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Objective: Society has changed during the last 100 years of evolution; however, some problems, such as suicide, remain. The objective here is to carry out a long-term epidemiological study in Spain, and to calculate the social and labor costs of 2016., Method: Epidemiological data were obtained from official data obtained between 1906 - 2016. The calculation of the costs of suicides included the social costs and the costs of production losses (labor costs). The latter were obtained by the human capital method, taking into account the unemployment rate. The economic growth rate stood at 2.6% per year., Results: The suicide rate was between 4 and 8% per year. The evolution during these 100 years had three periods. Until 1940 it had slight increases, and then it decreased until 1980 and, subsequently, the rate increased until it reached almost 8% in 2016. The costs of the suicides were 2,167 million € of economic losses for society, or its equivalent of 607 € for suicide., Conclusions: Public health policies aimed at the prevention of suicide should be increased, and supported by the economic costs they mean for society.

Background and Objective: Hospitalizations that could have been prevented with a timely and effective ambulatory care are known as avoidable hospitalizations (AH). The measure of AH is an indicator of the quality of primary health care centers. The objective of this study was to determine the factors that influence the level of AH at the Spanish public hospitals., Material and Method: We identified the characteristics of hospitalised patient as AH. We studied the total hospitalizations in public hospitals of Spain in 2000 related to AH., Results: AH admissions were the 15.8% of total in Spanish hospitals and the 16.6% of hospital stays. Patients' mean age was high, 54 years, males (age-adjusted OR = 1.54) with a large length of stay and presurgery stay, higher comorbidity (0.63 [0.8]), public financing, and admission was basically emergency-caused and in high complexity hospitals. There is a direct relationship between frequency of AH and hospital complexity., Conclusions: The control of AH is very important because its repercussion on the total hospitalary case-mix. We observe an inducing effect of the hospital offer because the hospital capacity increase the number of AH admissions.

Using a list of avoidable mortality (AM) causes as indicators of medical care (IMC) according to the Holland classification, a study on AM was conducted in the Valencia Community hospitals during 1994 and 1995. A total of 617 patients out of 106,540 discharges with IMC criteria died (mortality rate: 0.58%). The most common causes of AM included hypertension and cerebrovascular disease, with 46% of avoidable deaths; maternalperinatal disease, with 36%, and tuberculosis, 7%. According to the logistic regression analysis, men had a higher risk of AM than women, the age groups at highest risk were those over 50 years and less than 18 years, and the presence of a higher number of diagnoses was associated with increased risk.

Objective: In the first years after the finding of HIV-infection, the main was for its transmission among western women was the intravenous drug addiction. The objective of our work consisted in evaluating the main social and clinical characteristics of a group of seropositive mothers, and in analyzing their potential relationship with intravenous consumption of drugs., Method: We performed an observational prospective study in 220 HIV-infected women who had recently given birth to children with high risk for infection. We included every women at an HIV Unit of a hospital in Valencia who had been diagnosed of HIV infection at any moment between the first mother-child transmission reported in 1985 and 1993. The analysis was based on univariate analysis., Results: The virus transmission was produced by heterosexual relations in a 27.7% of the study women and due to the parenteral drug addiction in 69.1%. We detected more women who had an abortion, with criminal antecedents and parental abandonment among those who were intravenous drug users (IVDU), with OR of 1.8 (p = 0.087), 8.95 (p = 0.012) and 15 (p = 0.000), when compared with those mothers non-IVDU. Besides, IVDU presented a higher probability for getting hepatitis B or C infection and for other toxic habits, as smoking (OR = 6.19, p = 0.000) or alcoholism (OR = 5.91, p = 0.017)., Conclusion: Many of the analysed characteristics in these women were more related with the consumption of injected drug than with the HIV infection, such as the greater frequency of elective abortions, criminal antecedents, parental abandonment, multiple drug abuse and pathological precedents like hepatitis B or C.

Background: Avoidable mortality (AM) has been proposed as the indicator of the quality and the efficacy of health care services and a parameter useful to distribute health care resources. The aim of this study was to analyze the size and geographic variability of AM in the Community of Valencia, Spain (1975-1990)., Methods: The causes of AM were analyzed by the classification of Holland divided into indicators of medical care (IMC) and indicators on national health care policy (INHCP) in addition to the causes of the Charlton classification. Standard rates for Spain and the European Community, the rate of masculinity and contribution to total mortality were calculated. Geographic distribution by areas and provinces was analyzed by the rate of standardized mortality., Results: According to the Holland classification AM was 30% of the deaths from 5 to 64 years of age. Out of these cases, 18.5% corresponded to INHCP and 11.1% to IMC. According to the Charlton classification, this percentage was 3.6%. A considerable variation was observed among the 20 areas analyzed due to many causes. The geographic distribution by groups (IMC, INHCP and the Charlton classification) is quite homogeneous. The worse results corresponded to the city of Valencia and to the area 21 (area of the city of Alicante)., Conclusions: A great variation was found in the results regarding geographic distribution for individual causes of death while the distribution was quite homogeneous for all of the groups of mortality with the worst results being observed in large urban centers.

In this paper we study the general mortality trends by cancer in Spain (1951-1987), and also by sex and age groups. We focus on lung cancer, establishing comparisons with USA, England and Wales. We appreciate on the general mortality trend that only young age groups show a higher decrease, while in other countries this decrease was also in old age groups. We observed a lower mortality trend in Spain by lung cancer than in the other countries, however increasing the rates in both sexes and more in males. That evolution could be related with the evolution of cancer risk factors and especially lung cancer. On concluded that the general mortality trend in Spain is the same than other developed countries but with some delay in the evolution, when comparing lung cancer. Spain is now in an increasing phase and USA, England and Wales have stabilized their rates and begin to decrease their trends.

We studied 142 patients who received antituberculous chemoprophylaxis with isoniacide. We evaluated the increase in GOT and PGT levels, observing higher than normal values in 10.56% and 21.83% of the cases, respectively. This increase was near the limit of the statistical significance with respect to sex and it was not related with previous episodes of hepatotoxicity, although it was related to age, with a lower number of hepatic disorders among the younger groups. The presence of hepatotoxicity forced us to discontinue the therapy in just 2.81% of the cases. The level of therapy compliance was 69.1% for women and 85.25% for men, being greatest in the age group below 13 years (86.89%).

Objectives: To find out the satisfaction's level of the Nazaret (Valencia) Health Center's users; To detect the deficiencies in the areas under study; To find out whether or not there are differences with previous studies in primary care., Design: Transversal study, results evaluation with no equivalent control group., Setting: (site). Primary health care. Neighborhood of Valencia with 6749 people. With a regressive Sundbarg index, and the 42.6% of the population that are older than nine years are illiterate or with incomplete primary education, the income level index by neighborhood in 1986 is -5.6 (range: 13.4; -8.1)., Target Population: all the Nazaret Health Center users. The inclusion criteria were: 1. Eighteen years old (or older) users. 2. That had contacted previously for whatever reason (administrative or sanitary) with the health center at least in one occasion during the prior 6 months. The random sample was selected for a 5% maximum error, a 95.5% confidence level, and a p < or = 30% for the negative answers from the scale, its size was 323 patients, with a 20% increase for forecasted no cooperation/no answers (n = 388)., Intervention and Results: The average age of the interviewed was 42 years. The total adding score was 98.1 (theoretical range: 27-135). The score by areas (theoretical range 9-45) was: personal quality area 35.5 professional competence 32.4 and the relationship cost-comfort 30.5. A total (overall) satisfaction item had an average of 7.2 on a 1 to 10 scale, with P10 = 5, P50 = 7, P90 = 10. The analysis of variance shows that satisfaction increases with age, with the attachment to the same doctor, with feminine sex, with unemployment and, with low educational level, being more critic the young people and the people with educational level (not significative difference)., Conclusion: We consider that users have a good degree of satisfaction, that the ratio cost-comfort should be improved, there is a significative improvement compared with previous studies done with the former primary health care model.

Background: We intend to study the evolution of morbidity by typhoid-paratyphoid infections (TPI) in Spain and Valencia (1940-1990) as well as TPI morbidity and degree of sanitation in Valencia., Methods: Data related to morbidity, as well as the sanitation basic data in Valencia, have been obtained from official sources. Morbidity rates belonging to Spain and Valencia have been calculated., Results: It is found a decreasing trend of morbidity in Spain and Valencia. By Health Areas, a great decrease stands out in Valencia-City and, as a general rule, the highest rates belonged to the lowest automatic chlorination percentages. In general, there is an improvement in chlorination, sewers and sewage-depuration equipment., Conclusions: TPI morbidity in Spain shows a decreasing trend in both cases; it is more evident in Valencia when establishing a relation of TPI morbidity with the degree of hygiene by Health Areas of Valencia, an inverse relation appears and the highest rates belong to the interior Areas. The conclusion is that there is a remarkable improvement in the hygiene general situation in Valencia; in the city as well as in all the Health Areas.

Data are presented on hospital stay for the population 65 years-old and over, measured in percentage over the total for Spain, for the 1978 to 1988 period, by gender, for each province and autonomous region (Comunidad Autónoma). The country's total for the last available year was 35%. Except in Baleares and Murcia, the proportion of hospital stays increased in all Regions, especially in Navarra, where it increased from 23% to 51%. After adjusting for age, the increase in the proportion of hospital stays in the study population was due to an increase in utilization per person. The proportion, which was 13.3% in 1978, raised to 23.8% in 1988, with an adjusted value of 21.3%.

A study has been made of the death rate due to Rheumatic Fever (R.F.) and Rheumatic Heart Disease (R.H.D.) in Spain (1951-1985) as well as the disease rate due to Rheumatic Fever (1951-1988). It has been found that the death rate due to R.F. and R.H.D. has clearly decreased over the past 20 years, whilst it is important to note that disease rate due to R.F' has shown a noticeable increase over the past 10 years. And on comparing the death rate due to R.F. in Spain and in the United States, one finds that the U.S. death rate began to drop prior to that in Spain, it currently being minimal in both countries. Stress is placed on the need to increase the control of streptococcus infections, specially throat infections, in our environment.

We introduce an ecological research for Spain between the 1975 and 1979, trying to explain the variation of childhood mortality. The social-economical factor had an important weight, as the disposable familiar rent (R2 = 0.44) and the per capita rent, while the health factors had a least important influence. From this last group, the health resources utilization were the most important, as the consultation per habitant (partial regression coefficient -0.15 and -0.14 in 1977 and 1978 respectively) and the surgery activities. Every this reflect a country in change.

In this paper, ways of setting up the functions of personnel management is discussed. For this, the basic factors such as knowing exactly what the potential and needs of the personnel in question are used in order to undertake the objectives of the health care institution, as well as the different ways of employing incentives and motivation to strengthen the work capacity and maximize the results obtained from the hospital institution. In addition, the zero base planning and its role in this model are explained.

A study of the mortality due to leukaemias in Spain between 1951 and 1983 was performed. A clearly increasing trend was appreciated, with progressive higher affectation of males in the last four years, the mortality rates being constantly higher for this sex. When cytological types of the leukaemias, sex, and the different age groups were taken into account, and after comparing these findings with data reported from the United States of America, it was found that our mortality rates are in general much lower than those of the USA. Although the clinical course of the disease is similar for both countries as regards the four major groups of leukaemias, a striking increase of mortality in childhood (5-9 years) was found here in acute lymphoblastic leukaemia, which suggests, in accordance with our previous reports, high affectation of children in Spain. It seems advisable to improve the techniques and means of treating and preventing complications, especially infectious ones, in childhood.

We have reviewed the mortality from laryngeal cancer in Spain (1951-1983). An evident increase of the tendency for males has been observed, while an stabilization in females, with lower rates, has been appreciated. It is reflected in the increase of the sex ratio along the studied period, specially since 1970. Concerning the morbidity, through hospital diagnostic data in Spain, as much the absolute numbers as the corresponding morbidity rates have been clearly increasing in males, specially during the last years of our study (1977-1985).

In this study we review the mortality in Spain from liver cirrhosis between 1951 and 1983. There was a decrease in the general mortality due to this cause, while in the study of mortality by sexes there was only a tendency to decrease in males but not in females. When an analysis was made according to age groups, there was a tendency to rise in younger patients, while there was a lowering in older ones. We also studied comparatively the mortality data for the same cause in France.

In review of the rising bladder cancer mortality rate in Spain and its involvement in connection with other "risk factors", according to recent contributions, we proceeded to review these factors involved and to carry out an epidemiological study describing its mortality from 1968 to 1982, through specific mortality rates per hundred thousand in males and females, as well as the study by age groups from 50 upwards, concentrating on more highly affected ages. We also carried out transverse studies for the three years 1968, 1975 and 1982 and reviewed the evolution of mortality in accordance with the chorts of births. On the whole, we observe a continual rise in mortality due to this cancer, at a much higher level in the masculine sex, and we make interpretation as to its association with "risk factors" connected with life style.