Activos de salud, calidad de vida y morbimortalidad de la población en Asturias.

INTRODUCCIÓN: n promoción de la salud se ha detectado en los últimos años un incremento de investigaciones con enfoques teóricos basados en activos de salud. Pese a los estudios identificados, no se dispone de suficiente evidencia sobre los efectos que diferentes tipos de activos pueden tener en la calidad de vida y en la morbimortalidad de la población. OBJETIVO: analizar la relación entre los activos de salud disponibles con indicadores de morbilidad, mortalidad y calidad de vida de la población asturiana en el año 2018. METODOLOGÍA: diseño ecológico a partir de datos agregados municipales procedentes de los 78 municipios de Asturias (1.034.960 habitantes). Tras aplicar la definición de activos de salud como aquellas variables que pudieran redundar en una mejora de la salud y del bienestar de los individuos y de las comunidades, se seleccionaron 19 variables de activos agrupados en cuatro categorías: individuales, socioeconómicas, comunitarias e infraestructura. Una vez controladas las variables relacionadas con las características demográficas de la población, se analizó la asociación de los activos con las tasas de morbimortalidad y de calidad de vida. Se desarrollaron 5 modelos predictivos a partir de modelos de regresión lineal múltiple para las variables dependientes: calidad de vida, enfermedades crónicas, mortalidad por todas las causas, mortalidad por enfermedades cardiovasculares (ECV) y por cáncer. RESULTADOS: la disponibilidad de recursos sanitarios (beta = 0.474), coberturas sociales (beta = 0.305) y redes de apoyo social (beta = 0.225) constituyen los activos de salud con mayor peso explicativo en los resultados de salud de la población asturiana. Las variables incluidas en los modelos predictivos de calidad de vida (R2 = 0.650) y de mortalidad por ECV (R2 = 0.544) son las que mostraron una mayor capacidad explicativa. CONCLUSIONES: la inversión en recursos sociosanitarios y la mejora de redes de apoyo social impulsados desde el ámbito de la salud pública pueden producir importantes mejoras en la salud de la población asturiana.

Declaración de Sant Joan d’Alacant en defensa del acceso abierto a las publicaciones científicas, del Grupo de Editores de Revistas Españolas sobre Ciencias de la Salud (GERECS) / Declaration of Sant Joan d'Alacant in defense of open access to the scientific publications, from the publishers of Spanish journals group on (GERECS) health sciences

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No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain.

BACKGROUND: Spain's financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period. METHODS: An ecological longitudinal study was carried out in Spain's 17 regions. Two study periods were defined: pre-crisis period (2005-2007) and crisis period (2008-2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design. RESULTS: Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008. DISCUSSION: The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates. CONCLUSIONS: The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

Social determinants of self-perceived discrimination in Spain.

OBJECTIVES: To analyse the association between self-perceived discrimination and social determinants (social class, gender, country of origin) in Spain, and further to describe contextual factors which contribute to self-perceived discrimination. METHODS: Cross-sectional design using data from the Spanish National Health Survey (2006). The dependent variable was self-perceived discrimination, and independent and stratifying variables were sociodemographic characteristics (e.g. sex, social class, country of origin, educational level). Logistic regression was used. RESULTS: The prevalence of self-perceived discrimination was 4.2% for men and 6.3% for women. The likelihood of self-perceived discrimination was higher in people who originated from low-income countries: men, odds ratio (OR) 5.59 [95% confidence interval (CI) 4.55-6.87]; women, OR 4.06 (95% CI 3.42-4.83). Women were more likely to report self-perceived discrimination by their partner at home than men [OR 8.35 (95% CI 4.70-14.84)]. The likelihood of self-perceived discrimination when seeking work was higher among people who originated from low-income countries than their Spanish counterparts: men, OR 13.65 (95% CI 9.62-19.35); women, OR 10.64 (95% CI 8.31-13.62). In comparison with Spaniards, male white-collar workers who originated from low-income countries [OR 11.93 (95% CI 8.26-17.23)] and female blue-collar workers who originated from low-income countries (OR 1.6 (95% CI 1.08-2.39)] reported higher levels of self-perceived discrimination. CONCLUSIONS: Self-perceived discrimination is distributed unevenly in Spain and interacts with social inequalities. This particularly affects women and immigrants.

The effect of television news items on intimate partner violence murders.

BACKGROUND: This study has been carried out in order to explore the effect of the growing appearance of IPV in television news items on deaths by this cause. METHODS: Ecological study based on 340 deaths by intimate partner violence (IPV) and 3733 television news items covering this topic on Spanish television channels (2003 and 2007). Logistic regression analysis was carried out. Dependent variable: the difference between the number of IPV deaths in the 7 days following a news item broadcast and the number of IPV deaths in the 7 days before a media item. This outcome variable was conceptualised as a binary variable: increase vs. no increase. INDEPENDENT VARIABLES: days with IPV news items-in general, concerning deaths, measures or other IPV crimes. Adjusted variables: day of the week, month, year and public holidays. RESULTS: A small copycat effect was observed in the IPV murder rate (RR = 1.32, CI(95%) = 1.07 - 1.62) for IPV-related news item days compared with days without such news. This effect continued when information about deaths was broadcast (RR = 1.28, CI(95%) = 1.01 - 1.62). News items concerning measures (RR = 0.90, CI(95%) = 0.82 - 0.98) or other IPV crimes (0.84, CI(95%) = 0.82 - 0.98) were related to a lower possibility of an increase in deaths compared with days with death-related news. CONCLUSION: Given the results observed in the case of IPV-related news, there is an evident need to develop a journalistic style guide in order to determine what type of information is recommended due to the potential positive or negative effects.

How political epidemiology research can address why the millennium development goals have not been achieved: developing a research agenda.

The Millennium Development Goals (MDG) progress targets have not been met. Nevertheless, the United Nations (UN) has not yet undertaken in-depth review in order to discover the reasons behind this lack of progress in achieving the MDG. From a political epidemiology perspective, the intention here is to identify the political elements affecting the social factors impeding MDG fulfilment and, at the same time, to suggest future public policies and appropriate proposals that are both more coherent and supported by broader, empirical knowledge of the relevant issues.

Preventing disability through understanding international megatrends in Deaf bilingual education.

BACKGROUND: Education is a basic prerequisite for d/Deaf people's health. Deaf education varies considerably from country to country and we still know very little about the reasons for such variation. OBJECTIVE: To identify international megatrends that influence the current Deaf bilingual education move (Deaf Bilingual-Bicultural education; DBiBi) worldwide. METHODS: Using the Delphi technique, 41 experts in d/Deaf education (nine Deaf, 32 hearing) from 18 countries identified, ranked, and rated international megatrends in DBiBi education. RESULTS: The process revealed six main essential elements of the international implementation of DBiBi education and nine main barriers against it. The top five promoting forces in that list in order of priority were: (1) societal and political changes towards a growing acceptance of diversity and Deaf issues; (2) growing Deaf activism, self-awareness and empowerment; (3) scientific research in sign linguistics and bilingualism; (4) changes in the d/Deaf educational community; and (5) international cooperation. The top five hindering forces included: (1) the view of deafness as a medical condition with a technological solution; (2) phonocentrism and societal resistance to the unknown; (3) educational and d/Deaf educational policies; (4) DBiBi education weaknesses; and (5) invisibility, heterogeneity and underperformance of the d/Deaf population. CONCLUSION: The results of this study reveal that social/political changes and a medical/social model of Deaf people's health can promote or limit Deaf people's educational options much more than changes within the education system itself, and that a transnational perspective is needed in deciding how best to support DBiBi education at a national and local level in an increasingly globalised world.

Mapping public policy options responding to obesity: the case of Spain.

This study assesses the opinions of the main Spanish stakeholders from food and physical exercise policy networks on public policy options for responding to obesity. We followed the multi-criteria mapping methodology in the framework of the European project 'Policy options in responding to obesity' (PorGrow), through a structured interview to 21 stakeholders. A four-step approach was taken: options, criteria, scoring and weighting, obtaining in this way a measure of the performance of each option which integrates qualitative and quantitative information. In an overall analysis, the more popular policy options where those grouped as educational initiatives: include food and health in the school curriculum, improve health education to the general public, improve the training of health professionals in obesity care and prevention, incentives to caterers to provide healthier menus and improve community sports facilities. Fiscal measures as subsidies and taxes had the lowest support. The criteria assessed as priorities were grouped as efficacy and societal benefits. Obesity in Spain can be approached through public policies, although the process will not be easy or immediate. The feasibility of changes requires concerned public policymakers developing long-term actions taking into account the map of prioritized options by the stakeholders.

El espacio europeo en educación superior y la salud laboral / European convergence in higher education and occupational health

Se presenta una experiencia realizada en la Universidad de Alicante para conocer la valoración del alumno sobre el tiempo y esfuerzo requerido para superar las asignaturas de salud laboral en las titulaciones de Enfermería y Relaciones Laborales como paso previo a la implantación del nuevo sistema universitario acorde con las directrices de convergencia europea en Educación Superior

As a preliminary step to the implementation of new European Union directives in higher education, this study, conducted at the University of Alicante (Spain), evaluated student feedback on the time and level of effort required to successfully pass subject matter in occupational health by students enrolled in nursing and labour relations programmes

[Medical scientific Romania in the European context]. / România medicala stiintifica in context European.

UNLABELLED: A national and international publications bibliometric analysis was assessed to evaluate the scientific research situation about Romania and the relation with the European Parliament Health objectives for 2003-2008. MATERIAL AND METHODS: A bibliographical search in MEDLINE between 1999 and 2003 was performed. An annual review was done and the articles were classified on seven activity branches. The clinical medicine articles were classified by using medical specialties. The 2003-2008 Health European report was classified on fourteen objectives and related to the Romanian scientific production. RESULTS: 2068 articles were found, distributed 271 in 1999, 373 in 2000, 434 in 2001, 492 in 2002, and 498 in 2003. 1335 are clinical medicine, 485 basic sciences, 126 Public Health, 40 pollution and environmental, 36 mental health and 25 nursing articles. 21 were not classified. CONCLUSIONS: The highest article's number belongs to the clinical medicine field and the highest research interest was found in Ophthalmology medical specialty. An increasing scientific research evolution was found but a focussed research tendency was observed around some of the European Union Parliament's objectives.

Alcohol and intimate partner violence: do we have enough information to act?

BACKGROUND: Male alcohol consumption is one of the accepted risk factors for intimate partner violence. The aim of this study is to assess the magnitude of the association between male alcohol consumption and intimate partner violence against women and the quality of the evidence of published papers exploring this relationship empirically. METHODS: Systematic review and meta-analysis of quantitative studies (1966-2004). Eight databases from Social and Behavioural Sciences, Clinical Medicine, and Life Sciences were reviewed. Studies with available 2 x 2 table or odds ratio were analysed using meta-analytic techniques. RESULTS: A total of 22 studies fulfilled the inclusion criteria for the systematic review: 14 (63.6%) were cross-sectional studies, 6 (27.3%) case-series, 2 (9.1%) case-control studies. Ten studies analysed the relationship between alcohol and violence as their primary hypothesis and only two used a direct measure of alcohol consumption. Of them, 11 papers were included in the meta-analysis. The overall pooled odds ratio was 4.57 (95% confidence limits 3.30-6.35), but a high degree of heterogeneity was observed. The magnitude of the effect was inversely associated with the year of publication. The biggest odds ratios were obtained in the studies with the smallest sample sizes. CONCLUSIONS: The evidence about the relationship between alcohol consumption and intimate partner violence is of low quality in the study designs and maybe biased by publication of positive results. Currently there is not enough empirical evidence to support preventive policies based on male alcohol consumption as a risk factor in the particular case of intimate partner violence.

Propuesta de adaptación de un programa de salud laboral al programa de convergencia europea en educación / Adaptationof an occupational health academic program to the program of european convergence in higher education

La Declaración de Bolonia establece el compromiso de coordinación de las políticas educativas para conseguir la creación de un espacio europeo en educación superior. Entre sus objetivos figura establecer un sistema único de créditos, ECTS (European Credit Transfer System) por parte de las universidades europeas. La salud laboral es una materia impartida en diferentes diplomaturas y licenciaturas que también se ve afectada por este proceso. El objetivo de este trabajo fue realizar una propuesta de adaptación de un programa de salud laboral de acuerdo con las directrices ECTS. Se presenta el programa de salud laboral en la Diplomatura de Relaciones Laborales de la Universidad de Alicante adaptado al crédito europeo

The Bologna Declaration establishes a commitment to coordinate educational policies in order to create a European area in higher education. Among its objectives is the establishment of a uniform system of academic credits, the ECTS (European Credit Transfer System) by European universities. Occupational health is a subject taught in different degree programs that is also affected by this process. The aim of this study was to present a proposal for the adaptation of an existing occupational health program in accordance with the ECTS guidelines. The Labour Relations Diploma Program at the University of Alicante, adapted to the ECTS, is discussed

[Intimate partner violence in Spain]. / Violencia del compañero íntimo en España.

OBJECTIVE: To estimate mortality and the incidence of formal complaints of intimate partner violence (IPV) by age groups and Spanish provinces. METHODS: We performed a descriptive, epidemiological study of murders by intimate partners registered in the database of the Divorced and Separated Women's Federation (1998-2001) and of formal complaints of IPV in The Home Affairs database (1997-2000). The percentage of increase in formal complaints and deaths and the individual risk of dying from IPV and of reporting this crime was calculated through the simple accumulative method, specific mortality rates by age, average rates by provinces, and specific incidence rates of formal complaints of IPV by provinces. Finally, a simple regression analysis was performed to assess the relation between mortality and the incidence of formal complaints of IPV. RESULTS: Between the first and the last year of the study, formal complaints increased by 27% and murders increased by 49%. In Spain, during the period analyzed, one out of every 100,000 women was murdered by an intimate partner and one out of every 200 women reported IPV. Women aged 22-41 years and those aged 82-86 years presented the highest rates of mortality from IPV. Mortality from IPV and the incidence of formal complaints of IPV showed no clear geographical pattern. No correlation between mortality and the incidence of formal complaints of IPV by provinces was found (corrected r2 = 0.016). CONCLUSIONS: IPV is an increasing public health problem in Spain. There seems to be a bimodal curve by age in mortality from IPV, but no geographical patterns in mortality and the incidence of formal complaints of IPV or between the provinces with the highest incidence of formal complains and those with highest mortality were observed.

Violencia del compañero íntimo en España / Intimate partner violence in Spain

Objetivo: Estimar la mortalidad y la incidencia de las denuncias por la violencia del compañero íntimo (VCI) por grupos de edad y provincias españolas. Métodos: Estudio epidemiológico, descriptivo, basado en los asesinatos registrados en la base de datos de la Federación de Mujeres Separadas y Divorciadas (1998-2001) y las denuncias por VCI del Ministerio del Interior (1997-2000). Se calculó el porcentaje de incremento producido entre las denuncias y las muertes, el riesgo de una mujer de morir y denunciar por VCI por el método acumulativo simple, las tasas de mortalidad específicas por edad y ajustadas por edad y provincias y las tasas de incidencia bruta por provincias de las denuncias por VCI. También se realizó un análisis de regresión simple para explorar la relación entre mortalidad e incidencia de las denuncias. Resultados: Se observó un incremento del 27 por ciento en las denuncias y del 49 por ciento en los asesinatos desde el primer año del período al último. Durante el período de estudio una de cada 100.000 mujeres fue asesinada por VCI y una de cada 200 denunció ser víctima de VCI. Las mujeres de 22-41 años y las de 82-86 presentaron las tasas de mortalidad por VCI más altas. La mortalidad y la incidencia de las denuncias por VCI en las provincias españolas no siguió un patrón geográfico definido. No existe correlación entre la mortalidad y la incidencia de las denuncias por VCI por provincias (r2 corregida = -0,016).Conclusiones: La violencia del compañero íntimo es un problema de salud pública creciente en España. Parece existir un patrón bimodal por edad en mortalidad por VCI, pero no un patrón geográfico en mortalidad e incidencia de denuncias, ni tampoco una relación entre las provincias de mayor tasa de incidencia de denuncias y las de mayor tasa de mortalidad (AU)

Objective: To estimate mortality and the incidence of formal complaints of intimate partner violence (IPV) by age groups and Spanish provinces. Methods: We performed a descriptive, epidemiological study of murders by intimate partners registered in the database of the Divorced and Separated Women's Federation (1998-2001) and of formal complaints of IPV in The Home Affairs database (1997-2000). The percentage of increase in formal complaints and deaths and the individual risk of dying from IPV and of reporting this crime was calculated through the simple accumulative method, specific mortality rates by age, average rates by provinces, and specific incidence rates of formal complaints of IPV by provinces. Finally, a simple regression analysis was performed to assess the relation between mortality and the incidence of formal complaints of IPV. Results: Between the first and the last year of the study, formal complaints increased by 27% and murders increased by 49%. In Spain, during the period analyzed, one out of every 100,000 women was murdered by an intimate partner and one out of every 200 women reported IPV. Women aged 22-41 years and those aged 82-86 years presented the highest rates of mortality from IPV. Mortality from IPV and the incidence of formal complaints of IPV showed no clear geographical pattern. No correlation between mortality and the incidence of formal complaints of IPV by provinces was found (corrected r2= -0.016). Conclusions: IPV is an increasing public health problem in Spain. There seems to be a bimodal curve by age in mortality from IPV, but no geographical patterns in mortality and the incidence of formal complaints of IPV or between the provinces with the highest incidence of formal complains and those with highest mortality were observed (AU)

[The genome and its metaphors. Detectives, heroes or prophets?]. / El genoma y sus metáforas. 'Detectives, héroes o profetas?

The new genetics, or the impetus given to this discipline by the Genome Project, aims to a change of paradigm of the Health Sciences. This change is postulated from a phenotypic approach to a genotypic one, thereby excluding the influence of the environment, which could seriously undermine the grounds for the development and exercise of Public Health. Since the beginning of the genome project, information on genetic discoveries has frequently been reported in the mass media. Metaphors are often used by geneticists and journalists to convey the complex concepts of genetic research for which there are no equivalents in the lay language. The media do not merely shape the social agenda but also provide the space in which health culture is constructed. We present the results of a preliminary study exploring the metaphors used in the three most widely-read national daily newspapers in Spain, namely ABC, El Pais and El Mundo, when reporting news of the new genetics. The possible consequences of the natural history of these metaphors, or the process through which figurative terms acquire a literal meaning, are discussed. A preliminary taxonomy for the metaphors identified was developed. Fifty-one out of 342 identified headings (14.8%) contained metaphors. Strategic metaphors such as program, control, code, map, and puzzle, were the most commonly used, followed by teleological ones such as mystery or God language and finally war-like metaphors such as attack, defeat, and capture. The three groups of metaphors are characterized by an attempt to giving intentionality to genes. Strategic metaphors predominated over teleological and war-like ones and thus a technocratic perspective could form the basis of the future construction of health culture.

El genoma y sus metáforas. ¿Detectives, héroes o profetas? / The genome and its metaphors. Detectives, heroes or prophets?

La 'nueva genética', es decir, el impulso que esta disciplina toma a partir del denominado Proyecto Genoma, aspira a un cambio de paradigma en ciencias de la salud. Este cambio se postula desde una aproximación fenotípica de los problemas de salud hacia una aproximación genotípica, y por tanto excluyendo básicamente la influencia del medioambiente, lo que podría comprometer gravemente los fundamentos para el desarrollo y el ejercicio de la salud pública. Desde que empezó a desarrollarse el Proyecto Genoma, los nuevos descubrimientos genéticos se convirtieron en temas frecuentes de noticias en los medios de comunicación de masas. En este sentido, tanto genetistas como periodistas suelen utilizar metáforas para dar a conocer los conceptos complejos de la investigación genética para los que no existen bases en el lenguaje profano. Cabe señalar que los medios de comunicación no sólo modelan el establecimiento de la agenda social, sino que son también el espacio donde se conforma la cultura de salud de la población. Se presentan los resultados de un estudio preliminar en el que se exploran las metáforas utilizadas en los tres diarios de mayor difusión nacional (ABC, El País y El Mundo) en relación con las noticias sobre la 'nueva genética' y se plantean las posibles consecuencias para la cultura de salud que puede tener la historia natural o el proceso catacrético de estas metáforas, mediante el cual se traslada el sentido figurativo de un término al sentido literal. En el proceso de revisión se ha desarrollado una taxonomía preliminar de las metáforas encontradas. Un 14,8 per cent de los titulares identificados (51 de 342) contenía metáforas. Las metáforas estratégicas, como 'programa', 'control', 'código', 'mapa' o 'puzle' son las más utilizadas, seguidas de las teleológicas, con términos como 'misterio' o 'lenguaje de Dios', y por último las bélicas, como 'ataque', 'derrota' o 'captura'. Los tres tipos de metáforas se caracterizan por su intento de dotar de intencionalidad a los genes. Según estas observaciones, el punto de vista tecnocrático es el que parece estar prevaleciendo frente al religioso o el bélico, y es el que puede ejercer una mayor influencia en la construcción futura de la cultura de salud (AU)

The «new genetics», or the impetus given to this discipline by the Genome Project, aims to a change of paradigm of the Health Sciences. This change is postulated from a phenotypic approach to a genotypic one, thereby excluding the influence of the environment, which could seriously undermine the grounds for the development and exercise of Public Health. Since the beginning of the genome project, information on genetic discoveries has frequently been reported in the mass media. Metaphors are often used by geneticists and journalists to convey the complex concepts of genetic research for which there are no equivalents in the lay language. The media do not merely shape the social agenda but also provide the space in which health culture is constructed. We present the results of a preliminary study exploring the metaphors used in the three most widely-read national daily newspapers in Spain, namely ABC, El Pais and El Mundo, when reporting news of the «new genetics». The possible consequences of the natural history of these metaphors, or the process through which figurative terms acquire a literal meaning, are discussed. A preliminary taxonomy for the metaphors identified was developed. Fifty-one out of 342 identified headings (14.8%) contained metaphors. Strategic metaphors such as «program», «control», «code», «map», and «puzzle», were the most commonly used, followed by teleological ones such as «mystery» or «God language» and finally war-like metaphors such as «attack», «defeat», and «capture». The three groups of metaphors are characterized by an attempt to giving intentionality to genes. Strategic metaphors predominated over teleological and war-like ones and thus a technocratic perspective could form the basis of the future construction of health culture (AU)

[The pyramid trap]. / Armadilha das pirâmides.

This paper discusses the impact of globalization on public health practice. Neoliberal supremacy has resulted in both greater interdependence between countries and increasing inequalities. Globalization of health risks and the dependence of local health conditions on external forces precludes the use of local/national solutions for global problems. In this context, the classical organization of public health services in a hierarchical pyramid based on geographically defined areas (from the local to the regional and national levels) no longer makes sense. We thus suggest some characteristics of a different type of organization based on new information technologies: a transnational network, horizontally shaped, more independent from political power, allowing for exchange of information and good practices, promoting dissemination of knowledge and producing "glocal" solutions. Through the creation of work opportunities between health professionals, the model will permit the creation of common strategies and increase the power of their political demands, perhaps allowing for the collective development of a more equitable world.

Does the liberalisation of abortion laws increase the number of abortions? The case study of Spain.

BACKGROUND: Over the course of the 1980s a public debate on abortion took place in Spain culminating in a more permissive social climate and, in 1985, the partial decriminalisation of abortion. Before this, women were forced to abort illegally or abroad in countries which had decriminalised abortions. The aim of this study is to present jointly the evolution of abortions in Spanish women in England and Wales between 1974 and 1995, The Netherlands between 1980 and 1995 and Spain since the start of the register in 1987 through to 1995 and to compare trends both before and after the law in Spain. METHODS: Incidence rates were calculated in each of the countries studied and the slopes of the curves for 1974-1984 and 1987-1995 were compared. Data were obtained from reports published by the offices of abortion surveillance in England and Wales, The Netherlands and Spain. RESULTS: The rates increased constantly throughout the study period. From 1974 to 1985, a total of 204,736 Spanish women aborted in England and Wales and The Netherlands. After the law was passed, 34,895 Spanish women had abortions in those countries over the period 1986-1995. During 1987-1995, 340,214 Spanish women terminated their pregnancies in Spain. The regression coefficients before and after the passing of the law were beta = 0.3538 (0.307-0.400) and beta = 0.319 (0.243-0.394) respectively; no difference was observed. CONCLUSIONS: During the study period a significant proportion of reproductive-aged Spanish women had abortions in England and Wales and The Netherlands. Decriminalisation has had no observed effect on the trends in abortion, but rather it has benefited Spanish women by making abortion available locally and, therefore, reducing the inequalities implied by lack of access to proper health care services. These data demonstrate the impact of the liberalisation of abortion on the trends of procedures performed in other countries.