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The attack rate is increasing in Spain; and seems to have responded to a growing pattern of interpersonal violence; and is a true reflection of what is occurring in other neighbouring; similar countries.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the early 21st century the limited knowledge in Spain about the reality of this phenomenon was almost exclusively derived from reports made by victims. However, the reality is that professionals do not usually report these cases, and when they do it is usually only for the most serious cases of physical violence.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">By 2004, several initiatives had contributed to exploring the true extent of the problem and establishing its consequences: the physical and mental health of workers, the quality of services affected, and the relationship between the health-care system workers and users.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2–4</span></a> Since then much effort has been made to reform this area, resulting in the implementation of numerous measures of different types aimed at combating this problem.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A very important issue that has arisen over the last decade and generated broad debate is the legal measures to be taken against the aggressors, which are closely related to the legal considerations that must be considered in regard to these acts, and the protection the local government must provide doctors in cases of aggression, derived from the obligation to ensure the protection of workers under <span class="elsevierStyleItalic">Law 31/1995 of November</span> 8 on the <span class="elsevierStyleItalic">Prevention of Occupational Risks</span>.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this sense, the possibility of modifying the Penal Code and qualifying the act as a crime of assault has recently been the subject of extensive discussion among jurists, and have not resulted in a unanimous doctrinal or jurisprudential answer.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1,5</span></a> For some, criminal proceedings never seemed to offer an ultimate solution to this problem, and certain questions raised by this issue have been the subject of specific research by experts.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This purpose of this paper is to reflect on the reality of attacks on health professionals in Spain, the actual effectiveness of preventive measures taken in recent years and the significance of the new criminal category and analyse their potential protection for professionals. This interest stems from the recent amendment to the Penal Code, in force since July 1, 2015, which finally considers aggression committed against health officials who are performing their functions as crimes.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Violence and health: basic concepts</span><p id="par0035" class="elsevierStylePara elsevierViewall">In 2002 the World Health Organisation (WHO) defined the term “violence” as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation“.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> The cultural values of each country and the evolution of these values and social norms have an influence on its complexity and determinants that affect its tolerance.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> The definition above stresses that interpersonal violence should be considered an international, priority, public health problem, as was already established in 1996 at the 49th World Health Assembly.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Among the different varieties of violence that WHO identifies, “violence at work” stands out as a priority, defined as violence that occurs during the exercise of professional activity or as a direct consequence of that.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Within this category, “external violence” also deserves special attention (violence between workers and people present in the workplace, who have no employment relationship<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>), as it is more common than internal violence<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> (violence among workers<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>) and because the risk to health-care workers increases 16-fold compared to other service sector workers.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Attacks on health professionals</span><p id="par0045" class="elsevierStylePara elsevierViewall">Because violence in the health sector has increased steadily in recent years,<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1,12</span></a> workers in this sector currently make up one of the main risk groups.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> It is estimated that violence in the health sector accounts for approximately 25% of all workplace violence,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> and as it seems not to respect borders, it is a now global problem that affects more than half the health workers in the world.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The first international response to this conflict occurred in 2002,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> with the publication of the Framework Guidelines for Addressing Workplace Violence in the Health Sector Manual,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> aimed at raising awareness and providing guidance in addressing violence in this field. The guidelines in this document, along with others established in later works<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> conceptualised attacks on health professionals, as they were understood to be result of both physical and psychological violence (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">As previously mentioned, research studies in Spain trying to establish the characteristics and the real dimension of this type of violence have increased.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> To date, studies carried out are mainly descriptive and have analysed specific centres and/or certain regions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In this regard it should be stressed that a unified national register of attacks on health professionals is not currently available<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> but the creation of one would be desirable in order to better understand and possibly prevent its occurrence.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">At the National Health System Inter-territorial Council Plenary Session of June 2014, data from the Assaults on National Health System Professionals Report was reported, postulated as “<span class="elsevierStyleItalic">the first official document on this type of aggression”</span>.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> According to this report, more than 30,000 health professionals were attacked in Spain between 2008 and 2012, of which 80% were verbal attacks.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> The data provided appeared to further collaboration between the Ministry of Health and Justice in creating policies that recognised the status of civil-servant health workers as “public authorities”, and associated “presumption of truth” policies in case of conflict. This has resulted in the amendment of Article 550 of the Penal Code,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> an issue that will be addressed below.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Also worth noting is the work carried out by the Collegial Medical Organisation, which created its own Observatory on Assaults to quantify and study violent episodes registered in Spanish Medical Associations. Data for 2014 estimate the number of attacks on doctors to be 344, a figure that corroborates an apparent downward trend observed since 2011 (when the figure was 496).<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> The evaluation of the results raises additional questions: primary care is the context which is most affected (48%); the most common cause of attack was a discrepancy in health care provided (30%); a complaint was filed in 66% of cases; and between 2010 and 2014, 82 attacks were given the legal qualification of a crime and 119 an offence.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The work done by other observatories, such as the Junta de Castilla y León has also been very commendable. This observatory, in its February 2015 report regarding the evolution of the problem between 2011 and 2014, notes that the number of incidents and assaulted professionals has increased annually, except for a slight decline in 2012,<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> despite a decrease in the number of monitoring centres.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> In 2014 verbal abuse was the most predominant, followed by psychological and physical abuse. Psychiatry and emergency services were those where the greatest number of altercations occurred. Furthermore, the professional group most affected was that of nurses and the triggering cause was most frequently a disagreement in how service was provided.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Overview of the preventive measures taken in Spain</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">From the perspective of occupational risk prevention</span><p id="par0075" class="elsevierStylePara elsevierViewall">Violence in the health sector is an occupational risk and as such, requires specific interventions that focus on both parts that form the basic structure of any preventive action: the before and after.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The document prepared by WHO in conjunction with other organisations<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> is illuminating in this context, as it lists recommendations on preventive activities that should be put in place in the workplace. When these preventive measures fail and there is a presence of violent incidents, determining their origin becomes a priority, as does risk assessment, introducing corrective measures and finally verifying the effectiveness of those measures.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> There is not one single tool that can ensure the prevention of attacks; however, training is recommended as a fundamental strategy in most guidelines for avoiding workplace violence. Despite this, it is a resource that is not offered consistently, or universally, and whose effectiveness is evaluated on rare occasions, for this reason further research into it would be desirable.<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26,27</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In Spain, the protection of workers from risks at work has received special attention since the late 20th century and has been the focus of specific legislative. In this sense, Article 40.2 of the Spanish Constitution is worth recalling, as it emphasises that public authorities must guarantee health and safety at work, and notes that the aforementioned Law 31/1995 of November 8 on Prevention of Occupational Risks was a direct response to this constitutional mandate.</p><p id="par0090" class="elsevierStylePara elsevierViewall">To comply with their preventive responsibilities in regard to occupational risks, the Health Departments of the different autonomous communities have adopted additional measures to the legislations, which have been promoted in conjunction with different institutions such as associations (Provincial Medical Associations in coordination with General Councils, or Nursing Associations championed by the Nursing Organisation Association) and trade unions.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> The review offered in the Attacks on NHS Professionals Working Group Report summarised the major initiatives taken (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Regional Health Councils have implemented various prevention plans specifically designed to combat this type of violence, and in some cases it they can be freely consulted (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">One of the first initiatives taken was by the Official Medical Doctors’ Association of Barcelona in 2003. This initiative served to implement a violence prevention in the workplace programme which included the creation of a Doctors’ Safety Observatory – a guide to addressing and preventing violence – in addition to the contracting of a legal defence policy for doctors, among other measures.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Over recent years, almost all regional medical associations have joined forces to work on improving this situation.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">From a legislative perspective</span><p id="par0105" class="elsevierStylePara elsevierViewall">Law 14/1986 of April 25 on General Health referred to in Article 10 on the rights of patients and in 11 on their responsibilities, and subsequently Law 41/2002 of November 14th, regulating patient autonomy and their rights and obligations regarding clinical information and documentation amends those specific articles of the General Law,<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1,5</span></a> reinforcing and expanding the concept of patient autonomy and the importance that our legal system gives them in regard to their rights. Gradually, and somewhat paradoxically, while this legislative development took place, a scenario of growing violence towards healthcare workers evolved, eventually resulting in their rights of being consolidated in the different regional health regulations as well<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In parallel, and with the dual objective of protecting workers and deterring potential attacks, certain regional administrations categorised these aggressive behaviours, ensuring they were financially sanctioned.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1,6</span></a> Proof of this is <span class="elsevierStyleItalic">Law 8/2010, of August 30th, on the Organisation of the Castilla y León Health System</span>, where different types of offence are defined (minor, serious or very serious), with fines ranging from 300 to 600,000 euros.</p><p id="par0115" class="elsevierStylePara elsevierViewall">From a protection of health workers’ perspective, these measures have been considered positive and potentially more effective than criminal proceedings, as they address the principle of proportionality to the harm caused and Administration intervention is thus fundamental.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1,28</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The truth is that recourse to criminal proceedings and categorising the occurrences as assault have been the subject of lengthy and extensive discussions, as already noted above. During recent years, certain Spanish courts, particularly Criminal and Provincial courts, have described specific violent occurrences against health professionals as crimes of assault.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> In turn, the Prosecution has offered, through collaboration agreements with Associations or regional Ministries of Health, the possibility to toughen penalties for perpetrators and an immediate prosecution of cases.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1,29</span></a> However, it was the Supreme Court sentence on December 4, 2007 that established a before and after, when they categorised an attack by a patient against an NHS maxillofacial surgeon<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5,29</span></a> as an “crime on a public official” thereby creating a solid argument that could benefit further legal decisions.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Some authors advocate the need to prosecute cases as “assault crime”, as this would encourage more severe sentences, which, consequently, could help deter future attacks.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> Similarly, different groups have simultaneously called for the consideration of health professionals as a “public authority”, which would result in attacks being seen as “crimes of assault”.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> However, others have argued that the criminalising of these occurrences would not prevent these violent acts and that it is a measure that should be considered only after other channels have been explored, that is, following the principle of <span class="elsevierStyleItalic">ultima ratio</span> (last resort), as it could lead to unjust resolutions or ineffectiveness of the legislation when the punishments for the actions go unnoticed or are not proportional.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Finally, the demands of the former seem to have been satisfied with the entry into force on July 1, 2015 of the reform to the Penal Code and its effects on Articles 550 and 551 – those defining the crime of assault.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Thus, Article 550 of the Penal Code now reads as follows<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0135" class="elsevierStylePara elsevierViewall">Those who attack or oppose or offer serious resistance to authority, its agents or public officials, when they are exercising the functions of their office or functions that are related to those responsibilities, with serious or violent intimidation, are guilty of assault.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In any case, acts of assault are considered any attack committed against teachers or health officials who are exercising their duties or functions that are related to those responsibilities.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0145" class="elsevierStylePara elsevierViewall">The attacks will be punished with imprisonment during one to four years and a fine of three to six months if the infringement was against authority and imprisonment of six months to three years in other cases.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0150" class="elsevierStylePara elsevierViewall">Notwithstanding the provisions of the preceding paragraph, if the assault was against a member of Government, Members of the Autonomous Region Governments, Congress, the Senate or the Legislative Assemblies of the Autonomous Communities, Local Governments, the General Council of the Judiciary, Judge of the Constitutional Court, Judge, Magistrate or Member of the Prosecution, imprisonment of one to six years and a fine of six to twelve months will be imposed.</p></li></ul></p><p id="par0155" class="elsevierStylePara elsevierViewall">Thus, violent acts that meet these conditions and are committed against health officials may be considered, in any case, a crime of assault, consequently implying: harsher penalties and the guarantee of a firm legal judgement which judges can use for sentencing.</p><p id="par0160" class="elsevierStylePara elsevierViewall">For its part, the autonomous communities of Aragon, Castilla y León, Valencia and Extremadura have anticipated arbitrating their own measures in this regard and have recognised for some time certain health workers as public authorities (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Evaluation of the effectiveness of preventive measures taken in Spain</span><p id="par0165" class="elsevierStylePara elsevierViewall">Below is a summary of our comprehensive review into both scientific and grey literature on the issue of attacks on health professionals in our country and the effectiveness of preventive measures. To date there is only one document that addresses this aspect, the Assaults on National Health System Professionals Report published in 2014.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Its analysis is based on a questionnaire completed by a limited number of representatives from certain autonomous communities who score the degree of effectiveness “<span class="elsevierStyleItalic">from the qualitatively and subjective perspective of the experience of someone who knows and works in the National Health Service”</span>, and on internal analysis documents from each community, subsequently studied by the Ministry of Health, Social Services and Equality.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> This report concludes that in most cases the degree of effectiveness of the measures taken is medium-high.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> However, the bias of a subjective assessment necessary for conducting the study does exist, as the analysis comes from a small number of experts in the field. It is also recognised that in order to improve its objectivity, extending the evaluation to other participants involved in the process (health workers, prevention services, <span class="elsevierStyleItalic">etc.</span>) would be necessary. Thus, the conclusions exposed lack, <span class="elsevierStyleItalic">a priori</span>, the scientific rigour necessary to defend the real effectiveness of these measures.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">This review aims to reflect on the phenomenon of violence against health professionals in Spain as well as the preventive measures that have been implemented in recent years and their potential effect, with a particular reference to the latest changes in the legal field. Certain issues arising from the review are explored below, and should be subject to deeper review.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">The phenomenon</span><p id="par0175" class="elsevierStylePara elsevierViewall">The increase in the number of studies conducted in recent years is undeniable and has ensured a better characterisation of the phenomenon, but certain aspects still need to be defined better. Proof of this is the difficulty in establishing frequency parameters such as prevalence and incidence, which is to some extent due to the standardised approach of the conceptual, methodological and/or evaluative research studies.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10,12,18</span></a> Among the proposals for improving this aspect include the use of more precise conceptual frameworks and validation of the instruments used,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> including a standardised register of attacks.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">The design of the studies has tended to take a transversal descriptive approach<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> so that future research should aim to improve the quality of the scientific evidence available, thus facilitating the decision-making process. For example, assessing short and long term impacts through longitudinal cohort studies.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Under-reporting is another recurring problem that hinders, among other things, the required actions for classification and prosecution of these violent episodes.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Training programmes that instruct on the importance of registering any kind of attack could be helpful in raising workers’ awareness,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> as until now they tended to minimise its importance and even considered it a part of the profession.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16,19</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Prevention</span><p id="par0190" class="elsevierStylePara elsevierViewall">The prevention of this sort of violence appears to have been addressed by the autonomous communities and the competent Spanish health organisations, although there does still seem to be a pending challenge in regard to the momentum of organisational measures, policies and even the law.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Some authors consider training measures to be fundamental<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26,27</span></a> as they may reduce the number, severity and consequences of incidents. In spite of this, it is often believed that the needs of the various professional categories are not adequately defined, and the resulting effects have not even been evaluated.</p><p id="par0195" class="elsevierStylePara elsevierViewall">In recent years, various trends have advocated for categorising attacks as crimes of assault in order to deter and reduce the amount of violent cases occurring.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> However, others have noted that this could lead to an excessive penal reaction–and unequal protection, as private sector health workers would be excluded<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a>–and that criminal proceedings should be a last resort, believing that they are not appropriate for the proper and effective prevention of these behaviours.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Until now, there have been no consistent data to confirm the association between criminal sanctions and a long-awaited reduction in the number of incidents. According to data from the Castilla y León Observatory on Assault, this relationship could be jeopardised.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24,25</span></a> Between 2008 and 2014, 153 sentences were condemnatory, of which 37 convicted the offender of a crime–and the majority of them (32) classified the events as an attack against a public official.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Despite this, the peak of violent incidents between 2011 and 2014 was recorded in 2014.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Although general prevention recommendations emphasise the need to evaluate the measures that are being adopted,<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13,26</span></a> as of today we still lack studies providing quality scientific evidence regarding the actual effectiveness of current preventive actions. The Assaults on National Health System Professionals Report<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> is an initial approach, although their conclusions are certainly questionable due to bias recognised by authors themselves.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0205" class="elsevierStylePara elsevierViewall">Knowledge of this phenomenon in Spain has increased in recent years, however we are facing a reality that we have not yet been able to respond to suitably.</p><p id="par0210" class="elsevierStylePara elsevierViewall">We do not have exact numbers of detailed incidence or prevalence rates, although the data we do have indicate that attacks continue to rise and that the most common are verbal and mainly directed towards nurses. In general, workers do not report them.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Prevention plans and measures have recently been implemented in order to combat this phenomenon, but there is insufficient scientific evidence to prove that these measures are associated with an actual decrease in the number of incidents. If a conclusion can be obtained from this paper it is that we are missing critical data, without which we are unable to state whether the preventive measures taken are effective, and the data that does exist suffer from defects of bias and lack of sufficient quality to be considered reliable. This implies that new studies, which respect quality criteria, are needed to provide the information required. Consequently, as of today the true value of the actions carried out cannot be determined, nor can we confirm what the most effective deterrent is.</p><p id="par0220" class="elsevierStylePara elsevierViewall">In the future we will be able to verify whether the new reforms to the Penal Code regarding crimes of assault have resulted in a reduction in the number of violent attacks on healthcare staff. However, it is foreseeable that a reduction will need interventions and measures that relate not only to criminal proceedings. Financial administrative fines and educational intervention should be considered.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest in this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Violence and health: basic concepts" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Attacks on health professionals" ] 3 => array:3 [ "identificador" => "sec0020" "titulo" => "Overview of the preventive measures taken in Spain" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "From the perspective of occupational risk prevention" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "From a legislative perspective" ] ] ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Evaluation of the effectiveness of preventive measures taken in Spain" ] 5 => array:3 [ "identificador" => "sec0040" "titulo" => "Discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "The phenomenon" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Prevention" ] ] ] 6 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack246742" "titulo" => "Acknowledgements" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-12-16" "fechaAceptado" => "2016-01-01" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marinas-Sanz R, Martínez-Jarreta B, Casalod Y, Bolea M. Las agresiones a profesionales sanitarios en España: análisis tras la reciente modificación del Código Penal. Med Clin (Barc). 2016;147:35–42.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">These authors contributed equallay to this work.</p>" "identificador" => "fn1" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1675 "Ancho" => 2229 "Tamanyo" => 254994 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Violence: fundamental concepts.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1318 "Ancho" => 3337 "Tamanyo" => 312250 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Some of the preventive measures implemented in Spain. AC: autonomous communities. Source: Ministry of Health, Social Services and Equality.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AC, autonomous communities; (A), attacks on workers; (T), affected workers.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">See Refs.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4,14–20</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "fx1.jpeg" "imagenAlto" => 2490 "imagenAncho" => 4770 "imagenTamanyo" => 1045460 ] ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics and results of major studies by autonomous community.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autonomous community \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preventive plan \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Andalusia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Assault Prevention and Response Plan for Andalusian Public Health System Professionals<br>(<a class="elsevierStyleInterRef" id="intr0005" href="http://www.juntadeandalucia.es/servicioandaluzdesalud/library/plantillas/externa.asp?pag=/contenidos/./contenidos/profesionales/guia/AtencionAgresiones/PlanAtencionAgresiones.pdf">http://www.juntadeandalucia.es/servicioandaluzdesalud/library/plantillas/externa.asp?pag=/contenidos/./contenidos/profesionales/guia/AtencionAgresiones/PlanAtencionAgresiones.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aragon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Approval by the Health Commission of non-legislative proposal no. 91/05, on attacks on workers in the Aragonese public health system, which urges the creation of an Assault Prevention Plan for workers in the Aragonese public health system and a computerised register of such cases</span><br>(<a class="elsevierStyleInterRef" id="intr0010" href="http://bases.cortesaragon.es/bases%5Coriginal.nsf/%28BOCA1%29/BC792BE091482A49C1256FF800329456/$File/BocaVI_127.pdf">http://bases.cortesaragon.es/bases%5Coriginal.nsf/%28BOCA1%29/BC792BE091482A49C1256FF800329456/$File/BocaVI_127.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cantabria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevention and Response Plan for violent incidents in the Cantabria Public Health System<br>(<a class="elsevierStyleInterRef" id="intr0015" href="http://www.saludcantabria.es/uploads/Plan%20de%20Prevencion%20y%20Atencion.pdf">http://www.saludcantabria.es/uploads/Plan%20de%20Prevencion%20y%20Atencion.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Castilla-La Mancha \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SESCAM Corporate Security and Heritage Protection Plan. Plan Perseo<br>(<a class="elsevierStyleInterRef" id="intr0020" href="http://sescam.castillalamancha.es/sites/sescam.castillalamancha.es/files/documentos/pdf/20131015/plan_director_seguridad_corporativa_y_proteccion_patrimonio.pdf">http://sescam.castillalamancha.es/sites/sescam.castillalamancha.es/files/documentos/pdf/20131015/plan_director_seguridad_corporativa_y_proteccion_patrimonio.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Castilla y León \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Agreement between the Ministry of Health and the CE, SATSE, UGT, SAE-USCAL, CCOO and CSI-CSIF Trade Unions on actions to be taken to develop a Comprehensive Plan against assaults on Castilla y León Regional Health System workers.</span><br>(<a class="elsevierStyleInterRef" id="intr0025" href="http://www.saludcastillayleon.es/institucion/es/recopilacion-normativa/personal-profesiones-sanitarias/resolucion-2-junio-2008-direccion-general-trabajo-prevencio">http://www.saludcastillayleon.es/institucion/es/recopilacion-normativa/personal-profesiones-sanitarias/resolucion-2-junio-2008-direccion-general-trabajo-prevencio</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Catalonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevention and action procedures in situations of violence (in Institut Català de la Salut centres)<br>(<a class="elsevierStyleInterRef" id="intr0030" href="http://www.gencat.cat/ics/infocorp/pdf/PO_PS_02_v3_sit_violencia.pdf">http://www.gencat.cat/ics/infocorp/pdf/PO_PS_02_v3_sit_violencia.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Community of Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">ORDER 212/2004, of March 4, the Minister of Health and Consumer Affairs establishing guidelines for the development of prevention and response plans for potential conflict situations with citizens in public health institutions and centres also creates the central monitoring committee</span><br>(<a class="elsevierStyleInterRef" id="intr0035" href="http://www.madrid.org/wleg/servlet/Servidor?opcion=VerHtml%26idnorma=6271%26word=S%26wordperfect=N%26pdf=S">http://www.madrid.org/wleg/servlet/Servidor?opcion=VerHtml&idnorma=6271&word=S&wordperfect=N&pdf=S</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Navarra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Protocol for situations of external aggression. Navarra Health System–Osasunbidea<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valencian Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comprehensive Plan for Prevention and Response to Attacks on Public Health Sector Workers<br>(<a class="elsevierStyleInterRef" id="intr0040" href="http://www.san.gva.es/documents/155952/752483/DEFINITIVOPIP31_05.pdf">http://www.san.gva.es/documents/155952/752483/DEFINITIVOPIP31_05.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extremadura \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Strategies to mitigate attacks on all Extremadura Public Health System professionals<br>(<a class="elsevierStyleInterRef" id="intr0045" href="https://www.combadajoz.com/pdfs/LIBROAGRESIONESExtremadura.pdf">https://www.combadajoz.com/pdfs/LIBROAGRESIONESExtremadura.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Galicia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plan for the Prevention of Workplace Violence in the Galician Health Service<br>(<a class="elsevierStyleInterRef" id="intr0050" href="http://www.sergas.es/cas/EnPortada/PrevViolenLaboral/Campana/plan.pdf">http://www.sergas.es/cas/EnPortada/PrevViolenLaboral/Campana/plan.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balearic Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plan to Prevent Violence in Balearic Island Healthcare Centres (<a class="elsevierStyleInterRef" id="intr0055" href="http://www.caib.es/govern/rest/arxiu/91902">http://www.caib.es/govern/rest/arxiu/91902</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Canary Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevention Plan for Attacks on Canary Island Health Service Workers<br>(<a class="elsevierStyleInterRef" id="intr0060" href="http://portal.ugt.org/saludlaboral/observatorio/doc_interes/buenaspracticas/violencia_0005.pdf">http://portal.ugt.org/saludlaboral/observatorio/doc_interes/buenaspracticas/violencia_0005.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The Rioja \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plan for Prevention and Response to Riojano Health Service Professionals who are Victims of Assault during the Performance of their Duties<br>(<a class="elsevierStyleInterRef" id="intr0065" href="http://www.riojasalud.es/f/old/ficheros/prevagresionlaboral.pdf">http://www.riojasalud.es/f/old/ficheros/prevagresionlaboral.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The Basque Country \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Action Protocol for Violence at work (Osakidetza)<br>(<a class="elsevierStyleInterRef" id="intr0070" href="http://www.osakidetza.euskadi.eus/contenidos/informacion/salud_laboral/es_sl/adjuntos/violencia.pdf">http://www.osakidetza.euskadi.eus/contenidos/informacion/salud_laboral/es_sl/adjuntos/violencia.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asturias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevention and Response Plan against potential Conflicts in Health Centres<br>(<a class="elsevierStyleInterRef" id="intr0075" href="https://www.asturias.es/Astursalud/Ficheros/AS_SESPA/gu%C3%ADa%20de%20prevenci%C3%B3n%20situaciones%20conflictivas.pdf">https://www.asturias.es/Astursalud/Ficheros/AS_SESPA/gu%C3%ADa%20de%20prevenci%C3%B3n%20situaciones%20conflictivas.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Murcia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevention Plan for Assaults on Health Professionals in Murcia<br>(<a class="elsevierStyleInterRef" id="intr0080" href="http://www.murciasalud.es/recursos/ficheros/73542-agresiones.pdf">http://www.murciasalud.es/recursos/ficheros/73542-agresiones.pdf</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1227275.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Certain prevention plans linked with the administration established in each autonomous communities.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autonomous community \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated legislation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Andalusia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 2/1998 of June 15, on the Andalusia health system (art. 8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aragon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 6/2002 of April 15, on the Aragon Health system (art. 5)<br>Law 9/2013 of November 28, on the Authority of Aragonese Public Health System and Social Service Professionals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cantabria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cantabria Law 7/2002 of December 10, on Cantabria Health Management (art. 47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Castilla-La Mancha \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 8/2000 of November 30, on Castilla La Mancha health management (art. 5; amended by Article 44 of Law 5/2010 of June 24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Castilla y León \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 8/2003, of April 8 on the rights and duties of individuals in regard to health (art. 46)<br>Law 11/2013 of December 23 on Tax Measures and Autonomic Public Sector Restructuring: Amendment of Law 8/2010 of August 30, Castilla y León Health System Management (art. 34: Consideration of public authority) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Catalonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 15/1990 of July 9, on Health Management (No explicit mention of the obligation to respect medical personnel) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Community of Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 12/2001 of December 21, on the Community of Madrid health management (art. 30) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Navarra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Foral Law 17/2010, of November 8, on the rights and duties of individuals in the Navarra health system (art. 3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valencian Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 10/2014, of December 29, on the Valencian Health system (art. 53 and art. 16: personal and public authority) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extremadura \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 10/2001 of June 28, on the Extremadura health system (art. 12)<br>Law 11/2015 of April 8, on the Public Health System Professionals Authority and Extremadura health centres \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Galicia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 8/2008 of July 10, on the Galicia health system (art. 15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balearic Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 5/2003 of 4 April, on the Balearic Islands health system (art. 24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Canary Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 11/1994, of July 26, on the Canary Islands Health System Management (art. 11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The Rioja \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 2/2002 of April 17, on the Health system (art. 20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The Basque Country \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 8/1997 of June 26, on Euskadi Health Management (art. 10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asturias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 1/1992, of July 2, on the Health Service of Asturias (art. 50: No explicit mention of the obligation to respect medical personnel) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Murcia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Law 3/2009 of May 11, on the Rights and Duties of health system users in the Region of Murcia (art. 62) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1227274.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Legislation for each autonomous community in regard to attacks on health workers.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Las agresiones en el ámbito sanitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. 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Journal Information
Vol. 147. Issue 1.
Pages 35-42 (July 2016)
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Vol. 147. Issue 1.
Pages 35-42 (July 2016)
Special article
Aggressions towards healthcare workers in Spain: Status after the recent modification of the Spanish Penal Code
Las agresiones a profesionales sanitarios en España: análisis tras la reciente modificación del Código Penal
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