This article describes the use made of the Internet by immigrant children living in Spain and the opportunities and risks it involves. Specifically, it deals with children from the Maghreb, Ecuador, and Sub-Saharan Africa, three regions which account for a quarter of Spain's foreign-born population. A qualitative methodology was used, based on in-depth interviews with 52 children from these countries and educators from their support centres. Immigrant minors usually access the Internet via their smartphones rather than via computers. They have a very high rate of smartphone use and access the Internet over public Wi-Fi networks. However, they make little use of computers and tablets, the devices most closely associated with education and accessing information. Internet usage is fairly similar among immigrant and Spanish teens, although the former receive more support and mediation from their schools and institutions than from their parents. The Internet helps them to communicate with their families in their countries of origin. As one educator puts it, "they have gone from sending photos in letters to speaking to their families every day on Skype". Some teens, particularly Maghrebis, sometimes suffer from hate messages on social networks.
Trastorno por consumo de opiáceos; Programas de tratamiento de sustitución opiáceos; Analisis de decisión multicriterio; Experimento de elecciones discretas ; Trastorn per consum d'opiacis; Programes de tractament de substitució opiacis; Anàlisi de decisió multicriteri; Experiment d'eleccions discretes ; Opioid use disorder; Opioid substitution treatment programs; Multi-criteria decision analysis; Discrete elections experiment ; La utilización de nuevas intervenciones sanitarias con un innovador perfil de eficacia y seguridad, pero con mayor impacto presupuestario respecto a tratamientos utilizados anteriormente, se asocia con un aumento de los gastos sanitarios. Por tanto, en la toma de decisiones aparece la necesidad de utilizar criterios adicionales a los tradicionales de evidencia clínica, entre los que destaca la evaluación de la eficiencia, que establece la relación entre los costes y los resultados en salud de las nuevas opciones terapéuticas. En este sentido, los Sistemas Sanitarios basados en el Valor tienen como objetivo fundamental conseguir los mejores resultados en salud para los pacientes, a un coste aceptable y sostenible para estos sistemas. De ello, se deriva que resulte fundamental medir y comparar los resultados en salud de las estrategias utilizadas en una determinada patología (Porter, 2010; McMahon, 2012). Sin embargo, hay otros criterios adicionales en la toma de decisiones, como son la relevancia social, prevalencia e incidencia de las enfermedades, el grado de innovación, la efectividad comparada, las necesidades médicas no cubiertas, las decisiones individuales o preferencias de los pacientes, la satisfacción con el tratamiento, el número de pacientes afectados, el empoderamiento de los pacientes y los principios de equidad. Es decir, en muchos casos, considerando el importante número de aspectos a valorar, hay amplias diferencias de criterio en el abordaje de una enfermedad entre los profesionales sanitarios que la tratan, los decisores o gestores políticos que aportan recursos para ese tratamiento y los pacientes que la padecen. ; The adoption of new health care interventions offering innovative profiles regarding efficacy and safety but with a greater financial impact compared to previously used treatments is associated with increased health care costs. Other criteria alongside traditional clinical evidence are thus necessary for effective decision making. A prime example of this is health care efficiency assessment, with which the relationship between the health outcomes of new therapeutic options and their costs can be established. The fundamental aim of a value-based health system is to achieve the best health outcomes for patients at an acceptable and sustainable cost to the system. It is thus essential to measure and compare the health-related results of the strategies used with a given pathology (Porter, 2010, McMahon & Chopra, 2012). However, there are other additional criteria in decision making, such as social relevance, prevalence and incidence of the diseases, degree of innovation, comparative effectiveness, medical needs not covered, individual decisions or patient preferences, satisfaction with treatment, number of patients affected, empowerment of patients and principles of fairness. That is to say, considering the large number of criteria involved in any given disease and how to approach it, there will be substantial differences of opinion in many cases among the HCPs who treat it, the decision-makers or political actors who provide resources for its treatment, and the patients who suffer it. ; Para el desarrollo de este proyecto, Pharmacoeconomics & Outcomes Research Iberia (PORIB), una consultora independiente especializada en Evaluación de Intervenciones Sanitarias, ha recibido financiación no condicionada a resultados, por parte de Indivior España.
