To describe the response in research and innovation (R&I) against the COVID-19 syndemic at the national level, contextualized internationally.
Guided narrative review.
In the COVID-19 syndemic, pressure has been put on the scientific community in general, and the innovative biomedical community in particular, to provide solutions, especially biotechnological products. Most of the recommendations of expert panels are not oriented to a biotechnological response (which must also exist), but to governance, organizational, socio-economic measures, and support for public health infrastructures. There is a significant deficit in the inclusion of sex/gender perspective in COVID-19 R&I. The COVID-19 syndemic has offered a (wasted) opportunity to promote research and innovation from an epidemiological perspective against infectious outbreaks with the potential to provoke a crisis in public health, claiming leadership from epidemiology. It is necessary to assess whether the large investment in biomedical R&I aimed at personalized medicine can be efficiently integrated into public health providers in the face of health crises.
It is urgent to design a R&I strategy in Spain aligned with internationally available funds, but providing the country with maximum independence in order to face critical situations for public health.

To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used.
The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater.
176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72).
This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.

OBJECTIVE: To analyse changes in health professionals\' and immigrant users\' perceptions of the quality of care provided to the immigrant population during the crisis.
METHODS: A qualitative descriptive-interpretative and exploratory study was conducted in two areas of Catalonia. Semi-structured individual interviews were used with a theoretical sample of medical (n=24) and administrative (n=10) professionals in primary care (PC) and secondary care (SC), and immigrant users (n=20). Thematic analysis was conducted and the results were triangulated.
RESULTS: Problems related to technical and interpersonal quality emerged from the discourse of both professionals and immigrants. These problems were attributed to cutbacks during the economic crisis. Regarding technical quality, respondents reported an increase in erroneous or non-specific diagnoses, inappropriate use of diagnostic tests and non-specific treatments, due to reduction in consultation times as a result of cuts in human resources. With regard to interpersonal quality, professionals reported less empathy, and users also reported worse communication, due to changes in professionals\' working conditions and users\' attitudes. Finally, a reduction in the resolution capacity of the health services emerged: professionals described unnecessary repeated PC visits and limited responses in SC, while young immigrants reported an insufficient response to their health problems.
CONCLUSIONS: The results indicate a deterioration in perceived technical and interpersonal quality during the economic crisis, due to cutbacks mainly in human resources. These changes affect the whole population, but especially immigrants.

The 2008 economic crisis made the issue of good governance more present and visible, but the debate risks stalling in an academic and political discourse that barely exceeds the declarative. We acknowledge the existence of noteworthy documents from scientific medical societies and some institutional proposals that point towards promising changes. Viewing good governance as accountability, participation, transparency, intelligence and integrity, our objective is to identify the determinants of inaction and remove the barriers that prevent the adoption of rational and widely agreed-upon proposals. This led us: 1) to allocate the proposals to their appropriate governance level (macro, meso, micro and system environment) so as to more directly engage the agents of change; and 2) to highlight some decision nodes that can act as levers to catalyse selective transformations and to initiate the change processes. Taking into account the diversity of actors and scenarios, a top-down rational, integrated and reformist strategy for the whole Spanish National Health System does not seem likely or viable. Therefore, the purpose of this paper is to promote changes, setting a targeted and reasoned agenda to visualise key issues and to enable multilevel and multidimensional thinking and advocacy of health-sector and society stakeholders.

BACKGROUND: The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients\' views on the time devoted to counselling by venue of their last HIV test.
METHODS: We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008.
RESULTS: The majority (71%) were men (48% had had sex with other men), 51% were <30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported <10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings.
CONCLUSIONS: Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement.