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Autism spectrum disorder (ASD) is a neurodevelopmental disorder with complex clinical manifestations that arise between 18 and 36 months of age. Social interaction deficiencies, a restricted range of interests, and repetitive stereotyped behaviors are characteristics which are sometimes difficult to detect early. Several studies show that microRNAs (miRs/miRNAs) are strongly implicated in the development of the disorder and affect the expression of genes related to different neurological pathways involved in ASD. The present systematic review and meta-analysis addresses the current status of miRNA studies in different body fluids and the most frequently dysregulated miRNAs in patients with ASD. We used a combined approach to summarize miRNA fold changes in different studies using the mean values. In addition, we summarized p values for differential miRNA expression using the Fisher method. Our literature search yielded a total of 133 relevant articles, 27 of which were selected for qualitative analysis based on the inclusion and exclusion criteria, and 16 studies evaluating miRNAs whose data were completely reported were ultimately included in the meta-analysis. The most frequently dysregulated miRNAs across the analyzed studies were miR-451a, miR-144-3p, miR-23b, miR-106b, miR150-5p, miR320a, miR92a-2-5p, and miR486-3p. Among the most dysregulated miRNAs in individuals with ASD, miR-451a is the most relevant to clinical practice and is associated with impaired social interaction. Other miRNAs, including miR19a-3p, miR-494, miR-142-3p, miR-3687, and miR-27a-3p, are differentially expressed in various tissues and body fluids of patients with ASD. Therefore, all these miRNAs can be considered candidates for ASD biomarkers. Saliva may be the optimal biological fluid for miRNA measurements, because it is easy to collect from children compared to other biological fluids. [ABSTRACT FROM AUTHOR]

Background: The demand for urgent psychiatric care is increasing, but in Spain there are no clear recommendations for emergency departments (ED) on how to optimize care for patients with psychiatric emergencies. We aimed to provide expert consensus recommendations on the requirements for general hospitals´ emergency departments to treat patients with urgent psychiatric symptoms. Methods: We used a modified Delphi technique. A scientific committee compiled 36 statements based on literature search and clinical experience. The statements covered the organizational model, facilities, staffing, safety, patient interventions, and staff training. A panel of 38 psychiatry specialists with expertise in psychiatric emergencies evaluated the questionnaire in two rounds. Results: After two rounds of voting, 30 out of 36 proposed items (83%) were agreed upon. The panel agreed that psychiatric emergencies should be managed in a general hospital, with dedicated facilities for patient assessment, direct supervision of patients at risk, and an observation unit run by the psychiatric service. In addition to the psychiatrist, the ED should have specialist nurses and security staff available 24/7. Social workers should also be readily available. ED and consulting rooms should be designed to ensure patient and staff safety. A triage system should be established for patients with psychiatric symptoms, with medical evaluation preceding psychiatric evaluation. Guidance on supplies, equipment, and staff training is also provided. Conclusion: All ED in general hospitals should have adequate resources to handle any psychiatric emergency. This paper provides recommendations on the minimum requirements to achieve this goal. [ABSTRACT FROM AUTHOR]

Exposure to traffic-related air pollution (TRAP) generates oxidative stress, with downstream effects at the metabolic level. Human studies of traffic density and metabolomic markers, however, are rare. The main objective of this study was to evaluate the cross-sectional association between traffic density in the street of residence with oxidative stress and metabolomic profiles measured in a population-based sample from Spain. We also explored in silico the potential biological implications of the findings. Secondarily, we assessed the contribution of oxidative stress to the association between exposure to traffic density and variation in plasma metabolite levels. Traffic density was defined as the average daily traffic volume over an entire year within a buffer of 50 m around the participants' residence. Plasma metabolomic profiles and urine oxidative stress biomarkers were measured in samples from 1181 Hortega Study participants by nuclear magnetic resonance spectroscopy and high-performance liquid chromatography, respectively. Traffic density was associated with 7 (out of 49) plasma metabolites, including amino acids, fatty acids, products of bacterial and energy metabolism and fluid balance metabolites. Regarding urine oxidative stress biomarkers, traffic associations were positive for GSSG/GSH% and negative for MDA. A total of 12 KEGG pathways were linked to traffic-related metabolites. In a protein network from genes included in over-represented pathways and 63 redox-related candidate genes, we observed relevant proteins from the glutathione cycle. GSSG/GSH% and MDA accounted for 14.6% and 12.2% of changes in isobutyrate and the CH2CH2CO fatty acid moiety, respectively, which is attributable to traffic exposure. At the population level, exposure to traffic density was associated with specific urine oxidative stress and plasma metabolites. Although our results support a role of oxidative stress as a biological intermediary of traffic-related metabolic alterations, with potential implications for the co-bacterial and lipid metabolism, additional mechanistic and prospective studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare the hospitalization rate in individuals with schizophrenia who started their treatment with aripiprazole once monthly (AOM400) or atypical oral antipsychotics (OA) in Spain. Methods: This is an observational and retrospective study based on the electronic medical records from the BIG-PAC database. The study population consisted of individuals diagnosed with schizophrenia who initiated their treatment with AOM400 (AOM cohort) or atypical OA (OA cohort) from 01/01/2017 to 31/12/2019. A 1:1 propensity score matching (PSM) procedure was conducted to match individuals of both cohorts. The number and duration of hospitalizations, persistence to treatment, healthcare resources use, and costs were analyzed after 12 months. Results: After the PSM, 1,017 individuals were included in each cohort [age: 41.4 years (SD: 10.6); males: 54.6%]. During the follow-up period, the AOM cohort had a 40% lower risk of hospitalization than the OA group [HR: 0.60 (95% confidence interval, CI: 0.49–0.74)]. The median time to the first hospitalization was longer in individuals with AOM400 compared to those with OA (197 days compared to 174 days; p < 0.004), whereas hospital admissions were shorter (AOM400: 6 compared to OA: 11 days; p < 0.001). After 12 months, individuals receiving AOM400 were more persistent than those with OA (64.9% compared to 53.7%; p < 0.001). The OA cohort required more healthcare resources, mainly visits to primary care physicians, specialists, and emergency rooms than those receiving AOM400 (p ≤ 0.005 in all comparisons). AOM400 reduced the costs of hospitalizations, and emergency room, specialist and primary care visits by 50.4, 36.7, 16.1, and 10.9%, respectively, in comparison to the treatment with atypical OA. AOM400 led to annual cost savings of €1,717.9 per individual, from the societal perspective. Conclusion: Aripiprazole once monthly reduces the number and duration of hospitalizations, together with the treatment costs of schizophrenia, as it reduces the use of healthcare resources and productivity losses in these individuals. [ABSTRACT FROM AUTHOR]

Background: Cognitive reserve (CR) has been associated with the development and prognosis of psychosis. Different proxies have been used to estimate CR among individuals. A composite score of these proxies could elucidate the role of CR at illness onset on the variability of clinical and neurocognitive outcomes. Methods: Premorbid intelligence quotient (IQ), years of education and premorbid adjustment were explored as proxies of CR in a large sample (N = 424) of first-episode psychosis (FEP) non-affective patients. Clusters of patients were identified and compared based on premorbid, clinical and neurocognitive variables at baseline. Additionally, the clusters were compared at 3-year (N = 362) and 10-year (N = 150) follow-ups. Results: The FEP patients were grouped into five CR clusters: C1 (low premorbid IQ, low education and poor premorbid) 14%; C2 (low premorbid IQ, low education and good premorbid adjustment) 29%; C3 (normal premorbid IQ, low education and poor premorbid adjustment) 17%; C4 (normal premorbid IQ, medium education and good premorbid adjustment) 25%; and C5 (normal premorbid IQ, higher education and good premorbid adjustment) 15%. In general, positive and negative symptoms were more severe in the FEP patients with the lowest CR at baseline and follow-up assessments, while those with high CR presented and maintained higher levels of cognitive functioning. Conclusions: CR could be considered a key factor at illness onset and a moderator of outcomes in FEP patients. A high CR could function as a protective factor against cognitive impairment and severe symptomatology. Clinical interventions focused on increasing CR and documenting long-term benefits are interesting and desirable. [ABSTRACT FROM AUTHOR]

Background Single-dose vaccination was widely recommended in the pre-Omicron era for persons with previous SARS-CoV-2 infection. The effectiveness of a second vaccine dose in this group in the Omicron era is unknown. Methods We linked nationwide population registries in Spain to identify community-dwelling individuals aged 18–64, with a positive SARS-CoV-2 test before single-dose mRNA vaccination (mRNA-1273 or BNT162b2). Every day between 3 January and 6 February 2022 we matched 1:1 individuals receiving a second mRNA vaccine dose and controls on sex, age, province, first dose type and time, month of primary infection, and number of previous tests. We then estimated Kaplan–Meier risks of confirmed SARS-CoV-2 reinfection. We performed a similar analysis in a Delta-dominant period, between 19 July and 30 November 2021. Results In the Omicron period, estimated effectiveness (95% CI) of a second dose was 62.2% (58.2–66.4%) 7–34 days after administration, similar across groups defined by age, sex, type of first vaccine, and time since the first dose. Estimated effectiveness was 65.4% (61.1–69.9%) for mRNA-1273 and 52.0% (41.8–63.1%) for BNT162b2. Estimated effectiveness was 78.5% (67.4–89.9%), 66.1% (54.9–77.5%), and 60.2% (55.5–64.8%) when primary infection had occurred in the Delta, Alpha, and pre-Alpha periods, respectively. In the Delta period, the estimated effectiveness of a second dose was 8.8% (−55.3% to 81.1%). Conclusions Our results suggest that, over 1 month after administration, a second dose of mRNA vaccine increases protection against SARS-CoV-2 reinfection with the Omicron variant among individuals with single-dose vaccination and previously infected with another variant. [ABSTRACT FROM AUTHOR]

Background: Lower levels of education have been associated with the development of psychosis. Investigating educational achievement in the first episode of psychosis (FEP) patients may shed light on the origins of the alterations and on the variability of outcomes in psychotic disorders. Methods: Education achievement was explored in a large sample (n = 659) of FEP patients enrolled in programa de atención a fases iniciales de psicosis (PAFIP), a research and assistance program conducted in Spain. Patients were stratified according to the Spanish educational system according to their attendance in primary (low), secondary (medium) or university studies (high). The three groups were compared on available premorbid, clinical and neuropsychological variables. A subgroup of patients (n = 209), comprising the 10-year follow-up PAFIP cohort, were again compared. Results: Overall, 49% and 37% of FEP patients had low and medium levels of education, respectively. In total, 13% of the patients with a higher level of education were more frequently women (64%) and older at illness onset (36 years old), reported better premorbid adjustment, presented less severe positive symptoms and better functioning; and showed higher premorbid intelligence quotient and better performance on all the explored cognitive domains. Ten years later the FEP patients in the medium- and high-education groups had good global functioning and a neurocognitive performance within the normal limits. Conclusions: Higher education is associated with better initial conditions and more favourable outcomes after an FEP. Sharing this information with the world's educational systems is essential to targeting resources and designing innovative programs or strategies to compensate for student difficulties. [ABSTRACT FROM AUTHOR]

The main objective of this article is to analyze the importance of digital transformation and the funds provided by way of the Next Generation EU (NGEU) plan, taking into account the Spanish case. Through the working hypothesis, it was established that the Iberian country has a wide margin for improvement in the context of digitalization. Likewise, that NGEU forms a key impulse for the recovery from the crisis caused by Covid-19, as well as for the implementation of new digital technologies in Spain. The use of the Digital Economy and Society Index, developed by the European Commission, has allowed us to carry out empirical research. The evaluation of the current situation and the progress of Spain in the field of analysis, as well as the putting it in perspective regarding the rest of the Member States, have been undertaken. Moreover, the Eurostat database has been employed, in addition to the estimations of the Spanish executive exposed through the Digital Agenda 2025, to examine investment in R&D and intangible assets and try to assess the importance of the EU recovery fund for Spain's development and progress in the digitization framework. Finally, the hypothesis and the objectives have been achieved. [ABSTRACT FROM AUTHOR]

Background: On June 21st de-escalation measures and state-of-alarm ended in Spain after the COVID-19 first wave. New surveillance and control strategy was set up to detect emerging outbreaks.Aim: To detect and describe the evolution of COVID-19 clusters and cases during the 2020 summer in Spain.Methods: A near-real time surveillance system to detect active clusters of COVID-19 was developed based on Kulldorf's prospective space-time scan statistic (STSS) to detect daily emerging active clusters.Results: Analyses were performed daily during the summer 2020 (June 21st - August 31st) in Spain, showing an increase of active clusters and municipalities affected. Spread happened in the study period from a few, low-cases, regional-located clusters in June to a nationwide distribution of bigger clusters encompassing a higher average number of municipalities and total cases by end-August.Conclusion: STSS-based surveillance of COVID-19 can be of utility in a low-incidence scenario to help tackle emerging outbreaks that could potentially drive a widespread transmission. If that happens, spatial trends and disease distribution can be followed with this method. Finally, cluster aggregation in space and time, as observed in our results, could suggest the occurrence of community transmission. [ABSTRACT FROM AUTHOR]

Background and Objective: Schizophrenia is a low-prevalence mental disorder with a global age-standardized prevalence of 21 million people (2016). Second-generation antipsychotics (lurasidone and quetiapine XR) are recommended as the first-line treatment for schizophrenia. It is interesting to investigate how the results of clinical studies translate into direct medical costs. The objective of this analysis was to assess the direct medical costs related to pharmaceutical treatments and the management of relapses in patients affected with schizophrenia treated with lurasidone (74 mg) vs quetiapine XR (300 mg) assuming the Italian and Spanish National Health Service perspective. Methods: A health economic model was developed based on a previously published model. The analysis considered direct medical costs related to the pharmacological therapies and inpatient or outpatient management of relapses (direct medical costs referred to 2019). The probability of relapses and related costs were derived from two systematic reviews. A deterministic sensitivity analysis was implemented to test the robustness of the results. Results: The use of lurasidone (74 mg) compared with quetiapine XR (300 mg) would lead to a reduction in direct medical costs in Italy and Spain, with a lower cost per patient of − 163.7 € (− 9.0%) and − 327.2 € (− 22.7%), respectively. In detail, it would lead to an increase in the cost of therapy of + 53.8% and of + 30.5% in Italy and Spain, respectively, to a decrease in the cost of relapses with hospitalization of − 135.7%, and to an increase in the cost of relapses without hospitalization of + 24.5%. Conclusions: The use of lurasidone (74 mg) for the treatment of patients affected with schizophrenia, compared with quetiapine XR (300 mg), would be a cost-saving strategy in the two contexts investigated assuming the National Health Service point of view. [ABSTRACT FROM AUTHOR]

• Urbanization causes biodiversity loss in rivers. • Benthic macroinvertebrates can be used as indicators of land use changes. • Land uses changes modify the trophic structure of benthic communities. • Riparian forests act as a buffer zone important to preserve riverine biodiversity. • Management politics must highlight the importance of biological indicators. Since the second half of the 20th century, when monitoring programmes were implemented as a measure to improve the water quality of rivers, numerous advantages have been achieved. one of the most remarkable advances was the integration of bioindicators as a suitable and quick tool to complement the assessment based on the evaluation of physical and chemical parameters. This paper evaluated which of the already used water quality indices based on macroinvertebrates would be more suitable to assess the ecological status of 6 rivers (Barxas, Deva, Tea, Manco, Louro and Furnia rivers) within the Miño River international basin (NW Spain and N Portugal) applying the methodology proposed by the Water Framework Directive (WFD). In addition, the relationship between the water quality and the land uses within a buffer zone of 100 along the watershed of each river was studied. Our findings demonstrate that the IBMWP (Iberian Biomonitoring Working Party) is the most suitable index to evaluate the water quality of rivers from this geographical zone. Nevertheless it is necessary to use other more sensitive index like EPT and PT indices to identify any potential pressures that might be concealed by IBMWP. The tributaries of the Miño River generally presented a good ecological status according to the IBMWP. Nevertheless, the Louro River had the lowest score for all the indices being the worst preserved among all within the basin. On the contrary Barxas, Deva and Furnia rivers showed the higher values. The results indicated that the most urbanised river was the Louro River (13 %) followed, to a lesser extent, by Manco River (7 %) and Tea River (2 %). Consequently, the Louro River had the worst water quality (poor quality) and a less diverse benthic macroinvertebrate community, in which more generalist taxa such as Chironomids, Ceratopogonids, or Crustaceans were found. On the other hand, the rivers with the best water quality were the Barxas, Deva, and Furnia, all of them with a negligible proportion of artificial cover surface (<1 %) within the delimited buffer zone. This would suggest a negative influence of the proportion of artificial areas over diversity and quality indices. [ABSTRACT FROM AUTHOR]

Background and Aims Research suggests that tobacco smokers may develop psychosis at an earlier age than non-smokers, with effects on psychotic symptoms. We aimed to test the difference in age of onset of psychosis between smokers and non-smokers. Design Self-report data were collected from smokers and non-smokers in a population of first-episode psychosis patients. Setting Out-patient first-episode psychosis programme in Santander (Cantabria), Spain. Participants Three hundred and ninety-seven patients (226 male, 171 female) who agreed to take part between 2001 and 2011. Measurements Age of onset of psychosis, age of smoking initiation, demographics, family history of psychosis and cannabis use were collected by self-report. Findings Kaplan-Meier analysis showed that smokers had a significantly lower mean age of psychosis onset [smokers = 27.4 (± 8.1) years, non-smokers = 30.5 (± 9.9) years] than non-smokers (χ2(1) = 11.72, P = 0.001). The Cox proportional hazard model showed no significant difference in the age of psychosis onset between smokers and non-smokers adjusted for covariates [hazard ratio (HR) = 1.034, 95% confidence interval (CI) = 0.828-1.291]. Age of psychosis onset was predicted significantly by cannabis use (HR = 2.073, 95% CI = 1.633-2.633) and gender (HR = 1.706, 95% CI = 1.363-2.135). Conclusions Smokers do not appear to have a significantly earlier age of psychosis onset than non-smokers after taking into account cannabis use and gender. [ABSTRACT FROM AUTHOR]

The financial crisis of 2008 began a period of major global structural changes that are significantly affecting the lives of many countries and social protest increases. To implement these changes, it is resorting to forms of governmentality of exception related to military logic. In these logics, fear is often used as a tool for driving the behavior of the population. In this article, we asked about the use of fear as a tool of governmentality; we analyzed how is fear management in policing on the social movements and their possible consistent with those warlike logic of exception in the situation in Catalonia, in times of social mobilization around 15M, also known as the indignados (2011-2012). We conducted a field research in everyday life through which we locate numerous government and policing activity relatable to the management of fear. [ABSTRACT FROM AUTHOR]

Schizophrenia patients typically present a widespread bilateral cortical thinning from the early stages of the illness. However, there is controversy whether this reduction in cortical thickness (CT) is static or progressive over the evolution of the disorder. Disrupted-in-Schizophrenia 1 (DISC1) is one of the main candidates genes for schizophrenia, as it has been found associated to the illness, and to several endophenotypes of the disorder including structural brain differences. This gene is known to be involved in neurodevelopment and brain maturation processes. We therefore hypothesized that variations in this gene modulate different progressions of CT in psychosis. Seventy-nine Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs6675281 (Leu607Phe) and rs821616 (Ser704Cys) SNPs of the DISC1 gene. Brain MRIs were carried out at baseline and 3 years after initiating the treatment. Other clinical and socio-demographic variables were recorded to rule out possible confounding effects. Patients homozygous for the Leu allele of the rs6675281 SNP had a significant (p < 0.05) descend in CT over the 3-years period, while those carrying the Phe allele presented an increase in CT. When combining the two SNPs we found a synergic effect on CT progression, presenting those patients homozygous for Leu607 +Ser704 a more pronounced cortical thinning. In conclusion, DISC1 gene variations may modulate the longitudinal changes in cortical thickness in patients suffering from a first episode of non-affective psychosis. [ABSTRACT FROM AUTHOR]

Environmental genotoxicity and cytotoxicity along the Spanish Mediterranean coast was investigated through the determination of levels of micronuclei (MN) and other nuclear abnormalities (NAs) such as nuclear buds (NB) and binucleated cells (BN) in gills of wild mussels, Mytilus galloprovincialis, from 17 study sites. The results obtained were studied in relation to the exposure to main pollutants (metals, PAHs, PCBs and DDTs), gill antioxidant enzyme activities and environmental variables (temperature and salinity). The highest MN and NB levels were found in mussels from metalpolluted sites, such as Cartagena (MN: 11.6%, NB: 4.6%) and Portman (MN: 8.0%, NB: 3.5%), where genotoxicity seemed to be related to the oxidative stress generated by exposure to metals. High frequencies of MN and NB in mussels from Algeciras 1 (MN: 8.6%, NB: 4%) and of MN (7.2%) in mussels from Manilva also indicated genotoxicity, though not attributable to the pollutants analysed. In contrast, MN levels at sites highly polluted by organic contaminants such as Barcelona, Vallcarca, Tarragona and Valencia, were lower than expected (ranging from 3.8 to 5.8%). On the other hand, evidences of cytotoxicity indicated by the high frequencies of BN found in mussels from Vallcarca, Barcelona, and Cartagena (3.9, 3.4, and 2.3%, respectively) appeared to be specifically related to the accumulation of organic pollutants. Positive correlations found between MN and NB frequencies, and also between both NAs and water temperature, suggested that they were related genotoxic events, and that this environmental factor is able to influence their levels and has to be taken into account in the application of these biomarkers in field studies. [ABSTRACT FROM AUTHOR]

Measuring mortality has been a challenge during the COVID-19 pandemic. Here, we compared the results from the Spanish daily mortality surveillance system (MoMo) of excess mortality estimates, using a time series analysis, with those obtained for the confirmed COVID-19 deaths reported to the National Epidemiological Surveillance Network (RENAVE). The excess mortality estimated at the beginning of March 2020 was much greater than what has been observed in previous years, and clustered in a very short time. The cumulated excess mortality increased with age. In the first epidemic wave, the excess mortality estimated by MoMo was 1.5 times higher than the confirmed COVID-19 deaths reported to RENAVE, but both estimates were similar in the following pandemic waves. Estimated excess mortality and confirmed COVID-19 mortality rates were geographically distributed in a very heterogeneous way. The greatest increase in mortality that has taken place in Spain in recent years was detected early by MoMo, coinciding with the spread of the COVID-19 pandemic. MoMo is able to identify risk situations for public health in a timely manner, relying on mortality in general as an indirect indicator of various important public health problems. [ABSTRACT FROM AUTHOR]

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To evaluate the state and temporal trends of the residual metal contamination caused by the dumping of mine tailings into Portman Bay (SE Spain) during the 20th century, concentrations of Hg, Cd, Pb, Cu, Zn, and As in wild mussels (Mytilus galloprovincialis) were studied over the period 1991-2005. The results show significant downward trends (P < 0.05) in the concentrations of Hg, Cu, Pb, and Zn. Nevertheless, trace metal concentrations in mussels from Portman in 2005 were higher than the reference concentrations established for the coast of Murcia and the Spanish Mediterranean littoral, the only exceptions being Cu and As. Red mullets (Mullus barbatus) caught at Portman in 1990 and 2004 presented higher levels of Hg, Cd, and Pb, in comparison with other areas of the south and southeastern coast of Spain. The results indicate that Portman Bay is still one of the areas most heavily contaminated by Pb and Cd along the Mediterranean coast of Spain 15 years after the cessation of mining activities [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to analyse the treated incidence of schizophrenia in Cantabria (Northern Spain) and the sociodemographic risk factors associated with the illness onset. Methods: Data were obtained from patients included in the Cantabria's Clinical Programme on First-Episode Psychosis (schizophrenia spectrum DSM-IV diagnosis) from 2001 to 2005, from the Cantabria first-episode schizophrenia study (carried out between 1988 and 1989) and from the 2001 Spanish census. Results: Annual incidence was 1.38 per 10 000 inhabitants in the risk-ageperiod. Identified risk factors were male gender (relative risk (RR): 1.61), age 15–25 years (RR: 3.48), unemployment (RR: 2.82), single status (RR: 5.88), low educational level (RR: 4.38), urban environment (RR: 1.62) and cannabis consumption (odds ratio: 12.83). The incidence in females was significantly lower than the one obtained 15 years ago. Conclusions: The reported factors suggest that underlying biological and social factors modulate the risk of psychosis. This balance operates differently in males and females. [ABSTRACT FROM AUTHOR]

This article examines the historical process of construction of citizenship in Spain from the beginning of the democratic experience up to the last general elections. This historical process can only be understood properly if we analyse its close relationship with the development of democratic culture and the huge modernization of Spanish social life. The contrast between the persistence of the transition legacy and the change in political cultural patterns, as argued in the article, has produced a model of citizenship that is not entirely clear, where the high degree of institutionalisation of civic rights contrasts sharply with civic practices that are quite limited, although there are interesting signs that this situation is undergoing transformations. [ABSTRACT FROM AUTHOR]

Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide. Individuals with a recent suicide attempt were recruited from nine University Hospitals across Spain as part of the SURVIVE cohort study. Anxious and depressive symptoms, and perceived HRQoL were included in the network analysis. Network structures were estimated with the EBICglasso model. Centrality measures and bridge symptoms connecting communities were explored. Subnetworks comparing younger and older individuals, and women and men were analyzed. A total of 1106 individuals with a recent suicide attempt were included. Depressed mood was the symptom with the greatest influence in the overall network, followed by anxiety symptoms such as feeling nervous, worrying, restless, and having difficulties to relax. Perceived general health was associated with increased suicidal ideation in the whole sample. Older people showed a specific connection between perceived general health and depressed mood. The cross-sectional design does not allow determination of established causality. Depressed mood was the core network's symptom and, therefore, an important target in the management and prevention of suicide. HRQoL had more influence on the network of older populations, in which it should be a primary focus. • Identifying risk factors for suicide is crucial for developing prevention programs. • Network analysis allows studying interrelations of symptoms in suicidal behaviors. • Depressed mood is the core symptom in individuals who recently attempted suicide. [ABSTRACT FROM AUTHOR]

This study aimed to analyse whether intelligence quotient (IQ) improves, declines, or remains stable over 10 years among FEP patients and healthy subjects. A group of FEP patients enrolled in a Program of First Episode Psychosis in Spain called PAFIP, and a sample of Healthy Controls (HC) completed the same neuropsychological battery at baseline and approximately 10 years later, which included the WAIS vocabulary subtest to estimate premorbid IQ and 10-year IQ. Cluster analysis was performed separately in the patient group and the HC group to determine their profiles of intellectual change. One hundred and thirty-seven FEP patients were grouped into five clusters: "Improved low IQ" (9.49 % of patients), "Improved average IQ" (14.6 %), "Preserved low IQ" (17.52 %), "Preserved average IQ" (43.06 %), and "Preserved high IQ" (15.33 %). Ninety HC were grouped into three clusters: "Preserved low IQ" (32.22 % of the HC), "Preserved average IQ" (44.44 %), and "Preserved high IQ" (23.33 %). The first two clusters of FEP patients, characterized by a low IQ, earlier age at illness onset, and lower educational attainment, showed a substantial cognitive improvement. The remaining clusters demonstrated cognitive stability. The FEP patients showed intellectual improvement or stability, but no decline post-onset of psychosis. However, their profiles of intellectual change are more heterogeneous than that of HC over 10 years. Particularly, there is a subgroup of FEP patients with a significant potential for long-term cognitive enhancement. [ABSTRACT FROM AUTHOR]

A high Coronavirus Disease 19 (COVID-19) morbidity and mortality have been reported among users and workers of long-term care facilities. The main objective of this work was to explore the prevalence and temporal pattern of COVID-19 in comprehensive network of long-term mental health facilities in Spain. Secondly, we aimed to estimate the effect of having a severe mental health diagnosis on prevalence and COVID-19 outcomes. A cohort of 2552 participants were followed-up over a one-year. Sociodemographic and clinical data related to COVID-19 were recollected using a proforma. Frequency analyses were used to determine the prevalence of COVID-19 disease. Multivariable binary regression models sequentially adjusted by gender and age were employed to explore the potential role of severe mental health diagnosis on COVID-19 outcomes. Workers had higher risk of testing positive than mental health users (odds ratio [OR] 1.57 [95 % CI 1.01–2.43; p < 0.05] who presented an equivalent risk of testing positive after accounting for age and gender (OR 1.62 [95 % CI 0.98–2.66; p = 0.06]. The significant lower prevalence of COVID-19 among mental health users could be explained by the measures implemented to prevent COVID-19 as well as by the possible role that antipsychotic treatment could play in the prevention of SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Abstract: A suite of general physiological indicators and hepatic biomarker responses were determined in red mullet (Mullus barbatus) from priority pollution areas of W Mediterranean Sea, including the highly metal polluted area of Portmán (Cartagena, SE Spain). Concentrations of metals and persistent organic pollutants in fish muscle tissue and sediment samples were also analysed. Our results showed that fish from Portmán accumulated the highest concentrations of mercury, lead and arsenic and also of some polycyclic aromatic hydrocarbons and polychlorinated biphenyls congeners. In addition, they had significantly lower condition factor, muscle lipid content and gonadosomatic index, as well as the lowest levels of DNA integrity and the highest ethoxyresorufin-O-deethylase (EROD) activity in liver of the areas investigated. Contaminant body burden in fish only partly corresponded to chemical characteristics of the sediments in the areas in which they were collected. Our findings indicate that red mullets from Portmán had suboptimal health status that warrant further study. [Copyright &y& Elsevier]

Abstract: Different types of fractures and fault rocks occur within the major normal fault zones bordering the NW of the Neogene Penedès basin (NE Spain). In the southwest part of the basin, the main fault is the Baix Penedès fault that places the Upper Jurassic–Lower Cretaceous dolomicrites of the footwall in contact with the Miocene siliciclastic sediments of the hangingwall. Within the footwall damage zone, different fracture systems and their respective associated breccias and cements have been recognized. Using a combination of structural, petrologic and geochemical analyses, we show that these fracture systems evolved from mainly tectonic to mainly karstic features during the progressive development and upward propagation of the fault. The earlier fractures and associated breccias represent the initial stages of the fault propagation, when the process zone formed around the fault tip was dominated by dilatant fracturing (fractures 1 and dilatant breccias B1). The fluid involved in this early deformation precipitated the dolomite cement C1, in equilibrium with the host-rock in a closed hydrogeological system. Localization of frictional processes generated cataclasites and ultracataclasites along distinct second-order faults (fractures 2). In these fractures, the dolomite cement C2 precipitated in relation to the incipient opening of the hydrological system to percolating meteoric waters. The later fractures and associated breccias represent the late stages of the fault propagation. These structures (fractures 3, fractures 4 and the dilatant breccias B2) were formed when the extensional deformation reached the surface, resulting in an increasingly open hydrogeological system. At these stages, deposition of the dolomitic sediment DS and precipitation of the calcite cements C3, C4 and C5 show the circulation of freshwaters in a vadose meteoric environment, i.e. in karstic conditions. [Copyright &y& Elsevier]

The main aim of this study is to examine the association between psychosis and immigration, independent of the language barrier, drug consumption, and the social support index. The second aim is to explore the clinical and demographic characteristics of the immigrants in the catchment area, compared with the native Spanish population suffering from psychosis. All consecutive patients admitted to a hospital in Spain during 2018 and 2019 (n = 1484) were identified through the hospital's clinical records. The general representative sample (n=1484) was divided into two groups: immigrants (n=131) and non-immigrants (n=1353). Demographic, clinical, and social variables were then obtained and included in a logistic regression model. A subsample with all consecutive cases with psychosis (93 immigrants and 543 no immigrants) was also analysed to describe the diagnosis and evolution after admission. Our results show that there is higher significant prevalence of admissions due to psychosis in the immigrant population than in the non-immigrant population. This association is prominent in the population of Sub-Saharans, and is independent of cannabis use, a low social support index, or a language barrier. Understanding the specificities not only in the social context of this population but also the clinical needs is determinant for being able to shape the therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare self-reported changes on lifestyle behaviors during two phases of the COVID-19 pandemic in Spain, and to evaluate clinical and sociodemographic factors associated with lifestyles.Methods: Two cross-sectional web surveys were conducted during lockdown (April 15-May 15, 2020) and seven months later (November 16-December 16, 2020). Lifestyle behaviors were self-reported by a multidimensional scale (SMILE-C). Two separate samples of respondents were analyzed. A multivariate regression model was performed to evaluate the association of SMILE-C scores with demographic and clinical variables.Results: The sample comprised, 3412 participants from the first survey (S1) and in the S1 and 3635 from the second (S2). SMILE-C score decreased across surveys (p < 0.001). The rates of positive screenings for depression and anxiety were similar between the surveys, whereas those for alcohol abuse decreased (p < 0.001). Most participants in S2 reported that their lifestyle had not changed compared to those before the pandemic. Variables independently associated with an unhealthier lifestyle were working as an essential worker, lower educational level, previous mental disease, worse self-rated health, totally/moderate changes on diet, sleep or social support, as well as positive screenings for alcohol abuse, anxiety and depression.Limitations: The cross-sectional design and recruitment by non-probabilistic methods limit inferring causality and the external validity of the results.Conclusions: Overall lifestyle worsened seven months after the lockdown in Spain. Several demographic and clinical factors were associated with lifestyle scores. The contribution of common mental disorders to unhealthier lifestyles should be considered in order to prevent the negative impact of the pandemic. [ABSTRACT FROM AUTHOR]

Abstract: In this study the effects of the main marine pollutants (metals, PAHs, PCBs and DDTs) were assessed in native mussels from the Mediterranean coast of Spain. For this purpose several biomarkers such as benzo[a]pyrene hydroxylase (BPH), DT-diaphorase (DTD), glutathione S-transferase (GST), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidases (GPs), glutathione reductase (GR), metallothionein (MT) and lipid peroxidation (LPO) were measured in the digestive gland. Results showed increased LPO levels in mussels which accumulated high loads of organic compounds and arsenic in their tissues. BPH levels correlated to the concentrations of organic compounds in mussel tissues, though the range of BPH response was low in relation to the high gradient of accumulation of organic pollutants. Increased BPH levels, concomitant to low DTD and GST activities, were detected in mussels which presented high levels of organic pollutants in their tissues. This suggests that signs of LPO present in these organisms are related to the imbalance between phase I and phase II biotransformation processes. Furthermore, the increased levels of MT and CAT detected in mussels which showed high levels of Cd in their tissues appear to reflect a coordinated response which protects against the toxicity of this metal. The application of these biomarkers in environmental assessment is discussed. [Copyright &y& Elsevier]

Abstract: Antioxidant response was used to assess the effects of the main pollutants in wild mussels (Mytilus galloprovincialis) along the Mediterranean coast of Spain. Antioxidant enzyme activities – those of catalase, superoxide dismutase, glutathione peroxidases, glutathione reductase, glutathione S-transferase and DT-diaphorase – as well as lipid peroxidation and metallothionein concentrations were measured in gills of mussels from 16 selected sites. Furthermore, concentrations of the main contaminants (Hg, Pb, Cd, Cu, Zn, As, PAH, PCB, and DDT) were quantified in mussel tissue, and environmental parameters were measured in water samples collected at each site. Results showed that the glutathione-dependent antioxidant enzymes offered an increased and coordinated response against metal (Hg, Pb and Cd) contamination. These enzymatic activities correlated positively to temperature, suggesting the influence of this environmental parameter on antioxidant responses in gill tissues. Furthermore, although temperature did not reach stressful levels in the study area, it seemed to add a synergistic effect to that produced by metals to induce antioxidant enzymes in the most metal-polluted sites. Catalase activity appeared to be involved in a different antioxidant pathway, more related to organic pollutant bioaccumulation, offering an efficient protection mechanism against reactive oxygen species generation due both to organic exposure and high physiological activity, reflected by high condition indices. In general terms, increased levels of antioxidant enzymes at some sites suffering from metal and organic pollution indicated a situation of oxidative stress that nevertheless did not appear to be harmful, since lipid peroxidation levels showed no peroxidative damage in gill tissues of mussels collected from even the most heavily polluted sites. On the other hand, metallothionein and DT-diaphorase did not reflect pollutant exposure and seemed to be more influenced by environmental variables than by the pollutants. [Copyright &y& Elsevier]

• We found high rates of admissions for the FEP in migrants compared to no immigrants. • The findings of our study also suggest that sub-Saharan Africans are the immigrants most vulnerable to present an admission for the FEP in this province. • The increase in hospital admissions for FEP in the immigrant population observed in our study is consistent with data from previous studies across Europe. We present data on the incidence of admissions for first episode psychosis in a region of southern Spain. All consecutive cases of admissions to the psychiatric hospitalization unit due to psychosis were selected. The incidence rates for first episode psychosis among immigrants and non-immigrants between two years were calculated. Incidence rate ratio of first episode of psychosis was higher in immigrants (IRR 5.95 95% CI 3.8–9.3 p <0.001) and also in individuals from Sub-Saharan Africa (IRR: 30.09 95% CI:16.2–55.8 p <0.001). The results reflect the risk that immigrants have a greater risk of being hospitalized than non-immigrants. [ABSTRACT FROM AUTHOR]

The spatial distribution and temporal trends of trace metals (i.e. Cd, Cu, Hg, Pb and Zn) and a metalloid (i.e. As) along the Spanish Mediterranean coast from 1993 to 2013 are presented with a new estimation of their background levels monitored using wild mussels. Over a 20 years period, yearly mussel monitoring was undertaken with a rigorous field sampling protocol using 3 pooled samples strategy (3 x n = 80, with 8 mussels in the 3.0 to 3.9 size categories at each site), obtained in the pre-spawning period (May–June) to minimize biological factors and seasonal variability, which is a fundamental element of the international programme. Spatial distribution was characterized every 5 years and temporal trends were determined in 11 locations. The main aims of the present long term study are to evaluate the environmental status of different coastal locations regarding trace metal levels and follow the evolution of these levels over time after the implementation of regulatory measures. Regarding spatial distribution, the highest values for Cd, Cu, Hg and Pb were found close to known highly anthopogenic cities or shipyard areas. However, As and Zn did not strictly follow this pattern, showing natural increased concentrations in the Levantine Balearic and Strait of Gibraltar-Alboran Sea demarcations respectively. These distributions are associated with the conjunction of two geological formation inputs (Massif Central in France and Iberian Pyritic Belt in Spain) and the oceanographic conditions in the adjacent coastal area. In the case of temporal trends, metal concentrations decreased significantly over time in most stations, confirming the effectiveness of the regulatory measures and prohibitions established under European legislation. Concentrations of Pb were above the established thresholds for human consumption in only 12–14% of the sampling areas. With the information obtained for this study, we estimate background concentrations and propose new Background Assesment Criteria (BAC) for the Spanish Mediterranean coast as a threshold criterion: 1.62 mg/kg d.w. for Cd, 8.75 mg/kg d.w. for Cu, 0.202 mg/kg d.w. for Hg and 2.83 mg/kg d.w. for Pb. Exceptions should exist for As and Zn, for which there should be different levels in each demarcation, due to the geological, hydrological and oceanographic peculiarities of the Spanish coast. For the Levantine-Balearic demarcation, the proposed background concentrations are 117 mg/kg d.w. for As and 200 mg/kg d.w. for Zn., whereas in the Strait of Gibraltar-Alboran Sea demarcation, they are 27.5 mg/kg d.w. for As, and 471 mg/kg d.w. for Zn. This work demonstrates the vital importance of defining the background levels of metal(loid)s at a regional or subregional level because, for areas not affected by anthropogenic causes which have high values as the result of natural processes, this would avoid the risk of constantly surpassing the levels proposed in directives. [Display omitted] • Metal(loid) concentrations in mussels have decreased over the years in the Spanish Coast. • Environmental regulatory measures at different scales have proved to be effective. • The geology, hydrology or oceanography of the area influences metal levels. • It is mandatory to define metal(loid) baseline levels at a regional scale. [ABSTRACT FROM AUTHOR]

Human mobility drives the geographical diffusion of infectious diseases at different scales, but few studies focus on mobility itself. Using publicly available data from Spain, we define a Mobility Matrix that captures constant flows between provinces by using a distance-like measure of effective distance to build a network model with the 52 provinces and 135 relevant edges. Madrid, Valladolid and Araba/Álaba are the most relevant nodes in terms of degree and strength. The shortest routes (most likely path between two points) between all provinces are calculated. A total of 7 mobility communities were found with a modularity of 63%, and a relationship was established with a cumulative incidence of COVID-19 in 14 days (CI14) during the study period. In conclusion, mobility patterns in Spain are governed by a small number of high-flow connections that remain constant in time and seem unaffected by seasonality or restrictions. Most of the travels happen within communities that do not completely represent political borders, and a wave-like spreading pattern with occasional long-distance jumps (small-world properties) can be identified. This information can be incorporated into preparedness and response plans targeting locations that are at risk of contagion preventively, underscoring the importance of coordination between administrations when addressing health emergencies.

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

Background: The omicron (B.1.1.529) variant of SARS-CoV-2 has increased capacity to elude immunity and cause breakthrough infections. The aim of this study was to estimate the effectiveness of mRNA-based vaccine boosters (third dose) against infection with the omicron variant by age, sex, time since complete vaccination, type of primary vaccine, and type of booster., Methods: In this nationwide cohort study, we linked data from three nationwide population registries in Spain (Vaccination Registry, Laboratory Results Registry, and National Health System registry) to select community-dwelling individuals aged 40 years or older, who completed their primary vaccine schedule at least 3 months before the start of follow-up, and had not tested positive for SARS-CoV-2 since the start of the pandemic. On each day between Jan 3, and Feb 6, 2022, we matched individuals who received a booster mRNA vaccine and controls of the same sex, age group, postal code, type of vaccine, time since primary vaccination, and number of previous tests. We estimated risk of laboratory-confirmed SARS-CoV-2 infection using the Kaplan-Meier method and compared groups using risk ratios (RR) and risk differences. Vaccine effectiveness was calculated as one minus RR., Findings: Between Jan 3, and Feb 6, 2022, 3 111 159 matched pairs were included in our study. Overall, the estimated effectiveness from day 7 to 34 after a booster was 51·3% (95% CI 50·2-52·4). Estimated effectiveness was 52·5% (51·3-53·7) for an mRNA-1273 booster and 46·2% (43·5-48·7) for a BNT162b2 booster. Effectiveness was 58·6% (55·5-61·6) if primary vaccination had been with ChAdOx1 nCoV-19 (Oxford-AstraZeneca), 55·3% (52·3-58·2) with mRNA-1273 (Moderna), 49·7% (48·3-51·1) with BNT162b2 (Pfizer-BioNTech), and 48·0% (42·5-53·7) with Ad26.COV2.S (Janssen). Estimated effectiveness was 43·6% (40·0-47·1) when the booster was administered between 151 days and 180 days after complete vaccination and 52·2% (51·0-53·3) if administered more than 180 days after primary scheduled completion., Interpretation: Booster mRNA vaccine-doses were moderately effective in preventing infection with the omicron variant of SARS-CoV-2 for over a month after administration, which indicates their suitability as a strategy to limit the health effects of COVID-19 in periods of omicron variant domination. Estimated effectiveness was higher for mRNA-1273 compared with BNT162b2 and increased with time between completed primary vaccination and booster., Funding: None., Competing Interests: Declaration of interests We declare no competing interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

BackgroundAfter a national lockdown during the first wave of the COVID-19 pandemic in Spain, regional governments implemented different non-pharmaceutical interventions (NPIs) during the second wave.AimTo analyse which implemented NPIs significantly impacted effective reproduction number (R t ) in seven Spanish provinces during 30 August 2020-31 January 2021.MethodsWe coded each NPI and levels of stringency with a 'severity index' (SI) and computed a global SI (mean of SIs per six included interventions). We performed a Bayesian change point analysis on the R t curve of each province to identify possible associations with global SI variations. We fitted and compared several generalised additive models using multimodel inference, to quantify the statistical effect on R t of the global SI (stringency) and the individual SIs (separate effect of NPIs).ResultsThe global SI had a significant lowering effect on the R t (mean: 0.16 ± 0.05 units for full stringency). Mandatory closing times for non-essential businesses, limited gatherings, and restricted outdoors seating capacities (negative) as well as curfews (positive) were the only NPIs with a significant effect. Regional mobility restrictions and limited indoors seating capacity showed no effect. Our results were consistent with a 1- to 3-week-delayed R t as a response variable.ConclusionWhile response measures implemented during the second COVID-19 wave contributed substantially to a decreased reproduction number, the effectiveness of measures varied considerably. Our findings should be considered for future interventions, as social and economic consequences could be minimised by considering only measures proven effective.

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

The aim of this study is to propose national diagnostic reference levels (DRL) for updating in the field of interventional cardiology and to include technical details to help plan optimization. Medical physics experts and interventional cardiologists from 14 hospitals provided patient dose indicators from coronary angiography and percutaneous coronary interventions. Information about X-ray system dose settings and image quality was also provided. The dose values from 30,024 procedures and 26 interventional laboratories were recorded. The national DRLs proposed for coronary angiography and percutaneous coronary interventions were respectively 39 and 78 Gy·cm 2 for air kerma area product (P KA ), 530 and 1300 mGy for air kerma at reference point (K a,r ), 6.7 and 15 min of fluoroscopy time and 760 and 1300 cine images. 36% of the KAP meters required correction factors from 10 to 35%. The dose management systems should allow these corrections to be included automatically. The dose per image in cine in reference conditions differed in a factor of 5.5. Including X-ray system dose settings in the methodology provides an insight into the differences between hospitals. The DRLs proposed for Spain in this work were similar to those proposed in the last European survey. The poor correlation between X-ray systems dose settings and patient dose indicators highlights that other factors such as operation protocols and complexity may have more impact in patient dose indicators, which allows a wide margin for optimization. Dose reduction technology together with appropriate training programs will be determinant in the future reduction of patient dose indicators., (Copyright © 2020 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

In recent years, health asset maps have become increasingly important tools in the field of health promotion. They are being incorporated into the daily practice of many healthcare workers, in individualized care in consultations (through social prescription), and in groups or community development processes. It is necessary to reflect on how the asset maps are being produced, analyzing how the different stages of the process can be involved in their construction. The formats in which the data is obtained through the identification of health assets are presented, as well as the processes of production of the information, participative and evaluated processes, are crucial for the maps to be useful, for professionals as well as citizens and institutions., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

A dialogue between ethics and public health on the moral implications of the promotion of community health in which the importance of respecting autonomy and contributing to the empowerment of the community with which it collaborates is highlighted; in addition to the appropriateness of an explicit commitment that sets out the limits of collaboration and the opportunity for a specific deontology., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The thirteenth SESPAS (Spanish society of public health and health management) report is structured in three blocks Who, How and What about community health and local governance. In the who block the main agents working in community health are described: communities, health care system, and local government; and how their relations and implication in community health have evolved; which concepts are used; what is the current situation and which challenges they have. The How block contains methodological views, oriented towards implementation of community interventions, based upon participatory tools, development of networks and review of evidence and evaluations to build a National Strategy of Health Promotion of the Spanish Ministry of Health, welfare and consumers affairs including suitable deontologic principles. Finally, the what block refers to a wide range of experiences of community health at the local level as well as training in community health, urbanism, gender, neighborhoods, healthy universities. Additionally, besides regular papers, we show dialogs including debates to further develop community health. It contains 18 papers, without taking into account this introduction, authored by 40 men and 49 women., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Since 2009, the economic recession has led to cuts in spending on social welfare policy and in health care. The most important risks to health depend on negative changes in social determinants. Notable among these determinants are unemployment and the large proportion of people at risk of poverty, which affects 30% of children younger than 14 years. Social inequalities have increased significantly, much more than health inequalities, probably because the value of retirement pensions has been maintained until now. Most of the population is fairly satisfied with the public health system, although it is under considerable pressure. Mortality statistics have not been affected so far, but there has been an increase in mood disorders and mental health problems. Health services utilization has decreased and the number of publicly prescribed drugs has fallen dramatically. This restriction accounts for much of the decrease in public spending on health, since the hospital care budget has not decreased, despite the fall in primary care and public health spending. The crisis could encourage community health and the inclusion of health in all policies. It is the responsibility of professionals and public health institutions monitoring the trend in health problems and their determinants to avoid irreversible situations as far as possible., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To identify the basic competencies and contents related to public health to be included in degree programs according to the perspective of lecturers from various Spanish universities., Method: In the context of the Second Workshop on Public Health Contents in Degree Programs (Mahon, 19 to 20 September 2012), 20 lecturers from different Spanish universities were distributed in five working groups. The lecturers had been selected from the instructional guides on public health and epidemiology published on the web sites of the Rectors' Conference of Spanish Universities. Each group worked on a degree program and the results were discussed in plenary sessions., Results: The activities and competencies related to the three basic functions of public health were identified in all degree programs. Most of the professional competencies identified were related to the function of «assessment of population health needs». The contents proposed by the working groups related to epidemiology, basic concepts in public health, public health intervention, health management, and health policy. The main common topics among the degrees concerned the first three contents., Conclusions: Public health professional competencies and contents were identified in the degree programs examined. These results may serve as a starting point for a more detailed review of public health programs across degree levels and the search for a consensus on the common content that should be included in each of them., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objectives: To evaluate the adequacy of cardiovascular primary prevention by calculating cardiovascular risk (CVR) with 2 different equations and to evaluate the economic impact of the resulting drug expenditure. DESIGN. By means of a transversal study of all the new cases of lipaemia diagnosed, patients were classified in 2 CVR categories (> or =20% and <20%). The Framingham-Wilson (FW) and Framingham-REGICOR (FR) equations were used to analyse the difference between observed treatments (really prescribed) and expected treatments. Costs were compared., Setting: Barceloneta PCC, Barcelona, Spain., Patients: Ninety-two cases of lipaemia (2002 and 2003) that met the following inclusion criteria: no coronary history, no taking of lipid-lowering drugs, and age between 35 and 74. There were 10 losses in the 92 individuals through lack of a variable for calculating CVR., Results: According to the clinical criterion, 22 of the 82 patients were treated with medication (26.82%). The expected proportion of patients treated when the FW equation was used was 24.39% (20/82); and was 0% (0/82) with the FR equation. On applying the FW equation, it was seen that 12 of 22 patients treated and 10 of 60 patients not treated did not receive the correct drug treatment. If the mean cost per patient treated and per year at the PCC is applied to the new cases, there is a 9.09% reduction (euro 479.2) for the FW equation and 100% (euro 5271.2) for the FR equation., Conclusions: The use of one or other algorithm for calculating CVR entails pertinent differences in clinical practice and expenditure. All patients in primary prevention must receive non-pharmacological treatment.