[Does social mobility influence health status? A systematic review.] / ¿Influye la movilidad social en el estado de salud? Una revisión sistemática.

BACKGROUND: In the debate on the determinants of social class variation in health, it has been suggested that social mobility and associated factors play an important role in this variation. Social mobility describes changes or stability between social class positions. The aim of this paper was to identify studies on the association between social mobility and health. METHODS: The databases consulted were MEDLINE/PubMed, Cochrane, SciELO, CRD. The keywords used (in English), through the MeSH methodology, were: Health (MajorTerm), Class mobility, Vertical mobility, Social position, Socioeconomic factors, Social class, Social conditions, Social environment, Poverty and Social marginalisation (MeSHTerm). The search period was from January 2010 to December 2019. The STROBE statement has been used to develop the checklist. Finally, the evaluation of the studies has been carried out by means of a qualitative systematic review. RESULTS: The search identified 1,092 potentially relevant studies. After analysis, 376 studies were retained and their full texts were reviewed in depth, resulting in a final set of 42 studies. Of these, 2 studies were identified on Class Mobility and Health; 5 studies were also identified on Poverty and Health, showing evidence of effect on Health by Social Mobility; 9 studies on Social Class and Health, showing effect of Social Mobility on Health and 8 studies showing effect of Social Position on Health. CONCLUSIONS: Social mobility measures convey additional information to that of poverty indices. Using indices of social position and their impact on health inequalities could be empirically useful. More research is needed on this issue.

OBJETIVO: En el debate sobre los determinantes de la variación de la clase social en la salud, se ha sugerido que la movilidad social y los factores asociados a ella desempeñan un papel importante en esta variación. La movilidad social describe los cambios o la estabilidad entre las posiciones de clase social. El objetivo de este trabajo fue identificar estudios sobre la asociación entre movilidad social y salud. METODOS: Las bases de datos consultadas fueron MEDLINE/PubMed, Cochrane, SciELO, CRD. Las palabras clave utilizadas (en inglés), a través de la metodología MeSH, fueron: Salud (MajorTerm), Movilidad de clase, Movilidad vertical, Posición social, Factores socioeconómicos, Clase social, Condiciones sociales, Entorno social, Pobreza y Marginación social (MeSHTerm). El periodo de búsqueda fue de enero de 2010 a diciembre de 2019. La declaración de STROBE se ha utilizado para elaborar la lista de verificación. Finalmente, la evaluación de los estudios se ha realizado mediante una revisión sistemática cualitativa. RESULTADOS: La búsqueda identificó 1.092 estudios potencialmente relevantes. Tras el análisis, se retuvieron 376 estudios y se revisaron sus textos completos en profundidad, resultando un conjunto final de 42 estudios. De ellos, se identificaron 2 estudios sobre Movilidad de clase y Salud; también se identificaron 5 estudios sobre Pobreza y Salud, mostrando evidencia del efecto sobre la Salud por la Movilidad Social; 9 estudios sobre Clase Social y Salud, mostrando el efecto de la Movilidad Social sobre la Salud y 8 estudios que mostraron efecto de la Posición Social sobre la Salud. CONCLUSIONES: Las medidas de movilidad social transmiten información adicional a la de los índices de pobreza. Utilizar los índices de posición social y su impacto en las desigualdades en salud podría ser empíricamente útil. Se necesitan más estudios sobre esta cuestión.

Helping decision making for reliable and cost-effective 2b-RAD sequencing and genotyping analyses in non-model species.

High-throughput sequencing has revolutionized population and conservation genetics. RAD sequencing methods, such as 2b-RAD, can be used on species lacking a reference genome. However, transferring protocols across taxa can potentially lead to poor results. We tested two different IIB enzymes (AlfI and CspCI) on two species with different genome sizes (the loggerhead turtle Caretta caretta and the sharpsnout seabream Diplodus puntazzo) to build a set of guidelines to improve 2b-RAD protocols on non-model organisms while optimising costs. Good results were obtained even with degraded samples, showing the value of 2b-RAD in studies with poor DNA quality. However, library quality was found to be a critical parameter on the number of reads and loci obtained for genotyping. Resampling analyses with different number of reads per individual showed a trade-off between number of loci and number of reads per sample. The resulting accumulation curves can be used as a tool to calculate the number of sequences per individual needed to reach a mean depth ≥20 reads to acquire good genotyping results. Finally, we demonstrated that selective-base ligation does not affect genomic differentiation between individuals, indicating that this technique can be used in species with large genome sizes to adjust the number of loci to the study scope, to reduce sequencing costs and to maintain suitable sequencing depth for a reliable genotyping without compromising the results. Here, we provide a set of guidelines to improve 2b-RAD protocols on non-model organisms with different genome sizes, helping decision-making for a reliable and cost-effective genotyping.

Health polarization and inequalities across Europe: an empirical approach.

This paper examines inequality and polarization in self-assessed health, contributing towards the limited research existing on health economics. We use data from the European Health Interview Survey (EHIS) to investigate the relationship between health inequality and polarization across 27 European countries in two periods: 2006-2009 and 2013-2015. As our key variable is of an ordinal nature, we employ median based measures. Our empirical results suggest that Greece is the country with the highest level of health polarization in both periods, whereas Ireland has the lowest one when we consider countries where the median category is "very good", coinciding with the findings obtained in the inequality index. Estonia, Hungary and Lithuania have the highest degree of health polarization in both periods while Malta, The Netherlands and Spain are the countries with the lowest when we focus on those countries whose median category is "good" health.

Effect of copayment policies on initial medication non-adherence according to income: a population-based study.

OBJECTIVE: Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level. DESIGN: A population-based study was conducted using real-world evidence. SETTING: Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. PARTICIPANT: Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). OUTCOMES: IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups. RESULTS: Before changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners. CONCLUSION: Even nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions.

Socioeconomic status, health inequalities and non-communicable diseases: a systematic review.

AIM: A comprehensive approach to health highlights its close relationship with the social and economic conditions, physical environment and individual lifestyles. However, this relationship is not exempt from methodological problems that may bias the establishment of direct effects between the variables studied. Thus, further research is necessary to investigate the role of socioeconomic variables, their composition and distribution according to health status, particularly on non-communicable diseases. SUBJECTS AND METHODS: To shed light on this field, here a systematic review is performed using PubMed, the Cochrane Library and Web of Science. A 7-year retrospective horizon was considered until 21 July 2017. RESULTS: Twenty-six papers were obtained from the database search. Additionally, results from "hand searching" were also included, where a wider horizon was considered. Five of the 26 studies analyzed used aggregated data compared to 21 using individual data. Eleven considered income as a study variable, while 17 analyzed the effect of income inequality on health status (2 of the studies considered both the absolute level and distribution of income). The most used indicator of inequality in the literature was the Gini index. CONCLUSION: Although different types of analysis produce very different results concerning the role of health determinants, the general conclusion is that income distribution is related to health where it represents a measure of the differences in social class in the society. The effect of income inequality is to increase the gap between social classes or to widen differences in status.

Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain.

BACKGROUND: Initial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave. AIM: To estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups. DESIGN AND SETTING: A 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012. METHOD: Thirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre. RESULTS: Initially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term. CONCLUSION: Initial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.

Initial medication non-adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients.

AIMS: Adherence to medicines is vital in treating diseases. Initial medication non-adherence (IMNA) - defined as not obtaining a medication the first time it is prescribed - has been poorly explored. Previous studies show IMNA rates between 6 and 28% in primary care (PC). The aims of this study were to determine prevalence and predictive factors of IMNA in the most prescribed and expensive pharmacotherapeutic groups in the Catalan health system. METHODS: This is a retrospective, register-based cohort study which linked the Catalan PC System (Spain) prescription and invoicing databases. Medication was considered non-initiated when it was not collected from the pharmacy by the end of the month following the one in which it was prescribed. IMNA prevalence was calculated using July 2013-June 2014 prescription data. Predictive factors related to patients, general practitioners and PC centres were identified through multilevel logistic regression analyses. Missing data were attributed using simple imputation. RESULTS: Some 1.6 million patients with 2.9 million prescriptions were included in the study sample. Total IMNA prevalence was 17.6% of prescriptions. The highest IMNA rate was observed in anilides (22.6%) and the lowest in angiotensin-converting-enzyme (ACE) inhibitors (7.4%). Predictors of IMNA are younger age, American nationality, having a pain-related or mental disorder and being treated by a substitute/resident general practitioner in a resident-training centre. CONCLUSIONS: The rate of IMNA is high when all medications are taken into account. Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC.

[Outpatient treatment of uncomplicated acute diverticulitis: Impact on healthcare costs]. / Tratamiento ambulatorio de la diverticulitis aguda no complicada: impacto sobre los costes sanitarios.

BACKGROUND: Outpatient treatment of uncomplicated acute diverticulitis is safe and effective. The aim of this study was to determine the impact of outpatient treatment on the reduction of healthcare costs. PATIENTS AND METHODS: A retrospective cohort study comparing 2 groups was performed. In the outpatient treatment group, patients diagnosed with uncomplicated acute diverticulitis were treated with oral antibiotics at home. In the hospital treatment group, patients met the criteria for outpatient treatment but were admitted to hospital and received intravenous antibiotic therapy. Cost estimates have been made using the hospital cost accounting system based on total costs, the sum of all variable costs (direct costs) plus overhead expenses divided by activity (indirect costs). RESULTS: A total of 136 patients were included, 90 in the outpatient treatment group and 46 in the hospital group. There were no differences in the characteristics of the patients in both groups. There were also no differences in the treatment failure rate in both groups (5.5% vs. 4.3%; P=.7). The total cost per episode was significantly lower in the outpatient treatment group (882 ± 462 vs. 2.376 ± 830 euros; P=.0001). CONCLUSIONS: Outpatient treatment of acute diverticulitis is not only safe and effective but also reduces healthcare costs by more than 60%.

[Multimodal rehabilitation program in elective colorectal surgery: Impact on hospital costs]. / Impacto de un programa de rehabilitación multimodal en cirugía electiva colorrectal sobre los costes hospitalarios.

INTRODUCTION: Multimodal rehabilitation (MMRH) programs in surgery have proven to be beneficial in functional recovery of patients. The aim of this study is to evaluate the impact of a MMRH program on hospital costs. METHOD: A comparative study of 2 consecutive cohorts of patients undergoing elective colorectal surgery has been designed. In the first cohort, we analyzed 134 patients that received conventional perioperative care (control group). The second cohort included 231 patients treated with a multimodal rehabilitation protocol (fast-track group). Compliance with the protocol and functional recovery after fast-track surgery were analyzed. We compared postoperative complications, length of stay and readmission rates in both groups. The cost analysis was performed according to the system «full-costing¼. RESULTS: There were no differences in clinical features, type of surgical excision and surgical approach. No differences in overall morbidity and mortality rates were found. The mean length of hospital stay was 3 days shorter in the fast-track group. There were no differences in the 30-day readmission rates. The total cost per patient was significantly lower in the fast-track group (fast-track: 8.107 ± 4.117 euros vs. control: 9.019 ± 4.667 Euros; P=.02). The main factor contributing to the cost reduction was a decrease in hospitalization unit costs. CONCLUSION: The application of a multimodal rehabilitation protocol after elective colorectal surgery decreases not only the length of hospital stay but also the hospitalization costs without increasing postoperative morbidity or the percentage of readmissions.

Implementation of the European Marine Strategy Framework Directive: a methodological approach for the assessment of environmental status, from the Basque Country (Bay of Biscay).

The implementation of the Marine Strategy Framework Directive (MSFD) is directing European marine research towards the coordinated and integrated assessment of sea environmental status, following the ecosystem-based approach. The MSFD uses a set of 11 descriptors which, together, summarise the way in which the whole system functions. As such, the European Commission has proposed an extensive set of indicators, to assess environmental status. Hence, taking account of the large amount of data available for the Basque coast (southern Bay of Biscay), together with a recent proposal for assessment within the MSFD, an integrated environmental status assessment approach is developed (for the first time) in this contribution. The strengths and weaknesses of the method, combined with proposals from the MSFD, are discussed.

[Adapting health services to the specific needs and utilization patterns of the new Spaniards. 2008 SESPAS Report]. / Adaptación de los servicios de salud a las características específicas y de utilización de los nuevos españoles. Informe SESPAS 2008.

Because of the progressive increase in the number of immigrants and the uncertainty about the capacity of the Spanish health service to deal with the quantitative and qualitative increases in demand, the possibility of introducing changes to adapt our services to the new situation should be considered. Beginning with an analysis of the factors that influence health status and use of the health service, based on the National Health Survey (NHS), the European Statistics on Income and Living Conditions (EU-SILC) and the European Community Household Panel (ECHP), we compare the health profiles and patterns of medical resources utilization between the national and foreign populations. The pattern of demand for health services in the immigrant population corresponds basically to the needs of a young population in good health. According to NHS data, resource utilization among immigrants can even be lower than that among the national population. Assessing the link between health status and demand for healthcare from a dynamic point of view, by identifying variations in patterns of health and patterns of demand for healthcare, is important to identify imbalances in resources and to establish an appropriate hierarchy of preventive and treatment priorities.

[Endosonographic and manometric assessment of the internal anal sphincter in patients with chronic anal fissure]. / Estudio ecográfico y manométrico del esfínter anal interno en individuos con fisura anal crónica.

INTRODUCTION: High anal resting pressures have been implicated in the pathophysiology of chronic anal fissure. It is not known, however, whether altered function is associated with any morphological abnormalities of the internal anal sphincter (IAS). The aims of the present study were to determine IAS thickness in patients with chronic anal fissure and to investigate the correlation between IAS thickness and anal resting pressure. PATIENTS AND METHOD: Patients with chronic anal fissure were prospectively included between November 1999 and December 2002. Patients with a history of inflammatory bowel disease, anal surgery, and those previously treated with nitroglycerine ointment or botulinum toxin were excluded. Anal endosonography and manometry were performed. IAS thickness was considered to be increased when it was > 2.5 mm in patients < 50 years and > 3 mm in patients > or = 50 years. Anal resting pressure was considered to be increased when it was higher than 80 mmHg. RESULTS: Sixty-three patients were analyzed. An abnormally thick IAS was observed in 58 patients (92%). The mean IAS thickness was 3.7 +/- 0.7 mm. IAS hypertonia was found in 47 patients (66%). The mean anal resting pressure was 91 +/- 28 mmHg. No correlation was found between IAS thickness and anal resting pressure (r = 0.05; p < 0.68). CONCLUSIONS: Most of the patients with chronic anal fissure had an abnormally thick IAS. However, increased thickness of the IAS did not correlate with increased anal resting pressure.