[Equality in clinical practice. Proposals for patients, professionals and managers and policies to limit discrimination]. / La equidad en la consulta clínica. Propuestas a pacientes, profesionales, gestores y políticos para limitar la discriminación.

OBJECTIVE: To make feasible and practical proposals to improve equality in the course of clinical care during the patient-provider encounter. METHODS: Design: A focus group study was conducted with a qualitative approach from the perspective of reducing health inequalities in the clinic. Setting: A classroom discussion focused on equality in clinical work. Subjects: 98 professionals from several countries. Measurement tools: An analysis of the responses was performed, grouped by themes interpreted by analysts, and restructured to provide consistency and uniformity to responses given. Data were collected using a questionnaire with open answers, allowing free-form answers to three general questions that addressed improving equality from the perspective of the professional themselves, patients, and health policy managers. No saturation horizon of analytical discourses was set, to understand that from this subjective prioritization of opinion there is no possibility that discourses reached saturation. RESULTS: Responses were added to the 3 principal axes, recommending that professionals be aware of their discriminatory ability. Patients were asked to trust their health professionals and that they should be assigned to a professional. It was also proposed that managers provide information systems, help reduce health inequalities, and encourage professional freedom. CONCLUSIONS: The paper presents concrete measures to promote improved equality in clinics during the delivery of health care.

[Cross-cultural adaptation of the Spanish version of the Child Health and Illness Profile, Child Edition (CHIP-CE)]. / Adaptación de la versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE).

OBJECTIVES: To obtain a Spanish version of the CHIP-CE semantically and culturally equivalent to the original version. METHOD: The methodology used was based on the forward-backward method. Two translations into Spanish were performed. After the first reconciled version, 44 cognitive interviews were carried out with children aged 6-11 years old, selected from two schools in Barcelona. The interviews were recorded and transcribed. A qualitative content analysis of the textual data was carried out. A panel of experts developed the second reconciled version taking into account the children's comments. A back-translation into English was carried out and was compared with the original version. RESULTS: Of a total of 45 items induced in the first reconciled version, 21 were considered equivalent, 23 required changes and 1 was considered not equivalent. Comprehension of abstract concepts differed according to age. Older children differentiated among concepts and gave different examples of experiences related to these concepts, while younger children (6 to 7-year olds) provided similar examples for different concepts. The children's comments were used in the reformulation of the items. An illustrative figure reinforced understanding. Children aged 7 or more started to use an adequate recall period and used the response options correctly. CONCLUSIONS: The Spanish version of the CHIP-CE seems appropriate for children aged 6-11 in Spain. The present study shows that children from the age of 6 years onwards are able to describe the health concepts included in the CHIP-CE.

Adaptación de la versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE) / Cross-cultural adaptation of the Spanish version of the child health and illness profile, child edition (CHIP-CE)

Objetivos: Obtener una versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE), semántica y culturalmente equivalente a la versión original. Método: Se ha seguido la metodología de traducción directa e inversa. Se obtuvieron dos traducciones iniciales al español. Tras la primera versión consensuada se realizaron 44 entrevistas cognitivas a niños/as de 6 a 11 años de dos colegios de Barcelona. Las entrevistas fueron grabadas y transcritas. Se realizó un análisis cualitativo de contenido temático de los datos textuales. Con los comentarios de los niños, y tras un panel de expertos, se obtuvo la segunda versión consensuada. Se realizó la retrotraducción al inglés y se comparó con la versión original. Resultados: De los 45 ítems de la primera versión consensuada, 21 se consideraron equivalentes, 23 requirieron modificaciones y uno fue considerado no equivalente. Se observó una diferencia según la edad en la comprensión de los conceptos abstractos. Los niños/as de más edad diferenciaban los conceptos y daban ejemplos distintos de experiencias relacionadas con ellos, los de menor edad (6-7 años) describieron ejemplos similares para conceptos diferentes. Los comentarios de los niños/as ayudaron a la reformulación de las preguntas. La figura representó un refuerzo para la comprensión. A partir de los 7 años enmarcaron sus respuestas en un período recordatorio adecuado, y utilizaron correctamente las opciones de respuesta. Conclusiones: La versión española del CHIP-CE parece adecuada para los niños de 6-11 años de edad en nuestro medio. El presente estudio ha mostrado que los niños/as son capaces de describir los aspectos de su salud que se incluyen en el CHIP-CE (AU)

[The factors related to the research activities of primary care physicians]. / Factores relacionados con la actividad investigadora de los médicos de atención primaria.

OBJECTIVE: To find the factors related with the research activities of primary care (PC) doctors in Catalonia, especially their motivation and the obstacles to research perceived by the doctors themselves. DESIGN: An observational, crossover study. SETTING: Primary care doctors in Catalonia. PARTICIPANTS: The number of doctors (1,286) was divided into two: a) doctors who had published between 1989 and 1994 (n = 146), b) doctors who had not published. INTERVENTIONS: A survey concerning personal and workplace variables was carried out by post. RESULTS: The reply percentage was 49.5% (63.7% among those who had published and 44.85% among those who had not). The multivariant analysis showed a significant link between publishing and postgraduate residence training (MIR), the fact of working in a teaching centre and working in a centre with more than ten doctors. CONCLUSIONS: Research is close related to postgraduate residence training (MIR), work in a teaching unit and PC centres with over ten doctors. Care load, lack of time and difficulty in getting financing were the main obstacles to research given by the doctors polled.

[Women and breast feeding: understanding their experiences and analyzing the performance of the health system]. / Mujeres y lactancia: entendiendo sus vivencias y analizando la actuación del sistema sanitario.

OBJECTIVE: To understand the conditioning factors which, whether negatively or positively, affect the success or failure of breast-feeding and to analyse the intervention of the health system to support it. DESIGN: A descriptive, prospective study which uses qualitative methodology in data gathering and analysis. SETTING: Health District of Santa Perpetua de la Mogoda, Barcelona. PARTICIPANTS: 56 in-depth interviews of 20 women were carried out at different moments of the pregnancy and suckling. MEASUREMENTS AND MAIN RESULTS: The decision to breast-feed was taken by women before or during their pregnancy under the influence of their social and family environment. The performance of the health system had little influence on the decision. The birth, even if it was pathological, did not prevent breast-feeding except when it was experienced as a failure. The days before the milk came increased women's insecurity about their capacity to suckle. Information from hospitals was evaluated as being scant. Fear of not feeding the baby well was the major source of breast-feeding failure. Mothers who breast-fed for longer felt they received more sympathy from paediatricians than those who gave up early. These felt blamed and did not seek doctors' advice on their decision. CONCLUSIONS: The health system has to plan an efficient intervention to support breast-feeding in the most crucial moments: after the birth and on arriving home.

[Limitations of case-mix systems in primary care: comparison of the severity of patients in community hospitals and health care centers in the United States]. / Limitaciones de los sistemas case-mix en atencion primaria: comparación de la gravedad de los pacientes atendidos en un centro ubicado en el hospital y dos centros extrahospitalarios en EE.UU.

OBJECTIVE: The aim was to show the limitations of the case-mix "based on attendance", which take into account neither the seriousness of the diagnoses nor the comorbidity. DESIGN: A crossover descriptive study of a retrospective nature. SETTING: In New York, in two centres located in the Hispanic community of Upper Manhattan and a third in the Presbyterian Hospital. PARTICIPANTS: During 1991, 225 patients were studied: 150 attended in the hospital PCC and 75 in the non-hospital PCCs. A simple random sampling of the list of patients attended was performed. INTERVENTIONS: The seriousness of the conditions of the patients attended in the two different types of PCC was compared through the Duke Severity of Illness Scale (DUSOI), a patient-based case-mix which assesses the level of seriousness of each individual diagnosis and the comorbidity linked to the diagnoses grouped together. MEASUREMENTS AND MAIN RESULTS: Significant differences between the seriousness of the conditions of the patients in the two sub-samples were found when comparison by means of bivariant analysis was performed. Scoring on the Severity Scale was significantly higher for those attending hospital (65.5 and 55.1 respectively). CONCLUSIONS: Patient classification systems based on the reasons for attendance underestimate the seriousness of the condition. A case-mix in which the patient is the unit of analysis needs to be developed.