Catastrophic out-of-pocket payments for dental treatment: regional evidence from Spain.

BACKGROUND: To estimate the incidence and concentration of catastrophic out-of-pocket payments for healthcare and dental treatment, by region in Spain (calculated as the proportion of households needing to exceed a given threshold of their income to make these payments) in 2008, 2011 and 2015. METHODS: The data analysed were obtained from the Spanish Family Budget Survey reports for the years in question. The study method was that proposed by Wagstaff and van Doorslaer (2003), contrasting payments for dental treatment versus household income and considering thresholds of 10%, 20%, 30% and 40%, thus obtaining incidence rates. In addition, relevant sociodemographic variables were obtained for each household included in the study. RESULTS: With some regional heterogeneity, on average 4.75% of Spanish households spend more than 10% of their income on dental treatment, and 1.23% spend more than 40%. Thus, 38.67% of catastrophic out-of-pocket payments for dental services in Spain corresponds to payments at the 10% threshold. This value rises to 55.98% for a threshold of 40%. CONCLUSIONS: An important proportion of catastrophic out-of-pocket payments for health care in Spain corresponds to dental treatment, a service that has very limited availability under the Spanish NHS. This finding highlights the need to formulate policies aimed at enhancing dental cover, in order to reduce inequalities in health care and, consequently, enhance the population's quality of life and health status.

[Diet quality in a population aged over 65 and related socioeconomic factors]. / Calidad de la dieta en mayores de 65 años y factores socioeconómicos relacionados.

INTRODUCTION: The consumption of certain foods and healthy eating habits are related to preventing and suffering from a number of chronic diseases. These foods tend to be included in food pyramids, such as that proposed by the Spanish Society for Community Nutrition. One method of analysing diet quality is the use of indices that assess the frequency of consumption of different food groups. AIM: To analyse diet quality in a Spanish population of persons aged over 65years using the Healthy Eating Index and to determine how sociodemographic factors affect scores on the index. DESIGN: A cross-sectional, descriptive study was conducted on the diet followed at home by Spanish population aged over 65years, using the Healthy Eating Index and taking information from the 2014 European Health Interview Survey in Spain. Multiple linear regression analysis was used to determine the socioeconomic factors associated with diet quality. RESULTS: Of the study population, 89.6% need to make changes in their diet, while only 8.2% follow a healthy diet. Suffering from chronic diseases, overweight and occasional physical exercise were associated with higher scores on the Healthy Eating Index. CONCLUSION: Most of the population aged 65years or over need to make changes in their dietary patterns. Those with potential health risks are more careful about their diet. These findings confirm the need to promote guidelines for healthy eating in the non-clinical population.

The reverse mortgage: a tool for funding long-term care and increasing public housing supply in Spain.

Population ageing is one of the most significant challenges facing the world in the twenty-first century. Furthermore, people aged over 65 typically have a level of income below the national average, but the homeownership rate among those in this age group tends to be high. Equity release schemes, specifically reverse mortgages, can help cover increased care costs and ensure a reasonable level of income, thus guaranteeing the well-being of older adults. However, this product has not been greatly developed by private entities. If the State were to implement this financial operation through public administrations, it could obtain homes that might then be included in public housing stocks. Thus, our paper aims to contribute to the literature on government-based reverse mortgage systems. Under our assumptions, the results showed that if 313,833 homes were reverse-mortgaged, the investment by the public administration would be around 0.73% GDP, with this being a feasible proposal. This work helps to create alternative methods to finance problems related with the ageing of societies from a public perspective.

Effects of a practical training programme on burnout among professional caregivers in a care home for older adults with dementia: a pilot study.

AIM: As the number of persons with dementia has increased so has the need for both specialized care and long-term care centres. Professional caregivers working in these centres encounter specific problems, including stress, burnout, and feelings of dissatisfaction, each which can affect the quality of care. Due to the nature of their work, they are more likely to experience stress, which may lead to burnout syndrome. Therefore, the aim of this work was to assess the results of a practical training programme with regard to burnout among direct care professionals in a nursing home for people with dementia. METHODS: A practical training programme was conducted for caregivers at the Sagrado Corazón de Jesús Nursing Home in Cuenca, Spain. The programme used a dynamic, interactive methodology to provide training related to concepts and strategies for dementia care. Weekly 2-h sessions were held over 9 months, from April 2016 to January 2017, with the post-test administered in February. Pretest and post-test measures were taken for a sample of 36 caregivers. An anova was used to analyze the differences in means before and after training. An ancova was also performed to determine the effects of the intervention. RESULTS: The results revealed a significant difference between pre- and post-intervention emotional exhaustion and depersonalization scores. Personal accomplishment scores improved, but the changes were not significant. CONCLUSION: A practical training programme for direct care professionals working with dementia patients can decrease burnout levels.

Socioeconomic, demographic and lifestyle-related factors associated with unhealthy diet: a cross-sectional study of university students.

BACKGROUND: Food habits are important to promote and maintain good health throughout life, and unhealthy diet is a modifiable and preventable risk factor. University students are a key group of adults among whom to promote healthy lifestyles. The aim of this study is to determine the factors associated with unhealthy diet in a sample of university students. METHODS: An electronic cross-sectional survey was conducted with university students (n=593) from inland Spain, during the 2016-2017 academic year. The survey collected information on the participants' food habits using an annual food frequency questionnaire. We also collected socioeconomic and demographic data and lifestyle-related information. A multivariate logistic regression was used for analysis. RESULTS: The multivariate logistic regression revealed that the factors associated with an unhealthy diet were: being male, being underweight compared to the reference category (normal weight), having a mother of low socioeconomic status, the family home not being in the university city and, finally, studying a non health-related course CONCLUSION: Among students of the University of Castilla-La Mancha, being male, being underweight, the family home not being in the university city, having a mother of low socioeconomic status, and, finally, not studying a health-related course are the factors associated with a lower quality diet. Following a healthy diet is key in reducing the health costs of non-communicable diseases, and ensuring an acceptable long-term quality of life in populations.

Mediterranean diet and health outcomes: a systematic meta-review.

Background: The Mediterranean diet (MeDi) is considered a healthy dietary pattern, and greater adherence to this diet may improve health status. It also may reduce the social and economic costs of diet-related illnesses. This meta-review aims to summarize, synthesize and organize the effects of MeDi pattern on different health outcomes. Methods: This meta-review was performed following the PRISMA guidelines. A systematic search was conducted in the electronic databases PubMed, Web of Science and Scopus. Two researchers screened all the records to eliminate any duplicate, and they selected the articles to be fully reviewed. A third researcher was consulted to resolve discrepancies and so reach a consensus agreement. Results: Thirty-three articles were included, nine were systematic reviews and twenty-four were meta-analyses. Most of the diseases analysed are catalogued as non-communicable diseases (NCD), and the impact of these in populations may have major financial consequences for healthcare spending and national income. The results showed that the MeDi may improve health status, and it also may reduce total lifetime costs. Conclusion: MeDi has been shown to be a healthy dietary pattern that may reduce risk related to NCD. The effect is larger if the pattern is combined with physical activity, and tobacco and excessive alcohol consumption are avoided. Promoting the MeDi as a healthy dietary pattern presents challenges which need the collaboration of all levels of society.

Satisfaction and perceived quality of life results in patients operated on for primary hernia of the abdominal wall.

INTRODUCTION: Outpatient surgery is currently the standard procedure in 60-70% of the most prevalent surgical procedures. Minimally invasive models in health care have improved basic aspects such as postoperative pain and hospital stay, but there are few publications related to perceived quality shown by patients, such as the need for informal care at home or delay before surgery. The aim of the study was to determine the global satisfaction perceived by patients undergoing abdominal wall hernia repair. METHODS: An ad hoc split questionnaire has been completed on satisfaction after a week and postoperative quality a month after intervention by 203 patients operated on for abdominal hernia in a year. Variables included postoperative pain, need for informal care, surgical delay, information supplied, professional management and overall satisfaction. RESULTS: A total of 48.28% of patients needed informal care at home. They were largely attended by women, wives or daughters, for a few days. In 45.81% they were discharged on the same day, and 53.2% in less than 72 h. Overall satisfaction in the program of day surgery and short hospital stay was 94.6%. CONCLUSIONS: The overall process of satisfaction was not related to age, sex or educational level of patients, while there was an inverse relationship between satisfaction and days of hospitalization and days of pain that required analgesia at home.

Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave.

The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.

Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain.

OBJECTIVE: To estimate the prevalence of catastrophic health expenditure due to dental healthcare (CHED) in Spain, quantify its intensity and examine the related sociodemographic household characteristics. METHODS: Data from the Spanish Household Budget Survey, which addresses more than 20,000 households each year for the period 2008-2015 were included, and the methodology proposed by Wagstaff and van Doorslaer was followed. The prevalence (number of households that devote more than a certain threshold of their income to such payments) and intensity (amount that exceeds a certain percentage of income) were estimated. Ordered logistic regression models were estimated to analyse the sociodemographic factors associated with the prevalence of catastrophic payments. RESULTS: The prevalence and intensity remained stable during the period under analysis. In terms of prevalence, a mean proportion of 7.36% of the population dedicated, in terms of intensity, more than 10% of their resources to dental care payments [mean: €292.75 per year (SD €2144.14)] and 2.05% dedicated more than 40% [mean: €143.02 per year (SD €1726.42)]. This represents 36.32% and 51.34% (for the thresholds of 10% and 40%) of the total catastrophic expenditure derived from out-of-pocket payments for dental healthcare in Spain. CONCLUSION: This study shows that a significant proportion of catastrophic healthcare payments correspond to dental services. Being male, aged over 40 years, unattached (single, separated, divorced or widowed), having a low level of education, a low household income, being unemployed and living in an urban area are all associated with a greater risk of CHED. This finding highlights the need to establish policies aimed at increasing dental care coverage to mitigate related financial burdens on a large part of the Spanish population.

[Colorectal cancer screening pilot program in Castilla-La mancha. Partial results after first round: 2015-2018.] / Programa piloto de cribado poblacional de cáncer colorrectal en Castilla-La Mancha. Resultados parciales tras primera ronda: 2015-2018.

OBJECTIVE: Colorectal cancer is considered a public health problem due to its high incidence and mortality in developed countries. Primary preventions is not easy owing to the lack of knowledge of the main risk factors and the difficulty of modifying known risk factors, but it is one of the few tumors that meet the criteria for screening. In Spain, the Colorectal Cancer Population Screening Program was implemented in Catalonia in 2000, followed by the Valencian Community in 2005, beginning in Castilla La Mancha in April 2015. The objetive was to carry out a descriptive study of the results obtained in the first round of the Colorectal Cancer Screening Program at the Virgen de la Luz Hospital in Cuenca. METHODS: A retrospective, descriptive and observational study was carried out from the colonoscopies carried out from May 1, 2015 to November 2018, analyzing the number of lesions detected, the histology, the sex and the age range with the greatest affectation, as well as if there was a relationship between the different variables using Pearson's Chi square test. The qualitative variables were presented by means of their distribution in absolute and relative frequencies, and the quantitative ones by mean and standard deviation. RESULTS: The participation rate was 48.06%. 7.25% of fecal occult blood test were positive and 89% with a positive test had a colonoscopy. The positive of inmunological fecal occult test and the detection rate of adenomas were higher in men. 70.7% of colorectal cancers were diagnosed in early stages. There was no relationship between age and the presence of advanced lesions. CONCLUSIONS: The rates of people with adenomas and people with invasive cancers in Cuenca province are lower than those registered in Castilla-La Mancha.

OBJETIVO: El cáncer colorrectal (CCR) es considerado un problema de salud pública por su alta incidencia y mortalidad en los países desarrollados. La prevención primaria no es fácil, debido al desconocimiento de los principales factores de riesgo y a la dificultad de modificar factores de riesgo conocidos, pero se trata de uno de los pocos tumores que cumple los criterios para ser susceptible de cribado. En España, el Programa de Cribado Poblacional de CCR se implantó en Cataluña en el año 2000, seguida de la Comunidad Valenciana en 2005, comenzando en Castilla-La Mancha en abril de 2015. El objetivo del trabajo fue realizar un estudio descriptivo de los resultados obtenidos en la primera ronda del Programa de Cribado Poblacional de CCR en el Hospital Virgen de la Luz de Cuenca. METODOS: Se realizó un estudio retrospectivo, descriptivo y observacional a partir de las colonoscopias realizadas desde el 1 de mayo de 2015 hasta noviembre de 2018, analizándose el número de lesiones detectadas, la histología, el sexo y la franja de edad con mayor afectación, así como si existió relación entre las distintas variables mediante prueba de Chi cuadrado de Pearson. Las variables cualitativas se presentaron mediante su distribución en frecuencias absolutas y relativas, y las cuantitativas por media y desviación estándar. RESULTADOS: La tasa de participación fue del 48,06%. El 7,25% de los test de sangre oculta en heces (TSOHi) realizados fueron positivos y el 89% de las personas con test positivo se realizaron una colonoscopia. La positividad del test de sangre oculta en heces inmunológico y la tasa de detección de adenomas fueron mayores en hombres. El 70,7% de los cánceres colorrectales se diagnosticaron en estadios precoces. No existió relación entre la edad y la presencia de lesiones avanzadas. CONCLUSIONES: Las tasas de personas con adenomas y con cánceres invasivos en la provincia de Cuenca resultan inferiores a las registradas en toda Castilla-La Mancha.

Effectiveness of a Dog-Assisted Therapy Program to Enhance Quality of Life in Institutionalized Dementia Patients.

The aim of this study was to assess the effectiveness of a dog-assisted therapy intervention to enhance quality of life in persons with dementia institutionalized in a public care home and to study its effect on the use of psychotropic medications. A dog-assisted therapy intervention was designed, in which 34 residents of a public care home in Cuenca (Spain) participated. The participants were assigned to two groups, an experimental and a control group. The program consisted of one 50-min session per week during 9 months. Analysis of covariance (ANCOVA) was used to compare post-training values between groups, using baseline values as covariates. Our findings do seem to support the hypothesis that Animal-Assisted Therapy may contribute to enhancing quality of life for residents in an aged care home. However, aspects such as the format, time, and content of the sessions as well as their possibilities of reducing psychotropic medication require more research.

Aging, Dependence, and Long-Term Care: A Systematic Review of Employment Creation.

Population aging is an economic and social challenge in most countries in the world as it generates higher dependency rates and increased demand for long-term care. Undertaking the care of older dependent adults can result in new opportunities for job creation. There is limited knowledge of the impact of dependent care and long-term care on employment. We examined this impact through a systematic review. Countries with conditional cash benefits show job creation, and countries with unconditional economic benefits reveal the development of a grey care market with high participation of migrant labor. Migrant employment in developed countries affects the development of the labor market in the countries of origin. The employment created to care for dependent persons is generally precarious. In conclusion, global aging will increase long-term care worker demand, but the variations in policies can determine what kind of employment is created.

Socioeconomic Factors Related to Job Satisfaction among Formal Care Workers in Nursing Homes for Older Dependent Adults.

Population ageing is increasing the demand for dependent care. Aged care nursing homes are facilities that provide formal care for dependent older persons. Determining the level of job satisfaction among workers in nursing homes and the associated factors is key to enhancing their well-being and the quality of care. A cross-sectional survey was administered online to nursing home workers (n = 256) in an inland region of Spain over the period from February to May 2017. The questionnaire collected data on sociodemographic variables and others related to training and job satisfaction. The results show that most of the care is delivered by women with a medium level of education. A total of 68% of workers had received formal training, although a significant percentage (65%) thought this was not useful. The highest level of satisfaction was found to be related to users and co-workers. Our factor analysis revealed that the satisfaction components are decision-making, working conditions-e.g., schedule-and the work environment-e.g., relationship with coworkers-. Length of service and working with highly dependent persons are negatively associated with these components. Working in social health care is negatively related to decision-making and working conditions. Training, in contrast, is positively associated with these components. Care is a job that requires appropriate training and preparation to provide quality assistance and to guarantee workers' well-being.

Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain.

BACKGROUND: The financial effect of households' out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households' out-of-pocket payments associated with health care during the period 2008-2015. METHODS: The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. RESULTS: The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). CONCLUSION: The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs.

[Socio-demographic and health factors associated with the institutionalization of dependent people]. / Factores sociodemográficos y de salud asociados a la institucionalización de personas dependientes.

BACKGROUND: The analysis of the effect that different variables have in the probability that dependent people are institutionalized is a topic scantily studied in Spain. The aim of the work is to analyze as certain socio-demographic and health factors can influence probability of dependent person living in a residence. METHODS: A cross-section study has been conducted from a representative sample of the dependent population in Cuenca (Spain) in February, 2009. We have obtained information for people with level II and III of dependence. A binary logit regression model has been estimated to identify those factors related to the institutionalization of dependent people. RESULTS: People with ages between 65-74 years old are six times more likely to be institutionalized than younger people (< 65 years old); this probability increases sixteen times for those individuals with ages equal or higher than 95 years. The probability of institutionalization of people who live in an urban area is three times the probability of people who live in a rural area. People who need pharmacological, psychotherapy or rehabilitation treatments have between two and four times more probability of being institutionalized that those who do not need those. CONCLUSIONS: Age, marital status, place of residence, cardiovascular and musculoskeletal diseases and four times of medical treatment are the principal variables associated with the institutionalization of dependent people.

Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment.

Background: Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC. To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism after financial crisis in Spain. METHODS: The database that was used is the 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds. RESULTS: The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3955, 1 million (0.38% of GDP). CONCLUSION: This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.

[Provincial savings of costs in road accidents in Spain (2000-2014)]. / Ahorros de costes provinciales en los accidentes viales en España (2000-2014).

OBJECTIVE: To quantify cost savings obtained before and after the implementation of the penalty-points driving licence on the interurban roads in Spain. METHOD: Descriptive study through the construction of three indicators that expressed the cost savings by the number of victims avoided. We defined two periods according to the objective and collected data on fatalities, serious injuries and slight injuries on interurban roads in 1999-2014 for each Spanish province. Thus, data for its population, GDP or number of vehicles-kilometres travelled on its roads (MVKT) were used for each province. The quantification of savings was obtained using official figures of costs for each type of victim in 2014 prices. RESULTS: The cost savings per inhabitant on fatalities in the period of validity of the penalty-points driving licence was between ⿬ 3.89 and ⿬ 19.65 per year. Savings on serious injuries by MVKT were reduced by 15%-66% between 2006 and 2014, being from ⿬ 449.15 to 1707.88 ⿬ annually. CONCLUSIONS: During the period of validity of the penalty-points driving licence, the Spanish provinces have achieved significant cost savings.

Interregional inequality and road accident rates in Spain.

The aim of this study was to determine whether interregional inequality in Spain had the same impact on the risks of fatality and injury across the different provinces of Spain, in the period from 1999 to 2015. This allows us to map fatality and injury rates in Spanish provinces depending on their level of economic development. Provinces were divided in two large groups according to the mean weight of their per capita GDP on the national GDP from 2000 to 2015. Using fixed effects data panel models, estimations were obtained for each group of the impact of the relationships between per capita GDP, unemployment rate and other control variables on their risks of fatality and injury. The models reveal that economic conditions and education are explanatory factors with greater significance and impact on the risks of fatality and injury in provinces with higher levels of economic development. In this group, the penalty-points driving licence was found have a greater impact, although its effectiveness is now being questioned. In contrast, to reduce the risks of fatality and injury in less developed provinces, it is imperative to invest in road infrastructure, increasing the proportion of high capacity roads and investing more in road replacement and maintenance. The geographical distribution generated in this study allows us to better identify the areas with a higher risk of fatality or injury. This, in turn, confirms the need to improve the configuration of road safety policy, taking into account the different fatality or injury rates across provinces, the origins of which lie in the specific provincial conditions.

Correction: Social determinants of food group consumption based on Mediterranean diet pyramid: A cross-sectional study of university students.

[This corrects the article DOI: 10.1371/journal.pone.0227620.].

[Costs associated to informal caregiving hours for older people living in rural communities [Spain]]. / Costes asociados a las horas de cuidado informal de los mayores dependientes en un ámbito rural.

OBJECTIVES: To determine the costs associated with the variables that best predict hours of informal care among people living at home with some level of dependency for activities of daily living (ADL). METHODS: We performed a crosssectional observational study of 241 men and women aged more than 64 years old living in rural communities (men 37.8%, women 62.2%). The mean (standard deviation) age was 81.07 (7.07) years. Through the Resident Assessment Instrument Home Care (RAI-HC) questionnaire, sociodemographic variables, ADL dependencies and caregiving hours were assessed. Multiple linear regression analysis was applied. RESULTS: The predictive variables in the multiple linear regression model were living alone and requiring assistance for eating, meal preparation, bed mobility, and outdoor mobility. These predictive variables explained 46.3% of the total variation in caregiving hours. Standardized b coefficients were obtained from needing help to eat (0.272) and prepare meals (0.205). Needing help to eat represented an increment of 275 annual caregiving hours and its associated cost was 2,406.15 euro/year. Becoming dependent for meal preparation represented an increment of 307.2 h and a cost of 2688.18 euro/year. Dependency had a cost of between 4,972.72 and 21,479.15 euro/year, depending on ADL limitations. CONCLUSIONS: Almost 50% of the costs related to the care giving hours that may be required by an elderly person with some degree of dependency can be attributed to the fact of living alone and to some ADL that can be easily evaluated, such as eating, cooking, bed mobility, and outdoor mobility.