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The financial crisis has caused an exponential increase of home foreclosures in Spain. Recent studies have shown the effects that foreclosures have on mental and physical health. This study explores these effects on a sample of adults in the city of Granada (Spain), in terms of socio-demographic, socio-economic and process characteristics. A cross-sectional survey was administered to obtain information on self-perceived changes in several indicators of physical and mental health, consumption of medications, health-related behaviors and use of health services. A total of 205 persons, going through a foreclosure process, participated in the study. 85.7% of the sample reported an increase of episodes of anxiety, depression, and stress, 82.6% sleep disturbances, 42.8% worsening of previous chronic conditions, and 40.8% an increase in consumption of medication. Women, married persons and persons already in the legal stage of the foreclosure process reported higher probability of worsening health according to several indicators, in comparison with men, not married, and individuals in the initial stages of the foreclosure process. The results of this study reveal a general deterioration of health associated with the foreclosure process. These results may help to identify factors to prevent poor health among populations going through a foreclosure process.

[Objetivo] Proporcionar indicadores para evaluar, en Espana˜ y en sus comunidades autónomas, el impacto sobre la salud, sus determinantes sociales y las desigualdades en salud del contexto social y de la crisis económica más reciente. [Métodos] Basándonos en el marco conceptual de los determinantes de las desigualdades sociales en salud en Espana, ˜ identificamos indicadores secuencialmente a partir de documentos clave, Web of Science y organismos con estadísticas oficiales. La información recopilada dio lugar a un directorio amplio de indicadores que fue revisado por un panel de expertos. Posteriormente seleccionamos un conjunto de esos indicadores segúnuncriterio geográfico y otro temporal: disponibilidad de datos segúncomunidades autónomas y al menos desde 2006 hasta 2012. [Resultados] Identificamos 203 indicadores contextuales sobre determinantes sociales de la salud y seleccionamos 96 (47%) según los criterios anteriores. De los indicadores identificados, el 16% no cumplieron el criterio geográfico y el 35% no cumplieron el criterio temporal. Se excluyó al menos un 80% de los indicadores relacionados con la dependencia y los servicios de salud. Los indicadores finalmente seleccionados cubrieron todas las áreas de los determinantes sociales de la salud. El 62% de estos no estuvieron disponibles en Internet. Alrededor del 40% de los indicadores se extrajeron de fuentes relacionadas con el Instituto Nacional de Estadística. [Conclusiones] Proporcionamos un amplio directorio de indicadores contextuales sobre determinantes sociales de la salud y una base de datos que facilitarán la evaluación, en Espana˜ y sus comunidades autónomas, del impacto de la crisis económica sobre la salud y las desigualdades en salud., Este artículo ha contado con la financiación del Subprograma de Investigación en Crisis y Salud del CIBER de Epidemiología y Salud Pública (CIBERESP), así como de los proyectos FIS con números de expediente PI13/00897, PI13/02292 y PI13/00183.

Despite the higher proportion of foreclosures and home evictions executed in Spain, compared to other countries, and the known link between social exclusion and mental health problems, studies exploring this association in Spain remain scarce. This study investigated the link between the process of home eviction and the appearance of symptomatology of post-traumatic stress disorder (PTSD), anxiety, depression, and perceived stress. Two hundred and five people affected by the process of home eviction were assessed using a structured interview that included three validated assessment instruments for PTSD, perceived stress, anxiety and depression. Analysis involved comparison with the normative groups that formed the validation studies together with regression analysis to determine the major psychological and socio-demographic predictors of perceived stress. Of the participants, 95.1% reported that they were experiencing the process of home eviction with fear, helplessness, or horror. In PTSD symptomatology, they scored higher than the normative PTSD group in symptoms of avoidance (t = 5.01; p < .05), activation (t = 5.48; p < .01), and total score (t = 4.15; p < .05). Of this subgroup, 72.5% fulfilled the DSM-IV symptom criteria for PTSD. The major predictor of perceived stress was PTSD symptomatology (B = .09; p < .001). The process of home eviction in Spain is having an alarming impact on mental health of affected people calling for effective measures to provide psychological and social support.

To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia.A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the χ2 test and a multivariate logistic regression analysis were conducted.We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process.Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic.

This study describes the design and implementation of a health impact assessment (HIA) conducted in 2010 of the regeneration project of San Fernando Street, the main avenue crossing the San Miguel-El Castillo neighborhood in Alcala de Guadaíra (Seville, Spain). This project is part of the wider URBAN Plan aimed at the social, urban and economic regeneration of the city's historic center.This experience followed the standard HIA stages and procedures. The review of published evidence was complemented with new qualitative information gathered by means of a participative workshop with the local population and interviews with social and health workers involved in the neighborhood.During the building stage of the project, the adverse impacts were related to a worsening of the air quality, increased noise pollution, mobility restrictions and a higher risk of accidents, particularly among older or disabled people. Once the building stage was finished, the health benefits were associated with significant improvements in physical accessibility and the population's access to health services and other goods and services. Other positive effects were the enhanced safety and attractiveness of the neighborhood and the new opportunities for socializing, social cohesion and increasing the community's self-esteem.This is the first HIA experience in Andalusia whose results have been integrated into a formal cycle of decision making in the local community. This experience has provided new evidence of the potential of HIA and its applicability and acceptance at the municipal level and has has also facilitated a learning process and the piloting of new methods and tools associated with the HIA process.

Anemia is the most common haematological complication in cancer patients.Analysis of the incidence, prevalence and treatment of anemia in oncologic patients treated in Radiation Oncology Departments in Spain (ROD) and monitoring of the existing recommendations for the treatment of anemia.Observational, prospective, multicenter study which involved 19 Spanish ROD. The study was approved by the CEIC Central Defense Hospital. 477 patients with solid tumors, subsidiary of RT with radical intent referred to such centers within a period of one month (5/5/09 to 5/6/09) and gave their consent to participate in the study. We gathered the main characteristics of patients and their oncologic disease. All patients underwent a determination of Hb levels before RT, upon reaching 25-35 Gy and at the end treatment. In patients with anemia we assessed the existence of related symptoms and its treatment.Basal situation: The prevalence of anemia was 34.8% (166 patients). Mean Hb in patients with anemia was 11.17 ± 1.07 g/dl. Anemia-related symptoms were present in 34% of the patients. Anemia predisposing factors were: stage of the disease, previously received chemotherapy, and hormonal therapy. 39% (66 patients) received anemia treatment, with a mean Hb of 10.43 ± 1.04 g/dl. During RT: The prevalence of anemia was 38.9% (182 patients) with a mean Hb of 11.24 ± 1.21 g/dl. Predisposing factors for anemia during RT treatment were: age, male sex, chemotherapy prior to RT, basal anemia and chemotherapy during RT. 36.3% (66 patients) had anemia-related symptoms. 34.6% (63 patients) with a mean Hb of 10.5 ± 1.37 g/dl received treatment for anemia. The prevalence of anemia at the end of the RT was 38.1% (177 patients) with a mean Hb of 11.19 ± 1.18 g/dl. The predisposing factors for the appearance of anemia at the end of RT were: male sex, anemia at basal situation and during treatment and chemotherapy during RT. 34% (61 patients) had anemia-related symptoms and 73 patients (41.2%) with a mean Hb of 10.5 ± 1.22 g/dl received treatment for anemia. The presence of anemia-related symptoms was significantly correlated with the beginning of treatment for anemia. The incidence of anemia (new cases) during radiotherapy was 17.5%.The prevalence of anemia in basal situation, during RT and at the end of RT is 34.8%, 38.9% and 38.1%. During RT the incidence of anemia is 17.5%. 39.8%-41.2% of patients with anemia and 64.2%-68% of patients with anemia-related symptoms received treatment. Treatment of anemia starts with Hb11 g/dl and the goal is to achieve Hb 12 g/dl. In our Radiotherapy Oncology Departments, the treatment of anemia complies with the current recommendations and guidelines in use.

The study of the severity of occupational injuries is very important for the establishment of prevention plans. The aim of this paper is to analyze the distribution of occupational injuries by a) individual factors b) work place characteristics and c) working conditions and to analyze the severity of occupational injuries by this characteristics in men and women in Andalusia.Injury data came from the accident registry of the Ministry of Labor and social issues in 2003. Dependent variable: the severity of the injury: slight, serious, very serious and fatal; the independent variables: the characteristics of the worker, company data, and the accident itself. Bivariate and multivariate analysis were done to estimate the probability of serious, very serious and fatal injury, related to other variables, through odds ratio (OR), and using a 95% confidence interval (CI 95%).The 82.4% of the records were men and 17.6% were women, of whom the 78,1% are unskilled manual workers, compared to 44.9% of men. The men belonging to class I have a higher probability of more severe lesions (OR = 1.67, 95% CI = 1.17-2.38).The severity of the injury is associated with sex, age and type of injury. In men it is also related with the professional situation, the place where the accident happened, an unusual job, the size and the characteristics of the company and the social class, and in women with the sector.

Background. The study of the severity of occupational injuries is very important for the establishment of prevention plans. The aim of this paper is to analyze the distribution of occupational injuries by a) individual factors b) work place characteristics and c) working conditions and to analyze the severity of occupational injuries by this characteristics in men and women in Andalusia. Methods. Injury data came from the accident registry of the Ministry of Labor and Social Issues in 2003. Dependent variable: the severity of the injury: slight, serious, very serious and fatal; the independent variables: the characteristics of the worker, company data, and the accident itself. Bivariate and multivariate analysis were done to estimate the probability of serious, very serious and fatal injury, related to other variables, through odds ratio (OR), and using a 95% confidence interval (CI 95%). Results. The 82,4% of the records were men and 17,6% were women, of whom the 78,1% are unskilled manual workers, compared to 44,9% of men. The men belonging to class I have a higher probability of more severe lesions (OR = 1,67, 95% CI = 1,17 – 2,38). Conclusions. The severity of the injury is associated with sex, age and type of injury. In men it is also related with the professional situation, the place where the accident happened, an unusual job, the size and the characteristics of the company and the social class, and in women with the sector Yes Fundamento. El estudio de la gravedad de las lesiones por accidente de trabajo es clave para el establecimiento de planes de prevención. El objetivo de este trabajo es conocer la distribución de las lesiones registradas por accidente de trabajo con baja según: a) las características del trabajador/ora; b) las del centro de trabajo y; c) las condiciones de empleo y del puesto de trabajo; y analizar la gravedad de las lesiones registradas según estas características en hombres y mujeres en Andalucía. Métodos. Se utilizaron los datos del registro de lesiones por accidente de trabajo con incapacidad laboral durante 2003 en Andalucía. Variable dependiente: grado real de la lesión; variables independientes: las características del/a trabajador/a, de la empresa y las del propio accidente. Se realizó un análisis bivariante y multivariante para estimar la probabilidad de lesión grave, muy grave o mortal asociada al resto de variables mediante la razón de odds (OR) y su intervalo de confianza. Resultados. El 82,4% de las lesiones se produjeron en hombres y el 17,6% en mujeres, de las cuales el 78,1% eran trabajadoras manuales no cualificadas, frente al 44,9% de los hombres. En hombres de clase I se encontró una probabilidad mayor de presentar lesiones más graves (OR = 1,67; IC 95% = 1,17-2,38). Conclusiones. La gravedad de las lesiones se relaciona con el sexo, la edad y el tipo de lesión. En los hombres también se asocia con la situación profesional, la clase social, el lugar del accidente, la plantilla del centro y el realizar un trabajo que no es el suyo y en las mujeres con el sector de actividad.

Aims: This study examined the impact that individual social position and municipal area deprivation levels had on trends in inequalities in self-rated health in Spain, between 1987 and 2001. Methods: The study was based on cross-sectional data of the National Health Surveys of Spain for the years 1987, 1993, 1995, 1997, and 2001 (n=84,567). The indicators used were educational level and occupational class, and deprivation level as the indicator of municipal areas. Multilevel logistic regression models were made, with individuals nested into municipal areas. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. To evaluate trends, the relative index of inequality was calculated. Results: At the individual level, the likelihood of less-than-good health between those with no formal education as compared to those with graduate-level education increased from OR=2.66 (95% CI: 2.06—3.38) in 1987 to OR=3.62 (95% CI: 2.95—4.63) in 2001 among women. The values for men were OR=2.27 (95% CI: 1.89—2.72) and OR=2.94 (95% CI: 2.36—3.68) respectively. Living in areas with the highest deprivation levels as compared to the lowest systematically increased the likelihood of less-than-good health. The likelihood of reporting less-than-good health among women with no formal education as compared to women with graduate-level education in municipal areas with the highest deprivation levels increased from OR=3.61 (95% CI: 2.39—5.45) in 1987 to 4.85 (95% CI: 3.06—7.69) in 2001. Among men, the corresponding magnitudes were OR=2.07 (95% CI: 1.39—3.08) and OR=4.16 (95% CI: 2.52—6.89). Conclusions: Inequalities in self-rated health increased in Spain in this period. These inequalities may be explained by the social conditions existing throughout the period of reference, and the pattern varies according to gender, municipal area deprivation levels, and the individual indicator of social position used.

We analyzed the impact of municipal areas socio-economic environment and trends in inequalities in smoking in Spain, 1987-2001. Inequalities in smoking have increased in both sexes. In males are the result of a higher decrease in the prevalence of smoking among the most advantaged groups, and in women, it is due to a higher increase among the less advantaged groups. Males residing in more deprived areas have a higher likelihood of smoking. For women, the likelihood of smoking is higher when residing in less deprived municipal areas up to 1995/1997. Individual and environmental social factors are relevant for smoking in Spain.

Background The importance of emergency systems accessible by telephone for the early attention of patients with ischemic cardiopathy is well known. In Andalusia, this service is provided by calling 061. However, studies show an insufficient use of the existing emergency system in this type of patient. Objective To identify explanations related to the decision regarding the method of transport to health-care systems, by private means of transport or 061 services, for people with ischemic cardiopathy from the onset of symptoms until their arrival at the Emergency Department. Methods Eleven focal groups were held with subjects diagnosed with ischemic cardiopathy. The discussions were related to the method of transport (using 061 or their own means of transport to a major hospital or to a nearby health facility for onward transfer), depending on the existence of previous experience and distance to the hospital. Results The method of transport is related to the degree of ignorance about what is happening, perceptions regarding the fastest way to reach the hospital, people available around the patient when the event takes place, vehicle availability and possible stressful situations. Conclusions This study provides information about the reasons for using or not using the emergency transport systems for these patients and understanding how decisions were made. The study's importance lies in the possibility of improving individuals' access to health care systems through education-based actions and a strategic information and training plan that targets patients, families and health professionals.

The studies on women, gender and health are increasingly more frequent in Spain. This research is aimed at ascertaining the topics dealt with in these publications, the disciplines studying said topics, the sex of the leading author and whether these topics have been approached from a gender-related standpoint.A search was conducted for published studies in Biomedicine, Sociology, Nursing, Anthropology and Psychology databases. The main key words used were [women or gender] and [health] and [Spain]. Original articles, reviews and monographic studies, both national and international, published within the 1990-2005 period were included. The variables taken into consideration were the topic of study, field of expertise, gender focus and sex of those publishing the work. A total of 298 works were included.The topics dealt with the most were sexual and reproductive health (39.2%) and mental health (12.4%). A total of 58.7% of the works were authored by a woman as the leading author and 47.3% had no gender focus. A total of 85.3% of the publications on sexual and reproductive health do not incorporate the gender standpoint, whilst 94.1% of the works on productive and reproductive work did however include this standpoint. A total of 80.4% of the works in Biomedicine have no gender focus.Even though they are scarce, the works having a gender focus are signed mostly by women as the leading authors. In the material studied, women's health continues to be confined to reproduction, it being necessary for other factors having a direct bearing on women's health to be included.

ResumenObjetivosSe presenta la experiencia de una evaluación del impacto en la salud realizada en 2010 sobre el proyecto de reurbanización de la calle San Fernando, vía principal de acceso al barrio de San Miguel-El Castillo, en Alcalá de Guadaíra (Sevilla). Constituye ésta una de las primeras actuaciones previstas en el Plan URBAN de regeneración social, urbana y económica del casco histórico del municipio.MétodosSe han seguido las cinco fases y los procedimientos clásicos de una evaluación del impacto en la salud. La revisión de la evidencia se ha complementado con una consulta a la población afectada en forma de taller participativo, así como con entrevistas a profesionales sociosanitarios con implicación en el barrio.ResultadosDurante las obras, los impactos negativos se relacionan con los efectos nocivos del proyecto sobre la calidad del aire, el nivel de ruidos, las restricciones a la movilidad y el riesgo de siniestralidad, en especial entre la población mayor o con movilidad reducida. Cuando finalicen, se prevén mejoras en determinantes del entorno físico tales como la accesibilidad y la conectividad del barrio con servicios sanitarios y otros bienes y servicios en otras zonas del municipio. También se prevén impactos positivos vinculados a la seguridad y el atractivo del barrio, así como nuevas oportunidades para la sociabilidad, la cohesión social y la autoestima comunitaria.ConclusionesSe trata de la primera experiencia en Andalucía cuyos resultados se han integrado en un ciclo formal de toma de decisiones de ámbito local. Ello ha permitido valorar el potencial, la aplicabilidad y la aceptación de la evaluación del impacto en la salud en el ámbito municipal, así como facilitar un proceso de aprendizaje y un pilotaje de métodos y herramientas adaptadas.AbstractObjectivesThis study describes the design and implementation of a health impact assessment (HIA) conducted in 2010 of the regeneration project of San Fernando Street, the main avenue crossing the San Miguel-El Castillo neighborhood in Alcala de Guadaíra (Seville, Spain). This project is part of the wider URBAN Plan aimed at the social, urban and economic regeneration of the city's historic center.MethodsThis experience followed the standard HIA stages and procedures. The review of published evidence was complemented with new qualitative information gathered by means of a participative workshop with the local population and interviews with social and health workers involved in the neighborhood.ResultsDuring the building stage of the project, the adverse impacts were related to a worsening of the air quality, increased noise pollution, mobility restrictions and a higher risk of accidents, particularly among older or disabled people. Once the building stage was finished, the health benefits were associated with significant improvements in physical accessibility and the population's access to health services and other goods and services. Other positive effects were the enhanced safety and attractiveness of the neighborhood and the new opportunities for socializing, social cohesion and increasing the community's self-esteem.ConclusionsThis is the first HIA experience in Andalusia whose results have been integrated into a formal cycle of decision making in the local community. This experience has provided new evidence of the potential of HIA and its applicability and acceptance at the municipal level and has has also facilitated a learning process and the piloting of new methods and tools associated with the HIA process.

Resumen Introduccion: En Espana, la actual crisis economica nos ha llevado a un lamentable fenomeno poco conocido hasta ahora: el proceso del desahucio. Nuestro objetivo ha sido evaluar habitos poco saludables como el consumo del tabaco y alcohol en un grupo de granadinos/as en riesgo de perder su vivienda habitual. Metodo: Han participado 205 personas adultas (122 mujeres y 83 hombres) a los que se les administro los items de habitos relacionados con la salud de la Entrevista Andaluza de Salud 2011. Todos los participantes estaban vinculados a la Plataforma de Afectados por la Hipoteca Stop Desahucios de Granada. Resultados: Consumo de tabaco: observamos mayor porcentaje de fumadores a diario en hombres (54.22 %), personas que no viven en pareja y trabajadores. Las personas que han entrado en el proceso judicial fuman mas cigarrillos al dia ( t = -1.944, p = .055) y perciben un aumento en el consumo de tabaco debido al proceso de desahucio ( c 2 = 8.494, p = .037). Consumo de alcohol: encontramos mayor porcentaje en hombres c 2 = 10.005, p = .019) y en personas que no viven en pareja c 2 = 8.553, p = .036); los hombres perciben un mayor aumento en el consumo de alcohol debido al proceso de desahucio ( c 2 = 20.375, p = .000). Conclusiones: El proceso de desahucio afecta negativamente a los habitos relacionados con la salud por lo que deberia priorizarse en las politicas de Salud Publica como una poblacion de riesgo. Abstract Introduction: In Spain, the current economic crisis has led to an unfortunate phenomenon little known until now: the eviction process. The aim was to eval­uate unhealthy habits such as consumption of tobacco and alcohol in a group of Granada as at risk of losing their residence. Methods: Participated 205 adult un­dergoing an eviction process from their homes (122 women and 83 men) who were given the items of health-related habits of the Andalusian Health Survey 2011. All participants were linked to the Platform Af­fected by Mortgage, Stop Desahucios of Granada. Results: Consumption of tobacco: observe higher percentage of daily smokers among men (54.22 %), people who live as a couple and workers. People who have entered the judicial process smoke more ciga­rettes per day ( t = 1944, p = .055) and perceived an increase in the consumption of tobacco from the pro­cess of eviction. ( c 2 = 8.494, p = .037). Consumption of alcohol: find higher percentage in men ( c 2 = 10.005, p = .019) and in people who do not live with a partner ( c 2 = 8,553, p = .036); men perceive a greater increase in alcohol consumption due to the eviction process ( c 2 = 20,375, p = .000). Conclu­sions: The eviction process negatively affects health-related habits and should therefore be prioritized in Public Health policies as a population at risk

Purpose To determine whether an intervention based in patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. Methods 12 month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered in two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level, and glycated haemoglobin (HbA1c) >7% (53.01mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and on the use of a tool for monitoring glycaemic control and provide feedback to patients. The control group continued standard care. The primary outcome was difference in glycated haemoglobin after 12 months. dyslipidemia, blood pressure, body mass index, and abdominal circumference were also assessed as secondary outcomes. Two level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. Results The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-groupHbA1c difference=0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidemia, blood pressure, body mass index and abdominal circumference. Conclusions In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.