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PUBLIC ADMINISTRATION (183 journals)                 | Last

Showing 1 - 200 of 357 Journals sorted alphabetically
Academy of Management Annals, The     Full-text available via subscription   (Followers: 41)
Accounting and the Public Interest     Full-text available via subscription   (Followers: 2)
Acta Universitatis Danubius. Administratio     Open Access   (Followers: 1)
Administração Pública e Gestão Social     Open Access  
Administration : Journal of the Institute of Public Administration of Ireland     Open Access   (Followers: 2)
Administrative Sciences     Open Access   (Followers: 4)
Administrative Theory & Praxis     Full-text available via subscription   (Followers: 5)
African Journal of Governance and Development     Full-text available via subscription   (Followers: 2)
American Review of Public Administration     Hybrid Journal   (Followers: 16)
AQ - Australian Quarterly     Full-text available via subscription   (Followers: 2)
Australian Social Work     Hybrid Journal   (Followers: 9)
BAR. Brazilian Administration Review     Open Access   (Followers: 1)
Cadernos EBAPE.BR     Open Access   (Followers: 1)
Cadernos Gestão Pública e Cidadania     Open Access  
Canadian Public Administration/Administration Publique Du Canada     Hybrid Journal   (Followers: 9)
Cities     Hybrid Journal   (Followers: 13)
Citizenship Studies     Hybrid Journal   (Followers: 7)
Clinical Social Work Journal     Hybrid Journal   (Followers: 21)
COEPTUM     Open Access  
Commonwealth Journal of Local Governance     Open Access   (Followers: 4)
Congress & the Presidency: A Journal of Capital Studies     Hybrid Journal   (Followers: 3)
Critical Policy Studies     Hybrid Journal   (Followers: 8)
Cuadernos de Administración     Open Access  
Cuadernos de Relaciones Laborales     Open Access   (Followers: 1)
Der Staat     Full-text available via subscription   (Followers: 12)
Die Verwaltung     Full-text available via subscription   (Followers: 11)
Économie publique/Public economics     Open Access   (Followers: 2)
eJournal of eDemocracy and Open Government     Open Access   (Followers: 7)
eJournal of Public Affairs     Open Access  
Electronic Government, an International Journal     Hybrid Journal   (Followers: 15)
Electronic Journal of e-Government     Full-text available via subscription   (Followers: 5)
Éthique publique     Open Access  
Études rurales     Open Access   (Followers: 2)
EURE (Santiago) - Revista Latinoamericana de Estudios Urbano Regionales     Open Access  
European Journal of Government and Economics     Open Access   (Followers: 4)
European Journal of Social Work     Hybrid Journal   (Followers: 23)
Evaluation     Hybrid Journal   (Followers: 18)
Federal Governance     Open Access   (Followers: 1)
FOR Rivista per la formazione     Full-text available via subscription  
Frontiers in Public Health Services and Systems Research     Open Access   (Followers: 3)
Future Studies Research Journal : Trends and Strategies     Open Access   (Followers: 1)
Gaceta Sanitaria     Open Access   (Followers: 3)
Georgia Journal of Public Policy     Open Access   (Followers: 1)
Gestión y Política Pública     Open Access   (Followers: 2)
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 12)
Governance     Hybrid Journal   (Followers: 54)
Government Information Quarterly     Hybrid Journal   (Followers: 22)
Government News     Full-text available via subscription   (Followers: 2)
Growth and Change     Hybrid Journal   (Followers: 5)
Headmark     Full-text available via subscription   (Followers: 1)
Human Resource Development Quarterly     Hybrid Journal   (Followers: 15)
Human Service Organizations Management, Leadership and Governance     Hybrid Journal   (Followers: 22)
Ids Working Papers     Hybrid Journal   (Followers: 2)
IMIESA     Full-text available via subscription  
Indonesian Journal of Community Engagement     Open Access  
International Affairs and Global Strategy     Open Access   (Followers: 8)
International Journal of Electronic Government Research     Full-text available via subscription   (Followers: 3)
International Journal of Environmental Policy and Decision Making     Hybrid Journal   (Followers: 8)
International Journal of Information Systems for Crisis Response and Management     Full-text available via subscription   (Followers: 4)
International Journal of Leadership in Public Services     Hybrid Journal   (Followers: 8)
International Journal of Public Administration     Hybrid Journal   (Followers: 14)
International Journal of Public Sector Performance Management     Hybrid Journal   (Followers: 8)
International NGO Journal     Open Access   (Followers: 3)
International Review of Public Administration     Hybrid Journal   (Followers: 6)
International Tax and Public Finance     Hybrid Journal   (Followers: 6)
Journal of Asian Public Policy     Hybrid Journal   (Followers: 1)
Journal of Community Practice     Hybrid Journal   (Followers: 9)
Journal of Comparative Policy Analysis : Research and Practice     Hybrid Journal   (Followers: 7)
Journal of Developing Areas     Full-text available via subscription   (Followers: 6)
Journal of Development and Administrative Studies     Open Access   (Followers: 2)
Journal of Economic and Administrative Sciences     Hybrid Journal   (Followers: 3)
Journal of Economics, Finance and Administrative Science     Open Access   (Followers: 1)
Journal of Entrepreneurship and Public Policy     Hybrid Journal   (Followers: 9)
Journal of European Public Policy     Hybrid Journal   (Followers: 47)
Journal of Higher Education Outreach and Engagement     Open Access   (Followers: 10)
Journal of Management & Organization     Full-text available via subscription   (Followers: 332)
Journal of Nursing Management     Hybrid Journal   (Followers: 21)
Journal of Organisational Transformation & Social Change     Hybrid Journal   (Followers: 6)
Journal of Park and Recreation Administration     Full-text available via subscription   (Followers: 3)
Journal of Public Administration     Full-text available via subscription   (Followers: 22)
Journal of Public Administration and Governance     Open Access   (Followers: 18)
Journal of Public Administration and Policy Research     Open Access   (Followers: 3)
Journal of Public Administration Research and Theory     Hybrid Journal   (Followers: 23)
Journal of Science and Sustainable Development     Full-text available via subscription   (Followers: 1)
Journal of Social and Administrative Sciences     Open Access  
Journal of Social Work Education     Hybrid Journal   (Followers: 7)
Jurnal Bina Praja : Journal of Home Affairs Governance     Open Access  
Jurnal Ilmiah Administrasi Publik     Open Access  
Just Policy: A Journal of Australian Social Policy     Full-text available via subscription   (Followers: 10)
Law and Administration in Post-Soviet Europe : The Journal of Kolegium Jagiellonskie Torunska Szkola Wyzsza     Open Access  
Law, Democracy & Development     Open Access   (Followers: 4)
Law, Innovation and Technology     Hybrid Journal   (Followers: 10)
Liinc em Revista     Open Access  
Local Government Studies     Hybrid Journal   (Followers: 7)
Macramè. Trame e ritagli dell’urbanistica     Open Access  
Middle East Law and Governance     Hybrid Journal   (Followers: 7)
National Civic Review     Hybrid Journal  
NISPAcee Journal of Public Administration and Policy     Open Access   (Followers: 5)
Nordic Tax Journal     Open Access   (Followers: 1)
Organizações & Sociedade     Open Access  
Orientación y Sociedad : Revista Internacional e Interdisciplinaria de Orientación Vocacional Ocupacional     Open Access  
P3T : Journal of Public Policies and Territory     Open Access   (Followers: 1)
Parliaments, Estates and Representation     Hybrid Journal   (Followers: 2)
People Management     Full-text available via subscription   (Followers: 13)
Philosophy & Public Policy Quarterly     Open Access   (Followers: 4)
Pittsburgh Tax Review     Open Access   (Followers: 2)
PLOS Currents : Disasters     Open Access   (Followers: 5)
PLOS Currents : Outbreaks     Open Access   (Followers: 3)
Police Journal : Theory, Practice and Principles     Hybrid Journal   (Followers: 399)
Policy & Internet     Hybrid Journal   (Followers: 11)
Policy Sciences     Hybrid Journal   (Followers: 6)
Policy Studies     Hybrid Journal   (Followers: 13)
Policy Studies Journal     Hybrid Journal   (Followers: 12)
Politeia     Full-text available via subscription   (Followers: 1)
Politics and Governance     Open Access   (Followers: 4)
Politiques et Management Public     Open Access  
Poverty & Public Policy     Hybrid Journal   (Followers: 14)
Prawo Budżetowe Państwa i Samorządu     Open Access  
Prison Journal     Hybrid Journal   (Followers: 29)
Public Administration     Hybrid Journal   (Followers: 27)
Public Administration & Development     Hybrid Journal   (Followers: 13)
Public Administration Review     Hybrid Journal   (Followers: 32)
Public Choice     Hybrid Journal   (Followers: 22)
Public Infrastructure Bulletin     Open Access   (Followers: 3)
Public Organization Review     Hybrid Journal   (Followers: 4)
Public Personnel Management     Hybrid Journal   (Followers: 11)
Public Policy     Full-text available via subscription   (Followers: 14)
Public Policy and Administration     Hybrid Journal   (Followers: 16)
Public Policy And Administration     Open Access   (Followers: 12)
Public Policy and Administration Research     Open Access   (Followers: 14)
Public Policy Research     Hybrid Journal   (Followers: 15)
Public Sector     Full-text available via subscription   (Followers: 5)
Public Works Management & Policy     Hybrid Journal   (Followers: 8)
Publius: The Journal of Federalism     Hybrid Journal   (Followers: 5)
Pyramides     Open Access  
Qualit@s Revista Eletrônica     Open Access  
RACE - Revista de Administração, Contabilidade e Economia     Open Access   (Followers: 1)
REAd : Revista eletrônica de administração     Open Access  
Regards sur l'économie allemande     Open Access  
Regional Science Policy & Practice     Hybrid Journal   (Followers: 2)
Research on Economic Inequality     Hybrid Journal   (Followers: 4)
REUNA     Open Access  
Revista Brasileira de Administração Científica     Open Access  
Revista de Administração de Empresas     Open Access   (Followers: 1)
Revista de Administração Geral     Open Access  
Revista de Administração IMED     Open Access   (Followers: 1)
Revista de Administração Pública     Open Access  
Revista de Carreiras e Pessoas (ReCaPe)     Open Access  
Revista de Ciências da Administração     Open Access  
Revista de Evaluación de Programas y Políticas Públicas     Open Access  
Revista de Políticas Públicas     Open Access  
Revista Desenvolvimento Social     Open Access  
Revista Enfoques: Ciencia Política y Administración Pública     Open Access  
Revista Eurolatinoamericana de Derecho Administrativo     Open Access  
Revista Gestão e Desenvolvimento em Contexto     Open Access  
Revista Mexicana de Análisis Político y Administración Pública     Open Access  
Revista Panamericana de Salud Pública     Open Access  
Revista Pensamento Contemporâneo em Administração     Open Access  
Risk, Hazards & Crisis in Public Policy     Hybrid Journal   (Followers: 6)
Rivista trimestrale di scienza dell'amministrazione     Full-text available via subscription  
Singapore Economic Review, The     Hybrid Journal   (Followers: 6)
Skills at Work : Theory and Practice Journal     Full-text available via subscription  
Social Policy & Administration     Hybrid Journal   (Followers: 18)
Social Service Review     Full-text available via subscription   (Followers: 9)
Social Work Education: The International Journal     Hybrid Journal   (Followers: 10)
SourceOCDE Gouvernance     Full-text available via subscription   (Followers: 1)
SourceOECD Governance     Full-text available via subscription  
South Asian Journal of Macroeconomics and Public Finance     Hybrid Journal   (Followers: 3)
Sri Lanka Journal of Development Administration     Open Access  
State and Local Government Review     Hybrid Journal   (Followers: 5)
Statistics and Public Policy     Open Access   (Followers: 2)
Studi Organizzativi     Full-text available via subscription  
Surveillance and Society     Open Access   (Followers: 9)
Sustaining Regions     Full-text available via subscription  
Tax Breaks Newsletter     Full-text available via subscription   (Followers: 3)
TAXtalk     Full-text available via subscription   (Followers: 2)
Teaching Public Administration     Hybrid Journal   (Followers: 3)
The Philanthropist     Open Access   (Followers: 1)
The Review of International Organizations     Hybrid Journal   (Followers: 11)
Trabajo : Revista de la Asociación Estatal de Centros Universitarios de Relaciones Laborales y Ciencias del Trabajo     Open Access  
Virginia Tax Review     Full-text available via subscription   (Followers: 2)
Visión de futuro     Open Access  
Wroclaw Review of Law, Administration & Economics     Open Access  

       | 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  [3040 journals]
  • Salud pública basada en la evidencia en Gaceta Sanitaria: un
           guiño a Latinoamérica

    • Authors: Mercedes Carrasco-Portiño; Laura González Zapata; Leila Posenato García; Clara Bermúdez-Tamayo; Carlos Álvarez-Dardet
      First page: 1
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Mercedes Carrasco-Portiño, Laura González Zapata, Leila Posenato García, Clara Bermúdez-Tamayo, Carlos Álvarez-Dardet

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.12.001
  • Health conditions and role limitation in three European Regions: a
           public-health perspective

    • Authors: Gabriela Barbaglia; Núria D. Adroher; Gemma Vilagut; Ronny Bruffaerts; Brentan Bunting; José Miguel Caldas de Almeida; Silvia Florescu; Giovanni de Girolamo; Ron de Graaf; Josep Maria Haro; Hristo Hinkov; Vivianne Kovess-Masfety; Herbert Matschinger; Jordi Alonso
      Pages: 2 - 10
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Gabriela Barbaglia, Núria D. Adroher, Gemma Vilagut, Ronny Bruffaerts, Brentan Bunting, José Miguel Caldas de Almeida, Silvia Florescu, Giovanni de Girolamo, Ron de Graaf, Josep Maria Haro, Hristo Hinkov, Vivianne Kovess-Masfety, Herbert Matschinger, Jordi Alonso
      Objective To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach. Methods Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated. Results Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability. Conclusion The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.07.008
  • Time trends in health inequalities due to care in the context of the
           Spanish Dependency Law

    • Authors: Maria Salvador-Piedrafita; Davide Malmusi; Carme Borrell
      Pages: 11 - 17
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Maria Salvador-Piedrafita, Davide Malmusi, Carme Borrell
      Objective In Spain, responsibility for care of old people and those in situations of dependency is assumed by families, and has an unequal social distribution according to gender and socioeconomic level. This responsibility has negative health effects on the carer. In 2006, the Dependency Law recognised the obligation of the State to provide support. This study analyses time trends in health inequalities attributable to caregiving under this new law. Methods Study of trends using two cross-sectional samples from the 2006 and 2012 editions of the Spanish National Health Survey (27,922 and 19,995 people, respectively). We compared fair/poor self-rated health, poor mental health (GHQ-12 >2), back pain, and the use of psychotropic drugs between non-carers, carers sharing care with other persons, and those providing care alone. We obtain prevalence ratios by fitting robust Poisson regression models. Results We observed no change in the social profile of carers according to gender or social class. Among women, the difference in all health indicators between carers and non-carers tended to decrease among those sharing care but not among lone carers. Inequalities tend to decrease slightly in both groups of men carers. Conclusions Between 2006 and 2012, trends in health inequalities attributable to informal care show different trends according to gender and share of responsibility. It is necessary to redesign and implement policies to reduce inequalities that take into account the most affected groups, such as women lone carers. Policies that strengthen the fair social distribution of care should also be adopted.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.06.006
  • Age and gender effects on the prevalence of poor sleep quality in the
           adult population

    • Authors: Juan J. Madrid-Valero; José M. Martínez-Selva; Bruno Ribeiro do Couto; Juan F. Sánchez-Romera; Juan R. Ordoñana
      Pages: 18 - 22
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Juan J. Madrid-Valero, José M. Martínez-Selva, Bruno Ribeiro do Couto, Juan F. Sánchez-Romera, Juan R. Ordoñana
      Objective Sleep quality has a significant impact on health and quality of life and is affected, among other factors, by age and sex. However, the prevalence of problems in this area in the general population is not well known. Therefore, our objective was to study the prevalence and main characteristics of sleep quality in an adult population sample. Methods 2,144 subjects aged between 43 and 71 years belonging to the Murcia (Spain) Twin Registry. Sleep quality was measured by self-report through the Pittsburgh Sleep Quality Index (PSQI). Logistic regression models were used to analyse the results. Results The prevalence of poor sleep quality stands at 38.2%. Univariate logistic regression analyses showed that women were almost twice as likely as men (OR: 1.88; 95% confidence interval [95%CI]: 1.54 to 2.28) to have poor quality of sleep. Age was directly and significantly associated with a low quality of sleep (OR: 1.05; 95%CI: 1.03 to 1.06). Conclusions The prevalence of poor sleep quality is high among adults, especially women. There is a direct relationship between age and deterioration in the quality of sleep. This relationship also appears to be more consistent in women.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.05.013
  • Responsabilidad por pérdida de oportunidad asistencial en patologías
           neurológicas en la medicina pública española

    • Authors: Carlos Sardinero-García; Andrés Santiago-Sáez; M. del Carmen Bravo-Llatas; Bernardo Perea-Pérez; M. Elena Albarrán-Juan; Elena Labajo-González; Julián Benito-León
      Pages: 30 - 34
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Carlos Sardinero-García, Andrés Santiago-Sáez, M. del Carmen Bravo-Llatas, Bernardo Perea-Pérez, M. Elena Albarrán-Juan, Elena Labajo-González, Julián Benito-León
      Objetivo Analizar las sentencias condenatorias por responsabilidad derivada de pérdida de oportunidad asistencial, dictadas por la Jurisdicción Contencioso Administrativa (es decir, en la medicina pública), en las que tanto el origen de la patología a tratar como las secuelas fueron procesos neurológicos. Métodos Se han analizado las 90 sentencias relacionadas con patologías neurológicas que hacían referencia al concepto de pérdida de oportunidad asistencial y que fueron dictadas en España desde 2003 (año de la primera sentencia) hasta mayo de 2014. Resultados De las 90 sentencias, 52 (57,8%) fueron dictadas por error diagnóstico y 30 por tratamiento inadecuado (33,3%). Desde el año 2009 se han producido 72 (80,0%) sentencias, lo que supone más de un 300% de aumento con respecto a las 18 (20,0%) dictadas en los primeros 6 años del estudio (2003 a 2008). La mayoría de los pacientes fueron hombres (66,7%) que tuvieron secuelas (61,1%), siendo las patologías que con más frecuencia originaron la condena la encefalopatía neonatal hipóxico-isquémica (14,4%) y las lesiones medulares (14,4%). Conclusiones La actividad litigante por pérdida de oportunidad asistencial en patologías neurológicas, en la medicina pública española, ha aumentado de manera significativa estos últimos años. Las sentencias fueron dictadas fundamentalmente por error diagnóstico o por tratamiento inadecuado. Objective To analyse the sentences due to loss of chance that were passed by the Contentious-Administrative Court (i.e., in public medicine), in which both the origin of the disease to be treated and the damages were neurological. Methods We analysed the 90 sentences concerning neurological conditions that referred to the concept of loss of chance that were passed in Spain from 2003 (year of the first sentence) until May 2014. Findings Of the 90 sentences, 52 (57.8%) were passed due to diagnostic error and 30 (33.3%), due to inadequate treatment. 72 (80.0%) of the sentences were passed from 2009 onwards, which equates to more than a 300% increase with respect to the 18 (20.0%) issued in the first six years of the study (from 2003 to 2008). Most of the patients (66.7%) were men, and a 61.1% presented sequelae. Hypoxic-ischaemic encephalopathy (14.4%) and spinal cord disorders (14.4%) were the most common conditions to lead to sentencing. Conclusions The litigant activity due to loss of chance in neurological disease in the Spanish public healthcare system has significantly increased in the last few years. The sentences were mainly passed because of diagnostic error or inadequate treatment.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.08.002
  • Desprescripción de tratamientos de larga duración con bisfosfonatos para
           la osteoporosis en atención primaria en el País Vasco

    • Authors: Arritxu Etxeberria; Josune Iribar; Javier Hernando; Ignacia Idarreta; Itziar Vergara; Carmela Mozo; Kalliopi Vrotsou; Joaquín Belzunegui; Arantxa Lekuona
      Pages: 35 - 39
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Arritxu Etxeberria, Josune Iribar, Javier Hernando, Ignacia Idarreta, Itziar Vergara, Carmela Mozo, Kalliopi Vrotsou, Joaquín Belzunegui, Arantxa Lekuona
      Objetivo Evaluar el impacto de una intervención multifactorial para promover la desprescripción de tratamientos con bisfosfonatos de duración superior a 5 años (BF5a) en la Comarca Gipuzkoa y compararlo con la intervención estándar en el resto de las organizaciones de servicios (OS) de Osakidetza. Métodos Estudio de evaluación del impacto de dos intervenciones con medida de resultados antes y después, con un seguimiento de 8 meses. Se incluyeron todos los pacientes de Osakidetza que en julio de 2013 tenían un tratamiento activo con BF5a (prescripción electrónica). La intervención estándar (9 OS) consistió en el envío de un documento de consenso sobre desprescripción de BF5a y en facilitar los identificadores de pacientes con BF5a para su revisión por el médico de atención primaria. La intervención multifactorial (Comarca Gipuzkoa) incluyó, además, un consenso local con los especialistas de referencia y sesiones de formación en los centros de salud. Resultados Se incluyeron 18.725 pacientes, el 94,7% mujeres. Con la intervención estándar, los porcentajes de desprescripción oscilaron entre el 26,4% (C. Bilbao) y el 49,4% (C. Araba), siendo del 37,2% en su conjunto. Con la intervención multifactorial la desprescripción fue del 44,6%, un 7,4% superior a la estándar (p <0,0001; intervalo de confianza del 95% [IC95%]: 5,4-9,4). Los desplazamientos a otros tratamientos fueron menos frecuentes con la intervención multifactorial, con una diferencia del 3,7% (p <0.0001; IC95%: −2,2 a −5,2). Conclusiones Las intervenciones estándar y multifactorial son muy efectivas para disminuir los tratamientos innecesarios con bisfosfonatos. La intervención multifactorial es más efectiva que la estándar, aunque más compleja de llevar a cabo. Objective To evaluate the impact of a multifactorial intervention to promote bisphosphonate deprescription after over 5 years of use (BF5y) in a health care organisation (HCO) in Gipuzkoa (Spain) and to compare it with the standard intervention in other HCOs in the Basque Health Service-Osakidetza. Methods An 8-month follow-up study (results from before and after) to assess the impact of two interventions. All patients from Osakidetza receiving BF5y treatment (electronic prescription) in July 2013 were included. The standard intervention (9 HCOs) consisted of mailing a consensus statement on BF5y deprescribing and facilitating patient identifiers with BF5y prescription for review by the primary care physician. The multifactorial intervention (Gipuzkoa) also included a local consensus with leading specialists and training sessions in health centres. Results 18,725 patients were included; 94.7% were women. Standard intervention deprescribing rates ranged from 26.4% (Bilbao) to 49.4% (Araba), being 37.2% overall. The multifactorial intervention deprescribing rate was 44.6%, 7.4% (p <0.0001; 95% confidence interval [95%CI]: 5.4–9.4) higher than standard intervention. Changes to other treatments were less common with the multifactorial intervention, with a difference of 3.7% (p <0.0001; 95%CI: −2.2 to −5.2). Conclusions Standard and multifactorial interventions are very effective...
      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.07.003
  • Effectiveness of an intervention to improve diabetes self-management on
           clinical outcomes in patients with low educational level

    • Authors: Antonio Olry de Labry Lima; Clara Bermúdez Tamayo; Guadalupe Pastor Moreno; Julia Bolívar Muñoz; Isabel Ruiz Pérez; Mira Johri; Fermín Quesada Jiménez; Pilar Cruz Vela; Ana M. de los Ríos Álvarez; Miguel Ángel Prados Quel; Enrique Moratalla López; Susana Domínguez Martín; José Andrés Lopez de Hierro; Ignacio Ricci Cabello
      Pages: 40 - 47
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Antonio Olry de Labry Lima, Clara Bermúdez Tamayo, Guadalupe Pastor Moreno, Julia Bolívar Muñoz, Isabel Ruiz Pérez, Mira Johri, Fermín Quesada Jiménez, Pilar Cruz Vela, Ana M. de los Ríos Álvarez, Miguel Ángel Prados Quel, Enrique Moratalla López, Susana Domínguez Martín, José Andrés Lopez de Hierro, Ignacio Ricci Cabello
      Objective To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. Methods 12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. Results The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference. Conclusions In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.05.017
  • Ensayo clínico con intervención educativa en mujeres perimenopáusicas
           con un factor de riesgo cardiovascular

    • Authors: Anxela Soto-Rodríguez; José Luís García-Soidán; Manuel de Toro-Santos; Manuel Rodríguez-González; M. Jesús Arias-Gómez; María Reyes Pérez-Fernández
      Pages: 48 - 52
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Anxela Soto-Rodríguez, José Luís García-Soidán, Manuel de Toro-Santos, Manuel Rodríguez-González, M. Jesús Arias-Gómez, María Reyes Pérez-Fernández
      Objetivo Evaluar si una intervención educativa en mujeres en edad perimenopáusica con diabetes mellitus, hipertensión o dislipidemia podría mejorar aspectos relacionados con la calidad de vida o el ejercicio físico. Métodos Ensayo clínico aleatorizado. Variables: actividad física, calidad de vida y peso en mujeres de 45-60 años de edad (n = 320) en el momento 0 y 12 meses después de la intervención. Grupo de intervención: tres talleres interactivos sobre prevención de enfermedad cardiovascular. Grupo control: información por correo. Resultados El grupo de intervención obtuvo mejores puntuaciones en el componente mental de la calidad de vida 1 año después (p <0,05) y mostró un aumento significativo de la actividad física (p <0,01). Las mujeres del grupo de intervención mantuvieron su peso, mientras que las del grupo control lo aumentaron (p <0,01). Conclusiones Una sencilla intervención educativa en mujeres perimenopáusicas con un factor de riesgo cardiovascular mejora aspectos relacionados con la calidad de vida y con hábitos saludables como la actividad física. Objective To assess whether an educational intervention in women in perimenopausal age with diabetes mellitus, hypertension and/or dyslipidemia could improve aspects of quality of life and exercise. Methods A randomized clinical trial. Variables: physical activity, quality of life and weight in women aged 45-60 years (n = 320) at time 0 and 12 months after surgery. intervention group (IG): 3 interactive workshops on cardiovascular disease prevention and control group (CG): information by mail. Results The IG obtained better scores on the mental component of quality of life one year later (p < 0.05) and showed a significant increase in physical activity (p < 0.01). GI women maintained their weight while in CG women it increased (p < 0.01). Conclusions A simple educational intervention in premenopausal women with a cardiovascular risk factor improves aspects of quality of life and of healthy habits such as physical activity.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.07.022
  • Measuring social capital: further insights

    • Authors: Elena Carrillo Álvarez; Jordi Riera Romaní
      Pages: 57 - 61
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Elena Carrillo Álvarez, Jordi Riera Romaní
      Social capital is defined as the resources available to individuals and groups through membership in social networks. However, multiple definitions, distinct dimensions and subtypes of social capital have been used to investigate and theorise about its relationship to health on different scales, creating a confusing picture. This heterogeneity makes it necessary to systematise social capital measures in order to build a stronger foundation in terms of how these associations between the different aspects of social capital and each specific health indicator develop. We aim to provide an overview of the measurement approaches used to measure social capital in its different dimensions and scales, as well as the mechanisms through which it is presumed to influence health. Understanding the mechanisms through which these relationships develop may help to refine the existing measures or to identify new, more appropriate ones.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.09.002
  • El envase neutro de los productos de tabaco: una nueva estrategia para el
           control del tabaquismo

    • Authors: Juan Miguel Rey-Pino; Isabel Nerín; Ma Blanca Lacave-García
      Pages: 62 - 65
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Juan Miguel Rey-Pino, Isabel Nerín, Ma Blanca Lacave-García
      Existe evidencia de que las políticas de control del tabaquismo integrales contribuyen a reducir la prevalencia del tabaquismo, por lo que es necesaria la implementación de las distintas medidas de manera conjunta. El empaquetado y etiquetado neutro del tabaco es una de las medidas recomendadas por el Convenio Marco de Control del Tabaco propuesto por la Organización Mundial de la Salud que contribuye a reducir la demanda de tabaco. En el momento actual, una serie de países están implementando esta medida de envasado neutro de los productos del tabaco, que implica desprender a los envases de los aspectos atractivos y promocionales, conservando el nombre de la marca, el cual debería aparecer en una fuente, tamaño, color y localización estándar en el envase. Australia fue el primer país que incorporó este envase en 2012 y recientemente otros países han aprobado la misma medida. En España, la legislación sobre tabaquismo (de 2005 y 2010) supuso un importante avance en las políticas de control del tabaquismo. La introducción de esta medida en España constituiría el siguiente paso en el desarrollo de una estrategia global para luchar contra este importante problema de salud. El objetivo de este trabajo es resumir y presentar de manera estructurada la información disponible sobre el papel que tiene el envase en los productos de tabaco dentro de las estrategias de marketing y comunicación, y describir los potenciales efectos que produce el envase neutro sobre diversos aspectos relacionados con la conducta de fumar. There is evidence that global tobacco smoking control policies contribute to decrease the prevalence of smoking among populations, so there is a need to effectively implement different measures in a coordinated way. The plain packaging and labelling of tobacco products is one of the measures proposed by the World Health Organisation Framework Convention on Tobacco Control. At the moment, leading countries are implementing this tobacco control measure, which involves a plain packaging for all tobacco products, i.e., the absence of any promotional or communication tool in the packaging, except the name of the brand, appearing with a standardised font, size, colour and placing in the pack. Australia was the first country to implement this measure in 2012 and recently other countries are legislating and approving it. In Spain, tobacco legislation (2005 and 2010), was an important advance in tobacco control policies. The introduction of plain packaging in Spain would mean the next step in the development of a global strategy for fighting this significant health problem. The aim of this article is to synthesise in a structured manner the role that the packaging of tobacco products has within marketing and communication strategies, as well as to describe the potential effects that the plain packaging has on some aspects of smoking behaviour, according to current literature.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.07.020
  • Living under the influence: normalisation of alcohol consumption in our

    • Authors: Xisca Sureda; Joan R. Villalbí; Albert Espelt; Manuel Franco
      Pages: 66 - 68
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Xisca Sureda, Joan R. Villalbí, Albert Espelt, Manuel Franco
      Harmful use of alcohol is one of the world's leading health risks. A positive association between certain characteristics of the urban environment and individual alcohol consumption has been documented in previous research. When developing a tool characterising the urban environment of alcohol in the cities of Barcelona and Madrid we observed that alcohol is ever present in our cities. Urban residents are constantly exposed to a wide variety of alcohol products, marketing and promotion and signs of alcohol consumption. In this field note, we reflect the normalisation of alcohol in urban environments. We highlight the need for further research to better understand attitudes and practices in relation to alcohol consumption. This type of urban studies is necessary to support policy interventions to prevent and control harmful alcohol use.

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.07.018
  • Rotación en la OMS, el sueño cumplido de un especialista

    • Authors: José Luis Carretero Ares
      First page: 70
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): José Luis Carretero Ares

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.06.017
  • Probabilidad de hospitalización según la salud mental de la población
           adulta española

    • Authors: Virginia Basterra
      Pages: 72 - 73
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Virginia Basterra

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.06.010
  • Xavier Castellsagué (1959-2016)

    • Authors: Xavier Bosch
      Pages: 75 - 76
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Xavier Bosch

      PubDate: 2017-01-16T11:45:55Z
      DOI: 10.1016/j.gaceta.2016.08.006
  • Escolà C. Licencia para matar. Una historia del tabaco en España.
           Barcelona: Península; 2016. ISBN: 9788499425177. 304 p.

    • Authors: Joan
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Joan R. Villalbí

      PubDate: 2017-01-16T11:45:55Z
  • Mecanismo de acción de la anticoncepción de urgencia con levonorgestrel:
           ¿cuál es la evidencia?

    • Authors: del Mar
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): María del Mar García-Calvente

      PubDate: 2017-01-16T11:45:55Z
  • La acreditación de los comités de ética de la

    • Authors: Miguel Ramiro
      Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1
      Author(s): Miguel A. Ramiro Avilés
      Objetivo Según la Ley 14/2007 y el Real Decreto 1090/2015, la investigación biomédica debe ser evaluada por un comité de ética de la investigación (CEI), que deberá estar acreditado como comité de ética de la investigación con medicamentos (CEIm) si el dictamen recae sobre un estudio clínico con medicamentos o una investigación clínica con productos sanitarios. El objetivo de este estudio es comprobar cómo se regula la acreditación de los CEI y de los CEIm. Métodos Se ha analizado la legislación estatal y autonómica sobre investigación biomédica. Resultados Ni los CEI ni los CEIm tienen un procedimiento de acreditación definido con claridad en la legislación estatal o autonómica. Discusión Los CEI son fundamentales en el desarrollo de la investigación biomédica básica o clínica, y deben estar acreditados por un órgano externo para evitar que la independencia, la composición multidisciplinaria y la revisión se vean afectadas. Objective According to Law 14/2007 and Royal Decree 1090/2015, biomedical research must be assessed by an Research Ethics Committee (REC), which must be accredited as an Research ethics committee for clinical trials involving medicinal products (RECm) if the opinion is issued for a clinical trial involving medicinal products or clinical research with medical devices. The aim of this study is to ascertain how IEC and IECm accreditation is regulated. Methods National and regional legislation governing biomedical research was analysed. Results No clearly-defined IEC or IECm accreditation procedures exist in the national or regional legislation. Discussion Independent Ethics Committees are vital for the development of basic or clinical biomedical research, and they must be accredited by an external body in order to safeguard their independence, multidisciplinary composition and review procedures.

      PubDate: 2017-01-16T11:45:55Z
  • Gaceta Sanitaria a primera vista

    • Abstract: Publication date: January–February 2017
      Source:Gaceta Sanitaria, Volume 31, Issue 1

      PubDate: 2017-01-16T11:45:55Z
  • 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
  • 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
  • Patterns of physical activity and associated factors among teenagers from
           Barcelona (Spain) in 2012

    • Authors: Alicia Ruiz-Trasserra; Anna Pérez; Xavier Continente; Kerry O’Brien; Montse Bartroli; Ester Teixidó-Compaño; Albert Espelt
      Abstract: Publication date: Available online 3 January 2017
      Source:Gaceta Sanitaria
      Author(s): Alicia Ruiz-Trasserra, Anna Pérez, Xavier Continente, Kerry O’Brien, Montse Bartroli, Ester Teixidó-Compaño, Albert Espelt
      Objective To estimate the prevalence of moderate and vigorous physical activity (MVPA), as defined by the World Health Organisation (WHO), and associated factors among teenagers from Barcelona in 2012. Methods Cross-sectional survey to assess risk factors in a representative sample of secondary school students (aged 13–16 years, International Standard Classification of Education [ISCED] 2, n=2,162; and 17–18 years, ISCED 3, n=1016) in Barcelona. We estimated MVPA prevalence overall, and for each independent variable and each gender. Poisson regression models with robust variance were fit to examine the factors associated with high-level MVPA, and obtained prevalence ratios (PR) and 95% confidence intervals (95%CI). Results Only 13% of ISCED 2 and 10% of ISCED 3 students met the WHO physical activity recommendations. This percentage was lower among girls at both academic levels. MVPA was lower among ISCED 3 compared to ISCED 2 students, and among students with a lower socioeconomic status. Physical activity was associated with positive self-perception of the health status (e.g., positive self-perception of health status among ISCED 2 compared to ISCED 3 students: PR=1.31 [95%CI: 1.22–1.41] and 1.61 [95%CI: 1.44–1.81] for boys and girls, respectively]. Conclusions The percentage of teenagers who met WHO MVPA recommendations was low. Strategies are needed to increase MVPA levels, particularly in older girls, and students from low socioeconomic backgrounds.

      PubDate: 2017-01-09T11:41:18Z
      DOI: 10.1016/j.gaceta.2016.10.004
  • Priorización de intervenciones sanitarias. Revisión de criterios,
           enfoques y rol de las agencias de evaluación

    • Authors: Leonor Varela-Lema; Gerardo Atienza-Merino; Marisa López-García
      Abstract: Publication date: Available online 3 January 2017
      Source:Gaceta Sanitaria
      Author(s): Leonor Varela-Lema, Gerardo Atienza-Merino, Marisa López-García
      Objetivo El presente trabajo surge con el propósito de desarrollar una metodología explícita para la selección de prioridades sanitarias que apoye la toma de decisiones sobre las tecnologías a evaluar de cara a su inclusión en la cartera de servicios del Sistema Nacional de Salud. El objetivo principal es identificar y analizar los criterios, procesos y marcos conceptuales empleados para la priorización de intervenciones sanitarias en el ámbito nacional e internacional. Método Se ha llevado a cabo una revisión exhaustiva de la literatura. Para ello, se ha buscado en las principales bases de datos biomédicas y se han revisado las páginas web de las principales agencias de evaluación, entre otras fuentes. Resultados En términos generales, se encontró que no existen criterios universales ni procedimientos estándar para la asignación de prioridades, aunque se han identificado algunos acuerdos y tendencias comunes respecto a aspectos fundamentales (criterios, modelos y estrategias, actores clave, etc.). Globalmente se identificaron ocho dominios críticos: 1) necesidad de la intervención; 2) resultados en salud; 3) tipo de beneficio de la intervención; 4) consecuencias económicas; 5) conocimiento existente sobre la intervención/calidad e incertidumbre de la evidencia; 6) implementación y complejidad de la intervención/factibilidad; 7) prioridad, justicia y ética; y 8) contexto global. Conclusiones La revisión proporciona un análisis detallado de los aspectos relevantes y ofrece recomendaciones clave para el desarrollo de un marco de priorización nacional. Se plantea que esta información podría ser útil para diferentes organizaciones públicas que pretendan establecer prioridades sanitarias. Objective This study was carried out to develop an explicit health priority setting methodology to support decision-making regarding the technologies to be assessed for inclusion in the National Health Service service portfolio. The primary objective is to identify and analyse the criteria, approaches and conceptual frameworks used for national/international priority setting. Method An exhaustive review of the literature was carried out. For this purpose, a search of the main biomedical databases was performed and assessment agency websites were reviewed, among other sources. Results In general terms, it was found that there are no standardised criteria for priority setting, although some consensus and common trends have been identified regarding key elements (criteria, models and strategies, key actors, etc.). Globally, 8 key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality of and uncertainties regarding the evidence; 6) implementation and complexity of the intervention/feasibility; 7) priority, justice and ethics; and 8) overall context. Conclusions The review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritisation framework. Findings are envisioned to be useful for different public organisations that are aiming to establish healthcare priorities.

      PubDate: 2017-01-09T11:41:18Z
      DOI: 10.1016/j.gaceta.2016.09.015
  • 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
  • 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
  • Guía metodológica para la evaluación de la eficacia y la seguridad de
           nuevos fármacos: implementación de las recomendaciones de EUnetHTA

    • Authors: Ruth Ubago Pérez; María Auxiliadora Castillo Muñoz; Mercedes Galván Banqueri; Raúl García Estepa; Eva Rocío Alfaro Lara; María Dolores Vega Coca; Carmen Beltrán Calvo; Teresa Molina López
      Abstract: Publication date: Available online 3 January 2017
      Source:Gaceta Sanitaria
      Author(s): Ruth Ubago Pérez, María Auxiliadora Castillo Muñoz, Mercedes Galván Banqueri, Raúl García Estepa, Eva Rocío Alfaro Lara, María Dolores Vega Coca, Carmen Beltrán Calvo, Teresa Molina López
      La colaboración European Network for Health Technology Assessment (EUnetHTA) es la red colaborativa de agencias y organismos públicos de evaluación de tecnologías sanitarias de la Unión Europea. En este marco se han elaborado guías metodológicas y procedimientos comunes que han dado lugar al denominado HTA Core Model ® . La Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA), miembro de la Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud, y de la colaboración EUnetHTA, participa en la recién iniciada Tercera Acción Conjunta (Joint Action 3) de EUnetHTA (2016-2019). Adicionalmente, la AETSA cuenta con una línea de evaluación de medicamentos. Parte del trabajo se integra en la elaboración de informes de posicionamiento terapéutico (IPT) sobre fármacos que han recibido recientemente la autorización de comercialización, que coordina la Agencia Española de Medicamentos y Productos Sanitarios. Como apoyo a este trabajo, la AETSA elabora «Informes de síntesis de evidencia: medicamentos», en los que se realiza una evaluación comparada de la eficacia y la seguridad de los fármacos de los que va a elaborarse un IPT. La AETSA ha diseñado un proceso para la elaboración de dichos informes, basado en el HTA Core Model ® y en las guías metodológicas de EUnetHTA. En este trabajo se describe la metodología empleada en la elaboración de la guía realizada por la AETSA para la elaboración de estos informes y se presentan los distintos apartados en los que esta se estructura. The European network for Health Technology Assessment (EUnetHTA) is the network of public health technology assessment (HTA) agencies and entities from across the EU. In this context, the HTA Core Model®, has been developed. The Andalusian Agency for Health Technology Assessment (AETSA) is a member of the Spanish HTA Network and EUnetHTA collaboration In addition, AETSA participates in the new EUnetHTA Joint Action 3 (JA, 2016–2019). Furthermore, AETSA works on pharmaceutical assessments. Part of this work involves drafting therapeutic positioning reports (TPRs) on drugs that have recently been granted marketing authorisation, which is overseen by the Spanish Agency of Medicines and Medical Devices (AEMPS). AETSA contributes by drafting “Evidence synthesis reports: pharmaceuticals” in which a rapid comparative efficacy and safety assessment is performed for drugs for which a TPR will be created. To create this type of report, AETSA follows its own methodological guideline based on EUnetHTA guidelines and the HTA Core Model®. In this paper, the methodology that AETSA has developed to create the guideline for “Evidence synthesis reports: pharmaceuticals” is described. The structure of the report itself is also presented.

      PubDate: 2017-01-09T11:41:18Z
      DOI: 10.1016/j.gaceta.2016.10.005
  • Incentives and intrinsic motivation in healthcare

    • Authors: Mikel Berdud; Juan M. Cabasés; Jorge Nieto
      Pages: 408 - 414
      Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6
      Author(s): Mikel Berdud, Juan M. Cabasés, Jorge Nieto
      Objective It has been established in the literature that workers within public organisations are intrinsically motivated. This paper is an empirical study of the healthcare sector using methods of qualitative analysis research, which aims to answer the following hypotheses: 1) doctors are intrinsically motivated; 2) economic incentives and control policies may undermine doctors’ intrinsic motivation; and 3) well-designed incentives may encourage doctors’ intrinsic motivation. Method We conducted semi-structured interviews à-la-Bewley with 16 doctors from Navarre's Healthcare Service (Servicio Navarro de Salud-Osasunbidea), Spain. The questions were based on current theories of intrinsic motivation and incentives to test the hypotheses. Interviewees were allowed to respond openly without time constraints. Relevant information was selected, quantified and analysed by using the qualitative concepts of saturation and codification. Results The results seem to confirm the hypotheses. Evidence supporting hypotheses 1 and 2 was gathered from all interviewees, as well as indications of the validity of hypothesis 3 based on interviewees’ proposals of incentives. Conclusions The conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated.

      PubDate: 2016-11-02T01:00:38Z
      DOI: 10.1016/j.gaceta.2016.04.013
  • Encuesta de acceso a servicios de salud para hogares colombianos

    • Authors: Marcela Arrivillaga; Juan Carlos Aristizabal; Mauricio Pérez; Victoria Eugenia Estrada
      Pages: 415 - 420
      Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6
      Author(s): Marcela Arrivillaga, Juan Carlos Aristizabal, Mauricio Pérez, Victoria Eugenia Estrada
      Objetivo Diseñar y validar una encuesta de acceso a servicios de salud dirigida a hogares en Colombia para aportar una herramienta metodológica de país que permita ir acumulando evidencia sobre las condiciones de acceso real que tiene la población colombiana. Método Se realizó un estudio de validación con personas expertas y prueba piloto aplicada en el municipio de Jamundí, en el departamento del Valle del Cauca, Colombia. Se realizó un muestreo probabilístico, polietápico, estratificado y por conglomerados. La muestra final fue de 215 hogares. Resultados La encuesta quedó conformada por 63 preguntas distribuidas en cinco módulos: perfil sociodemográfico del jefe/a del hogar o adulto/a informante, perfil socioeconómico del hogar, acceso a servicios preventivos, acceso a servicios curativos y de rehabilitación, y gasto de bolsillo en acceso. En términos descriptivos, la promoción de servicios preventivos solo alcanzó valores del 44%; el uso de estos servicios siempre fue mayor, en especial en los grupos del primer año de vida y hasta los 10 años. Para los servicios de urgencias y hospitalización, la percepción de atención de la necesidad estuvo entre el 82% y el 85%. No obstante, hubo percepción de mala y muy mala calidad de la atención hasta en un 36%. Por su parte, la oportunidad de la atención de consulta médica general y con especialista presentó demoras. Discusión La encuesta diseñada es válida, relevante y representativa del constructo acceso a servicios de salud en Colombia. En términos empíricos, la prueba piloto mostró debilidades institucionales en un municipio del país, indicando además que la cobertura en salud no significa acceso real y efectivo a los servicios. Objective The aim of this study was to design and validate a health services access survey for households in Colombia to provide a methodological tool that allows the country to accumulate evidence of real-life access conditions experienced by the Colombian population. Methods A validation study with experts and a pilot study were performed. It was conducted in the municipality of Jamundi, located in the department of Valle del Cauca, Colombia. Probabilistic, multistage and stratified cluster sampling was carried out. The final sample was 215 households. Results The survey was composed of 63 questions divided into five modules: socio-demographic profile of the head of the household or adult informant, household socioeconomic profile, access to preventive services, access to curative and rehabilitative services and household out of pocket expenditure. In descriptive terms, the promotion of preventive services only reached 44%; the use of these services was always highest among children younger than one year old and up to the age of ten. The perceived need for emergency medical care and hospitalisation was between 82% and 85%, but 36% perceived the quality of care to be low or very low. Delays were experienced in medical visits with GPs and specialists. Discussion The designed survey is valid, relevant and representative of access to health services in Colombia. Empirically, the pilot showed institutional weaknesses in a municipality of the country, indicating that health coverage does not in practice mean real and effective access to health services.
      PubDate: 2016-11-02T01:00:38Z
      DOI: 10.1016/j.gaceta.2016.05.008
  • Barreras percibidas en el desplazamiento activo al centro educativo:
           fiabilidad y validez de una escala

    • Authors: Javier Molina-García; Ana Queralt; Isaac Estevan; Octavio Álvarez; Isabel Castillo
      Pages: 426 - 431
      Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6
      Author(s): Javier Molina-García, Ana Queralt, Isaac Estevan, Octavio Álvarez, Isabel Castillo
      Objetivo Examinar la fiabilidad y la validez de una escala para evaluar las barreras percibidas en el desplazamiento activo al centro escolar en jóvenes españoles. Método La validez de la escala fue evaluada en una muestra de 465 adolescentes (14-18 años de edad) mediante un análisis factorial confirmatorio y a través de la asociación con el transporte activo autorreportado. Una submuestra completó la escala dos veces, con una separación de una semana, a fin de evaluar su fiabilidad. Resultados Los resultados mostraron que la escala tenía índices de ajuste satisfactorios con dos factores. Un factor incluyó los ítems relativos a ambiente y seguridad (α=0,72), y otro los ítems sobre planificación y aspectos psicosociales (α=0,64). El transporte activo se relacionó significativamente con la puntuación total de la escala de barreras (rho=−0,27; p <0,001), con las barreras ambientales/seguridad (rho=−0,22; p <0,001) y con las barreras de planificación/psicosociales (rho=−0,29; p <0,001). Los test-retest (coeficiente de correlación intraclase) para las barreras mostraron valores entre 0,68 y 0,77. Conclusión La escala muestra una validez aceptable y una fiabilidad adecuada para evaluar las barreras en el transporte activo al centro educativo en jóvenes españoles. Objective To examine the reliability and validity of a scale to measure perceived barriers to active commuting to school among Spanish young people. Method The validity of the scale was assessed in a sample of 465 adolescents (14–18 years) using a confirmatory factor analysis and studying its association with self-reported active commuting to school. The reliability of the instrument was evaluated in a sub-sample that completed the scale twice separated by a one-week interval. Results The results showed that the barriers scale had satisfactory fit indices, and two factors were determined. The first included environment- and safety-related items (α=0.72), while the other concerned planning and psychosocial items (α=0.64). Active commuting to school showed significant correlations with the total score of the barriers scale (rho=−0.27; p <0.001), with the environmental/safety barriers (rho=−0.22; p <0.001), as well as with the planning/psychosocial barriers (rho=−0.29; p <0.001). Test-retest ICCs for the barriers ranged from 0.68 to 0.77. Conclusion The developed scale has acceptable validity and good reliability to assess barriers to active commuting to school among Spanish young people.

      PubDate: 2016-11-02T01:00:38Z
      DOI: 10.1016/j.gaceta.2016.05.006
  • Prevalencia y perfil de uso del cigarrillo electrónico en España

    • Authors: Cristina Lidón-Moyano; Jose M. Martínez-Sánchez; Marcela Fu; Montse Ballbè; Juan Carlos Martín-Sánchez; Esteve Fernández
      Pages: 432 - 437
      Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6
      Author(s): Cristina Lidón-Moyano, Jose M. Martínez-Sánchez, Marcela Fu, Montse Ballbè, Juan Carlos Martín-Sánchez, Esteve Fernández
      Objetivo Describir la prevalencia y el perfil de uso de los cigarrillos electrónicos en la población adulta española y evaluar el potencial uso dual de estos dispositivos con el tabaco combustible o convencional, en España, en 2014. Métodos Estudio transversal en una muestra representativa de la población adulta (16-75 años de edad) española (n=1016). Se realizó una encuesta telefónica asistida por ordenador en el año 2014. Se calcularon prevalencias y sus intervalos de confianza del 95% (IC95%) para el uso del cigarrillo electrónico estratificado por sexo, edad, consumo de tabaco y clase social. Se ponderó la muestra y se ajustó un modelo de regresión logística para calcular las odds ratios (OR) crudas y ajustadas por sexo, edad y clase social. Resultados El 10,3% (IC95%: 8,6-12,4) de la población adulta española declaró haber usado en alguna ocasión el cigarrillo electrónico (2% usuarios/as actuales, 3,2% usuarios/as en el pasado y 5,1% usuarios/as experimentadores/as). Entre los/las usuarios/as actuales de cigarrillos electrónicos, el 57,2% fumaba también tabaco combustible o convencional, el 28% nunca había fumado y el 14,8% eran ex fumadores/as. La prevalencia de uso del cigarrillo electrónico fue mayor entre la población joven (OR ajustada=23,8; IC95%: 2,5-227,7) y entre las personas fumadoras de tabaco combustible (OR ajustada=10,1; IC95: 5,8-17,5). Conclusiones El uso de cigarrillos electrónicos en España es poco frecuente y predomina en las personas jóvenes y las fumadoras de tabaco. Sin embargo, uno/a de cada cuatro usuarios/as actuales del cigarrillo electrónico nunca habían fumado. Por ello, debería reforzarse la regulación de estos dispositivos para evitar una posible puerta de entrada al uso de productos con nicotina. Objective To describe the prevalence and user profile of electronic cigarettes among Spanish adults and evaluate the potential dual use of these devices with combustible or conventional tobacco in 2014 in Spain. Methods Cross-sectional study of a representative sample of the Spanish adult (16-75 years old) population (n=1,016). A computer-assisted telephone survey was conducted in 2014. The prevalence and 95% confidence intervals (95% CI) for the use of electronic cigarettes stratified by gender, age, tobacco consumption and social status were calculated. The sample was weighted and a logistic regression model adjusted to obtain the crude odds ratios (OR) adjusted by gender, age and social status. Results 10.3% (95% CI: 8.6-12.4) of the Spanish adult population stated being ever users of electronic cigarettes (2% current users, 3.2% past users and 5.1% experimental users). Among current electronic cigarette users, 57.2% also smoked combustible or conventional tobacco, 28% had never smoked and 14.8% were former smokers. The prevalence of electronic cigarette use was higher in the younger population (adjusted OR=23.8; 95% CI: 2.5-227.7) and smokers of combustible tobacco (adjusted OR=10.1; 95% CI: 5.8-17.5). Conclusions T...
      PubDate: 2016-11-02T01:00:38Z
      DOI: 10.1016/j.gaceta.2016.03.010
  • Consumo intensivo de alcohol y cannabis, y prácticas sexuales de riesgo
           en estudiantes universitarios

    • Authors: Lucía Moure-Rodríguez; Sonia Doallo; Pablo Juan-Salvadores; Montserrat Corral; Fernando Cadaveira; Francisco Caamaño-Isorna
      Pages: 438 - 443
      Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6
      Author(s): Lucía Moure-Rodríguez, Sonia Doallo, Pablo Juan-Salvadores, Montserrat Corral, Fernando Cadaveira, Francisco Caamaño-Isorna
      Objetivo Determinar la incidencia de las prácticas sexuales de riesgo entre universitarios y su asociación con el consumo intensivo de alcohol y el consumo de cannabis. Método Se realizó un estudio de cohortes entre 2005 y 2011 en universitarios de la Cohorte Compostela (n=517). El consumo intensivo de alcohol se midió con la tercera pregunta del Alcohol Use Disorders Identification Test (AUDIT). Las prácticas sexuales de riesgo se midieron como sexo bajo la influencia del alcohol (SBA) y sexo sin condón (SSC). Se generaron modelos de regresión logística. Resultados Las incidencias de SBA fueron del 40,9% y 53,0%, y las de SSC del 13,7% y el 25,7%, para mujeres y hombres, respectivamente. El consumo intensivo de alcohol y el consumo de cannabis se han mostrado asociados al SBA tanto en mujeres (odds ratio [OR]=2,08, intervalo de confianza del 95% [IC95%]: 1,03-4,21); OR=2,78, IC95%:1,57-4,92) como en hombres (OR=4,74, IC95%:1,49-15,09; OR=4,37, IC95%:1,17-16,36). El consumo de cannabis en las mujeres también se mostró asociado al SSC (OR=2,96, IC95%:1,52-5,75). Las fracciones atribuibles poblacionales de SBA para el consumo intensivo de alcohol fueron del 24,7% para las mujeres y del 52,9% para los hombres. Conclusiones El consumo intensivo de alcohol y el consumo de cannabis constituyen problemas de salud pública debido a su asociación con una variedad de problemas, incluidas las prácticas sexuales de riesgo. Nuestros resultados permiten sugerir que una importante proporción de las prácticas de sexo no seguro podrían evitarse reduciendo este patrón de consumo de alcohol. Objective To determine the incidence of unsafe sex among university students and its association with heavy episodic drinking (HED) and cannabis use. Method A cohort study was carried out from 2005 to 2011 among university students of the Compostela Cohort (n=517). HED was measured using the third question of the Alcohol Use Disorders Identification Test (AUDIT). Unsafe sex was considered to be sex under the influence of alcohol (SUA) and sex without a condom (SWC). Logistic regression models were created. Results The incidence of SUA was 40.9% for women and 53.0% for men, while the SWC incidence ranged from 13.7% for women to 25.7% for men. HED and cannabis use were associated with SUA in both women (OR=2.08, 95% CI: 1.03-4.21; OR=2.78, 95%CI: 1.57-4.92) and men (OR=4.74 (95%CI: 1.49-15.09; OR=4.37, 95%CI: 1.17- 16.36). Moreover, cannabis use in women was associated with SWC (OR=2.96, 95%CI: 1.52-5.75). The population attributable fractions of SUA for HED were 24.7% and 52.9% for women and men, respectively. Conclusions HED and cannabis use represent a public health problem due to their association with a variety of problems, including engagement in unsafe sex. Our results suggest that a significant proportion of unsafe sex could be avoided by reducing this consum...
      PubDate: 2016-11-02T01:00:38Z
      DOI: 10.1016/j.gaceta.2016.03.007
  • Factores asociados a mala calidad de sueño en población brasilera a
           partir de los 40 años de edad: estudio VIGICARDIO

    • Authors: Maritza Muñoz-Pareja; Mathias Roberto Loch; Hellen Geremias dos Santos; Maira Sayuri Sakay Bortoletto; Alberto Durán González; Selma Maffei de Andrade
      Pages: 444 - 450
      Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6
      Author(s): Maritza Muñoz-Pareja, Mathias Roberto Loch, Hellen Geremias dos Santos, Maira Sayuri Sakay Bortoletto, Alberto Durán González, Selma Maffei de Andrade
      Objetivos Se determinó la prevalencia de mala calidad del sueño en hombres y mujeres ≥40 años del Estudio VIGICARDIO, y se identificaron factores sociodemográficos, de salud, de estilos de vida y de capital social relacionados con una mala calidad del sueño. Métodos Estudio de base poblacional realizado en Cambé, Estado de Paraná, Brasil, en el año 2011, con 1058 individuos no institucionalizados seleccionados aleatoriamente. Se evaluó, mediante regresión logística, la asociación entre la calidad del sueño y factores sociodemográficos, de salud, estilos de vida y capital social en hombres y mujeres. Resultados La prevalencia de mala calidad del sueño fue de un 34% en los hombres y de un 44% en las mujeres. Tener mala o regular percepción de la salud fue un factor asociado a mala calidad del sueño en los hombres (odds ratio [OR] 1,79; intervalo de confianza del 95% [IC95%]: 1,17-2,72) y en las mujeres (OR: 2,43; IC95%: 1,68-3,53). Ser obesa (OR: 1,67; IC95%: 1,13-2,46), tener depresión (OR: 2,09; IC95%: 1,41-3,13) y presentar dificultad para localizarse en el tiempo (OR: 1,95; IC95%: 1,08-3,52) fueron factores asociados en las mujeres. La dificultad para comprender lo que se explica (OR: 2,18; IC95%: 1,16-4,09) y un consumo abusivo de alcohol (OR: 1,85; IC95%: 1,21-2,83) fueron factores asociados en los hombres. Conclusión Son diferentes los factores que intervienen en la calidad del sueño de hombres y mujeres, por lo que deben considerarse a la hora de desarrollar actividades que promuevan su buena calidad, lo que permitiría mejorar la efectividad de las acciones. Objective The prevalence of poor sleep quality in men and women ≥ 40 years old from the VIGICARDIO Study was determined, and sociodemographic, health, lifestyle and social capital factors associated with poor sleep quality were identified. Methods A population-based study conducted in 2011 among 1,058 non-institutionalised individuals randomly selected from Cambé, Paraná State, Brazil. Logistic regression was used to evaluate the association between sleep quality and sociodemographic, health, lifestyle and social capital factors in men and women. Results The prevalence of poor sleep quality was 34% in men and 44% in women. Having bad/regular self-rated health status was a factor associated with poor sleep quality in men (OR: 1.79; 95% CI: 1.17-2.72) and women (OR: 2.43; 95% CI: 1.68-3.53). Being obese (OR: 1.67; 95% CI: 1.13-2.46), having depression (OR: 2.09; 95% CI: 1.41-3.13) and presenting temporal orientation difficulties (OR: 1.95; 95% CI: 1.08-3.52) were associated factors in women. Difficulty to understand what is explained (OR: 2.18; 95% CI: 1.16-4.09) and alcohol abuse (OR: 1.85; 95% CI: 1.21-2.83) were associated factors in men. Conclusion Factors affecting sleep quality are different for men and for women. These factors should be taken into consideration when devising activities that promote good sleep quality, with a view to improving their effectiveness.

      PubDate: 2016-11-02T01:00:38Z
      DOI: 10.1016/j.gaceta.2016.04.011
  • Protocolo de estudio sobre condicionantes de desestabilización física y
           psicosocial en los mayores

    • Authors: Sergio Benabarre Ciria; Mariano Rodríguez Torrente; Javier Olivera Pueyo; Teófilo Lorente Aznar; Soledad Lorés Casanova; Carmelo Pelegrín Valero; José Galindo Ortiz de Landazuri; Juan Valles Noguero
      Pages: 451 - 456
      Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6
      Author(s): Sergio Benabarre Ciria, Mariano Rodríguez Torrente, Javier Olivera Pueyo, Teófilo Lorente Aznar, Soledad Lorés Casanova, Carmelo Pelegrín Valero, José Galindo Ortiz de Landazuri, Juan Valles Noguero
      Objetivo El principal objetivo del estudio es determinar los factores relacionados con la fragilidad y el desequilibrio de la estabilidad psicosocial en los mayores que residen en la comunidad. Métodos Estudio prospectivo multicéntrico sobre una muestra representativa de las personas mayores de 75 años que residen en la comunidad en la provincia de Huesca. Seguimiento a 5 años con evaluaciones periódicas semestrales. Entrevista individual estandarizada realizada por médicos de atención primaria entrenados para evaluar depresión, ansiedad, deterioro cognoscitivo, síntomas psicóticos, sarcopenia, red de apoyo social, dependencia para las actividades básicas e instrumentales de la vida diaria, gravedad física, riesgo de dependencia y calidad de vida. Evaluación a los 2 y 5 años después para cuantificar acontecimientos adversos: institucionalización, dependencia funcional o mortalidad. Se valorarán posibles factores de riesgo: sexo, edad, situación social, situación funcional, situación psíquica y gravedad física. Se diseñarán modelos predictivos y de cuantificación del riesgo individual para definir finalmente las personas mayores con alta fragilidad psicosocial y riesgo de desestabilización. Conclusiones Conociendo los posibles factores de riesgo, sería posible definir al anciano con gran riesgo o mayor fragilidad psicosocial, y aplicarlo a actividades preventivas dirigidas a reducir la fragilidad y los acontecimientos adversos asociados (institucionalización, mortalidad, etc.). Objective The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. Methods Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. Conclusions An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.).

      PubDate: 2016-11-02T01:00:38Z
      DOI: 10.1016/j.gaceta.2016.04.010
  • Hacia una salud pública con orgullo: equidad en la salud en las personas
           lesbianas, gais, bisexuales y trans en España

    • Authors: Christian Carlo Gil-Borrelli; César Velasco; Carlos Iniesta; Paula de Beltrán; Javier Curto; Pello Latasa
      Abstract: Publication date: Available online 28 December 2016
      Source:Gaceta Sanitaria
      Author(s): Christian Carlo Gil-Borrelli, César Velasco, Carlos Iniesta, Paula de Beltrán, Javier Curto, Pello Latasa

      PubDate: 2016-12-28T11:33:17Z
      DOI: 10.1016/j.gaceta.2016.09.013
  • Multivariate Adaptative Regression Splines (MARS), una alternativa para el
           análisis de series de tiempo

    • Authors: Jairo Vanegas; Fabián Vásquez
      Abstract: Publication date: Available online 19 December 2016
      Source:Gaceta Sanitaria
      Author(s): Jairo Vanegas, Fabián Vásquez
      Multivariate Adaptative Regression Splines (MARS) es un método de modelación no paramétrico que extiende el modelo lineal incorporando no linealidades e interacciones de variables. Es una herramienta flexible que automatiza la construcción de modelos de predicción, seleccionando variables relevantes, transformando las variables predictoras, tratando valores perdidos y previniendo sobreajustes mediante un autotest. También permite predecir tomando en cuenta factores estructurales que pudieran tener influencia sobre la variable respuesta, generando modelos hipotéticos. El resultado final serviría para identificar puntos de corte relevantes en series de datos. En el área de la salud es poco utilizado, por lo que se propone como una herramienta más para la evaluación de indicadores relevantes en salud pública. Para efectos demostrativos se utilizaron series de datos de mortalidad de menores de 5 años de Costa Rica en el periodo 1978-2008. Multivariate Adaptive Regression Splines (MARS) is a non-parametric modelling method that extends the linear model, incorporating nonlinearities and interactions between variables. It is a flexible tool that automates the construction of predictive models: selecting relevant variables, transforming the predictor variables, processing missing values and preventing overshooting using a self-test. It is also able to predict, taking into account structural factors that might influence the outcome variable, thereby generating hypothetical models. The end result could identify relevant cut-off points in data series. It is rarely used in health, so it is proposed as a tool for the evaluation of relevant public health indicators. For demonstrative purposes, data series regarding the mortality of children under 5 years of age in Costa Rica were used, comprising the period 1978–2008.

      PubDate: 2016-12-21T11:28:36Z
      DOI: 10.1016/j.gaceta.2016.10.003
  • A favor del lazo rosa y la prevención del cáncer de mama:
           diferentes puntos de vista

    • Authors: Rosa Puigpinós-Riera; Gemma Serral
      Abstract: Publication date: Available online 19 December 2016
      Source:Gaceta Sanitaria
      Author(s): Rosa Puigpinós-Riera, Gemma Serral

      PubDate: 2016-12-21T11:28:36Z
      DOI: 10.1016/j.gaceta.2016.10.002
  • La validez del Conjunto Mínimo Básico de Datos como fuente de
           identificación de las anomalías congénitas en la Comunitat Valenciana

    • Authors: Clara Cavero-Carbonell; Silvia Gimeno-Martos; Óscar Zurriaga; María José Rabanaque-Hernández; Carmen Martos-Jiménez
      Abstract: Publication date: Available online 14 December 2016
      Source:Gaceta Sanitaria
      Author(s): Clara Cavero-Carbonell, Silvia Gimeno-Martos, Óscar Zurriaga, María José Rabanaque-Hernández, Carmen Martos-Jiménez
      Objetivo Evaluar la validez del Conjunto Mínimo Básico de Datos (CMBD) para identificar anomalías congénitas mayores en la Comunitat Valenciana. Métodos Se realizó un estudio epidemiológico retrospectivo. Del CMBD se seleccionaron las altas en menores de un año nacidos en 2007, residentes en la Comunitat Valenciana con código de anomalía congénita (740-759 CIE9-MC) y una muestra aleatoria de menores de un año sin altas con estos códigos. Tras revisar la documentación clínica, se clasificaron como verdaderos positivos y negativos y falsos positivos y negativos. Se calcularon el valor predictivo positivo y negativo y la sensibilidad. Se analizaron la concordancia de los diagnósticos entre el CMBD y la documentación clínica utilizando la prueba kappa. Resultados Se identificaron 2305 altas de 1651 pacientes. En los 544 pacientes de la muestra, 4 tenían alguna anomalía congénita mayor. El valor predictivo positivo fue del 56,4% (intervalo de confianza del 95% [IC95%]: 53,9-58,8) y el negativo fue del 99,3% (IC95%: 98,6-100,0). La sensibilidad del CMBD fue del 68,6% (IC95%: 66,1-71,1). Los códigos más frecuentes en los verdaderos positivos fueron: 745.5 (Comunicación interauricular), 745.4 (Comunicación interventricular) y 747.0 (Ductus arterioso persistente), y en los falsos positivos: 747.0, 745.5 y 752.51 (Criptorquidia). El 25,5% de los diagnósticos con anomalía congénita del CMBD no estaban en la historia clínica. Considerando todos los diagnósticos codificados en el CMBD, la concordancia fue de 0,70 (IC95%: 0,68-0,72). Conclusiones El CMBD es la principal fuente de información para la identificación de casos para el Registro Poblacional de Anomalías Congénitas de la Comunitat Valenciana, pero su principal limitación es el elevado número de casos falsos positivos que detecta. Objective To assess the validity of the Spanish Minimum Basic Data Set (MBDS) for identifying major congenital anomalies in the Valencian Community. Methods A retrospective epidemiological study was carried out. Children under the age of one year, born in 2007 and residing in the Valencian Community with congenital anomalies code 740-759 CIE9-MC, were selected from the MBDS, in addition to a random sample of children under the age of 1 year without these discharge codes. Having reviewed the clinical documentation, the cases were classified as true positives and negatives and false positives and negatives. Positive and negative predictive value and sensitivity were calculated. The kappa test was applied to analyse diagnostic consistency between the MBDS and the clinical documentation. Results A total of 2305 discharges of 1651 patients were identified. 4 out of the 5434 patients sampled had a major congenital abnormality. The positive predictive value was 56.4% (95% confidence interval [95%CI]: 53.9-58.8) and the negative predictive value was 99.3% (95%CI: 98.6-100.0). MBDS sensitivity was 68.6% (95%CI: 66.1-71.1). The most common codes in the true positives were: 745.5 (atrial septal defect), 745.4 (ventricular septal defect) and 747.0 (patent ductus arteriosus) and in the false positives: 747.0, 745.5 and 752.51 (cryptorchidism). 25.5% of diagnoses with congenital anomaly from the MBDS were not in the clinical documentation. Considering all diagnoses coded in the MBDS, the correlation was 0.70 (95%CI: 0.68-0.72)
      PubDate: 2016-12-21T11:28:36Z
      DOI: 10.1016/j.gaceta.2016.09.014
  • Prescripción facultativa y consentimiento informado ante el uso de
           restricciones físicas en centros geriátricos de las Islas Canarias

    • Authors: Gabriel J. Estévez-Guerra; Emilio Fariña-López; Eva Penelo
      Abstract: Publication date: Available online 30 November 2016
      Source:Gaceta Sanitaria
      Author(s): Gabriel J. Estévez-Guerra, Emilio Fariña-López, Eva Penelo
      Objetivo Identificar la frecuencia de cumplimentación del consentimiento informado y la prescripción facultativa en el expediente de personas mayores sometidas a restricción física, y analizar la asociación entre las características de estos usuarios y la ausencia de dichas garantías. Métodos Estudio multicéntrico, descriptivo y transversal realizado mediante observación directa y revisión de expedientes en nueve residencias públicas, con un total de 1058 camas. Resultados Estaban sometidos a restricción física 274 usuarios. El consentimiento no figuraba en el 82,5% de los casos y estaba incompleto en el 13,9%. La prescripción no constaba en el 68,3% y estaba incompleta en el 12,0%. Solo se encontró asociación entre la ausencia de prescripción y la mayor edad de los usuarios (razón de prevalencia: 1,03; p <0,005). Conclusiones La falta de estas garantías contraviene las normas jurídicas. Las características organizativas, el desconocimiento de la ley o el hecho de que los profesionales consideren la contención un procedimiento exento de riesgos, podrían explicar dicha carencia. Objective To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. Methods A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. Results 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients’ advanced age (PR=1.03; p <0.005). Conclusions Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results.

      PubDate: 2016-12-07T11:19:44Z
      DOI: 10.1016/j.gaceta.2016.09.010
  • Desarrollo y estudio piloto de un cuestionario para evaluar la
           satisfacción con la estancia hospitalaria en población infanto-juvenil

    • Authors: Montserrat Gómez de Terreros Guardiola; José Francisco Lozano Oyola; Isabel Avilés Carvajal; Rafael Jesús Martínez Cervantes
      Abstract: Publication date: Available online 30 November 2016
      Source:Gaceta Sanitaria
      Author(s): Montserrat Gómez de Terreros Guardiola, José Francisco Lozano Oyola, Isabel Avilés Carvajal, Rafael Jesús Martínez Cervantes
      Objetivo Elaborar un instrumento para evaluar la satisfacción de niños, niñas y adolescentes con su estancia hospitalaria. Métodos Análisis cualitativo de las dimensiones de la satisfacción hospitalaria a partir de narrativas de menores hospitalizados; validación de contenido mediante juicio de expertos de los ítems generados para las distintas dimensiones de satisfacción; y estudio piloto para valorar el funcionamiento del cuestionario con 84 niños, niñas y adolescentes ingresados en hospitales andaluces. Resultados Tras sucesivas depuraciones se obtuvo un cuestionario breve, cuya aplicación dura entre 5 y 15 minutos. Todos los ítems presentaron correlaciones ítem-total positivas (r>0,18). El cuestionario mostró un índice de consistencia interna de 0,779 (alfa de Cronbach) y contrastes de rangos significativos (U de Mann-Whitney; p<0,001), con tamaños de efectos medianos (η2 >0,151) en tres dimensiones de satisfacción comparadas entre hospitales. Discusión Se ha obtenido un cuestionario breve, de fácil aplicación, fiable en cuanto a su consistencia interna y sensible para detectar diferencias en las dimensiones de satisfacción hospitalaria. Una vez terminada su validación, servirá para evaluar la satisfacción de los menores con su estancia hospitalaria, además de ser un potencial indicador de calidad asistencial. Objective To develop an instrument to assess the satisfaction of children and teenagers with their stay in hospital. Methods A qualitative analysis of hospitalisation satisfaction dimensions based on the feedback of hospitalised children and teenagers; a content validation study by a group of experts of the items generated for the different satisfaction dimensions; and a pilot study to assess the usefulness of the questionnaire with a sample of 84 children and teenagers hospitalised in Andalusia. Results After successive refinements, a short questionnaire was obtained which took between 5 and 15minutes to complete. All items presented positive item-total correlations (r>0.18). The questionnaire showed an internal consistency index of 0.779 (Cronbach's alpha) and significant rank differences (Mann-Whitney U test; p<0.001) with medium size effects (η2 >0.151) in three satisfaction dimensions compared between hospitals. Discussion A short, easy-to-answer questionnaire was developed that is reliable regarding its internal consistency and sensitive to differences in hospital satisfaction dimensions. Once validated, it will be used to assess the satisfaction of children and teenagers with their hospital stay, in addition to being a potential indicator of quality of care.

      PubDate: 2016-12-07T11:19:44Z
      DOI: 10.1016/j.gaceta.2016.09.009
  • Relationship between caries, body mass index and social class in Spanish

    • Authors: Teresa Almerich-Torres; José María Montiel-Company; Carlos Bellot-Arcís; José Manuel Almerich-Silla
      Abstract: Publication date: Available online 23 November 2016
      Source:Gaceta Sanitaria
      Author(s): Teresa Almerich-Torres, José María Montiel-Company, Carlos Bellot-Arcís, José Manuel Almerich-Silla
      Objective To determine the association between caries, body mass index (BMI) and social class in child population of the Valencia region (Spain) at 6, 12 and 15 years, and study. Methods In a cross sectional study of 1326 children aged 6 (n=488), 12 (n=409) and 15 years (n=433) who took part in the 2010 Oral Health Survey of the Valencia region, the ICDAS II criteria were employed for diagnosing and coding all the teeth examined. The quantitative BMI values on a continuous scale were grouped into 3 categories (normal weight, overweight, obese) based on a table adjusted for age and gender. The highest-ranking occupation of the parents was taken to indicate the social class of the child. Results The mean BMI was 17.21 at 6 years, 21.39 at 12 years and 22.38 at 15 years. No significant differences in caries indexes (DMFT or dft) by degree of obesity stratified by social class were found in any of the age groups studied. There was no significant correlation between BMI and DMFT-dft in any of the age groups. Conclusions Obesity is not associated with dental caries in schoolchildren of this population

      PubDate: 2016-11-30T03:13:44Z
      DOI: 10.1016/j.gaceta.2016.09.005
  • Educación popular en salud para la educación en sexualidad en un
           movimiento social rural brasileño

    • Authors: Luiz Fabiano Zanatta
      Abstract: Publication date: Available online 24 November 2016
      Source:Gaceta Sanitaria
      Author(s): Luiz Fabiano Zanatta
      Sustentado en los conceptos de Paulo Freire, el marco metodológico de la Educación Popular en Salud (EPS) para la educación en sexualidad proporciona una mayor adecuación de las acciones, por incluir la participación social y las dimensiones sociales, históricas y culturales de las personas. El objetivo de esta nota es comunicar una experiencia de EPS para la educación en sexualidad, de un proyecto de trabajo comunitario desarrollado junto a estudiantes de 10 a 28 años de edad de las Escuelas Itinerantes y comunidades del Movimiento de los Trabajadores Rurales Sin Tierra (MST) del Estado de Paraná, Brasil. El trabajo aporta elementos para que puedan ser desarrollados proyectos similares, no solo para la educación en sexualidad, sino también para otros problemas de interés en salud pública, ya que evidencia una forma de garantizar la participación social efectiva en las estrategias de promoción para la salud en sus distintas dimensiones. Based on the ideas of Paulo Freire, the methodological framework of Popular Education for Health (PEH) provides a more adaptable method for sex education, including societal participation as well as the social, historical and cultural dimensions of the population. The purpose of this work is to relate one such PEH experience in sex education, which took the form of a community project with a group of students from 10 to 28 years of age attending Itinerant Schools and with groups from the Landless Rural Workers Movement (MST) in the state of Parana, Brazil. This work provides knowledge of certain elements that may help in developing similar projects, not only for sex education but also education for other public health issues. PEH demonstrates a method of ensuring socially effective participation in the different dimensions of health-promotion strategies

      PubDate: 2016-11-30T03:13:44Z
      DOI: 10.1016/j.gaceta.2016.07.021
  • Measuring the impact of alcohol-related disorders on quality of life
           through general population preferences

    • Authors: Eva Rodríguez-Míguez; Jacinto Mosquera Nogueira
      Abstract: Publication date: Available online 25 November 2016
      Source:Gaceta Sanitaria
      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: 2016-11-30T03:13:44Z
      DOI: 10.1016/j.gaceta.2016.07.011
  • 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: Available online 21 November 2016
      Source:Gaceta Sanitaria
      Author(s): Andreu Segura

      PubDate: 2016-11-23T03:09:31Z
  • ¿Existen los instrumentos validos? Un debate necesario

    • Authors: Luis
      Abstract: Publication date: Available online 20 November 2016
      Source:Gaceta Sanitaria
      Author(s): José Luis Ventura-León

      PubDate: 2016-11-23T03:09:31Z
  • 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: Available online 22 November 2016
      Source:Gaceta Sanitaria
      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: 2016-11-23T03:09:31Z
  • Analyzing recurrent events when the history of previous episodes is
           unknown or not taken into account: proceed with caution

    • Authors: Albert Navarro; Georgina Casanovas; Sergio Alvarado; David Moriña
      Abstract: Publication date: Available online 15 November 2016
      Source:Gaceta Sanitaria
      Author(s): Albert Navarro, Georgina Casanovas, Sergio Alvarado, David Moriña
      Objective Researchers in public health are often interested in examining the effect of several exposures on the incidence of a recurrent event. The aim of the present study is to assess how well the common-baseline hazard models perform to estimate the effect of multiple exposures on the hazard of presenting an episode of a recurrent event, in presence of event dependence and when the history of prior-episodes is unknown or is not taken into account. Methods Through a comprehensive simulation study, using specific-baseline hazard models as the reference, we evaluate the performance of common-baseline hazard models by means of several criteria: bias, mean squared error, coverage, confidence intervals mean length and compliance with the assumption of proportional hazards. Results Results indicate that the bias worsen as event dependence increases, leading to a considerable overestimation of the exposure effect; coverage levels and compliance with the proportional hazards assumption are low or extremely low, worsening with increasing event dependence, effects to be estimated, and sample sizes. Conclusions Common-baseline hazard models cannot be recommended when we analyse recurrent events in the presence of event dependence. It is important to have access to the history of prior-episodes per subject, it can permit to obtain better estimations of the effects of the exposures

      PubDate: 2016-11-16T02:39:43Z
      DOI: 10.1016/j.gaceta.2016.09.004
  • El copago de dependencia en España a partir de la reforma estructural
           de 2012

    • Authors: Raúl del Pozo-Rubio; Isabel Pardo-García; Francisco Escribano-Sotos
      Abstract: Publication date: Available online 14 November 2016
      Source:Gaceta Sanitaria
      Author(s): Raúl del Pozo-Rubio, Isabel Pardo-García, Francisco Escribano-Sotos
      Objetivo Estimar el coste de la dependencia y su financiación. En particular, determinar el copago de los usuarios tras la modificación introducida por la Resolución de 13 de julio de 2012, según el grado de dependencia y la comunidad autónoma de residencia. Métodos Se estimó el grado de dependencia a partir de la Encuesta sobre Discapacidades, Autonomía Personal y situaciones de Dependencia de 2008. El coste de la dependencia por grado y comunidad autónoma se calculó a partir de la información del Sistema para la Autonomía y Atención a la Dependencia. El copago se calculó a partir de la renta de las personas dependientes. La valoración monetaria de los servicios y la aportación de los usuarios se hizo de acuerdo a la normativa de 2012 y con indicadores de referencia comunes para todo el territorio nacional. Resultados El coste total estimado en 2012 es de 10.598,8 millones de euros (1,03% del producto interior bruto), y son Andalucía, la Comunidad Valenciana y Cataluña las que mayores cuantías presentan. El porcentaje del copago medio nacional por usuario es del 53,54%, con diferencias por grados y comunidades autónomas, aunque en general los usuarios financian más de la mitad del coste de las prestaciones en todas ellas. Conclusiones El cambio legislativo ha supuesto que el copago sea superior al tercio inicial establecido en la Ley y a los copagos anteriores a 2012, que eran en torno al 20%. Si a ello se añaden las diferencias por comunidades autónomas, sería conveniente reflexionar acerca de la desigual aplicación de la Ley. Objective The objective of this piece of work is to establish the cost of dependency and the cost of financing it. Specifically, we will determine the cost of co-payment for individual users following the modification introduced by the 13th of July 2012 Resolution as well as its allocation by the autonomous regions. Methods The degree and level of dependency was established using the Survey on Disability, Personal Autonomy and Dependency Situations, 2008. The cost of dependency according to degree and level and autonomous regions was established with information from the System for Personal Autonomy and Care of Dependent Persons. The co-payment was established according to applicants’ purchasing power. The rating of these services, and the contribution of individual users were done in agreement with 2012 legislation and with common indicators and benchmarks for the whole national territory. Results The total estimated cost is 10,598.8 million euros (1.03% of GDP), and Andalusia, the Valencian Community and Catalonia are those regions with the greatest costs. The average national co-payment per individual user is 53.54%, with differences due to degrees and levels of disability and autonomous regions, although, generally speaking, all of the users fund more than half of the care they receive. Conclusions This change in legislation has meant that co-payment is higher than the 33% established by this law and that co-payments prior to 2012 were about 20%. If we add to this the differences in autonomous regions, it would be useful to reflect on the uneven application of the law.

      PubDate: 2016-11-16T02:39:43Z
      DOI: 10.1016/j.gaceta.2016.09.003
  • Claves infantiles para prevenir la siniestralidad en el contexto escolar

    • Authors: M. Inés Gabari Gambarte; Raquel Sáenz Mendía
      Abstract: Publication date: Available online 3 November 2016
      Source:Gaceta Sanitaria
      Author(s): M. Inés Gabari Gambarte, Raquel Sáenz Mendía
      Objetivo Conocer la percepción infantil sobre las causas y las estrategias de prevención de los accidentes escolares. Método Muestra de 584 escolares de 8 y 9 años de edad, de Navarra. Se elige un diseño mixto mediante cuestionario con tres ítems de respuesta abierta y uno de valoración sugerida y respuesta múltiple. El análisis se realiza en dos fases: 1) cualitativa de elaboración de categorías y dimensiones de las respuestas de contenido narrativo, y 2) cuantitativa de recodificación de variables para análisis correlacional. Resultados Emergen 22 categorías que conforman tres dimensiones perceptivas: 1) atribución de causalidad (5), 2) identificación de mecanismos de evitación (11) y 3) elaboración de estrategias de afrontamiento (6). La correlación intravariables evidencia diversos grados: por un lado, cifras positivas moderadas (r >0,5) en atribución de causalidad y en identificación de mecanismos de evitación, y por otro, valores de correlación positiva elevados (r >0,7) referidos a elaboración de estrategias de afrontamiento. Discusión La población infantil sabe identificar los accidentes como problema de salud, se cuestiona la multiplicidad de elementos implicados y relaciona el origen y el tipo de los accidentes con mecanismos de prevención y de ayuda. Objective To learn about children's perception of the causes and prevention strategies involved in school accidents. Method The sample included 584 school children aged 8-9 years from Navarra. A mixed design was chosen by questionnaire with three open-response questions and one multiple-choice assessment. Analysis was performed in two phases: 1) qualitative development of categories and dimensions of the responses of narrative content, and 2) quantitative variables for recoding correlational analysis. Results 22 categories emerged, which make up three perceptual dimensions: 1) attribution of causality (5), 2) identification of mechanisms of avoidance (11), and 3) development of coping strategies (6). The correlation intra-variables portray varying degrees: on the one hand, moderate positive numbers (r>0.5) in allocating and identifying causality avoidance mechanisms and, on the other hand, high positive correlation values (r>0.7) referred to developing coping strategies. Discussion Children are able to identify accidents as a health problem. They question the multiplicity of elements involved and relate the origin and kind of accident to prevention and support mechanisms.

      PubDate: 2016-11-09T01:36:27Z
      DOI: 10.1016/j.gaceta.2016.07.007
  • Gaceta Sanitaria a primera vista

    • Abstract: Publication date: November–December 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 6

      PubDate: 2016-11-02T01:00:38Z
  • Power and Glory: applying participatory action research in public health

    • Authors: Frances E. Baum
      Abstract: Publication date: Available online 1 August 2016
      Source:Gaceta Sanitaria
      Author(s): Frances E. Baum

      PubDate: 2016-08-04T08:46:45Z
      DOI: 10.1016/j.gaceta.2016.05.014
  • Responsabilidad por pérdida de oportunidad asistencial en patología
           oncológica maligna en la medicina pública española

    • Authors: Carlos Sardinero-García; Andrés Santiago-Sáez; M. del Carmen Bravo; Bernardo Perea-Pérez; M. Elena Albarrán-Juan; Elena Labajo-González; Julián Benito-León
      Abstract: Publication date: Available online 26 July 2016
      Source:Gaceta Sanitaria
      Author(s): Carlos Sardinero-García, Andrés Santiago-Sáez, M. del Carmen Bravo, Bernardo Perea-Pérez, M. Elena Albarrán-Juan, Elena Labajo-González, Julián Benito-León
      Objetivo La pérdida de oportunidad asistencial se ha introducido con mucha fuerza en las resoluciones judiciales dictadas en los últimos años. Nuestro objetivo fue analizar las sentencias condenatorias por responsabilidad derivada de pérdida de oportunidad asistencial, dictadas por la Jurisdicción Contencioso Administrativa (es decir, en la medicina pública), en las que tanto el origen de la patología a tratar como las secuelas fueron procesos oncológicos. Método Se han analizado las 137 sentencias judiciales, relacionadas con patologías oncológicas, en el ámbito de la Jurisdicción Contencioso Administrativa, que hacían referencia al concepto de pérdida de oportunidad asistencial y que fueron dictadas en España hasta mayo de 2014. Resultados De las 137 sentencias, 119 (86,9%) fueron dictadas por error diagnóstico y 14 (10,2%) por un tratamiento inadecuado. Desde el año 2010 se han producido 100 (73,0%) sentencias, lo que supone más de un 170% de aumento con respecto a las 37 (27,0%) dictadas en los primeros 6 años del estudio (2004 a 2009). La mayoría de los pacientes (68,6%) fallecieron, siendo las de mama y de órganos genitales femeninos (24,1%), así como las digestivas (21,1%), las neoplasias malignas que con más frecuencia originaron la condena. Conclusiones La actividad litigante por pérdida de oportunidad asistencial en patologías oncológicas en la medicina pública española ha aumentado de manera significativa estos últimos años. Las sentencias fueron dictadas fundamentalmente por error diagnóstico o tratamiento inadecuado. Objective The loss of chance in healthcare has been forcibly introduced in the adjudications pronounced in recent years. Our objective was to analyse the verdicts of guilt resulting from the loss of chance ordered by the Contentious-Administrative Court (i.e., in the public healthcare system), in which both the origin of the disease to be treated and the sequelae were oncological processes. Method We analysed 137 cancer-related court judgments from the Contentious-Administrative Court, which referred to the concept of loss of chance, issued in Spain up to May 2014. Results Of the 137 sentences, 119 (86.9%), were pronounced due to diagnostic error and 14 (10.2%) due to inadequate treatment. Since 2010, 100 sentences have been passed (73.0%), representing an increase of more than 170% with respect to the 37 (27.0%) ordered in the first six years of the study (from 2004 to 2009). Most of the patients (68.6%) died, predominantly from breast cancer and gynaecological cancer (24.1%), and gastrointestinal cancers (21.1%). These malignancies were the ones most often involved in the sentences. Conclusions The litigant activity due to loss of chance in oncological processes in the public health care has significantly increased in the last years. The judgments were mainly given because of diagnostic error or inadequate treatment.

      PubDate: 2016-07-30T08:36:15Z
      DOI: 10.1016/j.gaceta.2016.05.007
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