Spanish National Research Articles

Tobacco, respiratory diseases, cardiovascular risk, and cancer: Classical approaches and new alternatives

Smoking tobacco is the main preventable aetiological factor of mortality worldwide, with a significant impact on respiratory and cardiovascular diseases and cancer. Smoking cessation and prevention must be prioritized in health care and legislative initiatives to reduce mortality and associated complications. To date, pharmacological treatments and behavioural therapies, along with community strategies, have been shown to be the most effective methods, especially when used in combination with a coordinated approach. However, their efficacy remains suboptimal and diminishes over time due to the high frequency of relapse. Data from the survey on alcohol and other drugs in Spain (EDADES) of the Spanish National Health System showed that the percentage of smokers has hardly decreased in recent decades and that many smokers do not intend to give up smoking, even those who have already suffered from some complications. In this context, the development of new products such as electronic cigarettes and heated tobacco may have some application in the population. The FDA recognition of risk-modifying products, the British Health System reports on electronic cigarettes, and the recommendations of the American College of Cardiology expert consensus on smoking cessation, among others, indicates the need to consider updating the multifactorial and multidisciplinary approach of smoking and its consequences.

Trends in glaucoma surgery in a tertiary hospital in Spain: 2010-2022.

This study aims to conduct an analysis glaucoma surgeries performed over a 13-year period at a tertiary hospital affiliated with the Spanish National Health System, with the goal of assessing temporal trends. This retrospective observational study scrutinized surgeries undertaken in the glaucoma unit of a tertiary center in Spain between 2010 and 2022. Data collected included surgical dates, procedure performed, whether it was standalone or combined, as well as patient demographics including age, sex, and type of underlying glaucoma. Surgeries on individuals under 18 years of age were excluded. An annual comparative analysis was performed to ascertain the evolving trends in glaucoma surgical interventions. A total of 12,944 surgeries were included in the analysis, comprising 9428 isolated cataract surgeries and 2975 glaucoma procedures. Trabeculectomy, glaucoma drainage devices (GDD), and cyclodestruction, collectively referred to as traditional surgery, demonstrated a decline from 93.2% to 23.6% over the study duration. Minimally invasive glaucoma surgery (MIGS) and minimally invasive bleb surgery (MIBS) demonstrated a significant increase from 3.8% in 2010 to 74.7% in 2022, relative to the total glaucoma surgeries. Furthermore, combined surgeries manifested a noteworthy increase from 39.0% in 2010 to 44.2% in 2022, with 86.4% of combined procedures in 2022 being MIGS or MIBS. In recent years, there has been a noticeable change in the trend of glaucoma surgeries, with MIGS and MIBS procedures experiencing a significant increase and becoming the most commonly performed glaucoma procedures. Consequently, traditional glaucoma surgeries have decreased in frequency.

Drug-facilitated sexual assault: An observational retrospective study in Barcelona (2018-2022)

Abstract Background Barcelona handles 400 to 500 sexual assaults yearly. Substance use is expected in one-third of reported assaults, being alcohol and cocaine the most detected substances. Nevertheless, there is a lack of updated information with reliable, recent, and context-specific data. Methods Retrospective observational study in people attended at the reference hospital for sexual assault care in Barcelona (H.Clinic) within 24 hours of the drug facilitated sexual assault (DFSA) in the period 2018-2022. Univariate and bivariate analysis have been carried out to describe the characteristics of the victims and identify possible associations with the assault settings, relationship with the aggressor and substances involved. Results Among 682 cases of DFSA, women represent 85%. Most incidents (73%) occur in the 18 to 35 age group, primarily in homes (42%), public spaces (23%), and nightlife establishments (15%). Spanish nationality is most common in both sexes (50%), yet Latin American men are prominent in drug-involved cases compared to non-Spanish European men. While alcohol (55%) and cocaine (28%) remain common, emerging drugs like GHB (15%) and MDMA (23%) are rising. The aggressor varies depending on the age and sex of the victim, with the perpetrator often being known (46%) in cases involving minor victims, while it tends to be unknown (46%) in cases involving adult victims. Chemical submission-related cases increased steadily, reaching 17% in 2022. Among these victims, 75% were women, with MDMA and cocaine being prevalent, while methamphetamine and GHB were more common among men. All these findings are statistically significant. Conclusions The study highlights a significant number of drug-facilitated sexual assaults mostly among young women, often occurring domestically, alongside emerging substance use trends. Adaptable surveillance systems are crucial to address these dynamic patterns and support vulnerable populations for safer environments. Key messages • Drug facilitated sexual assaults are a global health issue that demands attention through a gender perspective. Substances, spaces and consumption patterns evolve over time and across generations. • Patterns in substance use vary by age, nationality, sex, and consumption type, highlighting vulnerable population groups needing focused protection and assault prevention.

Hereditary transthyretin amyloidosis caused by Val142Ile variant in Spain: phenotypic characteristics, geographic distribution and population frequency

Abstract Background During recent years, several cases of hereditary transthyretin amyloidosis (ATTRv) due to p.Val142Ile have been described in patients without African ancestry in countries like Japan, Spain or Italy (1,2,3,4). All this evidence suggests that p.Val142Ile might be more prevalent than expected worldwide. Objectives The aim of this study was to analyze the impact of ATTRv caused p.Val142Ile in Spain to define its phenotypic characteristics, to explore endemic geographical areas and define its population frequency. Methods Patients diagnosed with ATTRv caused by p.Val142Ile and carriers irrespective of their phenotype were recruited from 16 centers in Spain. Baseline characteristics and events during follow-up were retrieved. Population frequency was assessed through the Spanish National DNA bank (N=3,569) and the Catalan Health Databank (N=790). Results The cohort included information regarding 164 subjects (75 probands [45.7%] and 89 relatives [54.3%]). Among probands, mean age was 73.9 ± 8.5 years and 47 (62.7%) were males. 67 probands (89.3%) had self-declared European ancestry and only 6 cases (8%) referred African or Afro-American ancestry. Cardiac symptoms were the most frequent reason leading to ATTRv diagnosis (N=64, 85.3%) followed by incidental finding (N=8, 10.7%) and neurologic symptoms (N=3, 4%). (Figure 1). Median follow-up was 1.6 years (Interquartile range 0.6-3.2). Neurologic involvement was observed in 35 probands (46.7%) at first evaluation or during follow-up. Overall penetrance at 65, 75 and 85 years was 12.8%, 44.3% and 94.2% respectively. Male sex was associated with earlier penetrance than women (P = 0.02). 38 patients initiated treatment with tafamidis during follow-up (28 [73.7%] 20 mg and 10 [26.3%] 61 mg), despite treatment, disease progression at 1 year (cardiovascular death or 30% increase of NTProBNP) was observed in 10 patients (40%). Population frequency was estimated between 0.0% and 0.12% based on the Spanish and Catalan databases respectively. Birthplace of probands suggests a higher prevalence in the Mediterranean basin. (Figure 2) Conclusions Our data suggests that ATTRv caused by p.Val142Ile has a significant prevalence in Spain, mostly in some specific regions. Phenotypic features are defined by late onset, male predominance, and cardiac involvement although a significant proportion develop neuropathy. Disease progression was observed in 40% of patients despite disease-modifying therapies.

Increasing trends in hepatitis E hospitalisations in Spain, 1997 to 2019.

BackgroundHepatitis E, a viral hepatitis caused mainly by the ingestion of raw or undercooked food, is not a notifiable disease in Spain.AimTo analyse the temporal trends, epidemiological characteristics and factors associated with severe disease from hepatitis E hospitalisations in Spain from 1997 to 2019.MethodsHospitalisation records were obtained from the Spanish National Hospital Discharge Database. Temporal trends and seasonality were analysed by Poisson regression in years 1997-2015 and 2016-19, given changes in hospital discharge databases. Multivariate logistic regression was used to identify factors associated with severe disease.ResultsHepatitis E hospitalisation incidence increased from 0.22 cases per 1,000,000 inhabitants in 1997 to a maximum of 2.95 in 2018. Seasonality was observed during 2016-19 period, with more cases in the second and third quarters of the year. The incidence was higher in men vs women, and in the population aged over 40 years. Factors independently associated with death were age ≥ 50 years (adjusted odds ratio (aOR): 2.43), chronic liver disease (aOR: 4.29), HIV infection (aOR: 3.00) and hepatitis B/C (aOR: 2.11).ConclusionsHepatitis E hospitalisations have increased in Spain in recent years, being more severe in cases with older age, chronic hepatic diseases and HIV infection. A greater incidence in men over 40 years and a possible seasonality were observed. Further studies are needed to assess the seasonality, geographical distribution and impact of the disease to guide public health actions for prevention and control.

Healthcare Costs of Hospitalizations Due to Aspergillosis and 25-Year Trends in Spain, 1997–2021

In the last 40 years, a significant increase in the incidence of lung infections by Aspergillus has been reported. The scarcity of studies that describe the costs of aspergillosis indicates that the economic impact of aspergillosis in the hospital environment is greater than that of other fungal infections. The objective of the study was to evaluate the direct healthcare costs associated with aspergillosis in the Spanish National Health System from 1997 to 2021. A retrospective nationwide longitudinal descriptive study was designed to review hospital records from the Minimum Basic Data Set of patients admitted to hospitals of the National Health System from 1997 to 2021, with a diagnosis of aspergillosis. A total of 44,586 patients were admitted for aspergillosis in the Spanish National Health System. There was a progressive increase in the average annual cost from 1997 to 2012, which reached a maximum peak, EUR 1,395,154.21 (±2,155,192.87). It decreased between 2014 and 2019, but increased again in 2020 and 2021, EUR 28,675.79 (±30,384.12). The Pearson correlation coefficient revealed a weak negative correlation between age and hospital costs and a moderate positive correlation between average length of stay and hospital costs. Our data show that the economic impact of hospitalizations for aspergillosis is significant and increasing at a rate proportionally higher than that of other prevalent diseases. Costs related to Aspergillus infection are associated mainly with respiratory diseases. The results of this economic evaluation may be useful for health authorities to develop a future economic strategy for managing this fungal infection.

Relationship Between Frequency of Physical Activity, Functional Mobility, and Self-Perceived Health in People with Different Levels of Pain: A Cross-Sectional Study.

Background: Habits including regular physical activity are necessary for maintaining good health. Functional mobility, including walking and going up and down stairs, is essential for personal autonomy and well-being. Pain is a condition related to biological and psychosocial aspects that influence people's lives. Objective: The main objectives of this study were (1) to analyse the associations between physical activity frequency (PAF) and self-perceived health (SPH) and functional mobility (walking and going up and down stairs) in middle-aged and older people living in Spain with different pain levels; and (2) to analyse the risk factors for having a negative SPH and functional mobility difficulties by calculating the probabilistic risks adjusted by different variables (sex, body mass index, social class, civil status, smoking status, pain level, and PAF). Methods: A cross-sectional study based on the European Health Survey data in Spain (EHSS 2014-2020) and The Spanish National Health Survey (SNHS 2017) was carried out, with a final sample of 21,152 participants with ages between 40 and 79 years. Results: Associations between high pain levels and worse SPH and difficulties in walking and climbing stairs were found. Lower PAF levels were associated with higher-probability risks of having a negative SPH and difficulties in walking and climbing stairs. Conclusions: Physical inactivity emerged as an important risk factor for worse SPH and functional mobility. These associations underline the importance that PA programmes can play in the improvement of health and functional mobility, as well as in other aspects, in people with pain.

Influence of patient characteristics and discharge destination on circulatory system diseases readmissions among older heart failure patients

IntroductionHeart failure (HF) prevalence is rising, particularly among older people, constituting a significant cause of hospitalization. Discharge destinations, including nursing homes (NH), play a crucial role in post-hospitalization outcomes but remain underexplored. MethodsA retrospective study utilizing the Spanish National Health System's Minimum Basic Data Set identified older HF patients (≥75 years) discharged from acute hospitals between 2016 and 2019. Patient demographics, comorbidities, and discharge destinations were analyzed. Predictors of 30-day readmissions for circulatory system diseases and NH admission were assessed using multilevel logistic regression models. ResultsOf 157,330 index episodes, 2.8 % were discharged to NH, more frequently in females. Thirty-day readmission incidence was 9.3 %, with HF exacerbations accounting for 80.6 % of cases. Predictors of 30-day readmission included renal failure (OR: 1.38), severe hematological disorders (OR: 1.30), and history of coronary revascularization surgery (OR: 1.23), while discharge to NH lowered the risk (OR: 0.70). Admission to NH was associated with neurological diseases (OR: 3.27), cardiogenic shock (OR: 3.19), stroke (OR: 2.68), advanced cancer (OR: 2.51), with higher likelihood among females (OR: 1.23). After propensity score-matched analysis, patients discharged to NH had significantly lower 30-day readmission rates than those discharged home (6.4 % vs. 28.9 %, adjusted OR: 0.169). ConclusionDischarge to NH is infrequent but associated with lower readmission risk for older HF patients. Female gender, specific comorbidities, and acute conditions influence NH admission. Enhanced collaboration between HF units and NH is crucial for optimizing post-hospitalization outcomes. Further research and policy initiatives are needed to improve care coordination and reduce HF readmissions.

Overeducation under different macroeconomic conditions: How Spanish university graduates fit in the labor market?

This paper analyzes a relevant issue for education and labor policymakers, overeducation in the early careers of university graduates. Using Spanish data, we investigate the role played by the business cycle and field of study and their interaction in shaping both the incidence and persistence of overeducation. We also analyze the relevance of specific types of knowledge and skills as driving factors in reducing overeducation risk. Our data come from the Survey on the Labor Insertion of University Graduates (EILU) conducted by the Spanish National Statistics Institute in 2014 and 2019. The survey collects rich information on cohorts that graduated in 2019 and 2014, during the Great Recession and the subsequent economic recovery, respectively. Our results show, first, the relevance of the economic scenario when graduates enter the labor market. Graduation during a recession increases overeducation risk and persistence. Second, a clear heterogeneous pattern is observed across fields of study, with health sciences graduates displaying better performance in terms of both overeducation incidence and persistence and less impact of the business cycle. Third, we find evidence that some transversal skills can help to reduce overeducation risk in the absence of specific knowledge required for the job, thus indicating some kind of compensatory role. Our findings have important policy implications. Overeducation, and more importantly overeducation persistence, imply a non-neglectable misallocation of resources, with serious consequences not only for the affected individuals but for the society as a whole. Therefore, policymakers need to address this issue in the design of education and labor market policies, seeking to ensure that the competencies acquired at university provide graduates with a better fit in the labor market.

Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study.

Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.

Hospital admissions for pyoderma gangrenosum in Spain (1999-2021): Epidemiological and clinical characteristics, temporal trends, and factors associated with poor prognosis and higher cost.

Pyoderma gangrenosum (PG) is a neutrophilic inflammatory dermatosis that can be idiopathic or associated with other diseases. The aim was to analyze the epidemiological and clinical characteristics, temporal trends, risk factors for poor prognosis, and admission costs associated with PG in Spain. We conducted a retrospective study, based on the Hospital Discharge Registry of the Spanish National Health System in Spain from 1999 to 2021. Of 82,161,670 admissions during the study period, 4901 were for PG (hospitalization rate of 59.7/1,000,000 admissions). PG hospitalizations increased from 28.8/1,00,000 in 1999 to 91.9/1,000,000 in 2021. PG was a primary cause of admission in 60.5% of cases, and 58.4% of patients were women. The main PG-related comorbidities were inflammatory bowel disease (15.7%) and neoplasms (10%). There was a significant increase over the years in admissions for inflammatory bowel disease, monoclonal gammopathy of undetermined significance, and lymphoma, as well as an increase in diseases unrelated to PG, such as hypertension, diabetes, and chronic kidney disease. The hospital mortality rate was 5.6%. Death was associated with PG being a primary diagnosis, older age, leukemia, neoplasms, diabetes, and chronic kidney disease. The cost of treatment increased over the years and was higher in older people. PG cases in the inpatient setting in Spain over the past 23 years make up a tiny proportion of all hospital admissions, although the rate of hospitalization for PG has increased in the last two decades.

Climate change and non-native species in the Spanish Network of National Parks

AbstractThe Iberian Peninsula is a primary entry point for non-native species (NNS) into Europe via maritime routes, and is a significant tourist destination. This positions the highly diverse Spanish National Parks at high risk from invasive species, necessitating proactive adaptation and mitigation strategies. We present a comprehensive analysis of the risks posed by NNS to the network of 15 continental and marine National Parks in Spain under climate change, aiming to align management strategies with international Global Biodiversity Framework (GBF) targets. We identified 200 NNS across the network of National Parks, including 78 listed in national NNS regulations. Park managers helped identify 22 priority NNS, including the water hyacinth, American mink, Cape fig and wakame, among others. Over half of the 22 priority NNS (55%) were classified as having a “Major” impact on native biodiversity according to EICAT standards, with another 23% considered “Massive”. Distribution models suggest that rising minimum temperatures could enable NNS to expand in altitude within the parks, particularly in high-mountain parks. Species like the barbary sheep, water hyacinth and largemouth bass may particularly benefit from global warming. Our findings prioritize national parks most vulnerable to the double threat posed by climate change and invasive species, such as Islas Atlánticas, Doñana and Archipelago de Cabrera. We conclude that, in order to progress towards achieving GBF goals, it is essential to: (i) coordinate NNS management efforts across administrations (national and regional), (ii) integrate resources and expertise in a unified strategy against invasion across the network and (iii) enhance public awareness about the risks of introduction and impact of NNS.

The societal cost of 'unwanted' loneliness in Spain.

Unwanted loneliness negatively affects people's health and quality of life, increasing morbidity and the risk of premature death; this situation can generate major social costs. The aim of this study is to estimate the social costs of loneliness in Spain for 2021: both tangible costs -monetary value of health costs and production losses- and intangible costs -Quality Adjusted Life Years (QALYs). To estimate costs not derived from mortality, information from a sample of 400 people with unwanted loneliness was compared with that derived from two samples of the general population obtained from the Spanish National Health Surveys. To estimate the costs associated with premature deaths, the population attributable fraction was calculated using the relative risks estimated in previous survival studies. In the baseline scenario, the tangible costs of unwanted loneliness are estimated to be around 14,129million euros in 2021, representing 1.2% of Spain's GDP. Approximately 56.8% of the tangible costs correspond to production losses due to reduced working time, and 43.2% are due to healthcare costs related with increased consultation frequency in healthcare services and higher consumption of medicines related to loneliness. In addition, loneliness generates a reduction in quality of life equivalent to 1.04million QALYs, which corresponds to 2.8% of the total stock of QALYs of the Spanish population over 15 years of age.

Influencia del sexo, país, IMC, uso de Instagram, moralización de la comida e imagen corporal sobre la dismorfia corporal en adultos jóvenes de España y Venezuela

Body Dysmorphia Disorder (BDD) is characterized by an excessive concern with physical appearance, which has been of interest to the scientific community in recent years. Different variables have been found to influence BDD; therefore, the aim of the present research was to determine the direct and indirect effect of gender, country, age, body mass index, Instagram use, food moralization and body image on dysmorphia; comparing Spanish and Venezuelan nationality. A path analysis was performed with the total sample (208 participants), finding that the variables thatdirectly or indirectly influence are sex, body mass index, food-related guilt, country and body image; also, people who present body dysmorphia behaviors tend to be women, people with high BMI, greater dissonance between their body image and perceived body image, and tend to feel food-related guilt. In addition, in an indirect way, Venezuelans presented greater body dysmorphia behaviors. We conclude the relevance of these variables on BDD and recommend considering these findings when planning intervention strategies and prevention policies.

"Code Headache": Development of a protocol for optimizing headache management in the emergency room.

Patients presenting at the emergency room (ER) with headache often encounter a hostile atmosphere and experience delays in diagnosis and treatment. The aim of this study was to design a protocol for the ER with the goal of optimizing the care of patients with urgent headache to facilitate diagnosis and expedite treatment. A narrative literature review was conducted via a MEDLINE search in October 2021. The "Code Headache" protocol was then developed considering the available characteristics and resources of the ER at a tertiary care center within the Spanish National Public Health system. The Code Headache protocol comprises three assessments: two scales and one checklist. The assessments identify known red flags and stratify patients based on suspected primary/secondary headaches and the need for pain treatment. Initial assessments, performed by the triage nurse, aim to first exclude potentially high morbidity and mortality etiologies (HEAD1 scale) and then expedite appropriate pain management (HEAD2 scale) based on scoring criteria. HEAD1 evaluates vital signs and symptoms of secondary serious headache disorders that can most benefit from earlier identification and treatment, while HEAD2 assesses symptoms indicative of status migrainosus, pain intensity, and vital signs. Subsequently, ER physicians employ a third assessment that reviews red flags for secondary headaches (grouped under the acronym 'PEACE') to guide the selection of complementary tests and aid diagnosis. The Code Headache protocol is a much needed tool to facilitate quick clinical assessment and improve patient care in the ER. Further validation through comparison with standard clinical practice is warranted.

Lifestyle Habits and Risk of Cardiovascular Mortality in Menopausal Women with Cardiovascular Risk Factors: A Retrospective Cohort Study.

Current cardiovascular prevention guidelines emphasise considering sex, gender, and gender identity in risk assessment. This study evaluated the impact of lifestyle habits and chronic diseases on cardiovascular mortality risk in women over 50 with high vascular risk and developed a predictive model for menopausal women with cardiovascular risk factors. A retrospective cohort study used data from the 2011 Spanish National Health Survey and the national death register, focusing on menopausal and postmenopausal women without prior cardiovascular events but with at least one major risk factor. Participants were followed for up to 10 years, assessing mortality from circulatory system diseases and other causes. Exposure variables included socio-demographics, lifestyle habits, health status, self-perceived health, health service use, and pharmacological treatments. Of the 21,007 respondents, 3057 women met the inclusion criteria. The 10-year cumulative incidence of mortality from circulatory causes was 5.9%, and from other causes, 12.7%. Independent predictors of cardiovascular mortality were never consuming legumes, poor self-perceived health, diabetes treatment, lack of physical activity, and older age. Lipid-lowering treatment was protective. The model demonstrated good fit and predictive capacity (C-index = 0.773). This study highlights the significant influence of physical activity, legume consumption, self-perceived health, and specific treatments on cardiovascular mortality risk in menopausal women.

The association of material deprivation with major depressive disorder and the role of loneliness and social support: A cross-sectional study

BackgroundExisting research has highlighted the positive association of material deprivation, loneliness, and poor social support with major depressive disorder (MDD). However, there is limited information on the complex interplay between these risk factors. In this study, we investigated (1) whether loneliness and social support moderate the relationship between material deprivation and MDD and (2) whether social support moderates the association between material deprivation and loneliness. MethodsWe conducted a cross-sectional study analyzing responses from a representative sample of the Spanish adult population, comprising 2790 individuals who were interviewed between 2019 and 2021. The 12-month prevalence of MDD was assessed using the Composite International Diagnostic Interview (CIDI). Loneliness was measured using the three-item UCLA Loneliness Scale, and social support was evaluated with the Oslo social support scale. Material deprivation was measured using an instrument developed by the Spanish National Institute of Statistics (INE). Regression models were constructed to investigate moderating effects. ResultsAbout 25 % of participants experienced material deprivation and 2.8 % had MDD. Among those with lower levels of loneliness, the probability of MDD was almost 0.10 and no significant differences were found in relation to material deprivation. Conversely, differences depending on material deprivation ranged from 0.10 (95 % CI 0.03, 0.18) to 0.44 (95 % CI 0.24, 0.65) among those with higher levels of loneliness. Social support effectively moderated the association between material deprivation and loneliness. LimitationThe cross-sectional nature limits causal inferences. ConclusionSocial support has the potential to improve loneliness and mental health in individuals with economic difficulties.

Why are workers in the Spanish energy industry more likely to earn higher wages than other Spanish workers?: Wages in the Spanish energy sector

In Spain, 85.5 % of energy industry workers have a salary that is more than the Spanish average salary. We apply a binomial logit model based on the maximum likelihood estimation method to analyze the factors that determine the probability of obtaining these higher wages. The sample used was taken from the Wage Structure Survey (2018) prepared by the Spanish National Institute of Statistics. Firstly, the results show that this sector has a consolidated workforce and that the workers' educational levels are appropriate for their jobs. Secondly, there are no gender-based wage differences in this industry. Finally, working conditions and wages are established through collective bargaining agreements at the company level, which stands in contrast to other types of agreements established in the rest of the Spanish economy.

Symptoms of Attention Deficit Hyperactivity Disorder and Oral Health Problems among Children in Spain

Introduction: The aim of this study was to explore the association between symptoms of attention deficit hyperactivity disorder (ADHD) and oral health in a representative sample of the Spanish population aged 6–14 years. We also examined the contribution of several sociodemographic and behavioral determinants of children/adolescents and their family environment. Methods: A cross-sectional study involving 3,402 subjects aged between 6 and 14 years from the Spanish National Health Survey. The presence of ADHD symptoms was determined using the self-reported hyperactivity/inattention subscale of the Strength and Difficulties Questionnaire. Oral health was assessed using five indicators: caries, extraction, restorations, gingival bleeding, and the presence of teeth in poor condition (e.g., broken or misaligned). Logistic regressions were used to examine the association between the presence of ADHD symptoms and oral health indicators. These models were adjusted for sociodemographic factors, lifestyle variables, and oral hygiene behaviors relating to both the children and their parents. Results: Compared to children without ADHD symptoms, children with ADHD symptoms had a higher risk of caries (fully adjusted odds ratio: 2.16; 95% confidence interval: 1.66–2.82), extraction (1.42; 1.09–1.85), restoration (1.47; 1.19–1.82) and gingival bleeding (1.64; 1.11–2.41). The increased risk of caries was maintained when the analyses were restricted to middle/high social class families and children with low sugar intake, good oral hygiene behaviors and regular dental visits. Conclusions: Children with ADHD symptoms in Spain had worse oral health indicators than those without ADHD symptoms. Our results suggest that the association of ADHD symptoms with caries was independent of socioeconomic level, cariogenic diet, frequency of toothbrushing, and dental visits.

Comprehensive analysis of multiple sclerosis hospitalization trends in Spain (1998–2022)

ObjectiveTo analyse the trends in MS hospitalization rates in Spain (1998–2022) considering age, period, and birth cohort (A-P-C) effects. MethodsThis retrospective study used data on MS hospitalizations from the Spanish National Health System Minimum Basic Data Set (CMBD). Age-Standardized Hospitalization Rates (ASHRs) and Joinpoint analysis were used to assess trends. A-P-C analysis was performed to estimate age-specific rates, period and cohort effects. ResultsFrom 1998 to 2022, MS hospital admissions in Spain declined annually by -2.1 %, with women showing a slightly greater decrease (-2.3 %) than men (-1.7 %). Joinpoint analysis revealed non-parallel trends, with three inflection points indicating distinct periods of stabilization and decline. ASHR showed an overall decrease, with -2.0 % for men and -2.2 % for women annually. Risk of hospitalization peaked in the 25–29-year age group for men and 30–34-year age group for women, declining with age. Women consistently had higher risk ratios across age groups. Cohort analysis showed periods of stabilization and decline in MS hospitalization risk, aligning with joinpoint analysis findings. Risk increased for cohorts born in the early 20th century, peaking around 1938, followed by a progressive decline in later cohorts. ConclusionsDespite an aging population, MS hospitalization rates in Spain decreased. The risk of hospitalization for MS is affected by a person's age, the time period they were born in, the historical context of healthcare received, and potentially their sex.