Catalonian Health Research Articles

El impacto diferencial del capital social sobre la salud mental de la población autóctona y los inmigrantes residentes en Cataluña

Objectives This study attempts to create a bridge between the literature on immigration and on social capital and health. The objectives were two-fold: firstly, to provide new empirical evidence on the association between social capital and health, using data from Catalonia for the first time and, secondly, to explore the possible existence of a differential impact of social capital on health between native-born residents and immigrants. We also distinguished between individual and community-level social capital. Methods We used the 2006 Catalan Health Survey (ESCA 2006). To assess the relationship between social capital and mental health, we used multilevel models, estimated separately for native-born and immigrant residents. Results The results revealed a positive link between social capital and good mental health in Catalonia. However, this effect was stronger for individual than for community-level social capital. The results did not support the hypothesis of a differential impact between immigrants and native-born Catalans, but did indicate differences with respect to Spaniards born outside Catalonia. Geographic heterogeneity in the effect of individual social capital on mental health in both immigrants and native-born residents was also detected. Conclusions We believe that enhancing social capital could potentially be an effective policy tool to achieve objectives related to health status improvement.

Differential features of foodborne gastroenteritis outbreaks of known and unknown etiology.

Foodborne diseases (FBD) are a major cause of disease and death, but their etiologies are not always known. Factors associated with determination of the etiologic agent of FBD outbreaks reported to the Department of Health in Catalonia (Spain) during 2002 to 2005 were studied. For each outbreak, the year, number of persons affected, hospitalization, and availability of samples from patients, food handlers, and foods were collected. The delay between the date of onset of symptoms of the second case and the report to the surveillance unit was calculated. The relationship between explanatory variables and determination of the cause of each outbreak was studied by logistic regression. The causal agent was identified in 242 (73.3%) of 330 outbreaks. Factors associated with determining the etiologic agent of the outbreak in the univariate analysis were availability of samples from cases (odd ratio [OR] of 6.0, 95% confidence interval [CI] of 3.2 to 11.1), hospitalization (OR of 5.1, 95% CI of 2.6 to 11.1), availability of samples from food handlers (OR of 2.7, 95% CI of 1.6 to 4.5), size > or = 10 cases (OR of 2.2, 95% CI of 1.3 to 3.2), availability of samples from food (OR of 1.8, 95% CI of 1.1 to 3.0), and the last year (2005) of the study period (OR of 1.9, 95% CI of 1.0 to 3.6). In the multivariate analysis, hospitalization (adjusted OR of 5.1, 95% CI of 2.4 to 11.2), size > or = 10 cases (adjusted OR of 2.1, 95% CI of 1.2 to 3.7), and the year 2005 (OR of 2.1, 95% CI of 1.1 to 4.0) remained associated. Collection and processing of clinical samples from cases and appropriate laboratory diagnoses of all possible etiologies of FBD, including viruses, are very important. Efforts by physicians and public health services to coordinate and improve their activity in these areas may help provide more accurate knowledge concerning the etiologies of FBD outbreaks and lead to more effective preventive procedures.

Prevalencia de incontinencia urinaria en Cataluña

To study the prevalence and severity of urinary incontinence (IU) in the population of Catalonia. Descriptive and cross-sectional study. Sample of 18.126 individuals, representative of the population of Catalonia, not institutionalized. 15.926 of them were older than 15 years and answered the Survey of Health of Catalonia (ESCA). Two questions about frequency and quantity of leakages of urine were added to the ESCA, a health questionnaire with 197 questions. Questions about UI were the Spanish version of Incontinence Severity Index (ISI). In Catalonia (Spain) 7.9% of the population (more than 500.000 persons) had symptoms of IU, corresponding to 12.2% of the women and 3.6% of the men. 77.8% of the total population with UI symptoms were women. The prevalence increased with age in both sexes. 12% of women with an age between the 45-64-years, 26.6% between 65-74 years and 41.8% with 75 years or more, had UI symptoms. Symptoms of UI were present in only 2.8% of the men between 45-64 years , 10.2% between 65-74 years and 22.7% of those of 75 years or more. A high prevalence of IU was found in the population of Catalonia. In two thirds of individuals with IU, their symptoms were moderate to severe. Severity of UI increases with age in men and women. Overall, symptoms of UI are 3 times more prevalent in women than in men.

Understanding the relationship of long working hours with health status and health-related behaviours

Background:The objectives of this study are to identify family and job characteristics associated with long work hours, to analyse the relationship between long work hours and several health indicators, and...

Antibiotic prescribing over the last 16 years: fewer antibiotics but the spectrum is broadening

The purpose of this study was to quantify the antibiotics prescribed in the outpatient setting of all primary health care professionals in Catalonia during 1992-2007. We calculated prescribed defined daily doses per 1,000 inhabitants and day (DID) from data provided by the Catalonian Health Service. The antibiotics analysed belonged to the J01 group (ATC/DDD classification). The overall prescribing of antibacterials has decreased by 11.9% during this period (1992: 16.75 DID, 2007: 14.75 DID). During this 16-year period, an increase was observed for penicillins (from 46.1% in 1992 to 59.6% in 2007) and for quinolones (from 13.3% to 15.7%). The prescription of cephalosporins remained steady and, conversely, a decrease in macrolides was found (from 14.8% to 12.2%). The leading antibiotic prescribed in 2007 was amoxicillin plus clavulanic acid (5.15 DID), followed by amoxicillin (2.95 DID). The former has increased by 84.4% since 2002. Penicillin V prescribing reached a peak in 2007 with 0.034 DID. There has been a slight reduction in antibiotic prescription in this 16-year study, with an increase of penicillins, mainly at the expense of those of broader antibacterial spectrum. Awareness of the rational use of antibiotics is mandatory, basically aimed at reducing the overall prescribing of antibiotics and encouraging those with a narrower spectrum.

Tendencias de la mortalidad por cáncer en Cataluña, 1985-2004

In the last two decades, major changes have occurred in both the epidemiology and the healthcare of cancer, which have had a substantial impact on the mortality due to this disease. The objective of this study was to analyze cancer mortality trends in Catalonia in the previous 20 years and to compare these trends with those in Europe. Mortality data were gathered from the mortality register of the Department of Health of Catalonia, which includes all deaths in Catalonia from 1985-2004. The causes of death are coded according to the International Classification of Diseases (ICD-9 for 1985-1998 and ICD-10 for 1999-2004). The population data used were inter-census (1985-2000), census (2001) and post-census (2002-2004) estimates from the Catalan Institute of Statistics. Ageadjusted rates (AR) (to the world population of 1960) and accumulated rates from 0 to 74 years old were calculated. A Poisson model was adjusted to the AR to estimate the mortality trend and the annual percentage of change was calculated for the years 1985-1994 and 1995- 2004 and for the period 1985-2002 as a whole. From 1985-2004, the risk of dying from cancer decreased from 18.54 % to 17.49% in men and from 9.24% to 7.69% in women. The adjusted rate of mortality decreased in cancer of the larynx (2,52%), prostate (1.11%) and stomach (2.89%) in men and in stomach cancer (-3.64) in women. In men, there was a significant increase in mortality from colorectal cancer (an increase of 2.8% to 1994 with subsequent stabilization) and from lung cancer (an increase of 1.36% to 1994 with a subsequent decrease). Cancer of the liver showed a nonsignificant increase until 1994 with a subsequent decrease of 3.13%. In women, breast cancer increased until 1994 (1.48%) and subsequently significantly decreased (2.72%). Lung cancer increased throughout the entire period but this increase was only significant (4,81%) in the last decade. In the last two decades, cancer mortality has shown a general decreasing trend, although mortality from several tumors has substantially increased. Compared with other European countries, Catalonia shows lower cancer mortality in women than in men. Nevertheless, the trends shown in the last decade are similar to those followed by the countries in the best positions.

Gender perspective in the analysis of the relationship between long workhours, health and health-related behavior

The objective of this study was to analyze gender differences in the impact of long workhours (>40 hours per week) on a variety of health outcomes and health-related behavior. The sample included all salaried contract workers aged 16-64 years (1658 men and 1134 women) and interviewed in the 2002 Catalonian Health Survey. Whereas the men with a high job status were more likely to work >40 hours a week, long workhours were associated with situations of vulnerability (low job status and being separated or divorced) among the women. For both genders, working >40 hours was related to a shortage of sleep [adjusted odds ratio (aOR) 1.54, 95% confidence interval (95% CI) 1.21-1.98, for the men and aOR 1.63, 95% CI 1.11-2.38, for the women]. Among the women, long workhours were also associated with poor mental health status (aOR 1.58, 95% CI 1.04-2.40), hypertension (aOR 2.25, 95% CI 1.17-4.32), job dissatisfaction (aOR 1.77, 95% CI 1.08-2.90), and smoking (aOR 1.71, 95% CI 1.22-2.39). In addition, among the women working more hours at home, long workhours were related to sedentary leisure time activity (aOR 1.98, 95% CI 1.06-3.71). The relationship between long workhours and health and health-related behavior was found to be directly related to long worktime and indirectly related to long exposure to poor work conditions among the women and, to a less extent, to domestic work. The pathways that explain the relationship between long workhours and health and health-related behavior seems to depend on the outcome being analyzed.

Propuestas de reforma de los servicios de salud pública en Cataluña

In the year 2004 the government of Catalonia undertook a process to reform its public health services. In this context, it created a working groupinvolving experts from diverse backgrounds to analyse the reforms to be undertaken, the Scientific Committee for the Reform of Public Health in Catalonia. Its members produced eight documents on specific aspects of public health, from which a global report of the Committee was compiled by the end of 2005. This paper makes a synthesis of their production, and includes as an annex their recommendations and proposals. Public health policies should be structured around three main goal: the reduction of health inequalities, the control and removal of social and environmental risks, and effective improvements in quality of life. To reach them, common criteria are defined as main directions. These are based in favouring decentralization of public health services and their administration, linking public health activities with health care services, designing interventions with a population perspective, and reinforcing cross-sectional implications of public health. The work of this Committee is produced in the context of an international debate on the future of public health services and the disproportion between its contribution to health and well being and its resources and visibility. The Committee produced proposals and recommendations which can he grouped in five facets: consolidating a solid and coherent system, developing an organizational reform, defining a port-folio of services, adopting improvements in management, and taking into account cross sectional aspects relating to public health.

Pacientes de trato difícil en atención primaria: ¿están satisfechos con la atención recibida en su centro de salud?

To evaluate the satisfaction of difficult to treat patients (DTP) cared for by a primary care team (PCT), as regards the organisational aspects and the care received, and to compare it with that obtained by a sample of the general patient population (GPP). DESIGN. Cross-sectional descriptive study. Urban health centre. One hundred-one DTP participated, after being selected using Ellis and O'Dowd criteria by 8 doctors. Between March and May 2004 the DTP were given self-administered anonymous questionnaires, prepared and validated by the Catalonian Health Institute, which was divided into 8 sections for their analysis. The results were compared with those obtained in June 2003 from a representative sample from the GPP. A total of 52 questionnaires were returned (51% participation), of which 62% were from women, with a mean age of 61.5+/-12.3. Average scores (0 to 10) were: organisation 7.2+/-1.8; (95% confidence intervale [CI], 6.6-7.7), care by the doctors 8.4+/-2.1 (95% CI, 7.7-9), by nurses 7.9+/-2.1 (95% CI, 7.3-8.6), by administrators 6.9+/-1.9 (95% CI, 6.3-7.4), care resolved 7.2+/-2 (95% CI, 6.6-7.9), installations 7.6+/-1.7 (95% CI, 7.1-8.1), overall satisfaction 7.5+/-1.8 (95% CI, 7-8), and total satisfaction total 7.2+/-1.6 (95% CI, 6.8-7.7). The 91.7% (95% CI, 80-97.7) would recommend their friends to be treated in the centre. All the scores are higher than those in the GPP sample, with no statistical differences in the care by doctors and nurses sections. Although the relationships with the DTP are often problematic, the results show a high level of satisfaction within the DTP in all the sections evaluated, even higher than that of the GPP group.

Factores individuales y del entrono asociados a la variabilidad geográfica de los trastornos psicológicos entre áreas pequeñas: un análisis multinivel

To know the geographic distribution of the prevalence of psychological distress is important for mental health services planning. This study is aimed at identifying the individual factors and those related to the area of residence which may explain the geographic variability of psychological distress (by healthcare districts) in Catalonia. The data was taken from the 1994 Catalonian Health Survey and from the 1996 Catalonia population statistics. The prevalence of psychological distress is estimated by age and sex and by healthcare district. In a two-level logic regression model, a study is made of the relationship between the individual variables (first level: health survey n = 12,455) and those of the area of residence (second level: the healthcare district, n = 46) to the geographic distribution of the prevalence of psychological distress. The significant variables at individual level are in men: age (45-64 years OR: 0.63 y > 64 years OR: 0.22), working status (no work OR: 1.60), number of chronic diseases (CD) (CD = 1 OR: 1.75 CD = 2 OR: 2.06 CD = 3-5 OR: 3.36 and CD > 5 OR: 8.9). In women: age (25-44 years OR: 0.63 45-64 years OR: 0.45 and > 64 years OR: 0.32), working status (no work OR: 1.30), number of chronic diseases (CD = 1 OR: 1.75 CD = 2 OR: 2.44 CD = 3-5 OR: 4.09 and CD > 5 OR: 11.14), and also the kind of parental household in women (single-parental OR: 1.42). The variables at the level of the area of residence are in migration (men OR: 1.55 and women OR: 1.68) and unemployment (men OR: 1.07 and women OR: 1.06). The individual factors do not suffice to explain the geographical variability of the prevalence of psychological distress, but the characteristics of the area of residence are also important.

Recovering birth rate, immigration and health in Catalonia

Recovering birth rate, immigration and health in Catalonia

Percepción de la vacunación antigripal entre los trabajadores sanitarios de atención primaria de Cataluña

Objectives To determine the prevalence of primary care workers (PCW) vaccinated against influenza during the 2002-03 campaign and to identify attitudes toward the vaccine. Material and methods We performed a cross sectional survey through a self-administered questionnaire in 27 randomly chosen Catalonian primary health centers between October 2002 and March 2003. Physicians were classified into pediatricians (attending patients up to 14 years old) and general practitioners. Nurses were classified in the same way. Participants were asked whether they had received the influenza vaccine and why they had or had not received it. They were also asked about absenteeism from work and adverse effects. The utility of the vaccine was evaluated through a Likert scale. Results The response rate was 76.4%. A total of 40.1% of the PCW had been vaccinated. The utility of the vaccine was given a mean value of 3.65. The highest value was given by pediatric nurses (4), followed by general practitioners (3.76), and the lowest value by general practice nurses (3.42; p<0.01). Vaccinated PCW gave a significantly higher value (4.2 versus 3.27; p < 0.001). Multivariate analysis revealed that the only factor related to vaccination was gender (OR men 1.73 [95% CI 1.15-2.59]). Conclusions The main conclusion of this study is that the prevalence of influenza vaccination among PCW is low. The only factor associated with vaccination was gender. Education about this vaccine and awareness of the need for it should be increased among PCW.

La opinión de los usuarios como oportunidad de mejora en atención primaria

To determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions. Results evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed. Rambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute. Users/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service. Reorganization of the family doctors' agendas and reduction of bureaucratic tasks in the physicians' offices. Respondents socio-demographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment. Among reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits. Patient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs.

Efficiency of the incorporation of the hepatitis A vaccine as a combined A + B vaccine to the hepatitis B vaccination programme of preadolescents in schools

In 1998, the Department of Health of Catalonia (Spain) began universal vaccination of preadolescents against hepatitis A by replacing the simple hepatitis B vaccine with a combined hepatitis A + B vaccine. Economic analyses were made of the two alternative strategies: to continue with the simple hepatitis B vaccination or to replace the simple vaccine with a combined hepatitis A + B vaccine. The analysis was made from the societal perspective and the time horizon considered was 25 years. In the base case, (estimated annual hepatitis A incidence of 15 per 100,000 and incremental price of the hepatitis A + B vaccine over the simple hepatitis B vaccine of €1.98) the net present value of the programme was positive (€+533,708) and the benefit-cost ratio was 2.58. If the estimated disease incidence were reduced by half, the programme would still be efficient.

Socio-Economic Inequalities in Health in Catalonia

In this paper we measure the degree of income related inequality in mental health as measured by the GHQ instrument and general health as measured by the EQOL-5D instrument for the Catalan population. We find that income is the main contributor to inequality, although the share of inequality in mental health that can be explained by income is much greater than the corresponding share of inequality in general health. We also find that the variation in demographic structure reduces income related inequality in mental health but increases income related inequality in general health. The regional variations in both instruments for health are striking, with the Barcelona districts faring relatively bad with respect to the rest of geographical areas and Lleida being the health region where, all else held equal, the population reports the greatest level of health. A big share of inequality in the two health measures, but specially mental health, is due to the favourable position in both health and income of those who enjoy an indefinite contract with respect to the rest of individuals. We also find that risky working conditions affect both health measures and are able to explain an important share of socio-economic inequality.

Impacto de un programa de adecuación de la prescripción de medicamentos en centros residenciales geriátricos. Resultados al año de su implantación

To evaluate the impact after one year of a program to improve appropriate prescribing of medications, medical care products and supplies at a group of residential centers for older persons. Multicenter, controlled, quasi-experimental, before-after study of all outpatient prescriptions charged from each center to the Catalonian Health Service during the study period (reference year 2001, monitoring year 2002). A total of 107 residential centers in the Barcelonés Norte y Maresme (Barcelona) health region. After situation analysis the centers were divided into two groups: intervention (n=21) and control (n=86). A total of 4789 older persons were residents at participating centers during the study. Interventions. The actions carried out in the intervention group were: a). letter describing the program; b). face-to-face interview to provide information; c). distribution of printed information about the study's aims and the indicators recorded, and d). monitoring with several follow-up interviews. We recorded quantitative indicators (general, specific and urinary incontinence products), qualitative indicators (use of medications with high intrinsic pharmacological value and generic pharmaceutical specialties) and relative drug use. The data were analyzed with a program written for Microsoft Access. In the intervention group we found that pharmaceutical costs were contained, a result we attributed to the greater efficiency achieved with the intervention (interannual increase of 0.7% in the reference period to 16.2% in the monitoring period; P=.000). The contribution of urinary incontinence supplies to cost reductions was noteworthy. Total costs in terms of numbers of packages dispensed for all therapeutic subgroups decreased by 4.8% (P=.000). The use of generic pharmaceutical specialties increased by from 7.9% to 13.1%, and the results for qualitative indictors for antiasthmatics and recommended NSAIDs also revealed improvements in prescribing quality. The preliminary results of the program show it to be effective in improving the efficiency of drug prescribing at participating nursing homes. The research method was useful in promoting the rational use of medications and improving the quality of prescribing practices.

Women, family demands and health: the importance of employment status and socio-economic position

Although it is generally assumed that women engaged in paid work have better health than full-time homemakers, little is known about the situation in Southern European countries like Spain or about differences in the impact of family demands by employment status or the potential interaction with educational level. The objectives of this study are to analyse whether inequalities in health exist among housewives and employed women, and to assess whether the relationship between family demands and health differs by employment status. Additionally, for both objectives we examine the potential different patterns by educational level. The data have been taken from the 1994 Catalonian Health Survey (Spain). The sample was drawn from all women aged 25–64 years who were employed or full-time homemakers and married or cohabiting. Four health indicators (self-perceived health status, limiting long-standing illness, chronic conditions and mental health) and two health related behaviours (hours of sleeping and leisure-time physical activity) were analysed. Family demands were measured through household size, living with children under 15 and living with elderly. Overall, female workers had a better health status than housewives, although this pattern was more consistent for women of low educational level. Conversely, the health related behaviours analysed were less favourable for workers, mainly for those of low educational level. Among workers of low educational level, family demands showed a negative effect in most health indicators and health related behaviours, but had little or no negative association at all in workers of high educational level or in full-time homemakers. Moreover, among women of low educational level, both workers and housewives, living with elderly had showed a negative association with poor health status and health related behaviours. These results emphasise the need of considering the interaction between family demands, employment status and educational level in analysing the impact of family demands on women's health as well as in designing family policies and programmes of women's health promotion.

Aproximación a la atención domiciliaria. ¿Cómo trabaja la sanidad pública catalana la atención domiciliaria?

To describe the organizational model, resources and implementation of the home care program run by the Catalonian public health service, and to note difficulties reported by primary care professionals. Cross-sectional, descriptive study.Setting. Autonomous Community of Catalonia. 214 primary care centers (PCCs) operating under reformed administrative procedures were surveyed, and responses were obtained from 112 (52.3%). Semistructured, self-administered questionnaire sent by mail, with variables that identified the center, resources, organization and use of protocols for home care. Questionnaires were collected during July to November, 2000. Home care programs were being used at 90.2% (95% CI, 84.7%-95.7%) of the centers, and had been in effect for a mean of 5.6 years. Nursing services predominated in 64% of the case, with nurses spending a mean of 5.09 h/week on the program, twice as much time as physicians and social workers. The mean rate of computerization of the data was 31.3%, and was highest (P<.05) in Gerona (51%) and in PCCs run privately (70%). Of all participating PCCs, 70% had social workers on the staff, 13% had a home care nurse and 50% operated in coordination with social services. Of all PCCs, 79.5% (95% CI, 72.1%-86.9%) used specific protocols for pressure sores (69.1%), terminal illnesses (43.6%), bedridden patients (41.8%) and pain management (40.9%). Evaluations were done with the Barthel scale (73.2%), the Mini-Mental State Examination (73.2%) and the Norton scale (53.6%). Continuing education (66%) and activities for care providers (>75%) were frequent in home care programs. The main difficulties identified were the burden of care (65.2%), time constraints (51.8%), inadequate social support (43.8%) and lack of coordination with other levels of care (33%). Noteworthy findings were the dedication of nursing staff to the home care programs, the low level of computerization of the data, the limitations in social service resources, the uniformity of assessment protocols and scales, and the agreement regarding current difficulties.

Gender inequalities in health among workers: the relation with family demands

OBJECTIVESTo analyse whether there are gender inequalities in health among male and female workers who are married or cohabiting and to assess whether there are gender differences in the relation...

Medicare’s DRG-weights in a European environment: the Spanish experience

Hospital payment systems are being changed to mixed systems, composed of case-mix categories and structure indicators. The Health Care Financing Administration’s Diagnosis-Related-Groups (HCFA’s DRGs) and DRG-weights are used in Catalonia as Prospective Payment System (PPS)-instruments for hospital inpatient reimbursement. The Catalonian and Spanish health systems, however, are very different from the US health environment. The aim of this study is to determine whether the HCFA’s DRGs and DRG-weights fit the special characteristics of a European environment. To do this, cost-based weights, determined from information from the cost accounting system of two public hospitals in Barcelona, are compared with Medicare-weights. A total of 35 262 discharges representing 12 794 million pesetas are analyzed. Medicare-weights do not differ globally from cost-based-weights and the adjusted correlation weighted least squares regression between the two weight-scales is 95%. There are, however, systematic deviations in six DRG-groupings. The most important deviations are concentrated in Ambulatory Surgery categories, in DRGs in which prostheses are used, and in specialties excluded from several PPSs because of extreme variability in treatment intensity. In conclusion, Medicare-weights can be used to pay hospital output in a European environment but they should be adjusted to avoid systematic deviations.