Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

Trends in mortality due to motor vehicle traffic accident injuries between 1987 and 2011 in a Spanish region (Comunitat Valenciana)

Objective: To analyse the time evolution of the rates of mortality due to motor vehicle traffic accidents (MVTA) injuries that occurred among the general population of Comunitat Valenciana between 1987 and 2011, as well as to identify trend changes by sex and age group. Methods: An observational study of annual mortality trends between 1987 and 2011. We studied all deaths due to MVTA injuries that occurred during this period of time among the non-institutionalised population residing in Comunitat Valenciana (a Spanish Mediterranean region that had a population of 5,117,190 inhabitants in 2011). The rates of mortality due to MVTA injuries were calculated for each sex and year studied. These rates were standardised by age for the total population and for specific age groups using the direct method (age-standardised rate – ASR). Joinpoint regression models were used in order to detect significant trend changes. Additionally, the annual percentage change (APC) of the ASRs was calculated for each trend segment, which is reflected in statistically significant joinpoints. Results: For all ages, ASRs decrease greatly in both men and women (70% decrease between 1990 and 2011). In 1990 and 2011, men have rates of 36.5 and 5.2 per 100,000 men/year, respectively. In the same years, women have rates of 8.0 and 0.9 per 100,000 women/year, respectively. This decrease reaches up to 90% in the age group 15–34 years in both men and women. ASR ratios for men and women increased over time for all ages: this ratio was 3.9 in 1987; 4.6 in 1990; and 5.8 in 2011. For both men and women, there is a first significant segment (p < 0.05) with an increasing trend between 1987 and 1989–1990. After 1990, there are 3 segments with a significant decreasing APC (1990–1993, 1993–2005 and 2005–2011, in the case of men; and 1989–1996, 1999–2007 and 2007–2011, in the case of women). Conclusion: The risk of death due to motor vehicle traffic accidents injuries has decreased significantly, especially in the case of women, for the last 25 years in Comunitat Valenciana, mainly as of 2006. This may be a consequence of the road-safety measures that have been implemented in Spain and in Comunitat Valenciana since 2004. The economic crisis that this country has undergone since 2008 may have also been a contributing factor to this decrease. Despite the decrease, ASR ratios for men and women increased over time and it is still a high-risk cause of death among young men. It is thus important that the measures that helped decrease the risk of death are maintained and improved over time.

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999–2008

Spain’s immigrant population has increased 380 % in the last decade, accounting for 13.1 % of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999–2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (−17.8 % for men and −16.6 % for women) as well as in the foreign-born one (−45.9 % for men and −35.7 % for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Urban environmental degradation and the standard of living: the case of the Spanish mining industry (1870–1930)

This paper analyses the consequences of urban environmental degradation on the well-being of Spanish miners. It is based on analyses of differences in mortality and height. The first part of the paper examines new hypotheses regarding the urban penalty. We take into consideration existing works in economic theory that address market failures when analysing the higher urban death rate. We explain the reduction in height using the model recently created by Floud, Fogel, Harris and Hong for British cities. The second part of the paper presents information demonstrating that the urban areas in the two largest mining areas in Spain (Bilbao and the Cartagena-La Unión mountain range) experienced a higher death rate relative to rural areas as a consequence of market failures derived from what we term an ‘anarchic urbanisation’.

Information systems contracts and relationships: A Spanish perspective

Despite the proliferation of academic research on information systems outsourcing, not many studies analyze the characteristics of outsourcing contracts. This research aims to provide an in-depth description of information systems outsourcing. An additional objective is to examine how these characteristics evolve over time. Finally, this study reports on the usefulness of measuring such characteristics over time to assess the maturity level of the information systems outsourcing. This study gathers the data from the responses of the information systems managers of the largest Spanish firms to a questionnaire. This longitudinal study covers 12 years of research and compares authors' previous research results with the results of this study.

Validation of the Spanish version of mackey childbirth satisfaction rating scale

Background: The “Mackey Childbirth Satisfaction Rating Scale” (MCSRS) is a complete non-validated scale which includes the most important factors associated with maternal satisfaction. Our primary purpose was to describe the internal structure of the scale and validate the reliability and validity of concept of its Spanish version MCSRS-E. Methods: The MCSRS was translated into Spanish, back-translated and adapted to the Spanish population. It was then administered following a pilot test with women who met the study participant requirements. The scale structure was obtained by performing an exploratory factorial analysis using a sample of 304 women. The structures obtained were tested by conducting a confirmatory factorial analysis using a sample of 159 women. To test the validity of concept, the structure factors were correlated with expectations prior to childbirth experiences. McDonald’s omegas were calculated for each model to establish the reliability of each factor. The study was carried out at four University Hospitals; Alicante, Elche, Torrevieja and Vinalopo Salud of Elche. The inclusion criteria were women aged 18–45 years old who had just delivered a singleton live baby at 38–42 weeks through vaginal delivery. Women who had difficulty speaking and understanding Spanish were excluded. Results: The process generated 5 different possible internal structures in a nested model more consistent with the theory than other internal structures of the MCSRS applied hitherto. All of them had good levels of validation and reliability. Conclusions: This nested model to explain internal structure of MCSRS-E can accommodate different clinical practice scenarios better than the other structures applied to date, and it is a flexible tool which can be used to identify the aspects that should be changed to improve maternal satisfaction and hence maternal health.

A potential case of attitude change: The Spanish spoken in the city of Malaga and used on social network sites

The Spanish spoken in the city of Malaga, as Andalusian Spanish in general, was in the past often times considered an incorrect, low prestige variety of Spanish which was strongly associated with the poor, rural, backward South of Spain. This southern Spanish variety is easily recognised because of its innovative phonetic features that diverge from the national standard, even though in the past years in the case of some features a convergence to the standard could be observed. Despite its low prestige the local variety of Spanish is quite often used on social network sites, where it is considered as urban, fashion and cool. Thus, this paper aims at analysing whether the Spanish used in the city of Malaga is undergoing an attitude change. The study draws on naturally occurring speech, data extracted from Facebook and a series of questionnaires about the salience, attitude and perception of the local variety of Spanish. The influence of the social factors age and gender is analysed, since they are both known to play a crucial role in many instances of language change. The first is of special interest, as during the Franco dictatorship dialect use was not accepted in schools and in the media. Results show that, on the one hand, people from Malaga hold a more positive attitude towards non-standard features used on social network sites than in spoken language. On the other hand, young female users employ most non-standard features online and unsurprisingly have an extremely positive attitude towards this use. However, in spoken Spanish the use and attitude of some features is led by men and speakers educated during the Franco dictatorship, while other features, such as elision of intervocalic /d/, elision of final /ɾ/, /l/ and /d/ and ceceo, are predominantly employed by and younger speakers and women. These features are considered as salient in the local variety and work as local identity markers.

Guidelines, special emphasis programs : Federal women's program : Hispanic employment program.

Cover title.

The works of Thomas Middleton, now first collected,

Imperfect: frontpiece wanting. cf. v.1, p. 4211.

Xarifa = The bridal of Andalla : from a set of six ancient Spanish ballads ... /

For voice and piano.

A set of six songs ; A set of six ancient Spanish ballads ; A set of six songs [third set] /

Three sets of songs bound together : a set of six songs.

A list of speakers on issues concerning Hispanic women.

Mode of access: Internet.

Spanish literature : an elementary handbook with indices, etc.,

"Alphabetical list of a few of the principle authorities on Spanish literature": p. [278]-280.

Child care and equal opportunity for women.

Authors: James A. Levine and others.

Great men and famous women; a series of pen and pencil sketches of the lives of more than 200 of the most prominent personages in history ...

--1,2. Soldiers and sailors. --3,4. Statesmen and sages. --5,6. Workmen and heroes. --7,8. Artists and authors.