Impacto del suministro de harina de maíz fortificada en la anemia de preescolares de zonas indígenas de México

Objective

To estimate changes in anemia status in preschool age children at 9 months after the provision of soy- and iron-fortified cornflour.

Methods

A non-experimental pre-post evaluation study was performed in a sample of 98 boys and 96 boys aged between 6 and 24 months. We analyzed demographic, anthropometric, and biochemical variables.

Results

During the 9-month period, the hemoglobin level increased from 11.0 to 11.9 mg/dL (p < 0,001). The prevalence of anemia (hemoglobin <11.0 mg/dL) decreased from 52.6% to 25.3% (p < 0,001). The indicators of height for age and body mass index changed from -2.1 (-5.5 to 2.8) to -2.3 (-6.5 to 1.3) (p < 0,001) and from 0,4 (-3.1 to 2.9) to 0,7 (-2.2 to 3.9) (p < 0,001), respectively.

Conclusions

The decreased prevalence of anemia suggests that the provision of soy- (3%) and iron-fortified flour is a viable alternative for combating childhood anemia.     

Patrón evolutivo de la incidencia de cáncer de tiroides en la Región de Murcia de 1984 a 2008

Objective

To study the trend pattern of the incidence of thyroid cancer.

Methods

We selected incident cases of thyroid cancer occurring in the Region of Murcia (Spain) in 1984-2008. The variables gathered were age, sex, date of diagnosis, and morphology. We calculated incidence rates and the annual percentage of change using Bayesian age-period-cohort models.

Results

During the study period, 1414 cases were diagnosed, representing an increase in adjusted rates from 2.9/100000 in 1984-1988 to 7.3 in 2004-2008. The incidence was 3.5 times higher in women than in men and the most frequent morphology was papillary carcinoma (67.7%). An increasing trend was found in both genders; these increments were more pronounced in papillary carcinoma. In women, the incidence increased with age, calendar year, and in those born in 1945-1963. The incidence of papillary microcarcinoma increased four-fold in women.

Conclusions

Thyroid cancer used to be a rare cancer but has become an emerging tumor. The greatest changes were found in papillary thyroid cancer, including a gradual increase in the proportion of microcarcinoma.     

Medida de la importancia de las dimensiones de la satisfacción en la provisión de servicios de salud

Objective

Identifying users’ perceptions of the quality of care is essential to improve health services delivery. The main objective of this article was to describe the application of a methodology to identify factors that facilitate the identification of areas for improvement.

Method

A questionnaire was applied in three health areas in Catalonia (Spain) (primary care [n = 332], outpatient specialty care [n = 410] and hospital emergency care [n = 413]) to measure user satisfaction and assess the importance given to the aspects analyzed.

Results

The main areas for improvement in primary care identified by an importance-performance analysis involved the time devoted to patients as well as health professionals’ willingness to listen to their views. In hospital emergency care, the main area of improvement was related to the hospital's physical conditions.

Conclusions

The tools designed and implemented by the Catalan Health Service (Spain) have proved to be valid for the detection of priority areas to improve service delivery and promote regional equity.     

Percepción de los factores de riesgo de cáncer por la población española

Objective

To analyze the perception of the Spanish population of risk factors for cancer.

Methods

Data were extracted from the OncoBarometro 2010 survey. Multivariate logistic models were applied to analyze the perception of the population on the importance of various risk factors: smoking, alcohol, sun, food, weight, sexually transmitted diseases, family history, radiation exposure, exposure to toxic substances and air pollution. The answers were rated on a 0 to 10 scale and were converted to low (0-6) and high (7-10) categories. The measure of association used was the prevalence ratio (PR).

Results

The greatest importance was assigned to smoking (high importance: 83.1%), whereas the least importance was assigned to weight (26.5%). In general, the probability of perceiving risk factors as important was lower among men (PR sun: 0.87; PR sexually transmitted diseases: 0.78) and increased among people who received professional advice on cancer prevention (PR alcohol: 1.11; PR sun: 1.18; PR food; 1.31; PR weight: 1.92). In particular, knowledge of symptoms and extreme fear of cancer were associated with perceiving smoking as an important risk factor, whereas a high perceived vulnerability to cancer was associated with perceiving exposure to toxic substances, pollution and smoking as important risk factors.

Conclusions

Greater awareness is required of the association of cancer with overweight and sexually transmitted diseases. The recommendations given by health professionals on cancer prevention are key to increasing the population's awareness of risk factors for cancer.     

Efecto de un programa de atención telefónica tras el alta hospitalaria de una unidad de cirugía traumatológica

Objective

To determine the impact of a 1-month telephone care program after hospital discharge from a trauma surgery unit on health services utilization and patient anxiety and to perform a budgetary analysis.

Methods

We carried out an experimental study in 604 patients who formed an experimental and a control group. The experimental group was offered telephone care to resolve doubts during the first month after discharge. After this period, data were collected from both groups on the following outcome variables: visits to the emergency department or family physician, hospital readmissions, and the results of an anxiety test. Data analyses included logistic and linear multivariate analyses and calculation of the budgetary impact of the program on the hospital, the Andalusian Health Service, and the National Health System.

Results

A total of 73 telephone consultations were conducted with 60 patients, almost half for doubts about the therapeutic regimen. For the outcome variable “visit to emergency department”, the group without telephone care had an odds ratio of 1.8 in the multivariate analysis adjusted for the other independent variables: days of hospital stay, patient anxiety and comprehension of discharge indications. No differences between groups were found in the remaining outcome variables. The budgetary analysis demonstrated the possibility of implementing the program at a cost of 1.65 € per patient.

Conclusions

This program proved effective in reducing visits to the emergency department at a low cost.     

Lieu de contrôle chez les obèses : traduction et première étude de validation de l’échelle du lieu de contrôle du poids de saltzer

The objectives of this study are to enable the use of the concept of locus of control in the treatment of obese subjects and to verify if the presence of an alimentary disorder influences the belief in the weight’s control. The translation and validation in French is also part of the objective. We translated into French Saltzer’s specific scale of Weight Locus of Control (WLOC: weight locus of control) and then examined it’s validity. Then we compared it on general scales of the place of control (IPC of Levenson and SOC-3 of Paulhus). The subjects were both classified according to the presence of eating disorders (ED). A sample of 46 obese women (IMC>30) was tested, 20 of them without ED, and 26 with, associated to the presence ED, according to the criteria of the DSM-IV.The internal validity of WLOC is rather satisfactory. It correlates negatively with internality (IPC), personal control and interpersonal control (SOC-3). ED at the obese subjects are related on the externality of weight control and the externality of personal control. Obese subjects without ED believe more in weight control by themselves and personal control that the obese subjects with ED (Eating Disorders). Finally the scale of weight locus of control (WLOC) remains the most adapted in the treatment and the study of the obese subject.     

Identificación y priorización de actuaciones de mejora de la eficiencia en el Sistema Nacional de Salud

Objectives

To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government.

Material and methods

A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods.

Results

The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high.

Conclusions

There are several opportunities to improve the efficiency of the Spanish NHS beyond the “anticrisis” measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures.