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Introduction: Nirmatrelvir/ritonavir (Paxlovid®) is the only oral treatment authorized in Europe to treat COVID-19 disease in adults who do not require supplemental oxygen and who are at high risk for progression to severe COVID-19. It is available in Spain after validation due to the profile of interactions and warnings for use. The objective is to determine effectiveness, safety and management of interactions. Method: Retrospective study of all patients on validated nirmatrelvir/ritonavir treatment at three urban health centres during 2022. Effectiveness was the proportion of participants without COVID-19-related hospitalization or death from any cause through day 28. Results: 24 patients were analyzed. It was considered effective in 23 (95.8 %). More than 80 % of patients presented potential interaction with the concomitant medication, recommending the temporary suspension of medications, highlighting simvastatin and metamizole. Conclusions: Nirmatrelvir/ritonavir has been considered effective but difficult to manage in polymedicated polypathological patients. [ABSTRACT FROM AUTHOR]

Objective: Air pollution is a global public health issue, with particulate matter (PM) being the pollutant with the greatest impact on health. The main objective of this article was to estimate the impact of mortality attributable to particulate pollution in the city of Valencia during the period 2015-2017., Methods: The Health Impact Assessment (HIA) methodology from the Aphekom project was used. Scenarios of a 5 µg/m 3 reduction in the annual mean concentration of PM 10 and PM 2.5 were employed, along with the assumption of meeting the World Health Organization (WHO) recommendations in effect during the study period, to estimate both short- and long-term impacts., Results: The estimated average concentrations for 2015-2017 were 18.4 µg/m 3 for PM 10 and 12.3 µg/m 3 for PM 2.5 . The short-term HIA, assuming a reduction of 5 µg/m 3 in the averages, resulted in a total of 65.4 premature deaths that could be postponed during that period (21.8 annually), corresponding to a rate of 2.8 deaths per 100,000 inhabitants. In the long term, if PM 2.5 concentrations had been reduced by 5 µg/m 3 , 124 premature deaths could have been postponed annually., Conclusions: The annual average concentrations of these pollutants meet the limits set by European regulations. However, compared to WHO recommendations, PM 2.5 levels are higher by 2.3 µg/m 3 . An air quality scenario in line with WHO recommendations would have resulted in a reduction of 122 premature deaths annually., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Economic recessions can increase socioeconomic inequalities in health. The objective of this study was to analyze socioeconomic inequalities in small-for-gestational-age (SGA) births before and during the Spanish economic crisis. We conducted an ecological study of trends based on 2 periods before the crisis (1999–2003 and 2004–2008) and another during the crisis (2009–2013). The study population was Spanish women resident in 13 cities who had given birth during 1999–2013. The prevalence of SGA was calculated for each census tract. A hierarchical Bayesian model was used to obtain the prevalence ratio (PR) and 95% credible intervals (CI). We analyzed the association between SGA and socioeconomic deprivation in each period for each city and for 3 age groups. The PR was above 1 and statistically significant for all 3 time periods in most of the 13 cities. The differences in PR between periods were only statistically significant for Madrid (PR = 1.56, 95% CI 1.48–1.65 for 1999–2003; PR = 1.28, 95% CI 1.19–1.38 for 2004–2008) and Barcelona (PR = 0.99, 95% CI 0.87–1.12 for 2004–2008; PR = 1.20, 95% CI 1.05–1.36 for 2009–2013). Socioeconomic inequalities in SGA births in small areas (census tracts) of most Spanish cities studied remained stable before and during the economic crisis. [ABSTRACT FROM AUTHOR]

Literature suggests that urban regeneration policies might contribute towards improving mental health of residents, but to date there is a lack of empirical research on how these policies and downward social mobility can interact and influence health outcomes. The current study aims to explicitly test whether regeneration policies implemented in deprived Andalusian urban places (southern Spain) moderate the use of anxiolytics and/or antidepressants, taking into consideration families' downward social mobility during the recent period of economic crisis in Spain. We designed a post intervention survey to retrospectively compare the evolution of psychotropic drug consumption in target and comparison areas. We observe a general increase in the use of anxiolytics and/or antidepressants from 2008 to 2015, specifically for people in whose families the economic crisis had the greatest impact (odds ratio = 2.18; p value < 0.001). However, better evolution is observed among residents of the target areas compared with residents of similar urban areas where this kind of polices have been not in force (odds ratio = 0.50; p value < 0.05). Therefore, urban regeneration policies might act as moderators of the risk of mental health, particularly when people are subject to the loss of individual/family resources in urban vulnerable contexts. [ABSTRACT FROM AUTHOR]

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences ( p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ocaña-Ortiz, Gea-Caballero, Juárez-Vela, Peiró, Pérez-Sanz, Santolalla-Arnedo, Sufrate-Sorzano, Garrote-Cámara and Paredes-Carbonell.)

Rapid urbanisation exacerbates health and wellbeing disparities in vulnerable contexts and underscores the imperative need to develop innovative and participatory co-creation approaches to understand and address the specificities of these contexts. This paper presents a method to develop an assessment framework that integrates top-down dimensions with bottom-up perspectives to monitor the impact of inclusive health and wellbeing interventions tailored to the neighbourhood's needs in Las Palmeras, a vulnerable neighbourhood in Cordoba (Spain). Drawing upon studies in the literature examining urban health and wellbeing trends, it delineates a participatory and inclusive framework, emphasising the need for context-specific indicators and assessment tools. Involving diverse stakeholders, including residents and professionals, it enriches the process and identifies key indicators and assessment methods. This approach provides valuable insights for managing innovative solutions, aligning them with local expectations, and measuring their impact. It contributes to the discourse on inclusive urban health by advocating for participatory, context-specific strategies and interdisciplinary collaboration. While not universally applicable, the framework offers a model for health assessment in vulnerable contexts, encouraging further development of community-based tools for promoting inclusive wellbeing.

Urban health faces significant challenges due to the rapid growth of cities and the concentration of population in urban settings that have a strong impact on people's health. The approach to characterize and address these challenges requires increased societal involvement and interdisciplinary solutions to ensure their effectiveness and democratic nature. With this purpose, it is necessary to explore methodologies for citizen participation that foster a critical understanding of the environment and promote their active role in generating scientific knowledge and change. This article describes the creation of a collaborative space for experimentation and learning that, through the intersection of citizen science and social innovation, aims to engage citizens in the research and diagnosis of their local environment, as well as in the design and implementation of local solutions, while raising awareness about the main challenges to urban health. Through a collaborative and participatory framework, the community identified relevant challenges to urban health they wanted to investigate, co-designed and developed the methodology for data collection and analysis, and ultimately, they devised, designed, and implemented innovative solutions based on the scientific evidence obtained. The framework and results of this project hold potential interest for the scientific community, facilities, institutions, and society by offering an innovative and participatory approach to addressing the present and future urban health challenges., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Santos-Tapia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background Studies on the association between frailty and health-related quality of life (HRQoL) are scarce and show contradictory results. This study aimed to evaluate the association between physical, psychological and social frailty and HRQoL among community-dwelling older people. Methods A cross-sectional study was performed with baseline data collected in 2015 from the Urban Health Centers Europe (UHCE) project in five European countries, the United Kingdom, Greece, Croatia, The Netherlands and Spain. A total of 2325 participants were included in the baseline measurements of the Urban Health Centers Europe project; 2167 participants (mean age = 79.7; SD=5.6) were included in the analyses after excluding participants with missing data. The Tilburg Frailty Indicator measured overall frailty as well as physical, psychological and social frailty. The 12-Item Short-Form Health Survey was used to measured physical and mental HRQoL. Results Regarding physical HRQoL, a large difference (d =1.29) between physically and not physically frail participants was observed. Regarding mental HRQoL, a large difference (d =1.20) between psychologically and not psychologically frail participants was observed. In the full model with all three domains of frailty and the covariates to explain physical HRQoL, physical (P <0.001) and social frailty (P <0.001) remained significant. In the full model to explain mental HRQoL, all three domains of frailty remained significant (P <0.001). Conclusion Physical frailty had the strongest association with physical HRQoL, and psychological frailty had the strongest association with mental HRQoL. The associations between social frailty and both physical and mental HRQoL remain significant when controlling for physical and psychological frailty. [ABSTRACT FROM AUTHOR]

Background: The efficacy of smoking cessation interventions can be quite diverse in day-to-day clinical practice.Objective: To analyse the effectiveness in smoking cessation of multicomponent interventions carried out in groups or individually in primary care practices.Methods: A quasi-experimental, multicentre study of 12-month follow-up of patients treated in multicomponent smoking cessation interventions was carried out in Urban health care centres in Sevilla, Spain. Two hundred and twenty smoking patients, ≥18 years of age, participated either in a multicomponent intervention group (n = 145; mean age 51.7 years; 53.1% women) or in individual interventions (n = 77; mean age 50.5 years; 61.0% women). The abstinence or relapse status was computed from patient self-reports, confirmed by relatives or companions when possible and supplemented by CO-oxymetry tests in 89 patients.Results: The overall percentage of smoking cessation was 36.9% (37.9% with group and 35.1% with individual intervention, P = 0.398). Patients who quit smoking were younger (48.7 versus 52.9 years old, P < 0.01), with fewer years of smoking (32.9 versus 36.8 years, P < 0.05), with higher education (39.0% versus 25.0%, P < 0.05) and had received pharmacological treatment (91.5% versus 67.9%, P < 0.001). In the multivariate analysis, level of education [odds ratio (OR): 1.995; 95% confidence interval (CI): 1.065-3.735, P < 0.01], group intervention (OR: 1.743; 95% CI: 1.006-3.287, P < 0.05) and drug prescription (OR: 2.368; 95% CI: 1.126-4.980, P < 0.05) were significantly associated with smoking cessation.Conclusions: Our study found that multicomponent group and individual interventions in primary care were associated with an overall quit rate of smoking of 36.9% at 12-month follow-up, with higher probability of success among patients with higher education and those who received the group intervention and drug treatment. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: childhood overweight and obesity have increased progressively in the last decades, especially in countries of Southern Europe. Objective: to analyze the association of overweight and obesity childhood in the city of Barcelona according to socioeconomic variables in schoolchildren in third grade primary school. Methods: transversal study. Study population: third grade primary school students in the city of Barcelona in year 2011 (n = 3,624). Body mass index was studied as the dependent variable, and sex, age, social class, parental status, origin, ownership school, neighborhood socioeconomic status of the school and district were studied as independent. Logistic regression models were analyzed, obtaining odds ratio (OR) with 95% confidence intervals (95% CI). Results: the prevalence of overweight and obesity in childhood were 24.5% and 13.8%, respectively. The variables associated with obesity were: boy (OR = 1.26; 95% CI = 1.02-1.57), low socioeconomic status (OR = 1.60; 95% CI = 1.16-2.20), single-parent family (OR = 1.35; 95% CI = 1.03-1.77), immigrant (OR = 1.68; 95% CI = 1.33-2.13) and living in one of the less favored districts of Barcelona. Conclusions: it is evident that social class, origin, family status and the district of residence play an important role in childhood obesity. [ABSTRACT FROM AUTHOR]

Urban wild boars (Sus scrofa) from Barcelona, Spain, harbor great diversity of Streptococcus suis strains, including strains with the cps2 gene and with the same molecular profile as local human cases. The increasing trend of potential effective contacts for S. suis transmission is of public health concern. [ABSTRACT FROM AUTHOR]

Objective: To gain a deeper understanding of the retail food environment by investigating similarities and differences between objective measures and residents' perspectives.Design: The study incorporated Geographic Information System (GIS)-based measures, in-store surveys and the results from a larger photovoice project. We combined these data using a convergent parallel mixed-methods approach.Setting: We conducted this study in a low-income neighbourhood in Madrid (Spain) in 2016.Subjects: We assessed healthy food availability, accessibility and affordability using GIS-based measures and in-store audits. We also analysed the photographs and discussions from twelve participants who engaged in a photovoice project on their food environment.Results: Quantitative results depicted a widely served and highly accessible retail food environment, in which supermarkets scored highest in terms of healthy food availability (36·5 out of 39) and 98·9 % of residents could access a healthy food store within a walking travel distance of less than 15 min. Qualitative results showed that participants preferred small local businesses over supermarkets, and revealed built environment obstacles for elderly residents. They also highlighted how the socio-economic context constrained residents' food choices.Conclusions: People's experienced retail food environment is different from the one quantitatively analysed. Results show the potential of using a mixed-methods approach to enrich food environment research and enhance public health interventions. [ABSTRACT FROM AUTHOR]

Aim: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities.Methods: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT.Results: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively).Conclusions: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions. [ABSTRACT FROM AUTHOR]

Background: Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation.Methods: In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive 'care as usual'. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants.Discussion: The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings.Trial Registration: ISRCTN registry number is ISRCTN52788952 . Date of registration is 13/03/2017. [ABSTRACT FROM AUTHOR]

To study the association between exercise facility availability and type 2 diabetes incidence and its complications, and to explore effect modification by socioeconomic status (SES) and sex in the Madrid adult population. A multilevel longitudinal design, based on a population-based retrospective cohort including 1,214,281 residents of Madrid (Spain) aged 40–75 years from 2015 to 2018. Outcomes were type 2 diabetes incidence and macrovascular (cardiac ischemia and/or stroke) and microvascular (chronic kidney disease, retinopathy, and/or peripheral vascular disease) complications in those with diabetes at baseline. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each participant's residence. Poisson regression models with robust standard errors were used to estimate the risk ratios (RR). Interactions were explored with SES tertiles and by sex. Residents living in areas with lower exercise facility availability showed higher risk of type 2 diabetes (RR tertile3vs1 = 1.25, CI95% 1.21–1.30) as well as macrovascular (RR Tertile 3vs1 = 1.09 CI95% 1.00–1.19), and microvascular (RR Tertile 3vs1 = 1.10 CI95% 1.01–1.19) complications. Associations were strongest in low SES areas for type 2 diabetes (RR tertile3vs1-LOW-SES = 1.22, CI95% 1.12–1.32; RR tertile3vs1-HIGH-SES = 0.91, CI95% 0.85–0.98) and microvascular complications (RR tertile3vs1-LOW-SES = 1.12, CI95% 0,94–1,33; RR tertile3vs1-HIGH-SES = 0.88, CI95% 0.73–1.05). Living in areas with lower availability of exercise facilities was associated with a greater risk of type 2 diabetes and its complications. Increasing exercise opportunities, particularly in low SES areas, could help reduce the social gradient of diabetes and its complications. • First study analysing effect of exercise facilities on diabetes and its complications. • Low exercise facilities availability is associated with higher risk of type 2 diabetes. • Results showed the same effect for microvascular and macrovascular complications. • People living in low SES areas showed stronger associations, especially for men. • Our results reinforce the role of exercise facilities availability on diabetes burden. [ABSTRACT FROM AUTHOR]

Background: An important health issue in urban areas is how changes arising from the regeneration of city-areas affect social determinants of health and equity. This paper examines the impacts attributable to a new fish market and to delays in the regeneration of a port area in a deteriorated region of the Bay of Pasaia (Spain). Potential differential impacts on local residents and socially vulnerable groups were evaluated to determine health inequalities. Methods: An in-depth, prospective and concurrent Health-Impact-Assessment (HIA) focused on equity was conducted by the regional Public Health Department, following the Merseyside guidelines. Data from different sources was triangulated and impacts were identified using qualitative and quantitative methods. Results: The intervention area is characterised by poor social, environmental, and health indicators. The distinctness of the two projects generates contrasting health and inequality impacts: generally positive for the new fish market and negative for the port area. The former creates recreational spaces and improves urban quality and social cohesion. By contrast, inaction and stagnation of the project in the port area perpetuates deterioration, a lack of safety, and poor health, as well as increased social frustration. Conclusions: In addition to assessing the health impacts of both projects this HIA promoted intersectoral partnerships, boosted a holistic and positive view of health and incorporated health and equity into the political discourse. Community-level participatory action enabled public health institutions to respond to new urban planning challenges and responsibilities in a more democratic manner. [ABSTRACT FROM AUTHOR]

Objective: To identify women's sociodemographic and variables related to health care with the prescription of hormonal therapy (HT) and phytotherapy (PT) in Spanish postmenopausal women.Method: The survey consisted of a multicenter, observational, cross-sectional, questionnaire-based investigation and was conducted among 3022 postmenopausal women.Results: Of all the women, 31.8% reported the use of systemic HT or PT sometime in their lives. Hot flushes and information received about menopause were the most important variables that influence HT and PT use, although far more intense symptoms were observed in those who were inclined to use HT. The use of HT or PT was more frequently reported among women with high levels of education, who came from private clinics and lived in urban areas. Women who had primary ovarian insufficiency or surgical menopause were inclined to use HT.Conclusion: Hot flushes and information received about menopause are the most important variables that influence HT and PT use. [ABSTRACT FROM AUTHOR]

Background: In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996-1998 and 2005-2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time.Methods: Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996-1998 and 2005-2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI).Results: For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12-1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09-1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05-1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02-1.06 in the 2nd period).Conclusions: In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities. [ABSTRACT FROM AUTHOR]

Two components of professional success have been defined: objective career success (OCS) and subjective career success (SCS). Despite the increasing number of women practicing medicine, gender inequalities persist. The objectives of this descriptive, cross-sectional, and multicenter study were (a) to construct and validate OCS and SCS scales, (b) to determine the relationships between OCS and SCS and between each scale and professional/family characteristics, and (c) to compare these associations between male and female family physicians (FPs). The study sample comprised 250 female and 250 male FPs from urban health centers in Andalusia (Spain). Data were gathered over 6 months on gender, age, care load, professional/family variables, and family-work balance, using a self-administered questionnaire. OSC and SCS scales were examined by using exploratory factorial analysis and Cronbach's α, and scores were compared by gender-stratified bivariate and multiple regression analyses. Intraclass correlation coefficients were calculated using a multilevel analysis. The response rate was 73.6%. We identified three OCS factors and two SCS factors. Lower scores were obtained by female versus male FPs in the OCS dimensions, but there were no gender differences in either SCS dimension. [ABSTRACT FROM AUTHOR]

Aim: Atrial fibrillation (AF) is associated with high morbidity and mortality. Early diagnosis is likely to improve therapy and prognosis. The study objective was to evaluate the usefulness of a programme for early diagnosis of AF in patients from an urban primary care centre.Methods and Results: Participants were recruited from a randomized sample of patients not diagnosed with AF but having relevant risk factors: age ≥ 65 years, ischaemic and/or valvular heart disease, congestive heart failure, hypertension, and/or diabetes. Patients were randomly assigned to the intervention group (IG) or control group (CG). The intervention included (i) initial visit with clinical history, electrocardiogram, and instruction about pulse palpation and warning signs and (ii) electrocardiogram every 6 months during a 2-year follow-up. The main endpoint of the study was the proportion of new cases diagnosed at 6 months. Secondary endpoints were number of new AF diagnoses and complications associated with the arrhythmia in both groups. A total of 928 patients were included (463 IG and 465 CG). At 6 months, AF was diagnosed in 8 IG patients and 1 CG patient (1.7 vs. 0.2%, respectively, P = 0.018). After 2 years of follow-up, 11 IG patients and 6 CG patients had newly diagnosed AF (2.5 vs. 1.3%, respectively, P = 0.132). Time to first diagnosis of AF was shorter in IG patients [median (inter-quartile range): 7 (192) days vs. 227 (188.5) days in CG, P = 0.029].Conclusion: The simple screening proposed could be useful for the early detection of AF in primary care. [ABSTRACT FROM AUTHOR]

Introduction: Socio-economic inequalities in health are large in urban areas; however, local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies. Methods: A qualitative research study describing policymakers' beliefs on health inequalities. The study population were twelve policymakers. These were politicians or officers from the city council. Informant profiles were selected using a theoretical sample. Semi-structured individual interviews were performed to collect the data and a thematic content analysis was carried out. Results: Politicians were aware of health inequalities in their city and identified diverse social causes. They viewed reducing inequalities as a priority for the city's government. Officers were less knowledgeable and described less efforts in addressing health inequalities. It was stated by some that reducing inequalities in non-health sectors helped to reduce health inequalities indirectly and there was some collaboration between two sectors. The most frequent barriers encountered when implementing policies were funding and the cities' limited authority. Conclusions: Officers and policymakers had different levels of awareness and access to information on health and its socials determinants. Officers referred to specific causes of health inequalities and policies which related to their sectors and politicians were more familiar with upstream determinants and policies. Some participants explained that policies and programmes needed to be evaluated and very little intersectoral action was said to be carried out. More efforts should be made to provide all policymakers with information on the social determinants of health inequalities. Research on health inequalities and policy should engage with policymakers and promote health as a cross cutting issue in the city council in liaison with the third sector. [ABSTRACT FROM AUTHOR]

Findings on the relationship between play spaces and childhood overweight and obesity are mixed and scarce. This study aimed to investigate the associations between residential proximity to play spaces and the risk of childhood overweight or obesity and potential effect modifiers. This longitudinal study included children living in the city of Barcelona identified in an electronic primary healthcare record database between 2011 and 2018 (N = 75,608). Overweight and obesity were defined according to the WHO standards and we used 300 m network buffers to assess residential proximity to play spaces. We calculated the risk of developing overweight or obesity using Cox proportional hazard models. A share of 29.4% of the study population developed overweight or obesity, but we did not find consistent associations between play space indicators and overweight or obesity. We did not find any consistent sign of effect modification by sex, and only some indications of the modifying role of area socioeconomic status and level of exposure. Although it is not possible to draw clear conclusions from our study, we call for cities to continue increasing and improving urban play spaces with an equitable, healthy, and child-friendly perspective.

Background: The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods: A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results: Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer's disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer's disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. Conclusions: This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been one of the most important health crises of the last century in Spain and worldwide. Mobility reduction interventions have been among the most common public health measures implemented to mitigate the pandemic through reducing community transmission. These measures may have an unequal impact across the population. We present a methodology based on the use of publicly available data from the Instituto Nacional de Estadística and the Sociedad Espanola de Epidemiología, to study socioeconomic inequalities in mobility during the pandemic. We describe an application of this methodology for a province (Asturias), showing socioeconomic rural-urban patterns. The use of geographic information system tools can provide useful evidence to explore the social determinants of health at multiple levels., (Copyright © 2021 SESPAS. All rights reserved.)

This study aims to describe trends in inequalities by women’s socioeconomic position and age in induced abortion in Barcelona (Spain) over 1992–1996 and 2000–2004. Induced abortions occurring in residents in Barcelona aged 20 and 44 years in the study period are included. Variables are age, educational level, and time periods. Induced abortion rates per 1,000 women and absolute differences for educational level, age, and time period are calculated. Poisson regression models are fitted to obtain the relative risk (RR) for trends. Induced abortion rates increased from 10.1 to 14.6 per 1,000 women aged 20–44 (RR = 1.44; 95% confidence interval (CI) 1.41–1.47) between 1992–1996 and 2000–2004. The abortion rate was highest among women aged 20–24 and 25–34 and changed little among women aged 35–44. Among women aged 20–24 and 25–34, those with a primary education or less had higher rates of induced abortion in the second period. Induced abortion rates also grew in those women with secondary education. In the 35–44 age group, the induced abortion rate declined among women with a secondary education (RR = 0.66; 95% CI 0.60–0.73) and slightly among those with a greater level of education. Induced abortion is rising most among women in poor socioeconomic positions. This study reveals deep inequalities in induced abortion in Barcelona, Spain. The trends identified in this study suggest that policy efforts to reduce unintended pregnancies are failing in Spain. Our study fills an important gap in literature on recent trends in Southern Europe. [ABSTRACT FROM AUTHOR]

The pandemic crisis has caused a change in tourism trends that affect the way hotels are managed. In accordance with the United Nations (2020), hotels must guarantee safe experiences for customers by incorporating sustainability measures. Collaboration between health and tourism authorities and the tourism industry is key. To test this proposal among hotels in Spain, 3 online focus groups and 25 personal interviews with 36 urban and 28 rural hotels were held in order to define the indicators. The questionnaire was applied to a sample of 475 urban hotels out of 443 rural hotels. The conclusions were: 1.) While in urban areas the testing protocols, especially for workers, are followed by most hotels, in rural areas hotel managers do not consider it as a priority in daily activity due to the reduced contact they have. 2.) A change in trends in the sustainable management of both rural and urban hotels is justified. 3.) Urban and rural hotels are more likely to incorporate collaborative strategies with tourism and health authorities to reduce the negative impact of COVID-19. According to the estimates of the hotels, the implementation of these measures would help to start the recovery process of the hotel industry. [ABSTRACT FROM AUTHOR]

This study investigates the human health risk of Al, As, Fe, Mn, Ni, Pb, Sb and Sr in the dry deposition fraction of settleable particulate matter (DSPM). Sixty samples were collected at an industrial suburban site ('EMA') and a waterfront urban site ('Naval') in Gijón, a coastal city in northern Spain. Up to 4898.4 mg m−2 d−1 were measured at the station closer to industrial activity. The levels of the eight elements were greater at this site. Fe and Al were the major constituents, comprising up to 50% of DSPM. The human health risk posed by DSPM was assessed using a U.S.EPA methodology. The level of exposure to the metals/metalloids in this atmospheric pollutant was studied via ingestion, inhalation, and dermal contact. The results showed that ingestion was the main exposure pathway for the residents at the two locations, followed by dermal contact and inhalation. For adults, the non-carcinogenic hazard indexes and the carcinogenic risk levels of the eight elements were within the acceptable levels (1 and 10−5, respectively). Nevertheless, in the case of children, the non-carcinogenic hazard indexes of Fe and Pb as well as the carcinogenic risk level of As via ingestion were higher than those thresholds. Despite its importance, little research has focused on assessing the human risk posed by metals/metalloids in DSPM. Although there are uncertainties regarding the exposure factors and toxicity values, the outcomes of this study provide useful knowledge for regulatory authorities to establish appropriate mitigation measures to reduce DSPM emissions in urban and suburban environments. [Display omitted] • Human health risk posed by dry deposition was compared at urban and suburban sites. • The closer to industries, the higher the levels of Al, As, Fe, Mn, Ni, Pb, Sb and Sr. • Ingestion pathway implied the greatest potential risks for both adults and children. • Fe and Pb exceeded the tolerable non-cancer risk threshold for children via ingestion. • Cancer risk indicators revealed that As via ingestion posed a threat to children. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this paper is to study the linkage between type of habitat and mortality from all causes in small areas of Southern Spain. An ecological study was conducted on 99,870 people who died between 1985 and 1999. The municipality was taken as the unit of analysis. Data analysis was carried out through hierarchical spatio-temporal bayesian models. Results show a 13.3% reduction in mortality rates among men and 14.1% among women in the most rural areas compared to more urban environments. The study demonstrates the usefulness of socio-demographic indices in small-area geographical analyses. [Copyright &y& Elsevier]

The aim of this study is to highlight the need for sustainable urban development by reviewing the different Indicator Systems (SI) and contrasting them with those factors that have had a correlation in the spread of the virus in order to detect its deficiencies. This research carries out an urban diagnosis and analyzes the influence of these factors in order to detect deficiencies and propose a new IS adapted to current needs. Lastly, the new SI is validated through its practical application in one of the Autonomous Communities most affected by the pandemic in Spain. It is concluded that most of the factors causing a worse incidence of the virus are hardly evaluated by the existing IS. The practical analysis shows that there are deficiencies in urban design, resulting in poor environmental quality and urban morphology. [ABSTRACT FROM AUTHOR]

Perceptions of local food environments and the ability of citizens to engage in participatory research may vary, even if participants share similar cultural and socioeconomic contexts. In this study, we aimed to describe participants' narratives about their local food environment in two cities in Spain. We used the participatory methodology of Photovoice to engage participants in Madrid ( n = 24) and Bilbao ( n = 17) who took and discussed photographs about their local food environment (Madrid; n = 163 and Bilbao; n = 70). Common themes emerged across both cities (food insecurity, poverty, use of public spaces for eating and social gathering, cultural diversity and overconsumption of unhealthy foods); however, in Bilbao citizens perceived that there was sufficient availability of healthy foods despite that living in impoverished communities. Photovoice was a useful tool to engage participating citizens to improve their local food environments in both cities. This new approach allowed for a photovoice cross-city comparison that could be useful to fully understand the complexity and diversity of residents' perceptions regardless of their place of residence.

The purpose of this study was to present the alcohol environment as perceived by its residents in two districts of Madrid using the Photovoice participatory methodology. Secondly, we compared the results according to the socio-economic status of the districts. The study was conducted in the city of Madrid, Spain, in two districts with different socio-economic status. A total of 26 people participated, who took and discussed photographs about their alcohol environment. They grouped them into 33 final categories, such as the socialising role of alcohol or the alcohol advertising. Co-authors further grouped participants final categories into seven general areas. The participants in the Photovoice project have helped to deepen the understanding of the alcohol urban environment. These results may help to design more effective policies to prevent hazardous alcohol consumption. [ABSTRACT FROM AUTHOR]

Antibiotics, such as sulfonamides (SAs), have recently raised concern as wastewater treatment plants (WWTPs) partly remove them, and thus, SAs continuously enter the aquifers. In this context, the aims of this work are to (1) investigate the temporal evolution of SAs and metabolites in an urban aquifer recharged by a polluted river; (2) identify the potential geochemical processes that might affect SAs in the river-groundwater interface and (3) evaluate the ecological and human health risk assessment of SAs. To this end, 14 SAs and 4 metabolites were analyzed in river and urban groundwater from the metropolitan area of Barcelona (NE, Spain) in three different sampling campaigns. These substances had a distinct behavior when river water, which is the main recharge source, infiltrates the aquifer. Mixing of the river water recharge into the aquifer drives several redox reactions such as aerobic respiration and denitrification. This reducing character of the aquifer seemed to favor the natural attenuation of some SAs as sulfamethoxazole, sulfapyridine, and sulfamethizole. However, most of the SAs detected were not likely to undergo degradation and adsorption because their concentrations were constant along groundwater flow path. In fact, the intensity of SAs adsorption is low as the retardation factors are close to 1 at average groundwater pH of 7.2 for most SAs. Finally, risk quotients (RQs) are used to evaluate the ecological and human health risks posed by single and mixture of SAs in river water and groundwater, respectively. Life-stage RQs of the SAs detected in groundwater for the 8 age intervals were low, indicating that SAs and their mixture do not pose any risk to human beings. Concerning the environmental risk assessment, SAs do not pose any risk for algae, fish and crustaceans as the RQs evaluated are further lower than 0.1. Image 1 • 14 sulfonamides (SAs) and 4 metabolites are analyzed in river and urban groundwater. • SAs present distinct behavior when river water infiltrates the aquifer. • Some SAs are naturally removed under the nitrate reducing groundwater conditions. • Other SAs are persistent as their concentrations remain constant along the flow path. • SAs pose no ecological and human health risks at detected concentrations. Sulfonamide antibiotics and their metabolites do not pose any risk to human health in an urban aquifer that is a potential source of water supply. [ABSTRACT FROM AUTHOR]

Tourism gentrification is as process of urban change and neighborhoods transformation, according to the needs of affluent visitors, increasing in some global cities. However, the link between tourism gentrification and resident's health is still an understudied topic. Using Photovoice, a participatory action research method, the aim of this study was to identify the perceived pathways that underlie the relationship between tourism gentrification and health among residents of Gòtic neighborhood, in Barcelona. The study was conducted between January 2018 and January 2019. Thirteen residents, recruited from two neighborhood organizations, took photographs of how tourism gentrification of the neighborhood was affecting their health. Participants analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants categorized 35 photographs and identified 7 emerging categories acknowledged as possible pathways between tourism gentrification and health, in Gòtic neighborhood: 1) decline of social networks; 2) loss of identity; 3) environmental changes; 4) pollution; 5) changes in services and stores; 6) property speculation/eviction and; 7) activism by residents. This Photovoice study recognizes important pathways underlying the relationship between tourism gentrification in the Gòtic neighborhood and the health of its residents, by altering the built environment, the social environment or psychological factors. Among them, six pathways were related to negative health outcomes, both physical and mental (respiratory diseases; worse nutrition habits; sleep deprivation; stress, anxiety and depression). 'Activism by residents' was perceived to buffer the negative health effects of living in a touristic area. The study also provides recommendations to tackle this serious urban health issue. • Tourism gentrification is a current and severe public health problem in Barcelona. • This study identifies several pathways between tourism gentrification and health. • Participatory action research is useful for advocacy and empowering of residents. [ABSTRACT FROM AUTHOR]

• Economic development impacts the number of road accidents in the richest provinces. • Greater development of the transport system benefits the lowest income provinces. • The penalty-points licence system should be reviewed to enhance its effectiveness. • Driving behaviour affects road safety in Spanish provinces. • The characteristics of a province are a determinant of its road accident rate. The aim of this study was to determine whether interregional inequality in Spain had the same impact on the risks of fatality and injury across the different provinces of Spain, in the period from 1999 to 2015. This allows us to map fatality and injury rates in Spanish provinces depending on their level of economic development. Provinces were divided in two large groups according to the mean weight of their per capita GDP on the national GDP from 2000 to 2015. Using fixed effects data panel models, estimations were obtained for each group of the impact of the relationships between per capita GDP, unemployment rate and other control variables on their risks of fatality and injury. The models reveal that economic conditions and education are explanatory factors with greater significance and impact on the risks of fatality and injury in provinces with higher levels of economic development. In this group, the penalty-points driving licence was found have a greater impact, although its effectiveness is now being questioned. In contrast, to reduce the risks of fatality and injury in less developed provinces, it is imperative to invest in road infrastructure, increasing the proportion of high capacity roads and investing more in road replacement and maintenance. The geographical distribution generated in this study allows us to better identify the areas with a higher risk of fatality or injury. This, in turn, confirms the need to improve the configuration of road safety policy, taking into account the different fatality or injury rates across provinces, the origins of which lie in the specific provincial conditions. [ABSTRACT FROM AUTHOR]

Objective: Know the number and percentage of chest X-rays (CXR) referred to a Primary Care Imaging Center and Primary Care Emergency Center to rule out lung involvement due to SARS-CoV-2 from March 16 to May 15, 2020, in an urban health area of about 400,000 reference population inhabitants. To determine the percentage of cases suggestive of pulmonary involvement due to SARS-CoV-2 CXR and the percentage of cases without pulmonary involvement of the total CXR derived in the reference population from March 16 to May 15, 2020., Material and Methods: Design observational descriptive study. The radiological criteria to classify probable pulmonary infection by SARS-CoV-2 (RxT[+]) are: 1) focal opacity; 2) faint focal opacity; 3) faint diffuse increase in density; 4) focal or diffuse interstitial pattern, and 5) focal or diffuse interstitial alveolus pattern., Results and Conclusions: Maintain CXR as a useful screening method in the middle stages of the disease, when CXR is more sensitive to detect lung involvement due to SARS-CoV-2. Our graph of affectation by SARS-CoV-2 does not present assessable differences with the expected curve in an epidemic., (Copyright © 2020 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Many teenagers experiment with addictive substances such as alcohol. The objective of this study was to estimate the frequency of binge drinking among secondary school students and its relationship with sex, grade, and type of school, as well as with urban contextual factors of the school neighborhood: socioeconomic level, density of alcohol outlet premises, and tourist pressure., Methods: This was an observational cross-sectional study. The study population were the students of 8th and 10th grade (2nd and 4th year of ESO) in the city of Barcelona in 2016. Alcohol use, sex, grade, type of school and school neighborhood were taken from the FRESC survey. The wealth of the neighborhood and tourist pressure were extracted from municipal statistics. The density of alcohol outlets was obtained by direct observation with the OHCITIES instrument. We estimated the prevalence of binge drinking (consumption of five or more units on one occasion) stratifying by age, sex and ownership of the school. We calculated a robust Poisson regression model with the individual and contextual variables and analyzed the situation of those neighborhoods with the highest prevalence of binge., Results: The self-declared frequency of binge drinking in the last 30 days was 6.1% in this sample of 2,329 students, 2.2% in 8th grade and 10.3% in 10th grade. It was higher in boys (7%) than in girls (5.1%), and slightly higher in private subsidized schools (6.4%) than in public schools (5.5%). In the Poisson regression models, neither the coefficients of the three contextual variables nor the type of school reached statistical significance, contrary to those obtained with the individual variables of sex and year. The adjusted prevalence of binge in the 36 neighborhoods ranged from 0 to 18.2%. Comparing the contextual variables of the 8 neighborhoods with the lowest prevalence of binge with the others, both a greater density of local alcohol sales and higher tourism pressure were associated with a higher prevalence of binge drinking, while for wealth there were no significant differences., Conclusions: The use of alcohol in early adolescence is related to individual variables such as sex and age. Urban contextual factors such as a higher tourist pressure and the density of premises that sell alcohol may exert also some influence., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The influence of unhealthy food environments on residents' eating behaviors has been previously documented. Yet, socioeconomic differences across areas are less studied. Participatory studies provide relevant knowledge to better inform future nutrition interventions. We conducted a participatory Photovoice project in which residents interpreted the influence of the local food environment on eating behaviors across three neighborhoods of contrasting area-level socioeconomic status (SES) in Bilbao, Spain. From April to July 2017, a total of 23 residents participated in the three Photovoice groups. Each group critically discussed their photographs (N = 110) in groups of 6-9 participants along six group sessions. Through a consensus-building process, participants identified 27 emerging categories choosing finally 39 related photographs, which followed six conceptual main themes characterizing their local food environment: 1) unhealthy eating behaviors, 2) cultural diversity, 3) retail transformation, 4) social relationships, 5) precariousness, and 6) healthy eating. Although high food quality and fresh products may portray a general healthy food environment in all three neighborhoods, participants discussed why some residents still adopt unhealthy eating behaviors characterized by an excessive consumption of alcohol (high-SES area), sugar loaded foods (high- and middle-SES) and fast food (middle and low-SES). This photovoice participatory methodology helps highlighting important similarities and differences regarding food environment perceptions in the whole socioeconomic spectrum of any given city. This type of participatory approach helps guiding local policies and interventions promoting healthier local food environments., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Subjective memory complaints (SMC) are considered predictor of cognitive impairment, but are also associated with other factors; social and lifestyle have been the least studied., Aim: To evaluate SMC and their association with epidemiological, health, social and lifestyle variables., Subjects and Methods: Cross-sectional epidemiological study of the randomly selected population of Madrid. Telephone interview., Target Population: 1,775 over 55 years of age. We asked about QSM, social, economic, health and lifestyle aspects. The Goldberg General Health Questionnaire (GHQ) and the COOP-Wonca Quality of Life Questionnaire were administered., Results: We found statistically significant association of SMC with age, temporal orientation, all variables related to mental health (depression), anxiety, sleep, mental health/GHQ, and quality of life. Association was found with all pain variables and with loneliness. There was no association with specific diseases, except chronic allergy and those linked to pain. The predictors of the SMC were temporal orientation, multimorbidity, mental health/GHQ, anxiety, pain and feeling lonely., Conclusions: SMC is a multi-caused symptom. They are associated with lower memory performance, but also with variables related to health, social aspects and lifestyle. When faced with a patient with SMC, which may be due to cognitive impairment because of Alzheimer's disease, these associations should be taken into account to assess this risk and know when follow-up is most needed.

Objective: The aim of this study was to evaluate the epidemiological profile of dermatophytoses from 2008 to 2017 in the area of "Barcelonès Nord", located in north-eastern Spain., Methods: From 2008 to 2017, 13,419 specimens obtained from patients with suspected superficial mycosis were subjected to direct microscopy and culture. Clinical and sociodemographic data were recorded. Proportions were compared using Chi-square and Fisher's exact tests. A logistic regression model was used for multivariate analysis., Results: Trichophyton rubrum was the most frequently isolated fungus (76.1%), followed by Trichophyton mentagrophytes/Trichophyton interdigitale (11.9%) and Microsporum canis (2.9%). Among the population over 15 years of age, tinea unguium pedum (40.4%) and tinea corporis (29.1%) were the predominant dermatophyte infections. Tinea capitis was mostly prevalent (53.6%) among patients up to 15 years of age, followed by tinea corporis (21.4%). We observed an increase in non-endemic anthropophilic dermatophytes (Trichophyton soudanense, Microsporum audouinii and Trichophyton violaceum) in the last few years. These species were associated with the population up to 15 years of age (p<0.001), having tinea capitis (p=0.0017) and being of African/Hindustani origin (p<0.001)., Conclusions: We confirmed the spread of T. rubrum as the predominant dermatophyte in our area and reported an increase in non-endemic anthropophilic dermatophytes in the last few years, especially in the African and Hindustani population up to 15 years of age., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Background: Identifying socioeconomic determinants that are associated with access to and availability of exercise facilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reduce health inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to, and availability of, exercise facilities in Madrid, Spain. Methods: Area-level SES was measured using a composite index based on seven sociodemographic indicators. Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional. Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the 125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilities in a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflated Poisson regression analyses to assess the association between area-level SES and exercise facility accessibility and availability. Results: Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities. Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities. Conclusion: Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number of facilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lower SES areas may be an intervention to improve health equity. [ABSTRACT FROM AUTHOR]

Introduction: PFAPA syndrome is an autoinflammatory disease whose diagnosis is mainly clinical. Several treatments have been proposed; among them, tonsillectomy could be an effective one., Material and Methods: Retrospective multicenter study. Patients included were diagnosed with PFAPA syndrome, according to the Thomas criteria, in 3 hospitals in Madrid between 2009-2013., Results: Thirty-two cases were included. Median age at onset and at diagnosis were 32 months (IQR 24-44) and 47.5 months (IQR 37-60), respectively. There were increases in leukocytes (13,580/μL [IQR 8,200-16,600] vs. 8,300/μL [IQR 7,130-9,650], P=.005), neutrophils (9,340/μL [IQR 5,900-11,620] vs. 3,660/μL [IQR 2,950-4,580], P=.002) and C-reactive protein (11.0mg/dL [IQR 6.6-12.7] vs. 0.2mg/dL [IQR 0.1-0.6], P=.003) during febrile episodes. In all, 80.8% of patients reported remission of symptoms within 24h after oral corticosteroid therapy. Fourteen patients were tonsillectomized. In 11, the febrile episodes stopped while, in 3, the frequency was reduced; there were 2 cases of postoperative bleeding. The disease was resolved in 56.3% of the patients, at a median age of 60 months (IQR 47-95), with similar duration in patients who were tonsillectomized and those who were not., Conclusions: We present a large cohort of children with PFAPA syndrome, with clinical and analytical features similar to those described in the literature, and a good response to corticosteroids and a high resolution rate of symptoms after tonsillectomy., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objective: Qualitative methods may help to understand features related to health urban inequalities as a way to include citizens' perceptions of their neighbourhoods in relation to their health-related behaviours. The aim of this article is to describe the methods and design of a qualitative urban health study., Methods: The Heart Healthy Hoods (HHH) analyses cardiovascular health in an urban environment using mixed methods: electronic health records, quantitative individual questionnaires, physical examination, semi-structured Interviews (SSIs), focus groups (FGs) and participatory technics such as photovoice. This article focuses on the HHH qualitative methods and design. A case study was used to select three neighbourhoods in Madrid with different socioeconomic levels: low, medium, and high. The selection process for these three neighbourhoods was as follows: classification of all Madrid's neighbourhoods (128) according to their socioeconomic level; after ranking this classification, nine neighbourhoods, three by socioeconomic level, were short-listed; different urban sociology criteria and non-participant observation were used for the final selection of three neighbourhoods. After selecting the three neighbourhoods, thirty SSIs were held with residents and six SSIs were held with key informants. Finally, twenty-nine FGs will be conducted over the course of 8 months, between May and December of 2018., Conclusions: Systematization in the selection of neighbourhoods and the use of adequate techniques are essential for the qualitative study of urban health inequalities., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Urban green spaces (UGS) have been linked with a series of benefits for the environment, and for the physical health and well-being of urban residents. This is of great importance in the context of the aging of modern societies. However, UGS have different forms and characteristics that can determine their utilization. Common elements in UGS such as the type of vegetation and the type of surface are surprisingly understudied in regard to their relationship with the type of activity undertaken in UGS. This paper aims to explore the relationship between landscape diversity and the type of surface with the time spent and the physical activity intensity performed by seniors. To do so, this study uses GPS tracking data in combination with accelerometer data gathered from 63 seniors residing in Barcelona, Spain. Results showed that senior participants spent little time inside the analyzed UGS and sedentary behaviors (SBs) were more common than physical activities (PAs). The presence of pavement surfaces positively influenced the total time spent in UGS while gravel surfaces were negatively associated with time spent in active behaviors. The provision of well-defined and maintained paved areas and paths are some key infrastructures to be considered when designing UGS for overall urban residents and, especially, when aiming to potentiate the access for senior visitors.

Introduction: Introduction: childhood overweight and obesity have increased progressively in the last decades, especially in countries of Southern Europe. Objective: to analyze the association of overweight and obesity childhood in the city of Barcelona according to socioeconomic variables in schoolchildren in third grade primary school. Methods: transversal study. Study population: third grade primary school students in the city of Barcelona in year 2011 (n = 3,624). Body mass index was studied as the dependent variable, and sex, age, social class, parental status, origin, ownership school, neighborhood socioeconomic status of the school and district were studied as independent. Logistic regression models were analyzed, obtaining odds ratio (OR) with 95% confidence intervals (95% CI). Results: the prevalence of overweight and obesity in childhood were 24.5% and 13.8%, respectively. The variables associated with obesity were: boy (OR = 1.26; 95% CI = 1.02-1.57), low socioeconomic status (OR = 1.60; 95% CI = 1.16-2.20), single-parent family (OR = 1.35; 95% CI = 1.03-1.77), immigrant (OR = 1.68; 95% CI = 1.33-2.13) and living in one of the less favored districts of Barcelona. Conclusions: it is evident that social class, origin, family status and the district of residence play an important role in childhood obesity.

This study describes a Pyrenean cross-cultural structure called Centre for the Promotion of Physical Activity and Health (CAPAS-City) that was created to promote physical activity (PA) in Huesca (Spain) and Tarbes (France). The main aim of this centre is to lead the way in the design, implementation, and evaluation of multilevel PA interventions to improve their efficacy and sustainability inside the city. CAPAS-City responds to the main challenges related to multilevel PA interventions, through six guiding principles: (1) promoting sustainability, (2) playing a leadership role, (3) promoting multisectoral partnerships, (4) using evidence-based strategies, (5) promoting integrated knowledge translation, and (6) using a participatory research approach. Five multilevel PA interventions were designed in both cities by CAPAS-City with these principles in mind. Through the example of the Annual MOT Test adapted to bikes, we also illustrate one practical application of the use of these principles, following the Social-Ecological approach, in which the main agents of influence are involved at different levels to encourage cycling. According to the promising results found in this study, CAPAS-City appears to be a structure that is able to respond to the main needs and challenges of multilevel interventions to increase PA levels in the whole population of both cities.

Across Europe, excess body weight rates are particularly high among children and adolescents living in Southern European contexts. In Spain, current food policies appeal to voluntary self-regulation of the food industry and parents' responsibility. However, there is no research (within Spain) assessing the food environment surrounding schools. We examined the association between neighborhood-level socioeconomic status (NSES) and the spatial access to an unhealthy food environment around schools using both counts and distance measures, across the city of Madrid. We conducted a cross-sectional study citywide ( n = 2443 census tracts). In 2017, we identified all schools ( n = 1321) and all food retailers offering unhealthy food and beverages surrounding them ( n = 6530) using publicly available data. We examined both the counts of retailers (within 400 m) and the distance (in meters) from the schools to the closest retailer. We used multilevel regressions to model the association of neighborhood-level socioeconomic status (NSES) with both measures, adjusting both models for population density. Almost all schools (95%) were surrounded by unhealthy retailers within 400 m (median = 17 retailers; interquartile range = 8-34). After adjusting for population density, NSES remained inversely associated with unhealthy food availability. Schools located in low-NSES areas (two lowest quintiles) showed, on average, 29% (IRR (Incidence Rate Ratio) = 1.29; 95% CI (Confidence Interval) = 1.12, 1.50) and 62% (IRR = 1.62; 95% CI = 1.35, 1.95) more counts of unhealthy retailers compared with schools in middle-NSES areas (ref.). Schools in high-NSES areas were farther from unhealthy food sources than those schools located in middle-NSES areas (β = 0.35; 95% CI = 0.14, 0.47). Regulating the school food environment (within and beyond school boundaries) may be a promising direction to prevent and reduce childhood obesity.