RESUMO
BACKGROUND: There is little information on the differential impact of the COVID-19 pandemic on mortality by occupation. The objective was to examine changes in mortality during the COVID-19 period compared with the prepandemic period in different occupational groups in Spain. METHODS: Average mortality in the entire period 2020-2021, and each of its semesters, was compared, respectively, with the average mortality in the entire period 2017-2019, and the corresponding semester (first or second) of this last period, across occupational skill levels. For this, age-standardised death rates and age-adjusted mortality rate ratios (MRRs) obtained through Poisson regression were used. Data were obtained from the National Institute of Statistics and the Labour Force Survey. RESULTS: The excess all-cause mortality during the 2020-2021 pandemic period by the MRR was higher in low-skilled (1.18, 95% CI 1.16 to 1.20) and medium-skilled workers (1.14; 95% CI 1.13 to 1.15) than high-skilled workers (1.04; 95% CI 1.02 to 1.05). However, the greatest excess mortality was observed in low-skilled workers in 2020 and in medium-skilled workers in 2021. Focusing on causes of death other than COVID-19, low-skilled workers showed the highest MRR from cardiovascular diseases (1.31; 95% CI 1.26 to 1.36) and high-skilled workers the lowest (1.02; 95% CI 0.98 to 1.02). However, this pattern was reversed for mortality from external causes, with low-skilled workers showing the lowest MRR (1.04; 95% CI 0.97 to 1.09) and high-skilled workers the highest (1.08; 95% CI 1.03 to 1.13). CONCLUSION: Globally, in Spain, during the 2020-2021 COVID-19 epidemic period, low-skilled workers experienced a greater excess all-cause mortality than other occupational groups, but this was not the case during the entire epidemic period or for all causes of death.
RESUMO
Locally advanced breast cancer (LABC) is a complex disease that requires a multidisciplinary approach. Neoadjuvant chemotherapy (NAC) is usually performed in order to achieve loco-regional radical resection; although its importance in the multidisciplinary approach to LABC is well recognized, a small number of patients show Progressive Disease (PD). No standard salvage treatment (ST) has been defined and different strategies can be adopted, such as second-line systemic therapies, radiation therapy, and surgery. Herein, a case of LABC in PD during NAC is reported with a literature review, with the aim of highlighting the importance of a tailored multidisciplinary treatment for each patient.
Assuntos
Neoplasias da Mama , Terapia Neoadjuvante , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Terapia Neoadjuvante/métodos , Progressão da Doença , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
INTRODUCTION: Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions regarding PCa screening. METHODS: A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test. RESULTS: Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24-2.50, p<0.001). CONCLUSIONS: Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients.
Assuntos
Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/diagnóstico , Pessoa de Meia-Idade , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Idoso , Estudos Transversais , Espanha , Antígeno Prostático Específico/sangue , Inquéritos e Questionários , AdultoRESUMO
Healthcare workers are people who work in health activities, whether or not they have direct contact with citizens. Currently, around 1.3 million people (70% women) work in healthcare activities in Spain. This represents around 10% of the active population, having increased by 33% since 2008, especially the number of women, which has doubled. Healthcare organizations, especially hospitals, are extremely complex workplaces, with precarious working and employment conditions, especially in more hierarchical occupations, exposing healthcare workers to numerous occupational hazards, mainly from ergonomic and psychosocial conditions. These causes frequent musculoskeletal and mental disorders, highlighting burnout, which is estimated at 40% in some services such as intensive care units. This high morbidity is reflected in a high frequency of absences due to illness, around 9% after the pandemic. The pandemic, and its consequences in the last three years, has put extreme pressure on the health system and has clearly shown its deficiencies in relation to working and employment conditions. The hundreds of occupational health professionals, technicians and healthcare workers, who are part of the structures of health organizations, constitute very valuable resources to increase the resilience of the NHS. We recommend the strengthening in resources and institutionally of the occupational health services of health centers and the creation of an Observatory of working, employment and health conditions in the National Health Service, as an instrument for monitoring changes and proposing solutions.
Assuntos
COVID-19 , Pessoal de Saúde , Saúde Ocupacional , Humanos , Pessoal de Saúde/psicologia , Espanha , COVID-19/epidemiologia , Emprego , Feminino , Doenças Profissionais/epidemiologia , Doenças Profissionais/psicologia , Esgotamento Profissional/epidemiologia , Pandemias , Masculino , Local de Trabalho/psicologia , Condições de TrabalhoRESUMO
OBJECTIVES: To analyze the association between occupational ergonomic risk, personal characteristics, and working conditions with the biomechanical properties of stiffness and muscular tone in the paravertebral muscles of electric pallet jack and forklift operators in the industrial sector. METHODS: A total of 75 industrial sector machine operators were evaluated in 2021. Personal characteristics and working conditions were assessed through a questionnaire. Ergonomic risk was assessed using the Rapid Entire Body Assessment (REBA) method, and biomechanical properties of stiffness and muscular tone were obtained using the Myoton Pro device. Stiffness in paravertebral muscles was compared based on the operated machine and observed ergonomic risk. A multilevel linear regression model was employed to quantify the relationship, with mean differences and 95% CI calculated. RESULTS: Very high ergonomic risk was found in 75% of the electric pallet truck drivers. In this group with the highest ergonomic risk, an association between biomechanical properties and older workers was observed. Additionally, among electric pallet truck drivers, stiffness (mean difference 335.9 N/m, 95% CI: 46.4 (3.4 to 110.0), P < 0.05) and paravertebral muscle tone (mean difference 17.5 Hz, 95% CI: 1.4 (0.1 to 3.4), P < 0.05) showed statistically significant differences in the very high ergonomic risk category compared to the high-risk category. No significant differences were observed in any of the analyzed variables among forklift drivers. CONCLUSIONS: Workers operating electric pallet trucks with very high ergonomic risk according to the REBA method and aged over 40 yr are associated with increased muscle stiffness and tone.
Assuntos
Ergonomia , Postura , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Postura/fisiologia , Fenômenos Biomecânicos/fisiologia , Doenças Profissionais/etiologia , Doenças Profissionais/epidemiologia , Inquéritos e Questionários , Feminino , Fatores de Risco , Tono Muscular/fisiologiaRESUMO
OBJECTIVE: The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education. METHODS: An observational study was carried out, using linked populations and deaths' data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017-2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison. RESULTS: All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25-64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people. CONCLUSION: Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.
Assuntos
COVID-19 , Masculino , Humanos , Feminino , Idoso , Adulto , Pessoa de Meia-Idade , COVID-19/epidemiologia , Pandemias , Espanha/epidemiologia , Escolaridade , MortalidadeRESUMO
Objective: To identify barriers and facilitators of the implementation of shared decision-making (SDM) on PSA testing in primary care. Design: Systematic review of articles. Data sources: PubMed, Scopus, Embase and Web of Science. Eligibility criteria: Original studies published in English or Spanish that assessed the barriers to and facilitators of SDM before PSA testing in primary care were included. No time restrictions were applied. Data extraction and synthesis: Two review authors screened the titles, abstracts and full texts for inclusion, and assessed the quality of the included studies. A thematic synthesis of the results were performed and developed a framework. Quality assessment of the studies was based on three checklists: STROBE for quantitative cross-sectional studies, GUIDED for intervention studies and SRQR for qualitative studies. Results: The search returned 431 articles, of which we included 13: five cross-sectional studies, two intervention studies, five qualitative studies and one mixed methods study. The identified barriers included lack of time (healthcare professionals), lack of knowledge (healthcare professionals and patients), and preestablished beliefs (patients). The identified facilitators included decision-making training for professionals, education for patients and healthcare professionals, and dissemination of information. Conclusions: SDM implementation in primary care seems to be a recent field. Many of the barriers identified are modifiable, and the facilitators can be leveraged to strengthen the implementation of SDM.
RESUMO
The objective of universal health care systems is to achieve equality in the use of health services at the same level of care need. This study evaluates the relationship of socioeconomic position with the frequency of doctor visits in subjects with and without chronic diseases in Germany and Spain. The dependent variables included number of consultations and if a medical consultation occurred. The socioeconomic factors were income and education. The magnitude of the relationship between socioeconomic position and medical consultation frequency was estimated by calculating the percentage ratio using binomial regression and by calculating the difference in consultations by analysis of the covariance, in the case of number of visits. Statistically significant findings according to education were not observed. The percentage ratio in the medical consultations among those with lower and higher income was 1.03 (95% confidence interval [CI] 1.01-2.88) in Germany and 1.11 (95% CI 1.03-1.20) in Spain among subjects with any of the studied chronic conditions. Also, in Germany the difference in the average number of consultations comparing lower income subjects with higher was 3.98 (95% CI 2.40-5.57) in those with chronic conditions. In both countries, there were no differences in the frequency of doctor visits according to education. However, a pro-inequality trend exists in favor of subjects with lower income.
Assuntos
Atenção à Saúde , Humanos , Espanha/epidemiologia , Fatores Socioeconômicos , Alemanha/epidemiologia , Doença CrônicaRESUMO
BACKGROUND: The effects of the COVID-19 pandemic were more pronounced among migrants than in the majority population and went beyond those directly caused by the virus. Evidence suggests that this overburden is due to complex interactions between individual and structural factors. Some groups of working migrants were in vulnerable positions, overrepresented in essential jobs, under precarious work conditions, and ineligible for social benefits or special COVID-19 economic assistance. This study aimed to explore the experience of migrants working in Norway during the COVID-19 pandemic to gather an in-depth understanding of the pandemic´s impact on their health and well-being, focusing on occupation-related factors. METHODS: In-depth personal interviews with 20 working migrants from different job sectors in Bergen and Oslo were conducted. Recruitment was performed using a purposive sampling method. Thematic analysis was used. RESULTS: At the workplace level, factors such as pressure to be vaccinated, increased in occupational hazards, and increased structural discrimination negatively impacted migrants' health. Other factors at the host country context, such as changes in social networks in and out of the workplace and changes in the labour market, also had a negative effect. However, the good Norwegian welfare system positively impacted migrants' well-being, as they felt financially protected by the system. Increased structural discrimination was the only factor clearly identified as migrant-specific by the participants, but according to them, other factors, such as changes in social networks in and out of the workplace and social benefits in Norway, seemed to have a differential impact on migrants. CONCLUSIONS: Occupational-related factors affected the health and well-being of working migrants during the pandemic. The pressure to get vaccinated and increased structural discrimination in the workplace need to be addressed by Norwegian authorities as it could have legal implications. Further research using intersectional approaches will help identify which factors, besides discrimination, had a differential impact on migrants. This knowledge is crucial to designing policies towards zero discrimination at workplaces and opening dialogue arenas for acknowledging diversity at work.
Assuntos
COVID-19 , Migrantes , Humanos , Pandemias , Pesquisa Qualitativa , OcupaçõesRESUMO
Background: Computer vision syndrome (CVS) is a common occupational health problem, but its clinical definition, prevalence and risk factors are not well defined. In general, non-validated diagnostic instruments have been used to assess its prevalence. For this reason, the aim of this study is to estimate the prevalence and potential risk factors for CVS using a validated questionnaire. Methods: A cross-sectional study (n = 238) was carried out in Italian office workers using digital devices. All participants responded to an anamnesis, a digital exposure questionnaire, and the validated Italian version of the Computer Vision Syndrome Questionnaire. A battery of 3 ocular surface and tear ophthalmic tests (break-up time, BUT), Schirmer II and corneal staining) was performed. Results: The mean age (±SD) was 45.55 (11.02) years, 64.3% were female. 71.4% wore glasses to work, whose design was monofocal (for distance) in 47.6%, monofocal (for near) in 26.5%, general progressive in 16.5% and occupational progressive in 8.8% of cases. 35.7% used digital devices >6 hours/day in the workplace. The prevalence of CVS was 67.2%. In the multivariate model, female sex (aOR: 3.17; 95% CI [1.75-5.73]), the use of digital devices >6 hours/day at workplace (aOR: 2.07; 95% CI [1.09-3.95]) and the use of optical correction at work (aOR: 2.69; 95% CI [1.43-5.08]) significantly increased the odds of CVS. Association was observed between presenting CVS and having abnormal BUT (χ2 = 0.017). Conclusions: The prevalence of CVS in Italian office workers, especially among females, was high. Intensive use of digital devices at work (>6 hours/day) and the use of optical correction at work significantly increased the odds of CVS. There is an association between poor tear stability and CVS. Further research is needed on the influence of wearing optical correction on CVS. The use of a validated questionnaire in health surveillance of digital workers is strongly recommended.
Assuntos
Doenças Profissionais , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Prevalência , Estudos Transversais , Síndrome , Fatores de Risco , Inquéritos e Questionários , Doenças Profissionais/diagnósticoRESUMO
En tres meses Archivos de Prevención de Riesgos Laborales cumple un cuarto de siglo. En 1998, la entonces Societat Catalana de Seguretat i Medicina del Treball, hoy Associació Catalana de Salut Laboral, presidida por Jaume de Montserrat, anunciaba una nueva revista, que nacía con 35 años de historia y 120 números publicados en la extinguida Medicina de Empresa. Fernando G. Benavides asumía la tarea (1998-2005). Archivos nació con una clara voluntad de hacer realidad un instrumento "de difusión de información relevante, rigurosa y actual que necesita todo campo de conocimiento para su desarrollo y evolución" parafraseando a su segunda directora, Ana M García (2005-2015) y además de acuerdo con los criterios internacionales de calidad científica. .
Assuntos
Bibliometria , PneumologiaRESUMO
OBJECTIVE: To evaluate the appropriateness of imaging tests associated with radiation in the field of otolaryngology according to the available recommendations, and to estimate the effective radiation dose associated. METHOD: Cross-sectional epidemiological study of the totality of the imaging test requests carried out by two Spanish hospitals (n = 1931). We collected the following information: patient demographic data, type of imaging test, imaging tests referred in the previous 12 months, referrer department and diagnostic suspicion. In accordance with the available guidelines, we considered the requests: (a) Appropriate; (b) Inappropriate; (c) Not adequately justified; (d) Not included in the guidelines. We calculated the prevalence of each category and their variation according to the different variables. Collective and per capita effective dose were calculated for each category. RESULTS: Of the 538 requests, 42% were considered appropriate, 34.4% inappropriate, 11.9% not adequately justified and 11.7% not included in the guidelines. Imaging tests requested by general partitioners (aOR: 0.18; 95% CI: 0.06-0.50) and clinical departments (aOR: 0.27; 95% CI: 0.11-0.60) were less likely to be considered appropriate than those requested by the Otolaryngology department. Patients with a diagnosis suspicion of tumour pathology were more likely to have a requested imaging test classified as appropriate (aOR: 7.12; 95% CI: 3.25-15.61). The cumulative effective dose was 877.8 mSv, of which 40% corresponded to tests classified as inappropriate. CONCLUSIONS: A high percentage of imaging tests are considered as inappropriate in the field of otolaryngology, with a relevant frequency of associated effective radiation dose. Type of department, the diagnostic suspicion and the type of imaging tests were variables associated to the inappropriateness of the test.
RESUMO
Background: Opportunistic prostate-specific antigen (PSA) screening may reduce prostate cancer mortality risk but is associated with false positive results, biopsy complications and overdiagnosis. Although different organisations have emphasised the importance of shared decision making (SDM) to assist men in deciding whether to undergo prostate cancer screening, recent evaluations show that the available decision aids fail to facilitate SDM, mainly because they do not consider the patients' perspective in their design. We aim to systematically develop and test a patient decision aid to promote SDM in prostate cancer screening, following the Knowledge to Action framework. Methods: (1) Feasibility study: a quantitative survey evaluating the population and clinician (urologists and general practitioners) knowledge of the benefits and risks derived from PSA determination and the awareness of the available recommendations. Focus groups to explore the challenges patients and clinicians face when discussing prostate cancer screening, the relevance of a decision aid and how best to integrate it into practice. (2) Patient decision aid development: Based on this data, an evidence-based multicomponent SDM patient decision aid will be developed. (3) User-testing: an assessment of the prototype of the initial patient decision aid through a user-testing design based on mix-methods (questionnaire and semi-structured review). The decision aid will be refined through several iterative cycles of feedback and redesign. (4) Validation: an evaluation of the patient decision aid through a cluster-randomised controlled trial. Discussion: The designed patient decision aid will provide balanced information on screening benefits and risks and should help patients to consider their personal preferences and to take a more active role in decision making. Conclusions: The well-designed patient decision aid (PDA) will provide balanced information on screening benefits and risks and help patients consider their personal preferences.
Assuntos
Tomada de Decisão Compartilhada , Neoplasias da Próstata , Tomada de Decisões , Técnicas de Apoio para a Decisão , Detecção Precoce de Câncer , Humanos , Masculino , Participação do Paciente , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: Early chimerism analysis is important to assess engraftment in allogeneic hematopoietic stem cell transplantations. METHODS: We retrospectively investigated the impact of T-cell chimerism at day 30 in bone marrow on acute graft-versus-host disease (aGVHD), relapse, and overall survival in 142 adult allo-transplanted patients. RESULTS: The majority of patients (89%) received myeloablative conditioning and 90% have undergone T-cell replete donor graft. At day 30, 103 patients showed T-complete chimerism with prevalence in haploidentical transplants, whereas 39 cases had CD3+ mixed chimerism, including 30 patients transplanted with HLA identical donors, and 21 with T-cell donors<90%. T-cell chimerism at day 30 was weakly inversely related to aGVHD grades II-IV (p = .078) with no cases of grades III-IV aGVHD in patients with CD3+ <95%. Mixed T-cell chimerism did not impact on relapse (p = .448) and five of the seven patients who relapsed had T-cell chimerism ≤90%. Older age and active disease at transplant had a statistically significant negative effect on overall survival (p = .01 and p = .0001, respectively), whereas mixed CD3+ chimerism did not. CONCLUSIONS: T lymphocyte chimerism analysis at day +30 in bone marrow could identify allo-transplanted patients at major risk of aGVHD grades III-IV (CD3+ donors >95%) mainly post-myeloablative conditioning regimen.
Assuntos
Doença Enxerto-Hospedeiro , Neoplasias Hematológicas , Transplante de Células-Tronco Hematopoéticas , Adulto , Medula Óssea , Quimerismo , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/epidemiologia , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Linfócitos T , Condicionamento Pré-Transplante/efeitos adversosRESUMO
The use of digital devices affects eye health; this can influence the performance of workers. To assess this impact, validated patient-reported outcome questionnaires are needed. The purpose of this study was to validate the psychometric properties of the Italian version of the Computer Vision Syndrome Questionnaire (CVS-Q©) using Rasch analysis. Two hundred and forty-one Italian workers completed an ad hoc questionnaire on anamnesis and exposure to digital devices, and the Italian version of the CVS-Q©. Subsequently, a battery involving three clinical ocular surface and tear tests was performed. The reliability and validity of the scale was assessed using the Andrich Rating Scale Model, and the prevalence of computer vision syndrome (CVS) was calculated. A good fit of both items and persons to the predictions of the Rasch model was observed, with acceptable reliability, unidimensionality, and no or minimal severe differences as a function of gender or age; moreover, good test-retest repeatability, adequate values of sensitivity, reliability, and area under the curve, and adequate construct validity based on clinical tests were obtained. Workers with a questionnaire score ≥ 7 were found to present with CVS. The prevalence of CVS was 76.6%. The CVS-Q IT© is a valid and reliable scale to assess CVS in Italian workers who use digital devices.
Assuntos
Astenopia , Computadores , Humanos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários , SíndromeRESUMO
BACKGROUND: The coronavirus (COVID-19) pandemic and control measures adopted have had a disproportionate impact on workers, with migrants being a group specifically affected but poorly studied. This scoping review aims to describe the evidence published on the impact of the COVID-19 pandemic on the physical and mental health of migrant workers. METHODS: Papers written in English covering physical and mental health among international migrant workers during the COVID-19 pandemic, retrieved from six electronic databases searched on July 31, 2021, were included. A total of 1,096 references were extracted, of which 26 studies were finally included. RESULTS: Most of the migrant populations studied were born in Asia (16 of 26) and Latin America (8 of 26) and were essential workers (15 of 26). Few studies described the length of stay in the host country (9 of 26), the legal status of the migrant population (6 of 26), or established comparison groups (7 of 26). Ten studies described COVID-19 outbreaks with high infection rates. Fourteen studies evaluated mental health (anxiety, depression, worries, fears, stress, and post-traumatic stress disorder). Three of the 26 studies presented collateral positive effects of the COVID-19 pandemic because of improved hygiene. CONCLUSION: There is a limited number of original publications related to the impact of the COVID-19 pandemic on the physical and mental health of migrant workers around the world. These publications mainly focus on migrants born in Asia and Latin America. The physical, long-term impact of the COVID-19 pandemic has, so far, not been evaluated. The positive collateral effects of improving healthcare conditions for migrant workers should also be further investigated.
Assuntos
COVID-19 , Migrantes , COVID-19/epidemiologia , Humanos , Saúde Mental , Pandemias , SARS-CoV-2RESUMO
Al igual que ya sucedió en 2020, 2021 ha estado dominado por la pandemia de COVID-19. Si hace un año escribíamos esta Nota Editorial con gran preocupación por la evolución de la situación de la infección originada por el SARS-CoV-2 y, a su vez, con grandes esperanzas puestas en las vacunas como estrategia preventiva, la actual viene marcada por la incertidumbre generada por la irrupción de la nueva variante de preocupación: Omicrón .
Assuntos
COVID-19 , Pneumologia , Bibliometria , Humanos , Pandemias/prevenção & controle , SARS-CoV-2RESUMO
BACKGROUND AND AIMS: Free treatments for HCV infection with direct-acting antivirals became widespread in Spain in April 2015. We aimed to test whether, after this intervention, there was a more favorable change in population mortality from HCV-related than from non-HCV-related causes. APPROACH AND RESULTS: Postintervention changes in mortality were assessed using uncontrolled before-after and single-group interrupted time series designs. All residents in Spain during 2001-2018 were included. Various underlying death causes were analyzed: HCV infection; other HCV-related outcomes (HCC, liver cirrhosis, and HIV disease); and non-C hepatitis, other liver diseases, and nonhepatic causes as control outcomes. Changes in mortality after the intervention were first assessed by rate ratios (RRs) between the postintervention and preintervention age-standardized mortality rates. Subsequently, using quasi-Poisson segmented regression models, we estimated the annual percent change (APC) in mortality rate in the postintervention and preintervention periods. All mortality rates were lower during the postintervention period, although RRs were much lower for HCV (0.53; 95% CI, 0.51-0.56) and HIV disease than other causes. After the intervention, there was a great acceleration of the downward mortality trend from HCV, whose APC went from -3.2% (95% CI, -3.6% to -2.8%) to -18.4% (95% CI, -20.6% to -16.3%). There were also significant accelerations in the downward trends in mortality from HCC and HIV disease, while they remained unchanged for cirrhosis and slowed or reversed for other causes. CONCLUSIONS: These results suggest that the favorable changes in HCV-related mortality observed for Spain after April 2015 are attributable to scaling up free treatment with direct-acting antivirals and reinforce that HCV eradication is on the horizon.
Assuntos
Carcinoma Hepatocelular , Infecções por HIV , Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Hepacivirus , Hepatite C/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Humanos , Cirrose Hepática , Espanha/epidemiologiaRESUMO
OBJECTIVE: To compare the main academic characteristics and contents of the different master's programs in public health currently offered in Spain. METHOD: A systematic search has been carried out in the Register of Universities, Centers and Degrees of the Ministry of Education, Culture and Sports. The main academic characteristics and the contents (mandatory and optional) of the programs of 11 official master's degrees with the renewed accreditation in 2018 were analyzed based on the data published on the universities' web pages. RESULTS: Most programs are 60 ECTS (European Credit Transfer and Accumulation System), face-to-face, taught in Spanish, include in their curriculum the completion of a master's thesis but not professional practices. Only contents related to statistics and basic epidemiology, and the training activity of master's thesis, are offers by all programs. CONCLUSIONS: The majority of public health master's programs in Spain shows a certain homogeneity regarding their academic characteristics, but a great heterogeneity in relation to their contents. There is also a great heterogeneity in the credits granted to the different subjects, especially optional subjects. It would be advisable to standardize a common core, especially in the mandatory contents.
Assuntos
Saúde Pública , Esportes , Currículo , Humanos , Espanha , UniversidadesRESUMO
OBJECTIVE: To compare avoidable mortality for causes amenable to medical care and suicide in physicians versus other professionals with similar university studies and socioeconomic position in Spain. METHODS: All people aged 25-64 years who were employed on 1 November 2001 (8,697,387 men and 5,282,611 women) were included. Their vital status was followed for 10 years and the cause of death of deceased was recorded. Using a Poisson regression to estimate the mortality rate ratio (MRR), we compared mortality due to causes of death amenable to medical care, all other causes, and suicide in physicians versus other professionals. Mortality in physicians was used as a reference. RESULTS: The lowest MRR for causes amenable to medical care was observed in engineers/architects (men: 0.84, 95% confidence interval [CI] 0.72, 0.97; women: 0.93, 95% CI 0.64, 1.35) and healthcare professions other than physicians/pharmacists/nurses (men: 0.86, 95% CI 0.56, 1.34; women: 0.69, 95% CI 0.32, 1.46). Regarding mortality for all other causes of death, professionals from these and other occupations presented lower mortality than physicians. Other healthcare professions, entrepreneurs, and managers/executives completed suicide at a higher rate than physicians. CONCLUSION: Although the accessibility to the healthcare system and to the pharmacological drugs could suggest that physicians would present low rates for causes amenable to medical care and high rates of suicide, our results show that this is not the case in Spain.