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

El papel de la promoción de la salud para hacer frente a las desigualdades en salud

La Promoción de la Salud es el proceso que proporciona a las poblaciones los medios necesarios para ejercer un mayor control sobre su propia salud y así poder mejorarla. La Promoción de la Salud tiene un importante papel en la lucha contra las desigualdades en salud. Los responsables de salud pública han intentado introducir diferentes medidas para promocionar estilos de vida saludables y reducir las diferencias sociales. Estas medidas deberían incluir también cambios estructurales tanto en el ámbito legislativo y fiscal, como organizativos y de desarrollo comunitario. La Promoción de la Salud comprende acciones dirigidas a informar sobre las posibilidades de decisión individual y familiar, así como a fomentar la participación responsable de los ciudadanos en actividades comunitarias decisivas encaminadas a proteger su derecho a la salud. Este enfoque tiene como fin alcanzar la equidad en materia de salud

A vueltas con revisiones

Una vez más estamos aquí. Le Beaujolais Nouveau est arrivée es la noticia que cada año, hacia mediados de noviembre, esperan los admiradores de ese especial vino francés. Desde la debida modestia, nos gustaría que nuestros lectores esperasen también ilusionados la aparición del suplemento anual de Revisiones hacia finales de año

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

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

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

Objective: The objective of this study is to describe the oral health status and the factors associated with oral health-related quality of life (OHRQoL) in people aged 65 and older institutionalized in Barcelona in 2009. Study Desing: Cross sectional study in 194 elderly. The dependent variable was poor OHRQoL, according to the Geriatric Oral Health Assessment Index (GOHAI). The independent variables were socio-demographic data, last dental visit, subjective and objective oral health status. Robust Poisson regression analysis was used to determine the factors associated with OHRQoL as well as the strengths of association (Prevalence Ratios with respective confidence intervals at 95%). Results: According to GOHAI, 94 women (68.1%) and 36 men (64.3%) had poor OHRQoL. The average DMFT index (number of decayed, missing and filled teeth) was 22.8, with mean 10.2 remaining teeth. According to the Community Periodontal Index only 1.9% were healthy. 33.8% of the sample (35.5% of women and 30.4% of men) presented edentulism, 54.2% needed upper dental prostheses (51.1% of women and 60.7% of men) and 64.7% needed lower ones (61.6% of women and 71.4% of men). Only 7.2% had visited a dentist in the past year (8.8% of women and 3.6% of men). After fitting several multivariate adjusted robust Poisson regression models, poor OHRQoL was found to be associated to self-reporting problems with teeth or gums, self-reporting poor opinion about teeth/gums/denture and also associated to functional edentulism, needing upper denture, but not to socio-demographic factors or time since last dental visit. Conclusions: The study population has poor objective oral health. A high percentage has poor OHRQoL associated to subjective and objective oral health conditions. Dental care is required and these services should be included in the Spanish National Health System

Conflict of interest in science communication: more than a financial issue. Report from Esteve Foundation discussion group, April 2009

A systematic review and meta-analysis suggests that around 2% of scientists admit to have falsified research at least once. Up to 33% admit other questionable practices such as plagiarism, duplicate publication, undisclosed changes in pre-research protocols or dubious ethical behavior. There can be no doubt that discovered cases of research and publication misconduct represent a tip of an iceberg and many cases go unreported

Prevalencia de problemas de salud mental y su asociación con variables socioeconómicas, de trabajo y salud : resultados de la encuesta nacional de salud de España

El objetivo del estudio es conocer la prevalencia de personas con problemas de salud mental en España y su asociación con variables socioeconómicas, de trabajo y salud. Se trata de un estudio transversal con los datos de la Encuesta Nacional de Salud de España (2006) en el que participaron 29.476 personas (16 y 64 años). El instrumento de cribado de problemas de salud mental utilizado es el General Health Questionnaire (GHQ-12). Se realizaron análisis descriptivos y de regresión logística para verificar la asociación entre la prevalencia de problemas de salud mental y las variables independientes. La prevalencia de problemas de salud mental es mayor en mujeres (24,6%) que en hombres (14,7%). Las variables más asociadas a una mayor prevalencia de problemas de salud mental son estar separado o divorciado, ser inmigrante de un país en vías de desarrollo, tener peores condiciones socioeconómicas, tener poco apoyo social (hombres OR 3,6; mujeres OR 3,3), estar desempleado o en baja laboral, tener enfermedades crónicas, estar limitado/a en la realización de actividades cotidianas en función de un problema de salud (hombres OR 7,5; mujeres OR 7,1). Estos resultados permiten la identificación de grupos de la población más vulnerables y pueden ser de utilidad para diseñar intervencionesThe aim of this study is to determine the prevalence of people with mental health problems in Spain and their association with socioeconomic, health and work variables. This is a cross-sectional study with data from the National Health Survey of Spain including 29,476 non-institutionalized people between 16 and 64 years of age. The screening instrument of mental health problems used is the General Health Questionnaire (GHQ-12). Descriptive analyses were performed, and logistic regression was used to verify the association between the prevalence of mental health problems and independent variables, by calculating odds ratios (OR) and the confidence interval. The prevalence of mental health problems is higher in women (24.6%) than in men (14.7%). The variables associated with an increased prevalence of mental health problems are being separated or divorced, being an immigrant from a developing country (men OR 1.3; women OR 1.5), having little social support (men OR 3.6; women OR 3.3), being unemployed or on sick leave, having chronic diseases, and being restricted or severely restricted in one's daily activities because of a health problem (men OR 7.5; women OR 7.1). These results allow the identification of the most vulnerable population groups and may be useful to design intervention

Tackling health inequalities in a public health organization : the case of the Barcelona Public Health Agency

Background: Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions. Methods: The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%). Results: Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities. Conclusions: The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health

Propiedades psicométricas y valores normativos del General Health Questionnaire (GHQ-12) en población general española

El objetivo principal del presente estudio es analizar las propiedades psicométricas del General Health Questionnaire (GHQ-12) como un instrumento de cribado en una muestra representativa de la población española, y en población mayor de 65 años. Se trata de un estudio instrumental utilizando los datos de la Encuesta Nacional de Salud de España (2006). Fueron entrevistadas 29.476 personas mayores de 16 años, no institucionalizadas. Se realizaron análisis de correlación entre ítems, análisis de consistencia interna, un análisis factorial exploratorio (AFE) y un análisis de validez externa del GHQ-12. Todos los análisis fueron realizados utilizando dos métodos de puntuación (Likert y GHQ). Los resultados muestran que cada uno de los ítems del GHQ se correlaciona con los demás, presentando valores de correlación superiores a 0,51. El análisis factorial exploratorio confirma que gran parte de la variabilidad del instrumento (67% Likert y 73% GHQ) puede ser explicada al reunir todos los ítems en un único factor. El GHQ-12 presenta una elevada consistencia interna en población general y también en población mayor de 65 años. Los análisis factoriales confirman que el GHQ-12 puede ser utilizado como un instrumento unidimensional de cribado y la puntuación más adecuada en este caso es la puntuación GHQThe main objective of this study is to analyze the psychometric properties of the General Health Questionnaire (GHQ-12) as a screening instrument in a representative sample of the Spanish population, and among people older than 65 years. This is a instrumental study using data from the National Health Survey of Spain (2006). The sample include 29,476 non-institutionalized interviewed persons over 16 years. Correlation analysis was carried out between items, internal consistency analysis, exploratory factor analysis (EFA) and a discussion of external validity of GHQ-12. All analyzes were performed using two scoring methods (Likert and GHQ). The results showed that the GHQ-12 has a high internal consistency in the general population and in people older than 65 years. Each of the items in the GHQ correlated with others, showing correlation values greater than .51. Exploratory factor analysis confirmed that much of the variability of the instrument (67% Likert and 73% GHQ) may be explained by gathering all the items into a single factor. The factor analysis confirmed that the GHQ-12 can be used as a unidimensional screening and scoring most appropriate in this cas