Biomedical subjects

Joan Benach

Publications and source records attributed to Joan Benach.

At least 19 recordsLinked to original sources

PubMed2006

Higher smoking prevalence in urban compared to non-urban areas: time trends in six European countries.

We investigated differences in smoking prevalence between urban and non-urban area of residence in six Western European countries (Sweden, Finland, Denmark, Germany, Italy and Spain), and smoking prevalence trends over the period 1985-2000. In most countries, smoking prevalence was highest in urban areas, and increased with urbanization. Urban/non-urban inequalities were most pronounced among individuals with low education levels, and also among females. There were no significant differences in annual rate of change in smoking prevalence between non-urban and urban areas.

Adult↗

PubMed2006

Is precarious employment more damaging to women's health than men's?

Current global economic trends in both developed and developing countries, including unregulated labor markets, trade competition and technological change, have greatly expanded a complex labor market situation characterised by many employees working under temporary work status, job insecurity, low social protection and low income level. Although the health of women is disproportionately affected by workplace flexibility, this has been largely ignored. The main purpose of this paper is to draw attention to this relevant but neglected topic.

Economic Competition↗

PubMed2006

Socioeconomic position and excess mortality during the heat wave of 2003 in Barcelona.

The objective of this study is to determine whether the excess of mortality which occurred in Barcelona during the summer of 2003 was dependent on age, gender and educational level. We included all deaths among Barcelona residents 20 years of age and older that occurred in the city during the months of June, July and August of 2003 and also during the same months of the five preceding years. Poisson regression models were fitted to obtain the risk of death in 2003 with respect to the period 1998-2002. The relative risk (RR) of mortality during the summer of 2003, compared to the summers of the previous 5 years, was higher for women than for men and among older ages. Although an increase among women was observed in all educational groups, in some age groups the increase was larger for people with less than primary education. The excess number of deaths was higher for those with less education. These results suggest that age, gender and educational level were important determinants of excess mortality in the 2003 Barcelona heat wave.

Adult↗

PubMed2006

Politics and health outcomes.

The aim of this study was to examine the complex interactions between political traditions, policies, and public health outcomes, and to find out whether different political traditions have been associated with systematic patterns in population health over time. We analysed a number of political, economic, social, and health variables over a 50-year period, in a set of wealthy countries belonging to the Organisation for Economic Co-operation and Development (OECD). Our findings support the hypothesis that the political ideologies of governing parties affect some indicators of population health. Our analysis makes an empirical link between politics and policy, by showing that political parties with egalitarian ideologies tend to implement redistributive policies. An important finding of our research is that policies aimed at reducing social inequalities, such as welfare state and labour market policies, do seem to have a salutary effect on the selected health indicators, infant mortality and life expectancy at birth.

Canada↗

PubMed2006

Social class, education, and smoking cessation: Long-term follow-up of patients treated at a smoking cessation unit.

Our objective was to examine social class and educational differences in long-term smoking cessation success among a cohort of smokers attending a specialized smoking clinic. We studied sustained abstinence after cessation among 1,516 smokers (895 men and 621 women) treated for smoking cessation between 1995 and 2001 at a university teaching hospital in the metropolitan area of Barcelona, Spain. We calculated 1-year and long-term (up to 8-year) abstinence probabilities by means of Kaplan-Meier curves and the hazard ratio of relapse by means of Cox regression, after adjusting for other predictors of relapse. Overall abstinence probability was .277 (95% CI = .254-.301). Men and women in social classes IV-V had significant hazard ratios of relapse after long-term follow-up (men: 1.36, 95% CI = 1.07-1.72; women: 1.60, 95% CI = 1.24-2.06), as compared with patients in social classes I-II. The same independent effect was observed for education: Men and women with primary or less than primary studies had higher hazard ratios of relapse (men: 1.75, 95% CI = 1.35-2.25; women: 1.92, 95% CI = 1.51-2.46), as compared with patients with a university degree. Similar estimates were obtained after adjustment for stage of change, Fagerström score for nicotine dependence, and type of treatment. Patients of lower socioeconomic status are at higher risk of relapse, and this association is independent of other well-known predictors of relapse. Social differences have to be taken into account in the clinical setting when tailoring specific actions to treat smoking dependence.

Adult↗

PubMed2006

Dental health differences by social class in home-dwelling seniors of Barcelona, Spain.

BACKGROUND: The aim of this study was to assess dental health differences by social class in home-dwelling seniors in Spain. METHODS: A cross-sectional household survey of a cohort of senior residents in Barcelona (Spain) was undertaken. Of 891 survivors (72 years or older), 561 (62.9%) oral examinations were completed according to the DMF Index (Decayed, Missing and Filled teeth). RESULTS: 42% of participants were edentate. The individuals of social class IV-V were more likely to be edentate, and to have fewer than 15 teeth compared to those in social class I-II. The DMF Index in dentate individuals (Adjusted mean=16.4) also showed significantly worse dental health for lower social classes (p = 0.001). CONCLUSIONS: The results of this study indicate a different level of utilization of dental health services and dental health by social class in home-dwelling seniors. Further research is needed to understand the barriers of access and social inequality.

Age Factors↗

PubMed2006

Venezuela's Barrio Adentro: an alternative to neoliberalism in health care.

Throughout the 1990s, all Latin American countries but Cuba implemented health care sector reforms based on a neoliberal paradigm that redefined health care less as a social right and more as a market commodity. These reforms were couched in the broader structural adjustment of Latin American welfare states as prescribed by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program, Misión Barrio Adentro (Inside the Neighborhood). In this article, the authors review the main features of the Venezuelan health care reform, analyzing, within their broader sociopolitical and economic contexts, previous neoliberal health care reforms that mainly benefited transnational capital and domestic Latin American elites. They explain the emergence of the new health care program, Misión Barrio Adentro, examining its historical, social, and political underpinnings and the central role played by popular resistance to neoliberalism. This program not only provides a compelling model of health care reform for other low- to middle-income countries but also offers policy lessons to wealthy countries.

Journal Article↗

PubMed2006

Work organization, economic inequality, and depression among nursing assistants: a multilevel modeling approach.

To investigate the relationships among the nursing home work environment, emotional strain, and depression in Nursing Assistants in Ohio and West Virginia, this cross-sectional study was conducted with 395 Nurse Assistants in 49 nursing homes in Ohio and West Virginia. Organizational attributes were measured independently at the individual and organizational levels. Multilevel modeling techniques were used to analyze the data. Our methods examined nursing home organizational structure (ownership type, managerial style), and work organization (emotional strain) was examined in relation to the prevalence of depression among nursing assistants. Our findings suggest workplace emotional strain and age are associated with increased odds of depression. Implications of our work include that work in nursing homes for the environment it fosters has a strong effect on emotional strain and depression among Nursing Assistants.

Adult↗

PubMed2005

Social inequalities in the impact of flexible employment on different domains of psychosocial health.

STUDY OBJECTIVES: (1) To analyse the impact of flexible employment on mental health and job dissatisfaction; and (2) to examine the constraints imposed by flexible employment on men's and women's partnership formation and people's decision to become parents. For the two objectives the potentially different patterns by sex and social class are explored. DESIGN: Cross sectional health survey. Multiple logistic regression models separated for sex and social class (manual and non-manual workers) and controlling for age were fitted. Four types of contractual arrangements have been considered: permanent, fixed term temporary contract, non-fixed term temporary contract, and no contract. SETTING: Catalonia (a region in the north east of Spain). PARTICIPANTS: Salaried workers interviewed in the 2002 Catalonian health survey with no longstanding limiting illness, aged 16-64 (1474 men and 998 women). MAIN RESULTS: Fixed term temporary contracts were not associated with poor mental health status. The impact of other forms of flexible employment on mental health depended on the type of contractual arrangement, sex, and social class and it was restricted to less privileged workers, women, and manual male workers. The impact of flexible employment on living arrangements was higher in men. Among both manual and non-manual male workers, those with fixed term temporary contracts were less likely to have children when married or cohabiting and, additionally, among non-manual male workers they also were more likely to remain single (aOR = 2.35; 95%CI = 1.13 to 4.90). CONCLUSION: Some forms of temporary contracts are related to adverse health and psychosocial outcomes with different patterns depending on the outcome analysed and on sex and social class. Future research should incorporate variables to capture situations of precariousness associated with flexible employment.

Adolescent↗

PubMed2004

Women, family demands and health: the importance of employment status and socio-economic position.

Although it is generally assumed that women engaged in paid work have better health than full-time homemakers, little is known about the situation in Southern European countries like Spain or about differences in the impact of family demands by employment status or the potential interaction with educational level. The objectives of this study are to analyse whether inequalities in health exist among housewives and employed women, and to assess whether the relationship between family demands and health differs by employment status. Additionally, for both objectives we examine the potential different patterns by educational level. The data have been taken from the 1994 Catalonian Health Survey (Spain). The sample was drawn from all women aged 25-64 years who were employed or full-time homemakers and married or cohabiting. Four health indicators (self-perceived health status, limiting long-standing illness, chronic conditions and mental health) and two health related behaviours (hours of sleeping and leisure-time physical activity) were analysed. Family demands were measured through household size, living with children under 15 and living with elderly. Overall, female workers had a better health status than housewives, although this pattern was more consistent for women of low educational level. Conversely, the health related behaviours analysed were less favourable for workers, mainly for those of low educational level. Among workers of low educational level, family demands showed a negative effect in most health indicators and health related behaviours, but had little or no negative association at all in workers of high educational level or in full-time homemakers. Moreover, among women of low educational level, both workers and housewives, living with elderly had showed a negative association with poor health status and health related behaviours. These results emphasise the need of considering the interaction between family demands, employment status and educational level in analysing the impact of family demands on women's health as well as in designing family policies and programmes of women's health promotion.

Adult↗

PubMed2004

Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour?

Social class understood as social relations of ownership and control over productive assets taps into parts of the social variation in health that are not captured by conventional measures of social stratification. The objectives of this study are to analyse the association between self-reported health status and social class and to examine the role of work organisation, material standards and household labour as potential mediating factors in explaining this association. We used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. This was a stratified sample, strata being the 10 districts of the city. The present study was conducted on the working population, aged 16-64 years (2345 men and 1874 women). Social class position was measured with Erik Olin Wright's indicators according to ownership and control over productive assets. The dependent variable was self-reported health status. The independent variables were social class, age, psychosocial and physical working conditions, job insecurity, type of labour contract, number of hours worked per week, possession of appliances at home, as well as household labour (number of hours per week, doing the housework alone and having children, elderly or disabled at home). Several hierarchical logistic regression models were performed by adding different blocks of independent variables. Among men the prevalence of poor reported health was higher among small employers and petit bourgeois, supervisors, semi-skilled (adjusted odds ratio-aOR: 4.92; 95% CI: 1.88-12.88) and unskilled workers (aOR: 7.69; 95%CI: 3.01-19.64). Work organisation and household material standards were associated with poor health status with the exception of number of hours worked per week. Work organisation variables were the main explanatory variables of social class inequalities in health, although material standards also contributed. Among women, only unskilled workers had poorer health status than the referent category of manager and skilled supervisors (aOR: 3.25; 95%CI: 1.37-7.74). All indicators of work organisation and household material standards reached statistical significance, excepting the number of hours worked per week. In contrast to men, among women the number of hours per week of household labour was associated with poor health status (aOR: 1.02; 95% CI: 1.01-1.03). Showing a different pattern from men in the full model, household material deprivation and hours of household labour per week were associated with poor health status among women. Our findings suggest that among men, part of the association between social class positions and poor health can be accounted for psychosocial and physical working conditions and job insecurity. Among women, the association between the worker (non-owner, non-managerial, and un-credentiated) class positions and health is substantially explained by working conditions, material well being at home and amount of household labour.

Adolescent↗

PubMed2004

Combining job and family demands and being healthy: what are the differences between men and women?

BACKGROUND: The objective of this study is to analyse gender inequalities in the combination of job and family life and their effect on health status and use of health care services. METHODS: The data come from the Navarra Survey of Working Conditions (Spain, 1997) carried out on a sample of 2185 workers. The analysis was restricted to 881 men and 400 women, aged 25-64 years, who were married or cohabiting. Dependent variables were self-perceived health status, psychosomatic symptoms, and medical visits, all of them dichotomized. Independent variables were family demands and number of hours of paid work a week. The analysis was adjusted for age and occupational social class. Multivariate logistic regression models, separated by sex, were fitted in order to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: Family demands were not associated with men's health whereas married women who lived in family units of more than three members had a higher risk of poor self-perceived health status (aOR=4.16; 95% CI: 1.37-12.65) and of psychosomatic symptoms (aOR=2.05; 95% CI: 1.12-3.75). Among women, working more than 40 hours a week was also associated with both health indicators and, additionally, with a higher probability of medical visits. CONCLUSION: In order to fully understand social determinants of workers' health, besides social class, gender inequalities in the distribution of family responsibilities should be considered.

Cross-Sectional Studies↗

PubMed2004

Types of employment and health in the European union: changes from 1995 to 2000.

BACKGROUND: This study compares associations between types of employment and health indicators in the Second (ES1995) and the Third European Survey on Working Conditions (ES2000) by gender, adjusting for individual and country-level confounders. METHODS: Two cross-sectional surveys of a representative sample of the European Union (EU) total active population (n=15,146 workers in ES1995 and n=21,703 workers in ES2000). Based on their comparability in both surveys four health indicators were considered: job dissatisfaction, stress, fatigue and backache. RESULTS: Non-permanent employment reported high percentages of job dissatisfaction but low levels of stress. Small employers were more likely to report fatigue and stress but less likely to report job dissatisfaction. Sole traders were more likely to report fatigue and backache. Workers in full-time employment almost always reported worse levels of health indicators than part-time. Two exceptions for part-time were found: temporary employment regarding job dissatisfaction, and in ES2000, sole traders with regard to job dissatisfaction, fatigue and backache. By and large, results by gender were similar in both surveys, although the magnitude of associations decreased in ES2000. Associations remained unchanged after adjustment. CONCLUSION: This study has compared for the first time the associations between various types of employment and four health indicators for the EU in ES1995 and ES2000, by gender. Overall, a slight increase in all health indicators was observed in the ES2000 compared to ES1995, and results were very consistent between both surveys. Similar findings in both surveys suggest that causal interpretation may be enhanced.

Adolescent↗

PubMed2004

Underreporting of fatal occupational injuries in Catalonia (Spain).

BACKGROUND: Thoroughness in a given health information system is one of its most important quality indicators. In Spain, in approximately 30% of serious occupational injuries, there is no information on the final outcome. AIM: To assess underreporting of fatal occupational injuries in Catalonia. METHODS: All serious occupational injuries (excluding commuting injuries) reported in Catalonia (Spain) between 1994 and 1998 (n = 7330) were linked with data from the Catalonian Mortality Register, 117 deaths being identified during the year following the injury date. In order to assess whether death could or could not have been related to the prior occupational injury, two experts examined these cases independently. RESULTS: The experts concluded (kappa = 0.98) that 69 (59%) of these deaths were probably related to occupational injuries; the vast majority (n = 65) occurred within 3 months of the injury. This represents an accumulated risk of dying of approximately 1% for the total of serious injuries, not varying with economic activity or job category. However, this risk varied depending on the form of accident, and the site and nature of the injury. CONCLUSIONS: Occupational injury cases, especially serious ones, should be followed up over at least 3 months. These results suggest the importance of carrying out active case-finding and of incorporating the death certificate as one of the documents to be systematically reviewed in order to complete the statistics.

Accidents, Occupational↗

PubMed2004

Psychosocial factors and work related sickness absence among permanent and non-permanent employees.

STUDY OBJECTIVE: To examine the association between psychosocial work factors and work related sickness absence among permanent and non-permanent employees by sex. DESIGN: A cross sectional survey conducted in 2000 of a representative sample of the European Union total active population, aged 15 years and older. The independent variables were psychological job demands and job control as measures of psychosocial work environment, and work related sickness absence as the main outcome. Poisson regression models were used to compute sickness absence days' rate ratios. SETTING: 15 countries of the European Union. PARTICIPANTS: A sample of permanent (n = 12 875) and non-permanent (n = 1203) workers from the Third European Survey on Working Conditions. RESULTS: High psychological job demands, low job control, and high strain and passive work were associated with higher work related sickness absence. The risks were more pronounced in non-permanent compared with permanent employees and men compared with women. CONCLUSIONS: This work extends previous research on employment contracts and sickness absence, suggesting different effects depending on psychosocial working conditions and sex.

Adolescent↗

PubMed2004

[Social classes and poverty].

Social classes and poverty are two key social determinants fundamental to understand how disease and health inequalities are produced. During the 90's in Spain there has been a notable oscillation in the inequality and poverty levels, with an increase in the middle of the decade when new forms of social exclusion, high levels of unemployment and great difficulties in accessing the labour market, especially for those workers with less resources, emerged. Today society is still characterized by a clear social stratification and the existence of social classes with a predominance of high levels of unemployment and precarious jobs, and where poverty is an endemic social problem much worse than the EU average. To diminish health inequalities and to improve the quality of life will depend very much on the reduction of the poverty levels and the improvement of equal opportunities and quality of employment. To increase understanding of how social class and poverty affect public health, there is a need to improve the quality of both information and research, and furthermore planners and political decision makers must take into account those determinants when undertaking disease prevention and health promotion.

Employment↗

PubMed2004

External validation of psychological job demands in a bus driver sample.

Psychosocial risk factors have been considered as characteristics of the work environment rather than an individual issue, but their presence in the workplace is usually measured by self-reported questionnaires, based on worker attitudes. The objective of the study was to compare a self-reported measure of psychological job demands in a bus driver sample with selected indicators of bus company activity, as external 'objective' indicators, in order to assess its external validity. The final sample included 713 drivers in 41 routes. Self-reported measures of psychosocial work risk factors were obtained by the Job Content Questionnaire (JCQ). Four external indicators were available for each route: passengers, break times, bus incidents, and regulating actions. Spearman's correlation coefficient was estimated to assess the validity. Correlation coefficients showed that self-reported psychological demands were statistically significant correlated (p<0.05) with two external indicators: bus incidents (rho=0.397), and regulating actions (rho=0.475). Self-reported psychosocial risk factors have been compared with independent external indicators of the psychosocial work environment, trying to avoid any subject's perception. According to our results, psychological demands measured by the JCQ seem to reflect the actual psychosocial work environment. Other studies are necessary to confirm these results and to assess job control and job social support. This would be another step in improving our knowledge of the quality of measurement of psychosocial risk factors.

Adult↗

PubMed2004

Unemployment and mental health: understanding the interactions among gender, family roles, and social class.

OBJECTIVES: We examined gender differences in the effects of unemployment on mental health and assessed whether such effects are associated with interactions among gender, family roles, and social class. METHODS: Our analysis included 3881 employed and 638 unemployed workers, aged 25 to 64 years, interviewed in the 1994 Catalonian Health Survey. RESULTS: Unemployment had more of an effect on the mental health of men (age-adjusted odds ratio [OR] = 2.98; 95% confidence interval [CI] = 2.30, 3.87) than on that of women (age-adjusted OR = 1.51; 95% CI = 1.11, 2.06). Gender differences in effects were related to family responsibilities and social class. CONCLUSIONS: Understanding the effects of unemployment on mental health requires consideration of the interactions among gender, family responsibilities, and social class.

Adult↗