Revista de sanidad e higiene publica最新文献

Background: The purpose of this article is to present an alternative medical model to the hegemonic model, from the point of view of gender. Gender is believed as a socio-cultural construction defining men and women ways of behaving in society at a definite historical time. Gender consideration in epidemiologic analysis, together with other social variables, constitutes a new approach in the knowledge of women practices. Gender values are the basis to transform social relations and health care within the health system. The position I show includes a macrosocial level: the State and social politics, and a microsocial level: woman and her connection with the doctor in her daily life scope.

Methods: A content analysis of the compiled bibliography was carried out from the point of view of gender. A Primary Health Care Center belonging to a marginal district in the City of Buenos Aires, Argentine was taken as reference.

Results and conclusions: As result of this study, a woman care typology, emphasizing the differences between an hegemonic medical model and an alternative model, was elaborated. In the same way, concepts, which may be a guide in the construction of an alternative model to the hegemonic one, are handled.

Background: Control of normal pregnancy in the scope of primary Health care has been implemented recently; this is the reason why, many factors which have an influence on the use of this service, still remain unknown. We carried out this descriptive study in two Primary Health Care Centers of the VIII Health Area in Asturias, in order to approach the pregnant woman's profile from our primary health care centers, and to study the relation between pregnancy acceptance and sociodemographic characteristics.

Methods: The social histories of all women, who requested health care for their pregnancy during 1991, were collected; the most interesting sociodemographic variables and those ones directly related to pregnancy were obtained.

Results: Out of a total of 139 women, the mean age was 0.4 0.0006. There is a 16% of unmarried women. In relation with the pregnancy acceptance or desire, it was found that 31% of women did not desire it and this rejection was greater among unmarried women, younger than 20 years, (p = 0.0002) among those ones, whose contraceptive method had failed, (p = 0.0000) and among those ones, whose relations with their family were bad or not good enough (p = 0.0004).

Conclusions: A pregnant woman's profile, from our health centers, is obtained. It is necessary to develop health education programmes and family planning in the groups of women with higher number of not desired pregnancies, (young unmarried women).

Background: Cardiovascular disease (CVD), specifically Coronary Health Disease and Cerebrovascular Disease, are the first cause of death in Spain. Information about their main modifiable risk factors (RF) distribution is needed in order to CVD prevention. The purpose of this paper is to estimate these RF prevalence and distribution by age, sex and habitat groups, i.e. tobacco smoking, cholesterolemia, high blood pressure, and obesity in the Spanish population.

Methods: A random cluster sampling cross-sectional study, stratified by habitat (rural and urban), age and sex, was carried out on 2021 men and women of 35 to 64 years of age in 1989. Definition criteria for variables studied were those from WHO and European Atherosclerosis Society. Additional data for study were treatment and control level of hypertensives, cardiovascular drugs consumption and CVD family history.

Results: Participation rate was 73.3%. Mean cholesterolemia was 211.2 mg/dl (210.1 mg/dl in males and 211.9 mg/dl in females). Mean systolic blood pressure was 132.3 mmHg (133.4 and 131.6 mmHg in men and women, respectively). Mean Quetelet Index was 27.5 kg/m2 (27.2 and 27.6 for men and women). 49.4% of males and 16.7% of females were smokers (25.7% and 78.3% were never smokers, respectively). Prevalence of hypercholesterolemia (> or = 250 mg/dl) was 18.6% in men and 17.6% in women, and that of high blood pressure (> or = 160/95 mmHg) was 21.5% in men (49.1% of them treated, and 26.7% controlled), and 19% in women (60.9% treated and 38% controlled). 18.4% of men and 27.4% of women had a Quetelet Index greater than thirty. 15 to 20% of individuals reported a CVD family history. For all these variables there were generally differences according to age, sex, and habitat.

Conclusions: Risk factors distributions and prevalences in Spanish middle-aged individuals rank relatively high. This suggest need of further study and control of them to address CVD prevention properly.

Background: The evaluation of hospital units efficiency is a major matter of health services management. Among the techniques to measure efficiency. The Data Envelopment Analysis (DEA) can be used in multiple resources units (inputs) obtaining multiple products (outputs). The objective of this study is the evaluation of Hospital Preventive Medicine Services in Andalucia, using the technique DEA.

Methods: The Preventive Medicine Services from seven hospitals of Andalucia were selected. DEA is technique, based on a linear programming, which finds the weights, which make a Service efficient in relation with the rest. The relative efficiency of seven units was calculated. The unit with the best practice was found by means of cross efficiency matrixes. With regard to the inefficient services, their necessity of increasing activities to achieve efficiency was identified.

Results: Two efficiency assumptions were elaborated. In the first one, 4 services were efficient (Efficiency = 1) in relation with the rest. In the second one, the Service S.1 was inefficient. Among the efficient units, S.2 shown the highest average efficiency in both assumptions and appeared as the reference unit for all the inefficient ones.

Conclusions: In the evaluation of Preventive Medicine Services efficiency, at least, three of them shown some kind of inefficiency. The Service S.2 was the point of reference for inputs and outputs selected.

Background: The great amount of information required to have the possibility of carrying out an opportune correct health planning has been the cause of an increased interest in the Information Systems about morbidity and it is primary level where the obtention of data becomes more difficult. The source of data is one of the problems to be solved; health surveys and consultation registers have been the most frequently used. Both show differences in their results, mainly due to the differences between the perceived morbidity and the treated morbidity, respectively established by each one of them. The objective of our study is to compare perceived morbidity with treated morbidity in the rural environment of Salamanca Province.

Methods: Data on morbidity obtained by the system of register in primary health care of the Community of Castilla y León in five base health areas of Salamanca Province, are compared with data obtained by interview survey in those areas during the same period of time.

Results: The three first causes of morbidity were: Diseases of Respiratory System, Digestive System and Circulatory System according to the home survey and Infectious and Parasite Diseases, Supplementary Classification and Signs, Symptoms and improperly Defined Morbid Status, according to registers.

Conclusions: Taking into account the results obtained, the differences between both sources were statistically significative and the greatest differences were found in the group of Signs and improperly defined Morbid Status, Infections Diseases and the Supplementary Classification.

Background: We intend to show the Community Health pharmacists's situation in the different Autonomous Communities of the State, independently from their health. With regard to the Community of Valencia, we propose to integrate the Community Health pharmacists in the health structures of Health Areas, so that they can better fulfil their duties: specially Food Hygiene.

Methods: The information provided by the Health Services of each Autonomous Community has been used. Data from the Community of Valencia come from the Public Health General Direction and from Valencia Health Service of Generalidad Valenciana. Official criteria of periodical inspection in order to study needs have been put into practice. Data process has been computerized.

Results: Two kinds of Autonomous Communities have been identified depending on wether they have carried out or not the reorganization and/or the reassignment of duties of Community Health pharmacists. The distribution of Community Health pharmacists in the Autonomous Community of Valencia is shown in its health map, as well as the needs of surveillance for industries and food establishments within a pharmaceutic scope.

Conclusions: The necessity of adapting the figure of the Community Health pharmacist to the Health General Law appears evident, particularly to health structures in the Areas; as well as the convenience of not making the chemist's shop possession compatible with the rest of duties assigned to this pharmacist's Body.

Background: Knowing the prevalence of periodontal disease, to identify some associated variables in youth population. Insulin dependent diabetes mellitus (DMID) has been included as a common variable.

Methods: Cross-sectional study over 383 individuals, 11 to 18 years old. Chi square and Odds ratio (95% confidence limits) have been determined.

Results: Periodontal disease prevalence is 37.53%. An epidemiological and statistical association were found with: Insulin-dependent diabetes mellitus, low social class, poor dental hygiene and plaque index over 0.20.

Conclusions: Juvenile diabetic population must be considered as a high risk group for periodontal disease.

Background: The Trend of lung cancer mortality rates in Asturias during 14 years is studied in order to know whether it shows the same change pattern described for other countries.

Methods: With this purpose, a graphic study of adjusted and age specific rates, including and analysis of birth cohorts, is carried out, and the change average percentage per year and the sex ratio are calculated.

Results: In men, the continuous increase of mortality stands out (change average percentage per year of age adjusted rates of 4.83%) with the only exception of the age group of 45-54 years, which had a variation per year of 1.90%, whereas in women, an overall decrease (-1.18 %) was observed, with the exception of women older than 74 years, who showed an increase of 1.73% per year. In men, the cohorts analysis showed on increasing cohort effect in all generations and a decreasing effect in some women.

Conclusions: Lung cancer will probably go on increasing in Asturias in the next years, among men, whereas in women, it seems that a generalized decrease has been initiated, mainly in the youngest ones and the, increase, observed in other countries in previous years, is not evident. Additional studies, focused on the reasons for these trends, will be necessary and basically the following up of the evolution in men of 45-54 years, whose incipient decrease may indicate a change of trend, which facilitates hypothesis generation and verification.

Background: We have carried out a prospective study among 2,047 patients, operated in the Department of Traumatology of "La Paz" Hospital during two years in order to know the time trend of nosocomial infection.

Methods: All the operated patients have been included in the Study. Several variables have been collected (age, kind of surgery, infection, day of infection onset). Information was collected from the patient's clinical history and evolution and processed with the Sigma programme.

Results: The total percentage of infection was 10.06%; it was 7.63% in clean surgery and 26.79% in dirty surgery. Wound was the most frequent location of infection, followed in order of frequency by urine, respiratory system and sepsis. Since the patient is operated, there are two periods when infection increase significantly; those are between the 7-10 and 25-30 post operation days. This tendency is typical of wound and urine infections; but in septicaemia, infection appears about the third post operation day in dirty surgery and about the 14th day in clean surgery. When studying the moment of patients's infection in clean surgery, a quick increase of wound infection is obtained in the second week, going from 33% (the 7th day) to 78% (the 14th day); next the curve slope diminishes down to 100% (the 61st day). In dirty surgery, the initial increase of wound infection is greater (54% on infections appear the 7th day) and next it slows (64% of infections appear the 14th day and 100% are present the 45th day).

Conclusions: It is necessary to reduce the infection rate in clean surgery mainly by improving surgical prophylaxis. The risk of infection appears earlier in dirty surgery than in clean surgery; for this reason, we shall insist upon its treatment (not prophylaxis) at the moment of the operation. Surveillance of infection signs must be intensified at maximum during the first post-operation week for dirty surgery and in the second week for clean surgery.