Aproximación a la gobernabilidad enfermera en la organización sociosanitaria en Cataluña / Approach to nurse governability at social and health centres in catalonia

La cuestionada sostenibilidad de la prestación sanitaria y el replanteamiento del modelo sociosanitario en Cataluña, permiten preguntarse sobre la gobernabilidad de las organizaciones sociosanitarias, u hospitales de media estancia, y su relación con la calidad asistencial. A través de la Teoría de la gobernabilidad se podrían explorarlos elementos del modelo sociosanitario y el rol mesogestor de la enfermera en laorganización: la toma decisiones, los intereses externos e internos, la misión y valores,y la facilitación de información y herramientas. La gobernabilidad enfermera esun concepto teórico medible con impacto claro y directo en la calidad y la sostenibilidad de los cuidados

Nowadays, in the region on Catalonia, there is an opportunity to reform social and health care model in the medium term care hospitals in order to protect and improve the quality of care and its sustainability. Due to financial crisis and limited resources in providing health care attention, nurse managers can focus to analyze their particular government practices in the organizations. So, nurse managers canexplore theory of governability in their centre: guarantee transparency, accountability, place in a structure of acute hospitals, and role respecting stakeholders interests. Furthermore, all these principles exposed can be explored, measured and compared their results with level of nursing quality care in the medium term care hospitals in Catalonia

Prevalencia y condicionantes de la obesidad en la población infantojuvenil de Cataluña, 2006-2012 / Prevalence and determinants of obesity in children and young people in Catalonia, Spain, 2006-2012

Fundamento y objetivo: Estimar la prevalencia de obesidad y sobrepeso en la población catalana de 2 a 14 años, conocer su evolución durante los períodos 2006 y 2010-2012 y evaluar los determinantes sociales y estilos de vida relacionados con la obesidad. Material y métodos: Estudio transversal a partir de 4.389 encuestas correspondientes a las ediciones 2006 y 2010-2012 de la Encuesta de Salud de Cataluña. El sobrepeso y la obesidad se determinaron aplicando los criterios de la Organización Mundial de la Salud. Los condicionantes evaluados fueron la clase social, el nivel de estudios de los padres/madres, los hábitos alimentarios, las actividades de ocio y el sueño. Resultados: Durante el período 2010-2012, las prevalencias de obesidad y sobrepeso fueron, respectivamente, 15,4 y 20,2%. La obesidad fue superior en niños (15,5%) que en niñas (12,8%) (p < 0,05), y superior en el grupo de 2 a 9 años (17,5%) que en el de 10 a 14 años (7,7%) (p < 0,05). Durante el período 2006, las prevalencias de obesidad y sobrepeso fueron similares a las observadas durante 2010-2012. La clase social baja y el bajo nivel de estudios de los progenitores se relacionaron significativamente con una mayor prevalencia de obesidad. Conclusiones: La obesidad y el sobrepeso en la población infantojuvenil catalana se han mantenido estables durante 2006-2012, siendo de las más altas de Europa. Para afrontar este importante problema de salud pública, es necesario un enfoque integral e interdisciplinario que considere tanto los determinantes sociales como los estilos de vida del entorno infantil (AU)

Background and objective: To estimate the prevalence of obesity and overweight in children aged 2 to 14 years in Catalonia, its trends between 2006 and 2010-2012, and to evaluate social determinants and lifestyle associated with obesity. Material and methods: A cross-sectional study, using the data from 4,389 surveys from Catalonia Health Surveys of the years 2006 and 2010-2012, was conducted. Obesity and overweight were determined by World Health Organization criteria. Socioeconomic position, parent's education, usual diet and activity, and hours of sleep were assessed. Results: The prevalence of obesity and overweight were: 15.4 and 20.2% in 2010-2012. The prevalence of obesity was higher in boys (15.5%) compared to girls (12.8%) (P < .05), and higher in children ranging from 2 to 9 years old (17.5%) than children aged 10 to 14 years (7.7%) (P < .05). In 2006, the prevalence of obesity and overweight were similar to the prevalence in 2010-2012. Obesity was more frequent in children with parents with a low socioeconomic position and/or a primary or elementary parent's education. Conclusions: During the last 5 years (2006-2012), child obesity and overweight have remained stable in Catalonia, yet they are relatively high in Europe. Public health programmes against obesity must consider conducting an intersectional action taking social determinants and family life styles into account (AU)

Nuevo diseño de la Encuesta de Salud de Cataluña (2010-2014): un paso adelante en planificación y evaluación sanitaria / New design of the Health Survey of Catalonia (Spain, 2010-2014): A step forward in health planning and evaluation

Se presenta la génesis de la Encuesta de Salud de Cataluña (2010-2014) con sus submuestras semestrales. Se detallan las características básicas de su diseño muestral polietápico. Entre las ventajas organizativas de esta nueva operación, en comparación con las anteriores, destacan la agilidad en la disponibilidad de datos y la capacidad de monitorización continuada de la población. Se señalan como beneficios la puntualidad en la obtención de indicadores y la posibilidad de introducir nuevos tópicos a través del cuestionario complementario, según las necesidades de información. Como limitación se apunta la mayor complejidad del diseño muestral y la falta de seguimiento longitudinal de la muestra. Se hace hincapié en la necesidad de utilizar ponderaciones adaptadas a las submuestras para el análisis estadístico que emplee microdatos, así como de acumular oleadas si se desea elevar el grado de desagregación del análisis, ya sea en el territorio o por subgrupos de población (AU)

This article presents the genesis of the Health Survey of Catalonia (Spain, 2010-2014) with its semiannual subsamples and explains the basic characteristics of its multistage sampling design. In comparison with previous surveys, the organizational advantages of this new statistical operation include rapid data availability and the ability to continuously monitor the population. The main benefits are timeliness in the production of indicators and the possibility of introducing new topics through the supplemental questionnaire as a function of needs. Limitations consist of the complexity of the sample design and the lack of longitudinal follow-up of the sample. Suitable sampling weights for each specific subsample are necessary for any statistical analysis of micro-data. Accuracy in the analysis of territorial disaggregation or population subgroups increases if annual samples are accumulated (AU)

[Prevalence and determinants of obesity in children and young people in Catalonia, Spain, 2006-2012]. / Prevalencia y condicionantes de la obesidad en la población infantojuvenil de Cataluña, 2006-2012.

BACKGROUND AND OBJECTIVE: To estimate the prevalence of obesity and overweight in children aged 2 to 14 years in Catalonia, its trends between 2006 and 2010-2012, and to evaluate social determinants and lifestyle associated with obesity. MATERIAL AND METHODS: A cross-sectional study, using the data from 4,389 surveys from Catalonia Health Surveys of the years 2006 and 2010-2012, was conducted. Obesity and overweight were determined by World Health Organization criteria. Socioeconomic position, parent's education, usual diet and activity, and hours of sleep were assessed. RESULTS: The prevalence of obesity and overweight were: 15.4 and 20.2% in 2010-2012. The prevalence of obesity was higher in boys (15.5%) compared to girls (12.8%) (P<.05), and higher in children ranging from 2 to 9 years old (17.5%) than children aged 10 to 14 years (7.7%) (P<.05). In 2006, the prevalence of obesity and overweight were similar to the prevalence in 2010-2012. Obesity was more frequent in children with parents with a low socioeconomic position and/or a primary or elementary parent's education. CONCLUSIONS: During the last 5 years (2006-2012), child obesity and overweight have remained stable in Catalonia, yet they are relatively high in Europe. Public health programmes against obesity must consider conducting an intersectional action taking social determinants and family life styles into account.

[New design of the Health Survey of Catalonia (Spain, 2010-2014): a step forward in health planning and evaluation]. / Nuevo diseño de la Encuesta de Salud de Cataluña (2010-2014): un paso adelante en planificación y evaluación sanitaria.

This article presents the genesis of the Health Survey of Catalonia (Spain, 2010-2014) with its semiannual subsamples and explains the basic characteristics of its multistage sampling design. In comparison with previous surveys, the organizational advantages of this new statistical operation include rapid data availability and the ability to continuously monitor the population. The main benefits are timeliness in the production of indicators and the possibility of introducing new topics through the supplemental questionnaire as a function of needs. Limitations consist of the complexity of the sample design and the lack of longitudinal follow-up of the sample. Suitable sampling weights for each specific subsample are necessary for any statistical analysis of micro-data. Accuracy in the analysis of territorial disaggregation or population subgroups increases if annual samples are accumulated.

La salud y los servicios sanitarios en las encuestas de salud de Cataluña. Introducción / No disponible

No disponible

Impacto de los trastornos crónicos en la esperanza de vida de la población de Cataluña en 1994 y 2006 / Impact of chronic diseases on life expectancy in the population of Catalonia, Spain, in 1994 and 200

Este trabajo analiza los cambios en la prevalencia de determinados trastornos crónicos y estima su impacto en la esperanza de vida de la población de Cataluña. Los trastornos crónicos seleccionados son: hipertensión arterial, diabetes, ictus, enfermedades del corazón, bronquitis crónica, asma, alergias crónicas, enfermedades del aparato locomotor y ansiedad/depresión. La prevalencia de estos trastornos se estima a partir de los datos recogidos por la Encuesta de Salud de Cataluña en 1994 y 2006. Los trastornos crónicos más frecuentemente presentes en la población catalana son los del aparato locomotor, la hipertensión arterial y la depresión y/o ansiedad. Mediante el análisis de los cambios en la esperanza de vida libre de trastornos crónicos se profundiza en el impacto que estas patologías tienen en la esperanza de vida. La importancia de la morbilidad crónica en nuestra sociedad, así como su impacto en los sistemas de salud, requiere de nuevos estudios que profundicen en el conocimiento de este fenómeno (AU)

This paper analyzes the changes in the prevalence of selected chronic conditions and their impact on the life expectancy in the population of Catalonia. The chronic conditions selected are: hypertension, diabetes, stroke, heart diseases, chronic bronchitis, asthma, chronic allergies, musculoskeletal system diseases, and anxiety/depression. The prevalence of these diseases is estimated from data collected by the Health Survey of Catalonia in 1994 and 2006. The most frequently chronic conditions among the Catalan population are the musculoskeletal disorders, the high blood pressure and the depression and/or anxiety. By the analysis of the changes in the life expectancy free of chronic disorders, this study shows the impact of these disorders in the life expectancy. The burden of the chronic morbidity in our community, and its impact on the health systems, requires further studies to increase the knowledge of this phenomenon (AU)

Riesgo individual y poblacional en salud mental en Cataluña / Individual and population-based risk in mental health in Catalonia, Spain

Los trastornos mentales son problemas de salud con un fuerte impacto social, sanitario, económico y una importante repercusión en la calidad de vida de las personas que los padecen y de sus familias. El objetivo de este artículo es medir la prevalencia de los trastornos mentales en Cataluña y comparar los cambios observados en los resultados obtenidos entre 1994 y 2006 de la Encuesta de Salud de Cataluña a partir del Goldberg General Health Questionnaire. La población con probabilidad de padecer un trastorno mental en el momento de la entrevista es similar en 1994 (12,6%) y 2006 (11,6%), con una prevalencia superior en las mujeres. Paradójicamente, entre la población sin riesgo es donde se concentran los casos declarados de depresión y/o ansiedad, sentirse ansioso o deprimido, consumir antidepresivos, visitar al psiquiatra o tener un estado de salud regular o malo. Los resultados concuerdan tanto con la paradoja del riesgo como con la paradoja de la prevención, hechos a tener en cuenta en las estrategias preventivas (AU)

Mental health disorders are health problems with a high health, social and economic impact and with relevant effects on the quality of life of both the patients and their families. The objective of this article is to measure the prevalence of mental disorders in Catalonia and to analyze changes the changes in the results obtained in the Goldberg General Health Questionnaire in the Catalan Health Survey editions developed in 1994 and 2006. The prevalence of population at risk of suffering of a mental health disorder does not differ in both years (12.6% in 1994 and 11.6% in 2006). Women showed a higher risk than men in both surveys. Paradoxically, it is amongst the people without risk where the highest number of cases of depression, anxiety, antidepressant use, psychiatry visits or bad perception of health was declared. The results agreed with the risk and prevention paradox and are relevant at the time of designing strategies for mental health disorders prevention (AU)

Prevalencia y carga de defectos visuales en Cataluña / Prevalence and burden of visual impairment in Catalonia, Spain

El objetivo de este artículo es determinar la prevalencia de defectos visuales en Cataluña y analizar las desigualdades en visión. Estudio transversal en población ≥ 15 años de edad (7.881 hombres y 8.045 mujeres) a partir de los datos de la Encuesta de Salud de Cataluña de 2006. Se usaron modelos de regresión logística para calcular las odds ratio ajustadas por edad, estado civil, nivel de estudios, nivel de ingresos y situación laboral con un intervalo de confianza (IC) del 95%. El 4,7% (IC del 95%, 4,4-5,0) de la población de Cataluña, el 5,3% (IC del 95%, 4,8-5,8) de las mujeres y el 4,1% (IC del 95%, 3,7-4,5) de los hombres, declara tener mala visión. Las situaciones más desfavorables de mala visión autodeclarada por la población catalana corresponden a los ancianos y las mujeres con menores niveles tanto de estudios como de ingresos (AU)

The aim of this work is to determine the prevalence of visual impairment in Catalonia and analyze inequalities in vision. Cross sectional study in the population having ≥15 years of age (7,881 men and 8,045 women) based on data from the Encuesta de Salud de Cataluña 2006. Logistic regression models were used to calculate the adjusted odds ratio by age, civil state, level of studies, income and working situation with a confidence interval (CI) of 95%. A 4.7% (CI 95% 4.4-5.0) of the population of Catalonia, a 5.3% of female (CI 95% 4.8-5.8), and 4.1% of men (CI 95% 3.7-4.5) state that they have poor vision. The most unfavourable situations of self-reported poor vision by the Catalan population correspond to the elderly and women with lower levels of both studies and income (AU)

[Impact of chronic diseases on life expectancy in the population of Catalonia, Spain, in 1994 and 2006]. / Impacto de los trastornos crónicos en la esperanza de vida de la población de Cataluña en 1994 y 2006.

This paper analyzes the changes in the prevalence of selected chronic conditions and their impact on the life expectancy in the population of Catalonia. The chronic conditions selected are: hypertension, diabetes, stroke, heart diseases, chronic bronchitis, asthma, chronic allergies, musculoskeletal system diseases, and anxiety/depression. The prevalence of these diseases is estimated from data collected by the Health Survey of Catalonia in 1994 and 2006. The most frequently chronic conditions among the Catalan population are the musculoskeletal disorders, the high blood pressure and the depression and/or anxiety. By the analysis of the changes in the life expectancy free of chronic disorders, this study shows the impact of these disorders in the life expectancy. The burden of the chronic morbidity in our community, and its impact on the health systems, requires further studies to increase the knowledge of this phenomenon.

[Individual and population-based risk in mental health in Catalonia, Spain]. / Riesgo individual y poblacional en salud mental en Cataluña.

Mental health disorders are health problems with a high health, social and economic impact and with relevant effects on the quality of life of both the patients and their families. The objective of this article is to measure the prevalence of mental disorders in Catalonia and to analyze changes the changes in the results obtained in the Goldberg General Health Questionnaire in the Catalan Health Survey editions developed in 1994 and 2006. The prevalence of population at risk of suffering of a mental health disorder does not differ in both years (12.6% in 1994 and 11.6% in 2006). Women showed a higher risk than men in both surveys. Paradoxically, it is amongst the people without risk where the highest number of cases of depression, anxiety, antidepressant use, psychiatry visits or bad perception of health was declared. The results agreed with the risk and prevention paradox and are relevant at the time of designing strategies for mental health disorders prevention.

[Prevalence and burden of visual impairment in Catalonia, Spain]. / Prevalencia y carga de defectos visuales en Cataluña.

The aim of this work is to determine the prevalence of visual impairment in Catalonia and analyze inequalities in vision. Cross sectional study in the population having ≥ 15 years of age (7,881 men and 8,045 women) based on data from the Encuesta de Salud de Cataluña 2006. Logistic regression models were used to calculate the adjusted odds ratio by age, civil state, level of studies, income and working situation with a confidence interval (CI) of 95%. A 4.7% (CI 95% 4.4-5.0) of the population of Catalonia, a 5.3% of female (CI 95% 4.8-5.8), and 4.1% of men (CI 95% 3.7-4.5) state that they have poor vision. The most unfavourable situations of self-reported poor vision by the Catalan population correspond to the elderly and women with lower levels of both studies and income.

[Health surveys: lights and shadows]. / Encuestas de salud: luces y sombras.

Surveys are relevant tolls to analyze social changes and its methods are appropriate to know about the distribution of perceptions and behaviors of different phenomena related to health and disease. Health surveys (HS) are usually focused on areas like social and demographic characteristics, health related behaviors, health status and health services utilization. They provide with information that is not possible to reach through other systematic data sources and are crucial to assist decision making in health policy. HS provide data from the general population which is complementary of that obtained through other procedures and takes into account the various dimensions and connections of health and health system. They are very important in health planning because of its adaptability different need, circumstances or population groups, and in all cases, when properly used, they provide with new knowledge that can be shared. Among its limitations it must be emphasized its reduced capacity to catch all the complexity of social phenomena, its high cost, and the need of a very strong work to coordinate different expert teams and its poor capacity to offer accurate estimates when little geographic areas or low prevalence phenomena are studied. The areas and opportunities for innovation in the design, data gathering and data analysis of HS are actually various and there is a need to try to optimize all its potentialities to get a better knowledge about populations' health and social reality.

Encuestas de salud: luces y sombras / Health surveys: lights and shadows

Las encuestas son una manera insustituible de observar la cambiante realidad social, lo que hace de éstas una metodología idónea para conocer la percepción y el comportamiento de fenómenos relacionados con la salud y la enfermedad. Los ámbitos comunes en las encuestas de salud (ES) son: características sociodemográficas, comportamientos relacionados con la salud, estado de salud y utilización de servicios. Las ES aportan información que no es posible obtener de registros y fuentes de información sistemáticas, siendo fundamentales en los sistemas de información sanitaria como instrumentos para la toma de decisiones en planificación sanitaria. Las experiencias de diferentes autoridades sanitarias ponen de manifiesto algunas de sus cualidades. Las principales ventajas de las ES son que proporcionan información poblacional, complementan información de otras fuentes o la nutren en su ausencia, ofrecen una visión multidimensional e interconectada de la salud, acompañan los diferentes momentos del ciclo de planificación sanitaria, se adaptan al entorno y a las necesidades cambiantes y contribuyen a generar y compartir conocimiento. Sus principales limitaciones son que reducen la complejidad de la realidad social a partir de datos obtenidos de cuestionarios limitados, tienen un coste elevado y concentrado presupuestariamente, requieren de la coordinación de equipos expertos, presentan problemas de representatividad en fenómenos de baja prevalencia o territorios peque- ños y también de observación ante otros fenómenos determinados. Los ámbitos de innovación (diseño, metodología, instrumentos, análisis, etc.) de las ES son muchos, y tienen un gran potencial que es preciso aprovechar para la mejora del conocimiento de la salud de la población y de la realidad social (AU)

Surveys are relevant tolls to analyze social changes and its methods are appropriate to know about the distribution of perceptions and behaviors of different phenomena related to health and disease. Health surveys (HS) are usually focused on areas like social and demographic characteristics, health related behaviors, health status and health services utilization. They provide with information that is not possible to reach through other systematic data sources and are crucial to assist decision making in health policy. HS provide data from the general population which is complementary of that obtained through other procedures and takes into account the various dimensions and connections of health and health system. They are very important in health planning because of its adaptability different need, circumstances or population groups, and in all cases, when properly used, they provide with new knowledge that can be shared. Among its limitations it must be emphasized its reduced capacity to catch all the complexity of social phenomena, its high cost, and the need of a very strong work to coordinate different expert teams and its poor capacity to offer accurate estimates when little geographic areas or low prevalence phenomena are studied. The areas and opportunities for innovation in the design, data gathering and data analysis of HS are actually various and there is a need to try to optimize all its potentialities to get a better knowledge about populations’ health and social reality (AU)

[Cost-effectiveness of hypertension treatment in Catalonia (Spain)]. / Estudio de coste-efectividad del tratamiento de la hipertensión arterial en Cataluña.

BACKGROUND: We assessed the cost-effectiveness of pharmacological treatments for hypertension to prevent coronary heart disease and stroke in Catalonia (Spain). METHODS: Cost-effectiveness was measured as the cost in Spanish Ptas per life year gained (LYG) in 1998 in individuals aged 40 to 69 years with moderate/severe hypertension (>= 105 mmHg) and mild hypertension (95-104 mmHg). We evaluated hydrochlorothiazide (diuretic), propranolol (-blocker), nifedipine (calcium antagonist), captopril (angiotensin-converting-enzyme inhibitor) and prazosin (*-adrenergic blocker). RESULTS: Cost-effectiveness ranged from 706,100 to 446,780 ptas. per LYG in men and from 635,100 to 810,270 ptas. per LYG in women with moderate/severe hypertension and from 108,770 to 682,460 ptas. per LYG in men and from 101,000 to 12,699,000 ptas. per LYG in women with mild hypertension. Incremental cost-effectiveness analysis showed that hydrochlorothiazide and propranolol were the most cost-effective treatments in individuals with moderate/severe hypertension while hydrochlorothiazide and nifedipine were most cost-effective in those with mild hypertension. CONCLUSION: In this study, greatest-to-lowest cost-effectiveness of assessed treatments was as follows: hydrochlorohiazide, propranolol, nifedipine, prazosin and captopril in moderate/severe hypertension and hydrochlorothiazide, nifedipine, propranolol, prazosin and captopril in mild hypertension.

Estudio de coste-efectividad del tratamiento de la hipertensión arterial en cataluña / Cost-effectiveness of hypertension treatment in Catalonia (Spain)

FUNDAMENTO: En este estudio se ha evaluado la razón coste-efectividad del tratamiento farmacológico de la hipertensión arterial para prevenir la cardiopatía coronaria y la enfermedad cerebrovascular en Cataluña. MÉTODOS: El coste-efectividad del tratamiento de la hipertensión arterial moderada-grave ( 105 mmHg) y ligera (95-104 mmHg) en el año 1998 se evaluó en términos de coste en pesetas por año de vida ganado (AVG) en los individuos de 40 a 69 años. Se evaluaron los siguientes tratamientos: hidroclorotiazida (diurético), propranolol (bloqueador beta), nifedipino (antagonista del calcio), captopril (inhibidor de la enzima conversiva de la angiotensina) y prazosina (bloqueador -adrenérgico). RESULTADOS: Se obtuvo un coste-efectividad de 706.100 a 446.780 ptas. por AVG en los varones y de 635.100 a 810.270 ptas. por AVG en las mujeres para el tratamiento de la hipertensión moderada/grave, y de 108.770 a 682.460 ptas. por AVG en los varones y de 101.000 a 12.699.000 ptas. por AVG en las mujeres para el tratamiento de la hipertensión ligera. El análisis del coste-efectividad incremental demostró que la hidroclorotiazida y el propranolol eran los más coste-efectivos en los individuos con hipertensión arterial moderada/severa y la hidroclorotiazida y el nifedipino en los individuos con hipertensión arterial ligera. CONCLUSIÓN: El orden de mayor a menor coste-efectividad de los tratamientos evaluados fue: hidroclorotiazida, propranolol, nifedipino, prazosina y captopril en la hipertensión arterial moderada/grave, e hidroclorotiazida, nifedipino, propranolol, prazosina y captopril en la hipertensión arterial ligera (AU)