Ongoing CPR with an onboard physician.

Introduction: Recent data are not available on ongoing CPR for emergency services with an onboard physician. The aim of the present study was to identify factors associated with the decision to transport patients to hospital with ongoing CPR and examine their survival to hospital discharge with good neurological status. Methods: An observational study based on a registry of out-of-hospital cardiac arrests attended to by emergency services with an onboard physician. All OHCA cases occurring between the 1st of January and the 31st of December 2022 were included. Patients receiving ongoing CPR during transport to the hospital were compared with patients pronounced dead at the scene following arrival of the care team. The dependent variable was ongoing CPR during transport to the hospital. The main characteristics and the neurological status of patients surviving to discharge were described. Results: A total of 9321 cases were included, of which 350 (3.7%) were transported to hospital with ongoing CPR. Such patients were young (59.9 ± 20.1 years vs 64.6 ± 16.9 years; p < 0.001; 95%CI: 0.98 [0.98; 0.99]) with arrest taking place outside of the home (151 [44.5%] vs 4045 [68.01%]; p < 0.001; 95%CI: 0.41 [0.31; 0.54]) and being witnessed by EMS (126 [36.0%] vs 667 [11.0%]; p < 0.001; 95%CI: 4.31 [3.19; 5.80]), whilst initial rhythm differed from asystole (164 [47.6%] vs 4325 [73.0%]; p < 0.01; 95%CI: 0.44 [0.33; 0.60]) and a mechanical device was more often employed during resuscitation and transport to hospital (199 [56.9%] vs 2050 [33.8%]; p < 0.001; 95%CI: 2.75 [2.10; 3.59]). Seven patients (2%) were discharged alive from hospital, five with ad integrum neurological recovery (CPC1) and two with minimally impaired neurological function (CPC2). Conclusions: The strategy of ongoing CPR is uncommon in EMS with an onboard physician. Despite their limited efficacy, the availability of mechanical chest compression devices, together with the possibility of specific hospital treatments, mainly ICP and ECMO, opens up the possibility of this approach with determined patients.

Incidence, treatment, and factors associated with survival of out-of-hospital cardiac arrest attended by Spanish emergency services: report from the Out-of-Hospital Spanish Cardiac Arrest Registry for 2022. / Incidencia, tratamiento y factores asociados con la supervivencia de la parada cardiaca extrahospitalaria atendida por los servicios de emergencias en España: informe 2022 del registro OHSCAR.

SUMMARY: Out-of-hospital cardiac arrest is a serious public health problem worldwide. The annual incidence is estimated at around 400 000 cases in Europe and the United States, and survival rates scarcely reach 10%. However, there is considerable variation between countries and even between regions that share a similar health care system within a single country. Information recorded by the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) provides information on care provided by emergency ambulance services, final health outcomes after cardiac arrest cases (including variations), the possibility of organ donation, and the impact of the COVID-19 pandemic. This paper presents the OHSCAR report for Spanish emergency services for the year 2022.

RESUMEN: La parada cardiorrespiratoria extrahospitalaria (PCREH) es un grave problema de salud pública mundial, con una incidencia anual estimada entorno a entorno a los 350.000 y 400.000 casos de PCERH en Europa y Estados Unidos, respectivamente. La supervivencia final se sitúa en porcentajes que apenas alcanzan el 10%, aunque existe una importante variabilidad entre países e incluso entre regiones del mismo país con modelos de atención similares. En España, el Registro Español de Parada Cardiaca Extrahospitalaria (acrónimo OHSCAR) ha ofrecido información sobre la asistencia a la PCRE prestada por los servicios de emergencias (SEM) y sus resultados finales en salud, así como sobre variabilidad, posibilidades de programas de donación o impacto de la pandemia COVID-19. A continuación se presenta el informe OHSCAR correspondiente a la asistencia a la PCRE por los SEM españoles durante el año 2022.

Out-of-Hospital Cardiac Arrest Following the COVID-19 Pandemic.

Importance: Out-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery. Objective: To determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels. Design, Setting, and Participants: This observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder. Exposure: The pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection. Main Outcome and Measures: The main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance. Results: A total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P < .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P < .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P < .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P < .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P < .001). Conclusions and Relevance: In this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.

Brecha de género persistente en la parada cardiaca extrahospitalaria en España durante el periodo 2013-2018 / Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018

Objetivos. Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España. Método. Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente. Resultados. Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p < 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p < 0,001; OR = 0,63; p <0,001, respectivamente). Conclusiones. En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE. (AU)

Objective. To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. Methods. Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. Results.Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P < .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P < .001 in both series). Conclusions. The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA. (AU)

Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018. / Brecha de género persistente en la parada cardiaca extrahospitalaria en España durante el periodo 2013-2018.

OBJECTIVES: To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. MATERIAL AND METHODS: Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. RESULTS: Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P .001 in both series). CONCLUSION: The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.

OBJETIVO: Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España. METODO: Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente. RESULTADOS: Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p 0,001; OR = 0,63; p 0,001, respectivamente). CONCLUSIONES: En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE.

Gender and Social Inequalities in Awareness of Coronary Artery Disease in European Countries.

Coronary artery disease (CAD) is the single leading cause of death in Europe and the most common form of cardiovascular disease. Little is known about awareness in the European population. A cross-sectional telephone survey of 2609 individuals from six European countries was conducted to gather information on perceptions of CAD, risk factors, preventive measures, knowledge of heart attack symptoms and ability to seek emergency medical care. Level of awareness was compared according to gender, age, socioeconomic status (SES) and educational level. Women were approximately five times less likely than men to consider heart disease as a main health issue or leading cause of death (OR = 0.224, 95% CI: 0.178-0.280, OR = 0.196, 95% CI: 0.171-0.226). Additionally, women were significantly less likely to have ever had a cardiovascular screening test (OR = 0.515, 95% CI: 0.459-0.578). Only 16.3% of men and 15.3% of women were able to spontaneously identify the main symptoms of a heart attack. Almost half of the sample failed to state that they would call emergency services in case of a cardiac event. Significant differences according to age, SES and education were found for many indicators amongst both men and women. Development of a European strategy targeting improved awareness of CAD and reduced gender and social inequalities within the European population is warranted.

Psychometric Properties of the Work Ability Index in Health Centre Workers in Spain.

The aim of the present study is to analyse the psychometric properties of the work ability index (WAI) within a sample of Spanish health centre workers. The WAI was translated into Spanish using transcultural and forward-backward translation processes and administered to 1184 Spanish health centre workers. Internal consistency, predictive validity, and discriminative ability were examined. Exploratory factor analysis, via principal components analysis and confirmatory factor analysis, determined the most appropriate questionnaire structure. All indices in relation to predictive validity and reliability were acceptable. Exploratory factor analysis supported validity of the one-factor structure, however, confirmatory factor analysis suggested better properties in relation to a two-factor structure (χ2 = 59.52; CFI = 0.98; TLI = 0.96; RMSEA = 0.06). Items 3, 4, and 5 loaded onto factor one, and items 1, 2, 6, and 7 loaded onto factor two. The two factors could be broadly described as "subjectively estimated work ability" and "ill-health-related ability". The WAI is valid and reliable when administered to health centre workers in Spain. In contrast to that suggested by studies conducted in other countries, future research and practical application with similar respondents and settings should proceed using the two-factor structure.

Mediational Occupational Risk Factors Pertaining to Work Ability According to Age, Gender and Professional Job Type.

The predictive value of work ability for several health and occupational outcomes is well known. Maintaining the ability to work of all employees has become an important topic in research although some evidence suggests that some groups of workers need greater attention than others. Healthcare workers (x¯ = 54.46 ± 5.64 years) attending routine occupational health checkups completed their work ability, occupational risk and sociodemographic measures. An analysis examined whether work ability differed according to gender, age and professional category. Mediation of these relationships by occupational risk variables, such as work-family conflict, was examined. Females and older adults had worse work ability than their counterparts. Professional group was not independently associated. Gender-related differences were mediated by current and historic ergonomic risk, psychosocial risk and work-family conflict. Age-related differences were mediated by violence/discrimination at work. All job risk variables, apart from current ergonomic risk, mediated associations between professional category and work ability. The present study identified the importance of risk variables for the work ability of health workers according to gender, age and professional job type. Perceptions of work-family conflict and violence-discrimination seem particularly important and should be considered when targeting improvements in work ability.

Influence of the Covid-19 pandemic on out-of-hospital cardiac arrest. A Spanish nationwide prospective cohort study.

AIMS: The influence of the COVID-19 pandemic on attendance to out-of-hospital cardiac arrest (OHCA) has only been described in city or regional settings. The impact of COVID-19 across an entire country with a high infection rate is yet to be explored. METHODS: The study uses data from 8629 cases recorded in two time-series (2017/2018 and 2020) of the Spanish national registry. Data from a non-COVID-19 period and the COVID-19 period (February 1st-April 30th 2020) were compared. During the COVID-19 period, data a further analysis comparing non-pandemic and pandemic weeks (defined according to the WHO declaration on March 11th, 2020) was conducted. The chi-squared analysis examined differences in OHCA attendance and other patient and resuscitation characteristics. Multivariate logistic regression examined survival likelihood to hospital admission and discharge. The multilevel analysis examined the differential effects of regional COVID-19 incidence on these same outcomes. RESULTS: During the COVID-19 period, the incidence of resuscitation attempts declined and survival to hospital admission (OR = 1.72; 95%CI = 1.46-2.04; p < 0.001) and discharge (OR = 1.38; 95%CI = 1.07-1.78; p = 0.013) fell compared to the non-COVID period. This pattern was also observed when comparing non-pandemic weeks and pandemic weeks. COVID-19 incidence impinged significantly upon outcomes regardless of regional variation, with low, medium, and high incidence regions equally affected. CONCLUSIONS: The pandemic, irrespective of its incidence, seems to have particularly impeded the pre-hospital phase of OHCA care. Present findings call for the need to adapt out-of-hospital care for periods of serious infection risk. STUDY REGISTRATION NUMBER: ISRCTN10437835.

Risk of suicide in households threatened with eviction: the role of banks and social support.

BACKGROUND: One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. METHODS: A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services. RESULTS: Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. CONCLUSIONS: To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.

Associations between Home Foreclosure and Health Outcomes in a Spanish City.

The financial crisis has caused an exponential increase of home foreclosures in Spain. Recent studies have shown the effects that foreclosures have on mental and physical health. This study explores these effects on a sample of adults in the city of Granada (Spain), in terms of socio-demographic, socio-economic and process characteristics. A cross-sectional survey was administered to obtain information on self-perceived changes in several indicators of physical and mental health, consumption of medications, health-related behaviors and use of health services. A total of 205 persons, going through a foreclosure process, participated in the study. 85.7% of the sample reported an increase of episodes of anxiety, depression, and stress; 82.6% sleep disturbances; 42.8% worsening of previous chronic conditions, and 40.8% an increase in consumption of medication. Women, married persons and persons already in the legal stage of the foreclosure process reported higher probability of worsening health according to several indicators, in comparison with men, not married, and individuals in the initial stages of the foreclosure process. The results of this study reveal a general deterioration of health associated with the foreclosure process. These results may help to identify factors to prevent poor health among populations going through a foreclosure process.

Post-Traumatic Stress Disorder Symptomatology in People affected by Home Eviction in Spain.

Despite the higher proportion of foreclosures and home evictions executed in Spain, compared to other countries, and the known link between social exclusion and mental health problems, studies exploring this association in Spain remain scarce. This study investigated the link between the process of home eviction and the appearance of symptomatology of post-traumatic stress disorder (PTSD), anxiety, depression, and perceived stress. Two hundred and five people affected by the process of home eviction were assessed using a structured interview that included three validated assessment instruments for PTSD, perceived stress, anxiety and depression. Analysis involved comparison with the normative groups that formed the validation studies together with regression analysis to determine the major psychological and socio-demographic predictors of perceived stress. Of the participants, 95.1% reported that they were experiencing the process of home eviction with fear, helplessness, or horror. In PTSD symptomatology, they scored higher than the normative PTSD group in symptoms of avoidance (t = 5.01; p < .05), activation (t = 5.48; p < .01), and total score (t = 4.15; p < .05). Of this subgroup, 72.5% fulfilled the DSM-IV symptom criteria for PTSD. The major predictor of perceived stress was PTSD symptomatology (B = .09; p < .001). The process of home eviction in Spain is having an alarming impact on mental health of affected people calling for effective measures to provide psychological and social support.

Post-traumatic stress disorder symptomatology in people affected by home eviction in Spain

Despite the higher proportion of foreclosures and home evictions executed in Spain, compared to other countries, and the known link between social exclusion and mental health problems, studies exploring this association in Spain remain scarce. This study investigated the link between the process of home eviction and the appearance of symptomatology of post-traumatic stress disorder (PTSD), anxiety, depression, and perceived stress. Two hundred and five people affected by the process of home eviction were assessed using a structured interview that included three validated assessment instruments for PTSD, perceived stress, anxiety and depression. Analysis involved comparison with the normative groups that formed the validation studies together with regression analysis to determine the major psychological and socio-demographic predictors of perceived stress. Of the participants, 95.1% reported that they were experiencing the process of home eviction with fear, helplessness, or horror. In PTSD symptomatology, they scored higher than the normative PTSD group in symptoms of avoidance (t = 5.01; p < .05), activation (t = 5.48; p < .01), and total score (t = 4.15; p < .05). Of this subgroup, 72.5% fulfilled the DSM-IV symptom criteria for PTSD. The major predictor of perceived stress was PTSD symptomatology (B = .09; p < .001). The process of home eviction in Spain is having an alarming impact on mental health of affected people calling for effective measures to provide psychological and social support (AU)

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Los desahucios y la salud, se necesita una respuesta desde la salud pública en España / Evictions and health, a response from the public health in Spain is needed

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La salud de las personas adultas afectadas por un proceso de desahucio / The health of adults undergoing an eviction process

Objetivo: Analizar el estado de salud percibida, y otros indicadores relacionados con la salud, en personas adultas de Granada que se encuentran en un proceso de desahucio de su vivienda habitual, de alquiler o en propiedad, en comparación con la salud de la población general andaluza. Métodos: Estudio transversal mediante encuesta administrada por personal entrenado que incluye instrumentos de la Encuesta Andaluza de Salud 2011 para la medición de variables de salud física y mental, y de hábitos relacionados con la salud. Se han comparado los resultados con los obtenidos sobre la población general andaluza mediante la Encuesta Andaluza de Salud. Se ha realizado un análisis bivariado utilizando la prueba de ji al cuadrado, y un análisis multivariado mediante regresión logística. Resultados: Se ha obtenido una muestra total de 205 personas en proceso de desahucio. El 59,5% (122) son mujeres y el 40,5% (83) hombres. Presentan una mayor probabilidad de tener una salud deficiente (odds ratio [OR]: 12,63; intervalo de confianza del 95% [IC95%]: 8,74-18,27), enfermedad cardiovascular (OR: 3,08; IC95%:1,54-6,16) o consumir tabaco (OR: 1,68; IC95%: 1,21-2,33), en comparación con la población general andaluza. La mayoría de los indicadores analizados muestran un peor resultado para las mujeres que experimentan un proceso de desahucio. Conclusiones: Nuestros resultados indican que las personas afectadas por un proceso de desahucio en Granada y su área metropolitana, en el actual contexto de crisis, expresan una peor salud en relación a la población general andaluza. Es necesario seguir investigando sobre la salud y los desahucios, desde diferentes aproximaciones metodológicas, para una mejor comprensión de este problema (AU)

Objective: To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia. Methods: A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the ji2 test and a multivariate logistic regression analysis were conducted. Results: We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process. Conclusions: Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic (AU)

[The health of adults undergoing an eviction process]. / La salud de las personas adultas afectadas por un proceso de desahucio.

OBJECTIVE: To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia. METHODS: A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the χ2 test and a multivariate logistic regression analysis were conducted. RESULTS: We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process. CONCLUSIONS: Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic.

[Elaboration of Criteria and Indicators to Develop and Evaluate Programs of Healthy Aging in the Workplace]. / Elaboración de criterios e indicadores para desarrollar y evaluar programas de envejecimiento saludable en los lugares de trabajo.

BACKGROUND: In the actual context of population ageing and extension of working age, programs for health promotion at the workplace are a key and necessary tool to promote an active and healthy ageing. This work presents the methodological process followed to elaborate a checklist tool, within the framework of the European project Progress, that contributes to orientate planning, implementation and evaluation of good practices in this field, to be applicable to a variety of programs, countries and workplaces. METHODS: A Delphi technique has been applied in three rounds in which experts in the area from five European countries participated. A questionnaire created from a list of criteria and indicators was adapted throughout the rounds, with the use of webmail, to the evaluation of interventions in the field of interest. Through processes of assessment and consensus, criteria and indicators most relevant were prioritized. RESULTS: From the nine starting criteria and after the implementation of the technique, four key criteria were prioritized: relevance: 62, adequacy to objective: 57, innovation: 50 and guarantee of quality: 41. Using this group of criteria and indicators, a checklist was designed containing the key information that should be collected for planning, implementation and evaluation of good practices in interventions in this field. CONCLUSIONS: The checklist tool helps to systematize the global methodology for the implementation of interventions which could be very useful for persons responsible of programmes to promote active and healthy ageing in the workplace.

Elaboración de criterios e indicadores para desarrollar y evaluar programas de envejecimientos saludable en los lugares de trabajo / Elaboration of criteria and indicators to develop and evaluate programs of healthy aging in the workplace

Fundamentos: en el actual contexto poblacional de envejecimiento de la población y prolongación de la vida laboral, los programas de promoción de salud en el trabajo son una herramienta clave y necesaria para promover un envejecimiento activo y saludable. El objetivo fue elaborar una herra-mienta tipo lista de verificación para orientar la planificación, implementación y evaluación de buenas prácticas en intervenciones en este ámbito, aplicables a una variedad de programas, países y centros de trabajo. Métodos: se utilizó una técnica Delphi en tres rondas en la que participaron expertos/as de cinco países europeos. Se elaboró un cuestionario en línea a partir de una lista de criterios e indicadores y, empleando el correo electrónico, se trabajó durante las sucesivas rondas en su adaptación a la evaluación de intervenciones. Mediante procesos de valoración y consenso, se priorizaron los criterios e indicadores más relevantes. Resultados: partiendo de nueve criterios basales se priorizaron cuatro criterios clave cuyas puntuaciones medias fueron: relevancia: 62, adecuación al objetivo: 57, innovación: 50 y garantía de calidad: 41. Utilizando esta matriz de criterios e indicadores se diseñó una lista de verificación con la información clave que debe recogerse a la hora de planificar, implementar y evaluar buenas prácticas en las intervenciones. Conclusiones: la lista de verificación ayuda a sistematizar la metodología global de implantación de intervenciones que puede ser utilizada por responsables de los programas para promover el envejecimiento activo y saludable en los centros de trabajo (AU)

Background: in the actual context of population ageing and extension of working age, programs for health promotion at the workplace are a key and necessary tool to promote an active and healthy ageing. This work presents the methodological process followed to elaborate a checklist tool, within the framework of the European project Progress, that contributes to orientate planning, implementation and evaluation of good practices in this field, to be applicable to a variety of programs, countries and workplaces. Methods: a Delphi technique has been applied in three rounds in which experts in the area from five European countries participated. A questionnaire created from a list of criteria and indicators was adapted throughout the rounds, with the use of webmail, to the evaluation of interventions in the field of interest. Through processes of assessment and consensus, criteria and indicators most relevant were prioritized. Results: from the nine starting criteria and after the implementation of the technique, four key criteria were prioritized: relevance: 62, adequacy to objective: 57, innovation: 50 and guarantee of quality: 41. Using this group of criteria and indicators, a checklist was designed containing the key information that should be collected for planning, implementation and evaluation of good practices in interventions in this field. Conclusions: the checklist tool helps to systematize the global methodology for the implementation of interventions which could be very useful for persons responsible of programmes to promote active and healthy ageing in the workplace (AU)

La visión de la ciudadanía sobre la epidemia de gripe H1N1 2009-2010. Un enfoque cualitativo / Public opinions about the 2009/2010 H1N1 pandemic influenza. A qualitative approach

Justificación: La epidemia de gripe H1N1 marcó el mapa sanitario epidemiológico del invierno 2009-2010. Objetivo: Conocer las opiniones de la población general, de los grupos de riesgo y del personal sanitario, sobre la epidemia de gripe. Diseño: cualitativo, estudio exploratorio. Metodología: 10 grupos focales en 3 CCAA, con 51 participantes. Análisis de contenido. Resultados principales: Las actitudes y opiniones de la población general y de los grupos de riesgo evolucionan a lo largo del proceso, desde un estado de preocupación inicial motivado por la sobreinformación y estado de alerta impulsado desde los medios de comunicación, hacia la reducción de la percepción de riesgo, la falta de confianza en las fuentes de información y la necesidad de mayor implicación de las autoridades y fuentes formales. Conclusión: Las autoridades deben apoyarse en sistemas de información avanzados, preparar al personal sanitario, coordinar e implicar a todos los sectores (AU)

Introduction: The H1N1 influenza pandemic of 2009-2010 has important health, social and media repercussions. Objective: to identify the opinions of the general population, risk groups and medical personnel on the 2009-2010 influenza epidemic. Design: Exploratory study, qualitative methodology. Methods: 10 focus groups in 3 Spanish regions with 51 participants. Content analysis. Main results: The attitudes and opinions of the general population and risk groups gradually change from a state of initial concern, caused by the social alert promoted by the media to a reduced perceived risk. The lack of trust in the information sources and the need for a greater involvement of the authorities also appear. Conclusion: The authorities must rely on advanced information systems, train personnel of health services and organize their work on coordination and involvement of all sectors (AU)