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OBJECTIVES: To analyse ongoing education within primary care teams from managers' perspective. DESIGN: Cross-sectional descriptive study. SETTING: The Mother-Infant Health Programme of Andalusia in primary care. INTERVENTION: The views of health centre professionals were obtained through 8 groups. The type of health district and the number of years in operation were used as criteria for division. The views of the area managers were collected through a self-filled questionnaire from all the managers in the autonomous community. MEASUREMENTS AND MAIN RESULTS: Professionals believed it necessary to keep up to date and train in new technology. They thought that training activities should focus on questions such as evaluation of programmes, focus of risk, counselling and communication, and certain techniques such as IUD insertion. Both managers and professionals coincided in recognising the effect of training on the development of mother-child services. There was consensus among professionals in affirming that training increases the quality of care delivered. Access to training was the main incentive element used by most area managers and one of those most highly valued by professionals. The professionals affirmed that in recent years there had been obstacles to their education by attending scientific events outside their areas. Many professionals stated that the economic assistance of the pharmaceutical industry for courses caused inequalities between doctors and nurses in access to training. Professionals were very critical of training combined with specialist training. CONCLUSIONS: Professionals think they have sufficient training for mother-child health care. It is generally recognised that family doctors are better trained for working on health programmes than other professionals at the centres. Ongoing training was rated very highly by both professionals and directors, as it was seen as a motivating element and thought to be an activity almost solely carried out at health centres.

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OBJECTIVE: To find and analyse the views of both health centre users and users of private insurance companies on the quality of services offered. DESIGN: Descriptive, crossover study using qualitative methodology. The views of health centre and private insurance company users on the quality of services delivered were gathered through 8 focus groups. The variables of opinion analysed were defined according to the SERVQUAL model of Parasuraman on perceived quality. SETTING: Three health districts in a health area in Andalusia. PARTICIPANTS: 70 users took part. RESULTS: Accessibility (prior appointment, information and reception service, hours open), capacity for response (speed and efficiency of processing) and internal organisational coordination were considered by health centre users weak-points of the primary care services, which affected negatively their credibility. These variables were identified by private insurance users as the main advantages of the care model for which they had opted. Reliability was valued positively by health centre users, but received a higher valuation from private insurance users. However, the courtesy and friendliness of health centre professionals was seen as an outstanding point of the service, and no different from that of private professionals. The use of clinical records, the competence of the professionals and the tangible aspects of health centres were identified by their users as strong points of the primary care services and give the public care model an advantage over the private one.

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OBJECTIVES: 1. To investigate health inequalities in the outlying towns around urban Granada. 2. To classify the towns in homogeneous groups according to their demographic, social and economic, and urban environment features, and to contrast these categories with their health situation. DESIGN: Ecological study using indicators of health and town environment from various sources. SETTING: The 29 towns in the periphery of Granada. MEASUREMENTS AND INTERVENTIONS: The differences in health of the towns were compared among themselves and with the group formed by all of them together. Cluster analysis was employed in order to classify the towns into homogeneous groups. RESULTS: It is noteworthy that only two towns had overall and premature mortality rates above and below the group as a whole. We found marked differences between towns for the other health indicators, with difference ratios up to 6 times greater than the group as a whole, as was the case for incidence of Brucellosis. There were some towns with poorer general conditions on Health and Poverty indexes than the rest. There were 5 clusters or groups of towns with homogeneous characteristics, for which the ratios of all the health indicators of the group with the best conditions were higher than the ratios of the group with the worst conditions. CONCLUSIONS: Better understanding of health inequalities at the small-area level, along with the use of health and poverty indices, help to characterise the place in question and favour the reduction of the inequalities.

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OBJECTIVE: To detect features of violence and sexism in cartoons in the children's programmes of Spanish television companies. DESIGN: Analysis of the content of cartoons broadcast by TV-1, TV-2, Canal Sur, Antena 3 and Tele 5 during one week. MEASUREMENTS AND MAIN RESULTS: The programmes recorded were viewed by two independent observers, first separately and then together. All those scenes with violent contents or sexist messages were noted. The main findings were: a) violent contents were very common; b) roles and jobs linked to gender were found; c) advertising accompanied and was inserted within children's programming. CONCLUSIONS: The points identified show the need for both school and family to encourage children to develop a critical attitude to the messages they receive.

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OBJECTIVE: To identify the defining characteristics of Primary (PC) and Specialist Care (SC), along with the level of concordance between managers in both sectors in the definition of these characteristics. SETTING: Intermediate course in Administration of the Andalucian School of Public Health, Granada. DESIGN: By means of the Philips 66 technique, followed by consensus construction, the enumeration of the characteristics of care sectors was requested of the managers, who had been previously selected for an Administration course. The procedure was repeated on five different occasions between 1991 and 1993. For each technique four groups were created (two formed by PC and two by SC professionals), in order to obtain self-referred (PC professionals assess PC and the SC ones, SC) and crossed assessments (PC professionals assess SC and vice versa). PARTICIPANTS: 116 professionals in all took part, 55 from the PC sphere, 45 SC and 16 in provincial and/or central services. RESULTS: There was dissonance in the expectations that managers placed in each sector of the health care system. PC managers' views of SC and SC managers' of PC did not coincide with the views of each group of managers on their own health care sector. CONCLUSIONS: When designing activities to coordinate between sectors, a period of clarification, both on the characteristics of each sector and on the expectations placed on each one, should be included. The subsequent negotiation of these can assist the development and maintenance of joint activities to improve coordination.

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Sexually transmitted diseases (STDs) are an important worldwide health problem. Their association with AIDS an other insidious viral processes have brought them to the foreground of sanitary authorities and general population concern. Often, health services have to struggle with reinfections, which concentrate in pockets of risk that consume large amount of care and constitute an important link in the transmission of these diseases. General publicity have little impact among high risk groups. Thus, it becomes necessary to be more precise and divide into segments the target population we want to reach. Prevention of reinfection in these communities requires the implementation of healthy behaviours through the promotion of a tangible product (condom). Regarding these considerations, social marketing emerges as the right instrument to be used. Through individual focused interviews with prostitutes, homosexual and young promiscuous heterosexual patients from a STDs Prevention, Diagnosis and Treatment Centre, determining factors of the use condoms and related behaviour guidelines have been identified. Also, a social marketing strategy is suggested to prevent these diseases among groups at risk by means of condom promotion.

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Social inequalities and health inequalities are closely related, and their reduction is the goal of international organizations and governments as well. In order to better understand the territorial distribution of social inequalities in the city of Málaga (Spain) and compare them with measured health differences, a descriptive study was done using different sources of information. Using the city's neighbourhoods as the unit of analysis, a cluster analysis was carried out based on a set of demographic, socioeconomic and standard of living indicators. This led to the configuration of six social areas within the city. In these areas, as defined by socially homogeneous criteria, diverse health indicators have been measured, leading the verification of important health differences among them. For example, clear differences in mortality rates between Area IV (socioeconomically deprived) and Area III (with a higher standard of living) are observed: the ratio between their respective "years of potential life lost" was 1.79, and between standardized mortality rates, 1.42. A similar disadvantage in low birth weight was confirmed notably so in adolescent pregnancies (five times higher). In conclusion, those areas of the city with a lower socio-economic status also had the lowest health levels.

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