Predictores de la duración de la incapacidad temporal por contingencias comunes en los trastornos de ansiedad

Objectives

To analyze the duration of non-work-related sick leave due to anxiety disorders and to identify demographic, occupational and clinical variables that may contribute to its prediction.

Methods

We performed a prospective cohort study of 1,161 workers with an episode of non-work-related sick leave due to an anxiety disorder, belonging to the insured population of a mutual insurance company. We assessed the duration of non-work-related sick leave episodes and the main potentially related demographic, occupational and clinical variables. All non-work-related sick leave processes were followed-up until discharge. Cox regression analyses were conducted to establish the predictors of non-work-related sick leave duration.

Results

The median duration of non-work-related sick leave due to anxiety disorders was 83 days. In a multivariate analysis, the following factors were identified as being significantly associated with increases in the duration of sick leave (p <0.05): age of over 35 years, lower educational level (primary school studies, secondary school studies or high-school diploma vs. university degree), and the existence of comorbidity and unemployment occurring during the sick leave. In contrast, being separated or divorced was associated with an earlier return to work (p <0.05).

Conclusions

Anxiety disorders are associated with long periods of non-work-related sick leave compared with other disorders and standard time duration. Demographic, occupational and clinical variables collected at the initial assessment of the sick leave episode would help to identify groups with an increased risk of prolonged sick leave, requiring strategies to facilitate return to work.     

Reflexiones bioéticas sobre el cuidado prematuro desencadenado por el diagnóstico precoz de la enfermedad de Alzheimer

Early diagnosis of Alzheimer disease raises important bioethical issues. In the interval between early disease detection and symptom onset, there is a time in which the patient's autonomy, privacy, and dignity may be undermined by certain healthcare measures or by family care and support. These measures may eventually turn patients into an object of care, preventing them from accepting the disease, developing an identity, and rearranging their living spaces. Every effort should be made to ensure that care does not become compassionate harassment or an invasive act, annulling the patient's autonomy, identity, and self-determination.     

Recuperar y conservar al familiar: estrategias de los familiares cuidadores para hacer frente a las crisis de salud mental

AimTo know and understand the strategies carried out by the relatives of people with mental health problems in the care of their sick relatives.DesignQualitative studySettingMental Health Service (SESCAM) and Social Health Centres of Castilla-La Mancha region (Spain).ParticipantsTwenty-four adult family members who live and care for a family member who suffers a mental health crisis. The participants were contacted both through the health directorate of the area and a social health foundation. They were selected with purpose and by snowball sampling.MethodTwenty-two semi-structured were conducted and analysed according to the constructivist grounded theory procedures between January 2014 and February 2016. The theoretical sampling guided the obtaining of the data that ended with the saturation of the emerging categories.ResultsA person with a mental problem during a crisis becomes a stranger and is inaccessible to family members. In this situation the efforts are aimed at the recovery of the relative, to take them out of the unreason and to keep them in a day-to-day normality constructed for them. Thanks to this, the ill relative is integrated into family life.ConclusionsFamily caregivers of people with mental problems struggle not to lose them in a crisis and to maintain family ties. Primary care professionals must give importance to these links, because it determines their care strategies during a crisis and the strategies to conserve the family member.     

Desigualdades sociales en salud en población mayor: una aportación desde la salud pública al debate sobre el retraso de la edad de jubilación en España

Objective

To analyse the inequalities in life expectancy in the Spanish population over the age of 65 according to educational level.

Evolución de la prestación real media en España por edad y sexo (1998-2008) y su repercusión en las proyecciones de gasto sanitario público

Objectives

To analyze changes in real per capita spending by age and sex from 1998 to 2008 in Spain, and to assess their effects on public healthcare expenditure projections.

Methods

Age- and sex-related expenditure profiles in constant terms were estimated for the Spanish population for 3 distinct years (1998, 2003 and 2008) by using data from hospital records and several National Health Surveys. These profiles were used to compare actual healthcare expenditure for 2003 and 2008 with the projections obtained by considering 1998 as the base year and by applying the methodology used by the Working Group on Aging of the European Union.

Results

The average annual growth rate of real per capita spending per person from 1998 to 2008 was 2.79%, which was higher than the GDP per capita growth rate (1.90%), basically due to its high rate of increase in the second half of the decade. From 1998 to 2008, per capita healthcare expenditure increased in most age groups, particularly in the groups aged 45-49 years, 60-64 years and 75 years and older. Projections of per capita expenditure in constant terms covered the real value observed for 2003, but were below the real value for 2008.

Conclusions

Changes in the quantity and quality of healthcare services consumed by each person are an important factor in changes in healthcare expenditure and must be included in spending projections.