Suchergebnisse

The way in which an infant is breastfed by a migrant woman reflects her bio-psycho-social circumstances and her process of cultural transformation and adaptation to the host country. Exploring facilitating and hindering factors to exclusive breastfeeding (EBF) of immigrant mothers in Spain is essential for the development of guidelines that protect EBF. The aim of this qualitative study is to explore the factors perceived as facilitating or hindering EBF during the first six months of the baby's life by Latin American women living in Colmenar Viejo, a city in the Community of Madrid (Spain). We carried out in-depth semi-structured face-to-face interviews between December 2018 and February 2019 with 11 Latin American mothers who were recruited through key informants and snowball sampling. We audio-recorded the interviews, transcribed them, and performed content analysis to examine the data. EBF was facilitated by the mother and her family having information about its benefits, lower economic expenses, family and healthcare system support, certain popular and spiritual beliefs, and the mother's acculturation process in Spanish society. The hindering factors identified were the perception of EBF as a sacrifice, incompatible with working life, with unsightly and painful consequences for the mother, insufficient to nourish the baby and ineffective after some months, poorly supported by the broader social environment and the healthcare system. EBF was restricted by certain popular beliefs, associated with a stigma if abandoned, and linked to less economically favored social classes. Some of these hindering or facilitating factors are similar to those present in the original Latin American society or the receiving Spanish society. EBF is a complex process, with satisfactory and suffering stages, regulated by beliefs and experiences. EBF must be promoted intersectorally by governmental, health and societal actors considering the biological, psychological, social, and cultural characteristics of the mother and her community ; Spanish Ministry of Education and Professional Training Collaboration Grant, number 18CO1/003827 (2000 € for the development of a collaboration project endorsed and evaluated by the Nursing Department of the Universidad Autónoma de Madrid)

Background: Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers' perceptions regarding PCEC utilization. Methods: A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase: 14 in-depth-interviews of rural-based PCEC providers. Results: Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p < 0.001). Healthcare providers perceived that distance to hospital increased PCEC utilization, and distance to PCEC decrease its use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours. Conclusions: The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.

Objective: To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. Methods: We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Results: Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. Conclusions: It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. ; Objetivo: Para hacer frente a la actual crisis económica, las administraciones han impulsado medidas de ajuste que han afectado al sistema público de salud. Presentamos la percepción que de esas medidas tienen los/las médicos/as de atención primaria de dos centros de salud de Madrid. Método: Se desarrolló un estudio cualitativo en dos centros de salud del distrito de Fuencarral-El Pardo (Madrid), que tiene tasas de paro y de población inmigrante superiores a la media de la ciudad. Se realizaron 12 entrevistas semiestructuradas a médicos/as de dichos centros. El análisis de la información se basó en el análisis del contenido clásico. Resultados: Se identifican dos categorías: valoración de medidas de ajuste y valoración de la toma de decisiones en dicho proceso. Las personas entrevistadas manifiestan la necesidad de impulsar medidas que mejoren el sistema público de salud, pero expresan su desacuerdo con las implementadas. Consideran que no están basadas en la evidencia y que obedecen a una necesidad de ahorro a corto plazo. Creen que ha habido una mala comunicación de las medidas, sin la participación de profesionales sanitarios/as asistenciales en su priorización, elección e implementación. Consideran imprescindible esta participación porque son quienes conocen de forma práctica las disfunciones del sistema, teniendo más presente la centralidad del paciente. Conclusiones: Se hace imprescindible que los poderes públicos incorporen activamente a profesionales sanitarios/as asistenciales en la toma de decisiones para garantizar la implementación de medidas basadas en la evidencia, con un alto respaldo profesional, manteniendo así la calidad asistencial ; El estudio ha recibido la financiación del CIBERESP para la transcripción de ocho entrevistas

El feminicidio o asesinato de mujeres por razones de género es ya un reconocido problema de salud pública, además de una grave vulneración de los derechos humanos. Todavía se desconoce con exactitud su magnitud en el mundo, dadas las dificultades metodológicas para diferenciar estos asesinatos de otros homicidios de mujeres. El Programa de la Unión Europea «Redes de Cooperación Europea en Ciencia y Tecnología» puso en marcha en 2013 la Acción COST Femicide across Europe, abriendo un marco europeo óptimo para la cooperación transnacional entre personas expertas que aborden grandes retos sociales y de salud pública como el feminicidio. En esta nota de campo se describen sus principales objetivos, los grupos de expertos y expertas que lo conforman, y los resultados obtenidos a medio plazo con dicha experiencia ; Femicide or the murder of women because of their gender is a recognised public health problem as well as a serious violation of human rights. Its magnitude worldwide is still unknown, given the methodological difficulties to differentiate these murders from other female homicides. The European Union programme entitled «European Cooperation in Science and Technology» (COST) launched the «Femicide across Europe» COST Action in 2013, establishing an optimal European framework for transnational cooperation among experts addressing great social and public health challenges such as femicide. This field note describes the main objectives, the participating groups of experts and the mid-term results of this experience.

[ES] Objetivo: Para hacer frente a la actual crisis económica, las administraciones han impulsado medidas de ajuste que han afectado al sistema público de salud. Presentamos la percepción que de esas medidas tienen los/las médicos/as de atención primaria de dos centros de salud de Madrid. Método: Se desarrolló un estudio cualitativo en dos centros de salud del distrito de Fuencarral-El Pardo (Madrid), que tiene tasas de paro y de población inmigrante superiores a la media de la ciudad. Se realizaron 12 entrevistas semiestructuradas a médicos/as de dichos centros. El análisis de la información se basó en el análisis del contenido clásico. Resultados: Se identifican dos categorías: valoración de medidas de ajuste y valoración de la toma de decisiones en dicho proceso. Las personas entrevistadas manifiestan la necesidad de impulsar medidas que mejoren el sistema público de salud, pero expresan su desacuerdo con las implementadas. Consideran que no están basadas en la evidencia y que obedecen a una necesidad de ahorro a corto plazo. Creen que ha habido una mala comunicación de las medidas, sin la participación de profesionales sanitarios/as asistenciales en su priorización, elección e implementación. Consideran imprescindible esta participación porque son quienes conocen de forma práctica las disfunciones del sistema, teniendo más presente la centralidad del paciente. Conclusiones: Se hace imprescindible que los poderes públicos incorporen activamente a profesionales sanitarios/as asistenciales en la toma de decisiones para garantizar la implementación de medidas basadas en la evidencia, con un alto respaldo profesional, manteniendo así la calidad asistencial. [EN] To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. ; El estudio ha recibido la financiación del CIBERESP para la transcripción de ocho entrevistas. ; Sí

El feminicidio o asesinato de mujeres por razones de género es ya un reconocido problema de salud pública, además de una grave vulneración de los derechos humanos. Todavía se desconoce con exactitud su magnitud en el mundo, dadas las dificultades metodológicas para diferenciar estos asesinatos de otros homicidios de mujeres. El Programa de la Unión Europea «Redes de Cooperación Europea en Ciencia y Tecnología» puso en marcha en 2013 la Acción COST Femicide across Europe, abriendo un marco europeo óptimo para la cooperación transnacional entre personas expertas que aborden grandes retos sociales y de salud pública como el feminicidio. En esta nota de campo se describen sus principales objetivos, los grupos de expertos y expertas que lo conforman, y los resultados obtenidos a medio plazo con dicha experiencia.Femicide or the murder of women because of their gender is a recognised public health problem as well as a serious violation of human rights. Its magnitude worldwide is still unknown, given the methodological difficulties to differentiate these murders from other female homicides. The European Union programme entitled «European Cooperation in Science and Technology» (COST) launched the «Femicide across Europe» COST Action in 2013, establishing an optimal European framework for transnational cooperation among experts addressing great social and public health challenges such as femicide. This field note describes the main objectives, the participating groups of experts and the mid-term results of this experience.

Objective: To identify the ethical conflicts that may arise between the nursing codes of ethics and the Royal Decree-law 16/2012 modifying Spanish health regulations. Method: We conducted a review and critical analysis of the discourse of five nursing codes of ethics from Barcelona, Catalonia, Spain, Europe and International, and of the discourse of the Spanish legislation in force in 2013. Language structures referring to five different concepts of the theoretical framework of care were identified in the texts: equity, human rights, right to healthcare, access to care, and continuity of care. Results: Codes of ethics define the function of nursing according to equity, acknowledgement of human rights, right to healthcare, access to care and continuity of care, while legal discourse hinges on the concept of beneficiary or being insured. Conclusions: The divergence between the code of ethics and the legal discourse may produce ethical conflicts that negatively affect nursing practice. The application of RDL 16/2012 promotes a framework of action that prevents nursing professionals from providing care to uninsured collectives, which violates human rights and the principles of care ethics. ; Objetivo: Evidenciar los conflictos éticos que pueden surgir entre los discursos legal y ético, a través deexplorar el contenido del Real Decreto-Ley 16/2012 que modifica la ley sanitaria en Espa˜na y los códigoséticos.Método: Revisión y análisis crítico del discurso de cinco códigos éticos de Enfermería de Barcelona,Catalu˜na, Espa˜na, Europa e Internacional, y del discurso de la legislación sanitaria vigente en Espa˜naen 2013, en los que se identificaron y compararon estructuras lingüísticas referentes a cinco principiosy valores éticos del marco teórico de la ética de los cuidados: equidad, derechos humanos, derecho a lasalud, accesibilidad y continuidad de los cuidados.Resultados: Mientras que el discurso ético define la función enfermera en función de la equidad, el recono-cimiento de los derechos humanos, el derecho a la salud, la accesibilidad y la continuidad de los cuidadosde la persona, el discurso legal se vertebra sobre el concepto de beneficiario o asegurado.Conclusiones: La divergencia entre el discurso ético y legal puede producir conflictos éticos que afectennegativamente a la práctica de la profesión enfermera. La aplicación del RDL 16/2012 promueve un marcode acción que impide que los profesionales enfermeros presten sus cuidados a colectivos no asegurados,lo que atenta contra los derechos humanos y los principios de la ética de los cuidados.

Objetivo: Evidenciar los conflictos éticos que pueden surgir entre los discursos legal y ético, a través deexplorar el contenido del Real Decreto-Ley 16/2012 que modifica la ley sanitaria en Espa˜na y los códigoséticos.Método: Revisión y análisis crítico del discurso de cinco códigos éticos de Enfermería de Barcelona,Catalu˜na, Espa˜na, Europa e Internacional, y del discurso de la legislación sanitaria vigente en Espa˜naen 2013, en los que se identificaron y compararon estructuras lingüísticas referentes a cinco principiosy valores éticos del marco teórico de la ética de los cuidados: equidad, derechos humanos, derecho a lasalud, accesibilidad y continuidad de los cuidados.Resultados: Mientras que el discurso ético define la función enfermera en función de la equidad, el recono-cimiento de los derechos humanos, el derecho a la salud, la accesibilidad y la continuidad de los cuidadosde la persona, el discurso legal se vertebra sobre el concepto de beneficiario o asegurado.Conclusiones: La divergencia entre el discurso ético y legal puede producir conflictos éticos que afectennegativamente a la práctica de la profesión enfermera. La aplicación del RDL 16/2012 promueve un marcode acción que impide que los profesionales enfermeros presten sus cuidados a colectivos no asegurados,lo que atenta contra los derechos humanos y los principios de la ética de los cuidados.

Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers-with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on characteristics of the health systems in which they are embedded.

BACKGROUND: EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. The Decision provides a context for the present study, which aims to identify good practices and lessons learned in preparedness and response to Middle East Respiratory Syndrome (MERS) (in UK, Greece, and Spain) and poliomyelitis (in Poland and Cyprus). METHODS: Based on a documentary review, followed by five week-long country visits involving a total of 61 interviews and group discussions with experts from both the health and non-health sectors, this qualitative case study has investigated six issues related to preparedness and response to MERS and poliomyelitis: national plans and overall preparedness capacity; training and exercises; risk communication; linking policy and implementation; interoperability between the health and non-health sectors; and cross-border collaboration. RESULTS: Preparedness and response plans for MERS and poliomyelitis were in place in the participating countries, with a high level of technical expertise available to implement them. Nevertheless, formal evaluation of the responses to previous public health emergencies have sometimes been limited, so lessons learned may not be reflected in updated plans, thereby risking mistakes being repeated in future. The nature and extent of inter-sectoral collaboration varied according to the sectors involved, with those sectors that have traditionally had good collaboration (e.g. animal health and food safety), as well as those that have a financial incentive for controlling infectious diseases (e.g. agriculture, tourism, and air travel) seen as most likely to have integrated public health preparedness and response plans. Although the formal protocols for inter-sectoral collaboration were not always up to date, good personal relations were reported within the relevant professional networks, which could be brought into play in the event of a public health emergency. Cross-border collaboration was greatly facilitated if the neighbouring country was a fellow EU Member State. CONCLUSIONS: Infectious disease outbreaks remain as an ongoing threat. Efforts are required to ensure that core public health capacities for the full range of preparedness and response activities are sustained.

Background: EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. The Decision provides a context for the present study, which aims to identify good practices and lessons learned in preparedness and response to Middle East Respiratory Syndrome (MERS) (in UK, Greece, and Spain) and poliomyelitis (in Poland and Cyprus). Methods: Based on a documentary review, followed by five week-long country visits involving a total of 61 interviews and group discussions with experts from both the health and non-health sectors, this qualitative case study has investigated six issues related to preparedness and response to MERS and poliomyelitis: national plans and overall preparedness capacity; training and exercises; risk communication; linking policy and implementation; interoperability between the health and non-health sectors; and cross-border collaboration. Results: Preparedness and response plans for MERS and poliomyelitis were in place in the participating countries, with a high level of technical expertise available to implement them. Nevertheless, formal evaluation of the responses to previous public health emergencies have sometimes been limited, so lessons learned may not be reflected in updated plans, thereby risking mistakes being repeated in future. The nature and extent of inter-sectoral collaboration varied according to the sectors involved, with those sectors that have traditionally had good collaboration (e.g. animal health and food safety), as well as those that have a financial incentive for controlling infectious diseases (e.g. agriculture, tourism, and air travel) seen as most likely to have integrated public health preparedness and response plans. Although the formal protocols for inter-sectoral collaboration were not always up to date, good personal relations were reported within the relevant professional networks, which could be brought into play in the event of a public health emergency. Cross-border collaboration was greatly facilitated if the neighbouring country was a fellow EU Member State. Conclusions: Infectious disease outbreaks remain as an ongoing threat. Efforts are required to ensure that core public health capacities for the full range of preparedness and response activities are sustained. ; This work was funded under the European Centre for Disease Prevention and Control's Framework Contract Number ECDC/2014/005.