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Background: Gender inequalities in health have been largely documented. The main objective of this study is to assess whether there are gender differences in perceived health and health services utilization, and their relation with double workload in a representative sample of immigrants and Murcian natives., Methods: We used data from the NHS 2006 and Health and Culture Study, 1,303 immigrants and 1,303 Spanish, both residents in the Region of Murcia. With the combination of reproductive work and paid work we built up the variable 'double workload' (DW). We estimated the prevalence ratio (PR) for positive self-perceived health, chronic morbidity, activity limitation, doctor's visits, hospitalization, emergency and drug use, by origin, using regression methods. Two models were constructed by adding double burden to the basic model adjusted by sociodemographic variables. Analyses were performed between and within sex., Results: After adjusting for DW, no changes were seen in the differences by gender [RP women/men of positive perception health: 0.70 (0.54-0.89) East European; 0.87 (0.79-0.95) autochthonous / chronic morbidity: 1.44 (1.14-1.82) Hispanic; 1.36 (1.19-1.55) autochthonous / activity limitation: 2.23 (1.29-3.83) Hispanic; 1.45 (1.01-2.10) autochthonous / doctor's visits: 1.93 (1.50-2.48) Hispanic; 1.74 (1.06-2.86) Moroccan; 1.32 (1.09-1.59) autochthonous / hospitalization: 1.80 (1.02-3.17) Hispanic], almost the same than unadjusted. Women used more drugs than men. Within sexes, both autochthonous men (1.19; 1.06-1.33) and women (1.18; 1.01-1.40) with shared DW had more positive self-perceived health than those without DW. Hispanic men with DW without assistance: 0.67 (0.47-0.94)., Conclusions: Women have worse health indicators and greater use of health services regardless of origin. Consideration of the double workload does not explain gender inequalities in health.

Background: The Medical Death Certificate and the Death Statistics Bulletin were unified and implemented in the year 2009 in Spain. National statistics detected an unusual increase for diabetes mellitus (DM) and hypertensive disease (HT) deaths in 2009, in relation to previous years trend.The objective is to study the documental causes of the increase, and describe the procedures and consequences in rates, after the revision and recodification of DM and HT., Methods: All death certificates in 2009 for diabetes and hypertension in the Region of Murcia (cases=670) were revised, according to previous guidelines for direct recoding after consultation to the certifying physician. A telephone survey to certifying physician was designed to determine the accuracy of the pattern of recoding. Kappa index and 95% confidence intervals (95%CI) were performed between initial and recoded causes. Confirmation rate and 95%CI was estimated after phone inquiry to the certifying physician, and the annual age-adjusted and age-specific rates from 1999 to 2009 (uncorrected and corrected) for DM and HT were calculated., Results: Simple agreement was 37% for DM and 30% for HT. The Kappa index between the initial and final causes was 49% (95%CI, 45 to 54%). Confirmation rates were 47% (95%CI, 43 to 52%) for DM and 38% (95%CI, 34 to 43%) for HT. The initial annual rates of 2009 for DM were corrected from 21.4 per 100,000 inhabitants to 17.1, and from 19.0 to 14.0 for hypertension. The respective specific age rates of 70 to 84 and older experienced similar reductions., Conclusions: The revision restored temporal trends in mortality of DM and HT in 2009, and identified no variations from previous years. It was detected that the erroneous fulfillment of DM AND HT came from the new death certificate.

Background: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied., Objective: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity., Methods: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38 degrees C and Min. 22.4 degrees C) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS)., Results: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4 degrees C (RR: 1.016; 95% CI 1.0076-1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure., Conclusions: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk.

Objectives: To validate the ability of a hospital administration data set (minimum data set [MDS]) to detect incident cases of colorectal cancer using the Murcia Cancer Registry (MCR) as the gold standard and to measure agreement between the MDS and registration of colorectal cancer., Material and Method: A cross sectional validation study of the MDS of the main hospital in the region of Murcia (Spain) was conducted. The study population consisted of incident cases of colorectal cancer in 2000 obtained from the MCR and cases in the MDS of the above-mentioned hospital for the same year with an ICD-9 diagnostic code between 153.0 and 154.1, eliminating readmissions. During the process, two analyses were performed: one analysis with the principal diagnosis only and another with all the diagnostic codes. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and agreement was calculated with their 95% confidence intervals (CI)., Results: With the first diagnosis only, the MDS detected 80% of the incident cases of colorectal cancer with a PPV of 75%. With all the diagnoses, the MDS detected 85% of the cases with a PPV of 64%. The agreement in codification was high at three digits (kappa 88% [95% CI, 0.79-0.97] first diagnosis, 89% [95% CI, 0.80-0.97] all diagnoses) as well as at four digits (kappa 77% [IC, 0.68-0.85] first diagnosis, 78% [95% CI, 0.70-0.86] all diagnoses) in both analyses., Conclusions: Because of its high sensitivity, the MDS is a good source for detecting incident cases of cancer. The high agreement found in the site of colorectal cancer helps to consolidate the MDS as a data source for cancer registration.