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1.
Objective
To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE).Methods
We surveyed 195 hospital (n = 113) and PC (n = 82) managers from eight autonomous communities to explore the level of implementation of five interventions recommended after an AE to protect the reputation of healthcare institutions.Results
Most institutions (70, 45.2% PC, and 85, 54.8% hospitals) did not have a crisis plan to protect their reputation after an AE. Internal (p = 0.0001) and external (p = 0.012) communications were addressed better in PC than in hospitals. Very few institutions had defined the managers’ role in case of an AE (10.7% hospitals versus 6.25% PC).Conclusion
A majority of healthcare institutions have not planned crisis intervention after an AE with severe consequences nor have they defined plans to recover citizens’ trust after an AE. 相似文献2.
Ramon Mir-Abellán Anna Falcó-Pegueroles María Luisa de la Puente-Martorell 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(2):145-149
Objective
To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables.Methods
The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative.Results
59% (n = 123) of respondents rated safety between 7 and 8. 53% (n = 103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was “teamwork in the unit/service” and the opportunity for improvement was “staffing”. A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff.Conclusions
This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies. 相似文献3.
Cristina Martínez Carlos Méndez María Sánchez José María Martínez-Sánchez 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(2):132-138
Objective
To assess attitudes towards the extension of outdoor smoke-free areas on university campuses.Methods
Cross-sectional study (n = 384) conducted using a questionnaire administered to medical and nursing students in Barcelona in 2014. Information was obtained pertaining to support for indoor and outdoor smoking bans on university campuses, and the importance of acting as role models. Logistic regression analyses were performed to examine agreement.Results
Most of the students agreed on the importance of health professionals and students as role models (74.9% and 64.1%, respectively) although there were statistically significant differences by smoking status and age. 90% of students reported exposure to smoke on campus. Students expressed strong support for indoor smoke-free policies (97.9%). However, only 39.3% of participants supported regulation of outdoor smoking for university campuses. Non-smokers (OR = 12.315; 95% CI: 5.377-28.204) and students ≥22 years old (OR = 3.001; 95% CI: 1.439-6.257) were the strongest supporters.Conclusions
The students supported indoor smoke-free policies for universities. However, support for extending smoke-free regulations to outdoor areas of university campuses was limited. It is necessary to educate students about tobacco control and emphasise their importance as role models before extending outdoor smoke-free legislation at university campuses. 相似文献4.
Xavier Continente Anna Pérez Albert Espelt Carles Ariza María José López 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(4):332-335
Objective
We aimed to analyse the prevalence of having multiple lifestyle risk behaviours (LRB) and the potential relationship between excess weight (including overweight and obesity) and cumulative multiple LRB among adolescents in Barcelona, Spain.Methods
A cross-sectional study was performed among a representative sample of 3,114 secondary school students in Barcelona. Height and weight were objectively measured and excess weight was defined in accordance with World Health Organization criteria. Information on screen time, breakfast, physical activity and sleep duration was obtained through a self-administered questionnaire.Results
More than 80% of the students had at least two LRBs. In compulsory schooling, the adjusted prevalence ratio (aPR) of excess weight increased with a higher number of reported LRBs (four LRBs: aPR = 1.56; 95% confidence interval: 1.19-2.05).Conclusions
These results highlight the importance of a multiple-behaviour approach in preventive programmes aimed at reducing adolescent obesity. 相似文献5.
Anna Maria Ingelido Vittorio Abate Annalisa Abballe Fulvia Lucia Albano Tatiana Battista Valter Carraro Michele Conversano Rosa Corvetti Silvia De Luca Silva Franchini Anna Rita Fulgenzi Laura Giambanco Nicola Iacovella Anna Laura Iamiceli Antonio Maiorana Francesco Maneschi Valentina Marra Flavia Pirola Elena De Felip 《International journal of hygiene and environmental health》2017,220(2):378-386
Background
Polychlorinated dibenzodioxins (PCDDs), polychlorodibenzofurans (PCDFs), and polychlorobiphenyls (PCBs) are persistent organic pollutants that represent a major concern for women of reproductive age because of the neurodevelopmental effects associated to perinatal exposure.Objectives
This study was aimed at characterizing exposure of women of reproductive age to PCDDs, PCDFs, and PCBs as a function of residence in different Italian Regions, in areas at presumable different environmental contamination and human exposure to these pollutants.Methods
Study participants were enrolled in 2011–2012 in 6 Italian Regions representative of Northern, Central and Southern Italy; in each region, areas at presumed different exposure (rural, urban and industrial) were selected for enrolment. Each participant provided a serum sample for the analysis of PCDDs, PCDFs and PCBs.Results
Median concentrations of PCDDs + PCDFs, DL-PCBs, NDL6-PCBs and NDL9-PCBs in serum samples were respectively 6.0 and 3.5 pgWHO-TE05/g fat, and 75 and 93 ng/g fat.Age was the variable that most affected median serum concentrations.Age adjusted concentrations were found significantly different between geographical zones: women from Northern Italy showed the highest values, followed by Central and Southern Italy.PCDDs + PCDFs concentrations were significantly higher in the group of women residing in industrial areas compared to the group residing in rural areas.A clear diminishing temporal trend was observed compared to levels reported in previous studies.Conclusions
This study produced the largest dataset on serum concentrations of PCDDs, PCDFs and PCBs in women of childbearing age in Italy.Results
confirmed that environmental and lifestyle factors may influence exposure to these contaminants and thereby the body burden.The observed marked temporal decline in body burden during three decades is in agreement with the general trend observed worldwide. 相似文献6.
Martin Emmert Fatemeh Taheri-Zadeh Benjamin Kolb Uwe Sander 《Health policy (Amsterdam, Netherlands)》2017,121(1):17-26
Background
Evidence from the US has demonstrated that hospital report cards might generate confusion for consumers who are searching for a hospital. So far, little is known regarding hospital ranking agreement on German report cards as well as underlying factors creating disagreement.Objective
This study examined the consistency of hospital recommendations on German hospital report cards and discussed underlying reasons for differences.Methods
We compared hospital recommendations for three procedures on four German hospital report cards. The agreement between two report cards was determined by Cohen’s-Kappa. Fleiss’ kappa was applied to evaluate the overlap across all four report cards.Results
Overall, 43.40% of all hospitals were labeled equally as low, middle, or top performers on two report cards (hip replacement: 43.2%; knee replacement: 42.8%; percutaneous coronary intervention: 44.3%). In contrast, 8.5% of all hospitals were rated a top performer on one report card and a low performer on another report card. The inter-report card agreement was slight at best between two report cards (κmax = 0.148) and poor between all four report cards (κmax = 0.111).Conclusions
To increase the benefit of public reporting, increasing the transparency about the concept of – medical – “quality” that is represented on each report card seems to be important. This would help patients and other consumers use the report cards that most represent one’s individual preferences. 相似文献7.
8.
Cristina Vert Gonzalo Sánchez-Benavides David Martínez Xavier Gotsens Nina Gramunt Marta Cirach José Luis Molinuevo Jordi Sunyer Mark J. Nieuwenhuijsen Marta Crous-Bou Mireia Gascon 《International journal of hygiene and environmental health》2017,220(6):1074-1080
Background
The association between exposure to air pollutants and mental disorders among adults has been suggested, although results are not consistent.Objective
To analyze the association between long-term exposure to air pollution and history of anxiety and depression disorders and of medication use (benzodiazepines and antidepressants) in adults living in Barcelona.Methods
A total of 958 adults (45–74 years old) residents in Barcelona, most of them having at least one of their parents diagnosed with dementia (86%), and participating in the ALFA (Alzheimer and Families) study, were included. We used Land Use Regression (LUR) models to estimate long-term residential exposure (period 2009–2014) to PM2.5, PM2.5 absorbance (PM2.5 abs), PM10, PM coarse, NO2 and NOx. Between 2013 and 2014 participants self-reported their history of anxiety and depression disorders and related medication use. The analysis was focused on those participants reporting outcome occurrence from 2009 onwards (until 2014).Results
We observed an increased odds of history of depression disorders with increasing concentrations of all air pollutants [e.g. an increased odds of depression of 2.00 (95% CI; 1.37, 2.93) for each 10 μg/m3 NO2 increase]. Such associations were consistent with an increased odds of medication use in relation to higher concentrations of air pollutants [e.g. an increased odds of antidepressants use of 1.23 (1.04, 1.44) for each 20 μg/m3 NOx increase]. Associations regarding anxiety disorders did not reach statistical significance.Conclusions
Our study shows that increasing long-term exposure to air pollution may increase the odds of depression and the use of antidepressants and benzodiazepines. Further studies are needed to replicate our results and confirm this association. 相似文献9.
10.
Riyadh Alshamsan Hannah Leslie Azeem Majeed Margaret Kruk 《Health policy (Amsterdam, Netherlands)》2017,121(3):315-320
Background
Countries globally are pursuing universal health coverage to ensure better healthcare for their populations and prevent households from catastrophic expenditure. The countries of the Gulf Cooperation Council (GCC) have and continue to implement reforms to strengthen their health systems. A common theme between the countries is their pursuit of universal health coverage to provide access to necessary health care without exposing people to financial hardship.Methods
Using nationally representative data from the Global Findex study, we sought to analyze the hardship faced by individuals from four high-income countries in the GCC. We estimated the weighted proportion of individuals borrowing for medical reasons and those who are not able to obtain emergency funds. We further examined variations in these outcomes by key socioeconomic factors.Results
We found up to 11% of respondents borrowed money for medical purposes, double of that reported in other high-income countries. In contrast to affluent respondents, we found that respondents from deprived background were more likely to borrow money for medical purposes (adjusted odds ratio: 1.81, P < 0.001) and expected to fail in obtaining emergency funds (adjusted odds ratio: 4.03, P < 0.001).Conclusion
In moving forward with their reforms, GCC countries should adopt a financing strategy that addresses the health needs of poorer groups in their pursuit of universal health coverage. 相似文献11.
12.
Seungho Lee Miyeon Shin Yun-Chul Hong Jin Hee Kim 《International journal of hygiene and environmental health》2017,220(2):407-414
Background
Biological measurements have been employed as useful biomarkers for exposure. Because of its property of reflecting toxicokinetic differences, however, within-subject variability leads to biased results in epidemiologic studies.Method
We examined the variability of lead (Pb), mercury (Hg), and cadmium (Cd) levels in blood samples from 1429 participants among 1677 elderly individuals aged over 60 years who lived in an urban area from August 2008 to April 2015.Results
The geometric means of blood Pb, Hg, Cd were 1.92 μg/dL, 2.48 μg/L, and 1.33 μg/L, and the intra-class correlations (ICCs) were 0.81, 0.71, and 0.83, respectively. The mean values of Pb and Hg levels in this study were lower than the results from single spot samples in other national biomonitoring surveys in Korea, with the exception of Cd was higher than those in other studies. Moreover, the predicted exceedances over the guidance levels for Pb, Hg, and Cd were 1.9%, 4.2%, and 0.3%, respectively.Conclusion
Korean elderly were exposed to high levels of Pb, Hg and Cd. Especially, those who had high levels of Cd were continuously exposed to Cd during study period with the 6 collection intervals. Therefore, factors affecting environmental Cd exposure should be further studied in the future. 相似文献13.
Alison Connolly Kate Jones Karen S. Galea Ioannis Basinas Laura Kenny Padraic McGowan Marie Coggins 《International journal of hygiene and environmental health》2017,220(6):1064-1073
Background
Pesticides and their potential adverse health effects are of great concern and there is a dearth of knowledge regarding occupational exposure to pesticides among amenity horticulturalists.Objective
This study aims to measure occupational exposures to amenity horticuturalists using pesticides containing the active ingredients, glyphosate and fluroxypyr by urinary biomonitoring.Methods
A total of 40 work tasks involving glyphosate and fluroxypyr were surveyed over the period of June – October 2015. Workers used a variety of pesticide application methods; manual knapsack sprayers, controlled droplet applicators, pressurised lance applicators and boom sprayers. Pesticide concentrations were measured in urine samples collected pre and post work tasks using liquid chromatography tandem mass spectrometry (LC–MS/MS). Differences in pesticide urinary concentrations pre and post work task, and across applications methods were analysed using paired t-tests and linear regression.Results
Pesticide urinary concentrations were higher than those reported for environmental exposures and comparable to those reported in some agricultural studies. Log-transformed pesticide concentrations were statistically significantly higher in post-work samples compared to those in pre-work samples (paired t-test, p < 0.001; for both μg L?1 and μmol/mol creatinine). Urinary pesticide concentrations in post-work samples had a geometric mean (geometric standard deviation) of 0.66 (1.11) μg L?1 for glyphosate and 0.29 (1.69) μg L?1 for fluroxypyr. Linear regression revealed a statistically significant positive association to exist between the time-interval between samples and the log-transformed adjusted (i.e. post- minus pre-task) pesticide urinary concentrations (β = 0.0039; p < 0.0001).Conclusion
Amenity horticulturists can be exposed to pesticides during tasks involving these products. Further research is required to evaluate routes of exposure among this occupational group. 相似文献14.
Borami Ahn Shin-Hye Kim Mi-Jung Park 《International journal of hygiene and environmental health》2017,220(1):37-42
Objective
To assess blood cadmium levels in Korean adolescents with respect to demographic and lifestyle factors.Methods
We analyzed data from the Korea National Health and Nutrition Examination Survey from 2010 to 2013, totaling 1472 adolescents aged 10–18 years. Geometric means of blood cadmium were calculated using a complex samples general linear model to compare blood levels in different demographic and lifestyle groups. Multivariate logistic regression analyses were also used to find predictors for high blood cadmium (>90th percentile).Results
The geometric mean of the blood cadmium concentrations was 0.30 μg/L in Korean adolescents. Older age, type of housing (multifamily house and commercial building), smoking and alcohol consumption, and iron deficiency/iron deficiency anemia (IDA) were significantly associated with higher blood cadmium concentrations (P < 0.05). Blood cadmium concentrations were not significantly affected by gender, region, body mass index status, or household income. In multivariate logistic regression analysis, independent predictors for higher blood cadmium levels included current smoker (OR = 7.77), alcohol consumption (OR = 4.31), living in a multifamily house or commercial building (OR = 3.11–3.46), and IDA (OR = 2.64).Conclusions
Possible associations between blood cadmium levels and type of housing or alcohol consumption in adolescents are suggested for the first time in this study. Further studies are needed to elucidate the mechanism of these findings. 相似文献15.
Steffen Andreas Schüle Katharina M.A. Gabriel Gabriele Bolte 《International journal of hygiene and environmental health》2017,220(4):711-718
Background
The environmental justice framework states that besides environmental burdens also resources may be social unequally distributed both on the individual and on the neighbourhood level. This ecological study investigated whether neighbourhood socioeconomic position (SEP) was associated with neighbourhood public green space availability in a large German city with more than 1 million inhabitants.Methods
Two different measures were defined for green space availability. Firstly, percentage of green space within neighbourhoods was calculated with the additional consideration of various buffers around the boundaries. Secondly, percentage of green space was calculated based on various radii around the neighbourhood centroid. An index of neighbourhood SEP was calculated with principal component analysis. Log-gamma regression from the group of generalized linear models was applied in order to consider the non-normal distribution of the response variable. All models were adjusted for population density.Results
Low neighbourhood SEP was associated with decreasing neighbourhood green space availability including 200 m up to 1000 m buffers around the neighbourhood boundaries. Low neighbourhood SEP was also associated with decreasing green space availability based on catchment areas measured from neighbourhood centroids with different radii (1000 m up to 3000 m). With an increasing radius the strength of the associations decreased.Conclusions
Social unequally distributed green space may amplify environmental health inequalities in an urban context. Thus, the identification of vulnerable neighbourhoods and population groups plays an important role for epidemiological research and healthy city planning. As a methodical aspect, log-gamma regression offers an adequate parametric modelling strategy for positively distributed environmental variables. 相似文献16.
Xinyang Hua Guido Erreygers John Chalmers Tracey-Lea Laba Philip Clarke 《Health policy (Amsterdam, Netherlands)》2017,121(4):426-433
Objectives
Australia’s universal health insurance system Medicare generates very large amounts of data on out-of-pocket expenditure (OOPE), but only highly aggregated statistics are routinely published. Our primary purpose is to develop indices from the Medicare administrative data to quantify changes in the level and distribution of OOPE on out-of-hospital medical services over time.Methods
Data were obtained from the Australian Hypertension and Absolute Risk Study, which involved patients aged 55 years and over (n = 2653). Socio-economic and clinical information was collected and linked to Medicare records over a five-year period from March 2008. The Fisher price and quantity indices were used to evaluate year-to-year changes in OOPE. The relative concentration index was used to evaluate the distribution of OOPE across socio-economic strata.Results
Our price index indicates that overall OOPE were not rising faster than inflation, but there was considerable variation across different types of services (e.g. OOPE on professional attendances rose by 20% over a five-year period, while all other items fell by around 14%). Concentration indices, adjusted for demographic factors and clinical need, indicate that OOPE tends to be higher among those on higher incomes.Conclusions
A major challenge in utilizing large administrative data sets is to develop reliable and easily interpretable statistics for policy makers. Price, quantity and concentration indices represent statistics that move us beyond the average. 相似文献17.
Carmen Franken Nathalie Lambrechts Eva Govarts Gudrun Koppen Elly Den Hond Daniëlla Ooms Stefan Voorspoels Liesbeth Bruckers Ilse Loots Vera Nelen Isabelle Sioen Tim S. Nawrot Willy Baeyens Nicolas Van Larebeke Greet Schoeters 《International journal of hygiene and environmental health》2017,220(2):468-477
Background
In Belgium, around 8.5% of the children have asthmatic symptoms. Increased asthma risk in children has been reported in relation to exposure to phthalate plasticizers but the underlying mechanisms are largely unknown.Aim
The aim of this study was to identify if oxidative stress, assessed by excision of 8-hydroxydeoxyguanosine (8-OHdG) from damaged DNA, is an intermediate marker for the association between phthalate exposure and doctor-diagnosed asthma.Material and methods
In 418 14–15-year-old youngsters, recruited as a representative sample of residents of Flanders (Belgium), personal exposure to phthalates was assessed by measuring phthalate metabolites in urine: mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-n-butyl phthalate (MnBP), mono-benzyl phthalate (MBzP), mono-isobutyl phthalate (MiBP) and mono-ethyl phthalate (MEP). Analysis of 8-OHdG in urine was used as a sensitive biomarker of oxidative stress at the level of DNA. The presence of doctor-diagnosed asthma was elicited by a self-administered questionnaire. Associations were assessed using multiple linear and logistic regression models. Mediation was tested using Baron and Kenny's regression approach.Results
A significant increased risk of a youngster being diagnosed with asthma was found for both urinary MnBP (metabolite of dibutyl phthalate (DBP)) and the sum of the three di(2-ethylhexyl) phthalate metabolites (ΣDEHP = MEHP + MEHHP + MEOHP), with respective odds ratio of 1.84 [95% CI: 1.02, 3.32] for MnBP and 1.94 [95% CI: 1.07, 3.51] for ΣDEHP. In addition, we observed significant associations between all urinary phthalate metabolites and increased urinary levels of 8-OHdG. The associations were stronger in girls than in boys. We did not found evidence that 8-OHdG was associated with doctor-diagnosed asthma.Conclusion
The results of our study are in line with other findings from epidemiological surveys and raise further concern about DEHP and DBP as risk factors for asthma, however, the underlying mechanisms are not yet well understood. 相似文献18.
19.
Maria Victoria Zunzunegui Emmanuelle Belanger Tarik Benmarhnia Milena Gobbo Angel Otero François Béland Fernando Zunzunegui Jose Manuel Ribera-Casado 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(4):313-319
Objective
To examine whether financial fraud is associated with poor health sleeping problems and poor quality of life.Methods
Pilot study (n = 188) conducted in 2015–2016 in Madrid and León (Spain) by recruiting subjects affected by two types of fraud (preferred shares and foreign currency mortgages) using venue-based sampling. Information on the monetary value of each case of fraud; the dates when subjects became aware of being swindled, lodged legal claim and received financial compensation were collected. Inter-group comparisons of the prevalence of poor physical and mental health, sleep and quality of life were carried according to type of fraud and the 2011–2012 National Health Survey.Results
In this conventional sample, victims of financial fraud had poorer health, more mental health and sleeping problems, and poorer quality of life than comparable populations of a similar age. Those who had received financial compensation for preferred share losses had better health and quality of life than those who had not been compensated and those who had taken out foreign currency mortgages.Conclusion
The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation. 相似文献20.
Marina Tarrazo Mónica Pérez-Ríos María I. Santiago-Pérez Alberto Malvar Jorge Suanzes Xurxo Hervada 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(3):204-209