Risk of dependence associated with health, social support, and lifestyle.

OBJECTIVE To analyze the prevalence of individuals at risk of dependence and its associated factors. METHODS The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered. RESULTS We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women. CONCLUSIONS Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.

Risk of dependence associated with health, social support, and lifestyle / Riesgo de dependencia asociado a la salud, el apoyo social y el estilo de vida

OBJECTIVE To analyze the prevalence of individuals at risk of dependence and its associated factors.METHODS The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered.RESULTS We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women.CONCLUSIONS Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.

OBJETIVO Analizar la prevalencia de personas en riesgo de dependencia y los factores asociados.MÉTODOS El estudio se basó en datos de la Encuesta de Salud de Cataluña, España, realizada de 2010 a 2011. A partir de una muestra aleatoria de 3.842 individuos, de 15 años o más, se llevaron a cabo modelos de regresión logística para clasificar a los individuos según el estado de su autonomía personal. Se plantearon modelos predictivos para identificar las variables susceptibles de intervención que permitieran distinguir a los individuos dependientes de aquellos en riesgo. Se consideraron variables acerca del estado de salud, apoyo social y estilos de vida.RESULTADOS El 18,6% de la población presentó riesgo de dependencia, con efecto más acusado a partir de los 65 años. En comparación con este colectivo, los individuos que se declararon dependientes (11,0%) manifestaron problemas para realizar las actividades cotidianas y obtuvieron apoyo para ello. Estilos de vida, como fumar, consumir alcohol en exceso y ser sedentario se asociaron con mayor probabilidad de dependencia, en particular para las mujeres.CONCLUSIONES Las dificultades para llevar a cabo las actividades cotidianas preceden a la aparición de dependencia. Preservar la propia autonomía y desenvolverse sin recibir apoyo aparecen como factores protectores. La adopción de un estilo de vida activo y saludable contribuye a reducir el riesgo de dependencia.

The Spanish version of the Warwick-Edinburgh mental well-being scale (WEMWBS) is valid for use in the general population.

PURPOSE: Mental well-being has aroused interest in Europe as an indicator of population health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed in the United Kingdom showing good face validity and has been previously adapted into Spanish. The aim of this study is to assess the validity and reliability of the Spanish version of WEMWBS in the general population. METHODS: Cross-sectional home face-to-face interview survey with computer-assisted personal interviewing was administered with the 2011 Catalan Health Interview Survey Wave 3, which is representative of the non-institutionalized general population of Catalonia, Spain. A total of 1,900 participants 15+ years of age were interviewed. The Spanish version of WEMWBS was administered together with socioeconomic and health-related variables, with a hypothesized level of association. RESULTS: Similar to the original, confirmatory factor analysis fits a one-factor model adequately (CFI = 0.974; TLI = 0.970; RMSEA = 0.059; χ (2) = 584.82; df = 77; p < .001) and has a high internal consistency (Cronbach's alpha = 0.930; Guttman's lambda 2 = 0.932). The WEMWBS discriminated between population groups in all health-related and socioeconomic variables, except in gender (p = 0.119), with a magnitude similar to that hypothesized. Overall, mental well-being was higher for the general population of Catalonia (average and whole distribution) than that for Scotland general population. CONCLUSIONS: The Spanish version of WEMWBS showed good psychometric properties similar to the UK original scale. Whether better mental well-being in Catalonia is due to methodological or substantive cultural, social, or environmental factors should be further researched.

Normas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de Cataluña / Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population

Fundamento y objetivo: El cuestionario de salud SF-12 es una versión reducida del SF-36. La estrategia principal de interpretación de estos cuestionarios de calidad de vida relacionada con la salud (CVRS) es la utilización de normas poblacionales. Este estudio pretende obtener las normas de referencia para la versión española del SF-12 versión 2 (SF-12v2), evaluar su validez de constructo y comparar los métodos de puntuación estándar y específico. Sujetos y método: Se analizó una submuestra de la Encuesta de Salud de Cataluña (n=4.261), representativa de la población general no institucionalizada. Se calculó la media y percentiles para las 8 dimensiones y los componentes sumarios, estratificando por sexo y edad. La validez de constructo se evaluó mediante la comparación de grupos conocidos aplicando la prueba de ANOVA. Resultados: Los resultados apoyaron las hipótesis establecidas a priori para los grupos conocidos (p<0,001): peor salud física en las personas con problemas de movilidad (EQ-5D) (37,8 frente a 52), con mayor restricción en actividades (41,8 frente a 51,2) y con mayor número de trastornos crónicos (43,2 frente a 53,9); y peor salud mental en las personas con problemas de ansiedad/depresión (EQ-5D) (42,2 frente a 51,9). Las puntuaciones obtenidas con ambos métodos de puntuación fueron similares, excepto en Salud General y Vitalidad. Conclusiones: El SF-12v2 es un instrumento válido para medir CVRS en nuestro entorno. Las normas obtenidas facilitan la interpretación de sus puntuaciones en la práctica clínica, la investigación y la gestión sanitaria. Se recomienda el método específico para comparaciones de CVRS a nivel nacional y el estándar para las internacionales (AU)

Background and objective: The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. Subjects and methods: We analyzed a subsample of the Catalan Health Interview Survey (n = 4,261),representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. Results: The results for the known groups analysis supported the hypothesis established a priori(P < .001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9);and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scoresobtained by the 2 different methods of calculation were similar, except for General Health and Vitality. Conclusions: The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison (AU)

Importancia de los problemas reumáticos en la población de Cataluña: prevalencia y repercusión en la salud percibida, restricción de actividades y utilización de recursos sanitarios / Importance of chronic musculoskeletal problems in the population of Catalonia (Spain): prevalence and effect on self-perceived health, activity restriction and use of health services

Objetivo Conocer la importancia de las enfermedades reumáticas en la población adulta de Cataluña y su repercusión en la salud autopercibida, la restricción de actividades y el uso de servicios sanitarios. Métodos Encuesta poblacional a 15.926 adultos. Muestreo estratificado polietápico. Variables recogidas: características sociodemográficas, problemas de salud, salud autopercibida, restricción de actividades y uso de recursos sanitarios. Los problemas musculoesqueléticos se clasificaron en cuatro categorías: artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis. Resultados El 77,4% declara problemas crónicos de salud. La dorsalgia-lumbalgia, la cervicalgia crónica y el grupo artrosis-artritis o reumatismo, por este orden, son los más frecuentemente declarados. Tras ajustar por la edad, el sexo femenino incrementa el riesgo de declarar artrosis-artritis o reumatismo, dorsalgia-lumbalgia crónica, cervicalgia crónica y osteoporosis (odds ratio [OR]=2,6, 1,5, 2,3 y 5,3, respectivamente). La prevalencia es más alta en los grupos de mayor edad con gradiente social. Tras ajustar por edad, sexo, clase social y obesidad, la percepción de la salud es peor en las personas afectadas (42,7% frente a 11%), que también declaran una mayor restricción de la actividad en el último año y en los últimos 15 días (OR=2,70 y 2,32, respectivamente), y un uso de los servicios sanitarios significativamente superior. Conclusiones Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor en las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios (AU)

Objective To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services. Methods A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis. Results Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services. Conclusiones Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios (AU)

[Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population]. / Normas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de Cataluña.

BACKGROUND AND OBJECTIVE: The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. SUBJECTS AND METHODS: We analyzed a subsample of the Catalan Health Interview Survey (n=4,261), representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. RESULTS: The results for the known groups analysis supported the hypothesis established a priori (P<.001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9); and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scores obtained by the 2 different methods of calculation were similar, except for General Health and Vitality. CONCLUSIONS: The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison.

[Importance of chronic musculoskeletal problems in the population of Catalonia (Spain): prevalence and effect on self-perceived health, activity restriction and use of health services]. / Importancia de los problemas reumáticos en la población de Cataluña: prevalencia y repercusión en la salud percibida, restricción de actividades y utilización de recursos sanitarios.

OBJECTIVE: To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services. METHODS: A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis. RESULTS: Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services. CONCLUSIONS: Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios.

Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey.

PURPOSE: To compare the EQ-5D, SF-6D, and SF-12 in terms of their capacity to discriminate between groups defined by relevant socio-demographic and health characteristics in a general population survey. METHODS: Data were obtained from the 2006 Catalan Health Interview Survey, a representative sample (n = 4,319) of the general population of Catalonia (Spain). Effect sizes (ES) and Receiver Operating Characteristic (ROC) curves were calculated to evaluate the instruments' capacity to distinguish between groups based on socio-demographic variables, recent health problems, perceived health, psychological distress, and selected chronic conditions. RESULTS: All instruments showed a similar discriminative capacity between groups based on socio-demographic variables, recent medical visit (ES = 0.47-0.55), activity limitations (ES = 0.92-0.98), perceived health (ES = 0.97-1.33), and psychological well-being (ES = 1.17-1.57). Effect sizes between respondents with and without any of fourteen selected chronic conditions were large (0.76-1.04) for 4, moderate (0.55-0.74) for 8, and small (0.17-0.39) for two on the EQ-5D index. A similar pattern was observed for the SF-12 but ES were predominantly moderate (7 conditions) or small (6 conditions) on the SF-6D. CONCLUSIONS: The EQ-5D and SF-12 were largely comparable in estimating the health burden of chronic conditions, recent health problems, and social inequalities. The SF-6D was less sensitive than the EQ-5D index and SF-12, particularly for physical chronic conditions.

Análisis del desempeño de los servicios sanitarios de Cataluña: evaluación de los primeros resultados del proyecto demostrativo / Performance assessment of health services in Catalonia (Spain): Evaluation of initial results of the Catalan healthcare service project

La medida del desempeño de los servicios sanitarios está recibiendo una mayor atención debido al aumento del gasto sanitario y de las expectativas de la población, y a la necesidad de obtener el máximo rendimiento de los recursos invertidos. En Cataluña, en el año 2005, aprovechando la experiencia previa de la Agència de Salut Pública de Barcelona y del Consorci Sanitari de Barcelona comparando los servicios sanitarios de Barcelona y Montreal, una beca de investigación de la Agència d’Avaluació de Tecnologia i Recerca Mèdiques, y el interés de planificación sanitaria del Departament de Salut, se puso en marcha el proyecto de análisis del desempeño de los servicios sanitarios de Cataluña. El objetivo de este artículo es presentar el desarrollo del proyecto, mostrar algunos ejemplos que ilustran el tipo de información que se ha podido obtener y el tipo de análisis que esta información permite, exponer posibles explicaciones de los resultados presentados y discutir algunas limitaciones e implicaciones. De hecho, el valor añadido de este proyecto es que permite conocer el desempeño del sistema sanitario en la consecución de sus objetivos, establecer un conjunto de indicadores homogeneizados de referencia y ser una pieza clave en el desarrollo de la Central de Resultats del Departament de Salut de la Generalitat de Catalunya (AU)

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d’Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005.This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya(AU)

[Performance assessment of health services in Catalonia (Spain): evaluation of initial results of the Catalan healthcare service project]. / Análisis del desempeño de los servicios sanitarios de Cataluña: evaluación de los primeros resultados del proyecto demostrativo.

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d'Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005. This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya.

Estrategia «Salud en los barrios»: actuaciones focalizadas en territorios de especial necesidad social y de salud / The ''neighbourhood health'' strategy: actions focused on areas with special social and health needs

Con la Ley 2/2004 de mejora de barrios, áreas urbanas y villas que requieren atención especial, el Gobierno de Cataluña creó un fondo de financiación de proyectos de mejora integral de barrios, elaborados por los ayuntamientos. El Departamento de Salud se sumó a la estrategia mediante el programa «Salud en los barrios», que es una prioridad de política sanitaria. Estructuras de salud y municipales cooperan a nivel del barrio en todas las fases de un proyecto de intervención comunitaria (análisis y detección de necesidades, priorización de los problemas detectados, definición y reparto de actuaciones). Se utilizan técnicas como el grupo nominal. Se han identificado cuatro colectivos vulnerables con mayor carga de enfermedad, comorbilidad, situaciones de riesgo, etc. (menores, gente de edad avanzada, mujeres y población de reciente inmigración). Posteriormente, se intensifican y priorizan las actuaciones de todos los agentes implicados, entre ellas las propias del Departament de Salut y se desarrolla una cartera de servicios de salud pública específica

Through the Law 2/2004 on improving neighbourhoods, urban areas and towns requiring special attention, the Government of Catalonia set up a fund for financing projects prepared by town/city councils for theintegral improvement of neighbourhoods. The Ministry of Health signed on to the strategy with “The Neighbourhood Health Programme”, which was a healthcare policy priority. Healthcare and municipal structurescooperate at neighbourhood level in all of the phases of the community intervention project (analysis and detection of needs, prioritisation of the problems detected, definition and distribution of actions). Techniques such as the nominal group are used. Four vulnerable groups have been identified with higher levels of illness, co-morbidity, situations ofrisk, etc. (the young, the elderly, women and recent immigrants). The actions of all the agents involved, among them those from the Ministry of Health itself, are then intensified and prioritised and a specific portfolioof public health services is prepared

Dissemination of periodic mammography and patterns of use, by birth cohort, in Catalonia (Spain).

BACKGROUND: In Catalonia (Spain) breast cancer mortality has declined since the beginning of the 1990 s. The dissemination of early detection by mammography and the introduction of adjuvant treatments are among the possible causes of this decrease, and both were almost coincident in time. Thus, understanding how these procedures were incorporated into use in the general population and in women diagnosed with breast cancer is very important for assessing their contribution to the reduction in breast cancer mortality. In this work we have modeled the dissemination of periodic mammography and described repeat mammography behavior in Catalonia from 1975 to 2006. METHODS: Cross-sectional data from three Catalan Health Surveys for the calendar years 1994, 2002 and 2006 was used. The dissemination of mammography by birth cohort was modeled using a mixed effects model and repeat mammography behavior was described by age and survey year. RESULTS: For women born from 1938 to 1952, mammography clearly had a period effect, meaning that they started to have periodic mammograms at the same calendar years but at different ages. The age at which approximately 50% of the women were receiving periodic mammograms went from 57.8 years of age for women born in 1938-1942 to 37.3 years of age for women born in 1963-1967. Women in all age groups experienced an increase in periodic mammography use over time, although women in the 50-69 age group have experienced the highest increase. Currently, the target population of the Catalan Breast Cancer Screening Program, 50-69 years of age, is the group that self-reports the highest utilization of periodic mammograms, followed by the 40-49 age group. A higher proportion of women of all age groups have annual mammograms rather than biennial or irregular ones. CONCLUSION: Mammography in Catalonia became more widely implemented during the 1990 s. We estimated when cohorts initiated periodic mammograms and how frequently women are receiving them. These two pieces of information will be entered into a cost-effectiveness model of early detection in Catalonia.

[The ''neighbourhood health'' strategy: actions focused on areas with special social and health needs]. / Estrategia "Salud en los barrios": actuaciones focalizadas en territorios de especial necesidad social y de salud.

Through the Law 2/2004 on improving neighbourhoods, urban areas and towns requiring special attention, the Government of Catalonia set up a fund for financing projects prepared by town/city councils for the integral improvement of neighbourhoods. The Ministry of Health signed on to the strategy with The Neighbourhood Health Programme, which was a healthcare policy priority. Healthcare and municipal structures cooperate at neighbourhood level in all of the phases of the community intervention project (analysis and detection of needs, prioritisation of the problems detected, definition and distribution of actions). Techniques such as the nominal group are used. Four vulnerable groups have been identified with higher levels of illness, co-morbidity, situations of risk, etc. (the young, the elderly, women and recent immigrants). The actions of all the agents involved, among them those from the Ministry of Health itself, are then intensified and prioritised and a specific portfolio of public health services is prepared.

[Public healthcare coverage versus double healthcare coverage: what are the differences?]. / Población con cobertura pública o doble cobertura de aseguramiento sanitario. Cuál es la diferencia?

OBJECTIVE: To identify differences in socioeconomic characteristics, health status, health services' utilization, and satisfaction with health services between the population with public healthcare coverage only and the population with double healthcare coverage through additional affiliation to mutual or private health insurance companies. METHODS: Data from the 2002 Catalan Health Interview Survey with interviews to 8,400 individuals were used. Individuals with public healthcare insurance were differentiated from those who also had private health insurance. Multivariate logistic regression analysis was used. RESULTS: A total of 99.2% of the population reported public healthcare coverage and 24.7% also had voluntary mutual or private insurance. Individuals with double coverage were younger, had a high level of education, belonged to advantaged classes, and reported better self-perceived health and fewer chronic diseases and disabilities. No significant differences in the percentage of individuals who reported visiting a health professional in the previous 15 days were observed. Significant differences in the type of professional visited were observed: 65% of individuals with public healthcare coverage only visited primary care settings but 51.1% of those with double coverage visited specialists. The proportion of persons reporting that they were satisfied or very satisfied with professional attitudes, waiting times and administrative procedures was higher in the double coverage group. CONCLUSIONS: Distinct sociodemographic and health profiles were found between persons with public coverage only and those with double coverage. Health services' utilization also differed between the two groups.

Población con cobertura pública o doble cobertura de aseguramiento sanitario. ¿Cuál es la diferencia? / Public healthcare coverage versus double healthcare coverage: what are the differences?

Objetivo: Conocer las diferencias en las características socioeconómicas, el estado de salud, la utilización de servicios y la satisfacción con éstos entre la población catalana que dispone únicamente de aseguramiento sanitario público y la que tiene doble cobertura de aseguramiento. Métodos: Datos de la Encuesta de Salud de Cataluña 2002 con entrevista a 8.400 personas. Entre los individuos que tenían cobertura pública de servicios sanitarios, se han diferenciado los que también tenían cobertura por entidades de aseguramiento libre. Se aplica un modelo de análisis multivariable de regresión logística. Resultados: El 99,2% de la población manifiesta disponer de cobertura sanitaria pública y un 24,7% estar además afiliada a una mutua voluntaria o aseguradora privada. La población con doble cobertura se caracteriza por ser más joven, tener mayor nivel de estudios, pertenecer a clases sociales más favorecidas, declarar mejor estado de salud percibido, menos enfermedades crónicas y discapacidades. El porcentaje de personas que han acudido a algún profesional sanitario los últimos 15 días no muestra diferencias estadísticamente significativas, pero sí se observan según el tipo de profesional; en la población sin doble cobertura, la última visita corresponde, en el 65,0% de los casos, a atención primaria, mientras que en el grupo con doble cobertura, el 51,1% corresponde a atención especializada. El porcentaje de personas satisfechas o muy satisfechas con la última visita es superior en el grupo con doble cobertura en relación con el trato profesional, el tiempo de espera y los trámites burocráticos. Conclusiones: Se constatan perfiles sociodemográficos y de salud diferentes entre las poblaciones con cobertura pública únicamente y con doble cobertura. Se observa un patrón distinto de utilización de servicios

Objective: To identify differences in socioeconomic characteristics, health status, health services’ utilization, and satisfaction with health services between the population with public health care coverage only and the population with double healthcare coverage through additional affiliation to mutual or private health insurance companies. Methods: Data from the 2002 Catalan Health Interview Survey with interviews to 8,400 individuals were used. Individuals with public healthcare insurance were differentiated from those who also had private health insurance. Multivariate logistic regression analysis was used. Results: A total of 99.2% of the population reported public health care coverage and 24.7% also had voluntary mutual or private insurance. Individuals with double coverage were younger, had a high level of education, belonged to advantage classes, and reported better self-perceived health and fewer chronic diseases and disabilities. No significant differences in the percentage of individuals who reported visiting a health professional in the previous 15 days were observed. Significant differences in the type of professional visited were observed:65% of individuals with public healthcare coverage only visited primary care settings but 51.1% of those with double coverage visited specialists. The proportion of persons reporting that they were satisfied or very satisfied with professional attitudes, waiting times and administrative procedures was higher in the double coverage group. Conclusions: Distinct sociodemographic and health profiles were found between persons with public coverage only and those with double coverage. Health services’ utilization also differed between the two groups

[The practice of preventive mammography in Catalonia [Spain]: a step forward]. / La práctica de la mamografía preventiva en Cataluña. Un paso adelante.

OBJECTIVE: To determine and compare the practice of periodic preventive mammography in women aged 50-69 years in the eight health regions of Catalonia in 1994 and 2002. METHODS: Data from the 1994 and 2002 Catalan Health Survey Interview were used. A cross-sectional survey of a representative sample of the non-institutionalized population of Catalonia was performed. All women aged 20 years old or older who directly answered the questionnaire (5,986 and 3,265 women in 1994 and 2002, respectively) were included. The influence of age, social class, type of health insurance and health region was evaluated using multivariate logistic regression analysis. RESULTS: In 1994, women aged 40-49 years reported a higher proportion of mammographic screening (42.8% of women in this age group) than the other groups, while in 2002 the highest proportion (76.3%) was observed in women aged 50-59 years. Rates of screening mammography in women aged 50-69 years were 26.9% in 1994 and 69.1% in 2002, increasing in all health regions and reducing differences among regions. In 1994 and 2002 women in the most advantaged social classes (I, II and III) reported higher proportions of mammographic screening than those in social class V, although this gap was smaller in 2002. CONCLUSIONS: The practice of preventive periodic mammography has significantly increased in women in the target group (women aged 50-69 years). Preventive mammography was lower in non-targeted age groups except in the group of women aged 40-49 years old, in which it was significantly increased. No significant differences in the practice of mammographic screening were observed among health regions in 2002.

[The White Paper of the health professions of Catalonia]. / Le livre Blanc des Professions de Santé de Catalogne.

The White Paper of the Health Professions of Catalonia (WPHPC) is a strategic document for the development of the health professions. It deals with the main components of the manpower development (education, management and planning) in relation to the health services development required to attain the objectives defined in the Catalan Health Plan. The WPHPC fosters the coherence between social needs and professional competencies required to respond to them, as well as to the quantitative aspects of service needs under adequate standards of quality, effectiveness and efficiency. The WPHPC has followed a methodological process with maximum stakeholder participation and transparency. Citizens, professionals and health organizations have contributed significantly. The conclusions and recommendations of the WPHPC are organized around four axis: the citizenship, the professionals, the health care organizations and the health care model. Key elements are: the requirement of a new social contract between the different stakeholders, the values of professionalism, the need for a new credentialism of professional competencies, innovation in the education process, innovation of governance and management for organization of knowledge, the redistribution of work inside teams requires deregulation and reregulation of the professions, the need for actualized data on workforce and job positions and the permanent requirement of sociological research.

La planificación de la salud en Cataluña, 1990-2000. Algunas claves para afrontar el futuro / Health planning in Catalonia 1990-2000. Some keys to afford future

Fundamento y objetivo: Las transformaciones sociales ocurridas en las últimas décadas han tenido un gran impacto en los servicios sanitarios y por extensión en los procesos de planificación. El objetivo es describir la evolución de los procesos de planificación de salud y servicios. Métodos: Revisión documental y entrevistas con miembros de los equipos de planificación. Resultados: Se identifican dos etapas de planificación: la de la década de los ochenta, orientada a la ordenación territorial y a los recursos sanitarios, y la de la década de los noventa a objetivos de salud (plan de salud, PS). El PS de Cataluña hace propuestas dirigidas a la promoción de la salud, prevención de la enfermedad, calidad de los servicios y satisfacción de los ciudadanos. Se inicia con el análisis de la situación de salud de la población y de los servicios, identifica los problemas prioritarios y define objetivos e intervenciones, aplica las propuestas y evalúa. Se elabora de forma descentralizada (regiones sanitarias) y con la participación de los profesionales, ciudadanos y sectores implicados. Permite identificar problemas y grupos de población vulnerables, definir objetivos cuantificados y con horizonte temporal, mejorar la gestión asistencial, la participación y la descentralización, evaluar resultados, explicitar el compromiso de las instituciones públicas y trabajar intersectorialmente. Se identifican aspectos susceptibles de mejora, principalmente en la participación, la proyección del PS en los servicios y el trabajo intersectorial. Conclusiones: La planificación por objetivos de salud ha supuesto un salto cualitativo. Para reforzar la potencialidad del PS habría que mejorar la gestión de su aplicación, así como asegurar la viabilidad de las intervenciones con un mayor compromiso intersectorial e institucional (AU)

Background and objective: The deep social transformations ocurred in the latest decades have influenced dramatically in health services and, by extension, in planning processes. The objective is to describe the evolution of health planning processes and services. Methods: Documental review and interviews with planning teams members. Results: We have identified two planning stages: The 80s, that showed a health planning oriented to territorial ordenation and health resources and in the other hand the 90s with the appearance of health objectives. The Catalonian health plan makes proposals related to health promotion, disease prevention, quality of services and citizens satisfaction. It starts with the analysis of population and services health situation. Then identify the priority problems and define objectives and interventions. Finally it applies the proposals and evaluate them. It is drawn up in a descentralized way (health regions) and with the collaboration of professionals, citizens and interested parties. Moreover, it allows to identify problems and vulnerable population groups, to define cuantitative objectives with deadlines and improve the assistential management and descentralization. It can also evaluate results and clarify public institutions commitments and work intersectorially. In addition, aspects with an improvement potential are identified, mainly related to participation, health plan projection on services and intersectorial work. Conclusions: Health planning by means of health objectives has brought about a qualitative jump. In order to reinforce the potentiality of health plans, we should improve the management of its application and secure the viability of interventions with a major intersectorial and institutional commitment (AU)

Aspectos metodológicos de la evaluación de los objetivos de salud y disminución de riesgo del Plan de Salud de Cataluña para el año 2000 / Methodological aspects in the evaluation of health and risk-reduction objectives of Health Plan for Catalonia for the year 2000

Fundamento y objetivo: Entre las fuentes de información utilizadas para la evaluación de los objetivos de salud y disminución de riesgo planteados para el año 2000 en Cataluña, destacan por su especial relevancia el registro de la mortalidad de Cataluña, el registro de morbilidad asistencial y la Encuesta de Salud de Cataluña. El objetivo de este estudio es describir aquellos aspectos metodológicos relevantes que afectan tanto a la gestión, codificación, análisis e interpretación de los datos como a la interpretación de los indicadores sanitarios y demográficos que de ellos se desprenden. Población y método: Para evaluar específicamente los objetivos formulados en relación con la mortalidad se ha analizado la evolución de las tendencias de mortalidad entre 1990 y 2000 por causas a partir de los datos elaborados por el registro de la mortalidad. El registro de morbilidad (CMBD) ha proporcionado información con base poblacional de la actividad asistencial en hospitales de agudos (100% de las altas de la red hospitalaria pública y la mitad de la actividad de los hospitales que no pertenecen a esta red), el 95% de la actividad de los hospitales psiquiátricos, el 93,6% de la actividad sociosanitaria y el 86% de los centros de la red de atención psiquiátrica ambulatoria, ambos con actividad contratada por el Servei Català de la Salut. Resultados: La Encuesta de Salud de Cataluña 2002, que por primera vez incluye un examen de salud, da continuidad a la que se realizó en 1994 que ya fue utilizada en la elaboración de los planes de salud de Cataluña en los períodos 1996-1998 y 1999-2001. La encuesta, realizada mediante entrevista personal a una muestra de 8.400 individuos representativa de la población catalana, ha aportado información de carácter general obtenida directamente de los ciudadanos y que complementa a otras fuentes de información sistemáticas existentes. Conclusiones: Mediante las fuentes de información habitualmente disponibles se ha podido evaluar la inmensa mayoría de los objetivos de salud y de disminución de riesgo planteados para el año 2000 en Cataluña, que se engloban dentro de los objetivos de la Organización Mundial de la Salud para Europa, marco de referencia de los mismos. No obstante, es todavía evidente la necesidad de información relevante, válida y comparable con otras fuentes de información, tanto para identificar problemas de salud como para controlar tendencias o evaluar intervenciones u objetivos de salud (AU)

Background and objective: The main purpose of this paper will be to describe outstanding methodological aspects related to data management, codification, analysis and health and demographic indicators interpretation. Subjects and method: We have analized cause-specific mortality trends between 1990 and 2000 by means of analyzing information from Mortality Register. The Morbidity Register has provided population-based information about clinical activity carried out in acute hospitals, 95% of psychiatric hospital activity, 93.6% of social health welfare activity and 86% of centers included in the ambulatory psychiatric attention network activity. Results: We have also used the Health Survey of Catalonia 2002 which includes, for the first time, a health exam and represents a certain continuity of previous health surveys. This opinion poll, which was carried out by means of personally interviewing 8,400 subjects from a Catalonian population representative sample, has provided valuable general information obtained straightly from citizens. Conclusions: We could evaluate the majority of health and risk-reduction objectives of Catalonian Health Plan 2000 using common information sources. However, outstanding, comparable and valid data are still required in order to identify health problems and monitorize trends or evaluate interventions and health objectives (AU)

Encuesta de Salud de Cataluña. Percepción de la salud, utilización y satisfacción con los servicios asistenciales desde la perspectiva de los ciudadanos / Health Survey of Catalonia. Health perception, use and satisfaction related to health services

Fundamento y objetivo: La definición de políticas de salud y servicios requiere obtener información directa de los ciudadanos. El Departament de Sanitat i Seguretat Social lleva a término periódicamente la Encuesta de Salud de Cataluña (ESCA). Objetivo: Exponer los resultados de la ESCA 2002 y compararlos con los de la ESCA 1994. Población y método: Encuesta por entrevista a 8.400 personas no institucionalizadas de todas las edades. Se analiza la autopercepción de salud, enfermedades crónicas y discapacidades, calidad de vida (movilidad, cuidados personales, actividades cotidianas, dolor o malestar, ansiedad o depresión), restricción de actividad por motivos de salud, utilización de servicios sanitarios y satisfacción. Estas variables se estudian en relación con la edad, el sexo y la clase social. Resultados: El 78,3% de la población declara que su salud es excelente, muy buena o buena; el 64,6% manifiesta no tener dificultades en las dimensiones sobre calidad de vida y el 69,4% revela que presenta o ha presentado trastornos crónicos. Entre las ESCA 1994 y 2002 el patrón de salud según variables sociodemográficas es similar, aumenta la proporción de personas que valoran positivamente su salud, las que declaran tener afectada la calidad de vida, tener problemas crónicos y consumir medicamentos, y disminuye la satisfacción con los servicios sanitarios utilizados. Conclusiones: Llama la atención que si bien aumenta la proporción de población que valora positivamente su salud también incrementa la declaración de tener enfermedades y limitaciones crónicas y la utilización de medicamentos. Con respecto a la insatisfacción de los usuarios, corresponde emprender acciones decididas para superar sus causas, ya que están suficientemente identificadas (AU)

Background and objective: Straight information from citizens is essential in order to define health policies and services. Therefore, the Departament de Sanitat i Seguretat Social carries out periodically the Catalan Health Survey (CHS). Objective. The main purpose of this paper is to set out the CHS 2002 results and then compare them with the ones from CHS 1994. Subjects and method: Survey carried out by means of interviewing 8,400 non-institutionalized people of any age. We have analized health perception, chronic diseases and disabilities, quality of life (mobility, personal cares, daily activities, pain or discomfort, anxiety or depression), activity restriction, health services utilization and satisfaction. All these variables have been analized by sex, age and social class. Results: 78,3% of population defines their health as excellent, very good or good. 64.6% have not difficulties in quality of life variables and 69.4% suffer or has suffered chronic disease. Comparing CHS 1994 and 2002, we have not noticed differences in health pattern related to sociodemographic variables. However there is an increase of people who value positively its health, people who declares that suffer from chronic disease, as well as drugs consumption and a decrease of users satisfaction with health services provission. Conclusions: The increase of people who value positively their health and the ones who declare that suffer from chronic disease, constitutes a remarkable fact. As regard to users insatisfaction, there is a need to implement actions oriented towards getting over its well-identified causes (AU)