A "Before and After" in the Use of Emergency Services in Spain? The Impact of the Economic Crisis

The objective of this study was to analyse whether variables associated with emergency services (ES) use in Spain have changed in the period 2006-2011 using a comparative analysis of the 2006 and 2011 Spanish National Health Surveys. The measure of association was the prevalence ratio with its 95% confidence interval, obtained by Poisson regression with robust variance. We studied interactions between the explanatory variables for ES use and year and subsequently performed a stratified analysis by year. ES use declined by 2.1% in 2011. Most emergency care (approximately 60% in both surveys) was provided in public hospitals. Between 2006 and 2011, ES use increased by 9% in women (p for interaction=0.008) [ref. men], 3% in persons with poor mental health (p for interaction=0.072) [ref. good mental health], and 8% in individuals with limitations on activities of daily living (p for interaction=0.006) [ref. no limitations]. The change in the effect of the variables sex, mental health, and limitations on activities of daily living on use of ES (2006 and 2011) is not explained by either demographic characteristics or individual socioeconomic indicators. These results could be associated with macroeconomic and structural changes occurring during the period 2006-2011.

Categoría:Crisis Económica
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2016-04-14

A framework for educating health professionals to adress the social determinants of health

A framework for educating health professionals to adress the social determinants of health The World Health Organization defines the social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These forces and systems include economic policies, development agendas, cultural and social norms, social policies, and political systems. In an era of pronounced human migration, changing demographics, and growing financial gaps between rich and poor, a fundamental understanding of how the conditions and circumstances in which individuals and populations exist affect mental and physical health is imperative. Educating health professionals about the social determinants of health generates awareness among those professionals about the potential root causes of ill health and the importance of addressing them in and with communities, contributing to more effective strategies for improving health and health care for underserved individuals, communities, and populations.

TipoLibros electrónicos
Publicado en ODS2016-04-01

Associations between non-discrimination and training policies and physicians' attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals

Associations between non-discrimination and training policies and physicians' attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals Background:Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM) individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians's knowledge, attitudes, and gender and sexual minority affirmative practices. Methods: A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Results: Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians attitudes and knowledge about SGM patients. Conclusion: Policies that mandate non-discrimination and training as they currently exist may not improve physicians attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians SGM affirmative practices.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2016-04-30

Access to health services by lesbian, gay, bisexual and transgender persons: systematic literature review

Access to health services by lesbian, gay, bisexual and transgender persons: systematic literature review Background:The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. Method:A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population’s access to health services and original articles with full text available online. Results:The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. Conclusions:The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to hea ...

Publicado en ODS2016-02-24

A Multilevel Regression Model for Geographical Studies in Sets of Non-Adjacent Cities

In recent years, small-area-based ecological regression analyses have been published that study the association between a health outcome and a covariate in several cities. These analyses have usually been performed independently for each city and have therefore yielded unrelated estimates for the cities considered, even though the same process has been studied in all of them. In this study, we propose a joint ecological regression model for multiple cities that accounts for spatial structure both within and between cities and explore the advantages of this model. The proposed model merges both disease mapping and geostatistical ideas. Our proposal is compared with two alternatives, one that models the association for each city as fixed effects and another that treats them as independent and identically distributed random effects. The proposed model allows us to estimate the association (and assess its significance) at locations with no available data. Our proposal is illustrated by an example of the association between unemployment (as a deprivation surrogate) and lung cancer mortality among men in 31 Spanish cities. In this example, the associations found were far more accurate for the proposed model than those from the fixed effects model. Our main conclusion is that ecological regression analyses can be markedly improved by performing joint analyses at several locations that share information among them. This finding should be taken into consideration in the design of futu ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-09-13

Advocacy for Health Equity: A Synthesis Review

Context:Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to -and distributions of- the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts. Methods:This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature. Findings:The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by "packaging" it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-07-15

Achieving gender equality to reduce intimate partner violence against women

This year marks 20 years since 189 countries signed the Beijing Declaration and Platform for Action and committed to prioritisation of women's empowerment and gender equality. Yet a recently released UN analysis1 shows that violence against women persists at “alarmingly high levels”. Worldwide, one in three women reports sexual or physical violence from a male partner at some point in their lifetime, and such experiences have been linked with harmful effects on health, including maternal morbidity, poor mental health, and vulnerability to HIV/AIDS.2 The UN report also contends that progress towards gender equality has been slow.1 Effective and scalable interventions to reduce intimate partner violence remain scarce, and questions remain about what drives individual violence and why prevalence differs across settings and countries.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-12

Atlas de Barrios Vulnerables de España: 12 ciudades 1991/2001/2006

Atlas de Barrios Vulnerables de España: 12 ciudades 1991/2001/2006 El Altas de Barrios Vulnerables de España se basa en los trabajos recogidos en los catálogos “Análisis urbanístico de Barrios Vulnerables” de 1991 y 2001, y su Adenda 2006, realizados gracias al convenio de colaboración entre la Sección de Urbanismo del Instituto Juan de Herrera de la Universidad Politécnica de Madrid (UPM) y el Ministerio de Fomento. En este documento no se recogen los catálogos de los barrios estudiados, que pueden ser consultados on-line, ya que el objetivo es presentar un panorama general sobre la dimensión y evolución de la vulnerabilidad de las ciudades españolas de más de 50.000 habitantes. El marco general se completa con los informes individuales de las 12 ciudades de más de 300.000 habitantes. Los informes individuales contienen el análisis estadístico de la evolución de la vulnerabilidad de cada una de las ciudades con un especial cuidado en su representación cartográfica, que permite al lector un análisis territorial de la vulnerabilidad urbana y la comparación tanto temporal como por tipo de vulnerabilidad. Además, para facilitar la comprensión de los datos analizados, este Atlas se acompaña de un conjunto de anexos en los que se describe la metodología empleada en el trabajo del que se extraen dicho datos, y un glosario de términos básicos para su comprensión.

Publicado en ODS2015-05-18

Atlas de desigualdades de género en salud en Andalucía

Atlas de desigualdades de género en salud en Andalucía El Atlas de desigualdades de género en salud en Andalucía se enmarca dentro de un proyectode investigación de excelencia, realizado en la Escuela Andaluza de Salud Pública (Granada, España), con la financiación de la Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía y del Fondo Europeo de Desarrollo Regional. Se trata del primer atlas interactivo realizado en la comunidad andaluza para medir esta realidad, a través de novedosos y útiles indicadores como son las brechas de género. Esta monografía resumelos principales mapas que ofrece este atlas interactivo.Estos mapas pueden ser utilizados para mejorar la información estadística en contextos como el andaluz, al resultar una potencial herramienta de comparación entre los datos disponibles y losque resultaría conveniente incluir en el futuro. El Atlas pretende ser un instrumento de apoyo tanto para la toma de decisiones políticas y el diseño de investigaciones científicas, como al servicio de la ciudadanía.

Publicado en ODS2015-05-06

A qualitative exploration of the impact of the economic recession in Spain on working, living and health conditions: reflections based on immigrant workers' experiences

Background:This study aimed to analyse how immigrant workers in Spain experienced changes in their working and employment conditions brought about Spain's economic recession and the impact of these changes on their living conditions and health status. Method:We conducted a grounded theory study. Data were obtained through six focus group discussions with immigrant workers (n = 44) from Colombia, Ecuador and Morocco, and two individual interviews with key informants from Romania living in Spain, selected by theoretical sample. Results:Three categories related to the crisis emerged – previous labour experiences, employment consequences and individual consequences – that show how immigrant workers in Spain (i) understand the change in employment and working conditions conditioned by their experiences in the period prior to the crisis, and (ii) experienced the deterioration in their quality of life and health as consequences of the worsening of employment and working conditions during times of economic recession. Conclusion:The negative impact of the financial crisis on immigrant workers may increase their social vulnerability, potentially leading to the failure of their migratory project and a return to their home countries. Policy makers should take measures to minimize the negative impact of economic crisis on the occupational health of migrant workers in order to strengthen social protection and promote health and well-being.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-04-20

A gender perspective on older workers' employment and working conditions

A gender perspective on older workers' employment and working conditions This Working Paper aims to give a structured gender analysis of the working and employment conditions of older workers (aged 50 and over). While working and employment conditions are increasingly recognized as key issues in ageing at work, gender disparities are still going under-considered. These are not only the outcome of horizontal (between sectors of activity) and vertical (between job categories) segregation that produce widely differing work situations for women and men; they are also about men and women’s respective career paths, how they impact on health among the over-50s, and changing workforce exit norms, not to mention opportunities for self-fulfilment in work and recognition at work. More broadly, women and men’s ageing at work is influenced by the unequal distribution of domestic work and the tasks of caring both for the older and younger generations.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-03-27

Action on the social determinants of health: Views from inside the policy process

Action on the social determinants of health: Views from inside the policy process It is now well documented that many of the key drivers of health reside in our everyday living conditions. In the last two decades, public health has urged political action on these critical social determinants of health (SDH). As noted by the World Health Organisation, encouraging action in this area is challenging. Recent research has argued that public health researchers need to gain a deeper understanding of the complex and changing rationalities of policymaking. This, it seems, is the crucial next step for social determinants of health research. In this paper, we turn our attention to the practitioners of 'the art of government', in order to gain insight into how to secure upstream change for the SDH. Through interviews with policy actors (including politicians, senior government advisors, senior public servants and experienced policy lobbyists) the research sought to understand the nature of government and policymaking, as it pertains to action on the SDH. Through exploring the policy process, we examine how SDH discourses, evidence and strategies align with existing policy processes in the Australian context. Participants indicated that approaches to securing change that are based on linear conceptualisations of the policy process (as often found in public health) may be seen as 'out of touch' with the messy reality of policymaking. Rather, a more dialogic approach that embraces philosophical and moral reasoning (alongside evidence) may be more effective. Based on our ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-03-09

Análisis espacial de la mortalidad por enfermedades cardiovasculares en la ciudad de Madrid, España

Fundamentos: Las enfermedades cardiovasculares son la principal causa de muerte en el mundo, aunque su distribución espacial no es homogénea.El objetivo del estudio fue analizar el patrón espacial de la mortalidad por enfermedades cardiovasculares en el área urbana poblada (AUP) del municipio de Madrid así como identificar agregaciones espaciales.Métodos: Se realizó un estudio ecológico, por sección censal, para hombres y mujeres durante 2010. Se calculó la Razón de Mortalidad Estandarizada (RME), Riesgo Relativo Suavizado (RRS) y Probabilidad Posterior (PP) de que el RRS fuera mayor que 1. Para identificar clusters espaciales se utilizó el índice de Moran (I Moran) y el Índice Local de AutocorrelaciónEspacial (LISA). Los resultados fueron representados cartográficamente.Resultados: En el caso de los hombres se observó una RME mayor de 1,1 especialmente en áreas centrales y en en el grupo de las mujeres ocurrió en la periferia. LA PP de que el RRS fuera mayor que 1 superó el 0,8 en el centro para los hombres y en la periferia en mujeres. El I Moran fue de 0,04 para hombres y de 0,03 para mujeres (p <0,05 en ambos casos).Conclusiones: En el patrón espacial de la mortalidad por enfermedades cardiovasculares en Madrid, se observaron diferencias por sexo. Los mapas de RME, RRS y PP mostraron un patrón más heterogéneo en los hombresmientras que en las mujeres se detectó uno más definido, con un riesgo relativamente mayor en zonas periféricas del AUP. El método LISA mostró agrup ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-01-21

Assessing the short term health impact of the Great Recession in the European Union: A cross-country panel analysis

Assessing the short term health impact of the Great Recession in the European Union: A cross-country panel analysis Background:There are great concerns and some initial country-specific, descriptive evidence about potential adverse health consequences of the recent Great Recession. Methods:Using data for 23 European Union countries we examine the short-term impact of macroeconomic decline during the Great Recession on a range of health and health behaviour indicators. We also examine whether the effect differed between countries according to the level of social protection provided. Results:Overall, during the recent recession, an increase of one percentage point in the standardised unemployment rate has been associated with a statistically significant decrease in the following mortality rates: all-cause-mortality (3.4%), cardiovascular diseases (3.7%), cirrhosis- and chronic liver disease-related mortality (9.2%), motor vehicle accident-related mortality (11.5%), parasitic infection-related mortality (4.1%), but an increase in the suicide rate (34.1%). In general, the effects were more marked in countries with lower levels of social protection, compared to those with higher levels. Conclusions:An increase in the unemployment rate during the Great Recession has had a beneficial health effect on average across EU countries, except for suicide mortality. Social protection expenditures appear to help countries “smooth” the health response to a recession, limiting health damage but also forgoing potential health gains that could otherwise result.

Categoría:Clase Social
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-12-27

A three-stage approach to measuring health inequalities and inequities

A three-stage approach to measuring health inequalities and inequities Introduction:Measurement of health inequities is fundamental to all health equity initiatives. It is complex because it requires considerations of ethics, methods, and policy. Drawing upon the recent developments in related specialized fields, in this paper we incorporate alternative definitions of health inequity explicitly and transparently in its measurement. We propose a three-stage approach to measuring health inequities that assembles univariate health inequality, univariate health inequity, and bivariate health inequities in a systematic and comparative manner. Methods:We illustrate the application of the three-stage approach using the Joint Canada/United States Survey of Health, measuring health by the Health Utilities Index (HUI). Univariate health inequality is the distribution of the observed HUI across individuals. Univariate health inequity is the distribution of unfair HUI – components of HUI associated with ethically unacceptable factors – across individuals. To estimate the unfair HUI, we apply two popular definitions of inequity: “equal opportunity for health” (health outcomes due to factors beyond individual control are unfair), and “policy amenability” (health outcomes due to factors amenable to policy interventions are unfair). We quantify univariate health inequality and inequity using the Gini coefficient. We assess bivariate inequities using a regression-based decomposition method. Results:Our analysis reveals that, empirically, different definitions ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-11-19