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This paper presents the results of a survey conducted among people walking the pilgrimage route to the shrine of St James in Santiago de Compostela. The aim of the research was to investigate how a pilgrimage on the Camino de Santiago among a married couple or family affects marital or familial relationships, whether walking the trail to Compostela together influences the behaviour of family members towards each other and whether it forms positive attitudes and behaviour. The empirical basis of the study is the results of a survey among respondents who made the Camino de Santiago pilgrimage, as well as in-depth interviews conducted with 24 spouses of pilgrims along the Way of St James. The study revealed that doing the pilgrimage as a married couple or family had a positive impact on intra-family relationships. According to the interviewees, going on the pilgrimage together helped to strengthen marital bonds and trust, improve communication and mutual connection, show care and affection and improve contact with children. [ABSTRACT FROM AUTHOR]

The aim of the study us to analyze the difference of bullying (traditional bullying and cyberbullying) in rural and urban contexts. A total of 1094 junior and senior high school students (62.5% from urban areas, 37.6% from rural areas) from the region of Castile-La Mancha (Spain) took part herein. The results showed a similar proportion of intervention in all bullying roles and in polybullying in urban and rural context schools. However, victimization and physical bullying perpetration is more frequent in schools in urban areas. In rural schools, aggression is normally aimed at schoolmates. Regression showed the link between context and perpetration role. Victims in rural settings expressed greater distress than victims in schools in urban areas. These results indicate that the size of the population where the schools are located may be a relevant factor for the intervention, as well as the need for intervention at individual, group and community level in collaboration between schools and social services. [ABSTRACT FROM AUTHOR]

Purpose: The market of assisted reproductive technologies (ARTs) is rapidly evolving, raising growing ethical and social dilemmas. This paper compares the regulatory responses to technological and market developments in Israel and Spain, both intensive users of ART. We identify strengths and deficiencies in the regulation of ART in these two countries. Methods: We developed a conceptual framework to classify the factors affecting regulations and priority setting, and applied it using a Delphi survey combined with in-depth interviews. We selected two panels of experts from various fields, trying to simulate the bioethics committees of Israel and Spain. Results: ART is often wrongfully perceived as a solution to age-related infertility. Both panels embraced alternative solutions. The impact of private commercial interest on regulations is resulting in excessive practices such as the repeat of ineffective cycles and the push of sometimes unnecessary treatment add-ons. Our findings show experts dissatisfaction with the regulations of donor-eggs concerning reimbursement and registries in both countries. Conclusions: The adequacy of ART to solve age-related infertility should be confronted with alternative approaches, with emphasis on the distribution of accurate information. The magnitude of ART markets, particularly the use of donor-eggs, should raise the need for additional societal debate and the reform of regulations. The impact factors analysis leads us to question the current regulatory framework, which could be improved by nominating a non-governmental statutory central regulatory agency in Israel and by reforming the Spanish agency. [ABSTRACT FROM AUTHOR]

Results of community-based childhood obesity intervention programs do not provide strong evidence for their effectiveness. In this study, we evaluated the effect of the Thao-Child Health Program (TCHP), a community-based, multisetting, multistrategy intervention program for healthy weight development and lifestyle choices. In four Catalan cities, a total of 2250 children aged 8 to 10 years were recruited. Two cities were randomly selected for the TCHP intervention, and two cities followed usual health care policy. Children were selected from 41 elementary schools. Weight, height, and waist circumference were measured at baseline and after a mean follow-up of 15 months. Physical activity and adherence to the Mediterranean diet were measured with validated questionnaires. Generalized estimating equations (GEE) models were fitted to determine the intervention's effect on body mass index (BMI) z-score, waist-to-height ratio, Mediterranean diet adherence, and physical activity. Fully adjusted models revealed that the intervention had no significant effect on the BMI z-score, incidence of general and abdominal obesity, Mediterranean diet adherence, and physical activity. Waist-to-height ratio was significantly lower in controls than in the intervention group at follow-up (p < 0.004).Conclusions: The TCHP did not improve weight development, diet quality, and physical activity in the short term. What is Known: • There is inconsistent evidence for the efficacy of school-based childhood obesity prevention programs. • There is little evidence on the efficacy of childhood obesity intervention programs in other settings. What is New: • This paper contributes information about the efficacy of a multisetting and multistrategy Community Based Intervention (CBI) program that uses the municipality as its unit of randomization. • This CBI had no effect on the prevention and treatment of childhood obesity in the short term. [ABSTRACT FROM AUTHOR]

The programme for international student assessment ( PISA) 2006 Report (OECD, PISA 2006: science competencies for tomorrow's world, Organisation for Economic Co-operation and Development, Paris in ) showed significant differences among Spanish students attending publicly financed schools. Publicly financed schools include entirely public schools and schools that are privately managed but publicly funded. Families with a lower socioeconomic status may self-select into public schools, so a direct efficiency comparison between the two school types could lead to flawed conclusions because of the possible school selection bias. In this paper, we suggest using a propensity score matching approach in order to correctly analyze the impact of school ownership on student performance. After tackling the self-selection problem, we use a stochastic parametric distance function framework to compare student efficiency and productivity in both school types across ten Spanish regions using PISA 2006 data. Furthermore, we propose two original measures to analyze the impact of school ownership on academic performance across regions: the average treatment effect on the treated on the production frontier and the average treatment effect on the treated assuming school inefficiency. We find that, on average, private government-dependent schools are more productive than public schools, although efficiency results across regions are highly divergent. [ABSTRACT FROM AUTHOR]

Italy and Spain, as countries of recent immigration and high irregularity rates, have struggled to adapt their statistical system, especially their population registers, to adequately reflect the presence of an increasing number of immigrants in their territory. The population registers of the two countries have adapted differently to these changing realities: Spain introduced significant improvements in Padrón which have increased its coverage and accuracy. This is still not the case in Italy, making it necessary to resort to non-random sampling methods. The paper discusses the methodological implications of these differences and evaluates different methodological solutions based on both random and non-random sampling methods in both countries. [ABSTRACT FROM AUTHOR]

In national health services, where there is a tendency towards a lack of resources and a continuous increase in demand, it is necessary to implement decisions that promote efficiency. In this paper we focus on potential diversification economies as a strategy to increase efficiency levels. We evaluate the change in efficiency in Catalan hospitals between 1987 and 1992, and analyse the presence of possible diversification economies in each hospital. We use Data Envelopment Analysis, which does not need information on either input or output prices. The results are that the majority of hospitals could increase their efficiency and reduce their costs by diversification to the output-mix offered. Potential productivity gains are between 29% and 46%. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to estimate the comorbidity of mental disorders and chronic physical conditions and to describe the impact of these conditions on health-related quality of life (HRQoL) in a sample of older primary care (PC) attendees by gender.Methods: Cross-sectional survey, conducted in 77 PC centres in Catalonia (Spain) on 1192 patients over 65 years old. Using face-to-face interviews, we assessed HRQoL (SF-12), mental disorders (SCID and MINI structured clinical interviews), chronic physical conditions (checklist), and disability (Sheehan disability scale). We used multivariate quantile regressions to model which factors were associated with the physical component summary-short form 12 and mental component summary-short form 12.Result: The most frequent comorbidity in both men and women was mood disorder with chronic pain and arthrosis. Mental disorders mainly affected 'mental' QoL, while physical disorders affected 'physical' QoL. Mental disorders had a greater impact on HRQoL than chronic physical conditions, with mood and adjustment disorders being the most disabling conditions. There were some gender differences in the impact of mental and chronic physical conditions on HRQoL. Anxiety disorders and pain had an impact on HRQoL but only in women. Respiratory diseases had an effect on the MCS in women, but only affected the PCS in men.Conclusions: Mood and adjustment disorders had the greatest impact on HRQoL. The impact profile of mental and chronic physical conditions differs between genders. Our results reinforce the need for screening for mental disorders (mainly depression) in older patients in PC. [ABSTRACT FROM AUTHOR]

Background: In January 2011 Spain modified clean air legislation in force since 2006, removing all existing exceptions applicable to hospitality venues. Although this legal reform was backed by all political parties with parliamentary representation, the government's initiative was contested by the tobacco industry and its allies in the hospitality industry. One of the most voiced arguments against the reform was its potentially disruptive effect on the revenue of hospitality venues. This paper evaluates the impact of this reform on household expenditure at restaurants and bars and cafeterias.Methods and Empirical Strategy: We used household expenditure micro-data for years 2006-2012 to estimate models for the probability of observing expenditures and the expected level of expenditure. We applied a before-after analysis with a wide range of controls for confounding factors and a flexible modeling of time effects in order to identify the effects of the reform.Results: Our results suggest that the reform caused a 2% reduction in the proportion of households containing smokers but did not cause reductions in households' expenditures on restaurant services or on bars and cafeteria services. [ABSTRACT FROM AUTHOR]

This study aimed to explore the family profile of adolescent-to-parent abuse cases. Concretely, this paper examines whether or not there is a different family profile of parent-abuse offenders compared with other types of offenders and with non-offender adolescents. The sample included 90 adolescents who were clustered into three groups (parent-abuse offenders, other type of offenders, and non-offender adolescents). Participants completed measures of quality of communication with parents and parents' educational styles. They were also evaluated using a brief interview with questions about family structure. Results indicate offenders who assault their parents have a different family structure and dynamics. Differences were found concerning the type of household, family size, and family incomes. In addition, parent-abuse offenders reported a lower quality of communication with both parents perceiving them as less warm, more rejecting, and less inductive than did the other groups. [ABSTRACT FROM AUTHOR]

Summary: We estimated the short-term impact of fragility fractures on community-dwelling women in five countries. Women with fragility fractures reported significantly more difficulties performing activities of daily living and significantly higher levels of lost productivity and caregiver support than those without fractures; results highlight the multi-country indirect burden of fragility fractures. Introduction: To estimate the impact of fragility fractures on activities of daily living (ADL), productivity loss and caregiver support in women with a recent fragility fracture. Methods: This multi-centre cross-sectional study enrolled community-dwelling women aged ≥ 50 years in South Korea, Spain, Germany, Australia and the United States. The fragility fracture cohort consisted of women with an index fragility fracture in the past 12 months; the fracture free cohort consisted of women with no fracture in the 18 months prior to study enrolment. Study participants completed three validated questionnaires: Lawton Instrumental ADL (IADL), Physical Self-Maintenance Scale (PSMS) and iMTA Productivity Cost Questionnaire (iPCQ). Results: In total, 1,253 participants from 41 sites across the five countries were included. Compared with the fracture free cohorts, fragility fracture cohorts had significantly lower function and were more dependent on support (p < 0.05 in all countries for Lawton IADL, and in South Korea, Spain, Australia and the United States for PSMS), significantly higher hours of paid absenteeism (p < 0.05, Spain, Germany, Australia), significantly higher unpaid lost productivity (p < 0.05, South Korea, Spain, Germany), significantly more days of paid help received in the home (p < 0.05 South Korea, Spain and the United States), and significantly more days of unpaid help from family members or friends (p < 0.05, all countries). Conclusion: In this multi-national study, fragility fractures in community-dwelling ≥ 50 years women were associated with several outcomes indicating higher indirect burden and lower quality of life, including more difficulties performing ADL and higher levels of lost productivity and caregiver support. [ABSTRACT FROM AUTHOR]

This paper investigates the effect of proprietary costs in relation to managers' decisions to disclose information. Further, we look into the impact of factors affecting the timing of disclosures in a comparative study of Spain and the UK. Our investigation focuses on management earnings press releases discussing annual results. These press releases allow managers great discretion in terms of the decision to release and the timing. Our results show that the potential for growth is negatively related to the likelihood of a company voluntarily issuing a press release. Moreover, once the decision to voluntarily disclose is made, the timing is also relevant. We find significant differences in the timing of press releases between the two countries examined in this study. Also, significant differences between companies having or not having an investor relations department are evident. The existence of an investor relations function in the company seems to have a different impact depending on the country. Interestingly, even though corporate performance seems not to have a direct effect on the timing of the press release, this factor is moderated by the country where companies operate. [ABSTRACT FROM AUTHOR]

This paper addresses four questions concerning the influence of culture on mathematics teachers' professional practice. Firstly, drawing on categorical data yielded by the application of low inference coding schedule to video recordings of sequences of lessons taught by case study teachers on four common topics in England, Flanders, Hungary and Spain, we undertook an exploratory factor analysis to examine the ways in which such coded variables interact. This process yielded five factors, each of which was interpretable against the literature and highlighted the extent to which dichotomisations of mathematics teaching as reform or traditional are not necessarily helpful, not least because all project teachers exhibited characteristics of both. Secondly, factors scores were analysed by nationality to reveal culturally located practices resonant with the available literature. Thirdly, cluster analyses yielded four well-defined cross-cultural clusters of episodes, each indicative of particular didactical perspectives that appeared to challenge the exclusivity of these culturally located practices. Finally, the key methodological finding was that the manner in which data are analysed influences greatly the outcomes of comparative mathematics research. [ABSTRACT FROM AUTHOR]

This article analyses the workings of the new Spanish system of intergovernmental transfers, which has been in operation since 2009, and compares its expected effects with those of the model that was in force until 2008. The paper considers the effects of the new model at the base year of application and the growth over time of these effects. On the positive side, the reform has significantly reduced the dispersion of the distribution of regional resources per capita. On the negative side, the system has become very complex and obscure regarding the distribution criteria it uses; also, of the five (1987, 1992, 1997, 2002, 2009) major revisions of the system, this is the most expensive. [ABSTRACT FROM AUTHOR]

Videotape is an increasingly used tool in cross-national studies of mathematics teaching. However, the means by which videotaped lessons are coded and analysed remains an underdeveloped area with scholars adopting substantially different approaches to the task. In this paper we present an approach based on generic descriptors of mathematics learning objectives. Exploiting live observations in five European countries, the descriptors were developed in a bottom-up recursive manner for application to videotaped lessons from four of these countries, Belgium (Flanders), England, Hungary and Spain. The analyses showed not only that the descriptors were consistently operationalised but also that they facilitated the identification of both similarities and differences in the ways in which teachers conceptualise and present mathematics that resonated with the available literature. In so doing we make both methodological and theoretical contributions to comparative mathematics research in general and debates concerning the national mathematics teaching script in particular. [ABSTRACT FROM AUTHOR]

This paper examines the status of Corporate Ethical Policies (CEP) in large companies in Argentina, Brazil and Spain, with a special emphasis on Corporate Ethics Statements (CES), documents that define the firms' philosophy, values and norms of conduct. It is based on a survey of the 500 largest companies in these nations. The findings reveal many similarities between these countries. Among other things, it emerges that most companies give consideration to ethics in business and have adopted some kind of formal or informal ethical policies. Regardless of whether or not they have a CES, companies agree that ethical conduct must be taken into account when selecting, appraising and promoting personnel as an important ethical policy. There is a growing tendency to draw up formal corporate ethics documents. These documents are perceived, first and foremost, as supporting the development of corporate culture. Most respondents believe that primary responsibility for ethical issues in the company rests with the CEO. Finally, the findings indicate that most companies that devote more resources to communicating and implementing CESs have two or more formal ethics documents. The main differences between the countries included in the study concern the emphasis given to specific aspects, such as avoiding misconduct or taking ethical criteria into account when selecting personnel. The emphasis is greatest in countries where corruption seems most prevalent. [ABSTRACT FROM AUTHOR]

Objectives: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses.Methods: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values.Results: The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4.Conclusions: The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology.Key Points: • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made. [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 aim of this study is to analyze the initial therapeutic alliance in family therapy with high-conflict divorced parents and identify facilitating elements of change. We sampled 16 family therapy cases (32 parents) from a public healthcare hospital in Spain. Based on the System for Observing Family Therapy Alliances (SOFTA-o) ratings, we divided the total number of cases into two groups, depending on the presence or absence of parents' positive indicators in the Shared Sense of Purpose dimension (i.e., productive within-family collaboration or within-system alliance). We quantitatively described and compared the initial therapeutic alliance of the two groups. To deeper explore the within-system alliance process of change, we completed the discovery-oriented phase of the Task Analysis methodology. The main differences between groups were found in the Safety dimension, which was higher in the group of cases with indicators of within-system alliance. More detailed differences were also found. The Task Analysis suggested a model of the within-system alliance process of change grounded in three main categories -or stages- that occurred sequentially (1. Narratives of conflict, 2. Narratives of joint responsibility, and 3. Narratives of opportunity) and a category that appeared in different moments across the task resolution (0. Contextualization). Five sub-categories emerged in a recursive movement within categories 1 and 2. Implications and recommendations for practice are described along with limitations and suggestions to continue this line of research. [ABSTRACT FROM AUTHOR]

Physical distancing is intended to mitigate the spread of the SARS-CoV-2 virus. However, the impact of a decrease in face-to-face contacts on non-physical social contacts of older people remains unclear. In particular, we focus on intergenerational contacts that are especially relevant for older people's mental health. Our analyses rely on an online quota sampling survey conducted in France, Italy and Spain during April 14–24, 2020. We considered the subsample of individuals aged 50 + (N = 4207). We calculated post-stratification weights based on official statistics and used logistic regressions to analyze how changes in intergenerational contacts differed by socioeconomic factors and to what extent non-physical contacts (via phone, social media, etc.) have compensated the reduction in face-to-face contacts. Finally, the change in digital devices' use has been explored as a consequence of both decreased physical intergenerational contacts (PIC) and increased non-physical intergenerational contacts (NPIC). We found that about 50% of older people have increased their NPIC during the first lockdown. Younger individuals, those with medium level of education, and those economically better off displayed higher probabilities of increased NPIC as compared to their counterparts. NPIC increased especially for individuals whose face-to-face contacts decreased, particularly so if this happened with respect to contacts with children. A large share of older people has increased their use of video calls and instant messages, while only some increased the use of social media. These findings are relevant to understand how intergenerational contacts changed during the pandemic and may be central to better plan future outbreak responses. [ABSTRACT FROM AUTHOR]

Purpose: The health benefits of the Mediterranean diet (MedDiet) have been widely studied. However, controversy remains for one of its components: alcohol intake. We aimed to assess the joint effect of adherence to the MedDiet and alcohol-drinking pattern on all-cause mortality. Methods: We used data from 20,506 subjects from a prospective cohort of Spanish university graduates, the Seguimiento Universidad de Navarra (SUN) cohort. Adherence to the MedDiet was operationalized using four different dietary indexes and then categorized in low or high adherence, according to the median score. Alcohol-drinking pattern was evaluated with the previously defined the Mediterranean alcohol-drinking pattern (MADP), grouped into three categories of adherence (low, moderate and high adherence) and a fourth category for abstainers. The outcome was all-cause mortality. Results: During a median follow-up of 12.1 years, we observed 460 deaths. No statistically significant supra-multiplicative interaction between the two exposures was found. Low adherence to both the MedDiet and MADP was associated with higher all-cause mortality compared to high adherence to both exposures [multivariable-adjusted hazard ratio (HR) = 2.02, 95% confidence interval (CI): 1.33–3.07]. Similar results were found for cancer mortality and cardiovascular mortality. Conclusions: Although the combined effect of the MedDiet and MADP was not significantly higher than the product of their individual effects, a low adherence to both the MedDiet and MADP was associated with higher rates of all-cause mortality. This report also shows the usefulness of the dietary pattern approach applied to alcohol intake and of including the drinking pattern as another component of the MedDiet. [ABSTRACT FROM AUTHOR]

The drawing analysed in this article, conserved at the MNAC in Barcelona and attributed to the Spanish architect Diego Siloé (ca. 1490–1563), has never previously been studied in depth. It is a relatively rapidly executed sketch depicting a Renaissance urban setting, in which the authors not only demonstrate the sound use of one-point perspective, an extraordinary feat in Spain at that time, but also reconstruct it geometrically. Raking light photography provides a tool for identifying numerous incised lines, the true geometric support for the drawing, while a comparative analysis reveals a significant connection between the drawing and Siloé's works, giving rise to new suppositions. The authors also detect a strong connection with Italy, consistent with existing hypotheses about the extent of the young Siloé's Italian sojourn. The research conducted reinforces the attribution of the drawing to Siloé and opens up new channels for interpreting his life and work. [ABSTRACT FROM AUTHOR]

Background: Increasing the interval of administration of anti-TNF agents over the duration specified in the data sheet is not common in inflammatory bowel disease (IBD).Aim: To evaluate the outcomes of IBD patients treated with this strategy.Methods: Patients with IBD who were treated with infliximab or adalimumab at intervals > 8 weeks or > 2 weeks, respectively, because of persistent clinical remission, were identified at local databases of the ENEIDA registry (a nationwide registry promoted by the Spanish Working Group in Crohn's disease and Ulcerative Colitis-GETECCU) of two referral centers. Treatment success was considered if patients remained in clinical remission with the same schedule or without biological therapy at the end of follow-up, and if no return to the conventional schedule, dose-escalation, change in biological agent, or a course of systemic corticosteroids or surgery were required.Results: Eighty-five patients were included, 60 treated with infliximab and 25 with adalimumab. The spaced schedule was initiated after a median of 25 months on anti-TNF treatment (IQR 14-49). Throughout a median follow-up of 34 months (IQR 21-47), fifty patients (59%) fulfilled the success criteria of the spaced strategy. No differences were found regarding type of IBD or anti-TNF agent. Baseline C-reactive protein levels and disease duration at the time of starting anti-TNF treatment were the only factors associated with treatment success.Conclusions: Anti-TNF administration at longer intervals than those provided in the data sheet may be an efficacious, convenient, and cheaper treatment option, particularly in patients in whom anti-TNF treatment was initiated early. [ABSTRACT FROM AUTHOR]

Background: The measurement and valuation of health-related quality of life for and by young people are increasingly important, yet research on the impact of study perspective and validity of preferences obtained from young populations remains limited.Objective: The objective of this study was to evaluate the feasibility and validity of collecting EQ-5D Youth version (EQ-5D-Y) preferences from adolescents, adults, and adults from a child perspective.Methods: A profile case best-worst scaling (BWS) online survey was administered to representative Australian and Spanish adult (age ≥ 18 years) and child (age 11-17 years) samples. Adults were told to either answer from their own perspective or for a hypothetical 10-year-old child. Marginal best- and worst-choice frequencies, analysis of dominant choices, self-reported difficulty completing the tasks, and time to complete tasks were used to determine the validity of responses.Results: In Australia, 2134 adults and 1010 adolescents completed the survey. In Spain, 2007 adults and 1000 adolescents completed it. Analysis of marginal choice frequencies and dominant choices indicated that the pattern of responses between adolescents and adults was similar. For Australian respondents, having no mobility problems was rated as best by adolescents, while adults rated having no pain and discomfort as 'best'. In Spain, both adults and adolescents rated no pain or discomfort as 'best'. Australian adolescents rated very worried, sad or unhappy as 'worst', while Spanish adolescents, Spanish adults and Australian adults rated a lot of pain and discomfort as 'worst'.Conclusions: Results suggest preferences from adolescents using direct BWS are valid. Our descriptive analysis also suggest that there are age-related and country-specific differences in elicitation values for the EQ-5D-Y. [ABSTRACT FROM AUTHOR]

The Sarcopenia and Quality of Life questionnaire (SarQol®) is a self-administered multidimensional sarcopenia-specific tool designed for community-dwelling subjects aged 65 years and older. The purpose of the present study was to evaluate the psychometric properties of the Spanish version of the SarQoL®. A total of 252 participants aged ≥ 65 years voluntarily participated in this cross-sectional study. Handgrip strength and bioelectrical impedance analysis were used for sarcopenia screening. Discriminative power, internal consistency, test-retest reliability, and floor and ceiling effects were analyzed. The generic 36-item Short-Form Health Survey (SF-36), the European Quality of Life 5-Dimension-3 Level (EQ-5D-3L), and the Hospital Anxiety and Depression Scale (HADS) were also used for convergent and divergent validity. Significant differences between sarcopenic (n = 66) and non-sarcopenic participants were observed for SarQoL® total score (p = 0.008) and for all domains except D2-locomotion. A high internal consistency of SarQoL® total score (Cronbach's alpha = 0.904) was found, and significant domain-to-total score correlations were obtained (all p < .001). Test-retest data showed excellent reliability for SarQoL® total score (ICC = 0.99; 95%CI 0.98-0.99) and in all dimensions, except for D6-leisure and D7-fears activities (substantial). No floor and ceiling effects were observed for SarQoL® total score. SarQoL® total score showed good and acceptable correlations(p < 0.001) with the selected domains of the SF-36 and EQ-5D-3L which have similar dimensions (convergent validity). Low and non-significant correlations existed with anxiety, depression, and EQ-5D-3L self-care and pain/discomfort domains (divergent validity). The Spanish SarQoL® shows satisfactory general psychometric properties in Spanish-speaking older adults from Spain and is able to discriminate between older adults with and without sarcopenia. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS).Methods: After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and "non-comedo" grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals.Results: We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77-96%) and 92% (95% CI, 84-97%), respectively.Conclusion: Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance.Key Points: • Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated. • Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time. • Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision. [ABSTRACT FROM AUTHOR]

Background Obesity is a risk factor for cardiovascular disease, the leading cause of death. Health education, nutritional follow-up, and life style habits modification are key for cardiovascular risk reduction in obese patients. Objective To measure the impact of pharmacist's intervention on cardiovascular risk in obese patients. Setting A Spanish community pharmacy. Method Obese patients (BMI ≥ 30) with (group A, n = 30) and without (group B, n = 14) comorbidities were selected. Variables determined in first visit on-site: anthropometric values (weight, height, waist circumference), blood pressure, glycemic (glucose, HbA1c) and lipid parameters (total cholesterol, HDL-c, LDL-c, triglycerides). The PharmaFit Protocol consisted in a 24-month follow-up focusing (i) monthly on adherence to nutritional guidelines and modification of life style habits, and (ii) bi-monthly on anthropometric variables, blood pressure, and biochemical determinations. Feedback was provided to the primary care physician or specialist. Main ouitcome measure Cardiovascular risk estimated by REGICOR score. Results Anthropometric variables significantly decreased in all groups. Plasma glucose levels were significantly reduced in group A without changes in HbA1c. Lipid parameters significantly improved in group A, whereas HDL-c significantly raised in all groups. REGICOR score was significantly reduced in group A female (13.8 ± 1.6 vs. 5.8 ± 1, p < 0.0001) and male (12.7 ± 1.7 vs. 4.4. ± 0.6, p < 0.005) patients, and in group B female patients (3.5 ± 0.7 vs. 1.9 ± 0.4, p < 0.001). Conclusion Community pharmacist intervention, delivered as a 24-month follow-up and combining health and dietary education, has a highly positive impact on the reduction of cardiovascular risk in obese patients. [ABSTRACT FROM AUTHOR]

The present research aimed to analyze the effect of experience and psychophysiological modification by combat stress in soldier's memory in a simulated combat situation. Variables of rate of perceived exertion, blood glucose, blood lactate, lower body muscular strength manifestation, cortical arousal, specific fine motor skills, autonomic modulation, state anxiety, and memory and attention through a postmission questionnaire were analyzed before and after a combat simulation in 15 experienced soldiers of a special operation unit and 20 non-experienced soldiers of light infantry unit from the Spanish Army. The stress of combat simulation produces a significant increase (p < 0.05) in rated perceived exertion, blood glucose, blood lactate, somatic anxiety and a low frequency domain of the heart rate, and a significant decrease of rifle magazine reload time, high frequency domain of the heart rate and somatic anxiety in both groups. The variables of RPE, glucose, CFFT, RMRT, RMSSD, LF/HF, CA, SA and STAI were significantly different in experienced soldiers shown the activation of fight-flight system. The anticipatory anxiety in experienced soldiers shows a cognitive behavioral association by past experiences. The analysis of correct response in the postmission questionnaire show elements more related with the sight and that endanger the physical integrity of soldiers are more remembered, and some significant differences (p < 0.05) in the memory performance of experienced soldiers and non experienced soldiers where experienced soldiers shown a better performance. As conclusion, combat stress produce an increase in the psichophysiological response of soldiers independently of experience, but experienced ones presented a lower negative effect on memory than non experienced. [ABSTRACT FROM AUTHOR]

Introduction: Various treatment options are available for metastatic hormone-sensitive prostate cancer. This study aimed to quantify how men with prostate cancer in the United Kingdom (UK), Germany, and Spain perceive the risks and benefits of hypothetical abiraterone acetate plus prednisone treatment and docetaxel-based chemotherapy treatment options.Methods: A targeted literature review, exploratory interviews with prostate cancer patients and oncologists, and pre-test interviews were used to develop a discrete choice experiments (DCE). The final DCE included 32 choice sets, selected using a main-effects orthogonal design, divided into two survey blocks. Paired profiles presented hypothetical treatments for prostate cancer through six attributes that could be presented at two or four levels each. Preference estimates were estimated using a conditional logit regression model. Preference results were stratified by cancer stage.Results: A total of 152 participants (mean age 69 years) completed the DCE in the UK, Germany, and Spain. Treatment effectiveness was the main concern for the patients (difference in preference estimates between 8 and 32 months 1.443). Participants wanted to avoid pain that was not well controlled (preference dummy coding estimate - 1.157). Participants valued a change from an oral medication to an intravenous treatment (change in preference estimate - 0.416) more negatively than a change from a 1% to a 5% risk of infection (change in preference estimate - 0.313).Conclusions: This study shows that treatment effectiveness and pain control were the most important attributes for patients with prostate cancer. These two attributes influenced more than 50% of their decision-making in this study. The risk of fatigue and mode of administration were least prioritised by patients. This study highlights the relative importance that Spanish, German, and British patients place on various aspects of treatment options for prostate cancer. Understanding patient preference and taking them into consideration shall help physicians when developing their treatment strategies for their patients.Funding: Janssen. [ABSTRACT FROM AUTHOR]

Background: Surgeons' overload is one of the main causes of medical errors that might compromise patient safety. Due to the drawbacks of current options to monitor surgeons' load, new, sensitive, and objective indices of task (over)load need to be considered and tested. In non-health-care scenarios, intraocular pressure (IOP) has been proved to be an unbiased physiological index, sensitive to task complexity (one of the main variables related to overload), and time on task. In the present study, we assessed the effects of demanding and complex simulated surgical procedures on surgical and medical residents' IOP.Methods: Thirty-four surgical and medical residents and healthcare professionals took part in this study (the experimental group, N = 17, and the control group, N = 17, were matched for sex and age). The experimental group performed two simulated bronchoscopy procedures that differ in their levels of complexity. The control group mimicked the same hand-eye movements and posture of the experimental group to help control for the potential effects of time on task and re-measurement on IOP. We measured IOP before and after each procedure, surgical performance during procedures, and perceived task complexity.Results: IOP increased as consequence of performing the most complex procedure only in the experimental group. Consistently, residents performed worse and reported higher perceived task complexity for the more complex procedure.Conclusions: Our data show, for the first time, that IOP is sensitive to residents' task load, and it could be used as a new index to easily and rapidly assess task (over)load in healthcare scenarios. An arousal-based explanation is given to describe IOP variations due to task complexity. [ABSTRACT FROM AUTHOR]

Objectives To quantify and compare the sedentary time estimated by the Sedentary Behavior Questionnaire (SBQ) and the sedentary time objectively measured by a multi-sensor monitor (SWA) in pregnant women. Methods One hundred eighty-six participants answered the SBQ and wore the SWA at least 7 valid days. The concordance, correlation, agreement and relative activity levels between both measures of sedentary time were examined. Differences of sedentary time between weekday and weekend and between groups stratified by sociodemographic and clinical characteristic were evaluated by one-way analysis of variance. Results Pregnant women were sedentary the 64% of their waking hours. Television viewing is the most prevalent sedentary behavior. The concordance, correlation, and agreement between SBQ and SWA were weak, yet a significant correlation in weekday and average day sedentary time (r = 0.23 and 0.20, P = 0.001 and 0.008, respectively) was observed. A significant linear trend was found for increasing sedentary time between both methods using a relative activity levels analysis. Conclusions for Practice Pregnant women experience high amount of sedentary time, for approximately half of the day. The SBQ shows a low validity and agreement, but strong ability to rank individuals compared with SWA in pregnant women. [ABSTRACT FROM AUTHOR]

This cross-sectional study assessed the prevalence of bacteria isolated from Spanish children with suspected chronic lower respiratory tract infection (LRTI) for whom bronchoalveolar lavage (BAL) was indicated. BAL fluid (BALF) was collected from 191 children (aged ≥ 6 months to < 6 years, with persistent or recurrent respiratory symptoms, non-responders to usual treatment) and cultured. Nasopharyngeal swabs (NPSs) were also obtained and cultured to assess concordance of BALF and NPS findings in the same patient. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were identified from BALF with a bacterial load indicative of infection (> 104 colony-forming units/mL) in 10.5, 8.9, and 6.3% of children, respectively. Clinical characteristics were similar among participants, regardless of positivity status for any of the bacteria. Approximately 26% of pneumococcal isolates were PCV13 serotypes, and 96% of H. influenzae isolates were non-typeable (NTHi). Concordance between BALF and NPS isolates was 51.0% for S. pneumoniae, 52.1% for H. influenzae, and 22.0% for M. catarrhalis.Conclusion: S. pneumoniae, NTHi, and M. catarrhalis were the main bacteria detected in BALF and NPS. Children with suspected chronic LRTI may benefit from a vaccine protecting against NTHi. What is Known: • Chronic lower respiratory tract infection (LRTI) in children can cause high morbidity and is a major use of healthcare resources worldwide. Despite this, their etiology or potential preventive measures are poorly assessed. • Bronchoalveolar lavage can be used to determine bacterial etiology of chronic LRTI. What is New: • We used conventional and molecular techniques to show that Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were present in the LRT of Spanish children with suspected chronic LRTI • Concordance between isolates from bronchoalveolar lavage fluid and nasopharyngeal swabs was low, suggesting that samples from the upper respiratory tract could not reliably predict the bacterial etiology of suspected chronic LRTI. [ABSTRACT FROM AUTHOR]

Purpose: To test whether the systematic monitoring of health-related quality of life (HRQOL) in clinical practice in Spanish pediatric patients with T1DM helps improve their daily life in a multicenter longitudinal study.Methods: One hundred thirty-six patients participated, recruited from five centers in Barcelona, Spain (72 girls, mean age 13.4 years). Complete data were collected for 119 patients (85%). Pediatricians were randomly assigned to the HRQOL intervention (n = 70), or control group (n = 49). The intervention group discussed the results of HRQOL face to face with the physician, quarterly over a year. The control group received care as usual. HRQOL was assessed using KIDSCREEN-27 collected online. Standardized mean differences (effect size, ES) and generalized estimating equation (GEE) were computed to compare group differences between baseline and follow-up, taking into account sociodemographic and clinical variables.Results: Statistically significant higher scores were seen in the intervention group at follow-up for the dimensions of Psychological well-being (ES = 0.56), School environment (ES = 0.56), and the KIDSCREEN-10 index (ES = 0.63). No differences were found in the control group. GEE analysis showed an improvement in HRQOL at follow-up with statistically significant association of the intervention on Psychological well-being (B = 4.32; p 0.03 for the interaction of group by follow-up) and School environment (B = 4.64; p 0.02 for the same interaction term).Conclusions: Routine assessment and face-to-face patient-physician discussion of HRQOL results improved HRQOL scores after a year of follow-up, especially in Psychological well-being and school environment. The results support the routinary use of HRQOL assessment in clinical practice. [ABSTRACT FROM AUTHOR]

Background and Objectives: To compare effectiveness and safety of dinoprostone, misoprostol and Cook's balloon as labour-inducing agents in women with intrauterine growth restriction (IUGR) at term.Methods: Retrospective cohort chart review of women diagnosed with foetal growth restriction at term in Reina Sofia Hospital, Cordoba, Spain from January 2014 to December 2015. Registration of baseline characteristics and method of induction was made. The main outcome was time from induction to delivery. Obstetric and perinatal outcomes were also collected.Results: A total of 99 women were diagnosed with IUGR in the mentioned period. Of them, 21 women were induced with dinoprostone [dinoprostone group (DG)], 20 with misoprostol (MG) and in 58 with Cook's balloon (CG). Groups were homogeneous regarding pre-induction Bishop score and parity. The CG required more time (24.36 vs. 19.23 h; p = 0.02) and more oxytocin dose for conduction of labour from induction to delivery (6.75 vs. 1.24 mUI; p < 0.01) than DG. Moreover, the CG also needed more oxytocin than MG, 6.75 vs. 2.37 mUI (p < 0.001). Caesarean rate was 5, 14.9 and 17.3% in MG, DG and CG, respectively. No differences were observed in rates of uterine tachysystole, non-reassuring foetal status and neonatal adverse events.Interpretation and Conclusions: Prostaglandins were more effective than Cook's balloon to induce labour and achieve vaginal birth in this sample of women with IUGR at term, with a similar safety profile. [ABSTRACT FROM AUTHOR]

Introduction: Most asthma patients have mild disease, although the burden of mild asthma is not well understood nor studied. Some evidence suggests that many patients with mild asthma experience suboptimal symptom control and exacerbations. This study characterizes the burden of illness and treatment patterns among patients with a confirmed diagnosis of mild asthma, defined as GINA Step 1 or Step 2, and residing in China, France, Germany, Italy, Japan, Spain, the United Kingdom, or the United States.Methods: The Respiratory Disease-Specific Programme prospective cross-sectional survey was conducted with primary care and specialty physicians in each of the eight countries. Physician and patient surveys assessed demographic and clinical characteristics, frequency and timing of asthma symptoms, exacerbations, and rescue inhaler usage, the most recent FEV1% predicted, and healthcare utilization. GINA Step was determined by prescribed treatment regimen. GINA Step 1 patients were prescribed as-needed reliever medication and Step 2 required treatment with a low-dose inhaled corticosteroid, leukotriene receptor antagonist, or theophylline. Treatment adherence was assessed with the Morisky Medication Adherence scale, disease control with the Asthma Control Test, and work and activity impairments with the Work Productivity and Activity Impairment scale.Results: The sample included 1115 GINA Step 1 and 2 patients, with 53% classified as Step 2. Overall asthma control was suboptimal, with reports of nocturnal symptoms (40.6%), symptom worsening (10.5%), and rescue inhaler usage in the last 4 weeks (33.6%). 25% of patients were uncontrolled. The overall mean number of exacerbations in the last 12 months was 0.4, with a higher frequency of exacerbations in Step 2 patients who also experienced more exacerbations requiring treatment intensification, an emergency department visit, or hospitalization.Conclusion: Mild asthma imposes a substantial burden on patients, establishing the need for comprehensive management plans and ongoing support for treatment adherence.Funding: AstraZeneca. [ABSTRACT FROM AUTHOR]

The consequences of poverty have been shown in many studies. Growing up in poor families supposes higher social exclusion risk, the effects of which persist over time and suppose adulthood disadvantages, including but not limited to a higher risk of poverty in adult life. The main goals of the study are to establish which elements affect child poverty in Spain and Portugal and to check AROPE indicators (At Risk of Poverty or Social Exclusion) for accuracy and adequacy in comparing European poverty. The study was carried out through AROPE comparative secondary data analysis, a multidimensional poverty measure that allows comparison among European countries in the aftermath of the economic crisis (2005-2013). Principal data were taken from Income and Living Conditions (EU-SILC, EUROSTAT) and European System of integrated Social Protection Statistics (ESSPROS, EUROSTAT). On one side, AROPE and components (poverty rate, severe material deprivation and households with very low work intensity) are analysed in two populations (younger than 16 years old and dependent children households) in Portugal and in Spain to identify differences. On the other, convergences and divergences between the two countries are analysed, finding different child poverty conditional factors as well as different impacts. In Spain, the main predictor is unemployment, while in Portugal, it is the level of poverty in the population. Additionally, we show that the investment and efficacy of social protection polices, through expenditure and social transfers, have a deep impact upon child poverty rate reduction across Europe. Potential mismatches in country comparison subsequent to AROPE construction components are also discussed. Our analysis finds that income structure variation has a bigger influence on AROPE than generalized structural poverty. [ABSTRACT FROM AUTHOR]

Purpose: To translate the patellofemoral disorder questionnaire "Kujala Score" into Spanish and to adapt it for Spanish culture .Methods: International recommendations were followed to translate the "Kujala Score" into Spanish together with a cultural adaptation and validation. We analysed the following parameters: internal consistency, agreement construct validity, test-retest reliability, ceiling and floor effects, and responsiveness. The reproducibility and responsiveness were tested in 72 patients with patellofemoral pain syndrome in a test-retest design with follow-up testing at 7 days. The "Kujala Score" and the VISA-P were administered to 98 patients and 30 patients, respectively, who completed the "Kujala Score" and VISA-P after physiotherapy treatment, which consisted of rest, ice, proprioceptive exercise and manual therapy.Results: The Spanish "Kujala Score" had high internal consistency (Cronbach α = 0.8; if an item was deleted, Cronbach α = 0.77-0.80), excellent reliability and agreement (interclass correlation coefficient = 0.99), and good construct validity that was significantly correlated with the outcome of the Spanish VISA-P (Spearman rho = 0.7; P < 0.001). No ceiling or floor effects was detected for the Spanish "Kujala Score" or the responsiveness of the participants based on 40 patients receiving physical therapy, rest, ice and proprioceptive exercises for 1 month, demonstrating that it is a good determinant of changes in the symptomatology of patients with knee pain.Conclusions: The Spanish adaptation of the patellofemoral disorder questionnaire "Kujala Score" proved to be valid and sensitive to clinical changes and to be a reliable instrument to assess the severity of pain and disability in patients with patellofemoral disorders. This questionnaire will be useful in clinical practice and research as an appropriate tool to evaluate and record the symptomatology of patients with patellofemoral pain syndrome among Spanish population.Level Of Evidence: Diagnostic study, Level I. [ABSTRACT FROM AUTHOR]

We evaluated phonological and visuospatial working memory (WM) in autism spectrum disorders. Autistic children and typically developing children were compared. We used WM tasks that measured phonological and visuospatial WM up to the capacity limit of each children. Overall measures of WM did not show differences between autistic children and control children. However, when the recall of children was examined in detail, autistic children showed reduced phonological WM compared with control children. Moreover, phonological and visuospatial WM did not increase with the age of autistic children while a development of phonological and visuospatial WM with age was found in control children. The pattern of results is discussed in terms of previous studies about WM and autism. [ABSTRACT FROM AUTHOR]

Introduction: Allergen immunotherapy is a long-term treatment that has been associated with patient adherence issues. The aim of the study was to increase the knowledge on compliance of patients allergic to house dust mites, receiving sublingual immunotherapy (SLIT).Methods: A retrospective observational study was performed in 53 Spanish allergy units. We enrolled patients undergoing the SLIT treatment for house dust mites including a scheduled control visit 12 months after initiating the therapy. We conducted a comprehensive assessment of compliance using three methods. In the first step, an allergist evaluated the patients according to the results of an interview and the existing medical records. The subjects taking more than 80% of the overall prescription were defined as compliant. The remaining noncompliant patients were divided into groups taking less than 25%, 25-50%, and 50-80% of the prescribed SLIT. In the second stage, we conducted the Morisky-Green test. Finally, the noncompliant patients were asked to fill a self-report assessment form. Data were stratified into age groups. The potential factors affecting compliance were also investigated.Results: Overall, 380 subjects participated in the study. The compliance rate was 79.7%, and the treatment discontinuation rate was 22.5%, while 66.8% of patients were adherent (both compliant and continuing with the treatment). The results showed that children were the most compliant and adolescents the least compliant (86.6% and 60.9%, respectively). The main reason for noncompliance was "forgetting some doses" in 31.0% of the children, 48.0% of the adolescents, and 53.2% of the adults. Compliance was associated with the following factors: age, number of annual control visits, and reduction in symptomatic medication.Conclusion: Our results showed that two out of three patients with house dust mite-induced allergic rhinitis adhered to the SLIT treatment. Multidisciplinary and integral solutions are needed to improve the compliance, with special attention paid to adolescents.Funding: Stallergenes Greer Spain. [ABSTRACT FROM AUTHOR]

The work reported here involved a comparative study regarding the understanding that high school students (16-18 years) have of the concept of chemical elements and their periodic classification. More specifically, the level of knowledge on this topic was compared before and after the completion of baccalaureate studies in a sample of Spanish students. In order to achieve this goal, a questionnaire was developed that included 14 items in an open format, through which various aspects of the students' understanding of the idea of chemical element and their periodic classification were assessed. In addition, the application of this knowledge to interpret and predict the behaviour and properties of elements and to carry out calculations on the atomic composition of the elements was evaluated. Aspects concerning the acquisition of scientific knowledge, the application of knowledge to different contexts and situations, and the use of scientific evidence to draw conclusions and knowledge about the nature and history of science were evaluated. The questionnaire was previously validated with a large group of students. The results of this study show that improvements occur primarily in addressing higher level cognitive questions (analysis, synthesis and evaluation) in comparison to the lower level tasks (capacity for retention, understanding or direct application of learning). In addition, students who start high school have a very limited understanding of the ideas behind the Periodic Table of the chemical elements and that their lack of understanding, to a large extent, remains upon completion of the baccalaureate. These results suggest that there are real difficulties in understanding this topic and show the limited influence of the studies completed in high school. [ABSTRACT FROM AUTHOR]

Purpose: Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH.Methods: Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index.Results: The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function.Conclusions: Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care. [ABSTRACT FROM AUTHOR]

We examined the influence of perceived parental sexual values, religiosity, and family environment on young adults' sexual values from the United States (n = 218), Spain (n = 240), Costa Rica (n = 172), and Peru (n = 105). On average, and across the four national groups, the messages young adults received from their parents about broad domains of sexual behaviors (masturbation, non-intercourse types of heterosexual sexual activity, premarital sex, same-sex activity, and cohabiting) were unequivocally restrictive. By contrast, across the four groups, young adults on average held rather permissive sexual values and their values differed significantly from those of their parents. Moreover, the nature of perceived parental sexual values (restrictive vs. permissive) was not associated significantly with young adults' sexual values, age of sexual debut, or number of sexual partners. Comparatively, Spanish young adults held the most permissive sexual values, whereas US young adults held the most restrictive sexual values. Religiosity was the strongest predictor of young adults' sexual values, followed by perceived parental sexual values and influence. In conclusion, it appears that despite having perceived restrictive parental messages about sex, these young adults currently hold permissive sexual attitudes, thus calling into question the influence parents actually have on their adult children's sexual values. [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]

Objective: The objectives of this analysis were to examine how patients' global severity with Alzheimer's disease (AD) relates to costs of care and explore the incremental effects of global severity measured by the clinical dementia rating (CDR) scale on these costs for patients in Spain.Methods: The Codep-EA study is an 18-multicenter, cross-sectional, observational study among patients (343) with AD according to the CDR score and their caregivers in Spain. The data obtained included (in addition to clinical measures) also socio-demographic data concerning the patient and its caregiver. Cost analyses were based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the resource utilization in dementia (RUD). Lite instrument and a complementary questionnaire. Multivariate regression analysis was used to model the effects of global severity and other socio-demographic and clinical variables on cost of care.Results: The mean (standard deviation) costs per patient over 6 months for direct medical, social care, indirect and informal care costs, were estimated at €1,028.1 (1,655.0), €843.8 (2,684.8), €464.2 (1,639.0) and €33,232.2 (30,898.9), respectively. Dementia severity, as having a CDR score 0.5, 2, or 3 with CDR score 1 being the reference group were all independently and significantly associated with informal care costs. Whereas having a CDR score of 2 was also significantly related with social care costs, a CDR score of 3 was associated with most cost components including direct medical, social care, and total costs, all compared to the reference group.Conclusions: The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Dementia severity, measured by CDR score, showed that with increasing severity of the disease, direct medical, social care, informal care and total costs augmented. [ABSTRACT FROM AUTHOR]

Migration can affect the mental health of migrants. This cross-sectional study has two objectives: (1) to compare the prevalence of common mental disorder (CMD) between migrants (n = 458) living in Granada (Spain) and Spanish-born women (n = 448); (2) within migrants, to analyse the associations of world region of origin, other sociodemographic factors and post-migration features with the presence of CMD. Participants answered a questionnaire, including sociodemographic characteristics, post-migration features and CMD that was measured by Kessler K6-scale. Logistic regression analyses showed that CMD (K6 ≥ 13) was significantly higher among migrants than Spaniards. Compared with Spaniards, the odds of CMD were 3.6 [95 % confidence intervals (CI) 2.1-6.0] and 2.9 (CI 1.6-5.3), respectively, for Latin Americans and for Moroccan and other African women. Among migrants, Latin Americans as opposed to the reference group (migrants from other countries), had higher probability of CMD (OR 2.3, CI 1.1-4.9). This study supports the hypothesis that migration leads to mental distress. Consideration of world region of origin may clarify the differences observed in mental health across different migrant groups. [ABSTRACT FROM AUTHOR]

Previous investigations found that a subset of children with autism spectrum disorder (ASD) in California possessed plasma autoantibodies that reacted intensely with brain interneurons or other neural profiles. Moreover, for several cohorts of American women, maternal autoantibody reactivity to specific fetal brain proteins was highly specific to mothers of children with ASD. We sought to determine whether children and their mothers from a regionally specific cohort from the Basque Country of Spain demonstrated similar reactivity. Some children's plasma reacted to interneurons, beaded axons or other neural profiles with no difference in the occurrence of these antibodies in children with or without ASD. Findings on the maternal antibodies confirmed previous research; plasma reactivity to fetal brain a combination of proteins at 37 and 73 kDa or 39 and 73 kDa was found exclusively in mothers of children with ASD. [ABSTRACT FROM AUTHOR]

We compared perinatal mortality rates (PMRs) and the risk from certain causes among immigrant and native population in the Valencian Community (Spain). Using data from the Perinatal Mortality Registry, crude and age standardized mortality ratios were obtained in the different groups of mothers. Mortality rate ratios were calculated to compare the causes of death resulting from prematurity, congenital anomalies, infectious diseases and Sudden Infant Death Syndrome between Spanish and foreign women. PMRs were higher among all the immigrant groups compared with the native population, with a statistical significance in Eastern European and sub-Saharan mothers. Neonatal mortality rates in North African and Latin American mothers were similar to those of native women. Babies of immigrant mothers were at a significant higher risk of dying from late infectious diseases and from causes resulting from being premature. More research is needed on the risk factors which contribute to generating differences in our setting. [ABSTRACT FROM AUTHOR]

The article presents a comparative analysis of historical ecologies from Idaho and Spain in terms of identity and native species conservation. The study uses qualitative data from ethnographic research with the farming community in Cabo de Gata, Andalusia and the members of Nez Perce in Lapwai, Idaho. The study reveals that the participants have shown historical relationships with the land as well as its impact of their own and their ancestors' activities on the local environment.

By applying the framework proposed by Millennium Ecosystem Assessment, we analysed the current state and trends of 20 ecosystem services provided by Spanish rivers and riparian areas using 139 indicators. We compared the obtained results with the Europe and UK assessment. It is the first document that attempts to analyse the importance of services provided by Spanish rivers and riparian areas, and it forms part of the evaluation carried out for the Spanish Millennium Ecosystem Assessment. Among the provisioning services, freshwater, hydropower energy and genetic resources were classified as high importance, and water regulation and self- purification capacity, and natural hazard mitigation are among the regulating services, with landscape- aesthetic values and recreation and ecotourism featuring among the cultural services. About 61 % of the assessed ecosystem services are currently declining or degrading, but are higher than the percentage calculated for Europe (45 %) or for the UK (53 %). All regulating services are degrading, especially water regulation, natural hazard mitigation, soil formation and fertility and biological control, and the cultural services related to rural populations. Likewise, the biodiversity of Spanish aquatic ecosystems is decreasing rapidly. Land use changes and overexploitation of biological and mineral raw materials have been the main direct drivers of change in Spanish rivers and riparian zones, and relate directly to increase urbanised areas and irrigated agriculture. Finally, we draw some considerations on alternative models for aquatic ecosystems management which maintain aquatic ecosystem services and their biodiversity. [ABSTRACT FROM AUTHOR]

This article investigates the pair-wise convergence hypothesis of 17 Spanish regions with respect to the European Union (EU) and Euro-Zone (EZ). Several definitions of convergence are taken into account. The IB-MPI unit root testing procedure is then applied. A simultaneous approach based on the gap in levels and logs is developed to study convergence. The empirical results show incomplete catching-up in six cases with respect to both EU and EZ, and complete catching-up in nine with respect to EU and four with respect to EZ. When taking into account the behaviour of both gaps and loggaps, we further get four cases of cointegrated regions with respect to EZ and only one with respect to EU. Finally, there are four regions that diverge with respect to EU, but do converge with respect to the EZ. Only Baleares diverges with respect to both of them. [ABSTRACT FROM AUTHOR]