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  • 1. Briones-Vozmediano, Erica
    et al.
    Carmen Davo-Blanes, Ma
    Garcia-de la Hera, Manuela
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. b Grupo de Investigación en Salud Pública, Universidad de Alicante, Alicante, Espa˜na.
    Vives-Cases, Carmen
    Discursos profesionales sobre la violencia del compañero íntimo: implicación en la atención de las mujeres inmigrantes en España2016In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 30, no 5, p. 326-332Article in journal (Refereed)
    Abstract [en]

    Objective: 1) to examine the discourses of professionals involved in the care of female victims of intimate partner violence (IPV), with emphasis on how they describe the immigrant women, the perpetrators and their own responsibility of care; and 2) to compare these discourses with the other professions involved in caring for these women (social services, associations and police and justice). Methods: Qualitative study based on semi-structured interviews with 43 professionals from social services, associations and the police and judicial systems. A discourse analysis was carried out to identify interpretive repertoires about IPV, immigrant women and their aggressors, their culture and professional practices. Results: Four interpretive repertoires emerged from professional discourses: "Cultural prototypes of women affected by IPV", "Perpetrators are similar regardless of their culture of origin", "Are victims credible and the perpetrators responsible?" and "Lack of cultural sensitivity of professionals in helping immigrant women in abusive situations". These repertoires correspond to preconceptions that professionals construct about affected women and their perpetrators, the credibility and responsibility they attribute to them and the interpretation of their professional roles. Conclusions: The employment of IPV-trained cultural mediators in the services responsible for caring for the female victims, together with cultural training for the professionals, will facilitate the provision of culturally sensitive care to immigrant female victims of intimate partner violence. (C) 2016 SESPAS. Published by Elsevier Espana, S.L.U.

  • 2.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Alicante, España.
    Aguilo, Elena
    Madrid, España.
    Madrid, Juan
    Madrid, España.
    Is youth-friendly primary care feasible in Spain?2015In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 29, no 4, p. 241-243Article in journal (Other academic)
  • 3.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Alicante, Grp Invest Salud Publ, E-03080 Alicante, Spain.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Marchal, Bruno
    Vives-Cases, Carmen
    Using realist evaluation to assess primary healthcare teams' responses to intimate partner violence in Spain2015In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 29, no 6, p. 431-436Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Few evaluations have assessed the factors triggering an adequate health care response to intimate partner violence. This article aimed to: 1) describe a realist evaluation carried out in Spain to ascertain why, how and under what circumstances primary health care teams respond to intimate partner violence, and 2) discuss the strengths and challenges of its application.

    METHODS: We carried out a series of case studies in four steps. First, we developed an initial programme theory (PT1), based on interviews with managers. Second, we refined PT1 into PT2 by testing it in a primary healthcare team that was actively responding to violence. Third, we tested the refined PT2 by incorporating three other cases located in the same region. Qualitative and quantitative data were collected and thick descriptions were produced and analysed using a retroduction approach. Fourth, we analysed a total of 15 cases, and identified combinations of contextual factors and mechanisms that triggered an adequate response to violence by using qualitative comparative analysis.

    RESULTS: There were several key mechanisms -the teams' self-efficacy, perceived preparation, women-centred care-, and contextual factors -an enabling team environment and managerial style, the presence of motivated professionals, the use of the protocol and accumulated experience in primary health care- that should be considered to develop adequate primary health-care responses to violence.

    CONCLUSION: The full application of this realist evaluation was demanding, but also well suited to explore a complex intervention reflecting the situation in natural settings.

  • 4.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain.
    Marchal, Bruno
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vives-Cases, Carmen
    Briones-Vozmediano, Erica
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Why do certain primary health care teams respond better to intimate partner violence than others?: A multiple case study2019In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 33, no 2, p. 169-176Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse how team level conditions influenced health care professionals’ responses to intimate partner violence.

    Methods: We used a multiple embedded case study. The cases were four primary health care teams located in a southern region of Spain; two of them considered "good" and two s "average". The two teams considered good had scored highest in practice issues for intimate partner violence, measured via a questionnaire (PREMIS - Physicians Readiness to Respond to Intimate Partner Violence Survey) applied to professionals working in the four primary health care teams. In each case quantitative and qualitative data were collected using a social network questionnaire, interviews and observations.

    Results: The two "good" cases showed dynamics and structures that promoted team working and team learning on intimate partner violence, had committed social workers and an enabling environment for their work, and had put into practice explicit strategies to implement a women-centred approach.

    Conclusions: Better individual responses to intimate partner violence were implemented in the teams which: 1) had social workers who were knowledgeable and motivated to engage with others; 2) sustained a structure of regular meetings during which issues of violence were discussed; 3) encouraged a friendly team climate; and 4) implemented concrete actions towards women-centred care.

  • 5.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, Spain.
    Mosquera, Paola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Briones-Vozmediano, Erica
    Otero-García, Laura
    García-Quinto, Marta
    Vives-Cases, Carmen
    Primary health care attributes and responses to intimate partner violence in Spain2017In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 31, no 3, p. 187-193Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV).

    METHODS: A qualitative study was conducted using semi-structured interviews with 160 health professionals working in 16 PHC centres in Spain. Data were analysed using a qualitative content analysis.

    RESULTS: Four categories emerged from the interview analysis: those committed to the PHC approach, but with difficulties implementing it; community work relying on voluntarism; multidisciplinary team work or professionals who work together?; and continuity of care hindered by heavy work load. Participants felt that person-centred care as well as other attributes of the PHC approach facilitated detecting IPV and a better response to the problem. However, they also pointed out that the current management of the health system (workload, weak supervision and little feedback, misdistribution of human and material resources, etc.) does not facilitate the sustainability of such an approach.

    CONCLUSION: There is a gap between the theoretical attributes of PHC and the "reality" of how these attributes are managed in everyday work, and how this influences IPV care.

  • 6.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vives-Cases, Carmen
    Minvielle, Fauhn
    Briones-Vozmediano, Erica
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Applying the WHO recommendations on health-sector response to violence against women to assess the Spanish health system: a mixed methods approach2014In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 28, no 3, p. 238-41Article in journal (Refereed)
    Abstract [en]

    This methodological note describes the development and application of a mixed-methods protocol to assess the responsiveness of Spanish health systems to violence against women in Spain, based on the World Health Organization (WHO) recommendations.

    Five areas for exploration were identified based on the WHO recommendations: policy environment, protocols, training, accountability/monitoring, and prevention/promotion. Two data collection instruments were developed to assess the situation of 17 Spanish regional health systems (RHS) with respect to these areas: 1) a set of indicators to guide a systematic review of secondary sources, and 2) an interview guide to be used with 26 key informants at the regional and national levels.

    We found differences between RHSs in the five areas assessed. The progress of RHSs on the WHO recommendations was notable at the level of policies, moderate in terms of health service delivery, and very limited in terms of preventive actions. Using a mixed-methods approach was useful for triangulation and complementarity during instrument design, data collection and interpretation.

  • 7.
    Jesus Rodriguez, Gabriel
    et al.
    Servicio de Medicina Preventiva, Salud Pública y Promoción de la Salud, Hospital Universitario Puerta del Mar, Cádiz, España.
    Escolar-Pujolar, Antonio
    Servicio de Medicina Preventiva, Salud Pública y Promoción de la Salud, Hospital Universitario Puerta del Mar, Cádiz, España and Delegación Territorial de Igualdad, Salud y Políticas Sociales, Cádiz, España.
    Cordoba-Dona, Juan Antonio
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Delegación Territorial de Igualdad, Salud y Políticas Sociales, Cádiz, España.
    Trends in socioeconomic inequalities in general mortality in the city of Cadiz, Spain (1992-2007)2014In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 28, no 4, p. 313-315Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze trends in socioeconomic inequality in mortality in the city of Cadiz (Spain) from 1992 to 2007. Methods: An ecological study was performed of trends over 3 cross-sections, with the census tract as the unit of analysis. Deaths were grouped into three periods: 1992-1996, 1997-2001 and 2002-2007 and were then classified according to a deprivation index of the census tract. We calculated adjusted rates by the direct method and three measures of health inequality. Results: Of 18,586 deaths, 96.7% was geocoded to a census tract. The population-attributable risk decreased in men and women, respectively, from 15.4% and 12.2% in 1992-1996 to 9.3% and 5.6% in 2002-2007. The other measures, slope index and the relative index also showed a decline in inequality but only among women. Conclusions: Despite a decreasing trend, social inequalities are a substantial component in the distribution of overall mortality in the city of Cadiz. 

  • 8.
    Murillo, Pilar
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Departamento de Enfermería I, Escuela de Enfermería, Universidad del País Vasco, Leioa, España.
    Vives-Cases, Carmen
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Grupo de Investigación en Salud Pública, Universidad de Alicante, Alicante, España.
    Factores asociados a la respuesta a la violencia del compañero íntimo en atención primaria de salud en España2018In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 32, no 5, p. 433-438Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyse the Spanish primary care professionals' readiness to respond to intimate partner violence (IPV) in primary care and identify possible determinants that could facilitate a better response.

    METHOD: A cross-sectional study with a non-probabilistic sampling by convenience was performed among healthcare professionals working in 15 primary care centres in Spain. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), the version validated and translated into Spanish, was the instrument used to collect information about knowledge, opinions and practices regarding intimate partner violence. Descriptive analysis and, simple and multiple linear regression analysis were performed.

    RESULTS: A total of 265 completed questionnaires were received, with a response rate of 80.3%. An exposure-response effect was observed, where at higher hours of training a higher score was obtained on the questionnaire sections (p <0.05). Age, type of profession, years of experience in primary care, hours of IPV training and reading the protocol showed positive association with knowledge (perceived preparation, perceived knowledge, actual knowledge), opinions (staff preparation, legal requirements, self-efficacy, workplace issues, constraints, understanding of the victim) and practice of healthcare professionals.

    CONCLUSIONS: Reading the regional/national protocol for action and receiving training in IPV were the most important interventions associated to a better primary care professionals' readiness to respond to IPV in Spanish primary care settings.

  • 9. Rodríguez-Blanes, Gloria M.
    et al.
    Vives-Cases, Carmen
    Miralles-Bueno, Juan José
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, España.
    Detección de violencia de compañero íntimo en atención primaria de salud y sus factores asociados2017In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 31, no 5, p. 410-415Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Intimate partner violence (IPV) against women is a significant public health and human rights problem. Primary care professionals play a key role in detecting and addressing this issue. The aim of this study is to determine the frequency of IPV and its associated factors in primary care by means of a screening questionnaire and to describe the main actions taken in identified cases.

    METHODS: Cross-sectional study in 15 health centres in four autonomous regions of Spain with a total of 265 health professionals. The information was collected through the self-administered PREMIS questionnaire (Physician Readiness to Manage Intimate Partner Violence Survey), which includes variables concerning screening questions, sociodemographic factors, level of training/knowledge about IPV, perceptions and actions. A descriptive and analytical study was conducted.

    RESULTS: 67.2% of participants said they ask about IPV during consultations. The most frequent actions were: referring patients to other departments, individual counselling and information delivery. ≥21hours of training, an advanced training level, knowledge of policies and programmes and the implementation of an appropriate protocol and reference resources were all factors that increased the likelihood of investigating IPV. The asking of questions increases in line with professionals' perceived level of training in IPV and the provision of a case management protocol.

    CONCLUSIONS: Two thirds of health professional respondents said they inquire about IPV. Given the influence of training in IPV and awareness of the resources to address the issue, it is essential to continue investing in the IPV training of healthcare personnel.

  • 10. Ruiz-Ramos, Miguel
    et al.
    Córdoba-Doña, Juan Antonio
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bacigalupe, Amaia
    Juárez, Sol
    Escolar-Pujolar, Antonio
    Crisis económica al inicio del siglo xxi y mortalidad en Espana. ˜ Tendencia e impacto sobre las desigualdades sociales. Informe SESPAS 2014 [The economic crisis at the beginning of the XXI century and mortality in Spain. Trend and impact on social inequalities. SESPAS Report 2014].2014In: Gaceta Sanitaria, ISSN 0213-9111, E-ISSN 1578-1283, Vol. 28 (Suppl 1), p. 89-96Article in journal (Refereed)
    Abstract [en]

    This study aimed to assess the impact of the current economic crisis on mortality trends in Spain and its effect on social inequalities in mortality in Andalusia. We used data from vital statistics and the Population Register for 1999 to 2011, as provided by the Spanish Institute of Statistics, to estimate general and sex- and age-specific mortality rates. The Longitudinal Database of the Andalusian Population (2001 census cohort) was used to estimate general mortality rates and ratios by educational level. The annual percentages of change and trends were calculated using Joinpoint regressions. No significant change in the mortality trend was observed in Spain from 2008 onward. A downward trend after 1999 was confirmed for all causes and both sexes, with the exception of nervous system-related diseases. The reduction in mortality due to traffic accidents accelerated after 2003, while the negative trend in suicide was unchanged throughout the period studied. In Andalusia, social inequalities in mortality have increased among men since the beginning of the crisis, mainly due to a more intense reduction in mortality among persons with a higher educational level. Among women, no changes were observed in the pattern of inequality.

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