Dimensión social del VIH y respuesta estatal / Social dimensión of HIV and state response

La infección por VIH está fuertemente condicionada por factores sociales. Dos de los mayores obstáculos a la respuesta a la infección son el estigma y la discriminación que todavía se asocian con ella. El proceso de estigmatización se produce a través de conductores individuales y facilitadores estructurales que se entrelazan con estigmas superpuestos. El estigma tiene diversas manifestaciones y produce complejas consecuencias que influyen negativamente en la prevención, diagnóstico, tratamiento y calidad de vida. Este artículo revisa estos aspectos, así como las evidencias de estigma existentes en España. La respuesta frente a la infección por VIH requiere un firme compromiso político. Sin embargo, los avances alcanzados en España se han ralentizado a causa de la crisis económica y la falta de liderazgo de las instituciones. Para alcanzar los objetivos internacionales, es necesario colocar al VIH en primera línea de la agenda política

HIV infection is strongly conditioned by social factors. Two of the most significant obstacles in the response to HIV is the stigma and the discrimination that is still associated with it. The stigmatization process occurs through individual drivers and structural facilitators that interweave with overlapping stigmas. These stig-mas manifest in several forms and lead to complex consequences that negatively influence prevention, diagnosis, treatment and quality of life. This article reviews these issues and the evidence of stigma in Spain. The response to HIV requires a strong political commitment. However, the economic crisis and the lack of leadership from institutions have slowed down the progress achieved in Spain. HIV must be placed at the forefront of the political agenda in order to achieve international goals

Social dimensión of HIV and state response. / Dimensión social del VIH y respuesta estatal.

HIV infection is strongly conditioned by social factors. Two of the most significant obstacles in the response to HIV is the stigma and the discrimination that is still associated with it. The stigmatization process occurs through individual drivers and structural facilitators that interweave with overlapping stigmas. These stig-mas manifest in several forms and lead to complex consequences that negatively influence prevention, diagnosis, treatment and quality of life. This article reviews these issues and the evidence of stigma in Spain. The response to HIV requires a strong political commitment. However, the economic crisis and the lack of leadership from institutions have slowed down the progress achieved in Spain. HIV must be placed at the forefront of the political agenda in order to achieve international goals.

Determinants of perceived sexism and their role on the association of sexism with mental health.

The authors of this study sought to compare the socioeconomic factors related to perceived sexism in employed and non-employed Spanish women and to examine whether the relationship of perceived sexism with mental health outcomes is reduced when such factors are taken into account. Data were taken from the 2006 Spanish Health Survey, including women aged 20-64 years (n=10,927). Multivariate logistic regression models were used to analyze the independent relationships between socioeconomic variables and perceived sexism and also between perceived sexism and poor mental health. In this latter case, socioeconomic variables were included by blocks in the logistic models. Perceived sexism was higher among employed women (3.9% vs. 2.8% among non-employed) and mainly among those in a managerial position (11.35%; adjusted OR: 2.71, 95% CI: 1.30-5.67) and having irregular working hours (5.5%; adjusted OR: 1.60, 95% CI: 1.10-2.34). Socioeconomic and family characteristics were associated with perceived sexism among women. Perceived sexism was associated with poor mental health, and this remained the case when different independent variables were taken into account. These results highlight the importance of taking into account gender discrimination in different aspects of our society, such as work and family organization, and in planning mental health interventions.

Investigación sobre las desigualdades en la incidencia, mortalidad, prevención y atención del cáncer en España / The state of research in Spain into inequalities in the incidence, mortality, prevention and healthcare in cancer

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Socioeconomic status and risk of acute myocardial infarction. Population-based case-control study.

INTRODUCTION AND OBJECTIVES: Socioeconomic status is associated with cardiovascular mortality. The aims of this study were to investigate the association between socioeconomic status and its various indicators and the risk of acute myocardial infarction (AMI), and to determine whether any association found is independent of the presence of cardiovascular risk factors (CVRFs). METHODS: Study cases were matched with controls by age, sex and year of recruitment. Cases were recruited from a hospital register and controls from cross-sectional studies of the general population. The socioeconomic status was determined from educational level and social class, as indicated by occupation. Self-reported data were collected on the presence of CVRFs. RESULTS: The study included 1369 cases and controls. Both educational level and social class influenced AMI risk. Among non-manual workers, there was an inverse linear relationship between educational level and AMI risk independent of CVRFs: compared with university educated individuals, the odds ratio (OR) for an AMI among those with a high school education was 1.63 (95% confidence interval [CI], 1.16-2.3), and among those with an elementary school education, 3.88 (95% CI, 2.79-5.39). No association between educational level and AMI risk was observed in manual workers. However, the AMI risk was higher in manual workers than non-manual university educated workers: in those with an elementary school education, the increased risk (OR=2.09; 95% CI, 1.59-2.75) was independent of CVRFs. CONCLUSIONS: An association was found between socioeconomic status and AMI risk. The AMI risk was greatest in individuals with only an elementary school education, irrespective of CVRFs and social class, as indicated by occupation.

Posición socioeconómica e infarto agudo de miocardio. Estudio caso-control de base poblacional / Socioeconomic status and risk of acute myocardial infarction. Population-based case-control study

Introducción y objetivos. La posición socioeconómica se relaciona con la mortalidad cardiovascular. El objetivo de este estudio fue analizar la relación entre la posición socioeconómica y sus diferentes indicadores y el riesgo de infarto agudo de miocardio (IAM), y determinar si ésta era independiente de los factores de riesgo cardiovascular (FRCV). Métodos. Estudio caso-control apareado por edad, sexo y año de reclutamiento. Los casos se obtuvieron de un registro hospitalario y los controles, de estudios transversales de base poblacional. La posición socioeconómica se determinó por el nivel de estudios y la clase social basada en ocupación. Se recogió información autodeclarada sobre los FRCV. Resultados. Se incluyó a 1.369 casos y controles. Hubo interacción entre nivel de estudios y clase social: en los trabajadores no manuales el nivel de estudios se asoció de forma lineal, inversa e independiente de los FRCV con el riesgo de IAM (estudios secundarios, odds ratio [OR] = 1,63; intervalo de confianza [IC] del 95%, 1,16-2,3; estudios primarios, OR = 3,88; IC del 95%, 2,79-5,39) respecto a universitarios; en los trabajadores manuales no se observó una asociación entre nivel de estudios y riesgo de IAM. Los trabajadores manuales presentaban un exceso de riesgo de IAM respecto a los no manuales universitarios, este exceso de riesgo era independiente de los FRCV en el grupo con estudios primarios (OR = 2,09; IC del 95%, 1,59-2,75). Conclusiones. Hay relación entre la posición socioeconómica y el riesgo de IAM. El grupo de la población con nivel de estudios primarios presenta mayor riesgo de IAM que es independiente de los FRCV y de la clase social basada en la ocupación (AU)

Introduction and objectives. Socioeconomic status is associated with cardiovascular mortality. The aims of this study were to investigate the association between socioeconomic status and its various indicators and the risk of acute myocardial infarction (AMI), and to determine whether any association found is independent of the presence of cardiovascular risk factors (CVRFs). Methods. Study cases were matched with controls by age, sex and year of recruitment. Cases were recruited from a hospital register and controls from cross-sectional studies of the general population. The socioeconomic status was determined from educational level and social class, as indicated by occupation. Self-reported data were collected on the presence of CVRFs. Results. The study included 1369 cases and controls. Both educational level and social class influenced AMI risk. Among non-manual workers, there was an inverse linear relationship between educational level and AMI risk independent of CVRFs: compared with university educated individuals, the odds ratio (OR) for an AMI among those with a high school education was 1.63 (95% confidence interval [CI], 1.16-2.3), and among those with an elementary school education, 3.88 (95% CI, 2.79-5.39). No association between educational level and AMI risk was observed in manual workers. However, the AMI risk was higher in manual workers than non-manual university educated workers: in those with an elementary school education, the increased risk (OR=2.09; 95% CI, 1.59-2.75) was independent of CVRFs. Conclusions. An association was found between socioeconomic status and AMI risk. The AMI risk was greatest in individuals with only an elementary school education, irrespective of CVRFs and social class, as indicated by occupation (AU)

Perceived sexism as a health determinant in Spain.

OBJECTIVES: The goals of the present study are to explore the association between perceived sexism and self-perceived health, health-related behaviors, and unmet medical care needs among women in Spain; to analyze whether higher levels of discrimination are associated with higher prevalence of poor health indicators and to examine whether these relationships are modified by country of origin and social class. MATERIALS AND METHODS: The study is based on a cross-sectional design using data from the 2006 Spanish Health Interview Survey. We included women aged 20-64 years (n = 10,927). Six dependent variables were examined: four of health (self-perceived health, mental health, hypertension, and having had an injury during the previous year), one health behavior (smoking), and another related to the use of the health services (unmet need for medical care). Perceived sexism was the main independent variable. Social class and country of origin were considered as effect modifiers. We obtained the prevalence of perceived sexism. Logistic regression models, adjusted for potential confounders, were fitted to study the association between sexism and poor health outcomes. RESULTS: The prevalence of perceived sexism was 3.4%. Perceived sexism showed positive and consistent associations with four poor health outcomes (poor self-perceived health, poor mental health, injuries in the last 12 months, and smoking). The strength of these associations increased with increased scores for perceived sexism, and the patterns were found to be modified by country of origin and social class. CONCLUSION: This study shows a consistent association between perceived sexism and poor health outcomes in a country of southern Europe with a strong patriarchal tradition.

Perceived discrimination and health by gender, social class, and country of birth in a Southern European country.

OBJECTIVES.: This study aimed to examine the association between perceived discrimination and five health outcomes in Spain as well as to analyze whether these relationships are modified by sex, country of birth, or social class. METHODS.: We used a cross-sectional design. Data were collected as part of the 2006 Spanish Health Interview Survey. The present analysis was restricted to the population aged 16-64 years (n=23,760). Five dependent variables on health obtained through the questionnaire were examined. Perceived discrimination was the main independent variable. We obtained the prevalence of perceived discrimination. Logistic regression models were fitted. RESULTS.: Perceived discrimination was higher among populations originating from low income countries and among women and showed positive and consistent associations with all poor health outcomes among men and with 3 poor health outcomes among women. Poor mental health showed the largest difference between people who felt and those who did not feel discriminated (prevalence for these 2 groups among men was 42.0% and 13.3%, and among women, was 44.7% and 22.8%). The patterns found were modified by gender, country of birth, and social class. CONCLUSION.: This study has found a consistent relationship of discrimination with five health indicators in Spain, a high-income Southern European country. Public policies are needed that aim to reduce discrimination.

Perfil sociodemográfico de las mujeres afectadas por violencia del compañero íntimo en España / Sociodemographic profile of women affected by intimate partner violence in Spain

ObjetivoDeterminar la prevalencia de la violencia del compañero íntimo declarada y analizar sus principales características sociodemográficas.MétodosEstudio transversal basado en la Encuesta Nacional de Salud de España de 2006 (ENS-06). La muestra son las 13.094 mujeres dispuestas a responder preguntas sobre malos tratos (87,2% del total de las encuestadas). Se realizó un análisis bivariado y multivariado, siendo la variable dependiente la violencia del compañero íntimo declarada y las independientes el nivel de estudios, el empleo, el estado civil, la situación de convivencia con la pareja o análogo, el número de menores en el hogar, el país de origen (españolas frente a extranjeras) y la edad.ResultadosLa violencia del compañero íntimo es reconocida por un 1% (n=128) de la muestra. La violencia declarada se asocia con tener estudios primarios o no tener estudios (odds ratio [OR]: 3,63 [1,90–6,92]), tres o más menores (OR: 3,51 [1,78–6,90]) y estar separada o divorciada (OR: 2,81 [1,89–4,97]), una vez controlado el efecto del resto de las variables. La violencia del compañero íntimo declarada es mayor entre las mujeres nacidas fuera de España (OR: 2,83 [1,87–4,28]).ConclusionesLa violencia del compañero íntimo parece manifestarse de manera desigual entre las mujeres españolas y las extranjeras. El nivel educativo, el número de menores en el hogar y el estado civil son las características que más se asocian a la violencia declarada por las mujeres. Sería pertinente reflexionar sobre la sensibilidad de las medidas existentes contra la violencia del compañero íntimo en relación a las necesidades de las mujeres afectadas(AU)

ObjectiveTo determine the prevalence of reported intimate partner violence (IPV) and to analyze the main sociodemographic characteristics of affected women.MethodsWe performed a cross-sectional study based on the Spanish National Health Survey of 2006. The sample comprised 13,094 women who agreed to answer questions about violence (87.2% of the total interviewees). Bivariate and multivariate analyses were performed. The dependent variable was reported IPV and the independent variables were educational level, employment, marital status, living arrangements with the partner or analogous individual, number of children at home, nationality (Spanish vs. foreign women) and age.ResultsIPV was reported by 1% (n=128) of the sample. Women with primary school education or without studies (odds ratio [OR]: 3.63 [1.90–6.92]), with three or more children (OR: 3.51 [1.78–6.90]), and those who were separated or divorced (OR: 2.81 [1.89–4.97]) were most likely to experience IPV when the effect of the remaining variables was controlled. The likelihood of IPV was also higher in women born outside Spain (OR: 2.83 [1.87–4.28]).ConclusionsIPV seems not to affect Spanish and foreign women equally. The characteristics most closely associated with women affected by IPV were educational level, the number of children at home and marital status. The sensitivity of current measures against IPV should be considered in relation to the needs of affected women(AU)

[Sociodemographic profile of women affected by intimate partner violence in Spain]. / Perfil sociodemográfico de las mujeres afectadas por violencia del compañero íntimo en España.

OBJECTIVE: To determine the prevalence of reported intimate partner violence (IPV) and to analyze the main sociodemographic characteristics of affected women. METHODS: We performed a cross-sectional study based on the Spanish National Health Survey of 2006. The sample comprised 13,094 women who agreed to answer questions about violence (87.2% of the total interviewees). Bivariate and multivariate analyses were performed. The dependent variable was reported IPV and the independent variables were educational level, employment, marital status, living arrangements with the partner or analogous individual, number of children at home, nationality (Spanish vs. foreign women) and age. RESULTS: IPV was reported by 1% (n=128) of the sample. Women with primary school education or without studies (odds ratio [OR]: 3.63 [1.90-6.92]), with three or more children (OR: 3.51 [1.78-6.90]), and those who were separated or divorced (OR: 2.81 [1.89-4.97]) were most likely to experience IPV when the effect of the remaining variables was controlled. The likelihood of IPV was also higher in women born outside Spain (OR: 2.83 [1.87-4.28]). CONCLUSIONS: IPV seems not to affect Spanish and foreign women equally. The characteristics most closely associated with women affected by IPV were educational level, the number of children at home and marital status. The sensitivity of current measures against IPV should be considered in relation to the needs of affected women.

Plant sterol intake and education level in the Spanish EPIC cohort.

OBJECTIVE: A cross-sectional study was conducted in the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to investigate the association among education level, as a measurement of socioeconomic position, gender, and dietary nutrient intake, focusing on plant sterols, in a Mediterranean population. METHODS: A sample of 25 615 women and 15 552 men (29-69 y old) from the Spanish EPIC cohort was recruited in 1992-1996. Nutrient and plant sterol intakes were estimated using a validated dietary history questionnaire and Spanish food composition tables. RESULTS AND CONCLUSION: Few differences in nutrient or plant sterol consumption existed between men and women with different education levels. Age and energy-adjusted linear regression models of plant sterol intake showed a small increase in subjects with lower education and higher consumption in men than in women. Homogeneity of healthy dietary habits across different socioeconomic groups in this population reflects a wide availability of characteristic Mediterranean foods at the time of recruitment. However, current changes in food supply and the increasing cost of healthy foods may lead to socioeconomic inequalities in Spain parallel to those taking place in other European populations.

The incorporation of gender perspective into Spanish health surveys.

BACKGROUND: Most studies into social determinants of health conducted in Spain based on data from health surveys have focused on social class inequalities. This paper aims to review the progressive incorporation of gender perspective and sex differences into health surveys in Spain, and to suggest design, data collection and analytical proposals as well as to make policy proposals. METHODS: Changes introduced into health surveys in Spain since 1995 to incorporate gender perspective are examined, and proposals for the future are made, which would permit the analysis of differences in health between women and men as a result of biology or because of gender inequalities. RESULTS: The introduction of gender perspective in health surveys requires the incorporation of questions related to family setting and reproductive work, workplace and society in general to detect gender differences and inequalities (for example, domestic work, intimate partner violence, discrimination, contract type or working hours). Health indicators reflecting differential morbidity and taking into account the different life cycle stages must also be incorporated. Analyses ought to be disaggregated by sex and interpretation of results must consider the complex theoretical frameworks explaining the differences in health between men and women based on sex differences and those related to gender. CONCLUSIONS: Analysis of survey data ought to consider the impact of social, political and cultural constructs of each society. Any significant modification in procedures for collection of data relevant to the study of gender will require systematic coordination between institutions generating the data and researchers who are trained in and sensitive to the topic.

Smoking and myocardial infarction case-fatality: hospital and population approach.

BACKGROUND: Smoking is a risk factor for coronary heart disease, but it has been associated with better short-term prognosis in hospitalized patients with acute myocardial infarction. The aims of this study were to determine the association between smoking and myocardial infarction 28-day case-fatality in hospitalized patients and at the population level; and, whether smokers presenting with fatal myocardial infarction are more likely to die before reaching a hospital. DESIGN AND METHODS: Population-based myocardial infarction registry, carried out in 1997-1998 in seven regions of Spain, used standardized methods to find and analyze suspected myocardial infarction patients (10 654 patients; 7796 hospitalized). Four categories of smoking status were defined: never-smokers, former smokers for more than 1 year, former smokers for less than 1 year, and current smokers. RESULTS: The main end-point was 28-day case-fatality, found to be 20.1, 17.1, 15.6, and 8.9%, in the four smoking status categories, respectively, for hospitalized patients; and 37.4, 33.0, 24.5, and 23.2%, respectively, at population level. Hospitalized current smokers had lower age, sex, and comorbidity-adjusted 28-day case-fatality than never-smokers (odds ratio=0.71; 95% confidence interval: 0.56-0.90). This association held at population level (odds ratio=0.68; 95% confidence interval: 0.60-0.76), in which former smoking was also associated with lower case-fatality. In fatal cases, recent former smokers presented a lower risk of out-of-hospital death than never-smokers (odds ratio=0.47; 95% confidence interval: 0.29-0.77), whereas current smoking was marginally associated with out-of-hospital death (odds ratio=1.22; 95% confidence interval: 0.99-1.50). CONCLUSIONS: Current smoking is associated with lower 28-day case-fatality in hospitalized myocardial infarction patients. This association held at population level. Among fatal cases, smoking is associated with higher and recent former smoking with lower risk of dying out-of-hospital.

Analysis of inequalities in secondary prevention of coronary heart disease in a universal coverage health care system.

OBJECTIVE: The purpose of this study was to analyse whether differences exist in social class or education level in coronary heart disease (CHD) secondary prevention and in cardiovascular risk factor control in a universal coverage health care system. DESIGN: Cross-sectional multi-centre study. PARTICIPANTS AND SETTING: 1022 CHD patients recruited from residents in the catchment areas covered by 23 primary health care facilities in Catalonia, Spain. MAIN OUTCOME MEASURES: Demographic data, cardiovascular co-morbidity, smoking, blood pressure, fasting blood glucose, triglycerides, total cholesterol, HDL and LDL cholesterol, body mass index (BMI), drug therapy used for secondary prevention, educational level, and social class based on occupation. RESULTS: Patients at the lowest educational level were more frequently women, older, and diabetic. Patients in the middle educational level were more frequently smokers than those in the highest or the lowest level (24.7, 8.7, and 12.0%, respectively; P = 0.008) and had better systolic blood pressure levels (125 mmHg (15), 135 mmHg (16), and 134 mmHg (17), respectively; P = 0.001). All educational levels and social classes had similar adjusted rates of risk factor control. Therapeutic management was also similar among all educational levels and social classes, after adjusting for confounders. CONCLUSIONS: CHD patients in the lower SES received similar treatment for secondary prevention and achieved similar control of risk factors. No social inequalities were found in secondary prevention in CHD patients using the National Health System in Spain.

[Effect of reactions to symptoms onset on early mortality from myocardial infarction]. / Impacto de la actitud frente a los síntomas en la mortalidad temprana por infarto de miocardio.

INTRODUCTION AND OBJECTIVES: A patient's social circumstances at the time when acute myocardial infarction (AMI) symptoms first appear might influence survival. Our objectives were to study the living conditions, the location where symptoms started, the type of symptoms, and the delay before action was taken in patients with AMI who survived more than one hour, and to analyze the relationship between these variables and mortality in different time periods. PATIENTS AND METHOD: Population-based observational cohort study carried out in 1997-1998. Main data source: Registre Gironí del Cor (REGICOR). Death certificates provided information on patients who died before they could be included in the register. The patients' demographic characteristics, lifestyle, clinical history, electrocardiographic abnormalities, cardiac enzyme levels, treatment, and diagnosis were recorded. Mortality before and during hospitalization, and overall mortality at 28 days were studied. RESULTS: Of the 1,097 patients included, 274 (24.97%) died before reaching hospital, 171 (15.58%) died in hospital, and 652 (59.4%) were alive at 28 days. Mortality was lower in patients who went directly to hospital (OR = 0.32, 95% CI, 0.17-0.59). Mortality at 28 days was higher in those with atypical symptoms (OR = 5.52, 95% CI, 2.90-10.50), and in those who lived in an institution (OR = 9.47, 95% CI, 1.05-84.9). CONCLUSIONS: In the absence of specially equipped ambulances, AMI patients who went directly to the hospital or who had typical symptoms had a better chance of survival both before hospitalization and at 28 days. In contrast, 28-day mortality was higher in institutionalized patients.

Impacto de la actitud frente a los síntomas en la mortalidad temprana por infarto de miocardio / Effect of reactions to symptom onset on early mortality from myocardial infarction

Introducción y objetivos. El entorno y las circunstancias del paciente en el inicio de los síntomas del infarto agudo de miocardio (IAM) pueden condicionar su supervivencia. El objetivo es estudiar los aspectos relativos a la convivencia, las características y el retraso en las primeras acciones tomadas por los pacientes con IAM que sobrevivieron más de 1 h y analizar su relación con la mortalidad en distintos períodos.Pacientes y método. Se ha realizado un estudio de cohortes de base poblacional entre 1997 y 1998. La principal fuente de información ha sido el Registre Gironí del Cor (REGICOR) y, para los fallecidos antes de acceder a monitorización, los boletines estadísticos de defunción. Se estudiaron las características demográficas, los hábitos y los antecedentes, los síntomas, las alteraciones electrocardiográficas, el valor de las enzimas miocárdicas y los procedimientos terapéuticos y diagnósticos. Se analizó la mortalidad prehospitalaria, intrahospitalaria y global a los 28 días. Resultados. Se analizaron 1.097 casos: 652 (59,4%) supervivientes a 28 días, 171 muertes en hospitales (15,58%) y 274 muertes prehospitalarias (24,97%). Los pacientes que fueron directamente al hospital presentaron menor mortalidad (odds ratio [OR] = 0,32; intervalo de confianza [IC] del 95%, 0,17-0,59). Hubo mayor mortalidad a los 28 días entre los que tenían síntomas atípicos (OR = 5,52; IC del 95%, 2,90-10,50) y/o vivían institucionalizados (OR = 9,47; IC del 95%,1,05-84,9). Conclusiones. En ausencia de un servicio de ambulancias medicalizadas, los pacientes con un IAM que se dirigen directamente a un hospital y/o presentan síntomas típicos sobreviven en mayor proporción a los 28 días y en la fase prehospitalaria de la enfermedad, y los institucionalizados presentan una mayor mortalidad a los 28 días

Introduction and objectives. A patient's social circumstances at the time when acute myocardial infarction (AMI) symptoms first appear might influence survival. Our objectives were to study the living conditions, the location where symptoms started, the type of symptoms, and the delay before action was taken in patients with AMI who survived more than one hour, and to analyze the relationship between these variables and mortality in different time periods. Patients and method. Population-based observational cohort study carried out in 1997-1998. Main data source: Registre Gironí del Cor (REGICOR). Death certificates provided information on patients who died before they could be included in the register. The patients' demographic characteristics, lifestyle, clinical history, electrocardiographic abnormalities, cardiac enzyme levels, treatment, and diagnosis were recorded. Mortality before and during hospitalization, and overall mortality at 28 days were studied. Results. Of the 1,097 patients included, 274 (24.97%) died before reaching hospital, 171 (15.58%) died in hospital, and 652 (59.4%) were alive at 28 days. Mortality was lower in patients who went directly to hospital (OR = 0.32, 95% CI, 0.17-0.59). Mortality at 28 days was higher in those with atypical symptoms (OR = 5.52, 95% CI, 2.90-10.50), and in those who lived in an institution (OR = 9.47, 95% CI, 1.05-84.9). Conclusions. In the absence of specially equipped ambulances, AMI patients who went directly to the hospital or who had typical symptoms had a better chance of survival both before hospitalization and at 28 days. In contrast, 28-day mortality was higher in institutionalized patients

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36)

Objetivo: El cuestionario de salud SF-36 puede ser autoaplicado o utilizado en entrevistas personales o telefónicas. El objetivo principal de este trabajo fue comparar la aplicación telefónica del cuestionario y la versión autoaplicada en una población de Girona (España). Métodos: Diseño cruzado y aleatorizado para la aplicación de las dos formas del cuestionario. Se asignaron dos órdenes de aplicación de las encuestas (telefónica-autoaplicada y autoaplicada-telefónica). Un total de 261 personas completaron los cuestionarios. Las comparaciones entre modos de aplicación se realizaron mediante la prueba de la t de Student para datos apareados. La consistencia interna y la concordancia entre modos de aplicación se analizaron mediante los coeficientes * de Chronbach y de correlación intraclase, respectivamente. Su utilizó un modelo lineal general para medidas repetidas para evaluar el efecto del orden de la aplicación de los cuestionarios. Resultados: Cuando se utilizó primero el cuestionario autoaplicado, las escalas de función física, rol físico y función social resultaron en una menor puntuación. Todos los coeficientes * de Chronbach fueron superiores a 0,70, excepto para la escala de función social en la modalidad autoaplicada cuando se aplicó primero la encuesta telefónica. El rango de los coeficientes de correlación intraclase fue de 0,41 a 0,83 en la modalidad telefónica-autoaplicada y de 0,32 a 0,73 en la modalidad autoaplicada-telefónica. No se observó un efecto relevante del orden de aplicación. Conclusiones: Los resultados de este estudio indican que la aplicación de la encuesta telefónica es equivalente e tan válida como la encuesta autoaplicada

Objective: The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). Methods: A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbach's alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. Results: Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbach's alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. Conclusions: The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36).

OBJECTIVE: The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). METHODS: A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbach's alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. RESULTS: Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbach's alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. CONCLUSIONS: The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode.

[Gender and ischemic heart disease]. / Género y cardiopatía isquémica.

Physiological and pathological processes differ in men and women, depending on factors such as sex and sociological and anthropological characteristics. However, many diseases are still approached from a masculine point of view. In this respect, ischemic heart disease is one of the diseases that most clearly reflects biological differences and social inequalities. In women, the disease presents at a more advanced age, and presentation is frequently atypical with a higher prevalence of comorbidities and greater severity. Consequently, treatment and outcome differ from those in men. Additionally, women differ in their knowledge, and beliefs regarding ischemic heart disease, as well as in their attitudes at symptom onset. Therefore, clinical practice should place significant emphasis on all these aspects in order to avoid inequalities between men and women in the correct diagnosis, treatment, prevention, and rehabilitation of ischemic heart disease.