Impactia: automating the study of the scientific production

Introduction The Andalusian Public Health System Virtual Library (Biblioteca Virtual del Sistema Sanitario Público de Andalucía, BV-SSPA) was set up in June 2006. It consists of a regional government action with the aim of democratizing the health professional access to quality scientific information, regardless of the professional workplace. Andalusia is a region with more than 8 million inhabitants, with 100,000 health professionals for 41 hospitals, 1,500 primary healthcare centres, and 28 centres for non-medical attention purposes (research, management, and educational centres). Objectives The Department of Development, Research and Investigation (R+D+i) of the Andalusian Regional Government has, among its duties, the task of evaluating the hospitals and centres of the Andalusian Public Health System (SSPA) in order to distribute its funding. Among the criteria used is the evaluation of the scientific output, which is measured using bibliometry. It is well-known that the bibliometry has a series of limitations and problems that should be taken into account, especially when it is used for non-information sciences, such us career, funding, etc. A few years ago, the bibliometric reports were done separately in each centre, but without using preset and well-defined criteria, elements which are basic when we need to compare the results of the reports. It was possible to find some hospitals which were including Meeting Abstracts in their figures, while others do not, and the same was happening with Erratum and many other differences. Therefore, the main problem that the Department of R+D+i had to deal with, when they were evaluating the health system, was that bibliometric data was not accurate and reports were not comparable. With the aim of having an unified criteria for the whole system, the Department of R+D+i ordered the BV-SSPA to do the year analysis of the scientific output of the system, using some well defined criteria and indicators, among whichstands out the Impact Factor. Materials and Methods As the Impact Factor is the bibliometric indicator that the virtual library is asked to consider, it is necessary to use the database Web of Science (WoS), since it is its owner and editor. The WoS includes the databases Science Citation Index (SCI), Social Sciences Citation Index (SSCI) and Arts & Humanities Citation Index. To gather all the documents, SCI and SSCI are used; to obtain the Impact Factor and quartils, it is used the Journal Citation Reports, JCR. Unlike other bibliographic databases, such us MEDLINE, the bibliometric database WoS includes the address of all the authors. In order to retrieve all the scientific output of the SSPA, we have done general searches, which are afterwards processed by a tool developed by our library. We have done nine different searches using the field ‘address’; eight of them including ‘Spain’ and each one of the eight Andalusian Regions, and the other one combining ‘Spain’ with all those cities where there are health centres, since we have detected that there are some authors that do not use the region in their signatures. These are some of the search strategies: AD=Malaga and AD=Spain AD=Sevill* and AD=Spain AD=SPAIN AND (AD=GUADIX OR AD=BAZA OR AD=MOTRIL) Further more, the field ‘year’ is used to determine the period. To exploit the data, the BV-SSPA has developed a tool called Impactia. It is a web application which uses a database to store the information of the documents generated by the SSPA. Impactia allows the user to automatically process the retrieved documents, assigning them to their correspondent centres. In order to do the classification of documents automaticaly, it was necessary to detect the huge variability of names of the centres that the authors use in their signatures. Therefore, Impactia knows that if an author signs as “Hospital Universitario Virgen Macarena”, “HVM” or “Hosp. Virgin Macarena”, he belongs to the same centre. The figure attached shows the variability found for the Empresa Publica Hospital de Poniente. Besides the documents from WoS, Impactia includes the documents indexed in Scopus and in other databases, where we do bibliographic searches using similar strategies to the later ones. Aware that in the health centres and hospitals there is a lot of grey literature that is not gathered in databases, Impactia allows the centres to feed the application with these documents, so that all the SSPA scientific output is gathered and organised in a centralized place. The ones responsible of localizing this gray literature are the librarians of each one of the centres. They can also do statements to the documents and indicators that are collected and calculated by Impactia. The bulk upload of documents from WoS and Scopus into Impactia is monthly done. One of the main issues that we found during the development of Impactia was the need of dealing with duplicated documents obtained from different sources. Taking into account that sometimes titles might be written differently, with slashes, comas, and so on, Impactia detects the duplicates using the field ‘DOI’ if it is available or comparing the fields: page start, page end and ISSN. Therefore it is possible to guarantee the absence of duplicates. Results The data gathered in Impactia becomes available to the administrative teams and hospitals managers, through an easy web page that allows them to know at any moment, and with just one click, the detailed information of the scientific output of their hospitals, including useful graphs such as percentage of document types, journals where their scientists usually publish, annual comparatives, bibliometric indicators and so on. They can also compare the different centres of the SSPA. Impactia allows the user to download the data from the application, so that he can work with this information or include them in their centres’ reports. This application saves the health system many working hours. It was previously done manually by forty one librarians, while now it is done by only one person in the BV-SSPA during two days a month. To sum up, the benefits of Impactia are: It has shown its effectiveness in the automatic classification, treatment and analysis of the data. It has become an essential tool for all managers to evaluate quickly and easily the scientific production of their centers. It optimizes the human resources of the SSPA, saving time and money. It is the reference point for the Department of R+D+i to do the scientific health staff evaluation.

Peripheral arterial disease in HIV patients older than 50 years of age

Our objective was to analyze the prevalence of peripheral arterial disease (PAD) in HIV patients at risk and to compare them with the general population. All HIV patients older than 50 years who attended our unit from October 2005-July 2006 and all persons attending for an annual medical checkup at an employees' insurance association during the same period were invited to participate in the study. Of the latter (n = 407), a person of the same sex and age (+/-5 years) was included for each HIV patient. PAD was assessed by the ankle-brachial index (ABI) in all subjects, and all completed the Edinburgh questionnaire. Ninety-nine HIV patients and 99 persons from the general population of the same age and sex were included in the study. The HIV patients had a greater prevalence of dyslipidemia, diabetes, and PAD, which was symptomatic in five of them and in one subject from the general population. Patients with HIV infection older than 50 had a high prevalence of PAD, and as it was asymptomatic in half the cases, an ABI may be performed in this population to actively look for PAD. Control of cardiovascular risk factors and the use of such drugs as platelet antiaggregation agents should therefore be optimized in this population.

Tea consumption and incidence of type 2 diabetes in Europe: the EPIC-InterAct case-cohort study.

BACKGROUND In previous meta-analyses, tea consumption has been associated with lower incidence of type 2 diabetes. It is unclear, however, if tea is associated inversely over the entire range of intake. Therefore, we investigated the association between tea consumption and incidence of type 2 diabetes in a European population. METHODOLOGY/PRINCIPAL FINDINGS The EPIC-InterAct case-cohort study was conducted in 26 centers in 8 European countries and consists of a total of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,835 individuals from a total cohort of 340,234 participants with 3.99 million person-years of follow-up. Country-specific Hazard Ratios (HR) for incidence of type 2 diabetes were obtained after adjustment for lifestyle and dietary factors using a Cox regression adapted for a case-cohort design. Subsequently, country-specific HR were combined using a random effects meta-analysis. Tea consumption was studied as categorical variable (0, >0-<1, 1-<4, ≥ 4 cups/day). The dose-response of the association was further explored by restricted cubic spline regression. Country specific medians of tea consumption ranged from 0 cups/day in Spain to 4 cups/day in United Kingdom. Tea consumption was associated inversely with incidence of type 2 diabetes; the HR was 0.84 [95%CI 0.71, 1.00] when participants who drank ≥ 4 cups of tea per day were compared with non-drinkers (p(linear trend) = 0.04). Incidence of type 2 diabetes already tended to be lower with tea consumption of 1-<4 cups/day (HR = 0.93 [95%CI 0.81, 1.05]). Spline regression did not suggest a non-linear association (p(non-linearity) = 0.20). CONCLUSIONS/SIGNIFICANCE A linear inverse association was observed between tea consumption and incidence of type 2 diabetes. People who drink at least 4 cups of tea per day may have a 16% lower risk of developing type 2 diabetes than non-tea drinkers.

Social inequalities and mortality in Europe-results from a large multi-national cohort

BACKGROUND Socio-economic inequalities in mortality are observed at the country level in both North America and Europe. The purpose of this work is to investigate the contribution of specific risk factors to social inequalities in cause-specific mortality using a large multi-country cohort of Europeans. METHODS A total of 3,456,689 person/years follow-up of the European Prospective Investigation into Cancer and Nutrition (EPIC) was analysed. Educational level of subjects coming from 9 European countries was recorded as proxy for socio-economic status (SES). Cox proportional hazard model's with a step-wise inclusion of explanatory variables were used to explore the association between SES and mortality; a Relative Index of Inequality (RII) was calculated as measure of relative inequality. RESULTS Total mortality among men with the highest education level is reduced by 43% compared to men with the lowest (HR 0.57, 95% C.I. 0.52-0.61); among women by 29% (HR 0.71, 95% C.I. 0.64-0.78). The risk reduction was attenuated by 7% in men and 3% in women by the introduction of smoking and to a lesser extent (2% in men and 3% in women) by introducing body mass index and additional explanatory variables (alcohol consumption, leisure physical activity, fruit and vegetable intake) (3% in men and 5% in women). Social inequalities were highly statistically significant for all causes of death examined in men. In women, social inequalities were less strong, but statistically significant for all causes of death except for cancer-related mortality and injuries. DISCUSSION In this European study, substantial social inequalities in mortality among European men and women which cannot be fully explained away by accounting for known common risk factors for chronic diseases are reported.

The association between dietary energy density and type 2 diabetes in Europe: results from the EPIC-InterAct Study

BACKGROUND Observational studies implicate higher dietary energy density (DED) as a potential risk factor for weight gain and obesity. It has been hypothesized that DED may also be associated with risk of type 2 diabetes (T2D), but limited evidence exists. Therefore, we investigated the association between DED and risk of T2D in a large prospective study with heterogeneity of dietary intake. METHODOLOGY/PRINCIPAL FINDINGS A case-cohort study was nested within the European Prospective Investigation into Cancer (EPIC) study of 340,234 participants contributing 3.99 million person years of follow-up, identifying 12,403 incident diabetes cases and a random subcohort of 16,835 individuals from 8 European countries. DED was calculated as energy (kcal) from foods (except beverages) divided by the weight (gram) of foods estimated from dietary questionnaires. Prentice-weighted Cox proportional hazard regression models were fitted by country. Risk estimates were pooled by random effects meta-analysis and heterogeneity was evaluated. Estimated mean (sd) DED was 1.5 (0.3) kcal/g among cases and subcohort members, varying across countries (range 1.4-1.7 kcal/g). After adjustment for age, sex, smoking, physical activity, alcohol intake, energy intake from beverages and misreporting of dietary intake, no association was observed between DED and T2D (HR 1.02 (95% CI: 0.93-1.13), which was consistent across countries (I(2) = 2.9%). CONCLUSIONS/SIGNIFICANCE In this large European case-cohort study no association between DED of solid and semi-solid foods and risk of T2D was observed. However, despite the fact that there currently is no conclusive evidence for an association between DED and T2DM risk, choosing low energy dense foods should be promoted as they support current WHO recommendations to prevent chronic diseases.

Evaluation of factors affecting plate waste of inpatients in different healthcare settings.

INTRODUCTION AND AIMS: Satisfaction of inpatients with served food within a hospital care system still constitutes one of the main attempts to modernize food services. The impact of type of menu, food category, hospital centre and timetable on the meals wastage produced in different Spanish healthcare settings, was evaluated. METHODS: Meal wastage was measured through a semiquantitative 5-point scale ("nothing on plate"; "¼ on plate"; "half on plate"; "¾ on plate" and "all on plate"). The study was carried out in two periods of three months each in 2010 and 2011. A trained person took charge of measuring plate waste classified into 726 servings belonging to 11 menus. In total 31,392 plates were served to 7,868 inpatients. A Kruskal-Wallis non-parametric test (p < 0.05) was applied to evaluate significant differences among the variables studied. RESULTS: The menus were satisfactorily consumed because more than 50% of the plates were classified as "nothing on plate". Regarding food categories, 26.78% of the plates corresponded to soups and purées, while pasta and rice, and prepared foods were only distributed in 4-5% of the servings. Desserts were mostly consumed, while cooked vegetables were less accepted by the inpatients evaluated. Other factors such as hospital centre influenced plate waste (p < 0.05) but timetable did not (p > 0.05). CONCLUSION: Visual inspections of plate waste might be useful to optimize type and quality of menus served. The type of menu served and the food category could have a great influence on food acceptability by the inpatientsstudied.