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Demografia; Salut; Economia; Territori Demografía; Salud; Economía; Territorio Demographics; Health; Economy; Territory Indicadors Clau de l’Alt Empordà 2022 presenta una selecció de dades estadístiques sobre l’Alt Empordà i la demarcació de Girona. Aquestes dades s’emmarquen en l’àmbit municipal en tots aquells casos en què ha estat possible i, en altres en què no s’ha pogut obtenir informació prou detallada, es presenten en àmbit comarcal o provincial. En aquest document es vol aportar una visió general que faciliti conèixer l’estat del territori amb dades de l’any 2021 o les més recents editades, i veure quines són les tendències actuals. El recull inclou dades sociodemogràfiques, de salut, d’economia, de medi ambient i d’altres recursos del territori. En l’edició de 2022, com ja passava l’any anterior, s’objectiva la influència de l'epidèmia de COVID-19 en diversos indicadors i tendències. Indicadores Clave del Alt Empordà 2022 presenta una selección de datos estadísticos sobre el Alt Empordà y la demarcación de Girona. Estos datos se enmarcan en el ámbito municipal en todos aquellos casos en los que ha sido posible y, en los que no se ha podido obtener información lo suficientemente detallada, se presentan en ámbito comarcal o provincial. En este documento se quiere aportar una visión general que facilite conocer el estado del territorio con datos del año 2021 o más recientes editados, y ver cuáles son las tendencias actuales. La recopilación incluye datos sociodemográficos, de salud, de economía, de medio ambiente y otros recursos del territorio. En la edición de 2022, como ya pasaba el año anterior, se objetiva la influencia de la epidemia de COVID-19 en varios indicadores y tendencias. Key Figures on Alt Empordà 2022 presents a selection of statistics on Alt Empordà and the province of Girona. Whenever possible, this data is defined within the municipal scope, but in many cases, it has not been possible to obtain sufficiently detailed information, so the figures are for the whole area or provincial. This document aims to provide a general view to help us find out about the state of the area using 2021 data or the most recent data available and identifying current trends. This document includes data on demographics, socio-demographics, health, economy, the territory and its resources. As was the case last year, in the 2022 edition, the influence of the COVID-19 epidemic has been objectified in various indicators and trends.

Additional file 1. Figures, graphics and tables. INLA summary results for Barcelona Metropolitan Police Region (BMPR).

Additional file 1: Supplementary Figure 1. Police reports of domestic violence in the census tracts of Girona per year (2012-2018).

We evaluated the epidemiological evidence on the built environment and its link to childhood obesity, focusing on environmental factors such as traffic noise and air pollution, as well as physical factors potentially driving obesity-related behaviors, such as neighborhood walkability and availability and accessibility of parks and playgrounds. Eligible studies were (i) conducted on human children below the age of 18 years, (ii) focused on body size measurements in childhood, (iii) examined at least one built environment characteristic, (iv) reported effect sizes and associated confidence intervals, and (v) were published in English language. A z test, as alternative to the meta-analysis, was used to quantify associations due to heterogeneity in exposure and outcome definition. We found strong evidence for an association of traffic-related air pollution (nitrogen dioxide and nitrogen oxides exposure, p p p&thinsp

Demografia; Salut; Economia; Territori Demografía; Salud; Economía; Territorio Demographics; Health; Economy; Territory Indicadores Clave del Alt Empordà 2021 presenta una selección de datos estadísticos sobre el Alt Empordà y la demarcación de Girona. Estos datos se enmarcan en el ámbito municipal en todos aquellos casos en que ha sido posible pero en muchos otros no se ha podido obtener información detallada, por lo que las cifras son de ámbito comarcal o provincial. Este documento quiere aportar una visión general que facilite conocer el estado del territorio en el momento de la publicación: las tendencias recientes, incluyendo datos demográficos, sociodemográficos, de salud, economía, territorio y sus recursos. Key Figures on the Alt Empordà 2021 presents a selection of statistics on the Alt Empordà and the area of Girona. Whenever possible, these data are defined within the municipal scope, but in many cases it has not been possible to obtain sufficiently detailed information, so the figures are regional or provincial. This document aims to provide a general view to help know the state of the area at the time of publication: recent trends, including data on demographics, socio-demographics, health, economy, the territory and its resources.

Background High placebo response in attention deficit hyperactivity disorder (ADHD) can reduce medication–placebo differences, jeopardizing the development of new medicines. This research aims to (1) determine placebo response in ADHD, (2) compare the accuracy of meta-regression and MetaForest in predicting placebo response, and (3) determine the covariates associated with placebo response. Methods A systematic review with meta-analysis of randomized, placebo-controlled clinical trial investigating pharmacological interventions for ADHD was performed. Placebo response was defined as the change from baseline in ADHD symptom severity assessed according to the 18-item, clinician-rated, DSM-based rating scale. The effect of study design–, intervention–, and patient–related covariates in predicting placebo response was studied by means of meta-regression and MetaForest. Results Ninety-four studies including 6614 patients randomized to placebo were analyzed. Overall, placebo response was −8.9 points, representing a 23.1% reduction in the severity of ADHD symptoms. Cross-validated accuracy metrics for meta-regression were R2 = 0.0012 and root mean squared error = 3.3219 for meta-regression and 0.0382 and 3.2599 for MetaForest. Placebo response among ADHD patients increased by 63% between 2001 and 2020 and was larger in the United States than in other regions of the world. Conclusions Strong placebo response was found in ADHD patients. Both meta-regression and MetaForest showed poor performance in predicting placebo response. ADHD symptom improvement with placebo has markedly increased over the last 2 decades and is greater in the United States than the rest of the world.

A systematic search of the literature was performed to compare the effects of interventions that targeted sedentary behaviours or physical activity (PA) or physical fitness, on primary prevention of obesity in 6-12-year-old children. The search identified 146 reports that provided relevant data for meta-analysis. Point estimates in % body fat were higher for fitness interventions compared to PA interventions (Standardised mean difference=-0.11%; 95% CI=-0.26 to 0.04, and -0.04; 95% CI=-0.15 to 0.06, respectively). Including sedentary behaviour to a PA-oriented or fitness-oriented intervention was not accompanied by an increase in intervention effectiveness, as the point estimates were slightly smaller compared to PA-only or fitness-only interventions. Overall, the effects tended to be larger in girls than boys, especially for PA+sedentary behaviour interventions. There was some evidence for inequality, as the effects on BMI were seen when interventions were delivered in the general population (Standardised mean difference=-0.05, 95%CI= -0.07 to -0.02), but not in groups of disadvantaged children (Standardised mean difference =-0.01, 95%CI=-0.29 to 0.19). In conclusion, school-based PA interventions appear to be an effective strategy in the primary prevention of childhood obesity among 6-12-year-old children but targeting sedentary behaviour in addition to PA or fitness does not increase the effectiveness of the intervention.

This study aimed to examine the prevalence of comorbidities in patients diagnosed with chronic lymphocytic leukemia (CLL), and to assess its influence on survival and cause-specific mortality at a population-based level. Incident CLL cases diagnosed in the Girona province (Spain) during 2008&ndash, 2016 were extracted from the Girona Cancer Registry. Rai stage and presence of comorbidities at diagnosis, further categorized using the Charlson comorbidity index (CCI), were obtained from clinical records. Observed (OS) and relative survival (RS) were estimated and Cox&rsquo, s proportional hazard models were used to explore the impact of comorbidity on mortality. Among the 400 cases included in the study, 380 (99.5%) presented at least one comorbidity at CLL diagnosis, with diabetes without end organ damage (21%) being the most common disease. 5-year OS and RS were 68.8 (95% CI: 64.4&ndash, 73.6) and 99.5 (95% CI 3.13&ndash, 106.0), respectively, which decreased markedly with increasing CCI, particularly in patients with CCI &ge, 3. Multivariate analysis identified no statistically significant association between the CCI and overall CLL-related or CLL-unrelated mortality. In conclusion, a high CCI score negatively influenced the OS and RS of CLL patients, yet its effect on mortality was statistically non-significant when also considering age and the Rai stage.

Additional file 1: Table S1. List of studies excluded. Table S2. Studies included in the qualitative synthesis Table S3. List of studies included in the qualitative synthesis. Figure S1. Number of studies by type of explanatory variable analyzed

Dos cartas publicadas en The Lancet y The Lancet Public Health en los últimos meses defienden la necesidad de evaluar de forma independiente la respuesta española ante la covid-19. Estamos de acuerdo, pero nos gustaría complementarlas con tres puntos que nos acercan a la ciencia abierta. Nos referimos a la confusión terminológica, la calidad de los datos y su disponibilidad. Según las cartas, una de las razones por las que España se ha visto más afectada por la pandemia es la poca confianza que hay en el asesoramiento científico. Creemos que gran parte de esta desconfianza está ocasionada por una importante confusión terminológica. Esta se produce en prácticamente todos los medios de comunicación (con notables excepciones), y conduce a una malinterpretación de los datos y, como consecuencia, a una pérdida de confianza en los sistemas de información sanitaria, en la investigación y la epidemiología., Consejo Superior de Investigaciones Científicas aporta financiación como institución fundacional de The Conversation ES. Universitat de València, Universitat de Barcelona, UOC - Universitat Oberta de Catalunya, Universidad de Granada, Universitat de Vic - Universitat Central de Catalunya , Universitat Politècnica de Catalunya · BarcelonaTech, Universitat Internacional de Catalunya y Universidade de Santiago de Compostela aportan financiación como miembros de The Conversation ES.

Demografia; Salut; Economia; Territori Demografía; Salud; Economía; Territorio Demographics; Health; Economy; Territory L’objectiu d’aquest document és proporcionar un conjunt de visualitzacions intuïtives, clares i concises sobre alguns dels indicadors disponibles de l’Alt Empordà amb la intenció d’aportar una mirada estratègica de l’estat actual de la comarca. El objetivo de este documento es proporcionar un conjunto de visualizaciones intuitivas, claras y concisas sobre algunos de los indicadores disponibles del Alt Empordà con la intención de aportar una visión estratégica del estado actual de la comarca. The objective of this document is to provide a series of intuitive, clear and concise visualisations of some of the available figures on the Alt Empordà to provide a strategic view of the current state of the region.

Background: Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.

Supplemental Digital Content is available in the text, Background: The response to antihypertensive drugs is predictable. The absence of precise prescription recommendations to treat arterial hypertension (HT) lead to use drugs unable to reduce blood pressure (BP) to target values. We published ATOM study, in which we found significant differences in the ability to reduce BP between the different drugs. The objective of the study was to determine the expected decrease in blood pressure with the use of commercialized doses of the drugs commonly used in the treatment of HT in clinical practice, to avoid the use of drugs or combinations that even with the best response, are unable to obtain the necessary BP decrease to reach the goal. Methods: The analysis was based on the results of the ATOM study. To convert the mean doses of the different drugs and combinations in commercialized doses, the conclusions of the study by Law et al have been applied. Results: Based on the results, two tables were drawn, one for systolic BP and the other for diastolic BP, where the doses of the different drugs and combinations are classified according to the BP decrease that can be expected from them. In order to favor the use of the tables in clinical practice, the different drugs have been grouped in intervals of 10 millimeters of mercury (mmHg) for the decrease of the systolic BP and of 5 mmHg for the diastolic BP. Conclusions: Recommendations for the use of antihypertensive treatments should not be limited to pharmacological families. They should also consider differences between drugs or specific combinations. From the data of the ATOM study we have implemented tables that express the effect of the drugs commonly used in clinical practice and that should allow the clinicians to choose with care the treatment to use.

Mental disorders are leading causes of ill-health and disability worldwide. Various factors influence mental health, such as lifestyle (diet, sport, alcohol and drug consumption), social environment/context, work conditions, family background and individual characteristics. This study focuses on lifestyle and, in particular, in the effects of physical activity. Numerous international health organisations have outlined the benefits of physical activity in reducing the risk of physical and mental illnesses. The objective of this paper is to conduct a rigorous systematic review on the relationship between physical activity and mental health. Through the analysis of 51 studies, we provide an overview, a comparison and a summary the main findings of this association. We also identify research gaps and priorities for further study. We find a positive relationship between physical activity and mental health. As a result, physical activity interventions may serve as a cost-effective mean to promote physical and mental health, as it also facilitates mental development.

Background: The Spanish Health Survey (SHS) is one of the main sources on social determinants of health. The objectives were to describe the data merging process of the 2006/07 and 2011/12 SHS editions, as well as to provide the merged databases and the directory of the variables. Methods: The comparable variables were identified from the questionnaires. Other new variables were created to achieve comparability or to provide new indicators of interest. We obtained two completed merged databases, as well as two variable directories with their dictionaries (each one for the adults and children samples). Results: 188 variables were identified as potentially comparable ones. 36,7% of them had difficulties for being comparable and 8% had to be removed. The topic with the worst consequences due to the lack of comparability was the working conditions and employment from the adult sample. Conclusion: The merging of both SHS editions had a lot of problems, especially in the adult’s sample. That affects to its comparability. This work may be useful to assess, design and merge these and other editions of the SHS, as well as to serve as a model to be applied in other cross-sectional population-based surveys. Yes Fundamentos: La Encuesta Nacional de Salud de España (ENSE) es una de las fuentes principales sobre determinantes sociales de la salud. Los objetivos de este trabajo fueron describir el procedimiento de fusión de las ediciones 2006/07 y 2011/12 de la ENSE, y proporcionar acceso libre a las bases de datos y directorio de variables. Métodos: Identificamos las variables comparables a partir de los cuestionarios, construyendo otras nuevas para conseguir la comparabilidad o para proporcionar nuevos indicadores de interés. Obtuvimos dos bases de datos fusionadas y dos directorios de variables con sus diccionarios (muestra de adultos y de menores). Resultados: Identificamos 188 variables potencialmente comparables. Un 36,7% tuvieron algún problema para su comparabilidad y un 8% tuvieron que ser eliminadas, fundamentalmente en la muestra de adultos. El ámbito con peores consecuencias de la falta de comparabilidad fue el de condiciones de trabajo y empleo en la muestra de adultos. Conclusión: La fusión de ambas ediciones de la ENSE tuvo muchas incidencias en la muestra de adultos, afectando de manera importante a su comparabilidad. Este trabajo es útil para evaluar, diseñar y fusionar estas y otras ediciones de la ENSE, e incluso sirve como modelo para la fusión de otras encuestas transversales de base poblacional.

Objetivo Proporcionar indicadores para evaluar, en España y en sus comunidades autónomas, el impacto sobre la salud, sus determinantes sociales y las desigualdades en salud del contexto social y de la crisis económica más reciente. Métodos Basándonos en el marco conceptual de los determinantes de las desigualdades sociales en salud en España, identificamos indicadores secuencialmente a partir de documentos clave, Web of Science y organismos con estadísticas oficiales. La información recopilada dio lugar a un directorio amplio de indicadores que fue revisado por un panel de expertos. Posteriormente seleccionamos un conjunto de esos indicadores según un criterio geográfico y otro temporal: disponibilidad de datos según comunidades autónomas y al menos desde 2006 hasta 2012. Resultados Identificamos 203 indicadores contextuales sobre determinantes sociales de la salud y seleccionamos 96 (47%) según los criterios anteriores. De los indicadores identificados, el 16% no cumplieron el criterio geográfico y el 35% no cumplieron el criterio temporal. Se excluyó al menos un 80% de los indicadores relacionados con la dependencia y los servicios de salud. Los indicadores finalmente seleccionados cubrieron todas las áreas de los determinantes sociales de la salud. El 62% de estos no estuvieron disponibles en Internet. Alrededor del 40% de los indicadores se extrajeron de fuentes relacionadas con el Instituto Nacional de Estadística. Conclusiones Proporcionamos un amplio directorio de indicadores contextuales sobre determinantes sociales de la salud y una base de datos que facilitarán la evaluación, en España y sus comunidades autónomas, del impacto de la crisis económica sobre la salud y las desigualdades en salud., Objective To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. Methods Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organisations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. Results We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. Conclusions We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions., Financiación del Subprograma de Investigación en Crisis y Salud del CIBER de Epidemiología y Salud Pública (CIBERESP), así como de los proyectos FIS con números de expediente PI13/00897, PI13/02292 y PI13/00183., Open Access funded by Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS)

Volunteered geographical information (VGI) [1] has become an important source of geospatial information. Nevertheless this source has a lack of credibility and quality assurance [2]. This is in fact because part of the spectrum of VGI contributors are not professionals or are casual users of VGI tools [3]. Therefore, it is difficult to trust VGI data and used it in scientific or professional environments without filtering it. The approach of this paper is to analyse point pattern data contributed by volunteers using Integrated Nested Laplace Approximation (INLA) and Stochastic Partial Differential Equation (SPDE) in order to be able to get some data classification depending on and response variable base on the data coming from the VGI source.

Most environmental-epidemiological researches emphasize modeling as the causal link of different events (e.g., hospital admission, death, disease emergency). There has been a particular concern in the use of the Generalized Linear Models (GLMs) in the field of epidemiology. However, recent studies in this field highlighted the use of non-parametric techniques, especially the Generalized Additive Models (GAMs). The aim of this work is to compare performance of both methods in the field of epidemiology. Comparison is done in terms of sharpening the relation between the predictors and the response variable as well as in predicting outbreaks. The most suitable method is then adopted to elucidate the impact of bioclimatic factors on the emergence of the zoonotic cutaneous leishmaniasis (ZCL) disease in Central Tunisia. Monthly epidemiologic and bioclimatic data from July 2009 to June 2016 are used in this study. Akaike information criterion, R-squared and F-statistic are used to compare model performance, while the root mean square error is used for checking predictive accuracy for both models. Our results show the potential of GAM model to provide a better assessment of the nonlinear relations and to give a high predictive accuracy compared to GLMs. The results also stress the inaccurate estimation of risk factors when linear trends are used to model nonlinear structured data.

RESUMEN Fundamentos: Es necesario profundizar en el conocimiento del conjunto mínimo básico de datos (CMBD-RSS) de la línea sociosanitaria de pacientes subagudos (con patología crónica asociada y frecuentes ingresos). El objetivo de este estudio fue conocer las características sanitarias de este tipo de pacientes. Métodos: Muestra de 660 pacientes que ingresaron en camas de subagudos del Hospital Santa Caterina (Región Sanitaria Girona), de octubre de 2013 a diciembre de 2014. La fuente de información fue el CMBD-RSS. Se realizó análisis estadístico descriptivo y se verificó la relación entre variables: número de días de estancia y edad, procedencia del paciente y días de estancia (Significación de Mann-Whitney); diagnóstico principal y días de estancia (Kruskal-Wallis). Se contrastaron la procedencia y el diagnóstico principal mediante χ2 de Pearson y el coeficiente V de Cramer). Resultados: La edad media de las personas de la muestra fue de 83 años, el 55% eran mujeres. Los cinco grupos de enfermedades que concentraron el 80% de los diagnósticos de los pacientes fueron trastorno mental, enfermedades del sistema nervioso, cardiovasculares, respiratoria e infecciones genitourinarias). Los pacientes que procedieron del hospital, tuvieron una estancia media 8 días inferior a los procedentes de domicilio (9 días). En el 80% de los casos se retornó al domicilio al alta. Conclusiones: Las personas con patología crónica asociada con frecuentes ingresos hospitalarios configuran un grupo de riesgo importante. La elevada edad y la descompensación clínica añaden complejidad. Una correcta valoración del paciente al inicio del episodio facilita la asignación del recurso más adecuado. En la muestra estudiada se plasman las patologías más prevalentes, la procedencia, la estancia media y el destino al alta. ABSTRACT Background: It is necessary to deepen in the knowledge of the Basic Minimum Set of Data (CMBD-RSS) of patients with chronic pathology associated and frequent hospitalisations (the subacute care). The aim of this study was to analyse the sanitary information of these patients, once initiated the subacute program. Methods: We used data of 660 patients hospitalised in the subacute care unit at the Santa Caterina Hospital, sanitary region of Girona, from October 2013 to December 2014. The CMBD data base was analysed using SPSS Statistics 15.0. We verified the relationship between variables i.e. length of stay and age; origin of the patient admission and length of stay (Mann-Whitney U Test); main diagnosis and length of stay (Kruskal-Wallis). We also studied the relationship between origin of the patient admission and main diagnosis (Chi-square test and Cramer's V). Results: The average age of patients was 83 years old, and mainly female profile (55%). Five illnesses concentrated 80% of all patients' diagnosed diseases (mental health problems, nervous system diseases, circulatory problems, respiratory system problems and genitourinary infections). Patients admitted from hospitals had a shorter length of stay (8 days) than patients admitted from home (9 days). 80% of cases patients come back home after the hospital discharge. Conclusions: People with chronic pathology associated and frequent hospitalisations are an important group of risk. Elderly and clinical decompensations add complexity to these cases. The evaluation of these patients at the admission and discharge procedures optimise the use of the resources.

This study analysed socioeconomic inequalities in mortality due to injuries in small areas of 15 European cities, by sex, at the beginning of this century. A cross-sectional ecological study with units of analysis being small areas within 15 European cities was conducted. Relative risks of injury mortality associated with the socioeconomic deprivation index were estimated using hierarchical Bayesian model. The number of small areas varies from 17 in Bratislava to 2666 in Turin. The median population per small area varies by city (e.g. Turin had 274 inhabitants per area while Budapest had 76,970). Socioeconomic inequalities in all injury mortality are observed in the majority of cities and are more pronounced in men. In the cities of northern and western Europe, socioeconomic inequalities in injury mortality are found for most types of injuries. These inequalities are not significant in the majority of cities in southern Europe among women and in the majority of central eastern European cities for both sexes. The results confirm the existence of socioeconomic inequalities in injury related mortality and reveal variations in their magnitude between different European cities.

Las incidencias de los modelos espacio-temporal de los incendios forestales y sus relaciones con las variables meteorológicas, geográficas y usos del suelo son analizadas en este trabajo. Estas relaciones pueden ser tratadas en un incendio forestal como componentes en los modelos de procesos puntuales es decir como actividades separadas. En este trabajo se muestran algunas técnicas para el análisis de modelos espaciales puntuales que están disponibles gracias a los recientes desarrollos de aplicaciones informáticas en los modelos de procesos puntuales. Estos avances permiten realizar un análisis exploratorio de los datos de forma conveniente, ajuste de los datos a un modelo y evaluación del modelo. La discusión de estas técnicas se realiza conjuntamente dentro del contexto de algunos análisis preliminares de una colección de datos que son de un considerable interés por ellos mismos. Este conjunto de datos consiste en los registros de incendios forestales en la provincia de Castellón (años del 2001 al 2006) y Cataluña (2001 al 2008). Los resultados de estos trabajos apuntan a la posibilidad de zonificar las áreas forestales en zonas de mayor o menor riesgo e intensidad de incendio forestal, con lo que se podría planificar las actuaciones preventivas de una forma mas efectiva y acotada

Esta es una versión ampliada del artículo presentado en el 6º Congreso Forestal Español. Las incidencias de los modelos espacio-temporal de los incendios forestales y sus relaciones con las variables meteorológicas, geográficas y usos del suelo son analizadas en este trabajo. Estas relaciones pueden ser tratadas en un incendio forestal como componentes en los modelos de procesos puntuales es decir como actividades separadas. En este trabajo se muestran algunas técnicas para el análisis de modelos espaciales puntuales que están disponibles gracias a los recientes desarrollos de aplicaciones informáticas en los modelos de procesos puntuales. Estos avances permiten realizar un análisis exploratorio de los datos de forma conveniente, ajuste de los datos a un modelo y evaluación del modelo. La discusión de estas técnicas se realiza conjuntamente dentro del contexto de algunos análisis preliminares de una colección de datos que son de un considerable interés por ellos mismos. Este conjunto de datos consiste en los registros de incendios forestales en la provincia de Castellón (años del 2001 al 2006) y Girona (2001 al 2008).Los resultados de estos trabajos apuntan a la posibilidad de zonificar las áreas forestales en zonas de mayor o menor riesgo e intensidad de incendio forestal, con lo que se podría planificar las actuaciones preventivas de una forma mas efectiva.

El diseño de casos cruzados es un diseño epidemiológico observacional propuesto por Maclure en 1991 para valorar si alguna exposición intermitente o inusual ha desencadenado un evento agudo a muy corto plazo. En este trabajo se presentan los fundamentos de los diseños de casos cruzados, con sus aplicaciones y limitaciones. El diseño de casos cruzados se basa en seleccionar sólo sujetos caso. Para calcular el riesgo relativo se compara la exposición durante el periodo de tiempo previo al evento (periodo caso) con la exposición del mismo sujeto en uno o varios periodos control. Este método únicamente es adecuado cuando las exposiciones son cambiantes en el tiempo, con efectos a corto plazo, y el efecto es agudo. Para exposiciones en que no existe tendencia, el planteamiento unidireccional es el más frecuente, y consiste en seleccionar uno o varios periodos control previos al momento caso. Cuando la exposición tiene una tendencia temporal (por ejemplo las de contaminación atmosférica), el planteamiento unidireccional proporciona estimaciones sesgadas, por lo que se utilizan diseños de casos cruzados bidireccionales, que seleccionan periodos de tiempo control anteriores y posteriores al del evento. Es un método que cuenta con una creciente utilización en amplios campos: desencadenantes de accidentes de tráfico, laborales y domésticos, o de infarto agudo de miocardio, contaminación atmosférica y salud, farmacoepidemiología, etc. Para el análisis de datos, generalmente se pueden considerar los diseños de casos cruzados como estudios de casos y controles emparejados, por lo que se aplica regresión logística condicional. Finalmente, en este trabajo se analizan ejemplos prácticos de diferentes aplicaciones del diseño de casos cruzados. Case-crossover analysis is an observational epidemiological design that was proposed by Maclure in 1991 to assess whether a given intermittent or unusual exposure may have triggered an immediate short-term, acute event. The present article outlines the basics of case-crossover designs, as well as their applications and limitations. The case-crossover design is based on exclusively selecting case subjects. To calculate relative risk, exposure during the period of time prior to the event (case period) is compared against the same subject's exposure during one or more control periods. This method is only appropriate when the exposures are transient in time and have acute short-term effects. For exposures in which there is no trend, a unidirectional approach is the most frequent and consists of selecting one or more control periods prior to the case period. When the exposure displays a time trend (e.g., air pollution), a unidirectional approach will yield biased estimates, and therefore bidirectional case-crossover designs are used, which select control time intervals preceding and subsequent to that of the event. The case-crossover design is being increasingly used across a wide range of fields, including factors triggering traffic, occupational and domestic accidents and acute myocardial infarction, and those involved in air pollution and health and pharmacoepidemiology, among others. Insofar as data-analysis is concerned, case-crossover designs can generally be regarded as matched case-control studies and consequently conditional logistic regression can be applied. Lastly, this study analyzes practical examples of distinct applications of the case-crossover design.

Un conglomerado de casos puede definirse como la aparición de un número de casos de una enfermedad en una cantidad superior a la que se esperaría para un determinado grupo de población, un área geográfica y un período de tiempo determinado. En el caso del cáncer el estudio de conglomerados presenta una serie de características específicas respecto a otras agrupaciones de enfermedades. El objetivo de este trabajo es proponer un protocolo que permita desarrollar el estudio de conglomerados de cáncer en el tiempo y/o en el espacio. Ilustramos la nota con una aplicación práctica en el caso del barrio de Campdorà, Girona. Tras proponer un protocolo para el estudio de conglomerados, describimos varios instrumentos estadísticos que permiten contrastar la existencia de agrupaciones temporales, así como el riesgo asociado. Durante el período considerado, 1994-2002, no pareció haber ocurrido de forma estadísticamente significativa, un exceso de casos de cáncer en el barrio de Campdorà de Girona. A conglomerate of cases may be defined as the onset of a number of cases of a disease larger than would be expected for a certain population group, geographical area or a certain timeframe. In the case of cancer, the study of conglomerates entails a number of specific characteristics as compared to other groups of diseases. This work is aimed at proposing a protocol affording the possibility of conducting the study of cancer conglomerates in time and/or space. This article is illustrated with a practical application in the case of the Campdorà District in Girona. Following a proposed protocol for the study of conglomerates, a description is provided of several statistical tools making it possible to draw a comparison among the existence of time-related groupings, as well as the related risk. During the period studied (1994-2002), no excessive statistically significant number of cancer cases seemed to have occurred in the Campdorà District in Girona.

El proyecto EMECAM constató el efecto a corto plazo de la contaminación atmosférica sobre la mortalidad en 14 ciudades españolas entre 1990 y 1995. El Estudio Multicéntrico Español de Contaminación Atmosférica y Salud (EMECAS) amplía estos objetivos incorporando al análisis datos de morbilidad hospitalaria, utiliza información más reciente y suma un total de 16 ciudades. Se trata de un estudio ecológico de series temporales, siendo las variables respuesta las defunciones diarias y los ingresos hospitalarios urgentes por enfermedades del aparato circulatorio y enfermedades respiratorias en los residentes de cada ciudad. Contaminantes analizados: partículas en suspensión, SO2, NO2, CO y O3. Variables de control: meteorológicas, de calendario, estacionalidad y tendencia e incidencia de gripe. Análisis estadístico: estimación de la asociación en cada ciudad mediante la construcción de modelos de regresión de Poisson aditivos generalizados, y meta-análisis para la obtención de estimadores conjuntos. Los niveles medios de contaminantes se situaron por debajo de los establecidos por la normativa actual para el dióxido de azufre, el monóxido de carbono y el ozono. Los valores de NO2 y PM10 se situaron alrededor de los establecidos en la normativa (40 µg/m³). Se trata del primer estudio de la relación entre contaminación atmosférica y morbilidad en un conjunto de ciudades españolas. Los niveles de contaminantes estudiados son moderados para algunos contaminantes, aunque en otros, especialmente NO2 y partículas, podrían representar un problema para el cumplimiento de la normativa vigente. The EMECAM Project demonstrated the short-term effect of air pollution on the death rate in 14 cities in Spain throughout the 1990-1995 period. The Spanish Multicentre Study on Health Effects of Air Pollution (EMECAS) is broadening these objectives by incorporating more recent data, information on hospital disease admissions and totaling 16 Spanish cities. This is an ecological time series study in which the response variables are the daily deaths and the emergency hospitalizations due to circulatory system diseases and respiratory diseases among the residents in each city. Pollutants analyses: suspended particles, SO2, NO2, CO and O3. Control variables: meteorological, calendar, seasonality and influenza trend and incidence. Statistical analysis: estimate of the association in each city by means of the construction of generalized additive Poisson regression models and metanalysis for obtaining combined estimators. The EMECAS Project began with the creation of three working groups (Exposure, Epidemiology and Analysis Methodology) which defined the protocol. The average levels of pollutants were below those established under the current regulations for sulfur dioxide, carbon monoxide and ozone. The NO2 and PM10 values were around those established under the regulations (40 mg/m3). This is the first study of the relationship between air pollution and disease rate among one group of Spanish cities. The pollution levels studied are moderate for some pollutants, although for others, especially NO2 and particles, these levels could entail a problem with regard to complying with the regulations in force.

Time series regression models are especially suitable in epidemiology for evaluating short-term effects of time-varying exposures on health. The problem is that potential for confounding in time series regression is very high. Thus, it is important that trend and seasonality are properly accounted for. Our paper reviews the statistical models commonly used in time-series regression methods, specially allowing for serial correlation, make them potentially useful for selected epidemiological purposes. In particular, we discuss the use of time-series regression for counts using a wide range Generalised Linear Models as well as Generalised Additive Models. In addition, recently critical points in using statistical software for GAM were stressed, and reanalyses of time series data on air pollution and health were performed in order to update already published. Applications are offered through an example on the relationship between asthma emergency admissions and photochemical air pollutants in Madrid for the period 1995-1998, of how these methods are employed.

This article examines the effect on price of different characteristics of holiday hotels in the sun-and-beach segment, under the hedonic function perspective. Monthly prices of the majority of hotels in the Spanish continental Mediterranean coast are gathered from May to October 1999 from the tour operator catalogues. Hedonic functions are specified as random-effect models and parametrized as structural equation models with two latent variables, a random peak season price and a random width of seasonal fluctuations. Characteristics of the hotel and the region where they are located are used as predictors of both latent variables. Besides hotel category, region, distance to the beach, availability of parking place and room equipment have an effect on peak price and also on seasonality. 3-star hotels have the highest seasonality and hotels located in the southern regions the lowest, which could be explained by a warmer climate in autumn.

FUNDAMENTOS: La mayoría de los estudios que muestran la existencia de una asociación a corto plazo entre contaminación atmosférica y morbimortalidad, analizan los efectos de los contaminantes ‘clásicos’ cuya fuente es la combustión. Sin embargo, los cambios en las fuentes de emisión, fundamentalmente hacia el tráfico rodado, han modificado la contaminación atmosférica, haciendo más importante los componentes foto-químicos, como el ozono (O3) y el dióxido de nitrógeno (NO2). Barcelona es una ciudad situada en una zona templada y su contaminación atmosférica proviene principalmente de las emisiones de los vehículos. El principal objetivo de este artículo es el de analizar la relación entre los contaminantes foto-químicos, NO2 y O3, y la mortalidad por diferentes causas, en la ciudad de Barcelona desde 1991 hasta 1995, utilizando el protocolo de análisis elaborado dentro del proyecto EMECAM. MÉTODOS: Variaciones diarias del número de muertes por todas las causas, del número de muertes por todas las causas entre mayores de 70 años, del número de muertes por causas del aparato circulatorio y por causas respiratorias se relacionan con las variaciones diarias de los contaminantes foto-químicos, a través de modelos de Poisson autoregresivos, controlando confusores como la temperatura, la humedad relativa, la estructura temporal sistemática y la estructura autoregresiva. RESULTADOS: Excepto la relación entre O3 y mortalidad a causa de enfermedades respiratorias, las relaciones entre contaminantes foto-químicos y mortalidad por todas las causas consideradas resultaron estadísticamente significativas. Los riesgos relativos de morir ante incrementos de O3 fueron mayores que ante incrementos de NO2, casi el triple entre enfermedades del aparato circulatorio. Los riesgos relativos de morir por todas las causas son menores que por causas específicas y que para aquellos individuos mayores de 70 años. Los resultados del análisis por semestres son muy similares a los del global mostrando, en todo caso, riesgos relativos algo mayores en los meses cálidos (mayo a octubre). CONCLUSIONES: La contaminación fotoquímica, sobre todo la causada por O3, representa un riesgo para la salud. En el caso del NO2 podría ocurrir que no fuese más que un indicador de las partículas suspendidas o de otros contaminantes cuyo origen es el tráfico urbano. Podría existir cierta modificación entre semestres de los efectos del O3 sobre la mortalidad por causas del aparato circulatorio. BACKGROUND: Most of the studies which demonstrate the existence of a short-term relationship between air pollution and morbidity and the death rate analyze the impact of "classic" pollutants which are by-products of combustion. However, the changes in the sources of these emissions, shifting basically toward road traffic, has made a change in air pollution, heightening the importance of the photochemical components, such as ozone (O3) and nitrogen dioxide (NO2). Barcelona is a city located in a mild climate zone, and its air pollution comes mainly from vehicle emissions. The main objective of this article is that of analyzing the relationship between the photochemical pollutants, NO2 and O3 and the death rate for different causes in the city of Barcelona throughout the 1991-1995 period, using the procedure for analysis set out as part of the EMECAM Project. METHODS: Daily changes in the number of deaths resulting from all causes, of the number of deaths for all causes of those over age 70, of the number of deaths resulting from circulatory system-related causes, and of the number of deaths resulting from respiratory-related causes are related to the daily changes in the photochemical pollutants using autoregressive Poisson models, controlling confusion-causing variables such as the temperature, the relative humidity, the systematic time structure and the autoregressive structure. RESULTS: Except for the relationship between O3 and the death rate for causes involving respiratory illnesses, the relationships between photochemical pollutants and the death rate for all the causes considered were statistically significant. The risks related to dying as a result of rises in O3 were greater than as a result of rises in NO2, almost triple among circulatory system diseases. The risks related to dying for all the causes are lower than for specific causes and than for those individuals over age 70. The results of the analysis by six-month periods are quite similar to the overall results, revealing, in any event, relative risks somewhat greater during the warm months (May to October). CONCLUSIONS: Photochemical pollution, especially that which is caused by O3, comprises a health risk. IN the case of NO2, this might not be more than an indicators of the suspended particles or of other pollutants stemming from city traffic. There may be a certain adjustment between six-month periods of the impact of O3 on the death rate for causes of the circulatory system.

Se revisan los métodos de series temporales en los estudios epidemiológicos sobre contaminación atmosférica, ilustrándolo mediante una regresión de Poisson autoregresiva, la cual ha sido utilizada en los proyectos APHEA y EMECAM. Se relacionan las variaciones en el número diario de muertos mayores de 70 años (todas las causas, CIE-9:001-799) en Barcelona, 1991-1995, con las variaciones en los niveles diarios promedio de contaminación por humos negros. Se utiliza una regresión de Poisson por cuanto la variable aleatoria dependiente sigue presumiblemente tal distribución de probabilidad. Como confusores se consideran variables meteorológicas (promedios diarios de temperatura y de humedad), comportamientos tendenciales, estacionales y efectos de calendario presentes en la mortalidad (todos ellos aproximados de forma determinista) así como cualquier otra variable que tenga un comportamiento que pueda relacionarse con la variable dependiente (ocurrencia de epidemias de gripe por ejemplo). La relación entre la mortalidad y las variables confusoras se modeliza de forma no lineal y se tienen en cuenta además los previsibles periodos de latencia (utilizando retardos de variables explicativa por ejemplo). Sin embargo, y debido a que el control no es perfecto, se opta por estimar un modelo de Poisson autoregresivo (introduciendo como variables explicativas diversos retardos de la mortalidad) corrigiendo la autocorrelación residual. La principal ventaja del método de análisis descrito es la de permitir un control de variables confusoras desde un punto determinista, con un software al alcance de todos los grupos que participan en el proyecto. Además, permite que el método se pueda aplicar de una formar protocolizada y estandarizada que facilite la comparación de resultados y permita la realización de un meta-análisis. The time series methods in the epidemiological studies on air pollution are reviewed, illustrated by means of an autoregressive Poisson regression which was employed in the APHEA and EMECAM Projects. A listing is provided of the variations in the daily number of deaths of people over age 70 (all causes, CIE-9:001-799) in Barcelona, 1991-1995, with the average variations in the daily smog pollution levels. A Poisson regression is used insofar as the dependent random variable presumably follows such a probability distribution. As variables possibly leading to confusion, the impact of weather variables (daily temperature and relative humidity averages), seasonal, tendency-related behaviors and day of the year on the death rate are taken into account (all estimated on a determinist basis), in addition to any other variable which behaves in a way that it can be related to the dependent variable (i.e. flu epidemics). The relationship between the death rate and the confusing-causing variables is modeled on a non-linear basis, and the foreseeable lag times are also taken into account (i.e. by using explicative variable time lags). However, due to control not being perfect, it has been decided to opt for estimating an autoregressive Poisson model (adding in some different explicative variables time giving rise to a lag in the death rate) offsetting the residual autocorrelation. The main advantage of the method of analysis described above is that of making it possible to control confusing variables from a determinist standpoint with a software to which all of the groups taking part in this Project had access. This also affords the possibility of using this method in a set, standardized manner, facilitating the comparison of results and making an objective point analysis possible.

Aunque la experiencia en el estudio de las desigualdades en la mortalidad en las ciudades españolas es amplia, quedan grandes núcleos urbanos que no han sido investigados utilizando la sección censal como unidad de análisis territorial. En este contexto se sitúa el proyecto coordinado «Desigualdades socioeconómicas y medioambientales en la mortalidad en ciudades de España. Proyecto MEDEA», en el cual participan 10 grupos de investigadores de Andalucía, Aragón, Cataluña, Galicia, Madrid, Comunitat Valenciana y País Vasco. Cabe señalar cuatro particularidades: a) se utiliza como área geográfica básica la sección censal; b) se emplean métodos estadísticos que tienen en cuenta la estructura geográfica de la región de estudio para la estimación de riesgos; c) se aprovechan las oportunidades que ofrecen 3 fuentes de datos complementarias (información sobre contaminación atmosférica, información sobre contaminación industrial y registros de mortalidad), y d) se emprende un análisis coordinado de gran alcance, favorecido por la implantación de la redes temáticas de investigación. El objetivo de este trabajo es explicar los métodos para la suavización de indicadores de mortalidad en el proyecto MEDEA. El artículo se centra en la metodología y los resultados del modelo de mapa de enfermedades de Besag, York y Mollié (BYM). Aunque en el proyecto se han suavizado, mediante el modelo BYM, las razones de mortalidad estandarizadas (RME) correspondientes a 17 grandes grupos de causas de defunción y 28 causas específicas, aquí se aplica esta metodología a la mortalidad por cáncer de tráquea, de bronquios y de pulmón en ambos sexos en la ciudad de Barcelona durante el período 1996-2003. Como resultado se aprecia un diferente patrón geográfico en las RME suavizadas en ambos sexos. En los hombres se observan unas RME mayores que la unidad en los barrios con mayor privación socioeconómica. En las mujeres este patrón se observa en las zonas con un mayor nivel socioeconómico. Although there is some experience in the study of mortality inequalities in Spanish cities, there are large urban centers that have not yet been investigated using the census tract as the unit of territorial analysis. The coordinated project «Socioeconomic and environmental inequalities in mortality in Spanish cities. The MEDEA project» was designed to fill this gap, with the participation of 10 groups of researchers in Andalusia, Aragon, Catalonia, Galicia, Madrid, Valencia, and the Basque Country. The MEDEA project has four distinguishing features: a) the census tract is used as the basic geographical area; b) statistical methods that include the geographical structure of the region under study are employed for risk estimation; c) data are drawn from three complementary data sources (information on air pollution, information on industrial pollution, and the records of mortality registrars), and d) a coordinated, large-scale analysis, favored by the implantation of coordinated research networks, is carried out. The main objective of the present study was to explain the methods for smoothing mortality indicators in the context of the MEDEA project. This study focusses on the methodology and the results of the Besag, York and Mollié model (BYM) in disease mapping. In the MEDEA project, standardized mortality ratios (SMR), corresponding to 17 large groups of causes of death and 28 specific causes, were smoothed by means of the BYM model; however, in the present study this methodology was applied to mortality due to cancer of the trachea, bronchi and lung in men and women in the city of Barcelona from 1996 to 2003. As a result of smoothing, a different geographical pattern for SMR in both genders was observed. In men, a SMR higher than unity was found in highly deprived areas. In contrast, in women, this pattern was observed in more affluent areas.

Background The risk of infection and death by COVID-19 could be associated with a heterogeneous distribution at a small area level of environmental, socioeconomic and demographic factors. Our objective was to investigate, at a small area level, whether long-term exposure to air pollutants increased the risk of COVID-19 incidence and death in Catalonia, Spain, controlling for socioeconomic and demographic factors. Methods We used a mixed longitudinal ecological design with the study population consisting of small areas in Catalonia for the period February 25 to May 16, 2020. We estimated Generalized Linear Mixed models in which we controlled for a wide range of observed and unobserved confounders as well as spatial and temporal dependence. Results We have found that long-term exposure to nitrogen dioxide (NO2) and, to a lesser extent, to coarse particles (PM10) have been independent predictors of the spatial spread of COVID-19. For every 1 μm/m3 above the mean the risk of a positive test case increased by 2.7% (95% credibility interval, ICr: 0.8%, 4.7%) for NO2 and 3.0% (95% ICr: -1.4%,7.44%) for PM10. Regions with levels of NO2 exposure in the third and fourth quartile had 28.8% and 35.7% greater risk of a death, respectively, than regions located in the first two quartiles. Conclusion Although it is possible that there are biological mechanisms that explain, at least partially, the association between long-term exposure to air pollutants and COVID-19, we hypothesize that the spatial spread of COVID-19 in Catalonia is attributed to the different ease with which some people, the hosts of the virus, have infected others. That facility depends on the heterogeneous distribution at a small area level of variables such as population density, poor housing and the mobility of its residents, for which exposure to pollutants has been a surrogate., Graphical abstract Number of positive PCR test stratified by quartiles of NO2. Number of daily deaths stratified by quartiles of NO2.Image 1, Highlights • Long-term exposure to NO2 and to PM10 are predictors of the spread of COVID-19. • Air pollutants could have actually been surrogates of the mobility of people. • High mobility implied a greater possibility of contact. • More contact could imply a higher probability of infection.

After the cases of COVID-19 skyrocketed, showing that it was no longer possible to contain the spread of the disease, the governments of many countries launched mitigation strategies, trying to slow the spread of the epidemic and flatten its curve. The Spanish Government adopted physical distancing measures on March 14; 13 days after the epidemic outbreak started its exponential growth. Our objective in this paper was to evaluate ex-ante (before the flattening of the curve) the effectiveness of the measures adopted by the Spanish Government to mitigate the COVID-19 epidemic. Our hypothesis was that the behavior of the epidemic curve is very similar in all countries. We employed a time series design, using information from January 17 to April 5, 2020 on the new daily COVID-19 cases from Spain, China and Italy. We specified two generalized linear mixed models (GLMM) with variable response from the Gaussian family (i.e. linear mixed models): one to explain the shape of the epidemic curve of accumulated cases and the other to estimate the effect of the intervention. Just one day after implementing the measures, the variation rate of accumulated cases decreased daily, on average, by 3.059 percentage points, (95% credibility interval: −5.371, −0.879). This reduction will be greater as time passes. The reduction in the variation rate of the accumulated cases, on the last day for which we have data, has reached 5.11 percentage points. The measures taken by the Spanish Government on March 14, 2020 to mitigate the epidemic curve of COVID-19 managed to flatten the curve and although they have not (yet) managed to enter the decrease phase, they are on the way to do so., Graphical abstract Unlabelled Image, Highlights • After the COVID-19 cases skyrocketed, the Spanish government launched physical distancing. • The measures taken to mitigate the COVID-19 epidemic managed to flatten the curve. • The daily variation rate of accumulated cases decreased by 3.059 percentage points. • This reduction will be greater as time passes.