[Modified version of the PCAT-A10 tool for the evaluation of primary care]. / Evaluación de la atención primaria, versión modificada del instrumento PCAT-A10.

OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n=3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version.

Inequalities in the utilization of psychiatric and psychological services in Catalonia: a multilevel approach.

The aim of this study was to analyze individual and contextual inequalities in psychiatrist and psychologist visits in Catalonia. This is a multilevel cross-sectional study using data from the 2006 Catalan Health Interview Survey (n = 15,554). 5.3 % of men and 9.0 % of women visited a psychologist and/or psychiatrist in the last 12 months. People aged 65 years or over were less likely to have visited these professionals and those with a supplemental private health insurance had a higher proportion of having visited. Moreover, people living in lower density regions were less likely to have visited, independently of their level of need. There is a need to develop policies for reducing inequalities in access by people with public health insurance and living in lower density areas.

Assessment of primary care in health surveys: a population perspective.

BACKGROUND: The objective of this study was to evaluate the metric properties of a selection of items of the Primary Care Assessment Tool (PCAT) included into 2006 Catalonia Health Survey and adapted to evaluate experiences of primary care (PC) under population perspective. METHODS: This was a cross-sectional study. The study population was composed of non-institutionalized residents of Catalonia over 15 years of age (n = 12,933). The instrument used was a 10-item selection of the adult user's version of the PCAT (PCAT10-AE). We assessed internal consistency, correlation between items and performed exploratory factor analysis and external validity analysis. RESULTS: The instrument presented adequate internal consistency (0.72). All items showed acceptable correlation with other items that constitute the scale. The single extracted factor explained 64% of the common variance in the responses, allowing the construction of a global index for evaluation of PC. We observed an association between better evaluation of PC and more satisfaction with the health system. CONCLUSIONS: Metric analysis supported the integrity and general adequacy of this very short tool included in a population health survey. The global index proposed could be a good measure for assessing and monitoring the adequacy of part of the PC experiences in first-contact care and person-focused care over time, under population perspective. On the other hand, the loss of content as a consequence of the selection of items, suggesting use of the expanded versions of the PCAT-AE whenever a global evaluation of PC is desired and it is possible.

[Social class and health in Latin America]. / Clase social y salud en América Latina.

This paper reviews the principal concepts of social class, occupation, and social stratification, and their contribution to the analysis of the social determinants of health (SDH), and reviews empirical studies conducted in Latin America that use employment relations as an SDH. The review focuses on studies of the relationship between health and social class based on neo-Weberian or neo-Marxist perspectives. A search of the BIREME Virtual Health Library and the SciELO database found 28 articles meeting these characteristics. This relative dearth contrasts with the profusion of papers that use these approaches written in Europe and in the United States, with a long tradition in the analysis of SDH. In this regard, the political and programmatic implications of research on social class and employment relations are different from and complementary to studies of health gradients associated with income and education. Globalization of employment relations requires the development of new concepts to explain and measure the mechanisms of action of the SDH going beyond what is strictly labor related; in particular, the importance in the current Latin American reality of the impact of informal work on health.

Properties of a short questionnaire for assessing primary care experiences for children in a population survey.

BACKGROUND: The Primary Care Assessment Tool (PCAT) is an interesting set of tools for primary care research. A very short version could inform policy makers about consumer experiences with primary care (PC) through health surveys. This work aimed to investigate the validity and reliability of a selection of items from the child short edition (CS) of the PCAT. METHODS: A 24 item questionnaire permitted the identification of a regular source of care and the assessment of the key attributes of first contact, ongoing care over time, coordination, services available and services received (comprehensiveness), and cultural competence. Structural validity, reliability, and construct validity were assessed using responses from 2,200 parents of a representative sample of the population aged 0 to 14 years in Catalonia (Spain) who participated in the 2006 Health Survey. Structural validity was analyzed using exploratory and confirmatory factor analyses and reliability was assessed using Cronbach's alpha. Construct validity was assessed using linear regression analysis between PC experience scores and a measure of overall user satisfaction with healthcare services. RESULTS: A total of 2,095 (95.2%) parents provided useable responses on PC. After Confirmatory Factor Analysis (CFA), the best fitting model was a 5-factor model in which the original dimensions of first contact and ongoing care were collapsed into one. The CFA also showed a second order factor onto which all domains except services available loaded (root mean square error of approximation = 0.000; comparative fit index = 1.00). Cronbach's alpha values for one of the original scales (first-contact) was poor (alpha < 0.50), but improved using the modified factor structure (alpha > 0.70). Scores on the scales were correlated with satisfaction with healthcare services (p < 0.01), thereby providing some preliminary evidence of construct validity. CONCLUSIONS: This very short questionnaire obtained from the PCAT-CE yields information about five attributes of PC and a summary score. It has shown evidence of validity and reliability for judgments about experiences with primary care overall. If space on surveys is at a premium, the instrument could be useful as a measure of PC experiences.

Class relations and all-cause mortality: a test of Wright's social class scheme using the Barcelona 2000 Health Interview Survey.

The aim of this study is to test the effects of neo-Marxian social class and potential mediators such as labor market position, work organization, material deprivation, and health behaviors on all-cause mortality. The authors use longitudinal data from the Barcelona 2000 Health Interview Survey (N=7526), with follow-up interviews through the municipal census in 2008 (95.97% response rate). Using data on relations of property, organizational power, and education, the study groups social classes according to Wright's scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled, and unskilled workers. Findings indicate that social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class men but not women. Workers (hazard ratio = 1.60; 95% confidence interval, 1.10-2.35) but also managers and small employers had a higher risk of death compared with capitalists. The extensive use of conventional gradient measures of social stratification has neglected sociological measures of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the "contradictory class location hypothesis," additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.

Counselling in STD/HIV/AIDS in the context of rapid test: Perception of users and health professionals at a counselling and testing centre in Porto Alegre.

This article discusses the perceptions of professionals and users about counselling practices at a counselling and testing centre in Porto Alegre/RS based on interviews with 27 service users and 14 members of the staff. The following categories emerged from thematic analysis: professionals' perceptions on counselling, users' perceptions on counselling and changes in counselling due to the introduction of rapid test procedures. The results show that, although initially there were some imprecision and apparent contradictions in its use, rapid testing was considered an invitation to rethink practices, bringing service closer to users' needs.

Inequalities in mental health in the spanish autonomous communities: a multilevel study.

The aim of this study was to analyze inequalities in the prevalence of poor mental health and their association with socioeconomic variables and with the care network in the Autonomous Communities in Spain. A cross-sectional multilevel study was performed, which analyzed individual data from the National Health Survey in Spain (ENS), in 2006 (n = 29,476 people over the age of 16). The prevalence of poor mental health was the dependent variable, measured by the General Health Questionnaire (GHQ-12 > = 3). Individual and contextual socioeconomic variables, along with mental health services in the Autonomous Communities, were included as independent variables. Models of multilevel logistic regression were used, and odds ratios (OR) were obtained, with confidence intervals (CI) of 95%. The results showed that there are inequalities in the prevalence of poor mental health in Spain, associated to contextual variables, such as unemployment rate (men OR 1.04 CI 1.01-1.07; women OR 1.02 CI 1.00-1.05). On the other hand, it was observed that inequalities in the mental health care resources in the Autonomous Communities also have an impact on poor mental health.

Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993-2006.

OBJECTIVE: The aim of this study was to analyse the trends and socio-economic inequalities in the use of health care services in Spain between 1993 and 2006. METHODS: A study of trends was performed using data from six Spanish National Health Surveys (1993, 1995, 1997, 2001, 2003 and 2006). Sample sizes were 21,061; 6,396; 6,396; 21,066; 21,650 and 29,478, respectively. The following dependent variables were analysed: having visited a general practitioner (GP) or specialist in the previous 2 weeks, having visited a dentist within the previous 3 months and having visited a gynaecologist, having used the emergency services or having been hospitalised in the previous year. The main independent variable was social class, classified as manual or non-manual occupation. For each service, age-standardised proportions of use were calculated by survey year, sex and social class, and indices of relative (RII) and absolute (SII) inequality were computed. Trend tests were applied. RESULTS: An increase in the proportion of use was observed for all services, particularly emergency services. Individuals from manual classes were more likely to visit the GP and emergency services than those from non-manual classes. Conversely, those from non-manual classes were more likely to use specialised services. This trend was most notable for dentist visits. Social inequalities did not change significantly during the study period. CONCLUSIONS: Despite the increase in the use of health care services, the relationship between social class and the use of these services has remained stable throughout the study period. Achieving equity in the use of specialised care services is still a challenge for universal health care systems.

Inequalities in the use of services provided by psychiatrists in Spain: a multilevel study.

OBJECTIVE: The objective was to identify individual or contextual inequalities in visits to psychiatrists in Spain, a country with a regionalized health care system and variable integration of mental health and primary care. METHODS: This cross-sectional study used data for the noninstitutionalized population from the 2006 Spanish Health Interview Survey (N=29,478). A score of ≥ 3 on the General Health Questionnaire represented a need for mental health care. The probability of having visited a psychiatrist in the previous four weeks was analyzed in relation to individual-level variables (age, social class, health insurance, and country of origin) and contextual socioeconomic variables (Gross Domestic Product; a measure of income equality; and characteristics of regional mental health systems, such as human resources, services, and organization). Multilevel logistic regression models were used. RESULTS: A total of 161 individuals (.55% of the sample) reported a visit to a psychiatrist during the previous four weeks. Individuals age 65 and older and immigrants from low-income countries were less likely to report a visit. Visits to psychiatrists were more common in regions with higher rates of psychiatrists per hospital (odds ratio [OR]=1.47, 95% confidence interval [CI]=1.18-1.83), more human resources for mental health (OR=1.03, CI=1.01-1.06), and better integration of primary care and specialized mental health care (OR=1.90, CI=1.32-2.76). CONCLUSIONS: Individual and contextual inequalities in use of psychiatrists' services exist in Spain. Better coordination between primary and mental health care and greater availability of mental health resources were associated with greater use. Policies seeking better integration of care should be promoted.

[One more step in the study of social inequalities in primary care provision from a population-based perspective]. / Un paso más en el estudio de las desigualdades sociales en la provisión de atención primaria desde la perspectiva de la población.

Evaluation of Primary Care (PC) must include different perspectives. The objective of the study was to know the assessment of the PC in Catalonia and detecting whether or not a pattern of social inequality exists, through user's experience. A cross-sectional study was conducted, in a representative sample (n = 13,292) of the Catalonia population (aged 15), who identify a reference professional. It was studied an index of experience with PC by personal variables and variables about the reference professional. Negative binomial regression models (bivariate and multivariate) were adjusted to obtain the prevalence ratios and confidence intervals of 95%. The index gained an average of 71 (scale 0-100). A rating above 70 was associated with higher age, greater number of visits in the last year, more time with the same professional and living in an area of lower population density. Items with lower scores: telephone attention and availability of mental health services. We concluded that factors associated with a better experience are associated with more frequent visits to professionals. We did not detect social inequalities.

Clase social y salud en América Latina / Social class and health in Latin America

Se repasan los principales conceptos de clase social, ocupación y estratificación social, y su contribución al análisis de los determinantes sociales de la salud (DSS), y se revisan los estudios empíricos desarrollados en América Latina que utilicen las relaciones de empleo como DSS. La revisión se ha enfocado en los estudios sobre la relación entre salud y clase social basados en las perspectivas neoweberiana o neomarxista. La búsqueda en la Biblioteca Virtual en Salud de BIREME y en la base de datos SciELO permitió localizar 28 artículos de esas características. Esta relativa escasez contrasta con la abundancia de trabajos con tales enfoques realizados en Europa y en los Estados Unidos, con una larga tradición en el análisis de los DSS. En tal sentido, las implicaciones políticas y programáticas de la investigación sobre clase social y relaciones de empleo son diferentes y complementarias de los estudios de gradientes de salud asociados a los ingresos y la educación. La globalización en las relaciones de empleo exige nuevos conceptos para explicar y medir los mecanismos de acción de los DSS trascendiendo lo estrictamente laboral; en particular, la relevancia en la realidad latinoamericana actual del impacto del trabajo informal sobre la salud.

This paper reviews the principal concepts of social class, occupation, and social stratification, and their contribution to the analysis of the social determinants of health (SDH), and reviews empirical studies conducted in Latin America that use employment relations as an SDH. The review focuses on studies of the relationship between health and social class based on neo-Weberian or neo-Marxist perspectives. A search of the BIREME Virtual Health Library and the SciELO database found 28 articles meeting these characteristics. This relative dearth contrasts with the profusion of papers that use these approaches written in Europe and in the United States, with a long tradition in the analysis of SDH. In this regard, the political and programmatic implications of research on social class and employment relations are different from and complementary to studies of health gradients associated with income and education. Globalization of employment relations requires the development of new concepts to explain and measure the mechanisms of action of the SDH going beyond what is strictly labor related; in particular, the importance in the current Latin American reality of the impact of informal work on health.

Revelação do diagnóstico de doenças sexualmente transmissíveis a parceiros (as) sexuais: um dilema bioético? / Revealing of sexuality transmitted diseases to sexual partners: a bioethical dilemma?

O presente artigo discute o posicionamento ético do profissional de saúde quanto à revelação do diagnóstico a parceiros sexuais de pacientes em tratamento para doenças sexualmente transmissíveis(DST) O estudo tem caráter descritivo. Uma situação-problrma, envolvendo uma possível quebra de confidencialidade, foi apresentada a três usuários em atendimento em um serviço público de Saúde Genital em Porto Alegre e a dois estudiosos de Bioética. Em seguida, foram feitas questões sobre a situação-problema apresentada, que foram gravadas e transcritas. Realizou-se análise de conteúdo dos depoimentos, os quais ofereceram subsídios para discussão bioética. As colocações dos participantes foram muito enriquecedoras e, em alguns momentos divergentes, demonstrando como a Bioética pode ser ferramenta no auxílio de profissionais que trabalham com DST. Propõe-se o aconselhamento individual como forma do habilitar o paciente, quando necessário, a revelar o diagnóstico.