PubMed Health⌕ Search

Biomedical subjects

C Borrell

Publications and source records attributed to C Borrell.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Mortality inequalities according to education in the city of Barcelona].

BACKGROUND: In Spain, individual-based studies on inequalities in mortality are scarce by the fact that death certificate often do not complete information on occupation. This study describes socio-economic inequalities in mortality using as social indicator the level of education, because in Barcelona the mortality registry is linked with the municipal census. MATERIAL AND METHODS: 28,046 residents in Barcelona, Spain, 24 years and older who died in 1992 and 1993 were studied. The level of education of the deceased people was obtained from the municipal census. Age standardized mortality rates were calculated by each educational level by sex. The most important causes of death were studied. Poisson regression models were adjusted to obtain the mortality ratio among the educational levels (being the more educated the reference group). RESULTS: The mortality ratio by all causes in illiterate was 2.05 times higher in males (p < 0.001) and 1.62 in females (p < 0.001). The higher was the education level, the lower were the rates. This mortality pattern was observed in the majority of causes of death studied and mainly in AIDS, cirrhosis and drug overdose, also in lung cancer in males and coronary disease in females. Breast and lung cancer in females were higher in the more educated. Educational inequalities by age group were more important in the youngest people and diminished with increasing age. CONCLUSION: This results show the existence in Barcelona, Spain, of inequalities in mortality by education level in the main causes of death in males and females and in the majority of age groups.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Disabilities resulting from traffic injuries in Barcelona, Spain: 1-year incidence by age, gender and type of user.

The purpose of this study was to examine the 1-year incidence of disabilities resulting from traffic injuries among the population of Barcelona (Spain), as well as its distribution by age, gender and type of motor-vehicle user, taking into account different exposure criteria. This is a population-based cross-sectional study; subjects were all cases (n = 4080) having undergone a medical examination for a traffic injury having occurred in 1993 resulting in a disability among residents in the area of Barcelona. Subjects were considered to have suffered a disability as a result of an injury if they were prevented from carrying out their normal activities for a period of 2 days or more. In 1993, the cumulative incidence rate of disability was 237.9 cases per 100,000 inhabitants, higher for men (287.1) than for women (193.9). The 20-24 year age group showed the highest incidence of disability (607.5). The rate of incidence of disability was 95.5 per 100,000 inhabitants among occupants of two wheeled vehicles, 87.7 among car occupants and 39.9 in pedestrians. When length of exposure to traffic was taken into account, the incidence rate of disability for residents aged > 14 years was 1.09 per 100,000 hours per person per year, similar for both sexes. This study represents a first attempt to use population-based health data to evaluate the incidence of disabilities due to traffic injuries. The results allow the identification of the groups with the greatest risk and who contribute the most to disabilities resulting from injuries, especially young users of two-wheeled motor vehicles.

Accidents, Traffic↗
PubMed1998

[Correction of social inequalities in health: reform of primary health care as a strategy].

OBJECTIVES: To evaluate the impact of a policy to define priorities for the reform of primary health care services among small areas according to health and social indicators. DESIGN: Qualitative study of the changes in the provision of primary health care services after a priority setting exercise based in social and a health indicators. SETTING: The city of Barcelona (Catalonia, Spain). PARTICIPANTS: The 66 basic health areas in which the city is divided for health care planning. INTERVENTION: Areas are ranked according to their health and social indicators, giving greater priority to those areas with unfavorable indicators for the development of the reform of primary health care services and a associated allocation of resources. RESULTS: Although at first new investments were determined by preexisting processes based in opportunity criteria, clear changes are observed. Three years after, there are improvements in the provision for services in all priority areas, or they are in the midst of change. CONCLUSIONS: In a context of tightening resources and of resistance to change, it is possible to introduce objective criteria to set priorities to improve primary health care services selectively in areas with most unfavorable indicators. This process has the capacity to overrun obstacles and resistances.

Health Care Reform↗
PubMed1997

[Influence of paid work on the perceived health state in women].

BACKGROUND: Several studies show that paid work has a positive effect on women's health, although few studies have shown this relationship in Southern-European countries. The aim of this paper was to analyze the self-perceived health status of women of Barcelona, Spain according to their type of work (homemaker or worker). PATIENTS AND METHODS: Cross sectional study using the 1992 Barcelona Health Interview Survey data. SUBJECTS: 1194 women aged 25 to 64 years old. Bivariate analysis of women's perceived health status by all other variables. A logistic regression model was performed with the dependent variable being women's self-perceived health status and the independent variables: type of work (homemaker or worker), age, number of chronic diseases, medical care visits, children under 12 years and elderly over 65 years living at home and social class based on occupation. RESULTS: 15.8% of workers and 31.4% of homemakers reported poor self-perceived health status (p < 0.05). This same distribution was maintained when adjusting for all independent variables. Social class had an important relationship with health, with women from lower social classes reporting poorer self-perceived health status than homemakers from upper social classes. CONCLUSIONS: The 1992 Barcelona Health Interview Survey analysis confirms that in Barcelona as well, paid work has a positive relationship on women's self-perceived health status.

Adult↗
PubMed1997

[The factors related to the research activities of primary care physicians].

OBJECTIVE: To find the factors related with the research activities of primary care (PC) doctors in Catalonia, especially their motivation and the obstacles to research perceived by the doctors themselves. DESIGN: An observational, crossover study. SETTING: Primary care doctors in Catalonia. PARTICIPANTS: The number of doctors (1,286) was divided into two: a) doctors who had published between 1989 and 1994 (n = 146), b) doctors who had not published. INTERVENTIONS: A survey concerning personal and workplace variables was carried out by post. RESULTS: The reply percentage was 49.5% (63.7% among those who had published and 44.85% among those who had not). The multivariant analysis showed a significant link between publishing and postgraduate residence training (MIR), the fact of working in a teaching centre and working in a centre with more than ten doctors. CONCLUSIONS: Research is close related to postgraduate residence training (MIR), work in a teaching unit and PC centres with over ten doctors. Care load, lack of time and difficulty in getting financing were the main obstacles to research given by the doctors polled.

Adult↗
PubMed1997

[The underreporting of perinatal mortality: 10 years' experience of active surveillance in Barcelona].

BACKGROUND: Perinatal mortality is considered a good effectiveness health care indicator during pregnancy, deliver and early perinatal period. The aims of this investigation were to describe the magnitude and tendency of underreporting perinatal mortality in Barcelona, Spain from 1985 to 1994 and to determine underreporting predictive variables. SUBJECTS AND METHODS: Perinatal deaths between 1985 and 1994 were studied according to WHO international statistics criteria and deaths from 1988 to 1994 were also studied according to the WHO national statistics criteria. Sources of information were: Statistical Deaths Certificates and the Active Surveillance Registry that collect information about perinatal deaths directly from hospitals. A perinatal death was considered underreported if it was registered in the Active Surveillance Register but not in the Statistical Death Certificate. RESULTS: 24.5% perinatal deaths were underreported from 1985 to 1995 (according to international statistics criteria) and 24.9% from 1988 to 1994 (according national statistics criteria). In both periods underreporting decreased. Deaths in the first 24 hours of live (OR = 1.8; CI 95% = 1-3), newborns weight between 1,000 and 1,499 g (OR = 1.5; CI 95% = 0.6-3.8), hospitals with mortality registry (OR = 4; CI 95% = 2.2-7.1) and the first years of the study (OR = 0.7; CI 95% = 0.7-0.8) were predictive of underreporting. CONCLUSIONS: Underreporting perinatal deaths decreased during the study period. Deaths of newborns with low birth weight and who lived less than 24 hours were more underreported. The work developed by Active Surveillance Registry contributed to the decense of underreporting perinatal deaths.

Birth Weight↗
PubMed1997

[Mortality trends in the young people of the city of Barcelona, 1983-1993].

BACKGROUND: The aim of this study was to analyze trends in overall and cause specific mortality in young people from 15 to 34 years-old residing in the city of Barcelona (Spain) from 1983 to 1993. METHODS: Data were obtained from death certificates. The overall deaths as well as deaths due to motor vehicle accidents, suicide, AIDS and drug overdose were studied. Annual crude and standardized rates were calculated (direct method) by sex and cause of death. Simple lineal regression analysis was performed to model time trends. RESULTS: Global mortality rates increased from 65.7 per 100,000 inhabitants in 1983 to 114.1 per 100,000 inhabitants in 1993. By causes, AIDS changed from being non existent as a cause of death in 1983 to becoming the main cause of death since 1990 to the present time (standardized rate = 45.6/100,000 inhabitants for men and 18.25 for women in 1993). In addition, this cause has experienced a significant increase among people older than 20 years. Overdose was the only cause with a significant increase in all age groups in men and women. Motor vehicle crashes were the main cause of death in the youngest age group (15-19 years) with significant increases in men. CONCLUSIONS: Since 1990, AIDS and drug overdoses are the principal causes of death in young people in the city of Barcelona. Although this situation has left motor vehicle accidents in the third place, deaths from this cause have also increased.

Accidents, Traffic↗
PubMed1997

Interobserver variability of midtrimester fetal nuchal thickness.

OBJECTIVE: To assess the interobserver variability of ultrasound measured fetal nuchal thickness (NT). STUDY DESIGN: NT was measured in 103 consecutive early midtrimester pregnancies (13-18 weeks) by three ultrasonographists with different levels of expertise, in our Prenatal Unit. Measurements were obtained prior to amniocentesis, blindly in relation to other examiners' values. The Lin's concordance correlation coefficient and the Kappa statistics were used to assess concordance between observed values. RESULTS: Mean differences between pairs of observers ranged from 0.44 to 0.57 mm. A higher concordance correlation between measurements was obtained between the more experienced observers (r = 0.77 versus r = 0.51). When assigning cases with a NT > or = 5 mm to a group at risk for Down's syndrome, a high concordance between experienced ultrasonographists was observed (98% agreement; kappa = 0.90). CONCLUSIONS: Interobserver variability in NT was acceptable between experienced ultrasonographists.

Adult↗
PubMed1997

Migration within Spain, level of education, and cervical cancer screening.

Migration has been related to the utilization of preventive care services. We analysed the relation between cervical cancer screening and migration within the same country and socioeconomic status in a context in which there is no organized screening. The health survey of Barcelona (Spain) was the data source. Barcelona, a city in north eastern Spain, has experienced important migration from the south and other regions of Spain. Variables studied were the migrant women's year of arrival, age at arrival, educational attainment and Pap smear test uptake. Multivariate logistic regression analysis was performed to examine the correlations among the variables of interest. Just over 30% of the women had never had a Pap smear test. Uptake was higher among younger, educated women born either in Barcelona or abroad. After adjusting for age, migrant women were at higher risk for not participating in screening tests (odds ratio: 1.23; 1.09-1.39); but after adjusting for educational attainment and age, the odds ratio was no longer significant. This study shows that migrants within Spain have less access to preventive services, such as cervical cancer screening in an opportunistic setting. However, this association is almost completely explained by socioeconomic status. Migration could be seen as a social factor that puts people at risk of falling into lower socioeconomic status associated with poor access to screening.

Adult↗
PubMed1997

Widening social inequalities in mortality: the case of Barcelona, a southern European city.

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Validation of perinatal causes of death in death certificates].

OBJECTIVE: The objective of this study was to assess the validity of perinatal causes of death in death certificates and the influence of some variables related to perinatal mortality. PATIENTS AND METHODS: All perinatal deaths having occurred in Barcelona in 1994 and reported in death certificates were included. Additional sources of information were certificates of abortions and also other documents such as autopsy reports and medical records, that served as references to determine the most reliable or standard cause of death (SBC) The SBC was determined by a group of experts. The validity was assessed by comparing the cause of death as stated in the death certificate (BC) and the SBC, calculating the general agreement, the detection rate (DR) or sensitivity and the confirmation rate (CR) or positive predictive value. The chi-square test was used to compare proportions. RESULTS: In 166 (91.2%) of the 182 cases, the BC and SBC were assigned to the same group of the International Classification of Diseases. For congenital defects, the DR was 85.7 (95% CI: 75.1-96.3) and the CR was 81.8 (95% CI: 70.4-93.2). For problems in the perinatal period the DR was 95.6 (95% CI: 92.1-99.1) and the CR was 94.9 (95% CI: 91.2-98.6). Both were considered reliable causes. These rates were similar for the different categories of other variables (birth weight, gestational age, vital status, sex, hospital of birth, autopsy and mother's age). Nevertheless, in the study of detailed causes (3 digits of the International Classification of Diseases) the general agreement was much lower (40.1%). Except for the congenital defects of the nervous system, the remaining causes of death had a low validity. CONCLUSIONS: This study shows the low validity of detailed causes of perinatal death reported in death certificates. It is necessary to improve the completion and coding of death certificates following the WHO recommendations.

Cause of Death↗
PubMed1996

[Inequalities in health at birth: Barcelona, 1990-1991].

OBJECTIVE: To study demographic and health related variables included in the municipal birth registry. Differences among municipal districts are assessed, as an approach to the study of inequalities in pregnancy, in birth and in its care. DESIGN: Observational study, based on secondary utilization of vital statistics data. SITE: The city of Barcelona (Catalonia, Spain), for the 1990-1991 years. PARTICIPANTS: Births from women who are city residents. MAIN RESULTS: Births concentrate around maternal ages of 25-29 years and 30-34. Adolescent mothers (less than 20 years) represent only a proportion of 1.9% of all births, and births from women above 34 years 13.7%, although only 2.1% of all births are from mothers above 40 years of age. Low birth weight (less than 2,500 g) occurs in 5.6% of all births. Preterm births (less than 37 weeks) occur in 4.7% of all deliveries. Teen age fertility, births to women above 34 years, low birth weight and preterm deliveries are compared across districts. Overall, four out of ten women use a public hospital for delivery, but this varies greatly among districts. There is no information on the father for 1.6% of all births. CONCLUSIONS: The completeness of this information source is high and the municipal registry is a useful database for the analysis of inequalities in small areas, using health related indicators which have higher frequency than more traditional indicators based on rare events (such as infant mortality). Differences among areas are found, related to life conditions and to prenatal and birth care.

Abortion, Induced↗
PubMed1996

Population-based study of emergency department admissions and deaths from injuries in Barcelona, Spain: incidence, causes and severity.

The aim of this study was to estimate the incidence of morbidity and mortality due to injuries in the population over the age of 14 years in Barcelona, Spain. Injury distribution according to sex, age, external cause, place of occurrence of the injury and severity was also obtained. A one-year survey was conducted in the emergency departments of the six main hospitals in Barcelona, based on a multistage sampling. Information was collected prospectively in emergency services by specially trained non-staff interviewers. Mortality data were drawn from death certificates. The incidence rate was 74.7 injury cases per 1,000 person-years over 14 years of age, higher in males than in females. Injury rates were highest in the youngest age-group and progressively lower until people over 75 years of age. Main external causes of injury were falls, being struck or caught by objects, and traffic-related injuries. The leading specific causes of injury mortality were traffic injuries, suicides and poisonings. While the overall admission incidence was 3.34 cases per 1,000 inhabitants, the proportion of hospitalized cases was 45.0 per 1,000 injury cases admitted to emergency rooms, higher for females, for traffic injuries and in the elderly population. Ninety-six percent of injury cases had an ISS value of 8 or less, mean ISS being highest for traffic injuries and falls. Injury morbidity and mortality amongst residents of Barcelona follow sex, age and cause of injury patterns which are, overall, comparable to those observed in other industrialized countries, suggesting that similar etiologic factors might be operating in those areas. The results should enable the orientation of injury prevention policies in the urban environment targeted on the young and the elderly population.

Adolescent↗
PubMed1996

[Prevalence and characteristics associated with tobacco use in a general population in Barcelona from 1983 to 1992].

OBJECTIVES: To describe the evolution of smoking habits in the general population of Barcelona from 1983 to 1992 and motivation of smokers and the perceived social pressure to leave smoking in 1992. DESIGN: Cross-sectional descriptive study of trends. PLACE AND PARTICIPANTS: From 1983 to 1992 two health surveys were conducted with independent samples of the general population not living in an institution (n = 3,134 and n = 5,004, respectively) with an age > or = 15 years and resident in Barcelona. RESULTS: Prevalence of smoking for the study period among males had decreased significantly, from 54.6% to 46.2%, whereas in females a non-significant increase was observed, from 20.9% to 25.4%. The most marked decrease in smoking among males has occurred in the upper socioeconomic levels (I and II), whereas the increase among women has occurred in the lower socioeconomic levels (IV and V). In 1992 half of smokers of both sexes admitted the wish to leave smoking and a third part to have tried to do so sometime. Approximately 30% of smokers report to have been required to stop smoking indoor sometime. CONCLUSIONS: From 1983 and 1992 a decrease was observed in overall differences of smoking prevalence among both sexes, whereas differences associated with socioeconomic levels increased, with a higher consume in the mid-low levels. More than half of smokers wish to leave smoking, which indicates the need for spreading and reinforcing methods to leave smoking among predisposed smokers.

Adolescent↗
PubMed1995

Emergency department and hospital admissions and deaths from traffic injuries in Barcelona, Spain. A one-year population-based study.

The purpose of the study was to assess the one-year incidence of traffic injuries among residents 14 years of age and older, as well as their distribution by age, gender, road-user category, place of occurrence, and severity of the injury. A one-year survey was conducted in the emergency departments in Barcelona, Spain, based on a multistage cluster sampling of 8-hour shifts stratified by time of the year, day of the week, and time of day. All death certificates (E810-829) for residents in this same age group were also included. Information was collected prospectively in EDs by specially trained nonstaff interviewers. The baseline estimate of incidence of injuries was 1,037 per 100,000 population. The highest incidence was for ages 20-24 and 15-20 years. Incidence rank-ordered road-use categories were: motorbike occupants, passenger car occupants and pedestrians, the first category accounting for almost half of all injuries. There were 108 admissions and 15 deaths per 1,000 incident cases. Case-admissions ratios increased with age and were highest for pedestrians, who also accounted for the highest case-fatality ratios and ISS mean scores. The study offers the first description of the epidemiology of traffic injuries in a large southern-European city. Although overall age and gender incidence patterns were similar to those described in other western countries, the striking contribution of motorcycle injuries has not been previously pointed out, underscoring the urgent need to implement effective strategies to reduce injury risk associated with motorcycles and mopeds.

Accidents, Traffic↗
PubMed1995

Socioeconomic factors and mortality in urban settings: the case of Barcelona, Spain.

STUDY OBJECTIVE: This study aimed to describe the relationship between health and socioeconomic indicators in the 38 neighbourhoods of the city of Barcelona, Spain. DESIGN: Mortality data for 1983-89 and socioeconomic data for each of the 38 neighbourhoods of Barcelona were used. Mortality indicators used were the comparative mortality figure, the ratio of potential years of life lost, and life expectancy at birth. Socioeconomic indicators were the percentage of unemployed, the percentage of illiteracy, monthly telephone usage, the average power and age of cars, and the average rateable value of buildings and of land. The statistical correlation between socioeconomic indicators and mortality indicators was studied by Spearman's rank correlation coefficient. SETTING: The 38 neighbourhoods of Barcelona, Spain. MEASUREMENTS AND MAIN RESULTS: The comparative mortality figure ranged from 87.41-152.43 and the ratio of potential years of life lost from 74.94-237.31 in both sexes. Both the absolute difference and the ratio of the value for the neighbourhood with lowest mortality and that with highest mortality were larger when premature mortality was examined. Life expectancy at birth ranged from 64.77-75.32 years in men and 75.04-81.51 in women. All correlations between mortality and socioeconomic indicators were high and statistically significant: the higher the unemployment and illiteracy levels and the older the cars, the greater the comparative mortality figure and ratio of potential years of life lost, and the lower the life expectancy (negative correlations). Conversely, the higher the telephone use, the more powerful the cars, and the greater the rateable value, the lower the mortality (negative correlations) and the greater the life expectancy. These correlations were greater in males than in females. The highest correlations were with illiteracy. CONCLUSIONS: This study has detected significant differences in mortality in a large town in the Mediterranean region of Europe.

Adolescent↗