Time of leaving work pregnancy results during COVID-19 pandemic. The MOACC-19 cohort from Spain.

BACKGROUND: COVID-19 pandemic has changed the way pregnancies have been controlled as well as working conditions. In countries with paid leave of work, leaving earlier has been a relevant measure for controlling the pandemic. No study has been published on factors associated with earlier leaving work in pregnancy and the consequences it could have on pregnancy outcomes. OBJECTIVE: We aimed to identify woman and pregnancy characteristics associated with leaving work earlier and its consequences on pregnancy results. METHOD: A cohort study was carried out in Cantabria, Northern Spain, including 760 women who were pregnant in 2020 and were working at the beginning of their pregnancy. Data on pregnancy characteristics and results were obtained from medical records and gestational age at leaving work was self-reported. In a logistic regression analysis, leaving work before 26th week of pregnancy was the main effect variable. RESULTS: Several factors were associated with lower probability of leaving work before 26th week, including university studies (OR = 0.49, 95% CI: 0.36, 0.68), having presential work (OR = 0.57, 95% CI: 0.40, 0.81), women born in non-European countries (OR = 0.55, 95% CI: 0.30, 1.01) and non-smokers (OR for smokers = 1.79, 95% CI: 1.12, 2.87). Neither type of delivery, gestational age at delivery nor other pregnancy results were associated with the gestational age of leaving work. CONCLUSION: Several pregnancy and women characteristics were associated with leaving work earlier in the COVID-19 pandemic, although it was not associated with any pregnancy outcome.

Prenatal and Birth Care of Roma Women.

BACKGROUND: The reproductive health of Roma women has been poorly studied. It is important to determine the follow-up care received by Roma women from pregnancy to the first postpartum visit, together with neonatal outcomes, to improve prenatal care and maternal-child outcomes. OBJECTIVE: The aim of this study was to examine differences in prenatal care and maternal-infant outcomes between Roma and non-Roma women. METHODS: A retrospective longitudinal study was conducted in 122 pregnant women (28 Roma and 94 non-Roma women) recruited from seven primary care centers in three districts of Asturias (Spain). Sociodemographic variables, prenatal control, birth characteristics, feeding, and neonatal outcomes (gestational age, weight, and APGAR [appearance, pulse, grimace, activity, and respiration]) were collected from the electronic medical records. Prenatal care was assessed using three indices: the Kessner index, the Modified Adequacy of Prenatal Care Utilization Spanish Index, and an ad hoc index that considered adherence to the recommendations for pregnant women in Spain. RESULTS: Compared with non-Roma women, advanced maternal age (≥35 years) and primigravida were less common among Roma women. Roma women visited the dentist less often, smoked more, and underwent group B streptococcus screening less frequently. No differences were found in the number of prenatal visits between Roma and non-Roma women. Consequently, there were no differences between the Kessner index and the Modified Adequacy of Prenatal Care Utilization Spanish Index. Using the ad hoc index, the non-Roma women more frequently had adequate prenatal visits. There were no differences in birth characteristics, type of feeding, and neonatal outcomes. DISCUSSION: Overall, prenatal care was slightly worse in Roma women; however, this did not imply worse neonatal health outcomes. Both study groups had similar birth characteristics and immediate puerperium, including feeding.

Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain.

BACKGROUND: Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. OBJECTIVE: The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. METHODS: A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used. RESULTS: 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). CONCLUSIONS: The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia.

A mixed-methods study to evaluate the acceptability of information leaflets for breast cancer screening.

AIMS AND OBJECTIVES: To obtain feedback regarding the comprehension and acceptability of an information leaflet on breast cancer screening among women. BACKGROUND: Women usually receive a leaflet inviting them to participate in breast cancer screening programmes for early detection of breast cancer. These leaflets include relevant information about mammograms to aid with decision-making. It is important to know how the target population perceives these leaflets, as this may influence the attitude towards breast cancer screening. DESIGN: A mixed-methods study (concurrent triangulation design). METHODS: Participants were 41 women aged between 40-60 years in the north of Spain. The leaflet included information about breast cancer, mammograms, benefits/risks of screening, and the breast cancer mortality and survival rates in relation to screening. Three written methods were used to assess the leaflet: a readability assessment (Flesch Index) and two comprehension assessments (Cloze and multiple-choice questions). In addition, 26 semi-structured interviews were conducted to explore the women's opinions regarding comprehension, acceptability and the contribution of the leaflet as a decision aid. The COREQ checklist was used to guarantee the quality and rigour of the qualitative study. RESULTS: Overall, women found the leaflet fairly easy to read and most understood the content. Some women found the information on mortality alarming, difficult to understand and a cause for rejection. The leaflet was viewed as a decision aid, although further information was requested on mammograms, the need for complementary tests and the risks and symptoms of breast cancer. CONCLUSION: The leaflet was accepted by women and, overall, easy to understand. The participation of the target population enabled the content and format of the leaflet to be adjusted to their needs. RELEVANCE FOR CLINICAL PRACTICE: Nurses can contribute towards improving the breast cancer screening leaflets, considering women's perceptions surrounding screening.

Knowledge of the Human Papillomavirus by Social Stratification Factors.

BACKGROUND: Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection. OBJECTIVES: The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women. METHODS: A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015-2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose-response associations were estimated based on p-trend. RESULTS: Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified "promiscuity" as a risk factor of HPV infection and "the use of condoms" as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose-response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine. DISCUSSION: In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.

Prevalence of high-risk HPV genotypes, categorised by their quadrivalent and nine-valent HPV vaccination coverage, and the genotype association with high-grade lesions.

BACKGROUND: The new nine-valent vaccine against human papillomavirus (HPV) includes the four HPV genotypes (6, 11, 16, and 18) that are targeted by the older quadrivalent HPV vaccine, plus five additional oncogenic types (31, 33, 45, 52, and 58) remain significantly associated with high grade lesions. We aimed to determine the prevalence of high-risk HPV genotypes in unvaccinated subjects and the association of these genotypes with the incidence of high-grade lesions. We also assessed which, if either, of these two HPV vaccines could have prevented these cases. METHODS: This cross-sectional study, conducted from 4 January 2010 to 30 December 2011, was composed of 595 women attending the Hospital General Universitario de Elche (Spain) gynaecology department who were positively screened for opportunistic cervical cancer by pap smears and HPV detection during a routine gynaecological health check. The pap smear results were classified using the Bethesda system. HPV genotyping was performed with the Linear Array HPV genotyping test, and viruses were classified by the International Agency for Research on Cancer assessment of HPV carcinogenicity. Odds ratios (ORs) with their 95% confidence intervals (95% CI) were estimated by logistic regression, adjusting for age and immigrant status. The prevented fraction among those exposed (PFe-adjusted) was determined as a measure of impact. RESULTS: At least one of the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine was detected in 20.5% of subjects. After excluding women with genotype 16 and/or 18 co-infection, high-risk genotypes (31, 33, 45, 52, and 58) were associated with a higher risk of intraepithelial lesion or malignancy: adjusted OR = 3.51 (95% CI, 1.29-9.56), PFe-adjusted = 0.72 (95% CI, 0.22-0.90). Genotypes that are still non-vaccine-targeted were detected in 17.98% of the women, but these were not significantly associated with high-grade lesions. CONCLUSION: The greater protection of the nine-valent HPV vaccine is likely to have a positive impact because, in the absence of genotype 16 or 18 infection, these five genotypes on their own remained significantly associated with high-grade lesions.

Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study.

PURPOSE: The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment. METHODS: A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle. CONCLUSIONS: Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients.

Does Jacobson's relaxation technique reduce consumption of psychotropic and analgesic drugs in cancer patients? A multicenter pre-post intervention study.

BACKGROUND: Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson's relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients. METHODS: This was a multicenter pre-post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured. RESULTS: A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique. CONCLUSIONS: The practice of abbreviated Jacobson's relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups. TRIAL REGISTRATION: ISRCTN 81335752 , DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

[Sexual risk behaviours and PAP testing in university women vaccinated against human papillomavirus]. / Conductas sexuales de riesgo y actividades preventivas frente al cáncer de cuello uterino en mujeres universitarias vacunadas frente al VPH.

AIM: To estimate the association between the human papillomavirus (HPV) vaccine and sexual risk behaviour, as well as the participation in the Cervical Cancer Screening Program (CCSP). DESIGN: Cross-sectional study. LOCATION: School of Medicine and Health Sciences, School of Law, and School of Economics and Business (University of Oviedo). PARTICIPANTS: Female university students. MAIN MEASUREMENTS: Information was collected about contraceptive methods, sexual behaviours, HPV knowledge, and participation in the CCSP. Furthermore, proportions and odds ratio (OR) were estimated with their corresponding 95% confidence intervals (95%CI). RESULTS: Approximately two-thirds (67.7%) of the sample was vaccinated against HPV, and 216 women (65.3%) were sexually active. Barrier contraceptive methods were used by 67.6% during their current intimate relationships, being less frequent in non-vaccinated women (54.9% vs. 75.4% in vaccinated female students) (P=.002). The risk of having at least one sexual risk behaviour was higher in non-vaccinated women: OR2.29 (95%CI: 1.29-4.07). In addition, the probability of having a PAP test within the CCSP was higher in non-vaccinated women: OR2.18 (95%CI: 1.07-4.47). CONCLUSIONS: The prevalence of sexual risk behaviours in non-vaccinated women is elevated, and it is related to the lack of use of barrier contraceptive methods. The vaccination against HPV could affect sexual behaviours and the participation in the CCSP. Therefore, the information received by young people about contraceptive methods, sexually transmitted diseases, and cancer prevention should be reinforced.

[Prevalence of non-vaccinable high risk genotypes of human papillomavirus in the Early Detection of Cervical Cancer Program in Cantabria]. / Prevalencia de genotipos del virus del papiloma humano de alto riesgo no vacunables dentro del programa de Detección Precoz de Cáncer de Cérvix en Cantabria.

OBJECTIVE: To estimate the prevalence of infection with non-vaccinable high risk genotypes of human papillomavirus (HPV). DESIGN: Cross-sectional study. LOCATION: Seven randomly selected health centres in Cantabria (Northern Spain). PARTICIPANTS: All women with an evaluable vaginal smear (n=3,359) between 2010 and 2011. MAIN MEASURES: The variables collected were cytological diagnosis, PCR results, and family planning method. The vaginal smear results were classified with the Bethesda system. The classification by Muñoz et al. was used for typing as oncogenic risk HPV. Proportions and odds ratio (OR) were estimated with corresponding confidence intervals at 95% (95% CI). RESULTS: The prevalence of HPV infection was 2.71% (95% CI: 2.15 to 3.27). The prevalence of high oncogenic risk HPV genotypes was 2.26%; (95% CI: 1.75 to 2.78). The most frequent genotype was 16 (28.89%). More than half of the women were positive for one of the non-vaccinable high risk genotypes: 51 (18.89%) and 58 (13.33%) and 68 (12.22%) or 31 (11.11%). At least two non-vaccinable high-risk genotypes co-existed in 23.33% of women. Younger women (≤30 years) had twice the risk of any HPV infection: OR 2.01 (95% CI: 1.02 to 3.96); and were twice as likely to use condoms compared to hormonal contraceptives, OR 2.09 (95% CI: 1.64 to 2.67). CONCLUSIONS: According to the high percentage of non-vaccinable high oncogenic risk HPV types, there should be a re-think of the prevention strategy in the population, who may have a false sense of protection.

[SYSTEMATIC REVIEW OF NURSING PROFESSIONAL ROLE IN SOCIAL HEALTH INEQUALITIES IN THE IMMIGRANT POPULATION]. / Revisión sistemática del papel que representan los profesionales de enfermería en las desigualdades sociales en salud entre la población inmigrante.

The current situation in Spain has led to increase social inequalities in health in the population. Immigrants without economic resources are the most vulnerable group with high rates of morbidity and mortality. For this reason, the Commission on Social Determinants of Health (CSDH) was created by developing a conceptual framework to classify the inequality factors, and thus, politically designing actions in order to reduce this problem. The nursing professional collaboration in developing effective policies to reduce health inequalities would be a new framework, because this profession possesses unique knowledge of people who are cared with social problem. One of the main problems identified by nurses in the immigrant population is social isolation, being developed in this text one of the nursing diagnoses included in a immigrant person care plan with social inequality in health.

Impact of an Intervention Aimed at Improving Sleep Quality in Hospitalized Children.

BACKGROUND: Hospitalized children need adequate sleep to favor early recovery. METHODS: To study the sleep pattern of children admitted to a pediatric inpatient unit, a cross-sectional study was carried out at a reference hospital in northern Spain. The main study variables were medical specialty of admission, sleep-inducing treatment, hours of sleep at home and during admission, number of nocturnal awakenings, and reasons for awakening. Differences in the hours of sleep and nighttime awakenings between the initial period and at six months were calculated using the Student's t-test. RESULTS: We included 100 baseline patients and 100 post-intervention patients. Up to 4% of the baseline sample and 3% of the six-month sample had been prescribed a sleep-promoting drug. Regarding awakenings, 79% of the children in the baseline sample suffered awakenings, with a mean of 1.98 awakenings (range 1-13). At six months, the percentage of children who experienced awakenings decreased by 17%, with a mean of 1.34 (range 1-5). In the baseline sample, 48% were caused by nursing care, decreasing to 34% after the intervention. CONCLUSIONS: An educational intervention with the implementation of targeted evidence-based practices is a useful measure for improving the sleep pattern by decreasing the number of awakenings.

Development of SARS-CoV-2 specific IgG and IgA antibodies in serum and milk with different SARS-COV-2 vaccines in lactating women.

BACKGROUND: Our main objective was to determine the evolution of IgG and IgA antibodies directed against SARS-CoV-2 protein S in the blood of lactating women and in breast milk. METHODS: A cohort of 110 uninfected and vaccinated breastfeeding women was followed-up for 6 months at the Marqués de Valdecilla University Hospital, Spain, in 2020. An additional group of 23 breastfeeding mothers who had no previously documented infection and had not been vaccinated against SARS-CoV-2 were included as a control group. The antibodies in blood and breast milk and their evolution at 6 months post-vaccination were analysed. RESULTS: One hundred ten breastfeeding mothers were included; 70 women (63.6%) were vaccinated with two doses of BNT162b2, 20 women (18.2%) received two doses of mRNA-1273, and 20 women (18.2%) received a single dose of ChAdOx1-S. No evidence of differences between concentrations of antibodies was found according to the type of vaccine, with the exception of serum IgA antibodies, which was higher in women vaccinated with mRNA-1273: mean [95%CI]: 0.05 AU/mL [0.03,0.06] with mRNA-1273, 0.02 AU/mL [0.01,0.03] with BNT162b2 and 0.01 AU/mL [0.00,0.03] with ChAdOx1-S, ANOVA p value = 0.03. The lack of difference between vaccines was also found when anti-S1 specific IgG in serum and breast milk were measured. CONCLUSIONS: In lactating women vaccinated against COVID-19, anti-SARS-CoV-2 antibodies can be detected in both serum and breastmilk 6 months after receiving the second dose, although their concentrations decreased when compared with concentrations reached immediately after vaccination.

Surgical vs. transcatheter aortic valve replacement in patients over 75 years with aortic stenosis: sociodemographic profile, clinical characteristics, quality of life and functionality.

Background: Aortic valve stenosis (AVS) affects 25% of the population over 65 years. At present, there is no curative medical treatment for AVS and therefore the surgical approach, consisting of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), is the treatment of choice. Methodology: The aim of this study was to analyze the sociodemographic and clinical characteristics, quality of life and functionality of a sample of patients with AVS over 75 years of age, who underwent TAVR or SAVR, applying standard clinical practice. A prospective multicenter observational study was conducted in two hospitals of the Spanish National Health System. Data were collected at baseline, 1, 6 months and 1 year. Results: In total, 227 participants were included, with a mean age of 80.6 [SD 4.1]. Statistically significant differences were found in terms of quality of life, which was higher at 1 year in patients who underwent SAVR. In terms of functionality, SAVR patients obtained a better score (p < 0.01). However, patients who underwent TAVR began with a worse baseline situation and managed to increase their quality of life and functionality after 1 year of follow-up. Conclusion: The individualized choice of TAVR or SAVR in patients with AVS improves patients' quality of life and function. Moreover, the TAVR procedure in patients with a worse baseline situation and a high surgical risk achieved a similar increase in quality of life and functionality compared to patients undergoing SAVR with a better baseline situation.

Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons.

Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007-2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.

Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study.

Background: Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods: A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results: A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.

Evolution of Legislation and Crimes Based on Sexual Identity or Orientation in Spain: A Retrospective Observational Study (2011-2021).

Respect for different sexual options and orientations prevents the occurrence of hate crimes against lesbian, gay, bisexual, trans and intersex (LGTBI) persons for this reason. Our aim was to review the legislation that protects the rights of LGTBI people and to quantify the victimization rates of hate crimes based on sexual identity and orientation. A retrospective observational study was conducted across all regions of Spain from 2011-2021. The laws on LGTBI rights in each region were identified. Hate crime victimization data on sexual identity and orientation were collected in annual rates per 100,000 inhabitants, annual percentage change and average change during the study period to assess the trend. The regulatory development of laws against discrimination against LGTBI individuals is heterogeneous across regions. Overall, in Spain there is an upward trend in the number of hate crime victimizations motivated by sexual identity or orientation. The effectiveness of data collection, thanks to better training and awareness of police forces regarding hate crimes and the processes of data cleansing and consolidation contributes to a greater visibility of hate crimes against LGTBI people.

Evolution of Legislation and the Incidence of Elective Abortion in Spain: A Retrospective Observational Study (2011-2020).

BACKGROUND: According to the WHO, "unsafe abortion occurs when a pregnancy is terminated either by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both". AIM: To review the legislation that ensures access to elective abortion and the main indicators of elective abortion in Spain. METHODS: A retrospective observational study was conducted across all regions of Spain from 2011 to 2020. The regulations of each region on the creation of the clinical committee and the creation of the registry of conscientious objector professionals were identified. Data were collected on rates of elective abortions per 1000 women, type of health center where the intervention was performed, interval of weeks of gestation, and cause. RESULTS: After Law 2/2010 entered into force, the Spanish regions created a clinical committee; however, very few regions have a registry of conscientious objectors. During the study period, the average annual rate in Spain was 11.10 elective abortions per 1000 women between 15 and 44 years of age, showing a decreasing trend (annual percentage change of -1.92%). Only 10.67% of abortions were performed at public centers. In 90.18% of the cases, abortions were performed at the woman's request. CONCLUSION: Spain legislated late compared to most European Union countries. The current law is similar to that of other member states, allowing abortion at the woman's request in the first fourteen weeks and thereafter for medical reasons. Most abortions are performed at private centers, although many territorial inequalities are observed.

Excessive alcohol consumption and binge drinking in college students.

Background: Binge drinking (BD) refers to a pattern of alcohol consumption characterized by the consumption of large amounts of alcohol in a short period of time followed by periods of abstinence. This drinking pattern is prevalent worldwide, mainly among young people. Excessive alcohol consumption is the spectrum of consumption patterns that may have or have had health consequences, and includes the concepts of risky alcohol use, harmful alcohol use and alcohol dependence according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the latter two are currently grouped into alcohol use disorder (AUD) according to the fifth edition of the DSM (DSM-5). Due to the high prevalence of BD among young people, especially university students, as well as the important consequences of its practice, a study was conducted to evaluate excessive alcohol consumption and its relationship with the practice of BD in university students. Methods: A cross-sectional study was conducted among students (aged 18-30 years) enrolled in the academic year 2018-2019 at the Faculty of Nursing at a university in northern Spain. Data collection included sociodemographic information, and alcohol use information, collected using a semi-structured questionnaire. To measure the excessive alcohol consumption, this study used the Alcohol Use Disorders Identification Test (AUDIT). Results: A total of 142 participants were included, of which 88.03% were women. Up to 38.03% were classified as BD. Up to 14.77% of non-BD participants and 66.67% of BD participants were classified as risky drinkers (AUDIT Total geq 8 in men or geq 6 in women) (p < 0.001). Up to 3.41% of the non-BD and 24.07% of the BD were drinkers with harmful alcohol use and probable alcohol dependence (AUDIT Total geq 13) (p < 0.001). A total of 5.68% of non-BD and 42.59% of BD were AUD drinkers (AUDIT Total geq 9 in males or geq 8 in females) (p < 0.001). In addition, statistically significant differences were found between the BD and non-BD groups in the responses to each of the AUDIT items, as well as in the total score and also in the scores of the three domains of the questionnaire. Conclusions: Excessive alcohol consumption is frequent among university students, especially among those who practice BD.

Cost analysis of chronic obstructive pulmonary disease (COPD): a systematic review.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a treatable disease with a high prevalence, and high morbidity associated with significant socioeconomic costs. OBJECTIVE: To carry out a systematic review of the literature to analyze the main cost studies associated with COPD, in order to determine the main factors that influence the costs of the disease. METHODS: Searches were conducted in PubMed, SCOPUS and Web of Science databases for cost studies on COPD published in English, between the years 2015 and 2020. The search terms were "COPD" OR "pulmonary disease, chronic obstructive", "cost*" OR "cost of illness", "economic impact" AND "burden of disease". The inclusion criteria included the identification of reported cost of the disease, economic burden, medical care expenses or use resources for COPD, the methodology used, data sources, and variables studied. RESULTS: 18 publications were analyzed: 17 included direct health costs, 6 included direct non-medical costs, 12 analyzed indirect costs and two reported intangible costs. Most of the studies reported data for developed and European countries, with direct costs being the most studied. Trends were observed in multiple studies of direct and healthcare costs for European countries measured by patient and year, where the higher costs were associated with more severe COPD and a frequent history of exacerbations. The highest costs reported corresponded to hospitalizations and the associated pharmacological treatment. The importance of the loss of productivity and premature retirement within the profile of the COPD patient was also highlighted as the main generator of indirect costs of the disease. CONCLUSION: COPD generates substantial costs for the health system, mainly related to moderate to severe stages and the exacerbations and complications entailed. It is important to strengthen health systems with monitoring, evaluation and health education models that allow these patients to remain stable to avoid decompensation and subsequent hospitalizations.