS, the Spanish Society of Public Health and Public Administration, set out a proposal for the design and organization of the future Spanish Agency for Public Health [SAPH]. A large working group, made up of experts from various fields of public health and from its ten federated scientific societies, has designed the SAPH proposal. The scope of the public health functions to be assumed include: the strategic planning of the State’s public health (including health security), the prioritisation of public health policies and communication strategies, the assessment of the population’s health status and social conditions, the guarantee of the transversality and horizontality of health policies (health and health equity in all State policies), as well as their verticality (serving as an enriching link between the European Union level and the administrations of the Autonomous Communities and local authorities). The proposal also include 11 recommendations on the main elements to be taken into account in the establishment of the future SAPH. Lessons COVID19 pandemic has highlighted the need of creating strong public health institutions. Spain is giving its first steps toward the creation of the SAPH, which constitute a key step in addressing the current and future challenges of public health in Spain. Key messages • Spanish Public Health Agency is an opportunity to transform health policies and to improve the health of the Spanish population. • Strengthening public health starts with building national institutions that ensure comprehensive and integrated health policies.
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Affiliation(s)
- G Barbaglia
- Spanish Society of Public Health , Barcelona, Spain
- Care and Prevention of Drugdependences, Public Health Agency , Barcelona, Spain
| | - D García-Abiétar
- Spanish Society of Public Health , Barcelona, Spain
- Preventive Medicine and Public Health, Hospital del Mar Teaching Unit , Barcelona, Spain
| | - JL Beltrán-Aguirre
- Spanish Society of Public Health , Barcelona, Spain
- Faculty of Law, Public University of Navarra , Pamplona, Spain
| | - AM García
- Spanish Society of Public Health , Barcelona, Spain
- Institute of Health Sciences in Aragon , Zaragoza, Spain
| | - S García-Armesto
- Spanish Society of Public Health , Barcelona, Spain
- Fund Vasca Innovación e Investigación Sanitar, BIOEF , Bizkaia, Spain
| | - I Gutiérrez-Ibarluzea
- Spanish Society of Public Health , Barcelona, Spain
- Catalonia Bioethics Committee, Public Health Advisory Council , Catalonia, Spain
| | - A Segura-Benedicto
- Spanish Society of Public Health , Barcelona, Spain
- John Hopkins University, Bloomberg School of Public Health , Baltimore, USA
| | - M Franco-Tejero
- Spanish Society of Public Health , Barcelona, Spain
- Public Health Department, Miguel Hernández University , Alicante, Spain
| | - R Urbanos-Garrido
- Spanish Society of Public Health , Barcelona, Spain
- Spanish Society of Public Health , Spain
- Department of Applied Economics, Universidad Complutense de Madrid , Madrid, Spain
| | - I Hernández-Aguado
- Spanish Society of Public Health , Barcelona, Spain
- Care and Prevention of Drugdependences, Public Health Agency , Barcelona, Spain
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Abiétar DG, Beltrán Aguirre JL, García AM, García-Armesto S, Gutiérrez-Ibarluzea I, Segura-Benedicto A, Franco M, Hernández-Aguado I. [Future National Public Health Agency: an opportunity for the public health system in Spain]. Gac Sanit 2022; 36:265-269. [PMID: 35120795 DOI: 10.1016/j.gaceta.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
The creation of a national centre for public health, with adequate resources, will make it possible to face the public health challenges of the present and the future in our country. To this end, the proposed state agency, should hold functions based on advanced public health organizational schemes, while linking with the sustainable development goals. The coordination of a national public health strategy built on a collaborative network of networks would also be essential, as developing an innovative, benchmarked and prioritised public health communication strategy, among other tasks. The lack of resources, the current relative disconnection of essential public health functions at the state level, and the inequity in their development of these functions at the regional and municipal levels, favour the development of the agency project as a network of networks. In this paper we give ideas for a process that seems decisive for Spanish public health in the 21st century.
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Affiliation(s)
- Daniel G Abiétar
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Departamento de Salud Comunitaria, Epidemiología y Vigilancia de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universidad Pompeu Fabra, Barcelona, España.
| | - Juan Luis Beltrán Aguirre
- Falcutad de Derecho, Departamento de Derecho Administrativo, Universidad Pública de Navarra, Pamplona, Navarra, España
| | - Ana M García
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España
| | | | - Iñaki Gutiérrez-Ibarluzea
- Gestión del Conocimiento y Evaluación de Tecnologías Sanitarias en BIOEF, Fundación Vasca de Innovación e Investigación Sanitarias, Barakaldo, Bizkaia, España
| | | | - Manuel Franco
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, Estados Unidos
| | - Ildefonso Hernández-Aguado
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, Alicante, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
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6
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Chilet-Rosell E, Hernández-Aguado I. Solving gender gaps in health, what else is missing? Gac Sanit 2021; 36:45-47. [PMID: 34763942 PMCID: PMC8754416 DOI: 10.1016/j.gaceta.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/27/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022]
Abstract
In recent years, a great deal of attention has been paid to gender inequities in health. However, while we have a good body of evidence on the impact of gender on the health and vulnerability of women and men, we have not yet been able to generate sufficient evidence on effective interventions that can transform this situation or can influence public health policy making. Only a limited number of educational interventions on gender-sensitivity, gender bias in clinical practice and policies to tackle gender inequalities in health have been formulated, implemented and evaluated. Even in the current pandemic situation caused by SARS-CoV2, we have seen the lack of gender mainstreaming reflected in the global response. This happens even when we have tools that facilitate the formulation and implementation of actions to reduce gender inequities in health. We consider that the current initiatives organized to carry out advocacy activities on gender inequity in health to be very positive. In the same line of these initiatives, we propose that while academic and institutional research on gender and health remains essential, we need to shift the focus towards action. In order to move forward, we need public health researchers questioning what public health practice need to do to address gender inequities and shake structural and social power inequities in order to increase the gender equity in health.
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Affiliation(s)
- Elisa Chilet-Rosell
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Alacant, Spain.
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Alacant, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Chilet-Rosell E, Hernández-Aguado I. It Is Not Enough to Assess Conflicts of Interest When We Bring the Commercial Sector to the Policy Table Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool". Int J Health Policy Manag 2021; 11:394-397. [PMID: 34814673 PMCID: PMC9278479 DOI: 10.34172/ijhpm.2021.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Abstract
Ralston et al offer us an interesting analysis of the consultation process of World Health Organization's (WHO's) "Draft approach on the prevention and management of conflicts of interests in the policy development and implementation of nutrition programs at country level," in which it shows us how the industry tries to frame the discussion in individual conflicts of interest, avoiding structural conflicts of interest. We must not forget other issues of importance in policy-making, such as the imbalance of power between different actors and the strategies of undue influence used by food and beverage corporations. It is essential to develop regulatory-based tools and procedures that embody ethics and good governance and that can be applied systematically and routinely to prevent corporate influence in health policy-making. A global observatory of corporate practices would also be needed to recommend to governments efficient actions to avoid corporate capture of their policies.
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Affiliation(s)
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Bernal-Soriano MC, Parker LA, López-Garrigós M, Hernández-Aguado I, Gómez-Pérez L, Caballero-Romeu JP, Pastor-Valero M, García N, Alfayate-Guerra R, Lumbreras B. Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines? J Clin Med 2021; 10:jcm10122650. [PMID: 34208627 PMCID: PMC8234229 DOI: 10.3390/jcm10122650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 12/15/2022] Open
Abstract
Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62-69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02-1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67-0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.
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Affiliation(s)
- Mari Carmen Bernal-Soriano
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Correspondence: ; Tel.: +34-9659-195-07
| | - Lucy Anne Parker
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Maite López-Garrigós
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Clinical Laboratory Department, University Hospital of San Juan de Alicante, Sant Joan d’Alacant, 03550 Alicante, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Luis Gómez-Pérez
- Urology Department, University Hospital of San Juan de Alicante, 03550 Alicante, Spain;
- Pathology and Surgery Department, Miguel Hernández University of Elche, 03550 Alicante, Spain
| | - Juan-Pablo Caballero-Romeu
- Department of Urology, University General Hospital of Alicante, 03010 Alicante, Spain; (J.-P.C.-R.); (N.G.)
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - María Pastor-Valero
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Nuria García
- Department of Urology, University General Hospital of Alicante, 03010 Alicante, Spain; (J.-P.C.-R.); (N.G.)
| | - Rocío Alfayate-Guerra
- Clinical Laboratory Department, University General Hospital of Alicante, 03010 Alicante, Spain;
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
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Crespí-Lloréns N, Hernández-Aguado I, Chilet-Rosell E. Have Policies Tackled Gender Inequalities in Health? A Scoping Review. Int J Environ Res Public Health 2021; 18:ijerph18010327. [PMID: 33466282 PMCID: PMC7796005 DOI: 10.3390/ijerph18010327] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/20/2023]
Abstract
Gender is recognized as one of the most relevant determinants of health inequalities. This scoping review sought to identify and analyse policies, either implemented or formulated as proposals, which aimed to reduce gender inequalities in health. We searched Medline, Web of Science, and Scielo. Of 2895 records, 91 full text articles were analysed, and 33 papers were included. Of these papers, 22 described the process of formulation, implementation, or evaluation of policies whose aim was to reduce gender inequalities in health; six focused on recommendations, and the remaining five dealt with both issues. Our review showed that the policies aimed at reducing gender inequalities in health, either implemented or formulated as proposals, are scarce. Moreover, despite some success, overall progress has been slow. The studies show failures in design and particularly in the implementation process. We found a lack of awareness and capacity in the policy-making progress, under-financing, bureaucratization, shortage of relevant data, and absence of women’s participation in decision-making. Therefore, an emphasis on the design and implementation of gender-sensitive policies seems essential to advance gender equality in health. This scoping review gathers evidence to support the design of such policies and recommendations that can facilitate their implementation.
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Affiliation(s)
- Nuria Crespí-Lloréns
- Preventive Medicine Service, Hospital General de Elche, 03203 Elche, Spain
- Correspondence:
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (I.H.-A.); (E.C.-R.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (I.H.-A.); (E.C.-R.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Mayneris-Perxachs J, Russo MF, Ramos R, de Hollanda A, Arxé AA, Rottoli M, Arnoriaga-Rodríguez M, Comas-Cufí M, Bartoletti M, Verrastro O, Gudiol C, Fages E, Giménez M, Gil ADG, Bernante P, Tinahones F, Carratalà J, Pagotto U, Hernández-Aguado I, Fernández-Aranda F, Meira F, Castro Guardiola A, Mingrone G, Fernández-Real JM. Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain. Front Endocrinol (Lausanne) 2021; 12:741248. [PMID: 34795637 PMCID: PMC8593102 DOI: 10.3389/fendo.2021.741248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19. METHODS Consecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms. RESULTS As expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels. CONCLUSIONS Blood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.
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Affiliation(s)
- Jordi Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Maria Francesca Russo
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Rafel Ramos
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Ana de Hollanda
- Department of Endocrinology & Nutrition, Hospital Clínic Barcelona, Diabetes Unit, Barcelona, Spain
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Arola Armengou Arxé
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Matteo Rottoli
- Department of Surgery, Diabetology and Otolaryngology, Surgery of the Alimentary Tract and Centre for the Study and Research of Treatment for Morbid Obesity, Bologna, Italy
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - María Arnoriaga-Rodríguez
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - Ornella Verrastro
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Department of Oncology, Institut Català d’Oncologia (ICO) Hospitalet de Llobregat, Barcelona, Spain
| | - Ester Fages
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Marga Giménez
- Department of Endocrinology & Nutrition, Hospital Clínic Barcelona, Diabetes Unit, Barcelona, Spain
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Ariadna de Genover Gil
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Paolo Bernante
- Department of Surgery, Diabetology and Otolaryngology, Surgery of the Alimentary Tract and Centre for the Study and Research of Treatment for Morbid Obesity, Bologna, Italy
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - Francisco Tinahones
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Malaga, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Uberto Pagotto
- Endocrinology and Prevention and Care of Diabetes Unit, Department of Medical and Surgical Sciences, Sant’ Orsola Policlinic, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain
- Department of Epidemiology, Centro de Investigación Biomédica en Red (CIBER) Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Fernández-Aranda
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Fernanda Meira
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Department of Infectious Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Antoni Castro Guardiola
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Geltrude Mingrone
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
- Department of Internal Medicine, King’s College London, London, United Kingdom
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- *Correspondence: José Manuel Fernández-Real,
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Alcalde-Rubio L, Hernández-Aguado I, Parker LA, Bueno-Vergara E, Chilet-Rosell E. Gender disparities in clinical practice: are there any solutions? Scoping review of interventions to overcome or reduce gender bias in clinical practice. Int J Equity Health 2020; 19:166. [PMID: 32962719 PMCID: PMC7510055 DOI: 10.1186/s12939-020-01283-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Lorena Alcalde-Rubio
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eduardo Bueno-Vergara
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Crta Nacional, N-332, s/n, 03550, Sant Joan d'Alacant, Spain. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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12
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Blasco-Blasco M, Puig-García M, Piay N, Lumbreras B, Hernández-Aguado I, Parker LA. Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review. PLoS One 2020; 15:e0237542. [PMID: 32886663 PMCID: PMC7473520 DOI: 10.1371/journal.pone.0237542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
Background Given that most evidence-based recommendations for managing type 2 diabetes mellitus (T2DM) are generated in high-income settings, significant challenges for their implementation exist in Latin America and the Caribbean region (LAC), where the rates of T2DM and related mortality are increasing. The aim of this study is to identify the facilitators and barriers to successful management of T2DM in LAC, from the perspectives of patients, their families or caregivers, healthcare professionals, and/or other stakeholders. Methods We conducted a systematic review in MEDLINE, Web of Science, SciELO, and LILACS. We included studies of disease management, prevention of complications and risk factor management. We qualitatively synthesized the verbatim text referring to barriers and/or facilitators of diabetes management according to the Theoretical Domain Framework and described their relative frequencies. Findings We included 60 studies from 1,595 records identified. 54 studies (90%) identified factors related to the environmental context and resources, highlighting the importance of questions related to health care access or lack of resources in the health system, and the environmental context and living conditions of the patients. Issues related to “social influences” (40 studies) and “social/professional role and identity” (37 studies) were also frequently addressed, indicating the negative impact of lack of support from family and friends and clinicians’ paternalistic attitude. 25 studies identified patients beliefs as important barriers, identifying issues such as a lack of patients’ trust in the effectiveness of the medication and/or the doctor’s advice, or preferences for alternative therapies. Conclusions Successful diabetes management in LAC is highly dependent on factors that are beyond the control of the individual patients. Successful disease control will require emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health promoting infrastructures at environmental level.
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Affiliation(s)
- Mar Blasco-Blasco
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Puig-García
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Nora Piay
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
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13
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Bernal-Soriano MC, Lumbreras B, Hernández-Aguado I, Pastor-Valero M, López-Garrigos M, Parker LA. Untangling the association between prostate-specific antigen and diabetes: a systematic review and meta-analysis. Clin Chem Lab Med 2020; 59:11-26. [PMID: 32681769 DOI: 10.1515/cclm-2020-0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/23/2020] [Indexed: 12/13/2022]
Abstract
Objectives Several studies have shown an inverse association between diabetes mellitus and prostate cancer (PCa). Some researchers suggest that this relationship is due to reduced PCa detection in diabetics due to lower prostate-specific antigen (PSA) levels compared to non-diabetics. Our objective is to analyze the impact of diabetes on PSA in asymptomatic men without known prostate pathology and without prior prostate intervention. Methods We searched Medline (via PubMed), Embase and Scopus. We included studies that reported the relationship between serum PSA levels and diabetes or diabetes treatment in asymptomatic adult men without known prostate pathology, and without prior prostate intervention. Pooled mean differences were compared between diabetics and non-diabetics. Results Of 2,392 screened abstracts, thirteen studies met the inclusion criteria and 8 (62%) reported appropriate measures that could be included in a meta-analysis. Eleven (85%) examined the influence of diabetes on PSA levels and 8 (62%) evaluated the influence of diabetes treatments on PSA levels. Overall diabetics had a significantly lower PSA level compared to non-diabetics (mean difference: -0.07 ng/mL; 95% CI -0.10, -0.04). Conclusions Diabetes and related factors (such as disease duration, severity and treatment) were significantly associated with lower PSA levels among asymptomatic men, yet differences were small and are unlikely to influence PCa detection in a screening setting.
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Affiliation(s)
- Mari Carmen Bernal-Soriano
- Department of Public Health, University Miguel Hernández, Crta. Nacional, N-332, s/n, Sant Joan, Alicante, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández, Crta. Nacional, N-332, s/n, Sant Joan, Alicante, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, University Miguel Hernández, Crta. Nacional, N-332, s/n, Sant Joan, Alicante, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Pastor-Valero
- Department of Public Health, University Miguel Hernández, Crta. Nacional, N-332, s/n, Sant Joan, Alicante, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maite López-Garrigos
- Clinical Laboratory Department, University Hospital of San Juan de Alicante, Alicante, Spain
| | - Lucy A Parker
- Department of Public Health, University Miguel Hernández, Crta. Nacional, N-332, s/n, Sant Joan, Alicante, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Affiliation(s)
- Ildefonso Hernández-Aguado
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Facultad de Medicina, Universidad Miguel Hernández, Elche (Alicante), España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro de Investigación en Salud Laboral (CISAL), Valencia, España
| | - Ana M García
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias Sociales, Universidad de Valencia, Valencia, España; Centro de Investigación en Salud Laboral (CISAL), Valencia, España.
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15
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Hernández-Aguado I, Chilet-Rosell E. The role of the media in the health policymaking process: perspectives of key actors in Spain. Critical Public Health 2020. [DOI: 10.1080/09581596.2019.1575949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Ciber de Epidemiología y Salud Pública (CIBERESP), San Juan de Alicante, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Ciber de Epidemiología y Salud Pública (CIBERESP), San Juan de Alicante, Spain
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Affiliation(s)
- Mário C Scheffer
- Preventative Medicine, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil
| | - Maria Pastor-Valero
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, Spain
- Centro de Investigación Biomédica de Epidemiología y Salud Publica (Ciberasp), Madrid, Spain
| | - Giuliano Russo
- Institute for Population Health Sciences, Queen Mary University of London, London, UK
| | - Ildefonso Hernández-Aguado
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, Spain
- Centro de Investigación Biomédica de Epidemiología y Salud Publica (Ciberasp), Madrid, Spain
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17
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Chilet-Rosell E, Piay N, Hernández-Aguado I, Lumbreras B, Barrera-Guarderas F, Torres-Castillo AL, Caicedo-Montaño C, Montalvo-Villacis G, Blasco-Blasco M, Rivadeneira MF, Pastor-Valero M, Márquez-Figueroa M, Vásconez JF, Parker LA. Contextualizing Evidence for Action on Diabetes in Low-Resource Settings-Project CEAD Part I: A Mixed-Methods Study Protocol. Int J Environ Res Public Health 2020; 17:ijerph17020569. [PMID: 31963116 PMCID: PMC7013726 DOI: 10.3390/ijerph17020569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
Abstract
Challenges remain for policy adoption and implementation to tackle the unprecedented and relentless increase in obesity, diabetes and other non-communicable diseases (NCDs), especially in low- and middle-income countries. The aim of this mixed-methods study is to analyse the contextual relevance and applicability to low-resource settings of a sample of evidence-based healthy public policies, using local knowledge, perceptions and pertinent epidemiological data. Firstly, we will identify and prioritise policies that have the potential to reduce the burden of diabetes in low-resource settings with a scoping review and modified Delphi method. In parallel, we will undertake two cross-sectional population surveys on diabetes risk and morbidity in two low-resource settings in Ecuador. Patients, community members, health workers and policy makers will analyse the contextual relevance and applicability of the policy actions and discuss their potential for the reduction in inequities in diabetes risk and morbidity in their population. This study tackles one of the greatest challenges in global health today: how to drive the implementation of population-wide preventative measures to fight NCDs in low resource settings. The findings will demonstrate how local knowledge, perceptions and pertinent epidemiological data can be used to analyse the contextual relevance and applicability of potential policy actions.
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Affiliation(s)
- Elisa Chilet-Rosell
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Public Health, Universidad Miguel Hernández, 03550 Sant Joan d’Alacant, Alicante, Spain
| | - Nora Piay
- Department of Public Health, Universidad Miguel Hernández, 03550 Sant Joan d’Alacant, Alicante, Spain
| | - Ildefonso Hernández-Aguado
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Public Health, Universidad Miguel Hernández, 03550 Sant Joan d’Alacant, Alicante, Spain
| | - Blanca Lumbreras
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Public Health, Universidad Miguel Hernández, 03550 Sant Joan d’Alacant, Alicante, Spain
| | | | - Ana Lucía Torres-Castillo
- Institute of Public Health, Pontificia Universidad Católica del Ecuador (PUCE), Quito 170143, Ecuador
| | - Cintia Caicedo-Montaño
- Centre of Community Epidemiology and Tropical Medicine (CECOMET), Esmeraldas 0801265, Ecuador
| | - Gregorio Montalvo-Villacis
- School of Medical Specialities, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito (USFQ), Quito 170901, Ecuador
| | - Mar Blasco-Blasco
- Department of Public Health, Universidad Miguel Hernández, 03550 Sant Joan d’Alacant, Alicante, Spain
| | | | - María Pastor-Valero
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Public Health, Universidad Miguel Hernández, 03550 Sant Joan d’Alacant, Alicante, Spain
| | - Mónica Márquez-Figueroa
- Centre of Community Epidemiology and Tropical Medicine (CECOMET), Esmeraldas 0801265, Ecuador
| | - Juan Francisco Vásconez
- Faculty of Nursing, Pontificia Universidad Católica del Ecuador (PUCE), Quito 170143, Ecuador;
| | - Lucy Anne Parker
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Public Health, Universidad Miguel Hernández, 03550 Sant Joan d’Alacant, Alicante, Spain
- Correspondence: ; Tel.: +34-96-591-9516
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Miralles M, Chilet-Rosell E, Hernández-Aguado I. [Framing of childhood obesity in Spanish lay press]. Gac Sanit 2019; 35:256-259. [PMID: 31879055 DOI: 10.1016/j.gaceta.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the frame, individual or collective, of childhood obesity in the main Spanish lay media. METHOD Analysis of a convenience sample of 132 publications regarding childhood obesity (August 2016-September 2018). Descriptive analysis about approach, measures and causes of obesity and food industry influence in the development of the publication. RESULTS 47% of the publications presented an individual approach. 54% included eating and physical activity as cause. 29% of the measures propose a healthy environment and 27% individual recommendations. Individual frame was present in 77% of the news influenced by the industry. CONCLUSION Publications on childhood obesity of the main Spanish lay press reveal a predominance of the individual approach to the problem. This majority perception may condition the development and implementation of public health policies or interventions.
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Affiliation(s)
- Mar Miralles
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, (Alicante), España
| | - Elisa Chilet-Rosell
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, (Alicante), España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
| | - Ildefonso Hernández-Aguado
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, (Alicante), España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
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Parker LA, Zaragoza GA, Hernández-Aguado I. Promoting population health with public-private partnerships: Where's the evidence? BMC Public Health 2019; 19:1438. [PMID: 31675935 PMCID: PMC6824113 DOI: 10.1186/s12889-019-7765-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/11/2019] [Indexed: 12/04/2022] Open
Abstract
Background Although public-private partnerships have become common in the health sector, the evidence supporting their effectiveness is limited, and when the products or services provided by the private partner are harmful to health inherent conflicts of interest may be difficult to overcome. The objective of this study is to appraise the evidence describing process or effectiveness of public-private partnerships (PPPs) that aim to promote population health, and analyse how characteristics such as independence or competing interests influence the results of their evaluation. Methods We carried out a systematic search of Medline and Web of Science to identify scientific reports evaluating the process or effectiveness of PPPs that aim to promote population health. Two reviewers applied inclusion criteria, extracted and evaluated study quality. We classified PPPs according to the health problem tackled, the independence of the evaluation, and the potential for competition between business interests of the private partner and health promotion activity undertaken. We classified the conclusions of the evaluation as positive (supportive/tentatively supportive) or negative (semi-critical/critical). Results We identified 36 studies evaluating 25 PPPs. Evaluations that were favourable to the use of PPPs in health promotion were more frequently classed as “not independent” and of poor quality. On the other hand, negative evaluations were more common when the PPP involved a private partner with a high potential for competition between the health promotion activity undertaken and their financial interests. PPPs that sought to prevent non-communicable diseases were more frequently negatively evaluated compared to PPPs tackling infectious disease or other types of health problem. Almost all of the evaluations evaluated process, with only 2 papers reporting quantitative health related outcomes. Conclusions There is still a lack of sound evidence supporting the effectiveness of public-private partnerships in health promotion, and the evidence base is skewed by non-independent evaluations. Public health actors should abstain from engaging in agreements with industries whose business interests have a high potential for competition with the health promotion activity undertaken.
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Affiliation(s)
- Lucy A Parker
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain. .,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | | | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Bernal-Soriano MC, Parker LA, López-Garrigos M, Hernández-Aguado I, Caballero-Romeu JP, Gómez-Pérez L, Alfayate-Guerra R, Pastor-Valero M, García N, Lumbreras B. Factors associated with false negative and false positive results of prostate-specific antigen (PSA) and the impact on patient health: Cohort study protocol. Medicine (Baltimore) 2019; 98:e17451. [PMID: 31577771 PMCID: PMC6783167 DOI: 10.1097/md.0000000000017451] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Prostate-specific antigen (PSA) is the main tool for early detection, risk stratification and monitoring of prostate cancer (PCa). However, there are controversies about the use of PSA as a population screening test because of the high potential for overdiagnosis and overtreatment associated. The net benefit of screening is unclear and according to the available recommendations, it should be offered to well-informed men with an adequate health status and a life-expectancy of at least 10 years or to men at elevated risk of having PCa. In addition, the factors that influence test results are unclear, as is impact of false positive or negative results on patient health.Our objective is to assess the clinical and analytical factors associated with the presence of false positive and false negative results and the diagnostic/therapeutic process followed by these patients. METHODS AND ANALYSIS A prospective observational cohort study will be carried out. We will include a cohort of patients with a positive PSA result (1.081 patients) and a sample of patients with negative results (572 patients); both will be followed for 2 years by reviewing medical records to assess the variables associated with these results, as well as characteristics of patient management after a positive PSA value. We will include those patients with a PSA determination from 2 hospitals in the Valencian Community. Patients who have been previously diagnosed with prostate cancer or who are being followed for previous high PSA values will be excluded. DISCUSSION The study will estimate the frequency of false positive and false negative PSA results in routine clinical practice, and allow us to quantify the potential harm caused. STUDY REGISTRATION Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03978299, June 7, 2019.
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Affiliation(s)
- Mari Carmen Bernal-Soriano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Department, Miguel Hernández University of Elche
| | - Lucy A. Parker
- CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Department, Miguel Hernández University of Elche
| | | | - Ildefonso Hernández-Aguado
- CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Department, Miguel Hernández University of Elche
| | - Juan P. Caballero-Romeu
- Urology Department, University Hospital of Vinalopó, Alicante, Spain and Alicante Institute for Health and Biomedical Research (ISABIAL)
| | - Luis Gómez-Pérez
- Urology Department, University Hospital of San Juan de Alicante, Alicante, Spain and Pathology and Surgery Department, Miguel Hernández University of Elche
| | | | - María Pastor-Valero
- CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Department, Miguel Hernández University of Elche
| | - Nuria García
- Urology Department, University General Hospital of Alicante, Alicante, Spain
| | - Blanca Lumbreras
- CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Department, Miguel Hernández University of Elche
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Chilet-Rosell E, Parker LA, Hernández-Aguado I, Pastor-Valero M, Vilar J, González-Álvarez I, Salinas-Serrano JM, Lorente-Fernández F, Domingo ML, Lumbreras B. The determinants of lung cancer after detecting a solitary pulmonary nodule are different in men and women, for both chest radiograph and CT. PLoS One 2019; 14:e0221134. [PMID: 31509550 PMCID: PMC6738604 DOI: 10.1371/journal.pone.0221134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/30/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives To determine the factors associated with lung cancer diagnosis and mortality after detecting a solitary pulmonary nodule (SPN) in routine clinical practice, in men and in women for both chest radiograph and CT. Materials and methods A 5-year follow-up of a retrospective cohort of of 25,422 (12,594 men, 12,827 women) patients aged ≥35 years referred for chest radiograph or CT in two hospitals in Spain (2010–2011). SPN were detected in 893 (546 men, 347 women) patients. We estimated the cumulative incidence of lung cancer at 5-years, the association of patient and nodule characteristics with SPN malignancy using Poisson logistic regression, stratifying by sex and type of imaging test. We calculated lung cancer specific mortality rate by sex and SPN detection and hazard rates by cox regression. Results 133 (14.9%) out of 893 patients with an SPN and 505 (2.06%) of the 24,529 patients without SPN were diagnosed with lung cancer. Median diameter of SPN in women who developed cancer was larger than in men. Men who had a chest radiograph were more likely to develop a lung cancer if the nodule was in the upper-lobes, which was not the case for women. In patients with an SPN, smoking increased the risk of lung cancer among men (chest radiograph: RR = 11.3, 95%CI 1.5–83.3; CT: RR = 7.5, 95%CI 2.2, 26.0) but smoking was not significantly associated with lung cancer diagnosis or mortality among women with an SPN. The relative risk of lung cancer diagnosis in women with SPN versus those without was much higher compared to men (13.7; 95%CI 9.2, 20.4 versus 6.2; 95%CI 4.9,7.9). Conclusion The factors associated with SPN malignancy and 5-year lung cancer mortality were different among men and women, especially regarding smoking history and SPN characteristics, where we observed a relatively high rate of lung cancer diagnosis among female non-smokers.
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Affiliation(s)
- Elisa Chilet-Rosell
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiologia y Salud Pública, Madrid, Spain
- * E-mail:
| | - Lucy A. Parker
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiologia y Salud Pública, Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiologia y Salud Pública, Madrid, Spain
| | - María Pastor-Valero
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiologia y Salud Pública, Madrid, Spain
| | - José Vilar
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | | | | | | | | | - Blanca Lumbreras
- Public Health, History of Science and Gynaecology Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiologia y Salud Pública, Madrid, Spain
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Parker LA, Chilet-Rosell E, Hernández-Aguado I, Pastor-Valero M, Gea S, Lumbreras B. Diagnostic Biomarkers: Are We Moving from Discovery to Clinical Application? Clin Chem 2018; 64:1657-1667. [DOI: 10.1373/clinchem.2018.292854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
Abstract
BACKGROUND
Despite considerable research investment, moving from biomarker discovery to clinical application has presented unique challenges. We aimed to evaluate progress toward clinical application of a sample of molecular- and “omics”-based diagnostic tests over a 10-year period.
METHODS
We used Scopus to locate studies, published before the December 31, 2016, citing 107 original-research articles published in 2006 that assessed the diagnostic value of a molecular- or “omics”-based test. We identified diagnostic studies of the same test and disease and determined whether the article represented progress in the validation of the molecular test. We classified the types of progress: (a) clinical validation (measuring diagnostic accuracy in a series of patients similar to the population in which the test will be used in practice), (b) technical improvement, (c) extended diagnostic application (modification of the diagnostic question attended initially by the test), (d) economic evaluation, or (e) clinical use or implementation.
RESULTS
In the 10-year period analyzed, 4257 articles cited the 107 diagnostic studies; 118 (2.8%) were diagnostic studies of the same test, and of these papers, 25 (21.2%) did not constitute progress toward validation of the test for use in clinical practice (potential research waste). Of the 107 molecular- or “omics”-based tests described in 2006, only 28 (26.2%) appeared to have made progress toward clinical application. Only 4 (9.1%) of 44 proteomics-based tests had made progress toward clinical application.
CONCLUSIONS
Articles evaluating molecular- or “omics”-based diagnostic tests are numerous in biomedical journals. Few tests have made progress toward clinical application in the 10 years following their discovery.
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Affiliation(s)
- Lucy A Parker
- Department of Public Health, University Miguel Hernández, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, University Miguel Hernández, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, University Miguel Hernández, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María Pastor-Valero
- Department of Public Health, University Miguel Hernández, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sonia Gea
- Department of Public Health, University Miguel Hernández, Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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23
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Redondo M, Hernández-Aguado I, Lumbreras B. The impact of the tax on sweetened beverages: a systematic review. Am J Clin Nutr 2018; 108:548-563. [PMID: 30535085 DOI: 10.1093/ajcn/nqy135] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/27/2018] [Indexed: 01/25/2023] Open
Abstract
Background Obesity has a serious impact on public health. Sugar-sweetened beverages (SSBs) are implicated in the obesity epidemic. Regulation has been suggested as one approach to limit consumption. Objective The aim of this study was to synthesize existing evidence related to the impact of taxes on the consumption, purchase, or sales of SSBs. Design A systematic review was conducted by using MEDLINE through PubMed (https://www.ncbi.nlm.nih.gov/pubmed), the Cochrane Library (http://www.cochranelibrary.com/), the Web of Science (https://login.webofknowledge.com/error/Error?PathInfo=%2F&Error=IPError), and Scopus (https://www.scopus.com/search/form.uri?display=basic) in the period 2011-2017 for studies that analyzed the impact of fiscal regulatory measures on the consumption, purchase, or sales of SSBs. The quality of evidence was assessed according to the CONSORT (Consolidated Standards of Reporting Trials) and the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) statements. Results Of the 17 studies, 5 (29.4%) evaluated the impact of a tax on SSBs in naturalistic experiments by county or city in the United States and in Mexico. Findings indicated that purchases or sales of SSBs decreased significantly with taxation amounts of 8% (Berkeley, CA) and 10% (Mexico). One study found no effect on sales of SSBs in 2 states that enacted a 5.5% tax on sodas. Twelve (70.6%) studies were based on virtual or experimental conditions evaluating either purchasing behavior or sales (6 studies; 50.0%) or behavioral intent (6 studies; 50.0%), resulting in a decrease in either purchasing behavior or sales or intent behavior with heterogeneity according to the tax rate. Conclusions Taxation significantly influences planned purchases and increases the probability of the purchase of healthy beverages. SSB taxes have the potential to reduce calorie and sugar intake, but further research is needed to evaluate effects on diet quality.
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Affiliation(s)
- Maite Redondo
- Pharmacy Faculty, Miguel Hernandez University, Alicante, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
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Hernández-Aguado I, Chilet-Rosell E. Pathways of undue influence in health policy-making: a main actor's perspective. J Epidemiol Community Health 2017; 72:154-159. [PMID: 29079588 DOI: 10.1136/jech-2017-209677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/01/2017] [Accepted: 10/13/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND It is crucial to know the extent to which influences lead to policy capture-by which the policy-making process is shifted away from the public interest towards narrow private interests. Using the case study of Spain, our aim was to identify interactions between public administration, civil society and private companies that could influence health policies. METHODS 54 semistructured interviews with key actors related to health policy. The interviews were used to gather information on main policy actors as well as on direct and subtle influences that could modify health policies. The analysis identified and described, from the interviewed persons' experiences, both the inappropriate influences exerted on the actors and those that they exerted. RESULTS Inappropriate influences were identified at all levels of administration and policy. They included actions for personal benefits, pressure for blocking health policies and pressure from high levels of government in favour of private corporations. The private sector played a significant role in these strategies through bribery, personal gifts, revolving doors, negative campaigns and by blocking unfavourable political positions or determining the knowledge agenda. The interviewees reported subtle forms of influence (social events, offers of technical support, invitations, etc) that contributed to the intellectual and cultural capture of health officials. CONCLUSION The health policy decision-making processes in Spain are subject to influences by stakeholders that determine a degree of policy capture, which is avoidable. The private sector uses different strategies, from subtle influences to outright corruption, taking advantage in many cases of flexible legislation.
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Affiliation(s)
- Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Ciber de Epidemiología y Salud Pública (CIBERESP), San Juan de Alicante, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Ciber de Epidemiología y Salud Pública (CIBERESP), San Juan de Alicante, Spain
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25
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Aranaz Andrés JM, Limón Ramírez R, Aibar Remón C, Gea-Velázquez de Castro MT, Bolúmar F, Hernández-Aguado I, López Fresneña N, Díaz-Agero Pérez C, Terol García E, Michel P, Sousa P, Larizgoitia Jauregui I. Comparison of two methods to estimate adverse events in the IBEAS Study (Ibero-American study of adverse events): cross-sectional versus retrospective cohort design. BMJ Open 2017; 7:e016546. [PMID: 28993382 PMCID: PMC5640028 DOI: 10.1136/bmjopen-2017-016546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Adverse events (AEs) epidemiology is the first step to improve practice in the healthcare system. Usually, the preferred method used to estimate the magnitude of the problem is the retrospective cohort study design, with retrospective reviews of the medical records. However this data collection involves a sophisticated sampling plan, and a process of intensive review of sometimes very heavy and complex medical records. Cross-sectional survey is also a valid and feasible methodology to study AEs. OBJECTIVES The aim of this study is to compare AEs detection using two different methodologies: cross-sectional versus retrospective cohort design. SETTING Secondary and tertiary hospitals in five countries: Argentina, Colombia, Costa Rica, Mexico and Peru. PARTICIPANTS The IBEAS Study is a cross-sectional survey with a sample size of 11 379 patients. The retrospective cohort study was obtained from a 10% random sample proportional to hospital size from the entire IBEAS Study population. METHODS This study compares the 1-day prevalence of the AEs obtained in the IBEAS Study with the incidence obtained through the retrospective cohort study. RESULTS The prevalence of patients with AEs was 10.47% (95% CI 9.90 to 11.03) (1191/11 379), while the cumulative incidence of the retrospective cohort study was 19.76% (95% CI 17.35% to 22.17%) (215/1088). In both studies the highest risk of suffering AEs was seen in Intensive Care Unit (ICU) patients. Comorbid patients and patients with medical devices showed higher risk. CONCLUSION The retrospective cohort design, although requires more resources, allows to detect more AEs than the cross-sectional design.
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Affiliation(s)
- Jesus Maria Aranaz Andrés
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Center of Biomedical Network Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Ramóny Cajal Biomedical Research Institute (IRYCIS), Madrid, Spain
- La Rioja International University (UNIR), Logroño, Spain
| | - Ramon Limón Ramírez
- Department of Preventive Medicine and Quality of Healthcare, Hospital de la Plana, Castellón, Spain
| | - Carlos Aibar Remón
- Department of Preventive Medicine and Public Health, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Aragón Healthcare Research Institute (IIS), Zaragoza, Spain
| | - Maria Teresa Gea-Velázquez de Castro
- Department of Preventive Medicine and Quality of Healthcare, Hospital Universitari Sant Joan d’Alacant, Sant Joan d’Alacant, Spain
- Department of Public Health, Science, History and Gynaecology, Miguel Hernández University, Sant Joan d’Alacant, Spain
| | - Francisco Bolúmar
- Center of Biomedical Network Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Unit of Public Health, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Center of Biomedical Network Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Public Health, Science, History and Gynaecology, Miguel Hernández University, Sant Joan d’Alacant, Spain
| | - Nieves López Fresneña
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Ramóny Cajal Biomedical Research Institute (IRYCIS), Madrid, Spain
- La Rioja International University (UNIR), Logroño, Spain
| | - Cristina Díaz-Agero Pérez
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Ramóny Cajal Biomedical Research Institute (IRYCIS), Madrid, Spain
- La Rioja International University (UNIR), Logroño, Spain
| | | | - Philippe Michel
- Centre Hospitalier Universitaire de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Paulo Sousa
- Universidade Nova de Lisboa, Escola Nacional de Saude Publica. Centro deInvestigação em Saúde Pública-UNL, Lisboa, Portugal
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Abstract
The aim of this study was to review recent literature in order to provide updated values of the typical effective doses associated with the top 20 imaging tests for adults and children and for the most widely used set of weights (ICRP60) as well as for the most recent one (ICRP103). We performed a systematic research on radiation dosimetry in radiology published from 2007 onwards through the Medline, Embase and Cochrane Library Plus databases. We also included studies backed by scientific or governmental organizations. Other variables included: year and type of study (survey or descriptive), country, method and sample used for the measurement. Mean effective dose, minimum, maximum and standard deviation were calculated. We compared our results with previous evidence and with data from DDM2. We included 27 articles and 5 web references in the study. A total of 378 values from the 20 procedures included were obtained, 280 (74%) using ICRP60 and 98 (26%) using ICRP103. Effective doses for CT procedures in children were very similar to those for adults, with the exception of CT Trunk, but fluoroscopy procedures had consistently lower dose. There were differences between the current data with either ICRP60 or ICRP103, and the previous published data. In conclusion, we provided the best available evidence from literature to evaluate the effective dose received by each patient for the most typical examinations. According to the recommendations from the Report 154 and from the European Council Directive, these results could also be useful to estimate the range of average exposures to the population.
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27
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Lumbreras B, Vilar J, González-Álvarez I, Guilabert M, Parker LA, Pastor-Valero M, Domingo ML, Fernández-Lorente MF, Hernández-Aguado I. Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study). BMJ Open 2016; 6:e012361. [PMID: 27799242 PMCID: PMC5093629 DOI: 10.1136/bmjopen-2016-012361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/26/2016] [Accepted: 09/13/2016] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN A quantitative and qualitative evaluation through a survey and focal groups. SETTING San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.
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Affiliation(s)
- B Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, and CIBER en Epidemiología y Salud Pública, Alicante, Spain
| | - J Vilar
- Radiodiagnostic Department, Peset Hospital, Valenciana, Spain
| | | | - M Guilabert
- Psychology Department, Miguel Hernández University, Alicante, Spain
| | - L A Parker
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Spain
| | - M Pastor-Valero
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Spain
| | - M L Domingo
- Radiodiagnostic Department, Peset Hospital, Valenciana, Spain
| | | | - I Hernández-Aguado
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Spain
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28
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Lumbreras B, Vilar J, González-Álvarez I, Gómez-Sáez N, Domingo ML, Lorente MF, Pastor-Valero M, Hernández-Aguado I. The Fate of Patients with Solitary Pulmonary Nodules: Clinical Management and Radiation Exposure Associated. PLoS One 2016; 11:e0158458. [PMID: 27392032 PMCID: PMC4938621 DOI: 10.1371/journal.pone.0158458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 06/16/2016] [Indexed: 12/21/2022] Open
Abstract
Background The appropriate management of the large number of lung nodules detected during the course of routine medical care presents a challenge. We aimed to evaluate the usual clinical practice in solitary pulmonary nodule (SPN) management and associated radiation exposure. Methods We examined 893 radiology reports of consecutive patients undergoing chest computed tomography (CT) and radiography at two public hospitals in Spain. Information on diagnostic procedures from SPN detection and lung cancer diagnosis was collected prospectively for 18 months. Results More than 20% of patients with SPN detected on either chest radiograph (19.8%) or CT (26.1%) underwent no additional interventions and none developed lung cancer (100% negative predictive value). 346 (72.0%) patients with SPN detected on chest radiograph and 254 (61.5%) patients with SPN detected on CT had additional diagnostic tests and were not diagnosed with lung cancer. In patients undergoing follow-up imaging for SPNs detected on CT median number of additional imaging tests was 3.5 and the mean cumulative effective dose was 24.4 mSv; for those detected on chest radiograph the median number of additional imaging tests was 2.8 and the mean cumulative effective dose was 10.3 mSv. Conclusions Patients who did not have additional interventions were not diagnosed of lung cancer. There was an excessive amount of interventions in a high percentage of patients presenting SPN, which was associated with an excess of radiation exposure.
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Affiliation(s)
- Blanca Lumbreras
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
- * E-mail:
| | - José Vilar
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | | | - Noemí Gómez-Sáez
- Public Health Department, Miguel Hernández University, Alicante, Spain
| | | | | | - María Pastor-Valero
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
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Camps V, Hernández-Aguado I, Puyol A, Segura A. An ethics training specific for European public health. Public Health Rev 2015; 36:6. [PMID: 29450034 PMCID: PMC5810105 DOI: 10.1186/s40985-015-0008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/13/2015] [Indexed: 11/24/2022] Open
Abstract
Training in public health ethics is not at the core of public health programmes in Europe. The fruitful progress of the United States could stimulate the European schools of public health and other academic institutions to develop specifically European teaching programmes for ethics that embrace both transatlantic innovations and some adaptations based on the evolution of moral values in European societies. This paper reviews the arguments for a European public health ethics curriculum and recommends the main features of such a programme. Europe shares common values and, above all, the three major ethical principles that were socially and politically crystallized by the French Revolution: liberty, equality, and fraternity. Fraternity, otherwise known as solidarity, although rarely mentioned in the literature on ethical issues, is the moral value that best defines the European concept of public health expressed as a common good, mutual aid, and a collective or shared responsibility for health of the population. Specific political motivations were responsible for the origin of European health systems and for current policy proposals led by the European Union, such as Europe's commitments, at least in theory, to: reduce social inequities in health and to develop the health in all policies approach. These and other initiatives, albeit not exclusively European, have political and legal repercussions that pose unique ethical challenges. Europe combines homogeneity in social determinants of health with heterogeneity in public health approaches and interventions. It is therefore necessary to develop training in ethics and good government for all public health workers in Europe, especially since a large segment of the population's health depends on actions and decisions adopted by the European Commission and its regulatory agencies as well as for non EU European Region countries. Based on these arguments, the paper concludes with several recommendations for a common nucleus for the ethics curriculum in Europe.
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Affiliation(s)
- Victoria Camps
- Universitat Autònoma de Barcelona and Victor Grifols y Lucas Foundation, Barcelona, Spain
| | - Ildefonso Hernández-Aguado
- Miguel Hernandez University, SESPAS, the Spanish Society of Public Health and Health Management and Ciberesp, Alicante, Spain
| | - Angel Puyol
- Department of Philosophy, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andreu Segura
- Health Department of the Catalan Government, Pompeu Fabra University and Ethics and Public Health Task Force from SESPAS, Barcelona, Spain
- Departament de Sanitat, Catalonia, Spain
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Rajmil L, Artazcoz L, García-Gómez P, Flores M, Hernández-Aguado I. Spanish children are most affected by the economic crisis, says the Spanish Society of Public Health (SESPAS). BMJ 2015; 350:h1945. [PMID: 25873561 DOI: 10.1136/bmj.h1945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Luis Rajmil
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) and IMIM Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08023, Spain
| | | | | | - Manuel Flores
- DEGA Instituto Universitario de Estudos e Desenvolvemento de Galicia, University of Santiago de Compostela, Santiago de Compostela, Spain
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Umaña-Peña R, Franco-Giraldo Á, Díaz CÁD, Ruíz-Cantero MT, Gil-González D, Hernández-Aguado I. Assessment of the association of health with the liberalisation of trade in services under the World Trade Organisation. PLoS One 2014; 9:e102385. [PMID: 25078783 PMCID: PMC4117476 DOI: 10.1371/journal.pone.0102385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/18/2014] [Indexed: 11/18/2022] Open
Abstract
Background The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators - life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established. Methods and Findings This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: −0.358 p<0.001; MM: −0.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services. Conclusions The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.
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Affiliation(s)
- Román Umaña-Peña
- Observatory of Public Policies and Health, University of Alicante, Alicante, Spain
- * E-mail:
| | - Álvaro Franco-Giraldo
- National School of Public Health, University of Antioquia, Medellin, Colombia
- Research Committee of the University of Antioquia (CODI): Research Group on public policy and health, Sustainability Strategy CODI 2013–2014, Medellin, Colombia
| | - Carlos Álvarez-Dardet Díaz
- Observatory of Public Policies and Health, University of Alicante, Alicante, Spain
- Public Health Research Unit, University of Alicante, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María Teresa Ruíz-Cantero
- Observatory of Public Policies and Health, University of Alicante, Alicante, Spain
- Public Health Research Unit, University of Alicante, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Diana Gil-González
- Observatory of Public Policies and Health, University of Alicante, Alicante, Spain
- Public Health Research Unit, University of Alicante, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, Miguel Hernández University, San Juan de Alicante, Spain
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Gómez-Sáez N, González-Álvarez I, Vilar J, Hernández-Aguado I, Domingo ML, Lorente MF, Pastor-Valero M, Parker LA, Picazo N, Calbo J, Lumbreras B. Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study. Eur Radiol 2014; 24:2174-82. [PMID: 24962823 PMCID: PMC4126995 DOI: 10.1007/s00330-014-3249-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/06/2014] [Accepted: 05/15/2014] [Indexed: 12/19/2022]
Abstract
Objective To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient’s features associated with malignancy in a non-high-risk clinical population. Methods Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. Results 25,529 patients were included: 23,102 (90.5 %) underwent chest radiograph and 2,497 (9.5 %) a CT. The prevalence of SPN was 2.1 % (95 % CI 1.9 – 2.3) in radiographs and 17.0 % (95 % CI 15.5 – 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. Conclusions The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. Key Points • There is a lower SPN prevalence in the clinical population than in screening studies. • SPN prevalence is associated with some patient characteristics: sex, age, imaging test. • Nodule characteristics related to malignancy were associated with some patient characteristics.
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Affiliation(s)
- N. Gómez-Sáez
- Public Health Department, Miguel Hernández University, Alicante, Spain
| | | | - J. Vilar
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | - I. Hernández-Aguado
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - M. L. Domingo
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | - M. F. Lorente
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - M. Pastor-Valero
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - L. A. Parker
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - N. Picazo
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - J. Calbo
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - B. Lumbreras
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
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Lumbreras B, González-Alvarez I, Gómez-Sáez N, Lorente MF, Hernández-Aguado I. Management of patients with incidental findings in imaging tests: a large prospective single-center study. Clin Imaging 2014; 38:249-54. [PMID: 24560749 DOI: 10.1016/j.clinimag.2013.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/22/2013] [Indexed: 12/21/2022]
Abstract
We prospectively followed up patients with an incidental finding detected in an image test to assess the additional interventions carried out and the clinical implications of the incidental findings detected. Out of 474 patients with an incidental finding, 63 (13.3%) were further evaluated, and of these patients, 25 (39.7%) had clinical implications. Patients who had an X-ray (24/76, 31.6%), with a preoperative examination (19/77 24.7%), and with an incidental finding in the thoracic cavity (34/117, 29.1%) or in the head/neck (6/28, 21.4%) were more likely to have additional evaluations.
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Affiliation(s)
- Blanca Lumbreras
- Public Health Department, Miguel Hernández University, Alicante, Spain; CIBER en Epidemiología y Salud Pública, Barcelona, Spain.
| | | | - Noemi Gómez-Sáez
- Public Health Department, Miguel Hernández University, Alicante, Spain
| | - M Fermina Lorente
- Radiodiagnostic Department, San Juan Hospital, San Juan de Alicante, Spain
| | - Ildefonso Hernández-Aguado
- Public Health Department, Miguel Hernández University, Alicante, Spain; CIBER en Epidemiología y Salud Pública, Barcelona, Spain
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Hernández-Aguado I, G. Benavides F, Porta M. Fe de errores a: Los profesionales españoles de la salud pública ante la Ley General de Salud Pública. Gaceta Sanitaria 2013. [DOI: 10.1016/j.gaceta.2013.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Ciber de epidemiología y salud pública, San Juan de Alicante, Spain.
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Hernández-Aguado I, Benavides FG, Porta M. Los profesionales españoles de la salud pública ante la Ley General de Salud Pública. Gaceta Sanitaria 2012; 26:295-7. [DOI: 10.1016/j.gaceta.2012.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/27/2012] [Accepted: 05/01/2012] [Indexed: 11/15/2022]
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Hernández-Aguado I, Santaolaya Cesteros M, Campos Esteban P. Las desigualdades sociales en salud y la atención primaria. Informe SESPAS 2012. Gaceta Sanitaria 2012; 26 Suppl 1:6-13. [DOI: 10.1016/j.gaceta.2011.09.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/29/2011] [Accepted: 09/30/2011] [Indexed: 10/14/2022]
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Parker LA, Lumbreras B, Hernández-Aguado I. Health information and advocacy for "Health in All Policies": a research agenda. J Epidemiol Community Health 2011; 64:114-6. [PMID: 20056965 DOI: 10.1136/jech.2008.081976] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Placing health in the agendas of all policy makers remains a challenge. Finding new ways to boost Health in All Policies should be a continuous process. Currently, health information initiatives gather core health statistics, indicators related to healthcare, along with individual level risk factors such as smoking or obesity. However, there is a lack of identifiable information showing the effect of non-primary health policies on population health. A research agenda is proposed, focusing on three related areas that would frame health information in such a way that the implications for decision-makers from non-health sectors are clear: (a) research in order to provide solid and quantitative evidence linking the social and environmental determinants of health with their ultimate health outcomes; (b) research that shows and quantifies the effect of policies and specific interventions on these determinants; and (c) the development of policy-linked indicators which provide a quantitative estimate of the health that would be gained (or disease burden that could be avoided) by adoption of a specific policy.
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Affiliation(s)
- Lucy A Parker
- Public Health Department, Miguel Hernandez University, Ctra. Alicante-Valencia, Km. 8'7, Alicante 03550, Spain.
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Parker LA, Lumbreras B, Lopez T, Hernández-Aguado I, Porta M. How useful is it clinically to analyse the K-ras mutational status for the diagnosis of exocrine pancreatic cancer? A systematic review and meta-analysis. Eur J Clin Invest 2011; 41:793-805. [PMID: 21391995 DOI: 10.1111/j.1365-2362.2011.02495.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND More clinically meaningful diagnostic tests are needed in exocrine pancreatic cancer (EPC). K-ras mutations are the most frequently acquired genetic alteration in EPC. We analysed the diagnostic utility of detecting K-ras mutations through a systematic analysis of the literature. METHODS We searched PubMed using suitable medical subject headings and text words. Original research articles that evaluated the diagnostic accuracy of detecting K-ras mutations for diagnosis of EPC were selected. Two investigators independently extracted data from each study regarding the methodology used, the methodological quality of the study, the diagnostic accuracy reported and the authors' conclusions about clinical applicability of the test. Combined estimates for the sensitivity and specificity of K-ras were determined using bivariate meta-analysis; heterogeneity was explored using meta-regression. RESULTS We assessed 34 studies from 30 published articles. The research reports were prone to numerous methodological biases and often lacked vital information for assessing external validity. The sensitivity of detecting K-ras status ranged from 0% through 100%, and the specificity from 58% through 100%. Diagnostic accuracy was highest when cytohistological samples were used: sensitivity and specificity were 76·5% (66·7-84·2) and 91·8% (87·6-94·1), respectively. Studies conducted in a clinically relevant population observed lower accuracy than case-control designs (68·4% vs. 82·7%). CONCLUSIONS Because of the numerous methodological limitations of studies, the utility of analysing K-ras mutations for the diagnosis of EPC remains unknown. Flaws in diagnostic biomarkers with well-established biological properties, as K-ras, become even more relevant when the promises of 'personalized medicine' are pondered.
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Affiliation(s)
- Lucy A Parker
- Department of Public Health, Miguel Hernández University, Alicante, Spain
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Parker LA, Porta M, Lumbreras B, López T, Guarner L, Hernández-Aguado I, Carrato A, Corominas JM, Rifà J, Fernandez E, Alguacil J, Malats N, Real FX. Clinical validity of detecting K-ras mutations for the diagnosis of exocrine pancreatic cancer: a prospective study in a clinically-relevant spectrum of patients. Eur J Epidemiol 2011; 26:229-36. [PMID: 21298467 DOI: 10.1007/s10654-011-9547-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 01/20/2011] [Indexed: 12/22/2022]
Abstract
The diagnostic utility of detecting K-ras mutations for the diagnosis of exocrine pancreatic cancer (EPC) has not been properly studied, and few reports have analysed a clinically relevant spectrum of patients. The objective was to evaluate the clinical validity of detecting K-ras mutations in the diagnosis of EPC in a large sample of clinically relevant patients. We prospectively identified 374 patients in whom one of the following diagnoses was suspected at hospital admission: EPC, chronic pancreatitis, pancreatic cysts, and cancer of the extrahepatic biliary system. Mutations in the K-ras oncogene were analysed by PCR and artificial RFLP in 212 patients. The sensitivity and specificity of the K-ras mutational status for the diagnosis of EPC were 77.7% (95% CI: 69.2-84.8) and 78.0% (68.1-86.0), respectively. The diagnostic accuracy was hardly modified by sex and age. In patients with either mutated K-ras or CEA > 5 ng/ml, the sensitivity and specificity were 81.0% (72.9-87.6) and 62.6% (72.9-87.6), respectively. In patients with mutated K-ras and CEA > 5 ng/ml the sensitivity was markedly reduced. In comparisons with a variety of non-EPC patient groups sensitivity and specificity were both always greater than 75%. In this clinically relevant sample of patients the sensitivity and specificity of K-ras mutations were not sufficiently high for independent diagnostic use. However, it seems premature to rule out the utility of K-ras analysis in conjunction with other genetic and 'omics' technologies.
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Affiliation(s)
- Lucy A Parker
- Department of Public Health, Miguel Hernández University, Alicante, Spain
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Parker LA, Gómez Saez N, Lumbreras B, Porta M, Hernández-Aguado I. Methodological deficits in diagnostic research using '-omics' technologies: evaluation of the QUADOMICS tool and quality of recently published studies. PLoS One 2010; 5:e11419. [PMID: 20625481 PMCID: PMC2896422 DOI: 10.1371/journal.pone.0011419] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 06/09/2010] [Indexed: 11/19/2022] Open
Abstract
Background QUADOMICS is an adaptation of QUADAS (a quality assessment tool for use in systematic reviews of diagnostic accuracy studies), which takes into account the particular challenges presented by ‘-omics’ based technologies. Our primary objective was to evaluate the applicability and consistency of QUADOMICS. Subsequently we evaluated and describe the methodological quality of a sample of recently published studies using the tool. Methodology/Principal Findings 45‘-omics’- based diagnostic studies were identified by systematic search of Pubmed using suitable MeSH terms (“Genomics”, “Sensitivity and specificity”, “Diagnosis”). Three investigators independently assessed the quality of the articles using QUADOMICS and met to compare observations and generate a consensus. Consistency and applicability was assessed by comparing each reviewer's original rating with the consensus. Methodological quality was described using the consensus rating. Agreement was above 80% for all three reviewers. Four items presented difficulties with application, mostly due to the lack of a clearly defined gold standard. Methodological quality of our sample was poor; studies met roughly half of the applied criteria (mean ± sd, 54.7±18.4%). Few studies were carried out in a population that mirrored the clinical situation in which the test would be used in practice, (6, 13.3%); none described patient recruitment sufficiently; and less than half described clinical and physiological factors that might influence the biomarker profile (20, 44.4%). Conclusions The QUADOMICS tool can consistently be applied to diagnostic ‘-omics’ studies presently published in biomedical journals. A substantial proportion of reports in this research field fail to address design issues that are fundamental to make inferences relevant for patient care.
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Affiliation(s)
- Lucy A Parker
- Departamento de Salud Pública, Universidad Miguel Hernández, Alicante, Spain.
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Abstract
The objective of this review is to summarise the available evidence on the frequency and management of incidental findings in imaging diagnostic tests. Original articles were identified by a systematic search of the MEDLINE, EMBASE and Cochrane Library Plus databases using appropriate medical headings. Extracted variables were study design; sample size; type of imaging test; initial diagnosis; frequency and location of incidental findings; whether clinical follow-up was performed; and whether a definitive diagnosis was made. Study characteristics were assessed by one reviewer and checked by a second reviewer. Any disagreement was solved by consensus. The relationship between the frequency of incidental findings and the study characteristics was assessed using a one-way ANOVA test, as was the frequency of follow-up of incidental findings and the frequency of confirmation. 251 potentially relevant abstracts were identified and 44 articles were finally included in the review. Overall, the mean frequency of incidental findings was 23.6% (95% confidence interval (CI) 15.8-31.3%). The frequency of incidental findings was higher in studies involving CT technology (mean 31.1%, 95% CI 20.1-41.9%), in patients with an unspecific initial diagnosis (mean 30.5, 95% CI 0-81.6) and when the location of the incidental findings was unspecified (mean 33.9%, 95% CI 18.1-49.7). The mean frequency of clinical follow-up was 64.5% (95% CI 52.9-76.1%) and mean frequency of clinical confirmation was 45.6% (95% CI 32.1-59.2%). Although the optimal strategy for the management of these abnormalities is still unclear, it is essential to be aware of the low clinical confirmation in findings of moderate and major importance.
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Affiliation(s)
- B Lumbreras
- Departament of Public Health, University Miguel Hernandez, Alicante, Spain.
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Villalbí JR, Carreras F, Martín-Moreno JM, Hernández-Aguado I. La cartera de servicios de salud pública en el Sistema Nacional de Salud: la aportación de la administración general del Estado. Rev Esp Salud Publica 2010; 84:247-54. [DOI: 10.1590/s1135-57272010000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gómez Sáez N, Hernández-Aguado I, Lumbreras B. Estudio observacional: evaluación de la calidad metodológica de la investigación diagnóstica en España tras la publicación de la guía STARD. Med Clin (Barc) 2009; 133:302-10. [DOI: 10.1016/j.medcli.2008.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 10/17/2008] [Indexed: 11/16/2022]
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Palma-Solís MA, Alvarez-Dardet Díaz C, Franco-Giraldo A, Hernández-Aguado I, Pérez-Hoyos S. State downsizing as a determinant of infant mortality and achievement of Millennium Development Goal 4. Int J Health Serv 2009; 39:389-403. [PMID: 19492631 DOI: 10.2190/hs.39.2.i] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to evaluate the worldwide effect of state downsizing policies on achievement of U.N. Millennium Development Goal 4 (MDG4) on infant mortality rates. In an ecological retrospective cohort study of 161 countries, from 1978 to 2002, the authors analyzed changes in government consumption (GC) as determining exposure to achievement of MDG4. Descriptive methods and a multiple logistic regression were applied to adjust for changes in gross domestic product, level of democracy, and income inequality. Excess infant mortality in the exposed countries, attributable to reductions in GC, was estimated. Fifty countries were found to have reduced GC, and 111 had increased GC. The gap in infant mortality rate between these groups of countries doubled in the study period. Non-achievement of MDG4 was associated with reductions in GC and increases in income inequality. The excess infant mortality attributable to GC reductions in the exposed countries from 1990 to 2002 was 4,473,348 deaths. The probability of achieving MDG4 seems to be seriously compromised for many countries because of reduced public sector expenditure during the last 25 years of the 20th century, in response to World Bank/International Monetary Fund Washington Consensus policies. This seeming contradiction between the goals of different U.N. branches may be undermining achievement of MDG4 and should be taken into account when developing future global governance policy.
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Lumbreras B, González-Alvárez I, Lorente MF, Calbo J, Aranaz J, Hernández-Aguado I. Unexpected findings at imaging: predicting frequency in various types of studies. Eur J Radiol 2009; 74:269-74. [PMID: 19231122 DOI: 10.1016/j.ejrad.2009.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 11/11/2008] [Accepted: 01/21/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : The objective was to evaluate the prevalence and associated variables of unsuspected findings from imaging tests in clinical practice. MATERIAL AND METHODS : Cross-sectional study of patients referred for an imaging test in 2006. Two independent radiologists classified the imaging tests according to the presence or absence of an unexpected finding in relation with the causes that prompted the test (kappa=0.95). A thorough chart review of these patients was carried out as a quality control. RESULTS : Out of 3259 patients in the study, 488 revealed unsuspected findings (15.0%). The prevalence of abnormal findings varied according to age: from 20.4% (150/734) in the over 74-group to 9.0% (76/847) in the under 43-group. The largest prevalence was in the category of infectious diseases (14/49, 28.6%) and in CT (260/901, 28.9%) and ultrasound (138/668, 20.7%). Studies showing moderate clinical information on the referral form were less likely to show unexpected findings than those with null or minor information (OR 0.51; 95% CI 0.36-0.73). CONCLUSION : Clinicians should expect the frequency of diseases detectable by imaging to increase in the future. Further research with follow-up of these findings is needed to estimate the effect of imaging technologies on final health outcomes.
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Affiliation(s)
- Blanca Lumbreras
- Public Health Department, Miguel Hernández University, Spain; CIBER en Epidemiología y Salud Pública, Spain.
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Lumbreras B, Porta M, Marquez S, Pollán M, Parker LA, Hernández-Aguado I. Sources of error and its control in studies on the diagnostic accuracy of “-omics” technologies. Proteomics Clin Appl 2009; 3:173-184. [DOI: 10.1002/prca.200800092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
Health crises shock the population and overwhelm the health services. This article analyzes 30 years of health crises in Spain from a multifaceted perspective: population, patients, clinicians, public health practitioners, politicians, the media and other groups involved. The interaction among all stakeholders shapes the response and management of any health crisis. Heterogeneity of management and of health effects-contributing to inequalities in health-is common. The participation and coordination of the health services is crucial in detection of the crisis and in modulating the population reactions. Public health services characterized by their low public profile could gain public influence by their role in coordinating politicians and the media when solving important health problems. Analyzing the mistakes and successes in previous crises together with risk and vulnerability assessments, research and drills are essential to give a quick and adequate response to future crises.
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Affiliation(s)
- Juan Gérvas
- Equipo CESCA, Escuela Nacional de Sanidad, Madrid, España
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Hurtado I, Hernández-Aguado I, Ferreros I, Lumbreras B, Pérez-Hoyos S. [Effect of distinct sociodemographic variables on progression of HIV infection in a cohort of drug users]. Gac Sanit 2008; 22:541-6. [PMID: 19080930 DOI: 10.1016/s0213-9111(08)75352-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze whether the effectiveness of combined antiretroviral therapy in delaying progression to AIDS and death is affected by social inequities in a cohort of HIV-positive injecting drug users (IDUs). METHODS A cohort of 3,122 HIV-positive IDUs identified in the AIDS Information and Prevention Centers of the autonomous region of Valencia was analyzed, with further follow-up in 1,876. Progression to AIDS and death after seroconversion were calculated by Kaplan-Meier estimation according to sociodemographic variables (age, sex, education, marital status, length of addiction). Cox regression models were also fitted. RESULTS No significant differences were observed according to the variables considered when analyzing time to AIDS development. Evaluation of survival time revealed that individuals with further follow-up showed an excess of mortality (HR = 1.35; 95%CI: 0.20-1.54). For individuals without follow-up, mortality risk was reduced in those with secondary school education (HR = 0.51; 95%CI: 0.35-0.74) and with university education (HR = 0.41; 95%CI: 0.18-0.93) compared with those with no education. When individuals with follow-up were analyzed, the differences lost significance for those with secondary school education (HR = 0.92; 95%CI: 0.72-1.19) and university education (HR = 0.62; 95%CI: 0.35-1.11). CONCLUSIONS The mortality excess found in IDUs with lower educational levels, especially among those not seeking healthcare in the initial period after being identified as HIV-positive, highlights the need for interventions aimed at facilitating access to health systems, especially among the socially disadvantaged.
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Affiliation(s)
- Isabel Hurtado
- CIBER de Epidemiología y Salud Pública (CIBERESP), Valencia, España.
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Jarrin I, Geskus R, Bhaskaran K, Prins M, Perez-Hoyos S, Muga R, Hernández-Aguado I, Meyer L, Porter K, del Amo J. Gender differences in HIV progression to AIDS and death in industrialized countries: slower disease progression following HIV seroconversion in women. Am J Epidemiol 2008; 168:532-40. [PMID: 18663213 DOI: 10.1093/aje/kwn179] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To evaluate sex differences in human immunodeficiency virus (HIV) disease progression before (pre-1997) and after (1997-2006) introduction of highly active antiretroviral therapy, the authors used data from a collaboration of 23 HIV seroconverter cohort studies from Europe, Australia, and Canada restricted to the 6,923 seroconverters infected through injecting drug use and sex between men and women. Within a competing risk framework, they used Cox proportional hazards models allowing for late entry to evaluate sex differences in time from HIV seroconversion to death, to acquired immunodeficiency syndrome (AIDS), and to each first AIDS-defining disease and death without AIDS. While no significant sex differences were found before 1997, from 1997 onward, women had a lower risk of AIDS (adjusted cumulative relative risk (aCRR) = 0.76, 95% confidence interval (CI): 0.63, 0.90) and death (adjusted hazard ratio = 0.68, 95% CI: 0.56, 0.82) than men did. Compared with men, women also had lower risks of AIDS dementia complex (aCRR = 0.23, 95% CI: 0.07, 0.74), tuberculosis (aCRR = 0.60, 95% CI: 0.39, 0.92), Kaposi's sarcoma (aCRR = 0.27, 95% CI: 0.07, 0.99), lymphomas (aCRR = 0.47, 95% CI: 0.23, 0.96), and death without AIDS (aCRR = 0.74, 95% CI: 0.56, 0.98). Sex differences in HIV disease progression have become larger and statistically significant in the era of highly active antiretroviral therapy, supporting a stronger impact of health interventions among women.
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Affiliation(s)
- Inmaculada Jarrin
- National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
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