Diferencias en la evolución del sobrepeso y la obesidad infantil en España en el periodo 2011-2019 por sexo, edad y nivel socioeconómico: resultados del estudio ALADINO / Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: Results of the ALADINO study

Introducción: El exceso de peso infantil es un problema de salud pública creciente. El objetivo del trabajo es estudiar la evolución de la prevalencia de sobrepeso, de obesidad y de obesidad central en escolares de 6 a 9años en España entre 2011 y 2019 según características demográficas y socioeconómicas.MetodologíaSe incluyeron las rondas 2011, 2015 y 2019 del estudio observacional, descriptivo y transversal ALADINO en escolares de ambos sexos de 6 a 9años. Se realizó un análisis descriptivo de la evolución de la prevalencia de sobrepeso y de obesidad según los criterios de la Organización Mundial de la Salud (OMS) y la International Obesity Task Force (IOTF), así como obesidad central, y las variables demográficas y socioeconómicas asociadas.ResultadosEntre 2011 y 2019 se redujo la prevalencia de sobrepeso (criterios OMS) en niños de 6, 7 y 8años (−5,4, −5,7 y −5,3 puntos porcentuales, respectivamente) y niños cuyos progenitores tenían estudios superiores (−5,3 puntos porcentuales). Por renta, el sobrepeso en niños se redujo en todos los niveles de ingresos. Sin embargo, entre 2011 y 2019 se mantuvieron estables tanto la prevalencia de sobrepeso en niñas como la prevalencia de obesidad según las referencias OMS e IOTF y la de obesidad central en ambos sexos.ConclusionesLas prevalencias de sobrepeso y de obesidad en escolares de 6 a 9años en España siguen siendo altas. Entre 2011 y 2019 disminuyó la prevalencia de sobrepeso en niños de 6 a 8años y aquellos cuyos progenitores tienen estudios universitarios, mientras que la obesidad en niños, el sobrepeso y la obesidad en niñas, y la obesidad central en ambos sexos han permanecido estables. (AU)

Introduction: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6 to 9years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics.MethodologyThe analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6 to 9years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization [WHO] and the International Obesity Task Force [IOTF]) and of central obesity, in addition to associated demographic and socioeconomic variables.ResultsBetween 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8years (by −5.4%, −5.7% and −5.3%, respectively) and boys whose parents had a higher educational attainment (by −5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable.ConclusionsThe prevalence of overweight and the prevalence of obesity in schoolchildren aged 6 to 9years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6 to 8years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable. (AU)

Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: results of the ALADINO study.

INTRODUCTION: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6-9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics. METHODOLOGY: The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6-9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables. RESULTS: Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by -5.4%, -5.7% and -5.3%, respectively) and boys whose parents had a higher educational attainment (by -5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable. CONCLUSIONS: The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6-9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6-8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable.

Tendência temporal da incompletude do registro da raça/cor nos sistemas de informação em saúde do Brasil, 2009-2018 / Incomplete recording of race/colour in health information systems in Brazil: time trend, 2009-2018

Resumo Propõe-se avaliar a incompletude e a tendência temporal do preenchimento do campo raça/cor das doenças e agravos mais prevalentes na população negra nos Sistemas de Informação em Saúde do Brasil, 2009-2018. Trata-se de estudo ecológico de tendência temporal e múltiplos grupos. Foi adotada a classificação de Romero e Cunha (2006) para análise da incompletude e utilizados dados secundários do Sistema Nacional de Agravos de Notificação, Sistema de Informações Hospitalares e Sistema de Informações sobre Mortalidade do Brasil e regiões brasileiras, calculada a proporção de subnotificação e a tendência temporal, utilizando o modelo de regressão linear simples, com correção Prais-Winsten (p-valor<0,05). Excetuando-se os registros de mortalidade por causas externas (excelente), tuberculose (bom) e mortalidade infantil (regular), todos os registros apresentaram escore ruim. Observou-se tendência decrescente da proporção de incompletude. A análise por região mostrou que as maiores médias de incompletude foram registradas na região Norte (30,5%), Nordeste (33,3%) e Centro-Oeste (33,0%). As regiões Sudeste e Nordeste foram as que mais apresentaram tendência decrescente. Os resultados visam ampliar a visibilidade acerca das implicações do preenchimento do campo raça/cor para a equidade em saúde.

Abstract This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil's National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.

Racial and ethnic disparities in premature births among pregnant women in the NISAMI cohort, Brazil / Disparidades étnicas e raciais nos partos prematuros entre gestantes da coorte NISAMI, Brasil

Abstract The incidence of premature birth has increased worldwide, unequally distributed by race/ethnicity. Racism generates economic inequalities, educational disparities, and differential access to health care, which increases the risk of preterm birth. Thus, this study aimed to evaluate the factors associated with preterm birth and racial and ethnic disparities in premature birth among pregnant women attending prenatal care at the Brazilian Unified Health System health units in the urban area of Santo Antônio de Jesus, Bahia, Brazil. This study used data from 938 pregnant women aged between 18 to 45 years within the NISAMI prospective cohort. Premature birth prevalence was 11.8%, with a higher prevalence among black than non-black women (12.9% versus 6.0%, respectively). Maternal age between 18 and 24 years was the only factor associated with premature birth. A higher risk of premature birth was found among black women than non-black women (RR 3.22; 95%CI 1.42-7.32). These results reveal the existence of racial and social inequalities in the occurrence of premature birth.

Resumo A incidência de parto prematuro tem aumentado em todo o mundo, distribuída de forma desigual por raça/etnia. O racismo gera desigualdades econômicas, disparidades educacionais e acesso diferenciado à saúde, o que aumenta o risco de parto prematuro. Assim, este estudo teve como objetivo avaliar os fatores associados à prematuridade e disparidades raciais e étnicas no parto prematuro entre gestantes atendidas durante o pré-natal em unidades de saúde do Sistema Único de Saúde na zona urbana de Santo Antônio de Jesus, Bahia, Brasil. Este estudo utilizou dados de 938 mulheres grávidas com idade entre 18 e 45 anos dentro da coorte prospectiva do NISAMI. A prevalência de prematuridade foi de 11,8%, sendo maior entre as negras do que entre as não negras (12,9% versus 6,0%, respectivamente). A idade materna entre 18 e 24 anos foi o único fator associado ao parto prematuro. Foi encontrado maior risco de prematuridade entre as mulheres negras do que entre as não negras (RR 3,22; IC95% 1,42-7,32). Esses resultados revelam a existência de desigualdades raciais e sociais na ocorrência do parto prematuro.

O racismo e o sexismo na trajetória das estudantes de Medicina negras: uma revisão integrativa / El racismo y el sexismo en la trayectoria de las estudiantes de medicina negras: una revisión integradora / Racism and sexism in the trajectory of black female medical students: an integrative review

Alunas negras do curso de Medicina são minoria e enfrentam diversos obstáculos durante a formação por serem mulheres negras. Objetivou-se sintetizar o conhecimento produzido em estudos empíricos sobre a discriminação racial e de gênero que sofrem estudantes de Medicina negras no curso. Realizamos uma revisão integrativa nas bases de dados do PubMed e BVS. Foram analisados em profundidade cinquenta estudos classificados em três categorias temáticas: I- O preconceito racial sistêmico-estrutural e estruturante; II- O racismo como um dos fatores da iniquidade na educação médica; e III- O racismo genderizado vivenciado pelas estudantes negras. Concluiu-se que, nas escolas médicas, um espaço social com baixa diversidade étnica/racial e atravessado pelo racismo estrutural, as estudantes negras são discriminadas pela intersecção das dinâmicas de raça, gênero e classe social.

Las alumnas negras del curso de medicina son minoría y enfrentan diversos obstáculos durante la formación por ser mujeres negras. El objetivo fue sintetizar el conocimiento producido en estudios empíricos sobre la discriminación racial y de género que sufren estudiantes de medicina negras en el curso. Realizamos una revisión integradora de las bases de datos del PubMed y BVS. Se analizaron en profundidad cincuenta estudios clasificados en tres categorías temáticas: 1- El prejuicio racial sistémico-estructural y estructurador. 2- El racismo como uno de los factores de la inequidad en la Educación Médica. 3- El racismo de género vivido por las estudiantes negras. Se concluyó que, en las escuelas médicas, un espacio social con baja diversidad étnica/racial, atravesado por el racismo estructural, las estudiantes negras son discriminadas por la intersección de las dinámicas de raza, género y clase social.

Black female medical students are a minority and face various obstacles during their training because they are black women. The study aimed to synthesize the knowledge produced in empirical studies on the racial and gender discrimination suffered by black female medical students. We carried out an integrative review using the PubMed and VHL databases. Fifty studies were analyzed in depth and classified into three thematic categories: 1- Systemic-structural and structuring racial prejudice. 2- Racism as one of the factors of inequity in medical education. 3- Genderized racism experienced by black students. It was concluded that in medical schools, a social space with low ethnic/racial diversity and crossed by structural racism, female black students are negatively discriminated by the intersection of race, gender and social class dynamics.

Desigualdades sociales urbano-rurales en la mortalidad por siniestros viales en Colombia, 1998-2019

Introducción: Anualmente se pierden 1,35 millones de vidas por causa de siniestros viales; su ocurrencia se ha relacionado, además de factores comportamentales, con desigualdades sociales. Objetivo: Analizar las desigualdades sociales urbano-rurales en la mortalidad por siniestros viales en Colombia para el periodo 1998-2019. Materiales y métodos: Estudio ecológico a partir del análisis de las tasas de mortalidad ajustadas de los grupos poblacionales urbanos y rurales estratificados por sexo. Se hicieron análisis con regresión de Joinpoint y se calcularon medidas de desigualdad simple absoluta y relativa. Resultados: Se registraron 139 323 muertes por siniestros viales, en Colombia la tasa de mortalidad por esta causa se ha venido reduciendo. En contraste con las áreas rurales, en las áreas urbanas esta reducción es más significativa. Existen desigualdades en la mortalidad entre las áreas urbanas y rurales que han venido estrechándose. No obstante, en el caso de hombres y mujeres ha venido incrementándose. Discusión: La reducción de la tasa de mortalidad por siniestros viales sugiere que las intervenciones en seguridad vial han sido efectivas. La mayor mortalidad en hombres puede explicarse a partir de factores comportamentales. Las desigualdades urbano-rurales pueden estar relacionadas con las dinámicas de desarrollo. Conclusiones: Se registra una reducción en la tasa de mortalidad por siniestros viales, la cual es más significativa en áreas urbanas. Existen desigualdades urbano-rurales en la mortalidad por esta causa. Las políticas de seguridad vial deben partir de un enfoque integrador vinculado con otras agendas políticas.

Introduction: Annually, 1,35 million lives are lost due to road accidents; their occurrence has been related, in addition to behavioral factors, to social inequalities. Objective: To analyze urban-rural social inequalities in mortality from traffic accidents in Colombia from 1998-2019. Methods and materials: Ecological study based on the analysis of standardized mortality rates adjusted for age and sex of urban and rural population groups stratified by sex. Joinpoint regression analyses were performed, and absolute and relative simple inequality measures were calculated. Results: There were 139.323 deaths from road accidents; in Colombia mortality rates from this cause has been decreasing. In urban areas, the reduction is more significant than in rural areas. Disparities in mortality between urban and rural areas have been narrowing, however, in the case of men and women, they have been increasing. Discussion: Reducing the mortality rate from road accidents suggests that road safety interventions have been effective. Behavioral factors can explain the higher mortality in men. Urban-rural inequalities can be related to development dynamics. Conclusions: There is a significant reduction in the mortality rate due to road accidents in urban areas. There are urban-rural inequalities in mortality from this cause. Road safety policies must be based on an integrative approach linked to other political agendas.

Consumo de tabaco de liar en el País Vasco: magnitud, desigualdades socioeconómicas y evolución en el periodo 2013-2018 / Use of Roll Your Own Tobacco in the Basque Country: magnitude, socio-economic inequalities and evolution in the period 2013-2018

Fundamentos: A pesar de la reducción del número de personas fumadoras a nivel mundial, el consumo de tabaco de liar ha aumentado en los últimos años en muchos países, lo que puede frenar la tendencia descendente del hábito tabáquico. El objetivo de este trabajo fue analizar la evolución del número de personas que consumen tabaco de liar y tabaco de cualquier tipo entre 2013 y 2018 en el País Vasco y determinar si existían desigualdades socioeconómicas en su consumo. Métodos: Se realizó un estudio observacional y transversal de una muestra representativa de la población residente en el País Vasco de dieciséis a cincuenta y nueve años (n 2013=6.929 y n 2018=7.961) a partir de la Encuesta de Salud del País Vasco (años 2013 y 2018) y de la Encuesta sobre Adicciones de Euskadi (2018). Se calcularon las prevalencias de consumo habitual de tabaco en general y de tabaco de liar según diferentes variables socioeconómicas para los años 2013 y 2018, así como las razones de prevalencia para la estimación del cambio entre esos años y según las variables anteriores mediante modelos de regresión de Poisson robusto. Los análisis se estratificaron por sexo y por dos grupos de edad. RESULTADOS // La prevalencia de consumo de tabaco en general disminuyó entre 2013 (hombres=27,7% y mujeres=24,1%) y 2018 (hombres=24,1% y mujeres=18,6%), pero se mantuvo en el caso del consumo de tabaco de liar (en 2013, hombres=5,1% y mujeres=3,2%; en 2018, 5,4% y 3,5%, respectivamente). A diferencia del consumo de tabaco en general, que presentó un claro gradiente socioeconómico, el consumo de tabaco de liar fue más prevalente entre las personas jóvenes (en 2018, hombres=6,4% y mujeres=4,1%), grupo en el que el patrón por posición socioeconómica era menos evidente. Conclusiones: Considerando la persistencia en el consumo de tabaco de liar, es preciso dirigir también la lucha contra el tabaquismohacia...(AU)

Background: Despite the global reduction in smoking, the consumption of roll-your-own tobacco has increased in recent years in many countries, which may be slowing down the downward trend in smoking. The aim of this paper was to analyse the evolution of the number of people who use roll-your-own tobacco and tobacco of any type between 2013 and 2018 in the Basque Country and measure whether there were socioeconomic inequalities in its consumption. Methods: We carried out an observational and cross-sectional study of a representative sample of the population living in the Basque Country aged 16 to 59 years (n2013=6929 y n2018=7961) from the Basque Health Survey (2013 and 2018) and the Basque Addictions Survey (2018). We calculated prevalences of regular tobacco smoking in general and of roll-your-own cigarettes according to different socioeconomic variables for the years 2013 and 2018, as well as prevalence ratios for the estimation of change between these years and according to the above variables through robust Poisson regression models. We stratified analyses by sex and two age groups.Results: Overall smoking prevalence decreased between 2013 (men=27.7% and women=24.1%) and 2018 but remained the same for those who used roll-your-own tobacco (in 2013, men=5.1% and women=3.2%; in 2018=5.4% and 3.5%, respectively). In contrast to tobacco in general, which showed a clear socio-economic gradient, roll-your-own tobacco use was more prevalent among young people (in 2018, men=6.4% and women=4.1%), a group where the pattern by socio-economic status was less evident.Conclusions: Considering the persistence of roll-your-own tobacco consumption, we also should direct tobacco control towards this kind of product, and its use should be monitored and supervised, especially among young people.(AU)

Marco conceptual del juego de apuestas y sus daños asociados / Conceptual framework of gambling and gambling-related harms

El juego de apuestas es una actividad de ocio legítima en muchos países, la cual muchas personas utilizan. Sin embargo, algunas de ellas experimentan daños significativos como resultado de estos juegos de apuestas. Estos daños, que pueden ser de carácter económico, social o de salud física y mental, no solo los sufre el individuo que juega, sino que afectan a la familia, a la comunidad y a toda la sociedad. El objetivo de este texto es proponer un marco conceptual para comprender los determinantes del juego de apuestas y sus daños asociados, que ayude a desarrollar políticas de prevención para reducir su impacto en la salud. El marco planteado en este manuscrito sitúa la evidencia actual en el modelo de desigualdades en salud y analiza la importancia del contexto socioeconómico y político, de los ejes de desigualdad, de los factores individuales y sociales, y del sistema sanitario en la desigualdad en salud asociada al juego de apuestas que sufren los grupos más vulnerables. La evidencia que se recoge en este marco sugiere que los determinantes de salud conllevan a una desigualdad en salud en relación con los juegos de apuestas y sus daños asociados.(AU)

Gambling is a legitimate leisure activity in many countries that many people use. However, some of them suffer significant harm because of gambling. This may involve economic, social, physical or mental harm. These harms are not only suffered by the individual gambler, but affect the family, the community and society. The aim of this text is to propose a conceptual framework for understanding the determinants of gambling and its related harms and thus, contribute to the development of prevention policies to reduce its impact on health. The framework proposed in this manuscript places present evidence in the model of health inequalities, analyzing the effect of the socioeconomic and political context, the axes of inequalities, individual and social factors, and the health system in generating the health inequalities of gambling suffered by the most vulnerable groups. The evidence gathered in this framework suggests that health determinants lead to health inequality in relation to gambling and its associated harms.(AU)

La tuberculosis en el municipio Marianao: tendencias en dos periodos recientes, 2001­2005 y 2015­2020 / Tuberculosis in the Marianao Municipality: Trends in Two Recent Periods, 2001-2005 and 2015-2020

Introducción: Marianao históricamente ha sido un municipio de La Habana con alta carga de tuberculosis. Una nueva mirada sería importante.

Introduction: Marianao has historically been a municipality of Havana with a high bur-den of tuberculosis. A new look would be important.

[Morbidity due to chronic diseases and their health care in Asturias: a gender analysis]. / Morbilidad por enfermedades crónicas y su atención sanitaria en Asturias: análisis de género.

OBJECTIVE: To determine gender differences in the magnitude and complexity of chronic diseases and gender inequalities in health care in the adult population of Asturias in 2022. METHOD: A cross-sectional population study in people (>14 years) with at least one diagnosis of chronic disease (780,566 inhabitants). SOURCES OF INFORMATION: computer program for morbidity groups (Ministry of Health), Electronic medical record of primary care and hospital. Comparative analysis by sex and age, the mean values of chronic diseases and complexity index (Student's t test and one-way ANOVA), and probability (odds ratio and 95% CI) of suffering from specific chronic diseases, making one or more visits to the hospital emergency department or one or more admissions to hospital. RESULTS: 89.9% of women and 82.1% of men were registered with at least one chronic disease. The mean was higher in women (4.36) than in men (3.22) (p<0.001). Complexity index: men 4.56 and women 5.85 (p<0.001). Results show that women are more likely to attend the hospital emergency department, with an attendance rate of 50% for the diseases cited, compared with men at 29%. The rate of hospital admission is higher in men in 13 of the 14 diseases studied (85%). CONCLUSIONS: Gender analysis can also be applied to secondary sources of the National Health System. Despite the greater magnitude and complexity of chronic diseases in women, there is a higher frequency of hospital admissions in men compared to women with the same diseases. This implies an unequal care profile in the field of hospital admissions that the scientific literature associates with gender biases in health care.

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers.

OBJECTIVE: This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. METHOD: The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. RESULTS: Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. CONCLUSIONS: This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers' fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.

Desigualdades de género en el consumo de ansiolíticos e hipnosedantes por parte de adolescentes en España: un estudio transversal / Gender inequalities in the consumption of anxiolytics and hypnosedatives by adolescents in Spain: a cross-sectional study

Fundamentos: Existen cada vez mayores indicios del deterioro en la salud mental de la población, especialmente en mujeres y adolescentes. El objetivo del estudio fue analizar las desigualdades de género en el consumo de ansiolíticos e hipnosedantes (AHS) por parte de adolescentes en España en 2021, además de su tendencia temporal, aplicando un análisis interseccional. Métodos: Se realizó un estudio transversal de tendencia temporal partiendo de la encuesta de ámbito estatal ESTUDES (n=22.321), con una muestra de estudiantes de catorce a dieciocho años. Se calcularon prevalencias, razones de prevalencia (RP) y términos de interacción del consumo alguna vez en la vida y en el último año, a partir de modelos de Poisson de varianza robusta (según sexo, edad, lugar de origen y nivel educativo de los progenitores). Asimismo, se realizó un análisis temporal del consumo (2010-2021). Resultados: Las chicas presentaron mayores consumos en todas las categorías de las variables estudiadas, junto con una mayor probabilidad de uso (RP vital=1,56 [1,47-1,64] y RP anual=1,81 [1,69-1,94]). El consumo aumentó con la edad, de manera más pronunciada en los chicos (dieciocho años: RP vital=1,93 [1,62-2,28]). No existieron diferencias estadísticamente significativas según el lugar de origen. El descenso del nivel educativo de los progenitores aumentó significativamente el consumo en las hijas, con mayor impacto de los estudios maternos. La tendencia de consumo fue creciente, siendo superior en chicas durante toda la serie. Conclusiones: El género o el nivel educativo de los progenitores determina de manera desigual el consumo de AHS entre los/las adolescentes en España. Es necesario ahondar en los determinantes sociales de la salud, dando lugar a intervenciones más efectivas en salud pública.(AU)

Background: There is increasing evidence of deterioration in the mental health of the population, especially among women and adolescents. We aimed to analyze gender inequalities in the consumption of anxiolytics and hypnosedatives (AHS) among adolescents in Spain in 2021 and its time trend, from an intersectional approach. Methods: We conducted a cross-sectional study of time trends based on the ESTUDES national survey (n=22,321), comprising students between the ages of fourteen and eighteen. We calculated prevalences, prevalence ratios (PR) and interaction terms for consumption (both ever and in the last year), based on robust variance Poisson models, by sex, age, place of origin and parents’ educational level. We also examine trends in consumption between 2010 and 2021. Results: Female students showed higher consumption in all categories of the studied variables, together with a higher probability of use (PRvital=1.56 [1.47-1.64] and PRannual=1.81 [1.69-1.94]). Likewise, consumption increased with age, more pronounced in the case of male students (18 years old: PRvital=1,93 1,62-2,28]). Place of origin showed no statistically significant differences in AHS consumption. Lower educational level of parents predicted higher consumption among daughters, with mothers´ educational level showing a stronger association. Consumption increased over the 11-year period, and was consistently higher among women. Conclusions: We observe inequalities by gender and parents’ educational level in AHS use among adolescents in Spain. It iscritical to apply the model of the social determinants of health, which will lead to effective interventions in public health.(AU)

Desigualdades socioeconómicas y de género en la obesidad infantil en España / Socioeconomic and gender inequalities in childhood obesity in Spain

Introducción: La obesidad infantil se asocia inversamente con el nivel socioeconómico familiar en países desarrollados. El objetivo es evaluar la asociación entre la situación ponderal infantil y el nivel socioeconómico familiar, según características familiares, percepciones, hábitos de vida y entorno escolar. Metodología: Análisis descriptivo de la situación ponderal infantil según factores socioeconómicos familiares y variables mediadoras en el estudio ALADINO 2019, en una muestra de 16.665 escolares representativa de la población escolar de seis a nueve años en España. Resultados: La prevalencia de obesidad infantil en hogares de bajo nivel socioeconómico (26,8% niños; 20,4% niñas) era, en ambos sexos, el doble de la de los de mayor nivel (12,1% niños; 8,7% niñas). En escolares de familias de baja renta eran más frecuentes hábitos alimentarios poco saludables, el sedentarismo (principalmente en niñas) y la presencia de pantallas en la habitación (más en niños). Por el contrario, en hogares más desfavorecidos eran menos frecuentes el antecedente de lactancia materna y la práctica de actividad física (especialmente en niñas). La disponibilidad de cocina propia, actividades deportivas y gimnasio cubierto en los centros era también menos habitual para los escolares de familias de menor renta. Conclusiones: Un menor nivel socioeconómico del hogar se asocia con peores hábitos alimentarios y de actividad física y ciertas características del entorno familiar y el escolar, que a su vez median la asociación inversa que existe entre el nivel socioeconómico y la prevalencia de obesidad infantil. Las niñas realizan menos actividad física y presentan más sedentarismo, mientras que los niños tienen más acceso a pantallas. Las intervenciones para combatir la obesidad infantil deben contemplar las desigualdades identificadas. (AU)

Introduction: Childhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment. Methods: We performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16 665 schoolchildren representative of the population aged 6–9 years in Spain. Results: The prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities. Conclusions: A lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities. (AU)

Socioeconomic and gender inequalities in childhood obesity in Spain.

INTRODUCTION: Childhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment. METHODS: We performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16,665 schoolchildren representative of the population aged 6-9 years in Spain. RESULTS: The prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities. CONCLUSION: A lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities.

A hipótese da equidade inversa na implementação do NASF-AB em municípios do Sul do Brasil / The inverse equity hypothesis in the implementation of NASF-AB in municipalities of Southern Brazil

Resumo O objetivo foi verificar a evolução da implementação do Núcleo Ampliado de Saúde da Família e Atenção Básica (NASF-AB) nos municípios da região Sul do Brasil, de 2008 a 2019, sob à luz da hipótese da equidade inversa. Estudo ecológico considerando 1.188 municípios do Sul do Brasil. As análises foram separadas por estado, com os municípios divididos em quartis de Índice de Desenvolvimento Humano Municipal - Renda. Foi calculado o percentual acumulativo de implementação do NASF-AB no período e a desigualdade entre Q1 (mais rico) e Q4 (mais pobre) verificada por medidas de desigualdade absoluta e relativa. No Paraná o Q1 apresentou maior cobertura do NASF-AB do que o Q4 e, apesar da desigualdade ter reduzido ao final do período, ainda estava bem demarcada, seguindo padrão "top inequality". Em Santa Catarina ocorreu o que prevê a hipótese, com aumento das desigualdades no início e posterior redução quando já existia NASF-AB em cerca de 90% dos municípios do Q1, caracterizando "botton inequality". No Rio Grande do Sul a hipótese foi refutada ao observar, a partir de 2014, maior implementação no Q4 em relação ao Q1.

Abstract The present study aimed to analyze the evolution of the implementation of Family Health and Primary Health Care Expanded Support Centers (NASF-AB, in Portuguese) in the municipalities of Southern Brazil, from 2008 to 2019, in light of the inverse equity hypothesis. This was an ecological study, considering 1,188 municipalities of Southern Brazil. The analyses were separated by state, with municipalities divided into quartiles of Municipal Human Development Index - Income (MHDI-Income). Our study calculated the cumulative percentage of the implementation of NASF-AB within the given period and the inequality between Q1 (richest) and Q4 (poorest), assessed by the absolute and relative inequality measures. In Paraná, Q1 presented a higher coverage of NASF-AB than did Q4, and, although the inequality had decreased at the end of the period, it was still quite distinct, according to the "top inequality" pattern. In Santa Catarina, the predictions of the hypothesis were confirmed, with inequalities found in the beginning of the period and a near 90% decline once NASF-AB had been implemented in the municipalities of Q1, characterizing the "bottom inequality" pattern. In Rio Grande do Sul, the hypothesis was refuted observing that since 2014 there was a greater implementation in Q4 as compared to Q1 was observed.

Cuidados paliativos y desigualdades sociales en cáncer. Una revisión narrativa de la literatura / Palliative care and social inequalities in cancer. A narrative literature review

Objetivos: a) Hacer una propuesta de agrupación y clasificación de los diversos abordajes que se recogen en la literatura para analizar el acceso y la utilización de los cuidados paliativos en pacientes con diagnóstico de cáncer avanzado, y b) revisar las desigualdades sociales que se han abordado en la literatura con relación a los cuidados paliativos en estos pacientes. Métodos: Revisión narrativa utilizando las bases de datos Embase, CINAHL y PubMed hasta noviembre de 2022. Resultados: Se realizó cribado por título y abstract de los 2666 estudios recuperados y lectura completa de los artículos incluidos para la extracción de datos. Se detectaron 5 temas principales de los diferentes abordajes en relación con el acceso y uso de los cuidados paliativos: a) control de síntomas, b) adecuación y calidad de los cuidados, c) atención paliativa oportuna, d) planificación de los cuidados y e) lugar de fallecimiento. Las personas mayores, hombres, pertenecientes a minorías étnicas, de bajo nivel socioeconómico y residentes en áreas rurales tienen menos posibilidades de acceder a los cuidados paliativos para aliviar el dolor y el sufrimiento producidos durante la enfermedad oncológica y al final de la vida. Conclusiones: Los cuidados paliativos se consideran un componente esencial para poder proporcionar una atención integral durante el continuo de la enfermedad oncológica. Sin embargo, a pesar de existir evidencia científica que recomienda la aplicación de los cuidados paliativos desde el diagnóstico de la enfermedad, edad, sexo, etnia/raza, nivel socioeconómico y residencia crean inequidad en el acceso y la utilización de los cuidados paliativos en pacientes con cáncer avanzado, produciendo grupos de mayor vulnerabilidad estructural. (AU)

Objectives: To conduct a broad literature review in order to: a) propose a grouping and a classification of the different approaches described in the literature to analyse the access and use of palliative care in advanced cancer patients, and b) review the social inequalities examined in the literature in relation to the access to and use of palliative care in advanced cancer patients. Methods: A narrative review using the Embase, CINAHL, and PubMed databases until November 2022. Results: A total of 2,666 articles were retrieved and screened by title and abstract, with included studies read in full for data extraction. Five main themes of the different approaches were identified in relation to access to and use of palliative care: a) symptom management, b) adequacy and quality of care, c) appropriate palliative care, d) advance care planning, and e) place of death. Older people, men, from a minority ethnic group, of low socioeconomic status, and residing in rural areas are less likely to have access to palliative care to relieve the pain and suffering produced by cancer disease and at the end of life. Conclusions: Palliative care is considered an essential component of comprehensive care all along the cancer disease continuum. However, despite the existence of scientific evidence to recommend the integration of palliative care from diagnosis, age, sex, ethnicity, socioeconomic level and residence create inequity in the access to and use of palliative care in patients with advanced cancer, producing groups of greater structural vulnerability. (AU)

Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria / Asthma control in children, socioeconomic inequality and health care

Introducción: La desigualdad socioeconómica (DSE) puede afectar negativamente al control del asma. El objetivo de este estudio fue identificar la relación de la DSE con el control del asma y la calidad de vida de los cuidadores. Métodos: El nivel socioeconómico se determinó por área de residencia, según la tasa de riesgo de pobreza (TRP). La población pediátrica de Castilla y León se estratificó en terciles de TRP, y se seleccionó una muestra mediante muestreo aleatorio estratificado, identificando a los niños (6-14 años) con asma activa en los registros clínicos de centros de atención primaria. La información se obtuvo mediante cuestionarios cumplimentados por los padres. Las variables primarias fueron el control del asma y la calidad de vida de los cuidadores. Se analizó su relación con la DSE, la calidad de la atención sanitaria y factores individuales (como el nivel educativo de los padres) mediante modelos multivariantes de regresión. Resultados: El tercil de TRP no se relacionó con ninguna medida de control del asma, calidad de vida ni calidad de la asistencia. El nivel educativo de la madre (educación media o superior) se asociaba a menor riesgo de consulta no programada/urgente (OR=0,50; IC 95%: 0,27-0,95; p=0,034) y el del padre a menor riesgo de asma mal controlada (OR=0,51; IC 95%: 0,28-0,94; p=0,030). Conclusión: En la población que hemos estudiado, no se encuentra asociación entre DSE, medida por área de residencia, y el control del asma en niños. Otros factores, como la educación de los padres, pueden ser factores protectores. (AU)

Introduction: Socioeconomic inequality (SEI) can adversely affect asthma control. The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life. Methods: We assessed socioeconomic status based on the area of residence, according to the at risk of poverty rate (ARPR). After stratifying the paediatric population of Castilla y León (an autonomous community in Spain) in ARPR tertiles, we selected participants by stratified random sampling, and identified children with asthma aged 6–14 years from the health records of primary care centres. We collected data through questionnaires completed by parents. The primary outcomes were asthma control and caregiver quality of life. We assessed their association with SEI, health care quality measures and individual factors (such as parental educational attainment) by means of multivariate regression models. Result: The ARPR tertile was not associated with asthma control, quality of life or health care quality. A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit (OR=.50; 95% CI: .27-.95; P=.034) and paternal educational attainment was associated with a lower risk of uncontrolled asthma (OR=.51; 95% CI: .28-.94; P=.030). Conclusion: In the sample under study, SEI assessed at the local level was not associated with asthma control in children. Other factors, such as parental educational attainment, may have a protective effect. (AU)

Inequalities in diabetes mortality in Mexico: 2010-2019.

BACKGROUND: The impact of diabetes mellitus has been shown to be differentially expressed between social groups. OBJECTIVE: To estimate inequality gaps in diabetes mellitus mortality through absolute and relative measures according to geographic distribution and social conditions. MATERIAL AND METHODS: Diabetes mellitus-related deaths recorded in Mexico between 2010 and 2019 were analyzed, and inequality measurements at the state level were calculated by gender. RESULTS: National age-adjusted diabetes mellitus mortality rate showed an increase during the study period. CONCLUSION: The inequalities present in diabetes mortality should be considered for the design of health strategies.

ANTECEDENTES: Se ha demostrado que el impacto de la diabetes mellitus se expresa de manera diferenciada entre los grupos sociales. OBJETIVO: Estimar las brechas en la desigualdad en la mortalidad por diabetes mellitus a través de medidas absolutas y relativas según distribución geográfica y condiciones sociales. MATERIAL Y MÉTODOS: Se analizaron las muertes registradas en México por diabetes mellitus entre 2010 y 2019 y se calcularon las mediciones de desigualdad a nivel estatal por sexo. RESULTADOS: La tasa de mortalidad nacional por diabetes mellitus ajustada por edad mostró un incremento durante el periodo estudiado. CONCLUSIÓN: Las desigualdades presentes en la mortalidad por diabetes deben considerarse para el diseño de estrategias de salud.

Trends and determinants of social inequities in cardiovascular risk factors in Spain: a mixed-methods study.

This sequential mixed-methods study aims to: 1) assess spatial and temporal trends in cardiovascular risk factors by socioeconomic position from 2001 to 2020 in Spain; 2) explore public health professionals' perspectives regarding interventions that might have impacted these inequities; and 3) analyze determinants on social inequities in cardiovascular risk factors. First, we will measure the change in absolute and relative social inequities in eight cardiovascular risk factors through time trend analysis using repeated cross-sectional data from both National and European Health Surveys for Spain from 2001 to 2020. Second, we will interview key informants -both at the regional and national level-, to contextualize data obtained in phase 1 and capture the content and variation of policies across regions. Third, we will use econometric methods to analyze how these identified interventions have impacted these social inequities within and across regions.