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  Subjects -> HEALTH AND SAFETY (Total: 1292 journals)
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HEALTH AND SAFETY (524 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 5)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 29)
American Journal of Health Promotion     Hybrid Journal   (Followers: 23)
American Journal of Health Sciences     Open Access   (Followers: 4)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 22)
American Journal of Public Health     Full-text available via subscription   (Followers: 221)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 2)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 5)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 17)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 12)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 2)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 5)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 1)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 49)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 13)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Policy     Hybrid Journal   (Followers: 36)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 48)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 11)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 12)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthy-Mu Journal     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 10)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 33)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 9)
International Journal of Health Geographics     Open Access   (Followers: 6)

        1 2 3 | Last

Journal Cover Gaceta Sanitaria
  [SJR: 0.397]   [H-I: 31]   [3 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0213-9111
   Published by Elsevier Homepage  [3043 journals]
  • El asbesto, una epidemia todavía por controlar

    • Authors: Roberto Alfonso Accinelli; Lidia Marianella López
      Pages: 365 - 367
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Roberto Alfonso Accinelli, Lidia Marianella López

      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2017.02.011
  • Inequidades en salud: análisis sociodemográfico y espacial del cáncer
           de mama en mujeres de Córdoba, Argentina

    • Authors: Natalia Tumas; Sonia Alejandra Pou; María del Pilar Díaz
      Pages: 396 - 403
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Natalia Tumas, Sonia Alejandra Pou, María del Pilar Díaz
      Objetivo Identificar determinantes sociodemográficos asociados a la distribución espacial de la incidencia de cáncer de mama en la provincia de Córdoba, Argentina, a fin de develar inequidades sociales en salud. Método Se desarrolló un estudio ecológico en Córdoba (26 departamentos como unidades geográficas de análisis). Mediante el índice de Moran se estimó la autocorrelación espacial de las tasas de incidencia de cáncer de mama, brutas y estandarizadas, y de indicadores sociodemográficos de urbanización, fecundidad y envejecimiento poblacional. Estas variables fueron incorporadas a a un Sistema de Información Geográfica para su mapeo. Se ajustaron modelos de regresión de Poisson multinivel, para la tasa de incidencia de cáncer de mama como variable respuesta, indicadores sociodemográficos seleccionados como covariables, y porcentaje de hogares con necesidades básicas insatisfechas como variable de ajuste. Resultados En Córdoba, Argentina, existe un patrón no aleatorio en las distribuciones espaciales de las tasas de incidencia de cáncer de mama y de ciertos indicadores sociodemográficos. El incremento medio anual de la población urbana fue inversamente asociado a la ocurrencia de cáncer de mama, mientras que la proporción de hogares con necesidades básicas insatisfechas presentó una asociación directa. Conclusiones Nuestros resultados definen escenarios de inequidad social que explican, en parte, los diferenciales geográficos de la carga del cáncer de mama en Córdoba, Argentina. Las mujeres residentes en hogares socioeconómicamente desfavorecidos y en áreas menos urbanizadas requieren especial atención en futuros estudios e intervenciones de salud pública en cáncer de mama. Objective To identify sociodemographic determinants associated with the spatial distribution of the breast cancer incidence in the province of Córdoba, Argentina, in order to reveal underlying social inequities. Method An ecological study was developed in Córdoba (26 counties as geographical units of analysis). The spatial autocorrelation of the crude and standardised incidence rates of breast cancer, and the sociodemographic indicators of urbanization, fertility and population ageing were estimated using Moran's index. These variables were entered into a Geographic Information System for mapping. Poisson multilevel regression models were adjusted, establishing the breast cancer incidence rates as the response variable, and by selecting sociodemographic indicators as covariables and the percentage of households with unmet basic needs as adjustment variables. Results In Córdoba, Argentina, a non-random pattern in the spatial distribution of breast cancer incidence rates and in certain sociodemographic indicators was found. The mean increase in annual urban population was inversely associated with breast cancer, whereas the proportion of households with unmet basic needs was directly associated with this cancer. Conclusions Our results define social inequity scenarios that partially explain the geographical differentials in the breast cancer burden in Córdoba, Argentina. Women residing in socioeconomically disadvantaged households and in less urbanized areas merit special attention in future studies and in breast cancer public health activities.
      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2016.12.011
  • Efficiency of “Prescribe Vida Saludable”, a health promotion
           innovation. Pilot phase

    • Authors: Aitor Sanz-Guinea; Maite Espinosa; Gonzalo Grandes; Álvaro Sáncheza; Catalina Martínez; Haizea Pombo; Paola Bully; Josep Cortada
      Pages: 404 - 409
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Aitor Sanz-Guinea, Maite Espinosa, Gonzalo Grandes, Álvaro Sáncheza, Catalina Martínez, Haizea Pombo, Paola Bully, Josep Cortada
      Objective “Prescribe Vida Saludable” (PVS) is an organisational innovation designed to optimise the promotion of multiple healthy habits in primary healthcare. It aims to estimate the cost effectiveness and cost-utility of prescribing physical activity in the pilot phase of the PVS programme, compared to the routine clinical practice of promoting physical activity in primary healthcare. Methods An economic evaluation of the quasi-experimental pilot phase of PVS was carried out. In the four control centres, a systematic sample was selected of 194 patients who visited the centre in a single year and who did not comply with physical activity recommendations. In the four intervention centres, 122 patients who received their first physical activity prescription were consecutively enrolled. The costs were evaluated from the perspective of the PVS programme using bottom-up methodology. The effectiveness (proportion of patients who changed their physical activity) as well as the utility were evaluated at baseline and after 3 months. The incremental cost-utility ratio (ICUR) and the incremental cost-effectiveness ratio (ICER) were calculated and a sensitivity analysis was performed with bootstrapping and 1,000 replications. Results Information was obtained from 35% of control cases and 62% of intervention cases. The ICUR was €1,234.66/Quality Adjusted Life Years (QALY) and the ICER was €4.12. In 98.3% of the simulations, the ICUR was below the €30,000/QALY threshold. Conclusions The prescription of physical activity was demonstrably within acceptable cost-utility limits in the pilot PVS phase, even from a conservative perspective.

      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2016.11.010
  • Detección de violencia del compañero íntimo en atención primaria de
           salud y sus factores asociados

    • Authors: Gloria M. Rodríguez-Blanes; Carmen Vives-Cases; Juan José Miralles-Bueno; Miguel San Sebastián; Isabel Goicolea
      Pages: 410 - 415
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Gloria M. Rodríguez-Blanes, Carmen Vives-Cases, Juan José Miralles-Bueno, Miguel San Sebastián, Isabel Goicolea
      Objetivo La violencia de compañero íntimo (VCI) contra las mujeres es un importante problema de salud pública y de derechos humanos. Los profesionales de atención primaria tienen un papel clave en su detección y abordaje. El objetivo de este estudio es determinar la frecuencia y los factores asociados a la realización de preguntas de detección de VCI en atención primaria, y describir las principales acciones desarrolladas en los casos identificados. Métodos Estudio transversal en 15 centros de salud de cuatro comunidades autónomas, con 265 profesionales sanitarios. Recogida de información mediante el cuestionario PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey) autocumplimentado, que incluye variables sobre realización de preguntas para detección, sociodemográficas, nivel de formación/conocimientos en VCI, percepciones y acciones. Se realizó un análisis descriptivo y analítico. Resultados El 67,2% de los participantes señalan que preguntan sobre VCI en la consulta, siendo las acciones más frecuentes referir/derivar a otros servicios, consejo individual y entrega de información. Se asociaron a mayor probabilidad de indagar sobre VCI tener ≥21 de horas de formación, nivel formativo avanzado, conocer políticas y programas, y disponer de protocolo y recursos apropiados de referencia. La realización de preguntas aumenta a medida que los/las profesionales se sienten formados en VCI y provistos/as de un protocolo de manejo de casos. Conclusiones Dos terceras partes de los/las profesionales sanitarios/as encuestados/as refirieron indagar sobre VCI. Dada la influencia de la formación en VCI y el conocimiento sobre los recursos para su abordaje, resulta imprescindible continuar invirtiendo en la formación en VCI del personal sanitario. Objective Intimate partner violence (IPV) against women is a significant public health and human rights problem. Primary care professionals play a key role in detecting and addressing this issue. The aim of this study is to determine the frequency of IPV and its associated factors in primary care by means of a screening questionnaire and to describe the main actions taken in identified cases. Methods Cross-sectional study in 15 health centres in four autonomous regions of Spain with a total of 265 health professionals. The information was collected through the self-administered PREMIS questionnaire (Physician Readiness to Manage Intimate Partner Violence Survey), which includes variables concerning screening questions, sociodemographic factors, level of training/knowledge about IPV, perceptions and actions. A descriptive and analytical study was conducted. Results 67.2% of participants said they ask about IPV during consultations. The most frequent actions were: referring patients to other departments, individual counselling and information delivery. ≥21hours of training, an advanced training level, knowledge of policies and programmes and the implementation of an appropriate protocol and reference resources were all factors that increased the likelihood of investigating IPV. The asking of questions increases in line with professionals’ perceived level of training in IPV and the provision of a case management protocol. Conclusions
      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2016.11.008
  • Cultura de la seguridad del paciente en directivos y gestores de un
           servicio de salud

    • Authors: Teresa Giménez-Júlvez; Ignacio Hernández-García; Carlos Aibar-Remón; Isabel Gutiérrez-Cía; Mercedes Febrel-Bordejé
      Pages: 423 - 426
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Teresa Giménez-Júlvez, Ignacio Hernández-García, Carlos Aibar-Remón, Isabel Gutiérrez-Cía, Mercedes Febrel-Bordejé
      Objetivo Evaluar la cultura de seguridad del paciente en personas directivas/gestoras. Método Estudio descriptivo transversal efectuado entre febrero y junio de 2011 en personal directivo/gestor del Servicio Aragonés de Salud mediante entrevistas semiestructuradas. Resultados Se realizaron 12 entrevistas. Todos/as admitieron la existencia de diversidad de problemas de seguridad del paciente y coincidieron en reconocerla como prioritaria de forma más teórica que práctica. La excesiva rotación de directivos/as se consideró como una importante barrera que dificulta establecer estrategias a largo plazo y dar continuidad a medio plazo. Conclusiones Este trabajo recogió las percepciones sobre cultura de seguridad del paciente en directivos/as, hecho esencial para mejorar la cultura de seguridad del paciente en este colectivo y en las organizaciones que dirigen. Objective To assess patient safety culture in directors/managers. Methods Cross-sectional descriptive study carried out from February to June 2011 among the executive/managing staff of the Aragón Health Service through semi-structured interviews. Results A total of 12 interviews were carried out. All the respondents admitted that there were many patient safety problems and agreed that patient safety was a priority from a theoretical rather than practical perspective. The excessive changes in executive positions was considered to be an important barrier which made it difficult to establish long-term strategies and achieve medium-term continuity. Conclusions This study recorded perceptions on patient safety culture in directors, an essential factor to improve patient safety culture in this group and in the organisations they run.

      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2017.01.009
  • Infobarris: una herramienta interactiva para monitorizar y divulgar
           información sobre la salud y sus determinantes en los barrios de

    • Authors: Pere Llimona; Glòria Pérez; Maica Rodríguez-Sanz; Ana M. Novoa; Albert Espelt; Patricia García de Olalla; Carme Borrell
      Pages: 427 - 431
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Pere Llimona, Glòria Pérez, Maica Rodríguez-Sanz, Ana M. Novoa, Albert Espelt, Patricia García de Olalla, Carme Borrell
      Para conocer la salud de la población es necesario realizar un análisis conjunto y continuado de su estado de salud y de sus determinantes. El objetivo de esta nota de campo es describir el desarrollo y el funcionamiento de la herramienta Infobarris, que permite visualizar una amplia batería de indicadores y determinantes de la salud de la población de la ciudad de Barcelona según el barrio de residencia. Para el desarrollo de Infobarris se ha usado una metodología ágil que permite el desarrollo de un proyecto de forma iterativa e incremental en etapas: selección de indicadores, diseño del prototipo, desarrollo de la herramienta de visualización, carga de datos, revisión y mejora de la herramienta. Infobarris permite la visualización interactiva de 64 indicadores de salud y de sus determinantes, mediante gráficos, mapas y tablas, lo que facilita la vigilancia de la salud y de sus determinantes en los barrios de la ciudad de Barcelona. In order to know about the health of the population, it is necessary to perform a systematic and continuous analysis of their health status and social and economic health determinants. The objective of this paper is to describe the development and implementation of the Infobarris tool, which allows to visualize a wide battery of indicators and social determinants of health by neighbourhoods in the city of Barcelona (Spain). For the development of the Infobarris tool, we used an agile methodology that allows the development of a project in iterative and incremental stages, which are the following: selection of indicators, design of the prototype, development of the tool, data loading, and tool review and improvements. Infobarris displays 64 indicators of health and its determinants through graphics, maps and tables, in a friendly, interactive and attractive way, which facilitates health surveillance in the neighbourhoods of Barcelona.

      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2017.01.012
  • Implementación del mapa de la vulnerabilidad en salud en la Comunidad
           de Madrid

    • Authors: Milagros Ramasco-Gutiérrez; Julio Heras-Mosteiro; Sonsoles Garabato-González; Emiliano Aránguez-Ruiz; Ramón Aguirre Martín-Gil
      Pages: 432 - 435
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Milagros Ramasco-Gutiérrez, Julio Heras-Mosteiro, Sonsoles Garabato-González, Emiliano Aránguez-Ruiz, Ramón Aguirre Martín-Gil
      Desde el modelo de los determinantes sociales de la salud y el enfoque de equidad, la Dirección General de Salud Pública de Madrid ha desarrollado la metodología de los mapas de la vulnerabilidad en salud para facilitar a los equipos sociosanitarios la planificación, la priorización y la intervención en salud en un territorio. A partir de la selección de las zonas básicas de salud con peores indicadores de vulnerabilidad en salud, se inicia un proceso de relación con los actores clave del territorio a fin de identificar conjuntamente áreas prioritarias de intervención y desarrollar un plan de acción consensuado. Se presentan el desarrollo de esta experiencia y su conexión con los modelos teóricos del mapeo en activos, los sistemas de georreferenciación integrados en salud y las intervenciones de salud comunitaria. The Public Health General Directorate of Madrid has developed a health vulnerability mapping methodology to assist regional social health teams in health planning, prioritisation and intervention based on a model of social determinants of health and an equity approach. This process began with the selection of areas with the worst social indicators in health vulnerability. Then, key stakeholders of the region jointly identified priority areas of intervention and developed a consensual plan of action. We present the outcomes of this experience and its connection with theoretical models of asset-based community development, health-integrated georeferencing systems and community health interventions.

      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2016.07.026
  • Uso de paneles de consumidores en estudios observacionales de salud

    • Authors: Nuria Matilla-Santander; Marcela Fu; Montse Ballbè; Cristina Lidón-Moyano; Juan Carlos Martín-Sánchez; Esteve Fernández; José M. Martínez-Sánchez
      Pages: 436 - 438
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Nuria Matilla-Santander, Marcela Fu, Montse Ballbè, Cristina Lidón-Moyano, Juan Carlos Martín-Sánchez, Esteve Fernández, José M. Martínez-Sánchez
      Los paneles de consumidores son una técnica de investigación de mercados de gran utilidad para obtener información sobre clientes poco frecuentes o de difícil acceso. El objetivo de esta nota de campo es exponer nuestra experiencia usando esta técnica para un estudio transversal de salud pública sobre el uso de cigarrillos electrónicos. Después de valorar diferentes técnicas de muestreo no probabilístico para obtener una muestra elevada de usuarios de cigarrillos electrónicos (n=600), se ha optado por el uso del panel de consumidores debido al tiempo relativamente corto para obtener el gran tamaño muestral requerido para el estudio y una buena representatividad de la muestra. Consumer panels are a market research method useful for gathering information about low-frequency or difficult-access customers. The objective of this field-note is to explain our experience using this method in a cross-sectional public health study on the use of electronic cigarettes. After taking into account other non-probabilistic sampling techniques to obtain a huge sample of electronic-cigarette users (n=600), in the end we decided to use consumer panels (recruiters) because of the relative short duration of the field work and the high representativeness of the sample.

      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2017.03.011
  • ¿Cómo ven los residentes y los estudiantes de medicina los conflictos de
           intereses en la clínica'

    • Authors: Carme Agra Tuñas; Susana Rujido Freire; Antonio Rodríguez Núñez
      Pages: 440 - 441
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Carme Agra Tuñas, Susana Rujido Freire, Antonio Rodríguez Núñez

      PubDate: 2017-09-09T05:36:03Z
      DOI: 10.1016/j.gaceta.2017.01.015
  • Differences in the prevalence of diagnosis of overweight-obesity in
           Spanish children according to the diagnostic criteria set used

    • Authors: María Julia Ajejas Bazán; María Isab Jiménez Trujillo; Julia Wärnberg; Silvia Domínguez Fernández; Ana López de Andrés; Napoleón Pérez Farinós
      Abstract: Publication date: Available online 29 September 2017
      Source:Gaceta Sanitaria
      Author(s): María Julia Ajejas Bazán, María Isab Jiménez Trujillo, Julia Wärnberg, Silvia Domínguez Fernández, Ana López de Andrés, Napoleón Pérez Farinós
      Objective To examine relevant differences in the prevalence of overweight and obesity in children aged 2-15 years according to different sets of criteria (Orbegozo Foundation, International Obesity Task Force and World Health Organization), and how their use affects the trends in obesity recorded for both sexes between 1995 and 2011 in Spain. Method Cross-sectional study, a population between 2 and 15 years. Three diagnosis criteria of overweight and obesity were be used. Results The boys according to the three criteria, showed higher values of overweight and obesity compared to the girls. The lowest levels of overweight and obesity were observed using the Orbegozo tables. Discussion The prevalence of overweight and obesity varies significantly according to the criteria used to define overweight and obesity. The percentiles of the Foundation Orbegozo gave the lowest estimates and the standards of growth of the World Health Organization were higher.

      PubDate: 2017-10-03T15:06:27Z
      DOI: 10.1016/j.gaceta.2017.07.014
  • Adecuación de las intervenciones selectivas en eventos

    • Authors: Ángel Gasch Gallén; Blanca Obón Azuara; Concepción Tomás Aznar
      Abstract: Publication date: Available online 29 September 2017
      Source:Gaceta Sanitaria
      Author(s): Ángel Gasch Gallén, Blanca Obón Azuara, Concepción Tomás Aznar

      PubDate: 2017-10-03T15:06:27Z
      DOI: 10.1016/j.gaceta.2017.07.017
  • Alfabetización para la salud, más que información

    • Authors: Dolors Juvinyà-Canal; Carme Bertran-Noguer; Rosa Suñer-Soler
      Abstract: Publication date: Available online 28 September 2017
      Source:Gaceta Sanitaria
      Author(s): Dolors Juvinyà-Canal, Carme Bertran-Noguer, Rosa Suñer-Soler

      PubDate: 2017-10-03T15:06:27Z
      DOI: 10.1016/j.gaceta.2017.07.005
  • Implementación de estrategias y herramientas de coordinación
           sociosanitaria en un departamento de salud

    • Authors: Pilar Botija; Mercedes Botija; Jorge Navarro
      Abstract: Publication date: Available online 27 September 2017
      Source:Gaceta Sanitaria
      Author(s): Pilar Botija, Mercedes Botija, Jorge Navarro
      Es objetivo de este artículo mostrar una experiencia de práctica novedosa implementada por la dirección de un departamento de salud. Se expone un modelo organizativo de coordinación sociosanitaria entre los diferentes niveles asistenciales y sectores, estableciendo sinergias de los recursos sociales y sanitarios comunes del Departamento de Salud Clínico-Malvarrosa (Valencia). Tras un año, se han constituido cinco consejos de salud de zona básica en atención primaria y una comisión de coordinación sociosanitaria integrada por tres subcomisiones: 1) de atención asistencial social y sanitaria, 2) de asociacionismo y voluntariado hospitalario, y 3) de acción comunitaria y participación ciudadana. La estructura organizativa propuesta se ha consolidado y las acciones realizadas se han valorado de manera positiva por las diferentes personas implicadas. Se ha generado una red de comunicación social y sanitaria: interdepartamental, extradepartamental y extrahospitalaria. The objective of this article is to show an experience of new practice as implemented by the management of a Department of Health. An organisational model is shown of sociosanitary coordination between the different levels of care and sectors, establishing synergies of the common social and health resources of the Clínico-Malvarrosa Department of Health (Valencia, Spain). After one year, five basic health councils have been set up in Primary Care and a Sociosanitary Coordination Commission composed of three subcommittees: 1) socio and health care, 2) associationism and hospital volunteering, and 3) community action and citizen participation. The proposed organisational structure has been consolidated, the actions carried out have been valued positively by the different agents involved. It has generated a network of social and health communication: interdepartmental, extra-departmental and out-of-hospital.

      PubDate: 2017-10-03T15:06:27Z
      DOI: 10.1016/j.gaceta.2017.07.008
  • Explaining differences in perceived health-related quality of life: a
           study within the Spanish population

    • Authors: Jesús Martín-Fernández; Gloria Ariza-Cardiel; Elena Polentinos-Castro; Teresa Sanz-Cuesta; Antonio Sarria-Santamera; Isabel del Cura-González
      Abstract: Publication date: Available online 27 September 2017
      Source:Gaceta Sanitaria
      Author(s): Jesús Martín-Fernández, Gloria Ariza-Cardiel, Elena Polentinos-Castro, Teresa Sanz-Cuesta, Antonio Sarria-Santamera, Isabel del Cura-González
      Objective To assess the burden of several determinants on health-related quality of life (HRQOL) and to study its heterogeneity among the different Spanish regions. Method Cross-sectional study. Data were obtained from the Spanish National Health Survey (2012), and HRQOL was measured using the EQ-5D-5L questionnaire (utility and visual analogue scale –VAS– scores). Demographic variables, physical health condition, social variables, mental health status, and lifestyle were also analysed. Tobit regression models were employed to study the relationships between expressed HRQOL and personal characteristics. Results A total of 20,979 surveys were obtained. Of them, 62.4% expressed a utility score of 1, corresponding to perfect health (95%CI: 61.8%–63.2%), and 54.2% showed VAS scores ≥80 (95%CI: 53.5%–54.9%). HRQOL was mainly described as a function of age, chronic limitation in daily activities, and mental health status. Belonging to a higher-class strata and physical activity were related to better self-perceived HRQOL. Ageing worsened perceived HRQOL, but did not influence its determinants, and differences in HRQOL by regions were also not significant after model adjustment. Conclusion HRQOL perception in the Spanish population varied slightly depending on the measure used (utilities index or VAS). Age, chronic limitations in daily life, and mental health status best explained the variability in perception, and no meaningful differences in HRQOL perception among regions were found after adjustment.

      PubDate: 2017-10-03T15:06:27Z
      DOI: 10.1016/j.gaceta.2017.05.016
  • Estado del bienestar y salud pública, una relación que debe ser

    • Authors: Fernando G. Benavides; Jordi Delclós; Consol Serra
      Abstract: Publication date: Available online 27 September 2017
      Source:Gaceta Sanitaria
      Author(s): Fernando G. Benavides, Jordi Delclós, Consol Serra
      La salud de las personas ha mejorado a lo largo del siglo xx, al mismo tiempo que se consolidaba el Estado del bienestar. Este trabajo explora la relación actual del Estado del bienestar y la salud pública. Las funciones esenciales de la salud pública se ejercen como parte del Estado, y su principal reto en la actualidad es conseguir que la salud sea protegida y promocionada en las diferentes políticas públicas, entre otras las de empleo. Los resultados de los estudios que valoran el efecto sobre la salud de los distintos tipos de Estado del bienestar son contradictorios, pero cuando se valora el impacto de políticas concretas, como por ejemplo el subsidio de desempleo, los resultados son positivos y consistentes. Sin embargo, la actual crisis del Estado del bienestar dificulta su continuidad, en gran medida por los cambios en el mercado de trabajo, con empleos más flexibles e inseguros. Human health has improved throughout the 20th century, at the same time that the Welfare State was consolidated. This paper explores the current relationship between the welfare state and public health. The essential functions of public health are exercised as part of the State, and currently the main challenge is to ensure that health is protected and promoted through different public policies, including employment. Studies assessing the health effect of different types of welfare state are contradictory, but when the impact of specific policies, such as unemployment benefits, is considered, the results are positive and consistent. However, the current crisis of the Welfare State hampers its continuity, largely due to changes in the labour market, with more flexible and insecure jobs.

      PubDate: 2017-10-03T15:06:27Z
      DOI: 10.1016/j.gaceta.2017.07.006
  • Los ingresos ectópicos y su relación con la aparición de complicaciones
           y estancias prolongadas

    • Authors: Enrique Cabrera Torres; María Aránzazu García Iglesias; María Teresa Santos Jiménez; Miguel González Hierro; María Luisa Diego Domínguez
      Abstract: Publication date: Available online 22 September 2017
      Source:Gaceta Sanitaria
      Author(s): Enrique Cabrera Torres, María Aránzazu García Iglesias, María Teresa Santos Jiménez, Miguel González Hierro, María Luisa Diego Domínguez
      Objetivo Analizar la relación entre el tipo de ingreso (ectópico y no ectópico) y la aparición de complicaciones clínicas y la estancia media. Métodos Mediante un estudio epidemiológico retrospectivo de cohorte de pacientes ingresados durante un periodo de 6 meses en el Hospital Complejo Asistencial Universitario de Salamanca se identificaron los pacientes ectópicos y no ectópicos. Se utilizaron las bases de datos del servicio de admisión, el conjunto mínimo básico de datos de hospitalización, el agrupador de pacientes por grupos relacionados por el diagnóstico (GRD) y el analizador estadístico clínico-asistencial ALCOR. El análisis se amplió detallando los resultados para los cinco GRD más frecuentes en el periodo. Resultados De un total de 11.842 ingresos, el 8,4% fueron ingresos ectópicos. En el estudio global, la estancia media fue mayor en los ectópicos (8,11 días) que en los no ectópicos (7,15 días). La mortalidad también fue superior en los ectópicos, pero aparecieron menos complicaciones (7,6% en ectópicos frente a 8,4% en no ectópicos). El análisis por GRD mantuvo estos resultados en tres de los cinco grupos analizados, con mayor estancia media, pero menos complicaciones, en los casos ectópicos. Conclusiones Un determinado porcentaje de pacientes ingresaron ectópicos. Fueron más frecuentes los pacientes de especialidades médicas ubicados en plantas quirúrgicas. Estos pacientes ectópicos presentaron una estancia media mayor respecto a los no ectópicos. No hubo diferencias significativas en la aparición de complicaciones. Objective To analyze the relationship between the type of hospital admission (outlier and non-outlier admissions) and the appearance of clinical complications and the average stay. Methods From a retrospective epidemiological study of a cohort of patients admitted to the Hospital Complejo Asistencial Universitario de Salamanca (Salamanca, Spain) over a six-month period, outlier and non-outlier patients were identified. This project had access to the admissions department database, the hospital's CMBD (in Spanish, Conjunto Mínimo Básico de Datos) for hospitalisation, the AP-DRG (All Patient-Diagnosis Related Groups) and ALCOR (a clinical-statistics analytics tool). It then proceeded to break down the results by DRG, looking at the five most common DRGs in that period. Results 8.4% of the total 11,842 admissions were medical outliers. In the overall study, the average stay was longer for outlier patients (8. 11 days) than for other patients (7.15 days). The mortality rate was, likewise, higher for outlier patients, although there was a reduced incidence of complications (7.6% for outlier patients as opposed to 8.4% for others). The analysis by DRG corroborated these results in three of the five cases investigated, showing longer average stays but fewer clinical complications in the case of outlier patients. Conclusions On admission to hospital, a significant proportion of patients were allocated beds on inappropriate wards (outlier patients). It was more common to find medical patients placed on surgical wards than vice versa. The average stay of outlier patients was longer than that of patients admitte...
      PubDate: 2017-09-27T13:27:37Z
      DOI: 10.1016/j.gaceta.2017.07.012
  • Facilitadores de la participación e implementación de la subcohorte
           PELFI de familias inmigrantes

    • Authors: Cristina Hernando Rovirola; Florianne Gaillardin; Laia Ferrer Serret; Ana Cayuela Mateo; Elena Ronda Pérez; Jordi Casabona Barbarà
      Abstract: Publication date: Available online 22 September 2017
      Source:Gaceta Sanitaria
      Author(s): Cristina Hernando Rovirola, Florianne Gaillardin, Laia Ferrer Serret, Ana Cayuela Mateo, Elena Ronda Pérez, Jordi Casabona Barbarà
      Objetivo PELFI es un estudio multicéntrico de cohortes de familias inmigradas en España. Los objetivos de este manuscrito son: 1) describir el reclutamiento, la recogida de información y las características sociodemográficas según origen y sexo de los participantes de las familias; y 2) valorar las estrategias de reclutamiento y recogida de información que facilitaron la participación en la subcohorte PELFI Badalona/SC. Método Estudio descriptivo con una muestra de conveniencia de familias inmigrantes y autóctonas residentes en Badalona y Santa Coloma de Gramanet. Se encuestaron los padres, madres e hijos >16 años, y se realizaron exámenes médicos. Resultados Participaron 115 familias. Entre las estrategias de reclutamiento, la bola de nieve logró el 69% de cooperación. La tasa de cooperación del estudio fue del 57,5% y de los exámenes médicos del 66,6%. La cooperación de las familias chinas fue del 38,5% y no se reclutaron hijos >16 años. El 28% de las encuestas se realizaron en fin de semana o por la noche. Las familias tenían un tiempo medio de residencia de 12,2 años. El 71,2% de los hijos >16 años tenían estudios secundarios finalizados. Los inmigrantes tenían una clase social más baja que los autóctonos (p<0,05) y las mujeres inmigradas menor nivel de estudios (p<0,05). Conclusiones Interaccionar frecuentemente con la comunidad, utilizar simultáneamente distintas estrategias de reclutamiento, incorporar investigadores del mismo origen geográfico que los participantes, minimizar las barreras idiomáticas y ofrecer flexibilidad de tiempo y lugar facilitó la participación. Las familias chinas presentaron mayores dificultades. Las conclusiones facilitarán la implementación de futuras cohortes de características similares. Objective PELFI is a multicentre cohort study of migrant families in Spain. The objectives of this manuscript were: 1) to describe the recruitment strategies, data collection and the main socio-demographic characteristics according to geographical origin and sex of participants of the families; and 2) to assess the recruitment and data collection strategies that facilitated participation in the basal assessment of the Badalona and Santa Coloma de Gramanet cohort. Method Descriptive study on a convenience sample of migrant and native families residing in Badalona and Santa Coloma de Gramanet. Health interviews were conducted on fathers, mothers and children>16 years; and medical examinations were performed. Results There were 115 participating families. Within the recruitment strategies, snow ball achieved 69% cooperation. The cooperation rate of the study was 57.5% and that of the clinical sub-sample was 66.6%. Cooperation rate of the Chinese families was 38.5% and Chinese children >16 years old were not recruited. Twenty-eight percent of the interviews were conducted at weekends or during the evening. Families had a mean of 12.2 years of residence. Seventy-one point two percent of the children >16 years had completed secondary studies. The migrants had lower social class than natives (p < 0.05) and the migrant women had lower levels of education (p < 0.05). Conclusions Interacting frequently with the community, using different recruitment strateg...
      PubDate: 2017-09-27T13:27:37Z
      DOI: 10.1016/j.gaceta.2017.07.010
  • Estado de bienestar y salud pública: el papel de la salud laboral

    • Authors: Fernando G. Benavides; Jordi Delclós; Consol Serra
      Abstract: Publication date: Available online 21 September 2017
      Source:Gaceta Sanitaria
      Author(s): Fernando G. Benavides, Jordi Delclós, Consol Serra
      En el contexto de la actual crisis del Estado de bienestar, la salud laboral puede contribuir significativamente a su sostenibilidad, facilitando un trabajo decente y saludable a lo largo de la vida laboral de las personas que trabajan. Para ello, la salud laboral debe afrontar el reto de la promoción de la salud, la prevención y la asistencia de lesiones, enfermedades y, sobre todo, incapacidades, basándose en una mejor coordinación de los servicios de prevención, las mutuas colaboradoras con la seguridad social y el sistema de salud, así como potenciando el liderazgo en prevención de las empresas y la participación activa de las personas que trabajan. In the context of the current crisis of the Welfare State, occupational health can contribute significantly to its sustainability by facilitating decent and healthy employment throughout the working life. To this end, occupational health must take on the challenge of promoting health, preventing and managing injuries, illnesses and disability, based on better coordination of prevention services, mutual insurance companies, and health services, as well as by empowering the leadership in prevention of companies and the active participation of those who work.

      PubDate: 2017-09-27T13:27:37Z
      DOI: 10.1016/j.gaceta.2017.07.007
  • Monitoring sedentary patterns in office employees: validity of an m-health
           tool (Walk@Work-App) for occupational health

    • Authors: Judit Bort-Roig; Anna Puig-Ribera; Ruth S. Contreras; Emilia Chirveches-Pérez; Joan C. Martori; Nicholas D. Gilson; Jim McKenna
      Abstract: Publication date: Available online 18 September 2017
      Source:Gaceta Sanitaria
      Author(s): Judit Bort-Roig, Anna Puig-Ribera, Ruth S. Contreras, Emilia Chirveches-Pérez, Joan C. Martori, Nicholas D. Gilson, Jim McKenna
      Objective This study validated the Walk@Work-Application (W@W-App) for measuring occupational sitting and stepping. Methods The W@W-App was installed on the smartphones of office-based employees (n=17; 10 women; 26±3 years). A prescribed 1-hour laboratory protocol plus two continuous hours of occupational free-living activities were performed. Intra-class correlation coefficients (ICC) compared mean differences of sitting time and step count measurements between the W@W-App and criterion measures (ActivPAL3TM and SW200Yamax Digi-Walker). Results During the protocol, agreement between self-paced walking (ICC=0.85) and active working tasks step counts (ICC=0.80) was good. The smallest median difference was for sitting time (1.5seconds). During free-living conditions, sitting time (ICC=0.99) and stepping (ICC=0.92) showed excellent agreement, with a difference of 0.5minutes and 18 steps respectively. Conclusions The W@W-App provided valid measures for monitoring occupational sedentary patterns in real life conditions; a key issue for increasing awareness and changing occupational sedentariness.

      PubDate: 2017-09-20T07:21:18Z
      DOI: 10.1016/j.gaceta.2017.05.004
  • Tabaco en adolescentes escolares brasileños: asociación con salud mental
           y contexto familiar

    • Authors: Camila Zander Neves; Claudine Devicari Bueno; Giovana Pires Felden; Mariane Costa Irigaray; María Fernanda Rivadeneira; Nágila Oenning; Bárbara Niegia Garcia de Goulart
      Abstract: Publication date: Available online 18 September 2017
      Source:Gaceta Sanitaria
      Author(s): Camila Zander Neves, Claudine Devicari Bueno, Giovana Pires Felden, Mariane Costa Irigaray, María Fernanda Rivadeneira, Nágila Oenning, Bárbara Niegia Garcia de Goulart
      Objetivo Estudiar la asociación entre aspectos de la salud mental y el contexto familiar con la experimentación y el consumo de tabaco en jóvenes escolares brasileños. Método Estudio transversal utilizando datos de la Encuesta Nacional de Salud Escolar de Brasil, que incluyó 109.104 escolares del noveno año de formación fundamental, turno diurno, de escuelas públicas y privadas de los 26 Estados y el Distrito Federal. Se realizó un análisis descriptivo de las variables, análisis bivariado y multivariado, con obtención de odds ratio (OR) e intervalo de confianza del 95% (IC95%). Resultados El 20,9% de los escolares experimentaron el tabaco por lo menos una vez en la vida. Los adolescentes que presentaban sentimientos de soledad más frecuentemente (OR: 2,07; IC95%: 1,98-2,16), dificultad para dormir (OR: 2,37; IC95%: 2,52-2,48) y menor interacción social (OR: 1,27; IC95%: 1,26-1,32) se asociaron más frecuentemente con consumo de tabaco, con independencia del tipo de escuela, el sexo y el color de piel. Los escolares de padres o responsables poco comprensivos (OR: 2,39; IC95%: 2,29-2,49), o que no saben lo que los hijos hacen en su tiempo libre (OR: 1,52; IC95%: 1,46-1,59), se asociaron con consumo frecuente de cigarrillos. Conclusión Se evidenció una asociación entre la salud mental y el contexto familiar con la experimentación y el uso de tabaco en adolescentes escolarizados brasileños, independientemente del tipo de escuela, sexo y color de piel. Es importante que programas destinados a prevenir y retardar la experimentación y el uso de tabaco en la adolescencia enfaticen en estos hallazgos y se planteen estrategias en ámbitos de salud mental y familiar. Objective To study the association between aspects of mental health and the family context with tobacco experimentation and consumption among Brazilian schoolchildren. Method A cross-sectional study using data from the National Survey of Schoolchildren's Health in Brazil conducted on 109,104 schoolchildren from the ninth year of elementary school, day scholars in public and private schools in all Brazilian state capitals and the Federal District. Descriptive analysis of variables, bivariate and multivariate analyses were performed with logistic regression estimates, adjusted for socioeconomic variables, obtaining the odds ratio (OR) and 95% confidence interval (95%CI). Results Among the participants, 52.2% were female. Twenty point nine percent of the students reported having experimented with cigarettes at least once. Adolescents who experienced more often feelings of loneliness (OR: 2.07; 95%CI: 1.98-2.16), difficulty sleeping (OR: 2.37; 95%CI: 2.52-2.48) and lower social interaction (OR: 1.27; 95%CI: 1.26-1.32), were more likely to smoke, regardless of socioeconomic status. The schoolchildren of parents or caregivers (OR: 2.39; 95%CI: 2.29-2.49) who did not know what their children did in their free time (OR: 1.52; 95%CI: 1.46-1.59) were associated with more frequent cigarette smoking. Conclusion An association was seen between aspects of mental health and the family context with the experimentation and consumption of tobacco in adolescents enrolled in the study in Brazil. These associations are independent of schoo...
      PubDate: 2017-09-20T07:21:18Z
      DOI: 10.1016/j.gaceta.2017.07.003
  • Conducta sexual y realización de la prueba del virus de la
           inmunodeficiencia humana en jóvenes que estudian en la universidad en
           Cuzco (Perú)

    • Authors: M. Paz Bermúdez; M. Teresa Ramiro; Inmaculada Teva; Tamara Ramiro-Sánchez; Gualberto Buela-Casal
      Abstract: Publication date: Available online 18 September 2017
      Source:Gaceta Sanitaria
      Author(s): M. Paz Bermúdez, M. Teresa Ramiro, Inmaculada Teva, Tamara Ramiro-Sánchez, Gualberto Buela-Casal
      Objetivo El objetivo era analizar la conducta sexual, la realización de la prueba del virus de la inmunodeficiencia humana (VIH), las intenciones para hacérsela y los motivos para no realizársela en jóvenes estudiantes en la universidad en Cuzco (Perú). Métodos Participaron 1377 estudiantes universitarios/as de diversas instituciones de educación superior de Cuzco (Perú). El rango de edad era de 16 a 30 años. Se aplicó un cuestionario sobre conducta sexual y realización de la prueba del VIH. El tamaño de la muestra se estableció considerando un nivel de confianza del 97% y un error de estimación del 3%. El cuestionario se cumplimentó en las aulas durante las horas lectivas. Resultados Un mayor porcentaje de varones que de mujeres ha tenido sexo vaginal, anal y oral, un mayor número de parejas sexuales y un inicio a una edad más temprana en el sexo vaginal y oral. Un mayor porcentaje de mujeres que de varones no utilizó el preservativo en la primera relación sexual anal y tenía un mayor índice de riesgo anal. La mayoría de los/las jóvenes no se había realizado nunca la prueba del VIH. El principal motivo para no hacérsela era la seguridad de no estar infectados/as. Conclusiones Parece existir una baja percepción de riesgo frente al VIH en los/las jóvenes a pesar de implicarse en conductas sexuales de riesgo. Es necesaria la realización de campañas de prevención dirigidas tanto a la población general como a las poblaciones clave, y considerar especialmente a la juventud. Objective To analyse sexual behaviour, HIV testing, HIV testing intentions and reasons for not testing for HIV in university students from Cuzco (Peru). Methods The sample comprised 1,377 university students from several institutions from Cuzco (Peru). The size of the sample was set according to a maximum 3% error estimation and a 97% confidence interval. Ages ranged from 16 to 30 years old. The data were collected through a self-administered, anonymous and voluntary questionnaire regarding sexual behaviour and HIV testing. The data were collected in classrooms during teaching hours. Results A higher percentage of males than females reported having had vaginal, anal and oral sex, a higher number of sexual partners and an earlier age at first vaginal and oral sex. A higher percentage of females than males did not use condoms when they first had anal sex and had a higher anal sex-risk index. Most of the participants had never been HIV tested. The main reason was that they were sure that they were not HIV infected. Conclusions It seems that there was a low HIV risk perception in these participants despite the fact that they had been involved in sexual risk behaviours. Prevention campaigns focused on the general population as well as the at-risk populations and young people are needed.

      PubDate: 2017-09-20T07:21:18Z
      DOI: 10.1016/j.gaceta.2017.07.002
  • Recortes en los presupuestos sanitarios y listas de espera

    • Authors: Marciano Sánchez-Bayle; Luis Palomo
      Abstract: Publication date: Available online 18 September 2017
      Source:Gaceta Sanitaria
      Author(s): Marciano Sánchez-Bayle, Luis Palomo

      PubDate: 2017-09-20T07:21:18Z
      DOI: 10.1016/j.gaceta.2017.07.013
  • Sarampión en Europa: necesidad de acción global y local para su

    • Abstract: Publication date: Available online 18 September 2017
      Source:Gaceta Sanitaria
      Author(s): Adrián González-Marrón, José M. Martínez-Sánchez

      PubDate: 2017-09-20T07:21:18Z
  • Reticencia vacunal: análisis del discurso de madres y padres con rechazo
           total o parcial a las vacunas

    • Authors: Maite Cruz Piqueras; Ainhoa Rodríguez García de Cortazar; Joaquín Hortal Carmona; Javier Padilla Bernáldez
      Abstract: Publication date: Available online 18 September 2017
      Source:Gaceta Sanitaria
      Author(s): Maite Cruz Piqueras, Ainhoa Rodríguez García de Cortazar, Joaquín Hortal Carmona, Javier Padilla Bernáldez
      Objetivo Analizar y comprender los discursos reticentes a la vacunación, particularmente los de las personas que han decidido no vacunar a sus hijos/as. Métodos Estudio cualitativo con cinco entrevistas individuales y dos grupos focales con personas que optaron por no vacunar a su hijos/as en la provincia de Granada. Resultados Padres y madres manifiestan un sistema de creencias en salud diferente al paradigma biomédico. Desde el punto de vista ético, justifican su posición a partir del derecho a la autonomía y la responsabilidad de sus decisiones. Como argumentos concretos, dudan de la administración de varias vacunas simultáneamente en edades muy tempranas de manera sistemática y sin individualizar cada caso, temen efectos adversos y no entienden la variabilidad en el calendario vacunal. Conclusiones Los discursos reticentes responden al conflicto de individualidad vs. colectividad: padres y madres, en defensa de su derecho a una crianza sin interferencias del Estado, centran su responsabilidad en el bienestar individual de sus hijos/as independientemente de las consecuencias que su acción u omisión conlleve a la colectividad. En su gestión de los riesgos, elevan los derivados de vacunar por encima de las consecuencias individuales y colectivas de no hacerlo. Las vacunas que más dudas generan son aquellas con mayor controversia en el ámbito científico. La transparencia en la comunicación de efectos adversos, el respeto de las autoridades a otros conceptos de salud/enfermedad, el destierro del término «antivacunas» del lenguaje mediático y científico, y el desarrollo de espacios de diálogo son puentes por construir. Objective To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters. Methods Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain). Results Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule. Conclusions These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term R...
      PubDate: 2017-09-20T07:21:18Z
      DOI: 10.1016/j.gaceta.2017.07.004
  • Marcos GRADE de la evidencia a la decisión (EtD): un enfoque sistemático
           y transparente para tomar decisiones sanitarias bien informadas. 2: Guías
           de práctica clínica

    • Authors: Pablo Alonso-Coello; Holger J. Schünemann; Jenny Moberg; Romina Brignardello-Petersen; Elie A. Akl; Marina Davoli; Shaun Treweek; Reem A. Mustafa; Gabriel Rada; Sarah Rosenbaum; Angela Morelli; Gordon H. Guyatt; Andrew D. Oxman
      Abstract: Publication date: Available online 13 September 2017
      Source:Gaceta Sanitaria
      Author(s): Pablo Alonso-Coello, Andrew D. Oxman, Jenny Moberg, Romina Brignardello-Petersen, Elie A. Akl, Marina Davoli, Shaun Treweek, Reem A. Mustafa, Per O. Vandvik, Joerg Meerpohl, Gordon H. Guyatt, Holger J. Schünemann
      Los médicos no disponen del tiempo ni de los recursos para considerar la evidencia subyacente en las innumerables decisiones que tienen que tomar diariamente. En consecuencia, dependen de las recomendaciones de las guías de práctica clínica. Los paneles de las guías deben considerar todos los criterios relevantes que influyen en una decisión o recomendación de manera estructurada, explícita y transparente, y proporcionar a los médicos recomendaciones factibles. En este artículo describiremos los marcos de la evidencia a la decisión (EtD) para las recomendaciones de práctica clínica. La estructura general de un marco EtD para recomendaciones clínicas es similar a la de los marcos EtD para otras recomendaciones y decisiones, e incluye la formulación de la pregunta, la evaluación de los distintos criterios y las conclusiones. Las recomendaciones clínicas requieren que los criterios se consideren de forma diferente, dependiendo de si se adopta una perspectiva individual o poblacional. Por ejemplo, desde la perspectiva individual, los gastos personales son un aspecto importante a considerar, mientras que desde la perspectiva poblacional son más importantes el uso de recursos (no solo los gastos personales) y el coste-efectividad. Son también importantes desde la perspectiva poblacional la equidad, la aceptabilidad y la factibilidad, mientras que la importancia de estos criterios suele ser limitada en el caso de la perspectiva individual. Los subgrupos específicos para los cuales pueden necesitarse recomendaciones deben estar claramente identificados y considerados con relación a cada criterio, porque los juicios pueden variar entre subgrupos. El siguiente artículo es una traducción del artículo original publicado en British Medical Journal. Los marcos EtD se utilizan actualmente en el Programa de Guías de Práctica Clínica en el Sistema Nacional de Salud, coordinado por GuíaSalud. Clinicians do not have the time or resources to consider the underlying evidence for the myriad decisions they must make each day and, as a consequence, rely on recommendations from clinical practice guidelines. Guideline panels should consider all the relevant factors (criteria) that influence a decision or recommendation in a structured, explicit, and transparent way and provide clinicians with clear and actionable recommendations. In this article, we will describe the EtD frameworks for clinical practice recommendations. The general structure of the EtD framework for clinical recommendations is similar to EtD frameworks for other types of recommendations and decisions, and includes formulation of the question, an assessment of the different criteria, and conclusions. Clinical recommendations require considering criteria differently, depending on whether an individual patient or a population perspective is taken. For example, from an individual patient's perspective, out-of-pocket costs are an important consideration, whereas, from a population perspective, resource use (not only out-of-pocket costs) and cost effectiveness are important. From a population perspective, equity, acceptability, and feasibility are also important considerations, whereas the importance of these criteria is often limited from an individual patient perspective. Specific subgroups for which different recommendations may be required should be clearly identified and considered in relation to each criterion because judgments might vary across subgroups. This article is a translation of the original article published in the British Medical Journal. The EtD frameworks are currently used in the Clinical Practice Guideline Programme of the Spanish National Health System, co-ordinated by GuíaSalud.

      PubDate: 2017-09-15T06:21:01Z
      DOI: 10.1016/j.gaceta.2017.02.010
  • Gaceta Sanitaria A PRIMERA VISTA

    • Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5

      PubDate: 2017-09-09T05:36:03Z
  • López S, Pi-Sunyer MT. Morir cuando la vida empieza. Conocer y despedir
           al hijo al mismo tiempo. Pamplona: Editorial Círculo Rojo; 2015. ISBN:
           978-84-9095-759-2. 187 p.

    • Authors: Ernesto
      Abstract: Publication date: September–October 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 5
      Author(s): Ernesto Magallón-Neri

      PubDate: 2017-09-09T05:36:03Z
  • Doctors’ opinions on clinical coordination between primary and secondary
           care in the Catalan healthcare system

    • Authors: Marta-Beatriz Aller; Ingrid Vargas; Jordi Coderch; Sebastià Calero; Francesc Cots; Mercè Abizanda; Lluís Colomés; Joan Farré; María-Luisa Vázquez-Navarrete
      Abstract: Publication date: Available online 26 August 2017
      Source:Gaceta Sanitaria
      Author(s): Marta-Beatriz Aller, Ingrid Vargas, Jordi Coderch, Sebastià Calero, Francesc Cots, Mercè Abizanda, Lluís Colomés, Joan Farré, María-Luisa Vázquez-Navarrete
      Objective To analyse doctors’ opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it. Methods A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted. Results In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination. Conclusions Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination.

      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.06.001
  • Compra de alimentos de proximidad en los comedores escolares de
           Andalucía, Canarias y Principado de Asturias

    • Authors: Panmela Soares; Pablo Caballero; Mari Carmen Davó-Blanes
      Abstract: Publication date: Available online 24 August 2017
      Source:Gaceta Sanitaria
      Author(s): Panmela Soares, Pablo Caballero, Mari Carmen Davó-Blanes
      Objetivo Explorar y comparar las características de los centros de educación primaria (CEP) de Andalucía, Canarias y Principado de Asturias en función de si compran o no alimentos de proximidad para los comedores escolares, así como la opinión de los/las responsables del comedor sobre los beneficios y las dificultades para incorporarla. Método Mediante un cuestionario electrónico se recogió información de las características de 186 CEP y la opinión de los/las responsables del comedor sobre los beneficios/dificultades de la compra de alimentos de proximidad. Los datos se estratificaron según la forma de adquisición de los alimentos (compra de alimentos de proximidad: sí/no) y se aplicó el test de ji al cuadrado. Resultados El 38,2% de los CEP estudiados compra alimentos de proximidad. Es más frecuente en centros de zonas rurales (51,0%), con comedores autogestionados (80,0%) y con cocina propia (65,5%). Dichos centros cuentan con menús más económicos que sus homólogos (69,8%), participan con mayor frecuencia en programas de alimentación saludable (81,5%) y compran más alimentos ecológicos (65,8%). Según la mayoría de los/las participantes cuyos centros compran alimentos de proximidad, sus beneficios son el fomento de la economía local (97,2%), la oferta de alimentos frescos (97,2%) y la sostenibilidad ambiental (93%), y sus dificultades son la capacidad productiva de la región (50,7%), la variación estacional de la producción (71,8%) y la falta de apoyo (42,3%) y de información de la Administración (46,5%). Conclusión La ubicación de los centros, la gestión del comedor y la disponibilidad de cocina pueden condicionar el desarrollo de la compra de alimentos de proximidad en las escuelas. El apoyo institucional podría ayudar a integrarla en los CEP, mejorando la alimentación escolar con menor coste económico y ambiental. Objective To explore and compare the characteristics of Primary Education Centres (PEC) in Andalusia, the Canary Islands and the Principality of Asturias depending on whether or not they make local food purchases (LFP) for school meals and to explore the opinion of cafeteria managers about the benefits and challenges of this type of purchase. Method Information on the characteristics of 186 PECs and opinions of cafeteria managers about the benefits/challenges of LFP was collected through an electronic questionnaire. Data were stratified according to how the products were purchased (LFP: yes/no), and the chi square test was applied. Results 38.2% of the PECs studied make LFP. This is more frequent in rural areas (51.0 with self-managed cafeterias (80.0%), and their own kitchen (65.5%). These centres have less expensive menus than their peers (69.8%), participate more frequently in healthy eating programmes (81.5%) and purchase more organic food products (65.8%). According to the majority of the participants whose centres engage in LFP, the benefits include: supporting the local economy (97.2%), the offer of fresh foods (97.2%) and environmental sustainability (93.0%). The challenges include: productive capacity of the region (50.7%), the seasonal variation in food production (71.8%), and the lack of support (42.3%) and information from the government (46.5%). Conclusion The location of the centres, the management of the cafeteria and the availability of ...
      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.05.015
  • Comparación de modelos predictivos para la selección de
           pacientes de alta complejidad

    • Authors: Marcos Estupiñán-Ramírez; Rita Tristancho-Ajamil; María Consuelo Company-Sancho; Hilda Sánchez-Janáriz
      Abstract: Publication date: Available online 19 August 2017
      Source:Gaceta Sanitaria
      Author(s): Marcos Estupiñán-Ramírez, Rita Tristancho-Ajamil, María Consuelo Company-Sancho, Hilda Sánchez-Janáriz
      Objetivo Comparar la concordancia de los pesos de complejidad entre los estratificadores Clinical Risk Groups (CRG) y los grupos de morbilidad ajustada (GMA), determinar cuál de ellos es el mejor predictor de ingreso hospitalario y optimizar el método para seleccionar el 0,5% de pacientes de más alta complejidad que se incluirán en un protocolo de intervención. Método Estudio analítico transversal en 18 zonas de salud de Canarias, con una población a estudio de 385.049 personas, usando variables sociodemográficas procedentes de la tarjeta sanitaria, los diagnósticos y el uso de los recursos asistenciales obtenidos de la historia electrónica de salud de atención primaria (HSAP) y del conjunto mínimo básico de datos hospitalario, el estado funcional registrado en la HSAP y los fármacos prescritos en el sistema de receta electrónica. A partir de esos datos se estimó la concordancia entre estratificadores, se evaluó la capacidad de cada estratificador para predecir ingresos y se construyeron modelos para optimizar la predicción. Resultados La concordancia entre los pesos de complejidad de los estratificadores fue fuerte (rho = 0,735) y la concordancia entre categorías de complejidad fue moderada (Kappa ponderado = 0,515). El peso de complejidad GMA predice el ingreso hospitalario mejor que el del CRG (área bajo la curva [AUC]: 0,696 [0,695-0,697] vs. 0,692 [0,691-0,693]). Se añadieron otras variables predictivas al peso GMA, obteniendo la mejor AUC (0,708 [0,707-0,708]) el modelo compuesto por GMA, sexo, edad, escalas de Pfeiffer y Barthel, existencia de reingreso y número de grupos terapéuticos prescritos. Conclusiones Se constató una fuerte concordancia entre estratificadores y una mayor capacidad predictiva de los ingresos por parte de los GMA, que puede aumentarse añadiendo otras dimensiones. Objective To compare the concordance of complexity weights between Clinical Risk Groups (CRG) and Adjusted Morbidity Groups (AMG). To determine which one is the best predictor of patient admission. To optimise the method used to select the 0.5% of patients of higher complexity that will be included in an intervention protocol. Method Cross-sectional analytical study in 18 Canary Island health areas, 385,049 citizens were enrolled, using sociodemographic variables from health cards; diagnoses and use of healthcare resources obtained from primary health care electronic records (PCHR) and the basic minimum set of hospital data; the functional status recorded in the PCHR, and the drugs prescribed through the electronic prescription system. The correlation between stratifiers was estimated from these data. The ability of each stratifier to predict patient admissions was evaluated and prediction optimisation models were constructed. Results Concordance between weights complexity stratifiers was strong (rho = 0.735) and the correlation between categories of complexity was moderate (weighted kappa = 0.515). AMG complexity weight predicts better patient admission than CRG (AUC: 0.696 [0.695-0.697] versus 0.692 [0.691-0.693]). Other predictive variables were added to the AMG weight, obtaining the best AUC (0.708 [0.707-0.708]) the model composed by AMG, sex, age, Pfeiffer and Barthel scales, re-admissions and number of prescribed therapeutic groups. Conclusions strong concord...
      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.06.003
  • Marcos GRADE de la Evidencia a la Decisión (EtD): un enfoque sistemático
           y transparente para tomar decisiones sanitarias bien informadas. 1:

    • Authors: Pablo Alonso-Coello; Holger J. Schünemann; Jenny Moberg; Romina Brignardello-Petersen; Elie A. Akl; Marina Davoli; Shaun Treweek; Reem A. Mustafa; Gabriel Rada; Sarah Rosenbaum; Angela Morelli; Gordon H. Guyatt; Andrew D. Oxman
      Abstract: Publication date: Available online 17 August 2017
      Source:Gaceta Sanitaria
      Author(s): Pablo Alonso-Coello, Holger J. Schünemann, Jenny Moberg, Romina Brignardello-Petersen, Elie A. Akl, Marina Davoli, Shaun Treweek, Reem A. Mustafa, Gabriel Rada, Sarah Rosenbaum, Angela Morelli, Gordon H. Guyatt, Andrew D. Oxman
      Los médicos y quienes elaboran guías y políticas a veces pasan por alto criterios importantes, les dan un peso indebido o no usan la mejor evidencia disponible para informar sus juicios. Los sistemas explícitos y transparentes para la toma de decisiones pueden ayudar a garantizar que se consideren todos los criterios importantes, y que las decisiones estén basadas en la mejor evidencia disponible. El grupo de trabajo GRADE ha desarrollado marcos «de la evidencia a la decisión» (EtD) para los diferentes tipos de recomendaciones o decisiones. El objetivo de los marcos EtD es ayudar a los paneles a usar la evidencia de una manera estructurada y transparente para informar las decisiones respecto de las recomendaciones clínicas, decisiones de cobertura y recomendaciones o decisiones sobre el sistema sanitario o sobre salud pública. Los marcos EtD tienen una estructura común: formulación de una pregunta, evaluación de la evidencia y conclusiones. No obstante, existen diferencias entre los marcos para cada tipo de decisión. Los marcos EtD informan a los usuarios sobre los juicios que se han hecho y la evidencia que los apoya dotando de transparencia la base para las decisiones a los grupos de interés. Los marcos EtD también facilitan la diseminación de las recomendaciones y permiten a los decisores de otras jurisdicciones adoptar recomendaciones o decisiones, o adaptarlas a su contexto. El siguiente artículo es una traducción del artículo original publicado en British Medical Journal. Los marcos EtD se utilizan actualmente en el marco del Programa de Guías de Práctica Clínica en el Sistema Nacional de Salud, coordinado por GuíaSalud. La Fundación Dr. Antonio Esteve ha asumido tanto el permiso de reproducción como la traducción del artículo original al español. La traducción ha sido realizada por María Victoria Leo Rosas y revisada por Andrea Cervera y Pablo Alonso-Coello. Clinicians, guideline developers, and policymakers sometimes neglect important criteria, give undue weight to criteria, and do not use the best available evidence to inform their judgments. Explicit and transparent systems for decision making can help to ensure that all important criteria are considered and that decisions are informed by the best available research evidence. The GRADE Working Group has developed Evidence to Decision (EtD) frameworks for the different type of recommendations or decisions. The purpose of EtD frameworks is to help people use evidence in a structured and transparent way to inform decisions in the context of clinical recommendations, coverage decisions, and health system or public health recommendations and decisions. EtD frameworks have a common structure that includes formulation of the question, an assessment of the evidence, and drawing conclusions, though there are some differences between frameworks for each type of decision. EtD frameworks inform users about the judgments that were made and the evidence supporting those judgments by making the basis for decisions transparent to target audiences. EtD frameworks also facilitate dissemination of recommendations and enable decision makers in other jurisdictions to adopt recommendations or decisions, or adapt them to their context. This article is a translation of the original article published in British Medical Journal. The EtD frameworks are currently used in the Clinical Practice Guideline Programme of the Spanish National Health System, co-ordinated by GuíaSalud. The Fundación Dr. Antonio Esteve has assumed the copyright license as well as the translation of the original article into Spanish. The translation was carried out by María Victoria Leo Rosas and proofread by Andrea Cervera and Pablo Alonso-Coello.

      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.02.010
  • The opportunity costs of caring for people with dementia in Southern Spain

    • Authors: Manuel Ruiz-Adame Reina; Manuel Correa; Katherine Burton
      Abstract: Publication date: Available online 12 August 2017
      Source:Gaceta Sanitaria
      Author(s): Manuel Ruiz-Adame Reina, Manuel Correa, Katherine Burton
      Objective The aim of this paper is to study the opportunity costs (OC) that are involved in being a caregiver and to compare them with the direct costs assumed by the State and the families. We evaluate direct cost (those that imply a payment-out-of-pocket) and indirect cost (those that imply a dedication in time). We hypothesized that costs increase with the severity of the dementia, with the educational level and active occupational situation of caregiver. They are greater if the caregiver is male, but if the patient and caregiver cohabit they are reduced. Method 778 surveys were analyzed. Data was collected using a questionnaire specifically designed for the purpose, with the collaboration of Alzheimer's Diseases Associations in Andalusia (Spain). For the indirect cost, we used the reveal preferences method. For the comparison between groups an ANOVA and a MANOVA was done. Results The hypotheses were confirmed. The OC exponentially increases with severity. More than 55% of costs are assumed by families. Occupied people have higher educational level and incomes and contract more external support. Costs are significantly higher for male caregivers. Cohabiting reduces all kinds of costs. Conclusions The relationship between educational level and employment situation lead to think that if these variables are greater more people will seek professional support. Cultural reasons still maintain women as main caregivers for all educational levels. The existence of these informal caregivers as the main care providers is a saving for the State, and a brake for the development of professional supply.

      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.06.004
  • Alcohol in the city: wherever and whenever

    • Authors: Xisca Sureda; Víctor Carreño; Albert Espelt; Joan R. Villalbí; Jamie Pearce; Manuel Franco
      Abstract: Publication date: Available online 10 August 2017
      Source:Gaceta Sanitaria
      Author(s): Xisca Sureda, Víctor Carreño, Albert Espelt, Joan R. Villalbí, Jamie Pearce, Manuel Franco
      Alcohol urban environment has been associated with individual alcohol behaviors. We are constantly exposed to a wide variety of alcohol products, its marketing and promotion and signs of alcohol consumption that may influence alcohol-drinking behaviors. In this photo-essay, we include photographs that visually explain the exposure to alcohol in the urban streetscape of Madrid. These photographs show the pervasiveness of alcohol products in this city, which can be found everywhere at any time.

      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.06.008
  • Cancer-related knowledge and health status among cancer survivors in

    • Authors: Ana Rute Costa; Pedro Moura-Ferreira; Nuno Lunet
      Abstract: Publication date: Available online 10 August 2017
      Source:Gaceta Sanitaria
      Author(s): Ana Rute Costa, Pedro Moura-Ferreira, Nuno Lunet

      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.06.007
  • Effectiveness of a parent-training program in Spain: reducing the Southern
           European evaluation gap

    • Authors: Noelia Vázquez; M. Cruz Molina; Pilar Ramos; Lucía Artazcoz
      Abstract: Publication date: Available online 9 August 2017
      Source:Gaceta Sanitaria
      Author(s): Noelia Vázquez, M. Cruz Molina, Pilar Ramos, Lucía Artazcoz
      Objective We implemented and evaluated the Parenting Skills Program for families in Spain 1) to examine differences in parenting skills, social support, children's behaviours and parental stress pre, immediately post and six months post intervention and 2) to identify mechanisms by which the intervention is related to changes in the four outcomes examined. Methods Quasi-experimental study design with pre (T0), post (T1), a follow-up (T2) and no control group, complemented by a qualitative study was used. The outcome variables were social support, parenting skills, parental stress and children's behaviours. 216 parents completed pre and post questionnaire and 130 parents the follow-up questionnaire. 39 professionals and 34 parents participated in 17 interviews and 5 discussion groups. Results Compared with T0, all four outcomes improved significantly at T1. 76% of the participants improved parenting skills and 61% social support. 56% reduced children's negative behaviours and 66% parental stress. All outcomes maintained this significant improvement at T2. Parents and professionals describe different changes in parents’ parenting skills, stress and social support after participation in the PSP, and in their children's behaviours. Some subcategories emerged after analysing parents’ and professionals’ discourses. Conclusions This study describes positive parenting effects on participants of a parent-training program in Spain, which is a country where implementation and evaluation of these kind of interventions is an incipient issue.

      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.06.005
  • Hotline for Zika virus

    • Authors: Beuy Joob; Viroj Wiwanitkit
      Abstract: Publication date: Available online 4 August 2017
      Source:Gaceta Sanitaria
      Author(s): Beuy Joob, Viroj Wiwanitkit

      PubDate: 2017-09-03T04:06:57Z
      DOI: 10.1016/j.gaceta.2017.06.009
  • Exposición ambiental a dióxido de nitrógeno y salud respiratoria a los
           2 años en la Cohorte INMA-Valencia

    • Authors: Alejandra Gutiérrez Oyarce; Amparo Ferrero; Marisa Estarlich; Ana Esplugues; Carmen Iñiguez; Ferran Ballester
      Abstract: Publication date: Available online 26 July 2017
      Source:Gaceta Sanitaria
      Author(s): Alejandra Gutiérrez Oyarce, Amparo Ferrero, Marisa Estarlich, Ana Esplugues, Carmen Iñiguez, Ferran Ballester
      Objetivo Analizar la relación entre la exposición a dióxido de nitrógeno (NO2) en las etapas prenatal y posnatal y la incidencia de problemas respiratorios en niños/as hasta los 2 años de edad. Método La población consistió en 624 niños/as de la cohorte INMA-Valencia. Se estimó la exposición individual al NO2 en el exterior de la vivienda durante el periodo prenatal y hasta los 2 años de edad, a partir de la combinación de datos empíricos y el desarrollo de métodos geoestadísticos. Se aplicó un cuestionario para obtener la información sobre los síntomas respiratorios a los 2 años. La asociación entre la exposición al NO2 y los eventos respiratorios se realizó mediante regresión logística multivariante. Resultados La incidencia acumulada fue del 16,3% para tos persistente, del 34,9% para episodios de sibilancias y del 27,6% para las infecciones respiratorias de vías bajas. No se encontró asociación entre los síntomas respiratorios y la exposición al NO2 en el conjunto de los/las niños/as. Sin embargo, sí se encontró una asociación entre la exposición al NO2 y la tos persistente en el segundo año de vida en los/las niños/as con antecedentes familiares de alergias. Conclusión La exposición al NO2 ambiental contribuiría a la presencia de tos persistente en los/las niños/as con antecedentes familiares de alergias. Objective To analyze the association between exposure to nitrogen dioxide (NO2) during pregnancy and the postnatal period up to the age of 2 years old and the incidence of respiratory problems in children from the INMA-Valencia cohort. Methods The study population included 624 children from the INMA-Valencia cohort. Individual exposure to NO2 was estimated in different environments outside the home during pregnancy and up to the age of 2 using empirical measurement and data from geo-statistical methods. Respiratory symptoms were obtained from a questionnaire applied at the age of two. The association between NO2 exposure and respiratory symptoms was performed using multivariate logistic regression. Results The cumulative incidence was 16.3% for persistent cough, 34.9% for wheezing and 27.6% for lower respiratory tract infections. No association was found between respiratory symptoms and exposure to NO2 in any of the children. However an association between NO2 exposure and persistent cough was found at two years of life in the children with a parental history of allergy. Conclusion NO2 exposure would lead to persistent cough in children with a parental history of allergies.

      PubDate: 2017-08-03T01:58:21Z
      DOI: 10.1016/j.gaceta.2017.05.012
  • Exploring the role of social capital in urban citizens’ initiatives
           in the Netherlands

    • Authors: Carlijn Wentink; Lenneke Vaandrager; Rosalie van Dam; Jan Hassink; Irini Salverda
      Abstract: Publication date: Available online 25 July 2017
      Source:Gaceta Sanitaria
      Author(s): Carlijn Wentink, Lenneke Vaandrager, Rosalie van Dam, Jan Hassink, Irini Salverda
      Objective This research explores the role of social capital in urban citizens’ initiatives in the Netherlands, by using in-depth interviews. Method Social capital was operationalized as shared norms and values, connectedness, trust and reciprocity. Results The findings show that initiatives form around a shared idea or ambition (shared norms and values). An existing network of relationships (connectedness) is needed for an idea to emerge and take form. Connectedness can also increase as a result of an initiative. Some level of trust between people needs to be present from the start of the initiative. For the initiative to persist, strong in-group connections seem important, as well as a good balance between investments and returns. This reciprocity is mainly about intangible assets, such as energy and friendship. Conclusion This study concludes that social capital within citizens’ initiatives is both a prerequisite for the formation of initiatives and a result of the existence of initiatives.

      PubDate: 2017-08-03T01:58:21Z
      DOI: 10.1016/j.gaceta.2017.05.011
  • La prevención y el control de la iatrogenia requieren varios frentes y
           alianzas. SESPAS llama a la colaboración

    • Authors: Beatriz González López-Valcárcel; Carlos Campillo-Artero
      Abstract: Publication date: Available online 16 June 2017
      Source:Gaceta Sanitaria
      Author(s): Beatriz González López-Valcárcel, Carlos Campillo-Artero

      PubDate: 2017-08-03T01:58:21Z
      DOI: 10.1016/j.gaceta.2017.04.001
  • Relevancia del contexto socioeconómico y sanitario en la
           satisfacción del paciente

    • Authors: Shirley Pérez-Romero; Juan J. Gascón-Cánovas; Diego Salmerón-Martínez; Pedro Parra-Hidalgo; Olga Monteagudo-Piqueras
      Abstract: Publication date: Available online 11 July 2017
      Source:Gaceta Sanitaria
      Author(s): Shirley Pérez-Romero, Juan J. Gascón-Cánovas, Diego Salmerón-Martínez, Pedro Parra-Hidalgo, Olga Monteagudo-Piqueras
      Objetivo Determinar qué factores de los contextos socioeconómico y sanitario influyen sobre la percepción de la satisfacción de la población con los servicios de salud. Método Los datos provienen de la Encuesta Europea de Salud de 2009. En los 22.188 sujetos encuestados se estudió la relación entre percepción de la satisfacción con los servicios sanitarios recibidos y las variables tanto individuales como contextuales, aplicando un análisis multinivel. Resultados Los factores de los contextos socioeconómico y sanitario que influyen sobre la satisfacción son las mayores tasas de población sin estudios, en la cual la percepción de excelencia es menos probable (odds ratio [OR]: 0,48-0,82) y la insatisfacción es más prevalente (OR: 1,46-1,63). Asimismo, la proporción de personas insatisfechas es menor cuando el gasto per cápita en servicios sanitarios es muy elevado (>1400 €) (OR: 0,49-0,87) y la ratio entre médicos de atención primaria de salud y habitantes es alta (>60) (OR: 0,50-0,85). Además, la prevalencia de insatisfacción describe una tendencia lineal positiva con la tasa de paro (OR: 1,12; p=0,0001) y la magnitud relativa del sector servicios (OR:1,03; p=0,001). Por el contrario, esta tendencia lineal es negativa conforme aumenta el índice de cobertura de la prestación sanitaria (OR: 0,88; p=0,04). Conclusiones Los factores individuales que determinan la satisfacción del paciente son el sexo, la edad, la salud mental y el país de nacimiento. Además, hay diferencias en la satisfacción del paciente entre las comunidades autónomas de acuerdo con determinantes socioeconómicos, como el producto interior bruto per cápita, las tasas de población sin estudios, las tasas de paro o la ratio número de habitantes/consultorios. Los estudios de satisfacción del usuario, además de ajustarse por variables individuales como el sexo, la edad o el nivel de salud, también deberían tomar en consideración características del entorno socioeconómico del área geográfica de residencia. Objective To determine which factors of the socioeconomic and health contexts influence the perception of the satisfaction of the population with the health services. Methods The data come from the European Health Survey of 2009. In the 22,188 subjects surveyed, the relationship between the perception of satisfaction with the health services received and the individual and contextual variables was studied, applying a multilevel analysis. Results The factors of the socioeconomic and health contexts that influence satisfaction are: higher rates of low level of studies where the perception of excellence is less likely (odds ratio [OR]: 0.48-0.82) and dissatisfaction is more prevalent (OR: 1.46-1.63). Likewise, the proportion of unsatisfied citizens is lower when per capita expenditure on health services is very high (>1400 €) (OR: 0.49-0.87) and the ratio “primary health care physicians/inhabitants” is high (>60) (OR: 0.500.85). In addition, the prevalence of dissatisfaction describes a positive linear trend with the unemployment rate (OR: 1.12; p=0.0001) and the relative magnitude of the services sector (OR: 1.03; p=0.001). By contrast, this linear trend is negative as the Health Care Coverage Ratio increases (OR: 0.88; p=0.04).
      PubDate: 2017-07-12T03:10:06Z
      DOI: 10.1016/j.gaceta.2017.05.003
  • Citizens’ perceptions of the presence and health risks of synthetic
           chemicals in food: results of an online survey in Spain

    • Authors: José Pumarega; Cristina Larrea; Araceli Muñoz; Natàlia Pallarès; Magda Gasull; Giselle Rodriguez; Manel Jariod; Miquel Porta
      Abstract: Publication date: Available online 27 June 2017
      Source:Gaceta Sanitaria
      Author(s): José Pumarega, Cristina Larrea, Araceli Muñoz, Natàlia Pallarès, Magda Gasull, Giselle Rodriguez, Manel Jariod, Miquel Porta
      Objective To explore factors influencing perceptions and viewpoints on the responsibility for the presence of toxic substances in food, on enforcement of laws and regulations that control human exposure to toxic substances in food, and on the effectiveness of such regulations. Methods An online survey was completed by 740 individuals from several parts of Spain (median age, 47 years; 67% were women; 70% had completed university studies). Results Over 87% of respondents said that it was possible that throughout their lives they could have accumulated in their body toxic substances potentially dangerous to their health. The attribution of the responsibility for toxic substances in food to a larger number of social groups was more frequent among respondents who consulted information about the problem more often (odds ratio [OR]: 1.92), who correctly identified factors that increase the likelihood of toxic substances in food being harmful to human health (OR: 2.86), who better knew the health problems that may be caused by such substances (OR: 2.48), and who recognised more food groups that tend to have concentrations of toxic substances potentially harmful to health (OR: 2.92) (all p values <0.001). Women were 65% less likely than men to answer that regulations on toxic substances in food are effective (p<0.001); and so were participants who identified more food groups with potentially toxic concentrations. Conclusions Among study participants there was a widespread scepticism and distrust towards the enforcement and effectiveness of laws and regulations that in Spain aim to control human exposure to toxic substances in food.

      PubDate: 2017-07-03T13:21:40Z
      DOI: 10.1016/j.gaceta.2017.03.012
  • The theft of well-being: a comment on Zunzunegui et al

    • Authors: Usama Bilal; Jay S. Kaufman
      Abstract: Publication date: Available online 22 June 2017
      Source:Gaceta Sanitaria
      Author(s): Usama Bilal, Jay S. Kaufman

      PubDate: 2017-07-03T13:21:40Z
      DOI: 10.1016/j.gaceta.2017.04.004
  • Cribado in situ de la enfermedad de Chagas con una intervención
           comunitaria: ¿puede mejorar la accesibilidad al diagnóstico y al

    • Authors: Hakima Ouaarab Essadek; Isabel Claveria Guiu; Johanna Caro Mendivelso; Elena Sulleiro; Conxita Pastoret; Miriam Navarro; Irene Barrabeig; Jordi Gómez i Prat
      Abstract: Publication date: Available online 20 June 2017
      Source:Gaceta Sanitaria
      Author(s): Hakima Ouaarab Essadek, Isabel Claveria Guiu, Johanna Caro Mendivelso, Elena Sulleiro, Conxita Pastoret, Miriam Navarro, Irene Barrabeig, Jordi Gómez i Prat

      PubDate: 2017-06-22T04:52:49Z
      DOI: 10.1016/j.gaceta.2017.04.007
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