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Introduction and Objectives: We report the results of the 2023 Spanish catheter ablation registry., Methods: Procedural data were collected and incorporated into the REDCap platform by all participating centers through a specific form., Results: There were 104 participating centers in 2023 compared with 103 in 2022. In 2023, the total number of ablation procedures was 26 207, indicating a stabilization of the increase observed in 2022 following the pandemic. The increase was mainly due to procedures for atrial fibrillation (AF), with a total of 9942 ablations, representing 38% of all substrates. Notably, pulse-field ablation represented 10.3% of all AF ablation procedures, leading single-shot ablation strategies to outnumber point-by-point AF ablation for the first time in the history of the registry. Cavotricuspid isthmus ablation remained the second most targeted substrate (19% of all substrates, n=5067). The overall acute success rate remained high (97%), with a downward trend in the complication rate (1.6% vs 1.8% in 2022) and mortality rate (0.03%; n=7). Compared with 2022, there was a significant increase in procedures performed using electro-anatomical mapping and zero-fluoroscopy techniques for cavotricuspid isthmus ablation (52% vs 26%), AV node re-entrant tachycardia (48% vs 34%), and accessory pathways (62% vs 22%). We registered 466 ablations in pediatric patients., Conclusions: The data indicate a stabilization in the post-pandemic increase in ablation procedures, with an absolute and relative increase in AF as the predominant substrate. Success rates remained stable with a modest reduction in complication and mortality rates., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts., Methods: The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol., Results: We analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001)., Conclusions: A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: To maximize the availability of suitable grafts and ensure effective management, several reports have demonstrated successful outcomes when using kidney grafts with urolithiasis. This multicenter study reports on the management and long-term outcomes of kidney transplantation using renal grafts with lithiasis., Methods: Retrospective data from three Spanish hospitals were analyzed for kidney transplants involving grafts with nephrolithiasis performed between December 2009 and August 2023. The study included adult patients, excluding those with incomplete records. It evaluated stone characteristics, complications, and outcomes in recipients and in living kidney donors., Results: Out of 38 analyzed kidney transplants, 57.9% were cadaveric and 42.1% were from living kidney donors. Most diagnoses were incidental during donor evaluation, with an average stone size of 7.06 mm. After follow-up (median 26 months), all recipients but one had functioning grafts, and there were no stone recurrences in both recipients and living kidney donors. Conservative management was adopted in 28 cases, while 10 cases required ex-vivo flexible ureterorenoscopy for stone removal. Following conservative management, 5 patients needed additional treatments for stone-related events., Conclusions: Kidneys with lithiasis can be considered for transplantation in selected cases, resulting in good functional outcomes with no stone recurrence in recipients or living donors., (© 2024. The Author(s).)

Background: Research shows that many mental disorders begin in childhood but are sometimes not diagnosed until later years. School-age children spend much of their time in schools and have daily interactions with school teachers., Aim: Examine school teachers' experiences of mental disorders in school going children and adolescents and their associated mental health training needs., Method and Sample: A descriptive cross-sectional study was carried out with teachers in Infant-Primary and Secondary Education-Baccalaureate schools., Results: A convenience sample of 685 teachers responded to the online survey. Participants worked in both urban and rural areas and in Infant-Primary and Secondary Education-Baccalaureate schools. Over half of participants reported classroom experiences of learner mental disorders such as ADHD, anxiety, conduct disorders or autism. Most participants acknowledged a training need, both in recognition of symptoms of mental disorders and in care resources and processes. However, 80% of respondents reported having not received any training in this regard. Participant preferences for training included face-to-face or hybrid - combined online learning. Participants also considered the management of their own mental health to be deficient, therefore any training should incorporate personal mental health awareness and self-help strategies., Conclusion: In Aragón (Spain), teachers of children and adolescents with mental disorders, recognize a need for training in the identification of symptoms and other aspects of mental healthcare, such as availability and access to services. Protocols for early identification and referral would promote mentally healthy school environments and reduce stigma which could be a barrier to timely intervention. In addition, any training should include mental health self-care for teachers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Granada-López, Ramón-Arbués, Echániz-Serrano, Juárez-Vela, Cobos-Rincón, Satustégui-Dordá, Navas-Echazarreta, Santolalla-Arnedo and Nash.)

Introduction: Aim: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2018 and 2019. Material and methods: from January 1, 2018 to December 31, 2019 the home enteral nutrition registry was recorded, and afterwards a further descriptive and analytical analysis was done. Results: in 2018, 4756 active patients were registered and the prevalence was 101.79 patients per one million inhabitants; in 2019 there were 4633 patients with a prevalence of 98.51 patients per one million inhabitants. They originated in 46 hospitals: 51.3 % were male, and median age was 71.0 years in both periods. The most frequent diagnosis was a neurological disorder that presents with aphagia or severe dysphagia - 58.7 % and 58.2 %, respectively. The main cause of episode termination was death. A total of 116 pediatric patients were registered in 2018 and 115 in 2019. Females represented 57.8 % and 59.1 %, respectively, in each of the periods. Median age at the beginning of HEN was 5 and 7 months. The most commonly recordered diagnostic group (42.2 % and 42.6 %) was included within the other pathologies group, followed by neurological disorders that present with aphagia or severe dysphagia in 41.4 % and 41.7 % of children. The route of administration was gastrostomy in 46.6 % and 46.1 %, respectively, in each of the periods. Conclusions: the NED registry of the NADYA-SENPE group continues to operate uninterruptedly since its inception. The number of registered patients and the number of participating hospitals remained stable in the last biennium analyzed.

Introduction: Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was "palliative oncological" and "others" (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable.

Given that there is only a limited body of evidence available concerning the dietary habits of Spanish university students, the present study assesses the quality of this group's diet, their adherence to the National Food-Based Dietary Guidelines, and the predictive factors of their diet quality. To do so, a cross-sectional study was performed on a sample of 1055 students. The quality of the participants' diets was then analysed by using the Spanish Healthy Eating Index, and then their level of compliance was assessed in light of the dietary recommendations put forth by the Spanish Society for Community Nutrition. According to these standards, only 17.4% of the participants had a healthy diet. The level of compliance with the recommendations was poor, highlighting especially the low levels of "fruit" and "vegetables" that they consumed as well as high levels of "cold meats and cuts" and "sweets". The factors that predicted a worse diet are being male, living alone, low levels of physical activity, smoking, high alcohol intake, leading a sedentary lifestyle, psychological distress, and insomnia ( p < 0.005). Furthermore, participants with low or high body weights showed signs of a higher quality diet ( p < 0.001). The present findings suggest that a significant proportion of university students ought to change their dietary habits; these also attest to the importance of developing strategies that are directly targeted at university students in order to promote a healthy diet.

Nitrate (NO 3 - ) pollution adversely impacts surface and groundwater quality. In recent decades, many countries have implemented measures to control and reduce anthropogenic nitrate pollution in water resources. However, to effectively implement mitigation measures at the origin of pollution,the source of nitrate must first be identified. The stable nitrogen and oxygen isotopes of NO 3 - (ẟ 15 N and ẟ 18 B) has further improved nitrate source identification. However, the use of these datasets has been limited due to their overlapping isotopic ranges, mixing between sources, and/or isotopic fractionation related to physicochemical processes. To overcome these limitations, we combined a multi-isotopic analysis with fecal indicator bacteria (FIB) and microbial source tracking (MST) techniques to improve nitrate origin identification. We applied this novel approach on 149 groundwater and 39 surface water samples distributed across Catalonia (NE Spain). A further 18 wastewater treatment plant (WWTP) effluents were also isotopically and biologically characterized. The groundwater and surface water results confirm that isotopes and MST analyses were complementary and provided more reliable information on the source of nitrate contamination. The isotope and MST data agreed or partially agreed in most of the samples evaluated (79 %). This approach was especially useful for nitrate pollution tracing in surface water but was also effective in groundwater samples influenced by organic nitrate pollution. Furthermore, the findings from the WWTP effluents suggest that the use of literature values to define the isotopic ranges of anthropogenic sources can constrain interpretations. We therefore recommend that local sources be isotopically characterized for accurate interpretations. For instance, the detection of MST inferred animal influence in some WWTP effluents, but the ẟ 3 - sources in water, and their combination with other stable isotopes such as boron (ẟ 11 B) has further improved nitrate source identification. However, the use of these datasets has been limited due to their overlapping isotopic ranges, mixing between sources, and/or isotopic fractionation related to physicochemical processes. To overcome these limitations, we combined a multi-isotopic analysis with fecal indicator bacteria (FIB) and microbial source tracking (MST) techniques to improve nitrate origin identification. We applied this novel approach on 149 groundwater and 39 surface water samples distributed across Catalonia (NE Spain). A further 18 wastewater treatment plant (WWTP) effluents were also isotopically and biologically characterized. The groundwater and surface water results confirm that isotopes and MST analyses were complementary and provided more reliable information on the source of nitrate contamination. The isotope and MST data agreed or partially agreed in most of the samples evaluated (79 %). This approach was especially useful for nitrate pollution tracing in surface water but was also effective in groundwater samples influenced by organic nitrate pollution. Furthermore, the findings from the WWTP effluents suggest that the use of literature values to define the isotopic ranges of anthropogenic sources can constrain interpretations. We therefore recommend that local sources be isotopically characterized for accurate interpretations. For instance, the detection of MST inferred animal influence in some WWTP effluents, but the ẟ 11 B values were higher than those reported in the literature for wastewater. The results of this study have been used by local water authorities to review uncertain cases and identify new vulnerable zones in Catalonia according to the European Nitrate Directive (91/676/CEE)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Two isolates of Rosellinia necatrix (Rn118-8 and Rn480) have previously obtained from diseased avocado trees in commercial orchards of the coastal area in southern Spain. Rn118-8 and Rn480 have weak virulence on avocado plants, and are infected by R. necatrix hypovirus 2 (RnHV2). In this work, the possible biological effects of the hypovirus on R. necatrix were tested. First, RnHV2 was transmitted from each of Rn118-8 and Rn480 to a highly virulent, RnHV2-free isolate of R. necatrix (Rn400) through hyphal anastomosis, using zinc compounds which attenuate the mycelial incompatibility reactions and allow for horizontal virus transfer between vegetatively incompatible fungal strains. Next, we carried out an analysis of growth rate in vitro and a virulence test of these newly infected strains in avocado plants. We obtained five strains of Rn400 infected by RnHV2 after horizontal transmission, and showed some of them to have lower colony growth in vitro and lower virulence on avocado plants compared with virus-free Rn400. These results suggest that R. necatrix isolates infected by RnHV2 could be used as novel virocontrol agents to combat avocado white root rot., (Copyright © 2020 British Mycological Society. Published by Elsevier Ltd. All rights reserved.)

Introduction: Introduction: during the COVID-19 crisis food habits have changed among the population as food consumption is now carried out totally at home, and visits to groceries or food centers have decreased considerably. Likewise, other habits, such as physical activity or sleeping hours have also been modified. Objectives: the objective of this work was to evaluate the changes occurred in eating and lifestyle habits among the adult Galician population during the confinement period ordered in Spain during the COVID-19 pandemic. Methods: a survey was conducted using Microsoft Forms, and spread among the population using an instant messaging service for mobiles through the internet. Results: a total of 1350 Galician adults completed the questionnaire; mean of age was 63.2 ± 8.1 years, 30 % were men, and 70 % were women. The obtained data show a trend towards consumption of healthy foods such as fruits and vegetables, and a decrease in less healthy ones such as processed foods. In total, 46 % of the population reported they were eating more than before the confinement, with an increase in snacking between meals (54 %) and in anxiety about food due to situations of stress or nervousness bieng reported by 40 % of respondents. This has resulted in an increase in body weight, reported by 44 % of participants, with the average gain being 2.8 ± 1.5 kg. Conclusions: during confinement, the eating and lifestyle habits of the Galician population have been modified. The weight gain observed in a population that already had a high level of overweight and obesity at confinement onset aggravates the present situation and may have a negative impact on the development of chronic, non-communicable.

Background: In the last three decades, the relationship between depression and cognition in geriatric patients has been a popular topic among researchers and clinicians. Clinical and epidemiological research has focused on the identification of risk factors that could be modified in pre-dementia syndromes, at a preclinical and early clinical stage of dementia disorders, with specific attention to the role of depression. The objective of this work was to determine the relationship between depressive disorder and cognitive deterioration in institutionalized older adults., Methods: In this descriptive, correlational study, data were gathered from two nursing homes in the province of Jaen (Spain), from a random sample of 140 older adults (70 nondependent and 70 dependent). The variables were measured using comprehensive geriatric assessment, the Cambridge Cognitive Test (CAMCOG), and the Geriatric Depression Scale (GDS)., Results: Depression was correlated with cognitive level in the nondependent older adult sample (r = -0.471, p = 0.004). Age was inversely associated with the score obtained in the CAMCOG of the nondependent older adult sample (r = -0.352, p = 0.038). The functional capacity in several activities of daily living was correlated with the score obtained in the CAMCOG in each of the two groups. Depression was more prevalent in the dependent than in the nondependent older adults (82.85 vs. 57.14%). No association was observed between institutionalization time and the score obtained on the cognitive and affective scales (GDS and CAMCOG) in both groups (GDS-nondependent, r = -0.209, p = 0.234; CAMCOG-nondependent, r = 0.007, p = 0.967; GDS-dependent, r = 0.251, p = 0.152; CAMCOG-dependent, r = -0.021, p = 0.907)., Conclusion: Depressive symptomatology is associated with cognitive deterioration. Depression is prevalent in institutions that care for older, more dependent adults., (© 2020 S. Karger AG, Basel.)

Aim: to communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2017., Material and Methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2017 to December 31st, 2017., Results: there were 308 patients from 45 Spanish hospitals (54.5% women), 38 children and 270 adults, with 3,012 episodes, which represent a prevalence rate of 6.61 patients/million inhabitants/year 2017. The most frequent diagnosis in adults was "palliative cancer" (25.6%), followed by "others". In children, it was Hirschsprung's disease with six cases (15.8%). The first indication was short bowel syndrome in both children (55.3%) and adults (33.7%). The most frequently used type of catheter was tunneled in both children (73.4%) and adults (38.2%). Ending 81 episodes, the most frequent cause was death (62.9%) and transition to oral feeding (34.7%)., Conclusions: the progressive increase of collaborating centers and professionals in the registry of patients receiving NPD is maintained. The main indications of HPN and the motive for ending have remained stable.

The Overall Anxiety Severity and Impairment Scale (OASIS) is a self-report questionnaire designed to evaluate the severity and functional impairment associated with anxiety. Given its transdiagnostic nature, it can be used indistinctly across anxiety and depressive disorders. In this study, the psychometric properties of the online version of the OASIS were evaluated in a Spanish clinical sample with emotional disorders. Patients (n = 583) with anxiety (n = 250) and depression (n = 333) with a mean age of 37.21 (SD = 12.22), underwent a diagnostic interview and questionnaires assessing anxiety, depression, positive and negative affect, and quality of life. Factorial structure, internal consistency, convergent and discriminant validity, cutoff scores, and sensitivity to change were analyzed. Confirmatory Factor Analysis yielded a unidimensional factor structure, consistent with previous validations of the instrument. The analyses showed good internal consistency and adequate convergent and discriminant validity, as well as sensitivity to change. A cutoff score of 7.5 was found to meet the criteria used in this study to select the optimal cutoff point. Overall, in this study, the psychometric properties of the online version of the OASIS were found to be appropriate. The brevity and ease of use of the OASIS support its adequacy as a valid measure of anxiety severity and impairment in Spanish clinical samples with anxiety and depression., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Disease-related malnutrition (DRM) is highly prevalent. Various European resolutions urge to screen and treat DRM. No policy in this regard has yet been developed in Extremadura (Spain)., Objectives: To assess the prevalence of DRM (defined as NRS 2002≥3) using an analytical method (FILNUT), and to compare it with the official rate., Results: FILNUT scores≥3 showed values of sensitivity (S) and positive predictive value (PPV) of 82.3% and 72.3% respectively. No statistically significant differences were found between men and women using this tool. FILNUT showed a significantly higher sensitivity for detecting malnutrition in medical - as compared to surgical - diseases when low scores were used. The estimated prevalence of DRM was 21.4%. Prevalence of DRM is much greater than officially reported., Conclusions: FILNUT scores≥3 show high sensitivity and PPV for detecting DRM, and is a good alternative as a nutritional screening tool to detect malnutrition at our center., (Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To validate the EAHFE-3D scale, based on the Acute Heart Failure in Emergency Departments registry, in a cohort of patients attended for acute heart failure., Material and Methods: Study of a multipurpose cohort of patients with acute heart failure in 3 hospitals in the Basque Country between 2011 and 2013. We extracted age, baseline New York Heart Association functional class, systolic blood pressure, baseline arterial oxygen saturation, sodium level in blood, and emergency department treatments (noninvasive mechanical ventilation, use of inotropic agents and vasopressors) in order to calculate each patient's EAHFE-3D score. The main outcome variable was mortality within 3 days of arrival at the emergency department., Results: The patient sample for score validation consisted of 717 patients with complete information. The model's intercept was 0.5 (95% CI, -2.7 to 3.7) and the slope was 1.3 (95% CI, 0.4 to 2.2). The area under the receiver operating characteristic curve was 0.76 (95% CI, 0.58 to 0.94)., Conclusion: The EAHFE-3D scale's ability to discriminate was good in this patient sample and similar to that reported by the authors who developed the scale; however, calibration was poor. The scale should be studied further before it is applied in clinical practice.

Introduction and Objectives: DRM is a highly prevalent condition in Spanish hospitals and is associated to increased healthcare costs. Costs associated to DRM were calculated using the methods of the PREDyCES study. The potential savings derived from specialized nutritional treatment were calculated by extrapolating the results of the SNAQ strategy., Results: Median cost per procedure in patients with DRM was €9,679.85, with a final cost of €28,700,775.2. The cost of each patient with DRM was 2.63 times higher than the cost of patients with no DRM. The potential cost saving associated to specialized nutritional treatment was estimated at €1,682,317.28 (5.86% of total cost associated to DRM)., Conclusions: Patients with DRM showed a higher consumption of financial resources as compared to well-nourished patients. Specialized nutritional treatment is a potential cost-saving procedure., (Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: School absenteeism because of infections is one of the most important problems facing both public and private primary schools. The aim of the study was to assess the impact of infections on school absenteeism and their reduction with a handwashing program using hand sanitizer., Methods: The study was an 8-month-long, randomized, controlled open study (N = 1,609 children, aged 4-12 years old) at 5 state schools in Almeria (Spain). The experimental group (EG) washed their hands with soap and water, complemented with the use of hand sanitizer, and the control group (CG) followed the usual handwashing procedure. The total number of episodes and days missed as well as those because of upper respiratory infections and gastrointestinal infections were compared in both groups with a Z-test., Results: The students were absent 12,386 days in 7,945 episodes. The incidence of total absent episodes and percent of missed days, including those because of upper respiratory infections and gastrointestinal infections, were significantly lower in the EG than the CG (P < .001), and this was maintained through the flu pandemic period., Conclusion: School absenteeism because of infections in schools is reduced when a hand hygiene program utilizing sanitizing gels is properly carried out, especially during the flu season., (Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Acute gastroenteritis (AGE) is one of the most common diseases among children and an important cause of school absenteeism. The aim of this study was to assess the effectiveness of a handwashing program using hand sanitizers for the prevention of school absenteeism due to AGE., Methods: A randomized, controlled and open study of a sample of 1341 children between 4 and 12 years of age, attending 5 state schools in Almería (Spain), with an 8-month follow up (academic year). The experimental group (EG) washed their hands with soap and water, complementing this with the use of a hand sanitizer, and the control group (CG) followed the usual handwashing procedure. Absenteeism rates due GI were compared between the 2 groups through the multivariate Poisson regression analysis. Percent days absent in both groups were compared with a Z-test., Results: 446 cases of school absenteeism due to AGE were registered. The school children from the EG had a 36% lower risk of absenteeism due to AGE (IRR: 0.64, 95% confidence interval: 0.52-0.78) and a decrease in absenteeism of 0.13 episodes/child/academic year (0.27 of EG vs 0.40 CG/episodes/child/academic year, P < 0.001). Pupils missed 725 school days due to AGE and absent days was significantly lower in the EG (EG: 0.31%, 95% confidence interval: 0.28-0.35 vs. CG: 0.44%, 95% confidence interval: 0.40-0.48, P < 0.001)., Conclusions: The use of hand sanitizer as a complement to handwashing with soap is an efficient measure to reduce absent days and the number of school absenteeism cases due to AGE.

There is empirical evidence regarding the interrelationships between materialism, negative emotions, and addictive buying. The aim of this study was to clarify the direction of the relationships among these variables. Specifically, the main objective was to explore the possible mediating roles of anxiety and depression in the link between materialism and addictive buying. Path analysis results, using a sample of 685 women, generally supported the suitability of the proposed model in which anxiety and depression mediated the effects of the materialism dimensions, "importance" and "success," on addictive buying, and that depression also mediates the influence of the "importance" and "happiness" dimensions. Moreover, a direct effect of the importance dimension on addictive buying was found.

Background: Concerning continuous subcutaneous insulin infusion (CSII), there are controversial results related to changes in glycemic response according to the meal composition and bolus design. Our aim is to determine whether the presence of protein and fat in a meal could involve a different postprandial glycemic response than that obtained with only carbohydrates (CHs)., Subjects and Methods: This was a crossover, randomized clinical trial. Seventeen type 1 diabetes (T1D) patients on CSII wore a blinded continuous glucose monitoring system sensor for 3 days. They ingested two meals (meal 1 vs. meal 2) with the same CH content (50 g) but different fat (8.9 g vs. 37.4 g) and protein (3.3 g vs. 28.9 g) contents. A single-wave insulin bolus was used, and the interstitial glucose values were measured every 30 min for 3 h. We evaluated the different postprandial glycemic response between meal 1 and meal 2 by using mixed-effects models., Results: The postmeal glucose increase was 22 mg/dL for meal 1 and 31 mg/dL for meal 2. In univariate analysis, at different times not statistically significant differences in glucose levels between meals occurred. In mixed-model analysis, a time×meal interaction was found, indicating a different response between treatments along the time. However, most of the patients remained in the normoglycemic range (70-180 mg/dL) during the 3-h postmeal period (84.4% for meal 1 and 93.1% for meal 2)., Conclusions: The presence of balanced amounts of protein and fat determined a different glycemic response from that obtained with only CH up to 3 h after eating. The clinical relevance of this finding remains to be elucidated.

Objective: The aim was to study the relation between same-donor renal biopsies and analyze whether the score influences graft survival., Methods: We retrospectively reviewed histologic results of expanded-criteria donors and the graft survival in patients followed at Reina Sofia Hospital (Cordoba, Spain) from January 2004 to October 2012. We analyzed clinical and demographic variables from the donors, as well the association between the scores of same-donor biopsies who had different scores for each kidney and the graft survival with a t test for paired data. A Kaplan-Meier with log-rank test was performed between the higher-score and the lower-score groups. We excluded retransplantation and those who received a combined transplantation (liver or pancreas)., Results: We analyzed 168 kidneys that had been biopsied, from 84 donors. Of the whole sample, 35.7% (n = 30) had the same score for each kidney, whereas 64.3% (n = 54) had discrepancies. In this second group, 81.8% (n = 44) had a difference of 1 point, and the remaining 18.2% (n = 10) had a larger difference. Both kidneys were suitable for transplantation in 72.7% of cases (n = 40), only 1 in 14.5% (n = 8), and none in 12.7% (n = 7). For analyzing the survival of the paired kidneys there were 48 kidneys from 24 donors with a different score for each kidney. We observed a difference in favor of the better scores, with a difference of 11 months up to the time of the analysis (P = .045). We found no significant differences in the log-rank test between the survival rate for the group with a less favorable score (95% confidence interval [CI], 61.26-95.67) versus those with a more favorable score (95% CI, 66.76-93.03)., Conclusions: A high percentage of biopsies had a different score for the 2 kidneys from the same donor. This difference was important for graft survival. We therefore recommend doing a biopsy of both kidneys., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: This study analyzed the factors related to recurrence of hepatitis C virus (HCV) among orthotopic liver transplantation (OLT) patients., Patients and Methods: We undertook a multicenter, prospective, observational study of OLT patients transplanted due to HCV at four Andalusian transplantation centers from 2005 to 2007. Patients were excluded if their survival was less than 1 month. The analysis included 110 pre-, peri-, and posttransplant variables that could affect HCV recurrence. We also examined the influence of cardiovascular risk factors and immunosuppression on HCV., Results: Among 121 HCV patients, 83 (69%) experienced a histologically significant recurrence of HCV, including 13 (16%) who died compared with 5 of 38 (13%) who did not show a severe recurrence of HCV (P = .3). The mean follow-up was 44 months (range, 4 to 64 months). The mean time to appearance of the relapse was 9 months (range, 1 to 40 months) with no differences according to the type of immunosuppression. Of all study variables, donor age (> 52 years) showed a trend for greater recurrence (P = .1). The use of powerful immunosuppression (three or more drugs), either as induction or as sustained therapy, during the first posttransplantation year was significantly associated with a greater relapse rate (P < .01), albeit with no significant difference according to the type of calcineurin inhibitor. Mycophenolate mofetil was not associated with a greater posttransplantation viral load or earlier relapse, although its use in multiple immunosuppression schedules was associated with a greater relapse rate (P < .01). Survival of patients with recurrent HCV was reduced, although not significantly. Multivariate analysis showed a 4.4 times greater risk for developing de novo diabetes mellitus (DM) among patients with a severe relapse of HCV., Conclusions: There was an important trend toward a greater recurrence rate of HCV among patients who received powerful immunosuppression protocols, particularly during the first 12 months. Special attention should be given to the risk for de novo DM among HCV-positive patients., (Copyright © 2013 Elsevier Inc. All rights reserved.)

To determine possible mechanisms of action that might explain the nutrient partitioning effect of betaine and conjugated linoleic acid (CLA) in Iberian pigs and to address potential adverse effects, twenty gilts were restrictively fed from 20 to 50 kg BW Control, 0.5% betaine, 1% CLA or 0.5% betaine + 1% CLA diets. Serum hormones and metabolites profile were determined at 30 kg BW and an oral glucose test was performed before slaughter. Pigs were slaughtered at 50 kg BW and livers were obtained for chemical and histological analysis. Decreased serum urea in pigs fed betaine and betaine + CLA diets (11%; P = 0.0001) indicated a more efficient N utilization. The increase in serum triacylglycerol (58% and 28%, respectively; P = 0.0098) indicated that CLA and betaine + CLA could have reduced adipose tissue triacylglycerol synthesis from preformed fatty acids. Serum glucose, low-density lipoprotein (LDL) cholesterol and non-esterified fatty acids were unaffected. CLA and betaine + CLA altered serum lipids profile, although liver of pigs fed CLA diet presented no histopathological changes and triglyceride content was not different from Control pigs. Compared with controls, serum growth hormone decreased (20% to 23%; P = 0.0209) for all treatments. Although serum insulin increased in CLA, and especially in betaine + CLA pigs (28% and 83%; P = 0.0001), indices of insulin resistance were unaffected. In conclusion, CLA, and especially betaine + CLA, induced changes in biochemical parameters and hormones that may partially explain a nutrient partitioning effect in young pigs. Nevertheless, they exhibited weak, although detrimental, effects on blood lipids. Moreover, although livers were chemically and histologically normal, pigs fed CLA diet challenged with a glucose load had higher serum glucose than controls.

The estimation of benzo(a)pyrene (BaP) concentrations in ambient air is very important from an environmental point of view especially with the introduction of the Directive 2004/107/EC and due to the carcinogenic character of this pollutant. A sampling campaign of particulate matter less or equal than 10 microns (PM10) carried out during 2008-2009 in four locations of Spain was collected to determine experimentally BaP concentrations by gas chromatography mass-spectrometry mass-spectrometry (GC-MS-MS). Multivariate linear regression models (MLRM) were used to predict BaP air concentrations in two sampling places, taking PM10 and meteorological variables as possible predictors. The model obtained with data from two sampling sites (all sites model) (R(2)=0.817, PRESS/SSY=0.183) included the significant variables like PM10, temperature, solar radiation and wind speed and was internally and externally validated. The first validation was performed by cross validation and the last one by BaP concentrations from previous campaigns carried out in Zaragoza from 2001-2004. The proposed model constitutes a first approximation to estimate BaP concentrations in urban atmospheres with very good internal prediction (Q(CV)(2)=0.813, PRESS/SSY=0.187) and with the maximal external prediction for the 2001-2002 campaign (Q(ext)(2)=0.679 and PRESS/SSY=0.321) versus the 2001-2004 campaign (Q(ext)(2)=0.551, PRESS/SSY=0.449)., (Copyright 2010 Elsevier B.V. All rights reserved.)

Lead is a toxic trace element which produces harmful effects on human health, even at low concentrations, and it can be useful as ambient pollution tracer because the relative abundance of its four stable isotopes (204, 206, 207 and 208) depends on the emission source. This study was focused on the lead concentrations and isotope ratios in the PM10 of Zaragoza, in order to determine the main Pb pollution sources and to check whether the influence of the prohibition of leaded fuel was worthwhile. Two sampling campaigns from 2001 until 2004, the first one in which leaded gasoline was still effective and the second one with the phase-out, were carried out by using a high-volume air sampler able to trap the particulate matter equal to or less than 10 microm (PM10) on Teflon-coated fibre glass filters. Firstly, the Pb concentrations for the two sampling campaigns were analysed by inductively-coupled plasma optical emission spectrometry (ICP-OES). No statistically significant decrease in the Pb average concentration was obtained from the first to the second sampling. Enrichment factors showed that anthropogenic sources were prevalent during both samplings, in particular during 2001-2002. Afterwards, only those samples with higher concentrations than the limit of quantification of Pb were analysed to determine the lead isotopic composition by inductively-coupled plasma quadrupole mass spectrometry (ICP-QMS). To apply this analytical technique successfully, it was necessary to optimize the parameters affecting the measurement accuracy and precision. Differences were found regarding the lead isotope ratios for both periods finding that anthropogenic sources related to industrial processes were reflected on both campaigns. The gasoline contribution for the first campaign was 23% whereas for the second sampling this contribution was negligible, corroborating the success of the lead policies on the quality of the environment.

Stricter regulations and controls for environmental lead have resulted in significantly lower frequency and reduced severity of chronic and acute lead intoxication. The aim of the present study was to update established reference ranges for lead in whole blood of healthy adults residing in Zaragoza and its region in northeastern Spain. The mean blood level was 2.94 +/- 2.02 microg/dl, with a median of 2.43 microg/dl (n = 156). For women, the mean was 2.29 +/- 1.64 microg/dl (n = 73) and for men 3.51 +/- 2.16 microg/dl (n = 83). The difference between genders is statistically significant (p < 0.005). Our results confirm an ongoing decline in blood lead levels in the studied region, which in 1989 were found to average 13.17 +/- 3.47 microg/dl. In addition, there is a clear need to take into account gender differences when defining normal ranges for lead.

Objective: To determine the prevalence of tobacco use among 12-18 year-olds in Biscay (Spain) and its relation with the family environment., Subjects and Method: We performed a cross-sectional study in 12-18 year-olds. A self-administered, anonymous questionnaire was distributed in different schools of the region selected by stratified sampling, based on the type of school (public school or subsidized private school) and on the linguistic model. The final study sample comprised 1921 students. Information was obtained on tobacco, alcohol and other drug use, as well as on family and sociodemographic characteristics., Results: A total of 51.8 % of the students had used tobacco. One-third (29.9%) of the teenagers were current smokers and 50.4% were daily smokers. The mean age of first tobacco use was 13.1 +/- 1.85 years. The prevalence of tobacco use was higher in girls and increased with age until the age of 15-16 years. More than 90 % of smokers had experimented with alcohol, 86.3 % had used cannabis at some time and 11 % had used other illegal drugs. In multivariate analysis, the variables associated with a higher odds of smoking were age, female sex, available money, use of other drugs, and smoking by siblings in front of the adolescent., Conclusions: The prevalence of tobacco use among 12-18 year-olds increased in relation to female gender, age, having siblings who smoked in their presence, available money, and the use of alcohol, cannabis and other illicit drugs. Maternal and sibling disapproval of smoking may be associated with lower tobacco use among adolescents.

Background: Cardiovascular disease is one of the leading causes of death and it has been shown that primary prevention with the HMG-CoA reductase inhibitor (statin) lipid-lowering drugs can reduce cardiovascular events. Acquisition costs vary between statins and this may be an important consideration in the overall cost effectiveness (CE) of different options., Objective: To perform a CE study of the main statins used in Spain for primary prevention of cardiovascular disease in patients with high cholesterol levels [corrected], Study Design: The CE analysis was based on an open-label, prospective, naturalistic, randomised intervention study under usual care conditions in primary care settings in patients with high cholesterol levels (total cholesterol [TC] >240 mg/dL, low-density lipoprotein cholesterol [LDL-C] >160 mg/dL) and one or more cardiovascular risk factors. The analysis was conducted from the perspective of the Spanish National Health System; the year of costing was 2001., Patients: A total of 161 patients (49.7% males), mean age 65 +/- 10.3 years, without evidence of cardiovascular disease were included in the study. Of those, 82.1% were hypertensive, 37.1% had diabetes mellitus and 17.9% were smokers., Interventions: Forty-eight patients received oral atorvastatin 10 mg/day, 32 received fluvastatin 40 mg/day, 44 received simvastatin 20 mg/day and 37 patients received pravastatin 20 mg/day for 6 months., Main Measurements and Results: After 6 months, the therapeutic goals of LDL-C control, according to the recommendations of the Spanish Society of Arteriosclerosis--Consensus-2000, were reached in 62.5%, 43.8%, 45.5% and 40.5% of patients treated with atorvastatin, fluvastatin, simvastatin and pravastatin, respectively. The average CE ratio, expressed as the cost in euros (euro) per patient achieving the therapeutic goals, was euros 424.3 for atorvastatin, euros 503.5 for fluvastatin, euros 527.0 for simvastatin and euros 683.4 for pravastatin. The incremental CE ratios for atorvastatin versus fluvastatin and simvastatin were euros 238.9 and euros 149.5, respectively, per additional patient reaching therapeutic goals. Atorvastatin, fluvastatin and simvastatin all dominated pravastatin., Conclusions: All the statins studied have been shown to be effective for reducing both TC and LDL-C levels. In this study, atorvastatin was the most efficient drug, with the best CE ratio (cost per patient reaching therapeutic goals). Atorvastatin was more effective and less costly than pravastatin, and when compared with fluvastatin or simvastatin the additional cost per additional patient achieving therapeutic goals was

Objective: Bladder cancer is such an important health problem and accounts for most of the surgical duty in the urology departments. We achieve to draw the features of patients diagnosed with bladder tumors in the Cuenca area throughout a seventeen-year period., Material and Method: From January 1985 to December 2002 we recorded in the Cuenca area the entire urologic tumor recently diagnosed. The following features were recorded: gender, age, pathology, TNM classification, risk factors (alcohol, cigarette smoking and coffee), social demography (rural/ urban) and the presence of metastasis., Results: We achieve significant differences within pathology, age at diagnosis, incidence, social demography and some risk factors throughout the seventeen-year period., Conclusions: More bladder cancers are diagnosed along this time, more of them are infiltrating, in an aging population and from a rural precedence although a slightly decrease in the overall population in this are has been documented.

Objective: To determine the normal profile of bone turnover markers in childhood in order to enable evaluation of bone mineralization status in the healthy pediatric population and in the population at risk of osteoporosis., Patients and Methods: A population of 75 healthy children aged between 6 months and 14 years was studied. Levels of osteocalcin and C-terminal procollagen peptide type I, as markers of bone apposition, were determined in serum. Levels of hydroxyproline and pyridinoline, as markers of bone resorption, were determined in urine samples. Statistical analysis of the results was performed., Results: The highest levels of the four markers were obtained in the first 4 years of life. Markers of bone resorption showed a continuous statistically significant decrease until the age of 14 years (p < 0.05), whereas markers of bone apposition decreased slightly after the age of 4 years and then remained stable until the age of 14 years., Discussion: These findings are compatible with the presence of intense bone turnover in the first 4 years of life and with a predominance of the phenomenon of bone apposition throughout the first 14 years of life. Knowledge of the normal profile of these markers allows evaluation of bone mineralization status in the healthy pediatric population and in the population at risk of osteoporosis.

Objective: To assess the prevalence of tuberculosis (TB) and latent tuberculous infection among immigrant residents of Bilbao who came from countries where the disease is highly prevalent. We also studied related social and health conditions., Material and Methods: A descriptive study carried out in the San Francisco neighborhood of Bilbao. Subjects were enrolled during a seven-month period by a social worker and by the personnel of a non-governmental organization (Médicos del Mundo) who recruited volunteers from among persons requesting medical or social assistance. The subjects who agreed to participate answered systematic questionnaires on social and medical conditions and were given tuberculin tests and chest X-rays., Results: We initially evaluated 406 immigrants (mean age 32.5 years; SD 9.7) mainly from sub-Saharan Africa, 83.2% of whom were undocumented. Three hundred six completed the study (75.4%). Compliance was higher among those who applied for medical certificates (p = 0.039) or who were symptomatic (p = 0.016). Thirty-one subjects had been exposed and 0.83% had active TB., Conclusion: We believe that TB screening tests for recently arrived immigrants are necessary given the high rate of exposure and disease. Incentives and the cooperation of non-governmental organizations could improve acceptance of and compliance with such programs.

Objectives: We analyze the risk factors which have an influence on osteoporosis. We study the relationship between the beginning of menopause and both ponderal index and tobacco consumption., Design: A two-year long prospective study., Setting: Hortaleza Council Health Center, Madrid., Patients: 504 women who took part in the Menopause Programa from may 1994 to may of 1996. All of them have had a quantitative computerized tomography., Measurements: We analyze the following risk factors: family background, tobacco consumption, calcium intake, physical exercise and ponderial index. We studied the risk factors frequency and its relation with osteoporosis. A statistical analysis of that relation has been made. We studied the relationship between both ponderal index and the tobacco consumption and the beginning of menopause., Main Results: Every risk factor we have studied has an influence on osteoporosis. However the lack of regular physical exercise together with a lower ponderial index seem to be the most outstanding risk factors: p = 0.024 for physical exercise and p = 0.05 for ponderal index. As to the age when menopause begins we have found out that among women who smoked menopause started 1.29 years earlier (p = 0.025). Meanwhile among women with a lower Quetelet rate menopause began 0.95 years earlier., Conclusions: The risk factors we have studied have an influence on the incidence of osteopenia/osteoporosis. The longer time of amenorrhea, the bigger influence. Prevention programs should start at an earlier age in order to avoid risk factors that depend on the patients behavior. Menopause begins earlier in women who smoke and those who have a lower ponderal index.

Laparoscopic, clinical and biological features of 51 patients admitted over a period of 22 years in two university hospitals of Madrid are analyzed. Mean age was 43 years, 30 patients were diagnosed in the period from 1967 to 1978 and in 32 of them, there was predisposing pathology. Main symptoms were abdominal pain, fever, general syndrome and ascites. Ascitic fluid was an exudate in 97% of cases, finding BAAR in one case, being the culture positive in four cases. Diagnostic was made through laparoscopy in 42 cases and using laparotomy in 9 cases, being confirmed with histological procedures in 38 cases and with microbiological procedures in 11 cases. Peritoneal tuberculosis is a non unfrequent tuberculosis localization. Laparoscopy is the more cost-effective diagnostic method of peritoneal tuberculosis.

We studied the antibiotic sensitivity of 130 Streptococcus pneumonia strains isolated from respiratory samples (96 cases), blood (13 cases), CSF (6 cases), ocular secretions (5 cases) and other origins (10 cases). High-level penicillin-resistance was found in 13.08% of strains, and intermediate-level penicillin resistance was also found in 22.3% of strains. A multiple-antibiotic resistance pattern was shown by 80.44% of all penicillin-resistant strains. Resistance rates found against antibiotics were as follows: tetracycline, 41.53%; chloramphenicol 17.69%; cotrimoxazole, 16.92% and erythromycin 6.92%. All isolated strains were sensitive to rifampin and vancomycin.

This article sets out the basic guidelines being applied in governmental and institutional action concerning drug trafficking and consumption in Spain. After a brief survey of the history of trafficking and consumption, and of government policy in this area, the current Spanish National Drugs Plan is described in detail. This ambitious project is of recent date, and it is still too early to attempt exhaustive evaluation of its results. However, a number of suggestions based on consideration of what has been achieved so far are made in the hope that they may serve to redirect future efforts to where they are most needed in this urgent field.

Gastric lipoma is an infrequent benign submucosal tumor that is usually asymptomatic. In view of the few reports of this pathology in the Spanish and international bibliography, a new case that debuted as massive upper gastrointestinal hemorrhage is communicated. We reviewed the cases published in Spain to date, emphasizing the methodology of preoperative diagnosis, with special attention to the endoscopic signs characterizing gastric lipoma and computerized axial tomography, which is now viewed as the technique of choice. Therapeutic options are discussed.