[THE GLOBAL AND ECONOMIC CRISIS. AND HEALTH MANAGEMENT]. / CRISIS ECONOMICA Y GLOBAL. GESTION DE SALUD.

The Global and economic crisis and Health Management The Health care process discussed are 4 steps: assessment, planing, intervention and evaluation. The identify association between social factors linked to social vulnerability (socio economic status, unemployed, poverty) and objective health relate quality of life. The poverty rate is 24.2%, unemployed 26.26%, youth unemployed 56.13%.ratio worker/retired 2.29. Debts 100% GDP The health inequality influence on health related quality of life. The Health System efficiency index. according Bloomber rate (2,013) Spain is 5 degrees in the world, points 68.3 on 100, for the life expectancy 82.3 years, the personal cost of health care 2,271€. Health care 10% GDP (public 7%,private 3%), SS protected population 92.4%, retired person cost 9.2% GDP, p. capita GDP 23,737€. Cost of Care: Hospital/specialist 54%, P. Care 15%, Pharmaceutical 19.8%, P. Health 3.1%.

[Society and health management]. / Reflexiones sobre la realidad social y la gestión de salud.

The Health Management require acting according the social reality. The economic crisis for the unemployments and the State debts could affected to support Health System. The cost per capita: 1,800 euros. At Alma-Ata 1970 WHO improve Primary Care as open door in the Heath System. Some problems are common to all countries (frequency of diseases, demands, danger individual and community, feasibility of action, economic consequences, (PC in our country 15,7%). Should improve the Community development, and the environment. The participation of Primary Health Workers in the Management cover health care and community development and coaching, should be regularly supervised, and to avoid Risk Factor to Health.

[Health management and primary care. Strength and weaknesses of the system]. / La gestión de la salud y la atención primaria. Fortaleza y debilidades del sistema.

At Alma-Alta 1970 WHO improve Primary Care as open door in the Health System. Some problems are common to all countries (frequency of diseases, demands, danger individual and community, feasibility of action, economic consequences (our country 15.7%). Should improve the Community development and the environment. The participation of Primary Health Workers in the Management cover health care and community development and coaching, should be regularly supervised.

[Fundamental epidemiology for health professional]. / Fundamentos epidemiológicos para los profesionales de la salud.

The authors, Professors of different Universities, of this book are introduced in the Epidemiology principles and concepts and to fcilitate comprehension and retention new material with relevant to evidence based medicine and the affectivity relationship in the care of the patients. The aims provide specific topic areas: Measuring disease frequency, describing pattern of disease occurrence, the utility of diagnosis test, the clinical areas of application, infectious and chronic diseases, ad prevention, vaccination shedules identifying the causes of diseases, effectiveness of treatment, decision making about treatment strategies. The measure to impact of disease in population, according the social and demography patterns, necessary for determining health Management and Medical service needs it is written concisely and can be used as a stand study guide.

[The social problem of pregnancy in teenagers]. / El problema social del embarazo de adolescentes.

Pregnancy in teenagers in an important problem due to its human, health and social implication, and the World Health Organization considers them as high-risk pregnancies. About one-third to one-half of teenagers assume high risk sex behaviours. Fecundity rates among teenagers have risen up 19 per 1,000. Birth from adolescents mothers (11,284 in the year 2,000) have not increased due to abortion (rate of 9,8 per 1,000) and the percentage of adolescents pregnant girls who have an abortion, 50% (in 2003). Sexual education campaigns have failed. Odds ratio for became pregnant was 3.2 among those girls who consulted about oral contraceptives, 2.9 in those who use oral contraceptives, and 2.7 in those who used contraceptive sheath. These data indicate that information per se is not enough is not accompanied by ah round training of the personality as to values, self-control and responsability.

[Epidemiological perspectives on SARS and avian influenza]. / Aspectos epidemiológicos del SARS y de la influenza aviar.

SARS is a respiratory infection caused by Coronavirus (Nidoviruses, RNA) from which 3 groups are known. Group 1 affects dogs, cats, pigs, and the human agent is 229 E. Group 2 affects bovines or rodents, and the human agent is OC43. And group 3 corresponds to the avian pathology.... The epidemics emerged on February 2003 in Guangdong, South China, due to consumption of exotic animals (Civeta, etc.), and it spread through interperson contagion to other regions in Asia, America and Europe. Incubation period is about 2-7 days. Transmission Of the virus is person-to person, but also by excretions and residual water. Basic reproductive rate is 2 to 4, and it is considered that 2.7 persons are infected from the initial case. In June 2003, SARS affected over 8,000 people and 774 were killed. Mortality approaches to 10%, and it is higher among older people rising up to 50% in those aged over 65 years. It is important to quickly establish action protocols regarding clinical, epidemiological and prevention aspects. Avian influenza is an infection caused by type A Influenza Orthomixovirus, in which migration birds and wild ducks are the main reservoir. Avian viruses correspond to H5, H7, H9. In 1997 it was observed that type AH5N1 jumped interspecies barrier and affected 18 humans, and 6 of them died. At the end of 2003 and in 2004 this type of poultry flu was described in Asia. FAO has emphasized that sacrifice of chicken in affected farms is the most effective measure to fight against the disease. It has also been established suppression of imports from these countries. There is no evidence on interperson contagion from chicken contagion, nor on food-borne contagion to humans.

[Poverty, social exclusion, social capital and health]. / Exclusión social, pobreza y salud.

Social capital is the social structure which facilitates the actions of individuals, stimulates production and allows for success. Poverty maintains basic needs unmet (food, health, autonomy) over time and unvoluntarily. Social exclusion does not allow individuals to participate in society. The following dimensions are assessed: financial poverty, social inclusion, employment, health and education. Social participation, work integration, empowerment, self-esteem, and personal achievement should be promoted. In Europe 15% of people is exposed to poverty; in Spain corresponding figures are 13.4%, while for the elderly reached 21%. Extreme poverty affects 6.2% population and severe poverty 14.2%. Women and those living in Andalusia, Canary Islands and Extremadura are particularly affected, health inequality are for elderly, immigration, gender, social class, and should be reduced 10% for 2010. The Gini indez measures the income distribution; in the European Union (EU) it is 0.29 while in Spain is 0.33. Poverty and health are inversely correlated, health care expenditure in Spain is 7.5% og GDP. Life expectancy in U.E. is 75.5 years for men and 81.6 years for women, while in Spain it is 78 and 83.1 respectively. Infant mortality in EU is 4.5/1000, 4.1 per thousand in Spain. Lastly, the number of children per women in EU is 1.47 and in Spain 1.3.

[Development of resistance and antibiotic consumption]. / Emergencia de las resistencias y consumo de antibióticos.

The development of antibiotics resistance is reaching epidemic proportions. Due to increased transportation of persons and goods across continents, some bacterial clones have disseminated over several countries. To increase benefits and reduce risk, and therefore improve quality of prescription, the rational use of antibiotics should be promoted. To do so, patterns of use and prescription rates expressed in DDD per 1,000 hospital beds should be examined. Hospitalised patients received 25-40% of all systemic doses, in many cases inappropriately. In community studies reference estimates are made per 1,000 inhabitants-day (DHD). Over the last years, consumption has levelled-of around 20 DHD in 2000, showing remarkable differences between regions in Spain. Antibiotic consumption is approximately 270 Tons (in 1997), with an increase of only 10% in the last decade. The URANO study estimated that 19% of patients receive chemotherapy, although 42% do not comply with treatment and 29% are self-medicated. Among the chemotherapeutic agents mostly used are penicillins (11.4 DHD), macrolides (3.6 DHD), Quinolones (2.2 DHD) and Cephalosporins (1.9 DHD). We recommend surveillance of antibiotics resistance and improvement in the training of health professionals and in health information for patients about risks of self-medication; we also propose a better control of antibiotics administered to farm animals.

Hypertension magnitude and management in the elderly population of Spain.

OBJECTIVE: The present study assessed the prevalence, awareness, treatment and control of hypertension among the elderly population of Spain. DESIGN: Based on a nationally representative sample of 4009 individuals aged 60 years, two sets of six blood pressure measurements were obtained by trained observers at each subject's home, using standardized methods. In each set, three mercury-based measurements were alternated with three automated measurements. RESULTS: The mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was 143/79 mmHg, and the pulse pressure was 64 mmHg. The prevalence rate of hypertension (SBP 140 mmHg, DBP 90 mmHg, or current drug treatment) was 68.3%. No result obtained was sensitive to a particular measurement device. Of the hypertensives, 65% were aware of their condition, 55.3% were treated and 16.3% were controlled. Among treated hypertensives, SBP control (32.2%) was much lower than DBP control (82.3%). Control was lower in men than in women, in older than in younger subjects, and in those with lowest than in those with higher educational levels. About 57% of uncontrolled treated hypertensives were on monotherapy. Weight loss was among the least heeded items of advice (39% among overweight hypertensives). CONCLUSIONS: Hypertension is a major public health problem in elderly Spaniards. Most hypertensives had their hypertension uncontrolled. Greater emphasis should be laid on the most disadvantaged (the older, men, and those with lowest education) in terms of hypertension management, and on reinforcing weight loss and combining drugs for enhanced hypertension control.

[Demography, healht-related life style and history of tobacco consumption among occasional smokers in Spain]. / Características demográficas, hábitos de vida e historia del consumo de tabaco de los fumadores ocasionales en España.

BACKGROUND: This study describes the sociodemographic characteristics, health-related lifestyle, and history of tobacco consumption of the occasional smokers in Spain, and examines whether they show differences against daily smokers. METHODS: Data were obtained from the National Health Survey of Spain, carried out in 1993 through household interviews on a sample representative of the non-institutionalised population aged 16 year and older. Analyses were performed with logistic regression and adjusted for sociodemographic, health-state and life-style variables. RESULTS: Out of the 6,668 smokers in the survey, occasional smokers were 9.2%, while daily smokers of < or = 5 cigarettes and > 5 cigarettes were 9.9% and 80.9%, respectively. As compared with daily smokers of > 5 cigarettes, occasional smokers were more frequently women (odds ratio (0R): 2.12; CI95%: 1.72-2.61), younger (OR aged 25-44 versus 16-24 years: 0.75; 0.58-0.96), with lower alcohol consumption (p for linear trend: 0.0349), and higher leisure-time physical activity (p for linear trend: < 0.0001). On the day they smoke, occasional smokers used to consume less cigarettes than daily smokers (p < 0.0001). Occasional smokers were more frequent among young smokers (aged less than 20) with relatively short history of tobacco consumption (less than 20 years), and also among older smokers (aged 65 year and older) with longer history of consumption (over 50 years). Daily smokers of < or = 5 cigarettes showed characteristics midway between those of occasional and daily smokers of > 5 cigarettes. CONCLUSIONS: Occasional smokers show sociodemographic characteristics, health-related lifestyle, and history of tobacco consumption different from daily smokers. Such differences suggest that research and intervention programs specifically tailored to occasional smokers should be developed.

[Immigrations from the perspective of demography. Impact on health]. / La inmigración desde la demografía. Repercusiones para la salud.

Spain has been a crossroads, for confrontation and peaceful living-together. The problems arising from immigration as a mass phenomenon are characteristic of the present times. Variables which define the immigration phenomenon are the attraction to the economically developed countries with an active labour market, while it is inversely related to the distance from the departure countries. The phenomenon is also modified by positive influences as the common language, and by negative factors as the political or social instability. The aging of the populations in developed countries, and the need of labour market, stimulate the immigration phenomenon, which may affect to 2.3% of the population. The reproductive capacity of the population depends not only on biological determinants but also on the heterogeneous culture of immigration, because immigrants are candidates to become stable members of society. There is a logic of discrimination of those which are different. Thus, we need a legislation to establish their rights and duties, as well as an integration policy to favour the cultural diversity.

Características demográficas, hábitos de vida e historia del consumo de tabaco de los fumadores ocasionales en España / Demographic characteristics, health-related lifestyle, and history of tobacco consumption of the occasional smokers in spain

Fundamento: El consumo ocasional de tabaco suele ser un estado de transición hacia otros patrones de consumo más intenso o frecuente. Este trabajo describe las características sociodemográficas, los hábitos de vida relacionados con la salud, y la historia de consumo de tabaco de los fumadores ocasionales en España, y examina si éstos presentan diferencias con los que consumen tabaco a diario. Métodos: Los datos se tomaron de la Encuesta Nacional de Salud de España realizada en 1993 mediante entrevista en los domicilios a una muestra representativa de la población española no institucionalizada de 16 y más años. Los análisis se realizaron mediante regresión logística múltiple ajustando por variables sociodemográficas, de estado de salud y hábitos de vida. Resultados: De los 6.668 fumadores de la encuesta, los fumadores ocasionales representaron el 9,2 per cent, mientras que los fumadores diarios de £5 cigarrillos y de >5 cigarrillos fueron respectivamente el 9,9 per cent y el 80,9 per cent. En comparación con los fumadores diarios de >5 cigarrillos, los fumadores ocasionales fueron con más frecuencia mujeres (odds ratio [0R]): 2,12; IC95 per cent:1,72-2,61), más jóvenes (OR de edad 25-44 frente a 16-24 años: 0,75; 0,58-0,96), tuvieron menor consumo de alcohol (p de tendencia lineal: 0,0349) e hicieron más actividad en tiempo libre (p tendencia lineal: 5 cigarrillos. Conclusiones. Los fumadores ocasionales tienen características sociodemográficas, hábitos de vida e historia de consumo de tabaco diferentes a los que consumen tabaco diariamente. Estas diferencias sugieren que deben realizarse programas de investigación e intervención dirigidos de forma específica a los fumadores ocasionales (AU)

Background. This study describes the sociodemographic characteristics, health-related lifestyle, and history of tobacco consumption of the occasional smokers in Spain, and examines whether they show differences against daily smokers. Methods. Data were obtained from the National Health Survey of Spain, carried out in 1993 through household interviews on a sample representative of the non-institutionalised population aged 16 year and older. Analyses were performed with logistic regression and adjusted for sociodemographic, health-state and life-style variables. Results. Out of the 6,668 smokers in the survey, occasional smokers were 9.2%, while daily smokers of 5 cigarettes and >5 cigarettes were 9.9% and 80.9%, respectively. As compared with daily smokers of >5 cigarettes, occasional smokers were more frequently women (odds ratio (0R):2.12; CI95%:1.72-2.61), younger (OR aged 25-44 versus 16-24 years: 0.75; 0.58-0.96), with lower alcohol consumption (p for linear trend: 0.0349), and higher leisure-time physical activity (p for linear trend: <0.0001). On the day they smoke, occasional smokers used to consume less cigarettes than daily smokers (p<0.0001). Occasional smokers were more frequent among young smokers (aged less than 20) with relatively short history of tobacco consumption (less than 20 years), and also among older smokers (aged 65 year and older) with longer history of consumption (over 50 years). Daily smokers of 5 cigarettes showed characteristics midway between those of occasional and daily smokers of >5 cigarettes. Conclusions: Occasional smokers show sociodemographic characteristics, health-related lifestyle, and history of tobacco consumption different from daily smokers. Such differences suggest that research and intervention programs specifically tailored to occasional smokers should be developed (AU)

Consumo de tabaco y salud subjetiva en España / Smoking and subjective health in Spain

FUNDAMENTO: Examinar la relación del consumo de tabaco con la salud subjetiva en España. MATERIAL Y MÉTODO: Los datos proceden de la Encuesta Nacional de Salud de 1993. Los análisis se realizaron mediante regresión logística y se ajustaron por los principales factores de confusión. RESULTADOS: En los menores de 25 años hay una relación dosis-respuesta positiva (p = 0,0001) entre el consumo de cigarrillos y la salud subóptima (regular, mala o muy mala). CONCLUSIONES: Las actividades de control del tabaquismo deben informar sobre la peor salud subjetiva de los jóvenes, en quienes otros efectos del tabaco, como el aumento de la mortalidad o la morbilidad, resultan menos interesantes por ser lejanos en el tiempo (AU)

Popper y el problema de la inducción en epidemiología / Popper and the problem of induction in eidemiology

En este artículo discutimos algunas aportaciones del filósofo austro-británico Karl R. Popper, uno de los más influyentes pensadores contemporáneos, cuyas teorías epistemológicas y sociopolíticas han llegado también al ámbito de la epidemiología. Nos centramos principalmente en el llamado problema de la inducción. Sostenemos, siguiendo a Popper, que el método científico no usa un razonamiento inductivo, sino hipotético-deductivo. Aunque el paso desde los datos que evalúan una hipótesis a una conclusión sobre ésta va de lo particular a lo general, e.d., en dirección inductiva, no existe la inducción como razonamiento o inferencia. Es decir, no existe un método que permita inducir o verificar las hipótesis o teorías (no es posible explorar todas las situaciones posibles para ver si la teoría se mantiene), ni siquiera hacerlas muy probables. Además, los científicos buscan teorías altamente informativas, no altamente probables. Lo que se hace realmente es proponer una hipótesis como solución tentativa de un problema, confrontar la predicción deducida de la hipótesis con la experiencia, y evaluar si la hipótesis queda rechazada o no por los hechos. Al no poder verificarse las teorías sólo podemos aceptarlas si resisten el intento de rechazarlas. Por tanto, la contrastación consiste en la crítica o intento serio de falsación, es decir, la eliminación de error dentro de una teoría, para rechazarla si es falsa. El objetivo es, pues, la búsqueda de teorías verdaderas. Para ello, el método científico utiliza un conjunto sistemático de reglas metodológicas (no lógicas), es decir, decisiones. Estas reglas o principios metodológicos se resumen en dos: ¡sea inventivo y crítico!, e.d., proponga hipótesis audaces y sométalas a tests rigurosos de la experiencia. La lógica juega principalmente su papel al permitir deducir de la hipótesis las predicciones que se confrontarán con los hechos o evidencias. Esto es aplicable tanto a la inferencia estadística como a la inferencia causal. Argumentamos que los criterios de causalidad usados en epidemiología no son sino reglas del método destinadas a lo mismo: tratan de eliminar o reducir el error (azar, sesgos...) al contrastar una hipótesis causal. Por tanto, la llamada inferencia causal, el paso de la evidencia a la teoría causal, no es un proceso lógico inductivo o probabilístico sino decisión basada en la evaluación de una hipótesis causal gracias a reglas metodológicas como los criterios de causalidad. Pensamos que el interés del debate entre los epidemiólogos popperianos y los inductivistas no es meramente verbal, pues si somos conscientes de que no operamos inductivamente, que no podemos establecer firmemente una hipótesis, ni siquiera afirmarla probabilísticamente, seremos presuntamente más humildes en nuestra actitud y buscaremos más los errores en las teorías que sus fáciles ejemplos confirmadores. (AU)

Variación geográfica en las hospitalizaciones y en la mortalidad por insuficiencia cardíaca congestiva en España, 1980-1993 / Geographical variation in hospitalization and mortality for congestive heart failure in Spain, 1980-1993

Introducción y objetivos. Las diferencias geográficas en las hospitalizaciones y en la mortalidad por insuficiencia cardíaca son una estimación del potencial teórico de reducción de su carga hospitalaria y demográfica en la población. Por ello, en este trabajo se analiza la variación geográfica de las hospitalizaciones y de la mortalidad por insuficiencia cardíaca en España en el período 1980-1993 y se examinan algunos de sus posibles determinantes. Métodos. Los datos sobre el diagnóstico primario de insuficiencia cardíaca proceden de la Encuesta Nacional de Morbilidad Hospitalaria y las Estadísticas Vitales Nacionales. La información sobre los determinantes de la insuficiencia cardíaca procede de amplias encuestas con representatividad nacional realizadas por el Instituto Nacional de Estadística. Resultados. En el período 1980-1993 disminuyeron las diferencias geográficas en las hospitalizaciones y la mortalidad por insuficiencia cardíaca. Sin embargo, todavía es teóricamente posible reducir en un 60 por ciento las hospitalizaciones y en un 30 por ciento la mortalidad por insuficiencia cardíaca en personas 45 años. En el período 1989-1993, las hospitalizaciones por insuficiencia cardíaca se correlacionaron (p < 0,05) con las hospitalizaciones por enfermedad isquémica del corazón y el número de camas/1.000 habitantes. La mortalidad por insuficiencia cardíaca se correlacionó (p < 0,05) con la mortalidad por enfermedad isquémica del corazón, el analfabetismo y el paro. Conclusión. Existe un gran potencial de reducción de la carga hospitalaria y demográfica de la insuficiencia cardíaca en España. El control de la enfermedad isquémica del corazón y la reducción de las diferencias geográficas en el estado socioeconómico probablemente pueden contribuir a disminuir la carga sanitaria de la insuficiencia cardíaca en España (AU)