La figura del mediador intercultural en Cataluña: la visión del colectivo formador

La aproximación al tipo de mediación intercultural que se está llevando a cabo en Cataluña en este momento en el ámbito educativo -y su desarrollo futuro- se concreta y se dibuja en la diversidad de respuestas y de enfoques que aparecen del mismo término. Hemos intentado poner en común la reflexión y el debate sobre cuál sería la figura ideal y real del mediador intercultural. Con esta finalidad se han realizado 17 entrevistas a todos los coordinadores y formadores en ejercicio.

Continuidad y cambios en la gestión de la inmigración

La inmigración ha comportado la elaboración de numerosos documentos de definición de las políticas de integración que han dibujado el camino seguido y las etapas vividas. Cataluña ha pasado de la observación del fenómeno migratorio a centrarse en los últimos años en la intervención, evidentemente haciendo esfuerzos importantes en organización de las administraciones y las entidades que trabajan con y para los inmigrantes. Una vez presentada la evolución realizada, analizamos, a partir de un trabajo empírico, las limitaciones que los profesionales de las dministraciones comarcales y locales observan para el desarrollo del modelo.

Diversidad cultural e instituciones educativas en Cataluña: el mediador intercultural como nueva figura profesional

En Cataluña en los últimos años, han ido proliferando una serie de "profesionales" que realizan, con más o menos adecuación a la definición teórica de mediador intercultural, dicha función. Primeramente se trataba de gitanos, pero recientemente, fruto del incremento de la presencia del alumndado de origen inmigrante en las escuelas, se ha visto crecer el número y el protagonismo de los mediadores de extranjero, sobre todo por el reconocimiento que se les ha otorgado desde la administración y las instituciones. Concretamente, los mediadores interculturales han intentado intervenir en cuestiones como la participación de los padres de origen inmigrante en los centros escolares, la adaptación del currículum a la diversidad cultural, la negociación de conflictos "culturales" (el uso del pañuelo en las clases, los menús del comedor...), la desescolarización, absentismlo y abandono escolar de los alumnos durante el período de la escoalrización obligatoria, la traducción lingüística y la interpretación sociocultural., etc. Al ser una práctica nueva, está aún llena de interrogantes, pero, como no se estaba produciendo paralelamente una reflexión y clarificación de sus fundamentos, nos parecía un momento pertinente para examinarla. Así pues, pretendemos profundizar en esta figura a partir de un trabajo empírico que ha consistido en 22 entrevistas en profundidad a mediadores de origen inmigrante que trabajan en las instituciones escolares de Cataluña.

Breast cancer incidence and overdiagnosis in Catalonia (Spain)

Introduction: Early detection of breast cancer (BC) with mammography may cause overdiagnosis and overtreatment, detecting tumors which would remain undiagnosed during a lifetime. The aims of this study were: first, to model invasive BC incidence trends in Catalonia (Spain) taking into account reproductive and screening data; and second, to quantify the extent of BC overdiagnosis. Methods: We modeled the incidence of invasive BC using a Poisson regression model. Explanatory variables were: age at diagnosis and cohort characteristics (completed fertility rate, percentage of women that use mammography at age 50, and year of birth). This model also was used to estimate the background incidence in the absence of screening. We used a probabilistic model to estimate the expected BC incidence if women in the population used mammography as reported in health surveys. The difference between the observed and expected cumulative incidences provided an estimate of overdiagnosis. Results: Incidence of invasive BC increased, especially in cohorts born from 1940 to 1955. The biggest increase was observed in these cohorts between the ages of 50 to 65 years, where the final BC incidence rates more than doubled the initial ones. Dissemination of mammography was significantly associated with BC incidence and overdiagnosis. Our estimates of overdiagnosis ranged from 0.4% to 46.6%, for women born around 1935 and 1950, respectively. Conclusions: Our results support the existence of overdiagnosis in Catalonia attributed to mammography usage, and the limited malignant potential of some tumors may play an important role. Women should be better informed about this risk. Research should be oriented towards personalized screening and risk assessment tools.

Competing risks to breast cancer mortality in Catalonia

Background: Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. Methods: The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. Results: There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945–54 in the 40–49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. Conclusion: We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia.

Dissemination of periodic mammography and patterns of use, by birth cohort, in Catalonia (Spain)

Background: In Catalonia (Spain) breast cancer mortality has declined since the beginning of the 1990s. The dissemination of early detection by mammography and the introduction of adjuvant treatments are among the possible causes of this decrease, and both were almost coincident in time. Thus, understanding how these procedures were incorporated into use in the general population and in women diagnosed with breast cancer is very important for assessing their contribution to the reduction in breast cancer mortality. In this work we have modeled the dissemination of periodic mammography and described repeat mammography behavior in Catalonia from 1975 to 2006. Methods: Cross-sectional data from three Catalan Health Surveys for the calendar years 1994, 2002 and 2006 was used. The dissemination of mammography by birth cohort was modeled using a mixed effects model and repeat mammography behavior was described by age and survey year. Results: For women born from 1938 to 1952, mammography clearly had a period effect, meaning that they started to have periodic mammograms at the same calendar years but at different ages. The age at which approximately 50% of the women were receiving periodic mammograms went from 57.8 years of age for women born in 1938–1942 to 37.3 years of age for women born in 1963–1967. Women in all age groups experienced an increase in periodic mammography use over time, although women in the 50–69 age group have experienced the highest increase. Currently, the target population of the Catalan Breast Cancer Screening Program, 50–69 years of age, is the group that self-reports the highest utilization of periodic mammograms, followed by the 40–49 age group. A higher proportion of women of all age groups have annual mammograms rather than biennial or irregular ones. Conclusion: Mammography in Catalonia became more widely implemented during the 1990s. We estimated when cohorts initiated periodic mammograms and how frequently women are receiving them. These two pieces of information will be entered into a cost-effectiveness model of early detection in Catalonia.

Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain)

Background: At present, it is complicated to use screening trials to determine the optimal age intervals and periodicities of breast cancer early detection. Mathematical models are an alternative that has been widely used. The aim of this study was to estimate the effect of different breast cancer early detection strategies in Catalonia (Spain), in terms of breast cancer mortality reduction (MR) and years of life gained (YLG), using the stochastic models developed by Lee and Zelen (LZ). Methods: We used the LZ model to estimate the cumulative probability of death for a cohort exposed to different screening strategies after T years of follow-up. We also obtained the cumulative probability of death for a cohort with no screening. These probabilities were used to estimate the possible breast cancer MR and YLG by age, period and cohort of birth. The inputs of the model were: incidence of, mortality from and survival after breast cancer, mortality from other causes, distribution of breast cancer stages at diagnosis and sensitivity of mammography. The outputs were relative breast cancer MR and YLG. Results: Relative breast cancer MR varied from 20% for biennial exams in the 50 to 69 age interval to 30% for annual exams in the 40 to 74 age interval. When strategies differ in periodicity but not in the age interval of exams, biennial screening achieved almost 80% of the annual screening MR. In contrast to MR, the effect on YLG of extending screening from 69 to 74 years of age was smaller than the effect of extending the screening from 50 to 45 or 40 years. Conclusion: In this study we have obtained a measure of the effect of breast cancer screening in terms of mortality and years of life gained. The Lee and Zelen mathematical models have been very useful for assessing the impact of different modalities of early detection on MR and YLG in Catalonia (Spain).

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): a 6-months prospective observational study

Background: There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations. Methods: Prospective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex. Results: The percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure. Conclusion: Pharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

Background: Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods: In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results: Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ≥10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p < 0.001) Conclusion: Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions.

Análisis discursivo de las actitudes lingüísticas de los escolares de origen inmigrante en Cataluña

La continua llegada de población inmigrante a los países de la Europa Occidental está produciendo transformaciones en estas sociedades. Evidentemente, la sociedad catalana no es ajena a estos cambios y, año tras año, ve incrementado el número de recién llegados/ as procedentes de orígenes geográficos, culturales y lingüísticos muy diversos. Estas personas, en ocasiones sin un conocimiento previo, se encuentran con las peculiaridades socioculturales y lingüísticas de la sociedad receptora. En el caso de Cataluña, nos interesa destacar la cuestión lingüística, a la cual se han dedicado muchos esfuerzos durante los últimos años en un intento de acercarse a una situación de normalidad en lo referente al conocimiento y uso de la lengua catalana. En el presente artículo se presentan los principales resultados de una investigación centrada en el análisis de los discursos sobre los que anclan las actitudes lingüísticas de los escolares de origen inmigrante en Cataluña. La técnica de investigación social utilizada ha sido la entrevista en profundidad semidirigida, realizando el análisis del contenido de las mismas a partir del «Análisis de contenido temático basado en categorías» (Bardin, 1986). Las conclusiones más relevantes indican que, por encima del Área de Origen o la Condición Lingüística Familiar, la principal variable que permite articular los discursos detectados es la que se puede denominar «Satisfacción y Percepción de Valoración e Integración Escolar y Social», de tal manera que los jóvenes de origen inmigrante que se sienten más valorados e integrados escolar y socialmente desarrollan mejores actitudes hacia la lengua catalana y castellana. Este hecho tiene claras repercusiones respecto las generalizaciones reduccionistas y estereotipadas que vinculan un área de origen con unas determinadas actitudes hacia las lenguas oficiales en Cataluña, así como de cara a la política lingüística y las ideologías lingüísticas de la sociedad en general.

Conocimiento del catalán y castellano por parte del alumnado inmigrante

A lo largo de la última década en Cataluña, la heterogeneidad identitaria, lingüística, cultural y étnica ha crecido de manera importante. En consecuencia, nuestras escuelas se han transformado en centros donde la pluralidad étnica, religiosa, cultural y lingüística es cada día más evidente. Pero, a diferencia de otros territorios del Estado, una de las características fundamentales de nuestro Sistema Educativo es su organización bajo los parámetros de la educación bilingüe. De esta manera, además de un profundo dominio del catalán, lengua propia de Cataluña y lengua usada como vehicular y de aprendizaje en la enseñanza, se persigue un buen conocimiento de la lengua castellana. En este contexto, diferentes estudios ponen en evidencia el papel clave del dominio de la lengua de la escuela tanto de cara a garantizar el éxito escolar como para la integración y la cohesión social. Con este marco de fondo, nos situamos en el caso del Instituto de Educación Secundaria (IES) de Guissona, en la comarca de la Segarra, donde por circunstancias diversas el fenómeno migratorio ha sido muy importante a lo largo de la última década. El objetivo de nuestra investigación es el análisis de las competencias lingüísticas del alumnado de dicho centro, tomando como referencia el nivel de competencia lingüística de sus iguales autóctonos.En concreto, a partir de una muestra de 28 niños y niñas inmigrantes que fueron comparados con un grupo de 93 escolares autóctonos de su misma edad y nivel escolar, nuestro trabajo analiza el desarrollo de diferentes habilidades en lengua catalana y castellana.

Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

Background: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.

La atención a la diversidad cultural en Cataluña: exclusión, segregación e interculturalidad

La diversidad cultural se ha incrementado notablemente en los centros escolares españoles por la llegada de alumnado de origen inmigrado y esto, más los discursos de toma en consideración de las diferencias culturales que han realizado la Unión Europea y las administraciones autonómicas, ha contribuido a la aparición del discurso intercultural. Este artículo presenta la evolución realizada hasta llegar al discurso dominante actual basándose en un trabajo empírico de análisis de documentación editada por la Generalitat de Cataluña sobre política de integración y de escolarización de los inmigrados y entrevistas en profundidad a políticos y técnicos de los diferentes niveles de la administración catalana. De ello se concluye la existencia de tres etapas en la política de integración de los inmigrados en Cataluña: un primer momento de mera observación del fenómeno; una segunda etapa en la que sin abandonar la observación se insiste en la organización vertical y horizontal de la administración para trabajar de forma coordinada un fenómeno que empieza a despertar preocupación; y, una tercera, en la que sin abandonar la necesaria observación y organización, el énfasis se sitúa en la intervención. Estas fases son el marco de lo realizado a nivel educativo donde observamos la dificultad de traducción del discurso intercultural a la práctica cotidiana de los centros escolares, de los noventa, es necesario incrementar los esfuerzos para incorporar al alumnado de origen inmigrado en el dominio de la creencia de que la educación intercultural (en contra de lo que esta implica) es cuestión que deben trabajar los centros con inmigrantes y, ante la presión existente en las aulas (por el incremento del alumnado, la matrícula viva, etc.), el retorno a prácticas potencialmente segregacionistas que nos recuerdan actuaciones implementadas para escolarizar a los gitanos años atrás. Sin negar los avances realizados desde mediados aulas y centros de Cataluña.

Contribution of early detection and adjuvant treatments to breast cancer mortality reduction in Catalonia, Spain

Background: Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings: A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975-2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30-69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance: Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods.

Inmigrantes menores de edad en Cataluña: un reto para las instituciones educativas

La llegada de menores inmigrantes procedentes principalmente de África, ha comportado que en España, y concretamente en Cataluña, las instituciones públicas y privadas se planteen cómo atenderles. La respuesta dada desde la administración catalana se ha caracterizado por una evolución desde el uso de las estructuras existentes hasta la propuesta más reciente de creación de nuevos centros ante la dificultad de dar una respuesta adecuada con lo existente. El artículo que presentamos analiza, a partir de grupos de discusión con los profesionales de los centros que acogían a estos menores, cómo se ha vivido esta presencia y qué retos estructurales (adaptación a las demandas, idoneidad de crear centros específicos para estos menores y/o contar con la presencia de educadores que pertenezcan o conozcan la cultura de origen de estos menores, etc.) y formativos ha planteado.