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Health-related quality of life of children with complex chronic conditions could be affected by sociodemographic factors. Most studies focus exclusively on the parents' perceptions of quality of life. This study aimed to determine the health-related quality of life of these children, according to their parents and the children themselves. A cross-sectional study was developed on children aged over five years with complex chronic conditions. Health-related quality of life, educational attainment, and social status were evaluated. A total of 101 children were included with a mean age of 10.48 years, and 35.6% were female. The most frequent disease was oncological (28.7%). Children perceived a better health-related quality of life, compared to their parents' assessment: median difference -8.4 (95%CI: -9.2 to -3.8). Moreover, differences were observed by socioeconomic factors. Parents and children with complex chronic conditions perceive differently the health-related quality of life. Social determinants associate with an uneven perceived quality of life. [ABSTRACT FROM AUTHOR]

Aims: Soil abiotic factors influence plant defensive traits by shaping the costs of defence production and these bottom-up effects on plants can in turn affect insect herbivory. However, few studies have disentangled direct and indirect effects of soil abiotic factors on plant defences and insect herbivory. Methods: To address this gap, we tested the influence of soil abiotic factors on seed predation via changes in plant defences for sea fennel (Crithmum maritimum), a common coastal plant in southern Spain whose seeds are consumed by specialist caterpillars (Aethes species). To this end, we estimated seed predation on plants across several sea fennel populations, as well as measured different types of putative chemical seed defences (phenolics, terpenes) and soil abiotic factors (macro- and micro-elements, physicochemical variables). Results: We found a positive association between seed chemical defences (terpenes such as α-thujene, α-pinene, β-pinene, β-myrcene, α-terpinene, y-terpinene, and thymol methylether) and seed predation. In addition, a few macro- and micro-elements such as Ca, S and Sr negatively correlated with seed defences; other macro- and micro-elements or physicochemical variables had no detectable association with defences. Despite observed effects of soil abiotic factors on defences and of the latter on seed predation, there was no detectable indirect effect of soil abiotic factors on seed attack. Conclusions: Our findings suggest that variation in a few key soil macro- and micro-elements in coastal environments can exert an important influence on seed chemical defences in sea fennel, with potential consequences for interactions between sea fennel and seed predators. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the relationship between the pressure exerted on the heel of one foot resting directly on a mattress, versus that exerted on the other heel, protected by a pillow beneath the Achilles tendon area and the changes thus produced in perfusion, oxygenation and temperature in the skin of heels of healthy volunteers lying in a supine position. Design: Experimental study in a pre‐clinical phase, with healthy volunteer participants and intrapeople control. Methods: The study was carried out from November 2017 – May 2018. A pressure measurement surface was placed between the participant and the constant low‐pressure support surface. Doppler laser devices were used to measure local temperature and perfusion. The degree of oxygenation was determined using an infrared beam close to the pressure zone in each heel. Both feet rested immobile on the bed, in a natural position, for 2 hr. To ensure intrapeople control, in every case the left heel was raised slightly, compared with the right. Results: Eighteen participants took part in this study. Analysis of the results obtained showed that capillary blood flow was significantly reduced in the heel subjected to pressure, compared with the other heel, while no significant effects on oxygen saturation or temperature were observed. The variables associated with greater oxygen saturation were capillary blood flow, local temperature and pressure exerted. Fat‐free mass, fat mass and duration of exposure to pressure were all significantly associated with reduced oxygen saturation. Conclusions: In healthy participants, when the heel is subjected to constant pressure against a constant low‐pressure support surface, there is a significant reduction in blood flow, compared with the heel where pressure is relieved. However, there are no significant differences in temperature or tissue oxygenation. Impact: Significant reductions in vascular flow were observed; however, the oxygenation and temperature of the heel tissues remained unchanged. These findings, corroborated in real patients, would advance our understanding and facilitate decision‐making on measures to prevent pressure ulcers, such as repositioning or tissue protection. Trial registration: The protocol is registered in ClinicalTrials.gov (NCT02736838). [ABSTRACT FROM AUTHOR]

Health measures instantiated to reduce the spread of COVID-19 have imposed significant constraints for the population and impacted on drinking habits and mental health. This study longitudinally compared changes in alcohol consumption before and after the COVID-19 outbreak and the impact of sociodemographic and mental health variables on such changes among a community sample of young adults. Data were collected in the context of a larger, ongoing longitudinal study. The sample consisted of 305 young adults from Spain aged between 18 and 26 years (mean age = 21.27, (SD = 2.21), female = 53.4%; college students = 61.6%) who completed first (November-2019 and February-2020; i.e., before the outbreak of COVID-19) and second follow-up questionnaires (March 2021, a year after the COVID-19 outbreak). Alcohol use (quantity and drinking frequency), depression and anxiety symptoms were measured. Quantity and frequency of alcohol use decreased from the pre- to post-COVID-19 period. A decrease in drinking frequency was observed among college students, but not in noncollege peers. Although we found no effect of pre-COVID-19 anxiety on alcohol use changes, those with more depressive symptoms at the pre-COVID assessment were more resistant to decreasing their drinking quantity and frequency after the COVID-19 outbreak. This information will be of value when designing interventions aimed at reducing harmful alcohol use and highlights the role of mental health status when identifying high risk populations of young-adults during this, and future, public health crises. [ABSTRACT FROM AUTHOR]

The superconducting tokamak JT-60SA is currently being assembled at the QST laboratories in Naka (Japan). Within the European contribution in the framework of the Broader Approach, Spain has been responsible for providing JT-60SA cryostat. The cryostat is a large vacuum vessel made up of 304 stainless steel which encloses the tokamak providing the vacuum environment to reduce thermal loads on the components at cryogenic temperature. It must withstand the external atmospheric pressure during normal operation and the internal overpressure in case of an accident. Due to functional purposes, the cryostat has been divided in three assemblies: the Cryostat Base (CB), the Cryostat Vessel Body Cylindrical Section (CVBCS) and the Top Lid. For transport and assembly reasons the cryostat is made up of 20 main parts: 7 making up the CB and 13 making up the CVBCS (including the top lid). The joints between them rely on bolted flanges together with light seal welds, non-structural fillet welds performed from inside and/or outside of the cryostat. The single wall is externally reinforced with ribs to support the weight of all the ports and port plugs and also to withstand the vacuum pressure. The material is SS 304 (Co < 0.05 wt%) with a permeability (μ rel) below 1.1. The CVBCS made of a single wall is a stainless steel shell with a thickness of 34 mm. The CB was manufactured and assembled in-situ in 2013, while the CVBCS has been manufactured, assembled, measured by a Spanish company (ASTURFEITO S.A) and delivered to Japan in November 2017. The paper summarizes the assembly and final measurement of the CVBCS at the factory. [ABSTRACT FROM AUTHOR]

• C. maritimum is an edible halophyte with large potential in human nutrition field. • Desired nutritional profile is maintained regardless of environmental conditions. • Plants under optimal growing conditions increased total essential amino acids • PUFAs and sodium accumulation changes under suboptimal growing conditions. • Phenolics compounds decreased under optimal greenhouse conditions Crithmum maritimum L. is an edible halophyte with large potential in human nutrition field. However, it is unclear whether its nutritional value is maintained throughout the contrasting habitats where it commonly grows (cliffs, sandy and rocky beaches) and the nutritional profile of cultivated plants still remains uncertain. In this work, we provided for the first time a comparison of the nutritional profile of C. maritimum across its different type of habitats in the south of Spain and between wild plants and plant material under optimal growing conditions. The protein, amino acids, lipids, fatty acids, minerals composition and phenolic content of plants were analysed. Plants under field conditions exhibited a nutritionally balanced composition (3.8–6.2 g protein/100 g DW, 4.9–7.5 mg lipids/g WW, 3.9–5.0 g Na/100 g DW), with high phenolic content (30.2–48.0 mg/g DW) regardless of the variability of the contrasting habitats. In contrast, under optimal conditions, C. maritimum showed a greater protein and lipid content (10.2 g/100 g DW and 9.6 mg/g WW, respectively), and lower sodium accumulation (1.2 g/100 g DW), allowing a greater consumption of this halophyte without exceeding the daily intake recommendations. Conversely, phenolics were strongly decreased in these plants (6.1 mg/g DW) likely due to the absence of stress factors. [ABSTRACT FROM AUTHOR]

Purpose: The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics., Design and Methods: A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models., Results: Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (β = 0.17), shorter survival time (β = -0.23), who had contact with the palliative care unit (β = 0.16), and whose mothers had a higher professional occupation (β = 0.14), had a greater use of the healthcare system., Conclusions: Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time., Practical Implications: Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The rise of biologic agents has been a major breakthrough in treating immune-mediated inflammatory diseases (IMIDs). However, their high cost underscores the need for strategies to optimize treatment efficiency. Biosimilars offer cost-effective alternatives to biologics. This study aimed to assess biosimilar drug availability's impact on biologic therapy access for IMIDs., Research Design and Methods: A retrospective observational study in 15 Spanish hospitals analyzed IMID patients (arthropathies, inflammatory bowel disease and psoriasis) initiating biologic therapy with originator or biosimilar drugs (infliximab, etanercept, adalimumab). Time to availability and initiation of biologic therapy were assessed., Results: 267 patients were included, with 58.4% starting on biosimilars. The mean time to availability of the biologic drugs in the hospitals was 15.9 ± 6.7 months, (20.0 ± 12.4 for originator and 11.8 ± 5.2 for biosimilars). Mean time to biologic treatment was 7.7 ± 9.0 years (8.6 ± 8.9 for originators and 7.0 ± 9.0 for biosimilars). Showing statistically significant differences among conditions., Conclusion: The emergence of biosimilar drugs has enhanced market competition and accelerated their adoption into hospitals' therapeutic regimens over original reference drugs. This has significantly improved access to biologic therapy for patients with IMIDs, evidenced by a notable 1.6-year reduction in access time for biosimilar drugs.

Aim: To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour., Design: Cluster randomized controlled clinical trial., Methods: This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18-75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP-Ti ® , an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self-care, health-related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014., Discussion: The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self-care behaviour in this population., Impact: The study will result in the publication of an educational program featuring well-defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population., (© 2020 John Wiley & Sons Ltd.)

Objective: The socio-health emergency caused by COVID-19 may have a significant psychological impact on the population. For this reason, it is necessary to identify especially vulnerable social groups and protective factors that may reduce this impact, which was the objective of this study., Methods: Using snowball sampling approach, 1,596 people residing in Spain during the lockdown answered an online questionnaire that included information on sociodemographic variables, symptoms, and contact with the disease, risk perception, precautionary measures to prevent infection and coping strategies during lockdown. Psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status with the Goldberg's General Health Questionnaire (GHQ-12). Simple linear regression models were performed to analyze the associations between the study variables and the psychological impact of the pandemic and the mental health of the participants., Results: Of all respondents, 24.7% reported a moderate or severe psychological impact, and 48.8% showed mental health problems. Women, students and the population with a lower level of economic income, in addition to those having less available space per person in the household presented a more significant psychological impact and worse mental health. Living with someone from the high-risk vulnerable group, and anticipating the adverse economic effects of social-health crisis raised the emotional distress and psychological morbidity. Precautionary measures to prevent infection did not present a connection to the psychological impact of the pandemic; however, several coping strategies did help to reduce it., Conclusions: These findings outline the existence of especially vulnerable social groups to the impact of the pandemic, and suggest lines of action that help reduce the psychosocial consequences of COVID-19., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives: Patient repositioning is a recommended intervention to prevent or treat pressure ulcers (PUs). One option under consideration is the tailored repositioning according to patient characteristics, but more knowledge is needed on how different repositioning patterns influence on skin pressure. To determine what degree of inclination of the body in bed generates more pressure in the trochanteric region. Additionally, to analyze the influence of factors such as gender, age and anthropometric characteristics in the variations of this pressure., Methods: Analytical cross-sectional study. Body Mass Index (BMI), lean mass and fat mass were measured in healthy volunteers subject to different inclinations (90°, 60° and 30°) in right lateral decubitus. Pressure was measured with a capacitive surface., Results: In total, 146 subjects were included, of which 45 were men and 101 women. The results showed pressure differences due to the inclination according to gender and anthropometric values, being statistically significant in men at 90° and 60°, and in women at 30°. (hombres 90° p = 0,026, 60° p = 0,049; mujeres 30° p = 0,036) según prueba Brown-Forsythe., Conclusions: There are differences in the pressures of the trochanteric zone depending on anthropometric factors and by gender, in different body positions. Obese people exerted a higher pressure in the trochanter area at 30° of body inclination than overweight, normal weight and underweight people, respectively. From the clinical point of view, these findings invite to consider a possible differentiation in the repositioning interventions of the patients, according to gender and BMI, as a preventive strategy for PUs., Competing Interests: Declaration of competing interest We certify that any affiliations with or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants) with any organization or entity with a potential financial interest in or financial conflict with the subject matter or materials discussed in the manuscript are completely disclosed. This work was supported by Spanish Ministry of Industry, Economy and Competitiveness through the Carlos III Health Institute (PI15/02016). The authors declare that they have no competing interests and that no other financial and material support for the research and work has existed., (Copyright © 2020 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Study Design: Cross-sectional., Objective: To examine whether 3 types of chronic pain are associated with absenteeism and with the number of days absent from work in the general population of Spain., Summary of Background Data: Chronic pain has been associated with absenteeism, but most of the evidence is based on unadjusted analyses and on specific professional categories., Methods: A cross-sectional analysis was performed on the basis of data of 8283 Spanish workers. Chronic pain was ascertained from self-reported information on frequent symptoms of pain in the low back and neck and/or migraine in the last 12 months. Absenteeism was defined as missing at least 1 day from work because of health problems. Multivariate regression models were adjusted for the main confounders., Results: Health-related absenteeism was reported by 27.8% of subjects. The prevalence of chronic pain was reported to be 12.3% in the neck, 14.1% in the low back, and 10.3% migraine. In adjusted analyses, absenteeism was associated with chronic neck pain (odds ratio: 1.20; 95% confidence interval [CI], 1.02-1.40), low back pain (odds ratio: 1.22; 95% CI, 1.06-1.42), and migraine (odds ratio: 1.22; 95% CI, 1.04-1.44). These associations were strongest in younger (18-34 yr) rather than in older workers. Furthermore, those who reported frequent pain in the neck and low back were 44% more likely to be absent for more than 30 days in the past year than those who did not report these symptoms., Conclusion: Spanish workers with chronic pain were more likely to be absent from work and to stay absent from work for longer. These associations are independent of sociodemographic characteristics, occupation, lifestyle, health status, and analgesics use., Level of Evidence: N/A.

Aerial images of the high summits of the Spanish Central Range reveal significant changes in vegetation over the period 1957 to 1991. These changes include the replacement of high-mountain grassland communities dominated by Festuca aragonensis, typical of the Cryoro-Mediterranean belt, by shrub patches of Juniperus communis ssp. alpina and Cytisus oromediterraneus from lower altitudes (Oro-Mediterranean belt). Climatic data indicate a shift towards warmer conditions in this mountainous region since the 1940s, with the shift being particularly marked from 1960. Changes include significantly higher minimum and maximum temperatures, fewer days with snow cover and a redistribution of monthly rainfall. Total yearly precipitation showed no significant variation. There were no marked changes in land use during the time frame considered, although there were minor changes in grazing species in the 19th century. It is hypothesized that the advance of woody species into higher altitudes is probably related to climate change, which could have acted in conjunction with discrete variations in landscape management. The pronounced changes observed in the plant communities of the area reflect the susceptibility of high-mountain Mediterranean species to environmental change.