Ballesta Ruiz, Mónica

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Ballesta Ruiz, Mónica

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Ballesta Ruiz, Mónica

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Universidad de Murcia. Departamento de Ciencias Sociosanitarias

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Open Access
Time trends and geographical variations in mortality due to suicide and causes of undetermined intent in Spain, 1991-2008
(Oxford University Press, 2013-01-04) Salmerón, D.; Cirera, L.; Navarro-Mateu, F.; Ballesta Ruiz, Mónica; Ciencias Sociosanitarias
Background This study analyses the trends, geographical variations, seasonal patterns and methods of mortality due to the combination of suicide and causes of undetermined intent in Spain between 1991 and 2008. Methods. Age-adjusted suicide rates were calculated. Poisson models were used to estimate rate ratios and annual percentage changes. Results. Suicide rates decreased in all age groups with the exception of the 35–44 and 45–54 age groups. There were important geographic variations in suicide rates. Spring and summer were the seasons with the highest suicide rates. Suicide rates for hanging decreased, although the rates increased in the 35–44 age group of males. A significant upward trend in suicide by jumping was observed for males aged 15–54 and for females aged 25–64. There were almost no differences when the deaths of undetermined intent were excluded. Conclusions. Suicide rates decreased in both males and females, although the downward trend was not observed in males and females aged 35–44 or in females in the 45–54 age group. A significant upward trend in suicide rates for jumping was observed in some age groups. Substantial geographical variations in suicide rates were observed. The highest rates were observed in the warmest months.
Open Access
Eficacia de la capacidad y la eficiencia pronósticas de la herramienta de inteligencia artificial Thoracic Care Suite de GE aplicada a la radiografía torácica de pacientes con neumonía COVID-19
(Elsevier, 2023-01-31) Plasencia Martínez, Juana María; Pérez Costa, Rafael; Ballesta Ruiz, Mónica; García Santos, José María; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
Objective: Rapid progression of COVID-19 pneumonia may put patients at risk of requiring ventilatory support, such as non-invasive mechanical ventilation or endotracheal intubation. Implementing tools that detect COVID-19 pneumonia can improve the patient's healthcare. We aim to evaluate the efficacy and efficiency of the artificial intelligence (AI) tool GE Healthcare's Thoracic Care Suite (featuring Lunit Insight CXR, TCS) to predict the ventilatory support need based on pneumonic progression of COVID-19 on consecutive chest X-rays. Methods: Outpatients with confirmed SARS-CoV-2 infection, with chest X-ray (CXR) findings probable or indeterminate for COVID-19 pneumonia, who required a second CXR due to unfavorable clinical course, were collected. The number of affected lung fields for the 2 CXRs was assessed using the AI tool. Results: One hundred fourteen patients (57.4 ± 14.2 years; 65 of them were men, 57%) were retrospectively collected; and 15 (13.2%) required ventilatory support. Progression of pneumonic extension ≥ 0.5 lung fields per day compared to pneumonia onset, detected using the TCS tool, increased the risk of requiring ventilatory support by 4-fold. Analyzing the AI output required 26 seconds of radiological time. Conclusions: Applying the AI tool, Thoracic Care Suite, to CXR of patients with COVID-19 pneumonia allows us to anticipate ventilatory support requirements requiring less than half a minute.
Open Access
Características sociales y de género en el ámbito de contagio de COVID-19 en una región mediterránea
(Ministerio de Sanidad y Consumo, 2022-12-19) Soriano López, Jesús; Salmerón Martínez, Diego; García Pina, Rocío; Humberto Gómez, Jesús; Sánchez Rodríguez, Inés; Ballesta Ruiz, Mónica; Chirlaque López, María Dolores; Ciencias Sociosanitarias; Facultad de Enfermería
BACKGROUND // Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin,occupational social class and gender, which is essential in order to designing public health strategies. METHODS // A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables. RESULTS // The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%). CONCLUSIONS // The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class.
Open Access
Partial contributions and temporal trends of leading causes of death during the last four decades in Spain
(Elsevier, 2020-12) Cirera, L; Márquez-Calderón, S; Saez, M; Salmerón, D; Ballesta Ruiz, Mónica; Chirlaque López, María Dolores; Ciencias Sociosanitarias
Objectives: The study was conducted to assess time trend shifts of leading causes of death and their partial contributions over the years 1975-2016 in Spain. Study design: A longitudinal ecological epidemiologic design was conducted to analyse linear trend period shifts using joinpoint regression as the annual percentage of change (APC) in the period 1975-2016. The partial contributions were illustrated as the rate ratio of a singular-cause to their major-cause shift periods. Results: HIV/AIDS shaped the increasing trend period of infectious diseases in 1989-1995 (APC = 25.3, P < 0.05) and the decreasing trend in 1995-1999 and 1999-2016. Lung cancer fell gradually from 1994 in men (-0.4, P < 0.05); however, in women, the condition continued increasing from 1990 (P < 0.05). Dementia types influenced mental and neurological disease drifts. The recent trend for circulatory periods (1980-2016) was mainly modulated by cardiac ischaemia, with increased partial contributions (25%, 32% and 30%). Traffic accidents defined the descending tendency of external causes. Conclusions: Spain showed a Western pattern in descended rates, including non-decreasing trends in mental and neurological diseases, pancreatic cancer, drug abuse and suicide. Trend shifts and partial contributions illustrated targets for further mortality reduction.
Open Access
Trastornos mentales e ideación suicida en la Región de Murcia : análisis geográfico
(Universidad de Murcia, 2023-06-19) Ballesta Ruiz, Mónica; Navarro Mateu, Fernando; Salmerón Martínez, Diego; Escuela Internacional de Doctorado
Introducción: La salud mental de la población es un área estratégica de la Salud Pública y su morbilidad no es geográficamente homogénea. Los últimos planes oficiales de salud mental poblacional remarcan la necesidad de establecer sistemas de información sanitaria a nivel geográfico. Las cifras de prevalencia de trastornos mentales suelen ser de ámbito nacional y/o por comunidades autónomas. Para la gestión sanitaria se necesitarían datos a menor escala como lo son las áreas sanitarias. Objetivo: Realizar un análisis geográfico y epidemiológico de la salud mental en las áreas sanitarias de la Región de Murcia. Métodos: El proyecto PEGASUS-Murcia es un estudio transversal realizado en 2011-2012 en una muestra representativa de la población de la Región de Murcia (n=2 621; tasa de respuesta=67.4%). Su diseño muestral incluyó sus nueve áreas sanitarias. Para detectar diferencias entre éstas en la prevalencia de los trastornos mentales, ideación suicida y uso de servicios sanitarios se utilizaron modelos de regresión logística multivariante. Resultados: Las áreas sanitarias de mayor prevalencia en la vida fueron el área IX Vega Alta del Segura (70.4, IC95%: 60.6, 78.5%) y área VIII Mar Menor (36.5, IC95%: 33.2, 40.0), mientras que la de menor fue el área III Lorca (22.5, IC95%: 17.2, 29.0). Considerada esta última como referencia, las diferencias geográficas se han dado entre todas las áreas excepto en una, el área IV Noroeste, siendo las mayores diferencias en el conjunto del área V Altiplano y área IX Vega Alta del Segura (OR=3.24, IC95%: 1.46, 7.19, p=0.009) y en el área VIII Mar Menor (OR=1.90, IC95%: 1.34, 2.70, p=0.003). En la prevalencia para el último año se han reducido las diferencias geográficas, aunque manteniéndose para estas dos últimas áreas (OR=2.11, IC95%: 1.53, 2.91, p=0.001 y OR=2.56, IC95%: 2.02, 3.23, p<0.001 respectivamente) y en el área VI Vega Media (OR=1.28, IC95%: 1.07, 1.53, p=0.014). Las diferencias geográficas se han establecido en los trastornos relativos a la ansiedad, no así en el estado del ánimo. Las áreas que ha presentado mayor ideación suicida han seguido siendo el conjunto del área V Altiplano y área IX Vega Alta del Segura (OR=2.58, IC95%: 1.09, 6.14, p=0.035) y las que menor uso de servicios sanitarios en salud mental el área VIII Mar Menor (30.3, IC95%: 24.8, 36.4), donde las diferencias han estado en esta área, en el área II Cartagena (OR=0.99, IC95%: 0.75, 1.30, p=0.936) y el conjunto de área V Altiplano y área IX Vega Alta del Segura (OR= 1.35, IC95%: 0.57, 3.21, p=0.447). Conclusiones: Existen diferencias en la prevalencia de trastornos mentales, la ideación suicida y el empleo de servicios en salud mental entre las áreas sanitarias, lo que conduce a detectar áreas de especial vulnerabilidad, especialmente el conjunto de áreas IX Vega Alta del Segura, V Altiplano, XIII Mar Menor y II Cartagena. Disponer de los datos de prevalencia por área de gestión facilitaría la planificación de estrategias de salud mental acordes con los ámbitos de gestión y planificación sanitaria.
Open Access
The adolescent problem gambling prevalence associated with leisure‑time activities and risky behaviors in Southern Spain
(Springer, 2022-11-18) Moñino García, Miriam; Ballesta Ruiz, Mónica; Huerta, J.M.; Correa‑Rodríguez, J.F.; Cabrera‑Castro, N.; Llorens, N.; Chirlaque López, María Dolores; Ciencias Sociosanitarias; Facultad de Enfermería
Gambling addiction is increasing and is becoming a public health concern due to the rise of gambling-related harms affecting the youth. Previous studies suggest a strong link between problem gambling (PG) and substance use and psychosocial and familial factors. Our main objective was to analyze the association between PG and factors like sport, leisure-time activities, and risk-taking behaviors in adolescents. A survey on substance use and addictive behaviors was performed in 2019 on a representative sample of 2240 subjects (14–18 years) from the Southern Spain Region. Data variables like socio-demographic characteristics, sport, leisure and free time activities, family environment, PG (Lie-Bet Scale), compulsive internet use (CIUS Scale), and consumption of alcohol and cannabis were collected using a standardized questionnaire. Weighted PG prevalence was estimated in either sex, as well as the differences between various levels of PG using chi-square tests. Crude and adjusted weighted logistic regression models were used to identify predictors associated with PG. The prevalence of PG was associated with shopping frequency, compulsive internet use, cannabis use in the previous month, higher family economic status, and having a homemaker father which increased the likelihood of PG. On the contrary, cultural hobbies such as playing an instrument, painting, singing, and writing, and having a working mother were inversely associated with PG. Our results suggest that encouraging participation in creative activities along with supervised shopping and monitoring compulsive internet use and cannabis consumption may contribute some protection against adolescent PG.
Open Access
Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)
(BioMed Central, 2015-04-01) Nolasco, Andreu; Quesada, José Antonio; Moncho, Joaquín; Melchor, Inmaculada; Pereyra Zamora, Pamela; Tamayo Fonseca, Nayara; Martínez Beneito, Miguel Ángel; Zurriaga, Óscar; Ballesta Ruiz, Mónica; Daponte, Antonio,; Gandarillas, Ana; Domínguez Berjón, María Felicitas; Marí-Dell'Olmo, Marc; Gotsens, Mercè; Izco, Natividad; Moreno, María Concepción; Sáez, Marc; Sánchez Villegas, Pablo; Borrell, Carme; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
Background Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
Open Access
Incidence and trend of type I and II endometrial cancer in women from two population-based european cancer registries (1998–2012)
(MDPI, 2022-03-23) Rodríguez-Palacios, Daniel Ángel; Colorado-Yohar, Sandra M.; Velten, Michel; Vaamonde-Martín, Ricardo J.; Ballesta Ruiz, Mónica; Chirlaque López, María Dolores; Ciencias Sociosanitarias; Facultad de Enfermería
Endometrial cancer (EC) is the most frequent female genital tract cancer in Europe. This cohort study aimed to determine age-standardised incidence rates and long-term trends of type I and II endometrial cancer in women from population-based cancer registries in the Region of Murcia (Spain) and the Bas-Rhin area (France). Data of new cases of endometrial cancer between 1998 and 2012 were obtained from the Murcia and Bas-Rhin cancer registries. In that period, 3756 cases of endometrial cancer were recorded, with 3270 corresponding to type I EC and 486 corresponding to type II EC. The Bas-Rhin area presented higher age-adjusted incidence rates than those in the Region of Murcia for both type I EC (24.2 and 19.3 cases/100,000 person-years (py), respectively) and type II EC (4.4 and 2.3 cases/100,000 py, respectively). Joinpoint regression showed no changes in trends. In both populations, there was an increasing trend for both EC types, but the trend was steeper in the Region of Murcia and larger overall for type II EC. Finally, a significant increase was observed in the annual trend of type II EC. Further studies are warranted to determine the potential risk factors, and continued efforts are needed to improve the recording and monitoring of EC types.
Open Access
Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities
(BioMed Central, 2016-07-29) Marí-Dell’Olmo, Marc; Gotsens, Mercè; Palència, Laia; Rodríguez Sanz, Maica; Martínez Beneito, A.; Ballesta Ruiz, Mónica; Calvo, Montse; Cirera, Lluís; Daponte, Antonio; Domínguez Berjón, Felicitas; Gandarillas, Ana; Izco Goñi, Natividad; Martos, Carmen; Moreno Iribas, Conchi; Nolasco, Andreu; Salmerón Martínez, Diego; Borrell, Carme; Taracido, Margarita; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
Background In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. Methods Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996–1998 and 2005–2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). Results For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12–1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09–1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05–1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02–1.06 in the 2nd period). Conclusions In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.
Open Access
Clinical prediction scale approach derived from a retrospective study to reduce the number of urgent, low-value cranial CT scans
(Springer, 2024-07-26) Plasencia Martínez, Juana María; Otón González, Elena; Sánchez Canales, Marta; Ortiz Mayoral, Herminia; Cotillo Ramos, Estefanía; Casado‑Alarcón, Nuria Isabel; Ballesta Ruiz, Mónica; Villaverde González, Ramón; García Santos, José María; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
Purpose: Fifty percent of cranial CT scans performed achieve no benefit and entail risks. Our aim is to determine the yield of non-traumatic urgent cranial-CT and develop a pretest clinical probability scale approach. Methods: Adult patients seen in our emergency department between 2017–2021 and referred for urgent cranial-CT for non-traumatic reasons were retrospectively recruited and randomly selected. Presenting complaint (PC), demographic variables, Relevant radiological findings (RRF) on the urgent cranial-CT and Relevant clinical-radiological findings (RCRF: admission need or RRF detection on the urgent cranial-CT or cranial CT/MRI in the following three months) were recruited. Results: We recruited 702 patients, with median age 62 [47–76] years, 363 (51.7%) females. RCRF were observed in 404 (57.55%); of these, 352 (50.1%) required admission. RRF were detected in 190 (27.06%): 36 acute ischemic and 27 acute hemorrhagic lesions, 115 masses, 9 edema, and 27 hydrocephalus. Predictive PC for urgent cranial-CT were motor, speech, sensory deficits, sudden alteration of mental status, epileptic seizure, cognitive impairment, neurological symptoms in cancer patients, acute headache without a prior history and with meningeal signs; nausea, vomiting, or hypertensive crisis; visual deficits, and dizziness. This algorithm provided sensitivity, specificity, positive predictive value, and negative predictive value (NPV, 95%CI in brackets) of 92.1% (89–94.5%), 27.5% (22.5–33.0%), 63.3% (59.2–67.2%), and 71.9% (62.7–80.0%), to diagnose RCRF, and 97.4% (93.4–99.1%), 21.3% (17.8–25.1%), 31.5% (27.7–35.4%), and 95.6% (90.1–98.6%), to diagnose RRF. In patients not requiring admission (n = 350), the NPV for RRF was 98.8% (93.6–100%); the negative likelihood ratio 0.08 (0.01–0.57), and sensitivity remained at 97.8% (82.2–99.9%). Applying it would have avoided performing 85/350 urgent cranial-CT (24.29%). To find one RRF, we would have gone from performing 7.8 (350/45) to 5.9 (265/45) CTs, failing to diagnose 1/45 (2.2%) RRF. Conclusions: This proposed clinical scale could potentially decrease 24% of urgent cranial-CT.