Geopolíticas de la pandemia: la salud pública en perspectiva histórica

En aquesta ocasió, la secció de diàleg s’ha organitzat entre dos especialistes: Esteban Ro- dríguez Ocaña, catedràtic d’Història de la Medicina i Col·laborador extraordinari del Depar- tament d’Anatomia Patològica i Història de la Ciència de la Universitat de Granada i Joan Benach, Catedràtic del Departament de Ciències Polítiques i Socials de la Universitat Pompeu Fabra. La proposta es mantenir una conversa que consisteix a abordar de manera analítica la salut pública des d’una perspectiva històrica i alhora com una qüestió central en clau de present i futur de la societat actual. Als dos reconeguts especialistes se’ls demana que aportin les seves reflexions sobre aquest as- sumpte des de camps disciplinaris diferents, amb l’objectiu principal d’oferir a les historiadors i historiadores instruments teòrics i metodològics amb què abordar els problemes i els models que ha plantejat i planteja la noció de “salut pública”. En els moments actuals ens sembla que aquest exercici contribueix a enfortir algunes de les línies de recerca ja existents i estimular noves línies amb què pensar el present en clau històrica. Finalment, ens sembla que val la pena esmentar que l’enregistrament d’aquest diàleg, poste- riorment transcrit per Andrea Tappi i revisat tant pels autors com per nosaltres com a editors, ha estat utilitzat com una activitat per als alumnes de l’assignatura “Pensar la Història Escoles, Teories i Interpretacions” de Primer Curs de Grau impartit a la Secció d’Història Contem- porània i Món Actual del Departament d’Història i Arqueologia de la Universitat de Barcelona. Els resultats obtinguts en aquesta pràctica, amb els informes lliurats del seu seguiment, i la resposta molt positiva que ofereix l’alumnat seria molt probablement matèria d’un altre diàleg futur sobre l’ensenyament universitari de la Història.On this occasion, the dialogue section has been organized between two specialists: Esteban Rodríguez Ocaña, Professor of History of Medicine and Special Collaborator of the Depart- ment of Pathological Anatomy and History of Science of the University of Granada, and Joan Benach, Professor of the Department of Political and Social Sciences of the Pompeu Fabra University. It is a proposal for a dialogue that consists of analytically approaching public health from a historical perspective and, at the same time, as a central issue in terms of the present and future of today’s society. The two renowned specialists were asked to contribute their reflections on this matter from different disciplinary fields, with the main objective of offering historians theoretical and methodological instruments with which to address the problems and models posed by the notion of “public health”. At present, it seems to us that this exercise contributed to the strengthening of some of the already existing research lines, and to stimulating new lines with which to think about present time in a historical key. Finally, we think it is worth mentioning that the recording of this dialogue, later transcribed by Andrea Tappi and reviewed both by the authors and by us as editors, has been used as an activity for the students of the subject “Thinking History. Schools, Theories and Interpreta- tions” of the First Degree Course, taught in the Contemporary History and Current World Section of the Department of History and Archaeology of the University of Barcelona.The results obtained in this activity, with the reports delivered on its follow-up, as well as the very positive response of the students, would most likely be the subject of another future dialogue, focused on university teaching of History.En esta ocasión la sección de diálogo se ha organizado entre dos especialistas: Esteban Ro- dríguez Ocaña, catedrático de Historia de la Medicina y Colaborador extraordinario del De- partamento de Anatomía Patológica e Historia de la Ciencia de la Universidad de Granada y Joan Benach, catedrático del Departamento de Ciencias Políticas y Sociales de la Universidad Pompeu Fabra. La propuesta es una conversación que consiste en abordar de manera analítica la salud pú- blica desde una perspectiva histórica y, al mismo tiempo, como una cuestión central en clave de presente y futuro de la sociedad actual. A los dos reconocidos especialistas se les pide que aporten sus reflexiones sobre este asunto desde campos disciplinarios diferentes, con el objetivo principal de ofrecer a los historiadores y las historiadoras instrumentos teóricos y metodológicos con los que abordar los problemas y los modelos que ha planteado y plantea la noción de “salud pública”. En los momentos actuales nos parece que este ejercicio contribuye a fortalecer algunas de las líneas de investigación ya existentes y estimular nuevas líneas con las que pensar el presente en clave histórica. Por último, nos parece que vale la pena mencionar que la grabación de este diálogo, pos- teriormente transcrito por Andrea Tappi y revisado tanto por los autores como por nosotros como editores, ha sido utilizado como una actividad para los alumnos de la asignatura “Pensar la Historia Escuelas,Teorías e Interpretaciones” del Grupo B1 del Primer Curso de Grado, impartido en la Sección de Historia Contemporánea y Mundo Actual del Departamento de Historia y Arqueología de la Universidad de Barcelona. Los resultados obtenidos en esta práctica, con los informes entregados de su seguimiento, y la respuesta muy positiva ofrecida por el alumnado sería muy probablemente materia de otro diálogo futuro sobre la enseñanza universitaria de la Historia

Why are there gender inequalities in visual impairment?

Background In high-income countries, the prevalence of blindness and visual impairment is higher among women, regardless of age although the mechanisms that produce these gender inequalities are not well understood. The objectives of this study were to analyse gender inequalities in the prevalence of blindness and visual impairment, age of onset, diagnosed and undiagnosed status and related eye diseases among visually impaired individuals. Methods Data were obtained from the 2008 Spanish Survey on ‘Disability, Personal Autonomy and Dependency Situations’ (n = 213 626) participants 360 blind (160 men and 200 women), and 5560 with some visual impairment (2025 men and 3535 women). The prevalence of blindness and visual impairment, age of onset of visual impairment and diagnosed and undiagnosed eye diseases was calculated. Hierarchical multiple logistic regression models were fit to test gender differences. Results Women were more likely to report visual impairment (crude OR = 1.6 [95% CI: 1.56–1.74]). Prevalence of diagnosed cataract was higher among visually impaired women (crude OR = 1.4 [95% CI: 1.25–1.67]) whereas undiagnosed eye disease (crude OR = 0.7 [95% CI: 0.64–0.81]) or diagnosed glaucoma (aORsex = 0.8 [95% CI: 0.65–0.93]) were more frequent among visually impairment men. These associations were not explained by age or educational level. Conclusions Strong gender inequalities were observed, with a higher prevalence of visual impairment and related cataracts among women, which could be related to gender inequalities in access to health care, and undiagnosed eye disease and related glaucoma among men, which could be related to their gender socialization resulting in less frequent and effectively use of health care services.Postprint (author's final draft

Lesiones por accidentes de trabajo, una prioridad en salud pública

El objetivo de esta revisión es generar nuevas ideas y acciones que nos ayuden a prevenir este importante problema de salud pública. El número total de LAT con baja en jornada, en los años 2002 y 2003, alcanzó la cifra de 971.406 y 906.638, respectivamente. Ello significa que cada día se producen en España algo más de 2.500 LAT con baja en jornada y entre 2 y 3 muertes diarias. Aunque el perfil de la población a riesgo de sufrir las LAT está cambiando profundamente en la última década, tanto cuantitativa como cualitativamente, el riesgo de sufrir una LAT se continúa concentrando en las ocupaciones que realizan trabajos de tipo manual, ya sean trabajadores cualificados o no cualificados, de los sectores primario y secundario. Los sobreesfuerzos para las lesiones no mortales y el tráfico para las mortales constituyen las principales formas en que se producen las LAT. La asociación entre temporalidad y riesgo de LAT muestra los efectos negativos sobre la salud de las nuevas formas de organización del trabajo, que enfatizan la desregulación del mercado laboral. Aunque en los últimos años se han puesto en marcha diferentes programas preventivos frente a las LAT, éstos parecen haber tenido un resultado muy limitado. Las actividades preventivas deben concentrarse, tanto en el ámbito de las condiciones de trabajo (micro), como en las políticas públicas de empleo e industriales (macro). En este segundo ámbito es imprescindible incrementar la evaluación en términos de salud de las políticas de empleo e industriales

Lesiones por accidentes de trabajo, una prioridad en salud pública

El objetivo de esta revisión es generar nuevas ideas y acciones que nos ayuden a prevenir este importante problema de salud pública. El número total de LAT con baja en jornada, en los años 2002 y 2003, alcanzó la cifra de 971.406 y 906.638, respectivamente. Ello significa que cada día se producen en España algo más de 2.500 LAT con baja en jornada y entre 2 y 3 muertes diarias. Aunque el perfil de la población a riesgo de sufrir las LAT está cambiando profundamente en la última década, tanto cuantitativa como cualitativamente, el riesgo de sufrir una LAT se continúa concentrando en las ocupaciones que realizan trabajos de tipo manual, ya sean trabajadores cualificados o no cualificados, de los sectores primario y secundario. Los sobreesfuerzos para las lesiones no mortales y el tráfico para las mortales constituyen las principales formas en que se producen las LAT. La asociación entre temporalidad y riesgo de LAT muestra los efectos negativos sobre la salud de las nuevas formas de organización del trabajo, que enfatizan la desregulación del mercado laboral. Aunque en los últimos años se han puesto en marcha diferentes programas preventivos frente a las LAT, éstos parecen haber tenido un resultado muy limitado. Las actividades preventivas deben concentrarse, tanto en el ámbito de las condiciones de trabajo (micro), como en las políticas públicas de empleo e industriales (macro). En este segundo ámbito es imprescindible incrementar la evaluación en términos de salud de las políticas de empleo e industriales

Visual impairment and blindness in Spanish adults: geographic inequalities are not explained by age or education

Objectives: The objectives of this study were to examine for the first time the prevalence of visual impairment and blindness among adults in Spain, to explore regional differences, and to assess whether they may vary as a function of sex or be explained by age and individual or regional socioeconomic position. Design: Data were obtained from the 2008 Spanish Survey on Disability, Personal Autonomy, and Dependency Situations, a cross-sectional survey based on a representative sample of the noninstitutionalized population of Spain. Participants: The sample was composed of 213 626 participants aged =15 years (103 093 men and 110 533 women); 360 were blind (160 men and 200 women), 4048 had near visual impairment (1397 men and 2651 women), and 4034 had distance visual impairment (1445 men and 2589 women). Methods: The prevalence of near and distance visual impairment was calculated for each region. Multiple logistic regression models were fitted to calculate odds ratios and 95% confidence intervals. All analyses were stratified by sex. Main Outcome Measures: Visual impairment was based on 3 questions aimed at identifying blindness and near and distance visual impairment. Results: The prevalence (percentage) of blindness was 0.17 (men, 0.16; women, 0.18): 1.89 for near visual impairment (men, 1.36; women, 2.40), 1.89 for distance visual impairment (men, 1.40; women, 2.34), and 2.43 for any visual impairment (men, 1.81; women, 3.02). Regional inequalities in the prevalence of visual impairment were observed, correlated with regional income, and the prevalence was consistently higher among women than men. The magnitude of the inequalities remained after adjusting for age and educational level, and a north-to-south pattern of increasing prevalence was observed. Conclusions: Regional and sex inequalities in the prevalence of visual impairment and blindness were observed in Spain, with a north-to-south gradient of increasing prevalence that was not explained by age or individual educational level but was correlated with regional level of economic development. Factors that could be prioritized for future policies and research include differential regional economic development, rural environment, quality of eye care services, diabetes, ultraviolet light exposure, or gender inequalities in diagnostic and therapeutic health care.Peer Reviewe

Visual impairment and blindness in Spanish adults: geographic inequalities are not explained by age or education

Objectives: The objectives of this study were to examine for the first time the prevalence of visual impairment and blindness among adults in Spain, to explore regional differences, and to assess whether they may vary as a function of sex or be explained by age and individual or regional socioeconomic position. Design: Data were obtained from the 2008 Spanish Survey on Disability, Personal Autonomy, and Dependency Situations, a cross-sectional survey based on a representative sample of the noninstitutionalized population of Spain. Participants: The sample was composed of 213 626 participants aged =15 years (103 093 men and 110 533 women); 360 were blind (160 men and 200 women), 4048 had near visual impairment (1397 men and 2651 women), and 4034 had distance visual impairment (1445 men and 2589 women). Methods: The prevalence of near and distance visual impairment was calculated for each region. Multiple logistic regression models were fitted to calculate odds ratios and 95% confidence intervals. All analyses were stratified by sex. Main Outcome Measures: Visual impairment was based on 3 questions aimed at identifying blindness and near and distance visual impairment. Results: The prevalence (percentage) of blindness was 0.17 (men, 0.16; women, 0.18): 1.89 for near visual impairment (men, 1.36; women, 2.40), 1.89 for distance visual impairment (men, 1.40; women, 2.34), and 2.43 for any visual impairment (men, 1.81; women, 3.02). Regional inequalities in the prevalence of visual impairment were observed, correlated with regional income, and the prevalence was consistently higher among women than men. The magnitude of the inequalities remained after adjusting for age and educational level, and a north-to-south pattern of increasing prevalence was observed. Conclusions: Regional and sex inequalities in the prevalence of visual impairment and blindness were observed in Spain, with a north-to-south gradient of increasing prevalence that was not explained by age or individual educational level but was correlated with regional level of economic development. Factors that could be prioritized for future policies and research include differential regional economic development, rural environment, quality of eye care services, diabetes, ultraviolet light exposure, or gender inequalities in diagnostic and therapeutic health care.Peer Reviewe

Why are there gender inequalities in visual impairment?

Background In high-income countries, the prevalence of blindness and visual impairment is higher among women, regardless of age although the mechanisms that produce these gender inequalities are not well understood. The objectives of this study were to analyse gender inequalities in the prevalence of blindness and visual impairment, age of onset, diagnosed and undiagnosed status and related eye diseases among visually impaired individuals. Methods Data were obtained from the 2008 Spanish Survey on ‘Disability, Personal Autonomy and Dependency Situations’ (n = 213 626) participants 360 blind (160 men and 200 women), and 5560 with some visual impairment (2025 men and 3535 women). The prevalence of blindness and visual impairment, age of onset of visual impairment and diagnosed and undiagnosed eye diseases was calculated. Hierarchical multiple logistic regression models were fit to test gender differences. Results Women were more likely to report visual impairment (crude OR = 1.6 [95% CI: 1.56–1.74]). Prevalence of diagnosed cataract was higher among visually impaired women (crude OR = 1.4 [95% CI: 1.25–1.67]) whereas undiagnosed eye disease (crude OR = 0.7 [95% CI: 0.64–0.81]) or diagnosed glaucoma (aORsex = 0.8 [95% CI: 0.65–0.93]) were more frequent among visually impairment men. These associations were not explained by age or educational level. Conclusions Strong gender inequalities were observed, with a higher prevalence of visual impairment and related cataracts among women, which could be related to gender inequalities in access to health care, and undiagnosed eye disease and related glaucoma among men, which could be related to their gender socialization resulting in less frequent and effectively use of health care services

The value of comparative research in major day surgery

Objective To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. Method Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. Results The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) Conclusions The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible.Peer ReviewedPostprint (published version

Monitoring the cluster of high-risk mortality areas in the southwest of Spain

Inspired by a previous study showing a striking geographical mortality clustering, not attributable to chance, in the south-western region of Spain in 1987-1995, the authors have conducted an ecological study of time trends in all-cause mortality risk between 1987-1995 and 1996-2004 in 2,218 small areas of Spain. To identify high-risk areas, age-adjusted relative risks for each area, stratified by sex and time period, were computed using a Bayesian approach. Areas of high-risk in both periods, or in the second period only, were identified. Annual excess mortality and percentage of people living in these high-risk areas, again stratified by sex and time period, were estimated. The cluster of high mortality risk areas identified in the southwest of Spain during 1987-1995 persisted in the period 1996-2004 with an increase in the number of highrisk areas and in annual excess of mortality. These increases showed a gender difference, being more pronounced in women.Postprint (published version

The value of comparative research in major day surgery

Objective To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. Method Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. Results The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) Conclusions The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible.Peer Reviewe