Dealing with Emotional Vulnerability and Anxiety in Nurses from High-Risk Units-A Multicenter Study.

Compassion fatigue and anxiety derived from continued exposure to trauma and death greatly impact nurses' quality of care and quality of life, increasing their desire to leave work. The aim of the study is to assess compassion fatigue and anxiety prevalence and their association with secondary variables. A multicenter, cross-sectional study in nurses from four high-risk units, Emergency, Intensive Care, Oncology, and Pediatrics, was carried out in 14 hospitals in Catalonia (Spain) between 2015 and 2016. The primary endpoints were compassion satisfaction and compassion fatigue (burnout and secondary traumatic stress), which were assessed by Professional Quality of Life (ProQOL), and anxiety, assessed with the State-Trait Anxiety Inventory (STAI). Multivariable logistic regression analyzed the association of sociodemographic, training, working, and psychological factors. Of a total of 1302 nurses, 18.6% presented low compassion satisfaction; 19.7%, high burnout; and 36.4%, high secondary traumatic stress. Trait anxiety scored high in 7.2%. Although compassion satisfaction was present, it did not protect sufficiently against the high level of compassion fatigue or anxiety present in nurses in all centers. The working conditions in the units and variables showed a strong association with nurses' desire to leave. This corroborates the global challenge of healthcare professionals' shortage. Participants expressed the need for better training in emotional management.

Malignant asbestos-related disease in a population exposed to asbestos.

OBJECTIVES: The first asbestos fiber cement plant in Spain operated in Cerdanyola, in the Barcelona metropolitan area, between 1907 and 1997. We describe clinical and epidemiological characteristics of patients diagnosed with the malignant asbestos-related disease (ARD) in the area of the plant between 2007 and 2016. METHODS: A prospective, descriptive study was undertaken in the 12 municipalities of the county of Barcelona most proximate to the plant. We describe malignant ARD cases by time of diagnosis, source of exposure, periods of exposure and latency, and distribution by sex. Cumulative incidence and age-standardized incidence rates (ASIR) are calculated. RESULTS: Of 477 patients diagnosed with ARD between 2007 and 2016, 128 (26%) presented with asbestos-associated malignancy. Pleural mesothelioma was noted in 105 patients (82.0%) with a linear trend Z-score of -0.2 (NS) in men and 2.7 (P < .01) in women. The highest ASIRs for malignant ARD (6.1/100 000 residents/year; 95% confidence interval [CI], 2.2-13.3) and pleural mesothelioma (4.8/100 000 residents/year; 95% CI, 1.5-11.6) occurred in municipalities closest to the focal point of contamination. The origin of malignant ARD was nonoccupational in 32.2% of men and 81.6% of women (P < .001). CONCLUSIONS: More than 20 years after the closure of the fiber cement plant, the grave consequences of exposure to asbestos remain. The detection of cases of pleural mesothelioma in men seems to have plateaued whereas in women an ascending trend continues, which principally has its origin in nonoccupational exposures.

Emotional impact and compassion fatigue in oncology nurses: Results of a multicentre study.

PURPOSE: To assess the prevalence of Compassion Satisfaction, Compassion Fatigue (Burnout and Secondary Traumatic Stress) and anxiety in oncology nurses and the association with demographics, training, work-related conditions, and psychological factors. METHOD: A multicentre, cross-sectional study in 8 selected hospitals in Catalonia (Spain) involving oncology nurses. Primary outcomes were Compassion Satisfaction and Compassion Fatigue (Burnout/Secondary Traumatic Stress), evaluated with the Professional Quality of Life questionnaire v.IV, and anxiety, evaluated with the State-Trait Anxiety Inventory. RESULTS: Of 297 participants, 18.2% (95% confidence interval [CI]:16.1-20.3) presented low Compassion Satisfaction; 20.2% (95% CI:18.0-22.4), high burnout; and 37.4% (95% CI:34.8-40.0), high Secondary Traumatic Stress. Trait and State Anxiety were high in 5.4% (95% CI:4.2-6.6) and 8.1% (95% CI:6.6-9.6) of participants, respectively. Nurses' desire to leave the unit was associated with high burnout (adjusted odds ratio [ORa] 3.7, 95% CI:1.9-7.5) and Secondary Traumatic Stress (ORa 3.2, 95% CI:1.9-5.3), while the desire to leave the profession was related to high State Anxiety (ORa 12.5, 95% CI:4.6-33.7). Most participants (96.9%) were interested in receiving emotional management training. CONCLUSIONS: Continuous demands on oncology nurses' empathy can lead them to experience compassion fatigue, anxiety and a desire to leave the profession. The first study carried out with Spanish oncology nurses shows Compassion Fatigue is highly prevalent. This is related to nurses' desire to change units, leave their profession and has negative implications on staff satisfaction and quality of care. This problem justifies institutions support strategies for these professionals.

Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis.

BACKGROUND: The mortality from all malignant and nonmalignant asbestos-related diseases remains unknown. The authors assessed the incidence and risk factors for all asbestos-related deaths. METHODS: The sample included 544 patients from an asbestos-exposed community in the area of Barcelona (Spain), between Jan 1, 1970, and Dec 31, 2006. Competing risk regression through a subdistribution hazard analysis was used to estimate risk factors for the outcomes. RESULTS: Asbestos-related deaths were observed in 167 (30.7%) patients and 57.5% of these deaths were caused by some type of mesothelioma. The incidence rate after diagnosis was 3,600 per 100,000 person-years. In 7.5% of patients death was non-asbestos-related, while pleural and peritoneal mesothelioma were identified in 87 (16.0%) and 18 (3.3%) patients, respectively. CONCLUSIONS: Age, sex, household exposure, cumulative nonmalignant asbestos-related disease, and single malignant pathology were identified as risk factors for asbestos-related death. These findings suggest the need to develop a preventive approach to the community and to improve the clinical follow-up process of these patients.

La salud comunitaria en los equipos de atención primaria: objetivo de dirección / Community health in primary health care teams: a management objective

OBJETIVO: Describir el proceso de desarrollo de la salud comunitaria (SC) en un territorio en que la dirección territorial de Atención Primaria decidió incluirla como línea estratégica en su hoja de ruta. DISEÑO: Investigación evaluativa mediante técnicas cualitativas, incluyendo análisis DAFO en SC, en 2 etapas (estudio bietápico). EMPLAZAMIENTO: Equipos de Atención Primaria del Instituto Catalán de la Salud en Barcelona. PARTICIPANTES Y CONTEXTO: El ámbito de estudio son los 24 EAP del Servicio de Atención Primaria Muntanya-Dreta de la ciudad de Barcelona, referentes de un total de 557.430 habitantes, con un total de 904 profesionales. MÉTODO: 1. a fase: constitución de un grupo de trabajo en SC; identificación de los proyectos comunitarios en el territorio con cuestionario ad hoc; análisis DAFO.2. a fase: a partir de las necesidades detectadas en la fase anterior se elaboró un plan de actividades formativas en SC: taller básico, taller avanzado y jornada de intercambio de experiencias en salud comunitaria. RESULTADOS: Ochenta profesionales de los equipos recibieron formación específica en los 4 talleres realizados, uno de ellos de nivel avanzado; se realizaron 2 jornadas de intercambio de experiencias en las que participaron 165 profesionales de los equipos del territorio y en las que se presentaron 22 experiencias locales. De los 24 EAP, 6 han efectuado diagnóstico comunitario en 2013. CONCLUSIONES: Aunque la SC está ciertamente desarrollada en determinadas áreas, dista todavía de tener un papel relevante en el modelo de atención. Su expansión va a depender del soporte directivo, la impronta comunitaria local y el propio EAP

OBJECTIVE: To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. DESIGN: Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. LOCATION: Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. PARTICIPANTS AND/OR CONTEXT: The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. METHOD: Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. RESULTS: A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. CONCLUSIONS: Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care

[Community health in primary health care teams: a management objective]. / La salud comunitaria en los equipos de atención primaria: objetivo de dirección.

OBJECTIVE: To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. DESIGN: Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. LOCATION: Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. PARTICIPANTS AND/OR CONTEXT: The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. METHOD: Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. RESULTS: A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. CONCLUSIONS: Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care.

Risk factors associated with asbestos-related diseases: a community-based case-control study.

BACKGROUND: Asbestos is a first level carcinogen. However, few epidemiological studies analyse the risk and protective factors associated with asbestos-related diseases and follow up these conditions in the general population. Pleural mesothelioma, caused by inhalation of asbestos fibres at work, at home or in the environment, is the most representative asbestos-related disease.The objectives of this study are to analyse the risk and protective factors associated with asbestos-related diseases and to investigate the incidence of new clinical manifestations in patients already diagnosed with some form of ARD. METHODS/DESIGN: We have designed a matched case-control study with follow up of both cohorts from a population of a health district of the Barcelona province that has been exposed to asbestos for a period of 90 years. DISCUSSION: A better understanding of asbestos-related diseases should improve i) the clinical and epidemiological follow up of patients with this condition; ii) the design of new treatment strategies; iii) and the development of preventive activities. At the end of the study, the two cohorts created in this study (affected cases and healthy controls) will constitute the basis for future research.

Pleural mesothelioma in relation to meteorological conditions and residential distance from an industrial source of asbestos.

OBJECTIVES: Few studies have focused on pleural mesothelioma and environmental exposure in individuals residing around an industrial source of asbestos. The aim of this study is to determine whether residential distance and wind conditions are related to the risk of developing pleural mesothelioma. METHODS: In this retrospective cohort study carried out in an area of Barcelona province (Catalonia, Spain), 24 environmental pleural mesothelioma cases were diagnosed between 2000 and 2009. We calculated the age-standardised incidence rate ratios of developing this disease in the population studied, taking into account the residential distance from the plant. For cases living within a 500-m radius of the plant, the geographical location in relation to the factory was also assessed. RESULTS: The incidence rate of environmental pleural mesothelioma was higher in the population living within 500 m of the plant than in those living in a radius of 500-2000 m and much higher than those living at 2000-10 000 m. The highest incidence rate ratio for pleural mesothelioma (161.9) was found in the southeast quadrant of the 500-m area, coinciding with the predominant wind direction. CONCLUSIONS: Residential distance from an industrial source of asbestos and local wind conditions have a considerable impact on the risk of developing environmental pleural mesothelioma.

Efficacy of an adjunctive computer-based cognitive training program in amnestic mild cognitive impairment and Alzheimer's disease: a single-blind, randomized clinical trial.

OBJECTIVE: This study evaluates the efficacy at 12 months of a computer-based cognitive training (CBCT) program, adjunctive to traditional cognitive training (TCT), on the basis of pen-and-paper exercises. METHODS: Sixty patients with multi-domain mild cognitive impairment and mild Alzheimer's disease who were already receiving cognitive training, recruited from a day hospital, were assigned into two groups following a simple randomization procedure (computerized random numbers): (i) a group that received CBCT during 3 months and TCT (CBCT + TCT), n = 37, and (ii) a group that received only TCT, n = 23. Patients were assessed at baseline and after 3 and 12 months of treatment by a neuropsychologist blinded to group assignment, with a neuropsychological battery (primary outcomes) and measures of decision making, memory complaints, and emotional disturbances. RESULTS: With the use of repeated-measures analyses of covariance, the CBCT + TCT group showed less anxiety symptoms (F = 5.13, p = 0.03, d = 1.12) and less disadvantageous choices (F = 4.70, p = 0.04, d = 0.89) in decision making than the TCT group at 12 months. No significant improvement or worsening was observed in the other measures examined. However, positive effect sizes favoring the CBCT + TCT group were observed in all variables. CONCLUSIONS: The addition of a CBCT program was effective in anxiety and decision making but had no significant effects on outcomes in basic cognitive functions in patients who were already receiving cognitive training, possibly due to a ceiling effect. Future studies should compare the efficacy of CBCT with TCT in naïve patients.

Plan de encuestas de satisfacción del CatSalut-PLAENSA ©. Estrategias para incorporar la percepción de la calidad de servicio de los ciudadanos en las políticas de salud / Satisfaction survey of CatSalut-PLAENSA ©. Strategies to incorporate citizens’ perception of the quality of the service in health policies

El objetivo de este artículo es presentar las estrategias, actividades y resultados del Plan de encuestas de satisfacción del CatSalut-PLAENSA© 2003-2010, que están facilitando avanzar en la mejora de la calidad de los servicios sanitarios. Desde 2003 se dispone del Plan de encuestas de satisfacción PLAENSA©, una herramienta de evaluación y de propuesta de mejora de los servicios que presta la aseguradora pública a través de las entidades proveedoras contratadas siguiendo 3 estrategias clave: medir sistemática y objetivamente la satisfacción de los asegurados con los servicios recibidos; elaborar propuestas de mejora acorde con un modelo sistematizado y normalizado con actividades de seguimiento, y fomentar la equidad mediante la diseminación en los centros sanitarios y territorios. Actualmente se dispone de la valoración de los asegurados de la mayor parte de servicios sanitarios, con más de 2.500 proyectos de mejora en funcionamiento en los distintos proveedores de las 7 regiones sanitarias de Cataluña (AU)

The aim of this work is to present the strategies, activities and results of satisfaction surveys Plan CatSalutPLAENSA© 2003-2010 that are making progress in improving the quality of health services. Since 2003, CatSalut has at its disposal the plan known as PLAENSA© Satisfaction Surveys, a tool for assessment and improvement proposals addressed to the insurance services provided by contracted public entities. The plan follows 3 key strategies: systematic and objective policyholders’ satisfaction measurement, related to the services received; release of improvement proposals according to a standardized model, including standardized monitoring, and promotion of equity through propagation among health centres and territories. Current assessment provided by the insured about most health services has been already collected, leading to more tan 2,500 projects of improvement which are being developed by the providers of the 7 health regions of Catalonia (AU)

Encuestas de salud en Cataluña: revisión bibliográfica / Health surveys in Catalonia, Spain: a literature review

El objetivo de este estudio es analizar las publicaciones biomédicas sobre encuestas de salud (ES) en el ámbito territorial de Cataluña a partir de los documentos publicados en diferentes bases de datos bibliográficas hasta 2010. Se efectuó el análisis de 1.287 documentos sobre ES en 3 fuentes de información bibliográ- ficas referidas a Cataluña, entre 1991 y 2010. Los artículos científicos sobre ES en el ámbito territorial catalán han sido 196. Se estudiaron las variables vinculadas con el tema del artículo publicado, la revista de publicación, el tipo de encuesta, las características del muestreo y el tamaño muestral, el ámbito geográfico y la periodicidad de la encuesta. Los artículos analizados representan el 15,23% de todos los documentos iniciales. La mitad de ellos se ha publicado en revistas españolas, destacando Gaceta Sanitaria y Medicina Clí- nica; los temas más estudiados son el estado de salud y los estilos de vida. Un 40,8% explicita claramente las características del diseño muestral; el tamaño de las muestras oscila entre 49 y 23.126 individuos. Se sugiere que las ES en Cataluña son útiles para generar conocimiento sobre el estado de salud, los estilos de vida y la utilización de recursos sanitarios de la población, así como su divulgación entre los expertos sanitarios y la población (AU)

The aim of this study is to analyze biomedical publications on health surveys (HS) in the Catalan territory from documents published in various bibliographic databases to 2010. Analysis of 1,287 HS documents on 3 bibliographic sources of information relating to Catalonia, between 1991 and 2010. Scientific papers on HS in the Catalan territory have been 196. We studied the variables related to the topic of the article published, the magazine publication of the survey, the characteristics of sampling and the sample size, geographical area and timing of the survey. The articles reviewed represent 15.23% of all original documents. Half of them have been published in Spanish journals, stressing Gaceta Sanitaria and Medicina Clínica and the most studied issues are health and lifestyles. A 40.8% clearly explicit the characteristics of the sample, the size of them range between 49 and 23,126 individuals. It is suggested that HS in Catalonia are useful for generating knowledge about health, lifestyle and health resource utilization of the population, and its disclosure among health experts and the public (AU)

[Satisfaction survey of CatSalut-PLAENSA(©). Strategies to incorporate citizens' perception of the quality of the service in health policies]. / Plan de encuestas de satisfacción del CatSalut-PLAENSA(©). Estrategias para incorporar la percepción de la calidad de servicio de los ciudadanos en las políticas de salud.

The aim of this work is to present the strategies, activities and results of satisfaction surveys Plan CatSalut- PLAENSA(©) 2003-2010 that are making progress in improving the quality of health services. Since 2003, CatSalut has at its disposal the plan known as PLAENSA(©) Satisfaction Surveys, a tool for assessment and improvement proposals addressed to the insurance services provided by contracted public entities. The plan follows 3 key strategies: systematic and objective policyholders' satisfaction measurement, related to the services received; release of improvement proposals according to a standardized model, including standardized monitoring, and promotion of equity through propagation among health centres and territories. Current assessment provided by the insured about most health services has been already collected, leading to more tan 2,500 projects of improvement which are being developed by the providers of the 7 health regions of Catalonia.

[Health surveys in Catalonia, Spain: a literature review]. / Encuestas de salud en Cataluña: revisión bibliográfica.

The aim of this study is to analyze biomedical publications on health surveys (HS) in the Catalan territory from documents published in various bibliographic databases to 2010. Analysis of 1,287 HS documents on 3 bibliographic sources of information relating to Catalonia, between 1991 and 2010. Scientific papers on HS in the Catalan territory have been 196. We studied the variables related to the topic of the article published, the magazine publication of the survey, the characteristics of sampling and the sample size, geographical area and timing of the survey. The articles reviewed represent 15.23% of all original documents. Half of them have been published in Spanish journals, stressing Gaceta Sanitaria and Medicina Clínica and the most studied issues are health and lifestyles. A 40.8% clearly explicit the characteristics of the sample, the size of them range between 49 and 23,126 individuals. It is suggested that HS in Catalonia are useful for generating knowledge about health, lifestyle and health resource utilization of the population, and its disclosure among health experts and the public.

[U.S.-Mexico cross-border cooperation in research on diabetes mellitus type 2]. / Cooperación transfronteriza en investigación sobre diabetes mellitus tipo 2: México-Estados Unidos.

OBJECTIVE: To describe and analyze, utilizing a case study approach, the U.S.- Mexico Border Diabetes Prevention and Control Project, a health research cooperation initiative incorporating the participation of federal, state, and local institutions of both countries. METHODS: A model of equal representation, participation, consensus, and shared leadership was used, with the participation of more than 130 institutions. A sample of 4 020 people over 18 years of age was obtained by a random, multistage, stratified, clustered design. A questionnaire about diabetes mellitus type 2 (DM2) and health was applied. The statistical analysis took into account the design effect. RESULTS: The prevalence of diagnosed DM2 was 14.9% (95% confidence interval [95% CI]: 12.5-17.6) and the prevalence of diagnosed DM2 adjusted by age was 19.5% (95% CI: 16.8-22.6) on the Mexican side of the border and 16.1% (IC95%: 13.5-19.2) on the U.S. border side. There were differences between the DM2 prevalence and risk factors along the border. CONCLUSIONS: The U.S.-Mexico Border Diabetes Prevention and Control Project allowed the border zone between the two countries to be considered, for the first time ever, as a unit for epidemiological research. A shared understanding among all participating institutions and entities of sociopolitical structures and procedures is required for effective border health cooperation initiatives.

Quality of diabetes care: a cross-sectional study of adults of Hispanic origin across and along the United States-Mexico border.

OBJECTIVE: To assess and monitor the quality of care provided to Hispanics diagnosed with diabetes living in the border region between the United States of America and Mexico. METHODS: From April 2001 to November 2002, Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, was conducted along the U.S.-Mexico border using two-stage cluster sampling of towns and households within towns. A questionnaire was administered on diabetes (self-reported) and lifestyle and a physical examination and blood sample were obtained. Of the 4 027 study participants, 521 (13.0%) reported receiving a pre-study diagnosis of diabetes. Of those, 466 were of Hispanic origin (226 on the Mexican side of the border and 240 on the U.S. side). RESULTS: Results indicated 42.1% of Hispanics on the U.S. side of the border (95% confidence interval [CI] 35.8%-48.6%) and 37.6% of Hispanics on the Mexican side (95% CI 31.3%-44.3%) had controlled diabetes (defined as glycosylated hemoglobin A1c < 7.0 %), and only one (on the Mexican side of the border) received optimal diabetes care, defined according to international criteria for systolic blood pressure and body mass index as well as health provider provision of yearly examinations of foot and eyes as preventive care measures for early detection of diabetes complications. CONCLUSIONS: Adult Hispanics diagnosed with diabetes and living on the U.S.-Mexico border region are not receiving adequate diabetes-related care, and health care professionals are not following international recommendations for providing that care. To improve diabetes control in the region, health care providers must become more aware of the effect of education and culture on diabetes self-care as well as the provision of preventative measures by health care professionals.

Cooperación transfronteriza en investigación sobre diabetes mellitus tipo 2: México-Estados Unidos / U.S.-Mexico cross-border cooperation in research on diabetes mellitus type 2

OBJETIVO: Describir y analizar con un enfoque de estudio de caso el Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos (PDF-México/Estados Unidos), un esfuerzo de cooperación en investigación en salud en el que participaron instituciones federales, estatales y locales de ambos países. MÉTODOS: El proyecto utilizó un modelo de igual representación, participación, consenso y liderazgo compartido, con la participación de más de 130 instituciones coordinadas por organismos de ambos países. Se estudió una muestra aleatoria, multietápica, estratificada y por conglomerados de 4 020 personas mayores de 18 años que respondieron un cuestionario de preguntas relacionadas con la diabetes mellitus tipo 2 (DM2) y la salud. El análisis estadístico de la información muestral obtenida tuvo en cuenta el efecto del diseño. RESULTADOS: La prevalencia de DM2 diagnosticada fue de 14,9 por ciento (intervalo de confianza de 95 por ciento [IC95 por ciento]: 12,5-17,6) y la prevalencia de DM2 diagnosticada ajustada por edad fue de 19,5 por ciento (IC95 por ciento: 16,8-22,6) en la parte mexicana y de 16,1 por ciento (IC95 por ciento: 13,5-19,2) en la estadounidense. La prevalencia de la DM2 y los factores de riesgo no fueron exactamente iguales a lo largo de la frontera. CONCLUSIONES: La ejecución del PDF-México/Estados Unidos ha permitido por primera vez considerar la franja fronteriza entre ambos países como una unidad para la investigación epidemiológica. En iniciativas fronterizas futuras, se sugiere fortalecer el entendimiento mutuo de la estructura sociopolítica y de las formas de actuación por parte de las instituciones y otras entidades participantes en ambos lados de la frontera.

OBJECTIVE: To describe and analyze, utilizing a case study approach, the U.S.- Mexico Border Diabetes Prevention and Control Project, a health research cooperation initiative incorporating the participation of federal, state, and local institutions of both countries. METHODS: A model of equal representation, participation, consensus, and shared leadership was used, with the participation of more than 130 institutions. A sample of 4 020 people over 18 years of age was obtained by a random, multistage, stratified, clustered design. A questionnaire about diabetes mellitus type 2 (DM2) and health was applied. The statistical analysis took into account the design effect. RESULTS: The prevalence of diagnosed DM2 was 14.9 percent (95 percent confidence interval [95 percent CI]: 12.5-17.6) and the prevalence of diagnosed DM2 adjusted by age was 19.5 percent (95 percent CI: 16.8-22.6) on the Mexican side of the border and 16.1 percent (IC95 percent: 13.5-19.2) on the U.S. border side. There were differences between the DM2 prevalence and risk factors along the border. CONCLUSIONS: The U.S.-Mexico Border Diabetes Prevention and Control Project allowed the border zone between the two countries to be considered, for the first time ever, as a unit for epidemiological research. A shared understanding among all participating institutions and entities of sociopolitical structures and procedures is required for effective border health cooperation initiatives.

Quality of diabetes care: a cross-sectional study of adults of Hispanic origin across and along the United States-Mexico border / Calidad de la atención de la diabetes: un estudio transversal de adultos hispanos residentes en ambos lados de la zona fronteriza entre México y los Estados Unidos

OBJECTIVE: To assess and monitor the quality of care provided to Hispanics diagnosed with diabetes living in the border region between the United States of America and Mexico. METHODS: From April 2001 to November 2002, Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, was conducted along the U.S.-Mexico border using two-stage cluster sampling of towns and households within towns. A questionnaire was administered on diabetes (self-reported) and lifestyle and a physical examination and blood sample were obtained. Of the 4 027 study participants, 521 (13.0 percent) reported receiving a pre-study diagnosis of diabetes. Of those, 466 were of Hispanic origin (226 on the Mexican side of the border and 240 on the U.S. side). RESULTS: Results indicated 42.1 percent of Hispanics on the U.S. side of the border (95 percent confidence interval [CI] 35.8 percent-48.6 percent) and 37.6 percent of Hispanics on the Mexican side (95 percent CI 31.3 percent-44.3 percent) had controlled diabetes (defined as glycosylated hemoglobin A1c < 7.0 percent), and only one (on the Mexican side of the border) received optimal diabetes care, defined according to international criteria for systolic blood pressure and body mass index as well as health provider provision of yearly examinations of foot and eyes as preventive care measures for early detection of diabetes complications. CONCLUSIONS: Adult Hispanics diagnosed with diabetes and living on the U.S.-Mexico border region are not receiving adequate diabetes-related care, and health care professionals are not following international recommendations for providing that care. To improve diabetes control in the region, health care providers must become more aware of the effect of education and culture on diabetes self-care as well as the provision of preventative measures by health care professionals.

OBJETIVO: Evaluar y vigilar la calidad de la atención prestada a los hispanos diagnosticados de diabetes residentes en la zona fronteriza entre los Estados Unidos y México. MÉTODOS: De abril del 2001 a noviembre del 2002, se llevó a cabo la primera fase del Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos, un estudio sobre la prevalencia de la diabetes tipo 2 y sus factores de riesgo; el proyecto se realizó a lo largo de la zona fronteriza entre los Estados Unidos y México, mediante muestreo por conglomerados, en dos etapas, de poblaciones y hogares de esas poblaciones. Mediante un cuestionario (se recogió la información facilitada por los entrevistados sobre la diabetes y su modo de vida; también se realizó una exploración física y se obtuvo una muestra de sangre. De los 4 027 participantes, 521 (13,0 por ciento) informaron que previamente al estudio ya se les había diagnosticado diabetes. De estos, 466 eran de origen hispano (226 del lado mexicano de la frontera y 240 del estadounidense). RESULTADOS: Los resultados indicaron que en 42,1 por ciento de los hispanos residentes en el lado estadounidense de la frontera (intervalo de confianza [IC] de 95 por ciento: 35,8-48,6 por ciento) y en 37,6 por ciento de los hispanos del lado mexicano (IC de 95 por ciento: 31,3-44,3 por ciento) la diabetes estaba controlada (hemoglobina glicosilada A1c < 7,0 por ciento) y solo una persona (residente en el lado mexicano de la frontera) recibía una atención óptima de su diabetes, definida según los criterios internacionales en cuanto a la presión arterial sistólica, el índice de masa corporal, la realización de revisiones anuales oftalmológicas y de los pies, llevadas a cabo por un proveedor de servicios de salud como medidas de atención preventiva para la detección temprana de las complicaciones de la diabetes. CONCLUSIONES: Los adultos hispanos con diagnósticos de diabetes residentes en la zona fronteriza entre los Estados Unidos y México no reciben una atención adecuada en relación con su enfermedad, y los profesionales de la salud no siguen las recomendaciones internacionales para la prestación de esa atención. Para mejorar el control de la diabetes en la zona, los proveedores de atención sanitaria deben ser más conscientes de la repercusión de la educación y la cultura en el autocuidado de la diabetes, así como de la importancia de la provisión de medidas preventivas por parte del personal de salud.

[Information, knowledge and healthcare practice: professionals participation as the key element of the gear]. / Información, conocimiento y práctica sanitaria: la participación de los profesionales como pieza clave del engranaje.

This article analyzes the role of ICT within the complicated gear between information, knowledge and healthcare practices, which particular focus on two specific cases: the digitalization process of the healthcare system and the application of knowledge into the healthcare practices. In both cases, international and local experiences suggest, and sometimes demonstrate the importance of the participation, capacity-building and empowerment of healthcare practitioners for the generation, transfer and use of information and knowledge empowered by the digital tools which should bring into the system better performance, more efficacy, efficiency, equity, equality, security, quality.

[Information systems in health and health indicators: an integrating perspective]. / Sistemas de Información en Salud e indicadores de salud: una perspectiva integradora.

Health Information Systems (HIS) are the core support to decision-making in health organizations. Within HIS, health indicators (HI) reflect, numerically, events measured in the health-illness continuum. The integrated health information system is intended to standardize, integrate and organize all the information available in health information systems through an accessible and secure repository, and to conveniently distribute information for decision-making. To standardize information it is necessary to define standards and semantic information to enable us to identify concepts and relate them uniquely to each other. The definition of a catalog of entities (DEA) with concepts, attributes and domains will enable the configuration of the information system, so there will be a catalog of entities (concepts of information and domains). Based on operational systems, analytical systems enabling management and strategy in the management of organizations will be built. The maximum level of analysis is the Balanced Score Card (BSC), which is established as the strategic tool for managers. It is necessary for the organization an integrated information system to plan, manage, evaluate and therefore provide managers with a decision tool for strategic and tactical decision-making in short and medium term.

Sistemas de Información en Salud e indicadores de salud: una perspectiva integradora / Information systems in health and health indicators: an integrating perspective

Los Sistemas de Información en Salud (SIS) constituyen el núcleo principal de soporte para la toma de decisiones en las instituciones sanitarias. Dentro de los SIS, los indicadores de salud (IS) reflejan numéricamente los acontecimientos medidos en el continuum salud-enfermedad. El sistema integrado de información en salud tiene por objetivo normalizar, integrar y organizar toda la información en salud disponible en sus sistemas de información, en un repositorio accesible y seguro, así como la distribución de la información de la forma más conveniente, para facilitar la toma de decisiones. Para normalizar la información hace falta definir estándares de información y semánticos que nos permitan identificar los conceptos de forma unívoca y relacionarlos entre sí. La definición de un catálogo de entidades (DEA) detallando conceptos, atributos y dominios, facilitará la configuración del sistema de información; por lo tanto, se dispondrá de un catálogo de entidades (conceptos de información y dominios de la misma). A partir de los sistemas operacionales se construirán los sistemas analíticos que permitirán constituir instrumentos que faciliten la gestión y la estrategia de la dirección en las organizaciones. El máximo nivel de análisis constituye el cuadro de mando integral (CMI) o Balanced Score Card (BSC), que se constituye como la herramienta estratégica para la dirección. La organización ha de disponer de un sistema integrado de información que permita planificar, gestionar, evaluar y, por lo tanto, facilitar a la dirección un instrumento de decisión táctico y estratégico para la toma de decisiones a corto y medio plazo (AU)

Health Information Systems (HIS) are the core support to decision-making in health organizations. Within HIS, health indicators (HI) reflect, numerically, events measured in the health-illness continuum. The integrated health information system is intended to standardize, integrate and organize all the information available in health information systems through an accessible and secure repository, and to conveniently distribute information for decision-making. To standardize information it is necessary to define standards and semantic information to enable us to identify concepts and relate them uniquely to each other. The definition of a catalog of entities (DEA) with concepts, attributes and domains will enable the configuration of the information system, so there will be a catalog of entities (concepts of information and domains). Based on operational systems, analytical systems enabling management and strategy in the management of organizations will be built. The maximum level of analysis is the Balanced Score Card (BSC), which is established as the strategic tool for managers. It is necessary for the organization an integrated information system to plan, manage, evaluate and therefore provide managers with a decision tool for strategic and tactical decision-making in short and medium term (AU)