[Effectiveness of lumbar sympathectomy in the treatment of occlusive peripheral vascular disease in lower limbs: systematic review]. / Efectividad de la simpatectomía lumbar en el tratamiento de la arteriopatía periférica oclusiva de miembros inferiores: revisión sistemática.

BACKGROUND AND OBJECTIVES: The aim of this work has been to check the scientific evidence on the efficacy of lumbar sympathectomy in the treatment of peripheral arterial disease of lower limbs. MATERIAL AND METHODS: Systematic review of the literature. DATA SOURCE: MedLine, Embase, Cochrane Library, INHATA, CRD, BioMed Central, and ClinicalTrials.gov register. Mesh terms: sympathectomy, peripheral vascular disease, lower extremity, vascular therapy, iliac artery, femoral artery, popliteal artery. INCLUSION CRITERIA: adult patients with occlusive peripheral arterial disease of lower limbs treated with sympathectomy. The quality was evaluated by means of the criteria of the CASP checklist and "ad hoc" questionnaire. RESULTS: Four clinical trials and four observational studies were included. Sympathectomy did not show significant differences for mortality, amputations and grade of intermittent claudication. When it was assessed regarding local anaesthetics or prostaglandin-E1, differences were not detected. Chemical sympathectomy showed better results than surgical sympathectomy in hospital stance. CONCLUSIONS: Evidence on the efficacy of sympathectomy does not show differences related to conventional treatments. Both sympathectomy techniques (surgical and chemical) do not report statistical differences regarding mortality or amputations.

[Trends in age-sex-specific mortality in Spain (1981-2016). Changes associated with the economic crisis]. / Tendencia de la mortalidad por edad y sexo en España (1981-2016). Cambios asociados a la crisis económica.

OBJECTIVE: To analyze trends in age-sex-specific mortality in Spain, and to identify if there have been changes following the onset of economic crisis. METHOD: A study of trends in mortality rates by sex and quinquennial groups of age was carried out, from 1981 to 2016. Time trends were established by joint-point regression models. The results of the last two periods identified in the regressions are presented in detail, identifying changes after the onset of the economic crisis. When slowdown or stagnation of the mortality trends were identified in several successive age groups, an analysis of trends by causes was carried out. RESULTS: Mortality was significantly reduced between 1981 and 2016. After the beginning of the economic crisis, the trend in total age-standardized mortality did not change for men, but it stagnated for women from 2013 to 2016. In the analysis by quinquennial age groups, the downward trend in mortality suffered a stagnation in men in all the groups between 15 and 39 years, which started between 2011 and 2014, and lasted until 2016. In both women and men, in the four groups between 60 and 79 years, the previous decline in mortality suffered a slowdown or stagnation, which began between 2009 and 2014, and continued until 2016. Negative changes in mortality trends were mainly influenced by external causes (in 15-39 years men) and diseases of the circulatory and respiratory systems (in 60-79 years men and women). CONCLUSIONS: The downward trend of mortality suffered stagnation or deceleration after the onset of the economic crisis in young men and 60-79 years old men and women.

Medical societies' recommendations for immunization with Human Papillomavirus vaccine and disclosure of conflicts of interests.

OBJECTIVE: To review the recommendations on Human Papillomavirus (HPV) vaccination issued by different medical societies, as well as disclosures of any conflict of interests regarding such recommendations. METHODS: The search for recommendations was mainly conducted through the Internet, together with a bibliography search on Pubmed (November 2008). The countries were selected to encompass a broad range of healthcare systems and income levels. RESULTS: In all, 18 documents were identified: 4 from the U.S., 5 from Canada, and 1 from France (all 10 in favor of recommending vaccination), 5 from Spain (3 in favor of vaccination and 2 recommending no vaccination until further evidence of the vaccine effectiveness to prevent cervical cancer becomes available), 2 from Argentina (one in favor of vaccination and another pointing to the missing information on the vaccine's cost-effectiveness), and 1 from Chile (recommending no vaccination until more information becomes available). Only two documents disclose specific conflicts of interests for authors (American Cancer Society and Chilean Working Group on HPV). One of the Canadian documents did not include any conflict of interest statement, although Merck and GSK are listed among the sponsors. CONCLUSIONS: Disclosure of conflicts of interest in documents where medical societies issue recommendations on HPV vaccination is very unusual. However, lack of disclosure is more frequent (near twice) when recommendations are in favor of the vaccination.

[Negative effects of individual-based preventive interventions. 2008 SESPAS Report]. / Los efectos negativos de las intervenciones preventivas basadas en el individuo. Informe SESPAS 2008.

Because preventive interventions are usually assumed to carry few risks, research on their negative effects is scarce, as revealed by a review of the Spanish literature. The studies retrieved analyze short-term effects (such as false-positive results of screening tests), but do not evaluate the long-term effects of postscreening interventions (for example: preventive drugs) or even less tangible negative effects (such as medicalization). Uncritical spread of preventive medicine is occurring, with continual proposals for new screening tests (for pre-diseases and risk factors) and new vaccines. The risk-benefit ratio of this spread is, at the very least, doubtful. The pharmaceutical industry plays a key role in this process but the role of other stakeholders (health professionals and health authorities, mass media and society) should also be reviewed. The present article highlights the role of the medical profession, since, without it, definition of new diseases and pre-diseases and the creation of guidelines on the use of new preventive interventions would not be possible. The medical profession has sufficient prestige to lead any change. Before any change occurs, however, scientific societies should conduct an internal debate on their current role in the adoption of new preventive interventions, their relationships with the pharmaceutical industry and their conflicts of interest. Some medical associations are already adopting a more critical approach to the evaluation of the benefit-risk trade-off of new interventions and are analyzing the impact of their own preventive recommendations on the medicalization of life. The adverse effects of the preventive measures implemented in health services should be continually assessed and procedures for the critical evaluation of the benefit-risk-cost trade-offs of new preventive interventions should be established before making decisions on their incorporation in the health services' portfolio. Finally, in daily clinical practice, enhancing citizen participation in decisions and adopting the approach of quaternary prevention would be desirable.

How a deliberative approach includes women in the decisions of screening mammography: a citizens' jury feasibility study in Andalusia, Spain.

OBJECTIVES: To verify whether a citizens' jury study is feasible to the Andalusian population and to know if women, when better informed, are able to answer the research question of whether the Andalusian Public Health System must continue offering screening mammography to women aged 50-69. The reasons for the pertinent decision and recommendations to the political authorities will be stated. DESIGN: Qualitative research study with the methodology of citizens' jury. SETTING: Breast cancer screening programme in Andalusia (Spain). PARTICIPANTS: Thirteen women aged 50-69 with secondary school or higher education accepted to participate as a jury. Two epidemiologists were the expert witnesses. The main researcher was the neutral moderator. INTERVENTIONS: Jury met on Monday, 15 February 2016. The moderator indicated to the jury that it had to assess the screening programme's key benefits and main harm. On Tuesday, 16 February, the expert witnesses positioned for and against the programme. On Thursday, 18 February, the jury deliberated, reached final conclusions, submitted its vote and stated its recommendations to politicians. The deliberation session was transcribed and analysed with the support of ATLAS.ti.5.2 software. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility in the Andalusian population, women's vote and opinion, reasons for votes and recommendations to political authorities. RESULTS: Eleven participants voted yes and two voted no. There are three reasons to vote 'yes': health, the test nature, and individual freedom. Some women invoke the lack of efficacy and the cost to justify their negative vote, at least in universal terms. On completion, they made suggestions to be submitted to the pertinent authorities for the improvement of information, psychology services and research. CONCLUSIONS: The deliberative strategy is feasible and causes a favourable positioning regarding screening mammography, although information changes the opinion of some women, who desire informed decision making and to keep or increase medicalisation in their lives.

Hospital mortality in acute coronary syndrome: differences related to gender and use of percutaneous coronary procedures.

BACKGROUND: To identify differences among men and women with acute coronary syndrome in terms of in-hospital mortality, and to assess whether these differences are related to the use of percutaneous cardiovascular procedures. METHODS: Observational study based on the Minimum Basic Data Set. This encompassed all episodes of emergency hospital admissions (46,007 cases, including 16,391 women and 29,616 men) with a main diagnosis of either myocardial infarction or unstable angina at 32 hospitals within the Andalusian Public Health System over a four-year period (2000-2003). The relationship between gender and mortality was examined for the population as a whole and for stratified groups depending on the type of procedures used (diagnostic coronary catheterisation and/or percutaneous transluminal coronary angioplasty). These combinations were then adjusted for age group, main diagnosis and co-morbidityharlson score). RESULTS: During hospitalisation, mortality was 9.6% (4,401 cases out of 46,007), with 11.8% for women and 8.3% for men. There were more deaths among older patients with acute myocardial infarction and greater co-morbidity. Lower mortality was shown in patients undergoing diagnostic catheterisation and/or PTCA. After adjusting for age, diagnosis and co-morbidity, mortality affected women more than men in the overall population (OR 1.14, 95% CI: 1.06-1.22) and in the subgroup of patients where no procedure was performed (OR 1.16, 95% CI: 1.07-1.24). Gender was not an explanatory variable in the subgroups of patients who underwent some kind of procedure. CONCLUSION: Gender has not been associated to in-hospital mortality in patients who undergo some kind of percutaneous cardiovascular procedure. However, in the group of patients without either diagnostic catheterisation or angioplasty, mortality was higher in women than in men.

[Cardiac complications of major elective non-cardiac surgery: incidence and risk factors]. / Complicaciones cardiacas en cirugía mayor programada no cardiaca: incidencia y factores de riesgo.

INTRODUCTION AND OBJECTIVES: Previous estimates of the incidence of cardiac complications following major elective surgery have all been obtained in populations with specific risk factors or in contexts that differ from those found in Spain. Our aims were to estimate the frequency of postoperative cardiac complications following major elective non-cardiac surgery in patients aged 40 years or more, and to identify associated risk factors. METHODS: Prospective observational study of consecutive patients undergoing surgery between November 1997 and October 1999. RESULTS: The overall incidence of postoperative cardiac complications was 9.6 (95% CI, 5.3-16): it was 1.9 (95% CI, 0.5-7.5) for superficial surgery, 36.2 (95% CI, 15.1-87) for deep surgery, and 150 (95% CI, 67.4-334) for peripheral vascular surgery. The risk of cardiac complications was greater in patients aged 75 years or more (relative risk [RR]=9.5; 95% CI, 2.6-34.9), in those with type-I diabetes (RR=7.1; 95% CI, 2.1-24.1), systolic blood pressure > or =180 mmHg (RR=5.8; 95% CI, 1.3-25.4), or electrocardiographic signs of ischemia (RR=25.3; 95% CI, 6-106.8), in those who had undergone deep or peripheral vascular surgery (RR=21; 95% CI, 5.4-81.6), and in those who experienced hypotensive episodes during surgery (RR=8.9; 95% CI, 2-39.1). CONCLUSIONS: Cardiac complications occurred in 1% of consecutive patients aged 40 years or more in the three months following major elective non-cardiac surgery.

[Differences between women's and men's access to interventional cardiovascular procedures at public hospitals in Andalusia (Spain)]. / Diferencias entre mujeres y varones en el acceso a procedimientos cardiovasculares intervencionistas en los hospitales públicos de Andalucía.

INTRODUCTION AND OBJECTIVES: The aim of this study was to determine whether there are differences between women's and men's access to coronary revascularization procedures for acute coronary syndrome in Andalusia, Spain. METHODS: This observational multicenter study was based on the Andalusian Minimum Basic Data Set (CMBDA). The study included all hospitalizations at public hospitals in the period 2000-2003 that involved emergency admission and in which the principal diagnosis was acute myocardial infarction or unstable angina. There were 46 007 cases (16 391 women and 29 616 men). The relationships between sex and the use of cardiac catheterization, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting were analyzed. Patients were categorized according to age, principal diagnosis, and comorbidity (Charlson index). Multivariate logistic regression analysis, which included adjustment for the other variables, was used to determine the association between sex and procedure use. RESULTS: Women in the study population were older and had more severe comorbidity than men. They underwent diagnostic and therapeutic procedures less frequently, irrespective of age group, diagnosis, and comorbidity. After adjusting for age, diagnosis, and comorbidity, the odds ratio (reference category: men) was 0.68 (95% CI, 0.64-0.72) for cardiac catheterization, 0.61 (95% CI, 0.57-0.66) for percutaneous transluminal coronary angioplasty, and 0.38 (95% CI, 0.29-0.50) for coronary artery bypass grafting. CONCLUSIONS: During hospitalization for acute coronary syndrome, women less frequently had access to interventional cardiovascular procedures than men. Further research is needed to clarify the roles played by social, cultural and biological factors in determining the observed differences.

[Trends in preventive drug prescription in the Primary Care District of Seville [2000-2003]]. / Tendencias en la prescripción de fármacos preventivos en el distrito de atención primaria de Sevilla (2000-2003).

OBJECTIVES: To describe trends in prescription rates for biphosphonates, raloxifene, calcitonin, statins and hormone replacement therapy (HRT) between 2000 and 2003 and to assess the impact of mass media information on the interruption of the Women's Health Initiative trial on HRT prescription rates. METHODOLOGY: We performed a descriptive, ecological study, with time (month) as the observation unit. Monthly rates of bisphosphonate, calcitonin, raloxifene, statins and HRT prescription, in defined daily doses per 1000 persons, were measured in the population assigned to 249 family physicians in 27 health centers in Seville. Trend graphs and time series analysis were carried out. RESULTS AND DISCUSSION: The prescription of preventive drugs has tended to increase between 2000 and 2003. The HRT prescription rate has decreased since the interruption of the Women's Health Initiative trial.

Tendencia de la mortalidad por edad y sexo en España (1981-2016). Cambios asociados a la crisis económica / Trends in age-sex-specific mortality in Spain (1981-2016). Changes associated with the economic crisis

OBJETIVO: Analizar la tendencia de las tasas de mortalidad por edad y sexo en España e identificar si se han producido cambios tras el comienzo de la crisis económica. MÉTODO: Estudio de tendencias de las tasas de mortalidad por grupos quinquenales de edad y sexo en el periodo 1981-2016, mediante regresión joint-point. Se detallan los resultados de los dos últimos periodos identificados en las regresiones, que permiten identificar cambios ocurridos después del inicio de la crisis. En caso de ralentización o estancamiento de la tendencia de mortalidad en varios grupos de edad sucesivos, se realizó un análisis de tendencias por causas. RESULTADOS: La mortalidad se redujo de forma significativa entre 1981 y 2016. Tras el inicio de la crisis económica, la tendencia de la mortalidad total estandarizada no cambió en los hombres, y sufrió un estancamiento en las mujeres entre 2013 y 2016. En el análisis por grupos quinquenales de edad, la tendencia descendente de la mortalidad sufrió un estancamiento en los hombres en todos los grupos entre los 15 y 39 años, que se inició entre 2011 y 2014 y duró hasta 2016. En ambos sexos, en los cuatro grupos de edad entre 60 y 79 años, la reducción previa de la mortalidad sufrió una ralentización o estancamiento, que se inició entre 2009 y 2014, y continuó hasta 2016. Las causas que más contribuyeron al cambio de tendencia fueron las causas externas en hombres de 15-39 años, y las enfermedades del sistema circulatorio y respiratorio en las personas de 60-79 años. CONCLUSIÓN: La tendencia descendente de la mortalidad ha sufrido una ralentización o un estancamiento después del inicio de la crisis económica, principalmente en hombres jóvenes, y en hombres y mujeres de 60-79 años

OBJECTIVE: To analyze trends in age-sex-specific mortality in Spain, and to identify if there have been changes following the onset of economic crisis. METHOD: A study of trends in mortality rates by sex and quinquennial groups of age was carried out, from 1981 to 2016. Time trends were established by joint-point regression models. The results of the last two periods identified in the regressions are presented in detail, identifying changes after the onset of the economic crisis. When slowdown or stagnation of the mortality trends were identified in several successive age groups, an analysis of trends by causes was carried out. RESULTS: Mortality was significantly reduced between 1981 and 2016. After the beginning of the economic crisis, the trend in total age-standardized mortality did not change for men, but it stagnated for women from 2013 to 2016. In the analysis by quinquennial age groups, the downward trend in mortality suffered a stagnation in men in all the groups between 15 and 39 years, which started between 2011 and 2014, and lasted until 2016. In both women and men, in the four groups between 60 and 79 years, the previous decline in mortality suffered a slowdown or stagnation, which began between 2009 and 2014, and continued until 2016. Negative changes in mortality trends were mainly influenced by external causes (in 15-39 years men) and diseases of the circulatory and respiratory systems (in 60-79 years men and women). CONCLUSIONS: The downward trend of mortality suffered stagnation or deceleration after the onset of the economic crisis in young men and 60-79 years old men and women

[Incorporation of cardiac rehabilitation programs and their characteristics in the Spanish National Health Service]. / Incorporation of cardiac rehabilitation programs and their characteristics in the Spanish National Health Service.

OBJECTIVES: To estimate the degree of incorporation of cardiac rehabilitation in the Spanish National Health Service, to describe the characteristics of the programs, and to report on the opinions of those responsible for them regarding their progress. PATIENTS AND METHOD: Cardiac rehabilitation centers were identified from different sources. A questionnaire which included items about coverage, resources, activities and services, selection of patients, and opinions was mailed to the heads of all units. RESULTS: Twelve public centers with cardiac rehabilitation programs were identified. Cardiac rehabilitation was offered to 53% of all eligible patients. All units treated patients with myocardial infarction, 64% treated those with heart failure; and 60% high risk patients. Approximately 10-19% of all patients were women. The physicians involved most frequently in programs were cardiologists; nonmedical professionals who participated most often were physiotherapists, and 64% of all units had a staff psychologist. Phase II rehabilitation was provided by all units, and phase III treatment was provided mainly by units that operated in coordination with out-patient services (45%). All units provided physical exercise training and counseling about the disease and risk factors, and 73% of them provided psychological support. The main reasons cited for providing rehabilitation were its efficacy and ability to prevent illness; and the main barriers to more widespread use were lack of resources and support. About three-fourths (73%) of all doctors interviewed thought that primary health care centers could play an important role in rehabilitation programs. CONCLUSIONS: Cardiac rehabilitation is poorly implemented in the Spanish National Health Service. The most significant differences between programs were related to the inclusion of high risk patients and with a diagnosis other than myocardial infarction, coordination with out-patient services, and provision of phase III rehabilitation.

[Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014]. / Promoción de la salud y prevención en tiempos de crisis: el rol del sector sanitario. Informe SESPAS 2014.

This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts' opinions are divided on the need for some preventive activities. Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions.

[Lessons from abroad. Current and previous crisis in other countries. SESPAS report 2014]. / Lecciones desde fuera. Otros países en ésta y otras crisis anteriores. Informe SESPAS 2014.

The evidence available on the impact of previous crises on health reveals different patterns attributable to study designs, the characteristics of each crisis, and other factors related to the socioeconomic and political context. There is greater consensus on the mediating role of government policy responses to financial crises. These responses may magnify or mitigate the adverse effects of crises on population health. Some studies have shown a significant deterioration in some health indicators in the context of the current crisis, mainly in relation to mental health and communicable diseases. Alcohol and tobacco use have also declined in some European countries. In addition, this crisis is being used by some governments to push reforms aimed at privatizing health services, thereby restricting the right to health and healthcare. Specifically, action is being taken on the three axes that determine health system financing: the population covered, the scope of services, and the share of the costs covered. These measures are often arbitrarily implemented based on ideological decisions rather than on the available evidence and therefore adverse consequences are to be expected in terms of financial protection, efficiency, and equity.

[Caesarean delivery in Andalusia, Spain: relationship with social, clinical and health services factors (2007-2009)]. / Frecuencia de la cesárea en Andalucía: relación con factores sociales, clínicos y de los servicios sanitarios (2007-2009).

BACKGROUND: Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables. METHODS: A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used. RESULTS: In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education. CONCLUSIONS: Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.

Promoción de la salud y prevención en tiempos de crisis: el rol del sector sanitario. Informe SESPAS 2014 / Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014

Este artículo revisa la evolución de los estilos de vida e identifica algunas prioridades y líneas de mejora en prevención y promoción de la salud en el momento actual de crisis económica. Se utilizan diversas fuentes, incluida una encuesta a 30 expertos/as en salud pública y atención primaria. Entre 2006 y 2012 no se detectan grandes cambios en estilos de vida, salvo un descenso en el consumo habitual de alcohol. Desciende ligeramente el consumo de drogas ilegales, pero aumenta el de psicofármacos. La mayoría de los/las expertos/as considera que debe mejorarse la toma de decisiones sobre cribados poblacionales y vacunas, incluyendo el análisis del coste de oportunidad, y mayor transparencia e independencia de los/las profesionales implicados/as. La prevención está contribuyendo a la medicalización de la vida, pero hay opiniones divididas sobre la necesidad de algunas actividades preventivas. Las prioridades en prevención están en el ámbito de la salud mental y de la infección por el virus de la inmunodeficiencia humana en grupos vulnerables. La mayoría de los/las expertos/as considera que las intervenciones de promoción de la salud tienen potencial para mitigar los efectos de la crisis, y que son grupos prioritarios la infancia, las personas desempleadas y otros grupos vulnerables. Son intervenciones prioritarias las actividades comunitarias en colaboración con ayuntamientos y otros sectores, la abogacía y la promoción de la salud mental. Se considera deseable un mayor uso de la legislación y de los medios de comunicación como herramientas de promoción. Es importante clarificar el rol del sector sanitario en las actividades intersectoriales, y reconocer las limitaciones, puesto que los determinantes sociales de salud dependen de otros sectores. Se advierte asimismo del riesgo derivado de los recortes y de las políticas que inciden negativamente en las condiciones de vida (AU)

This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts’ opinions are divided on the need for some preventive activities. Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions (AU)

[Current state of breast cancer surgery in Andalusia and Catalonia]. / Estado actual de la cirugía oncológica de mama en Andalucía y Cataluña.

BACKGROUND: Surgery is an essential element of breast cancer treatment. The aim of this study was to describe the progress and current practice in oncological breast surgery in Catalonia and Andalusia. MATERIAL AND METHOD: An observational study was conducted, collecting data from the Minimum Basic Data Set at Hospital Discharge. RESULTS: A total of 37,537 women from Catalonia and 24,186 from Andalusia were studied. The rate of admission due to breast cancer in women increased substantially during the study period, as well as the percentage of women who underwent breast-conserving surgery. However, the increase in breast-conserving surgery has not been consistent among age groups and hospital levels. CONCLUSIONS: As a whole, the increase in breast-conserving surgery has shown the need for interventions to promote the use of procedures of proven effectiveness.

Lecciones desde fuera. Otros países en ésta y otras crisis anteriores. Informe SESPAS 2014 / Lessons from abroad. Current and previous crisis in other countries. SESPAS report 2014

La evidencia acumulada sobre el efecto de crisis anteriores en la salud presenta patrones muy diferenciados atribuibles al diseño de los estudios, a la naturaleza de cada crisis y a otros factores del entorno socioeconómico y político. Existe, no obstante, un consenso cada vez mayor sobre el papel mediador de las respuestas políticas de los gobiernos, que pueden magnificar, o al contrario mitigar, los efectos adversos de las crisis. Estudios recientes revelan un deterioro en algunos indicadores de salud en el contexto de la crisis actual, fundamentalmente en salud mental y enfermedades transmisibles. En algunos países europeos también se ha constatado un descenso en el consumo de tabaco y alcohol. Por otro lado, algunos gobiernos están haciendo uso del contexto de crisis para avanzar reformas tendentes a la privatización de servicios y prestaciones sanitarias, restringiendo con ello el derecho a la salud y a la atención sanitaria. Se está actuando sobre los tres ejes que determinan el campo de la financiación de los sistemas sanitarios: la población protegida, la contribución del usuario y la cobertura de servicios. Estas medidas están siendo adoptadas a menudo de manera arbitraria basándose en decisiones ideológicas más que en la evidencia disponible, de lo que cabría esperar consecuencias adversas en términos de protección financiera, eficiencia y equidad (AU)

The evidence available on the impact of previous crises on health reveals different patterns attributable to study designs, the characteristics of each crisis, and other factors related to the socioeconomic and political context. There is greater consensus on the mediating role of government policy responses to financial crises. These responses may magnify or mitigate the adverse effects of crises on population health. Some studies have shown a significant deterioration in some health indicators in the context of the current crisis, mainly in relation to mental health and communicable diseases. Alcohol and tobacco use have also declined in some European countries. In addition, this crisis is being used by some governments to push reforms aimed at privatizing health services, thereby restricting the right to health and healthcare. Specifically, action is being taken on the three axes that determine health system financing: the population covered, the scope of services, and the share of the costs covered. These measures are often arbitrarily implemented based on ideological decisions rather than on the available evidence and therefore adverse consequences are to be expected in terms of financial protection, efficiency, and equity (AU)

Promoción de la salud en poblaciones de distinta etnia o cultura a la mayoritaria: revisión de las intervenciones y recomendaciones / Health promotion in minority groups: a review of interventions and recommendations

No disponible