Las desigualdades en salud como prioridad política en Barcelona

There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health.     

Tendencias en el consumo de alcohol en adolescentes escolarizados en España (2010-2018)

ObjectiveTo analyze trends in beer, wine, and distilled spirits consumption, as well as drunkenness among school-aged adolescents in Spain from 2010 to 2018 by sex and age.MethodThe sample is composed of 35,310 adolescents aged 15 to 18. The data is representative of the adolescent school population in Spain in 2010, 2014, and 2018. The alcohol consumption questionnaire and the drunkenness questionnaire provided by the international team of the study were employed. Prevalence Ratios and 95% confidence intervals were estimated using Poisson regression models with robust variance.Resultsthe data show a general decrease in alcohol consumption (beer, wine, as well as distilled spirits) and in drunkenness, but the decrease mainly occurs between 2010 and 2014. Sex differences (higher consumption and drunkenness among boys) are found among adolescents aged 17-18 but not in the age group of 15-16 years old. Older adolescents show higher levels of consumption and drunkenness than younger adolescents.ConclusionThe results confirm the relevance of carrying out specific analyses in order to identify risk groups which are not detected through general analyses. This data highlights the need to maintain alcohol prevention and control policies due to the risk of stabilization in alcohol-related behaviours.     

Hiperfrecuentación en Atención Primaria e hiperfrecuentadores en Urgencias

Objective

To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED).

Efectividad de las intervenciones basadas en telemedicina sobre resultados en salud en pacientes con multimorbilidad en atención primaria: revisión sistemática

ObjectiveTo evaluate the effectiveness of telemedicine interventions to improve health outcomes in patients with multiple morbidities in Primary Health Care.DesignA systematic review.Data sourcesINAHTA, Health Guidelines, NICE, Cochrane Library, Medline/PubMed and EMBASE up to April 2018.Study selectionInclusion criteria: patients (adults with 2 or more chronic diseases or a Charlson index greater than three); intervention (telemedicine intervention developed entirely in Primary Health Care); comparator (usual care); health outcomes (mortality, hospital admissions, emergency department visits, health-related quality of life, and satisfaction); study design(clinical practice guideline, systematic review, meta-analysis, randomised controlled clinical trial),and quasi-experimental design). English and Spanish language publication. A total of236 references were located.Data extractionDuplicated articles were removed. Titles, abstracts, and full text of references identified were assessed using the selection criteria; methodological quality assessment; data extraction, and qualitative analysis.ResultsFive articles, corresponding to 3 studies, were included, with 2 randomised controlled clinical trials and one quasi-experimental design. No significant results were observed in reducing mortality or improving health-related quality of life. The effectiveness of telemedicine on the number of hospital admissions or emergency visits showed contradictory results. Satisfaction was not measured in the studies included.ConclusionsThe relatively small number of studies, heterogeneity characteristics, and methodological limitations did not confirm the effectiveness of telemedicine intervention on the improvement of mortality, number of hospital admissions, emergency department visits, and health-related quality of life, compared to usual care.     

Inercia terapéutica en pacientes hipertensos asistidos en atención primaria en España. Estudio Objetivo Kontrol

ObjectivesTo determine the level of therapeutic inertia (TI), and the factors associated to the patient, doctor and the health organisation, in hypertensive patients treated in Primary Care (PC).DesignCross-sectional, multicentre study.SettingA sample of PC Teams from all over Spain.ParticipantsThe study was conducted among PC doctors using a questionnaire and clinical records of 4 patients.Main measurementsThe TI was calculated for each patient (TIp) as the proportion of visits in which there was no change in medication when this was indicated.ResultsA total of 543 PC doctors provided data on 2,032 patients, who fulfilled the indication of a change in requirement. There was TI In 77.8% of cases. The TIp observed was non-existent or low for 17.1% of the patients, intermediate for 42% and high for 40.8%. For the patients, the factors most associated with TIp were, age (P < .001), diabetes (P < .001), stroke (P < .01), obesity (P < .01) and a low education level (P < .001). To be female, be less than 40 years or more than 55 years, to be a family doctor with a training program other than MIR and to work in the public sector increased the probability of TIp (P < .001 for all the assumptions).ConclusionsThe results of the study indicate that there is TI in 7 out every 10 visits made by hypertensive patients in Primary care. There are significant differences as regards the clinical characteristics of the patients and of the doctors.     

Gesundheitsgefahren beim Schwei?en

Zusammenfassung Gesundheitsschädigungen durch das Schweißen kommen vor. BeimAutogenverfahren sind sie ausgesprochen selten, sofern wir von den Verbrennungen und andern unfallmäßigen Verletzungen absehen. BeimLichtbogenschweißen stehen die durch die Ultraviolettstrahlung hervorgerufenenAugenschäden im Vordergrund. GesteigerteOzonbildung vermag Schädigungen an den Atemschleimhäuten zu setzen. Trotz gelegentlich erhöhter Konzentrationen vonnitrosen Gasen gab es bis jetzt nur höchst selten ernsthafte Zwischenfälle. Dasselbe gilt vomKohlenoxyd (CO). In den Schweißrauchen spielt dasEisenoxyd mengenmäßig die größte Rolle, führt aber nur sehr selten zu Schädigungen. Die durch Eisen hervorgerufenen Lungenverstaubungen (Siderosen) erreichen nur sehr geringe Grade. Eventuell beeinflußt das aufgenommene Eisenoxyd den Zustand der Magenschleimhaut ungünstig. Häufiger sind Vergiftungen durchZink- undBleirauche. Chronische Staubschädigungen der Lungen — analog der Silikose — wurden bis jetzt nicht beobachtet. Allgemeinvergiftungen durch Fluor oder Mangan wurden unseres Wissens nie gesehen.Erkrankungen der obern Luftwege (Nase, Rachen) sind gemäß Reihenuntersuchungen häufiger als bei andern Berufen. Dafür könnten die Verbrennungsrauche der Elektroden und ihrer Ummantelungen verantwortlich sein. Auch Tabakgenuß und allgemeine Klimafaktoren können aber hier von Bedeutung sein. EntzündlicheSchädigungen der tiefern Luftwege (Bronchitiden) kommen nur unter ungünstigen Arbeitsbedingungen gelegentlich vor.Starkstromunfälle sind selten. Für die Vorbeugung von Schäden ist wichtig das Abführen der Schweißrauche durch eine geeignete natürliche oder künstliche Ventilation.

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Résumé Les effets nocifs de la soudure sur la santé sont très rares dans lasoudure autogène si on fait abstraction de brûlures ou d'autres blessures accidentelles. Dans lasoudure à l'arc lesaffections oculaires provoquées par les rayons ultraviolets sont les plus importantes. L'augmentation de laformation d'ozone peut entraîner des affections des muqueuses respiratoires. Malgré des concentrations parfois élevées degaz nitreux il n'a été observé que très rarement des ennuis consécutifs sérieux; il en est de même del'oxyde de carbone. Dans les fumées dues à la soudure l'oxyde de fer est quantitativement le facteur dominant, mais ne provoque que très rarement des affections. Les pneumoconioses dues au fer (sidéroses) n'atteignent que des degrés bénins. Il est possible quel'oxyde de fer absorbé ait des effets défavorables sur la muqueuse gastrique. Les intoxications parvapcurs de plomb et de zinc sont plus fréquentes. Jusqu'à ce jour on n'a pas observé de pneumoconioses chroniques semblables à la silicose, ni d'intoxications générales par fluor ou parmanganèse. Des examens en série révèlent que lesmaladies des voics respiratoires supérieures (nez, gorge) sont plus fréquentes parmi les soudeurs à l'électricité que dans les autres professions, ce dont les vapeurs dégagées par la combustion des électrodes et de leur revêtement pourraient être responsables. La fumée de tabac et des facteurs climatiques généraux peuvent jouer un rôle. Lestroubles inflammatoires des voies respiratoires inférieures (bronchites) ne se produisent que dans de mauvaises conditions de travail. Les accidents provoqués par lahaute tension sont rares.La prévention des affections peut être assurée par l'aspiration des fumées de soudure au moyen d'une ventilation naturelle ou artificielle adéquate.

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Vortrag gehalten am 22. Juni 1960 vor der «Studiengruppe für Gesundheitsschutz in Industrie und Gewerbe» in Zürich.     

Competencias y contenidos de salud pública en los programas del Grado en Veterinaria en las universidades españolas

ObjectiveTo reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into the Veterinary Medicine degree training.MethodsThe 3 rd Forum of University Professors of Public Health was held at the School of Veterinary Medicine of the University of Cordoba (12-13 January 2016). Forty-two university professors and lecturers from nine Spanish universities with veterinary degrees participated in the forum. They were divided into five working groups during three working sessions to identify and classify core public health competencies for the Veterinary Medicine degree, propose public health contents for the identified competencies and organize such contents in thematic blocks. The results were discussed in different plenary sessions.ResultsThe highest number of core competencies was identified in the activities related to the following public health functions: «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organized into five units: 1) Fundamentals of public health; 2) Study and research in public health; 3) Production, animal health and environment; 4) Food security; and 5) Health education.ConclusionsThe public health core competencies and contents identified in this Forum may be considered as a starting point to update public health training programmes for future veterinary professionals.     

Prise en charge nutritionnelle périopératoire en chirurgie de l'adulte

Over the past ten years, perioperative nutritional support has adapted with the preferential use of the oral and enteral route, earlier introduction of the postoperative enteral nutrition, using adapted digestive accesses, and the evidence of the additional benefits provided by the use of perioperative immunonutrition during surgery for cancer. In the case of severe trauma, the use of glutamine-supplemented enteral nutrition provides the best clinical outcome. In the case of postoperative complications handled in the intensive care unit, the nutritional support can also be optimized by the supplementation with glutamine and the use of antioxydant micronutrients. Several meta analysis and cost-effectiveness studies indicate that the intensification and the optimization of the perioperative nutrition, in particular by the use of a pharmaconutrients, favourably influences clinical outcome and can be cost-efficient. Finally, with the new concept of the metabolic conditioning, it appears that even in the absence of malnutrition or major surgery, an immediate preoperative pharmaconutritional conditioning, the reduction of the preoperative fast or a post-operative oral supplementation can significantly improve functional recovery and reduce the rate of post-operative complications.     

Alimentación y nutrición en atención primaria en Brasil

Objective

To describe food and nutrition actions in primary health care in Brazil.

La precariedad laboral en inmigrantes en situación irregular en España y su relación con la salud

ObjectiveTo describe the characteristics of precarious employment in undocumented immigrants in Spain and its relationship with health.MethodsA qualitative study was conducted using analytic induction. Criterion sampling, based on the Immigration, Work and Health project (Inmigración, Trabajo y Salud [ITSAL]) criterion (current definitions of ‘legal immigrant’ in Spain and in the literature) was used to recruit 44 undocumented immigrant workers from four different countries, living in four Spanish cities.ResultsThe characteristics of precariousness perceived by undocumented immigrants included high job instability; disempowerment due to lack of legal protection; high vulnerability exacerbated by their legal and immigrant status; perceived insufficient wages and lower wages than coworkers; limited social benefits and difficulty in exercising their rights; and finally, long hours and fast-paced work. Our informants reported they had no serious health problems but did describe physical and mental problems associated with their employment conditions and legal situation.ConclusionsOur results suggest that undocumented immigrants’ situation may not fit the model of precarious employment exactly. However, the model's dimensions can be expanded to better represent undocumented immigrants’ situation, thus strengthening the general model. Precarious employment in this group can be defined as «extreme», as it affects their working and social lives. If these workers continue to be exposed to such precarious conditions, the impact on their health may increase.