In Spain, regional health systems (universal access) depend on each Autonomous Communities (ACs). The management of the 2008 economic crisis has been different in the ACs, which may have led to an ...increase in inequities in the use of health services. The objective of this study was to analyse the impact of individual and regional characteristics on public hospitalisation inequities in Spain for the period 2003–2017. We developed a repeated cross‐sectional study through Spanish National Health Surveys (2003, 2006, 2011 and 2017) and the Spanish European Health Survey (2014; n = 118,499 subjects). Multilevel and Oaxaca decomposition analyses were conducted to analyse the effect of individual and regional factors in hospitalisation inequities. The results showed that the prevalence of hospitalisation was higher for women (2003: 11.2%; 2017: 9.0%) than for men (2003: 10.7%; 2017: 8.8%) and it decreased with time. Multilevel analyses showed that, after adjustment for variables related to healthcare demand, there were inequities in the probability of hospitalisation, mainly in women. The decomposition analyses showed a higher effect of the number of hospital beds available on hospitalisation in men than in women. There is a direct relationship between the number of hospital beds and the probability of hospitalisation in both sexes. In conclusion, a progressive decrease in hospitalisation use was observed in Spain in the context of the economic recession. Individual‐level and regional‐level factors were associated with hospitalisation inequities. It is necessary to guarantee equitable access to health services according to the need even in recession times.
Long COVID syndrome can have a major impact on life organization. Its persistent symptoms may cause a potentially disabling condition that affects the quality of life of those suffering from it. The ...resulting loss of functional independence hinders the ability to return to normal life. Many research studies carried out on this novel syndrome have focused on describing its extensive symptomatology. Studies on later repercussions, however, such as disability or loss of significant roles, remain scarce. This study examines the loss of socioemotional and occupational roles experienced by individuals suffering from Long COVID, as a result of the disease. A secondary objective is to analyze the sociodemographic and clinical factors associated with this loss of roles.
A cross-sectional study was conducted with the participation of 100 patients diagnosed with Long COVID, over the age of 18, and attended by Primary Health Care in the Autonomous Community of Aragon. The main study variable was the loss of significant socioemotional and occupational roles by the participants. Sociodemographic and clinical data were also collected through a structured interview. Subsequently, a descriptive, correlational, and regression-based statistical analysis was performed using the SPSS Statistics program.
Based on the 100 study participants, the median number of roles lost was 3 (IQR 2) and the median number of valuable roles lost was 2 (IQR 2). More cognitive impairment and not having an active work role were predictors of a greater loss of valuables roles.
Long COVID symptoms hinder the development of socioemotional and occupational roles. Healthcare professionals should consider this when intervening to ensure that their patients may recover their life as it was before the disease.
Long COVID patients suffer a negative impact on their quality of life, as well as their functioning, productivity or socialization. There is a need to better understand the individual experience and ...circumstances surrounding these patients.
To characterize clinical picture of Long COVID patients and to identify factors associated with quality of life.
A secondary data analysis from a randomized clinical trial (RCT) was carried out with 100 Long COVID patients treated by Primary Health Care and residents in the territory of Aragon (northeast of Spain). The main variable of the study was quality of life, evaluated using the SF-36 Questionnaire, in relation to socio-demographic and clinical variables. In addition, ten validated scales were used that contemplated their cognitive, affective, functional and social status, as well as personal constructs. Correlation statistics and linear regression model were calculated.
Long COVID patients suffer a decrease in their levels of physical and mental health. On the one hand, the higher number of persistent symptoms (b = -0.900, p = 0.008), worse physical functioning (b = 1.587, p = 0.002) and sleep quality (b = -0.538, p = 0.035) are predictors of worse quality of life, physical subscale. On the other hand, higher educational level (b = 13.167, p = 0.017), lower number of persistent symptoms (b = -0.621, p = 0.057) and higher affective affectation (b = -1.402, p<0.001) are predictors of worse quality of life, mental subscale.
It is necessary to design rehabilitation programs that consider both the physical and mental health of these patients, thus obtaining an improvement in their quality of life.
Abstract
Introduction
The COVID-19 pandemic necessitated the implementation of various measures within closed institutions like prisons to control the spread of the virus. Analyzing the impact of ...these measures on the health of inmates is crucial from a public health perspective. This study aimed to explore inmates’ subjective perception of the COVID-19 lockdown, the implemented measures, their physical self-perception, and their views on the vaccination process.
Method
Between April 2021 and January 2022, 27 semi-structured individual interviews and 1 focus group were conducted with inmates in a prison located in northwest Spain. The interviews were conducted in person and audio-recorded. Thematic content analysis was employed, utilizing methodological triangulation to enhance the coherence and rigor of the results.
Results
The analysis revealed two main themes and nine subthemes. The first theme focused on inmates’ perception of the implementation of protective measures against COVID-19 within the prison and its impact on their well-being. The second theme explored the pandemic’s emotional impact on inmates. All participants reported negative consequences on their health resulting from the measures implemented by the institution to contain the pandemic. However, they acknowledged that measures like lockdowns and mass vaccination helped mitigate the spread of the virus within the prison, contrary to initial expectations.
Conclusion
COVID-19 and related measures have directly affected the health of inmates. To improve their health and minimize the impact of pandemic-induced changes, community participation and empowerment of individuals are essential tools, particularly within closed institutions such as prisons.
Beverages play a substantial role meeting water, calorie, and nutrient requirements; however, they are presented as being major contributors to the current obesity epidemic. Although, the ...relationship between beverage consumption and metabolic risk factors for cardiovascular disease (CVD) in adults has been frequently studied, its association with subclinical atherosclerosis is of increased interest. We studied the association of beverage consumption with the presence of peripheral subclinical atherosclerosis among Spanish workers. We performed a cross-sectional study of 2089 middle-aged males, with a mean age of 50.9 (SD 3.9), and without CVD, carried out in the Aragon Workers' Health Study (AWHS). A food frequency questionnaire was used to measure beverage consumption of low-fat milk, coffee and tea (unsweetened), whole-fat milk, sugar-sweetened beverages, bottled fruit juice, artificially-sweetened beverages and 100% fruit juice. Atherosclerotic plaques were measured by ultrasound (in carotid arteries, and in femoral arteries). Atherosclerotic plaque was defined as a focal structure protruding ≥ 0.5 mm into the lumen, or reaching a thickness ≥ 50% of the surrounding intima-media thickness. As statistical analysis, we use logistic regression models, simultaneously adjusted for all beverage groups. As results, unsweetened coffee was the beverage most associated with peripheral subclinical atherosclerosis with an odds ratio (OR) of 1.25 (1.10-1.41), and 1.23 (1.09-1.40) 100g/day for carotid, and femoral territories respectively. Moreover, subclinical atherosclerosis was positively associated with whole-fat milk OR 1.10 (1.02-1.18) 100 g/day in the femoral territory. The association was protective for low-fat milk in the carotid territory OR 0.93 (0.88-0.99) 100g/day. There was also a protective association with bottled fruit juices in the femoral territory 0.84 (0.74-0.94) 100g/day. Our results suggest a detrimental association with the consumption of coffee, as well as with whole-fat milk and the presence of subclinical atherosclerosis. Therefore, an element of prudence excluding water and low-fat milk, must be applied when recommending beverage consumption.
Introduction
This research aims to study the role of social support as a mediator in the relationship between technostress or academic stress and health in university students.
Methods
A descriptive, ...quantitative cross-sectional study has been carried out through a self-reported survey answered by 389 students during March and April 2022. The current level of health was the outcome variable. Technostress and academic stress were the criterion variables. Perceived social support was the mediator variable. The sociodemographic variables and ICT use at the educational level were the independent variables.
Results
Women have higher levels of technostress and academic stress than men. Social support significantly and positively mediates the relationship between academic stress and self-perceived health in men.
Discussion
There is a clear need to develop new social management strategies that assist students in developing stable and long-lasting social networks, which can reduce stress during the student period and provide personal tools for later working life.
To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain.
Repeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 ...(n=139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex.
Healthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need.
Healthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services.
Analizar el efecto de la Gran Recesión en las desigualdades en el uso de atención primaria (AP) y atención especializada (AE) en España.
Análisis transversal repetido (Encuestas Nacionales de Salud 2001-2017; n=139.566). Se calcularon las prevalencias de utilización estandarizadas por edad y se realizó el cálculo de tendencias para explorar la evolución. Se llevaron a cabo análisis de regresión logística ajustados por el Modelo de demanda asistencial de Andersen para estudiar las desigualdades en los periodos anterior, durante y posterior a la crisis. Todos los análisis se estratificaron por sexo.
La tendencia en la utilización de los servicios sanitarios pasó de un rápido incremento en el periodo anterior a la crisis a una estabilización durante la crisis y un posterior descenso. La utilización de los servicios sanitarios fue mayor en las mujeres (AP: 15,8% a 32,5%; AE: 8,2% a 16,2%) que en los hombres (AP: 11,3% a 24,1%; AE: 5,4% a 11,6%), aumentando las diferencias. Durante la crisis, la probabilidad de usar la AP fue mayor en los grupos más desfavorecidos, mientras que en la AE se observa la tendencia contraria. Las desigualdades en la AE aumentaron durante la recesión, pero ello no puede atribuirse a factores de necesidad.
La tendencia de la utilización de los servicios sanitarios cambió en la Gran Recesión. Existen desigualdades en la utilización de servicios sanitarios en España, que han aumentado en AE durante el periodo de crisis y poscrisis. Es necesario considerar los factores socioeconómicos en planificación sanitaria con el fin de lograr la equidad.
It is essential to understand the impact of social inequalities on the risk of COVID-19 infection in order to mitigate the social consequences of the pandemic. With this aim, the objective of our ...study was to analyze the effect of socioeconomic inequalities, both at the individual and area of residence levels, on the probability of COVID-19 confirmed infection, and its variations across three pandemic waves. We conducted a retrospective cohort study and included data from all individuals tested for COVID-19 during the three waves of the pandemic, from March to December 2020 (357,989 individuals) in Aragón (Spain). We studied the effect of inequalities on the risk of having a COVID-19 confirmed diagnosis after being tested using multilevel analyses with two levels of aggregation: individuals and basic healthcare area of residence (deprivation level and type of zone). Inequalities in the risk of COVID-19 confirmed infection were observed at both the individual and area level. There was a predominance of low-paid employees living in deprived areas. Workers with low salaries, unemployed and people on minimum integration income or who no longer receive the unemployment allowance, had a higher probability of COVID-19 infection than workers with salaries ≥ €18,000 per year. Inequalities were greater in women and in the second wave. The deprivation level of areas of residence influenced the risk of COVID-19 infection, especially in the second wave. It is necessary to develop individual and area coordinated measures by areas in the control, diagnosis and treatment of the epidemic, in order to avoid an increase in the already existing inequalities.
BACKGROUND // There are different socioeconomic variables which determine tuberculosis’s epidemiology, diagnosis and treatment.
The objective of this paper was to analize these effects in the last ...years in Spain.
METHODS // A systematic review was conducted. Screened studies were original articles written in English or Spanish and published
between 2007 and 2020. Searching was performed in Pubmed and Web of Science databases. STROBE criteria were followed to analyze
studies’s quality, and studies included in the review had 15 points or more.
RESULTS // 23 articles were selected, and were classified in different topics. Foreigners’s proportion with tuberculosis changed in
different autonomous communities between 10%-50%. There were diagnostic delay for this group compared to natives. This group
had higher incidence of resistance to isoniazid, but without a clear increase in multidrug resistance. There were less adherence to
tuberculosis’s treatment in case of immigration, drug addiction, HIV coinfection, or lack of family support. Under-reporting of tuberculosis
cases varied between 18%-28%, and it was higher in cases of social marginality, HIV coinfection, Spanish nationality or male
sex. There were also other social risk groups in which the diagnostic approach to tuberculosis was relevant, such as in schools and
health centers. Tuberculosis was one of the most frequent HIV associated diseases, although screening tests were not performed in
almost 18%, depending on the concurrence of social risk factors.
CONCLUSIONS // Tuberculosis’s incidence, diagnosis, and treatment are influenced by a lot of social and economic factors, which
determine the approach to this disease.
FUNDAMENTOS // Existen diferentes variables socioeconómicas que condicionan la epidemiología, diagnóstico y tratamiento de la
tuberculosis. El objetivo del siguiente trabajo fue analizar dichos factores en los últimos años en España.
MÉTODOS // Se realizó una revisión sistemática de artículos originales escritos en inglés o castellano, entre los años 2007 y 2020.
La búsqueda se realizó en las bases de datos Pubmed y Web of Science. Se siguieron los criterios STROBE para analizar la calidad de
los estudios y seleccionando para su inclusión en la revisión aquellos que obtuvieron 15 puntos o más.
RESULTADOS // Se analizaron 23 artículos, dividiendo las conclusiones por áreas temáticas. La proporción de personas extranjeras
con tuberculosis varió en las diferentes comunidades autónomas entre un 10% y un 50%, pudiendo existir demora diagnóstica en
este grupo respecto a los autóctonos y presentando mayor incidencia de resistencia a isoniacida, pero sin claro aumento en la multirresistencia.
Se halló menor cumplimiento del tratamiento antituberculoso en caso de migración, adicción a drogas, coinfección de
tuberculosis y VIH o falta de apoyo familiar. La infranotificación de casos de tuberculosis varió entre un 18% y un 28%, siendo mayor
en casos de marginalidad social, coinfección de tuberculosis y VIH, nacionalidad española o sexo varón. La tuberculosis fue una de
las enfermedades asociadas a VIH más frecuentes, aunque no se realizaron pruebas de cribado en casi el 18%, según la concurrencia
de factores sociales de riesgo.
CONCLUSIONES // En la incidencia, diagnóstico y tratamiento de la tuberculosis influyen numerosos factores sociales y económicos
que condicionan su abordaje.
Background: We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe.
Methods: We developed a systematic review of scientific literature ...for the period 2008-2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed.
Results: Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services.
Conclusion: Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health.
PDF
