Elena Ronda

A framework to analyse gender bias in epidemiological research

The design and analysis of research may cause systematic gender dependent errors to be produced in results because of gender insensitivity or androcentrism. Gender bias in research could be defined as a systematically erroneous gender dependent approach related to social construct, which incorrectly regards women and men as similar/different. Most gender bias can be found in the context of discovery (development of hypotheses), but it has also been found in the context of justification (methodological process), which must be improved. In fact, one of the main effects of gender bias in research is partial or incorrect knowledge in the results, which are systematically different from the real values. This paper discusses some forms of conceptual and methodological bias that may affect women’s health. It proposes a framework to analyse gender bias in the design and analysis of research carried out on women’s and men’s health problems, and on specific women’s health issues. Using examples, the framework aims to show the different theoretical perspectives in a social or clinical research context where forms of selection, measurement and confounding bias are produced as a result of gender insensitivity. Finally, this paper underlines the importance of re-examining results so that they may be reinterpreted to produce new gender based knowledge.

Paternal exposure to agricultural pesticides and cause specific fetal death

Aims: To study the association between fetal death and paternal agricultural occupation in areas and time periods with different levels of use of agricultural pesticides. Methods: A total of 1 473 146 stillbirths and births occurring in Spain between 1995 and 1999 were analysed. Results: The offspring of agricultural workers had the highest risk of fetal death from congenital anomalies in the southern and eastern area (where pesticide use is greatest) and the lowest risk in the rest of Spain. In both areas the offspring of agricultural workers had a similar excess risk of fetal death from the remaining causes of death. The relative risk of fetal death from congenital anomalies in infants conceived between April and September (the months of greater use of pesticides) in the southern and eastern area was 0.90 in manual workers and 1.62 in agricultural workers, compared to non-manual workers; in individuals who were conceived during the rest of the year, the relative risk was 0.87 and 0.85, respectively. In both periods the offspring of agricultural workers had an excess risk of fetal death from the remaining causes of death. Conclusions: Paternal agricultural work in the areas where pesticides are massively used increases the risk of fetal death from congenital anomalies. The risk is also increased for fetuses conceived during the time periods of maximum use of pesticides The higher risk of fetal death from the remaining causes of death in the offspring of agricultural workers seems unrelated to pesticide exposure.

Airborne exposure to chemical substances in hairdresser salons

Several studies indicate health problems among hairdressers to be related to their chemical exposure at work. The purpose of this study was to describe the exposure of chemical compounds in the air of Spanish hairdresser salons, and to study differences between salons in central and suburban areas. Ten hairdresser salons were examined for two days, by recording number and type of customers, ventilation and size of salon. Both stationary and personal borne samples for organic compounds were collected, as well as stationary samples of ammonia. TVOC was calculated. Air temperature, relative humidity, CO and CO2 were logged for 48 h in each salon. Fifty-six personal and 28 stationary samples were analysed for organic compounds. Thirty-five different air-borne compounds were found in the working environment of the hairdressers. All levels were well below the limit values in Spain and USA, both for ammonia and organic compounds. TVOC ranged from 48.37 mg/m3 to 237.60 mg/m3, meaning that many salons had levels above suggested comfort values of 25. There were only minor differences in exposure between central and suburban salons. No salons had ventilation systems, and the CO2 was increasing during the day. The exposure was higher for several chemical compounds when hair dying was performed. Hairdressers were exposed to low air levels of a large number of chemical substances mostly related to work related to hair dying. There were no differences between exposure levels in salons in central and suburban areas.

Decreasing socioeconomic inequalities and increasing health inequalities in Spain: a case study.

OBJECTIVES We examined the evolution of income inequalities and health inequalities in Spain from the time of the countrys entry into the European Union. METHODS We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984-1986 and 1999-2001. RESULTS Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. CONCLUSIONS Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.

From the boom to the crisis: changes in employment conditions of immigrants in Spain and their effects on mental health

BACKGROUND Migrant workers have been one of the groups most affected by the economic crisis. This study evaluates the influence of changes in employment conditions on the incidence of poor mental health of immigrant workers in Spain, after a period of 3 years, in context of economic crisis. METHODS Follow-up survey was conducted at two time points, 2008 and 2011, with a reference population of 318 workers from Colombia, Ecuador, Morocco and Romania residing in Spain. Individuals from this population who reported good mental health in the 2008 survey (n = 214) were interviewed again in 2011 to evaluate their mental health status and the effects of their different employment situations since 2008 by calculating crude and adjusted odds ratios (aORs) for sociodemographic and employment characteristics. FINDINGS There was an increased risk of poor mental health in workers who lost their jobs (aOR = 3.62, 95%CI: 1.64-7.96), whose number of working hours increased (aOR = 2.35, 95%CI: 1.02-5.44), whose monthly income decreased (aOR = 2.75, 95%CI: 1.08-7.00) or who remained within the low-income bracket. This was also the case for people whose legal status (permission for working and residing in Spain) was temporary or permanent compared with those with Spanish nationality (aOR = 3.32, 95%CI: 1.15-9.58) or illegal (aOR = 17.34, 95%CI: 1.96-153.23). In contrast, a decreased risk was observed among those who attained their registration under Spanish Social Security system (aOR = 0.10, 95%CI: 0.02-0.48). CONCLUSION There was an increase in poor mental health among immigrant workers who experienced deterioration in their employment conditions, probably influenced by the economic crisis.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis †

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

Work ability, psychosocial hazards and work experience in prison environments

BACKGROUND Work ability is predicted by age- and work-related psychosocial hazards; however, its association with work experience has not been studied. Work ability has not been studied in prison environments as well. AIMS To describe work ability and its associates among prison workers. METHODS A cross-sectional study was carried out in two prisons in Spain, one large and one medium prison, randomly selected from 17 in total. Prison workers were randomly administered a voluntary anonymous questionnaire to measure work ability [Work Ability Index (WAI)], work-related psychosocial hazards (Spanish version of COPSOQ), sociodemographic, lifestyle and work-related variables. RESULTS Four hundred and forty-one workers (54%) participated. Results confirmed that older and more experienced workers (analysis of variance analysis) and workers in large prisons (t-student) presented significantly lower WAI scores. Quantitative and emotional demands, family work conflict, low work control, low autonomy, low social support from colleagues and stress had negative significant associations with WAI. Age, which highly correlated with work experience (Spearmans r = 0.85), had significant association with WAI (beta = -0.62). In the stepwise linear regression, the association between age and WAI lost statistical significance after controlling for work experience, which maintained significant correlation with WAI (beta = -0.37). CONCLUSIONS The apparent association between age and WAI was confounded by work experience. Interventions to improve work ability among prison workers may benefit from results of this study to focus their efforts on the risk groups in such a psychologically demanding work environment rarely examined in previous research.

¿Quiénes y qué pueden hacer en salud pública? Las competencias profesionales como base para la elaboración de programas en el Espacio Europeo de Educación Superior

OBJECTIVE To conform a frame of reference for the organization of the public health teaching in university degrees in Spain, in agreement with the directives of the European Space for Higher Education. METHODS Specific professional competencies in public health have been extracted from the Libros blancos published by the ANECA (National Agency of Quality Evaluation) for the degrees on medicine, pharmacy, nursing, human nutrition and dietetics, optics and optometry, veterinary, social work, occupational relations, teacher training, and environmental sciences. Following the framework proposed by the Working Group on professional competencies in public health in Spain, we have selected those competences that enable future professionals to participate in the development of the public health from their field of activity. We have also identified and correlated the specific competences of each degree with the corresponding activities and functions. RESULTS All the studied degrees have competences in public health functions. The majority has also defined activities in community health analysis, design and implementation of health interventions and programmes, promotion of social participation and citizens control of their own health. CONCLUSIONS There is academic space for the multidisciplinary development of the public health in Spain beyond the health professions. The identification of the specific competencies of each degree related with activities on public health reveal what are the contents to be in included in each syllabus.

Heterogeneous trend in smoking prevalence by sex and age group following the implementation of a national smoke-free law

Objective Given the limited evidence available about the effects of clean indoor air laws on smoking behaviour in the general population, the impact of national smoke-free workplace, bar and restaurant legislation, implemented on 1 January 2006, on smoking prevalence in Spain was assessed in this study. Methods Population-based trend analysis using estimates for 27 periods from the beginning of 2000 to the end of 2008—three periods per year. To calculate the period per cent change in smoking prevalence, the permutation test for joinpoint regression to detect significant changes was used. Results In men and women aged 15–24 years, the prevalence of smoking declined between the first period in 2000 and the third period in 2008, whereas in women aged 45–64 years, it increased by 1.7% per period. A declining trend was detected up to the first period in 2006 in men and women aged 25–44 years and in men aged 45–64 years, but between the beginning of 2006 and the end of 2008 the prevalence of smoking increased by 1.2%, 0.7% and 2.0% per period in men aged 25–44 years, in women aged 25–44 years and in men aged 45–64 years, respectively. Conclusions 3 years after a national smoke-free law was implemented, the trend in smoking prevalence in some population groups was unchanged; however, in others, the declining trend of previous years was reversed. The similarity of these findings to those observed in other countries suggests that clean indoor air laws, although effective in reducing exposure to second-hand smoke, may not achieve the secondary objective of reducing the prevalence of smoking in the population.

The Role of the Public Health Official in Communicating Public Health Information

The prevailing views on the role of public health professionals refer to professionals in the academic world, without taking into account the fact that many public health professionals are government employees. For example, the American Public Health Association states that public health professionals play an active role in communicating public health information to nonscientific audiences, such as the general population or the mass media. We propose that public health officials have an important responsibility to promote the practice of public health. However, they must do so within the bureaucracy. Any actions that public health officials wish to take as advocates of particular public health activities should be carried out independent of their role as government officials.