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1.
Gac Sanit ; 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34823902

RESUMO

The COVID-19 pandemic currently affects populations worldwide. Although everyone is susceptible to the virus, there are numerous accounts of the pandemic having a greater impact on lower socioeconomic groups and minorities, which is a ubiquitous phenomenon. It is essential for public health administrations and governments to uncover and understanding these inequities to develop proper intersectoral policies to tackle this crisis. Therefore, developing a conceptual framework on this topic, describing the social mechanisms that explain the unjust distribution of the incidence and mortality of COVID-19, is a key task. The aim of this paper is to adapt the framework on social determinants of health from the World Health Organization to the specifics of COVID-19 pandemic. Thus, it identifies and explains the structural and intermediate determinants involved in this pandemic, and adds some new elements (such as the role of the oppression systems and communication) which may help to understand, and ultimately tackle, social inequities in COVID-19 distribution.

2.
Gac Sanit ; 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34742601

RESUMO

OBJECTIVE: To analyze by gender the relationship of forced displacements due to neglected housing insecurity with the physical and mental health of renters in Barcelona in 2019, distinguishing between economic (EHI) and legal (LHI) housing insecurity. METHOD: We conducted a cross-sectional study based on the Survey of the Living Conditions of Renters in the Barcelona Metropolitan Area 2019 (1021 women; 584 men). Self-reported health and mental well-being were the dependents variables; the main explanatory variable was neglected housing insecurity. We used adjusted robust Poisson regression models to compare health outcomes among people affected by neglected housing insecurity and those who were not affected. RESULTS: We observed that the probability of worse health outcomes are greater in those affected by EHI, followed by those affected by LHI, both compared to those who have not been affected by housing insecurity. This association are mainly observed in mental health of renters affected by EHI, even after adjusting for socioeconomic and other housing variables (in women PR: 1,17, CI95%: 1,03-1,33; in men PR: 1,21, CI95%: 1,01-1,43). CONCLUSIONS: Neglected housing insecurity is associated with worse mental health. Enhancing the visibility of neglected housing insecurity and raising awareness of its effects on health is urgently needed to tackle this massive but hidden problem.

3.
Health Care Women Int ; : 1-20, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34652257

RESUMO

Little is known about how feminist abortion support initiatives -born in legally restrictive settings- approach quality of care. We conducted one focus group and one semi-structured interview with activists from eight organizations operating in Latin America and the Caribbean to understand their perspectives and strategies around quality of abortion care. Activists underscore the need of evidence-based information, trained providers and accessibility for people with diverse needs and resources. Grounded on feminism, they also highlight autonomy, dignity, horizontality and a new definition of safety. If applied in formal health systems, these strategies could improve quality of abortion care in other contexts.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34444557

RESUMO

OBJECTIVE: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. METHODS: This is an ecological study of trends in three periods of time: two before (2000-2003 and 2004-2008), and one after (2009-2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. RESULTS: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. CONCLUSIONS: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.


Assuntos
Recessão Econômica , Cirrose Hepática , Teorema de Bayes , Cidades , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Mortalidade , Fatores Socioeconômicos , Espanha
5.
J Urban Health ; 98(4): 496-504, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34231119

RESUMO

While the negative effects of housing insecurity and unaffordability on health are well known, most of the studies in Spain have focused on very specific social groups so their findings cannot be extrapolated to the general population. The aim of this study is to assess the effects of housing stress and risk of displacement due to economic reasons, and their combined effect, on the mental and physical health of the general population from a middle-income neighborhood of Barcelona. We conducted a cross-sectional study using a household health survey which included respondents from a representative sample of 1202 non-institutionalized residents (> 18 years old) of the Horta neighborhood. We carried out a descriptive analysis, estimated the prevalence of poor mental and self-rated health (stratifying by the independent variables) and fitted robust Poisson regression models to estimate the effects of housing stress (HS) and the risk of forced displacement (RD) on self-rated health and mental health (GHQ-12). All analyses were stratified by sex. We found a higher likelihood of poor general and mental health among people affected by HS and/or RD compared to those not affected by HS and/or RD. A graded effect of HS and RD emerged mainly on mental health, even after adjusting by socioeconomic variables and housing tenure. The serious problem of housing insecurity and unaffordability in Spain is a widespread public health issue. Evidence-based public policies to improve well-being and health of people under this threat are urgently needed.


Assuntos
Habitação , Saúde Mental , Adolescente , Estudos Transversais , Humanos , Características de Residência , Espanha/epidemiologia
6.
Sex Reprod Health Matters ; 29(3): 1948953, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34252017

RESUMO

Self-managed abortion is a common self-care practice that enables pregnant people to exercise their rights to health, bodily autonomy and to benefit from the advances of science even when living in contexts that do not guarantee these rights. In this interpretative qualitative study, we aimed to understand women's abortion trajectories, experiences with self-managed abortion and assessments of the quality of care provided by Women Help Women (WHW, an international activist non-profit organisation working on abortion access). Grounded in feminist epistemology and health inequalities approaches, we conducted eleven semi-structured interviews in Santiago, Chile. We found that illegality, stigma and expectations surrounding motherhood and abortion determined women's experiences. Participants perceived the WHW service as good, trustworthy, fast and affordable, and valued confidentiality and privacy; the quantity and quality of information; having direct, personalised and timely communication with service staff; being treated with respect; and feeling safe, cared for and supported in their decisions. Most participants considered self-managed abortion appropriate and acceptable given their circumstances. Fear was the dominant feeling in women's narratives. Some participants mentioned missing instant communication, in-person support and professional care. We conclude that support, information and company are key to improving abortion seekers' experiences and enabling their decisions, particularly in legally restrictive settings. Centring care in pregnant people's needs and autonomy is fundamental to ensure safe, appropriate and accessible self-care interventions in reproductive health. Social and legal changes, such as public funding for abortion, destigmatisation and decriminalisation, are needed to realise people's right to higher standards of healthcare.


Assuntos
Aborto Induzido , Telemedicina , Chile , Feminino , Acesso aos Serviços de Saúde , Humanos , Percepção , Gravidez
7.
Artigo em Inglês | MEDLINE | ID: mdl-34199387

RESUMO

Children have been identified as being particularly vulnerable to energy poverty (EP), but little empirical research has addressed the effect of EP on children's health and wellbeing, especially in southern Europe. In this work we aimed to provide an in-depth description of the distribution of EP by sociodemographic, socioeconomic and housing characteristics, as well as to analyse the association between EP and health and wellbeing in children in Barcelona. We performed a cross-sectional study using data from the Barcelona Health Survey for 2016 (n = 481 children under 15 years). We analysed the association between EP and health outcomes through prevalence differences and prevalence ratios (PR) and their 95% confidence interval (CI), using Poisson regression models with robust variance. In Barcelona, 10.6% of children were living in EP and large inequalities were found by sociodemographic, socioeconomic and housing characteristics. EP was strongly associated with poor health in children (PR (95% CI): 7.70 (2.86, 20.72)). Living in EP was also associated with poor mental health (PR (95% CI): 2.46 (1.21, 4.99)) and with more cases of asthma (PR (95% CI): 4.19 (1.47, 11.90)) and overweight (PR (95% CI): 1.50 (1.05, 2.15)) in children. It is urgent to develop specific measures to avoid such serious and unfair health effects on children.


Assuntos
Habitação , Pobreza , Criança , Cidades , Estudos Transversais , Europa (Continente) , Humanos , Fatores Socioeconômicos
8.
Artigo em Inglês | MEDLINE | ID: mdl-34070635

RESUMO

The geographical distribution of mortality has frequently been studied. Nevertheless, those studies often consider isolated causes of death. In this work, we aim to study the geographical distribution of mortality in urban areas, in particular, in 26 Spanish cities. We perform an overall study of 16 causes of death, considering that their geographical patterns could be dependent and estimating the dependence between the causes of death. We study the deaths in these 26 cities during the period 1996-2015 at the census tract level. A multivariate disease mapping model is used in order to solve the potential small area estimation problems that these data could show. We find that most of the geographical patterns found show positive correlations. This suggests the existence of a transversal geographical pattern, common to most causes of deaths, which determines those patterns to a higher/lower extent depending on each disease. The causes of death that exhibit that underlying pattern in a more prominent manner are chronic obstructive pulmonary disease (COPD), lung cancer, and cirrhosis for men and cardiovascular diseases and dementias for women. Such findings are quite consistent for most of the cities in the study. The high positive correlation found between geographical patterns reflects the existence of both high and low-risk areas in urban settings, in general terms for nearly all the causes of death. Moreover, the high-risk areas found often coincide with neighborhoods known for their high deprivation. Our results suggest that dependence among causes of death is a key aspect to be taken into account when mapping mortality, at least in urban contexts.


Assuntos
Mortalidade , Causas de Morte , Cidades , Feminino , Geografia , Humanos , Masculino , Risco , Fatores Socioeconômicos
9.
Artigo em Inglês | MEDLINE | ID: mdl-34158409

RESUMO

BACKGROUND: Intraurban sociodemographic risk factors for COVID-19 have yet to be fully understood. We investigated the relationship between COVID-19 incidence and sociodemographic factors in Barcelona at a fine-grained geography. METHODS: This cross-sectional ecological study is based on 10 550 confirmed cases of COVID-19 registered during the first wave in the municipality of Barcelona (population 1.64 million). We considered 16 variables on the demographic structure, urban density, household conditions, socioeconomic status, mobility and health characteristics for 76 geographical units of analysis (neighbourhoods), using a lasso analysis to identify the most relevant variables. We then fitted a multivariate Quasi-Poisson model that explained the COVID-19 incidence by neighbourhood in relation to these variables. RESULTS: Neighbourhoods with: (1) greater population density, (2) an aged population structure, (3) a high presence of nursing homes, (4) high proportions of individuals who left their residential area during lockdown and/or (5) working in health-related occupations were more likely to register a higher number of cases of COVID-19. Conversely, COVID-19 incidence was negatively associated with (6) percentage of residents with post-secondary education and (7) population born in countries with a high Human Development Index. CONCLUSION: Like other historical pandemics, the incidence of COVID-19 is associated with neighbourhood sociodemographic factors with a greater burden faced by already deprived areas. Because urban social and health injustices already existed in those geographical units with higher COVID-19 incidence in Barcelona, the current pandemic is likely to reinforce both health and social inequalities, and urban environmental injustice all together.

10.
Front Pharmacol ; 12: 617687, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33959003

RESUMO

Background: Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Nonprofit organizations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a nongovernmental organization based on the primary healthcare system, which provides free-of-charge access to medicines and their utilization pattern of medicines and healthcare products. Methods: This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries' characteristics was conducted and compared to the general population. Results: The beneficiaries (N = 1,206) were mainly adults with a low level of education, unemployed, with functional disability, and with ≥1 child. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and were more likely to be divorced and unemployed. The beneficiaries were polymedicated, and most were using medication related to the nervous (79%), musculoskeletal (68%), and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed, and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The pediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders, and attention deficit hyperactivity disorder). Conclusion: Patients with severe, chronic, and disabling conditions are affected by pharmaceutical poverty. While the system of copayment remains unchanged, family physicians and pediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.

11.
Aten Primaria ; 53(5): 102020, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33774346

RESUMO

OBJECTIVES: To explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants' satisfaction. DESIGN: Quasi-experimental before-after study. SETTING: Five low-income neighbourhoods of Barcelona during 2010-15. PARTICIPANTS: 147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months. INTERVENTION: Primary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers. MEASUREMENTS: We assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models. RESULTS: At 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04-1.62)] and mental health improvements [ß: 2.92(1.64-4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10. CONCLUSION: This community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.


Assuntos
Saúde Mental , Saúde Pública , Idoso , Acessibilidade Arquitetônica , Feminino , Humanos , Qualidade de Vida , Inquéritos e Questionários
12.
Gac Sanit ; 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33771401

RESUMO

OBJECTIVE: Previous research has found persistent socioeconomic inequalities in health outcomes at the national level, with different patterns after the economic crisis. However, inequalities in urban areas are also important. This study analyses socioeconomic inequalities in self-assessed health and mental health in the city of Barcelona. METHOD: Repeated cross-sectional design using quinquennial data from the Barcelona Health Surveys carried out in 2001, 2006, 2011 and 2016 for the population older than 22 years. Robust Poisson regressions models were used to compute socioeconomic gradients and relative (RII) and slope indexes of inequality (SII) by occupational social class, with stratification by sex. RII and SII were also obtained with further adjustment by employment situation. RESULTS: A consistent socioeconomic gradient was found for all years except for 2011. Relative and absolute inequalities followed a V-shape, showing a drop during the economic crisis but widening thereafter to recover pre-crisis figures for self-assessed health and widening for mental health, in both relative and absolute terms in 2016. Adjustment for employment situation reduces inequalities but a large part of these inequalities remains, with variability across years. CONCLUSIONS: The lasting effects of the 2008 economic crisis and the austerity programmes imposed since then may have contributed to the persistence of socioeconomic inequalities in self-assessed health and the widening of those for mental health.

13.
Gac. sanit. (Barc., Ed. impr.) ; 35(1): 60-66, ene.-feb. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-202096

RESUMO

OBJETIVO: Analizar los efectos de la inseguridad residencial sobre la salud y si estos son modificados por la situación laboral en personas participantes en el programa Treball als Barris, en Barcelona, entre 2015 y 2016. MÉTODO: Se realizó un estudio longitudinal con 469 personas a las cuales se les realizó una encuesta, basal y al año de seguimiento, que incluyó información sociodemográfica, residencial, laboral y de salud. Se construyó una variable de trayectorias residenciales con las situaciones al inicio y después del seguimiento. Luego se realizó un análisis descriptivo, se ajustaron modelos de regresión para estimar el efecto de la inseguridad residencial y de la situación laboral sobre la salud, y finalmente se analizó la interacción. RESULTADOS: La inseguridad residencial afectó principalmente la salud de las mujeres (la razón de prevalencia [RP] de mala salud percibida de quienes se mantuvieron en inseguridad residencial fue de 2,29, con un intervalo de confianza del 95% [IC95%] de 1,36-3,84, en comparación con quienes se mantuvieron en seguridad residencial), mientras que en los hombres fue la situación laboral la que tuvo efectos significativos sobre la salud (los desempleados sin subsidio ni prestación presentaron RP de mala salud percibida de 3,16, con IC95% de 1,02-6,15, comparados con quienes trabajaban). Además, parece existir una interacción de la inseguridad residencial y la situación laboral en los efectos sobre la salud mental de los hombres. CONCLUSIÓN: La inseguridad residencial es un fenómeno que se ha intensificado en los últimos años, tiene efectos negativos sobre la salud y podría interactuar con otros determinantes sociales, como el empleo, fundamentalmente en la salud mental de los hombres


OBJECTIVE: This study aims to analyse the effects of housing insecurity on health and whether they are modified by employment status of people belonging to the Treball als Barris programme in Barcelona (Spain) between 2015 and 2016. METHOD: We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals at baseline and after one year of follow-up. We then carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them. RESULTS: Among women, we found negative effects of housing insecurity on health (the prevalence ratio [PR] of poor self-reported health among women with housing insecurity was 2.29, with a 95% confidence interval [95%CI] of 1.36-3.84, compared to those in secure housing), while, among men, the main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [95%CI: 1.02-6.15] compared to those who were employed after follow-up). In addition, the results suggest an interaction between housing and employment status on mental health among men. CONCLUSION: Housing insecurity rates have increased in recent years. It produces negative effects on health and can interact with other social determinants such as employment, mainly on men's mental health


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Desemprego/psicologia , Emprego , Nível de Saúde , Determinantes Sociais da Saúde , Estresse Psicológico/epidemiologia , Estudos Longitudinais , Inquéritos e Questionários , Habitação/economia , Saúde Mental
14.
Artigo em Inglês | MEDLINE | ID: mdl-33573323

RESUMO

Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41-1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44-1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe.


Assuntos
COVID-19/epidemiologia , Disparidades nos Níveis de Saúde , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Teorema de Bayes , Criança , Pré-Escolar , Cidades , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias , Espanha/epidemiologia , Adulto Jovem
15.
Health Place ; 67: 102294, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526205

RESUMO

The aim of this study is to analyse the time trends in the European Union (EU) before and during the economic crisis in 1) the energy poverty (EP) prevalence; 2) the association between EP and health and 3) the impact of EP on health. We analyse trends among women and men in two EU macro regions, defined by a novel index of structural vulnerability to EP. The study shows how EP and its impact on health worsened during the economic crisis and identifies groups at higher risk such as women and people living in Mediterranean and Eastern European countries, which have been found to be countries with higher structural vulnerability to EP.


Assuntos
Recessão Econômica , Pobreza , União Europeia , Feminino , Humanos , Masculino
16.
Environ Pollut ; 271: 116393, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33388678

RESUMO

The quality characteristics of urban green spaces (UGS) have been suggested to play a critical role in their use and their potentials to exert health effects. However, epidemiological studies evaluating such a role are scarce. These studies have generally focused on a limited number of quality dimensions. We studied the association between 10 UGS quality dimensions, assessed through a comprehensive multidimensional tool, and physical activity, overweight/obesity, and UGS use. Our study was based on 2053 adults participating in the Barcelona Health Survey (2016) and the quality of 149 UGS located in Barcelona, Spain. For each participant, we abstracted the average and maximum quality score separately for each of the 10 quality dimensions and an overall quality score for the UGS within 300 m of the participant's residential address. Data on the study outcomes were obtained through face-to-face interviews. We developed logistic regression and negative binomial models to assess our evaluated associations and conducted mediation analyses between the different outcomes. We observed that the overall quality of UGS was associated with higher likelihood of engaging in moderate-to-vigorous physical activity (OR:1.13; 95% CI:1.00-1.27), lower risk of overweight/obesity (OR: 0.88; 95% CI: 0.79-0.98), and increased use of UGS (exponentiated regression coefficient: 1.08; 95% CI:1.01-1.15). For the quality dimensions, we observed different patterns of associations depending on the outcome; however, bird biodiversity and amenities seem to be relevant to all of our evaluated outcomes. The mediation analysis suggested that UGS use mediate the association between quality and physical activity, while physical activity mediates the association between quality and overweight/obesity. The novel results from this study will allow decision-makers better design UGS and directly pinpoint relevant quality dimensions to promote physical activity, reduce the risk of overweight/obesity and boost the use of UGS amongst citizens.


Assuntos
Exercício Físico , Parques Recreativos , Adulto , Humanos , Obesidade/epidemiologia , Espanha
17.
Aten. prim. (Barc., Ed. impr.) ; 53(1): 3-11, ene. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200083

RESUMO

OBJETIVO: Evaluar las características métricas del índice Primary Care Assessment Tool de 10 ítems, para adultos (PCAT-A10), versión en castellano y catalán, reducida del original Primary Care Assessment Tool-Adult Edition (PCAT-AE), habiendo modificado el ítem de salud mental. DISEÑO: Estudio observacional transversal. Emplazamiento: Población residente en la ciudad de Barcelona. PARTICIPANTES: De los 3.496 participantes mayores de 14 años de la muestra aleatoria representativa de la población de Barcelona, de la Encuesta de Salud de Barcelona 2016-17, se seleccionaron los que declararon tener un médico/a de cabecera, que alguna vez en la vida habían realizado una visita a algún especialista y que habían contestado más del 50% de ítems del PCAT-A10 (n = 3.107). Mediciones principales: Descriptiva de los ítems, análisis de consistencia interna y de correlación ítem-total corregida del índice PCAT-A10 modificado y los 10 ítems que lo conforman. Se analizan tres escenarios de tratamiento de las no respuestas: sustitución por 0, por el valor intermedio (2,5) y excluyendo las personas que no contestaron algún ítem. RESULTADOS: El índice PCAT-A10 obtuvo alfa de Cronbach de 0,73, 0,79 y 0,85 en los tres escenarios nombrados, correlaciones ítem-total corregida entre 0,41 y 0,66, y 20,8% de no respuesta al ítem de salud mental. CONCLUSIONES: La nueva versión del PCAT-A10 presenta una alta fiabilidad con una mayor respuesta en el ítem de salud mental respecto a la versión anterior


OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n = 3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Transversais , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Valores de Referência , Espanha , Saúde Mental/estatística & dados numéricos
18.
Gac Sanit ; 35(1): 60-66, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-31732187

RESUMO

OBJECTIVE: This study aims to analyze the effects of housing insecurity on health and if those are modified by employment status of people belonging to "Treball als Barris" program in Barcelona between 2015 and 2016. METHODS: We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals attended by "Treball als Barris" at baseline and after one year of follow-up. Then, we carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them. RESULTS: Among women, we found negative effects of housing insecurity on health (PR of poor self-reported health among women who stayed under housing insecurity was 2.29 [IC95%: 1.36-3.84] compared to those who stayed secured), while, among men, main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [IC95%: 1.02-6.15] compared to those who were employed after follow-up). In addition, results suggest an interaction between housing and employment status on mental health among. DISCUSSION: Housing insecurity rates have increased in last years. It produces negatives effects on health and can interact with other social determinants such as employment, mainly on men's mental health.

19.
Aten Primaria ; 53(1): 3-11, 2021 01.
Artigo em Espanhol | MEDLINE | ID: mdl-32035754

RESUMO

OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n=3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version.


Assuntos
Atenção Primária à Saúde , Adulto , Benzenoacetamidas , Estudos Transversais , Humanos , Piperidonas , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
20.
Gac Sanit ; 35(3): 282-288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32527681

RESUMO

Community health can reduce inequalities in health and improve the health of the most disadvantaged populations. In 2007, Barcelona Salut als Barris (Barcelona Health in the Neighbourhoods) was launched, a community health programme to reduce social inequalities in health. In 2018, this programme reached the 25 most disadvantaged neighbourhoods of the city. This article shares the lessons learned after 12 years of work. The programme was initially funded by a research grant and the funds were maintained during the economic crisis and were tripled when the programme became a political priority in the last municipal government. During the 12-year period, partnerships with stakeholders were generally stable and productive. Maximum community participation was obtained in the detection of health assets and needs and in action plans. During 2018, Barcelona Salut als Barris worked with more than 460 agents that co-produced 183 interventions involving more than 13,600 people. Most of the interventions assessed showed improvements in the health of participants, which could help to reduce health inequalities. The greatest difficulties were: a) citizen participation, b) the sustainability of working groups over the years, c) conflicts of interest, d) the sustainability of interventions, e) reaching certain minority groups and f) evaluation. The increase in resources in the last period contributed to the maturity and expansion of the programme. Key factors in its scope and results were political will, strong technical capacity and methodology, strong intersectoral partnerships and continued community work.


Assuntos
Participação da Comunidade , Disparidades nos Níveis de Saúde , Cidades , Humanos , Saúde Pública , Fatores Socioeconômicos
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