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OBJETIVO: presentar un ejemplo de metodología para la desadopción de una tecnología sanitaria; para ello se plantearon tres objetivos: describir las tasas de uso del legrado uterino diagnóstico en Andalucía y, por otro lado, priorizar las estrategias de intervención para la desadopción del legrado con fines diagnósticos y analizar las barreras y elementos facilitadores para esas estrategias en el Sistema Sanitario Público de Andalucía. MATERIAL Y MÉTODOS: se utilizó una metodología de métodos mixtos. En una primera fase se pretendía identificar centros con mejores prácticas, mediante un diseño de serie temporal descriptiva. Para ello se analizó la evolución de las tasas de legrado con fines diagnósticos para el período 2008-15 para los 40 hospitales públicos de Andalucía (España), mediante una regresión de joint point. En la segunda fase, para identificar los elementos claves para el diseño de intervenciones para la desadopción de la técnica, se utilizaron 2 pasos, el primero mediante una técnica de consenso (Delphi modificado), y posteriormente un taller y grupo de discusión. RESULTADOS: en el año 2015 se realizaron 1.433 procedimientos de legrado con fines diagnósticos (tasa cruda de 4,2 por cada 10,000 mujeres mayores de 15 años). Entre los años 2008 y 2015 se observó una disminución en el uso del legrado del 44,4%, siendo de 3,4 puntos por 10.000 mujeres en términos de tasa cruda. La fase cualitativa mostró que los profesionales sanitarios de centros con mejores prácticas priorizaron cinco de las posibles intervenciones. Por último, en el grupo de discusión se refirieron barreras fundamentalmente en aspectos relacionados con la disponibilidad de recursos (alternativas disponibles) y con la toma de decisiones compartida. CONCLUSIONES: el proceso de desadopción se está produciendo lentamente. Entre los facilitadores para la desadopción destaca la disponibilidad de alternativas; por el contrario, como barrera se mencionó la carga asistencial y las dificultades para la toma de decisiones compartidas. Por último, según se puede deducir de las intervenciones priorizadas, el profesional sanitario debe ser la diana de las intervenciones

OBJECTIVE: Present an example of methodology for the desadoption of a sanitary technology; for this, three objectives were proposed: The description of the rates of use of diagnostic uterine curettage in Andalusia and, on the other hand, prioritize the intervention strategies for the desadoption of the curettage for diagnostic purposes and analyze the barriers and facilitating elements for these strategies in the Andalusian Health System. MATERIAL AND METHODS: A mixed-method methodology was used in order to identify those centers with best practices, through a descriptive time series design. The evolution of curettage rates for diagnostic purposes for the period 2008-15 was analyzed for the 40 public hospitals of Andalusia (Spain), thru a joint point regression. In the second phase, to identify the key elements for the design of interventions for the desadoption of the technique, 2 steps were used, the first using a consensus technique (modified Delphi) and finally, a workshop and discussion group. RESULTS: In 2015, 1,433 curettage procedures were performed for diagnostic purposes (crude rate of 4.2 per 10,000 women over 15 years of age). Between 2008 and 2015, there was a decrease of curettage use, of 44.4%, being 3.4 points per 10,000 women in terms of crude rate. The qualitative phase showed that health professionals, from centers with best practices, prioritized 5 of the possible interventions. Lastly, in the discussion group, barriers mainly related to the availability of resources (available alternatives) and shared decision-making were referred. CONCLUSIONS: The process of desadoption is taking place slowly. Among the facilitators for the desadoption stand out the availability of alternatives; on the contrary, the burden of care and the difficulties in making shared decisions were mentioned as a barrier. Finally, as can be deduced from the prioritized interventions, the health professional must be the target of the interventions

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BACKGROUND: One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. METHODS: A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services. RESULTS: Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. CONCLUSIONS: To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.

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The financial crisis has caused an exponential increase of home foreclosures in Spain. Recent studies have shown the effects that foreclosures have on mental and physical health. This study explores these effects on a sample of adults in the city of Granada (Spain), in terms of socio-demographic, socio-economic and process characteristics. A cross-sectional survey was administered to obtain information on self-perceived changes in several indicators of physical and mental health, consumption of medications, health-related behaviors and use of health services. A total of 205 persons, going through a foreclosure process, participated in the study. 85.7% of the sample reported an increase of episodes of anxiety, depression, and stress; 82.6% sleep disturbances; 42.8% worsening of previous chronic conditions, and 40.8% an increase in consumption of medication. Women, married persons and persons already in the legal stage of the foreclosure process reported higher probability of worsening health according to several indicators, in comparison with men, not married, and individuals in the initial stages of the foreclosure process. The results of this study reveal a general deterioration of health associated with the foreclosure process. These results may help to identify factors to prevent poor health among populations going through a foreclosure process.

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Despite the higher proportion of foreclosures and home evictions executed in Spain, compared to other countries, and the known link between social exclusion and mental health problems, studies exploring this association in Spain remain scarce. This study investigated the link between the process of home eviction and the appearance of symptomatology of post-traumatic stress disorder (PTSD), anxiety, depression, and perceived stress. Two hundred and five people affected by the process of home eviction were assessed using a structured interview that included three validated assessment instruments for PTSD, perceived stress, anxiety and depression. Analysis involved comparison with the normative groups that formed the validation studies together with regression analysis to determine the major psychological and socio-demographic predictors of perceived stress. Of the participants, 95.1% reported that they were experiencing the process of home eviction with fear, helplessness, or horror. In PTSD symptomatology, they scored higher than the normative PTSD group in symptoms of avoidance (t = 5.01; p < .05), activation (t = 5.48; p < .01), and total score (t = 4.15; p < .05). Of this subgroup, 72.5% fulfilled the DSM-IV symptom criteria for PTSD. The major predictor of perceived stress was PTSD symptomatology (B = .09; p < .001). The process of home eviction in Spain is having an alarming impact on mental health of affected people calling for effective measures to provide psychological and social support.

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Despite the higher proportion of foreclosures and home evictions executed in Spain, compared to other countries, and the known link between social exclusion and mental health problems, studies exploring this association in Spain remain scarce. This study investigated the link between the process of home eviction and the appearance of symptomatology of post-traumatic stress disorder (PTSD), anxiety, depression, and perceived stress. Two hundred and five people affected by the process of home eviction were assessed using a structured interview that included three validated assessment instruments for PTSD, perceived stress, anxiety and depression. Analysis involved comparison with the normative groups that formed the validation studies together with regression analysis to determine the major psychological and socio-demographic predictors of perceived stress. Of the participants, 95.1% reported that they were experiencing the process of home eviction with fear, helplessness, or horror. In PTSD symptomatology, they scored higher than the normative PTSD group in symptoms of avoidance (t = 5.01; p < .05), activation (t = 5.48; p < .01), and total score (t = 4.15; p < .05). Of this subgroup, 72.5% fulfilled the DSM-IV symptom criteria for PTSD. The major predictor of perceived stress was PTSD symptomatology (B = .09; p < .001). The process of home eviction in Spain is having an alarming impact on mental health of affected people calling for effective measures to provide psychological and social support (AU)

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Objetivo: Analizar el estado de salud percibida, y otros indicadores relacionados con la salud, en personas adultas de Granada que se encuentran en un proceso de desahucio de su vivienda habitual, de alquiler o en propiedad, en comparación con la salud de la población general andaluza. Métodos: Estudio transversal mediante encuesta administrada por personal entrenado que incluye instrumentos de la Encuesta Andaluza de Salud 2011 para la medición de variables de salud física y mental, y de hábitos relacionados con la salud. Se han comparado los resultados con los obtenidos sobre la población general andaluza mediante la Encuesta Andaluza de Salud. Se ha realizado un análisis bivariado utilizando la prueba de ji al cuadrado, y un análisis multivariado mediante regresión logística. Resultados: Se ha obtenido una muestra total de 205 personas en proceso de desahucio. El 59,5% (122) son mujeres y el 40,5% (83) hombres. Presentan una mayor probabilidad de tener una salud deficiente (odds ratio [OR]: 12,63; intervalo de confianza del 95% [IC95%]: 8,74-18,27), enfermedad cardiovascular (OR: 3,08; IC95%:1,54-6,16) o consumir tabaco (OR: 1,68; IC95%: 1,21-2,33), en comparación con la población general andaluza. La mayoría de los indicadores analizados muestran un peor resultado para las mujeres que experimentan un proceso de desahucio. Conclusiones: Nuestros resultados indican que las personas afectadas por un proceso de desahucio en Granada y su área metropolitana, en el actual contexto de crisis, expresan una peor salud en relación a la población general andaluza. Es necesario seguir investigando sobre la salud y los desahucios, desde diferentes aproximaciones metodológicas, para una mejor comprensión de este problema (AU)

Objective: To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia. Methods: A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the ji2 test and a multivariate logistic regression analysis were conducted. Results: We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process. Conclusions: Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic (AU)

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OBJECTIVE: To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia. METHODS: A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the χ2 test and a multivariate logistic regression analysis were conducted. RESULTS: We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process. CONCLUSIONS: Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic.

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BACKGROUND: In the actual context of population ageing and extension of working age, programs for health promotion at the workplace are a key and necessary tool to promote an active and healthy ageing. This work presents the methodological process followed to elaborate a checklist tool, within the framework of the European project Progress, that contributes to orientate planning, implementation and evaluation of good practices in this field, to be applicable to a variety of programs, countries and workplaces. METHODS: A Delphi technique has been applied in three rounds in which experts in the area from five European countries participated. A questionnaire created from a list of criteria and indicators was adapted throughout the rounds, with the use of webmail, to the evaluation of interventions in the field of interest. Through processes of assessment and consensus, criteria and indicators most relevant were prioritized. RESULTS: From the nine starting criteria and after the implementation of the technique, four key criteria were prioritized: relevance: 62, adequacy to objective: 57, innovation: 50 and guarantee of quality: 41. Using this group of criteria and indicators, a checklist was designed containing the key information that should be collected for planning, implementation and evaluation of good practices in interventions in this field. CONCLUSIONS: The checklist tool helps to systematize the global methodology for the implementation of interventions which could be very useful for persons responsible of programmes to promote active and healthy ageing in the workplace.

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Fundamentos: en el actual contexto poblacional de envejecimiento de la población y prolongación de la vida laboral, los programas de promoción de salud en el trabajo son una herramienta clave y necesaria para promover un envejecimiento activo y saludable. El objetivo fue elaborar una herra-mienta tipo lista de verificación para orientar la planificación, implementación y evaluación de buenas prácticas en intervenciones en este ámbito, aplicables a una variedad de programas, países y centros de trabajo. Métodos: se utilizó una técnica Delphi en tres rondas en la que participaron expertos/as de cinco países europeos. Se elaboró un cuestionario en línea a partir de una lista de criterios e indicadores y, empleando el correo electrónico, se trabajó durante las sucesivas rondas en su adaptación a la evaluación de intervenciones. Mediante procesos de valoración y consenso, se priorizaron los criterios e indicadores más relevantes. Resultados: partiendo de nueve criterios basales se priorizaron cuatro criterios clave cuyas puntuaciones medias fueron: relevancia: 62, adecuación al objetivo: 57, innovación: 50 y garantía de calidad: 41. Utilizando esta matriz de criterios e indicadores se diseñó una lista de verificación con la información clave que debe recogerse a la hora de planificar, implementar y evaluar buenas prácticas en las intervenciones. Conclusiones: la lista de verificación ayuda a sistematizar la metodología global de implantación de intervenciones que puede ser utilizada por responsables de los programas para promover el envejecimiento activo y saludable en los centros de trabajo (AU)

Background: in the actual context of population ageing and extension of working age, programs for health promotion at the workplace are a key and necessary tool to promote an active and healthy ageing. This work presents the methodological process followed to elaborate a checklist tool, within the framework of the European project Progress, that contributes to orientate planning, implementation and evaluation of good practices in this field, to be applicable to a variety of programs, countries and workplaces. Methods: a Delphi technique has been applied in three rounds in which experts in the area from five European countries participated. A questionnaire created from a list of criteria and indicators was adapted throughout the rounds, with the use of webmail, to the evaluation of interventions in the field of interest. Through processes of assessment and consensus, criteria and indicators most relevant were prioritized. Results: from the nine starting criteria and after the implementation of the technique, four key criteria were prioritized: relevance: 62, adequacy to objective: 57, innovation: 50 and guarantee of quality: 41. Using this group of criteria and indicators, a checklist was designed containing the key information that should be collected for planning, implementation and evaluation of good practices in interventions in this field. Conclusions: the checklist tool helps to systematize the global methodology for the implementation of interventions which could be very useful for persons responsible of programmes to promote active and healthy ageing in the workplace (AU)

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