Revisión sistemática de utilidades relacionadas con la salud en España: el caso de la salud mental

Objectives

Currently, there is no registry of utility values for the Spanish population that could potentially be used in economic evaluations. Consequently, a systematic review of utilities or preferences for health states in the Spanish population was conducted. The results related to mental health are reported.

Methods

A systematic review of the literature was conducted. The main databases searched were MEDLINE, CRD, Embase, PsycINFO, CINAHL, and Cochrane. The search strategy combined terms related to utilities and Spain. The inclusion criteria comprised the resident population in Spain, whether affected by any disease or not; the reported utilities had to be evaluated through a tool validated in Spain (i.e., EQ-5D, HUI, SF-6D) and/or following accepted techniques (e.g., time trade-off, standard gamble, or the visual analog scale). A narrative synthesis of articles was undertaken and the results related to mental health summarized.

Results

A total of 103 articles were finally included, from which 742 utility values were extracted. Sixty-nine utility values related to mental health and behavioral disorders were extracted from 12 studies. The most widely used tool was the E5-QD questionnaire. Most of the excluded articles evaluated quality of life but did not provide an estimation of utilities.

Conclusions

This review adds value to research on utilities in Spain by gathering values to be included in economic evaluations, as well as by identifying research gaps in this field. The utility values related to mental health identified in this study are similar to those reported in international publications.     

Condicionantes para el abordaje del aislamiento social y la soledad de adultos mayores no institucionalizados desde atención primaria de salud

ObjetivoIdentificar los principales condicionantes que los profesionales de atención primaria indican a la hora de implementar y desarrollar intervenciones sobre el aislamiento y la soledad.DiseñoInvestigación cualitativa con análisis Sistemático de Teoría Fundamentada y Diseño narrativo de tópicos.EmplazamientoDesarrollada en 13 centros de atención primaria del Distrito Sanitario Córdoba y Guadalquivir, abarcando zonas urbanas y rurales.ParticipantesSe identificaron 3 perfiles: medicina de familia/atención comunitaria, enfermería comunitaria y enfermería de gestión de casos. La selección se llevó a cabo entre aquellos que mostraron mayor motivación y compromiso con una intervención sobre aislamiento/soledad.MétodoMuestreo intencional. El trabajo se fundamentó en entrevistas en profundidad individuales, en grupos focales y entrevistas dialógicas.Resultadosa) Persisten imágenes deformadas sobre la soledad/aislamiento social y el vivir solo que dificultan su identificación; b) Los principales determinantes disruptivos en la estructura y organización del sistema de atención tienen que ver con la ausencia de programas de detección, la hegemonía del modelo biomédico y el déficit de recursos (a la luz de este modelo); c) Los principales facilitadores se vinculan con el rol enfermero, privilegiado para estas intervenciones según los participantes; y, finalmente, d) Es necesario contar con componentes personales, tanto de la persona mayor como de los profesionales.ConclusionesLa intervención sobre el aislamiento social y la soledad en atención primaria está condicionada por factores, organizacionales y estructurales, profesionales y personales. Contar con ellos es fundamental a la hora de garantizar su factibilidad.Palabras clave: Aislamiento social, Soledad, Anciano, Atención primaria de salud, Estudios de factibilidad     

La violencia también es un problema de salud pública

In 1996, the World Health Organization declared violence a major and growing public health problem across the world. In Spain, despite the growing incidence of reports of deaths and abuse due to intimate partners violence; the emergent data on school-based violence among children and adolescents; the persisting political violence and the tragic experience of the 11-M attacks in Madrid; a clear positioning over the role of the public health structures in the study and intervention of violence has not taken place. This article provides a characterization of the impact of violence in the health of its victims, as derived from a non-systematic review of the clinical, psychological and social literature. It also includes some prevalence data from Spanish studies. Special emphasis is given to violence against women, and political violence. The article highlights the scarcity of epidemiological data, which hinders the assessment of the health impact of violence in Spain. It brings, instead, the opinions of a number of public health professionals over the role of the Spanish communities of epidemiology and public health in this matter. The article concludes with a call to public health professionals, including the Spanish scientific societies involved in public health, to facilitate the public debate leading to the definition of the role of the Spanish public health in the understanding and reduction of the impact of violence on the health of its victims.     

Presencia de familiares durante la reanimación cardiopulmonar: perspectivas de pacientes,familiares y profesionales de la salud en el País Vasco

Objective

To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients.

Estado actual sobre la exposición alimentaria al mercurio durante el embarazo y la infancia,y recomendaciones en salud pública

Exposure to high levels of mercury during vulnerable periods (such as pregnancy and childhood) may have serious consequences for cognitive development, as observed after acute poisoning episodes in Japan and Irak. The main source of mercury exposure in the general population is consumption of certain types of fish. There is growing concern about the possible neurotoxic effects of mercury, especially in younger children in populations where fish intake is moderate to high. The scientific evidence to date is inconclusive. In Spain, the Childhood and Environment (Infancia y Medio Ambiente [INMA]) project has provided information on levels of prenatal exposure to mercury among 1800 newborns from Valencia, Sabadell, Asturias and Guipúzcoa. In general, levels were high, being above the World Health Organization's recommended dose in 24% of children and above the recommended levels of the U.S. Environmental Protection Agency in 64%. However, the results did not indicate a significant association between prenatal mercury exposure and delayed cognitive development during the second year of life. Various agencies have developed recommendations on fish consumption for pregnant women and children, due to the presence of mercury. These recommendations should be strengthened, since there is general consensus among all regional and national public administrations that fish is an essential source of nutrients for development in the early stages of life.     

Evaluación del Observatorio de Salud de Asturias: métricas de web y redes sociales,y opinión de los profesionales de la salud

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.     

Concentración de cloro en el aire de las piscinas cubiertas y sus efectos en la salud de los trabajadores a pie de piscina

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.     

Identificación de las competencias actuales y futuras de los profesionales de la salud pública

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.     

Inmigración y salud: desigualdades entre la población autóctona e inmigrante en el País Vasco

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.     

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.