Evaluación de políticas y planes de salud

Evaluation of plans and policies is a key element in their administration and must be performed under real conditions. Such evaluation is complex, as plans and policies include a diverse set of components that operate simultaneously. Moreover, external factors frequently influence those same issues that programs attempt to change. Unless plans and policies are evaluated under real conditions, a policy that effectively reduces the effects of a problem may be deemed ineffective (if the problem increases due to the influence of factors the program does not attempt to affect), or a policy that is unable to influence the problem it attempts to solve may be judged useful (if the magnitude of the problem is being reduced through the influence of factors other than the policy). The present article discusses evaluation of health policies, plans or complex programs, with emphasis on effectiveness assessment, using data from real examples. Among other issues, the need to identify the distinct components of policies and plans is reviewed. This article also describes how to evaluate the outcome or results of a program with indicators from other sources. Aspects related to the timing of evaluation and assessment indicators are analyzed. We discuss situations in which the launch of a new policy or intervention is followed by an increase in the reported magnitude of the problem it attempts to solve. These situations are illustrated by cases in which this increase is attributable to improved detection and by others in which the increase is related to factors external to the intervention. The frequent confusion of the effects of the intervention with other events is covered, with data from some examples. Finally, evaluation of plans that include a wide range of objectives is also addressed.     

Manejo en atención primaria de las infecciones de transmisión sexual (I). Epidemiología. Síndrome secretor

These days sexually transmitted infections (STIs) are important public health problems not only due to their high prevalence, but also because they require early diagnosis and treatment to avoid complications.In recent years, there has been an exponential increase in cases of infections caused by Chlamydia trachomatis and gonococcus in the population under 25 years of age. In addition, an increase in the incidence of syphilis and hepatitis C (HCV) has also been detected, especially in men who have sex with other men (MSM).Genital herpes continues to be the second most frequent STI in the world, behind condyloma acuminata, and the first cause of genital ulcer among Spain in the sexually active population.A decrease in reported HIV cases was observed during 2020, but almost half of these new cases had a late diagnosis (< 350 CD4 cell/μL).Current guidelines recommend offering STI annual screening to populations at risk or more often depending on the risk.STIs can appear in the form of syndromes, such as secretory syndrome (urethritis, proctitis, and cervicitis) or ulcerated syndrome (ulcers). The STIs that can cause secretory syndrome are mainly caused by Neisseria gonorrhoeae and C. trachomatis, which co-infect up to 40% of cases, and also cause urethritis, cervicitis or proctitis depending on where they are located.Gonococcus has an incubation period of 2-7 days and Chlamydia 2-6 weeks, and they are diagnosed using PCR and/or culture (the last one only valid for gonococcus) of samples collected according to sexual activities.Empirical treatment to cover both germs will be accomplished with ceftriaxone, 1 g single intramuscular dose plus doxycycline 100 mg every 12 h orally for 7 days, or azithromycin 1 g single dose orally (we will use azithromycin only if we suspect a poor compliance with treatment, difficulty in going to the control or in pregnancy).Likewise, whenever we diagnose an STI firstly, we must offer advice and health education in order to promote the adoption of safe sexual behaviours and the correct use of barrier methods. Secondly, we must also screen for other STIs (HIV, syphilis, hepatitis B, and hepatitis A and C depending on the risk), offer HBV and HAV vaccination if it is appropriate, and finally study and treat all sexual partners from the previous 3 months.     

Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente

AimTo determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians’ self-perceived empathy levels and their patients’ assessments.Study designObservational, cross-sectional survey.LocationPrimary Care Teaching Unit. Madrid.ParticipantsA survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed.Primary measurement instrumentsEmpathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy.ResultsThe tutors scored 2.53 points higher for cognitive empathy than the residents (P = .04). Emotional empathy scores declined among older tutors (r =  −0.32; P = .05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P = .02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r = 0.72; P = .01) was observed between physicians’ self-perceived empathy and their patients’ perceptions.ConclusionsResidents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians’ self-perceived empathy and their patients’ views of their empathy levels.     

Estudio descriptivo y comparativo de factores de riesgo cardiovascular y actividad física en pacientes con síndrome coronario agudo

Aim

To analyse several cardiovascular risk factors by means of the physical activity performed by patients with acute coronary syndrome (ACS).

Ensayo clínico aleatorio: papel de la dieta y ejercicios físicos en mujeres con síndrome metabólico

ObjectiveTo evaluate a program of nutritional recommendations and exercise in women with metabolic syndrome.DesignMulticentre randomised controlled trial.LocationPrimary Health Care, Holguin, Cuba.ParticipantsA cluster sample of 150 obese women with metabolic syndrome without glucose disturbances, were randomly assigned to a control (n = 70) or experimental (n = 80) group. A total of 62 women in the control group and 60 in the intervention group completed the study (June 2008-July 2009).InterventionsLow calorie diets and a program of exercises in the experimental group. Usual care in the control group.MeasurementsBody weight, body mass index, waist circumference, blood pressure, blood glucose and lipid profile.ResultsCompared to the control group, after one year, the experimental group had a lower, diastolic blood pressure (78 ± 0.9 vs 91 ± 1.1 mm Hg), total cholesterol (4.7 ± 0.1 vs 6.0 ±0.1 mmol/L), triglycerides (1.9 ± 0.0 vs 2.9 ± 0.1 mmol/L) and LDL cholesterol (2.5 ± 0.0 vs 3.5 ± 0.1 mmol/L), and a higher HDL-cholesterol (1.2 ± 0.0 vs 1.1 ± 0.0 mmol/L). There were no appreciable changes in weight, body mass index, waist circumference, systolic blood pressure and blood glucose.ConclusionsWe demonstrated the effectiveness of the intervention program on blood pressure and blood lipid profile.     

Síndrome de desgaste profesional en trabajadores de atención a la salud en el área sanitaria de Ceuta

ObjectiveThe aim of this study is to determine the levels of burnout among employees of health care workers in the Health Area of Ceuta (Spain).DesignPrevalence study.SettingCeuta Health Area (Primary and Specialty Care).ParticipantsA sample of 200 workers stratified by sex, job and workplace.MeasurementsThe tool used was the MBI (Maslach Burnout Inventory). We also studied personal (age, sex, marital status) and work variables (centre, job, age) and blood parameters (C-reactive protein and others).ResultsThe burnout syndrome was present in 17.2% of workers (95% CI: 10.4-26.0). There was a significant relationship with job, with differences in emotional exhaustion, depersonalisation, and professional achievement. C-reactive protein was significantly higher in workers with burnout.ConclusionsBurnout prevalence in the health care workers in our sample is similar to other studies. The differences between health and non-health workers could be due to greater motivation for professional achievement, but they scored higher in exhaustion and depersonalisation. The increase in C-reactive protein, a non-specific inflammation marker, seems to confirm the findings of other studies.     

Efecto de la interacción clopidogrel-omeprazol en el reingreso hospitalario de pacientes por recidiva de síndrome coronario agudo: estudio de casos y controles

ObjectiveTo evaluate the effect of drug interaction between omeprazol and clopidogrel in hospital readmission of patients with acute coronary syndrome (ACS).DesignCase-control study.LocationUniversity Clinic Leon XIII, Medellin, Colombia.Participants: We selected from a prevalent population, between 2009-2010, use of clopidogrel patients on an outpatient basis (less than one year and more than 30 days), and hospital stay for ACS or the presence of a previous ACS.Main measuresA case-patient was defined as one who had a recurrence of ACS and a patient-control is defined as one that no recurrence of ACS. Both groups used ambulatory prior clopidogrel due to ACS. As defined risk factor the joint use of omeprazole and clopidogrel outpatients.ResultsDuring the study, 1680 patients clopidogrel formulated. This group identified 50 cases readmitted with ACS and 76 controls. No statistically significant association was found between use of clopidogrel-omeprazole and increased risk of hospital readmission for ACS (OR: 1.05; 95% CI: 0.516-2.152; P = .8851).ConclusionsIn this small group of patients with previous SCA, the simultaneous use of clopidogrel with omeprazole does not increase the risk of a readmission by recurrence of this type of coronary event.