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Background: The aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context. Methods: Three-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses. Results: The overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions. Conclusions: The new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain. Key points: • This paper provides a culturally translated, adapted, and validated version of the Caring Behaviors Assessment tool in the Spanish context, which can be used to obtain reliable and culturally adapted data on essential aspects of patient care. • The findings of this study contribute to the wider global clinical community by demonstrating the importance of considering cultural factors when assessing and evaluating patient care from patients' own perspective, and also emphasizes the need for culturally sensitive approaches in healthcare settings. • This validated instrument facilitates the measurement of caring behaviors in the Spanish context, allowing for objective evaluation and improvement. Use of the Caring Behaviors Assessment tool could thus serve as a valuable resource for both future research and clinical practice. [ABSTRACT FROM AUTHOR]

This study analyzes the use of Telegram as an electoral communication tool in Spain, focusing on the messages sent by the five major parties in the country (PSOE, PP, Vox, Unidas Podemos and Ciudadanos) during the campaigns corresponding to the general elections of April 28 and November 10, 2019. This research paper steps outside this somewhat still narrow area of methodology by combining two different research techniques on a methodological triangulation: traditional content analysis and data mining processes using Python. Results, which show how political parties in Spain use Telegram mainly as a mobilization tool while expressing closeness with the candidate, are contextualized thanks to the implementation of Big Data analysis techniques that improve and allow for an in-depth investigation and understanding of the study. [ABSTRACT FROM AUTHOR]

This paper aims at describing the eating experience of people diagnosed with and treated for laryngeal cancer. Going beyond the mere conceptualization of "after-effect" or the quantification of the disease's impact on the basis of standardized questionnaires, we present a qualitative analysis of the narratives of such experiences. Ethnographic study. Data is obtained from conversations, semi-structured interviews, participant observation, and written documents. A discourse analysis of the narrative information was conducted, with process coding and using the constant comparative method, inductive content analysis, category analysis, units of meaning associated with each other, and triangulation. The impact of cancer on eating processes is not limited to nutrition, but also affects the social and cultural value of food, which is put into question. The symbolic and social values which accompany the traditional way of eating are modified, which is connected with impaired quality of life. The impact on the eating process and its relationship with quality-of-life impairment are clear and connect with the importance of eating ways in culture and social organization. Greater attention should be paid to these contexts in clinical practice, which can affect even more than the impact on communicative processes. [ABSTRACT FROM AUTHOR]

Background: The migratory flows in Spain have changed due to the arrival of a diverse migrant population. Among the new migrants the Latino collective predominate with more than half being women of childbearing age. There are no previous studies exploring breastfeeding experiences of migrants in a country where their mother tongue is spoken. This study aimed to explore Latina migrants' breastfeeding experiences in a Spanish-speaking country. Methods: A descriptive qualitative study was carried out in the main province in southern Andalusia between November 2019 and June 2020. The study used intentional sampling. The study participants were contacted by video calls and data were collected through a semi-structured in-depth interview (n = 19). The interviews were transcribed and analysed by thematic analysis. Results: The nineteen participants were aged between 22 and 43 years old and came from six different countries in Latin America. The two main categories that emerged were breastfeeding facilitators and barriers, divided into ten interrelated sub-categories: working conditions; precarious socioeconomic conditions; lack of support (health professionals, family and society); physiological changes, pain and fatigue; ignorance and wrong beliefs; support networks (partner, health professionals and family); host country versus home country; religious practices/worship; appropriate attitude, knowledge and experience; and breastfeeding support groups. Most of the study participants stated that their breastfeeding experiences were influenced by barriers such as work and by facilitators such as peer support. Conclusions: More support from caregivers and more sensitivity to cultural diversity were demanded by the women and well-trained professionals are needed to enable breastfeeding for a longer time. This paper provides caregivers, such as nurses, more knowledge about the care demanded by migrant women to ensure a longer breastfeeding experience. [ABSTRACT FROM AUTHOR]

Background: Opioids are one of the most prescribed treatments for chronic pain (CP). However, their long‐term use (>3 months) has been surrounded by controversy, due to loss of beneficial effects. Objective: To explore the experiences of people with chronic non‐malignant low back pain in Spain undergoing long‐term treatment with opioids. Design: Qualitative study. Setting and participants: We conducted 15 semi‐structured interviews at the Pain Clinic with persons taking opioid treatment. Methods: The interviews were analysed by qualitative content analysis as described by Graneheim and Lundman, and developed categories and themes discussed in light of a biomedicalization framework. Main results: We developed one overarching theme—Living with opioids: dependence and autonomy while seeking relief—and three categories: The long pathway to opioids due to the invisibility of pain; Opioids: from blind date to a long‐term relationship; and What opioids cannot fix. Discussion: The long and difficult road to find effective treatments was a fundamental part of coping with pain, involving long‐term relationships with the health system. This study reflects the benefits, and drawbacks of opioids, along with struggles to maintain autonomy and make decisions while undergoing long‐term treatment with opioids. The paper also highlights the consequences of pain in the economy, family and social life of patients. Conclusions: Patients' experiences should be considered to a greater extent by health‐care professionals when giving information about opioids and setting treatment goals. Greater consideration of the social determinants of health that affect CP experiences might lead to more effective solutions to CP. [ABSTRACT FROM AUTHOR]

Introduction. This study examines the research methods and techniques used in Spanish journals of library and information science, the topics addressed by papers in these journals and their authorship affiliation. Method. The research ers selected 580 papers published in the top seven Spanish LIS journals indexed in Web of Science and Scopus and conducted a content analysis of 394 of these papers. In each case, the analysis considered: (1) type of paper (research/non-research) ; (2) authorship (country, sex, number of authors, academic versus professional profile); and (3) the research methods and techniques used and the topic addressed. Results. Sixty-eight er cent of the papers were identified as research papers. These papers used either a quantitative or qualitative approach to the topic and both were well represented, although rarely combined in the same paper (9.6%). The most frequently addressed topics were information sources, metric studies and technologies. Most of the authors were Spanish (78%). Forty-two per cent of the papers had just one author. Conclusions. In terms of the volume o f publication and the research methods and techniques most commonly used, library and information science research in Spain does not generally lag behind research in the international sphere. However, there is still room for improvement in experimental research, of which there is very little, and in the internationalisation of authorship. [ABSTRACT FROM AUTHOR]

Background: The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients.Main Body: This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources.Conclusion: Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level. [ABSTRACT FROM AUTHOR]

Background: Binge-drinking in adolescents is a highly prevalent healthcare problem that associates physical and mental health complications with community implications. This paper describes the design, implementation and evaluation of the first web-based computer tailored intervention aimed at the prevention of binge drinking in Spanish adolescents.Methods: The Alerta Alcohol program is based on the I-Change Model. First, feedback from focus and Delphi groups are used for cultural adaptation and to obtain further information on the items to be included on the program. A pilot study is then conducted to assess feasibility and to identify strengths and weaknesses. Second, a Cluster Randomized Controlled Trial is conducted to test the effectiveness of Alerta Alcohol in students aged 16 to 18 years. The study is performed in 16 high schools from Andalusia (southern Spain), which are randomized either to the experimental or the control condition (EC and CC). The EC receives the Alerta Alcohol intervention, which consists of four sessions at school (baseline questionnaire, two sessions in three scenarios: at home, celebrations, and public places, and a final evaluation). The adolescents are provided with answers related to their views of each scenario; this information is used to provide highly specific feedback regarding their knowledge, risk perception, self-esteem, attitude, social influence, and self-efficacy. In addition, two booster sessions are given at home to reinforce the previous messages. The CC just completes the baseline and the final evaluation questionnaires and then they are allowed to receive the intervention as well (as a waiting list). Evaluation takes place after four months. The primary endpoint is binge drinking within 30 days prior to the evaluation and alcohol use in the previous week. It is expected that Alerta Alcohol reduce the prevalence of binge drinking by 10%. Follow up analyses are carried out to determine the differences in effectiveness according to the compliance of the program (quality of the implementation).Discussion: The results are expected to be applicable and may incorporate improvements in the practice of the Healthcare and Education Systems. If the program proves to be effective, regional and eventual national implementation should be considered.Trial Registration: Trial registration number (ClinicalTrials.gov): NCT03288896 . This study was retrospectively registered on 19/09/2017. [ABSTRACT FROM AUTHOR]

Background: Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases.Methods: This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice.Discussion: This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases.Trial Registration: ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016. [ABSTRACT FROM AUTHOR]

Objective: This paper presents an empirical study of a formative mobile-based assessment approach that can be used to provide students with intelligent diagnostic feedback to test its educational effectiveness.Method: An audience response system called SIDRA was integrated with a neural network-based data analysis to generate diagnostic feedback for guided learning. A total of 200 medical students enrolled in a General and Descriptive Anatomy of the Locomotor System course were taught using two different methods. Ninety students in the experimental group used intelligent SIDRA (i-SIDRA), whereas 110 students in the control group received the same training but without employing i-SIDRA.Results: In the students' final exam grades, a statistically significant difference was found between those students that used i-SIDRA as opposed to a traditional teaching methodology (T(162)=2.597; p=0.010). The increase in the number of correct answers during the feedback guided learning process from the first submission to the last submission in four multiple choice question tests was also analyzed. There were average increases of 20.00% (Test1), 11.34% (Test2), 8.88% (Test3) and 13.43% (Test4) in the number of correct answers. In a questionnaire rated on a five-point Likert-type scale, the students expressed satisfaction with the content (M=4.2) and feedback (M=3.5) provided by i-SIDRA and the methodology (M=4.2) used to learn anatomy.Conclusions: The use of audience response systems enriched with feedback such as i-SIDRA improves medical degree students' performance as regards anatomy of the locomotor system. The knowledge state diagrams representing students' behavior allow instructors to study their progress so as to identify what they still need to learn. [ABSTRACT FROM AUTHOR]

Background: When patients are admitted to an intensive care unit (ICU) their risk of getting an infection will be highly depend on the length of stay at-risk in the ICU. In addition, risk of infection is likely to vary over calendar time as a result of fluctuations in the prevalence of the pathogen on the ward. Hence risk of infection is expected to depend on two time scales (time in ICU and calendar time) as well as competing events (discharge or death) and their spatial location. The purpose of this paper is to develop and apply appropriate statistical models for the risk of ICU-acquired infection accounting for multiple time scales, competing risks and the spatial clustering of the data.Methods: A multi-center data base from a Spanish surveillance network was used to study the occurrence of an infection due to Methicillin-resistant Staphylococcus aureus (MRSA). The analysis included 84,843 patient admissions between January 2006 and December 2011 from 81 ICUs. Stratified Cox models were used to study multiple time scales while accounting for spatial clustering of the data (patients within ICUs) and for death or discharge as competing events for MRSA infection.Results: Both time scales, time in ICU and calendar time, are highly associated with the MRSA hazard rate and cumulative risk. When using only one basic time scale, the interpretation and magnitude of several patient-individual risk factors differed. Risk factors concerning the severity of illness were more pronounced when using only calendar time. These differences disappeared when using both time scales simultaneously.Conclusions: The time-dependent dynamics of infections is complex and should be studied with models allowing for multiple time scales. For patient individual risk-factors we recommend stratified Cox regression models for competing events with ICU time as the basic time scale and calendar time as a covariate. The inclusion of calendar time and stratification by ICU allow to indirectly account for ICU-level effects such as local outbreaks or prevention interventions. [ABSTRACT FROM AUTHOR]

This paper presents an overview of a set of amphetamines and cannabinoids tests performed on head hair samples from the Medico-Legal sector at the Madrid Department of the Spanish National Institute of Toxicology and Forensic Sciences during the years 2013 and 2014. The hair samples were tested for five stimulant phenylalkylamine derivatives -amphetamine (AP), methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxy-amphetamine (MDA), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA)- and/or two cannabinoids-Δ(9)-tetrahydrocannabinol (THC) and cannabinol (CBN)- by gas chromatography equipped with mass spectrometry detection in selected-ion monitoring mode, applying a method accredited to ISO/IEC 17025 standards. The test results were interpreted according to the confirmation cut-offs proposed by the Society of Hair Testing (SoHT) to identify chronic drug use. The ratios of positive results were studied in relation to gender, age, hair colour, dyeing and length of the tested samples to assess the independence from these variables or the association with them. Low, medium and high ranges of concentration were also estimated for each drug. 21.94% of the 2954 hair samples tested for phenylalkylamine derivatives were positive for one or more substances. 16.38% of the samples were positive for AP, 12.09% for MDMA and only 0.44% for MA. 6.60% of the tested samples were positive for AP/MDMA combination. A total of 3178 samples were tested for cannabinoids, resulting in 53.40% positive for THC and CBN. Simultaneous tests for phenylalkylamine derivatives and cannabinoids were performed in 2931 of the samples; 14.94% of them were positive for THC, CBN, and one or more amphetamines. According to the results from the statistical analysis, the use of THC and MDMA vary with age and gender among the Medico-Legal sector in an extended area of Spain, while the use of AP appears to be independent of these variables. On the other hand, the results of THC in hair could be influenced by the length of the tested segment; therefore, a consensus regarding the hair length between 3.0 and 5.5cm for THC testing should be reached. [ABSTRACT FROM AUTHOR]

Background: Cost-Effectiveness Analysis (CEA) has been promoted as an important research methodology for determining the efficiency of healthcare technology and guiding medical decision-making. Our aim was to characterize the collaborative patterns of CEA conducted over the past two decades in Spain. Methods and Findings: A systematic analysis was carried out with the information obtained through an updated comprehensive literature review and from reports of health technology assessment agencies. We identified CEAs with outcomes expressed as a time-based summary measure of population health (e.g. quality-adjusted life-years or disabilityadjusted life-years), conducted in Spain and published between 1989 and 2011. Networks of coauthorship and institutional collaboration were produced using PAJEK software. One-hundred and thirty-one papers were analyzed, in which 526 authors and 230 institutions participated. The overall signatures per paper index was 5.4. Six major groups (one with 14 members, three with 7 members and two with 6 members) were identified. The most prolific authors were generally affiliated with the private-for-profit sector (e.g. consulting firms and the pharmaceutical industry). The private-for-profit sector mantains profuse collaborative networks including public hospitals and academia. Collaboration within the public sector (e.g. healthcare administration and primary care) was weak and fragmented. Conclusions: This empirical analysis reflects critical practices among collaborative networks that contributed substantially to the production of CEA, raises challenges for redesigning future policies and provides a framework for similar analyses in other regions. [ABSTRACT FROM AUTHOR]

Sometimes, research in social sciences becomes part of the transformative practices of the researchers themselves. In this way, these researchers try to promote social change. This paper is about one of those studies. During the realization of my PhD research, on sexual-affective education in two schools in the city of Granada (Spain) from the sociological view, both the research and the educational action work that seeks social change converged to the point that, once we had taken account of the demand of the reality being researched, educational action research became the most appropriate methodology in order to research acting on education for social change towards sexual and gender equality. In this paper, I will talk about all this process, which is methodological, systematic, and respectful of the scientific value of research. [ABSTRACT FROM AUTHOR]

Background: Process evaluation studies are recommended to improve our understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results and on their potential transferability to practice. This paper aims to document the translation of a type-2 diabetes (T2D) prevention program into the routine context of several primary care centers, assessing process indicators related to clinician adoption, patient recruitment, exposure to the intervention components and baseline characteristics.Methods: An observational descriptive process evaluation study was conducted of the 2.5-year implementation of the Prevention of Diabetes in Euskadi cluster randomized trial in 14 primary care centers of the Basque Health Service (Osakidetza). The clinical intervention consisted of three components: (1) risk screening, (2) an educational intervention promoting healthy lifestyles, and (3) remote support (follow-up). A passive dissemination strategy of providing training and materials was used to translate the intervention into practice. All non-diabetic patients aged 45 to 70 years who were identified as being at high risk of developing T2D were eligible for study inclusion. The RE-AIM framework guided the process evaluation.Results: Overall, 31.4 % of family physicians and 57.6 % of nurses participated in the study, while 4170 out of 67,293 (6.2 %) targeted patients who attended the centers during the implementation period were reached through the screening. Around half of the screened patients were identified as being at high risk of developing T2D (FINDRISC score ≥14). The rate of refusal to participate and the proportion of women were higher in the intervention group. Finally, 634 and 454 non-diabetic 45- to 70-year-old patients who were at high risk of T2D were included in the control and intervention group centers (intervention reach = 48 %). Significant variability in most process indicators was observed at center level.Conclusion: The passive dissemination strategy has produced modest process indicators related to the adoption, reach and implementation of the intervention program, and reduced the possibility of its standardized application in heterogeneous contexts. The resulting different procedures and strategies used by the centers were associated with process outcomes. Context-specific variability and possible confounding will require rigorous procedures for analysis of the intervention effects.Trial Registration: The trial was registered in ClinicalTrials.gov (identifier: NCT01365013 ). Registered on June 2011. [ABSTRACT FROM AUTHOR]

Objectives: This paper describes verdicts in court involving injury-producing medical errors in Spain.Design, Setting and Participants: A descriptive analysis of 1041 closed court verdicts from Spain between January 2002 and December 2012. It was determined whether a medical error had occurred, and among those with medical error (n = 270), characteristics and results of litigation were analyzed. Data on litigation were obtained from the Thomson Reuters Aranzadi Westlaw databases.Main Outcome Measures: All verdicts involving health system were reviewed and classified according to the presence of medical error. Among those, contributory factors, medical specialty involved, health impact (death, disability and severity) and results of litigation (resolution, time to verdict and economic compensations) were described.Results: Medical errors were involved in 25.9% of court verdicts. The cause of medical error was a diagnosis-related problem in 25.1% and surgical treatment in 22.2%, and Obstetrics-Gynecology was the most frequent involved specialty (21%). Most of them were of high severity (59.4%), one-third (32%) caused death. The average time interval between the occurrence of the error and the verdict was 7.8 years. The average indemnity payment was €239 505.24; the highest was psychiatry (€7 585 075.86) and the lowest was Emergency Medicine (€69 871.19).Conclusions: This study indicates that in Spain medical errors are common among verdicts involving the health system, most of them causing high-severity adverse outcomes. The interval between the medical error and the verdict is excessive, and there is a wide range of economic compensation. [ABSTRACT FROM AUTHOR]

Objective: this paper explores the experiences of registered nurses working with Spanish nursing students within the hospital. Methods: a qualitative phenomenological approach was followed. Purposeful sampling was employed. Twenty-one registered nurses, from a public hospital located in Spain, were included in the study. Data were collected by means of unstructured and semi-structured interviews and were analysed using Giorgi's proposal. The Consolidated Criteria for Reporting Qualitative Research were followed. Results: three main themes described the experience of registered nurses: "The nurse's relationship with nursing students"; most nurses emphasized the importance of the first contact with students and they considered students' attitude to be key. "Defining the role of the student in clinical practice"; it is necessary to unify the nurse's role and interventions to avoid misleading students and establish priorities in clinical practice. "Building bridges between clinical settings and the University"; the need to establish a common ground and connection between the university and hospital clinical settings was emphasized. Nurses felt that the training program should also be designed by the clinical settings themselves. Conclusions: understanding the meaning of nursing students with registered nurses might gain a deeper insight into their expectations. [ABSTRACT FROM AUTHOR]

Introduction: generic, preference-based Health- Related Quality of Life instruments are receiving growing attention in health-care decision-making process. In spite of this, to our knowledge, EQ-5D and SF-6D have never been compared in a Parkinson´s disease population sample.Objective: the aim of this paper was to assess the psychometric properties of both instruments in a Spanish PD population sample.Methods: a total sample of 133 patients were interviewed using EQ-5D-3L and SF-6D. The validity, level of agreement and sensitivity of both instruments were computed and then compared. The Spanish tariff has been used in both instruments.Results: utilities of EQ-5D-3L and SF-6D have shown a strong correlation (r >0.50 and p<0.001) with the summary score of the PDQ-8 and the EQ-VAS score. Significant differences were observed in the stages III-IV of the Hoehn & Yahr stage. SF-6D had 51% higher efficiency than EQ-5D at detecting differences in symptoms severity.Discussion: both EQ-5D-3L and SF-6D seem to be adequate generic Health-Related Quality of Life measures in terms of validity and sensitivity.Conclusion: EQ-5D-3L presents greater ceiling and floor effects than the SF-6D instrument in this sample. Besides, the instrument SF-6D was better at detecting changes in symptoms severity compared with EQ-5D-3L. [ABSTRACT FROM AUTHOR]

Background: Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we describe variation in prescribing style within and across groups of GPs from six countries. Methods: Cross-sectional study with the inclusion of 457 GPs and 6394 sore throat patients. We describe variation in prescribing antibiotics for sore throat patients across six countries and assess whether variation in “prescribing style” - understood as a subjective tendency to prescribe - has an important effect on variation in prescription of antibiotics by using the concept of prescribing style as a latent variable in a multivariable model. We report variation as a Median Odds Ratio (MOR) which is the transformation of the random effect variance onto an odds ratio; Thus, MOR = 1 means similar odds or strict homogeneity between GPs' prescribing style, while a MOR higher than 1 denotes heterogeneity in prescribing style. Results: In all countries some GPs always prescribed antibiotics to all their patients, while other GPs never did. After adjusting for patient and GP characteristics, prescribing style in the group of GPs from Russia was about three times more heterogeneous than the prescribing style in the group of GPs from Denmark - Median Odds Ratio (6.8, 95% CI 3.1;8.8) and (2.6, 95% CI 2.2;4.4) respectively. Conclusion: Prescribing style is an important source of variation in prescription of antibiotics within and across countries, even after adjusting for patient and GP characteristics. Interventions aimed at influencing the prescribing style of GPs must encompass context-specific actions at the policy-making level alongside GP-targeted interventions to enable GPs to react more objectively to the external demands that are in place when making the decision of prescribing antibiotics or not. [ABSTRACT FROM AUTHOR]

Background: A prospective Population Risk Stratification (PRS) tool was first introduced in the public Basque Health Service in 2011, at the level of its several Primary Care (PC) practices. This paper aims at exploring the new tool's implementation process, as experienced by its potential adopters/users, ie. PC clinicians (doctors and nurses). Findings could help guide future PRS implementation strategies. Methods: Three focus groups exploring clinicians' opinions and experiences related to the PRS tool and its implementation in their daily practice were conducted. A purposive sample of 12 General Practitioners and 11 PC nurses participated in the groups. Discussions were digitally recorded, transcribed verbatim and analysed by two independent researchers using thematic analysis based on Graham et al.'s Knowledge Translation Theory. Results: Exploring PC clinicians' experience with the new PRS tool, allowed us to identify certain elements working as barriers and facilitators in its implementation process. This series of closely interrelated elements, which emerged as relevant in building up the complex implementation process of the new tool, as experienced by the clinicians, can be grouped into four domains: 1) clinicians' characteristics as potential adopters, 2) clinicians' perceptions of their practice settings where PRS is to implemented, 3) clinicians' perceptions of the tool, and 4) the implementation strategy used by the PRS promoter. Conclusions: Lessons from the implementation process under study point at the need to frame the implementation of a new PRS tool within a wider strategy encouraging PC clinicians to orientate their daily practice towards a population health approach. The PRS tool could also improve the perceived utility by its potential adopters, by bringing it closer to the clinicians' needs and practice, and allowing it to become context-sensitive. This would require clinicians being involved from the earliest phases of conceptualisation, design and implementation of the new tool, and mounting efforts to improve communication between clinicians and tool promoters. Graham et al.'s Knowledge Translation Theory proved a suitable framework to explore the implementation process of a new PRS tool in the public Basque Health Service's PC practice, and hence to identify implementation barriers and facilitators as experienced by the clinicians. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify the situations preceding the incorrect selection of survey respondents in Spain and their consequences, focusing on research in which survey respondents were selected through random routes and quotas. The use of the first six Barometer Surveys by the Spanish Centre for Sociological Research (CIS) in 2011 reveals a steady increase in the number of incidents. However, these do not involve any major differences with respect to the population as a whole in terms of gender, age, educational level and occupational status. The paper shows that cooperation patterns differ depending on the time of day and the day of the week when field work is performed. It also reveals that the level of accessibility varies significantly depending on the different traits of the respondents. [ABSTRACT FROM AUTHOR]

Introduction: The 30-year history of AIDS (the Acquired Immune Deficiency Syndrome) the mass media has played a key role in terms of its function to inform the public and also its influence on the generation and strengthening of opinions. Objectives: The focus of the present study is to analyze material related to AIDS published in the written press, specifically in the newspaper "El País" (Andalusia Edition), during the period between 2008 and 2011. Said material is compared with similar texts mostly from the same media from the 1980s and 1990s. Material y Methods: This is a descriptive, transversal, retrospective and comparative study. In order to carry it out, the journalism documents access platform LexisNexis® is utilized along with the paper "AIDS in the Mass Media" (2002). Results: The 167 publications between 2008 and 2011 are compiled, selected, analyzed for content and then classified into categories for their posterior analysis. Discussion: There is a notable evolution in terms of the way in which news is dealt with regarding knowledge about the disease itself. Another fact to be considered is that there is no significant change with regards to the degree of discrimination or stigmata associated with the disease insofar as relates to society as a whole. [ABSTRACT FROM AUTHOR]

Social studies on disability have increased in number and importance in Spain and other countries over the last few years. Nevertheless, the majority of the available sources and studies do not adequately represent this heterogeneous group, which currently makes up about 9 per cent of the Spanish population. The implementation of social measures requires representative sources and studies containing relevant information. The aim of this paper is to identify the main difficulties involved in designing and developing social research methods concerning persons with disabilities, and offer proposals and recommendations in order to advance towards a more inclusive social research using the concepts of accessibility and design for all. [ABSTRACT FROM AUTHOR]

Social studies on disability have increased in number and importance in Spain and other countries over the last few years. Nevertheless, the majority of the available sources and studies do not adequately represent this heterogeneous group, which currently makes up about 9 per cent of the Spanish population. The implementation of social measures requires representative sources and studies containing relevant information. The aim of this paper is to identify the main difficulties involved in designing and developing social research methods concerning persons with disabilities, and offer proposals and recommendations in order to advance towards a more inclusive social research using the concepts of accessibility and design for all. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to know the experience of health professionals in situations of perinatal death and grief and to describe their action strategies in the management of perinatal loss. A qualitative study with a phenomenological approach was carried out through interviews conducted with 19 professionals. Three thematic categories were identified: Healthcare practice, feelings aroused by perinatal loss and meaning and beliefs about perinatal loss and grief. The results revealed that the lack of knowledge and skills to deal with perinatal loss are identified as the main reason behind unsuitable attitudes that are usually adopted in these situations. This generates anxiety, helplessness and frustration that compromise professional competency. The conclusion reached is that the promotion of training programs to acquire knowledge, skills and abilities in management of perinatal bereavement and the development of a clinical practice guideline for perinatal loss are necessary. [ABSTRACT FROM AUTHOR]

With growing levels of urbanization and agriculture throughout the world, it is increasingly important that both research and management efforts take into account the effects of this widespread landscape alteration and its consequences for natural systems. Freshwater ecosystems, namely reservoirs, are particularly sensitive to land use changes. In this context, modelling can be very useful, for decision support, as an investigative tool to forecast the outcome of various scenarios, to guide current management in order to meet future targets and to develop integrated frameworks for management accordingly to the Water Framework Directive (WFD). The present paper examined the applicability of a holistic Stochastic-Dynamic Methodology (StDM), coupled with a Cellular Automata (CA) model, in capturing how expected changes at land use level will alter the ecological status of lentic ecosystems, namely at physicochemical and biological levels. The methodology was applied to Portuguese reservoirs located in the Douro's basin and illustrated with a series of stochastic-dynamic and spatial outputs taking into account expected scenarios regarding land use changes. Overall, the simulation results are encouraging since they seem to demonstrate the tool reliability in capturing the stochastic environmental dynamics of the selected metrics facing spatial explicit scenarios. The ultimate goal was to couple monitoring assessment and the described modelling techniques to ease management and decision making regarding the practical implementation of the WFD, both at the scale of the reservoir body and at the scale of the respective river watershed dynamics. [Copyright &y& Elsevier]

The design of convection-permitting ensemble prediction systems capable of producing accurate forecasts of disruptive events is an extraordinarily challenging effort. The difficulties associated with the detection of extreme events found at these scales motivates the research of methodologies that efficiently sample relevant uncertainties. This study investigates the potential of multiple techniques to account for model uncertainty. The performance of various stochastic schemes is assessed for an exceptional heavy precipitation episode which occurred in eastern Spain. In particular, the stochastic strategies are compared to a multiphysics approach in terms of both spread and skill. The analyzed techniques include stochastic parameterization perturbation tendency and perturbations to influential parameters within the microphysics scheme. The introduction of stochastic perturbations to the microphysics processes results in a larger ensemble spread throughout the entire simulation. Conversely, modifications to microphysics parameters generate small-scale perturbations that rapidly grow over areas with high convective instability, in contrast to the other methods, which produce more widespread perturbations. A conclusion of specific interest for the western Mediterranean, where deep moist convection and local orography play an important role, is that stochastic methods are shown to outperform a multiphysics-based ensemble for this case, indicating the potential positive impact of stochastic parameterizations for the forecast of extreme events in the region. • In this paper, we have contributed in the field of heavy precipitation forecasting in the western Mediterranean region by analyzing the performance of multiple ensemble generation strategies based on model error sampling, mainly stochastic parameterizations for a specific episode occurred in eastern Spain. In particular, our most outstanding findings are: • Stochastic perturbations to specific parameters within the microphysics scheme result in larger ensemble spread. • Perturbations to microphysics display low initial spatial correlation, but intensely grow over areas with high convective instability. • Stochastic methods improve the skill of multiphysics, especially when deep moist convection and local orography play an influential role. • The regional increase in spread is translated to local scales. Maximum hourly precipitation intensities over small-to-medium size basins are generally captured with the proposed ensemble generation strategies. [ABSTRACT FROM AUTHOR]

In the last two years the Inspección de Servicios of the Universidad Complutense de Madrid (UCM) has been running a web-based panel survey with a probability sample of 889 students. In each wave of the panel students report on the incidences occurred at the academic lectures they attend in a particular day of the week. For the academic year 2006-2007, until the month of April we had a sample of more than 10.000 lectures, being the later our unit of analysis. In this paper we will report on the response rate of the online panel, on one hand related to those invited to participate (3.091) and on the other to the specific response rate in the different waves of the panel. We will cover the following aspects: • Basic methodological characteristics of the research and aim of the survey. • Participation rates in the invitation process and in the different waves of the panel. • Socio demographic characteristics of respondents. • The recalling process (up to 2 reminders in each wave). Reminders and its incidence in the measurement basic parameters of the survey. • Implications of the results for online based research in academic context. [ABSTRACT FROM AUTHOR]

The effect of population subdivision on the determination of kinship of any two persons is investigated in this paper. Expressions of the joint genotype probabilities and likelihood ratios on kinship testing are reported. Two real cases are analysed using the Hong Kong Chinese population data and the Spanish data. Various kinds of relationships are investigated for illustration. [Copyright &y& Elsevier]

Currently, there is a lack of accurate simulation tools for the thermal performance modeling of courtyards due to their intricate thermodynamics. Machine Learning (ML) models have previously been used to predict and evaluate the structural performance of buildings as a means of solving complex mathematical problems. Nevertheless, the microclimatic conditions of the building surroundings have not been as thoroughly addressed by these methodologies. To this end, in this paper, the adaptation of ML techniques as a more comprehensive methodology to fill this research gap, covering not only the prediction of the courtyard microclimate but also the interpretation of experimental data and pattern recognition, is proposed. Accordingly, based on the climate zoning and aspect ratios of 32 monitored case studies located in the South of Spain, the Support Vector Regression (SVR) method was applied to predict the measured temperature inside the courtyard. The results provided by this strategy showed good accuracy when compared to monitored data. In particular, for two representative case studies, if the daytime slot with the highest urban overheating is considered, the relative error is almost below 0.05%. Additionally, values for statistical parameters are in good agreement with other studies in the literature, which use more computationally expensive CFD models and show more accuracy than existing commercial tools. [ABSTRACT FROM AUTHOR]

Background: Catalonia (in the north east of the Iberian Peninsula) is among the most prospected territories in Europe, from the ethnobotanical point of view. The aim of the present paper is to undertake a global analysis in the area considered, including plants, plant life forms, and ethnobotanical data within a physiographic and geographic framework. Methods: Data from 21 ethnobotanical prospection areas in Catalonia were collected, analyzed, and compared, with the focus on plant life forms and geographic divisions. Results: A total of 824 taxa constitute the Catalan ethnoflora, and 316 of them are shared by the six physiographic zones recognized in Catalonia. When three major geographic areas are considered (Pyrenean, inland, and littoral), 394 taxa have been reported in only one out of the three areas. Concerning life forms, phanerophytes and chamaephytes together, i.e., those taxa present all through the year, are the most cited (37.12%). Conclusions: This first study constitutes a new approach to ethnobotanical data analysis. The results show the particular importance of plants with a large distribution area and plants with available biomass throughout the year. Apart from this, other kind of plants, e.g., those present in only one territory, are of interest for its originality and sometimes for the local significance. [ABSTRACT FROM AUTHOR]