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  Subjects -> HEALTH AND SAFETY (Total: 1279 journals)
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HEALTH AND SAFETY (508 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
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: 19)
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: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 2)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 24)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 170)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 7)
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  
Apuntes Universitarios     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 1)
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: 5)
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: 2)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access  
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BMC Oral Health     Open Access   (Followers: 4)
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: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
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: 9)
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: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
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: 2)
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: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
Ethiopian Journal of Health Development     Open Access   (Followers: 9)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     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: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 9)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 12)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 14)
Global Journal of Health Science     Open Access   (Followers: 3)
Global Journal of Public Health     Open Access   (Followers: 9)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 9)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 46)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 9)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 34)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 19)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 9)
Health Promotion Practice     Hybrid Journal   (Followers: 14)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 46)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Sciences and Disease     Open Access   (Followers: 1)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Heart Insight     Full-text available via subscription  
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: 9)
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: 2)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 2)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of 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: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 32)
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: 4)
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: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health and Rehabilitation Sciences     Open Access   (Followers: 13)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 6)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)
International Journal of Healthcare Delivery Reform Initiatives     Full-text available via subscription   (Followers: 1)
International Journal of Healthcare Information Systems and Informatics     Hybrid Journal   (Followers: 10)

        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  [3041 journals]
  • Adaptación española de las guías europeas de 2016 sobre prevención de
           la enfermedad cardiovascular en la práctica clínica

    • Authors: M.Á. Royo-Bordonada; P. Armario; J.M. Lobos Bejarano; J. Pedro-Botet; F. Villar Alvarez; R. Elosua; C. Brotons Cuixart; O. Cortés; B. Serrano; M. Cammafort Babkowski; A. Gil Núñez; A. Pérez; A. Maiques; A. de Santiago Nocito; A. Castro; E. Alegría; C. Baeza; M. Herranz; S. Sans; P. Campos
      Pages: 24 - 40
      Abstract: Publication date: Available online 11 March 2017
      Source:Gaceta Sanitaria
      Author(s): M.Á. Royo-Bordonada, P. Armario, J.M. Lobos Bejarano, J. Pedro-Botet, F. Villar Alvarez, R. Elosua, C. Brotons Cuixart, O. Cortés, B. Serrano, M. Camafort Babkowski, A. Gil Núñez, A. Pérez, A. Maiques, A. de Santiago Nocito, A. Castro, E. Alegría, C. Baeza, M. Herranz, S. Sans, P. Campos
      Las VI Guías Europeas de Prevención Cardiovascular recomiendan combinar las estrategias poblacional y de alto riesgo, con los cambios de estilo de vida como piedra angular de la prevención, y proponen la función SCORE para cuantificar el riesgo cardiovascular. Esta guía hace más hincapié en las intervenciones específicas de las enfermedades y las condiciones propias de las mujeres, las personas jóvenes y las minorías étnicas. No se recomienda el cribado de aterosclerosis subclínica con técnicas de imagen no invasivas. La guía establece cuatro niveles de riesgo (muy alto, alto, moderado y bajo), con objetivos terapéuticos de control lipídico según el riesgo. La diabetes mellitus confiere un riesgo alto, excepto en sujetos con diabetes tipo 2 con menos de 10 años de evolución, sin otros factores de riesgo ni complicaciones, o con diabetes tipo 1 de corta evolución sin complicaciones. La decisión de iniciar el tratamiento farmacológico de la hipertensión arterial dependerá del nivel de presión arterial y del riesgo cardiovascular, teniendo en cuenta la lesión de órganos diana. Siguen sin recomendarse los fármacos antiplaquetarios en prevención primaria por el riesgo de sangrado. La baja adherencia al tratamiento exige simplificar el régimen terapéutico e identificar y combatir sus causas. La guía destaca que los profesionales de la salud pueden ejercer un papel importante en la promoción de intervenciones poblacionales y propone medidas eficaces, tanto a nivel individual como poblacional, para promover una dieta saludable, la práctica de actividad física, el abandono del tabaquismo y la protección contra el abuso de alcohol. The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

      PubDate: 2017-03-16T12:41:21Z
      DOI: 10.1016/j.hipert.2016.11.006
      Issue No: Vol. 34, No. 1 (2017)
  • Gaceta Sanitaria en 2016. Una nueva etapa, fortalecimiento de eGaceta e

    • Authors: Clara Bermúdez-Tamayo; Miguel Negrín Hernández; Julia Bolívar; Erica Briones Vozmediano; David Cantarero; Mercedes Carrasco Portiño; Gonzalo Casino; Enrique Castro Sánchez; Mar García Calvente; Laura Inés González Zapata; David Epstein; Mariano Hernán; Cristina Linares; Leila Posenato García; María Teresa Ruiz Cantero; Andreu Segura; María Victoria Zunzunegui; Javier Arias; Iñaki Galán; Rosana Peiró; Carlos Álvarez-Dardet
      Pages: 77 - 81
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Clara Bermúdez-Tamayo, Miguel Negrín Hernández, Julia Bolívar, Erica Briones Vozmediano, David Cantarero, Mercedes Carrasco Portiño, Gonzalo Casino, Enrique Castro Sánchez, Mar García Calvente, Laura Inés González Zapata, David Epstein, Mariano Hernán, Cristina Linares, Leila Posenato García, María Teresa Ruiz Cantero, Andreu Segura, María Victoria Zunzunegui, Javier Arias, Iñaki Galán, Rosana Peiró, Carlos Álvarez-Dardet

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2017.02.002
  • Gender inequality and violence against women in Spain, 2006-2014: towards
           a civilized society

    • Authors: Erika M. Redding; María Teresa Ruiz-Cantero; José Fernández-Sáez; Marta Guijarro-Garvi
      Pages: 82 - 88
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Erika M. Redding, María Teresa Ruiz-Cantero, José Fernández-Sáez, Marta Guijarro-Garvi
      Objective Considering both the economic crisis of 2008 and the Gender Equality Law (2007), this study analyses the association between gender inequality in Spanish Autonomous Communities (AC) and intimate partner violence (IPV) from 2006 to 2014 in terms of socio-demographic characteristics. Methods Ecological study in the 17 Spanish AC on the correlation between the reported cases by IPV and deaths and the Gender Inequality Index and its dimensions: empowerment, participation in the labour market and adolescent birth rates; and their correlation with Young People Not in Education, Employment or Training (NEET). Results In 2006, IPV mortality rates were higher in autonomous communities with greater gender inequality than AC with more equality (4.1 vs. 2.5×106 women >14 years), as were reporting rates of IPV (OR=1.49; 95% CI: 1.47-1.50). In 2014, the IPV mortality rates in AC with greater gender inequality fell to just below the mortality rates in AC with more gender equality (2.5 vs. 2.7×106 women >14 years). Rates of IPV reports also decreased (OR=1.22; 95% CI: 1.20-1.23). Adolescent birth rates were most associated with IPV reports, which were also associated with the burden of NEET by AC (ρ2006 =0.494, ρ2014 =0.615). Conclusion Gender-sensitive policies may serve as a platform for reduced mortality and reports of IPV in Spain, particularly in AC with more gender inequality. A reduction of NEET may reduce adolescent birth rates and in turn IPV rates.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.07.025
  • Measuring the impact of alcohol-related disorders on quality of life
           through general population preferences

    • Authors: Eva Rodríguez-Míguez; Jacinto Mosquera Nogueira
      Pages: 89 - 94
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Eva Rodríguez-Míguez, Jacinto Mosquera Nogueira
      Objective To estimate the intangible effects of alcohol misuse on the drinker's quality of life, based on general population preferences Methods The most important effects (dimensions) were identified by means of two focus groups conducted with patients and specialists. The levels of these dimensions were combined to yield different scenarios. A sample of 300 people taken from the general Spanish population evaluated a subset of these scenarios, selected by using a fractional factorial design. We used the probability lottery equivalent method to derive the utility score for the evaluated scenarios, and the random-effects regression model to estimate the relative importance of each dimension and to derive the utility score for the rest of scenarios not directly evaluated. Results Four main dimensions were identified (family, physical health, psychological health and social) and divided into three levels of intensity. We found a wide variation in the utilities associated with the scenarios directly evaluated (ranging from 0.09 to 0.78). The dimensions with the greatest relative importance were physical health (36.4%) and family consequences (31.3%), followed by psychological (20.5%) and social consequences (11.8%). Conclusions Our findings confirm the benefits of adopting a heterogeneous approach to measure the effects of alcohol misuse. The estimated utilities could have both clinical and economic applications.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.07.011
  • Barriers for identification and treatment of problem drinkers in primary

    • Authors: Ainhoa Coloma-Carmona; José Luis Carballo; Sonia Tirado-González
      Pages: 95 - 99
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Ainhoa Coloma-Carmona, José Luis Carballo, Sonia Tirado-González
      Objective Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals’ health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. Method The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. Results The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. Conclusions Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.07.009
  • Attitudes of students of a health sciences university towards the
           extension of smoke-free policies at the university campuses of Barcelona

    • Authors: Cristina Martínez; Carlos Méndez; María Sánchez; José María Martínez-Sánchez
      Pages: 132 - 138
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Cristina Martínez, Carlos Méndez, María Sánchez, José María Martínez-Sánchez
      Objective To assess attitudes towards the extension of outdoor smoke-free areas on university campuses. Methods Cross-sectional study (n=384) conducted using a questionnaire administered to medical and nursing students in Barcelona in 2014. Information was obtained pertaining to support for indoor and outdoor smoking bans on university campuses, and the importance of acting as role models. Logistic regression analyses were performed to examine agreement. Results Most of the students agreed on the importance of health professionals and students as role models (74.9% and 64.1%, respectively) although there were statistically significant differences by smoking status and age. 90% of students reported exposure to smoke on campus. Students expressed strong support for indoor smoke-free policies (97.9%). However, only 39.3% of participants supported regulation of outdoor smoking for university campuses. Non-smokers (OR=12.315; 95% CI: 5.377-28.204) and students ≥22 years old (OR=3.001; 95% CI: 1.439-6.257) were the strongest supporters. Conclusions The students supported indoor smoke-free policies for universities. However, support for extending smoke-free regulations to outdoor areas of university campuses was limited. It is necessary to educate students about tobacco control and emphasise their importance as role models before extending outdoor smoke-free legislation at university campuses.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.08.009
  • Análisis de las buenas prácticas de participación ciudadana en las
           unidades de gestión clínica del Servicio Andaluz de Salud

    • Authors: M. Eugenia Gómez Martínez; Guadalupe Pastor Moreno; Olivia Pérez Corral; M. Teresa Iriarte de los Santos; Ángel Luis Mena Jiménez; M. Cecilia Escudero Espinosa; Inmaculada García Romera; Martín Germán Blanco García; Amelia Martín Barato
      Pages: 139 - 144
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): M. Eugenia Gómez Martínez, Guadalupe Pastor Moreno, Olivia Pérez Corral, M. Teresa Iriarte de los Santos, Ángel Luis Mena Jiménez, M. Cecilia Escudero Espinosa, Inmaculada García Romera, Martín Germán Blanco García, Amelia Martín Barato
      Objetivo Conocer buenas prácticas de participación ciudadana en las unidades de gestión clínica (UGC) del Servicio Andaluz de Salud (SAS) y explorar factores percibidos por profesionales de UGC del SAS que pueden influir en la existencia y la distribución de buenas prácticas de participación ciudadana. Método Estudio con metodología mixta realizado en Andalucía en dos fases (2013-2015). En la fase 1 (estudio cuantitativo) se realizó un cuestionario online a directores/as de UGC con una comisión de participación ciudadana constituida. En la fase 2 (estudio cualitativo) se realizaron entrevistas semiestructuradas a profesionales del SAS con experiencia en participación ciudadana. Se realizó un análisis descriptivo de la información cuantitativa y un análisis de contenido semántico de la cualitativa. Resultados En la fase 1 participaron 530 UGC. Las prácticas de participación ciudadana implementadas con mayor frecuencia en las UGC están circunscritas a los niveles de información y consulta. Otras prácticas que suponen una mayor implicación y delegación ciudadana son secundarias. En la fase 2 se entrevistó a 12 profesionales. Los obstáculos identificados por los/las profesionales que pueden afectar a la distribución de buenas prácticas están relacionados con las creencias y las actitudes de la ciudadanía, los/las profesionales, el sistema sanitario y el contexto. Conclusiones Las principales prácticas de participación ciudadana en las UGC están relacionadas con los niveles más básicos de participación. No se reconocen claramente la manera y los mecanismos que facilitarían el empoderamiento ciudadano en el sistema sanitario. Objective To discover good practices for inhabitant participation in the clinical management units (CMUs) of the Andalusian Health Service (AHS) (Spain) and to explore the reasons perceived by CMU and AHS professionals that may influence the presence and distribution of those good practices among the CMU. Methods Study with mixed methodology carried out in Andalusia (Spain) in two phases (2013–2015). Firstly, an online survey was delivered to the Directors of the CMUs which had set up an inhabitant participation commission. In a second phase, a qualitative study was carried out through semi-structured interviews with professionals from the Andalusian Health Service with previous experience in inhabitant participation. A descriptive analysis of the quantitative information and a semantic content analysis of the qualitative information were carried out. Results 530 CMUs took part in the survey. The inhabitant participation practices more often implemented in the CMUs are those related to the informing and consultation levels. Twelve professionals were interviewed in the second phase. Other practices with higher inhabitant involvement and delegation are secondary. The barriers which were identified by professionals are related to the beliefs and attitudes of the inhabitants, the professionals, the health system and the environment. Conclusion The main practices for inhabitant partici...
      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.06.003
  • Actitudes frente a la cultura de seguridad del paciente en el ámbito
           hospitalario y variables correlacionadas

    • Authors: Ramon Mir-Abellán; Anna Falcó-Pegueroles; María Luisa de la Puente-Martorell
      Pages: 145 - 149
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Ramon Mir-Abellán, Anna Falcó-Pegueroles, María Luisa de la Puente-Martorell
      Objetivo Describir las actitudes frente a la cultura de la seguridad en trabajadores de un hospital y la influencia de variables sociodemográficas y profesionales. Métodos En una muestra de profesionales y auxiliares de enfermería se administró el cuestionario Hospital Survey on Patient Safety Culture. Se consideró como fortaleza más del 75% de respuestas positivas y como oportunidad de mejora más del 50% de respuestas negativas. Resultados El 59% (n=123) calificó la seguridad entre 7 y 8. El 53% (n=103) no realizó ninguna declaración de incidente en el último año. Como fortaleza se identificó «trabajo en equipo en la unidad/servicio», y como oportunidad de mejora, «dotación de personal». Se obtuvo una cultura de seguridad más positiva en los servicios ambulatorios, en profesionales de enfermería y en contratación a jornada parcial. Conclusiones El estudio ha permitido medir la cultura de la seguridad, hecho que facilitará su seguimiento y orientará las estrategias de mejora trabajando los puntos débiles y reforzando los potenciales. Objective To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables. Methods The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative. Results 59% (n=123) of respondents rated safety between 7 and 8. 53% (n=103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was “teamwork in the unit/service” and the opportunity for improvement was “staffing”. A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff. Conclusions This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.07.019
  • Qué hacen los hospitales y la atención primaria para mitigar el impacto
           social de los eventos adversos graves

    • Authors: José Joaquín Mira; Irene Carrillo; Susana Lorenzo
      Pages: 150 - 153
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): José Joaquín Mira, Irene Carrillo, Susana Lorenzo
      Objetivo Explorar qué se está haciendo en atención primaria y en los hospitales para mitigar el impacto social de los eventos adversos graves. Método Encuesta a 195 directivos de hospitales (n=113) y de atención primaria (n=82) de ocho comunidades autónomas. Se exploró el grado de implantación de cinco intervenciones recomendadas tras un evento adverso para proteger la reputación de las instituciones sanitarias. Resultados La mayoría de las instituciones (70, el 45,2% de atención primaria, y 85, el 54,8% de hospitales) no tenían un plan de crisis para salvaguardar su reputación tras un evento adverso. En atención primaria realizaban un mejor tratamiento de la comunicación interna (p=0,0001) y externa (p=0,012) que en los hospitales. En pocos casos se había definido el papel de la dirección tras un evento adverso (el 10,7% de los hospitales y el 6,25% de atención primaria). Conclusiones La mayoría de las instituciones sanitarias no cuentan con planes para afrontar el impacto social de los eventos adversos con consecuencias graves que generan desconfianza y pérdida de reputación. Objective To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE). Methods We surveyed 195 hospital (n=113) and PC (n=82) managers from eight autonomous communities to explore the level of implementation of five interventions recommended after an AE to protect the reputation of healthcare institutions. Results Most institutions (70, 45.2% PC, and 85, 54.8% hospitals) did not have a crisis plan to protect their reputation after an AE. Internal (p=0.0001) and external (p=0.012) communications were addressed better in PC than in hospitals. Very few institutions had defined the managers’ role in case of an AE (10.7% hospitals versus 6.25% PC). Conclusion A majority of healthcare institutions have not planned crisis intervention after an AE with severe consequences nor have they defined plans to recover citizens’ trust after an AE.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.07.015
  • Resultados y retos en salud pública ante la alerta por Ébola: una
           perspectiva desde Cataluña

    • Authors: Mireia Jané; Mª José Vidal; Mar Maresma; Ana Martínez; Gloria Carmona; Ana Rodés; Nuria Torner; Josep Álvarez; Maria-Rosa Sala; Irene Barrabeig
      Pages: 161 - 166
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Mireia Jané, Mª José Vidal, Mar Maresma, Ana Martínez, Gloria Carmona, Ana Rodés, Nuria Torner, Josep Álvarez, Maria-Rosa Sala, Irene Barrabeig
      El brote de enfermedad por virus Ébola iniciado en Guinea Conakry y notificado a la Organización Mundial de la Salud en marzo de 2014ha sido el mayor documentado hasta la fecha. Su extensión a países limítrofes y el riesgo de expansión fuera del continente africano hicieron que, en agosto de 2014, fuese declarado emergencia de salud pública internacional. En el marco de lo establecido por el Centro de Coordinación de Alertas y Emergencias Sanitarias, la Agencia de Salud Pública de Cataluña inició las actuaciones de salud pública en marzo de 2014 y elaboró un único protocolo para todo el territorio, consejos para viajeros y cooperantes procedentes de países afectados, y una nota informativa semanal. Asimismo, en Cataluña, se crearon el Comité de Análisis y Seguimiento de Ébola y el Comité Científico Asesor de Ébola. Se realizaron sesiones informativas y formativas a más de 9600 profesionales de la salud de diferentes ámbitos. Desde agosto de 2014, a través del Sistema de Urgencias de Vigilancia Epidemiológica de Cataluña se notificaron 117 sospechas de Ébola. En tres casos se activó el protocolo con derivación al centro hospitalario de referencia, siendo los resultados descartados microbiológicamente. Se realizó la vigilancia de 95 cooperantes, un 52% mujeres y un 74% procedentes de Sierra Leona. En la gestión de alertas fueron esenciales la preparación y la planificación previas, el trabajo sinérgico entre la red epidemiológica, la asistencial y el conjunto de agentes implicados, así como la comunicación de riesgo precisa, veraz y proporcionada. Fue clave el circuito de cribado previo establecido ante la sospecha de casos por parte de los servicios de vigilancia epidemiológica. Así, solo se activó el protocolo de inmediato en aquellos casos que cumplían estrictamente los criterios. Este es un aspecto esencial a reforzar y mantener de cara a futuras alertas de salud pública internacional. The Ebola outbreak in Guinea Conakry was notified to the World Health Organization (WHO) in March 2014. It is the most complex Ebola outbreak to date, affecting Guinea Conakry as well as the surrounding countries and with a risk of the disease spreading outside Africa. For this reason, the World Health Organization declared this Ebola outbreak an international public health emergency in August 2014. The Public Health Agency of Catalonia, through the Spanish Alert and Emergencies Coordination Network, initiated public health actions in March 2014, developing a single protocol of action to be applied by all the health care providers in the whole Catalan territory, advice for travellers and voluntary workers arriving from affected countries and a weekly newsletter addressed to health professionals. At the same time, the Ebola Analysis and Monitoring Committee and the Ebola Scientific and Advisory Committee were established. More than 9600 professional health workers attended training sessions and informative sessions. From August 2014, the Catalan Epidemiological Surveillance Emergency Service (SUVEC) reported 117 suspected Ebola cases, of which only 3 met the epidemiological and clinical criteria leading to the activation of the action protocol. All 3 cases proved negative for Ebola. Also, 95 voluntary workers were monitored, 52% of whom were female and 74% had returned from Sierra Leone. Dealing with the suspected Ebola cases required a detailed advance preparation and planning, with a coordinated effort between the epidemiological and health-care network, and all the agents involved, as well as precise, realistic and appropriate risk communication. The prior screening of suspected Ebola cases by the SUVEC meant the immediate protocol was activated only in the cases that met the epidemiological and clinical criteria. This is a key point to be reinforced in any future international public health alerts.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.07.016
  • Patrones de actividad física durante el embarazo en mujeres de
           Aragón (España)

    • Authors: Enrique Ramón-Arbués; Susana Martín-Gómez; Blanca Martínez-Abadía
      Pages: 168 - 169
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Enrique Ramón-Arbués, Susana Martín-Gómez, Blanca Martínez-Abadía

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.08.005
  • ¿Cuánto saben los estudiantes del Grado en Medicina sobre la enfermedad
           de Chagas en España?

    • Authors: José Manuel Ramos; Carlos Martorell; Ana Isabel López-Amorós; Miriam Navarro
      Pages: 171 - 172
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): José Manuel Ramos, Carlos Martorell, Ana Isabel López-Amorós, Miriam Navarro

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.07.004
  • Evaluación del equilibrio alimentario de los menús escolares de la
           Comunidad Valenciana (España) mediante un cuestionario

    • Authors: Cristóbal Llorens-Ivorra; Ilona Arroyo-Bañuls; Joan Quiles-Izquierdo; Miguel Richart-Martínez
      Abstract: Publication date: Available online 21 March 2017
      Source:Gaceta Sanitaria
      Author(s): Cristóbal Llorens-Ivorra, Ilona Arroyo-Bañuls, Joan Quiles-Izquierdo, Miguel Richart-Martínez
      Objetivo Evaluar el equilibrio alimentario de los menús escolares de la Comunidad Valenciana (España) mediante un cuestionario. Método Estudio observacional transversal. Muestra por conveniencia de 255 menús escolares mensuales (20 días cada uno). Variables independientes: tamaño de la ciudad del colegio, provincia, ubicación (costa vs. interior), titularidad (público vs. privado), diseño del menú (empresa vs. colegio) y mes (mayo vs. octubre). Se usó como instrumento el cuestionario EQ-MEs con 17 ítems, que mide el equilibrio. Se compararon las diferencias en el equilibrio de los menús y la media de raciones mensuales considerando los diferentes niveles de las variables independientes. Resultados La media del índice de equilibrio obtenida fue de 9,19 puntos (rango: 0-17). El 78,4% de los menús fueron diseñados por empresas. El 60,4% fueron clasificados como adecuados y el 0,8% como equilibrados. Los menús de empresas obtuvieron mayor puntuación (9,49) que los diseñados por los colegios (8,13). Obtuvieron mayor puntuación los ubicados en Castellón (10,35) que los de Alicante (9,43) y Valencia (8,86). Solo un 3,1% de los menús estudiados se adecuaban a las recomendaciones de raciones de carne, el 37,6% a las de legumbres, el 49,4% a las de pescado y el 37% a las de fruta. Conclusión Con el cuestionario EQ-Mes, la mayoría de los menús ofertados en la Comunidad Valenciana son adecuados para la población infantil. Para mejorarlos deberían reducirse las raciones de patatas fritas, arroz, pasta, carne, fritos y lácteos, e incrementar las de legumbres, pescado, pescado azul y fruta. Objective To evaluate school menu food balance in the Autonomous Community of Valencia (Spain) by means of a questionnaire. Method Observational cross-section study. For convenience it shows of 255 monthly school menus (20 days each). Independent variables: size of the city the school is in, province, location (coast vs. inland), ownership (public vs. private), design of the menu (company vs. school) and month (May vs. October). The 17-item EQ-MEs questionnaire was used as a tool to measure balance. Differences in the balance of the menus and the average of monthly servings were compared, taking into account the different levels of the independent variables. Results The average of the balance index obtained was 9.19 points (range: 0–17). Approximately 78.4% of menus were designed by companies. Approximately 60.4% were classified as suitable and 0.8% as balanced. The menus designed by companies obtained a higher score (9.49) than those designed by schools (8.13). Menus in Castellón (10.35) achieved a higher score than those in Alicante (9.43) and Valencia (8.86). Only 3.1% of the studied menus met serving recommendations in terms of meat, 37.6% met pulses serving recommendations, 49.4% met fish serving recommendations and 37% met fruit serving recommendations. Conclusion With the EQ-MEs questionnaire, most of the menus offered in the Autonomous Community of Valencia are suitable for children. To improve them, they should reduce fried potato, rice, pasta, meat, fried food and dairy product servings, while increasing pulses, fish, oily fish and fruit servi...
      PubDate: 2017-03-21T12:45:54Z
      DOI: 10.1016/j.gaceta.2017.01.010
  • Evaluaciones rápidas de la eficacia y la seguridad de los nuevos

    • Authors: Ferrán Catalá-López; Manuel Ridao
      Abstract: Publication date: Available online 18 March 2017
      Source:Gaceta Sanitaria
      Author(s): Ferrán Catalá-López, Manuel Ridao

      PubDate: 2017-03-21T12:45:54Z
      DOI: 10.1016/j.gaceta.2017.01.008
  • Differences between men and women in substance use: the role of
           educational level and employment status

    • Authors: Ester Teixidó-Compañó; Albert Espelt; Luis Sordo; María J. Bravo; Ana Sarasa-Renedo; B. Iciar Indave; Marina Bosque-Prous; M. Teresa Brugal
      Abstract: Publication date: Available online 18 March 2017
      Source:Gaceta Sanitaria
      Author(s): Ester Teixidó-Compañó, Albert Espelt, Luis Sordo, María J. Bravo, Ana Sarasa-Renedo, B. Iciar Indave, Marina Bosque-Prous, M. Teresa Brugal
      Objective To determine differences between men and women in hazardous drinking, heavy cannabis use and hypnosedative use according to educational level and employment status in the economically active population in Spain. Method Cross-sectional study with data from 2013 Spanish Household Survey on Alcohol and Drugs on individuals aged 25-64 [n=14,113 (women=6,171; men=7,942)]. Dependent variables were hazardous drinking, heavy cannabis use and hypnosedative consumption; the main independent variables were educational level and employment situation. Associations between dependent and independent variables were calculated with Poisson regression models with robust variance. All analyses were stratified by sex. Results Hazardous drinking and heavy cannabis use were higher in men, while women consumed more hypnosedatives. The lower the educational level, the greater the gender differences in the prevalence of this substances owing to different consumption patterns in men and women. While men with a lower educational level were higher hazardous drinkers [RII=2.57 (95%CI: 1.75-3.78)] and heavy cannabis users [RII=3.03 (95%CI: 1.88-4.89)] compared to higher educational level, in women the prevalence was the same. Women with a lower education level and men with a higher education level had higher hypnosedative consumption. Unemployment was associated with increased heavy cannabis use and hypnosedative use in both women and men and with lower hazardous drinking only in women. Conclusions There are differences between men and women in the use of psychoactive substances that can be explained by the unequal distribution of substance use in them according to educational level. Unemployment was associated with substance use in both men and women.

      PubDate: 2017-03-21T12:45:54Z
      DOI: 10.1016/j.gaceta.2016.12.017
  • Radon exposure and tumors of the central nervous system

    • Authors: Alberto Ruano-Ravina; Ana Dacosta-Urbieta; Juan Miguel Barros-Dios; Karl T. Kelsey
      Abstract: Publication date: Available online 18 March 2017
      Source:Gaceta Sanitaria
      Author(s): Alberto Ruano-Ravina, Ana Dacosta-Urbieta, Juan Miguel Barros-Dios, Karl T. Kelsey
      Objective To review the published evidence of links between radon exposure and central nervous system tumors through a systematic review of the scientific literature. Methods We performed a thorough bibliographic search in Medline (PubMed) and EMBASE. We combined MeSH (Medical Subject Heading) terms and free text. We developed a purpose-designed scale to assess the quality of the included manuscripts. Results We have included 18 studies, 8 performed on miners, 3 on the general population and 7 on children, and the results have been structured using this classification. The results are inconclusive. An association between radon exposure and central nervous system tumors has been observed in some studies on miners, but not in others. The results observed in the general adult population and in children are also mixed, with some research evincing a statistically significant association and others showing no effect. Conclusions We cannot conclude that there is a relationship between radon exposure and central nervous system tumors. The available studies are extremely heterogeneous in terms of design and populations studied. Further research is needed in this topic, particularly in the general population residing in areas with high levels of radon.

      PubDate: 2017-03-21T12:45:54Z
      DOI: 10.1016/j.gaceta.2017.01.002
  • Inequidades en salud: análisis sociodemográfico y espacial del cáncer
           de mama en mujeres de Córdoba, Argentina

    • Authors: Natalia Tumas; Sonia Alejandra Pou; Maria del Pilar Diaz
      Abstract: Publication date: Available online 18 March 2017
      Source:Gaceta Sanitaria
      Author(s): Natalia Tumas, Sonia Alejandra Pou, Maria del Pilar Diaz
      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: 2017-03-21T12:45:54Z
      DOI: 10.1016/j.gaceta.2016.12.011
  • 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
      Abstract: Publication date: Available online 17 March 2017
      Source:Gaceta Sanitaria
      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: 2017-03-21T12:45:54Z
      DOI: 10.1016/j.gaceta.2017.01.009
  • Medicina herbal china ofertada en páginas web en español: calidad de la
           información y riesgos

    • Authors: Noelia Tejedor-García; Coral García-Pastor; Selma Benito-Martínez; Francisco Javier de Lucio-Cazaña
      Abstract: Publication date: Available online 17 March 2017
      Source:Gaceta Sanitaria
      Author(s): Noelia Tejedor-García, Coral García-Pastor, Selma Benito-Martínez, Francisco Javier de Lucio-Cazaña
      Objetivo El auge de la venta en Internet propicia el acceso a productos naturales potencialmente tóxicos y la rápida difusión de la información, no necesariamente veraz, que los proveedores ofrecen al consumidor acerca de sus propiedades. El objetivo del presente trabajo ha sido analizar en páginas web en español de venta de medicina herbal china la calidad de la información ofrecida al consumidor y los posibles riesgos derivados de su consumo. Métodos i) Búsqueda en Google España de sitios web de venta de medicina herbal china y posterior evaluación de la información sobre las propiedades y consumo seguro de los productos ofertados. ii) Identificación en los sitios web de plantas iii) Cuantificación de las retiradas de productos de medicina herbal china por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Resultados 1) Sólo un tercio de las 30 páginas web localizadas cumple con la legislación vigente, ya que las demás incluyen indicaciones terapéuticas occidentales como reclamo para la venta de medicina herbal china en España 2) Cinco páginas aportan información sobre consumo seguro 3) Dos páginas ofertan plantas potencialmente tóxicas y 4) Un importante porcentaje de productos retirados por la AEMPS corresponde a medicina herbal china adulterada con sibutramina, sildenafilo o sus derivados. Conclusión Nuestros resultados indican que existen motivos suficientes que aconsejan la creación por parte de las autoridades españolas de un sitio web que asesore a quienes pretenden utilizar Internet para comprar medicina herbal china y así permitir que los usuarios tomen decisiones estando bien informados. Objective The growing use of purchase online via Internet retailers favours the access to potentially toxic natural products. It also contributes to the quick dissemination of the claims made by the retailers on efficacy and safety, these claims being not always based upon reliable information. Here, we have conducted an online search to find Spanish-language retail websites for Chinese herbal medicine and we have analysed them for the quality of product information and the potential health risks. Methods i) Online search in Google España to find Spanish-language retail websites for Chinese herbal medicine in which we analysed both the claims regarding possible health benefits and adequate safe use indications ii) Identification of potentially toxic herbs in the websites iii) Quantification of Chinese herbal medicines withdrawn by the Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Results 1) Only one third of the 30 Spanish-language retail websites found which sell Chinese herbal medicine observe the law, given that the other websites include illegal Western disease claims as marketing tools, 2) Five websites provide some safety information, 3) Two websites offer potentially toxic herbs and 4) Chinese herbal medicine adulterated with sibutramine, silfenafil or their analogues make a considerable percentage of the total products withdrawn by the AEMPS. Conclusion Online health seekers should be warned about misinformation on retail websites for Chinese herbal medicine and directed to a Spanish government Web site for guidance in safely navigating the Internet for buying Chinese herbal medicine.
      PubDate: 2017-03-21T12:45:54Z
      DOI: 10.1016/j.gaceta.2016.12.018
  • Imputación de valores ausentes en salud pública: conceptos generales y
           aplicación en variables dicotómicas

    • Authors: Gilma Hernández; David Moriña; Albert Navarro
      Abstract: Publication date: Available online 15 March 2017
      Source:Gaceta Sanitaria
      Author(s): Gilma Hernández, David Moriña, Albert Navarro
      Que haya valores ausentes en variables registradas en encuestas de salud es habitual, pero no lo es imputarlos posteriormente cuando se realiza el análisis. Trabajar con datos imputados puede tener ventajas en términos de precisión de los estimadores y de identificación sin sesgos de la asociación entre variables. Probablemente, el proceso de imputación sigue siendo desconocido para muchos profesionales no estadísticos, que le atribuyen una alta complejidad y quizás un objetivo que no es exactamente el que persigue. Para aclarar estas cuestiones, esta nota pretende ofrecer una visión amena, no exhaustiva, del proceso de imputación, que permita conocer sus bondades para el trabajo de un salubrista. Todo ello en el marco de variables dicotómicas, habituales en salud pública. Para ilustrar los conceptos se usa un ejemplo en el cual se trabaja con datos con valores ausentes, imputados de forma simple y múltiple. The presence of missing data in collected variables is common in health surveys, but the subsequent imputation thereof at the time of analysis is not. Working with imputed data may have certain benefits regarding the precision of the estimators and the unbiased identification of associations between variables. The imputation process is probably still little understood by many non-statisticians, who view this process as highly complex and with an uncertain goal. To clarify these questions, this note aims to provide a straightforward, non-exhaustive overview of the imputation process to enable public health researchers ascertain its strengths. All this in the context of dichotomous variables which are commonplace in public health. To illustrate these concepts, an example in which missing data is handled by means of simple and multiple imputation is introduced.

      PubDate: 2017-03-16T12:41:21Z
      DOI: 10.1016/j.gaceta.2017.01.001
  • Multiple lifestyle risk behaviours and excess weight among adolescents in
           Barcelona, Spain

    • Authors: Xavier Continente; Anna Pérez; Albert Espelt; Carles Ariza; María José López
      Abstract: Publication date: Available online 15 March 2017
      Source:Gaceta Sanitaria
      Author(s): Xavier Continente, Anna Pérez, Albert Espelt, Carles Ariza, María José López
      Objective We aimed to analyse the prevalence of having multiple lifestyle risk behaviours (LRB) and the potential relationship between excess weight (including overweight and obesity) and cumulative multiple LRB among adolescents in Barcelona, Spain. Methods A cross-sectional study was performed among a representative sample of 3,114 secondary school students in Barcelona. Height and weight were objectively measured and excess weight was defined in accordance with World Health Organization criteria. Information on screen time, breakfast, physical activity and sleep duration was obtained through a self-administered questionnaire. Results More than 80% of the students had at least two LRBs. In compulsory schooling, the adjusted prevalence ratio (aPR) of excess weight increased with a higher number of reported LRBs (four LRBs: aPR=1.56; 95% confidence interval: 1.19-2.05). Conclusions These results highlight the importance of a multiple-behaviour approach in preventive programmes aimed at reducing adolescent obesity.

      PubDate: 2017-03-16T12:41:21Z
      DOI: 10.1016/j.gaceta.2017.01.003
  • El Registro de Gemelos de Murcia. Un recurso para la investigación sobre
           conductas relacionadas con la salud

    • Authors: Juan R. Ordoñana; Juan F. Sánchez Romera; Lucía Colodro-Conde; Eduvigis Carrillo; Francisca González-Javier; Juan J. Madrid-Valero; José J. Morosoli-García; Francisco Pérez-Riquelme; José M. Martínez-Selva
      Abstract: Publication date: Available online 9 March 2017
      Source:Gaceta Sanitaria
      Author(s): Juan R. Ordoñana, Juan F. Sánchez Romera, Lucía Colodro-Conde, Eduvigis Carrillo, Francisca González-Javier, Juan J. Madrid-Valero, José J. Morosoli-García, Francisco Pérez-Riquelme, José M. Martínez-Selva
      Los diseños genéticamente informativos, y en particular los estudios de gemelos, constituyen la metodología más utilizada para analizar la contribución relativa de los factores genéticos y ambientales a la variabilidad interindividual. Básicamente, consisten en comparar el grado de similitud, con respecto a una característica o rasgo determinado, entre gemelos monocigóticos y dicigóticos. Además de la clásica estimación de heredabilidad, este tipo de registros permite una amplia variedad de análisis únicos por las características de la muestra. El Registro de Gemelos de Murcia es un registro de base poblacional centrado en el análisis de conductas relacionadas con la salud. Las prevalencias de problemas de salud observadas son comparables a las de otras muestras de referencia de ámbito regional y estatal, lo que avala su representatividad. En conjunto, sus características facilitan el desarrollo de diversas modalidades de investigación, además de diseños genéticamente informativos y la colaboración con distintas iniciativas y consorcios. Genetically informative designs and, in particular, twin studies, are the most widely used methodology to analyse the relative contribution of genetic and environmental factors to inter-individual variability. These studies basically compare the degree of phenotypical similarity between monozygotic and dizygotic twin pairs. In addition to the traditional estimate of heritability, this kind of registry enables a wide variety of analyses which are unique due to the characteristics of the sample. The Murcia Twin Registry is population-based and focused on the analysis of health-related behaviour. The observed prevalence of health problems is comparable to that of other regional and national reference samples, which guarantees its representativeness. Overall, the characteristics of the Registry facilitate developing various types of research as well as genetically informative designs, and collaboration with different initiatives and consortia.

      PubDate: 2017-03-09T12:35:44Z
      DOI: 10.1016/j.gaceta.2016.10.008
  • Determinantes sociales de la salud y discapacidad: actualizando el modelo
           de determinación

    • Authors: Mauro Tamayo; Álvaro Besoaín; Jame Rebolledo
      Abstract: Publication date: Available online 6 March 2017
      Source:Gaceta Sanitaria
      Author(s): Mauro Tamayo, Álvaro Besoaín, Jame Rebolledo
      Los determinantes sociales de la salud (DSS) son las condiciones en las que las personas se desarrollan. Dichas condiciones impactan en sus vidas, condición de salud y nivel de inclusión social. Acorde a la evolución conceptual y de comprensión de la discapacidad, resulta importante actualizar los DSS por sus amplias implicancias en la ejecución de intervenciones de salud en la población. Esta propuesta fundamenta la incorporación de la discapacidad en el modelo como un determinante estructural, dado que produciría el mismo fenómeno de inclusión/exclusión social de las personas, descrito en otros DSS estructurales. Esta propuesta promueve un espacio relevante en el diseño y la implementación de políticas públicas con el fin de mejorar las condiciones de la población y contribuir a la equidad social. Esto será un acto de reparación, justicia y cumplimiento de la Convención sobre los Derechos de las Personas con Discapacidad. Social determinants of health (SDH) are conditions in which people live. These conditions impact their lives, health status and social inclusion level. In line with the conceptual and comprehensive progression of disability, it is important to update SDH due to their broad implications in implementing health interventions in society. This proposal supports incorporating disability in the model as a structural determinant, as it would lead to the same social inclusion/exclusion of people described in other structural SDH. This proposal encourages giving importance to designing and implementing public policies to improve societal conditions and contribute to social equity. This will be an act of reparation, justice and fulfilment with the Convention on the Rights of Persons with Disabilities.

      PubDate: 2017-03-09T12:35:44Z
      DOI: 10.1016/j.gaceta.2016.12.004
  • Desigualdades socioeconómicas en el control mamográfico en mujeres
           españolas de 45 a 69 años de edad

    • Authors: Gemma Serral; Carme Borrell; Rosa Puigpinós i Riera
      Abstract: Publication date: Available online 6 March 2017
      Source:Gaceta Sanitaria
      Author(s): Gemma Serral, Carme Borrell, Rosa Puigpinós i Riera
      Objetivo Analizar según variables sociodemográficas el control mamográfico que realizan las mujeres españolas de 45 a 69 años de edad y describir el papel que desempeñan los programas poblacionales de cribado del cáncer de mama en cuanto a la variabilidad de los controles mamográficos. Métodos Estudio transversal a partir de la Encuesta Nacional de Salud de 2011. La población de estudio son las mujeres residentes en España entre finales de 2011 y principios de 2012. La muestra ponderada analizada corresponde a 3.086 mujeres de 45 a 69 años de edad. Las variables dependientes fueron la realización de mamografías, la última mamografía y el motivo de su realización. Las variables independientes fueron la edad, la clase social, la situación laboral, el país de origen, el ámbito de procedencia, la cobertura sanitaria y los años de implantación del programa. Se realizaron modelos de regresión logística, obteniendo odds ratio (OR) ajustadas por edad y sus intervalos de confianza del 95% (IC95%). Resultados Un 91,9% indicó que se había realizado una mamografía alguna vez. Las mujeres que se habían realizado el último control mamográfico entre 1 y 2 años antes se asociaron a la clase social más alta (OR: 1,69; IC95%: 1,03-2,75). El motivo de realizar la última mamografía periódica por un programa poblacional se asoció a las mujeres cuya edad era de 60-69 años (OR: 1,51; IC95%: 1,04-2,19). Conclusión Los resultados indican que existen desigualdades sociales en la realización de prácticas preventivas. Debemos identificar posibles grupos de riesgo con el fin de impulsar la implementación de acciones específicas. Objective To analyse mammography screening in Spanish women aged 45 to 69 according sociodemographic variables and to describe the role of population-based breast cancer screening programmes in terms of variability of said screening. Methods Cross-sectional study of the 2011 National Health Survey. The study population includes women living in Spain between late 2011 and early 2012. The weighted sample analysed corresponds to 3,086 women aged 45 to 69. The dependent variables were mammograms and when the last mammogram was performed and why. Independent variables were age, social class, occupational status, country of origin, area of origin (rural/urban), health cover and years the programme had been in place. Logistic regression models were performed, with odds ratio (OR) adjusted according to age and 95% confidence intervals (95% CI). Results Approximately 91.9% indicated that they had had a mammogram before. The women who had had their last mammography screening in the previous 1 to 2 years were associated with the highest social class (OR: 1.69; 95% CI: 1.03–2.75). The reason for performing the last periodic mammogram via a population-based programme was associated with women aged between 60 and 69 years (OR: 1.51; 95% CI: 1.04–2.19). Conclusions The results show that there are still inequalities in preventive practices. Possible risk groups need to be identified in order to promote the implementation of specific actions.

      PubDate: 2017-03-09T12:35:44Z
      DOI: 10.1016/j.gaceta.2016.12.010
  • Análisis de contenido de la publicidad de productos alimenticios
           dirigidos a la población infantil

    • Authors: José Antonio Ponce-Blandón; Manuel Pabón-Carrasco; María de las Mercedes Lomas-Campos
      Abstract: Publication date: Available online 3 March 2017
      Source:Gaceta Sanitaria
      Author(s): José Antonio Ponce-Blandón, Manuel Pabón-Carrasco, María de las Mercedes Lomas-Campos
      Objetivo Conocer los contenidos y los mecanismos de persuasión utilizados en los anuncios de productos alimenticios procesados dirigidos al público infantil en Andalucía, comparándolos con los dirigidos al público adulto. Métodos Estudio basado en la técnica de análisis del contenido publicitario, con dos fases: una de diseño descriptivo y otra de diseño analítico observacional. Se procedió a seleccionar una muestra de anuncios procedentes de 60 horas de programación de los dos canales de televisión de mayor audiencia en Andalucía. Resultados Se obtuvieron 416 anuncios de productos alimenticios procesados y bebidas no alcohólicas, de los que se identificaron 91 productos distintos. El 42,9% (n=39) estaba dirigido al público infantil y el 53,8% (n=49) correspondía a productos clasificados como «no saludables». Estos últimos eran más frecuentes en los anuncios para niños (p <0,001). Se observaron diferencias significativas entre los anuncios dirigidos al público adulto y los dirigidos al público infantil, de modo que se utilizan, con más frecuencia en estos últimos, recursos persuasivos emotivos e irracionales, tales como la fantasía (p <0,001), los dibujos animados (p <0,001) o la entrega de obsequios con la compra del producto (p=0,003). Conclusiones La publicidad de productos alimenticios dirigidos al público infantil en Andalucía se basa fundamentalmente en la oferta de productos de escaso valor nutricional y en el empleo de recursos persuasivos basados en la fantasía o en la oferta de regalos, centrando el mensaje más en el incentivo que en el alimento. Deben ponerse en marcha medidas más eficaces que los actuales sistemas de autorregulación para contrarrestar estas informaciones publicitarias distorsionadas. Objective To determine the contents and persuasive techniques used in processed food adverts aimed at children in Andalusia, comparing them with those aimed at adults. Methods Study based on advert content analysis with two phases: a descriptive design phase and an analytical observational design phase. A sample of adverts from 60hours of broadcasting from the two most watched television channels in Andalusia. Results A total of 416 food and non-alcoholic beverage adverts were obtained, for 91 different products. Approximately 42.9% (n=39) was aimed at children and 53.8% (n=49) were products classified as “unhealthy”. Unhealthy foods were more common in adverts for children (p <0.001). Significant differences were found between the ads aimed at adults and those aimed at children. Emotional and irrational persuasive resources such as fantasy (p <0.001), cartoons (p <0.001) or offering gifts with the purchase of the product (p=0.003) were observed more frequently in adverts for children. Conclusions Food advertising aimed at children in Andalusia is mainly based on offering products with a low nutritional value and using persuasive resources based on fantasy or gifts. The message is focused on the incentive and not the food. More effective measures than the current self-regulatory systems must be put in pl...
      PubDate: 2017-03-09T12:35:44Z
      DOI: 10.1016/j.gaceta.2016.12.008
  • Financial fraud and health: the case of Spain

    • Authors: Maria Victoria Zunzunegui; Emmanuelle Belanger; Tarik Benmarhnia; Milena Gobbo; Angel Otero; François Béland; Fernando Zunzunegui; Jose Manuel Ribera-Casado
      Abstract: Publication date: Available online 2 March 2017
      Source:Gaceta Sanitaria
      Author(s): Maria Victoria Zunzunegui, Emmanuelle Belanger, Tarik Benmarhnia, Milena Gobbo, Angel Otero, François Béland, Fernando Zunzunegui, Jose Manuel Ribera-Casado
      Objective To examine whether financial fraud is associated with poor health sleeping problems and poor quality of life. Methods Pilot study (n=188) conducted in 2015–2016 in Madrid and León (Spain) by recruiting subjects affected by two types of fraud (preferred shares and foreign currency mortgages) using venue-based sampling. Information on the monetary value of each case of fraud; the dates when subjects became aware of being swindled, lodged legal claim and received financial compensation were collected. Inter-group comparisons of the prevalence of poor physical and mental health, sleep and quality of life were carried according to type of fraud and the 2011–2012 National Health Survey. Results In this conventional sample, victims of financial fraud had poorer health, more mental health and sleeping problems, and poorer quality of life than comparable populations of a similar age. Those who had received financial compensation for preferred share losses had better health and quality of life than those who had not been compensated and those who had taken out foreign currency mortgages. Conclusion The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.12.012
  • Gaceta Sanitaria a primera vista

    • Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2

      PubDate: 2017-03-03T10:46:31Z
  • Eficacia de las intervenciones no farmacológicas en la calidad de vida de
           las personas cuidadoras de pacientes con enfermedad de Alzheimer

    • Authors: Dolores
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Bárbara Amador-Marín, María Dolores Guerra-Martín
      Objetivo Explorar la eficacia de las intervenciones no farmacológicas realizadas para mejorar la calidad de vida de los/las cuidadores/as familiares de pacientes con Alzheimer. Métodos Se realizó una revisión sistemática, por pares, en distintas bases de datos: PubMed, Scopus, CINAHL, PsycINFO, WOS, Biblioteca Cochrane Plus, IME, Cuiden Plus y Dialnet. Los criterios de inclusión fueron: 1) estudios publicados entre 2010 y 2015; 2) idioma inglés, portugués o español; 3) ensayos clínicos controlados y aleatorizados; 4) puntuación ≥3 en la escala Jadad. Resultados Se incluyeron 13 estudios, de los cuales cuatro realizaron una intervención psicosocial con cuidadores/as familiares, tres psicoterapéutica, dos psicoeducativa, dos multicomponente, uno educativa y otro con grupos de apoyo mutuo. De los instrumentos para evaluar la calidad de vida, tres estudios utilizaron el Health Status Questionnaire (HSQ), tres el EuroQoL-5D (dos solo utilizaron la escala visual analógica), dos el cuestionario de salud SF-36, dos el WHOQoL-BREF, dos el Quality of Life SF-12 y uno el instrumento de calidad de vida percibida (PQoL). Respecto a la eficacia de las intervenciones no farmacológicas, cinco estudios obtuvieron resultados favorables en la calidad de vida tras las intervenciones de tipo psicoterapéutica, multicomponente, formación y comunitaria. Conclusión La diversidad de intervenciones no farmacológicas utilizadas y sus contenidos, las diferencias en el número de sesiones y horas, y la variabilidad de instrumentos de valoración utilizados para medir la calidad de vida de los/las cuidadores/as familiares, nos lleva a reflexionar sobre la idoneidad de unificar criterios en aras de mejorar la práctica clínica. Objective Explore the effectiveness of non-pharmacological interventions to improve the quality of life of family caregivers of Alzheimer's patients. Methods We conducted a systematic review, in pairs, in the following databases: PubMed, Scopus, CINAHL, PsycINFO, WOS, Cochrane Library, IME, Cuiden Plus and Dialnet. Inclusion criteria were: 1. Studies published between 2010-2015. 2. Language: English, Portuguese and Spanish. 3. Randomized controlled clinical trials. 4. Score greater than or equal to 3 on the Jadad scale. Results 13 studies were included. Four performed a psychosocial intervention with family caregivers, three psychotherapeutic, two psychoeducational, two multicomponent, one educational and another with mutual support groups. The tools to assess quality of life: three studies used the Health Status Questionnaire (HSQ), three EuroQol-5D (two only used the EVA), two health questionnaire SF-36, two WHOQOL-BREF, two Quality of Life SF-12 and one Perceived Quality of Life Scale (PQoL). Regarding the effectiveness of non-pharmacological interventions, five studies obtained favorable results in the quality of life after psychotherapeutic interventions and community-type multicomponent training. Conclusion The diversity of non-pharmacological interventions used and contents, differences in the number of sessions and hours, and variability of valuation tools used to measure quality of life of family caregivers, leads us to reflect on the appropriateness to standardize criteria, for the sake to improve clinical practice.

      PubDate: 2017-03-03T10:46:31Z
  • Características asistenciales de la población extranjera en el servicio
           de urgencias del Hospital Universitario de Torrevieja: diferencias con la
           población nacional

    • Authors: Juan
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Napoleón Meléndez-Cáliz, Juan C. Medina-Álvarez, José M. Ramos-Rincón

      PubDate: 2017-03-03T10:46:31Z
  • De Nadal, J. La construcción de un éxito. Así se hizo nuestra sanidad
           pública. Barcelona: Ediciones La Lluvia; 2016. ISBN: 978-84-15526-73-5.
           300 páginas

    • Authors: Andreu Segura
      Abstract: Publication date: March–April 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 2
      Author(s): Andreu Segura

      PubDate: 2017-03-03T10:46:31Z
  • Pasar de Quijote a Sancho y siempre pensar como Robin Hood. José María
           Mayoral (1956-2016): médico y epidemiólogo

    • Authors: Pere Godoy; Rosa Cano; María-José Sierra; Nuria Aragonés; Anxela Pousa; Ana Gandarillas; María-Antonia Galmés; Mauro Ramos; Eva Ardanaz; Francisco González
      Abstract: Publication date: Available online 28 February 2017
      Source:Gaceta Sanitaria
      Author(s): Pere Godoy, Rosa Cano, María-José Sierra, Nuria Aragonés, Anxela Pousa, Ana Gandarillas, María-Antonia Galmés, Mauro Ramos, Eva Ardanaz, Francisco González

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.12.016
  • Gasto de bolsillo en adultos mayores afiliados a un seguro público de
           salud en México

    • Authors: Patricia Pavón-León; Hortensia Reyes-Morales; Armando J. Martínez; Silvia María Méndez-Maín; María del Carmen Gogeascoechea-Trejo; María Sobeida L. Blázquez-Morales
      Abstract: Publication date: Available online 27 February 2017
      Source:Gaceta Sanitaria
      Author(s): Patricia Pavón-León, Hortensia Reyes-Morales, Armando J. Martínez, Silvia María Méndez-Maín, María del Carmen Gogeascoechea-Trejo, María Sobeida L. Blázquez-Morales
      Objetivo Identificar la asociación de distintas variables sociodemográficas con el gasto de bolsillo en servicios de salud en adultos de 60 años y más afiliados al Seguro Popular (SP). Método Estudio transversal analítico. Se realizó una encuesta a través de una entrevista cara a cara a usuarios de la consulta externa de tres unidades médicas del estado de Veracruz: centro de salud (primer nivel), hospital regional (segundo nivel) y hospital de alta especialidad. El gasto de bolsillo en salud en el último año se analizó con el modelo lineal generalizado. Resultados La muestra fue de 1049 adultos de 60 años y más beneficiarios del SP y la tasa de respuesta fue del 97,7%. El gasto de bolsillo en salud mensual fue US$ 64,8 (intervalo de confianza del 95% [IC95%]: 59,9-69,8). El rubro con mayor gasto fueron los medicamentos incluidos en el SP (US$ 28,8; IC95%: 25,8-31,7) y los medicamentos que no cubre el SP (US$ 8; IC95%: 6,7-9,2). Conclusiones Los adultos de 60 años y más afiliados al SP pagan de su bolsillo para atender su salud, a pesar de contar con un seguro público de salud, lo que representa una inequidad en el acceso, principalmente para los más vulnerables, como son la población rural. Objective To identify the association between various sociodemographic variables and out-of-pocket expenditure on health by elderly people enrolled in Seguro Popular (SP). Method Analytical cross-sectional study. An in-person survey was administered to users of three outpatient clinics in the state of Veracruz: a health centre (first level), regional hospital (second level) and highly specialised hospital. The out-of-pocket expenditure on health was analysed using a generalised linear model. Results The sample consisted of 1,049 beneficiaries of SP over age 60 with a response rate of 97.7%. The monthly out-of-pocket expenditure on health was $64.80 (95% confidence interval [95% CI]: 59.90–69.80). The highest expense category was drugs that are included in the SP ($28.80; 95% CI: 25.80–31.70) and drugs that are not covered by the SP ($8.00; 95% CI: 6.70–9.20). Conclusions People over age 60 enrolled in SP pay out of their pocket to meet their health needs, despite having public health insurance. This represents an inequity in access, especially for the most vulnerable such as the rural population.

      PubDate: 2017-03-03T10:46:31Z
      DOI: 10.1016/j.gaceta.2016.12.015
  • Perceived discrimination and self-rated health in the immigrant population
           of the Basque Country, Spain

    • Authors: Elena Rodriguez-Alvarez; Yolanda González-Rábago; Luisa N. Borrell; Nerea Lanborena
      Abstract: Publication date: Available online 22 February 2017
      Source:Gaceta Sanitaria
      Author(s): Elena Rodriguez-Alvarez, Yolanda González-Rábago, Luisa N. Borrell, Nerea Lanborena
      Objective To examine the effect of perceived discrimination and self-rated health among the immigrant population in the Basque Country, Spain, and determine whether this effect varies according to region of origin, age, sex and education. Methods Descriptive cross-sectional study. The study population included immigrants aged 18 and older residing in the Basque Country. Data from the 2014 Foreign Immigrant Population Survey (n=3,456) were used. Log-binomial regression was used to quantify the association between perceived discrimination and self-rated health before and after checking for the selected characteristics. Results Almost 1 in 10 immigrant adults reports perceiving discrimination. In adjusted analyses, the immigrants perceiving discrimination were almost were 1.92 more likely to rate their health as poor (prevalence ratio: 1.92; 95% CI: 1.44–2.56) than those who did not report discrimination. This association did not vary according to region of origin, age, sex or educational level. Conclusions Perceived discrimination shows a consistent relationship with perceived health. Moreover, this association did not depend on the region of origin, age, sex or educational level of immigrants. These results show the need for implementing inclusive policies to eliminate individual and institutional discrimination and reduce health inequalities between the immigrant and native populations.

      PubDate: 2017-02-24T09:39:07Z
      DOI: 10.1016/j.gaceta.2016.12.014
  • Efecto de la estrategia de promoción de salud escolar Forma Joven

    • Authors: Marta Lima-Serrano; Joaquín Salvador Lima-Rodríguez
      Abstract: Publication date: Available online 22 February 2017
      Source:Gaceta Sanitaria
      Author(s): Marta Lima-Serrano, Joaquín Salvador Lima-Rodríguez
      Objetivo Evaluar el efecto de la Estrategia Forma Joven (EFJ) sobre las actitudes y los comportamientos del alumnado de 4° curso de Educación Secundaria Obligatoria de la provincia de Sevilla (España). Métodos Se utilizó un diseño observacional longitudinal con dos grupos, uno que recibió la EFJ (grupo EFJ) y otro que no lo hizo (grupo no EFJ). En la evaluación inicial se contó con 402 participantes seleccionados aleatoriamente, y en el seguimiento, a los 6 meses, con 322 (161 por grupo). Se utilizaron instrumentos validados para la recogida de datos y se calcularon tablas de 2×2, odds ratio (OR) y ANOVA generales para diseños factoriales mixtos 2×2 (p<0,05). Resultados Se encontraron efectos favorables de la EFJ. En el área de sexualidad, el porcentaje de participantes que iniciaron relaciones sexuales completas en la evaluación final fue menor en el grupo EFJ (14,9% vs. 23,4%; OR=0,57). También se observaron efectos contrarios: el inicio del consumo de tabaco fue estadísticamente superior en el grupo EFJ (19,5% vs. 9,1%; OR=2,43), si bien estas diferencias no llegaron a ser estadísticamente significativas. Conclusiones La similitud del currículum de promoción de la salud escolar de los centros con la EFJ y sin la EFJ ha podido influir en la falta de resultados concluyentes. Las asesorías individuales o grupales en los centros, rasgo diferenciador de la EFJ, podrían haber retrasado las relaciones sexuales de sus participantes. Basándose en los estudios sobre intervenciones de promoción de la salud escolar, se recomiendan buenas prácticas que podrían ayudar a mejorar la efectividad de la EFJ. Objective To evaluate the impact of the Youth Form Strategy (EFJ, Estrategia Forma Joven) on the attitudes and behaviours of students in the fourth year of compulsory secondary school in Seville, Spain. Methods A longitudinal observational design was used with two groups; one received the EFJ (EFJ group) and other did not (non-EFJ group). In the initial evaluation, 402 participants were randomly selected and, in the follow-up at 6 months, 322 participants were evaluated (161 per group). Validated data collection tools were used, and 2×2 tables, odds ratio (OR) and general ANOVA for 2×2 mixed factorial design (p<0.05) were calculated. Results Favourable effects of the EFJ were found: in the area of sexuality, the percentage of participants who had sexual intercourse in the final assessment was lower in the EFJ group (14.9% vs 23.4%; OR=0.57), as were counter-effects: start of tobacco use was higher in the EFJ group (19.5% vs 9.1%; OR=2.43). However, these differences were not statistically significant. Conclusions The similarities in the school health promotion programme in centres with and without EFJ may have influenced the lack of conclusive results. Individual and/or group counselling at schools, a distinguishing feature of the EFJ, could have delayed sexual intercourse in the EFJ group. Based on the studies o...
      PubDate: 2017-02-24T09:39:07Z
      DOI: 10.1016/j.gaceta.2016.12.009
  • Repensar la Carta de Ottawa 30 años después

    • Authors: Luis Andrés López-Fernández; Orielle Solar Hormazábal
      Abstract: Publication date: Available online 22 February 2017
      Source:Gaceta Sanitaria
      Author(s): Luis Andrés López-Fernández, Orielle Solar Hormazábal

      PubDate: 2017-02-24T09:39:07Z
      DOI: 10.1016/j.gaceta.2016.12.013
  • Formación, la clave para mejorar las competencias informacionales en
           e-salud del alumnado de bachillerato

    • Authors: Carme Hernández-Rabanal; Aurora Vall; Clara Boter
      Abstract: Publication date: Available online 21 February 2017
      Source:Gaceta Sanitaria
      Author(s): Carme Hernández-Rabanal, Aurora Vall, Clara Boter
      Objetivo Explorar si una formación sobre estrategias de identificación y evaluación de información sanitaria en línea tiene un impacto positivo en la percepción de los/las estudiantes sobre sus propias competencias informacionales en e-salud. Métodos Se administró el cuestionario validado eHEALS a una muestra de estudiantes de bachillerato, de entre 15 y 18 años de edad. Una semana después asistieron a una sesión de formación sobre cómo buscar e identificar información y fuentes sanitarias fiables en Internet. Al final de la sesión respondieron nuevamente el cuestionario eHEALS. En ambas sesiones se registró información sobre el sexo y el curso de los participantes. Se evaluaron las competencias percibidas en e-salud antes de la formación y se compararon con las obtenidas después. Se llevaron a cabo regresiones bivariadas y múltiples. Resultados De 298 estudiantes cursando Bachillerato, 285 fueron incluidos/as en el estudio. El 52,28% (149) eran mujeres y el 47,72% (136) eran hombres. La media del resultado del cuestionario eHEALS antes de la intervención fue de 24,19 (rango: 8-40), y después fue de 28,54. La exposición a la formación estaba asociada con un incremento de los resultados de las competencias informacionales percibidas en e-salud (p <0,0001). La alfabetización sanitaria también estaba asociada con la utilidad y la importancia concedida a Internet por los estudiantes. Conclusiones La asistencia a una sesión formativa en estrategias de identificación y evaluación de recursos sanitarios en línea está asociada con un incremento del nivel percibido de competencias informacionales en e-salud. La incorporación de formaciones específicas sobre alfabetización informacional sanitaria en cursos de bachillerato es un enfoque prometedor para potenciar las habilidades informacionales en e-salud de los/las estudiantes. Objective To explore whether training on strategies to identify and assess health-related information online has a positive impact on students’ perception of their own eHealth literacy. Methods The validated eHealth Literacy Scale (eHEALS) was administered to a sample of upper secondary school students, aged 15–18. One week later, they attended a training session on how to search and identify reliable health-related information and resources online. The eHEALS was administered again at the end of this session. Information about gender and school year was collected in both sessions. Perceived eHealth literacy was assessed by comparing the scores obtained before and after the session. Bivariate and multiple linear regressions were completed. Results Of the 298 students enrolled in upper secondary school (Bachillerato), 285 were included in the study. Approximately 52.28% (149) were female, and 47.72% (136) were male. The mean eHEALS score before the session was 24.19 (range: 8–40), and was 28.54 after it. The training was associated with higher perceived eHealth literacy scores (p <0,0001). Health literacy was positively associated with the usefulness and importance students give the Internet. Conclusions Attendance at a training session on strategies to identify and assess health-related resources online is associated with higher levels of perceived eHealth literacy. Implementing specific training sessions on eHealth literacy in upper seco...
      PubDate: 2017-02-24T09:39:07Z
      DOI: 10.1016/j.gaceta.2016.12.005
  • Intervenciones que incluyen webs y redes sociales: herramientas e
           indicadores para su evaluación

    • Authors: María José López; Xavier Continente; Esther Sánchez; Montse Bartroli
      Abstract: Publication date: Available online 20 February 2017
      Source:Gaceta Sanitaria
      Author(s): María José López, Xavier Continente, Esther Sánchez, Montse Bartroli
      En el ámbito de la salud, las tecnologías de la información y la comunicación (TIC) pueden generar un espacio que, sin depender del lugar o del tiempo, permite compartir y difundir información rápidamente. A los retos habituales de la evaluación de intervenciones en salud pública, en la evaluación de intervenciones con TIC se añaden otras dificultades, como la falta de estándares previos, el desconocimiento sobre la exposición individual o la falta de información sobre las características de las personas expuestas. El objetivo de esta nota es describir algunas herramientas e indicadores que pueden contribuir a evaluar el alcance, la utilización y algunos parámetros relacionados con el posicionamiento de las páginas web, así como de las redes sociales vinculadas. In the field of health, information and communication technology (ICT) can create a space that, regardless of place or time, enables information to be shared and disseminated quickly. In addition to the usual challenges of evaluating public health activities, other difficulties are present when evaluating activities using ICT, such as lack of previous standards, unknown individual exposure or lack of information on the characteristics of those exposed. The aim of this paper is to describe some tools and indicators that may help to assess the scope, use and parameters related to website positioning on search engines as well as the connected social networks.

      PubDate: 2017-02-24T09:39:07Z
      DOI: 10.1016/j.gaceta.2016.12.006
  • Primary health care attributes and responses to intimate partner violence
           in Spain

    • Authors: Isabel Goicolea; Paola Mosquera; Erica Briones-Vozmediano; Laura Otero-García; Marta García-Quinto; Carmen Vives-Cases
      Abstract: Publication date: Available online 20 February 2017
      Source:Gaceta Sanitaria
      Author(s): Isabel Goicolea, Paola Mosquera, Erica Briones-Vozmediano, Laura Otero-García, Marta García-Quinto, Carmen Vives-Cases
      Objective This study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV). Methods A qualitative study was conducted using semi-structured interviews with 160 health professionals working in 16 PHC centres in Spain. Data were analysed using a qualitative content analysis. Results Four categories emerged from the interview analysis: those committed to the PHC approach, but with difficulties implementing it; community work relying on voluntarism; multidisciplinary team work or professionals who work together?; and continuity of care hindered by heavy work load. Participants felt that person-centred care as well as other attributes of the PHC approach facilitated detecting IPV and a better response to the problem. However, they also pointed out that the current management of the health system (workload, weak supervision and little feedback, misdistribution of human and material resources, etc.) does not facilitate the sustainability of such an approach. Conclusion There is a gap between the theoretical attributes of PHC and the “reality” of how these attributes are managed in everyday work, and how this influences IPV care.

      PubDate: 2017-02-24T09:39:07Z
      DOI: 10.1016/j.gaceta.2016.11.012
  • Cinco paradojas de la promoción de la salud

    • Authors: Olga López-Dicastillo; Navidad Canga-Armayor; Agurtzane Mujika; Miren Idoia Pardavila-Belio; Maider Belintxon; Inmaculada Serrano-Monzó; María J. Pumar-Méndez
      Abstract: Publication date: Available online 17 February 2017
      Source:Gaceta Sanitaria
      Author(s): Olga López-Dicastillo, Navidad Canga-Armayor, Agurtzane Mujika, Miren Idoia Pardavila-Belio, Maider Belintxon, Inmaculada Serrano-Monzó, María J. Pumar-Méndez
      La Organización Mundial de la Salud considera que la promoción de la salud es una estrategia fundamental para aumentar la salud de la población, concibiéndola como un proceso global que permite a las personas incrementar el control sobre su salud para mejorarla. Así, la promoción de la salud no se centra únicamente en capacitar a los individuos trabajando sus conocimientos, actitudes y habilidades, sino que tiene en cuenta las esferas políticas, sociales, económicas y ambientales que influyen en la salud y el bienestar. La complejidad de aplicar estos conceptos se refleja en las cinco paradojas de la promoción de la salud que surgen entre la retórica y la puesta en práctica de sus principios. Las paradojas que se identifican y discuten en este trabajo son el paciente versus la persona, lo individual versus lo colectivo, los profesionales de la enfermedad versus los profesionales de la salud, los indicadores de enfermedad versus los indicadores de salud y la salud como gasto versus la salud como inversión. Hacer explícitas estas contradicciones puede ayudar a identificar los motivos por los que resulta tan compleja la aplicación de los conceptos relacionados con la promoción de la salud, y a plantear líneas de trabajo que faciliten su puesta en práctica. The World Health Organization states that health promotion is a key strategy to improve health, and it is conceived as a global process of enabling people to increase control over, and to improve, their health. Health promotion does not focus solely on empowering individuals dealing with their knowledge, attitudes and skills, but it also takes political, social, economic and environmental aspects influencing health and wellbeing into account. The complexity of applying these concepts is reflected in the five paradoxes in health promotion; these arise in between the rhetoric in health promotion and implementation. The detected paradoxes which are described herein involve the patient versus the person, the individual versus the group, disease professionals versus health professionals, disease indicators versus health indicators, and health as an expense versus health as an investment. Making these contradictions explicit can help determine why it is so complex to put the concepts related to health promotion into practice. It can also help to put forward aspects that need further work if health promotion is to put into practice.

      PubDate: 2017-02-24T09:39:07Z
      DOI: 10.1016/j.gaceta.2016.10.011
  • Efficiency of “Prescribe Vida Saludable”, a health promotion
           innovation. Pilot phase

    • Authors: Aitor Sanz-Guinea; Maite Espinosa; Gonzalo Grandes; Alvaro Sanchez; Catalina Martinez; Haizea Pombo; Paola Bully; Josep Cortada
      Abstract: Publication date: Available online 10 February 2017
      Source:Gaceta Sanitaria
      Author(s): Aitor Sanz-Guinea, Maite Espinosa, Gonzalo Grandes, Alvaro Sanchez, Catalina Martinez, 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: 2017-02-11T12:16:29Z
      DOI: 10.1016/j.gaceta.2016.11.010
  • Employee reactions to the use of management control systems in hospitals:
           motivation vs. threat

    • Authors: Ernesto Lopez-Valeiras; Jacobo Gomez-Conde; Rogerio Joao Lunkes
      Abstract: Publication date: Available online 10 February 2017
      Source:Gaceta Sanitaria
      Author(s): Ernesto Lopez-Valeiras, Jacobo Gomez-Conde, Rogerio Joao Lunkes
      Objective Management control systems (such as budgets or balanced scorecards) are formal procedures used by managers to promote employee behavior aligned with organisational objectives. Employees may react to these control systems by either becoming more motivated or perceiving them as a threat. The aim of this paper is to determine the extent to which hospital ownership (public or private), professional group (physician, nurse, pharmacist or administrative employee), type of contract (fixed or temporary), gender and tenure can condition employee reaction to management control systems. Methods We conducted the study in the three largest hospitals in the State of Santa Catarina (Brazil), two public (federal and state-owned) and one private (non-profit organisation). Physicians, nurses, pharmacists and administrative employees received a questionnaire between October 2013 and January 2014 concerning their current perceptions. We obtained 100 valid responses and conducted an ANOVA variance analysis. Results Our results show that the effect of management control systems on employees differs according to hospital ownership, professional group and type of contract. However, no significant evidence was found concerning gender or tenure. Conclusions The results obtained contribute to creating specific knowledge on the reactions of employees to the use of management control systems in hospitals. This information may be important in adapting management control systems to the characteristics of the hospital and its employees, which may in turn contribute to reducing dysfunctional worker behavior.

      PubDate: 2017-02-11T12:16:29Z
      DOI: 10.1016/j.gaceta.2016.12.003
  • Urgencias hospitalarias procedentes de residencias geriátricas de una
           comarca: evolución, características y adecuación

    • Authors: Inma Sánchez-Pérez; Nuri Comes Garcia; Lola Romero Piniella; Gemma Prats Martos; Gemma Arnau Bataller; Jordi Coderch
      Abstract: Publication date: Available online 10 February 2017
      Source:Gaceta Sanitaria
      Author(s): Inma Sánchez-Pérez, Nuri Comes Garcia, Lola Romero Piniella, Gemma Prats Martos, Gemma Arnau Bataller, Jordi Coderch
      Objetivo Las urgencias hospitalarias (UH) procedentes de residencias asistidas (RA) aumentan. Se analizan la evolución, las características y la adecuación de las UH de personas institucionalizadas en RA de una comarca, y las hospitalizaciones generadas por ellas. Métodos Estudio descriptivo retrospectivo entre 2010 y 2013 con personas institucionalizadas en 11 RA del Baix Empordà (704 plazas) y el Hospital de Palamós. Variables Sexo, edad, morbilidad y peso relativo según grupos de riesgo clínico (CRG, clinical risk groups), RA, días de estancia, diagnóstico de la urgencia, adecuación de las UH según los criterios de Bermejo y el protocolo de adecuación de UH (PAUH), y de las hospitalizaciones según el Appropriateness Evaluation Protocol (AEP). Muestra para evaluar la adecuación: 159 UH y 91 hospitalizaciones. Análisis estadístico: frecuencias, media, desviación típica, percentiles, test exacto de Fisher y ANOVA, con un nivel de confianza del 95% y utilizando IBM SPSS Statistics 23. Resultados Se incluyeron 1474 personas (73% mujeres), el grupo ≥85 años aumentó al 60,3% y el peso medio de la morbilidad fue de 3,2 a 4,0 (p <0,001). Generaron 1805 UH. La tasa anual por 1.000 estancias de RA aumentó de 1,64 a 2,05, siendo adecuadas el 90,6% según los criterios de Bermejo y el 93,7% según el PAUH. De estas, 502 se hospitalizaron. La tasa anual por 10 urgencias descendió de 2,96 a 2,64, siendo adecuadas el 98,9% según el AEP. Conclusiones Las urgencias y las hospitalizaciones de personas institucionalizadas en RA aumentan y son adecuadas. El incremento de la edad y de la carga de morbilidad podrían explicar este fenómeno. Las RA y los hospitales deberían afrontarlo apropiadamente, considerando las necesidades de este sector. Objective Hospital emergencies (HE) arising from nursing homes (NH) are on the rise. We analyse the evolution, characteristics and appropriateness of HE of NH residents in a region, as well as resulting hospital admissions. Method Retrospective descriptive study between 2010 and 2013 of institutionalised residents of 11 NH located in Baix Empordà (704 beds) and Palamós Hospital. Variables Gender, age, morbidity and relative weight according to clinical risk groups (CRG), NH, length of stay, diagnosis of the emergency, appropriateness of HE according to Bermejo's criteria and the HE appropriateness protocol (HEAP), and appropriateness of hospitalisations according to the Appropriateness Evaluation Protocol (AEP). Sample to evaluate appropriateness: 159 HE and 91 hospitalisations. Statistical analysis: frequency, mean, standard deviation, percentiles, Fisher's exact test and ANOVA, with a confidence interval of 95% and using IBM SPSS Statistics 23. Results 1,474 people were enrolled, of which 73% were women. Group ≥85 years increased to 60.3% and the mean weight of morbidity was 3.2 to 4.0 (p <0.001). 1,805 HE were generated. The annual rate per 1,000 stays arising from NH increased from 1.64 to 2.05, o...
      PubDate: 2017-02-11T12:16:29Z
      DOI: 10.1016/j.gaceta.2016.11.005
  • Vigilancia en salud pública: una necesidad inaplazable

    • Authors: Isabel Noguer; Juan Pablo Alonso; José M. Arteagoitia; Jenaro Astray; Rosa Cano; Jesús de Pedro; Gonzalo Gutiérrez; Xurxo Hervada; Mario Margolles; Antonio Nicolau; Domingo Núñez; Marina Pollán; Julián Mauro Ramos; M. José Sierra; Hermelinda Vanoclocha
      Abstract: Publication date: Available online 8 February 2017
      Source:Gaceta Sanitaria
      Author(s): Isabel Noguer, Juan Pablo Alonso, José M. Arteagoitia, Jenaro Astray, Rosa Cano, Jesús de Pedro, Gonzalo Gutiérrez, Xurxo Hervada, Mario Margolles, Antonio Nicolau, Domingo Núñez, Marina Pollán, Julián Mauro Ramos, M. José Sierra, Hermelinda Vanoclocha

      PubDate: 2017-02-11T12:16:29Z
      DOI: 10.1016/j.gaceta.2016.11.002
  • Detección de violencia de 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
      Abstract: Publication date: Available online 8 February 2017
      Source:Gaceta Sanitaria
      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 Two thi...
      PubDate: 2017-02-11T12:16:29Z
      DOI: 10.1016/j.gaceta.2016.11.008
  • Dificultades para ofrecer cuidados al final de la vida en las unidades de
           cuidados intensivos. La perspectiva de enfermería

    • Authors: Juan Francisco Velarde-García; Raquel Luengo-González; Raquel González-Hervías; Sergio González-Cervantes; Beatriz Álvarez-Embarba; Domingo Palacios-Ceña
      Abstract: Publication date: Available online 8 February 2017
      Source:Gaceta Sanitaria
      Author(s): Juan Francisco Velarde-García, Raquel Luengo-González, Raquel González-Hervías, Sergio González-Cervantes, Beatriz Álvarez-Embarba, Domingo Palacios-Ceña
      Objetivo Describir las dificultades percibidas por el personal de enfermería para prestar cuidados al final de la vida al paciente grave dentro de la unidad de cuidados intensivos (UCI). Método Estudio cualitativo fenomenológico descriptivo. Se aplicó un muestreo por propósito y de bola de nieve. Las enfermeras debían tener una experiencia mínima de 1 año en UCI. Se incluyeron 22 participantes. Los datos se recopilaron mediante entrevistas en profundidad (no estructuradas y semiestructuradas) y notas de campo del investigador. El análisis se realizó mediante la propuesta de Giorgi. Resultados Se identificaron tres temas: dificultades académico-culturales, relacionadas con la orientación curativa de la UCI y la falta de formación en cuidados al final de la vida; dificultades estructurales-arquitectónicas, relacionadas con la falta de espacio e intimidad para el paciente y la familia en los últimos momentos; y dificultades psicoemocionales, relacionadas con el distanciamiento emocional como estrategia aplicada por el personal de enfermería. Conclusiones El personal de enfermería necesita formación sobre los cuidados al final de la vida mediante el uso de guías o protocolos y el desarrollo de estrategias de afrontamiento, junto a un cambio en la organización de la UCI orientado al cuidado terminal de los pacientes graves y a la atención de la familia. Objective To describe the difficulties perceived by nursing staff in the delivery of end-of-life care to critically ill patients within intensive care units (ICU). Method A descriptive phenomenological qualitative study was performed. A purposeful and snowball sampling of nursing staff with at least 1 year's previous experience working in an ICU was conducted. Twenty-two participants were enrolled. Data collection strategies included in-depth unstructured and semi-structured interviews and researcher's field notes. Data were analysed using the Giorgi proposal. Results Three themes were identified: academic-cultural barriers, related to the care orientation of the ICU and lack of training in end of life care; architectural-structural barriers, related to the lack of space and privacy for the patient and family in the last moments of life; and psycho-emotional barriers, related to the use of emotional detachment as a strategy applied by nursing staff. Conclusions Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support.

      PubDate: 2017-02-11T12:16:29Z
      DOI: 10.1016/j.gaceta.2016.11.006
  • New birthweight charts according to parity and type of delivery for the
           Spanish population

    • Authors: José Manuel Terán; Carlos Varea; Cristina Bernis; Barry Bogin; Antonio González-González
      Abstract: Publication date: Available online 1 February 2017
      Source:Gaceta Sanitaria
      Author(s): José Manuel Terán, Carlos Varea, Cristina Bernis, Barry Bogin, Antonio González-González
      Objective Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010–2014 period of the Spanish Birth Statistics Bulletin. Methods Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. Results Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). Conclusions Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth.

      PubDate: 2017-02-05T12:12:20Z
      DOI: 10.1016/j.gaceta.2016.09.016
  • Producción científica de los decanos de facultades de medicina
           de Argentina

    • Authors: Yeimer Ortiz-Martínez; Cristian Andrés Echavarría-Cadena
      Abstract: Publication date: Available online 6 January 2017
      Source:Gaceta Sanitaria
      Author(s): Yeimer Ortiz-Martínez, Cristian Andrés Echavarría-Cadena

      PubDate: 2017-01-09T11:41:18Z
      DOI: 10.1016/j.gaceta.2016.10.006
  • Distribución municipal de la incidencia de los tumores más frecuentes en
           un área de elevada mortalidad por cáncer

    • Authors: Manuel Jesús Viñas Casasola; Pablo Fernández Navarro; María Luisa Fajardo Rivas; José Luis Gurucelain Raposo; Juan Alguacil Ojeda
      Abstract: Publication date: Available online 3 January 2017
      Source:Gaceta Sanitaria
      Author(s): Manuel Jesús Viñas Casasola, Pablo Fernández Navarro, María Luisa Fajardo Rivas, José Luis Gurucelain Raposo, Juan Alguacil Ojeda
      Objetivo Describir los patrones de distribución geográfica de la incidencia municipal de los tumores más frecuentes en la provincia de Huelva y compararla con la estimada para el conjunto de España. Método Se calcularon los riesgos relativos (RR) usando el modelo condicional autorregresivo propuesto por Besag, York y Mollié mediante la herramienta INLA, para los años 2007-2011, de las siguientes localizaciones: colon, recto y ano en hombres y en mujeres; tráquea, bronquios y pulmón, próstata y vejiga en hombres; y mama en mujeres. Estos RR se representaron en mapas de coropletas y de isopletas (mediante interpolación por kriging). Resultados Los RR para cáncer de vejiga en hombres fueron superiores a 1 en todos los municipios, siendo sus intervalos de credibilidad superiores a la unidad en cuatro municipios, destacando la capital con 1,56 (intervalo de credibilidad al 95%:1,30-1,67). Para el cáncer de próstata, las probabilidades a posteriori en 68 de los 79 municipios quedaron por debajo de 0,1. Para el cáncer de pulmón, nueve municipios mostraron intervalos de credibilidad por debajo de la unidad, casi todos en la zona oriental. En las mujeres, los RR para cáncer de mama fueron significativamente superiores en la zona de la capital. Finalmente, las tasas de incidencia provincial de Huelva muestran en general valores próximos a las estimadas para el conjunto de España, destacando las diferencias en cáncer de vejiga en hombres (35% superior) y en cáncer de próstata (30% inferior). Conclusiones En la provincia de Huelva existe una distribución espacial municipal de la incidencia de cáncer con unos patrones bien definidos para algunas localizaciones tumorales concretas, presentando en general unas tasas de incidencia cercanas a las del territorio nacional. Objective To describe the geographic distribution patterns of the municipal incidence of the most common tumours in the Huelva province (Spain) as compared to the estimated incidence for all of Spain. Methods Relative risk (RR) was computed based on the conditional autoregressive model proposed by Besag, York and Mollié by applying the INLA tool to the cancer data for 2007-2011 for the following tumour locations: colon, rectum and anus (men and women); trachea, bronchia, and lungs, prostate and bladder in men; and breasts in women. The RR was presented in in choropleth and isopleth (with kriging interpolation) risk maps. Results RR for bladder cancer in men was greater than 1.0 in all municipalities, with confidence intervals over 1.0 in four municipalities; Madrid having a 1.56 RR (95%CI 1.30–1.67). For prostate cancer, a posteriori probabilities were below 0.1 in 68 of the 79 municipalities. For lung cancer, nine municipalities had confidence limits below 1.0, almost all of them in western Spain. For women, the RR for breast cancer was significantly higher in the capital of province area. The cancer incidence rates for the Huelva province were, in general, similar to those estimated for Spain, standing out bladder cancer in men (35% higher) and prostate cancer (30% lower). Conclusions In the Huelva province, there is a geographical municipal distribution of cancer incidence with well-defined patterns for some specific tumour locations, ...
      PubDate: 2017-01-09T11:41:18Z
      DOI: 10.1016/j.gaceta.2016.10.009
  • Percepción de los profesionales de la salud sobre las creencias y las
           tradiciones derivadas del Islam como barreras a la donación de órganos
           en Argelia

    • Authors: Nouhad Laidouni; Érica Briones-Vozmediano; Pilar Garrido Clemente; Diana Gil González
      Abstract: Publication date: Available online 31 December 2016
      Source:Gaceta Sanitaria
      Author(s): Nouhad Laidouni, Érica Briones-Vozmediano, Pilar Garrido Clemente, Diana Gil González
      Objetivo Explorar la percepción que tienen los profesionales de la salud sobre la influencia de las creencias y tradiciones derivadas del Islam en la donación y el trasplante de órganos en Argelia. Método Estudio cualitativo exploratorio mediante entrevistas personales semiestructuradas a 17 profesionales de la salud (nueve hombres y ocho mujeres) de diferentes especialidades en un hospital universitario en Argel (Argelia). Se realizó un análisis de contenido cualitativo de las transcripciones con la ayuda del software informático ATLAS.ti 5. Resultados Las y los profesionales de salud consideran que las creencias religiosas no afectan a la donación en vida, pero opinan que tienen un impacto negativo en la donación de órganos cadavérica debido a la existencia de mitos derivados de la religión islámica y al desconocimiento de la población argelina sobre el posicionamiento de los líderes religiosos en relación al trasplante y a la donación de órganos. Conclusión Existe confusión entre la población argelina sobre la postura del Islam en torno a la donación y el trasplante de órganos, que perjudica fundamentalmente a la tasa de donación cadavérica. La colaboración entre el sector sanitario y las figuras religiosas para sensibilizar a la población podría contribuir a mejorar la disposición de la población a donar sus órganos no solo en vida. Objective The aim of this study is to explore healthcare professionals’ perception of the influence of Islamic beliefs and traditions concerning organ donation and transplants in Algeria. Methods Exploratory qualitative study using individual semi-structured interviews of 17 healthcare professionals (9 men, 8 women) of different specialties in a University hospital in Algiers (Algeria). Qualitative content analysis of transcripts was performed using the computer software ATLAS.ti 5. Results Healthcare professionals believe that religious beliefs do not affect living donation but say they have a negative impact on donation of cadaveric organs due to the existence of myths derived from the Islamic religion and lack of knowledge of the Algerian population about the positioning of religious leaders in relation to organ donation and transplantation. Conclusion There is confusion among the Algerian population on the position of Islam around organ donation and transplantation, mainly to the detriment of the rate of cadaveric donation. Collaboration between the health sector and religious leaders to raise public awareness could improve the willingness of the population to donate organs after death.

      PubDate: 2017-01-09T11:41:18Z
      DOI: 10.1016/j.gaceta.2016.09.012
  • Análisis de la eficiencia técnica en los hospitales del Sistema Nacional
           de Salud español

    • Authors: Carmen Pérez Romero; M.a Isabel Ortega-Díaz; Ricardo Ocaña Riola; José Jesús Martín Martín
      Abstract: Publication date: Available online 30 December 2016
      Source:Gaceta Sanitaria
      Author(s): Carmen Pérez Romero, M.a Isabel Ortega-Díaz, Ricardo Ocaña Riola, José Jesús Martín Martín
      Objetivo Analizar la eficiencia técnica y la productividad de los hospitales generales del Sistema Nacional de Salud (SNS) español (2010-2012) e identificar variables hospitalarias y regionales explicativas. Métodos Se estudian 230 hospitales del SNS mediante análisis envolvente de datos midiendo la eficiencia técnica global, pura, de escala, y el índice de Malmquist. La robustez del análisis se evalúa con modelos input-output alternativos. Se emplean modelos multinivel lineales transversales de efectos fijos para analizar las variables explicativas de eficiencia. Resultados El índice medio de eficiencia técnica global (ETG) es de 0,736 en 2012, con una importante variabilidad por comunidades autónomas. El índice de Malmquist (2010-2012) es de 1,013. Un 23% de la variabilidad en ETG es atribuible a la comunidad autónoma. Las variables exógenas estadísticamente significativas (residentes por cada 100 facultativos, índice de envejecimiento, renta media anual por hogar, gasto en servicios públicos fundamentales y gasto público sanitario per cápita) explican el 42% de la variabilidad de ETG entre hospitales y el 64% entre comunidades autónomas. El número de residentes es estadísticamente significativo. En todas las comunidades autónomas existe una relación lineal directa significativa entre la ETG y la renta anual per cápita y el gasto en servicios públicos fundamentales, e indirecta con el índice de envejecimiento y el gasto público sanitario per cápita. Discusión El importante margen de mejora en eficiencia de los hospitales está condicionado por características específicas de cada comunidad autónoma, particularmente el envejecimiento, la riqueza y las políticas de gasto público de cada una. Objective To analyse the technical efficiency and productivity of general hospitals in the Spanish National Health Service (NHS) (2010–2012) and identify explanatory hospital and regional variables. Methods 230 NHS hospitals were analysed by data envelopment analysis for overall, technical and scale efficiency, and Malmquist index. The robustness of the analysis is contrasted with alternative input-output models. A fixed effects multilevel cross-sectional linear model was used to analyse the explanatory efficiency variables. Results The average rate of overall technical efficiency (OTE) was 0.736 in 2012; there was considerable variability by region. Malmquist index (2010–2012) is 1.013. A 23% variability in OTE is attributable to the region in question. Statistically significant exogenous variables (residents per 100 physicians, aging index, average annual income per household, essential public service expenditure and public health expenditure per capita) explain 42% of the OTE variability between hospitals and 64% between regions. The number of residents showed a statistically significant relationship. As regards regions, there is a statistically significant direct linear association between OTE and annual income per capita and essential public service expenditure, and an indirect association with the aging index and annual public health expenditure per capita. Discussion The significant room for improvement in the efficiency of hospitals is conditioned by region-specific characteristics, speci...
      PubDate: 2017-01-09T11:41:18Z
      DOI: 10.1016/j.gaceta.2016.10.007
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