Caída de la esperanza de vida en distritos de Madrid en 2020: relación con determinantes sociales / Decline in life expectancy in Madrid's districts in 2020: its correlation with social determinants

Objetivo: Estimar el descenso de la esperanza de vida (EV) de la población de Madrid y sus distritos, y su relación con variables socioeconómicas, en el primer año de pandemia de COVID-19. Método: Las defunciones proceden del Padrón de Habitantes (Servicio de Estadística Municipal). Por el método Chiang II se calcularon las esperanzas de vida al nacer y a los 65 años (EVN y EV65) con sus intervalos de confianza del 95% para hombres y mujeres, y sus caídas brutas, netas y mínimas en cada distrito en 2020 respecto a 2019, así como su correlación (r) con la distribución de algunas variables socioeconómicas y la existencia de modelos de regresión lineal explicativos. Resultados: En 2020, las defunciones en Madrid crecieron un 46,1% respecto al año previo, y la EVN fue de 79,31 años para los hombres y de 85,25 años para las mujeres, lo que supone un decremento de 3,67 y 2,56 años, respectivamente (4,42% y 2,91%). Todos los distritos registraron caídas de la EV, siendo la mayor la de los hombres de Tetuán (4,72 años) y la de las mujeres de Chamartín (3,91 años). Los más afectados fueron los distritos del sur, especialmente para los hombres. Las tasas de inmigrantes y de mayores de 80 años explicaron un 24% de la caída de la EV de los hombres según el modelo de regresión lineal múltiple. Conclusiones: La caída de la EV registrada en Madrid y sus distritos en 2020 es mayor que la de España (1,6 años) y retrotrae a cifras de 2002 (EV65) y de 2008 (EVN); es más acusada en el sur y se distribuye de forma desigual territorialmente y según variables socioeconómicas, asociándose a algunas de ellas. (AU)

Objective: Estimating the decrease in life expectancy (LE) of the population of Madrid and its districts and its relationship with socioeconomic variables in the first year of the COVID-19 pandemic. Method: Death records were obtained from the Municipal Register of inhabitants (Municipal Statistics Service). Based on Chiang II method, life expectancy at birth and at 65 years of age (LEB and LE65) were calculated, as well as their 95% confidence intervals both for men and women and their gross, net and minimum falls for each district in 2020 over 2019, their correlation with some socioeconomic variables distribution and the existence of multiple linear regression explicative models. Results: In 2020, deaths in Madrid increased by 46.1% compared with the previous year, the LEB was 79.31 years in men and 85.25 years in women, meaning a decrease of 3.67 and 2.56 years respectively (4.42% and 2.91%). All districts registered decreases in LE, with the largest decrease in men in Tetuan (4.72 years) and in women in Chamartín (3.91 years). The most affected were the southern districts, especially in men. Immigrant and people over 80 years old rates explained 24% of the drop in LE in men, using linear regression model. Conclusions: The decrease in LE recorded in Madrid and its districts in 2020 is bigger than in Spain (1.6 years), takes us back to values of 2002 (LE65) and 2008 (LEB), has a sharper fall in the south and is territorially unequally distributed, according to socioeconomic variables and being associated with some of them. (AU)

[SARS-CoV-2 seroprevalence study in patients undergoing addiction treatment in Madrid.] / Estudio de sero-prevalencia al SARS-CoV-2 en pacientes en tratamiento por adicciones en Madrid.

OBJECTIVE: Patients with addiction are a vulnerable group in which there is little data on the infection and severity of COVID-19. The objective of this study was to analyze the seroprevalence against SARS-CoV-2 in users in treatment for addictions in Madrid and to describe the factors related to the infection in this group. METHODS: Cross-sectional descriptive study (June-October 2020), in a non-probabilistic sample of 473 patients with Substance Use Disorder, from the 8 Addiction Care Centers (CAD) of the Madrid City Council. Their demographic, habits and health characteristics, IgM and IgG for SARS-CoV-2, previous PCR, presence of symptoms, contact with COVID-19 cases were described, and multivariate analysis was performed using binary logistic regression. RESULTS: 5.1% of the users had positive serology for SARS-CoV-2 (5.8% in men and 2.7% in women). The patients with the highest percentage of seropositivity were between 50-59 years old (8.3%), being the most prevalent main substance consumed alcohol (7.4%). Having a previous positive CRP showed a significant odds ratio (OR) regarding being seropositive in the frequentist analysis. CONCLUSIONS: The highest seroprevalence rate occurred among men, epidemiologically known factors being the ones that showed the greatest strength of association. The CAD seropositive user profile was a man at the age of 50, an alcohol user and without comorbidities. No characteristic related to substance use was found to justify the difference in risk of infection with the general population.

OBJETIVO: Los pacientes con adicción son un colectivo vulnerable en el que apenas hay datos sobre la infección y gravedad de la COVID-19. El objetivo de este estudio fue analizar la seroprevalencia frente a SARS-CoV-2 en usuarios en tratamiento por adicciones en Madrid y describir los factores relacionados con la infección en este colectivo. METODOS: Estudio descriptivo transversal (junio-octubre 2020), en una muestra no probabilística de 473 pacientes con Trastorno por Uso de Sustancias, de los 8 Centros de Atención a las Adicciones (CAD) del Ayuntamiento de Madrid. Se describieron sus características demográficas, de hábitos y de salud, IgM e IgG para SARS-CoV-2, PCR previa, presencia de síntomas, contacto con casos de COVID-19 y se realizó análisis multivariante mediante regresión logística binaria. RESULTADOS: El 5,1% de los usuarios tuvo serología positiva para SARS-CoV-2 (5,8% en hombres y 2,7% en mujeres). Los pacientes con mayor porcentaje de seropositividad tenían entre 50-59 años (8,3%), siendo la sustancia principal consumida más prevalente el alcohol (7,4%). Tener PCR positiva previa mostró una odds ratio (OR) significativa respecto a ser seropositivo en el análisis frecuentista. CONCLUSIONES: La mayor tasa de seroprevalencia se dio entre los hombres, siendo los factores epidemiológicamente conocidos los que más fuerza de asociación mostraron. El perfil de usuario seropositivo de los CAD fue un hombre en la década de los 50, consumidor de alcohol y sin comorbilidades. No se encontró característica alguna relacionada con el consumo de sustancias que justificase la diferencia de riesgo de infección con la población general.

Estudio de seroprevalencia al SARS-CoV-2 en pacientes en tratamiento por adicciones en Madrid / SARS-CoV-2 seroprevalence study in patients undergoing addiction treatment in Madrid

Fundamentos: Los pacientes con adicción son un colectivo vulnerable en el que apenas hay datos sobre la infección y gravedad de la COVID-19. El objetivo de este estudio fue analizar la seroprevalencia frente a SARS-CoV-2 en usuarios en tratamiento por adicciones en Madrid y describir los factores relacionados con la infección en este colectivo. Métodos: Estudio descriptivo transversal (junio-octubre 2020), en una muestra no probabilística de 473 pacientes con Trastorno por Uso de Sustancias, de los 8 Centros de Atención a las Adicciones (CAD) del Ayuntamiento de Madrid. Se describieron sus características demográficas, de hábitos y de salud, IgM e IgG para SARS-CoV-2, PCR previa, presencia de síntomas, contacto con casos de COVID-19 y se realizó análisis multivariante mediante regresión logística binaria. Resultados: El 5,1% de los usuarios tuvo serología positiva para SARS-CoV-2 (5,8% en hombres y 2,7% en mujeres). Los pacientes con mayor porcentaje de seropositividad tenían entre 50-59 años (8,3%), siendo la sustancia principal consumida más prevalente el alcohol (7,4%). Tener PCR positiva previa mostró una odds ratio (OR) significativa respecto a ser seropositivo en el análisis frecuentista. Conclusiones: La mayor tasa de seroprevalencia se dio entre los hombres, siendo los factores epidemiológicamente conocidos los que más fuerza de asociación mostraron. El perfil de usuario seropositivo de los CAD fue un hombre en la década de los 50, consumidor de alcohol y sin comorbilidades. No se encontró característica alguna relacionada con el consumo de sustancias que justificase la diferencia de riesgo de infección con la población general.(AU)

Background: Patients with addiction are a vulnerable group in which there is little data on the infection and severity of COVID-19. The objective of this study was to analyze the seroprevalence against SARS-CoV-2 in users in treatment for addictions in Madrid and to describe the factors related to the infection in this group.Methods: Crosssectional descriptive study (June-October 2020), in a non-probabilistic sample of 473patients with Substance Use Disorder, from the 8 Addiction Care Centers (CAD) of the Madrid City Council. Their demographic, habits and health characteristics, IgM and IgG for SARS-CoV-2, previous PCR, presence of symptoms, contact with COVID-19 cases were described, and multivariate analysis was performed using binary logistic regression. Results: 5.1% of the users had positive serology for SARS-CoV-2 (5.8% in men and 2.7% in women). The patients with the highest percentage of seropositivity were between 50-59 years old (8.3%), being the most prevalent main substance consumed alcohol (7.4%). Having a previous positive CRP showed a significant odds ratio (OR) regarding being seropositive in the frequentist analysis. Conclusions: The highest seroprevalence rate occurred among men, epidemiologically known factors being the ones that showed the greatest strength of association. The CAD seropositive user profile was a man at the age of 50, an alcohol user and without comorbidities. No characteristic related to substance use was found to justify the difference in risk of infection with the general population.(AU)

[Decline in life expectancy in Madrid's districts in 2020: its correlation with social determinants]. / Caída de la esperanza de vida en distritos de Madrid en 2020: relación con determinantes sociales.

OBJECTIVE: Estimating the decrease in life expectancy (LE) of the population of Madrid and its districts and its relationship with socioeconomic variables in the first year of the COVID-19 pandemic. METHOD: Death records were obtained from the Municipal Register of inhabitants (Municipal Statistics Service). Based on Chiang II method, life expectancy at birth and at 65 years of age (LEB and LE65) were calculated, as well as their 95% confidence intervals both for men and women and their gross, net and minimum falls for each district in 2020 over 2019, their correlation with some socioeconomic variables distribution and the existence of multiple linear regression explicative models. RESULTS: In 2020, deaths in Madrid increased by 46.1% compared with the previous year, the LEB was 79.31 years in men and 85.25 years in women, meaning a decrease of 3.67 and 2.56 years respectively (4.42% and 2.91%). All districts registered decreases in LE, with the largest decrease in men in Tetuan (4.72 years) and in women in Chamartín (3.91 years). The most affected were the southern districts, especially in men. Immigrant and people over 80 years old rates explained 24% of the drop in LE in men, using linear regression model. CONCLUSIONS: The decrease in LE recorded in Madrid and its districts in 2020 is bigger than in Spain (1.6 years), takes us back to values of 2002 (LE65) and 2008 (LEB), has a sharper fall in the south and is territorially unequally distributed, according to socioeconomic variables and being associated with some of them.

Influence of home/school environments on children's obesity, diet, and physical activity: the SUECO study protocol.

OBJECTIVE: The SUECO study examines the relationship between urban obesogenic environments and health outcomes among school-age children in the city of Madrid, Spain. We will study how features of the urban environment (related to the food- and the physical activity environment) associate with children's anthropometrics, eating habits, and physical activity levels. METHOD: We describe the study protocol of this multilevel study in a representative sample of school-age children in the city of Madrid (2017; n=5,961 children ages 3-12). Main outcome variables include anthropometrics (body mass index, waist circumference, and body fat), healthy and unhealthy consumption measures, and physical activity measures. The primary explanatory variables are grouped into food environment (e.g., unhealthy food retailers' density) and physical activity environment (e.g., walkability, physical activity opportunities) variable categories. Multilevel models will be used to calculate the associations between each indicator and obesity and physical inactivity.

Economic Migrants and Clinical Course of SARS-CoV-2 Infection: A Follow-Up Study.

Objective: To analyze whether social deprivation and economic migrant (EM) status influence the risk of being hospitalized with COVID-19. Methods: This was a retrospective follow-up study including all patients older than 18 years attending the Daroca Health Center in Madrid, Spain, diagnosed with COVID-19 during September 2020. Data on EM status and other sociodemographic, lifestyle and comorbidities that could affect the clinical course of the infection were obtained from electronic medical records. Results: Of the 796 patients positive for COVID-19, 44 (5.53%) were hospitalized. No significant differences were observed between those who were hospitalized and those who were not in the mean of social deprivation index or socioeconomic status, but EM status was associated with the risk of being hospitalized (p = 0.028). Logistic regression models showed that years of age (OR = 1.07; 95% CI: 1.04-1.10), EM status (OR = 5.72; 95% CI: 2.56-12.63) and hypertension (OR = 2.22; 95% CI: 1.01-4.85) were the only predictors of hospitalization. Conclusion: Our data support that EM status, rather than economic deprivation, is the socioeconomic factor associated with the probability of hospital admission for COVID-19 in Madrid, Spain.

[COVID-19 incidence in districts of Madrid and its relationship with socio-economic and demographic indicators.] / Incidencia de COVID-19 en distritos de Madrid y su relación con indicadores socioeconómicos y demográficos.

OBJECTIVE: The preventive measures to be taken in the face of a new epidemic require knowledge of the number of infected and which groups are most vulnerable. To know the cumulative incidence of COVID-19 in the city of Madrid and its 21 districts in the first 4 months of the epidemic and its relationship with some socioeconomic and demographic variables. METHODS: Cross-sectional ecological study (39,270 cases). The 39,270 cases diagnosed from the beginning of the pandemic until June 26, 2020, published by the Comunidad de Madrid in were studied. In the districts, the distribution of gross and fair incidence is related to the ones of the independent variables (Municipal Statistics and Estudio de Salud 2018, Madrid Salud). The Incidence and the r and r2 coefficients, obtained with the factors and the Multiple Linear Regression (MLR) model, are studied. RESULTS: The city of Madrid presents a cumulative incidence of COVID-19, which is double the national one (100), with a Standardized Cumulative Incidence Ratio (RIAE) of 204.59 per 100. The districts with the most RIAE were those in the southeast, all>240 per 100. In the districts, the per capita household rate, the per capita income, and the mortality rate from infectious diseases in men reached high and inverse correlations with RIAE (all r>-0.3). The RLM model with these 3 indicators predicts 30% of the RIAES. CONCLUSIONS: The relationship between material wealth and the risk of COVID-19 infection is inverse. The knowledge in the districts of per capita income, household rate and mortality rate due to infectious diseases in men reduces the uncertainty about the accumulated incidence by 30%.

OBJETIVO: Las medidas preventivas a tomar ante una nueva epidemia requieren conocimiento del número de infectados y de qué grupos son más vulnerables. El objetivo de este trabajo fue conocer la Incidencia Acumulada de COVID-19 en la ciudad de Madrid y sus 21 distritos en los 4 primeros meses de la epidemia y su relación con algunas variables socioeconómicas y demográficas. METODOS: Estudio ecológico transversal. Se estudiaron los 39.270 casos diagnosticados desde el inicio de la pandemia hasta el 26 de junio de 2020, publicados por la Comunidad de Madrid agregadamente. Se relacionó la distribución de la incidencia acumulada en los 21 distritos con la de algunas variables demográficas, socioeconómicas y de salud. Se estudiaron los coeficientes r y r2 que se calcularon con los factores y el modelo obtenido según Regresión Lineal Múltiple (RLM). RESULTADOS: La ciudad de Madrid presentó el doble de la incidencia acumulada (IA) de COVID-19 que la nacional (100), con una Razón de Incidencia Acumulada Estandarizada (RIAE) de 204,59 por 100, destacando los distritos del sureste, todos con IA mayores a 240 por 100. La Tasa de hogares por habitante, la Renta per cápita y la Tasa de Mortalidad por Enfermedades infecciosas en hombres alcanzaron en los distritos correlaciones altas e inversas con RIAE (todos r>-0,3). El modelo RLM con esos 3 indicadores predijo un 30% de las RIAES. CONCLUSIONES: La relación entre riqueza material agregada y riesgo de infección por COVID-19 es inversa. El conocimiento de renta, tasa de hogares y tasa mortalidad por enfermedades infecciosas en hombres disminuyó un 30% la incertidumbre sobre la incidencia acumulada en los distritos.

Smartphone Nonusers: Associated Sociodemographic and Health Variables.

Smartphone abuse and the associated consequences have been intensely studied. However, little attention has been given to the group of people who have a smartphone and yet barely use it. One might think that they are at the opposite end of abuse, both behaviorally and in relation to the consequences. This study aims to establish sociodemographic variables and health indicators for smartphone nonusers. A population survey through random stratified sampling in a large city (Madrid, Spain) obtained 6,820 people between 15 and 65 years who own a smartphone. About 7.5 percent (n = 511) stated they do not use their smartphone regularly. This group comprised more of men than of women with a higher mean age, underprivileged social class, residence in less-developed districts, and a lower education level. They showed worse mental health indicators, lower perceived quality of life relating to their health, more sedentarism, and greater tendency toward being overweight/obese and a higher feeling of loneliness. When looking at all these variables together, the regression model showed that in addition to sex, age, social class, and education level, the only significantly associated health indicator was a feeling of loneliness. Mobile phone abuse is associated with health problems, but nonregular use does not reflect the opposite. It is important to study the group of nonusers and explore the reasons and related consequences, particularly the role of perceived loneliness, which is paradoxical as a smartphone is a tool that can foster interpersonal contact.

Encuentros y desencuentros entre salud comunitaria y sistema sanitario español. Informe SESPAS 2018 / Agreements and disagreements between community health and the Spanish health system. SESPAS Report 2018

A través de un recorrido histórico por la relación del Sistema Nacional de Salud español y la Salud Comunitaria, se describen las diferentes etapas de auge o declive de la Atención Primaria -y en concreto de su orientación comunitaria-, los acercamientos y distanciamientos en su relación con la Salud Pública y la influencia de las ideologías políticas dominantes. Considerando la salud comunitaria como parte esencial de la Atención Primaria, y de acuerdo con la estrategia de Alma Ata y los principios de la Carta de Ottawa, se defiende una reorientación comunitaria de los servicios de salud y se propone retomar la Atención Primaria como eje estratégico del Sistema Nacional de Salud, dada su capacidad para un abordaje integral de los procesos salud-enfermedad, sus posibilidades de reducir desigualdades y enfrentar determinantes sociales, así como de superar inequidades en salud, con la participación de la población y en coordinación con otros sectores. Los desafíos del futuro inmediato, así como las consecuencias de la crisis económica y de los recortes y debilitamiento del Estado de Bienestar, hacen evidente la necesidad de promover procesos participativos que impliquen al conjunto de actores sociales y, sobre todo, a la ciudadanía, considerada no como destinataria y 'usuaria' o consumidora, sino como sujeto activo y colaborativo. Se señala la imperiosa necesidad de incorporar procesos participativos dirigidos a crear una nueva cultura colectiva respecto a la sostenibilidad y universalidad de los recursos públicos de salud existentes

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and 'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources

[Agreements and disagreements between community health and the Spanish health system. SESPAS Report 2018]. / Encuentros y desencuentros entre salud comunitaria y sistema sanitario español. Informe SESPAS 2018.

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources.

Entorno construido en función del nivel de desarrollo de los distritos de la ciudad de Madrid / Built Environment according to the level of development of districts in the city of Madrid

Objetivo: describir los elementos del entorno construido (EC) de Madrid en relación con el nivel de desarrollo de los distritos de la ciudad. Método: estudio descriptivo transversal. Los datos del EC de la ciudad (demográficos, de renta, superficie, acceso a recreación y bienes básicos, estética, zonas verdes, transporte público y ambiente de los barrios) se extrajeron de fuentes documentales: páginas web, sistemas de información geográfica, organismos oficiales. Se consideraron los 21 distritos de la ciudad estratificándolos en cuatro niveles de desarrollo en función de su resultado en un índice combinado de salud, conocimiento y renta. Se realizó un análisis estadístico univariante y bivariante (Chi cuadrado y ANOVA); se calcularon intervalos de confianza al 95% de seguridad (IC95%). Resultados: se encontraron diferencias estadísticamente significativas (p≤0,05) en la dotación de escuelas infantiles y centros de mayores (superior en distritos de desarrollo bajo); los centros deportivos y áreas infantiles para menores de 14 años (mayor en distritos de desarrollo medio alto); la renta media neta anual de los hogares, el comercio, las líneas de metro y bus, los elementos disuasorios del uso de automóvil y las concentraciones de población y vivienda (mayores en los distritos de desarrollo alto). Conclusiones: los distritos más desarrollados obtuvieron más indicadores en primera posición. Es necesario avanzar en relación a qué elementos son los que más mejoran el EC de los barrios (AU)

Objective: to describe the elements of the Built Environment (BE) according to the level of development in the city districts. Method: a descriptive transversal study. Data on the city BE (demographical, income, surface, access to recreation and basic commodities, appearance, green areas, public transport, and neighbourhood environment) were extracted from documentary sources: web-pages, geographical information systems, and official organizations. The 21 city districts were stratified into four levels of development based on their outcomes in a combined index for health, knowledge and income. A univariate and bivariate analysis was conducted (Square CHI and ANOVA); confidence intervals were calculated at 95% (CI95%). Results: statistically significant differences (p≤0.05) were found in funding for children’s schools and centres for the elderly (higher in low-development districts); sports centres and areas for <14-year-old children (higher in districts with medium-high development): the mean net annual income of homes, commerce, underground and bus lines, elements to discourage the use of cars, and concentration of population and housing (higher in those districts with high development). Conclusions: districts with higher development obtained more indicators in the first position. It is necessary to move forward regarding which elements improve the BE in neighbourhoods (AU)

COOP/WONCA: fiabilidad y validez de la prueba administrada telefónicamente / COOP/WONCA: Reliability and validity of the test administered by telephone

OBJETIVO: La prueba COOP/WONCA se propuso inicialmente como un autoinforme en el que las respuestas eran apoyadas por dibujos que ilustraban el estado indagado. Estudios posteriores han ratificado su utilidad como mero autoinforme verbal administrado presencialmente. Carecemos de datos sobre su utilidad administrada telefónicamente. El objetivo del presente trabajo es conocer las propiedades psicométricas de la prueba COOP/WONCA para estimar la calidad de vida relacionada con la salud (CVRS), administrada telefónicamente, y compararlas con las obtenidas en otras modalidades de administración previas. DISEÑO: Estudio epidemiológico transversal. Emplazamiento: Ciudad de Madrid. PARTICIPANTES: Muestra aleatoria de 802 sujetos adultos, representativa de la población adulta de Madrid, obtenida por estratificación a partir del censo poblacional. MEDICIONES PRINCIPALES: Cuestionario COOP/WONCA de 9 ítems, incluido en una batería más amplia, administrada mediante entrevista telefónica. RESULTADOS: El análisis factorial sin restricciones apunta a la unifactorialidad de la escala, que mide un solo constructo latente (CVRS), mostrando una gran consistencia interna, sin diferir significativamente de los hallados mediante administración presencial, descartándose la existencia de sesgos asociados a la modalidad telefónica. CONCLUSIONES: La prueba COOP/WONCA aparece como una medida fiable y válida de la CVRS y su administración telefónica no supone alteraciones en los resultados, lo que puede reducir costes en estudios poblacionales, aumentando su eficiencia sin pérdida de calidad en la información recogida

AIM: The COOP/WONCA test was initially proposed as a self-report in which the answers were supported by drawings illustrating the state investigated. Subsequent studies have confirmed its usefulness as a mere verbal self-report face-to-face administered. No data have been found about its useful when administered by telephone interview. The aim of this study was to determine the psychometric properties of the COOP / WONCA test to measure Related Quality of Life (HRQoL) administered by telephone and compare them with those obtained in other forms of prior administration. DESIGN: Cross-sectional study on a random. SETTING: City of Madrid. PARTICIPANTS: Random sample of 802 adult subjects, representative of the adult population in Madrid, obtained by stratification from the population census. MAIN MEASUREMENTS: Questionnaire COOP/WONCA with 9 ítems included in a broader battery, administered by telephone interview. RESULTS: The unrestricted factor analysis points to the unifactoriality of the scale, which measures a single latent construct (HRQOL), showing high internal consistency, not significantly different from those found by face-to-face administration, ruling out the existence of biases in the phone modality. CONCLUSIONS: The COOP/WONCA test appears as a reliable and valid measure of HRQOL and telephonic administration allows to assume no changes in the results, which can reduce costs in population studies, increasing efficiency without loss of quality in the information collected

[COOP/WONCA: Reliability and validity of the test administered by telephone]. / COOP/WONCA: fiabilidad y validez de la prueba administrada telefónicamente.

AIM: The COOP/WONCA test was initially proposed as a self-report in which the answers were supported by drawings illustrating the state investigated. Subsequent studies have confirmed its usefulness as a mere verbal self-report face-to-face administered. No data have been found about its useful when administered by telephone interview. The aim of this study was to determine the psychometric properties of the COOP / WONCA test to measure Related Quality of Life (HRQoL) administered by telephone and compare them with those obtained in other forms of prior administration. DESIGN: Cross-sectional study on a random. SETTING: City of Madrid. PARTICIPANTS: Random sample of 802 adult subjects, representative of the adult population in Madrid, obtained by stratification from the population census. MAIN MEASUREMENTS: Questionnaire COOP/WONCA with 9 ítems included in a broader battery, administered by telephone interview. RESULTS: The unrestricted factor analysis points to the unifactoriality of the scale, which measures a single latent construct (HRQOL), showing high internal consistency, not significantly different from those found by face-to-face administration, ruling out the existence of biases in the phone modality. CONCLUSIONS: The COOP/WONCA test appears as a reliable and valid measure of HRQOL and telephonic administration allows to assume no changes in the results, which can reduce costs in population studies, increasing efficiency without loss of quality in the information collected.

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries.

BACKGROUND: Different service characteristics are known to influence mental health care delivery. Much less is known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care to socially marginalized groups.The objectives of this work were to assess the organisational characteristics of services providing mental health care for marginalized groups in 14 European capital cities and to explore the associations between organisational quality, service features and country-level characteristics. METHODS: 617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level socioeconomic indicators were tested and related with the Index using linear regressions and random intercept linear models. RESULTS: The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with GDP explaining 12% of this variance. CONCLUSIONS: Socioeconomic contextual factors, in particular the national GDP are likely to influence the organisational quality of services providing mental health care for marginalized groups. Such factors should be considered in international comparative studies. Their significance for different types of services should be explored in further research.

Mental health-care provision for marginalized groups across Europe: findings from the PROMO study.

BACKGROUND: Providing mental health care to socially marginalized groups is a challenge. There is limited evidence on what form of mental health-care generic (i.e. not targeting a specific social group) and group-specific services provide to socially marginalized groups in Europe. AIM: To describe the characteristics of services providing mental health care for people with mental disorders from socially marginalized groups in European capitals. METHODS: In two highly deprived areas in different European capital cities, services providing some form of mental health care for six marginalized groups, i.e. homeless, street sex workers, asylum seekers/refugees, irregular migrants, travelling communities and long-term unemployed, were identified and contacted. Data were obtained on service characteristics, staff and programmes. RESULTS: In 8 capital cities, 516 out of 575 identified services were assessed (90%); 297 services were generic (18-79 per city) and 219 group-specific (13-50). All cities had group-specific services for the homeless, street sex workers and asylum seekers/refugees. Generic services provided more health-care programmes. Group-specific services provided more outreach programmes and social care. There was a substantial overlap in the programmes provided by the two types of services. CONCLUSIONS: In deprived areas of European capitals, a considerable number of services provide mental health care to socially marginalized groups. Access to these services often remains difficult. Group-specific services have been widely established, but their role overlaps with that of generic services. More research and conceptual clarity on the function of group-specific services are required.

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities.

BACKGROUND: Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities. METHOD: Two methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them. RESULTS: Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision. CONCLUSIONS: While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic services.

Mental health care for irregular migrants in Europe: barriers and how they are overcome.

BACKGROUND: Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice. METHODS: Data from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis. RESULTS: Experts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation. CONCLUSIONS: Even in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources.

Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries.

BACKGROUND: Socially marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. This study explored the experiences and views of experts in 14 European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sex workers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities. METHODS: Two highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed for each of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to explore experiences of good practice and analysed using thematic analysis. RESULTS: In a total of 154 interviews, four components of good practice were identified across all six groups: a) establishing outreach programmes to identify and engage with individuals with mental disorders; b) facilitating access to services that provide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c) strengthening the collaboration and co-ordination between different services; and d) disseminating information on services both to marginalised groups and to practitioners in the area. CONCLUSIONS: Experts across Europe hold similar views on what constitutes good practice in mental health care for marginalised groups. Care may be improved through better service organisation, coordination and information.

La utilización de los servicios sanitarios por la población inmigrante en España / Health services utilization by the immigrant population in Spain

Objetivo: Comparar la utilización de los servicios sanitarios por la población inmigrante y por la población autóctona. Métodos: Se ha utilizado la información proporcionada por cuatro encuestas de salud realizadas alrededor del año 2005: de Cataluña en 2006, de la ciudad de Madrid en 2005, de Canarias en 2004 y de la Comunidad Valenciana en 2005. Los servicios sanitarios investigados han sido médico general, médico especialista, servicio de urgencias, hospitalización y dos servicios preventivos: citología vaginal y mamografía. Resultados: En líneas generales, la población inmigrante utiliza con menor frecuencia que la española la mayoría de los servicios sanitarios. La consulta al médico general y la hospitalización constituyen los servicios sanitarios en que se ha encontrado una menor diferencia en su frecuentación entre ambas poblaciones, mientras que el médico especialista y los servicios preventivos constituyen los servicios sanitarios en que se ha encontrado una mayor diferencia. En la consulta al médico general y la hospitalización es donde los hallazgos son más heterogéneos, ya que algunos grupos de inmigrantes presentan una frecuencia relativamente alta en algunos ámbitos geográficos y una frecuencia relativamente baja en otros. Conclusiones: Los resultados reproducen los observados en otras investigaciones realizadas en países del entorno social y económico de España, y al igual que sucede con la evidencia disponible, no se pueden sugerir explicaciones. Las investigaciones futuras deberían probar a utilizar otros tipos de estudios y a contrastar explicaciones no sugeridas hasta ahora por la comunidad científica (AU)

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 (AU)

[Health services utilization by the immigrant population in Spain]. / 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.