Institucionalización de la evaluación del impacto en la salud en Andalucía

Health impact assessment (HIA) aims to incorporate people's health and wellbeing as a key feature in policy-making. Many authors believe that HIA might be systematically integrated into all decision-making processes as a way to achieve that goal. To that end, there is need to overcome a number of challenges, including the fact that Andalusia (Spain) has made HIA compulsory by law, the need for awareness of all public sectors whose decisions might have substantial impacts on health and for a methodology that would enable a comprehensive approach to health determinants and inequalities, and the training of both the public health staff and professional sectors responsible for its application. In Andalusia, a law provides mandatory and binding health impact reports for most authorisation procedures in different areas: from sectoral plans to urban planning schemes, and especially projects subject to environmental assessment. Implementation of this law has required its integration into authorisation procedures, the training of interdisciplinary working groups in public health, the preparation of technical guidelines, and the organisation of dissemination and training seminars for developers.     

La evaluación del proceso en relación con la evaluación de la efectividad: Experiencias de programas en el medio escolar

Evaluation of public health interventions usually focusses on the quality of design and research methods, and less on the quality of the intervention or process evaluation. In process evaluation of school-based interventions, key issues are how completely the intervention is carried out and adherence to the protocol. In addition, exploration of intermediate variables, such as those that influence (and often predict) preventable behavior, is highly useful. This article describes the basic concepts in this topic, using examples of the effectiveness of some preventive interventions carried out in schools. The interventions discussed were mainly quasi-experimental studies, based on data from programs promoted by public health teams in the city of Barcelona. Data from process evaluation of preventive programs in secondary schools that underwent formal assessment of their effectiveness is provided. The examples are drawn from preventive programs of HIV infection or unprotected sexual intercourse (PRESSEC program) and drug consumption prevention (the PASE, PASE.bcn and xkpts programs). These examples show why the intervention process influences the impact of the programs and their results. Thorough planning of process evaluation is essential to obtain valid indicators that will identify, in the effectiveness evaluation of the intervention, the most efficacious strategies to obtain positive outcomes.     

Problemas clínicos en relación con el origen profesional o no profesional del plomo en la intoxicación saturnina

Zusammenfassung Verfasser bespricht die Wechselbeziehungen der klinischen und chemischen Zeichen bei der Bleivergiftung. Er gibt statistische Angaben über Beruf und Jahreszeit der von ihm studierten Vergiftungen. Er erörtert berufliche und nichtberufliche Vergiftungen und berichtet über einige Bleivergiftungen durch den Genuß kohlensaurer Getränke.

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Homenaje al ilustre maestro Heinrich Zangger de Zurich en su 80 aniversario.     

Estratificación de la población en el País Vasco: resultados en el primer año de implantación

Predictive models allow populations to be stratified according to their health requirements for the following year. They offer health care organizations the opportunity to act proactively, designing specific interventions adapted to the level of need of different groups of people. The “Strategy for tackling the challenge of chronic illness in the Basque Country” proposes the use of such models, integrating them with other policies. The prospective categorization of all the population assigned to Osakidetza was performed for the first time in 2010 using the Johns Hopkins Adjusted Clinical Groups predictive model (ACG-PM). For this purpose, already recorded information extracted from electronic health records of primary care and hospital discharge reports was used. This article discusses the advantages of the combined use of various sources of information, and describes the application of the stratification in three programs, targeted at chronic patients who suffer different burdens of comorbidity.     

Salud en todas las políticas en la Comunitat Valenciana: pasos hacia la evaluación del impacto en salud

This paper describes the beginning of the implementation process of the health impact assessment in the Valencian Community (Spain), as an instrument to incorporate the framework of social determinants and health inequalities in the policies issued by the different departments of the Valencian government. The proposal involves: 1) political commitment, with legislative and strategic planning actions; 2) the creation of structures to allow intersectoral collaboration, with the establishment of the health impact assessment commission and the intersectoral technical committee; and 3) the design and validation of a tool for the simplified health impact assessment of non-health policies adapted to the Valencian Community. We highlight the importance of the participatory methodology used in the whole process and the potential of the health impact assessment for the development of public policies oriented to improve health and equity.     

La teoría del cambio: una herramienta para la planificación y la evaluación participativa en salud comunitaria

There is a growing interest in finding innovative approaches to the evaluation of complex interventions in public health. This methodological note presents the theory of change as a useful tool to facilitate both the planning and the evaluation of community health promotion interventions. A theory of change is a visual representation of how a programme or intervention works, in which its different components can be identified, together with how they relate to each other: what its objectives are, its expected results and through which actions they are expected to be achieved. It can be an applied research tool, developed using participatory approaches together with all relevant stakeholders, who can identify and jointly decide what to evaluate and how to.     

Validez diagnóstica del tacto rectal en la era del antígeno específico de la próstata

ObjetivoDeterminar la posible correlación entre los valores del antígeno específico de la próstata (PSA) y los hallazgos del tacto rectal en pacientes con cáncer prostático y enfermedad prostática benigna.DiseñoEstudio de evaluación de pruebas diagnósticas de tipo retrospectivo, longitudinal, con carácter observacional.EmplazamientoHospital Gregorio Marañón, Madrid.ParticipantesSe incluyó a 706 pacientes con PSA en el rango de 4,1-20 ng/ml estudiados por sospecha de cáncer prostático localizado mediante tacto rectal y ecografía transrectal, en los que se realizaron biopsies prostáticas aleatorizadas.Mediciones principalesSe estudiaron como variables predictoras el PSA total, el cociente PSA libre/total y el tacto rectal categorizado como normal o sospechoso de cáncer. La variable desenlace fue el diagnóstico de cáncer prostático obtenido mediante biopsia.ResultadosCon una detección de cáncer del 28,2%, no se encontraron diferencias estadísticamente significativas en los valores medios de PSA o PSA libre/total entre los pacientes sin/con tacto rectal sospechoso. El análisis mediante curvas ROC (con un intervalo de confianza del 95%) entre ambos grupos de pacientes encontró para el PSA en el valor de 4,8 ng/ml una misma sensibilidad del 95%, con una especificidad similar, del 6 y el 10%, respectivamente.ConclusionesEn el rango de PSA 4,1-20 ng/ml, los hallazgos del tacto rectal aparecieron como una variable sin relación con la elevación del PSA ni con el cociente PSA libre/total y, por tanto, no son indicativos de un menor o mayor volumen tumoral productor de PSA. La realización de esta exploración podría ser considerada como opcional.Palabras clave: Cáncer, Próstata, Pruebas diagnósticas     

Una evaluación crítica de la relación entre la industria alimentaria y la investigación en salud

Objective

To describe the influence of the food industry in health research, observing how funding influences health outcomes and the quality of the studies.

La animación científica en atención primaria

The scientific method is capable of being applied in primary care. In this article we defend the role of the “scientific entertainer “as strategic and necessary in achieving this goal. The task has to include playful and light-hearted content. We explore some words in English that may help us to understand the concept of “scientific entertainer” from a semantic point of view (showman, master of ceremonies, entrepreneur, go-between) also in Spanish language (counsellor, mediator, methodologist) and finally in Latin and Greek (tripalium, negotium, chronos, kairos). We define the clinical, manager or research health-worker who is skilled in primary care as a “primarylogist”.     

Relación entre la actividad física en el tiempo libre y la progresión del índice tobillo-brazo

ObjectiveTo study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population.MethodProspective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI) <0.9. A multivariate logistic regression analysis was performed to evaluate the independent association between physical activity during leisure time and ABI.ResultsThe mean age was 63.4 years and 54.6% were women. In the multivariate analysis, there was a positive relationship between physical activity during leisure time and ABI in patients with an energy consumption of more than 5000 MET in 14 days (odds ratio: 0.37; 95% confidence interval: 0.18-0.80). These specific activities doing sports or dancing, going shopping on foot, and cleaning the house for more than an hour a day showed a protective effect. In the group of subjects who maintained the physical activity during leisure time during the time of the research, a protective effect was observed with overall physical activity (MET) and going shopping on foot.ConclusionsIn our research, PALT was favorably associated with ABI, in a sample of the Spanish general population that is very active and has a low-cardiovascular risk.     

Evaluación del tratamiento con infiltraciones intraarticulares en la patología osteoarticular del hombro en atención primaria

Main objectiveTo evaluate the clinical response at 24 weeks after injection, measured as pain relief and functional recovery, in painful shoulder syndrome (PSS) in primary care (PC).DesignLongitudinal case series with injection treatment in the scapulohumeral joint, describing functionality and pain evolution before and at 24 weeks post injection.LocationNon-urban primary care centres.ParticipantsPatients with osteoarticular shoulder pathology susceptible to injection, failure of pharmacological treatment and rating on the visual analogue scale (VAS) ≥ 4 or constant score (CS) ≤ 70.InterventionsIntra-articular injection of corticosteroid and local anaesthetic into the scapulohumeral joint, describing its evolution at 1, 4, 12 and 24 weeks post injection.Main measurementsInfiltration response according to EVA before and after, CS before and after, number of infiltrations, side effects, temporary inability to work (TIL).ResultsSixty-six patients receiving injection, mean age 51.1 years (SD 14.7), 57.6% were women and 63.3% were injection in the right shoulder. A 22.7% required TIL and were discharged with a median of 14 days (range 7-56 days). They required an injection (80.3%) and the most frequent injection pathology was rotator cuff tendinitis (90.9%). They suffered mild side effects (9.4%). We found a decrease in pain from severe to mild and a functional improvement from poor to good. The variables: being retired (OR: 37.82, P = .001) and having an EVA score prior to injection > 8 (OR: 15.67, P = .055, almost significant) were associated with poor response.ConclusionsIntra-articular administration of corticosteroids in PSS reduces pain and provides functional improvement after the first week after injection, and is maintained in the long term. This allows a quick recovery to work after an injection at two weeks reducing recovery time by 50%, with few side effects.     

Efectividad del Mini-Mental en la detección del deterioro cognitivo en Atención Primaria

ObjectiveTo evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (CI) in Primary Care (PC) and to determine the best conditions of use for that purpose.DesignPooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain).SettingThe MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care.ParticipantsSubjects with cognitive complaints or suspected of having CI were consecutively recruited in the PC clinic.Principal measuresThe DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately.ResultsIn the total sample of 360 subjects (214 CI), the DA of the MMSd was significantly superior to that of the MMSa (0.84 ± 0.02 vs 0.82 ± 0.02, p ≤ .001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52 ± 0.05) and was not improved by any MMSa cut-off point.ConclusionThe DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off.     

La prevención universal del consumo de drogas en el entorno escolar: el valor de la monitorización continua

This paper documents the management of two programs for the universal prevention of substance use offered in secondary schools by the public health services of the city of Barcelona, reviewing the period from 1989–1990 to 2016–2017. Both programs had proven effectiveness in evaluations with a comparison group, they are promoted by the public health agency free of cost, and are taught by teachers, using standardized manuals with support materials and training. The coverage achieved over recent years declined from 40% to 25%. Changes observed in the acceptance and implementation of these programs could be related with logistics and follow-up by the public health services, changes in substance availability, and with budget cuts in education. The monitoring of effective programs by public health services is essential to preserve their actual implementation.     

Despenalización del aborto en Chile: una aproximación mixta desde la percepción del aborto en población comunitaria

ObjectiveTo identify the variables and the axiological argumentations that configure the perception of abortion as a crime, in a sample of a city in southern Chile during the debate of law 21.030.MethodThe design is quantitative, observational correlation cross-sectional followed by a qualitative approach. The quantitative sample of 289 members of the community of Temuco (Chile) answered a questionnaire about social categories, and their perception of the seriousness of 15 behaviours defined in Chile as crimes. For the qualitative phase, we carried out 12 semi-standardized interviews in the same community, subject to content analysis, incorporating some elements of grounded theory from the constructivist perspective.ResultsRegardless of sex, more than half of the study sample considers abortion to be between a serious and an extremely serious crime, despite its current decriminalization. Religious people, no matter what kind of religion, political conservatives and people of a lower educational level, perceive abortion as a serious crime. Frequency of participation in religious events has a mediating effect. The qualitative results establish t religious teaching as a very important argument to reject abortion, and that the perception of the severity of abortion as a crime is multidimensional.ConclusionReligion and a conservative political vision affect the traditional constructions of gender and motherhood, and therefore, there is a marked tendency to reject abortion. These results emphasize the need to pay special attention to the acceptance of Law 21.030 on the voluntary termination of pregnancy in regions. This is important for effective application of the Law.