Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

A comparative analysis of the modification of sexual desire of users of oral hormonal contraceptives and intrauterine contraceptive devices

OBJECTIVE

To compare the influence of oral hormonal contraceptives (OCs) and the use of intrauterine contraceptive devices (IUDs) on the modification of sexual desire.

MATERIALS AND METHODS

A prospective observational study of 1073 women using OCs or an IUD at the Family Planning Center 'Marina Alta' in Alicante, Spain. In order to evaluate the relative risk regarding the decrease in libido attributed to each contraceptive method, a logistic regression analysis was undertaken which considered the factors of age adjustment, level of studies, family planning information, relationship with partner, age when sexual relationships were initiated, parity, contraceptive method previously used and the duration of use of the contraceptive method.

RESULTS

No differences in the decrease of sexual desire were observed between the use of the OC and IUD (odds ratio (OR) 1.32; 95% confidence interval (CI) 0.70-2.49), yet differences were noted, however, in relation to age (OR 1.05; 95% CI 1.01-1.10). Although these differences were not statistically significant, a high level of awareness regarding family planning was shown to increase sexual desire when compared to a lower level of information on this subject (OR 0.64; 95% CI 0.41-1.01). Sexual desire was seen to decrease if the quality of the relationship with the partner was average (OR 2.24; 95% CI 1.36-3.69) or poor (OR 4.69; 95% CI 1.93-11.4). Nulliparous women showed a greater decrease in sexual desire in relation to women who had already given birth (OR 1.57; 95% CI 1.00-2.47). Sexual desire was greater if the contraceptive method had already been in use for 6-12 months (OR 0.41; 95% CI 0.17-0.98).

CONCLUSIONS

Sexual desire does not vary in relation to the use of OCs or IUDs, yet it does decrease with age, in nulliparous women and in those with an average or poor relationship with their partner. Furthermore, sexual desire shows an increase between the first 6 and 12 months of contraceptive treatment.

The prognostic implications of anaemia in the outcome of patients with early stages of uterine cervix carcinoma

We studied the prognostic value of anaemia in the evolution of patients with early stages of uterine cervix cancer and treated with radical surgery. An observational study of 114 patients treated for cervical cancer at the "La Fe" Maternity Hospital in Valencia (Spain) during the period 1971 to 1989. Survival analyses were carried out whereby both recurrence and mortality rates were considered. The level of haemoglobin influences the prognosis of the patients in the study presented, and explains a variation in the disease-free interval in correlation with that of tumour size. However, its influence on the survival interval proved to be somewhat less. Its predictive value is not diminished when associated with other important factors regarding the influence on patient evolution and is seen to be a protector variable against recurrence. Patients with haemoglobin levels of less than 13 gr/dl have a less favourable prognosis and this prognosis worsens still further when levels are lower than 12 gr/dl, which is more frequently the case in patients under 40 years of age and with a greater stromal invasion depth. The influence of haemoglobin levels is equally as important in its influence on prognosis and patient evolution as the volume of the tumour itself. The effect of this variable depends on both the clinical characteristics of the patients and the pathological characteristics of the tumour.

Multivariate analysis of the morphometric characteristics of tumours as prognostic factors in the survival of patients with uterine cervix cancer treated with radical surgery

OBJECTIVES

To analyse the influence of tumour size and anatomopathological characteristics in the prognosis of patients with early-stage cancer of the uterine cervix treated with radical surgery.

STUDY DESIGN

A historical study of 114 patients treated at the Maternity Hospital "La Fe" in Valencia was undertaken during the period 1971-1989. The influence of the principal risk factors on prognosis were studied and their effect adjusted using a multivariate analysis based on the Cox proportional hazards model.

RESULTS

A greater dimension of the tumour, tumour area, tumour volume, tumour-cervix quotient and stromal invasion depth all have a highly significant and negative correlation with survival and disease-free survival intervals. In the multivariate analysis, tumour volume and stromal invasion depth maintained their significance as indicators of an adverse prognosis regarding the disease-free survival interval, as did the stromal invasion depth in the case of survival.

CONCLUSIONS

The most important prognostic factor in the evolution of patients with a cervical carcinoma is the stromal invasion depth followed by tumour size.

Mortality trends in a cohort of opiate addicts, Catalonia, Spain

BACKGROUND

Opiate addiction affects young adults whose life expectancy is reduced as a consequence of their habit. In the midst of the AIDS epidemic, the present study objective was to analyse recent overall and cause-specific mortality trends among opiate addicts in Catalonia (Spain).

METHODS

Mortality was assessed retrospectively in an opiate addict cohort assembled from admissions to hospital emergency wards and drug treatment centres during the period 1985-1991. The cohort included 12 711 opiate addicts (12 045 men and 3666 women) aged 15-44 years. Overall and cause-specific mortality trends were analysed using age as the time scale and Cox regression with staggered entry determined by the age at entry in the study. Annual trends were adjusted by sex and source of entry, and were stratified by length of opiate use.

RESULTS

Mortality rates increased throughout the entire period from 13.8 to 34.8 deaths per 1000 person-years, with a statistically significant increase in 1987-1988 and 1988-1989. In a model including age, gender, source of entry and length of drug use, risk increased significantly in men and for longer length of use, but not with age and for source of entry into the study cohort. The causes of death associated with high mortality rates were AIDS and the causes directly related to addiction.

CONCLUSIONS

A threefold increase in mortality rates was observed during the period, mainly accounted for by AIDS and direct addiction-related causes. Length of opiate use was an important determinant of mortality.