Daniel La Parra

Will austerity cuts dismantle the Spanish healthcare system

In the face of austerity, a series of disconnected “reforms” could, without corrective measures, lead to the effective dismantling of large parts of the Spanish healthcare system, with potentially detrimental effects on health. Helena Legido-Quigley and colleagues explain

Contribución de las mujeres y los hogares más pobres a la producción de cuidados de salud informales

Summary Objective: To determine gender and socioeconomic inequalities in the production of informal home health care. Methods: Cross-sectional survey. The study population was formed by 17.907 individuals interviewed in 1994 in the Spanish sample of 1994 the European Community Household Panel. The number of caregivers in the sample is 1.305 individuals (7.3% of the total). Two outcome measures were analysed: the risk of being an informal caregiver and the risk of caring more than 28 h weekly. The independent variables were the household income level, occupation, gender, age and selfperceived health status. The odds ratio are obtained from logistic regression models. Results: Women are more likely than men to provide care for someone (74.4%). Low-income individual without occupation bear the greatest probability of providing care more than 28 h weekly OR = 2.24 (1.45-3.47). Bad self-perceived health status in people with occupation is associated with being a full-time caregiver OR = 4.51 (1.48-13.68). Age increase the probability both of being an informal caregiver and to care more than 28 hours a week. Conclusion: Women, low-income social classes and aged people bear the greatest burden of giving care.

Erosion of universal health coverage in Spain

1 La Secretaría General del Congreso de los Diputado. Presupuesto por programas y memoria de objetivos. http://www.sepg.pap. minhap.gob.es/Presup/PGE2011Ley/ MaestroTomos/PGE-ROM/doc/L_11_E_G16. PDF (accessed Nov 29, 2013). 2 Gobierno de España. Programa Nacional de Reformas de España 2013. http://www. mineco.gob.es/stfl s/mineco/comun/pdf/PNR_ Espana_2013.pdf (accessed Dec 2, 2013). 3 Medicos del Mundo. El impacto de la reforma sanitaria sobre el Derecho a la Salud. http:// www.medicosdelmundo.org/index.php/mod. conts/mem.detalle_cn/relmenu.111/id.3306 (accessed Nov 25, 2013). 4 Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health eff ects of fi nancial crisis: omens of a Greek tragedy. Lancet 2011; 378: 1457–58. 5 Boletin Ofi cial del Estado. Resolución de 10 de septiembre de 2013, de la Dirección General de Cartera Básica de Servicios del Sistema Nacional de Salud y Farmacia, por la que se procede a modifi car las condiciones de fi nanciación de medicamentos incluidos en la prestación farmacéutica del Sistema Nacional de Salud mediante la asignación de aportación del usuario. http://www.boe.es/diario_boe/ txt.php?id=BOE-A-2013-9709 (accessed Nov 25, 2013) 6 La Federación de Asociaciones para la Defensa de la Sanidad Pública. Las repercusiones del copago sobre la utilización de medicamentos por los pensionistas. http://imagenes.publicoestaticos.es/resources/archivos/2013/3/14/136 3292203193informe%20fadsp%20copago%20 jubilados.pdf (accessed Nov 25, 2013). 7 The Council of Europe. Report by Nils Muižnieks, Council of Europe Commissioner for Human Rights, following his visit to Spain, from 3 to 7 June 2013. https://wcd.coe.int/ViewDoc. jsp?id=2106465&Site=COE (accessed Nov 25, 2013). for drugs. Pensioners will have to pay an increasing part of the cost of medicines. From October, 2013, patients with hepatitis C, HIV, rheumatoid arthritis, and some cancers will also have to pay 10% of their treatment costs in hospital pharmacies up to €4·20 per prescription. Even small out-of-pocket expenses are a barrier to effective treatment. The Federation of Associations Defending Public Health reports that 17% of pensioners could not complete the course of their treatment because of their high and increasing costs. At the European level, several reports are worth mentioning. According to Eurostat’s At risk of poverty or social exclusion in the EU27, austerity measures could aff ect children in particular—they are disproportionately aff ected by the fi nancial crisis with nearly 30% being at risk of poverty or social exclusion. The Council of Europe has raised concerns regarding the diffi culties some children (ie, undocumented migrants) are facing in accessing health care. In its recent recommendations, the European Council has clearly emphasised the need for an assessment of the eff ects of austerity measures on vulnerable groups in Spain. Austerity measures adopted by Spain and other European countries have failed to heal their economies, and there is growing evidence that these measures threathen the health of their citizens. There is still time to save the Spanish health system and reverse the restrictions limiting universal protection. It is possible to re-establish universal access to quality health-care services, free at the point of delivery, in line with the UN resolution.

Las investigaciones sobre promoción y educación para la salud en las etapas de infantil y primaria de la escuela española: Una revisión de los estudios publicados entre 1995 y 2005

Objetivo: Conocer las caracteristicas de las intervenciones destinadas a la educacion y la promocion de la salud en la educacion infantil y primaria en Espana, a traves de los estudios publicados en las revistas cientificas. Metodo: Revision de estudios sobre educacion y promocion de la salud en la escuela espanola, publicados entre 1995 y 2005. Se consultaron las bases de datos internacionales Medline mediante Pubmed, Cinhal, Eric, Sociological Abstracts, Science Citation Index e Isooc. Se seleccionaron estudios de salud en la escuela espanola en infantil y primaria que incorporasen actividades de educacion y/o promocion de salud. Se analizaron las caracteristicas, el tema, la metodologia, las intervenciones desarrolladas y su adecuacion a los criterios para escuelas saludables. Resultados: Cumplian los criterios de inclusion 26 de los 346 articulos identificados. Los programas de educacion para la salud tienen una perspectiva mas preventiva de la enfermedad que de promocion de la salud y no son frecuentes en las etapas de infantil y primaria. Los criterios de escuelas saludables se incluyen en 5 articulos (19,2%). Destacan las instituciones sanitarias (n = 7; 26,9%) y universitarias (n = 8; 30,8%) en el impulso de los programas. El tabaquismo (n = 11; 42,3%) es el tema mas tratado. Conclusiones: El protagonismo del profesorado en el impulso de la promocion de la salud en la escuela es menor que el de las instituciones sanitarias en la implementacion y la difusion de los programas. La investigacion sobre el desarrollo de la promocion de la salud en la escuela en las etapas de infantil y primaria es escasa.

The health care experiences of British pensioners migrating to Spain: A qualitative study

BACKGROUND Notwithstanding the importance of cross-border healthcare mobility for Member States very little research has been carried out to understand the experiences of those that move. This paper focuses on a type of patient mobility that has had a significant growth in the past decades. These are pensioners who have moved from Northern European countries to countries in the South. OBJECTIVE To explore the health care experiences of British pensioners who have migrated to Spain. DESIGN Qualitative study using in-depth interviews complemented with natural group discussions. PARTICIPANTS Fifty-eight British retirees living in Spain and four that had returned to the UK from Spain. SETTING Spanish Autonomous Communities of Valencia and Baleares and the UK. RESULTS British pensioners reported high satisfaction with their experiences of Spanish health care, in contrast to their more negative experiences of other public services in Spain. The perceived high quality (assessed in terms of thoroughness of care and the cleanliness of facilities) and humanity of care provided were the pivotal features of health care encounters, at all levels of the health care system. Exceptions to the overall positive assessments were transport to health care facilities, personal care in hospitals, long term care, and the management of pain relief, which were compared unfavourably with the UK NHS. CONCLUSION In contrast to the existing literature, which suggests widespread problems faced by migrant British pensioners in accessing health care, we identified high levels of satisfaction with services.

Relación entre el número de horas de cuidado informal y el estado de salud mental de las personas cuidadoras

Background: Mental health of caregivers is damaged by caregiving tasks. Studies are needed to determine the influence of several variables on the association between informal care and mental health. The aim of this paper is to analyse the effects of the time devoted to informal caregiving on the mental health of women and men in relation to the type of dependents. Methods: National Health Survey 2006, sample 29,478. Variables: mental health state (GHQ-12), number of hours devoted to caregiving, age, social class, and functional support (Duke-UNC). A logistic regression analysis was performed to determine the probability of having poorer mental health according to the number of hours of caregiving, adjusted for age, social class and functional support. Results: Women show poorer mental health when they spend more than 97 hours per week taking care of children [OR=1,372], more than 25 hours caring for persons over 74 years of age [OR=1,602 between 25 and 48 hours; OR=1,467 49-96h.; OR=1,874 97-168h.], and when they devote some hours to provide care to adults with disabilities [OR=1,996 0-24h.; OR=2,507 25-48h.; OR=3,016 49-96h.; OR=1,651 97-168h.]. Men show deterioration in mental health when they devote a high number of hours to caring for persons over 74 years [OR=2,810 97-168h.] and adults with disabilities [OR=3,411 97-168h.], and when they devote some hours to childcare [OR=1,595 0-24h.]. Conclusions: The effect of the number of hours devoted to caregiving on the mental health of caregivers is influenced by the type of dependents and the gender of the caregiver.

Social and immigration factors in intimate partner violence among Ecuadorians, Moroccans and Romanians living in Spain.

BACKGROUND Intimate partner violence (IPV) against women occurs in all countries, all cultures and at every level of society; however, some populations may be at greater risk than others. The aim of this study was to explore IPV prevalence among Ecuadorian, Moroccan and Romanian immigrant women living in Spain and its possible association with their personal, family, social support and immigration status characteristics. METHODS Cross-sectional study of 1607 adult immigrant women residing in Barcelona, Madrid and Valencia (2011). Prevalence rates and adjusted odds ratios (AORs) were calculated, with current IPV being the outcome. Different womens personal (demographic), family, social support and immigration status characteristics were considered as explicative and control variables. All analyses were separated by womens country of origin. RESULTS Current IPV prevalence was 15.57% in Ecuadorians, 10.91% in Moroccans and 8.58% in Romanians. Some common IPV factors were found, such as being separated and/or divorced. In Romanians, IPV was also associated with lack of social support [AOR 5.96 (1.39-25.62)] and low religious involvement [AOR 2.17 (1.06-4.43)]. The likelihood of current IPV was lower among women without children or other dependents in this subgroup [AOR 0.29 (0.093-0.92)]. CONCLUSION The IPV prevalence rates obtained for Moroccan, Romanian and Ecuadorian women residing in Spain were similar. Whereas the likelihood of IPV appeared to be relatively evenly distributed among Moroccan and Ecuadorian women, it was higher among Romanian women in socially vulnerable situations related to family responsibilities and the lack of support networks. The importance of intervention in the process of separation and divorce was common to all women.

Los procesos de exclusión social y la salud del pueblo gitano en España

, la poblacion gitana es el grupo que menossimpatia despierta en la poblacion encuestada (51,7%), seguido dela poblacion musulmana (45,8%), la poblacion inmigrante (31%) ylas mujeres y los hombres homosexuales (21,8%).La investigacion sobre la salud de la poblacion gitana en Espana˜se ha centrado principalmente en las enfermedades transmisibles,los estudios geneticos y las anomalias congenitas, segun la revisionrealizada por Ferrer

Children as agents of their own health: exploratory analysis of child discourse in Spain

The promotion of childrens decision-making is one of the principles of health-promoting schools, and the empowerment of children means that they are enabled to influence their lifestyles and living conditions. The aim of this study was to find out the suggestions of Spanish school pupils in Year 3 and Year 6 of primary education to promote their own health and the health of the people closer to them, through their ideas about health. We analyse the discourse on health in the school environment from focus groups of primary school pupils aged around 8 and 12 of five schools in the town of Alicante (Spain). The groups were organized according to the type of school (public, private), the socioeconomic status of the neighbourhood (residential, working-class) and gender (single-sex, mixed groups) to ensure both the highest intergroup diversity and intra-group homogeneity. The findings show that primary school pupils have a wide and diverse notion of health. The application of the focus group technique has proved useful in eliciting information from groups of primary school pupils, and involving students in health-promoting programmes because it allows them to identify the social and interpersonal determinants of health. There is a firm basis to consider school pupils as health agents, particularly regarding interventions within the school environment itself. With the support of teachers, it is possible to train school pupils as community health agents, and increase their control over their own health.

Barriers and facilitators to effective coverage of intimate partner violence services for immigrant women in Spain

To explore service providers’ perceptions in order to identify barriers and facilitators to effective coverage of Intimate Partner Violence (IPV) services for immigrant women in Spain, according to the different categories proposed in Tanahashis model of effective coverage.