Democratic quality and excess mortality during the COVID-19 pandemic.

The aim of this study is to analyse the relationship between democratic quality and excess mortality produced in the year 2020 before COVID-19 vaccinations were generalised. Using cross-sectional data from 80 countries on five continents, multiple linear regression models between excess mortality, the general democracy index and its disaggregation into five categories: electoral process and pluralism, government functioning, political participation, political culture and civil liberties were estimated. The analysis also considered, public health spending per capita, overweight inhabitants, the average temperature of the country, population over 65 years of age, The KOF Globalisation Index, and the Gross National Income per capita as control variables.

Design, validation and piloting of clinical vignettes to analyze critical care clinical decision processes during the COVID-19 pandemic in three different countries (Spain, Chile and United States).

Background: The use of heuristics in clinical decision-making processes increases in contexts of high uncertainty, such as those in Intensive Care Units (ICU. Given the impossibility of empirically studying their impact on real-world conditions, clinical vignettes were developed with the goal of identifying the use of heuristics in the care of critically ill patients during the COVID-19 pandemic in different clinical contexts.

Methodology: Vignettes were designed by critical care physicians in Spain to assess the use of representativeness, availability, and status quo heuristics in the care of critically ill patients during the COVID-19 pandemic.

Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals.

Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure.

Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics.

Use of heuristics during the clinical decision process from family care physicians in real conditions.

Rationale Aims And Objectives: The available evidence on the use of heuristics and their relationship with diagnostic error in primary care is very limited. The aim of the study is to identify the use of unknown thought and specifically the possible use of Representativeness, Availability and overconfidence heuristics in the clinical practice of primary care physicians in cases of dyspnoea and to analyse their possible relationship with diagnostic error.

Methods: A total of 371 patients consulting with new episodes of dyspnoea in Primary Care centres in Spain were registered.

Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals.

To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010-2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. : 230 National Health System hospitals were studied over the two-year period 2010-2012 according to their ownership structure-public hospitals, private hospitals and public-private partnership (PPP)-data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier.

[Effect of the use of heuristics on diagnostic error in Primary Care: Scoping review].

Objective: To assess the use of representativeness, availability, overconfidence, anchoring and adjustment heuristics in clinical practice, specifically in Primary Care setting.

Design: Panoramic review (scope review).

Data Sources: OvidMedline, Scopus, PsycoINFO, Cochrane Library and PubMed databases.

[Multilevel analysis of the technical efficiency of hospitals in the Spanish National Health System by property and type of management].

Objective: To analyze technical efficiency by type of property and management of general hospitals in the Spanish National Health System (2010-2012) and identify hospital and regional explanatory variables.

Method: 230 hospitals were analyzed combining data envelopment analysis and fixed effects multilevel linear models. Data envelopment analysis measured overall, technical and scale efficiency, and the analysis of explanatory factors was performed using multilevel models.

[Sex Differences of Perceived Health before and During the Economic Crisis (2007 and 2011). Spain].

Objective: Several studies show the association between economic crises, unemployment and health income. However, it is necessary to differentiate their impact according to gender. The objective of this study was to analyze the effect that the economic crisis, unemployment and income may have had on the perceived health of men and women in Spain.

[Analysis of the technical efficiency of hospitals in the Spanish National Health Service].

Objective: To analyse the technical efficiency and productivity of general hospitals in the Spanish National Health Service (NHS) (2010-2012) and identify explanatory hospital and regional variables.

Methods: 230 NHS hospitals were analysed by data envelopment analysis for overall, technical and scale efficiency, and Malmquist index. The robustness of the analysis is contrasted with alternative input-output models.

Cost-effectiveness of an exercise intervention program in perimenopausal women: the Fitness League Against MENopause COst (FLAMENCO) randomized controlled trial.

Background: The high prevalence of women that do not reach the recommended level of physical activity is worrisome. A sedentary lifestyle has negative consequences on health status and increases health care costs. The main objective of this project is to assess the cost-effectiveness of a primary care-based exercise intervention in perimenopausal women.

[Technical efficiency of traditional hospitals and public enterprises in Andalusia (Spain)].

Objective: To assess the technical efficiency of traditional public hospitals without their own legal identity and subject to administrative law, and that of public enterprise hospitals, with their own legal identities and partly governed by private law, all of them belonging to the taxypayer-funded health system of Andalusia during the period 2005 -2008.

Methods: The study included the 32 publicly-owned hospitals in Andalusia during the period 2005-2008. The method consisted of two stages.

Identification of factors associated with diagnostic error in primary care.

Background: Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason's taxonomy of human error (slips, lapses, mistakes and violations).

[Influence of income, income inequalities and social capital on the health of persons aged 65 and over in Spain in 2007].

The aim of this study is to evaluate the influence of personal income [absolute income hypothesis (AIH)], income inequality and welfare [relative income hypothesis (RIH)], and social capital on the health of older people. Multi-level, cross-sectional logit models are calculated separately for women and men. The database employed was the Spanish Life Conditions Survey for 2007.

[The sustainability of the Spanish National Health System].

The Spanish National Health System (SNHS) has sustainability problems resulting from weaknesses in institutional design and governance compounded by the economic crisis it faces. The global economic crisis has had a particularly virulent impact in Spain, characterized by high levels of unemployment and public and private debt. Fiscal adjustment policies implemented may significantly compromise the SNHS.

Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS.

Background: The epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years.

Methods: Descriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004.

Cost-effectiveness of percent free PSA for prostate cancer detection in men with a total PSA of 4-10 ng/ml.

Objective: To assess the cost-effectiveness of two diagnostic strategies for prostate cancer in men with prostate-specific antigen (PSA) levels of 4-10 ng/ml and normal digital rectal examination (DRE).

Design: Cost-effectiveness analysis was performed using a decision tree model. Data collection and a systematic review of patients at the Urology Department (Carlos Haya Hospital) were made.

Estimation of an index of regional health needs in Spain using count regression models with filter.

The aim of this study is to obtain a measure of health needs at regional level, on the basis of information provided by the health module of the Survey of Disabilities, Deficiencies and State of Health, 1999 (SDDSH99). The methodology includes a careful selection of the independent variables and both estimations as tests of alternative regression models. The results show that, in the five analysed use dimensions, important differences exist in the clinical practice for a same health necessity (horizontal inequity) in function of the residence area.