Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007

Background: While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). Methods: All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders. Results: Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. Conclusions: Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.

Patients' and professionals' views on managing fibromyalgia

BACKGROUND: Managing fibromyalgia is a challenge for both health care systems and the professionals caring for these patients, due, in part, to the fact that the etiology of this disease is unknown, its symptoms are not specific and there is no standardized treatment. OBJECTIVE: The present study examines three aspects of fibromyalgia management, namely diagnostic approach, therapeutic management and the health professional-patient relationship, to explore specific areas of the health care process that professionals and patients may consider unsatisfactory. METHODS: A qualitative study involving semistructured interviews with 12 fibromyalgia patients and nine health professionals was performed. RESULTS: The most commonly recurring theme was the dissatisfaction of both patients and professionals with the management process as a whole. Both groups expressed dissatisfaction with the delay in reaching a diagnosis and obtaining effective treatment. Patients reported the need for greater moral support from professionals, whereas the latter often felt frustrated and of little help to patients. Patients and professionals agreed on one point: the uncertainty surrounding the management of fibromyalgia and, especially, its etiology. CONCLUSION: The present study contributes to a better understanding regarding why current management of fibromyalgia is neither effective nor satisfactory. It also provides insight into how health professionals can support fibromyalgia patients to achieve beneficial results. Health care services should offer greater support for these patients in the form of specific resources such as fibromyalgia clinics and health professionals with increased awareness of the disease.

From problems to opportunities a shift needed for public health

Public health has in the past been a problem orientated discipline which has devoted its energies mainly to defining, prioritizing and trying to solve problems. This means paying attention to the short-term. If we examine the rises and falls of public health as a discipline with its successes and failures in gaining health, and if we compare public health with successful organisations, the need for changing the emphasis from problems to opportunities becomes apparent. In this endeavour for the future, strategic thinking and policy analysis seem appropriate new tools for public health professionals. The economic crisis and the weakness of the welfare state are presented as major opportunities for public health to achieve health gain in Europe.

Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?

Purpose: To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes. Methods: We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool. Results: The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients’ symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency. Conclusions: Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.

Re-contacto mediante encuesta telefónica con trabajadores inmigrantes en España (ITSAL II)

Objetivo: La población inmigrante presenta dificultades específicas para acceder a ella. Este estudio describe y evalúa la experiencia de re-contacto (muestra final) con trabajadores inmigrantes que participaron en una encuesta tres años antes (muestra inicial), compara ambas muestras y describe la muestra final. Métodos: En 2008 se realizó una encuesta presencial a 2.434 trabajadores inmigrantes (proyecto ITSAL I). 1.229 dejaron un número telefónico para ser re-contactados. En 2011 se los llamó para encuestarlos nuevamente (proyecto ITSAL II). Se calcularon indicadores de resultados de contacto (American Association Public Opinion Research). Se compararon las características sociodemográficas y laborales de los trabajadores de las muestras inicial y final. En la muestra final se compararon las distribuciones de variables sociodemográficas y laborales según país de origen. Se analizaron los cambios de situación legal, sector de actividad y ocupación en este intervalo. Resultados: La proporción de entrevistados que contestaron la segunda entrevista (tasa de respuesta) fue 29,5%. La muestra final (n=318) contó con mayor participación de ecuatorianos, mujeres, mayores de 45 años y con personas mayor nivel de estudios. Rumanos y marroquíes presentan mayor desempleo (45,1%, 40,0%). El 71,1% no cambió de sector de actividad y el 63,2% mejoró su situación legal. Conclusiones: La tasa de respuesta fue similar a la obtenida en otros estudios de estas características. El re-contacto fue más difícil en algunos grupos determinados por país de origen, edad, nivel de estudios y situación legal, para los que habría que buscar vías alternativas para su seguimiento.

Social and immigration factors in intimate partner violence among Ecuadorians, Moroccans and Romanians living in Spain

Background: Intimate partner violence (IPV) against women occurs in all countries, all cultures and at every level of society; however, some populations may be at greater risk than others. The aim of this study was to explore IPV prevalence among Ecuadorian, Moroccan and Romanian immigrant women living in Spain and its possible association with their personal, family, social support and immigration status characteristics. Methods: Cross-sectional study of 1607 adult immigrant women residing in Barcelona, Madrid and Valencia (2011). Prevalence rates and adjusted odds ratios (AORs) were calculated, with current IPV being the outcome. Different women’s personal (demographic), family, social support and immigration status characteristics were considered as explicative and control variables. All analyses were separated by women’s country of origin. Results: Current IPV prevalence was 15.57% in Ecuadorians, 10.91% in Moroccans and 8.58% in Romanians. Some common IPV factors were found, such as being separated and/or divorced. In Romanians, IPV was also associated with lack of social support [AOR 5.96 (1.39–25.62)] and low religious involvement [AOR 2.17 (1.06–4.43)]. The likelihood of current IPV was lower among women without children or other dependants in this subgroup [AOR 0.29 (0.093–0.92)]. Conclusion: The IPV prevalence rates obtained for Moroccan, Romanian and Ecuadorian women residing in Spain were similar. Whereas the likelihood of IPV appeared to be relatively evenly distributed among Moroccan and Ecuadorian women, it was higher among Romanian women in socially vulnerable situations related to family responsibilities and the lack of support networks. The importance of intervention in the process of separation and divorce was common to all women.

Acceptability of pandemic A(H1N1) influenza vaccination by Essential Community Workers in 2010 Alicante (Spain), perceived seriousness and sources of information

Objective. Describe acceptability of pandemic A(H1N1) influenza vaccination by Essential Community Workers (ECWs) from Alicante province (Spain) in January 2010. Evaluate the correlation with attitudes, beliefs, professional advice and information broadcasted by media. Method. In this cross-sectional study, face-to-face interviews were conducted with 742 ECWs to assess their attitudes towards vaccination against the pandemic influenza strain. A multivariable regression model was made to adjust the Odds Ratios (ORs). Results. Some ECWs reported having been vaccinated with seasonal vaccine, 21.5% (95%IC 18.6–24.9); only 15.4% (95%IC 12.8–18.4) with the pandemic one. ECWs vaccinated regularly against seasonal flu (OR 5.1; 95%IC 2.9–9.1), those who considered pandemic influenza as a severe or more serious disease than seasonal flu (OR 3.8; 95%IC 2.1–6.7) and those who never had doubts about vaccine safety (OR 3.7; 95%IC2.1–6.7) had a better acceptance of pandemic vaccine. Finally, 78.7% (95%IC 75.1–81.4) had doubts about pandemic vaccine's effectiveness. Conclusion. The vast amount of information provided by the media did not seem to be decisive to prevent doubts or to improve the acceptability of the vaccine in ECWs. Professional advice should be the focus of interest in future influenza vaccination campaigns. These results should be taken into account by health authorities.

El papel del Marqués de Vadillo como propagador de la vacuna en Soria (1801)

El método desarrollado por Edward Jenner para prevenir la viruela en 1798 se difundió con extraordinaria rapidez por Europa. Las primeras vacunaciones en diciembre de 1800 marcan en España el inicio de una práctica que fue promovida por la iniciativa particular de médicos y cirujanos en distintos núcleos del país. Ignacio María Ruiz de Luzuriaga, secretario de la Real Academia de Medicina de Madrid, fue una figura central en la propagación del método al establecer una red espontánea de corresponsales a los que remitía vacuna e información sobre cómo utilizarla. Esta correspondencia, conservada en un legajo de la Academia con el título de Papeles de la vacuna, muestra la relación mantenida no solo con otros facultativos, sino también con miembros de la nobleza y burguesía peninsular que contribuyeron a impulsar la práctica. Este estudio analiza las cartas remitidas por Francisco González de Castejón, Marqués de Vadillo, interesado inicialmente por preservar de la viruela a su hija, y que junto al médico Josef Ubis propagó la vacuna en la provincia de Soria y algunas localidades de Navarra entre los meses de agosto y diciembre de 1801.

La estéril búsqueda del cowpox para perpetuar la vacuna contra la viruela

A finales del siglo xviii el cirujano inglés Edward Jenner (1749-1823) propuso la inoculación de la viruela de las vacas (cowpox) como método para prevenir la viruela humana (smallpox). La publicación de sus observaciones constituye la primera inoculación de un virus atenuado y el inicio de la vacunología como disciplina científica. La rápida difusión que obtuvo este hallazgo llevó aparejado un interés de los vacunadores por localizar vacas afectadas por el cowpox con el fin de mantener activa la vacunación de forma autóctona. Se hicieron también ensayos buscando la reproducción del virus en otras especies animales. Ninguna de estas iniciativas obtuvo el éxito esperado.

Creencias, actitudes e influencia de los medios de comunicación en trabajadores sanitarios españoles durante la gripe pandémica A (H1N1) 2009

Introducción: Considerado como grupo de riesgo específico en la estrategia de inmunización contra la gripe A (H1N1), el colectivo de trabajadores sanitarios ha sido objeto de este estudio desde la perspectiva de sus actitudes y creencias hacia la inmunización, con especial énfasis en la influencia de las fuentes de información para tomar la decisión de vacunarse. Métodos: Estudio observacional de carácter transversal dirigido a trabajadores sanitarios en activo de la provincia de Alicante y realizado mediante cuestionario cara a cara a una muestra aleatoria por cuotas según categoría profesional en trabajadores de hospitales y centros de salud. Resultados: Las fuentes de información difieren entre subgrupos: los médicos utilizaron revistas científicas y/o congresos, las enfermeras la obtuvieron a través de Sanidad y otras enfermeras, el resto de trabajadores optaron por la televisión y/o el médico de familia. De los 3 colectivos estudiados, los médicos son los que menos sensación de gravedad han percibido frente a la gripe A (H1N1) (59,4%), son los que más confían en la vacuna (42,3%), los que más la recomiendan (44,4%), los que mejor han seguido las recomendaciones para evitar el contagio (93%) y los más vacunados (18,3%). El 75,5% de los sanitarios valoró la información recibida como regular, mala o muy mala. La totalidad admitió que se creó alarma social. Discusión: El éxito de futuras campañas de inmunización contra la gripe en personal sanitario podría incrementarse si fueran diseñadas actividades informativas segmentadas y orientadas a cada subgrupo del colectivo, adecuando la estrategia y mejorando la calidad de la información.

Self-rated health and mortality: a follow-up study of a Spanish population

Objectives: Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population. Study design: Longitudinal study. Methods: A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations. Results: Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability. Conclusions: SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

Environment and health with respect to a poverty-related disease: the epidemiology of trachoma in Spain, 1925-1941

Trachoma currently represents one of the three main causes of ‘avoidable' blindness and reaches intolerable dimensions in many developing countries. It was endemic in many regions of eastern Spain until well into the twentieth century. The aim of this paper is to analyze the epidemiological development of this disease in contemporary Spain; to examine its determining factors, particularly environmental and sanitary/health factors, and, finally, to study the health care, environmental and socio-economic measures that led to its control and eradication. We believe that the historical approach not only highlights the role of environmental factors in the development of trachoma, but may also aid in understanding the current epidemiology of trachoma.