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Aims: To analyze the temporal and geographical distribution of different indicators for the evolution of intimate partner violence against women (IPV) before, during and after the COVID-19 induced lockdown between March and June 2020 in Spain., Methods: Descriptive ecological study based on numbers of 016-calls, policy reports, women killed, and protection orders (PO) issued due to IPV across Spain as a whole and by province (2015-2020). We calculated quarterly rates for each indicator. A cluster analysis was performed using 016-call rates and protection orders by province in the second quarters of 2019 and 2020. ANOVAs were calculated for clustering by province, unemployment rates by province, and the current IPV prevalence., Results: During the second quarter of 2020, the highest 016-call rate was recorded (12.19 per 10,000 women aged 15 or over). Policy report rates (16.62), POs (2.81), and fatalities (0.19 per 1,000,000 women aged 15 or over) decreased in the second quarter of 2020. In the third quarter, 016-calls decreased, and policy reports and POs increased. Four clusters were identified, and significant differences in unemployment rates between clusters were observed (F = 3.05, p < 0.05)., Conclusions: The COVID-19 lockdown fostered a change in IPV-affected women's help-seeking behavior. Differences between the volume of contacts made via 016-call and the policy reports generated provide evidence for the existence of barriers to IPV-service access during the lockdown and the period of remote working. More efforts are needed to reorganize services to cope with IPV in non-presential situations. The provinces with the highest 016-call and PO rates were also those with the highest rates of unemployment, a worrying result given the current socioeconomic crisis.

Background: Intimate partner violence (IPV) against women is a complex worldwide public health problem. There is scarce research on the independent effect on IPV exerted by structural factors such as labour and economic policies, economic inequalities and gender inequality., Objective: To analyse the association, in Spain, between contextual variables of regional unemployment and income inequality and individual women's likelihood of IPV, independently of the women's characteristics., Method: We conducted multilevel logistic regression to analyse cross-sectional data from the 2011 Spanish Macrosurvey of Gender-based Violence which included 7898 adult women. The first level of analyses was the individual women' characteristics and the second level was the region of residence., Results: Of the survey participants, 12.2% reported lifetime IPV. The region of residence accounted for 3.5% of the total variability in IPV prevalence. We determined a direct association between regional male long-term unemployment and IPV likelihood (P = 0.007) and between the Gini Index for the regional income inequality and IPV likelihood (P < 0.001). Women residing in a region with higher gender-based income discrimination are at a lower likelihood of IPV than those residing in a region with low gender-based income discrimination (odds ratio = 0.64, 95% confidence intervals: 0.55-0.75)., Conclusions: Growing regional unemployment rates and income inequalities increase women's likelihood of IPV. In times of economic downturn, like the current one in Spain, this association may translate into an increase in women's vulnerability to IPV., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Spain's financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period., Methods: An ecological longitudinal study was carried out in Spain's 17 regions. Two study periods were defined: pre-crisis period (2005-2007) and crisis period (2008-2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design., Results: Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008., Discussion: The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates., Conclusions: The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

Background: At the international level PREMIS -"Physician Readiness to Manage Intimate Partner Violence Survey"- is amongst the most comprehensive instruments to evaluate primary health care professionals' readiness. The aim of this study is to assess the reliability, internal consistency and construct validity of the Spanish version of this questionnaire., Methods: After translation, back translation and assessment of content validity of the questionnaire, 200 questionnaires were distributed to medical doctors and nurses working in 15 primary health care centres located in 4 autonomous regions (Comunidad Valenciana, Castilla León, Murcia, Cantabria), in 2013. Cronbach's alpha, intraclass correlation and rho Spearman coefficients were calculated., Results: the Spanish version of PREMIS encompasses 64 items. Cronbach's alpha coefficient was greater than or close to 0.7 in most of indices. Intraclass correlation coefficient of 0.87 and Spearman coefficient of 0.67 showed a high reliability. All correlations for the scale of Opinions, which is the only one that was considered factorial structure of the questionnaire PREMIS, were higher than 0.30., Conclusions: the Spanish version of PREMIS obtained good internal validity, high reliability and predictive self-reported capacity of medical practitioners and nurses in Intimate Partner Violence cases in PHC centers.

Background: Intimate partner violence (IPV) against women occurs in all countries, all cultures and at every level of society; however, some populations may be at greater risk than others. The aim of this study was to explore IPV prevalence among Ecuadorian, Moroccan and Romanian immigrant women living in Spain and its possible association with their personal, family, social support and immigration status characteristics., Methods: Cross-sectional study of 1607 adult immigrant women residing in Barcelona, Madrid and Valencia (2011). Prevalence rates and adjusted odds ratios (AORs) were calculated, with current IPV being the outcome. Different women's personal (demographic), family, social support and immigration status characteristics were considered as explicative and control variables. All analyses were separated by women's country of origin., Results: Current IPV prevalence was 15.57% in Ecuadorians, 10.91% in Moroccans and 8.58% in Romanians. Some common IPV factors were found, such as being separated and/or divorced. In Romanians, IPV was also associated with lack of social support [AOR 5.96 (1.39-25.62)] and low religious involvement [AOR 2.17 (1.06-4.43)]. The likelihood of current IPV was lower among women without children or other dependents in this subgroup [AOR 0.29 (0.093-0.92)]., Conclusion: The IPV prevalence rates obtained for Moroccan, Romanian and Ecuadorian women residing in Spain were similar. Whereas the likelihood of IPV appeared to be relatively evenly distributed among Moroccan and Ecuadorian women, it was higher among Romanian women in socially vulnerable situations related to family responsibilities and the lack of support networks. The importance of intervention in the process of separation and divorce was common to all women., (© The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

In this paper, we describe our experience of using the Putting Women First protocol in the design and implementation of a cross-sectional study on violence against women (VAW) among 1607 immigrant women from Morocco, Ecuador and Romania living in Spain in 2011. The Putting Women First protocol is an ethical guideline for VAW research, which includes recommendations to ensure the safety of the women involved in studies on this subject. The response rate in this study was 59.3%. The prevalence of VAW cases last year was 11.7%, of which 15.6% corresponded to Ecuadorian women, 10.9% to Moroccan women and 8.6% to Romanian women. We consider that the most important goal for future research is the use of VAW scales validated in different languages, which would help to overcome the language barriers encountered in this study., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)

Purpose: We sought to analyze whether the sociodemographic profile of battered women varies according to the level of severity of intimate partner violence (IPV), and to identify possible associations between IPV and different health problems taking into account the severity of these acts., Methods: A cross-sectional study of 8,974 women (18-70 years) attending primary healthcare centers in Spain (2006-2007) was performed. A compound index was calculated based on frequency, types (physical, psychological, or both), and duration of IPV. Descriptive and multivariate procedures using logistic regression models were fitted., Results: Women affected by low severity IPV and those affected by high severity IPV were found to have a similar sociodemographic profile. However, divorced women (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.2-20.3), those without tangible support (OR, 6.6; 95% CI, 3.3-13.2), and retired women (OR, 2.7; 95% CI, 1.2-6.0) were more likely to report high severity IPV. Women experiencing high severity IPV were also more likely to suffer from poor health than were those who experienced low severity IPV., Conclusions: The distribution of low and high severity IPV seems to be influenced by the social characteristics of the women involved and may be an important indicator for estimating health effects. This evidence may contribute to the design of more effective interventions., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To analyze whether sociodemographics and social support have a different or similar effect on the likelihood of Intimate Partner Violence in immigrants and natives, and to estimate prevalences and associations between different types of IPV depending on women's birthplace., Methods: Cross-sectional study of 10,048 women (18-70 years) attending primary healthcare in Spain (2006-2007)., Outcome: Current Intimate Partner Violence (psychological, physical and both). Sociodemographics and social support were considered first as explicative and later as control variables., Results: Similar Intimate Partner Violence sociodemographic and social support factors were observed among immigrants and natives. However, these associations were stronger among immigrants, except in the case of poor social support (adjusted odds ratio natives 4.36 and adjusted odds ratio immigrants 4.09). When these two groups were compared, immigrants showed a higher likelihood of IPV than natives (adjusted odds ratios 1.58)., Conclusion: Immigrant women are in a disadvantaged Intimate Partner Violence situation. It is necessary that interventions take these inequalities into account., (Copyright 2010 The Institute For Cancer Prevention. Published by Elsevier Inc. All rights reserved.)

Background: This study has been carried out in order to explore the effect of the growing appearance of IPV in television news items on deaths by this cause., Methods: Ecological study based on 340 deaths by intimate partner violence (IPV) and 3733 television news items covering this topic on Spanish television channels (2003 and 2007). Logistic regression analysis was carried out. Dependent variable: the difference between the number of IPV deaths in the 7 days following a news item broadcast and the number of IPV deaths in the 7 days before a media item. This outcome variable was conceptualised as a binary variable: increase vs. no increase., Independent Variables: days with IPV news items-in general, concerning deaths, measures or other IPV crimes. Adjusted variables: day of the week, month, year and public holidays., Results: A small copycat effect was observed in the IPV murder rate (RR = 1.32, CI(95%) = 1.07 - 1.62) for IPV-related news item days compared with days without such news. This effect continued when information about deaths was broadcast (RR = 1.28, CI(95%) = 1.01 - 1.62). News items concerning measures (RR = 0.90, CI(95%) = 0.82 - 0.98) or other IPV crimes (0.84, CI(95%) = 0.82 - 0.98) were related to a lower possibility of an increase in deaths compared with days with death-related news., Conclusion: Given the results observed in the case of IPV-related news, there is an evident need to develop a journalistic style guide in order to determine what type of information is recommended due to the potential positive or negative effects.

Objective: To compare the prevalence of gender-based violence among immigrant and Spanish women. To describe their responses to this problem and the possible differences. To identify specific interventions to deal with gender-based violence in immigrant women in Spain., Methods: We performed a cross-sectional survey through a self-administered questionnaire in 10,202 women attending primary care in Spain (2006-2007). A content analysis was performed of the follow-up report of law 1/2004 of integral protection measures against gender violence sent by each Spanish region (2005) and the most recent regional laws and acts., Results: The prevalence of gender-based violence was 14.3% in Spanish women and 27.9% in immigrant women. The likelihood of gender-based violence was higher in immigrant (odds ratio adjusted: 2.06; 95% confidence interval: 1.61-2.64). Immigrant women more frequently reported that they had denounced their intimate partners and that they did not know how to manage the situation. Some Spanish regions have already started interventions to overcome access barriers to social and health services, but only three have provided data on the number of immigrant women who received economic and occupational help up to 2005., Conclusions: Inequalities were observed in the prevalence of gender-based violence according to country of origin, with immigrant women being more frequently affected. Immigrant women more frequently denounce their intimate partners than Spanish women but this action does not guarantee effective results. Other specific interventions have been identified in some autonomous regions of Spain but these interventions need to be evaluated to ensure that they benefit immigrant women.

Objective: To determine the prevalence of reported intimate partner violence (IPV) and to analyze the main sociodemographic characteristics of affected women., Methods: We performed a cross-sectional study based on the Spanish National Health Survey of 2006. The sample comprised 13,094 women who agreed to answer questions about violence (87.2% of the total interviewees). Bivariate and multivariate analyses were performed. The dependent variable was reported IPV and the independent variables were educational level, employment, marital status, living arrangements with the partner or analogous individual, number of children at home, nationality (Spanish vs. foreign women) and age., Results: IPV was reported by 1% (n=128) of the sample. Women with primary school education or without studies (odds ratio [OR]: 3.63 [1.90-6.92]), with three or more children (OR: 3.51 [1.78-6.90]), and those who were separated or divorced (OR: 2.81 [1.89-4.97]) were most likely to experience IPV when the effect of the remaining variables was controlled. The likelihood of IPV was also higher in women born outside Spain (OR: 2.83 [1.87-4.28])., Conclusions: IPV seems not to affect Spanish and foreign women equally. The characteristics most closely associated with women affected by IPV were educational level, the number of children at home and marital status. The sensitivity of current measures against IPV should be considered in relation to the needs of affected women.

Objectives: To describe the distribution of mortality due to intimate partner violence (IPV) in foreign women living in Spain and to explore the potentially greater risk of dying from IPV in this group., Methods: We performed a retrospective ecological study of deaths from IPV registered by the Women's Institute of Spain (1999-2006). Mortality rates and Poisson models for relative risk and 95% confidence intervals were calculated., Results: The average risk of dying from IPV in foreign women was 5.3 times greater than that in Spanish women. In the years studied, the increased risk in foreign women was 2 to 8 times greater than that in Spanish women., Conclusion: Foreign women living in Spain are especially vulnerable to death from IPV. Further research on the causes of this phenomena and strategies involving health services are needed.

Background: Gender is an important health determinant for public health policies. This study describes the changes in gender development inequalities in Spain and its autonomous regions from 1990 to 2000., Methods: An ecological study using the Human Development Index (HDI) and the Gender Development Index (GDI) was done. IDG both men and women was analysed according to indexes of education, income and life expectancy at birth., Results: Although the GDI has had an increase of 5,05% in the 90 s, 51,5% of the population was located above the global GDI of Spain in 1990, moreover this number decreased to 46,3% in 2000. Gender inequalities have been reduced both at national and regional levels. The regions with the lowest increase were Asturias (3.37%), Cantabria (3.68%) and Baleares Islands (3.71%). The regions with the highest increase were Madrid (6,46%) and Extremadura (6,75%). All the autonomous regions showed a number of GDI lower than the value of HDI. Both sexes achieved similar increase in life expectancy (Men: 5% and Women: 4%). An unequal variation was detected according to the autonomous region (Basque Country; Men: 7% and Women: 3%; Madrid; Men:8% and Women:5%). Women have improved their educational level in comparison to men (Men: 3% and Women: 6%). In the 90 s, men obtained more income than women, but women improved their situation three times more than men., Conclusions: Inequalities in Human Development analysed by gender have been reduced in the 90 s in Spain. However, the improvement of education, income and life expectancy occurred only in some autonomous regions. This situation shows the differences among Spanish autonomous regions.

Background: Intimate Partner Violence (IPV) has received special attention in the spanish political agenda. Despite the importance of developed interventions, empirical evidence about their effectiveness is scarce. The aim of this study is to explore the temporary distribution of Intimate Partner Violence (IPV) reports and murders and to identify possible changes in the risk of dying and reporting by IPV from the Spanish law against gender violence of December of 2004., Methods: We performed a descriptive study based on statistics of The Woman's Institute and The Divorced and Separated Women Federation., Calculations: IPV mortality and reports rates by years and periods around the law (1998-2004 vs. 2005-2006); Poisson Regression; and, Epidemic index by months -Ratio between the actual number of IPV murders and reports in a given month and the median number of cases in the same month in the five preceding years- and underlying epidemic index -annual average of the scores of the epidemic index of reports and murders., Results: The epidemic index trends permit us to observe that the problem has decreased since 2005. Nevertheless, the possibility of reporting IPV between 2005 and 2006 is 1.6 times upper that between 1998 and 2004. The risk of dying by this cause does not show statistically significant changes., Conclusion: The possibility of reporting IPV has been increased in Spain throughout the time. However, the risk of dying stays. Although still it is soon for the evaluation of the impact of the law in this epidemic, we could say that its effectiveness for the reduction of IPV mortality seems limited.

Objective: To explore the geographical distribution of mortality due to intimate partner violence (IPV) and reports of IPV according to the gender development index (GDI) of Spanish provinces., Methods: We performed an ecological study, based on GDI by provinces, of deaths from IPV and official complaints of IPV made by women between 1997 and 2004. The sources were the "Report on Human Capital and Human Development in Spain", the "Home Affairs Statistics Yearbook", and the web page of the Federation of Separated and Divorced Women. Provinces were divided into 2 groups according to whether their GDI score was above or below the mean GDI score for Spain (0.895). Mortality rates by age and rates of official complaints of IPV were calculated for the two groups of provinces (high and low GDI). Relative risks and their confidence intervals were calculated to analyze the risk of dying from or reporting IPV in low GDI provinces compared with that in high GDI provinces., Results: The risk of death due to IPV was higher in women living in low GDI provinces than in those living in high GDI provinces (RR = 1.328; 95% CI, 1.253-1.406). Furthermore, the risk of reporting IPV was higher in low GDI provinces than in high GDI provinces (RR = 1.468; 95% CI, 1.462-1.474)., Conclusion: Despite the trend to develop IPV strategies focused on individual causes, our results suggest that to tackle this problem, strategies for promoting gender equity in Spain are required.

A study was made of 26 patients diagnosed as phase I reflex sympathetic dystrophy. In all of them, a bone:soft tissue uptake index was quantified by scintigraphic scanning before treatment and 3 months later. Eighteen patients were treated with 100 MRC units salmon calcitonin, followed by 500 mg elemental calcium 4 hours after hormone administration. The treatment was administered 10 days a month separated by intervals free of therapy. The other 8 patients were treated without interruption with 500 mg naproxen every 12 hours. In the group treated with calcitonin and calcium, the uptake index declined from 13.3 +/- 8.2 to 4.1 +/- 1.8 (p less than 0.001). The uptake index rose from 2.1.3 +/- 17.7 to 31.1 +/- 23.0 (NS) in the naproxen group. Using the Student t-test for paired samples to evaluate individual changes, a highly significant difference was reached (p less than 0.005) in the calcitonin-calcium group. The difference was also significant (p less than 0.01) in the naproxen group, but it was negative (t = 3.620). These results confirm the efficacy of treating reflex sympathetic dystrophy with calcitonin and calcium and the superiority of this treatment as compared with nonsteroidal anti-inflammatory drugs.

Two cases of late hypophosphatemic osteomalacia are described: a male aged 30 who had the disease since he was 22 and a woman of 23 who had the disease since she was 14. Both presented with myopathy and bone pain, and showed hypophosphatemia, hyperglycinuria, reduced tubular phosphate reabsorption (TPR), increased hydroxyprolinuria and normal iPTH and iCT values. Radiologically the male had no Looser's zones and the woman did. Bone biopsy confirmed hypophosphatemic osteomalacia. Both cases were treated with vitamin D and oral phosphate and no improvement was observed. When treatment with 25(OH)D3 was initiated, no improvement was seen and afterwards this was combined with treatment using 1.25(OH)2D3 and from this time on a clinical improvement of the myopathy became evident in both patients. In the woman, healing of the bone lesions occurred at the same time as that of the myopathy, whereas in the male the bone lesions became worse. Healing of the myopathy was only obtained when treatment with 1.25(OH)2D3 was begun. Both patients had reduced values of 2.3 erythrocytic DPG and low level of serum phosphorus when the myopathy was cured, which suggests a lack of effect of 2.3 DPG or serum phosphorus as a cause of the myopathy. Although this had been attributed to a deficiency in the function of 25(OH)D3, the response to 1.25(OH)2D3 and due to the effects of this metabolite on calcium transport in muscle, suggests that the myopathy which occurs in late hypophosphatemic osteomalacia is a result of deficiency or resistance to the muscular effect of this metabolite. We cannot explain the lack of bone healing in the man and further therapeutic studies are required.