Discordancias entre los estudios de ámbitos hospitalario y comunitario cuando evalúan la misma pregunta de investigación
(Disagreement among hospital and community studies evaluating the same research question)
M. Delgado Rodríguez
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mdelgado@ujaen.es
Correspondencia: Dr. Miguel Delgado Rodríguez. Cátedra de Medicina Preventiva. Universidad de Jaén. Edificio B-3. 23071 Jaén.
Correspondencia: Dr. Miguel Delgado Rodríguez. Cátedra de Medicina Preventiva. Universidad de Jaén. Edificio B-3. 23071 Jaén.
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"apellidos" => "Pinto" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021391110271933X?idApp=WGSE" "url" => "/02139111/0000001600000004/v1_201310251715/S021391110271933X/v1_201310251715/es/main.assets" ] "es" => array:14 [ "idiomaDefecto" => true "titulo" => "Discordancias entre los estudios de ámbitos hospitalario y comunitario cuando evalúan la misma pregunta de investigación" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "344" "paginaFinal" => "353" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Delgado Rodríguez" "autores" => array:1 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Delgado Rodríguez" "email" => array:1 [ 0 => "mdelgado@ujaen.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Universidad de Jaén" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleItalic">Correspondencia</span>: Dr. Miguel Delgado Rodríguez. Cátedra de Medicina Preventiva. Universidad de Jaén. Edificio B-3. 23071 Jaén." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "(Disagreement among hospital and community studies evaluating the same research question)" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2001-09-25" "fechaAceptado" => "2002-02-15" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec268859" "palabras" => array:4 [ 0 => "Estudios hospitalarios" 1 => "Estudios comunitarios" 2 => "Sesgos" 3 => "Concordancia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec268858" "palabras" => array:4 [ 0 => "Hospital studies" 1 => "Community studies" 2 => "Bias" 3 => "Agreement" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se abordan las razones que motivan que los resultados de la investigación realizada sobre poblaciones hospitalarias en ocasiones no sea consistente con la practicada en la comunidad. En la base de las diferencias se encuentran el proceso de selección de los pacientes y la recogida de datos por la historia clínica (su falta de uniformidad y el tratamiento de los «no consta»). Se estructura la razón de las discrepancias en función del tipo de pregunta de investigación: frecuencia, diagnóstico, etiología, pronóstico y tratamiento-prevención. Es el proceso de selección el que justifica las diferencias en frecuencia y pronóstico. En relación con el diagnóstico, las discrepancias se deben a la prevalencia de la enfermedad. En el estudio de asociaciones de causalidad ciertos errores son más frecuentes en los estudios hospitalarios, como los sesgos de detección, protopático (ambos exageran la asociación), y el de inclusión (reduce la asociación). Se analizan ejemplos publicados de cada una de ellas. En relación con el tratamientoprevención, los problemas son sobre todo de validez externa, ya que la metodología del ensayo clínico previene las amenazas a la validez interna; se analiza con un ejemplo de valoración de la eficacia vacunal en pacientes y población sana. La frecuencia de citación de los sesgos se midió en una búsqueda en Medline; en los estudios hospitalarios se mencionó con más frecuencia el sesgo de detección ([RR] = 2,71; intervalo de confianza [IC] del 95%, 1,69-4,37) y el sesgo de confusión por indicación (RR = 1,76; IC del 95%, 0,90-3,42). Por último, se da una serie de recomendaciones destinadas a aumentar la validez de los estudios realizados en el medio hospitalario.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "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. The main reasons for the differences are the selection of the hospital population and information based on clinical chart (its lack of uniformity and the treatment of the «not available» data). The reasons for lack of consistency are divided according to the type of research question: frequency, diagnosis, etiology, prognosis and treatment-prevention. The way a hospital population is selected justifies discrepancies regarding frequency and prognosis. As regards diagnosis, differences are mainly due the prevalence of disease. In the ascertainment of causality several biases are more common in hospital-based research, such as detection bias, protopathic (both producing an away-from-null estimate), and inclusion bias (diminishing the strength of association). Examples taken from the medical literature are offered to illustrate each bias. Regarding treatment-prevention problems arise from external validity, as clinical trials are less prone to bias; this latter situation is exemplified with an assessment of vaccine efficacy in both patients and healthy population. The frequency of citation of bias was assessed by a Medline search; in hospital studies detection bias and confounding by indication were more often quoted than in non-hospital research (RR = 2.71; 95% CI; 1.69-4.37; RR = 1.76; 95% CI, 0,90-3,42, respectively). Lastly, several recommendations are given to increase the validity of hospital-based research.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliogrífia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The environment and disease: association or causation?" 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 4 | 9 |
| 2024 Octubre | 60 | 39 | 99 |
| 2024 Septiembre | 42 | 24 | 66 |
| 2024 Agosto | 62 | 32 | 94 |
| 2024 Julio | 47 | 25 | 72 |
| 2024 Junio | 37 | 28 | 65 |
| 2024 Mayo | 42 | 27 | 69 |
| 2024 Abril | 42 | 16 | 58 |
| 2024 Marzo | 38 | 33 | 71 |
| 2024 Febrero | 39 | 34 | 73 |
| 2024 Enero | 26 | 19 | 45 |
| 2023 Diciembre | 26 | 17 | 43 |
| 2023 Noviembre | 59 | 40 | 99 |
| 2023 Octubre | 43 | 23 | 66 |
| 2023 Septiembre | 36 | 20 | 56 |
| 2023 Agosto | 38 | 15 | 53 |
| 2023 Julio | 38 | 31 | 69 |
| 2023 Junio | 57 | 23 | 80 |
| 2023 Mayo | 73 | 17 | 90 |
| 2023 Abril | 36 | 23 | 59 |
| 2023 Marzo | 49 | 35 | 84 |
| 2023 Febrero | 23 | 25 | 48 |
| 2023 Enero | 32 | 27 | 59 |
| 2022 Diciembre | 49 | 37 | 86 |
| 2022 Noviembre | 48 | 57 | 105 |
| 2022 Octubre | 54 | 55 | 109 |
| 2022 Septiembre | 34 | 45 | 79 |
| 2022 Agosto | 68 | 69 | 137 |
| 2022 Julio | 59 | 49 | 108 |
| 2022 Junio | 75 | 47 | 122 |
| 2022 Mayo | 65 | 46 | 111 |
| 2022 Abril | 35 | 41 | 76 |
| 2022 Marzo | 37 | 46 | 83 |
| 2022 Febrero | 31 | 37 | 68 |
| 2022 Enero | 36 | 50 | 86 |
| 2021 Diciembre | 33 | 50 | 83 |
| 2021 Noviembre | 29 | 50 | 79 |
| 2021 Octubre | 32 | 46 | 78 |
| 2021 Septiembre | 33 | 35 | 68 |
| 2021 Agosto | 26 | 39 | 65 |
| 2021 Julio | 33 | 36 | 69 |
| 2021 Junio | 22 | 35 | 57 |
| 2021 Mayo | 35 | 38 | 73 |
| 2021 Abril | 75 | 47 | 122 |
| 2021 Marzo | 40 | 24 | 64 |
| 2021 Febrero | 24 | 18 | 42 |
| 2021 Enero | 21 | 29 | 50 |
| 2020 Diciembre | 27 | 27 | 54 |
| 2020 Noviembre | 17 | 15 | 32 |
| 2020 Octubre | 25 | 22 | 47 |
| 2020 Septiembre | 17 | 11 | 28 |
| 2020 Agosto | 15 | 10 | 25 |
| 2020 Julio | 29 | 16 | 45 |
| 2020 Junio | 20 | 20 | 40 |
| 2020 Mayo | 24 | 17 | 41 |
| 2020 Abril | 23 | 30 | 53 |
| 2020 Marzo | 19 | 26 | 45 |
| 2020 Febrero | 23 | 50 | 73 |
| 2020 Enero | 28 | 21 | 49 |
| 2019 Diciembre | 21 | 14 | 35 |
| 2019 Noviembre | 17 | 9 | 26 |
| 2019 Octubre | 19 | 8 | 27 |
| 2019 Septiembre | 22 | 16 | 38 |
| 2019 Agosto | 19 | 17 | 36 |
| 2019 Julio | 17 | 8 | 25 |
| 2019 Junio | 10 | 9 | 19 |
| 2019 Mayo | 16 | 14 | 30 |
| 2019 Abril | 15 | 10 | 25 |
| 2019 Marzo | 13 | 17 | 30 |
| 2019 Febrero | 16 | 15 | 31 |
| 2019 Enero | 14 | 13 | 27 |
| 2018 Diciembre | 27 | 29 | 56 |
| 2018 Noviembre | 39 | 26 | 65 |
| 2018 Octubre | 57 | 28 | 85 |
| 2018 Septiembre | 26 | 10 | 36 |
| 2018 Agosto | 24 | 10 | 34 |
| 2018 Julio | 31 | 5 | 36 |
| 2018 Junio | 27 | 15 | 42 |
| 2018 Mayo | 25 | 12 | 37 |
| 2018 Abril | 27 | 5 | 32 |
| 2018 Marzo | 23 | 7 | 30 |
| 2018 Febrero | 21 | 8 | 29 |
| 2018 Enero | 26 | 10 | 36 |
| 2017 Diciembre | 25 | 11 | 36 |
| 2017 Noviembre | 14 | 11 | 25 |
| 2017 Octubre | 15 | 13 | 28 |
| 2017 Septiembre | 9 | 11 | 20 |
| 2017 Agosto | 17 | 7 | 24 |
| 2017 Julio | 24 | 13 | 37 |
| 2017 Junio | 33 | 12 | 45 |
| 2017 Mayo | 34 | 8 | 42 |
| 2017 Abril | 28 | 14 | 42 |
| 2017 Marzo | 39 | 10 | 49 |
| 2017 Febrero | 11 | 9 | 20 |
| 2017 Enero | 19 | 9 | 28 |
| 2016 Diciembre | 22 | 8 | 30 |
| 2016 Noviembre | 25 | 15 | 40 |
| 2016 Octubre | 29 | 12 | 41 |
| 2016 Septiembre | 24 | 8 | 32 |
| 2016 Agosto | 22 | 6 | 28 |
| 2016 Julio | 11 | 6 | 17 |
| 2015 Diciembre | 1 | 0 | 1 |
| 2015 Noviembre | 1 | 0 | 1 |
| 2015 Octubre | 3 | 0 | 3 |
| 2015 Septiembre | 2 | 0 | 2 |
| 2015 Agosto | 4 | 0 | 4 |
| 2015 Junio | 2 | 0 | 2 |
| 2015 Mayo | 1 | 0 | 1 |
| 2015 Abril | 4 | 0 | 4 |
| 2015 Marzo | 5 | 0 | 5 |
| 2015 Febrero | 3 | 0 | 3 |
| 2015 Enero | 6 | 0 | 6 |
| 2014 Diciembre | 11 | 0 | 11 |
| 2014 Noviembre | 18 | 0 | 18 |
| 2014 Octubre | 21 | 0 | 21 |
| 2014 Septiembre | 18 | 1 | 19 |
| 2014 Agosto | 16 | 3 | 19 |
| 2014 Julio | 18 | 3 | 21 |
| 2014 Junio | 16 | 1 | 17 |
| 2014 Mayo | 16 | 2 | 18 |
| 2014 Abril | 17 | 2 | 19 |
| 2014 Marzo | 25 | 2 | 27 |
| 2014 Febrero | 14 | 1 | 15 |
| 2014 Enero | 24 | 1 | 25 |
| 2013 Diciembre | 25 | 2 | 27 |
| 2013 Noviembre | 26 | 1 | 27 |
| 2013 Octubre | 37 | 2 | 39 |
| 2013 Septiembre | 17 | 4 | 21 |
| 2013 Agosto | 38 | 8 | 46 |
| 2013 Julio | 19 | 2 | 21 |
| 2002 Junio | 859 | 0 | 859 |
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