Background. Evidence on the health-damaging eﬀects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. is study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale. Methods. Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was de�ned as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondent�s sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men. Results. Crude PPRs showed a gradient association with poor mental health and remained generally unchanged aer adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95–3.31) for women and 2.23 (95% CI: 1.86–2.68) for men. Conclusion. e study �nds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making.
As regards the issue of health and physical activity, it is im- portant to bear in mind that the most highly developed western societies are characterised by two fundamental trends. On the one hand, processes that were once carried out by human be- ings by means of sheer physical strength and activity (transport, work, etc.) have now been mechanised and automated, thus giving rise to an important and relatively recent social phe- nomenon: sedentary life. On the other hand, life expectancy has increased to record levels (Fernández, Clúa, Báez, Ramírez, & Prieto, 2000). These trends have led to population ageing; a process that is particularly marked in societies such as Spain where citizens aged 65 years or older account for 16.5 per cent of the population according to data from the Spanish Institute of Statistics (INE, 2008); a percentage that increases to nearly 19 per cent in the case of women, thus ranking Spain among the countries with the oldest population in the world. Contempo- rary western societies therefore face a two-fold challenge: an
having found any statistically significant relationship, the results found in our study in the sub-sample of working population with married or cohabiting marital status (see Table I, online Appendix) were congruent with the results found in these studies as well as in the whole study population. These results suggest that the main breadwinner role could be associated with mental health problems through the stress and the worry about earning enough to cover household expenses that this role can have in some people. This stress may be higher among the people that belong to manual social classes in a crisis situation like the current one in Spain. Addition- ally, the role of household and family workers assigned to women in a country with traditional family policy such as Spain, could be related to poor mental health, as a result of the overload that these chores could pose when they are added to paid work, 21,22,34
All the previous studies have focused on analysing the demo- graphic, working, educational, salary and scientific production characteristics of people that are self-defined health economists or specialists in health economics and/or health management, inde- pendent of their previous educational background, and most of these studies were performed mainly in countries other than Spain. Our study is based on a theoretical framework of human capital theory, which assumes educational training is an invest- ment for individuals and organizations. We are adding to previous knowledge by way of looking at some variables that explain the motivations and how curriculum develop- ment contribute to professional outcomes, and additionally we add knowledge to the international research with data from a country where very little was studied previously. We consider these findings useful for policy makers and for a broad range of health and social disciplines in many coun- tries.
This study was a part of a larger one carried out in 10 countries, grouped into five culturally different regions: Anglo-Saxon, Central European, Scandinavian, Latin and Mediterranean (Valenti et al., 2015). The lack of references on the phenomenon of informal coercion in mental health in countries outside the Anglo-Saxon ones, and the common patterns of providing mental health services among Latin culture countries, led us to make a secondary reading of the data available in Spain, Italy, Mexico and Chile. It also al- lowed the researchers to analyze the results in the native language of the participants, avoiding possible misinterpre- tations derived from translations.
Of course, impacts have not halted from affecting peoples’ health as well. A report by the UCL Institute of Health Equity (2012) pointed out that data from past recessions suggest that the likely impacts of economic downturns are more mental health problems, increases in domestic violence and a rise of infectious diseases, as well as higher mortality (20). Particularly, long- term unemployed people show poorer physical and mental health. Data confirm that the EU-27 average of suicides witnessed a decline since 2000, but started to increase in 2008 and 2009, in times of recession (4,33). However, countries with good social protection were able to counteract increases in suicides. Thus, economic downturns without an upward trend in suicides are not inevitable (3). Unfortunately, such welcoming lessons learned are not the rule. A survey in Spain conducted in 2006 and 2010 offered evidence that patients from primary care centres had significant increases in depression, anxiety, somatoform and alcohol-related disorders, which were associated with unemployment and mortgage-payment difficulties (34). Also Greece reported about worsening of mental health problems (4). Unfortunately, the statements of the UCL Institute of Health Equity (2012) (20) were further confirmed, for instance, by Greek infectious diseases data. Particularly HIV infections rose dramatically (3,4). Another Greek study by Zavras, et al., reported about associations between poor self-related health and the economic crisis, too (35). In contrast, fewer road traffic deaths were predicted due to income cuts in households and therefore less car use (3,20). However, as road safety is quite good in many European states, effects were only reported from European countries where road deaths are still common (3,4). To conclude, health impacts of the economic crisis have been considerable, especially in countries such as Greece and Spain. The question is though, whether measures by the governments helped to protect the people or whether they reinforced the widening of health inequities.
Background and aim: There is a high prevalence in the Spanish general population of some cardiovascular risk factors like overweight, obesity and hypercholesterolaemia. But there is lack of research on Spanish seafarers. On the other hand, there is strong evidence of the cardiovascular risk predictive value of some biomarkers. The purpose of this work was to study the convenience of the introduction of detailed diet questionnaires and the measurement of some biomarkers in the pre-embarkation medical examination. Materials and methods: Seafarers undergoing medical checkup during 2011 in Madrid, Spain (n = 334). Overweight and obese subjects received general advice on healthy diet and physical activity. Seventy-four of them were followed up in 2012 and 2013. Glycated haemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), thyrotropin (TSH) and microalbuminuria were measured in two selected groups of patients in 2011. Results: Overweight and obesity were present in 207 (62%) individuals of the studied population. Those followed up in 2012 and 2013 showed a reduction of body mass index, waist circumference and total cholesterol values. We observed risk value of HbA1c in 60 (35.5%) individuals with significant association to other cardiovascular risk factors. Microalbuminuria appeared in subjects with high blood pressure. High TSH and hs-CRP were not significantly present in our population.
Once these potential limitations are assumed, the inci- dence of definite MI seems to be in accordance with other studies carried out in Spain describing higher incidence rates amongst the elderly than rates in middle age-adults. This finding is of crucial importance since elderly people are the fastest growing population segment in western countries and, in consequence, demand for health resources of diagnosis and treatment is bound to increase When comparing our results to those of the REGICOR-65 plus study we observed higher absolute values in our study but both confirm an overall increase with age, and higher risk in men than in women (table 4).
This observational retrospective study, performed in several public health centers in Spain, identified that the manage- ment of patients with nvAMD treated with VEGF inhibitors in routine clinical practice was variable and far away from that recommended by the European specialist guidelines in terms of treatment-related and not treatment-related visits. Likewise, the Lumiere study reflected poor compliance with treatment recommendations in France . For example, the SERV Guideline and three German ophthalmologic societies recommend a loading treatment initiation followed by monthly follow-up visits to detect early recurrences and perform prompt retreatments to avoid as much as possible the permanent anatomic and functional damage [9, 10].
The results of generalised cost -benefit analyses done showed that, also for the United States, there is a big heterogeneity in the efficiency of the treatment of different health problems. However, the mean positive productivity of healthcare expenditure, and the fact that the social value is bigger than the cost, is not a reason for the indiscriminate increase in healthcare services and medical innovations. Actually, in clinical practice, the extension of any innovation to marginal patients, i.e. those that obtain a small benefit from the treatment, could result in very small additional benefits derived from healthcare expenditure, although the innovation is efficient in mean terms. On the contrary, economic evaluation of health interventions should be encouraged, using proper methods and broad perspectives as discussed in Annex 3, to take into account all effects on society, in terms of extended life and quality of life improvement, and in relation to existing and alternative interventions, including health technologies, public health interventions, and lifestyle behaviours, such as in the example shown in Paper 3. A continuing challenge for health care economic analysis in Spain is to follow methodological guidelines and reporting conventions, to improve the dissemination of research, as well as to use more sophisticated economic analysis techniques, and to publish in international journals.
Our research provides two important evidences about this topic. First, fi nancial crisis differently affects the mental health of men and women in Spain between 2006-2007 and 2010-2011. In particular, the prevalence of mental disorders – except for Probable Alcohol Abuse/Dependence and Bulimia Nervosa - increased signifi cantly during the current economic crisis in both genders, but the gain is higher in men than in women for Major Depressive Disorder, Generalized Anxiety Disorder and Non-specifi c Multi- somatoform Disorder. When both genders are compared in 2010, the prevalence ratios tend to equalize as a result of a higher increase in men. Second, unemployment is considered a signifi cant predictor for some particular disorders, specifi cally in men. These results were consistent with some previous research that assesses general mental health during similar period of time and concludes that poor mental health was more prevalent among men.
To make health promotion campaigns more effective, the motivation of the people to whom they are directed is required, what can be achieved by gamification through electronic devices. There are no known experiences in Spanish that address the promotion of health from a generalist perspec- tive and not only focused on very specific issues. For this reason Healthy Jeart is created. It is an app for smartphones and tablets, aimed at a population between 8 and 16 years old, whose objective is the promotion of healthy habits on a physical, social and psychological level. Its content has been desig- ned by professors from the universities of Huelva and Seville (Spain). The thematic areas that com- prise it are: physical exercise, nutrition, physical well-being, psychological well-being, affective-se- xual relationships, use of new technologies and to- xic substances and addictions. In 2018 it achieved a certification granted by the Agency of Sanitary Quality of Andalusia as a healthy app.
The incidence and prevalence of PU are among the most representative indicators of the quality of nursing care. The prevalence data for hospitals in Spain (8.24%)  are very similar to those for neighbouring countries such as Italy (8.3%), France (8.9%), Germany (10.2%) and Portugal (12.5%) [5,6], and also to those of more distant countries, such as Jordan (12%) . The highest prevalence values reported correspond to Ireland (18.5%), Wales (26.7%) , Bel- gium (21.1%), United Kingdom (21.9%), Denmark (22.7%) and Sweden (23.0%) . With re- spect to the occurrence of PU in homes for the elderly, perhaps the most important study carried out is that by Park-Lee , who analysed the situation of nursing homes in the USA and recorded a prevalence of 11%, similar to that found in Spain. In primary healthcare, in pa- tients receiving home care, there are no data to compare the prevalence in Spain with that in other countries because the characteristics of health care systems vary greatly from country to country. However, we do have data from the second National Survey of Prevalence of Pressure Ulcers in Spain in 2005 , in which the crude prevalence of PU was 3.73% and the average prevalence recorded was 9.11% ± 10.9% for patients aged over 14 years and included in the
Garrido-Cumbrera, M., Borrell, C., Palencia, L., Espelt, A., Rodriguez-Sanz, M., Pasarin, MI., Kunst, A., (2010). Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national health system. International Journal of Health Services, 40(3), 525-542. doi: 10.2190/HS.40.3.h
the Center for Infection and Immunity in the Mailman School of Public Health of Columbia University is supported by National Institutes of Health Grants AI051292 and AI57158 (Northeast Biodefense Center– Lipkin), the US Department of Defense, and Google.org. Finally, we also thank Alla Tashmukhamedova for her help in sequencing. Disclaimer: Samples used were made anonymous to follow bioethics guides, and no conflict of interest related to this article was declared. Authors’ addresses: Ximena Collao, Antonio Tenorio, and María Paz Sánchez-Seco, Laboratory of Arbovirus and Imported Viral Diseases, National Center of Microbiology, Institute of Health “Carlos III,” Madrid, Spain, E-mails: email@example.com, firstname.lastname@example.org, and email@example.com. Gustavo Palacios and W. Ian Lipkin, Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, E-mails: firstname.lastname@example.org and email@example.com. Fernando de Ory, Serology Section, National Center of Microbiology, Institute of Health “Carlos III,” Madrid, Spain, E-mail: firstname.lastname@example.org. Sara Sanbonmatsu, Mercedes Pérez-Ruiz, and José María Navarro, Service of Microbiology, Universitary Hospital “Virgen de las Nieve,” Granada, Spain, E-mails: email@example.com, firstname.lastname@example.org, and josem.navarro .email@example.com. Ricardo Molina, Service of Parasitology, National Center of Microbiology, Institute of Health “Carlos III,” Madrid, Spain, E-mail: firstname.lastname@example.org. Stephen K. Hutchison, 454 Life Sciences, Branford, CT, E-mail: email@example.com. Ximena Collao actual address: Virology, Medicine School, Universidad de Valparaíso, Valparaiso, Chile.
A monitoring system should use a limited set of indicators (such as behavioural indication) that are easily and frequently measured to identify problems and correct them in a timely way. For example, water shortages at handwashing points may be monitored by staff according to an organized schedule, and signalled immediately to caretakers or maintenance staff, where these exist, for action. A periodic review of environmental health facilities should also be carried out in a way that illustrates the links between the various activities. As in assessments, reviews should seek to identify causes for problems and then propose realistic solutions.