[A deprivation index to reform the financing model of primary care in Catalonia (Spain)]

OBJECTIVE

To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables.

METHOD

Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity. principal components analysis was applied. Finally, the correlations of the index built with the MEDEA index and with variables of use of healthcare resources and morbidity was calculated stratifying by geographical dispersion.

RESULTS

The variables of income, occupation and education are the ones with the highest correlation with the need for healthcare and morbidity. The composed socioeconomic index (CSI) ranges from -.01 to 5.68, with an average value of 2.60 and a standard deviation of .91. The correlation between the CSI and the MEDEA index is .89. The CSI correlates with use for healthcare in both urban and rural environments, although in rural environments the association is lower.

CONCLUSIONS

The CSI was built with data that allow frequent updating and was integrated in the model for allocating resources to primary healthcare starting in 2017.

[Spatial and seasonal characterization of the drinking water from various sources in a peri-urban town of Salta]

Drinking water monitoring plans are important to characterize both treated and untreated water used for drinking purposes. Access to drinking water increased in recent years as a response to the Millennium Development Goals set for 2015. The new Sustainable Development Goals aim to ensure universal access to safe drinking water by 2030. Within the framework of these global goals, it is crucial to monitor local drinking water systems. In this paper, treated and untreated water from different sources currently consumed in a specific town in Salta, northern Argentina, was thoroughly assessed. Monitoring extended along several seasons and included the physical, chemical and microbiological variables recommended by the Argentine Food Code. On the one hand, treated water mostly complies with these standards, with some non-compliances detected during the rainy season. Untreated water, on the other hand, never meets microbiological standards and is unfit for human consumption. Monitoring seems essential to detect anomalies and help guarantee a constant provision of safe drinking water. New treatment plants are urgently needed to expand the water grid to the entire population.

[Interspinous spacers and disc herniation. Geomorphometric and clinical study of 71 cases treated by L4-L5 microdiscectomy associated to spacer placement]

OBJECTIVE

A controversial indication of interspinous spacers is their use as a complement to discectomy. At the present time, there is no solid clinical evidence of effectiveness of that association, which might result from variability in spacer positioning, restricting its correct biomechanical actions. In this study our goal was to identify and analyse the variability in the placement of an interspinous spacer, and to investigate its relationship with the clinical results.

MATERIALS AND METHODS

We performed a retrospective study on X-ray films from 71 patients suffering from disc herniation in L4-L5 who underwent surgery in our hospital, consisting of: microdiscectomy and biomed interspinous spacer implantation. The geomorphometric techniques used to analyse the data were procrustes superimposition and principal components analysis. We compared the clinical results (using the Herron and Turner scale), segmental lordosis and surgical distraction with the geomorphometric parameters.

RESULTS

Significant morphological variability was found in the implant position showing cephalo-caudal translation and clockwise-counterclockwise rotations. This variability did not correlate with clinical results. A relationship with anatomical features (lordosis) and additional surgical distraction was identified. A different morphology of implant-segment configuration was identified in cases with recurrence of disc herniation.

CONCLUSIONS

Geometric morphometrics allowed identifying high variability in the final placement of interspinous spacers. Nevertheless, it seems not to be related to the clinical outcome, depending rather on the degree of lordosis and distraction. Some differences in segment-implant morphology were identified in cases with recurrences. To assess the effectiveness of spacers, larger studies including morphological and clinical variables are required.