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(1) Background: Mental health problems are associated with negative connotations that may lead to discrimination and rejection of people diagnosed with mental disorders. The present study aimed to develop and validate a new scale (the Spanish Social Stigma Scale—S3) to assess the current level of social stigma in the general Spanish population. (2) Methods: The assessment tool was developed after reviewing the items of existing tools that represent the most appropriate indicators for the assessment of social stigma. A review was performed by volunteer subjects and by a group of experts in the field, based on the participation of 563 respondents to a survey. (3) Results: The confirmatory factor analysis revealed that the developed tool fits with the factors that determine the level of social stigma and shows good internal consistency (χ2SB = 412.0321, gl = 293, p < 0.01; BBNNFI = 0.922; CFI = 0.930; IFI = 0.931; RMSEA = 0.028 [0.022, 0.035]). (4) Conclusions: The S3 is useful for assessing knowledge, attitudes, and behavior towards people diagnosed with a mental disorder. This tool may be used for the identification and development of mechanisms necessary for the reduction of social stigma in the general population. [ABSTRACT FROM AUTHOR]

Objective: To contribute to the recognition of psychotherapeutic nursing (PTN) as a regulated advanced clinical practice (ACP) in Spain, as is the case in other countries. Background: Nurses are continually evolving to improve overall health outcomes. PTN has become a reality, with several authors describing it as an ACP. In Spain, psychotherapy is not officially regulated, which has led to a significant number of psychiatric nurses adopting an important ACP in this area without recognition. Sources of evidence: Evidence confirms that PTN possesses the attributes necessary to be considered an ACP. Nurses, like psychotherapists, independently address the complex needs of individuals and families within the context of therapeutic relationships, and there is a pressing need to advance formal processes of regulation and certification. Discussion: PTN has evolved at different rates depending on local initiatives, policies and various professional interests. In Spain, it is crucial to evaluate its outcomes, recognise it as an ACP and develop training plans for its regulation and accreditation. Conclusions: Mental health nurses in Spain have a strong interest in PTN being recognised as an ACP. To this end, they should join forces with other partners, scientific associations and international bodies such as the International Council of Nurses (ICN) to make PTN an internationally recognised ACP. Implications for nursing practice: Psychotherapeutic nurses could contribute to improving mental health outcomes, client satisfaction and health system efficiency, and their formal recognition is an opportunity to enhance their professional identity, competence and autonomy. Implications for nursing policy: Nursing policy needs to be reoriented towards strengthening psychotherapy as an ACP. Synergies and alliances between international nursing associations and the ICN can promote its development and implementation, while research, education and leadership are essential to achieving official regulation and accreditation. [ABSTRACT FROM AUTHOR]

Background/Objectives: To analyze changes in the prevalence of atrial fibrillation (AF) in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD); to evaluate hospital outcomes according to AF status, assessing sex differences; to identify factors associated with AF presence; and to analyze variables associated with in-hospital mortality (IHM) in AE-COPD patients with AF. Methods: We used data from the Registry of Specialized Care Activity-Basic Minimum Data Set (RAE-CMBD) to select patients aged ≥40 years with COPD in Spain (2016–2021). We stratified the study population according to AF presence and sex. The propensity score matching (PSM) methodology was employed to create comparable groups based on age, admission year, and comorbidities at the time of hospitalization. Results: We identified 399,196 hospitalizations that met the inclusion criteria. Among them, 20.58% had AF. The prevalence of AF rose from 2016 to 2021 (18.26% to 20.95%), though the increase was only significant in men. The median length of hospital stay (LOHS) and IHM were significantly higher in patients with AF than in those without AF. After PSM, IHM remained significantly higher for man and women with AF. Older age, male sex, and several comorbidities were factors associated with AF. Additionally, older age, male sex, different comorbidities including COVID-19, hospitalization in the year 2020, mechanical ventilation, and intensive care unit (ICU) admission were associated with higher IHM in patients with AE-COPD and AF. Conclusions: AF prevalence was high in patients hospitalized for AE-COPD, was higher in men than in women, and increased over time. AF presence was associated with worse outcomes. The variables associated with IHM in hospitalized AE-COPD patients with AF were older age, male sex, different comorbidities including COVID-19 presence, hospitalization in the year 2020, need of mechanical ventilation, and ICU admission. [ABSTRACT FROM AUTHOR]

Mycoplasma bovis (M. bovis) is one of the worldwide most important infectious agents involved in respiratory complex diseases (RCD). In Spain, the endemic presence of subtypes ST-2 and ST-3 with phenotypic differences linked to their susceptibility to fluoroquinolones opened the way to develop control strategies focused on previous diagnosis of the subtype and the use of directed therapies when M. bovis were involved in RCD. Surprisingly, microbiological studies conducted during 2023 evidenced for the first time the presence of Spanish isolates of a new polC-subtype, previously classified as ST-1, recovered from calves with respiratory symptoms and pneumonia in different areas of the country (n = 16). Curiously, the minimum inhibitory concentration (MIC) to a panel of antimicrobials revealed phenotypic differences between these ST-1 isolates when using fluoroquinolones (FLQ). There is no geographical correlation between MIC profiles even for a set of 8 isolates recovered from different animals in the same flock. Sequencing of 4 genes (gyrA, gyrB, parC and parE) encoding quinolone resistance-determining regions (QRDR) evidenced the presence of accumulate mutations in 2 ST-1 isolates with high FLQ MICs, but not in all them (n = 3), thus suggesting that, as previously recorded for ST-2 isolates, other mechanisms should be involved in the acquisition of resistence to these antimicrobials. Additionally, as previously detected in the Spanish ST-2 and ST-3, subtype ST-1 isolates are also resistant to macrolides or lincosamides. [ABSTRACT FROM AUTHOR]

(1) Background: Healthy aging is the process of developing and maintaining functional capacity and optimizing involvement in order to improve one's quality of life as people age. This study aimed to encourage healthy aging in people with cognitive impairment, as well as a control group, via the use of the Nintendo Switch combined with occupational therapy sessions, aiming to improve gross and fine motor skills, functionality, quality of life, and cognitive status. (2) Methods: A randomized clinical trial was undertaken. The sample was randomized using the OxMar software program Attribution 4.0 International, facilitating the division into a control group (CG), who received conventional occupational therapy sessions, and an experimental group (EG), who received therapy incorporating the Nintendo Switch, in addition to conventional occupational therapy sessions. The intervention period with the Nintendo Switch lasted for 8 weeks. (3) Results: Thirty-two participants were included in the study. Significant differences were found in the vast majority of the variables analyzed, which shows an improvement following the intervention; these improvements were mainly observed in measures of skill and the perception of quality of life. (4) Conclusions: An eight-week intervention with the Nintendo Switch alongside conventional occupational therapy helps to maintain cognitive status and functional independence. Following 8 weeks of intervention with the Nintendo Switch, improvements in gross motor dexterity, fine motor dexterity, and quality of life were observed in older people with cognitive impairment. [ABSTRACT FROM AUTHOR]

Introduction: Primary aldosteronism (PA) is associated with several cardiometabolic comorbidities. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA. Aim: To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account. Methods: A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy. Results: Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months' follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18–0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52–1.73]). Conclusion: Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy. [ABSTRACT FROM AUTHOR]

(1) Background: Anaphylaxis is a rapid-onset, life-threatening hypersensitivity reaction. This study explores the epidemiological trends and clinical outcomes of adult patients with and without asthma hospitalized for anaphylaxis in Spain from 2016 to 2021. (2) Methods: Data from the Spanish National Hospital Discharge Database (RAE-CMBD) were analyzed. We stratified patients with anaphylaxis based on their asthma diagnosis and evaluated various comorbidities and clinical outcomes. Propensity score matching was used to match confounders. (3) Results: The total number of hospitalizations for anaphylaxis remained stable, with a decrease in 2020 probably due to the COVID-19 pandemic. Drug-induced anaphylaxis increased, in addition to being the main triggering factor. Asthma prevalence among those admitted for anaphylaxis emerged from 7.63% to 10.69%, with a higher frequency of respiratory failure and need for mechanical ventilation in this group; despite this, ICU admissions and in-hospital mortality did not differ significantly between asthmatics and non-asthmatics. Asthma was also not a risk factor for severe anaphylaxis. Multivariable analysis identified advanced age, ischemic heart disease, acute respiratory failure, and invasive mechanical ventilation as factors associated with severe anaphylaxis. (4) Conclusions: This study provides valuable information on the complexity of anaphylaxis, its relationship with asthma, and factors influencing its severity. Overall, clinical outcomes did not differ significantly in asthmatic patients compared to non-asthmatic patients, although asthmatic patients had more respiratory complications. Further research is necessary to delve deeper into the multifactorial nature of anaphylaxis and its implications in clinical practice. [ABSTRACT FROM AUTHOR]

In 2020, the COVID-19 pandemic followed a two-wave pattern in most countries. Hospital admission for COVID-19 in one wave or another could have affected mortality, especially among the older persons. The objective of this study was to evaluate whether the admission of older patients during the different waves, before SARS-CoV-2 vaccination was available, was associated with a different mortality. We compared the mortality rates of patients hospitalized during 2020 before (first wave) and after (second wave) July 7, 2020, included in the SEMI-COVID-19 Registry, a large, multicenter, retrospective cohort of patients admitted to 126 Spanish hospitals for COVID-19. A multivariate logistic regression analysis was performed to control for changes in either the patient or disease profile. As of December 26, 2022, 22,494 patients had been included (17,784 from the first wave and 4710 from the second one). Overall mortality was 20.4% in the first wave and 17.2% in the second wave (risk difference (RD) − 3.2%; 95% confidence interval (95% CI) − 4.4 to − 2.0). Only patients aged 70 and older (10,973 patients: 8571 in the first wave and 2386 in the second wave) had a significant reduction in mortality (RD − 7.6%; 95% CI − 9.7 to − 5.5) (unadjusted relative risk reduction: 21.6%). After adjusting for age, comorbidities, variables related to the severity of the disease, and treatment received, admission during the second wave remained a protective factor. In Spain, patients aged 70 years and older admitted during the second wave of the COVID-19 pandemic had a significantly lower risk of mortality, except in severely dependent persons in need of corticosteroid treatment. This effect is independent of patient characteristics, disease severity, or treatment received. This suggests a protective effect of a better standard of care, greater clinical expertise, or a lesser degree of healthcare system overload. [ABSTRACT FROM AUTHOR]

(1) Background: Worldwide, asthma, back pain, and migraine are major public health problems due to their high prevalence, effect on the quality of life, and huge economic costs. The association of asthma with an increased risk of these types of pain has been suggested; however, no conclusive results have been obtained to date. The aims of our study were (1) to describe and compare the prevalence of three types of pain localization, namely migraine or frequent headaches (MFH), chronic neck pain (CNP), and chronic low back pain (CLBP), in adults with and without asthma in Spain during the years 2014 and 2020 and (2) to identify which variables were associated with the presence of these types of pain in adults with asthma. (2) Methods: A cross-sectional study and a case–control study were conducted. The 2014 and 2020 European Health Interview Surveys for Spain were used as the data source. (3) Results: A total of 2463 individuals were interviewed and had self-reported asthma. In this group, the prevalence of pain was high, with CLBP (30.9%) being the most common, followed by CNP (26.7%) and MFH (13.3%). All types of pain remained stable from 2014 to 2020. In both surveys, the women with asthma reported a remarkably higher prevalence of all the types of pain analyzed than the men with asthma. After matching by age and sex, the prevalence of all pain types was significantly higher in the patients with asthma than in the matched individuals without asthma. Multivariable adjustment showed that asthma increased the likelihood of CNP by 1.45 times (OR 1.45; 95% CI 1.19–1.76), that of CLBP by 1.37 times (OR 1.37; 95% CI 1.11–1.64), and that of MFH by 1.19 times (OR 1.19; 95% CI 1.02–1.51). The three types of pain analyzed were associated with the female sex and worse self-rated health. (4) Conclusions: Among the men and women with asthma, the prevalence of all the pain types was high and remained stable over time. The prevalence was higher and the severity was greater among the women with asthma than among the men with asthma. The prevalence of any pain was significantly higher in people with asthma than in the sex–age-matched individuals without asthma. Multivariable analysis showed that the variables associated with the reporting of the three types of pain in people with asthma were female sex, worse self-reported health, and self-reported mental illness. [ABSTRACT FROM AUTHOR]

(1) Background: We analyzed the association between atrial fibrillation or atrial flutter (AF) and in-hospital mortality (IHM) among patients who underwent solid organ transplants in Spain from 2004 to 2021. (2) Methods: We gathered information from all hospital admissions for lung, liver, kidney, and heart transplants. (3) Results: A total of 71,827 transplants were analyzed (4598 lung transplants; 18,127 liver transplants; 45,262 kidney transplants; and 4734 heart transplants). One third of these were for women. Overall, the prevalence of AF was 6.8% and increased from 5.3% in 2004–2009 to 8.6% in 2016–2021. The highest prevalence of AF was found for heart transplants (24.0%), followed by lung transplants (14.7%). The rates for kidney and liver transplants were 5.3% and 4.1%, respectively. The AF code increased over time for all of the transplants analyzed (p < 0.001). The patients' IHM decreased significantly from 2004–2009 to 2016–2021 for all types of transplants. AF was associated with a higher IHM for all of the types of transplants analyzed, except for heart transplants. (4) Conclusions: The prevalence of AF among patients admitted for solid organ transplants was highest for those who underwent heart transplants. The mortality rate during the patients' admission for lung, liver, kidney, or heart transplants decreased over time. AF was independently associated with a higher risk of dying in the hospital for those who underwent lung, liver, or kidney transplants. [ABSTRACT FROM AUTHOR]

This article discusses various cases of bone marrow failure syndrome (BMFS) caused by mutations in the ERCC6L2 gene. BMFS is a group of disorders characterized by low blood cell counts and often presents in infancy. The article compares different cases and provides a table summarizing families diagnosed with BMFS worldwide. Another document presents a table of genetic variants found in patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), providing information on the type, pathogenicity, and frequency of the variants. Lastly, a case study of two siblings diagnosed with BMFS-2 is presented, highlighting the importance of early detection and genetic analysis for guiding treatment. [Extracted from the article]

(1) Background: Alcohol consumption during pregnancy is a major concern, particularly in Europe and North America. Its prevalence has so far been under-researched. In most studies, the determination of this consumption may be underestimated, as it is based on the information obtained from questionnaires rather than from biomarkers, which will provide a much more reliable approach. The main objective of this study was to compare the prevalence of consumption during pregnancy as assessed by a questionnaire and a hair biomarker. (2) Method: A cross-sectional study with a random sample of 425 pregnant women treated in public hospital consultations in Seville (Spain) and in the 20th week of their pregnancy, orally interviewed using an elaborated ad hoc questionnaire that evaluated variables of sociodemographic, obstetric, and alcohol consumption. Furthermore, the ethyl glucuronide metabolite (EtG) was tested on a hair sample in 252 pregnant women who agreed to facilitate it. Once the data obtained through the questionnaire and hair test were analyzed, the level of metabolites and self-reported alcohol consumption were compared. (3) Results: The prevalence of self-reported alcohol consumption (questionnaire) was 20.7%, and the real consumption (metabolite analysis) was 20.2%. In 16.8% of pregnant women who declared not consuming alcohol during their pregnancy, noticeable consumption was detected according to the metabolite test. No relevant level of variability in estimated alcohol consumption was detected in the biomarker with respect to the sociodemographic and obstetric variables studied. (4) Conclusions: The prevalence of alcohol consumption during pregnancy obtained through both questionnaires and metabolite analyses was similar and high. There is no association between consumption and sociodemographic factors in this sample. The determination of consumption through biomarkers allows for a more accurate approximation of the prevalence of consumption than estimated through questionnaires. Larger sample-sized studies are needed to determine consumption patterns and thus guide the adoption of more precise policies fostering abstinence from alcohol consumption since the preconception period. [ABSTRACT FROM AUTHOR]

(1) Background: To assess and compare the temporal trends in the incidence, characteristics and hospital outcomes among children with and without asthma who were hospitalized with anaphylaxis in Spain from 2016 to 2021, and identify the variables associated with severe anaphylaxis among children with asthma. (2) Methods: An observational, retrospective study was conducted using a population-based database. The study population included pediatric patients with anaphylaxis. This population was stratified based on whether they had asthma. (3) Results: The number of hospital admissions was stable from 2016 to 2019, dropping in 2020 and raising to the highest number in 2021. A total of 60.63% of hospitalizations occurred in boys and the most common anaphylactic reactions were due to food consumption (67.28%), increasing over time. The in-hospital mortality (IHM) remained stable and under 1% in all the years studied. The incidence of anaphylaxis was 2.14 times higher in children with asthma than in those without asthma (IRR 2.14; 95% CI 1.87–2.44). Furthermore, it was 1.79 times higher in boys with asthma than in those without asthma (IRR 1.79; 95% CI 1.06–2.45) and 2.68 times higher in girls with asthma than in those without asthma (IRR 2.68; 95% CI 2.23–3.12). Asthma was not associated with severe anaphylaxis (OR 1.31; 95% CI 0.88–1.96). (4) Conclusions: The number of hospitalizations for anaphylaxis in children remained stable from 2016 to 2019, dropping in 2020 and recovering in 2021. IHM was low and remained stable during the study period. The incidence of hospitalizations for anaphylaxis was higher in asthmatic children than in non-asthmatics, but there were no differences in the occurrence of severe anaphylaxis among them. [ABSTRACT FROM AUTHOR]

For some people, a part-time job is merely an intermediate state that serves as a "stepping stone" to further employment and makes labour market integration easier. Yet, part-time work also appears in highly unstable careers. The present research aims to determine the role of part-time employment for young people with non-university studies. Using the Survey on Transition from Education/Training and Labour Market Integration (ETEFIL-2005), we build the monthly sequence of labour states for young people from when they finish their non-university studies until the time of the survey. The analysis allows us to conclude that part-time work is fairly atypical in the early stages of a career but that those who have part-time jobs spend quite a long time in them. In addition, we identify several patterns in the use of part-time work, the "integrative" pattern proving to be the most prevalent. Factors such as education and early preferences are seen to have a major impact on career paths.

Background: The impact of Type 2 Diabetes (T2D) on the outcomes of heart transplantation (HT) has not yet been clearly established. The objectives of this study were to examine the trends in the prevalence of T2D among individuals who underwent a HT in Spain from 2002 to 2021, and to compare the clinical characteristics and hospitalization outcomes between HT recipients with and without T2D. Methods: We used the national hospital discharge database to select HT recipients aged 35 and older. The International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) were used to identify patients with and without T2D. We also recorded comorbidities, complications of HT, and procedures. Propensity score matching (PSM) and Cox regression were used to analyze the effect of T2D on in-hospital mortality (IHM). Results: Between 2002 and 2021, a total of 4429 HTs (T2D, 19.14%) were performed in Spain. The number of HTs in patients with T2D decreased from 2002 to 2005 (n = 171) to 2014–2017 (n = 154), then rose during 2018–2021 (n = 186). Complications of HT increased in patients with and without T2D over the study period (26.9% and 31.31% in 2002–2005 vs. 42.47% and 45.01% in 2018–2021, respectively). The results of the PSM showed that pneumonia and Gram-negative bacterial infections were less frequent in patients with T2D and that these patients less frequently required hemodialysis, extracorporeal membrane oxygenation (ECMO), and tracheostomy. They also had a shorter hospital stay and lower IHM than patients without diabetes. The variables associated with IHM in patients with T2D were hemodialysis and ECMO. IHM decreased over time in people with and without T2D. The Cox regression analysis showed that T2D was associated with lower IHM (HR 0.77; 95% CI 0.63–0.98). Conclusions: The number of HTs increased in the period 2018–2021 compared with 2002–2005 in patients with and without T2D. Over time, complications of HT increased in both groups studied, whereas IHM decreased. The presence of T2D is associated with lower IHM. [ABSTRACT FROM AUTHOR]

(1) Background: To analyze the association between hospital-acquired pneumonia (HAP) and in-hospital mortality (IHM) during hospital admission for solid organ transplant in Spain during 2004–2021. (2) Methods: We used national hospital discharge data to select all hospital admissions for kidney, liver, heart, and lung transplants. We stratified the data according to HAP status. To examine time trends, we grouped data into three consecutive 6-year periods (2004–2009; 2010–2015; and 2016–2021). We assessed in-hospital mortality (IHM) in logistic regression analyses and obtained odds ratios (ORs) with their 95% confidence intervals (CIs). (3) Results: We identified a total of 71,827 transplants (45,262, kidney; 18,127, liver; 4734, heart; and 4598, lung). Two thirds of the patients were men. Overall, the rate of HAP during admission was 2.6% and decreased from 3.0% during 2004–2009 to 2.4% during 2016–2021. The highest rate of HAP corresponded to lung transplant (9.4%), whereas we found the lowest rate for kidney transplant (1.1%). Rates of HAP for liver and heart transplants were 3.8% and 6.3%, respectively. IHM was significantly lower during 2016–2021 compared to 2004–2009 for all types of transplants (ORs (CIs) = 0.65 (0.53–0.79) for kidney; 0.73 (0.63–0.84) for liver; 0.72 (0.59–0.87) for heart; and 0.39 (0.31–0.47) for lung). HAP was associated with IHM for all types of transplants (ORs (CIs) = 4.47 (2.85–9.08) for kidney; 2.96 (2.34–3.75) for liver; 1.86 (1.34–2.57) for heart; and 2.97 (2.24–3.94) for lung). (4) Conclusions: Rates of HAP during admission for solid organ transplant differ depending on the type of transplant. Although IHM during admission for solid organ transplant has decreased over time in our country, HAP persists and is associated with a higher IHM after accounting for potential confounding variables. [ABSTRACT FROM AUTHOR]

(1) Background: Epidermolysis bullosa (EB) comprises a group of rare skin diseases. We assessed diagnostic procedures, comorbidity profiles, length of hospital stay (LOHS), costs, and in-hospital mortality (IHM) associated with EB. (2) Methods: A retrospective, population-based observational study was performed using the Spanish National Hospital Discharge Database. Hospitalized patients with EB in Spain were identified for the period 2016 to 2021. (3) Results: A total of 677 hospitalizations were identified among 342 patients with a diagnosis of EB. Fifty percent of patients had at least one readmission during the 6-year follow-up. Notably, rehospitalizations were more common among patients aged 2–17 years. The most prevalent comorbidity was digestive disorders, which were associated with the frequency of esophageal dilatation procedures and percutaneous endoscopic gastrostomy. The longest LOHS was recorded for the 0- to 1-year age group. IHM increased with age, and the difference was statistically significant. The prevalence of malignant neoplasm was 36.88%, with cutaneous squamous cell carcinoma being the most frequent. The overall cost per hospitalized patient was estimated to be EUR 10,895.22 (SD EUR 13,394.81), with significant variations between age groups. (4) Conclusions: Readmissions are very frequent among people with EB. We observed a higher LOHS in the 0- to 1-year age group, while the highest rates of IHM were observed in patients older than 50 years. There was a substantial prevalence of comorbidities, namely, digestive disorders, infectious diseases, and especially cancer. [ABSTRACT FROM AUTHOR]

(1) Background: This paper aims to assess temporal trends (2016–2020) in incidence, patient's characteristics, complications, length of hospital stay (LOHS) and in-hospital mortality (IHM) among patients with and without idiopathic pulmonary fibrosis (IPF) undergoing lung transplantation (LTx). We also analyse the effect of the COVID-19 pandemic on LTx in these populations. (2) Methods: A retrospective, population-based observational study was conducted using the Spanish National Hospital Discharge Database. Multivariable adjustment was conducted with logistic regression to analyse the IHM. (3) Results: We identified 1777 admissions for LTx during the study period, of which 573 (32.2%) were performed in patients with IPF. The number of hospital admissions for LTx rose from 2016 to 2020, both in patients with and without IPF, but a marked reduction was observed from year 2019 to year 2020. Over time, the proportion of single LTx decreased and bilateral LTx increased significantly in both groups. The incidence of LTx complications increased significantly over time along with the increase in the incidence of IPF. No significant differences in the incidence of complications or in the IHM between patients with and without IPF were found. Suffering any complication of the LTx and pulmonary hypertension were conditions positively associated with IHM in patients with and without IPF. The IHM remained stable from 2016 to 2020 in both study populations and was not affected by the COVID pandemic. (4) Conclusions: Patients with IPF account for almost a third of all lung transplants. The number of LTx increased over time in patients with and without IPF, but a marked reduction was observed from 2019 to 2020. Although the proportion of LTx complications increased significantly over time in both groups, the IHM did not change. IPF was not associated with increased complications or IHM after LTx. [ABSTRACT FROM AUTHOR]

(1) Background: To examine the clinical characteristics and hospital outcomes of hospitalization for lung transplantation in COPD patients in Spain from 2016 to 2020; and to assess if the COVID-19 pandemic has affected the number or the outcomes of lung transplantations in these patients. (2) Methods: We used the Spanish National Hospital Discharge Database to select subjects who had a code for COPD (ICD-10: J44) and had undergone a lung transplantation (ICD-10 codes OBYxxxx). (3) Results: During the study period, 704 lung transplants were performed among COPD patients (single 31.68%, bilateral 68.32%). The absolute number of transplants increased with raising rates of 8%, 14% and 19% annually from 2016 to 2019. However, a marked decrease of −18% was observed from 2019 to year 2020. Overall, 47.44% of the patients suffered at least one complication, being the most frequent lung transplant rejection (24.15%), followed by lung transplant infection (13.35%). The median length of hospital stay (LOHS) was 33 days and the in-hospital-mortality (IHM) was 9.94%. Variables associated with increased risk of mortality were a Comorbidity Charlson Index ≥ 1 (OR 1.82; 95%CI 1.08–3.05) and suffering any complication of the lung transplantation (OR 2.14; 95%CI 1.27–3.6). COPD patients in 2020 had a CCI ≥ 1 in a lower proportion than 2019 patients (29.37 vs. 38.51%; p = 0.015) and less frequently suffered any complications after the lung transplantation (41.26 vs. 54.6%; p = 0.013), no changes in the LOHS or the IHM were detected from 2019 to 2020. (4) Conclusions: Our study showed a constant increase in the number of lung transplantations from 2016 to 2019 in COPD patients, with a drop from 2019 to 2020, probably related to the COVID-19 pandemic. However, no changes in LOHS or IHM were detected over time. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: The Acute Cystitis Symptom Score (ACSS) is a patient self‐reporting questionnaire for clinical diagnostics and patient‐reported outcome (PRO), which may assess the symptoms and the effect on the quality of life in women with acute cystitis (AC). The current study aimed to create a validated Spanish version of the ACSS questionnaire. Material and Methods: The process of linguistic validation of the Spanish version of the ACSS consisted of the independent forward and backward translations, revision and reconciliation, and cognitive assessment. Clinical evaluation of the study version of the ACSS was carried out in clinics in Spain and Latin America. Statistical tests included the calculation of Cronbach's α, split‐half reliability, specificity, sensitivity, diagnostic odds ratio, positive and negative likelihood ratio, and area under the receiver‐operating characteristic curve (AUC). Results: The study was performed on 132 patients [age (mean;SD) 45.0;17.8 years] with AC and 55 controls (44.5;12.2 years). Cronbach's α of the ACSS was 0.86, and the split‐half reliability was 0.82. The summary scores of the ACSS domains were significantly higher in patients than in controls, 16.0 and 2.0 (p < 0.001), respectively. The predefined cut‐off point of ≥6 for a summary score of the "Typical" domain resulted in a specificity of 83.6% and a sensitivity of 99.2% for the Spanish version of the ACSS. AUC was 0.91 [0.85; 0.97]. Conclusions: The validated Spanish ACSS questionnaire evaluates the symptoms and clinical outcomes of patients with AC. It can be used as a patient's self‐diagnosis of AC, as a PRO measure tool, and help to rule out other pathologies in patients with voiding syndrome. [ABSTRACT FROM AUTHOR]

Mastitis is a significant disease in dairy ruminants, causing economic losses to the livestock industry and severe risks to public health. Antibiotic therapy is one of the most crucial practices to treat mastitis, although the susceptibility of caprine mastitis pathogens to current antibiotics has not been tested under standard or modified incubation conditions. This work evaluated the in vitro activity of tildipirosin, gamithromycin, oxytetracycline, and danofloxacin against caprine mastitis pathogens incubated following standard conditions of Clinical and Laboratory Standards Institute (CLSI) and deviation method by 25% supplementation with goat serum. Mycoplasma agalactiae, Escherichia coli, Staphylococcus aureus, Streptococcus spp., and coagulase-negative Staphylococci (CNS) were isolated from dairy goats with mastitis in Spain. Minimum inhibitory concentrations (MICs) were determined using the broth microdilution technique. The lowest MIC90 under standard conditions was obtained with danofloxacin for mastitis-causing pathogens. An exception was M. agalactiae, where danofloxacin and oxytetracycline obtained low values. However, after adding serum, gamithromycin showed the lowest MIC50 for S. aureus, Streptococcus spp., and CNS. The lowest MIC50 was obtained with all the antibiotics tested (< 0.125 µg/ml) against M. agalactiae. Supplementing with serum resulted in a significant variation in tildipirosin and gamithromycin MIC values for CNS, S. aureus, M. agalagtiae, and E. coli. In brief, the MIC for antibiotics used against mastitis should be determined under conditions closely resembling intramammary infections to obtain representative susceptibility patterns against mastitis pathogens. Caprine mastitis pathogens were broadly susceptible to danofloxacin under standard conditions. The potency of macrolides against caprine mastitis pathogens increases when serum is present in culture media. [ABSTRACT FROM AUTHOR]

(1) Background: To assess the time trend in the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine or frequent headache (MFH) among people with diabetes in Spain from 2014 to 2020, this study identified sex differences and compared the prevalence of these pain sites between people with diabetes and age–sex-matched non-diabetic subjects. (2) Methods: The study design included a cross-sectional and a case–control study. The data were obtained from the European Health Interview Surveys for Spain conducted in 2014 and 2020. The presence of diabetes, CNP, CLBP, and MFH was self-reported. Study covariates included sociodemographic characteristics, comorbidities, lifestyles, and pain-related variables. (3) Results: Among people with diabetes, the prevalence of CNP, CLBP, and MFH did not improve from 2014 to 2020. Women with diabetes had a significantly higher prevalence of all the pain sites analyzed than men with diabetes. After matching by sex and age, the prevalence of CNP (26.0% vs. 21.1%; p < 0.001), CLBP (31.2% vs. 25.0%; p < 0.001), and MFH (7.7% vs. 6.5%; p = 0.028) was higher for people with diabetes than for those without diabetes. Self-reported mental disease was independently associated with reporting the three pain sites analyzed in people with diabetes. (4) Conclusions: The prevalence of CNP, CLBP, and MFH has remained stable over time. Remarkable sex differences were found, with a higher prevalence among women than men with diabetes. Diabetes was associated with reporting in all the pain sites analyzed. Self-reported mental disease was associated with reporting CNP, CLBP, and MFH. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is the ninth leading cause of death in Spain. The latest therapeutic developments in the advanced stages of this disease are the oral drugs trifluridine/tipiracil and regorafenib. Objective: Results of clinical trials (CTs) are not in real conditions and therefore, we want to study the effectiveness and the safety profile in the usual clinical practice and compare it with the bibliography. Materials and Methods: A retrospective and unicentric study was carried out in a health area of 500,000 inhabitants. Patients who started treatment with regorafenib and/or trifluridine/tipiracil were included from the date of marketing until June 2019. Patient-related variables, pathology, effectiveness, and treatment toxicity were collected. The statistical analysis was carried out with the PSPP program. Results: Fifty-four patients were analyzed. Men accounted for 59.3% of patients. Regorafenib was the treatment for 22.2% of patients and 77.8% received trifluridine/tipiracil. The reason for the drug's suspension was the disease progression in 85.2% of patients. No patient had a full response and 3.2% achieved partial response. The median progression-free survival time in treatments with regorafenib was 2.5 months (95% confidence interval [CI]: 0.0–5.4) and the overall survival time was 3.1 months (95% CI: 0.0–6.7), while in treatments with trifluridine/tipiracil, these data were, respectively, 2.8 (95% CI: 2.5–3.2) and 5.7 months (95% CI: 3.8–7.6). Side effects occurred in 91.7% of patients treated with regorafenib and in 100% of treated with trifluridine/tipiracil. Hematological adverse reactions were, on average, 0.4 ± 0.5/patient with regorafenib and 1.5 ± 0.9 with trifluridine/tipiracil. General (77.8%) and gastrointestinal disorders (50%) were common with both drugs. Conclusions: The effectiveness results of standard clinical practice are lower than those described in CTs and in the literature. The toxicity profile does reproduce what is described in the bibliography. [ABSTRACT FROM AUTHOR]

The pervasive impact of the COVID-19 pandemic is just beginning to be analyzed. To date, only a handful of these studies have investigated the relationship between an individual's quality of life (QoL) and their changes in food intake due to the virus (from the associated symptomatology of diagnosis to the universal impact of lockdown on individual lives, regardless of a person's health status). Therefore, the purpose of this study is to identify changes in food intake resulting from the pandemic and the corresponding impact on QoL in the Spanish population. This study focuses its investigation on the 3-month time period within which lockdown was its most restrictive, March–May 2020. Survey questions ask participants to compare their eating habits, general health status, and QoL during these 3 months to times prior to the pandemic. We conducted an online survey amongst the Spanish population over 18 years old. Three surveys were administered: (1) the adult eating behavior questionnaire (EABQ), (2) EuroQoL-5D-5L, and (3) The determinants lifestyle changes during lockdown period (March to May 2020). A total of 86 participants were included, with a mean age of 34 years. In the analysis of QoL, significant differences were found according to age, sex, and the presence of a COVID-19 diagnosis. Likewise, in the analysis of food intake, significant differences were found by age (greater changes in the 18–29-years-old population) (p< 0.01) and by sex (women p < 0.03), as well as greater changes in those with a diagnosis of COVID-19. Furthermore, both food intake and COVID-19 diagnosis were variables that predicted QoL outcomes. In sum, forced home lockdown can cause changes in food intake, which can predict a lower QoL. It follows that the lockdown situation caused by the worldwide COVID-19 pandemic has affected the food intake and overall QoL of the Spanish population. [ABSTRACT FROM AUTHOR]

Importance: Volunteering is an activity that facilitates social welfare, a sense of connection to others, and the construction of links with other people and the community. Objective: To describe the experience of a group of people with serious mental illness (SMI) who engaged in community volunteer work. Design: Qualitative, phenomenological study using purposeful sampling and an inductive thematic analysis. Setting: Several mental health community centers in Madrid and Catalonia, Spain. Participants: People with SMI engaged in community volunteer work. Outcomes and Measures: In-depth interviews were used to collect data. Results: Two themes, with four subthemes each, emerged from the data: (1) engaging in a meaningful occupation enhances the recovery process (subthemes: undergoing positive experiences, performing or resuming a meaningful occupation, living in the present moment, and relating with one's social and family environment) and (2) a process of mutual support (subthemes: in helping others, you help yourself; helping others on the basis of one's first-person experience; recover before you can help others; and role of professionals in volunteering). Conclusions and Relevance: Volunteering is perceived as a meaningful occupation. Helping others generates a reciprocal benefit that favors the recovery process and contributes to the establishment of personal and social bonds. What This Article Adds: This study provides a basis for understanding the potential of volunteering to be a meaningful occupation in the recovery process of people with SMI. It can help occupational therapy practitioners develop volunteer-based intervention programs that support the recovery process. A qualitative, phenomenological study of people living with SMI in Spain highlights the potential of volunteering to be a meaningful occupation in the SMI recovery process. [ABSTRACT FROM AUTHOR]

Aim: Primary dysmenorrhea is a problem that affects both young and adult women, with a significant impact on their daily lives. This pain is primarily managed through the consumption of non‐steroidal anti‐inflammatories and non‐pharmacological approaches such as exercise, acupressure and heat. The present study aimed to describe how Spanish university students manage dysmenorrhea. Design: Qualitative case study. Methods: Nursing students (N = 33) from the region of Andalusia (Spain) participated in focus groups. A purposive sampling method was used, and the data were collected through videoconferencing and subsequently analysed thematically. The guidelines for conducting qualitative studies established by the consolidated criteria for reporting qualitative research (COREQ) and the standards for reporting qualitative research (SRQR) were followed. Results: Four principal themes were identified: (a) Strategies for pain management; (b) using painkillers; (c) choosing the ideal treatment; (d) non‐pharmacological interventions. Conclusions: The nursing students experienced difficulties in managing primary dysmenorrhea, they self‐medicated, expressed reluctance to seek professional medical advice, used non‐pharmacological strategies and seeked advice from other women within their family/social circle. [ABSTRACT FROM AUTHOR]

Despite asthma has a considerable genetic component, an important proportion of genetic risks remain unknown, especially for non-European populations. Canary Islanders have the largest African genetic ancestry observed among Southwestern Europeans and the highest asthma prevalence in Spain. Here we examined broad chromosomal regions previously associated with an excess of African genetic ancestry in Canary Islanders, with the aim of identifying novel risk variants associated with asthma susceptibility. In a two-stage cases-control study, we revealed a variant within HLA-DQB1 significantly associated with asthma risk (rs1049213, meta-analysis p = 1.30 × 10–7, OR [95% CI] = 1.74 [1.41–2.13]) previously associated with asthma and broad allergic phenotype. Subsequent fine-mapping analyses of classical HLA alleles revealed a novel allele significantly associated with asthma protection (HLA-DQA1*01:02, meta-analysis p = 3.98 × 10–4, OR [95% CI] = 0.64 [0.50–0.82]) that had been linked to infectious and autoimmune diseases, and peanut allergy. HLA haplotype analyses revealed a novel haplotype DQA1*01:02-DQB1*06:04 conferring asthma protection (meta-analysis p = 4.71 × 10–4, OR [95% CI] = 0.47 [0.29– 0.73]). [ABSTRACT FROM AUTHOR]

This empirical research uses panel data methodology to find the main factors determining Spanish audit quality. on a sample with more than 60,000 audited companies from 2013 to 2018. Prior to analysing the quality of the audit, we have adjusted the best possible model to the audit fees behaviour in order to extract the abnormal fees. Our dynamic model shows that audited company's size, the previous year's audit fees, the years with the same audit firm, the auditor's opinion, the auditor rotation, the concentration or dedication to the client and the client sector are explanatory factors of audit fees. Further, we find evidence that audit quality improves with number of hours billed for audit work and decreases with sector concentration of auditor and, a novel multiplicative effect, the auditor size by abnormal audit fees, in such a way that the surcharge (abnormal fees) of the big audit firms contribute negatively to improve the audit quality. [ABSTRACT FROM AUTHOR]

The determination of the metrics to evaluate the figure of medical science liaison (MSL) presents certain difficulties, as there is a great deal of variability. Therefore, the aim of the present exploratory study is to evaluate the metrics for evaluating MSL performance that are currently being used by the medical departments of the pharmaceutical industry in Spain by using the Delphi methodology with two rounds of participation. Moreover, the study aims at providing an expert consensus about which metrics should be used and how they should be evaluated in order to be as appropriate and feasible as possible. After the first round, experts reached a consensus in 20 (38.5%) of 52 items: 18 in agreement and 2 in disagreement. In the second round, they established consensus in 8 (25.0%) of the remaining items. Overall, consensus was met in 28/52 (53.8%) items: 23 in agreement (44.2%) and 5 in disagreement (9.6%). No consensus was reached in 24 items (46.2%). On the general metrics, there was consensus agreement that the weight of each of these metrics should vary according to the product life cycle (96%), and disagreement that performance assessment should be done through a combination of quantitative (92%) and qualitative (80%) metrics. This study provides the company with greater knowledge to establish and adapt its strategies without losing focus on delivering value in the relationships with healthcare professionals and patients. [ABSTRACT FROM AUTHOR]

Background. Multiple sclerosis is a disorder which causes a loss of functionality, affecting the person's ability to perform activities of daily living, such as interpersonal interactions and relationship, dressing, self-care, or bathing, as well as having a negative impact on work and leisure activities. Aims. This study examined the relationship (correlational or associations/predictive) between self-perceived quality of life and performance of manipulative dexterity. Also, this study sought to measure predictors of dexterity. Study Design. A cross-sectional study from two associations of MS within the Community of Madrid, Spain. Methods and Procedures. A final sample of 30 people with multiple sclerosis. The outcome measures used were the ABILHAND questionnaire, the Purdue Pegboard Test, the Nine Hole Peg Test, and the Box and Block Test. Results. No significant correlations were found between dexterity and self-perception tests; however, correlations were found between perceived dexterity and quality of life (p < 0.001). Scores for the ABILHAND questionnaire, which measures the perception of skills in daily living, predicted up to 60% of the variance in the dexterity tests. Conclusions. The results of this study suggest that interventions for improving the manipulative dexterity of people with multiple sclerosis should address the person's perception of improving their manipulative dexterity and the perceived of quality of life, as both factors may influence manipulative dexterity. [ABSTRACT FROM AUTHOR]

To assess real-world safety and effectiveness of dapagliflozin in people living with type 1 diabetes mellitus (T1DM). We conducted a multicenter retrospective study in Spain including data from 250 people living with T1DM receiving dapagliflozin as add-on therapy to insulin (80.8 % on-label use). The number of diabetic ketoacidosis (DKA) events was calculated over a 12-month follow-up (primary outcome). Changes in body weight, HbA1c, total daily insulin dose, and continuous glucose monitoring (CGM) metrics from baseline (at dapagliflozin prescription) to 12 months were also evaluated. A total of five DKA events (2.4 % [95 % CI 0.3;4.5] were reported in patients with a 12-month follow-up, n = 207): two events related to insulin pump malfunction, two events related to concomitant illnesses, and one event related to insulin dose omission. DKA events were more frequent among insulin pump users than among participants on multiple daily injections (7.7 % versus 1.2 %). Four of the reported DKA events occurred within the first six months after initiation of dapagliflozin. No deaths or persistent sequelae due to DKA were reported. No severe hypoglycemia episodes were reported. Significant reductions in mean body weight (−3.3 kg), HbA1c (−0.6 %), and total daily insulin dose (−8.6 %), P < 0.001, were observed 12 months after dapagliflozin prescription. Significant improvements in TIR (+9.3 %), TAR (−7.2 %), TBR (−2.5 %), and coefficient of variation (−5.1 %), P < 0.001, were also observed in the subgroup of patients with available CGM data. Finally, an improvement in urinary albumin-to-creatinine ratio (UACR) was found among participants with UACR ≥ 30 mg/g at baseline (median decrease of 99 mg/g in UACR, P = 0.001). The use of dapagliflozin in people living with T1DM has an appropriate safety profile after careful selection of participants and implementation of strategies to reduce the risk of DKA (i.e., prescribed according to the recommendations of the European Medicines Agency), and also leads to clinical improvements in this population. [ABSTRACT FROM AUTHOR]

Objective To determine if adding dry needling to a four-week exercise program has an additional benefit compared with adding sham dry needling to the same exercise program in subjects with chronic low back pain. Design Randomized clinical trial. Setting Physiotherapy and Pain Clinic of Alcala University. Subjects Forty-six patients with chronic low back pain. Methods Subjects were randomized to two groups: the dry needling group (N = 23) or sham dry needling group (N = 23). Both groups received a four-week exercise program and before the exercise started a session of dry needling or sham dry needling. Pain (visual analog scale), disability (Roland-Morris Questionnaire), and fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire) were assessed at baseline, after treatment, and at three-month follow-up. Pressure pain thresholds (algometer) were measured at baseline, after the dry needling or the sham dry needling, and after treatment. Results Both groups showed significant improvements for all variables. In the between-group comparison, the dry needling group improved significantly in pain at three-month follow-up and pressure pain thresholds at the end of treatment for all measures, and at three-month follow-up there was no improvement in gluteus medium. Conclusions In chronic low back patients, adding dry needling to a four-week exercise program has an additional benefit in pain and sensitivity compared with adding sham dry needling to the same exercise program. [ABSTRACT FROM AUTHOR]

The presence of transmission clusters (TCs) and their epidemiological characteristics in a treatment-naive cohort of HIV-1 patients in southern Spain over a decade (2004–2015) were evaluated. Protease and reverse transcriptase sequences provided by each genotype test were used in the phylogenetic study, performed first by the neighbor-joining method and then confirmed by Bayesian analysis. We collected clinical, immunovirological, and demographic data for all patients included. Our cohort comprised 757 patients, 428 (56.5%) belonging to a TC. Overall, we found 123 TCs, 21 of them comprising five or more individuals and three with ≥10 sequences. Forty-three TCs (35.0%) remained active. The clustered patients were mainly men (92.8%) who had sex with men (MSM) (81.5%), Spanish (80.6%), and young adults (median age at diagnosis of 32.6 years). They had lower percentages of late diagnosis and AIDS cases (42.1% and 13.6%, respectively), whereas the presence of recent seroconverters (31.1%), HIV-1 B subtypes (79.4%), and transmission drug resistance (20.3%) increased within TCs, with regard to not-clustered individuals. Among the TCs of non-B variants, circulating recombinant forms (CRF) were predominant (87.5%), with the highest frequencies for CRF19_cpx (17.0% of non-B subtype sequences in TCs); CRF02_AG (15.9%); and CRF01_AE (9.1%). In conclusion, over half of our cohort was included within a TC. More than a third of TCs found could be considered active transmission events. Belonging to a TC was related to MSM, Spanish origin, recent seroconversion, high prevalence of resistance mutations, and B HIV subtype. Among the non-B genetic forms in TCs, we found a high prevalence of CRF19_cpx, CRF02_AG, and CRF01_AE variants. [ABSTRACT FROM AUTHOR]

Background. Manipulative dexterity impairments affect 76% of individuals with multiple sclerosis (MS). Patients with MS can experience reduced skill when performing both basic activities of daily living and instrumental activities of daily living. Many studies consider that physical rehabilitation leads to a decrease in the level of disability, especially at the mild and moderate stages of the disease. However, most studies fail to distinguish between the different MS subtypes. Purpose. Our aims were (1) to describe the manipulative skills of people according to the different subtypes of MS, (2) to analyze the correlation between dexterity and self-perception variables, and (3) to identify possible predictors of functionality. Study Design. A descriptive cross-sectional study. Methods. 30 individuals with MS. The measurement tools used were the ABILHAND, the Purdue Pegboard Test (PPT), the Nine-Hole Peg Test, and the Box and Block Test. Results. All subtypes of MS obtained lower scores for manipulative dexterity compared to normal skill levels, with individuals with primary progressive MS displaying the lowest values. However, the analysis of differences between the different subtypes did not reveal statistically significant intragroup differences. In addition, differences were found regarding the effect size of practically all the variables analyzed for both manipulative dexterity (PPT, NHPT, and BBT) and the self-perception of ADLs (ABILHAND), for which high values ( d r = 0.72) and very high values ( d r = 1.46) were obtained. Conclusions. Although no significant differences were found between the different types of MS, the assessment of manual dexterity and perceived efficacy of daily activities must be considered as prognostic factors in the progression of the disease. These findings may help support further research on targeted interventions to improve dexterity deficiencies, as well as promote an improved quality of therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: Although the electronic prescribing software is the same for all hospitals of a regional health service, each has its own drug database, which it is responsible for maintaining. The aim of this study was to develop a consensus to standardize the hospital drug database of the electronic prescribing software, and to apply this tool to the electronic prescribing system of an oncology outpatient clinic of a Spanish tertiary-level hospital. Additionally, we sought to analyze the impact of the implemented actions on the health care services provided. Methods: This was a prospective study carried out over a period of 15 months by a group of pharmacists representing all Organizational Integrated Management Systems of a regional health service, and coordinated by the General Subdirectorate of Pharmaceuticals. Results: A total of 500 drugs and 500 active pharmaceutical ingredients included in the hospital drug database were standardized to implement the electronic prescribing system in the oncology outpatient clinic. The implementation of such standardization process yielded a 70% decrease in medication errors. In the satisfaction survey concerning the usefulness of the tall-man letters implemented in the electronic prescribing system, the interviewed doctors reported the highest levels of satisfaction. Conclusions: The creation of consensus documents to standardize the hospital drug database served to unify the information available in the regional hospital pharmacy services of an autonomous community. In addition, the implementation of the electronic prescribing system in the oncology outpatient clinic of a tertiary-level hospital resulted in a decrease in the number of medication errors. [ABSTRACT FROM AUTHOR]

Diagnosis of von Willebrand disease (VWD) depends on personal and family history of bleeding and confirmatory laboratory testing. Currently available phenotypic tests for VWD contain potential sources for error that may distort results. Despite an exponential growth of information about the von Willebrand factor gene ( VWF ), the role of molecular diagnosis in VWD is still controversial. Due to the complexity and high cost of conventional molecular analyses, some investigators have recommended limiting this approach to distinguish suspected type 2N VWD from hemophilia A, type 2B from platelet-type VWD, and the exploration of type 3 VWD. New genetic methodologies and approaches are becoming available, but there is still some reluctance for their implementation in VWD diagnosis. This article discusses the pros and cons of molecular testing in VWD considering the experience obtained through the multicenter project "Molecular and Clinical Profile of VWD in Spain (PCM-EVW-ES)." [ABSTRACT FROM AUTHOR]

This work aimed to evaluate the effect of agronomic management and water regime on the number of lesions, levels of insect infestation and microbiological quality of dried figs in Extremadura. Dried fig samples from 18 orchards were collected. The results showed that birds were the primary pests, causing damage to dried figs, followed by insects and fungi. The effects of orchard management were more pronounced under irrigated conditions, with the percentage of undamaged dried figs and the number of insect-free fruits rising significantly with increasing management. Under rainfed conditions, the level of orchard management did not significantly influence damage. In addition, insects were detected in both damaged and undamaged dry figs. Cadra figulilella , Carpophilus hemipterus and Ceratitis capitata were the most common species. Regarding mycobiota, orchard conditions did not significantly affect fungi counts, but they did influence species composition. Aspergillus spp. were predominant under all conditions, followed by Alternaria spp. under irrigated conditions. This work provides relevant information on the different biotic agents that affect dried figs, showing that a higher level of management under irrigated conditions reduces pest incidence. Such knowledge is essential for designing control methods to obtain higher quality fruits. • Damage to dried figs under different agronomic management regimes was evaluated. • Management levels in irrigated orchards influence the percentage of damaged figs. • Bird pecking is the main cause of damage to dried figs. • C. figulilella , C. hemipterus and C. capitata were the main insect pests. • Aspergillus was the main mould linked to damage to dried figs. [ABSTRACT FROM AUTHOR]

The Activity Card Sort (ACS) measures the level of participation, as perceived by each person which, unlike other scales, makes it both personal and significant. However, there is a limitation to applying the ACS to Spanish older adults as it is restricted to culturally relevant activities solely in the United States. Therefore, the aim of this study was to select activity items that reflected Spanish older adults' lifestyles in order to develop the Activity Card Sort-Spain Version (ACS-SP). Frequently, activities performed in Spain (n=103) were listed in an initial draft. The Likert scale was administrated to a large group of Spanish nationals over the age of 60 years (n=98) to establish which type of activities will be eventually included in the Spanish version. The final version was drawn up comprising 79 activities distributed between four performance areas. In addition, other activities that were not previously included by other assessment tools were considered and have been listed in this review, such as taking a nap, going out for a drink or "tapas," or searching for a job. The gradual adaptation to ACS for Spaniards will make it possible to measure the level of an individual's participation within a community. However, further work on psychometric properties is needed. [ABSTRACT FROM AUTHOR]

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Purpose Despite the widely recognised importance of lifelong learning, there are mixed results on its causal economic impact. The purpose of this paper is to investigate how economic conditions change the composition of participants in non-formal lifelong learning and whether the business cycle is relevant for the impact of non-formal lifelong learning on employability.Design/methodology/approach Non-linear decomposition techniques and matching estimators based on multidimensional covariates are applied to the Spanish sample of the European Adult Education Survey. The analysis controls for background, human capital and personal traits and draws a distinction between unemployed and employed workers.Findings The results show major differences in the volume and composition of participants before and during the Great Recession. In addition, there is a business cycle dependence of the effectiveness of non-formal lifelong learning that varies with the individual labour market situation. While lifelong learning proves more effective for the unemployed in recessions, for the employed the impact is greater in expansions.Originality/value The paper provides new evidence on the scant results of the moderating effect of the business cycle on the impact of lifelong learning. The analysis is not restricted to training implemented within public programmes, but rather extends to any kind of non-formal lifelong learning undertaken by unemployed and employed workers. In this sense, the analysis provides information about the optimal moment to invest in lifelong learning from both the policymaker and individual as well as firm perspective. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterise nine commercial fig ( Ficus carica L.) varieties differing in colour (dark-purple, brown, green, and yellow-green) at three different ripening stages in regards to the health-promoting compounds of their fruits and to identify and quantify the bioactive compounds as well as total antioxidant activity (TAA) in the skin and flesh of each variety. Significant differences ( p < 0.05) were found between varieties and ripening stages. Dark-coloured varieties showed the highest levels of total phenolic compounds (from 26.7 to 169.5 mg gallic acid equivalents/100 g), quercetin-3- O -rutinoside (between 4.6 and 11.9 mg/100 g), and anthocyanins, specially cyanidin-3- O -rutinoside (from 3.03 to 97.4 mg/100 g), while brown-, green-, and yellow-green-coloured varieties contained the highest levels of chlorogenic acid (between 0.7 and 2.1 mg/100 g), total Vitamin C (from 0.8 to 9.0 mg/100 g), and (+)-catechin as proanthocyanin cleavage products (from 3.1 to 17.3 mg/100 g). Levels of TAA were measured by 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) diammonium salt (ABTS) total radical scavenging capacity both in hydrophilic (H-TAA) and lipophilic (L-TAA) fractions. The darker varieties exhibited higher H-TAA values, ranging from 16.3 to 177.4 mmol Trolox equivalents/100 g, than the lighter ones. In the case of L-TAA, its concentration also depended directly on the genotype and less on the ripening stage. We found higher concentrations of bioactive compounds and a higher antioxidant capacity in the skin compared to the flesh; moreover, their content increased during the ripening process, reaching the maximum level of phenolic compounds at stage three, although these changes were deeper in the dark-coloured varieties and in the brown-coloured variety ‘San Antonio’ Based on our results, it is advisable to consume unpeeled, fully ripe, dark figs in order to optimally benefit from the health-promoting properties. [ABSTRACT FROM AUTHOR]

The current world financial crisis is causing real difficulties in the operation of firms and has generated renewed interest in audit reports. This study aims to analyse the impact of the financial crisis on the audit reports issued by auditors. We focus especially on those reports that contain questions relating to going concern situations. The sample analysed is formed by 2935 audit reports of unlisted Spanish firms for the years 2007–2010. From the results obtained we can affirm that the crisis being suffered by Spanish firms has not gone unnoticed by audit professionals. Our research reveals that as the crisis in Spain has worsened, the proportion of reports that include references to going concern situations has increased in comparison with 2007, when the financial crisis had not become manifest in Spain. The sectors of the Spanish economy most affected by the crisis are real estate and construction. Taking into account whether the audit firm issuing the report is Big-4 or Non-Big-4, no significant differences can be appreciated in the percentage of reports issued with going concern qualifications before the start of the crisis (2007) and during the crisis (2008–2010). [ABSTRACT FROM AUTHOR]

In the late nineteenth century European intellectual circles participated in a debate on the possible confrontation between two so-called civilisations, represented respectively by Latin and Anglo-Saxon nations. The controversy moved to Latin America, where discussions showed certain peculiarities. Given the position occupied by Spanish intellectuals as links between Europe and the Western Hemisphere, this article seeks to emphasise how some prestigious Spanish publications dealt with the debate on race from 1898 to 1914. While the collaboration of foreign personalities and the publication of book reviews fostered the knowledge of this issue in Spain, one of the most important initiatives were the sections entitled ‘Review of Reviews’, which began to collect articles from other countries. The author takes as his object of study an important intellectual debate that transcended national borders and generated numerous reactions in both Europe and Latin America. This research demonstrates how the analysis of the Spanish press sheds light on the establishment of a circuit of opinions among foreign intellectuals. It not only allows to include Spain within a shared awareness network comprising European and Latin American nations, but also examines its special features within the transatlantic scenario. [ABSTRACT FROM PUBLISHER]

San Cristobal's micro watershed is a socioecological system (SES), located in the rural-urban border of Usaquen and the Eastern Hills Forest Reserve (Bogota D.C). This SES has been transformed by the phenomenon of urban growth, generating changes in land use and environmental degradation of the ecosystem, affecting biodiversity and the ecosystem service (ES) of water supply. For the case mentioned, this study analyzes spatial, temporal and social trade-offs, which are created by human decisions or interventions. The identification and subsequent analysis of these trade-offs is made from various sources and consultations with different types of actors. Thus, key moments as what led to the transformation of the ecosystem, the effects on the ecosystem service at different spatial scales and the balance of social actors that won or lost in the process were identified. Based on the lessons learned, key variables and social actors, possible scenarios, and actions aimed at the conservation or improvement of the SE are identified. [ABSTRACT FROM AUTHOR]

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Background: Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care. Methods: A descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels. Results: Mean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p < 0.001) varied by center, lifestyle habit and patient characteristics. Sustainability of intervention components changed thorough the implementation period within centers. Conclusions: The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care. Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to attain adequate program adoption and implementation through improved implementation strategies. [ABSTRACT FROM AUTHOR]

This report presents the findings of an online 38-item survey on the emerging role of medical scientific liaison in the pharmaceutical industry in Spain. A total of 44 complete surveys were received, the majority from large companies with more than 20 medical scientific liaisons. All medical scientific liaisons were primarily responsible for establishing and maintaining relationships with key opinion leaders. Forty-one percent of the respondents said that they did not have a formal technical training program, and more than half of the participants responded that there was no promotion ladder in their company. Some challenges cited by the respondents pertain to their difficulties over how they demark their roles with sales/marketing department and communicate the medical scientific liaison value to business partners. These findings can be used to identify areas for improvement and compare medical scientific liaison practices to those in the future. [ABSTRACT FROM AUTHOR]

This article presents information regarding a conference titled "Some Aspects of the Early Modern Historiography: Militia, Church, and Security. Tribute to Professor Enrique Martínez Ruiz," which took place in Madrid, Spain, from November 18-19, 2015. The author details the main topics of the conference, including Spanish military history, Church history, and national security during the 18th and 19th centuries.

The study examines the difference in occupational profile between healthy women and those suffering from fibromyalgia, as well as the perceived significance of occupational performance during self-care, productivity and leisure activities. Results showed that women with fibromyalgia had lower quality of life and needed more help in performing daily activities than healthy women.

For some people, a part-time job is merely an intermediate state that serves as astepping stoneto further employment and makes labour market integration easier. Yet, part-time work also appears in highly unstable careers. The present research aims to determine the role of part-time employment for young people with non-university studies. Using the Survey on Transition from Education/Training and Labour Market Integration (ETEFIL-2005), we build the monthly sequence of labour states for young people from when they finish their non-university studies until the time of the survey. The analysis allows us to conclude that part-time work is fairly atypical in the early stages of a career but that those who have part-time jobs spend quite a long time in them. In addition, we identify several patterns in the use of part-time work, the ‘integrative’ pattern proving to be the most prevalent. Factors such as education and early preferences are seen to have a major impact on career paths. [ABSTRACT FROM PUBLISHER]