Aim: The objective of the present study was to examine changes in the activity, surgical techniques and results from the process of centralization of complex digestive oncologic surgery in 2005-2012 as compared to 1996-2000. Material and methods: A retrospective cohort study employing the minimum basic data set of hospital discharge (MBDSHD 1996-2012) from public centers in Catalonia (Spain) was performed. The population consisted of individuals aged > 18 who underwent digestive oncologic surgery (esophagus, pancreas, liver, stomach or rectum). Medical centers were divided into low, medium, and high-volume centers (≤ 5, 6-10, and > 10 interventions/year, respectively). The tendency Chi-squared test was used to assess the centralization of patients in high-volume centers and hospital mortality evolution during the study period. Logistic regression was performed to assess the relationship between volume and outcome. Results: A centralization of complex oncologic digestive surgery between 10% (liver) and 46% (esophagus) was obtained by means of a reduction in the number of hospitals that perform these interventions and a significant rise in the number of patients operated in high-volume centers (all types p ≤ 0.0001, except for esophagus). A significant decrease in mortality was observed, especially in esophagus (from 15% in 1996/2000 to 7% in 2009/12, p = 0.003) and pancreas (from 12% in 1996/2000 to 6% in 2009/12, p trend < 0.0001). Conclusions: A centralization of oncologic digestive surgery in high-volume centers and a reduction of hospital mortality in Catalonia were reported among esophageal and pancreatic cancers. However, no significant changes were found for others cancer types.

Objetivo: se examinaron los cambios en actividad, técnicas quirúrgicas y resultados del proceso de concentración de la cirugía oncológica digestiva compleja entre 2005-2012 en relación a 1996-2000. Material y métodos: se realizó un estudio de cohortes retrospectivo a partir del Conjunto Mínimo Básico de Datos (CMBD) al alta hospitalaria (1996-2012) de centros públicos de Catalunya. Población > 18 años intervenida de cáncer de: esófago, páncreas, hígado, estómago y recto. Los centros se clasificaron en: bajo, medio y alto volumen (≤ 5, 6-10 y > 10 procedimientos/año, respectivamente). Utilización del test tendencia Chi-cuadrado para valorar la concentración de pacientes en centros de alto volumen y la evolución de la mortalidad hospitalaria y regresión logística para estudiar la relación entre volumen y resultado en el periodo de concentración (2005-2012). Resultados: se ha producido una progresiva concentración de la cirugía oncológica digestiva compleja, mediante la reducción de entre un 10% (hígado) y 46% (esófago) del número de hospitales que realizan estas intervenciones y el aumento significativo del porcentaje de pacientes intervenidos en centros de alto volumen (todas las p tendencia < 0,0001, excepto esófago). También se observa una reducción significativa de la mortalidad, especialmente en esófago (de 15% en 1996/2000 a 7% en 2009/12, p tendencia = 0,003) y páncreas (de 12% en 1996/2000 a 6% en 2009/2012, p tendencia < 0,0001). Conclusiones: se ha producido una concentración efectiva de la cirugía oncológica digestiva en Cataluña en centros de alto volumen que se ha acompañado de una reducción de la mortalidad hospitalaria clara en esófago y páncreas, aunque sin cambios significativos en los otros cánceres estudiados.

ABSTRACT Background: The PEGASO Project aims to design a technological system aimed at European adolescents to promote healthy lifestyles. The objective was to explore teenagers and their parents and teachers perceptions with regards to mobile technology use in promoting a healthier lifestyle, in terms of food and physical activity. Methods: Qualitative study based on primary data obtained through four focus groups analysis (three teenager groups between 13 and 15 y and 1 parent/teacher group). Verbatim transcriptions have been analysed following content analysis perspective. Results: Four different categories were identified: 1: social and cultural context, 2: adolescents and health, 3: role of technology in teenagers' lives and 4: use of technology to acquire healthier habits. Each category helped to arise various subcategories linked to the relation between teens and health: holistic health concept, health/disease perception directly related with feeling physically fit and social acceptance. With regards to technology, the arisen themes were: feeling connected with others, importance of entertainment/games, omnipresent use of Smartphones and risk of excessive dependence on technology. The difference between teens and adults with regards to health and technology categories were not significant. Conclusions: Both teens and adults think that for technology to be effective in acquiring healthier habits it has to help teens to improve and maintain their self-esteem, in an entertaining way and using their own communication codes, mainly audio-visual ones, always under the umbrella of a holistic and integrated perception of health.

RESUMEN Fundamento: El Proyecto PEGASO pretende diseñar un sistema tecnológico dirigido a adolescentes europeos para fomentar hábitos de vida saludables. El objetivo de este estudio fue explorar las percepciones de adolescentes, sus progenitores y profesores el uso de las tecnologías móviles, la salud y la influencia de las tecnologías en la promoción de estilos de vida saludables en cuanto a alimentación y actividad física. Métodos: Estudio cualitativo basado en datos primarios obtenidos mediante análisis de cuatro grupos focales (tres de adolescentes entre 13 y 15 años y uno de adultos, formado por padres y profesores) que se realizaron en abril y mayo de 2015. Las transcripciones se analizaron bajo la perspectiva del análisis del contenido. Resultados: Emergieron cuatro categorías: 1: marco social y cultural, 2: adolescentes y salud, 3: papel de la tecnología en la vida de los adolescentes y 4: uso de la tecnología para adquirir hábitos más saludables. En cada categoría se identificaron subcategorías vinculadas al nexo entre adolescentes y salud: concepto holístico de salud, identificación de salud/enfermedad con edad adulta, relación de la salud con sentirse en buena forma y aceptación social. En relación al papel que juega la tecnología en la vida de los adolescentes, las subcategorías obtenidas fueron: conexión con otros, elemento de entretenimiento/juego, uso omnipresente del móvil y riesgos asociados a la dependencia excesiva de la tecnología. Las diferencias entre adolescentes y adultos fueron mínimas. Conclusiones: Tanto adolescentes como sus progenitores y profesores consideraron que la tecnología puede ser un buen aliado para fomentar hábitos saludables. El uso de la tecnología es eficaz en la medida que les ayude a mejorar y mantener su autoestima, de forma divertida y utilizando sus propios códigos de comunicación (fundamentalmente audiovisuales), partiendo de una percepción holística e integrada de la salud.

No systematic review is available on studies conducted in Spain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrations of DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individuals may be over 200-fold higher than those of others. The actual magnitude of human contamination by PTS and their trends across Spain -as well as the geographic and social heterogeneity- remain largely unknown.

Aunque en España se han realizado estudios sobre concentraciones en medios biológicos humanos de compuestos tóxicos persistentes (CTP) desde hace varias décadas, no se ha llevado a cabo una revisión sistemática. Los objetivos fueron: a) identificar los estudios realizados en España en los últimos 30 años que hubiesen determinado concentraciones en humanos de diclorodifeniltricloroetano (DDT), diclorodifenildicloroeteno (DDE), hexaclorobenceno (HCB), hexaclorociclohexanos (HCH) y policlorobifenilos (PCB), y b) sintetizar las principales características y resultados de cada estudio. Los estudios son sumamente heterogéneos y la mayoría carece de representatividad poblacional. Las concentraciones de DDT y DDE parecen haber decrecido moderadamente en los últimos 20 años. Hay numerosas fluctuaciones en los valores de HCB, HCH y PCB, en algún caso compatibles con un estancamiento. Se observan grandes diferencias en los valores detectados en los distintos estudios y dentro de un mismo grupo: las concentraciones de CTP de algunos individuos pueden llegar a ser más de 200 veces superiores a los de otros. La magnitud real de la contaminación humana por CTP y sus tendencias a lo largo del territorio español, así como su diversidad geográfica y social, siguen siendo ampliamente desconocidas.

No systematic review is available on studies conducted in Spain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrations of DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individuals may be over 200-fold higher than those of others. The actual magnitude of human contamination by PTS and their trends across Spain -as well as the geographic and social heterogeneity- remain largely unknown.

Aunque en España se han realizado estudios sobre concentraciones en medios biológicos humanos de compuestos tóxicos persistentes (CTP) desde hace varias décadas, no se ha llevado a cabo una revisión sistemática. Los objetivos fueron: a) identificar los estudios realizados en España en los últimos 30 años que hubiesen determinado concentraciones en humanos de diclorodifeniltricloroetano (DDT), diclorodifenildicloroeteno (DDE), hexaclorobenceno (HCB), hexaclorociclohexanos (HCH) y policlorobifenilos (PCB), y b) sintetizar las principales características y resultados de cada estudio. Los estudios son sumamente heterogéneos y la mayoría carece de representatividad poblacional. Las concentraciones de DDT y DDE parecen haber decrecido moderadamente en los últimos 20 años. Hay numerosas fluctuaciones en los valores de HCB, HCH y PCB, en algún caso compatibles con un estancamiento. Se observan grandes diferencias en los valores detectados en los distintos estudios y dentro de un mismo grupo: las concentraciones de CTP de algunos individuos pueden llegar a ser más de 200 veces superiores a los de otros. La magnitud real de la contaminación humana por CTP y sus tendencias a lo largo del territorio español, así como su diversidad geográfica y social, siguen siendo ampliamente desconocidas.

Ainda que sua 'morte' tenha sido freqüentemente certificada, os livros continuam sendo relevantes para muitas profissões e disciplinas acadêmicas. Análises de citações recebidas por textos epidemiológicos podem complementar outras visões em epidemiologia. O objetivo do estudo foi avaliar o número de citações recebidas por alguns livros de epidemiologia e saúde pública, como um primeiro passo para estudar a influência do pensamento epidemiológico e o pensar da academia. Para este propósito, a base de dados do Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledge foi consultada em maio de 2006. O livro de Rothman & Greenland recebeu o maior número de citações no total (mais de 8.000) e por ano. Os livros de Kleinbaum et al, e de Breslow & Day tiveram em torno de 5.000 citações. Em termos de citações por ano, o livro de Sackett et al ocupou o terceiro lugar, e o de Rose, o quarto entre os incluídos no estudo. Outros livros que tiveram influência em salas de aula, comparativamente, tiveram menos citações. Os achados oferecem um rico retrato das influências acadêmicas e tendências de métodos epidemiológicos e interpretação em saúde pública, medicina clínica e outras ciências da saúde, da vida, e sociais. Eles podem contribuir para avaliar os esforços dos epidemiologistas para demarcar a epidemiologia e afirmar sua autoridade epistemológica, e para analisar algumas influências históricas de forças econômicas, sociais e políticas sobre as pesquisas epidemiológicas.

Whilst their 'death' has often been certified, books remain highly important to most professions and academic disciplines. Analyses of citations received by epidemiologic texts may complement other views on epidemiology. The objective was to assess the number of citations received by some books of epidemiology and public health, as a first step towards studying the influence of epidemiological thought and thinking in academia. For this purpose, Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledgedatabase was consulted, in May 2006. The book by Rothman & Greenland appeared to have received the highest number of citations overall (over 8,000) and per year. The books by Kleinbaum et al, and by Breslow & Day received around 5,000 citations. In terms of citations per year the book by Sackett et al ranks 3rd, and the one by Rose, 4th of those included in this preliminary study. Other books which were influential in the classrooms collected comparatively less citations. Results offer a rich picture of the academic influences and trends of epidemiologic methods and reasoning on public health, clinical medicine and the other health, life and social sciences. They may contribute to assess epidemiologists' efforts to demarcate epidemiology and to assert epistemic authority, and to analyze some historical influences of economic, social and political forces on epidemiological research.

Ainda que sua 'morte' tenha sido freqüentemente certificada, os livros continuam sendo relevantes para muitas profissões e disciplinas acadêmicas. Análises de citações recebidas por textos epidemiológicos podem complementar outras visões em epidemiologia. O objetivo do estudo foi avaliar o número de citações recebidas por alguns livros de epidemiologia e saúde pública, como um primeiro passo para estudar a influência do pensamento epidemiológico e o pensar da academia. Para este propósito, a base de dados do Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledge foi consultada em maio de 2006. O livro de Rothman & Greenland recebeu o maior número de citações no total (mais de 8.000) e por ano. Os livros de Kleinbaum et al, e de Breslow & Day tiveram em torno de 5.000 citações. Em termos de citações por ano, o livro de Sackett et al ocupou o terceiro lugar, e o de Rose, o quarto entre os incluídos no estudo. Outros livros que tiveram influência em salas de aula, comparativamente, tiveram menos citações. Os achados oferecem um rico retrato das influências acadêmicas e tendências de métodos epidemiológicos e interpretação em saúde pública, medicina clínica e outras ciências da saúde, da vida, e sociais. Eles podem contribuir para avaliar os esforços dos epidemiologistas para demarcar a epidemiologia e afirmar sua autoridade epistemológica, e para analisar algumas influências históricas de forças econômicas, sociais e políticas sobre as pesquisas epidemiológicas.

Whilst their 'death' has often been certified, books remain highly important to most professions and academic disciplines. Analyses of citations received by epidemiologic texts may complement other views on epidemiology. The objective was to assess the number of citations received by some books of epidemiology and public health, as a first step towards studying the influence of epidemiological thought and thinking in academia. For this purpose, Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledgedatabase was consulted, in May 2006. The book by Rothman & Greenland appeared to have received the highest number of citations overall (over 8,000) and per year. The books by Kleinbaum et al, and by Breslow & Day received around 5,000 citations. In terms of citations per year the book by Sackett et al ranks 3rd, and the one by Rose, 4th of those included in this preliminary study. Other books which were influential in the classrooms collected comparatively less citations. Results offer a rich picture of the academic influences and trends of epidemiologic methods and reasoning on public health, clinical medicine and the other health, life and social sciences. They may contribute to assess epidemiologists' efforts to demarcate epidemiology and to assert epistemic authority, and to analyze some historical influences of economic, social and political forces on epidemiological research.