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To describe the evolution of individually notifiable sexually transmitted infections diagnoses in the city of Barcelona between 2007 and 2024, and to analyse their association with sociodemographic variables and the type of reporting centre. Temporal trend analysis based on population-level data on cases of syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum in the city of Barcelona. Annual incidence rates and adjusted incidence rate ratios were estimated using robust Poisson regression, adjusting for sociodemographic variables and stratifying by type of centre. Overall, 44.3% of diagnoses were made in community-based services, 30.6% in primary care and 24.9% in hospital-based care. Men accounted for 78.6% of cases and were predominantly diagnosed in community settings, whereas women were mainly diagnosed in primary care. Compared with the 25-34-year age group, the probability of being diagnosed in any type of care setting decreased with increasing age. Being born in Central or South America was associated with a 112% higher probability of diagnosis in primary care and a 144% higher probability in hospital care. Low socioeconomic status was associated with a 238% higher probability of diagnosis in primary care. Sexually transmitted infections diagnoses in Barcelona show potential inequalities by sex, country of birth and socioeconomic level, which are reflected in the type of healthcare setting where diagnoses are made. The COVID-19 pandemic appears to have accentuated these patterns, with a relative shift in diagnostic activity towards community-based services. Strengthening primary care and improving coordination between healthcare settings are needed to move towards a more equitable model of sexual health care.

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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 the networks of health-promoting settings in Spain, with the aim of learning from the accumulated experience and thus contributing to their development. A document analysis of health-promoting settings in Spain using web searches and selected publications. A combination of terms and inclusion/exclusion criteria were used. The following information was collected from each network: geographic scope, name, website, settings included, objectives, number of members, whether it is a network of networks and/or integrated into a larger network. Subsequently, the Health Promotion Panel of the Public Health Commission was contacted to review the results. Sixty-seven networks were identified, of which 41 were included. All autonomous communities, except Illes Balears, Ceuta, and Melilla, have networks of health-promoting settings. The settings are varied: schools, health centers, municipalities, companies, universities, beaches, and parks. Four networks of networks and four networks integrated into a broader network were identified. Only five (12.2%) were created through legislation. Networks of health-promoting settings are a widespread model in Spain, developed across diverse scopes and contexts.

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This study analyzes the arguments underlying hesitation to receive any COVID-19 vaccine and how these discourses may have evolved throughout the pandemic. An exploratory, descriptive qualitative study was conducted in 2021-2022 in the province of Granada (Spain). Data were collected through four semi-structured interviews and three focus groups using theoretical sampling with individuals who expressed hesitancy toward COVID-19 vaccines. A thematic analysis was performed, leading to the development of a typology of vaccine-hesitant profiles. Participants' narratives about the origin of the virus ranged from moderate interpretations to conspiratorial explanations, while COVID-19 was perceived either as a mild illness or as one exaggerated by the media. The overabundance of information encouraged reliance on alternative sources and personal experience as evidence. Hesitant arguments clustered around two domains: scientific-public health concerns (including doubts about vaccine effectiveness, accelerated approval processes, components, and potential adverse ef fects) and ethical-political concerns (such as bodily autonomy, stigma, implicit mandates, and sociopolitical polarization). Four profiles of hesitancy were identified: empowered, infoxicated, paralyzed and resistant. These profiles reflecting different levels of agency, uncertainty, and distrust toward scientific and governmental institutions. The "neo-hesitancy" emerging around COVID-19 vaccines exhibits distinct features compared with "classical" vaccine hesitancy, incorporating a political dimension that undermines trust in health authorities and public health policies. Non-coercive, profile-specific strategies and transparent public communication that integrates scientific and community collaboration are recommended to strengthen preparedness for future health crises.

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This study investigates the application of the synthetic control method for the evaluation of public health policies, specifically assessing the impact of the 2010 anti-smoking legislation in Spain. This policy, which represented a paradigmatic shift, aimed to reduce smoking prevalence and its multiple consequences for public health. Utilizing data on tobacco consumption prevalence across various countries alongside key predictors of consumption, we examine the effectiveness of the legislation in reducing smoking rates. To achieve this, the synthetic control method is employed to construct a 'synthetic Spain' from a weighted combination of countries within a donor pool. This counterfactual represents the smoking prevalence that would have been observed in Spain in the absence of the law. The empirical results demonstrate that the legislation successfully reduced tobacco consumption. However, its gender-differentiated impact suggests the necessity of implementing gender-responsive regulatory frameworks.

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To identify and evaluate the questions included in Spanish national and regional surveys on emerging tobacco products, and to assess whether these questions regarding electronic cigarettes (e-cigs) comply with the stablished recommendations. The websites of national and regional public organisms were reviewed to identify surveys that included questions on the consumption of emerging tobacco products, and to extract and evaluate the wording; for e-cigs, the alignment of the questions with the criteria recommended was assessed with an ad hoc scale. Three national and seven regional surveys were identified, of which nine assessed the exclusive use of e-cigs, three surveys assessed the exclusive use of water pipes and one assesses the use of e-cigs and/or heated tobacco products. With regard to e-cigs, the surveys differ in the questions used and do not follow the recommendations. Health and drug surveys conducted in Spain, at the national and regional levels, collect information on a limited number of emerging tobacco products, focusing primarily on e-cigs and, to a lesser extent, water pipes. Having detailed information on new forms of consumption, the characteristics of the device used in the case of e-cigs, the perceived risk, and the reasons for use can help evaluate prevention campaigns and public health measures.

This article reviews the long and complex process of institutionalizing public health in Spain, from the mid-nineteenth century to the present, highlighting its persistent structural fragility despite the accumulation of regulatory advances. Beginning with the 1855 Health Act, conceived as a response to cholera epidemics, the paper describes the gradual assumption by the State of responsibilities for protecting collective health, in parallel with the late consolidation of the Spanish state itself. It shows how, throughout the twentieth century, public health was often subordinated to a view of health policy as a matter of public order or overshadowed by the development of healthcare services linked to the Social Security system, particularly during the Franco dictatorship. The democratic transition and the 1986 General Health Act represented a decisive step forward for healthcare services but failed to fully integrate public health or provide it with sufficient resources, a fragmentation that was further exacerbated by the transfer of responsibilities to the Autonomous Communities. The 2011 General Public Health Act and, more recently, the creation of the State Public Health Agency in 2025 opens a new phase shaped by the experience of the COVID-19 pandemic. Nevertheless, the effective consolidation of public health in Spain will depend less on legislation than on the availability of sufficient and stable financial and professional resources.

Misinformation is one of the main global risks threatening public health. During public health crises, which often involve a high degree of scientific uncertainty and a high social demand for information, the infodemic contributes to misinformation. The objective of this article is to analyze how to communicate effectively to contribute to the fulfillment of the public health mission while avoiding misinformation. Strategic communication, one of the essential functions of public health, involves not only providing the right message at the right time, delivering it to the right messenger, and disseminating it through the appropriate channels (mass, community, and interpersonal media), but also defending against the corporate capture of public health. In public health crises, the goal of communication is to enable people to make informed decisions to reduce risk and mitigate the impact of the crisis, recognizing and addressing community concerns and emotions, providing clear and truthful information, without hiding the uncertainties. Traditional media and social media are the primary sources of public health information for the population, especially during crises, so the active presence of public health institutions and professionals in these media is essential. Interinstitutional collaboration between levels of government with expertise in public health, including primary care professionals, and community leaders increases the coherence and effectiveness of messages, avoiding confusion and promoting public trust.

Established in 1988, the Unified Health System (SUS) unified the public system by transferring social security resources to states and municipalities. Its principles are universal access, fiscal financing, decentralization, and regional organization guided by primary health care. Financing is the responsibility of the three levels of government, with increasing municipal participation. Total health expenditure is 9.8% of GDP, with 44% public, 29% from private insurance, and 22% out-of-pocket spending. Underfunding has been an obstacle since SUS's creation, as public spending being lower than private constitutes a barrier to the principle of universal access. Governance proposes collegial decision-making between government levels and social participation, but in practice management is still fragmented, influenced by political-party interests and high turnover of managers, making it difficult the build of integrated networks. Nevertheless, the expansion of primary health care through the Family Health Strategy in 5570 municipalities, with 53,000 teams and 280,000 community agents, has had positive impacts. The current agenda of regionalization and expansion of specialized care aims to reduce waiting times, strengthen system legitimacy, and could promote its reconstruction from the ground up. Integrated public-private regulation and structural limits on social spending remain persistent challenges.

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.

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This study estimates life expectancy by sex and analyzes its relationship with social deprivation along the stations of Madrid Metro Line 5. It also applies a linear model to predict life expectancy in men and women. A descriptive and analytical study was conducted on the population living within 350 meters of each station (2015-2019). Socioeconomic status was assessed using a deprivation index. Pearson's correlation coefficient was applied to explore the relationship between life expectancy and deprivation by sex. Multiple linear regression models were then used to analyze the influence of index components. Socioeconomic inequalities were identified along the line. Average life expectancy was 82.29 years in men (95%CI: 80.05-84.54) and 86.95 in women (95%CI: 85.15-89.11). In men, it was inversely related to the deprivation index (r=-0.38; p <0.005). In women, a model including electoral abstention (p <0.005) and unemployment (p <0.005) explained 23% of the variability. Life expectancy varies along Madrid Metro Line 5. In men, it is associated with socioeconomic status, whereas in women electoral abstention and unemployment stand out. These findings reinforce the need for public health interventions aimed at reducing social inequalities.

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.

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This paper assesses whether integrated care policy instruments, from a primary care perspective, improve care outputs and outcomes, identifying lessons for the Spanish National Health System (SNS). A scoping review of 18 reviews (systematic, scoping, narrative, and meta-analyses) focused on disease-agnostic integrated care instruments, including care coordination models, incentive structures, resource distribution, professional competencies, communication channels, and governance. Additional policy documents and studies referring to the SNS were also analysed. Overall, the review identified studies addressing partial aspects of integrated care that frequently lacked robust methods to establish meaningful associations with care outcomes. Integrated care instruments were generally associated with modest improvements in service delivery and patient experience, with limited evidence of impact on health outcomes. Some instruments (multidisciplinary coordination, case management, and bundled payments) appeared more relevant, whereas others (resource distribution, use of information and communication technologies, professional training, or patient engagement) showed no consistent association. In Spain, strong regulatory instruments facilitated implementation but did not ensure a sustained transition from fragmented to integrated care. The development of fit-for-purpose information systems seems essential to support this transition, while the lack of publicly available data and independent evaluations limits understanding of the real impact of integrated care. Current evidence does not confirm that integrated care leads to better health outcomes; however, some integrated care instruments may improve certain care outputs. To better inform decision-making, future studies should adopt multifaceted approaches and more robust methodologies.