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ABSTRACT Background Ageing is associated with a gradual loss of muscle strength, which in the end may have consequences for survival. Whether muscle strength and mortality risk associate in a gradual or threshold‐specific manner remains unclear. This study investigates the prospective association of muscle strength with all‐cause mortality in the oldest old. Methods We included 1890 adults aged ≥ 90 years (61.6% women, mean age 91.0 ± 1.5 years) from 27 European countries and Israel participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) study. Muscle strength was assessed using handgrip dynamometry (unit: kilogram). Using time‐varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with mortality, controlling for age, sex, smoking, BMI, marital status, education, geographical region and self‐perceived health. Results Over a mean follow‐up of 4.2 ± 2.4 years, more than half of the participants died (n = 971, 51.4%). The mean handgrip strength was 20.4 ± 8.0 kg for all participants, with men (26.7 ± 7.5 kg) showing significantly higher strength than women (16.4 ± 5.4 kg) (p

OBJECTIVE: The aging population of European countries highlights the need for extended working lives. This study aims to investigate facilitators and barriers for working beyond the statutory pension age (SPA). METHODS: Using data from waves 1, 2, 4–9 of the Survey of Health, Ageing and Retirement in Europe (SHARE) (2004–2022), we followed 9131 workers with a mean age of 56.9 [standard deviation (SD) 3.5] years from 26 European countries until they surpassed the SPA for their respective country, sex and year of participation. Using robust Poisson regression, we modelled the prospective association of work factors, lifestyle, health, and demographics at baseline with working at least one year beyond the SPA. RESULTS: Participants were followed for 9.5 (SD 3.9) years. After surpassing the SPA by at least one year, 18% were still working. Among the work factors, opportunities for skill development [risk ratio (RR) 1.20, 95% confidence interval (CI) 1.07–1.34] and recognition at work (RR 1.13, 95% CI 1.01–1.26) facilitated working beyond SPA, while time pressure (RR 0.89, 95% CI 0.81–0.97) and poor prospects for job advancement (RR 0.76, 95% CI 0.70–0.83) were barriers. For the other factors, smoking was negatively associated with working beyond the SPA, while living in the northern part of Europe, higher level of education, and being divorced or separated were positively associated with working beyond the SPA. CONCLUSION: This prospective cohort study across 26 European countries identified four modifiable work factors that influenced working beyond the SPA. Addressing modifiable barriers and facilitators at the workplace and through public health initiatives could help extend working lives in Europe.

Self-regulation strategies and behaviors are important aspects of instrumental music learning because they allow students to set learning goals by testing and controlling their cognition, motivation, behaviors, and emotions. This work investigates the self-regulation processes of four young instrumentalists (aged 10-11 years) in their initial stages of viola and violin learning, during practice with Plectrus, a real-time instrumental intonation training and assessment software. The qualitative-hermeneutical nature of this research employed a multiple case study design to investigate the construct of self-regulation within a software-supported instrumental learning process. Data were collected from the participants' practice diaries over a 4-week period. The final practice session was also analyzed from audio-visual recordings. The results indicate that, despite their limited experience, the students showed a diversity of strategies and behaviors with which they self-regulated their cognitions, motivations, behaviors, and emotions. However, not all the students employed the same processes, and there was variability in the frequency of their use. One of the students showed more self-regulatory processes than the rest and achieved the best scores, although it has not been possible to establish a relationship between the scores and self-regulation.

Background and Aims: Painful shoulder is one of the most frequent consultation causes. Multiple treatments have been described to relieve pain, restore range of motion and improve functionality. Methods: This randomised clinical trial was conducted in 60 patients. The treatment group received combined pulsed radiofrequency (PRF) on suprascapular nerve (SN) and axillary-circumflex nerve (ACN). The control group received PRF on SN only. The primary outcome was pain intensity measured by the Numerical Rating Scale (NRS). The secondary outcomes were the Shoulder Pain and Disability Index (SPADI), the Constant-Murley range of motion scale and Disability of the Arm, Shoulder and Hand (DASH) scale. The patients were monitored at the baseline visit and at 1, 3, 6 and 9 months. A mixed ordinal regression model was estimated to evaluate the association between the study group and pain measured with NRS. Results: A global decrease in pain at the end of the study was noted. The global baseline NRS was 8.4, and the global final NRS at 9 months of follow-up was 6.2. Combined PRF on SN and ACN was not associated with lower NRS pain scores compared to single SN PRF [odds ratio (OR) =1.04, 95% confidence interval (CI) 0.91-1.20, P = 0.507]. Secondary outcomes showed no significant differences: SPADI (OR = 1.04, 95% CI 0.92-1.18), Constant-Murley (OR = 1.01, 95% CI 0.90-1.14), DASH (OR = 1.04, 95% CI 0.92-1.17). Conclusion: Combined PRF applied to SN and ACN was not superior to PRF applied to SN alone. Keywords: Axillary-circumflex nerve, pulsed radiofrequency, shoulder pain, Shoulder Pain and Disability Index, suprascapular nerve, Author(s): José Miguel Esparza Miñana (corresponding author) [1,2,3]; Guido Mazzinari [3,4]; Jose Emilio Llopis-Calatayud [5,6]; Germán Cerdá-Olmedo [7] INTRODUCTION Painful shoulder is one of the most frequent consultations in primary [...]

Abstract We assessed whether multiplex real-time PCR plus conventional microbiological testing is safe and more effective than conventional microbiological testing alone for reducing antibiotic use in community-acquired pneumonia (CAP). In this randomised trial, we recruited adults hospitalised with CAP at four Spanish hospitals. Patients were randomly assigned (1:1) to undergo either multiplex real-time PCR in non-invasive respiratory samples plus conventional microbiological testing or conventional microbiological testing alone. The primary endpoint was antibiotic use measured by days of antibiotic therapy (DOT). Between February 20, 2020, and April 24, 2023, 242 patients were enrolled; 119 were randomly assigned to multiplex real-time PCR plus conventional microbiological testing and 123 to conventional microbiological testing alone. All but one of the patients allocated to multiplex real-time PCR plus conventional microbiological testing underwent PCR, which was performed in sputum samples in 77 patients (65.2%) and in nasopharyngeal swabs in 41 (34.7%). The median DOT was 10.04 (IQR 7.98, 12.94) in the multiplex PCR plus conventional microbiological testing group and 11.33 (IQR 8.15, 16.16) in the conventional microbiological testing alone group (difference −1.04; 95% CI, −2.42 to 0.17; p = 0.093). No differences were observed in adverse events and 30-day mortality. Our findings do not support the routine implementation of multiplex real-time PCR in the initial microbiological testing in hospitalised patients with CAP. Clinicaltrials.gov registration: NCT04158492.

Abstract Background The promotion of daily breakfast consumption and the importance of making appropriate breakfast choices have been underscored as significant public health messages. The aim of this study was to examine the relationship between breakfast frequency and life satisfaction in large and representative samples of school-going children and adolescents aged 10–17 years from 42 different countries. Methods This study used information from the 2017/2018 Health Behavior in School-aged Children study, comprising nationally representative samples of children and adolescents aged 10–17 years who were attending school. The total number of participants from the 42 countries included in the study was 155,451 (51.3% girls). The evaluation of breakfast consumption in this study involved a specific question: “How often do you typically have breakfast (more than a glass of milk or fruit juice)?”. To measure life satisfaction, a subjective assessment scale was used in the form of a ladder, visually spanning from 0 to 10. On this scale, the topmost point (10) denotes the highest conceivable quality of life, whereas the bottom point (0) represents the worst imaginable quality of life. Results After adjusting for several covariates, the lowest estimated marginal mean of life satisfaction was identified in those participants who skipped breakfast (mean [M] = 5.6, 95% confidence interval [CI] 5.5 to 5.8). Conversely, the highest estimated marginal mean of life satisfaction was observed in those who had breakfast every day (M = 6.5, 95% CI 6.3 to 6.6). Overall, a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents was identified (p-for-trend

Abstract Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient’s values and target the best outcome possible given the patient’s desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.

Introduction Hepatitis B virus (HBV) affects 296 million people globally, causing 780 000 annual deaths. It has been estimated that 12–43 million individuals are co-infected with hepatitis D virus (HDV). In Spain, the prevalence of HBsAg in adults is 0.22%, with an anti-HDV prevalence of 7.7%, although not extensively documented since many HBsAg-positive cases are not tested for anti-HDV. The primary objective of this project is to optimise hepatitis D care by implementing a screening programme for anti-HDV in all HBsAg-positive individuals over a 1 year period in Catalonia. Secondary objectives include evaluating hepatitis D prevalence, establishing a digital registry for all anti-HDV positive cases, testing them for HDV-RNA in a centralised laboratory and offering linkage to care.Methods and analysis This prospective study will be performed in seven hospital centres in Catalonia, which attend to more than 95% of the adult population. Approximately, 9290 HBsAg-positive individuals are expected to be screened for anti-HDV in 1 year. All anti-HDV positive samples will be sent to a centralised laboratory for HDV-RNA quantification. All individuals testing positive for anti-HDV will be registered on an electronic platform and linked to care. The registry will collect data on demographics, infection stage, risk factors, disease awareness and previous diagnoses. No additional interventions will be conducted for those with adequate follow-up.Ethics and dissemination The Vall d’Hebron Hospital Ethics Committee (PR(AG)628/2023) and the Spanish Agency of Medicines and Medical Devices approved this study. These findings will be disseminated through peer-reviewed publications and conference presentations.Trial registration study Grant number: IN-ES-980–7058.

Ecosystem functions such as biological pest control are mediated by the richness and abundance of service providers i.e., biological control agents (BCAs), relative contributions of individual taxa and community structure. This is especially relevant in the native range of agricultural herbivores, where a speciose community of co-evolved BCAs can prevent them from attaining pest status. Here, we use a powerful graphical approach to assess the functional structure of BCA communities of the fall armyworm (FAW) Spodoptera frugiperda (Lepidoptera: Noctuidae) on maize in the Neotropics. Drawing upon a curated database of all-time field and laboratory studies, we graphed patterns in the functional contribution, abundance and niche breadth for a respective 69, 53 and 3 taxa of resident parasitoids, predators and pathogens. Regardless of varying taxon coverage and rigor of the underlying studies, functional structure follows a saturating relationship in which the first three taxa account for 90–98% of aggregate biological control function. Abundance-functionality matrices prove critically incomplete, as more than 80% of invertebrate taxa miss empirically derived efficiency metrics while associated FAW infestation data are scarce. Despite its methodological shortfalls and data gaps, our work pinpoints Chelonus insularis, several taxa of egg parasitoids, Doru spp. and Orius spp. as taxa with outsized (average) functionality and conservation potential. This is also exemplified by the highly variable aggregate function across studies, with dispersion indices of 1.52 and 2.14 for invertebrate BCAs. Our work underlines the critical importance of functional ecology research, networked trials and standardized methodologies in advancing conservation biological control globally.

IntroductionHistorically, Multiple Endocrine Neoplasia type 1 (MEN1)-related pituitary adenomas (PAs) were considered more aggressive and treatment-resistant than sporadic PAs. However, recent studies suggest similarities in their behavior. This study aimed to evaluate the long-term outcomes of MEN1 PAs and identify predictive factors.MethodsNationwide multicenter retrospective cohort study of MEN1-related PAs with a minimum 1-year follow-up, collecting patient demographics, germline MEN1 pathogenic variants (PV), PA size, secretory profile, radiological characteristics, treatments, and outcomes.ResultsWe analyzed 84 PAs, 69%in females and 31% in males (P

Normal aging presents subtle cognitive changes that can be detected before meeting the criteria for Mild cognitive impairment (MCI). Older people with low cognitive reserve and who receive limited cognitive stimulation are at greater risk of deterioration. In this regard, cognitive stimulation (CS) has been identified as an intervention that reduces this risk, provided that its design takes into account the differences in the level of cognitive reserve (CR) acquired throughout life and the baseline level of cognitive functioning. The general objective of this study is to evaluate, through a randomized clinical trial, the effectiveness of a computerized cognitive stimulation program, designed and adapted from Occupational Therapy based on the level of cognitive reserve in older adults in Primary Care. 100 participants will be randomized in a stratified manner according to the level of cognitive reserve (low/moderate/high), assigning 50 participants to the control group and 50 participants to the intervention group. The intervention group will carry out a computerized cognitive stimulation intervention designed and adapted from occupational therapy according to the level of cognitive reserve, through the “stimulus” platform. The main result expected to be achieved is the improvement of higher brain functions. As secondary results, we expect that those cognitive aspects most vulnerable to aging will decrease more slowly (in areas such as memory, executive function, attention and processing speed), and that the cognitive reserve of the participants will increase, in addition to being able to balance gender differences in these aspects. We think that these results can have a positive impact on the creation of adapted, meaningful and stimulating CS programs in older adults to prevent MCI and experience healthier aging.

This work presents an analysis of the didactic literature for the initial learning of intonation on violin and viola. Analysis has been conducted through a document-analysis design of 86 methods. The chosen analytic categories were: (1) contents (number of pitches and sequence of pitches presentation); (2) pedagogy (teaching approach and use of pizzicato); and (3) auxiliary learning resources (written accompaniments and audio resources). The results of the analysis allowed us to conclude that there is a great disparity in the number of pitches, which is reduced with the passage of time. Different sequences coexist in practically all the materials, and the traditional teaching approach occurs the most frequently in the documents analyzed. A homogeneous teaching approach is adopted in most of the documents, especially with the violin. Pizzicato is scarcely used as a didactic resource. There is a wide inclusion of written (accompaniments) and recorded (minus-one) auxiliary resources in the most modern documents. Based on these results, a methodological proposal for the initial learning of intonation on these instruments is presented.

En la investigación se determinan los aspectos esenciales del pensamiento de Bonifati Kedrov, desde la perspectiva marxista ciencia, tecnología y sociedad, como representante de la tradición europea ex socialista, a partir de sus obras con el objetivo de determinar su contribución a estos estudios; pues precisamente, desde la perspectiva de la integración ciencia-tecnología-sociedad, se continua el reto de nuevos estudios multidisciplinarios para profundizar de forma teórica y práctica en cómo lograr una sociedad científica y tecnológica más humanizada, capaz de rebasar la crisis de los paradigmas actuantes. Kedrov es considerado el más prestigioso de los teóricos soviéticos de la ciencia, resulta insuficiente la delimitación de las principales características de aquellas zonas de su quehacer científico que expresan una marcada contribución a los estudios sociales de la ciencia y la tecnología. En resumen, la atención al problema del contexto, así como, sus influencias en el desarrollo de la ciencia y la tecnología, constituye quizás la más cercana particularidad y aporte teórico de su pensamiento. Palabras clave: Kedrov, Tradición marxista, Estudios Sociales de la Ciencia y la Tecnología. ABSTRACT The research determines the essential aspects of Bonifati Kedrov`s thought, from the Marxist perspective science, technology and society, as a representative of the ex-socialist European tradition, from his works with the aim of determining his contribution to these studies; Well, precisely, from the perspective of science-technology-society integration, the challenge of new multidisciplinary studies continues to deepen in a theoretical and practical way how to achieve a more humanized scientific and technological society, capable of overcoming the crisis of the acting paradigms. Kedrov is considered the most prestigious of the Soviet theorists of science, it is insufficient to delimit the main characteristics of those areas of his scientific work that express a marked contribution to the social studies of science and technology. In summary, attention to the problem of context, as well as its influences on the development of science and technology, constitutes perhaps the closest particularity and theoretical contribution of his thought. Keywords: Kedrov, Marxist tradition, Social Studies of Science and Technology

Introduction: Healthcare advances have allowed an increase in the survival of paediatric patients with neurological diseases. As a result, it is increasingly common to find these patients in adult neurology consultations. The aim of this study is to evaluate the current level of consensus on the transition of neuropaediatric patients among neurology and paediatric professionals in the Balearic Islands. Material and methods: We conducted an observational, analytical, cross-sectional study through an anonymous questionnaire consisting of 27 questions, which was distributed to neurologists, paediatric neurologists, hospital paediatricians, and primary care paediatricians in the healthcare network of the Balearic Islands. It was developed using Google Forms and distributed by the competent professional societies. Consensus was considered to exist for answers with 70% or more agreement. Results: Responses were received from 58 professionals; 46.6% were hospital paediatricians, 29.9% were neurologists, 13.8% were paediatric neurologists, and 13.8% were primary care paediatricians. Among other issues, consensus was observed on the need for a transition programme for patients with neurological diseases. No consensus was observed regarding the duration of the transition (P=.029) and how long simultaneous follow-up must last after the transfer (P=.09). Conclusions: Due to increased survival rates, there is a need to create transition programmes for paediatric patients with neurological diseases. In our study, more than 70% of professionals believed that it would be beneficial to create such programmes. Resumen: Introducción: Los avances sanitarios han permitido un aumento de la supervivencia de pacientes pediátricos con enfermedades neurológicas. Por ello, cada vez es más frecuente encontrarlos en consultas de neurología de adultos. El objetivo de este estudio es evaluar el nivel de consenso actual sobre la transición del paciente neuropediátrico entre los profesionales de la neurología y de la pediatría de nuestra comunidad autónoma. Material y métodos: Estudio observacional, analítico y transversal a través de una encuesta anónima que consta de 27 preguntas realizada a neurólogos, neuropediatras, pediatras hospitalarios y pediatras de atención primaria de la red sanitaria de las Islas Baleares. Se ha llevado a cabo mediante un formulario Google y la difusión se ha realizado a través de las sociedades profesionales correspondientes. Se considera que existe consenso en aquellas respuestas que han obtenido el 70% o más de coincidencia. Resultados: Han respondido 58 participantes, donde el 46,6% son pediatras hospitalarios, 29,9% neurÓlogos, 13,8% neuropediatras y 13,8% pediatras de atención primaria. Se ha alcanzado consenso, entre otras cuestiones, en la necesidad de un programa de transición para pacientes con enfermedades neurológicas. No se ha alcanzado en la duración de la transición (p = 0,029) y cuánto tiempo tiene que durar el seguimiento simultáneo tras la transferencia (p = 0,09). Conclusiones: Debido a la mayor supervivencia de los pacientes pediátricos con enfermedades neurológicas se plantea la necesidad de crear programas de transición para estos pacientes. En nuestro estudio más del 70% de los profesionales cree que sería beneficioso formar programas de transición.

Abstract Aim To develop a conceptual framework for nurses' protocol‐based care decision‐making. Design Miles & Huberman's bottom‐up approach to developing conceptual frameworks was followed, using data collected from a multiple embedded case study examining protocol‐based decision‐making by nurses in three hospital wards within a university hospital in northern Spain. Methods The qualitative data from the case study, obtained through documentary analysis, observations, and interviews, underwent a secondary analysis consisting of four steps: data reduction, data display, comparison, and drawing conclusions. Results The framework for protocol‐based care decision‐making comprises four components: (1) protocol‐based care, as a balance between standardisation and individualised care, (2) the process, (3) the context, and (4) the elements of protocol‐based care decision‐making. These components and their relationship as a context‐dependent, linear, variable and multifactorial process, directly influenced by the perception of risk, are described and illustrated. Conclusions This study provides a rigorous bottom‐up framework for nurses' protocol‐based care decision‐making. The framework could be a valuable resource for managers, clinical nurses, educators, and researchers to guide and evaluate nurses' decision‐making, leading to improved care quality and reduced variability in clinical practice. Furthermore, the framework lays a foundation for further research and practical applications. Impact This study addressed the problem of understanding nurses' protocol‐based care decision‐making and the need for a specific conceptual framework. The main findings of the study contribute to the development of a rigorous bottom‐up framework comprising four components of protocol‐based care decision‐making. The framework has the potential to improve care quality, reduce variability, enhance patient safety, and increase healthcare efficiency by guiding nurses' decision‐making in various healthcare settings. No Patient or Public Contribution Patient or public contribution was not applicable since the study focused on nurses' decision making.

Grafting onto pepper rootstock NIBER® is an effective strategy to mitigate water stress effects on the grafted variety. In this work, we comparatively explored the metabolomic responses to water stress in the pepper variety “Maestral F1” (V) grafted onto NIBER® (V/N) and self-grafted (V/V) by untargeted metabolomics on leaves and roots. Leaf water status was also evaluated by relative water content (RWC) and gas exchange measurements. Under water stress, the V/N water use efficiency (WUE) and leaf RWC were higher than V/V, in agreement with major stomata closure and water retention in leaves. V/N showed a tolerance response, which was manifested in the untargeted metabolomic analysis. NIBER® modulated the grafted variety response to water stress as reflected in the differential metabolomic profiles in leaves and roots. The V/N-enriched metabolic pathways showed that the NIBER® response to water stress involved cutin and suberin biosynthesis, which act as protection layers, and jasmonic acid (JA) and jasmonates biosynthesis to favor signaling pathways. NIBER® did not induce flavonols and chlorophyll b synthesis, but likely promoted anthocyanins biosynthesis and maintained an undisturbed chlorophyll a:chlorophyll b ratio. Moreover, NIBER® increased vitamin B6, anthocyanins and stearic acid concentration in the variety leaves, whereas siroheme content rose in roots to improve nitrogen assimilation. Further studies are required to understand the contribution of secondary metabolites, such as phenylpropanoids, glycoalkaloids, and nitrogen-containing secondary metabolites, to NIBER® water stress tolerance.

IntroductionOlive oil is a widely recognized and appreciated food commodity, its quality and health benefits can be compromised when the oil goes through oxidative processes that may occur during production and storage. This study aimed to investigate the effects of the olive genotype on polar phenolic content after seven months of storage.MethodsOil produced from eight different olive cultivars (Leccino, Leccio del Corno, Moraiolo, Frantoio, Bianchera, Pendolino, Maurino, and Caninese) grown in southern Tuscany, Italy, were subjected to chemical analysis such as free fatty acids, peroxide value, K232 and K268, phenolics and UPLC-DAD at the beginning of the trial (Control) and seven months later (Stored).Results and ConclusionsFree fatty acids, peroxide values, K232 and K268, significantly increased, suggesting heightened hydrolysis and oxidation after storage. A cultivar effect was observed, with Leccino, Moraiolo, and Pendolino showing less susceptibility to oxidation (low differences between Control and Stored). In contrast, others (Bianchera and Caninese) are more affected (higher differences between Control and Stored). Phenolics analysis supports this observation, revealing that samples with higher resistance to oxidation exhibit elevated levels of hydroxytyrosol, tyrosol, vanillic acid, caffeic acid, p-coumaric acid, and ferulic acid. Principal Component Analysis highlights that Bianchera and Caninese cultivars correlate with rutin, tyrosol, and pinoresinol. As this research delves into the intricate relationship between genotype diversity, phenolic composition, and oxidative stability, a nuanced understanding emerges, shedding light on how different cultivars may present varying compositions and concentrations of phenols, ultimately influencing the oil’s resistance to the oxidation that occurred during storage.

Fibrosis is a common pathological process that can affect virtually all the organs, but there are hardly any effective therapeutic options. This has led to an intense search for antifibrotic therapies over the last decades, with a great number of clinical assays currently underway. We have systematically reviewed all current and recently finished clinical trials involved in the development of new antifibrotic drugs, and the preclinical studies analyzing the relevance of each of these pharmacological strategies in fibrotic processes affecting tissues beyond those being clinically studied. We analyze and discuss this information with the aim of determining the most promising options and the feasibility of extending their therapeutic value as antifibrotic agents to other fibrotic conditions.