Correlation between tobacco control policies and tobacco prevention in Mexico: a sub-national analysis.

This study aims to determinate the correlation between tobacco control policies (TCP) and the prevalence of tobacco use in the 32 Mexican states during the 2016-2017 period. This is an ecological study that measured TCP by the Tobacco Control Scale (TCS) which assigns a score (0-100) based on the level of these component's implementation: price, prohibition in public spaces, expenditures of public information campaigns, publicity prohibitions, health warnings, and treatments. We analyzed the associations between the TCS scores and prevalence of tobacco use extracted from the National Survey of Drug, Alcohol and Tobacco Consumption using Spearman correlations. Prevalence of daily smokers is negatively correlated with global TCS scores for adolescents (p = 0.026). Price showed similar negative correlations with daily prevalence in adolescents (p = 0.003), adults (p = 0.040), men (p < 0.006), and women (p = 0.040). Many Mexican states need to improve on tobacco control policies, especially targeting a key population: adolescents.

El uso diario de la profilaxis preexposición para el VIH en hombres gais, bisexuales y otros hombres que tienen sexo con hombres en España: prevalencia y factores asociados / Daily use of HIV pre-exposure prophylaxis among gay, bisexual and other men who have sex with men in Spain: Prevalence and associated factors

Objetivo: Estimar la prevalencia de uso diario de profilaxis preexposición (PrEP) frente al VIH 6 meses después de aprobarse su financiación pública en España e identificar los factores asociados en una muestra nacional de hombres gais, bisexuales y otros hombres que tienen sexo con hombres (GBHSH). Material y métodos: Se analizaron 4.692 hombres GBHSH no diagnosticados de VIH reclutados mediante un cuestionario online difundido a nivel nacional a través de apps y webs de contacto gay entre mayo y julio de 2020. Se estimó la proporción de participantes que usaban PrEP diaria y se identificaron factores asociados mediante regresión de Poisson con variancia robusta. Resultados: El 2,8% (IC 95% 2,3-3,3) de los participantes refirió usar PrEP diariamente. El uso diario de PrEP se asoció de forma independiente con: haber sido reclutado en programas comunitarios, ser mayor de 30 años, residir en grandes ciudades, vivir abiertamente su vida sexual con hombres, haber tenido relaciones anales sin preservativo con más de 10 parejas sexuales, haber consumido drogas para sexo, especialmente drogas chemsex, y haber sido diagnosticado de alguna infección de transmisión sexual. Conclusión: Transcurridos 6 meses desde la aprobación de la PrEP en España, se observa una baja prevalencia de uso diario en una muestra nacional de hombres GBHSH. Es necesario promover el acceso, la demanda y el interés por la PrEP, especialmente entre los hombres GBHSH jóvenes, residentes en ciudades pequeñas y medianas y los que ocultan sus relaciones con otros hombres.(AU)

Objective: We aim to estimate the prevalence of daily HIV pre-exposure prophylaxis (PrEP) use 6 months after public funding approval in Spain and identify associated factors in a national sample of gay, bisexual and other men who have sex with men (GBMSM). Material and methods: We analysed 4692 HIV-undiagnosed GBMSM men recruited via an online questionnaire distributed nationally via gay contact apps and websites between May and July 2020. We estimated the proportion of participants using daily PrEP and identified associated factors using Poisson regression with robust variance. Results: Daily PrEP use was reported by 2.8% (95% CI 2.3-3.3) of all participants. Daily PrEP use was independently associated with being recruited into community programmes, being older than 30 years, living in a large city, living with men, having condomless anal intercourse with more than 10 sexual partners, using drugs for sex, especially chemsex drugs, and being diagnosed with a sexually transmitted infection. Conclusion: Six months after PrEP was approved in Spain, the prevalence of daily use is low in a national sample of GBMSM men. There is a need to promote access, demand and interest in PrEP, especially among young GBMSM men, those living in small and medium-sized cities, and those who hide their relationships with other men.(AU)

Daily use of HIV pre-exposure prophylaxis among gay, bisexual and other men who have sex with men in Spain: Prevalence and associated factors. / El uso diario de la profilaxis preexposición para el VIH en hombres gais, bisexuales y otros hombres que tienen sexo con hombres en España: prevalencia y factores asociados.

OBJECTIVE: We aim to estimate the prevalence of daily HIV pre-exposure prophylaxis (PrEP) use 6 months after public funding approval in Spain and identify associated factors in a national sample of gay, bisexual and other men who have sex with men (GBMSM). MATERIAL AND METHODS: We analysed 4692 HIV-undiagnosed GBMSM men recruited via an online questionnaire distributed nationally via gay contact apps and websites between May and July 2020. We estimated the proportion of participants using daily PrEP and identified associated factors using Poisson regression with robust variance. RESULTS: Daily PrEP use was reported by 2.8% (95% CI 2.3-3.3) of all participants. Daily PrEP use was independently associated with being recruited into community programmes, being older than 30 years, living in a large city, living with men, having condomless anal intercourse with more than 10 sexual partners, using drugs for sex, especially chemsex drugs, and being diagnosed with a sexually transmitted infection. CONCLUSION: Six months after PrEP was approved in Spain, the prevalence of daily use is low in a national sample of GBMSM men. There is a need to promote access, demand and interest in PrEP, especially among young GBMSM men, those living in small and medium-sized cities, and those who hide their relationships with other men.

Association between severity of symptoms and minimum mental health treatment duration in humanitarian contexts: a retrospective observational study.

Background: Understanding and optimising mental health and psychosocial support (MHPSS) interventions in humanitarian crises is crucial, particularly for the most prevalent mental health conditions in conflict settings: anxiety, depression, and post-traumatic stress disorder. However, research on what is the most appropriate length of psychological intervention is lacking in this setting. We aimed to establish which factors are most closely related to improvement and to determine the required number of consultations needed to achieve this improvement. Methods: We retrospectively analysed records from 9028 patients allocated to treatment for anxiety, depression, and post-traumatic symptoms from the MHPSS programme in Borno State, Nigeria, from January 2018 to December 2019. Patient characteristics, severity (Clinical Global Impression of Severity Scale, CGI-S scale), and clinical improvement were assessed by an attending counsellor (CGI-I scale) and by the patient (Mental Health Global State, MHGS scale). Improvement was defined as scores 1, 2, and 3 in the Clinical Global Impression of Improvement (CGI-I) scale, and as a decrease of at least 4 points in the MHGS scale. We investigated the associations between the category of symptoms, the severity of illness, and improvement of symptoms using multivariable logistic regression. We used Kaplan-Meier (KM) curves to assess the number of consultations (i.e., time of treatment) needed to achieve improvement of symptoms, by symptom category and symptom severity. Findings: The patients included were referred to treatment for anxiety (n = 3462), depression (n = 3970), or post-traumatic symptoms (n = 1596). Median age was 31 years (range 16-103), and 84.3% were female. Patients categorised as severe were less likely to present improvement according to the CGI-I scale (OR 0.11, 95% CI 0.05-0.25), while none of the other categories of symptoms showed significant results. Overall, three or more consultations were associated with improvement in both scales (OR 3.55, 95% CI 1.47-8.57 for CGI-I; and OR 3.04, 95% CI 2.36-3.90 for MHGS). KM curves for the category of symptoms showed that around 90% of patients with anxiety, depression, or post-traumatic symptoms, as well as those with mild or moderate severity, presented improvement after three consultations, compared with six consultations for those with severe symptoms. Interpretation: Classification by severity among patients with anxiety, depression, or post-traumatic symptoms could predict the probability of improvement, whereas classification by symptoms could not. Our study highlights the importance of classifying patient severity in MHPSS programmes to plan and implement the appropriate duration of care. A major limitation was the number of patients lost to follow up after the first consultation and excluded from the logistic regression and KM analysis. Funding: The study was funded and staffed entirely by Médicos Sin Fronteras (Médecins Sans Frontières), Spain.

[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.

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.

Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study.

BACKGROUND: Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal or illegal). OBJECTIVE: This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulness as a surveillance tool. METHODS: This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish general population. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agency in daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeine and tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deaths registered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute, derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be those that indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidental poisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning of undetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORM and DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatment tier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19. RESULTS: The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006 and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year, although not statistically significant (all P≥.05). CONCLUSIONS: There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-related deaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in the illegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongest opioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that not only is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths.

Increase in educational inequalities in alcohol-related mortality in Spain during a period of economic growth.

BACKGROUND AND AIMS: Alcohol-related mortality risk is almost always greater in lower than higher socio-economic positions (SEPs). There is little information on the evolution of this SEP gradient and its relationship with the economic cycle. Some results suggest that during economic expansions, there is a hypersensitivity of low-SEP people to harmful drinking. The main objective of this study was to measure the evolution of educational inequality in alcohol-related and non-alcohol related mortality by sex and age group in Spain during 2012-19. DESIGN, SETTING AND MEASUREMENTS: This is a repeated cross-sectional study. This study includes all residents in Spain aged 25 years and over from 2012 to 2019. (1) We calculated age-standardized mortality rates (ASMRs) from strongly/moderately alcohol-related causes (directly alcohol-attributable, unspecified liver cirrhosis, liver and upper aerodigestive tract cancers and moderately alcohol-related), weakly alcohol-related causes and other causes by educational level. (2) We used age-adjusted relative index of inequality (RII) and slope index of inequality (SII) to measure relative and absolute educational inequality in mortality, respectively. (3) Age-adjusted annual percentage change (APC) was also used to measure linear trends in mortality by educational level. RII, SII and APC were obtained from negative binomial regression. FINDINGS: Between 2012-15 and 2016-19, economic growth accelerated, the RII in mortality from strongly/moderately alcohol-related causes increased from 2.0 to 2.2 among men and from 1.1 to 1.3 among women, and the SII in deaths/100 000 person-years from 181.4 to 190.9 among men and from 18.9 to 46.5 among women. It also increased relative and absolute inequality in mortality from weakly alcohol-related and other causes of death in both men and women. These increases in inequality were due primarily to a flattening or even reversal of the downward mortality trend among low- and medium-educated people. CONCLUSIONS: During the economic expansion of 2012-19 in Spain, changes in mortality risk from strongly/moderately alcohol-related causes were especially unfavourable among low- and medium-educated people.

Preventive Gambling Programs for Adolescents and Young Adults: A Systematic Review.

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

Methodology used to estimate alcohol-attributable mortality in Spain, 2001-2017. / Metodología utilizada para estimar la mortalidad atribuible a alcohol en España, 2001-2017.

The objective is to describe and discuss methods and assumptions to estimate the mortality attributable to alcohol in Spain in 2001-2017. The annual mean number of deaths attributable to alcohol (DAAs) was estimated based on 19 groups of alcohol-related causes of death (18 partially attributable and one directly attributable), and 20 alcohol population-attributable fractions (PAFs), resulting from combining sex, 5 age groups, and the periods 2001-2009 and 2010-2017, for each cause group. Deaths from causes were obtained from the Spanish National Institute of Statistics. For partially attributable causes, Spain-specific PAFs were calculated using the Levin formula with alcohol exposure data from health surveys and sales statistics, and relative risks from international meta-analyses. Annual prevalences of ex-drinkers and seven levels of daily alcohol consumption were considered. The underestimation of self-reported daily average consumption with respect to the sales statistics was corrected by multiplying by a factor of 1.58-3.18, depending on the calendar year. DAA rates standardized by age and standardized proportions of general mortality attributable to alcohol, according to sex, age group, calendar period, type of drinker and autonomous community were calculated. Sensitivity analyses were performed to assess how the DAA estimates changed when changing some methodological options, such as the ex-drinker criterion or the introduction of a latency period.

El objetivo es describir y discutir los métodos y asunciones para estimar la mortalidad atribuible a alcohol en España en 2001-2017. Se estimó el nº medio anual de muertes atribuibles a alcohol (MAAs) basándose en 19 grupos de causas de muerte relacionadas con alcohol (18 parcialmente atribuibles y uno directamente atribuible), y 20 fracciones atribuibles poblacionales al alcohol (FAPs) para cada grupo de causas, resultantes de combinar sexo, 5 grupos de edad, y los períodos 2001-2009 y 2010-2017. Las muertes por causa se obtuvieron del Instituto Nacional de Estadística. Para las causas parcialmente atribuibles se calcularon FAPs específicas para España, usando la fórmula de Levin con datos de exposición al alcohol procedentes de encuestas de salud y estadísticas de ventas, y riesgos relativos procedentes de metanálisis internacionales. Se consideraron las prevalencias anuales de exbebedores y de siete niveles de consumo diario de alcohol. Se corrigió la subestimación del consumo medio diario autoinformado con respecto a las estadísticas de venta, multiplicando por un factor de 1,58-3,18, dependiendo del año-calendario. Se calcularon tasas de MAA y porcentajes de la mortalidad general atribuibles a alcohol estandarizados por edad, según sexo, grupo de edad, periodo-calendario, tipo de bebedor y comunidad autónoma. Se realizaron análisis de sensibilidad observando cómo cambiaban las estimaciones de MAA al hacerlo algunas opciones metodológicas, como el criterio de exbebedor o la introducción de un período de latencia.

Evolution of mortality attributable to alcohol in Spain according to age, sex, cause of death and type of drinker (2001-2017). / Evolución de la mortalidad atribuible al alcohol en España según edad, sexo, causa de muerte y tipo de bebedor (2001-2017).

There are no recent estimates of alcohol-attributable mortality in Spain with Spanish alcohol consumption data. The objective is to estimate it and know its evolution between 2001 and 2017 in people ≥15 years, according to sex, age, period, cause of death and type of drinker. The cause-specific approach and Levin's equation were used. Survey consumption was corrected for underestimation with respect to sales statistics, and past consumption and binge drinking were considered. The average annual number of deaths attributable to alcohol in 2010-2017 was 14,927, 58.6% of which were premature (<75 years). The age-standardized alcohol-attributable mortality rate was 39.4/100,000 inhabitants, representing 3.9% of overall mortality. Using standardized percentages, 68.7% corresponded to heavy drinkers. The most frequent causes of alcohol-attributable mortality were cancer (44.7%) and digestive diseases (33.2%).  The rate of alcohol-attributable mortality was 3.5 times higher in men than in women (with higher ratios for young people and external causes). Between 2001-2009 and 2010-2017, the average annual rate decreased 16.8% (60.7% in 15-34 years; 19.4% in men and 9.8% in women). The contribution of heavy drinkers, digestive diseases and external causes to the risk of alcohol-attributable mortality decreased slightly between the two periods, while the contribution of cancer and circulatory diseases increased. These estimates are conservative. The contribution of alcohol to overall mortality is significant in Spain, requiring collective action to reduce it.

En España no hay estimaciones recientes de la mortalidad atribuible a alcohol con datos de consumo de alcohol españoles. El objetivo es estimarla y conocer la evolución entre 2001 y 2017 en personas ≥15 años, según sexo, edad, periodo, causa de muerte y tipo de bebedor. Se utilizó el enfoque causa específico y la ecuación de Levin. El consumo de las encuestas se corrigió por subestimación con respecto a las estadísticas de ventas y se consideró el consumo pasado y los atracones de alcohol. El número medio anual de muertes atribuibles a alcohol en 2010-2017 fue 14.927, un 58,6% prematuras (<75 años). La tasa de mortalidad atribuible a alcohol estandarizada por edad fue 39,4/ 100.000 habitantes, representando un 3,9% de la mortalidad general. Usando porcentajes estandarizados un 68,7% correspondió a bebedores de alto riesgo. Las causas de mortalidad atribuible a alcohol más frecuentes fueron cáncer (43,8%) y enfermedades digestivas (32,9%).  La tasa de mortalidad atribuible a alcohol fue 3,5 veces mayor en hombres que en mujeres (con cocientes más elevados para jóvenes y causas externas). Entre 2001-2009 y 2010-2017 la tasa media anual disminuyó un 16,8% (60,7% en 15-34 años; 19,4% en hombres y 9,8% en mujeres). La contribución de los bebedores de alto riesgo y de las enfermedades digestivas y causas externas al riesgo de mortalidad atribuible a alcohol disminuyó ligeramente entre los dos períodos, mientras que aumentó la contribución del cáncer y enfermedades circulatorias. Estas estimaciones son conservadoras. La contribución del alcohol a la mortalidad general es importante en España, requiriendo medidas colectivas para reducirla.

Effect of tramadol and DOACs with special attention to dabigatran on concomitant use, on the risk of mayor bleeding using BIFAP database in Spain.

BACKGROUND: Tramadol, a weak opioid, inhibits the reuptake of serotonin, a key feature on vascular homeostasis. A suspected interaction exists between dabigatran and tramadol, which might trigger an excess on risk of bleeding however, there is a gap in knowledge on this topic. PURPOSE: To estimate the effects of tramadol, dabigatran and concomitant use on the risk of hospitalized major bleeds (Gastrointestinal bleeding and intra-extracranial bleeds). METHODS: Among a validated established cohort of new users of oral anticoagulants for non-valvular atrial fibrillation (NVAF) aged 18 years or older, we identified all hospitalized bleed episodes (GIB and extra/intracranial bleeds) within 2008-2015. A nested case-control analysis was conducted using conditional logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for dabigatran, tramadol, and concomitant use. Several sensitivity analyses were carried out. RESULTS: aORs (95%CIs) for current use of only dabigatran, only tramadol and concomitant users were 1.73 (1.37-2.18) and 1.38 (1.13-1.67) and 2.04 (0.74-5.67) compared with non-users of both drugs (>365 days). aORs for current continuers and non-continuer users of dabigatran were 1.36 (1.00-1.86) and 2.19 (1.61-2.98), respectively. For the latter, non-continuer users with a short duration of dabigatran cumulated the highest risk (3.36 [1.88-5.99]). There also was an increased risk with concomitant use of tramadol and rivaroxaban (2.24 [1.19-4.21]), or antagonist of vitamin K (1.30 [1.00-1.69]). CONCLUSION: There was a trend towards and increased risk of excess bleeds when using concomitantly with dabigatran. The effect decreases with a narrower definition of current use.

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)

Evolución de la mortalidad atribuible al alcohol en España según edad, sexo, causa de muerte y tipo de bebedor (2001-2017) / Evolution of mortality attributable to alcohol in Spain according to age, sex, cause of death and type of drinker (2001-2017)

En España no hay estimaciones recientes de la mortalidad atribuible a alcohol con datos de consumo de alcohol españoles. El objetivo es estimarla y conocer la evolución entre 2001 y 2017 en personas ≥15 años, según sexo,edad, periodo, causa de muerte y tipo de bebedor. Se utilizó el enfoque causa específico y la ecuación de Levin. El consumo de las encuestas se corrigió por subestimación con respecto a las estadísticas de ventas y se consideró el consumo pasado y los atracones de alcohol. El número medio anual de muertes atribuibles a alcohol en 2010-2017 fue 14.927, un 58,6% prematuras(<75 años). La tasa de mortalidad atribuible a alcohol estandarizada por edad fue 39,4/ 100.000 habitantes, representando un 3,9% de la mortalidad general. Usando porcentajes estandarizados un 68,7% correspondió a bebedores de alto riesgo. Las causas de mortalidad atribuible a alcohol más frecuentes fueron cáncer (43,8%) y enfermedades digestivas (32,9%). La tasa de mortalidad atribuible a alcohol fue 3,5 veces mayor en hombres que en mujeres (con cocientes más elevados para jóvenes y causas externas). Entre2001-2009 y 2010-2017 la tasa media anual disminuyó un 16,8% (60,7%en 15-34 años; 19,4% en hombres y 9,8% en mujeres). La contribución de los bebedores de alto riesgo y de las enfermedades digestivas y causas externas al riesgo de mortalidad atribuible a alcohol disminuyó ligeramente entre los dos períodos, mientras que aumentó la contribución del cáncer y enfermedades circulatorias. Estas estimaciones son conservadoras. La contribución del alcohol a la mortalidad general es importante en España, requiriendo medidas colectivas para reducirla. (AU)

There are no recent estimates of alcohol-attributable mortality in Spain with Spanish alcohol consumption data. The objective is to estimate it and knowits evolution between 2001 and 2017 in people ≥15 years, according to sex, age, period, cause of death and type of drinker. The cause-specific approach and Levin’s equation were used. Survey consumption was corrected forunder estimation with respect to sales statistics, and past consumption and binge drinking were considered. The average annual number of deaths attributable to alcohol in 2010-2017 was 14,927, 58.6% of which were premature (<75 years). The age-standardized alcohol-attributable mortality rate was 39.4/100,000 inhabitants, representing 3.9% of overall mortality.Using standardized percentages, 68.7% corresponded to heavy drinkers. The most frequent causes of alcohol-attributable mortality were cancer(44.7%) and digestive diseases (33.2%). The rate of alcohol-attributable mortality was 3.5 times higher in men than in women (with higher ratiosfor young people and external causes). Between 2001-2009 and 2010-2017,the average annual rate decreased 16.8% (60.7% in 15-34 years; 19.4% inmen and 9.8% in women). The contribution of heavy drinkers, digestive diseases and external causes to the risk of alcohol-attributable mortality decreased slightly between the two periods, while the contribution of cancer and circulatory diseases increased. These estimates are conservative. The contribution of alcohol to overall mortality is significant in Spain, requiring collective action to reduce it. (AU)

Metodología utilizada para estimar la mortalidad atribuible a alcohol en España, 2001-2017 / Methodology used to estimate alcohol-attributable mortality in Spain, 2001-2017

El objetivo es describir y discutir los métodos y asunciones para estimar la mortalidad atribuible a alcohol en España en 2001-2017. Se estimó el nº medio anual de muertes atribuibles a alcohol (MAAs) basándose en 19 grupos de causas de muerte relacionadas con alcohol (18 parcialmente atribuibles y uno directamente atribuible), y 20 fracciones atribuibles poblacionales al alcohol (FAPs) para cada grupo de causas, resultantes de combinar sexo, 5 grupos de edad, y los períodos 2001-2009 y 2010-2017. Las muertes por causa se obtuvieron del Instituto Nacional de Estadística. Para las causas parcialmente atribuibles se calcularon FAPs específicas para España, usando la fórmula de Levin con datos de exposición al alcohol procedentes de encuestas de salud y estadísticas de ventas, y riesgos relativos procedentes de metanálisis internacionales. Se consideraron las prevalencias anuales de exbebedores y de siete niveles de consumo diario de alcohol. Se corrigió la subestimación del consumo medio diario autoinformado con respecto a las estadísticas de venta, multiplicando por un factor de 1,58-3,18, dependiendo del año-calendario. Se calcularon tasas de MAA y porcentajes de la mortalidad general atribuibles a alcohol estandarizados por edad, según sexo, grupo de edad, periodo-calendario, tipo de bebedor y comunidad autónoma. Se realizaron análisis de sensibilidad observando cómo cambiaban las estimaciones de MAA al hacerlo algunas opciones metodológicas, como el criterio de exbebedor o la introducción de un período de latencia. (AU)

The objective is to describe and discuss methods and assumptions to estimate the mortality attributable to alcohol in Spain in 2001-2017. The annual mean number of deaths attributable to alcohol (DAAs) was estimated based on 19 groups of alcohol-related causes of death (18 partially attributable and one directly attributable), and 20 alcohol population-attributable fractions (PAFs), resulting from combining sex, 5 age groups, and the periods 2001-2009 and 2010-2017, for each cause group. Deaths from causes were obtained from the Spanish National Institute of Statistics. For partially attributable causes, Spain-specific PAFs were calculated using the Levin formula with alcohol exposure data from health surveys and sales statistics, and relative risks from international meta-analyses. Annual prevalences of ex-drinkers and seven levels of daily alcohol consumption were considered. The underestimation of self-reported daily average consumption with respect to the sales statistics was corrected by multiplying by a factor of 1.58-3.18, depending on the calendar year. DAA rates standardized by age and standardized proportions of general mortality attributable to alcohol, according to sex, age group, calendar period, type of drinker and autonomous community were calculated. Sensitivity analyses were performed to assess how the DAA estimates changed when changing some methodological options, such as the ex-drinker criterion or the introduction of a latency period. (AU)

Socioeconomic differences in COVID-19 infection, hospitalisation and mortality in urban areas in a region in the South of Europe.

BACKGROUND: To analyse differences in confirmed cases, hospitalisations and deaths due to COVID-19 related to census section socioeconomic variables.  METHODS: Ecological study in the 12 largest municipalities in Andalusia (Spain) during the first three epidemic waves of the COVID-19 (02/26/20-03/31/21), covering 2,246 census sections (unit of analysis) and 3,027,000 inhabitants. Incidence was calculated, standardised by age and sex, for infection, hospitalisation and deaths based on average gross income per household (AGI) for the census tracts in each urban area. Association studied using a Poisson Bayesian regression model with random effects for spatial smoothing. RESULTS: There were 140,743 cases of COVID-19, of which 12,585 were hospitalised and 2,255 died. 95.2% of cases were attributed to the second and third waves, which were jointly analysed. We observed a protective effect of income for infection in 3/12 cities. Almeria had the largest protective effect (smoothed relative risk (SRR) = 0.84 (0.75-0.94 CI 95%). This relationship reappeared with greater magnitude in 10/12 cities for hospitalisation, lowest risk in Algeciras SRR = 0.41 (0.29-0.56). The pattern was repeated for deaths in all urban areas and reached statistical significance in 8 cities. Lowest risk in Dos Hermanas SRR = 0.35 (0.15-0.81). CONCLUSIONS: Income inequalities by geographical area were found in the incidence of COVID-19. The strengths of the association increased when analysing the severe outcomes of hospitalisations and, above all, deaths.

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.

Progress and challenges in tobacco control policies in Mexico, 2003-2017: an approach using the Tobacco Control Scale.

The study aims to assess the implementation of tobacco control policies in Mexico from 2003 through 2017 using the Tobacco Control Scale (TCS). The TCS is a research tool widely used in the European region. It facilitates assessment of tobacco control policy implementation based on six cost-effective interventions: tobacco taxes, smoke-free policies, advertising bans, public spending on the information campaign, health warnings, and smoking cessation treatment, reflecting results in a total score between 0 and 100. From 2003 through 2017, Mexico's total score improved from 24/100 to 55/100, with substantial progress in raising tobacco taxes, 11 subnational smoke-free laws, and with placement on cigarette packs of large health warnings with pictograms. Progress in tobacco control policies implemented in this period corresponds with a decrease in smoking prevalence across Mexico. This tool is useful for monitoring tobacco policy implementation in low- and middle-income countries and be used for advocacy purposes to enforce and improve tobacco control legislation.

Severity, symptomatology, and treatment duration for mental health disorders: a retrospective analysis from a conflict-affected region of northern Nigeria.

BACKGROUND: Mental Health and psychosocial support (MHPSS) programs are essential during humanitarian crises and in conflict settings, like Nigeria's Borno State. However, research on how types of traumatic stress and symptom severity affect clinical improvement is lacking in these contexts, as is consensus over how long these patients must engage in mental health care to see results. METHODS: Records from 11,709 patients from the MHPSS program in Pulka and Gwoza local government areas in Borno State, Nigeria from 2018 and 2019 were retrospectively analyzed. Patient information, symptoms, stress type, severity (CGI-S scale), and clinical improvement (CGI-I and MHGS scales) were assessed by the patient and counselor. Associations between variables were investigated using logistic regression models. RESULTS: Clinical improvement increased with consultation frequency (OR: 2.5, p < 0.001 for CGI-I; OR: 2, p < 0.001 for MHGS), with patients who received three to six counseling sessions were most likely to improve, according to severity. Survivors of sexual violence, torture, and other conflict/violence-related stressors were nearly 20 times as likely to have posttraumatic stress disorder (PTSD) (OR: 19.7, p < 0.001), and depression (OR: 19.3, p < 0.001) symptomatology. Children exposed to conflict-related violence were also almost 40 times as likely to have PTSD (OR: 38.2, p = 0.002). Most patients presented an improvement in outcome at discharge, per both counselors (92%, CGI-I) and self-rating scores (73%, MHGS). CONCLUSION: We demonstrate a threshold at which patients were most likely to improve (3 sessions for mild or moderate patients; 6 sessions for severe). In addition, we identify the specific types of stress and symptom severity that affected the number of sessions needed to achieve successful outcomes, and highlight that some stress types (especially torture or having a relative killed) were specifically linked to PTSD and depression. Therefore, we emphasize the importance of classifying patient stress type and severity to identify the appropriate duration of care needed.