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Objective: To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems. Design: A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12–14 weeks of pregnancy, at 29–30 weeks of pregnancy, and 4–6 weeks postpartum. All women completed a mental screening at week 12–14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS). Setting: Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain. Participants: Pregnant women (N = 335, age 18–45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020. Findings: The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12–14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29–30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4–6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems. Conclusions: Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this research is to identify the combinations of factors leading to experience in sustainability reporting by Spanish public universities. Design/methodology/approach: Using a sample of 49 public universities in Spain, this paper identifies the combinations of factors on innovation profile, political and internal factors that explain the different degree of corporate social reporting experience with fuzzy-set qualitative comparative analysis. Findings: The study's findings are a contribution to existing literature as the results obtained point out three different configurations leading to this expertise, with a combination of different conditions based on innovation profile, political and internal factors. Also, the results reveal new characteristics of sustainable development strategies by universities, such as devoting a specific sustainability reporting section in the university website, creating a sustainability body in the university structure or submitting the sustainability report to external assurance. Research limitations/implications: This study refers only to Spanish public universities. In the future, new studies can enlarge the sample and analyse country effects and impact of public versus private status of universities on sustainability reporting strategies. Practical implications: The study's findings are important for university community, regulators and other stakeholders to start considering the need to somehow promote further sustainability reporting and assurance practices by universities, especially in a context of budget restrictions. Originality/value: This paper opens up a new line of research on sustainability experience using an innovative methodology (fuzzy-set qualitative comparative analysis) useful with small sample sizes, and provides a complete picture of sustainability reporting by Spanish public universities.

The protection of groundwater resources in coastal aquifers is an increasingly important issue worldwide. To establish threshold values and remediation objectives, it is essential to know the natural background concentrations of relevant ions in groundwater. The rationale is to define the Natural Background Level (NBL) of chemical species determined by atmospheric and lithological forces. In many coastal aquifers, this evaluation worsens since atmospheric and lithological salinity combines with many other anthropogenic sources of salinity, including exogenous salinity induced by seawater intrusion (SWI). This paper presents a combination of six well-known statistical techniques and a new methodology (i.e., SITE index) in eight GWBs affected by SWI in Eastern Spain. The chloride ion was the selected conservative chemical specie to assess the qualitative status due to the variable SWI affection. The Natural Chloride Background (NCB) obtained from these methodologies at the GWB scale was compared with regional NCB data calculated with the Atmospheric Chloride Mass Balance (CMB) method in Continental Spain. The CMB method provides atmospherically derived NCB data that are not influenced by SWI or anthropogenic activities or lithological forces. This external evaluation can be considered the atmospheric fraction of NCB, which serves as a regional criterion to validate the more detailed statistical methodologies applied at the GWB scale. As a result, a conceptualization of NCB is obtained by means of a range of values between 115 mg L−1 and 261 mg L−1 in the studied coastal GWBs affected by SWI in Eastern Spain. [ABSTRACT FROM AUTHOR]

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. Material and methods: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4's new image analysis capability. Results: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as "error requiring intervention to sustain life" and "error resulting in death", had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implications for patient safety. [ABSTRACT FROM AUTHOR]

Featured Application: The underground salt cavern design by leaching process for green hydrogen storage to compensate for the variable/seasonal nature of renewables and increase the availability of a clean fuel to society. The Poza de la Sal diapir is a closed circular depression with Cretaceous Mesozoic materials, formed by gypsum, Keuper clays, and a large extension of salt in the center with intercalations of ophite. The low seismic activity of the area, the reduced permeability and porosity of the salt caverns, and the proximity to the Páramo de Poza wind park, make it a suitable place for the construction of a facility for underground storage of green hydrogen obtained from surplus wind power. The design of a cavern for hydrogen storage at a depth of 1000 m takes into account the differences in stresses, temperatures, and confining pressures involved in the salt deformation process. During the 8 months of the injection phase, 23.0 GWh can be stored in the form of hydrogen obtained from the wind energy surplus, to be used later in the extraction phase. The injection and extraction ratio must be developed under the conditions of geomechanical safety of the cavity, so as to minimize the risks to the environment and people, by conditioning the gas pressure inside the cavity to remain within a given range. [ABSTRACT FROM AUTHOR]

Background: Dementia is projected to affect 135 million by 2050. Diet is a pertinent target for primary prevention, but firm recommendations for dementia prevention are not available yet. Our aim was to address the association between exploratory (empirically derived) dietary patterns (DP) and changes in the Spanish Telephone Interview for Cognitive Status (STICS-m, maximum score = 41 points) over 6 years.Method: Information on diet was collected with a validated 136-item food-frequency questionnaire from 803 participants in the Mediterranean cohort "Seguimiento Universidad de Navarra." We used principal component analysis to derive exploratory DP. The derived DP were associated with change in STICS-m scores over 6 years, through adjusted multiple linear regression models.Results: Two main DP were identified. The first DP resembled a Western dietary pattern (WDP)-high in sugar, fat, processed foods, and red meat-and the second DP resembled a Mediterranean dietary pattern (MDP)-high in vegetables, fruits, nuts, fish, and olive oil. Adherence to the WDP (tertile 3 vs tertile 1) was significantly associated with negative STICS-m changes after 6 years (between-tertile difference in changes: -0.80 points; 95% confidence interval [CI] -1.51, -0.08, p value = 0.03). Meanwhile, the MDP showed a positive +0.71 point (95% CI 0.15, 1.26, p value = 0.01) between-tertile difference in changes in the STICS-m score.Conclusions: A healthy, prudent, MDP was associated with less decline in cognitive function and, thus, could help to lower dementia incidence. Western-type diets were associated with a greater decline in cognitive performance and could increase dementia incidence. [ABSTRACT FROM AUTHOR]

Sometimes class-attendance is a component (or requirement) to benefit from the continuous assessment. The objective of this study is to evidence that some students seem to be getting unfairly penalized for nonattendance. To address this issue, we provide alternative assessment solutions taking into account the different profiles of the students. This study is based on the performance in online tests undertaken in a subject of Financial Accounting taught in English in two groups at Valencia University (from Spain). This subject is especially important for International Business (IB) as managers make decisions based on financial information. In this course, students learn about the legal accounting framework, from a national and IB perspective (i.e., national standards and International Financial Reporting Standards). Difficulty of course contents, students' study time, students' university access mark, age, and class-attendance are determining factors of the mark obtained in online tests if we take into account all the students. However, for the students whose marks are the best and second best grades, only the difficulty of course contents, study time, age and parents' studies are significant factors. Evidence is found that attendance improves online test performance significantly for the whole group of students, yet this factor is not significant considering only the best performing students. Our findings justify that the continuous assessment system should only require a specific level of attendance if the online test performance drops below a certain grade (for instance the second best grade). That way, these students would have an extra motivation to attend classes but better performing students who are keeping best and second grades in their online tests will not get penalized if classes are missed as long as they keep performing well. [ABSTRACT FROM AUTHOR]

Summary Background Overweight and obesity are major causes of comorbidities which can lead to further morbidity and mortality. The main objective of the present study was to estimate the comorbidity associated with obesity in 40,010 patients attending Primary Health Care Centres in Navarra. Methods It is a descriptive cross-sectional study. The association of overweight and obesity in different diseases was studied. Odds ratios (OR) adjusted for age and sex were calculated by unconditional logistic regression, using as reference patients with body mass index (BMI) lower than 25 kg/m 2 . Results Increasing BMI is associated with glucose intolerance (OR: 1.07; 95% CI: 1.06–1.08), dyslipidemia (OR: 1.04; 95% CI: 1.03–1.04), hypertension (OR: 1.12; 95% CI: 1.12–1.13), type 2 diabetes (OR: 1.11; 95% CI: 1.10–1.11), kidney failure (OR: 1.04; 95% CI: 1.03–1.05), and osteoarthritis (OR: 1.06; 95% CI: 1.05–1.06). Moreover, all the degrees of obesity are associated with asthma (OR type I obesity: 1.33; OR type II obesity: 1.69; OR type III obesity: 1.75), heart failure (OR type I obesity: 1.68; OR type II obesity: 2.78; OR type III obesity: 4.35), and severe mental disorders (OR type I obesity: 2.02; OR type II obesity: 2.33; OR type III obesity: 2.50). Type II and morbid obesity are associated with chronic obstructive pulmonary disease and depression. Conclusion Our study showed a positive association of the overweight and obesity with glucose intolerance, dyslipidemia, type 2 diabetes, hypertension, osteoarthritis, and kidney failure. An interesting point is the association of higher levels of BMI with depression. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to evaluate the association between adherence to the Mediterranean Diet (MedDiet) and cognitive function in 823 participants (62 ± 6 years at baseline) from a Spanish prospective cohort (SUN project). Method: A validated 136-item food frequency questionnaire was used to assess the adherence to the MedDiet at baseline. The 10-point (0 to 9) MedDiet Score was used to categorize adherence to MedDiet. Cognitive function was assessed twice at follow-up with a mean follow-up time between exposure and outcome assessment of 6 and 8y using the Telephone Interview of Cognitive Status-modified (TICS-m, range 0 to 54 points). ANCOVA models were used to assess the association between adherence to the MedDiet and cognitive decline. Results: In the multivariable-adjusted analysis of 2-year changes, a higher cognitive decline was observed among participants with low or moderate baseline adherence to the MedDiet than among those with better adherence (adjusted difference = −0.56 points in TICS-m, 95% CI = −0.99 to −0.13). Conclusion: A higher adherence to the MedDiet might be associated with better cognitive function. However, observed differences were of small magnitude and further studies are needed to confirm this finding. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to determine the prevalence of asthma symptoms and overweight-obese in children aged 6-7years and adolescents aged 13-14 years within the metropolitan area of Pamplona, and analyse the risk of asthma within the age groups and the influences if sex on this relationship Methods: The study is based on data of asthma symptoms and body mass index of 4,413 children and adolescents obtained from the International Study of Asthma and Allergies phase III questionnaire. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% Cl) for overweight-obesity and asthma symptoms in both groups, taking as reference the group of normal weight. Afterwards, it was stratified by sex. Results: The prevalence of overweight-obesity in the group aged 6-7 years was 23.9% and in the group of teenagers was 11.5%. The prevalence of asthma symptoms in both age groups was lower than the Spanish average. The obese children aged 6-7 years had a higher risk of asthma symptoms. When it was stratified by sex, an increased risk in all asthma symptoms was observed only in obese girls. No relationship between obesity and asthma was observed n the adolescents group. Conclusions: Obesity in children is related to asthma symptoms. Obese girls have an increased risk and more severe asthma symptoms than boys. [ABSTRACT FROM AUTHOR]

This paper analyses the predictions of the election results for the Spanish Parliament published in the main Spanish newspapers. To gauge their degree of accuracy, the distance between the predictions and the actual results was defined and later assessed by comparing it with that of the so-called 'perfect poll'. This 'perfect poll' was generated by a simulation using the proportions of votes actually obtained by each party. Other issues related to the published polls are also analysed, such as the relationship between sample size and estimation quality, and between the error made (by excess or defect) for a party and the ideological affinity between that party and the newspaper publishing the survey. [ABSTRACT FROM AUTHOR]

The available large prospective studies supporting an inverse association between better adherence to the Mediterranean diet and lower mortality have mainly included older adults. It is not clear whether this inverse association is also present among younger individuals at lower mortality risk. Our aim was to assess the association between adherence to the Mediterranean diet and total mortality in middle-aged adults from the Seguimiento Universidad de Navarra (SUN) Project. We followed 15,535 Spanish university graduates for a mean of 6.8 y. Their mean age was 38 ± 12 y, 59.6% were females, and all were initially free of cardiovascular disease, cancer, and diabetes. A validated FFQ was used to assess dietary habits. Adherence to the Mediterranean diet was categorized into 3 groups according to the Mediterranean Diet Score (low, 0-2 points; moderate, 3-5 points; and high, 6-9 points). The outcome variable was total mortality. Cox proportional hazards models were used to estimate HR and 95% CI. We adjusted the estimates for sex, age, years of university education, BMI, smoking, physical activity, television watching, history of depression and baseline hypertension, and hypercholesterolemia. We observed 125 deaths during 105,980 person-years of follow-up. The fully adjusted HR for moderate and high adherence were 0.58 (95% CI: 0.34, 0.99; P= 0.05) and 0.38 (95% CI: 0.21, 0.70; P= 0.002), respectively. For each 2-point increment in the Mediterranean Diet Score, the HR of death was 0.72 (95% CI: 0.58, 0.91; P= 0.006). Among highly educated, middle-aged adults, adherence to the traditional Mediterranean diet was associated with reduced risk of death. [ABSTRACT FROM AUTHOR]

Water management has become a vital concern for both water supply companies and public administrations due to the importance of water for life and current scarcity in many areas. Studies exist that attempt to explain which factors influence water demand. In general, these studies are based on a small sample of consumers and they predict domestic water consumption using ordinary least squares regression models with a small number of socioeconomic variables as predictors, usually: price, population, population density, age, and nationality. We have followed a different approach in two ways; one, in the scope of the study: we have included in the study all consumers of the Barcelona area and as many socioeconomic variables as possible (all the available data from official statistics institutions); and also in the methodology: first, we have segmented clients into homogeneous socioeconomic groups that, as we show later in the Barcelona case, also have homogeneous water consumption habits. This allows for a better understanding of water consumption behaviours and also for better predictions through modeling water consumption in each segment. This is so because the segments' inner variability is smaller than the general one; thus, the models have a smaller residual variance and allow for more accurate forecasts of water consumption. The methodology was applied to the Barcelona metropolitan area, where it was possible to construct a database including both water consumption and socioeconomic information with more than one million observations. Data quality was a primary concern, and thus a careful exploratory data analysis procedure led to a careful treatment of missing observations and to the detection and correction or removal of anomalies. This has resulted in a stable division of the one million water consumers into 6 homogeneous groups and models for each of the groups. Although the methodology has been developed and applied to the Barcelona area, it is general and thus can be applied to any other region or metropolitan area. [ABSTRACT FROM AUTHOR]

This study included 11,825 participants of a Spanish dynamic prospective cohort based on former students from University of Navarra, registered professionals from some Spanish provinces, and university graduates from other associations, followed-up for 6.1 years. We aimed to assess the association between childhood or young adult overweight/obesity and the risk of depression. Participants were asked to select which of nine figures most closely represented their body shape at ages 5 and 20 years. Childhood and young adult overweight/obesity was defined as those cases in which participants reported body shape corresponding to the figures 6–9 (more obese categories) at age 5 or 20, respectively. A subject was classified as incident case of depression if he/she was initially free of depression and reported physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of biannual follow-up questionnaires. The association between childhood and young adult overweight/obesity and incidence of depression was estimated by multiple-adjusted hazard ratio (HR) and its 95% confidence interval (95% CI). Overweight/obesity at age 5 years predicted an increased risk for adult depression (HR = 1.50, 95% CI = 1.06–2.12), and a stronger association was observed at age 20 years ((HR = 2.22, 95% CI = 1.22–4.08), (subjects younger than 30 years at recruitment were excluded from this last analysis)). Childhood or young adult overweight/obesity was associated with elevated risk of adult depression. These results, if causal and confirmed in other prospective studies, support treating childhood and young adult overweight/obesity as part of comprehensive adult depression prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Despite low rates of obesity, many university students perceive themselves as overweight, especially women. This is of concern, because inappropriate weight perceptions can lead to unhealthy behaviours including eating disorders. Methods: We used the database from the Cross National Student Health Survey (CNSHS), consisting of 5,900 records of university students from Bulgaria, Denmark, Germany, Lithuania, Poland, Spain and Turkey to analyse differences in perceived weight status based on the question: "Do you consider yourself much too thin, a little too thin, just right, a little too fat or much too fat?". The association between perceived weight and body mass index (BMI) calculated from self-reported weight and height was assessed with generalized non-parametric regression in R library gam. Results: Although the majority of students reported a normal BMI (72-84% of males, 65-83% of females), only 32% to 68% of students considered their weight "just right". Around 20% of females with BMI of 20 kg/m2 considered themselves "a little too fat" or "too fat", and the percentages increased to 60% for a BMI of 22.5 kg/m2. Male students rarely felt "a little too fat" or "too fat" below BMI of 22.5 kg/m2, but most felt too thin with a BMI of 20 kg/m2. Conclusions: Weight ideals are rather uniform across the European countries, with female students being more likely to perceive themselves as "too fat" at a normal BMI, while male students being more likely to perceive themselves as "too thin". Programs to prevent unhealthy behaviours to achieve ill-advised weight ideals may benefit students. [ABSTRACT FROM AUTHOR]

This paper presents the results of a study on the psychometric properties of an authorized Spanish version of the McMaster Family Assessment Device, a self-report measure of family functioning. The study sample comprised 60 psychiatric patients and their family member and 60 controls, without mental health problems, and their family member. Compared to other studies, all subscales displayed adequate temporal stability and acceptable reliability. While the instrument discriminated well between the two groups of families on all subscales, the results nevertheless indicated limitations in the inter-item discriminant capacity of the “Roles” subscale. Factor analysis resulted in a three-factor model that does not coincide with the established structure of this instrument. Proposals to improve and adapt questionnaire are discussed with a view to make it applicable to cultures other than the one it was developed. Theoretical models relating to psychosocial aspects such as family functioning, albeit compatible in some areas, should be viewed with caution in cultures different to that in which the model originates. [ABSTRACT FROM AUTHOR]

Background: Although several studies have investigated the influence of diet on asthma in schoolchildren, none of them has evaluated how obesity can modify this effect. A study was undertaken to evaluate the association of various foods and a Mediterranean diet with the prevalence of asthma and rhinoconjunctivitis, adjusting for obesity and exercise. Methods: A cross-sectional study was performed in 20 106 schoolchildren aged 6-7 years from eight Spanish cities. Using the ISAAC phase III questionnaire, parents reported chest and nose symptoms, food intake, weight, height and other factors, including exercise. A Mediterranean diet score was developed. A distinction was made between current occasional asthma (COA) and current severe asthma (CSA). Results: Independent of the amount of exercise, each Mediterranean score unit had a small but protective effect on CSA in girls (adjusted OR 0.90, 95% CI 0.82 to 0.98). Exercise was a protective factor for COA and rhinoconjunctivitis in girls and boys (the more exercise, the more protection). Obesity was a risk factor for CSA in girls (adjusted OR 2.35, 95% Cl 1.51 to 3.64). Individually, a more frequent intake (1-2 times/week and ⩾3 times/week vs never/occasionally) of seafood (adjusted ORs 0.63 (95% CI 0.44 to 0.91) and 0.53 (95% CI 0.35 to 0.80)) and cereals (adjusted OR 0.56 (95% CI 0.30 to 1.02) and 0.39 (95% CI 0.23 to 0.68)) were protective factors for CSA, while fast food was a risk factor (adjusted ORs 1.64(95% Cl 1.28 to 2.10) and 2.26 (95% CI 1.09 to 4.68)). Seafood (adjusted ORs 0.74 (95% CI 0.60 to 0.92) and 0.67(95% CI 0.53 to 0.85)) and fruit (adjusted ORs 0.76 (95% CI 0.60 to 0.97) and 0.71 (95% CI 0.57 to 0.88)) were protective factors for rhinoconjunctivitis. Conclusions: A Mediterranean diet has a potentially protective effect in girls aged 6-7 years with CSA. Obesity is a risk factor for this type of asthma only in girls. [ABSTRACT FROM AUTHOR]

Background: The role of alcohol as a risk factor for motor vehicle crashes is long known. Yet, reports on the prevalence of drinking and driving suggest values between 20%-30% when the adult driving population is interviewed. We wondered whether these values hold true among European educated citizens and whether there are any significant differences in prevalence by age, gender, type of profession and other lifestyle indicators. Methods: Cross-sectional analyses of baseline data from a cohort of university graduates in Spain (SUN study). Answered questionnaires contained items on current drinking and driving practices, together with data on socio-demographic characteristics and lifestyle habits. Chi square, Fisher test, and multivariate logistic regression were used to investigate the impact of several variables on drinking and driving practices. Analyses were stratified by gender. Results: Almost 30% of the participants reported "sometimes" drinking and driving. This percent increased to 47% when "almost never" was also included as a positive answer to the drinking and driving practice question. These percentages varied significantly by gender, with up to 64% of men reporting "sometimes" or "almost never" vs. 36% of women doing so. Drinking and driving practices also differed by overall alcohol consumption habits, smoking, use of safety belts, and notably, type of profession. Conclusion: Our findings are amongst the first on the high prevalence of drinking and driving among Spanish. Particularly worrisome is the fact that health professionals reported this habit even at higher rates. Multidisciplinary interventions (e.g., legal, educational, economic) are needed to reduce this serious health risk. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities Methods: The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO2, NO2, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed. Results: Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0-1), except in the case of ozone where there was a more delayed relation (lag 2-3). For combined estimates an increase of 10 ²g/m³ in the PM10 levels in lag 0-1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1 .6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2-3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m³ in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO2 and NO2 estimates were more sensitive in two pollutant models Conclusions: A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the prevalence of metabolic syndrome (MS) and other surrogate markers of insulin resistance, and whether these markers are better for defining the prehypertensive state than is renal dysfunction. Methods: Data from 19,041 healthy active workers, mean age 42.2 (10.7) years, from three health insurance companies, were prospectively collected. Presence of MS, assessed according to the modified criteria of the National Cholesterol Education Program Third Adult Treatment Panel, and the ratio of triglycerides to high-density lipoprotein were considered as surrogate markers of insulin resistance. Renal function was assessed by the Modification of Diet in Renal Disease Study equation. Blood pressure was classified as normotension (NT), prehypertension (PHT), or hypertension (HT) according to the guidelines of the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Results: The global presence of MS was 11.8% The higher prevalence was found in subjects with hypertension (30%), followed by those with PHT (9.6%). The prevalence in normotensive subjects was very low (0.9%). The presence of MS and hypertension increased in parallel with age. Metabolic syndrome (odds ratio [OR] 4.3), obesity (OR 2.2), overweight (OR 1.7), impaired fasting glucose (OR 1.3), and elevated triglycerides to HDL ratio (OR 1.2), but no degree of renal dysfunction, were independent risk factors for the progression from NT to PHT. Conclusions: Prehypertension is associated with markers of insulin resistance, assessed by the presence of MS and other surrogate markers, and not with an initial renal dysfunction. In this study, MS was found to be present in almost one third of hypertensive but asymptomatic and otherwise healthy workers. [Copyright &y& Elsevier]

Background: The role of immunization with bacillus Calmette-Guérin (BCG) in the prevalence of asthma, hay fever and atopic dermatitis is not definitely established and seems to be influenced by ethnic background. The aim of this study was to analyze the relationship between this immunization and the prevalence of those diseases in a homogeneous population of Spanish schoolchildren. Methods: The International Study of Asthma and Allergies in Childhood (ISAAC) core and environmental questionnaires were used in four different centers of the Spanish North Atlantic coast. Bilbao, San Sebastián and Asturias have a universal BCG immunization policy during the first days of life, whereas La Coruña discontinued this practice in 1989. Except for this center, immunization coverage was above 90%. A random sample of schools of Asturias or all schools in the city district (rest of centers) with children 6 and 7 years old was surveyed. Results: The participation rate was above 70%. After excluding those children born outside Spain, the numbers were 6,762 immunized and 2,828 nonimmunized. After adjusting for gender, age, smoking habits of the father and mother, truck traffic near the household, older and younger siblings and having a cat or a dog during the first year of the child’s life, the adjusted ORs of the BCG-immunized children suffering from asthma, hay fever and atopic dermatitis were respectively 0.87 (95% CI 0.76–1.00), 0.87 (0.75–1.01) and 0.89 (0.76–1.05). Conclusions: BCG immunization offers a weak but significant protection against asthma and hay fever in Spanish schoolchildren. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Most studies show a steep increase in asthma prevalence in the last decades, although few studies had applied the same methodology. Recent reports point out the possibility that the epidemic has come to an end. We have studied the prevalence of asthma in a very large sample of children, repeating the study eight years apart.Repeated cross-sectional studies using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol in a sample of Spanish schoolchildren 6–7 (parent-reported) and 13–14 (self-reported) years old in 1994–95 (phase I) and 2002–2003 (phase III). The number of participants was 42 417 in phase I and 42 813 in phase III. The participation rate was over 87% (13–14 years) and 70% (6–7 years).The prevalence of wheezing in the previous year in children aged 13–14 years was 9.0 and 9.3% for boys and 9.6 and 9.2% for girls for phases I and III, respectively. Children 6–7 years of age showed a substantial increase in wheezing in the previous year (7.0 and 10.7% for boys and 5.3 and 8.2% for girls). Other symptoms and severity indexes followed the same patterns.In the last 8 years, the prevalence of asthma has not changed in 13–14-year-old Spanish children but has increased substantially in 6–7-year olds. [ABSTRACT FROM AUTHOR]

Organochlorine compounds have been linked to increased risk of several cancers. Despite reductions in their use and fugitive release, they remain one of the most important groups of persistent pollutants to which humans are exposed, primarily through dietary intake. We designed a case-control study to assess the risk of colorectal cancer with exposure to these chemicals, and their potential interactions with genetic alterations in the tumors. A subsample of cases (n = 132) and hospital controls (n = 76) was selected from a larger case-control study in Barcelona, Catalonia, Spain. We measured concentrations in serum of several organochlorines by gas chromatography. We assessed point mutations in K-ras and p53 genes in tissue samples by polymerase chain reaction/single-strand conformation polymorphism and assessed expression of p53 protein by immunohistochemical methods. An elevated risk of colorectal cancer was associated with higher serum concentrations of mono-ortho polychlorinated biphenyl (PCB) congeners 28 and 118. The odds ratio for these mono-ortho PCBs for middle and higher tertile were, respectively, 1.82 [95% confidence interval (CI), 0.90-3.70] and 2.94 (95% CI, 1.39-6.20). α-Hexachlorocyclohexane, hexachlorobenzene, and p,p'-DDE (4,4'-dichlorodiphenyltrichloroethene) showed nonsignificant increases in risk. Risk associated with mono-ortho PCBs was slightly higher for tumors with mutations in the p53 gene but was not modified by mutations in K-ras. Mono-ortho PCBs were further associated with transversion-type mutations in both genes. These results generate the hypothesis that exposure to mono-ortho PCBs contributes to human colorectal cancer development. The trend and magnitude of the association, as well as the observation of a molecular fingerprint in tumors, raise the possibility that this finding may be causal. [ABSTRACT FROM AUTHOR]

Background: We analyzed the relationship between the prevalence of schizophrenia and the season of birth and gestation during a period of an influenza pandemic. Methods: Cross-sectional analysis of a prospective population-based cohort of 470,942 adults. We fitted multivariant logistic regression models to determine whether the season of birth and birth in an influenza-pandemic year (1957, 1968, 1977) was associated with schizophrenia. Results: 2077 subjects had been diagnosed with schizophrenia. Logistic regression identified a significantly greater prevalence of schizophrenia in men than in women (OR = 1.516, CI 95% = 1.388–1.665); in those born in the winter or spring than in those born in the summer or autumn (OR = 1.112, CI 95% = 1.020–1.212); and in those born in a period of an influenza pandemic (OR = 1.335, CI 95% = 1.199–1.486). The increase in risk was also significant when each influenza pandemic year was analyzed separately. However, neither month of birth nor season of birth, when each of the four were studied individually, were associated with a statistically significant increase in that risk. Conclusions: The winter–spring period and the influenza pandemics are independent risk factors for developing schizophrenia. This study contradicts many previous studies and thus revitalizes a locked debate in understanding the neurodevelopmental hypothesis of this disorder. [ABSTRACT FROM AUTHOR]

Background: The objective structured clinical examination (OSCE) is a test used throughout Spain to evaluate the clinical competencies, decision making, problem solving, and other skills of sixth-year medical students.Objective: The main goal of this study is to explore the possible applications and utility of portable eye-tracking systems in the setting of the OSCE, particularly questions associated with attention and engagement.Methods: We used a portable Tobii Glasses 2 eye tracker, which allows real-time monitoring of where the students were looking and records the voice and ambient sounds. We then performed a qualitative and a quantitative analysis of the fields of vision and gaze points attracting attention as well as the visual itinerary.Results: Eye-tracking technology was used in the OSCE with no major issues. This portable system was of the greatest value in the patient simulators and mannequin stations, where interaction with the simulated patient or areas of interest in the mannequin can be quantified. This technology proved useful to better identify the areas of interest in the medical images provided.Conclusions: Portable eye trackers offer the opportunity to improve the objective evaluation of candidates and the self-evaluation of the stations used as well as medical simulations by examiners. We suggest that this technology has enough resolution to identify where a student is looking at and could be useful for developing new approaches for evaluating specific aspects of clinical competencies. [ABSTRACT FROM AUTHOR]

During the last years there has been an increasing interest in assessing health risks caused by exposure to contaminants found in soil, air, and water, like heavy metals or emerging contaminants. This work presents a study on the spatial patterns and interaction effects among relevant heavy metals (Sb, As and Pb) that may occur together in different minerals. Total organic carbon (TOC) have been analyzed too because it is an essential component in the regulatory mechanisms that control the amount of metal in soils. Even more, exposure to these elements is associated with a number of diseases and environmental problems. These metals can have both natural and anthropogenic origins. A key component of any exposure study is a reliable model of the spatial distribution the elements studied. A geostatistical analysis have been performed in order to show that selected metals are auto-correlated and cross-correlated and type and magnitude of such cross-correlation varies depending on the spatial scale under consideration. After identifying general trends, we analyzed the residues left after subtracting the trend from the raw variables. Three scales of variability were identified (compounds or factors) with scales of 5, 35 and 135 km. The first factor (F1) basically identifies anomalies of natural origin but, in some places, of anthropogenics origin as well. The other two are related to geology (F2 and F3) although F3 represents more clearly geochemical background related to large lithological groups. Likewise, mapping of two major structures indicates that significant faults have influence on the distribution of the studied elements. Finally, influence of soil and lithology on groundwater by means of contingency analysis was assessed. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: physical inactivity is the fourth most important risk factor for mortality worldwide and university students present this risk factor at a high level. Objective: to determine the changes in the physical activity of university students in Navarra during the first three years of college. Methods: prospective observational study of a cohort of university students. They participated in the first year, and two years later in the third year. The cohorts were comprised of 454 students who answered a voluntary and anonymous self-completion questionnaire with sociodemographic and physical activity related variables. Data were analyzed with SPSS v21.0. Results: of the participants, 67.4% (n = 306) were women and 32.6% (n = 148) were men. In the first year, 61.6% of students performed more than 150 minutes of physical activity per week. This percentage increased by 2.7%. The frequency of physical activity at least three times a week increased 6.1%, reaching 30.5% of students. Conclusions: university does not play a significant role in the promotion of physical activity, finding minimal modifications. In the future, it would be convenient to consider the reasons that hinder physical activity and design programs according to current recommendations. [ABSTRACT FROM AUTHOR]

Unexplained cardiac arrest (UCA) can be caused by low-penetrance genetic disorders. The aim of this cross-sectional study is to assess the usefulness of a new diagnostic protocol: Thirty-five patients were recruited from 9 Spanish centers. Electrocardiogram, echocardiogram, and coronary catheterization were used to rule out electrical or structural heart disease in all subjects. Patients underwent pharmacologic tests with epinephrine and flecainide, followed by assessment of family members using electrocardiogram and echocardiogram, and next-generation genetic sequencing to analyze 126 genes if all the other test results were negative. A firm diagnosis of channelopathy required phenotypic proof of the condition in unmasking tests, the presence of a pathogenic variant consistent with the phenotype observed, and/or co-segregation of the mutation found in a family member's phenotype. A firm diagnosis was made in 18 cases. The diagnoses were 7 Brugada syndrome, 5 catecholaminergic polymorphic ventricular tachycardia, 3 long QT syndrome, 2 early repolarization syndrome, and 1 short QT syndrome. Pharmacologic testing was the most frequent method of diagnosis. In 5 cases, the diagnosis was made based on positive genetic testing without phenotypic alterations. In conclusion, this sequential diagnostic protocol allows diagnoses to be made in approximately half of the UCA cases. These diagnoses are low clinical penetrance channelopathies. If interpreted carefully, genetic tests can be a useful tool for diagnosing UCA without a phenotype. [ABSTRACT FROM AUTHOR]

The article presents the study which sought to examine the association between the physical activity during leisure time on the incidence of mental disorder in university graduates in Spain. Researchers conducted the baseline assessment in a cohort of graduates which included a validated questionnaire on physical activity during leisure time and sedentary activities, and classified the subject of the study as an incident case of mental disorder if he or she reported a physician diagnosis of depression, anxiety or stress. Results showed that subjects with the highest level of the sedentary index had an increased risk of mental disorder.

Abstract: Background: Obesity and overweight are increasing progressively leading to an increase in cardiovascular risk factors and cardiovascular events. Methods: The MESYAS Registry (Metabolic Syndrome in Active Subjects) recruited active workers from their annual health examinations in Spain through 2003. Body mass index was used to diagnose overweight and obesity. Metabolic syndrome (MS) and risk factors were assessed according to the ATP-III definitions. Results: 19,041 subjects were included (80% males), mean age 42.2 (10.7). The prevalence of overweight was 44.6% (44.0–45.2), obesity 17.3% (17.0–17.5) and MS 12.0% (11.8–12.2). Women had lower prevalence of all cardiovascular risk factors. Multivariate analysis showed independent associations between overweight (OR: 2.4; 95% CI 2.2–2.6) or obesity (OR: 5.3; 95% CI 4.7–5.9) and any other two MS criteria. Overweight and obesity were independently associated with all cardiovascular risk factors, except low high-density lipoproteins in women. Significantly higher association was found in women between obesity and diabetes (OR: 13.6; 95% CI 3.8–48.6), MS (OR: 10.6; 7.6–14.8), hypertriglyceridemia (OR: 8.6; 95% CI 5.6–13.1), and impaired fasting glucose (OR: 3.7; 95% CI 2.7–5.3). Conclusions: Overweight and obesity are strongly related to classical cardiovascular risk factors, atherogenic dyslipidaemia and MS. Obesity has higher association to insulin-resistance related risk factors in women. [Copyright &y& Elsevier]

Background and Aims: In Spain, the incidence of coronary heart disease is below that expected based on the burden of classic cardiovascular risk factors present in the population. Whether the risk associated with metabolic syndrome is lower in Spain deserves to be investigated. This study evaluates the association of incident clinical coronary heart disease with metabolic syndrome and each of its individual defining components in a sample of Spanish working males., Methods and Results: Among the workers of a factory (MESYAS registry), 208 incident cases of coronary heart disease (between 1981 and 2005) were age-matched with 2080 healthy workers visited in 2004-2005. Metabolic syndrome was characterized using modified criteria of the joint consensus definition (2009). Metabolic syndrome was strongly associated with coronary heart disease (OR = 4.03; 95% CI: 2.98, 5.45) and the risk seemed to be fully explained by metabolic syndrome components (OR = 0.84, p = 0.54 after adjustment). Odds ratios for the independent effects of the diagnostic criteria were: hypertriglyceridemia (OR = 3.39, p < 0.001), hyperglycemia (OR = 2.70, p < 0.001), low HDL cholesterol (OR = 2.35, p < 0.001), hypertension (OR = 1.49, p = 0.016) and overweight (OR = 1.07, p = 0.678). Young workers showed a higher risk associated with metabolic syndrome., Conclusion: The risk associated with metabolic syndrome is fully explained by its components considered independently. The risk of coronary heart disease in a Spanish male working population is considerably increased among those with metabolic syndrome, by a factor similar to that described for other countries. Public health measures to prevent a rise in the prevalence of metabolic syndrome are advisable to minimize cardiovascular disease rate in Spain., (Copyright © 2010 Elsevier B.V. All rights reserved.)