Exploring trends and determinants of basic childhood vaccination coverage: Empirical evidence over 41 years.

Vaccination is widely considered to be one of the most important prevention measures as a health strategy. This paper examines trends in basic childhood vaccination coverage and which country and time-dependent determinants may have influenced childhood immunization rates (1-dose BCG, 1- and 3-dose DTP (diphtheria, tetanus, pertussis), 1-dose measles, and 3-dose polio) between 1980 and 2020 across 94 countries. We identify economic, inequality, demographic, health, education, labor market, environmental, and political stability factors of immunization. To do this, we use data from the annual WHO and United Nations International Children's Emergency Fund (UNICEF) coverage estimates. The empirical analysis consists of generalized estimating equation models to assess relationships between immunization rates and socioeconomic factors. Additionally, we follow the Barro and Sala-i-Martín approach to identify conditional convergence. Our findings show the strongest positive statistically significant association between immunization rates and GDP per capita, as well as births attended by skilled health staff. Moreover, our research demonstrates conditional convergence, indicating that countries converge towards different steady states. The present study brings new insights to investigating the determinants of childhood vaccination coverage and provides significant implications for health policies.

Economic costs related to coronavirus disease 2019 pandemic: A systematic literature review.

Due to the COVID-19 pandemic, the pressure on healthcare systems has been tremendous and it is having a huge economic impact. The objective of this paper is to carry out a systematic literature review of the publications that have analysed the costs derived from COVID-19 from the patient's perspective. Not only is this study aimed at measuring the impact of COVID-19 in economic terms, but also in qualitative terms, analysing, for instance, the types of costs (direct and indirect) and their variations depending on the geographical area under study. Searches were conducted in PubMed, Cochrane Library, Web of Science and Scopus. The time frame for the analysis was from the start of the pandemic until 9th December 2021. A total of 322 papers were found. The number of articles assessed for eligibility was 32, and after applying the exclusion criteria, 13 papers were included in the qualitative synthesis. Most of the studies analysed only direct costs (69.23%) and were focused on Asia (61.54%), where the larger indirect costs, as well as the greater total costs, were found. However, the higher costs per patient and year were shown for the United States. This investigation showed the importance of COVID-19 in national, regional and local budgets. More studies are to be developed in Europe due to both the existing differences in the health care systems and financing by country and the difference in the incidence of COVID-19 by country and wave.

The associations between suicides, economic conditions and social isolation: Insights from Spain.

Suicide is among the main challenges that need to be addressed in developed countries. In this paper, we analyse suicides across the 17 Spanish regions over the period 2014-2019. More precisely, our objective is to re-study the determinants of suicides focusing on the latest economic expansion period. We use count panel data models and sex stratification. A range of aggregate socioeconomic regional-level factors have been identified. Our empirical results show that: (1) a socioeconomic urban-rural suicide gaps exist; (2) there are significant gender differences, for the women a Mediterranean suicide pattern appears whereas unemployment levels have a significant importance for men, (3) social isolation factors, when significant, they show an (a priori) surprisingly positive result. We provide new highlights for suicide prevention in Spain. Precisely, it is highlighted that jointly policies by gender and attending to vulnerable groups are both necessary.

Coronavirus fear of contagion and compliance with social distancing measures: evidence for a sample of a Spanish university community.

Background: Social distancing measures have been one of the core pillars of the strategy against COVID-19 in all the countries. This study aims at understanding what motivates behaviours and compliance with social distancing measures among students and workers from a Spanish public university. Methods: We carry out two logistics models considering two different dependent variables: not maintaining social relation with non-cohabiting people and not to leave home except for emergencies (n = 507, sample is formed by students and workers from the University of Cantabria in the North of Spain). Results: Being very concerned about getting ill suggests higher risk of not maintaining social relation with non-cohabiting people. Getting older increase the probability of not leaving home except for emergencies as happens with those who are very concerned about getting ill. Young people often living with vulnerable older relatives may affect students' behaviour. Conclusions: Our findings suggest that compliance with social distancing measures depends on several factors related to age, the number or kind of cohabiting people and level of concern about getting ill. Policies should address all these factors through a multidisciplinary perspective.

Temporal Series Analysis of Population Cycle Threshold Counts as a Predictor of Surge in Cases and Hospitalizations during the SARS-CoV-2 Pandemic.

Tools to predict surges in cases and hospitalizations during the COVID-19 pandemic may help guide public health decisions. Low cycle threshold (CT) counts may indicate greater SARS-CoV-2 concentrations in the respiratory tract, and thereby may be used as a surrogate marker of enhanced viral transmission. Several population studies have found an association between the oscillations in the mean CT over time and the evolution of the pandemic. For the first time, we applied temporal series analysis (Granger-type causality) to validate the CT counts as an epidemiological marker of forthcoming pandemic waves using samples and analyzing cases and hospital admissions during the third pandemic wave (October 2020 to May 2021) in Madrid. A total of 22,906 SARS-CoV-2 RT-PCR-positive nasopharyngeal swabs were evaluated; the mean CT value was 27.4 (SD: 2.1) (22.2% below 20 cycles). During this period, 422,110 cases and 36,727 hospital admissions were also recorded. A temporal association was found between the CT counts and the cases of COVID-19 with a lag of 9-10 days (p ≤ 0.01) and hospital admissions by COVID-19 (p < 0.04) with a lag of 2-6 days. According to a validated method to prove associations between variables that change over time, the short-term evolution of average CT counts in the population may forecast the evolution of the COVID-19 pandemic.

A systematic review on suicide because of social isolation/and loneliness: does COVID-19 make a difference?

BACKGROUND: Suicide is a significant cause of death worldwide. Various purposes can explain why people choose to attempt or commit suicide such as mental-health disorders, income-related-factors, quality of life or issues related to social context. This study aims to identify an updated association between 'isolation' and suicides. METHODS: In this regard, we had made a systematic review of the most recent papers, published from January 2016 to March 2022, thought the most acknowledged databases. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. To the best of our knowledge, this issue is very important due to the indirect relationship between COVID-19 and suicides. RESULTS: Our analysis demonstrates that suicide and -social isolation and loneliness- have a positive and direct relationship although these findings varied slightly by areas. Moreover, most of the attention is focused on the youth during the most recent period and this is a real problem because economies cannot afford losing (young) population. CONCLUSIONS: In order to prevent suicides, public policies should prevent suicidal thoughts that it could induce to terminate the lives of individuals in their most productive years and harmful outcomes to their families and friends.

Change in eating habits during the Spanish COVID-19 pandemic lockdown: evidence for a sample of university community.

Background: The stress and anxiety caused by COVID-19 lockdown may have changed the eating habits of the population. Our aim is to assess the eating changes that have taken place due to the pandemic. Methods: Data were collected through an electronic survey created by the Health Economics Research Group of the University of Cantabria and IDIVAL and conducted between 14/01/2021 and 19/02/2021. A total of 1,417 responses were recorded, but only 507 complete observations were considered. We carried out a cross-sectional analysis through ordered probit regressions. Results: The improvement in post-confinement eating habits is associated with higher income level, better self-assessed health status and more physical activity. The worsening of eating habits is associated with having a certain level of nomophobia or the fear of contagion. Conclusions: Our analysis can be used for designing and implementing new strategies to overcome the negative spill overs of the COVID-19 pandemic and improve the dietary patterns.

Alleviating mental health disorders through doses of green spaces: an updated review in times of the COVID-19 pandemic.

The COVID-19 pandemic has highlighted issues due to mental health disorders, in particular the serious consequences derived from lockdown measures. This paper aims to analyse the literature on the potential direct impact of the natural environment on mental health disorders. We have systematically reviewed the studies analysing green spaces and mental health included in this review using PubMed, Web of Science, Scopus and Cochrane Library. A retrospective time-frame is considered, covering the COVID-19 pandemic. We have found that exposure to, use and proximity to green spaces have a beneficial impact on mental health among elderly, students and patients with underlying pathologies. However, it has negative effects on the mental health of women and young adults. Exposure to and interaction with the natural environment can improve certain mental health disorders and should be taken into account for strategies and policies related to future threats to public health.

The Economic Burden of Localized Prostate Cancer and Insights Derived from Cost-Effectiveness Studies of the Different Treatments.

Prostate cancer has huge health and societal impacts, and there is no clear consensus on the most effective and efficient treatment strategy for this disease, particularly for localized prostate cancer. We have reviewed the scientific literature describing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer in OECD countries. We initially identified 315 articles, studying 13 of them in depth (those that met the inclusion criteria), comparing the social perspectives of cost, time period, geographical area, and severity. The economic burden arising from prostate cancer due to losses in productivity and increased caregiver load is noticeable, but clinical decision-making is carried out with more subjective variability than would be advisable. The direct cost of the intervention was the main driver for the treatment of less severe cases of prostate cancer, whereas for more severe cases, the most important determinant was the loss in productivity. Newer, more affordable radiotherapy strategies may play a crucial role in the future treatment of early prostate cancer. The interpretation of our results depends on conducting thorough sensitivity analyses. This approach may help better understand parameter uncertainty and the methodological choices discussed in health economics studies. Future results of ongoing clinical trials that are considering genetic characteristics in assessing treatment response of patients with localized prostate cancer may shed new light on important clinical and pharmacoeconomic decisions.

Have Health Inequalities Increased during the COVID-19 Pandemic? Evidence from Recent Years for Older European Union Citizens.

Reducing inequality is one of the current challenges that most societies are facing. Our aim was to analyze the evolution of inequalities in self-assessed health among older Europeans in a time period spanning the 2008 economic crisis and the COVID-19 health crisis. We used data from Waves 2, 4 and 8 of the Survey of Health, Ageing and Retirement in Europe. We used inequality indices that accept ordinal variables. Our empirical results suggest that average inequality declines over time. Gender significantly influences the results. Some of the countries with the highest level of inequality are Denmark and Sweden, and some with the lowest are Estonia and the Netherlands. Our results may be of interest for the development of public policies to reduce inequalities. Special attention should be paid to vulnerable groups, such as the elderly.

Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study.

Background: Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods: A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results: A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.

A geographical information system model to define COVID-19 problem areas with an analysis in the socio-economic context at the regional scale in the North of Spain.

The work presented concerns the spatial behaviour of coronavirus disease 2019 (COVID-19) at the regional scale and the socio-economic context of problem areas over the 2020-2021 period. We propose a replicable geographical information systems (GIS) methodology based on geocodification and analysis of COVID-19 microdata registered by health authorities of the Government of Cantabria, Spain from the beginning of the pandemic register (29th February 2020) to 2nd December 2021. The spatial behaviour of the virus was studied using ArcGIS Pro and a 1x1 km vector grid as the homogeneous reference layer. The GIS analysis of 45,392 geocoded cases revealed a clear process of spatial contraction of the virus after the spread in 2020 with 432 km2 of problem areas reduced to 126.72 km2 in 2021. The socio-economic framework showed complex relationships between COVID-19 cases and the explanatory variables related to household characteristics, socio-economic conditions and demographic structure. Local bivariate analysis showed fuzzier results in persistent hotspots in urban and peri-urban areas. Questions about â€Ëœwhere, when and how’ contribute to learning from experience as we must draw inspiration from, and explore connections to, those confronting the issues related to the current pandemic.

Interregional variability in the use of cardiovascular technologies (2011-2019). Correlation with economic indicators, admissions, and in-hospital mortality.

INTRODUCTION AND OBJECTIVES: Equal opportunities to access technical advances with recognized clinical value should be a priority of the publicly-funded health system. We analyzed variability among all the Spanish autonomous communities in the use of cardiovascular techniques with an established indication and its relationship with economic indicators, burden of disease, and hospital mortality. METHODS: The activity registries of various Associations of the Spanish Society of Cardiology from 2011 to 2019 were analyzed for coronary angiography, overall percutaneous coronary intervention (PCI), primary PCI, implantable cardioverter-defibrillators (ICD), cardiac resynchronization therapy, and transcatheter aortic valve replacement (TAVR). Economic indices (gross domestic product and per capita health care expenditure) were obtained from public sources and data on attendance rates and mortality from the Resources and Quality in Cardiology (RECALCAR) reports of the Spanish Society of Cardiology. We analyzed the coefficient of variation for activity and the correlation of activity with regional economic indices, attendance rates, and risk-adjusted rates of in-hospital mortality. RESULTS: We identified wide variability in the use of technologies, especially for primary PCI (18%), ICD (22%), cardiac resynchronization therapy (36%), and TAVR (42%). A certain correlation with attendance rates was seen only for overall PCI and ICD. In general, no significant correlation was found between the use of the techniques and the economic indices of wealth and expenditure. The correlation with in-hospital mortality showed no significant results, although this was the analysis with the greatest limitations because the impact of these techniques on survival is exerted more in the mid- and long-term. CONCLUSIONS: The results of this study, despite its inherent limitations, show marked variability between autonomous communities in the use of cardiovascular technologies, which is not explained by economic differences or by hospital attendance rates due to the corresponding diseases.

Are spatial patterns of Covid-19 changing? Spatiotemporal analysis over four waves in the region of Cantabria, Spain.

This research approaches the empirical study of the pandemic from a social science perspective. The main goal is to reveal spatiotemporal changes in Covid-19, at regional scale, using GIS technologies and the emerging three-dimensional bins method. We analyze a case study of the region of Cantabria (northern Spain) based on 29,288 geocoded positive Covid-19 cases in the four waves from the outset in March 2020 to June 2021. Our results suggest three main spatial processes: a reversal in the spatial trend, spreading first followed by contraction in the third and fourth waves; then the reduction of hot spots that represent problematic areas because of high presence of cases and growing trends; and finally, an increase in cold spots. All this generates relevant knowledge to help policy-makers from regional governments to design efficient containment and mitigation strategies. Our research is conducted from a geoprevention perspective, based on the application of targeted measures depending on spatial patterns of Covid-19 in real time. It represents an opportunity to reduce the socioeconomic impact of global containment measures in pandemic management.

The effects of gastrointestinal disturbances on the onset of depression and anxiety.

BACKGROUND: Stomach pain is an ailment that occurs frequently in the general population. It is not unusual if such stomach issues produce some amount of stress in an individual, but it can be worrying if these pains lead to significant mental health problems. The relationship between some abdominal pain, such as bowel syndrome, and depression or anxiety has been gaining much interest. However, previous studies that have empirically investigated this relationship are scarce. METHODS: To analyze the impact of having gastrointestinal problems, among other socioeconomic conditions, on the onset of depression and anxiety in the Spanish population, we compare treating gastrointestinal diseases as exogenous in a single-equation probit model with a bivariate probit model in which this variable is treated as endogenous. A likelihood-ratio test of the correlation coefficient of the disturbances suggests that gastrointestinal problems are endogenous. Thus, the approach taken herein allows the direct testing of the hypothesis that having gastrointestinal problems and the onset of mental illnesses such as depression and anxiety are jointly determined by certain socioeconomic factors. A cross-sectional analytical study was analyzed using data from a 2017 survey of health indicators and life conditions that was developed by the Statistics Spanish Office. RESULTS: The probability of having depression or anxiety increases with age, stress, daily limitations and gastrointestinal disorders. On the other hand, the probability is lower for men, married people and those who engage in exercise several times per week. Our findings estimate that having gastrointestinal problems increases the probability of having depression in 7% and the probability of anxiety in 8.8% of the sample. CONCLUSIONS: Our empirical results suggest that not considering the endogeneity of gastrointestinal problems could result in an overestimate of the impact of this factor on the development of depression or anxiety.

The impact of disability on motherhood decisions: New evidence from Spain.

There exists a high proportion of women with disabilities who decide to be mothers although there is a high stigma about their capabilities. The objective is to analyze the impact of disability, among other socioeconomic conditions, on the motherhood decisions. We compared the results of treating disability as exogenous with a bivariate probit model. A cross-sectional analytical study has been analyzed by using data from the Fecundity Survey of 2018. The model estimates the probability of having children having disability, which is a 3.5%. Moreover, motherhood propensity for disabled women is 0.4 percentage points lower than for non-disabled.In this article the authors undertook a significant literature review, then it is included a development of the theoretical and methodology framework for analyzing the effect of disability on the attitudes of women toward the decision of having children. In this context, many disabled women have successfully become mothers but the existent barriers have unmotivated others. The difficulty is basically due to the stigma about their mothering capabilities or associated with physical conditions such as risk of abortion or even a worsening of health. The economic framework under our specification is an extension of the Households Health Production Model where women derive utility from having children and they use their skills, knowledge or time to achieve their objective. In this case, to have children is the outcome and education, health status and other socioeconomic factors are the inputs. Having children is only one of the sources of utility that a woman has, they also derive utility from labor time, consumption or healthcare, among others. Despite several studies used this methodology to analyze motherhood decisions in many Countries in the world, the impact of disability is much less explored.

Why Are Spanish Nurses Going to Work Sick? Questionnaire for the Measurement of Presenteeism in Nurses.

Presenteeism is defined as the presence of the worker at their workplace despite not being in optimal physical or mental conditions. Presenteeism is a phenomenon that has been poorly studied in the context of healthcare. Despite the many negative consequences associated with presenteeism, to date, no studies have investigated this issue in nurses in Spain. The objective was to develop and validate a questionnaire on presenteeism to be used by nursing staff in Spain. METHODS: A psychometric study for the development and validation of a questionnaire. The PRESENCA® questionnaire on presenteeism was created by a panel of experts, based on a survey comprised of 31 Likert-type items. RESULTS: In total, 355 nurses completed the questionnaire. The factorial analysis revealed the existence of 3 factors and confirmed appropriate levels of validity and reliability (alpha = 0.729). CONCLUSIONS: The PRESENCA® questionnaire is the first tool developed and validated in Spanish for the assessment of presenteeism in nursing. Our findings demonstrate that this scale has appropriate psychometric properties and its use may facilitate the detection of presenteeism among professionals. As a result, use of this questionnaire may contribute towards the improvement of clinical safety.

Changes in Physical Fitness, Dietary Habits and Family Habits for Spanish Children during SARS-CoV-2 Lockdown.

BACKGROUND: habits related to diet and physical activity in children were modified due to the lockdown that Spain had between March and June 2019 because of the health crisis caused by the appearance of SARS-CoV-2. The aim of the study was to know the impact that the lockdown had on physical fitness values in children aged 11-12. METHODS: the study consisted of 50 Spanish children aged 11-12 (M = 11.40; SD = 0.50), 33 (66%) boys and 17 (34%) girls. Data collection was performed using the Alpha-Fitness Battery, a validated instrument to assess dietary intake, habits and practices, and an ad hoc survey to collect sociodemographic data and other information relevant to the study. RESULTS: there were significant differences (p < 0.05) in the results of fitness variables measured in the standing long jump, agility speed and aerobic capacity, as well as in the results of maximal oxygen uptake (VO2 max) between, before and after lockdown in both boys and girls. No significant differences were found in measurements of right and left hand grip (p > 0.05). CONCLUSIONS: there is evidence of a significant impact of SARS-CoV-2 lockdown on physical fitness values in boys and girls aged 11-12.

Impact of SARS-CoV-2 Lockdown on Anthropometric Parameters in Children 11/12 Years Old.

BACKGROUND: During the great lockdown in Spain due to SARS-CoV-2, in between the months of March and June 2020, dietary and physical activity habits were modified in children. The aim of the study was to determine the impact of the lockdown on anthropometric parameters in children aged 11/12 years. METHODS: Fifty Spanish children aged 11/12 years (M = 11.40; SD = 0.50) participated: 33 (66%) boys and 17 (34%) girls. For data collection, we used an anthropometry kit; the Alpha-Fitness Battery, a validated instrument to assess dietary intake, habits and practices; and an ad hoc survey to collect sociodemographic and other data under investigation. RESULTS: There were significant differences in the anthropometric parameters measured and in the results obtained for Body Mass Index (BMI) and body fat percentage pre- and post-lockdown in both boys and girls (p < 0.05). No significant differences were found in waist-circumference measurements (p > 0.05). CONCLUSIONS: There is evidence of a significant impact of the SARS-CoV-2 lockdown on anthropometric parameters in boys and girls aged 11/12 years.

Kanban system applications in healthcare services: A literature review.

Lean Management method has been applied in several fields before its implementation in healthcare area. Among the different techniques associated with Lean, in this paper, we are focused on Kanban system, which is a method that presents several benefits such as inventory holding reduction or improvement of the employees' satisfaction. Our main objective is to carry out a literature review focused on Kanban methodology applied to health care. In this sense, this study can serve as a script to improve hospital management in pandemic periods, such as the one currently lived on COVID-19. We carry out a literature review searching in four different databases. We combine several terms to achieve our objective. We identify several articles which describe Kanban methodology applied to health field. More specifically, we present in what areas (nursing or pharmacy, among others) this method has been applied. In addition, we show all the barriers as well as benefits caused by the implementation of this system. There are a few studies focused on analysing how Kanban is applied to health care. Therefore, we can affirm that this topic is still recent.