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Background: The COVID-19 outbreak has led to an unprecedented crisis in Spain. After Italy, the spread of the virus was quick, and Spain became the second epicenter in Europe by number of cases and deceased. To tackle the outbreak and contain the spread, the Spanish authorities undertook exceptional measures based on a generalized lockdown by which the majority of the economic activity ceased for several weeks., Objectives: The goal of this paper is to examine the spread of COVID-19 in Spain from February to May 2020, as well as the public policies and technologies used to contain the evolution of the pandemic. In particular it aims to assess the effectivity of the policies applied within the different autonomous communities. Cases are presented until August as well as the main changes in containment and mitigation measures., Methods: Data was collected from various official sources, including government reports, press releases and datasets provided by national and international level institutions., Results: We show that the main measure to contain the spread of the pandemic was a stringent confinement policy enforced through fines. It resulted in a substantial reduction in the mobility and the economic activity. At a regional level, the negative consequences of the crisis affected differently across regions., (© 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.)

Purpose: Intra-arterial mechanical thrombectomy combined with appropriate patient selection (image-based selection of acute ischaemic stroke patients with large artery occlusion) yields improved clinical outcomes. We conducted a systematic review and meta-analysis, with trial sequential analysis to understand the benefits, risks and impact of new trials reporting in 2016 on the magnitude/certainty of the estimates for clinical effectiveness and safety of mechanical thrombectomy., Method: Random effects' models were conducted of randomised clinical trials comparing mechanical thrombectomy (stent retriever or aspiration devices) with/without adjuvant intravenous thrombolysis with intravenous thrombolysis and other forms of best medical/supportive care in the treatment of acute ischaemic stroke. Study inclusion and risk of bias were assessed independently by two reviewers. Functional independence (modified Rankin Scale 0-2) and mortality at 90 days, including symptomatic intracranial haemorrhage rate were extracted. Trial sequential analysis established the strength of the evidence derived from the meta-analyses., Findings: Eight trials of mechanical thrombectomy with a total sample size of 1841 (916 patients treated with mechanical thrombectomy and 925 treated without mechanical thrombectomy) fulfilled review inclusion criteria. The three most recent trials more precisely defined the effectiveness of mechanical thrombectomy (modified Rankin Scale 0 to 2; OR = 2.07, 95% CI = 1.70 to 2.51 based on data from eight trials versus OR = 2.39, 95% CI = 1.88 to 3.04 based on data from five trials). Meta-analyses showed no effect on mortality (OR = 0.81, 95% CI = 0.61 to 1.07) or symptomatic intracranial haemorrhage (OR = 1.22, 95% CI = 0.80 to 1.85) as found in analysis of first five trials. Trial sequential analysis indicated that the information size requirement was fulfilled to conclude the evidence for mechanical thrombectomy is robust., Discussion: The impact of three recent trials on effectiveness and safety of mechanical thrombectomy was a more precise pooled effect size for functional independence. Trial sequential analysis demonstrated sufficient evidence for effectiveness and safety of mechanical thrombectomy., Conclusion: No further trials of mechanical thrombectomy versus no mechanical thrombectomy are indicated to establish clinical effectiveness. Uncertainty remains as to whether mechanical thrombectomy reduces mortality or increases risk of symptomatic intracranial haemorrhage., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: PW is co-PI for two randomised trials (PISTE & STABILISE) investigating different aspects of thrombectomy in acute stroke. Start-up phase of PISTE was mainly funded by Stroke Association but was also part funded by unrestricted institutional educational grants from Covidien & Codman who both manufacture devices used for stroke thrombectomy. STABILISE is part funded by Microvention. PW has also undertaken educational consultancy work within last three years for Codman & Microvention who both manufacture devices used for stroke thrombectomy. GAF is co-PI for STABILISE. GAF’s previous institution has received research grants from Boehringer Ingelheim (manufacturer of Alteplase), and honoraria from Lundbeck for stroke-related activities. GAF has also received personal remuneration for educational and advisory work from Boehringer Ingelheim and Lundbeck. GAF is supported by an NIHR Senior Investigator award. DF, GAF and PM have been involved in marketing activity for a Computerised Decision Aid for Stroke Thrombolysis (COMPASS), which may be made available for a cost payable to purchase the decision aid to cover the costs of technical maintenance and updating of the predictive equations and user interface, in accordance with user feedback and availability of new data on the effectiveness of thrombolysis.

Background: Physical inactivity is associated with an increased risk of all-cause mortality and entails a substantial economic burden for health systems. Also, the analysis of inequality in lifestyles for young populations may contribute to reduce health inequalities during adulthood. This paper examines the income-related inequality regarding leisure-time physical inactivity in Spanish children., Methods: In this cross-sectional study based on the Spanish National Health Survey for 2011-12, concentration indices are estimated to measure socioeconomic inequalities in leisure-time physical inactivity. A decomposition analysis is performed to determine the factors that explain income-related inequalities., Results: There is a significant socioeconomic gradient favouring the better-off associated with leisure-time physical inactivity amongst Spanish children, which is more pronounced in the case of girls. Income shows the highest contribution to total inequality, followed by education of the head of the household. The contribution of several factors (education, place of residence, age) significantly differs by gender., Conclusions: There is an important inequity in the distribution of leisure-time physical inactivity. Public policies aimed at promoting physical activity for children should prioritize the action into the most disadvantaged subgroups of the population. As the influence of determinants of health styles significantly differ by gender, this study points out the need of addressing the research on income-related inequalities in health habits from a gender perspective.