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PUBLIC ADMINISTRATION (185 journals)                 | Last

Showing 1 - 200 of 357 Journals sorted alphabetically
Academy of Management Annals, The     Full-text available via subscription   (Followers: 37)
Accounting and the Public Interest     Full-text available via subscription  
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: 3)
Administrative Theory & Praxis     Full-text available via subscription   (Followers: 3)
African Journal of Governance and Development     Full-text available via subscription   (Followers: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 14)
AQ - Australian Quarterly     Full-text available via subscription   (Followers: 1)
Australian Social Work     Hybrid Journal   (Followers: 7)
BAR. Brazilian Administration Review     Open Access   (Followers: 1)
Cadernos EBAPE.BR     Open Access  
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: 5)
Clinical Social Work Journal     Hybrid Journal   (Followers: 19)
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: 7)
Cuadernos de Administración     Open Access  
Cuadernos de Relaciones Laborales     Open Access  
Der Staat     Full-text available via subscription   (Followers: 11)
Die Verwaltung     Full-text available via subscription   (Followers: 9)
Économie publique/Public economics     Open Access   (Followers: 2)
eJournal of eDemocracy and Open Government     Open Access   (Followers: 6)
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: 4)
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: 2)
European Journal of Social Work     Hybrid Journal   (Followers: 21)
Evaluation     Hybrid Journal   (Followers: 11)
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: 2)
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: 1)
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Governance     Hybrid Journal   (Followers: 53)
Government and Opposition     Full-text available via subscription   (Followers: 16)
Government Information Quarterly     Hybrid Journal   (Followers: 18)
Government News     Full-text available via subscription   (Followers: 2)
Growth and Change     Hybrid Journal   (Followers: 5)
Headmark     Full-text available via subscription   (Followers: 1)
HR Highway     Full-text available via subscription   (Followers: 1)
Human Resource Development Quarterly     Hybrid Journal   (Followers: 13)
Human Service Organizations Management, Leadership and Governance     Hybrid Journal   (Followers: 22)
Ids Working Papers     Hybrid Journal   (Followers: 2)
IMIESA     Full-text available via subscription  
In Vestigium Ire     Open Access  
Indonesian Journal of Community Engagement     Open Access  
International Affairs and Global Strategy     Open Access   (Followers: 7)
International Journal of Electronic Government Research     Full-text available via subscription   (Followers: 2)
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: 5)
International Journal of Public Administration     Hybrid Journal   (Followers: 13)
International Journal of Public Sector Performance Management     Hybrid Journal   (Followers: 7)
International NGO Journal     Open Access   (Followers: 2)
International Review of Public Administration     Hybrid Journal   (Followers: 4)
International Tax and Public Finance     Hybrid Journal   (Followers: 5)
Journal of Asian Public Policy     Hybrid Journal   (Followers: 1)
Journal of Community Practice     Hybrid Journal   (Followers: 7)
Journal of Comparative Policy Analysis : Research and Practice     Hybrid Journal   (Followers: 8)
Journal of Developing Areas     Full-text available via subscription   (Followers: 5)
Journal of Development and Administrative Studies     Open Access  
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: 36)
Journal of Higher Education Outreach and Engagement     Open Access   (Followers: 10)
Journal of Management & Organization     Full-text available via subscription   (Followers: 370)
Journal of Nursing Management     Hybrid Journal   (Followers: 19)
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: 19)
Journal of Public Administration and Governance     Open Access   (Followers: 16)
Journal of Public Administration and Policy Research     Open Access  
Journal of Public Administration Research and Theory     Hybrid Journal   (Followers: 21)
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: 4)
Jurnal Ilmiah Administrasi Publik     Open Access  
Just Policy: A Journal of Australian Social Policy     Full-text available via subscription   (Followers: 7)
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 Bulletin     Full-text available via subscription   (Followers: 1)
Local Government Studies     Hybrid Journal   (Followers: 6)
Macramè. Trame e ritagli dell’urbanistica     Open Access  
Middle East Law and Governance     Hybrid Journal   (Followers: 6)
National Civic Review     Hybrid Journal  
National Journal     Full-text available via subscription   (Followers: 3)
NISPAcee Journal of Public Administration and Policy     Open Access   (Followers: 3)
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  
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: 3)
PLOS Currents : Outbreaks     Open Access   (Followers: 2)
Policy & Internet     Hybrid Journal   (Followers: 10)
Policy Sciences     Hybrid Journal   (Followers: 6)
Policy Studies     Hybrid Journal   (Followers: 9)
Policy Studies Journal     Hybrid Journal   (Followers: 5)
Politeia     Full-text available via subscription   (Followers: 1)
Politics and Governance     Open Access   (Followers: 3)
Politiques et Management Public     Open Access  
Poverty & Public Policy     Hybrid Journal   (Followers: 12)
Prawo Budżetowe Państwa i Samorządu     Open Access  
Prison Journal     Hybrid Journal   (Followers: 13)
Public Administration     Hybrid Journal   (Followers: 25)
Public Administration & Development     Hybrid Journal   (Followers: 13)
Public Administration Review     Hybrid Journal   (Followers: 26)
Public Choice     Hybrid Journal   (Followers: 16)
Public Infrastructure Bulletin     Open Access  
Public Organization Review     Hybrid Journal   (Followers: 3)
Public Personnel Management     Hybrid Journal   (Followers: 7)
Public Policy     Full-text available via subscription   (Followers: 13)
Public Policy and Administration     Hybrid Journal   (Followers: 15)
Public Policy And Administration     Open Access   (Followers: 9)
Public Policy and Administration Research     Open Access   (Followers: 12)
Public Policy Research     Hybrid Journal   (Followers: 8)
Public Sector     Full-text available via subscription   (Followers: 4)
Public Works Management & Policy     Hybrid Journal   (Followers: 7)
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: 1)
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 IMED     Open Access  
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 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: 16)
Social Service Review     Full-text available via subscription   (Followers: 8)
Social Work Education: The International Journal     Hybrid Journal   (Followers: 9)
SourceOCDE Gouvernance     Full-text available via subscription  
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: 7)
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: 2)
The Philanthropist     Open Access   (Followers: 1)
The Police Journal     Full-text available via subscription   (Followers: 432)
The Review of International Organizations     Hybrid Journal   (Followers: 10)
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: 0.434]   [H-I: 27]   [3 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0213-9111
   Published by Elsevier Homepage  [2970 journals]
  • Acción COST Femicide Across Europe, un espacio de cooperación
           trasnacional para el estudio y el abordaje del feminicidio en Europa

    • Abstract: Publication date: Available online 16 June 2016
      Source:Gaceta Sanitaria
      Author(s): Belén Sanz-Barbero, Laura Otero-García, Santiago Boira, Chaime Marcuello, Carmen Vives Cases
      El feminicidio o asesinato de mujeres por razones de género es ya un reconocido problema de salud pública, además de una grave vulneración de los derechos humanos. Todavía se desconoce con exactitud su magnitud en el mundo, dadas las dificultades metodológicas para diferenciar estos asesinatos de otros homicidios de mujeres. El Programa de la Unión Europea «Redes de Cooperación Europea en Ciencia y Tecnología» puso en marcha en 2013 la Acción COST Femicide across Europe, abriendo un marco europeo óptimo para la cooperación transnacional entre personas expertas que aborden grandes retos sociales y de salud pública como el feminicidio. En esta nota de campo se describen sus principales objetivos, los grupos de expertos y expertas que lo conforman, y los resultados obtenidos a medio plazo con dicha experiencia. Femicide or the murder of women because of their gender is a recognised public health problem as well as a serious violation of human rights. Its magnitude worldwide is still unknown, given the methodological difficulties to differentiate these murders from other female homicides. The European Union programme entitled «European Cooperation in Science and Technology» (COST) launched the «Femicide across Europe» COST Action in 2013, establishing an optimal European framework for transnational cooperation among experts addressing great social and public health challenges such as femicide. This field note describes the main objectives, the participating groups of experts and the mid-term results of this experience.

      PubDate: 2016-06-18T18:42:29Z
  • Incentives and intrinsic motivation in healthcare

    • Abstract: Publication date: Available online 16 June 2016
      Source:Gaceta Sanitaria
      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: 2016-06-18T18:42:29Z
  • Deconstructing myths, building alliances: a networking model to enhance
           tobacco control in hospital mental health settings

    • Abstract: Publication date: Available online 17 June 2016
      Source:Gaceta Sanitaria
      Author(s): Montse Ballbè, Antoni Gual, Gemma Nieva, Esteve Saltó, Esteve Fernández
      Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.

      PubDate: 2016-06-18T18:42:29Z
  • Píldora postcoital: un debate científico necesario

    • Abstract: Publication date: Available online 18 June 2016
      Source:Gaceta Sanitaria
      Author(s): Emilio Jesús Alegre-del Rey, Silvia Fénix-Caballero, Jorge Díaz-Navarro, Esteban Rodríguez-Martín

      PubDate: 2016-06-18T18:42:29Z
  • Metodología para un proceso apreciativo, dinámico y
           colaborativo: III Plan de Salud de Canarias

    • Abstract: Publication date: Available online 17 June 2016
      Source:Gaceta Sanitaria
      Author(s): José Joaquín O'Shanahan Juan, Miguel Ángel Hernández Rodríguez, Laura Del Otero Sanz, José Andrés Henríquez Suárez, Vinita Mahtani Chugani
      La necesidad de nuevos enfoques de planificación estratégica con la incorporación de la visión de profesionales y ciudadanos ha orientado un nuevo modelo para el III Plan de Salud de Canarias (IIIPSC). Se propone un proceso participativo con soporte de metodología cualitativa en dos etapas: 1) fase local: estudio cuantitativo-cualitativo a través de una acción formativa y de investigación-acción-participación, y 2) fase insular: conferencias de salud, con debate sobre resultados en sesiones presenciales en cada área de salud (isla) y propuestas de acción. El proceso define una priorización de problemas y un plan de acción específico para cada isla mediante operaciones consideradas viables, agrupadas por temas y ponderadas según el potencial impacto sobre los problemas priorizados. Este proceso de interacción puede contribuir a orientar los cambios de modelo de planificación y la toma de decisiones en política sanitaria, y se encuentra recogido en el Proyecto del IIIPSC para su tramitación parlamentaria. The need for new approaches to strategic planning by incorporating the perspectives of professionals and inhabitants has led to a new model for the 3rd Canary Islands (Spain) Health Plan (IIIPSC). A dual-phase participatory process using qualitative techniques is proposed: 1) local phase: a quantitative and qualitative study based on training and a research-action-participation initiative; and 2) insular phase: health conferences with face-to-face discussion of results in each health area (island) and proposals for action. The process prioritises problems and establishes a specific action plan for each island through initiatives that are considered to be viable, grouped by themes and weighted according to the potential impact on priority problems. This process of interaction may help to guide planning model changes and health policy decision-making, and was included in the IIIPSC Project for its parliamentary procedure.

      PubDate: 2016-06-18T18:42:29Z
  • Validez de medidas antropométricas y percepciones ponderales
           declaradas por familiares de menores de 4 años

    • Abstract: Publication date: Available online 3 June 2016
      Source:Gaceta Sanitaria
      Author(s): Begoña Patiño-Villena, María Dolores Chirlaque, Diego Salmerón, Eduardo González, Carmen Navarro
      Objetivo Evaluar la validez del peso y la talla declarados por las familias y las percepciones del peso de sus hijos/as para valorar la prevalencia de exceso de peso en menores de 4 años. Métodos Estudio transversal mediante cuestionario autocumplimentado por familias de niñas/os de 3-45 meses de edad registrando peso y talla: 1) valores medidos en revisión pediátrica (valores de referencia); 2) valores declarados obtenidos en el domicilio; y 3) valores percibidos subjetivamente. Se usaron estándares de la Organización Mundial de la Salud. Resultados La talla declarada se subestimó, resultando el peso/talla y el índice de masa corporal/edad declarados sobrevalorados. La prevalencia de exceso de peso medido (18,6%) y declarado (26,5%) presentó una concordancia moderada (Kappa: 0,47 [0,34–0,60]), con una sensibilidad del 70% y una especificidad del 84%. La percepción subjetiva (11,2%) mostró una sensibilidad del 30% y una especificidad del 93%. Conclusiones La información declarada presenta escasa validez para estudios poblacionales, infraestima la talla y no reconoce adecuadamente el exceso de peso por distorsión de la percepción subjetiva. Resulta necesario validar cuestionarios y sensibilizar a las familias. Objective To assess the validity of weight and height measurements reported by parents and the perception of their children's weight status in order to assess the prevalence of overweight children under 4 years old. Methods Cross-sectional study. Anthropometric data was collected by self-report questionnaires completed by parents of children 3-45 months old: 1) information from paediatric check-ups (gold standard); 2) information reported from the home environment; and 3) data from individual perceptions. WHO standards were used. Results Reported height was underestimated, thus reported weight/height and BMI/age were overestimated. Overweight prevalence according to paediatric check-ups was 18.6%, compared to 26.5% reported prevalence, showing a moderate concordance (Kappa: 0.47 [0.34-0.60]), 70% sensitivity and 84% specificity. Subjective perception was 11.2%, representing 30% sensitivity and 93% specificity. Conclusions The reported information has little validity for population-based studies, as height is underestimated and overweight status is not correctly perceived due to distortion of individual perception. Questionnaires must be validated and awareness raised among families.

      PubDate: 2016-06-16T18:12:12Z
  • ¿Qué se busca sobre el aborto en Internet? Una
           evaluación con Google Trends en Perú

    • Abstract: Publication date: Available online 1 June 2016
      Source:Gaceta Sanitaria
      Author(s): Paul Jesús Tejada-Llacsa

      PubDate: 2016-06-16T18:12:12Z
  • Impacto del Real Decreto de la Troncalidad en la formación en
           medicina preventiva y salud pública y en otras especialidades del
           tronco común médico

    • Abstract: Publication date: Available online 3 June 2016
      Source:Gaceta Sanitaria
      Author(s): Pello Latasa, Christian Gil-Borrelli, José Antonio Aguilera, Laura Reques, Saul Barreales, Elena Ojeda, Guadalupe Alemán, Carlos Iniesta, Pedro Gullón
      Objetivo El Real Decreto de Troncalidad (RDT) plantea modificar la formación sanitaria especializada, estableciendo 24 meses de formación troncal común. El objetivo de este estudio es valorar su potencial impacto en la formación especializada de medicina preventiva y salud pública (MPSP) y en otras especialidades del tronco común médico (TCM). Métodos Se analizaron los programas de las 21 especialidades del TCM, recogiendo los periodos de rotación recomendados por cada especialidad y consensuando la información entre tres observadores. El impacto formativo se calculó como el porcentaje de meses que cada especialidad debería modificar para adaptarse al periodo común. Resultados MPSP (100%, 24 meses) es la especialidad en la cual el RDT tendrá más impacto. Medicina intensiva (0%, 0 meses) y oncología médica (17%, 4 meses) son las especialidades menos afectadas. Conclusiones El RDT va a afectar de manera diferente a las especialidades del TCM. El RDT supondrá un replanteamiento completo de sus actividades y de las competencias de los profesionales de MPSP. Objective The purpose of the Core Training Law (CTL) is to amend specialised medical training to include 24 months of common training. The aim of this study is to assess its potential impact on the Preventive Medicine and Public Health (PM&PH) training programme and other medical specialties. Method The programmes of the 21 common medical specialties were analysed and the recommended training periods for each specialty collected, before the information was agreed upon by three observers. The training impact was calculated as the percentage of months that should be amended per specialty to adapt to the common training schedule. Results The Preventive Medicine and Public Health training programme is the specialty most affected by the Core Training Law (100%, 24 months). Intensive medicine (0%, 0 months) and medical oncology (17%, 4 months) is the least affected. Conclusions The CTL affects the common medical specialties in different ways and requires a complete reorganisation of the activities and competencies of PM&PH professionals.

      PubDate: 2016-06-16T18:12:12Z
  • Motivaciones y experiencias emocionales del primer equipo
           multidisciplinario hospitalario entrenado para atender casos de Ébola
           en Andalucía (2014-2016)

    • Abstract: Publication date: Available online 3 June 2016
      Source:Gaceta Sanitaria
      Author(s): Rosa Casado-Mejía, M Teresa Brea-Ruiz, Dolores Torres-Enamorado, M Jesús Albar-Marín, Alicia Botello-Hermosa, María Santos-Casado, Irene Casado-Rojas
      Objetivo El Hospital Universitario Virgen del Rocío (HUVR) de Sevilla fue elegido centro referente andaluz para atender posibles casos de contagio de Ébola. Tras la alerta sanitaria (OMS, 2014) se conformó un equipo de profesionales voluntarios sanitarios/as y no sanitarios/as, que recibió entrenamiento y atendió un posible caso. Se plantea como objetivo comprender sus motivaciones y experiencias emocionales, e identificar los elementos que facilitan y dificultan su funcionamiento. Método Estudio cualitativo, interpretativo y fenomenológico. Unidad de observación: equipo de profesionales del HUVR entrenado para atender casos de Ébola. Unidades de análisis: trabajo en equipo, motivaciones, emociones. Se realizan tres entrevistas a informantes clave y tres grupos de discusión; participan 23 profesionales de 60 que integran el equipo (2014-2016). Se analizan con QSRNUDISTVivo10 (análisis de contenido) las categorías: motivaciones, emociones, elementos influyentes en el funcionamiento. Validez: se triangularon fuentes de datos, técnicas, perspectivas disciplinarias y se expusieron los resultados al equipo de profesionales, que mostró su acuerdo. Resultados Perciben interés formativo, responsabilidad profesional, autoestima profesional, atracción por el riesgo o lealtad al líder como motivaciones para ofrecerse voluntariamente. Expresan su evolución emocional, del miedo y estrés original al autocontrol de la presión, tranquilidad y confianza, a través de la formación y cohesión del equipo, elementos esenciales para su funcionamiento. La familia, el servicio de origen, los recursos, los medios de comunicación y la gestión de las emociones influyen, facilitando o entorpeciendo el éxito del equipo. Conclusión Conocer los factores que les motivan e influyen puede servir para orientar la gestión de equipos multidisciplinarios eficaces y satisfechos en casos de alertas sanitarias. Objective The Hospital Universitario Virgen del Rocío (HUVR) of Seville was chosen as the reference Andalusian site to treat possible cases of Ebola. After the health alert (WHO, 2014), a voluntary group of healthcare and non-healthcare professionals was set up, which, after being trained, treated a possible case. In this light, the aim is to understand the motivations and emotional experiences of this group and to identify the facilitators of and obstacles to its operation. Method Qualitative, interpretative and phenomenological study. Observation unit: professional team of the HUVR trained to treat Ebola cases. Analysis units: teamwork, motivations and emotions. Three interviews with key informants were conducted, as well as three discussion groups involving 23 of the 60 team members (2014–2016). A content analysis of the motivations, emotions and elements affecting the team's operation was conducted with QSRNUDISTVivo10. Validity: data sources, techniques and disciplinary perspectives were triangulated. The results were presented to the team, which duly agreed with the findings. Results Training, professional responsibility, professional self-esteem, risk appetite or loyalty to the leader stood out as motivations to voluntarily join the team. Emotional experiences evolved from fear and stress to self-pressure control, while essential elements for the team's operation were found to be calmness and confidence based on training and teamwork. Family, source department, resources, communication media and emotional management were facilitators of or obstacles to the team's success.
      PubDate: 2016-06-16T18:12:12Z
  • Trans-fatty acid content of food products in Spain in 2015

    • Abstract: Publication date: Available online 4 June 2016
      Source:Gaceta Sanitaria
      Author(s): Napoleón Pérez-Farinós, María Ángeles Dal Re Saavedra, Carmen Villar Villalba, Teresa Robledo de Dios
      Objective To ascertain the content of trans-fatty acids (TFA) in food products in Spain in 2015 and assess trends in TFA content since 2010. Methods We analysed the fat content of 277 food products purchased in Spanish supermarkets in 2015 and calculated both the total fat and TFA content and the proportion of TFA to total fats. The results obtained in 2015 were compared to those yielded by a similar study in 2010. Results In 2015, the majority of food products studied had a TFA content of less than 0.2g/100g product, and a TFA/total fat ratio of less than 2%. No significant increases were found compared to 2010. Food groups with a higher TFA content were dairy products of possible natural origin. Conclusions TFA content in Spain is low and has significantly fallen since 2010.

      PubDate: 2016-06-16T18:12:12Z
  • Influencia de la duración de la estancia hospitalaria sobre la
           mortalidad tras el alta en pacientes mayores con patología
           médica aguda

    • Abstract: Publication date: Available online 4 June 2016
      Source:Gaceta Sanitaria
      Author(s): Patricia López Pardo, Alberto Socorro García, Juan José Baztán Cortés
      Objetivo Analizar la influencia de la estancia hospitalaria sobre la mortalidad a los 6 meses del alta en ancianos. Métodos Estudio longitudinal observacional en pacientes supervivientes al alta tras un ingreso hospitalario. Se realizó un análisis de regresión logística binaria para estudiar factores relacionados con la estancia prolongada (>12 días). Se estudió la relación entre la mortalidad a los 6 meses y los cuartiles de estancia mediante un análisis de regresión de Cox. Resultados Se estudiaron 1180 pacientes, con una edad media de 86,6 años (desviación estándar: 6,9). La mediana de estancia fue de 8 días (rango intercuartílico: 5-12). La mortalidad a los 6 meses fue del 26,1%. Tras ajustar por edad, sexo, diagnóstico principal, comorbilidad, albúmina al ingreso, deterioro funcional al ingreso y situación funcional y mental al alta, la estancia por encima de la mediana se relacionó con la mortalidad a los 6 meses: para 9-12 días, hazard ratio (HR) de 1,79 e intervalo de confianza del 95% (IC95%) de 1,01-3,14; para más de 12 días, HR de 2,04 e IC95% de 1,19-3,53. Conclusiones La estancia hospitalaria prolongada es un factor de riesgo independiente de mortalidad a los 6 meses tras la hospitalización. Objective To analyse whether hospital length of stay is associated with mortality at six months after discharge in the elderly. Methods An observational longitudinal study of patients surviving at hospital discharge. A binary logistic regression analysis was performed to study factors related to extended stay (> 12 days). The relationship between mortality at 6 months and length-of-stay quartiles was studied using a Cox regression analysis. Results 1180 patients were studied with a mean age of 86.6 years (standard deviation: 6.9). The median length of stay was 8 days (interquartile range: 5-12). Six-month mortality was 26.1%. After adjusting for age, gender, main diagnosis, comorbidity, albumin at admission, functional deterioration at admission and functional and mental status at discharge, hospital stay above the median was associated with mortality at 6 months: 9-12 days, HR=1.79, 95% CI: 1.01-3.14; and > 12 days, HR=2.04, 95% CI: 1.19-3.53. Conclusions Prolonged hospital stay is an independent risk factor for mortality at 6 months after discharge.

      PubDate: 2016-06-16T18:12:12Z
  • Alcohol consumption and lung cancer risk in never smokers

    • Abstract: Publication date: Available online 5 June 2016
      Source:Gaceta Sanitaria
      Author(s): José Antonio García-Lavandeira, Alberto Ruano-Ravina, Juan Miguel Barros-Dios
      Objective The main objective of this study is to analyse the role of alcohol consumption on lung cancer risk in people who have never smoked. Methods We conducted a systematic review of the scientific literature following the PRISMA statement. We searched Medline, EMBASE and CINAHL using different combinations of MeSH terms and free text. We included cohort studies, pooled cohort studies and case-control studies comprising at least 25 anatomopathologically-confirmed diagnoses of lung cancer cases, a sample size larger than 100 individuals and more than five years of follow-up for cohort studies. We excluded studies that did not specifically report results for never smokers. We developed a quality score to assess the quality of the included papers and we ultimately included 14 investigations with a heterogeneous design and methodology. Results Results for alcohol consumption and lung cancer risk in never smokers are inconclusive; however, several studies showed a dose-response pattern for total alcohol consumption and for spirits. Heterogeneous results were found for wine and beer. Conclusion No clear effect is observed for alcohol consumption. Due to the limited evidence, no conclusion can be drawn for beer or wine consumption. There is little research available on the effect of alcohol on lung cancer risk for people who have never smoked, and more studies are urgently needed on this topic.

      PubDate: 2016-06-16T18:12:12Z
  • Promoting social capital in an ageing society: a win-win proposition?

    • Abstract: Publication date: Available online 7 June 2016
      Source:Gaceta Sanitaria
      Author(s): Laura Coll-Planas

      PubDate: 2016-06-16T18:12:12Z
  • Tiempos de equidad de género: descripción de las desigualdades
           entre comunidades autónomas, España 2006-2014

    • Abstract: Publication date: Available online 1 June 2016
      Source:Gaceta Sanitaria
      Author(s): José Fernández-Sáez, María Teresa Ruiz-Cantero, Marta Guijarro-Garvi, Carmen Rodenas-Calatayud, Mónica Martí-Sempere, María Dolores Jiménez-Alegre
      Objetivo La equidad de género es un determinante estructural de las desigualdades en salud. Por ello, se pretende visibilizar su evolución en las comunidades autónomas (CC.AA.) desde 2006, previamente a la promulgación de la Ley de Igualdad (2007) y la crisis económica (2008), hasta 2014. Método Estudio ecológico sobre la equidad de género en las 17 CC.AA. en 2006-2011-2014. Cálculo de: 1) índice de equidad de género modificado (IEGM) de las CC.AA. (0=equidad, ±1=inequidad); 2) convergencia interregional y temporal en equidad de género. Resultados El IEGM de las CC.AA.2014 toma valores negativos próximos a 0 (inequidad desfavorable a las mujeres). No hay convergencia interregional en la equidad de género, pues aumenta la dispersión (2006: 0,1503; 2011: 0,2280; 2014: 0,4964). Tampoco existe convergencia temporal, al no evolucionar mejor las CC.AA. menos equitativas. La brecha de género en actividad económica sigue desfavorable a las mujeres. En 2006-2011 disminuye en todas las CC.AA., y en 2014 aumenta en seis CCAA. La brecha de género en educación tiene valores positivos próximos a 0 (desfavorable a los hombres) en 2006-2011-2014, y en empoderamiento es desfavorable a las mujeres, siendo la dimensión que más pesa en la equidad de género. Se mantiene la dispersión entre CC.AA. en 2006-2014 en actividad económica y educación, y aumenta en empoderamiento. Conclusiones El contexto de equidad de género alcanzado en las CC.AA. españolas en 2006 se ha perdido durante la crisis económica, al aumentar la desigualdad en la equidad de género entre CC.AA. en 2014. La inequidad de género sigue siendo desfavorable a las mujeres. Objective Gender equity (GE) is a structural determinant of health inequalities. In this light, our objective is to show the evolution of gender equity in the Spanish autonomous communities since 2006, prior to the enactment of the Equality Act (2007) and the economic crisis (2008), until 2014. Method Ecological study of gender equity in the 17 Spanish autonomous communities from 2006–2011–2014. We have calculated: 1) modified gender equity index (MGEI) for the autonomous communities (0=equity, ±1=inequity); 2) interregional and temporal convergences in gender equity. Results The MGEI in the autonomous communities in 2014 has negative values close to 0 (inequity towards women). There is no interregional convergence due to the dispersion increase (2006: 0.1503; 2011: 0.2280; 2014: 0.4964), and no temporal convergence due to the lack of progress of the autonomous communities with poor gender equity. The gender gap in economic activity continues to be unfavourable to women, decreasing in all communities between 2006 and 2011 but increasing in six communities in 2014. The gender gap in education from 2006–2011–2014 has positive values close to 0 (unfavourable to men), while the gender gap in empowerment is unfavourable to women, representing the most significant gender equity disparity. Inter-community dispersion of economic activity and education did not change between 2006 and 2014, while inter-community dispersion of empowerment increased.
      PubDate: 2016-06-16T18:12:12Z
  • Health-related quality of life in young people at risk of exclusion in
           Melilla (Spain)

    • Abstract: Publication date: Available online 8 June 2016
      Source:Gaceta Sanitaria
      Author(s): Daniel Castrillejo, Carlos Muñoz-Bravo, Antonio García-Rodríguez, José Ruiz-Olivares, Mario Gutiérrez-Bedmar

      PubDate: 2016-06-16T18:12:12Z
  • Factores asociados a mala calidad de sueño en población
           brasilera a partir de los 40 años de edad: Estudio VIGICARDIO

    • Abstract: Publication date: Available online 8 June 2016
      Source:Gaceta Sanitaria
      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: 2016-06-16T18:12:12Z
  • Medida de la eficiencia de la atención primaria en Barcelona
           incorporando indicadores de calidad

    • Abstract: Publication date: Available online 11 June 2016
      Source:Gaceta Sanitaria
      Author(s): José Romano, Álvaro Choi
      Objetivo Demostrar el impacto que tiene la consideración de indicadores cualitativos en la evaluación de la eficiencia técnica de los equipos de atención primaria (EAP). La crisis económica que se inició en 2008ha llevado a procesos de reasignación de recursos basados en indicadores cuantitativos, dejando los cualitativos en un segundo plano. Métodos El estudio aplica técnicas de análisis envolvente de datos (AED) a 58 EAP pertenecientes a tres servicios de atención primaria (SAP) de la provincia de Barcelona. Los datos combinan información pública de la Generalitat de Catalunya con los proporcionados (previa solicitud) por el Observatorio del Sistema de Salud de Cataluña. El análisis compara los resultados de tres modelos, permitiendo esta aproximación identificar cambios en la eficiencia de los EAP en función de la (no) consideración de indicadores de calidad asistencial. Resultados Los modelos que emplean solamente indicadores de cantidad de inputs y outputs identifican como eficientes apenas un 16% de los EAP. La incorporación de variables que aproximan la calidad asistencial aumenta dicha proporción hasta un 58,6%. No se observan diferencias significativas en la eficiencia de los EAP en función del modelo de gestión (público o privado), el nivel territorial (SAP/modelo organizativo) ni el ámbito territorial (rural o urbano). Conclusiones Los resultados parecen indicar la conveniencia de incorporar la calidad asistencial como uno de los outputs relevantes a la hora de plantear criterios de racionalización de los servicios en asistencia primaria de salud. Su (no) incorporación se encuentra vinculada a diversas concepciones de la atención primaria de salud. Objective To demonstrate the impact of the incorporation of quality indicators in assessing the technical efficiency of primary healthcare teams. The processes through which primary healthcare resources have been allocated since the onset of the financial crisis in 2008 have focussed on quantitative rather than qualitative indicators. Methods This study applies data envelopment analysis (DEA) techniques to 58 primary healthcare teams from three different primary healthcare services from the province of Barcelona (Spain). We combine publicly available information from the regional government of Catalonia with data requested from the Catalan Health System Observatory. The analysis compares the results of three models, thereby allowing shifts in the efficiency of primary healthcare teams to be identified in terms of the (lack of) consideration for healthcare quality indicators. Results Only 16% of the primary healthcare teams were found to be efficient according to the baseline models, which only incorporated input and output quantity indicators. However, once proxies for healthcare quality are included in the analysis, this percentage increases to 58.6%. No meaningful differences in primary healthcare team efficiency were found between public and privately owned centres, between regional primary care services and organisational models, or between rural and urban teams. Conclusions The results suggest the need to incorporate healthcare quality indicators as outputs when considering criteria for the streamlining of primary healthcare services. Failure to incorporate quality indicators is associated with various primary healthcare conc...
      PubDate: 2016-06-16T18:12:12Z
  • Social security status and mortality in Belgian and Spanish male workers

    • Abstract: Publication date: Available online 3 June 2016
      Source:Gaceta Sanitaria
      Author(s): Xavier Duran, Christophe Vanroelen, Patrick Deboosere, Fernando G. Benavides
      Objective To assess differences in mortality rates between social security statuses in two independent samples of Belgian and Spanish male workers. Methods Study of two retrospective cohorts (Belgium, n=23,607; Spain, n=44,385) of 50–60 year old male employees with 4 years of follow-up. Mortality rate ratios (MRR) were estimated using Poisson regression models. Results Mortality for subjects with permanent disability was higher than for the employed, for both Belgium [MRR=4.56 (95% CI: 2.88–7.21)] and Spain [MRR=7.15 (95% CI: 5.37–9.51)]. For the unemployed/early retirees, mortality was higher in Spain [MRR=1.64 (95% CI: 1.24–2.17)] than in Belgium [MRR=0.88 (95% CI: 0.46–1.71)]. Conclusion MRR differences between Belgium and Spain for unemployed workers could be partly explained because of differences between the two social security systems. Future studies should further explore mortality differences between countries with different social security systems.

      PubDate: 2016-06-16T18:12:12Z
  • Análisis de fiabilidad y validez de tres cuestionarios de autoinforme
           para valorar la actividad física realizada por adolescentes

    • Abstract: Publication date: Available online 16 June 2016
      Source:Gaceta Sanitaria
      Author(s): José María Cancela Carral, Joaquín Lago Ballesteros, Carlos Ayán Pérez, María Belén Mosquera Morono
      Objetivo Analizar la fiabilidad y la validez de los cuestionarios Weekly Activity Checklist (WAC), One Week Recall (OWR) y Godin-Shephard Leisure Time Exercise Questionnaire (GLTEQ) en población adolescente. Método Setenta y ocho adolescentes portaron un podómetro durante una semana, completaron los cuestionarios al término de la misma y realizaron una prueba de estimación de consumo máximo de oxígeno (VO2max). Se realizó un análisis factorial para determinar la fiabilidad de los cuestionarios. Su validez convergente se obtuvo mediante la comparación entre los resultados obtenidos en el cuestionario, la actividad física cuantificada por el podómetro y el VO2max reportado. Resultados Se encontró una consistencia interna débil para los cuestionarios WAC (α=0,59-0,78), OWR (α=0,53-0,73) y GLTEQ (α=0,60). Se encontraron correlaciones estadísticamente significativas al comparar los valores obtenidos por el podómetro y los cuestionarios, moderadas para el WAC (r=0,69; p <0,01) y el OWR (r=0,42; p <0,01), y baja para el GLTEQ (r=0,36; p=0,01). El VO2max estimado mostró una baja asociación con los resultados del WAC (r=0,30; p <0,05) y del OWR (r=0,29; p <0,05). Al clasificar a los participantes como activos o inactivos, la concordancia con el podómetro fue moderada para el WAC (k=0,46) y el OWR (r=0,44), y leve para el GLTEQ (r=0,20). Conclusiones De los cuestionarios analizados, el WAC es el que mejor comportamiento psicométrico parece tener, ya que es el único que presenta una validez convergente respetable a la vez que comparte una baja fiabilidad con el OWR y el GLTEQ. Objective To analyse the reliability and validity of the Weekly Activity Checklist (WAC), the One Week Recall (OWR), and the Godin-Shephard Leisure Time Exercise Questionnaire (GLTEQ) in Spanish adolescents. Methods A total of 78 adolescents wore a pedometer for one week, filled out the questionnaires at the end of this period and underwent a test to estimate their maximal oxygen consumption (VO2max). The reliability of the questionnaires was determined by means of a factor analysis. Convergent validity was obtained by comparing the questionnaires’ scores against the amount of physical activity quantified by the pedometer and the VO2max reported. Results The questionnaires showed a weak internal consistency (WAC: α=0.59-0.78; OWR: α=0.53-0.73; GLTEQ: α=0.60). Moderate statistically significant correlations were found between the pedometer and the WAC (r=0.69; p <0.01) and the OWR (r=0.42; p <0.01), while a low statistically significant correlation was found for the GLTEQ (r=0.36; p=0.01). The estimated VO2max showed a low level of association with the WAC results (r=0.30; p <0.05), and the OWR results (r=0.29; p <0....
      PubDate: 2016-06-16T18:12:12Z
  • Prevalencia y perfil de uso del cigarrillo electrónico en España

    • Abstract: Publication date: Available online 16 May 2016
      Source:Gaceta Sanitaria
      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 The use of electronic...
      PubDate: 2016-05-19T17:52:05Z
  • Food consumption frequency and excess body weight in adolescents in the
           context of financial crisis in Barcelona (Spain)

    • Abstract: Publication date: Available online 9 May 2016
      Source:Gaceta Sanitaria
      Author(s): Teresa Arechavala, Xavier Continente, Anna Pérez-Giménez, Xavier Bartoll, Francesca Sànchez-Martínez, María José López
      Objectives To describe food consumption frequency in adolescents in the context of the financial crisis in 2012, and to analyse potential fluctuations in excess body weight between 2008 and 2012. Method A cross-sectional study of eating habits and excess body weight was conducted in adolescents aged 13 to 19 years old from public, subsidised and private secondary schools in Barcelona, Spain. The FRESC lifestyle risk factors survey was used, and food frequency consumption, food recommendations and body mass index were analysed according to gender, year of education and socioeconomic status. Results Girls ate vegetables and fruits more frequently than boys, while the prevalence of junk food consumption was higher in boys. The prevalence of compliance with food recommendations was lower than 50% for all foods, and gender and socioeconomic differences were found for eggs, red meat and soft drinks. Regarding excess body weight, boys had a higher prevalence than girls in the 2 years analysed. Furthermore, a reduction in excess body weight was observed among girls in secondary education in the highest socioeconomic groups (28.7% [95% CI: 24.8-32.6%] in 2008 to 20.5% [95% CI: 17.1-23.8%] in 2012). Conclusions The prevalence of adolescents following food recommendations is low, and gender differences were found in terms of food consumption frequency, even in the context of financial crisis. There is a need to promote programmes and policies to reduce inequalities related to eating habits and excess body weight in adolescents.

      PubDate: 2016-05-13T22:15:34Z
  • Los desahucios y la salud, se necesita una respuesta desde la salud
           pública en España

    • Abstract: Publication date: Available online 13 May 2016
      Source:Gaceta Sanitaria
      Author(s): Antonio Daponte Codina, Inmaculada Mateo Rodríguez, Hugo Vásquez-Vera

      PubDate: 2016-05-13T22:15:34Z
  • Desarrollo e implementación de la Estrategia de Cronicidad del
           País Vasco: lecciones aprendidas

    • Abstract: Publication date: Available online 13 May 2016
      Source:Gaceta Sanitaria
      Author(s): Roberto Nuño-Solinís
      La sanidad pública de Euskadi afronta unas altas tasas de envejecimiento y cronicidad, que tensionan la sostenibilidad del sistema. En respuesta a esta situación, en 2010 se puso en marcha la Estrategia Vasca de Cronicidad como una iniciativa de transformación de amplia escala y largo alcance centrada en un cambio del modelo de provisión sanitaria hacia la atención integrada a la cronicidad. Desarrollada en un contexto caracterizado por la crisis económico-financiera, la fuerte oposición política, y la resistencia o la pasividad de grupos de interés relevantes, el diseño y la implementación de la Estrategia aportó algunos elementos destacables, como son una narrativa de cambio diferente a la de austeridad, que era la dominante en ese momento; un enfoque estratégico sustentado en una base de evidencia y en referentes teóricos contrastados; y un planteamiento de implementación que propiciaba la innovación local y de «abajo arriba». Pese a ello, no se consiguió superar plenamente las barreras de la debilidad política y de la inmovilidad burocrática, las cuales limitaron el despliegue y el alcance de los cambios, sobre todo los relativos a la escalabilidad de las innovaciones locales de éxito. En cualquier caso, como fruto de la Estrategia son apreciables algunos cambios en la cultura de integración asistencial, tanto en el ámbito clínico como en el gestor, así como la progresión organizativa dentro de un modelo de atención orientado a la cronicidad. Public healthcare in the Basque Country (Spain) faces high rates of ageing and chronicity, which stress the sustainability of the system. In response to this situation, the Basque Chronicity Strategy was launched in 2010. This large-scale and far-reaching transformation initiative focused on changing the healthcare provision model towards integrated care of chronicity. Developed in the context of economic and financial crisis, strong political opposition and resistance or passivity of many relevant stakeholders, the design and implementation of the Strategy introduced some noteworthy elements, such as: a narrative of change different to the austerity discourse, which was the dominant narrative at that time; a strategic approach supported by an evidence base and solid theoretical references; and an implementation strategy that favoured local innovation and the “bottom up” approach. In spite of this, it was not possible to overcome the political barriers or bureaucratic immobility, which limited the implementation and scope of the changes, especially those related to the scalability of successful local innovations. However, some changes in the healthcare integration culture at clinical and managerial level have been introduced as a result of the Strategy, as well as organisational progression towards a chronicity-targeted healthcare model.

      PubDate: 2016-05-13T22:15:34Z
  • Cáncer y consumo de carne: más allá de los estilos de vida

    • Abstract: Publication date: Available online 4 May 2016
      Source:Gaceta Sanitaria
      Author(s): Usama Bilal, Javier Padilla-Bernáldez

      PubDate: 2016-05-06T21:06:12Z
  • Percepciones de los hombres sobre las complicaciones asociadas a la
           mutilación genital femenina

    • Abstract: Publication date: Available online 4 May 2016
      Source:Gaceta Sanitaria
      Author(s): Ismael Jiménez-Ruiz, Pilar Almansa Martínez, María del Mar Pastor Bravo
      Objetivo Explorar el conocimiento de los hombres procedentes de países donde se realiza la mutilación genital femenina sobre las consecuencias negativas en la salud de las mujeres afectadas. Métodos Metodología cualitativa con enfoque etnometodológico, a través de entrevistas semiestructuradas individuales y grupales a 25 hombres, en relación con la mutilación genital femenina, seleccionados mediante triple muestreo. Se entregó una carta de presentación del estudio a los participantes y la declaración del consentimiento informado, y se les solicitó permiso para grabar la entrevista en audio. El análisis de los datos se realizó con el software informático Atlas. Ti7. Resultados Los participantes contrarios al corte son conscientes de la diversidad de complicaciones físicas, obstétricas, psicológicas, sobre la sexualidad y sociales en las mujeres sometidas a mutilación. Sin embargo, los hombres que tienen un posicionamiento favorable muestran en general un desconocimiento de los problemas secundarios a esta práctica. Conclusiones Los participantes procedentes de países donde se realiza la mutilación genital femenina, contrarios a mantener esta práctica, muestran un mayor conocimiento de las consecuencias negativas que los que se manifiestan a favor. El diseño de herramientas y programas de sensibilización destinados a la lucha contra la mutilación genital femenina debe visibilizar las complicaciones sobre la salud de las mujeres y las niñas, e incluir intervenciones familiares que impliquen a los hombres en el proceso de erradicación de esta práctica. Objective To explore men's knowledge of the negative consequences of female genital mutilation (FGM) to women's health in countries where this practice is performed. Methods A qualitative methodology was used with an ethnomethodological approach. Both individual and group semi-structured interviews concerning FGM were conducted with 25 men, selected by triple sampling. A study presentation letter was provided to participants, together with an informed consent declaration. Permission was also procured to record the interviews in audio format. Data analysis was performed using the Atlas Ti7 software. Results Those participants against FGM are aware of the range of complications this practice can cause, being able to identify physical, obstetric, psychological, sexuality and social consequences in women subjected to FGM. However, those men who are in favour display a general ignorance of the problems resulting from this practice. Conclusions Participants from countries where FGM is performed who are against this practice are more aware of the negative consequences than those who claim to be in favour. The design of awareness-raising programmes and other tools to combat female genital mutilation must highlight the implications for women's and girls’ health, and include family-targeted campaigns which involve men in the process of eradicating this practice.

      PubDate: 2016-05-06T21:06:12Z
  • Nutrition and health claims in products directed at children via
           television in Spain in 2012

    • Abstract: Publication date: May–June 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 3
      Author(s): Miguel Ángel Royo-Bordonada, María José Bosqued-Estefanía, Javier Damián, Lázaro López-Jurado, María Ángeles Moya-Geromini
      Objective To describe the use of nutrition and health claims in products directed at children via television in Spain and to analyse their nutrient profile. Methods A cross-sectional study of television food advertisements over 7 days in five Spanish television channels popular among children. The products were classified as core, non-core or miscellaneous, and as either healthy or less healthy, according to the United Kingdom Nutrient Profile Model. We registered all claims contained on the product (packaging and labelling) and its advertisement. We calculated the frequency distributions of health and nutrition claims. Results During the 420hours of broadcasting, 169 food products were identified, 28.5% in the dairy group and 60.9% in the non-core category. A total of 53.3% of products contained nutrition claims and 26.6% contained health claims; 62.2% of the products with claims were less healthy. Low-fat dairy products were the food category containing the highest percentage of health and nutrition claims. Conclusion Over half of all food products marketed to children via television in Spain made some type of nutrition or health claim. Most of these products were less healthy, which could mislead Spanish consumers.

      PubDate: 2016-05-06T21:06:12Z
  • gaceta sanitaria a primera vista

    • Abstract: Publication date: May–June 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 3

      PubDate: 2016-05-06T21:06:12Z
  • Nuestra experiencia en el Comité Editorial de Gaceta Sanitaria. Sobre
           todo, ¡muchas gracias!

    • Abstract: Publication date: May–June 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 3
      Author(s): Carme Borrell, M Felicitas Domínguez-Berjón, Carlos Álvarez-Dardet, Clara Bermúdez-Tamayo, Pere Godoy, María José López, Miguel Ángel Negrín, Glòria Pérez, Napoleón Pérez-Farinós, Alberto Ruano, Carmen Vives-Cases

      PubDate: 2016-05-06T21:06:12Z
  • Consumo intensivo de alcohol y cannabis, y prácticas sexuales de
           riesgo en estudiantes universitarios

    • Abstract: Publication date: Available online 5 May 2016
      Source:Gaceta Sanitaria
      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 consumption pattern of alco...
      PubDate: 2016-05-06T21:06:12Z
  • La biomonitorización de sustancias tóxicas en muestras
           biológicas de población general

    • Abstract: Publication date: Available online 28 April 2016
      Source:Gaceta Sanitaria
      Author(s): Jesús Ibarluzea, Juan José Aurrekoetxea, Miquel Porta, Jordi Sunyer, Ferran Ballester
      La biomonitorización de sustancias tóxicas ha sido incorporada por buena parte de los países más desarrollados, con el objetivo de conocer sus concentraciones en muestras biológicas. Estas sustancias se incorporan al organismo por medio de diferentes exposiciones ambientales. La vigilancia en muestras biológicas debe permitir conocer sus valores en grupos vulnerables y su evolución en el tiempo, comparar con los valores observados en otros países, identificar grupos que presenten valores altos o de riesgo, y promover la investigación. Su finalidad más clara es la de servir como instrumento para el diseño de políticas que permitan poner en marcha medidas de actuación en diversos sectores: salud, ambiental, agrícola-ganadero o alimentario. En España se dispone de información sobre tóxicos de origen ambiental procedente de estudios específicos acerca de efectos para la salud de origen ambiental, como el proyecto INMA (INfancia y Medio Ambiente). Así mismo, se han desarrollado proyectos de biomonitorización en Cataluña e Islas Canarias, y un programa estatal de biomonitorización en población adulta trabajadora. Sin embargo, es necesario seguir avanzando hasta conseguir un sistema que abarque la población general y subgrupos de riesgo, en el cual colaboren las distintas administraciones implicadas, se cuente con la participación de expertos intersectoriales y se facilite la participación de organizaciones ciudadanas interesadas en las relaciones entre el medio ambiente y la salud. Many of the world's most developed countries have adopted biomonitoring of toxic substances in order to ascertain their levels in biological samples. These substances get into the body through different environmental exposures. Monitoring toxic substances in biological samples should allow us to ascertain their levels in vulnerable groups, assess their evolution over time, make comparisons with levels observed in other countries, identify groups at risk or with high toxic levels and promote research. The main objective of biomonitoring is to act as a policy design tool to facilitate the implementation of particular measures in various sectors: health, environmental, agricultural and livestock or food industry sectors. In Spain, information on levels of toxic substances of environmental origin is provided by specific studies on health effects from environmental sources, such as the INMA project (INfancia y Medio Ambiente [childhood and environment]). In addition, biomonitoring projects have been implemented in Catalonia and the Canary Islands, together with a national biomonitoring programme in the adult working population. However, further progress is needed to develop a system that covers the general population as well as subgroups at risk, which relies on the collaboration of the involved authorities and the participation of professionals from different sectors and citizen organisations interested in the relationship between health and the environment.

      PubDate: 2016-04-30T02:48:19Z
  • Variaciones en el proceso de confirmación diagnóstica entre
           unidades de cribado poblacional de cáncer de mama

    • Abstract: Publication date: Available online 29 April 2016
      Source:Gaceta Sanitaria
      Author(s): Carmen Natal, Ana Fernández-Somoano, Isabel Torá-Rocamora, Adonina Tardón, Xavier Castells
      Objetivo Analizar las variaciones en el proceso de confirmación diagnóstica entre unidades de cribado, las variaciones en los resultados de cada episodio y la relación entre las tasas de las diferentes pruebas de confirmación diagnóstica y las de detección de lesiones. Método Estudio observacional de las variaciones de las tasas estandarizadas de pruebas diagnósticas y de detección de lesiones, en 34 unidades de cribado de los programas poblacionales de detección precoz de cáncer de mama, de tres comunidades autónomas, en el periodo de 2002 a 2011. Resultados Las razones de variación entre los percentiles 25-75 en las tasas de realización de pruebas diagnósticas oscilaron entre 1,68 (recitaciones) y 3,39 (punción-aspiración con aguja fina). En las tasas de detección de lesiones benignas, carcinoma ductal in situ y cáncer invasivo fueron, respectivamente, 2,79, 1,99 y 1,36. Se encontró una relación positiva entre las tasas de realización de pruebas y las tasas de detección en punción-aspiración con aguja fina y lesiones benignas (R2: 0,53), punción-aspiración con aguja fina y carcinoma invasivo (R2: 0, 28), biopsias cerradas y lesiones benignas (R2: 0,64), biopsias cerradas y carcinoma ductal in situ (R2: 0,61), y biopsias cerradas y carcinoma invasivo (R2: 0,48). Conclusiones Se observaron variaciones en la realización de pruebas invasivas entre las unidades de detección precoz de cáncer de mama de mayor magnitud que las de detección de lesiones. Las unidades con más pruebas de punción-aspiración con aguja fina tienen mayores tasas de detección de lesiones benignas, y las que realizan más biopsias cerradas detectan más lesiones benignas y cáncer. Objective To analyse variations in the diagnostic confirmation process between screening units, variations in the outcome of each episode and the relationship between the use of the different diagnostic confirmation tests and the lesion detection rate. Method Observational study of variability of the standardised use of diagnostic and lesion detection tests in 34 breast cancer mass screening units participating in early-detection programmes in three Spanish regions from 2002–2011. Results The diagnostic test variation ratio in percentiles 25–75 ranged from 1.68 (further appointments) to 3.39 (fine-needle aspiration). The variation ratio in detection rates of benign lesions, ductal carcinoma in situ and invasive cancer were 2.79, 1.99 and 1.36, respectively. A positive relationship between rates of testing and detection rates was found with fine-needle aspiration-benign lesions (R2: 0.53), fine-needle aspiration-invasive carcinoma (R2: 0 28), core biopsy-benign lesions (R2: 0.64), core biopsy-ductal carcinoma in situ (R2: 0.61) and core biopsy-invasive carcinoma (R2: 0.48). Conclusions Variation in the use of invasive tests between the breast cancer screening units participating in early-detection programmes was found to be significantly higher than variations in lesion detection. Unit...
      PubDate: 2016-04-30T02:48:19Z
  • Participación para mejorar las condiciones de trabajo: evidencias y

    • Abstract: Publication date: Available online 29 April 2016
      Source:Gaceta Sanitaria
      Author(s): Ana M. García, Pere Boix, Fernando G. Benavides, Rafael Gadea, Fernando Rodrigo, Consol Serra
      La participación de los agentes de interés es un requisito clave para el éxito de los programas de salud pública. Las condiciones de trabajo y de empleo son determinantes principales de la salud y del bienestar de las personas, y los lugares de trabajo resultan un entorno ideal para llevar a cabo intervenciones con un grado muy directo de participación. Así, el principal marco normativo para la salud y la seguridad en el trabajo en nuestro país, la Ley 31/1995, establece los principios de «eficacia, coordinación y participación» como bases necesarias para la protección de la salud de los trabajadores. Esta Ley crea la figura del delegado de prevención, representante de los trabajadores con funciones específicas en materia de prevención de riesgos en el trabajo, y el comité de seguridad y salud en el trabajo, órgano con representación paritaria en el seno de la empresa y con la misma intención. Experiencias recientes de participación en salud laboral destacan los programas de ergonomía participativa. Estos programas están orientados a la mejora de las condiciones de trabajo que determinan la aparición de trastornos musculoesqueléticos, uno de los daños relacionados con el trabajo con mayor prevalencia e incidencia en la población trabajadora. En este trabajo se describen las características y los resultados de algunas experiencias de ergonomía participativa llevadas a cabo recientemente en España, de las que pueden extraerse enseñanzas sobre los procesos, los facilitadores y los obstáculos para extender este tipo de programas a otros ámbitos de la salud laboral y de la salud pública. Participation of stakeholders is a key requirement for the success of public health programmes. Working and employment conditions are major determinants for people's health and wellbeing, and workplaces are ideal environments to implement programmes with a very direct level of participation. In Spain, the main regulatory framework for occupational health and safety, Law 31/1995, establishes the principles of “efficiency, coordination and participation” as a necessary basis for workers’ health protection. This same Law establishes the role of the health and safety workers’ representative, responsible for occupational risk prevention, and the occupational health and safety committee, a body with equal representation and the same objectives at the heart of the company. Among recent experiences of participation in occupational health, participatory ergonomics programmes have stood out. The aim of these programmes is to improve working conditions with a view to reducing musculoskeletal disorders, which is a very common and highly prevalent work-related injury in Spain. This study describes the characteristics and results of some experiences of participatory ergonomics carried out recently in Spain, from which relevant learning can be extrapolated about processes, facilitators and barriers in order to extend such programmes to other areas of occupational and public health.

      PubDate: 2016-04-30T02:48:19Z
  • La vigilancia en España 3 años después de la entrada en
           vigor de la Ley General de Salud Pública

    • Abstract: Publication date: Available online 29 April 2016
      Source:Gaceta Sanitaria
      Author(s): Anxela Pousa, Pere Godoy, Nuria Aragonés, Rosa Cano, María José Sierra, Francisco González, José María Mayoral
      En 2014, el Grupo de Trabajo de Vigilancia Epidemiológica de la Sociedad Española de Epidemiología llevó a cabo un estudio descriptivo con el fin de evaluar el desarrollo de la Ley General de Salud Pública, promulgada en España en 2011. Se remitió una encuesta a las 19 comunidades y ciudades autónomas para evaluar la existencia de sistemas de información y otros aspectos de los distintos apartados de vigilancia incluidos en la ley. Todas disponían de un sistema de información para enfermedades transmisibles y en seis para condicionantes sociales; 18 vigilaban al menos una enfermedad crónica y 14 alguno de sus determinantes. El 100% analizaba sistemáticamente la información procedente de la vigilancia de las enfermedades transmisibles. Hay margen de mejora para la vigilancia de la salud pública en España. La acción debe ir dirigida a los principales problemas de salud. In 2014, the Epidemiological Surveillance Working Group of the Sociedad Española de Epidemiología (Spanish Society of Epidemiology), carried out a descriptive study in order to evaluate the level of development of the Spanish Public Health Law since its enactment in 2011. A survey collecting data on the existence of information systems and other aspects pertaining to each surveillance section included in the law was sent to all 19 autonomous communities and cities. All regional authorities reported the presence of an information system for communicable diseases, and six also reported an information system for social factors. 18 reported that at least one chronic disease was subject to surveillance and 14 confirmed surveillance of some of its determinants. They all systematically analysed the data derived from the communicable diseases. There is room for improvement in Public Health surveillance in Spain, and action should be aimed at the main health problems.

      PubDate: 2016-04-30T02:48:19Z
  • Evolución de las inequidades en mortalidad por causas externas entre
           los municipios de Antioquia (Colombia)

    • Abstract: Publication date: Available online 28 April 2016
      Source:Gaceta Sanitaria
      Author(s): Beatriz Caicedo-Velásquez, Luz Stella Álvarez-Castaño, Marc Marí-Dell’Olmo, Carme Borrell
      Objetivo Analizar la evolución de las inequidades en la mortalidad por causas externas en los municipios de Antioquia, departamento de Colombia, entre los años 2000 y 2010, y la asociación con sus condiciones socioeconómicas. Las causas externas incluyen, entre otras, las muertes violentas como los homicidios, los suicidios y los accidentes de tránsito. Método Diseño ecológico de tendencias de mortalidad con los 125 municipios del departamento de Antioquia como unidad de análisis. Para cada uno de los municipios se estimó la razón de mortalidad estandarizada y suavizada (RMEs) ajustada por la edad utilizando un modelo bayesiano empírico. Las diferencias en los riesgos de mortalidad entre los municipios más pobres y menos pobres se analizaron mediante un modelo jerárquico de dos niveles (nivel 1: año; nivel 2: municipio). Resultados La mortalidad por causas externas presenta una tendencia decreciente en el departamento en el periodo analizado, pero la situación no es similar en todos los municipios. Los resultados muestran que municipios pobres y con bajo desarrollo incrementan significativamente el riesgo de morir por causas externas. Conclusiones Es necesaria una intervención con políticas que tengan en cuenta las diferencias municipales en la mortalidad por causas externas. Objective To analyse the trend in inequalities in mortality due to external causes among municipalities in Antioquia, department of Colombia, from 2000 to 2010, and its association with socioeconomic conditions. External causes included violent deaths, such as homicides, suicides and traffic accidents, among others. Methods Ecological design of mortality trends, with the 125 municipalities of Antioquia as the unit of analysis. The age-adjusted smoothed standardized mortality ratio (SMR) was estimated for each of the municipalities by using an empirical Bayesian model. Differences in the SMR between the poorest and least poor municipalities were estimated by using a two-level hierarchical model (level-1: year, level-2: municipality). Results Mortality due to external causes showed a downward trend in the department in the period under review, although the situation was not similar in all municipalities. The findings showed that the risk of death from external causes significantly increased in poor and underdeveloped municipalities. Conclusions Intervention is required through policies that take into account local differences in mortality due to external causes.

      PubDate: 2016-04-30T02:48:19Z
  • Perfil sociodemográfico del feminicidio en España y su
           relación con las denuncias por violencia de pareja

    • Abstract: Publication date: Available online 28 April 2016
      Source:Gaceta Sanitaria
      Author(s): Belén Sanz-Barbero, Julio Heras-Mosterio, Laura Otero-García, Carmen Vives-Cases
      Objetivo Analizar las características asociadas al riesgo de feminicidio en España entre mujeres expuestas a la violencia de pareja o análogo y su posible asociación con las denuncias a los agresores. Métodos Se realizó un estudio de casos y controles para el periodo 2010-2011. Los casos, 135 mujeres mayores de edad, asesinadas por su pareja o análogo durante dicho periodo, se identificaron a través de la página web de la Federación de Asociaciones de Mujeres Separadas y Divorciadas, y de los informes del Consejo General del Poder Judicial. Los controles, 185 mujeres expuestas a la violencia de pareja el último año, proceden de la Macroencuesta de Violencia de Género 2011. La asociación entre la denuncia y el riesgo de feminicidio se estimó mediante modelos de regresión logística multivariada. Resultados No se encontró asociación entre denunciar al agresor y el riesgo de ser asesinada (odds ratio [OR]: 1,38; intervalo de confianza del 95% [IC95%]: 0,68-2,79). Las mujeres inmigrantes expuestas a la violencia de pareja registraron una mayor probabilidad de ser asesinadas (ref.: mujeres españolas; OR: 5,38; IC95%: 2,41-11,99). Esta asociación también se observó en las mujeres que vivían en zonas rurales (ref: zonas urbanas; OR: 2,94; IC95%: 1,36-6,38). Conclusiones La denuncia judicial al agresor no parece modificar el riesgo de asesinato entre las mujeres expuestas a la violencia de pareja. Las medidas de protección a las mujeres deberían extremarse en las mujeres inmigrantes y las que viven en el medio rural. Objective To analyse the characteristics associated with the risk of femicide in Spain among women exposed to domestic violence or similar aggression, and the possible association with filing judicial complaints against the aggressors. Methods A case-control study was carried out for the period 2010–2011. The cases included 135 adult women killed by their partners (or similar) during the period, identified through the webpage of the Federación de Asociaciones de Mujeres Separadas y Divorciadas (Association of Separated and Divorced Women), and from the reports of the General Council of the Judiciary. The control cases included 185 women exposed to domestic violence in the past year, from the Macrosurvey of Gender Violence 2011. The association between filing a complaint and the risk of femicide was estimated through multivariate logistic regression models. Results There was no association found between the filing of a complaint against the aggressor and the risk of murder (OR: 1.38; 95% CI: 0.68–2.79). Immigrant women exposed to domestic violence were at greater risk of being murdered (ref.: Spanish women; OR: 5.38; 95% CI: 2.41–11.99). This association was also observed in women living in rural areas (ref.: urban areas; OR: 2.94; 95% CI: 1.36–6.38). Conclusions Filing a judicial complaint against the aggressor does not seem to affect the risk of murder among women exposed to domestic violence. Protection measures for women should be strengthened among immigrant women and women living in rural areas.

      PubDate: 2016-04-30T02:48:19Z
  • Contra: el cribado del cáncer de pulmón con tomografía
           computarizada de baja dosis

    • Abstract: Publication date: Available online 27 April 2016
      Source:Gaceta Sanitaria
      Author(s): Alberto Ruano-Ravina, Alberto Fernández-Villar, Mariano Provencio-Pulla

      PubDate: 2016-04-30T02:48:19Z
  • Austeridad y privatización sanitaria en época de crisis:
           ¿existen diferencias entre las comunidades autónomas?

    • Abstract: Publication date: Available online 23 April 2016
      Source:Gaceta Sanitaria
      Author(s): Amaia Bacigalupe, Unai Martín, Raquel Font, Yolanda González-Rábago, Noemi Bergantiños

      PubDate: 2016-04-25T01:08:56Z
  • Enfermedades transmitidas por vectores. Un nuevo reto para los sistemas de
           vigilancia y la salud pública

    • Abstract: Publication date: Available online 19 April 2016
      Source:Gaceta Sanitaria
      Author(s): Carmen Amela Heras, María José Sierra Moros

      PubDate: 2016-04-20T21:34:30Z
  • Inequalities in mental health in the working population of Spain: a
           National Health Survey-based study

    • Abstract: Publication date: Available online 5 April 2016
      Source:Gaceta Sanitaria
      Author(s): Jorge Arias-de la Torre, Lucía Artazcoz, Antonio José Molina, Tania Fernández-Villa, Vicente Martín
      Objective In the working population, poor mental health is a significant problem whose prevalence rates and associated factors could differ by gender, especially in a period of socioeconomic changes. The aims of this study were: a) to determine the prevalence of poor mental health in the working population of Spain in 2011; b) to identify the association of this prevalence with socioeconomic and work-related variables for men and women separately; c) to determine if the patterns differ by gender. Methods A cross-sectional study was conducted with data from the National Health Survey of Spain (2011). Of the 21,007 participants in the survey, we selected 7396 whose employment status was described as “working” The General Health Questionnaire (GHQ-12) was used as a screening tool to detect poor mental health. Prevalences were calculated and bivariate and multivariate logistic regression models were fitted to verify the association between variables. Results The prevalence of poor mental health was higher among women (19.9%) than men (13.9%), the overall prevalence being 16.8%. The variables associated with a higher prevalence were type of contract and work-related variables in men, and age and socioeconomic variables in women. Conclusions This study shows that, in the working population of Spain, the prevalence of poor mental health and its related factors differ by gender. Poor mental health is mainly related to socioeconomic variables in women but is mostly associated with work-related variables in men.

      PubDate: 2016-04-10T18:21:03Z
  • Demanda asistencial en atención primaria y especializada según
           la salud mental de población adulta española

    • Abstract: Publication date: Available online 6 April 2016
      Source:Gaceta Sanitaria
      Author(s): Virginia Basterra

      PubDate: 2016-04-10T18:21:03Z
  • El enfoque de sostenibilidad en los planes de salud de las comunidades
           autónomas: el desarrollo sostenible como oportunidad

    • Abstract: Publication date: Available online 30 March 2016
      Source:Gaceta Sanitaria
      Author(s): Miguel A. Moyano-Santiago, Juana M. Rivera-Lirio
      Objetivo Determinar el grado de orientación de los planes de salud de las comunidades autónomas a las tres dimensiones habituales de sostenibilidad: económica, social y medioambiental; tanto en el nivel discursivo general como en las diferentes áreas de intervención. Método Investigación cualitativa mediante análisis de contenido de una amplia muestra de documentos. La metodología específica es el análisis de sensibilidad simbólica y operativa realizado a una muestra de once planes de salud de España. Resultados Los aspectos sociales, tales como los determinantes o los grupos más vulnerables, reciben cada vez más atención por parte del planificador sanitario, si bien hay espacio para fortalecer la atención a las cuestiones medioambientales y dotar de forma específica a las actuaciones en términos económicos. Conclusiones el análisis evidencia el estado incipiente en el que se encuentran los planes de salud como documentos de planificación estratégica que integren aspectos económicos, sociales y ambientales con los cuales contribuir a la sostenibilidad de los diferentes sistemas sanitarios del país. Objective To determine the degree to which the health plans of the autonomous communities focus on the usual three dimensions of sustainability: economic, social and environmental, both in the general level of discourse and in the different areas of intervention. Method A qualitative study was conducted through content analysis of a large sample of documents. The specific methodology was analysis of symbolic and operational sensitivity in a sample of eleven health plans of the Spanish state. Results Social aspects, such as social determinants or vulnerable groups, are receiving increasing attention from the health planner, although there is room to strengthen attention to environmental issues and to provide specific interventions in economic terms. Conclusions The analysis demonstrates the incipient state of health plans as strategic planning documents that integrate economic, social and environmental aspects and contribute to the sustainability of the different health systems of the country.

      PubDate: 2016-03-31T16:16:58Z
  • Problemas en el proceso de adaptación a los cambios en personas
           cuidadoras familiares de mayores con demencia

    • Abstract: Publication date: Available online 14 March 2016
      Source:Gaceta Sanitaria
      Author(s): Sara Moreno-Cámara, Pedro Ángel Palomino-Moral, Lourdes Moral-Fernández, Antonio Frías-Osuna, Rafael del-Pino-Casado
      Objetivo Identificar y analizar los problemas que surgen en el proceso de adaptación de la persona cuidadora a los cambios durante el cuidado familiar a una persona afectada por demencia. Método Estudio cualitativo basado en la metodología de la teoría fundamentada constructivista de Charmaz. Se realizaron siete grupos focales en diferentes centros de atención primaria de salud en la provincia de Jaén (España). Participaron 82 personas cuidadoras principales familiares de mayores con demencia, seleccionadas por muestreo propositivo de máxima variación y teórico. Se llevó a cabo una triangulación del análisis para favorecer la validez interna del estudio. Resultados Se obtuvieron tres categorías centrales, que fueron «Cuidados cambiantes», «Problemas en el proceso de adaptación a los cambios» y «Factores facilitadores del proceso de adaptación a los cambios». La persona cuidadora desempeña su rol en una realidad caracterizada por el cambio, tanto personal como de la persona a la que cuida y su contexto social y cultural. El reto adaptativo está en el balance entre los problemas que dificultan la adaptación a los cambios de la persona cuidadora a las nuevas situaciones de cuidado y los factores que facilitan su labor cuidadora. Conclusiones La escasez de apoyo formal y el infradiagnóstico de la demencia dificultan la adaptación de la persona cuidadora al cuidado de una persona afectada por demencia. El proceso de adaptación podría mejorar reforzando el apoyo formal en las primeras fases del cuidado para reducir el estrés del proceso de aprendizaje autodidacta de las familias cuidadoras, así como adaptando las intervenciones a cada fase de la evolución del rol cuidador. Objective To identify and analyse problems in adapting to change among the family caregivers of relatives with dementia. Method Qualitative study based on the methodology of Charmaz's Constructivist Grounded Theory. Seven focus groups were conducted in different primary health care centres in the province of Jaen (Spain). Eighty-two primary family caregivers of relatives with dementia participated by purposeful maximum variation sampling and theoretical sampling. Triangulation analysis was carried out to increase internal validity. Results We obtained three main categories: ‘Changing Care’, ‘Problems in the process of adapting to change’ and ‘Facilitators of the process of adapting to change’. Family caregivers perform their role in a context characterized by personal change, both in the person receiving the care and in the social and cultural context. The challenge of adaptation lies in the balance between the problems that hamper adaptation of the caregiver to new situations of care and the factors that facilitate the caregiver role. Conclusions The adaptation of family caregivers to caring for a person with dementia is hindered by the lack of formal support and under-diagnosis of dementia. The adaptation process could be improved by strengthening formal support in the early stages of care to reduce the stress of family caregivers who must teach themselves about their task and by interventions adapted to each phase in the development of the caregiver role.

      PubDate: 2016-03-16T17:07:18Z
  • Percepciones de médicas y médicos de atención primaria de
           Madrid sobre las medidas de ajuste en el sistema público de salud

    • Abstract: Publication date: Available online 14 March 2016
      Source:Gaceta Sanitaria
      Author(s): Julio Heras-Mosteiro, Laura Otero-García, Belén Sanz-Barbero, Jesús María Aranaz-Andrés
      Objetivo Para hacer frente a la actual crisis económica, las administraciones han impulsado medidas de ajuste que han afectado al sistema público de salud. Presentamos la percepción que de esas medidas tienen los/las médicos/as de atención primaria de dos centros de salud de Madrid. Método Se desarrolló un estudio cualitativo en dos centros de salud del distrito de Fuencarral-El Pardo (Madrid), que tiene tasas de paro y de población inmigrante superiores a la media de la ciudad. Se realizaron 12 entrevistas semiestructuradas a médicos/as de dichos centros. El análisis de la información se basó en el análisis del contenido clásico. Resultados Se identifican dos categorías: valoración de medidas de ajuste y valoración de la toma de decisiones en dicho proceso. Las personas entrevistadas manifiestan la necesidad de impulsar medidas que mejoren el sistema público de salud, pero expresan su desacuerdo con las implementadas. Consideran que no están basadas en la evidencia y que obedecen a una necesidad de ahorro a corto plazo. Creen que ha habido una mala comunicación de las medidas, sin la participación de profesionales sanitarios/as asistenciales en su priorización, elección e implementación. Consideran imprescindible esta participación porque son quienes conocen de forma práctica las disfunciones del sistema, teniendo más presente la centralidad del paciente. Conclusiones Se hace imprescindible que los poderes públicos incorporen activamente a profesionales sanitarios/as asistenciales en la toma de decisiones para garantizar la implementación de medidas basadas en la evidencia, con un alto respaldo profesional, manteniendo así la calidad asistencial. Objective To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. Methods We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Results Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. Conclusions It is essential that public authorities actively involve health care professionals in d...
      PubDate: 2016-03-16T17:07:18Z
  • Conflictos entre la ética enfermera y la legislación sanitaria
           en España

    • Abstract: Publication date: Available online 14 March 2016
      Source:Gaceta Sanitaria
      Author(s): Montserrat Gea-Sánchez, Lourdes Terés-Vidal, Erica Briones-Vozmediano, Fidel Molina, Denise Gastaldo, Laura Otero-García
      Objetivo Evidenciar los conflictos éticos que pueden surgir entre los discursos legal y ético, a través de explorar el contenido del Real Decreto-Ley 16/2012 que modifica la ley sanitaria en España y los códigos éticos. Método Revisión y análisis crítico del discurso de cinco códigos éticos de Enfermería de Barcelona, Cataluña, España, Europa e Internacional, y del discurso de la legislación sanitaria vigente en España en 2013, en los que se identificaron y compararon estructuras lingüísticas referentes a cinco principios y valores éticos del marco teórico de la ética de los cuidados: equidad, derechos humanos, derecho a la salud, accesibilidad y continuidad de los cuidados. Resultados Mientras que el discurso ético define la función enfermera en función de la equidad, el reconocimiento de los derechos humanos, el derecho a la salud, la accesibilidad y la continuidad de los cuidados de la persona, el discurso legal se vertebra sobre el concepto de beneficiario o asegurado. Conclusiones La divergencia entre el discurso ético y legal puede producir conflictos éticos que afecten negativamente a la práctica de la profesión enfermera. La aplicación del RDL 16/2012 promueve un marco de acción que impide que los profesionales enfermeros presten sus cuidados a colectivos no asegurados, lo que atenta contra los derechos humanos y los principios de la ética de los cuidados. Objective To identify the ethical conflicts that may arise between the nursing codes of ethics and the Royal Decree-law 16/2012 modifying Spanish health regulations. Method We conducted a review and critical analysis of the discourse of five nursing codes of ethics from Barcelona, Catalonia, Spain, Europe and International, and of the discourse of the Spanish legislation in force in 2013. Language structures referring to five different concepts of the theoretical framework of care were identified in the texts: equity, human rights, right to healthcare, access to care, and continuity of care. Results Codes of ethics define the function of nursing according to equity, acknowledgement of human rights, right to healthcare, access to care and continuity of care, while legal discourse hinges on the concept of beneficiary or being insured. Conclusions The divergence between the code of ethics and the legal discourse may produce ethical conflicts that negatively affect nursing practice. The application of RDL 16/2012 promotes a framework of action that prevents nursing professionals from providing care to uninsured collectives, which violates human rights and the principles of care ethics.

      PubDate: 2016-03-16T17:07:18Z
  • Infecciones de transmisión sexual en hombres internos en
           prisión: riesgo de desarrollo de nuevas infecciones

    • Abstract: Publication date: Available online 15 March 2016
      Source:Gaceta Sanitaria
      Author(s): Raquel Sánchez Recio, Juan Pablo Alonso Pérez de Ágreda, Javier Santabárbara Serrano
      Objetivo Medir la incidencia y determinar los factores de riesgo de las infecciones de transmisión sexual (ITS) en la población del Centro Penitenciario de Daroca (Zaragoza). Método Estudio de cohortes retrospectivo (2005-2013) para medir la incidencia de ITS y estudio transversal para estudiar los factores de riesgo. Resultados De los 203 internos, 79 desarrollaron una ITS, 37 tenían ITS previas, el 55,2% conocimientos y el 28,9% comportamientos no favorables a la prevención de ITS. La incidencia fue de 6,5 ITS por cada 1000 internos-año. Las de mayor incidencia fueron la hepatitis B (39,7%), la infección por Ureaplasma urealyticum (19,1%), el herpes simple (16,2%) y la infección por el virus de la inmunodeficiencia humana (8,8%). El riesgo (hazard ratio [HR]) de adquirir una nueva ITS fue significativamente mayor en los internos con antecedentes de ITS previa (HR=2,61; intervalo de confianza del 95% [IC95%]: 1,01-6,69), y en el límite de la significación para los comportamientos no preventivos (HR=2,10; IC95%: 0,98-4,53), pero no en los conocimientos frente a ITS (HR=1,33; IC95%: 0,58-3,07). Conclusión Los factores de riesgo más relevantes en prisión son los comportamientos y los antecedentes de ITS. Otros factores son ser reincidente, el consumo de drogas inyectadas o estar en un programa de metadona. Los/las profesionales sanitarios y la educación por pares pueden facilitar la prevención y el control. Objective To measure incidence and main risk factors related to sexually transmitted infections (STIs) in Daroca Prison (Zaragoza, Spain). Method A retrospective cohort study (2005-2013) to measure the incidence of STI and a cross-sectional study to measure risk factors. Results Of the 203 inmates, 79 developed an STI, 37 had a previous STI, 55.2% lacked knowledge on STI prevention, and 28.9% showed behaviours unfavourable for STI prevention. The incidence rate was 6.5 STIs per 1,000 inmates-year. The most frequent STIs were hepatitis B (39.7%), Ureaplasma urealyticum (19.1%), herpes simplex (16.2%) and HIV (8.8%). The risk (hazard ratio, HR) of acquiring a new STI was significantly higher in inmates with a history of previous STI (HR=2.61; 95%CI: 1.01 to 6.69), and was at the limit of significance for non-preventive behaviour (HR=2.10; 95%CI: 0.98 to 4.53), but not in knowledge related to STIs (HR=1.33; 95%CI: 0.58 to 3.07). Conclusion The most important risk factors in prison are behaviours related to STIs and previous history of STIs. Other factors are being a repeat offender, injecting drug use, or being in a methadone programme. Health personnel and peer education can facilitate prevention and control.

      PubDate: 2016-03-16T17:07:18Z
  • Impact of a community-based exercise programme on physical fitness in
           middle-aged and older patients with type 2 diabetes

    • Abstract: Publication date: Available online 18 February 2016
      Source:Gaceta Sanitaria
      Author(s): Romeu Mendes, Nelson Sousa, José Themudo-Barata, Victor Reis
      Objectives Physical fitness is related to all-cause mortality, quality of life and risk of falls in patients with type 2 diabetes. This study aimed to analyse the impact of a long-term community-based combined exercise program (aerobic+resistance+agility/balance+flexibility) developed with minimum and low-cost material resources on physical fitness in middle-aged and older patients with type 2 diabetes. Methods This was a non-experimental pre-post evaluation study. Participants (N=43; 62.92±5.92 years old) were engaged in a community-based supervised exercise programme (consisting of combined aerobic, resistance, agility/balance and flexibility exercises; three sessions per week; 70min per session) of 9 months’ duration. Aerobic fitness (6-Minute Walk Test), muscle strength (30-Second Chair Stand Test), agility/balance (Timed Up and Go Test) and flexibility (Chair Sit and Reach Test) were assessed before (baseline) and after the exercise intervention. Results Significant improvements in the performance of the 6-Minute Walk Test (Δ=8.20%, p<0.001), 30-Second Chair Stand Test (Δ=28.84%, p<0.001), Timed Up and Go Test (Δ=14.31%, p<0.001), and Chair Sit and Reach Test (Δ=102.90%, p<0.001) were identified between baseline and end-exercise intervention time points. Conclusions A long-term community-based combined exercise programme, developed with low-cost exercise strategies, produced significant benefits in physical fitness in middle-aged and older patients with type 2 diabetes. This supervised group exercise programme significantly improved aerobic fitness, muscle strength, agility/balance and flexibility, assessed with field tests in community settings.

      PubDate: 2016-02-24T12:27:49Z
  • Plaguicidas organofosforados y efecto neuropsicológico y motor en la
           Región del Maule, Chile

    • Abstract: Publication date: Available online 19 February 2016
      Source:Gaceta Sanitaria
      Author(s): María Teresa Muñoz-Quezada, Boris Lucero, Verónica Iglesias, María Pía Muñoz, Eduardo Achú, Claudia Cornejo, Carlos Concha, Angela Grillo, Ana María Brito
      Objetivo Evaluar la exposición a plaguicidas organofosforados y el desempeño neuropsicológico y motor de trabajadores/as agrícolas y no agrícolas de la Región del Maule, Chile. Método Estudio transversal analítico con 93 trabajadores/as agrícolas expuestos/as a plaguicidas organofosforados y 84 trabajadores/as no agrícolas no expuestos/as. Se administró una batería de cuatro pruebas neuropsicológicas junto con un examen físico neuromotor. Resultados Los/las trabajadores/as agrícolas expuestos/as tuvieron un menor desempeño en la escala de inteligencia de Wechsler para Adultos (WAIS-IV) en comprensión verbal (β=−3,2; p=0,034), en velocidad de procesamiento (β=−4,4; p=0,036) y en la escala total (β=−4; p=0,016); sensibilidad discriminativa (β=1, p=0,009) ajustada por años de educación o edad en comparación con los controles. Conclusiones Se sugiere el desarrollo de políticas en materia de control, venta y uso de plaguicidas organofosforados, y de intervenciones con la población expuesta respecto a medidas de seguridad. Objective To evaluate organophosphate pesticide exposure and neuropsychological and motor performance in agricultural and non-agricultural workers in the Maule Region in Chile. Method Analytic cross-sectional study in 93 exposed farm workers and 84 unexposed non-agricultural workers. A battery of four neuropsychological tests was administered together with a neuro-motor physical examination. Results On the Weschler adult intelligence scale (WAIS-IV), exposed agricultural workers exhibited poorer performance than non-agricultural workers in verbal comprehension (β=−3.2; p=0.034) and processing speed (β=−4.4; p=0.036) and in the full scale (β=−4; p=0.016), as well as in discrimination sensitivity (β=1, p=0,009), adjusted by years of schooling and/or age. Conclusions We suggest the development of policies and regulations for the control, sale and use of organophosphate pesticides and intervention strategies on safety measures aimed at the exposed population.

      PubDate: 2016-02-24T12:27:49Z
  • ¿Tenemos presente en las instituciones sanitarias el consumo indebido
           de medicamentos con fines de dopaje?

    • Abstract: Publication date: Available online 20 February 2016
      Source:Gaceta Sanitaria
      Author(s): Raquel Vázquez Mourelle, Arantzazu López Pérez, Estrella López-Pardo Pardo, Sinda Blanco Lobeiras

      PubDate: 2016-02-24T12:27:49Z
  • Tiempo de estancia prolongado en los pacientes ingresados por
           insuficiencia cardiaca aguda

    • Abstract: Publication date: Available online 19 February 2016
      Source:Gaceta Sanitaria
      Author(s): Francisco Javier Martín-Sánchez, Virginia Carbajosa, Pere Llorens, Pablo Herrero, Javier Jacob, Òscar Miró, Cristina Fernández, Héctor Bueno, Elpidio Calvo, José Manuel Ribera Casado
      Objetivo Identificar los factores asociados al tiempo de estancia hospitalaria prolongado en pacientes ingresados/as por insuficiencia cardiaca aguda. Método Estudio observacional de cohorte multipropósito que incluyó pacientes del registro EAHFE (Epidemiology Acute Heart Failure in Emergency) ingresados/as por insuficiencia cardiaca aguda en 25 hospitales españoles. Se recogieron variables demográficas y clínicas, el día y el lugar del ingreso. La variable resultado principal fue el tiempo de estancia hospitalaria mayor que la mediana. Resultados Se incluyeron 2400 pacientes con una edad media de 79,5 (±9,9) años, de los cuales 1334 (55,6%) eran mujeres. Quinientos noventa (24,6%) ingresaron en la unidad de corta estancia (UCE), 606 (25,2%) en cardiología y 1204 (50,2%) en medicina interna o geriatría. La mediana del tiempo de estancia hospitalaria fue de 7,0 (intervalo intercuartílico: 4-11 días). Cincuenta y ocho (2,4%) pacientes fallecieron y 562 (23,9%) sufrieron un reingreso a los 30 días tras el alta. Los factores independientes asociados a un tiempo de estancia hospitalaria prolongado fueron la enfermedad pulmonar obstructiva crónica, ser portador de un dispositivo, tener un factor precipitante desconocido o no común, la presencia en urgencias de insuficiencia renal, hiponatremia y anemia, no ingresar en una UCE o no disponer de dicha unidad e ingresar un lunes, martes o miércoles; y los asociados a un tiempo de estancia hospitalaria ≤7 días fueron la hipertensión arterial y tener como factor precipitante una crisis hipertensiva o la falta de adherencia al tratamiento. El área bajo la curva del modelo mixto ajustado al centro fue de 0,78 (intervalo de confianza del 95%: 0,76-0,80; p <0,001). Conclusiones Hay una serie de factores asociados con un tiempo de estancia hospitalaria prolongado que deben ser considerados para la gestión del proceso de la insuficiencia cardiaca aguda. Objective To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Methods Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. Results We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p<0.001).
      PubDate: 2016-02-24T12:27:49Z
  • Cómo evaluar y reducir desigualdades sociales en los programas de
           cribado de cáncer

    • Abstract: Publication date: Available online 23 February 2016
      Source:Gaceta Sanitaria
      Author(s): Gemma Binefa, Montse García, Rosana Peiró, Ana Molina-Barceló, Raquel Ibáñez
      Esta nota de campo presenta las conclusiones y recomendaciones elaboradas en el encuentro «¿Cómo reducir las desigualdades sociales en los programas de cribado de cáncer», celebrado en la XXVI Escuela de Salud Pública de Mahón (Menorca). Los participantes elaboraron recomendaciones a partir de las experiencias de los programas de cribado poblacionales de cáncer de mama y colorrectal, y del cribado oportunista de cáncer de cuello uterino. Las conclusiones y recomendaciones se centraron en cuatro grandes áreas (sistemas de información, evaluación y calidad, investigación e intervenciones): incorporar variables sociales individuales en los sistemas de información sanitarios; establecer unos estándares mínimos de recogida de información que permitan conocer las desigualdades en el acceso a los servicios preventivos; realizar acciones en población vulnerable; y promover el intercambio de experiencias y buenas prácticas a través de la Red de Programas de Cribado de Cáncer y de grupos de trabajo de sociedades científicas. This field note presents the conclusions and recommendations made at the meeting ‘How to reduce social inequalities in cancer screening programmes?’ held at the XXVI School of Public Health of Mahon (Menorca, Spain). Participants developed recommendations based on experiences of population-based screening programmes (breast and colorectal) and opportunistic screening (cervical). The conclusions and recommendations focused on four main areas (information systems, evaluation and quality, research, and interventions): the inclusion of social variables at an individual level in health information systems; the establishment of minimum standards for gathering information regarding inequalities in access to preventive services; the performance of actions in vulnerable populations; and the promotion of the exchange of experiences and best practices through the Cancer Screening Programmes Network and working groups of the scientific societies.

      PubDate: 2016-02-24T12:27:49Z
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