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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.

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.

Objective: The success of policies to eradicate COVID-19 depends on the acceptance of vaccines among the population. This paper measures the influence on the intention to get vaccinated of three usual variables in studies on consumer behavior: the perception of the efficiency and risk of the vaccine and the social influence., Methods: It was used a survey of 600 residents in Spain that was answered during September 2020 has been used. That survey was conveniently stratified by age and monthly income. The impact of the explanatory variables on the intention to use the vaccine was measured with generalized linear models: logistic regression and truncated negative binomial regression. Contro variables were gender, age and monthly income., Results: We have observed a positive (negative) influence of the variables efficacy perception and social influence (perception of risk), i.e. a ratio of rate use above (below) 1 that is statistically significant (p<0.01 in the case of the first two variables and p<0.05 in the third). Their importance follows the order described above. Neither gender nor age were significant in the intention to get vaccinated, but the income level was. We identified that at the highest income levels there was a greater propensity to reject the vaccine (p<0.1)., Conclusions: The results may be useful to guide the information policy that health authorities should carry out in order to induce the population to use the SARS-CoV-2 vaccine., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Equity is an unresolved issue on the Spanish healthcare agenda. This paper explores the importance that health professionals give to social determinants of health and the means they possess to address them. It also analyzes the relationship between food insecurity and increases in certain diseases. One of its objectives is to ascertain how increasing uncertainty is being addressed in primary healthcare services. We present a qualitative study carried out in six primary care centers in the cities of Reus and Tarragona between 2018 and 2019, involving 19 practitioners active in the areas of nursing, family practice, and social work. Results indicate that the lack of resources in primary care centers makes it difficult to integrate a social determinants of health approach, and thus to mitigate inequalities. Furthermore, a lack of structural actions diminishes the ability to respond to citizens' healthcare needs.

Introduction and Objectives: Juvenile gangrenous vasculitis of the scrotum was described by the Girona dermatologist Joaquín Piñol Aguadéin 1973. The objectives of this article are to review the world publications and provide a clinical case of this disease between urological and/or dermatological., Material and Methods: A review of juvenile gangrenous vasculitis of the scrotum between 1973 and 2019 is carried out and a new clinical case is contributed. The identification of articles in Medline was carried outwith MeSH terms "juvenile gangrenous vasculitis scrotum" and in Google with "juvenile gangrenous vasculitisscrotum". Ten clinical-epidemiological variables were studied in the articles: year, source, authors, number of cases, age, previous pharyngo-tonsillitis, biopsy of the lesion, treatment, days to healing, city and country. The results of the variables were analyzed with descriptive statistics. A new clinical case is described., Results: We found 26 world references, 18 of them Spanish, corresponding to 24 publications and 2 conference papers with a total of 29 patients. The meanage of the patients was 23.6 years. The treatments used were exeresis of the lesion (23%), cephalosporins and/or corticoids i.v. (15.3%), tetracyclines, ciprofloxacin or oral amoxicillin-clavulanate (15.3%), local cure and oral corticoids (11.5%) and mupirocin or topical tetracyclines (7.6%). Healing took place in an average of 21 days. The cities with the most cases reported were Barcelona with 11 (37.9%) and Pontevedra with 2 (6.8%). By country, Spain contributed 22 cases (75.8%) and Chile, Argentina, Portugal, Italy, Tunisia, Turkey and Great Britainthe remaining 7 cases (24.1%)., Conclusions: Juvenile gangrenous vasculitis of the scrotum is a benign entity with a self-limiting course. The process is preceded by pharyngo-tonsillitis in about half of the patients. The results of the study confirm the endemic nature of the disease in Mediterranean countries, including Spain.

Objective: The COVID-19 pandemic has been a time where social media allows increased conversations about it. These conversations have spread various conspiracies about vaccines against COVID-19. It is, therefore, necessary to develop communication strategies, led by official accounts, that offer accessible information on vaccination as a preventive public health strategy. The aim of this study was to analyze the role of public institutions on Twitter campaign #yomevacuno to deal with misinformation about vaccination against COVID-19., Methods: This paper performs a social network analysis and content analysis of Twitter data, using NodeXL software, from December 8 th to 23 rd , 2020. Tweets included content #yomevacuno hashtag., Results: A total of 6,080 interactions were collected, 82% were tweets. Data shows that public institutions generate 53.36% of traffic information, the most important was the Ministerio de Sanidad from Spain. Content analysis revealed that 48% of a sample of 50 Tweets the message was focused on vaccination as a social responsibility to defeat COVID-19 pandemic., Conclusions: The communication strategy of #yomevacuno hashtag, has been led by the Ministerio de Sanidad of Spain, by comparison to other campaigns in which there was no large presence of public institutions. This case represents the importance of social media as a way to spread information and prevention, even in public health and the need for them to be led by public organizations rather than by individual users., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Colonic inflammatory bowel diseases have a higher risk of developing colorectal cancer compared to the general population, which is why they require endoscopic screening techniques with specific follow-up intervals based on the different risk factors described on the literature. This position paper analyzes the current scientific evidence for the different endoscopic techniques available today, how their implementation should be carried out in endoscopic units and describes in detail how their implementation should be carried out, in which patients and with what interval, and finally, what should be the response to finding dysplasia, proposing a specific follow-up algorithm., (Copyright © 2021 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

A high prevalence of adolescent substance use, risky consumption patterns and the decrease in the age of initiation, together with the growth of non-substance addictions, represent a huge challenge for Public Health. This suggests the need for a change of focus in the work of the primary care settings, which must be more proactive in the early detection and intervention. Although there are some previous experiences in Spain, we do not have a duly standardised system, based on clinical practice and validated in consulting rooms, which could be used in a general, simple, and guaranteed manner. The SBIRT (Screening, Brief Intervention and Referral to Treatment) model, developed in the United States and conceived from a Public Health perspective, might represent such a paradigm shift. The aim of this paper was to provide researchers and professionals with a review of the available evidence in different countries, with a view to implementing it in Spain, where SBIRT remains a challenge. In addition, theoretical and technical foundations, and potential of the SBIRT are described. Not only its possible benefits and opportunities are put on the table, but also the shortcomings, limitations and needs that must be overcome for SBIRT implementation to be possible.

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future., (Copyright © 2021 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Nutritional assessment and treatment, necessary for the prevention and treatment of disease-related malnutrition, should be carried out by a multidisciplinary team where each member has well-defined skills and functions, and mechanisms are established to allow adequate coordination, both in the inpatient and outpatient settings. In Spain, the development and implementation of these teams or units dedicated to clinical nutrition has been very important: today they are present in most hospitals. This paper reviews the characteristics of clinical nutrition units, the functions of their team members, and the regulatory framework in our country.

This paper intends to raise the potential interest that the principles and experiences of the so-called behavioral economy have in the field of public health and, more specifically, in behavioral changes, thus substituting harmful behaviors to health for salutogenic behaviors while respecting the final freedom of choice of the person. In this article, we review the foundations of behavioral economics, emphasizing the work of Tversky and Kahneman and their approach to prospective theory and the role of brain activity levels 1 (automatic) and 2 (reflective) in decision making process. On the basis of these approaches, Thaler and Sustein identify a series of biases that will be used as tools to facilitate behavioral changes through a set of actions "that modify people's behavior in a predictable way without prohibiting any option or significantly changing their economic incentives" based on the so-called libertarian paternalism. We review its interest in public health, citing some empirical studies that demonstrate its high level of effectiveness and efficiency, reflected in the creation of Nudge Units in various countries, and concluding that this can be an interesting tool to add (not to replace) the classical techniques of health promotion and disease prevention.

This paper aims to describe our experience in an interventional radiology unit in a hospital in Spain that was severely affected by the COVID-19 pandemic. To this end, we did a prospective observational study of 20 consecutive patients with COVID-19 who underwent 21 interventional radiology procedures between March 13, 2020 and May 11, 2020. We describe the measures taken to reorganize the work and protective measures, as well as the repercussions of the situation on our unit's overall activity and activity in different phases. The COVID-19 pandemic has represented a challenge in our daily work, but learning from our own experience and the recommendations of the Spanish radiological societies (SERVEI and SERAM) has enabled us to adapt successfully. Our activity dropped only 22% compared to the same period in 2019., (Copyright © 2020 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The price elasticity of tobacco emerges as an instrument for minimizing tobacco consumption, sustained by the idea that although tobacco has an addictive nature, an increase in its price causes a decrease in its consumption. However, the price is not the only component of tobacco consumption studied in the literature. Some studies include income as an explanatory component of tobacco consumption. These studies conclude that income affects tobacco consumption positively., Methods: In this paper, the factors that affect the consumption of cigarettes are measured for the Spanish market using time series data from 1957 to 2018 and by applying the Logarithmic Mean Divisia Index LMDI method. The novel application of this method to this body of literature allows us to verify how effective the price policies that the government has implemented against the consumption of cigarettes have been., Results: Our results reveal that income is a determining factor that sometimes nullifies the effect of policies when governments increase the price of cigarettes by taxes. In order to reduce the prevalence of smokers, the increase in the price of tobacco must consider the effect of income on consumption, so that it does not cancel the effects of health policy., Conclusions: It is strongly recommended that tax authorities consider these results before applying anti-smoking policies. If the authorities do not do so, it is possible that they will not obtain the expected results in terms of minimized the cigarette consumption.

Based on the report on the situation of COVID-19 in Spain, dated April 3, 2020, the confirmed cases amount to 117,710, of which 343 are under 14 years of age (< 1%). It is essential to know the specificity of this process in the child population, as well the specific recommendations for proper prevention and care of children during the COVID-19 pandemic. The paper aim is to analyze the scientific evidence on the specific recommendations for pediatric care in cases of COVID-19 from the family and community settings.The main recommendations and preventive measures in primary health care settings and at home have been selected and analyzed from an integrative approach that includes the biopsychosocial aspects of the child during confinement.The importance of caring for children in the face of the disease lies above all in ensuring the correct measures for the prevention of contagion due to the condition of acting as possible carriers during an incubation period of up to 21 days. The recommendation is that children actively participate in routine preventive actions to contain the spread of the disease. At the household level, isolation is an important challenge for families where there are manifestations of uncertainty, fear and helplessness in the face of changes and among the recommendations are establishing routines and order through schedules of activities and leisure together with hygiene measures.Given the rapidity with which the COVID-19 pandemic has occurred, there is little evidence at the moment. Research on prevention and treatment in the pediatric age needs to be developed to improve the available recommendations., (© 2020 Elsevier España, S.L.U. All rights reserved.)

There is broad consensus on the health benefits that neonatal screening has provided in Spain, since Professor Mayor Zaragoza began his research project for the early detection of phenylketonuria and other aminoacidopathies in 1968, to date. In these decades there has been a great evolution and development of Neonatal Screening Programs (NSP) in Spain. This paper presents the effect on the development of the NSPs of the decentralization of Public Health responsibilities in the Autonomous Communities, creating differences among them by atomizing the decisions on the expansion of the diseases to be screened. The availability of effective detection and treatment methods was the justification, often unique, for the inclusion of new diseases in an NSP. On rare occasions, neonatal screening was assumed as a public health program that should offer guarantees of effectiveness, from information for informed consent to the correct treatment and follow-up of detected cases. This situation of enormous inequality in access to neonatal screening has changed with the introduction of appropriate legislation to guaranty the correct development of NSP within the National Health System. Forums coordinated by the Ministry of Health with the participation of those responsible for public health from the Autonomous Communities and scientific societies have been fundamental. An example of the convergence of research and science for the benefit of a basic Public Health program.

Objective: The objective of this paper is to demonstrate that it is possible to monetize the social value generated by a hospital and use it to establish a different perspective to analyze the efficiency of public spending., Method: A public hospital in Spain was selected using the case method. It is suitable for two reasons; first, the hospital activity is small and therefore dialogue with stakeholders is easy; and second, as it is a hospital of a residential nature, it allows an easy, modifiable and testable approximation of social accounting in hospitals., Results: It establishes the monetary translation of the activity of a hospital, including the social part of the economic transactions (market), the variables that have not been created based on economic transaction, but have been perceived and valued by the stakeholders (not market), and the satisfaction of the stakeholders (emotional). This socio-emotional value amounts to approximately 60 million Euros per year from 2013 to 2017., Conclusions: The social value generated for the stakeholders, and its monetization, allows more efficient management of decisions towards the social purpose of public hospitals. In particular, the social value added index can be a tool for the social-efficiency of hospitals, as it establishes how much social value it generates from the public funding allocated to it. Thus, the decline in this value in recent years denotes a problem that, without this analysis with a social perspective and from the stakeholders, could not have been detected., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

There is evidence that following the recommendations on screening and treatment of tuberculosis infection does not completely prevent the onset of tuberculosis in patients with inflammatory bowel disease. This fact, and the increasing use of new biologics and immunomodulators, has led the Spanish Group Working on Crohn's Disease and Ulcerative Colitis to update their recommendations for the prevention of tuberculosis in patients with inflammatory bowel disease. Diagnostic methods for latent tuberculosis infection, different scenarios in which screening is to be performed, strategies to reduce the risk of tuberculosis once biological treatment is initiated and chemoprophylaxis guidelines for latent tuberculosis infection are reviewed, as well as the management of active tuberculosis during biological treatment. Finally, there is a summary of the current recommendations within the paper and in an algorithm., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Neonatal Screening Programs (PCN) have widely demonstrated their benefits since Dr. Guthrie published his developments on Phenylketonuria (PKU) in 1961. This paper describes how a simple and effective organization, which incorporates all the fundamental actors under the responsibility of the Public Health Directorate (DSP), has managed to ensure that the PCN of the Basque Country meets all the objectives required for a population screening. The acceptance by Basque society of the PCN allowed it to exceed 95% coverage in its second year of operation. Likewise, the limited negative social impact of PCN is evidenced by its low number of false positives and incorrect samples. Excellent response times allow every newborn with a positive result to have an early diagnosis and optimal initiation of treatment. There are two relevant experiences that support the importance of the effective exercise of the responsibility of the DSP. Congenital adrenal hyperplasia (CAH) was incorporated into the PCN in 1991 meeting all technical and clinical criteria. At the request of the experts, the DSP ordered in 1993 to cease this activity showing that it did not provide the expected benefits. The problems of organically integrating the PCN into the healthcare system were also experienced. The need to compete for resources put public health activities, including the PCN, at risk and led to their return to direct dependence on the DSP. The availability of this structure, in addition to facilitating the incorporation of other screenings, allows facing the future challenges.

Objective: The purpose of this paper was to describe the diagnosis, treatment and follow-up of patients diagnosed with congenital hypothyroidism (CH) by the Neonatal Screening Program in the Autonomous Community of Madrid during the state of alarm due to the COVID-19 health crisis., Methods: The data were extracted from the retrospective analysis of patients diagnosed with CH and treated at the Clinical Diagnosis and Follow-up Center of CH located in the Pediatric Endocrinology Unit of the General University Hospital Gregorio Marañon., Results: During the period between March 14 and June 21, 2020, 7 neonates were diagnosed with congenital hypothyroidism. The Screening Center contacted the Clinical Diagnosis and Follow-up Center urgently, with the location and clinical assessment of the patient on the same day, performing the usual complementary examinations in all of them according to clinical pathway. The median age of diagnosis was 15.5 days (range 7.00-24.00). The subsequent clinical and analytical follow-up was carried out in all cases according to the recommended times. All patients presented normalization of the thyroid function after two weeks of treatment., Conclusions: All patients seen at the Congenital Hypothyroidism Clinical Diagnosis and Follow-up Center during the alarm state period were diagnosed, treated and reevaluated following the usual clinical pathways without incidents. The current epidemiological situation of the COVID-19 pandemic has revealed the correct functioning of the circuit of the Congenital Hypothyroidism Screening Program in less favorable circumstances.

Within the framework of the Global health sector strategy on viral hepatitis and the Strategic Plan for tackling hepatitis C in the Spanish National Health System, the Secretariat of the National Plan on HIV and STIs and the Unit for Screening Programs in the Ministry of Health have coordinated the policies around the screening of hepatitis C virus (HCV) in Spain. This paper describes the experience and learnings arisen around it. The key points of the process include interdisciplinary work through a Technical Group made up of experts from the different fields involved; the availability of scientific evidence for decision-making, highlighting the 2nd Seroprevalence Study in the general population; and a public health approach along the entire process. As a result, the recently published Guideline on hepatitis C testing includes the indication for HCV testing for people with risk exposures and situations, as well as the main recommendations to improve screening and linkage to care in the most affected populations. We hope that this Guideline and the continuation of joint work will be a step towards equitable access to the diagnosis and treatment of HCV infection in Spain.

The role that environmental factors can play in preventing and controlling the Covid-19 epidemic was explored and compared to that of influenza. Papers cited by the U.S. National Academy of Sciences were discussed, which indicate that temperature and humidity in the environment can influence the intensity of the spread of the disease. The fact that influenza viruses and coronaviruses appeared seasonally, prevailing in the winter and declining in the summer, was illustrated. It was discussed that ultraviolet light in the environment can contribute to the control of the spread of the virus. A study was cited to suggest that particulate matter contributes to increased infection mortality, and that it increases in summer in some regions, countering the health effects of humidity and temperature. Data generated by online electronic tools was compared with surveillance reports generated by the U.S. Centers for Disease Control and Prevention. The epidemic began stronger in northern hemisphere countries during the northern winter. (Evidence that the epidemic intensified during the southern winter is not disputed.) The incidence declined in the northern hemisphere during the summer, except for the U.S., where cases doubled. Evidence suggests that the high degree of SARS-CoV-2 infection counteracts the role that environmental factors may play in Covid-19 control.

This work places in context Spain's recent update of the defined limits for low risk alcohol consumption to 20g/day for men and 10g/day for women, and summarises data on the impact on individual health and the social costs of alcohol consumption. Furthermore, it considers the challenges that arise related to awareness of the risks of alcohol consumption, in the general population and among health professionals. The paper also reviews the implications of the new definitions in relation to the most effective policies for reducing alcohol-related harm. It looks at this from a public health perspective with particular emphasis on how to seize the opportunity to better promote the implementation of strategies for early identification and brief interventions in primary care in this country.

Objective: Botellón has established itself as a recreational ritual of great importance in the leisure of young people and it has contributed to the expansion of a worrying pattern of alcohol and other substances consumption. However, there are few papers that take an integrated approach to this issue. The aim of this work was to have new data to characterize this practice, while providing evidence of its consequences and identifying relevant prognostic factors for prevention., Methods: A cross-sectional study was carried out with a sample of 4,867 Galician adolescents between 12 and 18 years of age (Mean=14.68; SD=1.67). Data were collected in schools through an ad hoc questionnaire and they were analyzed through of a bivariate tabulation, with the application of the opportune contrasts according to the nature of the variables., Results: 27.3% of the teenagers in the sample went to botellón during the last year. 96.6% admitted to drinking alcohol when they went to a botellón, 53.4% alcohol and tobacco and 30.2% three or more substances. This practice was associated with significantly higher rates of Intensive Alcohol Consumption (28% vs. 0.9%), as well as of consumption of risk of alcohol, cannabis and drugs in general. The modulating role of variables such as risk perception and beliefs and expectations associated with consumption, money available or time of arrival at home was also found., Conclusions: At least 1 in 4 teenagers continue to go to botellones. This practice associated with risky consumption. The evidence found reinforces the multidimensional nature of the problem and suggests reorienting prevention policies., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

This paper presents a strategic analysis of the prevention of the harm caused by alcohol in Spain. The alcohol action plan of the European Office of the WHO offers a guide for the development of the most effective control policies. Following its scheme, the current situation and the prevention policies are reviewed with data available in 2020. Strategies and key actions for the future are proposed, considering as major goals to curb the early abuse of alcohol by adolescents and to reduce the risk consumption of the population at large. Besides helping persons with abuse criteria from health services, key actions for prevention include public policies such as fiscal, marketing and availability regulations, and drink driving measures. Some have followed a favorable evolution in Spain, but for others there is wide room for improvement.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures., (© 2020 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures., (© 2020 Published by Elsevier España, S.L.U.)

This paper aims to share the reflections related to the community actions in which the Agència de Salut Pública de Barcelona has been involved during the emergency of COVID-19. The tasks carried out can be arranged in three stages, frequently overlapping: detection of needs and problems; contact with key stakeholders to assess what to do and how to do it; adaptation of the interventions to the "new normal" and generation of new responses. The emerging problems included: not being able to do the confinement (due to homelessness, material conditions, living in a situation of violence); digital gap (lack of knowledge, devices, access to Wifi); greater exposure to COVID-19 in the essential but precarious, feminized and racialized jobs (care, cleaning, food shops) that are the most frequent in the neighborhoods in where we work; language and cultural barriers that preclude to follow recommendations; to lose employment; insufficient income to cover basic needs; social isolation; and the deterioration of emotional health caused by the situation. During the process, some interventions were adapted to be delivered on-line. Solidarity networks and local resources were key to meet basic needs, but also other needs related to lack of digital knowledge or device. Community action in health, from a critical, intersectional and local perspective, and with intersectoral work and community participation, can contribute to: facilitate a contextualized response in the event of a health crisis; mitigate the effects derived from its economic and social crisis.

In view of the exceptional public health situation caused by the COVID-19 pandemic, a consensus work has been promoted from the ethics group of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC), with the objective of finding some answers from ethics to the crossroads between the increase of people with intensive care needs and the effective availability of means.In a very short period, the medical practice framework has been changed to a 'catastrophe medicine' scenario, with the consequent change in the decision-making parameters. In this context, the allocation of resources or the prioritization of treatment become crucial elements, and it is important to have an ethical reference framework to be able to make the necessary clinical decisions. For this, a process of narrative review of the evidence has been carried out, followed by a unsystematic consensus of experts, which has resulted in both the publication of a position paper and recommendations from SEMICYUC itself, and the consensus between 18 scientific societies and 5 institutes/chairs of bioethics and palliative care of a framework document of reference for general ethical recommendations in this context of crisis., (© 2020 Published by Elsevier España, S.L.U.)

Objective: The Spanish registry of Covid-19 in Spanish pregnant women, made up of 100 centers, is created in response to the need to know the morbidity that Covid-19 generates in pregnant women and their newborns, to know the real incidence of the disease in this population group and to establish and monitor the package of measures to improve their care. The aim of this paper was the creation of a registry of pregnant women with Covid-19 infection in order to establish the interventions and measures necessary to improve the care of these patients during hospital admission., Methods: To prepare the registry, the main researcher of each center collected weekly / biweekly the number of total pregnant women screened, as well as the total number of positive and negative, sending these data to the responsible researchers so that it could be available in real time of the percentage of infected asymptomatic pregnant population and the evolution by weeks in the centers of each participating province. The data were analyzed using the linear regression test and the Mantel test., Results: As of May 31 st sup> 2020, 16,308 screening tests were carried out in these hospitals, in which 338 pregnant women were positive, which translates into 2.07% (95% Confidence Interval: 1.86-2.30) of the asymptomatic pregnant women we attended in our centers were carriers of the virus and could develop the disease in subsequent days., Conclusions: The Spanish epidemiological registry allows us to know the incidence of infection in pregnant women attended in the Spanish delivery centers, as well as the weekly and / or fortnightly evolution of the same, observing a significant decrease in the proportion of positive pregnant women over the total of screenings throughout this period, with an average of 6.5% in early April 2020 to an average of 0.93% positive in late May 2020., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background and Objective: Patients with thalassaemia major (TM) and sickle cell disease (SCD) in Spain have been counted since the creation of the Spanish registry of haemoglobinopathies (REHem). The objective of this paper is to update the published data after the increase in cases due to the inclusion of adults and introduction of new-born screening in almost the whole country., Material and Methods: An observational, descriptive, multicentre and ambispective study that included patients with haemoglobinopathies registered in the REHem, started in January 2014 and followed up annually. The data presented correspond until December 31, 2017., Results: Nine hundred and fifty-nine patients were collected. There were 75 cases of thalassaemia (62 TM), 826 of ECF and 58 of other types of haemoglobinopathies. The main diagnostic reason in the TM cohort was anaemia symptoms (70.6%), with a mean age at diagnosis of .7 years; in the SCD cohort it was neonatal screening (33.1%), with a mean age at diagnosis of 2.7 years; 26 patients with TM (41.9%) and 30 with SCD (3.6%) underwent a transplant. There were 2 deaths (3.2%) with TM and 19 (2.3%) with SCD. Overall survival was 96.7% in the TM and 97.5% in the SCD cases at 15 years., Conclusions: Since the previous publication and after the diffusion of new-born screening, the most frequent diagnostic method, to the majority of autonomous regions, and the inclusion of adult patients to the registry, the REHem has increased by more than 240 cases, reaching a total of 959 records., (Copyright © 2019. Published by Elsevier España, S.L.U.)

Introduction: Some studies have shown a lower female participation in scientific publications. The objective of this study is to analyse the gender inequalities in the main Spanish journals of medical publications., Material and Method: Cross-sectional study of the main Spanish medical journals classified by SCImago Journal & Country Ranking (n=24) and their publications (n=3.375), during the year 2017. Women/men ratio in authorship was calculated for all journals and types of papers. Bivariate analyses were developed with the type of article as the dependent variable, and gender, institution, and country of the first and last authors as the independent variables. Logistic regression models were performed to calculate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) of the types of papers according to authorship gender, institution, and country. The statistical program used was R., Results: The total number of authors was 16,252 (44.2% women, 53.9% men, and 1.9% non-identified gender). Women represented 46% of the first authors and 33.5% of the last ones. Women were the first authors of Editorials less often than men (aOR 0.39; 95% CI 0.30-0.51), but more often in Originals (aOR 1.55; 95% CI 1.33-1.80). Women were the last authors with less frequency in all types of papers, especially in Editorials (aOR 0.50; 95% CI 0.35-0.70). The women/men ratio in authorship was less than 0.80 in 10 of 26 journals analysed (41.7%)., Conclusions: These results show the gender inequalities in the authorship of the main Spanish medical journals in 2017, especially as first authors and Editorials., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic., (Copyright © 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Objective: To evaluate preventive interventions on alcohol consumption has been long recommended in Spain. The impact evaluation of structured programs and specific actions for the prevention and treatment of alcohol consumption (PAPTCA) would allow making better informed decisions on public health financing based on the efficiency criteria. To the best of our knowledge, there is no scientific document that illustrates the situation of the PAPTCAs' evaluation in Spain. This paper aims to classify and describe PAPTCAs in Spain, focused on their impact evaluation and information on financing for accountability to society., Methods: A systematic literature review of the PAPTCAs implemented in Spain, from 2000 till 2017, at regional (autonomous communities) and local level was carried out, and a descriptive analysis of the PAPTCA database obtained from the literature review was carried out., Results: 145 structured programs and 45 specific actions were identified. Only 25% of structured programs provided an impact evaluation, besides, only 15% presented some information about their financing. Regarding the specific actions, the numbers were less encouraging where 10% provided an impact evaluation while a similar figure of PAPTCAs showed financing information., Conclusions: There is a need to systematize the information of the PAPTCA that serves as an instrument to conduct impact evaluations in Spain. This should ease the scarce presence of evaluative culture in this area and promote the accountability of resources spent on public health to society.

Objective: Gambling may cause a variety of problems, both health and social, to the player, his family and his environment; Problems can be more serious for those who gamble more frequently or bet more money. Beyond the mental health gambling disorder and considering other harms derived from gambling, it is possible to develop a public health approach to the issue, including both prevention and harm reduction aspects. In recent decades gambling availability has expanded, with attempts at regulation. The objective of this paper is to provide basic information about gambling in Spain, stratifying data by Autonomous Communities (AC), from a public health perspective., Methods: A descriptive study of some aspects of gambling in Spain was carried out. The data for amounts gambled by participants, gross gaming revenue of the industry, and establishments or machines licensed for the year 2017 were extracted from the available systematic sources. Aggregated data were tabulated and stratified by AC for those presential gambling categories with the greatest compulsive gambling potential and relevant business volume. Crude results and ratios per 100,000 inhabitants were calculated., Results: Up to 41,826.8 million euros were spent gambling throughout Spain in 2017, a figure that exceeds 3.5% of the Gross Domestic Product, and the largest segment was online gambling in its various modalities (32%), followed by the national lottery and similar traditional games (27%). The supply of gambling venues (74.9 establishments per million inhabitants) was assessed by AC, showing large differences among them: their density in the region of Murcia is tenfold that of Catalonia. Gambling machines that can be installed in hospitality establishments (B machines) showed a density of 43.4 per 1,000 inhabitants, with greater homogeneity across AC than gambling premises. Regional data on the amounts spent in casinos, bingo cards, and sports betting show no homogeneous patterns., Conclusions: The volume of money spent on gambling in Spain is very important, and online gambling has become the largest business segment. The most traditional game modes and probably with less addictive potential such as lotteries and draws continue to have a relevant presence. The availability of presential gambling shows wide heterogeneity among AC, especially for licensed gambling establishments, whose density is ten times greater in the community with more supply compared to the one with less. The data by AC of some game modalities suggest that availability may be a relevant factor for gambling, but not the only one., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Use of the Internet has grown exponentially and adolescents are considered one of the most vulnerable groups in this new environment. Hence the problematic use of the Internet (PIU) at this stage has become a concern for a growing number of researchers. Taking into account the interest that this issue has generated at many levels, the aim of this paper is to find the prevalence of PIU among adolescents in the health area of Vigo (Spain)., Methods: Cross-sectional descriptive study. The PIU validated scale was applied to children between 10 and 16 years old, captured by systematic sampling with replacement in the primary care consultations of four health centers. A descriptive and bivariate analysis was performed., Results: The questionnaire was applaid to 165 children, 51.2% men. Problematic Internet use was observed in 38.8% (95% CI: 31.7-46.4), higher in women (46.3%) than in men (31.8%), with no significant differences (p 0.07). By age groups, the positive rate on the scale reached 36.8% in the 13-14 year range and 48.6% in the 15-16 range. The item that reached the highest score was "When I am online, I feel that time flies and hours pass without me realizing it" (60.6%)., Conclusions: The prevalence of UPI in children / adolescents is similar to that observed in Asian adolescents. This study is the first to apply a scale validated and adapted to the Spanish cultural context in the daily practice of Primary Care consultations. Its use would allow to identify the PIU in this context and intervene if necessary., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The public health crisis caused by COVID-19 disease has bring again to the public arena the old debate of the role in decision-making process of politics and science. In this paper we analyze, in the context of the current pandemics, how politics has left a stellar role for science, either because science has anticipated in its proposals to politics, or because politics has opted for it as a premeditated strategy. The references to the opinion of scientists as a decision-making criterion or, furthermore, their presence as true spokesmen for authority have been so frequent. This means rediscovering science and health as instruments of power, in terms that remind us of what Foucault denounced almost fifty years ago with his Biopolitics.

Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O 2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19., (Copyright © 2020 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

During the economic crisis, developed countries have experienced financial fraud, with effects on the physical and mental health of the people affected, and on social domains. Based on the theoretical framework in literature reviews and in quantitative studies, this paper aims to obtain evidence on the effects of financial fraud on health and on the family and social environments of those affected. An intentional sample of 32 people affected by abusive and multi-currency mortgages, preferred and swap stock in Madrid was approached. In-depth interviews were conducted, and the resulting data was analysed using content analysis. Fraud-affected individuals had conditions of age, sex, educational level and occupations that possibly allowed them to accumulate economic resources throughout the course of their lives and, predictably in many cases, to take out fraudulent financial products, based on trust in the financial institutions. Financial fraud has led to the emergence of various processes of anomia and adverse health effects. The consequences on health were physical ailments (symptoms and diseases in various systems and parts of the body) and mental disorders (anxiety, depression, suicidal ideation), all affecting lifestyles, behaviour and personal and social relationships, both in affected individuals and their families. The increase in the use of medical drugs and health services serves as a final corollary to the imbalances on the affected people's health. Individuals and the Spanish society demand public health policy measures to mitigate the effects on health and the recovery of their confidence in the banking and political system., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The biopsychosocial consequences in Spanish population affected by an eviction process were described in this paper. A scoping review was conducted, consulting the following databases: PubMed, Scopus, PsycINFO, CINAHL, LILACS, CSIC, MEDES, Scielo, Dialnet, Cuiden Plus and Cochrane. The search strategy was (Eviction OR "Home eviction" OR "Housing eviction" OR "Households at risk of eviction" OR Foreclosure) AND ("Health" OR "Mental Health" OR "Psychosocial impact" OR "Impacts on health" OR "Social impact indicators" OR "Social Determinants of Health" OR "Social Indicators").Eleven articles published between 2008 and September 2018 were selected. They followed a quantitative or qualitative methodology. The research quality was measured, and the results were organized according to the biopsychosocial model. From the physical perspective, results described a poor self-perception of health, as well as an increase of chronic diseases, pain, drug consumptions. From the psychological perspective, it was found negative thoughts, recurrent emotions and increased anxiety, depression, mental disorder and post-traumatic stress. From the social perspective, it was found that family, the offspring and the guarantor were affected, as well as the health system with greater medical visits and emergencies. This review showed worse health indicators among women, such as a headache, smoking habits, worse self-perception of health and more mental health disorders (depression, anxiety and other types of psychological distress). Daughters revealed worse self-perception of health than sons. It is necessary an approach from public health, epidemiological surveillance, action protocols and health programs, to advise, diagnose, prevent, protect and promote the health of the Spanish population affected., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Aim: The vascular anatomy of the hand has already been widely described macroscopically. However, there are very few papers that study the pattern of normality of in vivo vascularisation that describe and analyse the main arteries of the hand. The aim of this paper was to carry out a study to serve as a reference for the normal values of size and flow of the radial and ulnar artery at the level of the wrist, and the digital radial and ulnar arteries at the level of the fingers., Material and Method: A descriptive observational cross-sectional study on 200 hands in 100 healthy volunteers aged between 20-30years. Doppler-colour ultrasound was performed on the ulnar and radial arteries in the wrist, as well as on the radial and ulnar digital arteries in each finger. Once the measurements had been taken, a general comparative analysis was performed also taking laterality, dominance and gender into account., Results: It was observed that the radial artery is larger in size than the ulnar at wrist level, however, it was the ulnar artery that showed flow dominance at this level. At finger level, the arteries are greater in size and flow in the areas of the fingers more protected from injury (digital ulnar artery in the first three and radial artery in the fourth and fifth digits)., (Copyright © 2020 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Presbycusis or age-related hearing loss is a bilaterally symmetric sensorineural hearing loss associated exclusively with age, excluding any other causes of hearing loss. Presbycusis is very relevant because of its high prevalence, and its consequences (e.g., alterations in communication, social isolation, depression, dementia), and the economic impact. This paper reports the first attempt to estimate the prevalence of presbycusis in an otologically normal population, i.e., without previous ear disease, exposure to noise, or potentially ototoxic substances, or familial hearing loss., Methods: A total of 4290 subjects from 5 to 90 years old were included in the study., Results: No statistically significant differences were found between right and left ear, nor between males and females, in any of the age groups. Presbycusis was detected over 60 years following the WHO classification; although the results vary depending on the classification used. Moderate hearing loss (≥ 41dB) was detected in the population over 72 years. None of the subjects had severe or profound hearing impairment. The prevalence of presbycusis increased with age, being 100% in individuals aged 80 years and older. The prevalence of presbycusis is highly variable depending on the pure-tone averaged frequencies and the classification system used; therefore, a common classification system should be used., Conclusions: An otologically normal population is needed to establish the prevalence of presbycusis as in non-screened populations it is the hearing level including all types of hearing loss that is measured, but not presbycusis itself., (Copyright © 2019 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights.

Introduction: The world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic., Materials and Methods: We report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine., Results: In that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission., Conclusions: We may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients., (Copyright © 2020 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.)

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

The Committee for Immunization Programme and Registry (Ponencia de Programa y Registro de Vacunaciones) was created in 1991 to advise the Interterritorial Council of the National Health System on the situation of vaccine preventable diseases and the establishment and evaluation of measures for their prevention and control. Among other functions, this Committee evaluates the immunization programmes taking into account the scientific evidence and the epidemiological situation. In this way the Committee advises decision makers on the Public Health Commission of the Interterritorial Council. Any change in the National Immunization Programme, since the first one published in 1996 by the Interterritorial Council to the current Immunization Programme throughout life, has been advised from the technical and scientific point of view by this Committee. Taking into account both the work developed and the methodology used for developing the technical advice, the Committee for Immunization Programme and Registry is considered the National Immunization Technical Advisory Group for Spain. This paper reviews the functions and work developed by the Committee for Immunization Programme and Registry, the changes conducted in the National Immunization Programme under its advice and the current challenges.

Adolescence is a critical period in the development of addictive behaviors. In particular, the age at which adolescents start drinking is not a trivial matter, given the important consequences that it has. However, relatively little is known about what it is that causes them to start drinking at an ever earlier age. The aim of this paper is to collect new empirical data about the implications of an early age of onset and, at the same time, to identify possible associated variables. Furthermore, the mean age of onset of the different substances is updated by expanding the sample frame of the ESTUDES (14-18 years) to incorporate adolescents aged 12 and 13. The results obtained with a sample of 3,419 adolescents from the Autonomous Community of Galicia (M = 14.57 and SD = 1.76) reveal that at 13.4 years of age, the age at which adolescents tend to start drinking is lower than suggested by ESTUDES 2016-2017. In addition, those who start drinking earlier are more likely to use other substances, their rates of high-risk consumption are 3 times higher and they are more involved in potentially dangerous practices. Finally, variables such as risk perception and expectations of use yield very limited explanatory capacity, especially if they are compared with those related to drinking within the family or peer group. The results reinforce the need to delay the age of alcohol onset as one of the strategic objectives of prevention policies.