Equidad en prevención / Equity in prevention

Alcanzar la equidad en salud es un objetivo de justicia social que contribuye al desarrollo de sociedades más prósperas. Las desigualdades sociales en salud están presentes en todos los países y ámbitos, y en toda la población. Su abordaje requiere de la acción conjunta de distintos sectores, además del sector salud, así como de la participación de la población. Siendo también fundamental prestar especial atención a las actuaciones sobre el contexto y determinantes sociales de la salud para garantizar la equidad en salud. El abordaje de las desigualdades sociales en salud en la atención sanitaria, así como en las guías de práctica clínica, requiere que los y las profesionales reconozcan e interioricen el problema de la inequidad pudiendo identificar en sus pacientes las situaciones y características, personales y sociales, que pueden condicionarla. Es necesario también que se les reconozca como sujetos de derecho, tratándolos con respeto y aceptación de la diversidad y facilitando la información con confianza y empatía. A nivel profesional se necesita identificar y reconocer lagunas en el conocimiento para formarse y actualizar, y a nivel organizativo se deben realizar los cambios organizativos necesarios y poner a disposición de los equipos profesionales recursos e instrumentos tecnológicos apropiados para una observación y vigilancia rutinarios de la equidad, con indicadores relevantes y comparables a lo largo del tiempo, para poder conocer y mejorar sus actuaciones.(AU)

Achieving equity in health is a social justice goal that contributes to the development of more prosperous societies. Social inequalities in health are rife in all countries, settings and across the population. Tackling them requires the joint action of different sectors, in addition to the health sector, as well as the participation of the population. It is also essential to pay special attention to actions on the context and social determinants of health to ensure equality in health. Addressing social inequalities in health in health care, as well as in clinical practice guidelines, requires professionals to recognise and internalise the problem of inequality and to be able to identify in their patients the situations and characteristics, both personal and social, that may condition this. It is also necessary to recognise them as subjects of rights, treating them with respect and acceptance of diversity and providing information with trust and empathy. On a professional level, gaps in knowledge need to be identified and recognized to train and update. At the organisational level, the necessary organisational changes must be implemented, and appropriate resources and technological instruments must be made available to professional teams for routine observation and monitoring of equity; with relevant and comparable indicators over time, to be able to know and improve their actions.(AU)

Efectos del cambio a café filtrado sobre los niveles séricos de colesterol / A reversal study on the effects of change to filtered coffee on serum cholesterol levels

No disponible

Unfiltered coffee consumption has been associated to the increase in serum cholesterol levels. The aim of this population study was to verify if the change in the type of coffee consumed from unfiltered to filtered produces effects on the serum cholesterol levels of the participants. The sample was formed of 30 volunteers (9 men) with no health problems (age range= 18-47; average= 28.2; SD= 8.8). The study was structured according to an A-B-A reversible design with simultaneous replications between subjects. During the Baseline and Reversion phases (A), participants consumed unfiltered coffee in their usual way, while in the Intervention Phase (B) they consumed only filtered coffee. Participants were divided into two subgroups according to their serum level of cholesterol LDL at Baseline Phase (resulting in a subgroup formed by 16 participants with LDL <115 mg/dL, and a subgroup formed by 14 participants with LDL ≥115 mg/dL). Results indicated that 90% of participants showed decrease in their serum cholesterol LDL level at the end of the Intervention Phase contingent to coffee change with an increase in their serum cholesterol LDL level at the end of the Reversion Phase when they returned to consuming unfiltered coffee. Also a change in serum cholesterol HDL level was shown by 93% of participants, with an increase in serum cholesterol HDL level contingent on the change to filtered coffee and a decrease when they return to consume unfiltered coffee. The implications of these findings and the limitations of the study are discussed

Flexibilidad psicológica y autoabandono del tabaco / Smoking self-quitting and psychological flexibility

No disponible

The prevalence of smoking in the general population remains high in spite of the extended acknowledgement of the well-documented health consequences of smoking and potential benefits of quitting. Only a minority of smokers who attempt to quit seeks professional treatment, yet most of the research on smoking cessation focuses on such form of quitting. Research on self-quitting is scarce, although most smokers who successfully quit, do so on their own. Recently, research has evidenced that psychological flexibility, a core concept in Acceptance and Commitment Therapy, is an important variable in predicting successful behavioral change in many clinically relevant areas. The goal of this study was to analyze the relationship between psychological flexibility and successful self-quitting from smoking. 277 participants who had attempted to quit on their own (217 successfully abstinent and 60 still smoking) provided information on their smoking history, quit attempts, nicotine dependence, and demographics, and were assessed with the Acceptance and Action Questionnaire-II. Abstinence status was measured through self-reports of continuous abstinence and confirmed by concentrations of expired carbon monoxide below 8 ppm. Results show a statistically significant difference (t= -8,775; p <.01) for the AAQ-II scores of successful (M= 18.39, SD= 7.76) and unsuccessful self-quitters (M= 27.17; SD= 6.88). Only 26% participants with high level of psychological inflexibility quitted successfully, compared to 94% participants with low levels of psychological inflexibility. These results show clear evidence that psychological flexibility is associated to successful self-quitting, and suggest that this variable could facilitate success in attempts to stop smoking without professional help. Implications and limitations of this study are discussed (AU)

A longitudinal study of symptoms beliefs in hypertension / Un estudio longitudinal de las creencias sobre síntomas en hipertensión

A longitudinal study was conducted to assess the presence of beliefs about symptoms related to hypertension and the time since diagnosis in which they appear. A randomly selected sample of hypertensive patients (67% women, mean age 53.27 years and range 20-65) was divided into four groups according to the time from diagnosis. All patients (N = 171) were interviewed at the beginning (initial assessment) and 12 months later (final assessment) and the patients (n = 75) who did not report beliefs about symptoms at the initial assessment were interviewed in a follow-up schedule. The results showed that 56% of patients reported beliefs about symptoms at the initial assessment, and this percentage increased to 77% at the final assessment (p < .001) finding significant differences between the two groups with a more recent diagnosis and the two groups of long-standing patients. Longitudinal analysis of the group with the recent diagnosis showed that the critical period for the emergence of beliefs was the first year from diagnosis. This period could be decisive in order to prevent them. Healthcare professionals should pay attention to the emergence of these beliefs, as they could negatively affect treatment adherence (AU)

Se realizó un estudio para evaluar creencias sobre síntomas relacionados con la hipertensión y el tiempo transcurrido desde el diagnóstico. Una muestra elegida al azar de pacientes con hipertensión (media de edad 53,27 años, rango 20-65; 67% mujeres) se dividió en cuatro grupos de acuerdo al tiempo transcurrido desde el diagnóstico. Se entrevistó a todos los pacientes (N = 171) al comienzo del estudio (evaluación inicial) y 12 meses después (evaluación final). A los pacientes que no informaron creencias en síntomas (n = 75) se les entrevistó cada tres meses de acuerdo a un programa de seguimiento. Los resultados indicaron que en la evaluación inicial el 56% de los pacientes informó creencias en síntomas, elevándose al 77% en la evaluación final (p < .001), y diferencias significativas entre los grupos con menor y mayor tiempo desde el diagnóstico. El análisis longitudinal del grupo de pacientes de reciente diagnóstico mostró que el primer año es el período crítico para la emergencia de creencias en síntomas, información que resulta clave para planear la prevención. Los profesionales de la salud deberían prestar atención a la emergencia de creencias en síntomas dado que pueden afectar negativamente a la adherencia al tratamiento (AU)

A longitudinal study of symptoms beliefs in hypertension.

A longitudinal study was conducted to assess the presence of beliefs about symptoms related to hypertension and the time since diagnosis in which they appear. A randomly selected sample of hypertensive patients (67% women, mean age 53.27 years and range 20-65) was divided into four groups according to the time from diagnosis. All patients (N = 171) were interviewed at the beginning (initial assessment) and 12 months later (final assessment) and the patients (n = 75) who did not report beliefs about symptoms at the initial assessment were interviewed in a follow-up schedule. The results showed that 56% of patients reported beliefs about symptoms at the initial assessment, and this percentage increased to 77% at the final assessment (p < .001) finding significant differences between the two groups with a more recent diagnosis and the two groups of long-standing patients. Longitudinal analysis of the group with the recent diagnosis showed that the critical period for the emergence of beliefs was the first year from diagnosis. This period could be decisive in order to prevent them. Healthcare professionals should pay attention to the emergence of these beliefs, as they could negatively affect treatment adherence.

Se realizó un estudio para evaluar creencias sobre síntomas relacionados con la hipertensión y el tiempo transcurrido desde el diagnóstico. Una muestra elegida al azar de pacientes con hipertensión (media de edad 53,27 años, rango 20-65; 67% mujeres) se dividió en cuatro grupos de acuerdo al tiempo transcurrido desde el diagnóstico. Se entrevistó a todos los pacientes (N = 171) al comienzo del estudio (evaluación inicial) y 12 meses después (evaluación final). A los pacientes que no informaron creencias en síntomas (n = 75) se les entrevistó cada tres meses de acuerdo a un programa de seguimiento. Los resultados indicaron que en la evaluación inicial el 56% de los pacientes informó creencias en síntomas, elevándose al 77% en la evaluación final (p < .001), y diferencias significativas entre los grupos con menor y mayor tiempo desde el diagnóstico. El análisis longitudinal del grupo de pacientes de reciente diagnóstico mostró que el primer año es el período crítico para la emergencia de creencias en síntomas, información que resulta clave para planear la prevención. Los profesionales de la salud deberían prestar atención a la emergencia de creencias en síntomas dado que pueden afectar negativamente a la adherencia al tratamiento.

Infección por el virus de la inmunodeficiencia humana en diferentes grupos de edad: implicaciones potenciales para la prevención. Cohorte CoRIS, España, 2004–2008 / HIV infection in different age groups: Potential implications for prevention. CoRIS Cohort, Spain, 2004–2008

Fundamento y objetivo: Describir las características de pacientes adultos con infección por el virus de la inmunodeficiencia humana (VIH) según su edad al momento de la inclusión en la Cohorte de la Red de Investigación en Sida (CoRIS). Pacientes y métodos: Análisis de una cohorte abierta, prospectiva, multicéntrica de adultos con infección por el VIH sin tratamiento antirretroviral previo, atendidos por primera vez entre enero de 2004 y noviembre de 2008, en 28 hospitales españoles (CoRIS). Se analizaron sus características en la primera visita y la distribución de las enfermedades definitorias de sida (EDS) a lo largo de la vida, según la edad al momento de la inclusión. El retraso diagnóstico se definió como pacientes con diagnóstico de sida o cifra de CD4+ inferior a 200 cel/μl durante el año posterior al diagnóstico de la infección por el VIH. Resultados: Participaron 4.418 personas; el 30,4% con 30 años o menos, el 60,6% de entre 31 y 50 años y el 8,9% de mayores de 50 años. El 31,6% de los pacientes eran inmigrantes (el 44,1% entre los jóvenes), el 79,6% correspondía a transmisión sexual y el 15,2% tenía diagnóstico de sida en la primera visita (el 28,1% entre los mayores de 50 años). El 34,6% de los pacientes tenía retraso diagnóstico (el 53,3% en los mayores de 50 años). La distribución de las EDS varió con la edad: las tuberculosis son más frecuentes en jóvenes y la neumonía por Pneumocystis jiroveci, la leucoencefalopatía multifocal progresiva, la encefalopatía por VIH, la neumonía recurrente y el linfoma cerebral primario son más frecuentes en los mayores. Conclusiones: Las características inmunológicas y las EDS varían con la edad. El porcentaje de personas con retraso diagnóstico es inaceptablemente alto, lo que indica que deben diseñarse intervenciones dirigidas a efectuar un diagnóstico más precoz (AU)

Background and objective: To describe the characteristics of HIV infected adults according to their age at recruitment in CoRIS. Patients and methods: Analysis of an open, prospective, multicentric cohort of HIV+ adults without previous antiretroviral treatment, attended for the first time from January/2004 to November/2008, in 28 Spanish hospitals (CoRIS). We analyzed their characteristics at recruitment and the distribution of AIDS defining illnesses (ADI) prior to cohort entry and during follow up, according to their age at recruitment. Delayed diagnosis was defined as a patient with AIDS diagnosis and/or CD4+ cell count lower than 200 cells/μl within the first year after HIV diagnosis. Results: Of 4,418 patients included, 30.4% were <=30 years old, 60.6% between 31 and 50 and 8.9% older than 50 at cohort entry; 31.6% of patients were immigrants (44.1% in the youngest group), 79.6% had been sexually transmitted and 15.2% had an AIDS diagnosis at cohort entry (28.1% between those older than 50). In 34.6% of cases there was a late diagnosis (53.3% in the oldest group). The ADIs varied according to age; tuberculosis was more frequent in the youngest. Pneumocystis jiroveci pneumonia, progressive multifocal leukoencephalopathy, HIV related encephalopathy, recurrent pneumonia and primary lymphoma of brain were more frequent among the oldest. Conclusions: The immunological characteristics and the distribution of ADIs varied according to age. The proportion of late diagnosis was unacceptably high, suggesting the need of specific interventions designed to promote earlier diagnosis (AU)

[HIV infection in different age groups: Potential implications for prevention. CoRIS Cohort, Spain, 2004-2008]. / Infección por el virus de la inmunodeficiencia humana en diferentes grupos de edad: implicaciones potenciales para la prevención. Cohorte CoRIS, España, 2004-2008.

BACKGROUND AND OBJECTIVE: To describe the characteristics of HIV infected adults according to their age at recruitment in CoRIS. PATIENTS AND METHODS: Analysis of an open, prospective, multicentric cohort of HIV+ adults without previous antiretroviral treatment, attended for the first time from January/2004 to November/2008, in 28 Spanish hospitals (CoRIS). We analyzed their characteristics at recruitment and the distribution of AIDS defining illnesses (ADI) prior to cohort entry and during follow up, according to their age at recruitment. Delayed diagnosis was defined as a patient with AIDS diagnosis and/or CD4+ cell count lower than 200 cells/microl within the first year after HIV diagnosis. RESULTS: Of 4,418 patients included, 30.4% were < or =30 years old, 60.6% between 31 and 50 and 8.9% older than 50 at cohort entry; 31.6% of patients were immigrants (44.1% in the youngest group), 79.6% had been sexually transmitted and 15.2% had an AIDS diagnosis at cohort entry (28.1% between those older than 50). In 34.6% of cases there was a late diagnosis (53.3% in the oldest group). The ADIs varied according to age; tuberculosis was more frequent in the youngest. Pneumocystis jiroveci pneumonia, progressive multifocal leukoencephalopathy, HIV related encephalopathy, recurrent pneumonia and primary lymphoma of brain were more frequent among the oldest. CONCLUSIONS: The immunological characteristics and the distribution of ADIs varied according to age. The proportion of late diagnosis was unacceptably high, suggesting the need of specific interventions designed to promote earlier diagnosis.

Efectos del consumo de café para la salud cardiovascular, la diabetes y el desarrollo de cáncer / Effects of coffee consume on cardiovascular health, diabetes and cancer

Se revisan y analizan las relaciones entre consumo de café y riesgo para la salud en los tres grupos de trastornos primeras causas de muerte prematura: trastornos cardiovasculares, diabetes y cáncer. Se revisan los estudios epidemiológicos y experimentales existentes, y aquellos que han explorado los agentes o mecanismos responsables del efecto de riesgo o protector para la salud del consumo de café. Los resultados indican que existen evidencias de aumento del riesgo de trastornos cardiovasculares por consumo de café, mientras que los datos no son concluyentes respecto a las relaciones entre riesgo de diabetes y consumo. Las relaciones entre consumo de café y riesgo de cáncer parecen probables en el caso de los cánceres de páncreas y de ovario, mientras que el consumo de café se muestra como un factor protector del cáncer de colon y recto y los datos no son concluyentes para el cáncer de vejiga. En todos los casos se indican las hipótesis disponibles sobre mecanismos responsables del efecto y se señalan posibles formas de consumo saludable que reduzcan los riesgos (AU)

This paper presents a revision of the relationships between coffee consumption and health across the three groups of diseases that are the first causes of premature death: cardiovascular diseases, diabetes and cancer. Epidemiological and experimental studies show relative evidences of increasing cardiovascular risk correlated to coffee consumption while no clear relationship is found concerning diabetes. Relationships between coffee consumption and cancer risk are likely in the case of pancreas and ovarian cancers while coffee consumption appears as a protector factor in colorectal cancer with no concluding data in the case of bladder cancer. This paper also presents the available hypotheses concerning the mechanisms that might be responsible of coffee consumption as a risk or protector factor for the diseases revised, and healthy forms of coffee consumption that minimize risk are indicated (AU)