Biomedical subjects

M Delgado-Rodríguez

Publications and source records attributed to M Delgado-Rodríguez.

81 records · Page 5Linked to original sources

PubMedDate not supplied

[Inclusion of research quality in meta-analyses].

The objective of this review is how study quality is taken into account in the synthesis of information from several studies. Meta-analysis has been criticized for failing into account differential quality of evidence in primary studies, allowing poor studies to drive out good science by weight of numbers. Notwithstanding there is presently no agreement on the inclusion of study quality score in quantitative meta-analysis; on the other hand, agreement does exist on knowing study quality. However, and although there is a certain level of consensus about what a good study is and on what characteristics it should have, no evaluation protocol on study quality is uniformly accepted. Furthermore, there are no data on the reliability and validity of quality questionnaires. There are several procedures to include study quality in meta-analysis: a) it is generally accepted that bias-free studies should be pooled only; b) most researches reject to include quality scores in the weight; and c) no agreement is reached on the use the quality scores as a covariate in graphical methods and regression analysis. It may be superfluous or misleading.

Meta-Analysis as Topic↗

PubMedDate not supplied

[Comparison of 2 indexes of prenatal care and risk of preterm delivery].

OBJECTIVES: A new index the adequacy of prenatal care utilization (APNCU) index, has been proposed to provide a more accurate and comprehensive measure of antenatal care use than the widely used Kessner index. To better understand the value of the two above mentioned indexes as predictors of preterm delivery, we examined their ability to predict women who will or will not deliver before 37 weeks of gestation. METHODS: A case-control study was performed, including 207 cases and 381 controls. Prenatal care was assessed on the basis of the two above mentioned indexes, both taking into account the number of prenatal care visits, the date of the first visit and gestational age. Multiple-factor adjusted odds ratios and their 95% confidence intervals were estimated using logistic regression methods. RESULTS: The Kessner index showed a lineal trend with both crude and adjusted for (the APNCU index) estimates of preterm delivery risk. The APNCU index did not show any linear trend with adjusted for (the Kessner index) estimates of preterm delivery risk. To assess whether the Kessner index added explanatory information to the APNCU index (or vice versa), the APNCU index was regressed on the Kessner index (and viceversa), and a set of residuals was computed for both indexes. In logistic regression analyses, the residuals of Kessner added meaningful information to the APNCU index, whereas the residuals of the APNCU index did not add any relevant information to the Kessner index. There results remained unchanged after controlling for several confounders. CONCLUSIONS: A variation in the definition of adequate prenatal care use changes the association between prenatal care and preterm delivery. The Kessner index showed a better ability for discriminating and predicting the risk of preterm delivery.

Adult↗

PubMedDate not supplied

[Competing death risks].

The death of an individual is not a repetitive event, so if a cause of death overtakes another cause in producing death, mortality rates from the overtaken cause decrease. This phenomenon is known as competing risks of death and it must be taken into account in any cause-specific mortality analysis. In this work the competing risks concept is formalized and some historical data are described. The main parametric tools to analyze competing risks are displayed, with a special look at the Gompertz and Weibull functions. Regarding non-parametric models, the Chiang method is shown and its applicability on both dependent and independent causes of death is discussed. Finally, other tools specially useful in clinical epidemiology are enumerated, including Cox regression, Kaplan-Meier and log-rank methods, as well as the interactions between competing risks and misclassification and selection biases.

Bias↗

PubMedDate not supplied

[Analysis of the cohort effect on the trend in mortality from motor neuron disease in Spain, 19551-1002].

BACKGROUND: An increase in the mortality due to motor neuron disease (MND) has been reported in Spain over the past 30-40 years. It has been suggested that this increase is due to the cohort effect, but his hypothesis has not been proven. METHODS: The motor neuron disease (MND) mortality statistics by age and by gender were furnished from the Spanish National Institute of Statistics. The mortality specifically by age and the adjusted age-related rates were calculated. By Poisson regression, the cohort effect of birth on the mortality by ages has been analyzed, the cohort effect also having been analyzed by graphic methods. RESULTS: The mortality adjusted by age was declining up until 1969, as of which time it has been on the rise. Each five-year birth cohort increases the risk of dying from MND by 8.5%. CONCLUSIONS: The increase in the mortality due to MND in Spain is the result of a cohort effect.

Adult↗

PubMedDate not supplied

[The measurement of inequalities in age of death: calculating the Gini Index based on mortality tables].

The Gini index has been used to gauge the concentration of different variables, including income, the mortality distribution and the spread of physicians. The use of the Gini index for gauging the inequalities in the age of death based on actuarial mortality data. For this purpose, the 1990 age and gender-related mortality figures for each Autonomous Community were used. The inequalities in the number of years lived are greater among males than among females throughout all of the Autonomous Communities. The Communities showing the longest life expectancies are those which have also been revealed to involved the least degree of inequality in the number of years lived, which therefore makes in possible to pinpoint health-care priorities in some cases. The Gini index can be applied to age-related mortality for gauging the degree of inequality in the age of death and to pinpoint age groups on which to place priority with regard to health-care measures.

Adolescent↗

PubMedDate not supplied

[Comparison between several standard populations for age-adjusting].

BACKGROUND: To analyse the effect the choice of reference population has on different indicators derived from mortality rates age-adjusting. METHODS: The mortality rates for different causes of death in Spain from 1971 to 1992 were adjusted by using four reference populations: Spanish populations from 1971 and 1992, the Standard European population and the standard world population. The results obtained with the four populations were compared by applying three indicators: difference between the rates of 1992 and 1971, ratio between the rates of 1992 and 1971 and annual percentage change between 1971 and 1992. RESULTS: In the majority of the causes of death studied, including the total, ischemic heart disease and almost all of the tumours, the ratio between the rates and the percentage of annual change are similar regardless of the standard population used. However, the difference in rates is very noticeable in relation to the reference population. In the infectious diseases and testis cancer, the opposite occurs: the different in rates is steadfast while the ratio between the rates varies with the standard population. Finally, the mortality due to pneumonia, Parkinson's disease and encephalic cancer show changes all three indicators used. CONCLUSIONS: An analysis of the specific rates by age must be made before proceeding with their adjustment. This analysis will enable us to ascertain whether the adjustment by age is correct and which indicator (difference, ratio or percentage change) will be appropriate for making comparisons.

Age Distribution↗

PubMedDate not supplied

Determinants of the interval between diagnosis and treatment in patients with digestive tract cancer.

The main objective was to analyze the influence of social factors on the interval from diagnosis to treatment in a cohort of 217 patients with digestive tract cancer. From the clinical charts data were obtained for: date of the beginning of illness, dates of medical attendance, type and date of diagnostic tests, characteristics of the disease (symptoms, stage), and date of treatment. From the personal interview we gathered information lacking in the clinical charts such as socio-demographic factors, other underlying diseases, and variables related to life style. The information on hospital admission, diagnosis, and treatment was prospectively gathered, whereas data before hospitalization were retrospectively assessed. In statistical analysis the Kruskal-Wallis test and Cox regression were used. The predictors associated with a shorter diagnosis-treatment period were: low social class, lymphatic involvement at diagnosis, first visit at secondary/tertiary level of health care, no car availability, two or more symptoms at the beginning of disease, sex (male), age (less than 74 years), and diagnosis out of vacation periods. In conclusion, several socio-demographic variables (age, gender, social class, and car availability) influence the interval diagnosis-treatment.

Aged↗

PubMedDate not supplied

[Anesthetic morbimortality in a general hospital].

INTRODUCTION: Due to the lack of data in our medium and epidemiologic study was performed with the aims of knowing the numbers of morbimortality of anesthesia in a tertiary hospital as well as identify the risk factors of the same. METHODS: A general prospective study was carried out with a sample of 5,162 anesthesias administered in our hospital from October 1986 to October 1987. The questionnaires undertaken were completed by the anesthesiologists of the hospital staff. Age, sex, ASA, emergency, associated preoperative pathologies, premedication, length of operation, duration fo anesthesia, anesthesiologist experience, type of surgery, type of anesthesia, monitoring, type of complications and evolution of the same were the variables assessed. Severe cases were also evaluated by 3 anesthesiologists of the department, independent of those involved. The relative risk and the confidence interval of 95% were calculated as were the chi of Mantel-Haenszel tendency and a test of mean comparisons. RESULTS: The mortality partially linked to anesthesia found was 1:2,581. The numbers of morbidity were of 0.77% for severe complications and 14.1% for the slight complications. Upon analysis of severe complications 28.5% of the cases were found to be due to human error. The principal risk factors were age, emergency, bad preoperative physical state, lenght of operation, type of anesthesia and surgery. CONCLUSIONS: The situation in our center does not differ from that found by other authors and not only the numbers of morbimortality but also the factors of risk found in this study are similar to those published in recent studies.

Adolescent↗

PubMedDate not supplied

[Risk factors and length of stay attributable to hospital infections of the urinary tract in general surgery patients].

BACKGROUND: Urinary tract infection (UTI) is the second frequent site of infection in surgical patients; nevertheless, its study has been frequently neglected. The main objective of this report is the analysis of risk factors for ITU in general surgery. METHODS: A prospective study on 1,483 patients admitted at a service of general surgery for a 20-month study period has been carried out. The criteria used for diagnosing nosocomial were those of the CDC. Crude and adjusted for by logistic regression relative risks and its 95% confidence interval were estimated. To assess the length of stay attributable to UTI, infected patients were 1:1 matched with non-infected patients for surgical procedure, ASA score, age (+/- 10 years), emergency surgery, pre-operative stay, and urinary catheter. RESULTS: 33 patients (2.2%) developed UTI. In crude analysis, UTI risk was significantly associated with urethral catheter (and its duration), advanced age, severity of illness (McCabe-Jackson scale, ASA score, number of diagnoses), type of surgical wound, intrinsic risk of infection (measured by the SENIC and NNIS indices). Stepwise logistic regression analysis selected three independent predictors: urethral catheter, age and pre-operative stay. All urinary drain-ages were open. UTI prolonged hospital stay 4.7 days (95% Cl 3.4-6.2). The use of closed drain-age systems would eliminate 6 UTIs. Assuming a cost per day of hospital stay of $250 the use of closed systems would save $7,000 (IC 95%, 5300-9300). CONCLUSION: The use of closed systems for urethral catheters is cost-saving.

Adult↗