Understanding the Professional Care Experience of Patients with Stroke: A Qualitative Study Using In-Depth Interviews.

Background: Professional support and communication stimulates the professional-patient relationship and supports the recovery of stroke patients. Objectives: To describe the perspectives of patients with stroke regarding communication, professional support, and their ability to participate in processes and integrated care with health providers. Methods: A qualitative study was conducted. A purposeful sampling and snowball-technique were used. Patients diagnosed with moderate or severe stroke in the post-acute or chronic stage of the disease were included. Data collection consisted of in-depth interviews and researcher field notes. A thematic analysis was performed. Results: Thirty-one patients were included. Three themes were identified: 1) Providing support, with four categories, professional behavior, personalized attention, the heart of the professional and building a bond with the patient; 2) Facilitating communication, with three categories, the patient as the recipient, the content of the message and the channel, and the professional as the person that conveys the message; and 3) Promoting participation, with two categories, barriers, and incentives to participate. Conclusions: When providing support, professionals should consider communicating information and encouraging the participation of stroke patients for integrated care.

Estimation of the octanol-water distribution coefficient of basic compounds by a cationic microemulsion electrokinetic chromatography system.

The octanol-water partition coefficient (Po/w), or the octanol-water distribution coefficient (Do/w) for ionized compounds, is a key parameter in the drug development process. In a previous work, this parameter was estimated through the retention factor measurements in a sodium dodecyl sulfate (SDS) - microemulsion electrokinetic chromatography (MEEKC) system for acidic compounds. Nonetheless, when ionized basic compounds were analyzed, undesirable ion pairs were formed with the anionic surfactant and avoided a good estimation of log Do/w. For this reason, an alternative MEEKC system based on a cationic surfactant has been evaluated to estimate Po/w or Do/w of neutral compounds and ionized bases. To this end, it has been characterized through the solvation parameter model (SPM) and compared to the octanol-water partition system. Results pointed out that both systems show a similar partition behavior. Hence, the log Po/w of a set of neutral compounds has been successfully correlated against the logarithm of the retention factor (log k) determined in this MEEKC system. Then, the log Do/w of 6 model bases have been estimated at different pH values and they have been compared to data from the literature, determined by the reference shake-flask and potentiometric methods. Good agreement has been observed between the literature and the estimated values when the base is neutral or partially ionized (up to 99% of ionization).

Identification and characterization of new isoforms of human fas apoptotic inhibitory molecule (FAIM).

Fas Apoptosis Inhibitory Molecule (FAIM) is an evolutionarily highly conserved death receptor antagonist, widely expressed and known to participate in physiological and pathological processes. Two FAIM transcript variants have been characterized to date, namely FAIM short (FAIM-S) and FAIM long (FAIM-L). FAIM-S is ubiquitously expressed and serves as an anti-apoptotic protein in the immune system. Furthermore, in neurons, this isoform promotes NGF-induced neurite outgrowth through NF-кB and ERK signaling. In contrast FAIM-L is found only in neurons, where it exerts anti-apoptotic activity against several stimuli. In addition to these two variants, in silico studies point to the existence of two additional isoforms, neither of which have been characterized to date. In this regard, here we confirm the presence of these two additional FAIM isoforms in human fetal brain, fetal and adult testes, and placenta tissues. We named them FAIM-S_2a and FAIM-L_2a since they have the same sequence as FAIM-S and FAIM-L, but include exon 2a. PCR and western blot revealed that FAIM-S_2a shows ubiquitous expression in all the tissues and cellular models tested, while FAIM-L_2a is expressed exclusively in tissues of the nervous system. In addition, we found that, when overexpressed in non-neuronal cells, the splicing factor nSR100 induces the expression of the neuronal isoforms, thus identifying it as responsible for the generation of FAIM-L and FAIM-L_2a. Functionally, FAIM-S_2a and FAIM-L_2a increased neurite outgrowth in response to NGF stimulation in a neuronal model. This observation thus, supports the notion that these two isoforms are involved in neuronal differentiation. Furthermore, subcellular fractionation experiments revealed that, in contrast to FAIM-S and FAIM-L, FAIM-S_2a and FAIM-L_2a are able to localize to the nucleus, where they may have additional functions. In summary, here we report on two novel FAIM isoforms that may have relevant roles in the physiology and pathology of the nervous system.

Hybrid Surface Patterns Mimicking the Design of the Adhesive Toe Pad of Tree Frog.

Biological materials achieve directional reinforcement with oriented assemblies of anisotropic building blocks. One such example is the nanocomposite structure of keratinized epithelium on the toe pad of tree frogs, in which hexagonal arrays of (soft) epithelial cells are crossed by densely packed and oriented (hard) keratin nanofibrils. Here, a method is established to fabricate arrays of tree-frog-inspired composite micropatterns composed of polydimethylsiloxane (PDMS) micropillars embedded with polystyrene (PS) nanopillars. Adhesive and frictional studies of these synthetic materials reveal a benefit of the hierarchical and anisotropic design for both adhesion and friction, in particular, at high matrix-fiber interfacial strengths. The presence of PS nanopillars alters the stress distribution at the contact interface of micropillars and therefore enhances the adhesion and friction of the composite micropattern. The results suggest a design principle for bioinspired structural adhesives, especially for wet environments.

Thermally-induced softening of PNIPAm-based nanopillar arrays.

The surface properties of soft nanostructured hydrogels are crucial in the design of responsive materials that can be used as platforms to create adaptive devices. The lower critical solution temperature (LCST) of thermo-responsive hydrogels such as poly(N-isopropylacrylamide) (PNIPAm) can be modified by introducing a hydrophilic monomer to create a wide range of thermo-responsive micro-/nano-structures in a large temperature range. Using surface initiation atom-transfer radical polymerization in synthesized anodized aluminum oxide templates, we designed, fabricated, and characterized thermo-responsive nanopillars based on PNIPAm hydrogels with tunable mechanical properties by incorporating acrylamide monomers (AAm). In addition to their LCST, the incorporation of a hydrophilic entity in the nanopillars based on PNIPAm has abruptly changed the topological and mechanical properties of our system. To gain an insight into the mechanical properties of the nanostructure, its hydrophilic/hydrophobic behavior and topological characteristics, atomic force microscopy, molecular dynamics simulations and water contact angle studies were combined. When changing the nanopillar composition, a significant and opposite variation was observed in their mechanical properties. As temperature increased above the LCST, the stiffness of PNIPAm nanopillars, as expected, did so too, in contrast to the stiffness of PNIPAm-AAm nanopillars that decreased significantly. The molecular dynamics simulations proposed a local molecular rearrangement in our nanosystems at the LCST. The local aggregation of NIPAm segments near the center of the nanopillars displaced the hydrophilic AAm units towards the surface of the structure leading to contact with the aqueous environment. This behavior was confirmed via contact angle measurements below and above the LCST.

New Double-Infiltration Methodology to Prepare PCL-PS Core-Shell Nanocylinders Inside Anodic Aluminum Oxide Templates.

Melt nanomolding of core-shell nanocylinders of different sizes, employing anodic aluminum oxide (AAO) templates, is reported here for the first time. The core-shell nanostructures are achieved by a new melt double-infiltration technique. During the first infiltration step, polystyrene (PS) nanotubes are produced by an adequate choice of AAO nanopore diameter size. In the second step, PCL is infiltrated inside the PS nanotubes, as its melting point (and infiltration temperature) is lower than the glass transition temperature of PS. Scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR) measurements verified the complete double-infiltration of the polymers. Differential scanning calorimetry (DSC) experiments show that the infiltrated PCL undergoes a confined fractionated crystallization with two crystallization steps located at temperatures that depend on which surface is in contact with the PCL nanocylinders (i.e., alumina or PS). The melt double-infiltration methodology represents a novel approach to study the effect of the surrounding surface on polymer crystallization under confinement.

Changes in access to health services of the immigrant and native-born population in Spain in the context of economic crisis.

AIM: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. METHODS: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. RESULTS: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. CONCLUSION: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

Detección precoz de cáncer de cérvix según los discursos de las matronas de atención primaria en Segovia, España / Early detection of cervical cancer according to the discourses of primary care midwives in Segovia, Spain / Detecção precoce de câncer cervical segundo discursos de parteiras na atenção primária em Segóvia, Espanha

OBJETIVO: Analizar los discursos de las matronas de atención primaria sobre el acceso y la utilización del Programa Preventivo de Cáncer de Cérvix. PROCEDIMIENTOS METODOLÓGICOS: Se desarrolló un estudio cualitativo en un área de baja densidad poblacional, Segovia, España, que cuenta con un alto porcentaje de población rural, entre 2008 y 2009. Se utilizó como técnica la entrevista semi-estructurada. Se realizaron diez entrevistas a las matronas de atención primaria de las 16 Zonas Básicas de Salud. El análisis de la información se basó en las propuestas de la Teoría Fundamentada. ANÁLISIS DE RESULTADOS: El acceso y utilización del Programa Preventivo de Cáncer de Cérvix se relaciona con la utilización de la consulta de la matrona por las mujeres, sus vivencias de los exámenes de citología vaginal y su percepción de riesgo a padecer un cáncer de cuello uterino. La barrera percibida es la distancia para acceder a la consulta de la matrona, y para las mujeres inmigrantes, además son barreras la posibilidad de no disponer de tarjeta sanitaria y desconocer la existencia del Programa. La exclusión social es también considerada una barrera de acceso y utilización. Se identificó como el principal facilitador, la recomendación de los médicos de familia de participar en el Programa. CONCLUSIONES: Las matronas perciben desigualdades de acceso y utilización del Programa Preventivo de Cáncer de Cérvix que se relacionan tanto con características individuales de las mujeres, como con el medio geográfico donde viven y con la propia estructura del Programa. Hay situaciones de vulneración de la equidad en colectivos de mujeres poco representadas a nivel encuestal, como las mujeres inmigrantes y las que residen en zonas rurales.

OBJECTIVE: To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. METHODS: A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. RESULTS: Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, women's experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. CONCLUSIONS: The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Program's infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.

OBJETIVO: Analisar os discursos das parteiras atuantes na atenção primária sobre o acesso e utilização do Programa Preventivo de Câncer Cervical. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo realizado em Segóvia, em uma área de baixa densidade populacional na Espanha, com alta proporção de populações rurais e imigrantes, de 2008 a 2009. Utilizou-se a entrevista semi-estruturada para coleta de informações. Foram entrevistadas dez parteiras das 16 Zonas Básicas de Saúde. A análise da informação baseou-se nas propostas da Teoria Fundamentada. ANÁLISE DOS RESULTADOS: O acesso e utilização do Programa Preventivo de Câncer Cervical relacionam-se a mulheres atendidas pela parteira, as vivências das mulheres em relação os resultados do exame de citologia vaginal e sua percepção de risco de sofrer um câncer de colo uterino. A barreira percebida é a distância para comparecer à consulta com a parteira. Para as mulheres imigrantes há ainda a possibilidade de não dispor de carteira de saúde e desconhecer o programa. A exclusão social também está relacionada a barreiras de acesso e utilização. O principal facilitador identificado foi o aconselhamento dos médicos de família para participar do programa. CONCLUSÕES: As parteiras percebem desigualdades de acesso e utilização do Programa Preventivo de Câncer Cervical que se relacionam tanto com características individuais das mulheres como com o meio geográfico em que vivem e com a própria estrutura do Programa. Há situações de vulnerabilidade da eqüidade de grupos de mulheres pouco representadas em nível de inquéritos populacionais, como as imigrantes e as que moram em zonas rurais.

Early detection of cervical cancer according to the discourses of primary care midwives in Segovia, Spain.

OBJECTIVE: To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. METHODS: A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. RESULTS: Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, women's experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. CONCLUSIONS: The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Program's infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.

Tiempo de viaje y participación en el cribado del cáncer de mama en una región de alta dispersión poblacional / Travel time and participation in breast cancer screening in a region with high population dispersion

Objetivo: Análisis de ámbito municipal de la asociación entre el tiempo de viaje y la participación en el programa de cribado del cáncer de mama ajustando por variables contextuales en la provincia de Segovia.MétodoEstudio ecológico utilizando como fuentes de datos el Programa de Detección Precoz de Cáncer de Mama de la Gerencia de Atención Primaria de Segovia, el Censo de Población y Vivienda de 2001, y el Padrón municipal de habitantes de 2006-2007. El periodo de estudio fue de enero de 2006 a diciembre de 2007. Como variables dependientes se consideraron la tasa de participación municipal y el nivel deseado de participación municipal (≥70%). La variable independiente principal fue el tiempo de viaje del municipio a la Unidad Mamográfica, y las covariables agregadas por municipio fueron las características sociodemográficas y socioeconómicas. Se realizó un análisis univariado y multivariado por regresión de Poisson de la tasa de participación municipal, y por regresión logística del nivel deseado de participación.ResultadosLa muestra estuvo formada por 178 municipios. La tasa de participación media fue del 75,2%. Ciento diecinueve (67%) municipios tuvieron la participación deseada (≥70%). En el análisis multivariado por regresión de Poisson y logística, el mayor tiempo de viaje se asoció tanto a una menor tasa de participación como a un menor nivel de participación, una vez ajustado por la densidad geográfica, la edad, el nivel socioeconómico y la razón de dependencia, con un índice de riesgo relativo de 0,88 (intervalo de confianza del 95% [IC95%]: 0,81-0,96) y una odds ratio de 0,22 (IC95%: 0,1-0,47), respectivamente.ConclusiónEl tiempo de viaje hasta la Unidad de Mamografía puede ayudar a explicar la participación poblacional en los programas de detección precoz del cáncer de mama (AU)

Objective: To analyze the association between travel time and participation in a breast cancer screeningprogram adjusted for contextual variables in the province of Segovia (Spain).Methods: We performed an ecological study using the following data sources: the Breast Cancer EarlyDetection Program of the Primary Care Management of Segovia, the Population and Housing Census for2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December2007. Dependent variables consisted of the municipal participation rate and the desired level of municipalparticipation (greater than or equal to 70%). The key independent variable was travel time from themunicipality to the mammography unit. Covariables consisted of the municipalities’ demographic andsocioeconomic factors. We performed univariate and multivariate Poisson regression analyses of theparticipation rate, and logistic regression of the desired participation level.Results: The sample was composed of 178 municipalities. The mean participation rate was 75.2%. Thedesired level of participation (≥70%) was achieved in 119 municipalities (67%). In the multivariate Poissonand logistic regression analyses, longer travel time was associated with a lower participation rate andwith lower participation after adjustment was made for geographic density, age, socioeconomic statusand dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95%CI: 0.1-0.47), respectively.Conclusion: Travel time to the mammography unit may help to explain participation in breast cancerscreening programs (AU)

Pattern of health services use by immigrants from different regions of the world residing in Spain.

OBJECTIVE: To determine immigrants' frequency of use of four health services by place of origin and compare it with that of the Spanish population. METHODS: Based on the 2006 National Health Survey in Spain, we estimated the frequency of use of four health services in men and women from: Spain, Western countries, Eastern Europe, Latin America, North Africa, Sub Saharan Africa and Asia/Oceania. These results were compared with the Spanish population by calculating odds ratios adjusted for age, socioeconomic position, health status, and type of health coverage. RESULTS: Immigrant men generally use health services less frequently than Spanish nationals. The main exceptions are Latin American men, who more often use emergency services (OR 1.68, 95% CI 1.41-1.99) and Sub-Saharan men, who use specialists more frequently (OR 2.93, 1.70-5.05). Immigrant women use health services about as frequently as Spanish women. The main exceptions are North African women, who less frequently use specialists (OR 0.39, 0.22-0.71) and Sub-Saharan women who more frequently use GPs (OR 4.06, 2.21-7.44), specialists (OR 2.29, 1.06-4.95) and emergency services (OR 2.92, 1.49-5.72). CONCLUSIONS: Health services use by the immigrant population in Spain differs by gender and place of origin.

[Travel time and participation in breast cancer screening in a region with high population dispersion]. / Tiempo de viaje y participación en el cribado del cáncer de mama en una región de alta dispersión poblacional.

OBJECTIVE: To analyze the association between travel time and participation in a breast cancer screening program adjusted for contextual variables in the province of Segovia (Spain). METHODS: We performed an ecological study using the following data sources: the Breast Cancer Early Detection Program of the Primary Care Management of Segovia, the Population and Housing Census for 2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December 2007. Dependent variables consisted of the municipal participation rate and the desired level of municipal participation (greater than or equal to 70%). The key independent variable was travel time from the municipality to the mammography unit. Covariables consisted of the municipalities' demographic and socioeconomic factors. We performed univariate and multivariate Poisson regression analyses of the participation rate, and logistic regression of the desired participation level. RESULTS: The sample was composed of 178 municipalities. The mean participation rate was 75.2%. The desired level of participation (≥ 70%) was achieved in 119 municipalities (67%). In the multivariate Poisson and logistic regression analyses, longer travel time was associated with a lower participation rate and with lower participation after adjustment was made for geographic density, age, socioeconomic status and dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95% CI: 0.1-0.47), respectively. CONCLUSION: Travel time to the mammography unit may help to explain participation in breast cancer screening programs.

Prevention of childhood obesity in Spain: a focus on policies outside the health sector. SESPAS report 2010 / Prevención de la obesidad infantil en España: un enfoque en políticas ajenas al sector de la salud. Informe SESPAS 2010

Obesity is currently a global public health problem. Obesity in early life increases the risk of long-term energy imbalance and adult obesity and its comorbidities, type 2 diabetes, and cardiovascular disease. Since infancy and childhood are critical periods for the adoption of food preferences and physical activity, prevention strategies must intervene in these early periods to promote healthy habits and reduce risk behaviors. Trends in the prevalence of childhood obesity and overweight in Spain have continuously increased in the last three decades. Obesity and overweight currently affect 15 and 20% of Spanish children, respectively, and these percentages are among the highest in Europe. Childhood obesity is determined by social and economic factors pertaining to sectors other than the health system, such as advertising, the built environment, education and the school environment, transportation and the food environment. Following the Health in All Policies (HiAP) approach, the authors identified a series of multisector policy changes that may help to prevent and control the current rising trend of childhood obesity in Spain. The HiAP approach acknowledges that social factors including socioeconomic status, gender differences and the work-life balance are important to develop effective policy changes in the prevention of childhood obesity. A key to success in the prevention of childhood obesity in Spain through policy changes will depend on the ability to establish a policy with the explicit and primary goal of improving health outcomes, despite the anticipated resistance from various sectors and stakeholders (AU)

Actualmente, la obesidad es un problema de salud pública en todo el mundo. La obesidad temprana aumenta el riesgo de sufrir desequilibrio energético a largo plazo, así como de presentar obesidad en edad adulta o sus comorbilidades: diabetes tipo 2 y enfermedades cardiovasculares. Puesto que la infancia y la niñez son períodos cruciales para establecer las preferencias alimenticias y de actividad física, las estrategias de prevención deben iniciarse durante esta etapa para fomentar hábitos saludables y reducir los comportamientos de riesgo. La tendencia en la prevalencia de la obesidad y el sobrepeso infantil en España ha aumentado de forma continua en las tres últimas décadas. En la actualidad, la obesidad y el sobrepeso afectan a un 15 y a un 20% de los niños españoles, respectivamente, y estos porcentajes se encuentran entre los más elevados de Europa. La obesidad infantil viene determinada por factores sociales y económicos que son independientes del sistema sanitario, tales como la publicidad, el entorno, la educación y el ambiente escolar, el transporte y el entorno alimentario. Mediante el enfoque de la Unión Europea, Salud en Todas las Políticas, los autores identificaron una serie de cambios de política dirigidos a varios sectores y que podrían ayudar a prevenir y controlar la creciente tendencia actual de la obesidad infantil en España. Este enfoque reconoce que factores sociales como el nivel socioeconómico, las diferencias de género y el equilibrio entre la vida laboral y personal son importantes para la prevención de la obesidad infantil. El éxito de la prevención de la obesidad infantil en España dependerá en gran medida de la capacidad que tengamos para desarrollar políticas fuera del sector sanitario que tengan el objetivo explícito y primario de mejorar resultados en salud pese a la resistencia esperada de diferentes sectores económicos y partes interesadas (AU)

Prevention of childhood obesity in Spain: a focus on policies outside the health sector. SESPAS report 2010.

Obesity is currently a global public health problem. Obesity in early life increases the risk of long-term energy imbalance and adult obesity and its comorbidities, type 2 diabetes, and cardiovascular disease. Since infancy and childhood are critical periods for the adoption of food preferences and physical activity, prevention strategies must intervene in these early periods to promote healthy habits and reduce risk behaviors. Trends in the prevalence of childhood obesity and overweight in Spain have continuously increased in the last three decades. Obesity and overweight currently affect 15 and 20% of Spanish children, respectively, and these percentages are among the highest in Europe. Childhood obesity is determined by social and economic factors pertaining to sectors other than the health system, such as advertising, the built environment, education and the school environment, transportation and the food environment. Following the Health in All Policies (HiAP) approach, the authors identified a series of multisector policy changes that may help to prevent and control the current rising trend of childhood obesity in Spain. The HiAP approach acknowledges that social factors including socioeconomic status, gender differences and the work-life balance are important to develop effective policy changes in the prevention of childhood obesity. A key to success in the prevention of childhood obesity in Spain through policy changes will depend on the ability to establish a policy with the explicit and primary goal of improving health outcomes, despite the anticipated resistance from various sectors and stakeholders.

La utilización de los servicios sanitarios por la población inmigrante en España / Health services utilization by the immigrant population in Spain

Objetivo: Comparar la utilización de los servicios sanitarios por la población inmigrante y por la población autóctona. Métodos: Se ha utilizado la información proporcionada por cuatro encuestas de salud realizadas alrededor del año 2005: de Cataluña en 2006, de la ciudad de Madrid en 2005, de Canarias en 2004 y de la Comunidad Valenciana en 2005. Los servicios sanitarios investigados han sido médico general, médico especialista, servicio de urgencias, hospitalización y dos servicios preventivos: citología vaginal y mamografía. Resultados: En líneas generales, la población inmigrante utiliza con menor frecuencia que la española la mayoría de los servicios sanitarios. La consulta al médico general y la hospitalización constituyen los servicios sanitarios en que se ha encontrado una menor diferencia en su frecuentación entre ambas poblaciones, mientras que el médico especialista y los servicios preventivos constituyen los servicios sanitarios en que se ha encontrado una mayor diferencia. En la consulta al médico general y la hospitalización es donde los hallazgos son más heterogéneos, ya que algunos grupos de inmigrantes presentan una frecuencia relativamente alta en algunos ámbitos geográficos y una frecuencia relativamente baja en otros. Conclusiones: Los resultados reproducen los observados en otras investigaciones realizadas en países del entorno social y económico de España, y al igual que sucede con la evidencia disponible, no se pueden sugerir explicaciones. Las investigaciones futuras deberían probar a utilizar otros tipos de estudios y a contrastar explicaciones no sugeridas hasta ahora por la comunidad científica (AU)

Objective: To compare health services utilization between the immigrant and indigenous populations in Spain. Methods: We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. Results: In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. Conclusion: The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date (AU)

[Health services utilization by the immigrant population in Spain]. / La utilización de los servicios sanitarios por la población inmigrante en España.

OBJECTIVE: To compare health services utilization between the immigrant and indigenous populations in Spain. METHODS: We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. RESULTS: In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. CONCLUSION: The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date.

Validación de la Escala sobre el Deseo de Beber - EDB / Validation of the Desire to Drink Scale - dds

Se presenta la validación de la Escala sobre el Deseo de Beber (EDB), instrumento de medida de nueva creación, en una muestra de 126 alcohólicos en distintos tipos de tratamiento de su dependencia. Este instrumento ha reflejado una elevada consistencia interna (alfa de Cronbach de 0.917). Los factores obtenidos del análisis factorial proporcionan una estructura de contenido que permite realizar una medida holística del constructo. La EDB y los factores que se derivan de ella correlacionan de forma alta, significativa y positiva con la Escala de la Intensidad de la Dependencia Alcohólica (EIDA) y sus subescalas. Por todo ello podemos decir que este instrumento posee condiciones adecuadas para su uso en la medida del constructo "deseo de beber" y gran aplicabilidad en el ámbito clínico y de investigación

The validation of the Desire to Drink Scale (DDS) is presented. This original version of the instrument has been applied to a sample of 126 alcoholics participating in different programs designed to treat their alcohol dependence. Cronbach´s alpha scores suggest a high internal consistency (alpha= 0.917). Factor analysis reveals the presence of different factors, providing a content structure that allows us to make a global measurement of the construct. correlation between DDS (and its factors) and the Intensity of alcohol Dependence (IADS) (and associated scales) is significantly high. We can therefore conclude that this new instrument is adequate for clinical and research purposes since it provides a good measure of the desire-to-drink construct

Mujeres inmigrantes hablando de su salud. Utilización de sus discursos como estrategia para promocionar su salud / Women immigrants speaking about their health. Use of their statements as a strategy to promote their health

PLANTEAMIENTO: La salud de las mujeres inmigrantes es una cuestión importante no sólo por la implicación que tiene para ellas en su vida cotidiana, sino por la proyección para sus familiares en los países de acogida, en los países de origen, e incluso para la salud pública. PROPóSITO: analizar cómo las mujeres inmigrantes hablan de su salud. Conocer la percepción, accesibilidad y utilización de los servicios sanitarios por parte de las mujeres inmigrantes en la Comunidad de Madrid, al tiempo que se analizaron cuáles fueron los factores que estaban mediando en la forma de utilizar dichos servicios. DISEÑO: investigación cualitativa. RECOGIDA DE DATOS: Se realizaron 18 entrevistas a mujeres inmigrantes procedentes de Marruecos, Ecuador y Filipinas (mayores de 15 años y con un periodo de estancia en España superior o igual a 6 meses) y 8 a personal socio sanitario de centros donde se atiende a población inmigrante. Dos grupos de discusión con coordinadores médicos de los Centros Municipales de Salud y uno con inmigrantes de Ecuador fueron organizados. Finalmente, se llevaron a cabo 5 entrevistas grupales con las mujeres inmigrantes. HALLAZGOS PRINCIPALES: Se presenta de un lado cuáles son los elementos discursivos de las mujeres inmigrantes para hablar de la salud y de la enfermedad o del "padecer", y del otro, las dimensiones contextuales que dan sentido y ayudan a explicar la recurrencia a esos elementos. Por último veremos que entre los problemas de salud relatados, los dolores osteoarticulares, las cefaleas y las alteraciones digestivas y hormonales, en definitiva, manifestaciones psicosomáticas del estrés, de la soledad y de la violencia estructural y psicológica que padecen, fueron los más frecuentes (AU)