Health impact assessment of local policies: methodology and tools.

The aim of this work was to design some tools and a procedure for performing the Health Impact Assessment of municipal policies. A working group made up of municipal and public health specialists from the Valencian Community (Spain) was set up. After reviewing the tools used in other contexts, the Fem Salut? questionnaire for the simplified Health Impact Assessment of regional policies was adapted for use at the local level. A pilot study was carried out in six municipalities and local initiatives promoted by different sectors were analysed. Two workshops were held per municipality (with specialists and with citizens) and participatory techniques were used to identify the possible impacts on the social determinants of health, the population groups more particularly affected and the proposals for improvement. The feasibility of the methodology and the difficulties involved in carrying it out were discussed. A procedure was defined for the Health Impact Assessment of local initiatives in six steps: Describe (the municipality and the project), Extract (screening phase), Co-produce (participatory workshops), Integrate (the scientific evidence with the qualitative information obtained), Disseminate (to politicians, specialists and community) and Evaluate (direct and indirect results) (DECIDE). A guide was developed to facilitate its application at the local level along with two complementary tools (a questionnaire and worksheets). The technical group rated the process as simple and flexible, as well as being easy to adapt to the characteristics of the municipality and project. In addition to the cross-sectoral approach, the incorporation of citizen participation in the process is an important added value.

[Health in all policies in the Valencian Community: steps towards the health impact assessment]. / Salud en todas las políticas en la Comunitat Valenciana: pasos hacia la evaluación del impacto en salud.

This paper describes the beginning of the implementation process of the health impact assessment in the Valencian Community (Spain), as an instrument to incorporate the framework of social determinants and health inequalities in the policies issued by the different departments of the Valencian government. The proposal involves: 1) political commitment, with legislative and strategic planning actions; 2) the creation of structures to allow intersectoral collaboration, with the establishment of the health impact assessment commission and the intersectoral technical committee; and 3) the design and validation of a tool for the simplified health impact assessment of non-health policies adapted to the Valencian Community. We highlight the importance of the participatory methodology used in the whole process and the potential of the health impact assessment for the development of public policies oriented to improve health and equity.

[Inequities in mental health: admissions for psychosis in public hospitals of the Comunitat Valenciana (2008-2015)]. / Desigualdades en salud mental: Los ingresos por psicosis en hospitales públicos de la Comunitat Valenciana (2008-2015).

OBJECTIVE: The prevalence of mental health problems is increasing throughout the world. Certain population groups have more probability to suffer mental disorders, which may generate inequities in health. The main of this paper is analyze the differences in the frecuency of hospital admissions according to different inequities dimensions (age, sex and country of birth) of the populaion between 15 and 49 years old between 2008 and 2015 in the Comunitat Valenciana (Spain). METHODS: Transversal study based on all admissions for Diagnosis-related group "Psychosis" in public centers in the Comunitat Valenciana. Sources of information were Minimum Basic Data Set and Population Information System. Descriptive analysis of clinical and social variables was conducted, and differences among subgroups were analyzed by t-Student test for the comparison of a quantitative variable and χ2 test for the comparison of a qualitative variable, as well as the exact Wilcoxon and the Fisher test when application conditions were not satisfied. RESULTS: there were studied 23869 admissions for psychosis generated by 11265 patients. Most of these admissions were because of schizophrenia disorders (39.44%). When comparing by sex, differences in diagnosis were observed, being more frequent psychotic mood disorders in women (39.3%). There also observed differences when comparing by country of birth, being more frequent "Other non-organic psychosis" in foreign people (40.5%). Differences were found regarding mortality during admission, being higher in men (5.1% vs. 4%) and in foreign people (5.3% vs. 3.8%). CONCLUSIONS: There have been detected inequities in the frequency of psychosis admissions in the Comunitat Valenciana. These differences are observed around different dimensions such as age, gender and country of origin.

OBJETIVO: La prevalencia de problemas de salud mental está aumentando en todo el mundo. Ciertos grupos poblacionales tienen mayor probabilidad de padecer trastornos mentales, generando desigualdades en salud. El objetivo de este trabajo fue analizar las diferencias en la frecuencia de ingresos por psicosis según diferentes dimensiones de desigualdad (edad, sexo y país de nacimiento) de la población entre 15 y 49 años en los años 2008- 2015 en la Comunitat Valenciana. METODOS: Estudio transversal basado en los ingresos hospitalarios por el Grupo Relacionado por el Diagnóstico "Psicosis" en centros públicos de la Comunitat Valenciana. Las fuentes de información fueron el Conjunto Mínimo Básico de Datos y el Sistema de Información Poblacional. Se realizó un análisis descriptivo de variables clínicas y sociodemográficas y se analizaron diferencias por subgrupos poblacionales mediante el test t- Student para la comparación de una variable cuantitativa y el test χ2 para la comparación de una variable cualitativa, así como el test exacto de Wilcoxon y el test de Fisher cuando no se cumplían condiciones de aplicación. RESULTADOS: Se estudiaron 23.869 ingresos por psicosis generados por un total de 11.265 personas. La mayoría fueron debidos a trastornos esquizofrénicos (39,44%). Se observaron diferencias en cuanto al diagnóstico al comparar por sexo, siendo más frecuente en mujeres los trastornos episódicos del humor (39,3%) y por país de nacimiento, siendo el diagnóstico principal de "Otras psicosis no orgánicas" el más frecuente en las personas extranjeras (40,5%). Se encontraron diferencias respecto a la mortalidad durante el ingreso, siendo más alta en hombres (5,1% vs. 4%) y en población extranjera (5,3% vs. 3,8%). CONCLUSIONES: Se han detectado desigualdades en las frecuencias de ingresos por psicosis en la Comunitat Valenciana. Estas diferencias se observan en torno a distintas dimensiones como son la edad, el género y el país de origen.

[An open heart: experiences of the parents of children with congenital heart disease]. / A corazón abierto: vivencias de madres y padres de menores con anomalías congénitas cardiacas.

OBJECTIVE: To explore, from a gender perspective, the experiences of mothers and fathers of children with congenital heart disease at the time of diagnosis, including the opinions of medical staff taking care of these children and their families. METHODS: Qualitative research. Four individual interviews with medical staff and four focus groups with mothers and fathers living in Valencia Region (Spain) were carried out. Participants were selected by purposive sampling. The discourse analysis was triangulated between techniques and researchers and the results were verified with mothers, fathers and medical staff. RESULTS: Mothers and fathers differed in the way they expressed their emotions and in how they accepted the diagnosis of a serious illness in their child. However, both parents expressed the need for psychological support and highly appreciated the informal support from other parents with similar experiences. CONCLUSIONS: The experience of the disease in a child is experienced differently by mothers and fathers. Health servies should pay attention to the psychological well-being of families, by including peer support groups and patient associations, which can play an important role as health assets.

Inequalities in perinatal mortality rates among immigrant and native population in Spain, 2005-2008.

We compared perinatal mortality rates (PMRs) and the risk from certain causes among immigrant and native population in the Valencian Community (Spain). Using data from the Perinatal Mortality Registry, crude and age standardized mortality ratios were obtained in the different groups of mothers. Mortality rate ratios were calculated to compare the causes of death resulting from prematurity, congenital anomalies, infectious diseases and Sudden Infant Death Syndrome between Spanish and foreign women. PMRs were higher among all the immigrant groups compared with the native population, with a statistical significance in Eastern European and sub-Saharan mothers. Neonatal mortality rates in North African and Latin American mothers were similar to those of native women. Babies of immigrant mothers were at a significant higher risk of dying from late infectious diseases and from causes resulting from being premature. More research is needed on the risk factors which contribute to generating differences in our setting.

Perceptions and experiences of parenthood and maternal health care among Latin American women living in Spain: a qualitative study.

OBJECTIVE: to explore the experiences and perceptions of parenthood and maternal health care among Latin American women living in Spain. DESIGN: an exploratory qualitative research using focus groups and thematic analysis of the discussion. SETTING AND PARTICIPANTS: three focus groups with 26 women from Bolivia and Ecuador and three focus groups with 24 midwives were performed in three towns in the Valencian Community receiving a large influx of immigrants. FINDINGS: the women interpreted motherhood as the role through which they achieve fulfilment and assumed that they were the ones who could best take care of their children. They perceived that men usually make decisions about sex and pregnancy and recognised a poor or inadequate use of contraceptive methods in planning their pregnancies. Women reported that it was not necessary to go as soon and as frequently for health examinations during pregnancy as the midwives suggested. The main barriers identified to health-care services were linked to insecure or illegal employment status, inflexible appointment timetables for prenatal checkups and sometimes to ignorance about how public services worked. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: empowering immigrant women is essential to having a long-term positive effect on their reproductive health. Antenatal care providers should be trained to build maternity care that is culturally sensitive and responds better to the health needs of different pregnant women and their newborns.

[Women's satisfaction with the experience of childbirth: validation of the Mackey Childbirth Satisfaction Rating Scale]. / Satisfacción de las mujeres con la experiencia del parto: validación de la Mackey Satisfaction Childbirth Rating Scale.

OBJECTIVES: To determine the reliability and the content and construct validity of the Mackey Childbirth Satisfaction Rating Scale to measure women's satisfaction with labor and delivery. METHODS: The translation-back translation method was used to obtain an adapted version of the scale. For the validation study, a sample of 325 women who had delivered a healthy neonate through the vaginal route was selected. Data collection was performed using a self-administered questionnaire that included the modified scale, childbirth expectations, obstetric variables and sociodemographic characteristics. Reliability was assessed in a subsample of 45 women who completed the scale for the second time 15-30 days later. The factorial structure and internal consistency of the scale were analyzed. Construct validity was evaluated by analyzing the relationship between satisfaction with the experience, fulfillment of expectations and preferences regarding pain management. RESULTS: In the test-retest study, an intraclass correlation coefficient of 0.93 was obtained for the total scale. Factor analysis identified six factors that explained 69.42% of the variance. Cronbach's alpha coefficient was 0.94 for the total scale, ranging from 0.72 to 0.96 for the subscales. Satisfaction with the experience of childbirth was higher among women whose expectations were met and among those who accessed the pain relief method chosen. CONCLUSIONS: This scale is a useful instrument to measure women's satisfaction with the experience of childbirth, adapted to our context and with good psychometric properties.

[Neonatal thyrotropinemia (TSH) as an indicator of iodine nutritional level in Castellon and Valencia, Spain (2004-2006)]. / La tirotropinemia (TSH) neonatal como indicador del estado nutricional de yodo en Castellón y Valencia (2004-2006).

BACKGROUND: In the congenital hypothyroidism screening in populations with sufficient iodine intake, in the percentage of newborns with TSH values 5 mU/l must be less than 3%. This study is aimed at ascertaining the prevalence of iodine deficiency among the mothers and newborns in Castellon and Valencia and, secondly, to evaluate the bearing which the day on which the sample is taken and the use of iodized antiseptics may have. METHODS: The TSH value was studied in 91,853 newborns within the 2004-2006 period in Castellon and Valencia. The mean TSH values were compared considering the conditions defined by the WHO for analyzing the indicator: sampling at two days following birth and no use of antiseptics. The percentages of samples having TSH5 > mU/l.were calculated and compared. RESULTS: Among the samples having fulfilled the requirements for the analysis of the indicator, the prevalence of newborns having TSH5 > mlU/ showed a decrease from 2004 (2.2% CI95%:1.8%-2.6%), 2005 (2%; CI95%:1.6%-2.3%) and 2006 (1.7%; CI95%: 1.4%-2%). The mean TSH in samples of under 2 days was significantly higher (2.19 mlU/L; Q1-Q3: 1.35-3.40 as compared to 1.36 mlU/L; Q1-Q3: 0.78-2.21) (p<0,001). Considering the samples taken 2 days after birth, the use of antiseptics determined a significantly higher mean TSH (1.54 mlU/L; Q1-Q3: 0.88-2.50 as compared to 1.23 mlU/L; Q1-Q3: 0.72-1.97) (p< 0,001). CONCLUSIONS: The value of the newborn thyrotropinemia indicator in Castellon and Valencia is compatible with the WHO definition for populations having a proper iodine intake. Neonatal TSH screening is a good tool for monitoring the prevalence of iodine deficiency, but the point in time of the extraction must be suitable and the use of iodized perinatal antiseptics eliminated.