Barreras de acceso de la población inmigrante a los servicios de salud en Catalunya

Antecedentes El 15,9% de la población de Catalunya era inmigrante en el 2011. A pesar del reconocimiento legal del derecho a la atención sanitaria y del desarrollo de políticas específicas, las investigaciones sobre acceso a los servicios de salud (SS) de la población inmigrante (PI) en España apuntan hacia posibles barreras de acceso. Sin embargo, la evidencia existente es escasa, a menudo contradictoria y pocos factores quedan esclarecidos. Objetivo general Analizar, desde la perspectiva de la PI, los elementos que influyen en su acceso a los SS de Catalunya. Metodología Estudio cualitativo, fenomenológico descriptivo, basado en el marco conceptual de Aday y Andersen. El área de estudio comprende Barcelona, Lleida, Girona y Baix Empordà, y la población de estudio la PI residente en estos lugares. La muestra fue teórica, basada en diferentes perspectivas y relaciones con los SS (usuarios, mediadores de salud y representantes de asociaciones de inmigrantes); y diferentes procedencias (Pakistán, Rumanía, Senegal, Marruecos y Colombia). El tamaño final fue de 37 personas, determinado por saturación del discurso. Se realizaron entrevistas individuales semiestructuradas (2008-2009), grabadas y transcritas literalmente. Se realizó un análisis narrativo de contenido, los datos se segmentaron por informante, colectivo, y temas, y las categorías de análisis se generaron de manera mixta. Hubo triangulación de informantes y de analistas, y el proceso se documentó sistemática y detalladamente. Resultados La mayoría considera fácil el acceso, independientemente de la situación administrativa y laboral, y destacan la gratuidad de la atención. No obstante, la entrada al sistema es fácil solo si se dispone de tarjeta sanitaria (TS), cuya obtención se dificulta por la exigencia de empadronamiento y afiliación a la Seguridad Social, y el miedo a ser identificados por las autoridades. Además, emergen barreras que dependen de los SS y de la PI. En relación a SS: insuficiente provisión de información; horarios de atención primaria incompatibles; tiempos de espera excesivos; deficiente calidad técnica percibida; barrera lingüística; trato incorrecto y actitud negativa del profesional. En relación a la PI: desconocimiento de los SS y los idiomas locales; dificultad para ausentarse del trabajo y cumplir las bajas laborales; y rol social de la mujer. Aparece la percepción de discriminación en los SS. En consecuencia acuden a farmacias, urgencias hospitalarias, asociaciones y oenegés o centros privados; utilizan TS de otra persona; se automedican; y pagan por la atención pública y privada; retrasando la atención y empeorando la enfermedad. Conclusiones El acceso de los inmigrantes a los SS en Catalunya es fácil, pero se ve dificultado por elementos relativos a los SS y potenciados por características de la PI. La TS se configura como elemento clave, pero su obtención se basa en requisitos controvertidos y con frecuencia inalcanzables. El desconocimiento relacionado con la falta de provisión de información limita el acceso, y aunque es compensado parcialmente por el círculo social, éste no puede ni debe sustituir al sistema como fuente de información. La dificultad para ausentarse del trabajo se debe a la precariedad laboral y las prácticas abusivas e ilícitas de los empleadores, por lo que es necesario trasladar este conocimiento a las autoridades competentes y adecuar los horarios de los SS. La barrera lingüística, la falta de competencia cultural y la mala calidad técnica percibida deben ser tenidas en cuenta en la formación de profesionales y los recursos de mediación. Estos resultados denotan el incumplimiento de las leyes y la falta de implementación de las políticas, por lo que éstas deben ser revisadas, reforzadas, y mantenidas. El uso de las urgencias hospitalarias es consecuencia de muchas de estas barreras, por lo que su reducción conllevaría una mayor adecuación de la utilización de urgencias.Background 15.9% of the Catalan population was immigrant in 2011. Despite the legal recognition of the right to health care and the development of specific policies, research on access to health services (HS) of the immigrant population (IP) in Spain point to possible barriers to access. However, the evidence is scarce, often contradictory and few factors have been clarified. Main objective To analyze, from the IP perspective, the elements that influence their access to HS in Catalonia. Methodology Qualitative and phenomenological study, based on the conceptual framework of Aday and Andersen. The study area included Barcelona, Lleida, Girona and Baix Empordà, and the study population was defined as the IP living in these places. The theoretical sample was based on different perspectives and relationships with the HS (users, healthcare cultural mediators and immigrant associations' representatives), and different countries of origin (Pakistan, Romania, Senegal, Morocco and Colombia). The final size was 37 people, determined by saturation of the information. Semi-structured interviews were conducted (2008-2009), recorded and transcribed verbatim. A narrative content analysis was performed; data were segmented by informant, country of origin and themes; and categories of analysis were generated both based in the topics of the guide and the ones that emerged from the data. To enhance the quality of the analysis, triangulation of informants and analysts was carried out, and the process was systematically documented in detail. Results Most informants find it easy to access the HS regardless of their administrative and labour situation, and stress the access free of charge. However, entrance to the healthcare system is easy only if you have a health insurance card (HC), whose acquisition is hampered by the requirement of registration and Social Security affiliation, and the fear of being identified by authorities. In addition, barriers appear related to the HS and to characteristics of IP. Regarding the HS the following barriers appear: insufficient provision of information; primary care opening time; excessive waiting times; poor technical perceived quality of care; language barriers; unfair treatment and negative attitude of the professional. And in relation to the IP: ignorance of the HS and local languages, difficulty to leave work and comply with sick leave, and social role of women. There was also a perception of discrimination related to the HS. Due to these barriers, immigrants go to pharmacies, emergency departments, charitable associations or private institutions; use the HC of someone else; self-medicate; and pay for public and private care, thus delaying care and worsening the disease. Conclusions Access of immigrants to the HS in Catalonia is easy, but hampered by elements of the HS further intensified by features of the IP. The HC is configured as a key element, but its acquisition is based on requirements controversial and often unreachable. Lack of knowledge related to the lack of provision of information limits access, and although the social network partially assumes this provision, it cannot and should not replace the system as a source of information. The difficulty for missing work is due to job insecurity and abusive and illegal practices of employers; therefore it is necessary to transfer this knowledge to the competent authorities and adjust the opening times of HS. The language barrier, lack of cultural competence and perceived poor technical quality must be taken into account in the training of professionals and mediation resources. These results indicate non-compliance with laws and lack of policy implementation, so these must be reviewed, reinforced and maintained. As a result of many of these barriers immigrants use hospital emergency departments; their reduction would thus lead to greater adequacy of the utilization of the emergency departments

Diagnosis delay and follow-up strategies in colorectal cancer. Prognosis implications: a study protocol

<p>Abstract</p> <p>Background</p> <p>Controversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate.</p> <p>Methods/Design</p> <p>Multi-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragón and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953).</p> <p>At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients.</p> <p>Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out.</p> <p>Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables.</p> <p>Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed.</p> <p>Discussion</p> <p>This study will make it possible to verify if the different components of delay have an impact on survival rate in colon cancer and rectal cancer. In consequence, this multi-centre study will be able to detect the variability present in the follow-up of patients with colorectal cancer, and if this variability modifies the prognosis. Ideally, this study could determine which follow-up strategies are associated with a better prognosis in colorectal cancer.</p

SN 2009ip à la PESSTO: no evidence for core collapse yet★

We present ultraviolet, optical and near-infrared observations of the interacting transient SN 2009ip, covering the period from the start of the outburst in 2012 October until the end of the 2012 observing season. The transient reached a peak magnitude o

La educación en ética de la salud pública en los másteres de salud pública en España: Situación actual y recursos disponibles para la docencia

La formació en ètica dels professionals en salut pública (SP) és necessària però insuficient. Aquest article pretén descriure el grau en què els màsters de salut pública (MSP) a Espanya inclouen l'ètica en el seu programa i revisar els materials docents d'ètica en SP disponibles en llengua anglesa. Examinem a Internet el programa dels MSP i els materials docents utilitzant diferents estratègies de cerca. Dels 14 MSP identificats, la meitat (7) inclouen l'ètica en el seu programa i en tots els casos aquesta s'ensenya juntament amb altres aspectes de SP. Dotze llibres de text van ser revisats, 5 dels quals inclouen casos pràctics i gairebé tots ells tenen un alt valor com a material docent.Ethics education of public health (PH) professionals is insufficient, despite general consensus on the need for it. This article aims to describe the extent to which Spanish masters of public health (MPH) have adopted ethic courses, and to review teaching and/or learning resources on PH ethics available in English. We explored Internet sites from current MPH in Spain and searched for teaching resources using different strategies. A total of 14 MPH were identified out of which seven (50.0%) teach ethics. Ethics is taught together with other aspects of PH in all cases. A total of 12 textbooks on PH ethics were reviewed, 5 of them include case studies and most have good or high value as teaching tools.La formación en ética de los profesionales en salud pública (SP) es necesaria pero insuficiente. Este artículo pretende describir el grado en que los masters de salud pública (MSP) en España incluyen la ética en su programa y revisar los materiales docentes de ética en SP disponibles en lengua inglesa. Examinamos en Internet el programa de los MSP y los materiales docentes utilizando diferentes estrategias de búsqueda. De los 14 MSP identificados, la mitad (7) incluyen la ética en su programa y en todos los casos ésta se enseña junto con otros aspectos de SP. Doce libros de texto fueron revisados, 5 de los cuales incluyen casos prácticos y casi todos tienen un alto valor como material docente

Evolución del consumo de tabaco en trabajadores de un hospital de Cataluña

Background: In terms of tobacco consumption, health workers have been considered as reference group, however smoking prevalence in this group is higher than in general population. This study aimed to estimate the prevalence of tobacco consumption among workers of a health institution in Catalonia during a period of 10 years (2001-2011), and to describe their characteristics. Methods: The questionnaire on tobacco consumption prevalence was validated, and was administered in 2001, 2004, 2008 and 2011. A random sampling was carried out in two acute care institutions. The characteristics of the study sample and the differences between smokers were analyzed using the chi-square test for linear trend. A logistic regression model was performed including all the surveys. Results: The smoking prevalence among health care workers for 2001, 2004, 2008 and 2011, was 30.00%, 34.42%, 36.21% and 29.42%, respectively. Women had the highest consumption prevalence (33,40%). Tobacco smoking decreased in medical staff, from 25.97% in 2001, to 18.88% in 2011 (p=0.005), and in nurses from 35,15% in 2001 to 25.61% in 2011 (p=0.007), but not among the administrative staff. Conclusion: Overall and for the first time, smoking prevalence in health workers begins to decrease. However, it does not decrease in the same way among all types of healthcare workers and the prevalence remains high when compared with the population prevalence. This consumption reduction coincides with the measures introduced by the program after the legislative changes.Fundamentos: En términos de consumo de tabaco los trabajadores sanitarios se consideran de referencia. Sin embargo la prevalencia de fumadores entre ellos es superior a la de la población general. Este estudio pretende estimar la evolución de la prevalencia del consumo de tabaco entre los profesionales de una institución sanitaria de Cataluña durante un período de 10 años (2001-2011) y describir sus características. Métodos: Encuesta validada de prevalencia del consumo de tabaco, realizada en 2001, 2004, 2008 y 2011. La muestra se estratificó en dos centros de atención de agudos de la institución. La selección de los participantes fue aleatoria. Se analizaron las características de la muestra y se compararon las diferencias entre fumadores por año, valorando con el test de chi-cuadrado de tendencia lineal. Se realizó un modelo de regresión logística incluyendo todas las encuestas conjuntamente. Resultados: La prevalencia de tabaquismo global de los profesionales sanitarios fue de 30,00%, 34,42%, 36,21% y 29,42% en los años 2001, 2004, 2008 y 2011 respectivamente. La prevalencia fue mayor en mujeres (33,40%). El consumo de tabaco disminuyó en el personal médico de 25,98% en el 2001 a 18,89% en el 2011 (p=0,005) y en el de enfermería del 35,16% en el 2001 al 25,61% en el 2011 (p=0,007). Conclusión: Globalmente la prevalencia de fumadores en profesionales del ámbito hospitalario comienza por primera vez a disminuir. Sin embargo, no disminuye por igual en todas las categorías profesionales y persiste alta comparada con la prevalencia poblacional. Esta reducción del consumo de tabaco coincide con las medidas introducidas por el programa tras los cambios legislativos

Maquetación 1

Introduction: colorectal cancer is one of the most common malignancies in developed countries. Data on specific and 10-year survival are scarce. This study analyzes overall and disease-specific survival for patients with colorectal cancer and assesses the value of clinical factors on disease-specific survival. Methods: a retrospective cohort study of newly diagnosed invasive colorectal cancer cases diagnosed from 1992 to 2007 were identified through the Hospital del Mar Cancer Registry. Five-and 10-year survival functions were estimated using Kaplan-Meier method. Cox proportional hazard models were used to assess prognostic factors. Results: a total of 2,080 patients with colorectal cancer were identified. The median age at diagnosis was 72 years and 58.5% were men. By the end of the follow-up period (December 2008), 1,225 patients had died and 68.4% of deaths were due to colorectal cancer. The 5-and 10-year cancer-specific survival rates were 55.5% (95%CI 53.9-57.9%) and 48.5% (95%CI 45.6-51.3%), respectively. The 5-year specific survival rate improved in the last period (2003 Conclusions: cancer-specific survival improved from 1992 to 2007. This improvement could be due to more effective treatment, since changes in stage distribution or age at diagnosis were not observed during the study period. Overall survival rates should notably improve with the implementation of a population-based colorectal cancer screening program in Spain

Effect of an information leaflet on breast cancer screening participation: A cluster randomized controlled trial

Objective: To evaluate the impact of an information leaflet about the risk-benefit balance of breast cancer screening on women's participation. Methods: This cluster randomized controlled trial was conducted within a population-based breast cancer screening program and included women from the catchment areas of two hospitals in Barcelona, Spain. We evaluated women aged 50-69 years invited to screening between September 2019 and January 2020. The intervention group received an information leaflet on the benefits and harms of mammography screening. The control group received the usual invitation letter. The clusters consisted of the processing days of the invitation letter, assigned to the intervention with a simple random allocation scheme. We compared the participation rate at the individual level between groups, stratified by hospital and by per-protocol and intention-to-treat analyses. Results: We included 11,119 women (137 clusters): 5416 in the intervention group (66 clusters) and 5703 in the control group (71 clusters). A total of 36% (1964/5393) of the women in the intervention group and 37% (2135/5694) of those in the control group attended screening, respectively. Overall, we found no differences in participation among groups (difference in participation - 1.1%; 95%CI; - 2.9 to 0.7%). In a hospital attending a population with a low socioeconomic status, attendance was lower in the intervention group (- 1.4, 95%CI: - 5.7% to - 0.03%). Conclusions: Overall participation in our program was unaffected by a new information leaflet on the risk-benefit balance of breast cancer screening. However, participation was lower in certain populations with lower socioeconomic status TRIAL REGISTRATION: Trial registration number ISRCTN13848929

Maquetación 1

Introduction: colorectal cancer is one of the most common malignancies in developed countries. Data on specific and 10-year survival are scarce. This study analyzes overall and disease-specific survival for patients with colorectal cancer and assesses the value of clinical factors on disease-specific survival. Methods: a retrospective cohort study of newly diagnosed invasive colorectal cancer cases diagnosed from 1992 to 2007 were identified through the Hospital del Mar Cancer Registry. Five-and 10-year survival functions were estimated using Kaplan-Meier method. Cox proportional hazard models were used to assess prognostic factors. Results: a total of 2,080 patients with colorectal cancer were identified. The median age at diagnosis was 72 years and 58.5% were men. By the end of the follow-up period (December 2008), 1,225 patients had died and 68.4% of deaths were due to colorectal cancer. The 5-and 10-year cancer-specific survival rates were 55.5% (95%CI 53.9-57.9%) and 48.5% (95%CI 45.6-51.3%), respectively. The 5-year specific survival rate improved in the last period (2003 Conclusions: cancer-specific survival improved from 1992 to 2007. This improvement could be due to more effective treatment, since changes in stage distribution or age at diagnosis were not observed during the study period. Overall survival rates should notably improve with the implementation of a population-based colorectal cancer screening program in Spain