ObjectiveConsidering both the economic crisis of 2008 and the Gender Equality Law (2007), this study analyses the association between gender inequality in Spanish Autonomous Communities (AC) and intimate partner violence (IPV) from 2006 to 2014 in terms of socio-demographic characteristics.MethodsEcological study in the 17 Spanish AC on the correlation between the reported cases by IPV and deaths and the Gender Inequality Index and its dimensions: empowerment, participation in the labour market and adolescent birth rates; and their correlation with Young People Not in Education, Employment or Training (NEET).ResultsIn 2006, IPV mortality rates were higher in autonomous communities with greater gender inequality than AC with more equality (4.1 vs. 2.5 × 106 women >14 years), as were reporting rates of IPV (OR = 1.49; 95% CI: 1.47–1.50). In 2014, the IPV mortality rates in AC with greater gender inequality fell to just below the mortality rates in AC with more gender equality (2.5 vs. 2.7 × 106 women >14 years). Rates of IPV reports also decreased (OR = 1.22; 95% CI: 1.20–1.23). Adolescent birth rates were most associated with IPV reports, which were also associated with the burden of NEET by AC (ρ2006 = 0.494, ρ2014 = 0.615).ConclusionGender-sensitive policies may serve as a platform for reduced mortality and reports of IPV in Spain, particularly in AC with more gender inequality. A reduction of NEET may reduce adolescent birth rates and in turn IPV rates.

Introduction:Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS).Methods and analysis:A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l’Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. Analysis: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out.Ethics and dissemination:This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals.Trial registration:Clinical-Trials.gov: NCT04049006.

Some countries reached, in 2015, the Millennium Development Goal of reducing maternal mortality to 96 or less maternal deaths per 100,000 live births. Others, however, did not. This paper analyses the strength of the association between maternal mortality and each of the six components of Governance—a political determinant scarcely explored in the literature—in 174 countries. It was found that the greater the governance, the lower maternal mortality, independently of a country's wealth. We used all six indicators of the World Bank's Worldwide Governance Indicators Project in 2015: government effectiveness, regulatory quality, rule of law, control of corruption, voice and accountability, and political stability and absence of violence. Findings were encouraging as maternal mortality in low-income countries with higher government effectiveness and regulatory quality was similar to that of medium-income countries with lower government effectiveness and regulatory quality. To achieve the post-2015 sustainable development goal on preventable maternal mortality—which persists despite economic development—all governance dimensions are essential and represent interdependent cornerstones.

People’s eating habits and lifestyle can have a negative impact on health. In situations of difficulty or socioeconomic crisis, these habits tend to be modified, leading to unhealthy dietary patterns that result in an increase of chronic non-communicable diseases (NCDs). Previous studies have indicated that, due to the state of alarm imposed in Spain to combat the spread of COVID-19, an increase in the purchase of non-core products occurred, along with a decrease in the daily physical activity of the population. This could be a risk factor for COVID-19 infection. The objective of this observational study was to analyze the dietary pattern of the Spanish population during home confinement and to compare it with the pattern of habitual consumption collected in the last National Health Survey, analyzing the possible changes. More than half of the respondents in the sample increased their consumption of sweets and snacks during confinement, while the consumption of fresh products decreased. Most claimed to be emotionally hungry, leading to an increase in their daily energy intake. The stress and anxiety generated by confinement could be the cause of the increased consumption of products rich in sugars and saturated fats, which are associated with greater stress and anxiety.