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1.
Objectives
To determine the factors associated with participation in a prenatal education program among primiparous mothers.Methods
A multicenter observational study was carried out in four Andalusian hospitals (Spain) in primiparous women in 2010. Sociodemographic characteristics, obstetric history, and previous diseases were collected through an interview and from the clinical charts. Crude and adjusted odds ratios were calculated.Results
The study population consisted of 520 women. According to multivariate analysis, the factors associated with participation in the program were educational level (p <0.001), higher income levels (p <0.001), birth in Spain (p <0.001) and viewing the program as useful (p <0.001). After adjusting for these variables, no other variable was related to participation. The main reason given by women for not attending prenatal education was lack of an invitation to attend.Conclusions
Participation in the prenatal education program was favored by a higher educational level and income, birth in Spain, and viewing the program as useful. 相似文献2.
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. 相似文献3.
Marisa Estarlich Carmen Iñiguez Ana Esplugues Enrique Mantilla Òscar Zurriaga Andreu Nolasco Ferran Ballester 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To evaluate spatial variation in exposure to nitrogen dioxide (NO2) air pollution in the city of Valencia, Spain, and its association with socioeconomic deprivation and age.Methods
Census tract population data were obtained from the National Statistics Institute of Spain. Outdoor NO2 was monitored in 100 sites in the study area, through the use of passive samplers, in three campaigns between 2002 and April 2004. Land use regression (LUR) was used to obtain a map of NO2 levels. The LUR predictions were compared with the NO2 level obtained by: a) the nearest sampler of the monitoring network, b) the nearest passive sampler, c) the mean distance-weighted levels of the samplers in the neighborhood, and d) the NO2 level obtained by using Kriging. For each census tract, the NO2 levels were obtained. The association of NO2 air pollution exposure with population age (≥65 years) and the 5-category deprivation index was analyzed.Results
The LUR models showed less error than the other prediction methods. The safety levels proposed by the World Health Organization were exceeded in more than 99% of the population. An inverse relationship was found between NO2 levels and the deprivation index (β = –2.01 μg/m3 in the most deprived quintile compared with lower deprivation, 95%CI: –3.07; –0.95) and a direct relationship was found with age (β = 0.12 μg/m3 per unit increase in percentage of the population ≥ 65 years, 95%CI: 0.08; 0.16).Conclusions
The method allowed pollution maps to be obtained and the association between NO2 levels and sociodemographic characteristics to be described. 相似文献4.
Erica Briones Vozmediano Andrés A. Agudelo Suárez María José López Jacob Carmen Vives Cases Fernando Ballester Laguna Elena Ronda Pérez 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To examine the perceptions of female immigrant domestic workers of the effect of Royal Decree 1620/2011, which regulates the relationship of domestic workers in the family home and their employment conditions in Spain.Methods
An exploratory study was performed using qualitative content analysis of three focus group discussions with immigrant women from Colombia, Ecuador and Morocco.Results
Immigrant women positively assessed the theoretical benefits of the new regulation, but identified legal and economic barriers to obtaining a contract and being registered in the social security system by their employers, and to employers accepting the cost of these measures, especially for workers hired by the hour. These difficulties affected their possibilities of legalizing their status. The economic crisis posed a serious challenge to compliance with the new regulation.Conclusions
Although the new regime encourages job creation with stronger working rights for these workers, immigrant women perceived that its implementation has been hampered by the current financial crisis and has not, therefore, improved their employment conditions. 相似文献5.
Carmen Ballesteros Meseguer Pilar Almansa Martínez María del Mar Pastor Bravo Ismael Jiménez Ruiz 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To explore the perceptions of a group of women who underwent female genital mutilation on the impact of this practice on their sexual and reproductive health.Methods
We performed a phenomenological qualitative study in a sample of 9 sub-Saharan Africa women, whose mean age was 30 years old and who had lived in Spain for 1 to 14 years. These women underwent genital mutilation in their countries of origin. Data was collected using a socio-demographic survey and an in-depth, structured personal interview. Subsequently, we performed a thematic discourse analysis.Results
The discourses were grouped into four categories related to participants’ perceptions of female genital mutilation. These categories were intimate relationships, pregnancy, childbirth, and social impact.Conclusions
The practice of female genital mutilation is maintained due to social and family pressure, transmitted from generation to generation and silenced by women themselves. This practice affects their sexual and reproductive health, as demonstrated by anorgasmia and dyspareunia. The women were satisfied with the healthcare received during pregnancy and childbirth. Nevertheless, most of them were not satisfied with family planning. 相似文献6.
Objective
To determine whether reading is a protective factor against cognitive decline in the population aged over 65 years.Methods
We performed an unmatched case-control study in the Fuente de San Luis Health Center in Valencia, Spain. A total of 153 subjects aged more than 65 years old were studied, corresponding to 51 cases and 102 controls. Cognitive impairment was measured by the version of the Mini-Mental State Examination adapted and validated to Spanish. Reading habits were assessed with the scale of the Federación de Gremios y Editores de España.Results
Logistic regression showed a significant association with the habit of frequent reading for more than 5 years, complete primary school education, and age lower than 75 yearsConclusions
Reading is a protective factor against cognitive impairment. This protection is greater in frequent readers with a history of reading of over 5 years 相似文献7.
8.
Elena Rodríguez Álvarez Yolanda González-Rábago Amaia Bacigalupe Unai Martín Nerea Lanborena Elordui 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To analyze health inequalities between native and immigrant populations in the Basque Country (Spain) and the role of several mediating determinants in explaining these differences.Methods
A cross-sectional study was performed in the population aged 18 to 64 years in the Basque Country. We used data from the Basque Health Survey 2007 (n = 4,270) and the Basque Health Survey for Immigrants 2009 (n = 745). We calculated differences in health inequalities in poor perceived health between the native population and immigrant populations from distinct regions (China, Latin America, the Maghreb and Senegal). To measure the association between poor perceived health and place of origin, and to adjust this association by several mediating variables, odds ratios (OR) were calculated through logistic regression models.Results
Immigrants had poorer perceived health than natives in the Basque Country, regardless of age. These differences could be explained by the lower educational level, worse employment status, lower social support, and perceived discrimination among immigrants, both in men and women. After adjustment was performed for all the variables, health status was better among men from China (OR: 0.18; 95% confidence interval [CI95%]: 0.04-0.91) and Maghreb (OR: 0.26; 95% CI: 0.08-0.91) and among Latin American women (OR: 0.36; 95% CI: 0.14-0.92) than in the native population.Conclusions
These results show the need to continue to monitor social and health inequalities between the native and immigrant populations, as well as to support the policies that improve the socioeconomic conditions of immigrants. 相似文献9.
Objective
To evaluate the Health Observatory of Asturias (Observatorio de Salud de Asturias [OBSA]), which collects and disseminates health data from Asturias through a website and social networks.Method
A cross-sectional study was conducted between 2012 and 2013. The study included a process evaluation that analyzed the reach of the OBSA's website, Facebook and Twitter accounts through web metrics and the use made by health professionals in Asturias of these media. Satisfaction was assessed through an online questionnaire. To estimate the potential effects of the OBSA, the study also included an evaluation of the results with a non-experimental design.Results
The total number of visits to the website increased in 2012, with more than 37,000 visits. The questionnaire (n = 43) showed that 72.1% of the health professionals knew of the OBSA and that 81.5% of them had used it. Most health professionals reported they were satisfied with the OBSA and believed that it encouraged cooperation among professionals (51.6%).Conclusion
The OBSA is known and consulted by most health professionals and is achieving some of its main objectives: to inform health staff and stimulate discussion. According to the results, information and communication technologies could play an important role in the presentation of health data in a more interactive and accessible way. 相似文献10.
Yolanda González-Rábago Daniel La Parra Unai Martín Davide Malmusi 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
Population health surveys have been the main data source for analysis of immigrants’ health status in Spain. The aim of this study was to analyze the representation of this population in the Spanish National Health Survey (SNHS) 2011-2012.Methods
We analyzed methodological publications and data from the SNHS 2011-2012 and the population registry. Differences in the participation rate between the national and foreign populations and the causes for these differences were analyzed, as well as the representation of 11 countries of birth in the survey with respect to the general population, with and without weighting.Results
Households with any foreign person had a lower participation rate, either due to a higher error in the sampling frame or to a higher non-response rate. In each country of birth, the sample was smaller than would be expected according to the population registry, especially among the Chinese population. When we applied the sample weights to the 11 countries of birth, the estimated population volume was closer to the estimated volume of the population registry for all the countries considered, although globally both the underrepresentation and the intranational bias remained.Conclusions
The lower participation of the immigrant population and differences in participation depending on the country of origin suggest the existence of a potential bias in the SNHS, which should be taken into account in studies analyzing the health of this population. The lower participation rate should be studied in greater depth in order to take appropriate measures to increase the representativeness of health surveys. 相似文献11.
Ángela Blanco Moreno Rosa Urbanos Garrido Israel John Thuissard Vasallo 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objectives
To analyze changes in real per capita spending by age and sex from 1998 to 2008 in Spain, and to assess their effects on public healthcare expenditure projections.Methods
Age- and sex-related expenditure profiles in constant terms were estimated for the Spanish population for 3 distinct years (1998, 2003 and 2008) by using data from hospital records and several National Health Surveys. These profiles were used to compare actual healthcare expenditure for 2003 and 2008 with the projections obtained by considering 1998 as the base year and by applying the methodology used by the Working Group on Aging of the European Union.Results
The average annual growth rate of real per capita spending per person from 1998 to 2008 was 2.79%, which was higher than the GDP per capita growth rate (1.90%), basically due to its high rate of increase in the second half of the decade. From 1998 to 2008, per capita healthcare expenditure increased in most age groups, particularly in the groups aged 45-49 years, 60-64 years and 75 years and older. Projections of per capita expenditure in constant terms covered the real value observed for 2003, but were below the real value for 2008.Conclusions
Changes in the quantity and quality of healthcare services consumed by each person are an important factor in changes in healthcare expenditure and must be included in spending projections. 相似文献12.
Iván Martínez-Baz Marcela Guevara Fernando Elía Carmen Ezpeleta Mirian Fernández Alonso Jesús Castilla 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing.Method
A case-control study was performed of laboratory-confirmed cases (n = 909) and negative controls for influenza (n = 732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week.Results
The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p = 0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician.Conclusion
The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed. 相似文献13.
14.
Natalia Allué Pietro Chiarello Enrique Bernal Delgado Xavier Castells Priscila Giraldo Natalia Martínez Eugenia Sarsanedas Francesc Cots 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010.Methods
A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project.Results
This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure.Conclusions
Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System. 相似文献15.
Álvaro Fernández-Luna Pablo Burillo José Luis Felipe Leonor Gallardo Francisco Manuel Tamaral 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To describe chlorine levels in the air of indoor swimming pools in Castilla-La Mancha (Spain) and relate them to other chemical parameters in the installation and to the health problems perceived by swimming pool workers.Methods
We analyzed 21 pools with chlorine as chemical treatment in Castilla-La Mancha. The iodometry method was applied to measure chlorine concentrations in the air. The concentrations of free and combined chlorine in water, pH and temperature were also evaluated. Health problems were surveyed in 230 swimming pool workers in these facilities.Results
The mean chlorine level in the air of swimming pools was 4.3 ± 2.3 mg/m3. The pH values were within the legal limits. The temperature parameters did not comply with regulations in 17 of the 21 pools analyzed. In the pools where chlorine values in the air were above the legal regulations, a significantly higher percentage of swimming pool workers perceived eye irritation, dryness and irritation of skin, and ear problems.Conclusions
Chlorine values in the air of indoor swimming pools were higher than those reported in similar studies. Most of the facilities (85%) exceeded the concentration of 1.5 mg/m3 established as the limit for the risk of irritating effects. The concentration of chlorine in indoor swimming pool air has a direct effect on the self-perceived health problems of swimming pool workers. 相似文献16.
17.
Analía Abt Sacks Susana Pablo Hernando Pedro Serrano Aguilar Enrique Fernández Vega Roberto Martín Fernández 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To analyze information needs and search strategies among women with breast cancer in Spain. An additional aim was to explore how the internet, as a source of health information, influences the autonomy and active management of this disease among patients. The research was conducted in 2010 and 2011.Method
This study forms part of a broader qualitative study that focuses on describing patients’ experiences of breast cancer and the trajectory of the disease, with the aim of creating a platform of integrated information resources for patients, relatives and healthcare professionals (PyDEsalud: http://www.pydesalud.com). We carried out 41 in-depth, semi-structured interviews with breast cancer patients in different stage of the disease, who were aged between 32 and 69 years. The interviewees’ were selected by intentional sampling, which included 15 Spanish regions. The field work was carried out from June to August, 2010. The interviews were recorded on videotape or audio. Based on patients’ narratives of their disease, a thematic-inductive analysis was performed of the information gathered.Results
The findings show the importance of the internet as a source of health information. Moreover, the internet is a resource that is able to promote the empowerment process among patients and, consequently, to aid improvement in disease management.Conclusions
Users need access to web sites with high quality health information, adapted to their needs and objectives. 相似文献18.
Dolors Rodríguez Anna Berenguera Enriqueta Pujol-Ribera Jordina Capella Josep Lluís de Peray Josep Roma 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objectives
To identify current and future competencies (managers and technicians) for public health professionals in Catalonia (Spain).Methods
Qualitative research with a phenomenological approach. Between November 2009 and February 2010, 31 semistructured interviews were completed with public health professionals working in Catalonia. We purposely used a theoretical sample to include the maximum multiplicity of discourses. We conducted a thematic content analysis.Results
We obtained a wide range of current professional competencies, as well as those required for the future, classified according to professional profile. The participants highlighted transversal competencies, such as the importance of sharing a general theoretical framework of the discipline and the institution. Among the most frequently reported competencies were knowledge management, communication skills, teamwork, multidisciplinary and intersectoral orientation, legal knowledge, computer skills and languages, particularly English. It was also important for individual professionals to have specific skills in their areas of activity. In terms of differences between managers and technicians, the study showed that technicians prioritize management skills concerning human and material resources, while managers emphasize organizational and professional public health expertise.Conclusions
There is a need for transversal and specific competencies in distinct areas. Public health is a multidisciplinary field, which collaborates with a wide range of professionals and organizations. 相似文献19.
20.
Jose M. Martínez-Sánchez Marcela Fu Silvano Gallus Xisca Sureda Carlo La Vecchia Esteve Fernández 《Gaceta sanitaria / S.E.S.P.A.S》2013