Lourdes Lostao

Adverse psychological effects in women attending a second-stage breast cancer screening

OBJECTIVE The purpose of this study was to examine the emotional and psychopathological impact associated with a second-stage screening for breast cancer. METHOD We used a short-term longitudinal design. Interviews were conducted with 1195 women of 45-65 years old in three temporal conditions (premammogram, postmammogram, and follow-up). Participants included women attending for regular breast cancer screening who were recalled for a further mammogram (i.e., second-stage breast cancer screening) and women who were not recalled. Affective-cognitive concerns about cancer (worry, fear, and perceived vulnerability) were rated using a 10-point Likert scale. Psychopathology was assessed using the Hopkins Symptom Check List-Revised (SCL-90-R). RESULTS Women attending the second-stage screening exhibited significantly higher levels of breast cancer worries, fears, and beliefs than women attending for routine screening before obtaining the results of the mammogram. This affective-emotional impact disappeared quickly and was not relevant 2 months following the mammogram. Despite the fact that levels of psychopathological symptoms were higher in the premammogram condition, there were no differences between groups on these measures. CONCLUSION These results provide support for the hypothesis that women recalled for further mammograms tend to experience high levels of affective-cognitive distress but not psychopathological symptoms. Moreover, results do not sustain the prediction that this psychological impact persists beyond receipt of a negative result. Some recommendations to reduce these psychological side effects are suggested.

La utilización de los servicios sanitarios por la población inmigrante en España

OBJECTIVE To compare health services utilization between the immigrant and indigenous populations in Spain. METHODS We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. RESULTS In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. CONCLUSION The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date.

Evolución de las diferencias socioeconómicas en la utilización y accesibilidad de los servicios sanitarios en España entre 1987 y 1995/97

FUNDAMENTO: El objetivo del presente trabajo es evaluar la evolucion de la utilizacion y accesibilidad de los servicios sanitarios en Espana, entre 1987 y 1995/1997, en grupos con diferentes caracteristicas socioeconomicas. METODOS: Los datos utilizados proceden de las Encuestas Nacionales de Salud realizadas por el Ministerio de Sanidad y Consumo a la poblacion adulta en los anos 1987, y 1995/1997. Se ha agregado la informacion de 1995 y 1997 debido al diferente tamano muestral, de forma que las estimaciones asi obtenidas son una media de ambas. La poblacion analizada ha sido la de los individuos mayores de 24 anos de edad. Se han estudiado la consulta medica, la hospitalizacion, la consulta al dentista y la consulta al ginecologo, el tiempo invertido en llegar a la consulta, el tiempo de espera en la misma y el tiempo de espera para un ingreso hospitalario ordinario. Las caracteristicas socioeconomicas utilizadas han sido el nivel de estudios y el grupo socioeconomico de los entrevistados. La medida de la asociacion estimada entre la utilizacion de servicios y las caracteristicas socioeconomicas fue la razon de porcentajes, mediante regresion binomial. Igualmente, se estimo el indice relativo de desigualdad como medida resumen de la desigualdad. RESULTADOS: La consulta medica fue mas frecuente en los individuos sin estudios y en los grupos socioeconomicos bajos, en uno y en otro periodo, mientras que la consulta al dentista y la consulta al ginecologo fueron mas frecuentes en los individuos con estudios superiores y en los grupos socioeconomicos altos en ambos periodos. No se encontraron diferencias socioeconomicas estadisticamente significativas en la frecuencia de hospitalizacion en ambos periodos. Tanto en 1987 como en 1995/1997 no se hallaron diferencias estadisticamente significativas entre los distintos grupos socioeconomicos en el tiempo de llegada a la consulta (p>0,05), pero si en el tiempo de espera en la consulta (p<0,05). En el segundo periodo desaparecieron las diferencias socioeconomicas en el tiempo de espera para ingreso hospitalario ordinario que se observaron en el primer periodo. CONCLUSIONES: En la segunda mitad de los anos noventa se observa el mismo perfil socioeconomico en la utilizacion de los servicios sanitarios y en los tiempos de espera para acceder a los mismos que en la segunda mitad de los anos ochenta, con la excepcion del tiempo de espera para ingreso hospitalario ordinario en el segundo periodo.

Social inequalities in ischaemic heart and cerebrovascular disease mortality in men: Spain and France, 1980-1982 and 1988-1990

In this study we analyse the trend in socio-economic differences in mortality from ischaemic heart and cerebrovascular diseases in the economically active male population aged 25-64 years in Spain and France. The data used were taken from deaths from these two causes in 1980-1982 and 1988-1990; in the case of Spain the data came from the Eight Provinces Study. Individuals were grouped into four categories - professional/managerial, clerical/sales/service workers, farmers, and manual workers - and the mortality rate ratio was estimated with reference to the professional/managerial group. For ischaemic heart disease in 1980-1982, professionals and managers aged 25-44 years had the lowest risk of mortality in Spain, and the highest risk of mortality in France; in 1988-1990 the socioeconomic differences in mortality in Spain increased, whereas the relation was inverted in France. In 1980-1982, professionals and managers aged 45-64 years had higher mortality from ischaemic heart disease than the other occupational groups in both countries; in 1988-1990 this relation was inverted, except in the case of clerical/sales/service workers in Spain. For cerebrovascular disease, manual workers experienced the highest mortality in the 25-44 year age group in 1980-1982, and the differences increased in 1988-1990 in all groups with respect to professionals and managers in both places. Professionals and managers in France and manual workers in Spain had the highest mortality between 45 and 64 years in 1980-1982; in contrast, in 1988-1990 professionals and managers had the lowest risk of mortality from this disease in both Spain and France, although in Spain the magnitude was similar to that of clerical/sales/service workers. In general terms, mortality from each disease was different in professionals and managers than in clerical/sales/service workers. Thus, the pattern of mortality and its evolution in different socio-economic groups cannot be analysed accurately when the two occupational groups are combined in a single large group of non-manual workers.

Patient cost sharing and physician visits by socioeconomic position: findings in three Western European countries

The association between educational level and the probability of physician visits in three Western European countries, one of which has a system of patient cost sharing was evaluated. Cross-sectional surveys were performed in France, Germany and Spain around 1990 and around 2000. People representative of the French, German and Spanish populations, aged 25–74 years were studied. The probability of physician visits decreased in the second period with respect to the first in France and Germany, but it increased in Spain. In the two periods studied, subjects with low educational level had a lower probability of physician visits than those with high educational level in France, in contrast with the general trend in Germany and Spain. In both periods, France had patient cost sharing whereas Germany and Spain did not. The existence of patient cost sharing in the healthcare systems of Western European countries raises doubts about the possibility of making use of health services independent of individual socioeconomic position.

Desigualdades sociales en salud: situación en españa en los últimos años del siglo xx

Bajo el titulo Desigualdades sociales en salud: situacion en Espana en los ultimos anos del siglo XX, libro coordinado por Enrique Regidor, encontramos cinco contribuciones heterogeneas, en objetivos y areas de analisis, pero claramente comprometidas con la linea de investigacion que estudia las desigualdades en salud como consecuencia de las circunstancias sociales y economicas de los individuos. Este enfoque tiene, como el mismo coordinador apunta, una importancia epistemologica enorme, ya que para comprender los mecanismos que generan las diferencias socioeconomicas en salud es preciso conocer adecuadamente los pasos o relaciones en la cadena de causalidad y no solo controlar los efectos de unas y otras variables.

Stabilisation of the trend in prevalence of childhood overweight and obesity in Spain: 2001–11

BACKGROUNDS To ascertain whether the prevalence of childhood overweight and obesity had stabilised in Spain, in the same way as in other developed countries. METHODS Data were drawn from the 2001, 2006 and 2011 Spanish National Health Surveys. We estimated overweight and obesity on the basis of body mass index, and then calculated the prevalence of overweight and obesity for each year studied among boys and girls, respectively, in two different age groups; 5 -9 and 10 -15 years. The statistical significance of the trend in prevalence was evaluated using the chi-squared test. RESULTS The trend in the prevalence of overweight was not significant, with the magnitude generally proving similar in 2006 and 2011, e.g. prevalence among girls was 37.2% in 2006 and 37.5% in 2011 in the 5-9 age group, and 17.7% in 2006 and 17.5% in 2011 in the 10-15 age group. The magnitude of the prevalence of obesity in each sex and age group was similar across the 3 years of study, except in the case of boys aged 5-9 years, among whom a significant downward trend was observed, with prevalence declining from 16.8% in 2001 to 14.4% in 2006 and 12.6% in 2011. CONCLUSION In Spain, the prevalence of childhood overweight and obesity stabilised during the first decade of the present century.

A confirmatory factor-analytic validation of the tripartite model of depression and anxiety among undergraduates in Spain

The tripartite model of depression and anxiety proposes that low positive affect is a specific indicator of depression, whereas high physiological hyperarousal is a specific marker of anxiety. High negative affect, while common to both syndromes, is specific to neither. To test the validity of the tripartite model, we administered self-report scales on positive affect, negative affect, and physiological hyperarousal to 388 undergraduates in Spain. LISREL confirmatory factor analytic techniques were used. Consistent with the predictions of the tripartite view and with previous work on North American samples (e.g., Joiner, 1996), a three-factor model with Positive Affect, Physiological Hyperarousal, and Negative Affect as factors, provided the best fit for the observed data. These findings contribute to an emerging literature on the validity of the tripartite model, and, furthermore, are the first to indicate that the model and its implications may be applied cross-culturally.

Desigualdades sociales en mortalidad por enfermedad isquémica del corazón y por enfermedad cerebrovascular en hombres en España y Francia, 1988–1990

Objetivo: Comparar las diferencias socioeconomicas en la mortalidad por enfermedad isquemica del corazon y por enfermedad cerebrovascular en hombres en Espana y Francia en 1988-90. Metodos: En Espana, los datos proceden del Estudio de las Ocho Provincias, y en Francia el numero de fallecidos fue proporcionado por el Instituto Nacional Frances de la Salud (INSERM). Se han estimado las diferencias socioeconomicas en mortalidad mediante la razon de tasas. Resultados: Los agricultores y los trabajadores manuales tuvieron mayor mortalidad por enfermedad isquemica del corazon y por enfermedad cerebrovascular que los profesionales y directivos, mientras que la mortalidad de los trabajadores de los servicios mostro un patron diferente en ambos paises. Conclusiones: La utilizacion de dos clases ocupacionales (manual/no manual) en las comparaciones internacionales limita la interpretacion de los resultados en este tipo de investigaciones.

Health-oriented behaviors: their implication in attending for breast cancer screening.

OBJECTIVE To assess the implication of health-oriented behavior and state of health variables estimated to influence womens participation in a breast cancer screening program. METHODS A sample of 512 participants and 196 nonparticipants was taken from a total of 60,908 women between 45 and 65 years of age. RESULTS There are significant differences in womens perception of their knowledge of breast cancer, estimated prognosis, and reasons for not performing self-examination. The nonparticipant group reports more health problems. CONCLUSION The study assesses the relative contribution of these variables to participation levels, although further empirical testing of all these issues is recommended.