Recomanacions pràctiques per a la identificació i la millora de l’atenció de persones amb malalties cròniques avançades (MACA) amb necessitat d’atenció pal·liativa en territoris i serveis de salut i socials

Modelo de atención de la enfermedad crónica avanzada; Profesionales sanitariosModel d’atenció de la malaltia crònica avançada; Professionals sanitarisAdvanced chronic disease care model; Health professionalsAquest document resumeix i proposa les mesures pràctiques per a la implementació d’un model d’atenció de la malaltia crònica avançada (MACA) en els territoris i en els seus serveis sanitaris i socials, en el context del Programa per a l’atenció de la cronicitat (PPAC) del Pla de salut de Catalunya

Desigualdades en salud según la clase social en las mujeres: ¿Cómo influye el tipo de medida de la clase social? Inequalities in health related to social class in women: What is the effect of the measure used

Las teorías clásicas de estratificación social se han basado en la familia como unidad de estratificación, utilizándose la ocupación del hombre como medida de clase social. Estas teorías fueron criticadas sobre todo desde el feminismo, reclamando la visualización de las mujeres en el análisis de la estratificación social. Los objetivos de este artículo son revisar la medida de la clase social en las mujeres, así como los estudios que han analizado las desigualdades en salud en las mujeres según distintas medidas de clase social, y analizar, como un ejemplo, las diferencias de los distintas medidas a partir de los datos de la encuesta de salud de Barcelona 2000. Hay pocos estudios que hayan analizado las desigualdades en salud teniendo en cuenta distintas medidas de clase social para las mujeres. La mayoría de ellos han sido realizados en Gran Bretaña, aunque también existen trabajos realizados en otros países. Estos estudios suelen comparar distintos indicadores de clase social: la «clase social convencional», que atribuye a las mujeres la clase social del marido o de la persona cabeza de familia (medida de hogar), la «clase social individual», que atribuye a las mujeres la clase social basada en su propia ocupación, y la clase «dominante», que se basa en la atribución de la clase social más privilegiada del hogar. El impacto de las distintas medidas en las desigualdades en salud varía según el tipo de estudio, pero suele ser más importantes al utilizar tanto la medida convencional como la dominante. Los datos de la encuesta de salud de Barcelona del año 2000 muestran que existen desigualdades de clase con las 3 medidas, y la repercusión varía según el tipo de indicador de salud analizado y el grupo de mujeres seleccionadas. La obtención de la clase social a través de la ocupación dominante tiene ventajas: es neutra al género o no sexista, cuando la clase dominante es una clase menos privilegiada (p. ej., trabajador manual) implica que los 2 miembros de la pareja tienen una ocupación igual o inferior a ésta y, finalmente, es fácil de obtener.<br>Classical theories of social stratification share the assumption that the family is the unit of stratification, using the man's occupation as a measure of social class. These theories were criticized by feminism, which claimed that women were not visible in class analysis. The present article aims firstly to review measurement of women's social class, secondly to review studies on the impact of different measures of social class on inequalities in health among women, and thirdly to illustrate the differences among alternative measures, using data from the Barcelona Health Interview Survey 2000 as an example. There are few studies analyzing inequalities in health among women that take into account several measures of social class; most studies have been performed in the United Kingdom, although some studies have been conducted in other countries. Typically, these studies compare several social class indicators: the «conventional social class» measure, which uses the husband's occupation or tal of the head of household (a household measure); the «individual social class» measure, which uses women's occupation, and the «dominant social class» measure, which allocates an individual the highest social class within a household (also a household measure). The impact of the various measures on inequalities in health varies according to the study performed, but is usually greater with the conventional and dominant approaches. Data from the Health Interview Survey of Barcelona 2000 show the existence of inequalities in health using these three approaches, with varied impact according to the health indicators used and women's characteristics. The «dominant social class» measure has several advantages: it is gender-blind and is not sexist. When the dominant social class is a less privileged class (i.e. manual laborer) it means that both partners have an occupation equal to or lower than this measure. Finally, this indicator is easily obtained

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.Women's health Family characteristics Inequalities Work Spain