Cinco paradojas de la promoción de la salud

The World Health Organization states that health promotion is a key strategy to improve health, and it is conceived as a global process of enabling people to increase control over, and to improve, their health. Health promotion does not focus solely on empowering individuals dealing with their knowledge, attitudes and skills, but it also takes political, social, economic and environmental aspects influencing health and wellbeing into account. The complexity of applying these concepts is reflected in the five paradoxes in health promotion; these arise in between the rhetoric in health promotion and implementation. The detected paradoxes which are described herein involve the patient versus the person, the individual versus the group, disease professionals versus health professionals, disease indicators versus health indicators, and health as an expense versus health as an investment. Making these contradictions explicit can help determine why it is so complex to put the concepts related to health promotion into practice. It can also help to put forward aspects that need further work if health promotion is to put into practice.     

Herramienta multidimensional para la medición de la calidad de la participación en salud

Health strategies, programs and activities have historically been the result of institutional practices with a limited participatory component. Traditionally, institutional action is mainly determined by the criteria of the political actors and, in the best of cases, by the criteria of healthcare professionals. New forms of governance for health equity advocate for the inclusion of the community in the design of strategies, programmes and activities in health. For this reason, a growing concern in the field of participation in health is the measurement of the participatory quality of new designs of institutional practices. This article aims to develop an operational proposal to design, measure or describe the scope in participatory terms of the health planning processes. The proposal elaborates six dimensions for the measurement and assessment of participatory process: inclusivity, information flow, deliberative quality, decision making, institutional commitment and community empowerment.     

Faut-il encourager la perte de poids avant la chirurgie bariatrique ?

Bariatric surgery is recognized as a modality in its own right for the treatment of severe obesity but also of its comorbidities. Many centers of bariatric surgery encourage or even impose on their patients a weight loss before surgery. The purpose of this paper is to review the rationale of this practice and to propose a practical attitude in the expectation of conclusive data. The analysis of the current literature does not make it possible to conclude unequivocally about the value of preoperative weight loss in the context of bariatric surgery. There is thus currently no sufficient argument to consider that weight loss is a systematic prerequisite for bariatric surgery. The only benefit demonstrated is the reduction in liver size. It remains however to be demonstrated by randomized prospective studies that the reduction in hepatic volume caused by preoperative weight loss is accompanied by a reduction in per- and postoperative complications without any risk of undernutrition.     

Dénutrition de la personne âgée : de la sarcopénie à la cachexie

Because of metabolic changes due to ageing, malnutrition is accompanied by a preferential loss of fat free mass in the elderly and it exaggerates the physiological loss of body cell mass, muscle mass and muscle function observed in the aged. Exercise training has positive anabolic effects even in the frail elderly and may improve the effect of renutrition in malnourished elderly patients.     

¿Puede diagnosticarse la demencia en la Atención Primaria?

Despite the personal and social value of an early diagnosis, more than 50% of dementias remain undetected. The author shares the view that primary care is an adequate setting for both the detection and diagnosis of dementia. This diagnosis is conducted through clinical interview, physical examination and mental status examination. Once confusional and focal neurobehavioral syndromes have been ruled out, it is useful to differentiate between subjective cognitive complaints, mild cognitive impairment (MCI) and dementia. The target syndrome should be MCI, since more than 50% of these patients develop dementia. In both MCI and dementia an objective and persistent cognitive impairment is detected that, in case of dementia, precludes some of the usual activities. Along with diagnosis, a global plan of care ought to be outlined. This plan should contemplate the prevention of accidents, the management of behavioural and psychological symptoms, the specific pharmacological treatment and caregiver support.     

Impacto de la COVID-19 en la mortalidad de la comunidad autónoma de Castilla y León

ObjectiveTo estimate the increase in mortality associated with the SARS-CoV-2 coronavirus pandemic in the autonomous community of Castilla y León (Spain).MethodEcological study based on population and death data for the months of March 2016 to 2020 in Castilla y León. The general and provincial standardized rates, the relative risks of the year 2020 with respect to previous years and the risks adjusted by sex, periods and province, using Poisson regression, were calculated. Trend analysis was performed using joinpoint linear regression.ResultsAn increase in mortality was observed in March 2020 with respect to previous years, with an increase of 39% for men (relative risk [RR]: 1.39; 95% confidence interval [95%CI]: 1.32-1.47) and 28% for women (RR: 1.28; 95%CI: 1.21-1.35). The model predicts excess mortality of 775 deaths. In the trend analysis there is a significant turning point in 2019 in men, globally and for almost all provinces. The increase in mortality is general, although heterogeneous by sex, age group and province.ConclusionsAlthough the observed increase in mortality cannot be totally attributed to the disease, it is the best estimate we have of the real impact on deaths directly or indirectly related to it. The number of declared deaths only reaches two thirds of the increase in mortality observed.     

Representaciones sociales sobre la salud y la enfermedad de la población adulta de Guadajalara,México

ObjectiveThe aim of the study was to identify the content and the organization of social representations on health and disease of an adult population of Guadalajara, Mexico, and to describe differences between the points of view of men and women.MethodologyThe methodology was structured focus groups of the social representations: associative methods of open listing and paired comparisons were used. The participant population was men and women of Guadalajara city, Mexico. They were selected by purpose sampling. The final analysis generates graphs of words on social representations organization of health and disease concepts.ResultsThe health concept had a holistic vision; including physical, emotional and spiritual aspects. Cleaning and to have a job is fundamental for prevention of disease. Men emphasise not having bad habits and women great interpersonal relationships. The disease concept includes biological and social points of view, such as physical deficiency, altered emotional status, the treatment and care of disease. Men emphasised the economic expense of medical care, and the women, the physical exhaustion of caring for sick people.ConclusionThe proposals for the health educational practice are the inclusion of the gender point of view, respect for religious beliefs, emotional control and integral care.     

Sobre la pornografía y la educación sexual: ¿puede «el sexo» legitimar la humillación y la violencia?

The aim of this article is to argue for the need and urgency to open an interdisciplinary debate on the goals of critical sexual education. From a philosophical and gender approach, the consequences of generalized online access to pornography, a profitable business, are analyzed as a school of sexuality for youth. The article deals with the violence and misogyny of many of the most visited contents and poses two hypothesis to debate. Firstly, pornography is subject to a process of erotizing violence, which may become a new space of legitimization of inequality between female and male teenagers. Secondly, a mismatch exists between the expectations of female and male teenagers regarding what a good sexual life is. Movements such as Me too and Cuéntalo as well as social polarization over trials like that of “the herd” would confirm such a mismatch. The conclusions reflect on the contradictions in societies, committed to equality, which increasingly tolerate less sexual abuse and aggression and at the same time are becoming more tolerant towards pornographic contents freely accessed by young people as a school of misogyny and violence. Some of the most serious consequences of those contradictions are dealt with by way of three current examples.