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.

Social determinants of self-perceived discrimination in Spain.

OBJECTIVES: To analyse the association between self-perceived discrimination and social determinants (social class, gender, country of origin) in Spain, and further to describe contextual factors which contribute to self-perceived discrimination. METHODS: Cross-sectional design using data from the Spanish National Health Survey (2006). The dependent variable was self-perceived discrimination, and independent and stratifying variables were sociodemographic characteristics (e.g. sex, social class, country of origin, educational level). Logistic regression was used. RESULTS: The prevalence of self-perceived discrimination was 4.2% for men and 6.3% for women. The likelihood of self-perceived discrimination was higher in people who originated from low-income countries: men, odds ratio (OR) 5.59 [95% confidence interval (CI) 4.55-6.87]; women, OR 4.06 (95% CI 3.42-4.83). Women were more likely to report self-perceived discrimination by their partner at home than men [OR 8.35 (95% CI 4.70-14.84)]. The likelihood of self-perceived discrimination when seeking work was higher among people who originated from low-income countries than their Spanish counterparts: men, OR 13.65 (95% CI 9.62-19.35); women, OR 10.64 (95% CI 8.31-13.62). In comparison with Spaniards, male white-collar workers who originated from low-income countries [OR 11.93 (95% CI 8.26-17.23)] and female blue-collar workers who originated from low-income countries (OR 1.6 (95% CI 1.08-2.39)] reported higher levels of self-perceived discrimination. CONCLUSIONS: Self-perceived discrimination is distributed unevenly in Spain and interacts with social inequalities. This particularly affects women and immigrants.

Activos de salud, calidad de vida y morbimortalidad de la población en Asturias.

INTRODUCCIÓN: n promoción de la salud se ha detectado en los últimos años un incremento de investigaciones con enfoques teóricos basados en activos de salud. Pese a los estudios identificados, no se dispone de suficiente evidencia sobre los efectos que diferentes tipos de activos pueden tener en la calidad de vida y en la morbimortalidad de la población. OBJETIVO: analizar la relación entre los activos de salud disponibles con indicadores de morbilidad, mortalidad y calidad de vida de la población asturiana en el año 2018. METODOLOGÍA: diseño ecológico a partir de datos agregados municipales procedentes de los 78 municipios de Asturias (1.034.960 habitantes). Tras aplicar la definición de activos de salud como aquellas variables que pudieran redundar en una mejora de la salud y del bienestar de los individuos y de las comunidades, se seleccionaron 19 variables de activos agrupados en cuatro categorías: individuales, socioeconómicas, comunitarias e infraestructura. Una vez controladas las variables relacionadas con las características demográficas de la población, se analizó la asociación de los activos con las tasas de morbimortalidad y de calidad de vida. Se desarrollaron 5 modelos predictivos a partir de modelos de regresión lineal múltiple para las variables dependientes: calidad de vida, enfermedades crónicas, mortalidad por todas las causas, mortalidad por enfermedades cardiovasculares (ECV) y por cáncer. RESULTADOS: la disponibilidad de recursos sanitarios (beta = 0.474), coberturas sociales (beta = 0.305) y redes de apoyo social (beta = 0.225) constituyen los activos de salud con mayor peso explicativo en los resultados de salud de la población asturiana. Las variables incluidas en los modelos predictivos de calidad de vida (R2 = 0.650) y de mortalidad por ECV (R2 = 0.544) son las que mostraron una mayor capacidad explicativa. CONCLUSIONES: la inversión en recursos sociosanitarios y la mejora de redes de apoyo social impulsados desde el ámbito de la salud pública pueden producir importantes mejoras en la salud de la población asturiana.

The effect of television news items on intimate partner violence murders.

BACKGROUND: This study has been carried out in order to explore the effect of the growing appearance of IPV in television news items on deaths by this cause. METHODS: Ecological study based on 340 deaths by intimate partner violence (IPV) and 3733 television news items covering this topic on Spanish television channels (2003 and 2007). Logistic regression analysis was carried out. Dependent variable: the difference between the number of IPV deaths in the 7 days following a news item broadcast and the number of IPV deaths in the 7 days before a media item. This outcome variable was conceptualised as a binary variable: increase vs. no increase. INDEPENDENT VARIABLES: days with IPV news items-in general, concerning deaths, measures or other IPV crimes. Adjusted variables: day of the week, month, year and public holidays. RESULTS: A small copycat effect was observed in the IPV murder rate (RR = 1.32, CI(95%) = 1.07 - 1.62) for IPV-related news item days compared with days without such news. This effect continued when information about deaths was broadcast (RR = 1.28, CI(95%) = 1.01 - 1.62). News items concerning measures (RR = 0.90, CI(95%) = 0.82 - 0.98) or other IPV crimes (0.84, CI(95%) = 0.82 - 0.98) were related to a lower possibility of an increase in deaths compared with days with death-related news. CONCLUSION: Given the results observed in the case of IPV-related news, there is an evident need to develop a journalistic style guide in order to determine what type of information is recommended due to the potential positive or negative effects.

Mapping public policy options responding to obesity: the case of Spain.

This study assesses the opinions of the main Spanish stakeholders from food and physical exercise policy networks on public policy options for responding to obesity. We followed the multi-criteria mapping methodology in the framework of the European project 'Policy options in responding to obesity' (PorGrow), through a structured interview to 21 stakeholders. A four-step approach was taken: options, criteria, scoring and weighting, obtaining in this way a measure of the performance of each option which integrates qualitative and quantitative information. In an overall analysis, the more popular policy options where those grouped as educational initiatives: include food and health in the school curriculum, improve health education to the general public, improve the training of health professionals in obesity care and prevention, incentives to caterers to provide healthier menus and improve community sports facilities. Fiscal measures as subsidies and taxes had the lowest support. The criteria assessed as priorities were grouped as efficacy and societal benefits. Obesity in Spain can be approached through public policies, although the process will not be easy or immediate. The feasibility of changes requires concerned public policymakers developing long-term actions taking into account the map of prioritized options by the stakeholders.

[Medical scientific Romania in the European context]. / România medicala stiintifica in context European.

UNLABELLED: A national and international publications bibliometric analysis was assessed to evaluate the scientific research situation about Romania and the relation with the European Parliament Health objectives for 2003-2008. MATERIAL AND METHODS: A bibliographical search in MEDLINE between 1999 and 2003 was performed. An annual review was done and the articles were classified on seven activity branches. The clinical medicine articles were classified by using medical specialties. The 2003-2008 Health European report was classified on fourteen objectives and related to the Romanian scientific production. RESULTS: 2068 articles were found, distributed 271 in 1999, 373 in 2000, 434 in 2001, 492 in 2002, and 498 in 2003. 1335 are clinical medicine, 485 basic sciences, 126 Public Health, 40 pollution and environmental, 36 mental health and 25 nursing articles. 21 were not classified. CONCLUSIONS: The highest article's number belongs to the clinical medicine field and the highest research interest was found in Ophthalmology medical specialty. An increasing scientific research evolution was found but a focussed research tendency was observed around some of the European Union Parliament's objectives.

Inequalities in health in intensive care patients.

In order to study the possible association between socioeconomic status (SES) and critical care mortality, we examined a cohort of 847 patients over 14 years of age, as they were consecutively admitted to three general intensive care units (ICUs). The patients with low SES (social classes IV and V according to the British Registrar General's classification) were older (62.0 v 58.5 years old, p less than 0.0001) and showed a higher ICU mortality (odds ratio (OR) = 1.61, p = 0.0204) and severity of illness on admission (mean Simplified Acute Physiology Score [SAPS] 9.9 vs 8.7, p = 0.0002) than patients with high SES (social classes I-III). The initial severity of illness differential was detected both in patients admitted from the emergency area and in patients admitted from the general hospitalization ward, suggesting the existence of some kind of preselection procedure related to the SES of the patient. The stepwise logistic regression analysis identified as independent predictive variables of ICU mortality therapeutic effort (measured with the Therapeutic Intervention Scoring System [TISS]), SAPS score, age and hospital, but not SES. The TISS/SAPS ratio according to origin of patients (emergency/general wards) was comparable in the high and low SES. We conclude that there is an inverse relationship between SES and ICU mortality. The mortality excess in the low SES patients is largely accounted for by the covariates of the low SES (especially their high age and severity of illness on admission). There is no evidence of a different relative therapeutic effort according to the SES.

Predictors of death following ICU discharge.

In order to study possible predictors of early after-discharge mortality (EADM), 700 consecutive patients discharged alive from three intensive care units (ICUs) were followed up 2 months after their admission. The observed mortality was 7.3%. Univariate analysis indicated a strong statistically significant association of the following variables with mortality: initial simplified acute physiological score (SAPS) greater than 10, therapeutic intervention score in the first 24 h of admission greater than 20, age greater than or equal to 65, length of stay in the ICU greater than 10 days, and low educational level. The multiple logistic regression analysis included as predictive independent variables the SAPS, organs or systems failure, age, and length of stay. The model built upon these four variables was able to identify a group of patients at high risk (21-46%) of EADM. We conclude that some simple variables can be used as useful markers of patients groups at high risk of EADM.

Acute lymphoblastic leukaemia among Spanish children and mothers' occupation: a case-control study.

STUDY OBJECTIVE: The aim was to investigate the association between mothers' occupational exposure during pregnancy and the incidence of acute lymphoblastic leukaemia in children. DESIGN: The study was a case-control investigation. A face to face interview was used to assess exposures at work and relevant confounding variables. SETTING: The study was community based and was carried out in five provinces of Spain. SUBJECTS: 128 cases less than 15 years of age were interviewed (91% of those eligible). Controls (one for each case) were chosen from the census lists and were matched on year of birth, sex and municipality. MEASUREMENTS AND MAIN RESULTS: Children of mothers working at home had a relative risk (RR) of 7.0 (95% CI = 1.59-30.79) of developing acute lymphoblastic leukaemia. Exposure to organic dust was associated with a RR of 5.5 (95% CI = 1.21-24.8). There was a statistically significant interaction between exposure to organic dust and working at home. The majority of women working at home were hired by local industries to sew different types of tissues (cotton, wool, synthetic fibres) on a machine. CONCLUSION: A similar association has not been reported before: if confirmed, this finding may suggest a new health concern.

[Quitting the tobacco habit in Spain]. / El abandono del hábito tabáquico en España.

BACKGROUND: The tendencies in the cessation from smoking and their determinants provide useful information to developed preventive policies and to predict the evolution of diseases associated with cigarette consumption. Spain is one of the European countries with more prevalent smoking habits in the general population, and thus the study of factors determining cessation from smoking is particularly relevant. METHODS: The socioeconomic, demographic and health-related variables associated with the cessation from smoking were evaluated using the data bank from the National Health Survey carried out by the Ministerio de Sanidad y Consumo in 1987, which includes interviews to 29,647 individuals above 16 years of age. The data were analyzed by the calculation of the quit ratio standardized for age. RESULTS: The quit ratio is influenced by age and sex; it is higher among women and it increases with age. The results are questionable regarding the relation with educational level, family income and occupation. The smokers of less than 10 or more than 25 cigarettes/day are those with a higher quit ratio. The quit ratio is also higher in individuals with health problems, a higher rate of use of health services and in those without usual alcohol consumption. CONCLUSIONS: The profile of the individuals who quit smoking in Spain has specific features when compared with other countries, particularly regarding the higher quit rate among women and the lack of a linear correlation with indicators of socioeconomic level.

[Opinion of medical students about prescription, counseling and practice of voluntary interruptions of pregnancy]. / Opinión de los estudiantes de medicina sobre la prescripción, el consejo y la práctica de interrupciones voluntarias del embarazo.

BACKGROUND: A future prospect was carried out of the professional trends regarding prescription, counseling and practice of voluntary interruptions of pregnancy (VIP). METHODS: To this end, a questionnaire was administered to 177 last term students of the Valencia and Alicante Schools of Medicine regarding the opinions of the current law on VIP in Spain and the professional trends of approach, with practical examples of the four instances depenalized by the Spanish law. RESULTS: For 44% of the sample the present law is insufficient, 30% agree with it and 13% think that the present law threatens life. The instance which elicited a highest number of favorable professional trends was congenital malformation (85%), followed by physical problems (78%) and psychical problems (63%). Only 60% of students would take a favorable attitude in case of rape. The students without religious practice, who vote progressive political parties and who think that present law is insufficient have a significant tendency towards attitudes favoring VIP. Significant sex differences among students were not found. CONCLUSIONS: Although probably to a lesser degree than in the present, in the near future the unfavorable attitudes of physicians will continue hindering the access of women to the services of VIP. A wide debate and more studies are required for a better definition of the implications of this phenomenon for public health purposes.

[Infection caused by the human immunodeficiency virus type 1 in prostitutes and risk factors]. / Infección por el virus de la immunodeficiencia humana tipo 1 en prostitutas y factores de riesgo.

BACKGROUND: Women dedicated to prostitution constitute a group at risk of acquiring the human immunodeficiency virus-1 (HIV-1). This study was designed with the aim of knowing the frequency of this infection in prostitutes and the factors associated to the same. METHODS: A descriptive transversal study with analytic components including 444 women who voluntarily attended an AIDS prevention center from 1986-1991 was carried out. The HIV-1 antibody test was performed in 440 of the subjects. All the subjects were interrogated on sociodemographic variables and risk of infection. RESULTS: Of the 440 women studied, 24 had HIV-1 antibodies with a global prevalence (1986-1991) of 5.5% with confidence intervals of 3.4, and 7.6% at 95% (CI 95%). During the study period the prevalence remained stable: 6.8% (1986-87), 5.5% (1988), 4.3% (1989) and 4.3% (1990-91). No positive association was found between HIV-1 infection and education, time in prostitution and the use of condoms. HIV-1 infection was strongly associated to the use of drugs, adjusted odds ratio by logistic regression OR = 26.9 (CI 95%: 8.9; 9/1). Positive associations were also observed with greater number of sexual partners and syphilis but these did not reach statistical significance. The percentage of prostitutes who used condoms with more than 33% of their clients increased from 44.5% in 1986-87 to 85.9% in 1990-91. CONCLUSIONS: In this study no considerable changes were found with respect to the prevalence of infection by the human immunodeficiency virus-1 in prostitutes in Spain. Similarly, this collective has increased its use of preventive measures although they remain insufficient, indicating that more energetic preventive strategies are necessary. These measures should be particularly active with the group of young prostitutes.

[Prevalence of human immunodeficiency virus infection, hepatitis B virus and syphilis in full term pregnancy]. / Prevalencia de infección por el virus de la inmunodeficiencia humana, el virus de la hepatitis B y la sífilis en embarazadas a término.

BACKGROUND: The estimation of the frequency of infection by HIV, hepatitis B virus and syphilis in unselected populations of full-term pregnancy is useful for epidemiologic surveillance of these diseases and for decision marking in prenatal detection. METHODS: A transversal study of 3,193 women who gave birth in the Hospital General de Elche between March 1989 and February 1990 was carried out. A blind survey was developed to avoid ethic problems and bias derived from the undertaking of HIV test without patient consent. RESULTS: The prevalence of HIV was 0.5/1,000 women (CI 95%, 0-1.5); HBV 8.9/1,000 (CI 95%, 4.6-13.2) and syphilis 1.5/1,000 (CI 95%, 0.9-2.1). CONCLUSIONS: The diffusion of the AIDS epidemic in Spain to the general population does not at present seems important although studies should be performed in the future to monitor the trend. The prevalence of syphilis in Spain is low in this study in comparison with the results of other Spanish studies which may be explained by greater quality of care in to pregnancy. The prevalence of HBV suggests the need for detection and vaccination of newborns.

[Predictive value of obligatory reporting of sexually transmitted diseases]. / Valor predictivo de la declaración obligatoria en enfermedades de transmisión sexual.

Sexually transmitted diseases (STD) were recently included in the Spanish reporting system, or Compulsory Reporting of Diseases (EDO). In the present study, the validity of this system is evaluated with the estimation of the positive predictive values of the EDO. A preestablished questionnaire was administered by phone to the reporting physicians of the 478 cases of STD that had been reported to the EDO system from August 1987 to May 1988 in the Alicante and Valencia provinces. In this survey, in addition to data related to the reporting physician (specialty and place of work) and to the patient (sex, clinical symptoms and signs), information permitting to classify each diagnosis as certain, likely and unlikely was collected (incubation time, laboratory tests). Considered as a whole, the results suggested an acceptable accuracy (positive predictive value 79.09%, confidence limits 76.7%-81.5%) for both diseases. This permits to consider STD statistics as fairly accurate. Among the factors influencing the diagnostic precision are the disease itself, the patient's sex, the qualification of the reporting physician and his place of work. The predictive value of the cases reported from centers of diagnosis of STD was higher. We think that, although these results are acceptable for the epidemiological survey, the quality of care could be enhanced by a better organization of services and an improved undergraduate and postgraduate education.

[Rheumatology research. An analysis of the situation in Spain]. / Investigación en Reumatología. Un análisis de la situación española.

To analyze the present status of rheumatological research in Spain, three indicators have been evaluated: use of the different study designs, use of statistical techniques and relevance of the studies. This last point was determined by the comparison of the research areas that had been reported during one year and the lines of rheumatological research established as priorities by 10 investigators from the 10 units of clinical care with a higher scientific output during the period 1985-1987. A revision has been made of the 67 articles from Spain out of the 1106 reported in seven of the journals with a better national and international impact index: Scandinavian Journal of Rheumatology, Arthritis and Rheumatism, Journal of Rheumatology, Annals of the Rheumatic Diseases, British Journal of Rheumatology, Clinical Experimental Rheumatology and Revue du Rhumatisme, in addition to Revista Española de Reumatología. It was found that few studies with analytical design are being published and that complex statistical analysis techniques are not being used; therefore, most articles do not have a possible statistical inference and lack value as predictors. The reports of cases and clinical series in the Letters to the Editor section are most common, particularly in the Spanish journal. Most studies are related with clinical research, although the consulted investigators consider that basic and epidemiological research have a higher priority. It is concluded that the Spanish contribution to the international rheumatological literature is still small and has a mainly descriptive character; thus, it is necessary to emphasize the use of analytical designs to improve the competitiveness. The type of studies to be carried out in the future, according to the priorities established by the investigators themselves, should change if their wishes are to be fulfilled.

[Evaluation of the variability of rapid diagnosis of infection by Chlamydia trachomatis using direct immunofluorescence]. / Evaluación de la variabilidad del diagnóstico rápido de infección por Chlamydia trachomatis mediante immunofluorescencia directa.

The interobserver and intraobserver agreement between two microscopists was independently assessed in a blind fashion to evaluate the reproducibility of the results of the quick diagnosis of Chlamydia trachomatis infection with direct immunofluorescence. The study was carried out in two phases, and 604 samples of cervical and urethral exudate from patients seen at a center for the prevention and therapy of sexually transmitted diseases were evaluated. The two observers had a kappa index of agreement between them of 0.41, with 95% confidence intervals (95% Cl) of 0.31-0.51, while their agreement within themselves was 0.78 (95% Cl: 0.65-0.91) for the first observer and 0.61 (95% Cl: 0.47-0.75) for the second one. After discussion of the data and analysis of the reasons of disagreement, the evaluation was repeated. In this second phase, both interobserver and intraobserver agreement were substantially improved. The kappa index was 0.71 (95% Cl: 0.61-0.80) for the former, whereas regarding the latter the first observer had a kappa index of 1 (95% Cl: 0.86-1.13) and the second observer an index of 0.82 (95% Cl: 0.61-0.80). It was concluded that the test may have problems in its practical performance if the microscopists are not previously trained with systematic programs for the evaluation of results.

[Health inequalities in Barcelona and Valencia]. / Desigualdades en salud en Barcelona y Valencia.

BACKGROUND: Inequalities in health have been internationally recognized as an important public health problem with a reduction of 25% being the first target of WHO--Europe for the year 2000. It is, therefore, important to describe and monitor the same. METHODS: An ecological study was performed using secondary data from the statistics of mortality (years 1985-1988) and the municipal censuses from the year 1986 to describe and compare inequalities in health in the cities of Valencia and Barcelona with neighborhoods being the unit of observation and analysis. RESULTS: Although the rates of mortality in Barcelona city are slightly inferior and those of Valencia slightly higher to those of Spain, both cities demonstrate important inequalities in regard to mortality in their neighborhoods with respect to standardized mortality which ranged from 78 to 182 in Barcelona and from 63 to 147 in Valencia. The privileged zones in Barcelona are those of Pedralbes and Sant Gervasi and in Valencia in the neighborhoods of Sant Pau and Jaume Roig with the most unfavorable neighborhoods being District I in Barcelona (Gothic Quarter, City Park, Barceloneta and Raval) and the Na Rovella and Fuensanta neighborhoods of Valencia. The level of inequality in both cities is very similar. Statistically significant associations have been found in both cities between the state of health and the level of poverty in the neighborhoods according to an approximation to the Townsend et al indexes. CONCLUSIONS: The description of important inequalities in two large Spanish cities suggests the possibility of its existence in other cities and established the urgent need for a study using comparable methodologies. With the use of routine and presently available data sources it is possible to describe and posteriorly monitor the level of inequality in large cities in Spain. The development of policies to diminish the inequalities in the large cities would provide considerable gains in terms of human lives. The present results support the hypothesis that material conditions in everyday life play an important role as a condition for public health inequality.

[Age as a prognostic factor in intensive care]. / La edad como factor pronóstico en cuidados intensivos.

In order to define the prognostic impact of the age of critical patients as well as its association with the initial severity of illness (SAPS index) and therapeutic effort (TISS index), we studied 1.102 patients older than 14 years admitted consecutively to 3 general intensive care units. The oldest patients (more than 65 years) showed a higher mean SAPS (11.00 versus 8.58, p less than 0.0001) and mortality (odds ratio = 1.99, p less than 0.0001) than the younger ones. The association between age and mortality showed a "dose-response" pattern, even after controlling for the effect of initial severity (p less than 0.0001). The effect of age was stronger in the groups of patients with low SAPS (odds ratio = 2.94, p = 0.0007) or admitted for acute myocardial infarction (odds ratio = 3.28, p less than 0.0001). The oldest group showed a lower TISS/SAPS ratio and a shorter stay in the intensive care unit than younger patients, suggesting a low relative therapeutic effort in the latter. The differential therapeutic effort did not explain, however, the mortality excess in the oldest group, because the gradient of mortality increased after adjusting for TISS/SAPS ratio (adjusted odds ratio = 2.42, p less than 0.0001).

[Media impact of the SESPAS (Spanish Public Health Association) 2000 report]]. / El impacto mediático del informe SESPAS 2000.

OBJECTIVE: To measure the mediatic effect of different communication strategies used in public health advocacy. More specifically, to compare the effectiveness of the World Wide Web as a tool to attract the attention of journalists, with other more traditional formulas. METHODS: For the Spanish Public Health Association (SESPAS) Report 2000, two types of media strategies to communicate the report contents were programmed: a) traditional and passive strategies, centred in approaching journalists through press releases and press conferences around the SESPAS meeting (November 15-20 1999); b) interactive strategies, since August 15 to December 30, focused towards attracting health journalists to the non-embargoed, full text SESPAS report launched in a web site. To facilitate the web page use, we wrote a letter, in the first week of August, to all the members of the Spanish Health Communicators Association giving them the URL and the website map. In parallel, a monitoring system of the media impact was established from August to December 99, covering 250 magazines and 70 newspapers, in order to locate and recover all the stories about the SESPAS report for further analysis. RESULTS: Sixty-six stories were recovered; they were published in 32 press media from 24 provinces with an advertising value of 18,243,873 Ptas. As a whole, smaller circulation rate papers published more stories than larger ones. During five months, the SESPAS report was present in the press agenda, even though stories were not distributed homogeneously over time. Information concentrated around three moments: the first one, a week after our summer mailing; the second one, in the occasion of the publication of a story about the increase in traffic accidents in El País, and the third one during the SESPAS meeting. There were significant differences among those stories published from the traditional strategies of communication and those published from the interactive ones, the latter being more diverse, with more contributions of the journalists and tackling a wider range of issues. CONCLUSIONS: The combination of traditional and alternative communication strategies was a effective option. Unlike previous experiences in this occasion, with the network aid, the presence of SESPAS in media was not punctual around the Congress, but maintained during five months. The results and the obtained experience of this research can be useful for future public health advocacy interventions in Spain.

[The genome and its metaphors. Detectives, heroes or prophets?]. / El genoma y sus metáforas. 'Detectives, héroes o profetas?

The new genetics, or the impetus given to this discipline by the Genome Project, aims to a change of paradigm of the Health Sciences. This change is postulated from a phenotypic approach to a genotypic one, thereby excluding the influence of the environment, which could seriously undermine the grounds for the development and exercise of Public Health. Since the beginning of the genome project, information on genetic discoveries has frequently been reported in the mass media. Metaphors are often used by geneticists and journalists to convey the complex concepts of genetic research for which there are no equivalents in the lay language. The media do not merely shape the social agenda but also provide the space in which health culture is constructed. We present the results of a preliminary study exploring the metaphors used in the three most widely-read national daily newspapers in Spain, namely ABC, El Pais and El Mundo, when reporting news of the new genetics. The possible consequences of the natural history of these metaphors, or the process through which figurative terms acquire a literal meaning, are discussed. A preliminary taxonomy for the metaphors identified was developed. Fifty-one out of 342 identified headings (14.8%) contained metaphors. Strategic metaphors such as program, control, code, map, and puzzle, were the most commonly used, followed by teleological ones such as mystery or God language and finally war-like metaphors such as attack, defeat, and capture. The three groups of metaphors are characterized by an attempt to giving intentionality to genes. Strategic metaphors predominated over teleological and war-like ones and thus a technocratic perspective could form the basis of the future construction of health culture.