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1.
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2.
Elena Raffetti Fabrizio Speziani Francesco Donato Lucia Leonardi Grazia Orizio Carmelo Scarcella Pietro Apostoli Michele Magoni 《International journal of hygiene and environmental health》2017,220(2):461-467
Introduction
A chemical factory located in Brescia, an industrialized town in North Italy, produced polychlorinated biphenyls (PCBs) since the 1930s to the 1980s, determining a relevant pollution of soil, food and people. Since 2001, following a survey carried out in the general population living in the town, the individuals with PCB serum levels higher than the reference entered a follow-up study.Methods
We performed a prospective cohort study including subjects with at least three PCB measures during the period 2003–2015. We evaluated the temporal trends of total PCB serum levels, the most common PCB congeners (PCB 138,153, 170, 180, 194 and 209), and toxic equivalency of dioxin-like PCBs using univariate and multivariate mixed models with and without a cubic-spline term for time.Results
A total of 128 subjects were enrolled (46.1% males, mean age at enrolment 57.7 years). The geometric mean of PCBs decreased from 35.4 ng/ml at 0–3 years to 29.3 ng/ml at 4–8 years and to 23.0 ng/ml at 9–12 years. A 3.8% reduction of total PCB serum levels per year was estimated using both univariate and multivariate mixed models adjusted for age; a similar reduction was found for the most common PCB congeners and for toxic equivalency. Total PCB serum levels decreased over time for each age group: ?3.9%, ?4.0% and ?3.4% for subjects aged ≤55 years, 56–65 and ≥66 years, respectively.Conclusion
A significant decrease of serum concentrations of PCBs was observed in subjects with high serum levels of these chemicals at enrolment over a twelve year period. The decrease was evident for each PCB congener and age group. 相似文献3.
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4.
5.
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6.
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7.
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8.
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
Objective
To assess changes in smoking prevalence and study roll-your-own (RYO) tobacco and e-cigarette use in the Galician population between 2007 and 2015.Methods
Data were obtained from five independent, cross-sectional studies carried out in Galicia (Spain) between 2007-2015 in the population aged 16 and over (n = 8,000/year). Prevalence of use was estimated, with 95% confidence intervals, overall, according to sex and by age group, area of residence and level of education.Results
Smoking prevalence decreased from 25.4% in 2007 to 21.8% in 2015. In 2007, 1.8% of current smokers declared that they had smoked RYO tobacco, compared to 18.6% in 2015. Among smokers, RYO tobacco consumption increased across all demographic groups. In both 2014 and 2015, ever use of e-cigarettes was 0.7%. E-cigarette use was more frequent in urban settings.Conclusion
Smoking prevalence decreased in Galicia between 2007 and 2015, and there has been rapid growth in the prevalence of RYO tobacco use. Although smokers are more likely to use e-cigarettes, both former and never smokers declared their use. The boom of RYO cigarettes and the emergence of e-cigarettes highlight the importance of having continuous surveillance systems to identify smoking behavioural changes. 相似文献9.
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10.
11.
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12.
Gabriela Barbaglia Núria D. Adroher Gemma Vilagut Ronny Bruffaerts Brentan Bunting José Miguel Caldas de Almeida Silvia Florescu Giovanni de Girolamo Ron de Graaf Josep Maria Haro Hristo Hinkov Vivianne Kovess-Masfety Herbert Matschinger Jordi Alonso 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(1):2-10
Objective
To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach.Methods
Representative samples of the adult general population (n = 13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated.Results
Health conditions explained a large proportion of full role limitation (PAF = 62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability.Conclusion
The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation. 相似文献13.
Nina Roswall Gunn Ammitzbøll Jeppe Schultz Christensen Ole Raaschou-Nielsen Steen Solvang Jensen Anne Tjønneland Mette Sørensen 《International journal of hygiene and environmental health》2017,220(6):1006-1013
Background
Traffic levels have been found a significant environmental predictor for physical inactivity. A recent study suggested that traffic noise annoyance was associated with lower physical activity.Objectives
We investigated associations between modelled residential traffic noise and leisure-time sports.Methods
In the Diet, Cancer and Health cohort, we performed cross-sectional analyses using data from the baseline questionnaire (1993–97), and longitudinal analyses of change between baseline and follow-up (2000–02). People reported participation (yes/no) and hours of leisure-time sport, from which we calculated MET hrs/week. Present and historical addresses from 1987 to 2002 were found in national registries, and traffic noise was modelled 1 and 5 years before enrolment, and from baseline to follow-up. Analyses were performed using logistic and linear regression.Results
Traffic noise exposure 5 years before baseline was associated with higher prevalence odds ratio of non-participation in leisure-time sports; significantly for road traffic noise (odds ratio (OR): 1.10; 95% confidence interval (CI): 1.07–1.13) and borderline for railway noise (OR: 1.03; 95% CI: 0.99–1.07), per 10 dB. In longitudinal analyses, a 10 dB higher road traffic noise was associated with a higher prevalence odds ratio of ceasing (OR: 1.12; 95% CI: 1.07–1.18) and a lower prevalence odds ratio of initiating (OR: 0.92; 95% CI: 0.87–0.96) leisure-time sports. Exposure to railway noise was negatively associated with baseline MET hrs/week, whereas no association was found in longitudinal analyses, or for road traffic noise.Conclusion
The study suggests that long-term exposure to residential road traffic noise is negatively associated with leisure-time sports. Results for railway noise were less consistent. 相似文献14.
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15.
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16.
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17.
Suicidal behaviours in male and female users of illicit drugs recruited in drug treatment facilities
Elisabet Arribas-Ibar Josep Maria Suelves Albert Sanchez-Niubò Antònia Domingo-Salvany M. T. Brugal 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(4):292-298
Objective
We assessed prevalence of suicidal ideation and plans among illicit drug users and their association with contextual factors, by gender.Methods
Cross-sectional study. In a sample of 511 illicit drug users recruited during spring 2012 in drug treatment and prevention facilities in Catalonia (Spain), the prevalence of suicidal ideation/plans in the last 12 months was assessed. Poisson regression was used to examine associations between suicidal ideation/plans and various factors (socio-demographic, psychological, illegal drug market activities and marginal income generation activities, which included any reported sex work, stealing, peddling, begging or borrowing on credit from a dealer).Results
The average age was 37.9 years (standard deviation: 8.62); 76.3% were men. Suicidal ideation/plans were reported by 30.8% of men and 38.8% of women, with no significant differences by age or gender. Recent aggression (male prevalence ratio [PR] = 2.2; female PR = 1.4), psychological treatment (male PR = 1.2; female PR = 1.3) and illegal/marginal income generation activities (male PR = 1.5; female PR = 1.1) were associated with suicidal ideation/plans. Men who trafficked were more likely to have suicidal ideation/plans (PR = 1.3), while prison history was positive for women (PR = 1.8) and negative for men (PR = 0.7).Conclusions
Prevalence of suicidal ideation/plans was high among illicit drug users recruited from healthcare facilities. Besides psychological variables, participation in illegal market activities and crime ought to be considered in drug users’ suicidal prevention. Suicide risk needs to be evaluated in drug treatment facilities and psychological status and context contemplated. 相似文献18.
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19.
Erika M. Redding María Teresa Ruiz-Cantero José Fernández-Sáez Marta Guijarro-Garvi 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(2):82-88