Due to the unexpected emergence of COVID-19, different cities improvised responses to prevent the virus from spreading and infecting the population. Madrid, capital of Spain and one of the most affected cities in Europe, confined everyone home and closed most public and private spaces, including public parks. The whole situation was surely to be responsible for stress-levels to peak. We developed an online survey to better understand the relationship between people and Urban Green Spaces prior to the COVID-19 pandemic, and the new bond that may have emerged from this interruption. We recruited participants, without gender or age preference, excluding underage children and teenagers, using a combination of convenience sample and a snowball approach. A total of 132 responses were logged. The study was limited to mental health inferences, specifically related to stress and its most frequent manifestations among the urban population. These indicators included physical, mood or behavioral changes and were studied on those participants who had access to UGS before and during confinement. Among the most important findings, we confirmed that when people are confronted with stressful situations, indoor plant interaction is not a substitute for different outdoor green experiences; those who interacted with green spaces in a daily manner managed stress levels better than people who didn’t (but their effects might lose strength over time); and turning to green spaces for comfort during stressful times when you don’t usually do so helps overcome difficult situations. This article contributes to the growing study of green spaces as a means towards improved mental well-being in urban areas.

IntroductionHepatitis A (HA) is a liver disease with a low mortality rate, but it can cause debilitating symptoms and fulminant hepatitis in some cases. Its incidence is greater in geographical areas with poor sanitation and hygiene. Spain is considered a low-endemicity country, so universal childhood immunization against HA is currently not financed by the National Health System. The aim of this study was to synthesize the scientific evidence on the cost effectiveness of universal childhood vaccination against HA.MethodsFull economic evaluations, published in the English or Spanish languages, were included if they reported outcome measures related to the prevention of HA, adverse effects, or incremental cost-effectiveness ratios (ICERs). The Medline, Embase and Cochrane Library databases were searched for articles published from the beginning of the databases to April 2018.ResultsA total of 23 economic evaluations were included: one in a country of high endemicity, nine in countries of intermediate endemicity, and 13 in countries with low endemicity. Only one Spanish study, published in 1997, was found. Studies conducted in high- and intermediate- endemicity countries concluded that a universal childhood vaccination program against HA was a cost-effective option. However, in the case of countries with low endemicity the results were heterogeneous, although most agreed that a systematic vaccination strategy would not be a cost-effective option and that the adoption of such a strategy would not be justified given the limited benefits it would offer. The results of the economic evaluations depended on parameters such as the price and duration of the vaccine effect and the program coverage.ConclusionsIn countries with low endemicity the results were heterogeneous, although most studies concluded that the implementation of a universal vaccination strategy is not justified from the point of view of cost effectiveness.