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The chapter provides an account of the changing role played by active labour market policies (ALMPs) in Europe since the post-war years. Focusing on six countries (Sweden, Denmark, France, Germany, Italy, and the United Kingdom), it shows that the role of ALMPs is related to the broad economic situation. At times of rapid expansion and labour shortage, like the 1950s and 1960s, their key objective was to upskill the workforce. After the oil shocks of the 1970s, the raison d'être of ALMPs shifted from economic to social policy, and since the mid-1990s, we see the development of a new function, well captured by the notion of activation, which refers to the strengthening of work incentives and the removal of obstacles to employment, mostly for low-skilled people. The adequacy between economic context and policy is not always optimal, though. Like other ones, this policy domain suffers from inertia, with the result that the countries that have led the way in one period have more difficulty adapting to the economic conditions prevailing in the following one.

"The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology.

BACKGROUND Only multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance. METHODOLOGY/PRINCIPAL FINDINGS Pre-post intervention study of HH performance at baseline (October 2007-December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: "3/3 strategy"); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2-80.7) vs 84.6% (95% CI:83.8-85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time ("positive": 90.1% as highest HH compliance coinciding with the "World hygiene day"; and "negative":73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding). CONCLUSIONS/SIGNIFICANCE CQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive and negative) and to help establishing adequate feedback to healthcare workers.

Las subvenciones, instrumento para la participación en salud

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

National Health System Virtual Library Viability Project (Spain)

Introduction: The ICT progress and development are making the set up of virtual libraries easier, with great advantages for users in terms of immediate access to vast amounts of library information, online resources, and services. Most of the Autonomous Spanish Regions are presently working on the establishment of virtual libraries with the aim of optimising economic resources destined to subscribe bibliographic information sources and offering qualified documentary services to Public Health System Professionals. The Ministry of Health and Social Policy, an institution unifying health matters, issued this Project to study the National Health System Virtual Library creation viability, in order to guarantee relevant scientific information access equity. Objectives: - To study the National Health System (NHS) Virtual Library set up viability. - To elaborate the Spanish territory health information resource map. - To identify the appropriate technological model. - To identify the documentary services to be offered. - To identify the more optimum functional, structural model. - To identify the economic model. Method: - To create a chart organization for the project´s management. - To organize Work groups. - To elaborate a standardised survey model for the libraries of the autonomous regions. Results: - Identification of the different Autonomous Region libraries of health models. - Recommendations for the NHS Virtual Library: - Functional, structural model - Technological model - Financial-economic model Conclusions: The fact that the Virtual Library would be an invaluable space for access to quality scientific information, as well as that the minimum services could be offered to every NHS user regardless of geographical situation, is confirmed. Accordingly, we thought about three different models to develop the Virtual Library, depending on this initial analysis, which will allow us to establish the most suitable model for the Spanish National Health System, considering its economic, functional and technological recommendations. It would be necessary to do a study for the NHS Virtual Library Set Up following the recommendations arising from this Project.

Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial.

BACKGROUND Pressure ulcers are considered an important issue, mainly affecting immobilized older patients. These pressure ulcers increase the care burden for the professional health service staff as well as pharmaceutical expenditure. There are a number of studies on the effectiveness of different products used for the prevention of pressure ulcers; however, most of these studies were carried out at a hospital level, basically using hyperoxygenated fatty acids (HOFA). There are no studies focused specifically on the use of olive-oil-based products and therefore this research is intended to find the most cost-effective treatment and achieve an alternative treatment. METHODS/DESIGN The main objective is to assess the effectiveness of olive oil, comparing it with HOFA, to treat immobilized patients at home who are at risk of pressure ulcers. As a secondary objective, the cost-effectiveness balance of this new application with regard to the HOFA will be assessed. The study is designed as a noninferiority, triple-blinded, parallel, multi-center, randomized clinical trial. The scope of the study is the population attending primary health centers in Andalucía (Spain) in the regional areas of Malaga, Granada, Seville, and Cadiz. Immobilized patients at risk of pressure ulcers will be targeted. The target group will be treated by application of an olive-oil-based formula whereas the control group will be treated by application of HOFA to the control group. The follow-up period will be 16 weeks. The main variable will be the presence of pressure ulcers in the patient. Secondary variables include sociodemographic and clinical information, caregiver information, and whether technical support exists. Statistical analysis will include the Kolmogorov-Smirnov test, symmetry and kurtosis analysis, bivariate analysis using the Student's t and chi-squared tests as well as the Wilcoxon and the Man-Whitney U tests, ANOVA and multivariate logistic regression analysis. DISCUSSION The regular use of olive-oil-based formulas should be effective in preventing pressure ulcers in immobilized patients, thus leading to a more cost-effective product and an alternative treatment. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01595347.

Continuity and change in the gender segregation of the medical profession in Britain and France

It is a well established fact that the entry of women into higher-level professional occupations has not resulted in their equal distribution within these occupations. Indeed, the emergence and persistence of horizontal and vertical gender segregation within the professions has been at the heart of the development of a range of alternative theoretical perspectives on both the "feminisation process" and the future of the "professions"more generally. Through an in-depth comparative analysis of the recent changes in the organisation and administration of the medical profession in Britain and France, this paper draws upon statistical data and biographical interviews with male and female general practitioners (GPs) in both countries in order to discuss and review a variety of approaches that have been adopted to explain and analyse the "eminisation" process of higher-level professions. Our conclusions review the theoretical debates in the light of the evidence we have presented. It is argued that, despite important elements of continuity in respect of gendered occupational structuring in both countries, national variations in both professional and domestic gendered architectures lead to different outcomes as far as the extent and patterns of internal occupational segregation are concerned. Both female and male doctors are currently seeking - with some effect - to resist thepressures of medicine on family life.

Who benefits from parental leave in Spain? : a life course analysis

This paper analyses the extent to which individual and workplacecharacteristics and regional policies influence the use and duration ofparental leave in Spain. The research is based on a sample of 125,165people, and 6,959 parental leaves stemming from the ‘Sample ofWorking Life Histories’ (SWLH), 2006. The SWLH consists of administrative register data which include information from threedifferent sources: Social Security, Municipality and Income TaxRegisters. We adopt a simultaneous equations approach to analyse theuse (logistic regression) and duration (event history analysis) ofparental leave, which allows us to control for endogeneity and censoredobservations. We argue that the Spanish parental leave scheme increases gender and social inequalities insofar as reinforces genderrole specialization, and only encourages the reconciling of work andfamily life among workers with a good position in the labour market(educated employees with high and stable working status).

Do welfare benefits affect womens' choices of adult care giving?

The efficacy of social care, publicly and universally provided, has been contested from two different points of view. First, advocates of targeting social policy criticized the Matthew’s effect of universal provision and; second, theories arguing in favour of heterogeneous rationalities between men and women and, even different preferences among women, predict that universal provision of services is limiting women’s choices more than home allowances. The author tests both hypotheses and concludes that, at least in the case of adult care, women’s choices are significantly affected by women’s social positions and by the availability of public services. Furthermore, targeting through means-test eligibility criteria has no significant effect on inequality but, confirming the redistributive paradox, reduces women’s options.

Urban mobilities: the anglo-catalan production of the Barcelona model

The aim of the project was to gauge the extent to which the so-called ‘Barcelona Model’ of urban transformation has been ‘exported’ to Britain and whether Barcelona has learned from British cities. We engage with the literature on successive British governments’ strategies for cities, focused on collecting data on contemporary policy initiatives and debates in the UK, did interviews in Manchester, London Barcelona and participated in the official visit of Leeds to Barcelona in March. Our research findings to date suggest that there is a good deal of mobility and interaction between Barcelona and the UK. However, it is by no means certain that this has resulted in definite instances of policy transfer. While the ‘Barcelona model’ has indeed featured in oficial discourse on urban regeneration in the UK, it does not appear to be the preferred best practice ‘model’ – other North American and European cities figure discursively as much, if not more. Where Barcelona does feature in official discourse, it is usually as an example of good design and an appealing urban aesthetic, rather than in terms of economic or social policy best practice. Our research suggests that the Barcelona model is seen as non-transferable to the UK due to the relatively more centralised governance structure therein.In contrast, evidence collected suggests that the Barcelona model is not influenced by UK British cities experiences but there is small evidence of being influenced by UK-based professionals.

The drift of public spending towards the elderly: A generational analysis of the trend of public policies in Spain

The tendency for public welfare spending to be increasingly aimed at the elderly has been pointed out for the US and other developed countries. While population ageing is a common trend, it is not obvious why the shift in spending exceeds the trend in ageing, or why per capita spending on the elderly increases.We show that this is the case in Spain, identify the losers from this development, discuss the policies that underlie this trend, and propose adjustments based on Musgrave s fixed proportions rule as an inter-generationally fair distribution.

Trade-off between formal and informal care in Spain

The remarkable growth of older population has moved long term care to the front ranks of the social policy agenda. Understanding the factors that determine the type and amount of formal care is important for predicting use in the future and developing long-term policy. In this context we jointly analyze the choice of care (formal, informal, both together or none) as well as the number of hours of care received. Given that the number of hours of care is not independent of the type of care received, we estimate, for the first time in this area of research, a sample selection model with the particularity that the first step is a multinomial logit model. With regard to the debate about complementarity or substitutability between formal and informal care, our results indicate that formal care acts as a reinforcement of the family care in certain cases: for very old care receivers, in those cases in which the individual has multiple disabilities, when many care hours are provided, and in case of mental illness and/or dementia. There exist substantial differences in long term care addressed to younger and older dependent people and dependent women are in risk of becoming more vulnerable to the shortage of informal caregivers in the future. Finally, we have documented that there are great disparities in the availability of public social care across regions.

Estudi sobre el perfil de persones grans amb dependència del servei d'ajuda a domicili del Consell Comarcal d'Osona i el tipus de suport formal i informal

The aim of this study is to determine the profile of dependent elderly people users of the home care services (SAD) of the regional council in Osona (Consell Comarcal d´Osona) , and the characteristics of formal and informal types of support they use. Methodology. An observational study of a transversal format has been carried out, with retrospective and descriptive purposes. The target population is 63 people (26 men and 37 women) included in the program of the regional SAD They have a recognized dependence grade approved by the law 39 /2006, December 14th , promoting the individual autonomy and care of elderly people in a dependent situation. The data were collected by social workers of basic social services, first with a home visit and followed by handed out questionnaires, specifically designed for this study, in order to obtain information on socio-demographic characteristics, and the type of support formal and informal. The obtained results on the SAD users are women in a 58.7% and a 41.3 % are men. The 84% of the total sampling are 80 years old and more, being the average age of 85.2 years old. 45% of them are married, 41% are widows and widowers and 14% are single. 54% are rated with severe dependence (grade II), 42.8% with high dependence (grade III). 86% live accompanied. 100% have an informal caregiver and a 95% of the times, the caregiver is a relative who in 73% of the cases the dedication time is permanent. The coverage of the SAD has an average of 4.27 hours per week and per user. The formal services most used are the technical (62%), also the assessment of an occupational therapist at home (57%) and the telecare service in a (56%). Conclusions. The SAD is used primarily for women in an advanced age and severe dependence. The informal assistance structures have an informal caregiver, being a member of the family mostly, living with the dependent, and mainly in a permanent dedication basis. The SAD has a varied intensity in each case. The formal support services complementary to the SAD, are largely used in all cases.

Consideraciones educativas de la perspectiva ecológica de Urie Bronferbrenner

El objetivo de este artículo es presentar las bases teóricas y algunas aplicaciones contemporáneas de la teoría de Urie Bronfenbrenner. En primer lugar, se describe su biografía. Posteriormente, se explica su teoría ecología, su modelo “Proceso-Persona-Contexto-Tiempo” (PPCT) y su reciente aproximación bioecológica. A continuación, exponemos algunas consideraciones educativas de su teoría. Más específicamente, destacamos seis temas basados en algunas ideas de Bronfenbrenner: 1) la relación entre política social y ciencia, 2) la creación de contextos de desarrollo primarios y secundarios, 3) la implicación afectiva, 4) el currículo centrado en el cuidado o la atención de las personas, 5) la intervención comunitaria, y 6) el establecimiento de continuidades entre microsistemas (noción de “mesosistema”). Finalmente, revisamos algunas aportaciones contemporáneas en psicología y ciencias de la educación basadas en la perspectiva de Bronfenbrenner

Socio-economic inequalities in reported depression in Spain : a decomposition approach

Recent evidence questions some conventional view on the existence of income-related inequalities in depression suggesting in turn that other determinants might be in place, such as activity status and educational attainment. Evidence of socio-economic inequalities is especially relevant in countries such as Spain that have a limited coverage of mental health care and are regionally heterogeneous. This paper aims at measuring and explaining the degree of socio-economic inequality in reported depression in Spain. We employ linear probability models to estimate the concentration index and its decomposition drawing from 2003 edition of the Spanish National Health Survey, the most recent representative health survey in Spain. Our findings point towards the existence of avoidable inequalities in the prevalence of reported depression. However, besides ¿pure income effects¿ explaining 37% of inequality, economic activity status (28%), education (15%) and demographics (15%) play also a key encompassing role. Although high income implies higher resources to invest and cure (mental) illness, environmental factors influencing in peoples perceived social status act as indirect path as explaining the prevalence of depression. Finally, we find evidence of a gender effect, gender social-economic inequality in income is mainly avoidable.

Educational expansion, intergenerational mobility and over-education

[eng] There is a vast literature on intergenerational mobility in sociology and economics. Similar interest has emerged for the phenomenon of over-education in both disciplines. There are no studies, however, linking these two research lines. We study the relationship between social mobility and over-education in a context of educational expansion. Our framework allows for the evaluation of several policies, including those affecting social segregation, early intervention programs and the power of unions. Results show the evolution of social mobility, over-education, income inequality and equality of opportunity under each scenario.