Evidencia epidemiológica acerca del rol de la hostelería en la transmisión de la COVID-19: una revisión rápida de la literatura / Epidemiologic evidence on the role of hospitality venues in the transmission of COVID-19: a rapid review of the literature

Objetivo: Revisar la literatura científica disponible para resumir la evidencia epidemiológica al respecto del impacto de la hostelería en la incidencia y la mortalidad de la COVID-19. Método: Se incluyeron estudios en cualquier población, que describieran tanto el impacto del cierre o la reapertura de la hostelería como la exposición a negocios de hostelería sobre la incidencia y la mortalidad de la COVID-19. Se empleó el método de búsqueda en bola de nieve, con búsqueda retrospectiva y prospectiva de citas y cocitaciones. Resultados: Se encontraron 20 estudios que investigaron el papel de la hostelería en la epidemiología de la COVID-19. Los estudios de modelaje evidencian que las intervenciones relacionadas con la disminución de los contactos sociales en el interior de los negocios tienen la capacidad para disminuir la velocidad de transmisión. Los estudios de inferencia estadística mostraron resultados similares, afirmando que el cierre de la hostelería es una de las medidas más efectivas para disminuir la incidencia y la mortalidad. Los estudios de brotes muestran la capacidad de los establecimientos de hostelería y restauración para generar eventos de supercontagio, a la vez que enfatizan la importancia de controlar las corrientes de aire y la correcta ventilación del interior de los establecimientos. Conclusiones: Se encuentra una gran consistencia en la literatura al señalar que el cierre de los locales de hostelería es una de las medidas más efectivas para disminuir la incidencia y la mortalidad de la COVID-19. Además, se señalan algunas medidas, como la limitación de aforos y la ventilación, como aspectos a monitorizar en los procesos de reapertura de estos locales. (AU)

Objective: To review the scientific epidemiologic evidence on the role of hospitality venues in the incidence or mortality from COVID-19. Method: We included studies conducted in any population, describing either the impact of the closure or reopening of hospitality venues, or exposure to these venues, on the incidence or mortality from COVID-19. We used a snowball sampling approach with backward and forward citation search along with co-citations. Results: We found 20 articles examining the role of hospitality venues in the epidemiology of COVID-19. Modeling studies showed that interventions reducing social contacts in indoor venues can reduce COVID-19 transmission. Studies using statistical models showed similar results, including that the closure of hospitality venues is amongst the most effective measures in reducing incidence or mortality. Case studies highlighted the role of hospitality venues in generating super-spreading events, along with the importance of airflow and ventilation inside these venues. Conclusions: We found consistent results across studies showing that the closure of hospitality venues is amongst the most effective measures to reduce the impact of COVID-19. We also found support for measures limiting capacity and improving ventilation to consider during the re-opening of these venues. (AU)

[Epidemiologic evidence on the role of hospitality venues in the transmission of COVID-19: A rapid review of the literature]. / Evidencia epidemiológica acerca del rol de la hostelería en la transmisión de la COVID-19: una revisión rápida de la literatura.

OBJECTIVE: To review the scientific epidemiologic evidence on the role of hospitality venues in the incidence or mortality from COVID-19. METHOD: We included studies conducted in any population, describing either the impact of the closure or reopening of hospitality venues, or exposure to these venues, on the incidence or mortality from COVID-19. We used a snowball sampling approach with backward and forward citation search along with co-citations. RESULTS: We found 20 articles examining the role of hospitality venues in the epidemiology of COVID-19. Modeling studies showed that interventions reducing social contacts in indoor venues can reduce COVID-19 transmission. Studies using statistical models showed similar results, including that the closure of hospitality venues is amongst the most effective measures in reducing incidence or mortality. Case studies highlighted the role of hospitality venues in generating super-spreading events, along with the importance of airflow and ventilation inside these venues. CONCLUSIONS: We found consistent results across studies showing that the closure of hospitality venues is amongst the most effective measures to reduce the impact of COVID-19. We also found support for measures limiting capacity and improving ventilation to consider during the re-opening of these venues.

La eficiencia no basta. Análisis ético y recomendaciones para la distribución de recursos escasos en situación de pandemia / Efficiency is not enough. Ethical analysis and recommendations for the allocation of scarce resources in a pandemic situation

Objetivo: Elaborar una herramienta de apoyo que ayude a tomar decisiones en el marco de la pandemia de COVID19. Método: Se parte de una búsqueda de diferentes recomendaciones éticas surgidas en España sobre priorización de recursos sanitarios escasos en la pandemia de COVID19, así como de una revisión narrativa de modelos teóricos sobre distribución en pandemias para definir una fundamentación ética. Finalmente, se extraen recomendaciones para su posible aplicación en distintos ámbitos asistenciales. Resultados: Se identifican tres principios, igualdad estricta, equidad y eficiencia, que se sustancian en criterios de distribución específicos. Conclusiones: Se propone un modelo de distribución de recursos sanitarios escasos en situación de pandemia que parte de un procedimiento de toma de decisiones y adapta los criterios de distribución a los escenarios de la atención sanitaria: atención primaria, residencias sociosanitarias y atención hospitalaria. (AU)

Objective: To develop a support tool to decision-making in the framework of the COVID19 pandemic. Method: Different ethical recommendations that emerged in Spain on prioritizing scarce health resources in the COVID19 pandemic first wave were searched; it was conducted a narrative review of theoretical models on distribution in pandemics to define an ethical foundation. Finally, recommendations are drawn to be applied in different healthcare settings. Results: Three principles are identified; strict equality, equity and efficiency, which are substantiated in specific distribution criteria. Conclusions: A model for the distribution of scarce health resources in a pandemic situation is proposed, starting with a decision-making procedure and adapting the distribution criteria to different healthcare scenarios: primary care settings, nursing homes and hospitals. (AU)

Selective perimeter lockdowns in Madrid: a way to bend the COVID-19 curve?

Lockdowns have been widespread used to limit social interaction and bend the epidemic curve. However, their intensity and geographical delimitation have been variable across different countries. Madrid (Spain) implemented perimeter lockdowns in September with the purpose of bending the COVID-19 curve. In this article, we compared, using join point regressions, the evolution of COVID-19 cases in those areas where this intervention was implemented and those where it was not. According to our analysis, the decrease in the epidemic curve started before the impact of the perimeter lockdown could be reflected.

[Efficiency is not enough. Ethical analysis and recommendations for the allocation of scarce resources in a pandemic situation]. / La eficiencia no basta. Análisis ético y recomendaciones para la distribución de recursos escasos en situación de pandemia.

OBJECTIVE: To develop a support tool to decision-making in the framework of the COVID-19 pandemic. METHOD: Different ethical recommendations that emerged in Spain on prioritizing scarce health resources in the COVID-19 pandemic first wave were searched; it was conducted a narrative review of theoretical models on distribution in pandemics to define an ethical foundation. Finally, recommendations are drawn to be applied in different healthcare settings. RESULTS: Three principles are identified; strict equality, equity and efficiency, which are substantiated in specific distribution criteria. CONCLUSIONS: A model for the distribution of scarce health resources in a pandemic situation is proposed, starting with a decision-making procedure and adapting the distribution criteria to different healthcare scenarios: primary care settings, nursing homes and hospitals.

Prevención: ¿aún podemos ser amigos? / Prevention: can we still be friends?

La prevención ha pasado de ser un abordaje específico en el ámbito de algunas enfermedades a ser un valor central en los discursos y la organización de los sistemas de salud. No obstante, la prevención no es un valor absoluto sin externalidades negativas, problemas de gestión del conocimiento o utilización del poder, sino que su popularización y expansión ha supuesto el incremento de los inconvenientes derivados de la gestión inadecuada del riesgo, la utilización a nivel poblacional de valores éticos desarrollados en el ámbito de la ética clínica individual y la medicalización de la vida diaria, más acusada con los nuevos paradigmas surgidos de la medicina post-genómica. En este artículo se tratan de abordar los riesgos clave de la deriva preventiva de los sistemas de salud y destacar los aspectos que deberían caracterizar las actividades preventivas de las próximas décadas

Prevention has gone from being a specific approach in the field of some diseases to being a central value in discourses and the organization of health systems. However, prevention is not an absolute value without negative externalities, knowledge management problems or use of power, but its popularization and expansion have led to an increase in the drawbacks derived from inadequate risk management, population-level utilization of ethical values developed in the field of individual clinical ethics and the medicalization of daily life, more pronounced with the new paradigms arising from post-genomic medicine. This article tries to address the key risks of the preventive trend of health systems and highlight the aspects that should characterize the preventive activities of the coming decades

Reticencia vacunal: análisis del discurso de madres y padres con rechazo total o parcial a las vacunas / Vaccine hesitancy: discourse analysis of parents who have not fully or partially vaccinated their children

Objetivo: Analizar y comprender los discursos reticentes a la vacunación, particularmente los de las personas que han decidido no vacunar a sus hijos/as. Métodos: Estudio cualitativo con cinco entrevistas individuales y dos grupos focales con personas que optaron por no vacunar a su hijos/as en la provincia de Granada. Resultados: Padres y madres manifiestan un sistema de creencias en salud diferente al paradigma biomédico. Desde el punto de vista ético, justifican su posición a partir del derecho a la autonomía y la responsabilidad de sus decisiones. Como argumentos concretos, dudan de la administración de varias vacunas simultáneamente en edades muy tempranas de manera sistemática y sin individualizar cada caso, temen efectos adversos y no entienden la variabilidad en el calendario vacunal. Conclusiones: Los discursos reticentes responden al conflicto de individualidad vs. colectividad: padres y madres, en defensa de su derecho a una crianza sin interferencias del Estado, centran su responsabilidad en el bienestar individual de sus hijos/as independientemente de las consecuencias que su acción u omisión conlleve a la colectividad. En su gestión de los riesgos, elevan los derivados de vacunar por encima de las consecuencias individuales y colectivas de no hacerlo. Las vacunas que más dudas generan son aquellas con mayor controversia en el ámbito científico. La transparencia en la comunicación de efectos adversos, el respeto de las autoridades a otros conceptos de salud/enfermedad, el destierro del término «antivacunas» del lenguaje mediático y científico, y el desarrollo de espacios de diálogo son puentes por construir

Objective: To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters. Methods: Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain). Results: Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule. Conclusions: These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term "anti-vaccines" from the media and scientific vocabulary, and developing spaces for dialogue are bridges to be built

[Vaccine hesitancy: discourse analysis of parents who have not fully or partially vaccinated their children]. / Reticencia vacunal: análisis del discurso de madres y padres con rechazo total o parcial a las vacunas.

OBJECTIVE: To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters. METHODS: Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain). RESULTS: Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule. CONCLUSIONS: These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term "anti-vaccines" from the media and scientific vocabulary, and developing spaces for dialogue are bridges to be built.

Cáncer y consumo de carne: más allá de los estilos de vida individuales / Cancer and meat consumption: beyond individual life styles

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