Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys.

AIMS: This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. METHODS: We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level. RESULTS: There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. CONCLUSIONS: These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.

Health indicators of the National Roma Integration Strategy in Spain in the years 2006 and 2014.

BACKGROUND: In 2011, the European Commission adopted the European framework for the National Roma Integration Strategies (NRISs) 2020, which focussed on four areas: education, employment, health and housing. In 2012 Spain approved its Strategy 2012-20, one of the central aims of which is to reduce social inequalities in health that affect the Roma population. Our objective was to analyze changes in health inequalities between the Roma population and the general population in Spain in the years 2006 and 2014. METHODS: The Spanish National Health Surveys (NHSs) 2006 (n = 29 478) and 2012 (n = 20 884) and the NHS of the Spanish Roma Population 2006 (n = 933) and 2014 (n = 1155) were compared. This study considered the variables included in NRIS 2012-20: self-perceived health, tobacco use in men, traffic accidents in men and women, obesity in women and gynaecological visits. RESULTS: Despite the adoption of the NRIS 2012-20, there were no observed improvements in health between 2006 and 2014 in the Roma population. Nor was there a reduction in inequalities in health concerning the general population in Spain. Also, there was no reduction in the health inequalities by gender for the two populations. CONCLUSIONS: Health is determined in part by social factors including education, employment, housing and also by anti-Roma discourses and discrimination. Improving the health of the Roma population requires a multi-sectoral approach with a gender perspective.

Intimate Partner Violence against Women during the COVID-19 Lockdown in Spain.

AIMS: To analyze the temporal and geographical distribution of different indicators for the evolution of intimate partner violence against women (IPV) before, during and after the COVID-19 induced lockdown between March and June 2020 in Spain. METHODS: Descriptive ecological study based on numbers of 016-calls, policy reports, women killed, and protection orders (PO) issued due to IPV across Spain as a whole and by province (2015-2020). We calculated quarterly rates for each indicator. A cluster analysis was performed using 016-call rates and protection orders by province in the second quarters of 2019 and 2020. ANOVAs were calculated for clustering by province, unemployment rates by province, and the current IPV prevalence. RESULTS: During the second quarter of 2020, the highest 016-call rate was recorded (12.19 per 10,000 women aged 15 or over). Policy report rates (16.62), POs (2.81), and fatalities (0.19 per 1,000,000 women aged 15 or over) decreased in the second quarter of 2020. In the third quarter, 016-calls decreased, and policy reports and POs increased. Four clusters were identified, and significant differences in unemployment rates between clusters were observed (F = 3.05, p < 0.05). CONCLUSIONS: The COVID-19 lockdown fostered a change in IPV-affected women's help-seeking behavior. Differences between the volume of contacts made via 016-call and the policy reports generated provide evidence for the existence of barriers to IPV-service access during the lockdown and the period of remote working. More efforts are needed to reorganize services to cope with IPV in non-presential situations. The provinces with the highest 016-call and PO rates were also those with the highest rates of unemployment, a worrying result given the current socioeconomic crisis.

Empathy and Emotional Intelligence in Adolescent Cyberaggressors and Cybervictims.

The main objective of the present research was to examine the role played by emotional intelligence in its three dimensions-emotional attention, emotional clarity, and emotion regulation-and by empathy in its four dimensions-perspective-taking, empathic understanding, empathic stress, and empathic joy-in cyber violence, both in aggressors and victims. A total sample of 1318 adolescents (47% boys; aged between 11 and 17 years), enrolled in four secondary compulsory education schools in Spain, participated in the study. The results indicated that, regarding emotional intelligence, cyberaggressors showed statistically significant differences in the dimension of emotion regulation. Participation in violent online behaviors is associated with a lower capacity to regulate emotions; cybervictims showed statistically significant differences in the three dimensions of emotional intelligence. Regarding empathy, cyberaggressors obtained statistically significant group differences in three of these dimensions: perspective-taking, empathetic joy, and empathic stress. Finally, the empathy dimensions for the cybervictimization groups did not show significant mean differences, indicating that there was no statistical relationship between the degree of cybervictimization and the individual's empathy. These findings stress the relevance of emotion regulation in cyberviolence in students in adolescence and allow us to understand the different roles it plays for offenders and victims.

The Impact of Cybervictimization on Psychological Adjustment in Adolescence: Analyzing the Role of Emotional Intelligence.

Cybervictimization has been associated with serious emotional adjustment problems such as low self-concept and depressive symptomatology. In addition, these problems can negatively affect the well-being of the victims, manifesting in their levels of satisfaction with life. However, it should be noted that not all cybervictims develop these consequences with the same intensity. These differences seem to be related to the development of emotional intelligence (EI), as it can positively influence adolescents' emotional adjustment and well-being even when problems arise. The objective of this work was to analyze the role of EI on cybervictimization and adolescents' emotional adjustment, especially in self-concept, depression, and life satisfaction. The participants in the study were 1318 adolescents of both sexes and aged between 11 and 18 years (M = 13.8, SD = 1.32), from four secondary compulsory education centers in Spain. EI influences the relationship between self-concept and life satisfaction, and between depression and life satisfaction. In addition, the relationships of cybervictimization with self-concept and depression are influenced when introducing EI and its dimensions (emotional attention, clarity, regulation). These data support the idea that EI may affect the relationship between cybervictimization and adolescents' emotional adjustment.

The Role of Emotional Intelligence on Psychological Adjustment and Peer Victimization in a Sample of Spanish Adolescents.

In the last decades, interest in the study of the negative consequences of bullying for the victims has increased. Victims are often known to show emotional adjustment issues, such as negative self-concept and low life satisfaction. Moreover, some studies have observed important associations between self-concept and life satisfaction, in which a positive self-concept is related to high levels of life satisfaction. Other studies have pointed out the importance of emotional intelligence (EI), as a regulatory and protective factor against the negative impact of victimization on adjustment in adolescents. The main objective of this work was to analyze the mediating effect of self-concept on life satisfaction and the moderated mediation effect of EI on self-concept and life satisfaction in the context of peer victimization. The participants in the study were 1,318 Spanish students of both sexes and aged between 11 and 18 (M = 13.8, SD = 1.32) years, from four compulsory secondary education centers. The results indicated that, on the one hand, self-concept mediated the relationship between victimization and life satisfaction. On the other hand, EI was not only positively associated with self-concept, but it also significantly moderated the negative influence of victimization on self-concept. EI may also indirectly moderate the relationship between victimization and life satisfaction through the self-concept. These data show the importance of EI as a possible protective and moderating factor of the negative effect of bullying on emotional adjustment, which is interesting for the design of future prevention and intervention programs in school contexts.

Continuity and Overlap of Roles in Victims and Aggressors of Bullying and Cyberbullying in Adolescence: A Systematic Review.

The objective of this study was to conduct a systematic review of research focused on analyzing the overlap and continuity of the roles in victims and aggressors of bullying and cyberbullying, as well as the exchange of roles in both harassment dynamics in adolescents. Searches in the main electronic databases for studies published in the last 20 years identified 19 studies that fulfilled inclusion criteria. The findings of the studies analyzed were not homogeneous, however, the main conclusion of all of them, to a greater or lesser extent, was that there is a component of continuity or superposition in the roles of both forms of bullying. Some studies also found an exchange of roles, especially in the case of victims and cybervictims who decide to reprimand their aggressors in an online context, becoming in cyberaggressors too. It is necessary to continue investigating the coexistence of bullying and cyberbullying and its exchange in certain contexts and people, as well as whether they are part of the same phenomenon with a certain continuity, or if cyberbullying is another expression of traditional bullying. Future intervention programs focusing on traditional school bullying could also evaluate their impact in situations of cyberbullying among peers.

The Influence of Bullying and Cyberbullying in the Psychological Adjustment of Victims and Aggressors in Adolescence.

The objective of the present study was to analyze the extent to which violent peer behavior and victimization, both traditional and cybernetic, and predict certain indicators of psychological maladjustment in adolescents, such as self-concept, satisfaction with life, feeling of loneliness, depressive symptomatology, perceived stress, social anxiety, empathy, and emotional intelligence. Participants in the study were 1318 adolescents of both sexes, aged between 11 and 18 years and enrolled in Compulsory Secondary Education schools. The design of the study was cross-sectional. The results indicated that the victims generally present greater maladjustment than the aggressors. Both victims and cybervictims showed a greater decrease in all the dimensions of self-concept, compared with aggressors and cyberaggressors. However, the two types of aggressors showed a higher likelihood of presenting low levels of empathy. Feeling of loneliness, depressive symptomatology, perceived stress, and degree of life satisfaction was more probable to be present in all groups of aggressors and victims. Finally, with regard to emotional intelligence, victims had a higher probability of obtaining low scores in all the dimensions of this construct; this was the case for traditional aggressors only in the dimension of emotion regulation. These results contribute to our understanding of the consequences of harassment in the adaptation of the students involved, with relevant practical implications.

[High prevalence of hepatitis B infection in Amerindians in Japreira, Zulia State, Venezuela]. / Alta prevalencia de la infección por el virus de hepatitis B en la comunidad indígena Japreira, Estado Zulia, Venezuela.

The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in the Japreira indigenous community, Venezuela, and its relationship to age and gender. An intentional, non-probabilistic sample of 149 individuals was selected from a total of 300. All samples were studied for the presence of total HBV antibodies (total anti-HBc), and the positive samples were tested for HBV surface and "e" antigens (HBsAg, HBeAg). Overall prevalence rates of total anti-HBc were 72.9% in females and 81.1% in males. The highest prevalence of HBsAg was observed in males 26-35 years of age. Only four of the 44 HBsAg carriers were positive for HBeAg. The results showed a high endemic HBV infection rate and indicated that its spread begins at early ages. Sexual transmission may be the main route for spread of the virus. Crowding, close contact with bodily fluids, specific social practices, and features of the circulating viral strain among members of this community could be involved in the high chronicity observed in the Japreira indigenous community.

[The Zung's autoscale for depression as predictor of sensorial and autonomic alterations to pain]. / Autescala de Zung para depresión como predictor de la respuesta sensorial y autonómica al dolor.

Clinical and experimental evidence support a relationship between susceptibility to chronic pain and a subjacent depression. Nevertheless, it's not clear if the currently available clinical evaluation instruments for depression allow for linking both disorders. Thus, we evaluated a Zung's autoscale for depression and its different categories: affective, physiological, motor and psychological, as possible predictors of sensorial and autonomic alterations and vulnerability to clinical chronic pain. In 32 healthy controls and 11 subjects with minor depression and free of treatment, ischemic pain was first induced by applying a tourniquet on the dominant arm, and then followed by paresthesias during the reperfusion of arm as the tourniquet is released. Ischemic muscular pain, post-ischemic paresthesias and associated cardiovascular responses were recorded throughout the experimental procedure. The affective category's score was correlated linearly in individual form with the greatest number of variables and it was adjusted to a model of multiple regressions that almost explained the variance in 100% with a contribution of the sensorial and autonomic variables of a 70% and 30%, respectively. In addition, the affective category was 50% greater in subjects with persistent clinical pain. The Zung's index and the other categories had a smaller number of individual linear correlations and models of multiple correlations that only explained between 30-70% of the variance, with a more predominant contribution of the autonomic variables (20-50%), especially in the psychological category. This suggests that the affective category predicts cutaneous-muscular sensorial alterations with greater effectiveness than the Zung's total index.

[Serum levels of interferon-gamma and interleukine-10 in anemic children with vitamin A deficiency]. / Interferón-gamma e interleucina-l0 sérica en niños anémicos con deficiencia de vitamina A.

Studies done with human and animals have shown that the diminished vitamin A intake can produce anemia, but the ethiopathogenic mechanism hasn't been known due to the few studies about the complex interactions between micronutrients deficiencies, immune system and cytokine productions. The objective of the present study was to analyze the serum concentration of IFN-gamma and IL-10 in anemic and non anemic children according to vitamin A nutritional status. A descriptive study of 53 euthrophic children, without infectious diseases (45-77 month old; 29 girls, 24 boys), living in a slum in Maracaibo-Venezuela. Anemia was evaluated by means of blood hemoglobin concentration analysis, standard WHO criteria for anemia were Hb < 110 g/L in <60 month old children; Hb < 115 g/L in >60 month old children. Vitamin A status was assessed by Conjunctival Impression Cytology (CIC) technique, which determines Normal CIC=Control or Abnormal CIC=VAD. The serum concentration of IFN-gamma and IL-10 (pg/mL; X +/- DE), was determined by the ELISA method. Statistical significance of differences was tested by ANOVA (p < 0.05). Prevalence of anemia was 75.50%; VAD 50.94% and anemia+VAD 35.86%. The anemic children with VAD showed significant serum values of IFN-gamma e IL-10 lower than in other groups. This alteration of the complex immunoregulatory mechanism could be responsible for dysfunction eritrhoid cell formation.

Changes in blood pressure in children undergoing psychological treatment before dental procedures.

Different dental procedures in children undergoing treatment can induce changes in blood pressure. These changes will be minimized if psychological treatment is applied prior to any procedure. The objective of this study was to determine changes in blood pressure (systolic-diastolic) in children undergoing psychological treatment before dental procedures. The population studied consisted of 100 children and adolescents, ages 6 to 15 years. The patients were assigned to two groups at random, i.e. with or without psychological treatment before dental procedures. Behavior management was carried out applying the tell-show-do technique of conduct handling. The systolic and diastolic blood pressures were measured prior to the initiation of the treatment, during drilling, restoring, and before dismissing the patient. The no-psychological treatment group exhibited significant differences in diastolic and systolic blood pressures during the dental procedure whereas the psychological treatment group evidenced no significant differences in blood pressure. No correlation was found between the alterations of blood pressure and the type of dental treatment performed. The application of the tell-show-do method would have an effect on the blood pressure in patients undergoing dental procedures.

[Hepatic alterations in patients with dengue]. / Alteraciones hepáticas en pacientes con dengue.

Clinical features of Dengue are very variable due to multiple alterations induced by the virus in the organism. Increased levels of transaminases similar to those produced by the Hepatitis virus have been reported in patients with Dengue from hiperendemic zones in Asia. The objectives of this study were to determine alterations in the liver tests in patients with Dengue and to relate them to the disease, clinically and serologically. Clinical history, hemathological tests serum transaminases (ALT y AST) and bilirubin assays were performed in 62 patients with clinical and serological diagnosis of Dengue. According to clinical features 38.7% of the patients with classical (CD) and hemorrhagic (DHF) forms of Dengue reffered abdominal pain and 2 patients with DHF had ictericia and hepatomegaly. Laboratory test findings showed leucopenia in 72.5% in both forms of Dengue and of patients with DHF severe thrombocytopenia (< 50.000 platelets x mm3), long PT and PPT in 70.9%, 23.0% and 42.3%, respectively. Transaminase values five fold higher than the normal values (p < 0.005) were observed in 36.8% and 74.4% of patients with CD and DHF respectively; AST was predominant in both groups. Our results suggest liver damage during the course of Dengue. A differential diagnosis has to be done between the hepatic involvement of Dengue cases and others viral diseases with hepatic disfunctions.

Prevalence and pathogenic role of Cyclospora cayetanensis in a Venezuelan community.

The prevalence and pathogenic role of Cyclospora cayetanensis among 212 subjects (age range = two months to 70 years) in an impoverished community in Venezuela were assessed retrospectively. For identification of the coccidium, modified Ziehl-Neelsen carbolfuchsin staining of formalin-ether concentrates was used. For other pathogenic parasites, iron-hematoxylin-stained smears and formalin-ether concentrates were examined. Cyclospora infections were identified in 13 (6.1%) subjects with a high percentage of asymptomatic carriers (11 of 13, 84.6%). Only two (15.4%) infants had diarrhea and the coccidium as the single detectable pathogenic parasite. The findings suggest that Cyclospora infections are relatively common and often asymptomatic in this region.

[Serum values of cytokines in children with vitamin A deficiency disorders]. / Valores séricos de citocinas en niños con desórdenes por deficiencia de vitamina A.

Vitamin A Deficiency Disorders (VADD) have been associated with alterations of cellular differentiation, regulatory functions of the immune system and increased children morbidity and mortality rates due to acute respiratory and intestinal infections. The aim of the present study was to determine serum concentrations of Thl-Th2 cytokines in VADD children. The sample consisted of 138 children (F=72; M=66; 4-7 y old) living in slums in Maracaibo, Venezuela, with an adequate nutrition assessed by clinics and anthropometry. Vitamin A status was assessed by the Conjunctival Impression Cytology (CIC) technique following the ICEPO methodology, which determines Normal CIC = control or Abnormal CIC = VADD. The cytokines IL-10, IL-4 and IFN-gamma (pg/mL) were analyzed by the ELISA method; and IL-2 (U/mL) by the EAISA method. The Student's t test was applied to detect differences between values (p<0.05). No one child presented clinical evidence of VADD; 71 children (51.40%) exhibited normal CIC (control), whereas 67 children (48.60%) presented abnormal CIC indicative of sub-clinical manifestation of VADD. The prevalence was higher, although non significant, in females, 5-6 y old children and amerindians (51.39%, 64.18% and 60.40%, respectively). A diminished serum concentration of IL-10 was detected in VADD children, in comparison with the control group (4.41 +/- 1.27 pg/mL vs. 6.03 +/- 3.90 pg/mL) (p<0.03). The rest of studied cytokines were not significantly different with respect to control. The IL-10 diminution in VADD children would be related to the alteration of the inflammatory response at the level of respiratory and intestinal epithelia affected by infections.

Interleukin-2 receptor serum concentrations in normal pregnancy and pre-eclampsia.

The purpose of this research was to assess interleukin-2 receptor serum levels in normal pregnancy and pre-eclampsia. Sera from 90 healthy pregnant women (30 for each trimester), 30 with pre-eclampsia and a group of 30 healthy non-pregnant were analyzed. Soluble interleukin-2 receptor was measured by specific double antibody enzymatic immunoassay (ELISA). Results were: 267.5 +/- 12.3 (mean +/- s.e.m) pg/mL in the uncomplicated first trimester sample, 300.9 +/- 14.5 pg/mL in the second trimester and 248.8 +/- 12.5 pg/mL in the third. The non-pregnant control group had 443.7 +/- 39.6 pg/mL, significantly different from normal pregnancy in all trimesters (p < 0.001). The concentration in pre-eclamptic patients was 382.2 +/- 24.2 pg/mL, with p < 0.01 with regard to the normal third trimester group. The conclusion is that interleukin-2 receptor serum levels diminish in normal pregnancy and rise in preeclampsia. The first finding seems to be a protective mechanism to the fetal allograft. The latter, point to increased cellular activity.

[Immunity to flavivirus in Amerindian population of the Sierra de Perijá, Zulia state, Venezuela]. / Inmunidad a flavivirus en la población indígena de la Sierra de Perijá, estado Zulia, Venezuela.

Little information is available about Flavivirus infection in amerindian populations in western Venezuela. On this account the activity and seroprevalence of these viruses were determined and the hypothesis concerning the existence of a sylvatic cycle, conditioning the infection transmission of these viruses in indigenous populations, was studied. For this, blood samples from Yukpas (n=144) and Barí (n=110) communities were collected, 35 (Yukpas=25 and Barí=10) of which were processed for viral isolation followed by RT-PCR. The anti-Flavivirus IgG antibodies were determined by ELISA. The results did not show active Dengue cases and the seroprevalence of anti-Flavivirus IgG in the Yukpa population was significantly higher (p < 0.0001) than in the Barí population (43.1% vs. 6.4%). The present study has determined the presence of Flavivirus immunity in Yukpa and Barí populations. These results show a higher prevalence at the former than in the Barí population, which suggests circulation of Flavivirus, mainly in the Yukpa communities, being scarce and sporadic in Barí villages. However, in the indigenous populations studied, the causes or factors that determine the off set of Flavivirus infections in these zones could vary. The detected prevalence between both communities may be due to differences in the structure settlements and social habits. No evidences were found to support the presence of a sylvatic cycle in the Flavivirus transmission, specially of Dengue, in this population.

[Prevalence of infection by Toxocara in schoolchildren in the community of El Moján, Zulia state, Venezuela]. / Prevalencia de infección por Toxocara en pre-escolares de una comunidad educativa de El Moján, estado Zulia, Venezuela. Resultados preliminares.

The systemic Toxocariasis or migrant larva is a helminto-zoonosis caused by the migration of nematode larvae through human tissues mainly, of the canine helminth Toxocara canis, which can infect humans, especially children. The aim of this study was to determine the prevalence of anti-T. canis antibodies in an infantile population. Serum samples of 73 children of either sex with ages between 4 and 6 years were examined. The determination of anti-Toxocara antibodies was carried out through an ELISA test (using excretory/secretory antigen from the Toxocara larvae). The statistical analysis was carried out through the Chi square test, the Fisher exact test and the correlation of Spearman. The overall prevalence of infection was 9.72%, the highest percentage (50%) was observed in 4 year-old children (3/6), there were significant differences among the ages. No differences were observed with regard to sex. An inverse correlation was observed between the age and ELISA positivity. These results suggest that the toxocariasis is frequent in children from this community.

[Vitamin A deficiency and the anthropometric nutritional status of urban and rural marginalized children in the state of Zulia, Venezuela]. / Deficiencia de vitamina A y estado nutricional antropométrico en niños marginales urbanos y rurales en el Estado Zulia, Venezuela.

The present transversal study was carried out to estimate the prevalence of both vitamin A deficiency (VAD) and protein-energy malnutrition among children (24 to 85 months) from three urban slums (n = 173) in Maracaibo city, Zulia State, Venezuela and a rural slum area (n = 34), vieinal to Maracaibo, by measuring serum retinol and z score of anthropometric indices Height//Age (H//AZ); Weight//Age (W//AZ) and Weight//Height (W//HZ), compared to NCHS-WHO reference values. The Graffar's methodology adapted to Venezuela by Méndez Castellano (1986) confirmed the underprivileged socio-economic condition of the children population. For serum retinol analysis, peripheral venous blood was drawn and serum was treated according to the Bieri et al. (1979) technique and HPLC procedure. Values were recorded in microgram/dL. Statistical analysis was done by using Epi Info 2000, release 1.0 and SAS release 6.0 (1996) computer programs. The prevalence of VAD (serum retinol < 20 micrograms/dL) in the total children population (n = 207) was 22.2%, being higher in urban children than in rural children (22.5% vs 20.5%). No clinical signs of VAD were detected in the children. The nutritional status analysed by Z score of anthropometric indices revealed that 27.4% of children suffered from undernutrition (Z score = -2 to > -3 SD), being 15.4% stunted, 9.6% wasted and 2.6% with acute protein-energy malnutrition. Neither severe malnutrition nor overweight were detected. According with the H//AZ index, 54.6% of children had adequate nutrition. However 23% of them suffered from VAD. In children at risk of developing undernutrition (Z score = -1 to > -2 SD), 20.9% had VAD and of the stunted children, 21.9% presented VAD. With W//AZ, 60.3%, 29.9% and 9.1% of children were with adequate nutrition, at risk, or wasted respectively; of each group, 25.6%, 17.7% and 15%, respectively had serum retinol values below 20 micrograms/dL. The Z score of W//HZ indicator revealed that 87.4%, 10.4% and 2.4% of children were in good nutrition, at risk, or with acute protein-energy malnutrition, respectively. In the three groups 22.1%, 23.8% and 20%, respectively were affected by VAD. These results indicate that VAD coexists indistinctly in healthy, adequately nourished children, as in those malnourished ones. Our VAD prevalence results and others from Venezuela, are higher than the criteria laid down by WHO and PAHO which warrant wide community intervention. This public health problem becomes more significant because children are apparently healthy and, if timely vitamin A supplementation is not given, any intercurrent infection is likely to worsen the vitamin A status, increasing the widely known consequences.

Programas de intervención en acoso escolar y ciberacoso en educación secundaria con eficacia evaluada: una revisión sistemática / Intervention programs in school bullying and cyberbullying in secondary education with effectively evaluated: A systematic review

Resumen En numerosos países no existen hoy normativas que regulen de forma específica e integral la intervención en situaciones de acoso escolar y ciberacoso, sino que existe una diversidad de protocolos y programas que, además, no han sido habitualmente partícipes de un proceso de evaluación de la eficacia de su implementación. El objetivo del presente trabajo tiene como finalidad hacer una revisión sistemática de las publicaciones existentes en las últimas dos décadas de programas de prevención e intervención en acoso escolar y ciberacoso, desarrollados en España, para el estudiantado de secundaria, implementados en escuelas y que, además, hayan incluido una evaluación de su eficacia. Un total de 10 programas cumplieron los criterios de inclusión. El análisis de los programas permite identificar diseños de intervención con eficacia moderada y alta. Sin la diversidad de enfoques, objetivos específicos y medidas de evaluación, no es posible identificar claves de eficacia generalizables.

Abstract There is currently no regulation in many countries that specifically and comprehensively regulates the intervention in bullying and cyberbullying situations, but rather a variety of protocols and programs that, moreover, have not usually been part of a process to evaluate the effectiveness of their implementation. The objective of the present work was to carry out a systematic review of the existing publications in the last two decades on prevention and intervention programs in school bullying and cyberbullying developed in Spain for secondary school students, implemented in schools, and that have also included an evaluation of its effectiveness A total of 10 programs met the inclusion criteria. The analysis of the programs allows the identification of intervention designs with moderate and high efficiency, although the diversity of approaches, specific objectives and evaluation measures does not make it possible to identify generalizable efficiency keys.