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OBJECTIVES: To assess time trends in mortality rates in European countries for the period 2011 to 2015 by level of austerity measures imposed by governments in response to the economic and financial crisis. METHODS: We analyzed standardized mortality rates (SMRs) for 2011 through 2015 in 15 European countries based on Eurostat data ( http://ec.europa.eu/eurostat/data/database ). We used the Cyclically Adjusted Primary Balance (CAPB) in terciles as an independent variable to represent the level of austerity adopted in each country. We conducted a longitudinal analysis of panel data using generalized estimating equation models of SMR. We included interaction terms to assess the influence of time period and level of austerity. RESULTS: SMRs generally declined in the study period, except in the last year of the study. In 2015, compared with countries in the low-austerity group, countries with intermediate austerity had excess mortality of 40.2 per 100 000 per year and those with high austerity had excess mortality of 31.22 per 100 000 per year. CONCLUSIONS: The results suggest a negative effect on mortality in those countries that apply a higher level of austerity.
Assuntos
Disparidades nos Níveis de Saúde , Mortalidade/tendências , Condições Sociais , Recessão Econômica/tendências , Europa (Continente) , Feminino , Humanos , MasculinoRESUMO
No disponible
Assuntos
Determinação de Necessidades de Cuidados de Saúde/ética , Nível de Saúde , Classe Social , Fatores Socioeconômicos , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Atenção Primária à Saúde/ética , /éticaRESUMO
The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000-50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children's health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses.
Assuntos
Proteção da Criança , Recessão Econômica , Indicadores Básicos de Saúde , Adolescente , Criança , Pré-Escolar , Humanos , Classe SocialRESUMO
OBJECTIVES: To analyse changes in the family living conditions of children in Catalonia between 2006 and the 2010-2012 period, and to study associations between these changes and health outcomes. DESIGN: A before-after analysis of two cross-sectional surveys. SETTING: Population younger than 15 years of age from Catalonia, Spain. PARTICIPANTS: Representative samples of children in the 2006 Catalan Health Survey (ESCA), baseline, before the crisis; n=2200) and the first four waves of ESCA 2010-2012 (after start of the crisis, n=1967). MAIN OUTCOME MEASURES: Overweight/obesity, health behaviour, mental health and health-related quality of life (HRQOL). Logistic regression and multiple linear regression models were used to analyse the influence of changes in family conditions on outcome measures, including interaction terms to describe the potential influence of the study period on the results. RESULTS: The percentage of unemployed families rose from 9.1% (2006) to 20.6% (2010-2012), with inequalities by level of education. Overweight/obesity increased from 18.4% (95% CI 16.5% to 20.4%) to 26.9% (24.6% to 29.2%) in 2010-2012, and inequalities related to maternal education and employment status persisted. Eating habits have improved in 2010-2012 in disadvantaged families (ie, junk food consumption improved in families with a maternal primary education level; beta (B)=2.85; 0.83 to 4.88, for the survey interaction by primary education level). An improvement in HRQOL was found in the second survey (B=6.07; 4.15 to 7.99), although children whose mothers had a primary education showed poorer HRQOL scores in this survey than in 2006 (B=-4.14; -7.17 to -1.12). CONCLUSIONS: Although some health-related behaviour improved during the study period, childhood obesity increased and inequalities in HRQOL appeared. Policy measures that fight against these inequalities should be urgently implemented to avoid their negative impact on the health of future generations of Catalans.
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PURPOSE: To determine the extent of differences and similarities in content between heath-related quality of life (HRQOL) instruments for children and adolescents. METHODS: A descriptive and explanatory qualitative approach was carried out. Instruments specifically designed for use with children or adolescents were included. To assure the validity of the findings a triangulation of the analysis and "member checking" were performed. RESULTS: Ten questionnaires were analyzed. All of them included items referring to physical, psychological, and social aspects of health. A relatively low number of categories explained the content of the questionnaires. CONCLUSIONS: A reasonably coherent notion of HRQOL underlies instruments available for children and adolescents. HRQOL measurement in young people is still in its developmental step.
