Paloma Ortega

Síndrome de Burnout en el personal de enfermería de un hospital de Madrid

Fundamento: El termino Burnout se refiere a una situacion que es cada vez mas frecuente entre los profesionales que prestan sus servicios a traves de una relacion directa y mantenida con las personas, entre los que se encuentran todos los profesionales sanitarios. El objetivo de nuestro estudio ha sido determinar la prevalencia del sindrome de Burnout y de sus tres componentes (cansancio emocional, despersonalizacion y falta de realizacion personal) entre los profesionales del area de enfermeria del Hospital Clinico Universitario San Carlos de Madrid y su relacion con determinados factores sociodemograficos, laborales e institucionales. Metodos: Se realizo un estudio tranversal entre los profesionales adscritos al area de enfermeria del mencionado hospital. Las variables implicadas se recogieron mediante un cuestionario de elaboracion propia. En cuanto al sindrome de Burnout se midio mediante el Maslach Burnout Inventory, en su version validada en espanol. Resultados: El personal de enfermeria esta mas despersonalizado (p=0,004) y menos realizado (p=0,036) que el grupo de auxiliares/tecnicos. Cuando se analizaron los resultados de las 4 escalas por servicios comprobamos que el agotamiento es superior en los trabajadores de oncologia y urgencias (p=0,001), la despersonalizacion en urgencias (p=0,007), y el Burnout es de nuevo mas alto en las areas de oncologia y urgencias (p=0,000). Los profesionales que respondian que su labor asistencial era poco reconocida obtenian las peores puntuaciones en el Burnout y sus tres dimensiones (p =0,000). A menor grado de satisfaccion laboral mas altas son las puntuaciones en las 4 escalas (p=0,000). Conclusiones: Podemos concluir que en nuestro estudio el perfil del sujeto afecto de Burnout se corresponde con el de un profesional con experiencia laboral que sin embargo manifiesta un escaso grado de reconocimiento a su labor asistencial y un alto nivel de insatisfaccion con la gestion de su centro de trabajo.

Socioeconomic patterns in the use of public and private health services and equity in health care

BackgroundSeveral studies in wealthy countries suggest that utilization of GP and hospital services, after adjusting for health care need, is equitable or pro-poor, whereas specialist care tends to favour the better off. Horizontal equity in these studies has not been evaluated appropriately, since the use of healthcare services is analysed without distinguishing between public and private services. The purpose of this study is to estimate the relation between socioeconomic position and health services use to determine whether the findings are compatible with the attainment of horizontal equity: equal use of public healthcare services for equal need.MethodsData from a sample of 18,837 Spanish subjects were analysed to calculate the percentage of use of public and private general practitioner (GP), specialist and hospital care according to three indicators of socioeconomic position: educational level, social class and income. The percentage ratio was used to estimate the magnitude of the relation between each measure of socioeconomic position and the use of each health service.ResultsAfter adjusting for age, sex and number of chronic diseases, a gradient was observed in the magnitude of the percentage ratio for public GP visits and hospitalisation: persons in the lowest socioeconomic position were 61–88% more likely to visit public GPs and 39–57% more likely to use public hospitalisation than those in the highest socioeconomic position. In general, the percentage ratio did not show significant socioeconomic differences in the use of public sector specialists. The magnitude of the percentage ratio in the use of the three private services also showed a socioeconomic gradient, but in exactly the opposite direction of the gradient observed in the public services.ConclusionThese findings show inequity in GP visits and hospitalisations, favouring the lower socioeconomic groups, and equity in the use of the specialist physician. These inequities could represent an overuse of public healthcare services or could be due to the fact that persons in high socioeconomic positions choose to use private health services.

Prevalence of antibodies against varicella zoster, herpes simplex (types 1 and 2), hepatitis B and hepatitis A viruses among Spanish adolescents

The aim of this cross-sectional study was to assess the seroprevalence of antibodies against varicella zoster (VZV), herpes simplex type 1 (HSV-1) and type 2 (HSV-2), hepatitis B (HBV) and hepatitis A (HAV) viruses in adolescents (14-17 years of age) in Madrid, Spain. At the study visit, demographic data and blood samples were obtained. The enzyme linked immunosorbent assay (ELISA) method was used to assess the presence of anti-VZV, anti-HSV-1, anti-HSV-2, anti-HBc and anti-HAV antibodies. A total of 1191 serum samples were collected. Mean age (SD) and male/female ratio of the study population were 15.3 (1.1) years and 0.9, respectively. Seroprevalences obtained were as follows: anti-VZV (94%), anti-HSV-1 (46%), anti-HSV-2 (5%), anti-HBc (3%) and anti-HAV (5%). These data show that Spanish adolescents should be considered a target group for prevention programmes against HSV-2, HBV and HAV infections.

Area-based socioeconomic environment, obesity risk behaviours, area facilities and childhood overweight and obesity: socioeconomic environment and childhood overweight.

OBJECTIVE The objective of this study is to evaluate whether the relation between area-based socioeconomic environment and childhood obesity can be explained by household socioeconomic position, obesity-related risk behaviours and area facilities. METHODS Two indicators of socioeconomic environment based on wealth and deprivation were estimated in a sample of 4529 Spanish children and adolescents in 2006. Multilevel logit models were used to calculate the relation between each indicator and obesity. RESULTS After adjusting for socioeconomic position and risk behaviours, no relation was observed between wealth and overweight; however, obesity prevalence was 1.45 times higher in subjects living in areas with lower wealth than in those living in areas with higher wealth. After adjusting for these variables, the prevalence of overweight and obesity in subjects living in deprived areas was, respectively, 1.26 and 1.63 higher than in those living in non-deprived areas. There was a graded association between number of sports facilities and prevalence of physical inactivity, but no relation was found between the price of fruits and vegetables and frequency of consumption. CONCLUSION The relation of socioeconomic environment with childhood obesity could not be explained by household socioeconomic position or obesity-related risk behaviours. Availability of sport facilities may mediate this relation.

Asociación de los ingresos económicos con la utilización y la accesibilidad de los servicios sanitarios en España al inicio del siglo XXI

Objetivo: Estimar la asociacion de los ingresos economicos del hogar y de la renta provincial con las consultas al medico general y al especialista y con la hospitalizacion. Estimar si el tiempo de espera para acceder a esos servicios varia con esas caracteristicas. Metodo: Datos de la Encuesta Nacional de Salud de 2001. La asociacion se estimo mediante la odds ratio, ajustada por edad y sexo, y en el caso de la renta per capita se ajusto tambien por los ingresos economicos del hogar. Se estimaron los percentiles y la media geometrica de los tiempos de espera en cada servicio sanitario y se evaluo la significacion estadistica de su asociacion con ambas variables economicas. Resultados: Los sujetos con menores ingresos economicos presentan la mayor frecuencia de consultas al medico general y hospitalizacion, aunque esperan mas tiempo para ser hospitalizados. Estos sujetos presentan la menor frecuencia de consultas al especialista: la odds ratio en el cuartil mas bajo de ingresos frente al mas alto fue 0,73 (intervalo de confianza del 95%, 0,62-0,87), aunque en las consultas financiadas publicamente la menor frecuencia se observa en los sujetos con mayores ingresos. No se han encontrado diferencias en la utilizacion y en los tiempos de espera segun la renta provincial. Conclusiones: La frecuencia de consultas al especialista segun los ingresos economicos del hogar muestra un patron distinto al observado en las consultas al medico general y en la hospitalizacion. El mayor tiempo de espera para hospitalizacion se observa en los sujetos con menores ingresos economicos.

Differential Wnt Pathway Gene Expression and E-Cadherin Truncation in Sporadic Colorectal Cancers with and without Microsatellite Instability

Purpose: Alterations in the Wnt pathway play a major role in colorectal cancer with high (MSI-H) or low microsatellite instability (MSS/MSI-L). However, the differential impact of the Wnt pathway components on these tumors is poorly understood. MMP-3 (stromelysin-1) promoter is a target of the mutator phenotype in sporadic colorectal cancer. Among MMP-3 targets, we investigated E-cadherin integrity status in both groups of tumors. Because beta-catenin is the main effector of the Wnt pathway, we have also investigated the differential cellular status of beta-catenin. Experimental Design: Expression profiles of 114 genes related to the Wnt pathway were analyzed by oligo microarrays in 48 tumors classified by their MSI status. In addition, we analyzed 48 sporadic colorectal cancers for E-cadherin integrity status. We performed investigation of beta-catenin and cyclin D1 by immunohistochemistry using tissue arrays containing 96 tumors. Results: Our data show that a group of genes that negatively regulate Wnt signaling are downregulated in MSS/MSI-L as compared with MSI-H colorectal tumors. E-cadherin truncation was significantly higher in MSS/MSI-L as compared with MSI-H tumors. Moreover, MSI-H tumors showed low or null beta-catenin nuclear presence, whereas the group of tumors classified as MSS or MSI-L displayed a high content of the nuclear beta-catenin location. Conclusions: Our results suggest that the differential expression of genes that negatively regulate the Wnt pathway, as well as the status of E-cadherin and beta-catenin in MSI-H or MSS/MSI-L colorectal tumors, shed some light on the different clinical behavior showed by the two groups.

Factores asociados al consumo de farmacos psicotropos en la poblacion adulta espanola. Datos obtenidos a partir de las Encuestas Nacionales de Salud de Espana de los anos 1993, 1995 y 1997

BACKGROUND In this study, the aim is the identification of the factor associated with psychotropic drug use among the Spanish adult population. MATERIALS AND METHOD A descriptive and cross-sectional survey is carried out using data from the Spanish National Health Surveys from 1993, 1995 and 1997. As subjects of the study we have chosen the spanish adult population (aged 16 plus). INDEPENDENT VARIABLES socio-demographic factors and health profile. Dependent variables are the overall consumption of psychotropic drug, both prescribed and no prescribed. RESULTS Prevalence of psychotropic drug consumption is higher among women (6.9% in 1993; 9.9% in 1995, and 9.7% in 1997) than among men (3.1% in 1993; 4.8% in 1995, and 4.7% in 1997). According to multivariance analysis, alcohol consumption have negative association, anxiety or sleep disorder and depression seem to be strongly associated (OR = 22.44; CI 95%, 13.06-38.56 women, and OR = 42.97; CI 95%, 17.69-104.40 men). CONCLUSIONS Prevalence of psychotropic drug consumption is higher in women than in men. The most strongly associated variable is nervous or sleep disorder and depression.Fundamento En este estudio se plantea como objetivo principal la identificacion de los factores asociados al consumo de farmacos psicotropos en la poblacion adulta Material y metodo Estudio descriptivo y transversal. La fuente de los datos fueron las Encuestas Nacionales de Salud de Espana de los anos 1993, 1995 y 1997. Como poblacion de estudio se escogio la poblacion adulta del Estado espanol (16 anos o mas). Las variables independientesfueron de tipo sociodemografico y del perfil de salud, y se consideraron variables dependientes los consumos total, prescrito y automedicado de los farmacos psicotropos Resultados La prevalencia de consumo es mayor en las mujeres (del 6,9% en 1993; del 9,9%en 1995, y del 9,7% en 1997) que en los varones (un 3,1% en 1993; un 4,8% en 1995, y un 4,7% en 1997). Tras el analisis multivariante, en las tres encuestas destaca la asociacion negative entre el consumo de psicofarmacos y el alcohol. Los problemas de ansiedad o depression y la dificultad para dormir presentan una fuerte asociacion en ambos sexos (odds ratio [OR] = 22,44; intervalo de confianza [IC] del 95%, 13,06-38,56 en mujeres, y OR = 42,97; IC del 95%, 17,69-104,40 en varones) Conclusiones La prevalencia de consumo de psicotropos es mayor en las mujeres que en los varones.La variable mas fuertemente asociada a dicho consumo son los problemas de ansiedad o depresion y la dificultad para dormir

Evolución de las desigualdades socioeconómicas y las desigualdades en la percepción de la salud en España

Objetivo: Estudiar la evolucion de las desigualdades socioeconomicas y las desigualdades socioeconomicas en la percepcion subjetiva de la salud en Espana entre 1987 y 2001. Metodos: Se han estimado la distribucion del nivel de estudios y de la renta per capita provincial, asi como las diferencias en la percepcion de la salud segun el nivel de estudios y segun la renta per capita provincial en cada periodo. Resultados: El porcentaje de poblacion que habia completado estudios de segundo grado o superiores fue mayor, y la desigualdad en la renta per capita provincial fue menor en el ano 2001 que en 1987. En lineas generales, las diferencias en la percepcion de la salud como segun el nivel de estudios y la renta per capita provincial fueron mayores en 2001que en 1987, en terminos relativos y absolutos. En cambio, cuando se tuvo en cuenta el efecto de la correlacion residual dentro de las provincias en el resultado, las diferencias segun la renta per capita provincial fueron menores en 2001 que en 1987. Conclusion: La redistribucion de los recursos socioeconomicos basicos consigue una mayor justicia social, pero probablemente no siempre consigan reducir las desigualdades en salud.

The role of political and welfare state characteristics in infant mortality: a comparative study in wealthy countries since the late 19th century

BACKGROUND A close examination of the literature suggests that the consistent relation between political and welfare state characteristics and infant mortality in the second half of the 20th century in wealthy countries may not be causal. METHODS The evolution of infant mortality since the late 19th century was studied in 17 wealthy countries classified according to political traditions, family policy model and period of infant mortality transition. The relation of public health expenditure and income inequality to infant mortality from 1980 to 2005 was also evaluated. RESULTS The Social Democratic and Scandinavian countries, and those with the earliest transition in infant mortality, had the lowest infant mortality rates until the early 21st century, whereas the late democracies, the Southern European countries, and those in which the transition in infant mortality took place later, had the highest rates until the late 20th century. By the early 21st century, the differences in infant mortality were negligible. Three of the four Scandinavian countries were the first to achieve infant mortality transition, whereas the Southern European countries were the last. The relation between public health expenditure and infant mortality varied depending on the time period in which the analysis was made, and increased income inequality was associated with higher infant mortality. CONCLUSIONS The relation between political and welfare state characteristics and infant mortality in previous studies probably reflects the historical moment in which the transition in infant mortality took place in each country. Methodological limitations do not allow inference of causality in the associations found between welfare state characteristics and infant mortality.

Decreasing income inequality and emergence of the association between income and premature mortality: Spain, 1970-2010.

This study evaluates the relationship between income and mortality in Spain over a long period of declining in income inequality. The ratio between income in the richest and poorest provinces was 2.74 in 1970 and 2.10 in 2010. Pearson correlation coefficients for the association between provincial income and the measures of mortality were estimated, as well as absolute and relative differences between the mortality rates of the poorest and richest provinces. The correlation coefficient between income and infant mortality decreased from -0.59 in 1970 to -0.17 in 2010, and lost significance from 1995 onwards. The coefficient for premature all-cause mortality increased from -0.04 in 1970 to -0.40 in 2010, and acquired significance beginning in 2005. The coefficient also increased in mortality from cardiovascular, respiratory and digestive diseases. No association was found between provincial income and cancer mortality or mortality from injuries. The findings on premature mortality do not support the theory that decreasing income inequality will lead to reduced inequalities in mortality.