Factores predictores de la participación en un programa de "Screening" de cáncer de mama: implicación del modelo de creencias de salud y de las variables sociodemográficas

El presente artículo tiene por objeto analizar la posible implicación de las variables del modelo de creencias de salud y las variables sociodemográficas en la participación en un programa de «screening» de cáncer de mama, el cual se ha llevado a cabo en Navarra, dentro de la Red Piloto Europea de Programas de Detección Precoz de Cáncer de Mama, dirigido a mujeres de 45-65 años de edad. Se utilizó una muestra total de 708 mujeres normales, de las cuales 512 tenían la condición de participantes en el Programa de Detección Precoz del Cáncer de Mama en Navarra, en tanto que las restantes 196 no acudieron al mismo. A todas ellas se les administró un cuestionario de forma individual. De acuerdo con el modelo de creencias de salud, las variables analizadas fueron: Severidad, Susceptibilidad y Beneficios. Además, se estudiaron las variables sociodemográficas siguientes: edad, estado civil, nivel asociativo y status social. Tras la realización de análisis de regresión logística se constató que las variables severidad, estado civil, nivel asociativo y status social están asociadas a la participación en el programa de «screening» de cáncer de mamaThe aim of this article is to analyse the possible implication of variables in the health beliefs model and socio-demographic variables in participation in a breast cancer screening programme, which was carried out in Navarre within the framework of the European Pilot Network of Programmes for Early Detection of Breast Cancer, targeted at women between the ages of 45 and 65. A total sample of 708 women with normal health was used; 512 of them participated in the programme carried out in Navarre for early detection of breast cancer, while the remaining 196 did not take part in it. All the women were asked to complete a questionnaire on an individual basi

Erosion of universal health coverage and trend in the frequency of physician consultations in Spain

Background: We studied the frequency of physician visits in the native and immigrant populations in Spain before and after implementation of a governmental measure to restrict the use of public healthcare services by undocumented immigrants beginning in 2012. Methods: Data were taken from the 2009 and 2014 European Health Surveys carried out in Spain. We investigated any physician consultation in the last 4 weeks before the interview, as well as visits to a family physician, public specialist physician and private specialist physician. We estimated the frequency of visits in 2009 and in 2014 in the native and immigrant populations and the difference in the frequency between the two populations, by calculating the percentage ratio estimated by binomial regression and adjusted for different confounders that are indicators of the need for assistance. Results: The percentage of persons who consulted any physician in 2009 and 2014 was 31.7 and 32.9% in the native population, and 25.6 and 30.1% in the immigrant population, respectively. In the immigrant population, the frequency of visits to the general practitioner and public specialist physician increased, whereas in the native population only public specialist physician visits increased. The frequency of private specialist visits remained stable in both populations. After adjusting for the indicators of need for healthcare, no significant differences between the immigrant and native populations were seen in the frequency of visits, except for private specialist consultations, which were less frequent among immigrants. Conclusion: The restriction of universal healthcare coverage in Spain did not reduce the frequency of physician visits between 2009 and 2014, as the frequency of these consultations was seen to increase in both the native and immigrant populations.This study was supported by a grant from the “Plan Estatal de I + D, Ministry of Science, Innovation and Universities of Spain (no. CSO2017–83180-P)

Rural–urban disparities in the reduction of avoidable mortality and mortality from all other causes of death in Spain, 2003–2019

Aim This study aims to evaluate the trend of avoidable mortality and of mortality from all other causes of death in urban and rural areas in Spain, throughout the first 2 decades of the twenty-first century. Methods Data deaths and population by age and sex, according to the area of residence, were obtained from the National Institute of Statistics. Avoidable mortality refers to premature deaths (≤ 75 years old) for which there is reasonable scientific consensus that they should not occur in the presence of timely health care. In large urban, small urban, and rural areas, annual age-standardized mortality rates from avoidable causes and from all other causes of death were calculated from 2003 to 2019. The annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as dependent variable. Results Mortality rates decreased between the beginning and the end of the period analysed. Large urban areas and rural areas showed the largest and smallest reduction in mortality rate respectively. The APC in avoidable mortality was −3.5% in men and −3.0% in women in large urban areas, and −2.7% in men and −2.6% in women in rural areas. The APC in the mortality rate from all other causes of death was −2.4% in men and −1.2% in women in large urban areas, and −1.4% in men and −1.0% in women in rural areas. Conclusion In Spain, avoidable mortality and mortality from other causes of death in rural and urban areas show similar trends, which suggests the presence of a common factor responsible for such findings.Open Access funding provided by Universidad Pública de Navarra. This study was supported by the Universidad Complutense de Madrid (grant No UCM 2022-920743)

Desigualdades sociales en salud. Un análisis de la mortalidad por las principales causas de muerte en España y Francia, 1988-1990

The objective of this study was to compare social inequalities in mortality by main causes of death in Spain and France during the 1988-90 period. In both Spain and France mortality in the manual workers category was always higher than that of the rest of the occupational groups for all causes. Farmers presented an intermediate level of mortality between professionals and managers and manual workers. The mortality of manual workers was 1.89 times higher than that of professionals and managers in Spain, and 1.67 higher in France. In Spain the greatest difference between the mortality of manual workers and professionals and managers was observed in accidents and respiratory diseases; in France, the greatest differences were observed in digestive diseases and respiratory diseases.El objetivo de este artículo es comparar las desigualdades sociales en la mortalidad por las principales causas de muerte en España y en Francia durante el período 1988-90. Tanto en España como en Francia, la mortalidad en el grupo de trabajadores manuales es más alta que la mortalidad en el resto de los grupos ocupacionales para todas las causas de muerte analizadas. Por su parte, los agricultores presentan una mortalidad intermedia entre los profesionales y directivos y entre los trabajadores manuales. Los trabajadores manuales tienen una mortalidad 1,89 veces más alta que los profesionales y directivos en España y 1,67 veces más alta en Francia. En España, las mayores diferencias entre la mortalidad de trabajadores manuales y la mortalidad de profesionales y directivos se observa en accidentes y en las enfermedades del aparato respiratorio; por su parte, en Francia, las mayores diferencias se observan en las enfemiedades del aparato digestivo y en las enfermedades del aparato respiratorio

Trends and equity in the use of health services in Spain and Germany around austerity in Europe

Background: Following the 2008 economic crisis many countries implemented austerity policies, including reducing public spending on health services. This paper evaluates the trends and equity in the use of health services during and after that period in Spain – a country with austerity policies – and in Germany – a country without restriction on healthcare spending. Methods: Data from several National Surveys in Spain and several waves of the Socio-Economic Panel in Germany, carried out between 2009 and 2017, were used. The dependent variables were number of doctor’s consultations and whether or not a hospital admission occurred. The measure of socioeconomic position was education. In each year, the estimates were made for people with and without pre-existing health problems. First, the average number of doctor’s consultations and the percentage of respondents who had had been hospitalized were calculated. Second, the relationship between education and use of those health services was estimated by calculating the difference in consultations using covariance analysis – in the case of number of consultations – and by calculating the percentage ratio using binomial regression – in the case of hospitalization. Results: The annual mean number of consultations went down in both countries. In Spain the average was 14.2 in 2009 and 10.4 in 2017 for patients with chronic conditions; 16.6 and 13.5 for those with a mental illness; and 6.4 and 5.9 for those without a defined illness. In Germany, the averages were 13.8 (2009) and 12.9 (2017) for the chronic group; 21.1 and 17.0 for mental illness; and 8.7 and 7.5 with no defined illness. The hospitalization frequency also decreased in both countries. The majority of the analyses presented no significant differences in relation to education. Conclusion: In both Spain and Germany, service use decreased between 2009 and 2017. In the first few years, this reduction coincided with a period of austerity in Spain. In general, we did not find socioeconomic differences in health service use.This study was supported by a grant from the “Plan Estatal de Investigación Científica y Técnica y de Innovación”, Ministry of Economy, Industry and Competitiveness of Spain (no. CSO2017–83180-P)

Cardiovascular mortality and risk behaviours by degree of urbanization before, during and after the economic crisis in Spain

BACKGROUND: To estimate the relationship of the degree of urbanization to cardiovascular mortality and to risk behaviours before, during and after the 2008 economic crisis in Spain. METHODS: In three areas of residence - large urban areas, small urban areas and rural areas - we calculated the rate of premature mortality (0-74 years) from cardiovascular diseases before the crisis (2005-2007), during the crisis (2008-2010 and 2011-2013) and after the crisis (2014-2016), and the prevalence of risk behaviours in 2006, 2011 and 2016. In each period we estimated the mortality rate ratio (MRR) and the prevalence ratio, taking large urban areas as the reference. RESULTS: In men, no significant differences were observed in mortality between the two urban areas, while the MRR in rural areas went from 0.92 [95% confidence interval, 0.90-0.94) in 2005-2007 to 0.94 (0.92-0.96) in 2014-2016. In women, no significant differences were observed in mortality between the rural and large urban areas, whereas the MRR in small urban areas decreased from 1.11 (1.08-1.14) in 2005-2007 to 1.06 (1.02-1.09) in 2014-2016. The rural areas had the lowest prevalence of smoking, obesity and physical inactivity in men, and of obesity in women. No significant differences were observed in smoking or physical inactivity by area of residence in women. CONCLUSION: The pattern of cardiovascular mortality by degree of urbanization was similar before and after the crisis, although in women the excess mortality in small urban areas with respect to large urban areas was smaller after the crisis. The different pattern of risk behaviours in men and women, according to area of residence, could explain these findings.This work was supported by the Instituto de Salud Carlos III (PI16/00455) y el European Regional Development Fund. The funders had neither role in study design, data collection, analysis, decision to publish, nor preparation of the manuscript.S

Use of health services according to income before and after elimination of copayment in Germany and restriction of universal health coverage in Spain

Background: In Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012. This study shows the relationship between income and the use of health services before and after these measures in each country. Methods: Data were taken from the 2009 and 2014 Socio-Economic Panel conducted in Germany, and from the 2009 and 2014 European Health Surveys in Spain. The health services investigated were physician consultations and hospital admissions, and the measure of socioeconomic position used was household income. The magnitude of the relationship between socioeconomic position and the use of each health service in people from 16 to 74 years old was estimated by calculating the percentage ratio using binary regression. Results: In Germany, after adjusting for age, sex, and need for care, in the model comparing the two lower income categories to the two higher categories, the percentage ratio for physician consultation was 0.97 (95% CI 0.96–0.99) in 2009 and 0.98 (95% CI 0.97–0.99) in 2014, and the percentage ratio for hospitalization was 1.01 (95% CI 0.93–1.10) in 2009 and 1.16 (95% CI 1.08–1.25) in 2014. In Spain, after adjusting for age, sex, and self-rated health, the percentage ratio for physician consultation was 0.99 (95% CI 0.94–1.05) in 2009 and 1.08 (95% CI 1.03–1.14) in 2014, and the percentage ratio for hospitalization was 1.04 (95% CI 0.92–1.18) in 2009 and 0.99 (95% CI 0.87–1.14) in 2014. Conclusion: The results suggest that elimination of the copayment in Germany did not change the frequency of physician consultations, whereas after the restriction of universal health coverage in Spain, subjects with lower incomes had a higher frequency of physician consultations.This study was supported by a grant from the “Plan Estatal de I + D + I”, Ministry of Economy and Competitiveness of Spain (no. CSO2013–40877-P)

Validación española del cuestionario de preocupación PSWQ : estructura factorial y propiedades psicométricas

The present study validated the Spanish version of the Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger & Borkovec, 1990) in a nonclinical sample (N = 1052). Exploratory and confirmatory factor analyses of the PSWQ indicated a structure of two correlated factors consistent with the dimensions “worry engagement” and “absence of worry”.. The PSWQ demonstrated good internal consistence and test-retest reliability. Correlations with variables of personality, anxiety and depression provided evidence of good convergent and discriminant validity of the questionnaire. Also, data support the hypothesis that the second factor, which was associated with inversely worded items, could represent more a method effects phenomenon than a substantive factor. The PSWQ-11, an abbreviated version of the PSWQ with the 5 inversely formulated items removed, possesses excellent psychometric properties and is proposed as an instrument to be preferred to the complete PSWQ for assessment of pathological worry. Normative data as to both the PSWQ and the PSWQ-11 are provided.Mediante el presente estudio validamos la versión española del Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger and Borkovec, 1990) a partir de una muestra de participantes no clínicos (N = 1052). Los análisis factoriales exploratorios y confi rmatorios del PSWQ reflejaron una estructura de dos factores correlacionados consistentes con las dimensiones de «presencia de preocupación» y «ausencia de preocupación». Los resultados demuestran que el PSWQ posee buena consistencia interna y fi abilidad test-retest. Las correlaciones con variables de personalidad, ansiedad y depresión proporcionan evidencia a favor de la validez convergente y discriminante del cuestionario. Así mismo, los datos apoyan la hipótesis de que el segundo factor, que se asociaba a los items formulados de forma inversa, podría representar un artefacto metodológico más que un factor sustantivo. La forma abreviada del cuestionario (PSWQ-11), en la que se suprimen los 5 items formulados de forma inversa, posee excelentes propiedades psicométricas y es sugerida como instrumento preferible al PSWQ completo para la evaluación de la preocupación patológica. Se proporcionan datos normativos sobre el PSWQ y el PSWQ-11