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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.

The different studies published and indexed in Medline and in the Spanish Medical Index (IME) from 1984 up to 1998 (IME: 1971-1996) are reviewed. To start with, an assessment was made of the number of publications put out which have to do with the impact of pollution on human health as well as the percentage thereof which analyze the mortality as a health indicator. Afterward, the original works published within the January 1994-June 1998 period were reviewed in detail. Most of the original articles are combined time series studies which analyze, on a single-day basis, the relationship between the levels of pollution and the mortality for non-accidental causes. Other original articles were also summarized based on an approach other than the time series one, highlighting different cohort studies which relate the levels of pollution to the mortality on an individual level and which confirm the findings of prior ecological studies. The pollutants analyzed most often are the different types of particles, although studies are also common regarding the impact of sulfur dioxide, nitrogen dioxide, ozone and carbon monoxide. The method of analysis most used is the Poisson regression, into which different confusion variables bearing an impact thereon such as seasonality and tendency, temperature and relative humidity and day of the year are basically added. In the studies reviewed, the positive significant findings prevail, being consistent especially for particles, which is the pollutant most analyzed. The articles studying other pollutants, although fewer in number, also indicate a significant relationship between pollution levels and the mortality.

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.

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.

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.

Objective: Mental health problems are increasing in Spain, and those related to drug use are a preventable aspect of public health. In Spain there are few studies on the incidence and characteristics of acute psychosis due to illegal drug use, especially at national and multicenter level, reason that motivated this paper., Methods: A prospective multicentre study was carried out in eleven hospital Emergency Departments in Spain, lasting twenty-four months (REDUrHE Registry). Patients with acute psychosis were compared with those with organic pathology, analysing demographic aspects, drugs involved, associated clinical manifestations and evolution Quantitative variables were compared using Student's t-test and qualitative variables were compared using the chi-squared test (or Fisher's exact test as appropriate) and the magnitude of the association with the presence of psychosis using logistic regression. A p-value of less than 0.05 was considered statistically significant or if the 95%CI of the OR excluded the value 1., Results: Of the 4,487 patients in the registry, 9.5% presented acute psychosis, with a median age of thirty-two years and 79% male. The main clinical features were agitation (53%, p=0.001), hallucinations (43.2%, p=0.001) and anxiety (40%, p=0.00). Psychosis was more frequent with cannabis (57.7%), cocaine (42%) and amphetamines and derivatives (26.4%), although in the analysis adjusted for co-drug use (39.5%), or in association with ethyl alcohol (57.7%), it was only statistically significant for cannabis (p=0.0). Patients with psychosis required more hospital admissions (38.1% vs. 10%, p=0.001), mainly in psychiatric units (34.1% vs. 4.2%, p=0.001), with hardly any intensive care unit admissions (0.4% vs. 2.1%, p=0.01). ED stay was high (29.3±73.8 hours vs 10.5±58.8 hours, p=0.001)., Conclusions: In Spain, cannabis is the drug most associated with psychosis. This clinical condition produces more hospital admissions, although with a low risk at an organic level., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Risk assessment of patients with chest pain is based on clinical parameters; however, without a scoring system, such as risk stratification scales, estimates are less precise and accurate. The aim of this paper was to compare the HEART, GRACE score and clinical parameters in the prediction of major cardiovascular events (cardiovascular mortality or acute myocardial infarction) during hospitalization, in patients with chest pain attended in the emergency department., Methods: A descriptive observational study of patients with ischemic chest pain, who attended to the Miguel Servet University Hospital emergency department (Zaragoza, Spain) during one year was carried out. HEART and GRACE scores were calculated retrospectively from clinical history. Quantitative variables were expressed as mean (±standard deviation), and qualitative variables as frequencies and percentages. A bivariate analysis was carried out using the chi-square test. The performance of the scales and clinical parameters was compared by calculating the area under the curve. The primary outcome was the occurrence of a major cardiovascular event (cardiovascular mortality or acute myocardial infarction) during hospital admission., Results: 306 patients were registered (66.3% men, n=203), with a mean age of 71.45±12.85 years and a 48.7% history of ischemic heart disease. The areas under the curve for HEART scales, GRACE and clinical parameters were 0.80 (95% CI: 0.73-0.86), 0.79 (95% CI: 0.72-0.85) and 0.74 (95% CI: 0.68-0.80), respectively. During hospitalization, the incidence of the primary event was 13.4% and no low-risk patient, in both scales, presented a major cardiovascular event., Conclusions: In patients with ischemic chest pain attended in the emergency department, the GRACE and HEART scale have a greater area under curve than clinical parameters.

Objective: Despite the global reduction in smoking, the consumption of roll-your-own tobacco has increased in recent years in many countries, which may be slowing down the downward trend in smoking. The aim of this paper was to analyse the evolution of the number of people who use roll-your-own tobacco and tobacco of any type between 2013 and 2018 in the Basque Country and measure whether there were socioeconomic inequalities in its consumption., Methods: We carried out an observational and cross-sectional study of a representative sample of the population living in the Basque Country aged 16 to 59 years (n 2013 =6929 y n 2018 =7961) from the Basque Health Survey (2013 and 2018) and the Basque Addictions Survey (2018). We calculated prevalences of regular tobacco smoking in general and of roll-your-own cigarettes according to different socioeconomic variables for the years 2013 and 2018, as well as prevalence ratios for the estimation of change between these years and according to the above variables through robust Poisson regression models. We stratified analyses by sex and two age groups., Results: Overall smoking prevalence decreased between 2013 (men=27.7% and women=24.1%) and 2018 but remained the same for those who used roll-your-own tobacco (in 2013, men=5.1% and women=3.2%; in 2018=5.4% and 3.5%, respectively). In contrast to tobacco in general, which showed a clear socio-economic gradient, roll-your-own tobacco use was more prevalent among young people (in 2018, men=6.4% and women=4.1%), a group where the pattern by socio-economic status was less evident., Conclusions: Considering the persistence of roll-your-own tobacco consumption, we also should direct tobacco control towards this kind of product, and its use should be monitored and supervised, especially among young people.

Objective: The Hereditary Haemorrhagic Telangiectasia (HHT) is a low prevalence disease which presents heterogeneous signs and symptoms and just few population-based epidemiological studies are available. The aims of this paper were to describe the sociodemographic characteristics of people affected by HHT in the Valencian Region (VR), to determine its prevalence and mortality rate, and to analyse the sources of recruitment and verification tests used by the Rare Diseases Information System of the VR (SIER-CV)., Methods: Cross-sectional observational epidemiological study of HHT prevalent cases between 2010-2019 in SIER-CV was performed. The distribution of sociodemographic and clinical characteristics were determined, the prevalence and mortality rates, and the sources of recruitment and verification tests used by SIER-CV were analysed. Statistical analysis was performed using Stata (version 16.1) and Microsoft Excel Office., Results: During 2010-2019, two hundred cases were identified, 55.5% were female. The mean ages were: 56.8 years at recruitment and 50.9 years at diagnosis. 48.4% of cases were diagnosed between thirty-six/sixty-four years of age. 25.5% died, with a mean age of 76.6 years, identifying statistically significant differences above the age of 64. The prevalence was 39.6/1,000,000 inhabitants and the crude mortality rate was 10.1/1,000,000 inhabitants. 95.5% of cases were recruited from the Hospital discharges database and the most frequent verification test was the clinical basis (45.7%)., Conclusions: The increasing trend in prevalence coincides with a better knowledge of HHT, which favours its detection, and also with dying at older ages. To describe the situation of HHT in the VR facilitates its health management and contributes to the establishment of the relevant health policies for the HHT. The need to promote genetic diagnosis and to incorporate the Primary Care Clinical History as a source of recruitment in the population-based registries has been shown.

Objective: Healthcare professionals were subjected to very demanding working conditions during the COVID-19 pandemic. The aim of this paper was to assess the level of risk of suffering a psychosocial disorder in the professionals of the Epidemiological Surveillance Services of Catalonia (EVS) during the sixth wave of the COVID-19 pandemic., Methods: An epidemiological study of prevalence was carried out in SVE workers in Catalonia. The information was collected through a questionnaire of sociodemographic and occupational data and the Goldberg General Health Questionnaire (GHQ-28) from January to March 2022. A score equal to or greater than 7 on the GHQ-28 was considered positive and indicated a risk of suffering some disorder. The dependent variables were the score and positivity of the GHQ-28 test. The relationship between the GHQ-28 score and the rest of the independent variables of the study was studied with the Odds Ratio (OR) and its 95% confidence intervals (IC)., Results: The mean age of the population studied was 37 years (SD=±11.4) and 75% were women. 53.8% of the participants presented a positive result in the GHQ-28. The participants with the highest psychosocial risk were workers with a history of psychological problems (OR 2.8; IC95% 1.2-6.7). The risk was also higher in women (OR 1.8; IC95% 0.8-4.1), participants with health professions (OR 1.2: IC95% 0.6-2.5), those who were taking pharmacological treatment (OR 2.4; IC95% 0.6-9.7) or those who were undergoing psychological therapy (OR 1.5; IC95% 0.6-3.6) at the time of data collection and workers who did not had a perception of work support and recognition from their work teams (OR 1.8; IC95% 0.9-3.8), although some differences were not statistically significant., Conclusions: The professionals of the SVE professionals presented, during the sixth pandemic wave, a high risk of psychosocial disorder. As measures to be adopted, and with the aim of reducing psychosocial risk among its professionals, it is recommended to introduce organizational changes in surveillance services to prevent psychosocial disorders among its professionals.

Objective: The COVID-19 pandemic indirectly affected other communicable diseases, such as human immunodeficiency virus (HIV) infection. The aim of this paper was to evaluate the impact of the COVID-19 pandemic on the epidemiological surveillance of HIV through epidemiological indicators., Methods: Data collected in the New HIV Diagnosis Information System (SINIVIH, acronym in Spanish) in the period 2013-2021 was analyzed. The epidemiological indicators analyzed were: 1) Reporting delay of new diagnoses; 2) Under diagnosis of cases, calculated per month of diagnosis and for each year of diagnosis; 3) Late diagnosis, cases diagnosed with less than 350 CD4 cell/mm 3 ., Results: Regarding the reporting delay of new diagnoses, in 2022 2,770 diagnoses were reported in 2020, 43.8% more than those reported in 2021 for that year. The cases diagnosed per month between 2016 and 2019 followed a constant trend. In 2020, a significant decrease in diagnoses was observed between March and May that was not recovered after correcting for reporting delay. When comparing the rates of cases diagnosed in 2013 with the successive years, a continuous decrease was interrupted in the last year of the study period. The percentage of cases with late diagnosis had remained stable in the study period (between 46% and 50%), and a decrease in this percentage was observed after correcting for reporting delay., Conclusions: The epidemiological surveillance of HIV suffered a significant reporting delay. A decrease in cases diagnosed is confirmed, partly due to lockdown and lack of access to the health system. Changes on late diagnosis is not observed.

Objective: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Since the onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country., Methods: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student's t- test were used to compare epidemiological and demographic variables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020)., Results: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, we observed a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSV infection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions)., Conclusions: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distribution of the disease are not uniform. It starts in the center of Spain and ends on the coast.

Objective: There are controversies regarding the effect of the influenza vaccine on the risk of suffering from COVID-19. The aim of this paper was to compare the risk of suffering from COVID-19 between vaccinated and unvaccinated patients against influenza., Methods: A retrospective case-control study of patients assigned to an urban CAP (coverage: 44,564 inhabitants) was carried out during 2020. Patients with diagnostic confirmation of COVID-19 (ART, PCR or serology) were defined as cases, and those who have not had said infection, selected by simple random sampling, were defined as controls. The case/control ratio was 1:1. The data sources used were the Khalix health data registry databases and the computerized medical record (E-cap). Data were analyzed with a multivariable logistic regression model., Results: A total of 4,320 patients were included in the study: 2,160 cases (50%) and 2,160 controls. 18% of the cases and 14.3% of the controls were vaccinated against influenza [OR=1.3 (95% CI: 1.2-1.5; p=0.001)]. Multivariate analysis showed that in patients under eighty years of age, there were no differences between vaccinated and unvaccinated patients [OR=1.02 (95% CI: 0.8-1.3; p=0.8)]; while in those over eighty years of age, there was a lower risk of presenting COVID-19 in vaccinated patients [OR=0.4 (95% CI: 0.3-0.7; p<0.001)]., Conclusions: The adjusted model shows that at ages above than 80 years, flu-vaccinated patients have decreased risk of COVID-19 with statistical significance.

Objective: Alzheimer's disease has become the great epidemic of the 21st century, being a challenge for the sustainability of the social and health system. Alzheimer's causes disability and dependency among the elderly, requiring continued care with therapies that improve the health and quality of life of these people. The objective of this paper was to evaluate the effectiveness of non-pharmacological therapies applied to people with Alzheimer's in Primary Care., Methods: A systematic review of articles published between April 2017 and April 2022 was carried out, applying the PRISMA methodology. The databases consulted were: PubMed, CINAHL, Dialnet, Web of Science and PsycINFO. MeSH and DeSH were used, with the Boolean operators AND and OR. The quality of the articles was evaluated with the STROBE, COCHRANE, AMSTAR-2 and JBI scales., Results: A total of nineteen articles were selected in which various non-pharmacological therapies and their effectiveness in people with Alzheimer's were evaluated. Therapies based on physical activity and rehabilitation, cognitive stimulation and occupational therapy with music, animals and art, applied and maintained over time, are an alternative which, either combined or applied in isolation, are effective in preventing, stopping and slowing down Alzheimer's disease symptoms, especially in the first phase., Conclusions: Physical activity and rehabilitation, cognitive stimulation and therapy with music, animals and art, improve the health status and quality of life of patients with Alzheimer's disease in the first phase of the disease.

Objective: Functional assessment is part of geriatric assessment. How it is performed in hospital Emergency Departments (ED) is poorly understood, let alone its prognostic value. The aim of this paper was to investigate whether baseline disability to perform basic activities of daily living (BADL) was an independent prognostic factor for death after the index visit to the ED during the first wave of the COVID-19 pandemic and whether it had a different impact on patients with and without diagnosis of COVID-19., Methods: A retrospective observational study of the EDEN-Covid (Emergency Department and Elder Needs during COVID) cohort was carried out, consisting of all patients aged ≥65 years seen in 52 Spanish EDs selected by chance during 7 consecutive days (30/3/2020 to 5/4/2020). Demographic, clinical, functional, mental and social variables were analyzed. Dependence was categorized with the Barthel index (BI) as independent (BI=100), mild-moderate dependence (100>BI>60) and severe-total dependence (BI<60), and their crude and adjusted association was evaluated with mortality at 30, 180 and 365 days using COX proportional hazards models., Results: Of 9,770 enrolled patients with a mean age of 79 years, 51% were men, 6,305 (64.53%) were independent, 2,340 (24%) had mild-moderate dependence, and 1,125 (11.5%) severe-total dependence. The number of deaths at 30 days in these three groups was 500 (7.9%), 521 (22.3%) and 378 (33.6%), respectively; at 180 days it was 757 (12%), 725 (30.9%) and 526 (46.8%); and at 365 days 954 (15.1%), 891 (38.1%) and 611 (54.3%). In relation to independent patients, the adjusted risks (hazard ratio) of dying within 30 days associated with mild-moderate and severe-total dependency were 1.91 (95% CI: 1.66-2.19) and 2.51. (2.11-2.98); at 180 days they were 1.88 (1.68-2.11) and 2.64 (2.28-3.05); and at 365 days they were 1.82 (1.64-2.02) and 2.47 (2.17-2.82). This negative impact of dependency on mortality was greater in patients diagnosed with COVID-19 than in non-COVID-19 (p interaction at 30, 180 and 365 days of 0.36, 0.05 and 0.04)., Conclusions: The functional dependence of older patients who attend Spanish EDs during the first wave of the pandemic is associated with mortality at 30, 180 and 365 days, and this risk is significantly higher in patients treated for COVID-19.

Objective: The prevalence of chronic pain in Spain is 17%, which causes suffering and significant loss of quality of life. Therapies should not focus only on pain reduction, to improve function and quality of life are necessary. Currently, it is committed to combining drugs and other therapies such as relaxation, meditation, cognitive behavioral therapy, targeted exercises, healthy lifestyles and techniques to increase self-esteem and motivation for change. These therapies can be used as part of a multimodal approach, forming part of multicomponent programs or workshops. In this paper we proposed to evaluate the effectiveness of a workshop developed from the Hospital San Juan de Dios del Ajarafe, that integrated different non-pharmacological therapies in the control of chronic non-oncologic pain and to analyze patients' perceptions of the techniques applied and how they affected pain and lifestyles., Methods: An intragroup before-after study (beginning-end of the workshop) was carried out, comparing pain, well-being, drug use, quality of life, and self-esteem. Surveys were conducted to deepen more qualitative aspects and identify improvements. The workshop consisted of psychoeducational action and training for the mental control of pain and emotions, based on the active participation of the patient in the management of his disease, promoting self-care and self-esteem, and aiming to improve well-being and quality of life. It consisted of 5 sessions of 3 hours (1 per week); of a group, interactive and practical nature. Statistical analysis was performed with SPSS vs.27.0. To compare related measures (before-after) we used Student's T tests for paired samples and Wilcoxon's test and to compare independent groups, Student's T and Mann Whitney's U; for the qualitative variables, we used Chi-Square and Fisher's test., Results: Four workshops were evaluated in which 63 patients participated, with a mean age of 57.6 (SD:11.37) years, 60 (95.2%) of them were women. At the end of the workshop pain decreased 1.5 median (-2.0-0) and well-being increased 2.0 (0-2.0); quality of life increased a median of 0.121 (SD: 0.209), health status 16.8 (23.78) and self-esteem 2.74 (4.73); [p<0.001]. The best valued techniques were meditations, mainly mental analgesia, affirmations in the mirror and self-esteem techniques., Conclusions: Overall satisfaction with the workshop is 9.8 out of 10. There is a pain control and improvement in quality of life, self-perception of health status, well-being and self-esteem.

Objective: Breast cancer screening (BCS) leaflets are important for outreach and dissemination of BCS programs. Knowing how women perceive these leaflets is relevant to better understand their attitude towards BCS. The objective of this paper was to explore women's reactions regarding BCS leaflet., Methods: A simple descriptive qualitative design was performed involving women aged between forty and sixty years of age in Asturias (Spain). Twenty-six semi-structured interviews were conducted with women of different socioeconomic profiles in 2018. Thematic analysis was carried out., Results: Reading the leaflet elicited positive emotions such as peace of mind, well-being or gratitude, in addition to fear or anxiety. The women expressed various beliefs about breast cancer (highly prevalent and high survival rates), about BCS (a program aimed at prevention, a normative activity among their peers) and about the relevant role of health services and the media. Ambivalent attitudes towards BCS were detected, related to emotions., Conclusions: The emotional response after reading the brochure is ambivalent, although most of the women express positive emotions. Women compare the information with previous beliefs, especially regarding breast cancer (BC) and BCS. It is important to understand how certain emotions (especially negative ones) are closely related to the attitude towards BCS., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violence suffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect cases of sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists., Methods: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapists in charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out on a convenience sample of fourteen physiotherapists., Results: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as well as the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinical field, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age, professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception of its impact, will be assessed., Conclusions: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and, also, to assess the evolution over time of each violence separately for providing direction for successful policies and training., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Pressure ulcers (PU) are the most prevalent of the dependency-related injuries, affecting the quality of life of the patients who suffer them. However, there are no instruments adapted to the Spanish context to evaluate this quality of life. The use of specific tools in Spanish to evaluate the quality of life perceived by patients with PUs is considered an indispensable element for healthcare decisions. The aim of this paper was to translate and culturally adapt the Pressure Ulcer Quality of Life Questionnaire (PU-QOL) into Spanish for the measurement of health-related quality of life in patients with pressure ulcers., Methods: A translation, back-translation, and pre-test method was used on the target population to obtain an adapted version of the original PU-QOL instrument. The area was Primary Care. The participants were fifteen Primary Care patients. Main steps: 1) Direct translation; 2) Synthesis and concordance of versions by an expert committee; 3) Back translation; 4) Consistency of the back translation with the author from the original questionnaire; and 5) Analysis of comprehensibility through cognitive interviews with a sample of patients., Results: An instrument to measure perceived quality of life in patients with PU was obtained, composed of ten scales and eighty-three items. The scales and items of the original questionnaire were maintained. Conceptual and semantic analysis produced adjustments in wording, clarification and reformulations adapted to the Spanish context., Conclusions: We present this first phase of translation and cross-cultural adaptation of the PU-QOL questionnaire in Spanish, which could be a useful tool for decision-making on health care in patients with PUs., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: One in one hundred minors has some mental health problem. Symptomatology varies according to gender. Most research has been conducted with the general population. The objective of this paper was to analyze the moderating role of sex in the presence of internalizing (emotional disorders, anxiety and depression) and externalizing symptomatology (behavioral disorders and hyperactivity) in childhood, as well as to compare the general population with the clinical population., Methods: A descriptive cross-sectional study was conducted with 552 boys and girls between ten and twelve years of age, 94 mental health patients and 458 schoolchildren. Participants completed self-report measures: Strengths and Difficulties Questionnaire (SDQ-Cas), Modified Depression Scale (MDS) and a sociodemographic information questionnaire. For data analysis, descriptive statistics and multivariate and univariate mean comparisons were performed by parametric and re-sampling procedures., Results: Statistically significant differences were observed between clinical and school population groups in externalizing, internalizing and depressive symptomatology (p<0.001). No sex differences were found in externalizing and depressive symptomatology. Sex differences were found in internalizing symptoms (p<0.001, p boot <0.001) as well as group interaction effects (p=0.016), girls had higher scores than boys, with greater differences in the clinical group (p<0.001, p boot =0.003)., Conclusions: Research with mental health patients is essential to verify the existence or not of differences with the general population as well as differences by sex, which will allow adapting preventive and intervention strategies to each case., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: The term trans brings together all transgender identities. The early social transition towards the affirmed gender has benefits in the child's development. For families, transit is a period of great uncertainty, requiring support aimed at families of trans minors. The aim of this paper was to explore the needs and experiencies of parents and close-relatives who supported the social transition of their children., Methods: We worked with focus groups of functional families of transgender minors who had begun the transition (n=14), with a medium-high educational level and who belonged to urban areas of Tenerife. Through a semi-structured interview, they commented on their experiences in the process of supporting the social transition of their children. The data was recorded in a video recording and processed through content analysis and categorization., Results: Early social transition had positive and immediate benefits on child development as well as in the reduction of anxiety. There was a general improvement in mood, self-esteem, and social and family relationships. The accompaniment of specialists and associations helped in the different social situations and favoured resilience., Conclusions: Early social transition is positive in the personal and socio-family sphere of the minor. To improve their resilience, families demand accompaniment in this process, as well as meeting other trans people who serve as transpositive references. In addition, they point out the need for specific training in health professionals., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: During the ageing process the loss of family and social relationships is frequent which conditions loneliness, similarly the current COVID-19 pandemic has generated more social limitations in this age group and has increased the risk factors to trigger feelings of loneliness. This paper aimed to examine how loneliness among older people had been studied in Europe over the last ten years. Specific objectives were: i) to describe the methodological aspects; ii) to identify the scales or questions for the assessment of loneliness; iii) what were the main variables or dimensions that were related to loneliness in old age., Methods: A total of 1,591 articles were found in WoS and Scopus digital platforms. After initial assessment of titles and abstracts, full text reading and review of the established criteria, 42 scientific articles were finally included in the systematic review., Results: The countries that had carried out the most studies were the Netherlands and Spain. Most of the research was quantitative and uses the De Jong Gierveld Loneliness Scale (DJGLS) and the University of California at Los Angeles (UCLA) Loneliness Scale. The most analysed variables were: marital status, household structure, social support networks, social participation, depression, health problems, co-morbidity and physical functioning., Conclusions: The scientific interest in studying loneliness, with a focus on social support networks, in older people in Europe and strategically addressing loneliness as a public health problem is confirmed.

Objective: Health personnel are at greater risk of contracting infections related to their work within the group of workers with biological risk, and these mishaps can affect their physical and mental health. therefore, the objective of this paper was to understand the experience of health professionals in an intensive care unit (ICU) in Cali (Colombia) who suffered biological accidents., Methods: Explanatory sequential mixed design, it was developed in two phases, the first of a descriptive quantitative type and the second of a qualitative type with a phenomenological approach. Initially the knowledge about biosafety in 40 workers was characterized through a survey and a in the first contact, five participants were chosen who shared their experiences with biological accidents, through in-depth interviews. The statistical analysis was descriptive, the quantitative variables were presented through measures of central tendency and the qualitative variables through frequency and percentage., Results: 39% of the professionals knew the biosafety barriers, 35% identified the pathogenic pathways, 34% were right about the protection measures, 51% answered correctly about hand washing, 70% answered adequately about biological waste, and only 38% recognized the procedure for reporting an accident., Conclusions: A low level of knowledge is identified on issues related to biosafety principles, transmission routes, hand sanitizing agents, and procedures to follow in the event of a biohazard accident. In addition, ICUs are identified as high-risk places. biological that cause feelings of fear, anguish, and stress that are added to the long working hours., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Some bibliography supports a diagnostic and therapeutic delay in women with high cardiovascular risk. The objective of this paper was to know the incidence of cardiovascular disease (CVD) and mortality in a cohort with Metabolic Syndrome (MetS); analyze possible differences in gender and place of residence, regarding the performance of primary angioplasties in patients with ischemic heart disease (IHD)., Methods: Population cohort study, with SIDIAP database (Sistema de Información para la Investigación en Atención Primaria), in primary care in Catalonia. We selected people of both sexes, between 35-75 years old, exempt from CVD at the beginning (2009), fulfilling MetS criteria (NCEP-ATPIII-National Cholesterol Education Program-Adult Treatment Panel III- criteria diagnoses). We performed descriptive statistics, and ANOVA and Chi-square test to evaluate differences between variables., Results: 167,673 people met MetS criteria (5.2% of the population), 105,969 men (63.2%). 22% of the population belonged to rural areas. Those urban areas with the most socioeconomic differences (urban-1 and urban-5) exhibited the highest incidences of CVD and IHD. We registered 51,129 CVD (30.7%) of which 8,889 were acute myocardial infarctions (AMI) (5,3%) and 24,284 were IHD (14,5%). 1.758 primary angioplasties procedures were performed, 1,467 in men and 291 in women, representing, respectively, 4.4% and 0.9% (p<0.005)., Conclusions: The incidence of IHD and AMI in subjects with MetS is high in Catalonia. There is a difference in the angioplasties performed, according to sex and place of residence. Probably a practical implication would be to detect IHD in time in women with MetS, so that they can benefit from revascularization therapy in the same way as men., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

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.

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.

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 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.

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.

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.

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.