Recursos

Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches

Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches Background: There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings.Methods: The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals' abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a "buddying" process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design.Results: In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in ...

Categoría:Territorio
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-04-06

Economic crisis and suicides in Spain. Socio-demographic and regional variability

Background: Evidence from previous recessions suggests that at times of economic deterioration, suicides increase. Spain has been one of the European countries hardest hit by the financial crisis that started in 2008. The aim of this paper is to examine the impact of the double-dip recession in Spain on the most recent trends in suicide.Methods: Suicide data from the years 2002-2012 were obtained from the "Death Statistic according to Cause of Death" of the National Statistics Institute (NSI). Population figures were obtained from the population estimates of the NSI.Results: While the suicide rate decreased between 2002 and 2012, the downward trend has reversed twice, in 2008-2009, and in 2012. This rise was particularly pronounced in males, with the rate ratio of 1.12 (95 % CI 1.05-1.20) in 2008 and 1.10 (95 % CI 1.03-1.18) in 2009. Following a decrease in 2010 and 2011, suicides among males have increased again in 2012-with RR of 1.10 (95 % CI 1.03-1.18) compared to 2007, however the difference between 2011 amounted to 14 % rise- the biggest interannual change in a decade. There was a similar but less pronounced pattern in females. Regional data showed variable results.Conclusions:These results suggest that the Spanish economic crisis has been associated with suicide rates in 2008, 2009, and 2012. These findings are consistent with the double-dip recession that Spain experienced.

Categoría:Crisis Económica
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2016-03-31

Explicaciones de las prácticas sexuales de riesgo en hombres que tienen sexo con hombres

Explicaciones de las prácticas sexuales de riesgo en hombres que tienen sexo con hombres Objetivo:Conocer las explicaciones sobre prácticas sexuales de riesgo, la percepción del virus de la inmunodeficiencia humana (VIH) y propuestas de intervención para prevenir infecciones por VIH en un grupo de hombres que tienen sexo con hombres. Métodos:Estudio cualitativo con una muestra de 13 hombres que tenían sexo con hombres, participantes de una cohorte de VIH seronegativos contactados en saunas gay de Barcelona. Se realizaron entrevistas en profundidad semiestructuradas y un posterior análisis de contenido temático. Resultados:Las prácticas sexuales de riesgo se atribuyeron a una masculinidad asociada a una alta necesidad sexual, a determinados lugares de intercambio sexual (como saunas, fiestas privadas y clubs), al consumo de drogas y al deseo de experimentar con el riesgo y la propia sexualidad. La infección por VIH se percibía como una enfermedad normalizada, aunque contraerla se asociaba a vergüenza y culpa. Entre las propuestas de intervención se encontraban: concienciar sobre lo que significa vivir con el VIH, generar más alarma social, incorporar las nuevas tecnologías en la prevención y aumentar las acciones en lugares de encuentro gay. Conclusiones:El concepto de la masculinidad desempeña un papel fundamental en las prácticas sexuales entre los hombres que tienen sexo con hombres. Se sugiere innovar en los programas preventivos e incorporar la percepción de riesgo y la infección por el VIH desde una perspectiva de género.

Categoría:Género
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-07-23

Eurofound yearbook 2014: Living and working in Europe

Eurofound yearbook 2014: Living and working in Europe Eurofound in 2014 expanded its evidence base on the repercussions of the crisis on the living and working conditions of Europeans, and offered guidance on viable options available to policymakers in their efforts to turn Europe around. The Agency produced new knowledge in some of the areas of most immediate concern to Europeans and in fields crucial to their long-term prosperity. Its reporting of recent employment trends highlighted where in the economy most job creation and job loss has occurred and suggested where investment in future growth is best directed. The yearbook is accompanied by the Consolidated annual activity report of the Authorising Officer for 2014, which is the Agency's formal reporting on operations, staff and budgets.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-07-17

Economic crisis and counter-reform of universal health care systems: Spanish case

The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities.

Categoría:Crisis Económica
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-07-17

Elderly women living alone: an update of their living conditions

Elderly women living alone: an update of their living conditions Upon request by the FEMM Committee, this study presents recent changes in the living conditions of elderly women living alone with a focus on the effects of recent pension reforms and active ageing policies. The study is largely based on a literature review and a desk analysis of the micro-data and information available at the European level, as well as a qualitative analysis of good practices in active ageing introduced in recent years in six countries selected as representative of European welfare systems.

Categoría:Género
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-30

Emergència habitacional a Catalunya. Impacte de la crisi hipotecària en el dret a la salut i els drets dels infants

L’objectiu d’aquest informe és analitzar la situació d’emergència habitacional que afecta Catalunya des d’una perspectiva de drets. Per a fer-ho, s’estudien, d’una banda, els compromisos jurídics assumits pel Govern de Catalunya en matèria de dret a l’habitatge, i de l’altra els impactes concrets que suposen les execucions hipotecàriesi els desnonaments per a les persones afectades. A partir dels resultats de l’estudi Emergencia habitacional en el Estado español. La crisis de las ejecuciones hipotecarias y los desalojos desde una perspectiva de derechoshumanos, publicat conjuntament entre l’Observatori DESC i la Plataforma d’Afectats per la Hipoteca, aquest informe respon a la necessitat d’abordar la problemàtica des d’una perspectiva integral.Això significa tenir cura dels impactes de la vulneració del dret a l’habitatge en el gaudiment d’altres drets per part de tots els membres de la llar. El present document,en particular, estudia els efectes de la crisi habitacional en la salut física i mental de les persones afectades, i fa especial atenció a la situació dels menors que integren la unitat familiar.

Categoría:Crisis Económica
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-19

Emergència habitacional a Catalunya. Impacte de la crisi hipotecària en el dret a la salut i els drets dels infants

L’objectiu d’aquest informe és analitzar la situació d’emergència habitacional que afecta Catalunya des d’una perspectiva de drets. Per a fer-ho, s’estudien, d’una banda, els compromisos jurídics assumits pel Govern de Catalunya en matèria de dret a l’habitatge, i de l’altra els impactes concrets que suposen les execucions hipotecàriesi els desnonaments per a les persones afectades. A partir dels resultats de l’estudi Emergencia habitacional en el Estado español. La crisis de las ejecuciones hipotecarias y los desalojos desde una perspectiva de derechoshumanos, publicat conjuntament entre l’Observatori DESC i la Plataforma d’Afectats per la Hipoteca, aquest informe respon a la necessitat d’abordar la problemàtica des d’una perspectiva integral. Això significa tenir cura dels impactes de la vulneració del dret a l’habitatge en el gaudiment d’altres drets per part de tots els membres de la llar. El present document, en particular, estudia els efectes de la crisi habitacional en la salut física i mental de les persones afectades, i fa especial atenció a la situació dels menors que integren la unitat familiar.

Categoría:Crisis Económica
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-19

Emergència habitacional a Catalunya. Impacte de la crisi hipotecària en el dret a la salut i els drets dels infants

Emergència habitacional a Catalunya. Impacte de la crisi hipotecària en el dret a la salut i els drets dels infants L’objectiu d’aquest informe és analitzar la situació d’emergència habitacional que afecta Catalunya des d’una perspectiva de drets. Per a fer-ho, s’estudien, d’una banda, els compromisos jurídics assumits pel Govern de Catalunya en matèria de dret a l’habitatge, i de l’altra els impactes concrets que suposen les execucions hipotecàriesi els desnonaments per a les persones afectades. A partir dels resultats de l’estudi Emergencia habitacional en el Estado español. La crisis de las ejecuciones hipotecarias y los desalojos desde una perspectiva de derechoshumanos, publicat conjuntament entre l’Observatori DESC i la Plataforma d’Afectats per la Hipoteca, aquest informe respon a la necessitat d’abordar la problemàtica des d’una perspectiva integral. Això significa tenir cura dels impactes de la vulneració del dret a l’habitatge en el gaudiment d’altres drets per part de tots els membres de la llar. El present document, en particular, estudia els efectes de la crisi habitacional en la salut física i mental de les persones afectades, i fa especial atenció a la situació dels menors que integren la unitat familiar.

Categoría:Crisis Económica
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-19

Economic crisis, health systems and health in Europe: country experiences

Economic crisis, health systems and health in Europe: country experiences The financial and economic crisis has had a visible but varied impact on many health systems in Europe, eliciting a wide range of responses from governments faced with increased financial and other pressures. This book maps health system responses by country, providing a detailed analysis of policy changes in nine countries and shorter overviews of policy responses in 47 countries. It draws on a large study involving over one hundred health system experts and academic researchers across Europe. Focusing on policy responses in three areas – public funding of the health system, health coverage and health service planning, purchasing and delivery – this book gives policymakers, researchers and others valuable, systematic information about national contexts of particular interest to them, ranging from countries operating under the fiscal and structural conditions of international bailout agreements to those that, while less severely affected by the crisis, still have had to operate in a climate of diminished public sector spending since 2008. Along with a companion volume that analyses the impact of the crisis across countries, this book is part of a wider initiative to monitor the effects of the crisis on health systems and health, to identify those policies most likely to sustain the performance of health systems facing fiscal pressure and to gain insight into the political economy of implementing reforms in a crisis.

Categoría:Crisis Económica
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-15

Estimating the costs of gender-based violence in the European Union

Estimating the costs of gender-based violence in the European Union Gender-based violence is perceived as one of the most severe forms of gender inequality and it remains one of the most pervasive human rights violations of modern time. It is an issue that affects women disproportionally as it is directly connected with the unequal distribution of power between women and men; thus, it has a profound effecton families, communities and societies as a whole. The elimination of gender-based violence and the protection of victims/survivors is a stated goal of the European Union and one of the future key areas of work for the European Institute for Gender Equality (EIGE). Identifying the economic costs of gender-based violence will contribute to betterinformed decision-making in this area and support the comprehensive process of policy development.This report aims to analyse and assess the methodological options in the existing literature and studies on the costs to society of intimate partner violence.

Categoría:Género
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-05-27

Excess mortality among the eldery in European countries, December 2014 to February 2015

Since December 2014 and up to February 2015, the weekly number of excess deaths from all-causes among individuals???65 years of age in 14 European countries have been significantly higher than in the four previous winter seasons. The rise in unspecified excess mortality coincides with increased proportion of influenza detection in the European influenza surveillance schemes with a main predominance of influenza A(H3N2) viruses seen throughout Europe in the current season, though cold snaps and other respiratory infections may also have had an effect.

Categoría:Edad
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-04-15

Educational inequalities in diabetes mortality across Europe in the 2000s: the interaction with gender

Educational inequalities in diabetes mortality across Europe in the 2000s: the interaction with gender Objectives:To evaluate educational inequalities in diabetes mortality in Europe in the 2000s, and to assess whether these inequalities differ between genders.Methods:Data were obtained from mortality registries covering 14 European countries. To determine educational inequalities in diabetes mortality, age-standardised mortality rates, mortality rate ratios, and slope and relative indices of inequality were calculated. To assess whether the association between education and diabetes mortality differs between genders, diabetes mortality was regressed on gender, educational rank and ‘gender × educational rank’.Results:An inverse association between education and diabetes mortality exists in both genders across Europe. Absolute educational inequalities are generally larger among men than women; relative inequalities are generally more pronounced among women, the relative index of inequality being 2.8 (95 % CI 2.0–3.9) in men versus 4.8 (95 % CI 3.2–7.2) in women. Gender inequalities in diabetes mortality are more marked in the highest than the lowest educated.Conclusions:Education and diabetes mortality are inversely related in Europe in the 2000s. This association differs by gender, indicating the need to take the socioeconomic and gender dimension into account when developing public health policies.

Categoría:Territorio
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-04-09

Evidencias sobre la teoría del inmigrante sano en atención primaria

Objetivo: Comparar la carga de morbilidad de inmigrantes y nativos residentes en Aragón a partir de los datos poblacionales procedentes de atención primaria, la cual representa el primer nivel de contacto de los individuos con el sistema sanitario. Método: Estudio observacional retrospectivo basado en la historia clínica electrónica de atención primaria y la base de datos de usuarios de Aragón. La población de estudio la conforman los 1.251.540 individuos asignados a alguno de los centros de salud de Aragón (12% de ellos inmigrantes). Los perfiles de morbilidad se estudiaron a través del sistema ACG. Se realizaron regresiones logísticas para comparar la población inmigrante y nativa, ajustando por edad y sexo. Resultados: Se confirmó la teoría del “inmigrante sano”, en especial en los hombres. La prevalencia de las enfermedades más frecuentes fue menor entre los inmigrantes. La proporción de la población con una carga de morbilidad entre moderada y muy elevada fue mayor en autóctonos (52%) que en latinoamericanos (33%), africanos (29%), europeos occidentales y norteamericanos (27%), europeos del este (26%) y/o asiáticos (20%). Las diferencias fueron menores en los inmigrantes con estancias mayores de 5 años. Conclusión:La duración de la estancia en el país de acogida influye de manera decisiva en la evolución de la carga de morbilidad que presenta la población inmigrante, produciéndose un empeoramiento de la misma a medida que aumenta la estancia en el país de acogida.

Categoría:Etnia
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-01-12

Effect of neighbourhood motorization rates on walking levels

Effect of neighbourhood motorization rates on walking levels Background: Motorized traffic may discourage people walking. This study analyses the influence of motorization on pedestrian mobility in the neighbourhoods of a European city, controlling for environmental, sociodemographic, mobility and road safety characteristics of the neighbourhood in which each trip was made. Methods: Cross-sectional ecological study using the 38 neighbourhoods of Barcelona as the unit of analysis. Mobility information was obtained from the 2006 Daily Mobility Survey. Walking rates were calculated for 32.343 men and women who made walking trips, per 1000 men and women who made trips in the 38 neighbourhoods. Data were aggregated to calculate the total number of motorized trips made in each neighbourhood. ? coefficients and their confidence intervals were calculated using Poisson regression, in order to study the relationship between walking and motorization, in the different tertiles of motorization and adjusting for contextual factors and their corresponding interactions with motorization. Results: Levels of motorization in the neighbourhood negatively influence walking, even when environmental variables of the neighbourhood are considered. In men we observe a gradient whereby walking rates fall as motorization rises (? = ?0.248; P < 0.001 and ? = ?0.363; P < 0.001 in the second and third quartiles of motorization, respectively). In the case of women we find that only high levels of motorization have a negative influence on the rates of women who ...

Categoría:Territorio
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-12-15

Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven approach

Introduction:Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach. Methods:We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona’s (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link. Discussion:In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security. Conclusion:This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and e ...

Categoría:Territorio
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-12-03

Equity-focused knowledge translation: a framework for "reasonable action" on health inequities

Objectives:To identify gaps in procedural approaches to knowledge translation and outline a more relational approach that addresses health inequities based on creating collaborative environments for reasonable action.Methods:A literature review encompassing approaches to critical inquiry of the institutional conditions in which knowledge is created combined with a process for encouraging reflexive professional practice provide the conceptual foundation for our approach, called equity-focused knowledge translation (EqKT).Results:The EqKT approach creates a matrix through which teams of knowledge stakeholders (researchers, practitioners, and policymakers) can set common ground for taking collaborative action on health inequities.Conclusions:Our approach can contribute to the call by the WHO Commission on the Social Determinants of Healths for more reasonable action on health inequities by being incorporated into numerous public health settings and processes. Further steps include empirical applications and evaluations of EqKT in real world applications.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-10-23

Educational differences in mortality and the relative importance of different causes of death: a 7-year follow-up study of Spanish adults.

BACKGROUND:The evidence on mortality patterns by education in Spain comes from regional areas. This study aimed to estimate these patterns in the whole Spanish population.METHODS:All citizens aged 25?years and over and residing in Spain in 2001 were followed during 7?years to determine their vital status, resulting in a total of 196?470?401 person-years and 2?379?558 deaths. We estimated the age-adjusted total and cause-specific mortality by educational level-primary, lower secondary, upper secondary and university education-and then calculated the relative and absolute measures of inequality in mortality and contribution of the leading causes of death to absolute inequalities.RESULTS:Except for some cancer sites, the mortality rate for the leading causes of death shows an inverse gradient with educational level. The leading causes of death with the highest relative index of inequality ratios were HIV disease (9.81 in women and 11.61 in men), diabetes in women (4.02) and suicide in men (3.52). The leading causes of death that contribute most to the absolute inequality in mortality are cardiovascular diseases (48.8%), respiratory diseases (9.3%) and diabetes mellitus (8.8%) in women, and cardiovascular diseases (20.8%), respiratory diseases (19.8%) and cancer (19.6%) in men.CONCLUSIONS:Although the causes of death with the strongest gradient in mortality rate are HIV disease in both sexes, diabetes mellitus in women and suicide in men, most of the absolute education-related in ...

Categoría:Clase Social
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-10-09