Background The current coronavirus disease (COVID-19) has a great impact worldwide. Healthcare workers play an essential role and are one of the most exposed groups. Information about the psychosocial impact on healthcare workers is limited. Methods 3109 healthcare workers completed a national, internet-based, cross-sectional 45-item survey between 9 and 19 April 2020. The objective is to assess the psychological impact of the COVID-19 pandemic in Spanish healthcare workers. A Psychological Stress and Adaptation at work Score (PSAS) was defined combining four modified versions of validated psychological assessment tests (A) Healthcare Stressful Test, (B) Coping Strategies Inventory, (C) Font-Roja Questionnaire and (D) Trait Meta-Mood Scale. Results The highest psychosocial impact was perceived in Respiratory Medicine, the mean (S.D.) PSAS was 48.3 (13.6) and Geriatrics 47.6 (16.4). Higher distress levels were found in the geographical areas with the highest incidence of COVID-19 (>245.5 cases per 100 000 people), PSAS 46.8 (15.2); p < 0.001. The least stress respondents were asymptomatic workers PSAS, 41.3 (15.4); p < 0.001, as well as those above 60 years old, PSAS, 37.6 (16); p < 0.001. Workers who needed psychological therapy and did not receive it, were more stressed PSAS 52.5 (13.6) than those who did not need it PSAS 39.7 (13.9); p < 0.001. Conclusions The psychological impact in healthcare workers in Spain during COVID-19 emergency has been studied. The stress perceived is parallel to the number of cases per 100 000 people. Psychotherapy could have a major role to mitigate the experimented stress level.

In the present study we analyzed the impact of vocational goals, sexist attitudes toward women, and motivation on career choice, in a sample of 448 Spanish college students (65.2% women and 34.1% men). Although we found some similarities between men and women in terms of their motivational orientations (extrinsic vs. intrinsic) and vocational goals, men's extrinsic motivations appear to differ depending on the college major. We also found differences in sexist attitudes toward women by gender and chosen major: both male and female students enrolled in technical majors reported the most sexist attitudes (both hostile and benevolent). These findings underline the importance of taking sexist attitudes toward women into account in attempts to explain gender differences in career choice, something which has been largely overlooked in the research to date.The political and social changes that have taken place in Spain over the past few decades in the interest of equality between the sexes have allowed a large number of women to obtain a higher education and thus be guaranteed a place in the public sphere. Before such changes occurred, women generally were segregated from public life and relegated to the privacy of family life. Nowadays, as many Spanish women as men receive formal education, and women represent 60% of the Spanish college undergraduate student population (MEC, 2004). Data on Working Population by GenderNot only are women enrolled in formal education to the same extent as men are, they are obtaining excellent academic results (more than one-half of the college valedictoriansonly three are chosen nationally for each major-were women during the -2003 BOE, 2004). However, what is surprising, and indeed discouraging, is that despite such academic achievements, women still have not attained the same presence in the working world that men have. In fact, there is still a relatively small percentage of women who work outside the home (35.9% of the total Spanish workforce are women, as compared to 43.9% in the European Union overall; Instituto de la Mujer, 2003).Spain is, in fact, the country in the European Union with the greatest gap between men and women in terms of employment. In Spain, 25.1% more men than women are employed, followed by Italy (25.0% difference) and Greece (24.1%); the average European gender gap is 17.1% (MTAS, 2004). In addition, almost twice as many Spanish women as men are unemployed and looking for work (15.56% women vs. 8.2% men), and the difference between men's and women's gross annual income is 29% (INE, 2002). Fields of Study by GenderOne possible explanation for such differences in men's and women's income and employment status may be the differential enrollment of women and men in the various college majors. In our country, the distribution of college students among the different fields of study is still largely determined by gender. Women represent only one-fourth of all graduates in technical fields, whereas in the remaining degrees, three of every four graduates is a woman (MEC...

ObjectiveThis study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer.MethodsThis international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed.ResultsAfter excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget’s disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05).ConclusionsAdvanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

The aim of this study was to determine the prevalence of bullying in its various forms from the perspective of all of the individuals involved (victims, bullies, and witnesses) and to explore its distribution as a function of gender. The study had a correlational design and used a representative sample of 1500 Spanish students attending compulsory secondary education in the academic year 2007-2008. It applied an instrument measuring different types of bullying, taken from the studies conducted by Díaz-Aguado, Martínez, and Martín (2004) and the Defensor del Pueblo (Spanish Ombudsman's Office)-UNICEF (2007). The findings reveal that all the types of bullying considered take place at school and that there is an inverse relationship between the severity and the prevalence of bullying behaviors, with verbal abuse proving to be the most common type of abusive behavior. Boys are involved in all kinds of bullying incidents as bullies significantly more often than girls are, except in cases involving 'talking about someone behind their back'; in these situations, girls are involved significantly more often as bullies than boys are. As for victimization, boys are victims of direct physical abuse significantly more often than girls are, while girls are more often the subject of malicious gossip.

IMPORTANCE Limited information on the transmission and dynamics of SARS-CoV-2 at the city scale is available. OBJECTIVE To describe the local spread of SARS-CoV-2 in Valencia, Spain. DESIGN, SETTING, AND PARTICIPANTS This single-center epidemiological cohort study of patients with SARS-CoV-2 was performed at University General Hospital in Valencia (population in the hospital catchment area, 364 000), a tertiary hospital. The study included all consecutive patients with COVID-19 isolated at home from the start of the COVID-19 pandemic on February 19 until August 31, 2020. EXPOSURES Cases of SARS-CoV-2 infection confirmed by the presence of IgM antibodies or a positive polymerase chain reaction test result on a nasopharyngeal swab were included. Cases in which patients with negative laboratory results met diagnostic and clinical criteria were also included. MAIN OUTCOMES AND MEASURES The primary outcome was the characterization of dissemination patterns and connections among the 20 neighborhoods of Valencia during the outbreak. To recreate the transmission network, the inbound and outbound connections were studied for each region, and the relative risk of infection was estimated. RESULTSIn total, 2646 patients were included in the analysis. The mean (SD) age was 45.3 (22.5) years; 1203 (46%) were male and 1442 (54%) were female (data were missing for 1); and the overall mortality was 3.7%. The incidence of SARS-CoV-2 cases was higher in neighborhoods with higher household income (β 2 [for mean income per household] = 0.197; 95% CI, 0.057-0.351) and greater population density (β 1 [inhabitants per km 2 ] = 0.228; 95% CI, 0.085-0.387). Correlations with meteorological variables were not statistically significant. Neighborhood 3, where the hospital and testing facility were located, had the most outbound connections (14). A large residential complex close to the city (neighborhood 20) had the fewest connections (0 outbound and 2 inbound). Five geographically unconnected neighborhoods were of strategic importance in disrupting the transmission network. CONCLUSIONS AND RELEVANCEThis study of local dissemination of SARS-COV-2 revealed nonevident transmission patterns between geographically unconnected areas. The results suggest that tailor-made containment measures could reduce transmission and that hospitals, including testing facilities, play a crucial role in disease transmission. Consequently, the local dynamics of SARS-CoV-2 spread might inform the strategic lockdown of specific neighborhoods to stop the contagion and avoid a citywide lockdown.