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The COVID-19 pandemic has hit Spain particularly hard, despite being a country with a developed economy and being praised for the robustness of its national health system. In order to understand what happened and to identify how to improve the response, we believe that an independent multi-disciplinary evaluation of the health, political and socio-economic spheres is essential. In this piece we propose objectives, principles, methodology and dimensions to be evaluated, as well as outlining the type of results and conclusions expected. Inspired by the requirements formulated by the WHO Independent Panel for Pandemic Preparedness and Response and by experiences in other countries, we detail the multidimensional aspects to be evaluated. The goal is to understand key aspects in the studied areas and their scope for improvement in terms of preparedness, governance, regulatory framework, national health system structures (primary care, hospital, and public health), education sector, social protection schemes, minimization of economic impact, and labour framework and reforms for a more resilient society. We seek to ensure that this exercise serves not only at present, but also that in the future we are better prepared and more agile in terms of our ability to recover from any pandemic threats that may arise.

The Maudsley Violence Questionnaire (MVQ) is an instrument specifically developed to evaluate violent thinking through two subscales examining macho attitudes and the acceptance of violence. This study analyzed the psychometric properties and factor structure of the Spanish version of the MVQ questionnaire in a large sample of 1933 Spanish adolescents. An online questionnaire was used to collect variables, such as sociodemographic and sexism data. The factor structure showed good fit indices in Spanish adolescents, which were similar to the original scale. The exploratory analysis yielded a first factor that explained 11.3% of the total variance and a second factor that explained 10.8% of the total variance. The Goodness of Fit Index (GFI) (0.902), Adjusted Goodness of Fit Index (AGFI) (0.90), Normed Fit Index (NNFI) (0.85), and the Comparative Fit Index (CFI) (0.86) suggested that the model fit the data adequately (with values = 0.90) and the Root Mean Square Error of Approximation (RMSEA) (=0.10) values indicative of an adequate fit. This study contributes a Spanish-language validated tool to measure machismo and the acceptance of violence among adolescents.

Background. Acute interstitial nephritis (AIN) is an emerging cause of acute kidney disease. While this disease usually follows an acute course, it may occasionally recur, representing a major challenge for the clinician. Methods. We performed a retrospective, observational cohort study in 13 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients with biopsy-proven AIN between 1996 and 2018 were included. Results. The study group consisted of 205 patients with AIN, 22 of which developed recurrent AIN (RAIN) after a median of 111 days from diagnosis. RAIN was due to a surreptitious reintroduction of a previously known implicated drug or toxic in six patients (27%), sarcoidosis in two (9%), Sjogren's syndrome in three (14%), light-chain-mediated AIN in two (9%) and tubulointerstitial nephritis and uveitis syndrome in two (9%), while in the rest of cases (32%), no precise cause could be identified. Microscopic haematuria was more frequent in patients with underlying systemic diseases. The first RAIN episode was treated with a repeated course of corticosteroids in 21 patients (95%). In six cases (27%), azathioprine and mycophenolate mofetil were added as corticosteroid-sparing agents. During a median follow-up of 30 months, 50 patients (27%) with no recurrences and 12 patients (55%) with RAIN reached Stages 4 and 5 chronic kidney disease (CKD). By multivariable logistic regression analysis, RAIN was independently associated with the risk of reaching Stages 4 and 5 CKD, even after adjusting for potential covariables. Conclusions. RAIN is infrequent but is associated with poor kidney survival. RAIN should prompt clinicians to search for an underlying aetiology other than drug induced. However, in a large percentage of cases, no precise cause can be identified.

SummaryFor modern Western societies with a regime of monogamy, it has recently been demonstrated that the socioeconomic status of men is positively associated with being or having been married. This study aims to compare marriage patterns (if a person has been married at least once) for cultures with a tradition of monogamy and polygyny. As no worldwide data on polygyny exist, religion was used as a proxy for monogamy (Christians) vs polygyny (Muslims). The analyses were based on 2000–2011 census data from 39 countries worldwide for 52,339,594 men and women, controlling for sex, sex ratio, age, education, migration within the last 5 years and employment. Overall, a higher proportion of Muslims were married compared with Christians, but the difference in the fraction of married men compared with married women at a certain age (the ‘marriage gap’) was much more pronounced in Muslims than in Christians, i.e. compared with Christians, a substantially higher proportion of Muslim women than men were married up to the age of approximately 31 years. As expected for a tradition of polygyny, the results indicate that the socioeconomic threshold for entering marriage is higher for Muslim than Christian men, and Muslim women in particular face a negative effect of socioeconomic status on the probability of ever being married. The large ‘marriage gap’ at a certain age in Muslim societies leads to high numbers of married women and unmarried young men, and may put such polygenic societies under pressure.

Objectives: (1) To analyze the prevalence of Intimate Partner Violence by types. (2) To examine the relationship between sociodemographic characteristics and Intimate Partner Violence. Design: Cross-sectional study using a self-administered questionnaire. Setting: Primary Healthcare centers in Spain. Participants: 10,322 women (18-70 years) attending Primary Healthcare centers. Main measurements: A compound index was calculated based on frequency, types, and duration of Intimate Partner Violence. Multivariable adjusted logistic regression models were used to identify the sociodemographic factors, which were independently associated with each Intimate Partner Violence category. Results: The prevalence of Intimate Partner Violence was 24.8%. For the physical only category, no differences were observed regarding education or employment status, and women with the highest income have less risk. For the psychological only category, no differences were observed according to the income level. The risk increases as the education level decreases, and the greatest frequency of only psychological Intimate Partner Violence was observed in women who were unemployed or students. For both the physical and psychological category of Intimate Partner Violence, a clear risk increase is observed as income and education levels decrease. Retired women showed the highest frequency of this violence category. Conclusion: The results show that Intimate Partner Violence affects women of all social strata, but the frequency and Intimate Partner Violence category will vary according to the socioeconomic. (C) 2016 Elsevier Espana, S.L.U.

Intimate partner violence (IPV) against women is a significant public health and human rights problem. Primary care professionals play a key role in detecting and addressing this issue. The aim of this study is to determine the frequency of IPV and its associated factors in primary care by means of a screening questionnaire and to describe the main actions taken in identified cases.

El feminicidio o asesinato de mujeres por razones de género es ya un reconocido problema de salud pública, además de una grave vulneración de los derechos humanos. Todavía se desconoce con exactitud su magnitud en el mundo, dadas las dificultades metodológicas para diferenciar estos asesinatos de otros homicidios de mujeres. El Programa de la Unión Europea «Redes de Cooperación Europea en Ciencia y Tecnología» puso en marcha en 2013 la Acción COST Femicide across Europe, abriendo un marco europeo óptimo para la cooperación transnacional entre personas expertas que aborden grandes retos sociales y de salud pública como el feminicidio. En esta nota de campo se describen sus principales objetivos, los grupos de expertos y expertas que lo conforman, y los resultados obtenidos a medio plazo con dicha experiencia.

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.

A la Sociedad Española de Epidemiología, la Sociedad Española de Salud Pública y Administraciones Sanitarias, y la Universidad Rey Juan Carlos, por su apoyo en la organización de la 2 ª Reunión del Foro de Profesorado Universitario de Salud Pública en el Grado de Medicina., Davó-Blanes, M.C., Vives-Cases, C., Barrio-Fernández, J.L., Porta, M., Benavides, F.G., Miguel, T.G.D., Remón, C.A., Vicente, R.A., del Barco, A.A., Martínez, M.V.C., Soler, J.C., Fernández Ballart, J.D., Muñoz, E.F., Pino, C.G., Miner, M.G., Godoy García, P., Pérez-Regadera, A.G., Aguado, I.H., Mejías, E.J., López-Torres Hidalgo, J., Martínez, A.M., Pastor-Valero, M., Ruiz-Canela López, M., García, A.T., Valero-Juan, L.F.

Most people would prefer to die in their own bed, but in fact only a quarter of deaths occur in the home. The “Fin de vie en France” [End of life in France] survey follows the residential and medical trajectories of patients up to their death. In cases of non-sudden death, 45% of persons are living at home four weeks before they die. The most frequent pattern is a move from home to hospital before death (30%); just 14% remain at home throughout the last month of life. A transfer back home from hospital is much less frequent (2%). The complexity of treatment often makes home care unfeasible, so a hospital transfer is inevitable. This is the reason most frequently given for not respecting the patient’s wish to die at home.

Background. There are a significant number of studies assessing the negative health consequences of violence against women. However, a limited number of studies analyse the health consequences of violence committed against young women by different types of aggressors. Objectives. The goal of this study is to assess the prevalence of interpersonal violence against young women in Spain and analyse its impact on the physical and mental health of the victims. Methods. A total of 1076 women aged 18-25 years attending Spanish primary care services were selected. We estimated the prevalence of interpersonal violence and compared the health data and demographic characteristics of abused and non-abused young women, multi-logistic regression models were fitted. The Wald test was used to assess whether there were differences in the negative health consequences of intimate partner (IPV) versus non-IPV. Results. As many as 27.6% young women reported a history of abuse, of whom 42.7% had been assaulted by their partner, 41.1% by someone other than their partner and 16.2% both by their partner and another person. The distribution of social and demographic characteristics was similar for IPV and non-IPV victims. Young abused women were three times more likely to suffer psychological distress and have somatic complaints, and they were four times more likely to use medication as compared to non-abused women. Conclusion. Our results suggest that all forms of violence compromise young women's health seriously. Including patients' history of abuse in their health record may help make more informed clinical decisions and provide a more integrated care.

Background: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. Methods: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 1564 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). Results: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.241.56, PR2012 = 1.56; 95% CI: 1.331.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.861.40, PR2012 = 1.34; 95% CI: 1.061.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.110.43, PR2012 = 1.20; 95% CI: 0.732.01). Conclusions: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants health status. © The Author 2015.

Fundamentos: La realidad socio-demográfica configurada en España a partir de la incorporación de la población inmigrante requiere analizar las necesidades y prioridades generadas por esta situación en todos los ámbitos, incluido el de la investigación en salud. El objetivo del presente estudio es conocer las características generales de los artículos incluidos en una revisión bibliográfica sobre este tema y realizada en el marco del Subprograma de Salud e Inmigración del CIBERESP. Métodos: Revisión bibliográfica de los artículos originales publicados en español o inglés en el periodo 1998-2012. Se seleccionaron artículos realizados en España y que cumplieran la definición de inmigrante de la Organización Internacional de Migraciones. La búsqueda bibliográfica se realizó en Medline y MEDES. Se analizó la distribución temporal de la producción y las características generales de los artículos mediante frecuencias absolutas y relativas. Resultados: En la búsqueda inicial se identificaron 2.625 artículos (2.434 Medline y 191 Medes-MEDicina), finalmente se incluyeron los 311 que cumplían criterios de inclusión. La mayoría eran estudios epidemiológicos de diseño transversal realizados con datos primarios. En el 69% se comparó a la población inmigrante con la autóctona. En 217, (70%) la temática principal fue la relacionada con enfermedades transmisibles. En 256 (82%) el periodo producción fue entre 2004 y 2011. En 220 (71%) el país de origen fue la forma más común de clasificación de la población inmigrante. Conclusiones: Las enfermedades transmisibles fueron el principal objeto de investigación de los estudios desarrollados en España sobre salud de la población inmigrante. La mayoría de estudios incluyen a la población autóctona como grupo de comparación. Background: The new socio-demographic reality that came about with the incorporation of the immigrant population in Spain requires an analysis of the needs and priorities generated by this situation in all areas, including research in health. The objective of this study is to determine the general characteristics of a group of articles included in a literature review on the subject, carried out within the framework of the CIBERSP Subprogram on Migration and Health. Methods: Scoping Review of the literature published in the period 1998-2012. Articles in Spanish or English developed in Spain and that fulfil the definition of immigrant from the International Organization for Migration were selected. The literature search was performed in Medline and MEDES. The temporal distribution of the production and main characteristics of the articles are described trough absolute and relative frequencies. Results: The initial search identified 2.625 articles (Medline 2434; 191 Medes-MEDicina) 311 were including finally. Most epidemiological studies are cross-sectional design with primary data. 69% compared with native population. The main theme has been associated with infectious diseases (n=217, 70%). The period of maximum production is between 2004 and 2011(n=256, 82%). The country of origin is the most common way of classifying immigrants (n=220, 71%). Conclusions: The epidemiology of infectious prevails as the main theme of the studies performed in Spain about the health of the immigrant population. Most of the studies include native population as a comparison group.