Social mobility and healthy behaviours from a gender perspective in the Spanish multicase-control study (MCC-Spain).

There is evidence for the influence of socioeconomic status (SES) on healthy behaviours but the effect of social mobility (SM) is not yet well known. This study aims to analyse the influence of origin and destination SES (O-SES and D-SES) and SM on healthy behaviours and co-occurrence, from an integrated gender and age perspective. Data were obtained from the controls of MCC-Spain between 2008-2013 (3,606 participants). Healthy behaviours considered: healthy diet, moderate alcohol consumption, non-smoking and physical activity. SM was categorized as stable high, upward, stable medium, downward or stable low. Binary and multinomial logistic regression models were adjusted. Those aged <65, with a low O-SES, D-SES and stable low SM are less likely to have healthy behaviours in the case of both women (physically active: OR = 0.65 CI = 0.45-0.94, OR = 0.71 CI = 0.52-0.98, OR = 0.61 CI = 0.41-0.91) and men (non-smokers: OR = 0.44 CI = 0.26-0.76, OR = 0.54 CI = 0.35-0.83, OR = 0.41 CI 0.24-0.72; physically active: OR = 0.57 CI = 0.35-0.92, OR = 0.64 CI = 0.44-0.95, OR = 0.53 CI = 0.23-0.87). However, for those aged ≥65, this probability is higher in women with a low O-SES and D-SES (non-smoker: OR = 8.09 CI = 4.18-15.67, OR = 4.14 CI = 2.28-7.52; moderate alcohol consumption: OR = 3.00 CI = 1.45-6.24, OR = 2.83 CI = 1.49-5.37) and in men with a stable low SM (physically active: OR = 1.52 CI = 1.02-1.26). In the case of men, the same behaviour pattern is observed in those with a low O-SES as those with upward mobility, with a higher probability of co-occurring behaviours (three-to-four behaviours: OR = 2.00 CI = 1.22-3.29; OR = 3.13 CI = 1.31-7.48). The relationship of O-SES, D-SES and SM with healthy behaviours is complex and differs according to age and gender.

Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey.

The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged.

To participate or not? Giving voice to gender and socio-economic differences in colorectal cancer screening programmes.

This paper examines the influence of gender and socio-economic status (SES) on participation in colorectal cancer (CRC) screening. Qualitative study with eight focus groups comprised of participants and non-participants in a CRC screening programme in Valencia (Spain), structural sample design and discursive analysis by gender, SES and participation. Non-participants and those with lower SES tended to have less knowledge about both the disease and the programme. Reasons for participation varied according to gender: women were motivated because they value the importance of self-care and early detection in order to prevent personal and family suffering while men were encouraged by their partners. Reasons for non-participation were also influenced by gender: women feared the results and considered the test unpleasant whereas men showed carelessness and lack of concern. In population-based programmes, people with lower SES and men are those with the most obstacles to participation due to low health literacy and traditional gender roles respectively. To increase participation in CRC screening programmes based on informed decision making and taking into account social inequalities, information should be more accessible, comprehensible and adapted to gender and SES differences and emphasise the greater vulnerability of men for CRC and the benefits of early detection.

¿Techos de cristal y escaleras resbaladizas? Desigualdades degénero y estrategias de cambio en SESPAS / Glass ceiling and slippery stairs? Gender inequalities and strategies for change in the Spanish Society of Public Health and Health Services Administration

En las sociedades científicas, como en otros espacios públicos, la presencia de las mujeres en la toma de decisiones es menor que la de los varones. Describimos la situación en la Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) donde, a pesar de existir un 40% de socias, las mujeres han estado escasamente representadas en los puestos donde se toman las decisiones y en los de reconocimiento profesional. Se explica el proceso de cambio que se ha impulsado en los últimos años y algunos de los efectos de las acciones emprendidas. Visualizar las desigualdades de género existentes provocó el debate y el interés por la acción. Se ha establecido un grupo de trabajo de género y salud pública. En los dos últimos años se han incorporado más mujeres a los puestos de poder y de reconocimiento profesional en SESPAS (AU)

In scientific societies, as in other social fields, women's participation in decision making is lower than that of men. We describe the situation in SESPAS (Spanish Society of Public Helath and Health Services Administration) where, despite representing a 40% of its members, very few women have been in positions in which decisions are taken or in those of professional recognition. The process of change implemented during recent years and some of the effects of the actions taken are presented. Making the existing inequalities known has generated debate and interest in the intervention. A gender and public health working group was set up. In the last two years more women have been prometed to more senior positions in SESPAS (AU)

[Glass ceiling and slippery stairs? Gender inequalities and strategies for change in the Spanish Society of Public Health and Health Services Administration]. / 'Techos de cristal y escaleras resbaladizas? Desigualdades de género y estrategias de cambio en SESPAS.

In scientific societies, as in other social fields, women's participation in decision making is lower than that of men. We describe the situation in SESPAS (Spanish Society of Public Health and Health Services Administration) where, despite representing a 40% of its members, very few women have been in positions in which decisions are taken or in those of professional recognition. The process of change implemented during recent years and some of the effects of the actions taken are presented. Making the existing inequalities known has generated debate and interest in the intervention. A gender and public health working group was set up. In the last two years more women have been promoted to more senior positions in SESPAS.

[Women's opinion about their health: a qualitative study]. / La opinión de las mujeres sobre su salud: un estudio cualitativo.

OBJECTIVE: To find out what urban low and middle class women think about the relationship between health and daily behaviours, their social and family situation and the setting in which they live. DESIGN: Qualitative methodology and the focus group technique. SETTING: Urban population. PARTICIPANTS: Low and middle class women aged between 25 and 45. MEASUREMENTS AND MAIN RESULTS: For the sample design homogeneity variables (applicable to the whole group) such as socio-economic level and age were chosen and for heterogeneity variables (only applicable to some of the group's participants) motherhood and paid work outside the home. Two focus groups were conducted. For the analysis the opinions expressed by the women were identified, and were classified according to the scheme that the study group had made previously. Opinions were identified on the importance of food and information about it, concern for their children and for the options provided for the establishment of healthy lifestyles. Only the group of low socioeconomic level identified money as relevant for access to health services. No reference was made to smoking and alcohol. Mental health aspects were predominant. CONCLUSIONS: The opinions of women about aspects which influence their health differ according to social class. The factors identified by scientific literature are not a priority for them. They are not necessarily concerned about health problems with highest mortality and morbility.

[Health education of women in a rural setting: an interventional study]. / Educación para la salud con mujeres en el medio rural: un estudio de intervención.

OBJECTIVE: To compare the health knowledges and the reasons for the participation between two groups of women with regard to the participation in a health education programme. To describe the satisfaction and the behaviors changes of those who participated. DESIGN: Pos-test intervention study with a control group not aleatory. It was used the test "t" of student for quantitative variables and square "ji" for the qualitative variables. SETTING: Primary health care, auxiliary consulting rooms which belong to Barracas and El Toro, Castellón. PARTICIPANTS: The intervention group was formed by 48 women, and the control group by 43. MAIN RESULTS: All significant different was founded positively associated which the intervention group, and in which questions without significant different, always the percentage of two answers was bigger than the control group. The most important reasons expressed for the women for the participation were: "to learn", "to be interesting", "to feel comfortable". The most important reasons for the non participation were: "to have work", "I didn't know", "I forgot it". CONCLUSIONS: The intervention study outcome shows that women who participated in the workshops had move knowledges in the worked health subjects than those who didn't participate. Every women expresated satisfaction with the experience, and the 66.6% changed something comportment. The knowledge of the causes for which the women participated or not, it is a very useful information to improve the intervention in future experiences.

[Avoidable pediatric hospitalization in the Community of Valencia and Catalonia]. / Hospitalización pediátrica evitable en la Comunidad Valenciana y Cataluña.

OBJECTIVE: To estimate the rates of avoidable pediatric hospitalization in the health areas of the Valencia Community and health sectors of Catalonia, and to analyze if they are related to socioeconomic level or development of primary care. METHOD: Available paediatric (0-14 years old) hospitalizations were analyzed using the Minimum Basic Data Set of Hospital Discharge in two Autonomous Regions: the Valencia Community and Catalonia (1993-1994). Variables analyzed included age, gender, socioeconomic level and coverage by the new model of primary care. Crude and standardized rates for age were calculated and the variation in areas and sectors was assessed. The association between rates and socioeconomic and primary care characteristics was analyzed. RESULTS: Avoidable paediatric hospitalizations represent 21% of all paediatric hospitalizations in the Valencia Community and 15% in Catalonia. Crude rates for Valencia Community ranged between 5.7 and 12.7 in 1993 and 6.6 and 17.8 in 1994; extreme quotient was 2.2 and coefficient of variation 37% in 1993 and 2.7 and 48% respectively in 1994. For Catalonia they ranged between 2.7 and 24.3 in 1993 and 1.4 and 23.8 in 1994; extreme quotient was 9 and coefficient of variation 52% in 1993, and 7 and 42% in 1994 respectively. All these differences were significant (p < 0.005). There was no significant correlation between socioeconomic level and development of primary health care and rates of avoidable paediatric hospitalization by health areas or sectors. CONCLUSIONS: Avoidable paediatric hospitalization represent a significant proportion of paediatric hospitalizations. There are differences in avoidable paediatric hospitalization rates by health areas and sectors, not associated with socioeconomic level and primary care indicators.

[Hospital admissions of children for conditions treatable by ambulatory care in the community of Valencia]. / Ingresos hospitalarios infantiles por procesos susceptibles de cuidados ambulatorios en la Comunidad Valenciana.

OBJECTIVE: To describe the importance which ambulatory care sensitive conditions (ACSC) have for the child population of the Valencia Community during the period 1980 to 1988, taken from the Hospital Morbidity Survey (HMS). DESIGN: Descriptive, retrospective study. SETTING: Hospital discharges collected in the HMS from the Valencia Community. PATIENTS: Children under 15 years old. MEASUREMENTS AND MAIN RESULTS: The total percentage of hospital discharges from ACSC observed were 16, 13.2 and 10% for the provinces of Valencia, Castellón and Alicante respectively. The highest percentage was shown in the 1 to 4 year old age group (19%). The proportion of discharges for ACSC was higher in girls (15%) than in boys (13%). Children under one year old show the highest rates. Valencia has for the whole period the highest rate ratio than 1 of being hospitalised for ACSC. CONCLUSIONS: The magnitude of these conditions is important and suggest the possibility of their use as a monitoring instrument of certain health care activities.