Tuberculosis y factores socioeconómicos en la población española: una revisión sistemática / Tuberculosis and socioeconomic factors in spanish population: a systematic review

FUNDAMENTOS: Existen diferentes variables socioeconómicas que condicionan la epidemiología, diagnóstico y tratamiento de la tuberculosis. El objetivo del siguiente trabajo fue analizar dichos factores en los últimos años en España. MÉTODOS: Se realizó una revisión sistemática de artículos originales escritos en inglés o castellano, entre los años 2007 y 2020. La búsqueda se realizó en las bases de datos Pubmed y Web of Science. Se siguieron los criterios STROBE para analizar la calidad de los estudios y seleccionando para su inclusión en la revisión aquellos que obtuvieron 15 puntos o más. RESULTADOS: Se analizaron 23 artículos, dividiendo las conclusiones por áreas temáticas. La proporción de personas extranjeras con tuberculosis varió en las diferentes comunidades autónomas entre un 10% y un 50%, pudiendo existir demora diagnóstica en este grupo respecto a los autóctonos y presentando mayor incidencia de resistencia a isoniacida, pero sin claro aumento en la multirresistencia. Se halló menor cumplimiento del tratamiento antituberculoso en caso de migración, adicción a drogas, coinfección de tuberculosis y VIH o falta de apoyo familiar. La infranotificación de casos de tuberculosis varió entre un 18% y un 28%, siendo mayor en casos de marginalidad social, coinfección de tuberculosis y VIH, nacionalidad española o sexo varón. La tuberculosis fue una de las enfermedades asociadas a VIH más frecuentes, aunque no se realizaron pruebas de cribado en casi el 18%, según la concurrencia de factores sociales de riesgo. CONCLUSIONES: En la incidencia, diagnóstico y tratamiento de la tuberculosis influyen numerosos factores sociales y económicos que condicionan su abordaje.(AU)

BACKGROUND: There are different socioeconomic variables which determine tuberculosis’s epidemiology, diagnosis and treatment. The objective of this paper was to analize these effects in the last years in Spain. METHODS: A systematic review was conducted. Screened studies were original articles written in English or Spanish and published between 2007 and 2020. Searching was performed in Pubmed and Web of Science databases. STROBE criteria were followed to analyze studies’s quality, and studies included in the review had 15 points or more. RESULTS: 23 articles were selected, and were classified in different topics. Foreigners’s proportion with tuberculosis changed in different autonomous communities between 10%-50%. There were diagnostic delay for this group compared to natives. This group had higher incidence of resistance to isoniazid, but without a clear increase in multidrug resistance. There were less adherence to tuberculosis’s treatment in case of immigration, drug addiction, HIV coinfection, or lack of family support. Under-reporting of tuberculosis cases varied between 18%-28%, and it was higher in cases of social marginality, HIV coinfection, Spanish nationality or male sex. There were also other social risk groups in which the diagnostic approach to tuberculosis was relevant, such as in schools and health centers. Tuberculosis was one of the most frequent HIV associated diseases, although screening tests were not performed in almost 18%, depending on the concurrence of social risk factors. CONCLUSIONS: Tuberculosis’s incidence, diagnosis, and treatment are influenced by a lot of social and economic factors, which determine the approach to this disease.(AU)

Impacto de la crisis económica sobre la percepción de la salud en la población española / Impact of the financial crisis on health perception in the Spanish population

Objetivo: analizar el impacto de la situación económica en la percepción del estado de salud y la capacidad explicativa de las características individuales en esta percepción. Método: estudio transversal con enfoque analítico. Se extrajeron datos de la Encuesta Nacional de Salud (ENSE) publicada en 2011-2012 (crisis económica) y en 2017 (recuperación). La variable dependiente fue la percepción de la salud recogida en una escala Likert de 1 (muy bueno) a 5 (muy malo). Las variables independientes fueron: el momento de recogida (crisis/recuperación), sociodemográficas, relacionadas con el estilo de vida, relativas al estado «objetivo» de salud y relacionadas con el uso de servicios. Se construyeron modelos lineales generalizados para dar respuesta a los objetivos. Para valorar la magnitud del tamaño del efecto de las asociaciones se valoró la dispersión de las distribuciones según la relación existente entre el efecto y la desviación estándar de la media (DS). Resultados: se encontró una mejoría en la percepción del estado de salud de -0,066 (intervalo de confianza [IC] 95%: entre -0,080 y -0,052) puntos en el período de recuperación. Se hallaron asociaciones de tamaño del efecto «moderado» entre una peor percepción de salud y las variables relacionadas con el estado «objetivo» de salud; y «pequeño», con las variables relacionadas con el estilo de vida poco saludable y la clase social más desfavorecida. Conclusión: los períodos de crisis económica se asocian a una peor percepción del estado de salud, impactando más en aquella población perteneciente a una categoría social baja, con hábitos de vida poco saludables y especialmente en los pacientes crónicos.(AU)

Objective: to analyse the impact of the economic situation on the perception of health status and the explanatory role of certain individual characteristics in its variability. Method: cross-sectional study with an analytical approach. Data from the Spanish National Health Survey (NHS) published in 2011/12 (economic crisis) and 2017 (recovery) were used. The dependent variable was self-perceived health measured on a Likert scale from 1 (very good) to 5 (very bad). Independent variables were: the time of collection (crisis/recovery), socio-demographic, lifestyle-related, related to “objective” health status and related to service use. Generalised Linear Models were constructed to tackle the objectives. To evaluate the magnitude of the effect size of the associations, the dispersion of the distributions was assessed according to the ratio of the effect to the standard deviation of the mean (SD). Results: an improvement in the self-perceived health of -0.066 (95%CI: -0.080/-0.052) points was detected for the recovery period. “Moderate” effect size associations were revealed between worse self-perceived health and variables related to “objective” health status and “small” with variables related to unhealthy lifestyle and most deprived social class.Conclusion: periods of the economic crisis are associated with worse self-perceived health with a greater impact on the population belonging to a low social category, unhealthy lifestyle habits and especially on chronic patients.(AU)

Crise econômica e a Covid-19: rebatimentos na vida (e morte) da classe trabalhadora brasileira / Economic crisis and COVID-19: impact on the life (and death) of the Brazilian working class / Crisis económica y Covid-19: los golpes en la vida (y muerte) de la clase trabajadora brasileña

Resumo Nesta breve exposição, pretende-se discutir como a crise político-econômica conjugou-se, à perfeição, à pandemia, para construir soluções lucrativas aos grandes capitais. O texto apresenta, com base na análise de dados recentes, como o Estado brasileiro, no governo Bolsonaro, empenha-se em aprofundar o programa de ajuste, por meio de privatizações de estatais e de rebaixamento dos direitos e do valor da força de trabalho, como base de um programa político-econômico e fiscal. A Nota explora ainda a hipótese de que tal plataforma tem o potencial de assegurar o continuado apoio da grande burguesia ao governo de Bolsonaro e Guedes.

Abstract In this brief presentation, we intend to discuss how the political-economic crisis combined perfectly with the pandemic to build profitable solutions for big capitalists. Based on the analysis of recent data, the text shows how the Brazilian State, under the Bolsonaro government, is committed to deepening the adjustment program, through privatization of state enterprises and downgrading the workforce's rights and value, as the basis of a political-economic and fiscal program. The Note also explores the hypothesis that such a platform has the potential to ensure the continued support of the great bourgeoisie to the government of Bolsonaro and Guedes.

Resumen En esta breve exposición, se pretende discutir como la crisis político económica se conjugó, a la perfección, con la pandemia, para construir soluciones lucrativas para los grandes capitales. El texto, basado en el análisis de datos recientes, presenta como el Estado brasileño, en el gobierno Bolsonaro, se empeña en profundizar el programa de ajuste, por medio de la privatización de las estatales y rebajando los derechos y el valor de la fuerza de trabajo, como base de un programa político económico y fiscal. La Nota explora aun la hipótesis de que tal plataforma tiene el potencial de asegurar el continuado apoyo de la gran burguesía al gobierno de Bolsonaro y Guedes.

Pandemia e desemprego no Brasil / Pandemia y desempleo en Brasil / The pandemic and the labor market in Brazil

Resumo A pandemia da COVID-19 é um problema de saúde pública global que imprimiu uma nova dinâmica à economia mundial. A rápida propagação da doença e o uso do distanciamento como forma de prevenção expuseram as desigualdades sociais e urbanas das cidades capitalistas. No Brasil, como em outros países, o isolamento social promoveu rápidas mudanças no mercado de trabalho, com impactos mais severos para 37,3 milhões de pessoas que vivem na informalidade, já que elas não têm direitos como Fundo de Garantia por Tempo de Serviço (FGTS) e seguro-desemprego. Para a Organização Internacional do Trabalho (OIT), as primeiras demissões estão ocorrendo entre aqueles que vivem do trabalho precário, como terceirizados, balconistas, garçons, funcionários de cozinha, diaristas, manipuladores de bagagem e produtos de limpeza. Assim, faremos uma breve síntese das consequências que a crise sanitária vem promovendo para os trabalhadores brasileiros, bem como proporemos medidas de enfrentamento que não se limitem aos auxílios emergenciais. A recuperação e a criação de ocupações dependerão, entre outros fatores, da retomada dos gastos com programas sociais e econômicos que reduziram as desigualdades sociais no início deste século, como o Programa de Aceleração do Crescimento em Favelas (PAC-Favelas); o Programa Minha Casa, Minha Vida; o Programa Bolsa Família (PBF); e o Programa de Geração de Emprego e Renda (Proger) com recursos do Fundo de Amparo ao Trabalhador (FAT). Esses programas podem e devem ser ampliados a fim de fazer com a que a economia retome o crescimento em longo prazo.

Resumen La pandemia de COVID-19 es un problema de salud pública global que ha dado una nueva dinámica a la economía mundial. La rápida propagación de la enfermedad y el uso de la distancia como un medio de prevención expusieron las desigualdades sociales y urbanas de las ciudades capitalistas. En Brasil, como en otros países, el aislamiento social promovió cambios rápidos en el mercado laboral con impactos más severos para 37,3 millones de personas que viven en la informalidad, ya que no tienen derechos como el Fondo de Garantía por Tiempo de Trabajo y seguro de desempleo. Para la Organización Internacional del Trabajo, los primeros despidos ocurren entre quienes viven del trabajo precario, tales como: trabajadores subcontratados, vendedores de mostrador, camareros, personal de cocina, jornaleros, manipuladores de equipaje y productos de limpieza. Por lo tanto, haremos una breve síntesis de las consecuencias que la crisis sanitaria está promoviendo para los trabajadores brasileños, y propondremos medidas de afrontamiento que no se limiten a las ayudas de emergencia. La recuperación y la creación de ocupaciones dependerán, entre otros factores, de la reanudación de los gastos en programas sociales y económicos que redujeron las desigualdades sociales a principios de este siglo, como el Programa de Aceleración del Crecimiento (PAC Favelas); el "Programa Minha Casa, Minha Vida"; el "Programa Bolsa Família" y el Programa Fondo de Amparo al Trabajador (FAT). Esos programas pueden y deben expandirse para que la economía vuelva a crecer a largo plazo.

Abstrac The COVID-19 pandemic is a global public health problem that has given new dynamics to the world economy. The rapid spread of the disease and the use of social distancing as a form of prevention exposed the social and urban inequalities of capitalist cities. In Brazil, as in other countries, social distancing has promoted rapid changes in the labor market with more severe impacts for 37.3 million people living in the informal sector, as they do not have rights to, for example, the severance pay indemnity fund (FGTS) and unemployment benefit. According to the International Labour Organization, the first layoffs are occurring among those who live off precarious work, such as: outsourced workers, clerks, waiters, kitchen workers, day laborers, baggage handlers, and cleaners. We show a brief synthesis of the consequences that the health crisis has brought to Brazilian workers and propose coping measures that are not limited to emergency aid. The recovery and creation of occupations will depend, among other factors, on the resumption of spending on social and economic programs that were able to reduce social inequalities at the beginning of this century, such as PAC-favelas; Minha Casa, Minha Vida Program; Bolsa Família Program and the FAT Employment and Income Generation Program. These programs can and must be expanded to bring the economy back to growth in the long run.

[Impact of Great Recession on mental health in Spain. SESPAS Report 2020]. / El impacto de la Gran Recesión en la salud mental en España. Informe SESPAS 2020.

The objective of this article is to identify the effects of the Great Recession on the mental health of people residing in Spain. After presenting a conceptual framework on the mechanisms through which economic crises affect mental health, we describe the main results of 45 papers identified in our search. Studies indicate a worsening of mental health in Spain in the years of economic crisis, especially in men. Working conditions (unemployment, low wages, instability, precariousness) emerge as one of the main channels through which mental health is put at risk or deteriorates. This deterioration occurs with intensity in particularly vulnerable groups, such as immigrant population and families with economic burdens. In the case of suicides, the results were inconclusive. Regarding the use of health care services, an increase in the consumption of certain drugs seems to be identified, although the conclusions of all the studies are not coincidental. Social inequalities in mental health do not seem to have remitted. We conclude that Spain needs to improve information systems to a better understanding of the health effects of economic crises. In terms of public policies, together with the reinforcement of health services aimed at addressing mental health problems, an income guarantee network for people in vulnerable situations should be promoted, as well as the development of policies aimed at the labour market.

The use of health care services in the Great Recession: evaluating inequalities in the Spanish context.

OBJECTIVE: To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain. METHOD: Repeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 (n=139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex. RESULTS: Healthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need. CONCLUSIONS: Healthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services.

Effect of the recent economic crisis on socioeconomic inequalities in mortality in nine urban areas in Europe.

OBJECTIVE: To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. METHOD: This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. RESULTS: We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. CONCLUSIONS: Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders.

[Trends in age-sex-specific mortality in Spain (1981-2016). Changes associated with the economic crisis]. / Tendencia de la mortalidad por edad y sexo en España (1981-2016). Cambios asociados a la crisis económica.

OBJECTIVE: To analyze trends in age-sex-specific mortality in Spain, and to identify if there have been changes following the onset of economic crisis. METHOD: A study of trends in mortality rates by sex and quinquennial groups of age was carried out, from 1981 to 2016. Time trends were established by joint-point regression models. The results of the last two periods identified in the regressions are presented in detail, identifying changes after the onset of the economic crisis. When slowdown or stagnation of the mortality trends were identified in several successive age groups, an analysis of trends by causes was carried out. RESULTS: Mortality was significantly reduced between 1981 and 2016. After the beginning of the economic crisis, the trend in total age-standardized mortality did not change for men, but it stagnated for women from 2013 to 2016. In the analysis by quinquennial age groups, the downward trend in mortality suffered a stagnation in men in all the groups between 15 and 39 years, which started between 2011 and 2014, and lasted until 2016. In both women and men, in the four groups between 60 and 79 years, the previous decline in mortality suffered a slowdown or stagnation, which began between 2009 and 2014, and continued until 2016. Negative changes in mortality trends were mainly influenced by external causes (in 15-39 years men) and diseases of the circulatory and respiratory systems (in 60-79 years men and women). CONCLUSIONS: The downward trend of mortality suffered stagnation or deceleration after the onset of the economic crisis in young men and 60-79 years old men and women.

Decline in fertility induced by economic recession in Spain.

OBJECTIVE: To describe trends in fertility in Spain before (pre-recession; 1998-2008) and during (recession period; 2009-2013) the economic crisis of 2008, taking into account women's age and regional unemployment in 2010. METHOD: The study consisted of a panel design including cross-sectional ecological data for the 17 regions of Spain. We describe fertility trends in Spain in two time periods, pre-recession (1998-2008) and recession (2009-2013). We used a cross-sectional, ecological study of Spanish-born women to calculate changes in fertility rates for each period using a linear regression model adjusted for year, period, and interaction between them. RESULTS: We found that compared to the pre-recession period, the fertility rate in Spain generally decreased during the economic recession. However, in some regions, such as the Canary Islands, this decrease began before the onset of the recession, while in other regions, such as the Basque country, the fertility rate continued to grow until 2011. The effects of the recession on the fertility rate are clearly observed in women aged 30-34 years. CONCLUSIONS: The current economic recession has disrupted the positive trend in fertility that began at the start of this century. Since Spain already had very low fertility rates, the further decline caused by the economic recession could jeopardize the sustainability of welfare-state systems.

El comportamiento dual de la crisis económica en las trayectorias laborales de inmigrantes colombianos en Madrid (España) / The Dual Behavior of the Economic Crisis in the Working Trajectories of Colombian Immigrants in Madrid, Spain

Resumen El artículo analiza el comportamiento de la crisis económica en las trayectorias laborales de colombianos en Madrid, examinando los dos segmentos del mercado de trabajo español. Recurriendo al método biográfico, se constata que la crisis irrumpe como elemento definitivo en el re-direccionamiento laboral. Dicha dinámica se muestra tanto para trabajadores del segundo segmento laboral, como para aquellos ubicados en el segmento primario, desarrollando distintas estrategias que permiten para unos, resistir las inclemencias del ciclo económico, y para otros, superar estos obstáculos. El capital social y la situación administrativa se muestran como mecanismos decisivos para afrontar este contexto.

Abstract The article analyzes the behavior of the economic crisis in the labor trajectories of Colombians in Madrid, by examining the two segments of the Spanish labor market. By using the biographical method, it is found that the crisis breaks as a definitive element in labor redirection. This dynamic is shown both for workers in the second labor segment, as well as for those located in the primary segment, by developing different strategies, which allow for some, to resist the inclement conditions of the economic cycle, and for others, to overcome these hurdles. The social capital and administrative situation are shown as decisive mechanisms to deal with this context.

Men, Women, and Economic Changes: Social Representations of the Economic Crisis / Hombres, mujeres y cambios económicos: representaciones sociales de la crisis económica

Resumen La crisis económica actual ha sido un fenómeno nuevo e inesperado; es parte del sistema capitalista, bancario y económico que ha sido conocido hasta el año 2008. La crisis ha llevado a los bancos, los Estados, las instituciones internacionales, así como a las personas del común, a ver profundos cambios en sus representaciones sobre la economía. En este escenario, se plantea la pregunta: ¿cómo los hombres y las mujeres de estratos sociales diferentes afrontan el fenómeno complejo y desconocido de la crisis económica? ¿El género y el estatus social justifican diferentes significados atribuidos a la crisis, sus causas y consecuencias? En el presente artículo se elige la teoría de las representaciones sociales para estudiar el papel del género y el nivel educativo en la producción de las representaciones de la crisis. Se presentan resultados de encuestas realizadas en el sur de Italia (N = 120), los cuales revelan que tanto el género como el nivel educativo de las personas marcan diferencias en la forma de definir y afrontar la crisis. Por un lado, los participantes de alto nivel definen la crisis en términos más abstractos que los participantes de bajo nivel. Por otra parte, los hombres de alto nivel mantienen un estado de coping más proactivo con la crisis que los otros participantes, especialmente mujeres. La discusión se enfoca en el papel de la teoría de la representación social entendiendo la relación entre género, estatus y comportamiento económico, aportando ideas sobre cómo la igualdad de género puede ser mejorada.

Abstract The current economic crisis has been a new and unexpected phenomenon; it is part of the capitalist banking and economic system that has been known until 2008. The crisis has led to banks, states, international institutions, as well as common people, changing profoundly their representations about the economy. In this scenario, some questions arise: how do men and women of different social status face the complex and unknown phenomenon of the economic crisis? Do gender and social status justify the different meanings attributed to the crisis, to its causes and its consequences? When confronted with an external threat like the economic crisis, people draw on social representations to provide meaning to that unfamiliar situation. Through media and interpersonal communication, social groups produce naive theories that improve familiarity with an unexpected and distressing phenomenon. In order to analyze these lay theories elaborated though daily economic thinking and acting, this research has been conducted using Social Representation Theory and its methodological approaches. This theory, in fact, contributes to our understanding of the societal process of sense making when an unexperienced external shock affects society. It offers a way to understand economic phenomena's impact on social groups. Social representations (SRs) serve the purpose of making the unfamiliar become familiar, and the unusual become usual, as well as to provide orientation in times of change. In this sense, in this article, social representations theory is used to examine the role of gender and educational status in the production of representations of the crisis. Presented findings came from a survey carried out in Southern Italy (N = 120) revealing status and gender differences in the ways people define the crisis and cope with it. Participants were asked to order the first most important five statements and the first least important statements, among a list of 15 (according to the rule of a multiple of 3) to code every item with a score of 1 (less characteristic), 3 (more characteristic), or 2 (not chosen). Every Questionnaire of Characterization was created starting from social descriptions and explanations of the crisis, identified in a previous study. They covered every sub-dimension of the content (complementary to the structure) of the social representation of the crisis, such as: cognitive-evaluative aspects about the representation's structure (central and peripheral elements); descriptive-defining aspects of the representation; informative sources and interaction networks; level of involvement/implication with the object; relationship between representation and social practices; perceptions, attributions and categorizations (causes, responsibilities, duration/evolution, solutions, positive implications, the EU's role). In this paper, we will only consider the answers related to the following dimensions: crisis definitions, strategies to tackle the crisis and social practices related to the crisis. The analysis of the data was carried out primarily using Multiple Correspondence Analysis (MCA). In this analysis, in order to uncover the objectification and anchoring processes, we considered the interaction of status and gender as an illustrative variable. These findings were further substantiated with the use of Discriminant analysis. The social anchoring of social representations of the economic crisis is influenced by gender and social status. Nevertheless, the difference in status modifies the stereotypical dimensions, also coherently with predictions derived from gender role theory about the reduction of the impact of gender stereotypes when men and women occupy similar social positions. On the one hand, high-status participants defined the crisis in more abstract terms than low-status participants. On the other hand, high-status men hold a more proactive style of coping with the crisis than other participants, especially women. The discussion focuses on the role of social representations theory in understanding the relationships between gender, status and economic behavior, providing insights into how gender equality might be improved.

[Mortality due to medical and surgical complications, economic crisis and health spending in Spain, 2002-2013]. / Mortalidad por complicaciones médicas y quirúrgicas, impacto de la crisis y gasto sanitario en España, 2002-2013.

OBJECTIVE: To describe the evolution of mortality risks for complications due to medical care or surgery between the periods prior to (2002-2007) and after (2008-2013) the beginning of the economic crisis for Spain and by autonomous region, and to analyse the relationship between the changes in the risks of death and the socioeconomic impact of the crisis and the variation in health spending. METHOD: Ecological study based on age-standardized mortality rates, synthetic index of vulnerability as a socioeconomic indicator and variation in health expenditure as an indicator of health expenditure. The relative risk of death between periods was estimated with Poisson regression models. RESULTS: The number of deaths increased for Spain in the period studied. Although the relationship between the increase in public investment in health and the decrease in mortality due to this cause has not been clearly demonstrated, it was possible to determine that the autonomous regions with the lowest increase in health expenditure had rates higher than the rest throughout the period, and that the most vulnerable to the crisis and with the lowest increase in spending presented the greatest increase in the risk of death between the periods. CONCLUSIONS: Given the increase in these deaths, due to avoidable failures of the system, it is necessary to continue investigating this cause of mortality.

Trends in cancer mortality in Spain: the influence of the financial crisis.

OBJECTIVE: To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends. METHOD: We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein. RESULTS: After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis. CONCLUSIONS: Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.

The impact of the 2008 economic crisis on the increasing number of young psychiatric inpatients. / Impacto de la crisis económica del 2008 en el número de jóvenes hospitalizados por patología psiquiátrica.

BACKGROUND: Little is published about the impact of the 2008 economic crisis on mental health services in Spain. METHOD: An interrupted time series analysis was conducted to investigate a potential short-term association between the 2008 economic crisis and the number of psychiatric hospital admissions. The timing of the intervention (April 2008) was based on observed changes in Gross Domestic Product (GDP). Data on 1,152,880 psychiatric inpatients from the national Hospital Morbidity Survey, 69 months before and after the onset of the economic crisis (April 2008), were analyzed. RESULTS: Age-adjusted psychiatric (ICD9 290-319) hospital discharge rates significantly increased from April 2008, matching the onset of the crisis, especially for inpatients aged 15-24 years old and to a less extend for inpatients aged 25-34 years old. Other age groups were not affected. There was a significant increase in diagnoses for disturbance of conduct and emotions, depression, neurotic and personality disorders and alcohol and drug disorders; however, diagnoses for mental retardation and organic psychosis for 15-34 years old inpatients were unaffected. CONCLUSIONS: Psychiatric hospital admissions abruptly increased in April 2008, coinciding with the onset of the economic crisis. We identified age groups and diagnoses affected. Increased hospitalizations were found only at the age-ranges most affected by the rise in unemployment. The diagnoses affected were those most sensitive to environmental changes.

Prevalencia del bajo peso al nacer en un escenario de depresión económica en Argentina / Prevalence of low birth weight in a scenario of economic depression in Argentina

Introducción. El bajo peso al nacer (BPN) es considerado un indicador general de salud por su relación con complicaciones en la vida del recién nacido y por ser una de las primeras causas de mortalidad infantil. Es multifactorial y, entre sus determinantes, se incluyen los socioeconómicos. Objetivo. Evaluar el impacto de la desigualdad económica sobre la prevalencia del BPN, cuantificando el efecto diferencial según edad y educación materna y nivel de atención. Población y métodos. Estudio epidemiológico de diseño transversal, en el cual se analizaron los nacimientos ocurridos en Argentina desde 2001 a 2013 con datos obtenidos del Registro Nacional de los nacimientos, perteneciente a la Dirección de Estadísticas e Información en Salud (DEIS). Se estudió la variación temporal de la prevalencia de recién nacidos con BPN (< 2500 gramos) y su relación con indicadores demográficos y socioeconómicos. Se evaluó su asociación a través de modelos de regresión logística. Resultados. Se incluyeron 9 001 960 nacimientos. Se observó un incremento en la prevalencia de recién nacidos con BPN durante la crisis económica de 2001 -de un 6% en 2002 y un 7% en 2003-. Fue heterogéneo y tuvo mayor impacto en hospitales públicos (razón de prevalencia -RP-= 1,03) y madres adolescentes (RP= 1,07) y ningún impacto sobre la educación materna baja (RP= 0,99). Conclusiones. El impacto de la desigualdad socioeconómica sobre la prevalencia de bajo peso fue significativo y heterogéneo, más importante en hospitales públicos y madres en edades extremas.

Introduction. Low birth weight (LBW) is considered a general indicator of health because it is related to complications in the life of a newborn infant and is one of the leading causes of infant mortality. It is a multifactorial indicator, and its determinants include socioeconomic factors. Objective. To assess the impact of economic inequality on the prevalence of LBW by quantifying its differential effect by maternal age, level of maternal education, and level of care. Population and methods. Epidemiological, cross-sectional study that analyzed all births occurred in Argentina between 2001 and 2013 based on data provided by the National Registry of births, corresponding to the Health Statistics and Information Department. The temporal variation in the prevalence of LBW newborn infants (< 2500 grams) and its relation to demographic and socioeconomic indicators were studied. Its association was assessed using logistic regression models. Results. A total of 9 001 960births were included. The prevalence of LBW newborn infants during the 2001 economic crisis increased -6% in 2002 and 7% in 2003- The impact was heterogeneous and higher on public hospitals (--1;PR--3; = 1.03) and adolescent mothers (PR=1.07), but no impact was observed on a low level of maternal education (PR= 0.99). Conclusions. The impact of socioeconomic inequality on the prevalence of LBW was significant and heterogeneous, especially on public hospitals and mothers at the extremes of maternal age.

Crisis, austeridad y áreas rurales: estudio cualitativo de las percepciones sobre los impactos en el sistema sanitario y la salud en Navarra, España / Economic crisis, austerity and rural areas: a qualitative study exploring perceptions of the effects on health care system and health in Navarra, Spain

Resumen La crisis financiera ha impulsado severas medidas de austeridad al sistema español de atención a la salud, entre las que se destacan la reducción del gasto público, la modificación del principio básico de cobertura universal, el copago y las reformas laborales. En este artículo se presentan los resultados de un estudio cualitativo sobre la percepción del personal sanitario y de la población de los impactos de la crisis en el sistema sanitario y de la salud en las áreas rurales. Se consideró la metodología cualitativa como la opción idónea para el estudio de un fenómeno complejo, en el que se buscó profundidad en su comprensión, teniendo en cuenta los significados y el contexto. El estudio se realizó en tres valles del Pirineo navarro. Se llevaron a cabo 22 entrevistas semiestructuradas a informantes clave y de perfiles no expertos, que fueron analizadas según el análisis sociológico del discurso. La desigual accesibilidad a los servicios de salud por parte de la población rural fue el factor identificado de forma unánime como la mayor amenaza y desafío para estos territorios. Una desigualdad que se consideró agravada en la población más envejecida. Las personas entrevistadas no refirieron un impacto negativo en la calidad del servicio de atención primaria, sino que lo localizaron en el entorno urbano y en la asistencia especializada. Los impactos diferenciados de las políticas en las zonas rurales exigen más investigación atendiendo a sus particularidades y de esta forma comprender el impacto específico de la crisis en estos territorios.

Abstract The financial crisis has led to severe austerity measures in the Spanish health care system, among which are the reduction of public spending, the modification of the basic principle of universal coverage, the co-payment and labor reforms. This article presents the findings from a qualitative study that explores the perceptions of primary health care professionals and population of the effects of the crisis on the health system and health in rural areas. The qualitative methodology was considered ideal for the study of a complex phenomenon. We looked for depth in the understanding considering meanings and context. The study was carried out in three valleys of the Spanish Pyrenees (Navarra). We conducted 22 semi-structured interviews with key informants and non-expert profiles analyzed according to the sociological analysis of the speech. The unequal accessibility to health services by rural population was unanimously identified as the greatest threat and challenge for these territories. An inequality that was considered aggravated in older population. The people interviewed did not mention a negative impact on the quality of rural primary care service. They noticed that quality of health care had become worse in urban centers and in specialized healthcare. The differential impacts of policies in rural areas require more research, considering their particularities and thus understanding the specific impact of the crisis on these territories.

Has the quality of health care for the immigrant population changed during the economic crisis in Catalonia (Spain)? Opinions of health professionals and immigrant users.

OBJECTIVE: To analyse changes in health professionals' and immigrant users' perceptions of the quality of care provided to the immigrant population during the crisis. METHODS: A qualitative descriptive-interpretative and exploratory study was conducted in two areas of Catalonia. Semi-structured individual interviews were used with a theoretical sample of medical (n=24) and administrative (n=10) professionals in primary care (PC) and secondary care (SC), and immigrant users (n=20). Thematic analysis was conducted and the results were triangulated. RESULTS: Problems related to technical and interpersonal quality emerged from the discourse of both professionals and immigrants. These problems were attributed to cutbacks during the economic crisis. Regarding technical quality, respondents reported an increase in erroneous or non-specific diagnoses, inappropriate use of diagnostic tests and non-specific treatments, due to reduction in consultation times as a result of cuts in human resources. With regard to interpersonal quality, professionals reported less empathy, and users also reported worse communication, due to changes in professionals' working conditions and users' attitudes. Finally, a reduction in the resolution capacity of the health services emerged: professionals described unnecessary repeated PC visits and limited responses in SC, while young immigrants reported an insufficient response to their health problems. CONCLUSION: The results indicate a deterioration in perceived technical and interpersonal quality during the economic crisis, due to cutbacks mainly in human resources. These changes affect the whole population, but especially immigrants.

[The health of the elderly in Spain during the economic crisis]. / La salud de las personas mayores en España durante la crisis económica.

INTRODUCTION: Numerous studies have shown that economic crises are linked to a worsening of health conditions of the population. During the current economic crisis in Spain, there have been significant cuts in social and health services and a general worsening of the emotional well-being of the population. All these changes could have an impact on the health of the population, especially in the most vulnerable groups like older people. MATERIAL AND METHODS: The evolution of life expectancy and healthy life years in the period 2004-2014 have been examined in order to examine the health status of people aged 65 years and over in Spain during the economic crisis. RESULTS: Changes are observed in the evolution of healthy life years of people aged 65 years and over, particularly in the case of women. CONCLUSIONS: The results do not show that the current economic crisis has had a negative impact on the health conditions of older people in Spain, but there has been a decline in their well-being and quality of life.

Crise econômica mundial: infância e adolescência na análise dos documentos do UNICEF / Crisis económica mundial: infancia y adolescencia en el análisis de los documentos de UNICEF / World economic crisis: childhood and adolescence in the analysis of UNICEF documents

RESUMO Este artigo investiga a produção histórica da infância e juventude de diversos países afetados pela crise econômica mundial que eclodiu em 2008, nos Estados Unidos. Foram utilizados documentos produzidos pelo UNICEF acerca das condições de vida garantidas à infância e adolescência, decorrentes das disputas ocasionadas e/ou agravadas pelo colapso financeiro mundial; foram analisados artigos internacionais que deram suporte e contribuíram nas análises dos dados documentais. Esta pesquisa foi feita por de meio de uma revisão histórica e de problematização das narrativas da literatura, com pesquisas voltadas aos países dos continentes: asiático, africano, europeu e americano. Encontraram-se fortes indicadores da precariedade em que está a política pública para a infância ao redor do mundo, principalmente em países com dificuldades socioeconômicas, além dos pertencentes ao leste europeu e nos EUA. Alerta-se acerca da necessidade de estudos sobre o impacto à infância brasileira da crise internacional e como o UNICEF tem abordado essas questões.

RESUMEN Este artículo propuso investigar la producción histórica de la niñez y la juventud de diversos países afectados por la crisis económica mundial que estalló en 2008 en los EEUU. Fueron utilizados documentos elaborados por la UNICEF sobre condiciones de vida garantizados a la infancia y adolescencia, como consecuencia de disputas influenciadas por el colapso financiero mundial; se analizaron artículos internacionales que sirvieron como soporte y contribución. Esta investigación fue realizada mediante una revisión histórica y de problematización de las narrativas de la literatura, dirigidas a la infancia en los continentes: asiático, africano, europeo, y americano. Se encontraron fuertes indicadores de inseguridad que afectan a la política publica de la infancia al rededor del mundo, principalmente en países con dificultades socioeconómicas, además de países de Europa oriental y los EEUU. Se alerta la necesidad de estudios sobre el impacto de la crisis internacional en la infancia brasileña y como la UNICEF viene ocupándose de ello.

ABSTRACT This article had as goal to investigate the historical production of childhood and youth in several countries affected by the global financial crisis that ecloded in 2008 at the United States. Various documents produced by UNICEF describing how the financial system collapse affected or aggravated the life conditions of children and adolescents were used, as well as other international articles that gave support to the documental data analysis. This research was done by means of a historical revision and problematization of literature narratives in the African, Asian, European and American continents. The search found strong indicators about the precariousness of public policies for children around the world, especially in countries with socioeconomic problems, and in Eastern Europe and the USA as well. Therefore, we alert to the need for studies about the impact of the international crisis in Brazilian children and how UNICEF is addressing these issues.

Crisis económicas y salud en controversia: el "debate Brenner", 1970-2012 / Economic Crises and Health Controversies: o "debate Brenner", 1970-2012 / The "Brenner Debate", 1970-2012 / Crises económicas e saúde em controvérsia

Objetivo: en este artículo exploro algunos de los debates acerca de los efectos de las crisis económicas en la salud pública desarrollados en el mundo anglosajón desde la década de 1970. Desarrollo: me concentro en particular en los trabajos de quien iniciara y dominara esos debates en los Estados Unidos, el sociólogo Harvey Brenner, las críticas de sus contradictores salubristas y economistas, así como en la figuración de Brenner en la prensa norteamericana quien como uno de los expertos reportó sobre las crisis y la salud en ese periodo. Conclusiones: encuentro que mientras Brenner ha argumentado que las crisis económicas afectan negativamente la salud, sus críticos han encontrado resultados opuestos: que las crisis de hecho mejoran la salud. Muestro cómo estos últimos cuestionaron tanto las premisas y la metodología de Brenner, así como su intención de intervenir en las políticas en salud. Argumento que hay indicios de que la diferencia entre los agentes en controversia está relacionada no solo con el uso de métodos distintos, sino también con visiones diferentes sobre la dinámica social y la salud, y quizás con intereses profesionales divergentes

Objective: This paper presents some of the debates on the effects of economic crises on public health that developed since 1970. Content: I follow the work of the sociologist Harvey Brenner who initiated this debate, the work of Brenner's critics, as well as news reports on crises and health. Conclusions: I found that whereas Brenner has argued that recessions and economic downturns increase death and illness, Brenner's critics have claimed the opposite: that crises actually improve health. I show how the latter criticize Brenner's methodology and assumptions as well as his efforts to influence on health policies. I argue that the source of this controversy is due not just to differences in methods, but also to different views about social dynamics and health, and perhaps with divergent professional interests

Objetivo: Neste artigo explorou-se alguns dos debates acerca dos efeitos das crises económicas na saúde pública desenvolvidos no mundo anglo-saxão desde a década de 1970. Desenvolvimento: me concentro em particular nos trabalhos de quem iniciara e dominara esses debates nos Estados Unidos, o sociólogo Harvey Brenner, as críticas de seus contraditores profissionais da saúde e economistas, assim como na figuração de Brenner na imprensa norte-americana como um dos expertos sobre as crises e a saúde nesse período. Conclusões: Encontro que enquanto Brenner tem argumentado que as crises económicas afetam negativamente a saúde, os seus críticos têm encontrado resultados opostos: que as crises de fato melhoram a saúde. Mostro como estes últimos questionaram tanto as premissas e a metodologia de Brenner, assim como a sua intenção de intervir em políticas de saúde. Argumento que há indícios de que a diferença entre os agentes em controvérsia está relacionada não só com o uso de métodos distintos, mas também com visões diferentes sobre a dinâmica social e a saúde, e talvez com interesses profissionais divergentes