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.     

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.     

Adaptación española de la Escala de Impacto de la Publicidad de Apuestas en adolescentes

Media pressure from gambling advertising has reached worrying levels. It constitutes a risk to the mental health of young people and adolescents by promoting a favourable attitude towards gambling, a higher frequency of gambling and a perception of greater accessibility. Currently, there is no instrument available to assess the impact of gambling advertising.ObjectiveThe present study aims to adapt and validate the Impact of Gambling Advertising Scale (IGAS).DesignThe IGAS scale was translated from English ensuring its linguistic, conceptual and metric equivalence. The psychometric properties were then tested.SiteComunidad Valenciana (España).Participants1724 adolescents with a mean age of 16.52 years (SD = .759).InterventionSelf-administered, paper-based questionnaire in a single measure.Main measurementsAdvertising impact, and gambling intention, severity and availability.ResultsInternal consistency and two-half reliability were good, Cronbach's α = .782 and α = .70, respectively. Confirmatory factor analysis concluded that the Spanish version replicates the original three-dimensional version. Convergent validity analyses showed direct and significant relationships with different aspects of gambling behaviour, and other predictors.ConclusionThe adapted version of the IGAS is a reliable and valid measure for the assessment of the impact of advertising on adolescents. The scale is a useful instrument for the diagnosis of risk level and the evaluation of preventive interventions.     

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.     

Correlaciones entre la ingesta de sal en la dieta y la eliminación de sodio en la orina de 24 h en una muestra de población urbana de Cáceres

ObjectiveExcessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na⁺/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice.DesignObservational study.SiteUrban Health Center in Cáceres.Main measurementsWe estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard).Results92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na⁺). When sodium intake is determined by the Na⁺/K⁺ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it “adequate”. 32.4% add salt to food once served. FFQ underestimate Na⁺ intake and targeted surveys provide higher values. The correlation between FFQ and Na⁺ urinary elimination is weak.ConclusionWe must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.     

Diffusion des recommandations de la Conférence de consensus sur la prophylaxie de l’endocardite infectieuse

A card holding specific data was edited to ensure an optimal distribution of Consensus Conference recommendations for the prophylaxis of infectious endocarditis. It is given by cardiologists to their patients with risk heart diseases. It gives information only on antibiotic prophylaxis for dental care and must be presented to the dentist. Articles in medical, paramedical, and public magazines have reported the recommendations and promoted this card. In 9 years, 273,244 cards have been handed out and may be from 84,000 to 210,000 were really given to patients. Surveys show that it is known by 97% of cardiologists, but only by 55% of dentists and 28% of GPs. Enquiries made on patients having received a card show that they have acknowledged and used it, including for those who have held it for a long time.     

Implantación de un programa de promoción de la salud de las mujeres en zonas de exclusión social de la ciudad de Sevilla

Health promotion can contribute towards reducing inequality and ensuring equal opportunities, providing the means to enable the entire population to develop its maximum health possibilities. Women living in areas with social transformation needs (ASTN) are an especially vulnerable group due to the situation of material deprivation and social exclusion in which they live. Health promotion programmes for this group can bring about an improvement in their health. This paper describes the health promotion programme Socio-educational Groups of Primary Care for Women (SEGPC-W), and evaluates its implementation in ASTN in the city of Seville (Spain), as well as the benefits and difficulties of its development through a documentary analysis and interviews with participating professionals.