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Barbara Badanta,1,* Isabel Álvarez-Pérez,2 Patricia Bonilla Sierra,3 María González-Cano-Caballero,4,* Giancarlo Lucchetti,5 Rocío de Diego-Cordero1,* 1Department of Nursing; Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain; 2Faculty of Nursing, Physiotherapy and Podiatry. University of Seville, Seville, Spain; 3Department of Health Sciences, Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador; 4Department of Nursing; Faculty of Health Sciences, University of Granada, Granada, Spain; 5Department of Medicine; School of Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil*These authors contributed equally to this workCorrespondence: María González-Cano-Caballero, Department of Nursing, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, Granada, 18071, Spain, Email mariagcc@ugr.esAbstract: This study aims to investigate the current evidence for the use of complementary and alternative medicine (CAM) in fibromyalgia (FM). A systematic review was conducted searching for PubMed, Scopus, CINAHL, PsycInfo, and Web of Science databases. Randomized controlled trials published up to December 2023 in peer-reviewed journals were included. Methodological quality was assessed by the Quality Assessment of Controlled Intervention Studies tool. A total of 216 articles were identified and 15 constituted the final sample. The type of CAM most used was traditional Chinese medicine (60%), and the most common instrument used was the Fibromyalgia Impact Questionnaire (60%). Our review was grouped into four themes based on the origin of the therapies: 1) Traditional Chinese Medicine; 2) Japanese natural harmonization (eg, Reiki); 3) Ayurvedic Medicine; and 4) Other non-drug therapies. Our systematic review showed that there is a wide range of CAMs used to treat FM. Most of the clinical trials have shown significant results for the effectiveness of these interventions in both physical and mental health outcomes of FM as compared to control groups. However, the heterogeneity of the interventions and outcomes warrants further studies on this topic.Keywords: complementary therapies, fibromyalgia treatment, nonpharmacological interventions, traditional medicine

The experience of menstruation is often associated with negative connotations and gender stereotypes, which results in making it invisible. This research aimed to explore the perceptions, beliefs, and knowledge of young Spanish women regarding the menstrual cycle and menstruation and their impact on their lives. The study delves into their understanding, menstrual management practices, the types of menstrual products employed, and their experiences related to menstrual health. Qualitative methodology was used with discussion groups as a data collection technique. The participants comprised 45 young Spanish women, aged between 18 and 23, hailing from both rural and urban areas. The majority were university students, with some engaged in part-time work, and one participant working full-time. While many experienced menstrual pain ranging from mild to debilitating, a normalization of this pain often led them to forego seeking specialist assistance. Disposable menstrual products (DMPs) are the most used by participants, despite limited awareness of their absorption capacity. Regarding reusable menstrual products (RMPs), menstrual cup users emphasized comfort but expressed a need for proper training. Negative menstruation experiences could evoke fear and difficulties, underscoring the importance of providing comprehensive menstrual health education encompassing both theoretical and practical components.

Background: To learn about the experiences and opinions of adolescent non-consumers and regular cannabis users about cannabis use and the factors that determine its use, using the I-Change explanatory model as a basis., Methods: Qualitative methodology with a content analysis was used. Focus groups were conducted with adolescents who were non-regular cannabis users (those who had not tried cannabis or had only experimented with it before) and semi-structured interviews were conducted with adolescent and young adult in recovery who were in a detoxification program. A deductive analysis of the audio-recorded and transcribed interviews was performed, using the domains of the I-Change Model as a reference., Results: Personal problems, social problems or family problems can lead to cannabis use. There was a lack of knowledge and low risk perception about consumption of this drug. There are other factors that influence consumption, the perception of advantages, such as the feeling of freedom and the influence of the peer group. The consumption of this substance in girls is changing, becoming more and more equal to that of boys. The family has an important role to play in preventing drug use., Conclusion: Knowledge of these factors is of vital importance as a prior step to the development of efficient intervention measures adjusted to the needs identified and the characteristics of the population., (© 2023. The Author(s).)

Introduction: Vaccination is a fundamental intervention in disease prevention; therefore, the advice and recommendations of health professionals have a major influence on the population's decision to be vaccinated or not. Professionals must have sufficient competencies to carry out their work and recommend vaccination with evidence-based knowledge. The aim is to design and validate a strategy to improve professional competencies in vaccination to positively influence adherence and increase vaccination rates in the population., Methods and Analysis: Training will be designed based on evidence and previous studies and piloted with healthcare providers. To test changes in knowledge, a pretest and post-test will be conducted. To test feasibility, a think-aloud method will be used with participants and triangulated with focus groups using SWOT (strengths, weaknesses, opportunities and threats) analysis. Transfer will be measured using the questionnaire 'factors for the indirect evaluation of transfer' and an efficacy questionnaire 1½ months later; for satisfaction, an ad hoc questionnaire will be used. A summative approach will be used for the analysis of the focus groups and descriptive and bivariate statistics for the questionnaires., Ethics and Dissemination: This study was approved by the Andalusian Research Ethics Committee, Spain (approval number: 0524-N-20). The results will be made available to the public at journal publications and scientific conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% ( n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association ( n = 78), and 26% ( n = 69) of the children used alternative therapies. Furthermore, 75.4% ( n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.

This study aims to identify acculturation experiences about social relations and health behaviors of first-generation Chinese immigrants in the South of Spain, including food patterns, physical exercise, and tobacco and alcohol use. A phenomenological qualitative study was conducted using semi-structured interviews, informal conversations, and field notes. All data were analyzed under the Berry's Model of Acculturation. A total of 133 Chinese immigrants were included. Our findings show that separation was the dominant acculturation strategy, followed by integration and assimilation, while marginalization was not present in this immigrant population. Most of the immigrant population maintains a link to the customs of their home country, favoring the process of identity and collective self-esteem. These results can help health managers and the government to further understand Chinese immigrants in Europe and to establish appropriate health interventions to this group.

Background: For school medical services and the staff responsible for sex education for adolescents, it is important to understand the factors that may influence gender violence. The aim of this study is to determine whether the presence of sexist attitudes, double standards and/or romantic myths contributes to the risk of gender violence., Methods: This cross-sectional study was carried out at five secondary schools in the province of Malaga (Spain). In total, 879 adolescents aged 12-18 years were included, studying years 1-4 of compulsory secondary education. Their attitudes were measured on the following scales: Ambivalent Sexism Inventory (ASI), Double Standard Scale (DSS) and Romantic Love Myths Scale (EMA)., Results: Significant differences were observed among the age/year groups for the mean scores obtained on each of the above scales (DSS, p < 0.01; EMA, p < 0.01; ASI, p < 0.01). By gender, the boys recorded higher scores for ASI and lower ones for DSS ( p < 0.01). The Spearman's rho value revealed significant relationships between the presence of sexual double standards and that of romantic myths and ambivalent attitudes ( p < 0.01)., Conclusions: Adolescents commonly express romantic love myths, sexist attitudes and sexual double standards. These three factors, which are significantly correlated, influence the presence of violence in dating relationships.

Background: Pregnancies that follow perinatal loss are often associated with mental health disorders, which are not usually treated or even identified., Objectives: The main study aim is to identify the prevalence of symptoms of post-traumatic stress disorder and complicated perinatal grief at different stages of pregnancy following a prior gestational loss., Methods: This descriptive longitudinal study will be conducted with a twelve-month follow-up. The study variables addressed will include sociodemographic data (age, sex, education, marital status, employment status and obstetric history) together with clinical data on complicated perinatal grief and post-traumatic stress disorder scores., Results: The results obtained are expected to provide a new perspective on the healthcare approach to perinatal loss and subsequent pregnancy., Conclusions: We seek to optimise comprehensive healthcare in cases of pregnancy following previous perinatal loss and to evaluate options to minimise possible risks.

This article aims to explore the food patterns of Chinese immigrants living in Spain and to understand the factors associated with these behaviors. This qualitative ethnographic study included 133 Chinese immigrants; using interviews with scripts were based on the National Health Survey of Spain. Three categories were defined: "Differences between Chinese food and Western food"; "Products and dishes consumed by Chinese immigrants" and "Modification of eating habits". Participants found a remarkable difference between eastern (i.e., vegetables and rice) and western (i.e., dairy, high-fat, bread) foods. They also experienced a change in their eating habits, mostly related to acculturation and lack of time. Chinese immigrants have different eating patterns as compared to the native population in Spain and this information could help in future healthcare strategies. Knowing the food culture could infer aspects, such as insertion or integration, and promoting health and well-being.

Expanding businesses was the main reason for the immigration of Chinese people in Spain, which consists the fifth largest nationality of immigrants in this country. Nevertheless, few studies have been carried out to understand the working conditions of this population. Using an ethnographic design, this study examined the work patterns and working conditions among Chinese immigrants living in southern Spain and how these factors affected their health. Observing participants, field notes, and semi-structured interviews with question script were conducted with 133 Chinese immigrants. Five main themes were defined: "Economic improvement as a migratory reason", "Conception to Work", "Labor Sector", "Work conditions", and "Occupational health". Our results showed that Chinese immigrants worked in the provision of services, with long working hours and little rest. Although they had low rates of unemployment, the working conditions had an important impact on their dietary patterns and their family life. Ergonomic and psychosocial risks also explained high rates of musculoskeletal problems and stress. In conclusion, Chinese immigrants living in southern Spain work actively in the service sector of the economy, but with many work hours. These characteristics seem to impact their health at a physical, psychological, and social level.

Background: The human papillomavirus (HPV) is the most common sexually transmitted disease, but its vaccination coverage is among the lowest in Andalusia. The aim of this study is to determine what primary health care professionals think and find out about the prevention of HPV infection among adolescents and the administration of the vaccine Method. Qualitative study using six focus groups with professionals from Primary Health Care in Seville, Granada and Jaen. Fourty-five professionals participated. An analysis of the semantic content was made, and answers were categorized in thematic units., Results: Professionals recognize the difficulties in reaching the adolescent population concerning prevention of sexual risk behaviors, due to lack of time and little concern amongst adolescents about the preventive measures. Although the professionals recognize the symptoms of HPV infection, some did not know about the disease in men as well as the association with other cancers other than cervical cancer. They hesitate over whether to recommend the vaccine or not, leaving the decision to vaccinate their daughters in the hands of the parents., Conclusion: It would be advisable to establish strategies that improve the information that the professionals have about HPV as well as the benefits of the vaccine, so that they can transmit the benefits clearly and assertively to the parents. This would avoid parental uncertainty, improve vaccination rates, and decrease complications of infection (cancer).