Impact of socioeconomic and health-related factors on consumption of homeopathic and natural remedies in Spain in 2006, 2011 and 2017 / 中西医结合学报

OBJECTIVE@#Complementary and alternative medicine use and type of use may be influenced by sociodemographic and economic determinants through which we could identify characteristics of patients with greater trend to use it. This paper aims to describe the changes in the consumption of homeopathic and natural remedies in Spain for three time points in order to discern changes in rate of consumption, associated factors and whether their use has been affected by a period of economic recession.@*METHODS@#This study utilized 2006, 2011 and 2017 cross-sectional data from the Spanish National Health Survey, a nationally representative survey of the population aged more than 15 years old and resident in Spain. Independent bivariate and multivariate descriptive analyses for each of the 3 years studied were performed.@*RESULTS@#The rate of consumption of both homeopathic and natural remedies has decreased over the periods studied. In spite of this decrease, the consumer profile appears to remain stable over the three periods. The sociodemographic factors associated with their consumption were being female, being 30-64 years old, being separated/divorced, having higher education qualifications, being employed and belonging to a higher social class. Psychiatric morbidity, chronic health problems such as pain, mental health problems or malignant tumors, and absence of major cardiovascular events were the clinical factors associated.@*CONCLUSION@#It can be concluded that beyond the economic situation, the use of homeopathic and natural remedies obeys to the needs of the patients related to their state of health and the response they receive from the health system. It may be that women have different needs and expectations of the healthcare system and, given this breach of expectations, seek remedy to alleviate their needs outside the system and conventional medicine.

Effect of a Mobile-based Intervention on Mental Health in Frontline Healthcare Workers Against COVID-19: Protocol for a Randomized Controlled Trial

AimTo evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness-based approaches on the mental health of healthcare workers at the frontline against COVID-19 in Spain. DesignWe will carry out a two-week, individually randomised, parallel group, controlled trial. Participants will be individually randomised to receive the PsyCovidApp intervention or control App intervention. MethodsThe PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended COVID-19 patients will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the two weeks intervention period. Measures will include stress, depression and anxiety (DASS-21 questionnaire - primary endpoint), insomnia (ISI), burnout (MBI-HSS), post-traumatic stress disorder (DTS), and self-efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation. DiscussionDespite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence regarding the effectiveness of this type of intervention on this specific population and context. ImpactDespite the lack of solid evidence about their effectiveness, mobile-based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits. Clinical trial registrationNCT04393818 (ClinicalTrials.gov identifier)

Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review

ObjectivesTo examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers'(HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact. DesignSystematic rapid review and meta-analysis. Data sourcesMEDLINE, Embase, and PsycINFO, searched up to 23 March 2020. MethodWe selected observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. One reviewer screened titles and abstracts, and two reviewers independently reviewed full texts. We extracted study characteristics, symptoms, prevalence of mental health problems, risk factors, mental health interventions, and its impact. We assessed risk of bias for each individual study and used GRADE to ascertain the certainty of the evidence. We conducted a narrative and tabulated synthesis of the results. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems. ResultsWe included 61 studies (56 examining impact on mental health and five about interventions to reduce such impact). Most were conducted in Asia (59%), in the hospital setting (79%), and examined the impact of the SARS epidemic (69%). The pooled prevalence was higher for anxiety (45%, 95% CI 21 to 69%; 6 studies, 3,373 participants), followed by depression (38%, 95% CI 15 to 60%; 7 studies, 3,636 participants), acute stress disorder (31%, 95% CI 0 to 82%, 3 studies, 2,587 participants), burnout (29%, 95% CI 25 to 32%; 3 studies; 1,168 participants), and post-traumatic stress disorder (19%, 95% CI 11 to 26%, 10 studies, 3,121 participants). Based on 37 studies, we identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, social rejection or isolation, stigmatization), and occupational (working in a high risk environment (frontline staff), specific occupational roles (e.g., nurse), and lower levels of specialised training, preparedness and job experience) factors. Five studies reported interventions for frontline HCW, two of which were educational and aimed to prevent mental health problems by increasing HCWs' resilience. These interventions increased confidence in support and training, pandemic self-efficacy, and interpersonal problems solving (very low certainty). One multifaceted intervention implemented training and organisational changes) targeted at hospital nurses during the SARS epidemic, reporting improvements in anxiety, depression, and sleep quality (very low certainty). The two remaining interventions, which were multifaceted and based on psychotherapy provision, did not assess their impact. ConclusionThe prevalence of anxiety, depression, acute and post-traumatic stress disorder, and burnout, was high both during and after the outbreaks. These problems not only have a long-lasting effect on the mental health of HCWs, but also hinder the urgent response to the current COVID-19 pandemic, by jeopardising attention and decision-making. Governments and healthcare authorities should take urgent actions to protect the mental health of HCWs. In light of the limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified in this study, more so when they are modifiable, represent important targets for future interventions. SUMARY BOX1: What is already known on this topic?O_LIPrevious studies showed that healthcare workers involved providing frontline care during viral epidemic outbreaks are at high risk of developing mental health problems. C_LIO_LIGiven the current COVID-19 pandemic, there is an urgent need to synthesize the evidence regarding the impact of viral epidemic outbreaks on mental health of healthcare workers. C_LI 2: What does this study add?O_LIThis timely systematic rapid review offers for the first time pooled estimations of the prevalence of the most common mental health problems experienced by HCWs during and after viral epidemic outbreaks, namely anxiety (45%), depression (38%), and acute stress disorder (31%), among others. C_LIO_LIOur study also identifies a broad number of factors associated with these conditions, including sociodemographic factors such as younger age and female gender, social factors such as lack of social support, social rejection or isolation, stigmatization, and occupational factors such as working in a high risk environment, specific occupational roles, and having lower levels of specialised training, preparedness and job experience. C_LIO_LIOur study shows that, although educational and multifaceted interventions might mitigate the development of mental health problems, the certainty on the evidence is very low - therefore indicating that further high quality research is urgently needed to inform evidence-based policies for viral pandemics. C_LI

Economic crisis and suicides in Spain. Socio-demographic and regional variability.

BACKGROUND: Evidence from previous recessions suggests that at times of economic deterioration, suicides increase. Spain has been one of the European countries hardest hit by the financial crisis that started in 2008. The aim of this paper is to examine the impact of the double-dip recession in Spain on the most recent trends in suicide. METHODS: Suicide data from the years 2002-2012 were obtained from the 'Death Statistic according to Cause of Death' of the National Statistics Institute (NSI). Population figures were obtained from the population estimates of the NSI. RESULTS: While the suicide rate decreased between 2002 and 2012, the downward trend has reversed twice, in 2008-2009, and in 2012. This rise was particularly pronounced in males, with the rate ratio of 1.12 (95 % CI 1.05-1.20) in 2008 and 1.10 (95 % CI 1.03-1.18) in 2009. Following a decrease in 2010 and 2011, suicides among males have increased again in 2012-with RR of 1.10 (95 % CI 1.03-1.18) compared to 2007, however the difference between 2011 amounted to 14 % rise-the biggest interannual change in a decade. There was a similar but less pronounced pattern in females. Regional data showed variable results. CONCLUSIONS: These results suggest that the Spanish economic crisis has been associated with suicide rates in 2008, 2009, and 2012. These findings are consistent with the double-dip recession that Spain experienced.