It is essential to understand the impact of social inequalities on the risk of COVID-19 infection in order to mitigate the social consequences of the pandemic. With this aim, the objective of our study was to analyze the effect of socioeconomic inequalities, both at the individual and area of residence levels, on the probability of COVID-19 confirmed infection, and its variations across three pandemic waves. We conducted a retrospective cohort study and included data from all individuals tested for COVID-19 during the three waves of the pandemic, from March to December 2020 (357,989 individuals) in Aragón (Spain). We studied the effect of inequalities on the risk of having a COVID-19 confirmed diagnosis after being tested using multilevel analyses with two levels of aggregation: individuals and basic healthcare area of residence (deprivation level and type of zone). Inequalities in the risk of COVID-19 confirmed infection were observed at both the individual and area level. There was a predominance of low-paid employees living in deprived areas. Workers with low salaries, unemployed and people on minimum integration income or who no longer receive the unemployment allowance, had a higher probability of COVID-19 infection than workers with salaries ≥ €18,000 per year. Inequalities were greater in women and in the second wave. The deprivation level of areas of residence influenced the risk of COVID-19 infection, especially in the second wave. It is necessary to develop individual and area coordinated measures by areas in the control, diagnosis and treatment of the epidemic, in order to avoid an increase in the already existing inequalities.

The anatomy of the pelvis may obscure differences in pelvic tilt, potentially underestimating its correlation with clinical measures. Measuring the total sagittal range of pelvic movement can serve as a reliable indicator of pelvic function. This study assessed the inter- and intra-examiner reliability of the Kinovea^® version 0.9.5 and its agreement with the Qualisys System (3D motion capture) for measuring the total pelvic range of movement (ROM) in the sagittal plane, establishing Kinovea^®’s validity in standing and sitting positions with 45° of hip flexion. A cross-sectional study was conducted with 13 asymptomatic participants. Pelvic kinematics were recorded using both systems. Pelvic posture, anterior and posterior tilt, and total pelvic ROM in the sagittal plane were analyzed. The Intraclass Correlation Coefficient (ICC) was used to evaluate reliability and validity. Additionally, the technical error of measurement (TEM), relative TEM, standard error of measurement, and minimal detectable change (MDC) were calculated to establish Kinovea^®’s accuracy. Kinovea^® demonstrated excellent inter- and intra-examiner reliability for total pelvic ROM in standing and sitting measurements (ICC > 0.90), with relative TEM values below 10% and MDC values between 1.60°and 11.20°. Validity showed good-to-excellent ICC values when comparing Kinovea^® and the Qualisys System. This finding suggests that Kinovea^® is a valid tool for obtaining reproducible measurements of total pelvic ROM in the sagittal plane in standing and sitting positions, demonstrating excellent-to-good inter- and intra-examiner reliability for pelvic kinematics.

To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain. Repeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 (n=139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex. Healthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need. Healthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services.

Objetivo. Identificar la existencia de desigualdades de género en utilización de atención primaria (AP), urgencias y consulta de enfermería. Material y métodos. Estudio transversal, con encuestas nacionales y europeas de salud (2006-2017) de población española de 16 o más años (n=98 929 personas). Se estudió la evolución en el tiempo y la influencia de los determinantes de género mediante regresiones logísticas en la utilización de servicios sanitarios. Resultados. La utilización de los tres servicios asistenciales fue mayor en mujeres. Personas pensionistas, aquellas dedi­cadas a labores del hogar, con estudios bajos y clase social manual, tuvieron mayor riesgo de utilización de AP. Urgencias: a mayor edad menor riesgo de utilización. Enfermería: aque­llas dedicadas a las labores del hogar tenían mayor riesgo de utilización. Conclusiones. Son necesarios estudios que analicen las desigualdades de género en contextos como la utilización de servicios sanitarios, así como nuevas estrategias de gestión para conseguir la equidad asistencial.

Background: We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe. Methods: We developed a systematic review of scientific literature for the period 2008-2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed. Results: Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services. Conclusion: Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health.