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Rationale aims and objectives: The available evidence on the use of heuristics and their relationship with diagnostic error in primary care is very limited. The aim of the study is to identify the use of unknown thought and specifically the possible use of Representativeness, Availability and overconfidence heuristics in the clinical practice of primary care physicians in cases of dyspnoea and to analyse their possible relationship with diagnostic error. Methods: A total of 371 patients consulting with new episodes of dyspnoea in Primary Care centres in Spain were registered. Based on specific operational definitions, the use of unconscious thinking and the use of heuristics during the diagnostic process were assessed. Subsequently, the association between their use and diagnostic error was analysed. Results: In 49.6% of cases, the confirmatory diagnosis coincided with the first diagnostic impression, suggesting the use of the representativeness heuristic in the diagnostic decision process. In 82.3% of the cases, the confirmatory diagnosis was among the three diagnostic hypotheses that were first identified by the general physicians, suggesting a possible use of the availability heuristic. In more than 50% of the cases, the physicians were overconfident in the certainty of their own diagnosis. Finally, a diagnostic error was identified in 9.9% of the recorded cases and no statistically significant correlation was found between the use of some unconscious thinking tools (such as the use of heuristics) and the diagnostic error. Conclusion: Unconscious thinking manifested through the acceptance of the first diagnostic impression and the use of heuristics is commonly used by primary care physicians in the clinical decision process in the face of new episodes of dyspnoea; however, its influence on diagnostic error is not significant. The proposed explicit and reproducible methodology may inspire further studies to confirm these results. [ABSTRACT FROM AUTHOR]

The term deprivation is often used to refer to economic or social shortages in a given geographical area. This concept of deprivation has been identified for years using simple indicators such as income level, education and social class. One of the advantages of using simple indicators is the availability of data, since they come directly from sources of information like censuses and population registers. However, the main disadvantage of these indicators is their limited usefulness when measuring a concept as complex as deprivation with a single variable. One possible solution to this problem is using compound indices, made up of a combination of simple indicators. For years, the concept of material deprivation in Spain has been measured using indices or indicators imported from other countries. However, there are no studies that investigate if all of these variables are really related to material deprivation in Spain. In this context, the objective of this study is to create a synthetic index for material deprivation for the municipalities in Spain, bearing in mind the variables available from the Population and Housing Census. The index was built on a principal components factor analysis. The analysis showed two factors. The first factor showed a high positive correlation to the variables relating to illiteracy rate, unemployment rate and percentage of manual labourers, while the second factor was seen as highly positively correlated to the variables relating to the percentage of homes without access to a vehicle and the dependency index and also correlated, though negatively, to the percentage of foreigners between 16 and 49 who lived abroad in 1991. The variables that make up the first factor can be considered to be an approximation of the concept of deprivation in Spain. This study proposes a deprivation index made up of three simple indicators available from national information sources: percentage of illiteracy, percentage of unemployment and percentage of manual labourers. With this index, the criteria for measuring deprivation in Spanish municipalities can be unified and a comparison of the results of the different studies in our context facilitated. [ABSTRACT FROM AUTHOR]

Objective: To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain). Methods: A small-area ecological study was devised using the census section as the unit for analysis. 188 983 Deaths occurring in the capital cities of the Andalusian provinces and 109 478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation. Main results: In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities. Conclusions: Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this paper is to study the linkage between type of habitat and mortality from all causes in small areas of Southern Spain. An ecological study was conducted on 99,870 people who died between 1985 and 1999. The municipality was taken as the unit of analysis. Data analysis was carried out through hierarchical spatio-temporal bayesian models. Results show a 13.3% reduction in mortality rates among men and 14.1% among women in the most rural areas compared to more urban environments. The study demonstrates the usefulness of socio-demographic indices in small-area geographical analyses. [Copyright &y& Elsevier]

Introduction and Objectives: Ischemic heart disease is the leading cause of death and one of the top 4 causes of burden of disease worldwide. The aim of this study was to evaluate age-period-cohort effects on mortality from ischemic heart disease in Andalusia (southern Spain) and in each of its 8 provinces during the period 1981-2008., Methods: A population-based ecological study was conducted. In all, 145 539 deaths from ischemic heart disease were analyzed for individuals aged between 30 and 84 years who died in Andalusia in the study period. A nonlinear regression model was estimated for each sex and geographical area using spline functions., Results: There was an upward trend in male and female mortality rate by age from the age of 30 years. The risk of death for men and women showed a downward trend for cohorts born after 1920, decreasing after 1960 with a steep slope among men. Analysis of the period effect showed that male and female death risk first remained steady from 1981 to 1990 and then increased between 1990 and 2000, only to decrease again until 2008., Conclusions: There were similar age-period-cohort effects on mortality in all the provinces of Andalusia and for Andalusia as a whole. If the observed cohort and period effects persist, male and female mortality from ischemic heart disease will continue to decline., (Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: This study describes the design and implementation of a health impact assessment (HIA) conducted in 2010 of the regeneration project of San Fernando Street, the main avenue crossing the San Miguel-El Castillo neighborhood in Alcala de Guadaíra (Seville, Spain). This project is part of the wider URBAN Plan aimed at the social, urban and economic regeneration of the city's historic center., Methods: This experience followed the standard HIA stages and procedures. The review of published evidence was complemented with new qualitative information gathered by means of a participative workshop with the local population and interviews with social and health workers involved in the neighborhood., Results: During the building stage of the project, the adverse impacts were related to a worsening of the air quality, increased noise pollution, mobility restrictions and a higher risk of accidents, particularly among older or disabled people. Once the building stage was finished, the health benefits were associated with significant improvements in physical accessibility and the population's access to health services and other goods and services. Other positive effects were the enhanced safety and attractiveness of the neighborhood and the new opportunities for socializing, social cohesion and increasing the community's self-esteem., Conclusions: This is the first HIA experience in Andalusia whose results have been integrated into a formal cycle of decision making in the local community. This experience has provided new evidence of the potential of HIA and its applicability and acceptance at the municipal level and has has also facilitated a learning process and the piloting of new methods and tools associated with the HIA process., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objectives: The factors associated to tuberculosis (TB) treatment drop-out can be very specific to the population and the local health care organization. We have studied the factors associated to TB treatment drop out in the province of Granada., Subjects and Methods: A retrospective cohort study of TB cases registered in the province of Granada by the Epidemiological Surveillance System of Andalusia (SVEA) between 2003 and 2010 was carried out. Incidence was calculated in the native and foreign population. An univariate analysis was performed to describe the characteristics in both groups and a logistic regression model was used to identify factors associated to therapeutic abandonment., Results: A decreasing trend in the incidence of TB was observed, (20.47 in 2007 to 11 cases per 100,000 inhabitants in 2010, respectively. Mean age of foreign patients was lower than that of the natives (30.8 years vs. 46.0 years, P<.001). The former predominately lived in the Granada district, while the natives lived in the Metropolitan district. The percentage of patients who abandoned antituberculous treatment was 12.2%, this being somewhat higher in the foreign patients than the national ones (14% vs 10%; P=.062). Being male (OR: 1.65; 95% CI: 1.04-2.60; P=.033), foreigner (OR: 1.72; 95% CI: 1.04-2.83; P=.032), resident in the North-east district (OR: 3.64; 95% CI: 1.76-7.52; P=.005) and/or having extrapulmonary TB (OR: 1.78; 95% CI: 1.06-3.00; P=.029) were associated significantly to therapeutic abandonment., Conclusions: The incidence of TB in the province of Granada has decreased to about 10 cases per 100,000 inhabitants/year. The percentage of patients who abandon TB treatment is significant, it being higher in foreign patients than in the natives. TB treatment abandonment was associated to being a man, living in the North-east district of Granada and having extrapulmonary TB., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

The Ria of Huelva (south-west Spain) is a highly polluted estuary as a consequence of long-term mining and industrial activities. Between 2003 and 2004, we conducted a biomonitoring study of exposure to arsenic and some heavy metals (cadmium, chromium, copper and nickel) in urine samples of a representative sample (n=227) of children and adolescents residing in this area, and of a reference group of 196 children and adolescents living in other less industrialised areas of Andalusia (south Spain). We also assessed the determinants of the variability in urinary metals within the population of the Ria of Huelva. There were no significant differences in the concentration of metal compounds between the two groups with the exception of Cd levels, which were significantly higher in the reference group. Levels of the five metal ions in both groups were generally within the range of values reported by other biomonitoring studies for general children population, although mean Cd levels tended to be higher as compared to other European studies. Among the population of the Ria of Huelva, the main determinants of the interindividual variation in urinary metals were age, sex, area of residence, and frequency of intake of certain food items (mainly fish and shellfish). Overall, results suggest that living in the Ria of Huelva is not increasing current levels of exposure to certain metals among children and adolescents above those found in other urban areas of Andalusia., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Until now, mortality atlases have been static. Most of them describe the geographical distribution of mortality using count data aggregated over time and standardized mortality rates. However, this methodology has several limitations. Count data aggregated over time produce a bias in the estimation of death rates. Moreover, this practice difficult the study of temporal changes in geographical distribution of mortality. On the other hand, using standardized mortality hamper to check differences in mortality among groups. The Interactive Mortality Atlas in Andalusia (AIMA) is an alternative to conventional static atlases. It is a dynamic Geographical Information System that allows visualizing in web-site more than 12.000 maps and 338.00 graphics related to the spatio-temporal distribution of the main death causes in Andalusia by age and sex groups from 1981. The objective of this paper is to describe the methods used for AIMA development, to show technical specifications and to present their interactivity. The system is available from the link products in www.demap.es. AIMA is the first interactive GIS that have been developed in Spain with these characteristics. Spatio-temporal Hierarchical Bayesian Models were used for statistical data analysis. The results were integrated into web-site using a PHP environment and a dynamic cartography in Flash. Thematic maps in AIMA demonstrate that the geographical distribution of mortality is dynamic, with differences among year, age and sex groups. The information nowadays provided by AIMA and the future updating will contribute to reflect on the past, the present and the future of population health in Andalusia.