Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side.

Background: New era of cardiac surgery aims to provide an enhanced postoperative recovery through the implementation of every step of the process. Thus, perfusion strategy should adopt evidence-based measures to reduce the impact of cardiopulmonary bypass (CPB). Hematic Antegrade Repriming (HAR) provides a standardized procedure combining several measures to reduce haemodilutional priming to 300 mL. Once the safety of the procedure in terms of embolic release has been proven, the evaluation of its beneficial effects in terms of transfusion and ICU stay should be assessed to determine if could be considered for inclusion in Enhanced Recovery After Cardiac Surgery (ERACS) programs. Methods: Two retrospective and non-randomized cohorts of high-risk patients, with similar characteristics, were assessed with a propensity score matching model. The treatment group (HG) (n = 225) received the HAR. A historical cohort, exposed to conventional priming with 1350 mL of crystalloid confirmed the control group (CG) (n = 210). Results: Exposure to any transfusion was lower in treated (66.75% vs. 6.88%, p < 0.01). Prolonged mechanical ventilation (>10 h) (26.51% vs. 12.62%; p < 0.01) and extended ICU stay (>2 d) (47.47% vs. 31.19%; p < 0.01) were fewer for treated. HAR did not increase early morbidity and mortality. Related savings varied from 581 to 2741.94 $/patient, depending on if direct or global expenses were considered. Discussion: By reducing the gaseous and crystalloid emboli during CPB initiation, HAR seems to have a beneficial impact on recovery and reduces the overall transfusion until discharge, leading to significant cost savings per process. Due to the preliminary and retrospective nature of the research and its limitations, our findings should be validated by future prospective and randomized studies.

Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial.

Particulate and gaseous microemboli (GME) are side effects of cardiac surgery that interfere with postoperative recovery by causing endothelial dysfunction and vascular blockages. GME sources during surgery are multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic load. Hematic antegrade repriming (HAR) is a novel procedure that combines the benefits of repriming techniques with additional measures, by following a standardized procedure to provide a reproducible hemodilution of 300 ml. To clarify the safety of HAR in terms of embolic load delivery, a prospective and controlled study was conducted, by applying Doppler probes to the extracorporeal circuit, to determine the number and volume of GME released during CPB. A sample of 115 patients (n = 115) was considered for assessment. Both groups were managed under strict normothermia, and similar clinical conditions and protocols, receiving the same open and minimized circuit. Significant differences in GME volume delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and high embolic volume exposure (>1 ml) were found between the groups (CG = 30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not represent an additional embolic risk and provided a four-fold reduction in the embolic volume delivered to the patient (coefficient, 0.24; 95% CI, 0.08-0.72; p = 0.01), which appears to enhance GME clearance of the oxygenator before CPB initiation.

[COVID-19 exposure setting, social and gender determinants in a mediterranean region.] / Características sociales y de género en el ámbito de contagio de COVID-19 en una región mediterránea.

OBJECTIVE: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies. METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables. RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%). CONCLUSIONS: The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class.

OBJETIVO: El conocimiento de los determinantes sociales y de género que influyen en el ámbito de exposición al SARS-CoV-2 puede ser relevante en el planteamiento de estrategias preventivas y de control de la transmisión. No se han encontrado estudios previos que evalúen cómo influyen la clase social ocupacional y el país de origen en el ámbito de exposición del SARS-CoV-2. El objetivo de este trabajo fue conocer el contexto en que se contagiaron los casos de COVID-19 (ámbito: hogar, trabajo, sanitario, sociosanitario y social-ocio) según país de origen, clase social ocupacional y género, lo cual es esencial para orientar estrategias de Salud Pública. METODOS: Se realizó un estudio descriptivo de un registro epidemiológico de 56.628 casos incidentes de COVID-19 en los que se estudió el ámbito de exposición/contagio en función de las variables anteriormente indicadas entre el 15 de junio y el 23 de diciembre de 2020 en la Región de Murcia. Se utilizó una prueba exacta de Fisher para el estudio de la distribución de los casos de COVID-19 en función de las variables anteriores. RESULTADOS: La incidencia acumulada fue mayor en personas procedentes de África (5.133,5 casos por cada 100.000 habitantes) y Latinoamérica (11.351,1) que en no inmigrantes (3.145,7) y superior en mujeres (3.885,6) que en hombres (3.572,6). Es destacable que el 53,3% de los casos COVID-19 con empleo registrado eran operarios en industria o construcción, artesanos, trabajadores agrarios o con ocupaciones elementales (15 de junio y el 23 de diciembre de 2020). En contraste, el 41,3% de la población ocupada en la Región de Murcia realizaba dichos empleos (promedio 3º y 4º trimestre de 2020). El hogar fue el principal ámbito de contagio (56,5% de los casos con ámbito conocido), seguido del social-ocio (20,7%) y el laboral (18,2%). Este último tuvo mayor peso en personas procedentes de África (28,4%) y Latinoamérica (35,7%) que en no inmigrantes (12%), a la inversa que el social-ocio. Fue más importante en mujeres (19,6%) que en hombres (16,5%) y en trabajadores manuales (44,1%) que en no manuales (26,6%). CONCLUSIONES: El contexto en el que los casos de COVID-19 se contagiaron es diferente en función de las desigualdades sociales relativas a país de origen, género y clase social ocupacional.

Características sociales y de género en el ámbito de contagio de COVID-19 en una región mediterránea / COVID-19 exposure setting, social and gender determinants in a mediterranean region

FUNDAMENTOS: El conocimiento de los determinantes sociales y de género que influyen en el ámbito de exposición al SARS-CoV-2 puede ser relevante en el planteamiento de estrategias preventivas y de control de la transmisión. No se han encontrado estudios previos que evalúen cómo influyen la clase social ocupacional y el país de origen en el ámbito de exposición del SARS-CoV-2. El objetivo de estetrabajo fue conocer el contexto en que se contagiaron los casos de COVID-19 (ámbito: hogar, trabajo, sanitario, sociosanitario y social-ocio) según país de origen, clase social ocupacional y género, lo cual es esencial para orientar estrategias de Salud Pública. MÉTODOS: Se realizó un estudio descriptivo de un registro epidemiológico de 56.628 casos incidentes de COVID-19 en los que seestudió el ámbito de exposición/contagio en función de las variables anteriormente indicadas entre el 15 de junio y el 23 de diciembre de 2020 en la Región de Murcia. Se utilizó una prueba exacta de Fisher para el estudio de la distribución de los casos de COVID-19 en función de las variables anteriores. RESULTADOS: La incidencia acumulada fue mayor en personas procedentes de África (5.133,5 casos por cada 100.000 habitantes) y Latinoamérica (11.351,1) que en no inmigrantes (3.145,7) y superior en mujeres (3.885,6) que en hombres (3.572,6). Es destacable que el 53,3% de los casos COVID-19 con empleo registrado eran operarios en industria o construcción, artesanos, trabajadores agrarios ocon ocupaciones elementales (15 de junio y el 23 de diciembre de 2020). En contraste, el 41,3% de la población ocupada en la Región de Murcia realizaba dichos empleos (promedio 3º y 4º trimestre de 2020). El hogar fue el principal ámbito de contagio (56,5% de los casos con ámbito conocido), seguido del social-ocio (20,7%) y el laboral (18,2%). Este último tuvo mayor peso en personas procedentes de África (28,4%) y Latinoamérica (35,7%) que en no inmigrantes (12%), a la inversa que el socialcio...(AU)

BACKGROUND: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies.METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables.RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%)...(AU)

Evaluación mediante script concordance test del razonamiento clínico de residentes en Atención Primaria / Clinical reasoning evaluation using script concordance test in primary care residents

Introducción: Actualmente desconocemos el razonamiento clínico objetivo de los residentes durante su formación, lo que impide orientar su reciclaje formativo a solventar los déficits detectados. El script concordance test (SCT) evalúa el razonamiento clínico planteando situaciones clínicas reales, pero aún no ha sido utilizado en España con contenidos propios de Atención Primaria. Por ello consideramos relevante diseñar un SCT de Atención Primaria que cumpla los criterios de validez, fiabilidad y aceptabilidad descritos en la bibliografía. Métodos: Elaboración, corrección y validación de un SCT para evaluar el razonamiento clínico en Atención Primaria de los residentes y que incluya variables sociolaborales para estudiar su posible relación con la puntuación obtenida. Resultados: Nuestro cuestionario fue aprobado por un comité de expertos, alcanzó una fiabilidad y accesibilidad adecuadas, y distinguió a los expertos de los residentes. No se observaron diferencias estadísticamente significativas en función de la edad, género, tipo y duración de la formación recibida en Atención Primaria, y la realización de un curso sobre dicha formación. Conclusiones: Se construyó un SCT que obtuvo la aprobación por parte de un comité de expertos, cumplió con los criterios de fiabilidad y accesibilidad, y permitió objetivar diferencias significativas en el razonamiento clínico de los expertos y residentes. Excepto en el 2.o año de residencia, no se observaron diferencias estadísticamente significativas respecto al año formativo dentro de la residencia, la edad, el género, la realización y duración de la rotación en Atención Primaria y la realización de un curso sobre dicha formación. (AU)

Introduction: Actual unawareness about paediatric resident's residency program factual clinical reasoning precludes professional retraining directed to solve deficiencies. Script concordance test (SCT) evaluates clinical reasoning due to its orientation to usual clinical practice but surprisingly it has not been used in Spain for Paediatric Primary Care clinical reasoning evaluation so far. Due to this we consider to be of relevance to design a paediatric primary care SCT which meets validity, reliability and accessibility criteria described in bibliography.Methods: Development, validation and application of an SCT questionnaire for clinical reasoning analysis in paediatric primary care applied on a population of paediatric residents and which includes demographic and employment data in order to study possible relationship between them and achieved scores.Results: Our SCT was approved by an experts committee. It met reliability and accessibility criteria and it allowed distinguishing experts from paediatric internal residents. No statistically significant differences were found concerning age, gender, type and duration of the training received in Primary Care, and the completion of a course on that training.Conclusions: We developed an SCT that was approved by a Paediatric Experts Committee, it met reliability and accessibility criteria and it allowed distinguishing clinical reasoning from experts and paediatric internal residents. Except second year residency program, we did not objectified relevant differences in residency program year, age, gender, duration and realization of Paediatric Primary Care rotation, and training course realisation. (AU)

Clinical reasoning evaluation using script concordance test in primary care residents.

INTRODUCTION: Actual unawareness about paediatric resident's residency program factual clinical reasoning precludes professional retraining directed to solve deficiencies. Script Concordance Test (SCT) evaluates clinical reasoning due to its orientation to usual clinical practice but surprisingly it has not been used in Spain for Paediatric Primary Care clinical reasoning evaluation so far. Due to this we consider it to be of relevance to design a Paediatric Primary Care SCT which meets validity, reliability and accessibility criteria described on bibliography. METHODS: Development, validation and application of an SCT questionnaire for clinical reasoning analysis in Paediatric Primary Care applied on a population of paediatric residents and which includes demographic and employment data in order to study possible relationship between them and achieved scores. RESULTS: Our SCT was approved by an experts committee. It met reliability and accessibility criteria and it allowed distinguishing experts from paediatric internal residents. No statistically significant differences were found concerning age, gender, type and duration of the training received in Primary Care, and the completion of a course on that training. CONCLUSIONS: We developed a SCT that was approved by a Paediatric experts committee, it met reliability and accessibility criteria and it allowed distinguishing clinical reasoning from experts and paediatric internal residents. Except second year residency program, we didn't objectified relevant differences in residency program year, age, gender, duration and realization of Paediatric Primary Care rotation, and training course realization.

Hematic Antegrade Repriming: A Reproducible Method to Decrease the Cardiopulmonary Bypass Insult.

The current practice of cardiopulmonary bypass (CPB) requires a preoperative priming of the circuit that is frequently performed with crystalloid solutions. Crystalloid priming avoids massive embolism but is unable to eliminate all microbubbles contained in the circuit. In addition, it causes a sudden hemodilution which is correlated with transfusion requirements and an increased risk of cognitive impairment. Several repriming techniques using autologous blood, collectively termed retrograde autologous priming (RAP), have been demonstrated to reduce the hemodilutional impact of CPB. However, the current heterogeneity in the practice of RAP limits its evidence and benefits. Here, we describe hematic antegrade repriming as an easy and reliable method that could be applied with any circuit in the market to decrease transfusion requirements, emboli, and inflammatory responses, reducing costs and the impact of CPB on postoperative recovery.

Influence of operator's professional experience in the postoperative course after surgical extrac-tion of the impacted lower third molar: A pilot study.

BACKGROUND: Third molars are present in 96.6% of humans, although they do not always erupt completely. Between 9.5% and 73% of them remain impacted. Surgical removal of impacted third molars is the most common practice in oral and maxillofacial surgery. This procedure results in traumatism and, consequently, the postoperative phase will involve symptomatology. It is uncommon to find studies that directly relate postoperative symptomatology and the operator's experience. The aim of this study was to determine the differences regarding postoperative symp-tomatology in patients undergoing the bilateral extraction of lower impacted third molars and according to the operator's experience. MATERIAL AND METHODS: A prospective cohort double-blind study was conducted in 50 healthy patients (100 molar extractions) to whom both lower third molars were removed by two dentists with different degree of professional experience. The extractions were randomly assigned with a split-mouth design. If an operator extracted the lower third molar on one side, the other operator extracted the contralateral one. The variables studied after four days of postoperative period were Pain (EVA scale), Inflammation and Trismus, in addition to intraoperative time and local anesthesia administered. RESULTS: Statistically significant differences were detected in the time of intervention and in trismus, since the most experienced operator always needed less time and caused higher degree of trismus. However, this does not entail more inflammation or pain in patients, so there are no relevant differences between operators with more or less experience (p>0.05). CONCLUSIONS: The postoperative period is more favorable for the most experienced operator, although the results do not vary in a relevant manner between them. Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.

Relevancia del contexto socioeconómico y sanitario en la satisfacción del paciente / Relevance of the socioeconomic and health context in patient satisfaction

Objetivo: Determinar qué factores de los contextos socioeconómico y sanitario influyen sobre la percepción de la satisfacción de la población con los servicios de salud. Método: Los datos provienen de la Encuesta Europea de Salud de 2009. En los 22.188 sujetos encuestados se estudió la relación entre percepción de la satisfacción con los servicios sanitarios recibidos y las variables tanto individuales como contextuales, aplicando un análisis multinivel. Resultados: Los factores de los contextos socioeconómico y sanitario que influyen sobre la satisfacción son las mayores tasas de población sin estudios, en la cual la percepción de excelencia es menos probable (odds ratio [OR]: 0,48-0,82) y la insatisfacción es más prevalente (OR: 1,46-1,63). Asimismo, la proporción de personas insatisfechas es menor cuando el gasto per cápita en servicios sanitarios es muy elevado (>1400 Euros) (OR: 0,49-0,87) y la ratio entre médicos de atención primaria de salud y habitantes es alta (>60) (OR: 0,50-0,85). Además, la prevalencia de insatisfacción describe una tendencia lineal positiva con la tasa de paro (OR: 1,12; p=0,0001) y la magnitud relativa del sector servicios (OR:1,03; p=0,001). Por el contrario, esta tendencia lineal es negativa conforme aumenta el índice de cobertura de la prestación sanitaria (OR: 0,88; p=0,04). Conclusiones: Los factores individuales que determinan la satisfacción del paciente son el sexo, la edad, la salud mental y el país de nacimiento. Además, hay diferencias en la satisfacción del paciente entre las comunidades autónomas de acuerdo con determinantes socioeconómicos, como el producto interior bruto per cápita, las tasas de población sin estudios, las tasas de paro o la ratio número de habitantes/consultorios. Los estudios de satisfacción del usuario, además de ajustarse por variables individuales como el sexo, la edad o el nivel de salud, también deberían tomar en consideración características del entorno socioeconómico del área geográfica de residencia (AU)

Objective: To determine which factors of the socioeconomic and health contexts influence the perception of the satisfaction of the population with the health services. Methods: The data come from the European Health Survey of 2009. In the 22,188 subjects surveyed, the relationship between the perception of satisfaction with the health services received and the individual and contextual variables was studied, applying a multilevel analysis. Results: The factors of the socioeconomic and health contexts that influence satisfaction are: higher rates of low level of studies where the perception of excellence is less likely (odds ratio [OR]: 0.48-0.82) and dissatisfaction is more prevalent (OR: 1.46-1.63). Likewise, the proportion of unsatisfied citizens is lower when per capita expenditure on health services is very high (>1400 Euros) (OR: 0.49-0.87) and the ratio "primary health care physicians/inhabitants" is high (>60) (OR: 0.500.85). In addition, the prevalence of dissatisfaction describes a positive linear trend with the unemployment rate (OR: 1.12; p=0.0001) and the relative magnitude of the services sector (OR: 1.03; p=0.001). By contrast, this linear trend is negative as the Health Care Coverage Ratio increases (OR: 0.88; p=0.04). Conclusions: The individual factors that determine patient satisfaction are: sex, age, mental health and country of birth. In addition, there are differences in patient satisfaction among the autonomous communities according to socio-economic determinants such as GDP per capita, low-level study rates, unemployment rates or number of inhabitants/doctor's ratio. User satisfaction studies as well as being adjusted for individual variables such as sex, age or health level should also take into account characteristics of the socioeconomic environment of the geographic area where they reside (AU)

[Relevance of the socioeconomic and health context in patient satisfaction]. / Relevancia del contexto socioeconómico y sanitario en la satisfacción del paciente.

OBJECTIVE: To determine which factors of the socioeconomic and health contexts influence the perception of the satisfaction of the population with the health services. METHODS: The data come from the European Health Survey of 2009. In the 22,188 subjects surveyed, the relationship between the perception of satisfaction with the health services received and the individual and contextual variables was studied, applying a multilevel analysis. RESULTS: The factors of the socioeconomic and health contexts that influence satisfaction are: higher rates of low level of studies where the perception of excellence is less likely (odds ratio [OR]: 0.48-0.82) and dissatisfaction is more prevalent (OR: 1.46-1.63). Likewise, the proportion of unsatisfied citizens is lower when per capita expenditure on health services is very high (>1400 €) (OR: 0.49-0.87) and the ratio "primary health care physicians/inhabitants" is high (>60) (OR: 0.500.85). In addition, the prevalence of dissatisfaction describes a positive linear trend with the unemployment rate (OR: 1.12; p=0.0001) and the relative magnitude of the services sector (OR: 1.03; p=0.001). By contrast, this linear trend is negative as the Health Care Coverage Ratio increases (OR: 0.88; p=0.04). CONCLUSIONS: The individual factors that determine patient satisfaction are: sex, age, mental health and country of birth. In addition, there are differences in patient satisfaction among the autonomous communities according to socio-economic determinants such as GDP per capita, low-level study rates, unemployment rates or number of inhabitants/doctor's ratio. User satisfaction studies as well as being adjusted for individual variables such as sex, age or health level should also take into account characteristics of the socioeconomic environment of the geographic area where they reside.

[Influence of double workload in perceived health and health services utilization of immigrants and Murcian natives, Spain]. / Influencia de la doble carga de trabajo en el estado de salud percibida y utilización de servicios sanitarios de las poblaciones inmigrante y autóctona de la región de Murcia.

BACKGROUND: Gender inequalities in health have been largely documented. The main objective of this study is to assess whether there are gender differences in perceived health and health services utilization, and their relation with double workload in a representative sample of immigrants and Murcian natives. METHODS: We used data from the NHS 2006 and Health and Culture Study, 1,303 immigrants and 1,303 Spanish, both residents in the Region of Murcia. With the combination of reproductive work and paid work we built up the variable 'double workload' (DW). We estimated the prevalence ratio (PR) for positive self-perceived health, chronic morbidity, activity limitation, doctor's visits, hospitalization, emergency and drug use, by origin, using regression methods. Two models were constructed by adding double burden to the basic model adjusted by sociodemographic variables. Analyses were performed between and within sex. RESULTS: After adjusting for DW, no changes were seen in the differences by gender [RP women/men of positive perception health: 0.70 (0.54-0.89) East European; 0.87 (0.79-0.95) autochthonous / chronic morbidity: 1.44 (1.14-1.82) Hispanic; 1.36 (1.19-1.55) autochthonous / activity limitation: 2.23 (1.29-3.83) Hispanic; 1.45 (1.01-2.10) autochthonous / doctor's visits: 1.93 (1.50-2.48) Hispanic; 1.74 (1.06-2.86) Moroccan; 1.32 (1.09-1.59) autochthonous / hospitalization: 1.80 (1.02-3.17) Hispanic], almost the same than unadjusted. Women used more drugs than men. Within sexes, both autochthonous men (1.19; 1.06-1.33) and women (1.18; 1.01-1.40) with shared DW had more positive self-perceived health than those without DW. Hispanic men with DW without assistance: 0.67 (0.47-0.94). CONCLUSIONS: Women have worse health indicators and greater use of health services regardless of origin. Consideration of the double workload does not explain gender inequalities in health.

Infuencia de la doble carga de trabajo en el estado de salud percibida y utilización de servicios sanitarios de las poblaciones inmigrante y utóctona de la Región de Murcia / Influence of double workload in perceived health and health services utilization of immigrants and Murcian natives, Spain

Fundamentos: Las desigualdades de género en salud han sido ampliamente documentadas. El principal objetivo es evaluar si existen diferencias de género en salud percibida y utilización de servicios sanitarios, y su relación con la doble carga de trabajo, en una muestra representativa de población inmigrante y autóctona de la Región de Murcia (RM). Métodos: Se utilizaron datos de la ENS 2006 y el Estudio Salud y Culturas, 1.303 inmigrantes y 1.303 españoles residentes en la RM. La combinación del trabajo reproductivo y remunerado se consideró «doble carga» (DC). Se estimó la razón de prevalencia (RP) de la percepción positiva de salud, morbilidad crónica, limitación de actividad, visitas al médico, hospitalización, visitas a urgencias y consumo de fármacos, en cada grupo de origen, mediante métodos de regresión. Se construyeron dos modelos, añadiendo el ajuste por DC al modelo ajustado por variables sociodemográficas. Se realizó análisis inter e intrasexo. Resultados: Al ajustar por DC no se observaron cambios en las diferencias entre sexos [RP mujeres/hombres de percepción positiva salud: 0,70 (0,54-0,89) europeos Este; 0,87 (0,79-0,95) autóctonos / morbilidad crónica: 1,44 (1,14-1,82) hispanoamericanos; 1,36 (1,19-1,55) autóctonos / limitación actividad: 2,23 (1,29-3,83) hispanoamericanos; 1,45 (1,01-2,10) autóctonos / consulta médico: 1,93 (1,50-2,48) hispanoamericanos; 1,74 (1,06-2,86) marroquíes; 1,32 (1,09-1,59) autóctonos / hospitalización: 1,80 (1,02-3,17) hispanoamericanos], casi los mismos que sin ajustar. Las mujeres consumieron más fármacos que los hombres. Entre sexos, hombres (1,19; 1,06-1,33) y mujeres (1,18; 1,01-1,40) de la RM con DC compartida declararon mayor percepción positiva de salud que aquellos sin DC; hombres hispanoamericanos con DC sin ayuda: 0,67 (0,47-0,94). Conclusiones: Las mujeres presentan peores indicadores de salud y mayor uso de servicios sanitarios independientemente del origen. La doble carga no modifica las desigualdades de género en salud(AU)

Background: Gender inequalities in health have been largely documented. The main objective of this study is to assess whether there are gender differences in perceived health and health services utilization, and their relation with double workload in a representative sample of immigrants and Murcian natives. Methods: We used data from the NHS 2006 and Health and Culture Study, 1,303 immigrants and 1,303 Spanish, both residents in the Region of Murcia. With the combination of reproductive work and paid work we built up the variable “double workload” (DW). We estimated the prevalence ratio (PR) for positive self-perceived health, chronic morbidity, activity limitation, doctor’s visits, hospitalization, emergency and drug use, by origin, using regression methods. Two models were constructed by adding double burden to the basic model adjusted by sociodemographic variables. Analyses were performed between and within sex. Results: After adjusting for DW, no changes were seen in the differences by gender [RP women/men of positive perception health: 0.70 (0.54-0.89) East European; 0.87 (0.79-0.95) autochthonous / chronic morbidity: 1.44 (1.14-1.82) Hispanic; 1.36 (1.19-1.55) autochthonous / activity limitation: 2.23 (1.29-3.83) Hispanic; 1.45 (1.01-2.10) autochthonous / doctor’s visits: 1.93 (1.50-2.48) Hispanic; 1.74 (1.06-2.86) Moroccan; 1.32 (1.09-1.59) autochthonous / hospitalization: 1.80 (1.02-3.17) Hispanic], almost the same than unadjusted. Women used more drugs than men. Within sexes, both autochthonous men (1.19; 1.06-1.33) and women (1.18; 1.01-1.40) with shared DW had more positive self-perceived health than those without DW. Hispanic men with DW without assistance: 0.67 (0.47-0.94). Conclusions: Women have worse health indicators and greater use of health services regardless of origin. Consideration of the double workload does not explain gender inequalities in health(AU)

Razones de comparabilidad total y por sexo entre la CIE-9 y la CIE-10 en las listas de mortalidad del INE y las de la Región de Murcia / Comparability rathios of the total and by sex between ICD-9 and ICD-10 for the mortality lists of Murcia and the National Institute of Statistics of Spain

No disponible