Juan Antonio Córdoba-Doña

Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, Southern Spain

IntroductionAlthough suicide rates have increased in some European countries in relation to the current economic crisis and austerity policies, that trend has not been observed in Spain. This study examines the impact of the economic crisis on suicide attempts, the previously neglected endpoint of the suicidal process, and its relation to unemployment, age and sex.MethodsThe study was carried out in Andalusia, the most populated region of Spain, and which has a high level of unemployment. Information on suicide attempts attended by emergency services was extracted from the Health Emergencies Public Enterprise Information System (SIEPES). Suicide attempts occurring between 2003 and 2012 were included, in order to cover five years prior to the crisis (2003–2007) and five years after its onset (2008–2012). Information was retrieved from 24,380 cases (11,494 men and 12,886 women) on sex, age, address, and type of attention provided. Age-adjusted suicide attempt rates were calculated. Excess numbers of attempts from 2008 to 2012 were estimated for each sex using historical trends of the five previous years, through time regression models using negative binomial regression analysis. To assess the association between unemployment and suicide attempts rates, linear regression models with fixed effects were performed.ResultsA sharp increase in suicide attempt rates in Andalusia was detected after the onset of the crisis, both in men and in women. Adults aged 35 to 54 years were the most affected in both sexes. Suicide attempt rates were associated with unemployment rates in men, accounting for almost half of the cases during the five initial years of the crisis. Women were also affected during the recession period but this association could not be specifically attributed to unemployment.ConclusionsThis study enhances our understanding of the potential effects of the economic crisis on the rapidly increasing suicide attempt rates in women and men, and the association of unemployment with growing suicidal behaviour in men. Research on the suicide effects of the economic crisis may need to take into account earlier stages of the suicidal process, and that this effect may differ by age and sex.Resumen (Spanish/Español)IntroducciónA pesar de que las tasas de suicidio han aumentado en algunos países europeos en relación con la crisis económica actual y las políticas de austeridad, esa tendencia no se ha observado en España. Este trabajo examina el impacto de la crisis económica sobre los intentos de suicidio, punto final del proceso suicida poco estudiado hasta ahora, y su relación con desempleo, edad y sexo.MétodosEl estudio fue llevado a cabo en Andalucía, la región más poblada de España, y con un alto nivel de desempleo. La información sobre los intentos de suicidio atendidos por los servicios de emergencia se obtuvo del Sistema de Información de la Empresa Pública de Emergencias de Salud (SIEPES). Se incluyeron los intentos de suicidio ocurridos entre 2003 y 2012, con el fin de cubrir los cinco años anteriores a la crisis (2003–2007) y cinco años desde su inicio (2008–2012). Se recuperó información de 24 380 casos (11 494 hombres y 12 886 mujeres) sobre sexo, edad, dirección y tipo de atención recibida. Se calcularon las tasas de intentos de suicidio ajustadas por edad. Se estimó el exceso de intentos de suicidio en 2008–2012 para cada sexo utilizando las tendencias históricas de los cinco años anteriores con modelos de regresión temporal mediante regresión binomial negativa. Para evaluar la asociación entre el desempleo y las tasas de intentos de suicidio se ajustaron modelos de regresión lineal con efectos fijos.ResultadosSe detectó un importante aumento de las tasas de intento de suicidio en Andalucía tras el comienzo de la crisis, tanto en hombres como en mujeres. Los adultos de 35 a 54 años fueron los más afectados en ambos sexos. Los intentos de suicidio se asociaron con el nivel de desempleo en los hombres, explicando casi la mitad de los casos durante los cinco primeros años de la crisis. Las mujeres también se vieron afectadas durante el período de recesión, pero el incremento de los intentos de suicidio no pudo atribuirse específicamente al desempleo.ConclusionesEste estudio mejora nuestra comprensión de los efectos potenciales de la crisis económica sobre el rápido aumento de los intentos de suicidio en mujeres y hombres, y de la asociación del desempleo con el auge de la conducta suicida en los hombres. La investigación del impacto de la crisis económica sobre el suicidio debe tener en cuenta las etapas iniciales del proceso suicida, y que sus efectos pueden manifestarse de forma diferente según edad y sexo.

Outbreak of silicosis in Spanish quartz conglomerate workers.

Abstract Objectives: To describe the epidemiological and clinical characteristics of an outbreak of occupational silicosis and the associated working conditions. Methods: Cases were defined as men working in the stone cutting, shaping, and finishing industry in the province of Cádiz, diagnosed with silicosis between July 2009 and May 2012, and were identified and diagnosed by the department of pulmonology of the University Hospital of Puerto Real (Cádiz). A census of workplaces using quartz conglomerates was carried out to determine total numbers of potentially exposed workers. A patient telephone survey on occupational exposures and a review of medical records for all participants were conducted. Results: Silicosis was diagnosed in 46 men with a median age of 33 years and a median of 11 years working in the manufacturing of countertops. Of these cases, 91·3% were diagnosed with simple chronic silicosis, with an abnormal high-resolution computerized tomography (HRCT) scan. One patient died during the study period. Employer non-compliance in prevention and control measures was frequently reported, as were environmental and individual protection failures. Conclusions: The use of new construction materials such as quartz conglomerates has increased silicosis incidence due to intensive occupational exposures, in the context of high demand fuelled by the housing boom. This widespread exposure poses a risk if appropriate preventive measures are not undertaken.

Evolución de las desigualdades sociales en la mortalidad general de la ciudad de Sevilla (1994-2002)

OBJECTIVE To analyze trends in socioeconomic inequality in mortality in the city of Cadiz (Spain) from 1992 to 2007. METHODS An ecological study was performed of trends over 3 cross-sections, with the census tract as the unit of analysis. Deaths were grouped into three periods: 1992-1996, 1997-2001 and 2002-2007 and were then classified according to a deprivation index of the census tract. We calculated adjusted rates by the direct method and three measures of health inequality. RESULTS Of 18,586 deaths, 96.7% was geocoded to a census tract. The population-attributable risk decreased in men and women, respectively, from 15.4% and 12.2% in 1992-1996 to 9.3% and 5.6% in 2002-2007. The other measures, slope index and the relative index also showed a decline in inequality but only among women. CONCLUSIONS Despite a decreasing trend, social inequalities are a substantial component in the distribution of overall mortality in the city of Cadiz.

Silicosis: diferencias relevantes entre marmolistas y mineros

Following the alarming outbreak of a series of cases of silicosis among machine workers handling quartz conglomerates in Chichlana de la Frontera, Cadiz,1 our experience leads us to conclude that the classification of the International Labor Organization (ILO)2 used for diagnosing this type of pneumoconiosis is inappropriate. In our study,3 we included 46 male synthetic stone workers diagnosed with silicosis who had been employed in the installation of quartz conglomerates for kitchen countertops, in particular. Nine of these patients had a normal chest X-ray but the typical bilateral diffuse micronodular interstitial pattern was found on high-resolution computed axial tomography. We are dealing with a new form of this disease that is distinct from the original silicosis in miners. We know that it affects younger men after a greater exposure over a shorter period of time (median age, 33 years; median working history, 11 years).3 Lack of understanding of the clinical course of this type of silicosis means that we must bear in mind not only the lack of cure for this disease but also the potential risk of cancer from the various components of these materials. The high crystalline free silica content in quartz conglomerates (70%–90%, depending on the finish and color of the countertop), the greater potential for harm from the particles compared to other silicates due to their smaller size (<5 microns), and the fact that crystalline forms of silica (quartz, cristobalite and tridimite)4 are classified as group 1 (human carcinogens), give an indication of the possible complications of this disease over time.

Crisis económica al inicio del siglo xxi y mortalidad en España. Tendencia e impacto sobre las desigualdades sociales. Informe SESPAS 2014

This study aimed to assess the impact of the current economic crisis on mortality trends in Spain and its effect on social inequalities in mortality in Andalusia. We used data from vital statistics and the Population Register for 1999 to 2011, as provided by the Spanish Institute of Statistics, to estimate general and sex- and age-specific mortality rates. The Longitudinal Database of the Andalusian Population (2001 census cohort) was used to estimate general mortality rates and ratios by educational level. The annual percentages of change and trends were calculated using Joinpoint regressions. No significant change in the mortality trend was observed in Spain from 2008 onward. A downward trend after 1999 was confirmed for all causes and both sexes, with the exception of nervous system-related diseases. The reduction in mortality due to traffic accidents accelerated after 2003, while the negative trend in suicide was unchanged throughout the period studied. In Andalusia, social inequalities in mortality have increased among men since the beginning of the crisis, mainly due to a more intense reduction in mortality among persons with a higher educational level. Among women, no changes were observed in the pattern of inequality.

Factors Associated With Tuberculin Conversion Among Staff at a University-Affiliated Hospital

To the Editor: Early identification of tuberculosis (TB) conversion among hospital workers is the cornerstone by which the quality of TB control measures can be evaluated. Moreover, regular screening identifies newly infected individuals, who are most likely to develop the disease during the 2 years following infection, allowing timely chemoprophylaxis. The aim of this study was to determine the incidence of, and factors associated with, tuberculin conversion at a university-affiliated hospital. A retrospective cohort was compiled from staff at the University Hospital Puerta del Mar, Cadiz, Spain, from January 1989 through July 1996. This is an 850-bed tertiarycare facility with a staff of 2,700 and 24,000 admissions per year. Workers were classified as belonging to a high-risk work area if they had been employed for at least 1 year in the infectious diseases, pulmonary, or medicine unit; emergency department; adult intensive-care unit; pathology; or hematology. All 400 staff who were skin-test negative in January 1989 or who tested negative from that date through July 1996 were included in the study. The test was read by the presence or absence of induration, as determined by palpation, 72 hours after inoculation, and the diameter of the induration was measured. The tuberculin skin-test (TST) conversion rate was defined as representing an increase of 10 mm or more in induration, with respect to that of any test carried out in the previous 2 years. From this information, Kaplan-Meier curves were drawn for each of the independent variables. Log-rank testing was used to compare the incidence density of the conversion among the groups. Coxs TABLE CUMULATIVE INCIDENCE AND INCIDENCE DENSITY OF TUBERCULOSIS CONVERSION IN RELATION TO THE INDEPENDENT VARIABLES STUDIED

Crisis económica al inicio del siglo xxi y mortalidad en Espana. ˜ Tendencia e impacto sobre las desigualdades sociales. Informe SESPAS 2014 [The economic crisis at the beginning of the XXI century and mortality in Spain. Trend and impact on social inequalities. SESPAS Report 2014].

This study aimed to assess the impact of the current economic crisis on mortality trends in Spain and its effect on social inequalities in mortality in Andalusia. We used data from vital statistics and the Population Register for 1999 to 2011, as provided by the Spanish Institute of Statistics, to estimate general and sex- and age-specific mortality rates. The Longitudinal Database of the Andalusian Population (2001 census cohort) was used to estimate general mortality rates and ratios by educational level. The annual percentages of change and trends were calculated using Joinpoint regressions. No significant change in the mortality trend was observed in Spain from 2008 onward. A downward trend after 1999 was confirmed for all causes and both sexes, with the exception of nervous system-related diseases. The reduction in mortality due to traffic accidents accelerated after 2003, while the negative trend in suicide was unchanged throughout the period studied. In Andalusia, social inequalities in mortality have increased among men since the beginning of the crisis, mainly due to a more intense reduction in mortality among persons with a higher educational level. Among women, no changes were observed in the pattern of inequality.

Withstanding austerity : equity in health services utilisation in the first stage of the economic recession in Southern Spain

Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011–2012 (crisis), using a composite income index as socioeconomic status (SES) indicator. Horizontal inequity indices (HII) were calculated to take differential healthcare needs into account, and a decomposition analysis of change in inequality between periods was performed. Results showed that before the crisis, the HII was positive (greater access for people with higher SES) for specialist visits but negative (greater access for people with lower SES) in the other three utilisation models. During the crisis no change was observed in inequalities in GP visits, but a pro-poor development was seen for the other types of utilisation, with hospital and emergency care showing significant inequality in favour of low income groups. Overall, the main contributors to pro-poor changes in utilisation were socio-economic variables and poor mental health, due to changes in their elasticities. Our findings show that inequalities in healthcare utilisation largely remained in favour of the less well-off, despite the cuts in welfare benefits and health services provision during the early years of the recession in Andalusia. Further research is needed to monitor the potential impact of such measures in subsequent years.

Familia, economía y servicios sanitarios: claves de los cuidados en pacientes con diabetes y amputación de miembros inferiores. Estudio cualitativo en Andalucía

AIM To examine the experience of diabetic care in patients undergoing lower limb amputation. DESIGN A qualitative study using the phenomenological approach. SETTING Cadiz Health District. PARTICIPANTS A total of 16 patients (11 men and 5 women) diagnosed with diabetes mellitus type 2 and with non-traumatic lower limb amputation. METHODS Semi-structured interviews were performed, followed by a content analysis according Graneheim and Lundman. RESULTS Four categories were identified: 1. The family is the cornerstone for diabetic care. 2. The socio-economic and working conditions determine the quality of self-care. 3. The patient-health professional interaction facilitates patient care. 4. Limitations in the provision of health services. CONCLUSION Family, economic and working conditions, along with health system-related factors are the most important elements in the care of patients with diabetes and amputations. Social, economic and working conditions determine diabetic complications. In order to enhance health care impact on the prevention of diabetes mellitus complications, health system policy makers must take these facts seriously into consideration and in a more personalised manner.

Five-Year Eradication of Hepatitis B Infection After an Outreach Immunization Program in the Waorani Population in the Ecuadorian Amazon

In Waorani communities of the Amazon basin of Ecuador, hepatitis B (HB) surface antigen was found in 14% of asymptomatic persons. The aim of this study was to identify the Waorani population in Ecuador and obtain an epidemiologically adequate coverage of vaccination against hepatitis B virus (HBV) among them. Between February and September 2010, three vaccination campaigns were completed as part of a collaborative activity between the Ecuadorian Ministry of Public Health and the community leaders in the intervention areas. In addition, in 10 of the 22 Waorani communities, during first contact, a questionnaire about risk factors for HBV infection was administered. A total of 16 Waorani communities were registered before the beginning of this intervention, but during the actual process, six additional communities were identified. In total, 1,251 community members were registered, 92.7% of which received all three doses of the vaccine. Among them, 83% of survey respondents reported having been vaccinated, but only 22% were able to show proof. Only 1% of respondents were intravenous drug users, whereas 22% had at least one tattoo. All self-identified as heterosexual, but only 32% reported using condoms during sexual intercourse. By March 2015, no new cases of HB were been reported in any of the Waorani communities. Herein, we report the importance of intersectoral collaboration to strengthen health interventions in an isolated population like the Waorani area.