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Chronic pancreatitis is a chronic fibroinflammatory disease of the pancreas with prevalence around 50 cases per 100,000 inhabitants. It appears to originate from diverse and yet mixed etiological factors. It shows highly variable presenting features, complication types and disease progression rates. Treatment options are as wide as the multiple personalized scenarios the disease might exhibit at a given time point. Some medical societies have developed guidelines for diagnosis and treatment based on scientific evidence. Although these efforts are to be acknowledged, the gathered level of evidence for any topic is usually low and, therefore, recommendations tend to be vague or weak. In the present series of position papers on chronic pancreatitis from the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees we aimed at providing defined position statements for the clinician based on updated review of published literature and on interdisciplinary expert agreement. The final goal is to propose the use of common terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 51 sections related to chronic pancreatitis were reviewed by 21 specialists from 6 different fields to generate 88 statements altogether. Statements were designed to harmonize concepts or delineate recommendations. Part 1 of this paper series discusses topics on aetiology and diagnosis of chronic pancreatitis. Main clinical features are abdominal pain, exocrine and endocrine insufficiency and symptoms derived from complications. Some patients remain symptom-free. Diagnosis (definitive, probable or uncertain) should be based on objective data obtained from imaging, histology, or functional tests., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Over the last few years, the Acta Otorrinolaringológica Española (Acta ORL) has been working to improve its impact factor. A high citation rate in the Journals indexed at the Institute for Scientific Information (ISI) is needed to achieve this, particularly in the ones with a high impact factor. The objective of this study was to analyse the index of citation by other national research groups of the articles by Spanish otorhinolaryngologists published in the Acta ORL Esp., Material and Methods: Retrospective descriptive-bibliometric study to analyse the publications and citations of original articles published in the Acta ORL between January 2004 and December 2008., Results: We observed that Spanish otolaryngologists had a low publication index in the Acta ORL, where only 39.1% of the Spanish biomedical production was published. Moreover, the original articles published in the Acta ORL had a low index (32%) of citation by other national authors or groups, displaying a strong self-citation tendency (18.9%)., Conclusion: National otorhinolaryngologists or ORL research groups had a low tendency to cite other national (ORL) authors in their publications. In addition, national authors had low biomedical production compared with their European peers. The biomedical production and the articles published in the Acta ORL had a low citation index by ISI indexed journals., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

The use of the students' first language (L1) in the foreign language class (FL) is a common but controversial issue that has received little attention. This might be more relevant in the case of Content and Language Integrated Learning (CLIL), since, under CLIL approaches, students need to acquire content through an FL that they have not mastered yet. The current paper aims at analysing teachers' uses and perceptions of translanguaging in CLIL classrooms in a primary education context following a case study. Five CLIL primary education teachers from Catalonia participated in the study. They were voice-recorded for several sessions teaching a subject in CLIL with the same class and they also completed a questionnaire. The analysis showed that all the participants used their L1 for a number of purposes. Even though individual perceptions differed, in general, teachers were positive about using translanguaging. CLIL teachers would benefit both from reflecting on their own practices in terms of translanguaging uses and from formal instruction in the matter. [Translation from English by Mercè Rius.]

The teaching of STEAM has been gaining ground in the world of education for some years now. This article presents two fundamental contributions to STEAM literature. The first contribution is the detailed description of a STEAM work experience with secondary school students using Project Based Learning, in which the disciplines of science and art are connected and integrated. To achieve this, connections established among the disciplines corresponding to S, T, E, A and M are analysed. The second contribution presented in this paper is the study of the relationships established between the members of the educational community and the external educational agents (artists, researchers and research centres) involved in the project. These relationships among all the educational agents give rise to important connections relevant to STEAM education. Additionally, an increase in performance and interest in science and technology manifested by the students is analysed in a quantitative way. The students perceive an improvement in certain skills, such as teamwork, creativity, communication and self-evaluation. [Translation from Spanish by Jennifer Martin.]

Previous research indicates that developmental contexts influence language development. These developmental contexts include bilingualism, which is the focus of the current paper. This study analyses the influence that the acquisition of a language, Catalan, has when the simultaneous acquisition of another similar language, Spanish, occurs. This influence is examined according to degree of exposure to the languages. The parents of 801 children completed the Catalan version of the MacArthur-Bates CDI-II questionnaire, which assesses the acquisition of vocabulary, morphology and grammatical complexity. Subjects were divided into three groups according to age and linguistic context (Catalan monolingual, medium bilingual and familiar bilingual). The results do not reveal substantial differences according to linguistic context. However, children aged 26--30 months with a medium bilingual profile show a higher level of vocabulary as compared to the other groups. The results are discussed in relation to the sociolinguistic context, caregiver diversity, typological distance between the languages and developmental stages of language acquisition. [Translation from Spanish by Jennifer Martin.]

Background and Objective: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency., Materials and Method: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus., Results: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus., Conclusions: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units., (Copyright © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Small cell lung cancer (SCLC) comprises 10-15% of all lung cancer cases and is the most aggressive histological type. Survival is poor and the molecular landscape of this disease is extraordinarily complex. The objective of this paper was to perform a Genome-Wide Association Study (GWAS) of this disease using a case-control study specifically designed for small cell lung cancer (SCLC)., Methods: Incident cases were consecutively recruited from 8 hospitals from different regions of Spain. Controls were recruited from the same hospitals using a frequency sampling based on age and sex distribution of cases. Biological samples were obtained along with detailed information on cases and controls lifestyle, including tobacco and radon exposure., Results: We included 271 SCLC cases and 557 controls. We found evidence (p-values<10 -5 ) of an association in the complete dataset for several loci, while MAP4 showed a significant association in the gene-based analysis. Pathway analysis suggested that ATR, ATRIP, MCM4, MCM5, ORC4, RPA3 and CDC25A genes have a role on the onset of SCLC., Conclusion: This study provides biological evidence for pathways related to SCLC, offering novel loci for further research., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

The respiratory syncytial virus (RSV) causes a substantial burden worldwide. After over six decades of research, there is finally a licensed immunization option that can protect the broad infant population, and other will follow soon. RSV immunization should be in place from season 2023/2024 onwards. Doing so requires thoughtful but swift steps. This paper reflects the view of four immunization experts on the efforts being made across the globe to accommodate the new immunization options and provides recommendations organized around five priorities: (I) documenting the burden of RSV in specific populations; (II) expanding RSV diagnostic capacity in clinical practice; (III) strengthening RSV surveillance; (IV) planning for the new preventive options; (V) achieving immunization targets. Overall, Spain has been a notable example of converting RSV prevention into a national desideratum and has pioneered the inclusion of RSV in some of the regional immunization calendars for infants facing their first RSV season., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Lifetime prevalence of cannabis use is estimated 192 million adults worldwide (2017) and has increased by 16% in the last decade. However, data on quantity and frequency of use that can lead to harm is lacking. We have developed a survey to assess patterns of cannabis use and related harms in a sample of cannabis users. This paper focuses on evaluating the feasibility of the survey and the users' satisfaction in a pilot sample. Forty cannabis users were recruited (>18 years old, living in Spain, cannabis use at least once during the last 12 months) between December 2018 and January 2019. Participants answered an online survey (mental health, organic harm and injury) and an ad hoc questionnaire to assess accessibility, feasibility, satisfaction, design and content appropriateness. Of the participants, 93.23% (n = 37.3) were satisfied with the design, 94.92% (n = 38.2) were satisfied with the content, and 94.73% (n = 37.0) were satisfied with the accessibility of the survey; only minor changes were required to improve feasibility and accessibility. Participants used a median of 1.0 Standard Joint Unit per day (Interquartile Range [IQR] 1.0-2.0). Of the sample, 92.5% reported at least one related harm and suffers a median of 4.0 disorders (IQR, 1.25-5.0). The present study allows for designing a feasible online survey to conduct a cross-sectional study with a larger sample.

Chronic obstructive pulmonary disease (COPD) is a public health problem due to its high prevalence (11% in the adult population in Spain), increasing incidence, and great social and economic impact. Despite this, it is underdiagnosed (and, therefore, undertreated) at a rate of around 80%. In this paper, a group of respiratory physicians specializing in COPD discuss 7 fundamental problems ("cardinal sins") that contribute to this situation, with the explicit aim of proposing specific solutions that may help to improve this unfavorable state of affairs., (Copyright © 2022 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Over the last two decades there has been an increase in outbreaks of arboviral diseases, being Spain at high risk for disease emergence. This paper reviews the current evidence regarding the transmissibility, disease epidemiology, control strategies and mosquito-borne disease drivers and maintaining factors in Spain. There is risk of autochthonous cases and outbreaks in Spain due to recent transmission occurrence. Recently, there has been an expansion of Aedes Albopticus, a vector for Dengue, Zika and Chikungunya; and Cullex spp., vector for West Nile Virus, already endemic in Spain. Their establishment has been facilitated by climate and environmental drivers. If climate change projections are to be met, an increase in disease transmission is to be expected, as well as the re-establishment of other vectors such as Aedes Aegypti. Our review supports the need to understand the threat of these emerging diseases and implement preventive strategies in order to minimise their impact., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Spain is one of the countries of the European Union in which alcohol consumption has decreased in the past decades. The aim of this paper is to distinguish different phases of the level of alcohol consumption in Spain since 1990. Adult alcohol consumption per capita data between 1990 and 2019 were analysed for temporal trends using the Joinpoint regression model. An additional analysis using interrupted time-series between 1962 and 2016 was performed using data from Global Information System on Alcohol and Health. Data from the survey on alcohol and other drugs in Spain were collected and a narrative review was conducted to identify possible reasons for the trends found. Five point changes were identified on the timeline between 1990 and 2019, including: a decrease of 3.2% per year from 1990 to 1995, an increase of 1.1% per year from 1995 to 2000, a period of stability from 2000 to 2006, a decrease of 4.5% per year from 2006 to 2011, and a period of stability from 2011 onwards. These changes can largely be explained by the different public health measures carried out by the Spanish government, as well as the change in the pattern of consumption in society, which shifted its alcoholic beverage preference from wine to beer, and increased its binge-drinking behaviour. Further studies such as interrupted time-series analyses should test if indeed the hypothesized measures on public health have been effective; this could inform future policies in Spain and in other countries.

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non-healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.

Colonic inflammatory bowel diseases have a higher risk of developing colorectal cancer compared to the general population, which is why they require endoscopic screening techniques with specific follow-up intervals based on the different risk factors described on the literature. This position paper analyzes the current scientific evidence for the different endoscopic techniques available today, how their implementation should be carried out in endoscopic units and describes in detail how their implementation should be carried out, in which patients and with what interval, and finally, what should be the response to finding dysplasia, proposing a specific follow-up algorithm., (Copyright © 2021 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

This paper aims to describe our experience in an interventional radiology unit in a hospital in Spain that was severely affected by the COVID-19 pandemic. To this end, we did a prospective observational study of 20 consecutive patients with COVID-19 who underwent 21 interventional radiology procedures between March 13, 2020 and May 11, 2020. We describe the measures taken to reorganize the work and protective measures, as well as the repercussions of the situation on our unit's overall activity and activity in different phases. The COVID-19 pandemic has represented a challenge in our daily work, but learning from our own experience and the recommendations of the Spanish radiological societies (SERVEI and SERAM) has enabled us to adapt successfully. Our activity dropped only 22% compared to the same period in 2019., (Copyright © 2020 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

There is evidence that following the recommendations on screening and treatment of tuberculosis infection does not completely prevent the onset of tuberculosis in patients with inflammatory bowel disease. This fact, and the increasing use of new biologics and immunomodulators, has led the Spanish Group Working on Crohn's Disease and Ulcerative Colitis to update their recommendations for the prevention of tuberculosis in patients with inflammatory bowel disease. Diagnostic methods for latent tuberculosis infection, different scenarios in which screening is to be performed, strategies to reduce the risk of tuberculosis once biological treatment is initiated and chemoprophylaxis guidelines for latent tuberculosis infection are reviewed, as well as the management of active tuberculosis during biological treatment. Finally, there is a summary of the current recommendations within the paper and in an algorithm., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Patients with thalassaemia major (TM) and sickle cell disease (SCD) in Spain have been counted since the creation of the Spanish registry of haemoglobinopathies (REHem). The objective of this paper is to update the published data after the increase in cases due to the inclusion of adults and introduction of new-born screening in almost the whole country., Material and Methods: An observational, descriptive, multicentre and ambispective study that included patients with haemoglobinopathies registered in the REHem, started in January 2014 and followed up annually. The data presented correspond until December 31, 2017., Results: Nine hundred and fifty-nine patients were collected. There were 75 cases of thalassaemia (62 TM), 826 of ECF and 58 of other types of haemoglobinopathies. The main diagnostic reason in the TM cohort was anaemia symptoms (70.6%), with a mean age at diagnosis of .7 years; in the SCD cohort it was neonatal screening (33.1%), with a mean age at diagnosis of 2.7 years; 26 patients with TM (41.9%) and 30 with SCD (3.6%) underwent a transplant. There were 2 deaths (3.2%) with TM and 19 (2.3%) with SCD. Overall survival was 96.7% in the TM and 97.5% in the SCD cases at 15 years., Conclusions: Since the previous publication and after the diffusion of new-born screening, the most frequent diagnostic method, to the majority of autonomous regions, and the inclusion of adult patients to the registry, the REHem has increased by more than 240 cases, reaching a total of 959 records., (Copyright © 2019. Published by Elsevier España, S.L.U.)

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic., (Copyright © 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O 2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19., (Copyright © 2020 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Aim: The vascular anatomy of the hand has already been widely described macroscopically. However, there are very few papers that study the pattern of normality of in vivo vascularisation that describe and analyse the main arteries of the hand. The aim of this paper was to carry out a study to serve as a reference for the normal values of size and flow of the radial and ulnar artery at the level of the wrist, and the digital radial and ulnar arteries at the level of the fingers., Material and Method: A descriptive observational cross-sectional study on 200 hands in 100 healthy volunteers aged between 20-30years. Doppler-colour ultrasound was performed on the ulnar and radial arteries in the wrist, as well as on the radial and ulnar digital arteries in each finger. Once the measurements had been taken, a general comparative analysis was performed also taking laterality, dominance and gender into account., Results: It was observed that the radial artery is larger in size than the ulnar at wrist level, however, it was the ulnar artery that showed flow dominance at this level. At finger level, the arteries are greater in size and flow in the areas of the fingers more protected from injury (digital ulnar artery in the first three and radial artery in the fourth and fifth digits)., (Copyright © 2020 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Presbycusis or age-related hearing loss is a bilaterally symmetric sensorineural hearing loss associated exclusively with age, excluding any other causes of hearing loss. Presbycusis is very relevant because of its high prevalence, and its consequences (e.g., alterations in communication, social isolation, depression, dementia), and the economic impact. This paper reports the first attempt to estimate the prevalence of presbycusis in an otologically normal population, i.e., without previous ear disease, exposure to noise, or potentially ototoxic substances, or familial hearing loss., Methods: A total of 4290 subjects from 5 to 90 years old were included in the study., Results: No statistically significant differences were found between right and left ear, nor between males and females, in any of the age groups. Presbycusis was detected over 60 years following the WHO classification; although the results vary depending on the classification used. Moderate hearing loss (≥ 41dB) was detected in the population over 72 years. None of the subjects had severe or profound hearing impairment. The prevalence of presbycusis increased with age, being 100% in individuals aged 80 years and older. The prevalence of presbycusis is highly variable depending on the pure-tone averaged frequencies and the classification system used; therefore, a common classification system should be used., Conclusions: An otologically normal population is needed to establish the prevalence of presbycusis as in non-screened populations it is the hearing level including all types of hearing loss that is measured, but not presbycusis itself., (Copyright © 2019 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic., Materials and Methods: We report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine., Results: In that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission., Conclusions: We may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients., (Copyright © 2020 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.)

Adolescence is a critical period in the development of addictive behaviors. In particular, the age at which adolescents start drinking is not a trivial matter, given the important consequences that it has. However, relatively little is known about what it is that causes them to start drinking at an ever earlier age. The aim of this paper is to collect new empirical data about the implications of an early age of onset and, at the same time, to identify possible associated variables. Furthermore, the mean age of onset of the different substances is updated by expanding the sample frame of the ESTUDES (14-18 years) to incorporate adolescents aged 12 and 13. The results obtained with a sample of 3,419 adolescents from the Autonomous Community of Galicia (M = 14.57 and SD = 1.76) reveal that at 13.4 years of age, the age at which adolescents tend to start drinking is lower than suggested by ESTUDES 2016-2017. In addition, those who start drinking earlier are more likely to use other substances, their rates of high-risk consumption are 3 times higher and they are more involved in potentially dangerous practices. Finally, variables such as risk perception and expectations of use yield very limited explanatory capacity, especially if they are compared with those related to drinking within the family or peer group. The results reinforce the need to delay the age of alcohol onset as one of the strategic objectives of prevention policies.

Background and Objective: Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided., Material and Methods: We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV)., Results: We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%)., Conclusions: Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management., (Copyright © 2019 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Psychometrics is a simple, intuitive approach used in educational research and in multiple-choice questionnaires. Since 2009, the competitive examination through which access to residency programs in Spain is determined (MIR) has included questions related to radiological images. The objective of this paper is to show the results of the psychometric analysis of these questions with the aim of comparing their degree of difficulty, discriminative capacity, and internal structure with respect to those of the other questions on the examination., Material and Methods: We analyzed all questions on the examination since 2009, classifying them as clinical cases with and without radiological images, clinical cases with and without non-radiological images, multiple choice questions, and negative questions. We used classical test theory and item response theory to assess the difficulty and degree of discrimination of the questions., Results: Of 225 questions, between 11% and 15% of the questions included in the examinations were associated with images. The questions associated with radiological images were more difficult (corrected difficulty index, 0.51) and had worse discriminative capacity. The increased difficulty of radiological questions was associated with worse discriminative capacity, especially if the clinical information provided was inadequate or if the clinical information was contrary to the radiological concept or if there had never been any questions about the concept in previoous MIR examinations., Conclusions: To equalize the standards of the MIR examination, it is necessary to maintain an appropriate structure in devising radiology questions, with terms from the clinical context, appropriate use of distracters, and a lower level of difficulty, which could be achieved by using radiological images with typical radiological findings., (Copyright © 2019 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: One of the main sources of energy in Spain is still coal combustion. It releases multiple pollutants into the atmosphere, such as PM 2.5 , that has been linked to an increase in cardiovascular morbidity and mortality. The objectives of this paper are: 1) to determine the national distribution of these particles and their proximity to coal plants, 2) to estimate the cardiovascular impact of PM 2.5 particles in Spain in 2014., Methods: In order to complete the national pollutant dispersion study, we used the CALPUFF model. The epidemiologic and demographic data were obtained from the National Statistics Institute. The associations «pollutant-effect» were obtained by internationally validated methodologies., Results: The total number of deaths due to coal pollutants were 709, from which 586 (82.6%) were related to PM 2.5 particles. Most of them were due to myocardial infarctions, fatal strokes and heart failure, adding up to 170 cases of mortality related to PM 2.5 (29%). The greatest densities were found in the regions of Asturias and Castilla y León., Conclusions: This study describes an increase in cardiovascular mortality and morbidity in Spain, due to coal combustion pollutants. It finds a greater impact in the provinces of Asturias and Castilla León, where a higher presence of coal power plants can be found. This reflects that the people that live in those areas have a greater risk of cardiovascular death due to PM 2.5 pollutant exposure from coal., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

En: International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers.

Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation. This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons. We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events. The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery., (Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

The CRAFFT Substance Abuse Screening Instrument, developed by the Center for Adolescents Substance Abuse Research (CeASAR) (Knight et al., 1999), is a screening tool for high-risk alcohol and drug risk consumption designed for use with adolescents. Since its publication it has been the subject of translations and validations in different countries, populations and contexts that have demonstrated its enormous potential. However, there is still no empirical validation study that would ensure its good psychometric performance in Spain. The aim of this paper is to develop an adapted version of the CRAFFT in Spanish and to analyze its psychometric properties in a sample of Spanish adolescents. For this purpose an individual interview was conducted on 312 adolescents aged between 12 and 18 years of age (M = 15.01; SD = 1.83) from the Galician community. The interview included a part of the Adolescent Diagnostic Interview (ADI) and the Problem Oriented Screening Instrument for Teenagers (POSIT). The results obtained, similar to those found in other countries, allow us to report that the Spanish version of the CRAFFT has a good psychometric behaviorproperties. It was found to have a satisfactory internal consistency with a Cronbach&rsquo;s alpha value of .74. In terms of sensitivity and specificity, values of 74.4% and 96.4% respectively, were obtained and the area under the ROC curve was .946. The Spanish version of the CRAFFT is made available to researchers and professionals in the field of addictive behaviors, so that it can be used with the necessary psychometric guarantees.

Urgent readmissions have a major impact on outcomes in patient health and healthcare costs. The associated risk factors have generally been infrequently studied. The main objective of the present work is to identify pre- and perioperative determinants of readmission; the secondary aim was to determine readmission rate, identification of readmission diagnoses, and impact of readmissions on survival rates in related analytical studies. The review was performed through a systematic search in the main bibliographic databases. In the end, 19 papers met the selection criteria. The main risk factors were: sociodemographic patient variables; comorbidities; type of resection; postoperative complications; long stay. Despite the great variability in the published studies, all highlight the importance of reducing readmission rates because of the significant impact on patients and the healthcare system., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: We performed a study of the top 100 most cited articles in the five general surgery journals with the highest impact according to Journal Citation Report., Methods: We selected the five journals with the highest impact in 2015: Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons. In January 2017, using the Web of Science application, we performed a search of all articles published by these journals and identified the 100 most cited articles (top 100). We evaluated the number of citations, year of publication, type of article, country and hospital of the article, area of interest and number of authors., Results: The median number of citations per top 100 paper was 490. Twenty percent of the top 100 papers have been published since 2000. Overall, 70% are original papers, 8% randomized control trials, 11% reviews, 1% meta-analyses and 11% other subtypes. There are 13% proceedings papers. Sixty-one percent are from the US. The most frequently discussed topic is hepato-pancreato-biliary surgery (33%)., Conclusions: The top 100 most cited articles tend to be original articles describing studies carried out in the US, reporting significant surgical breakthroughs. Hepato-pancreato-biliary surgery is the most common subject area. Annals of Surgery had twice as many citations as the other journals studied. The archetypal article of the Top15 most cited is an original paper published in the twentieth century, with an average of 2000 citations., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Care of chronicity is a pressing issue for health systems because of its high prevalence and the organisational challenges that it generates. Different countries solve the complexity of the care of chronicity through case management by the nursing profession, obtaining good results. This paper analyses the status of institutionalisation of the case management nurse in Spain through the design of a reference standard to compare between the autonomous communities in their approach to chronicity. Thus, we sought to monitor the degree of progress of the institutional structure of the policies for the care of chronicity in our country through this healthcare professional. Our results showed that no autonomous community has reached the maximum standard of implementation and that the situation is very heterogeneous, confirming a weak and erratic degree of institutionalisation of the case management nurse in Spain despite the formal recognition of their role in patient care., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Stroke is a cerebrovascular disease caused by a decrease or abrupt obstruction of blood flow to the brain. Nerve cells do not receive oxygen and there is a transient or permanent alteration of the function of a certain region of the brain. It causes high morbidity and mortality resulting in disabilities with a large economic cost to society. The Stroke Code was established at the Mollet Hospital in 2015. A protocol, action guideline and registry were created. The Mollet Hospital does not have a specialist unit so people who suffer thrombolysis and / or who require specific care are transferred to the referral centre. This registry is organized in several parts: demographic and clinical data, A-B-C-D assessment, procedures, National Institute of Health Stroke Scale (NIHSS) and Rankin scale, and nursing diagnoses: Impaired verbal communication, Impaired physical mobility, Acute pain, Anxiety and Risk for aspiration. This paper aims to describe the implementation of the Stroke Code registry and the level of completion in the emergency department of the Mollet hospital, revealing care times and transfers to other centres; NIHSS and Ranking scales completion and the activation of nursing diagnoses. An analysis of the Stroke Code registry provides data about healthcare services and detects weak points to improve to establish new action plans, standardise and promote continuity of care and avoid possible errors., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Introduction: This paper describes the presence of alcohol in the public space, assessing establishments that offer it, its advertising, and signs of consumption, as factors that may influence its consumption., Method: Descriptive observational study based on cluster sampling with two-step selection. Results are described, and the spatial association between variables is assessed., Results: In the 20 census tracts studied, 306 premises were identified that offered alcoholic beverages: 204 were on-premises and 102 were off-premises, mainly supermarkets and food retail stores. Their spatial distribution was uneven, concentrated in two central districts. We identified 72 publicity items, mostly sponsorship of musical events. There were many promotional items linked to on- premises, especially in their terraces. Five people were detected promoting consumption or selling alcohol in the Old Town. In each time slot, between 39 and 51 signs of consumption on the public space were observed (mostly abandoned beer cans), more frequent at night and in the Old Town. There is an association between the presence of establishments that offer alcohol and advertising. There is no relationship between these variables and signs of consumption in the public space; these are concentrated in the Old Town, which has greater presence of tourism., Conclusions: The urban environment is characterized by elements that stimulate alcohol use and its distribution is uneven, with a strong influence of tourism-related activities. Further regulation of alcohol promotion, availability and consumption in the public space may change its social image and decrease its use.

Introduction: Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality., Material and Methods: A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality., Results: Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women., Conclusions: Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries., (Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Publishing in scientific journals is an indicator of hospital quality and has become a standard of excellence for medical doctors and institutions. The aim of the study is to identify the scientific publications performed by Otolaryngology Departments in Spain within the period 2011-2015 and to compare them to a previous period between 1998-2002., Material and Methods: Original papers published by Otolaryngology Departments in Spain in PubMed within 2011-2015 were retrieved. They were classified according to the type of journal published (international or Acta ORL Española) and the following subspecialty areas: Otology, Audiology and Neuro-Otology, Head and Neck Surgery (including Oncology), Rhinology and Paediatric ENT. Hospitals were ranked according to: number of original papers, accumulated impact factor and total number of publications., Results: Between 2011 and 2015, 49342 publications were included in PubMed, 1.44% from Otolaryngology Departments in Spain. Between 1998 and 2002, 3.80% publications were from Spanish ENT departments. Of the 712 papers published within the period 2011-2015, 389 were published in Acta ORL Española and 323 in international journals. From the latter, 20.7% belong to the Otology area, 19.2% to Audiology-Neuro-otology, 30.6% to Head and Neck Surgery, 15.2% to Rhinology and 3.4% to Paediatric ENT. Five tertiary centres published at least 10 original papers in the same period., Conclusions: Spanish otolaryngology's contribution to international journals has decreased in the last 12 years. A few institutions are responsible for the majority of publications and they have notably increased the cumulative impact factor., (Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Tuberculosis continues to be a major public health problem in Spain. The incidence of tuberculosis in the native population has declined steadily in recent years. Migration flows have changed drastically since the beginning of the 21st century, with Spain becoming a recipient country for immigrants. Because most of the immigrants comes from countries with high incidence of tuberculosis, the contribution of the migrant population to new cases of tuberculosis is higher in relative terms than its weight in the total population. Tuberculosis programs must address the cultural, economic and medical aspects of the disease, and particularly target groups at risk, including the migrant population. In this paper, we will review the epidemiology and dynamics of tuberculosis in the migrant population, their differentiating clinical characteristics and the programmatic actions to address the problem., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Background: and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents., Methods: A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website., Results: A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format., Conclusions: The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Introduction and Objectives: In recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia., Method: Forty subjects participated in this study 40, 20 controls and 20 with dysphonia. Two voice samples were recorded for each subject (one sustained vowel/a/and four phonetically balanced sentences) and the CPPs was calculated using the Praat programme. Three raters perceptually evaluated the voice sample with the Grade parameter of GRABS scale., Results: Significantly lower values were found in the dysphonic voices, both for/a/(t [38] = 4.85, P<.000) and for phrases (t [38] = 5,75, P<.000). In relation to the type of voice sample most suitable for evaluating the severity of voice alterations, a strong correlation was found with the acoustic-perceptual scale of CPPs calculated from connected speech (r s = -0.73) and moderate correlation with that calculated from the sustained vowel (r s = -0,56)., Conclusion: The results of this preliminary study suggest that CPPs is a good measure to detect dysphonia and to objectively assess the severity of alterations in the voice., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Violence against health workers is a highly prevalent phenomenon with serious psychological and labour consequences among professionals. This paper aims, first, to find out the main studies undertaken to date to describe and analyse the phenomenon, as well as to present different initiatives and protocols of action carried out. The second objective is to offer a procedure of action both to prevent aggression and to intervene in the event of receiving an aggression at work. After a bibliographic search in PubMed, Scopus and SciELO databases, the impact of the aggressions suffered by health professionals, the contexts in which aggressions are more frequent, their main consequences and different strategies and protocols conducted in Spain are reviewed. Given that rigorous reviews supporting such procedures are lacking in scientific journals, different action guidelines for professionals to prevent and to deal with hostile behaviour based on available evidence are developed and proposed. Finally, an easily consultable and applicable action procedure for health workers attacked in the workplace is presented., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

En: Stroke is the main cause of morbidity and mortality in Spain and in Galicia in particular. Tissue viability after stroke depends on the time taken to restore circulation. The widely dispersed and aging population of this region challenges efforts to provide equal care for patients with time-sensitive emergencies such as stroke. Two regional hospitals (Hospital do Salnés and Hospital do Barbanza) and the reference Hospital Clínico de Santiago launched a telestroke pilot program in 2011 in which patients whose treatment was guided at a distance were discharged with lower levels of stroke severity and mortality. That outcome was probably attributable to more rapid diagnosis. Given those preliminary results and the characteristics of the population, the centrally coordinated Galician Stroke Care Plan was launched in 2016 to provide a telemedicine service that connects all hospitals in the health system of Galicia. This paper summarizes the experience of developing and implementing the program.

Introduction: Cannabis is the illicit drug mostly widely consumed by adolescents in Spain. The understanding of consumption motives is an important factor for intervention. In Spain, there are no available instruments for their evaluation, hence, the goal of this paper is to study the psychometric properties of the Marihuana Motives Measure (MMM) in a sample of adolescent consumers., Material and Method: Firstly, translation and back-translation was performed. A total of 228 adolescent consumers of cannabis were evaluated. Factorial analysis was conducted, and the reliability of the total scores and of each scale of the questionnaire was studied through Cronbach's alpha. Test-retest reliability was analyzed through interclass correlations. Validity evidence of the MMM was examined through correlations between current cannabis use, subjective consumption effects measured with the Addiction Research Center Inventory (ARCI), and personality measured with the Millon Adolescent Clinical Inventory (MACI)., Results: High reliability was observed in total score of the MMM (Cronbach α = .86), and high and moderate reliability for each of the five factors obtained in the factorial analysis of the MMM, Social = .82, Enhancement = .72, Coping = .83, Expansion = .74, and Conformity = .64. Significant correlations were also observed between cannabis consumption motives and subjective effects, and between consumption motives and personality., Conclusion: The Spanish version of the MMM shows a similar factorial structure as the one obtained by the original author, and its measures are reliable and valid for the study of cannabis consumption motives in adolescent consumer population.

The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travellers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicentre prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travellers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

First, this paper estimates the dimensions of the market for cannabis in Spain using data on the extent of consumption and the main patterns of use of consumers. Then the paper reviews the hypothetical production and distribution costs of these drugs in different production regimes under different legal conditions. The review shows that current prices of cannabis in the illegal market could be notably reduced if production and distribution of cannabis were decriminalized and even more if they were performed by legal enterprises. Thirdly, we examine the relationship between prices and consumption levels by analysing the price elasticity of demand. A fall in the prices of cannabis products will likely result in an increase in the number of users and in the total amount consumed. Lastly we consider several alternatives for the taxation of cannabis derivatives to counteract the likely fall in prices, and their pros and cons.

Background: Biobank certification ISO 9001:2008 aims to improve the management of processes performed. This has two objectives: customer satisfaction and continuous improvement. This paper presents the impact of certification ISO 9001:2008 on the sample transfer process in a Spanish biobank specialising in kidney patient samples. The biobank experienced a large increase in the number of samples between 2009 (12,582 vials) and 2010 (37,042 vials)., Methods: The biobank of the Spanish Renal Research Network (REDinREN), located at the University of Alcal&aacute;, has implemented ISO standard 9001:2008 for the effective management of human material given to research centres. Using surveys, we analysed two periods in the &ldquo;sample transfer&rdquo; process. During the first period between 1-10-12 and 26-11-12 (8 weeks), minimal changes were made to correct isolated errors. In the second period, between 7-01-13 and 18-02-13 (6 weeks), we carried out general corrective actions., Results: The identification of problems and implementation of corrective actions for certification allowed: a 70% reduction in the process execution time, a significant increase (200%) in the number of samples processed and a 25% improvement in the process. The increase in the number of samples processed was directly related to process improvement., Conclusion: The certification of ISO standard 9001:2008, obtained in July 2013, allowed an improvement of the REDinREN biobank processes to be achieved, which increased quality and customer satisfaction.