A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Sighted volunteers’ motivations to assist people with visual impairments in freetime sport activities

Since the changing of the political and economic system in 1989-1990 in Hungary, volunteer movements have appeared all over the country. Volunteers of different ages and socioeconomic backgrounds are engaged in a wide range of activities, wishing to add values to the lives of others in need, hoping to improve their micro or/and macro environment. Volunteering has also appeared in the field of sport, and the work of a large number of nongovernmental sport organisations is strongly dependent on volunteers’ participation. In the socialist era disability sports were neglected by the state. The new democratic state has been paying increasing attention to disability sports and volunteers have been a great asset in improving the accessibility of spare time sport activities. The present empirical research investigates which factors motivate sighted volunteers to join Hungarian Sports and Leisure Association for the Visually Impaired (Látássérültek Szabadidős Sportegyesülete, LÁSS). Results confirm that joining LÁSS was in few cases (N=3) attributed to having parental or other family relations with blind or partially sighted people. Respondents unanimously admit to have a wish to share the joy of physical activity with their visually impaired peers.

La incuestionabilidad del riesgo

Con anterioridad a la década de 1980, la literatura especializada en análisis y gestión del riesgo estaba dominada por la llamada visión tecnocrática o dominante. Esta visión establecía que los desastres naturales eran sucesos físicos extremos, producidos por una naturaleza caprichosa, externos a lo social y que requerían soluciones tecnológicas y de gestión por parte de expertos. Este artículo se centra en desarrollar una nueva explicación para entender la persistencia hegemónica de la visión tecnocrática basada en el concepto de incuestionabilidad del riesgo. Esta propuesta conceptual hace referencia a la incapacidad y desidia de los expertos, científicos y tomadores de decisiones en general (claimmakers) de identificar y actuar sobre las causas profundas de la producción del riesgo ya que ello conllevaría a cuestionar los imperativos normativos, las necesidades de las elites y los estilos de vida del actual sistema socioeconómico globalizado.

Cerámica e Islamización: el origen de la tradición alfarera

La cerámica es uno de los testimonios arqueológicos más abundantes y reconocibles. Generalmente se le atribuye un importante valor histórico en tanto que informa sobre procesos socioeconómicos de gran importancia y constituye un significativo referente cronológico. No obstante, son varias las perspectivas de estudio ceramológico: sus formas de producción, las formas de distribución y comercialización y las pautas de consumo, etc. Todas ellas arrojan luz sobre aspectos que permiten estudiar las sociedades del pasado. En el caso que nos ocupa queremos discutir el valor de la cerámica en la comprensión del proceso de islamización social, es decir de integración en un nuevo sistema social y cultural. El siglo VII marca en el Mediterráneo occidental el final de un sistema económico de ámbito “mundial”, capaz de producir y distribuir cerámicas altamente estandarizadas y especializadas por todo el ámbito mediterráneo. El siglo X permite reconocer la reconstrucción de los mercados y la uniformización productiva y formal, que refleja la nueva sociedad representada en el Califato. Entre ambos extremos se abre un periodo interesante y complejo, plagado de luces y sombras, que permite reconocer tanto los procesos de reestructuración económica como la generalización de nuevos patrones culturales. En este trabajo se intentarán plantear los temas más importantes y novedosos sobre la cerámica de los siglos VII a X, a partir de varios trabajos recientes, leyendo a través de la cerámica el proceso de islamización.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

Social Services in Times of Economic and Social Crisis: The case of Spain

The financial and economic crisis which originated in 2008 has had a severe impact on the population of the Southern European countries. The economic policies of austerity and public deficit control, as well as the neo-liberal and conservative social policies are redefining the public social protection systems, in particular the Social Services. In order to get to understand the current situation, we shall explain how the Social Services were developed in Spain and analyse the causes and consequences of the economic crisis. The working hypothesis is that the greater the increase on the population’s needs, the more developed the Social Services should be. We carried out a descriptive analysis of the situation as far as the social impacts of the crisis per region are concerned. We tested the hypothesis through a parametric model of analysis of variance (one-way ANOVA) triangulating with the non-parametric Kruscal-Wallis test. The working hypothesis failed. The regions with better developed Social Services show a lower level of poverty and social exclusion. The challenges that the public Social Services system faces in times of crisis is three-fold: 1) re-modelling of local administration and transferring of the municipal Social Services responsibilities to the regional administration; 2) an increase of the population at risk of poverty and social exclusion 3) impact on social policies.