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INTRODUCTION: Perinatal mortality has been decreasing in Spain; nevertheless completeness of death certificates was questioned because of the underreporting observed. OBJECTIVE: To quantify perinatal mortality reporting of birth and infant-death certificates and obstetrics and neonatal hospital records of the Autonomous Community of Murcia in 2003. MATERIAL AND METHODS: Newborns with a weight of at least 500 g or 22 weeks gestation, who died before the 8th day, were included. The dates came from birth certificates (stillbirths and infants died before one day of life) and death certificates (more than one day, and obstetrics-neonatal hospital records. Detection rates were calculated for death certificates and hospital registrations. RESULTS: One hundred fifty WHO-cases, of which 72 agreed with both sources. Sixty one percent of coincident cases were stillbirths. The underreporting was 26 % in Obstetrics and 10 % in Neonatology. Only 16 % of deaths were reported in the Official Statistics. CONCLUSIONS: Medical perinatal mortality reporting remains inadequate. Official Statistics and Obstetrics - Neonatology records add independent and complementary information.

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Introducción: La mortalidad perinatal desciende en España, pero varios estudios cuestionan su exhaustividad por la subdeclaración detectada. Objetivo: Cuantificar y comparar la mortalidad perinatal detectada por los boletines estadísticos de parto (BEP) y de defunción (BED) frente a los registros de obstetricia y neonatología de la Región de Murcia en 2003. Material y métodos: Se incluyen los nacidos de al menos 500 g o 22 semanas de gestación que fallecen antes del día 8. Los datos provienen del BED, BEP, paritorio o neonatología. Se calculan las tasas de detección de boletines y registros sanitarios. Resultados: Se obtienen 150 casos-OMS, de los cuales 72 coinciden en ambas fuentes. El 61 % de los casos coincidentes son nacidos muertos. La subcertificación es del 26 % en obstetricia y del 10 % en neonatología. El 16 % de las defunciones sólo constan en los boletines estadísticos. Conclusiones: La certificación médica de la mortalidad perinatal sigue siendo insuficiente. La estadística oficial y los registros obstétrico-pediátricos aportan información independiente y complementaria

Introduction: Perinatal mortality has been decreasing in Spain; nevertheless completeness of death certificates was questioned because of the underreporting observed. Objective: To quantify perinatal mortality reporting of birth and infant-death certificates and obstetrics and neonatal hospital records of the Autonomous Community of Murcia in 2003. Material and methods: Newborns with a weight of at least 500 g or 22 weeks gestation, who died before the 8th day, were included. The dates came from birth certificates (stillbirths and infants died before one day of life) and death certificates (more than one day, and obstetrics-neonatal hospital records. Detection rates were calculated for death certificates and hospital registrations. Results: One hundred fifty WHO-cases, of which 72 agreed with both sources. Sixty one percent of coincident cases were stillbirths. The underreporting was 26 % in Obstetrics and 10 % in Neonatology. Only 16 % of deaths were reported in the Official Statistics. Conclusions: Medical perinatal mortality reporting remains inadequate. Official Statistics and Obstetrics - Neonatology records add independent and complementary information

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OBJECTIVE: To know the training need priorities in Spanish physicians in death certification. DESIGN: Study of needs by consensus technique Delphi. SETTING: Health care and medical-legal institutions in Spain. PARTICIPANTS: Physicians who ask for information in death certification, after reading an article in a medical magazine (n=38), and agree to participate (n=33). METHODS: Priorities were established by means of a list of items, based on teaching experience and professional advice. The scores obtained for each priority were hierarchized, and the participants professional profiles were described. An analysis of hierarchical clusters was done to determine profiles of training. RESULTS: The median age of the participants was 42 years, with 18 years experience in general/family, emergency or forensic medicine, which usually certified in median 8 death a year (rank from 0 to 50). The maximum training priorities were how to register a death and which doctor should make out the official documents. Intermediate priorities included the role of doctors in violent or accidental deaths. In the main three grouping needs were, in one, include certification as a degree subject and learn how different documents are made out; although in the others two, were how to register a death, which physician make out the documents, and when it should certify the family doctor and when the coroner. CONCLUSIONS: The priorities in certification training are how to register a death and who should make out the documents, pointing out that the shortcoming continues in medical training in death certification.

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Evaluamos la exactitud del diagnóstico de cáncer en la certificación de defunción (CD) de los habitantes de la Región de Murcia en 1992, comparándolo con la información clínica del registro de cáncer, para obtener la concordancia por edad y sexo, y la sensibilidad y el valor predictivo positivo. En el 79,4 por ciento de los 1.351 fallecidos coincide el cáncer del CD con la documentación clínica. La concordancia es algo mayor en hombres (79,0 por ciento) que en mujeres (76,1 por ciento), y en los casos sin confirmación histológica (83,5 por ciento) que con microscopía (77,1 por ciento), sin ser significativos. La concordancia es significativamente mayor en los menores de 80 años frente a los de más edad. Las localizaciones bien certificadas son el cáncer de estómago, pulmón, melanoma, mama de la mujer, ovario, próstata, encéfalo, mieloma múltiple y las leucemias linfoides; y las peor certificadas el cáncer de hueso, el de tejido conjuntivo y los de sitio primario desconocido. Los resultados son semejantes a otras áreas españolas, aunque con algunas diferencias por localizaciones anatómicas (AU)

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Objetivo. Conocer las necesidades prioritarias en formación de certificación de defunciones en los médicos españoles. Diseño. Estudio de necesidades por la técnica de consenso Delphi. Emplazamiento. Centros sanitarios y de medicina legal en España. Participantes. Médicos lectores de un artículo de divulgación, que solicitan materiales sobre certificación de defunciones (n = 38) y aceptan participar (n = 33).Método. Establecimiento de prioridades mediante una lista de ítems basada en la experiencia docente y la asesoría de expertos. Jerarquizamos las puntuaciones de prioridades, caracterizamos a los participantes y realizamos un análisis de clusters jerárquicos para determinar perfiles de formación. Resultados. Los informantes tienen una mediana de edad de 42 años, con 18 años de ejercicio en medicina general/familiar, urgencias o legal y certifican/informan una mediana de 8 muertes-año (rango, 0-50).Las necesidades más priorizadas son conocer cómo hay que declarar y saber qué médico debe cumplimentar los documentos. En posiciones intermedias se ubica el papel de los médicos en las muertes violentas o accidentales. En los tres principales agrupamientos observamos que las prioridades son, en uno, incluir la certificación como materia docente en la licenciatura, conocer las diferencias de cumplimentación entre los documentos, y en los otros dos conocer cómo declarar la defunción, qué médico debe cumplimentarla y cuándo debe certificar el médico de cabecera y cuándo el médico forense. Conclusión. Las prioridades de formación son conocer cómo declarar una defunción y saber qué médico debe certificarla, señalando que se mantiene el déficit de formación médica en la certificación de defunciones (AU)

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Objetivo. Los estudios epidemiológicos y las intervenciones para reducir las desigualdades en salud en la comunidad requieren la asignación de indicadores socioeconómicos exhaustivos y fáciles de obtener. Dos de los más utilizados son la ocupación y la educación. En este estudio pretendemos evaluar la asociación entre educación y ocupación en población adulta ocupada, por si, en ausencia de una variable, fuera posible utilizar la otra con la menor pérdida posible de información sobre nivel socioeconómico. Diseño. A partir de una muestra representativa (n = 3.091) de población general (18-65 años), tomada de una encuesta de prevalencia sobre factores de riesgo de enfermedades crónicas realizada en la Región de Murcia, se ha realizado un análisis (log)lineal entre educación y ocupación en la población ocupada (65,8 por ciento varones y 34,2 por ciento mujeres de la muestra total). Resultados. Los varones presentan una asociación significativa entre las posiciones directivas y la educación universitaria. La asociación se reduce entre la ocupación en tareas administrativas y la categoría de estudios secundarios, para incrementarse en los trabajadores manuales con estudios primarios o sin estudios. En las mujeres, con un menor número de efectivos, la asociación educación-ocupación describe el mismo patrón, incluso con mayor magnitud en las asociaciones entre las clases directivas y el nivel educativo universitario. En varones y mujeres las mayores asociaciones se encuentran en ambas diagonales de las tablas de educación por ocupación, indicando: a mejor ocupación, mayor educación, y lo contrario. Conclusión. La clasificación de la gente con trabajo de acuerdo con la educación y la ocupación presenta: asociación, consistencia interna y gradiente. En ausencia de información exhaustiva sobre ocupación, la educación puede ser una alternativa como indicador de nivel socioeconómico (AU)

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OBJECTIVE: Epidemiological studies and interventions to reduce inequalities in community health require the assignation of exhaustive and easy-to-obtain social indicators. Occupation and education are two of the most often used. In this study we attempt to evaluate the association between education and occupation among adult working population because if, in the absence of one of these two variables, it will be feasible to use the remaining with the lesser lost of socio-economic information. DESIGN: From a representative sample (n = 3091) of general population (18-65 years old) drawn out from a prevalence survey on chronic disease risk factors performed in the Region of Murcia, a log-lineal analysis has been made between education and occupation among working people (65.8% of males and 34.2% of females from the original sample). RESULTS: Men present significant association between managerial positions and university education. The association drops between clerks and high school graduates to increase among all manual workers with or without primary schooling education. Among women--with a lesser number of participants--the education/occupation association describes the same pattern but with higher magnitudes in the positive associations between managerial positions and university education. For both genders, the greatest associations are found in both diagonals of the education by occupation tables indicating: better occupation, more education, and the opposite. CONCLUSIONS: The classification of working people according to education and occupation presents association, internal consistency and gradient. In absence of comprehensive information regarding occupation, education could be an alternative as socio-economic indicator.

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The aim of this study is to Mortality show the protocol of analysis which was set out as part of the EMECAM Project, illustrating the application thereof to the effect of pollution has on the mortality in the city of Valencia. The response variables considered will be the daily deaths rate resulting from all causes, except external ones. The explicative variables are the daily series of different pollutants (black smoke, SO2, NO2, CO, O3). As possible confusion variables, weather factors, structural factors and weekly cases of flu are taken into account. A Poisson regression model is built up for each one of the four deaths series in two stages. In the first stage, a baseline model is fitted using the possible confusion variables. In the second stage, the pollution variables or the time legs thereof are included, controlling the residual autocorrelation by including mortality time lags. The process of fitting the baseline model is as follows: 1) Include the significant sinusoidal terms up to the sixth order. 2) Include the significant temperature or temperature squared terms with the time lags thereof up to the 7th order. 3) Repeat this process with the relative humidity. 4) Add in the significant terms of calendar years, daily tendency and tendency squared. 5) The days of the week as dummy variables are always included in the model. 6) Include the holidays and the significant time lags of up to two weeks of flu. Following the reassessment of the model, each one of the pollutants and the time lags thereof up to the fifth order are proven out. The impact is analyzed by six-month periods, including interaction terms.

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BACKGROUND: The problems of air pollution became noticeable in Cartagena in the seventies, high SO2 and particle levels having been reached from time to time. Our aim is to assess, using the EMECAM methodology, the acute impact of SO2 and particle air pollution on the daily death rate of the city of Cartagena in the 1992-1996 period. METHODS: A daily listing is provided of the total number of non-accidental deaths within the population as a whole and for those over age 70, the cardiovascular and the respiratory deaths due to dioxide and particle air pollution for the 1992-1996 period using autoregressive Poisson models which control seasonality, weather, time of year, flu, special events, and time lags. RESULTS: In the period under study, there has been a drop in the SO2 air pollution as compared to previous years, which was not as marked for the particles. The analyses reveal significant relationships in the total non-accidental deaths in those over age 69, with the average particle count and those particles with cardiovascular deaths for the months of May to October. In the six-month period of the year, when the weather is cold, we found a positive statistically significant relationship to exist in the maximum daily hourly value of the particles and the deaths due to cardiocirculatory and respiratory diseases. However, there is no consistency in the between on assessing the reliability of the models.

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BACKGROUND: To broaden the experiences of evaluation of the learning and satisfaction of the workshops of pre and postgraduates of medicine for the improvement in the certification of the causes of death with contributions from the Region of Murcia, 1992-1996. METHODS: With a quasi-experimental pre-posttest epidemiological design, a workshop is given, being both theoretical and practical of 2 hours addressed to students of medicine, interns in Family and Community Medicine and doctors in the course of obtaining said specialty. The goal of the workshop is to teach the usefulness of Mortality Statistics and the International WHO norms of certification. At start and finish we evaluated the formation by research, using indicators of formal quality, concept and result of the completion. Also, we administrate a questionnaire of satisfaction. RESULTS: In five years 23 workshops with 646 assistants were given, including 472 pairs of exercises and 586 satisfaction's questionnaires. In the pretest, more than 78% of the individual indicators were correct and 52.3% of the participants completed everything well. There were statistically significant improvements in the groups of indicators of concept and result, but not that of form, which showed a high qualification from the beginning (77.5%). The assignation of cause of death has improve more with the students (24.6%) than in physicians (14.4%). The contents of the course are very adequate/adequate (92.7%), without difference among the types of helpers. There is an equilibrium between theory and practice (64.7%). Eighty-one point three of physicians and 80.2% of the students stated that the workshop was useful for correctly certifying a death, independent of the previous background. CONCLUSIONS: The good initial qualifications were improved after the educational intervention. In accordance with workshops demonstrated efficacy, we propose their generalization and to follow its impact on Mortality Statistics.

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