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This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

It has been reported that frontline health professionals have suffered from an increased rate of mental disorders as a consequence of the SARS-CoV-2 pandemic. Objective: This study aims to evaluate the impact of the pandemic on the mental health of Spanish specialists in the obstetrics and gynecology fields after the fifth Spanish COVID-19 wave. Methods: Psychometric screening of the professionals was performed using a nationwide online survey designed by the Psychosocial Obstetrics and Gynecology taskforce. Post-traumatic stress disorder (PTSD), depression, and general anxiety disorder were screened. Results: We found high scores for PTSD, depression, and generalized anxiety disorder. Up to 12.4% of specialists met the PTSD criteria, 12.8% showed complex PTSD, 37% showed depression, and up to 37% had a positive screening for generalized anxiety disorder. Our results showed that the pandemic has particularly affected the group of female Ob-Gyn specialists, with significant higher scores in depression and anxiety scales. Conclusions: As a lesson learned for the future in case of new health emergencies, it would be very important to provide professionals with adequate psychological support, ensuring enough human and material resources, flexible work shifts, and facilities to reconcile work and family-life, especially in the case of female specialists.

(1) Background: In Spain, as in other countries, there is an increase in policies and practices focused on the humanization of perinatal care. In this regard, the quality of interpersonal interactions between women and health professionals is one of the main factors, and, apart from other factors, it is influenced by health professionals´ attitudes towards childbirth. The main objective of this study was to determine the attitudes of obstetricians towards the humanization of childbirth and the promotion of a positive childbirth experience. (2) Methods: The psychosocial task force of the Spanish Society of Obstetrics and Gynecology designed a nationwide online survey. The questionnaire on attitudes towards childbirth (CAVE, acronym for “cuestionario de actitudes sobre vivencias y experiencias en el parto”) was used for the assessment. Exploratory and confirmatory factor analyses of the scale were also performed. (3) Results: A total of 384 participants completed the survey. Obstetricians showed a high-quality clinical obstetric performance, but some difficulties in identifying birth-related psychological-trauma risk factors. Some differences according to practice and gender were found in the final score and in areas regarding psychosocial risk, pain, accompaniment, and women´s expectations. (4) Conclusions: In light of the results, it is advisable to launch education initiatives aimed to improve interaction with pregnant women.

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study.&nbsp, Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9, range 17–34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson’s coefficient −0.128 (p &lt, 0.05). Conclusions: In the period 2000–2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.

Space weather driven atmospheric density variations affect low Earth orbit (LEO) satellites during all phases of their operational lifetime. Rocket launches, re-entry events and space debris are also similarly affected. A better understanding of space weather processes and their impact on atmospheric density is thus critical for satellite operations as well as for safety issues. The Horizon 2020 project Space Weather Atmosphere Model and Indices (SWAMI) project, which started in January 2018, aims to enhance this understanding by:Developing improved neutral atmosphere and thermosphere models, and combining these models to produce a new whole atmosphere model.Developing new geomagnetic activity indices with higher time cadence to enable better representation of thermospheric variability in the models, and improving the forecast of these indices.The project stands out by providing an integrated approach to the satellite neutral environment, in which the main space weather drivers are addressed together with model improvement. The outcomes of SWAMI will provide a pathway to improved space weather services as the project will not only address the science issues, but also the transition of models into operational services.The project aims to develop a unique new whole atmosphere model, by extending and blending the Unified Model (UM), which is the Met Office weather and climate model, and the Drag Temperature Model (DTM), which is a semi-empirical model which covers the 120–1500 km altitude range. A user-focused operational tool for satellite applications shall be developed based on this. In addition, improved geomagnetic indices shall be developed and shall be used in the UM and DTM for enhanced nowcast and forecast capability.In this paper, we report on progress with SWAMI to date. The UM has been extended from its original upper boundary of 85 km to run stably and accurately with a 135 km lid. Developments to the UM radiation scheme to enable accurate performance in the mesosphere and lower thermosphere are described. These include addition of non-local thermodynamic equilibrium effects and extension to include the far ultraviolet and extreme ultraviolet. DTM has been re-developed using a more accurate neutral density observation database than has been used in the past. In addition, we describe an algorithm to develop a new version of DTM driven by geomagnetic indices with a 60 minute cadence (denoted Hp60) rather than 3-hourlyKpindices (and corresponding ap indices). The development of the Hp60 index, and the Hp30 and Hp90 indices, which are similar to Hp60 but with 30 minute and 90 minute cadences, respectively, is described, as is the development and testing of neural network and other machine learning methods applied to the forecast of geomagnetic indices.