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Background Optimizing colonoscopy resources is challenging, and information regarding performing diagnostic quantitative faecal immunochemical test (FIT) in daily clinical practice in primary health care is still limited. This study aimed to assess the sensitivity, specificity, positive predictive value and negative predictive value of varying FIT positivity thresholds on colorectal cancer (CRC) detection in primary health care. Methods A retrospective cohort study of 38,675 asymptomatic and symptomatic patients with a FIT (OC-Sensor™) performed between 2012 and 2016 in a primary health-care setting, using a clinical laboratory database of two Spanish areas linked with the National Health System's Hospital Discharge Records Database. The primary outcome was 2-year CRC incidence. Results The mean age of the participants was 63.2 years; 17,792 (46.0%) were male. CRC prevalence was 1.7% (650/38,675). The percentage of patients with a FIT result above the threshold was 20.7% and 14.6% for 10 μg Hb/g faeces and 20 μg Hb/g faeces thresholds, respectively. Sensitivity was 90.5% (95% confidence interval 88.0%–92.5%) at a 10 μg Hb/g faeces threshold, and this decreased by 3.1% when a 20 μg Hb/g faeces threshold was used. The negative predictive value for CRC was at least 99.2% in any subgroup analysed. At a 20 μg Hb/g faeces threshold, less than one additional CRC would be missed per 1000 patients investigated, while approximately 1.3 times more colonoscopy examinations were needed to identify an incidence of CRC using the lowest threshold for any situation analysed. Conclusions In primary health care, a quantitative FIT threshold should be tailored to colonoscopy capacity and CRC prevalence in specific populations. Instituto de Salud Carlos III, España | Ref. PI17/00837

Background Workers and residents in Care Homes are considered at special risk for the acquisition of SARS-CoV-2 infection, due to the infectivity and high mortality rate in the case of residents, compared to other containment areas. The role of presymptomatic people in transmission has been shown to be important and the early detection of these people is critical for the control of new outbreaks. Pooling strategies have proven to preserve SARS-CoV-2 testing resources. The aims of the present study, based in our local experience, were (a) to describe SARS-CoV-2 prevalence in institutionalized people in Galicia (Spain) during the Coronavirus pandemic and (b) to evaluate the expected performance of a pooling strategy using RT-PCR for the next rounds of screening of institutionalized people. Methods A total of 25,386 Nasopharyngeal swab samples from the total of the residents and workers at Care Homes in Galicia (March to May 2020) were individually tested using RT-PCR. Prevalence and quantification cycle (Cq) value distribution of positives was calculated. Besides, 26 pools of 20 samples and 14 pools of 5 samples were tested using RT-PCR as well (1 positive/pool). Pooling proof of concept was performed in two populations with 1.7 and 2% prevalence. Results Distribution of SARS-CoV-2 infection at Care Homes was uneven (0–60%). As the virus circulation global rate was low in our area (3.32%), the number of people at risk of acquiring the infection continues to be very high. In this work, we have successfully demonstrated that pooling of different groups of samples at low prevalence clusters, can be done with a small average delay on Cq values (5 and 2.85 cycles for pools of 20 and 5 samples, respectively). Conclusions A new screening system with guaranteed protection is required for small clusters, previously covered with individual testing. Our proposal for Care Homes, once prevalence zero is achieved, would include successive rounds of testing using a pooling solution for transmission control preserving testing resources. Scale-up of this method may be of utility to confront larger clusters to avoid the viral circulation and keeping them operative.

Background: Telemedicine has been incorporated into daily clinical practice. The purpose of this paper is to evaluate the economic impact of electronic consultation as a means of referring patients between Primary Care (PC) services and the referral Cardiology Service (CS) of a tertiary hospital, in particular, the cost of reduced air pollution. Methods: The direct and indirect costs associated with all the interconsultations between PC and a CS of a tertiary hospital were analyzed under a universal single act model versus a prior e-consultation model that selected patients who would later attend the single-act consultation. The cost of pollution from private motor vehicle travel by road has been analyzed with a Cobb–Douglas cost function. Results: The total cost per patient, including the costs associated with death, represented a saving in the model with e-consultation of 25.6%. The economic value for the reduction of contamination would be EUR 12.86 per patient. Conclusions: The introduction of e-consultation in the outpatient management of patients referred from PC to a CS, helps to reduce direct and indirect costs for the patient and the Health Care System. The cost of pollution associated with the trips explains the total cost to a greater extent, except for the first face-to-face consultation.

Background: Comprehensive geriatric evaluation should include a functional and cognitive assessment to guide the intervention of interdisciplinary teams. The aim of this study was to analyze the physical capacities of institutionalized elderly people and to describe the preventive actions of physical activity and music therapy as non-invasive preventive pharmacological treatments given their importance for the cognitive and functional performance of elderly people. An observational and descriptive cross-sectional study was carried out. The participants in the study were 109 elderly people institutionalized in three residential centers with a mean age of 83.41 years (SD = 8.72). Findings: Most of the residents had very impaired physical faculties. However, cognitive impairment was not very high. Most residents (55.04%) had some form of dementia and/or high blood pressure (54.12%) followed by pathologies such as diabetes (27.52%), heart failure (17.43%), Parkinson’s disease (9.17%) and chronic obstructive pulmonary disease (8.25%). There were no differences in cognitive or physical capacity among the residents according to sex, age, or education and only those who had worked in the service sector had less cognitive capacity than those who had worked in the agricultural sector or as housewives. Applications: Facilitate the creation and development of programs based on physical activity and music therapy in residential centers that can prevent and improve pathologies on the elderly.

Aim: This study aims to assess the influence of training on nurses’ attitudes toward end-of-life care during the COVID-19 pandemic alarm state in Spain. Design: Cross-sectional descriptive study. Data collection was carried out by means of an ad hoc questionnaire using Google Forms in April and May 2020. The score of attitudes toward end-of-life care was used, to which sociodemographic variables and training in palliative care were added. Methods: Data were collected from 238 nursing professionals who had cared for COVID-19 and non-COVID-19 adult patients at the end-of-life stage in a hospital or nursing home. Results: Results showed that 51% of the nurses in the sample had training in palliative care. However, the percentage decreased to 38.5% among those who cared for COVID-19 patients and to 44.5% in those who cared for non-COVID-19 patients. In relation to attitudes about end-of-life care, more positive attitudes and a higher mean score were found in the trained group. Conclusions: Palliative care training is a key element in end-of-life care and is even more important in times of COVID-19. Impact: Although end-of-life accompaniment has been studied, few studies have included the influence of training on this during the pandemic. This study identifies key elements of accompaniment and training in a comparison of COVID-19 and non-COVID-19 patients during the pandemic. In relation to attitudes toward end-of-life care, the results showed a more positive attitude and a higher mean score in the trained group (3.43 ± 0.37 versus 3.21 ± 0.32), the difference being statistically significant (p &lt, 0.001).

[Abstract] Sedentary (sitting) time may produce many anatomical and physiological consequences which are supposedly associated with a decreased quality of life (QoL) related to foot health. Accordingly, this study aimed to analyze the QoL impact on the overall health and the foot health among male and female sedentary people. A total of 312 participants with an age mean of 39.81 ± 15.40 years completed all phases of the study. In addition, self-reported data were registered. The participants' sedentary lifestyle was determined using the European Prospective Investigation into Cancer and Nutrition (EPIC) physical activity questionnaire. Furthermore, the scores obtained from the Portuguese version of the Foot Health Status Questionnaire were registered. Sedentary people in the equivalent metabolic energy had 301.09 ± 72.22 (min/week). In the first section, values were higher for foot pain and foot function and lower for general foot health and footwear. In the second section, values were higher for general health and vigor and lower for physical activity and social capacity. The differences between the sex groups of the study were statistically significant for footwear (P = 0.008), physical activity (P= 0.002), social capacity (P = 0.001) and vigor (P = 0.001) showing a worst QoL related to foot health in favor of male subjects in comparison with females. The rest of the domains did not show any statistically significant difference (P ≥ .01). The sedentary population evidenced a negative impact on the QoL related to foot health. This problem may be associated with this lifestyle, especially for males. [Resumo] O tempo sedentário (sentado) pode produzir muitas consequências anatômicas e fisiológicas que supostamente estão associadas a uma redução de qualidade de vida (QoL) relacionada à saúde do pé. Por conseguinte, o objetivo deste estudo foi analisar o impacto da QV sobre a saúde geral e a saúde do pé entre pessoas sedentárias masculinas e femininas. Uma amostra de 312 participantes com idade média de 39,81 ± 15,40 anos completou todas as fases do processo de estudo. Além disso, os dados autorrelatados foram registrados. O comportamento sedentário dos informantes foi determinado usando o questionário de prospecção prospectiva de câncer e nutrição (Epic). Além disso, os resultados obtidos com a versão em português do Questionário de Status de Saúde do Pé (PFHSQ) foram registrados. As pessoas sedentárias no equivalente de energia metabólica apresentaram 301,09 ± 72,22 (min/semana). Na primeira seção, os valores foram maiores para a dor no pé e função do pé e diminuíram a saúde e o calçado do pé geral. Na segunda seção, os valores foram maiores para saúde geral e vigor e menores para atividade física e capacidade social. As diferenças entre os grupos sexuais do estudo foram estatisticamente significativas para o calçado (P = 0,008), atividade física (P = 0,002), capacidade social (P = 0,001) e vigor (P = 0,001), mostrando uma pior QV relacionada à saúde do pé a favor dos sujeitos do sexo masculino em relação aos participantes sedentários femininos. O restante dos domínios não apresentou diferença estatisticamente significante (P ≥ 0,01). A população sedentária evidenciou um impacto negativo na QoL relacionada à saúde dos pés. Esse problema pode estar associado a este comportamento, especialmente no sexo masculino.

Background:The coronavirus disease 2019 pandemic has affected millions of people worldwide, compromising the responsiveness of governments and states and thus generating anxiety and fear at the population level.Objective:To assess the level of anxiety and fear of coronavirus disease 2019 in a Spanish adult population group.Methods:A descriptive cross-sectional study, using the anxiety and fear of COVID-19 assessment scale (AMICO, for its acronym in Spanish). The sample was composed of 1038 subjects. Univariate and bivariate statistical analyses were performed, after analysis of normality in the data distribution. Categorical regression analyses were also executed.Findings:The total sample size was 1036 subjects, 56.3% was made up of females, with a mean age of 48.11 years (SD = 15.13). The mean score obtained on the AMICO scale was 5.54 points (SD = 1.83), with a score range between 1.22 and 10. Bivariate analysis only demonstrated statistically significant differences in the mean score of the scale and the variables: sex, marital status, work area and academic level. The executed categorical regression analysis revealed an R2value of 0.75 and a significance of p = 0.00.Conclusions:The results obtained show that the Spanish population presents moderate anxiety levels to coronavirus disease 2019. Women, married, with primary and/or secondary education level, and working in the public transport, services and/or hospitality sectors are more likely to have high levels of fear and anxiety.Application to Practice:These results could be used for therapeutic and preventive psychological interventions, and also to plan new research under sex perspective and observing the socio-economic environment.

Heart failure (HF) is a complicated clinical syndrome that is considered an increasingly frequent reason for hospitalization, characterized by a complex therapeutic regimen, reduced quality of life, and high morbidity. Long-standing hypertension ultimately paves the way for HF. Recently, there have been improvements in the treatment of hypertension and overall management not limited to only conventional medications, but several novel pathways and their pharmacological alteration are also conducive to the treatment of hypertension. Beta-arrestin (β-arrestin), a protein responsible for beta-adrenergic receptors’ (β-AR) functioning and trafficking, has recently been discovered as a potential regulator in hypertension. β-arrestin isoforms, namely β-arrestin1 and β-arrestin2, mainly regulate cardiac function. However, there have been some controversies regarding the function of the two β-arrestins in hypertension regarding HF. In the present review, we try to figure out the paradox between the roles of two isoforms of β-arrestin in the treatment of HF.

Extreme heat events impact people and ecosystems across the globe, and they are becoming more frequent and intense in a warming climate. Responses to heat span sectors and geographic boundaries. Prior research has documented technologies or options that can be deployed to manage extreme heat and examples of how individuals, communities, governments, and other stakeholder groups are adapting to heat. However, a comprehensive understanding of the current state of implemented heat adaptations—where, why, how, and to what extent they are occurring—has not been established. Here, we combine data from the Global Adaptation Mapping Initiative with a heat-specific systematic review to analyze the global extent and diversity of documented heat adaptation actions (n = 301 peer-reviewed articles). Data from 98 countries suggest that documented heat adaptations fundamentally differ by geographic region and national income. In high-income, developed countries, heat is overwhelmingly treated as a health issue, particularly in urban areas. However, in low and middle income, developing countries, heat adaptations focus on agricultural and livelihood-based impacts, primarily considering heat as a compound hazard with drought and other hydrological hazards. 63% of the heat-adaptation articles feature individuals or communities autonomously adapting, highlighting how responses to date have largely consisted of coping strategies. The current global status of responses to intensifying extreme heat, largely autonomous and incremental yet widespread, establishes a foundation for informed decision making as heat impacts around the world continue to increase.

Obxectivo: Moitas vítimas de vítimas mortais por afogamento son legos que intentan rescatar a outro. Esta revisión ten como obxectivo identificar as técnicas e os equipos máis seguros (mellorados ou fabricados a propósito) para que unha testemuña non adestrada os utilice cando intente un rescate acuático. Método: Tras a busca bibliográfica incluíuse unha mostra de 249 traballos, nos que finalmente se seleccionaron 19 seguindo a metodoloxía PRISMA e 3 procedementos de revisión por pares presentados en congresos internacionais. Engadíronse un total de 22 documentos á síntese cualitativa. Resultados: A situación xeográfica, o nivel económico, a condición física ou a experiencia poden variar o perfil dos socorristas legos e a forma de realizar un rescate acuático con seguridade. Identificáronse catro perfís de socorristas legos: 1) Nenos que rescatan nenos en países de ingresos baixos e medios (LMIC), 2) Adultos que rescatan a adultos ou nenos, 3) Legos con certa experiencia e formación en rescate, 4) Legos con motivacións culturais ou profesionais. Tres tipos de técnicas empregadas por estes perfís de socorristas legos: a) técnicas sen contacto para rescates desde terra: lanzamento e alcance, b) técnicas de rescate sen contacto mediante un dispositivo de flotación e, c) técnicas de contacto para o rescate na auga. Conclusión: A recomendación experta da técnica máis segura para un salvador lego é intentar o rescate usando un poste, corda ou equipo de flotación sen entrar na auga. Non obstante, a pesar das recomendacións de rescates sen contacto desde terra, existe unha tendencia global a tentar rescates por contacto na auga, a pesar de que non hai probas sobre a técnica, procedemento ou equipamento que contribúa a un rescate máis seguro. Deben considerarse estratexias de adestramento para profanos. Objective: Many victims of drowning fatalities are lay-people attempting to rescue another. This review aims to identify the safest techniques and equipment (improved or purpose made) for an untrained bystander to use when attempting a water rescue. Method: A sample of 249 papers were included after the bibliographic search, in which 19 were finally selected following PRISMA methodology and 3 peer review proceeding presented at international conferences. A total of 22 documents were added to qualitative synthesis. Results: Geographical location, economic level, physical fitness, or experience may vary the profile of the lay-rescuers and how to safely perform a water rescue. Four lay-rescuers profiles were identified: 1) Children rescuing children in low- and middle-income countries (LMICs), 2) Adults rescuing adults or children, 3) Lay-people with some experience and rescue training, 4) Lay-people with cultural or professional motivations. Three types of techniques used by those lay-rescuers profiles: a) non-contact techniques for rescues from land: throw and reach, b) non-contact techniques for rescue using a flotation device and, c) contact techniques for rescue into the water: swim and tow with or without fins. Conclusion: The expert recommendation of the safest technique for a lay-rescuer is to attempt rescue using a pole, rope, or flotation equipment without entering the water. However, despite the recommendations of non-contact rescues from land, there is a global tendency to attempt contact rescues in the water, despite a lack of evidence on which technique, procedure or equipment contributes to a safer rescue. Training strategies for lay-people should be considered. Financiado para publicación en acceso aberto: Universidade de Vigo/CISUG

This paper analyzes the mediating role of employees’ emotional exhaustion between laissez-faire leadership and employees’ job attitudes (intrinsic satisfaction and turnover intention), and also the moderating role of influence at work, interactional justice and helping behaviors on employees’ feelings of emotional exhaustion. Structural equation modeling and multigroup analysis were used in a sample of 511 public healthcare professionals. The results show that emotional exhaustion partially mediates the relationships between laissez-faire leadership and both intrinsic satisfaction and turnover intention. Influence at work moderates the relationship between laissez-faire leadership and emotional exhaustion; interactional justice moderates the relationship between emotional exhaustion and intrinsic satisfaction; and extra-role behaviors moderate the relationship between emotional exhaustion and turnover intention. To date, there are few studies analyzing the mediating role of emotional exhaustion in public healthcare, and there are no studies analyzing how its negative effects can be moderated. The conclusions may help human resources managers design new strategies to prevent and mitigate emotional exhaustion and contribute healthcare employees to cope with its serious effects, encouraging a healthy environment that gives priority to workers’ well-being and service quality.

Funding Information: The author V.T. would like to thank the Department of Science and Technology (DST), Science and Engineering Research Board (SERB), Government of India (file no ECR/2017/001809) for financial support. Publisher Copyright: © 2021 by the authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved. The disposal of municipal solid waste (MSW) directly at landfills or open dump areas, without segregation and treatment, is a significant concern due to its hazardous contents of antibioticresistant bacteria (ARB), antibiotic resistance genes (ARGs), and metal resistance genes (MGEs). The released leachate from landfills greatly effects the soil physicochemical, biological, and groundwater properties associated with agricultural activity and human health. The abundance of ARB, ARGs, and MGEs have been reported worldwide, including MSW landfill sites, animal husbandry, wastewater, groundwater, soil, and aerosol. This review elucidates the occurrence and abundance of ARB, ARGs, and MRGs, which are regarded as emerging contaminants (ECs). Recently, ECs have received global attention because of their prevalence in leachate as a substantial threat to environmental and public health, including an economic burden for developing nations. The present review exclusively discusses the demands to develop a novel eco-friendly management strategy to combat these global issues. This review also gives an intrinsic discussion about the insights of different aspects of environmental and public health concerns caused due to massive leachate generation, the abundance of antibiotics resistance (AR), and the effects of released leachate on the various environmental reservoirs and human health. Furthermore, the current review throws light on the source and fate of different ECs of landfill leachate and their possible impact on the nearby environments (groundwater, surface water, and soil) affecting human health. The present review strongly suggests the demand for future research focuses on the advancement of the removal efficiency of contaminants with the improvement of relevant landfill management to reduce the potential effects of disposable waste. We propose the necessity of the identification and monitoring of potential environmental and human health risks associated with landfill leachate contaminants.

Background Cardiorespiratory fitness may moderate the association between obesity and all‐cause mortality (ie, the “fat‐but‐fit” hypothesis), but unaddressed sources of bias are a concern. Methods and Results Cardiorespiratory fitness was estimated as watts per kilogram from a submaximal bicycle test in 77 169 men and women from the UK Biobank cohort and combined with World Health Organization standard body mass index categories, yielding 9 unique fitness‐fatness combinations. We also formed fitness‐fatness combinations based on bioimpedance as a direct measure of body composition. All‐cause mortality was ascertained from death registries. Multivariable‐adjusted Cox regression models were used to estimate hazard ratios and 95% CIs. We examined the association between fitness‐fatness combinations and all‐cause mortality in models with progressively more conservative approaches for accounting for reverse causation, misclassification of body composition, and confounding. Over a median follow‐up of 7.7 years, 1731 participants died. In our base model, unfit men and women had higher risk of premature mortality irrespective of levels of adiposity, compared with the normal weight–fit reference. This pattern was attenuated but maintained with more conservative approaches in men, but not in women. In analysis stratified by sex and excluding individuals with prevalent major chronic disease and short follow‐up and using direct measures of body composition, mortality risk was 1.78 (95% CI, 1.17–2.71) times higher in unfit‐obese men but not higher in obese‐fit men (0.94 [95% CI, 0.60–1.48]). In contrast, there was no increased risk in obese‐unfit women (1.09 [95% CI, 0.44–1.05]) as compared with the reference. Conclusions Cardiorespiratory fitness modified the association between obesity and mortality in men, but this pattern appeared susceptible to biases in women.

Rapid population growth and increasing food demand have impacts on the environment due to the generation of residues, which could be managed using sustainable solutions such as the circular economy strategy (waste generated during food processing must be kept within the food chain). Reusing discarded fish remains is part of this management strategy, since they contain high-value ingredients and bioactive compounds that can be used for the development of nutraceuticals and functional foods. Fish side streams such as the head, liver, or skin or the cephalothorax, carapace, and tail from shellfish are important sources of oils rich in omega-3. In order to resolve the disadvantages associated with conventional methods, novel extraction techniques are being optimized to improve the quality and the oxidative stability of these high-value oils. Positive effects on cardiovascular and vision health, diabetes, cancer, anti-inflammatory and neuroprotective properties, and immune system improvement are among their recognized properties. Their incorporation into different model systems could contribute to the development of functional foods, with market benefits for consumers. These products improve the nutritional needs of specific population groups in a scenario where noncommunicable diseases and pandemic crises are responsible for several deaths worldwide. European Commission | Ref. H2020, AQUABIOPROFIT, n. 790956 CYTED | Ref. 119RT0568 Axencia Galega de Innovación | Ref. IN607A2019 / 01

Background: The emergence of the new severe acute respiratory syndrome coronavirus 2, which causes COVID-19 disease, has been a major public health challenge and an increase in the feeling of uncertainty of the population, who is also experiencing an increase in levels of anxiety and fear regarding the COVID-19 disease. Objective: The objective of the study was the construct and criterion validation of the Escala de evaluación de la Ansiedad y MIedo a COVID-19 (AMICO, for its acronym in Spanish) to measure both constructs in the general Spanish population Methods: Descriptive study of psychometric validation. A field study was carried out to execute univariate and bivariate analyses, in addition to the exploratory and confirmatory factorial analysis of the scale. For the criteria validity study, the State-Trait Anxiety Inventory ( STAI) and sensitivity and specificity values were calculated. Results: The study sample was composed of 1036 subjects over 18 years of age, who resided in Spain, where 56.3% were women with a mean age of 48.11 years (SD = 15.13). The study of construct validity reported two factors and 16 items, with a Cronbach's alpha value of 0.92. The scale was concurrently valid with the used gold standard and obtained sensitivity values of 90.48% and specificity values of 76%. Conclusions: The AMICO scale is valid and reliable for assessing the level of anxiety and fear of COVID-19 in the adult Spanish population and is highly sensitive.

Expenditure on healthcare and services can be a serious problem for public health. Personality variables should be included as indicators to be considered when studying the consumption of health resources and their planning. This study aims to identify the psychological and psychosocial variables that identify people who can be considered high consumers of health resources versus those who barely consume such resources. The sample was made up of a total of 1124 subjects, one half were men, and one half were women, all of legal age and residents in Spain. A battery of tests was created that included a questionnaire of sociodemographic variables and of healthcare consumption, as well as several psychological variables (Zimbardo Time Paradox Inventory, Multidimensional Locus of Control Scale, Psychological Reactance Scale, Coping Responses Inventory, self-efficacy scale applied to health, and the Symptom Checklist-90-R). The following variables of the model were significant predictors (p ≤ 0.05): a negative past, a fatalistic present, psychological cognitive reactance, behavioral coping, health self-efficacy, and the level of somatization. Data from the statistical analyses show how to create a psychological profile of people who are high consumers of healthcare resources that will allow for the creation of intervention programs in this regard.

This article describes patterns of compliance with social distancing measures among the Spanish population during the coronavirus disease-2019 (COVID-19) pandemic. It identifies several factors associated with higher or lower compliance with recommended measures of social distancing. This research is part of a 67-country study, titled the International COVID-19 study on Social & Moral Psychology, in which we use a Spanish dataset. Participants were residents in Spain aged 18 or above. The sample comprises 1,090 respondents, weighted to be representative of the Spanish population. Frequencies, correlations, bivariate analysis, and six models based on hierarchical multiple regressions were applied. The main finding is that most Spaniards are compliant with established guidelines of social distance during the pandemic (State of Alarm, before May 2020). Variables associated more with lower levels of compliance with these standards were explored. Six hierarchical multiple regression models found that compliance with social distance measures has a multifactorial explanation (R 2 between 20.4 and 49.1%). Sociodemographic factors, personal hygiene patterns, and the interaction between personal hygiene patterns and the support for political measures related to the coronavirus brought significant effects on the regression models. Less compliance was also associated with beliefs in some specific conspiracy theories with regard to COVID-19 or general conspiracy mentality (Conspiracy Mentality Questionnaire, CMQ), consumption patterns of traditional mass media (television, paper newspapers, magazines, and radio) and modern means to get informed (online digital newspapers, blogs, and social networks), political ideology, vote, trust in institutions, and political identification. Among the future lines of action in preventing the possible outbreak of the virus, we suggest measures to reinforce trust in official information, mainly linked to reducing the influence of disinformation and conspiracy theories parallel to the pandemic.

The aim was to assess the effect of adherence to the Mediterranean Diet, measured with five different indexes, on the risk of gastric cancer. Data come from the multicase-control study MCC—Spain, which included 354 gastric cancer cases and 3040 controls with data on diet. We used five indexes to evaluate adherence to the Mediterranean diet and assess the association between each pattern with the risk of gastric cancer, using multivariate logistic regression. The analyses were performed for the whole set of gastric cancer cases, by anatomical location (cardia and non-cardia) and by histological type (intestinal and diffuse). According to the used index, a high adherence protects one from gastric cancer (between 48% (aOR = 0.52, CI 95% = 0.28–0.94) and 75% (aOR = 0.25, CI 95% = 0.12–0.52)), from non-cardia (between 48% (aOR = 0.52, CI 95% = 0.36–0.75) and 65% (aOR = 0.35, CI 95% = 0.23–0.52)), and from the intestinal type (between 41% (aOR = 0.59, CI 95% = 0.36–0.95) and 72% (aOR = 0.28, CI 95% = 0.16–0.50)), but not from the diffuse type. In conclusion, high adherence to a Mediterranean diet pattern is a protective factor for the risk of gastric cancer, with greater adherence leading to greater protection.

Research on personality variables and consumption of health services in actively employed people or retirees has been extensive, but the group of pre-retirees has hardly been studied. This work attempts to determine the mental health and use of health resources of the three groups, hypothesizing that, as the group of pre-retirees does not receive the social stigma of work exclusion, it will present better mental health. A sample of 1332 Spanish participants aged between 51 and 69 years was randomly chosen, and various personality tests were applied, and consumption of healthcare resources was determined. Pairwise analysis of the three work situations using binary logistic regressions showed that pre-retirees present better mental health, although there were no differences in the consumption of healthcare resources. The implications of this study for the creation of health promotion policies targeting older people, depending specifically on their employment status, are discussed.

Video games have proven useful in physical rehabilitation therapy. Accessibility, however, is limited for some groups such as the elderly or patients with Parkinson’s disease (PD). We explore the potential of fully immersive video games as a rehabilitation tool in PD patients. Four patients with mild-moderate PD (3 males:1 female, 53–71 years) participated in the study. Training consisted in two immersive virtual reality video gaming sessions. Outcomes were evaluated using System Usability Scale (SUS), Simulator Sickness Questionnaire (SSQ), Game Experience Questionnaire-post game (GEQ), an ad hoc satisfaction questionnaire and perceived effort. All participants completed the sessions without adverse effects (100%), without SSQ symptoms reported. Post-gaming SUS was >75% in both sessions (range 75–80%). Post-gaming GEQ scores were 3.3–4.0/4 in both sessions. Immersive virtual reality video gaming is feasible in patients with mild-moderate PD, with positive usability and patient satisfaction, and no adverse effects. Xunta de Galicia | Ref. ED481A-2019/158

Background: Military physical readiness largely depends on soldiers maintaining their general health and physical fitness at a level which enables them to perform their requisite occupational duties in garrison and deployment environments. Understanding the physical fitness of naval cadets throughout its formative stages will help us define a training programme tailored to their needs. The objective of this study was to analyse the physical fitness of cadets enrolled in military training in the academic year 2018–2019 in the Military Naval Academy in Marín, Spain. Materials and methods: A longitudinal correlational-descriptive design was undertaken. 167 of the 292 students who participated in the global analysis participated in the pre and post (first and second semester) physical fitness tests (153 males and 14 females, mean age 21.9 ± 3.5) and were stratified into age groups. Anthropometric measurements and data from the Spanish army physical fitness assessment system (2 min push-ups, 1000 and 50 m races, vertical jump and 50 m swimming) were used. A descriptive, inferential, and correlational analysis was carried out and the level of significance set for the study was p ≤ 0.05. Results: Inferential analysis between age group markers and over the total sample shows statistical differences for the total sample in the 1000 m and 50 m race (p < 0.001) and in vertical jump test (p < 0.010). There was significant statistical correlation between all five tests undertaken. Conclusions: The level of physical fitness of cadets at the Military Naval Academy in Marín, Spain appears to be acceptable when compared to other countries’ military naval corps. Coherence between training and evaluation is extremely important, and a re-evaluation of stamina and strength training is probably advisable

To determine the prevalence of self-medication in nursing students and their related factors, a transversal, descriptive study was performed on a sample of 378 nursing students. A total of 73.8% of the sample declared having used off-prescription drugs during the last month (2.84, 2.26–3.58). A total of 28.9% said they did this because they are familiar with the health problem and its pharmacological solution and 25% deemed that it was a mild health problem. Drugs most commonly used off-prescription were analgesics in 88.91% (3.63, 2.74–4.80) of occasions. They were mainly recommended by the students’ family (1.31, 1.03–1.65) on 58.12% of the cases. Students keep analgesics they take off-prescription in their home first aid kit (4.47, 3.28–6.08, p &lt, 0.001). Unlike other studies, 53.2% obtained off-prescription drugs from the home first aid kit (1.13, 0.89–1.43, 0.001). In addition, they gave advice and recommend drugs they have taken to other people with similar symptoms (1.97, 1.59–2.44). A total of 85.72% kept excess drugs after a treatment (6.00, 4.50–7.99). Self-medication is related to the storage of unused medicines and giving advice on the use of drugs to other people, among other things. Self-medication of drugs among nursing students is high. Thus, it appears necessary to review the training on rational the use of drugs and responsible self-medication in the discipline’s curriculum.

Exposure to high concentration levels of radon gas constitutes a major health hazard, being nowadays the second-leading cause of lung cancer after smoking. Facing this situation, the last years have seen a clear trend towards the search for methodologies that allow an efficient prevention of the potential risks derived from the presence of harmful radon gas concentration levels in buildings. With that, it is intended to establish preventive and corrective actions that might help to reduce the impact of radon exposure on people, especially in places where workers and external users must stay for long periods of time, as it may be the case of healthcare buildings. In this paper, a new methodology is developed and applied to the prevention of the risks derived from the exposure to radon gas in indoor spaces. Such methodology is grounded in the concurrent use of expert systems and regression trees that allows producing a diagram with recommendations associated to the exposure risk. The presented methodology has been implemented by means of a software application that supports the definition of the expert systems and the regression algorithm. Finally, after proving its applicability with a case study and discussing its contributions, it may be claimed that the benefits of the new methodology might lead on to an innovation in this field of study. Universidade de Vigo Xunta de Galicia

This paper analyzes the stability of citizens&rsquo, preferences on public healthcare services in Spain. Nowadays, the increasing privatization of some healthcare services and the rapid emergence of private hospitals have caused changes in people&rsquo, s preferences on public healthcare systems. This paper focuses on analyzing the preferences of Spaniards on their healthcare system over time under the assumption that citizens&rsquo, preferences are represented by complete pre-orders. Data for this study were collected from the Spanish Health Barometer survey, and they were searched from 1995 until 2018. The results show that preferences on the public healthcare system are very stable along time.

Background: The identification of factors that alter postural stability is fundamental in the design of interventions to maintain independence and mobility. This is especially important for women because of their longer life expectancy and higher incidence of falls than in men. We constructed the percentile box charts and determined the values of reference for the accelerometric assessment of the gait in women. Methods: We used a cross-sectional study with 1096 healthy adult women, who were asked to walk a distance of 20 m three times. Results: In all of the variables, a reduction in the magnitude of accelerations was detected as the age of the group advanced. The box charts show the amplitude of the interquartile ranges, which increases as the age of the participants advances. In addition, the interquartile ranges were greater in the variables that refer to the maximum values of the accelerations. Conclusions: The values obtained can be used to assess changes in gait due to aging, trauma and orthopaedic alterations that may alter postural stability and neurodegenerative processes that increase the risk of falling.

Menstrual problems affect many young women worldwide, conditioning both their academic performance and quality of life. This study sought to analyse the prevalence of menstrual problems and their possible relationship with lifestyle among Spanish university women, as part of a research project (UniHcos Project) involving a cohort of 11 Spanish universities with 7208 university students. A descriptive analysis was performed using the bivariate chi-square test and the Student&rsquo, s t-test together with a binary logistic regression, in which the dependent variable was &lsquo, suffering from menstrual problems&rsquo, Menstrual problems were identified in 23.8% of the students, representing women who paid more visits to the doctor and to emergency rooms, and who consumed more painkillers and contraceptives. In relation to dietary preferences, menstrual problems were 1.39 (CI 95% 1.22&ndash, 1.61, p = 0.000) times more likely among women classified as high-risk alcohol users according to the AUDIT questionnaire, and 1.187 (CI 95% 1.029&ndash, 1.370, p = 0.019) times greater among those who consumed sweets daily, 1.592 (CI 95% 1.113&ndash, 2.276, p = 0.011) times more frequent among those who eat fish daily, and 1.199 (CI 95% 1.004&ndash, 1.432, p = 0.045) times greater among those who were dieting. Menstrual problems affect many college students and potentially modifiable lifestyle variables exist which may influence their prevalence. It would be interesting to develop programmes to promote women&rsquo, s health in the university context.

To evaluate nursing students’ CPR skills using mouth-to-mouth (MMV) and bag-valve-mask (BMV) ventilation techniques on manikin simulators for infant and adult victims after practical and theoretical training. A quasi-experimental randomised cross-over design study with 44 nursing students was carried out. The participants attended a 5-hour theoretical and practical CPR training session using MMV and BMV on adult and infant manikins. A month later, four 4-minute CPR tests were performed in pairs. Two tests were performed on the infant manikin and two on the adult, using the two ventilation techniques (MMV and BMV). No significant differences between the tests were observed in the quality of chest compression (p > 0.008). Significantly higher values of effective ventilations were observed with MMV as compared with BMV in both age groups: Adult (MMV: 98 ± 7% / BMV: 84 ± 17% / p = 0.003) and Infant (MMV: 97 ± 11% / BMV: 76 ± 26% / p = 0.001). CPR quality was significantly higher when using MMV on the infant (68 ± 16%; p < 0.001) than in the other tests. The nursing students did not manage to master BMV with either victim. New complementary strategies to help them grasp the necessary BMV skills will be required.

Background: This study aims to analyze the effect of physical activity practice on the postural control state of school children. If such an effect was detected, the second aim of the study was to identify which specific capacities of postural control benefited the most from physical activity. Methods: A cross-sectional study was performed using a convenience sample of 118 healthy children (54 girls) with a mean age of 10.3 &plusmn, 1.2 years. Their weight and height were measured. The accelerometric assessment of balance included four different tests in static balance and walking. Results: Physical activity habit prevalence was 38.9% in girls and 60.9% in boys, and its frequency was 2.3 days per week in girls and 2.8 days in boys. The active children obtained lower accelerations, but the active and sedentary girls showed lower accelerometric values than the active boys. The logistic regression analysis demonstrated the influence of sex on the accelerations of the body (p &lt, 0.001), regardless of the habit of physical activity. Conclusions: Active children have better postural control than sedentary children, although sedentary girls have better balance than active boys. Therefore, physical activity practice seems to favor a more efficient development of postural control, but it cannot level or reverse the effect of the neurophysiological factors that are conditioned by sex.

This research proposes analyzing the influence of new ways of working (NWW) on healthcare professional’s well-being and how these may affect work performance and public service motivation. These variables and relationships were important before COVID-19 pandemic, and everything points to the fact that during and after the pandemic their importance will be higher. To buffer the potential negative effects of implementing the NWW, both organizations and employees must identify personal (psychological capital) and job resources (inter-role conflict, psychological empowerment, meaning of work) capable of acting as effective moderators to promote employee well-being and avoid negative experiences at work. This paper aims to shed light on new ways of coping and adapting to uncertain job requirements such as those that have arisen during COVID-19. Moreover, it highlights the great changes that public healthcare needs to face to improve the quality of the service offered to society. It is urgent that public administrators and human resources managers design effective strategies and make effective decisions in which employee well-being and service quality are main priorities.

There is uncertainty regarding carotenoid intake recommendations, because positive and negative health effects have been found or are correlated with carotenoid intake and tissue levels (including blood, adipose tissue, and the macula), depending on the type of study (epidemiological vs intervention), the dose (physiological vs supraphysiological) and the matrix (foods vs supplements, isolated or used in combination). All these factors, combined with interindividual response variations (eg, depending on age, sex, disease state, genetic makeup), make the relationship between carotenoid intake and their blood/tissue concentrations often unclear and highly variable. Although blood total carotenoid concentrations, This research received support from the EU Cooperation in Science and Technology Action CA15136 EUROCAROTEN. Support was also received from the Instituto de Salud Carlos III (grant PI16/01991), co-funded by ERDF/European Social Fund.

Background: Alzheimer&rsquo, s disease (AD) which is the most common type of dementia is characterized by mental or cognitive disorders. People suffering with this condition find it inherently difficult to communicate and describe symptoms. As a consequence, both detection and treatment of comorbidities associated with Alzheimer&rsquo, s disease are substantially impaired. Equally, action protocols in the case of emergencies must be clearly formulated and stated. Methods: We performed a bibliography search followed by an observational and cross-sectional study involving a thorough review of medical records. A group of AD patients was compared with a control group. Each group consisted of 100 people and were all Le&oacute, n residents aged &ge, 65 years. Results: The following comorbidities were found to be associated with AD: cataracts, urinary incontinence, osteoarthritis, hearing loss, osteoporosis, and personality disorders. The most frequent comorbidities in the control group were the following: eye strain, stroke, vertigo, as well as circulatory and respiratory disorders. Comorbidities with a similar incidence in both groups included type 2 diabetes mellitus, glaucoma, depression, obesity, arthritis, and anxiety. We also reviewed emergency procedures employed in the case of an emergency involving an AD patient. Conclusions: Some comorbidities were present in both the AD and control groups, while others were found in the AD group and not in the control group, and vice versa.

Introduction. Cognitive decline usually coexists with motor impairment in PD. Multitask settings provide appropriate measures to evaluate the complex interaction between motor and cognitive impairments. The main objective was to analyze which concurrent task, i. e., motor or hybrid motor-cognitive, in combination with a cognitive task better differentiates between PD patients with mild and moderate levels of disease. Methods. Thirty-seven individuals (19 male and 18 female) with idiopathic PD performed dual and triple tasks combining a cognitive task (phonemic fluency) with motor (pedaling) and/or cognitive-motor hybrid (tracking) tasks. Mild and moderate disability PD groups were specified considering the Hoehn and Yahr scale. Mixed ANOVA analyses for each of the concurrent task were carried out to test differences between the single and dual or triple condition performances comparing the low and high PD disability groups. Supplementary mixed ANCOVA analysis was performed considering the cognitive status as the covariate. Results. The only significant differences between disability PD groups were found for performances in the cognitive-motor hybrid (tracking) task, both in dual and triple conditions. Our results showed a better performance for the mild rather than for the moderate disability group in the single condition task and a significant decline of the mild disability group in the dual and triple condition when compared to the levels of those shown by the moderate disability group. The group-condition interaction remained significant when the cognitive status was statistically controlled. Conclusion. The hybrid of motor-cognitive task combining with a cognitive task (i. e., fluency) successfully differentiated between mild and moderate PD patients in the context of dual and triple multitask sets even when the cognitive status was statistically controlled. Our results highlight the importance of jointly measuring the complex interplay between motor and cognitive skills in PD.

This paper presents the usability assessment of the design of an Internet of Medical Things (IoMT) system for older adults, the evaluation, using heuristics, was held early on the design process to assess potential problems with the system and was found to be an efficient method to find issues with the application design and led to significant usability improvements on the IoMT platform.

Knowledge management is one of the key priorities of many organizations. They face different challenges in the implementation of knowledge management processes, including the transformation of tacit knowledge&mdash, experience, skills, insights, intuition, judgment and know-how&mdash, into explicit knowledge. Furthermore, the increasing number of information sources and services in some domains, such as healthcare, increase the amount of information available. Therefore, there is a need to transform that information in knowledge. In this context, learning ecosystems emerge as solutions to support knowledge management in a different context. On the other hand, the dashboards enable the generation of knowledge through the exploitation of the data provided from different sources. The model-driven development of these solutions is possible through two meta-models developed in previous works. Even though those meta-models solve several problems, the learning ecosystem meta-model has a lack of decision-making support. In this context, this work provides two main contributions to face this issue. First, the definition of a holistic meta-model to support decision-making processes in ecosystems focused on knowledge management, also called learning ecosystems. The second contribution of this work is an instantiation of the presented holistic meta-model in the healthcare domain.

Purpose The objective of this study is to analyse the relative survival with breast cancer in women diagnosed after new treatments were generalised and to ascertain the current efect that tumour characteristics such as grade, stage or subtype have on survival as well as the new AJCC-pathological prognostic score. Methods The breast cancer MCC-Spain follow-up study is a prospective cohort study of 1685 incident breast cancer cases. Women between 20 and 85 years old were recruited between the years 2008 and 2013 in 18 hospitals located in 10 Spanish provinces and they have been followed until 2017/2018. Relative survival was estimated after 3, 5 and 8 years of follow-up using Ederer II method. In addition, Weibull regression adjusted by age, hospital, grade and stage was used to investigate prognosis factors. Results Among components of TNM staging system, tumour size greater than 50 mm (i.e. T3 or T4) more than doubled the risk of dying, while N3 nodal involvement and presence of metastasis had a huge efect on mortality. The AJCC pathological prognostic score strongly correlated with survival; thus, hazard ratios increased as the score rose, being 2.31, 4.00, 4.94, 7.92, 2.26, 14.9 and 58.9 for scores IB, IIA, IIB, IIIA, IIIB, IIIC and IV, respectively. Conclusion Both TNM staging and histological/molecular biomarkers are associated with overall survival in Spanish women with breast cancer; when both are combined in the AJCC pathological prognosis score, the prognostic value improved with risk indices that increased rapidly as the pathological prognosis score increased, Biological samples were stored at the biobanks supported by Instituto de Salud Carlos III- FEDER: Parc de Salut MAR Biobank (MARBiobanc) (RD09/0076/00036), ‘Biobanco La Fe’ (RD 09 0076/00021) and FISABIO Biobank (RD09 0076/00058), as well as at the Public Health Laboratory of Gipuzkoa, the Basque Biobank, the ICOBIOBANC (sponsored by the Catalan Institute of Oncology), the IUOPA Biobank of the University of Oviedo and the ISCIII Biobank. SNP genotyping services were provided by the Spanish ‘Centro Nacional de Genotipado’ (CEGEN-ISCIII). We thank all the subjects who participated in the study and all MCC-Spain collaborators. This work was supported by the ‘Acción Transversal del Cancer’, approved by the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III, co-founded by FEDER funds – ‘a way to build Europe’ (grants PI08/1770, PI08/0533, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/00613 and PI15/00069). Support was also provided by the Fundación Marqués de Valdecilla (grant API 10/09); the Junta de Castilla y León (grant LE22A10-2); the Consejería de Salud of the Junta de Andalucía (2009-S0143); the Conselleria de Sanitat of the Generalitat Valenciana (grant AP 061/10); the Recercaixa (grant 2010ACUP 00310); the Regional Government of the Basque Country; the Consejería de Sanidad de la Región de Murcia; European Commission grants FOOD-CT-2006–036224-HIWATE; the Spanish Association Against Cancer (AECC) Scientifc Foundation; the Catalan Government DURSI (grant 2014SGR647); the Fundación Caja de Ahorros de Asturias; the University of Oviedo; Societat Catalana de Digestologia; and COST action BM1206 Eucolongene.

Aberrant DNA methylation detected in liquid biopsies is a promising approach for colorectal cancer (CRC) detection, including premalignant advanced adenomas (AA). We evaluated the diagnostic capability of serum NEUROG1 methylation for the detection of AA and CRC. A CpG island in NEUROG1 promoter was assessed by bisulfite pyrosequencing in a case-control cohort to select optimal CpGs. Selected sites were evaluated through a nested methylation-specific qPCR custom assay in a screening cohort of 504 asymptomatic family-risk individuals. Individuals with no colorectal findings and benign pathologies showed low serum NEUROG1 methylation, similar to non-advanced adenomas. Contrarily, individuals bearing AA or CRC (advanced neoplasia&mdash, AN), exhibited increased NEUROG1 methylation. Using &gt, 1.3518% as NEUROG1 cut-off (90.60% specificity), 33.33% of AN and 32.08% of AA were identified, detecting 50% CRC cases. Nonetheless, the combination of NEUROG1 with fecal immunochemical test (FIT), together with age and gender through a multivariate logistic regression resulted in an AUC = 0.810 for AN, and 0.796 for AA, detecting all cancer cases and 35&ndash, 47% AA (specificity 98&ndash, 95%). The combination of NEUROG1 methylation with FIT, age and gender demonstrated a convenient performance for the detection of CRC and AA, providing a valuable tool for CRC screening programs in asymptomatic individuals.

Purpose: Identifying whether the recommendations of the WHO regarding the amount of weekly time dedicated to the practice of PA in its different modalities are being met in the population of people over 65 in Spain. Method: This study has used data provided by 1317 interviewees aged 65 to 69 years old included in the Spanish Health Survey. Results: 19.1% of the sample said to not walk any day of the week at least 10 minutes, being the 84.2% those who did, at least, 150 minutes per week. Concerning the accomplishment of intense and moderate physical activity generally, the general or optimal recommendations for the weekly time were not satisfied. The proportion of individuals that comply the recommendations, general and optimal, of physical activity moderate were 17.4% in both cases. Those percentages, regarding intense exercise, the percentage of individuals that comply with the recommendations are reduced to 6.6% and 2.4%, for general and optimal recommendations, respectively. Conclusion: The practice of moderate and intense exercise is not within the frequent habits of people over 65 years of age, and this phenomenon could be one of the causes of the increasing health demand in this country (regardless of whether it is of a sensitive sector to get sick from the ageing process).

Respiratory diseases are currently considered to be amongst the most frequent causes of death and disability worldwide, and even more so during the year 2020 because of the COVID-19 global pandemic. Aiming to reduce the impact of these diseases, in this work a methodology is developed that allows the early detection and prevention of potential hypoxemic clinical cases in patients vulnerable to respiratory diseases. Starting from the methodology proposed by the authors in a previous work and grounded in the definition of a set of expert systems, the methodology can generate alerts about the patient&rsquo, s hypoxemic status by means of the interpretation and combination of data coming both from physical measurements and from the considerations of health professionals. A concurrent set of Mamdani-type fuzzy-logic inference systems allows the collecting and processing of information, thus determining a final alert associated with the measurement of the global hypoxemic risk. This new methodology has been tested experimentally, producing positive results so far from the viewpoint of time reduction in the detection of a blood oxygen saturation deficit condition, thus implicitly improving the consequent treatment options and reducing the potential adverse effects on the patient&rsquo, s health.

Spa tourism is considered one of the most important segments of the $639 billion wellness market. The literature refers to two types of spa tourists: wellness tourists and healthcare/medical tourists. However, virtually no studies have compared spa choice models between these two segments. The present study uses the Cognitive-Affective-Normative (CAN) model to compare the variables that explain purchase intention in relation to spas between the two segments. Data were collected through a questionnaire administered to a sample of 810 potential Spanish spa-goers, and consistent partial least squares (PLSc) structural equation modeling (SEM) was used. Contrary to what might be expected, no major differences were found between the spa choice models for wellness tourists and for healthcare/medical tourists. The results show that R2 and Q2 were similar for both models. The most influential variable was performance expectancy, and differences were only found in the influence of the pleasure variable.

When an infrared thermography camera is used inside buildings, the characteristics of the place where the camera is used should be considered since results could be affected. For this reason, the development of methodologies is of great interest to know, as accurate as possible, whether these spaces have the appropriate conditions to use those cameras. The goal of this research is to establish the possibility of applying quality management methodologies, such as the Quality Function Deployment, very known and usually used in other scopes. Thus, the characteristics of enclosures belonging to medical emergency units in Spain were used as the object of experimentation given the importance of these services for society and the possibility of using directly useful technologies for diagnosis. After collecting the starting information based on references, the consultation to 21 experts, and the characteristics of these enclosures included in regulations, standards and recommendations in Spain, and also after applying the methodology mentioned above, the results showed that air conditioning (13.6/100), the thermal insulation of the room (11.9/100), windows (10.5/100), dimensions of spaces (10.2/100), and humidity (10.1/100) are the most influential factors. Within the scope of medical emergency services, those triage, consultation, examination, treatment, and observation rooms fulfilling what is specified by Spanish regulations, standards and recommendations obtained positive assessments (≥3/5) in most cases. It was therefore concluded that this methodology is of great interest to assess generally the suitability of indoor enclosures to use infrared thermography cameras, and regarding the specific case of the main enclosures of medical emergency services fulfilling with Spanish standards and recommendations, their characteristics make them suitable for using infrared thermography cameras, at least in relation to the fulfilment of basic conditions. © 2020 Elsevier B.V.

Thermal baths are the main touristic attraction of Ourense (Galicia, Spain). Therefore, protecting and potentializing the resources related to this type of tourism is essential for the province. Most of these resources are located by the banks or nearby rivers, which makes them particularly susceptible to flooding, a very common phenomenon throughout the province. In this context, vulnerability analysis, and particularly flooding damage evaluation, are of utmost importance to this area. Considering this scenario, the present study consists of a preliminary analysis of a historical-heritage tourism resource&rsquo, s vulnerability to flooding. To this end, the study examines the visitation patterns to the Aquis Querquennis complex (Bande, Ourense, Spain), which is located by the banks of the As Conchas reservoir, and the water levels of said reservoir. The complex is a touristic resource with great historical value. Apart from the thermal baths, it encompasses a military campsite and a hostel. The Roman complex attracts a constant tourist flow, which has a positive socioeconomic impact to the area. The analysis showed that there is a correlation between the number of visits and flooding patterns. Increased levels of water are a hinderance for those willing to access the attraction. Consequently, there is a negative relationship between water level and number of visitors.

With the increase in global life expectancy and the advance of technology, the creation of age-friendly environments is a priority in the design of new products for elderly people healthcare. This paper presents a proposal for a real-time health monitoring system of older adults living in geriatric residences. This system was developed to help caregivers to have a better control in monitoring the health of their patients and have closer communication with their patients&rsquo, family members. To validate the feasibility and effectiveness of this proposal, a prototype was built, using a biometric bracelet connected to a mobile application, which allows real-time visualization of all the information generated by the sensors (heart rate, body temperature, and blood oxygenation) in the bracelet. Using these data, caregivers can make decisions about the health status of their patients. The evaluation found that the users perceived the system to be easy to learn and use, providing initial evidence that our proposal could improve the quality of the adult&rsquo, s healthcare.

Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose of the study was to analyze the evolution of a cohort of patients with suspected SARS-CoV-2 disease followed by primary care professionals and to determine the factors that are associated with hospital admission. A prospective cohort study was carried out on 166 patients selected by consecutive sampling that showed symptoms compatible with COVID-19. The follow-up was approached via telephone for 14 days analyzing hospitalization and comorbidities of the patients. There were 75% of the hospitalized patients that were male (p = 0.002), and 70.8% presented comorbidities (p &lt, 0.001). In patients with diabetes, the risk of hospitalization was 4.6-times larger, in hypertension patients it was 3.3-times, those suffering from renal insufficiency 3.8-times, and immunosuppressed patients 4.8-times (IC 95%: 1.9–11.7). In 86.7% of the cases, clinical deterioration was diagnosed in the first seven days of the infection, and 72% of healing was reached from day seven to fourteen. Monitoring from primary care of patients with COVID-19 allows early diagnosis of clinical deterioration and detection of comorbidities associated with the risk of poor evolution and hospital admission.

The declaration of the COVID-19 pandemic has resulted in drastic changes to life worldwide. In Spain, the state of alarm caused the confinement of 47 million inhabitants, affecting every aspect of life. This study analyzes the impact of such confinement on the health of men and women, as well as the effect on the practice of physical activity (PA) of both genders. An ad hoc questionnaire was administered. A total of 1046 people (48.57% men and 51.43% women) with an average age of 40 years (SD &plusmn, 13.35) participated in this study. For both genders, there was a significant decrease in quantity and intensity (p = 0.000). There was also an alteration in the type of PA practiced, shifting from cardiorespiratory exercise and muscular fitness to flexibility and neuromotor exercise (especially in women). The most popular way of practicing PA during the confinement was &ldquo, autonomously&rdquo, (statistically higher in men (M = 3.58) compared to women (M = 3.18)) and the most frequent format was &ldquo, virtual&rdquo, (statistically higher in women (M = 2.81) compared to men (M = 1.94)). Confinement modifies the habits of PA practice, especially in men. Both genders put their health and quality of life at risk by not following the PA guidelines of the health authorities World Health Organization (WHO) and American College of Sports Medicine ACSM). These conclusions highlight the importance of considering gender when designing programs and PA formats for the promotion of physical activity to reduce the existing gender divide.

Background: There is still no consensus on the most suitable interventions for exercise practice in breast cancer survivors. Therefore, the aim of this study was to evaluate the effect of a two-year physical activity intervention (strength, aqua fitness and aerobic exercise programs) on the self-perceived quality of life and physical functionality of female breast cancer survivors. Methods: A randomized, controlled, experimental trial with a sample of 316 women (63 &plusmn, 7 years), who had been diagnosed with breast cancer. The evaluations were performed using the Rikli &amp, Jones Senior Fitness Test, and the Short Form 12 Health Survey (SF-12). Results: The participants in the strength program showed statistically significant improvements in all the items of the SF-12. The aqua fitness program obtained significant improvements in Physical Functioning and Limitations, Pain and Emotional Limitations, General Health, Vitality, Social Functioning and the physical and mental components of the SF-12. The participants in the aerobic program showed a progressive deterioration of Vitality and Mental Health. Conclusion: When assigning breast cancer survivors to an exercise program, the preferential or predominant activity should include strength exercises. On the other hand, as the second choice, those patients with particularly low levels of Vitality or Physical Limitations will show greater improvement with an aqua fitness program.

Many young people suffer from chronic stress and other issues that inhibit the functioning and development of the prefrontal cortex, and this also affects their intrinsic motivation to engage in any activity. In short, unless their well-being is addressed, they cannot engage effectively. The HIPPOCAMPUS project aims to address these issues by promoting the well-being of young people through the practice of a range of techniques derived from yoga. Yuva Yoga app is part of the approach to support the yoga-based practices with young people. It is a multiplatform mobile app developed as Backend as a Service both for Android and iOS. The first public version of the mobile app is part of the pilots implemented in the schools involved in the project, but there is not a special focus on the usability of the app. This work presents the heuristic evaluation of Yuva Yoga for iOS carried out by four experts as part of a major usability study that combines heuristic techniques, both iOS and Android, and empirical methods with users. Some problems were detected during the evaluation, but more of the problems have a low priority rating. They are mainly cosmetic problems that do not need to be fixed unless extra time is available on the project, or minor usability problems. The results have provided an important input to develop a new minor version of the mobile app, in order to improve the user experience in the pilots at schools.

The global increase in the proportion of the population with disabilities has caused a greater awareness toward guaranteeing their use of public services. In particular, there is emphasis on the accessibility and inclusivity of tourism resources, to improve the enjoyment and well-being for people with motor disabilities. This paper presents a case study on accessibility to beaches in the Region of Murcia, Spain, which is one of the main tourist areas in the country. First, the most important elements that allow for the accessible use of beaches are analyzed and exposed in detail. Then, an extensive field-work in the area of interest has been carried out and its results are evaluated. Finally, the development of a new mobile app is described. The objective of this tool is to provide updated, accurate, and reliable accessibility information regarding the beaches. As a result, more than a third of the beaches analyzed had a high level of accessibility, while almost another third are totally inaccessible. The proposed application is a valuable tool, not only to help people with physical and motor disabilities, but also to raise awareness among local authorities to create and improve accessible services. This work was supported by the Spanish MICINN, as well as European Commission FEDER funds, under grants RTI2018-098156-B-C53 and RTI2018-098309-B-C33. The authors thank Manuel García-Hernández and Salvador Parada-Sarabia for their participation in the collection of data of the study, Khalil Merzouki for the contribution in the software development of the proposed system, and the Federation of Associations of People with Physical and Organic Disability of Murcia (FAMDIF) for the extensive support in carrying out this work.

Background This paper analyses the 2008 economic collapse in Spain with its long-lasting effects. Precisely, the ones associated with lifestyles. Thus, the aim of this paper is to examine to what extent economic downturns affect individual’s drinking behavior when focusing on unemployed people. Methods We use discrete-choice models and matching techniques. Data from the National Health Survey for 2006 and 2011–2012 provides a clear picture before and after the 2008 breakdown in Spain. Results We find that drinking over the business cycle is a function of individual socio-demographic status. Besides, our empirical findings are consistent with the idea that following the crisis differences between unemployed and non-unemployed fell to at least in accordance with a lower overall consumption of alcoholic beverages. Conclusions Public policy design for drinkers would require both prevention and recovery from alcohol use strategies to be met towards health and labour pillars. Electronic supplementary material The online version of this article (10.1186/s12889-019-6882-2) contains supplementary material, which is available to authorized users.

Social Network Analysis (SNA) is a set of techniques developed in the field of social and behavioral sciences research, in order to characterize and study the social relationships that are established among a set of individuals. When building a social network for performing an SNA analysis, an initial process of data gathering is achieved in order to extract the characteristics of the individuals and their relationships. This is usually done by completing a questionnaire containing different types of questions that will be later used to obtain the SNA measures needed to perform the study. There are, then, a great number of different possible network-generating questions and also many possibilities for mapping the responses to the corresponding characteristics and relationships. Many variations may be introduced into these questions (the way they are posed, the weights given to each of the responses, etc.) that may have an effect on the resulting networks. All these different variations are difficult to achieve manually, because the process is time-consuming and error-prone. The tool described in this paper uses semantic knowledge representation techniques in order to facilitate this kind of sensitivity studies. The base of the tool is a conceptual structure, called &ldquo, ontology&rdquo, that is able to represent the different concepts and their definitions. The tool is compared to other similar ones, and the advantages of the approach are highlighted, giving some particular examples from an ongoing SNA study about alcohol consumption habits in adolescents.

Aim A comprehensive approach to health highlights its close relationship with the social and economic conditions, physical environment and individual lifestyles. However, this relationship is not exempt from methodological problems that may bias the establishment of direct effects between the variables studied. Thus, further research is necessary to investigate the role of socioeconomic variables, their composition and distribution according to health status, particularly on non-communicable diseases. Subjects and methods To shed light on this field, here a systematic review is performed using PubMed, the Cochrane Library and Web of Science. A 7-year retrospective horizon was considered until 21 July 2017. Results Twenty-six papers were obtained from the database search. Additionally, results from “hand searching” were also included, where a wider horizon was considered. Five of the 26 studies analyzed used aggregated data compared to 21 using individual data. Eleven considered income as a study variable, while 17 analyzed the effect of income inequality on health status (2 of the studies considered both the absolute level and distribution of income). The most used indicator of inequality in the literature was the Gini index. Conclusion Although different types of analysis produce very different results concerning the role of health determinants, the general conclusion is that income distribution is related to health where it represents a measure of the differences in social class in the society. The effect of income inequality is to increase the gap between social classes or to widen differences in status.