[The FECYT seal of quality, a recognition and a stimulus for Archivos]. / El sello de calidad FECYT, un reconocimiento y un estímulo para Archivos.

Un año más, mediante esta nota editorial, damos cuenta de las estadísticas y los principales avances de nuestra revista. En cuanto a las estadísticas editoriales, que se detallan en los apartados posteriores, podemos afirmar que son las de una revista consolidada: flujo nutrido y constante de trabajos recibidos/publicados, tasas de aceptación y rechazo proporcionadas, tiempos de gestión razonables y diversidad en las autorías. El logro más destacable del 2023 fue superar con éxito el proceso de evaluación de la Octava edición de Evaluación de la calidad editorial y científica de las revistas científicas españolas, comúnmente conocido como 'Sello FECYT'….

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers.

OBJECTIVE: This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. METHOD: The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. RESULTS: Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. CONCLUSIONS: This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers' fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.

Workplace aggression against healthcare workers in a Spanish healthcare institution between 2019 and 2021: The impact of the COVID-19 pandemic.

Objectives: Describe the incidence of first aggressions among healthcare workers (HCWs) before and during the COVID-19 pandemic in a Spanish healthcare institution, according to workers' socio-occupational characteristics and analyze the impact of the pandemic on it. Methods: A cohort involving HCWs who worked in the institution for at least 1 week each year from 1 January 2019 to 31 December 2021. Adjusted relative risks (aRR) were estimated using generalized estimating equations and negative binomial models to calculate the differences in WPA between the different time periods. All analyses were stratified by gender. Results: Among women, the incidence was 6.8% (6.0; 7.8) during the pre-COVID-19 period, 6.0% (5.2; 7.0) during the COVID-19 baseline and 5.1% (4.3; 5.9) during the COVID-19 endline; and 4.6% (3.4; 6.1), 5.3% (4.1; 6.8) and 4.4% (3.5; 5.8), respectively, among men. Among men, the incidence of WPA was 4.6 (3.4; 6.1), 5.3 (4.1; 6.8), and 4.4% (3.5; 5.8), respectively. These incidences were significantly higher among male nurses and aides [11.1 (8.0; 15.4), 12.3 (8.9; 16.6), and 9.3% (6.5; 13.3) during each period] and psychiatric center workers [women: 14.7 (11.2; 19.0), 15.4 (11.8; 19.8), and 12.4% (9.2; 16.6); men: 12.3 (7.2; 20.0), 17.8 (11.6; 26.2), and 14.3% (8.8; 22.4)]. Among women, the risk of WPA was 23% lower in the post-COVID-19 period compared to before the pandemic [aRR = 0.77 (0.64; 0.93)], while the risk during the COVID-19 baseline was not significantly different [aRR = 0.89 (0.74; 1.06)]. Conclusions: The COVID-19 pandemic led to an unexpected decrease in first-time WPA against HCWs. However, ~5% of HCWs experienced at least one incidence of aggression in the last follow-up year. Healthcare managers should continue to increase the prevention of aggression against HCWs, especially among vulnerable groups with a higher level of incidence.

Extreme temperatures and sickness absence in the Mediterranean province of Barcelona: An occupational health issue.

Objectives: This study aims to assess the association between daily temperature and sickness absence episodes in the Mediterranean province of Barcelona between 2012 and 2015, according to sociodemographic and occupational characteristics. Methods: Ecological study of a sample of salaried workers affiliated to the Spanish social security, resident in Barcelona province between 2012 and 2015. The association between daily mean temperature and risk of new sickness absence episodes was estimated with distributed lag non-linear models. The lag effect up to 1 week was considered. Analyses were repeated separately by sex, age groups, occupational category, economic sector and medical diagnosis groups of sickness absence. Results: The study included 42,744 salaried workers and 97,166 episodes of sickness absence. The risk of sickness absence increased significantly between 2 and 6 days after the cold day. For hot days there was no association with risk of sickness absence. Women, young, non-manual and workers in the service sector had a higher risk of sickness absence on cold days. The effect of cold on sickness absence was significant for respiratory system diseases (RR: 2.16; 95%CI: 1.68-2.79) and infectious diseases (RR: 1.31; 95%CI: 1.04-1.66). Conclusion: Low temperatures increase the risk of having a new episode of sickness absence, especially due to respiratory and infectious diseases. Vulnerable groups were identified. These results suggest the importance of working in indoor and possibly poorly ventilated spaces in the spread of diseases that eventually lead to an episode of sickness absence. It is necessary to develop specific prevention plans for cold situations.

[Archivos, positioned on the road to impact]. / Archivos, posicionada en la senda del impacto.

Con este bagaje, comenzamos 2023, un año en el que nuestra revista cumple un cuarto de siglo llevando a cabo la misión para la que fue concebida, misión que los distintos comités editoriales que hemos participado consideramos un acierto: contribuir a la transferencia de conocimiento útil para avanzar en la mejora de la salud de las personas trabajadoras.

[How do the different dimensions of precarious employment affect mental health?] / ¿Cómo afectan las distintas dimensiones de la precariedad laboral a la salud mental?

OBJECTIVE: To analyse the relationship between precarious employment, measured by dimensions and as a multidimensional index, on the mental health of salaried men and women in the Basque Country (Spain). METHOD: A subsample (n=3345) of the 2018 Basque Autonomous Community Health Survey was used to calculate the standardised prevalence of poor mental health according to the degree of precarious employment, measured as a composite scale and by each of its dimensions, and to perform robust Poisson regression models to analyse the association between precarious employment, also composite and by dimensions, and the mental health of the salaried population. RESULTS: Precarious employment is significantly associated with poor mental health among men (prevalence ratio [PR]: 3.51; 95% confidence interval [95%CI]: 2.05-6.01) and women (PR: 3.42; 95%CI: 2.35-4.97). Additionally, some of its constituent dimensions, such as wage level among both sexes (PR: 2.58, 95%CI: 1.65-4.03, and PR: 2.29, 95%CI: 1.58-3.32) or vulnerability among women (PR: 2.55; 95%CI: 1.80-3.61), also appear to be significantly and independently related to poorer mental health status. CONCLUSIONS: It is necessary to approach precarious employment from a multidimensional perspective, and to know the relative importance of each of its dimensions, both for research into its effects on health and for policy interventions directed at combating this phenomenon.

Non-Pharmacological Preventive Measures Had an Impact on COVID-19 in Healthcare Workers before the Vaccination Effect: A Cohort Study.

Healthcare workers have been and still are at the forefront of COVID-19 patient care. Their infection had direct implications and caused important challenges for healthcare performance. The aim of this study is to assess the impact of non-pharmacological preventive measures against COVID-19 among healthcare workers. This study is based on a dynamic cohort of healthcare workers (n = 5543) who had been hired by a Spanish hospital for at least one week during 2020. Negative binomial regression models were used to estimate the incidence rate and the rate ratio (RR) between the two waves (defined from 15 March to 21 June and from 22 June to 31 December), considering natural immunity during the first wave and contextual variables. All models were stratified by socio-occupational variables. The average COVID-19 incidence rate per 1000 worker-days showed a significant reduction between the two waves, dropping from 0.82 (CI95%: 0.73-0.91) to 0.39 (0.35-0.44). The adjusted RR was 0.54 (0.48-0.87) when natural immunity was acquired during the first wave, and contextual variables were considered. The significant reduction of the COVID-19 incidence rate could be explained mainly by improvement in the non-pharmacological preventive interventions. It is needed to identify which measures were more effective. Young workers and those with a replacement contract were identified as vulnerable groups that need greater preventive efforts. Future preparedness plans would benefit from these results.

Occupational health, frontline workers and COVID-19 lockdown: new gender-related inequalities?

INTRODUCTION: The abrupt onset of COVID-19, with its rapid spread, has had brutal consequences in all areas of society, including the workplace. In this paper, we report the working conditions, health, and tranquilisers and opioid analgesics use of workers during the first months of the ensuing pandemic, according to whether they were frontline workers or not and also according to sex. METHODS: Our analysis is based on cross-sectional survey data (collected during April and May 2020) from the wage-earning population in Spain (n=15 070). We estimate prevalences, adjusted prevalence differences and adjusted prevalence ratios by sex and according to whether the worker is a frontline worker or not. RESULTS: Employment and working conditions, exposure to psychosocial risks, as well as health status and the consumption of tranquilisers and opioid analgesics all showed sex and sectoral (frontline vs non-frontline) inequalities, which placed essential women workers in a particularly vulnerable position. Moreover, the consumption of tranquilisers and opioid analgesics increased during the pandemic and health worsened significantly among frontline women workers. CONCLUSIONS: The exceptional situation caused by the COVID-19 pandemic provides an opportunity to revalue essential sectors and to dignify such employment and working conditions, especially among women. There is an urgent need to improve working conditions and reduce occupational risk, particularly among frontline workers. In addition, this study highlights the public health problem posed by tranquilisers and opioid analgesics consumption, especially among frontline women.

Informal employment and poor self-perceived health in Latin America and the Caribbean: a gender-based comparison between countries and welfare states in a pooled analysis of 176,786 workers.

BACKGROUND: More than half of the working population in Latin American and Caribbean (LAC) countries is engaged in informal employment. The few previous studies indicate that this employment condition could have negative consequences for workers' health. The aim of the present study was to estimate the association between self-perceived health and informality in LAC countries according to gender and welfare state type. METHODS: The cross-sectional study based on different working conditions and health national surveys was carried out in 13 LAC countries between 2012 and 2018. A sample of 176,786 workers was selected from these surveys. The association between health and informality was estimated using Poisson regression. Finally, a random effects meta-analysis was carried out by country. All results were stratified by sex and type of welfare state (statalist or familialist). RESULTS: Informal workers reported significantly worse health than formal workers, for both women (1.28 [95% CI 1.14-1.43]) and men (1.30 [1.12-1.50]). This difference was broader and more significant in countries with statalist welfare state regimes, among both women (1.40 [1.22-1.60]) and men (1.51 [1.30-1.74]), than in familialist regime countries (1.19 [1.03-1.38] and 1.24 [1.03-1.49], respectively). CONCLUSIONS: This study provides strong evidence of the association between informal employment and worker health. Welfare states appear to have a modifying effect on this association. The transition from the informal to the formal labour market in LAC is essential to improving the health of the population.

Which are the intermediate determinants of gender inequalities in mental health?: A scoping review.

BACKGROUND: Gender segmentation in the labour market and women's greater burden of domestic work and caregiving increase their risk of developing mental health problems, especially in vulnerable social groups. AIMS: The objectives of this study were to identify and describe the role of working and labour conditions, domestic work and caregiving and social support in gender inequalities in mental health, as well as to assess whether studies have taken an intersectional approach, describing its role in gender inequalities in mental health. METHODS: We carried out a systematic review of scientific articles published between 2010 and 2019 in PubMed, Scopus, WoS and PsycInfo, in Spanish and English, conducted in the European Economic Area in populations aged between 25 and 65 years. Studies were excluded if they were qualitative, focused on sexual identity or factors based on biological differences, or considered use of medical services, medicalisation or suicide as the outcome variable. RESULTS: A total of 30 articles were included, of which only four concerned studies in which intersectional analysis had been performed. The mental health of men was seen to be more influenced by employment conditions and that of women by working conditions, the double presence and civil status. Further, depending on the size of the household (women) and unemployment (men), people in lower social classes had poorer mental health outcomes. CONCLUSIONS: The results may be useful for designing policies focused on reducing gender inequalities in mental health. Additionally, they show the need for taking an intersectional perspective.

SARS-CoV-2 transmission in students of public schools of Catalonia (Spain) after a month of reopening.

INTRODUCTION: SARS-CoV-2 transmission within schools and its contribution to community transmission are still a matter of debate. METHODS: A retrospective cohort study in all public schools in Catalonia was conducted using publicly available data assessing the association between the number of reported SARS-CoV-2 cases among students and staff in weeks 1-2 (Sept 14-27th, 2020) of the academic year with school SARS-CoV-2 incidence among students in weeks 4-5. A multilevel Poisson regression model adjusted for the community incidence in the corresponding basic health area (BHA) and the type of school (primary or secondary), with random effects at the sanitary region and BHA levels, was performed. RESULTS: A total of 2184 public schools opened on September 14th with 778,715 students. Multivariate analysis showed a significant association between the total number of SARS-CoV-2 cases in a centre in weeks 1-2 and the SARS-CoV-2 school incidence among students in weeks 4-5 (Risk Ratio (RR) 1.074, 95% CI 1.044-1.105, p-value <0.001). The adjusted BHA incidence in the first two weeks was associated with school incidence in weeks 4-5 (RR 1.002, 95% CI 1.002-1.003, p-value <0.001). Secondary schools showed an increased incidence in weeks 4 and 5 (RR primary vs secondary 1.709 95% CI 1.599-1.897, p-value <0.001). CONCLUSIONS: Safety measures adopted by schools were not enough to stop related-to-school transmission in students and could be improved. The safest way to keep schools open is to reduce community transmission down to a minimum.

The impact of precarious jobs on mental health: a gender-sensitive literature review.

PURPOSE: The aim of this study is to analyse the extent to which research and knowledge production on a key occupational health issue-the impact of precarious employment on health-incorporates, and is sensitive to, a gender perspective. METHODS: A systematic literature review was carried out to identify studies that analysed the relationship between precarious employment and mental health in the period January 2010-May 2018 through. A minimum of two independent reviewers assessed each article for quality and eligibility. A checklist was used to determine whether the articles included in the review incorporated a gender perspective. RESULTS: The search retrieved 1522 papers, of which 54 (corresponding to 53 studies) met the inclusion criteria. Of these 54 papers, 22 (40.7%) stratified the analyses by sex. Only 5.4% of the total of articles both stratified by sex and considered variables of household composition and marital status, while only 33.3% incorporated an intersectional perspective. None considered the distribution of domestic work and only a quarter (25.9%) approached the study and interpreted the results in terms of gender. CONCLUSION: Too few studies researching paid work and health include a gender perspective. This omission necessarily implies a biased interpretation of the reality of precarious employment and its impact on health.

Persistent inequality: evolution of psychosocial exposures at work among the salaried population in Spain between 2005 and 2016.

PURPOSE: To assess the prevalence of poor mental health and of exposure to psychosocial risks among the working population in Spain in 2005, 2010 and 2016; to analyse the associations between workplace psychosocial exposures and mental health problems according to gender and occupation. METHODS: Three representative samples of the Spanish working population were analysed, in 2005 (n = 7,023), 2010 (n = 4,979), and 2016 (n = 1,807). Prevalence ratios between mental health and the five dimensions - job demands, job control, social support, employment insecurity and insecurity over working conditions-were estimated using multilevel mixed-effects Poisson regressions. All the analyses were separated by gender and occupation. RESULTS: In 2016, there were improvements in job control, job demands and social support, and deteriorations in employment insecurity and insecurity over working conditions. The risk of poor mental health among manual workers rose if they were exposed to high demands, low social support and high employment insecurity; among non-manual workers, the risk increased if they were exposed to high demands, low control, low social support and high insecurity over working conditions. There were no differences according to gender. CONCLUSION: The new findings shed light on the evolution of the working conditions and health of the wage-earning population in Spain over the last 11 years. The stratification by gender and occupational group is relevant, since it allows a detailed analysis of the social disparities in the associations between psychosocial risks and mental health. The most vulnerable groups can be identified and preventive measures developed at source.

Employment precariousness and mental health, understanding a complex reality: a systematic review.

Precarious employment has expanded during the last decades, but there is no full consensus on its definition, and its impact on mental health is not completely understood. The relevance of several micro- and macro-level variables in the association between precarious employment and mental health has not been fully addressed. This review has 2 aims: to identify scientific evidence on the relationship between various dimensions of precarious employment and mental health, and to synthesize the inclusion of a gender-sensitive perspective, context variables, workers' household variables, and the discussion of causal mechanisms underlying the association. The literature was searched in PubMed, EMBASE, Web of Science and PsycINFO including articles dated 2010-May 2018. A minimum of 2 independent reviewers assessed each article regarding quality and eligibility criteria. The search retrieved 1522 papers, of which 54 (corresponding to 53 studies) met the inclusion criteria. Most of the studies analyzing job insecurity, temporariness and multidimensional approaches reported a significant association. Nevertheless, results for working time arrangements and downsizing are inconclusive. Around half of the studies included sex-stratified analyses and formulated contradictory conclusions. Overall, 7 studies considered workers' household situation and only 3 delivered significant results, and 16 described some of the potential pathways. There is evidence of an association between various precarious employment approaches and mental health problems. Further research (preferably longitudinal) should aim to discuss theoretical models explaining the pathways between precarious employment and mental health, including a gender-sensitive perspective, and integrating several levels of individual and contextual variables. Int J Occup Med Environ Health. 2020;33(5):569-98.

[Online surveys and the false illusion of the large n. On a survey on euthanasia among medical practitioners]. / Las encuestas online y la falsa ilusión de la n grande. A propósito de una encuesta sobre la eutanasia en profesionales médicos.

The use of studies based on online surveys has expanded significantly. Despite having particularly small response rates, they allow a large sample size to be easily obtained. However, this strategy may entail a selection bias that significantly compromises the results. The results of two surveys on the regulation of euthanasia and assisted suicide are compared. One is an online survey with a self-selected sample and the other a survey with random sampling, conducted in 2018 among the members of the Medical Association of Bizkaia. The response rates were 10.4% (online survey) and 87.8% (random survey). No differences were found in sociodemographic characteristics, although there were differences in the opinion variables, so that the percentage of people who opposed euthanasia regulation was overestimated. The results of this study show that this sampling strategy generates biases in the results, some of which are difficult both to detect and to repair.

Role of employment-related inequalities in young adults' life satisfaction: A comparative study in five European welfare state regimes.

AIMS: There is evidence that young people are less satisfied with their lives when they are unemployed or working in precarious conditions. This study aims to shed light on how the life satisfaction of unemployed and precariously employed young people varies across welfare states with different labour market policies and levels of social protection. METHODS: The analyses are based on representative cross-sectional survey data from five European countries (Denmark, the UK, Germany, Spain and the Czech Republic), corresponding to five different welfare state regimes. For economically active young adults ( N=6681), the prevalence ratios of low life satisfaction were estimated through multivariate logistic regressions. RESULTS: In all five countries, unemployed young adults presented a higher prevalence of low life satisfaction. When we compared employees with people with permanent and temporary contracts, the former were more satisfied with their lives only in Germany and the UK, examples of conservative and liberal welfare regimes, respectively. Experience of unemployment decreased young adults' life satisfaction only in Germany and the Czech Republic, examples of a conservative and an eastern European welfare regime, respectively. In almost all countries, young adults with low economic self-sufficiency presented a higher prevalence of low life satisfaction. CONCLUSIONS: There are nuanced patterns of employment type and life satisfaction across European states that hint at welfare state regimes as possible moderators in this relationship. The results suggest that the psychological burdens of unemployment or work uncertainty cannot be overlooked and should be addressed according to different types of social provisions.

Specific psychosocial exposures for workers' mental health: A population-based study.

BACKGROUND: In order to plan interventions it is important to obtain evidence on the relation between a health outcome and specific exposures. However, there are few studies that identify the effect of specific psychosocial work exposures on poor mental health. This is the aim of this study. METHODS: Population-based cross-sectional study in Catalonia. We estimated prevalence ratios (PR) of minor psychiatric disorder associated with several psychosocial work exposures. RESULTS: The items with highest PR were "Are there times when you need to be at work and at home at the same time?" (PR = 1.81), "Are you worried about a variation in your salary?" (PR = 1.77), "Is your work emotionally demanding?" (PR = 1.65) and "Are you worried about it being difficult for you to find another job if you became unemployed?" (PR = 1.51). CONCLUSIONS: This study could be useful in order to begin planning interventions on specific psychosocial exposures to protect mental health in the workplace.

How unemployment and precarious employment affect the health of young people: A scoping study on social determinants.

BACKGROUND: The impact of unemployment and precarious employment on the health of young people is not well understood. However, according to social causation, higher socio-economic positions and thus better working conditions are beneficial to health in general. We tried to synthesize the results of studies that test this hypothesis in the case of young people. METHODS: We conducted a scoping study mapping all the academic articles published in the period 2006-2016 in Europe. The literature was searched in PubMed/Medline, Science Direct, Web of Science and Scopus. RESULTS: We identified 1770 studies, of which only 46 met the inclusion criteria. There are more studies that focus on the relationship between unemployment and health than between precarious employment and health (28 and 16, respectively). The vast majority of the studies (44) found support for the social causation hypothesis, the most common health outcomes being mental health disorders, health risk behaviour, poor quality of life and occupational injuries. The causal mechanisms behind this association relied mainly on the life-course perspective, the breadwinner model, and the lack of social and economic benefits provided by standard employment. CONCLUSIONS: There is evidence that young people are especially vulnerable to health problems when unemployed or working in precarious conditions. Active labour market and training programmes, inclusive social security measures, improved working conditions and targeted health programmes are important for addressing this vulnerability. Further research should strive to enhance the causal model by including a gender perspective, longitudinal data, more indicators on precariousness and third factor explanations.

Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women.

BACKGROUND: The FRAX® tool estimates the risk of a fragility fracture among the population and many countries have been evaluating its performance among their populations since its creation in 2007. The purpose of this study is to update the first FRIDEX cohort analysis comparing FRAX with the bone mineral density (BMD) model, and its predictive abilities. METHODS: The discriminatory ability of the FRAX was assessed using the 'area under curve' of the receiver operating characteristic (AUC-ROC). Predictive ability was assessed by comparing estimated risk fractures with incidence fractures after a 10-year follow up period. RESULTS: One thousand three hundred eight women ≥ 40 and ≤ 90 years followed up during a 10-year period. The AUC for major osteoporotic fractures using FRAX without DXA was 0.686 (95 % CI 0.630-0.742) and using FN T-score of DXA 0.714 (95 % CI 0.661-0.767). Using only the traditional parameters of DXA (FN T-score), the AUC was 0.706 (95 % CI 0.652-0.760). The AUC for hip osteoporotic fracture was 0.883 (95 % CI 0.827-0.938), 0.857 (95 % CI 0.773-0.941), and 0.814 (95 % CI 0.712-0.916) respectively. For major osteoporotic fractures, the overall predictive value using the ratio Observed fractures/Expected fractures calculated with FRAX without T-score of DXA was 2.29 and for hip fractures 2.28 and with the inclusion of the T-score 2.01 and 1.83 respectively. However, for hip fracture in women < 65 years was 1.53 and 1.24 respectively. CONCLUSIONS: The FRAX tool has been found to show a good discriminatory capacity for detecting women at high risk of fragility fracture, and is better for hip fracture than major fracture. The test of sensibility shows that it is, at least, not inferior than when using BMD model alone. The predictive capacity of FRAX tool needs some adjustment. This capacity is better for hip fracture prediction and better for women < 65 years. Further studies in Catalonia and other regions of Spain are needed to fine tune the FRAX tool's predictive capability.

Female genital mutilation/cutting: changes and trends in knowledge, attitudes, and practices among health care professionals in The Gambia.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a harmful traditional practice that affects two out of three girls in The Gambia, seriously threatening their life and well-being with severe health consequences. By tracking the reference values established in former research conducted between 2009 and 2011, the objectives of this study are to explore trends and to measure and assess changes in knowledge, attitudes, and practices regarding FGM/C among health care professionals (HCPs) in The Gambia. METHODS: A cross-sectional descriptive study was designed to collect and analyze data from an overall stratified sample consisting of 1,288 HCPs including health professionals and students throughout the six regions of The Gambia. Data were collected by the implementation of a self-administered written knowledge, attitudes, and practices questionnaire between 2012 and 2014. RESULTS: The results of this study showed that 76.4% of HCPs are eager to abandon FGM/C, and 71.6% of them regard it as a harmful practice with negative consequences on life and health. HCPs reported more knowledge and favorable attitudes towards FGM/C abandonment, being better able to identify the practice, more aware of its health complications, and more concerned in their essential role as social agents of change. However, 25.4% of HCPs still embraced the continuation of the practice, 24.4% expressed intention of subjecting their own daughters to it, and 10.5% declared to have performed it within their professional praxis. CONCLUSION: Findings confirm progress in knowledge and attitudes regarding FGM/C among HCPs, who are better skilled to understand and manage the consequences. Nevertheless, discrepancies between information, intention, and behavior unveil resistance in practice and proves that FGM/C medicalization is increasing. Thus, there is an urgent need to support HCPs in the integration of FGM/C preventive interventions within the public health system, to address arguments favoring medicalization, and to use data to design appropriate strategies.