[Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]

INTRODUCTION

Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access.

METHODS

A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes.

RESULTS

A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy.

CONCLUSION

The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

[Vulnerability and social determinants in diabetes]

Social determinants of health significantly influence the development and progression of chronic diseases such as type2 diabetes (T2DM). This article examines key social determinants including education, economic stability, neighborhood, and factors such as ethnicity, race, or religion that impact individuals with T2DM. The role of gender as a social determinant is also explored, emphasizing the need for gender-specific considerations in T2DM management and research. Additionally, the impact of poverty on health outcomes is analyzed, highlighting the bidirectional relationship between poverty and disease. Comprehensive measures addressing these determinants are crucial to improving the health and well-being of individuals with T2DM. Addressing social inequalities through targeted interventions can contribute to better treatment outcomes and equitable healthcare.

[Entornos de Vida tool: innovation in participatory health analysis with an equity approach]

Municipal governments have the capacity to tackle the social determinants of health that play a role in their territories. The Valencian Community's local health action strategy promotes an intersectoral, participatory and equity-oriented approach to health inequalities affecting neighborhoods and municipalities across the region. To guide local health action, there is a need to adopt methodologies that capture community-based knowledge and experiences, encouraging community engagement at all stages. This article presents a methodology to carry out a local health needs assessment applying the Entornos de Vida tool. This tool enables the analysis of neighborhoods and municipalities through identifying how their characteristics have an impact on the health and well-being of their inhabitants.

[Monitoring COVID-19 in Spain: is a gender analysis possible?]

OBJECTIVE

To analyse the sex disaggregation and availability of gender indicators in the reports of the National Epidemiological Surveillance Network (RENAVE) and the National Study of Sero-Epidemiology (ENE-COVID-19).

METHOD

Peer review of indicators available in 72 RENAVE reports and 4 rounds of the ENE-COVID-19 study to calculate the percentage of those disaggregated by sex and their variation over time.

RESULTS

In March 2021, 52.4% of RENAVE indicators were disaggregated by sex. From July 2020, 54% of disaggregated indicators ceased to be published and 23% lost their disaggregation. In the ENE-COVID-19 study, the 1st round 88,23% of the indicators are disaggregated and the 4th round 94,74%. The 2nd and 3rd round do not disaggregated by sex.

CONCLUSIONS

The RENAVE reports do not allow for a gender-sensitive analysis while the ENE-COVID-19 study provides the most information on social determinants.

[Participatory evaluation in place-based communities: adaptating and validating the Place Standard tool to Spanish context]

OBJECTIVE

Translation and cross-cultural adaptation to the Spanish context of the Place Standard tool to undertake participatory evaluations in place-based communities.

METHOD

A back-translation method was used to obtain an adapted version of the original Place Standard tool. The translated version was reviewed by a multidisciplinary committee of experts and validated using the Delphi method.

RESULTS

The final version of the adapted Place Standards tool (Entornos de Vida in Spanish) consists of 14 dimensions and 99 items. 21% of the items presented semantic difficulties during the translation. Total consensus through the Delphi panel was reached on 72% of the items. The analysis resulted in changes to the wording, and organization of the items, and the inclusion of new or modified questions to reflect the characteristics of the Spanish context.

CONCLUSIONS

The validation of the Entornos de Vida tool will enable the evaluation of place-based communities characteristics/physical and socio-economic contexts in a participatory and equitable manner that focuses on social determinants of health. Its application in scenarios that take into account processes of local health action will support the practice of health promotion and equity, and centre the attention and action on the physical and socio-economic contexts with the aim to learn how places and municipal policies can affect health and well-being.

[Health status among immigrant in Catalonia from a gender perspective: PELFI project]

OBJECTIVE

The objective of the study is to assess the health status of immigrant men and women from non-EU countries living in the Metropolitan Area of Barcelona (Catalonia, Spain) and to identify the social determinants of health from a gender perspective.

METHOD

Cross-sectional analysis from a cohort of immigrant families recruited in Badalona and Santa Coloma de Gramenet, in Spain (PELFI cohort). In 2015-2016, 167 immigrants answered the baseline epidemiological questionnaire and the 5-level EuroQol instrument (EQ-5D) which measures health status. To identify health determinants, Tobit models were constructed to the EQ-5D index.

RESULTS

Women rated poorer self-perceived health (p=0.005). To be diagnosed with and illness was only associated with poor self-perceived health among men (p<0.05). Length of residence, domestic work, and especially double workload deteriorated women's health. After adjusting models by demographics and social determinants, permanent administrative status (-0.136; p=0.015) and social support (0.182; p=0.02) were associated with health status in both sexes. To have a job was associated with better health only in men.

CONCLUSIONS

Non-EU immigrants living in the Metropolitan Area of Barcelona are a socially vulnerable group of population and present inequalities in health by sex. Social support and occupation are key factors of their health status. Interventions to reduce immigrant vulnerabilities and inequalities in health should promote their social inclusion and cohesion from a gender perspective.

[Municipalism and community health: transforming through local government. SESPAS Report 2018]

Municipalities and local government are an essential element to promote public policies that improve people's health, and impact the social determinants of health, through developing approaches which incorporate equity, community engagement and intersectoral partnership at their core. The objective of this article is to analyze the barriers and opportunities that can be encountered within local governments when interventions aimed at improving people's health are developed and implemented. The evolution of the city councils, their competence frameworks and the current socio-political context are described, and three key tools for local action are proposed: intersectorality, community engagement and working in partnership with other administrations. Global strategies such as the implementation of the "community health" and "health in all policies" approach through cross-sectoral networks/partnerships are described, emphasizing the importance of developing formal and informal structures or processes of community engagement and designing local health action plans in cooperation with other administrations, such as regional and national governing bodies. To continue supporting these forms of local governance, we propose adapting the local administrations to the new social realities, with more horizontal and flexible organization models and resource allocation, integrating efficiency and evaluation processes, reclaiming local autonomy, and building local governance through networks and alliances.

[A good investment: promoting health in cities and neighbourhoods]

Local administration is responsible for health-related areas, and evidence of the health impact of urban policies is available. Barriers and recommendations for the full implementation of health promotion in cities and neighbourhoods have been described. The barriers to the promotion of urban health are broad: the lack of leadership and political will, reflectes the allocation of health outcomes to health services, as well as technical, political and public misconceptions about the root causes of health and wellbeing. Ideologies and prejudices, non-evidence-based policies, narrow sectoral cultures, short political periods, lack of population-based health information and few opportunities for participation limit the opportunities for urban health. Local policies on early childhood, healthy schools, employment, active transport, parks, leisure and community services, housing, urban planning, food protection and environmental health have great positive impacts on health. Key tools include the political prioritisation of health and equity, the commitment to «Health in All Policies» and the participation of communities, social movements and civil society. This requires well organised and funded structures and processes, as well as equity-based health information and capacity building in the health sector, other sectors and society. We conclude that local policies have a great potential for maximising health and equity and equity. The recommendations for carrying them out are increasingly solid and feasible.

Inequities in visual health and health services use in a rural region in Spain

OBJECTIVE

To analyse perceived visual health and health services use in a rural population in relation to socioeconomic characteristics and compared with the general population in Spain.

METHOD

Cross-sectional study in a rural population using a structured questionnaire including questions comparable to the Spanish National Health Survey (2012). A descriptive analysis was carried out through the calculation of frequencies and prevalence, the χ² test for independent variables, contrasts of proportions and logistic regression to obtain associations between the rural and general populations and socioeconomic variables.

RESULTS

For the rural population studied, the prevalence of poor perceptions of visual health is 40.8% in men and 39.4% in women, and is strongly associated with age, employment situation, income and presence of chronic diseases (p ˂0.001). Compared with the general population, the rural population has a higher risk of presenting with serious difficulties related to farsightedness (OR: 2.56; 95% CI: 1.32-4.95) and make less use of optical correction (OR: 0.57; 95%CI: 0.44-0.74). The use of health services is not sufficient for adequate prevention, particularly in diabetics. For those affected by poor vision, the distance to travel to receive an eye exam, the belief that eyesight problems come with age and the cost of glasses are the principal reasons used to explain why eyesight problems are not resolved.

CONCLUSIONS

The rural population presents worse visual health that is influenced by social and economic factors. Improving accessibility and reducing barriers is essential to tackle avoidable visual disability and reduce health inequities.

Measuring social capital: further insights

Social capital is defined as the resources available to individuals and groups through membership in social networks. However, multiple definitions, distinct dimensions and subtypes of social capital have been used to investigate and theorise about its relationship to health on different scales, creating a confusing picture. This heterogeneity makes it necessary to systematise social capital measures in order to build a stronger foundation in terms of how these associations between the different aspects of social capital and each specific health indicator develop. We aim to provide an overview of the measurement approaches used to measure social capital in its different dimensions and scales, as well as the mechanisms through which it is presumed to influence health. Understanding the mechanisms through which these relationships develop may help to refine the existing measures or to identify new, more appropriate ones.