Aproximació ecològica a la mortalitat per accidents de trànsit a Catalunya (1983-1985)

A partir de la distribució geogràfica de Catalunya en 9 regions, s'estudia la correlació ecològica existent entre la mortalitat per accident de vehicles de motor, estandaritzada per edat (índex de mortalitat estàndard [IME] i diverses variables sòcio-econòmiques i sanitàries. La regió I és la que presenta una menor taxa de mortalitat per aquesta causa. La correlació més intensa ha estat la que presenten l'índex de mortalitat estàndard i el percentatge de transport sanitari de la regió, respecte del de tota Catalunya. Així mateix, aquesta és l'única variable que entra en el model multivariant (regressió múltiple stepwise) IME = 164,9 + (-1,6) x % transport sanitari

Aproximación a la gobernabilidad enfermera

La cuestionada sostenibilidad de la prestación sanitaria y el replanteamiento del modelo sociosanitario en Cataluña, permiten preguntarse sobre la gobernabilidad de las organizaciones sociosanitarias, u hospitales de media estancia, y su relación con la calidad asistencial. A través de la Teoría de la gobernabilidad se podrían explorar los elementos del modelo sociosanitario y el rol mesogestor de la enfermera en la organización: la toma decisiones, los intereses externos e internos, la misión y valores, y la facilitación de información y herramientas. La gobernabilidad enfermera es un concepto teórico medible con impacto claro y directo en la calidad y la sostenibilidad de los cuidados

Nuevo diseño de la Encuesta de Salud de Cataluña (2010-2014): un paso adelante en planificación y evaluación sanitaria

Se presenta la génesis de la Encuesta de Salud de Cataluña (2010-2014) con sus submuestras semestrales. Se detallan las características básicas de su diseño muestral polietápico. Entre las ventajas organizativas de esta nueva operación, en comparación con las anteriores, destacan la agilidad en la disponibilidad de datos y la capacidad de monitorización continuada de la población. Se señalan como beneficios la puntualidad en la obtención de indicadores y la posibilidad de introducir nuevos tópicos a través del cuestionario complementario, según las necesidades de información. Como limitación se apunta la mayor complejidad del diseño muestral y la falta de seguimiento longitudinal de la muestra. Se hace hincapié en la necesidad de utilizar ponderaciones adaptadas a las submuestras para el análisis estadístico que emplee microdatos, así como de acumular oleadas si se desea elevar el grado de desagregación del análisis, ya sea en el territorio o por subgrupos de población

Estrategia individual y poblacional en las intervenciones frente a la epidemia del tabaquismo

La estrategia poblacional de las intervenciones frente a los factores de riesgo se dio a conocer por los trabajos de Geoffrey Rose en el campo de la salud pública y la medicina preventiva de las enfermedades cardiovasculares a finales del siglo XX. En la actualidad, uno de los factores de riesgo con mayor impacto sobre la salud es el tabaquismo. El objetivo de este trabajo es describir y aplicar las estrategias de la medicina preventiva propuesta por Geoffrey Rose en el control de la epidemia del tabaquismo. Para ilustrarlo hemos utilizado los datos de concentración de cotinina en saliva de una muestra representativa de la población adulta de la ciudad de Barcelona. En conclusión, las políticas públicas de control de tabaquismo en todo el mundo deberían tener en consideración la utilidad de la estrategia poblacional para el abordaje de este importante problema de salud, sin menospreciar intervenciones seleccionadas dirigidas a colectivos de "alto riesgo" que sean de probada eficacia

Prevalencia y condicionantes de la obesidad en la población infantojuvenil de Cataluña, 2006-2012

Estimar la prevalencia de obesidad y sobrepeso en la población catalana de 2 a 14 años, conocer su evolución durante los períodos 2006 y 2010-2012 y evaluar los determinantes sociales y estilos de vida relacionados con la obesidad

Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the Catalan Codi Infart network

Objectives: To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart). Design Cost-utility analysis. Setting: The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people. Participants: Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries. Outcome measures costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140). Results: A substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from 8306 to 7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of 4355 per life saved (30-day mortality) and 495 per QALY. Below a cost threshold of 30,000, results were sensitive to variations in costs and outcomes. Conclusions: The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios

Visual correction and occupational social class

PURPOSE: To determine whether types of optical correction for refractive error are associated with sex, social class, and occupational group in the working population. METHODS: A cross-sectional study was carried out among employees in Catalonia (Spain) aged 16 to 65 years who underwent the Asepeyo Prevention Society health examination in 2009 (86,831 participants: 59,397 men and 27,421 women). The type and purpose of refractive correction used were self-reported, as were sociodemographic variables; visual acuity with habitual correction was also measured. We performed descriptive and logistic regression analyses to evaluate the prevalence and type of correction used for refractive error as a function of age, sex, social class, and occupational group. RESULTS: Forty-six percent (95% confidence interval [CI] = 45.6 to 46.3) of individuals in this sample were users of optical correction for refractive error. Use of optical correction was more common among women than among men (54.8 and 41.9%, respectively) and especially among women aged 55 to 64 years (91.8%). Nonmanual (class I) workers were three times more likely to use optical correction than manual (class V) workers (odds ratio = 3.02; 95% CI = 2.82 to 3.24). Individuals in technical, administrative, or intellectual occupations were more likely to wear optical correction than unskilled professionals. CONCLUSIONS: The use of visual correction is more prevalent among women than among men, especially in older individuals. The use of optical correction is more common among more advantaged social groups and is associated with particular occupations

The extension of smoke-free areas and acute myocardial infarction mortality: before and after study

Objectives: Recent studies suggest that comprehensive smoking regulations to decrease exposure to second-hand smoke reduce the rates of acute myocardial infarction (AMI). The objective of this paper is to analyse if deaths due to AMI in Spain declined after smoking prevention legislation came into force in January 2006. Design: Information was collected on deaths registered by the Instituto Nacional de Estadistica for 2004e2007. Age- and sex-specific annual AMI mortality rates with 95% CIs were estimated, as well as age-adjusted annual AMI mortality rates by sex. Annual relative risks of death from AMI were estimated with an age-standardised Poisson regression model. Results: Adjusted AMI mortality rates in 2004 and 2005 are similar, but in 2006 they show a 9% decline for men and a 8.7% decline for women, especially among those over 64 years of age. In 2007 there is a slower rate of decline, which reaches statistical significance for men (-4.8%) but not for women (-4%). The annual relative risk of AMI death decreased in both sexes (p<0.001) from 1 to 0.90 in 2006, and to 0.86 in 2007. Conclusion: The extension of smoke-free regulations in Spain was associated with a reduction in AMI mortality, especially among the elderly. Although other factors may have played a role, this pattern suggests a likely influence of the reduction in population exposure to second-hand smoke on AMI deaths

Children's visual impairment and visual care related to socioeconomic status in Catalonia (Spain)

Background: The objective of this study is to assess the prevalence of visual impairment and visual care practices and its association with socioeconomic conditions in the infant population in Catalonia. Methods: The Catalan Institute of Statistics provided a random sample of 0 to 14-year-old non-institutionalized children whose parents were interviewed in a continuous health survey from 2011 to 2015 in Catalonia. A multistage stratified and random sampling procedure considering age, sex, county and town was followed. All results have been weighted according to the sample design and are presented as the proportion of the condition with its 95% confidence limits. Chi-square tests were performed to evaluate the association between categorical variables. To study the association of visual care with independent variables, a multiple logistic regression model was used. Results: In 0 to 14-year-old children, a 12.9% (95% confidence interval [CI] [11.8-13.9]) prevalence of correctable visual impairment was observed. The prevalence of non-correctable visual impairment was 0.9% (95% CI [0.6-1.2]). Non-correctable visual impairment was more prevalent in families with lower education levels, manual professions or unemployed. Of children without visual impairment, 13,5% (95% CI:12.3-14.6) visited a visual care professional in the last 12 months while this proportion was 67.4% (95% CI [63.3-71.5]) among those with correctable visual impairment. When parents have a university degree or non-manual professions, a higher level of visual care was observed. In children with correctable visual impairment, visual reviews were more frequent when parents are employed in a non-manual profession. Conclusions: For the first time, indicators related to visual impairment in children in Catalonia have been recorded. There is an association between lower socioeconomic status and having non-correctable visual impairment, and conversely, having correctable visual impairment was significantly associated with employed parents. More visual care is associated with higher socioeconomic status

Prevalencia y carga de defectos visuales en Cataluña

El objetivo de este artículo es determinar la prevalencia de defectos visuales en Cataluña y analizar las desigualdades en visión. Estudio transversal en población ≥ 15 años de edad (7.881 hombres y 8.045 mujeres) a partir de los datos de la Encuesta de Salud de Cataluña de 2006. Se usaron modelos de regresión logística para calcular las odds ratio ajustadas por edad, estado civil, nivel de estudios, nivel de ingresos y situación laboral con un intervalo de confianza (IC) del 95%. El 4,7% (IC del 95%, 4,4-5,0) de la población de Cataluña,/nel 5,3% (IC del 95%, 4,8-5,8) de las mujeres y el 4,1% (IC del 95%, 3,7-4,5) de los hombres, declara tener mala visión. Las situaciones más desfavorables de mala visión autodeclarada por la población catalana corresponden a los ancianos y las mujeres con menores niveles tanto de estudios como de ingresosThe aim of this work is to determine the prevalence of visual impairment in Catalonia and analyze inequalities in vision. Cross sectional study in the population having ≥15 years of age (7,881 men and 8,045 women) based on data from the Encuesta de Salud de Cataluña 2006. Logistic regression models were used to calculate the adjusted odds ratio by age, civil state, level of studies, income and working situation with a confidence interval (CI) of 95%. A 4.7% (CI 95% 4.4-5.0) of the population of Catalonia, a 5.3% of female (CI 95% 4.8-5.8), and 4.1% of men (CI 95% 3.7-4.5) state that they have poor vision. The most unfavourable situations of self-reported poor vision by the Catalan population correspond to the elderly and women with lower levels of both studies and incom