Andreu Nolasco

a) Describir la metodología seguida en la construcción de un índice de privación por sección censal en ciudades, que permite identificar las secciones con situaciones socioeconómicas más desfavorables, y b) analizar la relación de este índice con la mortalidad general. Se elaboraron diversos indicadores socioeconómicos (Censo 2001) correspondientes a las secciones censales de las ciudades de Barcelona, Bilbao, Madrid, Sevilla y Valencia. Se estudiaron sus correlaciones con la razón estandarizada de mortalidad (1996-2003), así como sus dimensiones conceptuales. Finalmente, mediante el análisis de componentes principales, se agregaron en un índice los indicadores seleccionados, usando como valores de peso las saturaciones correspondientes al primer eje. Los indicadores que presentaron mayores correlaciones con la mortalidad general fueron los referidos a trabajo, educación, vivienda-entorno y hogares monoparentales. En el análisis dimensional de los indicadores aparece una primera dimensión que contiene los indicadores relativos a trabajo (desempleo, trabajadores manuales y eventuales) y educación (instrucción insuficiente total y en jóvenes). El índice elaborado con estos 5 indicadores recoge, en todas las ciudades estudiadas, más del 75% de la variabilidad de los indicadores que lo componen. Las correlaciones de este índice con la mortalidad muestran, en general, mayores valores que las obtenidas individualmente con cada indicador. El índice de privación que se propone puede ser un instrumento útil para la planificación sanitaria al detectar áreas pequeñas de grandes ciudades con una situación socioeconómica desfavorable, que se relaciona con la mortalidad, y puede contribuir al estudio de las desigualdades sociales en salud en España. a) To describe the methodology used to construct a deprivation index by census tract in cities, to identify the tracts with the least favorable socioeconomic conditions, and b) to analyze the association between this index and overall mortality. Several socioeconomic indicators (Census 2001) were defined by the census tracts of the following cities: Barcelona, Bilbao, Madrid, Seville and Valencia. The correlations with the standardized mortality ratio (1996-2003), and the dimensionality of the socioeconomic indicators were studied. Finally, the selected indicators were aggregated in an index, in which the results of the factor loadings from extraction of a factor by principal components were used as weighting values. The indicators with the strongest correlations with overall mortality were those related to work, education, housing conditions and single parent homes. In the analysis of dimensionality, a first dimension appeared that contained indicators related to work (unemployment, manual and eventual workers) and education (insufficient education overall and in young people). In all the cities studied, the index created with these 5 indicators explained more than 75% of their variability. The correlations between this index and mortality generally showed higher values than those obtained with each indicator separately. The deprivation index proposed could be a useful instrument for health planning as it detects small areas of large cities with unfavorable socioeconomic characteristics and is associated with mortality. This index could contribute to the study of social inequalities in health in Spain.

A prospective cohort study with a 1-year follow-up of 156 neonates was carried out specifically designed to test the hypothesis that there is a positive relationship between iron deficiency during pregnancy and the development of the same disease in newborn infants. Exposure was defined as being born of a mother with ferropenic anaemia at delivery, and cases as the infants who developed iron deficiency during their first year of life. A statistically significant positive association was detected with an odds ratio of 6.57 (95% confidence limits 1.81-25.97). A stratified analysis was also performed to control the effect of potential confounders such as socio-economic variables, feeding practices and other factors linked with the iron status of infants. This second analytical procedure showed no alteration in the association detected in the simple analysis but that there was a statistically significant strong interaction between the quantity of cow's milk intake and the ferropenic status of the mother. These results show a relationship between iron deficiency of the mother at delivery and the development of iron deficiency in the infants. These new findings could be important in the development of new prevention programmes applied to pregnant women.

BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) is a tool to measure the risk for mental disorders in children. The aim of this study is to describe the diagnostic efficiency and internal structure of the SDQ in the sample of children studied in the Spanish National Health Survey 2006. METHODS: A representative sample of 6,773 children aged 4 to 15 years was studied. The data were obtained using the Minors Questionnaire in the Spanish National Health Survey 2006. The ROC curve was constructed and calculations made of the area under the curve, sensitivity, specificity and the Youden J indices. The factorial structure was studied using models of exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA). RESULTS: The prevalence of behavioural disorders varied between 0.47% and 1.18% according to the requisites of the diagnostic definition. The area under the ROC curve varied from 0.84 to 0.91 according to the diagnosis. Factor models were cross-validated by means of two different random subsamples for EFA and CFA. An EFA suggested a three correlated factor model. CFA confirmed this model. A five-factor model according to EFA and the theoretical five-factor model described in the bibliography were also confirmed. The reliabilities of the factors of the different models were acceptable (>0.70, except for one factor with reliability 0.62). CONCLUSIONS: The diagnostic behaviour of the SDQ in the Spanish population is within the working limits described in other countries. According to the results obtained in this study, the diagnostic efficiency of the questionnaire is adequate to identify probable cases of psychiatric disorders in low prevalence populations. Regarding the factorial structure we found that both the five and the three factor models fit the data with acceptable goodness of fit indexes, the latter including an externalization and internalization dimension and perhaps a meaningful positive social dimension.Accordingly, we recommend studying whether these differences depend on sociocultural factors or are, in fact, due to methodological questions.

Describir las propiedades psicométricas y el nivel de comprensión del cuestionario de alfabetización en salud HLS-EU-Q16 en español, implementado en la Encuesta de Salud de la Comunitat Valenciana de 2016. Estudio descriptivo transversal para describir la comprensión, la fiabilidad, la estructura y la consistencia interna del cuestionario sobre la muestra de 5485 sujetos, de 15 o más años de edad, participantes en la encuesta. Los porcentajes de comprensión sin mucha dificultad fueron elevados. La fiabilidad fue alta (coeficiente de correlación intraclase: 0,923; kappa: 0,814). El análisis factorial sugirió una estructura unifactorial (79,1% de variabilidad explicada por el factor común), con altas cargas factoriales. La consistencia fue alta (alfa de Cronbach: 0,982). El HLS-EU-Q16 en español es un instrumento breve, adecuado y válido para medir el nivel de alfabetización en salud de la población. To describe the psychometric properties and the level of understanding of the health literacy questionnaire HLS-EU-Q16 in Spanish, implemented in the Health Survey of the Valencian Region (Spain) of 2016. Descriptive cross-sectional study to describe understanding, reliability, structure and internal consistency of the questionnaire on a sample of 5485 subjects, aged 15 or over, who participated in the survey. The percentages of understanding without much difficulty were high. Reliability was high (intraclass correlation coefficient:.923; kappa:.814). The factorial analysis suggested a unifactorial structure (79.1% of variability explained by the common factor), with high factorial loads. The consistency was high (Cronbach's alpha: 0.982). The HLS-EU-Q16 in Spanish is a short, adequate and valid instrument to measure the level of health literacy in the population.

BACKGROUND: Empirical evidence of the efficacy and effectiveness of psychosocial family intervention and of the specificity of its effects on the course of schizophrenia is limited. The aim was to study the efficacy and effectiveness of psychosocial family intervention with regard to clinical and social functioning and family burden after controlling for compliance and several prognostic factors. METHOD: A 2-year randomized controlled trial with blind assessments. Fifty patients with DSM-IV schizophrenia and persistent positive symptoms and/or previous clinical relapse were allocated to psychosocial family intervention, individual counselling and standard treatment versus individual counselling and standard treatment. RESULTS: Family intervention was associated with fewer clinical relapses, hospitalizations and major incidents, and an improvement in positive and negative symptoms, social role performance, social relations, employment and family burden. The reduction in hospitalizations in the family intervention group was significantly greater than that observed in the group of patients who refused to participate but this was not the case for the control group. The effects of family intervention were independent of compliance and prognostic factors. CONCLUSIONS: Family intervention is effective in severe schizophrenia independently of compliance and prognostic factors.