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Pain is a subjective experience that is mediated by the social structure and by the contextual aspects of people in pain. From the point of view of those affected, a sociological analysis has been carried out of why society doubts pain and the impact that the lack of credibility has on people in pain. Qualitative methodology is used. In total, 19 semi-structured interviews have been conducted with men and women in pain. Research has shown that pain produces discredit in all dimensions of individual’s social life, from the most intimate to that related to healthcare and production. The lack of credibility takes the form of epistemic injustice, being a reaction produced from the social structure to avoid the impacts that pain could produce on the social system. Epistemic injustice affects anyone in pain, but the form it takes will be related to sufferer’s circumstances. Studying this topic is important because it shows the rigidity of expert systems to deal with some old and new situations related to pain. It also shows the frequent lack of fit between the systems and the sufferers. Finally, the article shows that to deal unfairly with the testimony of people in pain has negative consequences on the treatment of pain. A better understanding of these issues could improve the sufferers’ living conditions., This work was supported by Spain’s State R&D Program Oriented to The Challenges of The Society, 2018 (Grant number: RTI2018-099483-B-100).

El dolor, un problema de primer orden en salud, es la primera causa de consulta médica en atención primaria y del consumo de medicamentos de la población general. Mientras a nivel mundial se asume que el principal problema es la falta de acceso a medicamentos de importantes sectores de población en ciertos países, en otros puntos geográficos se pone el acento en un posible abuso o utilización inadecuada de los mismos. El objetivo principal de este artículo es conocer qué características influyen en el consumo de medicamentos para el dolor de la población española. Para ello se han analizado, por un lado, los datos de la Encuesta Nacional de Salud del año 2017 y, por otro, la Encuesta sobre Percepción Social del Dolor del año 2016. Hemos encontrado que las mujeres, así como las personas de mayor edad y con estudios básicos son las que mayor consumo de medicamentos presentan, pero también que el dolor de origen emocional, que es el que mayor intensidad dolorosa reporta, es el menos medicado de los dolores padecidos, siendo al mismo tiempo un dolor que sufren principalmente las mujeres. Pain is the leading cause of medical consultation in primary care and also of drug use in the general population. In some countries, the main problem is the lack of access to pain medication for large sectors of the population. In other countries, the problem is the abuse or misuse of painkillers and other drugs. The main objective of this article is to know the social factors that influence the consumption of pain medication in the Spanish population. For this purpose, we analyzed data from the 2017 National Health Survey on the one hand and the 2016 Survey on Social Perception of Pain on the other. We have found, among other relevant issues, that women, the elderly age and people with basic education have the highest drug use. Additionally, we found that emotional pain is both the most intense and the least medicalized pain, and it is a pain more women than men suffer from.

Investigar la experiencia del dolor requiere el empleo de una perspectiva teórica constructivista, que permita ir más allá de posiciones analíticas biologicistas y también de las subjetivistas, porque ambas suelen ofrecer análisis incompletos de la realidad. En este artículo se persigue mostrar que los aspectos sociales influyen sobre la percepción del dolor del parto, teniendo en cuenta que está aceptado, científica y comúnmente, que aquel es uno de los dolores más intensos que se puede experimentar. Para ello se han realizado diez grupos de discusión compuestos por mujeres que fueron madres hace no más de dos años, que responden a criterios de edad, nivel de estudios, situación laboral y hábitat. Tras analizar los discursos sociales, los principales resultados muestran que al dolor del parto se le atribuyen sentidos diferentes en función del tipo de maternidad con el que se identifican las mujeres. El tipo de maternidad ejercida está relacionado con las condiciones sociales de vida de las mujeres y con los discursos circulantes en sus entornos que, mayoritariamente, se construyen sobre la base de conocimientos comunes, ajenos al ámbito científico. Observamos, asimismo, que a través de las prácticas sociales relacionadas con la maternidad, las mujeres persiguen la obtención de capital simbólico, que es el reconocimiento social de ser una buena madre. Una práctica útil para obtener capital simbólico es el dolor del parto que, además, introduce una jerarquía del valor social de las mujeres en el campo de la maternidad. El artículo muestra que el dolor tiene una dimensión social que modela su experiencia y también la existencia de un consenso entre las mujeres para asumirlo como una práctica útil y conveniente.

The conspiracy of silence is extremely important due to both its high incidence and its consequences. This process usually occurs in situations of palliative care, or death; however, this concept is also mentioned in the literature linked to other contexts. Therefore, our objective was to study whether the conspiracy of silence may be extrapolated to the context of decision-making on the location of care in old age. To this end, we first analyzed the in-depth semi structured qualitative interviews conducted with older people, caregivers, and professionals, about decision-making on the location of care in old age. Subsequently, a comparative analysis was performed between the basic elements of the conspiracy of silence and this decision-making. Our findings revealed an avoidance process developed by all three groups. Furthermore, this decision-making presents similarities with the conspiracy of silence in the process of avoidance coping and denial that is developed. However, there are significant differences, as information is not withheld from the older person, who has an active attitude in the process of avoidance. Decision-making on the location of care in old age does not exactly match the conspiracy of silence process, but it does seem to correspond to a pact of silence.

© 2021 by the authors., The objective of this review was to understand how participants experience the decision-making process regarding the place of care for the elderly. Therefore, we conducted a systematic review of qualitative studies. The articles were included if they were original studies with qualitative/mixed methodology, written in English/Spanish, and that approached the decision-making process regarding the place of care for the elderly, already experienced by the participants. Forty-four articles were included, identifying experiences, both negative and positive. Negative experiences have been the most frequently reported experiences by all population groups; fear was the most relevant experience for the elderly, whereas concern was the most relevant for family members and professionals. This review has not only found a great variability of experiences, but also, it has deepened the differences between groups and the situations motivating/generating these experiences. This review highlights a wide range of experiences of those directly involved in the entire decision-making process on the place of care for the elderly. In future research it would be interesting to carry out qualitative primary studies conducted with professionals and other relevant people involved in this decision-making process, in order to know first-hand how they experience this process., The first author has earned a grant from the Ministerio de Educación, Cultura y Deporte (Spanish government) to be trained as university teacher (Formación de Profesorado Universitario: FPU).

Background: Relocation is a very important event in people’s lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people. Methods: Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO, Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826). Results: A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push. Conclusion: This differentiation allows for a more detailed and in-depth analysis of the motivations of the different groups involved in this process.

Lourdes Biedma-Velázquez, María Isabel García-Rodríguez, Rafael Serrano-del-Rosal Institute for Advanced Social Studies, Spanish National Research Council (IESA/CSIC), Córdoba, Spain Background: Pain is a perception conditioned both by the painful experience and by each society’s collective imagination. The general objective of the project which this work forms part of it was to discover what citizens think about different aspects of this complex experience. More precisely, this paper’s objective is to get to know which is the worst pain that can be suffered according to Spaniards and what determines that hierarchy, bearing in mind that this work has chosen a broad definition of pain, including pains of different origins, namely, physical, psychological, and emotional pain. Materials and methods: The data from the CIS 3137 study “Social perceptions of pain” have been used, which is a survey module designed by the Institute of Advanced Social Studies (IESA) of the Spanish National Research Council (CSIC). A hierarchical multiple factor analysis has been performed, using the SPSS statistical analysis software, where the dependent variable is the citizen’s opinion on which is the worst pain that can be suffered, recoded according to the origin of pain (physical, psychological, and emotional pain). Sociodemographic variables and variables linked to the experience of pain have been included as independent variables. Results and conclusion: Although the most frequent pains among Spanish citizens are those of a physical origin, especially those linked to musculoskeletal problems and pains of an orofacial origin, when they are asked about the worst pain a person can suffer, they do not mention this type of pain, but those of an emotional origin. It has also been possible to confirm that the pain that citizens refer to when asked about the worst pain that can be suffered, and, therefore, the hierarchy of pain held by Spanish citizens as a group, is conditioned, although not determined, by the pain that has previously been suffered – by one’s own experience of pain. Keywords: pain, social perception, physical pain, psychological pain, emotional pain, experience of pain

Background: Relocation is a very important event in people¿s lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people. Methods: Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO,Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826). Results: A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push. Conclusion: This dierentiation allows for a more detailed and in-depth analysis of the motivations of the dierent groups involved in this process.

ObjectivesTo understand who are the participants in the decision-making process about the location of care of the elderly.DesignSystematic review of qualitative studies.Data sourcesThe following databases were consulted: Web of Science, MEDLINE, Scopus, CINAHL, PsycINFO and SciELO (from the beginning until 29 November 2017). The bibliographical references in the studies that were finally included in the review were also searched.Study selectionThe studies had to deal with the decision-making process (already experienced by the participants) on the location of care of the elderly (adults who are 65 or older), had to use a qualitative methodology and had to be written in English or Spanish.Data extraction and synthesisA data extraction tool was used. Data analysis was conducted through the constant comparative method from Glaser and Strauss’ grounded theory.Results46 studies were included in this review. Most of them were carried out in the USA, and in 21 of them the study population focused exclusively on the elderly. This review has found that there are many participants, with different roles and degrees of involvement, who may act jointly, separately or sequentially. These participants may be: the elders, family members, professionals and other relevant.ConclusionsThe main result of this review has been the variability found on how this decision is made, even varying the way of acting/perceiving the situation of the involved persons on certain occasions, simply due to the influence of some of the other groups of participants studied. Besides, this review has focused its results on the main participant in this process, the elders and how their family members interact with them when it comes to making this decision. This has allowed relevant results to be obtained about roles and degrees of involvement.PROSPERO registration numberCRD42018084826.

Introduction The elderly must take part in the management of their own health. One of the aspects they should be able to decide on is the place where they want to live. The aim of this review is to synthetise qualitative evidence in order to understand how decisions are made on the location of care of the elderly. Methods and analysis Systematic review of qualitative studies. Six databases have been consulted: Web of Science, PubMed, Scopus, CINAHL Complete, PsycINFO and SciELO Citation Index (from the beginning to 29 November 2017). The inclusion criteria will be: studies that deal with the decision-making process on the location of care of the elderly (already experienced by the participants), original studies, qualitative or mixed-method studies and studies written in English or Spanish. The obtained results will be exported to the Zotero bibliography manager. The references will be reviewed by title and abstract and, later, the complete texts will be reviewed for their inclusion. A tool created for this study will be used to extract the data. The quality will be assessed with Critical Appraisal Skills Programme Español. The data synthesis will be carried out using the constant comparative method. All this process will be performed independently by two reviewers. Enhancing transparency in reporting the synthesis of qualitative research has been used to draw up this protocol. Ethics and dissemination This protocol did not require ethical approval, since it is a protocol for a systematic review. The plans to disseminate our results include publishing a research paper in a high-impact journal in our study area. Also, if possible, our results will be presented in scientific conferences. Besides, the obtained results will complement and discuss the doctoral thesis of one of the authors of the review. PROSPERO registration number CRD42018084826. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. http://dx.doi.org/10.1136/bmjopen-2018-022411

The article addresses a thorny issue in our time, sedentarism. Concern over sedentarism pervades current medical discourse as well as public opinion. However, this article does not enter into debate or discuss solutions. Instead, it offers a different perspective on an issue that has been largely defined by the medical profession. Physical activity and sports are a source of health; biological and epidemiological studies have demonstrated this. But health is not merely the absence of disease or the biophysical state of the individual. Culture and living conditions contribute to it. Well-being is also a reflection of elements of a social and not just biological nature. Thus, the study of health and well-being must not ignore the value of the social sciences. Here we analyze the extent to which our lifestyles (active or sedentary) are determinants of our health and subjective well-being. The results provide a reflection on the cost of our lifestyles, not only in regard to our own health and well-being, but also regarding the health system itself. Hence, our diagnosis is based on the idea that, as with health and well-being, our lifestyles depend on cultural prescriptions and not merely medical ones.

Assess whether the universalization of epidural analgesia supplied in hospitals of the Andalusia Public Health Service (SSPA) has ended up with the inequalities shown in previous studies regarding to their demand: the percentage of women who rejected epidural analgesia was higher among the users having low educational level, lower income and working as housekeeper.The data are based on satisfaction surveys conducted by the Institute for Advanced Social Studies amongst of SSPA users. This survey includes a section aimed at women attended in labor (N = 21,300). The hierarchical segmentation analysis shows which variables are the ones that discriminate most in the usage of epidural analgesia. Subsequently, through a model of binary logistic regression we analyze which socio-demographic variables are significant (2012) and how its impact is on the choice of epidural analgesia in childbirth.Overall, the socio-demographic variables of the users are statistically significant in the demand or not of epidural analgesia during labor. However, the detailed analysis of the last year (2012) shows that none of the socio-demographic variables introduced in the model has a significant effect on the decision of using epidural analgesia.The process of universalization of epidural anesthesia in childbirth has ended with social inequalities in their use, that is, with those differences that are not due to a real choice but are induced by socio-cultural characteristics of women.

This study analyzes the social participation of older people based on individual and contextual variables. For this purpose the data of the Survey of Health, Ageing and Retirement in Europe (SHARE) in particular waves 1, 2 and 4 have been used. A four-level model with fixed and random effects was carried out. The model obtained shows the effect of individual variables: a greater participation in more recent waves, in ages between 60-70 years and the effect of variables such as cognitive functioning, years of education and health self-perception. But significant differences were also found in participation in contextual variables and between countries. These results are important for public policy managers, who must take into account not only individual variables, but also contextual variables, which explain the differences in the participation rate of the elderly. pre-print 1693 KB

Objetivo: Analizar la visión que tienen de su formación y práctica profesional los médicos internos residentes (MIR) que han elegido la especialidad de medicina de familia y comunitaria (MFC) frente al resto de residentes de otras especialidades, para ver las diferencias entre ambos y sus implicaciones para el sistema. Material y métodos: Encuesta online a MIR que comenzaron su formación residencial en Andalucía en 2008. Se realizó un análisis factorial de los componentes principales a partir de variables de opinión sobre aspectos profesionales y formativos con el fin de agruparlas en dimensiones y posteriormente un ANOVA para observar las diferencias entre los 2 grupos estudiados con respecto a dichas dimensiones. Resultados: Se obtuvieron 3 dimensiones que resumen las opiniones de los residentes sobre su formación residencial. Los residentes de MFC tienen una visión más positiva del sistema de formación y le dan más importancia a cuestiones generales de la práctica médica respecto a los residentes de otras especialidades. Conclusiones: Actualmente las políticas sanitarias posicionan al ciudadano como eje del sistema y ponen el acento no solo en cuestiones biológicas sino también en otras de carácter social (prevención, educación, atención de enfermedades comunes y de colectivos con mayores problemas, etc.). A tenor de los resultados los MIR-MFC parecen estar más en consonancia con estos valores, lo cual puede ser indicativo de una mejor adaptación a esta nueva cultura organizativa.

Objective. To analyze how the overall satisfaction of users of the Andalusian Public Health Service varies according to their level of satisfaction with the different dimensions and specific aspects of the service. Materials and Methods. Data stem from the Primary Care Services User Survey conducted in 2005 as part of a larger research project regarding user satisfaction with the Andalusian Public Health Service. The methodology was to establish a compound variable for Global satisfaction from three initial satisfaction measurements found in the survey and to reduce 23 indicators for partial satisfaction to three satisfaction dimensions in order to analyze the existing relationship between them. Results. The level of satisfaction with the dimension called the “organizational aspects of the service” best reflects the increase or decrease in the users’ Global satisfaction level. Users’ satisfaction with “medical services received” as well as the “state of the amenities” has less of an impact on the level of Global satisfaction. Conclusions. Once a high level of satisfaction with the medical services is attained, the organization is the dimension that most determines the level of Global satisfaction with Primary Care services because this dimension contains factors that reflect the highest levels of dissatisfaction.

Research on Subjective Well-being (SWB) recognizes the important role of individual leisure satisfaction – measured by responses to a stated leisure experience valuation question – as a mediator of individual happiness. Since leisure is a complex human need, individual heterogeneity must be taken into account due to the relevance of tastes, skills, and resources. We investigate the determinants of leisure satisfaction using data derived from the 2003 Survey on Living Conditions and Poverty for Andalucia (Spain). Using self-reported measures of leisure experience valuation (leisure satisfaction), ordered probit models are estimated, accounting for personal-demographic and household-socio-economic variables. This allows us to disentangle the impact of the latter into the resources allocation for leisure experience production and thus, leisure satisfaction.

Background: The main objective of this paper is to analyze the prevalence of each of the different clinical subtypes of temporomandibular disorders (TMD) in a sample of patients with this pathology. In addition, a second objective was to analyze their distribution according to gender. Material and Methods: To this end, the results of 1603 patients who went to the Unit of Temporomandibular Disorders in the Córdoba Healthcare District because they suffered from this pathology were analyzed. In order to diagnose them, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were applied, analyzing the different Axis I subtypes (myopathy, discopathy and arthropathy) and obtaining the combined Axis I for each patient and the relation of all these variables according to gender. The null-hypothesis test confirmed the lack of connection between the gender variable and the different subtypes in the clinical analysis, and between the former and the combined Axis I of the RDC/TMD. Results: The prevalence was high for the muscle disorders subtype in general, showing an 88.7% prevalence, while the presence of discopathies or arthropathies was much lower. Among discopathies, the most frequent ones were disc displacements with reduction, with 39.7% and 42.8% for the left and right temporomandibular joints (TMJ), respectively, while the prevalence of arthropathies was 26.3% for the right TMJ and 32.9% for the left TMJ. The bivariate analysis on the connection with gender reveals a p≥ 0.05 value for the muscle and arthralgia subtypes. Conclusions: The patients seen at the TMD Unit where mostly middle-aged women whose main clinical axis subtype was the muscle disorder subtype. For their part, both discopathies and arthropathies, although present, are much less prevalent.

This paper aims to contribute further research on the conceptualization of individual financial satisfaction as a particular domain of satisfaction with life as a whole. Based on the 2003 Survey on Living Conditions and Poverty for Andalucia (Spain) and using a self-reported measure of welfare, ordered probit models are used to analyze the extent to which individual financial satisfaction can be solely explained by income in absolute terms, or alternatively, by taking into account the importance of relative income in its two dimensions: (1) personal aspirations as individual’s adaptation to previous and future income levels (intra-individual comparisons), and (2) social comparisons as individual’s concern for her peer’s income (inter-personal dependency).

When we talk about the “meaning of pain,” we can do so from two main fields. First of all, the biological meaning of pain may be referred to. Second, we can talk about the function or “social meaning” of pain.

Objective: To compare the attitudes of Spanish citizens with existing legal models on euthanasia and assisted suicide to identify which of them the citizens could agree with. Methods: Data collected by the Social Research Centre in Study 2,803 “care for patients who are terminally ill” in 2009 were analysed. Descriptive analysis and comparisons with McNemar test were carried out. Results: Spanish populationclearly supports the practice of euthanasia for the terminally ill. Agreement is lower in the case of physician assisted suicide and degenerative diseases. Conclusions: The Belgian model matches the approach favoured by Spanish public opinion closest. This represents a starting point for the social, political and legal debate needed to regulate individuals’ rights at the end of life., Introducción: Comparar las actitudes de los ciudadanos españoles con los modelos legales existentes sobre eutanasia y suicidio asistido para identificar con cuál de ellos la ciudadanía podría estar más de acuerdo. Metodología: Se analizaron los datos recogidos por el Centro de Investigaciones Sociológicas en el Estudio 2.803 “Atención para pacientes con enfermedad terminal”. Realizamos análisis descriptivos y comparaciones mediante la prueba de McNemar. Resultados: La población española apoya claramente la práctica de eutanasia en enfermos terminales. El suicidio médico asistido y los casos de enfermedad degenerativa hacen disminuir el grado de aceptación. Conclusiones: El modelo belga es el que mejor se ajusta a las opiniones de la ciudadanía española. Se considera un punto de partida, para conducir el debate social, político y jurídico, necesario para lograr una regulación de los derechos que asisten a los ciudadanos al final de la vida.

El trabajo infantil ha sido en los últimos años objeto de preocupación social. Sin embargo en España en general, y en la comunidad andaluza en particular, existen pocos estudios fiables sobre el mismo. En este artículo el autor presenta algunos de los resultados del estudio cualitativo “El trabajo de los menores en Andalucía” realizado en el marco del Instituto de Estudios Sociales Avanzados de Andalucía (IESA–Córdoba) del Consejo Superior de Investigaciones Científicas (CSIC). Según esta investigación sociológica, los dos factores que la sociedad andaluza actual considera más unánimemente como fundamentales para valorar si el trabajo que realiza un menor es digno de considerarse explotación o no, son la edad y la asistencia del menor a la escuela.

Objectives: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study Design: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diagnosed following the standard criteria accepted by the scientific community – the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) – were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the degree of association between the patients’ OHIP-14 score and pain duration, pain intensity, and various sociodemographic variables. Results: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p

It determines if participating in sports and/or physical activity influences perceived health among the elderly. Basic procedures: Data were drawn from a population subsample of subjects aged 65 - 79 years old that took part in a survey conducted in 2008 by the IESA-CSIC. A regression model was performed with perceived health status with the dependent variable and sociodemographic characteristics and physical activity as independent variables. Results: Physical activity is closely associated to per-ceived health, although sport has little influence on this relationship. Conclusions: Doing exercise or feeling that one is physically active makes the elderly feel better about their health status. However, this age group practises few sports and sport is not found to have an important or constant influence on self-perceived health status among the elderly.

In this article we examine, through six focus groups, the various arguments put forth by social actors to defend or reject the right to choose how to die, including palliative sedation, euthanasia and even assisted suicide. This qualitative technique allows us to establish the relative weight of traditional, modern and neo-modern models of coping with death in the discourses of the Spanish subjects sampled within the study, how these models are reflected in specific cultural scripts and to what extent these scripts for a good death are the product of a reflexive project of identity.

Objetivo: Analizar qué características sociodemográficas y de opinión predicen el respaldo de los ciudadanos a la Ley antitabaco en España. Métodos: Se han analizado los datos de una encuesta telefónica realizada en 2008 por el Centro de Investigaciones Sociológicas (CIS) sobre hábitos relacionados con el tabaco a población española, estableciendo cuotas de sexo y edad y con distribución por comunidades autónomas y tamaño de hábitat. Se ha realizado un análisis descriptivo de los principales resultados y un análisis de regresión logística (stepwise forward). La variable dependiente es la posición ante la ley antitabaco, y las variables independientes, las características sociodemográficas del entrevistado y las opiniones sobre la ley. Resultados: Lo que más predice la posición favorable a la ley es la apreciación de su efectividad, es decir, la percepción de que la ley ayuda a mejorar la salud de la población y a reducir el número de fumadores y la cantidad de cigarrillos fumados. Conclusión: Es necesario que la población apoye políticas sanitarias que son claramente beneficiosas para la salud pública en general. En este sentido, la información sobre la efectividad de la ley se postula como un elemento decisivo para conseguir el respaldo popular necesario para llevar a cabo políticas restrictivas y/o prohibitivas.

Background: Medical residents play two roles that enter into conflict during their educational period: trainees and workers. This dual role can lead to dissatisfaction among residents that can affect both the quality of the services they provide to citizens and the proper functioning of the health services model itself. Aim: To analyse discrepancies between the preferences and expectations of first-year medical residents and whether these differences affect satisfaction with the residency. Method: A questionnaire was administered on-line to the entire population of first-year medical residents of the Autonomous Community of Andalusia (Spain) in 2008. We performed a means contrast test between the indicator discrepancy (difference between preferences and expectations during the residency as a training or a working period), overall satisfaction with the residency and their relationship to other expectations of medical residents. Results: Respondents showing greater discrepancy have a more negative opinion about the residency. Conclusion: There is a gap between what residents prefer and what they expect from the residency, giving rise to dissatisfaction. This gap must be bridged to improve the quality of training received by these new physicians, their satisfaction and hence the delivery of health services to citizens. © 2012 Informa UK Ltd.

Health is a key area for humans and the main indicator of the quality of life we enjoy. For this reason health has been studied, analysed, and discussed across numerous scientific disciplines from a wide range of theoretical perspectives. From the quantitative point of view, it is noteworthy that life expectancy in Western countries has reached its highest level in the history of mankind1. Medical research has made significant contributions to our understanding of the human organism, as well as the treatment and prevention of many diseases. These advances have had a direct impact not only on increased life expectancy, but have also changed the concept of medical practice, which is increasingly focused on “adding life to years rather than adding years to life” (Herrera & Duran, 1995). Indeed, in medical practice today, the patient’s quality of life has become as or even more important than the disease itself. From the qualitative standpoint, this has led to a significant change in how health is conceived. Health is now understood as a multidimensional concept that in addition to purely medical aspects (morbidity, mortality, life expectancy ), encompasses physical elements (physical surrounding, housing, the environment, etc.), social components (occupational health and safety, education and health care, equitable distribution of available resources, etc.), lifestyle (adequate diet, physical exercise, tobacco and alcohol consumption, etc.), the healthcare system (physical and human resources, hospital care, social security, research, etc.), and others.

Objective: A study is made of the influence of gender, educational level, marital status, income, social support, and perceived general and oral health upon pain intensity in a sample of patients with temporomandibular joint disorders (TMJD) explored in primary care (AP). Design: A review was made of 899 patients from Córdoba Healthcare District (Spain) referred to the primary care TMJD Unit by their primary care physician and/or dentist. Of these subjects, 151 failed to meet the inclusion criteria. The remaining 748 subjects were explored according to the corresponding research diagnostic criteria (RDC/TMJD). A bivariate analysis was made the association of pain intensity to the demographic and psychological characteristics of the patients, and to perceived general and oral health, followed by a multivariate linear regression analysis to explain pain intensity as a function of the rest of the variables. The SPSS version 19.0 statistical package was used. Results: The patient age ranged from 18-86 years, with a mean of 45.8 years (± 15.8), and a female predominance of 5:1. The characteristic pain intensity (CPI) score was almost 15 points higher on average in women than in men (p

Los estudios realizados para medir la calidad de un servicio sanitario, muestran que la satisfacción del paciente es un instrumento importante para evaluar aquélla y el funcionamiento real de dicho servicio. La información que aportan puede ser una buena guía para los políticos o gestores encargados del diseño y puesta en práctica de programas orientados a aumentar la calidad y eficacia sin olvidar a una parte fundamental: sus usuarios. En este contexto se enmarca un proyecto de investigación que se lleva a cabo en el Instituto de Estudios Sociales Avanzados del Consejo Superior de Investigaciones Científicas en colaboración con el Servicio Andaluz de Salud. Bajo este marco, el objetivo de este trabajo es conocer la importancia que tiene la satisfacción de los usuarios con los profesionales de enfermería, en el conjunto de su satisfacción con el servicio sanitario recibido. Para ello, se exponen los resultados de un riguroso análisis con los datos del estudio de satisfacción del usuario de Atención Primaria del año 2008. Se plantea la siguiente paradoja, los usuarios están claramente satisfechos con los enfermeros, con un porcentaje por encima del resto de los profesionales, sin embargo, cuando dichos usuarios conforman su satisfacción global con el servicio recibido, la importancia de estos profesionales disminuye notablemente centrándose principalmente en el papel de los médicos. The studies carried out to measure the quality of the health services show patient satisfaction as an important tool to evaluate the actual running of the service and its quality. This information can be a good guide in the design and implementation of health programs aimed at increasing their quality and efficiency for policy makers and managers. In this context, the aim is to know the importance of user satisfaction with nursing professionals in all of their overall satisfaction with the health service received. An empirical study is been undertaken at the Institute of Advanced Social Studies of the Higher Council for Scientific Research in collaboration with the Andalusian Public Health Service. Data are obtained from the Primary Care Services User Survey in 2008. As a result of a rigorous analysis, users are very satisfied with nurses but the importance of these professionals focus decreases significantly in favour of the role of doctors when these users make up their overall satisfaction with the service received.

20 páginas, 6 tablas., [ES] Diferentes estudios se han centrado en definir cuáles son los papeles que deben adoptar médico y paciente durante su relación en la consulta en aras de conseguir altos niveles de satisfacción del usuario y confianza en la asistencia recibida. Elementos ambos de suma importancia para incrementar la probabilidad de seguir los consejos y tratamientos del médico, aspectos indicativos del éxito de dicha consulta. Dada la inexistencia de un consenso claro entre los investigadores, este trabajo se ha centrado en estudiar empíricamente, a partir de los datos de la Encuesta a usuarios de los Servicios de Atención Primaria prestados por el Servicio Andaluz de Salud en 2006, cómo varía la confianza en la asistencia médica en función de las evaluaciones que realizan los usuarios sobre diferentes aspectos del acto médico. Los resultados apuntan que las condiciones de una relación médico-paciente exitosa se basan principalmente en mantener una verdadera comunicación y no un mero intercambio de información., [EN] Various studies have focused on defining the roles that both doctors and patients should adopt during consultations with a view to improving user satisfaction and confidence in the medical care they receive. These two factors clearly contribute to ensuring compliance with the advice and treatments prescribed by healthcare providers and the subsequent success of consultations. Due to the lack of consensus among researchers, this paper aims to empirically examine how confidence in healthcare varies based on assessments made by users regarding different aspects of medical care. The data were taken from the Survey of primary healthcare users of the Andalusian Healthcare Service in 2006. Trust in healthcare is highly related to the satisfaction users express in the four variables examined in the study. The main conclusion is that successful doctor-patient relationships are based on effective communication and not a mere exchange of information., Ministerio de Educación y Ciencia español, Plan Nacional I+D+I (SEJ2005-06099) da el apoyo financiero a este proyecto.

To analyse differences in the satisfaction of health service users associated with the sex of the attending doctor.Data obtained from the Primary Care Services User Survey (2005), part of a project regarding user satisfaction with the Andalusian Public Health Services. A bivariate analysis was conducted, the two variables being doctors sex and user satisfaction, as was an ANOVA, taking as a dependent variable the indicator of general satisfaction and as independent variables the characteristics of the individual and that of the system, including physician sex.In the bivariate analysis a relation was confirmed between doctors sex and satisfaction with the components of the health service received. Nevertheless, this influence disappears in the analysis of dependence, which includes sociodemographic and system variables.Differences between practices by male and female doctors are confirmed, but not the differences in general satisfaction with the service received.

To analyze how the overall satisfaction of users of the Andalusian Public Health Service varies according to their level of satisfaction with the different dimensions and specific aspects of the service.Data stem from the Primary Care Services User Survey conducted in 2005 as part of a larger research project regarding user satisfaction with the Andalusian Public Health Service. The methodology was to establish a compound variable for Global satisfaction from three initial satisfaction measurements found in the survey and to reduce 23 indicators for partial satisfaction to three satisfaction dimensions in order to analyze the existing relationship between them.The level of satisfaction with the dimension called the "organizational aspects of the service" best reflects the increase or decrease in the users' Global satisfaction level. Users' satisfaction with "medical services received" as well as the "state of the amenities" has less of an impact on the level of Global satisfaction.Once a high level of satisfaction with the medical services is attained, the organization is the dimension that most determines the level of Global satisfaction with Primary Care services because this dimension contains factors that reflect the highest levels of dissatisfaction.

This study provides additional empirical evidence for research concerning the effects of gender and age on retrospective time judgements using data obtained from a Spanish database with more than 40,000 individual observations on time estimations. Statistical analyses were performed using the Levene F-test and the t-test of variances and means, respectively. The most important results of the study are as follows: (a) differences in time estimation in relation to gender largely depend on the age groups analysed, with greater differences observed in the younger age group; and (b) although there are some differences regarding age, they are related to certain age groups, particularly the youngest age group.

En este artículo, el autor discute la tesis de la crisis u obsolescencia del sindicalisino en las sociedades industriales avanzadas, para el caso del sindicalismo español de finales del siglo XX. Para ello analiza. en piiner lugw, la evolución rcciente del mercado de trabajo español con objeto de describir el escenario en el que los trabajadores definen sus problemas y plantean sus demandas a las sindicatos, y, a su vez, el marca en el que los sindicatos definen sus objetivos y desarrollan estrategias para adaptarse y defender los intereses dc los trabajadores: en segundo lugar, los problemas que consideran que tienen los trabajadores y las demandas que dirigen a los sindicatos, es decir, los intereses dc los trabajadores: y, en tercer lugar, los principales ob,jetivos sindicales y las estrategias que ponen en marcha para implementarlos en las postciinerías del siglo XX. Con estos elementos se tratará de contestar a la pregunta: se adaptan las organizaciones sindicales españolas de iinales de siglo a los intereses de los trabajadores.