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      "titulo" => "¿Qué es una tecnología sanitaria eficiente en España?"
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          "autoresLista" => "J.A. Sacristán, J. Oliva, J. Del Llano, L. Prieto, J.L. Pinto"
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              "nombre" => "J.A."
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    "titulo" => "Discordancias entre los estudios de ámbitos hospitalario y comunitario cuando evalúan la misma pregunta de investigación"
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        "autoresLista" => "M. Delgado Rodríguez"
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            "correspondencia" => "<span class="elsevierStyleItalic">Correspondencia</span>&#58; Dr&#46; Miguel Delgado Rodr&#237;guez&#46; C&#225;tedra de Medicina Preventiva&#46; Universidad de Ja&#233;n&#46; Edificio B-3&#46; 23071 Ja&#233;n&#46;"
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        "titulo" => "&#40;Disagreement among hospital and community studies evaluating the same research question&#41;"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se abordan las razones que motivan que los resultados de la investigaci&#243;n realizada sobre poblaciones hospitalarias en ocasiones no sea consistente con la practicada en la comunidad&#46; En la base de las diferencias se encuentran el proceso de selecci&#243;n de los pacientes y la recogida de datos por la historia cl&#237;nica &#40;su falta de uniformidad y el tratamiento de los &#171;no consta&#187;&#41;&#46; Se estructura la raz&#243;n de las discrepancias en funci&#243;n del tipo de pregunta de investigaci&#243;n&#58; frecuencia&#44; diagn&#243;stico&#44; etiolog&#237;a&#44; pron&#243;stico y tratamiento-prevenci&#243;n&#46; Es el proceso de selecci&#243;n el que justifica las diferencias en frecuencia y pron&#243;stico&#46; En relaci&#243;n con el diagn&#243;stico&#44; las discrepancias se deben a la prevalencia de la enfermedad&#46; En el estudio de asociaciones de causalidad ciertos errores son m&#225;s frecuentes en los estudios hospitalarios&#44; como los sesgos de detecci&#243;n&#44; protop&#225;tico &#40;ambos exageran la asociaci&#243;n&#41;&#44; y el de inclusi&#243;n &#40;reduce la asociaci&#243;n&#41;&#46; Se analizan ejemplos publicados de cada una de ellas&#46; En relaci&#243;n con el tratamientoprevenci&#243;n&#44; los problemas son sobre todo de validez externa&#44; ya que la metodolog&#237;a del ensayo cl&#237;nico previene las amenazas a la validez interna&#59; se analiza con un ejemplo de valoraci&#243;n de la eficacia vacunal en pacientes y poblaci&#243;n sana&#46; La frecuencia de citaci&#243;n de los sesgos se midi&#243; en una b&#250;squeda en Medline&#59; en los estudios hospitalarios se mencion&#243; con m&#225;s frecuencia el sesgo de detecci&#243;n &#40;&#91;RR&#93; &#61; 2&#44;71&#59; intervalo de confianza &#91;IC&#93; del 95&#37;&#44; 1&#44;69-4&#44;37&#41; y el sesgo de confusi&#243;n por indicaci&#243;n &#40;RR &#61; 1&#44;76&#59; IC del 95&#37;&#44; 0&#44;90-3&#44;42&#41;&#46; Por &#250;ltimo&#44; se da una serie de recomendaciones destinadas a aumentar la validez de los estudios realizados en el medio hospitalario&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The goal of this review is to delineate some of reasons that justify the lack of consistency between hospital-based and community research&#46; The main reasons for the differences are the selection of the hospital population and information based on clinical chart &#40;its lack of uniformity and the treatment of the &#171;not available&#187; data&#41;&#46; The reasons for lack of consistency are divided according to the type of research question&#58; frequency&#44; diagnosis&#44; etiology&#44; prognosis and treatment-prevention&#46; The way a hospital population is selected justifies discrepancies regarding frequency and prognosis&#46; As regards diagnosis&#44; differences are mainly due the prevalence of disease&#46; In the ascertainment of causality several biases are more common in hospital-based research&#44; such as detection bias&#44; protopathic &#40;both producing an away-from-null estimate&#41;&#44; and inclusion bias &#40;diminishing the strength of association&#41;&#46; Examples taken from the medical literature are offered to illustrate each bias&#46; Regarding treatment-prevention problems arise from external validity&#44; as clinical trials are less prone to bias&#59; this latter situation is exemplified with an assessment of vaccine efficacy in both patients and healthy population&#46; The frequency of citation of bias was assessed by a Medline search&#59; in hospital studies detection bias and confounding by indication were more often quoted than in non-hospital research &#40;RR &#61; 2&#46;71&#59; 95&#37; CI&#59; 1&#46;69-4&#46;37&#59; RR &#61; 1&#46;76&#59; 95&#37; CI&#44; 0&#44;90-3&#44;42&#44; respectively&#41;&#46; Lastly&#44; several recommendations are given to increase the validity of hospital-based research&#46;</p>"
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