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We report TeV gamma-ray observations of the ultra-high-energy source MGRO J1908+06 using data from the High Altitude Water Cherenkov (HAWC) Observatory. This source is one of the highest-energy known gamma-ray sources, with emission extending past 200 TeV. Modeling suggests that the bulk of the TeV gamma-ray emission is leptonic in nature, driven by the energetic radio-faint pulsar PSR J1907+0602. Depending on what assumptions are included in the model, a hadronic component may also be allowed. Using the results of the modeling, we discuss implications for detection prospects by multi-messenger campaigns., Comment: accepted by ApJ, in press

The radio galaxy M87 is the central dominant galaxy of the Virgo Cluster. Very high-energy (VHE, ≳0.1 TeV) emission from M87 has been detected by imaging air Cherenkov telescopes. Recently, marginal evidence for VHE long-term emission has also been observed by the High Altitude Water Cherenkov Observatory, a gamma-ray and cosmic-ray detector array located in Puebla, Mexico. The mechanism that produces VHE emission in M87 remains unclear. This emission originates in its prominent jet, which has been spatially resolved from radio to X-rays. In this paper, we construct a spectral energy distribution from radio to gamma rays that is representative of the nonflaring activity of the source, and in order to explain the observed emission, we fit it with a lepto-hadronic emission model. We found that this model is able to explain nonflaring VHE emission of M87 as well as an orphan flare reported in 2005.

The High Altitude Water Cherenkov (HAWC) gamma-ray observatory observes atmospheric showers produced by incident gamma rays and cosmic rays with energy from 300 GeV to more than 100 TeV. A crucial phase in analyzing gamma-ray sources using ground-based gamma-ray detectors like HAWC is to identify the showers produced by gamma rays or hadrons. The HAWC observatory records roughly 25,000 events per second, with hadrons representing the vast majority ($>99.9\%$) of these events. The standard gamma/hadron separation technique in HAWC uses a simple rectangular cut involving only two parameters. This work describes the implementation of more sophisticated gamma/hadron separation techniques, via machine learning methods (boosted decision trees and neural networks), and summarizes the resulting improvements in gamma/hadron separation obtained in HAWC., 35 pages, 9 figures, published in Nuclear Instruments and Methods in Physics Research Section A

The extragalactic background light (EBL) contains all the radiation emitted by nuclear and accretion processes in stars and compact objects since the epoch of recombination. Measuring the EBL density directly is challenging, especially in the near- to far-infrared waveband, mainly due to the zodiacal light foreground. Instead, gamma-ray astronomy offers the possibility to indirectly set limits on the EBL by studying the effects of gamma-ray absorption in the very high energy (VHE:$>$100 GeV) spectra of distant blazars. The High Altitude Water Cherenkov gamma ray observatory (HAWC) is one of the few instruments sensitive to gamma rays with energies above 10 TeV. This offers the opportunity to probe the EBL in the near/mid IR region: $\lambda$ = 1 $\mu$m - 100 $\mu$m. In this study, we fit physically motivated emission models to Fermi Large Area Telescope (LAT) GeV data to extrapolate the intrinsic TeV spectra of blazars. We then simulate a large number of absorbed spectra for different randomly generated EBL model shapes and calculate Bayesian credible bands in the EBL intensity space by comparing and testing the agreement between the absorbed spectra and HAWC extragalactic observations of two blazars. The resulting bands are in agreement with current EBL lower and upper limits, showing a downward trend towards higher wavelength values $\lambda>10\, \mu$m also observed in previous measurements., Comment: Submitted to ApJ

International audience; The High Altitude Water Cherenkov (HAWC) observatory and the High Energy Stereoscopic System (H.E.S.S.) are two leading instruments in the ground-based very-high-energy γ-ray domain. HAWC employs the water Cherenkov detection (WCD) technique, while H.E.S.S. is an array of Imaging Atmospheric Cherenkov Telescopes (IACTs). The two facilities therefore differ in multiple aspects, including their observation strategy, the size of their field of view, and their angular resolution, leading to different analysis approaches. Until now, it has been unclear if the results of observations by both types of instruments are consistent: several of the recently discovered HAWC sources have been followed up by IACTs, resulting in a confirmed detection only in a minority of cases. With this paper, we go further and try to resolve the tensions between previous results by performing a new analysis of the H.E.S.S. Galactic plane survey data, applying an analysis technique comparable between H.E.S.S. and HAWC. Events above 1 TeV are selected for both data sets, the point-spread function of H.E.S.S. is broadened to approach that of HAWC, and a similar background estimation method is used. This is the first detailed comparison of the Galactic plane observed by both instruments. H.E.S.S. can confirm the γ-ray emission of four HAWC sources among seven previously undetected by IACTs, while the three others have measured fluxes below the sensitivity of the H.E.S.S. data set. Remaining differences in the overall γ-ray flux can be explained by the systematic uncertainties. Therefore, we confirm a consistent view of the γ-ray sky between WCD and IACT techniques.

This work was supported by the Spanish Ministry of Economy and Competitiveness (MINECO), Plan Nacional de I+D+i calls RETOS 2016 (reference DEP2016-74926-R) and RETOS 2018 (reference RTI2018-093302-A-I00). EM-R and MAI were funded by the Spanish Ministry of Science, Innovation and Universities (FPU18/01107 and FPU17/01158, respectively). AH-M and LL-S were funded by the predoctoral fellowship program of the University of Almeria. The funding sources approved this study although they had no role in the design and will not have any role during its execution, analyses and interpretation of the data, writing manuscripts, or decision to submit for publication., Background Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training programis poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies. Purpose The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity. Material and Methods The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7–14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery., Spanish Ministry of Economy and Competitiveness (MINECO), Plan Nacional de I+D+i calls RETOS DEP2016-74926-R RTI2018-093302-A-I00, Spanish Ministry of Science, Innovation and Universities FPU18/01107 FPU17/01158, predoctoral fellowship program of the University of Almeria

Forest spatial structure describes the relationships among different species in the same forest community. Automation in the monitoring of the structural forest changes and forest mapping is one of the main utilities of applications of modern geoinformatics methods. The obtaining objective information requires the use of spatial data derived from photogrammetry and remote sensing. This paper investigates the possibility of applying light detection and ranging (LiDAR) point clouds and geographic information system (GIS) analyses for automated mapping and detection changes in vegetation structure during a year of study. The research was conducted in an area of the Ourense Province (NWSpain). The airborne laser scanning (ALS) data, acquired in August 2019 and June of 2020, reveal detailed changes in forest structure. Based on ALS data the vegetation parameters will be analysed.To study the structural behaviour of the tree vegetation, the following parameters are used in each one of the sampling areas: (1) Relationship between the tree species present and their stratification; (2) Vegetation classification in fuel types; (3) Biomass (Gi); (4) Number of individuals per area; and (5) Canopy cover fraction (CCF). Besides, the results were compared with the ground truth data recollected in the study area.The development of a quantitative structural model based on Aerial Laser Scanning (ALS) point clouds was proposed to accurately estimate tree attributes automatically and to detect changes in forest structure. Results of statistical analysis of point cloud show the possibility to use UAV LiDAR data to characterize changes in the structure of vegetation.

The highest-energy known gamma-ray sources are all located within 0.5 degrees of extremely powerful pulsars. This raises the question of whether ultra-high-energy (UHE; $>$ 56 TeV) gamma-ray emission is a universal feature expected near pulsars with a high spin-down power. Using four years of data from the High Altitude Water Cherenkov (HAWC) Gamma-Ray Observatory, we present a joint-likelihood analysis of ten extremely powerful pulsars to search for UHE gamma-ray emission correlated with these locations. We report a significant detection ($>$ 3$��$), indicating that UHE gamma-ray emission is a generic feature of powerful pulsars. We discuss the emission mechanisms of the gamma rays and the implications of this result. The individual environment that each pulsar is found in appears to play a role in the amount of emission., accepted by ApJL

Background Forest fires have increased in extent and intensity in the Mediterranean area in recent years, threatening forest ecosystems through loss of vegetation, changes in soil properties, and increased soil erosion rates, particularly in severely burned areas. However, establishing the relationships between burn severity and soil properties that determine infiltration remain challenging. Determining where soil burn severity evaluation should be carried out is critical for planning urgent measures to mitigate post-fire soil erosion. Although previous research has indicated that spectral indices are suitable for assessing fire severity, most of the classifications used consider combined effects in vegetation and soil. Moreover, the relationship between spectral indices and soil burn severity has scarcely been explored until now. Results We selected three pine stands in Spain for study immediately after being burned by wildfires. We analyzed various soil properties (soil saturated hydraulic conductivity, mean weight diameter of soil aggregates, and soil organic carbon) in relation to six levels of soil burn severity in all three stands. In addition, we established 25 field plots in the burned areas. We computed ten spectral indices for each plot by using Sentinel-2 satellite data. The soil burn severity categories indicated the degree of degradation of important soil properties related to soil erosion susceptibility. Of the spectral indices considered, the relativized burn ratio (RBR) was the best predictor of cumulative infiltration and mean weight diameter of soil aggregates. The differenced mid-infrared bispectral index (dMIRBI) was most closely correlated with soil organic carbon content. Conclusions The findings demonstrate the potential applicability of remote sensing to determining changes in soil properties after fire.

The High Altitude Water Cherenkov (HAWC) Gamma-Ray Observatory surveys the very high energy sky in the 300 GeV to $>100$ TeV energy range. HAWC has detected two blazars above $11\sigma$, Markarian 421 (Mrk 421) and Markarian 501 (Mrk 501). The observations are comprised of data taken in the period between June 2015 and July 2018, resulting in a $\sim 1038$ days of exposure. In this work we report the time-averaged spectral analysis for both sources above 0.5 TeV. Taking into account the flux attenuation due to the extragalactic background light (EBL), the intrinsic spectrum of Mrk 421 is described by a power law with an exponential energy cut-off with index $\alpha=2.26\pm(0.12)_{stat}(_{-0.2}^{+0.17})_{sys}$ and energy cut-off $E_c=5.1\pm(1.6)_{stat}(_{-2.5}^{+1.4})_{sys}$ TeV, while the intrinsic spectrum of Mrk 501 is better described by a simple power law with index $\alpha=2.61\pm(0.11)_{stat}(_{-0.07}^{+0.01})_{sys}$. The maximum energies at which the Mrk 421 and Mrk 501 signals are detected are 9 and 12 TeV, respectively. This makes these some of the highest energy detections to date for spectra averaged over years-long timescales. Since the observation of gamma radiation from blazars provides information about the physical processes that take place in their relativistic jets, it is important to study the broad-band spectral energy distribution (SED) of these objects. To this purpose, contemporaneous data in the gamma-ray band to X-ray range, and literature data in the radio to UV range, were used to build time-averaged SEDs that were modeled within a synchrotron self-Compton leptonic scenario., Comment: 16 pages, 5 tables, 9 figures

The study of high-energy gamma rays from passive Giant Molecular Clouds (GMCs) in our Galaxy is an indirect way to characterize and probe the paradigm of the "sea" of cosmic rays in distant parts of the Galaxy. By using data from the High Altitude Water Cherenkov (HAWC) observatory, we measure the gamma-ray flux above 1 TeV of a set of these clouds to test the paradigm. We selected high-galactic latitude clouds that are in HAWC's field-of-view and which are within 1~kpc distance from the Sun. We find no significant excess emission in the cloud regions, nor when we perform a stacked log-likelihood analysis of GMCs. Using a Bayesian approach, we calculate 95\% credible intervals upper limits of the gamma-ray flux and estimate limits on the cosmic-ray energy density of these regions. These are the first limits to constrain gamma-ray emission in the multi-TeV energy range ($>$1 TeV) using passive high-galactic latitude GMCs. Assuming that the main gamma-ray production mechanism is due to proton-proton interaction, the upper limits are consistent with a cosmic-ray flux and energy density similar to that measured at Earth., 6 figures, 6 tables

The High Altitude Water Cherenkov Gamma-Ray Observatory (HAWC) continuously detects TeV photons and particles within its large field-of-view, accumulating every day a deeper exposure of two thirds of the sky. We analyzed 1523~days of HAWC live data acquired over four and a half years, in a follow-up analysis of {138} nearby ($z, Comment: The HAWC survey of Fermi 3FHL AGNs: 30 pages, 13 figures. Submitted to the Astrophysical Journal

We present a new catalog of TeV gamma-ray sources using 1523 days of data from the High Altitude Water Cherenkov (HAWC) observatory. The catalog represents the most sensitive survey of the Northern gamma-ray sky at energies above several TeV, with three times the exposure compared to the previous HAWC catalog, 2HWC. We report 65 sources detected at $\geq$ 5 sigma significance, along with the positions and spectral fits for each source. The catalog contains eight sources that have no counterpart in the 2HWC catalog, but are within $1^\circ$ of previously detected TeV emitters, and twenty sources that are more than $1^\circ$ away from any previously detected TeV source. Of these twenty new sources, fourteen have a potential counterpart in the fourth \textit{Fermi} Large Area Telescope catalog of gamma-ray sources. We also explore potential associations of 3HWC sources with pulsars in the ATNF pulsar catalog and supernova remnants in the Galactic supernova remnant catalog., 20 pages, 11 figures. Matches the version published in The Astrophysical Journal. See accompanying data release at https://data.hawc-observatory.org/datasets/3hwc-survey/index.php

We present the detection of VHE gamma-ray emission above 100 TeV from HAWC J2227+610 with the HAWC observatory. Combining our observations with previously published results by VERITAS, we interpret the gamma-ray emission from HAWC J2227+610 as emission from protons with a lower limit in their cutoff energy of 800 TeV. The most likely source of the protons is the associated supernova remnant G106.3+2.7, making it a good candidate for a Galactic PeVatron. However, a purely leptonic origin of the observed emission cannot be excluded at this time., Accepted for publication by ApJL

Background & aim Worldwide, measures are being implemented to eradicate hepatitis B (HBV) and C (HCV) viruses, which can be transmitted from the mother during childbirth. This study aims to determine the prevalence of HBV and HCV in pregnant women in Spain, focusing on country of origin, epidemiological factors and risk of vertical transmission (VT). Methodology Multicentre open-cohort study performed during 2015. HBV prevalence was determined in 21870 pregnant women and HCV prevalence in 7659 pregnant women. Epidemiological and risk factors for VT were analysed in positive women and differences between HBV and HCV cases were studied. Results HBV prevalence was 0.42% (91/21870) and HCV prevalence was 0.26% (20/7659). Of the women with HBV, 65.7% (44/67) were migrants. The HBV transmission route to the mother was unknown in 40.3% of cases (27/67) and VT in 31.3% (21/67). Among risk factors for VT, 67.7% (42/62) of the women had viraemia and 14.5% (9/62) tested HBeAg-positive. All of the neonates born to HBV-positive mothers received immunoprophylaxis, and none contracted infection by VT. In 80% (16/20) of the women with HCV, the transmission route was parenteral, and nine were intravenous drug users. Viraemia was present in 40% (8/20) of the women and 10% (2/20) were HIV-coinfected. No children were infected. Women with HCV were less likely than women with HBV to breastfeed their child (65% vs. 86%). Conclusions The prevalences obtained in our study of pregnant women are lower than those previously documented for the general population. Among the women with HBV, the majority were migrants and had a maternal family history of infection, while among those with HCV, the most common factor was intravenous drug use. Despite the risk factors observed for VT, none of the children were infected. Proper immunoprophylaxis is essential to prevent VT in children born to HBV-positive women., This study received financial assistance from the following: Ciberehd, Fondo de Investigaciones Sanitarias del Instituto de Salud Carlos III. ISCIII, Proyecto del Plan Nacional I+D+i 2013-2016 (PI13/01925), Confinanciacio´n Fondos FEDER. Gilead Fellowship Program (GLD14-00292 and GLD15-00307).

© 2020 the Author(s)., [Background]: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life. [Methods]: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured. [Discussion]: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery., This work was supported by Ministerio de Economía y Competitividad (MINECO), Plan Nacional de I+D+i call RETOS 2018 (grant n° RTI2018-093302-A-I00). EM-R was funded by the Spanish Ministry of Science, Innovation and Universities (FPU18/01107) and AH-M by the Gerty Cory pre-doctoral program for deficit areas at the University of Almería.

Assessing biomass is critical for accounting bioenergy potentials and monitoring forest ecosystem responses to global change and disturbances. Remote sensing, especially Light Detection and Ranging (LiDAR) data combined with field data, is being increasingly used for forest inventory purposes. We evaluated the feasibility of the combined use of freely available data, both remote sensing (LiDAR data provided by the Spanish National Plan for Aerial Ortophotography - PNOA - and Landsat vegetation spectral indices) and field data (from the National Forest Inventory) to estimate stand dendrometric and aboveground biomass variables of the most productive tree species in a pilot area in Galicia (northwestern Spain). The results suggest that the models can accurately predict dendrometric and biomass variables at plot level with an R2 ranging from 0.49 to 0.65 for basal area, from 0.65 to 0.95 for dominant height, from 0.48 to 0.68 for crown biomass and from 0.55 to 0.82 for stem biomass. Our results support the use of this approach to reduce the cost of forest inventories and provide a useful tool for stakeholders to map forest stand variables and biomass stocks.

Intergalactic space is believed to contain non-zero magnetic fields (the Intergalactic Magnetic Field: IGMF) which at scales of Mpc would have intensities below $10^{-9}$ G. Very high energy (VHE $>$100 GeV) gamma rays coming from blazars can produce e$^+$e$^-$ pairs when interacting with the Extragalactic Background Light (EBL) and the Cosmic Microwave Background, generating an electromagnetic cascade of Mpc scale. The IGMF may produce a detectable broadening of the emission beam that could lead to important constrains both on the IGMF intensity and its coherence length. Using the Monte Carlo-based Elmag code, we simulate the electromagnetic cascade corresponding to two detected TeV sources: PKS 2155-304 visible from the South and H1426+428 visible from the North. Assuming an EBL model and intrinsic spectral properties of the sources we obtain the spectral and angular distribution of photons when they arrive at Earth. We include the response of the next generation Cherenkov telescopes by using simplified models for CTA (Cherenkov Telescope Array)-south and CTA-north based on a full simulation of each array performance. Combining the instrument properties with the simulated source fluxes, we calculate the telescope point spread function for null and non-null IGMF intensities and develop a method to test the statistical feasibility of detecting IGMF imprints by comparing the resulting angular distributions. Our results show that for the analysed source PKS 2155-304 corresponding to the southern site, CTA should be able to detect IGMF with intensities stronger than 10$^{-14.5}$G within an observation time of $\sim$100 hours., Accepted for publication by ApJ, 13 pages, 13 figures

Objective The mental foramen (MF) hosts main neurovascular structures, making it of crucial importance for surgical procedures. This study aimed to analyze the factors influencing the dimensions and location of the MF. Materials and methods Cone beam computed tomography (CBCT) scans of 344 patients were examined for MF dimensions, as well as for the distances from the MF to the alveolar crest (MF-MSB), and to the inferior mandibular border (MF-MIB). Results Gender, mandibular side and presence of accessory mental foramina (AMF) significantly influence MF area. Males, left hemimandibles, and hemimandibles with no AMF had a higher rate of large MF areas (B = − 0.60; p = 0.003, females; B = 0.55; p = 0.005; B = 0.85; p = 0.038). Age, gender and dental status significantly influence MF-MSB distance. The distance decreased as age increased (B = −0.054; p = 0.001), females showed a lower rate of long MF-MSB distances (B = −0.94, p = 0.001), and dentate patients showed a higher rate of long MF-MSB distances (B = 2.27; p = 0.001). Age, gender and emerging angle significantly influenced MF-MIB distance. The distance decreased as age and emerging angle increased (B = −0.01; p = 0.001; B = −0.03; p = 0.001), and females had a lower rate of long MF-MIB distances (B = −1.94, p = 0.001). Conclusions General and local factors influence the dimensions and location of MF. MF dimensions are influenced by gender, mandibular side, anteroposterior position, and the presence of AMF. Distance from MF to alveolar crest is influenced by gender, age and dental status, while the relative MF position is influenced by age and dental status. CBCT images make it possible to analyze the MF in order to avoid complications during surgical procedures SI

Background: The mental foramen (MF) is a small foramen located in the anterolateral region of the mandible through which the mental nerve and vessels emerge. The knowledge on the anatomic characteristics and variations of MF is very important in surgical procedures involving that area. The aim of this study was two-fold: firstly, to analyze the anatomic characteristics of MF and the presence of accessory mental foramen (AMF) using CBCT and, secondly, to compare the capability of CBCT and PAN in terms of MF and AMF visualization, as well as influencing factors. Material and Methods: A sample of 344 CBCT scans was analyzed for presence and characteristics (i.e. diameter, area, shape, exit angle) of MF and AMF. Subsequently, corresponding PANs were analyzed to ascertain whether MF and AMF were visible. Results: Out of the 344 patients, 344 (100%) MFs and 45 (13%) AMFs were observed on CBCT. Regarding gender, MF diameter and area, MF-MIB and MF-MSB distances, and exit angle were all significantly higher in males. Also, statistically significant differences were found in terms of age and dental status. Statistically significant differences in MF long and short diameters and MF area were found with respect to AMF presence ( p =.021, p =.008, p =.021). Only 83.87% of the MFs and 45.83% of the AMFs identified on CBCT were also visible on PANs. MF diameter, shape, exit angle, and age had a significant influence on MF visualization on PAN (B=.43, p =.005; B=-.55, p =.020; B=.20, p =.008; B=.61, p =.005). Conclusions: PAN is not an adequate technique to properly identify MF and AMF. Diameter, shape, exit angle, and age are all factors influencing MF visualization on PAN images. For surgery involving the MF anatomical region, a preoperative radiological study with CBCT is of crucial importance to avoid complications.

Vitamin D is acquired from skin photosynthesis and digestive absorption. Two hydroxylations are required to obtain the bioactive compound. In the liver, the first metabolizes vitamin D3 into 25-hyd...

To evaluate rehabilitation outcomes at discharge and at year patients older 85 years admitted to functional treatment after hip fracture.A prospective study of inpatients admitted after hip fracture to medium-stay geriatric unit between May 2000 and September 2002. Baseline, clinical variables (location of fracture, serum albumin and Charlson comorbidity index), functional status assessed by Barthel Index, mobility by Physical Red Cross Scale and cognitive status by Pfeiffer questionnaire. Functional status, mobility, institutionalization and death was evaluated at discharge and by phone interview at years after discharge.116 patients were studied (42% with 85 years and older, 85% women). After multivariable logistic analysis, age older than 84 years did not appear as a factor related to functional dependence or institutionalization at discharge or one year after. Indeed, oldest old age was not related with death or institutionalization and mobility dependence one year after. In the other hand, the presence of cognitive impairment at admission and functional impairment before hip fracture were independently variable associated to the presence of poor outcome at discharge and one year after.Oldest old age does not appear as a independent risk factor of poor outcomes after rehabilitation of hip fracture when other related clinical, functional and mental factors are considered.

Objetivo: Valorar los resultados de la rehabilitación en pacientes de 85 y más años con fractura de cadera y su persistencia al año, en relación con ancianos más jóvenes. Método: Estudio prospectivo de todos los pacientes ingresados con fractura de cadera para recuperación funcional en una unidad geriátrica de media estancia entre mayo de 2000 y septiembre de 2002. Se recogieron variables clínicas (tipo de fractura, albúmina sérica e índice de comorbilidad de Charlson), situación funcional (Índice de Barthel), capacidad de deambulación (escala física de Cruz Roja) y la situación cognitiva (test de Pfeiffer). La situación funcional, deambulación e institucionalización fueron las variables de resultado al alta. El seguimiento se realizó telefónicamente recogiendo al año la incidencia de muerte, institucionalización, situación funcional y capacidad de deambulación. Resultados: Se estudiaron 116 pacientes (42% ≥ 85 años; 85% mujeres). Tras el análisis logístico multivariante la edad ≥ 85 no fue un factor asociado a dependencia funcional o institucionalización al alta. Tampoco se asoció al riesgo de muerte o institucionalización ni de deambulación dependiente al año del alta. Por contra, la presencia de deterioro cognitivo al ingreso y de deterioro funcional previo a la fractura se asociaron de forma independiente a la presencia de estos pobres resultados al alta y al año. Conclusiones: La edad muy avanzada no aparece como un factor de riesgo independiente de pobres resultados tras la rehabilitación de fractura de cadera cuando se consideran otros factores clínicos, funcionales y mentales asociados.

a) To find the prevalence of anti-tetanus vaccination in a health district, and b) to detect difficulties in the implementation of corrective measures, after the appearance of three cases of tetanus in 6 months.An observational descriptive crossover study.Primary care. Rural health district with 18266 inhabitants.People of both sexes over 14 from the 3 population nuclei, which had the best records of attendance and vaccination in the health district.Vaccination coverage at the start and end of the intervention for 328 people chosen by systematic randomised sampling.clinical records.At the start of the intervention there was less vaccination coverage among males, over-50s and people living in small nuclei of population. During the study period vaccination coverage increased more in the nuclei where there had been a tetanus case. Vaccines were lacking at the start of the intervention.A low use of clinical records in the health district was detected, which posed difficulties for the research. Except for one of the population nuclei, very few people at the start of the study were recorded as correctly vaccinated. It is seen that the health service responded slowly to such serious cases as these. It is suggested that primary health care activities should be programmed more in accord with the health problems prevailing in each area. With an illness like tetanus we should not wait for a case to occur before acting.

A diferencia de lo que ocurre en otros paises, la atencion a las toxicomanias en Espana ha experimentado una progresiva descentralizacion administrativa, con la intencion de aproximarse a las necesidades de los ciudadanos. En la actualidad, tienen competencias en la materia las administraciones central, autonomica y local, junto con otras entidades privadas que cada vez tienen mas importancia. Este proceso supone una mayor dificultad a la hora de conocer las actuaciones emprendidas por todos y cada uno de las instituciones implicadas. Para conocer la situacion esta investigacion ha combinado la utilizacion de fuentes primarias y secundarias. Como resultados fundamentales, se aprecian diferencias entre las regiones, tanto en la situacion del consumo como en la planificacion y desarrollo de las politicas correspondientes. En este sentido, aun queda mucho por avanzar en el diseno de una verdadera estrategia, con objetivos cuantificables, indicadores de resultado y evaluaciones rigurosas. Estas peculiaridades coexisten con problemas comunes como la necesidad de mejorar la coordinacion entre instituciones; enfatizar las actuaciones preventivas, implicando a toda la sociedad; de normalizar y universalizar la asistencia; de desarrollar una red de integracion sociolaboral y de fomentar programas rigurosos y modelos basados en la evidencia.