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Breast density is a strong risk factor for breast cancer. In this paper, we present an automated approach for breast density segmentation in mammographic images based on a supervised pixel-based classification and using textural and morphological features. The objective of the paper is not only to show the feasibility of an automatic algorithm for breast density segmentation but also to prove its potential application to the study of breast density evolution in longitudinal studies. The database used here contains three complete screening examinations, acquired 2 years apart, of 130 different patients. The approach was validated by comparing manual expert annotations with automatically obtained estimations. Transversal analysis of the breast density analysis of craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts acquired in the same study showed a correlation coefficient of ρ = 0.96 between the mammographic density percentage for left and right breasts, whereas a comparison of both mammographic views showed a correlation of ρ = 0.95. A longitudinal study of breast density confirmed the trend that dense tissue percentage decreases over time, although we noticed that the decrease in the ratio depends on the initial amount of breast density. [ABSTRACT FROM AUTHOR]

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

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

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

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

Objectives: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses.Methods: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values.Results: The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4.Conclusions: The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology.Key Points: • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Social and economic inequalities in condom use by adolescents have been reported previously. Also, condom use has declined during the last decade. The aim of the study was to describe trends in the use of condoms in our setting, and how these trends may differ between socioeconomic groups in boys, and separately in girls, aged 17-19 years attending school in Barcelona between 2004 and 2012. We analyzed data from three annual surveys on risk factors in secondary students, which included a representative sample of the city's population; individuals who had previously had sexual intercourse (n = 1570) were included in the study. We calculated adjusted prevalence ratios (aPR) and their confidence intervals (95% CI) using robust Poisson regression models. The prevalence of condom use among boys was 87.0% in 2004 and 76.2% in 2012, and 76.7 and 64.7% among girls, respectively. This decrease was greater in adolescents with a low socioeconomic level, both in boys (aPR = 0.80) and girls (aPR = 0.84). The observed increase of socioeconomic inequalities in condom use in adolescents highlights a possible deterioration in good sexual practices and policies during the studied period. [ABSTRACT FROM AUTHOR]

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

The increasing demand for gluten-free products has favoured the design of numerous gluten-free bakery products which intended to mimic the quality characteristics of wheat bakery products. The objective of this study was to evaluate the nutritional pattern of gluten-free breads representative of the Spanish market for this type of products. The protein, fat and mineral content of the gluten-free breads showed great variation, ranging from 0.90 to 15.5 g/100 g, 2.00 to 26.1 g/100 g and 1.10 to 5.43 g/100 g, respectively. Gluten-free breads had very low contribution to the recommended daily protein intake, with a high contribution to the carbohydrate dietary reference intake. Dietary fiber content also showed great variation varying from 1.30 to 7.20 g/100 g. In vitro enzymatic hydrolysis of starch showed that the most predominant fraction was the rapidly digestible starch that varied from 75.6 to 92.5 g/100 g. Overall, gluten-free breads showed great variation in the nutrient composition, being starchy based foods low in proteins and high in fat content, with high glycaemic index. [ABSTRACT FROM AUTHOR]

Background: Recent articles have described patients that share eosinophilic esophagitis (EoE) and celiac disease (CD) suggesting a true relationship between both diseases.Aims: The purpose of this study was to investigate whether HLA DQ2 and DQ8 predisposing to CD are increased in adult patients with EoE.Methods: HLA alleles conferring risk for CD was assessed in 75 adult EoE patients attended at two hospitals located in different Spanish regions over the past 2 years. We compared the frequencies to the registered data of 421 healthy kidney and bone marrow donors from our hospitals for the following alleles: (a) DR3-DQ2 haplotype; (b) the combination of DR3-DQ2 and DR4-DQ8; (c) DR4-DQ8 haplotype; (d) the simultaneous presence of the DR5-DQ7 and DR7-DQ2 haplotypes; and lastly (e) any combination of haplotypes not conferring risk for the development of CD.Results: The HLA DQ2 and DQ8 alleles were analyzed in 58 adult EoE patients from hospital #1 and in 20 patients from hospital #2, and they were compared to recorded HLA genotyping data from 298 and 123 healthy donors, respectively. No differences were found between the distribution of the HLA frequencies of the patients and controls at both hospitals and the data could be combined. EoE patients did not show increased frequencies of DQ2 and DQ8 alleles compared to controls.Conclusions: Our work does not allow us to establish a common genetic basis for EoE and CD because an increased frequency of the HLA DQ2 and DQ8 alleles predisposing to CD was not observed in adult EoE patients compared to controls. [ABSTRACT FROM AUTHOR]

This observational, prospective study was undertaken to estimate the burden of rotavirus (RV) gastroenteritis (GE) leading to general practitioner (GP)/family paediatrician (FP) visits among children aged <5 years in Czech Republic, Germany, Italy, Poland, Spain and the UK. Children aged <5 years presenting with acute GE provided stool samples for rapid RV testing. RV+ samples were confirmed and typed by RT-PCR. Demographic and clinical data were collected for all RVGE episodes. Transmission patterns among other household children aged <5 years were also assessed. From November 2005 to May 2007, excluding data from the UK, 497/3,813 (13.0%) children aged <5 years presenting with acute GE to GP/FP and tested were RV+ by PCR. Most RVGE cases (69.1%) occurred in children aged <2 years, occurred between December and May (93.1%) and were moderate or severe by Vesikari score (92.9%). RV strain distribution varied between countries: G9P[8] was the most common type in Poland (54/76) and Spain (172/196), G1P[8] was predominant in the Czech Republic (56/64) and Italy (46/107), and G4P[8] and G1P[8] both prevailed in Germany (17/54 and 13/54, respectively). A total of 24/122 (19.7%) children aged <5 years resident in the same household as a PCR+ study participant also developed RVGE. Conclusion. This multinational epidemiological study in Europe shows that RV is easily transmitted among household children, with RVGE burden highest among children aged <2 years accessing primary healthcare for acute GE. [ABSTRACT FROM AUTHOR]

We aimed to describe the sleep patterns in Spanish adolescents and to examine the relationships of sleep duration and morning tiredness with participation in leisure-time physical-sporting activities (LT-PA) and television (TV) watching. Sleep duration, morning tiredness, participation in LT-PA and time spent on watching TV were reported by 2,179 (1,139 females) Spanish adolescents (AVENA study). Data were analyzed by binary logistic regression. One-fifth of the adolescents reported insufficient night sleep (<8 h) on school days. The review of the literature (30 studies) showed that the Spanish adolescents sleep as long as adolescents from central Europe, and longer than those from other Mediterranean countries, South Africa, Asia and North America. Insufficient sleep duration doubled the odds of excessive TV watching (≥3 h/day) in males, regardless of morning tiredness (OR 2.15, 95% CI 1.42-3.27). Morning tiredness reduced the odds of participating in any LT-PA in both males and females (0.49, 0.34-0.70 and 0.49, 0.35-0.69, respectively), and increased the odds of excessive TV watching in females, regardless of sleep duration (2.49, 1.64-3.79). We conclude that non-participation in LT-PA is associated with morning tiredness in male and female adolescents, while excessive TV watching is more associated with short sleep or morning tiredness depending on gender. [ABSTRACT FROM AUTHOR]

Mutations in the HFE gene result in iron overload and can produce hereditary hemochromatosis (HH), a disorder of iron metabolism characterized by increased intestinal iron absorption. Dietary quality, alcoholism and other life-style factors can increase the risk of iron overload, especially among genetically at risk populations. Polymorphisms of the HFE gene (C282Y, H63D and S65C) were measured together with serum ferritin (SF), transferrin saturation (TS) and hemoglobin, to measure iron status, in randomly-selected healthy subjects living in the Spanish Mediterranean coast (n = 815; 425 females, 390 males), 18 to 75 years of age. The intake of dietary components that affect iron absorption was calculated from 3-day dietary records. The presence of C282Y/H63D compound heterozygote that had a prevalence of 2.8% in males and 1.2% in females was associated with an elevated TS and SF. No subject was homozygous for C282Y or S65C. The C282Y heterozygote, H63D heterozygote and homozygote and H63D/S65C compound heterozygote genotypes were associated with increased TS relative to the wild type in the general population. These genotypes together with the alcohol and iron intake increase the indicators of iron status, while calcium intake decreases them. We did not observe any affect of the S65C heterozygote genotype on these levels. All the HFE genotypes except for the S65C heterozygote together with the alcohol, iron and calcium intake affect the indicators of iron status. The C282Y/H63D compound heterozygote genotype has the higher phenotypic expression in our Spanish Mediterranean population. [ABSTRACT FROM AUTHOR]

Methylmercury (MeHg) is a bioaccumulable toxin in the trophic chain and a powerful neurotoxin during fetal and child development. Consumption of contaminated fish and shellfish is a principal environmental source of MeHg exposure. This study was designed to assess the Hg and estimated MeHg intake in vulnerable groups of the Murcia region, a Mediterranean part of Spain, compared with international regulations. A validated food frequency questionnaire was used to assess seafood consumptions in 320 children younger than 10 years, 301 women of childbearing age, and 537 pregnant women. Hg concentrations were measured in the most consumed fish products by cold vapor generation-atomic fluorescence spectrometry. The weekly intake of MeHg (microg/kg bw/week) was 2.60 (95% CI = 2.10-3.10) in children 1-5 years, 2.65 (95% CI = 2.26-3.03) in children 6-10 years, 0.98 (95% CI = 0.89-1.07) in women of childbearing age, and 0.88 (95% CI = 0.81-0.95) in pregnant women. The main exposure to MeHg, especially in young children, is related to intake of bluefin tuna and swordfish. Fifty-four percent of children aged 1-10 years, 10% of pregnant women, and 15% of women of childbearing age exceed the Joint Expert Committee on Food Additives provisional tolerable weekly intake of MeHg. In the Murcia region, where fish is a central component of the diet, the focus should be on educating vulnerable populations to reorient fish consumption in order to lower the amount of Hg incorporated with the diet as well as to reduce Hg emissions into the environment. [ABSTRACT FROM AUTHOR]

Several endocrine regulators are implicated in the development of metabolic syndrome. The aim of our study was to assess normal ranges for glucose, growth hormone (GH), insulin-like growth factor-1 (IGF-1), cortisol, insulin and the yet-to-be-published quantitative insulin sensitivity check index (QUICKI) for newborns and a number of homeostatic model assessment (HOMA)-related equations that have been proposed as indicators of insulin sensitivity (HOMA-S) and insulin resistance (HOMA-R). The study included 115 (54 males, 61 females) singleton, normoweight, Spanish Caucasian neonates delivered without foetal distress from mothers of the Mérida (Spain) Birth Cohort who tested negative in the O'Sullivan screen. Neonatal normal values given as the mean (95% confidence interval) were: glucose, 75.3 mg/dL (68.29-82.29); cortisol, 7.4 microg/dL (6.85-7.97); GH, 16.7 ng/mL (14.87-18.60); insulin, 5.5 microUI/mL (4.12-6.88), IGF-155.2 ng/mL (50.82-59.53); QUICKI, 0.45 (0.43-0.48); HOMA-R, 1.36 (0.84-1.88); HOMA-S, 4.07 (2.66-5.49), the glucose/insulin ratio, 33.6 (24.58-42.67); the insulin/cortisol ratio, 0.8 (0.61-1.05). Hormone ranges (except for cortisol, whose values were lower) were equivalent to those of other studies. Cortisolaemia values cannot be associated with the type of delivery, as only three births (2.6%) were by caesarean section, while 20 (17.4%) were instrumental deliveries. Neonates from the lowest quartile of the insulin/cortisol ratio presented higher (p < 0.001) HOMA-S and QUICKI and lower (p < 0.01) HOMA-R values. The results of our study indicate normal ranges for insulin resistance and sensitivity at birth. The insulin/cortisol ratio at birth appears to be a good early indicator of insulin resistance. [ABSTRACT FROM AUTHOR]

GB virus C (GBV-C) is a blood-borne flavivirus. The prevalence of GBV-C viremia among healthy adults is 0.5% to 4% and, to date, no disease has been definitely associated with GBV-C infection. We conducted a cross-sectional study to evaluate GBV-C viremia prevalence in a group of 327 healthy children with normal alanine amino transferase (ALT) levels (Group A) and elevated ALT levels (Group B) of unknown origin, and among 38 pediatric patients with mother-to-child-transmitted hepatitis C virus (HCV) infection (Group C). No statistically significant differences were observed between prevalences in Groups A and B (2.2% vs 6.7%, p = 0.06). None of the children in Groups A or B who tested positive for GBV-C RNA showed any clinical symptoms. The prevalence of GBV-C viremia in Group A was lower than for patients in Group C (2.2% vs 13.2%, p = 0.007); no differences were observed in HCV infection characteristics between those patients who were co-infected with GBV-C and those who were not. In conclusion, while GBV-C viremia is more frequent among HCV-infected pediatric patients, it is neither associated with liver disease nor has any influence on HCV-related chronic hepatitis. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of bortezomib plus docetaxel in patients with anthracycline-pretreated advanced/metastatic breast cancer. Forty-eight patients received up to eight 21-day cycles of docetaxel (60-100 mg m(-2) on day 1) plus bortezomib (1.0-1.5 mg m(-2) on days 1, 4, 8, and 11). Pharmacodynamic and pharmacokinetic analyses were performed in a subset of patients. Five patients experienced DLTs: grade 3 bone pain (n=1) and febrile neutropenia (n=4). The MTD was bortezomib 1.5 mg m(-2) plus docetaxel 75 mg m(-2). All 48 patients were assessable for safety and efficacy. The most common adverse events were diarrhoea, nausea, alopecia, asthenia, and vomiting. The most common grade 3/4 toxicities were neutropenia (44%), and febrile neutropenia and diarrhoea (each 19%). Overall patient response rate was 29%. Median time to progression was 5.4 months. In patients with confirmed response, median time to response was 1.3 months and median duration of response was 3.2 months. At the MTD, response rate was 38%. Pharmacokinetic characteristics of bortezomib/docetaxel were comparable with single-agent data. Addition of docetaxel appeared not to affect bortezomib inhibition of 20S proteasome activity. Mean alpha-1 acid glycoprotein concentrations increased from baseline at nearly all time points across different bortezomib dose levels. Bortezomib plus docetaxel is an active combination for anthracycline-pretreated advanced/metastatic breast cancer. The safety profile is manageable and consistent with the side effects of the individual agents. [ABSTRACT FROM AUTHOR]

Rotavirus is one of the most common causes of gastroenteritis worldwide. With the commercialisation of effective rotavirus vaccines in Europe in sight, it is necessary to provide studies which evaluate the disease burden. The aim of this study is two-fold, on one hand, to determine the burden of the rotavirus disease in Spanish children under the age of five, and on the other, to estimate the economic cost of these hospitalizations. The study was undertaken during a 5 year period (2000-2004). The rotavirus hospitalization rate was determined using the Minimum Basic Data Set of the national hospital discharge register. The observed data were compared with those expected by applying a model developed by the Centers for Disease Control and Prevention (CDC) adapted for European Countries. The financial expense of these hospitalizations was estimated. Of all admissions coded as gastroenteritis, 31.6% were due to rotavirus. The hospitalization rate by rotavirus was 480 cases per 100,000 children under five. These data are within the confidence range proposed by the adapted CDC model. The financial expense due to hospitalizations reaches 123,262 euros yearly in a Spanish University Hospital. In conclusion, rotavirus contributes significantly to the hospitalization of acute gastroenteritis. The rate of hospitalization by rotavirus is higher compared to other studies carried out in Spain. In view of future commercialisation of rotavirus vaccines, more in-depth analysis considering direct and indirect costs are necessary. [ABSTRACT FROM AUTHOR]

Objective: To compare the prevalence of eating disorders (ED), socio-cultural risk factors, and body image characteristics in two populations of female adolescents, one Mexican and one Spanish, from similar socio-economic backgrounds.Method: A total of 467 Spanish and 329 Mexican girls aged from 11-12 to 17-18 years were assessed using the Eating Attitude Test-26 (EAT-26), the CETCA (Eating Disorders Assessment Questionnaire), the CIMEC (Questionnaire on Influences on Body Shape Model), and a survey of socio-demographic and risk factors produced for this study.Results: One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase.Conclusions: Risk behaviors and the ideal body models of these Spanish and Mexican adolescent girls varied significantly, indicating major socio-cultural differences. However, the prevalence of ED was similar. Further research should aim to clarify whether the similarities found between this Spanish sample and a Mexican sample taken from an upper-middle class urban environment, a minority that is unrepresentative of the general population, are also observed in samples from other sectors of Mexican society. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship between the Arg72Pro polymorphism of p53 and the outcome after traumatic brain injury (TBI) in humans.Design and Setting: A prospective study was carried out in a ten-bed surgical intensive care unit (SICU) of a university hospital.Patients: The study included 90 caucasian patients who had experienced a severe TBI within the previous 24 h. The exclusion criterion was a previous deficit in the central nervous system.Measurements and Results: The main recorded outcomes were values on the Glasgow Outcome Scale (GOS) at discharge from the SICU (GOS-0) and 6 months later (GOS-6). A blood sample was taken from each patient and all samples were analyzed by an allele-specific polymerase chain reaction for detection of Arg72Pro polymorphism of p53. These polymorphisms were tested for their association with values of GOS-0 and GOS-6. A two-tailed value of p<0.05 was considered statistically significant. The frequency of the argine/argine (Arg/Arg) genotype was greater among the patients who had a bad outcome at GOS-0 (69 vs 31% in the bad-outcome group; p=0.029). A multiple logistic regression analysis showed that patients with the Arg/Arg variation had a 2.9-fold greater risk of having a bad outcome at discharge from the SICU (95% confidence interval, 1.05-8.31; p=0.039 ). There was no similar relationship with respect to GOS-6.Conclusion: The Arg/Arg genotype of the Arg72Pro polymorphism in p53 is associated with increased likelihood of a bad outcome at discharge from the SICU. [ABSTRACT FROM AUTHOR]

Unlabelled: To create an instrument to be used in an outpatient clinic to detect adolescents prone to risk-taking behaviours. Based on previous research, five identified variables (relationship with parents and teachers, liking going to school, average grades, and level of religiosity) were used to create a screening tool to detect at least one of ten risky behaviours (tobacco, alcohol, cannabis and other illegal drugs use; sexual intercourse and sexual risky behaviour; driving while intoxicated, riding with an intoxicated driver, not always using a seat belt, and not always using a helmet). The instrument was tested using the Barcelona Adolescent Health Survey 1993. A Receiver Operating Characteristics curve was used to find the best cut-off point between high and low risk score. Odds ratios and 95% confidence intervals were calculated to detect at least one risky behaviour and for each individual behaviour. In order to assess its predictive value, the analysis was repeated using the Barcelona Adolescent Health Survey 1999. In both cases, analyses were conducted for the whole sample and for younger and older adolescents. Adolescents with a high-risk score were more likely to take at least one risky behaviour both when the whole sample was analysed and by age groups. With very few exceptions, the Behaviour Evaluation for Risk-Taking Adolescents showed significant odds ratios for each individual variable.Conclusion: The Behaviour Evaluation for Risk-Taking Adolescents has shown its potential as an easy to use instrument to screen for risk-taking behaviours. Future research must aim towards assessing this instrument's predictive value in the clinical setting and it's application to other populations. [ABSTRACT FROM AUTHOR]

Background: Methods for comparing local mental health service systems are needed to allow identification of different patterns of service provision and of inequities within and between countries.Aim: The aim of this study was to describe and compare mental health service systems in 13 catchment areas in Spain and Italy. Within each country, a range of area characteristics was represented.Method: The European Service Mapping Schedule (ESMS) and European Socio-Demographic Schedule (ESDS) were used to describe: (i) socio-demographic and geographical area characteristics; (ii) services provided; and (iii) service utilisation in each area.Results: Great differences emerged in patterns of service provision and use between and within countries. In contrast to Northern Europe, high unemployment rates were not associated with high service utilisation rates, but areas with large numbers of single-person households tended to have high service use. Most service utilisation rates were substantially below those reported from Northern European studies. Spanish centres tended to have low rates of hospital service utilisation despite limited development of community-based services. Trieste, where there has been a strong emphasis on developing innovative community services, showed a distinctive pattern with low hospital bed use and high rates of day service use and of contacts in the community.Conclusion: This methodology yielded useful data, which raise significant questions regarding equity and the implementation of mental health policy. The very large variations indicate that underlying local patterns of service provision must be investigated and taken into account in the interpretation of research evaluations of interventions. [ABSTRACT FROM AUTHOR]

Objective: To describe a nosocomial outbreak of gastric mucormycosis caused by Rhizopus microsporus var. rhizopodiformis in five adult patients admitted to an intensive care unit (ICU).Design: Epidemiological surveillance study.Setting: A 12-bed polyvalent ICU of an acute care teaching hospital in Pamplona, Spain.Patients: Five patients admitted to the ICU requiring artificial ventilation, diagnosis on admission severe pneumonia in four patients and one polytrauma patient, within a 14-week period, were diagnosed with gastric mucormycosis based on microbiological and/or histopathological characteristics. Upper gastrointestinal bleeding was the presenting manifestation in 80% of patients.Interventions: Filamentous fungi isolated at the microbiology laboratory of the hospital were examined at the national Mycology Reference Laboratory in Madrid.Measurements and Results: Rhizopus microsporus var. rhizopodiformis growth was detected in gastric aspiration samples, environmental samples, wooden tongue depressors used to prepare oral medications (and given to patients through a nasogastric catheter), and in some tongue depressors stored in unopened boxes unexposed to the ICU environment. All depressors were purchased from the same supplier. R. microsporus was not isolated from batches purchased at different times from the same supplier and from another supplier. The outbreak terminated when contaminated tongue depressors were withdrawn from use.Conclusions: Wooden tongue depressors contaminated by R. microsporus var. rhizopodiformis used to prepare oral medications caused an outbreak of fungal gastritis with an attributable mortality of 40%. Wooden material should not be used in the hospital setting. [ABSTRACT FROM AUTHOR]

Background: In spite of a well-established development of instruments, difficulty in interpreting health related quality of life scores may limit its use in clinical practice.Objective: To develop generalizable interpretation aids for a measure of perceived functional visual status, the VF-14 index.Design: Item Response Theory (Rasch analysis) was used to analyze the performance of VF-14 items. The 'ruler' aid was derived from the most difficult activity (item) a patient is able to do without difficulty; the 'clinical scenarios' aid, first identified all significantly different clusters of items within the index and then estimated the mean expected difficulty (responses) to perform a benchmark item in each cluster.Setting: The study was conducted in four hospitals and six ambulatory cataract surgery centers in Barcelona, Spain.Patients: One hundred and ninety-eight patients scheduled for first eye cataracts surgery.Measurements: The self-reported VF-14 index and clinical measures were used.Results: All VF-14 items were found unidimensional with three items showing only partial misfit. For a patient with a VF-14 Rasch score of 71, the 'ruler' aid indicated that 'doing fine handwork' would be the most requiring activity he/she would perform without difficulty. The 'clinical scenarios' aid estimated that such a patient would be unable to 'drive at night', would have some difficulty 'reading small print' and no difficulty 'doing fine handwork', 'watching TV' or 'recognizing people'. Concordance between modeled and observed responses was fair to substantial.Conclusions: Simple content-based interpretation aids for the VF-14 scores were developed that should facilitate its use in clinical practice. These aids should be easily generalizable to other quality of life instruments. [ABSTRACT FROM AUTHOR]

Objective: To examine the characteristics, prognostic factors, and outcome of patients with severe hospital-acquired pneumonia admitted to the ICU.Design and Setting: Prospective observational clinical study in two medical-surgical ICUs with 16 and 20 bedsPatients and Participants: During a 7-year period all hospitalized patients requiring admission to either ICU for hospital-acquired pneumonia were followed up.Measurements and Results: We diagnosed 96 episodes of severe hospital-acquired pneumonia, and in 67 cases a causal diagnosis was made. Most episodes were late-onset pneumonia. Gram-negative micro-organisms were isolated in 51% of episodes diagnosed, and Pseudomonas aeruginosa was the most frequent pathogen isolated (24%). Clearly significant variations happened between hospitals, particularly affecting the incidence of Aspergillus spp. and Legionella pneumophila. Forty-nine patients developed septic shock (51%). Fifty-one patients died (53%). Aspergillosis and pneumonia due to P. aeruginosa were associated with the highest mortality. Septic shock (OR: 14.27) and chronic obstructive pulmonary disease (OR: 6.11) were independently associated with a poor prognosis.Conclusions: Patients with severe hospital-acquired pneumonia admitted to the ICU present high mortality. The presence of septic shock and chronic obstructive pulmonary disease in conjunction with specific microorganisms are associated with a poor prognosis. Local epidemiological data combined with a patient-based approach may allow a more accurate therapy decision making. [ABSTRACT FROM AUTHOR]

Objectives: To determine the most appropriate outlier trimming method when the main source of information for case mix classification is length of stay (LOS) because cost information is unavailable.Methods: Discharges (35,262) from two public hospitals were analysed. LOS and cost outliers were calculated using different trimming methods. The agreement between cost and LOS trimming was analysed.Results: The trimming method using the geometric mean with two standard deviations (GM2) showed the highest level of agreement between cost and LOS and revealed the greatest proportion of extreme costs. Nearly 5% of cases were outliers, containing 16% of total LOS. This was the best approximation to 18% of extreme cost because when GM2 was applied to LOS, 88% of outlier cost was revealed.Conclusions: The methods were analysed because they are the most frequently used but the same methodology could be employed to compare other outlier determination methods. Outliers should be calculated because they ought to be valued differently from inlier cases. [ABSTRACT FROM AUTHOR]

The aim of this article is to identify those factors which produce differences in the use of public health care services among individuals whose medical needs are similar. The empirical analysis employs Spanish data for three separate years and obtains results for four types of medical attention: visits to a GP, visits to a specialist, visits to the emergency services and hospital inpatient days. The results show that the influence of demand factors upon the probability of consuming more medical attention than expected depends on the type of health care considered.In addition, the minimal impact of supply factors is demonstrated. [ABSTRACT FROM AUTHOR]

Sociologists and urban commentators often portray metropolitan areas as highly segregated by social class and race. We measured the extent of socioeconomic residential segregation in urbanized areas of the United States in 1970, determined whether cities were as segregated as suburban rings, and compared levels of socioeconomic and racial residential segregation. We found moderate levels of residential segregation and socioeconomic groups. Levels of social class segregation varied little from one urbanized area to another and were about the same in central cities and suburban rings. Racial residentail segregation was much greater than the segregation of social classes within either the black or white communities. The extent of racial residential segregation does not vary by educational attainment, occupation, or income. [ABSTRACT FROM AUTHOR]

Over the past two centuries, extensive mental health care systems have come to be a feature of all Western societies. However, the theoretical model generally invoked to account for this process has only limited applicability to Spain, where the growth of capitalism and the liberal state followed an atypical and uneven course. Political power and economic power, usually coterminous, were divided in Spain between center and periphery, so that, until the 1960s, Spain's economic center of gravity was localized in Catalonia, the most culturally and linguistically distinct region. Here we are dealing with a paradox: on the one hand, the failure of the incompletely centralized and economically underdeveloped Spanish state to develop a system of psychiatric care comparable to those of other European states; and on the other hand, the success of the Catalan bourgeoise, though lacking a state of its own, in creating such a system through private initiative. [ABSTRACT FROM AUTHOR]

Objective: To customize the Acute Physiology and Chronic Health Evaluation (APACHE) III mortality equation for Spanish admissions to the intensive care unit (ICU) and evaluate its discrimination and calibration.Design: Prospective multicenter inception cohort study.Setting: 86 ICUs located in all regions of Spain.Patients: 10,929 adult patients selected by a systematic sampling method. All types of critical care patients were included, including coronary bypass patients, but excluding those with burn injury, those admitted for pacemaker implants, patients under 16 years of age, and patients with length of ICU stay < 6 h.Measurements and Results: Data collection in the first 24 h after patient admission included: APACHE III score, treatment location prior to ICU admission, and main ICU admission diagnosis. Using these variables, a model for predicting hospital mortality was constructed, adapted to Spain, and its discriminating ability was assessed by the area below the ROC curve, which was 0.83. The model was validated using the jacknife method and the area below the receiver operating characteristic (ROC) curve for the cross-validated predictions was 0.82. The percentage of patients correctly classified at 0.50 risk of death was 82.3%. Model calibration was evaluated by analysis of the agreement between the observed and cross-validated predicted mortality using the Hosmer-Lemeshow test, which gave a value of (H) 12.27, with no statistical significance, i.e., good calibration.Conclusions: We have customized the APACHE III mortality prediction system for the Spanish population. This adapted model has demonstrated the requisite validation, calibration, and discrimination for its use among Spanish critical care patients. [ABSTRACT FROM AUTHOR]

In order to study possible predictors of early after-discharge mortality (EADM), 700 consecutive patients discharged alive from three intensive care units (ICUs) were followed up 2 months after their admission. The observed mortality was 7.3%. Univariate analysis indicated a strong statistically significant association of the following variables with mortality: initial simplified acute physiological score (SAPS) greater than 10, therapeutic intervention score in the first 24 h of admission greater than 20, age greater than or equal to 65, length of stay in the ICU greater than 10 days, and low educational level. The multiple logistic regression analysis included as predictive independent variables the SAPS, organs or systems failure, age, and length of stay. The model built upon these four variables was able to identify a group of patients at high risk (21-46%) of EADM. We conclude that some simple variables can be used as useful markers of patients groups at high risk of EADM. [ABSTRACT FROM AUTHOR]