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Summary: COVID-19 continues to pose a significant threat: mortality stands at nearly twice that of influenza, and the incidence rate is growing as the population's vaccination rate decreases, particularly in Spain and other areas of Europe. Given this situation, it is vitally important know whether medical protocols are consistent and appropriately implemented by health care staff in the interest of preventing possible inefficiency or inequity. Physicians from hospital emergency departments met to study their hospitals' usual clinical practices for managing SARS-CoV-2 infection and to determine their expert opinions on the use of antiviral agents. The participating physicians then reached consensus on evidencebased recommendations for strategies that would optimize emergency treatment.

Chronic pancreatitis is a chronic fibroinflammatory disease of the pancreas with prevalence around 50 cases per 100,000 inhabitants. It appears to originate from diverse and yet mixed etiological factors. It shows highly variable presenting features, complication types and disease progression rates. Treatment options are as wide as the multiple personalized scenarios the disease might exhibit at a given time point. Some medical societies have developed guidelines for diagnosis and treatment based on scientific evidence. Although these efforts are to be acknowledged, the gathered level of evidence for any topic is usually low and, therefore, recommendations tend to be vague or weak. In the present series of position papers on chronic pancreatitis from the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees we aimed at providing defined position statements for the clinician based on updated review of published literature and on interdisciplinary expert agreement. The final goal is to propose the use of common terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 51 sections related to chronic pancreatitis were reviewed by 21 specialists from 6 different fields to generate 88 statements altogether. Statements were designed to harmonize concepts or delineate recommendations. Part 1 of this paper series discusses topics on aetiology and diagnosis of chronic pancreatitis. Main clinical features are abdominal pain, exocrine and endocrine insufficiency and symptoms derived from complications. Some patients remain symptom-free. Diagnosis (definitive, probable or uncertain) should be based on objective data obtained from imaging, histology, or functional tests., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used. There are few data on the medium and long-term health outcomes when removing all animal foods from the child's diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies. In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B 12 supplements at all ages, as well as other nutrients (iodine, iron, vitaminD 3 , poly-unsaturated fatty acid n-3), when required. A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet., (Copyright © 2019 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Una de las limitaciones para el uso de los Cuestionarios de Calidad de Vida Relacionada con la Salud y de los resultados reportados por pacientes es la dificultad de interpretar los valores obtenidos. La diferencia mínima clínica importante es una medida que ayuda a comprender los resultados de estos cuestionarios y valorar la relevancia clínica del efecto conseguido por la intervención realizada. En este trabajo revisamos el concepto de diferencia mínima clínica importante, describimos los métodos utilizados para su obtención y exponemos sus dificultades, limitaciones y aplicabilidad. Dentro de los resultados reportados por pacientes y, particularmente, en los de calidad de vida, la diferencia mínima clínica importante es una herramienta que ayuda a los clínicos a utilizar correctamente las escalas de medida e interpretar el efecto de las intervenciones. Con este artículo esperamos facilitar la implantación y uso de la diferencia mínima clínica importante y los Cuestionarios de Calidad de Vida Relacionada con la Salud en la práctica habitual con nuestros pacientes.

Background and Objective: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency., Materials and Method: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus., Results: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus., Conclusions: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units., (Copyright © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

In its action plan (2022-2030) to reduce the harmful use of alcohol, WHO calls on economic operators to "substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups". This paper investigates substitution within beer brands at the level of the consumer, based on Spanish household purchase data using interrupted time series analysis. For households (n = 1791, 9.1% of all households) that newly bought at least one of eleven branded zero-alcohol beers (responsible for over three-quarters of all zero-alcohol beer purchased), the associated purchases of all grams of alcohol after the first purchase of zero-alcohol beer were reduced by 5.5%, largely due to substituting every one litre of higher strength beer (ABV > 3.5%) with 0.75 litres of same-branded zero-alcohol beer (ABV = 0.0%). For households (n = 337, 1.8% of all households) that had never previously purchased a same-branded higher-strength beer, but newly purchasing a same-branded zero-alcohol beer, the associated purchases of all grams of alcohol after the first purchase of zero-alcohol beer were reduced by 14%; this reduction was largely due to such households' decreasing their associated purchases of wines and spirits. Thus, at the level of the consumer, based on Spanish household purchase data of branded zero-alcohol beers, the evidence behind WHO's call for substitution appears to be substantiated.

Drug-facilitated sexual assault (DFSA) is a topic of growing social concern in recent years. Despite this, few empirical studies carried out in Spain have analysed the phenomenon from a preventive approach. The aim of this study, in addition to providing new evidence on DFSA, specifically in minors, was to identify possible associated variables, thus contributing to a better understanding of the problem and to the design of more effective prevention policies. To this end, a survey was carried out among minors in the autonomous community of Galicia. A total of 7,181 students aged 12 to 17 (M = 14.79; SD = 1.57) participated. Data collection was carried out by means of a self-administered questionnaire on paper. Data concerning DFSA were collected by means of specific items, piloted beforehand. Screening instruments for problem drug use (AUDIT, CAST, CRAFFT and EUPI-a) were also used. The results allow us to estimate the rate of victimisation by DFSA in Galician minors at 1.7%, of which only 11.4% would have reported it. Beyond the socio-demographic profile of the victims (females in 2 out of 3 cases), they present different patterns with regard to the pattern of problematic consumption of alcohol and other substances and the pattern of problematic use of the Internet and social networks, with a significantly higher prevalence of online risk behaviours. This suggests that this phenomenon goes far beyond sexual violence, so it is necessary to address it at a preventive level from a comprehensive perspective, including educational and public health perspectives.

Objective: The use of non-pharmacological preventive measures during the COVID-19 pandemic has helped to reduce the incidence of multiple airborne or contact diseases. The objective of this paper was to evaluate the impact that all preventive measures have had on the transmission of different microorganisms, both by respiratory and contact transmission., Methods: We compared the incidence of different infectious episodes coded with the CIAP-2 code (International Classification of Primary Care second edition of the WONCA International Classification Committee) collected from the computerized history of primary care, both with respiratory tract and digestive tract involvement, in the period from March 2018 to February 2020 (pre-pandemic period) and from March 2020 to February 2022 (pandemic period). The data corresponded to the entire region, with an estimated average population for the four years of 650,000 people. The statistical treatment of the data consisted of a descriptive analysis with the calculation of absolute values and percentages. Rates were calculated and compared using data provided by the National Institute of Statistics as a denominator. The P was obtained by statistical comparison by the exact method. A comparison of rates was made., Results: The incidence in the number of CIAP-2 episodes studied, both corresponding to respiratory and gastrointestinal pathologies, comparing the period March 2018-February 2020 with the period March 2020-February 2022 decreased by 65.81%, from 534,439 cases to 182,707., Conclusions: The preventive measures applied during the pandemic produce a significant decrease in pathology involving the respiratory or the digestive tract., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction: Exposure to gases and particulate matter released during volcanic eruptions can prove harmful to population health. This paper reports the preliminary results of the ASHES study, aimed at ascertaining the respiratory health effects of the 2021 volcanic eruption in La Palma Island (Spain) on the adult population without previous respiratory disease., Methods: Ambispective cohort study on the healthy adult population. Three exposure groups were considered: Group 1, high exposure; Group 2, moderate exposure; and Group 3, minor or no exposure. We carried out a descriptive analysis of symptoms during and after the eruption, as well as measure lung function after the eruption (through forced spirometry and diffusing capacity of carbon monoxide)., Results: The analysis included 474 subjects: 54 in Group 1, 335 in Group 2, and 85 in Group 3. A significant increase in most symptoms was observed for subjects in the groups exposed during the eruption. After the eruption, this increase remained for some symptoms. There seems to be a dose-response relationship, such that the higher the exposure, the higher the odds ratio. A prebronchodilator FEV 1 /FVC ratio<70% was observed in 13.0% of subjects in Group 1, 8.6% of subjects in Group 2, and 7.1% of subjects in Group 3., Conclusions: This study is the first to report a dose-response relationship between exposure to volcanic eruptions and the presence of symptoms in adults. Furthermore, there is a tendency toward obstructive impairment in individuals with higher exposure., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Scientific research promotes the development of essential skills for medical practice. However, student participation in research projects is low, with multiple limitations and students' perceptions of deficient research skills. This study aims to describe the organization of the two medical student conferences held by the Scientific Society of Medical Students of the Universidad de Valparaíso and to analyze the papers presented. Finally, we make recommendations for promoting scientific research among medical students., Methods: An analytical cross-sectional study was conducted, including all the presentations given at the conferences., Results: The conferences comprised four phases: registration, evaluation, selection, and presentation. A total of 399 papers were received. A total of 157 case reports and 12 cross-sectional studies were presented, including 797 authors (56.7% women) from 21 universities. Most of the first authors were women in the internship cycle at public universities. The specialties with the highest representation were internal medicine (32.5%), pediatrics (18.3%) and surgery (13%). In the case reports, the best-evaluated section was the title (6.66 ± 0.76), and the worst-evaluated section was the discussion (6.17 ± 0.84). The case reports from private universities scored significantly higher in six of the eight items assessed., Conclusions: Greater participation was represented by students in their internship cycle presenting case reports. The worst evaluated section was the discussion, which could reflect difficulties in the research process. It is crucial to increase student participation from the first years of the career and encourage their involvement in research. More studies are needed to evaluate student participation and barriers to scientific research., Competing Interests: The authors completed the ICMJE conflict of interest statement and declared that they received no funds for the realization of this article; they have no financial relationships with organizations that may have an interest in the published article in the last three years and have no other relationships or activities that may influence the publication of the article. Forms can be requested by contacting the corresponding author., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objective: COVID-19 has evidenced the importance of a Primary and Community Care (PCC), able to respond in the front line with capacity and adaptation to health and social crises. In order to reinforce its role, the Strategic Framework for Primary and Community Care was created in 2019, and one of its lines of action is to consolidate a budgetary and human resources policy. This translates into the Primary Care Action Plan 2022 and 2023, which includes the adequacy of HHRR based on the morbidity attended, health outcomes and sociodemographic characteristics. For this purpose, the development of the model for its calculation is urged. The objective of this paper was to offer a model as a guideline for the adequacy of the needs of Family Care Units (FAU)., Methods: The study was carried out in the Tenerife Health Area, which has 41 ZBS with 97 health care centers. The variables weighted in the model were: percentage of people over 65 years of age; utilization index; complexity by GMA (Adjusted Morbidity Groups) and frequentation. An Adequate Quota Index was calculated to establish the quota for each health care center between 1,200 and 1,600 per UAF and projection to 2025., Results: The total need for UAF increase was 62, compared to 57 with the capita criterion of 1,500, at the extremes of the model range there were 12 centers of 1,200 and 11 of 1,600., Conclusions: In a very heterogeneous Health Area, the model achieves a more equitable allocation without increasing in practice the need for FAUs compared to the capitated criterion.

Objective: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases., Method: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training, and degree of satisfaction., Results: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=21), hospitalised patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma, and lung transplant as a priority. 51% considered integration to be adequate and 91% considered it necessary to implement prioritisation criteria. Professional competencies ranged from 6.5 to 6.9 out of 10 points. Only 45% of participants had received specific training in the last 4 years, indicating greater priority for asthma, pulmonary hypertension, and IPF., Conclusions: Most centers have pharmacists specialised in respiratory diseases. However, there is room for improvement in terms of subspecialisation, participation in multidisciplinary committees, implementation of prioritisation criteria, diversification in pathologies treated, as well as greater specific training in this area., Competing Interests: Declaration of competing interest None declared. The authors declare the following collaborations that could be perceived as potentially influencing the results and/or discussion reported in this article: Marta Calvin has received fees in the last 3 years for papers sponsored by AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, and CSL Behring. Astrid Crespo-Lessmann has received fees in the last 3 years for sponsored presentations from AstraZeneca, GlaxoSmithKline, Sanofi, Orion Pharma, Gebro, Novartis, MSD, and Boehringer Ingelheim; travel and conference attendance fees from GlaxoSmithKline, Chiesi, Novartis; and consultancy fees from GlaxoSmithKline, Sanofi, and AstraZeneca. Jorge Del Estal has received fees in the last 3 years for sponsored lectures from AstraZeneca; travel and conference attendance fees from GlaxoSmithKline; and consultancy fees from AstraZeneca. Daniel Echeverría-Esnal has received fees in the last 3 years for papers sponsored by MSD, Shionogi, and Pfizer; and travel and conference attendance fees from MSD and Pfizer. Sara Garcia Gil has received fees in the last 3 years for presentations sponsored by AstraZeneca and GlaxoSmithKline; travel and conference attendance fees from GlaxoSmithKline; and consultancy fees from GlaxoSmithKline. Noé Garin has received fees in the last 3 years for sponsored presentations from GlaxoSmithKline, Sanofi, and AstraZeneca; and travel and conference attendance fees from PharmaMar and Pfizer. Sonia Jornet has received fees in the last 3 years for sponsored presentations from AstraZeneca, GlaxoSmithKline, and Sanofi; travel and conference attendance fees from Janssen Cilag, AstraZeneca, Sanofi, Gilead, and Pfizer; and consultancy fees from AstraZeneca and GlaxoSmithKline. Hilario Martinez has participated in projects in the last 3 years with grants from Sanofi and AstraZeneca. José Javier Martínez has received fees in the last 3 years for sponsored lectures from AstraZeneca, Sanofi, and GlaxoSmithKline; and travel and conference fees from Gilead. Borja Zarate-Tamames has received fees in the last 3 years for papers sponsored by GlaxoSmithKline; and travel and conference fees from Boehringer Ingelheim and Galapagos Biopharma., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Background: the number of infants and children who receive artificial nutrition at home has been steadily increasing over the last decades, as better outcomes for children with chronic conditions have been achieved. In order to evaluate the need of resources to implement the technique it is necessary to know how many patients benefit from home artificial nutrition. This information can be estimated from the register of patients, when available. Methods: in this paper the characteristics of all registers were reviewed, especially those devoted to pediatric patients. Results: only two pediatric registers are active in 2023: the Canadian register and the Spanish one. NADYA register from the Spanish Society for Clinical Nutrition and Metabolism (SENPE) and the recent REPAFI, form the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition. The most valuable register from the British Society, BANS, stopped providing information in 2018. Conclusion: despite the fact of acknowledging the importance of having gathered information on the prevalence and incidence of home artificial nutrition, to fit resources to necessities, the number of active registers is quite short.

Objective: From the healthcare policies that support Public Health strategies, technology implementation in healthcare is an innovative element to address chronicity. Its introduction is not uniform across Spain, despite of the existence of digital strategic implementation and national chronicity plans. The aim of this paper was to explore the current deployment of autonomic strategies for chronicity and the implementation of digital tools for telemonitoring and user support., Methods: A descriptive cross-sectional study was conducted through documental review of autonomous strategies in digital health and chronicity care, available until 2020. Consequently, a consultation was carried out to eighteen experts addressing autonomic availability, benefits and barriers to healthcare digitalization., Results: The expert consultation revealed that, in fifteen autonomous communities, the use and the enhancement of digital technologies were addressed and in nine the focus was on promoting digital transformation. Eleven communities are working on updates, fourteen have health-related digital applications, thirteen allow users checking their test results, ten allow them to carry out administrative procedures, nine deliver patient support resources, and three provide telematic communication channels. 38.89% of the consulted refered not knowing about the existence of any follow-up and monitoring programs in their community. The 60% identified a gap in digital competencies among citizens and the lack of resources, as main barriers to implementation., Conclusions: There exists disparity in the update of strategies to address chronicity and the introduction of digital technologies. Many of them are currently updating, which is an opportunity to provide efficient responses that incorporate digital tools.

Text: The prevalence of active hepatitis C virus (HCV) infection is higher in hospital emergency departments (EDs) than in the general population. Numerous patients who seek emergency care are unaware that they have detectable viremia, yet they fall outside established ED protocols for HCV screening. Often they belong to groups with difficult access to health care who use the ED as their point of entry to the system. The aim of this consensus paper was to develop an approach to guide ED detection of HCV infection in all Spanish hospitals. Experts from the Spanish Society of Emergency Medicine (SEMES), the Spanish Association for Study of the Liver (AEEH), and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) met to establish criteria to guide health care professionals' decisions. The experts' review of the literature and discussion in consensus-building meetings resulted in evidence-based recommendations that consider the following aspects: 1) the population to target for HCV screening in the ED, 2) how to inform patients of the process, 3) how to carry out HCV screening, 4) how to order an HCV test, and 5) additional issues such as bundling HCV with other viral tests for comprehensive diagnosis, recording results in medical records, and implementing ways to retain and follow all patients with positive results. This consensus report provides guidelines and tools to facilitate emergency physicians' work and ensure effective detection of HCV infections and subsequent incorporation of patients into the health care system.

Background: The development of skin cancer is closely related to high exposure to UV radiation. Lifeguards are at an increased risk of excessive sun exposure., Objectives: The main objective of this study was to measure the exposure of Barcelona's beach lifeguards to UV radiation., Methods: Measurements in the work chair were taken every 30min on a typical working day from 10:45 am to 19:15 pm. These measurements were carried out on four different days. These data were used to calculate the erythematous doses received during working hours, as well as those potentially received throughout the summer season. Vitamin D production was also estimated for the four days that the radiation received was measured, and the amount generated was calculated for the entire summer season., Results: Exposure to UV radiation among Barcelona lifeguards far exceeds safety limits. In some locations, the exposure to UVB radiation is more than 16 times the minimum erythematous dose for phototype II skin., Limitations: This study assessed the radiation received during only four days. However, is a much higher number than most of the published papers., Conclusion: Although the health risks of excessive exposure to UV radiation are known, Barcelona's beach lifeguards are insufficiently protected., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The development of skin cancer is closely related to high exposure to UV radiation. Lifeguards are at an increased risk of excessive sun exposure., Objectives: The main objective of this study was to measure the exposure of Barcelona's beach lifeguards to UV radiation., Methods: Measurements in the work chair were taken every 30min on a typical working day from 10:45 am to 19:15 pm. These measurements were carried out on four different days. These data were used to calculate the erythematous doses received during working hours, as well as those potentially received throughout the summer season. Vitamin D production was also estimated for the four days that the radiation received was measured, and the amount generated was calculated for the entire summer season., Results: Exposure to UV radiation among Barcelona lifeguards far exceeds safety limits. In some locations, the exposure to UVB radiation is more than 16 times the minimum erythematous dose for phototype II skin., Limitations: This study assessed the radiation received during only four days. However, is a much higher number than most of the published papers., Conclusion: Although the health risks of excessive exposure to UV radiation are known, Barcelona's beach lifeguards are insufficiently protected., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Several studies stated greater impact on mental health among psychiatric population during the first wave of the COVID-19 pandemic. The aim of this paper was to study the pandemic effects more than a year after its outbreak on the mental state of adult patients with pre-existing psychopathology attending a Mental Health Center in Madrid (Spain)., Methods: A cross-sectional observational study was carried out with a sample of fifty-eight patients using a questionnaire that collected different descriptive variables. Results of the PHQ-9 Depression Scale, the GAD-7 Anxiety Scale, the IES-R Impact of Event Scale-Revised, the Clinical Global Impression scale CGI-GI, and the assessment of the professionals responsible for the patients about their clinical state were also collected. A descriptive analysis and binary logistic regression models were performed., Results: There was a prevalence of 70% anxiety, 76% depression and 57% stress due to a stressful event more than one year after the start of the pandemic. Likewise, associations were found between the symptoms and certain clinical, mediating variables and gender., Conclusions: The psychological state of patients with pre-existing psychopathology attended at the Mental Health Center is negatively affected by the COVID-19 pandemic up to a year and a half after its onset., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Diabetes mellitus is a chronic disease with high morbidity and mortality, affecting 537 million adults worldwide. Spain is the second European country in prevalence, with 14.8% in the population aged twenty/seventy-nine years; with 11.6 cases per 1,000 people/year. Diabetic retinopathy (DR) is the fifth cause of vision loss worldwide and the seventh cause of blindness/visual impairment among members of the National Organization of the Blind in Spain (ONCE). Early detection of DR prevents blindness in diabetics and is conditioned by glycosylated hemoglobin. The aim of this paper was to analyze the management of diabetic patients in Aljarafe region (Seville) and identify opportunities for improvement in the coordination of their follow-up between the Primary Care physician and the ophthalmologist., Methods: A retrospective observational study (2016-2019) was carried out, with patients registered in the diabetic census of the twenty-eight municipalities of Aljarafe. The primary care and hospital health history, and telemedicine program were consulted. About statistical analysis, for qualitative variables, totals and percentages were calculated; for quantitative variables, mean and standard deviation (if normally distributed) and median and quartiles (if non-normally distributed)., Results: There were 17,175 diabetics registered in Aljarafe (5.7% of the population); 14,440 patients (84.1%) had some determination of hemoglobin during the period, 9,228 (63.9%) had all of them in the appropriate range. Fundoscopic control was performed on 12,040 diabetics (70.1%), and of those who did not, 346 (10.6%) had all of them out of range. There were 1,878 (10.9%) patients without fundoscopic or metabolic control, 1,019 (54.3%) were women, 1,219 (64.9%) were under sixty-five years of age, 1,019 (54.3%) had severe comorbidity., Conclusions: Most patients have adequate screening, and more than half have determinations within range. However, a significant percentage with no glycated hemoglobin within range lack fundoscopic control, and another smaller group lack fundoscopic or metabolic control, with inter-municipal variability. We propose to improve communication channels between levels.

Introduction: Different parameters of suicide attempts treated since the implementation of the Attention to Suicide Risk Program (ARSUIC) in 2012 at the Hospital Ramón y Cajal in Madrid Region are described in this paper., Method: The sample was composed of 107 patients and the information was collected through a questionnaire created ad hoc with the following variables: type of suicidal ideation; drug use immediately prior to the attempt; method (in case of drug overdosing: drug/s used); location; accessibility to rescue; planning; intentionality; criticism; and brakes., Results: Descriptive statistics were obtained and a comparison by gender was made through the χ 2 and contingency coefficients tests. The data from the retrospective longitudinal study showed that the most common profile was of patients with unstructured ideas of death and no previous drug use who took an unplanned drug overdose in the family home, with the intention of self-harm or avoidance of discomfort, especially with benzodiazepines. Patients tend to ask for help afterwards and criticise the attempt, but potential restraints are often not recorded in the clinical report. Regarding the dissimilarities based on gender, statistically significant differences were found in prior alcohol consumption, in favour of men and in the overdose method, specifically with benzodiazepines, in favour of women., Conclusions: Knowing the types of attempts at self-harm is essential for improving prevention, understanding and patient management., (Copyright © 2022 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: Currently, esterility affects between 15% and 20% of couples of fertile age. Female reproductive success is mainly determined by age and ovarian reserve (OR). Recent studies highlight the influence of modifiable factors such as dietary habits and nutritional status on OR. In this regard, the Mediterranean Diet (MD) is postulated as a standard of healthy eating. Therefore, the objective of this paper was to analyze the influence of adherence to DM and nutritional status on the OR of infertile women., Methods: A descriptive cross-sectional study was carried out, lasting one year, between February 2022 and February 2023, in a sample of forty-five female patients who attended the Gynaecology-Esterility consultation at the Marina Salud Hospital in Denia (Spain) due to genital desire older than one year. An exploratory descriptive analysis based on univariate statistics was performed., Results: The mean age of the sample (n=45) was 31.84 (±3.99) years, with an average BMI of 26.27 (±6.08) kg/m2, with 44.4% (n=20) having excess body weight. The RO was measured based on AMH, with an average value of 2.32 (±1.59) ng/ml and RFA, with an average of 19.80 (±14.13) antral follicles. A statistically significant association was found between low adherence to DM and lower anti-Müllerian hormone (AMH; p=0.025) levels. In addition, an association was found between low consumption of vegetables (p=0.044), excessive consumption of red meat (p=0.027) and carbonated beverages (p=0.015) with insufficient AMH levels, indicative of low OR. Low fruit consumption was also found to be associated with low oestradiol levels (p=0.045). Statistically significant associations were also found reflecting the influence of nutritional status on OR., Conclusions: One of the main factors conditioning the success of ART (assisted reproductive technology) is the woman's OR. The most widely used parameter to assess OR is AMH. Lifestyle and diet are modifiable factors that can influence OR. High adherence to DM and consumption of vegetables is associated with higher levels of AMH; however, high intake of red meat and carbonated beverages is associated with lower levels. Nutritional status, adherence to DM and dietary habits influence the status of OR, so it would be advisable to promote programmes to improve the population's diet in order to improve reproductive health.

Objective: Although the lack of progress in reducing obesity is a global problem, different places have different contributing factors. One of the factors currently contributing to the increasing prevalence of obesity is emotional eating. The aim of this paper was to describe and compare the level of emotional eating and to analyse which variables and to what extent they affected the other variables., Methods: A descriptive cross-sectional study was conducted in students from 3 universities of the Iberian Peninsula (n=1,654) between October 2019 and June 2020. Data were collected through an online self-report questionnaire which included sociodemographic and anthropometric data and validated questionnaires such as: the Emotional Eaters Questionnaire, the ShortForm-36 and the Hospital Anxiety and Depression Questionnaire. Stratified random sampling was performed by faculty, degree, and class groups. For descriptive results, means, standard deviation and relative frequencies of variables were calculated. Student's t-test, chi-square and ANOVA were used to compare means. Simple and multiple linear regressions were performed for both samples., Results: The mean emotional eating score was 8.77±5.66 for spanish students and 10.02±6.19 for portuguese students, with a difference of 3.62 (<0.001). In Spain, the dependent variable that most affected emotional eating was quality of life (13.8% variance [<0.001]), while in Portugal it was anxiety (10.1% variance [<0.001])., Conclusions: Statistically significant differences are found in the level of emotional eating between populations. In addition, there is dissimilarity in the variables influencing the principal in both countries. These findings imply that they should be considered in the design of future research or health interventions.

Objective: Sexually Transmitted Infections (STI), as their name suggests, are infections caused by more than thirty different bacteria, viruses, and parasites and are transmitted through sexual contact, including vaginal, anal, or oral intercourse, although some sexually transmitted infections can also transmitted from mother to child during pregnancy, childbirth and lactation. According to World Health Organization, one of the main populations at risk for acquiring these diseases are sex workers and their clients. Due to the high prevalence, the characteristics and behaviors that favor the development of these diseases are analyzed. The main objective of this paper was to analyze the risk factors in the acquisition of sexually transmitted diseases in the population of sex workers., Methods: A literature search was conducted in Scopus, Pubmed, CINAHL, Medline, LILACS and IBECS, of observational, longitudinal and mixed methods studies conducted in sex workers and published between January 2011 and March 2021, with a final sample of fourty-three articles. The mixed methods assessment tool (MMAT) was used to assess the methodological quality of the papers., Results: After analyzing the literature, eleven groups of risk factors related to the acquisition of sexually transmitted diseases were obtained, these being economic factors, factors related to sexual practices, drug use, sex work, education, health problems, country of origin and mobility, partner, age, violence and other factors not belonging to the previous categories., Conclusions: Sex workers have numerous characteristics and behaviors that make them vulnerable to sexually transmitted infections. Of note are years of prostitution, drug use, number of partners and condom use, which are key factors for future prevention and intervention strategies, as well as research.

Objective: Different studies identify mental health literacy as a protective factor for developing a mental health problem. The aim of this paper was to determine the degree of mental health literacy of the adolescent population of Barcelona, and its relationship with socio-demographic and educational variables., Methods: A cross-sectional study was carried out in Barcelona during the 2017-2018 academic year. A total of 1,032 young people between thirteen and seventeen years of age participated. The following variables were collected: sex, age, nationality, socioeconomic status (RDHpc) and average school grade. The aim was to determine the degree of mental health literacy (knowledge, stigma and help-seeking) of the adolescent population of Barcelona, and its relationship with socio-demographic and educational variables. Multiple linear regression analysis was performed adjusting for the effect of sociodemographic variables on the score of each scale., Results: The mean score (standard deviation) of the EMHL test was 7.28 (1.27) and 4.24 (1.14) respectively, with higher scores obtained by girls, high RDHpc, excellent score and Spanish nationality. The greatest difference in EMHL scores, adjusting for the rest of the variables, corresponded to adolescents with an excellent mean score and a high RDHpc index (with respect to the baseline category, beta=0.72 and 0.52 respectively). The mean stigma score was 27.6 (4.47) for CAMI and 8.83 (3.36) for RIBS. The variables related to a greater difference in score with respect to the baseline category and adjusted for the rest of the variables were: gender (boy=1.54) and academic grade (excellent=-2.38) for CAMI, and nationality (foreign=0.82) and academic grade (excellent=-1.30) for RIBS. The mean RIBS score was 8.83 (3.36) with the largest difference in score from baseline being foreign nationality (beta=0.82) and having a grade of excellent (1.30). Help-seeking was higher in parents and friends, with differences according to gender and nationality., Conclusions: The level of mental health literacy is medium-low. While gender, nationality and educational attainment are the factors that are related to knowledge and stigma, socio-economic status is only related to mental health literacy.

Objective: Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large limbs, and show that, beyond the physical consequences, there are important psychological consequences. The goal of this paper was to show the updated knowledge on the main psychopathological consequences of amputations in work accidents, as well as the variables that can modulate them., Methods: A non-systematic bibliographic review was carried out, with varied ad hoc searches for the different variables studied., Results: Studies have focused mainly on anxiety and depressive symptoms, post-traumatic stress disorder, and phantom limb pain. Modulating variables whose presence improves the prognosis of these persons have been identified, such as adaptation to daily life, physical exercise, coping strategies, resilience and quality of life., Conclusions: The different psychological areas reviewed should be considered when attending people who have suffered an amputation in a work accident. Likewise, enhancing the modulating variables whose presence improves the prognosis is an interesting field for professional intervention.

Objective: Teaching first aid (FA) to children and young people is a priority strategy in Public Health. The aim of this paper was to review and analyze new educational legislation within the FA curriculum framework, which is necessary for providing teachers and healthcare professionals with a practical guide that guides teaching to train first responders in different school stages., Methods: A group of four experts with curricular experience at different educational levels, as well as in the field of FA, participated in this analysis. The methodology involved a consensus analysis approach on the content of the spanish Royal Decrees (RD) for Primary Education (RD 157/2022), Secondary Education (RD 217/2022), and Baccalaureate (RD 243/2022) that develop the curriculum of the Organic Law 3/2020 (LOMLOE)., Results: In the analysis of the three RD, ten general concepts were identified: accident prevention; protocol Protect, Alert, Assist (PAS); 1-1-2 protocol; recovery position (PLS); cardiopulmonary resuscitation (CPR); automated external or semi-automatic defibrillator (AED); foreign body airway obstruction (FBAO); FA; transportation of the injured; and stroke. Throughout all educational stages, in twenty-seven instances appeared content explicitly related to accident prevention or the learning of FA., Conclusions: The current curriculum provides FA content from the age of eight-nine (3 rd year of Primary Education). By the end of compulsory education, all students should be able to identify cardiac arrest, alert emergency services, initiate resuscitation maneuvers, use the defibrillator, and know how to respond to choking incidents., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: The COVID-19 pandemic has had a strong impact on other infectious diseases. The aim of this paper was to analyze the epidemiological changes that occurred during the pandemic in eight infectious diseases with different epidemiological patterns: influenza, respiratory syncytial virus, rotavirus, pneumococcus, Campylobacter , non-typhoid Salmonella , gonorrhea and herpes zoster., Methods: From the Microbiological Surveillance Network, the time series of cases was traced from January 2017 to March 2023. Three periods were distinguished: reference, pandemic and beginning of the post-pandemic. The distribution by age and sex in these periods was analyzed. Incidence rates and rate ratios (RR) were calculated. These RRs and their 95% confidence intervals were estimated overall and by year of age in children under five years of age., Results: Statistically significant differences were found in the impact that the pandemic had on each of these diseases. Some, after a period of epidemic silence, have revealed an intense post-pandemic rebound. The post-pandemic global RT increased for influenza (2.4), RSV (1.9) and gonorrhea (3.1); rotavirus recovered its pre-pandemic level (1.07); and pneumococcus (0.84), Campylobacter (0.83) and Salmonella (0.60) decreased. In children under 5 years of age, the patterns were specific and heterogeneous for each disease., Conclusions: The impact of the pandemic is very different in these diseases. Pediatric and respiratory-transmitted seasonal viral infections are the ones that are most affected, but with different patterns of recovery to normality. Gastrointestinal bacterial infections suffer fewer variations, except for rotavirus. Gonorrhea do not interrupt its increasing trend seen in the pre-pandemic. Shingles show a slight post-pandemic increase. Several diseases with different epidemiological patterns have been studied for a sufficient period to observe how the acute phase of the pandemic emerges.

Recurrent imbalances between supply, demand and personnel needs are one of the main challenges facing the National Health System (NHS). This situation has its origin both in supply factors and in the conditioning factors of the demand for human resources in the public health sector. The demographic structure of the NHS health professionals is generating an increasing number of outflows of doctors and nurses. On the other hand, the complex institutional architecture of the public health system produces dysfunctions in the structure of demand and in the form of recruitment. This paper argues for the need to articulate a strategic response that addresses the improvement of the governance of the human resources of the NHS and the reform of the instruments of coordination and harmonization of actions at the three levels of government of public healthcare., (Copyright © 2024 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today's medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive., (Copyright © 2024 SESPAS. All rights reserved.)

The nursing shortage is a multi-causal phenomenon that affects all countries and currently a global concern. The shortage of nurses jeopardizes the sustainability of health systems and the population health outcomes. Spain has historically had no difficulties in attracting new generations of nurses. The shortage of nurses is caused by the precarious working conditions and lack of professional development that have led to episodes of high international migration and abandonment of the profession. In this paper we focus on the evolution of different indicators of the working conditions of non-specialist nurses, who make up the bulk of the profession. These indicators allow us to analyse the abandonment of the profession, the duration of contracts, their full-time or part-time dedication and the excessive hiring. We have analysed the effect of COVID-19 and the labour reform on these indicators. COVID-19 reduced the abandonment of the profession and is currently at its lowest level, it has also accelerated the need to improve working conditions by increasing the percentage of permanent contracts and reducing the multiplicity of contracts in the same month. The labour reform has helped reduce the percentage of temporary contracts until reaching around 80% of the total contracts, and has reduced the number of nurses in Spain with more than one contract in the same month to below 3000 nurses on a sustained basis., (Copyright © 2024 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The Spanish public health system is overburdened. As a result, heath care professionals are showing symptoms of burnout, while private health services are expanding more than ever. As revealed by numerous strikes in recent years, health care professionals want better pay and work conditions and feel frustrated by their inability to give proper time and care to their patients. The institutional response from regional governments in Spain has been to remove the exclusivity clause that provided a salary bonus for physicians who worked entirely in the public sector; now all physicians receive this bonus, effectively promoting dual (public and private) practice. Although dual practice may increase the income of physicians and other health professionals, it poses several challenges that are analyzed in this paper. We also discuss alternative and more far-reaching policies that we believe should be implemented by the government in order to deal with the current crisis of the health system., (Copyright © 2024 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Mental health problems are increasing in Spain, and those related to drug use are a preventable aspect of public health. In Spain there are few studies on the incidence and characteristics of acute psychosis due to illegal drug use, especially at national and multicenter level, reason that motivated this paper., Methods: A prospective multicentre study was carried out in eleven hospital Emergency Departments in Spain, lasting twenty-four months (REDUrHE Registry). Patients with acute psychosis were compared with those with organic pathology, analysing demographic aspects, drugs involved, associated clinical manifestations and evolution Quantitative variables were compared using Student's t-test and qualitative variables were compared using the chi-squared test (or Fisher's exact test as appropriate) and the magnitude of the association with the presence of psychosis using logistic regression. A p-value of less than 0.05 was considered statistically significant or if the 95%CI of the OR excluded the value 1., Results: Of the 4,487 patients in the registry, 9.5% presented acute psychosis, with a median age of thirty-two years and 79% male. The main clinical features were agitation (53%, p=0.001), hallucinations (43.2%, p=0.001) and anxiety (40%, p=0.00). Psychosis was more frequent with cannabis (57.7%), cocaine (42%) and amphetamines and derivatives (26.4%), although in the analysis adjusted for co-drug use (39.5%), or in association with ethyl alcohol (57.7%), it was only statistically significant for cannabis (p=0.0). Patients with psychosis required more hospital admissions (38.1% vs. 10%, p=0.001), mainly in psychiatric units (34.1% vs. 4.2%, p=0.001), with hardly any intensive care unit admissions (0.4% vs. 2.1%, p=0.01). ED stay was high (29.3±73.8 hours vs 10.5±58.8 hours, p=0.001)., Conclusions: In Spain, cannabis is the drug most associated with psychosis. This clinical condition produces more hospital admissions, although with a low risk at an organic level., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Risk assessment of patients with chest pain is based on clinical parameters; however, without a scoring system, such as risk stratification scales, estimates are less precise and accurate. The aim of this paper was to compare the HEART, GRACE score and clinical parameters in the prediction of major cardiovascular events (cardiovascular mortality or acute myocardial infarction) during hospitalization, in patients with chest pain attended in the emergency department., Methods: A descriptive observational study of patients with ischemic chest pain, who attended to the Miguel Servet University Hospital emergency department (Zaragoza, Spain) during one year was carried out. HEART and GRACE scores were calculated retrospectively from clinical history. Quantitative variables were expressed as mean (±standard deviation), and qualitative variables as frequencies and percentages. A bivariate analysis was carried out using the chi-square test. The performance of the scales and clinical parameters was compared by calculating the area under the curve. The primary outcome was the occurrence of a major cardiovascular event (cardiovascular mortality or acute myocardial infarction) during hospital admission., Results: 306 patients were registered (66.3% men, n=203), with a mean age of 71.45±12.85 years and a 48.7% history of ischemic heart disease. The areas under the curve for HEART scales, GRACE and clinical parameters were 0.80 (95% CI: 0.73-0.86), 0.79 (95% CI: 0.72-0.85) and 0.74 (95% CI: 0.68-0.80), respectively. During hospitalization, the incidence of the primary event was 13.4% and no low-risk patient, in both scales, presented a major cardiovascular event., Conclusions: In patients with ischemic chest pain attended in the emergency department, the GRACE and HEART scale have a greater area under curve than clinical parameters.

Objective: Despite the global reduction in smoking, the consumption of roll-your-own tobacco has increased in recent years in many countries, which may be slowing down the downward trend in smoking. The aim of this paper was to analyse the evolution of the number of people who use roll-your-own tobacco and tobacco of any type between 2013 and 2018 in the Basque Country and measure whether there were socioeconomic inequalities in its consumption., Methods: We carried out an observational and cross-sectional study of a representative sample of the population living in the Basque Country aged 16 to 59 years (n 2013 =6929 y n 2018 =7961) from the Basque Health Survey (2013 and 2018) and the Basque Addictions Survey (2018). We calculated prevalences of regular tobacco smoking in general and of roll-your-own cigarettes according to different socioeconomic variables for the years 2013 and 2018, as well as prevalence ratios for the estimation of change between these years and according to the above variables through robust Poisson regression models. We stratified analyses by sex and two age groups., Results: Overall smoking prevalence decreased between 2013 (men=27.7% and women=24.1%) and 2018 but remained the same for those who used roll-your-own tobacco (in 2013, men=5.1% and women=3.2%; in 2018=5.4% and 3.5%, respectively). In contrast to tobacco in general, which showed a clear socio-economic gradient, roll-your-own tobacco use was more prevalent among young people (in 2018, men=6.4% and women=4.1%), a group where the pattern by socio-economic status was less evident., Conclusions: Considering the persistence of roll-your-own tobacco consumption, we also should direct tobacco control towards this kind of product, and its use should be monitored and supervised, especially among young people.

Objective: The Hereditary Haemorrhagic Telangiectasia (HHT) is a low prevalence disease which presents heterogeneous signs and symptoms and just few population-based epidemiological studies are available. The aims of this paper were to describe the sociodemographic characteristics of people affected by HHT in the Valencian Region (VR), to determine its prevalence and mortality rate, and to analyse the sources of recruitment and verification tests used by the Rare Diseases Information System of the VR (SIER-CV)., Methods: Cross-sectional observational epidemiological study of HHT prevalent cases between 2010-2019 in SIER-CV was performed. The distribution of sociodemographic and clinical characteristics were determined, the prevalence and mortality rates, and the sources of recruitment and verification tests used by SIER-CV were analysed. Statistical analysis was performed using Stata (version 16.1) and Microsoft Excel Office., Results: During 2010-2019, two hundred cases were identified, 55.5% were female. The mean ages were: 56.8 years at recruitment and 50.9 years at diagnosis. 48.4% of cases were diagnosed between thirty-six/sixty-four years of age. 25.5% died, with a mean age of 76.6 years, identifying statistically significant differences above the age of 64. The prevalence was 39.6/1,000,000 inhabitants and the crude mortality rate was 10.1/1,000,000 inhabitants. 95.5% of cases were recruited from the Hospital discharges database and the most frequent verification test was the clinical basis (45.7%)., Conclusions: The increasing trend in prevalence coincides with a better knowledge of HHT, which favours its detection, and also with dying at older ages. To describe the situation of HHT in the VR facilitates its health management and contributes to the establishment of the relevant health policies for the HHT. The need to promote genetic diagnosis and to incorporate the Primary Care Clinical History as a source of recruitment in the population-based registries has been shown.

Objective: Healthcare professionals were subjected to very demanding working conditions during the COVID-19 pandemic. The aim of this paper was to assess the level of risk of suffering a psychosocial disorder in the professionals of the Epidemiological Surveillance Services of Catalonia (EVS) during the sixth wave of the COVID-19 pandemic., Methods: An epidemiological study of prevalence was carried out in SVE workers in Catalonia. The information was collected through a questionnaire of sociodemographic and occupational data and the Goldberg General Health Questionnaire (GHQ-28) from January to March 2022. A score equal to or greater than 7 on the GHQ-28 was considered positive and indicated a risk of suffering some disorder. The dependent variables were the score and positivity of the GHQ-28 test. The relationship between the GHQ-28 score and the rest of the independent variables of the study was studied with the Odds Ratio (OR) and its 95% confidence intervals (IC)., Results: The mean age of the population studied was 37 years (SD=±11.4) and 75% were women. 53.8% of the participants presented a positive result in the GHQ-28. The participants with the highest psychosocial risk were workers with a history of psychological problems (OR 2.8; IC95% 1.2-6.7). The risk was also higher in women (OR 1.8; IC95% 0.8-4.1), participants with health professions (OR 1.2: IC95% 0.6-2.5), those who were taking pharmacological treatment (OR 2.4; IC95% 0.6-9.7) or those who were undergoing psychological therapy (OR 1.5; IC95% 0.6-3.6) at the time of data collection and workers who did not had a perception of work support and recognition from their work teams (OR 1.8; IC95% 0.9-3.8), although some differences were not statistically significant., Conclusions: The professionals of the SVE professionals presented, during the sixth pandemic wave, a high risk of psychosocial disorder. As measures to be adopted, and with the aim of reducing psychosocial risk among its professionals, it is recommended to introduce organizational changes in surveillance services to prevent psychosocial disorders among its professionals.

Objective: The COVID-19 pandemic indirectly affected other communicable diseases, such as human immunodeficiency virus (HIV) infection. The aim of this paper was to evaluate the impact of the COVID-19 pandemic on the epidemiological surveillance of HIV through epidemiological indicators., Methods: Data collected in the New HIV Diagnosis Information System (SINIVIH, acronym in Spanish) in the period 2013-2021 was analyzed. The epidemiological indicators analyzed were: 1) Reporting delay of new diagnoses; 2) Under diagnosis of cases, calculated per month of diagnosis and for each year of diagnosis; 3) Late diagnosis, cases diagnosed with less than 350 CD4 cell/mm 3 ., Results: Regarding the reporting delay of new diagnoses, in 2022 2,770 diagnoses were reported in 2020, 43.8% more than those reported in 2021 for that year. The cases diagnosed per month between 2016 and 2019 followed a constant trend. In 2020, a significant decrease in diagnoses was observed between March and May that was not recovered after correcting for reporting delay. When comparing the rates of cases diagnosed in 2013 with the successive years, a continuous decrease was interrupted in the last year of the study period. The percentage of cases with late diagnosis had remained stable in the study period (between 46% and 50%), and a decrease in this percentage was observed after correcting for reporting delay., Conclusions: The epidemiological surveillance of HIV suffered a significant reporting delay. A decrease in cases diagnosed is confirmed, partly due to lockdown and lack of access to the health system. Changes on late diagnosis is not observed.

Objective: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Since the onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country., Methods: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student's t- test were used to compare epidemiological and demographic variables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020)., Results: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, we observed a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSV infection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions)., Conclusions: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distribution of the disease are not uniform. It starts in the center of Spain and ends on the coast.

Objective: There are controversies regarding the effect of the influenza vaccine on the risk of suffering from COVID-19. The aim of this paper was to compare the risk of suffering from COVID-19 between vaccinated and unvaccinated patients against influenza., Methods: A retrospective case-control study of patients assigned to an urban CAP (coverage: 44,564 inhabitants) was carried out during 2020. Patients with diagnostic confirmation of COVID-19 (ART, PCR or serology) were defined as cases, and those who have not had said infection, selected by simple random sampling, were defined as controls. The case/control ratio was 1:1. The data sources used were the Khalix health data registry databases and the computerized medical record (E-cap). Data were analyzed with a multivariable logistic regression model., Results: A total of 4,320 patients were included in the study: 2,160 cases (50%) and 2,160 controls. 18% of the cases and 14.3% of the controls were vaccinated against influenza [OR=1.3 (95% CI: 1.2-1.5; p=0.001)]. Multivariate analysis showed that in patients under eighty years of age, there were no differences between vaccinated and unvaccinated patients [OR=1.02 (95% CI: 0.8-1.3; p=0.8)]; while in those over eighty years of age, there was a lower risk of presenting COVID-19 in vaccinated patients [OR=0.4 (95% CI: 0.3-0.7; p<0.001)]., Conclusions: The adjusted model shows that at ages above than 80 years, flu-vaccinated patients have decreased risk of COVID-19 with statistical significance.

Objective: Alzheimer's disease has become the great epidemic of the 21st century, being a challenge for the sustainability of the social and health system. Alzheimer's causes disability and dependency among the elderly, requiring continued care with therapies that improve the health and quality of life of these people. The objective of this paper was to evaluate the effectiveness of non-pharmacological therapies applied to people with Alzheimer's in Primary Care., Methods: A systematic review of articles published between April 2017 and April 2022 was carried out, applying the PRISMA methodology. The databases consulted were: PubMed, CINAHL, Dialnet, Web of Science and PsycINFO. MeSH and DeSH were used, with the Boolean operators AND and OR. The quality of the articles was evaluated with the STROBE, COCHRANE, AMSTAR-2 and JBI scales., Results: A total of nineteen articles were selected in which various non-pharmacological therapies and their effectiveness in people with Alzheimer's were evaluated. Therapies based on physical activity and rehabilitation, cognitive stimulation and occupational therapy with music, animals and art, applied and maintained over time, are an alternative which, either combined or applied in isolation, are effective in preventing, stopping and slowing down Alzheimer's disease symptoms, especially in the first phase., Conclusions: Physical activity and rehabilitation, cognitive stimulation and therapy with music, animals and art, improve the health status and quality of life of patients with Alzheimer's disease in the first phase of the disease.

Objective: Functional assessment is part of geriatric assessment. How it is performed in hospital Emergency Departments (ED) is poorly understood, let alone its prognostic value. The aim of this paper was to investigate whether baseline disability to perform basic activities of daily living (BADL) was an independent prognostic factor for death after the index visit to the ED during the first wave of the COVID-19 pandemic and whether it had a different impact on patients with and without diagnosis of COVID-19., Methods: A retrospective observational study of the EDEN-Covid (Emergency Department and Elder Needs during COVID) cohort was carried out, consisting of all patients aged ≥65 years seen in 52 Spanish EDs selected by chance during 7 consecutive days (30/3/2020 to 5/4/2020). Demographic, clinical, functional, mental and social variables were analyzed. Dependence was categorized with the Barthel index (BI) as independent (BI=100), mild-moderate dependence (100>BI>60) and severe-total dependence (BI<60), and their crude and adjusted association was evaluated with mortality at 30, 180 and 365 days using COX proportional hazards models., Results: Of 9,770 enrolled patients with a mean age of 79 years, 51% were men, 6,305 (64.53%) were independent, 2,340 (24%) had mild-moderate dependence, and 1,125 (11.5%) severe-total dependence. The number of deaths at 30 days in these three groups was 500 (7.9%), 521 (22.3%) and 378 (33.6%), respectively; at 180 days it was 757 (12%), 725 (30.9%) and 526 (46.8%); and at 365 days 954 (15.1%), 891 (38.1%) and 611 (54.3%). In relation to independent patients, the adjusted risks (hazard ratio) of dying within 30 days associated with mild-moderate and severe-total dependency were 1.91 (95% CI: 1.66-2.19) and 2.51. (2.11-2.98); at 180 days they were 1.88 (1.68-2.11) and 2.64 (2.28-3.05); and at 365 days they were 1.82 (1.64-2.02) and 2.47 (2.17-2.82). This negative impact of dependency on mortality was greater in patients diagnosed with COVID-19 than in non-COVID-19 (p interaction at 30, 180 and 365 days of 0.36, 0.05 and 0.04)., Conclusions: The functional dependence of older patients who attend Spanish EDs during the first wave of the pandemic is associated with mortality at 30, 180 and 365 days, and this risk is significantly higher in patients treated for COVID-19.

Introduction: Small cell lung cancer (SCLC) comprises 10-15% of all lung cancer cases and is the most aggressive histological type. Survival is poor and the molecular landscape of this disease is extraordinarily complex. The objective of this paper was to perform a Genome-Wide Association Study (GWAS) of this disease using a case-control study specifically designed for small cell lung cancer (SCLC)., Methods: Incident cases were consecutively recruited from 8 hospitals from different regions of Spain. Controls were recruited from the same hospitals using a frequency sampling based on age and sex distribution of cases. Biological samples were obtained along with detailed information on cases and controls lifestyle, including tobacco and radon exposure., Results: We included 271 SCLC cases and 557 controls. We found evidence (p-values<10 -5 ) of an association in the complete dataset for several loci, while MAP4 showed a significant association in the gene-based analysis. Pathway analysis suggested that ATR, ATRIP, MCM4, MCM5, ORC4, RPA3 and CDC25A genes have a role on the onset of SCLC., Conclusion: This study provides biological evidence for pathways related to SCLC, offering novel loci for further research., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The prevalence of chronic pain in Spain is 17%, which causes suffering and significant loss of quality of life. Therapies should not focus only on pain reduction, to improve function and quality of life are necessary. Currently, it is committed to combining drugs and other therapies such as relaxation, meditation, cognitive behavioral therapy, targeted exercises, healthy lifestyles and techniques to increase self-esteem and motivation for change. These therapies can be used as part of a multimodal approach, forming part of multicomponent programs or workshops. In this paper we proposed to evaluate the effectiveness of a workshop developed from the Hospital San Juan de Dios del Ajarafe, that integrated different non-pharmacological therapies in the control of chronic non-oncologic pain and to analyze patients' perceptions of the techniques applied and how they affected pain and lifestyles., Methods: An intragroup before-after study (beginning-end of the workshop) was carried out, comparing pain, well-being, drug use, quality of life, and self-esteem. Surveys were conducted to deepen more qualitative aspects and identify improvements. The workshop consisted of psychoeducational action and training for the mental control of pain and emotions, based on the active participation of the patient in the management of his disease, promoting self-care and self-esteem, and aiming to improve well-being and quality of life. It consisted of 5 sessions of 3 hours (1 per week); of a group, interactive and practical nature. Statistical analysis was performed with SPSS vs.27.0. To compare related measures (before-after) we used Student's T tests for paired samples and Wilcoxon's test and to compare independent groups, Student's T and Mann Whitney's U; for the qualitative variables, we used Chi-Square and Fisher's test., Results: Four workshops were evaluated in which 63 patients participated, with a mean age of 57.6 (SD:11.37) years, 60 (95.2%) of them were women. At the end of the workshop pain decreased 1.5 median (-2.0-0) and well-being increased 2.0 (0-2.0); quality of life increased a median of 0.121 (SD: 0.209), health status 16.8 (23.78) and self-esteem 2.74 (4.73); [p<0.001]. The best valued techniques were meditations, mainly mental analgesia, affirmations in the mirror and self-esteem techniques., Conclusions: Overall satisfaction with the workshop is 9.8 out of 10. There is a pain control and improvement in quality of life, self-perception of health status, well-being and self-esteem.

The respiratory syncytial virus (RSV) causes a substantial burden worldwide. After over six decades of research, there is finally a licensed immunization option that can protect the broad infant population, and other will follow soon. RSV immunization should be in place from season 2023/2024 onwards. Doing so requires thoughtful but swift steps. This paper reflects the view of four immunization experts on the efforts being made across the globe to accommodate the new immunization options and provides recommendations organized around five priorities: (I) documenting the burden of RSV in specific populations; (II) expanding RSV diagnostic capacity in clinical practice; (III) strengthening RSV surveillance; (IV) planning for the new preventive options; (V) achieving immunization targets. Overall, Spain has been a notable example of converting RSV prevention into a national desideratum and has pioneered the inclusion of RSV in some of the regional immunization calendars for infants facing their first RSV season., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: Breast cancer screening (BCS) leaflets are important for outreach and dissemination of BCS programs. Knowing how women perceive these leaflets is relevant to better understand their attitude towards BCS. The objective of this paper was to explore women's reactions regarding BCS leaflet., Methods: A simple descriptive qualitative design was performed involving women aged between forty and sixty years of age in Asturias (Spain). Twenty-six semi-structured interviews were conducted with women of different socioeconomic profiles in 2018. Thematic analysis was carried out., Results: Reading the leaflet elicited positive emotions such as peace of mind, well-being or gratitude, in addition to fear or anxiety. The women expressed various beliefs about breast cancer (highly prevalent and high survival rates), about BCS (a program aimed at prevention, a normative activity among their peers) and about the relevant role of health services and the media. Ambivalent attitudes towards BCS were detected, related to emotions., Conclusions: The emotional response after reading the brochure is ambivalent, although most of the women express positive emotions. Women compare the information with previous beliefs, especially regarding breast cancer (BC) and BCS. It is important to understand how certain emotions (especially negative ones) are closely related to the attitude towards BCS., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Lifetime prevalence of cannabis use is estimated 192 million adults worldwide (2017) and has increased by 16% in the last decade. However, data on quantity and frequency of use that can lead to harm is lacking. We have developed a survey to assess patterns of cannabis use and related harms in a sample of cannabis users. This paper focuses on evaluating the feasibility of the survey and the users' satisfaction in a pilot sample. Forty cannabis users were recruited (>18 years old, living in Spain, cannabis use at least once during the last 12 months) between December 2018 and January 2019. Participants answered an online survey (mental health, organic harm and injury) and an ad hoc questionnaire to assess accessibility, feasibility, satisfaction, design and content appropriateness. Of the participants, 93.23% (n = 37.3) were satisfied with the design, 94.92% (n = 38.2) were satisfied with the content, and 94.73% (n = 37.0) were satisfied with the accessibility of the survey; only minor changes were required to improve feasibility and accessibility. Participants used a median of 1.0 Standard Joint Unit per day (Interquartile Range [IQR] 1.0-2.0). Of the sample, 92.5% reported at least one related harm and suffers a median of 4.0 disorders (IQR, 1.25-5.0). The present study allows for designing a feasible online survey to conduct a cross-sectional study with a larger sample.

Objective: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violence suffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect cases of sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists., Methods: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapists in charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out on a convenience sample of fourteen physiotherapists., Results: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as well as the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinical field, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age, professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception of its impact, will be assessed., Conclusions: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and, also, to assess the evolution over time of each violence separately for providing direction for successful policies and training., Competing Interests: Disclosure The authors report no conflicts of interest in this work.