Kairos study protocol: a multidisciplinary approach to the study of school timing and its effects on health, well-being and students' performance.

Recent evidence from chronobiology, chssronomedicine and chronopsychology shows that the organisation of social time (e.g., school schedules) generally does not respect biological time. This raises concerns about the impact of the constant mismatch between students' social and internal body clocks on their health, well-being and academic performance. The present paper describes a protocol used to investigate the problem of (de) synchronisation of biological times (chronotypes) in childhood and youth in relation to school times. It studies the effects of student chronotype vs. school schedule matches/mismatches on health behaviours (e.g., how many hours students sleep, when they sleep, eat, do physical activity, spend time outdoors in daylight) and learning (verbal expression, spatial structuring, operations) and whether alert-fatigue levels mediate this effect alignments/misalignments on learning (verbal expression, spatial structuring, operations) and their mediation by alert-fatigue levels. The novelty of our protocol lies in its multidisciplinary and mixed methodology approach to a relevant and complex issue. It draws on up-to-date knowledge from the areas of biology, medicine, psychology, pedagogy and sociology. The methods employed include a varied repertoire of techniques from hormonal analysis (cortisol and melatonin), continuous activity and light monitoring, self-registration of food intake, sleep timings, exercise and exposure to screens, alongside with systematic application of cognitive performance tests (e.g., memory, reasoning, calculation, attention) and self-reported well-being. This comprehensive and interdisciplinary protocol should support evidence-based education policy measures related to school time organisation. Appropriate and healthier school timetables will contribute to social change, healthier students and with more efficient learning. The results of studies using a similar methodology in other countries would ensure replication and comparability of results and contribute to knowledge to support policy making.

National Radon Action Plans in Europe and Need of Effectiveness Indicators: An Overview of HERCA Activities.

Protection of the population and of workers from exposure to radon is a unique challenge in radiation protection. Many coordinated actions and a variety of expertise are needed. Initially, a National Radon Action Plan (NRAP) has been developed and implemented by some countries, while it is currently recommended by international organizations (e.g., World Health Organization) and required by international regulations, such as the European Council Directive 2013/59/Euratom and the International Basic Safety Standards on Radiation Protection and Safety of Radiation Sources, cosponsored by eight international organizations. Within this framework, the Heads of the European Radiological Protection Competent Authorities (HERCA) have organized activities aimed at sharing experiences to contribute toward the development and implementation of effective NRAPs. Two workshops were held in 2014 and 2015, the latter on radon in workplaces. As a follow-up to these, an online event took place in March 2021, and a second specific workshop on NRAP is planned for June 2022. These workshops were attended by experts from the competent authorities of European countries, relevant national and international organizations. The experience of several countries and the outcomes from these workshops have highlighted the need for adequate indicators of the effectiveness and progress of the actions of NRAPs, which could also be useful to implement the principle of optimization and the graded approach in NRAPs. In this paper, the activities of HERCA to support the development and implementation of effective NRAPs are described and some examples of effectiveness indicators are reported, including those already included in the NRAP of some European countries.

Lung cancer mortality attributable to residential radon exposure in Spain and its regions.

Lung cancer has the highest cancer mortality rate in developed countries. The principal risk factor for lung cancer is tobacco use, with residential radon being the leading risk factor among never smokers and the second among ever smokers. We sought to estimate mortality attributable to residential radon exposure in Spain and its Autonomous Regions, with correction for dwelling height and differentiation by tobacco use. We applied a prevalence-based method for estimating attributable mortality. For estimations, we considered exposure to radon in the different Autonomous Regions corrected for dwelling height, using the National Statistics Institute Housing Census and prevalence of tobacco use (never smokers, smokers and ex-smokers). The results showed that 3.8% (838 deaths) of lung cancer mortality was attributable to radon exposure of over 100 Bq/m3, a figure that rises to 6.9% (1,533 deaths) when correction for dwelling height is not performed. By Autonomous Region, the highest population attributable fractions, corrected for dwelling height, were obtained for Galicia, Extremadura, and the Canary Islands, where 7.0, 6.9, and 5.5% of lung cancer mortality was respectively attributable to radon exposure. The greatest part of the attributable mortality occurred in men and among smokers and ex-smokers. Residential radon exposure is a major contributor to lung cancer mortality, though this contribution is highly variable among the different territories, indicating the need for targeted prevention policies. Correction of estimates for dwelling height is fundamental for providing reliable estimates of radon-attributable mortality.

Geolocation of premises subject to radon risk: Methodological proposal and case study in Madrid.

Useful information on the potential radon risk in existing buildings can be obtained by combining data from sources such as potential risk maps, the 'Sistema de Información sobre Ocupación del Suelo de España' (SIOSE) [information system on land occupancy in Spain], cadastral data on built property and population surveys. The present study proposes a method for identifying urban land, premises and individuals potentially subject to radon risk. The procedure draws from geographic information systems (GIS) pooled at the municipal scale and data on buildings possibly affected. The method quantifies the magnitude of the problem in the form of indicators on the buildings, number of premises and gross floor area that may be affected in each risk category. The findings are classified by type of use: residential, educational or office. That information may guide health/prevention policies by targeting areas to be measured based on risk category, or protection policies geared to the construction industry by estimating the number of buildings in need of treatment or remediation. Application of the methodology to Greater Madrid showed that 47% of the municipalities have houses located in high radon risk areas. Using cadastral data to zoom in on those at highest risk yielded information on the floor area of the vulnerable (basement, ground and first storey) premises, which could then be compared to the total. In small towns, the area affected differed only scantly from the total, given the substantial proportion of low-rise buildings in such municipalities.

Interpersonal Violence and Health in Female University Students in Spain.

BACKGROUND: Most studies address the health impact of violence by an intimate partner; therefore, violence exerted by someone other than a partner in university students and its health effects are less known. PURPOSE: This study aims to analyze the effect of different forms of interpersonal violence on female university students' health. DESIGN: Women 18 to 25 years of age enrolled at two schools of the University of Valencia in the academic year 2013-2014 (N = 540) were selected, with a participation rate of 82%. Students were grouped as follows: no lifetime violence, violence by an intimate partner (IPV), other personal violence (OPV), and by both (IPV and OPV). Adjusted logistical regression analysis was performed to assess the effects of the different forms of violence on students' health. RESULTS: As many as 92 students (20.6%) experienced violence at least once in their lives: 46 (10.3%) by an intimate partner, 24 (5.4%) by someone other than a partner, and 22 (4.9%) by both. Abused students are more likely to suffer psychological distress and poor health perception, and more regularly used psychoactive drugs than nonabused students, although the use of medication is higher for those abused by a partner and others. Women who experienced only IPV are more likely to suffer psychological distress (adjusted odds ratio [aOR] = 1.78, p < .05, 95% confidence interval [CI; 1.10-2.86]), while those who experienced only OPV are more than twice as likely to perceive their health as poor (aOR = 2.68, p < .05, 95% CI [1.38-5.22]). CONCLUSIONS: The high prevalence of violence and its consistent association with a wide range of female university students' health problems suggest that violence seriously compromises women's health. CLINICAL RELEVANCE: Prevention programs that promote harmonious social relationships among university students should be implemented.

Intimate partner violence in older women in Spain: prevalence, health consequences, and service utilization.

The purpose of this study is to estimate the prevalence of lifetime intimate partner violence (IPV) in older women and to analyze its effect on women's health and Healthcare Services utilization. Women aged 55 years and over (1,676) randomly sampled from Primary Healthcare Services around Spain were included. Lifetime IPV prevalence, types, and duration were calculated. Descriptive and multivariate procedures using logistic and multiple lineal regression models were used. Of the women studied, 29.4% experienced IPV with an average duration of 21 years. Regardless of the type of IPV experienced, abused women showed significantly poorer health and higher healthcare services utilization compared to women who had never been abused. The high prevalence detected long standing duration, negative health impact, and high healthcare services utilization, calling attention to a need for increased efforts aimed at addressing IPV in older women.

Strategic responses to intimate partner violence against women in Spain: a national study in primary care.

BACKGROUND: Research on women''s responses to intimate partner violence (IPV) has largely been limited to women who have been exposed to severe physical violence with scarce generalisation. This study aimed to analyse how Spanish abused women from different backgrounds and with different IPV characteristics respond to violence. METHOD: Women experiencing IPV before the previous year (1469) were selected from a large cross-sectional national survey of adult women recruited during 2006-7 among female patients seeking medical care for whatever reason in primary healthcare services. The outcome variables were women's responses to IPV and the predictor variables were personal and social resources profiles and characteristics of the abuse (type, duration and women's age at onset). Stepwise logistic regression models were fitted. RESULTS: 87.5% of abused women took some kind of action to overcome IPV. Significant differences on personal and social profile and type and duration of the abuse were detected between the three strategic responses: distancing, in process and inhibition. The probability of a woman responding with a distancing strategy (seeking outside help or leaving temporarily) is almost three times greater if she is employed, was young when the abuse began, had experienced physical and psychological abuse and when the abuse was under 5 years. CONCLUSIONS: The results of this study show that personal and social resources and the specific circumstances of the abuse should be taken into account to understand women's responses to IPV. Well-validated interventions targeted at abused women's needs and the circumstances of IPV remain a priority.

Mapping the awareness of inequalities in health programs in Spanish communities: moving forward together.

The aim of this study is to map the awareness of gender, socioeconomic, immigrant and ethnic health inequalities in health at schools, maternal health and traffic injury health prevention programs. The study was conducted in the 19 health descentralized areas in Spain, 17 autonomous community (ACs) and the 2 autonomous cities (ACities). The data were collected from May 2008 to January 2009. The unit of analysis was the collection of policy documents setting out the programs mentioned above and the related support material in each AC. A reading guide was used to analyze the awareness of inequalities. With regard to health at schools, 2 of 10 programs show a high awareness of inequalities and include many specific proposals to be implemented at the local level. Regarding maternal health, 13 ACs have prepared support material with high awareness of inequalities to be implemented. A traffic injury program has been created in two ACs. We map the whole situation in Spain regarding the health programs that we have used as examples and their awareness of inequalities. We can conclude that there are differences between the regions studied in Spain and in general, the awareness of inequalities is low.

Violence against women from different relationship contexts and health care utilization in Spain.

BACKGROUND: Studies reported an excess of health services utilization among women with violence by an intimate partner (IPV). However, little is known about health utilization by women victims of other forms of interpersonal violence than IPV. This study aimed to determine the effect of violence from different relationship contexts on health care utilization. METHODS: A cross-sectional study following a multistage cluster sampling scheme was conducted. Women aged 18 to 70 years were randomly selected according to their scheduled health care visit. The number of women invited to participate was 16,419 and 73% accepted. After exclusion, the final sample consisted of 10,815 women. The outcome variables were health care utilization (primary care, specialty services, emergency rooms, and hospital admissions) and the predictor variable was interpersonal violence from different relationship contexts. Multivariable adjusted logistic regression models were conducted to assess the independent effect of each violence relationship context on health care utilization. MAIN FINDINGS: Compared with never abused women, use of health services was significantly higher for abused women, although the rates varied depending on the violence relationship context. The greatest probability of service use was among women whose abuse was perpetrated by both a partner and others. Comparing the magnitude of effect of each violence category by perpetrators other than a partner, this effect was stronger for violence in a social context in the case of emergency rooms only. CONCLUSION: Regardless of the perpetrator, lifetime violence increased health services utilization. Violence affects women's behavior in terms of how they use health services.

Interpersonal violence and women's psychological well-being.

BACKGROUND: The health impact of violence against women by perpetrators other than intimate partners has received little attention. This study aims to analyze the effect of different forms of interpersonal violence on women's health. METHODS: Adult women (10,815) randomly sampled from primary healthcare services around Spain were included. Women were grouped as follows: (1) no history of violence, (2) history of intimate partner violence only (IPV), (3) history of non-IPV only, and (4) history of both IPV and non-IPV. Lifetime prevalence of violence by IPV, non-IPV, and both was calculated. Adjusted multivariable regression analysis was performed to assess the effects of the different forms of violence on women's health status. RESULTS: Of the women, 32.7% experienced lifetime violence. Poor self-perceived health, psychological distress, co-occurring somatic complaints, and use of antidepressant or tranquilizer medication were significantly higher for women with a history of violence than for women with no history of violence. Women who reported both types of violence, IPV and non-IPV, were almost five times more likely to suffer psychological distress and co-occurring somatic complaints and > six times more likely to use medication than women with no history of violence. CONCLUSIONS: The high prevalence of violence and its consistent association with a wide range of women's health problems suggest that violence seriously compromises women's health. Health providers should ask their female patients specifically about their history of violence, both IPV and non-IPV. Including this in patient's assessment would lead to more informed clinical decisions and more integrated care.

Clinical trials with a new atypical antipsychotic (Aripiprazole): gender specific information analysis.

INTRODUCTION: In 1993, the Food and Drug Administration (FDA) published a guideline for the study and evaluation of gender-related differences in clinical trials. However, the extent of the implementation of these recommendations has not been systematically reviewed. OBJECTIVES: To determine the proportion of women in clinical trials of Aripiprazole, a new atypical antipsychotic, and to analyze the resulting information on a gender-specific basis. METHOD: A systematic review was conducted in Medline to identify randomized trials that compared this new antipsychotic drug with placebo or with typical or atypical antipsychotics in patients diagnosed with schizophrenia. The FDA Guideline was followed for the study and evaluation of gender-specific results of clinical trials. RESULTS: Despite the inclusion of female participants in the samples studied, the failure to conduct analyses stratified by sex prevented us from ascertaining the possible differences between men and women in the therapeutic response or in the adverse side effects of treatment with Aripiprazole.

210Po and major ions in drainage water from soil treated with various types of fertilizers.

The levels of (210)Po, nutrients (NH(4)(+), NO(3)(-), PO(4)(3 -)) and major ions (Na(+), K(+), Mg(2 +), Ca(2 +), F(-), NO(2 -), Br(-), Cl(-), SO(4)(2 -)) were determined, by means of lysimeter experiences, in drainage waters for agricultural soils untreated and treated with different types of fertilizers (animal manure, sewage sludge and NPK synthetic fertilizer) applied at several rates. Analytical determinations were performed by using alpha -spectrometry in the case of (210)Po, or Ion Exchange liquid chromatography for the other ionic species. Statistical uni and multivariate analysis of the results shown significant differences among lixiviates according to the different fertilizer treatments. Sewage sludge and manure applications resulted in similar compositions of lixiviates with low (210)Po levels, whereas synthetic fertilizers produced higher (210)Po concentrations and different concentration patterns of ionic species when applied at or above the recommended rates. All (210)Po levels were well below the limits proposed by the 2001/928/ Euratom Recommendation. The concentrations of the rest of the ionic species, exception made from NH(4)(+) and NO(3)(-), were also below the limits proposed by Spanish regulations.

Regional calibration of erosion radiotracers (210Pb and 137Cs): atmospheric fluxes to soils (northern Spain).

Inventories of radionuclides commonly used to study environmental processes, especially in erosion research, were determined in soil cores from two distant river basins in northern Spain. Results showed that 210Pb atmospheric fluxes correlate very well with mean annual rainfall across the region, and this is also the case for 137Cs inventories but only on the basin scale. Therefore we suggest that 210Pb is a better candidate as a radiotracer for soil erosion studies. In this region, the equation 210Pb flux (Bq m(-2) yr(-1)) = (0.19 +/- 0.02) x rainfall (mm yr(-1)) - (24 +/- 17) can be used as a calibration to estimate input 210Pb fluxes, a key parameter in soil erosion studies and models, when mean annual rainfall is known.

[Nutritional education at school]. / Educación nutricional en la escuela.

Children and youths who are well-educated run a lower risk of developing eating disorders; therefore teaching these topics in schools is very important. Nonetheless, disorders such as obesity, anorexia and bulimia occur more frequently all the time among children and youths. What is happening? If students are offered a correct nutritional basis, why do these disorders not decrease? What can be done in schools about these disorders?

Educación nutricional en la escuela / Nutritional education in schools

Una infancia y juventud bien formadas tiene menor riesgo de desarrollar trastornos en las conductas alimentarias, de ahí la importancia de la educación en estos temas en la escuela. Sin embargo, los problemas de obesidad, anorexia y bulimia son cada vez más frecuentes en este sector de edad. ¿Qué ocurre? Si se ofrece al alumnado una formación alimentaria correcta, ¿por qué no decrecen estos problemas? ¿Qué se puede hacer desde los centros de enseñanza? (AU)