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Objective: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies., Methods: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables., Results: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%)., Conclusions: The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: There are different socioeconomic variables which determine tuberculosis's epidemiology, diagnosis and treatment. The objective of this paper was to analize these effects in the last years in Spain., Methods: A systematic review was conducted. Screened studies were original articles written in English or Spanish and published between 2007 and 2020. Searching was performed in Pubmed and Web of Science databases. STROBE criteria were followed to analyze studies's quality, and studies included in the review had 15 points or more., Results: 23 articles were selected, and were classified in different topics. Foreigners's proportion with tuberculosis changed in different autonomous communities between 10%-50%. There were diagnostic delay for this group compared to natives. This group had higher incidence of resistance to isoniazid, but without a clear increase in multidrug resistance. There were less adherence to tuberculosis's treatment in case of immigration, drug addiction, HIV coinfection, or lack of family support. Under-reporting of tuberculosis cases varied between 18%-28%, and it was higher in cases of social marginality, HIV coinfection, Spanish nationality or male sex. There were also other social risk groups in which the diagnostic approach to tuberculosis was relevant, such as in schools and health centers. Tuberculosis was one of the most frequent HIV associated diseases, although screening tests were not performed in almost 18%, depending on the concurrence of social risk factors., Conclusions: Tuberculosis's incidence, diagnosis, and treatment are influenced by a lot of social and economic factors, which determine the approach to this disease.

Objective: One of the problems associated to SARS-CoV-2 was its persistence in nasopharyngeal tract. The existence of markers that help to predict this situation could be useful to management of the patients. The objective of this paper was to determine the relationship between the CT value from the initial PCR of patients with COVID-19 and the persistence of the infection., Methods: It was performed an observational retrospective study of patients with positive PCR to SARS-CoV-2 attended in emergency department of a general hospital. Data about compatible symptoms, radiological findings and the CT value obtained with each PCR kit were collected. The control group (G0) included patients with a positive PCR followed by two negative PCR results (P-N-N), while problem group (G1) included patients with at least three consecutive positive PCR results (P-P-P). Chronic infections were discarded selecting only patients with negative serology, and only were included those whose PCR were separated by a minimum of five and maximum of twenty days. The comparison between the study groups was carried out using the t-student test for quantitative variables and the χ 2 test for qualitative variables., Results: The mean CT value were 30.8 and 21.5 (p<0.001) on G0 and G1, respectively. G0 reported higher CT values than G1, regardless of symptoms, radiological pattern and the PCR kit utilized., Conclusions: The CT value from the SARS-CoV-2 initial PCR is related to the persistence of its positivity, regardless of the patient´s symptoms or radiological pattern. Thus, low CT values could be related to persistent infections., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The paper is aimed to analyze if religion plays a relevant role in health promotion and, thus, if it can be included in the interpretations on the positive role of religions in the public sphere. In this regard, Habermas refers to a crisis of meaning in secular societies that has been caused, among other reasons, by individualistic and selfish lifestyles that fail to encourage a moral action when it goes beyond the law. In contrast, it seems that the strong social ties of religious communities foster solidarity and altruistic attitudes, which could be interpreted as a sign of greater social cohesion; but is it really like that? Pandemic and its consequences help to assess whether the religious element (analyzed as belief, belonging, bonding and behavior) has created positive attitudes in the face of the health challenges (i.e., compliance with rules of social distance, vaccination) or, on the contrary, the motivational deficits of some societies have to do with other factors not related to the religious/secular dichotomy., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

In behavioral science, the term nudge refers to any aspect of decision architecture that predictably alters people's behavior to improve the chooser's own welfare without forbidding or significantly restricting their choices. Its promoters invoke libertarian paternalism, which means, on the one hand, that the behavior of the individual is guided without counting on his autonomy, but, on the other hand, that this form of influence does not reach the point of restricting freedom of choice when it is manifest. This paper analyzes the role of nudges in the field of health policies. A cognitive analysis of these nudges is carried out and are distinguished the clinical nudges (those that take place within the healthcare professional and patient relationship) from the public health nudges (specific to public health policies). The ethical aspects of both categories of nudge will be analyzed to point out some of their virtues and the ethical challenges they face. This study focuses in particular on public health nudges, to consider whether it is reasonable, and with what limits, their implementation in health crises (for example, pandemics). Analyzing that public policies face the dilemma between preserving freedom at the expense of health or, on the contrary, prioritize health to the point of limiting freedom. It is raised whether in this context greater restrictions on individual freedoms should be allowed (for example, through mandatory lockdowns and quarantines, imposed vaccinations, forced tests) or whether to use nudges as an intermediate solution and less harmful to individual rights to promote health measures., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

COVID-19 pandemics gave us relevant lessons that are going to leave a durable mark in our individual and collective experience. Those lessons are both practical and endowed with a moral import. But the pandemic has left a trail of experiences poorly elaborated that leads, with some urgency, to forced silence and to the cancellation of emotional trauma. The aim of this paper was to disentangle the complex relationship that arises, under conditions of uncertainty, between knowledge and ignorance, both from the perspective of experts and of policy makers, and even of the ordinary people, struck or not by the SARS-CoV-2 virus. To that end, I distinguish between three different levels of analysis (agency, institutions, and ideological frameworks) so to argue that the mismatches that occur in all of them, and between them, are sources of avoidable harm. The purpose of this exploration was, therefore, to bring to the floor, relying on the conceptual tools of the political epistemology, both the aspects of the traumatic experience that still lack an adequate elaboration and the features that provide an improved resilience for individuals and societies in tackling with the frightful consequences of the pandemic., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Health research is an accessory activity for most health professionals in the national health service of Spain. One way to recognize your worth is through professional careers. The objective of this paper has been to compare how research activity is valued in the professional careers of the health services of the different regions of Spain., Design: Review of agreements, resolutions and decrees that define the professional careers of each community collected from the corporate websites of health services and health ministries. SITE: Health Research and Innovation Commission of the Extremadura Health Service., Participants: Members of said commission., Methods: The following was considered for comparison: if the research activity is valued in isolation from other concepts, if it is considered to advance in different levels, if it is a requirement for any of them, and the percentage of score assigned to the block to which it belongs., Results: Almost all the regions consider research as merit at all career levels. The score of the research block is between 4 and 50% of overall. They are only considered independently, of others activities, in the Canary Islands, Castilla-La Mancha, Castilla-León, Cataluña, Madrid and Murcia. They are required to climb a certain level in the Canary Islands and Castilla-León., Conclusions: There is a high variability in the recognition of research activity between regions. The careers that best value research would be those of the Canary Islands and Castilla-León, which consider it an independent activity and it becomes a requirement. The regions that have a more negative approach are those that can be promoted to the highest level, without making any contribution to research., (Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

In this paper we compared brand-specific COVID-19 vaccine effectiveness (VE) during August 2021 in persons born 1962-1971 and vaccinated during June. For SARS-CoV-2 symptomatic infection, protection was lower for Janssen (56%; CI95%: 53-59) or AstraZeneca [Vaxzevria] (68%; CI95%: 65-70), compared to Pfizer-BioNTech [Comirnaty] (78%; CI95%: 77-78), AstraZeneca/Pfizer (86%; CI95%: 80-90) or Moderna [Spikevax] (89%; CI95%: 88-90). VE against hospitalization was ranged 86% for Janssen to 97%-98% for other vaccines.

Objective: Hip fracture (HF) in the elderly carries high mortality and decreases functionality and quality of life after one year. The aim of this paper was to identify risk factors that influenced functionality (Barthel) and quality of life (EQ-5D) of the elderly with osteoporotic HF., Methods: A prospective observational study was made in people over 65 years of age with HF between October 2017 and November 2018. Clinical information was collected from the digital medical record and the scales were measured by telephone at four times: baseline, one month, six months and twelve months. Statistical analysis was made thanks to SPSS vs 25.0. Multivariate analysis was performed using a generalized linear model for repeated measures to determine the relationship of risk factors with functionality and quality of life., Results: Functionality showed significant differences (p<0.001) between baseline measurement and one month (90 points vs 50); baseline and at twelve months (90 vs 60 points); and that of the month and at twelve months (50 points vs 60). Quality of life also presented significant differences (p<0.001) between baseline and one month (0.587 vs 0.113); and baseline and twelve months (0.220). The functionality should be in transfused and with high surgical risk (p<0.05) and the quality of life will arrive in high surgical risk (p=0.017). Those older than 85 years were the ones who recovered the least after one year, as well as patients with delirium on admission and those who received transfusions. Patients with iron therapy recovered better at six months compared to those who did not and maintained this improvement at twelve months., Conclusions: Among the main risk factors are advanced age, male sex, transfused, high surgical risk, delirium on admission and malnutrition., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: The benefit-risk balance of statins and ezetimibe as primary prevention of cardiovascular disease is controversial in elderly patients due to the doubts about their effectiveness and certainty about adverse effects. The aim of this paper was to analyze health outcomes of a statin and ezetimibe deprescription strategy in patients aged 75 or older treated with these drugs for primary prevention of cardiovascular disease., Methods: An observational ambispective cohort study was made to evaluate health outcomes after the implementation of a strategy for deprescribing statins and ezetimibe in patients aged 75 or older who take these drugs for primary prevention of cardiovascular disease. To avoid the risk of bias due to non-random assignment of patients to different groups, a propensity score will be calculated for each patient using logistic regression. The outcome of interest will be the deprescription or not of statins or ezetimibe. Time to hospital admission or death from any cause and other variables related to health outcomes will be analysed. Groups with and without statin or ezetimibe deprescription will be compared by survival analysis using Cox regression to estimate the hazard ratio., Conclusions: It is expected to obtain health outcomes of the strategy of deprescribing statins and ezetimibe in primary prevention in patients aged 75 or older. They will provide information on the advisability of continuing the strategy.

Objective: Drowning is one of major public health problem in childhood. The aim of this paper was to describe the characteristics, locations, interventions and outcomes of child drowning in Galicia over 17 years., Methods: Retrospective study of 100% of data of drowning amongst children aged 0-14 in the 2004-2020 period who were attended by the 061 emergency services in Galicia (Spain) was made. The characteristics of the incident, the victim's profile, location, type of medical care given and whether the victim survived or died were analysed using the Chi Square test to compare relative frequencies, and Odds Ratio to estimate the risk., Results: During the period under study, 100 child drownings were recorded. In 55%, the main cause was lack of supervision. Young children (aged 0-4) primarily drowned in pools, and pre-teens and teenagers (aged 10-14) in the sea. In 42% of the incidents, bystanders performed CPR (37% included ventilation). Emergency services took 12 minutes on average to arrive at the scene. 6% died in situ and of the rest, were taken to hospital and admitted in 47% PICU, 26% ward, 8% discharged from Accident and Emergency (43% with pulmonary oedema, 41% with supplemental oxygen, 13% with IMV/NIMV [invasive mechanical ventilation/non-invasive]). Pneumonia was the most common complication and survival to discharge was 77%., Conclusions: Small children usually drown in pools and water facilities because of lack of supervision, whereas adolescents usually drown in the sea. CPR started by bystanders and the fast response of emergency services contributed to a high rate of survival. A large amount of data was lost during the process: accurate, standardized coding of drowning is necessary., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: We know the importance of hand hygiene in the prevention of healthcare-associated infections. However, its compliance is still a challenge. Moreover, when it is complied with, as in the case of preoperative hygiene, there are few studies on the proper performance of the technique. The aim of this paper is to assess adequacy of pre-surgical hand hygiene in operating room staff of different surgical specialities at a university teaching hospital in Madrid., Methods: A cross-sectional study was made. Adequacy of pre-surgical hand hygiene was assessed in operating room staff of the different specialities and professional categories by direct covert observation. It was evaluated in 852 opportunities during the months of October, November and December 2020. A specific form was designed for data collection, following the recommendations of the World Health Organisation (WHO). Adequacy was described with frequency distributions of the different groups observed. Whether Chi-square or Fisher's exact tests were used to compare the different categories., Results: Pre-surgical hand hygiene opportunities were evaluated, 75.5% in surgeons and 24.5% in nurses. Overall compliance with pre-surgical hand hygiene technique was 80.5 % (686). The most frequent surgical service evaluated was General Surgery with 240 observations. The professional category with the best adequacy was nursing (86.1%) and the surgical service one was Traumatology (90.2%). An stopwatch was used by some 25.8% of the evaluated professionals, with an adequate hygiene time of 96,8% (p<0,05) for that group., Conclusions: The overall adequacy of pre-surgical hand hygiene in the operating room professionals is high. Significant statistically differences in adequacy are found between professional categories and surgical specialities, with better compliance in nursing staff and in Traumatology. Better results are achieved by the use of an stopwatch., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Wolf-Hirschhorn syndrome is a rare disease of genetic origin caused by the deletion of the distal end of chromosome 4, including at least the region p16.3. The objectives of this work were to determine the prevalence of the disease in the Spanish population, as well as to establish the geographical distribution of the syndrome throughout the Spanish geography, elucidating the age range in which there are more patients., Methods: Patients diagnosed with the disease for nine years (2013-2021) throughout the Spanish territory were recruited for the research, thanks to agreements with the Spanish Association of Wolf-Hirschhorn Syndrome (AESWH). The clinical information of the patients was obtained from referring physicians using two standardized questionnaires completed with data from medical reports and the parent interview. The molecular characterization of the disease was made using SNP (single nucleotide polymorphism) microarrays (cytoSNP850K, Illumina, USA). The data were statistically processed using Microsoft Excel (Microsoft Corporation) and SPSS (IBM) software, using comparisons between two groups s with Student's t-test (for continuous variables) or with Chi-square tests (for categorical ones). For more than two groups, ANOVA analyses were performed (followed by Bonferroni or T3-Dunnett post hoc tests) for continuous variables and z-tests between column proportions for categorical variables., Results: In Spain (until 2021) eighty people are diagnosed with this syndrome, estimating its prevalence at 1.69x10-4 per 10,000 inhabitants and / or 1/172,904 for each live newborn. This paper remarks the existence of important differences in prevalence between the different regions in Spain. The region with the most diagnosed patients was Madrid, although the highest prevalence was observed in Asturias. Significant differences have been established in terms of sex and disease (ratio of women to men of 2:1), and the mean age at diagnosis has been established at 7.20 years., Conclusions: The prevalence of this syndrome in Spain has been estimated well below the prevalence that is handled in scientific texts (1/50,000 newborns). In addition, we have determined that this prevalence shows large geographical differences, which allows us to affirm that this syndrome could be under-diagnosed in our country. Most of the patients included in this cohort are of paediatric age. It has not been possible to corroborate that mortality in this syndrome, in our population, occurs preferably during the first two years of life, as has been claimed., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Chronic obstructive pulmonary disease (COPD) is a public health problem due to its high prevalence (11% in the adult population in Spain), increasing incidence, and great social and economic impact. Despite this, it is underdiagnosed (and, therefore, undertreated) at a rate of around 80%. In this paper, a group of respiratory physicians specializing in COPD discuss 7 fundamental problems ("cardinal sins") that contribute to this situation, with the explicit aim of proposing specific solutions that may help to improve this unfavorable state of affairs., (Copyright © 2022 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The aim of this paper was to estimate the SARS-CoV-2 infection incidence regarding the occupation in Catalonia, globally and in the different waves of the pandemic., Methods: We performed a retrospective cohort study. We included all people between 16 and 65 years old with an occupation identified from the sick leave recorded in the primary care electronic health records of the Institut Català de la Salut (ICS) (total n=2,199,745 people). The study period was from March 1 st , 2020 to September 16 th , 2021., Results: Healthcare workers had the highest incidence, with an age and sex adjusted cumulative rate of 27.7% [95% CI: 27.3%-28.1%]: 29.4% in nursing assistants, 27.3% in medical professions and 26.3% in nursing professionals; followed by the elementary occupations group with an adjusted incidence of 16.9% [95% CI: 16.7%-17%], such as the agricultural laborers (23% [95% CI: 21%-25.1%]) and rural occupations (19.1% [95% CI: 18.3%-19.8%) -especially during the 2020 summer period-, the domestic employees (20.5% [95% CI: 18.9%-22.2%]) and cleaning professionals (17.5% [95% CI: 17.2%-17.9%])., Conclusions: Healthcare workers are the hardest hit during the pandemic. On the other hand, the less qualified professions have high incidences, highlighting the different inequities in access to telework, working conditions and other social determinants of health.

The creation of a national centre for public health, with adequate resources, will make it possible to face the public health challenges of the present and the future in our country. To this end, the proposed state agency, should hold functions based on advanced public health organizational schemes, while linking with the sustainable development goals. The coordination of a national public health strategy built on a collaborative network of networks would also be essential, as developing an innovative, benchmarked and prioritised public health communication strategy, among other tasks. The lack of resources, the current relative disconnection of essential public health functions at the state level, and the inequity in their development of these functions at the regional and municipal levels, favour the development of the agency project as a network of networks. In this paper we give ideas for a process that seems decisive for Spanish public health in the 21st century., (Copyright © 2021 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Over the last two decades there has been an increase in outbreaks of arboviral diseases, being Spain at high risk for disease emergence. This paper reviews the current evidence regarding the transmissibility, disease epidemiology, control strategies and mosquito-borne disease drivers and maintaining factors in Spain. There is risk of autochthonous cases and outbreaks in Spain due to recent transmission occurrence. Recently, there has been an expansion of Aedes Albopticus, a vector for Dengue, Zika and Chikungunya; and Cullex spp., vector for West Nile Virus, already endemic in Spain. Their establishment has been facilitated by climate and environmental drivers. If climate change projections are to be met, an increase in disease transmission is to be expected, as well as the re-establishment of other vectors such as Aedes Aegypti. Our review supports the need to understand the threat of these emerging diseases and implement preventive strategies in order to minimise their impact., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Pedro Felipe Monlau was a prominent Spanish hygienist and defender of the Miasmatic Theory of Diseases. By the nineteenth-century, Spain had not enough health infrastructure. Monlau's publications became a powerful source of transmission of the dominant scientific ideas of European hygienism. Levy, Londe, Villermé, Chadwick, Farr and Smith were personalities who influenced the thinking of the Spanish hygienist. The aim of this paper is to show whether the Florence Nightingale's hygienist doctrine influenced Spain through the work of Monlau. A review of primary documentary sources was carried out and the results were analysed from the hermeneutic perspective. The Digital Newspaper Library of the National Library of Spain was used as the main resource. Monlau referred to Nightingale eleven times. Nine fragments responded to Monlau's Hygienic Aphorisms. He recommended Nightingale's ideas regarding ventilation, lighting and housekeeping, among others. In addition, Monlau suggested the need for hospital statistics following Nightingale's proposal. In this sense, the surgeon Rubio y Galí was a clear example of its applicability in the Institute of Therapeutic Surgery. Monlau also recognized the work of Nightingale in the Crimean War. The results show the need to make women scientists visible in contemporary history, revisiting the biographies written so far.

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non-healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.

Spain is one of the countries of the European Union in which alcohol consumption has decreased in the past decades. The aim of this paper is to distinguish different phases of the level of alcohol consumption in Spain since 1990. Adult alcohol consumption per capita data between 1990 and 2019 were analysed for temporal trends using the Joinpoint regression model. An additional analysis using interrupted time-series between 1962 and 2016 was performed using data from Global Information System on Alcohol and Health. Data from the survey on alcohol and other drugs in Spain were collected and a narrative review was conducted to identify possible reasons for the trends found. Five point changes were identified on the timeline between 1990 and 2019, including: a decrease of 3.2% per year from 1990 to 1995, an increase of 1.1% per year from 1995 to 2000, a period of stability from 2000 to 2006, a decrease of 4.5% per year from 2006 to 2011, and a period of stability from 2011 onwards. These changes can largely be explained by the different public health measures carried out by the Spanish government, as well as the change in the pattern of consumption in society, which shifted its alcoholic beverage preference from wine to beer, and increased its binge-drinking behaviour. Further studies such as interrupted time-series analyses should test if indeed the hypothesized measures on public health have been effective; this could inform future policies in Spain and in other countries.

In 2003 at the ending of the Human Genome Project, it aroused the idea that all newborns could be sequenced and its genome archived in the clinical record, in order to manage risks of diseases and response to medicaments along his whole life. Eighteen years later, promises of genomic medicine and tremendous decrease of costs of next generation sequencing technologies, continues feeding this dream that shows important practical, ethical and social challenges and genomic sequencing is presented as the next historical change in newborn screening programs. In this paper we analyze challenges and opportunities of next generation sequencing technologies, their real costs, problems associated to management, storage and protection of the enormous amount of genomic data produced and finally, according to conclusions of recent researches, there are considered the conclusions in two contexts, sick newborn with diagnostic purposes and healthy asymptomatic newborns with public health purposes (newborn screening programs). In a second part of this article it will be considered ethical, legal and social issues (ELSI). Final objective is to contribute to scientific, professional, ethics and social debate in order to promote that genome sequencing in newborn don't be used indiscriminately constituting a risk, but properly done, as a partner in the promotion of health and prevention of consequences of genetic diseases.

Background: In the debate on the determinants of social class variation in health, it has been suggested that social mobility and associated factors play an important role in this variation. Social mobility describes changes or stability between social class positions. The aim of this paper was to identify studies on the association between social mobility and health., Methods: The databases consulted were MEDLINE/PubMed, Cochrane, SciELO, CRD. The keywords used (in English), through the MeSH methodology, were: Health (MajorTerm), Class mobility, Vertical mobility, Social position, Socioeconomic factors, Social class, Social conditions, Social environment, Poverty and Social marginalisation (MeSHTerm). The search period was from January 2010 to December 2019. The STROBE statement has been used to develop the checklist. Finally, the evaluation of the studies has been carried out by means of a qualitative systematic review., Results: The search identified 1,092 potentially relevant studies. After analysis, 376 studies were retained and their full texts were reviewed in depth, resulting in a final set of 42 studies. Of these, 2 studies were identified on Class Mobility and Health; 5 studies were also identified on Poverty and Health, showing evidence of effect on Health by Social Mobility; 9 studies on Social Class and Health, showing effect of Social Mobility on Health and 8 studies showing effect of Social Position on Health., Conclusions: Social mobility measures convey additional information to that of poverty indices. Using indices of social position and their impact on health inequalities could be empirically useful. More research is needed on this issue.

Health systems must have tools and policies to solve the challenge of having sufficient specialists) and with the appropriate skills. In the Spanish health system, this planning function corresponds to the Ministry of Health, through the consultation and participation of different boards, such as the National Commissions of the Specialty, the offer of specialist training is defined according to the forecasts of each institution. The existence of explicit planning criteria in professional scientific societies of the different medical specialities has been analyzed, exploring the documentation reflected in their white papers or strategic plans. As a result, we highlight that, although several professional scientific societies have descriptive data on the status of the workforce in their speciality, only eight specialities define criteria for estimating the demand for specialists. No description of objective criteria to guide future demand for specialists has been found.

Objective: The COVID-19 pandemic caused by the SARS-CoV-2 virus has generated a great burden on health systems, and healthcare workers have been the most affected. In Spain, the Health Ministry issued common protocols regarding the return-to-work of healthcare workers presenting a negative PCR (Polymerase Chain Reaction) test result and complete resolution of symptoms. Some autonomous communities decided to include a CT (Cycle Threshold) value criterion as well. The aim of this paper was to compare the time intervals required to obtain a negative PCR result by means of both criteria., Methods: A multicenter, cross-sectional study was performed from March to September of 2020, in the health areas of Navarra, La Rioja and Vigo (Galicia), managed by their own Occupational Risk Prevention Units. The PCR negativization time intervals were analyzed according to gender, age, professional category and the PCR repetition criteria used (clinical or defined by CT). Mean difference calculation by Student's t-test and Kaplan-Meier survival analyzes were conducted., Results: The sample amounted to a total of 1,052 workers: 673 from Navarra, 335 from La Rioja and 44 from Vigo, with an average age of 46 years, and of which 81% were women, 35.48% nursing personnel and 23.65% physicians. No statistically significant differences were found between the PCR negativization time periods with any of the variables, except with the CT criterion, which presented a mean of 6.49 days (95% CI, 4.96-8.02), longer and displaying positively displaced survival curves., Conclusions: The CT criterion for carrying out the control PCR test lengthened the reincorporation of essential personnel in the fight against the pandemic., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

In this paper we analyze the role of Labor and Social Security Inspectorate (Inspección de Trabajo y Seguridad Social in Spanish) in the assessment and management of the risks associated to COVID-19 in the workplaces, since the beginning of the pandemic until the enforcement of the Royal Decree-Law 26/2020, with special focus on the Operative and Technical Criteria issued by the Directorate of the State Labor and Social Security Inspectorate. The paper describes the differentiation of those situations where the infection risk is derived from the work activity itself and, therefore, has a professional nature, from those where the risk is external to the work activity, thus lacking such character. A specific part of this paper is dedicated to the study of the collaboration and coordination between the Labor and Social Security Inspectorate and the Public Health Authorities, which has been become essential to effectively protect the health of workers.

The Spanish Vaccination Strategy against COVID-19 has been prepared by a multidisciplinary Technical Working Group. It has considered the situation of the different socio-occupational groups against COVID-19, having assessed the criteria of risk of exposure, transmission, serious illness and death, negative social and economic impact, feasibility and acceptability of vaccination, in addition to taking into consideration the ethical pillars that govern the Strategy. In the working population, priority has been given to first-line health and social-healthcare personnel in the first stage and, later, to the rest of healthcare and social-healthcare personnel (Groups 1, 2 and 3 of the Strategy). Group 6 included emergency personnel, security and army forces, and early childhood, special, primary and secondary education teaching personnel, due to the role that they played during the state of alarm, the significant risk of exposure, and the essential role they play in maintaining the proper functioning of society. This paper describes the stages of vaccination and their prioritization by groups in the labour context, and shows the strategy by age groups, together with the prioritization of Group 6, has been shown to be efficient and to reach workers with high risk of COVID-19 early.

Background: Theres is uncertain evidence regarding the prevalence, measurement tools, outcomes, and efficacy of the interventions on frailty in hospitalized older adults. For this reason, we present the results of a systematic review about Frailty and Hospital, following the PRISMA methodology., Methods: We found 2,050 articles published in PubMed. After an initial assessment of titles and abstracts, complete comprehensive text lecture, and meta-analysis review, we finally included in the systematic review 246 originals., Results: The main result of the systematic review is that from the 246 articles, 179 described frailty prevalence in hospital older adults, with a pooled prevalence of 41.4% (95% CI 38.4% to 44.4%; range 4.7% to 92.5%). The most frequent type of studies were those observational prospectives 166 (67.5%), being the rest observtcional retrospectives or cross-sectional 64 (26.2%) or randomized clinical trials 15 (6.1%). The most frequent healthcare levels where the studies took place were the Hospital/Hospitalization in 125 (50.8%), Geriatric Department in 41 (16.7%), Surgical Units in 23 (9.3%), Cardiology Department in 18 (7.3%), Emergency Department in 15 (6.1%), and other in 24 (9.8%). The most frequent used measurement tolos were the Clinical Frailty Scale in 69 works (28%), the frailty phenotype in 41 (15.9%), the Frailty Index in 39 (15.9%) and the FRAIL scale in 27 (11.0%). In several papers, more than one instrument was used, and in many of them, scales and cut-off points were arbitrarely determined, producing a great results heterogeneity., Conclusions: The prevalence of frailty in hospitalized older adults is very high. It is necessary to improve frailty measure homogenity and to realize randomized clinical trials in this population.

Meningioma is a common slow-growing intra-cranial neoplasm affecting 2-3% of the population, with the potential for irreversible brain damage. The widespread availability of modern neuroimaging allows early detection of small asymptomatic meningiomas. Given that morbidity and mortality rates associated to treatment of small asymptomatic meningiomas is remarkably lower than that of symptomatic, it can be hypothesized whether active search for meningiomas in the general population is warranted. In this paper we explore the justifications and rationale of an eventual screening program for the detection of small asymptomatic meningiomas and discuss its feasibility. Cost-effectiveness, applicability, and ethical issues are also analyzed. Screening for meningiomas would secondarily identify other incidental findings (brain aneurysms, pituitary adenomas, and many others) that would also benefit from surveillance and/or treatment. A broad screening protocol, based on magnetic resonance, with specific calculations for a regional area in Spain, is also provided. Meningiomas are prevalent lesions with a prolonged pre-symptomatic period in which early detection is possible. Magnetic resonance is simple, accurate, innocuous, and serves as screening and confirmatory test. Although screening for asymptomatic meningiomas seems to be clinically well-substantiated and no ethical issues a priori preclude its implementation, its cost-effectiveness needs to be further studied and confirmed.

During the state of alert declared in the national territory in March 2020 due to the health crisis caused by SARS-CoV-2, the free movement of the population was restricted in order to prevent the spread of the virus. In the Balearic Islands, access by air and sea was limited and, in addition, health controls were established at the entry points of the islands aimed to detect people with COVID-19. The health check is understood as a Public Health surveillance procedure through which all persons authorised to travel at that time were tested. This procedure, together with the security measures to prevent the spread of the virus, had never before been implemented in the Balearic Islands and required the collaboration of various organizations in order to organise and execute it. This paper shares the experience and analysis of the health control measures implemented in these circumstances. To do so, it describes the procedure carried out, the devices that were developed, the main results and the assessment of the project as a whole. Finally, the positive aspects and possible improvements are considered. The most of people screened upon arrival in Balearics Islands did not register or show clinical symptoms of COVID-19.