Belén Sanz

La utilización de los servicios sanitarios por la población inmigrante en España

OBJECTIVE To compare health services utilization between the immigrant and indigenous populations in Spain. METHODS We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. RESULTS In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. CONCLUSION The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date.

Prevention of childhood obesity in Spain: a focus on policies outside the health sector. SESPAS report 2010.

Obesity is currently a global public health problem. Obesity in early life increases the risk of long-term energy imbalance and adult obesity and its comorbidities, type 2 diabetes, and cardiovascular disease. Since infancy and childhood are critical periods for the adoption of food preferences and physical activity, prevention strategies must intervene in these early periods to promote healthy habits and reduce risk behaviors. Trends in the prevalence of childhood obesity and overweight in Spain have continuously increased in the last three decades. Obesity and overweight currently affect 15 and 20% of Spanish children, respectively, and these percentages are among the highest in Europe. Childhood obesity is determined by social and economic factors pertaining to sectors other than the health system, such as advertising, the built environment, education and the school environment, transportation and the food environment. Following the Health in All Policies (HiAP) approach, the authors identified a series of multisector policy changes that may help to prevent and control the current rising trend of childhood obesity in Spain. The HiAP approach acknowledges that social factors including socioeconomic status, gender differences and the work-life balance are important to develop effective policy changes in the prevention of childhood obesity. A key to success in the prevention of childhood obesity in Spain through policy changes will depend on the ability to establish a policy with the explicit and primary goal of improving health outcomes, despite the anticipated resistance from various sectors and stakeholders.

Prevention of childhood obesity in Spain: a focus on policies outside the health sector. SESPAS report 2010

Obesity is currently a global public health problem. Obesity in early life increases the risk of long-term energy imbalance and adult obesity and its comorbidities, type 2 diabetes, and cardiovascular disease. Since infancy and childhood are critical periods for the adoption of food preferences and physical activity, prevention strategies must intervene in these early periods to promote healthy habits and reduce risk behaviors. Trends in the prevalence of childhood obesity and overweight in Spain have continuously increased in the last three decades. Obesity and overweight currently affect 15 and 20% of Spanish children, respectively, and these percentages are among the highest in Europe. Childhood obesity is determined by social and economic factors pertaining to sectors other than the health system, such as advertising, the built environment, education and the school environment, transportation and the food environment. Following the Health in All Policies (HiAP) approach, the authors identified a series of multisector policy changes that may help to prevent and control the current rising trend of childhood obesity in Spain. The HiAP approach acknowledges that social factors including socioeconomic status, gender differences and the work-life balance are important to develop effective policy changes in the prevention of childhood obesity. A key to success in the prevention of childhood obesity in Spain through policy changes will depend on the ability to establish a policy with the explicit and primary goal of improving health outcomes, despite the anticipated resistance from various sectors and stakeholders.

Pattern of health services use by immigrants from different regions of the world residing in Spain

ObjectiveTo determine immigrants’ frequency of use of four health services by place of origin and compare it with that of the Spanish population.MethodsBased on the 2006 National Health Survey in Spain, we estimated the frequency of use of four health services in men and women from: Spain, Western countries, Eastern Europe, Latin America, North Africa, Sub Saharan Africa and Asia/Oceania. These results were compared with the Spanish population by calculating odds ratios adjusted for age, socioeconomic position, health status, and type of health coverage.ResultsImmigrant men generally use health services less frequently than Spanish nationals. The main exceptions are Latin American men, who more often use emergency services (OR 1.68, 95% CI 1.41–1.99) and Sub-Saharan men, who use specialists more frequently (OR 2.93, 1.70–5.05). Immigrant women use health services about as frequently as Spanish women. The main exceptions are North African women, who less frequently use specialists (OR 0.39, 0.22–0.71) and Sub-Saharan women who more frequently use GPs (OR 4.06, 2.21–7.44), specialists (OR 2.29, 1.06–4.95) and emergency services (OR 2.92, 1.49–5.72).ConclusionsHealth services use by the immigrant population in Spain differs by gender and place of origin.

Detección precoz de cáncer de cérvix según los discursos de las matronas de atención primaria en Segovia, España

OBJECTIVE To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. METHODS A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. RESULTS Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, womens experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. CONCLUSIONS The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Programs infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.OBJETIVO: Analisar os discursos das parteiras atuantes na atencao primaria sobre o acesso e utilizacao do Programa Preventivo de Câncer Cervical. PROCEDIMENTOS METODOLOGICOS: Estudo qualitativo realizado em Segovia, em uma area de baixa densidade populacional na Espanha, com alta proporcao de populacoes rurais e imigrantes, de 2008 a 2009. Utilizou-se a entrevista semi-estruturada para coleta de informacoes. Foram entrevistadas dez parteiras das 16 Zonas Basicas de Saude. A analise da informacao baseou-se nas propostas da Teoria Fundamentada. ANALISE DOS RESULTADOS: O acesso e utilizacao do Programa Preventivo de Câncer Cervical relacionam-se a mulheres atendidas pela parteira, as vivencias das mulheres em relacao os resultados do exame de citologia vaginal e sua percepcao de risco de sofrer um câncer de colo uterino. A barreira percebida e a distância para comparecer a consulta com a parteira. Para as mulheres imigrantes ha ainda a possibilidade de nao dispor de carteira de saude e desconhecer o programa. A exclusao social tambem esta relacionada a barreiras de acesso e utilizacao. O principal facilitador identificado foi o aconselhamento dos medicos de familia para participar do programa. CONCLUSOES: As parteiras percebem desigualdades de acesso e utilizacao do Programa Preventivo de Câncer Cervical que se relacionam tanto com caracteristicas individuais das mulheres como com o meio geografico em que vivem e com a propria estrutura do Programa. Ha situacoes de vulnerabilidade da equidade de grupos de mulheres pouco representadas em nivel de inqueritos populacionais, como as imigrantes e as que moram em zonas rurais.

Early detection of cervical cancer according to the discourses of primary care midwives in Segovia, Spain

OBJECTIVE To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. METHODS A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. RESULTS Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, womens experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. CONCLUSIONS The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Programs infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.OBJETIVO: Analisar os discursos das parteiras atuantes na atencao primaria sobre o acesso e utilizacao do Programa Preventivo de Câncer Cervical. PROCEDIMENTOS METODOLOGICOS: Estudo qualitativo realizado em Segovia, em uma area de baixa densidade populacional na Espanha, com alta proporcao de populacoes rurais e imigrantes, de 2008 a 2009. Utilizou-se a entrevista semi-estruturada para coleta de informacoes. Foram entrevistadas dez parteiras das 16 Zonas Basicas de Saude. A analise da informacao baseou-se nas propostas da Teoria Fundamentada. ANALISE DOS RESULTADOS: O acesso e utilizacao do Programa Preventivo de Câncer Cervical relacionam-se a mulheres atendidas pela parteira, as vivencias das mulheres em relacao os resultados do exame de citologia vaginal e sua percepcao de risco de sofrer um câncer de colo uterino. A barreira percebida e a distância para comparecer a consulta com a parteira. Para as mulheres imigrantes ha ainda a possibilidade de nao dispor de carteira de saude e desconhecer o programa. A exclusao social tambem esta relacionada a barreiras de acesso e utilizacao. O principal facilitador identificado foi o aconselhamento dos medicos de familia para participar do programa. CONCLUSOES: As parteiras percebem desigualdades de acesso e utilizacao do Programa Preventivo de Câncer Cervical que se relacionam tanto com caracteristicas individuais das mulheres como com o meio geografico em que vivem e com a propria estrutura do Programa. Ha situacoes de vulnerabilidade da equidade de grupos de mulheres pouco representadas em nivel de inqueritos populacionais, como as imigrantes e as que moram em zonas rurais.

Detecção precoce de câncer cervical segundo discursos de parteiras na atenção primária em Segóvia, Espanha

OBJECTIVE To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. METHODS A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. RESULTS Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, womens experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. CONCLUSIONS The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Programs infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.OBJETIVO: Analisar os discursos das parteiras atuantes na atencao primaria sobre o acesso e utilizacao do Programa Preventivo de Câncer Cervical. PROCEDIMENTOS METODOLOGICOS: Estudo qualitativo realizado em Segovia, em uma area de baixa densidade populacional na Espanha, com alta proporcao de populacoes rurais e imigrantes, de 2008 a 2009. Utilizou-se a entrevista semi-estruturada para coleta de informacoes. Foram entrevistadas dez parteiras das 16 Zonas Basicas de Saude. A analise da informacao baseou-se nas propostas da Teoria Fundamentada. ANALISE DOS RESULTADOS: O acesso e utilizacao do Programa Preventivo de Câncer Cervical relacionam-se a mulheres atendidas pela parteira, as vivencias das mulheres em relacao os resultados do exame de citologia vaginal e sua percepcao de risco de sofrer um câncer de colo uterino. A barreira percebida e a distância para comparecer a consulta com a parteira. Para as mulheres imigrantes ha ainda a possibilidade de nao dispor de carteira de saude e desconhecer o programa. A exclusao social tambem esta relacionada a barreiras de acesso e utilizacao. O principal facilitador identificado foi o aconselhamento dos medicos de familia para participar do programa. CONCLUSOES: As parteiras percebem desigualdades de acesso e utilizacao do Programa Preventivo de Câncer Cervical que se relacionam tanto com caracteristicas individuais das mulheres como com o meio geografico em que vivem e com a propria estrutura do Programa. Ha situacoes de vulnerabilidade da equidade de grupos de mulheres pouco representadas em nivel de inqueritos populacionais, como as imigrantes e as que moram em zonas rurais.