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Background and purpose: Spain has been one of the countries more heavily stricken by SARS‐CoV‐2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID‐19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. Methods: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra‐ and intra‐hospital times of action, Code Stroke activation pathway, COVID‐19 status, reperfusion rate, and short‐term outcome before and after the setting of the emergency state were analysed. Results: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out‐of‐hospital (95.0 vs. 110.0 min, P = 0.001) and door‐to‐needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID‐19 patients had more in‐hospital mortality. Conclusion: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out‐of‐hospital and door‐to‐needle times and worse reperfusion rates in northwest Spain. COVID‐19 patients had more in‐hospital mortality. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the Stanford Presenteeism Scale‐6 to assess presenteeism in the Spanish healthcare population. Background: Presenteeism, referring to going to work despite being ill, has been associated with job stress, productivity losses, reduced patient safety and increased health problems among the professionals who suffer from it. Introduction: The highest prevalence of presenteeism in the healthcare sector is among nurses. Their decision to attend work while ill has been related to role overload, lack of supervisor support, mental health and physical conditions. Methods: A cross‐sectional and validation study was conducted between September 2015 and June 2016 in a hospital in Asturias, Spain. Four hundred and ninety‐five healthcare professionals voluntarily agreed to participate (281 nurses, 122 physicians and 92 nursing assistants). Results: Presenteeism prevalence was high; the majority of it being in the nursing category. Bartlett's test and the Kaiser–Meyer–Olkin test indicated that the data meet the conditions for factorial analysis, evidencing a small variability in the median of each sample item and a significant standard deviation. Adjustment rates obtained in the exploratory factor analysis showed adequacy, and reliability rates also showed adequacy for both factors. It was verified by a confirmatory analysis that the factors of presenteeism are positively associated with burnout. Conclusion: The Stanford Presenteeism Scale‐6 showed good psychometric properties to study presenteeism in the Spanish healthcare sector. Implications for Nursing and Health Policy: Nursing leaders must develop measurements to assess and control psychosocial risks in order to improve the physical and mental health of professionals and reduce patient safety risks. [ABSTRACT FROM AUTHOR]

ABSTRACT Wetlands inventory is one of the goals of conservation plans on a national scale and a global scale. Inventories are needed for long-term monitoring or for identifying lost wetlands and those where restoration is feasible. In this article, we present an updated inventory of the saline wetlands of Southern Monegros, Spain. We depicted the evolution of these saline wetlands, locally named saladas with a unique long-term retrospective study based on aerial photographs from 1927. Their inventory has been accomplished through a map analysis based on a geographical information system using aerial photographs and orthophotographs, topographic maps, unpublished local studies and field surveys. Remaining vegetation, changes in soil moisture and colour, and geomorphology have been the key features in identifying the saladas. Their changes in number, size and shape have been driven by human pressure, the main modifier of landscape in the last 80 years. The information gathered will contribute to the awareness of stakeholders and decision makers for their conservation as natural resources. Moreover, our large retrospective approach is a consistent base from which to propose the inclusion of the saladas of Monegros in the Ramsar list of Wetlands of International Importance. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The hydro-physical properties of gypseous soils, which are commonly associated with dry climates, determine the productivity of rangelands and croplands. The objective of this paper is to study, in the semiarid central Ebro Basin, NE Spain, some hydro-physical properties of gypseous soils under five different contrasted soil managements: soils of ungrazed (N) and grazed (GR) uncultivated lands, and freshly moldboard tilled (MB), cropped (C), and fallowed (F) agricultural soils. The gypsum content of the studied soils, with concentrations that are natural, ranged from 50 to 92%. The soil bulk density (ρb), saturated sorptivity (S10), hydraulic conductivity (K10), and the water retention curve (WRC) of undisturbed soil samples from the 0–10 cm deep soil layer after removing the soil surface crust were calculated. Soil penetration resistance (SPR) for the upper 10 cm soil layer was also measured. Additional measurements of soil surface crust sorptivity (Scrust) and hydraulic conductivity (Kcrust) were conducted. Livestock trampling in GR promoted the highest ρband SPR values. The lack of soil disturbance in N caused that this treatment showed the lowest values ofScrustandKcrust, but the highestS10andK10. The specific behavior of gypseous soils, whose loose aggregates easily collapse during the soil wetting process, showed that the MB freshly tilled soil produced the lowest values ofS10andK10. A typical bimodal function of the WRC was found. Pore size distribution was affected by the soil treatment, with the highest and lowest values under MB and GR treatments, respectively. [ABSTRACT FROM PUBLISHER]

Longwave radiation is an important component of the energy balance of the Earth's surface. The downward component, emitted by the clouds and aerosols in the atmosphere, is rarely measured, and is still not well understood. In mountainous areas, direct observations are even scarcer and the fitting of existing models is often subjected to local parameterization in order to surplus the particular physics of the atmospheric profiles. The influence of clouds makes it even harder to estimate for all sky conditions. This work presents a long-time continuous dataset of high-resolution longwave radiation measured in a weather station at a height of 2500ma.s.l. in Sierra Nevada, Spain, together with the parameterization of the apparent atmospheric emissivity for clear and cloudy skies resulting from three different schemes. We evaluate the schemes of Brutsaert, and Crawford and Duchon with locally adjusted coefficients and compare them with a completely parametric expression adjusted for these data that takes into account three possible significant atmospheric states related to the cloud cover: clear, completely covered, and partly covered skies. All the parametric expressions are related to the screen-level values of temperature, relative humidity and solar radiation, which can be frequently found in standard weather stations. Unobserved cloudiness measurements needed for Brutsaert scheme for cloudy sky are also parameterized from screen-level measurements. The calibration performed for a 6-yr period at the study site resulted in satisfactory estimations of emissivity for all the analyzed schemes thanks to the local fitting of the parameterizations, with the best achievement found for the completely parametric expression. Further validation of the expressions in two alternative sites showed that the greater accuracy of the latter can also be found in very close sites, while a better performance of the Brutsaert scheme, with a more physical background and the successful parameterization of the clouds effect, is found in nearby sites outside the initial mountain range. The results show the feasibility for the local calibration of expressions to estimate instantaneous atmospheric emissivity for all sky conditions only using surface data, either with a completely parametric scheme if longwave data are available, or through obtaining of locally fitted coefficients for Brutsaert and derived schemes. Nevertheless, the best performance of the first approach would be at the expense of a reduced local applicability. [ABSTRACT FROM AUTHOR]

This paper studies the influence of changing spatial resolution on the implementation of distributed hydrological modelling for water resource planning in Mediterranean areas. Different cell sizes were used to investigate variations in the basin hydrologic response given by the model WiMMed, developed in Andalusia (Spain), in a selected watershed. The model was calibrated on a monthly basis from the available daily flow data at the reservoir that closes the watershed, for three different cell sizes, 30, 100, and 500 m, and the effects of this change on the hydrological response of the basin were analysed by means of the comparison of the hydrological variables at different time scales for a 3- yr-period, and the effective values for the calibration parameters obtained for each spatial resolution. The variation in the distribution of the input parameters due to using different spatial resolutions resulted in a change in the obtained hydrological networks and significant differences in other hydrological variables, both in mean basin-scale and values distributed in the cell level. Differences in the magnitude of annual and global runoff, together with other hydrological components of the water balance, became apparent. This study demonstrated the importance of choosing the appropriate spatial scale in the implementation of a distributed hydrological model to reach a balance between the quality of results and the computational cost; thus, 30 and 100-m could be chosen for water resource management, without significant decrease in the accuracy of the simulation, but the 500- m cell size resulted in significant overestimation of runoff and consequently, could involve uncertain decisions based on the expected availability of rainfall excess for storage in the reservoirs. Particular values of the effective calibration parameters are also provided for this hydrological model and the study area. [ABSTRACT FROM AUTHOR]

BACKGROUND Monitoring assisted reproductive technology (ART) is essential to evaluate the performance of fertility treatment and its impact on birth rates. In Europe, there are two kinds of ART registers: voluntary and mandatory. The validity of register data is very important with respect to the quality of register-based observational studies. The aim of this paper is to determine the degree of agreement between voluntary and mandatory ART registers. METHODS The two sources for the data compared in this study (referring to 2005 and 2006) were FIVCAT.NET (an official compulsory Assisted Reproduction Registry within the Health Ministry of the Regional Government of Catalonia, to which all authorized clinics, both public and private, performing assisted reproduction in the region are obliged to report) and the register of the Spanish Fertility Society (SEF), to which data are provided on a voluntary basis. The SEF register data were divided into two groups: (i) data from clinics in Catalonia (SEF-CAT); (ii) data from the rest of Spain, excluding Catalonia (SEF-wCAT). The techniques compared were IVF cycle using patients’ own eggs (IVF cycle) versus donor egg cycles. RESULTS For IVF cycles, the voluntary ART register reflected 77.2% of those on the official one, but the corresponding figure was only 34.4% with respect to donated eggs. The variables analysed in the IVF cycle (insemination technique used, patients’ age, number of embryos transferred, pregnancy rates, multiple pregnancies and deliveries) were similar in the three groups studied. However, we observed significant differences in donor egg cycles with regard to the insemination technique used, pregnancy rates and multiple pregnancies between the voluntary and the official register. CONCLUSIONS Data from the voluntary ART register for IVF cycles are valid, but those for donor egg cycles are not. Further study is necessary to determine the reasons for this difference. [ABSTRACT FROM AUTHOR]

Abstract: Remote sensing is a powerful tool for thematic mapping, but its use for the discrimination of different kinds of soils has been scarce and the results variable. We demonstrate the usefulness of Landsat ETM+ images to discriminate gypseous lands in two contrasting regions, Cedral, Mexico, and Bujaraloz, Spain. We also discuss the contribution of the infra-red bands, and found the bands of mid and thermal infra-red to be the more useful. A supervised classification of Landsat ETM+ images enabled us to discriminate land covers related to gypseous lands in Cedral, and to locate gypsum lithologies in Bujaraloz. The thermal infra-red band does not substantially improve the classification in Bujaraloz, but it does in Cedral, being best in the wet season, when the differences of temperatures among classes are relevant. [Copyright &y& Elsevier]

The small playa-lakes and other saline wetlands of Monegros, scattered over a dry area with winter cereal monoculture, are threatened by the settlement of new irrigation districts and other kinds of human pressure. Enforcing the protection rules of European Union in these valuable habitats requires, first, their delimitation and monitoring. This article shows how these tasks can be undertaken using remote sensing in conjunction with field observations. A series of Landsat images covering different seasons provided a comprehensive view of these wetlands encompassing their changing facies, hydrologic regime, state of conservation, and functional status. Remotely-sensed data were the primary, and in most cases the only available, source of consistent information. Our approach can help planning and surveying for the implementation of saline wetland protection measures in harmony with the conterminous agricultural areas. [Copyright &y& Elsevier]

Abstract: Increasing pressure on water resources in Spain is forcing farmers to move from flood to pressurized water application. Initial recommendations for this upgrading require soil survey information, especially in areas prone to soil salinity. In this article a 3158ha soil survey at a scale of 1:25,000 is presented. Soil series are split in phases based on the texture of the surface layer, slope, and salinity. Available water holding capacity (AWHC), to a depth of 1.5m or to a lithic or paralithic contact, texture and coarse components in the surface horizons, and salinity mapped as discrete soil units are combined to develop a regional soil suitability map for irrigation upgrade. To minimize soil erosion and salt mobilization in the soils, our recommendations are: (i) maintain and improve flood irrigation on 296ha, (ii) develop standard sprinkler irrigation on 2261ha, and (iii) move to high frequency sprinkler irrigation on 601ha. This research demonstrates the importance of soil survey as part of the decision making process for upgrading the regional irrigation systems. [Copyright &y& Elsevier]

Diagnosis of soil salinity and its spatial variability is required to establish control measures in irrigated agriculture. This article shows the usefulness of electromagnetic (EM) and soil sampling techniques to map salinity. We analysed the salinity of a 1-ha plot of surface-irrigated olive plantation in Aragon, NE Spain, by measuring the electrical conductivity of the saturation extract (ECe) of soil samples taken at 22 points, and by reading the Geonics EM38 sensor at 141 points in the horizontal (EMH) and vertical (EMV) dipole positions. EMH and EMV values had asymmetrical bimodal distributions, with most readings in the non-saline range and a sharp transition to relatively high readings. Most salinity profiles were uniform (i.e. EMH=EMV), except in areas with high salinity and concurrent shallow water tables, where the profiles were inverted as shown by EMH>EMV, and by ECe being greater in shallow than in deeper layers. The regressions of ECe on EM readings predicted ECe with R² > 84% for the 0-100 to 0-150 cm soil depths. We then produced salinity contour maps from the 141 ECe values estimated from the electromagnetic readings and the 22 measured values of ECe. Owing to the high soil sampling density, the maps were similar (i.e. mean surface-weighted ECe values between 3.9 dS m-1 and 4.2 dS m-1), although the electromagnetically estimated ECe improved the mapping of details. Whereas soil sampling is preferred for analysing the vertical distribution of soil salinity, the electromagnetic sensor is ideal for mapping the lateral variability of soil salinity. [ABSTRACT FROM AUTHOR]

During the last two decades, the traditional media model of the local press has suffered a deep crisis which, together with the economic one, has led to the closure of many newspapers and staff cuts. The growing need for a truthful local news offer and the adverse labor reality in the communication sector have motivated many journalists to found their own local and hyperlocal media in the network. In this research, an exploratory study is carried out to elaborate the first map of local and hyperlocal online media in Spain, with the objective of knowing the presence of this type of media in the State. Subsequently, these online media are subjected to a content analysis to identify their basic characteristics and development trends. The results show a relevant growth of local and hyperlocal online media in the country, and their features reflect the search for new information models from proximity. [ABSTRACT FROM AUTHOR]

• Effect of grazing on soil hydraulic properties of gypseous soils were studied. • Three grazing intensities, High, Medium and Low, were compared. • Soil surface S and K c and subsurface ρ b , K s , θ s , α and n were measured. • H presented the highest ρ b and the lowest K c values. • In semiarid gypseous soils M did not have a negative effect of soil properties. Although is well known that grazing has a significant effect on the soil hydraulic properties and through them on the pasture productivity in semi-arid regions, there is still little data about the effect of this management on soils with high gypsum content. This work compares the effect of three increasing grazing intensities (low, medium, and high) on the hydraulic properties of the upper soil layers, measured on two areas with increasing gypsum content (56 and 73%, respectively) located in a semi-arid region of the Middle Ebro Valley (NE, Spain). 90 soil samplings were taken on bare soil surface areas. The measured soil parameters included the saturated sorptivity (S c) and hydraulic conductivity (K c) of the soil surface layer and the soil bulk density (ρ b), saturated hydraulic conductivity (K s), saturated volumetric water content, θ s , and α and n parameters of the water retention curve of the 1–8 cm depth soil layer. Increasing gypsum content increased the soil water infiltration but did not affect the water retention capacity and total porosity. All studied gypseous soils presented low water retention. High grazing intensities decreased the soil water infiltration. While soils with high gypsum content tended to attenuate the effect of the livestock trampling on ρ b , a significant influence of grazing on ρ b was observed in the fields with moderate soil gypsum content. No effect of livestock trampling on the soil water retention characteristics was observed. Moderate grazing, which did not show negative effects on the soil hydro-physical properties, could be an acceptable management for soil conservation in these semiarid regions of soils with high gypsum content. [ABSTRACT FROM AUTHOR]

Abstract: The influence of snowmelt in semiarid alluvial rivers is determined by the river bed configuration and erosion processes. Moreover, the large amount of available sediment in the floodplains of these rivers limits traditional bedload sampling methodologies and suggests the use of large control volumes and long-term studies to understand erosive dynamics. In this study, bedload monitoring in a large control volume (0.2hm3) from 2004 to 2010 was used to study erosive processes of the Guadalfeo River, a semiarid alluvial river in southeastern Spain with high mountain influences and a hydrological regime conditioned by snow dynamics. The methodological approach to testing the performance of different transport models included characterization of the forcing agents (precipitation and snowmelt events), hydraulic configuration of the river, determination of the river bed material (surface and substrate), and one-off measurements for particular events. The results indicate a sediment volume–effective runoff relationship that is consistent with the existence of steep channels with a flashy runoff regime, although the existence of an armored layer derived from snowmelt events greatly controls the transport dynamics, with equivalent fractions of cobble–gravel and sand in the measured bedload. This apparent predominance of near-equal mobility was confirmed by the calibrated hiding function exponent (x≈0.94–0.97). The thresholds for entrainment and transport efficiency are similar to those observed for mountain rivers that exhibit torrential flow, although notable differences can be observed in the dynamics of the processes. The strong performance of the original Meyer-Peter and Müller model (with c=8) is shown to estimate the total transported volume associated with intense events when the variability of d 50 is included in the analysis. However, this model does not sufficiently capture transport because of moderate events (rain or snowmelt) and thus underestimates bedload on medium and long timescales. The calibrated model of Parker–Klingeman adequately represents erosive dynamics, with τ r50 ⁎ values between 0.03 and 0.041 for moderate and intense events, respectively, and a flow threshold of 14.2m3 s−1 that separates these two situations. Nevertheless, these models based on hiding functions present greater dispersion if the variability of diameters related to cobbles and pebbles is considered. For such cases, the Wilcock and Crowe model performed better for both intense and moderate events. The latter is important in the study area, where snowmelt pulses occasionally exceed the critical flow and break the surface layer with significant sediment contributions. These processes differentiate the transport dynamics from other studies and are distinctive characteristics that are more closely related to mountainous influences in semiarid environments where pulses of intense snowmelt are common. Despite its limitations, the proposed methodology, based on a large check-dam, has proven to be adequate and representative for assessment of erosion processes. [Copyright &y& Elsevier]

Summary: The arid agricultural lands of the Monegros Desert, in the central Ebro Basin (NE Spain), show contrasting white patches (WPs) and dark patches (DPs), evidencing their different soil composition. The white patches have shallow soils with low or nil crop development in most years. Soil at the dark patches uses to be deeper, and winter cereal attains better development. This paper analyzes soil hydro-physical features in order to identify differences in soil physical properties between white and dark soils. For this purpose, 20 pairs of WP/DP soils were studied on several agricultural plots. Each sampled pair was under the same soil condition. Three soil treatment (ST) were studied: freshly tilled soil (MB), cropped (C), and fallowed soil (F). The gypsum and calcium carbonate content, organic matter (OM) content, and particle size distribution for the 0–10cm depth soil were determined. Field measurements for the 1–10cm depth soil layer were soil bulk density (ρb ), soil penetration resistance (SPR), saturated hydraulic conductivity (K 1–10) and sorptivity (S 1–10). The water retention curve (WRC) was determined in the lab on undisturbed soil cores for the 1–10cm depth soil layer. Additional field measurements of soil surface crust sorptivity (Scrust ) and hydraulic conductivity (Kcrust ) at saturation were also performed. The results show that WP soils have significantly (p <0.05) higher contents of gypsum, lower contents of calcium carbonate and OM, and a coarser texture than DP soils. Compared to DP, the WP soils have higher values of SPR but lower ρb , K and S values in both the surface crust and the 0–10cm depth soil layer. On average, K 1–10 in DP was 1.4times higher than that measured in WP. DP showed a better-defined microstructure and retained more water retention at near saturation conditions than WP. Soil treatments have a significant effect on ρb , SPR, S 1–10, K 1–10 and on the WRC parameters. Overall, ρb and SPR was the lowest under MB, with maximal S 1–10 and K 1–10 values under C. Compared to C and F, MB presented the highest volume of structural porosity and the lowest water retention at near saturation conditions. [Copyright &y& Elsevier]

Abstract: A method for determining the total heat loss coefficient, the effective heat capacity and the net solar gain of a building is presented. The method uses a linear regressions approach based on daily energy consumption combined with readily available meteorological data. The effective heat capacity of the building is evaluated by correlating the energy consumption and outdoor temperature changes from the previous day. The net solar gain of the building is assessed by analysing the data separated into groups by amount of daily solar irradiation. Corrected total heat loss coefficient is determined by explicitly including in the building''s energy balance the accumulated heat and the solar gain. The method has been applied to the analysis of nine public buildings in Spain. An improvement of the estimated heat loss coefficient due to the corrections is observed. The effective heat capacity normalised by the building area is shown to be a useful indicator of the building operation, detecting continuous or intermittent heating. The estimated parameters in this study can enable specific benchmarking, detecting opportunities for energy savings and evaluating their potential. With the increasing implementation of smart metering technologies, the method is promising for application to the analysis of large building stocks. [Copyright &y& Elsevier]

Abstract: Cultivation of paddy rice in semiarid areas of the world faces problems related to water scarcity. This paper aims at characterizing water use in a set of paddies located in the central Ebro basin of Spain using experimentation and computer simulation. A commercial field with six interconnected paddies, with a total area of 5.31ha, was instrumented to measure discharge and water quality at the inflow and at the runoff outlet. The soil was classified as a Typic Calcixerept, and was characterized by a mild salinity (2.5dSm−1) and an infiltration rate of 5.8mmday−1. The evolution of flow depth at all paddies was recorded. Data from the 2002 rice-growing season was elaborated using a mass balance approach to estimate the infiltration rate and the evolution of discharge between paddies. Seasonal crop evapotranspiration, estimated with the surface renewal method, was 731mm (5.1mmday−1), very similar to that of other summer cereals grown in the area, like corn. The irrigation input was 1874mm, deep percolation was 830mm and surface runoff was 372mm. Irrigation efficiency was estimated as 41%. The quality of surface runoff water was slightly degraded due to evapoconcentration and to the contact with the soil. During the period 2001–2003, the electrical conductivity of surface runoff water was 54% higher than that of irrigation water. However, the runoff water was suitable for irrigation. A mechanistic mass balance model of inter-paddy water flow permitted to conclude that improvements in irrigation efficiency cannot be easily obtained in the experimental conditions. Since deep percolation losses more than double surface runoff losses, a reduction in irrigation discharge would not have much room for efficiency improvement. Simulations also showed that rice irrigation performance was not negatively affected by the fluctuating inflow hydrograph. These hydrographs are typical of turnouts located at the tail end of tertiary irrigation ditches. In fact, these are the sites where rice has been historically cultivated in the study area, since local soils are often saline-sodic and can only grow paddy rice taking advantage of the low salinity of the irrigation water. The low infiltration rate characteristic of these saline-sodic soils (an experimental value of 3.2mmday−1 was obtained) combined with a reduced irrigation discharge resulted in a simulated irrigation efficiency of 60%. Paddy rice irrigation efficiency can attain reasonable values in the local saline-sodic soils, where the infiltration rate is clearly smaller than the average daily rice evapotranspiration. [Copyright &y& Elsevier]

Purpose: In recent years, the need for a more appropriate prescription of medications in the older population has emerged as a significant public health concern. In this study, we aimed to evaluate the prevalence of potentially inappropriate medications (PIM) in hospitalized adults aged ≥ 75., Patients and Methods: This was a retrospective descriptive observational study of patients at 16 hospitals in Spain. The study population included inpatients aged ≥ 75 admitted during a 7-day period (May 10 to 16, 2021). Data were obtained from the pharmacy databases of the participating hospitals. The list of PIMs was based on the Beers, STOPP-START, EU-PIM and PRISCUS criteria., Results: A total of 4,183 patients were included. PIMs were detected in 23.5% (N = 1,126) of the cohort. The prevalence rates at the participating hospitals ranged from 10% to 42.5%. The PIM/patient ratio was 1.2. The most common PIMs were midazolam, dexketoprofen, diazepam, and doxazosin, all of which (except for doxazosin) were more common in women. Benzodiazepines accounted for 70% of all PIMs. In 35% of cases, the PIMs were initiated before hospital admission. Of the 818 PIMs initiated during hospitalization, the two most common were benzodiazepines (49%) and anti-inflammatory drugs (25%). At discharge, only 4.9% of the PIMs initiated during the hospital stay were still prescribed., Conclusion: In this population of older hospitalized patients, the overall prevalence of PIMs was moderate. However, the prevalence rate at the participating hospitals was highly variable. In most cases, PIMs prescribed prior to hospitalization for chronic conditions were not withdrawn during the hospital stay. No significant increase in PIMs was observed from pre-admission to post-discharge. These findings underscore the need for multidisciplinary interventions to optimize the pharmaceutical treatment in older adults in the hospital setting to reduce the consequences of PIMs in patients., (© 2024. The Author(s).)

Radon is, after tobacco, the most frequent cause of lung cancer. Communicating about its risks with a didactic perspective so that citizens become aware and take action to avoid radon remains a challenge. This research is framed in Spain, where 17% of the territory exceeds the maximum radon limits allowed by the WHO, and aims to study the role and impact of the media in radon risk communication. A mixed methodological design is applied, combining content analysis of news published in the last two decades by local media in the most affected areas with interviews with journalists and a survey of citizens to provide a multi-perspective approach. The results show that, although news coverage of radon is becoming more frequent, it is a topic that fails to position itself on the agenda for effective communication. The media are the most frequent source of information on radon, although they are not considered by the public the most trustworthy one. News stories about radon focus mainly on health and research to inform about the radon levels to which citizens are exposed and the risks associated with cancer. Collaborative strategies between the media, organizations, and public administration seem key to advancing the fight against radon.

Two-round Delphi study carried out in Spain. Three theme-based blocks were set out: 1) Patient profiles: therapeutic goal and parameters to be analysed according to POSEIDON patient profiles; 2) Ovarian stimulation protocols with antagonists: monotherapy (FSH) vs combined therapy (FSH + LH/HMG); 3) Safety and effectiveness of the devices. The antral follicle count and the anti-Müllerian hormone level were considered indicators that can be used to predict ovarian response. More than 80% of the participants agreed that FSH monotherapy is the recommended regimen in normal/hyper-responsive patients of < 35 years of age; that 150-300 IU is the dose to be used in ovarian stimulation in monotherapy depending on clinical parameters; and that FSH monotherapy improves patients' comfort compared to two combined drugs. It was unanimously considered that the type of device used by the patient influences the comfort of the treatment.IMPACT STATEMENT What is already known on this subject? There is currently no consensus on the optimal treatment for controlled ovarian stimulation for patients undergoing IVF which leads to highly variable clinical practices. What the results of this study add? This study's strong point is that, since it is a consensus, it has been possible to include more topics than would normally be dealt with in a systematic review or guidelines, which are generally based on a strict method that restricts the scope of the research. Experts have reached a consensus on most of the statements and based on these they have issued consensus statements that will enable the optimal use of gonadotropins in IVF. What the implications are of these findings for clinical practice and/or further research? This Delphi consensus provides a real-life clinical perspective on gonadotropin usage in IVF.

Introduction: The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid., Methods: We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy)., Results: The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%., Conclusions: The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up., (Copyright © 2020 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals., Methods: We conducted a non-systematic literature search using the keywords "stroke" and "COVID-19" or "coronavirus" or "SARS-CoV-2." Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee., Results: These recommendations address 5 main objectives: 1) coordination of action protocols to ensure access to hospital care for stroke patients; 2) recognition of potentially COVID-19-positive stroke patients; 3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; 4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and 5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home)., Conclusions: The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals., (Copyright © 2020 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Soil microbial communities (both Bacteria and Archaea) were studied after 16S rRNA genes massive sequencing in two hypersaline and gypsum-rich contrasted sites located in NE Spain. Soil microbial communities were also locally analysed according to environmental variables, including geological, physico-chemical, biogeochemically, and climatic data. Typical soil characteristics, climate data, and plant composition clearly split the two sites and major differences among the microbial communities for the areas were initially expected. Overall, high values of microbial species richness (up to 2300 taxa) and ecological diversity was detected in both sites. High genetic novelty levels were found mostly to environmental sequences, highlighting the high potential for microbiological studies. In contrast to the initial expectations, a substantial overlapping between Monegros and Gallocanta microbes was observed, indicating a high similarity despite of the geographical, botanical and environmental distances between sites, in agreement with both high dispersal and local selection inherent to the microbial world. The potential biogeochemical cycling showed small differences between sites, with presence of photosynthetic green and purple sulfur bacteria, cyanobacteria and aerobic and anaerobic chemolitotrophs. Potential for aerobic methane oxidation and anaerobic methanogenesis was observed in both sites, with predominance of potential nitrification mostly by ammonia-oxidizing archaea, nitrite oxidation and denitrification, and minor contribution for nitrate reduction and nitrate ammonification. The predicted functions based on the taxonomic composition showed high overlapping between the two studied regions, despite their difference in gypsum richness., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Only one prognostic model for laryngeal cancer has been published, but it has not been properly validated and is only applicable to patients treated with radiotherapy. Consequently, we constructed, internally validated and implemented in an App (Android), a predictive model of 5-year mortality in patients with glottic cancer in a cohort study of 189 patients with glottic cancer in 2004-2016 in Spain. The main variable was time-to-death. Secondary variables were age, gender, TNM, stage, smoking, alcohol consumption, histology and treatment. A scoring system to predict mortality at 5 years was constructed, validated internally by bootstrapping and then integrated into an Android app. In all, 70 patients died (37.0%, 76 deaths per 1,000 patient-years). The predictive model had the following prognostic factors: larger tumour size, greater degree of lymph node metastasis, higher stage, smoking and alcohol consumption. The internal validation of the model through bootstrapping was satisfactory. In conclusion, a points system to predict mortality at 5 years in patients with glottic cancer has been constructed, internally validated and integrated into an Android application. External validation is suggested to make available a quick and simple tool to establish the prognosis for these patients., (© 2018 John Wiley & Sons Ltd.)

Background: The role that intensive care unit (ICU)-acquired pneumonia plays in the long-term outcomes of cardiac surgery patients is not well known. This study examined the association of pneumonia with in-hospital mortality and long-term mortality after adult cardiac surgery., Methods: A total of 2750 patients admitted to our ICU after cardiac surgery from January 2003 to December 2009 are the basis for this observational study. Patients who developed ICU-acquired pneumonia were matched with patients without it in a 1:2 ratio. The matching criteria were age, urgent or scheduled surgery, surgical procedure, and the propensity score for pneumonia. Multiple regression analysis was used to find predictors of hospital mortality. The relationship between pneumonia and long-term survival was analyzed with Kaplan-Meier survival estimates and a risk-adjusted Cox proportional regression model for patients discharged alive from hospital., Results: Pneumonia was diagnosed in 32 (1.2%) patients and there were 19 cases per 1000 days of mechanical ventilation. Patients with pneumonia had a significantly higher hospital mortality rate (28% vs 6.2%, P = .003) and a higher mortality at the end of follow-up (53% vs 19%, P < .0001) than those without it. Regression analysis showed that pneumonia was a strong predictor of hospital mortality. Five-year survival was as follows: pneumonia, 62%; control, 81%; and cohort patients, 91%. The Cox model showed that, after adjusting for confounding factors, patients with pneumonia (hazard ratio = 3.96, 95% confidence interval [CI]: 1.41-11.14) had poorer long-term survival., Conclusion: Pneumonia remains a serious complication in patients operated for cardiac surgery and is associated with increased hospital mortality and reduced long-term survival., (© The Author(s) 2014.)

Objective: To evaluate the outcome of patients with hepatocellular-cholangiocarcinoma (HCC-CC) or intrahepatic cholangiocarcinoma (I-CC) on pathological examination after liver transplantation for HCC., Background: Information on the outcome of cirrhotic patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study is limited., Methods: Multicenter, retrospective, matched cohort 1:2 study., Study Group: 42 patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study; and control group: 84 patients with a diagnosis of HCC. I-CC subgroup: 27 patients compared with 54 controls; HCC-CC subgroup: 15 patients compared with 30 controls. Patients were also divided according to the preoperative tumor size and number: uninodular tumors 2 cm or smaller and multinodular or uninodular tumors 2 cm or larger. Median follow-up: 51 (range, 3-142) months., Results: The 1-, 3-, and 5-year actuarial survival rate differed between the study and control groups (83%, 70%, and 60% vs 99%, 94%, and 89%, respectively; P < 0.001). Differences were found in 1-, 3-, and 5-year actuarial survival rates between the I-CC subgroup and their controls (78%, 66%, and 51% vs 100%, 98%, and 93%; P < 0.001), but no differences were observed between the HCC-CC subgroup and their controls (93%, 78%, and 78% vs 97%, 86%, and 86%; P = 0.9). Patients with uninodular tumors 2 cm or smaller in the study and control groups had similar 1-, 3-, and 5-year survival rate (92%, 83%, 62% vs 100%, 80%, 80%; P = 0.4). In contrast, patients in the study group with multinodular or uninodular tumors larger than 2 cm had worse 1-, 3-, and 5-year survival rates than their controls (80%, 66%, and 61% vs 99%, 96%, and 90%; P < 0.001)., Conclusions: Patients with HCC-CC have similar survival to patients undergoing a transplant for HCC. Preoperative diagnosis of HCC-CC should not prompt the exclusion of these patients from transplant option.

Objective: To measure the appropriateness of hospital admissions, to classify its Clinical Services (CS) according to the level of inappropriateness, and to determine the usefulness of applying rapid assessment techniques (lot quality assurance sampling) in these types of measurements., Material and Methods: A descriptive, retrospective study was conducted in a tertiary hospital to assess the clinical records of emergency admissions to the 12 CS with a higher volume of admissions, using the Appropriateness Evaluation Protocol (AEP). A four-level («A» to «D») increasingly inadequate admissions scale was constructed setting both standard and threshold values in every stratum. Every CS was classified in one of them using lot quality assurance sampling (LQAS). A total of 156 cases (13 cases from every CS) were assessed. The assessment effort (devoted time) was also estimated., Results: There were 22.4±6.3% of inadequate admissions. In the CS classification, 9 (75%) got a good or acceptable appropriateness level, and only 1 (8%) got an inacceptable level. The time devoted was estimated at 17 hours., Conclusions: AEP is useful to assess the admission appropriateness and may be included in the «Emergencies» process management, although its variability prevents the use for external comparisons. If both LQAS and the appropriateness classification level and the global estimation (by unifying lot samples) are combined, the monitoring is affordable without a great effort. To extend these tools to other quality indicators requiring direct observation or clinical records, manual assessment could improve the monitoring efficiency., (Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.)

Between 2006 and 2008, an outbreak of Infectious Keratoconjunctivitis (IKC) affected Pyrenean chamois Rupicapra p. pyrenaica, an endemic subspecies of mountain ungulate that lives in the Pyrenees. The study focused on 14 mountain massifs (180,000 ha) where the species' population is stable. Cases of IKC were detected in ten of the massifs and, in five of them, mortality was substantial. The outbreak spread quickly from the first location detected, with two peaks in mortality that affected one (2007) and three (2008) massifs. In the latter, the peak was seasonal (spring to autumn) and, in the former, the outbreak persisted through winter. To identify the outbreak's aetiology, we examined 105 Pyrenean chamois clinically affected with IKC. TaqMan rt-PCR identified Mycoplasma conjunctivae in 93 (88.5%) of the chamois. Another rt-PCR detected Chlamydophila spp. in 14 of chamois, and 12 of those had mixed infections with mycoplasmas. In the period 2000-2007, the chamois population increased slightly (λ 1.026) but decreased significantly during the IKC outbreak (λ 0.8, 2007-2008; λ 0.85, 2008-2009) before increasing significantly after the outbreak (λ 1.1, 2009-2010). Sex-biased mortality shifted the adult sex ratio toward males (from 0.6 to 0.7 males per female) and reduced productivity slightly. Hunting was practically banned in the massifs where chamois experienced significant mortality and allowed again after the outbreak ended. Long-term monitoring of wild populations provides a basis for understanding the impacts of disease outbreaks and improves management decisions, particularly when species are subject to extractive exploitation.

Objective: To evaluate embryos with direct cleavage (≤5 hours) from two to three cells (DC2-3) and correlate this morphokinetic parameter to implantation and ongoing pregnancy., Design: Clinical multicenter retrospective study., Setting: Private in vitro fertilization (IVF) centers., Patient(s): From three clinics, a total of 979 treatments including 5,225 embryos using autologous or donated oocytes, of which 1,659 embryos were transferred., Intervention(s): None., Main Outcome Measure(s): Clinical pregnancy confirmed by ultrasound in week 7., Result(s): Of the total embryo cohort, 715 (13.7%) underwent direct cleavage from two to three cells, 1,659 embryos were transferred to recipients, and 109 of the transferred embryos cleaved directly from two to three cells (6.6%). Only one DC2-3 embryo was known to result in a clinical pregnancy (1%) and 80 (73.4%) DC2-3 embryos did not implant. Of the 1,550 embryos transferred not showing DC2-3, 203 embryos were from treatments with 100% implantation (13.1%), and 804 (51.8%) embryos did not implant. The known implantation rate of DC2-3 embryos was statistically significantly lower than for embryos with a normal cleavage pattern (1.2% vs. 20.2%, respectively)., Conclusion(s): Embryos with DC2-3 had a statistically significantly lower implantation rate than embryos with a normal cleavage pattern, suggesting that rejection of these embryos for transfer could improve the implantation rate., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The main goal of this study is to analyze the degree to which several community elements such as insecurity, discrimination and informal community support might have an influence on the social integration of Latin-American immigrants, a group at risk of social exclusion in Spain. Multivariate linear regression analyses results showed that informal community support is positively related to social integration whereas insecurity is negatively related. The statistical relationship between discrimination and social integration disappears once levels of informal community support are taken into account. A better understanding of the factors that either promote or inhibit the social integration progress of immigrant population is important to orientate public policies and intervention programs that contribute to the adaptation of this population to the host society.

Background: Liver transplant recipients have a high risk of developing nonmelanoma skin cancer (NMSC). Some develop multiple NMSC., Methods: Patients with a follow-up of >1 year have been prospectively followed to detect NMSC. We studied the risk of developing >1 NMSC., Results: After a follow-up of 2658 patient-years (mean, 8.5 years per patient), 59/312 (19%) patients were diagnosed with NMSC. Twenty-five had >1 NMSC. The 5-year risk of developing 1 NMSC, >1 NMSC, and a subsequent NMSC (a new NMSC after a first one) were 15%, 5.5%, and 46.5%, respectively. Age >60 years and transplantation for hepatocellular carcinoma were independently associated with a higher risk of developing >1 NMSC., Conclusion: NMSC are frequent complications after liver transplantation and they may show a high rate of recurrence. Older age and hepatocellular carcinoma were related to the development of multiple NMSC., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: Little data is available concerning variations in the clinical characteristics of lymphoid neoplasms at presentation. We decided to investigate whether any variations in these characteristics had occurred in Spain during the last few years., Materials and Methods: The GOTEL group database is an archive of all new lymphoma cases, regardless of their histological subtype, diagnosed in the hospitals within the group. An analysis was made of all the records between 1 January 1999 and 1 January 2009. Though the number of hospitals submitting data has changed over the course of time, data were provided by 26 hospitals from 16 Spanish provinces., Results: A total of 3651 cases of lymphoma were recorded during this period. Grouped by clinical features, 42.8% (1561 patients) had low-grade lymphoma, 30.4% (1110 patients) intermediate-grade lymphoma and 15.2% (556 patients) Hodgkin's lymphoma; 208 patients had T lymphoma (5.7%), 111 patients high-grade lymphoma (3%) and 105 patients (2.9%) suffered lymphomas that were difficult to classify. A total of 6.3% of the diagnoses (231 patients) were made prior to 1999, 29.5% between 2000 and 2001, 25.7% between 2002 and 2003, 19.7% between 2004 and 2005, 11.2% between 2006 and 2007, and there were 200 entries from 2008 to the close of the study period, corresponding to 1.5% of the complete database. The median age at diagnosis was 60 (range 7-105 years), by percentiles: 25 corresponded to 44 years old, 50 to 60 years old and 75 to 71. Distribution by gender was 53.1% male and 46.9% female. An analysis was made of all the clinical variables collected, comparing their behaviour during the different diagnostic periods. The periods, gender, ECOG, stage, LDH, ß2 microglobulin, Hodgkin's or non- Hodgkin's type neoplasm, B lymphoma vs. Hodgkin's, NK or T, nodal or extra-nodal origin, median age at diagnosis and histological type by region of origin did not show any statistically significant differences in their distribution over the course of time., Conclusion: In our experience, there are no significant variations in clinical presentation or histological type in lymphomas diagnosed over the course of time in Spain.

The study of host-parasite relationships involving vector-borne parasites requires understanding interactions between parasites and vectors. The capacity of haemosporidians to infect insects has clear evolutionary consequences for the transmission of diseases. Here, we investigated (i) the associations between blood parasites, biting midges and birds and (ii) the potential specificity between biting midge and haemosporidian haplotypes. A total of 629 parous biting midges Culicoides and 224 wild birds (belonging to seven species) from a locality of central Spain were individually examined for the presence of Haemoproteus and Plasmodium parasites by sequencing a fragment of cytochrome B. Biting midges were identified morphologically and characterized on the basis of a fragment of the cytochrome c oxidase (COI) gene. Overall, 12 Haemoproteus and three Plasmodium haplotypes were isolated and sequenced. Among them, 10 haplotypes were exclusively isolated from biting midges, three haplotypes only from birds and two haplotypes from both biting midges and birds. Biting midge haplotypes showed both specific and generalist relationships with Haemoproteus haplotypes but only generalist relationships with Plasmodium haplotypes. Several C. festivipennis and C. kibunesis haplotypes established significant coevolutionary links with Haemoproteus haplotypes. These results shed light on the specificity of interactions between vectors and blood parasites., (© 2011 Blackwell Publishing Ltd.)

Introduction and Objectives: Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain)., Methods: From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality., Results: In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5 years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged ≥ 70 years showed a lower survival rate than those aged <70 (log rank test, P <.0001). At the end of follow-up, mortality was 6.5% (CI 95%, 5.4%-7.7%). Age ≥ 70 years, a history of severe ventricular dysfunction (ejection fraction < 30%), severe pulmonary hypertension, diabetes mellitus, preoperative anemia, postoperative stroke, and hospital stay were independently associated with mid-term mortality., Conclusions: Mid-term survival after discharge was highly satisfactory. Mid-term mortality varied with age and other pre- and postoperative factors., (Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction: Neurocysticercosis (NC) is the most prevalent parasitic infection in the CNS. Its frequency in our environment has increased with migratory movements. The clinical and demographic characteristics of patients with NC attended in a third level hospital in an area with a high prevalence of immigrant have been analyzed., Patients and Methods: A retrospective study was done of the patients registered by the Coding Service of Virgen de la Arrixaca Hospital (January 2996 to December 2009), analyzing all the clinical histories of patients discharged with the primary or secondary diagnosis of neurocysticercosis. The most relevant epidemiological, diagnostic and therapeutic data were analyzed., Results: 35 patients were included in the study. Of these, 24 were men, all coming from Latin America. The most prevalent onset was seizure episode (27 patients). The number of cases per year began to increase after 2002. Although only 21 of the cases had criteria to begin medical treatment with albendazole, it had been prescribed to 29 patients., Conclusion: In Murcia, NC is mainly an imported disease. An increase in the annual incidence has been observed since 2002, parallel to the rise in the number of immigrants. Approximately 25% of the patients received treatment in spite of not having antiparasitic treatment indication., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Advance care planning (ACP) and the subsequent advance directive document (ADD), previously known as "living wills", have not been widely used in Spain. The Ethics Group from the Spanish Society of Nephrology has developed a survey in order to investigate the opinion of dialysis patients regarding the ADD and end-of-life care. Patients received documentation explaining ACP and filled out a survey about their familiarity with and approval of the ADD. Seven hospital dialysis centres participated in the study for a total of 416 active dialysis patients. Questionnaires were distributed to 263 patients, 154 of which answered (69.2% completed them without assistance). The rates for ADD implementation (7.9%) and designation of a representative person (6.6%) were very low. Most of the patients clearly expressed their wishes about irreversible coma, vegetative state, dementia and untreatable disease. More than 65% did not want mechanical ventilation, chronic dialysis, tube feeding or resuscitation if cardiorespiratory arrest occurred. They reported that an ADD could be done before starting dialysis but most thought that it should be offered only to those who requested it (65% vs 34%). In conclusion, patients have clear wishes about end-of-life care, although these desires had not been documented due to the very low implementation of the ADD.

Aim: Nosocomial pneumonia (NP) and tracheobronchitis after cardiac surgery are associated with worse outcomes. The aim of this study was to identify risk factors associated with NP and tracheobronchitis after cardiac surgery and to determine the impact of these infections on hospital morbidity and mortality., Methods: We evaluated 1600 adult patients undergoing cardiac surgery under standard cardiopulmonary bypass. Data were collected prospectively. All NP and tracheobronchitis episodes were confirmed by a semiquantitative culture of endotracheal aspirate. Logistic regression analysis was done to identify risk factors for respiratory tract infection and mortality., Results: The rate of NP was 1.2% (15.6 episodes per 1000 days of mechanical ventilation) and that of tracheobronchitis was 1.6% (21 episodes per 1000 days of mechanical ventilation). Significant independent risk factors for respiratory tract infection (pneumonia or tracheobronchitis) were: left ventricular ejection fraction < 30% (P = 0.001), chronic renal failure (P < 0.0001) and urgent surgery (P < 0.0001). Patients with NP had significantly higher mortality (42% versus 0.9%, P < 0.0001) than patients without respiratory tract infection. The median hospital length of stay was significantly longer in patients with pneumonia (42 days) and tracheobronchitis (28 days) than in patients without any respiratory tract infection (11 days, P < 0.0001)., Conclusion: NP after cardiac surgery is associated with severe outcomes. Independent risk markers for respiratory tract infection were left ventricular ejection fraction < 30%, chronic renal failure and urgent surgery.

Background: The shortage of available transplant organs has made it necessary to search for new alternatives, one of which is xenotransplantation. However, the use of animal organs and the personnel involved in its implementation could face opposition. Our objective was to analyze the attitudes of veterinary degree students in a Spanish university toward xenotransplantation and to determine the factors that affect its acceptance., Methods: Of the 515 students registered in a veterinary degree course (2007-2008), we surveyed 482 94% of whom completed the questionnaire. Attitudes toward organ xenotransplantation were evaluated using a validated, self-administered questionnaire concerning organ donation, which was completed anonymously. We applied Student's t-tests and chi(2) tests., Results: If xenotransplantation was confirmed as a clinical reality, 91% (n = 436) of those students surveyed would accept a xenotransplanted organ, whereas 9% (n = 46) would not. Furthermore, 95% (n = 457) would accept tissue xenotransplantation and 97% (n = 467) cell xenotransplantation. Attitudes toward xenotransplantation were not affected by the academic year in which a student was studying, even when this was the year in which it was taught as a subject. Attitudes were not associated with any pyschosocial variable or attitude toward deceased organ donation; (P = .779). The students who believed that the demand for organs is not covered had a more favorable attitude toward xenotransplantation than those who think that there is no shortage (91% vs 70%; P = .027)., Conclusion: Veterinary students had favorable attitudes toward xenotransplantation, assuming that the animal organs functioned as well as human organs. Therefore, these students could play important roles in the future promotion of this technique., (Copyright 2010 Elsevier Inc. All rights reserved.)

The objective of this study was to test whether the Blatant and Subtle Prejudice Scales of Meertens and Pettigrew (1992) are valid for the evaluation of prejudicial attitudes in Spanish school-based adolescents. To do so gypsies and immigrants were chosen as two exogroups that might be the object of prejudice among the Spanish population. Participants were 1,378 Spanish school-based adolescents in the Autonomous Community of the Principality of Asturias, Spain. The results indicate that the scales present a factor structure different from that of the original study. Also, covariates of both blatant and subtle prejudice scales scores were explored. A different pattern of relationships between covariates and scores on blatant and subtle prejudice were found.

The aim of this study is to describe trends in the percentage of samples with undetectable HIV viral load in Spain after the implementation of HAART. A descriptive observational study of HIV-VL measurements carried out in the microbiology department of the Hospital Clínico Universitario de Valladolid (HCUV) was conducted over a 9-year period (1996-2004). Regarding the trend over the study period, the 30-39 years age group accounted for most of the samples, although the percentage decreased from 65.5% to 59.6% over the study period. In contrast, the 40-49 years group increased from 9.1% to 14.5%. The preponderance of men, with percentages above 70%, was observed during the whole period. Although the purpose of this treatment is to maintain undetectable viral loads, since 1999 more than 60% of nonfirst samples had detectable levels. Based on the results of the VL trend among HIV/AIDS patients observed in this study, a large number of patients maintain elevated detectable VL years after HAART was implemented. Although different factors may be the cause of this and should be delimited in future studies, the phenomenon observed demonstrates the usefulness of monitoring VL and analyzing its time trend to gain further knowledge about the therapeutic results and care of HIV patients as a whole, also serving as the basis for corrective measures.

Introduction: In a population-based study of the incidence of stroke conducted on a broad denominator, it is wise first to carry out a pilot study., Aim: To present the results of the pilot phase of the study on stroke incidence in Spain, entitled Iberictus., Patients and Methods: Population of the study: all cases involving the first episode of acute cerebrovascular disease (stroke or transient ischaemic attack) diagnosed among residents over 17 years of age with their habitual place of abode registered in the areas of study between 15th and 31st October 2005 (total denominator: 1,440,997 inhabitants)., Source of Data: prospective, hospital records (basic minimum data set, discharge abstracts) and casualty department registers. Standardised definitions: diagnostic categorisation and pathological, topographical and aetiological classification. Inter-observer agreement analysis among researchers (kappa)., Results: A total of 128 cases were identified. Age range, 37-103 years; mean age, 75.7 +/- 13.4 years; 54% were females. In all, 71.1% of the cases were collected by means of a basic minimum data set. There were 91 ischaemic events (29.7% atherothrombotic and 29.7% cardioembolic). Of the 15 haemorrhagic strokes, 40% due to arterial hypertension, six were lobar hemispheric, six were deep basal ganglia, and there were three cerebellar haemorrhages. The incidence of stroke was seen to increase exponentially with age. Inter-observer agreement was good for the classifications that were employed (range of kappa indices, 0.57-0.78). Several problems were detected and corrected in the fieldwork., Conclusions: The Iberictus pilot study yielded data that were consistent with the literature and provided us with the opportunity to detect and correct issues that would hinder us from conducting the main study.

Background: End-stage renal disease is a major health problem worldwide nowadays. Although conventional hemodialysis is the most widely used modality, short daily hemodialysis has been proposed as a more physiologic treatment. The objective of this article is to compare the quality of life of patients on each hemodialysis modality., Methods: A multicentric cross-sectional study was performed in 9 Spanish hospitals. Patients treated for at least 3 months with conventional or short daily hemodialysis were included and quality of life measured using the Euroqol-5D quality of life questionnaire. Bayesian models were used for analyzing quality of life results., Results: Ninety-three patients were included, 27 were on daily hemodialysis and 66 on conventional hemodialysis. All models demonstrated a better quality of life for daily hemodialysis versus conventional hemodialysis. Only 14% of the patients on conventional hemodialysis were willing to change to a daily schedule., Conclusions: Short daily hemodialysis shows a better quality of life than conventional hemodialysis with all Bayesian approaches considered., (Copyright 2009 S. Karger AG, Basel.)

Introduction: Epidemiological data on the incidence of cerebrovascular diseases in our country are scarce. A representative population-based study with a large denominator is required., Aim: To present the design of the study on stroke incidence in Spain, entitled Iberictus., Subjects and Methods: We conducted a prospective, population-based study on the incidence of strokes and transient ischemic attacks, in which it is possible to distinguish: 1) population with a steady risk, which was well defined and had a broad denominator. We included all the cases in which the first episode of acute cerebrovascular disease was diagnosed among those over the age of 17 years (with no upper age limit) with their habitual residence in the areas of study between the 1st January and 31st December 2006: Lugo, Segovia, Talavera de la Reina, Mallorca and Almeria (total denominator, 1,440,997 inhabitants; minimum denominator per area, 100,000 inhabitants); 2) source of multiple and complementary data: hospital records (minimum basic data set, discharge abstracts), emergency and primary care records for the area with diagnostic codes 430-39 and 674.0 (International Classification of Diseases-9), population-based mortality records; 3) standardised definitions: diagnostic categorisation (MONICA-World Health Organisation, 1987), pathological classification (ischaemia, haemorrhagic), topography and aetiology; 4) presentation of data in suitable age groups, by sex and overall; 5) pilot study and analysis of inter-observer agreement among researchers., Conclusions: With this design, the Iberictus study satisfies the methodological criteria as an 'ideal' study of the incidence of acute cerebrovascular diseases proposed by Malgrem, Sudlow and Warlow, and represents a unique opportunity to further our knowledge of the epidemiology of strokes in our country.

Multiple victimization in adolescence is an issue that has received little research attention. Furthermore, adolescents are particularly vulnerable to victimization in different contexts. The aim of this study is to analyze correlates of multiple victimization in three contexts (home, school, and street). The following forms of victimization were considered: stealing, hitting, insulting, threatening, blackmailing, and weapon intimidation. Multiple victimization correlates explored were: sex, age, public/private school, socioeconomic status, quality of family relationships, and antisocial behavior. A probabilistic sample of 1,908 adolescents (ages 13 to 18) was used. Multilevel analyses were conducted to separate correlates at the individual level from those operating at the contextual level. Results show that gender, quality of family relationships, and deviant behavior were related to multiple victimization in adolescence.

A 1-year retrospective multicentre study was performed to identify factors influencing hospital length of stay (LOS) and mortality of patients (n = 3233) admitted to hospital because of community-acquired pneumonia (CAP). Pneumonia severity index (PSI) high-risk classes (IV and V), positive blood culture, admission to an intensive care unit (ICU), multi-lobar involvement and alcohol consumption were associated independently with prolonged LOS. Tobacco smoking was associated with a reduced LOS. The LOS varied markedly among centres. Only PSI high-risk class, admission to ICU and multi-lobar involvement were associated with early, late and global mortality. Positive blood cultures, antimicrobial therapy according to treatment guidelines and the establishment of an aetiological diagnosis were linked to reduced late and global mortality. These data suggest that early mortality associated with CAP is highly dependent on the clinical status of the patient at presentation. Conversely, late mortality seems to be associated more closely with clinical management factors; hence, an aetiological diagnosis and compliance with appropriate therapeutic guidelines have a significant influence on outcome.

Aim: To assess the psychometric attributes of the stroke-adapted 30-item version of the Sickness Impact Profile, Spanish version (SA-SIP30), in stroke survivors., Patients and Methods: 79 patients were evaluated (mean age: 68.1 years) by means of the modified Rankin Scale (m-RS), Scandinavian Stroke Scale (SSS), Barthel Index (BI), and the modified 23-item Beck-Hamilton's Depression Rating Scale (HDRS). Health-related quality of life was evaluated using the MOS-Short Form 36 (SF-36) and the SA-SIP30., Results: SA-SIP30 mean score was 36.8. SA-SIP30 floor and ceiling effects were 3.8% and 0%. Regarding SA-SIP30 categories, floor effect ranged from 15.2% (social interaction) to 49.4% (alertness behavior), whereas ceiling effect ranged from 2.5% (social interaction) to 26.6% (household management). A floor effect was observed in seven SA-SIP30 categories. The internal consistency of SA-SIP30 (Cronbach's alpha = 0.87), physical (Cronbach's alpha = 0.89) and psychosocial (Cronbach's alpha = 0.75) dimensions were satisfactory. Standard error of measurement (SEM) values for each SA-SIP30 category ranged from 15.9 (household management) to 26.3 (ambulation). SEM values for overall SA-SIP30, physical and psychosocial dimensions were 8, 10 and 17.3, respectively. Corrected item-category correlations ranged from 0.17 (item 28) to 0.83 (item 23). A significant correlation (Spearman's correlation coefficient; p < 0.0001) between SA-SIP30 scores and BI (-0.71), m-RS (0.68), SSS (-0.67), HDRS (0.52), SF-36 physical (-0.67) and mental components (-0.51) was found. SA-SIP30 mean score significantly increased as m-RS increased (discriminative validity; Kruskal-Wallis, p < 0.0001)., Conclusion: The Spanish-version of the SA-SIP30 has satisfactory internal consistency, convergent validity and discriminative validity in stroke patients.

Major histocompatibility complex class II locus DRB variation was investigated by single-strand conformation polymorphism analysis and sequence analysis in the two subspecies of Pyrenean chamois (Rupicapra pyrenaica) endemic to the Iberian Peninsula. Low levels of genetic variation were detected in both subspecies, with seven different alleles in R. p. pyrenaica and only three in the R. p. parva. After applying the rarefaction method to cope with the differences in sample size, the low allele number of parva was highlighted. The low allelic repertoire of the R. p. parva subspecies is most likely the result of bottlenecks caused by hunting pressure and recent parasitic infections by sarcoptic mange. A phylogenetic analysis of both Pyrenean chamois and DRB alleles from 10 different caprinid species revealed that the chamois alleles form two monophyletic groups. In comparison with other Caprinae DRB sequences, the Rupicapra alleles displayed a species-specific clustering that reflects a large temporal divergence of the chamois from other caprinids, as well as a possible difference in the selective environment for these species.