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Problem: Midwifery led units are rare in Spain., Background: Midwife-Led Care (MLC) is a widely extended model of care and, within this, the alongside midwifery-led units (AMLU) are those hospital-based and located in close connection with obstetric units. In Spain, CL is the first center belonging to the National Health System of these characteristics., Aim: To evaluate the first year of activity of this pioneering unit., Methods: An observational cross-sectional study was carried out to assess maternal and neonatal outcomes of births facilitated at CL by comparing with those births that fulfilled the criteria to be admitted at the AMLU but were assisted at the standard obstetric care unit of the hospital., Findings: 174 (20,3%) women and birthing people decided to give birth at CL, whereas 684 (79,7%) gave birth at the Obstetric Unit of the Hospital. Women assisted at the AMLU had lower intervention rates (episiotomy, epidural analgesia) and a higher rate of breastfeeding practice. There were no statistical differences in maternal outcomes (postpartum hemorrhage, third-or-four-degree laceration) or neonatal outcomes (Apgar< 7 at 5 min; birth weight < 2500 gr; macrosomia; shoulder dystocia, neonatal care transfer)., Discussion: There were differences in transfers from MLU to OU between nulliparous and multiparous; the main reason for transfer is the request for analgesia. Epidural analgesia should be considered when analyzing maternal outcomes., Conclusion: An alongside midwifery-led unit is a safe option with a low incidence of complications. This model of care can be positively implemented at the Public Healthcare System., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Emotional education programmes are universal preventive strategies for health promotion, especially mental health. The aim of this study is to evaluate the effectiveness and implementation of '1,2,3, emoció!': a preschool-based programme designed to improve emotional competence and targeted to 3-5-year-old children in Barcelona during three academic years., Study Design: Cluster randomised trial, using schools as clusters., Methods: The study's population included preschoolers 3-5 years old from Barcelona. Teachers offered the programme during one or three academic years in the intervention groups. We evaluated the emotional competence of each child at the beginning and the end of the academic year with the Emotional Competence Assessment Questionnaire (30-180 scale). We studied the implementation process and analysed the outcomes with nested linear regression models. Considering sociodemographic variables and implementation outcomes, we obtained the individual differences in emotional competence at the end of the school year-segregated by sex-for intervention and comparison groups., Results: 1586 children participated in the study. The emotional competence level increased significantly after one year (4.1 in boys; 5.6 in girls; P < 0.05) and after three years of intervention (5.5 in boys; 8.0 in girls; P < 0.01), compared to comparison group. The level of emotional competence was the highest for the 3-year intervention group: we obtained an average ECAQ score of 131.1 (95% CI 126.9-135.2) for boys and 141 (95% CI 137.2-144.9) for girls. We observed that an accurate implementation improved its results., Conclusions: The programme '1,2,3, emoció!' effectively increases preschool children's emotional competence, especially when the programme is rigorously implemented for three years., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: The acquisition of emotional competencies through emotional education programs improves both short- and long-term health outcomes. The 1,2,3,emoció! program directed at children aged 3-5 years aims to promote health through the development of emotional competencies. This study evaluated the effectiveness of the program during its first year of implementation., Study Design: Cluster randomized trial., Methods: The information sources were an ad-hoc questionnaire to evaluate emotional competencies and focus group discussions with the teachers implementing the program. For the quantitative data analysis, we compared mean emotional competencies scores pre- and postintervention for the intervention group and the comparison group. We also conducted a multilevel regression with repeated measures, adjusted by sociodemographic variables and stratified by gender and school year. For the qualitative data, we performed a thematic content analysis., Results: The sample consisted of 2625 children (48.4% girls and 49.2% intervention group). Emotional competencies improved in both groups after the school year (P-value < 0.001), but the increase was greater in the intervention group. The multilevel analysis showed an improvement in the final scores attributed to the intervention, especially for those in the first year of preschool [boys: 12.33 points (95% CI 5.51-19.15), girls: 9.66 points (95% CI 3.36-15.96)]. The thematic content analysis also highlighted enhanced emotional competencies in the intervention group. The final scores did not vary by sociodemographic variables., Conclusions: The 1,2,3,emoció! program had a positive effect on emotional competencies among children, with effectivity being higher among younger children., (Copyright © 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: The objective of this study was to describe the temporal relationship between an illicit drug market abrupt disruption and the number of discarded syringes collected from public space in Barcelona., Methods: The monthly number of discarded syringes collected and interrupted time-series analyses were used to analyze changes and trends from January 2014 to December 2017, before and after an illicit drug market disruption comparing three different areas of the city: intervened (A) and not intervened (B) high trafficking areas and, as a reference, a low trafficking area (C)., Results: After the disruption, a decrease in the average number of syringes collected in area A was observed, although the trend was not significant (p value 0.09). In area B, there was a significant increase with an upward trend in the average number of collected syringes (p value <0.001). A flat trend was observed throughout the period in area C (p value 0.62) The systematic counting of discarded syringes collected from public places is confirmed as a useful indicator to monitor drug dealing and use in urban areas. It may help public health services strengthen safe needle disposal practices and harm reduction interventions in these areas., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The opening hours of drug consumption rooms could constitute a barrier to access among people who use drugs (PWUD). CAS Baluard is an outpatient substance use care center in Barcelona, which provides a drug consumption room in Barcelona among other services. The objectives of our study were to compare the client profile, the facility use, the drugs used, and the number of non-fatal overdose episodes between (1) a 15-hour opening period of a drug consumption room versus a 24-hour opening period; and (2) between daytime and nighttime during the 24-hour period., Methods: Data from CAS Baluard was obtained from March-June (15-hour opening period) and July-October (24-hour opening period), 2018. The sociodemographic characteristics of clients were gathered in both periods and in the daytime and nighttime client groups in the 24-hour period. Finally, associations were estimated between facility use and period and between facility use and opening hours., Results: There were 1,089 clients in the 15-hour period and 1,262 in the 24-hour period. There were no sociodemographic differences in the clients between periods. During nighttime, there was a higher proportion of women (17%) and homeless people (47%) than during daytime (12% and 30%, respectively). Injected cocaine use was more frequent during nighttime (34%) than during daytime (25%) and injected heroin use was less frequent during nighttime (17%) than during daytime (24%). There was a non-significant increase in non-fatal overdose risk during nighttime (PR 3.9 95%CI 0.98-15.64). However, when we analyzed heroin use alone, the increase in non-fatal overdose risk was significant (PR 4.69 95%CI 1.17-18.75)., Conclusion: During nighttime, attendance at the facility was higher among women, homeless people, and people who used stimulants. Our results point to a possible increase in overdose risk during nighttime, when most drug consumption rooms are closed., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Anxiety and depression are the most prevalent mental health pathologies among women with breast cancer. Social, clinical and contextual variables may influence emotional stress among women with breast cancer. The aim of this work is to study anxiety and depression in a cohort of women diagnosed with breast cancer between 2003 and 2013 in Barcelona. We evaluate social and clinical determinants., Methods: We performed a mixed cohort study (prospective and retrospective) using a convenience sample of women diagnosed with breast cancer. The information sources were the Hospital Anxiety and Depression questionnaire and hospital medical records. Dependent variables were anxiety and depression; independent variables were social class, age, employment status, tumour stage at diagnosis, time since diagnosis, social network and social support. We performed a descriptive analysis, a bivariate analysis, and a multivariate logistic regression analysis., Results: A total of 1086 (48.6%) women had some degree of anxiety-related problem. As for depression. In the case of depression, 225 (15%) women had some degree of depression-related problem. Low emotional support and social isolation were clear risk factors for having more anxiety and depression. Low social class was also a risk factor, and age also played a role., Discussion: Our results show that women long period of cancer survival have high prevalences of anxiety than depression, and this prevalence of anxiety is higher than the general population. In addition, we found inequalities between social classes and the isolation and social support are worse too in low social class., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Immune-checkpoint inhibitors against programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) have shown remarkable therapeutic activity in non-small-cell lung cancer (NSCLC). However, biomarker-based patient selection remains a challenge. Our aim was to assess the heterogeneity of various immune markers between different tumor areas of surgically resected NSCLC specimens., Materials and Methods: We included 94 adenocarcinoma (ADC) and 50 squamous cell carcinoma (SCC) specimens. Two distinct tumor areas of each tumor sample were selected and incorporated into tissue microarrays. PD-L1 expression in tumor cells (TCs) and immune cells (ICs) was assessed using clone SP142 (Ventana). PDL1 gene amplification was assessed using fluorescence in situ hybridization. CD3 and CD8 densities were quantified using digital image-based analysis. Heterogeneity was assessed using kappa agreement index (KI) and intraclass correlation coefficient., Results: Prevalence of PD-L1 expression was 16.8% in TCs and 27.8% in ICs. Eleven tumors (7.6%) showed PDL1 amplification. In ADC, KI of PD-L1 TC and IC expression between cores was 0.465 and 0.260, compared with 0.274 and 0.124 in SCC, respectively. Higher concordance was observed for PDL1 amplification (KI, 0.647 in ADC and KI, 1 in SCC). Eleven (61.1%) of 18 amplified cores showed PD-L1 staining in < 5% of TCs. Intraclass correlation coefficients for CD3 and CD8 were 0.293 and 0.186 in ADC and 0.489 and 0.610 in SCC samples, respectively., Conclusions: We found significant heterogeneity of PD-L1 expression in both ADC and SCC samples, especially in the IC compartment. Heterogeneous expression of PD-L1 could misclassify patients for PD-1/PD-L1-directed therapies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Benefits of cardiopulmonary rehabilitation (CPR) in patients with chronic obstructive pulmonary disease (COPD) are well established, but long-term sustainability of training-induced effects and its translation into healthy lifestyles are unsolved issues. It is hypothesized that Integrated Care Services supported by Information and Communication Technologies (ICS-ICT) can overcome such limitations. In the current study, we explored 3 ICS-ICT deployment experiences conducted in Barcelona, Trondheim and Athens., Methods: In the 3 sites, a total of 154 patients completed an 8-week supervised CPR program. Thereafter, they were allocated either to an ICS-ICT group or to usual care (CPR + UC) during a follow-up period of at least 12 months with assessment of 6-min walking test (6MWT) as main outcome variable at all time points in the 3 sites. Because real deployment was prioritized, the interventions were adapted to site heterogeneities., Results: In the ICS-ICT group from Barcelona (n = 77), the use of the personal health folder (PHF) was the cornerstone technological tool to empower COPD patients for self-management showing high applicability and user-acceptance. Long-term sustainability of training-induced increase in exercise capacity was observed in ICS-ICT compared to the control group (p = 0.01). Likewise, ICS-ICT enhanced the activities domain of the SGRQ (p < 0.01) and daily physical activity (p = 0.03), not seen in controls. No effects of ICS-ICT were observed in Trondheim (n = 37), nor in Athens (n = 40), due to technological and/or organizational limitations., Conclusions: The study results suggest the potential of the ICS-ICT Barcelona's approach to enhance COPD management. Moreover, it allowed identification of the factors limiting transferability to the other sites. The research prompts the need for large multicenter trials specifically designed to assess effectiveness, efficiencies and transferability of this type of intervention., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Cannabinoid agonists are potential therapeutic agents because of their antinociceptive and anxiolytic-like effects, although an important caveat to their use is the possible adverse responses related to memory impairment. An alternative approach to circumvent this limitation consists of enhancing the concentration of the endocannabinoids anandamide and 2-arachidonoylglycerol., Methods: Using low doses of the specific inhibitors of the endocannabinoid metabolizing enzymes fatty acid amide hydrolase, URB597, and monoacylglycerol lipase, JZL184, we analyzed their acute and chronic effects on memory consolidation, anxiolytic-like effects, and nociception in mice (n = 6-12 per experimental group)., Results: We show that anandamide is a central component in the modulation of memory consolidation, whereas 2-arachidonoylglycerol is not involved in this process. Interestingly, both URB597 and JZL184 induce anxiolytic-like effects through different cannabinoid receptors. In addition, the results show that the antinociceptive and anxiolytic-like responses of both inhibitors, as well as their acute effects on memory consolidation, are maintained after chronic treatment., Conclusions: These results dissociate the role of anandamide and 2-arachidonoylglycerol in memory consolidation and anxiety and reveal the interest of cannabinoid receptor 2 as a novel target for the treatment of anxiety-related disorders., (Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Nicotine, the main psychoactive component in tobacco smoke, appears to play a major role in tobacco addiction, producing a high morbidity and mortality in the world. A great amount of research has been developed to elucidate the neural pathways and neurotransmitter systems involved in such a complex addictive behaviour. One possible candidate is the cannabinoid system, which has been reported to participate in the addictive properties of other drugs of abuse. This review is focused on the recent pharmacological and molecular studies assessing cannabinoid-nicotine interactions, with special attention to those studies evaluating the behavioural responses related to the development of nicotine addiction.