Physical exercise as an intervention in people at clinical high-risk for psychosis: A narrative review. / Ejercicio físico como intervención en personas en alto riesgo clínico de psicosis: revisión narrativa.

The concept of clinical high risk for psychosis has favored research in the neurobiology of the stages prior to psychosis, as well as in preventive interventions. This group is made up of young people with: (1) psychotic symptoms of less intensity or less frequency during a brief time or having genetic history of psychotic disorders associated to a significant deterioration in functioning. The few existing interventions for this population have a low level of evidence. Physical activity and exercise have been shown to be part of the therapy for multiple psychiatric disorders, while a sedentary lifestyle would be a factor that favors psychosis. Indeed, people in clinical high risk for psychosis present a worse physical condition associated with a greater sedentary lifestyle and unhealthy habits. It has been proposed that exercise generates a positive biological effect on the hippocampus and surrounding areas, regions that would be involved in the pathophysiology of psychosis. Some experimental studies have shown a decrease in psychotic symptoms in patients with clinical high risk for psychosis who have followed physical exercise guidelines, as well as morphofunctional changes in brain structures. Although there are barriers to the implementation of this intervention, it is safe and feasible. It is necessary to conduct a greater number of experimental studies on a larger scale to measure its efficacy, generating scientific evidence that will eventually allow physical exercise to be included in clinical practice guidelines as a systematic recommendation for clinical high risk for psychosis.

El constructo de alto riesgo clínico de psicosis ha favorecido la investigación en la neurobiología de los estadios previos a la psicosis, así como también en intervenciones preventivas. Se trata de personas jóvenes que presentan síntomas psicóticos de menor intensidad o de menor frecuencia en un tiempo determinado, o bien tienen antecedentes genéticos de trastornos psicóticos sumados a un deterioro significativo del funcionamiento. Las escasas intervenciones existentes para esta población cuentan con un bajo nivel de evidencia. La actividad y el ejercicio físico han demostrado ser parte de la terapia de múltiples trastornos psiquiátricos, mientras que el sedentarismo sería un factor favorecedor de la psicosis. Efectivamente, las personas en alto riesgo clínico de psicosis presentan un peor estado físico asociado a mayor sedentarismo y hábitos de vida poco saludables. Se ha propuesto que el ejercicio genera un efecto biológico positivo sobre el hipocampo y las áreas circundantes, regiones que estarían involucradas en la fisiopatología de la psicosis. Algunos estudios experimentales han mostrado una disminución en la sintomatología psicótica en pacientes en alto riesgo clínico de psicosis que han seguido pautas de ejercicio físico. También dan cuenta de cambios morfofuncionales en estructuras cerebrales. Si bien existen barreras para la implementación de esta intervención, se trata de una intervención segura y factible. Es necesario realizar una mayor cantidad de estudios experimentales de una escala mayor para medir su eficacia, generando evidencia científica que permita eventualmente integrar el ejercicio físico a las guías de práctica clínica como una recomendación sistemática.

Ejercicio físico como intervención en personas en alto riesgo clínico de psicosis: revisión narrativa / Physical exercise as an intervention in people at clinical high-risk for psychosis: A narrative review

El constructo de alto riesgo clínico de psicosis ha favorecido la investigación en la neurobiología de los estadios previos a la psicosis, así como también en intervenciones preventivas. Se trata de personas jóvenes que presentan síntomas psicóticos de menor intensidad o de menor frecuencia en un tiempo determinado, o bien tienen antecedentes genéticos de trastornos psicóticos sumados a un deterioro significativo del funcionamiento. Las escasas intervenciones existentes para esta población cuentan con un bajo nivel de evidencia. La actividad y el ejercicio físico han demostrado ser parte de la terapia de múltiples trastornos psiquiátricos, mientras que el sedentarismo sería un factor favorecedor de la psicosis. Efectivamente, las personas en alto riesgo clínico de psicosis presentan un peor estado físico asociado a mayor sedentarismo y hábitos de vida poco saludables. Se ha propuesto que el ejercicio genera un efecto biológico positivo sobre el hipocampo y las áreas circundantes, regiones que estarían involucradas en la fisiopatología de la psicosis. Algunos estudios experimentales han mostrado una disminución en la sintomatología psicótica en pacientes en alto riesgo clínico de psicosis que han seguido pautas de ejercicio físico. También dan cuenta de cambios morfofuncionales en estructuras cerebrales. Si bien existen barreras para la implementación de esta intervención, se trata de una intervención segura y factible. Es necesario realizar una mayor cantidad de estudios experimentales de una escala mayor para medir su eficacia, generando evidencia científica que permita eventualmente integrar el ejercicio físico a las guías de práctica clínica como una recomendación sistemática.

The concept of clinical high risk for psychosis has favored research in the neurobiology of the stages prior to psychosis, as well as in preventive interventions. This group is made up of young people with: (1) psychotic symptoms of less intensity or less frequency during a brief time or having genetic history of psychotic disorders associated to a significant deterioration in functioning. The few existing interventions for this population have a low level of evidence. Physical activity and exercise have been shown to be part of the therapy for multiple psychiatric disorders, while a sedentary lifestyle would be a factor that favors psychosis. Indeed, people in clinical high risk for psychosis present a worse physical condition associated with a greater sedentary lifestyle and unhealthy habits. It has been proposed that exercise generates a positive biological effect on the hippocampus and surrounding areas, regions that would be involved in the pathophysiology of psychosis. Some experimental studies have shown a decrease in psychotic symptoms in patients with clinical high risk for psychosis who have followed physical exercise guidelines, as well as morphofunctional changes in brain structures. Although there are barriers to the implementation of this intervention, it is safe and feasible. It is necessary to conduct a greater number of experimental studies on a larger scale to measure its efficacy, generating scientific evidence that will eventually allow physical exercise to be included in clinical practice guidelines as a systematic recommendation for clinical high risk for psychosis.

The PYK2 inhibitor PF-562271 enhances the effect of temozolomide on tumor growth in a C57Bl/6-Gl261 mouse glioma model.

BACKGROUND: The development of resistance to temozolomide (TMZ), a standard chemotherapeutic, limits the effective treatment of glioblastoma (GBM). Focal adhesion kinase (FAK) and proline rich tyrosine kinase 2 (Pyk2) regulate proliferation and invasion of GBM cells. We found that TMZ activates FAK and Pyk2 signaling in GBM. We hypothesized that pharmacological inhibitors of Pyk2/FAK together with TMZ can enhance the inhibitory effect of TMZ on tumor growth and dispersal and improve the treatment outcome. METHODS: Primary human GBM cell cultures and a C57Bl/6-GL261 mouse glioma implantation model were used. Pyk2 (Tyr579/580) and FAK (Tyr925) phosphorylation was analyzed by western blotting. Viability, cell cycle, migration, invasion and invadopodia formation were investigated in vitro. Animal survival, tumor size and invasion, TUNEL apoptotic cell death and the Ki67 proliferation index were evaluated in vivo upon treatment with TMZ (50 mg/kg, once/day, orally) and the Pyk2/FAK inhibitor PF-562271 (once/daily, 50 mg/kg, orally) vs. TMZ monotherapy. RESULTS: In vitro studies revealed significantly reduced viability, cell cycle progression, invasion and invadopodia with TMZ (100 µM) + PF-562271 (16 nM) compared with TMZ alone. In vivo studies demonstrated that combinatorial treatment led to prominent reductions in tumor size and invasive margins, extensive signs of apoptosis and a reduced proliferation index, together with a 15% increase in the survival rate in animals, compared with TMZ monotherapy. CONCLUSION: TMZ + PF-562271 eliminates TMZ-related Pyk2/FAK activation in GBM and improves the treatment efficacy.

Microglial Cytokines Induce Invasiveness and Proliferation of Human Glioblastoma through Pyk2 and FAK Activation.

Glioblastoma is the most aggressive brain tumor in adults. Multiple lines of evidence suggest that microglia create a microenvironment favoring glioma invasion and proliferation. Our previous studies and literature reports indicated the involvement of focal adhesion kinase (FAK) and proline-rich tyrosine kinase 2 (Pyk2) in glioma cell proliferation and invasion, stimulated by tumor-infiltrating microglia. However, the specific microglia-released factors that modulate Pyk2 and FAK signaling in glioma cells are unknown. In this study, 20 human glioblastoma specimens were evaluated with the use of RT-PCR and western blotting. A Pierson correlation test demonstrated a correlation (0.6-1.0) between the gene expression levels for platelet-derived growth factor ß(PDGFß), stromal-derived factor 1α (SDF-1α), IL-6, IL-8, and epidermal growth factor (EGF) in tumor-purified microglia and levels of p-Pyk2 (Y579/Y580) and p-FAK(Y925) in glioma cells. siRNA knockdown against Pyk2 or FAK in three primary glioblastoma cell lines, developed from the investigated specimens, in combination with the cytokine receptor inhibitors gefitinib (1 µM), DMPQ (200 nM), and burixafor (1 µM) identified EGF, PDGFß, and SDF-1α as key extracellular factors in the Pyk2- and FAK-dependent activation of invadopodia formation and the migration of glioma cells. EGF and IL-6 were identified as regulators of the Pyk2- and FAK-dependent activation of cell viability and mitosis.

Análisis psicopatológico y sociodemográfico de pacientes hospitalizados por intento de suicidio en un hospital público chileno: estudio transversal analítico / Psychopathological and sociodemographic analysis of hospitalized patients for suicide attempt in a Chilean public hospital: An analytical cross-sectional study

Resumen Introducción: El suicidio es una problemática de salud pública global. A nivel regional, el análisis de las dimensiones psicopatológicas y sociodemográficas del intento de suicidio (IS) son escasas. Método: estudio transversal que analizó psicopatológica y sociodemográficamente a adultos hospitalizados por IS en un hospital público de Chile. Los participantes se caracterizaron sociodemográficamente y clínicamente, evaluando síndromes neuropsiquiátricos, trastornos de la personalidad y niveles de desesperanza, impulsividad, intencionalidad, letalidad y agresividad del IS. Se aplicó estadística no paramétrica. Resultados: 45 participantes fueron incluidos, con una mediana de 39 años de edad. La mayoría residió en zonas urbanas, pertenecía a un nivel socioeconómico bajo, eran solteros, presentó algún evento vital estresante y antecedente de IS. El método de IS más frecuente fue la ingesta medicamentosa. Los diagnósticos más frecuentes fueron trastorno por consumo de alcohol y personalidad límite. En la mitad de los casos la desesperanza fue leve o inexistente. La letalidad se correlacionó positiva y significativamente con la intencionalidad suicida, así como la impulsividad con la agresividad. El antecedente familiar de IS y el trauma psíquico fueron significativamente mayores en mujeres y el dolor crónico en hombres. Los casos graves mostraron altos niveles de desesperanza, intencionalidad y letalidad, mientras que la impulsividad fue significativamente menor que en los casos no graves. En este grupo, el diagnóstico más frecuente fue episodio depresivo. Conclusiones: La muestra analizada mostró características psicopatológicas y sociodemográficas distintivas. La letalidad y la intencionalidad del IS deben ser sistemáticamente evaluadas. Los casos graves de IS mostraron características psicopatológicas diferenciales.

Introduction: Suicide is a global public health problem. At the regional level, the analysis of the psychopathological and sociodemographic dimensions of suicide attempt (SA) are scarce. Methods: We conducted a cross-sectional study to analyze psychopathological and sociodemographic characteristics of adults hospitalized for SA in a public hospital in Chile. We describe participants according to sociodemographic and clinical characteristics, appraising neuropsychiatric syndromes, personality disorders, and levels of hopelessness, impulsiveness, intentionality, lethality and aggressiveness of the SA. Non-parametric statistics were applied. Results: 45 participants were included, with a median of 39 years of age. The majority lived in urban areas, belonged to low socioeconomic status, were single, had some stressful life event and a history of SA. The most frequent SA method was drug intake. The most frequent diagnoses were alcohol use disorder and borderline personality. In half of the cases the hopelessness was low or inexistent. Lethality was positively and significantly correlated with suicidal intent, as was impulsivity with aggressiveness. Family history of SA and psychological trauma were significantly higher in women and chronic pain in men. Severe cases showed high levels of hopelessness, intentionality, and lethality, while impulsivity was significantly less than in non-severe cases. In this group, the most frequent diagnosis was depressive episode. Conclusions: The analyzed sample showed distinctive psychopathological and sociodemographic characteristics. The lethality and intent of the SA must be systematically appraised. The severe cases of SA showed particular psychopathological characteristics.

Mitochondrial angiotensin receptors and cardioprotective pathways.

A growing body of data provides strong evidence that intracellular angiotensin II (ANG II) plays an important role in mammalian cell function and is involved in the pathogenesis of human diseases such as hypertension, diabetes, inflammation, fibrosis, arrhythmias, and kidney disease, among others. Recent studies also suggest that intracellular ANG II exerts protective effects in cells during high extracellular levels of the hormone or during chronic stimulation of the local tissue renin-angiotensin system (RAS). Notably, the intracellular RAS (iRAS) described in neurons, fibroblasts, renal cells, and cardiomyocytes provided new insights into regulatory mechanisms mediated by intracellular ANG II type 1 (AT1Rs) and 2 (AT2Rs) receptors, particularly, in mitochondria and nucleus. For instance, ANG II through nuclear AT1Rs promotes protective mechanisms by stimulating the AT2R signaling cascade, which involves mitochondrial AT2Rs and Mas receptors. The stimulation of nuclear ANG II receptors enhances mitochondrial biogenesis through peroxisome proliferator-activated receptor-γ coactivator-1α and increases sirtuins activity, thus protecting the cell against oxidative stress. Recent studies in ANG II-induced preconditioning suggest that plasma membrane AT2R stimulation exerts protective effects against cardiac ischemia-reperfusion by modulating mitochondrial AT1R and AT2R signaling. These studies indicate that iRAS promotes the protection of cells through nuclear AT1R signaling, which, in turn, promotes AT2R-dependent processes in mitochondria. Thus, despite abundant data on the deleterious effects of intracellular ANG II, a growing body of studies also supports a protective role for iRAS that could be of relevance to developing new therapeutic strategies. This review summarizes and discusses previous studies on the role of iRAS, particularly emphasizing the protective and counterbalancing actions of iRAS, mitochondrial ANG II receptors, and their implications for organ protection.

Critical role of angiotensin II type 2 receptors in the control of mitochondrial and cardiac function in angiotensin II-preconditioned rat hearts.

Angiotensin II preconditioning (APC) involves an angiotensin II type 1 receptor (AT1-R)-dependent translocation of PKCε and survival kinases to the mitochondria leading to cardioprotection after ischemia-reperfusion (IR). However, the role that mitochondrial AT1-Rs and angiotensin II type 2 receptors (AT2-Rs) play in APC is unknown. We investigated whether pretreatment of Langendorff-perfused rat hearts with losartan (L, AT1-R blocker), PD 123,319 (PD, AT2-R blocker), or their combination (L + PD) affects mitochondrial AT1-R, AT2-R, PKCε, PKCδ, Akt, PKG-1, MAPKs (ERK1/2, JNK, p38), mitochondrial respiration, cardiac function, and infarct size (IS). The results indicate that expression of mitochondrial AT1-Rs and AT2-Rs were enhanced by APC 1.91-fold and 2.32-fold, respectively. Expression of AT2-R was abolished by PD but not by L, whereas the AT1-R levels were abrogated by both blockers. The AT1-R response profile to L and PD was also shared by PKCε, Akt, MAPKs, and PKG-1, but not by PKCδ. A marked increase in state 3 (1.84-fold) and respiratory control index (1.86-fold) of mitochondria was observed with PD regardless of L treatment. PD also enhanced the post-ischemic recovery of rate pressure product (RPP) by 74% (p < 0.05) compared with APC alone. Losartan, however, inhibited the (RPP) by 44% (p < 0.05) before IR and reduced the APC-induced increase of post-ischemic cardiac recovery by 73% (p < 0.05). Finally, L enhanced the reduction of IS by APC through a PD-sensitive mechanism. These findings suggest that APC upregulates angiotensin II receptors in mitochondria and that AT2-Rs are cardioprotective through their permissive action on AT1-R signaling and the suppression of cardiac function.

Angiotensin II-preconditioning is associated with increased PKCε/PKCδ ratio and prosurvival kinases in mitochondria.

Angiotensin II-preconditioning (APC) has been shown to reproduce the cardioprotective effects of ischaemic preconditioning (IPC), however, the molecular mechanisms mediating the effects of APC remain unknown. In this study, Langendorff-perfused rat hearts were subjected to IPC, APC or both (IPC/APC) followed by ischaemia-reperfusion (IR), to determine translocation of PKCε, PKCδ, Akt, Erk1/2, JNK, p38 MAPK and GSK-3ß to mitochondria as an indicator of activation of the protein kinases. In agreement with previous observations, IPC, APC and IPC/APC increased the recovery of left ventricular developed pressure (LVDP), reduced infarct size (IS) and lactate dehydrogenase (LDH) release, compared to controls. These effects were associated with increased mitochondrial PKCε/PKCδ ratio, Akt, Erk1/2, JNK, and inhibition of permeability transition pore (mPTP) opening. Chelerythrine, a pan-PKC inhibitor, abolished the enhancements of PKCε but increased PKCδ expression, and inhibited Akt, Erk1/2, and JNK protein levels. The drug had no effect on the APC- and IPC/APC-induced cardioprotection as previously reported, but enhanced the post-ischaemic LVDP in controls. Losartan, an angiotensin II type 1 receptor (AT1-R) blocker, abolished the APC-stimulated increase of LVDP and reduced PKCε, Akt, Erk1/2, JNK, and p38. Both drugs reduced ischaemic contracture and LDH release, and abolished the inhibition of mPTP by the preconditioning. Chelerythrine also prevented the reduction of IS by APC and IPC/APC. These results suggest that the cardioprotection induced by APC and IPC/APC involves an AT1-R-dependent translocation of PKCε and survival kinases to the mitochondria leading to mPTP inhibition. In chelerythrine-treated hearts, however, alternate mechanisms appear to maintain cardiac function.

Mitochondria-targeted ROS scavenger improves post-ischemic recovery of cardiac function and attenuates mitochondrial abnormalities in aged rats.

Mitochondria-generated reactive oxygen species (ROS) play a crucial role in the pathogenesis of aging and age-associated diseases. In this study, we evaluated the effects of XJB-5-131 (XJB), a mitochondria-targeted ROS and electron scavenger, on cardiac resistance to ischemia-reperfusion (IR)-induced oxidative stress in aged rats. Male adult (5-month old, n=17) and aged (29-month old, n=19) Fischer Brown Norway (F344/BN) rats were randomly assigned to the following groups: adult (A), adult+XJB (AX), aged (O), and aged+XJB (OX). XJB was administered 3 times per week (3mg/kg body weight, IP) for four weeks. At the end of the treatment period, cardiac function was continuously monitored in excised hearts using the Langendorff technique for 30 min, followed by 20 min of global ischemia, and 60-min reperfusion. XJB improved post-ischemic recovery of aged hearts, as evidenced by greater left ventricular developed-pressures and rate-pressure products than the untreated, aged-matched group. The state 3 respiration rates at complexes I, II and IV of mitochondria isolated from XJB-treated aged hearts were 57% (P<0.05), 25% (P<0.05) and 28% (P<0.05), respectively, higher than controls. Ca(2+)-induced swelling, an indicator of permeability transition pore opening, was reduced in the mitochondria of XJB-treated aged rats. In addition, XJB significantly attenuated the H2O2-induced depolarization of the mitochondrial inner membrane as well as the total and mitochondrial ROS levels in cultured cardiomyocytes. This study underlines the importance of mitochondrial ROS in aging-induced cardiac dysfunction and suggests that targeting mitochondrial ROS may be an effective therapeutic approach to protect the aged heart against IR injury.

Angiotensin II and ischemic preconditioning synergize to improve mitochondrial function while showing additive effects on ventricular postischemic recovery.

Recent studies indicate that the cardioprotective effects of ischemic preconditioning (IPC) against sustained ischemia/reperfusion can be replicated by angiotensin II (Ang II). However, it is not clear whether IPC and Ang II-induced preconditioning (APC) act through similar mechanisms or synergize to enhance cardioprotection. In this study, Langendorff-perfused rat hearts were subjected to IPC, APC, or their combination (IPC/APC) followed by ischemia/reperfusion. IPC, and less potently APC, significantly increased the percent recoveries of the left ventricular developed pressure, the first derivative of developed pressure, and the rate pressure product compared with control. Furthermore, the postischemic recovery of the heart was significantly higher for IPC/APC compared with IPC or APC. The improvements in cardiac function by IPC, APC, and IPC/APC were associated with similar reductions in lactate dehydrogenase release and infarct size. However, a significant improvement in mitochondrial respiration was observed with IPC/APC. The postischemic recovery observed with APC and IPC/APC was inhibited by treatment with losartan, an Ang II type-1 receptor blocker, during the preconditioning phase but not by chelerythrine, a pan-PKC inhibitor. Both drugs, however, abolished the enhanced mitochondrial respiration by IPC/APC. Altogether, these results indicate that APC and IPC interact through mechanisms that enhance cardioprotection by affecting cardiac function and mitochondrial respiration.

Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies.

Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants' access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations. The analysis included policy principles, objectives, strategies and evaluations. Results show that the national and regional policies analyzed are based on the principle that health care is a right granted to immigrants by law. These policies include strategies to facilitate access to health care, reducing barriers for entry to the system, for example simplifying requirements and raising awareness, but mostly they address the necessary qualities for services to be able to attend to a more diverse population, such as the adaptation of resources and programs, or improved communication and training. However, limited planning was identified in terms of their implementation, necessary resources and evaluation. In conclusion, the policies address relevant barriers of access for migrants and signal improvements in the health system's responsiveness, but reinforcement is required in order for them to be effectively implemented.

Políticas sanitarias de ámbito estatal y autonómico para la población inmigrante en España

Objetivos: Analizar el contenido de las políticas sanitarias estatales y autonómicas dirigidas a inmigrantes en España. Material y métodos: Se realizó un estudio comparativo descriptivo de las políticas sanitarias para inmigrantes, estatales y autonómicas, mediante análisis de contenido. Se seleccionaron Andalucía, Comunidad Valenciana, Comunidad de Madrid y País Vasco por tener políticas específicas, proporción diferente de inmigrantes y evaluación de la política. Se seleccionaron planes estatales o autonómicos con intervenciones sanitarias dirigidas a inmigrantes. Se realizó un análisis de contenido cuyas dimensiones iniciales fueron: principios, objetivos, estrategias y evaluación. Posteriormente se clasificaron las estrategias según el ámbito de actuación.

Health professional perceptions regarding healthcare provision to immigrants in Catalonia.

OBJECTIVES: To analyse health personnel perceptions regarding the provision of care to immigrant population. METHODS: An exploratory and descriptive qualitative study was carried out by means of semi-structured individual interviews and focus groups to a theoretical sample of informants: Healthcare managers (19) and health professionals (46) from primary and secondary care. Narrative content analysis was conducted, segmented by informants' groups and themes. The area of study was five regions (comarcas) of Catalonia (Spain). RESULTS: Having to provide healthcare to immigrants generates feelings of distress, overload and exhaustion in health professionals, particularly in primary care personnel. However, problems faced in providing care were identified both by professionals and managers. Communication barriers emerged as the main problem. Other problems were attributed to specific characteristics of immigrants, their inappropriate use of services and professionals' attitudes. Structural and organizational deficiencies of the health system also emerged. CONCLUSIONS: For health professionals in Catalonia to provide care of quality to immigrants, interventions that reduce communication barriers and improve their cultural competences are requested. In addition, structural changes are needed to adapt the Catalonian health care system to the new circumstances.

Health policies for migrant populations in three European countries: England; Italy and Spain.

OBJECTIVES: The study aimed at providing a comparative analysis of health policies for immigrant populations in three European countries. METHODS: A descriptive comparative study of health policies for immigrant population was conducted through content analysis. England, Italy and Spain were selected because they have similar national health systems and different histories of immigration. For each country national or regional plans that included health policies for immigrants or ethnic minorities were selected. The analysis was conducted along the following dimensions: policy objectives, strategies, and evaluation of results. Subsequently, strategies were categorized according to the field of action. RESULTS: Improvements in immigrants' health are the ultimate objectives of these policies but they differ in emphasis and strategies. Main strategies relate to: addressing specific health issues; access to healthcare - information, communication, service supply and administrative proceedings; and improving quality of healthcare provision - services adaptation, professionals training and health needs' analysis. Only in England are some results of policy evaluation available. CONCLUSIONS: Different models of immigrant integration in receiving countries seem to condition the health policy approach. England and Spain propose actions to address immigrants' healthcare needs, while in Italy the development of specific strategies is limited.

Perception of the Ecuadorian population living in Barcelona regarding access to health services.

OBJECTIVES: To analyse the factors that influence access to health services from the point of view of the Ecuadorian population living in Barcelona. METHODS: A qualitative, descriptive and phenomenological study was carried out by semi-structured individual interviews on a sample of Ecuadorians (18) with maximum variation in age, sex, time since arrival and administrative status. The analysis was conducted according to Colaizzi's method. The study area was Barcelona. RESULTS: Access was considered to be easy for personal health-care card (PHC) holders. However, interviewees identified few factors that facilitated access related to the Ecuadorian population (PHC holder, language, social networks) and the health system (free care, opening hours). In contrast, a number of hindering factors related to both the Ecuadorian population (insufficient knowledge of the system, problems with the documentation in obtaining the PHC, working conditions) and to the system itself (information availability, resources, organisation, attitude of staff) were also identified. CONCLUSIONS: Although access was perceived as easy, the Ecuadorian population has to overcome a number of barriers to obtain care. These obstacles may have consequences on immigrants' health and on the efficiency of the system.

Políticas sanitarias de ámbito estatal y autonómico para la población inmigrante en España / Health policies of national and regional level for the immigrant population in Spain

Objetivos Analizar el contenido de las políticas sanitarias estatales y autonómicas dirigidas a inmigrantes en España.MétodosSe realizó un estudio comparativo descriptivo de las políticas sanitarias para inmigrantes, estatales y autonómicas, mediante análisis de contenido. Se seleccionaron Andalucía, Comunidad Valenciana, Comunidad de Madrid y País Vasco por tener políticas específicas, proporción diferente de inmigrantes y evaluación de la política. Se seleccionaron planes estatales o autonómicos con intervenciones sanitarias dirigidas a inmigrantes. Se realizó un análisis de contenido cuyas dimensiones iniciales fueron: principios, objetivos, estrategias y evaluación. Posteriormente se clasificaron las estrategias según el ámbito de actuación.ResultadosLas políticas sanitarias dirigidas a inmigrantes se definen principalmente en los planes de inmigración. Los principios se basan en la igualdad de derechos en salud con la población autóctona, y los objetivos se dirigen a su consecución. Buena parte de las acciones están encaminadas a la mejora del acceso a la atención. Además, contemplan estrategias específicas para adaptación de los servicios, promoción de la salud, análisis de las necesidades y formación de los profesionales. Las políticas autonómicas siguen las directrices generales marcadas para todo el Estado, pero con acciones más concretas. Las evaluaciones de las políticas son muy limitadas.ConclusiónEl contenido de las políticas sanitarias, especialmente estatales, responden a aspectos importantes a considerar en la atención a la población inmigrante. Sin embargo, la ausencia de evaluaciones, junto a la persistencia de problemas en la atención e inequidades en el acceso, podría indicar una insuficiente implantación y requiere un seguimiento cuidadoso(AU)

ObjectivesTo analyze the content of health policies for the immigrant population developed by central and regional governments in Spain.MethodsA descriptive comparative study of central and regional healthcare policies for the immigrant population was conducted in Spain through content analysis. The selected regions were Andalusia, Valencia, Madrid and the Basque Country as these regions have specific policies, distinct proportions of immigrants and policy evaluations. National or regional health and immigration plans with health policies for immigrants were selected. Contents analysis was conducted of the following main dimensions: policy principles and objectives, strategies and results’ evaluation. Subsequently, strategies were categorized according to the area of intervention.ResultsHealthcare policies for the immigrant population are mainly included in national and regional immigration plans. The principles of these policies are based on equal rights to healthcare between the immigrant and native-born populations and the objectives aim to achieve this end. National objectives and actions address access to and adaptation of health services, health promotion, health needs assessment, and health personnel training in cultural competences. Regional policies follow the national guidelines but their actions are more specific. Policy evaluations are highly limited.ConclusionsThe content of the health policies, especially national policies, address major issues in meeting immigrants’ healthcare needs. However, the absence of assessments, together with persistent problems in the provision of care and inequalities in access, could indicate insufficient implementation and requires careful monitoring(AU)

[Health policies of national and regional level for the immigrant population in Spain]. / Políticas sanitarias de ámbito estatal y autonómico para la población inmigrante en España.

OBJECTIVES: To analyze the content of health policies for the immigrant population developed by central and regional governments in Spain. METHODS: A descriptive comparative study of central and regional healthcare policies for the immigrant population was conducted in Spain through content analysis. The selected regions were Andalusia, Valencia, Madrid and the Basque Country as these regions have specific policies, distinct proportions of immigrants and policy evaluations. National or regional health and immigration plans with health policies for immigrants were selected. Contents analysis was conducted of the following main dimensions: policy principles and objectives, strategies and results' evaluation. Subsequently, strategies were categorized according to the area of intervention. RESULTS: Healthcare policies for the immigrant population are mainly included in national and regional immigration plans. The principles of these policies are based on equal rights to healthcare between the immigrant and native-born populations and the objectives aim to achieve this end. National objectives and actions address access to and adaptation of health services, health promotion, health needs assessment, and health personnel training in cultural competences. Regional policies follow the national guidelines but their actions are more specific. Policy evaluations are highly limited. CONCLUSIONS: The content of the health policies, especially national policies, address major issues in meeting immigrants' healthcare needs. However, the absence of assessments, together with persistent problems in the provision of care and inequalities in access, could indicate insufficient implementation and requires careful monitoring.

Necesidades de los profesionales de salud en la atención a la población inmigrante / Perceived needs of health personnel in the provision of healthcare to the immigrant population

ObjetivoAnalizar las necesidades de apoyo expresadas por el personal sanitario en la atención al colectivo inmigrante y aportar sugerencias de mejora.MétodosEstudio cualitativo, descriptivo, de carácter exploratorio y fenomenológico. Se llevaron a cabo entrevistas individuales semiestructuradas y grupos focales en una muestra teórica de informantes: directivos de proveedores (21) y profesionales de primaria y especializada (42). Se hizo un análisis narrativo del contenido con generación mixta de categorías y segmentación por grupo de informantes y temas.ResultadosEn el discurso de los informantes emergen con fuerza diversas necesidades de apoyo para la atención a la población inmigrante, con algunas voces discrepantes. Por un lado, para superar las barreras a la comunicación e información se requieren materiales en diversos idiomas y servicios de traducción, así como más tiempo por paciente. Por otro lado, para proveer atención a pacientes con culturas diversas se requiere formación centrada en aspectos culturales y de carácter práctico con aplicación inmediata. Además, para adaptar los recursos a la nueva situación, destaca la necesidad de introducir cambios en el sistema sanitario, liderados por el Departament de Salut.ConclusiónLas necesidades identificadas de apoyo para la comunicación, la información y la formación, así como de cambios en el sistema, indican que las intervenciones contempladas en el Plan Director de Inmigración en Salud no son debidamente implantadas, pero además se observan deficiencias estructurales y organizativas que deberían abordarse mediante políticas generales(AU)

ObjectiveTo analyze the needs perceived by health personnel in the provision of healthcare to the immigrant population and to provide suggestions for improvement.Methods A descriptive, exploratory and phenomenological qualitative study was carried out by means of semi-structured individual interviews and focus groups to a criterion sample of informants: healthcare managers (n=21) and health professionals (n=44) from primary and specialized care. A narrative content analysis was conducted by three analysts, segmented by groups of informants and themes, with mixed generation of categories.ResultsThe need for support in providing healthcare to the immigrant population strongly emerged in the informants’ discourses, with some discrepant voices. On the one hand, translated materials, translation services, and a greater length of time allocated per patient, were required to address communication and information barriers. On the other hand, specific training focusing on cultural aspects and practical tools for immediate implementation were needed to provide adequate care to patients from diverse cultural backgrounds. In addition, changes in the healthcare system, led by the Health Department, were requested to adapt resources to the new situation.ConclusionThe needs identified for support in communication, information and training, as well as changes in the system, reveal the insufficient implementation of the interventions contemplated in the Immigration and Health Plan. In addition, structural and organizational deficiencies were identified that should be addressed by general policies(AU)

[Perceived needs of health personnel in the provision of healthcare to the immigrant population]. / Necesidades de los profesionales de salud en la atención a la población inmigrante.

OBJECTIVE: To analyze the needs perceived by health personnel in the provision of healthcare to the immigrant population and to provide suggestions for improvement. METHODS: A descriptive, exploratory and phenomenological qualitative study was carried out by means of semi-structured individual interviews and focus groups to a criterion sample of informants: healthcare managers (n=21) and health professionals (n=44) from primary and specialized care. A narrative content analysis was conducted by three analysts, segmented by groups of informants and themes, with mixed generation of categories. RESULTS: The need for support in providing healthcare to the immigrant population strongly emerged in the informants' discourses, with some discrepant voices. On the one hand, translated materials, translation services, and a greater length of time allocated per patient, were required to address communication and information barriers. On the other hand, specific training focusing on cultural aspects and practical tools for immediate implementation were needed to provide adequate care to patients from diverse cultural backgrounds. In addition, changes in the healthcare system, led by the Health Department, were requested to adapt resources to the new situation. CONCLUSION: The needs identified for support in communication, information and training, as well as changes in the system, reveal the insufficient implementation of the interventions contemplated in the Immigration and Health Plan. In addition, structural and organizational deficiencies were identified that should be addressed by general policies.

[Impact of a capitation payment system on healthcare coordination]. / Impacto de un sistema de compra capitativo en la coordinación asistencial.

OBJECTIVE: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective. METHODS: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants' groups, themes, and areas. The study area consisted of the 5 pilot zones. RESULTS: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty, providers' fears of losing their identity, lack of interest, and the management limits of some providers. CONCLUSIONS: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia.