Antonia Medina

Natural outdoor environments and mental and physical health: Relationships and mechanisms

BACKGROUND Evidence is growing for the beneficial impacts of natural outdoor environments on health. However, most of the evidence has focused on green spaces and little evidence is available on health benefits of blue spaces and about possible mediators and modifiers of such impacts. We investigated the association between natural outdoor environments (separately for green and blue spaces) and health (general and mental) and its possible mediators and modifiers. METHODS Cross-sectional data from adults interviewed in Catalonia (Spain) between 2010 and 2012 as part of the Catalonia Health Survey were used. The collected data included sociodemographic characteristics, self-perceived general health, mental health, physical activity and social support. Indicators of surrounding greenness and access to natural outdoor environments within 300 m of the residence and degree of urbanization were derived for residential addresses. Associations were estimated using logistic regression and negative binominal models. RESULTS Green spaces were associated with better self-perceived general health and better mental health, independent of degree of urbanization. The associations were more consistent for surrounding greenness than for access to green spaces. The results were consistent for different buffers, and when stratifying for socioeconomic status. Slightly stronger associations were found for women and residents of non-densely populated areas. No association was found between green spaces and social contacts and physical activity. The results for blue spaces were not conclusive. CONCLUSION Green spaces are associated with better general and mental health across strata of urbanization, socioeconomic status, and genders. Mechanisms other than physical activity or social support may explain these associations.

Normas de referencia para el Cuestionario de Salud SF-12 version 2 basadas en poblacion general de Cataluna

BACKGROUND AND OBJECTIVE The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. SUBJECTS AND METHODS We analyzed a subsample of the Catalan Health Interview Survey (n=4,261), representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. RESULTS The results for the known groups analysis supported the hypothesis established a priori (P<.001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9); and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scores obtained by the 2 different methods of calculation were similar, except for General Health and Vitality. CONCLUSIONS The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison.

OriginalNormas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de CataluñaReference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population

BACKGROUND AND OBJECTIVE The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. SUBJECTS AND METHODS We analyzed a subsample of the Catalan Health Interview Survey (n=4,261), representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. RESULTS The results for the known groups analysis supported the hypothesis established a priori (P<.001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9); and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scores obtained by the 2 different methods of calculation were similar, except for General Health and Vitality. CONCLUSIONS The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison.

Población con cobertura pública o doble cobertura de aseguramiento sanitario: ¿Cuál es la diferencia?

Objetivo: Conocer las diferencias en las caracteristicas socioeconomicas, el estado de salud, la utilizacion de servicios y la satisfaccion con estos entre la poblacion catalana que dispone unicamente de aseguramiento sanitario publico y la que tiene doble cobertura de aseguramiento. Metodos: Datos de la Encuesta de Salud de Cataluna 2002 con entrevista a 8.400 personas. Entre los individuos que tenian cobertura publica de servicios sanitarios, se han diferenciado los que tambien tenian cobertura por entidades de aseguramiento libre. Se aplica un modelo de analisis multivariable de regresion logistica. Resultados: El 99,2% de la poblacion manifiesta disponer de cobertura sanitaria publica y un 24,7% estar ademas afiliada a una mutua voluntaria o aseguradora privada. La poblacion con doble cobertura se caracteriza por ser mas joven, tener mayor nivel de estudios, pertenecer a clases sociales mas favorecidas, declarar mejor estado de salud percibido, menos enfermedades cronicas y discapacidades. El porcentaje de personas que han acudido a algun profesional sanitario los ultimos 15 dias no muestra diferencias estadisticamente significativas, pero si se observan segun el tipo de profesional; en la poblacion sin doble cobertura, la ultima visita corresponde, en el 65,0% de los casos, a atencion primaria, mientras que en el grupo con doble cobertura, el 51,1% corresponde a atencion especializada. El porcentaje de personas satisfechas o muy satisfechas con la ultima visita es superior en el grupo con doble cobertura en relacion con el trato profesional, el tiempo de espera y los tramites burocraticos. Conclusiones: Se constatan perfiles sociodemograficos y de salud diferentes entre las poblaciones con cobertura publica unicamente y con doble cobertura. Se observa un patron distinto de utilizacion de servicios.

Lesiones por caídas y factores asociados en personas mayores de Cataluña, España

OBJECTIVES To assess, based on a population health survey, what proportion of individuals in a sample of non-institutionalized older persons suffered injuries from unintentional falls, and to evaluate the associated demographic and health-related factors. METHODS A total of 3,247 individuals over 65 years of age, selected by multistage random sampling, participated in the Health Survey of Cataluña (ESCA-2006), answering an interviewer-administered questionnaire that included questions about injuries from falls, and any relevant associated factors, during the 12 months preceding the survey. RESULTS Of the respondents, 14.9% reported having been injured by falling. Multivariate analysis indicated that sex, age, living alone, taking five or more medications, and suffering from mobility problems, diabetes, or musculoskeletal disorders were associated with an increased risk of injury from falls. However, no statistically significant effect was observed from sensory or communication impairment, cardiovascular disease, cataracts, or alcohol consumption. CONCLUSIONS Health care services, which are often in contact with the elderly, can identify those who are at increased risk of falling and put into place a variety of proven, preventive interventions. Though somewhat limited, population health surveys provide useful information regarding the burden of fall-related injuries on elderly health and complement data provided by other sources.

La opinión de los profesionales sanitarios sobre el Plan de Salud de Cataluña: punto de partida para una reflexión orientada al futuro

Objetivos: Conocer la opinion de los profesionales sanitarios sobre el Plan de Salud (PS) de Cataluna y obtener nuevos elementos para la formulacion y gestion de nuevos planes. Diseno: Combinacion de metodologia cuantitativa y cualitativa. Encuesta postal a personal medico y de enfermeria, por muestreo aleatorio polietapico con estratificacion. Se obtuvieron 3.223 cuestionarios (tasa de respuesta del 34,1%). Entrevista a una muestra de conveniencia formada por 41 profesionales asistenciales y de la gestion. Mediciones y resultados principales: El PS es conocido por el 78,8% (intervalo de confianza del 95%: ± 1,4) de los profesionales y es valorado positivamente por la mayoria de los consultados. Segun el 28,9% (IC del 95%: ± 1,7) de los encuestados que lo conocen, el PS ha tenido repercusiones favorables en su labor diaria, y el 51,8% (IC del 95%: ± 1,9) opina que no ha tenido repercusiones. Se critican aspectos de su elaboracion, contenido, difusion y la escasa asignacion de recursos especificos. Se observan diferencias por edad, sexo, ambito asistencial y colectivo profesional. Conclusiones: Es necesaria una mayor implicacion de los profesionales en la discusion, diseno e implementacion de las propuestas del PS. Se debe avanzar en la identificacion de problemas, en el establecimiento de prioridades y en la asignacion de recursos. Tambien hay que lograr un mayor compromiso intersectorial y desarrollar estrategias de comunicacion especificas para politicos, gestores y profesionales que permitan mejorar la proyeccion de los objetivos del PS en el sistema sanitario y otros sectores con responsabilidad en el ambito de la salud. En definitiva, es necesario replantearse el papel del PS en el sistema y, de acuerdo con el, redisenar los procesos para el establecimiento y aplicacion de estrategias de salud.

Nineteen years of prevention policies: the impact of the targets on non intentional injuries established in the health plan for Catalonia

Context In 1991, the Department of Health of the Government of Catalonia (autonomous region in Spain, population 7.3 million), following the recommendations of the WHO European Regional Office, started an innovative health planning scheme, with well established health and risk reduction targets for two main periods, 1991–2000 and 2001–2010. In Catalonia, as in other European countries, injuries produced by non intentional causes are one of the main public health problems, account for a substantial proportion of morbidity and avoidable mortality. Objectives To analyse the evolution of the selected indicators in order to evaluate the impact of the policies implemented and assess the targets of the periodical Health Plans on injury prevention and control in Catalonia. Methods and products To present the main strategies on injury prevention and control, the elements of the 12 health and risk reduction targets, with the quantification of their indicators, previously established. It shows, also, the 47 operative targets developed during the five periods of the Health Plan. The values of the indicators used to know the evolution and the attainment of each formulated target are detailed by tables and figures. Discussion During a wide planning period, interventions developed have contributed to the attainment of the health targets on non intentional injuries, measured and assessed. The trends of mortality and morbidity due to non intentional injuries evolved positively during this period. The four targets established for the year 2000 were achieved, and five of the eight targets for 2010 evolves positively.

PHM19 USING THE EQ-5DTO MONITOR HEALTH-RELATED QUALITY OF LIFE OVERTIME IN THE CATALAN HEALTH INTERVIEW SURVEY

assumed identical for each subsequent injection. RESULTS: The systematic review revealed that different regimens were applied across pre-FENOC studies. Furthermore the Bayesian analysis demonstrated that medication type, alone or combined with dosage, had a significant influence on modelled efficacy. Using a standard treatment regimen of one 90 mg/kg rFVIIa injection every 3 hours, the model estimated that at 12, 24, and 36 hours the probability of bleed resolution was 76%, 94%, and 99%, respectively. In contrast, using a standard regimen of one 75 IU/kg APCC injection every 12 hours, the probability of bleed resolution at the corresponding times was 40%, 60%, and 79%, respectively. CONCLUSION: The present Bayesian metaregression suggests that, despite the outcome of the FENOC study, on-demand treatment with rFVIIa may be associated with a faster time to joint bleed resolution than APCC using the standard treatment regimens specified. Future research should include time-independent confounding factors (e.g., efficacy rating scale method, efficacy rater, treatment setting, bleed severity).