Childhood, families and the Internet: a qualitative approach on health assets / Infancia, familias e Internet: un enfoque cualitativo sobre activos para la salud

Objective: To explore the views of the Internet in childhood, identifying both health assets and risks. Method: A qualitative study was performed using 14 focus groups, eight of which comprised boys and girls, four of which comprised parents and two of which were mixed (children and parents) in primary schools in urban and rural settings in Andalusia (Spain). Teachers in these schools were also asked to complete an online questionnaire using LimeSurvey. This study involved 114 individuals: 64 pupils (33 girls and 31 boys), 28 parents (18 mothers and 10 fathers), and 22 teachers (14 women and 8 men). Analysis of manifest content and underlying meanings was carried out. QSR NVivo 9 software was used to facilitate analysis and make it systematic. Results: Our findings show how the differences in the way parents and children understand health and wellbeing affect the way they discuss the Internet and health. The discussion of results looks at the implications of computer literacy for public health and wellbeing, particularly with regard to health assets. Conclusions: Parents and children understand the contribution of the Internet to health and wellbeing differently. Whilst parents emphasize the risks (unsafe environment, relationships and quality of information, social networks, physical problems and addiction), the children emphasize the assets offered by the Internet. (AU)

Objetivo: Explorar la visión de Internet en la infancia, identificando riesgos y activos para la salud. Método: Estudio cualitativo con 14 grupos focales: ocho con niños y niñas, cuatro con familias y dos mixtos con niños/as y familias en centros de educación primaria de los ámbitos rural y urbano en Andalucía (España). También se aplicó un cuestionario on-line al profesorado de los centros educativos. En total participaron 114 personas (33 chicas y 31 chicos; 18 madres y 10 padres; 14 maestras y 8 maestros). Se llevó a cabo un análisis de contenido manifiesto y contenido latente, utilizando el software QSR NVivo 9 para facilitar dicho análisis y hacerlo más sistemático. Resultados: Los resultados ponen de manifiesto cómo la forma diferencial de entender la salud y el bienestar entre padres/madres e hijos/as influye en la orientación de los discursos sobre Internet y salud. Los resultados son discutidos ampliando el debate existente en torno a las implicaciones en salud pública de la alfabetización digital y su conexión con el enfoque de activos para la salud. Conclusión: Las familias y la infancia entienden la contribución de Internet a la salud y al bienestar de manera muy diferente. Mientras los padres y las madres enfatizan los riesgos (ambiente inseguro, relaciones y calidad de la información, redes sociales, problemas físicos y adicciones), los/las niños/as se centran en enfatizar las potencialidades de Internet, descritas como activos. (AU)

Childhood, families and the Internet: a qualitative approach on health assets.

OBJECTIVE: To explore the views of the Internet in childhood, identifying both health assets and risks. METHOD: A qualitative study was performed using 14 focus groups, eight of which comprised boys and girls, four of which comprised parents and two of which were mixed (children and parents) in primary schools in urban and rural settings in Andalusia (Spain). Teachers in these schools were also asked to complete an online questionnaire using LimeSurvey. This study involved 114 individuals: 64 pupils (33 girls and 31 boys), 28 parents (18 mothers and 10 fathers), and 22 teachers (14 women and 8 men). Analysis of manifest content and underlying meanings was carried out. QSR NVivo 9 software was used to facilitate analysis and make it systematic. RESULTS: Our findings show how the differences in the way parents and children understand health and wellbeing affect the way they discuss the Internet and health. The discussion of results looks at the implications of computer literacy for public health and wellbeing, particularly with regard to health assets. CONCLUSIONS: Parents and children understand the contribution of the Internet to health and wellbeing differently. Whilst parents emphasize the risks (unsafe environment, relationships and quality of information, social networks, physical problems and addiction), the children emphasize the assets offered by the Internet.

Content of Public Health Ethics Postgraduate Courses in the United States.

UNLABELLED: This paper evaluates the content of the syllabi of postgraduate courses on public health ethics (PHE) within accredited schools and programs of public health (PH) in the United States in order to gain an awareness of the topics addressed within these courses. METHODS: Data was gathered via the analysis of syllabi of courses on PHE. In 2012, information was requested by e-mail from the 48 schools and 86 PH programs accredited by the U.S. Council on Education for Public Health for 2012. The "Epidemiology and PHE Syllabi" project of the University of Miami also was consulted. A table of topics was drawn up in order to carry out content analysis of the documents. RESULTS: Data was obtained from 25 schools (52%) and 36 accredited programs (42%); 36 syllabi were gathered and 75 different topics were found. Of these, 38 topics were addressed in six or more syllabi and can be grouped as follows: foundations of PHE; autonomy and its limits; infectious disease control; justice; research ethics; health education and promotion; environmental and occupational health; screening; genetics; privacy and confidentiality; and community-based practice and vulnerable populations. CONCLUSIONS: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi.

Stability over time in the preferences of older persons for life-sustaining treatment.

OBJECTIVE: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. DESIGN: Longitudinal cohort study. SETTING: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. RESULTS: 86 percent of the patients did not change preferences. Sex, age, marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. CONCLUSION: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning.

Euthanasia and physician-assisted suicide: knowledge, attitudes and experiences of nurses in Andalusia (Spain).

The aim of this study is to assess the knowledge, attitudes and experiences of Spanish nurses in relation to euthanasia and physician-assisted suicide. In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases of euthanasia had occurred in Spain and 11.4% believed the same for assisted suicide. There was greater support (70%) for legalisation of euthanasia than for assisted suicide (65%), combined with a greater predisposition towards carrying out euthanasia (54%), if it were to be legalised, than participating in assisted suicide (47.3%). Nurses in Andalusia should be offered more education about issues pertaining to the end of life, and extensive research into this area should be undertaken.

[Euthanasia in Belgium]. / La eutanasia en Bélgica.

The experience of the Netherlands in relation with the legalization and practice of euthanasia is better known in Spain than the Belgian experience in this matter. But the historical process of social debate in Belgium has many specific details which should be known by Spanish healthcare professionals, bioethicists, politicians and lawyers. This paper begins with a comparative analysis of both countries: Spain and Belgium and follows with a description of the milestones of the historical process of debating and, finally, passing the Belgian Law on Euthanasia in 2002. The next chapter consists of a description of the main contents of this important Law. The paper continues then with an approach to the epidemiology of the practice of euthanasia in Belgium and finishes with a description of the different positions of the actors of the process. Two positions are described more in depth: the opinion of the specialists in palliative care, and the opinion of the Catholic Church. The paper ends underlining the reason for the incorporation of the Belgian experience on euthanasia to the debate about the possibility of legalizing euthanasia in Spain.

End-of-life healthcare decisions, ethics and law: the debate in Spain.

The debate on euthanasia in Spain has been ongoing from the beginning of the 20th century and remains extant. Three periods can be identified: prior to 1978, 1978-2002, and after 2002. The debate increased significantly after the Ramon Sampedro case (1995-1998), and was fuelled with new, although very different cases, such as those of Leganés (2005-2008), Jorge Leon (2006) or Inmaculada Echevarria (2006-2007). As a consequence of these cases in 2008 the Regional Government of Andalusia started a legal process to pass a law regulating end-of-life decisions, excluding euthanasia and assisted-suicide, which was finally enacted in 2010. Two other Spanish regions (Navarra and Aragón) passed similar laws. The central government also initiated a legal process to approve a national law, excluding euthanasia and assisted-suicide. The project failed because of the dissolution of the Parliament in June 2011. The new government will have to decide how to continue the process.

La eutanasia en Bélgica / Euthanasia in Belgium

La experiencia holandesa en relación con la legalización y la práctica de la eutanasia es más conocida en España que la experiencia belga. Sin embargo, el proceso histórico de debate social en Bélgica en torno a la eutanasia tiene una riqueza en matices que debería ser conocida por los profesionales sanitarios, bioeticistas, políticos y juristas. El presente trabajo se inaugura con un análisis sobre las similitudes y diferencias que existen entre España y Bélgica, lo que permite encuadrar el desarrollo posterior. Después se describe la historia del proceso de debate realizado en Bélgica que tiene su punto álgido en la aprobación de la ley de eutanasia en el año 2002. En el apartado siguiente se analiza de forma detallada el contenido de esta disposición legislativa, señalando los aspectos más relevantes. A continuación se exponen algunos datos epidemiológicos sobre la práctica de la eutanasia en Bélgica y se finaliza con un relato sobre la manera en que diversos grupos de población han afrontado el tema de la eutanasia. En este último apartado el trabajo se detiene en las posiciones de dos grupos especialmente relevantes: los especialistas en Cuidados Paliativos y la Iglesia Católica. Se finaliza con una exposición de los motivos por los que resulta conveniente incorporar la perspectiva y experiencia belga en futuros debates sobre la posible legalización de la eutanasia en España(AU)

The experience of the Netherlands in relation with the legalization and practice of euthanasia is better known in Spain than the Belgian experience in this matter. But the historical process of social debate in Belgium has many specific details which should be known by Spanish healthcare professionals, bioethicists, politicians and lawyers. This paper begins with a comparative analysis of both countries: Spain and Belgium and follows with a description of the milestones of the historical process of debating and, finally, passing the Belgian Law on Euthanasia in 2002. The next chapter consists of a description of themain contents of this important Law. The paper continues then with an approach to the epidemiology of the practice of euthanasia in Belgium and finishes with a description of the different positions of the actors of the process. Two positions are described more in depth: the opinion of the specialists in palliative care, and the opinion of the Catholic Church. The paper ends underlining the reason for the incorporation of the Belgian experience on euthanasia to the debate about the possibility of legalizing euthanasia in Spain(AU)

Are the health messages in schoolbooks based on scientific evidence? A descriptive study.

BACKGROUND: Most textbooks contains messages relating to health. This profuse information requires analysis with regards to the quality of such information. The objective was to identify the scientific evidence on which the health messages in textbooks are based. METHODS: The degree of evidence on which such messages are based was identified and the messages were subsequently classified into three categories: Messages with high, medium or low levels of evidence; Messages with an unknown level of evidence; and Messages with no known evidence. RESULTS: 844 messages were studied. Of this total, 61% were classified as messages with an unknown level of evidence. Less than 15% fell into the category where the level of evidence was known and less than 6% were classified as possessing high levels of evidence. More than 70% of the messages relating to "Balanced Diets and Malnutrition", "Food Hygiene", "Tobacco", "Sexual behaviour and AIDS" and "Rest and ergonomics" are based on an unknown level of evidence. "Oral health" registered the highest percentage of messages based on a high level of evidence (37.5%), followed by "Pregnancy and newly born infants" (35%). Of the total, 24.6% are not based on any known evidence. Two of the messages appeared to contravene known evidence. CONCLUSION: Many of the messages included in school textbooks are not based on scientific evidence. Standards must be established to facilitate the production of texts that include messages that are based on the best available evidence and which can improve children's health more effectively.

Mejora de la información sanitaria contenida en los prospectos de los medicamentos: expectativas de pacientes y de profesionales sanitarios / Quality improvement of health information included in drug information leaflets. Patient and health professional expectations

ObjetivoAnalizar la opinión y las expectativas de los pacientes y de los profesionales sobre la información contenida en los prospectos de los medicamentos y conocer la legibilidad lingüística formal de los medicamentos más consumidos durante el año 2003.DiseñoEstudio cualitativo y cuantitativo.EmplazamientoCentros de Atención Primaria y Especializada de Andalucía, Cataluña, País Vasco, Navarra, Aragón y Extremadura.ParticipantesPacientes de centros de salud, profesionales expertos, médicos especialistas y farmacéuticos, representantes de asociaciones de usuarios(as), elegidos por muestreo intencional.Las mediciones y resultados principales se basan en entrevistas semiestructuradas y grupos focales. Estudio de legibilidad mediante el test de Flesch.Mediciones y resultados principalesEntre profesionales y pacientes hay diferentes grados de satisfacción respecto a la cantidad y a la calidad del prospecto. Destacan las deficiencias de usar un lenguaje técnico y con un tamaño de letra demasiado pequeño. Los profesionales otorgan al prospecto gran importancia divulgativa, mientras que los pacientes lo usan como fuente de información complementaria. Los expertos y los usuarios coinciden en considerar más difíciles de entender los apartados referidos a la posología, a los efectos secundarios y a las contraindicaciones. Los prospectos tienen un grado de legibilidad insuficiente(AU)

ConclusionesEs deseable que la información sanitaria se centre en los aspectos prácticos del proceso de salud, enfermedad y atención, mediante la adaptación del contenido y la forma de los prospectos a los usuarios y a los profesionales que manifiestan estas necesidades. El personal facultativo es el principal referente de la información en salud, por lo que es aconsejable su formación en habilidades de comunicación. Además, se recomienda reforzar cauces alternativos que ofrezcan a la ciudadanía información sanitaria de calidad(AU)

ObjectiveTo report on patient and professional opinions and expectations concerning the information included in drug package leaflets and to determine their readability.DesignQualitative and quantitative study.PlacementPrimary Care and Specialized Centres from Andalusia, Catalonia, Basque Country, Navarra, Aragon and Extremadura.ParticipantsPatients from Primary Care Health Centers, physicians, pharmacists and citizen associations, using intentional sampling.MethodQualitative interviews. Flesch Readability Test is used to determine the leaflet readability.ResultsThere are different degrees of satisfaction between professionals and patients, concerning both quality and quantity of information leaflets. The use of technical language and a small lettering size was observed. The leaflet is considered an important source of information among professionals, but not among patients who prefer information from their physicians. The greatest comprehension difficulties appear in paragraphs on posology, secondary and adverse effects.ConclusionsHealth information must centre on practical aspects of the health-illness-care process. Leaflets must be adapted to the needs of the patients and professionals. Physicians are commonly consulted by patients, so it is important to ensure they have high communication skills. Patients have the need for constant information; therefore new information channels must be created(AU)

Interventions to promote the use of advance directives: an overview of systematic reviews.

OBJECTIVE: To identify, appraise and synthesise the results of systematic reviews of the literature (SRLs) that examines the effectiveness of interventions to increase advance directive (AD) completion rate. METHODS: Narrative review of the literature-an overview of SRLs focused on interventions to improve patients' AD completion rate. RESULTS: Seven SRLs were located. A wide range of interventions was identified in order to determine their influence on the AD completion rate. CONCLUSION: The most effective method of increasing the use of ADs is the combination of informative material and repeated conversations over clinical visits. The use of passive informative material in isolation does not significantly increase AD completion rates. However, when interactive informative interventions are employed, the AD completion rate increases and the majority of the studies identify multiple sessions as the most effective method for direct interaction between patients and health care professionals. PRACTICE IMPLICATIONS: The progressive ageing of the population and the provision of quality care during the process of ageing and dying, have given rise to the Governments' interest in developing moral autonomy and regulating tools as ADs. In order to put legislation into practice it is necessary to set up successful interventions to expand ADs use.

[Quality improvement of health information included in drug information leaflets. Patient and health professional expectations]. / Mejora de la información sanitaria contenida en los prospectos de los medicamentos: expectativas de pacientes y de profesionales sanitarios.

OBJECTIVE: To report on patient and professional opinions and expectations concerning the information included in drug package leaflets and to determine their readability. DESIGN: Qualitative and quantitative study. PLACEMENT: Primary Care and Specialized Centres from Andalusia, Catalonia, Basque Country, Navarra, Aragon and Extremadura. PARTICIPANTS: Patients from Primary Care Health Centers, physicians, pharmacists and citizen associations, using intentional sampling. METHOD: Qualitative interviews. Flesch Readability Test is used to determine the leaflet readability. RESULTS: There are different degrees of satisfaction between professionals and patients, concerning both quality and quantity of information leaflets. The use of technical language and a small lettering size was observed. The leaflet is considered an important source of information among professionals, but not among patients who prefer information from their physicians. The greatest comprehension difficulties appear in paragraphs on posology, secondary and adverse effects. CONCLUSIONS: Health information must centre on practical aspects of the health-illness-care process. Leaflets must be adapted to the needs of the patients and professionals. Physicians are commonly consulted by patients, so it is important to ensure they have high communication skills. Patients have the need for constant information; therefore new information channels must be created.

Advance directives and proxies' predictions about patients' treatment preferences.

The accuracy of proxies when they interpret advance directives or apply substituted decision-making criteria has been called into question. It therefore became important to know if the Andalusian Advance Directive Form (AADF) can help to increase the accuracy of proxies' predictions. The aim of this research was to compare the effect of the AADF on the accuracy of proxies' predictions about patients' preferences with that gained from informative and deliberative sessions about end-of-life decision making. A total of 171 pairs of patients and their proxies were randomized to three groups. The control group's answers to the Life Sustaining Preferences Questionnaire (LSPQ) were compared with their proxies' answers to the same questionnaire. In one intervention group, the patients had already completed the AADF and given it to their proxies, who used it to guide their own answers to the LSPQ. In the second intervention (discussion) group, both patients and proxies attended two educative sessions guided by trained nurses and later filled in the LSPQ. Comparisons of accuracy and other variables showed a strong association with the discussion group. The findings show that promoting communication between patients and their proxies improves the accuracy of proxies' predictions much more than isolated use of the AADF form.

Opinión de los pacientes sobre la legibilidad de los folletos de Educación para la Salud / Opinion of the patients about legible health education leaflets

Antecedentes: los Servicios de salud normalmente proporcionan a los pacientes folletos u otros documentos relacionados con tratamientos. Este material no está escrito con mucha legibilidad y los pacientes tienen dificultad en entenderlos. Objetivos: determinar la opinión de los lectores en relación a los requisitos que deberían ser encontrados en este material para asegurar la legibilidad. Metodología: metodología cualitativa de entrevistas semiestructuradas. 24 participantes fueron entrevistados con preguntas abiertas. Los participantes tenían un bajo nivel académico. Resultados: ocho categorías fueron identificadas en los folletos que debían encontrarse para aumentar la legibilidad: escribir como se habla, interés por el tema, estilo directo, ordenar las ideas, mensajes afirmativos, imágenes, amplios márgenes, letra grande y clara. Conclusiones: los profesionales sanitarios y los escritores de folletos educativos deberían involucrar a los pacientes en el proceso de diseño del material educativo (AU)

Introduction: Healthcare Service usually provides patients with leaflets relating to treatment. Often, this material is written not very legible and patients have difficulty understanding it. Aims: This study aims to determine the opinion of readers in relation to the requisites that should be met by this material in order to ensure legibility. Design: Qualitative method of semi-structured interviews. Method: Twelve interviews were conducted. Open-ended questions were asked in each interview. Participants had a low academic level, poor reading habits, but they usually were capable of read. Finding: Eight categories were identified that describe the opinion of the participants in relation to the requisites that the leaflets must meet in order to improve legibility: Writing like speaking, interest in the subject, direct style, order of the ideas, affirmative messages, images and clear fonts. Conclusions: Health professionals and writers of educational leaflets should involve patients in the process of designing educational material (AU)

La capacidad de los pacientes para tomar decisiones: una tarea todavía pendiente / The decission-making capacity of patients: a still unsettled job

La evaluación de la capacidad constituye un reto abierto para el modelo de relación clínica basado en la idea de consentimiento informado (AU)

The evaluation of the capacity constitutes a challenge for the model of clinical relation based on the idea of informed consent (AU)

[Grammatical readability of the package leaflets of the medicinal products most widely consumed and generating the highest expense in Spain during 2005]. / Legibilidad gramatical de los prospectos de los medicamentos de más consumo y facturación en España en 2005.

BACKGROUND: The manufacturers of medicinal products are responsible for providing consumers proper information on the use of such products. This information is set out in the package leaflets which, according to current legislation, must be easy for patients to read and understand. The purpose of this study is to analyse the linguistic/grammatical readability of the package leaflets of medicinal products through application of the Flesch formula. METHODS: The 30 medicinal products most widely consumed and the 30 which generated the highest expenditure during 2005 in Spain were selected. In line with the recommendations of the relevant literature, documents with a Flesch Index value of > or = 10 were considered readable. The grammatical readability was calculated by using the Flesch Index accessible through the Microsoft Office 2000 programme. RESULTS: Only 5 documents obtained an acceptable Flesch Index score (= 10), while 18 scored 0. Half of the values were under 2; 25% were 0 and 25% scored 6 or more. CONCLUSIONS: The data obtained reveal a low level of linguistic and grammatical readability in the package leaflets analysed. The syntax used on drafting the texts tends to use long words.

Ética y muerte digna: propuesta de consenso sobre un uso correcto de las palabras / Ethics and dignified death: consensus proposal on the correct use of words

Un debate serio sobre el “derecho a una muerte digna” sólo es posible si se hace un uso correcto de las palabras con que se lo construye. La palabra “eutanasia” es la que exige una mayor clarificación terminológica y conceptual, dado el abuso al que ha sido sometida. Hay cinco escenarios relevantes en relación con la tomade decisiones clínicas al final de la vida. Estos cinco escenarios son: eutanasia y suicidio asistido, limitación del esfuerzo terapéutico, rechazo de tratamiento, sedación paliativa y suspensión deatención médica por fallecimiento. Este artículo plantea que sólo el primero carece de acuerdo ético suficiente en la sociedad española y en el centro de la controversia sobre la “muerte digna”. En los otros cuatro escenarios, que no son en ningún caso eutanasia, sí existe ya un amplio grado de acuerdo ético y jurídico que ampara las actuaciones de los profesionales

The debate about the “right to die with dignity” will only be productive if the words used are constructed properly. “Euthanasia” is probably the word that most needs further clarification. This word isfrequently abused and still remains unclear. Five scenarios around end-of-life care can be highlighted: euthanasia and assisted suicide, withholding or withdrawal of life sustaining therapies, refusal oftreatment or withdrawal of consent, palliative sedation and withdrawal of treatment because of patient death. This work supports the hypothesis that Spanish society has reached a sufficient ethical and legal consensus on the lastfour scenarios, which should never beenconsidered “euthanasia” but forms of dignified death and good clinical practice. So, the mainstream of the Spanish debate on the “right to die” should not be based on these four scenarios but on the first, the question of “euthanasia and assisted suicide”, whichremain open to further discussion

Legibilidad gramatical de los prospectos de los medicamentos de más consumo y facturación en España en 2005 / Grammatical readability of the package leaflets of the medicinal products most widely consumed and generating the highest expense in Spain during 2005

Fundamento. Los fabricantes de medicamentos tienen el deber de proporcionar a los consumidores información correcta sobre su uso. Esta información está recogida en el prospecto que, según la normativa vigente, debe ser legible y comprensible para el paciente. El objetivo de este estudio es analizar la legibilidad lingüística gramatical de los prospectos de medicamentos mediante la aplicación de la fórmula de Flesch. Métodos. Se seleccionan las 30 medicamentos más consumidos y los 30 que más gasto han generado durante el año 2005 en España. Siguiendo las recomendaciones de la literatura, se han considerado legibles aquellos documentos cuyo Índice de Flesch fuese ≥ 10. Se ha calculado la legibilidad gramatical a través del Índice de Flesch accesible en el programa Microsoft Office 2000. Resultados. Sólo 5 documentos alcanzan un índice de Flesch aceptable (= 10) y 18 tienen una puntuación de 0. La mitad de los valores si sitúan por debajo de 2; 25% de los valores tienen valor 0 y 25% tiene valores de 6 ó más. Conclusiones. Los datos obtenidos revelan una baja legibilidad lingüística y gramatical de los prospectos analizados. La sintaxis empleada al redactarlos tiende a usar frases y palabras largas, lo que incumple claramente las indicaciones de la normativa vigente (AU)

Background. The manufacturers of medicinal products are responsible for providing consumers proper information on the use of such products. This information is set out in the package leaflets which, according to current legislation, must be easy for patients to read and understand. The purpose of this study is to analyse the linguistic/grammatical readability of the package leaflets of medicinal products through application of the Flesch formula. Methods. The 30 medicinal products most widely consumed and the 30 which generated the highest expenditure during 2005 in Spain were selected. In line with the recommendations of the relevant literature, documents with a Flesch Index value of ≥ 10 were considered readable. The grammatical readability was calculated by using the Flesch Index accessible through the Microsoft Office 2000 programme. Results. Only 5 documents obtained an acceptable Flesch Index score (= 10), while 18 scored 0. Half of the values were under 2; 25% were 0 and 25% scored 6 or more. Conclusions. The data obtained reveal a low level of linguistic and grammatical readability in the package leaflets analysed. The syntax used on drafting the texts tends to use long words (AU)

[Presence of current child and adolescent health priorities in school textbooks]. / Presencia de las actuales prioridades de salud infantil y adolescente en los libros de texto escolares.

BACKGROUND: Textbooks are an educational tool for learning health habits. The aim of this study was to determine how these textbooks present the health priorities defined by health organizations to children and teenagers. METHOD: We performed a descriptive study in 3 steps: a) the priorities defined by health organizations were identified; b) the messages on health in the textbooks used in the schools of a municipality were identified, and c) the extent to which these messages fitted the priorities established was analyzed. RESULTS: The World Health Organization, the European Union, the Spanish Ministry of Health and Consumption, and the Spanish Society of Public Health and Healthcare Administration define 24 priorities. One hundred textbooks were collected, with 663 health messages. The priorities most frequently covered in the textbooks were diet, physical exercise and the impact of environmental contamination. The least frequently covered topics was bullying, child maltreatment, poverty, self harm, and obesity. The latter topic was especially lacking in kindergartens and elementary schools. CONCLUSIONS: The health messages contained in school textbooks are not well adapted to the priorities defined by health organizations.

Revisión de la literatura sobre el uso del testamento vital por la población mayor / Review of literature about the use of living bill by elderly population

El Testamento Vital (TV) recoge las preferencias detratamiento de una persona para cuando sea incapazde tomar decisiones por sí misma. Nuestro país estádando los primeros pasos para su implantación. Paraque el TV sea accesible y útil para las personas mayores,conviene conocer cómo se ha desarrollado en otrospaíses. En EE.UU., el TV ha pasado de una concepciónformal y burocrática a otra integral, denominadade Planificación Anticipada de Decisiones Sanitarias.La población mayor española tiene una opinión favorablesobre el TV si se incluye en una estrategia de comunicacióncon la familia y los profesionales. Teneren cuenta los hallazgos de la literatura facilitará eldesarrollo de un modelo organizativo efectivo que normaliceen España el uso del testamento vital por partede los mayores(AU)

The Living Will (LW) gathers the treatment preferencesof a person. Spain is starting the LW’ implantation.In order to the TV will be accessible and usefulfor the older people, we have to know how it has beendeveloped in other countries. In United States, TV hashappened through different stages: from a formal andbureaucratic conception to an integral concept, denominatedAdvance Care Planning. Spanish oldadults have a favourable opinion about TV, but it isnecessary to include it in a strategy of communicationand dialogue with its family and its professionals caregivers.Review literature findings will facilitate the developmentof an effective organizational model thatstandardizes in Spain the use of the TV by the oldadults(AU)