[Factors associated with prehospital delay in men and women with acute coronary syndrome]. / Factores asociados a la demora prehospitalaria en hombresy mujeres con síndrome coronario agudo.

OBJECTIVE: To identify factors associated with prehospital delay in people who have had an acute coronary syndrome. METHODS: Using a survey we studied patients admitted due to acute coronary syndrome in the 33 Andalusian public hospitals, obtaining information about different types of variables: socio-demographic, contextual,clinical, perception, action, and transportation.Multivariate logistic regression models were applied to calculate the odds ratios for the delay. RESULTS: Of the 1,416 patients studied, more than half had a delay of more than an hour. This is associated to distance to the hospital and means of transport: when the event occurs in the same city,using the patient's own means of transport increases the delay, odds ratio = 1.51 (1.02 to 2.23); if the distance is 1 to 25 kilometers from the hospital,there is no difference between the patient's own means of transport and an ambulance, odds ratio =1.41 and odds ratio =1.43 respectively; and when the distance exceeds 25 kilometers transport by ambulance means more delay, odds ratio = 3.13 and odds ratio = 2.20 respectively. Also, typical symptoms reduce delay amongst men but increase amongst women. Also, not caring and waiting for the resolution of symptoms, seeking health care other than a hospital or emergency services, previous clinical history, being away from home, and having an income under 1,500 euros, all increase delay. Respiratory symptoms reduce delay. CONCLUSIONS: Prehospital delay times do not meet health recommendations. The physical and social environment,in addition to clinical, perceptual and attitudinal factors, are associated with this delay.

Factores asociados a la demora prehospitalaria en hombres y mujeres con síndrome coronario agudo / Factors associated with prehospital delay in men and women with acute coronary syndrome

Fundamento: Identificar factores asociados a la demora prehospitalaria en personas que han tenido un síndrome coronario agudo Material y métodos: Se estudiaron mediante encuesta pacientes ingresados por síndrome coronario agudo en los 33 hospitales públicos andaluces, obteniéndose información sobre diferentes tipos de variables: socio-demográficas, contextuales, clínicas, percepción, actuaciones, y transporte. Se aplicaron modelos de regresión logística multivariante para calcular las odds ratio para la demora. Resultados: De los 1.416 pacientes en total, más de la mitad tuvieron una demora superior a la hora. Se asocia a la distancia al hospital y al medio de transporte: cuando el evento ocurre en la misma ciudad del hospital, utilizar medios propios aumenta la demora, odds ratio= 1,51 (1,02-2,23); si la distancia es entre 1-25 kilómetros, no hay una diferencia entre medios propios y ambulancia, odds ratio = 1,41 y odds ratio = 1,43 respectivamente; y cuando supera los 25 kilómetros la ambulancia implica mayor demora, odds ratio = 3,13 y odds ratio = 2,20 respectivamente. Además, la sintomatología típica reduce la demora entre los hombres, pero la aumenta entre las mujeres. Asimismo, no darle importancia, esperar a la resolución de los síntomas, buscar atención sanitaria diferente a urgencias hospitalarias o al 061, tener antecedentes, encontrarse fuera de la vivienda habitual, y tener ingresos menores de 1.500 euros aumentan la demora. Tener síntomas respiratorios la reduce. Conclusiones: La demora prehospitalaria no se ajusta a las recomendaciones sanitarias, asociándose al entorno físico y social, a factores clínicos, y de percepción y actitudinales de los sujetos (AU)

Objective. To identify factors associated with prehospital delay in people who have had an acute coronary syndrome. Methods. Using a survey we studied patients admitted due to acute coronary syndrome in the 33 Andalusian public hospitals, obtaining information about different types of variables: socio-demographic, contextual, clinical, perception, action, and transportation. Multivariate logistic regression models were applied to calculate the odds ratios for the delay. Results. Of the 1,416 patients studied, more than half had a delay of more than an hour. This is associated to distance to the hospital and means of transport: when the event occurs in the same city, using the patient’s own means of transport increases the delay, odds ratio = 1.51 (1.02 to 2.23); if the distance is 1 to 25 kilometers from the hospital, there is no difference between the patient’s own means of transport and an ambulance, odds ratio = 1.41 and odds ratio =1.43 respectively; and when the distance exceeds 25 kilometers transport by ambulance means more delay, odds ratio = 3.13 and odds ratio = 2.20 respectively. Also, typical symptoms reduce delay amongst men but increase amongst women. Also, not caring and waiting for the resolution of symptoms, seeking health care other than a hospital or emergency services, previous clinical history, being away from home, and having an income under 1,500 euros, all increase delay. Respiratory symptoms reduce delay. Conclusions. Prehospital delay times do not meet health recommendations. The physical and social environment, in addition to clinical, perceptual and attitudinal factors, are associated with this delay (AU)

Cannabis, juventud y género: nuevos patrones de consumo, nuevos modelos de intervención / Cannabis, youth and gender: new patterns of use, new prevention models

Incorporar la perspectiva de género al mundo de las drogodependencias conlleva generar nuevos conceptos y formas de entender los usos de los consumidores y consumidoras. El cannabis es la droga ilegal más consumida por los estudiantes españoles de 14 a 18 años. El consumo está más extendido entre los chicos en todos los indicadores, si bien esta diferencia con las chicas no es tan acusada como para otras drogas ilegales. En nuestra sociedad, sustancias como el cannabis ya no se asocian a marginalidad, sino que están inmersas en contextos sociales categorizados como "normales", y así son percibidas por la mayoría de sus consumidores y consumidoras. El proceso de normalización de la sustancia y la baja percepción del riesgo asociado a su uso y abuso han debido de jugar un papel en la incorporación de las mujeres a su consumo. Consideraciones sobre el rol del género en el uso de tabaco, alcohol u otras drogas han sido omitidas en la mayoría de los estudios sobre la efectividad de las intervenciones preventivas. Como consecuencia, poco se sabe de los programas efectivos para las mujeres. Las políticas de drogas que pueden aspirar a tener un cierto nivel de eficacia tienen que sintonizar de algún modo con las normas informales de sus consumidores (AU)

Incorporate the gender perspective into the world of drug studies generate new concepts and ways of understanding the realities of the drug uses for women and men. Cannabis is the illicit drug most consumed by Spanish students 14 to 18 years. Consumption is more prevalent among boys in all indicators, although this difference is not as strong as for other illegal drugs. Substances such as cannabis are not longer associated with the poor and marginal people, but are embedded in social contexts categorized as "normal", and so are perceived by most consumers. The normalization process of the comsuption and low perception of risk associated with its use and abuse have had to play a role in the incorporation of women to their consumption. Consideration of the role of gender in alcohol, tobacco, and drug use, for the most part, has been omitted from studies of intervention effectiveness. Consequently, although scientists now can state with confidence that effective prevention approaches exist, it is not clear whether those programs are effective specifically for girls. If drug policies can aspire to a certain level of efficiency they have to tune in some way with the informal norms of their consumers (AU)

Género y uso de drogas. De la ilegalidad a la legalidad para enfrentar el malestar / Gender and drug consumption: from legality to illegality as a way to face disconform

Objetivo. Conocer el discurso de las mujeres consumidoras de psicofármacos y comprender las dinámicas de género que favorecen el consumo. Material y método. Metodología cualitativa mediante grupos de discusión realizados con mujeres consumidoras de psicofármacos en tres Comunidades Autónomas. Estrategia de análisis en dos procesos diferenciados: análisis de contenido con categorías consensuadas y análisis del discurso desde la perspectiva de género. Resultados. Existen tres discursos diferentes con respecto al consumo de psicofármacos y éstos se relacionan con la edad. En todos ellos la utilización de psicofármacos se realiza cuando perciben «malestar» asociado a falta de modelos, sobrecarga de trabajo y/o sobrecarga emocional, pero también aparece como consecuencia del estrés ocasionado por la toma de decisiones. El consumo se lleva a cabo mediante dos estrategias diferentes: la prescripción y el autoconsumo. Conclusiones. Los diversos elementos que forman la construcción de género influyen en la forma de inicio y de continuar el consumo de sustancias psicofármacos, y tiene relación con la permisividad social de la sustancia. El contexto social favorece diferencias de género en la forma de consumir y en las expectativas sociales que los consumidores generan

Objetive. To know the discourses of women's who consume psychotropic for the understanding of the gender constructions that facilitated the consumptions between Spanish women. Material y methods. This is a qualitative research based on discussion groups with women from three Spanish Regions. The analysis was made using contend analysis and consensus categories from a gender perspective. Results. There are three different discourses in relation to psychotropic use and they are in relation with the women ages. In all of them the utilisation of psychotropic are in relation with what the call «malestar» in relation with suffering with the lack of models when they are young, too much work and emotional pressure. At the same time they feel stress in relation with decisions. Conclusions. Gender as a social construction is in relation with the way of initiation and to continuing psychotropic drug use and is connected with the social approval in the ways of using these kinds of drugs. Social context is facilitating gender differences in the way of using and in the social expectations generated by users

[Gender and psychiatric drugs: a qualitative study to find the views of prescription-fillers]. / Género y psicofármacos: la opinión de los prescriptores a través de una investigación cualitativa.

OBJECTIVES: To find the views of those filling out prescriptions on the factors that affect differential prescription of psychiatric medication, and on reducing the prescription; and to analyse their discourse for possible implicit gender bias. DESIGN: Qualitative methodology. Semi-structured interviews conducted in 2002-2003. SETTING: Urban and rural health centres. PARTICIPANTS: Family and community medicine and psychiatry professionals working in the public health services of Andalusia, the Community of Madrid, and the Basque Country. Segmentation criteria: community of residence, age, sex, medical speciality, and location of centre. METHODS: Structural sample. Interviews conducted by the research team. Strategy of analysis in two distinct processes: contents analysis with agreed categories and gender analysis of the discourse. RESULTS. The prescribers found that taking psychiatric medication was associated with sex, age, social and economic category, and social expectations. In the discourses we found consumer profiles emerging that were not found in the epidemiological literature. Discourse analysis showed implicit gender bias in the beliefs of some prescribers. CONCLUSIONS. To minimise the growing offer and demand for psychiatric medication, prescribers thought training in diagnosis and psychotherapy should be improved, case-loads should be reduced, co-ordination between services improved and alternative treatments favoured. To minimise gender bias in the diagnosis and prescription of psychiatric medication, we think training is needed on the influence of cultural and gender factors on the process of construction of identities.

Género y psicofármacos: la opinión de los prescriptores a través de una investigación / Gender and psychiatric drugs: a qualitative study to find the views of prescription-fillers

Objetivos. Conocer la opinión de los prescriptores en relación con los factores que influyen en la prescripción diferencial y sus propuestas para disminuir la prescripción de psicofármacos, así como analizar los discursos con el objeto de mostrar los posibles sesgos de género implícitos. Diseño. Metodología cualitativa. Entrevistas semiestructuradas realizadas durante los años 2002 y 2003. Emplazamiento. Centros de salud urbanos y rurales. Participantes. Profesionales de medicina familiar y comunitaria y psiquiatría que trabajan en los servicios públicos de salud de Andalucía, Comunidad de Madrid y País Vasco. Criterios de segmentación: comunidad de residencia, edad, sexo, especialidad médica y ubicación del centro. Métodos. Muestra estructural. Entrevistas realizadas por el equipo investigador. Estrategia de análisis en dos procesos diferenciados: análisis de contenido con categorías consensuadas y análisis del discurso desde la perspectiva de género. Resultados. En los prescriptores se observa una asociación entre el consumo de psicofármacos y el sexo, la edad, el nivel socioeconómico y las expectativas sociales. En los discursos encontramos perfiles emergentes de consumidores que no aparecen en la bibliografía epidemiológica. El análisis del discurso pone de manifiesto sesgos de género implícitos en las creencias de algunos prescriptores. Conclusiones. Para minimizar la creciente oferta y demanda de psicofármacos, los prescriptores consideran necesario mejorar la formación en diagnosis y psicoterapia, rebajar la presión asistencial, mejorar la coordinación entre servicios y favorecer tratamientos alternativos. Para minimizar los sesgos de género en el diagnóstico y la prescripción de psicofármacos consideramos necesaria la formación en cuestiones relacionadas con la influencia de los factores culturales y generalizadas en el proceso de construcción de las identidades

Objectives. To find the views of those filling out prescriptions on the factors that affect differential prescription of psychiatric medication, and on reducing the prescription; and to analyse their discourse for possible implicit gender bias. Design. Qualitative methodology. Semi-structured interviews conducted in 2002-2003. Setting. Urban and rural health centres. Participants. Family and community medicine and psychiatry professionals working in the public health services of Andalusia, the Community of Madrid, and the Basque Country. Segmentation criteria: community of residence, age, sex, medical speciality, and location of centre. Methods. Structural sample. Interviews conducted by the research team. Strategy of analysis in two distinct processes: contents analysis with agreed categories and gender analysis of the discourse. Results. The prescribers found that taking psychiatric medication was associated with sex, age, social and economic category, and social expectations. In the discourses we found consumer profiles emerging that were not found in the epidemiological literature. Discourse analysis showed implicit gender bias in the beliefs of some prescribers. Conclusions. To minimise the growing offer and demand for psychiatric medication, prescribers thought training in diagnosis and psychotherapy should be improved, case-loads should be reduced, co-ordination between services improved and alternative treatments favoured. To minimise gender bias in the diagnosis and prescription of psychiatric medication, we think training is needed on the influence of cultural and gender factors on the process of construction of identities