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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.)

In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used. There are few data on the medium and long-term health outcomes when removing all animal foods from the child's diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies. In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B 12 supplements at all ages, as well as other nutrients (iodine, iron, vitaminD 3 , poly-unsaturated fatty acid n-3), when required. A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet., (Copyright © 2019 Asociación Española de Pediatría. Publicado por 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.)

Background: The prevalence of disability shows a high geographical variability and the identification of factors that could explain these variations can be useful to the heath and social welfare planning. Here the analysis of disability variations among autonomous regions in Spain is made taking into account individual and geographical setting factors together., Methods: Data come from the Spanish Disability, Impairment and Health Status survey of 1999 and from Inebase both of the National Institute for Statistics. The prevalence of disability crude and adjusted by age was calculated for each autonomous region. Individual factors related to disability are identified by means of a logistic regression. The analysis accounting for both, individual and geographical setting factors was performed by means of a logistic regression of two levels., Results: Disability prevalence showed a maximum difference of 5.75 points among regions. In a logistic regression the region of residence was statistically significant (OR: 3.35 in the highest rated region related to the lowest) beside several individual factors: age (OR 40-64= 1.78 OR 65-79= 1.87 and OR >79= 3.34), sex (OR women= 0.66), working status (OR unemployment=2.25 OR housewife/student=1.39 y OR other=2.03), health status (OR regular= 1.69 OR bad/very bad= 2.05) and chronic diseases (OR 1-3=1.56 OR 4-6=1.82 OR > 6=2.59). Individual factors accounted for a very few variance at the two levels regression model (s=0.261) and none of the regional variables improved the model., Conclusions: Individual factors do not explain enough the observed disability variations among the regions and none factor related to the geographical setting has been identified as statistically significant.