Effect of COVID-19 prevention as part of an urban renewal programme.

OBJECTIVES: To address existing inequalities, the Barcelona City Council launched a Neighbourhood Plan in 2016-2020. During the first wave of the COVID-19 pandemic, the Neighbourhood Plan interventions were intensified. This study aimed to assess the effect of the plan on the incidence of COVID-19 during the first wave of the pandemic in Barcelona. STUDY DESIGN: We used a quasi-experimental design with 16 intervention neighbourhoods and 17 neighbourhoods in the comparison group with similar socioeconomic characteristics. METHODS: We calculated the cumulative incidence rate (CIR) of COVID-19 per 100,000 inhabitants by sex, age groups, and neighbourhood of residence. Poisson regression models were fitted to estimate the crude relative risk and relative risk adjusted by socioeconomic status (cRR and aRR) and their 95% confidence intervals (CIs). RESULTS: The CIR of COVID-19 was lower in the intervention neighbourhoods (CIR: 841 per 100,000 inhabitants) than in the comparison group (CIR: 973 per 100,000 inhabitants). On multivariate analysis, the aRR was 0.77 (CI: 0.70-0.83) for men and 0.89 (CI: 0.83-0.96) for women. Among men older than 75 years (aRR = 0.73; CI: 0.62-0.86), statistically significant differences were found in the intervention neighbourhoods compared to the comparison group. This pattern was not observed in women older than 75 years (aRR = 1.13; CI: 0.99-1.30). CONCLUSION: This research finds positive short-term effect in the intervention neighbourhoods. We conclude that the COVID-19 control and prevention interventions are likely to explain the better performance in the neighbourhoods included in the Neighbourhood Plan.

Personal and psychosocial predictors of psychological abuse by partners during and after pregnancy: a longitudinal cohort study in a community sample.

OBJECTIVE: To describe the incidence and risk factors of psychological intimate partner violence (IPV) during pregnancy and the first year after childbirth. DESIGN: Longitudinal cohort study. SETTING: Nine primary care centers in the Valencia Region (Spain). POPULATION: A consecutive sample of 1400 women in the first trimester of pregnancy, attending the prenatal programme in the Valencia Region of Spain in 2008, with follow-up in the third trimester of pregnancy, and at 5 and 12 months postpartum. A total of 888 women (66.5%) participated in all four phases. METHODS: A logistic regression model was fitted using generalised estimating equations to assess the effects of previous partner violence, consumption of alcohol or illicit drugs and social support on subsequent psychological partner violence. MAIN OUTCOME MEASURE: Psychological IPV during follow-up. RESULTS: We observed an increase in the incidence of psychological IPV after birth, particularly at 5 months postpartum. The strongest predictor of psychological IPV was having experienced abuse 12 months before pregnancy (OR 10.46, 95%CI 2.40-45.61). Other predictors were consumption of alcohol or illicit drugs by the partner or a family member (OR3.50, 95%CI 1.38-8.85) and lack of affective social support (OR2.83, 95%CI 1.31-6.11). CONCLUSIONS: Previous abuse and psychosocial risk factors predict partner psychological abuse after birth. Monitoring psychological IPV and effective interventions are needed not only during pregnancy but also during the postpartum period.

Understanding the relationship of long working hours with health status and health-related behaviours.

BACKGROUND: The objectives of this study are to identify family and job characteristics associated with long work hours, to analyse the relationship between long work hours and several health indicators, and to examine whether gender differences for both objectives exist. METHODS: The sample was composed of all salaried workers aged 16-64 years (3950 men and 3153 women) interviewed in the 2006 Catalonian Health Survey. Weekly work hours were categorised as less than 30 h (part-time), 30-40 (reference category), 41-50 and 51-60 h. Multiple logistic regression models separated by sex were fitted. RESULTS: Factors associated with long working hours differed by gender. Among men, extended work hours were related with being married or cohabiting and with being separated or divorced. In men, working 51-60 h a week was consistently associated with poor mental health status (aOR 2.06, 95% CI 1.31 to 3.24), self-reported hypertension (aOR 1.60, 95% CI 1.12 to 2.29), job dissatisfaction (aOR 2.05, 95% CI 1.49 to 2.82), smoking (aOR 1.33, 95% CI 1.03 to 1.72), shortage of sleep (aOR 1.42, 95% CI 1.09 to 1.85) and no leisure-time physical activity (aOR 2.43, 95% CI 1.64 to 3.60). Moreover, a gradient from standard working hours to 51-60 h a week was found for these six outcomes. Among women it was only related to smoking and to shortage of sleep. CONCLUSION: The association of overtime with different health indicators among men could be explained by their role as the family breadwinner: in situations of family financial stress men work overtime in order to increase the income and/or accept poor working conditions for fear of job loss, one of them being long working hours.

Health inequalities among the elderly in western Europe.

BACKGROUND: This paper analyses gender inequalities in health status and in social determinants of health among the elderly in western Europe. METHODS: Data came from the first wave of the "Survey of Health, Ageing and Retirement in Europe" (2004). For the purposes of this study a subsample of community-residing people aged 65-85 years with no paid work was selected (4218 men and 5007 women). Multiple logistic regression models separated by sex and adjusted for age and country were fitted. RESULTS: Women were more likely to report poor health status, limitations in mobility and poor mental health. Whereas in both sexes educational attainment was associated with the three health indicators, household income was only related to poor self-rated health among women. The relationship between living arrangements and health differed by gender and was primarily associated with poor mental health. In both sexes, not living with their partner but living with other people and being the household head was related to poor mental health status (adjusted odds ratio (aOR) 2.14; 95% CI 1.11 to 4.14 for men and aOR 1.75; 95% CI 1.12 to 2.72 for women). In addition, women living with their partner and other(s) and those living alone were more likely to report poor mental health status (aOR 1.67; 95% CI 1.17 to 2.41 and aOR 1.58; 95% CI 1.26 to 1.97, respectively). CONCLUSIONS: Health inequalities persist among the elderly. Women have poorer health status than men and in both sexes the risk of poor health status increases among those with low educational attainment. Living arrangements are primarily associated with poor mental health status with patterns that differ by gender.

Factors related to depression during pregnancy: are there gender differences?

OBJECTIVE: To determine gender differences between women and their partners in the effect of psychosocial and personal factors on depression during the third trimester of pregnancy. METHOD: A cross-sectional survey was carried out among 687 women and their partners (n = 669) attending the prenatal programme of Valencia province (Spain). Data collection was carried out by means of a self-reported questionnaire. The outcome variable was depression during the third trimester of pregnancy measured by the Edinburgh Postnatal Depression Scale. Predictor variables were psychosocial (marital dissatisfaction, confidant and affective social support) and personal (previous history of depression, partner depression and unplanned pregnancy) variables. The adjusted odds ratios (aOR) and their 95% confidence intervals were calculated by fitting a logistic regression model. RESULTS: The prevalence of pregnancy depression was higher among women (10.3%) than men (6.5%). In both sexes, the probability of depression during pregnancy was higher in those with marital dissatisfaction (aOR 3.05, 95% CI 1.59 to 5.82 for women and 3.14, 95% CI 1.24 to 7.99 for men) and among those whose with a previous history of depression (aOR 2.18, 95% CI 1.22 to 3.89 for women and 5.22, 95% CI 2.05 to 13.34 for men). Unplanned pregnancy did not increase the risk of pregnancy depression either in women or men. Gender differences were found on the impact of social support and partner's depression. Whereas among men low affective social support and partner depression were associated with a higher probability of reporting depression, none of these variables were related to women's depression. CONCLUSION: Most predictor factors of depression during pregnancy are similar for both sexes but a gender-different impact of social support and partner depression on pregnancy depression was appreciated. Health professionals should be aware of potentially vulnerable groups for early diagnosis of pregnancy depression and to provide effective interventions.

Immigration and self-reported health status by social class and gender: the importance of material deprivation, work organisation and household labour.

OBJECTIVE: Spain and Catalonia have experienced several immigration waves over the last century. The goal of this study was to examine the role of social class and its mediating pathways (ie, work organisation, material deprivation at home and household labour) in the association between migration status and health, as well as whether these associations were modified by social class or gender. SETTING: Barcelona city, Spain. DESIGN AND PARTICIPANTS: The study used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. The present study was conducted on the working population, aged 16-64 years (2342 men and 1872 women). The dependent variable was self-reported health status. The main independent variable was migration status. Other variables were: social class (measured using Erik Olin Wright's indicators); age; psychosocial and physical working conditions; job insecurity; type of labour contract; number of hours worked per week; material deprivation at home and household labour. Two hierarchical logistic regression models were built by adding different independent variables. RESULTS: Among men, foreigners presented the poorest health status (fully adjusted odds ratios (OR) 2.16; 95% CI 1.14 to 4.10), whereas among women the poorest health status corresponded to those born in other regions of Spain. There was an interaction between migration and social class among women, with women owners, managers, supervisors or professionals born in other regions of Spain reporting a worse health status than the remaining groups (fully adjusted OR 3.60; 95% CI 1.83 to 7.07). CONCLUSION: This study has shown that the pattern of perceived health status among immigrant populations varies according to gender and social class. These results have to be taken into account when developing policies addressed at the immigrant population.

Clinical characteristics associated with psychosocial functioning among patients with uncomplicated epilepsy in Spain.

OBJECTIVE: To identify the clinical characteristics associated with poor psychosocial functioning among Spanish patients with epilepsy but no other neurological or psychiatric disorder. METHODS: Between May and September 2001 a survey among patients with epilepsy was carried out in 32 Spanish health care centres. The selection criteria of patients were attendance to a routine neurologist visit, to be aged between 25 and 64 and not having another additional neurological handicap (n=812). Psychosocial function was elicited through six indicators: educational level, marital status, unemployment status, restricted car driving, self-perception of epilepsy as an important limiting factor in the educational level achieved and, among unemployed, as the cause of their unemployment. Multiple logistic regression models were fitted in order to calculate adjusted odds ratios (aOR) and their 95% confidence intervals. RESULTS: After simultaneously adjusting for socio-demographic variables and clinical characteristics, the six outcomes analysed increased with seizure frequency. Moreover, all the outcomes except low educational level were also related to early age at onset of epilepsy. Although no relation with objective educational level was found, there was a strong association between early age at onset of symptoms and self-perception of epilepsy as an important limiting factor of educational achievement. CONCLUSION: These findings emphasize the need for more effective treatment of epilepsy and also highlight the importance of a psychosocial approach to management of epilepsy for patients with an early onset of symptoms in order to prevent social limitations in adult life.

[Classic antiepileptic and new generation antiepileptic drugs: gender differences in effectiveness and adverse drug reactions]. / Fármacos antiepilépticos clásicos y de nueva generación: diferencias de sexo en la efectividad y en las reacciones adversas.

INTRODUCTION: Women are more likely to suffer adverse drug reactions. Moreover adverse drug reactions differ depending on gender. The main objective of new generation antiepileptic drugs (AED) is to reduce adverse drug reactions while maintaining the same effectiveness as the classic ones. OBJECTIVES: a) To identify sociodemographic and clinical variables associated with being treated with new generation AEDs, and b) to compare effectiveness, averse drug reactions and quality of life among patients treated with monotherapy, either with classic or with new generation AEDs, examining the potential gender differences. PATIENTS AND METHODS: A survey among 990 patients aged 16-64 with epilepsy was carried out in 32 Spanish hospitals (response rate: 96 %). For the purposes of this study patients treated with monotherapy (n = 496) were selected. The outcome variables were: effectiveness in seizure control, adverse drug reactions and three dimensions of the SF-36 questionnaire (vitality, mental health and self-perceived health status). RESULTS: 21 % of women and 8% of men were treated with new AEDs. Women were more likely to be treated with new generation AEDs. Moreover, age of epilepsy onset was also positively related to new AEDs and a gradient was found. Whereas no differences in effectiveness, adverse drug reactions or quality of life were observed among men, among women, those treated with new generation AEDs had less adverse drug reactions but, on the other hand, effectiveness for controlling seizures was lower. CONCLUSIONS: Women are more likely to be treated with new AEDs. Although these new treatments seem to have less adverse drug reactions among females, their effectiveness in controlling seizures are lower than that of classic AEDs.

[Impact of a smoke-free workplace policy in a company]. / Impacto de la implantación de una política de trabajo libre de humo en una empresa.

OBJECTIVE: To assess the impact of a smoke-free workplace policy in a company. METHOD: The impact of the implementation of a smoke-free workplace policy was assessed between October 2001 and February 2003 in a company with 184 employees. Two surveys of the entire staff were performed, one before the implementation of the new policy and the other 14 months after. RESULTS: Both passive exposure to tobacco smoke and tobacco consumption among smokers decreased. The proportion of workers free of tobacco smoke exposure at their workplace increased from 32% to 84% (p < 0.001) and, among smokers, the mean daily consumption of cigarettes was reduced by 7.3 cigarettes (p = 0.049). CONCLUSIONS: Demarkation of areas where smoking is allowed not only reduces passive exposure to tobacco smoke at the workplace but also seems to encourage smokers to quit smoking or to reduce tobacco consumption.

[Halogenated by-products of chlorination in tap water]. / Subproductos halogenados de la cloración en el agua de consumo público.

OBJECTIVE: The presence of trihalomethanes in the water systems of several Spanish cities has been demonstrated. The aim of this study was to analyze trihalomethane concentrations in the water provided for human consumption in the city of Barcelona. METHODS: We analyzed 151 water samples collected in 1998. The analyses were performed in the Public Health Laboratory of Barcelona using the purge-and-trap method and subsequent determination by gas chromatography and mass spectrometry. The results are presented according to the source of the water: the rivers of Llobregat or Ter, or a mixture of these. RESULTS: Trihalomethane concentrations in the water from Ter were relatively low, with a predominance of chloroform and bromodichloromethane, while concentrations in the water from Llobregat were much higher, with a predominance of bromoform and dibromochloromethane. Mixed water showed intermediate concentrations. The total concentrations reached in the water from Llobregat were above 100 microg/l. CONCLUSIONS: The results show the need to continue reducing organic pollution and halogenated compounds in the water used for human consumption in Barcelona.

Gender inequalities in health among workers: the relation with family demands.

OBJECTIVES: To analyse whether there are gender inequalities in health among male and female workers who are married or cohabiting and to assess whether there are gender differences in the relation between family demands and health. Additionally, for both objectives it will be examined whether these gender patterns are similar for manual and non-manual workers. DESIGN AND SETTING: The data have been taken from the 1994 Catalonian Health Survey (CHS), a cross sectional survey based on a representative sample of the non-institutionalised population of Catalonia, a region in the north east of Spain that has about 6 million inhabitants. The dependent variables were four ill health indicators (self perceived health status, limiting longstanding illness, having at least one chronic condition and mental health) and two health related behaviours closely related to having time for oneself (no leisure time physical activity and sleeping six hours or less a day). Family demands were measured with three variables: household size, living with children under 15 years and living with adults older than 65 years. The analysis was separated for gender and social class (manual and non-manual workers) and additionally adjusted for age. Gender differences for all dependent and independent variables were first tested at the bivariate level using the chi(2) test for categorical variables and the t test for age. Secondly, multivariate logistic regression models were fitted. PARTICIPANTS: Persons who were employed, married or cohabiting, aged 25 to 64 years (2148 men and 1185 women). RESULTS: A female excess for all the ill health indicators was found, while there were no gender differences in the health related behaviours analysed. Family demands had a greater impact on health and health related behaviours of female manual workers. In this group household size was positively related to four dependent variables. The adjusted odds ratios (ORs) to living in family units of more than four persons versus living only with the spouse were 2.74 (95%CI=1.22, 6.17) for poor self perceived health status, 3.16 (95%CI=0.98, 10.15) for limiting long standing illness, 3.28 (95%CI=1.45, 7.44) for having at least one chronic condition, and 2.60 (95%CI=1.12, 6.00) for sleeping six hours or less a day. Among female manual workers living with children under 15 years was positively associated with no leisure time physical activity (adjusted OR=2.37; 95% CI=1.43, 3.92) and with sleeping six hours or less a day (adjusted OR=1.91; 95% CI=1.13, 3.32). Living with adults older than 65 years had an unexpected negative relation with poor self perceived health status (adjusted OR=0.33; 95%CI=0.16, 0.66), and with chronic conditions (adjusted OR=0.45; 95%CI=0.24, 0.87) in female manual workers. Among male manual workers living with children under 15 years was positively associated with longstanding limiting illness (adjusted OR=2.44; 95%CI=1.36, 4.38). CONCLUSION: When gender differences in health are analysed, both the paid and the non-paid work should be considered as well as the interaction between these two dimensions, gender and social class. In Catalonia, as probably in Spain and in other countries, private changes such as sharing domestic responsibilities, as well as active public policies for facilitating family care are needed in order to reduce gender health inequalities attributable to the unequal distribution of family demands.

[Housework, gender and health in the working population]. / Trabajo doméstico, género y salud en población ocupada.

OBJECTIVE: To analyse the relation between domestic workload and self-perceived health status among workers and to examine whether there are gender inequalities. METHODS: The selected population were the 215 men and 106 women younger than 65 years interviewed in the Terrassa Health Survey, 1998 who had a paid work and were married or cohabiting. Adjusted odds ratios (aOR) by domestic workload, age and occupational social class with their 95% confidence intervals (CI) were calculated. RESULTS: Whereas among men domestic workload was not associated with health status, among women poor self-perceived health status was positively related to household size (aOR = 3.65; 95% IC = 1.06-12.54) and to lack of a person for doing domestic tasks (aOR = 4.43; 95% CI = 1.05-18.62). CONCLUSION: Both household characteristics and having a support for facing domestic tasks play an important role in gender health inequalities.

[The importance of the gender perspective in health interview surveys]. / La importancia de la perspectiva de género en las encuestas de salud.

The identification and measurement of the population health needs should be the first step in health planning. In order to guarantee equity criteria, to know the situation of the whole population, and therefore also that of women, is a key issue. Health interview surveys are a good tool for pinpointing the needs of the population, but mainly they are usually focused on health risk factors that explain men's health status such as health behaviours and paid job. These factors often fail to capture aspects that are relevant for women's health, such as household work. The main objective of this paper is to emphasise the importance of a gender perspective in the design and analysis of health interview surveys, and to propose variables that should be included in health surveys in order to better know gender health inequalities. Likewise, this article deals with the gender concept and its importance as a health inequality factor. Gender is an analytical construct based on the social organisation of the sexes that can be used to better understand the conditions and factors influencing women's and men's health beginning by the social roles that each culture and society assigns to people based on their sex. Health is a complex process determined by a wide range of factors: biological, social, environmental and health services related factors. Gender, because of its close relation to all of them, plays a key role. The gender approach is characterised by the analysis of the social relation between men and women, taking into account that sex is a determinant of social inequalities. This paper presents the variables that health interview surveys should include from a gender approach point of view: reproductive work, productive work, social class, social support, self-perceived health status, quality of life, mental health and chronic conditions. In addition, issues related to the wording of questions, data collection and analysis are discussed.

[Gender differences in the influence of housework on health]. / Diferencias de género en la influencia del trabajo doméstico sobre la salud.

OBJECTIVE: To analyze the influence of domestic workload on the health of the working population of Catalonia, taking into account its differential impact on males and females. SUBJECTS AND METHODS: The study population were the 2,164 men and 1,215 women interviewed in the Catalonian Health Survey (ESCA) of 1994, with a paid work who were the main responsible for the family unit. The dependent variable was the self-perceived health status that was dichotomized for the bivariate and multivariate analysis. The domestic workload was measured with the number of people living at home (2, 3, 4 or more than 4), living with children younger than 15 and living with older than 65. The adjusting variables were age and occupational social class. The analysis was separated for men and women and crude, adjusted for age, and for all the predictor variables odds ratios (OR) were calculated with their 95% confidence intervals (95%CI). RESULTS: There was no relation between domestic workload and health status among men. Among women the risk or poor health status increased with the number of people living at home with adjusted OR associated to living with more than four persons of 2.35 (95%CI = 1. 33-4.15), as compared with living only with the spouse. Living with older than 65 was protector for women (adjusted OR = 0.63; 95%CI = 0. 39-1.03). CONCLUSIONS: The risk of poor health status associated to the domestic workload among women with paid work, suggests the need of increasing community resources for caring children, as well as, increasing the participation of men in the domestic work. Future health surveys should collect information about the number of people of different age strata living at home.

[Habitual physical activity in a population residing in the city of Barcelona]. / Actividad física habitual de la población residente en la ciudad de Barcelona.

OBJECTIVES: To describe the sociodemographic distribution of habitual physical activity and to analyse its relationship with self-perceived health status and occupational status, among the population older that 16 years of age in the city of Barcelona, Spain. METHODS: A sample of 1,885 adult men and 2,196 women answered the Health Interview Survey of Barcelona in 1992. Those whose habitual activity required high physical exertion or walking were considered as active. Bivariate and multivariate analyses adjusting logistic regression models were used to study the relationship between habitual physical activity and the rest of variables, for each occupational situation. RESULTS: Fifty six percent of adults reported being physically active. Physical activity was lower among workers than non workers, although workers reported more physical exertion (14.5% in men and 8.0% in women). Physical activity was associated with occupation and educational level among male workers, but only with occupation among female workers. In the non working population, physical activity was lower among those who perceived their health status as fair or poor, compared with those that described it as good or very good, (ORa in men was 0.2, 95% confidence interval = 0.1-0.5; ORa in women was 0.5, 95% confidence interval = 0.3-0.8). CONCLUSIONS: More than half of the Barcelona population were physically active in an habitual manner. Among workers, this activity was mainly determined by the occupation. Non-workers with a poor self-perceived health status did less physical activity.

[Occupational accidents in Barcelona (Spain), from 1992 to 1993]. / Acidentes de trabalho em Barcelona (Espanha), no período de 1992-1993.

INTRODUCTION: The statistics related to labor accidents as with any other notification system ought to be the basis for programs and policies with a view to the adoption of preventive measures. In order to establish preventive norms, however, the health system needs data from researchers focussing on the dynamics of and the pitfalls revealed by specific events. Within this context the main objective of this study is to proceed with an in-depth analysis of the labor accidents verified in Barcelona (Spain) using for this purpose a descriptive statistics model to test variables such as type of accident, economic sector, economic enterprise and type of labor contract. METHOD: The data source utilized was the notification system for labor accidents with grave consequences such as death of the victim registered in Barcelona during the period 1992-1993. Labor accidents registered for male workers numbered 848. A log-linear model was applied to this data base. RESULTS AND CONCLUSIONS: The results show a positive association between traumatic accidents with the construction, traffic and services sectors. A positive association was also found between traumatic accidents and the size of the company concerved the small ones being the worse type in terms of worker's injuries. Regarding the nontraumatic accidents, the study showed a positive correlation between large-sized enterprises and type of temporary worker and the civil construction sector as compared to workers with long term work contracts within industry and services. There was some evidence, also, of a positive association between small and medium sized companies and temporary work and the occurrence of work accidents.

[Influence of paid work on the perceived health state in women]. / Influencia del trabajo remunerado en el estado de salud percibido de las mujeres.

BACKGROUND: Several studies show that paid work has a positive effect on women's health, although few studies have shown this relationship in Southern-European countries. The aim of this paper was to analyze the self-perceived health status of women of Barcelona, Spain according to their type of work (homemaker or worker). PATIENTS AND METHODS: Cross sectional study using the 1992 Barcelona Health Interview Survey data. SUBJECTS: 1194 women aged 25 to 64 years old. Bivariate analysis of women's perceived health status by all other variables. A logistic regression model was performed with the dependent variable being women's self-perceived health status and the independent variables: type of work (homemaker or worker), age, number of chronic diseases, medical care visits, children under 12 years and elderly over 65 years living at home and social class based on occupation. RESULTS: 15.8% of workers and 31.4% of homemakers reported poor self-perceived health status (p < 0.05). This same distribution was maintained when adjusting for all independent variables. Social class had an important relationship with health, with women from lower social classes reporting poorer self-perceived health status than homemakers from upper social classes. CONCLUSIONS: The 1992 Barcelona Health Interview Survey analysis confirms that in Barcelona as well, paid work has a positive relationship on women's self-perceived health status.