Gait speed assessment as a prognostic tool for morbidity and mortality in vulnerable older adult patients following vascular surgery.

INTRODUCTION: Predicting the risk associated with vascular surgery in older adult patients has become increasingly challenging, primarily due to limitations in existing risk assessment tools. This study aimed to evaluate the utility of gait speed, a clinical indicator of frailty, in enhancing the prediction of mortality and morbidity in older adult patients undergoing vascular surgery. METHODS: A single-center prospective cohort study was conducted, involving older adult patients undergoing vascular surgery at four tertiary care hospitals between 2021 and 2022. Eligible patients were aged 80 years or older and scheduled for surgical treatment of peripheral arterial disease of the lower limbs (IIb Leriche-Le Fontaine). The primary factor of interest was gait speed, defined as taking more than 6 s to walk 5 meters. The primary outcomes were in-hospital postoperative mortality and major morbidity. RESULTS: The cohort comprised 131 patients with a mean age of 82.8 ± 1.4 years, with 34 % being female. Before vascular surgery, 60 patients (46 %) were categorized as slow walkers. Slow walkers were more likely to be female (43 % vs. 25 %, p < 0.03) and diabetic (50 % vs. 28 %, p < 0.01). Among the patients, 30 (23 %) experienced the primary composite outcome of mortality or major morbidity following vascular surgery. After adjusting for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Surgical Risk Calculator, slow gait speed independently predicted the composite outcome (odds ratio: 3.05; 95 % confidence interval: 1.23 to 7.54). CONCLUSIONS: Gait speed is a straightforward and effective test that can help identify a subgroup of frail older adult patients at an elevated and incremental risk of mortality and major morbidity after vascular surgery. While gait speed remains a valuable clinical indicator of frailty, it is important to recognize that the broader context of mobility plays a pivotal role in postoperative outcomes.

Ribavirin-resistant chronic norovirus infection-associated enteropathy in common variable immunodeficiency. Case report and review of the literature.

Chronic Norovirus infection is particularly challenging in patients with common variable immunodeficiency (CVID) because of their inability to achieve viral clearance and the risk of developing enteropathy leading to intestinal villous atrophy and malabsorption. To date, therapeutic options to eliminate the virus are limited and only ribavirin has been shown to induce viral clearance in norovirus enteropathy associated with CVID. We report a case of a 48-year-old female patient diagnosed with CVID enteropathy possibly related to norovirus infection who failed a ribavirin-based therapy despite dosage optimization through drug plasma level monitoring.

Rissoidae gastropods of the outer continental shelf and slope off Galicia (NW Spain).

More than 5000 shells (more than half of them with soft tissues) belonging to the caenogastropod family Rissoidae have been found in samples from several expeditions carried out in the outer continental shelf and slope off Galicia (Northwest Spain) in the depth range 100-2700 m. They belong to 9 genera and 23 species, two of them described as new for science: Alvania candasae sp. nov. and Alvania xelae sp. nov. The most abundant species in the samples were Obtusella macilenta (Monterosato, 1880) and Alvania testae (Aradas & Maggiore, 1844), followed by Alvania cimicoides (Forbes, 1844), Alvania jeffreysi (Waller, 1864) and Gofasia thalassae (Bouchet & Warén, 1993) comb. nov., which is proposed to be assigned to the genus Gofasia instead of Frigidoalvania. Five of the species are typically from upper shelf of which only few empty shells were found (Alvania cancellata, Crisilla semistriata, Manzonia crassa, Onoba semicostata) and their presence in the samples studied was considered accidental. Taxonomic complexity involving the species Alvania electa (Monterosato, 1874), Pseudosetia amydralox Bouchet & Warén, 1993 and Pusillina inconspicua (Alder, 1844) are highlighted.

[Healthier decisions. Nudges.] / Decisiones más saludables. Nudges.

This paper intends to raise the potential interest that the principles and experiences of the so-called behavioral economy have in the field of public health and, more specifically, in behavioral changes, thus substituting harmful behaviors to health for salutogenic behaviors while respecting the final freedom of choice of the person. In this article, we review the foundations of behavioral economics, emphasizing the work of Tversky and Kahneman and their approach to prospective theory and the role of brain activity levels 1 (automatic) and 2 (reflective) in decision making process. On the basis of these approaches, Thaler and Sustein identify a series of biases that will be used as tools to facilitate behavioral changes through a set of actions "that modify people's behavior in a predictable way without prohibiting any option or significantly changing their economic incentives" based on the so-called libertarian paternalism. We review its interest in public health, citing some empirical studies that demonstrate its high level of effectiveness and efficiency, reflected in the creation of Nudge Units in various countries, and concluding that this can be an interesting tool to add (not to replace) the classical techniques of health promotion and disease prevention.

Se pretende plantear el potencial interés que los principios y experiencias de la denominada economía conductual tienen en el terreno de la salud pública y, más concretamente, en los cambios conductuales, substituyendo conductas nocivas para la salud por conductas salutogénicas, respetando la libertad final de elección de la persona. En el artículo revisamos las bases de la economía conductual, haciendo hincapié en los trabajos de Tversky y Kahneman, con su planteamiento de la teoría prospectiva y el rol de los niveles de actividad cerebral 1 (automático) y 2 (reflexivo) en la toma de decisiones. A partir de estos planteamientos Thaler y Sustein identifican una serie de sesgos que serán utilizados como herramientas para facilitar los cambios conductuales mediante un conjunto de actuaciones "que modifican la conducta de las personas de una manera predecible sin prohibir ninguna opción ni cambiar de forma significativa sus incentivos económicos" basándose en el denominado paternalismo libertario. Revisamos su interés en salud pública, citando algunos estudios empíricos que demuestran su alto nivel de efectividad y eficiencia, plasmado en la creación de Unidades de Nudges en diversos países, y llegando a la conclusión de que esta puede ser una herramienta interesante para añadir, no para substituir, a las técnicas clásicas de la promoción de la salud y la prevención de la enfermedad.

Sensing solutions for improving the performance, health and wellbeing of small ruminants.

Diversity of production systems and specific socio-economic barriers are key reasons explaining why the implementation of new technologies in small ruminants, despite being needed and beneficial for farmers, is harder than in other livestock species. There are, however, helpful peculiarities where small ruminants are concerned: the compulsory use of electronic identification created a unique scenario in Europe in which all small ruminant breeding stock became searchable by appropriate sensing solutions, and the largest small ruminant population in the world is located in Asia, close to the areas producing new technologies. Notwithstanding, only a few research initiatives and literature reviews have addressed the development of new technologies in small ruminants. This Research Reflection focuses on small ruminants (with emphasis on dairy goats and sheep) and reviews in a non-exhaustive way the basic concepts, the currently available sensor solutions and the structure and elements needed for the implementation of sensor-based husbandry decision support. Finally, some examples of results obtained using several sensor solutions adapted from large animals or newly developed for small ruminants are discussed. Significant room for improvement is recognized and a large number of multiple-sensor solutions are expected to be developed in the relatively near future.

IGRA testing in patients with immune-mediated inflammatory diseases: which factors influence the results?

Diagnosis of latent tuberculosis infection in patients with immune-mediated inflammatory chronic diseases (IMIDs) can be challenged as diagnostic test reliability could be impaired by immunosuppression. We retrospectively analyzed the Quantiferon Gold-Test in-Tube (QFT-G-IT) results of all patients with IMIDs seen at the Department of Internal Medicine of Son Llàtzer Hospital, Palma de Mallorca (Spain), looking for the factors related to QFT-G-IT indeterminate results. During the study period (2008-2015), 520 patients met the inclusion criteria. Factors associated with indeterminate QFT-G-IT results in a univariate analysis were inflammatory bowel disease, disease activity, lymphopenia, and medium-to-high doses of corticosteroids. In a subsequent multivariate analysis, only lymphopenia (defined as < 1500 cells) was associated with indeterminate QFT-G-IT results. Lymphocyte count was the only factor independently associated with an increased number of indeterminate QFT-G-IT results in patients with different autoimmune diseases. Others factors such as the use of medium-to-high doses of corticosteroids should be considered before testing with QFT-G-IT.

Successful elimination of a lethal wildlife infectious disease in nature.

Methods to mitigate the impacts of emerging infectious diseases affecting wildlife are urgently needed to combat loss of biodiversity. However, the successful mitigation of wildlife pathogens in situ has rarely occurred. Indeed, most strategies for combating wildlife diseases remain theoretical, despite the wealth of information available for combating infections in livestock and crops. Here, we report the outcome of a 5-year effort to eliminate infection with Batrachochytrium dendrobatidis affecting an island system with a single amphibian host. Our initial efforts to eliminate infection in the larval reservoir using a direct application of an antifungal were successful ex situ but infection returned to previous levels when tadpoles with cleared infections were returned to their natal sites. We subsequently combined antifungal treatment of tadpoles with environmental chemical disinfection. Infection at four of the five pools where infection had previously been recorded was eradicated, and remained so for 2 years post-application.

Context-dependent amphibian host population response to an invading pathogen.

Amphibian chytridiomycosis, caused by the chytrid fungus Batrachochytrium dendrobatidis (Bd), is an emerging infectious disease that widely threatens amphibian biodiversity. However, population-level outcomes following the introduction of the pathogen are highly context dependent and are mediated by a broad suite of biotic and abiotic variables. Here, we examine the effect of the introduction of Bd on native island populations of the IUCN red-listed amphibian species Alytes muletensis, the Mallorcan midwife toad. We show that the outcome of pathogen introduction is not only dependent on biotic factors, but is also dependent on environmental factors that vary across local scales. Our experimental infections confirm that the genotype of Bd occurring on Mallorca is hypovirulent in A. muletensis when compared against the lineage found occurring on mainland Iberia. Long-term population data show that A. muletensis populations on the island are increasing overall, but trends in highly infected populations are conflicting. We use mathematical models and field data to demonstrate that this divergence in population response to infection can be explained by local environmental differences between infected sites, whereas pathogen genetics, host genetics, and intrinsic epidemiological dynamics driven by fungal load are less likely to be the cause of these differing population trajectories. Our results illustrate the need to take into account the appropriate environmental scale and context when assessing the risk that an emerging pathogen presents to a naive population or species.

Use of Quantiferon-TB-Gold in Tube ® test for detecting latent tuberculosis in patients considered as candidates for anti-TNF therapy in routine clinical practice

Background/methods Quantiferon-TB-Gold in Tube® test (QFT-G-IT) may have advantages if combined with TST when screening for Latent Tuberculosis Infection (LTBI) prior to initiating anti-TNF therapy in an area of intermediate tuberculosis incidence such as Spain. In a small-scale prospective study, we evaluate the use of QFT-G-IT in combination with the screening recommended in Spain (Tuberculin-Skin Test, TST retest, clinical data, and Chest X-Ray (CXR)) for LTBI in patients considered as candidates for anti-TNF a treatment. Results From June 2008 to October 2010, 123 patients from a 300-bed hospital in Palma de Mallorca (Spain) were included in the study. The majority of patients were under immunosuppressive therapy. A positive TST and TST booster were found in 22 and 17 patients, respectively. Thus 39 (31.7%) of the 123 patients had a positive TST. QFT-G-IT was positive in 16 patients (13.6%), indeterminate in 4 (3.2%), and negative in 103 (83.7%). One of the two tests was positive and LTBI was diagnosed in 34.1% of patients. The agreement between TST and QFT-G-IT among vaccinated patients was low and not statistically significant (Kappa=0.15) and was almost perfect among non-BCG vaccinated patients (K=0.81). TST positive responses were significantly related to BCG-vaccination (p<0.05) and QFT-G-IT positive response rates were related to older age (p<0.05).Conclusion QFT-G-IT may have advantages when combined with TST in immune suppressed patients especially in older patients with a negative TST; in BCG vaccinated patients with a positive TST, QFT-G-IT could avoid unnecessary treatments and toxicities related to a false-positive TST result (AU)

Introducción/método Quantiferon-TB-Gold in Tube® (QFT-G-IT) en combinación con la Prueba de la tuberculina (PT) puede ser útil para el diagnóstico de infección tuberculosa latente (ITL) en pacientes candidatos a tratamiento con anti-TNF en un país de incidencia intermedia de tuberculosis como España. Se evalúa en un estudio piloto prospectivo QFT-G-IT en combinación con las pruebas recomendadas en España (PT, PT-booster, datos clínicos y radiografía de tórax) para el diagnóstico de ITL en pacientes con enfermedades inmunológicas candidatos a tratamiento con fármacos anti-TNFa. Resultados Se incluyeron 123 pacientes desde junio de 2008 a octubre de 2010 en el hospital Son Llàtzer de Palma de Mallorca. La PT inicial y la PT booster fueron positivas en 22 y 17 pacientes, respectivamente, el 31,6% tuvo una PT positiva, QFT-G-IT fue positivo en 16 (13,6%), indeterminado en 4 (3,2%) y negativo en 103 pacientes (83,7%). En 34,1% al menos uno de los dos tests fue positivo y se diagnosticó ITL. La concordancia entre PT y QFT-G-IT fue baja en pacientes vacunados con BCG (Kappa=0,15) y excelente en no vacunados con BCG (K=0,81). La positividad de la PT se relacionó con la vacunación con BCG (p<0.05) y la de QFT-G-IT con una mayor edad (p<0.05).Conclusión El uso de QFT-G-IT puede optimizar el diagnóstico de ITL en estos pacientes especialmente en los más añosos con una PT negativa. En pacientes vacunados de BCG con una PT positiva, QFT-G-IT podría evitar tratamientos innecesarios de ITL relacionados con un falso positivo (AU)

Use of Quantiferon-TB-Gold in Tube(®) test for detecting latent tuberculosis in patients considered as candidates for anti-TNF therapy in routine clinical practice.

BACKGROUND/METHODS: Quantiferon-TB-Gold in Tube(®) test (QFT-G-IT) may have advantages if combined with TST when screening for Latent Tuberculosis Infection (LTBI) prior to initiating anti-TNF therapy in an area of intermediate tuberculosis incidence such as Spain. In a small-scale prospective study, we evaluate the use of QFT-G-IT in combination with the screening recommended in Spain (Tuberculin-Skin Test, TST retest, clinical data, and Chest X-Ray (CXR)) for LTBI in patients considered as candidates for anti-TNFα treatment. RESULTS: From June 2008 to October 2010, 123 patients from a 300-bed hospital in Palma de Mallorca (Spain) were included in the study. The majority of patients were under immunosuppressive therapy. A positive TST and TST booster were found in 22 and 17 patients, respectively. Thus 39 (31.7%) of the 123 patients had a positive TST. QFT-G-IT was positive in 16 patients (13.6%), indeterminate in 4 (3.2%), and negative in 103 (83.7%). One of the two tests was positive and LTBI was diagnosed in 34.1% of patients. The agreement between TST and QFT-G-IT among vaccinated patients was low and not statistically significant (Kappa=0.15) and was almost perfect among non-BCG vaccinated patients (K=0.81). TST positive responses were significantly related to BCG-vaccination (p<0.05) and QFT-G-IT positive response rates were related to older age (p<0.05). CONCLUSION: QFT-G-IT may have advantages when combined with TST in immunosuppressed patients especially in older patients with a negative TST; in BCG vaccinated patients with a positive TST, QFT-G-IT could avoid unnecessary treatments and toxicities related to a false-positive TST result.

Percepción del sistema sanitario catalán de la población marroquí. Creencias sobre salud y enfermedad / Moroccan population perception of the catalonian health system. Beliefs on health and disease

ObjetivoDescribir la percepción que tiene la población marroquí del sistema sanitario catalán.DiseñoEstudio epidemiológico descriptivo y transversal.EmplazamientoInstituciones sociales y población general marroquí de la ciudad de Reus.ParticipantesCiento cincuenta individuos (el 50,8% eran mujeres) de 33±13 años de edad, de origen marroquí. Porcentaje de participación: 82,7%.MétodoValoración de la percepción del sistema sanitario catalán mediante un cuestionario validado para el estudio, traducido al árabe.ResultadosLa población marroquí cree mayoritariamente en la efectividad de los fármacos y los programas de vacunación, pero también piensa que la enfermedad depende de la voluntad de Alá (el 93,7% de las mujeres y el 95,0% de los hombres). La desconfianza de los maridos a que los médicos varones atiendan a su mujer aumenta con los años de residencia en nuestro país (del 17,1 al 21,1%).ResultadosEl colectivo se siente satisfecho con el sistema sanitario español (el 92,2% de las mujeres y el 86,7% de los hombres), aunque tiene dificultades relacionadas con el idioma (el 51,6% de las mujeres y el 43,3% de los hombres) y, especialmente los hombres, manifiestan dificultades para acudir a las visitas programadas (50,8%).ConclusionesLa mayoría de los inmigrantes de origen marroquí están satisfechos con la asistencia sanitaria recibida en Cataluña. Indican como principales problemas las dificultades para acudir a las visitas programadas y el idioma.ConclusionesEl tiempo de residencia en España no disminuye las dificultades y las diferencias en la relación con la población marroquí con el sistema sanitario. Esto indica la necesidad de promover acciones educativas en los colectivos implicados(AU)

ObjectiveTo describe the perception that the Moroccan population have of the Catalonian Health System.DesignA cross-sectional, descriptive epidemiological study.SettingSocial Institutions and the general Moroccan population in the city of Reus, Spain.ParticipantsA total of 150 people of Moroccan origin (50.8% females) from 33±13 years of age, were selected, of which 82.7% took part.MethodEvaluation of the perception of the Catalonian Health System using a questionnaire validated for the study, translated into Arabic.ResultsThe majority of the Moroccan population believe that medications and vaccination programmes are effective, but also think that the disease depends on Allah (93.7% females and 95% males). The distrust of the husbands that their wives may be seen by male doctors increases (from 17.1% to 21.1%).ResultsAs group they felt satisfied with the Spanish Health System (92.2% females and 86.7% males), had difficulties associated with language (51.6% females and 43.3% males) and, the males, in particular, found it difficult to keep appointments (50.8%).ConclusionsThe majority of immigrants of Moroccan origin are satisfied with the health care received in Catalonia. The main difficulties they appear to have are keeping appointments and the language.ConclusionsThe length of residence in Spain as regards the Moroccan population does not decrease the difficulties and differences in the Health System. This shows that education activities need to be promoted in the groups involved(AU)

[Moroccan population perception of the Catalonian health system. Beliefs on health and disease]. / Percepción del sistema sanitario catalán de la población marroquí. Creencias sobre salud y enfermedad.

OBJECTIVE: To describe the perception that the Moroccan population have of the Catalonian Health System. DESIGN: A cross-sectional, descriptive epidemiological study. SETTING: Social Institutions and the general Moroccan population in the city of Reus, Spain. PARTICIPANTS: A total of 150 people of Moroccan origin (50.8% females) from 33+/-13 years of age, were selected, of which 82.7% took part. METHOD: Evaluation of the perception of the Catalonian Health System using a questionnaire validated for the study, translated into Arabic. RESULTS: The majority of the Moroccan population believe that medications and vaccination programmes are effective, but also think that the disease depends on Allah (93.7% females and 95% males). The distrust of the husbands that their wives may be seen by male doctors increases (from 17.1% to 21.1%). As group they felt satisfied with the Spanish Health System (92.2% females and 86.7% males), had difficulties associated with language (51.6% females and 43.3% males) and, the males, in particular, found it difficult to keep appointments (50.8%). CONCLUSIONS: The majority of immigrants of Moroccan origin are satisfied with the health care received in Catalonia. The main difficulties they appear to have are keeping appointments and the language. The length of residence in Spain as regards the Moroccan population does not decrease the difficulties and differences in the Health System. This shows that education activities need to be promoted in the groups involved.

El análisis de contenidos: ¿qué nos están diciendo? / Contents analysis. What are they telling us?

Se presenta la técnica del análisis de contenidos, su concepto, definición y metodología, ventajas y limitaciones. El análisis de contenidos es una herramienta de gran utilidad basada en el análisis y la interpretación de fuentes documentales y en identificar los códigos utilizados por el emisor del discurso, su contenido manifiesto, el contexto en el que surge y se desarrolla el mensaje, para descubrir y evidenciar sus contenidos latentes. El objetivo es conocer no sólo lo que se transmite literalmente, sino todo aquello que pueda influir o condicionar el mensaje implícitamente

This article presents the technique of content analysis, its concept, definition, methodology, advantages and limitations. Content analysis is a highly useful tool based on the analysis and interpretation of documented sources. The aim is to identify the codes used by the agents of discourse, the manifest content, the context in which the content arises and the message is developed to discover and reveal the underlying contents. The objective is not just to find out whether it is transmitted literally, but also if all this could effectively influence or determine the message

[Not Available]. / El análisis de contenidos: ¿qué nos están diciendo?

This article presents the technique of content analysis, its concept, definition, methodology, advantages and limitations. Content analysis is a highly useful tool based on the analysis and interpretation of documented sources. The aim is to identify the codes used by the agents of discourse, the manifest content, the context in which the content arises and the message is developed to discover and reveal the underlying contents. The objective is not just to find out whether it is transmitted literally, but also if all this could effectively influence or determine the message.

Definitely life but not definitively.

Although there have been attempts at a definition of life from many disciplines, none is accepted by all as definitive. Some people believe that it is impossible to define 'life' adequately at the moment. We agree with this point of view on linguistic grounds, examining the different types of definition, the contexts in which they are used and their relative usefulness as aids to arriving at a scientific definition of life. We look at some of the more recent definitions and analyse them in the light of our criteria for a good definition. We argue that since there are so many linguistic and philosophical difficulties with such a definition of life, what is needed is a series of working descriptions, which are suited to the audience and context in which they are used and useful for the intended purpose. We provide some ideas and examples of the forms these may take.

Pacientes, médicos y enfermeros: tres puntos de vista distintos sobre una misma realidad. Actitudes y percepciones ante los derechos de los pacientes / Patients, physicians and nurses: three different points of view on the same issue. Attitudes to and preceptions of patient rights

Objetivos: Analizar las actitudes y las percepciones de pacientes, médicos y enfermeros respecto a los derechos de los pacientes en el ámbito de los hospitales públicos del sector sanitario de Reus (Tarragona). Métodos: Análisis cualitativo, mediante grupos focales de profesionales sanitarios (médicos y enfermeros) y usuarios dados de alta, seguido de 3 encuestas dirigidas a cada uno de estos colectivos. Se realizó un análisis descriptivo de los resultados y de las diferencias entre colectivos. Se utilizó el análisis de componentes principales categóricos para reducir el número de dimensiones y revelar las relaciones existentes entre las diversas variables. Resultados: Ex pacientes y enfermeros identifican los «derechos a la información» y «autonomía del paciente» como los más importantes, mientras que para los médicos las 2 dimensiones más importantes son «derecho a la autonomía» y «derecho a la formulación de la opinión del paciente». Una minoría de pacientes es refractaria a la toma de decisiones. Las mujeres, los más jóvenes y los niveles de educación altos son más favorables al respeto a la autonomía del paciente. Hay posiciones menos favorables a las visiones «autonomistas» por parte de los pacientes, en comparación con las visiones más favorables por parte de los médicos y radicalmente partidarias por parte de los enfermeros. Conclusiones: Los derechos de los pacientes no son suficientemente conocidos y el derecho a la información es valorado como más importante que el derecho al ejercicio de la autonomía. Ex pacientes, médicos y enfermeros tienen actitudes y percepciones diferentes frente a situaciones similares

Objectives: To analyze patients', physicians' and nurses' attitudes to and perceptions of patient rights in the public hospitals of the Reus health district in Catalonia (Spain). Methods: We performed a qualitative analysis, through focus groups composed of health professionals (physicians and nurses) and discharged patients, followed by three surveys aimed at physicians, nurses, and patients. A descriptive analysis was performed of the results and of the differences among the three collectives. A principal components analysis for categorical data was used to reduce the number of dimensions and to reveal the associations among the different variables. Results: Among discharged patients and nurses, the most important patient rights were «the right to information» and «patient autonomy», whereas among physicians, the most important dimensions were the «right to autonomy» and «the patient's right to form an opinion». A minority of patients was reluctant to participate in decision-making. The groups with the most favorable attitudes to exercising patient autonomy were women, younger patients, and those with the highest educational level. Patients were less in favor of patient autonomy than physicians while nurses had the most radical attitudes in favor of patient autonomy. Conclusions: Patient's rights are not sufficiently well known, and the right to information is valued more highly than the right to exercise autonomy. Discharged patients, physicians and nurses have different attitudes to and perceptions of the same issue

[Patients, physicians and nurses: three different points of view on the same issue. Attitudes to and perceptions of patient rights]. / Pacientes, médicos y enfermeros: tres puntos de vista distintos sobre una misma realidad. Actitudes y percepciones ante los derechos de los pacientes.

OBJECTIVES: To analyze patients', physicians' and nurses' attitudes to and perceptions of patient rights in the public hospitals of the Reus health district in Catalonia (Spain). METHODS: We performed a qualitative analysis, through focus groups composed of health professionals (physicians and nurses) and discharged patients, followed by three surveys aimed at physicians, nurses, and patients. A descriptive analysis was performed of the results and of the differences among the three collectives. A principal components analysis for categorical data was used to reduce the number of dimensions and to reveal the associations among the different variables. RESULTS: Among discharged patients and nurses, the most important patient rights were "the right to information" and "patient autonomy", whereas among physicians, the most important dimensions were the "right to autonomy" and "the patient's right to form an opinion". A minority of patients was reluctant to participate in decision-making. The groups with the most favorable attitudes to exercising patient autonomy were women, younger patients, and those with the highest educational level. Patients were less in favor of patient autonomy than physicians while nurses had the most radical attitudes in favor of patient autonomy. CONCLUSIONS: Patient's rights are not sufficiently well known, and the right to information is valued more highly than the right to exercise autonomy. Discharged patients, physicians and nurses have different attitudes to and perceptions of the same issue.

[Quality in public health]. / Calidad en salud pública.

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services.

Calidad en salud pública / Quality in public health

A partir de la definición de los conceptos de calidad y de salud pública, y de la consideración de las organizaciones de salud pública como organizaciones de servicios, se plantea la conveniencia de poder llegar a establecer un modelo de referencia de calidad en salud pública basado en criterios objetivos, indicadores y estándares. Se revisan los 2 principales modelos de gestión de la calidad en el terreno de las organizaciones de servicios, ISO 9001-2000 y EFQM, y se contrastan sus ventajas y desventajas en lo referente a su aplicación en los servicios de salud pública. A partir de la definición del Institute of Medicine de las funciones en salud pública, seguimos los planteamientos del estudio Delphi de la OMS y del modelo APEX PH (Assesstment Protocol fo Excellence in Public Health). Se describe y propone el Proyecto Nacional de Medición de Estándares y Desempeño de la Salud Pública (NPHPSP) planteado por los Centers for Disease Control como modelo de referencia para la gestión y la mejora de la calidad en las organizaciones de salud pública. Por último, se concluye que la aprobación de la Ley de Cohesión y Calidad del Sistema Nacional de Salud, con el planteamiento de las 8 principales prestaciones en salud que debe prestar el Sistema Nacional de Salud, permitiría una adaptación a nuestro contexto del modelo NPHSPS como herramienta de gestión de la calidad de los servicios de salud pública españoles

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health servicesBased on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services