Crisis económica, salud y bienestar en trabajadores con discapacidad / Economic downturn, health, and well-being in workers with disabilities

Este estudio tiene como objetivo analizar las consecuencias del deterioro de las condiciones de trabajo como resultado de la crisis o recesión económica sobre la salud, el bienestar, la percepción y las actitudes laborales en trabajadores con discapacidad. Para ello se utilizó una muestra de 31 trabajadores con discapacidad en empleo ordinario (no protegido) con medidas tomadas en 2013 y 2014. Tras identificar indicadores objetivos y valoraciones de expertos acerca de las condiciones de trabajo de estos trabajadores, se analizaron sus relaciones con las variables percepción de apoyo organizacional, apoyo de los supervisores y compañeros, satisfacción laboral, intención de abandono, estrés percibido, burnout y satisfacción vital. Los análisis, paramétricos y no paramétricos, señalan que estas variables son sensibles, con diferencias estadísticamente significativas, a las peores condiciones de trabajo percibidas en 2014 con respecto a 2013. Se discuten las consecuencias de estos resultados en relación con los efectos de la crisis económica en la calidad de vida laboral de las personas con discapacidad y en el incremento de la discriminación hacia ellas (AU)

This study's aim is to analyze the consequences of the deterioration of working conditions caused by the economic downturn on occupational health, well-being, perceptions, and job attitudes in workers with disabilities. A sample of 31 workers with disabilities in ordinary firms (i.e., not in protégé employment organizations) was used, with repeated measures being taken in 2013 and 2014. After identifying objective indicators and expert assessments of these workers’ working conditions, we tested these workers’ relationships with perceived organizational support, supervisors and coworker support, job satisfaction, intention to quit, perceived stress, burnout, and life satisfaction. Parametric and non-parametric analyses indicate that these variables are sensitive, with statistically significant differences, to the worse working conditions perceived in 2014 compared to 2013. The consequences of these results are discussed in relation to the effects of the economic downturn on the quality of working life of people with disabilities, and on the increase of discrimination towards them (AU)

Home health nursing care services in Greece during an economic crisis.

AIM: The purpose of this review was to describe public home healthcare nursing services in Greece. BACKGROUND: The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. SOURCES OF EVIDENCE: A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. RESULTS: The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. CONCLUSION: There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. IMPLICATIONS FOR NURSING AND HEALTH POLICY: At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided.

Factores condicionantes e impacto de la crisis económica sobre la salud mental de la población española / Determinants and impact of economic crisis on the mental health of population of Spain

OBJETIVOS. Los objetivos de este estudio son conocer la incidencia y el tipo de reacciones transfusionales en un hospital de tercer nivel, comprobar si existe algún protocolo que determine la actuación ante una transfusión y detectar cual es la reacción más frecuente en este ámbito. METODOLOGÍA. Es un estudio con un diseño cuantitativo, descriptivo, longitudinal y no experimental. La recogida de datos se hizo durante los meses de enero a diciembre del año 2013. El ámbito de estudio es el Hospital Universitari de Bellvitge. La población de estudio fueron los pacientes que recibieron una transfusión de cualquier componente sanguíneo. La muestra son los pacientes que han presentado una reacción transfusional. RESULTADOS. Los resultados obtenidos son: el sexo masculino fue el predominante, representando un 60 % del total de las reacciones transfusionales; la edad media de los pacientes que presentaron alguna reacción fue de 67.85 años, con una desviación estándar de 11.06 años. Se estudiaron 8090 pacientes que presentaron 20 reacciones transfusionales. Se observa un mayor porcentaje de reacciones transfusionales en pacientes transfundidos ocasionalmente (45 %). Las reacciones transfusionales más frecuentes fueron las febriles no hemolíticas, seguidas de las alérgicas, las cuales representan un 75 % del total de las reacciones recogidas. Según el tipo de reacción, los síntomas que se presentaron con mayor frecuencia fueron: fiebre (55 %), escalofríos (25 %), prurito (15 %), disnea (15 %). CONCLUSIÓN. Como conclusión, las reacciones más frecuentes en nuestro hospital son las reacciones febriles no hemolíticas. En el Hospital Universitari de Bellvitge existe un protocolo para el abordaje correcto del seguimiento completo de una transfusión y de la actuación que se ha de seguir ante una reacción transfusional (AU)

OBJECTIVES. The objectives of this study are to find out the incidence and the type of transfusional reactions in a tertiary level hospital, check for any protocol which determines the proceedings facing a blood transfusion and to detect which is the most common and frequent reaction in this area. METHODOLOGY. This is a study with quantitative, descriptive, longitudinal, non-experimental design. Data collection was done from January to December 2013. The scope of the study is the University Hospital of Bellvitge, the study population are the patients who received a transfusion of any blood component, and the sample is constituted by the patients who filed a transfusion reaction. RESULTS. The results obtained indicate that male sex was the predominant, accounting for 60% of all transfusion reactions; and the average age of patients who presented a reaction was 68 years. There was 8090 patients who presented 20 transfusion reactions were studied. It’s observed a larger percentage of transfusion reactions in patients transfused occasionally (45 %). The most frequent transfusion reactions were febrile nonhaemolytic reactions, followed by allergic reactions, representing 75 % of the registered reactions. Depending on the type of reaction, symptoms that occurred most frequently were fever (55 %), chills (25 %), pruritus (15 %), dyspnea (15 %). CONCLUSION. In conclusion, the most common reactions in a tertiary level hospital are non-haemolytic febrile reactions. At the University Hospital of Bellvitge there is a protocol for the correct approach of the full monitoring of a transfusion and the procedures to follow facing a transfusion reaction (AU)

The influence of the environmental management system on the environmental impact of seaport companies during an economic crisis: Lithuanian case study.

Freight handling in EU ports fell by more than 12 % during the global economic crisis in 2008-2009 after almost a decade of continuous growth. The decrease of freight handling in the Klaipeda seaport, the only port in Lithuania, was 6.7 % and happened due to the dominant outward movement of goods (mainly oil products). The Klaipeda seaport, due to its peculiarity, is the only ice-free port in the northern part of Baltic Sea. The present study explores the environmental impact of Klaipeda seaport activities from 2001 to 2011. Moreover, it compares the environmental effectiveness of environmental protection strategies used in the four biggest companies that, in fact, cover about 88 % of total activities (except general cargo) of the seaport. The first group of targeted companies used an environmental protection strategy to implement an ISO 14001-based environmental management system, and the second group selected to follow environmental management practices without certification. The paper analyses the development of the companies' activities in regard to the change of environmental effectiveness. The paper evaluates the pressure of the economic crisis on the companies' activities and its influence on environmental decisions, with particular interest in the ability of different environmental protection systems to resist and handle the expected performance. The study identified a significant decrease in companies' activities during the crisis period. However, the economic activities and environmental effectiveness demonstrated similar short-term tendencies in regard to the environmental strategy selection but differed in long-term perspective.

El derecho de acceso sanitario en el contexto del Real Decreto-ley 16/2012: la perspectiva de organizaciones de la sociedad civil y asociaciones profesionales / Right of access to healthcare in the context of the Royal Decree-Law 16/2012: the perspective of civil society organizations and professional associations

Objetivo. La publicación del Real Decreto-ley 16/2012 (RDL 16/2012), que introduce cambios estructurales en el Sistema Sanitario Público Español, puede situarse en el contexto más amplio de políticas de ajuste en el momento actual de crisis económica. En el análisis de la interrelación de crisis económica, políticas sanitarias y salud, la participación ciudadana se nombra entre las potenciales estrategias para mitigar un impacto de la situación en la población. Desde esta valoración, se plantea el interés de un conocimiento de la perspectiva de la ciudadanía sobre las modificaciones introducidas por el RDL 16/2012. Métodos. Revisión narrativa de publicaciones de organizaciones de la sociedad civil y asociaciones profesionales relacionadas con el RDL 16/2012 en el contexto español. Resultados. Se observa una amplia respuesta ciudadana a la introducción del RDL 16/2012. Los documentos revisados incluyen un análisis del cambio del modelo sanitario inherente al RDL 16/2012, así como la previsión de su impacto en el acceso sanitario, la calidad asistencial y la salud. Las organizaciones de la sociedad civil y las asociaciones profesionales aportan recomendaciones y propuestas, además de ofrecer su colaboración en la elaboración de estrategias alternativas de ahorro. Conclusiones. La respuesta al RDL 16/2012 por parte de organizaciones de la sociedad civil y asociaciones profesionales indica el interés de fomentar canales de participación ciudadana para el desarrollo de políticas sanitarias basadas en el objetivo de mantener el carácter universal y la sostenibilidad del Sistema Sanitario Público Español en el momento actual de crisis económica y sistémica (AU)

Objective. The recent publication of the Royal Decree-Law 16/2012 (RDL 16/2012), which introduces structural changes in the Spanish Public Healthcare System, can be placed in the broader context of budgetary adjustments in response to the current economic crisis. An analysis of the interrelationships among economic crisis, healthcare policies, and health reveals that citizen participation is one of several potential strategies for reducing the impact of this situation on the population. This observation raises the interest to know the citizens’ perspectives on the modifications introduced by the RDL 16/2012. Methods. Narrative review of documents related to the RDL 16/2012 published by civil society organizations and professional associations in the Spanish context. Results. A broad citizen response can be observed to the introduction of RDL 16/2012. The documents reviewed include an analysis of changes in the healthcare model inherent to the RDL 16/2012, as well as predictions on its impact on access to healthcare, healthcare quality, and health. The civil society organizations and professional associations offer recommendations and proposals, as well as collaboration in elaborating alternative strategies to reduce costs. Conclusions. The response of civil society organizations and professional associations underscores the importance of strengthening citizen participation in the development of healthcare policies aimed at maintaining the universal character and sustainability of the Spanish Public Healthcare System in the current moment of economic and systemic crisis (AU)

Greek's health, waiting for the 'deus ex machina'.

Greece from May 2010 has been following Troika's (European Commission, European Central Bank and International Monetary Fund) austere policies in all over the public finance sector. Troika's instructions which are adopted by the politicians resulted to depressed and weak citizens. The consequences in health care sector are becoming visible across the society. A big part of Greek's society is uninsured without any access to public health care system. The vulnerable social groups confront catastrophic health care expenditures and impoverishment with no social net protection. Greeks are paying the price of their irrational way of living. The current paper has gathered from the literature the early effects of the implementation of these policies on public health and healthcare.

Public procurement of health technologies in Greece in an era of economic crisis.

Public procurement is generally an important sector of the economy and, in most countries, is controlled by the introduction of regulatory and policy mechanisms. In the Greek healthcare sector, recent legislation redefined centralized procurement through the reestablishment of a state Health Procurement Committee (EPY), with an aim to formulate a plan to reduce procurement costs of medical devices and pharmaceuticals, improve payment time, make uniform medical requests, transfer redundant materials from one hospital to another and improve management of expired products. The efforts described in this paper began in early 2010, under the co-ordination of the Ministry of Health (MoH) and with the collaboration of senior staff from the International Monetary Fund (IMF), the European Commission (EC) and the European Central Bank (ECB). The procurement practices and policies set forth by EPY and the first measurable outcomes, in terms of cost savings, resulting from these policies are presented. The importance of these measures is discussed in light of the worst economic crisis faced by Greece since the restoration of democracy in 1974, as a result of both the world financial crisis and uncontrolled government spending.

COBRA ARRA subsidies: was the carrot enticing enough?

OBJECTIVE: To help preserve continuity of health insurance coverage during the recent recession, the American Recovery and Reinvestment Act provided a 65 percent Consolidated Omnibus Budget Reconciliation Act (COBRA) premium subsidy for workers laid off in 2008-2010. We examined COBRA enrollment levels with the subsidy and the health, access, and financial consequences of enrollment decisions. STUDY DESIGN/DATA COLLECTION: Telephone interviews linked with health system databases for 561 respondents who were laid off in 2009 and eligible for the COBRA subsidy (80 percent response rate). PRINCIPAL FINDINGS: Overall, 38 percent reported enrolling in COBRA and 54 percent reported having some gaps in insurance coverage since being laid off. After adjustments, we found that those who had higher cost-sharing, who had higher incomes, were older, or were sicker were more likely to enroll in COBRA. COBRA enrollees less frequently reported access problems or that their health suffered because of poor access, but they reported greater financial stress due to health care spending. CONCLUSION: Despite the substantial subsidy, a majority of eligible individuals did not enroll in COBRA, and many reported insurance coverage gaps. Nonenrollees reported more access problems and that their health worsened. Without a mandate, subsidies may need to be widely publicized and larger to encourage health insurance enrollment among individuals who suffer a negative income shock.

Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis.

The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes.

Economic recession and fertility in the developed world.

This article reviews research on the effects of economic recessions on fertility in the developed world. We study how economic downturns, as measured by various indicators, especially by declining GDP levels, falling consumer confidence, and rising unemployment, were found to affect fertility. We also discuss particular mechanisms through which the recession may have influenced fertility behavior, including the effects of economic uncertainty, falling income, changes in the housing market, and rising enrollment in higher education, and also factors that influence fertility indirectly such as declining marriage rates. Most studies find that fertility tends to be pro-cyclical and often rises and declines with the ups and downs of the business cycle. Usually, these aggregate effects are relatively small (typically, a few percentage points) and of short durations; in addition they often influence especially the timing of childbearing and in most cases do not leave an imprint on cohort fertility levels. Therefore, major long-term fertility shifts often continue seemingly uninterrupted during the recession­including the fertility declines before and during the Great Depression of the 1930s and before and during the oil shock crises of the 1970s. Changes in the opportunity costs of childbearing and fertility behavior during economic downturn vary by sex, age, social status, and number of children; childless young adults are usually most affected. Furthermore, various policies and institutions may modify or even reverse the relationship between recessions and fertility. The first evidence pertaining to the recent recession falls in line with these findings. In most countries, the recession has brought a decline in the number of births and fertility rates, often marking a sharp halt to the previous decade of rising fertility rates.

The Medicaid trap.

Even as the economy rebounds, unemployment remains high and tax revenues low. States face enormous deficits, and many could cut Medicaid reimbursements or levy fees on providers to help fund the program, typically among their largest budget items. If and how the federal government will help is unclear. "We're looking at tremendous pressure over the next two years, making institutional players, especially hospitals, very vulnerable," one expert warns.