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There is a growing interest in using social media and digital platforms as allies to strengthen social support among the aged. Drawing on ethnographic interviews and observations of 21 people in their 80s, the article foregrounds the multiple and intersecting temporalities of informal mediated care practices in later life through an exploration of the wide range of infrastructures on which they rely, from social media platforms to housing and urban infrastructure. We identify four temporalities of mediated informal care to assert the need to problematize the future-oriented temporalities of new caring media. The article paves the way to consider infrastructures of informal care as making time in multiple forms, irrespective of their newness or oldness, or the futures that every new piece of technology and service may potentially bring to our present.

Recently, a lot of attention has been directed towards designing and implementing innovative technologies to fight against older people’s social isolation and loneliness. Our chapter explores how older people and their families use social media in their everyday life to connect with others, share everyday lived experiences and undertake quotidian arrangements. In doing so, the chapter investigates underexplored ways of mediated ‘care about’. Drawing on an ethnographic study, we focus on the form and characteristics of the care about infrastructures assembled in affective relational practices among family members. Eventually, from the care about practices settled in everyday life mediated relationships, it makes three suggestions for the techno-care area: to study mediated social connectedness as a matter of care, considering emotions and affects and incorporate relational theoretical frameworks in technology innovation design.

One of the more evident uses of spatio-temporal disease mapping is forecasting the spatial distribution of diseases for the next few years following the end of the period of study. Spatio-temporal models rely on very different modeling tools (polynomial fit, splines, time series, etc.), which could show very different forecasting properties. In this paper, we introduce an enhancement of a previous autoregressive spatio-temporal model with particularly interesting forecasting properties, given its reliance on time series modeling. We include a common spatial component in that model and show how that component improves the previous model in several ways, its predictive capabilities being one of them. In this paper, we introduce and explore the theoretical properties of this model and compare them with those of the original autoregressive model. Moreover, we illustrate the benefits of this new model with the aid of a comprehensive study on 46 different mortality data sets in the Valencian Region (Spain) where the benefits of the new proposed model become evident.

Ferritin status during prenatal brain development may influence the risk of attention deficit and hyperactivity disorder (ADHD) symptoms in childhood. We investigated the association of maternal ferritin in pregnancy and ADHD-like symptoms in offspring. A total of 1095 mother-child pairs from three birth cohorts of the INMA Project (Spain) were studied. Maternal plasma ferritin in pregnancy was measured at 11.57 weeks of gestation. Children&prime, s ADHD-like symptoms at ages 4&ndash, 5 years were assessed using the ADHD Rating Scale-IV. The count model of the zero-inflated Poisson regression model showed a significant inverse association between ferritin (continuous variable) and inattention, &beta, = &minus, 0.19 (&minus, 0.32, &minus, 0.07), for boys. Comparing ferritin level by tertiles, significant differences were observed between the first tertile ([1.98, 20.92]) and the second ([20.92, 38.79]) and third tertiles ([38.79, 216.5]) (mg/L).The number of symptoms was lower for those in the third tertile, &beta, 0.3 (&minus, 0.55, &minus, 0.5), and for those in the second one, &beta, 0.37 (&minus, 0.6, &minus, 0.14). The model stratification by sex also showed this inverse association for boys only, &beta, 0.21 (&minus, 0.34, &minus, 0.08). No associations were found between ferritin level and hyperactivity or total ADHD symptoms. High ferritin levels during pregnancy show a protective association with child inattentive-type ADHD symptoms.

Background Several studies have shown a substantial impact of Rotavirus (RV) vaccination on the burden of RV and all-cause acute gastroenteritis (AGE). However, the results of most impact studies could be confused by a dynamic and complex space-time process. Therefore, there is a need to analyse the impact of RV vaccination on RV and AGE hospitalisations in a space-time framework to detect geographical-time patterns while avoiding the potential confusion caused by population inequalities in the impact estimations. Methods A retrospective population-based study using real-world data from the Valencia Region was performed among children aged less than 3 years old in the period 2005–2016. A Bayesian spatio-temporal model was constructed to analyse RV and AGE hospitalisations and to estimate the vaccination impact measured in averted hospitalisations. Results We found important spatio-temporal patterns in RV and AGE hospitalisations, RV vaccination coverage and in their associated adverted hospitalisations. Overall, ~ 1866 hospital admissions for RV were averted by RV vaccination during 2007–2016. Despite the low-medium vaccine coverage (~ 50%) in 2015–2016, relevant 36 and 20% reductions were estimated in RV and AGE hospitalisations respectively. Conclusions The introduction of the RV vaccines has substantially reduced the number of RV hospitalisations, averting ~ 1866 admissions during 2007–2016 which were space and time dependent. This study improves the methodologies commonly used to estimate the RV vaccine impact and their interpretation.

Developmental exposure to bisphenol A (BPA) and other phenolic endocrine disrupting chemicals (EDCs) may affect child neurodevelopment, but data on the effects of prenatal exposure to phenols on cognitive function remain sparse. Our aim was to examine the association of placental concentrations of several phenolic EDCs, including BPA, parabens (PBs), and benzophenones (BzPs), with cognitive development in preschool children from the Environment and Childhood (INMA) Project in Spain. Concentrations of BPA, four PBs (methylparaben [MePB], ethylparaben [EtPB], propylparaben [PrPB], and butylparaben [BuPB]), and six BzPs (BzP-1, BzP-2, BzP-3, BzP-6, BzP-8, and 4-hydroxybenzophenone [4-OH-BzP]) were measured in 490 placenta samples randomly selected from five INMA cohorts collected between 2000 and 2008. Neuropsychological assessment of cognitive and motor function was performed with the McCarthy Scales of Children's Abilities (MSCA) at the age of 4-5 years. Associations were assessed in a sub-sample of 191 mother-child pairs using linear and logistic regression models adjusted for confounding factors. PB compounds were detected in more than 71% of placentas, BPA in 62%, 4-OH-BzP in 50%, and the remaining BzPs in9% of the samples. Because of the low detection frequency of BzP compounds, only 4-OH-BzP was included in the exposure-outcome analyses. After adjustment for confounders, BPA was associated with greater odds of scoring lower (below the 20th percentile) in the verbal (third vs. first exposure tertile: odds ratio [OR] = 2.78, 95% confidence interval [CI] = 1.00; 5.81, p-trend = 0.05) and gross motor (detected vs. undetected: OR = 1.75, 95%CI = 1.06; 9.29) areas, and these associations were only significant for boys. Regarding PB compounds, PrPB was associated with lower scores in memory (detected vs. undetected: β = -4.96, 95%CI = -9.54; -0.31), span memory (OR = 2.50, 95%CI = 0.95; 6.92 and 2.71, 95%CI = 0.97; 6.64, respectively for second and third tertiles, p-trend = 0.03), and motor function (β = -5.15, 95%CI = -9.26; -0.01 for third vs. first exposure tertile, p-trend = 0.04). EtPB and total PBs concentrations in the second tertile were also associated with poorer visual function of posterior cortex and worse quantitative performance, respectively, but linear trends were not statistically significant. The associations of BPA and PrPB with poorer verbal, memory, and motor skills are novel observations that warrant further attention. Larger prospective studies are required to confirm whether prenatal exposure to BPA and other phenolic EDCs is associated with impaired cognitive development.

Le App per smartphone possono essere utili per migliorare l’udito?L’obiettivo dello studio è quello valutare l’efficacia di un’App per smartphone creata con lo scopo di migliorare le performance uditive sia in soggetti normoudenti che in pazienti affetti da ipoacusia da lieve a severa. Si tratta di uno studio analitico multicentrico, eseguito tra giugno e dicembre 2017, che ha analizzato un campione di 68 pazienti di cui 55 ipoacusici e 13 normoudenti; a tutti i pazienti sono stati somministrati test audiologici specifici sia durante l’utilizzo della suddetta App che in assenza di ausili uditivi. Il protocollo di valutazione audiologica prevedeva l’esecuzione di un’audiometria tonale liminare e del WRT (word recognition test) sia nel silenzio che in competizione a differenti livelli di rapporto segnale/rumore; la batteria di test è stata eseguita sia in assenza di amplificazione uditiva che utilizzando l’App per smartphone. I pazienti sono stati sottoposti ad un sondaggio relativo all’esperienza uditiva con un questionario sviluppato ad hoc. I dati preliminari sono piuttosto incoraggianti in quanto dimostrano che l’utilizzo dell’App migliora le performance del WRT nei pazienti ipoacusici. Il test ha evidenziato un miglioramento medio del 30,3% nel silenzio, del 24,3% nel rumore con SNR (signal to noise ratio) + 10 dB e del 20,8% nel rumore con SNR+5dB. L’utilizzo dell’app è stato identificato come un fattore che migliora il riconoscimento verbale (Odds Ratio = 1,812, p0,05) e il 61% dei soggetti ha valutato come buono o eccellente la qualità del suono utilizzando l’App. L’utilizzo dell’App per smartphone ha migliorato nella maggior parte dei casi i punteggi sia all’audiometria tonale che al WRT e i pazienti con un’ipoacusia bilaterale60% hanno ottenuto i risultati migliori; tutti i pazienti sono stati soddisfatti dell’App durante l’utilizzo in cabina silente.The objective of the study is to assess whether a smartphone application (App) designed to improve hearing can improve audiological performance in patients with normal hearing and with varying grades of hearing loss (HL). This is a multicentre prospective analytical study. We performed a battery of audiological tests consisting of pure tone audiometry (PTA) and a word recognition test (WRT) in quiet and in noise at different signal-to-noise ratio (SNR) using or not a smartphone App. Intra-subject results under both conditions were compared to determine the App’s effect on hearing. A survey was also carried out to obtain data on subjective hearing experience with the App. We recruited 55 HL patients and 13 normal-hearing controls between June to December 2017. The results show that use of the App in HL patients improved WRT scores by a mean of 30.3% in quiet, 24.3% in noise + 10 dB SNR, and 20.8% in + 5 dB SNR. App use was identified as a factor that increased word recognition (odds ratio = 1.812, p0.05) and 61% of subjects rated sound quality when using the App as good or excellent. The use of a smartphone hearing App improved scores in both PTA and WRT in most cases. Patients with binaural hearing impairment60% obtained the best results. Subjective user satisfaction was good in both conditions.

Society has become thoroughly mediatised. Every aspect and part of society from the economy, politics and education to civil society and everyday social relations is immersed by media. Today we have the internet, smart phones, apps, social network services, blogs, email, and other social media platforms. Social media has brought changes to the way we inform, communicate with others, learn, play and socialize. Most people are quite well connected and communicate with others and while being connected they obtain, organize, produce and share information on a regular basis. These common routinely activities generate a large amount of information and knowledge of different forms, much of it created by ‘ordinary people’. This information is generally referred as digital social data which is potentially of great interest to social scientists (Sloan and Quan-Haase, 2017). From the emergence of the internet, both quantitative and qualitative research have been interested in analysing digital data for its endeavour. As social media have enlarged the size and variety of the traces of social actors’ actions and expressions, the analytical possibilities available for social science researchers have been reshaped too. This has brought to the fore the necessity of methodological innovations and interdisciplinary collaboration for the study of social media data. Conversely, this digital turn has generated lively debates about its potential to know the contemporary social world. While at the beginning of internet research scholars tended to study social life online as a separated from ‘real life’, researchers disputed this and argued the need for online social life to be viewed as an integral part of social life (Beneito-Montagut, 2011). Nevertheless, linking social media data to what is going on offline is still one of the challenges of digital social science research.

This paper presents theoretical and empirical evidence that an increase in tuition fees may boost university students’ academic effort. We examine the tuition fee rise introduced in 2012 by Spanish universities, where students register and pay for their chosen modules and fees increase each time students retake a module until they pass it. Data refer to students of economics, business and medicine at the University of Valencia during 2010–2014. The fact that some students pay fees in full while others are exempt from payment provides an identifying source of variation that we exploit using a flexible difference-in-differences methodology.

In the last years, industrial applications of chemometrics have largely increased due to their capacity to extract important information from complex records as chromatograms or spectra data. The use of chemometric methods also can avoid the use of detectors of elevated cost. In this work, a procedure to recognize the relevant chemical information contained in complex UV–vis chromatograms, after a trypsin digestion, to identify the three enzyme main classes (proteases, amylases and cellulases) commonly employed in the cleaning industry, has been developed. In order to recognize the chromatogram peaks, six indices of peak identity or identifiers were defined. A program written in MATLAB was elaborated to accomplish multiple comparisons between chromatograms to construct 3 rd order tensors, which contain the common peaks of two or more chromatograms. Using a training test and these tensors, the target and sample chromatograms were ordered according to the proximity to its respective class centroids. Further, the peaks with the best warranties of being correctly recognized as belonging to characteristic peptides, common to at least two chromatograms, were used to align the sample chromatograms. Afterwards, to construct an LDA model for enzyme classification, the relative peak area of the aligned and identified peaks were employed. The LDA model was validated showing a 100% of prediction capability by leave-one-out, by dividing the samples in training and evaluation sets and also by the successful prediction of some spiked real samples.

The complexity of palliative care means that the emotional distress and burden that primary family caregivers su er under can be particularly high. The objective of this study was to determine the level of burden endured by these primary family caregivers and to identify the variables that predict it in the caregiving relatives of people who require home-based palliative care. A descriptive-correlational cross-sectional study was conducted. Socio-demographic and clinical data were collected from caregivers through a self-administered questionnaire that included questions from the 12-Item Short Form Health Survey (SF-12), Zarit Caregiver Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS), Brief Resilient Coping Scale (BRCS), Post Traumatic Growth Inventory (PTGI), and Fatigue Assessment Scale (FAS). A total of 77 caregivers participated; 66.2% were women, and the mean age was 61.5 years. Most (62.3%) were providing care to cancer patients. From among these data, the presence of anxiety as a clinical problem (48.1%), a high average fatigue score (FAS) of 23.0 (SD = 8.5), and the prevalence of intense overload (41.6%) stood out. We found statistically significant correlations between the variables of burden, fatigue, post-traumatic growth, anxiety, and depression, with the latter two being the main predictive variables of burden. In addition, caregiver burden was associated with a worsening of health. Identifying the factors that influence the appearance of overburden will allow the specific needs of careers to be assessed in order to o er them emotional support within the healthcare environment., This work was supported by grants UGP-18-255 from ISABIAL, PI17/00328 from the Carlos III Health Research Institute (ISCIII) belonging to the Spanish Ministry of Health, and by FEDER (“A way of making Europe”) project funds.

Background: Trans fatty acid (TFA) intake has been positively associated with obesity in adults, although the evidence in children is scarce. There is growing evidence that TFA of industrial or natural origin may have different effects. Objectives: We aimed to explore the association between total, industrial, and natural TFA intake and overweight including obesity in 4 to 5-year-old Spanish children. Methods: We cross-sectionally analyzed data of 1744 children aged 4 to 5 from the INMA study, a prospective mother-child cohort study in Spain. We estimated the intake of total, industrial, and natural TFA in grams per day (g/day) using a validated food frequency questionnaire and expressed it as quartiles. Overweight including obesity was defined according to the International Obesity Task Force criteria. We used multiple logistic regression to estimate adjusted odds ratios (OR) and confidence intervals (95% CI). Results: After adjusting for major risk factors, the highest quartile of industrial TFA intake (>0.7 g/day) was positively associated with overweight including obesity (OR 1.57, 95% CI 1.13-2.21, P trend for quartiles 0.01). No significant associations were observed between natural TFA intake and overweight including obesity. Conclusions: In 4 to 5-year-old Spanish children, higher intake of industrial but not natural TFA was positively associated with overweight including obesity.

In 2011, the European Central Bank (ECB) developed a customized information management maturity model that was subsequently applied to assess the success of the implementation of the organizational policies, processes, and technologies supporting the information management function and to identify and priorities future activities. This chapter provides an overview of the model's objectives, design process, and principles and a comparison of the sources that were used to support its design. In addition, it provides a detailed description of the model's structure, including goals, key process areas and key practices, common features, and maturity levels. Furthermore, the chapter describes the process and the tools that the authors designed to support the maturity assessment and the results obtained during the first two applications of the model.

Background: Several studies have investigated the possible association between prenatal exposure to perfluoroalkyl substances (PFASs) and birth anthropometry. However, none has assessed fetal size longitudinally. We studied the possible association between PFASs and fetal biometry. Methods: In 1230 mother-child pairs of three cohorts from the Spanish INMA-Project, we analyzed perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) in first-trimester maternal plasma (collection: 2003-2008). We measured abdominal circumference (AC), femur length (FL), biparietal diameter (BPD), and estimated fetal weight (EFW) by ultrasounds at 12, 20, and 34 gestational weeks. We conducted multivariable linear regression analyses between log2-transformed (PFASs) and SD-scores of fetal parameters in each cohort and subsequent meta-analysis. We also assessed effect modification by sex and maternal smoking. Results: PFHxS, PFOA, PFOS, and PFNA medians were: 0.58, 2.35, 6.05, and 0.65 ng/mL, respectively. There were no associations for the whole population in any trimester of pregnancy. However, we found an indication that maternal smoking modified the effect in different directions depending on the PFAS. Among smokers (31%), we found negative associations between both PFOA and PFNA and FL or EFW at week 20 (% change ranging between -6.8% and -5.7% per twofold PFAS increase) and positive associations between PFHxS or PFOS and BPD at week 34 (6.8% and 6.3%, respectively). Conclusions: Results did not suggest an overall association between prenatal PFASs and fetal growth. The results among smokers should be taken with caution and further studies are warranted to elucidate the possible role of smoking in this association. This work was supported by grants from the European Union [FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1] and from Spain: Instituto de Salud Carlos III [Red INMA G03/176, CB06/02/0041, FIS-FEDER: PI03/1615, PI041436, PI04/1509, PI04/1112, PI04/1931, PI05/1079, PI05/1052, PI06/0867, PI06/1213, PI07/0314, PI081151, PI09/02647, PI09/00090, PI11/01007, PI11/02591, PI11/02038, PI12/01890, PI13/1944, PI13/2032, PI14/00891, PI14/01687, PI16/1288, and PI17/00663; Miguel Servet-FEDER CP11/0178, Miguel Servet-FSE: MS16/00128, and MSII16/00051; and PFIS-FI14/00099]; Alicia Koplowitz Foundation 2017; Generalitat Valenciana [FISABIO-UGP 15-230, 15-244, and 15-249]; Department of Health of the Basque Government [2005111093 and 2009111069]; the Provincial Government of Gipuzkoa [DFG06/004 and DFG08/001]; and the Generalitat de Catalunya-CIRIT [1999SGR 00241].

Highly multivariate disease mapping has recently been proposed as an enhancement of traditional multivariate studies, making it possible to perform the joint analysis of a large number of diseases. This line of research has an important potential since it integrates the information of many diseases into a single model yielding richer and more accurate risk maps. In this paper we show how some of the proposals already put forward in this area display some particular problems when applied to small regions of study. Specifically, the homoscedasticity of these proposals may produce evident misfits and distorted risk maps. In this paper we propose two new models to deal with the variance-adaptivity problem in multivariate disease mapping studies and give some theoretical insights on their interpretation.

Variable generation from chromatograms is conveniently accomplished using unsupervised rather than manual techniques. With unsupervised techniques, there is no need for selecting a few peaks for manual integration and valuable information is quickly and efficiently collected. The generation of variables can be performed by using either peak searching or moving window (MW) strategies. With a MW approach, the peaks are ignored and many variables, only part of them carrying information, are generated. Thus, variable generation by MWs should be followed by data compression to generate the variables to be further used for classification or quantitation purposes. In this work, unsupervised processing of chromatograms was performed by MWs followed by principal component analysis (MW-PCA). The principal components were selected and used as input variables for class prediction by linear discriminant analysis (LDA). Both simulated and real chromatograms were used to study the influence of both the window width and the degree of overlapping of consecutive windows on the quality of the predictions (estimated as the percentage of correctly classified chromatograms by leave-one-out). Hence, the quality of the variables generated by MW-PCA was inferred. For this purpose, a series of chromatograms containing a few peaks and belonging to four classes or categories were generated. Extra virgin olive oils of four pure cultivars were also used. In this case, a gas chromatograph provided with a flame ionization detector was used to obtain the chromatograms of fatty acid methyl esters. Windows within a wide range of moderate widths provided similar performances, and the quality of the predictions always increased with the degree of overlapping of consecutive windows. Thus, for MW-PCA variable generation, moderately wide and largely overlapped windows are recommended.

Qurrat al-ʿAyn is the name of the enigmatic Maiden who appeared alongside Ibn ʿArabī when he was inspired to recite the four verses that open The Interpreter of Desires, as he was wandering around the Kaʿba. In this article, through the analysis of the passage in which she is mentioned, the identity of the Maiden is explored from various perspectives typical of the author’s theo-anthropo-cosmovision, characterised by his concept of theophany (tajallī) or divine self-revelation, resorting especially to both the analysis of the lexical inter-reference in the roots of the Arabic terms used by Ibn ʿArabī in his Tarjumān al-ashwāq, as well as the study of the symbolism characteristic of the Arabic alphanumeric system. Furthermore, the article proposes that the kaleidoscopic structure of this collection of odes, studied here for the first time, is the result of a themenophany of the Kaʿba: the Tarjumān has been ‘‘inspired’’ by/on the Kaʿba itself, so that in a sense it is a bibliophany of the so-called House of God, to whose geometry—four corners, six faces, seven ritual turns, eight vertices—its structural conception corresponds. The symbolism of Arabic geomancy in relation to the structure of the Tarjumān is also considered.

Purpose Social isolation and loneliness are recognised social, health and wellbeing problems that particularly affect later life. They have been the subject of many recent studies. Studies examining the role of the internet in addressing these problems have multiplied. However, it is still not known whether internet-mediated social interaction has any role in mitigating social isolation and or loneliness. To address this gap, the purpose of this paper is to review previous research that investigates the relationship between internet use for communication and social isolation and loneliness. Design/methodology/approach This paper reviews the empirical literature published since 2000 and expands on previous literature reviews by including a variety of research designs and disciplines. Findings Despite the recent increase in studies, there is still little evidence to show internet effects on social isolation and loneliness. It is concluded that future research programmes aimed at reducing them by the use of the internet should include more robust methodological and theoretical frameworks, employ longitudinal research designs and provide a more nuanced description of both the social phenomena (social isolation and loneliness) and internet-mediated social interaction. Originality/value Previous reviews are not restricted to internet-based studies and include several types of interventions aiming at reducing social isolation and/or loneliness. They do not attempt to disentangle the internet effects of social isolation and loneliness.

Objective To develop a method to estimate vaccination coverage using both a computerized vaccine registry with an unknown underreporting rate and a seroprevalence study. A real example of a meningococcal C conjugate vaccine (MCCV) coverage estimation is studied to illustrate the proposed methodology. Methods We reviewed the Vaccine Information System of Valencia (Sistema de Informacion Vacunal, SIV) for the MCCV status of 1430 subjects aged 3–29 years as part of a seroprevalence study. When MCCV was not registered in SIV, subjects were classified into three groups (MCCV non-registered, no vaccination records and missing information) depending on the registry of other vaccines. A Bayesian model was developed to ascertain the percentage of MCCV-vaccinated subjects based on the meningococcal C seroprotection levels from the seroprevalence study. Results The seroprotection levels in subjects with no MCCV registered in SIV (358) were similar to those in subjects with MCCV registered (1072). This indicated a large proportion of vaccinated subjects with no MCCV registered. The estimated vaccine coverage was over 80% in all age groups, except >22 years, where it was 67.6% (95% CI: [54.0–80.4]), which corresponded to those aged over 13 years at the time of the catch-up campaign. An underreporting rate of 23.5–73.4%, depending on the age group, was estimated in those vaccinated in the 2002 catch-up campaign. Conclusion The Bayesian model allowed for a more realistic estimation of MCCV uptake. In this example, we quantified the underreporting of a vaccine registry, especially occurring during a catch-up campaign that occurred at the establishment of the registry.

Aim: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. Methods: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996–2001; 2002–2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. Results: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996–2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32–15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25–7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). Conclusions: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions. This work was partially supported by FIS (PI0426, PI081488, PI080330, PI081017, PI081713), the DGA (PI126/08), FUNCIS (PI84/07), Fundación Caja Murcia (FFIS/CM10/27), and by CIBER Epidemiología y Salud Pública (CIBERESP).

In this paper we analyse the effect of ownership on the response of firms’ R&D expenditures to the business cycle, using a panel dataset of Spanish manufacturing firms for the period 1990–2006. Following Aghion et al. (2012, Journal of the European Economic Association), we allow the impact of the business cycle on firms’ R&D expenditures to depend upon credit constraints, but we extend their analysis by considering the moderating effect of different firms’ ownership types. We find that firms’ R&D spending is countercyclical but that credit constraints may reverse this counter cyclicality, in line with previous results in the literature. However, our findings indicate that these results are moderated by firms’ ownership. In particular, in the case of firms that are family owned and firms that are group affiliated, the responsiveness of R&D to the business cycle is considerably less dependent on being credit constrained, especially during recessions.

Spatio-temporal disease mapping can be viewed as a multivariate disease mapping problem with a given order of the geographic patterns to be studied. As a consequence, some of the techniques in multivariate literature could also be used to build spatio-temporal models. In this paper we propose using the smoothed ANOVA multivariate model for spatio-temporal problems. Under our approach the time trend for each geographic unit is modeled parametrically, projecting it on a preset orthogonal basis of functions (the contrasts in the smoothed ANOVA nomenclature), while the coefficients of these projections are considered to be spatially dependent random effects. Despite the parametric temporal nature of our proposal, we show with both simulated and real datasets that it may be as flexible as other spatio-temporal smoothing models proposed in the literature and may model spatio-temporal data with several sources of variability.

The purpose of this study was to examine if the short semi-quantitative food frequency questionnaire (FFQ) is a reliable and valid tool to assess the diet of Spanish children aged 7&ndash, 9 years. We collected data from 156 children of the birth cohort INMA (Infancia y Medio Ambiente (Environment and Childhood)). Children&rsquo, s parents or care-givers completed a 46-item FFQ on two occasions over a 9&ndash, 12-month period about the children&rsquo, s diet. To explore the reproducibility of the FFQ, the nutrient and food group intake collected from the both FFQs were compared, while validity was examined by contrasting the nutrient values from the FFQs and the average of three 24-hour dietary recalls (24hDRs) taken in this period, and also with the concentration of several vitamins in the blood (carotenoids, vitamin D and &alpha, tocopherol). Pearson and de-attenuated correlation coefficients were calculated. The average correlation coefficients for nutrient intake&rsquo, s reproducibility was 0.41, ranging from 0.25 (calcium) to 0.65 (&beta, carotene), and for food group intake was 0.45, ranging from 0.18 (cereals) to 0.68 (sweetened beverages). Correlation coefficients slightly improved when we compared energy-adjusted intakes. The average correlation coefficients for validity against 24hDRs was 0.34 for energy-adjusted intakes, and 0.39 when de-attenuation coefficients were used. The validity coefficients against the blood concentrations of vitamins were 0.38 for &beta, cryptoxanthin, 0.26 for lycopene, 0,23 for &alpha, carotene and 0.15 for &beta, carotene, all of them statistically significant (p &lt, 0.05). This study suggests that our brief FFQ is a suitable tool for the dietary assessment of a wide range of nutrients and food groups in children 7&ndash, 9 years, despite the low to moderate reproducibility and validity observed for some nutrients.

The paper aims to contribute to the sociological analysis of power through the study of the structuration and retrieval of information on the internet. The main argument of the paper is that, paradoxically, in an age when the availability of information has increased exponentially, there is a risk that diversity in the use of sources for the construction of knowledge becomes more restricted than in the past and that information search moves towards greater objectification and centralisation. Knowledge management systems increasingly shape the ways in which we think about the questions we ask and how we try to answer them, which raises fundamental and largely neglected questions for education policy. The paper illustrates these trends with particular reference to the use of Google and Google Scholar.

Meningococcal C conjugate (MCC) vaccination programs provide direct and indirect protection against meningococcal disease. However, a decrease in the antibodies could affect herd immunity. We conducted a seroprevalence study to assess the immunity in subjects 8-12years after different MCCV vaccination programs were launched and evaluated the impact of vaccination on seroprotection.Seroepidemiological study conducted from October 2010 to April 2012 in the region of Valencia, Spain. Sample size was not proportional to the population but to the expected seroprotection by age group. Sera from subjects that were≥3years old were tested using a standardized complement-mediated serum bactericidal antibodies (SBA) assay. Age-stratified proportions of subjects with SBA titers≥8 were considered seroprotected and evaluated. A multivariate logistic regression model was performed to evaluate the impact of vaccination on the seroprotection.Serum samples from 1880 subjects were collected. In total, 523 (27.8%) of the 1880 subjects and 446 (31.2%) of the 1430 subjects30years (targeted to any vaccination campaign) showed protective SBA titers. The highest percentage of seroprotected subjects (67.8%, 95%CI 56.9-77.4) was observed in those that were vaccinated in a catch-up campaign at 10-13years of age (20-21years old at the time of blood sampling). Those scheduled for immunization in infancy at 2, 4 and 6months of age (7-8years at blood sample) represented the lowest (7.1%, 95% CI 3.3-13.1) number of seroprotected subjects. Having received one vaccine dose after 12months of age was associated with increased seroprotection. The present study revealed a positive correlation between the increasing age at vaccination and longer duration of seroprotection.Only one in three subjects who were vaccinated with MCC vaccine was seroprotected after 8-12years. These findings emphasize that seroprevalence studies are essential to identify susceptible cohorts and to inform vaccine policy.

Background: In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. Methods: Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996– 1998 and 2005–2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). Results: For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12–1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09–1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05–1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02–1.06 in the 2nd period). Conclusions: In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities This article was partially funded by Plan Nacional de I + D + I 2008–2011 and Instituto de Salud Carlos III (ISCIII) –Subdirección General de Evaluación y Fomento de la Investigación- (Award numbers: PI081488, PI081978, PI080367, PI08/1017, PI080330, P08/0142, PI081785, PI080662, PI081713, PI081058, PI081340, PI080803, PI126/08), Fundación Canaria de Investigación Sanitaria FUNCIS 84/07 and by CIBER Epidemiología y Salud Pública (CIBERESP) SI

The article argues that current discussions about governance through data in education can be fruitfully extended through: (1) the establishment of connections with wider debates about the role of commensuration processes and governmentality in the recreation of education systems; (2) greater emphasis on the ‘artefacts’ through which data – increasingly in the form of digital data – is collected, displayed and retrieved; and (3) the strategies of alignment and resistance that social actors adopt to deal with the increase in data availability and capacity for the automated interrogation of that data. The article concludes that these artefacts and strategies are providing a wide set of ‘active’ social actors with new resources in, and arenas for, their struggles for economic as well as social advancement, processes of self-monitoring and also, crucially, of self-formation. The article focuses on the interplay and tensions between governments and bureaucracies, private companies, education institutions, and various types of ‘active’ individuals (the individual customer, the individual manager and the individual worker) in the process of surveillance and recreation of education through digital data.

Ethnographic research is increasingly concerned with how the internet operates within our everyday life. This article attempts to offer a methodological contribution of online communication and an exploration of initial empirical data generated with this methodology. The article calls for a specification of how ethnography can be applied appropriately to the study of relationships online. It departs from the real versus virtual dichotomy, offering a user-centred methodology to study interpersonal communications on the internet. It suggests the use of three main strategies to pay tribute to the characteristics of uses online: multi-situated, online and offline, and flexible and multimedia data collection methods. This approach facilitates a holistic analysis of the way in which social information and communication technologies operate within society in everyday life. It deals with the problem of defining the setting of research online and proposes an expanded ethnography. The article specifies details of this methodology for research into interpersonal communications and emotions online. It does so by drawing on empirical data generated in a study on everyday life and emotions on the internet. Epistemic questions related to this methodological approach will also be discussed. Overall, the exemplification suggests that the methodological approach proposed here is able to capture the uses and understandings of the internet.

This paper covers the design of a DC–DC power converter aimed for hydrogen production from photovoltaic sources. Power conditioning for such application is usually driven by different constraints: high step-down conversion ratio is required if the input voltage of such equipment has to be compatible with photovoltaic sources that are connected to grid-connected inverters; galvanic isolation; high efficiency and low mass. Taking into account those factors, this work proposes a push–pull DC/DC converter for power levels up to 5 kW. The operation and features of the converter are presented and analyzed. Design guidelines are suggested and experimental validation is also given.

Renewable energy sources such as wind turbines and solar photovoltaic are energy sources that cannot generate continuous electric power. The seasonal storage of solar or wind energy in the form of hydrogen can provide the basis for a completely renewable energy system. In this way, water electrolysis is a convenient method for converting electrical energy into a chemical form. The power required for hydrogen generation can be supplied through a photovoltaic array. Hydrogen can be stored as metal hydrides and can be converted back into electricity using a fuel cell. The elements of these systems, i.e. the photovoltaic array, electrolyzer, fuel cell and hydrogen storage system in the form of metal hydrides, need a control and monitoring system for optimal operation. This work has been performed within a Research and Development contract on Hydrogen Production granted by Solar Iniciativas Tecnologicas, S.L. (SITEC), to the Politechnic University of Valencia and to the AIJU, and deals with the development of a system to control and monitor the operation parameters of an electrolyzer and a metal hydride storage system that allow to get a continuous production of hydrogen.

Multilevel analysis has been widely used to allow the simultaneous examination of the effects of individual- and group-level variables on individual health outcomes. In spite of its utility, multilevel design can have some drawbacks in the estimation of risk factor effects when the within-group variation of variables of interest is small relative to between-group variation. An extreme case of this is a group-level risk factor, which by definition has no within-group variation. To improve the estimation of group-level and individual-level risk factor effects, we consider an integrated epidemiologic design using a population-based estimating equation approach that can be considered a further extension of the multilevel design. Although the integrated design uses the same individual-level and group-level data as the multilevel design, it includes aggregated health outcome data in each group as additional information. This paper explains differences between the 2 designs, describing advantages and disadvantages of the integrated design over the multilevel design. The 2 designs are applied to a real example of mortality following chronic kidney disease, illustrating differences that might be encountered in practice.

PurposeThe purpose of this paper is to explore the practice of records retention in relation to statistical records and to provide answers and solutions to the challenge of retention from two perspectives: by offering some recommendations on how to approach the identification of validated retention periods and by presenting findings resulting from the practical use of this recommended approach.Design/methodology/approachThe research presented in this paper was conducted for the final dissertation of the BSc (Hons) Information and Records Management Programme at the University of Northumbria. A Delphi study was used as the method to achieve the research objectives.FindingsWhile answers to the question of what retention value should be attributed to records vary enormously depending on who is asked, this research shows that the involvement of end‐users to gather feedback and attempt to reach a consensus of opinions on retention periods is successful and provides meaningful results, and can also help in gaining end‐user support in the subsequent schedule implementation.Practical implicationsSuccessful implementation of a retention schedule is more likely to happen if end‐users are involved from the start in the design process and if they understand the benefits of this tool. In this respect, involving end‐users in the retention decisions throughout the performance of a Delphi Study has revealed to be very effective and is therefore recommended for attaining similar objectives.Originality/valueThe paper presents a validated method for assigning retention values to records that could be applied by practitioners in other organisations. Further information on the resulting retention schedule can be obtained by contacting the author.

Background Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process This work was partly supported by the FIS-FEDER projects PI080330, PI081713, PI081978, PI0463/2010, PI081017, PI081785, PI081058, PI080142, and the FUNDACIÓN CAJAMURCIA project FFIS/CM10/27

Background Although rotavirus vaccines have been licensed in Spain for over 8 years, they are not funded by its public health systems. The analysis of their effectiveness in the Valencia Region could better inform decisions about potential inclusion in the official immunization schedule. Our aim was to assess the effectiveness of Rotarix® (RV1) and RotaTeq® (RV5) against rotavirus hospitalizations. Methods We conducted a retrospective cohort study using the region’s health care databases, among resident children aged

Web interfaces play a very important role in teaching-learning processes in virtual environments, since this is how students carry out their activity. This paper describes a web interface for online learning based on a graphic map that orients learners, tries to reduce cognitive overload, gives access to learning resources and personalizes learning. The interface was designed to guide the learning process in accordance with Shapiro’s “site map principle”. The objective of this article is to analyze the impact of such web interface on students' satisfaction with the learning process and on their academic performance. We conducted experimental research. The experiment tested the goodness of the interface among students enrolled in a Multimedia Degree in an open university. We used the T-Test, the Chi-square Test and the Kendall correlation Test. The results showed that the interface had a positive impact on students’ satisfaction and performance. It also encouraged students to take a more proactive role in their learning activity than with the “normal” interface. These results are in keeping with the features the site map principle has shown in face-to-face environments.

Resumen Objetivo Con la introduccion de los Potenciales Evocados Auditivos de estado estable (PEAee), se hace necesario el establecimiento de las posibilidades y limitaciones de esta tecnica para establecer su valor en el ambito clinico. Mediante este trabajo se han comparado los umbrales auditivos obtenidos mediante PEAee con los umbrales conductuales aportados por la Audiometria Tonal Liminar (ATL) al considerar estos ultimos como "gold standard". Materiales y metodos Se obtuvieron los umbrales auditivos a una muestra de 84 oidos mediante PEAee a multifrecuencia de forma monoaural, y los umbrales conductuales mediante ATL. Los valores obtenidos se procesaron para calcular sus correlaciones y otras variables. Resultados Los PEAee aportan umbrales algo mayores de los umbrales conductuales, con una diferencia media de 23 dB. Esta diferencia disminuye en frecuencias altas y sujetos hipoacusicos. Conclusion Los PEAee a multifrecuencia posibilitan la determinacion de umbrales auditivos objetivamente, siendo mas aproximados al aumentar la frecuencia de estimulacion y el grado de hipoacusia. Se hace necesario el establecimiento de protocolos de exploracion que aseguren el maximo rendimiento de la tecnica. Mediante este trabajo proponemos un algoritmo diagnostico con el que llevarla a cabo.

Resumen Presentamos un caso de sinusitis frontal complicada con empiema subdural, en la que el microorganismo identificado fue Gemella morbillorum , un comensal de la via aerodigestiva que en ocasiones se asocia con infecciones fulminantes. El caso fue resuelto con exito mediante cirugia endoscopica nasal y abordaje externo del seno, complementado posteriormente con drenaje subdural mediante craniectomia. El empiema subdural es una infrecuente pero muy grave complicacion de la sinusitis. Mediante este trabajo hacemos enfasis en la importancia de la deteccion precoz de las complicaciones craneales, la necesidad de un estudio microbiologico detallado, el metodo utilizado para obtencion de las muestras, y la conveniencia de un abordaje combinado ORL y neuroquirurgico para su completo drenaje.

We report a case of a 79-year-old woman presenting subglottic tumor whose hystopathological study was MALT-type lymphoma. After excluding the possibility of systemic dissemination, local radiotherapy treatment was applied. The interest of this study lies in the rare involvement of haematopoietic neoplasms in the larynx, especially the MALT-type in subglottic location. We review the literature on this subject, exposing the clinical, therapeutical and follow up data in respect to the initial location of the lymphoma.

Background: While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). Methods: All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders. Results: Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. Conclusions: Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth. This work was partly supported by the FIS-FEDER projects PI040170 and PI080330.

Background The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. Conclusions This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered. This article was partially funded by Ministerio de Economia y Competitividad via the research grant MTM2010-19528 (jointly financed with European Regional Development Fund), the FIS-FEDER projects: PI042013, PI040041, PI040170, PI040069, PI042602, PI040388, PI040489, PI042098, PI041260, PI040399, PI08/1488, PI08/0330 and by the CIBER Epidemiología y Salud Publica (CIBERESP), Spain SI

Objective: To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. Design: A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. Results: The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia – the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia – the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. Conclusions: The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia. Key words:Anesthesia, intraosseous, oral anesthesia, infiltrating, mandibular block, Quicksleeper®.

La presente Guía de Aprendizaje, elaborada por Guillermo de la Iglesia, tiene como objetivo adquirir el conocimiento del entorno de producción de Fireworks y sus múltiples alternativas de creación gráfica.

Background: This article affords an overview of the patterns and time trends of childhood cancer incidence (1983–2002) and survival (1991–2002) in Spain. Patients and methods: A population-based study was conducted, including 5936 cases for incidence and 3257 for survival analyses. Differences in incidence were tested with the standardised incidence ratio. Trends were analysed for all tumours, and for all malignant, haematological, central nervous system (CNS) (all and only malignant) and other solid tumours. Incidence trends were analysed using Poisson and Bayesian joinpoint models. Observed, relative and age-adjusted survival rates were calculated, and trends were tested using the log-rank test. Results: The incidence pattern in Spain was similar to that in Europe. Rates, both overall and for leukaemias, lymphomas, CNS, soft tissue and, remarkably, for sympathetic nervous system and bone tumours, were high. Upward incidence trends were present for all tumour groups. All groups, except solid tumours (excluding CNS), displayed a change-point centred around 1990–95, after which the trend stopped rising. Five-year survival increased significantly across the period for all groups, except for CNS tumours. Recent survival results were in line with Italy, the UK and the European average. Conclusions: To confirm these results, ongoing surveillance of incidence and survival trends, and studies targeting specific tumours are called for.