Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study

Background: Despite the progress made on policies and programmes to strengthen primary health care teams’ response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. Methods: A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems’ managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. Results: This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. Conclusions: The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This process has been supported, but not caused, by a favourable policy for integration of a health care response to IPV. Specific contextual factors of La Virgen facilitated the uptake of the policy. To some extent, the performance of La Virgen has the potential to shape the IPV learning processes of other primary health care teams in Murcia.

A public-professional web-bridge for vaccines and vaccination: User concerns about vaccine safety

Vacunas.org (http://www.vacunas.org), a website founded by the Spanish Association of Vaccinology offers a personalized service called Ask the Expert, which answers any questions posed by the public or health professionals about vaccines and vaccination. The aim of this study was to analyze the factors associated with questions on vaccination safety and determine the characteristics of questioners and the type of question asked during the period 2008–2010. A total of 1341 questions were finally included in the analysis. Of those, 30% were related to vaccine safety. Questions about pregnant women had 5.01 higher odds of asking about safety (95% CI 2.82–8.93) than people not belonging to any risk group. Older questioners (>50 years) were less likely to ask about vaccine safety compared to younger questioners (OR: 0.44, 95% CI 0.25–0.76). Questions made after vaccination or related to influenza (including H1N1) or travel vaccines were also associated with a higher likelihood of asking about vaccine safety. These results identify risk groups (pregnant women), population groups (older people) and some vaccines (travel and influenza vaccines, including H1N1) where greater efforts to provide improved, more-tailored vaccine information in general and on the Internet are required.

Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis

Background: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. Methods: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15–64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). Results: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24–1.56, PR2012 = 1.56; 95% CI: 1.33–1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86–1.40, PR2012 = 1.34; 95% CI: 1.06–1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11–0.43, PR2012 = 1.20; 95% CI: 0.73–2.01). Conclusions: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants’ health status.

Intimate partner violence among women in Spain: the impact of regional-level male unemployment and income inequality

Background: Intimate partner violence (IPV) against women is a complex worldwide public health problem. There is scarce research on the independent effect on IPV exerted by structural factors such as labour and economic policies, economic inequalities and gender inequality. Objective: To analyse the association, in Spain, between contextual variables of regional unemployment and income inequality and individual women’s likelihood of IPV, independently of the women’s characteristics. Method: We conducted multilevel logistic regression to analyse cross-sectional data from the 2011 Spanish Macrosurvey of Gender-based Violence which included 7898 adult women. The first level of analyses was the individual women’ characteristics and the second level was the region of residence. Results: Of the survey participants, 12.2% reported lifetime IPV. The region of residence accounted for 3.5% of the total variability in IPV prevalence. We determined a direct association between regional male long-term unemployment and IPV likelihood (P = 0.007) and between the Gini Index for the regional income inequality and IPV likelihood (P < 0.001). Women residing in a region with higher gender-based income discrimination are at a lower likelihood of IPV than those residing in a region with low gender-based income discrimination (odds ratio = 0.64, 95% confidence intervals: 0.55–0.75). Conclusions: Growing regional unemployment rates and income inequalities increase women’s likelihood of IPV. In times of economic downturn, like the current one in Spain, this association may translate into an increase in women’s vulnerability to IPV.

Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches

Background. Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. Methods. A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. Results. The emerging programme theory highlighted the importance of the combination of each team’s self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Conclusions. Interventions to improve primary health care teams’ response to intimate partner violence should focus on strengthening team’s self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged.

Marketing de proximidad en la empresa de franquicia

Se analiza la implantación de las estrategias del Marketing de Proximidad en las Empresas de Franquicia españolas y extranjeras, en España. Parte de dos hipótesis: 1. la empresa de franquicia tiene poco aprovechada su web; 2. la empresa de franquicia tiene una alta presencia en los espacios 2.0, generando herramientas que le permiten una rápida y eficaz interacción con sus consumidores. El objetivo es describir y analizar los recursos utilizados para interactuar con sus clientes finales, centrándose en el estudio de la presencia en medios sociales. Para la recogida de información se ha utilizado un cuestionario estructurado. Los principales resultados muestran que la empresa de franquicia posee una web corporativa escasamente aprovechada como herramienta de comunicación con su público. Se observa una gran presencia en canales 2.0, gestionados mayoritariamente por un Community Manager.

No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain

Background: Spain’s financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period. Methods: An ecological longitudinal study was carried out in Spain’s 17 regions. Two study periods were defined: pre-crisis period (2005–2007) and crisis period (2008–2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design. Results: Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008. Discussion: The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates. Conclusions: The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

The regulation of professional advertising practices in Spain, 1988–2013

From the perspective of the sociology of professions, every professional activity should have its own clearly circumscribed and regulated sphere of action. Such an articulation facilitates the regulation of the production of a given profession as well as the way in which it is practiced. The purpose of the research reported here was to provide a comprehensive review and evaluation of the regulatory framework governing the advertising sector in Spain. To this end, the authors analysed external regulatory legislation and self-regulatory codes extracted from the data base of the Asociación para la Autoregulación de la Comunicación Comercial (Autocontrol) that had been enacted or adopted between 1988, the year that Law 11/1998 on General Telecommunications entered into force, and 2003 as well as other relevant documents retrieved from the Boletin Oficial del Estado (BOE) pertaining to the same period. Findings indicate that although there has been a groundswell of legislation governing advertising practices in Spain since 1988, especially at the regional level, lawmakers have focused on the content of advertising messages and shown very little interest in regulating the professions of advertising and public relations. Furthermore, Spanish legislation enacted in 2003 and EU policies appear to have encouraged the adoption of voluntary codes of ethics. Sectors traditionally subject to mandatory advertising regulation, either due to the vulnerability of their target audiences or the potential impact of their commercial messages on public health or the environment, are more likely to develop self-regulatory codes of conduct than others

High Speed Rail Passenger Profile in Sun and Beach Tourism Destinations: The Case of Alicante (Spain)

This paper aims to study and highlight the profile of the high speed rail (HSR) passenger in the case of the well-known sun and beach destination of Alicante, located in the Southeast of Spain. This region, which is directly connected with Madrid, differs from others because of its warm and sunny weather. The province is a tourist destination for both Spanish citizens and foreigners. However, the studies on the dynamics of the corridor towards Madrid and Alicante regarding HSR are quite recent and it is not possible to draw final conclusions about its impact on tourist mobility.

Zoning and Open Spaces, Washington, D.C., 1936 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Base map of the District of Columbia showing public and zoning areas, base prepared in the Office of the Surveyor, D.C., by direction of the Engineer Commissioner, D.C. It was published by Engineer Commissioner in 1936. Scale [ca. 1:19,200]. Base map "complete to June 13, 1933." The image inside the map neatline is georeferenced to the surface of the earth and fit to the Maryland State Plane Coordinate System Meters NAD83 (Fipszone 1900). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as residential areas, open spaces, commercial and industrial areas, alley dwelling areas, roads, block numbers, railroads and stations, drainage, selected public buildings and points of interest, parks, cemeteries, and more. This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

The euro area's tightrope walk: debt and competitiveness in Italy and Spain. Bruegel Policy Contribution 2013/11, September 2013

Competitiveness adjustment in struggling southern euro-area members requires persistently lower inflation than in major trading partners, but low inflation worsens public debt sustainability. When average euro-area inflation undershoots the two percent target, the conflict between intra-euro relative price adjustment and debt sustainability is more severe. In our baseline scenario, the projected public debt ratio reduction in Italy and Spain is too slow and does not meet the European fiscal rule. Debt projections are very sensitive to underlying assumptions and even small negative deviations from GDP growth, inflation and budget surplus assumptions can easily result in a runaway debt trajectory. The case for a greater than five percent of GDP primary budget surplus is very weak. Beyond vitally important structural reforms, the top priority is to ensure that euro area inflation does not undershoot the two percent target, which requires national policy actions and more accommodative monetary policy. The latter would weaken the euro exchange rate, thereby facilitating further intra-euro adjustment. More effective policies are needed to foster growth. But if all else fails, the European Central Bank’s Outright Monetary Transactions could reduce borrowing costs.

Autonomy in the global era: Euro-regionalism and new policy spaces in education. ACES Working Papers, August 2010

Framed by a critical discussion of methodological nationalism, this paper explores the intersection of new and evolving regional, central state, and supranational education policy spaces through examples drawn from post-Franco Spain. This work is situated within the broader literature on the development of a European Education Policy Space, which aims to understand changing governance structures in European education (cf. Grek et al., 2009; Lawn & Lingard,2002; N6voa & Lawn, 2002). Using policy documents since 2000 and interview data, the paper first examines Spanish and regional (Catalan) education policy related to devolution, namely Catalonia's recently revised Statute of Autonomy. The paper then places devolution in Spain and Catalonia in a broader context of Euro-regionalism, which has deepened and legitimized regional autonomy. Together these shifts in educational governance and the development of new education policy spaces have promoted a concept of the multi-scalar, European "ideal citizen" (Engel & Ortloff, 2009). The last section presents an overview of the recent influx of immigrants into Catalonia and Spain, exploring whether and to what extent recent education policy promoting the "ideal citizen" has taken non-European immigrants into account.

The Labour Market in Spain: Problems, Challenges and Future Trends. Policy Brief #2015/01

Spain’s economy was hit particularly hard by the financial crisis. After severe austerity measures have been implemented in recent years to contain a strong public debt increase, first signs of economic recovery are emerging. However, as SIM Europe results show, very few measures to soften the social consequences have been enacted. Spain scores second to last in the ‘Labour Market Access’ dimension of the Social Justice Index 2015, with the greatest deterioration among all EU countries compared to 2008. According to the Reform Barometer 2015, the quality of labour market reforms in Spain ranks last in the EU. With economic recovery gaining momentum, high priority should be given to ameliorating labour market access through higher education improvements, professional training, investments into R&D and promotion of high added-value industries.

Cadastro do Património Arbóreo da Cidade de Portalegre – Conceção de um Sistema de Informação Geográfico

Os meios urbanos são espaços cada vez mais edificados, compactos e com solos impermeabilizados, onde a ausência ou reduzida presença de espaços verdes é uma realidade. Os elementos arbóreos, qualquer que seja a sua disposição, ganham cada vez mais significado enquanto representantes do meio natural na conservação da qualidade e conforto de vida nas cidades. Este trabalho desenvolveu-se a partir do tema das árvores em meio urbano, tendo por base os benefícios das árvores nas cidades, a sua distribuição espacial e o estado de conservação deste tipo de património. O principal fio condutor passou pela concepção do inventário do Património Arbóreo da cidade de Portalegre, com recurso às novas tecnologias da informação, nomeadamente os Sistemas de Informação Geográfica, capaz de se integrar nos sistemas homólogos do Município de Portalegre. O inventário à escala do perímetro urbano da cidade de Portalegre contabilizou 2087 elementos arbóreos localizados em áreas públicas, dos quais 1500 são árvores de folha caduca e 587 são perenifólias. Registou-se um elevado índice de diversidade para aquela área, cerca de 705 árvores/km2, embora as árvores estejam distribuídas de forma heterogénea pelo território considerado, percebendo-se com isso as zonas de carência de arborização. Com este inventário foi ainda possível conceber uma avaliação económica segundo a Norma de Granada, de 13 árvores isoladas e uma alameda com 38 indivíduos, assim como propor a classificação destes elementos a Árvores de Interesse Público. Anseia-se que este trabalho seja um documento informativo e sensibilizador de todo o público em geral, mas principalmente que se assuma como uma ferramenta útil aos responsáveis pelos espaços verdes da cidade de Portalegre.

Working in confined spaces.

Mode of access: Internet.