Dissemination of periodic mammography and patterns of use, by birth cohort, in Catalonia (Spain)

Background: In Catalonia (Spain) breast cancer mortality has declined since the beginning of the 1990s. The dissemination of early detection by mammography and the introduction of adjuvant treatments are among the possible causes of this decrease, and both were almost coincident in time. Thus, understanding how these procedures were incorporated into use in the general population and in women diagnosed with breast cancer is very important for assessing their contribution to the reduction in breast cancer mortality. In this work we have modeled the dissemination of periodic mammography and described repeat mammography behavior in Catalonia from 1975 to 2006. Methods: Cross-sectional data from three Catalan Health Surveys for the calendar years 1994, 2002 and 2006 was used. The dissemination of mammography by birth cohort was modeled using a mixed effects model and repeat mammography behavior was described by age and survey year. Results: For women born from 1938 to 1952, mammography clearly had a period effect, meaning that they started to have periodic mammograms at the same calendar years but at different ages. The age at which approximately 50% of the women were receiving periodic mammograms went from 57.8 years of age for women born in 1938–1942 to 37.3 years of age for women born in 1963–1967. Women in all age groups experienced an increase in periodic mammography use over time, although women in the 50–69 age group have experienced the highest increase. Currently, the target population of the Catalan Breast Cancer Screening Program, 50–69 years of age, is the group that self-reports the highest utilization of periodic mammograms, followed by the 40–49 age group. A higher proportion of women of all age groups have annual mammograms rather than biennial or irregular ones. Conclusion: Mammography in Catalonia became more widely implemented during the 1990s. We estimated when cohorts initiated periodic mammograms and how frequently women are receiving them. These two pieces of information will be entered into a cost-effectiveness model of early detection in Catalonia.

Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain)

Background: At present, it is complicated to use screening trials to determine the optimal age intervals and periodicities of breast cancer early detection. Mathematical models are an alternative that has been widely used. The aim of this study was to estimate the effect of different breast cancer early detection strategies in Catalonia (Spain), in terms of breast cancer mortality reduction (MR) and years of life gained (YLG), using the stochastic models developed by Lee and Zelen (LZ). Methods: We used the LZ model to estimate the cumulative probability of death for a cohort exposed to different screening strategies after T years of follow-up. We also obtained the cumulative probability of death for a cohort with no screening. These probabilities were used to estimate the possible breast cancer MR and YLG by age, period and cohort of birth. The inputs of the model were: incidence of, mortality from and survival after breast cancer, mortality from other causes, distribution of breast cancer stages at diagnosis and sensitivity of mammography. The outputs were relative breast cancer MR and YLG. Results: Relative breast cancer MR varied from 20% for biennial exams in the 50 to 69 age interval to 30% for annual exams in the 40 to 74 age interval. When strategies differ in periodicity but not in the age interval of exams, biennial screening achieved almost 80% of the annual screening MR. In contrast to MR, the effect on YLG of extending screening from 69 to 74 years of age was smaller than the effect of extending the screening from 50 to 45 or 40 years. Conclusion: In this study we have obtained a measure of the effect of breast cancer screening in terms of mortality and years of life gained. The Lee and Zelen mathematical models have been very useful for assessing the impact of different modalities of early detection on MR and YLG in Catalonia (Spain).

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

Background: Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods: In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results: Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ≥10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p < 0.001) Conclusion: Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions.

Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

Background: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.

L'Origen de l'arquitectura en pedra i l'urbanisme a la Catalunya Occidental

The consolidation of an agricultural economy based in extensive cereals production influenced the development of the typical communities of the plains of western Catalonia during the second millennium BC and the first centuries of the first and differentiated them from the villages of the coast. This paper analyzes the occupation and exploitation pattems of temtories, settlements and specially the development of stone architecture in the Bronze and Iron Age periods. We characterise the process that leads from the first open-air sedentary settlements to the agricultural settlements in early and middle Bronze Age period and the appearance of wellbuilt houses and town planning during the late Bronze Age. We can asses the contribution of the early Urnfield period and link the kind of settlement, the town plan, the architecture and building techniques - which centuries later characterised the Ibero-Ilergeta society - to their origin during the later Urnfield period: systematic exploitation of lands suitable for agriculture (Urgell, Monegros), the phenomenon of concentration-depopulation and the decrease in number of settlements combined with an increase in size.

La noció d'Espanya a la Catalunya medieval

A partir de la necessitat de conèixer les bases del propi present i d'assolir puntals on arrelar els discursos de futur, ara i adés les diferents col·lectivitats es remeten als orígens, "l'obsessió pels orígens" deia Marc Bloch. I aquests, en una Europa que parla de l'Edat Mitjana com la infantesa de la pròpia identitat, s'aboquen a una època medieval on conflueixen -en el que des de la llunyania de la nostra quotidianitat pot semblar una amalgama poc destriada- tant les realitats gresoladores dels actuals signes d'identitat culrurals, socials i lingüístics, com les projeccions que delerosament hi cerquen les justificacions del present i els condicionants del furur. Així doncs, convé apamar bé l'espai físic i conceptual per definir adientment la realitat existent en aquells moments que han alimentat les arrels d'identitats que, travessant diferents estímuls al llarg de la història, han menat fins als nostres dies.

La Seu Vella de Lleida i la introducció de l'arquitectura gòtica a Catalunya

This study is trying to evidence how Gothic entered Catalonia in the XIII century, specially in the Seu Vella of Lleida. First only partially with the introduction of isolated elements that, essentially, did not alter the leading Romanesque, particularly the prompted arch and the cross vault; but on the last third of the XIII century, the gothic elements are well manifested leading to its total introduction in 1300.

El naixement d'un vilar medieval: Moredell (Gironès) en època carolíngia

This is the description of the birth, development and transformations of a small rural community in carolingian epoch through the written documentation and the analysis of the landscape.

Entorn al testament de Brunissèn d'Alentorn i alguns costums funeraris de la Lleida medieval

In this research from the late medieval period, we want to analyze diferent aspects related to funerary world through Brunissèn d’Alentorn’s will. The document is compared with other wills from Lleida’s area that acquire knowledge to these customs, for instance, the draps d’or’s uses. These were provided of deceased’ heraldry, and were comissioned to cover the tomb. Also, in Lleida’s case, they were used to decorate the ancient cathedral’s presbitery during the main festivities, and the patrons’ wedding bed. Artistic patronage, social prestige, family arms ostentation, pomp and devotion are other aspects that would be emphasized in this tour, just as the private devotions in the chapels and altars that were founded regarding this topic.

La historia medieval en las escuelas: ¿una visión deformada?

A menudo se acusa a los libros de texto escolares de transmitir una imagen falsa, peyorativa, de la Edad Media. Aunque semejantes reproches puedan parecer nuevos, las protestas contra la hostilidad a la Edad Media, que rechazan el tópico del oscurantismo medieval, han estado a la orden del día durante los dos últimos siglos. Sin embargo, es muy difícil encontrar en los modernos libros de historia nada que justifique la acusación de haber exagerado las tinieblas medievales. En general, los historiadores modernos, tanto liberales como socialistas, han mantenido una opinión favorable de las instituciones y la cultura medievales, llegando incluso a encomiar la obra de la Iglesia como resguardo de la civilización, pero sin ocultar sus aspectos irracionales y reaccionarios. Las acusaciones que Jacques Heers y Jeffrey Burton Russell dirigen contra una presunta falsificación de la historia medieval apuntan explícitamente contra la influencia del darwinismo y el anticlericalismo, lo cual nos pone sobre la pista de sus verdaderas motivaciones ideológicas.

Contribution of early detection and adjuvant treatments to breast cancer mortality reduction in Catalonia, Spain

Background: Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings: A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975-2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30-69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance: Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods.

Automated monitoring of medical protocols: a secure and distributed architecture

The control of the right application of medical protocols is a key issue in hospital environments. For the automated monitoring of medical protocols, we need a domain-independent language for their representation and a fully, or semi, autonomous system that understands the protocols and supervises their application. In this paper we describe a specification language and a multi-agent system architecture for monitoring medical protocols. We model medical services in hospital environments as specialized domain agents and interpret a medical protocol as a negotiation process between agents. A medical service can be involved in multiple medical protocols, and so specialized domain agents are independent of negotiation processes and autonomous system agents perform monitoring tasks. We present the detailed architecture of the system agents and of an important domain agent, the database broker agent, that is responsible of obtaining relevant information about the clinical history of patients. We also describe how we tackle the problems of privacy, integrity and authentication during the process of exchanging information between agents.

Magias y brujerías literarias en la Castilla medieval

El objetivo del presente trabajo es trazar una panorámica sobre algunas de las plasmaciones literarias más relevantes de la magia y de la brujería en las letras castellanas medievales y sobre sus significaciones históricas. Con tal propósito se comentan textos de Don Juan Manuel, Juan Ruiz, Juan de Mena o Garci Rodríguez de Montalvo, entre otros autores de los siglos XIII al XV, y se apuntan algunas coordenadas culturales que reformulan la especificidad del contexto hispánico en su marco europeo.