This study scrutinizes the use of supplementary pension plans (SPPs) in the executive compensation strategies of multinational and multi-Latin firms. The proposed analysis focuses on the internal and ...external factors that may influence the implementation of SPPs and their role in attracting, retaining, and motivating strategically valuable human capital in the form of executive managers. The analysis was based on in-depth interviews with a range of managers, representatives of multilateral institutions, researchers, and heads of pension funds and mandatory pension plans. Relevant complementary data was obtained from a variety or documentary sources. The paper offers valuable findings and implications for the design of compensation strategies of senior managers of multinational and multi-Latin firms. The study also has implications regarding the use of loyalty mechanisms aimed at developingcompetitive advantages to enhance business performance.
This study aims to describe the accessibility to and promotion of alcohol and tobacco around secondary schools in Madrid and its distribution in relation with area-level socioeconomic deprivation; ...analyze the relationship between this exposure and individual consumption characteristics of students between 14 and 18 years old; and explore other facilitators of this consumption.
Mixed-methods study conducted in three phases: 1) we collected data on accessibility to and promotion of alcohol and tobacco in the environment using systematic social observation around 55 secondary schools; 2) we administered 2287 questionnaires among the students in these centers to gather information about characteristics and determinants of consumption; and 3) we conducted 20 semi-structured interviews and one discussion group to deepen in the results obtained in surveys and systematic social observation. We will use Geographic Information Systems to integrate and analyze the data from a spatial perspective.
Este estudio tiene como objetivo describir la accesibilidad y la promoción de alcohol y tabaco alrededor de los centros de enseñanza secundaria en Madrid y su distribución en relación con la privación socioeconómica del área; analizar la relación entre esta exposición y las características individuales de consumo en estudiantes de entre 14 y 18 años; y explorar otros facilitadores del consumo.
Estudio de métodos mixtos en tres fases: 1) recogimos datos sobre accesibilidad y promoción de estas sustancias en el entorno mediante observación social sistemática alrededor de 55 centros de secundaria; 2) administramos 2287 cuestionarios a estudiantes de estos centros sobre características y determinantes de consumo; y 3) realizamos 20 entrevistas semiestructuradas y un grupo de discusión en estos centros para profundizar en los resultados obtenidos en las encuestas y la observación social sistemática. Utilizaremos Sistemas de Información Geográfica para integrar y analizar los datos desde una perspectiva espacial.
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Childhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and ...household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment.
We performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16,665 schoolchildren representative of the population aged 6–9 years in Spain.
The prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities.
A lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities.
La obesidad infantil se asocia inversamente con el nivel socioeconómico familiar en países desarrollados. El objetivo es evaluar la asociación entre la situación ponderal infantil y el nivel socioeconómico familiar, según características familiares, percepciones, hábitos de vida y entorno escolar.
Análisis descriptivo de la situación ponderal infantil según factores socioeconómicos familiares y variables mediadoras en el estudio ALADINO 2019, en una muestra de 16.665 escolares representativa de la población escolar de 6 a 9 años en España.
La prevalencia de obesidad infantil en hogares de bajo nivel socioeconómico (26,8% niños; 20,4% niñas) era, en ambos sexos, el doble de la de los de mayor nivel (12,1% niños; 8,7% niñas). En escolares de familias de baja renta eran más frecuentes hábitos alimentarios poco saludables, el sedentarismo (principalmente en niñas) y la presencia de pantallas en la habitación (más en niños). Por el contrario, en hogares más desfavorecidos eran menos frecuentes el antecedente de lactancia materna y la práctica de actividad física (especialmente en niñas). La disponibilidad de cocina propia, actividades deportivas y gimnasio cubierto en los centros era también menos habitual para los escolares de familias de menor renta.
Un menor nivel socioeconómico del hogar se asocia con peores hábitos alimentarios y de actividad física y ciertas características del entorno familiar y el escolar, que a su vez median la asociación inversa que existe entre el nivel socioeconómico y la prevalencia de obesidad infantil. Las niñas realizan menos actividad física y presentan más sedentarismo mientras que los niños tienen más acceso a pantallas. Las intervenciones para combatir la obesidad infantil deben contemplar las desigualdades identificadas.
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Although mean physical activity in COPD patients declines by 400•500steps/day annually, it is unknown whether the natural progression is the same for all patients. We aimed to ...identify distinct physical activity progression patterns using a hypothesis-free approach and to assess their determinants.
We pooled data from two cohorts (usual care arm of Urban Training NCT01897298 and PROactive initial validation NCT01388218 studies) measuring physical activity at baseline and 12 months (Dynaport MoveMonitor). We identified clusters (patterns) of physical activity progression (based on levels and changes of steps/day) using k-means, and compared baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics across patterns.
In 291 COPD patients (mean±SD 68±8 years, 81% male, FEV1 59±19%pred) we identified three distinct physical activity progression patterns: Inactive (n=173 59%, baseline: 4621±1757 steps/day, 12-month change (): ∧487±1201 steps/day), ActiveImprovers (n=49 17%, baseline: 7727±3275 steps/day, :+3378±2203 steps/day) and ActiveDecliners (n=69 24%, baseline: 11 267±3009 steps/day, : ∧2217±2085 steps/day). After adjustment in a mixed multinomial logistic regression model using Active Decliners as reference pattern, a lower 6-min walking distance (RRR 95% CI 0.94 0.90•0.98 per 10m, P=.001) and a higher mMRC dyspnea score (1.71 1.12•2.60 per 1 point, P=.012) were independently related with being Inactive. No baseline variable was independently associated with being an Active Improver.
The natural progression in physical activity over time in COPD patients is heterogeneous. While Inactive patients relate to worse scores for clinical COPD characteristics, Active Improvers and Decliners cannot be predicted at baseline.
Aunque la actividad física en pacientes con EPOC declina una media anual de 400-500 pasos/día, se desconoce si esta progresión es igual en todos los pacientes. Este estudio pretendió identificar los patrones de progresión de la actividad física mediante mèc)todos libres de hipótesis y evaluar sus determinantes.
Se estudiaron 291 pacientes con EPOC estable (media±DE: 68±8años, 81% hombres, VEMS 59±19%pred) de dos cohortes europeas con actividad física basal y a 12meses (acelerómetro Dynaport MoveMonitor). Se identificaron conglomerados (patrones) de progresión de actividad física basados en los niveles y cambios de pasos/día usando k-means, y se compararon entre patrones las características sociodemográficas, interpersonales, ambientales, clínicas y psicosociales basales.
Se identificaron tres patrones: inactivo (n=173 59%, basal: 4.621±1.757 pasos/día, cambio en 12meses (): ∧487±1.201 pasos/día), activo que aumenta (n=49 17%, basal: 7.727±3.275 pasos/día, : +3.378±2.203 pasos/día) y activo que reduce (n=69 24%, basal: 11.267±3.009 pasos/día, : ∧2.217±2.085 pasos/día). La distancia en la prueba de la marcha de 6minutos (6MWD) y la disnea se asociaron independientemente con ser inactivo: RRR IC95% 0,94 0,90-0,98 por cada 10m de 6MWD (p=0,001) y 1,71 1,12-2,60 por cada punto en la escala mMRC (p=0,012), respectivamente, en comparación con el patrón activo que reduce. No se encontraron variables basales independientemente asociadas con ser activo que aumenta.
La progresión natural de la actividad física en pacientes con EPOC es heterogèc)nea. Mientras que el patrón de pacientes inactivo se relaciona con peores características clínicas de EPOC, no se pudo predecir la evolución de los activos a aumentar o reducir.
The coronavirus disease (COVID-19) that appeared in 2019 gave rise to a major global health crisis that is still topping global health, socioeconomic, and intervention program agendas. Although the ...outbreak of COVID-19 has had substantial and devastating impacts on developed countries, the countries of the Global South share a higher proportion of the epidemic's effects as shown particularly in morbidity and mortality rates in low-income countries. Modeling the effects of underlying factors and disease mortality is essential to plan effective control strategies for disease transmission and risks. The relationship between COVID-19 mortality rates and sociodemographic and health determinants can highlight various epidemic fatality risks. In this research, geographic information systems (GIS) and a multilayer perceptron (MLP) artificial neural network (ANN) were adopted to model and examine variations in COVID-19 mortality rates in the Global South. The model's performance was tested using statistical measures of mean square error (MSE), root mean square error (RMSE), mean bias error (MBE), and the coefficient of determination (R
2
). The findings indicated that the most important variables in explaining spatial mortality rate variations were the size of the elderly (sixty-five and older) population, accessibility to handwashing facilities, and hospital beds per 1,000 population. Mapping the explanatory variables and estimated mortality rates and determining the importance of each variable in explaining the spatial variation of COVID-19 death rates across countries of the Global South can shed light on how public health care and demographic structures can offer policymakers invaluable guidelines to planning effective intervention strategies.
This paper reviews the potential utility of using the concepts and tools of systems to understand and act on health in cities. The basic elements of systems approaches and the links between cities as ...systems and population health as emerging from the functioning of a system are reviewed. The paper also discusses implications of systems thinking for urban health including the development of dynamic conceptual models, the use of new tools, the integration of data in new ways and the identification of data gaps, and the formulation of different kinds of questions and identification of new policies. The paper concludes with a review of caveats and challenges.
The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can ...generate problems of inequity, frequently unnoticed in health care.
The aim of this study is to identify the "non-medical" barriers that influence the choice of RRT in an advanced chronic kidney disease (ACKD) consultation in Spain.
Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel Scale) and instrumental activities of daily living (Lawton and Brody Scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged.
A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation (LDRT) and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7% vs. 22.5%) (p = 0.002), Spanish nationality (91% vs. 77.7%) (p < 0.001), to a lower language barrier (0.6% vs 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs 92.9) and on the Lawton and Brody scale (7 vs 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques.
Patients who opted for CC were significantly older (81.1 vs 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6% vs 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7% vs 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC.
Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.
La influencia de los determinantes sociales de la salud en la elección de las técnicas de tratamiento renal sustitutivo (TRS) en la enfermedad renal crónica avanzada (ERCA) ha sido escasamente explorada, pudiendo generar problemas de inequidad, frecuentemente desapercibidos en la asistencia sanitaria.
El objetivo de este estudio es identificar las desigualdades sociales y económicas que influyen en la elección de TRS en una consulta de Enfermedad renal crónica avanzada (ERCA) en España.
Análisis retrospectivo incluyendo el total de pacientes atendidos en la consulta de ERCA en un hospital terciario desde 2009 a 2020. La inclusión en la consulta de ERCA comenzaba por un proceso de toma de decisiones, conducido por una enfermera específicamente instruida. Las variables consideradas para el estudio fueron: edad, sexo, etiología de la ERC, nivel de dependencia para las actividades básicas de la vida diaria (Escala de Barthel) y actividades instrumentales de la vida diaria (Escala de Lawton y Brody), nacionalidad española versus extranjera, nivel socioeconómico y barrera idiomática. El nivel socioeconómico se extrapoló según el domicilio y el distrito sanitario por centro de atención primaria al que pertenecían los pacientes.
Un total de 673 personas fueron atendidas en la consulta de ERCA en el periodo de estudio, de los cuales 400 (59,4%) optaron por la técnica de hemodiálisis (HD), 156 (23,1%) por diálisis peritoneal (DP), 4 (0,5%) por trasplante renal de donante de vivo (TRDV) anticipado y 113 (16,7%) eligieron tratamiento conservador (TC). La elección de DP como técnica de TRS elegida (frente a HD) se asoció a personas con nivel socioeconómico alto (38,7% vs 22,5%) (p = 0,002), a la nacionalidad española (91% vs 77,7%) (p < 0,001), a una menor barrera idiomática (0,6% vs 10,5%) (p < 0,001), y a una mayor puntuación en la escala de Barthel (97,4 vs 92,9) y en la escala de Lawton y Brody(7 vs 6,1) (p < 0,001). Ni la edad ni el sexo mostraron diferencias significativas en la elección de ambas técnicas.
Los pacientes que optaron por TC eran significativamente de mayor edad (81,1 vs 67,7 años; p < 0,001), más dependientes (p < 0,001), con una mayor proporción de mujeres (49,6% vs 35,2%; p = 0,006) y una mayor proporción de españoles (94,7% vs 81%, p = 0,001) en relación con la elección de otras técnicas (DP y HD). El nivel socioeconómico no influyó en la elección de TC.
A pesar de que el proceso de toma de decisiones en la elección de TRS está reglado y estandarizado, existen factores como la situación socioeconómica, la migración, la barrera idiomática o la dependencia que influyen en el tipo de TRS elegido. Para abordar estos aspectos que pueden ser causa de inequidad se requiere de una intervención intersectorial y multinivel con equipos interdisciplinares que incluyan, entre otros, trabajadores sociales, para brindar una evaluación más holística y centrada en la persona.
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