Search

Background: Accurate symptom monitoring is vital when managing pediatric asthma, providing an opportunity to improve control and relieve associated burden. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) has been validated for asthma control assessment in children; however, there are concerns that response option images used in the C-ACT are not culturally universal and could be misinterpreted. This cross-sectional, qualitative study developed and evaluated alternative response option images using interviews with children with asthma aged 4–11 years (and their parents/caregivers) in the United States, Spain, Poland, and Argentina. Interviews were conducted in two stages (with expert input) to evaluate the appropriateness, understanding and qualitative equivalence of the alternative images (both on paper and electronically). This included comparing the new images with the original C-ACT response scale, to provide context for equivalence results. Results: Alternative response option images included scale A (simple faces), scale B (circles of decreasing size), and scale C (squares of decreasing quantity). In Stage 1, most children logically ranked images using scales A, B and C (66.7%, 79.0% and 70.6%, respectively). However, some children ranked the images in scales B (26.7%) and C (58.3%) in reverse order. Slightly more children could interpret the images within the context of their asthma in scale B (68.4%) than A (55.6%) and C (47.5%). Based on Stage 1 results, experts recommended scales A (with slight modifications) and B be investigated further. In Stage 2, similar proportions of children logically ranked the images used in modified scales A (69.7%) and B (75.7%). However, a majority of children ranked the images in scale B in the reverse order (60.0%). Slightly more children were able to interpret the images in the context of their asthma using scale B (57.6%) than modified scale A (48.5%). Children and parents/caregivers preferred modified scale A over scale B (78.8% and 90.9%, respectively). Compared with the original C-ACT, most children selected the same response option on items using both scales, supporting equivalency. Following review of Stage 2 results, all five experts agreed modified scale A was the optimal response scale. Conclusions: This study developed alternative response option images for use in the C-ACT and provides qualitative evidence of the equivalency of these response options to the originals. Plain English summary: Accurate monitoring of the symptoms associated with pediatric asthma is important when managing the condition. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) is a questionnaire widely used to measure asthma severity in young children (aged 4–11 years). Each question answered by the child in the C-ACT has four possible answer choices. To help children answer, each choice is presented alongside an image of a male child's face ranging from sad to happy. However, there are concerns that the images used are not culturally universal and could be misinterpreted—due to difficulties translating to electronic formats and a lack of differentiation between the images used. Through interviewing children with asthma, we aimed to address these concerns by developing and testing new images. Alternative image options developed included simpler faces, circles of decreasing size and squares of decreasing quantity. Children aged 4–11 years old were interviewed to test whether they understood the response scale using the new images and if they answered in the same way as with the original images. Interviews were conducted in two stages, with expert guidance at key stages. Results showed that children can interpret and understand the newly developed images and that they answer the questions the same as they would using the original images. These new images have the advantages of being culturally neutral and easier to implement on an electronic device. [ABSTRACT FROM AUTHOR]

Abstract  This paper presents an application of the Analytic Network Process (ANP) to farmland appraisal. The purpose of this new methodology is to solve some of the drawbacks found in comparative and capitalisation methods, called classical appraisal methods, which cannot deal with contexts where only partial information is available and/or qualitative variables are used. The ANP is a method based on the Multiple Criteria Decision Analysis (MCDA). Previous works have already applied other MCDA techniques to the appraisal context, such as the Analytic Hierarchy Process (AHP), however they have not been able to handle all the complexities of many real world appraisal problems. The ANP provides a more accurate approach for modelling complex environment because it allows the general study of the quantitative and qualitative explanatory variables of the price and the incorporation of feedback and interdependence relationships among variables. The new proposed methodology has been applied to a case study of a farm located in Valencia (Spain) in order to demonstrate its goodness. Both quantitative and qualitative variables, such as the age of the trees, productivity or water quality, have been considered to assess the market value of the farm. Six farms from the same region have been selected as reference assets. The appraisal problem has been solved in three different ways in order to study the influence of each model on the value of the problem farm. In this study it has been proved that the more information is incorporated into the model, the higher accuracy of the solution. From the results of this work we can conclude that the approach proposed stands out as a good alternative to current farmland appraisal approaches, as it has proven to be useful when data are only partially available, qualitative variables are used and influences among the explanatory variables are present. [ABSTRACT FROM AUTHOR]

Background: Several studies have described potential microRNA (miRNA) biomarkers associated with migraine, but studies are scarcely reproducible primarily due to the heterogeneous variability of participants. Increasing evidence shows that disease-related intrinsic factors together with lifestyle (environmental factors), influence epigenetic mechanisms and in turn, diseases. Hence, the main objective of this exploratory study was to find differentially expressed miRNAs (DE miRNA) in peripheral blood mononuclear cells (PBMC) of patients with migraine compared to healthy controls in a well-controlled homogeneous cohort of non-menopausal women. Methods: Patients diagnosed with migraine according to the International Classification of Headache Disorders (ICHD-3) and healthy controls without familial history of headache disorders were recruited. All participants completed a very thorough questionnaire and structured-interview in order to control for environmental factors. RNA was extracted from PBMC and a microarray system (GeneChip miRNA 4.1 Array chip, Affymetrix) was used to determine the miRNA profiles between study groups. Principal components analysis and hierarchical clustering analysis were performed to study samples distribution and random forest (RF) algorithms were computed for the classification task. To evaluate the stability of the results and the prediction error rate, a bootstrap (.632 + rule) was run through all the procedure. Finally, a functional enrichment analysis of selected targets was computed through protein–protein interaction networks. Results: After RF classification, three DE miRNA distinguished study groups in a very homogeneous female cohort, controlled by factors such as demographics (age and BMI), life-habits (physical activity, caffeine and alcohol consumptions), comorbidities and clinical features associated to the disease: miR-342-3p, miR-532-3p and miR-758-5p. Sixty-eight target genes were predicted which were linked mainly to enriched ion channels and signaling pathways, neurotransmitter and hormone homeostasis, infectious diseases and circadian entrainment. Conclusions: A 3-miRNA (miR-342-3p, miR-532-3p and miR-758-5p) novel signature has been found differentially expressed between controls and patients with migraine. Enrichment analysis showed that these pathways are closely associated with known migraine pathophysiology, which could lead to the first reliable epigenetic biomarker set. Further studies should be performed to validate these findings in a larger and more heterogeneous sample. [ABSTRACT FROM AUTHOR]

In recent years, loneliness has been receiving increasing attention, yet there remains a lot to learn about how older adults cope with loneliness. In this study, the practices older adults consider for coping with loneliness and the relationship between various types of coping practices, loneliness, and personal resources are examined. Several hypotheses about the relationship between social and emotional loneliness, personal resources, and mentioning coping practices are formulated. Data was collected in Gipuzkoa (Basque Country, Spain) through structured interviews using a telephone survey among a representative sample of older adults aged 55 and over (N = 894). Results show that lonely and non-lonely respondents alike consider a few coping practices and prefer active and individual coping practices over social and passive ones for coping with loneliness. Experiencing emotional loneliness is related to mentioning more individual and active coping practices. Social coping practices were considered less often by respondents who experienced better self-rated health and more often by respondents with vision loss, a higher educational level and higher quality of life. In conclusion, while older adults differ in coping efforts they mention, these differences are only explained to a small extent by their experience of loneliness and available resources. For future research and practice development, a deeper understanding of the process of coping with loneliness is needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the factor structure of the MOS-SSS in a sample of community-dwelling Spanish older adults. The sample comprised 406 community-dwelling older adults aged between 65 to 99 years old (Mage = 74.88, SD = 6.75). Confirmatory factor analysis (CFA) was performed, and four possible models were compared: the one-factor, the three-factor, the four-factor and the five-factor model, using an additional analysis with a second-order factor. The internal consistency reliability and convergent validity of the scale were also assessed. For the 19-item MOS-SSS scale, the five-factor model had the best fit to the data. All five subscales of the MOS-SSS showed adequate internal consistency, good convergent and discriminant validity. These findings contribute to the literature on the factor structure of the MOS-SSS in Spanish older adults. The MOS-SSS is a reliable and valid scale that can be used to assess Spanish older adults' social support perception for social services, health and in research contexts. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65 years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan–Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5 years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan–Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Social and economic inequalities in condom use by adolescents have been reported previously. Also, condom use has declined during the last decade. The aim of the study was to describe trends in the use of condoms in our setting, and how these trends may differ between socioeconomic groups in boys, and separately in girls, aged 17-19 years attending school in Barcelona between 2004 and 2012. We analyzed data from three annual surveys on risk factors in secondary students, which included a representative sample of the city's population; individuals who had previously had sexual intercourse (n = 1570) were included in the study. We calculated adjusted prevalence ratios (aPR) and their confidence intervals (95% CI) using robust Poisson regression models. The prevalence of condom use among boys was 87.0% in 2004 and 76.2% in 2012, and 76.7 and 64.7% among girls, respectively. This decrease was greater in adolescents with a low socioeconomic level, both in boys (aPR = 0.80) and girls (aPR = 0.84). The observed increase of socioeconomic inequalities in condom use in adolescents highlights a possible deterioration in good sexual practices and policies during the studied period. [ABSTRACT FROM AUTHOR]

Study design:Retrospective descriptive observational study.Objective:The primary objective of this study was to quantify the incidence of iatrogenic spinal cord injury (SCI) at our SCI unit (SCIU). The secondary objective was to discover the surgical and medical procedures that cause iatrogenic SCI and to estimate the incidence with each procedure.Subjects:Patients admitted to or seen at outpatient services of the SCIU at a university hospital.Methods:Histories were compiled from 1 July 2005 to 30 June 2009. We included patients with SCI caused by any medical or surgical procedure. We collected age, sex, diagnosis leading to medical intervention, predominant clinical manifestations, medical-surgical procedure and level and grade of injury upon admission and discharge.Results:Out of 250 patients admitted to the SCIU, 32 (14.7%) patients presented iatrogenic SCI. Average age was 56.2 (s.d. 17.3), ranging from 0 to 82 years old. The most frequent clinical manifestation was pain. The most common diagnosis was channel stenosis. Lumbar level grade C of American Spine Injury Association (ASIA) was the most frequently observed.Conclusion:The rise in the population's life expectancy entails an increase in elderly patients with vascular risk factors, who underwent invasive interventions leading to spinal cord iatrogenia. [ABSTRACT FROM AUTHOR]

PurposeTo determine the prevalence of pinguecula and pterygium and to investigate their associations in a general adult population in North-Western Spain.MethodsAn age-stratified random sample of 1155 subjects ≥40 years was selected in O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (SD): 63.4 (14.5) years, range: 40-96 years, 37.0% males). An interview to collect history of systemic diseases and lifestyle details and a comprehensive ophthalmic evaluation in which pinguecula and pterygium were recorded was carried out. The prevalence of pinguecula and pterygium and their relationship with lifestyle factors and ocular and systemic diseases was investigated.ResultsThe prevalence of pinguecula was 47.9% (95% confidence interval (CI): 43.9-51.9). This prevalence increased significantly with aging (P=0.002) and was higher in men (56.4%; 95% CI: 50.0-62.7) than in women (42.7%; 95% CI: 37.8-47.8) (P=0.001). The prevalence of pterygium was 5.9% (95% CI: 4.3-7.9). This prevalence also increased significantly with aging (P=0.005) and was 4.8% (95% CI: 2.6-8.4) in men and 6.5% (95% CI: 4.5-9.3) in women (P=0.346). After controlling for age and sex, pinguecula was associated with alcohol intake (adjusted odds ratio (ORa): 3.08; 95% CI: 1.60-5.95), pterygium with fluorescein staining (ORa: 2.64; 95% CI: 1.08-6.46) and both disorders with outer activity (ORa: 2.07; 95% CI: 1.36-3.15 and 2.28; 95% CI: 1.04-4.98, respectively).ConclusionsPinguecula is far more common than pterygium. Alcohol consumption is strongly associated with pinguecula. Fluorescein staining is highly prevalent in subjects with pterygium. Both disorders increase with age and are associated with outer activity. [ABSTRACT FROM AUTHOR]

The European Water Framework Directive establishes the need to define stream type-specific reference conditions to identify “high ecological status”. Methods for selecting reference sites using a priori criteria have been proposed by many authors. A review of these criteria revealed that the most relevant criteria for streams and rivers were those related to riparian vegetation, diffuse and point sources of pollution, river morphology and hydrological conditions and regulation. In this work, we propose 20 criteria that reflect the characteristics of Mediterranean streams and their most frequent disturbances for the selection of reference sites in Mediterranean streams in Spain. We studied 162 sites located in 33 Mediterranean basins belonging to five stream types. Of the locations, 57% were selected as a priori reference sites by having applied the proposed criteria. Reference sites were identified for all stream types except for “large watercourses” which includes the lower reaches of some rivers in this study area. This a priori selection of reference sites was subjected to validation using the macroinvertebrate community by applying of an IBMWP threshold, which is considered to be an indicator of undisturbed sites in Mediterranean streams. This approach determined that whole of this selection (100%) could be considered valid reference sites. Furthermore, we identified differences in the reference conditions for each stream type on the basis of macroinvertebrate assemblage composition. [ABSTRACT FROM AUTHOR]

We have studied the underlying factors responsible for the heterogeneous ecophysiological status of a semiarid Stipa tenacissima L. steppe in a subcatchment of SE Spain by assessing population composition and habitat structure of S. tenacissima stands. To do this, we measured and estimated 18 variables (11 biotic and seven abiotic) in 15 plots randomly distributed in the subcatchment, and then zoned this area by plot affinity using PCA. This analysis produced three sectors determined mainly by S. tenacissima cover and soil depth variables. The linear relationship fitted between S. tenacissima tussock biomass and tussock density in monospecific stands (both logarithmic) indicated a curve close to −1, suggesting that the system is close to the maximum constant yield state. Ecophysiological measurements (gas exchange, fluorescence and individual leaf area index) were taken in two periods with different water availability in a representative plot in each sector. The intraspecific competition (inferred from the density dependence of green biomass) and rock outcrops were the main factors influencing the ecophysiological status in the study area. While, in the wet season, intraspecific competition regulated water consumption in zones where S. tenacissima tussocks (monospecific stands) are dominant, during the dry season, stands in zones with extensive rock outcrops and stone cover (tussocks in “soil pockets”) had no access to non-rainfall water gains because of the adjacent bare soil, and so in these stands, gas exchange was lower and photoinhibition higher. This article stresses the importance of considering the connection between tussocks and bare-ground interspace in the functional and structural analysis of semiarid steppes. [ABSTRACT FROM AUTHOR]

In natural systems, the chemistry of floodplain waters is a function of the source of the water, which is influenced by geomorphic features of riparian wetlands. However, anthropogenic disturbances may alter both geomorphic features and the natural balance of water mixing in the floodplain. The aim of this study was to classify riparian wetlands and characterize their water characteristics in one reach of the Middle Ebro River to assess the hydrochemical functioning of the system. In order to accomplish that goal, water samples were collected at 40 sampling sites during low-water conditions and two floods of different magnitude. Moreover, geomorphic characteristics of riparian wetlands were also analyzed to interpret the results at broader spatio-temporal scales. Three group of wetlands were identified using multivariate ordination: (1) major and secondary channels highly connected to the river by surface water, containing weakly ionized water with high nitrate levels during floods; (2) secondary channels and artificial ponds located in riparian forests near the river, most of which were affected by river seepage during the examined events. This type of sites had high major ions concentrations and elevated spatial variability with respect to nutrient concentrations during floods; (3) Siltated oxbow lakes, whose hydrogeochemical features seemed to be unaffected by factors related to river fluctuations. Total dissolved solids, major ion (sulfate, chloride, sodium, calcium, magnesium, and potassium) and nutrient (nitrate, ammonium and organic nitrogen, and phosphate) depended upon the relationships between surface and subsurface water flows. Seasonal changes and geomorphic characterization indicated that a strong functional dependence of floodplain wetlands close to the main river channel is established, whereas most of the floodplain area remains disconnected from river dynamics. Moreover, the effect of nitrate-enriched agricultural runoff seems to affect water... [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of bortezomib plus docetaxel in patients with anthracycline-pretreated advanced/metastatic breast cancer. Forty-eight patients received up to eight 21-day cycles of docetaxel (60-100 mg m(-2) on day 1) plus bortezomib (1.0-1.5 mg m(-2) on days 1, 4, 8, and 11). Pharmacodynamic and pharmacokinetic analyses were performed in a subset of patients. Five patients experienced DLTs: grade 3 bone pain (n=1) and febrile neutropenia (n=4). The MTD was bortezomib 1.5 mg m(-2) plus docetaxel 75 mg m(-2). All 48 patients were assessable for safety and efficacy. The most common adverse events were diarrhoea, nausea, alopecia, asthenia, and vomiting. The most common grade 3/4 toxicities were neutropenia (44%), and febrile neutropenia and diarrhoea (each 19%). Overall patient response rate was 29%. Median time to progression was 5.4 months. In patients with confirmed response, median time to response was 1.3 months and median duration of response was 3.2 months. At the MTD, response rate was 38%. Pharmacokinetic characteristics of bortezomib/docetaxel were comparable with single-agent data. Addition of docetaxel appeared not to affect bortezomib inhibition of 20S proteasome activity. Mean alpha-1 acid glycoprotein concentrations increased from baseline at nearly all time points across different bortezomib dose levels. Bortezomib plus docetaxel is an active combination for anthracycline-pretreated advanced/metastatic breast cancer. The safety profile is manageable and consistent with the side effects of the individual agents. [ABSTRACT FROM AUTHOR]

Background: In spite of a well-established development of instruments, difficulty in interpreting health related quality of life scores may limit its use in clinical practice.Objective: To develop generalizable interpretation aids for a measure of perceived functional visual status, the VF-14 index.Design: Item Response Theory (Rasch analysis) was used to analyze the performance of VF-14 items. The 'ruler' aid was derived from the most difficult activity (item) a patient is able to do without difficulty; the 'clinical scenarios' aid, first identified all significantly different clusters of items within the index and then estimated the mean expected difficulty (responses) to perform a benchmark item in each cluster.Setting: The study was conducted in four hospitals and six ambulatory cataract surgery centers in Barcelona, Spain.Patients: One hundred and ninety-eight patients scheduled for first eye cataracts surgery.Measurements: The self-reported VF-14 index and clinical measures were used.Results: All VF-14 items were found unidimensional with three items showing only partial misfit. For a patient with a VF-14 Rasch score of 71, the 'ruler' aid indicated that 'doing fine handwork' would be the most requiring activity he/she would perform without difficulty. The 'clinical scenarios' aid estimated that such a patient would be unable to 'drive at night', would have some difficulty 'reading small print' and no difficulty 'doing fine handwork', 'watching TV' or 'recognizing people'. Concordance between modeled and observed responses was fair to substantial.Conclusions: Simple content-based interpretation aids for the VF-14 scores were developed that should facilitate its use in clinical practice. These aids should be easily generalizable to other quality of life instruments. [ABSTRACT FROM AUTHOR]

Sociologists and urban commentators often portray metropolitan areas as highly segregated by social class and race. We measured the extent of socioeconomic residential segregation in urbanized areas of the United States in 1970, determined whether cities were as segregated as suburban rings, and compared levels of socioeconomic and racial residential segregation. We found moderate levels of residential segregation and socioeconomic groups. Levels of social class segregation varied little from one urbanized area to another and were about the same in central cities and suburban rings. Racial residentail segregation was much greater than the segregation of social classes within either the black or white communities. The extent of racial residential segregation does not vary by educational attainment, occupation, or income. [ABSTRACT FROM AUTHOR]

Background: Many different preventatives have showed efficacy in the treatment of migraine. National guidelines differ in their recommendations and patients' characteristics are usually taken into account in their selection. In Spain, real life use of preventive therapies seems to be heterogeneous. We aimed to evaluate differences in clinical practice and adherence to national guidelines among Spanish neurologists.Methods: Observational descriptive study. A survey was conducted among neurologists ascribed to the Spanish Society of Neurology. Participants were differentiated in accordance with their dedication to headache disorders. We analysed socio-demographic parameters and evaluated 43 questions considering migraine management as well as therapeutic choices regarding migraine sub-types and finally, neurologists' personal perception.Results: One hundred fifty-five neurologists participated from 17 different regions, 43.4% of them female and 53.3% under 40 years of age. 34.9% confirmed headache disorders as their main interest.The first choice for preventive therapy in chronic migraine among participants was topiramate (57%) followed by amytriptiline (17.9%) and beta-blockers (14.6%). However in episodic migraine, the preferred options were beta-blockers (47.7%), topiramate (21.5%) and amytriptiline (13.4%). Regarding perceived efficacy, topiramate was considered the best option in chronic migraine (42.7%) followed by onabotulinumtoxinA (25.5%) and amitryptiline (22.4%). Where episodic migraine was concerned, surveyed neurologists perceived topiramate (43.7%) and beta-blockers (30.3%) as the best options. When we evaluated the duration of treatment use with a view to adequate therapeutic response, 43.5% of neurologists preferred 3 months duration and 39.5% were in favour of 6 months duration in episodic migraine. However, considering the preferred duration of treatment use in chronic migraine, 20.4% recommended 3 months, 42.1% preferred 6 months and 12.5% and 22.4% opted for 9 and 12 months respectively. When considering onabotulinumtoxinA therapy, the number of prior therapeutic failures was zero in 7.2% of neurologists, one in 5.9%, two in 44.1%, three in 30.9% and four or more in 11.9%. Following an initial treatment failure with onabotulinumtoxinA, 49% of subjects decided against a second treatment. The number of OnabotA procedures before considering it as ineffective was two in 18.9% of neurologists, three in 70.8% and four in 10.4%.Conclusions: The initial management of migraine among Spanish Neurologists is in line with most guidelines, where first choice preventative drugs are concerned. The Management of episodic migraine differed from chronic migraine, both in terms of neurologist preference and in their perceived efficacy. [ABSTRACT FROM AUTHOR]