Adquisición de competencias para la atención integral de casos poblacionales afectos por la COVID-19 en los Grados de Medicina y Trabajo Social

El objetivo de este proyecto de innovación docente fue capacitar al alumnado de los Grados en Medicina y Trabajo Social en la adquisición de competencias que le permitieran conocer el manejo general de las situaciones que se presentan más frecuentemente entre la población afectada por COVID-19. Para ello, a través de informadores clave, se realizaron once entrevistas individuales en profundidad a diversos perfiles poblacionales (personas sin hogar, personas con escasos recursos económicos, personas inmigrantes, mujeres con hijos pequeños a cargo y dificultades de conciliación, etc.). Dichas entrevistas se transcribieron y, en el primer semestre del presente curso académico 2021-2022, se ofertó al alumnado de los citados grados la posibilidad de analizar su contenido, aplicando para ello las competencias adquiridas en las correspondientes asignaturas impartidas por nuestro departamento. Al ser una actividad voluntaria sin consecuencias en la calificación, un inconveniente que enfrentamos fue la escasa participación (ocho alumnos del grado de Trabajo Social y seis alumnos del grado de Medicina). Por ello, la experiencia se llevó a cabo en modo pilotaje. No obstante, esta situación conllevó algunas ventajas, como la posibilidad de realizar sesiones presenciales con los alumnos en lugar de utilizar la herramienta foros de PRADO como estaba previsto en un inicio (fomentando así un aprendizaje más cercano y activo). Los alumnos participantes expresaron una elevada satisfacción con el proceso de enseñanza-aprendizaje, manifestando su interés por repetir experiencias similares en el futuro. La transcripción de las entrevistas en profundidad, por motivos éticos, no puede ser colgada en el repositorio digital DIGIBUG. No obstante, el equipo docente está trabajando en la actualidad en analizar sus resultados con metodologías cualitativas para su publicación en una revista de impacto en el ámbito de la educación. La aplicación práctica a la docencia habitual será discutida en los siguientes apartados.The aim of this project was to train students of the Degrees in Medicine and Social Work in the acquisition of skills that would enable them to understand the general management of the situations that occur most frequently among the population affected by COVID-19. To this end, through key informants, eleven individual in-depth interviews were conducted with different population profiles (homeless people, people with scarce economic resources, immigrants, women with young children and difficulties in reconciling work and family life, etc.). These interviews were transcribed and, in the first semester of the current academic year 2021-2022, students of the aforementioned degrees were offered the possibility of analyzing their content, applying the skills acquired in the corresponding subjects taught by our department. As this was a voluntary activity with no consequences for the qualification, one drawback we faced was the low level of participation (eight students from the Bachelor's Degree in Social Work and six students from the Bachelor's Degree in Medicine). Therefore, the experience was conducted in pilot mode. However, this situation had some advantages, such as the possibility of conducting faceto-face sessions with the students instead of using the PRADO forum tool as originally planned (thus promoting closer and more active learning). The participating students expressed a high level of satisfaction with the teaching-learning process, expressing their interest in repeating similar experiences in the future. The transcript of the in-depth interviews, for ethical reasons, cannot be uploaded to the DIGIBUG digital repository. However, the teaching team is currently working on analyzing the results with qualitative methodologies for publication in an impact journal in the field of education. The practical application to regular teaching will be discussed in the following sections

Alcohol use and family‑related factors among Spanish university students: the unHicos project

Background: During adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students. Methods: Observational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated. Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi- Square test and Student’s T-Test, and non-conditional logistic regression models were carried out to examine this association. Results: The prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2–17.6), and that of BD was 48.8% (95% CI = 47.9–48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed. Conclusions: Risky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association. The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health services.National Drug Plan, Ministry of Health, Social Services and Equality of Spain 2010|145 2013|034 PI16/0194

Maternal trauma due to motor vehicle crashes and pregnancy outcomes: a systematic review and meta-analysis

Objectives To systematically review and quantify the effect of motor vehicle crashes (MVCs) in pregnancy on maternal and offspring outcomes. Design Systematic review and meta-analysis of observational data searched from inception until 1 July 2018. Searching was from June to August 2018 in Medline, Embase, Web of Science, Scopus, Latin-American and Caribbean System on Health Sciences Information, Scientific Electronic Library Online, TRANSPORT, International Road Research Documentation, European Conference of Ministers of Transportation Databases, Cochrane Database of Systematic Reviews and Cochrane Central Register. Participants Studies were selected if they focused on the effects of exposure MVC during pregnancy versus non-exposure, with follow-up to verify outcomes in various settings, including secondary care, collision and emergency, and inpatient care. Data synthesis For incidence data, we calculated a pooled estimate per 1000 women. For comparison of outcomes between women involved and those not involved in MVC, we calculated ORs with 95% CIs. Where possible, we statistically pooled the data using the random-effects model. The quality of studies used in the comparative analysis was assessed with Newcastle– Ottawa Scale. Results We included 19 studies (3 222 066 women) of which the majority was carried out in high-income countries (18/19). In population-level studies of women involved in MVC, maternal death occurred in 3.6 per 1000 (95% CI 0.25–10.42; 3 studies, 12 000 women; Tau=1.77), and fetal death or stillbirth in 6.6 per 1000 (95% CI 3.81–10.12; 8 studies, 47 992 women; I2 =92.6%). Pooled incidence of complications per 1000 women involved in MVC was labour induction (276.43), preterm delivery (191.90) and caesarean section (166.65). Compared with women not involved in MVC, those involved had increased odds of placental abruption (OR 1.43, 95%CI 1.27–1.63; 3 studies, 1 500 825 women) and maternal death (OR 202.27; 95%CI 110.60–369.95; 1 study, 1 094 559 women). Conclusion Pregnant women involved in MVC were at higher risk of maternal death and complications than those not involved

Healthcare-associated infections by multidrug-resistant bacteria in Andalusia, Spain, 2014 to 2021

Background: Multidrug-resistant (MDR) bacteria are among chief causes of healthcare-associated infections (HAIs). In Spain, studies addressing multidrug resistance based on epidemiological surveillance systems are lacking. Aim: In this observational study, cases of HAIs by MDR bacteria notified to the epidemiological surveillance system of Andalusia, Spain, between 2014−2021, were investigated. Notified cases and their spatiotemporal distribution were described, with a focus on social determinants of health (SDoH). Methods: New cases during the study period of HAIs caused by extended-spectrum β-lactamase (ESBL)-/carbapenemase-producing Enterobacterales, MDR Acinectobacter baumannii, MDR Pseudomonas aeruginosa or meticillin resistant Staphylococcus aureus were considered. Among others, notification variables included sex and age, while socio-economic variables comprised several SDoH. Cases’ spatial distribution across municipalities was assessed. The smooth standardised incidence ratio (sSIR) was obtained using a Bayesian spatial model. Association between municipalities’ sSIR level and SDoH was evaluated by bivariate analysis. Results: In total, 6,389 cases with a median age of 68 years were notified; 61.4% were men (n = 3,921). The most frequent MDR bacteria were ESBL-producing Enterobacterales (2,812/6,389; 44.0%); the main agent was Klebsiella spp. (2,956/6,389; 46.3%). Between 2014 and 2021 case numbers appeared to increase. Overall, up to 15-fold differences in sSIR between municipalities were observed. In bivariate analysis, there appeared to be an association between municipalities’ sSIR level and deprivation (p = 0.003). Conclusion: This study indicates that social factors should be considered when investigating HAIs by MDR bacteria. The case incidence heterogeneity between Andalusian municipalities might be explained by SDoH, but also possibly by under-notification. Automatising reporting may address the latte

Shift Work and Prostate Cancer: An Updated Systematic Review and Meta-Analysis

The International Agency of Research in Cancer (IARC) has recently confirmed shift work as a type 2A carcinogen. The results presented in published epidemiological studies regarding prostate cancer are inconsistent and the association remains controversial. The aims of this study were: (a) to investigate the possible association between shift work and prostate cancer incidence, identifying possible sources of heterogeneity; and (b) to analyze the potential effect of publication bias. A search for cohort and case-control studies published from January 1980 to November 2019 was conducted. The quality of the articles was assessed using the Newcastle–Ottawa Scale. Pooled OR were calculated using random-effects models. Heterogeneity was evaluated using Cochran’s Q test and data were stratified by potential sources of heterogeneity. Publication bias was analyzed. Eighteen studies were included. No association was found between rotating/night-shift work and prostate cancer, pooled OR 1.07 (95%CI 0.99 to 1.15), I2 = 45.7%, p = 0.016. Heterogeneity was eliminated when only cohort studies (pooled OR 1.03; 95%CI 0.96 to 1.10; I2 = 18.9%, p = 0.264) or high-quality studies (pooled OR 0.99; 95%CI 0.89 to 1.08; I2 = 0.0%, p = 0.571) were considered. A publication bias was detected. An association between shift work and prostate cancer cannot be confirmed with the available current data. Future analytical studies assessing more objective homogeneous exposure variables still seem necessary

Family Caregivers’ Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture

This research was funded by EIT Health (210752).Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, our objective was to use semi-structured interviews to explore family caregivers experience with the telerehab program. Methods: Twenty-one family caregivers were interviewed between three and six months after the older adults completed @ctivehip. One occupational therapist with research and clinical experience, but not involved in the main trial, conducted and transcribed the interviews. We conducted a multi-step content analysis, and two authors completed one coding cycle and two recoding cycles. Results: Family caregivers who enrolled in @ctivehip were satisfied with the program, stated it was manageable to use, and perceived benefits for older adults’ functional recovery after hip fracture. They also suggested improvements for the program content, such as more variety with exercises, and increased monitoring by health professionals. Conclusions: This work extends existing literature and generates research hypotheses for future studies to test telerehab content and program implementation.EIT Health 21075

Declared experiences of risky sexual behaviors in relation to alcohol consumption in the first year of college

El estudio ha sido financiado por el Plan Nacional Sobre Drogas del Ministerio de Salud, Servicios Sociales e Igualdad. Convocatoria de 2010 y de 2013. (Códigos: 2010/145 and 2013/034) y por el Instituto de Salud Carlos III a través de la convocatoria del FIS (Fondo de Investigación Sanitaria) de 2016 (PI16/01947).A Gregorio Barrio Anta, científico del Instituto Salud Carlos III, por su apoyo en la revisión final del artículo.Fundamentos: En universitarios, el consumo de alcohol de mayor riesgo (borracheras y binge drinking (BD), tiene consecuencias negativas sobre su desarrollo y probablemente facilita conductas sexuales de riesgo. El objetivo de este trabajo fue estudiar si las conductas sexuales de riesgo al consumir alcohol (CSRA) se asocian a los consumos de mayor riesgo. Métodos: Estudio multicéntrico transversal con datos del Proyecto uniHcos, de universitarios de 1er año de 11 universidades españolas, entre los cursos 2011-2012 y 2017- 2018. Datos recogidos mediante cuestionario autoadministrado. Se realizó un análisis uni y bivariable, evaluando la significación estadística de las diferencias de prevalencia con chi-cuadrado. Se utilizó media y desviación típica para variables cuantitativas y como estadístico de contraste t de Student. Resultados: 9.862 participantes (72,2% mujeres). El 90,3% consumió alcohol y el 60,9% tuvo borracheras en último año; el 49% tuvo BD en el último mes. El consumo en el último mes y las borracheras fueron mayores en hombres y < 21 años. Las CSRA fueron superiores entre los que se emborracharon (15,7% sexo sin protección, 1,9% abuso sexual y 0,7% aprovecharse sexualmente) y consumieron en BD (17,1%, 1,9% y 0,7%). Las mujeres con ambos consumos de riesgo presentaron más abusos sexuales (2,2%), y los hombres fueron quienes más se aprovecharon sexualmente de otros (borracheras:1,2%; BD: 1,3%). Conclusiones: El consumo de alcohol está por encima de grupos similares. El BD tiene un patrón similar por género y edad. Las CSRA se asocian a los consumos de mayor riesgo, no detectándose en este grupo diferencias por género en sexo sin protección, sí en otras CSRA.Background: In college students, higher risk alcohol consumption (drunkenness and binge drinking-BD) has negative consequences on their development and and probably facilitates risk sexual behaviors. The objective was to study if risky sexual behaviors when consuming alcohol (RSBA) are associated with higher risk consumption. Methods: Cross-sectional multicenter study with UniHcos Project, 1st year university students from 11 universities in Spain, academic years 2011-2012 to 2017-2018 data. This data were collected by self-administered questionnaire. A uni and bivariate analysis was performed, evaluated the statistical significance of the differences in prevalence with chisquare. Mean and standard deviation were used for quantitative variables and Student’s t test statistic was used. Results: 9,862 subjects (72.2% women). 90.3% reported having consumed alcohol and 60.9% had drunk the last year, 49% BD in last month. It was deteded in men, significantly higher consumption in the last month and drunkenness. Last month consumption and drunkenness were significantly higher in men and in <21 years. The RSBA were significantly higher among who were drunk (15.7% unprotected sex, 1.9% sexual abuse and 0.7% taking sexual advantage) and had BD (17.1%, 1.9% and 0.7 %). Women with both risk consumptions had more sexual abuse (2.2%), and men had greater behaviors of taking sexual advantage of someone (drunk: 1.2%; BD: 1.3%). Conclusions: Alcohol consumption was above similar groups. BD consumption was similar by gender and age. Risk sexual behaviors appear mainly in problematic consumption. Gender differences are not detected in alcohol consumers in unprotected sex but deteded in the rest.Plan Nacional Sobre Drogas del Ministerio de Salud, Servicios Sociales e Igualdad. Convocatoria de 2010 y de 2013. (Códigos: 2010/145 and 2013/034)Instituto de Salud Carlos III a través del FIS (Fondo de Investigación Sanitaria) de 2016 (PI16/01947

Prevalence of Depression and Fish Consumption among First Year Spanish University Students: UniHcos Project

The World Health Organization estimates that one fifth of university students have experienced major depressive disorder at some point in their lives. Nutrition may be one of the modifiable factors that influence the development of depression. Specifically, low omega-3 fatty acid and vitamin D levels, both nutrients found in high quantities in fish, have been linked to depressive disorders. The main objective of this study was to evaluate the prevalence of depression among young Spanish university students, in addition to the pattern of fish consumption among students and the possible relationship between fish consumption and the presence of depression. Data were collected retrospectively from a nationally representative sample of 11,485 Spanish university students aged 18 years or older in 11 Spanish universities, from 2012 to 2022. The respondents were analyzed according to frequency of consumption and compliance with weekly recommendations for fish intake and the presence of depression. Regression models were also performed to determine students’ odds of depression as a function of compliance with recommendations according to selected sociodemographic variables. The prevalence of depression was 10.5%; it was more prevalent in women, older students and in those with both high and low BMIs. In addition, it was also more prevalent in those that lived outside the family home, with roommates and those who were employed. Sixty-seven percent of the students met the fish intake recommendations. The most common frequency of fish consumption was 1–2 times/week (44.2%), and the least frequent was 2.3% daily fish consumption. Students from northern universities were more likely to consume fish (68.4%) than those from southern universities (66.4%). Non-consumption of fish was found to increase the risk of depression (ORa = 1.45 (1.28–1.64); AF = 31.0% (21.9–39.0)), but it was the student’s own conditions that had the greatest influence on the development of the disorder. In summary, a lower consumption of fish seems to be associated with a higher incidence of depression in Spanish university students; however, other social factors of the student may influence the development of the disorder, and all of this should be taken into account for the development of prevention strategies.variables. The prevalence of depression was 10.5%; it was more prevalent in women, older students and in those with both high and low BMIs. In addition, it was also more prevalent in those that lived outside the family home, with roommates and those who were employed. Sixty-seven percent of the students met the fish intake recommendations. The most common frequency of fish consumption was 1–2 times/week (44.2%), and the least frequent was 2.3% daily fish consumption. Students from northern universities were more likely to consume fish (68.4%) than those from southern universities (66.4%). Non-consumption of fish was found to increase the risk of depression (ORa = 1.45 (1.28–1.64); AF = 31.0% (21.9–39.0)), but it was the student’s own conditions that had the greatest influence on the development of the disorder. In summary, a lower consumption of fish seems to be associated with a higher incidence of depression in Spanish university students; however, other social factors of the student may influence the development of the disorder, and all of this should be taken into account for the development of prevention strategies.National Drug Plan from the Ministry of Health, Social Services and Equality of Spain 2010|145 2013|034 2020|030nstituto de Salud Carlos III Spanish Government PI16/0194

Cycling area can be a confounder and effect modifier of the association between helmet use and cyclists’ risk of death after a crash

The effect of helmet use on reducing the risk of death in cyclists appears to be distorted by some variables (potential confounders, effect modifiers, or both). Our aim was to provide evidence for or against the hypothesis that cycling area may act as a confounder and effect modifier of the association between helmet use and risk of death of cyclists involved in road crashes. Data were analysed for 24,605 cyclists involved in road crashes in Spain. A multiple imputation procedure was used to mitigate the effect of missing values. We used multilevel Poisson regression with province as the group level to estimate the crude association between helmet use and risk of death, and also three adjusted analyses: (1) for cycling area only, (2) for the remaining variables which may act as confounders, and (3) for all variables. Incidence–density ratios (IDR) and their 95% confidence intervals were calculated. Crude IDR was 1.10, but stratifying by cycling area disclosed a protective, differential effect of helmet use: IDR = 0.67 in urban areas, IDR = 0.34 on open roads. Adjusting for all variables except cycling area yielded similar results in both strata, albeit with a smaller difference between them. Adjusting for cycling area only yielded a strong association (IDR = 0.42), which was slightly lower in the adjusted analysis for all variables (IDR = 0.45). Cycling area can act as a confounder and also appears to act as an effect modifier (albeit to a lesser extent) of the risk of cyclists’ death after a crash

Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study

Objective To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash. Results Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists (‘over 74’ category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling. There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41). Conclusions We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.This work was partially supported by the National Council of Science and Technology of Mexico [doctorate grant number 410668]