[Health literacy in childhood and adolescence: An overview and current state of research]. / Health Literacy bei Kindern und Jugendlichen : Ein Überblick über den aktuellen Forschungsstand.

BACKGROUND: Health literacy is multidisciplinary and brings together many concepts, and is of increasing importance for disease protection, health promotion, and prevention, and for health policy within Europe. Although its importance is increasingly recognised, adults are mostly the target audience, whereas children and adolescents, in addition to education and schools, have so far been neglected. OBJECTIVES: The aim is to give an overview of the state of the art in childhood and adolescence health literacy research, and to identify any existing gaps. MATERIALS: A literature review has been performed to identify the relevant research data. RESULTS: Limitations in developmental and age-adjusted conceptual frameworks and a lack of prevalence data, however, significantly impede our understanding of the meaning of health literacy in children and adolescents. School health promotion programmes could serve as a platform for effective health literacy education, beginning in early childhood. CONCLUSIONS: In addition to compatibility with a broader literacy perspective, the proximity to several theories of health promotion and defined concepts, and the importance of school health promotion and education, it is vital to focus research on current gaps in the understanding of health literacy determinants, health literacy as a determinant of health, and in terms of the design and systematic implementation of intervention programmes.

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999-2008.

Spain's immigrant population has increased 380% in the last decade, accounting for 13.1% of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999-2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (-17.8% for men and -16.6% for women) as well as in the foreign-born one (-45.9% for men and -35.7% for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Self-rated health and mortality: a follow-up study of a Spanish population.

OBJECTIVES: Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population. STUDY DESIGN: Longitudinal study. METHODS: A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations. RESULTS: Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability. CONCLUSIONS: SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

Vivienda social accesible: evaluación de costos / Accessible social home: cost evaluation

Introduction: Physical accessibility is considered a fundamental part in the exercise of rights and the development of independent living for people with a disability. One of the most important spaces where accessibility should be considered is the home. Accessibility is presumably associated to high construction cost therefore social homes do not incorporate this criteria. An evaluation is needed to verify this presumption. Objective: To evaluate the economic impact of incorporating physical accessibility in basic housing solutions, or type Solidarity Fund 1 (FSV1) homes. Method: Cost evaluation was performed on the basis of an academic comparison of direct construction cost of 15 built social homes (FSV1), versus 15 counterproposals with incorporated accessibility. Results: 13 of 15 cases increased costs between 1.27 percent and 6.11 percent of the basic construction cost. However, the unitary cost per constructed square meter did not increase. Conclusion: Limited cost variations was associated more to the surface increase needed to generate accessibility conditions, than to the incorporation of new elements o technical aids.

Introducción: La accesibilidad física es considerada como parte fundamental para el ejercicio de los derechos y el desarrollo de una vida independiente de las personas en situación de discapacidad. Uno de los espacios más importantes que debiera considerar accesibilidad es la vivienda, especialmente la vivienda social, siendo uno de los principales impedimentos a la hora de incorporar este criterio, el supuesto alto costo asociado; sin embargo, no existen evaluaciones que lo puedan objetivar. Objetivo: Evaluar el impacto económico que tendría incorporar accesibilidad física en soluciones habitacionales más básicas o tipo Fondo Solidario de Vivienda I (FSV1). Materiales y Método: La evaluación de costos se realizó sobre la base de un ejercicio académico de comparación de costos directos de construcción de 15 casos de viviendas sociales construidas (FSV1) con 15 contrapropuestas con accesibilidad incorporada. Resultados: Trece de 15 casos aumentaron sus costos de construcción, entre 1,27 por ciento y 6,11 por ciento del costo base de la vivienda construida. Sin embargo, el costo unitario por metro cuadrado construido no presenta incremento. Conclusiones: Las variaciones de costo fueron bastante acotadas y estuvieron relacionadas con el aumento de superficie necesario para generar condiciones de accesibilidad, más que en la incorporación de nuevos elementos o ayudas técnicas.

Vivienda social accesible: un nuevo desafío para Chile / Accessible social homes: a new challenge for Chile

Introduction: Since 2004, Teleton´s Volunteer Corp through their Program“Abre” is working to eliminate architectural barriers in the homes of rehabilitation services users. Most of these homes are obtained by the families through State financial aid. This on site work has shown low levels of accessibility, thus a full and autonomous use of the home is restricted. Objective: To establish design criteria for social homes from the Solidary Fund 1 (FSV1), regarding unnoticed accessibility characteristics. Method: Sample gathering was obtained with the collaboration of the Housing and Town Planning Ministry (MINVU). Regions with greatest concentration of granted subsidies from FSV1 during the year 2011 were selected. Based on 15 counterproposals, the concept of unnoticed accessibility was implemented in the homes. Design criteria complied with current FSV1regulations. Results: The design process resulted in 15 cases of social homes with different degrees of accessibility. Discussion: The objective of this study allowed the accomplishment of accessibility solutions for social homes from FSV1, with marginal built surface increase. As a second gain, they allowed for the design of construction plants, which improve housing conditions for families, throughout their entire life cycle independent of health conditions. Conclusions: Accessible social home proposals were implemented with marginal increase.

Introducción: Desde el año 2004 el programa Abre del Voluntariado Teletón trabaja a través de la eliminación de barreras arquitectónicas en las viviendas de familias usuarias de Teletón, que en su mayoría acceden a viviendas sociales obtenidas mediante subsidios estatales. Esta realidad en terreno ha permitido visualizarlos bajos niveles de accesibilidad que estas viviendas poseen, dificultando el acceso, uso pleno y autónomo de los recintos. Objetivo: Establecer criterios de diseño que permitan que las viviendas sociales del fondo solidario 1 (FSV1) posean características de accesibilidad desapercibida. Material y Método: La recopilación de la muestra de tipos de vivienda social se realizó en colaboración con el Ministerio de Vivienda y Urbanismo (MINVU), trabajando con las Regiones de mayor concentración de subsidios del FSV1 asignados durante el año 2011.Se desarrollaron 15 contrapropuestas en las cuales se implementó el concepto de accesibilidad desapercibida. Los criterios de diseño se enmarcaron en el reglamento actual del FSV1. Resultados: El proceso de diseño culminó con la obtención de 15 casos de viviendas sociales con distintos grados de accesibilidad. Discusión: Desde los objetivos propuestos en este estudio, se ha podido brindar soluciones de accesibilidad para las viviendas sociales del FSV1, sin que ello implicase un aumento considerable de la superficie construida. De igual manera, se han podido diseñar plantas de edificación que permiten mejorar las condiciones de habitabilidad, independiente de la condición de salud del grupo familiar en todo su ciclo de vida. Conclusiones: Las propuestas de vivienda social accesible se lograron con un aumento marginal de superficie.

[Subjective global assessment in neoplastic patients]. / Valoración global subjetiva en el paciente neoplásico.

As malnutrition is a common complication among patients with cancer, it seems necessary identifying it with simple tools. Subjective Global Assessment (SGA) is useful to evaluate nutritional status on a basis of clinical parameters and can be used by any clinician with a basic training. Our intention is to determine usefulness of SGA applied by staff not working at Clinical Nutrition to guess if they identify properly malnourished patients. We included in our study thirty male and female patients with several types of active neoplasm who were being treated with chemo or radiotherapy. Oncology and Clinical Nutrition staff used SGA separately after the patients answered the form; there were also taken biochemical and anthropometrical determinations. Sixty-three percent of patient were diagnosed as malnourished or suspected being so by Oncologists, 30% by Clinical Nutrition staff and 26% by anthropometrical means. Incidence of malnutrition was low because the most common neoplasm among patients in the study was colorectal cancer. Oncologists tended to diagnose more cases of malnutrition due to a deficient training; nevertheless, SGA was useful because none of the malnourished patients was misdiagnosed and half of the well nourished patients were correctly identified as ones with no need for nutritional support.

[Evaluation of health policy intervention on the community level--the "Neighborhood Coordination of Health and Social Care" Model Project in North Rhine-Westphalia]. / Evaluation einer gesundheitspolitischen Intervention auf kommunaler Ebene--Das Modellprojekt "Ortsnahe Koordinierung der gesundheitlichen und sozialen Versorgung" in Nordrhein-Westfalen.

Between October 1995 and December 1998 the pilot project 'Local Coordination of Health and Social Care' was conducted in 28 communities of the state of North Rhine-Westphalia. The project has been evaluated by two university research teams. The aim of the project was basically to establish new structures of health planning and coordination at the community level, in order to improve health reporting and health care as well as health promotion. To realize this aim round tables, working groups and project-offices were implemented in the communities. The evaluation was focused on the following question: What were the conditions (structures) and processes that influenced the project outcomes? Qualitative and quantitative methods were applied (interviews, standardised self-administered questionnaires, analyses of documents) to this end. Evaluation of structures showed that most communities succeeded in integrating relevant health policy actors into the newly created round tables and working groups. Working climate and achievements were evaluated favourably by most of the involved actors. All communities succeeded in developing and enacting recommendations for programmes, and about 40% of these programmes were implemented during the project. The probability of programme implementation was particularly high if the programme was based on reliable local data and if execution was effected only on the community level. The possibly beneficial effects on health care and welfare produced by the new programmes could not be assessed within the short project period. The paper concludes with a brief discussion of practical consequences for future health policy at community level.

[Who is the infrequent patient?]. / Quién es el paciente no frecuentador?

OBJECTIVE: To reach the rarely attending section of the population, in order to define its sociodemographic characteristics, and analyse its health status and use of the Health Services. DESIGN: Observational, crossover study, using a questionnaire. SETTING: Primary Care. PATIENTS: Patients over 19 assigned to four morning-shift doctors at the Parla Health Centre (Madrid) and who had not attended for health care over the preceding four years. INTERVENTION: Communication by letter and phone. Questionnaire. MEASUREMENTS AND MAIN RESULTS: 5.07% (468) of the catchment population satisfied our criteria for inclusion. More than half of these could not be located. Only 51 (10.9%) could be interviewed; and 14 (2.99%) remained in the study. Gender accounted for no significant differences. No one was over 65. Self-perception of their own health status was good or very good in 85.7%. 85.7% were smokers. 71% said that they "rarely" attended for health care. One male had three cardiovascular risk factors. CONCLUSIONS: We found that finding the rarely attending person was not easy. The few cases analysed do not allow for extrapolation. Our findings showed he was a married 37-year old male with a steady job in the service sector. He smokes, doesn't drink and considers himself in a good state of health.

A simple dynamic flow-through exposure system for assessment of biological activity of complex organic mixtures to mammalian cells in vitro.

A system for in vitro exposure of lung epithelial cells and Chinese hamster ovary cells maintained at an air-medium interface to volatile organic compounds has been developed. The system has been used for exposure of cells to phenol (vapor pressure at 40 degrees C = 1.6 mm Hg) and to a complex mixture of organic compounds (vapor pressure range at 32 degrees C = 0.17 to 269 mm Hg). A linear relationship was found between vapor generator air flow rate (0.25 to 1.0 L/min at 39 degrees C) and exposure chamber phenol concentration. The relationship between generator air flow rate (0.5 to 1.0 L/min at 39 degrees C) and concentration of the complex mixture in the exposure chamber was also linear. Gas chromatographic analyses of chamber exhaust indicated that a majority of the compounds present in the crude mixture had been volatilized and made available to the cells in the chamber. This exposure system appears suitable for screening of complex mixtures of volatile organic pollutants for biological activity in mammalian cells in culture.