Clinical characteristics associated with psychosocial functioning among patients with uncomplicated epilepsy in Spain

Objective To identify the clinical characteristics associated with poor psychosocial functioning among Spanish patients with epilepsy but no other neurological or psychiatric disorder. Methods Between May and September 2001 a survey among patients with epilepsy was carried out in 32 Spanish health care centres. The selection criteria of patients were attendance to a routine neurologist visit, to be aged between 25 and 64 and not having another additional neurological handicap (n = 812). Psychosocial function was elicited through six indicators: educational level, marital status, unemployment status, restricted car driving, self-perception of epilepsy as an important limiting factor in the educational level achieved and, among unemployed, as the cause of their unemployment. Multiple logistic regression models were fitted in order to calculate adjusted odds ratios (aOR) and their 95% confidence intervals. Results After simultaneously adjusting for socio-demographic variables and clinical characteristics, the six outcomes analysed increased with seizure frequency. Moreover, all the outcomes except low educational level were also related to early age at onset of epilepsy. Although no relation with objective educational level was found, there was a strong association between early age at onset of symptoms and self-perception of epilepsy as an important limiting factor of educational achievement. Conclusion These findings emphasize the need for more effective treatment of epilepsy and also highlight the importance of a psychosocial approach to management of epilepsy for patients with an early onset of symptoms in order to prevent social limitations in adult lif

Social inequalities in the association between partner/marital status and health among workers in Spain

The objectives of this study are to examine the association between partner/marital status and several health outcomes among workers and to assess whether it depends on gender and occupational social class. The sample was composed of all workers aged 21-64 years interviewed in the 2006 Spanish National Health Survey (8563 men and 5881 women). Partner/marital status had seven categories: married and living with the spouse (reference category), married and not living with the spouse, cohabiting, single and living with parents, single and not living with parents, separated/divorced and widowed. Four health outcomes were analysed: self-perceived health status, mental health, psychiatric drugs consumption and hypertension. Multiple logistic regression models stratified by sex and social class were fitted. Female manual workers who were cohabiting were more likely to report poor self-perceived health status, poor mental health status, psychiatric medication consumption and hypertension than their married and living with the spouse counterparts. In that group the prevalence of poor health outcomes was even higher when compared with single people. Among male non-manual workers, being married and not living with the spouse was associated with poor self-perceived health status, poor mental health status and hypertension. There were almost no differences in health between being married and the rest of partner/marital status categories for different combinations of gender and social class and, even, some groups of single people reported better health outcomes than people who were married. Our results show no evidence that being married and living with the spouse is unequivocally linked to better health status among Spanish workers. They emphasize the importance of not only considering marital status, but also partner status, as well as the role of gender, social class and the sociocultural context in the analysis of the association between family characteristics and health.Spain Marital status Family characteristics Gender Social factors Work

Perceived sexism as a health determinant in Spain

OBJECTIVES: The goals of the present study are to explore the association between perceived sexism and self-perceived health, health-related behaviors, and unmet medical care needs among women in Spain; to analyze whether higher levels of discrimination are associated with higher prevalence of poor health indicators and to examine whether these relationships are modified by country of origin and social class. MATERIALS AND METHODS: The study is based on a cross-sectional design using data from the 2006 Spanish Health Interview Survey. We included women aged 20-64 years (n = 10,927). Six dependent variables were examined: four of health (self-perceived health, mental health, hypertension, and having had an injury during the previous year), one health behavior (smoking), and another related to the use of the health services (unmet need for medical care). Perceived sexism was the main independent variable. Social class and country of origin were considered as effect modifiers. We obtained the prevalence of perceived sexism. Logistic regression models, adjusted for potential confounders, were fitted to study the association between sexism and poor health outcomes. Results: The prevalence of perceived sexism was 3.4%. Perceived sexism showed positive and consistent associations with four poor health outcomes (poor self-perceived health, poor mental health, injuries in the last 12 months, and smoking). The strength of these associations increased with increased scores for perceived sexism, and the patterns were found to be modified by country of origin and social class. CONCLUSION: This study shows a consistent association between perceived sexism and poor health outcomes in a country of southern Europe with a strong patriarchal tradition.This study was partially funded by CIBER Epidemiología y Salud Pública, Spain; by the Ministerio de Sanidad y Consumo—Observatorio de Salud de la Mujer, Dirección General de la Agencia de Calidad—y Ministerio de Ciencia e Innovación—Instituto de Salud Carlos III, Spain; and by the project "Analysis of the Effects of Discrimination in the Self-perceived Health in Adult and Children Populations in Spain" from the Fondo de Investigación Sanitaria of the latter institutions (reference PI080782)

Informal employment and health status in Central America

SALTRAPrograma Salud, Trabajo y Ambiente en América CentralBackground: Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low-and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60 % of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment. Methods: Employment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract-only for employees-(written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables. Results: Poor self-perceived health was reported by 34 % of women and 27 % of men, and 30 % of women and 26 % of men reported poor mental health. Lack of social security coverage was associated with poor self-perceived health (women, aOR: 1.38, 95 % CI: 1.13-1.67; men, aOR: 1.36, 95 % CI: 1.13-1.63). Almost all employment profiles with no social security coverage were significantly associated with poor self-perceived and poor mental health in both sexes. Conclusions: Our results show that informal employment is a significant factor in social health inequalities among Central American workers, which could be diminished by policies aimed at increasing social security coverage.Antecedentes: Se supone que el empleo informal es un determinante social importante de la salud, pero rara vez estudiado, que afecta a un gran número de trabajadores en todo el mundo. Aunque los acuerdos de empleo informal constituyen un pilar estructural permanente de muchos mercados laborales en países de ingresos bajos y medianos, los estudios sobre su relación con el estado de salud aún son escasos. En Centroamérica más del 60% de los trabajadores no agrícolas tienen empleo informal. Por lo tanto, nuestro objetivo fue evaluar las diferencias en el estado de salud mental y autopercibido de los centroamericanos con diferentes patrones de empleo informal y formal. Métodos: Los perfiles laborales se elaboraron combinando relaciones laborales (asalariados, autónomos, empresarios), cobertura de la seguridad social (sí / no) y tipo de contrato -sólo para asalariados- (escrito, oral, ninguno), en forma transversal. estudio de 8.823 trabajadores no agrícolas basado en la I Encuesta Centroamericana de Condiciones de Trabajo y Salud de 2011. Mediante modelos de regresión logística, se calcularon las odds ratios (ORa) ajustadas por país, edad y ocupación, de mala autopercepción y salud mental por sexo. Primero se ajustaron diferentes modelos por separado para las tres dimensiones de las condiciones de empleo, luego para los perfiles de empleo como variables independientes. Resultados: El 34% de las mujeres y el 27% de los hombres informaron de mala salud autopercibida, y el 30% de las mujeres y el 26% de los hombres informaron de mala salud mental. La falta de cobertura de la seguridad social se asoció con una mala salud autopercibida (mujeres, ORa: 1,38, IC del 95%: 1,13-1,67; hombres, ORa: 1,36, IC del 95%: 1,13-1,63). Casi todos los perfiles laborales sin cobertura de seguridad social se asociaron significativamente con una mala percepción de sí mismos y una mala salud mental en ambos sexos. Conclusiones: Nuestros resultados muestran que el empleo informal es un factor significativo en las desigualdades sociales en salud entre los trabajadores centroamericanos, que podría ser disminuido por políticas dirigidas a incrementar la cobertura de la seguridad social.Contexto: O emprego informal é considerado um determinante social da saúde importante, mas raramente estudado, afetando um grande número de trabalhadores em todo o mundo. Embora os arranjos de emprego informal constituam um pilar estrutural permanente de muitos mercados de trabalho em países de renda baixa e média, os estudos sobre sua relação com o estado de saúde ainda são escassos. Na América Central, mais de 60% dos trabalhadores não agrícolas têm empregos informais. Portanto, nosso objetivo foi avaliar as diferenças na autopercepção e no estado de saúde mental dos centro-americanos com diferentes padrões de emprego formal e informal. Métodos: Perfis de emprego foram criados combinando relações de trabalho (empregados, autônomos, empregadores), cobertura de seguridade social (sim / não) e tipo de contrato somente para empregados (escrito, oral, nenhum), em um corte transversal estudo de 8.823 trabalhadores não agrícolas com base na I Pesquisa Centro-americana de Condições de Trabalho e Saúde de 2011. Usando modelos de regressão logística, foram calculados os odds ratios ajustados (aOR) por país, idade e ocupação, autopercepção ruim e saúde mental por sexo. Diferentes modelos foram ajustados separadamente para as três dimensões das condições de emprego e, em seguida, para perfis de emprego como variáveis ​​independentes. Resultados: A autopercepção de saúde ruim foi relatada por 34% das mulheres e 27% dos homens, e 30% das mulheres e 26% dos homens relataram saúde mental ruim. A falta de cobertura de seguridade social foi associada à autopercepção de saúde ruim (mulheres, aOR: 1,38, IC 95%: 1,13-1,67; homens, aOR: 1,36, IC 95%: 1,13-1,63). Quase todos os perfis de emprego sem cobertura de seguridade social foram significativamente associados a uma autopercepção ruim e a uma saúde mental ruim em ambos os sexos. Conclusões: Nossos resultados mostram que o emprego informal é um fator significativo nas desigualdades sociais em saúde entre os trabalhadores da América Central, que poderia ser diminuído por políticas destinadas a aumentar a cobertura da seguridade social.Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, EspañaHospital del Mar Medical Research Institute, EspañaUniversidad de Salamanca, EspañaAgènciade Salut Pública de Barcelona, EspañaInstitute of Biomedical Research, Españahttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2030-9Instituto Regional de Estudios en Sustancias Tóxica

High quality employment in a regulated labour market is beneficial to workers´health and reduces inequality

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