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.     

Diseño y validación de un cuestionario sobre las actitudes ante la prevención y promoción de la salud en atención primaria (CAPPAP)

ObjectiveTo develop and validate a questionnaire to measure attitudes towards prevention and health promotion.DesignCross-sectional study for the validation of a questionnaire.LocationPrimary Health Care (autonomous community of Andalusia, Spain).Participants282 professionals (nurses and doctors) belonging to the Public Health System.Main measurementsContent validation by experts, ceiling effects and floor effects, correlation between items, internal consistency, stability and exploratory factor analysis.ResultsThe 56 items of the tool (CAPPAP) obtained, including those from the review of other tools and the contributions of the experts, were grouped into 5 dimensions. The percentage of expert agreement was over 70% on all items, and a high concordance between prevention and promotion item was obtained, thus, duplicates were removed leaving a final tool with 44 items. The internal consistency, measured by Cronbach's alpha, was 0.888. The test retest indicated concordance from substantial to almost perfect. Exploratory factor analysis identified five factors that accounted for 48.92% of the variance.ConclusionsCAPPAP is a tool that is quick and easy to administer, that is well accepted by professionals, and that has acceptable psychometric results, both globally and at the level of each dimension.     

Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía

ObjectiveTo evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used.MethodThe Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater.Results176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72).ConclusionsThis Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.     

Atención Primaria y promoción de la salud bucodental: evaluación de una intervención educativa en población infantil

ObjectiveTo evaluate the short and medium term effectiveness of a Primary Care-driven oral health promotion intervention.DesignA non-randomised community intervention trial.SettingThree socio-demographically similar primary schools of a deprived neighborhood in Granada, Spain.ParticipantsEighty-two intervention and 109 control students aged 5 to 6, as well as the teachers and the parent's association of the intervention school (IS) participated in the study.InterventionSchool-based health promotion activities aimed at students, and regular meetings with the teachers and parents of the IS during 2 consecutive years.Main measurementsStudents’ oral health-related knowledge and behavior, assessed via questionnaires distributed before the intervention, and 6 and 18 months afterwards.ResultsCompared to the control groups at 18 months, students belonging to the IS reported enhanced oral health knowledge (OR 3.54; 95% CI 1.46-8.58), and an increased consumption of healthy food at breakfast (OR 2.95; 95% CI 1.26-6.89) and during mid-afternoon snack (OR 3.67; 95% CI 1.49-9.05). A significant decrease was seen in the intake of pastries (OR 4.05; 95% CI 1.68-9.81) and sweetened soft drinks and juices (OR 3.79; 95% CI 1.57-9.12) amongst intervention compared to control students in the medium term (18 months). No significant improvements were observed concerning oral hygiene in the IS.ConclusionsSchool-based educational interventions, when developed through an intersectoral and participative approach and considering the socio-economic context, appear to be effective in improving students’ diet-related knowledge and behaviors.     

Promoción de la salud y prevención en tiempos de crisis: el rol del sector sanitario. Informe SESPAS 2014

This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts’ opinions are divided on the need for some preventive activities.Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions.     

Arte,salud y prevención: primeras colaboraciones

This article presents a summary of the first 2 years of the collaboration between the Faculty of Fine Arts of the Universidad Complutense in Madrid and Madrid Health, an autonomous organism of Madrid Council. This collaboration has allowed the development of joint experiences and projects among distinct professionals with highly diverse profiles: health professionals (sexologists, psychiatrists, nurses, etc.), and teachers, researchers, artists and students in the Faculty of Fine Arts. As a result, these experiences could be the beginning of future collaborations between the arts, health and prevention.     

Aplicabilidad y percepción de utilidad del European Quality Instrument for Health Promotion (EQUIHP) en un programa de promoción de la salud

Objective

To describe the results of applying the European Quality Instrument for Health Promotion (EQUIHP) tool in the MIHsalud programme and to discuss its perceived utility by the programme's team members.

Adecuación del tratamiento de la osteoporosis en prevención primaria. Estudio cuantitativo y cualitativo

Objective

Quantitative study: To assess the prevalence of inadequacy of treatment for osteoporosis in primary prevention (OPP) in women aged 60-74 years. Qualitative study: To evaluate the diagnostic and treatment criteria of the OPP and it's variability in primary care physicians (PC) and specialists.

Adaptación de los servicios de una organización de salud pública a la disminución de los recursos

This paper describes the review process of the Agency of Public Health of Barcelona's service portfolio in response to the budget cuts introduced since 2010 in the public administrations in Spain. A working group reviewed the different business activities, taking into account their costs and generated revenue and their justification, assessing factors such as the existence of legal constraints, tied funding, explicit demands from the founding administrations and other actors that may be capable of undertaking particular activities. The changes and their consequences are described. The new service portfolio has been consolidated and is considered ratified by the Agency board, which was renewed after political changes. We conclude that this is because it was based on professional consensus and management criteria, which are key for the smooth operation of a public autonomous executive organisation.     

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.     

La financiación de la industria alimentaria y la investigación epidemiológica sobre nutrición y salud

The interests of the food industry to fund nutrition and health research are not limited to promoting scientific advances. Recently, several systematic reviews conducted about the effect of sugar-sweetened beverages and health outcomes have shown some biased conclusions in studies that acknowledge industry sponsorship. In this context, the Nutrition Working Group of the Spanish Epidemiology Society presented a scientific session entitled Food industry and epidemiologic research at its annual meeting. In a round table, four experts in nutrition research presented their points of view about whether the food industry should fund nutrition-related research and the related potential conflicts of interest of the food industry. All the experts agreed not only on defending independence in nutritional epidemiology regarding the design, interpretation and conclusion of their studies but also on the crucial need for guaranteed scientific rigor, scientific quality of the results and measures to protect studies against potential biases related to the conflicts of interest of funding by the food industry. Drs Pérez-Farinós and Romaguera believe that the most effective way to prevent conflicts of interest would be not to allow the food industry to fund nutrition research; Drs Marcos and Martínez-González suggested the need to establish mechanisms and strategies to prevent the potential influences of the food industry in selecting researchers or institutional sponsorship and in the analysis and results of the studies, to ensure maximum independence for researchers, as well as their professional ethics.     

Beneficios para la salud del uso de anticoncepción oral

For decades, abortion has been the principal birth control method for Soviet women. As indicated by some earlier local surveys, most couples use unreliable methods. Little is known about the latest trends in contraceptive use affected by the recent general liberalization of Soviet society, including more open attitudes about sex. A survey was conducted in 1991 via a questionnaire in the popular Health magazine with national circulation. A total of 8059 women returned the questionnaire. The sample is selective with an overrepresentation of young and better educated urban residents, mostly from Russia and the Ukraine. Some 81% reported use of a contraceptive method during the last 5 years. Traditional methods still prevail (41% used withdrawal, rhythm and douche). Among women younger than 25 years there is a clear trend toward use of modern methods (IUD 35% and the pill 10%), although their notion of the pros and cons is biased. Of the respondents, 20% used a barrier method, mainly condom. The preferred method is the IUD (51%) and the pill (18%). Abortions resulting from contraceptive failure were reported by 60% of women. Eighty-nine percent considered pregnancy termination more dangerous than its prevention. For only 12% of respondents, a physician was the main source of contraceptive information, although 49% addressed him for advice. The results indicate a gap between conservative birth control practice and preferences of Russian women, with a positive general trend in the near future.

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Resumen El aborto ha sido durante décadas el principal método anticonceptivo de las mujeres soviéticas. Según lo indican algunos estudios locales anteriores, la mayoría de las parejas utilizan métodos no fiables. Poco se sabe acerca de las tendencias más recientes en el uso de anticonceptivos afectadas por la liberalización general de la sociedad soviética en los últimos tiempos, incluso actitudes más abiertas respecto de las relaciones sexuales. En 1991 se realizó un estudio a través de la revista popular Salud, de circulación nacional. En total, 8.059 mujeres llenaron el formulario. La muestra es selectiva, con una representación excesiva de residentes urbanas jóvenes y de mejor nivel de educación, en su mayoría de Rusia y Ucrania. Alrededor del 81 por ciento dijo que había utilizado u método anticonceptivo en los 5 últimos años. Continúan predominando los métodos tradicionales (el 41 por ciento recurría al coitus interruptus, ritmo y lavaje vaginal). Entre las mujeres de menos de 25 años, hay una clara tendencia a utilizar métodos modernos (DIU, 35 por ciento y píldora, 10 por ciento) si bien su conocimiento de las ventajas y desventajas indica prejuicio. El 20 por ciento de las mujeres utilizaba un método de barrera, principalmente el preservativo. El método preferido es el DIU (51 por ciento) y la píldora (18 por ciento). El 60 por ciento de las mujerers notificaron abortos resultantes de la falla de los métodos anticonceptivos. El 89 por ciento de las mujeres consideraban que la interrupción del embarazo era más peligrosa que su prevención. En el caso de sólo el 12 por ciento de las entrevistadas, un médico era la principal fuente de información sobre métodos anticonceptivos, si bien el 49 por ciento le consultaba en busca de asesoramiento. Los resultados indican un vacío entre la práctica conservadora, del control de la natalidad y las preferencias de las mujeres rusas, con una tendencia general positiva en un futuro próximo.

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Resumé Depuis des dizaines d'années l'avortement est la principale méthode de contraception utilisée par les femmes soviétiques. Comme l'ont indiqué des enquêtes locales précédentes, la plupart des couples font appel à des méthodes incertaines. On connaît peu les incidences qu'a eues la récente libéralisation générale au sein de la société soviétique sur les dernières tendances de la contraception, et notamment sur les attitudes plus ouvertes à l'égard des relations sexuelles. Une enquête a été menée en 1991, par l'intermédiaire d'une revue populaire à tirage national (Santé). Au total 8.059 femmes ont répondu au questionnaire. L'échantillonnage en est sélectif; il représente, pour une très, forte majorité, des femmes jeunes ayant reçu une certaine éducation et résidant dans des centres urbains, pour la plupart en Russie et en Ukraine. Environ 81% d'entre elles ont indiqué qu'elles avaient fait appel à une méthode contraceptive durant les cinq années passées. Les méthodes classiques sont encore les plus (41% pour le retrait, la méthode des rythmes et l'irrigation). Parmi les femmes de moins de 25 une nette tendance à employer les méthodes modernes (35% les DIU, 10% la pillule), bien que leurs perceptions des pour et des contre soient confuses. Les méthodes de barrière, essentiellement les préservatifs, sont utilisées par 20% des femmes ayant répondu au questionnaire. Les préférences vont au DIU (51%) et à la pillule (18%). Soxiante pour cent des femmes ont signalé qu'elles avaient eu recours à des avortements lorsque la méthode de contraception utilisée avait échoué, et 89% considéraient que l'interruption d'une grossesse présentait plus de danger que sa prévention. Dans le cas de 12% à peine des femmes, un médecin avait été la principale source de renseignements sur la contraception, sur un pourcentage de 49% de celles qui s'étaient adressées au corps médical. Les résultats font apparaître un écart entre les pratiques contraceptives traditionnelles et les préférences des femmes russes, avec une tendance générale positive pour l'avenir immédiat.