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Background: This study examines the relationship between unmet healthcare needs and employment status, with a focus on how this relationship was influenced by the Spanish economic recession of 2008-2012., Methods: Data were obtained from the Spanish National Health Survey for 2006 and 2011-2012. The outcome variable was the presence of unmet healthcare needs, describing its reasons. The analysis included the period (pre-crisis/crisis), demographic variables (sex, age, Spanish citizenship), employment status, social factors (level of education, marital status, social-class), and health indicators (self-assessed health, chronic conditions, and limitations). Logistic regression was used to predict unmet health needs based on the period, employment status, and control variables., Results: The frequency of unmet healthcare needs was low and decreased further during the crisis (5% pre-crisis vs 3% during the crisis). Unmet healthcare needs were more strongly associated with health status than with employment status. However, among the unemployed, unmet healthcare needs increased during the crisis compared to the pre-crisis., Conclusions: The most vulnerable groups, characterized by higher unmet healthcare needs, included women, individuals with lower levels of education, and those in poorer health. These groups may require more targeted attention. These findings should be interpreted in the context of the Spanish National Health System, which is fully decentralized and provides healthcare and protection to all residents.

In current times, we coexist with technology, using it every day. However, in older people, the use and employability of technology on a day-to-day basis is often more complicated or even null due to a lack of knowledge., Background/objectives: The youngest generation were born surrounded by technology, which has given them superior capabilities when it comes to handling technology compared to elderly people. In short, older people have grown up without technology and only later in life have they crossed paths with it. Therefore, these circumstances can produce what is known as a "digital divide", an unequal distribution in the access, use, or impact of information and communication technologies among social groups. Thus, the aim of this study is to examine whether there is a digital divide among European older adults and to show its effect on the mental health of individuals. In this way, we analyze how technological characteristics (digital divide) cause worsen mental health. Additionally, we examine whether, over time, the digital divide has had a greater impact on the mental health of older adults., Methods: For this purpose, recently published data from the Survey on Health, Aging, and Retirement in Europe are used., Results: Our analysis has revealed that the digital divide, driven by age, negatively affects the mental health of older adults in Europe. Thus, we have analyzed how technological characteristics related to the digital divide lead to poorer mental health among this population. Additionally, we have examined whether the digital divide has increasingly impacted older adults' mental health over time., Conclusions: These findings highlight the need to address the digital divide as a public health issue, promoting greater digital inclusion to improve the psychological well-being of older adults.

Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The aim of this study was twofold: to assess the annual pharmaceutical savings associated with the treatment of cancer patients at Marqués de Valdecilla University Hospital and to estimate the cost of innovative antineoplastic therapies that patients receive as experimental treatment, both during clinical trials throughout 2020., Material and Methods: An observational and financial analysis of the drug cost related to clinical trials was applied. Direct cost savings to the Regional Health System of Cantabria and the cost of innovative therapies used as an experimental treatment in clinical trials were quantified., Results: This study includes 38 clinical trials with a sample of 101 patients. The clinical trials analyzed provide a total cost savings of €603,350.21 and an average cost saving of €6,630.22 per patient. Furthermore, the total investment amounts to €789,892.67, with an average investment of €15,488.09 per patient., Conclusions: Clinical trials are essential for the advancement of science. Furthermore, clinical trials can be a significant source of income for both hospitals and Regional Health Systems, contributing to their financial sustainability., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Vaccination is widely considered to be one of the most important prevention measures as a health strategy. This paper examines trends in basic childhood vaccination coverage and which country and time-dependent determinants may have influenced childhood immunization rates (1-dose BCG, 1- and 3-dose DTP (diphtheria, tetanus, pertussis), 1-dose measles, and 3-dose polio) between 1980 and 2020 across 94 countries. We identify economic, inequality, demographic, health, education, labor market, environmental, and political stability factors of immunization. To do this, we use data from the annual WHO and United Nations International Children's Emergency Fund (UNICEF) coverage estimates. The empirical analysis consists of generalized estimating equation models to assess relationships between immunization rates and socioeconomic factors. Additionally, we follow the Barro and Sala-i-Martín approach to identify conditional convergence. Our findings show the strongest positive statistically significant association between immunization rates and GDP per capita, as well as births attended by skilled health staff. Moreover, our research demonstrates conditional convergence, indicating that countries converge towards different steady states. The present study brings new insights to investigating the determinants of childhood vaccination coverage and provides significant implications for health policies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lanza-León et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Due to the COVID-19 pandemic, the pressure on healthcare systems has been tremendous and it is having a huge economic impact. The objective of this paper is to carry out a systematic literature review of the publications that have analysed the costs derived from COVID-19 from the patient's perspective. Not only is this study aimed at measuring the impact of COVID-19 in economic terms, but also in qualitative terms, analysing, for instance, the types of costs (direct and indirect) and their variations depending on the geographical area under study. Searches were conducted in PubMed, Cochrane Library, Web of Science and Scopus. The time frame for the analysis was from the start of the pandemic until 9th December 2021. A total of 322 papers were found. The number of articles assessed for eligibility was 32, and after applying the exclusion criteria, 13 papers were included in the qualitative synthesis. Most of the studies analysed only direct costs (69.23%) and were focused on Asia (61.54%), where the larger indirect costs, as well as the greater total costs, were found. However, the higher costs per patient and year were shown for the United States. This investigation showed the importance of COVID-19 in national, regional and local budgets. More studies are to be developed in Europe due to both the existing differences in the health care systems and financing by country and the difference in the incidence of COVID-19 by country and wave., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Suicide is a significant cause of death worldwide. Various purposes can explain why people choose to attempt or commit suicide such as mental-health disorders, income-related-factors, quality of life or issues related to social context. This study aims to identify an updated association between 'isolation' and suicides., Methods: In this regard, we had made a systematic review of the most recent papers, published from January 2016 to March 2022, thought the most acknowledged databases. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. To the best of our knowledge, this issue is very important due to the indirect relationship between COVID-19 and suicides., Results: Our analysis demonstrates that suicide and -social isolation and loneliness- have a positive and direct relationship although these findings varied slightly by areas. Moreover, most of the attention is focused on the youth during the most recent period and this is a real problem because economies cannot afford losing (young) population., Conclusions: In order to prevent suicides, public policies should prevent suicidal thoughts that it could induce to terminate the lives of individuals in their most productive years and harmful outcomes to their families and friends., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Suicide is among the main challenges that need to be addressed in developed countries. In this paper, we analyse suicides across the 17 Spanish regions over the period 2014-2019. More precisely, our objective is to re-study the determinants of suicides focusing on the latest economic expansion period. We use count panel data models and sex stratification. A range of aggregate socioeconomic regional-level factors have been identified. Our empirical results show that: (1) a socioeconomic urban-rural suicide gaps exist; (2) there are significant gender differences, for the women a Mediterranean suicide pattern appears whereas unemployment levels have a significant importance for men, (3) social isolation factors, when significant, they show an (a priori) surprisingly positive result. We provide new highlights for suicide prevention in Spain. Precisely, it is highlighted that jointly policies by gender and attending to vulnerable groups are both necessary., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Blázquez-Fernández, Cantarero-Prieto. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Social distancing measures have been one of the core pillars of the strategy against COVID-19 in all the countries. This study aims at understanding what motivates behaviours and compliance with social distancing measures among students and workers from a Spanish public university., Methods: We carry out two logistics models considering two different dependent variables: not maintaining social relation with non-cohabiting people and not to leave home except for emergencies ( n  = 507, sample is formed by students and workers from the University of Cantabria in the North of Spain)., Results: Being very concerned about getting ill suggests higher risk of not maintaining social relation with non-cohabiting people. Getting older increase the probability of not leaving home except for emergencies as happens with those who are very concerned about getting ill. Young people often living with vulnerable older relatives may affect students' behaviour., Conclusions: Our findings suggest that compliance with social distancing measures depends on several factors related to age, the number or kind of cohabiting people and level of concern about getting ill. Policies should address all these factors through a multidisciplinary perspective., Competing Interests: The authors declare there are no competing interests., (©2023 Cantarero Prieto et al.)

Tools to predict surges in cases and hospitalizations during the COVID-19 pandemic may help guide public health decisions. Low cycle threshold (CT) counts may indicate greater SARS-CoV-2 concentrations in the respiratory tract, and thereby may be used as a surrogate marker of enhanced viral transmission. Several population studies have found an association between the oscillations in the mean CT over time and the evolution of the pandemic. For the first time, we applied temporal series analysis (Granger-type causality) to validate the CT counts as an epidemiological marker of forthcoming pandemic waves using samples and analyzing cases and hospital admissions during the third pandemic wave (October 2020 to May 2021) in Madrid. A total of 22,906 SARS-CoV-2 RT-PCR-positive nasopharyngeal swabs were evaluated; the mean CT value was 27.4 (SD: 2.1) (22.2% below 20 cycles). During this period, 422,110 cases and 36,727 hospital admissions were also recorded. A temporal association was found between the CT counts and the cases of COVID-19 with a lag of 9-10 days ( p ≤ 0.01) and hospital admissions by COVID-19 ( p < 0.04) with a lag of 2-6 days. According to a validated method to prove associations between variables that change over time, the short-term evolution of average CT counts in the population may forecast the evolution of the COVID-19 pandemic.

Background: The stress and anxiety caused by COVID-19 lockdown may have changed the eating habits of the population. Our aim is to assess the eating changes that have taken place due to the pandemic., Methods: Data were collected through an electronic survey created by the Health Economics Research Group of the University of Cantabria and IDIVAL and conducted between 14/01/2021 and 19/02/2021. A total of 1,417 responses were recorded, but only 507 complete observations were considered. We carried out a cross-sectional analysis through ordered probit regressions., Results: The improvement in post-confinement eating habits is associated with higher income level, better self-assessed health status and more physical activity. The worsening of eating habits is associated with having a certain level of nomophobia or the fear of contagion., Conclusions: Our analysis can be used for designing and implementing new strategies to overcome the negative spill overs of the COVID-19 pandemic and improve the dietary patterns., Competing Interests: The authors declare that they have no competing interests., (© 2023 Cantarero Prieto et al.)

The COVID-19 pandemic has highlighted issues due to mental health disorders, in particular the serious consequences derived from lockdown measures. This paper aims to analyse the literature on the potential direct impact of the natural environment on mental health disorders. We have systematically reviewed the studies analysing green spaces and mental health included in this review using PubMed, Web of Science, Scopus and Cochrane Library. A retrospective time-frame is considered, covering the COVID-19 pandemic. We have found that exposure to, use and proximity to green spaces have a beneficial impact on mental health among elderly, students and patients with underlying pathologies. However, it has negative effects on the mental health of women and young adults. Exposure to and interaction with the natural environment can improve certain mental health disorders and should be taken into account for strategies and policies related to future threats to public health.

Introduction and Objectives: Equal opportunities to access technical advances with recognized clinical value should be a priority of the publicly-funded health system. We analyzed variability among all the Spanish autonomous communities in the use of cardiovascular techniques with an established indication and its relationship with economic indicators, burden of disease, and hospital mortality., Methods: The activity registries of various Associations of the Spanish Society of Cardiology from 2011 to 2019 were analyzed for coronary angiography, overall percutaneous coronary intervention (PCI), primary PCI, implantable cardioverter-defibrillators (ICD), cardiac resynchronization therapy, and transcatheter aortic valve replacement (TAVR). Economic indices (gross domestic product and per capita health care expenditure) were obtained from public sources and data on attendance rates and mortality from the Resources and Quality in Cardiology (RECALCAR) reports of the Spanish Society of Cardiology. We analyzed the coefficient of variation for activity and the correlation of activity with regional economic indices, attendance rates, and risk-adjusted rates of in-hospital mortality., Results: We identified wide variability in the use of technologies, especially for primary PCI (18%), ICD (22%), cardiac resynchronization therapy (36%), and TAVR (42%). A certain correlation with attendance rates was seen only for overall PCI and ICD. In general, no significant correlation was found between the use of the techniques and the economic indices of wealth and expenditure. The correlation with in-hospital mortality showed no significant results, although this was the analysis with the greatest limitations because the impact of these techniques on survival is exerted more in the mid- and long-term., Conclusions: The results of this study, despite its inherent limitations, show marked variability between autonomous communities in the use of cardiovascular technologies, which is not explained by economic differences or by hospital attendance rates due to the corresponding diseases., (Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Prostate cancer has huge health and societal impacts, and there is no clear consensus on the most effective and efficient treatment strategy for this disease, particularly for localized prostate cancer. We have reviewed the scientific literature describing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer in OECD countries. We initially identified 315 articles, studying 13 of them in depth (those that met the inclusion criteria), comparing the social perspectives of cost, time period, geographical area, and severity. The economic burden arising from prostate cancer due to losses in productivity and increased caregiver load is noticeable, but clinical decision-making is carried out with more subjective variability than would be advisable. The direct cost of the intervention was the main driver for the treatment of less severe cases of prostate cancer, whereas for more severe cases, the most important determinant was the loss in productivity. Newer, more affordable radiotherapy strategies may play a crucial role in the future treatment of early prostate cancer. The interpretation of our results depends on conducting thorough sensitivity analyses. This approach may help better understand parameter uncertainty and the methodological choices discussed in health economics studies. Future results of ongoing clinical trials that are considering genetic characteristics in assessing treatment response of patients with localized prostate cancer may shed new light on important clinical and pharmacoeconomic decisions.

Reducing inequality is one of the current challenges that most societies are facing. Our aim was to analyze the evolution of inequalities in self-assessed health among older Europeans in a time period spanning the 2008 economic crisis and the COVID-19 health crisis. We used data from Waves 2, 4 and 8 of the Survey of Health, Ageing and Retirement in Europe. We used inequality indices that accept ordinal variables. Our empirical results suggest that average inequality declines over time. Gender significantly influences the results. Some of the countries with the highest level of inequality are Denmark and Sweden, and some with the lowest are Estonia and the Netherlands. Our results may be of interest for the development of public policies to reduce inequalities. Special attention should be paid to vulnerable groups, such as the elderly.

Background: Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care., Methods: A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test ( χ 2 ) were used., Results: A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital., Competing Interests: The authors declare there are no competing interests., (©2022 Pellico-López et al.)

This research approaches the empirical study of the pandemic from a social science perspective. The main goal is to reveal spatiotemporal changes in Covid-19, at regional scale, using GIS technologies and the emerging three-dimensional bins method. We analyze a case study of the region of Cantabria (northern Spain) based on 29,288 geocoded positive Covid-19 cases in the four waves from the outset in March 2020 to June 2021. Our results suggest three main spatial processes: a reversal in the spatial trend, spreading first followed by contraction in the third and fourth waves; then the reduction of hot spots that represent problematic areas because of high presence of cases and growing trends; and finally, an increase in cold spots. All this generates relevant knowledge to help policy-makers from regional governments to design efficient containment and mitigation strategies. Our research is conducted from a geoprevention perspective, based on the application of targeted measures depending on spatial patterns of Covid-19 in real time. It represents an opportunity to reduce the socioeconomic impact of global containment measures in pandemic management., Competing Interests: The authors declare that they have no conflicts of interest., (© 2022 The Authors. Transactions in GIS published by John Wiley & Sons Ltd.)

There exists a high proportion of women with disabilities who decide to be mothers although there is a high stigma about their capabilities. The objective is to analyze the impact of disability, among other socioeconomic conditions, on the motherhood decisions. We compared the results of treating disability as exogenous with a bivariate probit model. A cross-sectional analytical study has been analyzed by using data from the Fecundity Survey of 2018. The model estimates the probability of having children having disability, which is a 3.5%. Moreover, motherhood propensity for disabled women is 0.4 percentage points lower than for non-disabled.In this article the authors undertook a significant literature review, then it is included a development of the theoretical and methodology framework for analyzing the effect of disability on the attitudes of women toward the decision of having children. In this context, many disabled women have successfully become mothers but the existent barriers have unmotivated others. The difficulty is basically due to the stigma about their mothering capabilities or associated with physical conditions such as risk of abortion or even a worsening of health. The economic framework under our specification is an extension of the Households Health Production Model where women derive utility from having children and they use their skills, knowledge or time to achieve their objective. In this case, to have children is the outcome and education, health status and other socioeconomic factors are the inputs. Having children is only one of the sources of utility that a woman has, they also derive utility from labor time, consumption or healthcare, among others. Despite several studies used this methodology to analyze motherhood decisions in many Countries in the world, the impact of disability is much less explored.

The work presented concerns the spatial behaviour of coronavirus disease 2019 (COVID-19) at the regional scale and the socio-economic context of problem areas over the 2020-2021 period. We propose a replicable geographical information systems (GIS) methodology based on geocodification and analysis of COVID-19 microdata registered by health authorities of the Government of Cantabria, Spain from the beginning of the pandemic register (29th February 2020) to 2nd December 2021. The spatial behaviour of the virus was studied using ArcGIS Pro and a 1x1 km vector grid as the homogeneous reference layer. The GIS analysis of 45,392 geocoded cases revealed a clear process of spatial contraction of the virus after the spread in 2020 with 432 km2 of problem areas reduced to 126.72 km2 in 2021. The socio-economic framework showed complex relationships between COVID-19 cases and the explanatory variables related to household characteristics, socio-economic conditions and demographic structure. Local bivariate analysis showed fuzzier results in persistent hotspots in urban and peri-urban areas. Questions about ‘where, when and how’ contribute to learning from experience as we must draw inspiration from, and explore connections to, those confronting the issues related to the current pandemic.

Background: Stomach pain is an ailment that occurs frequently in the general population. It is not unusual if such stomach issues produce some amount of stress in an individual, but it can be worrying if these pains lead to significant mental health problems. The relationship between some abdominal pain, such as bowel syndrome, and depression or anxiety has been gaining much interest. However, previous studies that have empirically investigated this relationship are scarce., Methods: To analyze the impact of having gastrointestinal problems, among other socioeconomic conditions, on the onset of depression and anxiety in the Spanish population, we compare treating gastrointestinal diseases as exogenous in a single-equation probit model with a bivariate probit model in which this variable is treated as endogenous. A likelihood-ratio test of the correlation coefficient of the disturbances suggests that gastrointestinal problems are endogenous. Thus, the approach taken herein allows the direct testing of the hypothesis that having gastrointestinal problems and the onset of mental illnesses such as depression and anxiety are jointly determined by certain socioeconomic factors. A cross-sectional analytical study was analyzed using data from a 2017 survey of health indicators and life conditions that was developed by the Statistics Spanish Office., Results: The probability of having depression or anxiety increases with age, stress, daily limitations and gastrointestinal disorders. On the other hand, the probability is lower for men, married people and those who engage in exercise several times per week. Our findings estimate that having gastrointestinal problems increases the probability of having depression in 7% and the probability of anxiety in 8.8% of the sample., Conclusions: Our empirical results suggest that not considering the endogeneity of gastrointestinal problems could result in an overestimate of the impact of this factor on the development of depression or anxiety., Competing Interests: The authors have declared that no competing interests exist.

Background: habits related to diet and physical activity in children were modified due to the lockdown that Spain had between March and June 2019 because of the health crisis caused by the appearance of SARS-CoV-2. The aim of the study was to know the impact that the lockdown had on physical fitness values in children aged 11-12., Methods: the study consisted of 50 Spanish children aged 11-12 (M = 11.40; SD = 0.50), 33 (66%) boys and 17 (34%) girls. Data collection was performed using the Alpha-Fitness Battery, a validated instrument to assess dietary intake, habits and practices, and an ad hoc survey to collect sociodemographic data and other information relevant to the study., Results: there were significant differences ( p < 0.05) in the results of fitness variables measured in the standing long jump, agility speed and aerobic capacity, as well as in the results of maximal oxygen uptake (VO 2 max) between, before and after lockdown in both boys and girls. No significant differences were found in measurements of right and left hand grip ( p > 0.05)., Conclusions: there is evidence of a significant impact of SARS-CoV-2 lockdown on physical fitness values in boys and girls aged 11-12.

Background: During the great lockdown in Spain due to SARS-CoV-2, in between the months of March and June 2020, dietary and physical activity habits were modified in children. The aim of the study was to determine the impact of the lockdown on anthropometric parameters in children aged 11/12 years., Methods: Fifty Spanish children aged 11/12 years (M = 11.40; SD = 0.50) participated: 33 (66%) boys and 17 (34%) girls. For data collection, we used an anthropometry kit; the Alpha-Fitness Battery, a validated instrument to assess dietary intake, habits and practices; and an ad hoc survey to collect sociodemographic and other data under investigation., Results: There were significant differences in the anthropometric parameters measured and in the results obtained for Body Mass Index (BMI) and body fat percentage pre- and post-lockdown in both boys and girls ( p < 0.05). No significant differences were found in waist-circumference measurements ( p > 0.05)., Conclusions: There is evidence of a significant impact of the SARS-CoV-2 lockdown on anthropometric parameters in boys and girls aged 11/12 years.

Lean Management method has been applied in several fields before its implementation in healthcare area. Among the different techniques associated with Lean, in this paper, we are focused on Kanban system, which is a method that presents several benefits such as inventory holding reduction or improvement of the employees' satisfaction. Our main objective is to carry out a literature review focused on Kanban methodology applied to health care. In this sense, this study can serve as a script to improve hospital management in pandemic periods, such as the one currently lived on COVID-19. We carry out a literature review searching in four different databases. We combine several terms to achieve our objective. We identify several articles which describe Kanban methodology applied to health field. More specifically, we present in what areas (nursing or pharmacy, among others) this method has been applied. In addition, we show all the barriers as well as benefits caused by the implementation of this system. There are a few studies focused on analysing how Kanban is applied to health care. Therefore, we can affirm that this topic is still recent., (© 2021 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Presenteeism is defined as the presence of the worker at their workplace despite not being in optimal physical or mental conditions. Presenteeism is a phenomenon that has been poorly studied in the context of healthcare. Despite the many negative consequences associated with presenteeism, to date, no studies have investigated this issue in nurses in Spain. The objective was to develop and validate a questionnaire on presenteeism to be used by nursing staff in Spain., Methods: A psychometric study for the development and validation of a questionnaire. The PRESENCA ® questionnaire on presenteeism was created by a panel of experts, based on a survey comprised of 31 Likert-type items., Results: In total, 355 nurses completed the questionnaire. The factorial analysis revealed the existence of 3 factors and confirmed appropriate levels of validity and reliability (alpha = 0.729)., Conclusions: The PRESENCA ® questionnaire is the first tool developed and validated in Spanish for the assessment of presenteeism in nursing. Our findings demonstrate that this scale has appropriate psychometric properties and its use may facilitate the detection of presenteeism among professionals. As a result, use of this questionnaire may contribute towards the improvement of clinical safety.

Population ageing is one of the current challenges that most societies are facing, with great implications for health systems and social services, including long-term care. This increasing long-term care use is particularly rising for dependent older people, motivating the implementation of regional dependency laws to ensure their care needs' coverage. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from the year 2004 until 2017, the aim of this study is to assess the impact that the Spanish System for Personal Autonomy and Dependency might have on (i) household income, according to different needs for care levels, by running Generalized Linear Models (GLMs); and (ii) formal and informal care use depending on the income-related determinant through the performance of logit random-effects regression models. We show that the different degrees of needs for personal care are associated with a lower household income, being associated with an income reduction from €3300 to nearly €3800, depending on the covariates included, per year for the more severely in-need-for-care older adults. Moreover, our findings point towards a higher use of formal and informal care services by the moderate and severe dependents groups, regardless of the household income group and time period. Bearing in mind the demographic ageing, our results highlight the need for the identification of potentially vulnerable populations and the efficient planification of long-term care systems and social support services.

The financial crisis of 2008 precipitated the "Great Recession". In this scenario, we took Spain as a country of study, because although it experienced significant negative shocks associated with macroeconomic variables (GDP or unemployment), its welfare indicators have been marked by limited changes. This study used data from waves 2 and 4 (years 2006-2007 and 2010-2012, respectively) of the Survey on Health, Aging and Retirement in Europe (SHARE). Specifically, through logistic regressions we have analysed the effects of socioeconomic, demographic, health and "Great Recession" factors on the quality of life (QoL) of elders in Spain. Although QoL did not change too much during the "Great Recession", the results confirmed the importance of several factors (such as chronicity) that affect the satisfaction with the QoL among the older people. In this regard, statistically significant effects were obtained for individual exposure to recession. Therefore, a decrease in household income in the crisis period with respect to the pre-crisis period would increase by 44% the probability of reporting a low QoL (OR = 1.44; 95% CI: 1.00-2.07). Furthermore, gender differences were observed. Health and socioeconomic variables are the most significant when determining individual QoL. Therefore, when creating policies, establishing multidisciplinary collaborations is essential.

The increase in the proportion of elderly people in developed societies has several consequences, such as the rise in demand for long-term care (LTC). Due to cost, inequalities may arise and punish low-income households. Our objective is to examine socioeconomic inequalities in LTC utilization in Europe. We use the last wave from the Survey of Health, Aging, and Retirement in Europe SHARE (Munich Center for the Economics of Ageing, Munich, Germany), dated 2017, to analyze the impact of socioeconomic status (SES) on LTC. For this purpose, we construct logistic models and control for socioeconomic/household characteristics, health status, and region. Then, concentration indices are calculated to assess the distribution of LTC. Moreover, we also analyze horizontal inequity by using the indirect need-standardization process. We use two measures of SES (household net total income and household net wealth) to obtain robust results. Our findings demonstrate that informal care is concentrated among low-SES households, whereas formal care is concentrated in high-SES households. The results for horizontal concentration indices show a pro-rich distribution in both formal and informal LTC. We add new empirical evidence by showing the dawning of deep social inequalities in LTC utilization. Policymakers should implement policies focused on people who need care to tackle socioeconomic inequalities in LTC.

The purpose of this article is to analyse the available literature describing the economic burden of dementia and to compare costs between studies examining cost drivers. To shed light on this field, a systematic review is performed using PubMed, the Cochrane Library and Web of Science. An eight-year retrospective horizon was considered until 25 May 2018. Several papers were obtained from the database search (n = 23), being others (n = 3) identified through other sources (hand-searching) because we did not detect it through the three databases. The cost estimates were compared between three perspectives: state/publicly funded health services, third-party/private sector/not-for-profit organisations and patient and family and/or societal. The estimated total annual cost per person with dementia in Europe is on average €32,506.73 (n = 10), whereas for the United States, it gets €42,898.65 (n = 2). Furthermore, differences are appreciated by type of costs. Besides, differences by severity groups are also considered. Overall, the higher the severity the higher the associated costs. Dementia imposes a huge economic burden. The figures here presented provide a good framework to quantify these costs for both, economic experts and researchers, and policy decision makers.

Background: Multiple sclerosis has both high healthcare and social impacts., Objective: The purpose of this article is to analyse the available literature describing the economic burden of multiple sclerosis and to compare costs among studies examining main cost drivers., Methods: A literature search on studies published in English on cost-of-illness of multiple sclerosis included in this review using PubMed, the Cochrane Library, SCOPUS and Web of Science includes a retrospective horizon and it describes direct and indirect costs in patients categorized into severity groups., Results: Several papers were obtained from the database search (n=37). Additionally, results from "hand searching" were also included, where a wider horizon was considered. Cost estimates were compared among studies that used a societal perspective on costs, time-period studied, and year of price level used. The estimated total annual cost per patient in Europe is on average 40,300€ (n=20). In addition, differences by geographic areas and severity groups are also considered. All in all, the higher the severity, the higher the associated costs., Conclusions: This systematic review provides one clear finding: multiple sclerosis places a huge economic burden on healthcare models and societies due to productivity losses and caregiver burden. Moreover, costs of drugs were main cost determinants for less severe cases of multiple sclerosis and informal care and production losses for the most severe cases of multiple sclerosis., Competing Interests: Declaration of Competing Interest None of the authors has financial interest related to this study to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aim: Early intervention psychiatric services for patients with psychosis aim to limit the most damaging outcomes and reduce the patient's risk of social drift, decreasing illness severity and thus containing healthcare costs. There is a scarcity of studies that focus on first-episode psychosis (FEP), and those few that have been published only looked at direct health costs, but not at indirect costs, which make up the bulk of the budget. Our study aims to explore the short-term (1-year follow-up) economic cost of a FEP Program, including both direct and indirect costs., Methods: Data were collected retrospectively from the clinical records of 157 patients included in the Programa Atención Fases Iniciales de Psicosis, from Marqués de Valdecilla University Hospital, Santander. Our data collection sheet collated data from direct and indirect costs associated with the illness. Data were also extracted from the Cantabria Health Service Records. STATA 15.0 was used for statistical analysis., Results: On average, the total costs during the first year were €48 353.51 per patient, with direct healthcare costs being €13 729.47 (28.39%), direct non-medical costs €108.6 (0.22%), and indirect costs €34 515.44 (71.39%). We found that hospitalization costs were higher in males (p = 0.081) and in cannabis users (p = 0.032). The number of relapses increased both, hospitalization and treatment costs (r = 0.40 p = 0.000; r = 0.24 p = 0.067, respectively)., Conclusions: Intensive Early Intervention in Psychosis Services may result in cost savings by decreasing hospitalization, premature mortality, disability, unemployment, and legal problems; however, the first year after diagnosis would represent the one with the highest costs., (© 2018 John Wiley & Sons Australia, Ltd.)

In recent years, and because of the economic crisis, Spain's government has been worried about changes in health poverty. In this paper, we examine individual health status measured subjectively (SAH) and we decompose some socio-economic determinants to analyse how this situation affects health. We focus on SAH to estimate the poverty trends over time using the Foster-Greer-Thorbecke (FGT) index. For this purpose, we have used data provided by the European Union Statistics on Income and Living Conditions (EU-SILC). Our results show a negative growth if a poor SAH status is chosen as a health poverty threshold, and a positive growth of health poverty, if a fair SAH status is chosen. Furthermore, we decompose some socio-economic factors (such as gender, age and education level) to study how these characteristics affect health poverty. Our findings, based on different subgroup decompositions, reveal a rise of health poverty in Spain., (Copyright © 2019. Published by Elsevier B.V.)

We aim to study among European older adults (after age 50) if partner's mental health influences the individual's well-being. A sample of married or with registered partnership couples that live together, from the latest wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) is considered. More specifically, we use logistic regressions to determine the impact that partner's mental health has on an individual well-being. Besides, personal health and socio-demographic characteristics are also analysed. Differences by gender have been also considered. We shed new light on the factors determining well-being. The empirical findings show that there are important spillover effects from individual's mental health to the well-being of their partners within households (OR = 1.51; 95% C.I 1.43, 1.59). Our results show utility and empathy between couples, regardless of being a man or a woman. Further, once controlled by the individual traditional factors (age, education or labour status), the interdependence of the closest environment is shown. These findings play a very important role in explaining the public policies that consider the social perspective of well-being in general, as well as mental health policies in particular.

Objective: To analyse the impact of per capita income and environmental air quality variables on health expenditure determinants., Method: In this study, we analyse the relationship between air pollution and health expenditure in 29 OECD countries over the period 1995-2014. In addition, we test whether our findings differ between countries with higher or lower incomes., Results: The econometric results show that per capita income has a positive effect on health expenditure, but is not as statistically significant as expected when lag-time is incorporated. In addition, an anchorage effect is observed, which implies that about 80%-90% of previous expenditure explain current expenditure. Our empirical results are quite consistent between groups and when compared with the full sample. Nevertheless, there appear to be some differences when broken down by financing scheme (total, public, and private)., Conclusions: Overall, our findings could be used to clarify the appropriate health expenditure level or to obtain better environmental quality and social well-being. That is, empirical support is provided on how health management and policy makers should include more considerations for the use of cleaner fuels in developed countries., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: This paper analyses the 2008 economic collapse in Spain with its long-lasting effects. Precisely, the ones associated with lifestyles. Thus, the aim of this paper is to examine to what extent economic downturns affect individual's drinking behavior when focusing on unemployed people., Methods: We use discrete-choice models and matching techniques. Data from the National Health Survey for 2006 and 2011-2012 provides a clear picture before and after the 2008 breakdown in Spain., Results: We find that drinking over the business cycle is a function of individual socio-demographic status. Besides, our empirical findings are consistent with the idea that following the crisis differences between unemployed and non-unemployed fell to at least in accordance with a lower overall consumption of alcoholic beverages., Conclusions: Public policy design for drinkers would require both prevention and recovery from alcohol use strategies to be met towards health and labour pillars.

The aim of this study is to explain the trends in socioeconomic inequality and diabetes outcomes in terms of hospital admission and death in old European people. The sample includes 73,301 individuals, across 16 European countries taken from the Survey of Health, Ageing and Retirement in Europe (SHARE). People being diagnosed of diabetes were more likely to be admitted to hospital than those without diabetes, although its effect dropped after controlling for clinical and functional complications. Largest asscociations were observed in women, people aged 50-65 years old, with medium educational level and medium household income. Diabetes was significant and positively related to mortality in the whole sample. Diabetes is significantly associated with mortality risk especially in males, oldest old people, low education and medium income people. These findings have important implications for public policies to reduce socioeconomic-related health inequalities., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Different studies have found that socioeconomic determinants influence the prevalence of chronic diseases in older people. However, there has been relatively little research on the incidence of how social isolation may affect them. We suggest that social isolation is a serious concern for people living with chronic illnesses., Method: In this paper, we examine whether there is an increase in the propensity of being diagnosed with chronic illnesses because of a decrease in social relations for elderly Europeans. We have used a panel data for Waves 1-6 (2004-2015) of Survey on Health, Ageing and Retirement in Europe (SHARE) and logistic regressions. Besides, we have studied three geographic macro-areas (Nordic, Continental and Southern). Being diagnosed with three or more chronic diseases is considered as a dependent variable, and as social control variables we have used three isolation proxies (living alone, providing help to family, friends or neighbours and participation-club activities). Other socio-demographic variables are included (gender, age, educational level, job situation, area of location and quality of life)., Results: Our results for the full sample indicate that people who participate in social activities have fewer probability of suffering from chronic diseases (OR = 0.70, 95% CI 0.54, 0.92). For people who live alone the reverse effect is observed (OR = 1.20, 95% CI 1.04, 1.39). Differences are shown by macro-areas, e.g. providing help (OR = 0.58, 95% CI 0.34, 0.97) isolation proxy is significant for the Nordic macro-area. Club-participation activities and living alone are significant for Continental and Southern macro-areas, respectively (OR = 0.65, 95% CI 0.55, 0.82; OR = 1.46, 95% CI 1.21, 1.77)., Conclusions: Social isolation increases the risk of being diagnosed with chronic illnesses. That is, people with greater social participation have lower risk of suffering from multiple chronic diseases. This risk linked to isolation, together with the traditional one associated with lifestyles, should be considered in the development of new public policies., Competing Interests: The authors have declared that no competing interests exist.

Background: Several stakeholders have undertaken initiatives to propose solutions towards a more sustainable health system and Spain, as an example of a European country affected by austerity measures, is looking for ways to cut healthcare budgets., Methods: The aim of this paper is to study the effect of private health insurance on health care utilization using the latest micro-data from the European Community Household Panel (ECHP), the Spanish National Health Survey (SNHS) and the European Union Statistics on Income and Living Conditions (EU-SILC). We use matching techniques based on propensity score methods: single match, four matches, bias-adjustment and allowing for heteroskedasticity., Results: The results demonstrate that people with a private health insurance, use the public health system less than individuals without double health insurance coverage., Conclusions: Our conclusions are useful when policy makers design public-private partnership policies.

This paper introduces a framework for modelling the impact that diabetes has on employment status and wages, improving the existing literature by controlling for diabetes-related complications. Using the last wave of the Spanish National Health Survey, we find that 1710 adults out of the original sample of 36,087 have diabetes, reporting higher rates of unemployment. Our empirical results suggest that persons with diabetes, compared with non-diabetic persons, have poorer labor outcomes in terms of length of unemployment and lower income. However, diabetes is not significantly associated with unemployment probabilities, suggesting that the burden of diabetes on employment is mediated by lifestyle factors and clinical and functional complications. In addition, there are mixed outcomes to this econometric approach, depending on age and gender, among other factors. This interesting finding has several implications for research and policy on strategies to get lower health inequalities., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Increased life expectancy has had a corresponding socioeconomic impact due to the ageing population and, among other issues, has increased the incidence of diseases related to cognitive impairment, such as dementia. These changes particularly affect the most developed countries. Any analysis of economic costs aiming to study patients with health problems related to cognitive impairment or dementia should consider the reality of the distinct phases of these disorders and should be conducted from the perspective of the payer, that is, the publicly-funded healthcare system. Moreover, given the complexity and importance of cognitive impairment, there is a need to consider both direct healthcare costs, such as hospitalization measures, medication for the treatment of these diseases, specialist consultations, transport (eg, ambulances in severe cases), and direct non-healthcare costs (eg, professional care, nonprofessional care). In addition, indirect costs (related to productivity losses such as sick leave) must be considered for these diseases. Lastly, in 2014, the annual total mean cost (direct and indirect costs) in Spain for each patient with cognitive impairment, dementia and Alzheimer disease, was around €30 000. A large part of this economic burden was due especially to indirect costs, which are usually a borne by affected individuals and their families., (Copyright © 2017 Sociedad Española de Geriatría y Gerontología. Publicado por Elsevier España, S.L.U. All rights reserved.)

The most famous modern definition of health was created during a Preamble to the Constitution of the World Health Organization in 1946: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." This definition has not been amended and, since then, many indicators have been proposed to measure health such as Self-Assessed Health (SAH) status. It provides an overall measure of a population's health based on individuals' personal perceptions of their own health.In this paper, we focus our analysis on "under-health" as the fact of having a level that falls behind the health requirements necessary to perform what is considered an "expected life based on Self Assessed Health". For Spain using the European Union Statistics on Income and Living Conditions (EU-SILC), we can confirm there exist under-healthy people by occupation, age group and sex. Additionally, under-healthy workers are most likely to be found among skilled agricultural, fishery workers and elementary occupations.