Desigualdades en la salud autopercibida de la población española mayor de 65 años / Health inequalities in self-perceived health among older adults in Spain

Objetivo. Recientes publicaciones han concluido que existen desigualdades sociales en salud en las personas mayores de 65 años en España, que afectan principalmente a mujeres y personas con bajo nivel socioeconómico. La salud autopercibida se ha relacionado con la prevalencia de enfermedades crónicas, la utilización de los servicios sanitarios y la mortalidad. El objetivo de este trabajo es valorar las desigualdades en la salud autopercibida de los mayores en relación con la edad, el género, los factores socioeconómicos y el nivel de dependencia. Métodos. Se diseñó una revisión sistemática de la literatura siguiendo los criterios PRISMA. Se realizó una búsqueda exhaustiva en PubMed, WOK, Science Direct, EMBASE, IME, Cochrane, JSTOR, Ovid, Proquest y BMJ Group, y en bases electrónicas de tesis doctorales españolas hasta abril de 2013. La calidad de los estudios se evaluó por dos revisores de forma independiente mediante el instrumento desarrollado por Berra. Resultados. Se seleccionaron 20 documentos concordantes en señalar el empeoramiento de la salud autopercibida en los individuos de mayor edad (excepto en los más longevos), en los que tienen dependencia funcional, pertenecen a un nivel socioeconómico bajo y al género femenino. Conclusiones. Esta revisión muestra que entre las personas mayores persiste la desigualdad de género y de nivel socioeconómico con respecto a la salud autopercibida. Son necesarios futuros estudios para aclarar los factores que hacen que persistan las desigualdades en los mayores, y así poder diseñar políticas de salud específicas para este sector de la población (AU)

Objective. Recent publications have concluded that there are social health inequalities in people older than 65 years in Spain, especially among women and people with low socioeconomic status. Self-perceived health is an indicator that is related to the possibility of chronic disease, the use of health services, and mortality. The aim of this study was to assess inequalities in self-perceived health in relation to age, gender, socioeconomic factors, and functional dependence. Methods. A systematic review was conducted following the PRISMA criteria. An exhaustive search was performed in PubMed, WOK, Science Direct, EMBASE, IME, Cochrane, JSTOR, Ovid, Proquest, the BMJ Group and in Spanish doctoral theses up to April 2013. The quality of the studies was assessed by two independent editors through the Berra Tool. Results. A total of 20 documents were selected. These studies were in agreement in the deterioration of self-perceived health among older people (except the oldest), in those with functional dependence, lower socioeconomic status, and in women. Conclusions. This review shows that, among older people, inequalities in self-perceived health due to socioeconomic status and gender have persisted in time. Future research is needed to cast light on the factors determining the persistence of these inequalities among older people, so that specific health policies can be designed for this sector of the population (AU)

[Health inequalities in self-perceived health among older adults in Spain]. / Desigualdades en la salud autopercibida de la población española mayor de 65 años.

OBJECTIVE: Recent publications have concluded that there are social health inequalities in people older than 65 years in Spain, especially among women and people with low socioeconomic status. Self-perceived health is an indicator that is related to the possibility of chronic disease, the use of health services, and mortality. The aim of this study was to assess inequalities in self-perceived health in relation to age, gender, socioeconomic factors, and functional dependence. METHODS: A systematic review was conducted following the PRISMA criteria. An exhaustive search was performed in PubMed, WOK, Science Direct, EMBASE, IME, Cochrane, JSTOR, Ovid, Proquest, the BMJ Group and in Spanish doctoral theses up to April 2013. The quality of the studies was assessed by two independent editors through the Berra Tool. RESULTS: A total of 20 documents were selected. These studies were in agreement in the deterioration of self-perceived health among older people (except the oldest), in those with functional dependence, lower socioeconomic status, and in women. CONCLUSIONS: This review shows that, among older people, inequalities in self-perceived health due to socioeconomic status and gender have persisted in time. Future research is needed to cast light on the factors determining the persistence of these inequalities among older people, so that specific health policies can be designed for this sector of the population.

Estudio de macrocitosis sin anemia en una población urbana / Macrocytosis without anaemia in an urban population

Objetivo: Describir las situaciones relacionadas con la macrocitosis sin anemia en nuestrapoblación, entendida esta como un volumen corpuscular medio (VCM) mayor o igual a 97 fl ycifras de hemoglobina dentro de los límites normales poblacionales. Si descartadas las principalescausas recogidas en la literatura médica no existe justificación clara para esta macrocitosis,debe realizarse un test del aliento para valorar la posible asociación del aumento del VCM conla presencia de infección por Helicobacter pylori.Dise˜no: Transversal y descriptivo.Emplazamiento: Atención primaria.Mediciones principales: Las variables medidas fueron datos de filiación, antecedentes personalesy analíticos relacionados con la macrocitosis, consumo de tóxicos y fármacos. Todos estosdatos se recogieron de la historia clínica.Resultados: La prevalencia de macrocitosis sin anemia en la población de estudio fue de un7,12% (1.403/19.710). La principal causa que se encontró fue el hipotiroidismo en 37/234pacientes (15,8%), seguido del consumo elevado de alcohol en 34/234 pacientes (14,5%). Laasociación que se dio con mayor frecuencia fue la de consumo de alcohol y tabaco en 9/234pacientes (3,8%). En 87/234 pacientes (37,18%) no se halló causa conocida aparente de elevacióndel VCM. Se realizó el test del aliento a 37 pacientes y fue positivo en 23 pacientes(AU)

Conclusiones: La macrocitosis sin anemia es un hallazgo de alta prevalencia en nuestro medio.El hipotiroidismo es la causa que se encuentra en primer lugar, por delante del alcohol, causaprincipal en la literatura médica consultada, pero también es frecuente que exista más deuna causa por paciente que pueda justificar este hallazgo. Hoy en día, el H. pylori parecerelacionado con diversas enfermedades, digestivas o no, y puede ser causa de VCM elevado sinanemia. Sin embargo, en nuestro estudio no podemos concluir este hallazgo, pero podemosconfirmar la elevada prevalencia de H. pylori en nuestro medio(AU)

Objective: Observational study on a group of patients with macrocytosis without anaemia. Theprobable relationship of cause and effect between Helicobacter pylori and macrocytosis.Methods and material: An observational and cross-sectional study.Main measurements: The measured variables were: personal data, medical and analytical historyin relation to macrocytosis, alcohol and smoking habitss and drug use. This informationwas taken from the medical history of the patient.Results: The prevalence of macrocytosis without anaemia was 7.12%. The main cause found washyphothyroidism in 37/234 (15.8%) patients, followed by alcoholism in 34/234 (14.5%) patients.The most frequent association was alcohol and tobacco in 9/234 (3.8%) patients. It was notpossible to find a cause of the increased mean corpuscular volume (MCV) in 87/234 (37.18%)patients. Out of 37 tests conducted for Helicobacter pylori, 23 of them were positive.Discussion: Macrocytosis without anaemia has a high prevalence. Finding the most frequent causescould help in the early diagnosis and treatment. H. pylori currently appears to be associatedto different digestive tract and non-digestive tract diseases.It could be a cause of increasedMCV, but this study was unable demonstrate this(AU)

[Macrocytosis without anaemia in an urban population]. / Estudio de macrocitosis sin anemia en una población urbana.

OBJECTIVE: Observational study on a group of patients with macrocytosis without anaemia. The probable relationship of cause and effect between Helicobacter pylori and macrocytosis. METHODS AND MATERIAL: An observational and cross-sectional study. MAIN MEASUREMENTS: The measured variables were: personal data, medical and analytical history in relation to macrocytosis, alcohol and smoking habits and drug use. This information was taken from the medical history of the patient. RESULTS: The prevalence of macrocytosis without anaemia was 7.12%. The main cause found was hypothyroidism in 37/234 (15.8%) patients, followed by alcoholism in 34/234 (14.5%) patients. The most frequent association was alcohol and tobacco in 9/234 (3.8%) patients. It was not possible to find a cause of the increased mean corpuscular volume (MCV) in 87/234 (37.18%) patients. Out of 37 tests conducted for Helicobacter pylori, 23 of them were positive. DISCUSSION: Macrocytosis without anaemia has a high prevalence. Finding the most frequent causes could help in the early diagnosis and treatment. H. pylori currently appears to be associated to different digestive tract and non-digestive tract diseases.It could be a cause of increased MCV, but this study was unable demonstrate this.