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Background: The ageing process may lead to functional limitations, musculoskeletal pain, and worsened quality of life. The aim of this paper is to evaluate two physical therapy interventions for reducing musculoskeletal pain and improving quality of life in older adults. Methods: A cohort study was carried out with older people (60–75 years old). The Geriatric Physical Therapy group (n = 70) received massage therapy, therapeutic exercise, and therapeutic education program for 5 weeks; the Standardized Therapeutic Exercise group (n = 140) received a standardized therapeutic exercise and therapeutic education program for 3 weeks. Health-related quality of life (SF-36v2) and musculoskeletal pain intensity (VAS) were collected at baseline (A0), post-intervention (A1), and 12 weeks after baseline (A2). Results: There was pain intensity reduction in both groups (p < 0.05) and health-related quality of life improvement, except for Emotional Role (p = 0.34); Physical Function (p = 0.07), Bodily Pain (p = 0.02), and General Health (p = 0.09). At A2 there was a difference (p < 0.05) for neck pain in favor of the Geriatric Physical Therapy Group. Conclusions: Within the limitations of the study, it was possible to conclude that both physical therapy interventions showed a positive effect for reducing non-specific neck pain and low back pain in older adults, which may contribute to health-related quality of life improvement.

En este ultimo ano, todos hemos sufrido las devastadoras consecuencias de la epidemia por SARS-CoV2. En unos meses, los medios de comunicacion nos han bombardeado con mensajes sobre incidencias, letalidad o incluso medidas mas tecnicas como el R0 o la tasa de ataque. Con esta actualizacion se pretende aclarar los conceptos basicos sobre la dinamica de la epidemia, asi como exponer lo que, hasta la fecha en que se escribe, se conoce de la misma. Para ello, se ha utilizado y extraido la informacion disponible en organismos internacionales como la Organizacion Mundial de la Salud, asi como en el Ministerio de Sanidad. En ningun caso se ha de entender como una situacion fija o conocida. Una situacion que, por otro lado, invariablemente ha de ser cambiante.

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies. This work was supported by grants from the Instituto de Salud Carlos III (ISCIII)/Ministerio de Ciencia e Innovación/FEDER, Spain (Jordi Alonso, grant number COV20/00711); ISCIII-FEDER, Spain (Jordi Alonso, grant number PI17/00521); ISCIII-FSE, Spain: Sara Borrell and Miguel Servet grants (Philippe Mortier, grant number CD18/00049 and CP21/00078); Generalitat de Catalunya, Spain (2017SGR452); and PERIS, Departament de Salut, Spain (Itxaso Alayo; SLT017/20/000009). Additional partial funding was received from the Gerencia Regional de Salud de Castilla y León (SACYL), Spain (José María Pelayo Terán, grant number GRS COVID 32/A/20). Sí

There is still much controversy regarding the epidemiology of endometriosis. The objective of this work is to conduct a systematic review, and if possible, proceed with a meta-analysis of studies that have analyzed the incidence and prevalence of this condition among women in the general population. The inclusion criteria were papers published after 1997 that had reported data of the incidence or prevalence of endometriosis. The PubMed search engine was used to identify papers meeting the inclusion criteria from 1997 to 2019, with an additional manual search for the identification of potentially eligible studies. The search was limited to papers published in English. The risk of bias was assessed according to the Joanna Briggs Institute Critical Appraisal Checklist. As a result, 27 papers, which included a total of 28,660,652 women, were classified according to the type of design and sources of information in five subgroups. Pooled estimates of prevalence for studies with self-reported data were 0.05 (95% CI: 0.03; 0.06), 0.01 for population-based integrated information systems (95% CI: 0.01; 0.02), and 0.04 (95% CI 0.04; 0.05) in studies using other designs. The pooled incidence rate of endometriosis was: 1.36 per 1000 person-years (PY) (95% CI: 1.09; 1.63) for studies based on hospital discharges, 3.53 per 1000 PY (95% CI: 2.06; 4.99) for cohort studies, and 1.89 per 1000 PY (95% CI: 1.42; 2.37) for population-based integrated information systems. Meta-analysis indicated high heterogeneity based on I-squared statistics. This significant variability may not only be due to methodological issues and the specific limitations of the different designs and data analyzed, including case definitions and subject selection strategies, but also to the inherent heterogeneity of endometriosis. Epidemiological studies with appropriate study designs remain necessary to provide a valid estimation of the population burden of endometriosis.

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

We focused on tweets containing hashtags related to ADHD pharmacotherapy between 20 September and 31 October 2019. Tweets were classified as to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. Furthermore, we classified any links included within a tweet as either scientific or non-scientific. We created a dataset of 6568 tweets: 4949 (75.4%) related to stimulants, 605 (9.2%) to non-stimulants and 1014 (15.4%) to alpha-2 agonists. Next, we manually analyzed 1810 tweets. In the end, 481 (48%) of the tweets in the stimulant group, 218 (71.9%) in the non-stimulant group and 162 (31.9%) in the alpha agonist group were considered classifiable. Stimulants accumulated the majority of tweets. Notably, the content that generated the highest frequency of tweets was that related to treatment efficacy, with alpha-2 agonist-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to alpha-2 agonists. Stimulant-related tweets obtained the highest proportion of likes and were the most disseminated within the Twitter community. Understanding the public view of these medications is necessary to design promotional strategies aimed at the appropriate population.

This study aimed to create an individualized analysis model of the risk of intensive care unit (ICU) admission or death for coronavirus disease 2019 (COVID-19) patients as a tool for the rapid clinical management of hospitalized patients in order to achieve a resilience of medical resources. This is an observational, analytical, retrospective cohort study with longitudinal follow-up. Data were collected from the medical records of 3489 patients diagnosed with COVID-19 using RT-qPCR in the period of highest community transmission recorded in Europe to date: February&ndash, June 2020. The study was carried out in in two health areas of hospital care in the Madrid region: the central area of the Madrid capital (Hospitales de Madrid del Grupo HM Hospitales (CH-HM), n = 1931) and the metropolitan area of Madrid (Hospital Universitario Pr&iacute, ncipe de Asturias (MH-HUPA) n = 1558). By using a regression model, we observed how the different patient variables had unequal importance. Among all the analyzed variables, basal oxygen saturation was found to have the highest relative importance with a value of 20.3%, followed by age (17.7%), lymphocyte/leukocyte ratio (14.4%), CRP value (12.5%), comorbidities (12.5%), and leukocyte count (8.9%). Three levels of risk of ICU/death were established: low-risk level (&lt, 5%), medium-risk level (5&ndash, 20%), and high-risk level (&gt, 20%). At the high-risk level, 13% needed ICU admission, 29% died, and 37% had an ICU&ndash, death outcome. This predictive model allowed us to individualize the risk for worse outcome for hospitalized patients affected by COVID-19.

Background Antiobesity drugs are prescribed for the treatment of obesity in conjunction with healthy eating, physical activity, and behavior modification. However, poor adherence rates have been reported. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. The analysis of tweets has become a tool for health research. Objective The aim of this study is to investigate the content and key metrics of tweets referring to antiobesity drugs. Methods In this observational quantitative and qualitative study, we focused on tweets containing hashtags related to antiobesity drugs between September 20, 2019, and October 31, 2019. Tweets were first classified according to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. We additionally rated it as positive or negative. Furthermore, we classified any links included within a tweet as either scientific or nonscientific. Finally, the number of retweets generated as well as the dissemination and sentiment score obtained by the antiobesity drugs analyzed were also measured. Results We analyzed a total of 2045 tweets, 945 of which were excluded according to the criteria of the study. Finally, 320 out of the 1,100 remaining tweets were also excluded because their content, although related to drugs for obesity treatment, did not address the efficacy, side effects, or adherence to medication. Liraglutide and semaglutide accumulated the majority of tweets (682/780, 87.4%). Notably, the content that generated the highest frequency of tweets was related to treatment efficacy, with liraglutide-, semaglutide-, and lorcaserin-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to liraglutide and semaglutide. Semaglutide-related tweets obtained the highest probability of likes and were the most disseminated within the Twitter community. Conclusions This analysis of posted tweets related to antiobesity drugs shows that the interest, beliefs, and experiences regarding these pharmacological treatments are heterogeneous. The efficacy of the treatment accounts for the majority of interest among Twitter users.

Background Health awareness initiatives are frequent but their efficacy is a matter of controversy. We have investigated the effect of the Eating Disorder Awareness Week and Wake Up Weight Watchers campaigns on Twitter. Objective We aimed to examine whether the Eating Disorder Awareness Week and Wake Up Weight Watchers initiatives increased the volume and dissemination of Twitter conversations related to eating disorders and investigate what content generates the most interest on Twitter. Methods Over a period of 12 consecutive days in 2018, we collected tweets containing the hashtag #wakeupweightwatchers and hashtags related to Eating Disorder Awareness Week (#eatingdisorderawarenessweek, #eatingdisorderawareness, or #EDAW), with the hashtag #eatingdisorder as a control. The content of each tweet was rated as medical, testimony, help offer, awareness, pro-ana, or anti-ana. We analyzed the number of retweets and favorites generated, as well as the potential reach and impact of the hashtags and the characteristics of contributors. Results The number of #wakeupweightwatchers tweets was higher than that of Eating Disorder Awareness Week and #eatingdisorder tweets (3900, 2056, and 1057, respectively). The content of tweets was significantly different between the hashtags analyzed (P Conclusions Both awareness campaigns effectively promoted tweeting about eating disorders. The majority of tweets did not promote any specific preventive or help-seeking behaviors.

Chronic venous disease (CVD) is a multifactorial vascular disorder frequently manifested in lower limbs in the form of varicose veins (VVs). Women are a vulnerable population for suffering from CVD, especially during pregnancy, when a plethora of changes occur in their cardiovascular system. Previous studies have indicated a worrisome association between CVD in pregnancy with the placental structure and function. Findings include an altered cellular behavior and extracellular matrix (ECM) composition. Integrin-linked kinase (ILK) is a critical molecule involved in multiple physiological and pathological conditions, and together with cadherins, is essential to mediate cell to ECM and cell to cell interplay, respectively. Thus, the aim of this study was to evaluate the implication of ILK and a set of cadherins (e-cadherin, cadherin-6 and cadherin-17) in placentas of women with CVD in order to unravel the possible pathophysiological role of these components. Gene expression (RT-qPCR) and protein expression (immunohistochemistry) studies were performed. Our results show a significant increase in the gene and protein expression of ILK, cadherin-6 and cadherin-17 and a decrease of e-cadherin in the placenta of women with CVD. Overall, this work shows that an abnormal expression of ILK, e-cadherin, cadherin-6 and cadherin-17 may be implicated in the pathological changes occurring in the placental tissue. Further studies should be conducted to determine the possible associations of these changes with maternal and fetal well-being.

Aims The purposes of this study were: (i) to evaluate the reliability of vaginal palpation, vaginal manometry, vaginal dynamometry; and surface (transperineal) electromyography (sEMG), when evaluating pelvic floor muscle (PFM) strength and/or activation; and (ii) to determine the associations among PFM strength measured using these assessments. Methods One hundred and fifty women with pelvic floor disorders participated on one occasion, and 20 women returned for the same investigations by two different raters on 3 different days. At each session, PFM strength was assessed using palpation (both the modified Oxford Grading Scale and the Levator ani testing), manometry, and dynamometry; and PFM activation was assessed using sEMG. Results The interrater reliability of manometry, dynamometry, and sEMG (both root-mean-square [RMS] and integral average) was high (Lin's Concordance Correlation Coefficient [CCC] = 0.95, 0.93, 0.91, 0.86, respectively), whereas the interrater reliability of both palpation grading scales was low (Cohen's Kappa [k] = 0.27-0.38). The intrarater reliability of manometry (CCC = 0.96), and dynamometry (CCC = 0.96) were high, whereas intrarater reliability of both palpation scales (k = 0.78 for both), and of sEMG (CCC = 0.79 vs 0.80 for RMS vs integral average) was moderate. The Bland-Altman plot showed good inter and intrarater agreement, with little random variability for all instruments. The correlations among palpation, manometry, and dynamometry were moderate (coefficient of determination [r2] ranged from 0.52 to 0.75), however, transperineal sEMG amplitude was only weakly correlated with all measures of strength (r2 = 0.23-0.30). Conclusions Manometry and dynamometry are more reliable tools than vaginal palpation for the assessment of PFM strength in women with pelvic floor disorders, especially when different raters are involved. The different PFM strength measures used clinically are moderately correlated; whereas, PFM activation recorded using transperineal sEMG is only weakly correlated with PFM strength. Results from perineal sEMG should not be interpreted in the context of reporting PFM strength.

Background: Twitter is an indicator of real-world performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis. Objective: The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus). Methods: Each tweet’s content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness’s diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated. Results: We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3% (212/636) vs 1.15% (853/7419; P

Background and objective Edema of the uvula (EU) may appear in isolation or in association with clinical manifestations such as urticaria, angioedema, and anaphylaxis. EU may lead to upper airway obstruction, provoking obstructive respiratory distress and asphyxia. Objective: We sought to investigate the etiology of and predisposing factors for EU in a large population of patients referred to an outpatient clinic. Methods In this 3-year follow-up cohort study, 171 patients presenting with EU were identified and classified as having isolated EU or nonisolated EU. The etiology of each patient's condition was studied, and possible predisposing factors were recorded. An allergology work-up and a statistical study (bivariate/multivariate analyses) were performed. Results The predisposing factors for both groups of EU patients were found to be different. The etiology of the problem was identified for most patients; allergy to Anisakis simplex was the most common cause in both groups. Nonsteroidal anti-inflammatory drugs and antibiotics were also found to be triggers in both groups. Conclusions Isolated EU was associated with snoring, an elongated uvula, and having experienced previous episodes of EU. We found no associations between groups of EU patients and gender, obesity, smoking, alcohol consumption, personal and family history of atopy, and obstructive sleep apnea. Allergy to A simplex was the most commonly recorded cause.

Background: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. Objective: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. Methods: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. Results: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P

Objective To study the relationship between tension-type headaches and the oculomotor system in terms of binocular coordination, mechanosensitivity of the supraorbital nerve, and myofascial trigger points in the lateral rectus muscle, assessing the influence of visual effort caused by using a computer at work. Design Observational study with blind evaluation of the response variable. Methods Two groups were compared: 19 subjects with tension-type headaches and 16 healthy subjects, both exposed to computer use at work. A blinded assessor conducted three tests: measurement of the supraorbital nerve pressure pain threshold using a pressure algometer, evaluation of myofascial trigger points of the lateral rectus using the verbal numerical scale, and assessment of binocular coordination in smooth pursuit eye movements using an innovative video-oculography system. Tests were performed before work began and four hours later, and subjects in the headache group were examined when they presented a headache score of less than or equal to 3 on the verbal numerical scale. Results The headache group presented a greater sensitivity of the supraorbital nerve and greater local and referred pain of the lateral rectus ( P

[ES] Objetivos: Identificar los recursos y actividades preventivas más prevalentes en el sector del transporte de mercancías por carretera y los hechos diferenciales con el resto de la población trabajadora española. Metodología: Estudio descriptivo de los datos de la Encuesta de Salud y Condiciones de Trabajo del sector del transporte y estudio comparativo con el resto de la población trabajadora a través de la V-Encuesta Nacional de Condiciones de Trabajo. Para el análisis estadístico se ha aplicado el ji cuadrado y la t-student. Resultados: El 77% de las empresas de este sector tienen menos de 50 trabajadores. El 41% de los conductores señala que en su empresa no existe Delegado de Prevención y un 25% no dispone de ningún Recurso Preventivo. Destaca el alto desconocimiento existente entre los conductores de los recursos preventivos en su empresa (34,3%). La modalidad preventiva más frecuentemente instaurada en el sector es la asunción de la prevención por parte del empresario (13,6%) a diferencia del resto de sectores donde predomina el SP. Ajeno (43%). Conclusiones: Predominio de la pequeña empresa en el Sector del transporte asociado a un escaso desarrollo del tejido prevenGoals: To identify the most prevalent resources and preventive activities in professional long-haul drivers and their peculiarities related to the other Spanish production branches. Methodology: We develop a descriptive analysis of data from the Survey of Health and Working Conditions in professional truck drivers and we compare these results with the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T-Student test and the Ji square. Results: In this branch 77% of companies have less than 50 employees. 41% of drivers referred that it does not exist the «Delegado de Prevención» (workers representative) in their companies and 25% that there is not any Preventive Action. It is specially relevant the unknowledge among drivers about preventive resources in their companies (34.3%). The most frequently introduced preventive modality in the sector is the employer taking prevention by himself (13.6%) whilst other sectors are mainly covered by External Preventive Services (43%). Conclusions: If Transport branch is compared with the general - reference population it shows an image in which undersized companies linked to a weak development of preventive network could be determinant to their lowest preventive activities. Also we find a better self perceived health related to a better access to preventive activities.tivo en comparación con la población de referencia. Ambas características pueden ser determinantes de la menor actividad preventiva, más baja que la observada en la población de referencia. El acceso a actividades preventivas entre los conductores se relaciona con una mejor salud percibida. Goals: To identify the most prevalent resources and preventive activities in professional long-haul drivers and their peculiarities related to the other Spanish production branches. Methodology: We develop a descriptive analysis of data from the Survey of Health and Working Conditions in professional truck drivers and we compare these results with the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T-Student test and the Ji square. Results: In this branch 77% of companies have less than 50 employees. 41% of drivers referred that it does not exist the «Delegado de Prevención» (workers representative) in their companies and 25% that there is not any Preventive Action. It is specially relevant the unknowledge among drivers about preventive resources in their companies (34.3%). The most frequently introduced preventive modality in the sector is the employer taking prevention by himself (13.6%) whilst other sectors are mainly covered by External Preventive Services (43%). Conclusions: If Transport branch is compared with the general - reference population it shows an image in which undersized companies linked to a weak development of preventive network could be determinant to their lowest preventive activities. Also we find a better self perceived health related to a better access to preventive activities.[EN] Goals: To identify the most prevalent resources and preventive activities in professional long-haul drivers andtheir peculiarities related to the other Spanish production branches.Methodology: We develop a descriptive analysis ofdata from the Survey of Health and Working Conditions inprofessional truck drivers and we compare these resultswith the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T-Student test and the Ji square. Results: In this branch 77% of companies have less than 50 employees. 41% of drivers referred that it does not exist the "Delegado de Prevención" (workers representative) in their companies and 25% that there is not any Preventive Action. It is specially relevant the unknowledge among drivers about preventive resources in their companies (34.3%). The most frequently introduced preventivemodality in the sector is the employer taking prevention by himself (13.6%) whilst other sectors are mainly covered by External Preventive Services (43%). Conclusions: If Transport branch is compared with the general - reference population it shows an image in which undersized companies linked to a weak development of preventive network could be determinant to their lowest preventive activities. Also we find a better self perceived health related to a better access to preventive activities Sí

Objetivo: Consensuar las competencias profesionales de salud pública que deben adquirir los estudiantes en el Grado en Medicina y los contenidos fundamentales que debe incluir la materia de salud pública según el criterio de un grupo de docentes de salud pública del Grado en Medicina de distintas universidades españolas. Métodos:Se organizó una 2 ª Reunión del Foro de Profesorado Universitario de Salud Pública en la Universidad Rey Juan Carlos (Madrid, 11-12 de diciembre de 2014), en la que participaron 24 docentes de 19 universidades españolas con Grado en Medicina que fueron distribuidos en tres grupos durante tres sesiones de trabajo. En la primera sesión, se identificaron y clasificaron las competencias propias del Grado; en la segunda, se propusieron contenidos de salud pública para las competencias identificadas; en la tercera, se organizaron los contenidos en bloques temáticos. Los resultados se discutieron hasta alcanzar acuerdos, en distintas sesiones plenarias. Resultados: El mayor número de competencias identificadas corresponde a actividades de las funciones «Valorar las necesidades de salud de la población» y «Desarrollar políticas de salud». El programa final incluye contenidos básicos organizados en cinco bloques: Concepto de salud, salud pública y sus condicionantes; Epidemiología e investigación en salud; Condicionantes y problemas de salud; Estrategias, intervenciones y políticas; y Sistemas de salud, gestión clínica y sanitaria. Conclusiones:Las competencias y los contenidos comunes consensuados en este Foro constituyen una base para actualizar y mejorar la formación en salud pública de los futuros profesionales de la medicina. Objective: To reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into undergraduate medical degrees. Methods: The 2 nd Forum of University Teachers was held at the Rey Juan Carlos University (Madrid, 11-12 December 2014). Twenty-four university professors and lecturers from 19 Spanish universities imparting medical degrees participated in the forum. They were distributed in three working groups during three working sessions. In the first session, they were asked to identify and classify core public health competencies for medical degrees. In the second, they were asked to propose public health contents for the identified competencies. In the third session, the participants organized these contents in thematic blocks. The results were discussed in distinct plenary sessions. Results: The highest number of core competencies was identified in the activities related to the public health functions «Assessment of the population''s health needs» and «Developing health policies». The final programme included basic contents organised into five units: Concept of health, public health and its determinants; Epidemiology and health research; Determinants and health problems; Strategies, interventions and policies; and health systems, clinical and healthcare management. Conclusions: The public health core competencies and contents identified in this Forum may be considered as a starting point to improve and update public health training programmes for future medical professionals.

Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized.We analyzed the effect of preoperative psychologic distress on changes in pain, function, and quality of life 1 year after elective TKA.In this prospective cohort study, we assessed patients who underwent TKAs in 2009 and 2010. Before surgery, patients completed the Folstein Mini Mental Test, the Hospital Anxiety and Depression Scale (HAD), The Knee Society Score(©), the WOMAC quality-of-life questionnaire, and the VAS for pain. The patients were divided into two groups based on the degree of psychologic distress on the HAD Scale, and the groups were compared in terms of the above-listed clinical outcomes tools 1 year after surgery using multivariate linear models. Two hundred sixty-three patients met the inclusion criteria, and 202 (77%) completed the study protocol.The presence of preoperative psychologic distress did not influence 1-year postoperative pain assessment (average reduction in pain, 40.33; 95% CI, 36.9-43.8; p = 0.18). The only factor influencing change in pain experienced by patients was the preoperative pain recorded (R(2) = 0.31; β = -0.82; p0.001). The patients experiencing preoperative psychologic distress obtained poorer outcomes in function (R(2) = 0.16; β = -5.62; p = 0.001) and quality of life (R(2) = 0.09; β = -0.46; p0.001) 1 year after receiving TKA.The presence of preoperative psychologic distress is associated with worse 1-year outcomes for function and quality of life in patients undergoing TKA. Interventions designed to reduce psychologic distress may be indicated for patients to undergo this type of surgery, and incorporation of these data into discussions with patients may facilitate informed and shared decision making regarding the surgical treatment of knee osteoarthritis.Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Background Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. Methods And Findings We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Conclusions Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation.

Background The oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency. Methods/design The proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited. Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3–8,and 1 mg/month in weeks 9–52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses. Discussion The results of this study should help establish, taking quality of life into account, whether the oral administration of vitamin B12 is an effective alternative to its intramuscular administration. If this administration route is effective, it should provide a cheaper means of treating vitamin B12 deficiency while inducing fewer adverse effects. Having such an alternative would also allow patient preferences to be taken into consideration at the time of prescribing treatment. Trial registration This trial has been registered with ClinicalTrials.gov, number NCT 01476007, and under EUDRACT number 2010-024129-20.

Introducción: El consumo excesivo de alcohol es un problema de salud pública, según la OMS anualmente mueren 2,5 millones de personas por esta causa, el sector laboral no escapa a esta situación, creando la necesidad detectar precozmente el consumo de alcohol en los trabajadores. Objetivos: Identificar los factores de riesgo para el consumo de alcohol en el medio laboral, y describir instrumentos útiles para el médico del trabajo, en el reconocimiento de trabajadores con problemas de abuso de alcohol. Método: Se consultaron distintas bases de datos PUBMED, CISDOC, SCIELO, LILACS, MEDLINE The cocrhane library. Se evaluaron resúmenes y se recuperaron a texto completo aquellos relacionados con abuso de alcohol en población trabajadora. Resultados: Se encontraron estudios epidemiológicos, de casos y controles, publicaciones de organismos oficiales y revistas de salud laboral. Estos evaluaron factores psicosociales y alcohol, algunos estudios usaron medidas de cribaje como cuestionarios AUDIT, CAGE y MALT para diagnosticar consumo perjudicial de alcohol. Conclusiones: Se identificaron factores de riesgo en la población trabajadora, relacionados con el ambiente laboral, organización del trabajo, cualificación profesional y factores individuales: edad, sexo, y nivel socio-cultural. El uso de cuestionarios para detectar consumo de alcohol fue considerado la mejor opción, por fácil aplicación y bajo coste. Es necesario promover el uso de herramientas aplicables en el reconocimiento y prevención del abuso de alcohol en la población trabajadora. Background: The alcohol abuse (AA) is a public health problem that causes 2.5 million deaths annually (WHO), the labor sector is not immune to this situation, creating the need for early detection of AA on workers. Objective: To identify risk factors and instruments for health surveillance of workers with AA problems. Methods: We reviewed the literature, PUBMED, CIS-DOC, SCIELO, LILACS, MEDLINE and the Cochrane Library. We included studies relating to AA in the working population, risk factors and consequences in the labor sector. They were classified according to level of evidence (Scottish Intercollegiate Guidelines Network, SIGN). Results: There were 75 articles, 31 met the criteria for inclusion: A 2+ evidence study. Fifteen evidence 3 and sixteen with evidence level 4. Alcohol was the most consumed psychoactive substance in the working population prevalence of 77.8% in men and 72.9% in women. It was considered a risk factor for the AA, non-qualified. Two studies with evidence level 4 reported the increased accident rates and absenteeism related to AA. The AA screening methods used were CAGE and AUDIT . Conclusions: The risk factors were identified in the working population, related to work organization, skill levels and individual factors. The use of CAGE and AUDIT for detection of AA was considered the best option for easy application and low cost. Insufficient documentation was found on the effects of AA, suggesting the promotion of study of these issues and assess the use of screening measures to enhance prevention.

espanolIntroduccion: El consumo excesivo de alcohol es un problema de salud publica, segun la OMS anualmente mueren 2,5 millones de personas por esta causa, el sector laboral no escapa a esta situacion, creando la necesidad detectar precozmente el consumo de alcohol en los trabajadores. Objetivos: Identificar los factores de riesgo para el consumo de alcohol en el medio laboral, y describir instrumentos utiles para el medico del trabajo, en el reconocimiento de trabajadores con problemas de abuso de alcohol. Metodo: Se consultaron distintas bases de datos PUBMED, CISDOC, SCIELO, LILACS, MEDLINE The cocrhane library. Se evaluaron resumenes y se recuperaron a texto completo aquellos relacionados con abuso de alcohol en poblacion trabajadora. Resultados: Se encontraron estudios epidemiologicos, de casos y controles, publicaciones de organismos oficiales y revistas de salud laboral. Estos evaluaron factores psicosociales y alcohol, algunos estudios usaron medidas de cribaje como cuestionarios AUDIT, CAGE y MALT para diagnosticar consumo perjudicial de alcohol. Conclusiones: Se identificaron factores de riesgo en la poblacion trabajadora, relacionados con el ambiente laboral, organizacion del trabajo, cualificacion profesional y factores individuales: edad, sexo, y nivel socio-cultural. El uso de cuestionarios para detectar consumo de alcohol fue considerado la mejor opcion, por facil aplicacion y bajo coste. Es necesario promover el uso de herramientas aplicables en el reconocimiento y prevencion del abuso de alcohol en la poblacion trabajadora. EnglishBackground: The alcohol abuse (AA) is a public health problem that causes 2.5 million deaths annually (WHO), the labor sector is not immune to this situation, creating the need for early detection of AA on workers. Objective: To identify risk factors and instruments for health surveillance of workers with AA problems. Methods: We reviewed the literature, PUBMED, CIS-DOC, SCIELO, LILACS, MEDLINE and the Cochrane Library. We included studies relating to AA in the working population, risk factors and consequences in the labor sector. They were classified according to level of evidence (Scottish Intercollegiate Guidelines Network, SIGN). Results: There were 75 articles, 31 met the criteria for inclusion: A 2+ evidence study. Fifteen evidence 3 and sixteen with evidence level 4. Alcohol was the most consumed psychoactive substance in the working population prevalence of 77.8% in men and 72.9% in women. It was considered a risk factor for the AA, nonqualified. Two studies with evidence level 4 reported the increased accident rates and absenteeism related to AA. The AA screening methods used were CAGE and AUDIT . Conclusions: The risk factors were identified in the working population, related to work organization, skill levels and individual factors. The use of CAGE and AUDIT for detection of AA was considered the best option for easy application and low cost. Insufficient documentation was found on the effects of AA, suggesting the promotion of study of these issues and assess the use of screening measures to enhance prevention.