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Breast cancer incidence and overdiagnosis in Catalonia (Spain)
Montserrat Martinez-Alonso, Ester Vilaprinyo, Rafael Marcos-Gragera, Montserrat Rue
Breast Cancer Research , 2010, DOI: 10.1186/bcr2620
Abstract: We modeled the incidence of invasive BC using a Poisson regression model. Explanatory variables were: age at diagnosis and cohort characteristics (completed fertility rate, percentage of women that use mammography at age 50, and year of birth). This model also was used to estimate the background incidence in the absence of screening. We used a probabilistic model to estimate the expected BC incidence if women in the population used mammography as reported in health surveys. The difference between the observed and expected cumulative incidences provided an estimate of overdiagnosis.Incidence of invasive BC increased, especially in cohorts born from 1940 to 1955. The biggest increase was observed in these cohorts between the ages of 50 to 65 years, where the final BC incidence rates more than doubled the initial ones. Dissemination of mammography was significantly associated with BC incidence and overdiagnosis. Our estimates of overdiagnosis ranged from 0.4% to 46.6%, for women born around 1935 and 1950, respectively.Our results support the existence of overdiagnosis in Catalonia attributed to mammography usage, and the limited malignant potential of some tumors may play an important role. Women should be better informed about this risk. Research should be oriented towards personalized screening and risk assessment tools.Breast cancer (BC) incidence rates in women have been increasing steadily in the 1980 s and 1990 s in many countries. Time trends in the incidence of breast cancer have been influenced by different factors: changes in reproductive patterns, the introduction of screening mammography, obesity trends, hormone replacement therapy (HRT), oral contraceptive use and better health awareness [1-10]. In Europe, BC incidence increased in all countries, with or without national screening programs [6]. In Spain, where BC incidence is lower than the European average, incidence rates have increased since 1973, with a more marked rise during the 1990 s [11] in parall
Construction of the birth weight by gestational age population reference curves of Catalonia (Spain): Methods and development
Ramos,Francisca; Pérez,Glória; Jané,Mireia; Prats,Ramon;
Gaceta Sanitaria , 2009, DOI: 10.1590/S0213-91112009000100016
Abstract: infant size at birth is a useful indicator to evaluate fetal growth in relation to gestational age. there is no standard model to create anthropometric reference curves in neonates, but the method chosen could determine the reference values estimated. we describe the methods used to construct population-based reference curves of birth weight for gestational age in catalonia, spain. these methods included detection of implausible values of birth weight for gestational age by a probabilistic cluster model, utilization of the generalized additive model for location and scale method to obtain smoothed percentiles and z-scores, and calculation of 95% confidence intervals by bootstrapping. to our knowledge, these are the first reference curves in neonates constructed through a method allowing asymmetric distributions with kurtosis to be modelled. estimation of confidence intervals is useful to determine which reference intervals can be employed to assess newborn size.
Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain)
Montserrat Rue, Ester Vilaprinyo, Sandra Lee, Montserrat Martinez-Alonso, Misericordia Carles, Rafael Marcos-Gragera, Roger Pla, Josep-Alfons Espinas
BMC Cancer , 2009, DOI: 10.1186/1471-2407-9-326
Abstract: We used the LZ model to estimate the cumulative probability of death for a cohort exposed to different screening strategies after T years of follow-up. We also obtained the cumulative probability of death for a cohort with no screening. These probabilities were used to estimate the possible breast cancer MR and YLG by age, period and cohort of birth. The inputs of the model were: incidence of, mortality from and survival after breast cancer, mortality from other causes, distribution of breast cancer stages at diagnosis and sensitivity of mammography. The outputs were relative breast cancer MR and YLG.Relative breast cancer MR varied from 20% for biennial exams in the 50 to 69 age interval to 30% for annual exams in the 40 to 74 age interval. When strategies differ in periodicity but not in the age interval of exams, biennial screening achieved almost 80% of the annual screening MR. In contrast to MR, the effect on YLG of extending screening from 69 to 74 years of age was smaller than the effect of extending the screening from 50 to 45 or 40 years.In this study we have obtained a measure of the effect of breast cancer screening in terms of mortality and years of life gained. The Lee and Zelen mathematical models have been very useful for assessing the impact of different modalities of early detection on MR and YLG in Catalonia (Spain).Randomized controlled trials (RCT) are the gold standard for measuring medical interventions. Although controversial, RCT assessing the effectiveness of screening with mammography have provided valuable information [1,2]. While there is still debate about the best screening strategies, and what benefits they produce, at present the cost, time, contamination issues and difficulties with compliance preclude additional RCT for early detection of breast cancer. Because statistical population trends are affected by many factors and therefore are not accurate in measuring the effect of health interventions, there has been increased interest i
Competing risks to breast cancer mortality in Catalonia
Ester Vilaprinyo, Rosa Gispert, Montserrat Martínez-Alonso, Misericòrdia Carles, Roger Pla, Josep-Alfons Espinàs, Montserrat Rué
BMC Cancer , 2008, DOI: 10.1186/1471-2407-8-331
Abstract: The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death.There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945–54 in the 40–49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts.We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia.Breast cancer is the leading cause of mortality among middle-aged women in many developed countries, including Catalonia, a region in the northeast of Spain, where it accounts for a fifth of all female cancer deaths and, on the average, fourteen years of potential life lost per death from this cause [1].Causes of death other than breast cancer may influence mortality trends in two ways: 1) by changing the number of women at risk of having breast cancer and, 2) by changing the risk of dying of breast cancer once it has developed. For example, infectious diseases at the beginning of the 20th centu
Notes on the history of International Polar Years in Catalonia and Spain  [PDF]
J. Batlló
Tethys : Journal of Mediterranean Meteorology & Climatology , 2008,
Abstract: On the occasion of the celebration of the current International Polar Year, this work presents a revision of the meaning and contributions of the three previous Polar Years, and the Catalan and Spanish contributions to previous editions. Although in the current edition there are scientific expeditions sent from the Iberian Peninsula to the Antarctic and the Arctic for the first time, participation in previous editions has not been insignificant, and has resulted in an improvement in Earth sciences in Catalonia and Spain.
The Crisis of Public Local Digital Terrestrial Television in Spain: The case of Catalonia
Josep àngel Guimerà-i-Orts, Ph. D.,Federica Alborch-Gil, M.A.
Revista Latina de Comunicación Social , 2011,
Abstract: The article describes and analyses the state of public local digital terrestrial television (L-DTT) in Catalonia just after the analogue switch-off in April 2010. The results show that only 12 of the 37 anticipated public television channels were broadcasting, and only five more were expected to do so in the medium term. These data indicate that public local television was experiencing a crisis in the context of the digital switchover process: while some digital programmes were finding it hard to get off the ground due to severe limitations, other historical analogue stations were disappearing.The article is grounded on qualitative research based on in-depth interviews with representatives of the 37 aforementioned channels. The objectives of the paper are: to describe the L-DTT model and its roll-out status in Catalonia as at May 2010; to provide interpretative elements to explain the crisis identified; and to provide insights for the formulation of hypotheses about the state of the sector in the rest of Spain. The results suggest that the problems of public L-DTT stem from the digital roll-out policies of the Government of Spain and the Government of Catalonia, neither of which – especially the first – seems to have taken into account the pre-existing analogue reality. In this respect, the Catalan case offers signs and evidence that can be extrapolated to the situation in Spain as a whole.
Hospitalizations due to rotavirus gastroenteritis in Catalonia, Spain, 2003-2008
Alberto L García-Basteiro, Anna Bosch, Elisa Sicuri, José M Bayas, Antoni Trilla, Edward B Hayes
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-429
Abstract: We analyzed hospital discharge data from the Catalan Health Services regarding hospital admissions coded as infectious gastroenteritis in children under 5 for the period 2003-2008. In order to estimate admission incidence, we used population estimates for each study year published by the Statistic Institut of Catalonia (Idescat). The costs associated with hospital admissions due to rotavirus diarrhea were estimated for the same years. A decision tree model was used to estimate the threshold cost of rotavirus vaccine to achieve cost savings from the healthcare system perspective in Catalonia. From 2003 through 2008, 10655 children under 5 years old were admitted with infectious gastroenteritis (IGE). Twenty-two percent of these admissions were coded as RVGE, yielding an estimated average annual incidence of 104 RVGE hospitalizations per 100000 children in Catalonia. Eighty seven percent of admissions for RVGE occurred during December through March. The mean hospital stay was 3.7 days, 0.6 days longer than for other IGE. An additional 892 cases of presumed nosocomial RVGE were detected, yielding an incidence of 2.5 cases per 1000 child admissions. Total rotavirus hospitalization costs due to community acquired RVGE for the years 2003 and 2008 were 431,593 and 809,224 €, respectively. According to the estimated incidence and hospitalization costs, immunization would result in health system cost savings if the cost of the vaccine was 1.93 € or less. At a vaccine cost of 187 € the incremental cost per hospitalization prevented is 195,388 € (CI 95% 159,300; 238,400).The burden of hospitalizations attributable to rotavirus appeared to be lower in Catalonia than in other regions of Spain and Europe. The relatively low incidence of hospitalization due to rotavirus makes rotavirus vaccination less cost-effective in Catalonia than in other areas with higher rotavirus disease burden.Rotavirus gastroenteritis (RVGE) is the most common cause of severe gastroenteritis among childr
Teacher Gender and Student Performance in Mathematics. Evidence from Catalonia (Spain)  [cached]
Josep-Oriol Escardíbul,Toni Mora
Journal of Education and Training Studies , 2013, DOI: 10.11114/jets.v1i1.22
Abstract: This paper analyses the impact of teacher gender towards students’ test results in a blinded Math test administered to students in Catalonia (Spain). The data for this analysis are drawn from a sample of secondary school students who participated in an international blind-test known as the “Mathematical Kangaroo” in 2008. The estimation considers a two-stage procedure since participation on the test leads to the presence of sample selection. Results show a correlation between female teacher gender and student results. Moreover, students with female teachers have a higher probability of participating in the “Kangaroo” test (in this case, the effect being more marked among male students).
The medical construction of midwifery. Representations and practices in Catalonia, Spain
Montes Mu?oz,María Jesús;
Investigación y Educación en Enfermería , 2012,
Abstract: objective. to describe how discourse has been constructed regarding parturition (delivery) and the need for medical intervention in spain. methodology. this was a qualitative study. interviews were conducted with seven midwives who practiced in catalu?a (spain) during the middle of the last century. their opinions were compared to medical discourse gathered from research published in the spanish journal on obstetrics and gynecology (revista espa?ola de obstetricia y ginecología) between 1954 and 1960. results. against the normality of the evolution of most parturitions reported by the stories of the midwives, in medical definitions these appear as problematic or altered in their duration and by the presence of pain, justifying their systematic interventions; although the aforementioned poses a risk for women and their offspring. as a result, the discourse defining most deliveries as pathological is reaffirmed. conclusion. the medical system constructed midwifery as a surgical process. women are engaged in other more realistic constructions in agreement to their needs. care at birth is perceived as a cultural construction and, hence, susceptible to change.
Conception of a macroseismic catalogue for Catalonia (Spain)
M. T. Susagna,X. Goula,A. Roca
Annals of Geophysics , 1996, DOI: 10.4401/ag-4036
Abstract: Since 1989 the Servei Geològic de Catalunya has been collecting macroseismic information of the North East of Spain and the South of France to create a comprehensive and reliable Catalogue which would be of use in seismic hazard assessment. Existing compilations have been submitted to a critical analysis and comparison, bearing in mind the resu1ts of recent historical research. For the seismicity of the present century macroseismic information is being studied by analyzing the original questionnaires. For each earthquake the felt intensities are stored on a data bank system. Due to the geographic location of the area under scrutiny, near the French border, collaboration with French agencies has been necessary to achieve joint information for Pyrenean earthquakes. Ancient instrumental records taken in two observatories (FBR and EBR) working since the beginning of this century have helped to determine focal parameters.
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