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Introduction To assess exposure to second-hand smoke (SHS) in bus stops and markets, settings excluded from the Spanish Law 42/2010 regulating smoking in closed and open public places. Material and Methods Cross-sectional study in Barcelona assessing SHS exposure in 20 bus stops, 8 open markets, and 9 closed for comparison. We measured PM2.5 and vapour-phase nicotine as markers of SHS during 30 min (both in μg/m3), using a SidePak AM510 monitor and a cassette containing a filter treated with sodium bisulphate, respectively. We computed medians and interquartile ranges (IQR) and compared them according to traffic density, evidence of smoking (tobacco smell/butts), presence of smokers, wind speed, and type of bus stop (with/without shelter) or type of market (open/closed). Results Median (IQR) PM2.5 concentration was 13.52 µg/m3 (9.62–17.68 µg/m3) in bus stops, being higher in those with evidence of smoking (14.04 vs. 8.84 µg/m3; p

Introduction : Stroke represents the third cause of morbidity and mortality in adults, the first medical determinant of disability and the second of dementia. Around 50% of stroke survivors develop mobility limitations and disability in the activities of daily living (ADL). After a stroke, treatment aims include the recovery of the maximum possible independence and the promotion of social and working reinsertion, while reducing the risk of institutionalization and mortality. Early supported discharge from acute care has demonstrated quicker return home and a higher chance of achieving independence. Efficiency of such programs is associated, among other factors, with an appropriate selection of patients and with coordination with community and social services. In Barcelona, both the healthcare and social systems provide a wide range of resources, but the two systems are not integrated. After a stroke, patients admitted to acute or intermediate care hospitals are currently discharged with a personal healthcare plan, but the activation of social resources requires further assessments by primary healthcare and municipal social services at the patient’s home; this activates a process to assign resources and to establish the economic contribution of the user. The Return Home Program (RHP) aims at facilitating home discharge and the achievement of maximum possible independence. It is directed to improve coordination in order to: - Early detect post-stroke patients admitted to acute or intermediate care hospitals and candidate to home-based social and rehabilitation interventions. - Direct activate municipal social services (including personal assistance, house cleaning, tele-care, meals-on-wheels, rehabilitation aids) through the empowerment of social workers staff of the hospitals, which traditionally could only refer the person to primary care or social services. During the first weeks after discharge, activation is independent of the economic situation of the person. - Guarantee the availability of social resources right at discharge. - Provide the most efficient rehabilitation resource. Methods : Quasi-experimental study, with pre-post intervention and comparison groups. Aims: to evaluate short and middle-term impacts of RHP on functional recovery, quality of life and return home, as well as patients’ and caregivers’ satisfaction; to evaluate cost-effectiveness of RHP, compared to usual care. Target population: stroke patients admitted to acute or intermediate care hospitals ,with >2 impaired ADL and social needs. Barcelona healthcare services are organized in 4 Integral Healthcare Areas (IHA): the intervention group includes hospitals of the Left and Seaboard IHAs (reference population= 815.285 inhabitants), whereas the control group includes hospitals of the other 2 IHAs (812.177 inhabitants). Progress report : RHP will start in January 15th 2016, and the pilot will run for 1 year. So far, we concluded: - Bibliographic review about similar interventions and outcomes - Program and study design, by 3 parallel and partially overlapping working groups: 1) “intervention working group”, including specialists in rehabilitation and geriatrics, nurses, social workers from the healthcare and social sectors, psychologists, who defined the program, target population and screening and assessment tools; 2) “evaluation working group”, which sums, to the previous profiles, experts in public health and healthcare assessment, who refined study design and methods; 3) “implementation working group”, expanded to strategic stakeholders from the participants institutions, in charge of the training and follow-up. - Institutional support and funding (gratuity of municipal social resources and study funding), by the Government of Catalonia and the Municipality of Barcelona. Discussion : This experience, in a highly fragmented environment such as the city of Barcelona, adds the value of integrating healthcare social services in the hospital and basic municipal social services in the community. Early detection of needs in the hospital is cardinal for the effectiveness of the intervention. A further innovative aspect is the gratuity for the patient, independent of the economic level. The design of the study will allow the estimation of effectiveness and cost-effectiveness of the program through the comparison between the study groups. In order to guarantee the feasibility of the study, we included in the project all the relevant stakeholders, experts professionals, who allowed taking into account the context and possible barriers, and leaders from the involved public administrations. We will present preliminary results at ICIC16. Conclusions : RHP is an innovative program which will promote integrated health and social care for a group of particularly vulnerable adults, in a high fragmented environment. Due to these elements of difficulty, in case of positive results we envision the translation of this program to other groups and contexts. After completing the design and planning phases, we will start the program shortly.

Background. While progress has been made to create smoke-free airports, sales of e-cigarettes at airports and airplanes and the presence of advertisements might detract from these smoke-free policies. The objective of this study is to describe the presence of policies, advertising, sales and use of e-cigarettes in airports and on flights in Europe and the US. Methods. A cross-sectional study was conducted between March-May, 2014. The study included 21 large and mid-sized airports of Europe and the US as well as 19 flights. A standardised protocol was used to observe points of sales and advertisements and to collect information on the implementation of policies on e-cigarette use. In addition, a series of questions were developed to obtain policy details from airport personnel and flight attendants. Results. Retail outlets selling e-cigarettes in airports were present in approximately 20% and 40% of the observed pre and post-security areas, respectively. In post-security, 27.8% of the airport staff reported that the use of e-cigarettes indoors was not allowed, 22.2% reported that they did not know, 27.8% reported that it was only allowed in the smoking room, and 22.2% reported that it was allowed anywhere. Smoking ban announcements were made on all flights. However, only 15.8% of the flights made a specific announcement regarding the ban of using e-cigarettes. Conclusions. In light of our results, it seems necessary to reinforce in-flight e-cigarette smoking ban announcements and to instruct airport employees about the existence of e-cigarette smoking policies. Furthermore, airports themselves should also be encouraged to adopt smoke-free policies.

Entre las funciones de los epidemiologos se encuentra la de estudiar la asociacion entre ciertos factores y la calidad de vida de determinadas poblaciones. Ademas, sabemos bien que muchos factores muestran una relacion sinergica, de manera que cuando se presentan dos o mas factores, el efecto conjunto es mayor que el de cada uno de ellos de forma independiente. Este editorial pretende describir cual es el potencial efecto (?sinergico?) de que se den estos dos factores: ser joven y dedicarse –o quiza deberiamos decir «intentar dedicarse»– a la epidemiologia. Es obligado, y a la vez complicado, empezar por definir que es ser joven. Seguramente John Last estuvo muy acertado (y tambien muy diplomatico) en su Diccionario de salud publica al afirmar que la definicion de joven varia segun el lugar y las circunstancias1. En este editorial, cuando hablemos de jovenes nos referiremos basicamente a personas que no superan la treintena. Asi, la Sociedad Espanola de Epidemiologia (SEE)2, por ejemplo, considera investigadores jovenes a aquellos menores de 35 anos, mientras el Grupo Espanol de Jovenes Epidemiologos y Salubristas (Grupo EJE)3 establece el limite de edad en menores de 36 anos.

Durante las últimas décadas, ha crecido el interés por el estudio del estrés y los factores psicosociales relacionados con el trabajo. Se suele estudiar el estrés en unidades específicas, pero es frecuente encontrar situaciones de estrés en Unidades Médicas. Fue objetivo de ese estudio identificar y clasificar factores laborales estresantes que afectan a los profesionales de enfermería en Unidades Hospitalarias. Estudio cualitativo, descriptivo-analítico, prospectivo siguiendo la metodología Delphi, en España – Hospital Geral. Universitario de Alicante y Hospital Geral. de Elda. Participaron profesionales de enfermería (n=30) de las unidades. Se identifican en las cuatro etapas del proceso diferente factores de estrés en los profesionales, elevándose progresivamente los niveles de consenso. Se concluye que los factores con mayor consenso y mayor puntuación en el grupo, pueden usarse como herramienta en la gestión clínica de unidad hospitalaria, a fin de mejorar la calidad de vida laboral de los trabajadores, y buscar la excelencia en la línea gestora. Interest in the study of stress and the psycho-social factors related with work has grown over recent decades. Stress may be studied in specific units, but situations of stress are frequently to be found in medical units. The objective of this study was to identify and classify work-related stress factors which affect nursing professionals in hospital units. The study was qualitative with a descripto-analytical approach, following the Delphi methodology, and was carried out in Spain at the University of Alicante General Hospital and Elda General Hospital. Thirty nursing professionals from these units participated. Different stress factors acting on the health professionals were identified in the four stages of the process, in progressively raising levels of consensus. It is concluded that the factors referred to most frequently and with the greatest consensus may be used as a tool in the clinical management of hospital units, to improve the work life of the staff and to seek excellence in management. Durante as últimas décadas, o interesse pelo estudo do estresse vem crescendo, bem como os fatores psicossociais relacionados com o trabalho. É comum estudar o tema estresse em unidades específicas, porém frequentemente se encontram situações de estresse em Unidades Médicas. O objetivo desse estudo foi identificar e classificar fatores laborais estressantes que afetam os profissionais de enfermagem em Unidades Hospitalares. Estudo qualitativo, descritivo-analítico, prospectivo segundo a metodologia Delphi, na Espanha – Hospital Geral. Universitário de Alicante e Hospital Geral. de Elda. Participaram 30 profissionais de enfermagem das unidades. Foram identificados, nas quatro etapas do processo, diferentes fatores de estresse nos profissionais, elevando-se progressivamente os níveis de consenso. A conclusão a que se chegou foi a de que os fatores com maior consenso e maior pontuação no grupo podem ser usados como feramenta na gestão clínica de unidade hospitalar, a fim de melhorar a qualidade de vida laboral dos trabalhadores e buscar a excelência na linha gestora.

This study evaluate the safety and immunogenicity of pneumococcal seven-valent conjugate vaccine (Prevenar ® ) in 115 children, aged 2–3 years (24–36 months), who have not been previously vaccinated with Prevenar ® . Results: Safety: As for local reactions, 40% of children reported erythema, 32.2% induration and 39.1% tenderness at the injection site. Regarding systemic reactions, fever ≥38C was recorded in 7% of patients. Other commonly reported events were decreased appetite (24.3%), restlessness (20%), and fussiness (18.3%). Immunogenicity: After vaccination, more than 98% of the subjects achieved antibody levels of ≥0.15 μg/mL for all seven serotypes and more than 95% achieved antibody levels ≥0.50 μg/mL for all serotypes. Conclusions: Pneumococcal seven-valent conjugate vaccine (Prevenar ® ) was safe, well tolerated and highly immunogenic when administered in previously unvaccinated children aged 24–36 months.