Gaceta Sanitaria最新文献

{"title":"¿Qué sabemos y qué deberíamos saber sobre los desequilibrios de médicos en España? Diagnóstico y propuestas. Informe SESPAS 2024","authors":"Beatriz González López-Valcárcel,&nbsp;Patricia Barber Pérez","doi":"10.1016/j.gaceta.2024.102366","DOIUrl":"10.1016/j.gaceta.2024.102366","url":null,"abstract":"<div><p>This article characterizes the main features of the supply, demand, and labor markets for physicians in Spain, with an international and territorial perspective. It also presents some of the results of the simulation model for specialist physicians with a 2035 horizon and proposes strategic and short-term lines of action in the planning, regulation, and management of health professionals in Spain, with a focus on specialist physicians. In Spain there are high rates of physicians and medical graduates, but low rates of nurses, compared to other developed countries. Approximately 30% of practicing physicians (not considering residents) practice only in the private network. In the last two decades, competition from the private sector for health professionals has intensified, competing with the public network, which is subject to an excessively rigid regulatory framework. There is currently a shortage of physicians in some specialties, particularly in family medicine, which urgently needs specific incentives to stimulate vocations. Numbers consider only part of the story. The imbalances in the educational and labor markets are not resolved by creating vacancies, but by reforming the regulatory framework, the incentive systems, and the slack in public management to compete with the private sector in attracting and retaining talent.</p></div>","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102366"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S021391112400013X/pdfft?md5=83c9ff5c3c6442f78ebad7c10fdc65b9&pid=1-s2.0-S021391112400013X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139907082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sinhogarismo como determinante de la salud y su impacto en la calidad de vida","authors":"Mercedes Botija ,&nbsp;Ana Isabel Vázquez-Cañete ,&nbsp;Laura Esteban-Romaní","doi":"10.1016/j.gaceta.2024.102388","DOIUrl":"https://doi.org/10.1016/j.gaceta.2024.102388","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the health status of the homeless population who spend the night on the streets and in shelters (extreme residential exclusion), with reference to their quality of life, self-perceived health, comorbidity and access to health resources.</p></div><div><h3>Method</h3><p>A cross-sectional descriptive study was carried out on a sample of 263 homeless people in the city of Valencia by means of a nocturnal count and using the EQ-5D-3L Health Related Quality of Life questionnaire and questions from the European Quality of Life Survey for Spain.</p></div><div><h3>Results</h3><p>Of the people who participated in the study, 129 of them slept outdoors, 49% (62.79% men, 19.37% women and 17.84% unidentified), while 134 slept in hostels, i.e. 51% (67.16% men and 32.84% women) with an estimated average age of 41.53 years and 55% had been living on the street for less than 12 months. People staying overnight on the streets presented worse quality of life and more than a quarter of the sample lacked a health card.</p></div><div><h3>Conclusions</h3><p>There is a relationship between homelessness and poor health conditions in terms of quality of life, perceived health, comorbidity and accessibility to health to resources. The inverse care law is evidenced.</p></div>","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102388"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213911124000359/pdfft?md5=c76692aeb04e9d9f2c0683680afdd6b0&pid=1-s2.0-S0213911124000359-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140546213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumplimiento de la legislación sobre tabaco en espacios al aire libre y cubiertos en recintos hospitalarios","authors":"Carmen Cánovas Pérez,&nbsp;Olga Monteagudo-Piqueras","doi":"10.1016/j.gaceta.2024.102418","DOIUrl":"10.1016/j.gaceta.2024.102418","url":null,"abstract":"","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102418"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213911124000700/pdfft?md5=3b7848368df5531d68f2cd94a708e300&pid=1-s2.0-S0213911124000700-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141985266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unequal impact of COVID-19 on excess deaths, life expectancy, and premature mortality in Spanish regions (2020-2021)","authors":"Nazrul Islam ,&nbsp;Fernando J. García López ,&nbsp;Dimitri A. Jdanov ,&nbsp;Miguel Ángel Royo-Bordonada ,&nbsp;Kamlesh Khunti ,&nbsp;Sarah Lewington ,&nbsp;Ben Lacey ,&nbsp;Martin White ,&nbsp;Eva J.A. Morris ,&nbsp;María Victoria Zunzunegui","doi":"10.1016/j.gaceta.2024.102424","DOIUrl":"10.1016/j.gaceta.2024.102424","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to estimate regional inequalities in excess deaths and premature mortality in Spain during 2020 and 2021, before high vaccination coverage against COVID-19.</div></div><div><h3>Method</h3><div>With data from the National Institute of Statistics, within each region, sex, and age group, we estimated the excess deaths, the change in life expectancy at birth (<em>e</em>₀) and age 65 (<em>e</em>₆₅) and years of life lost as the difference between the observed and expected deaths using a time series analysis of 2015-2019 data and life expectancies based on Lee-Carter forecasting using 2010-2019 data.</div></div><div><h3>Results</h3><div>From January 2020 to June 2021, an estimated 89,200 (men: 48,000; women: 41,200) excess deaths occurred in Spain with a substantial regional variability (highest in Madrid: 22,000, lowest in Canary Islands: −210). The highest reductions in <em>e</em>₀ in 2020 were observed in Madrid (men −3.58 years, women −2.25), Castile-La Mancha (−2.72, −2.38), and Castile and Leon (−2.13, −1.39). During the first half of 2021, the highest reduction in <em>e</em>₀ was observed in Madrid for men (−2.09; −2.37 to −1.84) and Valencian Community for women (−1.63; −1.97 to −1.3). The highest excess years of life lost in 2020 was in Castile-La Mancha (men: 5370; women: 3600, per 100 000). We observed large differences between reported COVID-19 deaths and estimated excess deaths across the Spanish regions.</div></div><div><h3>Conclusions</h3><div>Regions performed highly unequally on excess deaths, life expectancy and years of life lost. The investigation of the root causes of these regional inequalities might inform future pandemic policy in Spain and elsewhere.</div></div>","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102424"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Niveles para la orientación comunitaria de la atención primaria en Colombia","authors":"José Ivo Montaño-Caicedo","doi":"10.1016/j.gaceta.2024.102414","DOIUrl":"10.1016/j.gaceta.2024.102414","url":null,"abstract":"","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102414"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213911124000669/pdfft?md5=38c40b9490c50fdaf768206d235e06df&pid=1-s2.0-S0213911124000669-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aborto en Melilla: barreras de océano y frontera","authors":"Eva Estévanez Jiménez ,&nbsp;Maite Cruz Piqueras","doi":"10.1016/j.gaceta.2024.102355","DOIUrl":"https://doi.org/10.1016/j.gaceta.2024.102355","url":null,"abstract":"<div><h3>Objective</h3><p>To provide insights into the challenges faced by women seeking abortion services in Melilla, Spain. It seeks to describe the journey these women undertake and to identify and analyze the barriers they encounter in accessing abortion care.</p></div><div><h3>Method</h3><p>A qualitative research approach was employed, involving a series of eight semi-structured interviews during 2022. Three interviews were conducted with national experts in the field of abortion, while five interviews were conducted with healthcare professionals from the Melilla Health Area who are directly involved in providing abortion services and supporting women throughout the process. The study was guided by a theoretical framework that focuses on barriers to abortion access and sexual and reproductive rights. The collected data was analyzed using content analysis and categorized based on key dimensions of the study.</p></div><div><h3>Results</h3><p>The study identified several significant barriers to abortion care access in Melilla. These include conscientious objection among healthcare providers, the geographical remoteness of Melilla, the legal challenges faced by Moroccan women due to their irregular status, and the requirement of parental consent for minors aged 16 and 17. Consequently, women seeking abortion services are forced to travel to mainland Spain, continue with undesired pregnancies, or resort to unsafe clandestine abortions in Morocco, thereby endangering their lives in the worst cases.</p></div><div><h3>Conclusions</h3><p>The barriers to abortion access identified in this study represent a violation of women's reproductive rights in Melilla. Urgent action is required to review the current process, ensuring that access is improved and the right to safe abortion is guaranteed for all women residing in Melilla.</p></div>","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102355"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213911124000025/pdfft?md5=51bfe659080b31405fb4ca03b370b8c4&pid=1-s2.0-S0213911124000025-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139674791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"John E. Wennberg (1935-2024). Apoyando la hipótesis nula","authors":"Enrique Bernal-Delgado","doi":"10.1016/j.gaceta.2024.102431","DOIUrl":"10.1016/j.gaceta.2024.102431","url":null,"abstract":"","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102431"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consumption of hypnosedatives in Spain: characterization and time trends, 2005-2022","authors":"Nerea Mourino ,&nbsp;Ana Teijeiro ,&nbsp;Carla Guerra-Tort ,&nbsp;Julia Rey-Brandariz ,&nbsp;Cristina Candal-Pedreira ,&nbsp;Lucía Martín-Gisbert ,&nbsp;Marta Mascareñas-García ,&nbsp;Guadalupe García ,&nbsp;Leonor Varela-Lema ,&nbsp;Mónica Pérez-Ríos","doi":"10.1016/j.gaceta.2024.102433","DOIUrl":"10.1016/j.gaceta.2024.102433","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the evolution of hypnosedative use in the Spanish population aged 15 to 64 (2005-2022), identifying regional variations and changes in users profile.</div></div><div><h3>Method</h3><div>We used data from the Survey on the Use of Alcohol and other Drugs in Spain. Past 30-day use was analyzed by sex, age and autonomous community between 2005 and 2022. A multivariate logistic regression was used to identify characteristics of consumption; the temporal trend of prevalence and adjusted odds ratio were evaluated using joinpoint regression models.</div></div><div><h3>Results</h3><div>Between 2005 and 2022, the prevalence of hypnosedative use in Spain increased (from 3.7% to 9.7%) with an annual percentage change of 4.7%. The maximum increase was observed among women aged 55 to 64, reaching a prevalence of 21.4% in 2022. Use increased in all autonomous communities, with Cantabria, La Rioja and Andalusia standing out. The likelihood of using hypnosedatives was higher among women, the oldest age groups, those with basic or intermediate education, those unemployed or economically inactive, those not living with a partner or family, Spanish citizens, and tobacco or cannabis users.</div></div><div><h3>Conclusions</h3><div>An upward trend in the use of hypnosedatives in Spain has been observed since 2005, with variations according to sex, age, and autonomous community. It is crucial to update regional addiction plans, promote preventive strategies and foster collaboration between health authorities, medical professionals and the population to address mental health inequalities and ensure adequate care and responsible prescribing.</div></div>","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102433"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone use by children in fast food restaurants in Barcelona (Spain): a direct observation study","authors":"Sonia de Paz-Cantos ,&nbsp;Adrián González-Marrón ,&nbsp;Cristina Lidón-Moyano ,&nbsp;Íñigo Cabriada ,&nbsp;María Cerrato-Lara ,&nbsp;Rafael Gómez-Galán ,&nbsp;José M. Martínez-Sánchez","doi":"10.1016/j.gaceta.2024.102421","DOIUrl":"10.1016/j.gaceta.2024.102421","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To explore the use of smartphones at mealtimes by children in fast food restaurants in the city of Barcelona and to assess the variables associated with this use.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;A cross-sectional study was carried out. Data from 1616 children of estimated ages between 4 to 10 years were collected in fast-food restaurants in the ten districts of Barcelona between October 2021 and July 2022. The percentage of smartphone use, overall and according to covariates, were calculated. Chi-squared and Fisher's exact tests, and crude and adjusted Poisson regression models with robust variance, were carried out to assess the association between use and covariates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Direct observation revealed that in 28.1% of meals with children at fast food restaurants, children used smartphones. Smartphone use was significantly higher in older children if their caregivers were younger than 30 years and when there was no caregiver-child interaction. In the adjusted model, higher patterns of smartphone use were associated with older children (aPR [95% CI]: 1.36[1.20-1.55]) and younger parents (aPR [95% CI]: 1.38[1.09-1.73]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Almost one in three meals with children at fast-food restaurants in Barcelona involves smartphone use. This finding underlines the importance of raising awareness of responsible screen use and promoting healthier environments for children at mealtimes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objetivo&lt;/h3&gt;&lt;div&gt;Explorar el uso de &lt;em&gt;smartphones&lt;/em&gt; en los actos de comida en niños/as en restaurantes de comida rápida de la ciudad de Barcelona y evaluar las variables asociadas a este uso.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Método&lt;/h3&gt;&lt;div&gt;Se llevó a cabo un estudio transversal. Se recogieron datos de 1616 niños/as de edades estimadas entre 4 y 10 años en restaurantes de comida rápida de los diez distritos de Barcelona entre octubre de 2021 y julio de 2022. Se calculó el porcentaje de uso de &lt;em&gt;smartphones&lt;/em&gt;, global y según covariables. Se realizaron pruebas de Chi-cuadrado y exacta de Fisher, y modelos de regresión de Poisson crudos y ajustados con varianza robusta, para evaluar la asociación entre el uso y las covariables.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;div&gt;La observación directa reveló que en el 28,1% de las comidas realizadas con niños/as en restaurantes de comida rápida, estos/estas utilizaban &lt;em&gt;smartphones&lt;/em&gt;. El uso de &lt;em&gt;smartphones&lt;/em&gt; fue significativamente mayor en niños/as mayores, si sus cuidadores/as eran menores de 30 años y cuando no había interacción entre cuidador/a y niño/a. En el modelo ajustado, los patrones más altos de uso de teléfonos inteligentes se asociaron con niños mayores (aPR [95% IC]: 1.36[1.20-1.55]) y padres más jóvenes (aPR [95% IC]: 1.38[1.09-1.73]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusiones&lt;/h3&gt;&lt;div&gt;En casi una de cada tres comidas con niños/as en restaurantes de comida rápida de Barcelona se utiliza el &lt;em&gt;smartphone&lt;/em&gt;. Es","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102421"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reclutamiento, selección y retención de profesionales en servicios de salud de gestión directa. Informe SESPAS 2024","authors":"Ricard Meneu","doi":"10.1016/j.gaceta.2024.102381","DOIUrl":"10.1016/j.gaceta.2024.102381","url":null,"abstract":"<div><p>In an organization with highly specialized and changing services over the course of a working life, such as health services managed directly by public administrations (DM-NHS) are, the issues related to the recruitment, selection and retention of professionals should receive special attention. much larger than what is provided. For too long, the DM-NHS has mainly been working to resolve the problems that affect the organization, with enormous disregard for those suffer by the recipients of its services, the real population to which it provides assistance. In the DM-NHS, its administration (rather than management) of human resources is circumscribed by the contours of the Framework Statute and its implementing regulations and rulings. This is an inadequate instrument, both empirically in view of the results obtained (50% temporary employment among professionals working in the NHS), and conceptually, since it fails to comply with the reasons that normatively justify its existence: “that its legal regime is adapts to the specific characteristics of the practice of health professions, as well as the organizational peculiarities of the National Health System”. The text describes the characteristics of statutory regulation and reviews how regulatory restrictions affect recruitment, selection and retention policies. Finally, possible alternatives are proposed to have coherent and rational permanent staffing policies that cover the real needs of the health services.</p></div>","PeriodicalId":12494,"journal":{"name":"Gaceta Sanitaria","volume":"38 ","pages":"Article 102381"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213911124000281/pdfft?md5=0e5f68edc4fc4687a6b75d9cd590416f&pid=1-s2.0-S0213911124000281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}