Este estudio explora el fenómeno del elogio desmedido a la forma de hablar español por parte de un hablante nativo hacia uno no nativo. Aunque podría. Hacia un modelo de diccionario monolingüe del español para usuarios extranjeros. HUMBERTO HERNÁNDEZ. Universidad de La Laguna. Que el español es. El inglés y el español en los Estados Unidos: lengua e inmigración . tica, y en muchos casos esto ha generado un salto hacia métodos de enseñanza y aprendizaje education/policies/lang/doc/sidjudendelstead.tk

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With regard to the Charlson index, the majority of patients had a score of two or less with the exception of liver cancer, where a greater number of patients scored six points or more. The same patterns were observed irrespective of the volume of the hospital. Table 2 describes the activity and outcome for cancer surgery during the periods analyzed. The percentage variability in the use of each surgical technique with respect to center volume is shown in figure 1.

Table 3 presents the relationship between center volume and hospital mortality for each of the digestive oncology surgeries studied. In all cases an inverse relationship between a greater number of interventions and hospital mortality was observed, although this did not reach statistical significance. The exception was rectal cancer, where a greater volume resulted in a higher mortality rate although the association was not statistically significant continuous OR: 1.

Discussion Our results show that in recent years there has been a progressive centralization of complex digestive oncology surgery in Catalonia. The number of hospitals that carry out this kind of intervention has been reduced.

A significant decrease in mortality has also been observed, particularly with respect to cancers of the esophagus and pancreas. There have not been any clear relevant changes in other digestive cancers.

Essentially, this means that more than patients have survived to the point of hospital discharge during the period from to , particularly in the case of pancreatic cancer, where the number of intervened patients has increased. However, there is a possibility that a lower volume itself might lead to a greater variation. The percentage of one technique or another is not so relevant, but rather the decrease in variability among the centers during the study period data not shown.

In oncology surgery, an increased centralization of complex procedures has been repeatedly associated with a better therapeutic outcome and not only with respect to hospital mortality 1,22, This could be due to the fact that performing more interventions leads to a wider experience, which in turn gives rise to better results Measuring this experience at the level of the principal surgeon and the surgical equipment, as well as other services and technological resources available at the hospital, is a major challenge.

In addition, there exists the possibility that changes in the surgical equipment during the seven-year study period could imply a centralization of patients in recent years. It is surprising that volume itself has little effect on variation in hospital mortality among centers, even though the study was undertaken during a period of centralized oncology surgery. Variability remained stable for these procedures during the study periods with a marked increase in the number of annual interventions in the case of the rectum.

The organizational culture of each center has been proposed as a key factor in results together with intervention volume, the clinician's qualifications and available equipment in each hospital. Such a culture fosters objectives that seek a continuous improvement in quality, greater involvement of the senior professionals, active participation of the nursing staff, better communication and coordination among groups and investigation of errors Unfortunately, it is difficult to measure these factors objectively, and systematic information is not available as there are no studies evaluating them.

Standardization of processes and adhesion to quality care measures are also elements that can explain this observation rather than the simple annual volume of interventions, although more at the level of efficiency than effectiveness The centralization of complex surgical procedures presents some drawbacks for professionals, centers and patients.

The former see their portfolio of services diminished and undermined when attracting patients and specialists, whilst patients may have to travel a large distance to reference hospitals which may lead to inequality of access. Such disadvantages should be balanced against improvements in the patients' health.

Without a doubt, all these factors should be examined within each geographical context and strategies could be implemented where the surgical team goes to the patient and not vice versa, without losing the proposed benefits 8, Some factors are more qualitative than quantitative and, consequently, harder to gather and measure.

Even though they might have a greater influence. Any possible Hawthorne effects during the audits should be considered as well as constant examination of processes carried out and the results obtained 23, Finally, there may be some confusion with regard to the university status of some hospitals and their accreditation for specialized training. Whilst some reviews did not observe any effect due to the limitation of the study 29 , others have reported favorable outcomes that were greater than the referred volume of interventions Limitations The use of clinical-administrative databases for research in healthcare services, especially with the lack of population registers or alternative sources of reliable information has the following advantages: thoroughness, low cost and descriptive potential.

Nevertheless, there are issues related to quality and homogeneity in the coding of the diagnoses and procedures as well as shortcomings in the number of included diagnoses and associated procedures. A previous study noted that health workers rarely gathered data on the clinical and functional state of the patient, information that is clearly prognostic Nevertheless, it has become increasingly possible to integrate all the data collected in the healthcare service and incorporate part of these variables, which are of a huge clinical relevance, into the clinical-administrative databases.

On the other hand, the use of hospital mortality as a measure of outcome instead of mortality at 30 days hinders the comparison among centers. This approach favors those with an efficient referral policy to health and welfare centers or to long-stay centers for a relatively early convalescence period.

Hospital mortality does permit the evaluation of results immediately following surgery as it provides information about post-surgical complications such as relapses, re-interventions and re-hospitalizations, which add to the evaluation. Finally, the database used did not allow the assessment of the impact of the surgeon or specific equipment. Conclusions In conclusion, our findings show that in Catalonia and other regions 23 a centralization of digestive oncology surgery in high volume centers has been introduced which is accompanied by a clear reduction in hospital mortality for pancreatic and esophageal cancers.

An inverse relationship between the volume of annual interventions and hospital mortality was observed, although it was not statistically significant and there were other factors that were not taken into account. The progressive centralization and the limitations related to the evaluation of the outcome could have hindered our observations. Nevertheless, we believe that this progressive centralization should be maintained in oncologic surgical techniques, especially those that are more complex and less frequently performed, such as esophageal and pancreatic surgery, as this can provide a better outcome including a reduction in mortality.

References 1. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med ; 25 DOI: Variation in hospital mortality associated with inpatient surgery. N Engl J Med ; 14 Donabedian A. The quality of care.

How can it be assessed? JAMA ; 12 Iezzoni LI. The risks of risk adjustment. Mortality control charts for comparing performance of surgical units: Validation study using hospital mortality data. BMJ ; Public reporting of surgeon outcomes: Low numbers of procedures lead to false complacency.

Lancet ; Hospital volume and late survival after cancer surgery. Ann Surg ; 5 State of evidence on the relationship between high-volume hospitals and outcomes in surgery: A systematic review of systematic reviews.

J Am Coll Surg ; 5 Relationship between volume and in-hospital mortality in digestive oncological surgery. Cir Esp ;94 3 The case against volume as a measure of quality of surgical care. World J Surg ;29 10 Hospital volume and failure to rescue with high-risk surgery. Med Care ;49 12 Observatori del Sistema de Salut de Catalunya. Departament de Salut.

Generalitat de Catalunya. Does volume influence outcome in cancer surgery? Analysis based on clinical-administrative data. Cir Esp ;75 4 Rev Esp Cardiol ;61 3 In-hospital mortality after stomach cancer surgery in Spain and relationship with hospital volume of interventions.

BMC Public Health ; Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. We also analyzed the correlation between anti-immigrant prejudice and RWA. Taking into account that the different areas register different migratory trajectories INDEC, , the inclusion of these different areas becomes necessary. The total sample size was of students Instruments Sociodemographic and control variables: sex, age, academic unit, career, year of study, occupational status and place of residence were controlled using close-ended questions.

Subtle and Blatant Prejudice Scale: we applied an adapted Spanish version of the prejudice scale developed by Pettigrew and Meertens We included the 20 items and 5 dimensions scale. Assimilationism: we applied the instrument developed by Levin et al. This version has a two-dimensional structure consisting of 14 items with a 5-point likert response format.

Research Procedure Data was collected through the individual application of a questionnaire. Prior to its administration, people were given information about the study, they were explained that the data collected would be used exclusively for academic-scientific purposes, guaranteeing anonymity and confidentiality.

In turn, it was emphasized that they could leave the study whenever they wished. First, according to the proposal by Hair, Black, Babin, Anderson and Tatham within the framework of the Classic Theory of Testing, descriptive statistics of the items were calculated: mean, standard deviation, asymmetry and kurtosis. Then, the construct validity of the scales was studied by confirmatory factor analysis using the maximum likelihood estimation method and replicating the 5-factor dimensional structure proposed by the literature.

Subsequently, the reliability of the subscales was analyzed by estimating their internal consistency by the Cronbach's Alpha statistic.

Also, to identify if there were items that reduced the reliability of the scale, we estimated the alpha coefficient when each element was eliminated. Finally, convergent validity was studied through correlation analysis between each of the subtle and blatant prejudice sub-scales and the assimilationist and RWA measurements.

For that matter we estimated Pearson correlation coefficient. It is worth mentioning that prior to this procedure it was controlled that the latter also had satisfactory levels of reliability. Results Table 1 shows the descriptive indexes for each of the items on the prejudice scale. Including the 18 items that presented an adequate adjustment, we proceeded to study the construct validity through a confirmatory factor analysis CFA.

Table 2 shows the model global adjustment indexes. Meanwhile, the rest of the fit indexes are within the parameters established by the specialized literature, thus providing evidence of their adequacy. Figure 1 shows the model structure and the standardized beta coefficients that account for the load of each item on the dimension with their corresponding error terms.

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From this structure, we proceeded to the internal consistency analysis for each sub-dimensions. In addition, in order to verify the existence of items that reduce the reliability of the subscales, we estimated the Cronbach's Alpha statistic considering its variation if each element is eliminated Table 3. Lastly, we could not estimate internal consistency for the positive emotions dimensions since it has only two items. This evidence indicates the adequacy of this construct for the evaluation of prejudice.

More specifically, the results above presented provide evidence about the adequacy of the construct, both with respect to its structure and internal consistency and its external validity. On our part, we were able to account for the multidimensional structure of the prejudice consistently with the original proposal developed by Pettigrew and Meertens This is particularly relevant since enables a more comprehensive analysis of this phenomenon.

It is possible that, depending on the particularities of the migratory processes in each region, some of these items are ambiguous for many respondents. However, this is a hypothetical assumption and we need complementary evidence to test its adequacy for example, application of the scale in conjunction with a cognitive interview. It is relevant to highlight another original contribution of this study which refers to the convergent validity test.

We were able to establish the relationship between our version of the subtle and blatant prejudice scale and two documented related variables Berry, ; Dru, ; Guimond et al. That is probably due to the fact that they correspond to the attitudinal aspects that emphasize less on cultural asymmetries, which are those that are more specifically evaluated trough the two convergent variables especially the Asymilization index.

On the other hand, the positive emotions index consists of only two items that can be interpreted in an ambiguous way, as they can refer positively to a certain empathy due to the unfavorable situation of immigrants in our country, or negatively to demonstrations of condescension towards those groups. Thus, it is possible that this index is not an exact approximation to the affective dimension of subtle prejudice insofar it may be biased by social desirability.

However, it would be necessary to collect more empirical evidence to support this hypothesis and it would be desirable to make this measurement more complex, avoiding the evaluation of ambiguous affective aspects.

To sum up, the main findings of our study are the identification of the prevalence of prejudicial attitudes -even among young people- and the relevance of being able to evaluate the subtle dimensions of prejudice in order to achieve a better understanding of this phenomenon.

Also, it allowed us to provide a locally validated measure that allows us to dialogue with the previous literature that has applied the same construct in different contexts. Also, as noted by Rueda and Navas , it is possible that these measurements do not avoid the effect of social desirability, which should be controlled in future studies. For this reason, we emphasize the need to update and evaluate the adequacy of our empirical approaches in the study of complex social phenomena that are in permanent transformation.

Consequently, the social function of prejudice is not only maintained, but it is reinvented in ways that -because they are less evident- become increasingly difficult to perceive, challenge and counteract.

Furthermore, the use of instruments that are incapable of capturing the refined expression of prejudice could be functional to the masking of the consequences of prejudice.

Thus, the illusion is created that it is an increasingly banished phenomenon of our social practices while inequality between groups is attributed to intrinsical and static attributes.


In this framework, the Pettigrew and Meertens scale and its adaptations, represent a valid contribution for the detection and study of new forms of prejudice in different contexts. In addition, it is necessary to point out some methodological limitations of our research that must be taken into account for complementary studies.

First, data were collected through a non-probabilistic sampling method, which limits the possibility of its generalization to the population. In addition, this instrument assesses attitudes towards immigrants as a general category, although this is not a homogeneous group and it is possible that - in accordance with prevailing hegemonic discourses - people have different attitudes towards immigrants based on aspects such as their origin. Thus, it would be relevant to compare attitudes towards European immigrants and Latin American immigrants; or towards immigrant women, given their particular difficulty in obtaining employment, which has been the subject of previous research i.

Finally, we want to emphasize the relevance of including the perspective of the immigrants themselves, who are directly suffering the consequences of prejudice and discrimination. It is essential to take into account the complexity of these phenomena and its concrete consequences for immigrants in order to devise public policies aimed to reversing situations of inequality and the achieving of real intercultural integration.

The authoritarian specter.

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CienciaUAT,11 1, Guidelines for the process of cross-cultural adaptation of self-report measures. Spine,25 24 , DOI: Sociological Inquiry,83 1 , Mutual attitudes among immigrants and ethnocultural groups in Canada. International Journal of Intercultural Relations,30 6 , What is and is not ethnocentrism? A conceptual analysis and political implications. Political Psychology,33 6 , Psychometric properties: concepts of reliability and validity.

Handbook of psychiatric measures. Washington: American Psychiatric Association. Las nuevas formas de prejuicio y sus instrumentos de medida.

European Journal of Social Psychology, 39 2 , Ideology and prejudice: The role of value conflicts. Psychological Science,24 2 , Blatant and subtle prejudice: dimensions, determinants, and consequences; some comments on Pettigrew and Meertens. European Journal of Social Psychology,31 3 , Public support for Hispanic deportation in the United States: the effects of ethnic prejudice and perceptions of economic competition in a period of economic distress.

Journal of Population Research,30 1 , Aversive racism and contemporary bias. Barlow Eds. Authoritarianism, social dominance orientation and prejudice: Effects of various self-categorization conditions.

A dual-process motivational model of ideology, politics, and prejudice.

Psychological Inquiry,20 , Political Psychology,33 4 , Helping and the avoidance of inappropriate interracial behavior: A strategy that perpetuates a nonprejudiced self-image. Journal of Personality and Social Psychology, 50 6 , The aversive form of racism. Descriptive statistics. SPSS for Windows step by step.

A simple guide and reference, 18, The organizational culture of each center has been proposed as a key factor in results together with intervention volume, the clinician's qualifications and available equipment in each hospital. Witness the many Quechua folk tales in which the villain is foiled because of his gullibility.

Journal of conflict resolution,25 4 , Cusco, Algunos ejemplos: Subsequently, the reliability of the subscales was analyzed by estimating their internal consistency by the Cronbach's Alpha statistic. Su uso, junto con el pluscuamperfecto, es bastante frecuente en cuentos y narraciones.