[Cancer and unemployment]. / Cáncer y paro.

The lack of work is a increasingly dramatic situation in the times we are living. Daily experience of clinicians provides us with important clues that remind us of the existence of a direct relationship between prolonged unemployment and predisposition to serious health problems, in particular to suffering certain types of cancer. This paper aims to review the major epidemiological studies that have dealt the relationship between cancer and unemployment. Several hypotheses may be formulated with the results of this review arising from the possible etiological relationship between unemployment and development (or poor prognosis) of neoplastic processes.

Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter?

AIM: To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity. METHODS: Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n=65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes. RESULTS: Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]:1.25; 95% confidence interval [CI]:1.12-1.39, IRR:1.21; 95% CI:1.06-1.39), average length of stay (IRR:1.47; 95% CI:1.25-1.73), and total and priority emergency room visits (IRR:1.26; 95% CI:1.17-1.35, IRR:1.30; 95% CI:1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR:1.38; 95% CI:1.33-1.43) and to different specialties (IRR:1.36; 95% CI:1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR:1.08; 95% CI:1.06-1.11), but especially for those with mental comorbidity (IRR:1.17; 95% CI:1.14-1.21). CONCLUSION: In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent.

Differences in the use of primary care services between Spanish national and immigrant patients.

UNLABELLED: Knowing what real use is made of health services by immigrant population is of great interest. The objectives are to analyze the use of primary care services by immigrants compared to Spanish nationals and to analyze these differences in relation to geographic origin. Retrospective observational study of all primary care visits made in 26 urban health centers. Main variable: total number of health centre visits/year. DEPENDENT VARIABLES: type of clinician requested; type of attention, and origin of immigrants. The independent variable was nationality. Statistics were obtained from the electronic medical records. The 4,933,521 appointments made in 2007 were analyzed for a reference population of 594,145 people (11.15% immigrants). The adjusted annual frequency for nationals was 8.3, versus whereas 4.6 for immigrants. The immigrant population makes less use of primary care services than national population. This is evident for all age groups and regardless of the immigrants' countries of origin. This result is important when planning health care resources for immigrant population.

Competencia cultural y población inmigrante: un reto cotidiano en nuestras consultas / Cultural competence and immigrant population: a daily challenge in our clinical offices

Los últimos años, en España, ha habido un gran aumento de la población inmigrante. Este fenómeno ha supuesto un reto para los pediatras que han tenido que adaptarse a esta nueva realidad. En la actualidad, muchas de las dificultades y retos que nos plantea el niño inmigrante tienen más que ver con problemas de comunicación y diferentes concepciones de la salud y la enfermedad, que con patologías importadas o problemas de salud concretos. En la línea de lo anterior, se habla de la competencia cultural como un conjunto de habilidades, actitudes y comportamientos, en los que el profesional debería estar entrenado para proporcionar unos cuidados sensibles, empáticos, flexibles y respetuosos con el paciente, que implican una comunicación centrada en el paciente efectiva. Son pilares básicos de la competencia cultural, la sensibilidad hacia las diferencias y hacia el otro, y la capacidad de escucha y saber preguntar. No se trata de habilidades diferentes a las necesarias para hacer una atención adecuada a nuestros pacientes en general, sino de aplicar las habilidades necesarias para un enfoque centrado en el paciente a la población inmigrante. Por lo tanto profundizar en estas habilidades nos hará mejorar nuestra atención a la población autóctona. En nuestra atención al inmigrante, nos encontramos con dificultades y barreras para superar estas dificultades. Dentro de estas barreras nos encontramos con problemas de actitud, prejuicios, recelos, barreras lingüísticas, escaso tiempo en las consultas, falta de formación en temas específicos de la población inmigrante, etc. Identificar estas barreras y buscar soluciones a esas dificultades son los objetivos de la presente revisión (AU)

In recent years, Spain has experienced a large increase in the immigrant population. This phenomenon has been a challenge for pediatricians who have had to adapt to this new reality. Today, many of the difficulties and challenges regarding immigrant children have more to do with communication problems and different conceptions of health and disease, than with imported diseases or specific health problems. According to this, we speak of cultural competence as a set of skills, attitudes and behaviours in which the practitioner should be trained in order to provide a sensitive, empathetic, flexible and patient friendly care, which also includes an effective patient-centred communication. They are cornerstones of cultural competence, together with sensitivity to differences and to others, and the ability to listen and to know how to ask. Those abilities and skills are not different from the necessary ones to take appropriate care of our patients in general, but to apply them is necessary for a patient-centred approach to the immigrant population. Therefore the further development of these skills will improve our attention to the local population. In our attention to immigrants we encounter difficulties and barriers to overcome. Within these barriers we face problems of attitude, prejudice, mistrust, language barriers, short time in consultations, lack of training in specific areas of the immigrant population, etc. Identifying these barriers and seeking solutions to these difficulties is the target of this review (AU)