Calibration and XGBoost reweighting to reduce coverage and non-response biases in overlapping panel surveys: application to the Healthcare and Social Survey.

BACKGROUND: Surveys have been used worldwide to provide information on the COVID-19 pandemic impact so as to prepare and deliver an effective Public Health response. Overlapping panel surveys allow longitudinal estimates and more accurate cross-sectional estimates to be obtained thanks to the larger sample size. However, the problem of non-response is particularly aggravated in the case of panel surveys due to population fatigue with repeated surveys. OBJECTIVE: To develop a new reweighting method for overlapping panel surveys affected by non-response. METHODS: We chose the Healthcare and Social Survey which has an overlapping panel survey design with measurements throughout 2020 and 2021, and random samplings stratified by province and degree of urbanization. Each measurement comprises two samples: a longitudinal sample taken from previous measurements and a new sample taken at each measurement. RESULTS: Our reweighting methodological approach is the result of a two-step process: the original sampling design weights are corrected by modelling non-response with respect to the longitudinal sample obtained in a previous measurement using machine learning techniques, followed by calibration using the auxiliary information available at the population level. It is applied to the estimation of totals, proportions, ratios, and differences between measurements, and to gender gaps in the variable of self-perceived general health. CONCLUSION: The proposed method produces suitable estimators for both cross-sectional and longitudinal samples. For addressing future health crises such as COVID-19, it is therefore necessary to reduce potential coverage and non-response biases in surveys by means of utilizing reweighting techniques as proposed in this study.

Comparing temporal changes and predictors of different types of mental health and socio-emotional wellbeing outcomes during COVID-19: an overlapping panel study of Spanish residents.

OBJECTIVES: Few panel studies have investigated how different types of mental health (MH) and socio-emotional wellbeing (SEW) outcomes have changed during the pandemic and if their burden has been equally distributed at the population-level. We aimed to examine temporal changes in these outcomes and their socio-ecological predictors using panel data. STUDY DESIGN: Longitudinal population-based survey with overlapping panels. METHODS: Analyses were carried out using four measurements of data from the Health and Social Survey (April 2020 to April 2021). Participants included Andalusian (Spanish) residents aged 16 years or older who participated in all four measurements (n = 1223). Seven dichotomous MH and SEW outcomes, as well as several socio-ecological predictors informed by a conceptual model, were examined in descriptive and multivariate analyses. RESULTS: Unadjusted odds of regular/bad perceived mental health (vs. excellent/very good/good), low socio-emotional wellbeing (vs. regular), low happiness (vs. regular), and feeling anxious (vs. not feeling anxious) decreased significantly from the first to the second measurement; however, in the fourth, low socio-emotional wellbeing significantly increased while low optimism decreased. Considering varying coefficients, objectively measured COVID-19 status and self-reported severity levels of the infection were statistically significant. Health status, social support, and household financial difficulty predicted higher adjusted odds in most of the seven assessed outcomes. CONCLUSIONS: Significant temporal variations in MH and SEW outcomes, along with their predictors, were observed during the first year of the pandemic. Some of these outcomes worsened as the pandemic progressed, whereas others improved. Findings also suggest that some individuals such as those experiencing poor health, limited social support, and low socioeconomic status are disproportionately impacted.

The use of healthcare services and disabling chronic pain: results from the cross-sectional population-based Andalusian Health Survey.

BACKGROUND: Several factors seem to be related to the use of healthcare services, and chronic pain (CP) is among these characteristics. The objective is to describe the number of visits to a doctor's surgery or emergency rooms, and the periods of hospitalization; to identify characteristics associated with frequent healthcare use, including disabling chronic pain (DCP) and non-disabling chronic pain (n-DCP). METHODS: Representative population-based cross-sectional study of 6569 people older than 16 years from southern Spain was collected. The frequency of visits to a doctor's surgery or emergency rooms and periods of hospitalization were defined as at or above the 90th percentile. Binary logistic regression analyses were conducted separately on women and men to identify characteristics associated with being frequent visitors. RESULTS: People with DCP are more frequent visitors to a doctor's surgery and emergency rooms and endure longer periods of hospitalization compared to people with n-DCP and without pain. In logistic regression models, people with DCP are twice as likely to over-visit a doctor's surgery; to endure longer periods of hospitalization and more visits to an emergency room service. No relationship was found in n-DCP. CONCLUSIONS: Disability seems to modulate a greater use of health services among the population with CP, doubling it when compared to n-DCP and n-CP, both in women and men. Understanding the role of disability in the use of healthcare services for individuals with CP allows for the identification of needs and strategies to optimize resources.

Alcohol, Tobacco and Psychotropic Drugs Use Among a Population with Chronic Pain in Southern Spain. A Cross-Sectional Study.

BACKGROUND: Substance use seems to be higher among populations with chronic pain. AIM: The aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men. METHOD: Linear and logistic regression analyses were carried out using data from the 2015-2016 adults' version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men). RESULTS: Disabling chronic pain was statistically associated with higher tobacco consumption among men (ß = -30.0, 95% confidenct interval [CI] -59.5 to -0.60; t = -2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: ß = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: ß = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs. CONCLUSIONS: Chronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.

Profiles of adult people in a Spanish sample with chronic pain: Cluster analysis.

AIM: To establish groups of people with chronic non-cancer pain according to the impairment caused by pain and to identify factors associated with the group with a higher level of impairment. BACKGROUND: Knowing the profiles of people who suffer from chronic non-cancer pain could make it possible to direct their treatment and to detect associated risks. DESIGN: A cross-sectional study. METHODS: A sample of 395 people with chronic non-cancer pain was collected in Pain Units and Primary Healthcare Centres in southern Spain (January to March 2020). A cluster analysis was performed to divide the population into groups and a binary logistic regression model was established to determine factors associated with the group with a higher level of impairment. RESULTS: Two groups were identified: lower level of impairment due to pain, characterized by being 45-65 years old, not medicated with opioids or anxiolytics, employed and with a mild level of impact on daily life; and higher level of impairment characterized by being older than 65 years old, medicated with opioids and anxiolytics, retired or on medical leave and with a severe impact on daily life. In addition, among women, being widowed, single or a smoker are risk factors for belonging to the group with a higher level of impairment; being smokers or consuming alcohol three or less times a week would be risk factors in men. CONCLUSIONS: Age, chronic non-cancer pain impact on daily life, work situation and the consumption of opioid drugs and/or anxiolytics are factors that appear to influence the level of impairment due to chronic pain. IMPACT: These findings could help detect impairment due to pain in its early stages, determining the specific needs of each person.

Factors that Influence Coping with Chronic Noncancer Pain in European Countries: A Systematic Review of Measuring Instruments.

BACKGROUND AND AIM: Coping can be defined as the cognitive efforts and behavioral practices that people develop in situations which they consider to be stressful. In people with Chronic Non-Cancer Pain (CNCP), coping is influenced by the biological, psychological, and socio-cultural resources available to them. The aim of this systematic review is to evaluate the psychometric properties of European measuring instruments related to coping with CNCP in non-hospitalized adults. DATABASE AND DATA TREATMENT: The review was conducted following the guidelines of the PRISMA Statement and the methodological framework of the Joanna Briggs Institute. The CINAHL, PubMed, Scopus, and Web of Science databases were searched by two reviewers independently. The analysis of psychometric properties was performed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, and the risk of bias was analyzed using the Quality Assessment of Diagnostic Accuracy Study-2 (QUADAS-2) tool. RESULTS: Thirty-six studies validated twenty-four different instruments. The Portuguese version of the Pain Beliefs and Perceptions Inventory (PBPI), which assess catastrophizing, and the Spanish version of the Roland-Morris Questionnaire (RMQ), which assess disability, are the instruments with the best methodological quality and bias control. CONCLUSIONS: There are important gaps in the measurement of different aspects of pain coping, such as stress, social and family support, or self-care. Future studies could consider the creation of an instrument to comprehensively assess the resources that influence coping with chronic non-cancer pain.

[Group intervention from a sensorimotor approach to reduce the intensity of chronic pain]. / Intervención grupal desde un enfoque sensoriomotriz para reducir la intensidad del dolor crónico.

OBJECTIVE: To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms. DESIGN: A randomized clinical trial with a control group, taking three measurements over three months. SETTING: Granada, Spain. PARTICIPANTS: A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM). INTERVENTIONS: Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3h was planned and the total of the program was developed during five weeks. MAIN MEASUREMENTS: Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM). RESULTS: Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were 'very important' on intensity of pain (d=-1.01, d=-0.97) and interference of pain (d=-0.85, d=-0.74), with an improvement percentage from 21% to 30%. CONCLUSIONS: Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life.

[Impact of disabling chronic pain: results of a cross-sectional population study with face-to-face interview]. / Impacto del dolor crónico discapacitante: resultados de un estudio poblacional transversal con entrevista cara a cara.

OBJECTIVE: To assess the impact of disabling chronic pain (DCP) on quality of life, work, consumption of medication and usage of health services. DESIGN: Cross-sectional population study with face-to-face interview. SETTING: Andalusian Health Survey (2011 edition). PARTICIPANTS: 6,507 people over the age of 16 (p=q=0.5; confidence level=95%; sampling error=1.49, design effect=1.52). INTERVENTIONS: Not applicable. MAIN MEASUREMENTS: Dependent variable: DCP: population limited in their activity by any of the CP specified in the survey. INDEPENDENT VARIABLES: quality of life, absence from work, consumption of medication and utilization of health services. RESULTS: Compared to a population without CP, DCP impact is 6 points less on the mental quality of life and 12 points on the physical one, medication consumption is triple, health services utilization is almost double, and long absence from work is triple. On the other hand, a population with nondisabling chronic pain (nDCP) presents similar results to a population without CP. CONCLUSIONS: We have considered DCP as another CP category because of its huge impact, as is shown in our study, on the study variables. On the contrary, the population with nDCP does not obtain significant impact differences when compared to the population without CP. Therefore, we believe that Primary Care and Public Health should lead different prevention strategies for DCP as well as for the identification of the nDCP population to decrease its possible deterioration towards DCP.

Understanding the Impact of Chronic Non-Cancer Pain on Daily Life from a Gender Perspective Using the PAIN_Integral Scale©.

The experience of chronic non-cancer pain differs between women and men due to gender-related factors. This study (1) assessed the difference in responses to the impact of chronic non-cancer pain on daily life in women and men using the PAIN_Integral Scale© and (2) evaluated its invariance through multigroup confirmatory factor analysis. This was conducted by means of an analysis of invariance through a multigroup confirmatory factor analysis. A cross-sectional sample of 400 participants over 18 years of age with Chronic Non-Oncological Pain in Pain Units and Primary Care Centres belonging to the Spanish Public Health System was recruited (January to March 2020). An analysis was performed to assess whether any of the items in the instrument showed different behaviours. All analyses were performed using AMOS® v.26 software. The results showed that the structure of the PAIN_Integral© Scale remained adequate when analysing its invariance in women and men, showing no metric, scalar and/or strict invariance. Therefore, these results indicated that the PAIN_Integral Scale© instrument has a different interpretation for women and men, identifying eight items with a singular functioning in both sexes and belonging to the subscales of proactivity, resilience and support network. These findings can be explained by gender stereotypes, since the dimensions where there are differences have an important social burden.

Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol.

INTRODUCTION: The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health. METHODS AND ANALYSIS: DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration. ETHICS AND DISSEMINATION: The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Factors that influence the impact of Chronic Non-Cancer Pain on daily life: A partial least squares modelling approach.

BACKGROUND: Chronic Non-Cancer Pain is pain of more than three months' duration and is not associated with an oncological condition. There is ample literature that recognises that Chronic Non-Cancer Pain impacts numerous areas of the life of the person who suffers from it. This impact is difficult to determine and quantify because Chronic Pain is a subjective experience. OBJECTIVE: The objective of this study was to test a recursive model of hypothesised factors that comprise the concept of Chronic Non-Cancer Pain Impact on daily life using Partial Least Squares-Structural Equation Modelling. DESIGN: A cross-sectional study was carried out. The sample size was calculated using G*Power V.3.1.9.4 with five parameters (two-tailed, large effect size (f2 = 0.35), power of 0.95, statistical significance of 95% (α = 0.05) and 36 predictors). The minimum number of subjects was considered to be 137. METHODS: A recursive model was built based on data from a sample of 395 people over 18 years of age with Chronic Non-Cancer Pain. Data collection was conducted between January and March 2020 at Pain Units and Primary Healthcare Centres belonging to the Spanish Public Health System in the province of Seville (Spain). Analyses were based on Partial Least Squares-Structural Equation Modelling. The internal consistency, convergent validity and discriminant validity of the internal measurement model were assessed. For the external measurement model, global model adjustment and structural validity were assessed. The predictive capacity of the final model was also evaluated. All analyses were performed using SmartPLS version 3.3.2 in consistent mode. RESULTS: Findings showed an adequate validity of the proposed model, which comprised nine factors: pain catastrophising, hopelessness due to pain, support network, proactivity, treatment compliance, self-care, mobility, resilience, and sleep. The internal validity of the model (Cronbach's alpha and rho_A > 0.70; Average Variance Extracted>0.50; standardised outer loadings>0.60; Heterotrait-Monotrait-Ratio < 0.85), goodness of fit (Standardised Root Mean Square Residuals<0.08; Geodesic and Euclidean distance p-value<0.05) and predictive power with out-of-sample values (Stone-Geisser test>0.5) were adequate. The hypothesised structure of the instrument has also been confirmed (path coefficients>0.3; R2 > 0.1; f2 > 0.2). CONCLUSIONS: The results have shown an adequate internal consistency, convergent validity and discriminant validity of the model. Likewise, the model has shown an adequate goodness of fit, and the validity of its structure and the hypothesis have been confirmed. However, more research is needed in this regard as the possible interaction between the different factors evaluated in the model with the confounding or moderating variables that may exist.

Scoping review of the methodology of large health surveys conducted in Spain early on in the COVID-19 pandemic.

Background: The use of health surveys has been key in the scientific community to promptly communicate results about the health impact of COVID-19. But what information was collected, where, when and how, and who was the study population? Objective: To describe the methodological characteristics used in large health surveys conducted in Spain early on in the COVID-19 pandemic. Methods: Scoping review. Inclusion criteria: observational studies published between January 2020 and December 2021, with sample sizes of over 2,000 persons resident in Spain. Databases consulted: PubMed, CINAHL, Literatura Latinoamericana y del Caribe en CC de la Salud, Scopus, PsycINFO, Embase, Sociological Abstracts, Dialnet and Web of Science Core Collection. We analyzed the characteristics of the literature references, methodologies and information gathered in the surveys selected. Fifty five studies were included. Results: Sixty percentage of the studies included had mental health as their main topic and 75% were conducted on the general adult population. Thirteen percentage had a longitudinal design, 93% used the internet to gather information and the same percentage used non-probability sampling. Thirty percentage made some type of sampling correction to reduce coverage or non-response biases, but not selection biases. Sixty seven percentage did not state the availability of their data. Conclusions: Consistent with the extensive use of non-probability sampling without any bias correction in the extraordinary setting created by COVID-19, quality population frameworks are required so that probability and representative samples can be extracted quickly to promptly address other health crises, as well as to reduce potential coverage, non-response and particularly selection biases by utilizing reweighting techniques. The low data accessibility despite the huge opportunity that COVID-19 provided for Open Science-based research is striking.

Variables associated with sun protection behaviour of preschoolers.

Little research has been published on the variables associated with sun protection behaviour in preschoolers. We aimed to define variables associated with sun protection behaviour of a sample of Spanish preschoolers. A cross-sectional observational study was conducted in two stages: 1) the design and validation of the measurement instrument, and 2) its application in a final sample of 100 (60 valid questionnaires) children for bivariate and multivariate binary logistic regression analyses of the data. The sun protection behaviour of the children was most strongly associated with: parental sun protection behaviour, absence or low frequency of sunburn in parents and children, and lower parental perception of obstacles to sun protection. Other significant factors were lower phototype, younger age, shorter sun exposure times and awareness of the sun as a risk factor. The role of social communication programmes, dermatologists and other agents providing information or sun protection advice was contradictory and associated with lower sun protection in some cases. Parental sun protection, absence or lower frequency of sunburns in parents and children, lower phototype of children, knowledge about sun exposure as a risk factor, younger age and lower parental perception of obstacles to their children's sun protection were significantly associated with the sun protection of the children.

[Association between neighborhood walkability and mortality due to different causes in Andalusia (Spain)]. / Asociación entre la caminabilidad del barrio de residencia y la mortalidad por distintas causas en Andalucía.

OBJECTIVE: To describe the association between the Neighborhood Walkability and mortality. METHOD: Ecological study of small areas. The standardized mortality ratios (SMR) and the Walk Score© were calculated in each census tract. These values were compared with parametric and nonparametric tests. RESULTS: For men, in the case of ischemic diseases, the means of the SMR for the categories with the highest walkability and the least were 1.03 and 0.85 (p <0.01), and in chronic obstructive pulmonary disease (COPD) were 1,009 and 1.20 (p <0.01). In women, the means of the SMR for diabetes were 0.97 and 1.2 (p <0.01), for ischemic diseases were 1.01 and 1.12 (p <0.01), for cerebrovascular diseases were 1.007 and 1.18 (p <0.01), for COPD were 1.01 and 1.49 (p <0.01) and for all causes were 1.006 and 1.08 (p <0.01) CONCLUSIONS: Behavior about walking in the activities of daily life is different between sexes. Living in walkable neighborhoods is a protective factor for women.

[Health Exam for Adults Over 65 program in Andalusia: descriptive study of participants.] / Programa examen de salud para personas mayores de 65 años en Andalucía: estudio descriptivo de participantes.

OBJECTIVE: The Health Exam for Adults Over 65 (EdS65+) is a health promotion program delivered in Primary Care (PC) settings in Andalusia. It seeks early detection of frailty and implementation of person-centered biopsychosocial intervention plans. The aim of the study was to describe the characteristics and functional capacity of the participating population, as well as the interventions carried out. METHODS: The sample consists of EdS65+ participants between May 2018 and February 2020 (203,077 individuals). Sociodemographic variables, functional capacity and implemented interventions were collected. Descriptive statistics were obtained and significance tests were performed to measure the sample representativeness and to detect statistically significant differences in the study variables according to sex, age or degree of urbanization. RESULTS: Functional capacity screening results were as follows: autonomous individuals accounted for 61.8%, 22.5% were dependent, 8.2% were pre-fragile, 4.8% were frail and 2.6% were categorized with low dependency. The prevalence of frailty ranged from 1.8% in persons aged 65-69 years to 7.7% in 80-84 years, with overall prevalence of 6.8% in women and 2.1% in men. In the frail population, a basic assessment was performed in 45.4% of cases, health promotion counseling in 55.2%, and prescription of a physical activity program in 43.3% of cases. A total of 19.6% of participants had one or more follow-ups and of these, 13.7% had two or more. CONCLUSIONS: EdS65+ is a unique program in Europe in terms of its long-term implementation and large-scale application in Primary Care services. Hence, the results presented in this study are valuable in growing the knowledge base around frailty and the design and implementation of actions aimed at proactive health promotion and disease prevention.

OBJETIVO: El Examen de Salud para mayores de 65 años (EdS65+) es un programa de promoción de la salud contextualizado en la Atención Primaria (AP) de Andalucía. Busca detectar precozmente la fragilidad y determinar planes de intervención biopsicosociales centrados en la persona. El objetivo del estudio fue describir las características y la capacidad funcional de la población participante, así como las intervenciones realizadas. METODOS: Muestra formada por participantes en EdS65+ entre mayo 2018 y febrero 2020 (203.077 personas). Se recogieron variables sociodemográficas, de capacidad funcional e intervenciones realizadas. Se obtuvieron estadísticos descriptivos y se realizaron pruebas de significación para medir la representatividad de la muestra y detectar diferencias estadísticamente significativas de las variables de estudio según sexo, edad o grado de urbanización. RESULTADOS: Las personas autónomas representaron el 61,8%, seguido del 22,5% de dependientes, 8,2% prefrágiles, 4,8% frágiles y 2,6% con baja dependencia. La prevalencia de fragilidad fue desde el 1,8% en personas de 65-69 años al 7,7% en 80-84 años, del 6,8% en mujeres y del 2,1% en hombres. En población frágil se realizó una valoración básica en el 45,4%, asesoramiento en promoción de la salud en el 55,2% y prescripción de un programa de actividad física en el 43,3%. Un 19,6% tuvo uno o más seguimientos y, de ellos, un 13,7% tuvo dos o más. CONCLUSIONES: El EdS65+ es un programa único en Europa en cuanto a su implementación a largo plazo y su aplicación a gran escala en los servicios de Atención Primaria, lo que hace que los resultados presentados en este estudio aporten gran valor al conocimiento de la fragilidad y al diseño y puesta en marcha de actuaciones dirigidas a la promoción proactiva de la salud y la prevención de la enfermedad.

Impact of COVID-19 on the Health of the General and More Vulnerable Population and Its Determinants: Health Care and Social Survey-ESSOC, Study Protocol.

This manuscript describes the rationale and protocol of a real-world data (RWD) study entitled Health Care and Social Survey (ESSOC, Encuesta Sanitaria y Social). The study's objective is to determine the magnitude, characteristics, and evolution of the COVID-19 impact on overall health as well as the socioeconomic, psychosocial, behavioural, occupational, environmental, and clinical determinants of both the general and more vulnerable population. The study integrates observational data collected through a survey using a probabilistic, overlapping panel design, and data from clinical, epidemiological, demographic, and environmental registries. The data will be analysed using advanced statistical, sampling, and machine learning techniques. The study is based on several measurements obtained from three random samples of the Andalusian (Spain) population: general population aged 16 years and over, residents in disadvantaged areas, and people over the age of 55. Given the current characteristics of this pandemic and its future repercussions, this project will generate relevant information on a regular basis, commencing from the beginning of the State of Alarm. It will also establish institutional alliances of great social value, explore and apply powerful and novel methodologies, and produce large, integrated, high-quality and open-access databases. The information described here will be vital for health systems in order to design tailor-made interventions aimed at improving the health care, health, and quality of life of the populations most affected by the COVID-19 pandemic.

Consequences of Chronic Non-Cancer Pain in adulthood. Scoping Review.

OBJECTIVE: To examine and map the consequences of chronic pain in adulthood. METHOD: Documents addressing the impact of chronic pain on the psychological and social spheres of people suffering from chronic pain, published in Spanish and English between 2013 and 2018, were included. Those who addressed pharmacological treatments, chronic pain resulting from surgical interventions or who did not have access to the full text were excluded. Finally, 28 documents from the 485 reviewed were included. RESULTS: Studies show that pain is related to high rates of limitation in daily activities, sleep disorders and anxiety-depression spectrum disorders. People in pain have more problems to get the workday done and to maintain social relationships. Chronic pain is also associated with worse family functioning. CONCLUSIONS: This review shows that limitations in the ability to perform activities of daily living, sleep, psychological health, social and work resources and family functioning are lines of interest in published articles. However, knowledge gaps are detected in areas such as the influence of having suffered pain in childhood or adolescence, the consequences of non-fulfillment of working hours and gender inequalities.

Attitudes of adolescent Spanish Roma toward noninjection drug use and risky sexual behavior.

Our objective with this study was to analyze the opinions of a potentially socially marginalized group of Spanish Roma adolescents and young adults about noninjection drug use, HIV infection, and risky sexual behavior. Descriptive qualitative research was conducted through focus groups with Roma participants and semistructured interviews with professionals who work with them in areas such as education and health promotion. Results were triangulated by cross analysis among researchers. Declared drug consumption is lower among females than males. The former claim they do not maintain sporadic sexual relations, and link risky sexual practices to being in love and involved in a stable relationship. Males only use condoms in sporadic sexual relations. They attribute their lack of condom use to lost sensitivity, perceiving sex as something uncontrollable, and not having condoms available when using drugs. Results suggest the need to improve actions aimed at preventing the sexual transmission of HIV among the Roma population.

Did psychotropic drug consumption increase during the 2008 financial crisis? A cross-sectional population-based study in Spain.

OBJECTIVES AND SETTING: Although psychotropic drugs are used to treat mental health disorders, little evidence analyses the effects the 2008 economic downturn had on psychotropic drug consumption in the case of Spain. We analyse these effects, considering both gender and employment situation. PARTICIPANTS: We used the microdata from the face-to-face cross-sectional population-based Spanish National Health Survey for two periods: 2006-2007 (n=28 954) and 2011-2012 (n=20 509). Our samples included adults (>15 years old). METHODS: The response variables are consumption (or not) of antidepressants or sedatives and the explanatory variables are the year of the survey, gender and employment status. Covariates are mental health problems, mental health index General Health Questionnaire (GHQ-12) and self-reported health outcome variables such as self-rated health, chronic diseases, smoking behaviour, sleeping hours, body mass index, physical activity in the workplace, medical visits during the past year, age, region of residence (autonomous communities), educational level, marital status and social class of the reference person. Finally, we include interactions between time period, gender and employment status. We specify random effects logistic regressions and use Bayesian methods for the inference. RESULTS: The economic crisis did not significantly change the probability of taking antidepressant drugs (OR=0.56, 95% CI 0.18 to 2.56) nor sedatives (OR=1.21, 95% CI 0.26 to 5.49). In general, the probability of consuming antidepressants among men and women decreases, but there are differences depending on employment status. The probability of consuming sedatives also depends on the employment status. CONCLUSIONS: While the year of the financial crisis is not associated with the consumption of antidepressants nor sedatives, it has widened the gap in consumption differences between men and women. Although antidepressant use dropped, the difference in consumption levels between men and women grew significantly among the retired, and in the case of sedatives, risk of women taking sedatives increased in all groups except students.