Towns with extremely low mortality due to ischemic heart disease in Spain

BACKGROUND: The cause of coronary disease inframortality in Spain is unknown. The aim of this study is to identify Spanish towns with very low ischemic heart disease mortality, describe their health and social characteristics, and analyze the relationship with a series of contextual factors. METHODS: We obtained the number of deaths registered for each of 8,122 Spanish towns in the periods 1989-1998 and 1999-2003. Expected deaths, standardized mortality ratio (SMR), smoothed Relative Risk (RR), and Posterior Probability (PP) of RR > 1 were calculated using Bayesian hierarchical models. Inframortality was defined as any town that displayed an RR below the 10th percentile, an SMR of under 1 for both sexes, and a PP of RR > 1 less than or equal to 0.002 for male and 0.005 for female mortality, during the two periods covered. All the remaining towns, except for those with high mortality classified as "tourist towns", were selected as controls. The association among socioeconomic, health, dietary, lifestyle and vascular risk factors was analyzed using sequential mixed logistic regression models, with province as the random-effects variable. RESULTS: We identified 32 towns in which ischemic heart disease mortality was half the national rate and four times lower than the European Union rate, situated in lightly populated provinces spread across the northern half of Spain, and revealed a surprising pattern of geographic aggegation for 23 of the 32 towns. Variables related with inframortality were: a less aged population (OR 0.93, 95% CI 0.89-0.99); a contextual dietary pattern marked by a high fish content (OR 2.13, 95% CI 1.38-3.28) and wine consumption (OR 1.50, 95% CI 1.08-2.07); and a low prevalence of obesity (OR 0.47, 95% CI 0.22-1.01); and, in the case of towns of over 1000 inhabitants, a higher physician-population ratio (OR 3.80, 95% CI 1.17-12.3). CONCLUSIONS: Results indicate that dietary and health care factors have an influence on inframortality. The geographical aggregation suggests that other factors with a spatial pattern, e.g., genetic or environmental might also be implicated. These results will have to be confirmed by studies in situ, with objective measurements at an individual level.This study was funded by research study grant no. PI06/0656 from Spain's Health Research Fund (Fondo de Investigación Sanitaria).S

Towns with extremely low mortality due to ischemic heart disease in Spain

Abstract Background The cause of coronary disease inframortality in Spain is unknown. The aim of this study is to identify Spanish towns with very low ischemic heart disease mortality, describe their health and social characteristics, and analyze the relationship with a series of contextual factors. Methods We obtained the number of deaths registered for each of 8,122 Spanish towns in the periods 1989-1998 and 1999-2003. Expected deaths, standardized mortality ratio (SMR), smoothed Relative Risk (RR), and Posterior Probability (PP) of RR > 1 were calculated using Bayesian hierarchical models. Inframortality was defined as any town that displayed an RR below the 10th percentile, an SMR of under 1 for both sexes, and a PP of RR > 1 less than or equal to 0.002 for male and 0.005 for female mortality, during the two periods covered. All the remaining towns, except for those with high mortality classified as "tourist towns", were selected as controls. The association among socioeconomic, health, dietary, lifestyle and vascular risk factors was analyzed using sequential mixed logistic regression models, with province as the random-effects variable. Results We identified 32 towns in which ischemic heart disease mortality was half the national rate and four times lower than the European Union rate, situated in lightly populated provinces spread across the northern half of Spain, and revealed a surprising pattern of geographic aggegation for 23 of the 32 towns. Variables related with inframortality were: a less aged population (OR 0.93, 95% CI 0.89-0.99); a contextual dietary pattern marked by a high fish content (OR 2.13, 95% CI 1.38-3.28) and wine consumption (OR 1.50, 95% CI 1.08-2.07); and a low prevalence of obesity (OR 0.47, 95% CI 0.22-1.01); and, in the case of towns of over 1000 inhabitants, a higher physician-population ratio (OR 3.80, 95% CI 1.17-12.3). Conclusions Results indicate that dietary and health care factors have an influence on inframortality. The geographical aggregation suggests that other factors with a spatial pattern, e.g., genetic or environmental might also be implicated. These results will have to be confirmed by studies in situ, with objective measurements at an individual level.</p

Multinational Cholera Outbreak after Wedding in the Dominican Republic

We conducted a case–control study of a cholera outbreak after a wedding in the Dominican Republic, January 22, 2011. Ill persons were more likely to report having consumed shrimp on ice (odds ratio 8.50) and ice cubes in beverages (odds ratio 3.62). Travelers to cholera-affected areas should avoid consuming uncooked seafood and untreated water

Design of an information and management system for the management of the Heart Institute of the Colombian Eastern Cardiovascular Foundation based on the Balanced Scorecard methodology

Con la promulgación de la Ley 100 de 1993 y sus decretos reglamentarios, se puso sobre la mesa el diseño de un Sistema de Garantía de Calidad integral para Colombia y se definieron unos instrumentos que el país consideró prioritarios como son: los requisitos esenciales, definidas como las condiciones mínimas de estructura para permitir el funcionamiento de un prestador; la acreditación para buscar mejoramiento de las instituciones; la auditoría para tener un sistema de seguimiento o monitoreo permanente en la prestación de servicios y el sistema de información a usuarios. En respuesta a lo anterior, la Fundación Cardiovascular, a través del Instituto del Corazón ha venido en el transcurso de los años incorporando acciones relacionadas con el diseño de la prestación del servicio, con la gestión que se lleva a cabo para que este diseño cumpla sus objetivos, con la información que se recoge para mirar su desempeño y con las acciones que se emprenden para corregir sus deficiencias; demostrando así ser una de las mejores instituciones cardiovasculares del país, galardonada en varias oportunidades por su liderazgo en programas, servicios, actividades e investigaciones de calidad y excelencia en el servicio; entre las cuales se pueden mencionar la implementación del sistema de Gestión de la Calidad con la Norma ISO 9000, que certificó los procesos organizativos de la institución y formula los planes de mejoramiento de acuerdo a la evaluación realizada.INTRODUCCIÓN 7 1. JUSTIFICACIÓN 9 2. OBJETIVOS 11 2.1. OBJETIVO GENERAL 11 2.2. OBJETIVOS ESPECÍFICOS 11 3. MARCO DE REFERENCIA 13 3.1. ANÁLISIS INSTITUCIONAL 13 3.2. MARCO CONCEPTUAL 18 3.2.1. Gerencia Estratégica 20 3.2.2. Balanceó Scorcard (BSC) o Tablero de Mando Integral 26 3.2.2.1. Perspectiva financiera 28 3.2.2.2. Perspectiva del cliente 29 3.2.2 3. Perspectiva del proceso interno 30 3.2.2.4. Perspectiva de aprendizaje y crecimiento 33 3.2.3. Etapas metodológicas del B.S.C. 43 3.2.3.1. Primera Etapa 43 3.2.3.2. Segunda Etapa 44 3.2.3.3. Tercera Etapa 44 3 2.3.4. Cuarta Etapa 44 3.2.3.5. Quinta Etapa 45 3.2.3.6. Sexta Etapa 45 3.2.3.7. Séptima Etapa 45 3.3. MARCO LEGAL 46 4. DISEÑO METODOLÓGICO 49 4.1. TIPO DE ESTUDIO 49 4.2. AREA DE ESTUDIO 49 4.3. POBLACIÓN 49 4.4. MÉTODOS DE RECOLECCIÓN DE DATOS 49 4.5. TIEMPO 50 4.6. PROCESO 50 4.6.1. Identificar el enfoque de la organización a través de las Perspectivas 50 4.6.2. Construcción de los objetivos estratégicos 51 4.6.3. Graficación de objetivos estratégicos en un mapa enlace causa-efecto 51 4.6.4. Indicador o inductor con sus respectivas metas. 51 Tablero de Mando Integral 4.6.5. A cada objetivo se le definieron las iniciativas estratégicas y a una de éstas, se le realizó un ejercicio como ejemplo de un plan de acción 4.6.6. Plan para la implementación del Diseño 51 4.7. ANÁLISIS Y TABULACIÓN DE LA INFORMACIÓN 51 5. DISEÑO DE LA PROPUESTA 52 6. ALINEAMIENTOS SUGERIDOS PARA LA IMPLEMENTACIÓN Y CONSOLIDACIÓN DEL DISEÑO 85 CONCLUSIONES 90 RECOMENDACIONES 92 GLOSARIO 94 BIBLIOGRAFÍA 96 ANEXOS 98EspecializaciónWith the promulgation of Law 100 of 1993 and its regulatory decrees, the design of a comprehensive Quality Assurance System for Colombia was put on the table and some instruments were defined that the country considered a priority, such as: essential requirements, defined as the minimum structural conditions to allow the operation of a provider; accreditation to seek improvement of institutions; the audit to have a system of permanent follow-up or monitoring in the provision of services and the information system for users. In response to the above, the Cardiovascular Foundation, through the Heart Institute, has been incorporating actions related to the design of service provision over the years, with the management that is carried out so that this design meets its objectives. objectives, with the information that is collected to look at its performance and with the actions that are undertaken to correct its deficiencies; thus proving to be one of the best cardiovascular institutions in the country, awarded several times for its leadership in quality programs, services, activities and research and service excellence; among which we can mention the implementation of the Quality Management system with the ISO 9000 Standard, which certified the organizational processes of the institution and formulates improvement plans according to the evaluation carried out.Modalidad Presencia