Análisis del modelo salutogénico en España: aplicación en salud pública e implicaciones para el modelo de activos en salud

This article seeks to provide an in depth review about one of the most revolutionary and influential methods used in understanding the variables and processes that explain human health. Based on a new vision in the analysis of the consequences of theNazi Holocaust, a doctor-sociologist—Aaron Antonovsky— managed to influence medicine and behavioral science by facilitating the keys for the optimal development of public health today. Despite the fact that this theory began appearing in the1970s in the 20th century, its real development and expansion have been seen in recent years. In fact, in Spain, there is littlescientific literature that analyses the theoretic keys of the model in depth. This work seek to cover this gap; to achieve this objective, it first presents how the construct of salutogenesis arose, the social-cultural context that promoted it, as well as the importance public health acquires today. This is the aim of this work, which analyses the theoretical bases of the salutogenesis model,with specific emphasis on its background and precursors, aswell as its inception, development and current expansion

Ética y muerte digna, historia de una ley : El proceso de regulación jurídica de la atención sanitaria al final de la vida en Andalucía (España)

End-of-life healthcare in any part of the world is always rife with ethical conflicts and legal challenges. In this matter, the opinions and preferences of patients, family members, healthcare professionals, society as a whole and politicians may differ or diverge entirely1. Nevertheless, death comes to all eventually; it is part of human life itself. The fact remains that we will all die. Therefore, it is natural for all societies to seek the necessary consensus for guaranteeing that individuals can live, and die, in a way befitting their nature, i.e., humanely and with full dignity. This article tells the story of how the citizens of Andalusia, in the south of Spain, reached this majority consensus during the process of drafting and approving a law regulating this issue: Law 2/2010, of 8 April, on personal rights and guarantees to die in dignity.

Standardisation of the waist circumference (WC) for each range of body mass index (BMI) in adult outpatients attended to in Endocrinology and Nutrition departments

By this study we seek the expectable range of waist circumference (WC) for every degree of body mass index (BMI), which will serve to studies targeting ascertaining the health risk. We studied 2,932 patients (39.6% men and 60.4% women, between 18 and 96 years ) of the same ethnic group who consecutively attended outpatient departments of our clinics between 2000 and 2004. BMI correlated linearly with the WC (cc: 0.85; p < 0.001). The men, the obese, and diabetics were older (p < 0.001). BMI was greater in women and WC in men. The women had a greater WC if they had diabetes (p < 0.01), being equal to diabetic males. The men had greater WC when they had diabetes (p < 0.001). Waist at risk was detected (men > or = 102 cm and women > or = 88 cm) in 94.3% of the obese, in 32.3% of overweight patients, in 3.8% of patients with BMI < 25, in 84.3% of diabetics, and in 72.6% of patients without diabetes. We made graphic standardisation of WC with regard to BMI, and we calculated the percentiles 10, 25, 50, 75 and 90, grouping in ranges of 2 kg/m(2) of BMI. The diabetic patients are grouped in ranges of 4 kg/m(2). As conclusion we present a standardisation of the WC measurement of patients attended to in our Endocrinology and Nutrition practices distributed in percentiles as a clinically usable tool to define the ranges of WC for every BMI value.

Niveles de evidencia clínica y grados de recomendación.

An update of the levels of scientific evidence stating the varying degrees of recommendation for asymptomatic patients, indicating which procedures are most appropriate and what should be avoided all the systems described, we seek one that meets the principle of simplicity and utility. We chose for our setting the valuation of the Centre for Evidence-Based Medicine, Oxford (OCEBM). This classification has the advantage that assures us the knowledge on each scenario, its high degree of specialization. It also has the prerogative to clarify how it affects the lack of methodological rigor to the study design, reducing its assessment not only in the grading of the evidence, but also on the strength of recommendations.

Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]

BACKGROUND Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment of painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). METHODS/DESIGN Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. DISCUSSION The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis.