Female sex workers and access to social and health services in Catalonia: Influence of region of origin and place of work.

The objectives of the study were to describe the use of social and health services (SHS) of female sex workers (FSW) in Catalonia according to place of work and region of origin, and explore the barriers these women encountered when accessing these services. Quantitative and qualitative methods were combined. A questionnaire-based survey (n = 400) was conducted from October 2009 to January 2010, and complemented by focus group discussions technique (n = 23). More than 60% of FSW had used health services (HS) in the last 6 months (no differences by context of work and region of origin). Nevertheless, there were differences in the characteristics of health resources used. Although all women in clubs contracted the private HS provided by the club itself, they were those who least benefited from social services (SS), in particular Eastern-Europe women (24.6% in the last 6 months). The stigma and discrimination that FSW women suffer were one of the main barriers to access SHS. Women from Eastern Europe who worked in clubs were the most isolated and vulnerable women. Access to the public health system must continue to be provided for all FSW, assuring confidentiality and diminishing the burden associated with discrimination which they generally feel.

Differences in cardiovascular mortality in smokers, past-smokers and non-smokers: findings from the FRENA registry.

BACKGROUND: The influence of smoking on outcome in patients with coronary artery disease (CAD) is controversial. Even less is known about its influence in patients with cerebrovascular (CVD), or peripheral artery (PAD) disease. PATIENTS AND METHODS: FRENA is an ongoing, observational registry of consecutive outpatients with symptomatic CAD, CVD, or PAD. We reviewed their cardiovascular mortality according to smoking status. RESULTS: As of May 2008, 2501 patients had been enrolled in FRENA. Of these, 439 (18%) were current smokers, 1086 (43%) past-smokers, 976 (39%) had never smoked. Current- and past-smokers were 10 years younger, more often males, and more likely to have chronic lung disease, but had diabetes, hypertension, heart failure, or renal insufficiency less often than non-smokers. Over a mean follow-up of 14 months, 123 patients died (cardiovascular death, 68). On univariate analysis, current smokers had a significantly lower rate of cardiovascular death: 1.1 (95% CI: 0.4-2.4) per 100 patient-years in current smokers; 1.9 (95% CI: 1.2-2.8) in past-smokers; 3.5 (95% CI: 2.5-4.7) in non-smokers, with no differences between patients with CAD, CVD or PAD. Mean age at cardiovascular death was 82+/-6.4; 70+/-9.9 and 67+/-15 years, respectively. On multivariate analysis, smoking status was not independently associated with a lower risk for cardiovascular death. CONCLUSIONS: Current and past-smokers with CAD, CVD or PAD had a less than half cardiovascular mortality than those who never smoked, but this may be explained by the confounding effect of additional variables. They died over 10 years younger than non-smokers.

Objetivos conseguidos del tratamiento hipolipemiante en una unidad de lípidos / Reached objectives in the treatment of hypolipemia in a lipid unit

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[Hospital mortality in an Internal Medicine service]. / Mortalidad hospitalaria en un Servicio de Medicina Interna.

UNLABELLED: The Internal Medicine service of the Hospital General de Vic (Barcelona) takes part in the mortality committee by revising and discussing in-hospital mortality. BACKGROUND: to establish the characteristics of the deceased, death causes and to revise possible changes in the last six-years time or problems related to the exitus, to evaluate and improve hospitalized patients assistance. METHODOLOGY: Every case was revised following a specific register: demographical data, diagnosis and death cause, hospital death, documentation data, terminal or agonic situation when hospitalized, autopsies and death quality data. Exitus due to hospital problems were analyzed and classified in different groups. The statistical analysis was performed with measures of central tendency and of standard deviation. RESULTS: During the revised six years, there were 819 exitus (5.1%). Global average death age was 79 +/- 1.8 years: 52.5% were men and 47.4% were women; 22.8% died in less than forty-eight hours after hospitalization. The most frequent death causes were cerebrovascular accident (24%), chronic obstructive pulmonary disease (14.4%) and pneumonia (9.6%). There were a small number of autopsies (4.8%). Ratio of exitus due to hospital problems was stable during the six years (0.5%), in which nosocomial infection was the severest problem. CONCLUSIONS: The total percentage of exitus was 5.1%, higher than the common standards. Mortality causes coincide with other series. Ratio of exitus due to hospital problems was according to recommended objectives. The number of autopsies was very small. A correct completing and revision of the clinical recording is indispensable to spot a shortage in the hospitalized patients assistance.

Mortalidad hospitalaria en un Servicio de Medicina Interna / Hospital mortality in an Internal Medicine Service

El Servicio de Medicina Interna del Hospital General de Vic (Barcelona) forma parte del comité de mortalidad revisando y discutiendo los fallecimientos hospitalarios. Fundamento y objetivo: Establecer las características de los fallecidos, causas de muerte y revisar si existen cambios en los últimos 6 años o problemas en relación con el éxitus, para evaluar y mejorar la asistencia de los pacientes ingresados. Sujetos y métodos: Se realizó revisión de cada caso a través de un registro específico con: datos demográficos, diagnóstico y causa de muerte, problemas hospitalarios, datos de documentación, situación terminal/agónica al ingreso, si se realizó autopsia y datos de calidad de muerte. Se analizan los éxitus secundarios a problemas hospitalarios (ESPHS). Para el análisis estadístico se utilizaron las medidas de centralización y dispersión estándar. Resultados: En los 6 años revisados hubieron 819 éxitus (5,1 por ciento), la edad media global fue de 79 ± 1,8 años. el 52,5 por ciento eran varones y el 47,4 por ciento mujeres, el 22,8 por ciento fallecieron en menos de 48 horas de ingreso. las causas más frecuentes de muerte fueron: el accidente vascular cerebral (24 por ciento), la enfermedad pulmonar obstructiva crónica (14,4 por ciento), la pneumonia (9,6 por ciento).el número de autopsias fue muy reducido (4,8 por ciento) los esphs se mantuvieron estables durante los 6 años, con una tasa del 0,5 por ciento siendo la infección nosocomial el problema más importante. Conclusiones: El porcentaje total de éxitus fue del 5,1 por ciento, superior a los estandards aconsejados. Las causas de mortalidad coinciden con otras series. La tasa de ESPHs se ajustó a los objetivos recomendados. El número de autopsias fue muy reducido. La correcta cumplimentación y revisión de la historia clínica es imprescindible para detectar déficits en la asistencia de los pacientes ingresados (AU)