Economic evaluation of the levonorgestrel-releasing intrauterine system for the treatment of dysfunctional uterine bleeding in Spain

To compare the cost and effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus combined oral contraception (COC) and progestogens (PROG) in first-line treatment of dysfunctional uterine bleeding (DUB) in Spain. STUDY DESIGN: A cost-effectiveness and cost-utility analysis of LNG-IUS, COC and PROG was carried out using a Markov model based on clinical data from the literature and expert opinion. The population studied were women with a previous diagnosis of idiopathic heavy menstrual bleeding. The analysis was performed from the National Health System perspective, discounting both costs and future effects at 3%. In addition, a sensitivity analysis (univariate and probabilistic) was conducted. RESULTS: The results show that the greater efficacy of LNG-IUS translates into a gain of 1.92 and 3.89 symptom-free months (SFM) after six months of treatment versus COC and PROG, respectively (which represents an increase of 33% and 60% of symptom-free time). Regarding costs, LNG-IUS produces savings of 174.2-309.95 and 230.54-577.61 versus COC and PROG, respectively, after 6 months-5 years. Apart from cost savings and gains in SFM, quality-adjusted life months (QALM) are also favourable to LNG-IUS in all scenarios, with a range of gains between 1 and 2 QALM compared to COC and PROG. CONCLUSIONS: The results indicate that first-line use of the LNG-IUS is the dominant therapeutic option (less costly and more effective) in comparison with first-line use of COC or PROG for the treatment of DUB in Spain. LNG-IUS as first line is also the option that provides greatest health-related quality of life to patients.

Measuring Intermediary Determinants of Early Childhood Health: A Composite Index Comparing Colombian Departments

In recent years there has been growing interest in composite indicators as an efficient tool of analysis and a method of prioritizing policies. This paper presents a composite index of intermediary determinants of child health using a multivariate statistical approach. The index shows how specific determinants of child health vary across Colombian departments (administrative subdivisions). We used data collected from the 2010 Colombian Demographic and Health Survey (DHS) for 32 departments and the capital city, Bogotá. Adapting the conceptual framework of Commission on Social Determinants of Health (CSDH), five dimensions related to child health are represented in the index: material circumstances, behavioural factors, psychosocial factors, biological factors and the health system. In order to generate the weight of the variables, and taking into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations was employed in constructing the index. From this method five principal components were selected. The index was estimated using a weighted average of the retained components. A hierarchical cluster analysis was also carried out. The results show that the biggest differences in intermediary determinants of child health are associated with health care before and during delivery.

Measuring early childhood health : a composite index comparing Colombian departments

This paper presents a composite index of early childhood health using a multivariate statistical approach. The index shows how child health varies across Colombian departments, -administrative subdivisions-. In recent years there has been growing interest in composite indicators as an efficient analysis tool and a way of prioritizing policies. These indicators not only enable multi-dimensional phenomena to be simplified but also make it easier to measure, visualize, monitor and compare a country’s performance in particular issues. We used data collected from the Colombian Demographic and Health Survey, DHS, for 32 departments and the capital city, Bogotá, in 2005 and 2010. The variables included in the index provide a measure of three dimensions related to child health: health status, health determinants and the health system. In order to generate the weight of the variables and take into account the discrete nature of the data, we employed a principal component analysis, PCA, using polychoric correlation. From this method, five principal components were selected. The index was estimated using a weighted average of the components retained. A hierarchical cluster analysis was also carried out. We observed that the departments ranking in the lowest positions are located on the Colombian periphery. They are departments with low per capita incomes and they present critical social indicators. The results suggest that the regional disparities in child health may be associated with differences in parental characteristics, household conditions and economic development levels, which makes clear the importance of context in the study of child health in Colombia.

A qualitative analysis of immigrant population health practices in the Girona Healthcare Region

The research we present here forms part of a two-phase project - one quantitative and the other qualitative - assessing the use of primary health care services. This paper presents the qualitative phase of said research, which is aimed at ascertaining the needs, beliefs, barriers to access and health practices of the immigrant population in comparison with the native population, as well as the perceptions of healthcare professionals. Moroccan and sub-Saharan were the immigrants to who the qualitative phase was specifically addressed. The aims of this paper are as follows: to analyse any possible implications of family organisation in the health practices of the immigrant population; to ascertain social practices relating to illness; to understand the significances of sexual and reproductive health practices; and to ascertain the ideas and perceptions of immigrants, local people and professionals regarding health and the health system. Methods: qualitative research based on discursive analysis. Data gathering techniques consisted of discussion groups with health system users and semi-structured individual interviews with healthcare professionals. The sample was taken from the Basic Healthcare Areas of Salt and Banyoles (belonging to the Girona Healthcare Region), the discussion groups being comprised of (a) 6 immigrant Moroccan women, (b) 7 immigrant sub-Saharan African women and (c) 6 immigrant and native population men (2 native men, 2 Moroccan men and 2 sub-Saharan men); and the semi-structured interviews being conducted with the following healthcare professionals: (a) 3 gynaecologists, (b) 3 nurses and 1 administrative staff. Results: use of the healthcare system is linked to the perception of not being well, knowledge of the healthcare system, length of time resident in Spain and interiorization of traditional Western medicine as a cure mechanism. The divergences found among the groups of immigrants, local people and healthcare professionals with regard to healthcare education, use of the healthcare service, sexual and reproductive healthcare and reticence with regard to being attended by healthcare personnel of the opposite sex demonstrate a need to work with the immigrant population as a heterogeneous group. Conclusions: the results we have obtained support the idea that feeling unwell is a psycho-social process, as it takes place within a specific socio-cultural situation and spans a range of beliefs, perceptions and ideas regarding symptomology and how to treat it

Estudi epidemiològic de l'obesitat de 1r d'ESO de l'IES Pedraforca

Treball de recerca realitzat per una alumna d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. L'obesitat és una malaltia crònica que es caracteritza per un augment de la massa grassa i en conseqüència per un augment de pes. En el segle XXI aquesta malaltia, considerada epidèmia, està arribant a la població infantil i adolescent, i ha cridat l'atenció de totes les institucions de salut pública que estan lluitant per evitar aquesta alta prevalença d'obesitat i sobrepès. Aquest estudi confirma que existeix un alt percentatge d'obesitat i sobrepès en l'edat infantil i que està relacionat amb factors de risc (alguns modificables) que poden ser clau per a evitar aquesta malaltia. El mètode emprat és la realització d’un estudi epidemiològic transversal sobre una mostra de nens compresa en 39 individus de 12 a 14 anys d'edat. Es van determinar el pes, la talla, el plec bicipital i tricipital, l'ample del canell i del colze, a més de la realització d'una enquesta sobre hàbits alimentaris en l’esmorzar i dades socioculturals. L'obesitat i el sobrepès es van definir com resultats de IMC iguals als percentils 85 i 97 de les taules Orbegozo, respectivament. Els resultats van mostrar una prevalença de sobrepès i obesitat en la nostra mostra de població que va ser de 28,2%, la de només sobrepes del 15,4% i la de només obesitat del 12,8%. La prevalença d'obesitat és major en nens amb un 13,6% que en nenes 12,5% igual que el sobrepès. L'obesitat i sobrepès és major quan els estudis materns són inferiors als universitaris, també quan existeixen famílies amb 3 o més fills i quan es veu la TV més de 3 hores al dia.

La medicina Xinesa a la Xina contemporània

La medicina occidental és la imperant a tot el planeta. Malgrat tot, a la Xina la medicina tradicional hi té un pes important. La convivència entre totes dues visions de la salut i la malaltia -l'occidental i l'oriental- no és senzilla. En aquest treball es fa un recorregut pel sistema de salut xinès per a fer una aproximació a la situació de la medicina xinesa a la Xina contemporània.

Modernització tecnològica, canvi organitzatiu i serveis als usuaris en el sistema de salut de Catalunya. Informe de recerca (volum III)

Aquest estudi va analitzar la interacció del canvi organitzatiu, els valors culturals i el canvi tecnològic en el sistema sanitari català. L'estudi se subdivideix en cinc parts diferents. La primera és una anàlisi de contingut de webs relacionats amb la salut a Catalunya. La segona és un estudi dels usos d'Internet en qüestions relacionades amb la salut entre la població en general, les associacions de pacients i els professionals de la salut, i es basa en un sondeig per Internet adaptat a cada un d'aquests grups. La tercera part és un estudi de treball de camp dels programes experimentals duts a terme pel Govern català en diverses àrees i hospitals locals per a integrar electrònicament la història clínica dels pacients. La quarta és un estudi de les implicacions organitzatives de la introducció de sistemes d'informació en la gestió d'hospitals i centres d'assistència primària a l'Institut Català de Salut, el principal proveïdor de salut pública a Catalunya, i es basa en un sondeig per Internet i entrevistes en profunditat. La cinquena part és un estudi de cas dels efectes organitzatius i socials de la introducció de les tecnologies de la informació i la comunicació en un dels principals hospitals de Catalunya, l'Hospital Clínic de Barcelona. L'estudi es va dur a terme entre el maig del 2005 i el juliol del 2007.

Financiación capitativa, articulación entre niveles asistenciales y descentralización de las organizaciones sanitarias

Public organisations are subjected to weak incentivesfor competition. Therefore, institutional Darwinismcannot apply. Regulation and performance monitoring isrequired to protect the public interest. This isparticularly the case of organisations in the healthcare arena, since strong incentives may risk the wholesupply of public health services. Regarding to the pathdependence of the Spanish public health institutionswith respect to the international experience and theobserved health technological changes, this paper triesto ground some theoretical bases for the organisationalchange in our health system. We do this by building ourargument from the very basic public goal: the improvementof the health status of the Spanish population. Thisrequires a better integration of health care services.To this regard, capitation in finance shows somecomparative advantages: it takes an integral view forthe care of the population, it allows for a betterdecentralisation ('deconcentration') of risks to healthproviders and favours managed care under a globalperspective, replacing partial payment to differentproviders. However, the paper shows some potentiallimitations for this purpose and the need of a gradualstrategy for its implementation.

Las deducciones en el IRPF por gasto sanitario privado: situación actual y posibilidades de reforma

The paper provides information about the tax treatment given to personalhealth expenditures in the Personal Income Tax in Spain, and analyseswhat we know about it and how the tax credit or other forms ofpreferential tax treatment can contribute to the financement of privatehealth expenditures, of special relevance in view of the recent PersonalIncome Tax modification proposals . It also points out some of the mainredistributive results coming out from this type of public financement,differentiating between types of expenditures (mainly those on healthservices which are not provided by the public health system, from thosewhich are).

El impacto de los servicios sanitarios sobre la salud

This paper reviews what has increased medical-care spending bought in terms of health benefitswith longitudinal data from the U.S and, more limited, from Spain. Health services contributionto health has been positive in average, especially during the last 50 years for the U.S andthe last 30 years for Spain. This contribution differs among countries and is much greater forsome diseases (cardiovascular) than for others (cancer). Benefits from health care interventionscan be valued on basis on the social willin gness to pay, observed or declared on the process ofestablishing health policy priorities. 30.000 euros per Quality Adjusted Life Year could providean efficiency threshold for financing publicly health services in Spain: Consensus andlegitimacy of the political process of establishing health priorities becomes, however, moreimportant than any approximate number. Attention is paid finally to bridging the gap betweenefficacy (the possibilities given by innovation and resources devoted to health care) andeffectiveness (the distance to the frontier) of the everyday working of a health system with itsinappropriate care and limited application of the existing knowledge.

La gestión sanitaria: orientaciones a futuro para el cambio organizativo, del control y la financiación

This paper offers a general view of changes in health care management in theSpanish Health System. We focus on the organisational, financing andaccountability aspects of health care provision. We do this by encompassingmanagerial changes and social change and well-grounded in theory health economicsliterature. In this way we try to link applied economics and management issues,as we did in a former paper, ten years ago on the same basis(López-Casasnovas, 2002). We emphasise mistakes and milestones in the wayforward to improve health systems by better understanding the public natureof health policies. Key aspects of this are to achieve a better allocation ofresponsibilities to providers on patients health, to incentive the organisationof medical self-managed health care institutions and to build global budgets onrisk-adjusting capitation and better integrated health care providers on acommunity basis.

Valoración del patrón sexualidad en las personas usuarias de los servicios sanitarios

Desde enfermería es necesario realizar una valoración integral del usuario de los servicios sanitarios. La persona es un ser biopsicosocial y se hace necesario una visión en su integridad. La sexualidad forma parte de nuestra vida cotidiana y es un aspecto fundamental en la vida de todos nosotros. Sin embargo, parece ser excluida por los profesionales de enfermería, cuando el usuario entra dentro del sistema de salud. Independientemente de la patología que sufra el sujeto de nuestros cuidados, la sexualidad está presente y forma parte de su vivencia personal y cotidiana. La influencia del sistema biomédico hace que muchas veces la sexualidad sea tratada desde la patogenia, obviando la valoración de una vivencia de una sexualidad saludable. La sexualidad es observada, en muchas ocasiones desde una perspectiva únicamente heterosexual, o ligada únicamente a la reproducción, negando con esta actitud la vivencia de una sexualidad a muchos de nuestros pacientes. Deberíamos ofrecer unos cuidados integrales y holísticos, pero tanto en la formación enfermera como en la práctica, en muchas ocasiones, excluimos el patrón sexualidad, convirtiéndolo así en un tema tabú.A través de un estudio cuantitativo, no experimental descriptivo y transversal se pretende conocer por qué las enfermeras y enfermeros no exploramos suficientemente el patrón de sexualidad de los usuarios y cuáles son las causas que nos impiden hacerlo. El estudio se realizará a partir de un cuestionario, distribuido entre los enfermeros y enfermeras de los diferentes servicios sanitarios del parc de salut mar.

Intervenció educativa per a la millora de la detecció precoç de la depressió major en adolescents

La depressió major és una patologia mental que afecta a persones de qualsevol edat, condició econòmica, nivell educatiu, cultural i suposen un gran cost per l’individu, la família, el sistema sanitari i la comunitat en general. Es creu que una de cada cinc persones arribarà a desenvolupar un trastorn depressiu al llarg de la seva vida i que al 2020 serà la segona causa de discapacitat i de pèrdua d’anys de vida saludables a escala mundial i la primera en països desenvolupats. L’objectiu d’aquest estudi quasi experimental és millorar la detecció precoç de la simptomatologia depressiva en adolescents, descriure els factors de risc i atendre les necessitats d’aquests joves. Utilitzarem el Test de Beck Depression Inventory-2nd (BDI-II) i el Patient Health Questionnaire-Adolescent version (PHQ-9) per detectar l’estat de salut mental dels alumnes. No tenim la certesa de que la mostra sigui representativa, ja que escollim un grup intacte d’alumnes de 1r d’ ESO, del municipi de Cardedeu, amb una edat per norma general de 12 -13 anys i per tant, potser una amenaça per la nostra validació ja que el factor entorn influeix directament en la situació sociodemografica de la població escollida, la situació econòmica i familiar.

The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study

It is well known that hospital malnutrition is a highly prevalent condition associated to increase morbidity and mortality as well as related healthcare costs. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regional or even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown in Spain. The PREDyCES® (Prevalence of hospital malnutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs. Some aspects made this study unique: a) It was the first study in a representative sample of hospitals of Spain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System.

Abordaje en las heridas de difícil cicatrización

Los conocimientos sobre la cicatrización han evolucionado de forma importante en las últimas dos décadas. Gracias a ello, actualmente es posible predecir la secuencia probable de acontecimientos que tendrán lugar a lo largo de la cicatrización y pronosticar el tiempo aproximado que tardará una herida, pero a menudo, durante la práctica clínica, y a pesar del mayor conocimiento y desarrollo de intervenciones, muchos profesionales de enfermería se enfrentan a diario ante heridas de difícil cicatrización, es decir, la cicatrización se prolonga en el tiempo o no se llega a alcanzar. Estos esfuerzos pueden provocar al profesional un aumento del estrés psicosocial y ansiedad, convirtiéndose en una carga financiera importante para el sistema de salud, ya de por sí, tan necesitado en los tiempos actuales. Estas heridas complejas siguen siendo en la actualidad un problema prevalente y de especial atención en salud, que afecta a pacientes en todos los niveles asistenciales y de todas las clases sociales. Requieren un compromiso de todos los profesionales de salud respecto a la prevención y atención de las mismas hasta el punto final de la cicatrización, por lo que los profesionales sanitarios, deben potenciar avances y conocimientos que permitan un cambio radical en la atención de estas lesiones.