Assessing the social impacts of the COVID-19 crisis using phone helplines. The case of the Balearic Islands, Spain.

Background: Crises and health policies to tackle them can increase health inequalities. We explored the scope and usefulness of helplines set up during the COVID-19 crisis and characterised the vulnerability of their users. This study explored the geographic and socioeconomic effects of the telephone helplines set up by the Balearic Islands Government and aimed to characterise the vulnerability of their users. Methods: Telephonic survey combined with a geographical analysis of a sample of calls made between 15th of March and 30th of June of 2020 to five helplines: COVID-19 general information; psychological, social (minimum vital income), labour (temporary employment regulation), and housing (rental assistance) helps. The questionnaire included sociodemographic and housing characteristics, type of problem, and if it was solved or not. We used multinomial regression to explore factors associated with having solved the problem. We calculated the standardised rate of calls by municipality using Chi-squared and z-test to test differences. Results: 1,321 interviews from 2,678 selected (231 excluded, 608 untraceable, and 518 refusals). 63.8% of women, 48.7% were born in another country. They had no internet at home in 3.1%, only on the phone in 17.3%. The 23.5% had no income at home. The Problem was solved in 25.4%, and partly in 30.9%. Factors associated with not solving the problem were not having income at home (p = 0.021), labour (p = 0.008), economic (p = 0.000) or housing (p = 0.000) problems. People from 55 of 67 municipalities did at least one call. The highest rates of calls were from coastal tourist municipalities. Conclusion: Helplines reached most of the territory of the Balearic Islands and were used mainly in tourist municipalities. It probably has not been helpful for families with more significant deprivation. Digital inequalities have emerged.

Vulnerabilidad sobrevenida. El impacto social de la Covid-19 / Successful vulnerability. The social impact of Covid-19

Las crisis sanitarias, así como las medidas adoptadas para hacerles frente, pueden aumentar las desigualdades. Este estudio quiere ahondar sobre el impacto social que ha tenido la crisis sanitaria de la COVID-19. Objetivos: 1. Identificar aquellas personas, grupos o familias más vulnerables y aquellas a las que les ha afectado especialmente la crisis del COVID-19; 2. Describir en profundidad la situación que han vivido y cómo la han afrontado; 3. Conocer qué dificultades han encontrado para solicitar las ayudas del Gobierno. Métodos: Estudio cualitativo que forma parte de un estudio más amplio cuantitativo, que combinó una encuesta telefónica con un estudio geográfico. Se entrevistaron 1.321 personas mediante un cuestionario semiestructurado con algunas preguntas abiertas, de las cuales se seleccionaron 243 para su análisis cualitativo. Se realizaron 8 entrevistas en profundidad. Resultados: El impacto de la pandemia se ha reflejado en forma de malestar psicológico. Algunas familias han tenido que cambiar de vivienda, comunidad autónoma e incluso volver a la vivienda de sus padres. Se han observado grandes dificultades para las familias con personas dependientes (mayores, con discapacidad, hijos e hijas); monoparentales; para familias cuyo sustento básico son pensiones no contributivas y para las personas solas. Los Servicios Sociales han sido un gran apoyo, aunque se ha percibido falta de coordinación entre estos y las diferentes instituciones. Conclusiones: Dadas las características de esta pandemia, algunos grupos no vulnerables se han encontrado con dificultades, no han podido hacer frente a la situación, y los que ya eran vulnerables han aumentado su vulnerabilidad. (AU)

Objectives: 1) To rank more vulnerable people, groups, or households in relation to how the COVID-19 crisis has affected them; 2) To describe the circumstances experienced during the COVID-19 crisis, the way to dealt with, and the success in handling them; 3) To identify the difficulties when applying for government aid. Methods: It was a qualitative study that was part of a broader quantitative study, combining a telephone survey with a geographical study. We phone surveyed 1321 persons using a semi-structured questionnaire with some open questions. From them, 243 we selected for qualitative analysis. Afterwards, we conducted eight in-depth interviews. Results: The COVID-19 crisis caused psychological discomfort. The drawback most frequently reported has been the need to move into worse homing conditions, which include moving to other neighbourhoods or regions, or sharing with relatives (typically, moving into parent’s home). The households more frequently reporting difficulties have been those with dependent persons (young children, elderly or disabled people), single-parents households, households receiving basic subsidy only, and singles living alone. In most cases, Social Services have helped to dealt with the effects of COVID -19 crisis. However, coordination between different institutions should be improved. Conclusions: Given the characteristics of this pandemic and the impossibility of anticipating it, people already socially vulnerable have encountered special difficulties in dealing with the COVID-19 crisis, have been unable to cope with them, and have worsened their degree of vulnerability. (AU)

Impacto de la drepanocitosis en las familias de los afectados. Estudio cualitativo sobre sus experiencias, percepciones y necesidades / Impact of sickle cell disease on the families of affected patients. Qualitative study of their experiences, perceptions and needs

Introducción: la drepanocitosis o enfermedad de células falciformes es una enfermedad genética que afecta mayoritariamente a población de origen africano. Requiere ingresos largos y repetidos, afectando a la calidad de vida. Si la situación socioeconómica es vulnerable, el efecto de la enfermedad en su vida se agrava. Este estudio pretende conocer las preocupaciones, creencias y necesidades de las familias de los menores afectados de drepanocitosis, los conocimientos previos sobre la enfermedad, las repercusiones psicosociales, la satisfacción con la asistencia sanitaria y el posible estigma que rodea esta enfermedad. Material y métodos: estudio cualitativo mediante entrevistas a familiares de los afectados Resultados: se realizaron 20 entrevistas. Se exploró la relación de las familias con la enfermedad, el entorno sociofamiliar, las preocupaciones, emociones y estrategias de afrontamiento, los recursos deseados y no deseados y la satisfacción con la atención recibida. Al analizarlas, destacó el impacto del diagnóstico, un buen conocimiento de los síntomas y tratamiento, y diferencias en el conocimiento de las causas de la enfermedad. El rol de cuidador está ligado al género femenino. La organización familiar y laboral es causa frecuente de estrés. Se detectan preocupaciones por la enfermedad y el día a día, emociones y sentimientos negativos y positivos, así como diferentes estrategias de afrontamiento. Expresan recursos deseados como ayudas por hijo/a enfermo/a. Valoran positivamente la atención sanitaria recibida. Conclusiones: las entrevistas en profundidad con las familias de las personas afectadas ayudan a conocer mejor su realidad y sus necesidades, mejorando así la atención a los menores con drepanocitosis (AU)

Introduction: sickle cell disease is a genetic disease that mainly affects the population of African ancestry. It requires repeated and protracted hospitalizations thereby impairing quality of life. The impact of the disease in life is worse in socially vulnerable individuals. This study aimed to establish the concerns, beliefs and needs of the families of children and adolescents affected by sickle cell disease, their knowledge of sickle cell disease, the psychosocial impact of the disease, the satisfaction with health care services and the potential stigma surrounding the disease.Material and methods: qualitative study through interviews with relatives of affected individuals.Results: we conducted 20 interviews. We explored how families dealt with the disease; the social and family environment; concerns, emotions, and coping strategies; which resources were wanted versus not, and the satisfaction with the care received. The most salient results of the analysis were the impact of the diagnosis, the good level of knowledge about the symptoms and treatment and differences in the knowledge about the causes of the disease. The caregiver role was associated with female sex. Organizing family life and work was a frequent source of stress. We identified concerns about the disease and everyday life, negative and positive emotions and feelings and different coping strategies. Participants expressed the resources they wished for, such as aid for the sick child. They expressed a positive perception of the care received.Conclusions: in-depth interviews with families of affected individuals help improve our understanding of their experiences and needs, and therefore also improve the care provided to paediatric patients with sickle cell disease. (AU)

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case-control studies.

OBJECTIVE: Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. DESIGN: Two case-control studies. SETTING: Performed in primary care of five Spanish regions. SUBJECTS: In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. MAIN OUTCOME MEASURES: Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. RESULTS: The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). CONCLUSIONS: Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.

Habitos de alimentación y actividad física en un instituto de Educación Secundaria secundaria de Baleares / Dietary habits and physical activity in a secondary school in the balearic islands

Objetivo Evaluar los cambios en los hábitos de alimentación y actividad física así como la prevalencia de obesidad y sobrepeso que se han producido en una cohorte de alumnos entre 1° y 4° de secundaria tras una intervención no estructurada de educación para la salud. Método Estudio descriptivo longitudinal. Se recogieron variables antropométricas y de hábitos de alimentación, ocio y actividad física a los alumnos de 1° de ESO (n=61) y se midieron de nuevo cuando cursaban 4° de ESO. Se realizo un analisis apareado de los datos mediante el test Mc Nemar-Bowker. Durante el periodo de estudio se realizaron sesiones educativas sobre alimentación saludable y actividad física. Resultados La prevalencia de sobrepeso ha mejorado significativamente (de 14,8% a 3,7%) y se ha incrementado el nivel de actividad física. No se han detectado cambios en la calidad del desayuno ni en la calidad de la dieta mediterránea. Conclusiones Algunos de los aspectos estudiados han mejorado sin poderse atribuir esa mejora a las sesiones educativas realizadas. Conocer y analizar los hábitos de vida saludable de los adolescentes permitirá planificar intervenciones realistas, adaptadas al entorno concreto, estructuradas y continuadas en el tiempo, que aborden las áreas de conocimientos, habilidades y emociones y que vayan dirigidas no sólo a los jóvenes sino también a sus familias, al entorno interno del centro educativo y a la coordinación de los recursos comunitarios que permita un abordaje coordinado (AU)

Objective To evaluate the changes in dietary habits and physical activity, as well as the prevalence of obesity and overweight that have occurred in a cohort of 1st and 4th year secondary school pupils after non-structured health education activities. Method A descriptive, longitudinal study, in which anthropometric variables, dietary habits, leisure and physical activity were collected in the 1st year secondary school pupils (n=61), and they were measured again when they were in the 4th year. The differences between the two school years were analysed using the Mc Nemar-Bowker Test. During the period of the study educational sessions were given on healthy eating and physical activity. Results The prevalence of overweight decreased significantly (from 14.8% to 3.7%) and the level of physical activity has increased. No statistical differences were detected in the quality of breakfast or in the quality of the Mediterranean diet. Conclusions Some of the aspects studied have improved without being able to attribute this improvement to the educational sessions given. To determine and analyse the healthy living habits of adolescents would enable us to plan realistic interventions, adapted to the particular environment. They should be structured and continuous over time and approach areas of knowledge, skills and emotions, and directed, not only at the young people, but also their families, the internal environment of the educational centre. There should be coordination of community resources in order to make a coordinated approach (AU)

Observational study on factors related to health-promoting community activity development in primary care (frAC Project): a study protocol.

INTRODUCTION: According to Spanish health regulations, primary care professionals have the responsibility to carry out health-promoting community activities (CAs). However, in practice, their implementation is not as widespread as it should be. The aims of this study were to identify factors within the team, the community and the professionals that influence the development of these activities and to describe the community interventions in progress. METHODS AND ANALYSIS: This study is an observational analytical retrospective study. The information will be collected from five Spanish regions: Catalonia, Madrid, the Balearic Islands, Navarra and Aragón. The authors will contact primary care teams (PCTs) and identify the CAs from the previous year. The research team will conduct a peer review whether the inclusion criteria are met. In the health centres where CAs are implemented, the authors will select professionals carrying them out and randomly select an identical number of professionals not doing these activities. In the centres where no CA is implemented, three professionals will be randomly selected. The selected professionals will complete the questionnaires for individual-level variables. Information about the registered population and the PCTs will be collected through questionnaires and secondary sources. OUTCOMES: Variables will be collected from the community, the PCTs, the individual professionals and CAs. ANALYSIS: A descriptive analysis of all the variables will be carried out, along with a bivariate and a logistic regression analysis, with CAs being the primary outcome. ETHICS AND DISSEMINATION: This study has been approved by the Research Ethics Committee of the Jordi Gol y Gurina Foundation in Barcelona and area 11 in Madrid. The questionnaire distributed to the professionals will be anonymous.

[Dietary habits and physical activity in a secondary school in the Balearic islands]. / Habitos de alimentación y actividad física en un instituto de Educación Secundaria secundaria de Baleares.

OBJECTIVE: To evaluate the changes in dietary habits and physical activity, as well as the prevalence of obesity and overweight that have occurred in a cohort of 1st and 4th year secondary school pupils after non-structured health education activities. METHOD: A descriptive, longitudinal study, in which anthropometric variables, dietary habits, leisure and physical activity were collected in the 1st year secondary school pupils (n=61), and they were measured again when they were in the 4th year. The differences between the two school years were analysed using the Mc Nemar-Bowker Test. During the period of the study educational sessions were given on healthy eating and physical activity. RESULTS: The prevalence of overweight decreased significantly (from 14.8% to 3.7%) and the level of physical activity has increased. No statistical differences were detected in the quality of breakfast or in the quality of the Mediterranean diet. CONCLUSIONS: Some of the aspects studied have improved without being able to attribute this improvement to the educational sessions given. To determine and analyse the healthy living habits of adolescents would enable us to plan realistic interventions, adapted to the particular environment. They should be structured and continuous over time and approach areas of knowledge, skills and emotions, and directed, not only at the young people, but also their families, the internal environment of the educational centre. There should be coordination of community resources in order to make a coordinated approach.