Jorge Soler-González

Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrant and Spanish-born populations.

BackgroundThe use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain).MethodsCross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population.ResultsImmigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts.ConclusionIn Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): A 6-months prospective observational study

BackgroundThere are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations.MethodsProspective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex.ResultsThe percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure.ConclusionPharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

Utilización de recursos de atención primaria por parte de inmigrantes y autóctonos que han contactado con los servicios asistenciales de la ciudad de Lleida

Objetivo Evaluar y comparar la utilizacion de recursos en los distintos servicios de atencion primaria (AP) entre inmigrantes y autoctonos. Diseno Estudio observacional transversal en poblacion visitada en AP. Emplazamiento Personas atendidas por 15 medicos de AP en 5 areas basicas de salud (ABS) de la ciudad de Lleida de marzo a agosto de 2005. Participantes Se incluyo a todos los inmigrantes atendidos durante el periodo de estudio (1.599 pacientes de origen inmigrante). Se realizo un muestreo aleatorio de 300 pacientes en cada una de las 15 consultas participantes (4.156 pacientes de origen autoctono). Se considero poblacion autoctona aquella cuyo pais de origen es Espana y poblacion inmigrante aquella que proviene de los paises de renta baja y media, independientemente del tiempo de asistencia al ABS. Mediciones principales Edad, sexo, tipo de visitas realizadas y las derivaciones efectuadas. Se utilizaron modelos de regresion multinomial para estimar el riesgo relativo (RR) de haber realizado las visitas. Resultados Los inmigrantes tienen una probabilidad superior a los autoctonos de realizar mas de 3 visitas, frente a 1 o 2 visitas (RR = 1,23; intervalo de confianza [IC] del 95%, 1,04-1,91%). La estimacion del RR de haber realizado visitas es superior en los inmigrantes para todas las categorias, excepto en enfermeria (RR = 0,59; IC del 95%, 0,5-0,71%). Conclusiones Los inmigrantes que contactan con AP lo hacen con mayor frecuencia en las consultas de medicina de familia y de ginecologia, y ademas se realizan mas pruebas complementarias. Sin embargo, la frecuentacion del colectivo inmigrante a las consultas de enfermeria parece ser inferior.

Association between low empathy and high burnout among primary care physicians and nurses in Lleida, Spain

Abstract Background: Burnout is a growing problem among healthcare professionals and may be mitigated and even prevented by measures designed to promote empathy and resilience. Objectives: We studied the association between burnout and empathy in primary care practitioners in Lleida, Spain and investigated possible differences according to age, sex, profession, and place of practice (urban versus rural). Methods: All general practitioners (GPs) and family nurses in the health district of Lleida (population 366 000) were asked by email to anonymously complete the Maslach Burnout Inventory (MBI) and the Jefferson Scale of Physician Empathy (JSPE) between May and July 2014. Tool consistency was evaluated by Cronbach’s α, the association between empathy and burnout by Spearman’s correlation coefficient, and the association between burnout and empathy and sociodemographic variables by the χ2 test. Results: One hundred and thirty-six GPs and 131 nurses (52.7% response rate) from six urban and 16 rural practices participated (78.3% women); 33.3% of respondents had low empathy, while 3.7% had high burnout. The MBI and JSPE were correlated (P < .001) and low burnout was associated with high empathy (P < .05). Age and sex had no influence on burnout or empathy. Conclusion: Although burnout was relatively uncommon in our sample, it was associated with low levels of empathy. This finding and our observation of lower empathy levels in rural settings require further investigation. KEY MESSAGES More empathic primary care practitioners have lower burnout scores. Practitioners working in rural areas have significantly lower levels of empathy than their urban counterparts have. Interventions designed to foster attributes and skills such as empathy, resilience, and doctor–patient communication may help to reduce and prevent burnout.

[Use of primary care resources by immigrants and the autochthonous persons who contact the care services in the city of Lleida, Spain].

OBJECTIVE To evaluate and compare the use of the different primary care (PC) services between immigrants and the indigenous population. DESIGN Cross-sectional observation study of a population seen in (PC). SETTING Patients seen by 15 PC doctors, in 5 basic health areas (BHA) in the city of Lleida, Spain, from March to August 2005. PARTICIPANTS All immigrants (1,599 patients of immigrant origin) who seen during the study period were included. A random sample of 300 patients was taken from each of the 15 participating clinics (4,156 autochthonous patients). The autochthonous was considered as those whose country of origin is Spain and the immigrant population those who come from low and medium income countries, regardless of the time of residence in the BHA. PRIMARY MEASUREMENTS Age, sex, type of visit made, and referrals made. Multinomial regression models were used to calculate the relative risk (RR) of having made visits. RESULTS Immigrants have a higher probability to make 3 visits than the indigenous population, who would make 1 or 2 visits (RR, 1.23; 95% confidence interval, 1.04-1.91). The estimation of the RR of having made visits is higher in the immigrants for all categories, except nursing. CONCLUSIONS Immigrants who come into contact with PC, make more frequent visits to the family doctor and gynaecology, and also have more complementary tests done. However, the frequency of use of the immigrant group for nursing visits seems to be less.

La población inmigrante controla peor su diabetes que la población autóctona

INTRODUCTION Ethnic differences are known to exist in the prevalence of diabetes, but little is known about possible differences in the degree of diabetes control among ethnic groups. The aim of this study was to determine whether there are differences in diabetes detection and control between immigrants and the autochthonous population in our health region. METHODS We performed a cross-sectional, observational, population-based study of all patients diagnosed with diabetes mellitus type 2 registered and treated in 2010. We analyzed diabetes quality indicators and used multivariate logistic regression models adjusted for age, sex and number of visits. The adjustment method was forced and the absence of collinearity was identified through the ROC curve and Hosmer and Lemeshows test. RESULTS There were 77,999 autochthonous patients (6,846 diabetics) and 30,748 immigrant patients (415 diabetics). A total of 8.78% of the autochthonous patients were diabetic versus 1.35% of immigrants (p <0.001). HbA1c <7.5% was found in 68.04% of the native population compared with 54.76% of immigrants. The probability of achieving optimal HbA1c control was 27% lower in immigrants (adjusted OR=0.73), while the probability of achieving good HbA1c control was 30% lower in the immigrant cohort. The model showed moderate discrimination (ROC =0.65 and Hosmer and Lemeshows contrast, p>0.05). CONCLUSIONS Diabetes control and quality indicators are poorer in some immigrant groups.

Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study

BackgroundNon-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure.The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region.MethodsPopulation-based (n=206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4months and when patients withdrew more than 80% of the packs required.Results5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives=3months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42).ConclusionsIn the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.

Method for Improving EEG Based Emotion Recognition by Combining It with Synchronized Biometric and Eye Tracking Technologies in a Non-invasive and Low Cost Way

Technical advances, particularly the integration of wearable and embedded sensors, facilitate tracking of physiological responses in a less intrusive way. Currently, there are many devices that allow gathering biometric measurements from human beings, such as EEG Headsets or Health Bracelets. The massive data sets generated by tracking of EEG and physiology may be used, among other things, to infer knowledge about human moods and emotions. Apart from direct biometric signal measurement, eye tracking systems are nowadays capable of determining the point of gaze of the users when interacting in ICT environments, which provides an added value research on many different areas, such as psychology or marketing. We present a process in which devices for eye tracking, biometric, and EEG signal measurements are synchronously used for studying both basic and complex emotions. We selected the least intrusive devices for different signal data collection given the study requirements and cost constraints, so users would behave in the most natural way possible. On the one hand, we have been able to determine basic emotions participants were experiencing by means of valence and arousal. On the other hand, a complex emotion such as empathy has also been detected. To validate the usefulness of this approach, a study involving forty-four people has been carried out, where they were exposed to a series of affective stimuli while their EEG activity, biometric signals, and eye position were synchronously recorded to detect self-regulation. The hypothesis of the work was that people who self-regulated would show significantly different results when analyzing their EEG data. Participants were divided into two groups depending on whether Electro Dermal Activity (EDA) data indicated they self-regulated or not. The comparison of the results obtained using different machine learning algorithms for emotion recognition shows that using EEG activity alone as a predictor for self-regulation does not allow properly determining whether a person in self-regulation its emotions while watching affective stimuli. However, adequately combining different data sources in a synchronous way to detect emotions makes it possible to overcome the limitations of single detection methods.

Análisis comparativo de las serologías realizadas a los inmigrantes en la región sanitaria de Lleida

OBJECTIVE Evaluate the process of screening and detection of HIV, HBV, HCV and syphilis in the province of Lleida by determining the proportions of positive results in the different groups during one year. DESIGN Descriptive, multicentre study of all the serological tests performed in immigrants and natives attended in 2007. SETTING Province of Lleida (Spain). PARTICIPANTS 255,410 users. MAIN MEASUREMENTS Age, sex, country of origin and period of residence in Spain, and the results for HIV, hepatitis B, hepatitis C and syphilis. We calculated the proportions in which a serological test had been requested, and examined the association between the rates of positive tests and the geographical area of origin, and calculated age-adjusted rates taking the age distribution of the native population as the reference. RESULTS Risk of HBV was 4.6 times higher in immigrants than in natives (11.7 times in sub-Saharan Africans). The rate of positive syphilis tests was three times higher in the immigrant group. For HIV the PR was 2.3 (sub-Saharan Africans 7.4). For hepatitis C the risk was lower in immigrants than in natives (PR=0.4). CONCLUSIONS Immigrants have a higher probability of testing positive in screening in hepatitis B, syphilis and HIV. The rates differ significantly according to the origin of the immigrant.

Aplicaciones de la tecnología digital en la medicina rural

En pocos anos el uso de la tecnologia digital y de la videoconferencia sera algo habitual en nuestro trabajo asistencial. El hecho de usar la fotografia digital en las consultas de las areas rurales, aporta multiples ventajas asistenciales, representando una dificultad tecnica y economica baja, entre las que destacan la mejoria de la asistencia a nuestros pacientes, la eficiente mejoria entre los diversos profesionales y especialistas, disminuira el tiempo de demora asistencial, e incrementara la formacion medica continuada de aquellos medicos que se dedican al ejercicio de la medicina rural.