[Insight on how to assess and improve the response to the COVID-19 pandemic]. / Reflexiones sobre cómo evaluar y mejorar la respuesta a la pandemia de COVID-19.

The COVID-19 pandemic has hit Spain particularly hard, despite being a country with a developed economy and being praised for the robustness of its national health system. In order to understand what happened and to identify how to improve the response, we believe that an independent multi-disciplinary evaluation of the health, political and socio-economic spheres is essential. In this piece we propose objectives, principles, methodology and dimensions to be evaluated, as well as outlining the type of results and conclusions expected. Inspired by the requirements formulated by the WHO Independent Panel for Pandemic Preparedness and Response and by experiences in other countries, we detail the multidimensional aspects to be evaluated. The goal is to understand key aspects in the studied areas and their scope for improvement in terms of preparedness, governance, regulatory framework, national health system structures (primary care, hospital, and public health), education sector, social protection schemes, minimization of economic impact, and labour framework and reforms for a more resilient society. We seek to ensure that this exercise serves not only at present, but also that in the future we are better prepared and more agile in terms of our ability to recover from any pandemic threats that may arise.

La respuesta de Gaceta Sanitaria a la pandemia de COVID-19. Gestión rápida y transferencia / Gaceta Sanitaria’s response to the COVID-19 pandemic. Rapid management and transfer

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[Communication, participation and leadership in the perception of the emotional climate in a university hospital in Andalusia, Spain]. / Comunicación, participación y liderazgo en la percepción del clima emocional en un hospital universitario de Andalucía, España.

The aim of this study was to identify and analyze perceptions and opinions among health professionals in a university hospital in Andalusia, Spain, regarding the emotional climate, leadership style, quality of information, and internal communication. The study also aimed to collect health professionals' suggestions for improving these workplace characteristics. The study included 730 participants and used a quantitative and qualitative methodology. The results reflect a medium-to-low level of emotional climate, correlated with the leadership style and information and internal communication. Statistically significant differences appeared when comparing professional categories and hospital units. The health professionals provided a positive assessment of the administrators' work, although requiring more task-oriented, participative, and affiliative leadership skills.

Comunicación, participación y liderazgo en la percepción del clima emocional en un hospital universitario de Andalucía, España / Communication, participation and leadership in the perception of the emotional climate in a university hospital in Andalusia, Spain / Comunicação, participação e liderança na percepção do clima emocional em um hospital universitário da Andaluzia, Espanha

El objetivo de este artículo es conocer y analizar la valoración del personal de un hospital universitario de Andalucía, España, sobre el clima emocional, el tipo de liderazgo ejercido y la calidad de la información y comunicación interna, así como recoger sus propuestas de mejora. El estudio realizado con 730 profesionales facultativos, enfermeros y auxiliares, usa metodología cuantitativa y cualitativa. Los resultados reflejan la existencia de un clima emocional medio-bajo, que se correlaciona con el estilo de liderazgo y la percepción sobre el grado de información y comunicación. Se observan diferencias estadísticamente significativas en los resultados, en función de las categorías profesionales, así como de la unidad o servicio hospitalario. Las demandas de los y las profesionales reflejan una valoración positiva de sus responsables, aunque se evidencia la necesidad de más habilidades propias de un estilo de liderazgo orientador, participativo y afiliativo.

The aim of this study was to identify and analyze perceptions and opinions among health professionals in a university hospital in Andalusia, Spain, regarding the emotional climate, leadership style, quality of information, and internal communication. The study also aimed to collect health professionals' suggestions for improving these workplace characteristics. The study included 730 participants and used a quantitative and qualitative methodology. The results reflect a medium-to-low level of emotional climate, correlated with the leadership style and information and internal communication. Statistically significant differences appeared when comparing professional categories and hospital units. The health professionals provided a positive assessment of the administrators' work, although requiring more task-oriented, participative, and affiliative leadership skills.

O objetivo deste artigo foi identificar e analisar a percepção e a opinião de profissionais de um hospital universitário na Andaluzia, Espanha, sobre clima emocional, tipo de liderança e qualidade da informação e comunicação interna, assim como identificar propostas de melhoria. O estudo foi realizado com 730 profissionais de saúde e utilizou metodologia quantitativa e qualitativa. Os resultados refletem a existência de um clima emocional médio-baixo, relacionado com o estilo de liderança e com a percepção sobre o grau de informação e comunicação interna. São observadas diferenças estatisticamente significativas nos resultados, em função das categorias profissionais e unidades ou serviço hospitalar. As demandas dos profissionais refletem uma valoração positiva de seus líderes, apesar de evidenciar a necessidade de habilidades próprias de um estilo de liderança orientador, participativo e afiliativo.

La salud 2.0, los blogs y las revistas científicas / Health 2.0, blogs and journals

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Los directivos hospitalarios y la comunicación interna: una asignatura pendiente / Hospital managers and internal communication: a pending subject

Objetivo. Conocer la percepción de los directivos de los hospitales españoles sobre el desarrollode la comunicación interna en sus centros.Método. Estudio descriptivo transversal, de ámbito nacional. La información se obtuvo a travésde un cuestionario autoadministrado de comunicación interna, distribuido a una muestra de135 directivos de hospitales públicos, seleccionados a través de muestreo aleatorio estratificado,con afijación proporcional a los dos estratos establecidos según el tamaño del hospital (de 0 a500 camas y de 501 a 2.000). El error muestral máximo admitido para el conjunto de la muestraes de ± 1,58 para un nivel de confianza del 95,5% (dos sigmas) y P=Q. La tasa de respuestaalcanzada fue del 63%.Resultados. Mientras que un 43,6% de los directivos de los hospitales de 500 camas o menos semuestran bastante o muy satisfechos con la comunicación interna en sus centros, este porcentaje desciendeal 26,3% en los hospitales de más de 500 camas, considerándose un 42,1% de los directivosde estos hospitales de mayor tamaño nada o poco satisfechos. Los hospitales de menos tamañoobtienen puntuaciones superiores en las diversas escalas Likert propuestas para valorar la comunicacióninterna en el centro (cantidad, claridad, puntualidad, perioricidad y formalización de los canales),siendo esta diferencia estadísticamente significativa para la variable grado percibido de formalizaciónde los canales empleados. Se detecta,además, que los gerentes de los hospitales de 500 camas o menosconceden un mayor peso al equipo directivo, juntas facultativa y de enfermería y a los mandos intermedioscomo fuentes de información de los profesionales que los gerentes de los hospitales de mayortamaño. Sin embargo, los compañeros se perciben como una fuente de información significativamentemás importante en los hospitales de más de 500 camas(AU)

Conclusiones. Se observa una tendencia a un mayor grado de satisfacción con la comunicacióninterna en los hospitales de 500 camas o menos que en los grandes. Ello puede explicarse por el hechode que en los hospitales más pequeños es más fácil el contacto directo entre la dirección y los profesionales.El menor tamaño del hospital favorece la utilización de canales formalizados de carácterpersonal.Todo ello indica la importancia de desarrollar canales formales bien establecidos en los planesde comunicación para que la información llegue a los públicos definidos y lo haga de la formamás clara posible(AU)

Objective. The aim of this study is to become acquainted with the guidelines of the Spanish hospitalson the development of Internal Communication in their hospitals.Design and methods. A descriptive, cross-sectional and national wide study was conducted. Informationwas obtained with a self-administered questionnaires on Internal Communication that wasdistributed to 135 public hospital managers who were randomly chosen with a stratified method proportionalto the distribution to the two strata established according to the hospital’s bed-capacity (upto 500 beds or from 501 to 2000 beds).The maximum standard error admitted for the global samplewas ± 1.58, with a 95% Confidence Interval and P=Q.The response ratio was 63%.Results. While 43.6% of the managers of hospitals with up to 500 beds were quite or very satisfiedwith the Internal Communication in their hospitals, only 26.3% of the managers of the largerhospitals manifested these levels of satisfaction, with 42.1% of the managers of these larger hospitalsexpressing none or little satisfaction. The smaller hospitals show higher scores on the Likert’s scalesproposed to assess Internal Communication in the center (quantity, clarity, punctuality, periodicity andchannel formalization).This difference was statistically significant for the self–perceived degree or formalizationof the channels used variable.Furthermore, it was observed that the managers of the smaller hospital gave more importance to theManagement Teams, Medical and Nursing Committees, and to the middle level managers as sources ofinformation of the professionals than the managers of the larger hospitals.However, the colleagues wereperceived as a more powerful resource of information in those hospital having more than 500 beds(AU)

Conclusions. A tendency towards higher levels of satisfaction with the Internal Communication inthe smaller hospitals was observed.The phenomenon can be explained by the fact that face-to-facecontact between the management levels and the staff is easier is the smaller hospitals. Small size ofthe hospital favors the use of personal type formal channels. All of the above indicates the importanceof developing well-established formal channels in the Communication Plans to assure that theinformation arrives to defined receptors in the clearest possible way(AU)

Inconsistent condom use among socially excluded heroin users.

The study focused in sexual behaviour among socially excluded heroin users, identifying factors associated with inconsistent condom use. Data was collected in the cities of Granada and Seville between July and October 2000, through a structured questionnaire, to 391 participants. Twenty two and 15% of participants have made consistent use of condoms in vaginal sex in the last year with occasional and regular partners respectively. There is a greater likelihood of inconsistent condom use with occasional partners among users who had had oral sex, and who does not know if their partner(s) inject or injected drugs. For regular partners those who have an injecting partner and do not speak with their sexual partners about AIDS have a higher probability to do not use always a condom. For both groups, when always the partner is who propose the use of condoms (when used) and not themselves, the risk not to use it is near 4 times more than when themselves propose to use it. Speaking about condoms and AIDS with mate, partners and family, and learning to negotiate the use of condoms seems to be the most important strategies to be approached for this sample, from the social and health care system in order to promote a protected sex.

Uso inconsistente del condón en los usuarios de heroina en situación de exclusión social / Inconsistent condom use among socially excluded heroin users

El objetivo del presente trabajo es analizar las conductas sexuales entre los usuarios de heroína, en situación de exclusión social, y conocer los factores asociados al uso inconsistente del condón en sus relaciones sexuales (coito vaginal) con parejas ocasionales y estables. Los datos fueron recogidos en las ciudades de Granada y de Sevilla entre julio y octubre de 2000, a través de un cuestionario estructurado, a 391 participantes. El 22 y el 15% de los participantes han hecho un uso consistente del condón durante el último año con sus parejas ocasionales y estables, respectivamente. Se ha encontrado una mayor probabilidad de un uso inconsistente del condón con las parejas ocasionales entre usuarios que habían practicado el sexo oral, y que desconocen si su(s) pareja(s) se inyecta drogas. En cuanto a las parejas estables, las que se inyectan y no hablan de sida entre ellos mostraron una probabilidad más alta de no utilizar consistentemente el condón. Para ambos grupos, cuando la pareja es quien siempre propone el uso del condón, el riesgo de no utilizarlo es de 4 veces más que cuando son ellos mismos quienes proponen su uso. Hablar sobre condones y sida con los amigos, las parejas y la familia, así como aprender a negociar el uso del condón, parecen ser las estrategias más apropiadas para el abordaje de esta población, de cara a promover un sexo protegido dentro del sistema sociosanitario

The study focused in sexual behaviour among socially excluded heroin users, identifying factors associated with inconsistent condom use. Data was collected in the cities of Granada and Seville between July and October 2000, through a structured questionnaire, to 391 participants. Twenty two and 15% of participants have made consistent use of condoms in vaginal sex in the last year with occasional and regular partners respectively. There is a greater likelihood of inconsistent condom use with occasional partners among users who had had oral sex, and who does not know if their partner(s) inject or injected drugs. For regular partners those who have an injecting partner and do not speak with their sexual partners about AIDS have a higher probability to do not use always a condom. For both groups, when always the partner is who propose the use of condoms (when used) and not themselves, the risk not to use it is near 4 times more than when thems elves propose to use it. Speaking about condoms and AIDS with mate, partners and family, and learning to negotiate the use of condoms seems to be the most important strategies to be approached for this sample, from the social and health care system in order to promote a protected sex

Factors associated with reported hepatitis C and HIV among injecting drug users in ten European cities.

BACKGROUND: To analyze self-reported prevalence of HCV and HIV in a sample of socially excluded injecting drug users, as well as factors associated with the presence of these diseases. METHODS: Cross-sectional study. Data were collected with a structured, face-to-face questionnaire by outreach workers and privileged access interviewers in 1131 participants who had injected heroin and/or cocaine over the past year (71.5% men; mean age, 30 years) from Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England; Lisbon, Portugal and Perugia, Italy. RESULTS: Among the total sample, 595 (52.6%) participants reported HCV-positive status and 143 (12.6%) HIV-positive status. Multivariate analysis for HCV showed that women are at less risk than men, and that longer drug use, injecting while in prison, sharing needles, and reported positive status for tuberculosis, HBV, HIV or sexually-transmitted disease are positively associated with HCV. Participants reporting positive HIV status were generally older, had injected drugs while in prison, had completed less than 8 years of schooling, were divorced, had no regular employment, and declared infection with tuberculosis, sexually-transmitted disease and HCV. CONCLUSIONS: The highest incidences of HCV and HIV were reported by participants in a poorer social and health situation. Drug addicts must cope not only with their addiction but also with the process of social exclusion they are immersed in. To the greatest extent possible, any course of action for this group should be built into integrated, coordinated plans that take a broad approach to the main issues involved.

Factors associated with reported hepatitis C and HIV among injecting drug users in ten European cities

Objetivos. Analizar la prevalencia del virus de la hepatitis C (VHC) y del virus de la inmunodeficiencia humana (VIH), según autoinformes, en una muestra de usuarios de drogas por vía inyectada en situación de exclusión social, así como los factores asociados a dichas enfermedades. Método. Estudio transversal. Los datos se recogieron con un cuestionario estructurado, cara a cara, llevados a cabo por entrevistadores expertos en el campo de estudio, y con acceso privilegiado a la muestra (iguales). La muestra se compone de 1.131 participantes que habían usado heroína y/o cocaína el último año por vía inyectada (71,5% hombres; edad media de 30 años), en las ciudades de Sevilla y de Granada, España; Colonia, Alemania; Viena, Austria; Bruselas, Bélgica; Atenas, Grecia; Dublín, Irlanda; Londres, Inglaterra; Lisboa, Portugal y Perugia, Italia. Resultados. 595 (52,6%) participantes dijeron ser positivos al VHC y 143 (12,6%) al VIH. Los análisis multivariantes para el VHC muestran que las mujeres están a menor riesgo que los varones, y que un uso más prolongado de las drogas, haberse inyectando en prisión, compartir agujas, y referir ser positivo a la tuberculosis el VHB, VIH y enfermedades de transmisión sexual (ETS) se asocian positivamente al VHC. Los participantes que refieren ser VIH positivos son generalmente de mayor edad, se han inyectado drogas en prisión, tienen menos de 8 años de escolarización, están divorciados, no tienen empleo regular, y declaran ser positivos a la tuberculosis, las ETS y VHC. Conclusiones. Las incidencias más altas de VHC y del VIH fueron referidas por los participantes que se encuentran en una peor situación social y de salud. Las personas toxicómanas no sólo deben hacer frente a su adicción sino también al proceso de exclusión social que generalmente acompaña a ésta. Cualquier acción orientada a estos grupos debería, en la medida de lo posible, llevarse a cabo dentro de un plan coordinado e integrado que tenga en cuenta los principales aspectos que deben ser abordados (AU)

Background. To analyze self-reported prevalence of HCV and HIV in a sample of socially excluded injecting drug users, as well as factors associated with the presence of these diseases. Methods. Cross-sectional study. Data were collected with a structured, face-to-face questionnaire by outreach workers and privileged access interviewers in 1131 participants who had injected heroin and/or cocaine over the past year (71.5% men; mean age, 30 years) from Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England; Lisbon, Portugal and Perugia, Italy. Results. Among the total sample, 595 (52.6%) participants reported HCV-positive status and 143 (12.6%) HIV-positive status. Multivariate analysis for HCV showed that women are at less risk than men, and that longer drug use, injecting while in prison, sharing needles, and reported positive status for tuberculosis, HBV, HIV or sexually-transmitted disease are positively associated with HCV. Participants reporting positive HIV status were generally older, had injected drugs while in prison, had completed less than 8 years of schooling, were divorced, had no regular employment, and declared infection with tuberculosis, sexually-transmitted disease and HCV. Conclusions. The highest incidences of HCV and HIV were reported by participants in a poorer social and health situation. Drug addicts must cope not only with their addiction but also with the process of social exclusion they are immersed in. To the greatest extent possible, any course of action for this group should be built into integrated, coordinated plans that take a broad approach to the main issues involved (AU)

La captación de pacientes para el proyecto experimental de prescripción de estupefacientes de Andalucía (PEPSA): el papel del mediador / Patient recruitment for the experimental stupefacient prescription project in Andalusia (Spain): the role of the mediator

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Controlled trial of prescribed heroin in the treatment of opioid addiction.

AIM: This study aimed to assess the efficacy of the prescription of intravenous diacetylmorphine (DAM) versus oral methadone with medical and psychosocial support, with a view of improving physical and mental health as well as social integration among socially excluded, opioid-dependent individuals for whom standard treatments have failed. DESIGN: This study used an open, randomized controlled trial. SETTING: This study took place in Granada, Spain. PARTICIPANTS: Sixty-two opioid-dependent participants were randomized, 31 in each treatment group, and 50 of them were analyzed. The participants were recruited directly from the streets, through peer outreach, in well-known meeting places for drug-addicted individuals. INTERVENTIONS: Participants in the experimental group received injected DAM, twice a day, plus oral methadone, once a day, for 9 months. The control group received only oral methadone, once a day. The two groups received an equivalent opioid dosage. The average DAM dosage was 274.5 mg/day (range: 15-600 mg), and an average methadone dosage was 42.6 mg/day (range: 18-124 mg). The daily methadone dosage in the control group was 105 mg/day (range: 40-180 mg). Comprehensive clinical, psychological, social, and legal support was given to both groups. MEASUREMENTS: The following were measured in this study: general health, quality of life, drug-addiction-related problems, nonmedical use of heroin, risk behavior for HIV and HCV, and psychological, family, and social status. FINDINGS: Both groups improved with respect to the total domain assessed. Those in the experimental group showed greater improvement in terms of physical health (the improvement was 2.5 times higher; p = .034) and risk behavior for HIV infection (the improvement was 1.6 times higher; p = .012). In addition, this group decreased its street heroin use from 25 days/month to 8 days/month as seen on the Addiction Severity Index (p = .020), as well as the number of days free from drug-related problems (the improvement was 2.1 times higher; p = .004) or involvement in crime (from 11 days/month to <1 day/month; p = .096 between groups). CONCLUSIONS: These findings support the hypothesis that, under the same conditions, DAM could be safely delivered, in our context. Also, in physical health, HIV risk behavior, street heroin use, and days involved in crime, DAM plus methadone was more efficacious than methadone alone. This implies that this treatment could provide an effective alternative for the treatment of socially excluded, opioid-dependent patients with severe physical and mental health problems because of drug addiction, when all available previous treatments have failed.