[Cancer and unemployment]. / Cáncer y paro.

The lack of work is a increasingly dramatic situation in the times we are living. Daily experience of clinicians provides us with important clues that remind us of the existence of a direct relationship between prolonged unemployment and predisposition to serious health problems, in particular to suffering certain types of cancer. This paper aims to review the major epidemiological studies that have dealt the relationship between cancer and unemployment. Several hypotheses may be formulated with the results of this review arising from the possible etiological relationship between unemployment and development (or poor prognosis) of neoplastic processes.

Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter?

AIM: To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity. METHODS: Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n=65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes. RESULTS: Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]:1.25; 95% confidence interval [CI]:1.12-1.39, IRR:1.21; 95% CI:1.06-1.39), average length of stay (IRR:1.47; 95% CI:1.25-1.73), and total and priority emergency room visits (IRR:1.26; 95% CI:1.17-1.35, IRR:1.30; 95% CI:1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR:1.38; 95% CI:1.33-1.43) and to different specialties (IRR:1.36; 95% CI:1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR:1.08; 95% CI:1.06-1.11), but especially for those with mental comorbidity (IRR:1.17; 95% CI:1.14-1.21). CONCLUSION: In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent.

Differences in the use of primary care services between Spanish national and immigrant patients.

UNLABELLED: Knowing what real use is made of health services by immigrant population is of great interest. The objectives are to analyze the use of primary care services by immigrants compared to Spanish nationals and to analyze these differences in relation to geographic origin. Retrospective observational study of all primary care visits made in 26 urban health centers. Main variable: total number of health centre visits/year. DEPENDENT VARIABLES: type of clinician requested; type of attention, and origin of immigrants. The independent variable was nationality. Statistics were obtained from the electronic medical records. The 4,933,521 appointments made in 2007 were analyzed for a reference population of 594,145 people (11.15% immigrants). The adjusted annual frequency for nationals was 8.3, versus whereas 4.6 for immigrants. The immigrant population makes less use of primary care services than national population. This is evident for all age groups and regardless of the immigrants' countries of origin. This result is important when planning health care resources for immigrant population.