Variabilidad en el porcentaje de cesáreas y en los motivos para realizarlas en los hospitales españoles

Objective

To describe variability in the cesarean ratio and indications for this procedure in women with and without a previous cesarean section.

Methods

We conducted a cross-sectional study of 111 hospitals (year 2010) categorized in six levels. Ten groups of indications for cesarean section were developed. Measures of central tendency and diversity were used to determine variability and the Kruskal-Wallis test was used for comparisons among hospital levels.

Results

The percentage of cesarean sections was 25.4%. In women without a previous cesarean section, the percentage was higher in private and public hospitals with a lower technological level (34.7% and 30.4% in private and 22.4% in lower level public hospitals). Among public hospital levels, no differences in the percentage of cesarean sections indicated were observed.

Conclusions

Research on non-clinical factors could clarify the differences in the ratio of cesarean sections in private hospitals compared with public hospitals and among distinct levels of public hospitals.     

El proyecto Ineq-Cities de investigación en desigualdades urbanas en salud: diseminación y transferencia de conocimiento en España

The Ineq-Cities project analyzed inequalities in mortality in small areas and described interventions to reduce inequalities in health in 16 European cities. This field note describes the dissemination of the project in Spain. In accordance with the recommendations of the project, the objective was to translate relevant results to key stakeholders – mainly technical staff, municipal officers and local social agents – and to provide an introduction to urban inequalities in health and strategies to address them. Twenty-four workshops were given, attended by more than 350 professionals from 92 municipalities. Knowledge dissemination consisted of the publication of a short book on inequalities in health and the approach to this problem in cities and three articles in nonspecialized media, a proposal for a municipal motion, and knowledge dissemination activities in social networks. Users rated these activities highly and stressed the need to systematize these products. This process may have contributed to the inclusion of health inequalities in the political agenda and to the training of officers to correct them.     

La restauration en milieu scolaire : état des lieux en région Rhône-Alpes

A survey on school lunches has been carried out in primary and secondary schools in the Rhone Alpes area to assess if dietary guidelines of June 25^th 2001 French regulation are well applied or not and to try to identify the difficulties encountered.The results of the surveys which have been mailed to school administrators and the analysis of meals composition show that these guidelines are little applied in secondary schools and in primary schools of small towns, while big cities are able to propose better balanced lunches.In secondary schools, lunch time very often takes less than 30 minutes, and there are too many “à la carte” menus which are not favourable especially considering the low level of nutritional information given to pupils.In all school settings, the following points can be considered as well-controlled: the availability of bread, no soft drinks during lunch and a good frequency of raw fruits and vegetables. Weak points to be improved concern too many high fat protein foods and a lack of fish and of high calcium level dairy products.     

Oportunidad de integración de la perspectiva de género en investigación e innovación en salud en Europa: red COST genderSTE

The European Commission supports several routes for incorporating the gender perspective. The Commission currently supports the new Horizon 2020 program, and also funds projects such as “gendered innovations”, which show how gender innovations increase the quality of research and professional practice for health and welfare. One of the policy instruments is the Recommendation on Gender, Science and Innovation. Against this background, the international European Cooperation in Science and Technology (COST) network genderSTE (Gender, Science, Technology and Environment) was created, which seeks to: 1) promote structural changes in institutions to increase the number of women researchers; 2) identify the gender dimensions relevant to the environment; and 3) improve the integration of a gender perspective in research and technology. COST GenderSTE supports networking and the dissemination of knowledge with a gender perspective. All these tools provide an opportunity to incorporate a gender perspective in research in Europe.     

Análisis de desigualdades en mortalidad en áreas pequeñas: queda camino por recorrer

No analyses have been performed in the Balearic Islands (Spain) to assess health inequalities in mortality in small areas. The objective of this study was to construct a mortality atlas using geocoding of mortality records. During this process, several problems were encountered, which are summarized in this article. These problems were based on the lack of stable small geographical areas, difficulties in obtaining the population for small areas divided by age and sex for the study period, problems with the quality of the cartography, and the poor quality of the mortality records. The methodological problems identified in this process should be considered in future studies.     

Quelles nouveautés en antibiothérapie ?

There is a constant need for new antibacterial agents because of the unavoidable development of bacterial resistance that follows the introduction of antibiotics in clinical practice. As observed in many fields, innovation generally comes by series. For instance, a wide variety of broad-spectrum antibacterial agents became available between the 1970s and the 1990s, such as cephalosporins, penicillin/β-lactamase inhibitor combinations, carbapenems, and fluoroquinolones. Over the last 2 decades, the arrival of new antibacterial drugs on the market has dramatically slowed, leaving a frequent gap between isolation of resistant pathogens and effective treatment options. In fact, many pharmaceutical companies focused on the development of narrow-spectrum antibiotics targeted at multidrug-resistant Gram-positive bacteria (e.g. methicillin-resistant Staphylococcus aureus, penicillinresistant Streptococcus pneumoniae, and vancomycin-resistant Enterococcus faecium). Therefore, multidrug-resistant Gram-negative bacteria (e.g. extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii) recently emerged and rapidly spread worldwide. Even if some molecules were developed, new molecules for infections caused by these multidrug-resistant Gram-negative bacteria remain remarkably scarce compared to those for Gram-positive infections. This review summarises the major microbiological, pharmacological, and clinical properties of systemic antibiotics recently marketed in France (i.e. linezolid, daptomycin, tigecycline, ertapenem, and doripenem) as well as those of antibacterial drugs currently in development (i.e. ceftobiprole, ceftaroline, dalbavancin, telavancin, oritavancin, iclaprim, and ramoplanin) or available in other countries (i.e. garenoxacin, sitafloxacin, and temocillin).     

Mortalidad general y por causas en la población autóctona e inmigante en Andalucía

Objective

To compare mortality rates between immigrant and native-born residents of Andalusia between 2006 and 2010, and to characterize mortality by cause.

Material and methods

The data consisted of deaths from mortality statistics by cause, and the aggregated populations registered in the lists of inhabitants by country of birth in the case of native-born individuals and immigrants (with immigrants grouped into six geographical areas of origin). Crude rates and age-standardized mortality rates (0-39, 40-65 and 65 years and above) were calculated by cause of death separately for men and women.

Results

In the group aged 0-39 years, mortality due to external causes was higher in immigrants than in the native-born population, especially in African immigrants, with standardized rates of 142 and 145 deaths per 100,000 persons/year in women and men, respectively. Deaths due to maternal-related factors were particularly high among Africans. In the group aged 40-64 years, mortality rates were higher in immigrant women than in native-born women but were lower in immigrant men than in native-born men; in this age group, mortality was particularly high in African women and men from Europe and North America. In the group aged 65 years and over, mortality was higher in the native-born population of both genders than in immigrants due to cancer and cardiovascular disease.

Conclusions

The differences in mortality between immigrants and native-born residents varied depending on age, gender, cause of death and birthplace. Notable findings were the higher mortality among elderly native-born residents, due to chronic degenerative diseases, and the high mortality in the Sub-Saharan population at younger ages due to accidents.     

Stratégies de prise en charge nutritionnelle spécifiques : l'enfant en cancérologie

In children with cancer, malnutrition may antedate the diagnosis or be a result of aggressive chemotherapeutic regimens. The prevalence of malnutrition at diagnosis is related to the type of tumour and the extent of the disease, ranging from < 10% in patients with standard-risk acute lymphoblastic leukaemia to 50% in children with advanced neuroblastoma. The pathogenis of the energy imbalance that underlies the development of malnutrition is complex, including increased breakdown of fat and protein as well as energy-consumptive changes in carbohydrate metabolism (Cori cycle). Despite several confounding factors (different definitions of nutritional status and the wide variety of measures used for its assessment), studies have shown decreased tolerance of chemotherapy associated with altered metabolism of antineoplastic drugs, increased infection rates, altered quality of life and possibly poor clinical outcome in malnourished patients. In this article, we review guidelines for the nutritional management of a child with cancer and we purpose an algorithm for nutritional support.