Assessing the social impacts of the COVID-19 crisis using phone helplines. The case of the Balearic Islands, Spain.

Background: Crises and health policies to tackle them can increase health inequalities. We explored the scope and usefulness of helplines set up during the COVID-19 crisis and characterised the vulnerability of their users. This study explored the geographic and socioeconomic effects of the telephone helplines set up by the Balearic Islands Government and aimed to characterise the vulnerability of their users. Methods: Telephonic survey combined with a geographical analysis of a sample of calls made between 15th of March and 30th of June of 2020 to five helplines: COVID-19 general information; psychological, social (minimum vital income), labour (temporary employment regulation), and housing (rental assistance) helps. The questionnaire included sociodemographic and housing characteristics, type of problem, and if it was solved or not. We used multinomial regression to explore factors associated with having solved the problem. We calculated the standardised rate of calls by municipality using Chi-squared and z-test to test differences. Results: 1,321 interviews from 2,678 selected (231 excluded, 608 untraceable, and 518 refusals). 63.8% of women, 48.7% were born in another country. They had no internet at home in 3.1%, only on the phone in 17.3%. The 23.5% had no income at home. The Problem was solved in 25.4%, and partly in 30.9%. Factors associated with not solving the problem were not having income at home (p = 0.021), labour (p = 0.008), economic (p = 0.000) or housing (p = 0.000) problems. People from 55 of 67 municipalities did at least one call. The highest rates of calls were from coastal tourist municipalities. Conclusion: Helplines reached most of the territory of the Balearic Islands and were used mainly in tourist municipalities. It probably has not been helpful for families with more significant deprivation. Digital inequalities have emerged.

¿Cómo influyen los determinantes sociales de la salud en el cáncer de mama? / How do social determinants of health influence breast cancer?

Objetivo: explorar la influencia de los determinantes sociales de la salud en la etiología, el proceso diagnóstico, el tratamiento, la vivencia de la enfermedad y la supervivencia del cáncer de mama. Métodos: revisión exploratoria de la literatura. Se consultó la base Pubmed, donde se identificaron artículos publicados entre los años 2019 y 2022. Los criterios de inclusión fueron: sexo femenino y artículos del tipo revisión, los informes de casos y/o la revisión sistemática. Resultados: la edad avanzada, la obesidad, el consumo de alcohol y/o tabaco aumentaron el riesgo de esta enfermedad. La pobreza se asoció con un diagnóstico premenopáusico más agresivo y con una supervivencia más pobre, el bajo nivel educativo derivó en un diagnóstico tardío y una tasa de supervivencia más baja, la raza negra se asoció a un diagnóstico tardío, estadios más avanzados y subtipos más agresivos del mismo. La dieta mediterránea y la actividad física fueron factores protectores. Otros determinantes sociales como la religión, el apoyo social o las condiciones laborales influyeron en menor o mayor medida en el cáncer de mama. Conclusiones: los determinantes sociales contribuyen a las desigualdades existentes en cada una de las etapas del proceso que esta enfermedad conlleva. Se necesitan intervenciones eficaces que tengan en cuenta los contextos sociales y ambientales. (AU)

Objective: To explore the influence of the social determinants of health in the etiology, diagnostic process, treatment, experience of disease and survival of breast cancer. Methods: Exploratory review of the literature. The Pubmed database was consulted, where articles published between 2019-2022 were identified. The inclusion criteria were female gender and articles of the review, case report and/or systematic review type. Results: Advanced age, obesity, alcohol and/or tobacco consumption increased the risk of this disease. Poverty was associated with more aggressive premenopausal diagnosis and poorer survival, low educational level led to later diagnosis and lower survival rate, black race was associated with later diagnosis, more advanced stages, and more subtypes aggressive of it. The Mediterranean diet and physical activity were protective factors. Other social determinants such as religion, social support or working conditions influenced breast cancer to a lesser or greater extent. Conclusions: Social determinants contribute to the existing inequalities in each of the stages of the process that this disease entails. Effective interventions are needed that take into account social and environmental contexts. (AU)

Vulnerabilidad sobrevenida. El impacto social de la Covid-19 / Successful vulnerability. The social impact of Covid-19

Las crisis sanitarias, así como las medidas adoptadas para hacerles frente, pueden aumentar las desigualdades. Este estudio quiere ahondar sobre el impacto social que ha tenido la crisis sanitaria de la COVID-19. Objetivos: 1. Identificar aquellas personas, grupos o familias más vulnerables y aquellas a las que les ha afectado especialmente la crisis del COVID-19; 2. Describir en profundidad la situación que han vivido y cómo la han afrontado; 3. Conocer qué dificultades han encontrado para solicitar las ayudas del Gobierno. Métodos: Estudio cualitativo que forma parte de un estudio más amplio cuantitativo, que combinó una encuesta telefónica con un estudio geográfico. Se entrevistaron 1.321 personas mediante un cuestionario semiestructurado con algunas preguntas abiertas, de las cuales se seleccionaron 243 para su análisis cualitativo. Se realizaron 8 entrevistas en profundidad. Resultados: El impacto de la pandemia se ha reflejado en forma de malestar psicológico. Algunas familias han tenido que cambiar de vivienda, comunidad autónoma e incluso volver a la vivienda de sus padres. Se han observado grandes dificultades para las familias con personas dependientes (mayores, con discapacidad, hijos e hijas); monoparentales; para familias cuyo sustento básico son pensiones no contributivas y para las personas solas. Los Servicios Sociales han sido un gran apoyo, aunque se ha percibido falta de coordinación entre estos y las diferentes instituciones. Conclusiones: Dadas las características de esta pandemia, algunos grupos no vulnerables se han encontrado con dificultades, no han podido hacer frente a la situación, y los que ya eran vulnerables han aumentado su vulnerabilidad. (AU)

Objectives: 1) To rank more vulnerable people, groups, or households in relation to how the COVID-19 crisis has affected them; 2) To describe the circumstances experienced during the COVID-19 crisis, the way to dealt with, and the success in handling them; 3) To identify the difficulties when applying for government aid. Methods: It was a qualitative study that was part of a broader quantitative study, combining a telephone survey with a geographical study. We phone surveyed 1321 persons using a semi-structured questionnaire with some open questions. From them, 243 we selected for qualitative analysis. Afterwards, we conducted eight in-depth interviews. Results: The COVID-19 crisis caused psychological discomfort. The drawback most frequently reported has been the need to move into worse homing conditions, which include moving to other neighbourhoods or regions, or sharing with relatives (typically, moving into parent’s home). The households more frequently reporting difficulties have been those with dependent persons (young children, elderly or disabled people), single-parents households, households receiving basic subsidy only, and singles living alone. In most cases, Social Services have helped to dealt with the effects of COVID -19 crisis. However, coordination between different institutions should be improved. Conclusions: Given the characteristics of this pandemic and the impossibility of anticipating it, people already socially vulnerable have encountered special difficulties in dealing with the COVID-19 crisis, have been unable to cope with them, and have worsened their degree of vulnerability. (AU)

Relationship between time from symptom's onset to diagnosis and prognosis in patients with symptomatic colorectal cancer.

BACKGROUND: Controversy exists regarding the relationship of the outcome of patients with colorectal cancer (CRC) with the time from symptom onset to diagnosis. The aim of this study is to investigate this association, with the assumption that this relationship was nonlinear and with adjustment for multiple confounders, such as tumor grade, symptoms, or admission to an emergency department. METHODS: This multicenter study with prospective follow-up was performed in five regions of Spain from 2010 to 2012. Symptomatic cases of incident CRC from a previous study were examined. At the time of diagnosis, each patient was interviewed, and the associated hospital and clinical records were reviewed. During follow-up, the clinical records were reviewed again to assess survival. Cox survival analysis with a restricted cubic spline was used to model overall and CRC-specific survival, with adjustment for variables related to the patient, health service, and tumor. RESULTS: A total of 795 patients had symptomatic CRC and 769 of them had complete data on diagnostic delay and survival. Univariate analysis indicated a lower HR for death in patients who had diagnostic intervals less than 4.2 months. However, after adjustment for variables related to the patient, tumor, and utilized health service, there was no relationship of the diagnostic delay with survival of patients with colon and rectal cancer, colon cancer alone, or rectal cancer alone. Cubic spline analysis indicated an inverse association of the diagnostic delay with 5-year survival. However, this association was not statistically significant. CONCLUSIONS: Our results indicated that the duration of diagnostic delay had no significant effect on the outcome of patients with CRC. We suggest that the most important determinant of the duration of diagnostic delay is the biological profile of the tumor. However, it remains the responsibility of community health centers and authorities to minimize diagnostic delays in patients with CRC and to implement initiatives that improve early diagnosis and provide better outcomes.

[Smoking prevalence and associated factors during pregnancy in Andalucía 2007-2012]. / Prevalencia de tabaquismo durante el embarazo y factores asociados en Andalucía 2007-2012 (*).

BACKGROUND: Smoking during pregnancy is the most important preventable perinatal health problem. The aim of this research is to determine smoking prevalence in pregnant women at different times of pregnancy in Andalucía, using biochemical validation methods and to explore factors associated with it. METHODS: Cross-sectional study. The study population was pregnant women followed in andalusian public health centers. A random sample of 40 health centers, stratified by number of pregnancies was collected, with 1813 pregnant enrolled in 3 independent samples (beginning and end of pregnancy, postpartum). The smoke exposure was measured by urinary cotinine, self-report and carbon monoxide in exhaled air. Control variables were socio-demographic, obstetric and related to smoking habit. A logistic regression was performed to explore factors associated with pregnancy smoking. RESULTS: The mean prevalence in the whole sample was 21.6%, which was lower at the end of pregnancy (15.6%) and postpartum (16.7%) than at the beginning (30.3%). Daily smokers fell from 56.3% before pregnancy to 14% at the end (according to selfreport). Most of the quitters gave up before pregnancy (21.8%) or when they noticed they were pregnant (23.6%). Deception rate was 19.6%, varying according to gestational age and the amount of tobacco consumed. Younger age (OR: 0.956, CI 0.92-0.99), be exposed to second hand smoke at home (OR: 3.48, CI 2.6 to 4.7), a higher level of consumption before pregnancy (6-10 OR 13.1 CI 3 to 56.9,> 10 OR 25.1 CI 5.8 to 109.6), greater gestational age at measurement (end OR: 0.5 CI: 0.4-0.8; immediate postpartum OR 0.4 CI 0.3-0.6) and lower educational level (no education and first grade compared to university OR: 1.98, CI 1.22 to 3.22) were identified as factors associated. CONCLUSION: Consumption variations with gestational age compel to indicate the time of measurement in prevalence studies. The profile of the pregnant smoker was being young, poorly educated, exposed to tobacco smoke at home and with a previous history of heavy smoking.

Auricular acupuncture for primary care treatment of low back pain and posterior pelvic pain in pregnancy: study protocol for a multicentre randomised placebo-controlled trial.

BACKGROUND: About 45% of all pregnant women suffer low back pain and/or pelvic girdle pain (LBPGP). This study seeks to evaluate the effect of auricular acupuncture on LBPGP compared with placebo auricular acupuncture and with standard obstetric care in the field of primary health care. METHODS AND DESIGN: This study will be a four-parallel-arm, multicentre, randomised, placebo-controlled trial. A total of 212 pregnant women (24 to 36 weeks' gestation), aged at least 17 years, with LBPGP, will be randomly assigned to the verum auricular acupuncture plus standard obstetric care group (VAAc), to the non-specific auricular acupuncture plus standard obstetric care group (NSAAc), to the non-specific placebo auricular acupuncture plus standard obstetric care group (PAAc), or the standard obstetric care group (SOC). The VAAc, NSAAc, and PAAc groups will receive treatment at three auricular acupuncture points (specific points for the VAAc group or non-specific ones for the NSAAc and PAAc groups), once a week for 2 weeks; the SOC group will receive only standard obstetric care during the same period. The primary outcome will be the reduction in pain intensity, according to the visual analogue scale (iVAS), at 2 weeks after the start of treatment. The secondary outcomes will be functional status with respect to LBPGP (according to the Roland-Morris disability questionnaire), health-related quality of life (SF12) at 2 weeks after the start of treatment, and iVAS at 12 and 48 weeks postpartum. DISCUSSION: This trial will implement a high-quality methodology and may provide evidence for the efficacy, safety, and specificity of auricular acupuncture as a treatment for pregnant women with LBPGP. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41033073 (date 20/03/2014).

Prevalencia de tabaquismo durante el embarazo y factores asociados en Andalucía 2007-2012 / Smoking prevalence and associated factors during pregnancy in Andalucía 2007-2012

Fundamentos: El tabaquismo durante la gestación constituye el principal problema prevenible de salud perinatal. El objetivo es establecer la prevalencia de tabaquismo de las mujeres gestantes en distintos momentos del embarazo así como explorar factores asociados al mismo. Métodos: estudio transversal. La población diana fueron las mujeres cuyo control de embarazo se realizaba en centros de salud públicos. Muestra aleatoria representativa de 40 centros estratificados según número de embarazos. Participaron 1.813 mujeres seleccionadas en 3 muestras independientes (inicio y final del embarazo y posparto). La exposición se midió mediante cotinina en orina, autodeclaración y monóxido de carbono. Se registraron variables ociodemográficas, de tabaquismo y clínico-obstétricas. Se realizó una regresión logística para identificar los factores asociados al tabaquismo. Resultados: La prevalencia media fue 21,6%, menor al final del embarazo (15,6%) y en el puerperio (16,7%) y mayor en el principio del embarazo (30,3%). Las mujeres fumadoras diarias pasaron del 56,3% antes del embarazo al 14% al final (autodeclaración). El 21,8% de los abandonos se produjo antes del embarazo y el 23,6% cuando las mujeres supieron que estaban embarazadas. La ocultación del consumo fue 19,6% . Fueron factores asociados ser joven (OR: 0,956; IC: 0,92-0,99), estar ex- puesta al tabaco en el hogar (OR: 3,48; IC: 2,6-4,7), consumo pregestacional alto (6-10 OR: 13,1 IC: 3-56,9; >10 OR: 25,1 IC: 5,8-109,6), mayor edad gestacional en la medición (al final OR: 0,5 IC: 0,4-0,8; posparto inmediato OR: 0,4 IC: 0,3-0,6) y menor nivel de estudios (sin estudios y primer grado comparadas con universitarias OR: 1,98; IC: 1,22-3,22) . Conclusiones: El perfil de la mujer gestante fumadora es el de una mujer joven con bajo nivel educativo, expuesta al humo de tabaco en el hogar y con alto consumo pregestacional (AU)

Background: Smoking during pregnancy is the most important preventable perinatal health problem. The aim of this research is to determine smoking prevalence in pregnant women at different times of pregnancy in Andalucía, using biochemical validation methods and to explore factors associated with it. Methods: Cross-sectional study. The study population was pregnant women followed in andalusian public health centers. A random sample of 40 health centers, stratified by number of pregnancies was collected, with 1813 pregnant enrolled in 3 independent samples (beginning and end of pregnancy, postpartum). The smoke exposure was measured by urinary cotinine, self-report and carbon monoxide in exhaled air. Control variables were socio-demographic, obstetric and related to smoking habit. A logistic regression was performed to explore factors associated with pregnancy smoking. Results: The mean prevalence in the whole sample was 21.6%, which was lower at the end of pregnancy (15.6%) and postpartum (16.7%) than at the beginning (30.3%). Daily smokers fell from 56.3% before pregnancy to 14% at the end (according to selfreport). Most of the quitters gave up before pregnancy (21.8%) or when they noticed they were pregnant (23.6%). Deception rate was 19.6%, varying according to gestational age and the amount of tobacco consumed. Younger age (OR: 0.956, CI 0.92- 0.99), be exposed to second hand smoke at home (OR: 3.48, CI 2.6 to 4.7), a higher level of consumption before pregnancy (6-10 OR 13.1 CI 3 to 56.9,> 10 OR 25.1 CI 5.8 to 109.6), greater gestational age at measurement (end OR: 0.5 CI: 0.4-0.8; immediate postpartum OR 0.4 CI 0.3-0.6) and lower educational level (no education and first grade compared to univer- sity OR: 1.98, CI 1.22 to 3.22) were identified as factors associated. Conclusion: Consumption variations with gestational age compel to indicate the time of measurement in prevalence studies. The profile of the educated, exposed to tobacco smoke at home and with a previous history of heavy smoking (AU)

Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial.

OBJECTIVE: To compare the effectiveness of additional moxibustion at point BL67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation. METHODS: This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33-35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare. RESULTS: In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (RR 1.34, 95% CI 1.05 to 1.70) and 44.8% of those in the usual care group (RR 1.29, 95% CI 1.02 to 1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95% CI 3.1% to 55.2%) and the number needed to treat was 8 (95% CI 4 to 72). There were no severe adverse effects during the treatment. CONCLUSIONS: Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus. TRIAL REGISTRATION: Current Controlled Trials ISRCTN10634508.

Revisión de los trabajos publicados sobre promoción de la salud en jóvenes españoles / Review of published works on spanish youth health promotion

El objetivo de este estudio ha sido revisar las intervenciones de promoción de la salud dirigidas a jóvenes españoles, publicadas entre los años 1995 y 2000 en español, y describirlas de acuerdo al ámbito en el que se han desarrollado, los temas a los que se han dirigido, la metodología y el diseño de evaluación utilizados y los resultados obtenidos.Se identificaron 214 intervenciones. Las drogas ilegales fueron el tema en el que se centraron el mayor número de intervenciones (29,8 por ciento), seguido por el alcohol (15,9 por ciento), las conductas sexuales de riesgo (14,6 por ciento) y el ocio (12,6 por ciento). Las actividades realizadas con mayor frecuencia fueron: técnicas educativas participativas (30,7 por ciento), técnicas educativas expositivas (11,5 por ciento) y elaboración de materiales educativos (11 por ciento). En el 80,8 por ciento de casos había constancia de que se había realizado una evaluación. De ellas, las más frecuente fueron las evaluaciones de proceso (73,7 por ciento), y las menos frecuente las evaluaciones de resultados a medio-largo plazo (2,2 por ciento). Las metodologías de evaluación más utilizadas fueron los cuestionarios (28,2 por ciento). La combinación de técnicas cualitativas y cuantitativas fue utilizada en el 13,2 por ciento de los casos. Las 4 intervenciones en las que se midió el impacto a medio-largo plazo tenían como objetivo la prevención o reducción del consumo de tabaco y/o alcohol y/o cánnabis, y todas ellas consiguieron reducir el consumo de tabaco.En conclusión, parece necesario mejorar el diseño evaluativo de las intervenciones de promoción de la salud dirigidas a jóvenes en nuestro país y aumentar la difusión de las mismas mediante su publicación (AU)

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