Development and evaluation of the OHCITIES instrument: assessing alcohol urban environments in the Heart Healthy Hoods project.

OBJECTIVES: To describe the development and test-retest reliability of OHCITIES, an instrument characterising alcohol urban environment in terms of availability, promotion and signs of consumption. DESIGN: This study involved: (1) developing the conceptual framework for alcohol urban environment by means of literature reviewing and previous alcohol environment research experience; (2) pilot testing and redesigning the instrument; (3) instrument digitalisation; (4) instrument evaluation using test-retest reliability. SETTING: Data for testing the reliability of the instrument were collected in seven census sections in Madrid in 2016 by two observers. PRIMARY AND SECONDARY OUTCOME MEASURES: We computed per cent agreement and Cohen's kappa coefficients to estimate inter-rater and test-retest reliability for alcohol outlet environment measures. We calculated interclass coefficients and their 95% CIs to provide a measure of inter-rater reliability for signs of alcohol consumption measures. RESULTS: We collected information on 92 on-premise and 24 off-premise alcohol outlets identified in the studied areas about availability, accessibility and promotion of alcohol. Most per cent-agreement values for alcohol measures in on-premise and off-premise alcohol outlets were greater than 80%, and inter-rater and test-retest reliability values were generally above 0.80. Observers identified 26 streets and 3 public squares with signs of alcohol consumption. Intraclass correlation coefficient between observers for any type of signs of alcohol consumption was 0.50 (95% CI -0.09 to 0.77). Few items promoting alcohol unrelated to alcohol outlets were found on public spaces. CONCLUSIONS: The OHCITIES instrument is a reliable instrument to characterise alcohol urban environment. This instrument might be used to understand how alcohol environment associates with alcohol behaviours and its related health outcomes, and can help in the design and evaluation of policies to reduce the harm caused by alcohol.

Salut, estils de vida i condicions laborals dels pediatres a Espanya / Salud, estilos de vida y condiciones laborales de los pediatras en España / Health, life style, and working conditions of pediatricians in Spain

Fonament: la salut, els estils de vida i els hàbits dels pediatres, així com les característiques sociodemogràfiques del lloc de treball, les condicions laborals i els factors de risc psicosocial, són aspectes poc estudiats. Objectiu: conèixer la situació de salut, estil de vida i condicions laborals dels pediatres a Espanya. Mètode: enquesta adreçada a pediatres de tot Espanya, amb una mostra final de 1.028 professionals i una taxa de resposta total del 18,5%. Resultats: s'observa un augment de la feminització, amb un 59% de dones. El 71% dels pediatres treballa en atenció primària. La jornada de treball predominant és contínua pels matins, amb contracte estatutari, amb més precarietat en les dones i els joves, i una mitjana de 45 hores de treball setmanals. El 64,7% estan satisfets amb les condicions la-borals. El risc psicosocial és alt, amb una taxa de trastorns d'ansietat i depressió més alta que en la població general. Conclusions: s'observa una tendència a la feminització i un alt nivell de formació amb subespecialitat o doctorat. La majoria dels pediatres treballa en el sector públic en atenció primària, com a assalariats, amb poques perspectives de promoció i amb horaris inestables i jornades extenses. Hi ha riscos psicosocials relacionats amb la càrrega de treball i amb la baixa participació en les decisions. Els preocupa l'impacte de la crisi sobre la seva pràctica mè-dica i els seus pacients, més que sobre el seu salari, que com a conseqüència s'ha vist reduït. S'han observat estils de vida saludables i una bona salut autopercebuda, tot i presentar un risc elevat de mala salut menta

Fundamento. La salud, los estilos de vida y los hábitos de los pediatras, así como las características sociodemográficas del lugar de trabajo, las condiciones laborales y los factores de riesgo psicosocial, son aspectos poco estudiados. Objetivo. Conocer la situación de salud, estilos de vida y condiciones laborales de los pediatras en España. Método. Encuesta dirigida a pediatras de toda España, con una muestra final de 1.028 profesionales y una tasa de respuesta total del 18,5%. Resultados. Se observa un aumento de la feminización con el 59% de mujeres. El 71% de los pediatras trabaja en atención primaria. La jornada de trabajo predominante es continua por las mañanas, con contrato estatutario, mayor precariedad en las mujeres y los jóvenes, y una media de 45 horas de trabajo semanales. El 64,7% están satisfechos con las condiciones laborales. El riesgo psicosocial es alto, con una tasa de trastornos de ansiedad y depresión más alta que en la población general. Conclusiones. Se observa una tendencia a la feminización y un alto nivel de formación con subespecialidad o doctorado. La mayoría de los pediatras trabaja en el sector público en atención primaria, como asalariados, con pocas perspectivas de promoción y con horarios inestables y jornadas extensas. Existen riesgos psicosociales relacionados con la carga de trabajo y con la baja participación en las decisiones. Les preocupa el impacto de la crisis sobre su práctica médica y sus pacientes, más que sobre su salario que como consecuencia se ha visto reducido. Se han observado estilos de vida saludables y una buena salud autopercibida, a pesar de presentar un riesgo elevado de mala salud mental (AU)

Background. Health, life style, habits, working conditions, sociodemographic characteristics of the work place, and psychosocial risks of pediatricians in Spain has been poorly studied. Objective. To evaluate the health status, life style, and working conditions of pediatricians in Spain. Method. We constructed a multiple-choice survey addressed to pediatricians in Spain, with a final sample of 1,028 professionals (response rate of 18.5%). Results. There was a preponderance of females (59%), and primary care providers (71%). The predominant working day model was as continuous morning shift under statutory contract, which was more precarious for young practitioners and women, with an average of 45 hours per week. The working conditions were satisfactory for 64.7% of the pediatricians. The psychosocial risk was high; the proportion of professionals suffering anxiety and depression disorders was higher than among the general population. Conclusions. We observed a trend towards the increase of females and of individuals with subspecialty or doctorate. Most pediatricians work in the public sector in primary care, with limited options for promotion, and with unstable schedules and long shifts. There are significant psychosocial risks related to the workload and the low participation in decision making, along with concerns about the impact of the financial crisis on their practice and their patients, rather than on their own salaries. Despite the high risk for poor mental health, the pediatricians indicate having a healthy life style and good health (AU)

The Transition of Medical Students Through Residency: Effects on Physical Activity and Other Lifestyle-Related Behaviors.

BACKGROUND: Little is known about lifestyle choices and preventive healthcare-seeking behaviors during the transition from medical school graduation to residency training, a period characterized by increased rates of stress and lack of free time due to demanding working conditions. All of these issues are likely to affect physical activity (PA) level. This study explored the evolution of PA and other lifestyle behaviors during this transition. METHODS: A cross-sectional study and a cohort study were conducted with medical students (2010) and physicians before and after the first year of residency (2013 and 2014). A self-administered questionnaire assessed PA, health and lifestyle behaviors. RESULTS: From a sample of 420 medical students and 478 residents, 74% comply with current PA guidelines. PA decreased by 16% during residency. Low levels of PA were found among (i) females and in respondents who reported (ii) poor self-perceived health and (iii) unhealthy body weight (P < .05). Low PA level was also significantly associated with poor mental health in first-year residents. CONCLUSIONS: The transition has a negative effect on physicians' PA level that may affect physicians' own health and patient care. Medical programs should encourage residents to engage in PA to assure physicians' personal and mental health.

Atención a las enfermedades músculo-esqueléticas: distintas visiones del mismo problema / Attention to musculoskeletal diseases. Different visions of the same problem

Objetivo. Detectar los principales problemas que afectan a los médicos de familia (MF) y a los especialistas hospitalarios, en la atención de las principales enfermedades del aparato locomotor en Cataluña. Método. Estudio descriptivo transversal realizado mediante una encuesta auto-administrada dirigida a MF y a especialistas hospitalarios de 4 ámbitos (cirugía ortopédica y traumatología [COT], reumatología [RMT], medicina física y rehabilitación [MFR] y unidades del dolor [UD]). Las variables recogidas evalúan datos socio-demográficos, dedicación asistencial, destreza autodeclarada, el proceso de derivación, los mecanismos de coordinación y las principales dificultades para ofrecer una atención de calidad. Resultados. Los MF consideran bueno su nivel de destreza en el manejo de las enfermedades del aparato locomotor (6,7±1,0 en una escala del 1 al 10). Menos del 25% refieren coordinarse con especialistas hospitalarios. Para los MF el mayor problema son las listas de espera en las especialidades citadas (8,2±1,6/10), seguido de la falta de información de retorno (8±1,9/10) y de la escasa coordinación (7,8±1,9/10). Según su criterio, la especialidad de referencia debería cambiar en algunas patologías (como la lumbalgia y la artrosis). Los especialistas hospitalarios son críticos respecto al papel de los MF. Para ellos, los principales problemas son la propia sobrecarga asistencial (7,8±2/10) y la ineficiencia de los sistemas de información (7,4±2/10). Conclusiones. La opinión sobre los problemas que afectan a la atención de las enfermedades del aparato locomotor difiere entre los MF y los especialistas hospitalarios. La falta de accesibilidad y la sobrecarga asistencial de la atención especializada, las deficiencias en el flujo de información y la escasa coordinación son los problemas más destacados (AU)

Objective: To identify the main problems affecting general practitioners (GPs) and specialists in the care of the main musculoskeletal problems in Catalonia. Method: Cross-sectional, self-administered survey in a representative sample of GPs and all specialists in four areas (orthopedic surgery, rheumatology, physical medicine and rehabilitation and pain units). Variables evaluated in the survey were related to socio-demographic data, attention to musculoskeletal diseases, self-declared expertise, referral process, coordination mechanisms and major constraints to provide high quality care. Results: GPs value well their expertise in the management of musculoskeletal diseases (6,7 ± 1,0 on a scale of 1 to 10). Less than 25% of GPs are coordinated with hospital specialists. For them, waiting lists are the main problem (8.2 ± 1,6/10) followed by lack of feedback (8 ± 1,9/10) and poor coordination (7.8 ± 1,9/10). Referenced specialties should change for some diseases (back pain and osteoarthritis). Specialists are critical for GPs. For specialists, the main problems are excessive workload (7,8 ± 2/10) and the inefficiency of healthcare information systems (7.4 ± 2/10). Conclusions: The vision of the problems affecting the care of musculoskeletal diseases differs between GPs and hospital specialists. The limited accessibility and workload excess, deficiencies in the flow of information and poor coordination are the most important problems in the proper care for musculoskeletal diseases (AU)

Attention to musculoskeletal diseases. Different visions of the same problem.

OBJECTIVE: To identify the main problems affecting general practitioners (GPs) and specialists in the care of the main musculoskeletal problems in Catalonia. METHOD: Cross-sectional, self-administered survey in a representative sample of GPs and all specialists in four areas (orthopedic surgery, rheumatology, physical medicine and rehabilitation and pain units). Variables evaluated in the survey were related to socio-demographic data, attention to musculoskeletal diseases, self-declared expertise, referral process, coordination mechanisms and major constraints to provide high quality care. RESULTS: GPs value well their expertise in the management of musculoskeletal diseases (6,7±1,0 on a scale of 1 to 10). Less than 25% of GPs are coordinated with hospital specialists. For them, waiting lists are the main problem (8.2±1,6/10) followed by lack of feedback (8±1,9/10) and poor coordination (7.8±1,9/10). Referenced specialties should change for some diseases (back pain and osteoarthritis). Specialists are critical for GPs. For specialists, the main problems are excessive workload (7,8±2/10) and the inefficiency of healthcare information systems (7.4±2/10). CONCLUSIONS: The vision of the problems affecting the care of musculoskeletal diseases differs between GPs and hospital specialists. The limited accessibility and workload excess, deficiencies in the flow of information and poor coordination are the most important problems in the proper care for musculoskeletal diseases.

El tabaco en los establecimientos de restauración y hostelería: estudio observacional en Barcelona, 2008 / Smoking in the hospitality sector: an observational study in Barcelona (Spain), 2008

ObjetivosDescribir la situación real del consumo de tabaco en los locales de restauración y hostelería tras la ley de medidas sanitarias frente al tabaquismo, que establece exenciones en este sector a la prohibición general de fumar en el trabajo desde 2006.MétodosEstudio observacional descriptivo en Barcelona en 2008, con muestreo por conglomerados de 1130 establecimientos. Se presentan los resultados estratificados por tipo de establecimiento.ResultadosEn el 85,7% de los comercios con degustación (panaderías, pastelerías…) y el 85% de los locales de comida rápida se prohíbe fumar. El 40% de los restaurantes son libres de humo u ofrecen zonas separadas. En los bares-cafeterías y cafeterías-restaurantes (locales más abundantes) no se suele prohibir fumar. Hay mayor oferta de locales sin humo en los distritos céntricos y centros comerciales.ConclusionesEn un 75,4% de los locales se permite fumar libremente. Estos resultados muestran las limitaciones de la ley(AU)

ObjectivesTo describe the actual presence of smoking in restaurant and hospitality premises after the smoking prevention act banning smoking in workplaces came into force in 2006, with wide exemptions in this sector.MethodsWe performed an observational, descriptive study in Barcelona (Catalonia, Spain) in 2008 based on cluster sampling, with 1130 premises. The results were stratified by premise type.ResultsUp to 85.7% of food shops allowing consumption within their premises (bakeries, pastry shops…) ban smoking, as well as 85% of fast food establishments. Among restaurants, 40% are smoke-free or have separate smoking areas. Bar-cafés and café-restaurants (the most abundant premises) usually allow smoking. There are more smoke-free options in central districts and in shopping malls.ConclusionsUp to 75.4% of all premises allow smoking freely. These results show the limitations of the law(AU)

[Smoking in the hospitality sector: an observational study in Barcelona (Spain), 2008]. / El tabaco en los establecimientos de restauración y hostelería: estudio observacional en Barcelona, 2008.

OBJECTIVES: To describe the actual presence of smoking in restaurant and hospitality premises after the smoking prevention act banning smoking in workplaces came into force in 2006, with wide exemptions in this sector. METHODS: We performed an observational, descriptive study in Barcelona (Catalonia, Spain) in 2008 based on cluster sampling, with 1130 premises. The results were stratified by premise type. RESULTS: Up to 85.7% of food shops allowing consumption within their premises (bakeries, pastry shops...) ban smoking, as well as 85% of fast food establishments. Among restaurants, 40% are smoke-free or have separate smoking areas. Bar-cafés and café-restaurants (the most abundant premises) usually allow smoking. There are more smoke-free options in central districts and in shopping malls. CONCLUSIONS: Up to 75.4% of all premises allow smoking freely. These results show the limitations of the law.

[Regulatory policies and public opinion: the case of smoking]. / Políticas reguladoras y opinión pública: el caso del tabaco.

BACKGROUND: Collecting and disseminating information about the public opinion on a regulatory process gives visibility to the silent social support and facilitates the process, which often confronts resistance from interest groups. This paper presents a survey about a proposed legislation on tobacco in its final stages and its results, and some considerations on the use of this sort of information in change processes. METHODS: Cross sectional descriptive study. In December 2005 a brief telephone survey was made to a population sample of 18 and more years of age (N=830) in Catalonia (Spain). The questionnaire explored opinions on the proposed regulations under discussion. We present the degree of support and the rating of nine regulatory measures, stratified by the respondents use of tobacco. RESULTS: Daily smokers are 26.3% of the surveyed population. Awareness and general support for tobacco regulation are very high. Aspects with wider support include bans on sales to minors (97.3%), smoking in enclosed public places (92.8%) and workplaces (89%), and publicity (90.8%). The aspect with less social support is banning smoking in bars and cafes (80.2%). CONCLUSIONS: The population supports widely tobacco regulation. This reinforces the process and weakens the arguments of those against it. Although smokers are less supportive, most of them accept the regulations, except for limitations in bars and cafes.

Políticas reguladoras y opinión pública: el caso del tabaco / Regulatory policies and public opinion: the case of smoking

Fundamento: Obtener y difundir información de la opiniónpública acerca de un proyecto de regulación permite hacer visible elapoyo social silencioso y facilita el proceso, que con frecuencia debeafrontar resistencias por las partes interesadas. Este trabajo presentauna encuesta de opinión sobre el proyecto de regulación del tabaquismoen los últimos tramos del proceso y sus resultados, y se formulanalgunas consideraciones sobre el uso de este tipo de informaciónen procesos de cambio.Métodos: Estudio descriptivo transversal. En diciembre de 2005se realizó una encuesta telefónica breve mediante cuestionario precodificadoa una muestra de la población de 18 o más años (n=830)de Cataluña. El cuestionario explora la opinión acerca de las propuestasde regulación en discusión. Se presenta el grado de acuerdoy la valoración con nueve medidas regulatorias, estratificando segúnel patrón de uso de tabaco de los respondientes.Resultados: El 26,3% de la población entrevistada son fumadoresdiarios. El grado de conocimiento y aceptación de la regulaciónes muy elevado. Los aspectos con mayor apoyo son la prohibición dela venta a menores (97,3%), la prohibición de fumar en lugares públicoscerrados (92,8%) y centros de trabajo (89%), y la prohibición dela publicidad (90,8%). El aspecto con menor apoyo es la prohibiciónde fumar en bares y cafeterías (80,2%).Conclusiones: La regulación recibe el apoyo mayoritario de lapoblación. Aunque expresen menos apoyo, las medidas son mayoritariamenteaceptadas por los fumadores: son rechazadas mayoritariamentesólo las limitaciones en bares y cafeterías

Background: Collecting and disseminating information aboutthe public opinion on a regulatory process gives visibility to thesilent social support and facilitates the process, which often confrontsresistance from interest groups. This paper presents a surveyabout a proposed legislation on tobacco in its final stages and itsresults, and some considerations on the use of this sort of informationin change processes.Methods: Cross sectional descriptive study. In December 2005 abrief telephone survey was made to a population sample of 18 andmore years of age (N=830) in Catalonia (Spain). The questionnaireexplored opinions on the proposed regulations under discussion. Wepresent the degree of support and the rating of nine regulatory measures,stratified by the respondents use of tobacco.Results: Daily smokers are 26.3% of the surveyed population.Awareness and general support for tobacco regulation are very high.Aspects with wider support include bans on sales to minors (97.3%),smoking in enclosed public places (92.8%) and workplaces (89%),and publicity (90.8%). The aspect with less social support is banningsmoking in bars and cafes (80.2%).Conclusions: The population supports widely tobacco regulation.This reinforces the process and weakens the arguments of thoseagainst it. Although smokers are less supportive, most of them acceptthe regulations, except for limitations in bars and cafes