Parte II. Estilos de vida
Inducción sanitaria de los cribados: impacto y consecuencias. Aspectos éticos
Screening induced by health services: impact and consequences. Ethical issues
Andreu Segura-Benedictoa,b,
Autor para correspondencia
asegura@ies.scs.es
Correspondencia: Institut d’Estudis de la Salut (IES). Balmes, 132-136 6.ª planta. 08008 Barcelona. España.
Correspondencia: Institut d’Estudis de la Salut (IES). Balmes, 132-136 6.ª planta. 08008 Barcelona. España.
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Aspectos éticos" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "88" "paginaFinal" => "95" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andreu Segura-Benedicto" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Andreu" "apellidos" => "Segura-Benedicto" "email" => array:1 [ 0 => "asegura@ies.scs.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Salud Pública de la Universidad de Barcelona. Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Área de Salud Pública e Investigación en Servicios de Salud. Institut d’Estudis de la Salut. Generalitat de Catalunya. Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Institut d’Estudis de la Salut (IES). Balmes, 132-136 6.ª planta. 08008 Barcelona. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Screening induced by health services: impact and consequences. Ethical issues" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13944" "palabras" => array:3 [ 0 => "Cribados" 1 => "Penitencia, efectividad, eficiencia y equidad" 2 => "Participación y soberanía comunitaria" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13943" "palabras" => array:3 [ 0 => "Screening" 1 => "Appropriatness, effectiveness, efficiency and equity" 2 => "Participation and community sovereignty" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">El cribado pretende identificar a las personas con una elevada probabilidad de beneficiarse de actividades preventivas, tradicionalmente de prevención secundaria pero también de prevención primaria. Bien para facilitar la detección precoz de enfermedades para instaurar un tratamiento temprano que modifique favorablemente el pronóstico, para reconocer a los expuestos a factores de riesgo que incrementan el riesgo de una patología determinada, de forma que las intervenciones preventivas reduzcan su incidencia.</p><p class="elsevierStyleSimplePara elsevierViewall">La bondad del propósito no es suficiente para conseguir un resultado benéfico en términos de efectividad, seguridad, eficiencia y equidad, de manera que debe procederse a la valoración de las consecuencias que la aplicación de los cribados comporta y, en particular, del impacto que tienen sobre la salud de las personas y sobre la organización de los servicios sanitarios.</p><p class="elsevierStyleSimplePara elsevierViewall">La diversidad de los cribados hace estimar el impacto neto derivado de su aplicación. Además, los cambios en el estado de salud de las poblaciones dependen de muchos factores de origen ajeno a la sanidad. Aunque conviene determinar la efectividad y la seguridad de los cribados más frecuentemente aplicados, la valoración de los beneficios y los perjuicios atribuibles a los programas preventivos es poco frecuente. En España sólo se han publicado algunas valoraciones parciales, en general referidas a las actividades y procesos más que a los resultados finales.</p><p class="elsevierStyleSimplePara elsevierViewall">Como el origen de los cribados corresponde a los servicios sanitarios y se dirigen a poblaciones mayoritariamente sanas, los aspectos éticos son de suma importancia. Se recomienda que para cualquier actividad de cribado se proceda al análisis de los principios éticos de autonomía, beneficencia, no maleficencia y justicia, de forma que en la eventualidad de que no puedan satisfacerlos razonablemente se excluyan del catálogo de prestaciones públicas. Del mismo modo debería sistematizarse la evaluación de la efectividad, seguridad y eficiencia de cualquier cribado que se ofrezca a la población.</p><p class="elsevierStyleSimplePara elsevierViewall">Finalmente, se recomienda investigar nuevas posibilidades de participación efectiva de la población en el establecimiento de prioridades preventivas y en la valoración del impacto de estas intervenciones.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">The main aim of screening is to identify people with an increased probability to benefit from preventive interventions, generally from secondary prevention but also from primary prevention activities. The goal is to facilitate early diagnosis and treatment in order to modify positively the prognosis (the former case), or to recognize people exposed to risk factors which increase the incidence rate of disease, and then to prevent the disease (the latter case).</p><p class="elsevierStyleSimplePara elsevierViewall">Good intentions are not enough to achieve good results in terms of effectiveness, safety, efficiency or equity. It is necessary to have a systematic assessment of the consequences of screening, particularly on the impact on peoples¿ health and on the health services.</p><p class="elsevierStyleSimplePara elsevierViewall">Due to the diversity of types of screenings that are done, it is very difficult to estimate the net impact caused by their implementation. Moreover, the changes in the health of a population depend on many factors other than health service interventions. Thus, it is very important to determine the effectiveness and safety of the screening methods that are most frequently applied. Unfortunately, assessment of the benefits and the harm potentially caused by preventive interventions has not been done often. In Spain only a few partial assessments have been published, and they focus on the activities and the processes themselves rather than the final outcomes.</p><p class="elsevierStyleSimplePara elsevierViewall">Given that screening activities are carried out in health care services, and that the populations screened are mostly healthy people, the ethical issues have great importance when health policies are designed and implemented. Thus, it is recommended that screenings activities be analyzed applying the ethical principles of autonomy, benefit, safety and justice. If any screening program cannot reasonably satisfy these principles then they should be removed from the list of public health activities that are financed by public resources.</p><p class="elsevierStyleSimplePara elsevierViewall">In the same sense, all screening procedures offered to the population must be subjected to a systematic evaluation of their effectiveness, safety, efficiency and equity in terms of how the procedure would be applied. Lastly, to achieve an effective implementation of the principle of autonomy as well the desired goal of empowering the population to exercise some control over their determinants of health, it is recommended to explore new ways of achieving active citizen participation to establish preventive priorities and to assess the impact of screening interventions.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:61 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "A dictionary of epidemiology" "edicion" => "3<span class="elsevierStyleSup">rd</span> ed." "serieFecha" => "1995" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13086031
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