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Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997-2011)., Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen's conceptual framework of access and use of health services and by incorporating other emergent categories., Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability., Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Background: There is controversy on when and in who recommend visual screening, the aim of this paper is to assess the level of evidence on the topic and compare it with current recommendations., Methods: Systematic review of scientific papers searching in Medline and Cochrane Library Plus, without date limit and only papers in English and Spanish. Grey literature accessed through manual search, no restrictions were made by study design., Results: There is a great variability in recommendations ranging from very restrictive to very lax. The vast majority were through clinical practice guidelines or opinion papers. The scientific paper identified, 2 were RCT, 3 non controlled trials, and one cross-sectional., Conclusions: Professional associations should use scientific arguments instead of corporative ones. The studies on adults don't allow to determine if the recommendation made by associations are evidence based. In the case of children, the studies and the recommendations give no information on what is the ideal age to perform the screening.

The authors of this study sought to compare the socioeconomic factors related to perceived sexism in employed and non-employed Spanish women and to examine whether the relationship of perceived sexism with mental health outcomes is reduced when such factors are taken into account. Data were taken from the 2006 Spanish Health Survey, including women aged 20-64 years (n=10,927). Multivariate logistic regression models were used to analyze the independent relationships between socioeconomic variables and perceived sexism and also between perceived sexism and poor mental health. In this latter case, socioeconomic variables were included by blocks in the logistic models. Perceived sexism was higher among employed women (3.9% vs. 2.8% among non-employed) and mainly among those in a managerial position (11.35%; adjusted OR: 2.71, 95% CI: 1.30-5.67) and having irregular working hours (5.5%; adjusted OR: 1.60, 95% CI: 1.10-2.34). Socioeconomic and family characteristics were associated with perceived sexism among women. Perceived sexism was associated with poor mental health, and this remained the case when different independent variables were taken into account. These results highlight the importance of taking into account gender discrimination in different aspects of our society, such as work and family organization, and in planning mental health interventions.

Background: Discrimination is an important determinant of health inequalities, and immigrants may be more vulnerable to certain types of discrimination than the native-born. This study analyses the relationship between immigrants' perceived discrimination and various self-reported health indicators., Methods: A cross-sectional survey was conducted (2008) amongst a non-random sample of 2434 immigrants from Ecuador, Morocco, Romania and Colombia in four Spanish cities: Barcelona, Huelva, Madrid and Valencia. A factorial analysis of variables revealed three dimensions of perceived discrimination (due to immigrant status, due to physical appearance, and workplace-related). The association of these dimensions with self-rated health, mental health (GHQ-12), change in self-rated health between origin and host country, and other self-reported health outcomes was analysed. Logistic regression was used adjusting for potential confounders (aOR-95%CI). Subjects with worsening self-reported health status potentially attributable to perceived discrimination was estimated (population attributable proportion, PAP %)., Results: 73.3% of men and 69.3% of women immigrants reported discrimination due to immigrant status. Moroccans showed the highest prevalence of perceived discrimination. Immigrants reporting discrimination were at significantly higher risk of reporting health problems than those not reporting discrimination. Workplace-related discrimination was associated with poor mental health (aOR 2.97 95%CI 2.45-3.60), and the worsening of self-rated health (aOR 2.20 95%CI 1.73- 2.80). 40% (95% CI 24-53) PAP of those reporting worse self-rated health could be attributable to discrimination due to immigrant status., Conclusions: Discrimination may constitute a risk factor for health in immigrant workers in Spain and could explain some health inequalities among immigrant populations in Spanish society.

Objectives: To describe the recommendations and interventions addressing violence against women (VAW) in vulnerable women (disabled, pregnant, ethnic minority, immigrant and older women) in key documents and laws enacted in different countries., Methods: Content analysis of key documents for the development of VAW policies and laws: The United Nations Handbook for Legislation on Violence Against Women Advance Version, the Model of Laws and Policies on Intrafamiliar Violence Against Women of the Pan-American Health Organization and Recommendation No. R(2002)5 of the Committee of Ministers of the European Council. The content of the 62 VAW laws was also analyzed., Results: Key documents demonstrate the importance of eliminating any obstacle facing disabled, pregnant, immigrant, ethnic minority or older women when accessing VAW services. Only 12 laws mention one or more of these groups of vulnerable women. Pregnant, disabled and ethnic minority women are the groups most often mentioned. In these laws, references to punitive measures, action plans and specific strategies to guarantee access to VAW resources are the most common interventions., Conclusion: Decisive interventions addressing the specific needs of disabled, pregnant, immigrant, ethnic minority and older women are needed in order to achieve a broader equity approach in VAW legislation., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To analyze whether sociodemographics and social support have a different or similar effect on the likelihood of Intimate Partner Violence in immigrants and natives, and to estimate prevalences and associations between different types of IPV depending on women's birthplace., Methods: Cross-sectional study of 10,048 women (18-70 years) attending primary healthcare in Spain (2006-2007)., Outcome: Current Intimate Partner Violence (psychological, physical and both). Sociodemographics and social support were considered first as explicative and later as control variables., Results: Similar Intimate Partner Violence sociodemographic and social support factors were observed among immigrants and natives. However, these associations were stronger among immigrants, except in the case of poor social support (adjusted odds ratio natives 4.36 and adjusted odds ratio immigrants 4.09). When these two groups were compared, immigrants showed a higher likelihood of IPV than natives (adjusted odds ratios 1.58)., Conclusion: Immigrant women are in a disadvantaged Intimate Partner Violence situation. It is necessary that interventions take these inequalities into account., (Copyright 2010 The Institute For Cancer Prevention. Published by Elsevier Inc. All rights reserved.)

Objectives: The goals of the present study are to explore the association between perceived sexism and self-perceived health, health-related behaviors, and unmet medical care needs among women in Spain; to analyze whether higher levels of discrimination are associated with higher prevalence of poor health indicators and to examine whether these relationships are modified by country of origin and social class., Materials and Methods: The study is based on a cross-sectional design using data from the 2006 Spanish Health Interview Survey. We included women aged 20-64 years (n = 10,927). Six dependent variables were examined: four of health (self-perceived health, mental health, hypertension, and having had an injury during the previous year), one health behavior (smoking), and another related to the use of the health services (unmet need for medical care). Perceived sexism was the main independent variable. Social class and country of origin were considered as effect modifiers. We obtained the prevalence of perceived sexism. Logistic regression models, adjusted for potential confounders, were fitted to study the association between sexism and poor health outcomes., Results: The prevalence of perceived sexism was 3.4%. Perceived sexism showed positive and consistent associations with four poor health outcomes (poor self-perceived health, poor mental health, injuries in the last 12 months, and smoking). The strength of these associations increased with increased scores for perceived sexism, and the patterns were found to be modified by country of origin and social class., Conclusion: This study shows a consistent association between perceived sexism and poor health outcomes in a country of southern Europe with a strong patriarchal tradition.

Background: Household service work has been largely absent from occupational health studies. We examine the occupational hazards and health effects identified by immigrant women household service workers., Methods: Exploratory, descriptive study of 46 documented and undocumented immigrant women in household services in Spain, using a phenomenological approach. Data were collected between September 2006 and May 2007 through focus groups and semi-structured individual interviews. Data were separated for analysis by documentation status and sorted using a mixed-generation process. In a second phase of analysis, data on psychosocial hazards were organized using the Copenhagen Psychosocial Questionnaire as a guide., Results: Informants reported a number of environmental, ergonomic and psychosocial hazards and corresponding health effects. Psychosocial hazards were especially strongly present in data. Data on reported hazards were similar by documentation status and varied by several emerging categories: whether participants were primarily cleaners or carers and whether they lived in or outside of the homes of their employers. Documentation status was relevant in terms of empowerment and bargaining, but did not appear to influence work tasks or exposure to hazards directly., Conclusions: Female immigrant household service workers are exposed to a variety of health hazards that could be acted upon by improved legislation, enforcement, and preventive workplace measures, which are discussed., ((c) 2009 Wiley-Liss, Inc.)

OBJECTIVES.: This study aimed to examine the association between perceived discrimination and five health outcomes in Spain as well as to analyze whether these relationships are modified by sex, country of birth, or social class. METHODS.: We used a cross-sectional design. Data were collected as part of the 2006 Spanish Health Interview Survey. The present analysis was restricted to the population aged 16-64 years (n=23,760). Five dependent variables on health obtained through the questionnaire were examined. Perceived discrimination was the main independent variable. We obtained the prevalence of perceived discrimination. Logistic regression models were fitted. RESULTS.: Perceived discrimination was higher among populations originating from low income countries and among women and showed positive and consistent associations with all poor health outcomes among men and with 3 poor health outcomes among women. Poor mental health showed the largest difference between people who felt and those who did not feel discriminated (prevalence for these 2 groups among men was 42.0% and 13.3%, and among women, was 44.7% and 22.8%). The patterns found were modified by gender, country of birth, and social class. CONCLUSION.: This study has found a consistent relationship of discrimination with five health indicators in Spain, a high-income Southern European country. Public policies are needed that aim to reduce discrimination., (Copyright 2009 Elsevier Inc. All rights reserved.)

Objective: To compare the prevalence of gender-based violence among immigrant and Spanish women. To describe their responses to this problem and the possible differences. To identify specific interventions to deal with gender-based violence in immigrant women in Spain., Methods: We performed a cross-sectional survey through a self-administered questionnaire in 10,202 women attending primary care in Spain (2006-2007). A content analysis was performed of the follow-up report of law 1/2004 of integral protection measures against gender violence sent by each Spanish region (2005) and the most recent regional laws and acts., Results: The prevalence of gender-based violence was 14.3% in Spanish women and 27.9% in immigrant women. The likelihood of gender-based violence was higher in immigrant (odds ratio adjusted: 2.06; 95% confidence interval: 1.61-2.64). Immigrant women more frequently reported that they had denounced their intimate partners and that they did not know how to manage the situation. Some Spanish regions have already started interventions to overcome access barriers to social and health services, but only three have provided data on the number of immigrant women who received economic and occupational help up to 2005., Conclusions: Inequalities were observed in the prevalence of gender-based violence according to country of origin, with immigrant women being more frequently affected. Immigrant women more frequently denounce their intimate partners than Spanish women but this action does not guarantee effective results. Other specific interventions have been identified in some autonomous regions of Spain but these interventions need to be evaluated to ensure that they benefit immigrant women.

Objective: To describe the migratory process (reasons for migrating, time of residence), legal status and the personal, working and health characteristics of the immigrants with work experience in Spain., Methods: We performed a cross sectional survey in a sample stratified by country of origin (Colombia, Ecuador, Morocco and Romania), legal status and sex. Personal interviews were conducted with 2434 workers (57.4% men). Information on the migratory process, working conditions, health profile, and work and life expectations was analyzed. A frequency comparison by country of origin was carried out., Results: Ninety percent of the sample was aged<45 years and most had secondary education (51%). Most of the people surveyed had migrated for economic and working reasons and 63% had economic dependents. They were working in jobs that were below their educational level and reported problems concerning the type of contract, salaries, and the length of the working week, which was often more than 40 hours. The immigrants frequently reported general health problems (18%), mental health problems (27%), absence from work due to health problems (48%) and occupational injuries requiring medical care (23%). A 51% of them wanted to stay in Spain and 48% reported that their expectations of emigration to Spain had been met., Conclusions: The immigrant workers included in this study had limited opportunities for work and experienced precarious conditions and social vulnerability. The data varied by country of origin. The special needs of this collective should be taken into account to establish public health policies and strategies.

Objective: To determine the prevalence of reported intimate partner violence (IPV) and to analyze the main sociodemographic characteristics of affected women., Methods: We performed a cross-sectional study based on the Spanish National Health Survey of 2006. The sample comprised 13,094 women who agreed to answer questions about violence (87.2% of the total interviewees). Bivariate and multivariate analyses were performed. The dependent variable was reported IPV and the independent variables were educational level, employment, marital status, living arrangements with the partner or analogous individual, number of children at home, nationality (Spanish vs. foreign women) and age., Results: IPV was reported by 1% (n=128) of the sample. Women with primary school education or without studies (odds ratio [OR]: 3.63 [1.90-6.92]), with three or more children (OR: 3.51 [1.78-6.90]), and those who were separated or divorced (OR: 2.81 [1.89-4.97]) were most likely to experience IPV when the effect of the remaining variables was controlled. The likelihood of IPV was also higher in women born outside Spain (OR: 2.83 [1.87-4.28])., Conclusions: IPV seems not to affect Spanish and foreign women equally. The characteristics most closely associated with women affected by IPV were educational level, the number of children at home and marital status. The sensitivity of current measures against IPV should be considered in relation to the needs of affected women.

Objective: This study was aimed at describing the main features of articles published in scientific journals between 1992 and 2007 addressing the analysis of the etiological factors associated with this condition., Materials and Methods: This consisted of a systematic review of scientific articles regarding this association using the following health and social science databases: Medline, Cinhal, Web of Science, Lilacs, Sociological Abstracts, Embase, Psycoinfo and ISI web of Knowledge., Results: 21 articles were obtained during the study period, distributed as follows: 7 theoretical reviews (33.3 %), 6 cross-sectional studies (28.5 %), 4 cohort studies, (19.0 %) 2 case-control studies (9.5 %) and 1 systematic review (4.7 %). Of these, 7 (33.3 %) considered the following to risk factors to be associated with the emergence of other factors such as silicone implants, socio-demographic and hormonal factors: 3 on stress (14.3 %), 4 on hepatitis C (19.0 %), 3 on traumatic antecedents (14.3 %) and 4 on occupation (19.0 %). The most productive time was 2000-2004. There was broad thematic dispersion in the published journals., Discussion: Available empirical evidence about risk factors related to fibromyalgia is still scarce and scattered. Future studies should focus on generating more knowledge about the risk factors studied so as to help improve fibromyalgia care, diagnosis and treatment.

Objective: Describing and analysing the Spanish Parliamentary debate on immigration and health., Methods: A systematic search regarding parliamentary initiatives (PI) on immigration and immigration and health was conducted from the beginning of the Spanish democratic period (1979 to 2007). A protocol for collecting information was used to identify the parliamentary debate's main characteristics and the main topics related to PI concerning immigration and health. The PI immigration rate was calculated regarding the total rate of PI about the immigrant population based on the Spanish population per year., Results: 4,022 PI concerning "immigration" were identified. The main content concerned statistical information about the immigrant population (57.2 %). 116 PI about "immigration and health" were analysed. The most frequently recurring topics were health-care strategies (25 %), health-service access (24.1 %) and epidemiological information (19.8 %). Most PI concerned questions related to the function of government control (94 %). No decisions were taken in 113 PI (97.4 %). Immigrant population rates increased per year; however, notable changes in PI regarding immigration were not observed until 1996 and PI about immigration and health until 1999., Conclusion: The immigration and health debate on the parliamentary agenda is heterogeneous. It would seem necessary to increase parliamentary debate about strategies and action for promoting immigrant-based needs in health.

A systematic review was performed to analyse the characteristics and quality of the studies that consider the relationship between verbal marital conflict and/or male domination in the family and violent behaviour by men towards their partner. Only 11 articles were identified between 1986 and 2006. Most of them find a positive association between male domination in the family and/or verbal marital conflict and violence towards the woman in the couple. However, limitations such as misclassification bias, recall bias, selection bias, external validity and the problem of consistency (overestimation of effect) were acknowledged by authors of this studies. In eight of the 11 studies reviewed, preventive measures or interventions to deal with the problem were recommended. More and better empirical evidence is required in order to provide suitable measures to address the issue of verbal marital conflict and male domination and its influence on IPV.

Background: Association between immigration and low birth weight (LBW) and preterm birth (PB) is an important indicator of health inequalities. The objective of this study is to analyse the differences between LBW and PB according to the mothers nationality in newborns in Spain., Methods: Data were provided from the National Statistical Bulletin of Birth of 1,878,718 newborns in the period 2001-2005. The nationality was considered the exposure variable (Spanish- Immigrant). The outcomes were LBW (< 2,500 gr and >or=37 gestational weeks) and PB (< 37 gestational weeks). Odds ratios were calculated and adjusted by possible confounders by logistic regression., Results: PB and LBW prevalence were higher in Spanish women (7.9% and 3.2% respectively). In comparison with Spanish ones, the lowest risk of PB was observed in North Africa (ORa= 0.77 CI95% 0.74-0.80). With respect to LBW, the lowest risk was found in mothers from South America (ORa=0.62 CI95% 0.59-0.65) and Eastern Europe (ORa=0.65 CI95% 0.60-0.71)., Conclusion: Results of LBW and PB were more favourable in the births of immigrant women. It could be associated with the healthy migrant effect and a low frequency of risk practices during gestation.

Objective: To conform a frame of reference for the organization of the public health teaching in university degrees in Spain, in agreement with the directives of the European Space for Higher Education., Methods: Specific professional competencies in public health have been extracted from the Libros blancos published by the ANECA (National Agency of Quality Evaluation) for the degrees on medicine, pharmacy, nursing, human nutrition and dietetics, optics and optometry, veterinary, social work, occupational relations, teacher training, and environmental sciences. Following the framework proposed by the Working Group on professional competencies in public health in Spain, we have selected those competences that enable future professionals to participate in the development of the public health from their field of activity. We have also identified and correlated the specific competences of each degree with the corresponding activities and functions., Results: All the studied degrees have competences in public health functions. The majority has also defined activities in community health analysis, design and implementation of health interventions and programmes, promotion of social participation and citizen's control of their own health., Conclusions: There is academic space for the multidisciplinary development of the public health in Spain beyond the health professions. The identification of the specific competencies of each degree related with activities on public health reveal what are the contents to be in included in each syllabus.

The Millennium Development Goals (MDGs) are now at the midterm of their target period, as 2015 is the date scheduled by the United Nations Organisation (UN) for their attainment. The purpose of this article is to review the current situation of the MDGs worldwide and to analyse the barriers which are preventing them from being attained in each of the MDG areas, as well as to assess a number of the indicators evaluated. In order to do so, a review has been made of the scientific literature published on the MDGs in the principal health sciences and social sciences databases, as well as the most significant reports on the issue drawn up by the United Nations. The scientific studies on the 8 MDGs and their 18 Targets make it possible to undertake a critical analysis of the situation in which each of these Goals are found at the present time, identifying the determinants that are preventing the attainment of the Goals and the actions considered necessary in order to achieve progress. Although there have been improvements in some of the goals on a world level, the research carried out to date reveals barriers to the attainment of the MDGs, as well as the insufficient weight of the developing countries in the economic and political decision-making processes, together with the incoherence between the economic policies and the social and health policies. Furthermore, Sub-Saharan Africa constitutes the most disadvantaged region, which means that it will not attain the majority of the MDGs. Spain and the developed countries, in addition to contributing resources, can also contribute to the MDGs by means of the identification and eradication of the barriers preventing attainment. This involves promoting international economic relations under conditions of social justice, by supporting a greater decision-making power for developing countries and denouncing actions that increase social inequalities and the impoverishment of the population.

Objectives: To describe the distribution of mortality due to intimate partner violence (IPV) in foreign women living in Spain and to explore the potentially greater risk of dying from IPV in this group., Methods: We performed a retrospective ecological study of deaths from IPV registered by the Women's Institute of Spain (1999-2006). Mortality rates and Poisson models for relative risk and 95% confidence intervals were calculated., Results: The average risk of dying from IPV in foreign women was 5.3 times greater than that in Spanish women. In the years studied, the increased risk in foreign women was 2 to 8 times greater than that in Spanish women., Conclusion: Foreign women living in Spain are especially vulnerable to death from IPV. Further research on the causes of this phenomena and strategies involving health services are needed.

Background: Gender is an important health determinant for public health policies. This study describes the changes in gender development inequalities in Spain and its autonomous regions from 1990 to 2000., Methods: An ecological study using the Human Development Index (HDI) and the Gender Development Index (GDI) was done. IDG both men and women was analysed according to indexes of education, income and life expectancy at birth., Results: Although the GDI has had an increase of 5,05% in the 90 s, 51,5% of the population was located above the global GDI of Spain in 1990, moreover this number decreased to 46,3% in 2000. Gender inequalities have been reduced both at national and regional levels. The regions with the lowest increase were Asturias (3.37%), Cantabria (3.68%) and Baleares Islands (3.71%). The regions with the highest increase were Madrid (6,46%) and Extremadura (6,75%). All the autonomous regions showed a number of GDI lower than the value of HDI. Both sexes achieved similar increase in life expectancy (Men: 5% and Women: 4%). An unequal variation was detected according to the autonomous region (Basque Country; Men: 7% and Women: 3%; Madrid; Men:8% and Women:5%). Women have improved their educational level in comparison to men (Men: 3% and Women: 6%). In the 90 s, men obtained more income than women, but women improved their situation three times more than men., Conclusions: Inequalities in Human Development analysed by gender have been reduced in the 90 s in Spain. However, the improvement of education, income and life expectancy occurred only in some autonomous regions. This situation shows the differences among Spanish autonomous regions.

Background: Perpetrators' experiences of violence during childhood are considered a risk factor for intimate partner violence (IPV). The objective of this study is to systematically review the characteristics and quality of papers which analyse the association between being battered during childhood, witnessing marital violence as a child within the family of origin and having an absent or rejecting father and the occurrence of IPV., Methods: Nine scientific databases were consulted (1960-2004). After applying the exclusion criteria, 10 studies were analysed. Variables are sample characteristics, directionality/study design, IPV and perpetrators' childhood measurements, findings, limitations and interventions., Results: All the studies found an association. Conflict Tactics Scale was the main tool used to measure the IPV. Different instruments were used to measure violent childhood experiences in men as an exposure. Recall bias (seven papers) and retrospective data (four papers) were reported as the main methodological limitations. Despite these, 50% of the studies proposed treatments/preventive measures., Conclusion: Our findings support the results of previous studies, implying that action recommendations within IPV prevention are still not evidence based. Methodological problems of the papers reviewed should be solved to obtain more useful data. Scientific evidence about the aetiology of IPV should be increased to guide effective prevention programmes.

Objective: To identify the characteristics of health education and promotion interventions in Spanish nursery and primary schools, through the studies published in scientific journals., Method: We performed a review of studies on health education and promotion interventions in Spanish nursery and primary schools, published from 1995 to 2005. The information sources were Medline (through Pubmed), Cinhal, Eric, Sociological Abstracts, Science Citation Index, and Isooc (CSIC). Studies performed in Spanish nursery and primary schools that incorporated health education and promotion interventions were selected. The studies' general features, main subject and aims, methodology, the kind of intervention described, and compliance with the criteria for Healthy Schools were analyzed., Results: Only 26 of the 346 articles identified met the inclusion criteria. Health education programs focussed more on disease prevention than on health promotion and only a few studies were performed in nursery and primary schools. The criteria for health promotion in schools were included in 5 articles (19.2%). The importance of health institutions (n = 7; 26.9%) and universities (n = 8; 30.8%) as promoters of programs was notable. The most frequent subject was smoking (n = 11; 42.3%)., Conclusions: Teachers play a lesser role in health promotion in schools than health institutions in the implementation and dissemination of health programs. Research into health promotion in nursery and primary schools is scarce.

Objective: Exploring the self-perceptions of a group of migrants from Colombia living in Alicante , Spain , regarding their working conditions and health., Material and Methods: This was a qualitative and descriptive research was conducted on a group of Colombian workers (with and without legal permission to work) having lived in Alicante ( Spain ) for more than 6 months. 11 interviews were carried out, plus 2 focal groups, from November 2006 to January 2007. The interviews were recorded and transcribed. A narrative analysis of the contents was carried out, a mixture of categories being obtained from different viewpoints., Results: Immigration was understood as being an action for improving an immigrant worker and family's socioeconomic conditions. Work and social recognition should lead to avoiding exclusion and discrimination. The people interviewed had associated their health problems with their living conditions. Such problems were considered to be a limitation on carrying out their daily activities., Conclusions: Working and health situations were perceived from a multi-dimensional perspective associated with biological and socio-cultural conditions. More political action should be taken for improving immigrant people's economic, work and health conditions.

Background: Despite the visibility of intimate partner violence against women in low socioeconomic groups, the association of low socioeconomic status and violent behavior is unclear. We performed a systematic review of the empirical evidence on the causal role of batterers' socioeconomic status in this phenomenon., Methods: We performed a systematic review, using the following databases: Eric (1966-2004), Sociological Abstracts (1963-2005), Science Citation Index (1945-2005), Social Science Citation Index (1956-2005), Medline through Pubmed (1966-2005), Social Service Abstracts (1980-2005), Lilacs (1982-2005) and Psycinfo (1972-2005). We included empirical papers with aims or hypothesis related to the causal relation between low socioeconomic status (employment, education, income) in men and IPV., Results: A total of 251 studies were identified, but only 10 met the inclusion criteria. There was one cohort study, one case-control study, one ecological study and one study based on a series of cases. Two studies calculated odds ratio in the analyses. One of these studies reported an odds ratio of 1.4 (95% CI, 1.1-1.9) with unemployment and the other study showed no significant positive associations with this factor or with low income or education., Conclusions: More information and better quality data are required to establish conclusive results on the causal role of the socioeconomic status of men who batter their intimate partners. The empirical evidence on the relationship between violent male behavior against their partners and low socioeconomic status is still insufficient.

The Millennium Development Goals, and within these the Millennium Targets, constitute a working plan that strives to achieve basic goals within the field of health, eradicate poverty, and ensure compliance with basic human rights. Its scope of action represents a historic breakthrough as a step toward a possible global social policy, in which cooperation between the different sectors is essential for its efficiency. Due to its multidisciplinary nature, public health, as well as political epidemiology, can be used to help increase scientific knowledge in the field of health with respect to the Millennium Development Goals. Despite the opportunity that this international agreement provides, insufficient in-depth study has been carried out on the potential -mainly political- difficulties that could arise during its implementation. Therefore, a conceptual and methodological change is required so that concern does not simply center on social determinants of health but instead takes into consideration the political reasons behind them. To reduce inequality, not only must injustice be classified but effective ways must also be found to encourage institutions with political power to take part in this initiative.

Aims: To systematically examine the characteristics of the processes of formulating and taking decisions on gender-based violence in the Spanish Parliament., Methods: A search was performed for all parliamentary initiatives on gender-based violence in the Spanish parliament (1979-2004) and their qualitative content was analyzed. The ratio between initiatives on gender-based violence and those on other issues was calculated by years and legislatures. The probability of presenting initiatives on gender-based violence was analyzed by sex and political group (government vs. opposition) (odds ratio, 95% CI and statistical significance using the Mantel-Haenszel method)., Results: In the 26 years studied, there were 322,187 initiatives, of which 569 concerned gender-based violence. Initiatives on this issue increased in 1998 (4.12 per 1,000), 2001 (4.49 per 1,000) and 2004 (9.19 per 1,000). Sixty-seven percent were questions to the government. The majority of the initiatives were registered without agreement or decision (81%). Men had a higher probability of asking questions (OR = 17.08; 95%CI, 5.91-55.62), but women instigated 60% of the initiatives. Parliamentary groups in government showed a higher probability of asking questions (OR = 2.63; 95%CI, 1.32-5.31), but 88% of the initiatives were promoted by the opposition., Conclusions: The process of policy construction has been started in Spain, which could lead to the development of true policies on gender-based violence in the future. Parliamentary activity on this issue should be maintained in the long-term, as the problem shows no sign of abating.