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PUBLIC ADMINISTRATION (182 journals)                 | Last

Showing 1 - 200 of 357 Journals sorted alphabetically
Academy of Management Annals, The     Full-text available via subscription   (Followers: 41)
Accounting and the Public Interest     Full-text available via subscription   (Followers: 1)
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: 16)
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   (Followers: 1)
Cadernos Gestão Pública e Cidadania     Open Access  
Canadian Public Administration/Administration Publique Du Canada     Hybrid Journal   (Followers: 9)
Cities     Hybrid Journal   (Followers: 12)
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: 8)
Cuadernos de Administración     Open Access  
Cuadernos de Relaciones Laborales     Open Access   (Followers: 1)
Der Staat     Full-text available via subscription   (Followers: 12)
Die Verwaltung     Full-text available via subscription   (Followers: 9)
Économie publique/Public economics     Open Access   (Followers: 2)
eJournal of eDemocracy and Open Government     Open Access   (Followers: 7)
eJournal of Public Affairs     Open Access  
Electronic Government, an International Journal     Hybrid Journal   (Followers: 15)
Electronic Journal of e-Government     Full-text available via subscription   (Followers: 5)
Éthique publique     Open Access  
Études rurales     Open Access   (Followers: 2)
EURE (Santiago) - Revista Latinoamericana de Estudios Urbano Regionales     Open Access  
European Journal of Government and Economics     Open Access   (Followers: 3)
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: 3)
Future Studies Research Journal : Trends and Strategies     Open Access   (Followers: 1)
Gaceta Sanitaria     Open Access   (Followers: 3)
Georgia Journal of Public Policy     Open Access   (Followers: 1)
Gestión y Política Pública     Open Access   (Followers: 1)
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 12)
Governance     Hybrid Journal   (Followers: 51)
Government Information Quarterly     Hybrid Journal   (Followers: 21)
Government News     Full-text available via subscription   (Followers: 2)
Growth and Change     Hybrid Journal   (Followers: 4)
Headmark     Full-text available via subscription   (Followers: 1)
Human Resource Development Quarterly     Hybrid Journal   (Followers: 14)
Human Service Organizations Management, Leadership and Governance     Hybrid Journal   (Followers: 22)
Ids Working Papers     Hybrid Journal   (Followers: 2)
IMIESA     Full-text available via subscription  
Indonesian Journal of Community Engagement     Open Access  
International Affairs and Global Strategy     Open Access   (Followers: 8)
International Journal of Electronic Government Research     Full-text available via subscription   (Followers: 3)
International Journal of Environmental Policy and Decision Making     Hybrid Journal   (Followers: 8)
International Journal of Information Systems for Crisis Response and Management     Full-text available via subscription   (Followers: 4)
International Journal of Leadership in Public Services     Hybrid Journal   (Followers: 6)
International Journal of Public Administration     Hybrid Journal   (Followers: 15)
International Journal of Public Sector Performance Management     Hybrid Journal   (Followers: 8)
International NGO Journal     Open Access   (Followers: 3)
International Review of Public Administration     Hybrid Journal   (Followers: 6)
International Tax and Public Finance     Hybrid Journal   (Followers: 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: 10)
Journal of European Public Policy     Hybrid Journal   (Followers: 39)
Journal of Higher Education Outreach and Engagement     Open Access   (Followers: 10)
Journal of Management & Organization     Full-text available via subscription   (Followers: 338)
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: 23)
Journal of Public Administration and Governance     Open Access   (Followers: 18)
Journal of Public Administration and Policy Research     Open Access   (Followers: 1)
Journal of Public Administration Research and Theory     Hybrid Journal   (Followers: 22)
Journal of Science and Sustainable Development     Full-text available via subscription   (Followers: 1)
Journal of Social and Administrative Sciences     Open Access  
Journal of Social Work Education     Hybrid Journal   (Followers: 7)
Jurnal Ilmiah Administrasi Publik     Open Access  
Just Policy: A Journal of Australian Social Policy     Full-text available via subscription   (Followers: 9)
Law and Administration in Post-Soviet Europe : The Journal of Kolegium Jagiellonskie Torunska Szkola Wyzsza     Open Access  
Law, Democracy & Development     Open Access   (Followers: 4)
Law, Innovation and Technology     Hybrid Journal   (Followers: 10)
Liinc em Revista     Open Access  
Local Government Studies     Hybrid Journal   (Followers: 7)
Macramè. Trame e ritagli dell’urbanistica     Open Access  
Middle East Law and Governance     Hybrid Journal   (Followers: 6)
National Civic Review     Hybrid Journal  
NISPAcee Journal of Public Administration and Policy     Open Access   (Followers: 4)
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: 4)
PLOS Currents : Outbreaks     Open Access   (Followers: 2)
Policy & Internet     Hybrid Journal   (Followers: 10)
Policy Sciences     Hybrid Journal   (Followers: 6)
Policy Studies     Hybrid Journal   (Followers: 10)
Policy Studies Journal     Hybrid Journal   (Followers: 5)
Politeia     Full-text available via subscription   (Followers: 1)
Politics and Governance     Open Access   (Followers: 4)
Politiques et Management Public     Open Access  
Poverty & Public Policy     Hybrid Journal   (Followers: 12)
Prawo Budżetowe Państwa i Samorządu     Open Access  
Prison Journal     Hybrid Journal   (Followers: 14)
Public Administration     Hybrid Journal   (Followers: 27)
Public Administration & Development     Hybrid Journal   (Followers: 13)
Public Administration Review     Hybrid Journal   (Followers: 31)
Public Choice     Hybrid Journal   (Followers: 17)
Public Infrastructure Bulletin     Open Access   (Followers: 3)
Public Organization Review     Hybrid Journal   (Followers: 3)
Public Personnel Management     Hybrid Journal   (Followers: 10)
Public Policy     Full-text available via subscription   (Followers: 13)
Public Policy and Administration     Hybrid Journal   (Followers: 16)
Public Policy And Administration     Open Access   (Followers: 11)
Public Policy and Administration Research     Open Access   (Followers: 13)
Public Policy Research     Hybrid Journal   (Followers: 8)
Public Sector     Full-text available via subscription   (Followers: 5)
Public Works Management & Policy     Hybrid Journal   (Followers: 8)
Publius: The Journal of Federalism     Hybrid Journal   (Followers: 5)
Pyramides     Open Access  
Qualit@s Revista Eletrônica     Open Access  
RACE - Revista de Administração, Contabilidade e Economia     Open Access   (Followers: 1)
REAd : Revista eletrônica de administração     Open Access  
Regards sur l'économie allemande     Open Access  
Regional Science Policy & Practice     Hybrid Journal   (Followers: 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 Geral     Open Access  
Revista de Administração IMED     Open Access   (Followers: 1)
Revista de Administração Pública     Open Access  
Revista de Carreiras e Pessoas (ReCaPe)     Open Access  
Revista de Ciências da Administração     Open Access  
Revista de Evaluación de Programas y Políticas Públicas     Open Access  
Revista de Políticas Públicas     Open Access  
Revista Desenvolvimento Social     Open Access  
Revista Enfoques: Ciencia Política y Administración Pública     Open Access  
Revista Eurolatinoamericana de Derecho Administrativo     Open Access  
Revista Gestão e Desenvolvimento em Contexto     Open Access  
Revista Mexicana de Análisis Político y Administración Pública     Open Access  
Revista Panamericana de Salud Pública     Open Access  
Revista Pensamento Contemporâneo em Administração     Open Access  
Risk, Hazards & Crisis in Public Policy     Hybrid Journal   (Followers: 6)
Rivista trimestrale di scienza dell'amministrazione     Full-text available via subscription  
Singapore Economic Review, The     Hybrid Journal   (Followers: 6)
Skills at Work : Theory and Practice Journal     Full-text available via subscription  
Social Policy & Administration     Hybrid Journal   (Followers: 16)
Social Service Review     Full-text available via subscription   (Followers: 9)
Social Work Education: The International Journal     Hybrid Journal   (Followers: 10)
SourceOCDE Gouvernance     Full-text available via subscription   (Followers: 1)
SourceOECD Governance     Full-text available via subscription  
South Asian Journal of Macroeconomics and Public Finance     Hybrid Journal   (Followers: 3)
Sri Lanka Journal of Development Administration     Open Access  
State and Local Government Review     Hybrid Journal   (Followers: 5)
Statistics and Public Policy     Open Access   (Followers: 2)
Studi Organizzativi     Full-text available via subscription  
Surveillance and Society     Open Access   (Followers: 8)
Sustaining Regions     Full-text available via subscription  
Tax Breaks Newsletter     Full-text available via subscription   (Followers: 3)
TAXtalk     Full-text available via subscription   (Followers: 2)
Teaching Public Administration     Hybrid Journal   (Followers: 3)
The Philanthropist     Open Access   (Followers: 1)
The Police Journal     Full-text available via subscription   (Followers: 397)
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: 0.397]   [H-I: 31]   [3 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0213-9111
   Published by Elsevier Homepage  [3039 journals]
  • Impacto del abuso sexual durante la infancia-adolescencia en las
           relaciones sexuales y afectivas de mujeres adultas

    • Abstract: Publication date: Available online 15 September 2016
      Source:Gaceta Sanitaria
      Author(s): Sílvia López, Concepció Faro, Lourdes Lopetegui, Enriqueta Pujol-Ribera, Mònica Monteagudo, Jesús Cobo, María Isabel Fernández
      Objetivo Analizar la satisfacción sexual percibida, las disfunciones sexuales, la satisfacción con las relaciones afectivas, la confianza y la comunicación con la pareja actual, en función del antecedente de abuso sexual en la infancia y la adolescencia, y el tipo padecido, en mujeres atendidas dentro del Programa de Atención a la Salud Sexual y Reproductiva de Catalunya (PASSIR). Método Estudio multicéntrico, descriptivo y transversal. Participaron 1013 mujeres mayores de 18 años, atendidas en visita psicológica en los 24 Centros del PASSIR. Se utilizó un cuestionario estructurado autoadministrado y anónimo adaptado del Cuestionario de abuso sexual en la infancia y adolescencia de Wyatt (1985) y Dubé et al. (2005), y el Female Sexual Function Index de Rosen (2000). Análisis estadístico descriptivo, bivariado y multivariado. Resultados Todas las disfunciones sexuales resultaron significativamente más frecuentes en las mujeres que padecieron abuso sexual en la infancia y la adolescencia, y la satisfacción sexual percibida fue menor. Las situaciones de abuso sexual con intento de penetración o penetración se asociaron a más dificultades de excitación y mayor rechazo. Las mujeres que sufrieron abuso sexual en la infancia y la adolescencia manifestaron menos confianza y más dificultades de comunicación con la pareja. Conclusiones Es necesario identificar un posible abuso sexual en la infancia y la adolescencia en las mujeres que consultan por problemas con sus parejas, y continuar investigando sobre factores protectores e intervenciones terapéuticas tendentes a paliar las consecuencias de dicho abuso al llegar a la vida adulta. Objective To analyse perceived sexual satisfaction, sexual dysfunction, satisfaction with affective relationships and confidence and communication in existing relationships, related to a past history of childhood sexual abuse (CSA) and type suffered, among women treated as part of the Catalonian Sexual and Reproductive Health Care Programme (PASSIR). Method Multicentric, descriptive, cross-sectional study. A total of 1,013 women over the age of 18 years, who underwent psychological therapy at any of the 24 PASSIR centres, were enrolled. A structured, anonymised, self-administered Sex History Questionnaire adapted from Wyatt (1985) & Dubé et al. (2005), and the Female Sexual Function Index (Rosen, 2000), were used. Statistical analysis was descriptive, bivariate and multivariate. Results Women who suffered childhood sexual abuse had a significantly higher prevalence of sexual dysfunction, with lower perceived sexual satisfaction. CSA with penetration or attempted penetration was associated with greater arousal difficulties and greater rejection. Women who experienced CSA were less confident and experienced greater communication difficulties with their partner. Conclusions It is necessary to identify potential childhood sexual abuse among women who seek therapy due to relationship problems. It is also necessary to continue research into protective factors and therapeutic interventions to alleviate the consequences of CSA in adult life.

      PubDate: 2016-09-17T15:34:01Z
  • Rotación en la OMS, el sueño cumplido de un especialista

    • Abstract: Publication date: Available online 12 September 2016
      Source:Gaceta Sanitaria
      Author(s): José Luis Carretero Ares

      PubDate: 2016-09-17T15:34:01Z
  • Análisis de las buenas prácticas de participación ciudadana en las
           unidades de gestión clínica del Servicio Andaluz de Salud

    • Abstract: Publication date: Available online 14 September 2016
      Source:Gaceta Sanitaria
      Author(s): M. Eugenia Gómez Martínez, Guadalupe Pastor Moreno, Olivia Pérez Corral, M. Teresa Iriarte de los Santos, Ángel Luis Mena Jiménez, M. Cecilia Escudero Espinosa, Inmaculada García Romera, Martín Germán Blanco García, Amelia Martín Barato
      Objetivo Conocer buenas prácticas de participación ciudadana en las unidades de gestión clínica (UGC) del Servicio Andaluz de Salud (SAS) y explorar factores percibidos por profesionales de UGC del SAS que pueden influir en la existencia y la distribución de buenas prácticas de participación ciudadana. Método Estudio con metodología mixta realizado en Andalucía en dos fases (2013-2015). En la fase 1 (estudio cuantitativo) se realizó un cuestionario online a directores/as de UGC con una comisión de participación ciudadana constituida. En la fase 2 (estudio cualitativo) se realizaron entrevistas semiestructuradas a profesionales del SAS con experiencia en participación ciudadana. Se realizó un análisis descriptivo de la información cuantitativa y un análisis de contenido semántico de la cualitativa. Resultados En la fase 1 participaron 530 UGC. Las prácticas de participación ciudadana implementadas con mayor frecuencia en las UGC están circunscritas a los niveles de información y consulta. Otras prácticas que suponen una mayor implicación y delegación ciudadana son secundarias. En la fase 2 se entrevistó a 12 profesionales. Los obstáculos identificados por los/las profesionales que pueden afectar a la distribución de buenas prácticas están relacionados con las creencias y las actitudes de la ciudadanía, los/las profesionales, el sistema sanitario y el contexto. Conclusiones Las principales prácticas de participación ciudadana en las UGC están relacionadas con los niveles más básicos de participación. No se reconocen claramente la manera y los mecanismos que facilitarían el empoderamiento ciudadano en el sistema sanitario. Objective To discover good practices for inhabitant participation in the clinical management units (CMUs) of the Andalusian Health Service (AHS) (Spain) and to explore the reasons perceived by CMU and AHS professionals that may influence the presence and distribution of those good practices among the CMU. Methods Study with mixed methodology carried out in Andalusia (Spain) in two phases (2013–2015). Firstly, an online survey was delivered to the Directors of the CMUs which had set up an inhabitant participation commission. In a second phase, a qualitative study was carried out through semi-structured interviews with professionals from the Andalusian Health Service with previous experience in inhabitant participation. A descriptive analysis of the quantitative information and a semantic content analysis of the qualitative information were carried out. Results 530 CMUs took part in the survey. The inhabitant participation practices more often implemented in the CMUs are those related to the informing and consultation levels. Twelve professionals were interviewed in the second phase. Other practices with higher inhabitant involvement and delegation are secondary. The barriers which were identified by professionals are related to the beliefs and attitudes of the inhabitants, the professionals, the health system and the environment. Conclusion The main practices for inhabitant participation i...
      PubDate: 2016-09-17T15:34:01Z
  • Factores relacionados con la calidad de vida en la adolescencia

    • Abstract: Publication date: Available online 25 August 2016
      Source:Gaceta Sanitaria
      Author(s): Marta Lima-Serrano, José Manuel Martínez-Montilla, María Dolores Guerra-Martín, Ana Magdalena Vargas-Martínez, Joaquín S. Lima-Rodríguez
      Objetivo Conocer la calidad de vida (CV) y su relación con estilos de vida en adolescentes de educación secundaria. Método Estudio observacional transversal con 256 estudiantes de 12 a 17 años de edad, de la provincia de Sevilla (España). Se utilizaron modelos de regresión lineal múltiple (p <0,05). Resultados Los chicos presentan mayor puntuación en diversas dimensiones de CV, relacionándose inversamente el ser chica y la CV física, psicológica, familiar y el índice general de CV (p <0,05). El funcionamiento familiar y la realización de actividad física se asociaron fuertemente a una mejor CV, en todas sus dimensiones. Los modelos multivariados fueron estadísticamente significativos y explicaron desde el 11% de variabilidad de la CV social hasta el 35% del Índice general de CV. Conclusiones Los hallazgos podrían ser útiles para el desarrollo de intervenciones de promoción de la salud escolar dirigidas a promover estilos de vida saludables y CV. Objective To determine quality of life (QoL) and its relationship to lifestyles in adolescents in high schools. Methods Cross-sectional, observational study with 256 students aged 12 to 17 in Seville (Spain). Multiple linear regression models were tested (p <0.05). Results The boys had higher scores in most of the QoL areas. The female gender was inversely related to physical, psychological, familial QoL areas and the general QoL index. Family functionality and performing physical activity were the factors most associated with better QoL in all areas. All multivariate models were statistically significant and explained from 11% of social QoL variability to 35% of the general QoL index. Conclusions The findings could be useful for developing interventions to promote health in schools, with the objective of promoting healthy lifestyles and QoL.

      PubDate: 2016-08-29T09:09:35Z
  • Indicadores contextuales para evaluar los determinantes sociales de la
           salud y la crisis económica española

    • Abstract: Publication date: Available online 21 August 2016
      Source:Gaceta Sanitaria
      Author(s): Andrés Cabrera-León, Antonio Daponte Codina, Inmaculada Mateo, Elena Arroyo-Borrell, Xavier Bartoll, María José Bravo, María Felicitas Domínguez-Berjón, Gemma Renart, Carlos Álvarez-Dardet, Marc Marí-Dell’Olmo, Julia Bolívar Muñoz, Marc Saez, Vicenta Escribà-Agüir, Laia Palència, María José López, Carme Saurina, Vanessa Puig, Unai Martín, Mercè Gotsens, Carme Borrell, Laura Serra Saurina, Luis Sordo, Amaia Bacigalupe, Maica Rodríguez-Sanz, Glòria Pérez, Albert Espelt, Miguel Ruiz, Mariola Bernal
      Objetivo Proporcionar indicadores para evaluar, en España y en sus comunidades autónomas, el impacto sobre la salud, sus determinantes sociales y las desigualdades en salud del contexto social y de la crisis económica más reciente. Métodos Basándonos en el marco conceptual de los determinantes de las desigualdades sociales en salud en España, identificamos indicadores secuencialmente a partir de documentos clave, Web of Science y organismos con estadísticas oficiales. La información recopilada dio lugar a un directorio amplio de indicadores que fue revisado por un panel de expertos. Posteriormente seleccionamos un conjunto de esos indicadores según un criterio geográfico y otro temporal: disponibilidad de datos según comunidades autónomas y al menos desde 2006 hasta 2012. Resultados Identificamos 203 indicadores contextuales sobre determinantes sociales de la salud y seleccionamos 96 (47%) según los criterios anteriores. De los indicadores identificados, el 16% no cumplieron el criterio geográfico y el 35% no cumplieron el criterio temporal. Se excluyó al menos un 80% de los indicadores relacionados con la dependencia y los servicios de salud. Los indicadores finalmente seleccionados cubrieron todas las áreas de los determinantes sociales de la salud. El 62% de estos no estuvieron disponibles en Internet. Alrededor del 40% de los indicadores se extrajeron de fuentes relacionadas con el Instituto Nacional de Estadística. Conclusiones Proporcionamos un amplio directorio de indicadores contextuales sobre determinantes sociales de la salud y una base de datos que facilitarán la evaluación, en España y sus comunidades autónomas, del impacto de la crisis económica sobre la salud y las desigualdades en salud. Objective To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. Methods Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organisations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. Results We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute.
      PubDate: 2016-08-25T09:05:26Z
  • ¿Cuánto saben los estudiantes del Grado en Medicina sobre la enfermedad
           de Chagas en España?

    • Abstract: Publication date: Available online 24 August 2016
      Source:Gaceta Sanitaria
      Author(s): José Manuel Ramos, Carlos Martorell, Ana Isabel López-Amorós, Miriam Navarro

      PubDate: 2016-08-25T09:05:26Z
  • Probabilidad de hospitalización según la salud mental de la población
           adulta española

    • Abstract: Publication date: Available online 24 August 2016
      Source:Gaceta Sanitaria
      Author(s): Virginia Basterra

      PubDate: 2016-08-25T09:05:26Z
  • Desprescripción de tratamientos de larga duración con bisfosfonatos para
           la osteoporosis en atención primaria en el País Vasco

    • Abstract: Publication date: Available online 24 August 2016
      Source:Gaceta Sanitaria
      Author(s): Arritxu Etxeberria, Josune Iribar, Javier Hernando, Ignacia Idarreta, Itziar Vergara, Carmela Mozo, Kalliopi Vrotsou, Joaquín Belzunegui, Arantxa Lekuona
      Objetivo Evaluar el impacto de una intervención multifactorial para promover la desprescripción de tratamientos con bisfosfonatos de duración superior a 5 años (BF5a) en la Comarca Gipuzkoa y compararlo con la intervención estándar en el resto de las organizaciones de servicios (OS) de Osakidetza. Métodos Estudio de evaluación del impacto de dos intervenciones con medida de resultados antes y después, con un seguimiento de 8 meses. Se incluyeron todos los pacientes de Osakidetza que en julio de 2013 tenían un tratamiento activo con BF5a (prescripción electrónica). La intervención estándar (9 OS) consistió en el envío de un documento de consenso sobre desprescripción de BF5a y en facilitar los identificadores de pacientes con BF5a para su revisión por el médico de atención primaria. La intervención multifactorial (Comarca Gipuzkoa) incluyó, además, un consenso local con los especialistas de referencia y sesiones de formación en los centros de salud. Resultados Se incluyeron 18.725 pacientes, el 94,7% mujeres. Con la intervención estándar, los porcentajes de desprescripción oscilaron entre el 26,4% (C. Bilbao) y el 49,4% (C. Araba), siendo del 37,2% en su conjunto. Con la intervención multifactorial la desprescripción fue del 44,6%, un 7,4% superior a la estándar (p <0,0001; intervalo de confianza del 95% [IC95%]: 5,4-9,4). Los desplazamientos a otros tratamientos fueron menos frecuentes con la intervención multifactorial, con una diferencia del 3,7% (p <0.0001; IC95%: −2,2 a −5,2). Conclusiones Las intervenciones estándar y multifactorial son muy efectivas para disminuir los tratamientos innecesarios con bisfosfonatos. La intervención multifactorial es más efectiva que la estándar, aunque más compleja de llevar a cabo. Objective To evaluate the impact of a multifactorial intervention to promote bisphosphonate deprescription after over 5 years of use (BF5y) in a health care organisation (HCO) in Gipuzkoa (Spain) and to compare it with the standard intervention in other HCOs in the Basque Health Service-Osakidetza. Methods An 8-month follow-up study (results from before and after) to assess the impact of two interventions. All patients from Osakidetza receiving BF5y treatment (electronic prescription) in July 2013 were included. The standard intervention (9 HCOs) consisted of mailing a consensus statement on BF5y deprescribing and facilitating patient identifiers with BF5y prescription for review by the primary care physician. The multifactorial intervention (Gipuzkoa) also included a local consensus with leading specialists and training sessions in health centres. Results 18,725 patients were included; 94.7% were women. Standard intervention deprescribing rates ranged from 26.4% (Bilbao) to 49.4% (Araba), being 37.2% overall. The multifactorial intervention deprescribing rate was 44.6%, 7.4% (p <0.0001; 95% confidence interval [95%CI]: 5.4–9.4) higher than standard intervention. Changes to other treatments were less common with the multifactorial intervention, with a difference of 3.7% (p <0.0001; 95%CI: −2.2 to −5.2). Conclusions Standard and multifactorial interventions are very effective in reducing unn...
      PubDate: 2016-08-25T09:05:26Z
  • Contra: el cribado del cáncer de pulmón con tomografía
           computarizada de baja dosis

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      Author(s): Alberto Ruano-Ravina, Alberto Fernández-Villar, Mariano Provencio-Pulla

      PubDate: 2016-08-14T08:55:28Z
  • Uso de customer relationship management para mejorar la atención
           sanitaria de la ciudadanía. Servicio Salud Andalucía 24 horas. Salud

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      Author(s): Manuel Quero, María Belén Ramos, Wilfredo López, Juan José Cubillas, José María González, José Luis Castillo
      Salud Responde es un centro de información y servicios de salud del Sistema Sanitario Público de Andalucía, que ofrece, entre otros, un servicio telefónico de atención sanitaria denominado Salud Andalucía 24 horas. El objetivo principal es informar y asesorar a la ciudadanía en materia de salud y sobre los recursos existentes de los servicios sanitarios. El servicio se basa en un customer relationship management que organiza la información en varios niveles de especialización y dependiendo de la dificultad de la consulta del ciudadano es atendida por diferentes perfiles de profesionales, ofreciendo una respuesta consensuada con profesionales de Salud Responde o con otros niveles de atención sanitaria. Salud Andalucía 24 horas ha dado respuesta a 457.168 pacientes desde finales de 2008 hasta el 1 de diciembre de 2015. Sus operadores han resuelto un 9,4% de las consultas y un 84,1% han sido resueltas por personal sanitario. Un 6,5% fueron derivados al servicio de urgencias. El 88,8% de quienes usaron el servicio no necesitaron ir a su médico de su centro de salud en menos de 24 horas, evitando así desplazamientos innecesarios. Salud Responde (in English: Healthline) is a Health Service and Information Centre of the taxpayer-funded Andalusian Health System (AHS) that offers a Telephone Health Advisory Service called SA24h, among other services. The main objective of SA24h is to inform and advise citizens on health issues and the available health resources of the AHS. SA24h has a Customer Relationship Management information technology tool that organises information at various levels of specialization. Depending on the difficulty of the query, the citizen is attended by professionals with distinct profiles, providing a consensual response within the professionals working within Salud Responde or within other healthcare levels of the AHS. SA24h provided responses to 757,168 patient queries from late 2008 to the end of 01/12/2015. A total of 9.38% of the consultations were resolved by the non-health professionals working at Salud Responde. The remaining 84.07% were resolved by health staff. A total of 6.5% of users were referred to accident and emergency facilities while 88.77% did not need to attend their general practitioner within the next 24hours, thus avoiding unnecessary visits to health care facilities.

      PubDate: 2016-08-14T08:55:28Z
  • Trans-fatty acid content of food products in Spain in 2015

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      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: 2016-08-14T08:55:28Z
  • Influencia de la duración de la estancia hospitalaria sobre la mortalidad
           tras el alta en pacientes mayores con patología médica aguda

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      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: 2016-08-14T08:55:28Z
  • Prevalence and profile of alcohol consumption among university students in

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      Author(s): Pablo Ruisoto, Raúl Cacho, José J. López-Goñi, Silvia Vaca, Marco Jiménez
      Objective Alcohol consumption is one of the main health and social problems in Ecuador. The aim of this study was to explore gender differences in the prevalence and psychosocial profile of problematic consumers among university students. Method We surveyed 3,232 students by using the AUDIT and psychosocial scales. To discriminate the explanatory value of each variable, a CHAID segmentation analysis was used. Results The prevalence of alcohol consumption was 92.24% in men and 82.86% in women. In total, 49.73% of men and 23.80% of women reported problematic consumption. In men, the profile of problematic consumption was defined by higher scores in anxiety and depression, especially if they showed higher levels of psychological stress and lower life engagement. In women, problematic consumption showed a tendency towards psychological inflexibility, especially in those with lower life engagement. Conclusion There is a need to prioritise attention to alcohol consumption in university students and to design different interventions for men and women.

      PubDate: 2016-08-14T08:55:28Z
  • The use of clinical practice guidelines in primary care: professional
           mindlines and control mechanisms

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      Author(s): Joan Gené-Badia, Pedro Gallo, Jordi Caïs, Emília Sánchez, Carme Carrion, Liliana Arroyo, Marta Aymerich
      Objective To identify the relevant barriers and enablers perceived by primary care professionals in implementing the recommendations of clinical practice guidelines (CPG). Methods Two focus groups were conducted with primary care physicians and nurses in Catalonia (Spain) between October and December 2012. Thirty-nine health professionals were selected based on their knowledge and daily use of CPG. Finally, eight general practitioners and eight nurses were included in the discussion groups. Participants were asked to share their views and beliefs on the accessibility of CPG, their knowledge and use of these documents, the content and format of CPG, dissemination strategy, training, professional-patient relationship, and the use of CPG by the management structure. We recorded and transcribed the content verbatim and analysed the data using qualitative analysis techniques. Results Physicians believed that, overall, CPG were of little practical use and frequently referred to them as a largely bureaucratic management control instrument that threatened their professional autonomy. In contrast, nurses believed that CPG were rather helpful tools in their day-to-day practice, although they would like them to be more sensitive to the current role of nurses. Both groups believed that CPG did not provide a response to most of the decisions they faced in the primary care setting. Conclusions Compliance with CPG recommendations would be improved if these documents were brief, non-compulsory, not cost-containment oriented, more based on nursing care models, sensitive to the specific needs of primary care patients, and integrated into the computer workstation.

      PubDate: 2016-08-14T08:55:28Z
  • Promoting social capital in an ageing society: a win-win proposition?

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      Author(s): Laura Coll-Planas

      PubDate: 2016-08-14T08:55:28Z
  • Inequalities in mental health in the working population of Spain: a
           National Health Survey-based study

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5
      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: 2016-08-14T08:55:28Z
  • Gaceta Sanitaria a primera vista

    • Abstract: Publication date: September–October 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 5

      PubDate: 2016-08-14T08:55:28Z
  • Características del uso inadecuado de medicamentos en pacientes
           pluripatológicos de edad avanzada

    • Abstract: Publication date: Available online 30 July 2016
      Source:Gaceta Sanitaria
      Author(s): Paula Carlota Rivas-Cobas, Nieves Ramírez-Duque, Mercedes Gómez Hernández, Juana García, Antonia Agustí, Xavier Vidal, Francesc Formiga, Alfonso López-Soto, Olga H. Torres, Antonio San-José
      Objetivo Analizar el uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. Método Estudio multicéntrico, observacional y prospectivo. Se reclutaron 672 pacientes mayores de 75 años hospitalizados en Medicina Interna entre abril de 2011 y marzo de 2012. Se utilizaron los criterios Beers, STOPP-START y ACOVE para detectar el uso inadecuado de medicamentos, y los resultados se compararon entre pacientes pluripatológicos y no pluripatológicos. Resultados De 672 pacientes incluidos, 419 (62%) eran pluripatológicos y el 89,3% de ellos presentaban un uso inadecuado de medicamentos, frente al 79,4% de los no pluripatológicos (p <0,01). El 40,3% de los pacientes pluripatológicos cumplía criterios de Beers, el 62,8% criterios STOPP, el 62,3% criterios START y el 65,6% criterios ACOVE. El uso inadecuado de medicamentos fue mayor en los pacientes pluripatológicos con independencia de la herramienta utilizada. Conclusiones La alta prevalencia de uso inadecuado de medicamentos en pacientes pluripatológicos hace necesario desarrollar estrategias para mejorar la adecuación farmacológica. Objective To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). Method Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. Results Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. Conclusions Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed.

      PubDate: 2016-08-04T08:46:45Z
  • Power and Glory: applying participatory action research in public health

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

      PubDate: 2016-08-04T08:46:45Z
  • Time trends in health inequalities due to care in the context of the
           Spanish Dependency Law

    • Abstract: Publication date: Available online 1 August 2016
      Source:Gaceta Sanitaria
      Author(s): Maria Salvador-Piedrafita, Davide Malmusi, Carme Borrell
      Objective In Spain, responsibility for care of old people and those in situations of dependency is assumed by families, and has an unequal social distribution according to gender and socioeconomic level. This responsibility has negative health effects on the carer. In 2006, the Dependency Law recognised the obligation of the State to provide support. This study analyses time trends in health inequalities attributable to caregiving under this new law. Methods Study of trends using two cross-sectional samples from the 2006 and 2012 editions of the Spanish National Health Survey (27,922 and 19,995 people, respectively). We compared fair/poor self-rated health, poor mental health (GHQ-12 >2), back pain, and the use of psychotropic drugs between non-carers, carers sharing care with other persons, and those providing care alone. We obtain prevalence ratios by fitting robust Poisson regression models. Results We observed no change in the social profile of carers according to gender or social class. Among women, the difference in all health indicators between carers and non-carers tended to decrease among those sharing care but not among lone carers. Inequalities tend to decrease slightly in both groups of men carers. Conclusions Between 2006 and 2012, trends in health inequalities attributable to informal care show different trends according to gender and share of responsibility. It is necessary to redesign and implement policies to reduce inequalities that take into account the most affected groups, such as women lone carers. Policies that strengthen the fair social distribution of care should also be adopted.

      PubDate: 2016-08-04T08:46:45Z
  • Costos directos de las hospitalizaciones por diabetes mellitus en el
           Instituto Mexicano del Seguro Social

    • Abstract: Publication date: Available online 3 August 2016
      Source:Gaceta Sanitaria
      Author(s): Leonardo Salas-Zapata, Lina Sofía Palacio-Mejía, Belkis Aracena-Genao, Juan Eugenio Hernández-Ávila, Emmanuel Salvador Nieto-López
      Objetivo Estimar para el Instituto los costos directos de las hospitalizaciones por diabetes mellitus y sus complicaciones en el Instituto Mexicano del Seguro Social. Método Se estimaron los costos hospitalarios de la atención a pacientes con diabetes mellitus utilizando los grupos relacionados por el diagnóstico en el Instituto Mexicano del Seguro Social (IMSS) entre 2008 y 2013, y los egresos hospitalarios de los códigos E10-E14 correspondientes a diabetes mellitus. Los costos se agruparon según características demográficas y afección principal, y se estimaron en dólares estadounidenses de 2013. Resultados Se registraron 411.302 egresos hospitalarios por diabetes mellitus, con un costo de 1563 millones de dólares. El 52,44% correspondieron a hombres y el 77,26% fueron por diabetes mellitus tipo 2. El mayor costo es atribuible a las complicaciones circulatorias periféricas (34,84%) y a las personas con 45-64 años de edad (47,1%). En el periodo analizado, los egresos disminuyeron un 3,84% y los costos totales un 1,75%. Las complicaciones que provocaron mayor variación de los costos fueron la cetoacidosis (50,70%), las oftálmicas (22,6%) y las circulatorias (18,81%). Conclusiones La atención hospitalaria de la diabetes mellitus representa un importante reto financiero para el IMSS, y más aún lo es el incremento en la frecuencia de las hospitalizaciones en población en edad productiva, que afecta a la sociedad en su conjunto, lo que sugiere la necesidad de fortalecer las acciones de control de las personas diabéticas con miras a prevenir complicaciones que requieran atención hospitalaria. Objective To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security Methods The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. Results 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). Conclusions Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care.

      PubDate: 2016-08-04T08:46:45Z
  • Reorientar los estudios normativos del desarrollo motor

    • Abstract: Publication date: Available online 26 July 2016
      Source:Gaceta Sanitaria
      Author(s): Tomás Caycho, Miguel Barboza-Palomino

      PubDate: 2016-07-30T08:36:15Z
  • Age and gender effects on the prevalence of poor sleep quality in the
           adult population

    • Abstract: Publication date: Available online 26 July 2016
      Source:Gaceta Sanitaria
      Author(s): Juan J. Madrid-Valero, José M. Martínez-Selva, Bruno Ribeiro do Couto, Juan F. Sánchez-Romera, Juan R. Ordoñana
      Objective Sleep quality has a significant impact on health and quality of life and is affected, among other factors, by age and sex. However, the prevalence of problems in this area in the general population is not well known. Therefore, our objective was to study the prevalence and main characteristics of sleep quality in an adult population sample. Methods 2,144 subjects aged between 43 and 71 years belonging to the Murcia (Spain) Twin Registry. Sleep quality was measured by self-report through the Pittsburgh Sleep Quality Index (PSQI). Logistic regression models were used to analyse the results. Results The prevalence of poor sleep quality stands at 38.2%. Univariate logistic regression analyses showed that women were almost twice as likely as men (OR: 1.88; 95% confidence interval [95%CI]: 1.54 to 2.28) to have poor quality of sleep. Age was directly and significantly associated with a low quality of sleep (OR: 1.05; 95%CI: 1.03 to 1.06). Conclusions The prevalence of poor sleep quality is high among adults, especially women. There is a direct relationship between age and deterioration in the quality of sleep. This relationship also appears to be more consistent in women.

      PubDate: 2016-07-30T08:36:15Z
  • Actitudes de los médicos hacia el problema de las pruebas y los
           procedimientos innecesarios

    • Abstract: Publication date: Available online 29 July 2016
      Source:Gaceta Sanitaria
      Author(s): José Luis Zambrana-García, Aquiles Lozano Rodríguez-Mancheño

      PubDate: 2016-07-30T08:36:15Z
  • Financiamiento de la investigación en pregrado en las facultades de
           medicina peruanas

    • Abstract: Publication date: Available online 27 July 2016
      Source:Gaceta Sanitaria
      Author(s): Carlos J. Toro-Huamanchumo, Laura R. Arce-Villalobos, Jorge Gonzales-Martínez, Alejandro Melgarejo-Castillo, Álvaro Taype-Rondán

      PubDate: 2016-07-30T08:36:15Z
  • Responsabilidad por pérdida de oportunidad asistencial en patología
           oncológica maligna en la medicina pública española

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

      PubDate: 2016-07-30T08:36:15Z
  • Effectiveness of an intervention to improve diabetes self-management on
           clinical outcomes in patients with low educational level

    • Abstract: Publication date: Available online 29 July 2016
      Source:Gaceta Sanitaria
      Author(s): Antonio Olry de Labry Lima, Clara Bermúdez Tamayo, Guadalupe Pastor Moreno, Julia Bolívar Muñoz, Isabel Ruiz Pérez, Mira Johri, Fermín Quesada Jiménez, Pilar Cruz Vela, Ana M. de los Ríos Álvarez, Miguel Ángel Prados Quel, Enrique Moratalla López, Susana Domínguez Martín, José Andrés Lopez de Hierro, Ignacio Ricci Cabello
      Objective To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. Methods 12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. Results The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference. Conclusions In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.

      PubDate: 2016-07-30T08:36:15Z
  • Cambios en el consumo de tabaco: auge del tabaco de liar e introducción
           de los cigarrillos electrónicos

    • Abstract: Publication date: Available online 29 July 2016
      Source:Gaceta Sanitaria
      Author(s): Marina Tarrazo, Mónica Pérez-Ríos, María I. Santiago-Pérez, Alberto Malvar, Jorge Suanzes, Xurxo Hervada
      Objetivo Valorar los cambios en el consumo de tabaco y estudiar de forma detallada el consumo de tabaco de liar y de cigarrillos electrónicos en la población gallega desde 2007 hasta 2015. Métodos Información aportada por cinco estudios transversales, independientes, realizados entre 2007 y 2015 en mayores de 15 años (n=8000/año). Se estimaron prevalencias de consumo, acompañadas de sus intervalos de confianza del 95%, global, en función del sexo y en grupo de edad, ámbito de residencia y nivel de estudios. Resultados La prevalencia de consumo de tabaco fue del 25,4% en 2007 y del 21,8% en 2015. En 2007, el 1,8% de los fumadores consumían tabaco de liar, y en 2015 eran el 18,6%. El consumo del tabaco de liar entre fumadores aumentó en todos los grupos estudiados. La prevalencia de consumo de cigarrillos electrónicos fue, en 2014 y 2015, del 0,7%. En el ámbito urbano es donde se observan prevalencias más altas de consumo de cigarrillos electrónicos. Conclusión Entre 2007 y 2015, la prevalencia de consumo de tabaco ha disminuido en Galicia y ha aumentado la prevalencia de fumadores que consumen tabaco de liar. El uso de cigarrillos electrónicos es bajo y más frecuente entre los fumadores, aunque no exclusivo. El auge del tabaco de liar y la introducción de los cigarrillos electrónicos reflejan la importancia de mantener sistemas de vigilancia que puedan identificar de forma inmediata cambios de comportamiento asociados al consumo de tabaco. Objective To assess changes in smoking prevalence and study roll-your-own (RYO) tobacco and e-cigarette use in the Galician population between 2007 and 2015. Methods Data were obtained from five independent, cross-sectional studies carried out in Galicia (Spain) between 2007-2015 in the population aged 16 and over (n=8,000/year). Prevalence of use was estimated, with 95% confidence intervals, overall, according to sex and by age group, area of residence and level of education. Results Smoking prevalence decreased from 25.4% in 2007 to 21.8% in 2015. In 2007, 1.8% of current smokers declared that they had smoked RYO tobacco, compared to 18.6% in 2015. Among smokers, RYO tobacco consumption increased across all demographic groups. In both 2014 and 2015, ever use of e-cigarettes was 0.7%. E-cigarette use was more frequent in urban settings. Conclusion Smoking prevalence decreased in Galicia between 2007 and 2015, and there has been rapid growth in the prevalence of RYO tobacco use. Although smokers are more likely to use e-cigarettes, both former and never smokers declared their use. The boom of RYO cigarettes and the emergence of e-cigarettes highlight the importance of having continuous surveillance systems to identify smoking behavioural changes.

      PubDate: 2016-07-30T08:36:15Z
  • El cribado del cáncer de pulmón mediante tomografía computarizada de
           baja dosis de radiación. Posición a favor

    • Abstract: Publication date: Available online 25 July 2016
      Source:Gaceta Sanitaria
      Author(s): Juan Bertó, Javier J. Zulueta

      PubDate: 2016-07-30T08:36:15Z
  • Protocolo del estudio sobre el efecto de la crisis económica en la

    • Abstract: Publication date: Available online 26 July 2016
      Source:Gaceta Sanitaria
      Author(s): Glòria Pérez, Mercè Gotsens, Laia Palència, Marc Marí-Dell’Olmo, M. Felicitas Domínguez-Berjón, Maica Rodríguez-Sanz, Vanessa Puig, Xavier Bartoll, Ana Gandarillas, Unai Martín, Amaia Bacigalupe, Elia Díez, Miguel Ruiz, Santiago Esnaola, Montserrat Calvo, Pablo Sánchez, Miguel Ángel Luque Fernández, Carme Borrell
      Se presenta el protocolo de los dos subestudios sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en España. Subestudio 1: describir la evolución de la mortalidad y la salud reproductiva entre 1990 y 2013 mediante un estudio longitudinal ecológico en las comunidades autónomas. Se analizarán los cambios producidos por la crisis económica en la tendencia de los indicadores de mortalidad y salud reproductiva utilizando datos panel (17 comunidades autónomas por años de estudio) y ajustando modelos de Poisson de efectos aleatorios. Subestudio 2: analizar las desigualdades según la privación socioeconómica en la mortalidad y en la salud reproductiva en varias zonas de España. Se realizará un estudio ecológico de tendencias en el cual se analizará la precrisis (1999-2003 y 2004-2008) y la crisis (2009-2013). Se ajustarán modelos de efectos aleatorios según Besag York y Mollié para estimar los indicadores de mortalidad y de salud reproductiva suavizados en secciones censales. The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999–2003 and 2004–2008) and crisis (2009–2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts.

      PubDate: 2016-07-30T08:36:15Z
  • La infección por virus Zika: una nueva emergencia de salud pública con
           gran impacto mediático

    • Abstract: Publication date: Available online 26 July 2016
      Source:Gaceta Sanitaria
      Author(s): Joan A. Caylà, Ángela Domínguez, Elena Rodríguez Valín, Fernando de Ory, Ana Vázquez, Claudia Fortuny
      La infección por virus Zika (VZ) está afectando intensamente a los países latinoamericanos y se ha convertido en una nueva epidemia mediática. Su posible asociación con microcefalia y síndrome de Guillain-Barré motivó que la Organización Mundial de la Salud (OMS) declarase el 1 de febrero de 2016 que esta epidemia constituye una emergencia de salud pública de importancia internacional. Los datos epidemiológicos muestran una incidencia creciente en países como Brasil y Colombia, y que la epidemia sigue expandiéndose por muchos otros países. Desde enero de 2007 hasta el 27 de abril de 2016, la OMS ha detectado transmisión autóctona en 55 países (en 42 de ellos ha sido el primer brote de Zika), y 1198 microcefalias y otros trastornos neurológicos en Brasil. Así mismo, durante 2015 y 2016, 13 países detectaron un incremento de los casos de síndrome de Guillain-Barré y de confirmación de VZ asociado a este. En relación a las microcefalias y otras graves alteraciones cerebrales en recién nacidos de madres afectadas por VZ, las investigaciones ya evidencian una relación causal. Clínicamente muchos casos son asintomáticos y el diagnóstico ofrece dificultades con otras arbovirosis. El control de vectores en España es prioritario, dada la existencia de Aedes albopictus (mosquito tigre). También se recomienda el diagnóstico precoz, evitar viajes a zonas endémicas, mantener relaciones sexuales protegidas y procurar que la prioridad política, que puede evitar que esta epidemia se convierta en una enfermedad endémica de alta prevalencia, no nos haga olvidar otros problemas de salud. Infection with Zika virus (ZV) has become a new epidemic, with great impact on the media, and is having a strong effect in Latin American countries. Its possible association with microcephaly and Guillain-Barré syndrome prompted the World Health Organization (WHO) to declare on 1 February 2016 that this epidemic is a public health emergency of international concern. Epidemiological data show an increasing incidence in countries like Brazil and Colombia, and that the epidemic is still expanding in many other countries. Between January 2007 and 27 April 2016, the WHO detected transmission in 55 countries (in 42 of these, this was the first outbreak of Zika) and 1,198 microcephalies and other neurological disorders in Brazil. Also, during 2015-2016, 13 countries detected an increase in Guillain-Barré syndrome and/or confirmation of ZV associated with Guillain-Barré syndrome. Research has already demonstrated a causal relationship between microcephaly and other serious brain disorders in newborns and ZV infection in the mother. Clinically, many cases are asymptomatic and it can be difficult to distinguish this diagnosis from that of other arboviruses. Vector control in Spain is a priority because of the presence of the Aedes albopictus (tiger mosquito). Early diagnosis is recommended, as is avoiding travel to endemic areas and unprotected sex, and ensuring that the high political profile, which can prevent this epidemic from becoming a high prevalence endemic disease, does not cause us to forget about other health problems.

      PubDate: 2016-07-30T08:36:15Z
  • Protocolo de estudio sobre condicionantes de desestabilización física y
           psicosocial en los mayores

    • Abstract: Publication date: Available online 9 July 2016
      Source:Gaceta Sanitaria
      Author(s): Sergio Benabarre Ciria, Mariano Rodríguez Torrente, Javier Olivera Pueyo, Teófilo Lorente Aznar, Soledad Lorés Casanova, Carmelo Pelegrín Valero, José Galindo Ortiz de Landazuri, Juan Valles Noguero
      Objetivo El principal objetivo del estudio es determinar los factores relacionados con la fragilidad y el desequilibrio de la estabilidad psicosocial en los mayores que residen en la comunidad. Métodos Estudio prospectivo multicéntrico sobre una muestra representativa de las personas mayores de 75 años que residen en la comunidad en la provincia de Huesca. Seguimiento a 5 años con evaluaciones periódicas semestrales. Entrevista individual estandarizada realizada por médicos de atención primaria entrenados para evaluar depresión, ansiedad, deterioro cognoscitivo, síntomas psicóticos, sarcopenia, red de apoyo social, dependencia para las actividades básicas e instrumentales de la vida diaria, gravedad física, riesgo de dependencia y calidad de vida. Evaluación a los 2 y 5 años después para cuantificar acontecimientos adversos: institucionalización, dependencia funcional o mortalidad. Se valorarán posibles factores de riesgo: sexo, edad, situación social, situación funcional, situación psíquica y gravedad física. Se diseñarán modelos predictivos y de cuantificación del riesgo individual para definir finalmente las personas mayores con alta fragilidad psicosocial y riesgo de desestabilización. Conclusiones Conociendo los posibles factores de riesgo, sería posible definir al anciano con gran riesgo o mayor fragilidad psicosocial, y aplicarlo a actividades preventivas dirigidas a reducir la fragilidad y los acontecimientos adversos asociados (institucionalización, mortalidad, etc.). Objective The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. Methods Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. Conclusions An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.).

      PubDate: 2016-07-11T04:40:23Z
  • Encuesta de acceso a servicios de salud para hogares colombianos

    • Abstract: Publication date: Available online 4 July 2016
      Source:Gaceta Sanitaria
      Author(s): Marcela Arrivillaga, Juan Carlos Aristizabal, Mauricio Pérez, Victoria Eugenia Estrada
      Objetivo Diseñar y validar una encuesta de acceso a servicios de salud dirigida a hogares en Colombia para aportar una herramienta metodológica de país que permita ir acumulando evidencia sobre las condiciones de acceso real que tiene la población colombiana. Método Se realizó un estudio de validación con personas expertas y prueba piloto aplicada en el municipio de Jamundí, en el departamento del Valle del Cauca, Colombia. Se realizó un muestreo probabilístico, polietápico, estratificado y por conglomerados. La muestra final fue de 215 hogares. Resultados La encuesta quedó conformada por 63 preguntas distribuidas en cinco módulos: perfil sociodemográfico del jefe/a del hogar o adulto/a informante, perfil socioeconómico del hogar, acceso a servicios preventivos, acceso a servicios curativos y de rehabilitación, y gasto de bolsillo en acceso. En términos descriptivos, la promoción de servicios preventivos solo alcanzó valores del 44%; el uso de estos servicios siempre fue mayor, en especial en los grupos del primer año de vida y hasta los 10 años. Para los servicios de urgencias y hospitalización, la percepción de atención de la necesidad estuvo entre el 82% y el 85%. No obstante, hubo percepción de mala y muy mala calidad de la atención hasta en un 36%. Por su parte, la oportunidad de la atención de consulta médica general y con especialista presentó demoras. Discusión La encuesta diseñada es válida, relevante y representativa del constructo acceso a servicios de salud en Colombia. En términos empíricos, la prueba piloto mostró debilidades institucionales en un municipio del país, indicando además que la cobertura en salud no significa acceso real y efectivo a los servicios. Objective The aim of this study was to design and validate a health services access survey for households in Colombia to provide a methodological tool that allows the country to accumulate evidence of real-life access conditions experienced by the Colombian population. Methods A validation study with experts and a pilot study were performed. It was conducted in the municipality of Jamundi, located in the department of Valle del Cauca, Colombia. Probabilistic, multistage and stratified cluster sampling was carried out. The final sample was 215 households. Results The survey was composed of 63 questions divided into five modules: socio-demographic profile of the head of the household or adult informant, household socioeconomic profile, access to preventive services, access to curative and rehabilitative services and household out of pocket expenditure. In descriptive terms, the promotion of preventive services only reached 44%; the use of these services was always highest among children younger than one year old and up to the age of ten. The perceived need for emergency medical care and hospitalisation was between 82% and 85%, but 36% perceived the quality of care to be low or very low. Delays were experienced in medical visits with GPs and specialists. Discussion The designed survey is valid, relevant and representative of access to health services in Colombia. Empirically, the pilot showed institutional weaknesses in a municipality of the country, indicating that health coverage does not in practice mean real and effective access to health services.
      PubDate: 2016-07-07T02:55:56Z
  • Immigration, tourism and the heart: a descriptive analysis of
           cardiovascular diseases in different populations

    • Abstract: Publication date: Available online 2 July 2016
      Source:Gaceta Sanitaria
      Author(s): Alejandro Salinas, José M. Ramos, Miguel Górgolas

      PubDate: 2016-07-07T02:55:56Z
  • Barreras percibidas en el desplazamiento activo al centro educativo:
           fiabilidad y validez de una escala

    • Abstract: Publication date: Available online 3 July 2016
      Source:Gaceta Sanitaria
      Author(s): Javier Molina-García, Ana Queralt, Isaac Estevan, Octavio Álvarez, Isabel Castillo
      Objetivo Examinar la fiabilidad y la validez de una escala para evaluar las barreras percibidas en el desplazamiento activo al centro escolar en jóvenes españoles. Método La validez de la escala fue evaluada en una muestra de 465 adolescentes (14-18 años de edad) mediante un análisis factorial confirmatorio y a través de la asociación con el transporte activo autorreportado. Una submuestra completó la escala dos veces, con una separación de una semana, a fin de evaluar su fiabilidad. Resultados Los resultados mostraron que la escala tenía índices de ajuste satisfactorios con dos factores. Un factor incluyó los ítems relativos a ambiente y seguridad (α=0,72), y otro los ítems sobre planificación y aspectos psicosociales (α=0,64). El transporte activo se relacionó significativamente con la puntuación total de la escala de barreras (rho=−0,27; p <0,001), con las barreras ambientales/seguridad (rho=−0,22; p <0,001) y con las barreras de planificación/psicosociales (rho=−0,29; p <0,001). Los test-retest (coeficiente de correlación intraclase) para las barreras mostraron valores entre 0,68 y 0,77. Conclusión La escala muestra una validez aceptable y una fiabilidad adecuada para evaluar las barreras en el transporte activo al centro educativo en jóvenes españoles. Objective To examine the reliability and validity of a scale to measure perceived barriers to active commuting to school among Spanish young people. Method The validity of the scale was assessed in a sample of 465 adolescents (14–18 years) using a confirmatory factor analysis and studying its association with self-reported active commuting to school. The reliability of the instrument was evaluated in a sub-sample that completed the scale twice separated by a one-week interval. Results The results showed that the barriers scale had satisfactory fit indices, and two factors were determined. The first included environment- and safety-related items (α=0.72), while the other concerned planning and psychosocial items (α=0.64). Active commuting to school showed significant correlations with the total score of the barriers scale (rho=−0.27; p <0.001), with the environmental/safety barriers (rho=−0.22; p <0.001), as well as with the planning/psychosocial barriers (rho=−0.29; p <0.001). Test-retest ICCs for the barriers ranged from 0.68 to 0.77. Conclusion The developed scale has acceptable validity and good reliability to assess barriers to active commuting to school among Spanish young people.

      PubDate: 2016-07-07T02:55:56Z
  • Las matronas y la alfabetización en salud relacionada con la vacunación,
           ¿un aspecto infrautilizado?

    • Abstract: Publication date: Available online 28 June 2016
      Source:Gaceta Sanitaria
      Author(s): Rafael Vila-Candel, Francisco Javier Soriano-Vidal, Enrique Castro-Sánchez

      PubDate: 2016-07-01T16:04:33Z
  • Cost-utility analysis of an integrated care model for multimorbid patients
           based on a clinical trial

    • Abstract: Publication date: Available online 29 June 2016
      Source:Gaceta Sanitaria
      Author(s): Itziar Lanzeta, Javier Mar, Arantzazu Arrospide
      Objective To conduct a cost-utility analysis on an integrated healthcare model comprising an assigned internist and a hospital liaison nurse for patients with multimorbidity, compared to a conventional reactive healthcare system. Methods A cluster randomised clinical trial was conducted. The model consisted of a reference internist and a liaison nurse, who aimed to improve coordination and communication between levels and to enhance continuity of care after hospitalisation. We recorded sociodemographic data, diagnoses and corresponding clinical categories, functional status, use of healthcare resources and quality of life. Data were collected by reviewing electronic medical records and administering questionnaires. We performed univariate and multivariate analyses both for utilities and total costs. Bootstrapping methods were applied to calculate the confidence ellipses of incremental costs and efficiency. Results We recruited a total of 140 patients. The model assessed was not found to be efficient in general. We found an incremental cost of €1,035.90 and an incremental benefit of −0.0762 QALYs for the initiative compared to standard care after adjusting for the main variables. However, the subgroup of patients under 80 years of age with three or more clinical categories resulted in an 89% cost saving in the simulations. Conclusions The integrated model was not suitable for all study patients. However, the subgroup analysis identified a narrow target population that should be analysed in future studies.

      PubDate: 2016-07-01T16:04:33Z
  • Discursos profesionales sobre la violencia del compañero íntimo:
           implicación en la atención de las mujeres inmigrantes en España

    • Abstract: Publication date: Available online 25 June 2016
      Source:Gaceta Sanitaria
      Author(s): Erica Briones-Vozmediano, M Carmen Davó-Blanes, Manuela García-de la Hera, Isabel Goicolea, Carmen Vives-Cases
      Objetivo 1) Explorar los discursos de los/las profesionales implicados/as en la atención a las mujeres que sufren violencia del compañero íntimo en cuanto a cómo describen a las mujeres inmigrantes afectadas, los agresores y su propia responsabilidad en la atención a este problema, y 2) comparar estos discursos entre los diferentes grupos profesionales implicados en la atención a dichas mujeres (servicios sociales, asociaciones y policial judicial). Métodos Estudio cualitativo basado en entrevistas semiestructuradas a 43 profesionales de servicios sociales, asociaciones y ámbitos policial y judicial. Se realizó un análisis del discurso para identificar repertorios interpretativos sobre la violencia del compañero íntimo, las mujeres inmigrantes y sus agresores, su cultura y las prácticas profesionales. Resultados Emergieron cuatro repertorios interpretativos en los discursos profesionales: «Prototipos culturales de mujeres afectadas por violencia del compañero íntimo», «Los agresores son similares independientemente de su cultura de origen», «¿Son las víctimas creíbles y los agresores responsables?» y «Falta de sensibilidad cultural de los/las profesionales para ayudar a las mujeres inmigrantes en situación de maltrato». Estos repertorios corresponden a los prototipos que los/las profesionales construyen de las mujeres afectadas y de sus agresores, la credibilidad y la responsabilidad que les atribuyen, y la interpretación de su propio rol profesional. Conclusiones La presencia de mediadores culturales con formación específica sobre violencia del compañero íntimo en los servicios implicados en la atención a las mujeres que la sufren, junto a la formación en competencias culturales de los/las profesionales, contribuirían a proporcionar una atención culturalmente sensible a las mujeres inmigrantes afectadas por violencia del compañero íntimo. Objective 1) to examine the discourses of professionals involved in the care of female victims of intimate partner violence (IPV), with emphasis on how they describe the immigrant women, the perpetrators and their own responsibility of care; and 2) to compare these discourses with the other professions involved in caring for these women (social services, associations and police and justice). Methods Qualitative study based on semi-structured interviews with 43 professionals from social services, associations and the police and judicial systems. A discourse analysis was carried out to identify interpretive repertoires about IPV, immigrant women and their aggressors, their culture and professional practices. Results Four interpretive repertoires emerged from professional discourses: “Cultural prototypes of women affected by IPV”, “Perpetrators are similar regardless of their culture of origin”, “Are victims credible and the perpetrators responsible?” and “Lack of cultural sensitivity of professionals in helping immigrant women in abusive situations”. These repertoires correspond to preconceptions that professionals construct about affected women and their perpetrators, the credibility and responsibility they attribute to them and the interpretation of their professional roles. Conclusions The employment of IPV-tra...
      PubDate: 2016-06-27T12:45:09Z
  • Opinions and practices regarding electronic cigarette use among Romanian
           high school students

    • Abstract: Publication date: Available online 25 June 2016
      Source:Gaceta Sanitaria
      Author(s): Lucia Maria Lotrean, Bianca Varga, Monica Popa, Cornel Radu Loghin, Milena Adina Man, Antigona Trofor
      Objective The study assessed awareness, opinions, practices regarding electronic cigarettes (e-cigarettes) and factors associated with their use among Romanian high school students. Methods A cross-sectional study was conducted in 2013 in two major Romanian cities, distributing anonymous questionnaires to 342 high school students aged 16–18. Results 52.3% of the smokers, 29.2% of the ex-smokers and 7% of the never-smokers had tried e-cigarettes at least once in their life; 7.8% of the smokers and 4.6% of the ex-smokers had used e-cigarettes in the last month. Among smokers, e-cigarette use was associated with lower participation in school health education regarding e-cigarettes and with having parents using e-cigarettes.. Among ex-smokers and never-smokers, e-cigarette use was associated with intention to use e-cigarettes in the next year and with having friends who use e-cigarettes. Conclusion Health education programmes and regulatory interventions addressing e-cigarettes are needed in Romania. More research is necessary on how to develop effective public health messages.

      PubDate: 2016-06-27T12:45:09Z
  • Intervención integral al paciente polimedicado

    • Abstract: Publication date: Available online 21 June 2016
      Source:Gaceta Sanitaria
      Author(s): Elena Rodríguez del Río, María Martínez Agüero, Lourdes Arias Fernández, Francisco Javier Martín-Sánchez

      PubDate: 2016-06-27T12:45:09Z
  • Gaceta Sanitaria a primera vista

    • Abstract: Publication date: July–August 2016
      Source:Gaceta Sanitaria, Volume 30, Issue 4

      PubDate: 2016-06-27T12:45:09Z
  • 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
  • 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
  • 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
  • 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
  • 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
  • Análisis de fiabilidad y validez de tres cuestionarios de autoinforme
           para valorar la actividad física realizada por adolescentes españoles

    • 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
  • 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
  • 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
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