Desigualdades y servicios de salud

Los objetivos de este trabajo son tres: en primer lugar, se revisan las causas de las desigualdades sociales en salud incluyendo el papel que juegan los servicios sanitarios en las mismas; posteriormente se analiza la influencia de la financiación y la organización de los servicios sanitarios en las desigualdades y finalmente, se muestra un ejemplo de las desigualdades en la utilización de los servicios sanitarios en Cataluña, comunidad autónoma del Estado Español donde existe un Sistema Nacional de Salud. Se analizan las siguientes causas de las desigualdades en salud: los estilos de vida o conductas relacionadas con la salud, los servicios sanitarios, los factores materiales o estructurales, las desigualdades de renta y los factores políticos. Los servicios sanitarios no son los determinantes principales de la salud ni de las desigualdades en salud. Pero la existencia de servicios sanitarios adecuados es una necesidad fundamental y el acceso a los mismos debería ser un derecho de todas las personas sin distinciones sociales. Tanto la calidad como la cobertura de los servicios sanitarios son una parte integral de la definición del desarrollo en sí mismo y constituyen unos de los principales indicadores de bienestar social. Finalmente, se muestra un ejemplo sobre las desigualdades según clase social en la utilización de servicios sanitarios en Cataluña en 1994 y en 2002, desigualdades que son prácticamente inexistentes en el caso de los servicios sanitarios curativos, pero que se mantienen en los servicios preventivos.The objectives of this paper are three: first to review the causes of inequalities in health and the role played by health services; second, to analyze the influence of health care financing and the organization of health services on inequalities in health and to show an example of the study of inequalities in health services utilization in Catalonia, an autonomous community of Spain where a National Health System exists. The following causes of health inequalities are analyzed: life styles or health behaviors, health services, material or structural factors, income inequalities and political factors. Health services are not the main determinants of health or of health inequalities. But the existence of health services is a fundamental need for everyone and the access to them should be a right for all people independently of their social characteristics. Quality and coverage of health services is an important part of development and they constitute main indicators of social wellbeing. Finally, it is shown an example of social class inequalities in health services utilization in Catalonia in 1994 and 2002, inequalities that are non existent for curative services but that still remain for preventive services

Criteris de reintegració de positius fotogràfics en paper i recuperació de la imatge

A l’hora de restaurar una fotografia, una de les qüestions més importants que se’ns planteja és com tractar les pèrdues del suport i de la imatge (emulsió); s’han de tenir en compte els diferents valors de la fotografia, els interessos del propietari i, sobretot, si la fotografia ha de ser exposada. Actualment, amb els grans avenços tecnològics i informàtics, sovint es confon la reintegració del suport original positivat en paper amb la reintegració digital d’una còpia; aquest error només el podem esmenar els restauradors marcant els criteris d’intervenció

Social inequalities in utilization of a feminist telehealth abortion service in Brazil : A multilevel analysis

The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5-8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels

Gender inequalities in science: Gaceta Sanitaria takes a step forward

Las desigualdades de género están presentes en la familia, el trabajo, los salarios, los recursos económicos, el uso del tiempo y el poder, de manera que las mujeres tienen una peor situación. La desigual distribución del poder se refleja también en las instituciones y las estructuras relacionadas con la ciencia, y a su vez se plasma en la producción científica. En este editorial se contextualiza y presenta una iniciativa promovida por el equipo editorial de Gaceta Sanitaria para responder a estas desigualdades a través de la nueva «Política de Gaceta Sanitaria para fomentar la igualdad de género en la publicación científica»

Oral health care activities performed by caregivers for institutionalized elderly in Barcelona-Spain

Objectives: To describe the frequency of brushing teeth and cleaning of dentures, performed by caregivers, for institutionalized elderly people. Methods: A cross-sectional study in a sample of 196 caregivers of 31 health centers in Barcelona. The dependent variables were frequency of dental brushing and frequency of cleaning of dentures of the elderly by caregivers. The independent variables were characteristics of caregivers and institutions. We performed bivariate and multivariate descriptive analyses. Robust Poisson regression models were fitted to determine factors associated with the dependent variables and to assess the strength of the association. Results: 83% of caregivers were women, 79% worked on more than one shift, 42% worked only out of necessity, 92% were trained to care for elderly persons, 67% were trained in oral hygiene care for the elderly, and 73% recognized the existence of institutional protocols on oral health among residents. The variables explaining the lower frequency of brushing teeth by caregivers for the elderly, adjusted for the workload, were: no training in the care of elderly persons (PRa 1.7 CI95%: 1.6-1.8), not fully agreeing with the importance of oral health care of the elderly (PRa 2.5 CI95%: 1.5-4.1) and not knowing of the existence of oral health protocols (PRa 1.8 CI95%: 1.2-2.6). The variables that explain the lower frequency of cleaning dentures, adjusted for the workload, were lack of training in elderly care (PRa 1.7 CI95%: 1.3-1.9) and not knowing of the existence of protocols (PRa 3.7 CI95%: 1.6-8.7). Conclusion: The majority of caregivers perform activities of oral health care for the elderly at least once per day. The frequency of this care depends mainly on whether caregivers are trained to perform these activities, the importance given to oral health, the workload of caregivers and the existence of institutional protocols on oral health of institutionalized elderly persons

Abandono y prevalencia del tabaquismo: sexo, clase social y atención primaria de salud

ObjetivoValorar el papel conjunto de la clase social y la fuente de atención primaria de salud sobre la cesación.DiseñoEstudio transversal.EmplazamientoBarcelona (Cataluña, España), 2000-2001.ParticipantesMuestra de población residente no institucionalizada, con restricción a personas de 15-50 años que identifican una fuente habitual de atención primaria (n=4.178).Mediciones principalesObtenidas en la Encuesta de Salud. Las variables independientes son el sexo, la clase social y la fuente habitual de atención primaria de salud. Las variables dependientes son haber sido alguna vez fumador, haber dejado de fumar y fumar actualmente. Se estiman proporciones e intervalos de confianza (IC) del 95% ajustando por edad.ResultadosPor clase social se ve que más trabajadores manuales han sido fumadores. Por sexo se aprecia que más varones han fumado. La cesación general es similar en ambos sexos. El abandono muestra un gradiente social en varones. Por fuente de atención, la cesación parece mayor en usuarios de consultas privadas, pero los IC se solapan. Estratificando la fuente de atención primaria por clase social, aparece un efecto en varones pero los IC se solapan. La prevalencia en el momento de la encuesta es mayor para varones; parece emerger un gradiente por clase en varones, menor para mujeres donde los IC se solapan.ConclusionesLa clase social es un poderoso determinante del tabaquismo. Los varones de categoría ocupacional baja tienen mayor riesgo de empezar a fumar, menos probabilidades de dejarlo, y una mayor prevalencia. La proporción de cesaciones parece menor en usuarios de la red pública. La intervención sanitaria es eficaz, pero en términos poblacionales otros factores parecen tener mayor influencia.ObjectiveTo analyse the joint role of social class and primary health care in giving up smoking.DesignCross-sectional study.SettingBarcelona (Catalonia, Spain), 2000-2001.ParticipantsA sample of the resident non-institutionalized population, restricted to people aged 15-50 who have a habitual primary care source (n=4178).Main measurementsThese were obtained from the Barcelona Health Interview Survey. Independent variables include sex, social class and usual source of primary health care. Dependent variables are having ever been a smoker, having quit, and being a current smoker. Age-adjusted proportions were calculated (95% CI).ResultsSocial class shows that more manual workers have been smokers. Men smoked more than women. Overall quitting is similar in both sexes.Quitting showed a social gradient in men. Measurement of source of care showed quitting was higher among users of private clinics, but CI overlapped. On stratifying the source of Primary Care by social class, an effect seemed to emerge for men, but the CI overlapped. Prevalence at the time of the survey was higher for men; a class gradient in current prevalence emerged for men, but was less visible for women, where CI overlapped.ConclusionsSocial class is a powerful determinant of smoking. Men in low-classed jobs are at greater risk of starting to smoke, are less likely to give up, and smoke more. The proportion of quitting seems lower in of public clinics service users. Health advice is efficacious, but in population terms other factors seem to have greater influence

Factors influencing publication of scientific articles derived from masters theses in public health

Objectives: To evaluate theses of a Masters program in Public Health (MPH), in terms of the students' and theses' characteristics that influence publication of the thesis as a scientific article. Methods: Longitudinal study of students who successfully completed the MPH at Universitat Pompeu Fabra and Universitat Autònoma de Barcelona (Spain) from 2006 to 2010. Participants completed an electronic survey and additional data were gathered from university files. Results: 162 students participated in the study (83 % response rate). 60.5 % had already published an article derived from their thesis at the time of the study or were in process of publishing it. The likelihood of publishing in a peer-reviewed journal was greater among women (aRR = 1.41), among those who had a bachelor's degree in sciences other than health (aRR = 1.40), had completed the MPH on time (aRR = 2.10), had enrolled in a doctoral program after the MPH (aRR = 1.44) or had a masters thesis score of ≥7 (aRR = 1.61). Conclusions: The majority of MPH students published their thesis in a peer-reviewed journal. The strongest predictors of successful publication were related to academic performance

Analysis of the formulation of policies on aging in plans for social and health care and care of the elderly in autonomous communities in Spain

Objetivo: Describir y comparar la formulación de las políticas autonómicas sobre envejecimiento en España disponibles en el año 2002. Material y método: Se analiza la formulación de las políticas sobre envejecimiento en las comunidades autónomas que tienen publicado un plan específico de atención a las personas mayores o un plan sociosanitario, que incluye atención a las personas mayores, comparando con un estándar de referencia. Resultados: Siete comunidades autónomas tenían en 2002 un documento de las características del estudio. Seis de ellos son planes sociosanitarios, que incluyen una parte específica de atención a las personas mayores; en Canarias hay un plan específico de atención a las personas mayores en el nivel primario de salud. Existen diferencias en el número de intervenciones que propone cada región, entre un rango de 14 (Cataluña) hasta 44 acciones (Cantabria), de las 62 propuestas en el estándar de referencia. Cantabria y Extremadura son las únicas que plantean acciones en todos los ámbitos posibles. Existe una gran variabilidad en los planes, en función de su orientación al aspecto individual y curativo (Extremadura), o hacia los aspectos sociales y preventivos (Cantabria). Conclusiones: El número de propuestas de los diferentes planes está por debajo de lo que sería posible realizar según el estándar de referencia utilizado en esta comparación. En general, los planes están más orientados hacia fases más tardías de la dependencia y al entorno próximo de las personas mayores.Objective: To describe and compare the formulation of policies on aging in the autonomous communities of Spain available in 2002. Material and method: The formulation of policies on aging in autonomous communities that published a specific plan on the care of the elderly or a social and health care plan that included elderly care were compared with a standard. Results: In 2002, seven autonomous communities had a document with the above-mentioned characteristics. Six of these were social and health care plans that included a specific section on the care of the elderly; the Canary Islands had a plan for the care of the elderly in primary care. Differences were found in the number of interventions proposed by each autonomous community, ranging between 14 (Catalonia) and 44 (Cantabria) out of the 62 proposed in the standard. Cantabria and Extremadura were the only autonomous communities that established interventions in all the possible areas. Wide variability was found in the plans, depending on their orientation toward an individual and treatment focus (Extremadura) or toward a social and preventive focus (Cantabria). Conclusions: The number of proposals in the various plans was lower that that in the standard used for comparison. In general, the plans focused on the later phases of dependency and on the immediate setting of the elderly.Merck Sharp & Dohme

Discursos de movimientos sociales sobre privatización de los servicios de salud catalanes

En ese artículo discutimos los discursos sobre la privatización de la sanidad a partir del análisis de entrevistas y de manifiestos, en tres movimientos catalanes: Centre d'Anàlisis i Programes Sanitaris (Caps), Grup de Defensa de Sanitat Pública (15MBCNSalut) y Plataforma Pel Dret a la Salut (PDS). Para el tratamiento metodológico utilizamos el análisis de contenido. El análisis enuncia la dicotomía entre sistema público/privado como dualidad que organiza los discursos de defensa del modelo público y el gran trabajo que tienen los movimientos para garantizar este modelo, lo que configura los movimientos como una fuerza revolucionaria que defiende el sistema público de las amenazas privadas y que lo hacen presuponiendo que éste, en esencia, representa los ideales de la población. Es central en el análisis el debate entre lo tradicional y lo nuevo en actuación social y la problemática de la coexistencia de diferentes modelos de actuación.In this paper, we discuss the discourses about the health privatization from the analysis of interviews and manifests of three Catalan movements: Centre d'Anàlisis i Programes Sanitaris (Caps), Grup de Defensa de Sanitat Pública (15MBCNSalut) and Plataforma Pel Dret a la Salut (PDS). The content analysis has been adopted as methodology. The analysis has evidenced a dichotomy between public and private systems as a duality that structures discourses favoring the public model and the great efforts made by the movements to guarantee that model. This has shaped the movements as a revolutionary force that defends the public system from private threats by assuming that it essentially represents the people's ideals. The debate between the traditional and the new in social action has been central to the analysis, as well as the problem of coexistence of different models of action