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

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

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

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

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

Introduction: Over the last few years, the Acta Otorrinolaringológica Española (Acta ORL) has been working to improve its impact factor. A high citation rate in the Journals indexed at the Institute for Scientific Information (ISI) is needed to achieve this, particularly in the ones with a high impact factor. The objective of this study was to analyse the index of citation by other national research groups of the articles by Spanish otorhinolaryngologists published in the Acta ORL Esp., Material and Methods: Retrospective descriptive-bibliometric study to analyse the publications and citations of original articles published in the Acta ORL between January 2004 and December 2008., Results: We observed that Spanish otolaryngologists had a low publication index in the Acta ORL, where only 39.1% of the Spanish biomedical production was published. Moreover, the original articles published in the Acta ORL had a low index (32%) of citation by other national authors or groups, displaying a strong self-citation tendency (18.9%)., Conclusion: National otorhinolaryngologists or ORL research groups had a low tendency to cite other national (ORL) authors in their publications. In addition, national authors had low biomedical production compared with their European peers. The biomedical production and the articles published in the Acta ORL had a low citation index by ISI indexed journals., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Background: The prevalence of disability shows a high geographical variability and the identification of factors that could explain these variations can be useful to the heath and social welfare planning. Here the analysis of disability variations among autonomous regions in Spain is made taking into account individual and geographical setting factors together., Methods: Data come from the Spanish Disability, Impairment and Health Status survey of 1999 and from Inebase both of the National Institute for Statistics. The prevalence of disability crude and adjusted by age was calculated for each autonomous region. Individual factors related to disability are identified by means of a logistic regression. The analysis accounting for both, individual and geographical setting factors was performed by means of a logistic regression of two levels., Results: Disability prevalence showed a maximum difference of 5.75 points among regions. In a logistic regression the region of residence was statistically significant (OR: 3.35 in the highest rated region related to the lowest) beside several individual factors: age (OR 40-64= 1.78 OR 65-79= 1.87 and OR >79= 3.34), sex (OR women= 0.66), working status (OR unemployment=2.25 OR housewife/student=1.39 y OR other=2.03), health status (OR regular= 1.69 OR bad/very bad= 2.05) and chronic diseases (OR 1-3=1.56 OR 4-6=1.82 OR > 6=2.59). Individual factors accounted for a very few variance at the two levels regression model (s=0.261) and none of the regional variables improved the model., Conclusions: Individual factors do not explain enough the observed disability variations among the regions and none factor related to the geographical setting has been identified as statistically significant.

Introduction: The research on critical care nursing is generally presented in the annual national congresses of the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC). This study has aimed to analyze the main features of the papers presented in the above-mentioned congresses in order to get a deeper knowledge of the research capacity of our professional group., Materials and Methodology: A descriptive, observational and retrospective study., Sample: all the papers. Dimension studied: structure and process. Time: 8 years., Data Source: a collection of the papers presented in congresses., Development: collected variables: number of authors, type of paper, city and region, type of study, timing, nursing role, dimension analyzed, topic, hospital, department, type of statistics, relevance, financing, structural quality and others. Statistical processing: descriptive statistics for quantitative variables with means and standard deviation (SD); qualitative variables are written in percentages. We have contrasted hypotheses with chi(2) accepting if p < 0.05 as a statistical significance., Results: Papers 736 (65-119), oral papers 270 (40.4%), mean of authors 4.87 (1-16), SD 1.97; per provinces: Barcelona 146 (19.8%); per autonomous communities: Catalonia 166 (22.6%); hospitals: University Hospital from Bellvitge 27 (4.2%); research studies 426 (65.3%); prospective studies 333 (51%), quantitative 345 (53%); with descriptive statistics 305 (46.9%); with a health perception and health management pattern 76 (10.3%); analyzed quality area: structure 379 (51.5%); with the presence of an autonomous role 380 (51.6%); most mentioned theme: respiratory care 100 (13.6%), with relevance and/or applicability 450 (69%); financed 23 (3.5%). Fulfillment of scientific structure: 97%., Conclusions: Intensive Nursing Care shows an important amount of oral papers. Research studies stand out among these papers, the former having high structural quality and relevance and/or applicability.

Objective: Analyze the different contribution of hierarchical categories in the papers published by radiologists of hospitals belonging to Comunidad Valenciana along the period 1994-2001, as well as their distribution in the different journals., Material and Methods: For the recovery of the papers sample we have designed specific search profiles for EMI and Medline databases. Hierarchical category of the authors was identified through personal interviews., Results: We have analyzed 417 works, with 1,321 authors distributed in the following form: chief of service, 8.8%; chief of section, 12.4%; assistant physician, 50.7%, and resident, 28%. Hierarchical groupings with participation of residents were more consistent for publishing papers along all the study period (1994-2001). Higher percentage of papers (21%) corresponded to <> grouping. Radiología was the most productive journal (42% papers). All results were statistically significant (p < 0.0001)., Conclusion: Radiodiagnosis residents of Comunidad Valenciana hospitals showed an active participation in research papers published along the period 1994-2001, in collaboration with the rest of the hierarchical categories, basically with the assistant physician. Assistant physicians contributed most of papers. Chief of section and chief of department contributed fifth of papers.

Alpha-1 antitrypsin (AAT) deficiency is an under-diagnosed disease and screening programs have therefore been recommended for patients with chronic obstructive pulmonary disease (COPD). We present the results of the pilot phase of a screening program for AAT deficiency in order to evaluate the technique used, the procedures for transporting samples and the results obtained. Over a period of one month, five centers collected samples from all COPD patients for whom plasma concentrations of AAT or Pi phenotype had not yet been determined. Capillary blood spots were dried on filter paper and then sent by surface mail to a central laboratory for study. An immunonephelometric assay was used to determine AAT and DNA phenotyping was done by use of a Light Cycler. Samples were analyzed from 86 COPD patients (76 men, 10 women) with a mean age of 68.2 years. AAT deficiency was ruled out for 74 patients (86%) who had concentrations above the cutoff established, although one of them was MZ heterozygote by genotype. Among the 12 remaining patients (13.9%), only two also had a Z allele. The rest were individuals with concentrations below the established threshold and no evidence of a Z allele (10 patients, 11.6%). The Z allele frequency observed (3/172; 1.74%) was very similar to that found in the general population. The results of this pilot study allowed us to confirm that the method used to collect samples worked well. The sampling method is applicable, easy and well-accepted by participating physicians. It allowed AAT concentrations and Z allele deficiency to be determined. The method correlates well with standard techniques used for samples in whole blood.

Background: A relevant increase in the spanish biomedical production has occurred in the last few years. The magnitude, evolution and characteristics of the Spanish scientific production in Rheumatology is here analyzed through the published papers in foreign specialty journals., Methods: Location in spanish documents published from 1990 to 1996 in nine foreign rheumatology journals of great visibility in MEDLINE. Classification of documents according to type of publication, specialty of authors and type of design. Estimation of bibliometric and collaboration indicators. Analysis of their evolution and comparison with data published for 1987., Results: The number of Spanish documents from 1990 to 1996 doubled and from 1987 to 1996 tripled, with a 54% increase for the four journals with more visibility. In 1996, the spanish documents reached 5% of the total of published documents in several journals. From 1990 to 1996 original papers increased almost four times more than letters, the analytical studies increased almost eight times more than descriptive studies, and the mean expected impact factor of the originals multiplied by 1.6. The published documents by spanish rheumatologists had a more favorable profile--higher ratios for originals: letters, analytical studies: descriptive studies--than publications performed by other specialists in this area. The number of authors by document (median) increased from 5 to 6 during the analyzed period. Seventy-two percent of documents was signed by more than one department and 75% by only one institution., Conclusions: A relevant increase has occurred in the number and quality spanish documents published in the rheumatology area during the last ten years. To note a lack of collaboration between different institutions and few analytical studies of great complexity: cohort studies and controlled clinical trials.

Objective: To analyse the thematic content and the origin of the free papers presented at four Family Medicine conferences (two national and two international) during 1992 and 1993; and to check the possibility of differences between Spanish and international lines of research., Design: Descriptive study., Measurements and Main Results: A total of 1,339 papers were classified. There were statistically significant differences (p < 0.001) in the thematic areas of Family Medicine (25.33% in international conferences, 7.77% national), Community Medicine (18.16% international, 28.20% national) and organisation of care (17.68% international, 30.16% national). The provinces with the highest number of contributions at national conferences were Barcelona, Madrid, Valencia and Zaragoza. At international conferences (WONCA) the greatest number of contributions came from the Scandinavian countries, Holland, the United Kingdom, Israel and Spain., Conclusions: Spanish investigators do not often tackle questions of under- and post-graduate training, professional attitude, clinical interviews or Bioethics. The papers at national conferences come mainly, in quantitative terms, from large provinces. The lower participation of liberal health systems like the German, French and North-American is noticeable.

The following report is to appraise the utility of the Selective Committee of Works of the Pediatric Surgery Society as an assessing organ for the Directive Board to develop the scientific program for the annual congress. For this purpose, a revision was made of a four year period (1990-1993), compiling 738 summaries, which focused primarily on the capacity of the communicated message to widen our concept of disease or our diagnostic or therapeutic possibilities. The secondary topic focused on was the way in which the investigation was decided on planned and executed. The last point taken into consideration was the formal aspects of the summary, according to the regulations given to the authors. From the 738 summaries evaluated, 510 were remitted to be presented as oral communications and 228 as posters. From all these, a total of 311 articles were admitted (172 oral communications and 139 posters). The average pointage obtained was 8.22 (maximum: 20). The articles with the highest acceptance were those dealing with experimental surgery and/or clinical investigation (70%), transplantation (665), urology (50.7%), oncology (45.6%), cardiovascular surgery (45.5%) plastic surgery (40.5%), orthopedics (39.1%), digestive-abdominal (36.8%) and maxillofacial surgery (26.3%). In 77.5% of the articles, the study method followed is not specified, in 70.7% there is no description of the results obtained and in 85.4% there is no description of the conclusions. Deducing from the above information exposed, it is necessary to maintain a system of selection of the best communications, which in turn, will guarantee a greater scientific quality in the congresses.

In the context of a historical cohort study among workers in the pulp and paper industry, we examined the agreement between the underlying cause of death obtained from municipal mortality files and from the mortality register of Catalonia (n = 50 pairs). The percentage of simple agreement (P0) for major causes of death was 76%. The agreement and the Kappa index was higher for external causes (P0 = 98%; K = 0.87) and for cancer (P0 = 90%; K = 0.79). The agreement was moderate for mortality from circulatory diseases (K = 0.57). Agreement between 3 digit ICD codes was 48% but was higher for deaths from cancer (P0 = 67%). These results indicate that information on major causes of death and on specific causes of cancer retrieved from municipal mortality files may be used for the follow-up of historical cohort studies.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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