Mortality trends for accidental falls in older people in Spain, 2000-2015

BACKGROUND: Accidental falls in older people are a major public health problem but a relatively limited number of studies have analyzed the mortality trends from this cause. Effective public health interventions have been found to prevent the incidence of falls and their complications. Therefore, characterizing the mortality trends of falls for different subpopulations can help to identify their needs and contribute to develop more appropriate prevention programs for specific target groups. METHODS: This study was based on a longitudinal analysis of death rates from accidental falls (2000-2015) stratified by sex for the population ≥ 65 years and by age groups (65-74, 75-84, ≥85). A joinpoint regression model was used to identify trend inflection points. The Annual Percent Change (APC) was estimated for each trend. RESULTS: Mortality rates per 100,000 person-years increased from 20.6 to 30.1 for men and 13.8 to 20.8 for women between 2000 and 2015. Men presented a relevant trend increase between 2008 and 2015 (APC [95% CI] 7.2% [5.3;9.2]) and women between 2008 and 2013 (7.9% [4.1;11.8]) There were no trend differences between sexes. For 65-74 years old men we found a relevant increase in the last period (2011-2015) (7.8% [1.0;15.1]). Those aged 75-84 years showed a trend increase between 2007 and 2015 (6.4% [4.4;8.4]) and men ≥85 years presented a remarkably high trend between 2008 and 2015 (9.0% [5.2;13]). There were no relevant differences between age groups. Women aged 65-74 had no relevant trend through the period. Those aged 75-84 presented an uniform trend increase for the whole period, 2000-2015, (3.4% [2.3;4.4]) and women ≥85 had and important trend increase between 2008 and 2013 (11.1% [5.3;17.2]), that has reached an stable level in the last 2 years. There were no relevant differences between the 75-84 and ≥85 age groups. CONCLUSIONS: Recent mortality trends from accidental falls increased in men ≥65 years and women ≥75 years. These results recommend the implementation of specific preventive programs.This work was supported by grant PI15CIII/00037 from the “Carlos III” Institute of Health.S

Mortalidad por causas esternas en España

En España se producen unas 14.000 muertes anuales por causas externas. Según datos de Eurostat 1, en el trienio 2008-2010 España tenía en hombres las tasas ajustadas de mortalidad por causas externas más bajas de los países de la Unión Europea, incluidos los de la Asociación Europea de Libre Comercio (EFTA), y en mujeres sólo Grecia presentaba tasas más bajas. La mortalidad mayor por estas causas se encontraba en Lituania, con unas tasas que para uno y otro sexo cuadruplicaban a las españolas, seguida de Letonia y Estonia. Al hablar de mortalidad por causas externas nos referimos a la que tiene su origen en accidentes, violencia, acontecimientos ambientales, envenenamientos y otros efectos adversos, tal como se recoge en el Capítulo XX de la décima revisión de la Clasificación Internacional de Enfermedades (CIE) y en los códigos «E» de revisiones anteriores 2. Cuando se produce un fallecimiento que obedezca o se sospeche que pueda ser debido a alguna de estas situaciones, es preceptiva la intervención judicial y la práctica de autopsia medicolegal para determinar la causa y circunstancias de la muerte 3, 4. El secretario judicial es el responsable, a partir del informe forense, de cumplimentar el Boletín Estadístico de Defunción Judicial (BEDJ) 5 (hasta 2009 era el documento MNP-52), que es el documento con finalidad estadística a partir del que se selecciona la causa básica de defunción que se codifica de acuerdo con la CIE vigente para la elaboración, por parte del Instituto Nacional de Estadística (INE), de la Estadística de Defunciones según la Causa de Muerte 6. En estos casos se considera como causa básica de defunción el acontecimiento que origina las lesiones que conducen a la muerte, siguiendo las normas de la Organización Mundial de la Salud. Dentro de este grupo tenemos una variedad de causas que de acuerdo con la CIE se pueden clasificar en intencionales (suicidio y homicidio), no intencionales (accidentes, ya sean de tráfico o de cualquier otro tipo, incluyendo las causas de iatrogenia) y de intención indeterminada. Los accidentes laborales mortales no se pueden diferenciar por la configuración de las CIE. Según las fuentes específicas, la mortalidad por accidentes laborales de causa traumática vendría a suponer alrededor de un 11% de todas las defunciones de causa externa no intencional en las edades productivas 7, 8. Las causas de intención indeterminada en España supusieron en el período 2007-2011 solo un 0,6% de todas las externas, porcentaje muy inferior al de otros países. Así, en la unión europea, como media en el trienio 2008-2010 significaron el 5,1%, aunque con grandes variaciones, presentando los porcentajes más bajos los países mediterráneos, y los más altos los del este y, principalmente y a bastante distancia, Portugal (25%) 9. En algunos países, una mayoría de fallecimientos así clasificados responden a la sospecha de que pueda tratarse de algunas causas como homicidio y principalmente suicidio, pero cuya intencionalidad no queda absolutamente clara.N

Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues

OBJECTIVE: Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders. DESIGN: Ecological time series analysis. SETTING: Residents of Madrid and Barcelona cities (Spain). OUTCOME: Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003-2006 Spanish hospital admissions registry. METHODS: Changes in admission rates between 2006 and the 2003-2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count. RESULTS: In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona. CONCLUSIONS: Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity.This work was supported by grant FIS PI11/01276 from the Institute of Health Carlos III, Ministry of Economy and Competitiveness.S

Classification of illicit drug-induced deaths in Spain: toward the adoption of the European standard criteria.

[ES] Objetivos: Describir los patrones de codificación CIE-10 de las muertes directamente relacionadas con drogas ilegales (DRDI) en el Registro General de Mortalidad (RGM), evaluar la aplicabilidad del criterio europeo (que no considera X44) para extraer estas muertes del RGM y estimar la mortalidad DRDI en España corrigiendo la subestimación. Métodos: Se extrajeron las muertes DRDI del RGM para 1999–2007 utilizando los criterios europeo y español, se compararon ambas cifras y se evaluaron las diferencias temporoespaciales en los patrones de codificación. Se estimó la mortalidad DRDI estatal aplicando un índice corrector de subestimación, procedente de un registro específico, a las muertes extraídas del RGM. Resultados: Utilizando el criterio español en 1999–2007 se extrajeron del RGM 5.878 muertes DRDI, un 88,4% del capítulo XX, principalmente de X42 (48,4%) y X44 (38,8%), y el resto del capítulo V, principalmente de F19 (11,5%). El capítulo V supuso un 6,6% en 1999, un 24,6% en 2003 y un 8,0% en 2007. En 2005–2007 las comunidades que más utilizaron el capítulo V fueron Cataluña y Andalucía (34,9% y 30,1%, respectivamente). Con el criterio europeo se extraen bastantes menos muertes DRDI que con el español. La mortalidad DRDI corregida por subnotificación utilizando el criterio español pasó de 4,7/100.000 habitantes de 15–49 años de edad en 1999 a 4,1/100.000 en 2007. Conclusiones: En España, aplicar el criterio europeo para extraer las muertes DRDI da problemas, porque a cada muerte DRDI se le asigna un único código, que además en ocasiones es bastante inespecífico. Hay que adoptar criterios estatales comunes de codificación en línea con los europeos. [EN] To describe patterns of ICD-10 classification of illicit drug-induced deaths (DID) in the General Mortality Register (GMR), to assess the applicability of the European criterion (which excludes the X44 code) to extract these deaths from the GMR, and to estimate drug-induced mortality in Spain by applying a correction index for underestimation. DID between 1999 and 2007 were extracted from the GMR using the European and the Spanish criteria. Both data sets were compared, and differences in classification patterns by time and space were assessed. Estimations of national mortality from DID were calculated by applying a correction index for underestimation, derived from a specific mortality register, to the deaths extracted from the GMR. Using the Spanish criterion, 5,878 DID were extracted from the GMR for 1999-2007, 88.4% within chapter XX, mainly X42 (48.4%) and X44 (38.8%), and the remaining within chapter V, mainly F19 (11.5%). Chapter V accounted for 6.6% in 1999, 24.6% in 2003 and 8.0% in 2007. Between 2005 and 2007, Catalonia and Andalusia were the autonomous regions showing greatest use of this chapter (34.9% and 30.1%, respectively). Substantially fewer deaths were extracted when the European criterion was used. When the Spanish indicator was used, the estimated DID mortality rate corrected by the underestimation index decreased slowly from 4.7/100,000 in 1999 to 4.1/100,000 inhabitants aged 15-49 years old in 2007. In Spain, applying the European criterion for extracting DID from the GMR created certain problems, because each DID is assigned a single code, which is sometimes non-specific. Common national criteria should be adopted, following the European criteria as far as possible.Proyecto FIS (PI070661) y RTA (RD06/0001/1018).S

Reuse of terminological resources for efficient ontological engineering in Life Sciences

This paper is intended to explore how to use terminological resources for ontology engineering. Nowadays there are several biomedical ontologies describing overlapping domains, but there is not a clear correspondence between the concepts that are supposed to be equivalent or just similar. These resources are quite precious but their integration and further development are expensive. Terminologies may support the ontological development in several stages of the lifecycle of the ontology; e.g. ontology integration. In this paper we investigate the use of terminological resources during the ontology lifecycle. We claim that the proper creation and use of a shared thesaurus is a cornerstone for the successful application of the Semantic Web technology within life sciences. Moreover, we have applied our approach to a real scenario, the Health-e-Child (HeC) project, and we have evaluated the impact of filtering and re-organizing several resources. As a result, we have created a reference thesaurus for this project, named HeCTh

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Unidad de excelencia María de Maeztu CEX2019-000940-MAim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types

Estimating the global conservation status of more than 15,000 Amazonian tree species

Estimates of extinction risk for Amazonian plant and animal species are rare and not often incorporated into land-use policy and conservation planning. We overlay spatial distribution models with historical and projected deforestation to show that at least 36% and up to 57% of all Amazonian tree species are likely to qualify as globally threatened under International Union for Conservation of Nature (IUCN) Red List criteria. If confirmed, these results would increase the number of threatened plant species on Earth by 22%. We show that the trends observed in Amazonia apply to trees throughout the tropics, and we predict thatmost of the world’s >40,000 tropical tree species now qualify as globally threatened. A gap analysis suggests that existing Amazonian protected areas and indigenous territories will protect viable populations of most threatened species if these areas suffer no further degradation, highlighting the key roles that protected areas, indigenous peoples, and improved governance can play in preventing large-scale extinctions in the tropics in this century

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Aim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types. Location: Amazonia. Taxon: Angiosperms (Magnoliids; Monocots; Eudicots). Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran\u27s eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny. Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R$^{2}$ = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R$^{2}$ = 28%). A greater number of lineages were significant indicators of geographic regions than forest types. Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions