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au:López Fernández, Luis Andrés

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Hacia una salud pública orientada desde los determinantes sociales de la salud: informe de un taller
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González Rojo, Elena

; Álvarez-Dardet, Carlos

; López Fernández, Luis Andrés

Gaceta Sanitaria

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oct 2018, Volume 32 N. 5 Pages 488 - 491

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT This article is the result of a workshop with public health experts held in Granada (Spain) in October 2015 in order to reflect upon the components of the framework that should be part of a public health approach based on the social determinants of health. Advocacy and training professionals in health advocacy were identified as key elements where this was needed. During the workshop, it was agreed that the gender perspective, the salutogenic approach, interdisciplinary work and particular attention to disadvantaged groups are crucial. The importance of working from a human rights’ framework and promoting legislative changes were also mentioned. Moreover, the group mentioned that even though much progress has been made identifying social determinants of health and creating conceptual frameworks, there is limited knowledge about how to intervene to reduce health inequality gaps in our societies.

RESUMEN Este artículo es el producto de los resultados de un taller con expertos y expertas en salud pública realizado en Granada en octubre de 2015, que tuvo por objetivo reflexionar sobre qué elementos clave deberían caracterizar una salud pública orientada desde los determinantes sociales de la salud. La labor de abogacía y la formación de profesionales críticos en defensa de la salud pública fueron señalados como elementos centrales. Hubo acuerdo en que el enfoque de género, la mirada salutogénica, el trabajo con otros sectores y una particular atención a colectivos más desfavorecidos son también elementos indispensables. Se subrayó la importancia de trabajar desde un marco de derechos humanos y de promover cambios legislativos. Además, el grupo señaló como reto la necesidad de generar conocimiento sobre cómo intervenir para reducir las brechas de desigualdad en salud, porque hasta ahora solo se ha avanzado identificando determinantes sociales de la salud y generando marcos conceptuales.

https://doi.org/10.1016/j.gaceta.2017.09.003 11 downloads

Hacia una salud pública orientada desde los determinantes sociales de la salud: informe de un taller
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González Rojo, Elena

; Álvarez-Dardet, Carlos

; López Fernández, Luis Andrés

Gaceta Sanitaria

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oct 2018, Volume 32 N. 5 Pages 488 - 491

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

https://doi.org/10.1016/j.gaceta.2017.09.003

Políticas de austeridade fiscal: tentativa de desmantelamento do Sistema Nacional de Salud da Espanha e resistência cidadã
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Borges, Fabiano Tonaco

; Fernández, Luís Andres López

; Campos, Gastão Wagner de Sousa

Saúde e Sociedade

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sep 2018, Volume 27 N. 3 Pages 715 - 728

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Este ensaio de natureza teórica analisa os ajustes fiscais colocados em marcha na Espanha como resposta à crise financeira de 2008, suas implicações para o Sistema Nacional de Salud (SNS) e a consequente resistência cidadã. Elaboramos um estudo de caso tendo como fonte primária a narrativa de um ator social que participou da reforma espanhola. Utilizamos também fontes secundárias para coleta de dados socioeconômicos e a análise de 20 artigos publicados pelo Relatório Sespas 2014. O SNS formou-se por aumento progressivo da cobertura populacional, financiamento total por impostos e organização da rede por meio da Atenção Primária em Saúde (APS). As medidas de austeridade fiscal impuseram limitações de ordem orçamentária, reduziram a provisão de serviços, introduziram copagamentos e retrocederam o direito à saúde à meritocracia. A corrente crítica da economia política sinaliza que o propósito dos ajustes econômicos é a transferência regressiva de renda e riqueza. As Mareas Ciudadanas constituíram-se numa resposta cidadã com êxito em muitas lutas sociais contra a austeridade fiscal. A alternativa de resistência e superação pela via política se fez presente com vigor na Espanha e tem resistido ao desmantelamento do SNS.

Abstract This theoretical essay analyzes the fiscal measures adopted in Spain as a response to the economic crisis of 2008, its implications to the Spanish National Health System (SNS) and the social response. We performed a case study having as primary source of information the narrative of a social actor who participated in the Spanish reform. We also used secondary sources to gather socioeconomic data and performed a literature review of 20 articles published in the 2014 Sespas Report. SNS was implemented by a progressive growth of healthcare coverage, complete funding by taxes and Primary Health Care-based organization. Austerity measures imposed cuts on the health care budget, reduced the roll of services delivered, introduced co-payments, and moved the universal coverage back to meritocracy. Critical political economy pointed out that the purpose of the measures on fiscal policy is to regressively redistribute income and wealth. The Mareas Ciudadanas constituted themselves as a citizen response with success in many social struggles against austerity. The alternative of resistance and overcoming through a political path is strongly present in Spain and is resisting the dismantling of SNS.

https://doi.org/10.1590/s0104-12902018180043 20 downloads

Políticas de austeridade fiscal: tentativa de desmantelamento do Sistema Nacional de Salud da Espanha e resistência cidadã
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Borges, Fabiano Tonaco

; Fernández, Luís Andres López

; Campos, Gastão Wagner de Sousa

Saúde e Sociedade

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sep 2018, Volume 27 N. 3 Pages 715 - 728

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s0104-12902018180043 2538 downloads

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study)
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Torres, Armando

; Torregrosa, Vicens

; Marcen, Roberto

; Campistol, Josep María

; Arias, Manuel

; Hernández, Domingo

; Fernández, Constantino

; Esforzado, Nuria

; Paschoalin, Raphael

; Pérez, Nuria

; García, Ana Isabel

; Amo, Montserrat del

; Pomés, Jaume

; González Rinne, Ana

; Marrero, Domingo

; Pérez, Estefanía

; Henríquez, Fernando

; Díaz, Juan Manuel

; Silva, Irene

; López, Verónica

; Perello, Manuel

; Ramos, David

; Beneyto, Isabel

; Cruzado, José María

; Martínez Castelao, Alberto

; Bravo, Juan

; Rodríguez, Minerva

; Díaz, Carmen

; Crespo, Josep

; Anaya, Fernando

; Rodríguez, María Luisa

; Cubero, Juan José

; Pascual, Pilar

; Romero, Rafael

; Andrés Belmonte, Amado

; Checa, María Dolores

; Jiménez, Carlos

; Escuin, Fernando

; Crespo, Marta

; Mir, Marisa

; Gómez, Gonzalo

; Bayes, Beatriz

; González, María José

; Gutiérrez, Alex

; Cuberes, Marta

; Rodríguez Benoit, Alberto

; García, Teresa

; Llamas, Francisco

; Ortega, Agustín

; Conde, José Luis

; Gómez Alamillo, Carlos

Nefrología (Madrid)

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jun 2016, Volume 36 N. 3 Pages 255 - 267

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Background and objectives: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Results: Vitamin D deficiency (25OHD3 < 15 ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p = 0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p = 0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100 pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

resumen está disponible en el texto completo

https://doi.org/10.1016/j.nefro.2016.03.004 345 downloads

Derivación a las consultas de gastroenterología desde atención primaria: evaluación de dos programas
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Quintas Lorenzo, Paola

; Dacal Rivas, Andrés

; Francisco González, María

; Cubiella Fernández, Joaquín

; López Sánchez, Luis

; García García, María Jesús

; Fernández Seara, Javier

Gaceta Sanitaria

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dec 2011, Volume 25 N. 6 Pages 468 - 473

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Objectives: To analyze the effect of implementing a high-resolution clinic (HRC) and an increasing resolution capacity program in primary care (IRCPPC) for referrals to a gastroenterology outpatient clinic from primary care and the resources used. Methods: A retrospective and observational study based on a review of referral sheets and databases was performed. We analyzed the number and reason for referrals, delay times and resource consumption in two periods: before (first 4 months of 2007) and after (first 4 months of 2009) the launch of the IRCPPC and HRC. Results: In the first and second periods, 881 and 1076 patients, respectively, referred from primary health care were evaluated in the gastroenterology clinic, with a decrease in the delay time in the second period (80.8±64.34 days vs 36.1±29.12 days, p<0.001). The most frequent reasons for referral were dyspepsia (27.7%), high-risk of colorectal cancer (17.1%), disturbance of bowel rhythm (18.2%), abdominal pain (16%), and gastroesophageal reflux (11.2%), with no differences between the two periods. Although delay times until the first visit (10.8±9.03 days vs 42.8±28.67 days, p<0.001) and until discharge (39.6±80.65 days vs 128.6±135.34 days, p<0.001) were lower in referrals to the HRC, the number of visits (3.6±2.20 vs 3.2±1.95, p=0.015) and the cost of referrals (592.7±421.50 € vs 486.0±309.66 €, p<0.001) was higher. Conclusions: In the study period the number of referrals increased, while the delay time decreased. Although the HRC reduces delay times, it is associated with an increase in health resource use.

Objetivo: Analizar el efecto de la puesta en marcha de una consulta de alta resolución (CAR) y de un programa de aumento de la capacidad resolutiva de atención primaria (PACRAP) en las derivaciones a las consultas de gastroenterología desde atención primaria y en los recursos utilizados. Métodos: Estudio observacional retrospectivo basado en la revisión de las hojas de derivación y de las bases de datos de documentación clínica. Se analizaron el número y el motivo de las derivaciones, los tiempos de demora y el consumo de recursos en dos periodos: anterior (primer cuatrimestre de 2007) y posterior (primer cuatrimestre de 2009) a la puesta en marcha de la CAR y el PACRAP. Resultados: Se evaluaron 881 derivaciones en el periodo anterior y 1076 en el posterior, y se halló una disminución de los tiempos de demora en el segundo periodo (80,8±64,34 días frente a 36,1±29,12 días, p<0,001). Las causas de derivación más frecuentes fueron dispepsia (27,7%), alto riesgo de cáncer colorrectal (17,1%), alteración del ritmo intestinal (18,2%), dolor (16%) y reflujo gastroesofágico (11,2%), sin diferencias entre ambos periodos. En el segundo periodo, los tiempos de demora fueron menores en las derivaciones a la CAR (primera consulta: 10,8±9,03 días frente a 42,8±28,67 días, p<0,001; alta: 39,6±80,65 días frente a 128,6±135,34 días, p<0,001). Sin embargo, el número de citas (3,6±2,20 frente a 3,2±1,95, p=0,015) y el coste por derivación (592,7±421,50 € frente a 486,0±309,66 €, p<0,001) fueron más altos. Conclusiones: En el periodo estudiado aumentó el número de derivaciones evaluadas con una reducción en la demora. La CAR reduce los tiempos de atención, incrementando los recursos sanitarios utilizados.

1211 downloads

Derivación a las consultas de gastroenterología desde atención primaria: evaluación de dos programas
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Quintas Lorenzo, Paola

; Dacal Rivas, Andrés

; Francisco González, María

; Cubiella Fernández, Joaquín

; López Sánchez, Luis

; García García, María Jesús

; Fernández Seara, Javier

Gaceta Sanitaria

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dec 2011, Volume 25 N. 6 Pages 468 - 473

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

bjectives: To analyze the effect of implementing a high-resolution clinic (HRC) and an increasing resolution capacity program in primary care (IRCPPC) for referrals to a gastroenterology outpatient clinic from primary care and the resources used. Methods: A retrospective and observational study based on a review of referral sheets and databases was performed. We analyzed the number and reason for referrals, delay times and resource consumption in two periods: before (first 4 months of 2007) and after (first 4 months of 2009) the launch of the IRCPPC and HRC. Results: In the first and second periods, 881 and 1076 patients, respectively, referred from primary health care were evaluated in the gastroenterology clinic, with a decrease in the delay time in the second period (80.8±64.34 days vs 36.1±29.12 days, p<0.001). The most frequent reasons for referral were dyspepsia (27.7%), high-risk of colorectal cancer (17.1%), disturbance of bowel rhythm (18.2%), abdominal pain (16%), and gastroesophageal reflux (11.2%), with no differences between the two periods. Although delay times until the first visit (10.8±9.03 days vs 42.8±28.67 days, p<0.001) and until discharge (39.6±80.65 days vs 128.6±135.34 days, p<0.001) were lower in referrals to the HRC, the number of visits (3.6±2.20 vs 3.2±1.95, p=0.015) and the cost of referrals (592.7±421.50 € vs 486.0±309.66 €, p<0.001) was higher. Conclusions: In the study period the number of referrals increased, while the delay time decreased. Although the HRC reduces delay times, it is associated with an increase in health resource use.

944 downloads

La gripe A desde la teoría de la elección racional: propuestas para la toma de decisiones de políticas preventivas
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Garrido Peña, Francisco

; López Fernández, Luís Andrés

; Gil García, Eugenia

Revista Española de Salud Pública

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dec 2009, Volume 83 N. 6 Pages 785 - 790

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

This article is a reflection on the social uncertainty caused by Influenza A and on the consequences that it can have on decision making in health promotion policies. We use concepts and metaphors of the Rational Choice Theory, among them, the "ingratitude effect" or the "distrust effect", as we analyse how these can become obstacles for the efficiency of prevention policies. Then, we focus on the information asymmetry of the principal-agent relationship, and we propose measures to diminish the "moral risk" that they cause. We finish by advancing some proposals for designing lines and strategies of action in health promotion policies.

El artículo que presentamos es una reflexión sobre la incertidumbre social que gira en torno a la Gripe A y las consecuencias que puede generar en las decisiones sobre las políticas de promoción de salud. Utilizamos conceptos y metáforas de la Teoría de la Elección Racional, entre ellas el "efecto ingratitud" y "el efecto desconfianza" y analizamos cómo estas pueden constituir obstáculos para la eficacia de las políticas preventivas. Posteriormente, nos centramos en la asimetría informacional de la relación agente-principal y proponemos medidas para disminuir el "riesgo moral" que ocasionan. Por último, avanzamos algunas propuestas para el diseño de líneas y estrategias de actuación en políticas de promoción de salud.

925 downloads

La gripe A desde la teoría de la elección racional: propuestas para la toma de decisiones de políticas preventivas
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Garrido Peña, Francisco

; López Fernández, Luís Andrés

; Gil García, Eugenia

Revista Española de Salud Pública

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dec 2009, Volume 83 N. 6 Pages 785 - 790

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

947 downloads

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La lucha contra el estigma y la discriminación en salud mental: Una estrategia compleja basada en la información disponible
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López, Marcelino

; Laviana, Margarita

; Fernández, Luis

; López, Andrés

; Rodríguez, Ana María

; Aparicio, Almudena

Revista de la Asociación Española de Neuropsiquiatría

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2008, Volume 28 N. 1 Pages 48 - 83

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Reviews about stigma and discrimination in mental illness today, and tries to propose a general model for the development of interventions against that.

Revisión sobre el estigma y la discriminación que afecta hoy a la enfermedad mental, intentando elaborar un modelo general que pueda orientarnos.

50434 downloads Cited 13 times in SciELO

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