Revista Espanola De Salud Publica最新文献

{"title":"[Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic.]","authors":"Joaquín Salas-Coronas, Mª Ángeles García-Jerez, Javier Luis Sandoval-Codoni, Carmen María Lara-Rojas, Javier Gamir Ruiz, María Jesús Sanabria-Medina, María Del Carmen Cortés-González, Silvia Vallejo-Godoy, Ignacio Aguilar-Martín, Enriqueta Quesada-Yañez, Mª Ángeles Martín-Linares, María Luisa Álvarez Moreno","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease.</p><p><strong>Methods: </strong>A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency.</p><p><strong>Results: </strong>Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission.</p><p><strong>Conclusions: </strong>The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes.</p>","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"94 ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38631850","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":"[Influence of early hip fracture surgery in the elderly on mortality, readmissions, dependence and quality of life.]","authors":"María Victoria Ruiz-Romero, María Del Rocío Fernández-Ojeda, Javier Castilla Yélamo, José Boris García-Benítez, María Luz Calero-Bernal, Antonio Fernández-Moyano","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>In spite of technical advances, hip fracture causes high mortality in the elderly. We wanted to know early surgery influence to mortality during admission, one year and after five years, as well as readmissions at one month and one year. We also wanted to know how dependence and Health-Related Quality of Life (HRQOL) evolved in the twelve months of follow-up and what factors were associated with poor patient evolution.</p><p><strong>Methods: </strong>A prospective observational study was made in patients over 65 years of age treated for osteoporotic hip fracture in a level III hospital between 2010- 2012, with consecutive sampling. We evaluated functionality (Barthel) and quality of life (EuroQol-5D) basal (before fracture), within 30 days, within six and twelve months; readmissions within the 30 days and within one year; and mortality during admission; within one and five years. We used the statistical program SPSS Version 25.0 for the statistical analysis.</p><p><strong>Results: </strong>We followed 327 patients of 82.9 (SD: 6.9) years of means, 258 (78.9%) were women. Fifty-four (45.9%) were treated within 24 hours and 237 (72.5%) within 48 hours. They returned 14 (4.3%) within the 30 days and 44 (13.5%) within the one year. There were 8 deaths during admission (2.4%) and 61 (19.2%) in the first year and 185 (54,6%) within five years. The pre-fracture quality of life was 0.43 median (0.24-0.74), at the month 0.15 (0.07-0.28), at six months 0.26 (0, 13-0.59) and at twelve 0.24 (0.15-0.58). The previous functionality was 85.0 (55.0-100) at the month 35.0 (20.0-60.0) and 60.0 (25.0-85.0) at six and twelve months. There were significant differences between all visits except between six and twelve months.</p><p><strong>Conclusions: </strong>The patients get worse significantly at the month of surgery and recover in the six months, remaining at twelve, without reaching the baseline value. The results in mortality and readmissions per year are worse for men and older. Early surgery does not reduce mortality, but re-admissions to the year.</p>","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"94 ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38727950","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":"[Strategies in the prevention and control of the Covid-19 pandemic caused by SARS-CoV-2. Environmental factors.]","authors":"Francisco Alberto Tomei Torres","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The role that environmental factors can play in preventing and controlling the Covid-19 epidemic was explored and compared to that of influenza. Papers cited by the U.S. National Academy of Sciences were discussed, which indicate that temperature and humidity in the environment can influence the intensity of the spread of the disease. The fact that influenza viruses and coronaviruses appeared seasonally, prevailing in the winter and declining in the summer, was illustrated. It was discussed that ultraviolet light in the environment can contribute to the control of the spread of the virus. A study was cited to suggest that particulate matter contributes to increased infection mortality, and that it increases in summer in some regions, countering the health effects of humidity and temperature. Data generated by online electronic tools was compared with surveillance reports generated by the U.S. Centers for Disease Control and Prevention. The epidemic began stronger in northern hemisphere countries during the northern winter. (Evidence that the epidemic intensified during the southern winter is not disputed.) The incidence declined in the northern hemisphere during the summer, except for the U.S., where cases doubled. Evidence suggests that the high degree of SARS-CoV-2 infection counteracts the role that environmental factors may play in Covid-19 control.</p>","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"94 ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38719008","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":"[Utility of the classification analysis in the typology of the the suicide attempt in a hospital population.]","authors":"Ángel F García-Martín, Andrés Santiago-Sáez, Elena Labajo-González, María E Albarrán-Juan, Enrique Olivares-Pardo, Bernardo Perea-Pérez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Subjects who attempt suicide are not a homogeneous group. Numerous studies accredit different subtypes of individuals with suicide attempts. One of the main applications of classification analysis is the segmentation and selection of the subject's characteristics. The objective of this study is to identify groups of subjects with a suicide attempt and to discover the relationships between them in the hospital population of an area of the Community of Madrid.</p><p><strong>Methods: </strong>In a case-control study, the classification tree technique based on the CHAID (Chi-square automatic interaction detector) algorithm, included in the SPSS 23.0 program, was applied to a sample of 201 subjects admitted to a highly complex hospital of Madrid. Impulsiveness, couple conflict, psychiatric history and depression were evaluated.</p><p><strong>Results: </strong>Three subtypes or differentiable profiles of the subject related to the suicide attempt have been obtained, (high profile 144 cases 71.64%, medium 35 cases 17.41% and low 22 cases 10.94% of basic risk patterns) with high application value to the clinical setting.</p><p><strong>Conclusions: </strong>The typologies found allow us to adapt preventive measures on the suicide attempt and carry out focused clinical interventions of a preventive and predictive nature.</p>","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"94 ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38719007","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":"[Survey data as a way to estimate the prevalence of COVID-19. A pilot study in the city of Madrid.]","authors":"Julio Carabaña Morales","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>This research (EP-Covid19-Madrid) was inspired on the lack in the middle of March 2020 of data on COVID-19 produced from representative samples. Its goal was to evaluate the potential of interviewing such type of samples in order to assess the incidence and prevalence of epidemics as COVID-19.</p><p><strong>Methods: </strong>The sample was of 211 households in the city of Madrid, with one informant for all household members (571). Households were selected through random generation of phone numbers, informants through sex and age quotes. A questionnaire was applied on April/3/20, with a list of symptoms and basic socio-demographic questions for the informant and a general question on COVID-19 for co-residents. Data was analyzed through cross-tabulations and logistic regression.</p><p><strong>Results: </strong>Prevalence for individuals. On April/3/20, 10,9% of people 18 years and older living in Madrid reported symptoms compatible with COVID19 (SCC19). Occurrence of SCC19 was similar for both sexes, being respectively above and below the mean for the 40-49 (18,9%) and for the >69 (4%) age groups, showing no relation with household size, but being associated with economic activity (19% among working population) and, even more strongly, with the fact of living with symptomatic co-residents (52%). As for households, there was one member with SCC19 in 17% of households. In 8% of the households two or more members presented SSC19, in fact representing 42,9% of the people in these multiply affected households.</p><p><strong>Conclusions: </strong>Prevalence of SSC19 was much higher than officially reported for COVID-19, although surprisingly low for people of >65. This prevalence associates with work and intra-home transmission. The inter and intra-home prevalence rates (17% and 42,9% respectively) might be useful to assess the proportion of asymptomatic carriers. These results would benefit from confirmation in larger surveys, preferably also including COVID-19 serological testing.</p>","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"94 ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38610033","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":"Coronavirus COVID-19","authors":"Marla Franco, Pello Latasa Zamalloa","doi":"10.4321/S1135-57272020000100001","DOIUrl":"https://doi.org/10.4321/S1135-57272020000100001","url":null,"abstract":"We know this is the last thing our community needs, however we ask that you consider the needs of our most vulnerable residents at this time by following the latest advice to help limit the spread of COVID-19 (Coronavirus).","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"1 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70478182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfacción parental con el apoyo recibido durante la primera infancia por el equipo de pediatría: desarrollo y validación de un cuestionario","authors":"Enrique Callejas Castro, Sonia Byrne, M. J. López","doi":"10.4321/S1135-57272020000100013","DOIUrl":"https://doi.org/10.4321/S1135-57272020000100013","url":null,"abstract":"RESUMEN Fundamentos: La Estrategia de Promocion de la Salud y Prevencion de la Enfermedad del Sistema Nacional de Salud incluye una linea de prevencion destinada a la infancia de cero a tres anos que promueve el apoyo a las figuras parentales en la atencion primaria. Este articulo describe el desarrollo y la validacion de un cuestionario que evalua la satisfaccion de las figuras parentales con el apoyo recibido por el equipo de pediatria. Metodos: Participaron 226 figuras parentales con hijos/as entre 0 y 36 meses, que eran usuarios del Servicio Canario de Salud. Los datos se recogieron durante los anos 2018 y 2019. Para la validacion del instrumento, se realizo un analisis factorial mediante un Modelo de Ecuaciones Estructurales Exploratorio con rotacion oblimin, y el metodo de estimacion de ponderacion de minimos cuadrados para su confirmacion. Ademas, se analizaron las diferencias individuales segun las variables sociodemograficas, y la salud infantil mediante ANOVAs. Resultados: Se obtuvo una estructura factorial optima de cuatro factores y 14 items, con una fiabilidad de α=0,84, que recogen la “Adecuacion del servicio”, el “Descontento con el servicio”’, la relacion de “Colaboracion del profesional con la familia” y la promocion de la “Capacitacion parental”. El analisis del perfil sociodemografico indico que a mayor nivel educativo de las figuras parentales se constata una menor satisfaccion con el servicio. Conclusiones: Se ha elaborado una herramienta util de evaluacion para mejorar la calidad del servicio, de acuerdo con el Modelo Centrado en la Familia y el marco europeo de la Parentalidad Positiva, que cumple con las garantias psicometricas de validez y fiabilidad.","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"1 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70478324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intoxicaciones agudas por productos químicos: análisis de los primeros 15 años del Sistema Español de Toxicovigilancia (SETv)","authors":"A. González-Díaz, A. F. Dufol, S. Xarau, J. P. Ferrando, A. D. Laita, C. R. Álvarez, G. Burillo-Putze","doi":"10.4321/S1135-57272020000100023","DOIUrl":"https://doi.org/10.4321/S1135-57272020000100023","url":null,"abstract":"RESUMEN Fundamentos: Existen pocos estudios epidemiologicos, sobre todo de tipo multicentrico, sobre las intoxicaciones agudas a causa de productos quimicos agroindustriales y del hogar en Espana. El objetivo de este trabajo fue describir el perfil epidemiologico y clinico de estas intoxicaciones en nuestro pais, y analizar su evolucion temporal. Metodos: El Sistema Espanol de Toxicovigilancia (SETv) es un registro prospectivo que incluye a 32 Servicios de Urgencias y Unidades de Cuidados intensivos de Espana. Se realizo un estudio descriptivo observacional de las intoxicaciones agudas por agentes quimicos (excluyendo drogas y farmacos) en sus primeros 15 anos de funcionamiento (1999-2014). Las comparaciones de proporciones se realizaron mediante las pruebas de Chi-cuadrado o exacta de Fisher, y entre pares de grupos independientes con la prueba de Mann-Whitney. Se consideraron significativos los valores de probabilidad menores de 0,05. Resultados: Los 10.548 casos estudiados presentaban una edad media de 38,41 (±22,07) anos, siendo significativamente superior en las mujeres (p=0,0001). El 67,7% de las intoxicaciones ocurrieron en el hogar, y las vias de entrada mas frecuentes fueron la respiratoria (48,3%), la digestiva (35,3%) y la ocular (13,1%). Los grupos toxicos mas frecuentes fueron los gases toxicos (31%), los causticos (25,6%) y los gases irritantes (12,1%). Un 76,2% de los casos requirieron tratamiento (27,2% con antidotos). Ingreso en un centro hospitalario un 20,6% de las personas, con una estancia media de 32 (±151,94) dias, con diferencias significativas para los plaguicidas y disolventes (p=0,02). Presentaron secuelas al alta un 2,1%. La mortalidad fue del 1,4% (146 pacientes), con una edad media de 62,08 anos (±19,58; p=0,0001). Conclusiones: En las intoxicaciones por productos quimicos, las medidas preventivas deben centrarse fundamentalmente en el ambito domestico, controlando las fuentes de exposicion al monoxido de carbono y la manipulacion de los productos de limpieza, fundamentalmente los liquidos causticos y la generacion de gases irritantes al mezclarlos.","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"1 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70478364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuestiones éticas en los registros clínicos de un grupo de pacientes terminales ingresados en un hospital de tercer nivel. Carencias y mejoras","authors":"Estela Hernández-Bello, Ángel Gasch-Gallén","doi":"10.4321/S1135-57272020000100020","DOIUrl":"https://doi.org/10.4321/S1135-57272020000100020","url":null,"abstract":"RESUMEN Fundamentos: Los/las pacientes en estado terminal y sus familiares deben conocer su situacion y ser tratados segun el principio de autonomia, para establecer asi objetivos terapeuticos adaptados a cada uno/a de acuerdo a sus necesidades y decisiones. El objetivo de este estudio fue identificar la existencia de registros en las historias clinicas de pacientes terminales que senalen su situacion, como la informacion ofrecida, los codigos de limitacion del esfuerzo terapeutico (LET), la no reanimacion cardiopulmonar (No-RCP) o Z.51.5, y la relacion con las variables sociodemograficas y clinicas. Metodos: Se realizo un estudio descriptivo transversal en un hospital de tercer nivel, con pacientes ingresados entre enero y diciembre de 2017, que fallecieron con criterios de enfermedad terminal. Se recogieron los datos de las historias clinicas y, fundamentalmente, de las notas clinicas de enfermeria. El analisis estadistico se realizo con el programa SPSS, version 22. Resultados: Participaron 140 personas, 54,3% de hombres, de 78,51 anos (Desviacion estandar -DS-=13,5) de edad media. Las personas menores de 70 anos recibieron menos informacion (Odds Ratio -OR-: 0,077; Intervalo de Confianza -IC- 95%: 0,015-0,390) y menor sedacion (OR: 0,366; IC 95%: 0,149-0,899). Proceder de ciudad redujo la probabilidad de recibir informacion (OR: 0,202; IC 95%: 0,058-0,705). Presentar disnea redujo la LET (OR: 0,44; IC 95%: 0,20-093), el No RCP (0,29; IC 95%: 0,12-0,68) y la sedacion (OR:0,27; IC 95%: 0,12-060). La fatiga aumento la probabilidad de ser No RCP (OR: 2,77; IC 95%: 1,163-6,627) y de recibir sedacion (OR:2,6; IC 95%: 1,065-6,331). Conclusiones: Los esfuerzos por empoderar al paciente en la toma de decisiones son todavia escasos. Un mayor y mejor registro facilita conocer como se desarrollan las actuaciones, permitiendo identificar y poner en marcha intervenciones eticas y responsables.","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49476624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[New care models for transgender people in the Spanish Health System: demands, controversies and reflections.]","authors":"Esther Gómez-Gil, Isabel Esteva de Antonio, María Fernández Rodríguez, Maricruz Almaraz Almaraz, Felipe Hurtado Murillo, Marcelino Gómez Balaguer, Nuria Asenjo Araque, Mireia Mora Porta, Irene Halperin Rabinovich, Rosa Fernández García, Ángel Luis Montejo González, Grupo Gidseen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Health care for transgender people in Spain has been progressively established since 1999 when the first multidisciplinary unit for the treatment of sex reassignment was created in Andalusia. In this document, the social changes, the demands and debates of users and professionals, the new models of health care for trans people, and reflections on the current situation, have been analysed. The social openness in Spain regarding sexual and gender diversity has evolved quite positively. The health demands of the transgender users are not uniform and do not always match with the criteria of the professionals. In some Spanish regions, health care is distancing itself from the internationally recommended multidisciplinary model. The new healthcare models have been established under the aegis of primary care and/or endocrinologist in the area, without a required psychological assessment. The main contributing factors for this change of model have been the pressure from some associations with demands for \"depathologization\" and \"decentralization\". The professionals of gender units, while recognizing the need for a broader vision of trans reality, warn of the risk of treating trans people without the involvement of mental health specialists or by professionals in proximity with little experience. Moreover, the decentralization would not allow acting on large cohorts, which hinders the advance of knowledge and contrasted evaluations with neighbouring countries. In summary, the new health models, although intended to facilitate care through proximity, do not guarantee improvements in quality and difficult to make a comparative evaluation of the results.</p>","PeriodicalId":47152,"journal":{"name":"Revista Espanola De Salud Publica","volume":"94 ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38708619","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}