Anna Mompart-Penina

Impact of the economic crisis on children's health in Catalonia: a before–after approach

Objectives To analyse changes in the family living conditions of children in Catalonia between 2006 and the 2010–2012 period, and to study associations between these changes and health outcomes. Design A before–after analysis of two cross-sectional surveys. Setting Population younger than 15 years of age from Catalonia, Spain. Participants Representative samples of children in the 2006 Catalan Health Survey (ESCA), baseline, before the crisis; n=2200) and the first four waves of ESCA 2010–2012 (after start of the crisis, n=1967). Main outcome measures Overweight/obesity, health behaviour, mental health and health-related quality of life (HRQOL). Logistic regression and multiple linear regression models were used to analyse the influence of changes in family conditions on outcome measures, including interaction terms to describe the potential influence of the study period on the results. Results The percentage of unemployed families rose from 9.1% (2006) to 20.6% (2010–2012), with inequalities by level of education. Overweight/obesity increased from 18.4% (95% CI 16.5% to 20.4%) to 26.9% (24.6% to 29.2%) in 2010–2012, and inequalities related to maternal education and employment status persisted. Eating habits have improved in 2010–2012 in disadvantaged families (ie, junk food consumption improved in families with a maternal primary education level; beta (B)=2.85; 0.83 to 4.88, for the survey interaction by primary education level). An improvement in HRQOL was found in the second survey (B=6.07; 4.15 to 7.99), although children whose mothers had a primary education showed poorer HRQOL scores in this survey than in 2006 (B=−4.14; −7.17 to −1.12). Conclusions Although some health-related behaviour improved during the study period, childhood obesity increased and inequalities in HRQOL appeared. Policy measures that fight against these inequalities should be urgently implemented to avoid their negative impact on the health of future generations of Catalans.

Características metodológicas de la Encuesta de Salud de Cataluña 2006

The Health Survey of Catalonia (ESCA) gives essential population information for health planning and evaluation. On the edition of 2006, 18,126 non-institutionalized persons were interviewed. The sample design is complex with the aim to guarantee the representatively also in small geographic areas with interest in health and service planning. There are certain novelties in the third edition such as the relevance given to the territory, questionnaires adaptations to the interviewed population and new subject areas studied. This paper describes the useful methodological aspects for the ESCA 2006 users. In the first part we describe the sample design, questioners, field work, interviewers formation, codification and quality micro data control. In the second part compound variables, used tools and their references are shown. And the third part describes the indicators construction since the sample design determines the use of weighing and elevation factors to obtain representative estimation values.

The local burden of emotional disorders: An analysis based on a large health survey in Catalonia (Spain)

OBJECTIVE Mental health conditions are associated with a significant burden on individuals. Using data from a large population health survey, the present study aimed to quantify the burden of emotional disorders (depression and anxiety) on health-related quality of life (HRQoL) in the region of Catalonia (Spain) for evidence-informed policy making. METHODS Regression models were used to estimate the impact of emotional disorders on HRQoL, controlling by socioeconomic factors and somatic health problems. The rate of emotional disorders was based on the General Health Questionnaire (GHQ-12) and quality of life scores were based on the EQ-5D. RESULTS The impact of emotional disorders on HRQoL was equal to a reduction of 0.17 in the EQ-5D score. Translation of this individual impact to population figures yielded a total loss of 78,742 quality-adjusted life years (QALYs) for 2006. This strong impact highlights the need for global policies aiming to reduce this burden. CONCLUSION The negative relation between emotional disorders and the HRQoL of individuals was confirmed and quantified for the population of Catalonia. The use of quality of life scales such as the SF or EQ-5D, combined with data on quasi-specific health conditions provides substantial information for prioritizing and planning health programs.

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

BACKGROUND AND OBJECTIVE To estimate the prevalence of obesity and overweight in children aged 2 to 14 years in Catalonia, its trends between 2006 and 2010-2012, and to evaluate social determinants and lifestyle associated with obesity. MATERIAL AND METHODS A cross-sectional study, using the data from 4,389 surveys from Catalonia Health Surveys of the years 2006 and 2010-2012, was conducted. Obesity and overweight were determined by World Health Organization criteria. Socioeconomic position, parents education, usual diet and activity, and hours of sleep were assessed. RESULTS The prevalence of obesity and overweight were: 15.4 and 20.2% in 2010-2012. The prevalence of obesity was higher in boys (15.5%) compared to girls (12.8%) (P<.05), and higher in children ranging from 2 to 9 years old (17.5%) than children aged 10 to 14 years (7.7%) (P<.05). In 2006, the prevalence of obesity and overweight were similar to the prevalence in 2010-2012. Obesity was more frequent in children with parents with a low socioeconomic position and/or a primary or elementary parents education. CONCLUSIONS During the last 5 years (2006-2012), child obesity and overweight have remained stable in Catalonia, yet they are relatively high in Europe. Public health programmes against obesity must consider conducting an intersectional action taking social determinants and family life styles into account.

Encuestas de salud: luces y sombras

Surveys are relevant tolls to analyze social changes and its methods are appropriate to know about the distribution of perceptions and behaviors of different phenomena related to health and disease. Health surveys (HS) are usually focused on areas like social and demographic characteristics, health related behaviors, health status and health services utilization. They provide with information that is not possible to reach through other systematic data sources and are crucial to assist decision making in health policy. HS provide data from the general population which is complementary of that obtained through other procedures and takes into account the various dimensions and connections of health and health system. They are very important in health planning because of its adaptability different need, circumstances or population groups, and in all cases, when properly used, they provide with new knowledge that can be shared. Among its limitations it must be emphasized its reduced capacity to catch all the complexity of social phenomena, its high cost, and the need of a very strong work to coordinate different expert teams and its poor capacity to offer accurate estimates when little geographic areas or low prevalence phenomena are studied. The areas and opportunities for innovation in the design, data gathering and data analysis of HS are actually various and there is a need to try to optimize all its potentialities to get a better knowledge about populations’ health and social reality.

OriginalPrevalencia y condicionantes de la obesidad en la población infantojuvenil de Cataluña, 2006-2012Prevalence and determinants of obesity in children and young people in Catalonia, Spain, 2006-2012

BACKGROUND AND OBJECTIVE To estimate the prevalence of obesity and overweight in children aged 2 to 14 years in Catalonia, its trends between 2006 and 2010-2012, and to evaluate social determinants and lifestyle associated with obesity. MATERIAL AND METHODS A cross-sectional study, using the data from 4,389 surveys from Catalonia Health Surveys of the years 2006 and 2010-2012, was conducted. Obesity and overweight were determined by World Health Organization criteria. Socioeconomic position, parents education, usual diet and activity, and hours of sleep were assessed. RESULTS The prevalence of obesity and overweight were: 15.4 and 20.2% in 2010-2012. The prevalence of obesity was higher in boys (15.5%) compared to girls (12.8%) (P<.05), and higher in children ranging from 2 to 9 years old (17.5%) than children aged 10 to 14 years (7.7%) (P<.05). In 2006, the prevalence of obesity and overweight were similar to the prevalence in 2010-2012. Obesity was more frequent in children with parents with a low socioeconomic position and/or a primary or elementary parents education. CONCLUSIONS During the last 5 years (2006-2012), child obesity and overweight have remained stable in Catalonia, yet they are relatively high in Europe. Public health programmes against obesity must consider conducting an intersectional action taking social determinants and family life styles into account.

Calidad de vida relacionada con la salud y factores asociados al sobrepeso y la obesidad en la población infantil de Cataluña

The aim of this work is to describe the health-related quality of life (HRQOL), and to analyze the associated factors to overweight/obesity in a representative sample of the Catalan population 0-14 years old. Proxyrespondents answered the childs questionnaire of the Encuesta de Salud de Cataluna (ESCA) 2006 (n = 2.200). Variables analyzed were weight and height, the KIDSCREEN-10 HRQOL questionnaire, and also scales on risky behaviors, physical activity, frequency of fast food consumption, and number of hours of television viewing. Logistic regression models were adjusted. In 31% of children HRQOL was excellent/very good. Risky behaviors and restriction of activity were the associated factors to the best and the worst HRQOL. Maternal level of education and some habits and behaviors were associated to overweight/obesity. The ESCA contributes with useful information to monitor and to assess interventions addressed to the children population.

Dependencia para la realización de actividades de la vida diaria en las personas mayores de Cataluña

The aim of this article is to estimate the disabilty prevalence for the activities of daily living (ADL), the socioeconomic and demographic characteristics and the use of health services, distinguishing between the population receiving assistance for ADL and not. Cross-sectional study (Encuesta de Salud de Cataluna [ESCA] 2006). We have analyzed 17 ADL. Differences among proportions are estimated with a 95% confidence interval to characterize the analysis groups. Logistic regression describes the explanatory variables about getting help or not. Disabilty prevalence for the ADL: 26.6% men and 48.2% in women. Of these, 79.6% is getting help. There is a socioeconomic gradient in prevalence, not being observed in relation to assistance or not. We must deepen our understanding of the phenomenon and its evolution to which the ESCA is an essential tool.The aim of this article is to estimate the disabilty prevalence for the activities of daily living (ADL), the socioeconomic and demographic characteristics and the use of health services, distinguishing between the population receiving assistance for ADL and not. Cross-sectional study (Encuesta de Salud de Cataluña [ESCA] 2006). We have analyzed 17 ADL. Differences among proportions are estimated with a 95% confidence interval to characterize the analysis groups. Logistic regression describes the explanatory variables about getting help or not. Disabilty prevalence for the ADL: 26.6% men and 48.2% in women. Of these, 79.6% is getting help. There is a socioeconomic gradient in prevalence, not being observed in relation to assistance or not. We must deepen our understanding of the phenomenon and its evolution to which the ESCA is an essential tool.

Riesgo individual y poblacional en salud mental en Cataluña

Resumen Los trastornos mentales son problemas de salud con un fuerte impacto social, sanitario, economico y una importante repercusion en la calidad de vida de las personas que los padecen y de sus familias. El objetivo de este articulo es medir la prevalencia de los trastornos mentales en Cataluna y comparar los cambios observados en los resultados obtenidos entre 1994 y 2006 de la Encuesta de Salud de Cataluna a partir del Goldberg General Health Questionnaire. La poblacion con probabilidad de padecer un trastorno mental en el momento de la entrevista es similar en 1994 (12,6%) y 2006 (11,6%), con una prevalencia superior en las mujeres. Paradojicamente, entre la poblacion sin riesgo es donde se concentran los casos declarados de depresion y/o ansiedad, sentirse ansioso o deprimido, consumir antidepresivos, visitar al psiquiatra o tener un estado de salud regular o malo. Los resultados concuerdan tanto con la paradoja del riesgo como con la paradoja de la prevencion, hechos a tener en cuenta en las estrategias preventivas.Mental health disorders are health problems with a high health, social and economic impact and with relevant effects on the quality of life of both the patients and their families. The objective of this article is to measure the prevalence of mental disorders in Catalonia and to analyze changes the changes in the results obtained in the Goldberg General Health Questionnaire in the Catalan Health Survey editions developed in 1994 and 2006. The prevalence of population at risk of suffering of a mental health disorder does not differ in both years (12.6% in 1994 and 11.6% in 2006). Women showed a higher risk than men in both surveys. Paradoxically, it is amongst the people without risk where the highest number of cases of depression, anxiety, antidepressant use, psychiatry visits or bad perception of health was declared. The results agreed with the risk and prevention paradox and are relevant at the time of designing strategies for mental health disorders prevention.

Risk of dependence associated with health, social support, and lifestyle

OBJECTIVE To analyze the prevalence of individuals at risk of dependence and its associated factors. METHODS The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered. RESULTS We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women. CONCLUSIONS Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.