Process evaluation of PsyCovidApp, a digital tool for mobile devices aimed at protecting the mental health of healthcare professionals during the COVID-19 pandemic: a mixed method study.

Introduction: PsyCovidApp, a digital intervention aimed at safeguarding the mental health of healthcare workers during the COVID-19 pandemic, demonstrated in a randomized clinical trial to yield significant improvements solely among healthcare workers undergoing psychotherapy or receiving psychotropic medication. Objectives: (1) To identify contextual factors and mechanisms of action that influenced the impact of PsyCovidApp during the aforementioned trial; (2) To pinpoint enhancements for optimizing its efficacy. Materials and methods: For the first objective, a process evaluation was conducted, amalgamating quantitative techniques (surveying 216 healthcare professionals who had utilized PsyCovidApp during the trial) and qualitative methods (in-depth interviews with 16 healthcare workers). The second objective involved a panel of seven experts, utilizing the RAND-UCLA methodology. Results: The quantitative study (response rate = 40%) revealed that 22% of respondents had not fully accessed the content of PsyCovidApp. The average usage time was 22.7 min/day, being higher (p < 0.05) among consumers of psychotropic medications. Contents related to relaxation and mindfulness were most highly rated. Acceptability and usefulness scores ranged between 7.3-7.5/10 points, with higher ratings (p < 0.05) among women and older healthcare workers. The qualitative study uncovered that the primary barriers to using PsyCovidApp were workload, lack of time, and exhaustion. Its primary mechanisms of action included emotion identification, mental health regulation (e.g., insomnia, intense emotions), and learning of techniques and skills. The expert panel reached a consensus on 29 proposals to optimize PsyCovidApp. Conclusion: The knowledge derived from this study could inform the design and implementation of future similar digital tools.

Cyber sexual harassment against women and impact on health. A cross-sectional study in a representative population sample.

BACKGROUND: This study focuses on the frequency of cyber sexual harassment (CSH) and examines its link with five health impact indicators (self-perceived health, medication, suicidal ideation, suicide attempts and use of health services). METHODS: Analyzing the data provided by the 2019 Macro-survey on violence against women in Spain, two items of which refer to CSH. It was conducted in Spain on a representative sample of 9568 women aged over 16 years old. RESULTS: A total of 9.15% of the women surveyed had experienced CSH at some point in their lives. Being under 25 years old, having higher education, not being in a relationship, having no religious beliefs and having a certified disability are sociodemographic characteristics associated with a higher risk of CSH. Women who have experienced other forms of gender-based violence also show an increased risk. Female victims of CSH reported higher rates of suicidal ideation (20% versus 9.79% in non-victims of CSH) and suicidal attempts (7.20% versus 1.74% in non-victims of CSH). CONCLUSIONS: These findings have significant implications for the design of preventive health polices, which should incorporate strategies to address CSH as part of the continuum of multiple interrelated forms of gender violence that affect women and girls throughout their lives.

[Barriers and proposals for a health care approach to trafficking for sexual exploitation]. / Barreras y propuestas para el abordaje sanitario de la trata con fines de explotación sexual.

OBJECTIVE: To examine the perception of the trafficking in women for sexual exploitation, identify the difficulties and collect the proposals of professionals in direct contact with the victims of trafficking in women for sexual exploitation in Andalusia (Spain). METHOD: Qualitative study based on interviews with 10 key informants, selected from organizations providing support and care to victims of trafficking in women for sexual exploitation in 2021. Two researchers carried out a thematic categorical content analysis, integrative and relational analysis. Three themes with different sub-themes were analyzed. RESULTS: Difficulties have been identified in relation to women (delay in recognizing themselves as victims, cultural differences, distrust of the system), traffickers (modification of strategies), health professionals (lack of sensitivity and lack of homogeneity in actions) and the health system (lack of cultural intermediation, administrative complexity). The key informants propose more training for professionals, the use of effective action protocols and better coordination between institutions. CONCLUSIONS: The health sector faces a number of challenges in responding comprehensively and effectively to trafficking in women for sexual exploitation. Improvements are needed in raising awareness among health professionals, the development of standardized protocols, greater collaboration between sectors, the provision of specialized mental health services and effective cultural mediation.

Characteristics and effectiveness of interventions to reduce cyberbullying: a systematic review.

Background: This paper presents the results from a systematic review on the effectiveness of interventions to reduce Cyberbullying (CB) as a function of their outcomes and main characteristics; and an analysis of the level of completeness to which the characteristics of these interventions are described. Methods: Systematic searches were conducted in PubMed, Scopus, ERIC and Psycinfo databases on February 14, 2022. In addition, relevant publications were hand searched for relevant studies. We considered interventions that provided data on CB prevalence changes in populations between primary school and college age. Results: In total, 111 studies were retained for further screening from 3,477 results. Following rigorous screening, 43 reports including 46 studies and information from 36 different interventions were included in our systematic review. Results shows that most of the interventions measuring reductions in global CB, cyberperpetration/victimization, cybervictimization and cyberperpetration were effective or partially effective. While the interventions measuring reductions in cyber-bystanding were not effective. Multicomponent interventions showed higher effectiveness than single-component interventions. After completion of the TIDieR check-list, included interventions were considered to offer an insufficient level of detail for a number of the analyzed items in relation to "how well planned," "intervention modifications" and "tailoring." Conclusion: Given the aforementioned, it is critical to increase the number of studies and the quality of interventions targeting CB and the level of detail of its description in order to obtain more robust outcomes about how to reduce its prevalence and facilitate the replication of the effective interventions. Systematic review registration: https://archive.org/details/osf-registrations-wn5u4-v1, Identifer DOI: 10.17605/OSF.IO/WN5U4.

New Patients in Treatment for Opioid Addiction in Spain.

Introduction: Patients seeking first time treatment for opioid consumption reflect the characteristics of the consumer population. This group has not been studied in Spain in decades. The objective of this study was to characterize the opioid user population seeking first time treatment (incidents) and compare them group with those with prior treatment (prevalents). Methods: Cross-sectional study (N = 3325) with patients with opioid addiction seeking care at public addiction centers in the Community of Madrid from 2017 through 2019. Differentiation and comparisons were carried out using bivariate analysis, adjusted by sociodemographic characteristics related and those related to substance use consumption in incident and prevalent patients. Results: About 12.2% were incidents. Compared to prevalents, there were more foreigners (34.1% vs 19.1% P < .001), but with a better social network. Regarding opioid use, incidents were less likely to use injection (10.7% compared to 16.8% P = .008), but had greater daily frequency (75.8% vs 52.2%, P < .001). The age of initial consumption was greater (27 years vs 21.3 years, (P < .001)). About 15.5% of incidents sought care for non-heroin opioids, compared to 4.8% of prevalents (P < .001). Women sought care at twice the rate of men (29.3% vs 12.3%; P > .001). Discussion: New patients presented a profile with many stable characteristics, but which highlighted an increase in the use of other opioids, as occurs in the international context. Surveillance of the new patient characteristics can serve as an early indicator of consumption changes in. Thus, periodic monitoring is important.

Corrigendum: "You knew you had to be there, it had to be done": experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain.

[This corrects the article DOI: 10.3389/fpubh.2023.1089565.].

Cuidados paliativos y desigualdades sociales en cáncer. Una revisión narrativa de la literatura / Palliative care and social inequalities in cancer. A narrative literature review

Objetivos: a) Hacer una propuesta de agrupación y clasificación de los diversos abordajes que se recogen en la literatura para analizar el acceso y la utilización de los cuidados paliativos en pacientes con diagnóstico de cáncer avanzado, y b) revisar las desigualdades sociales que se han abordado en la literatura con relación a los cuidados paliativos en estos pacientes. Métodos: Revisión narrativa utilizando las bases de datos Embase, CINAHL y PubMed hasta noviembre de 2022. Resultados: Se realizó cribado por título y abstract de los 2666 estudios recuperados y lectura completa de los artículos incluidos para la extracción de datos. Se detectaron 5 temas principales de los diferentes abordajes en relación con el acceso y uso de los cuidados paliativos: a) control de síntomas, b) adecuación y calidad de los cuidados, c) atención paliativa oportuna, d) planificación de los cuidados y e) lugar de fallecimiento. Las personas mayores, hombres, pertenecientes a minorías étnicas, de bajo nivel socioeconómico y residentes en áreas rurales tienen menos posibilidades de acceder a los cuidados paliativos para aliviar el dolor y el sufrimiento producidos durante la enfermedad oncológica y al final de la vida. Conclusiones: Los cuidados paliativos se consideran un componente esencial para poder proporcionar una atención integral durante el continuo de la enfermedad oncológica. Sin embargo, a pesar de existir evidencia científica que recomienda la aplicación de los cuidados paliativos desde el diagnóstico de la enfermedad, edad, sexo, etnia/raza, nivel socioeconómico y residencia crean inequidad en el acceso y la utilización de los cuidados paliativos en pacientes con cáncer avanzado, produciendo grupos de mayor vulnerabilidad estructural. (AU)

Objectives: To conduct a broad literature review in order to: a) propose a grouping and a classification of the different approaches described in the literature to analyse the access and use of palliative care in advanced cancer patients, and b) review the social inequalities examined in the literature in relation to the access to and use of palliative care in advanced cancer patients. Methods: A narrative review using the Embase, CINAHL, and PubMed databases until November 2022. Results: A total of 2,666 articles were retrieved and screened by title and abstract, with included studies read in full for data extraction. Five main themes of the different approaches were identified in relation to access to and use of palliative care: a) symptom management, b) adequacy and quality of care, c) appropriate palliative care, d) advance care planning, and e) place of death. Older people, men, from a minority ethnic group, of low socioeconomic status, and residing in rural areas are less likely to have access to palliative care to relieve the pain and suffering produced by cancer disease and at the end of life. Conclusions: Palliative care is considered an essential component of comprehensive care all along the cancer disease continuum. However, despite the existence of scientific evidence to recommend the integration of palliative care from diagnosis, age, sex, ethnicity, socioeconomic level and residence create inequity in the access to and use of palliative care in patients with advanced cancer, producing groups of greater structural vulnerability. (AU)

"You knew you had to be there, it had to be done": Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain.

Introduction: The COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned. Methods: We carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi's 7-step data analysis method. Results: During the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic. Conclusion: In the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemic.

Relationship between Sexual Violence and the Health of Spanish Women-A National Population-Based Study.

BACKGROUND: Health consequences are likely to be different when sexual violence is analysed independently from other types of violence. It is also likely that different health consequences will result in the cases of partner or ex-partner sexual violence, non-partner sexual violence and sexual harassment. METHODS: This study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality on a sample of 9568 women aged 16 years or older. Odds ratios were calculated, and multinomial logistic regression analyses were performed. RESULTS: The present study estimates that 4 out of 10 surveyed women had experienced some form of sexual violence in their lifetime. Sexual harassment is the most frequently reported form of this violence, while intimate partner sexual violence is the form with the most unfavourable sociodemographic characteristics and the worst health impact indicators, such as a greater likelihood of suicidal behaviour. CONCLUSIONS: Sexual violence is a widespread, under-studied problem with negative health impacts. Women exposed to intimate partner violence are the most vulnerable and at risk. It is advised that responses and comprehensive care plans be developed that place special emphasis on the protection of victims' mental health.

The prevalence of intimate partner violence against women with disabilities: a systematic review of the literature.

PURPOSE: Although systematic reviews have already been conducted on violence and disability, the evidence is not conclusive in Intimate Partner Violence (IPV). This study examined the prevalence of IPV in women with disabilities, taking account of the different types of violence and disability. METHODS: We performed a search in five databases. We included observational studies that analysed the frequency of IPV in women with disabilities compared to women without. Two independent reviewers selected and assessed studies. We made a qualitative synthesis according to the type of IPV analysed in relation to disability. RESULTS: We identified 26 articles. The frequency and risk of IPV were greater in women with disabilities than in those without. All of the articles that studied financial violence, 81.3% of those that studied physical violence, 78.5% of those that studied psychological violence, 75% of those that studied physical/sexual violence, 73.3% of those that studied sexual violence and 50% of those that studied any type of violence found a significant association whit disability. CONCLUSIONS: Women with disabilities are at higher risk of IPV. Rehabilitation centers and its professionals must have a leading role in the identification of these situations and this should be considered in IPV prevention plans.Implications for rehabilitationPeople with disabilities are at higher risk of multiple types of violence.Violence against women with disabilities therefore involves two public health issues interacting simultaneously.Rehabilitation centers and its professionals should have a leading role in the identification of IPV in women with disabilities.IPV prevention plans should consider rehabilitation centers and its professionals as a main component of interventions in women with disabilities.

Barreras y propuestas para el abordaje sanitario de la trata con fines de explotación sexual / Barriers and proposals for a health care approach to trafficking for sexual exploitation

Objetivo: Explorar la percepción de la trata de mujeres con fines de explotación sexual, identificar las dificultades y recoger las propuestas de profesionales en contacto directo con las víctimas en Andalucía. Método: Estudio cualitativo basado en entrevistas a 10 informantes clave seleccionados en entidades de apoyo y atención a víctimas de trata de mujeres con fines de explotación sexual en 2021. Dos investigadoras llevaron a cabo un análisis de contenido categórico temático. Se analizaron tres temas con diferentes subtemas. Resultados: Se han identificado dificultades relacionadas con las mujeres (tardan en reconocerse como víctimas, diferencias culturales, desconfianza en el sistema), con los traficantes (modificación de estrategias), con profesionales de la salud (falta de sensibilidad y poca homogeneidad en las actuaciones) y con el sistema sanitario (ausencia de intermediación cultural, complejidad administrativa). Las personas informantes clave proponen una mayor capacitación de profesionales, el empleo de protocolos de actuación efectivos y una mejor coordinación entre instituciones. Conclusiones: El sector sanitario enfrenta diversos desafíos para dar una respuesta integral y efectiva a la trata de mujeres con fines de explotación sexual. Se requieren mejoras en la sensibilización de profesionales de la salud, el desarrollo de protocolos estandarizados, una mayor colaboración entre sectores, la provisión de servicios especializados en salud mental y una mediación cultural eficaz.(AU)

Objective: To examine the perception of the trafficking in women for sexual exploitation, identify the difficulties and collect the proposals of professionals in direct contact with the victims of trafficking in women for sexual exploitation in Andalusia (Spain). Method: Qualitative study based on interviews with 10 key informants, selected from organizations providing support and care to victims of trafficking in women for sexual exploitation in 2021. Two researchers carried out a thematic categorical content analysis, integrative and relational analysis. Three themes with different sub-themes were analyzed. Results: Difficulties have been identified in relation to women (delay in recognizing themselves as victims, cultural differences, distrust of the system), traffickers (modification of strategies), health professionals (lack of sensitivity and lack of homogeneity in actions) and the health system (lack of cultural intermediation, administrative complexity). The key informants propose more training for professionals, the use of effective action protocols and better coordination between institutions. Conclusions: The health sector faces a number of challenges in responding comprehensively and effectively to trafficking in women for sexual exploitation. Improvements are needed in raising awareness among health professionals, the development of standardized protocols, greater collaboration between sectors, the provision of specialized mental health services and effective cultural mediation.(AU)

Characterization of Cyberbullying Victimization and Perpetration Before and During the COVID-19 Pandemic in Spain.

Cyberbullying is an extremely damaging form of interpersonal violence. Little is yet known about cyberbullying behaviors in the child and youth population during the COVID-19 pandemic and what effect this reduction in face-to-face social interactions has had on an increase in socialization via the Internet and cyberbullying. The present study is a cross-sectional descriptive study conducted in young people between the ages of 12 and 27 years attending two secondary schools in southern Spain (N = 733) to examine differences regarding sociodemographic characteristics, academic performance, and digital device use (independent variables) in the experiences of cybervictimization, cyberperpetration, and adverse psychological effects (dependent variables). Logistic regression models were constructed for each of the dependent variables including the independent variables mentioned above. More than 50 percent of the sample were victims of cyberbullying. Females and the LGBTIQ+ Community were at greater risk of being cybervictims and suffer adverse psychological effects. A total of 22.8 percent of the students reported having been victims and 26.5 percent perpetrators of cyberbullying for the first time during the COVID-19 pandemic, but no other major differences were observed. These findings point out that cyberbullying must be prioritized in public policy as part of an overall strategy for combating violence in childhood and adolescence, as well as gender-based and discriminatory violence.

Frequency, Types, and Manifestations of Partner Sexual Violence, Non-Partner Sexual Violence and Sexual Harassment: A Population Study in Spain.

BACKGROUND: This study analyzes the frequency and sociodemographic characteristics associated with sexual violence by a partner/ex-partner (PSV), someone other than a partner or ex-partner (NPSV), or sexual harassment (SH). METHODS: The study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality among a sample of 9568 women age 16 or more years. Odds Ratios were calculated and multinomial logistic regression analyses were performed. RESULTS: Forty-four women had suffered some kind of sexual violence over their lifetime, 9.2% had experienced PSV, 6.5% NPSV and 40.4% SH. More than 7% of women had been raped by a partner and 2.2% by another man. In the three groups, violence was associated with lower age and having a certified disability. NPSV and SH were significantly associated with a higher education and internet use. In NPSV, 9.2% of cases were reported to the police and 3.9% were reported to the courts. In SH, 91.7% of women told a family member or a close friend and 4.2% reported it to the police or the courts. CONCLUSIONS: A greater emphasis needs to be placed on reporting sexual violence in its various forms. Rape within intimate partnerships ought to be investigated and studied in greater depth.

Cyberbullying and Associated Factors in Member Countries of the European Union: A Systematic Review and Meta-Analysis of Studies with Representative Population Samples.

The aim of this study is to conduct a systematic review and meta-analysis to summarise the current state of empirical research and establish an up-to-date estimate of the prevalence of cyberbullying through the gathering of self-reported experiences from representative population samples from EU countries. Bibliographic searches were conducted on main electronic databases for studies until November 2021. We considered observational studies that provided data on cyberbullying prevalence and/or associated factors. Seven studies with data from 25 countries were included. Rates ranged between 2.8-31.5% for cybervictimization, between 3.0-30.6% for cyberperpetration, and between 13.0-53.1% for cyberbystanding. The rate of cybervictimization perpetration was 4%. Meta-analysis-pooled prevalence showed rates of 9.62% and 11.91% for cybervictimization and cyberperpetration, respectively. Given the large variation in the rates seen between the different examined studies, in addition to the increase over recent years in the prevalence rates of the different examined dimensions of cyberbullying, it would be useful to deepen research into the causes of these differences and the factors associated with each of the dimensions. This should be performed through populational surveys which enable the collection of a greater quantity of more consistent information with a view to designing prevention and intervention CB programs that are targeted and adapted towards the characteristics of the target population.

Feasibility of the SINERGIAPS ("Sinergias entre profesionales y pacientes para una Atención Primaria Segura") intervention for improving patient safety in primary care.

AIM: The primary aim was to examine the feasibility of intervention delivery and of trial procedures. Secondary aims were to study the intervention uptake; its acceptability and perceived utility; and its potential to improve safety culture and avoidable hospital admissions. METHODS: We conducted a 3-month, single-arm feasibility study in 10 primary care (PC) centres in Spain. Centres received information regarding patients' experiences of safety (through the Patient Reported Experiences and Outcomes of Safety in Primary Care [PREOS-PC] questionnaire), and were instructed to plan safety improvements based on that feedback. We used a bespoke online tool to recruit PC professionals, collect patient feedback, and deliver it to the centres, and to collect outcome data (patient safety culture [Medical Office Survey on Patient Safety Culture, MOSPSC questionnaire]). We measured recruitment and follow-up rates and intervention uptake (based on the number of safety improvement plans registered). We conducted semistructured interviews with 9 professionals to explore the intervention acceptability and perceived utility. RESULTS: Of 256 professionals invited, 120 (47%) agreed to participate, and 97 completed baseline and postintervention measures. Of 780 patients invited, 585 (75%) completed the PREOS-PC questionnaire. Five of 10 centres (50%) designed an improvement plan, providing 27 plans in total (range per centre, 1-14). The intervention was perceived as a novel strategy for improving safety, although the healthcare professionals identified several factors limiting its acceptability and utility: lack of feedback at the individual professional level; potentially unrepresentative sample of patients providing feedback; and number of educational materials deemed overwhelming. DISCUSSION: It is feasible to deliver the proposed intervention so long as the identified limitations are addressed.

Medidas de contención de la violencia de género durante la pandemia de COVID-19 / Measures to contain gender-based violence during the COVID-19 pandemic

Las crisis, las emergencias y las épocas de disturbios se han relacionado con un aumento de la violencia interpersonal, incluida la violencia hacia las mujeres. A raíz de la declaración de estado de alarma y confinamiento se han puesto en marcha nuevas medidas encaminadas a paliar el posible impacto de la violencia de género (Plan de Contingencia contra la violencia de género ante la crisis del coronavirus o Real Decreto-Ley de medidas urgentes). Se revisan en este documento las medidas de contención adoptadas hasta el momento por el gobierno de España y las comunidades autónomas, y las iniciativas formuladas en diferentes países. Ante la ausencia de medidas económicas concretas planteadas hasta la fecha y el escenario de incertidumbre económica concluimos que no es posible prevenir la violencia de género de manera integral sin considerar el aumento del desempleo, la temporalidad y la inestabilidad laboral, la dependencia económica o la sobrecarga de tareas reproductivas, entre otros elementos que la facilitan. (AU)

Crises, emergencies and times of unrest have been linked to increased interpersonal violence, including violence against women. Following the declaration of alarm status and quarantine, different measures have been implemented to mitigate the possible effect of gender violence (Contingency Plan against Gender-Based Violence in Coronavirus Crisis or Royal Decree Law on Emergency Measures). This document reviews the measures adopted so far by the government of Spain, the autonomous governments and the initiatives formulated in different countries. In the absence of concrete economic measures to date, and the scenario of economic uncertainty, we conclude that it is not possible to prevent gender-based violence in a comprehensive way, without considering the increase in unemployment, temporary and instability employment, economic dependency or the overload of household chores and reproductive tasks, among other elements that facilitate it. (AU)

Changes in Employment Situation and Macroeconomic Indicators Linked to Mental Health Following the Recession in Spain: A Multi-level Approach.

BACKGROUND: Periods of financial crisis are associated with higher psychological stress in the population and greater use of mental health services. This paper analyses the individual and contextual factors associated with mental health in the Spanish population in 2006, 2012 and 2017. METHOD: This was a cross-sectional, descriptive study at three timepoints: before (2006), during (2012) and after the recession (2017). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. Dependent variable: psychiatric morbidity (PM). INDEPENDENT VARIABLES: 1) Individual socio-economic variables: (socio-demographic and psycho-social variables) and 2) contextual socio-economic variables (financial, public welfare services and labour market indicators). Multilevel logistic regression models with mixed effects were constructed to determine changes in PM in relation to the variables studied. RESULTS: Among women, the risk of PM increased when per capita health spending decreased and the percentage of temporary workers increased. The risk for men and women was lower when the employment rate decreased and the unemployment rate increased. CONCLUSIONS: It is possible that not only unemployment but also insecure employment entails a risk to mental health and that much of the employment created no longer guarantees basic levels of security it had achieved in previous decades.

A Mobile Phone-Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial.

BACKGROUND: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. OBJECTIVE: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. METHODS: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. RESULTS: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference -0.04; 95% CI -0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (-0.29; 95% CI -0.48 to -0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (-0.25; 95% CI -0.49 to -0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. CONCLUSIONS: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. TRIAL REGISTRATION: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818.

Effect of a mobile-based intervention on mental health in frontline healthcare workers against COVID-19: Protocol for a randomized controlled trial.

AIM: To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness-based approaches on the mental health of healthcare workers at the frontline against COVID-19 in Spain. DESIGN: We will carry out a two-week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention. METHODS: The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID-19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS-21 questionnaire-primary endpoint), insomnia (ISI), burnout (MBI-HSS), post-traumatic stress disorder (DTS), and self-efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation. DISCUSSION: Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context. IMPACT: Despite the lack of solid evidence about their effectiveness, mobile-based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits. CLINICAL TRIAL REGISTRATION: NCT04393818 (ClinicalTrials.gov identifier). APPROVED FUNDING: May 2020.

[Measures to contain gender-based violence during the COVID-19 pandemic]. / Medidas de contención de la violencia de género durante la pandemia de COVID-19.

Crises, emergencies and times of unrest have been linked to increased interpersonal violence, including violence against women. Following the declaration of alarm status and quarantine, different measures have been implemented to mitigate the possible effect of gender violence (Contingency Plan against Gender-Based Violence in Coronavirus Crisis or Royal Decree Law on Emergency Measures). This document reviews the measures adopted so far by the government of Spain, the autonomous governments and the initiatives formulated in different countries. In the absence of concrete economic measures to date, and the scenario of economic uncertainty, we conclude that it is not possible to prevent gender-based violence in a comprehensive way, without considering the increase in unemployment, temporary and instability employment, economic dependency or the overload of household chores and reproductive tasks, among other elements that facilitate it.