Gestão e liderança na percepção de enfermeiros: um caminhar à luz da burocracia profissional / Gestión y liderazgo en la percepción de los enfermeros: un paseo a la luz de la burocracia profesional / Management and leadership in the nurses' perception: A walk in the light of professional burocracy

Resumo Objetivo analisar os estilos e fatores intervenientes na gestão e liderança de enfermeiros em três países, Brasil, Portugal e Espanha, à luz da Burocracia Profissional. Método estudo exploratório e descritivo de abordagem qualitativa realizado em três hospitais universitários localizados em diferentes países: Brasil, Espanha e Portugal. Participaram da pesquisa 30 enfermeiros. Os dados foram coletados por meio de um roteiro de coleta de dados com questões sociodemográficas e entrevistas analisadas com auxílio do software WebQda. Resultados diferentes percepções sobre os elementos integradores da participação foram reveladas nos três países, destacando-se a comunicação em diversas óticas. Verificou-se algumas convergências em relação ao trabalho em equipe, sendo a confiança o elemento que impulsiona e motiva a equipe. Sinaliza-se para uma relação participativa no desenvolvimento do trabalho. Conclusão e implicações para a prática foi possível identificar, nos três países, a importância da comunicação no processo de gestão, bem como dos estilos de gestão e de liderança, como elementos que oportunizam a atuação da equipe. Também foi evidenciada a presença de fatores intervenientes de relevância, tais como escuta, clima organizacional, relação interpessoal, transparência no trabalho e delegação de funções, os quais envolvem a burocracia profissional em que o conhecimento do enfermeiro possibilita o exercício de suas habilidades de forma horizontalizada e participativa.

Resumen Objetivo analizar los estilos y factores implicados en la gestión y el liderazgo de enfermeros en tres países, Brasil, Portugal y España, a la luz de la Burocracia Profesional. Método estudio descriptivo exploratorio con abordaje cualitativo realizado en tres hospitales universitarios ubicados en diferentes países: Brasil, España y Portugal. Treinta enfermeros participaron en la investigación. Los datos fueron recolectados a través de un script de recopilación de datos con preguntas sociodemográficas y entrevistas analizadas con la utilización del software WebQda. Resultados se revelaron diferentes percepciones sobre los elementos integradores de la participación en los tres países, destacando la comunicación desde diferentes perspectivas. Se constataron algunas convergencias en relación al trabajo en equipo, siendo la confianza el elemento que impulsa y motiva al equipo. Se advierte una relación participativa en el desarrollo del trabajo. Conclusión e implicaciones para la práctica se pudo advertir, en los tres países, la importancia de la comunicación en el proceso de gestión, así como los estilos de gestión y liderazgo, como elementos que permiten mejorar el desempeño del equipo. También se evidenciaron factores intervinientes relevantes, como la escucha, el clima organizacional, la relación interpersonal, la transparencia en el trabajo y la delegación de funciones, que conforman la burocracia profesional en la cual el conocimiento de los enfermos les permite el despliegue de sus competencias de manera horizontal y participativa.

Abstract Objective to analyze the styles and factors involved in nurses' management and leadership in three countries, Brazil, Portugal and Spain, in the light of Professional Bureaucracy. Method a descriptive and exploratory study with a qualitative approach carried out in three university hospitals located in different countries, namely: Brazil, Spain and Portugal. Thirty nurses participated in the research. Data was collected through a collection script with sociodemographic questions and interviews analyzed using the WebQda software. Results different perceptions about the integrating elements of participation in the three countries were revealed, highlighting communication from different perspectives. Some convergences in relation to teamwork were verified, where trust was the element that drives and motivates the team. It is a participatory relationship in the development of work. Conclusion and implications for the practice in the three countries, it was possible to identify the importance of communication in the management process, as well as the management and leadership styles, as elements that favor performance of the team. Presence of relevant intervening factors was also evidenced, such as choice, organizational climate, interpersonal relationships, transparency in work and delegation of functions, which involves professional bureaucracy in which the nurses' knowledge allows them to exercise their skills in a horizontal and participatory manner.

Lactancia materna y feminismo: recorrido social y cultural en España / Breastfeeding and feminism: social and cultural journey in Spain / Breastfeeding and feminism: social and cultural journey in Spain

RESUMEN OBJETIVO Analizar la influencia de cambios socio-políticos, educativos y feministas de España en el mantenimiento de lactancia materna. MÉTODO Revisión histórico-descriptiva de documentación en bases de datos, Boletines Oficiales del Estado, del Ministerio de Sanidad y Consumo y Bienestar Social. RESULTADOS La lactancia materna es un fenómeno complejo influenciado por factores demográficos, biológicos, sociales y psicológicos. Ha cambiado a lo largo de la historia y, evolucionado con los movimientos feministas. La incorporación de la mujer al mercado laboral (s.XIX), produjo una modificación en el rol familiar y pareja. La sociedad del siglo XXI reclama a los poderes públicos la conciliación personal y laboral para la crianza de sus hijos. CONCLUSIONES E IMPLICACIÓN PARA LA PRÁCTICA Han sido múltiples los factores y procesos evolutivos para la situación socio-cultural de la mujer en la lactancia materna. Actualmente sigue siendo complicado compaginar gestación y crianza con el empleo, las redes formales e informales permiten avances en políticas sanitarias.

RESUMO OBJETIVO Analisar a influência das mudanças sócio-políticas, educativas e feministas em Espanha na manutenção do aleitamento materno. MÉTODO Revisão histórico-descritiva da documentação em bases de dados, Boletins Oficiais do Estado, do Ministério da Saúde e do Consumo e da Previdência Social. RESULTADOS O aleitamento materno é um fenómeno complexo influenciado por factores demográficos, biológicos, sociais e psicológicos. Ela mudou ao longo da história e evoluiu com os movimentos feministas. A incorporação das mulheres ao mercado de trabalho (século XIX), produziu uma modificação no papel da família e do casal. A sociedade do século XXI exige do poder público a conciliação pessoal e laboral para a educação dos seus filhos. CONCLUSÕES E IMPLICAÇÕES PARA A PRÁTICA Tem havido múltiplos factores e processos evolutivos para a situação sociocultural das mulheres em aleitamento materno. Hoje em dia, ainda é complicado combinar gravidez e educação com emprego, e as redes formais e informais permitem avanços nas políticas de saúde.

ABSTRACT OBJECTIVE To analyze the influence of socio-political, educational and feminist changes in Spain on the maintenance of breastfeeding. METHOD Historical-descriptive review of documentation in databases, Official State Bulletins, of the Ministry of Health and Consumer Affairs and Social Welfare. RESULTS Breastfeeding is a complex phenomenon influenced by demographic, biological, social and psychological factors. It has changed throughout history and evolved with the feminist movements. The incorporation of women to the labor market (19th century), produced a modification in the family and couple role. The society of the 21st century demands from the public authorities the personal and labor conciliation for the upbringing of their children. CONCLUSIONS AND IMPLICATION FOR PRACTICE There have been multiple factors and evolutionary processes for the socio-cultural situation of women in breastfeeding. Nowadays, it is still complicated to combine pregnancy and upbringing with employment, and formal and informal networks allow advances in health policies.

The effect of diet and sociopolitical change on physiological stress and behavior in late Roman-Early Byzantine (300-700 AD) and Islamic (902-1,235 AD) populations from Ibiza, Spain.

OBJECTIVES: This study evaluated chronological changes in physiological stress and levels of habitual loading of Ibizan populations from the Late Roman-Early Byzantine (LREB) to the Islamic period (300-1,235 AD) using measures of body size and bone cross-sectional properties to compare Urban LREB, Urban Medieval Islamic, and Rural Medieval Islamic groups. It also explored the effect of diet, modeled using stable isotopes, on physiological stress levels and behavior. MATERIALS AND METHODS: The sample comprised individuals from three archeological populations: Urban Late Roman- Early Byzantine (LREB) (300-700 AD), Medieval Urban Islamic (902-1,235 AD), and Medieval Rural Islamic. Bone lengths, femoral head dimensions, and cross-sectional properties, diaphyseal products and circumferences, were compared to assess differences in body size and habitual loading in 222 adult individuals. Ordinary least squares regression evaluated the correlations between these measures and carbon (δ13 C) and nitrogen (δ15 N) stable isotope ratios in 115 individuals for whom both isotope values and osteological measures are available. RESULTS: The Medieval Rural Islamic group had shorter stature and reduced lower limb cross-sectional properties compared to the two urban groups. Limb shape differs between Urban LREB and Urban Medieval Islamic groups. Measures of body size length were positively correlated with δ13 C values in all individuals and separately in the Urban LREB and Rural Medieval Islamic groups. δ15 N showed a positive correlation with left humerus shape in the Urban LREB sample. CONCLUSIONS: The low stature and cross-sectional properties of the Medieval Rural Islamic group may be an indicator of greater physiological stress, potentially due to poorer diet. Positive correlations between measures of body size and δ13 C values further suggest that greater access to C4 resources improved diet quality. Alternatively, this relationship could indicate greater body size among migrants from areas where individuals consumed more C4 resources.

The Prevalence and Risk Factors for Antenatal Depression Among Pregnant Immigrant and Native Women in Spain.

Introduction: The aim was to examine the risk factors of anternatal depression among immigrant and native pregnant women in Spain. Method: A total of 1,524 pregnant women completed the Patient Health Questionnaire and the Postpartum Depression Predictors Inventory-Revised form. Results: The native group reported a lower prevalence (15.2%) compared with immigrant group (25.8%). For immigrants, primiparity, moving, and perceived lack instrumental support from friends or emotional support from partners and family members were significant risk factors. Discussion: The study identified risk factors that can be used for preventive interventions during pregnancy. Significance: Screening and interventions for depression during pregnancy should take migration status into account to maximize effective health care. Also, health providers should consider how migration status can result in different risk factors that affect depression during pregnancy.

Student nurse perceptions of Gypsy Roma Travellers; A European qualitative study.

BACKGROUND: Gypsy Roma Travellers are Europe's largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals' attitudes towards these communities and no studies exploring nursing students' perceptions. OBJECTIVES: To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers. PARTICIPANTS: 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19 and 32 year old, there was a mix of students between year one to year three of their programme and both male (n = 3) and female students (n = 19). METHODS: This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students' first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study. RESULTS: Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers. CONCLUSIONS: Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students' perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals' attitudes towards these communities that needs to be explored through further research.

Taking stock of Roma health policies in Spain: Lessons for health governance.

Roma health inequities are a wicked problem. Despite concerted efforts to reduce them under the Decade of Roma Inclusion initiative, the health gap between Roma and non-Roma populations in Europe persists. To address this problem, the European Commission devised the National Roma Integration Strategies (NRIS). This paper provides a critical assessment of the implementation of the NRIS' health strand (NRIS-H) in Spain and proposes an evaluation tool to monitor Roma health policies - the Roma Health Integration Policy Index (RHIPEX). It also makes recommendations to promote Roma health governance. To achieve these goals, four community forums, 33 stakeholder interviews and a scoping review were conducted. Results show that the NRIS-H implementation is hindered by lack of political commitment and poor resource allocation. This has a negative impact on Roma's entitlement to healthcare and on their participation in decision-making processes, jeopardising the elimination of the barriers that undermine their access to healthcare and potentially contributing to reproduce inequalities. These unintended effects point out the need to rethink Roma health governance by strengthening intersectional and intersectoral policies, enabling transformative Roma participation in policymaking and guaranteeing shared socio-political responsibility and accountability.

Adolescents' Daily Perception of Internalizing Emotional States by Means of Smartphone-based Ecological Momentary Assessment.

This study uses ecological momentary assessment (EMA) with smartphone devices to examine community adolescents' perceptions regarding both the intensity of and variability in their daily sadness/depression, anxiety, and somatic problems over the period of one week. Participants were 90 high-school students (M age = 14.61, SD = 1.64; range 12-18). The sample was divided according to gender (61.1% girls), migratory status (68.5% Spanish nationals and 31.5% Latin American immigrants), and level of psychological symptoms (17% risk group). Sadness/depression, anxiety, and somatic problems were examined using a smartphone app, five times per day, semi-randomly, for seven days (35 possible moments). A high proportion of adolescents did not report feelings of sadness (80.0%) or worry (79.3%) or physical symptoms on a daily basis (84.9%). Girls and the risk group reported greater intensity levels for the three analyzed problems than did boys and the normal group, respectively (p .05 in all cases). Day-to-day fluctuations in mood during the week were statistically significant but not meaningful (b = 0.0004, 95% CI [0.0001, 0.0008], p = .001).

Discourses on the Toxic Effects of Internal Chemical Contamination in Catalonia, Spain.

Human exposure to and contamination by environmental toxic compounds generates discourses and practices that merit greater attention. In this article, we assess internal chemical contamination and the risk of toxic effects as an experience related to the production of meaning in everyday life. Drawing on the analysis of semantic networks of narratives from semi-structured interviews conducted with 43 informants in Catalonia, Spain, we consider participants' perceptions of the health risks of toxic compounds, including social discourses on exposure, toxicity, and internal chemical contamination, and on responsibilities, consequences, and proposed strategies for controlling toxic compounds. Informants' narratives on the relationships between nature and nurture suggest that they no longer perceive rigid boundaries separating the human body from the external environment and its chemical pollutants.

Two worlds apart: Determinants of height in late 18th century central Mexico.

Anthropometric literature on the American territories of the Hispanic monarchy before their independence is still scarce. We attempt to expand the field with a case study that includes some important novelties. Albeit our main source, the military records of the Censo de Revillagigedo (conducted in the early 1790s), has already been used, the sample size and the geographical scope are unprecedented: 19,390 males of four ethnicities (castizos, españoles, mestizos, and mulatos) aged from 16 to 39 from 24 localities, including towns and villages scattered across central regions of the Viceroyalty of New Spain. We build a database that, complemented with information on resource endowments obtained from other sources, permits to analyze the determinants of height. Our results show the importance of spatial differences as well as the significance of ethnicity, occupation, rurality, age and resource endowments as determinants of height. Unprivileged mulatos are only 0.5cm shorter than, assumedly privileged, españoles in the "first world" (El Bajío) and 1.3cm taller in the "second world" (Eastern Central Highlands). In turn, living in the "first world" implies being between nearly 1.5cm and 5cm taller than the inhabitants of the "second world". Our estimates of physical statures are placed within an international comparative context and offer a relatively "optimistic" picture.

Comparison of Mediterranean diet compliance between European and non-European populations in the Mediterranean basin.

Fruit, vegetables, cereals, and olive oil are common elements of the Mediterranean diet (MD), but each country in the Mediterranean basin has its own gastronomic customs influenced by socio-cultural, religious, and economic factors. This study compared the dietary habits of three Mediterranean populations with different cultures and lifestyles, a total of 600 adults (61.9% females) between 25 and 70 yrs from Spain, Morocco, and Palestine. All participants completed a self administered questionnaire, including sociodemographic and anthropometric items, a validated semi-quantitative food frequency questionnaire adapted to the foods consumed in each country, and three 24-h recalls. MD adherence was estimated with the MD Serving Score (MDSS). All populations showed a moderate adherence to the Mediterranean dietary pattern. In comparison to the Palestine population, MDSS-assessed adherence to the MD was 6.36-fold higher in the Spanish population and 3.88-fold higher in the Moroccan population. Besides the country of origin, age was another predictive factor of MD adherence, which was greater (higher MDSS) in participants aged over 50 yrs than in those aged 30 yrs or younger. This preliminary study contributes initial data on dietary differences between European and non-European countries in the Mediterranean basin. The Spanish diet was shown to be closer to MD recommendations than the diet of Morocco or Palestine. Given the impact of good dietary habits on the prevention of chronic non-transmittable diseases, health policies should focus on adherence to a healthy diet, supporting traditional dietary patterns in an era of intense commercial pressures for change.

Patterns of pharmaceutical use for immigrants to Spain and Norway: a comparative study of prescription databases in two European countries.

BACKGROUND: Although equity in health care is theoretically a cornerstone in Western societies, several studies show that services do not always provide equitable care for immigrants. Differences in pharmaceutical consumption between immigrants and natives are explained by variances in predisposing factors, enabling factors and needs across populations, and can be used as a proxy of disparities in health care use. By comparing the relative differences in pharmacological use between natives and immigrants from the same four countries of origin living in Spain and Norway respectively, this article presents a new approach to the study of inequity in health care. METHODS: All purchased drug prescriptions classified according to the Anatomical Therapeutic Chemical (ATC) system in Aragon (Spain) and Norway for a total of 5 million natives and nearly 100,000 immigrants for one calendar year were included in this cross-sectional study. Age and gender adjusted relative purchase rates for immigrants from Poland, China, Colombia and Morocco compared to native populations in each of the host countries were calculated. Direct standardisation was performed based on the 2009 population structure of the OECD countries. RESULTS: Overall, a significantly lower proportion of immigrants in Aragon (Spain) and Norway purchased pharmacological drugs compared to natives. Patterns of use across the different immigrant groups were consistent in both host countries, despite potential disparities between the Spanish and Norwegian health care systems. Immigrants from Morocco showed the highest drug use rates in relation to natives, especially for antidepressants, "pain killers" and drugs for peptic ulcer. Immigrants from China and Poland showed the lowest use rates, while Colombians where more similar to host countries. CONCLUSIONS: The similarities found between the two European countries in relation to immigrants' pharmaceutical use disregarding their host country emphasises the need to consider specific immigrant-related features when planning and providing healthcare services to this part of the population. These results somehow remove the focus on inequity as the main reason to explain differences in purchase between immigrants and natives.

The social class gradient in health in Spain and the health status of the Spanish Roma.

OBJECTIVE: To determine the social class gradient in health in general Spain population and the health status of the Spanish Roma. DESIGN: The National Health Survey of Spanish Roma 2006 (sample size = 993 people; average age: 33.6 years; 53.1% women) and the National Health Surveys for Spain 2003 (sample size: 21,650 people; average age: 45.5 years; 51.2% women) and 2006 (sample size: 29,478 people; average age: 46 years; 50.7% women) are compared. Several indicators were chosen: self-perceived health, activity limitation, chronic diseases, hearing and sight problems, caries, and obesity. Analysis was based on age-standardised rates and logistic regression models. RESULTS: According to most indicators, Roma's health is worse than that of social class IV-V (manual workers). Some indicators show a remarkable difference between Roma and social class IV-V: experiencing three or more health problems, sight problems, and caries, in both sexes, and hearing problems and obesity, in women. CONCLUSION: Roma people are placed on an extreme position on the social gradient in health, a situation of extreme health inequality.

A qualitative exploration of the impact of the economic recession in Spain on working, living and health conditions: reflections based on immigrant workers' experiences.

BACKGROUND: This study aimed to analyse how immigrant workers in Spain experienced changes in their working and employment conditions brought about Spain's economic recession and the impact of these changes on their living conditions and health status. METHOD: We conducted a grounded theory study. Data were obtained through six focus group discussions with immigrant workers (n = 44) from Colombia, Ecuador and Morocco, and two individual interviews with key informants from Romania living in Spain, selected by theoretical sample. RESULTS: Three categories related to the crisis emerged--previous labour experiences, employment consequences and individual consequences--that show how immigrant workers in Spain (i) understand the change in employment and working conditions conditioned by their experiences in the period prior to the crisis, and (ii) experienced the deterioration in their quality of life and health as consequences of the worsening of employment and working conditions during times of economic recession. CONCLUSION: The negative impact of the financial crisis on immigrant workers may increase their social vulnerability, potentially leading to the failure of their migratory project and a return to their home countries. Policy makers should take measures to minimize the negative impact of economic crisis on the occupational health of migrant workers in order to strengthen social protection and promote health and well-being.

Perceived discrimination among Maghrebi users of health services in Tarragona (Spain).

BACKGROUND: Discrimination in health services for reasons of nationality or ethnicity is not a rare occurrence. This work aims to qualitatively analyse the perceived discrimination among Maghrebi community in Tarragona (Spain) with regard to the healthcare services they receive. METHODS: A qualitative study was carried by means of 12 semi-structured interviews and 10 focus groups with Maghrebi adults living in Tarragona. The scope of the study was public health services in the area. A content analysis was performed using open coding. RESULTS: Our results show that perceived discrimination is greater than actual discrimination because the deficiencies of the healthcare system are often interpreted as unfairness. However, our subjects also recounted incidents of clear discrimination against Maghrebi users of the healthcare system. The tendency to feel discriminated against is the culmination of an interaction between the group's low self-esteem and locals' often negative sentiments towards the group. CONCLUSIONS: We suggest addressing the shortcomings of the healthcare system in order to reduce this level of perceived discrimination and thus improve patient satisfaction. To improve this group's self-esteem and change how they are perceived, public policies should be put into effect which promote social inclusion and the respect for Maghrebis' rights as people, with actions taken on both fronts: in the host society and within the Maghrebi community itself. Furthermore, an active role for the patient with regard to his or her rights should be encouraged in order to minimize abuse from professionals and to facilitate institutional control of individual actions.

O impacto da crise econômica espanhola na mão de obra imigrante / The impact of the Spanish economic crisis on immigrant labor in Spain / El impacto de la crisis económica española en la mano de obra inmigrante

Artigo tem o objetivo de analisar a situação da mão de obra imigrante na Espanha nos últimos dez anos, vinculando-a com as transformações econômicas e sociais pelas quais o país tem passado desde meados da década de 1990, com ênfase no panorama gerado pela crise econômica que eclodiu a partir do final de 2008 e o seu impacto na situação dos imigrantes, coletivo que mais tem sofrido com o novo quadro econômico e social estabelecido com a crise. Diante da situação que a Espanha atravessa, com notável aumento do desemprego e de deterioração dos indicadores sociais, nota-se o retorno considerável de imigrantes para os seus países de origem depois de esgotarem todas as vias alternativas de permanência na Espanha. O fundamento para o desenvolvimento deste trabalho foram os dados proporcionados pelo Instituto Nacional de Estadística (INE) da Espanha, utilizando a EPA (Encuesta de Población Activa), além dos dados do Eurostat e das fontes bibliográficas citadas...

This paper aims to analyze the situation of immigrant labor in Spain over the last ten years, linking it to social and economic transformations, which the country has undergone since the mid-1990s, with emphasis on the scenario generated by the economic crisis that erupted at the end of 2008 and its impact on the situation of immigrants, the people who have been most deeply affected by the new economic and social setting resulting from the crisis. Faced with the situation in Spain, with a remarkable increase in unemployment and deterioration of social indicators, immigrants have been returning to their countries of origin after exhausting all alternative ways to remain in Spain. The development of this paper is based on data provided by the Instituto Nacional de Estadística (INE - National Statistics Institute), of Spain, which used the Encuesta de Población Activa (EPA - Active Population Survey), in addition to data from Eurostat and the bibliographical references cited...

Este artículo tiene por objetivo analizar la situación de la mano de obra inmigrante en España en los últimos diez años, vinculándola con las transformaciones económicas y sociales por las que ha atravesado el país desde mediados de la década de 1990, con énfasis en el panorama generado por la crisis económica que eclosionó a fines de 2008 y su impacto en la situación de los inmigrantes, colectivo que más ha sufrido con el nuevo escenario económico y social establecido con la crisis. Ante la situación por la que atraviesa España, con un notable aumento del desempleo y del deterioro de los indicadores sociales, se observa un considerable retorno de los inmigrantes hacia sus países de origen, después de agotar todas las vías alternativas para su permanencia. El fundamento para el desarrollo de este trabajo han sido los datos proporcionados por el Instituto Nacional de Estadística (INE) de España, utilizando la Encuesta de Población Activa (EPA), además de los datos de Eurostat y de las fuentes bibliográficas citadas...

Gait-cycle characteristics and running economy in elite Eritrean and European runners.

PURPOSE: This study aimed to determine whether biomechanical characteristics such as ground-contact time, swing time, and stride length and frequency contribute to the exceptional running economy of East African runners. METHODS: Seventeen elite long-distance runners (9 Eritrean, 8 European) performed an incremental maximal running test and 3 submaximal running bouts at 17, 19, and 21 km/h. During the tests, gas-exchange parameters were measured to determine maximal oxygen uptake (VO2max) and running economy (RE). In addition, ground-contact time, swing time, stride length, and stride frequency were measured. RESULTS: The European runners had higher VO2max values than the Eritrean runners (77.2 ± 5.2 vs 73.5 ± 6.0 mL · kg-1 · min-1, P = .011, effect sizes [ES] = 0.65), although Eritrean runners were more economical at 19 km/h (191.4 ± 10.4 vs 205.9 ± 13.3 mL · kg-1 · min-1, P = .026, ES = 1.21). There were no differences between groups for ground-contact time, swing time, stride length, or stride frequency at any speed. Swing time was associated with running economy at 21 km/h in the Eritrean runners (r = .71, P = .033), but no other significant association was found between RE and biomechanical variables. Finally, best 10-km performance was significantly correlated with RE (r = -.57; P = .013). CONCLUSIONS: Eritrean runners have superior RE compared with elite European runners. This appears to offset their inferior VO2max. However, the current data suggest that their better RE does not have a biomechanical basis. Other factors, not measured in the current study, may contribute to this RE advantage.

Factors associated with lack of adherence to antenatal care in African immigrant women and Spanish women in northern Spain: the role of social risk factors in combination with language proficiency.

OBJECTIVE: to examine the association and interaction between language proficiency, social risk factors and lack of adherence to antenatal care in African immigrant women (AIW). METHODOLOGY: retrospective cohort study. Two hundred and thirty-one AIW with delivery dates from 2007 to 2010 were identified, and data were collected on knowledge of Spanish, referral to a social worker because of social risk factors, and adequacy of antenatal care using the Kessner Index (KI) and the authors' own index (OI). The Spanish-born population sample was obtained by simple random sampling in a 1:3 ratio. Odds ratios (OR) were estimated by non-conditional logistic regression. The term 'language*referral to social worker' was included in the logistic models to study interaction. FINDINGS: eighty-four per cent of AIW had insufficient knowledge of Spanish, and 47% had been referred to a social worker. Of the AIW who had not been referred to a social worker, the association between poor knowledge of Spanish and inadequate antenatal care was weak and not significant (OR for KI 1.31). On the contrary, of the AIW who had been referred to a social worker, the association was stronger and significant (OR for KI 8.98; p interaction=0.026). Social risk factors were the main independent factors associated with inadequate antenatal care in Spanish women (adjusted OR 3.17; 95% confidence interval 1.42-7.06). CONCLUSIONS: this study found that the main factor associated with inadequate antenatal care in AIW is insufficient language proficiency, but only in the presence of social risk factors, which have also been associated with worse antenatal care in Spanish women.

Changes in access to health services of the immigrant and native-born population in Spain in the context of economic crisis.

AIM: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. METHODS: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. RESULTS: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. CONCLUSION: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

[Use of health services for immigrants and native population: a systematic review]. / Frecuentación de las consultas de medicina general y especializada por población inmigrante y autóctona: una revisión sistemática.

BACKGROUND: Spain was among the top immigration destinations globally between 1990 and 2005, becoming in 2006 in the European country with the highest net migration. As a result of the migration process and the living conditions in the host countries, immigrants' health may be affected. Limited research has investigated access and use of health services for this population. The aim of this study was to describe the scientific evidence on the use of general and specialist medical services for the immigrant population compared to the native. METHODS: Systematic review. It has carried out a search of the national and international scientific literature of comparative studies on the use of general and specialist medical services among immigrant and native since 1994-2013. It was used the MEDLINE database as well as a manual search, no language limit or type of study. The methodological quality of the 29 studies included was evaluated. Subject, context, methodological and extrinsic characteristics were collected for comparison of the included studies. RESULTS: We selected 29 studies on the general practitioners' (9 from Spain) and 15 of specialist physician (7 from Spain), they mainly used health surveys as a source of information. Analyze both the attendance and contact with the general practitioner / specialist by nationality or country of birth (among others), mostly by adjusting variables of need and / or socioeconomic. CONCLUSION: Overall, the immigrant population in Spain have a similar use of general medical services than the native population, and less or similar use of the specialist physician services. These results are in line with studies in other countries.