To analyze two good practices of intersectoral coordination promoted by public health, including primary care and other health and non-health sectors, and to identify the strengths and weaknesses perceived by public health and primary care professionals for the development of effective coordination. A qualitative and participatory study was conducted based on the analysis of two well-established experiences: the mihsalud program (Valencia) and the Barcelona Action Plan on Drugs and Addictions (PADAB). The study combined a descriptive review of the practices with a participatory strategic analysis using the SWOT methodology. A total of 27 public health and primary care professionals from one autonomous community were purposively selected to identify strengths, weaknesses, opportunities, and threats related to coordination, as well as proposals for improvement. Both experiences show that shared governance, community participation, and intersectoral collaboration facilitate the integration of public health and healthcare services, contributing to the sustainability and effectiveness of interventions. Key strengths include professional expertise, the existence of supportive regulatory frameworks, and interinstitutional partnerships. Nevertheless, persistent weaknesses were identified, such as organizational fragmentation, lack of interoperability of information systems, limited joint training, and insufficient stable funding. The SWOT analysis made it possible to define strategies aimed at strengthening interdisciplinary training, improving interoperability, reducing bureaucracy, and consolidating stable governance frameworks. Effective coordination between public health and healthcare services is essential to improve equity, system efficiency, and health outcomes. The experiences analyzed provide transferable lessons that highlight the need for structural reforms, sustained investment, and the strengthening of collaborative governance to move toward integrated and sustainable models.
To describe potential conditioning factors and to analyse improvement measures proposed by reporters in hospitals of an autonomous region of Spain. A cross-sectional study was conducted analysing all notifications from the public hospital network reported in Aragon (Spain) during 2023. Among all reports (n=959), incidents related to medication prevail (22.9%), followed by falls (14.9%) and identification issues (6.2%). Most of the reports were submitted by nurses (79.14%). Free text categories mainly indicated a need for improvements in terms of correct identification of patients and samples, both interpersonal and family communication, and a need of improvement in hospital staff stability and training. Despite the limitations of the study, the main one being the voluntary and anonymous nature of the notification system, it presents a valuable source of knowledge to identify patient safety issues. In addition, following notifiers' reports, it raises several important challenges, including better training for the notifying staff and the adoption of legal measures that guarantee the safety of the notifiers.
To explore the trends in hospitalisations and referrals to a psychiatrist among 0- to 30-year-olds with a pre-existing mental disorder between 2019 and 2022. We conducted an observational study of psychiatric hospitalisations and referrals from primary care to psychiatric services in the Basque Country population aged 0-30 years with a previously recorded mental disorder, from 2019 to 2022. Logistic regression models were used to assess the effects of calendar year (2019-2022), gender, age, psychiatric comorbidity and socioeconomic status. Of the 608,984 individuals in 2019, 97,962 had a mental health diagnosis. Of these individuals, 0.77% were admitted to a psychiatric ward, while 9.44% were referred to a psychiatrist. Overall, there was a decrease in hospitalisations among patients in 2020, with an odds ratio (OR) of 0.89 (confidence interval [CI]: 0.79-0.99), followed by increases in 2021 (OR: 1.22; CI: 1.10-1.36) and 2022 (OR: 1.29; CI: 1.16-1.43). The clusters with the greatest increases in hospitalisations were self-harm and anxiety. Total referrals to specialist services did not show significant changes. Patients with a low to middle socioeconomic status were more likely to decompensate. Psychiatric comorbidity was the main cause of decompensation, with an OR >40. The change in trend on mental health decompensation was more evident in hospital-based care than in community care. The high decompensation rate in people with psychiatric comorbidities indicates a deterioration in clinical course, suggesting the need for more intensive monitoring.
To describe human papillomavirus (HPV) vaccination coverage among people living with human immunodeficiency virus (HIV) and evaluate factors influencing completion of the vaccination schedule. Retrospective study of 198 HIV patients aged ≥18 years in active follow-up at Hospital Clínico Universitario San Juan (Alicante, Spain) during 2018-2023. Sociodemographic and clinical variables, referral/attendance at preventive medicine service (PMS), and completion of HPV vaccination (3 doses) were collected. Adjusted logistic regression analyses were used to determine factors associated with complete HPV vaccination. Overall, 19.7% (39/198) of individuals in follow-up successfully completed the three-dose HPV vaccination regimen. In the multivariable model adjusted for age, biological sex, CD4 nadir, time since HIV diagnosis, and time in study, attendance at PMS (OR: 4.20; 95%CI: 2.00-8.80), time since diagnosis (OR: 1.19; 95%CI: 1.00-1.42), and loss to follow-up (OR: 0.14; 95%CI: 0.04-0.33) were associated with complete vaccination. HPV vaccination coverage among people with HIV remains suboptimal. Referral and attendance at PMS are key determinants of vaccination success, whereas loss to follow-up represents a major barrier. Interventions in tertiary care should prioritize patient retention after referral to specialized programs.
Patient and public involvement in research contributes to improving the relevance of studies, although its reporting in the literature is inconsistent and lacks clarity. To enhance the transparency and quality of this involvement, the GRIPP2 (Guidance for Reporting Involvement of Patients and the Public) guidelines were developed, providing specific guidance for systematic and transparent reporting. This methodological note describes the adaptation and translation of these guidelines into Spanish, with the aim of promoting quality, consistency, and transparency in the evidence on patient and public involvement in research. Two versions are presented: GRIPP2 long form, with 34 items aimed at studies where patient and public involvement is the primary focus, and GRIPP2 short form, with 5 items for studies where involvement is a secondary component. The guidelines are primarily intended for researchers and authors wishing to incorporate patient and public involvement in their research, as well as for reviewers and journal editors. Additionally, they may be of interest to research policy makers, funding agencies, health technology assessment bodies, and, of course, patients and the public.
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Mamás del Río is a community-based intervention that, since 2015, has strengthened maternal and child health in the Peruvian Amazon by empowering community health workers. In July 2024, a leadership workshop was conducted with 24 Indigenous community health workers, employing participatory and intercultural methodologies. The workshop was structured in three stages: 1) participatory diagnosis, 2) capacity building, and (3) strategic planning. As a result, key challenges were identified, and an action plan was developed focusing on partnership development, economic sustainability, and organizational strengthening of the Asociación de Agentes Comunitarios de Salud Intercultural de Loreto. This experience highlights the potential of community empowerment in rural settings and underscores the fundamental role of community health workers in Amazonian health systems.
To explore women's perceptions and their improvement proposals of a Women's Space for women experiencing homelessness, from a gender perspective. Between November 2023 and December 2024, an exploratory qualitative study was conducted using a phenomenological approach. The sample included eight cis women of Women's Space within a center for people experiencing homelessness in Barcelona. Data was collected through two triangular groups and three individual interviews conducted in Spanish and English. Thematic analysis combined deductive and inductive approaches, based on script structure, categorization, and triangulation. Women's perceptions and proposals were grouped into four categories: 1) reasons for attending, 2) organizational and physical structure, 3) services and activities, and 4) interpersonal relationships among participants, volunteers, and staff. Attendance was primarily motivated by the female-only environment, and the fulfilment health needs for hygiene, rest, food, safety and social connection, and belonging. Participants valued the respectful and supportive atmosphere and suggested extending the duration of the sessions, improving hygiene and food services, and diversifying activities. Interpersonal relationships among women, volunteers, and staff were highly valued. Women reported that Women's Space addressed essential health and social needs in a safe environment. These results could be transferred to other women-only spaces with similar sociodemographic characteristics. This study expands the literature on female homelessness and the integration of a gender perspective into care services.
The quality, equity, and sustainability of health systems depend in part on effective health care coordination, which raises ethical and legal challenges that go beyond purely operational concerns. In decentralized systems such as the Spanish one, inadequate coordination is associated with fragmented care, increased risk of iatrogenesis, inefficient use of resources, rising costs, and loss of public trust, placing fundamental ethical values such as justice, responsibility, transparency, and beneficence under strain. This article presents a narrative review of a conceptual and normative nature that examines the ethical and legal aspects of health care coordination in Spain, distinguishing between interorganizational coordination within the National Health System and intraorganizational coordination within health care organizations. The analysis shows that although the legal framework provides formal coordination mechanisms, their effectiveness largely depends on ethical governance practices, responsible leadership, and deliberation among actors with diverse interests and values. From an ethical perspective, the article argues that health care coordination involves principles of distributive justice, equity, efficiency, and transparency, and that health care organizations should be recognized as moral agents responsible for the consequences of their decisions. As a result, an ethical framework for decision-making in health care coordination is proposed, highlighting the role of organizational ethics committees as deliberative spaces, with implications for health care management, clinical practice, and public policy aimed at reducing inequities and improving system quality.
To analyze whether Emergency Aid Program (EAP) availability and COVID-19 vaccination were associated to changes in hospitalizations and mortality due to COVID-19 in Brazil. This was a longitudinal ecological study with 5570 Brazilian municipalities as analysis units. Data from March 2020 to December 2021 were analysed. As control covariates, we considered socioeconomic, sociodemographic and morbidity characteristics and health services access, including COVID-19 testing availability and vaccination. Bayesian hierarchical models were adjusted with spatial and temporal effects. EAP coverage (RR: 0.986; 95%CI: 0.984-0.988) and COVID-19 vaccine first dose coverage (RR: 0.982; 95%CI: 0.979-0.985) exhibited a negative association with the relative risk of COVID-19 hospitalization in Brazil. EAP coverage (RR: 0.975; 95%CI: 0.973-0.977), first-dose COVID-19 vaccine coverage (RR: 0.983; 95%CI: 0.981-0.985), and coverage of regular vaccination in children under 5 years old (RR: 0.996; 95%CI: 0.994-0.996) exhibited a negative association with COVID-19 mortality. The results highlight the important role of income transfer in COVID-19 morbidity and mortality, as well as the complementary effects and relevance of strengthening social protection policies and vaccination efforts in reducing severe cases in a pandemic scenario.
The Spanish National Health System, founded on the principles of universality and equity, faces structural challenges arising from population ageing, increasing chronicity, and the fragmentation of the care system. This fragmentation represents its main weakness and particularly affects people with complex conditions, characterized by multimorbidity and combined health and social care needs. Although various care integration initiatives have been promoted in recent decades, such as the Integrated Health Organizations in the Basque Country and Catalonia, their results have been uneven and, in many cases, limited. The article argues that the central problem does not lie in the absence of organizational structures, but in the mismatch between existing coordination models and people's actual needs, and it presents four main theses. First, coordination must be adapted to the level of clinical, social, and care complexity, avoiding uniform approaches that are ineffective for the most vulnerable groups. Second, it is necessary to address persistent structural barriers, such as misaligned financing systems and professional hierarchies. Third, coordination facilitators must be specific, operational, measurable, and sustainable, avoiding the transfer of solutions across contexts without proper adaptation. Finally, the article highlights the importance of clearly defining key professional roles. Overall, the text proposes moving toward a person-centered coordination model that acknowledges complexity, strengthens primary care, and contributes to improving health outcomes and system equity.
To qualitatively analyze the abuse situations, as well as victims' perception on the resources needed for reporting and prevention. Interviews with 10 medical students and 15 medical residents were conducted using a semi-structured questionnaire. The interviews were interrupted once saturation was reached in both aspects of the research subject. Information was collected using pre-designed outlines and completed with transcribed notes at the end of each interview. A range of power abuse behaviors were identified, including social exclusion, hierarchical dynamics, and insufficient teaching and mentorship. Participants reported arbitrary favoritism of colleagues in the allocation of on-call duties. Instances of mockery, verbal abuse, and racial slurs were described. Gender-based discrimination manifested through sexist remarks and the sexualization of female physicians, including inappropriate comments and unsolicited advances, such as non-consensual touching and kissing. Victims frequently refrained from reporting these events due to fear of retaliation or a lack of awareness regarding available reporting mechanisms. Participants emphasized the need for preventive and protective strategies, and proposed training in labor rights and medical professionalism, alongside mentorship by educators genuinely committed to teaching, as essential preventive measures. The results of this initial investigation support the notion that abuse is part of the medical training process. Victims identified multiple preventive strategies that merit consideration at the institutional level within both academic and healthcare settings.
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To develop and asses the usability of a Spanish-language mobile application (PreveCan) to educate the public about the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) recommendations for cancer prevention. The app was developed using a user-centred design approach involving epidemiology, medical, nutrition and software design experts and public. PreveCan educates users on WCRF/AICR recommendations rating their adherence from 1 (poor) to 5 (excellent), offering advice for improvement and evidence-based additional information on the relationship between lifestyles and cancer. Usability was assessed in a cross-sectional study of 181 participants using a translated version of the 20-item mHealth App Usability Questionnaire, which rated ease of use and satisfaction, information layout, and overall usefulness of PreveCan on 1-5 scale. General usability of PreveCan was rated highly, with a median score of 94/100 (IQR: 85-99). Ease of use and satisfaction scored 39/40 (IQR: 35-40), with 87% of users rating all items ≥4 points. Information organization scored 33/35 (IQR: 30-35), with 83% of users rating ≥4. Usefulness was rated ≥4 by 77% of users, but satisfaction was slightly lower (22/25; IQR: 20-25). Common feedback highlighted the need for a standardized response format and stronger incentives to encourage regular use. Based on this, PreveCan was updated and is freely available on Google Play and the Apple Store. PreveCan is a useful tool to inform Spanish-speaking users on lifestyle changes to reduce cancer risk by assessing adherence to WCRF/AICR cancer prevention guidelines.
To conduct a spatio-temporal analysis of the incidence and severity of COVID-19 in the municipalities comprising the large urban area of Madrid (GAU) across five epidemic periods, considering the impact of demographic, with the deprivation index included as the socioeconomic indicator. An ecological study and a spatio-temporal analysis of COVID-19 were conducted from June 22, 2020 to March 28, 2022, encompassing five epidemic periods. The first epidemic period was excluded from the analysis. The variables used were: the population of the 52 municipalities within the GAU of Madrid, disaggregated by postal code and stratified by sex; and total confirmed COVID-19 cases and hospitalizations among individuals with laboratory-confirmed COVID-19 reported to the National Network of Epidemiological Surveillance, and the 2011 Deprivation Index of the Spanish Society of Epidemiology. The incidence ratio (IR) was calculated using the indirect adjustment method and the percentages of hospitalised cases for each postcode. In addition, the Moran Index for IR was calculated and spatial regression models were used to analyse the relationship between socioeconomic and demographic variables and IR and percentage of hospitalised cases. The risk of infection exceeded the national average during the second and fourth epidemic periods (IR: 1,15 in men and 1,14 in women in the second period, and 1,48 in men and 1,47 in women in the fourth period) exhibiting generally heterogeneous spatial patterns. In the spatial analysis, no increased risk of COVID-19 infection was observed in areas with higher social deprivation; however, these areas showed a higher risk of hospitalization (statistically significant regression model coefficients ranging from 0,87 to 4 in all periods and for both sexes). Socioeconomic deprivation was not associated with a higher incidence of COVID-19, but it was associated with a higher proportion of hospitalizations, consistent with previous studies. The study of different population determinants and public health factors is necessary to assess and guide decision-making in the face of emerging diseases.
Patient and public involvement (PPI) is an essential component of Health Technology Assessment (HTA), as it enhances the relevance and transparency of evaluation processes. Nevertheless, the scope of such involvement varies considerably across contexts, and empirical evidence on current practices within the National Health System remains limited. This study will examine the extent to which HTA reports incorporate PPI and how these practices are performed and described. We will conduct a cross-sectional meta-research study of HTA reports produced by the Spanish Network of HTA Agencies (RedETS) between 2020 and 2026. Eligible reports will be identified through public repositories (https://redets.sanidad.gob.es/). A random sample of 150 reports will be selected. General and methodological characteristics, and PPI reporting practices will be extracted (by at least three researchers) from each HTA report using a standardised data extraction form. Descriptive analyses will be carried out to synthesise PPI reporting practices. Open Science Framework (https://osf.io/k6e3q/).
Healthcare coordination is an essential element in ensuring comprehensive, equitable, and high-quality care in the National Health System (NHS). This article analyzes the role of health strategies as technical and political tools aimed at improving coordination between levels of care and territories, promoting continuity of care, and strengthening healthcare governance. It reviews their evolution in Spain since Law 16/2003 on cohesion and quality in the NHS, highlighting their dual dimension: an instrument for rational planning and an expression of political and ethical commitment. Based on an evidence-based and participatory approach, the structural components of an effective strategy are identified: definition of the object, vision and mission, scope, guiding principles, participation, evaluation, territorialization, and connection with international commitments. Relevant experiences, such as the Strategy for Addressing Chronicity, are examined, and international contributions from the World Health Organization and leading authors are incorporated. It concludes that the success of strategies depends on their ability to integrate different levels and actors, institutionalize participatory processes, and ensure the continuity and sustainability of actions. Their value lies in converting the principles of equity, justice, and rights into operational decisions that strengthen public health and the cohesion of the NHS.
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