Erosion of universal health coverage and trend in the frequency of physician consultations in Spain.

BACKGROUND: We studied the frequency of physician visits in the native and immigrant populations in Spain before and after implementation of a governmental measure to restrict the use of public healthcare services by undocumented immigrants beginning in 2012. METHODS: Data were taken from the 2009 and 2014 European Health Surveys carried out in Spain. We investigated any physician consultation in the last 4 weeks before the interview, as well as visits to a family physician, public specialist physician and private specialist physician. We estimated the frequency of visits in 2009 and in 2014 in the native and immigrant populations and the difference in the frequency between the two populations, by calculating the percentage ratio estimated by binomial regression and adjusted for different confounders that are indicators of the need for assistance. RESULTS: The percentage of persons who consulted any physician in 2009 and 2014 was 31.7 and 32.9% in the native population, and 25.6 and 30.1% in the immigrant population, respectively. In the immigrant population, the frequency of visits to the general practitioner and public specialist physician increased, whereas in the native population only public specialist physician visits increased. The frequency of private specialist visits remained stable in both populations. After adjusting for the indicators of need for healthcare, no significant differences between the immigrant and native populations were seen in the frequency of visits, except for private specialist consultations, which were less frequent among immigrants. CONCLUSION: The restriction of universal healthcare coverage in Spain did not reduce the frequency of physician visits between 2009 and 2014, as the frequency of these consultations was seen to increase in both the native and immigrant populations.

Impact of tobacco prices and smoke-free policy on smoking cessation, by gender and educational group: Spain, 1993-2012.

BACKGROUND: To evaluate the effect of tobacco prices and the implementation of smoke-free legislation on smoking cessation in Spain, by educational level, across the period 1993-2012. METHODS: National Health Surveys data for the above two decades were used to calculate smoking cessation in people aged 25-64 years. The relationship between tobacco prices and smoking quit-ratio was estimated using multiple linear regression adjusted for time and the presence of smoke-free legislation. The immediate as well as the longer-term impact of the 2006 smoke-free law on quit-ratio was estimated using segmented linear regression analysis. The analyses were performed separately in men and women with high and low education, respectively. RESULTS: No relationship was observed between tobacco prices and smoking quit-ratio, except in women having a low educational level, among whom a rise in price was associated with a decrease in quit-ratio. The smoke-free law altered the smoking quit-ratio in the short term and altered also pre-existing trends. Smoking quit-ratio increased immediately after the ban - though this increase was significant only among women with a low educational level - and then decreased in subsequent years except among men with a high educational level. CONCLUSION: A clear relationship between tobacco prices and smoking quit-ratio was not observed in a recent period. After the implementation of smoke-free legislation the trend in the quit ratio in most of the socio-economic groups was different from the trend observed before implementation, so existing inequalities in smoking quit-ratio were not widened or narrowed.

[Process and results of constructing a deprivation index for the districts of Madrid and Barcelona, Spain]. / Construcción de un índice de privación para los barrios de Madrid y Barcelona.

BACKGROUND: There are few economic indicators that take the neighbourhood as the unit of reference in our context. The aim of this article is to describe the process and results of secondary data collection and development of a deprivation index (DI) for the neighbourhoods of the cities of Madrid and Barcelona, discussing their utility for research on health inequalities. METHODS: Initial DI conceptual framework contained different elements that characterize deprivation and for which we collected second-level variables. ID was adapted to the availability of variables and to the results of an exploratory analysis. Finally, a factor analysis was performed to validate the IP. We built a DI based on five dimensions for Madrid (economy, population and territory, housing, cars and demographics) and 4 for Barcelona (all except "demographics"). Neighbourhoods were grouped into quartiles according to their score for the DI (Q4: higher levels of deprivation). Premature mortality rates and premature mortality ratios adjusted by age were calculated for each quartile. RESULTS: The IP explained 55% of the observed variability in the indicators for Madrid and 69% for Barcelona. Premature mortality rate in Madrid for Q1 was 1.65 per 10³ in men and 0.92 per 10³ women and 2.81 per 10³ in men and 1.22 per 10³ in women residing in Q4. In Barcelona, the mortality rate was 2.33 per 10³ men and 1.15 per 10³ women in Q1 and 3.49 per 10³ in men and 1.52 per 103 in women living in Q4. CONCLUSION: Premature mortality rates showed higher premature mortality in the most deprived districts.

Construcción de un índice de privación para los barrios de Madrid y Barcelona / Processand results of constructing a deprivation index for the districts of Madrid and Barcelona, Spain

Fundamentos: los indicadores socioeconómicos que toman el barrio como unidad de referencia en nuestro contexto son escasos. Los objetivos de este artículo son describir el proceso de construcción y la validez de un índice de privación a nivel de barrio y analizar su asociación con la mortalidad. Métodos: el esquema conceptual inicial del IP contuvo elementos que caracterizaban teóricamente la privación y para las que se realizó una recogida de variables de segundo nivel. El IP se adaptó a la disponibilidad de variables y a los resultados de sus análisis exploratorios. Finalmente, se realizó un análisis factorial para la validación del IP que se compuso de 5 dimensiones para Madrid (economía, población y territorio, vivienda, parque móvil y demografía) y 4 para Barcelona (las mismas salvo «demografía»). Los barrios fueron agrupados en cuartiles según la puntuación obtenida para el IP (Q4: mayor nivel de privación). Se calcularon tasas de mortalidad prematura estratificadas por sexo y ajustadas por edad y razones de mortalidad para cada cuartil. Resultados: El IP explicó el 55% de la variabilidad observada en los indicadores para Madrid y el 69% para Barcelona. La tasa de mortalidad prematura para el Q1 en Madrid fue 1,65por 103 en hombres y 0,92 por 103 y de 2,81 por 103 en hombres y 1,22 por 103 en mujeres residentes en Q4. En Barcelona la tasa de mortalidad fue de 2,33 por 103 en hombres y de 1,15 por 103 mujeres en el Q1 y de 3,49 por 103 en hombres y 1,52 por 103 en mujeres del Q4. Conclusión: Las tasas de mortalidad mostraron mayor mortalidad prematura en los barrios con un índice de privación mayor (AU)

Background: There are few economic indicators that take the neighborhood as the unit of reference in our context. The aim of this article is to describe the process and results of secondary data collection and development of a deprivation index (DI) for the neighborhoods of the cities of Madrid and Barcelona, discussing their utility for research on health inequalities. Methods: initial DI conceptual framework contained different elements that characterize deprivation and for which we collected second-level variables. ID was adapted to the availability of variables and to the results of an exploratory analysis. Finally, a factor analysis was performed to validate the IP. We built a DI based on five dimensions for Madrid (economy, population and territory, housing, cars and demographics) and 4 for Barcelona (all except "demographics"). Neighborhoods were grouped into quartiles according to their score for the DI (Q4: higher levels of deprivation). Premature mortality rates and premature mortality ratios adjusted by age were calculated for each quartile. Results: The IP explained 55% of the observed variability in the indicators for Madrid and 69% for Barcelona. Premature mortality rate in Madrid for Q1 was 1.65 per 103 in men and 0.92 per 103 women and 2.81 per 103 in men and 1.22 per 103 in women residing in Q4. In Barcelona,the mortality rate was 2.33 per 103 men and 1.15 per 103 women in Q1 and 3.49 per 103 in men and 1.52 per 103 in women living in Q4. Conclusion: Premature mortality rates showed higher premature mortality in the most deprived districts (AU)

Sports facilities in Madrid explain the relationship between neighbourhood economic context and physical inactivity in older people, but not in younger adults: a case study.

BACKGROUND: Neighbourhood characteristics may contribute to differences in physical inactivity. PURPOSE: To evaluate whether the availability of sports facilities helps explain the differences in physical inactivity according to the economic context of the neighbourhood. METHODS: 6607 participants representative of the population aged 16-74 years, resident in Madrid (Spain) in 2005, were analysed. Using ORs calculated by multilevel logistic regression, the association between per capita income of the neighbourhood of residence and physical inactivity was estimated, after adjusting for age, population density, individual socioeconomic characteristics and the availability of green spaces. The analysis was repeated after further adjustment for the availability of sports facilities to determine if this reduced the magnitude of the association. RESULTS: Residents in the neighbourhoods with the lowest per capita income had the highest OR for the prevalence of physical inactivity. In participants aged 16-49 years, after adjusting for the availability of sports facilities, the magnitude of the OR in the poorest neighbourhoods with respect to the richest neighbourhoods increased in men (from 2.22 to 2.35) and declined by 13% in women (from 2.13 to 1.98). In contrast, in the population aged 50-74 years, this adjustment reduced the magnitude of the OR by 21% in men (from 2.00 to 1.80) and by 53% in women (from 2.03 to 1.48). CONCLUSIONS: The poorest neighbourhoods show the highest prevalence of physical inactivity. The availability of sports facilities explains an important part of this excess prevalence in participants aged 50-74 years, but not in younger individuals.

The role of political and welfare state characteristics in infant mortality: a comparative study in wealthy countries since the late 19th century.

BACKGROUND: A close examination of the literature suggests that the consistent relation between political and welfare state characteristics and infant mortality in the second half of the 20th century in wealthy countries may not be causal. METHODS: The evolution of infant mortality since the late 19th century was studied in 17 wealthy countries classified according to political traditions, family policy model and period of infant mortality transition. The relation of public health expenditure and income inequality to infant mortality from 1980 to 2005 was also evaluated. RESULTS: The Social Democratic and Scandinavian countries, and those with the earliest transition in infant mortality, had the lowest infant mortality rates until the early 21st century, whereas the late democracies, the Southern European countries, and those in which the transition in infant mortality took place later, had the highest rates until the late 20th century. By the early 21st century, the differences in infant mortality were negligible. Three of the four Scandinavian countries were the first to achieve infant mortality transition, whereas the Southern European countries were the last. The relation between public health expenditure and infant mortality varied depending on the time period in which the analysis was made, and increased income inequality was associated with higher infant mortality. CONCLUSIONS: The relation between political and welfare state characteristics and infant mortality in previous studies probably reflects the historical moment in which the transition in infant mortality took place in each country. Methodological limitations do not allow inference of causality in the associations found between welfare state characteristics and infant mortality.

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.

Heterogeneity in the association between socioeconomic position in early life and adult self-rated health in two birth cohorts of Spanish adults.

BACKGROUND: The purpose of this work was to evaluate the association between socioeconomic circumstances in early life and poor self-rated health in adulthood, and to determine whether this association varies depending on birth cohort. METHODS: Using data from the 2005 Living Conditions Survey carried out in a Spanish population sample, separate analyses were made for persons born between 1941 and 1959 who lived their childhood and adolescence in a period marked by absence of economic growth in Spain, and those born between 1960 and 1980. The authors estimated of the relation of financial difficulties in adolescence, occupation of father, education of father and education of mother with poor self-reported health, adjusted for the measures of socioeconomic position in adulthood. Also evaluated was the possibility of interaction between early and adult socioeconomic position and the cumulative effect of low socioeconomic position across the life course. RESULTS: In the two cohorts, the presence of financial difficulties in adolescence showed an association with an increased risk of poor self-rated health; in contrast, the relation of occupation and education of parents with poor self-rated health varied depending on the birth cohort and gender of the study subjects. The effect of family financial situation was shown to accumulate over the life course, whereas the effect of socioeconomic position across the life course was heterogeneous when occupation and education of parents were used. CONCLUSION: The importance of financial difficulties in the household has probably not varied over time; in contrast, the heterogeneity of the findings regarding occupation and education of parents suggests that the importance of these indicators and, consequently, their aetiological pathways may differ depending on the gender and birth cohort of the study subjects.

Socio-economic position, family demands and reported health in working men and women.

BACKGROUND: This study evaluates the extent to which domestic workload explains socio-economic differences in poor self-reported health in women and men. METHODS: In total, 6284 men and women who were employed and living with a partner were selected from the 2003 Spanish Health Interview Survey. The indicators of family demands investigated were person responsible for housework, number of persons in the household and the presence of at least one child under 15 years of age in the household. The measures of socio-economic position were educational level and household income, and the measures of health status were poor perceived health and limitation of activity due to disease. RESULTS: Household size and presence of a child under 15 in the home were not related with the measures of health status. The indicator about the person who does the housework was related with poor perceived health and with activity limitation. Specifically, the worst health status was seen in respondents who lived in homes where the partner or other family members did the housework. In general, the relation between indicators of socio-economic position and measures of health status was not modified after taking into account the person who does the housework. CONCLUSION: Among working people with a partner, persons who work and do their own housework do not have poorer perceived health than those living in homes where other people do the housework. This indicator of family demands does not explain the socio-economic differences in self-reported health.

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.

Mortalidad por enfermedades cardiovasculares en inmigrantes residentes en la Comunidad de Madrid / Mortality from cardiovascular diseases in immigrants residing in Madrid

Fundamento y objetivo: Estimar la mortalidad por enfermedades cardiovasculares entre inmigrantes residentes en una de las comunidades españolas con la tasa de inmigración más alta en los primeros años del siglo xxi. Población y método: Se estudió a la población de 20 a 64 años de edad residente en la Comunidad de Madrid en el período 2000-2004. La mortalidad por enfermedades cardiovasculares en los inmigrantes de diferentes partes del mundo se comparó con la mortalidad en la población autóctona española. Para ello se estimó la razón de tasas ajustada por edad, sexo y renta per cápita del lugar de residencia. Resultados: Los inmigrantes del África subsahariana mostraron la mayor razón de tasas de mortalidad por el conjunto de enfermedades cardiovasculares y por enfermedad isquémica del corazón, y los procedentes de América del Sur, la menor. La mayor razón de tasas de mortalidad por enfermedad cerebrovascular se observó en los inmigrantes de América Central y el Caribe. Conclusiones: El patrón de mortalidad por enfermedades cardiovasculares en la población inmigrante es muy similar al encontrado en investigaciones realizadas en otros países y probablemente refleje la carga de enfermedad en sus lugares de origen (AU)

Background and objective: To estimate the mortality from cardiovascular diseases in immigrants residing in one of the regions of Spain with the highest immigration rate during the early years of the 21st century. Population and method: The study included people aged 20 to 64 years of age residing in Madrid for the period 2000-2004. Mortality form cardiovascular disease in immigrants from different parts of the world was compared with the mortality in the native Spanish population. Mortality rates ratios adjusted for age, sex and per capita income in the area of residence were estimated. Results: Immigrants from Sub-Saharan Africa and from South America showed, respectively, the highest and the lowest mortality rate ratio of cardiovascular diseases and ischemic heart disease. Immigrants from the region of Central America and the Caribbean showed the highest mortality rate ratio of cerebrovascular disease. Conclusions: The pattern of cardiovascular disease mortality in immigrants residing in Madrid is quite similar to those found in studies made in other countries, and probably reflect the burden of disease in their places of origin (AU)

[Mortality from cardiovascular diseases in immigrants residing in Madrid]. / Mortalidad por enfermedades cardiovasculares en inmigrantes residentes en la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: To estimate the mortality from cardiovascular diseases in immigrants residing in one of the regions of Spain with the highest immigration rate during the early years of the 21st century. POPULATION AND METHOD: The study included people aged 20 to 64 years of age residing in Madrid for the period 2000-2004. Mortality form cardiovascular disease in immigrants from different parts of the world was compared with the mortality in the native Spanish population. Mortality rates ratios adjusted for age, sex and per capita income in the area of residence were estimated. RESULTS: Immigrants from Sub-Saharan Africa and from South America showed, respectively, the highest and the lowest mortality rate ratio of cardiovascular diseases and ischemic heart disease. Immigrants from the region of Central America and the Caribbean showed the highest mortality rate ratio of cerebrovascular disease. CONCLUSIONS: The pattern of cardiovascular disease mortality in immigrants residing in Madrid is quite similar to those found in studies made in other countries, and probably reflect the burden of disease in their places of origin.

Socioeconomic environment, availability of sports facilities, and jogging, swimming and gym use.

The aim of the study was to evaluate the association of the availability of sports facilities and socioeconomic environment with jogging, swimming and gym use in Spain. The indicators of availability of sports facilities were the number of swimming pools and the number of gyms per 10,000 population. The indicators of socioeconomic environment were average provincial income and provincial unemployment rate. The number of sports facilities was not related with either swimming or gym use and the indicators of socioeconomic environment were not associated with swimming in either sex, or with gym use in men. The findings of this study do not support the hypotheses proposed in previous investigations to explain the consistent relation between socioeconomic environment and lack of physical activity.

Adverse side effects of statins in the oral cavity

No disponible

Increased plasma levels of cholesterol are high risk factors of cardiovascular disease. Statins are drugs that inhibit cholesterol synthesis at both pancreatic and extrahepathic levels, being the treatment of choice for hypercholesterolemia.Objective: To analyze the side effects of statins in the mouth cavity, and to analyze the symptoms after interruption of the treatment.Design: Observational study, preliminary.Material and methods: Patients aged 50-70, diagnosed with hypercholesterolemia and undergoing treatment withstatins, referred from their primary care physician to the dentist’s office. Anamnesis over oral symptoms was performed in the first visit. Statin treatment was discontinued, followed by lab tests and control visits seven and fifteen days later. We monitored the improvement and/or remission of oral symptoms. Statin treatment was resumed, sending out a report of the patient evolution to the PCP. Symptoms were registered in sheet specially designed for the study.Exclusion criteria: patient refusal, use of drugs for dry mouth treatment, Sjögren’s syndrome.Results: n=26 patients. Dry mouth patients: improvement in 17 out of 23 patients (88.5%). Itchiness: 6 out of 15cases improved (57.7%). Bitterness: improvement in 13 out of 14 patients (53.8%). Cough: improvement in 11 outof 12 patients (46.1%).Discussion: A high percentage of oral symptoms are associated to treatment with statins. There is a marked improvement after temporary interruption of the treatment. Little is known regarding the side effects of oral treatment with statins. This preliminary study includes a relatively small number of patients. The design of experimental treatments will be required to establish a true correlation between statin treatment and oral symptoms

Adverse side effects of statins in the oral cavity.

UNLABELLED: Increased plasma levels of cholesterol are high risk factors of cardiovascular disease. Statins are drugs that inhibit cholesterol synthesis at both pancreatic and extrahepathic levels, being the treatment of choice for hypercholesterolemia. OBJECTIVE: To analyze the side effects of statins in the mouth cavity, and to analyze the symptoms after interruption of the treatment. DESIGN: Observational study, preliminary. MATERIAL AND METHODS: Patients aged 50-70, diagnosed with hypercholesterolemia and undergoing treatment with statins, referred from their primary care physician to the dentist's office. Anamnesis over oral symptoms was performed in the first visit. Statin treatment was discontinued, followed by lab tests and control visits seven and fifteen days later. We monitored the improvement and/or remission of oral symptoms. Statin treatment was resumed, sending out a report of the patient evolution to the PCP. Symptoms were registered in sheet specially designed for the study. EXCLUSION CRITERIA: patient refusal, use of drugs for dry mouth treatment, Sjögren's syndrome. RESULTS: n=26 patients. Dry mouth patients: improvement in 17 out of 23 patients (88.5%). Itchiness: 6 out of 15 cases improved (57.7%). Bitterness: improvement in 13 out of 14 patients (53.8%). Cough: improvement in 11 out of 12 patients (46.1%). DISCUSSION: A high percentage of oral symptoms are associated to treatment with statins. There is a marked improvement after temporary interruption of the treatment. Little is known regarding the side effects of oral treatment with statins. This preliminary study includes a relatively small number of patients. The design of experimental treatments will be required to establish a true correlation between statin treatment and oral symptoms.

Increasing the price of tobacco: economically regressive today and probably ineffective tomorrow.

The tobacco price increase during the fourth stage of the smoking epidemic has coincided with a decrease in smoking prevalence, less marked in the lower socio-economic groups. In countries that are at the third stage of the epidemic, smoking prevalence in poor and less educated women has not changed or has increased at the same time as tobacco prices have increased. It is assumed, however, that people with low incomes and those with less education in developed countries are more responsive to price changes. The inconsistent results with regard to the price elasticity of tobacco in different socio-economic groups and the conflicting trends in smoking prevalence between socio-economic groups during periods of increased tobacco prices do not support that consensus. Evidence suggests that increasing tobacco taxation is a regressive measure today and will probably achieve only a moderate reduction in tobacco use in the future, as smoking is becoming a phenomenon associated with poorer and less-educated people.

The association of current and sustained area-based adverse socioeconomic environment with physical inactivity.

This paper evaluates the association between socioeconomic environment in the province of residence and physical inactivity, using measures of current and sustained area-based adverse socioeconomic environment. The analysis included 19,324 individuals representative of the Spanish non-institutionalised population aged 16-74 years. The measure of association estimated was the prevalence odds ratio for physical inactivity by current gross domestic product per capita (GDPpc) and current Gini coefficient, and by number of times each province has had a low GDPpc and number of times each province has had a high Gini coefficient in the last two decades. After adjusting for age, individual socioeconomic characteristics, and number of sports facilities per 1,000 population, the odds ratio for physical inactivity in residents of provinces with the lowest current GDPpc versus those with the highest was 1.64 in men and 2.01 in women. The odds ratio in residents of provinces that had always been among those with the lowest GDPpc versus residents in provinces that had never been among those with lowest GDPpc was 1.54 in men and 1.91 in women. Neither the current Gini coefficient nor the indicator that reflects sustained high Gini coefficient were associated with physical inactivity. These findings show that physical inactivity is associated with current socioeconomic context and with the duration of exposure of the area of residence to adverse socioeconomic circumstances when the indicators of socioeconomic environment are based on GDPpc, but not on income inequality. Also, this association is not explained by individual socioeconomic characteristics or the number of sports facilities.

The role of the public health official in communicating public health information.

The prevailing views on the role of public health professionals refer to professionals in the academic world, without taking into account the fact that many public health professionals are government employees. For example, the American Public Health Association states that public health professionals play an active role in communicating public health information to nonscientific audiences, such as the general population or the mass media. We propose that public health officials have an important responsibility to promote the practice of public health. However, they must do so within the bureaucracy. Any actions that public health officials wish to take as advocates of particular public health activities should be carried out independent of their role as government officials.

Poliposis adenomatosa familiar / Familial adenomatous polyposis

La poliposis adenomatosa familiar es una enfermedad genética poco frecuente caracterizada por la presencia de más de 100 pólipos en el colon y el recto, y que comúnmente se asocia a toda una serie de manifestaciones clínicas extracolónicas. Esta enfermedad hereditaria, habitualmente con patrón autosómico dominante, evoluciona sin tratamiento a cáncer colorrectal. El manejo de esta enfermedad debe iniciarse con un consejo genético para informar del tipo de patología, de la mejor terapéutica y del seguimiento necesario de ella. Actualmente, la cirugía profiláctica es necesaria. Sin embargo, el tipo de técnica quirúrgica dependerá principalmente de la gravedad de la manifestación clínica de la enfermedad, de la edad del paciente al diagnóstico y, finalmente, de algunas circunstancias clínicas especiales. Esta enfermedad requerirá además que cada uno de los pacientes tenga un seguimiento de por vida adecuado. El objetivo de este trabajo es realizar una revisión de los principales estudios publicados sobre la poliposis adenomatosa familiar, con el objetivo de conocer cuál es el mejor manejo de estos pacientes

Familial adenomatous polyposis is a rare genetic disease characterized by the development of more than a hundred adenomatous polyps in the colorectal area, as well as by extracolonic manifestations. Without treatment, this inherited disease, usually transmitted by autosomal dominant inheritance, predisposes to colorectal cancer. Treatment must be preceded by counseling about the nature of the syndrome and by recommendations for the optimal management and surveillance of the disease. Currently, prophylactic surgical therapy is imperative. However, the type of surgical technique used depends mainly on the severity of the polyposis phenotype, the age of the patient at diagnosis, and a series of special clinical circumstances. Lifetime follow-up of all patients is required. This article reviews the main studies published on familial adenomatous polyposis in order to provide an update on the most appropriate management of these patients