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Background Since the 2008 economic crisis in Spain, overall fertility has continued to decrease, while urban inequalities have increased. There is a general lack of studies of fertility patterns in small-areas of Spanish cities. We explored the effects of the economic crisis on fertility during three time periods in urban settings in Spain. Methods We studied the distribution of fertility rates among women (15–49 years) from Spain and low-middle income countries (LIC) who were living in 13 Spanish cities. We mapped fertility and the MEDEA socioeconomic deprivation index in small-areas, and analyzed age-related trends in fertility rates. We performed an ecological regression analysis of fertility and the deprivation index in two pre-crisis periods (1999–2003 and 2004–2008) and one crisis period (2009–2013). Fertility rates were calculated and smoothed using the hierarchical Bayesian model (BYM). Results Higher fertility was generally associated with socioeconomic deprivation, with adjustment for the mothers’ age and nationality. While Spanish citizens tended to delay childbearing throughout the three study periods, fertility increased among Spanish adolescents from deprived urban areas during the economic crisis. There was a general decline in fertility among immigrants after the crisis, especially in southern cities. Overall, fertility appeared to be stable, with higher fertility in more deprived areas. Conclusion Increased unemployment and changes to government family policies may have contributed to delayed childbearing in Spain. For immigrants, more restrictive immigration policies may have played a crucial role in decreasing fertility rates. Reforming such policies will be key for better reproductive rights and improved fertility rates across all population cohorts in Spain.

Rationale, aims and objectives Online surveys have several advantages, but a low response rate is common and it is uncertain how results are affected. Response inducement techniques can be used to overcome this problem. The objectives of this study were to describe the percentage of change in the response rate after reminders and to analyse the characteristics associated with non-response and late response based on the survey results, as well as by applying archival and extrapolation techniques. Method In the Autonomous Community of Madrid, an online questionnaire about cancer prevention was sent to a random sample of primary care health professionals (3586 physicians and nurses). Two reminders were sent later. The percentage of change in response rates after reminders, global and by demographic and health care characteristics of participants; and factors associated with non-response and late response were analysed using response rates and odds ratios (ORs). Results After the reminders, the response rate increased from 22.6% to 32.9% and to 39.4%. Non-response was associated with age [OR: 3.14; confidence interval (CI) 95%: 2.23–4.42 for aged >60 years], gender and functional area. Further, a higher response rate after reminders was observed in professionals with heavier workloads (OR: 1.46; CI 95%: 1.08–1.97) and in those who stated a lower relevance of cancer prevention in primary care. Conclusions After electronic reminders, the response rate increased, especially among professionals with the highest workloads and a minor interest in the survey topic. However, possible bias associated with non-response remains and the factors behind this should be examined in future research.

Las desigualdades de género están presentes en la familia, el trabajo, los salarios, los recursos económicos, el uso del tiempo y el poder, de manera que las mujeres tienen una peor situación. La desigual distribución del poder se refleja también en las instituciones y las estructuras relacionadas con la ciencia, y a su vez se plasma en la producción científica. En este editorial se contextualiza y presenta una iniciativa promovida por el equipo editorial de Gaceta Sanitaria para responder a estas desigualdades a través de la nueva «Política de Gaceta Sanitaria para fomentar la igualdad de género en la publicación científica».

The main advantages of online questionnaires are the speed of data collection and cost savings, but response rates are usually low. This study analyzed response rates and associated factors among health professionals in three opinion surveys in the autonomous region of Madrid. The participants, length of the questionnaire and topic differed among the three surveys. The surveys were conducted by using paid Internet software. The institutional e-mail addresses of distinct groups of health professionals were used. Response rates were highest in hospitals (up to 63%) and administrative services and were lowest in primary care (less than 33%). The differences in response rates were analyzed in primary care professionals according to age, sex and professional category and only the association with age was statistically significant. None of the surveys achieved a response rate of 60%. Differences were observed according to workplace, patterns of Internet usage, and interest in the subject.

This study aimed to ascertain the coverage of vaccination against pandemic influenza in individuals aged over 6 months for whom vaccination is indicated due to a chronic health condition using as data source clinical information recorded in the primary care clinical history. Of all those for whom vaccination was indicated (1,114,632), 14.6% (162,616) finally received the vaccine. There were statistically significance differences in coverage for sex (16.5% for men and 13.1% for women), age groups (5% for people under 30 years and 20% for those over 60), number of chronic conditions (11.1% for one condition, 22.5% for two conditions, and 31.3% for three or more conditions) and depending on the chronic health condition considered. The probability of being vaccinated increased with male sex, age, number of indications, type of medical card (lower among no income) and having been vaccinated against 2009 season influenza. We concluded that the coverage finally reached for those people with an indication due to chronic health condition in the H1N1 campaign was much lower than expected and wished. It is essential to investigate the different factors that could have intervened in the behavior of the population so that more efficient approaches can be adopted in future influenza pandemics.

Using electronic clinical records in primary care (ECRPC) of the entire population living in the Autonomous Community of Madrid, Spain (5,102,568 persons) as a data source, this study aimed to ascertain seasonal anti-influenza vaccination coverage in the chronically ill at-risk children (aged 6 months to 14 years) and adults (15-59 years). Of the total population aged 6 months to 59 years with a medical card in the Autonomous Community of Madrid, 10.3% (n=528,095 patients) had a chronic condition for which anti-influenza vaccination was indicated. In children with chronic conditions, coverage was 27.1% and it was particularly high among diabetics (41.1%) and particularly low in children with "other pulmonary conditions" (15.2%). In adults with chronic conditions, coverage was 22.1% and in patients with diagnosed heart failure coverage reached 39.1%; with the lowest coverage was observed in patients suffering neuromuscular diseases (12.8%). The factors associated with vaccination among children and adults suffering a chronic condition included: having been vaccinated during the previous campaign, national origin (lower among immigrants), and having more than one chronic condition. In conclusion, our study shows that vaccination coverage for 2009 seasonal influenza in children and adults with chronic conditions living in Madrid (Spain) was less than acceptable.

Un año más, iniciamos el número 2 de Gaceta Sanitaria con esta nota editorial en la que resumimos los resultados del trabajo conjunto de autores/as, revisores/as y editores/as en 2015. Manuscritos recibidos y publicados. A lo largo de 2015 se han recibido 416 manuscritos (además de dos artículos del monográfico de lesiones que quedaban pendientes y 10 del Informe SESPAS 2016), que representan una disminución de 22 manuscritos respecto a 2014 (fig. 1). Probablemente esto se deba al hecho de que es el primer año completo en que las/los autoras/es que han enviado manuscritos deben pagar parte de los gastos de producción.