Knowledge and attitudes of Spanish adolescent girls towards human papillomavirus infection: where to intervene to improve vaccination coverage

Background: HPV vaccine coverage is far from ideal in Valencia, Spain, and this could be partially related to the low knowledge about the disease and the vaccine, therefore we assessed these, as well as the attitude towards vaccination in adolescent girls, and tried to identify independently associated factors that could potentially be modified by an intervention in order to increase vaccine coverage. Methods: A cross sectional study was conducted in a random selection of schools of the Spanish region of Valencia. We asked mothers of 1278 girls, who should have been vaccinated in the 2011 campaign, for informed consent. Those that accepted their daughters’ participation, a questionnaire regarding the Knowledge of HPV infection and vaccine was passed to the girls in the school. Results: 833 mothers (65.1%) accepted participation. All their daughters’ responded the questionnaire. Of those, 89.9% had heard about HPV and they associated it to cervical cancer. Only 14% related it to other problems like genital warts. The knowledge score of the girls who had heard about HPV was 6.1/10. Knowledge was unrelated to the number of contacts with the health system (Pediatrician or nurse), and positively correlated with the discussions with classmates about the vaccine. Adolescents Spanish in origin or with an older sister vaccinated, had higher punctuation. 67% of the girls thought that the vaccine prevented cancer, and 22.6% felt that although prevented cancer the vaccine had important safety problems. 6.4% of the girls rejected the vaccine for safety problems or for not considering themselves at risk of infection. 71.5% of the girls had received at least one vaccine dose. Vaccinated girls scored higher knowledge (p = 0.05). Conclusion: Knowledge about HPV infection and vaccine was fair in adolescents of Valencia, and is independent to the number of contacts with the health system, it is however correlated to the conversations about the vaccine with their peers and the vaccination status. An action to improve HPV knowledge through health providers might increase vaccine coverage in the adolescents.

Barriers and facilitators to effective coverage of Intimate Partner Violence services for immigrant women in Spain

Objective: To explore service providers’ perceptions in order to identify barriers and facilitators to effective coverage of Intimate Partner Violence (IPV) services for immigrant women in Spain, according to the different categories proposed in Tanahashi's model of effective coverage. Methods: A qualitative study based on 29 in-depth personal interviews and four group interviews with a total of 43 professionals working in public services (social and health-care services, women's refuges, the police force, the judiciary) and NGOs in Barcelona, Madrid, Valencia and Alicante (Spain) in 2011. Findings: Current IPV services in Spain partially fail in their coverage of abused immigrant women due to barriers of (i) availability, such as the inexistence of culturally appropriate services; (ii) accessibility, as having a residence permit is a prerequisite for women's access to different services and rights; (iii) acceptability, such as women's lack of confidence in the effectiveness of services; and (iv) effectiveness, for example, lack of specific training among professionals on the issues of IPV and immigration. However, interviewees also identified facilitators, such as the enabling environment promoted by the Spanish Law on Gender-Based Violence (1/2004), and the impetus it has provided for the development of other specific legislative tools to address IPV in immigrant populations in Spain (availability, accessibility and effectiveness). Conclusion: Whilst not dismissing cultural barriers, aspects related to service structure are identified by providers as the main barriers and facilitators to immigrant women use of IPV services. Despite noteworthy achievements, improvements are still required in terms of mainstreaming assistance tailored to immigrant women's needs in IPV policies and services.

Erosion of universal health coverage in Spain

Whereas the recent UN resolution urges governments to accelerate progress towards universal access to affordable and quality health-care services, the Spanish Government, bypassing the parliamentary procedure, enacted a Royal Decree to limit access to free services at the point of delivery for all-undermining the principle of universal coverage. Spanish health and social service budgets have been subjected to large cuts (13,7% in 2012 and 16,2% in 2013) with some regions imposing additional budget cuts.

Coverage and invariance for the biological control of pests in mediterranean greenhouses

A major problem related to the treatment of ecosystems is that they have no available mathematical formalization. This implies that many of their properties are not presented as short, rigorous modalities, but rather as long expressions which, from a biological standpoint, totally capture the significance of the property, but which have the disadvantage of not being sufficiently manageable, from a mathematical standpoint. The interpretation of ecosystems through networks allows us to employ the concepts of coverage and invariance alongside other related concepts. The latter will allow us to present the two most important relations in an ecosystem – predator–prey and competition – in a different way. Biological control, defined as “the use of living organisms, their resources or their products to prevent or reduce loss or damage caused by pests”, is now considered the environmentally safest and most economically advantageous method of pest control (van Lenteren, 2011). A guild includes all those organisms that share a common food resource (Polis et al., 1989), which in the context of biological control means all the natural enemies of a given pest. There are several types of intraguild interactions, but the one that has received most research attention is intraguild predation, which occurs when two organisms share the same prey while at the same time participating in some kind of trophic interaction. However, this is not the only intraguild relationship possible, and studies are now being conducted on others, such as oviposition deterrence. In this article, we apply the developed concepts of structural functions, coverage, invariant sets, etc. (Lloret et al., 1998, Esteve and Lloret, 2006a, Esteve and Lloret, 2006b and Esteve and Lloret, 2007) to a tritrophic system that includes aphids, one of the most damaging pests and a current bottleneck for the success of biological control in Mediterranean greenhouses.

Coverage and invariability in fuzzy systems

This paper presents a new complex system systemic. Here, we are working in a fuzzy environment, so we have to adapt all the previous concepts and results that were obtained in a non-fuzzy environment, for this fuzzy case. The direct and indirect influences between variables will provide the basis for obtaining fuzzy and/or non-fuzzy relationships, so that the concepts of coverage and invariability between sets of variables will appear naturally. These two concepts and their interconnections will be analyzed from the viewpoint of algebraic properties of inclusion, union and intersection (fuzzy and non-fuzzy), and also for the loop concept, which, as we shall see, will be of special importance.