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Introduction: Transfemoral access (TFA) is the primary access approach for neurointerventional procedures. Transradial access (TRA) is established in cardiology due to its lower complications, yet, it is at its early stages in neuroprocedures. This study performs an early exploration of the economic impact associated with the introduction of TRA in diagnostic and therapeutic neuroprocedures from the Spanish NHS perspective., Methods: An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed., Results: TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results., Limitations: Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured., Conclusions: The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.

This paper describes the beginning of the implementation process of the health impact assessment in the Valencian Community (Spain), as an instrument to incorporate the framework of social determinants and health inequalities in the policies issued by the different departments of the Valencian government. The proposal involves: 1) political commitment, with legislative and strategic planning actions; 2) the creation of structures to allow intersectoral collaboration, with the establishment of the health impact assessment commission and the intersectoral technical committee; and 3) the design and validation of a tool for the simplified health impact assessment of non-health policies adapted to the Valencian Community. We highlight the importance of the participatory methodology used in the whole process and the potential of the health impact assessment for the development of public policies oriented to improve health and equity., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The prevalence of mental health problems is increasing throughout the world. Certain population groups have more probability to suffer mental disorders, which may generate inequities in health. The main of this paper is analyze the differences in the frecuency of hospital admissions according to different inequities dimensions (age, sex and country of birth) of the populaion between 15 and 49 years old between 2008 and 2015 in the Comunitat Valenciana (Spain)., Methods: Transversal study based on all admissions for Diagnosis-related group "Psychosis" in public centers in the Comunitat Valenciana. Sources of information were Minimum Basic Data Set and Population Information System. Descriptive analysis of clinical and social variables was conducted, and differences among subgroups were analyzed by t-Student test for the comparison of a quantitative variable and χ2 test for the comparison of a qualitative variable, as well as the exact Wilcoxon and the Fisher test when application conditions were not satisfied., Results: there were studied 23869 admissions for psychosis generated by 11265 patients. Most of these admissions were because of schizophrenia disorders (39.44%). When comparing by sex, differences in diagnosis were observed, being more frequent psychotic mood disorders in women (39.3%). There also observed differences when comparing by country of birth, being more frequent "Other non-organic psychosis" in foreign people (40.5%). Differences were found regarding mortality during admission, being higher in men (5.1% vs. 4%) and in foreign people (5.3% vs. 3.8%)., Conclusions: There have been detected inequities in the frequency of psychosis admissions in the Comunitat Valenciana. These differences are observed around different dimensions such as age, gender and country of origin., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

We compared perinatal mortality rates (PMRs) and the risk from certain causes among immigrant and native population in the Valencian Community (Spain). Using data from the Perinatal Mortality Registry, crude and age standardized mortality ratios were obtained in the different groups of mothers. Mortality rate ratios were calculated to compare the causes of death resulting from prematurity, congenital anomalies, infectious diseases and Sudden Infant Death Syndrome between Spanish and foreign women. PMRs were higher among all the immigrant groups compared with the native population, with a statistical significance in Eastern European and sub-Saharan mothers. Neonatal mortality rates in North African and Latin American mothers were similar to those of native women. Babies of immigrant mothers were at a significant higher risk of dying from late infectious diseases and from causes resulting from being premature. More research is needed on the risk factors which contribute to generating differences in our setting.

Objective: to explore the experiences and perceptions of parenthood and maternal health care among Latin American women living in Spain., Design: an exploratory qualitative research using focus groups and thematic analysis of the discussion., Setting and Participants: three focus groups with 26 women from Bolivia and Ecuador and three focus groups with 24 midwives were performed in three towns in the Valencian Community receiving a large influx of immigrants., Findings: the women interpreted motherhood as the role through which they achieve fulfilment and assumed that they were the ones who could best take care of their children. They perceived that men usually make decisions about sex and pregnancy and recognised a poor or inadequate use of contraceptive methods in planning their pregnancies. Women reported that it was not necessary to go as soon and as frequently for health examinations during pregnancy as the midwives suggested. The main barriers identified to health-care services were linked to insecure or illegal employment status, inflexible appointment timetables for prenatal checkups and sometimes to ignorance about how public services worked., Key Conclusions and Implications for Practice: empowering immigrant women is essential to having a long-term positive effect on their reproductive health. Antenatal care providers should be trained to build maternity care that is culturally sensitive and responds better to the health needs of different pregnant women and their newborns., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: In the congenital hypothyroidism screening in populations with sufficient iodine intake, in the percentage of newborns with TSH values 5 mU/l must be less than 3%. This study is aimed at ascertaining the prevalence of iodine deficiency among the mothers and newborns in Castellon and Valencia and, secondly, to evaluate the bearing which the day on which the sample is taken and the use of iodized antiseptics may have., Methods: The TSH value was studied in 91,853 newborns within the 2004-2006 period in Castellon and Valencia. The mean TSH values were compared considering the conditions defined by the WHO for analyzing the indicator: sampling at two days following birth and no use of antiseptics. The percentages of samples having TSH5 > mU/l.were calculated and compared., Results: Among the samples having fulfilled the requirements for the analysis of the indicator, the prevalence of newborns having TSH5 > mlU/ showed a decrease from 2004 (2.2% CI95%:1.8%-2.6%), 2005 (2%; CI95%:1.6%-2.3%) and 2006 (1.7%; CI95%: 1.4%-2%). The mean TSH in samples of under 2 days was significantly higher (2.19 mlU/L; Q1-Q3: 1.35-3.40 as compared to 1.36 mlU/L; Q1-Q3: 0.78-2.21) (p<0,001). Considering the samples taken 2 days after birth, the use of antiseptics determined a significantly higher mean TSH (1.54 mlU/L; Q1-Q3: 0.88-2.50 as compared to 1.23 mlU/L; Q1-Q3: 0.72-1.97) (p< 0,001)., Conclusions: The value of the newborn thyrotropinemia indicator in Castellon and Valencia is compatible with the WHO definition for populations having a proper iodine intake. Neonatal TSH screening is a good tool for monitoring the prevalence of iodine deficiency, but the point in time of the extraction must be suitable and the use of iodized perinatal antiseptics eliminated.

Aim: The objective of the study was to determine the situation concerning mineral metabolism and bone disease in hemodialysis (HD) patients living in the community of Valencia (Spain), as well as the clinical practices for bone disease control in relation to the laboratory targets recommended in the National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) guidelines., Methods: In December 2003, a cross-sectional study was performed including 2392 patients (1485 males and 907 females) from 43 different centers in the council of Valencia (the entire HD population). Mean age was 65.8 +/- 14 yrs. Cut-off levels for the study of calcium, phosphorus, calcium-phosphorus product (Ca x P) and parathyroid hormone (PTH) were performed following the recommendations of the K/DOQI guidelines., Results: The mean values for calcium were 9.57 +/- 0.7 mg/dL, phosphorus 4.97 +/- 1.5 mg/dL, intact PTH (iPTH) 297 +/- 353 pg/mL, Ca x P 47.5 +/- 15 mg2/dL2. Hypocalcemia (<8.4 mg/dL) was present in 5% of patients, whereas 17.8% of patients presented hypercalcemia (>10.2 mg/dL), 60.3% of whom received vitamin D. Hypophosphoremia (<3.5 mg/dL) was present in 16% of patients, and 29% of patients presented hyperphosphoremia (>5.5 mg/dL). Ca x P was <55 mg2/dL2 in 73% of patients. Thirty one percent of patients presented secondary hyperparathyroidism (HPTH >300 pg/mL), being severe in 12% (>600 pg/mL); 43% of patients presented iPTH <150 pg/mL. Only 7.3% of patients achieved the four recommendations provided in the K/DOQI guidelines. Vitamin D treatment was administered in 48% of patients., Conclusions: The population undergoing dialysis in the community of Valencia achieved targets based on the clinical recommendations of the K/DOQI guidelines as follows: 45% of patients achieved targets for calcium, 55% for phosphorus, 73% for Ca x P and 26% for iPTH levels. Surprisingly, only 7.3% of patients achieved all four targets.

The enzyme carnitine-acylcarnitine translocase (CACT) is involved in the transport of long-chain fatty acids into mitochondria. CACT deficiency is a life-threatening, recessively inherited disorder of lipid beta-oxidation which manifests in early infancy with hypoketotic hypoglycemia, cardiomyopathy, liver failure, and muscle weakness. We report here the clinical, biochemical, and molecular features of six CACT-deficient patients from Italy, Spain, and North America who exhibited significant clinical heterogeneity. In five patients (Patients 1, 2, 4, 5, and 6) the disease manifested in the neonatal period, while the remaining patient (Patient 3), the younger sibling of an infant who had died with clinical suspicion of fatty acid oxidation defect, has been treated since birth and was clinically asymptomatic at 4.5 years of age. Patients 1 and 4 were deceased within 6 months from the onset of this study, while the remaining four are still alive at 8, 4.5, 3.5, and 2 years, respectively. Sequence analysis of the CACT gene (SLC25A20) disclosed five novel mutations and three previously reported mutations. Three patients were homozygous for the identified mutations. Two of the novel mutations (c.718+1G>C and c.843+4&#95;843+50del) altered the donor splice site of introns 7 and 8, respectively. The 47-nt deletion in intron 8 caused both skipping of exon 8 only and skipping of exons 6-8. Four mutations [[c.159dupT;c.163delA] ([p.Gly54Trp;p.Thr55Ala]) c.397C>T (p.Arg133Trp), c.691G>C (p.Asp231His), and c.842C>T (p.Ala281Val)] resulted in amino acid substitutions affecting evolutionarily conserved regions of the protein. Interestingly, one of these exonic mutations (p.Ala281Val) was associated with a splicing defect also characterized by skipping of exons 6-8. The deleterious effect of the p.Arg133Trp substitution was demonstrated by measuring CACT activity upon expression of the normal and the mutant protein in E. coli and functional reconstitution into liposomes. Combined analysis of clinical, biochemical, and molecular data failed to indicate a correlation between the phenotype and the genotype., (Copyright 2004 Wiley-Liss, Inc.)

Background: The primary care reform (PCR) has give rise to some major changes in the nursing profession. The objectives of this study are to analyze the achievements made by the nurses, to identify the problems they currently have in primary care and to suggest some lines along which work can be done for the future., Method: Qualitative research (focal group method). Eight groups were made segmented by occupational category and the position held. Scope of the analysis: the role of nurses, services supply and organization, participation and management, marketing and training., Results: In the opinion of those surveyed, the PCR has entailed a broadening of the nurses' skills, although their role is still well-defined. The nurses are of the opinion that there is no listing of services inherent to nursing despite the leading role they obviously play in home care and health education. The need has been identified of assess the existing health programs in terms of results. Concerning to health services organization, main problems were related to the lack of adapting staffing in keeping with the rise in population and difficulties of internal communications within the health professional teams and the very small degree to which nursing services are disseminated. The need is felt of broadening pre-diploma training with regard to some subjects (health education) and skills (teamwork)., Conclusions: Although the PCR has meant improvements for the nurses, solutions have as yet to have been provided to some aspects (including defining a listing of services, adapting staffing, internal communications, marketing, training) and given the opportunity the transferring of authorities over health care entail, further progress must be made toward innovative proposals to improve the health services.

Objective: The aim of this study was to determine the reliability and construct validity of the three dimensions of the Job Content Questionnaire (JCQ): demand, control and job support among hospital nursing staff., Methods: The minimun reduced version of the JCQ was used, which include three dimensions: psychological demands (9 items), job control (9 items) and job support (11 items). Validity was assessed in a random sample of 330 nursing staff from two general hospitals in the province of Alicante (Spain). The reliability of the questionnaire was evaluated after re-interviewing a subsample of 50 nurses 15 days after the first interview. Construct validity was evaluated by calculating correlations between the three dimensions of the JCQ obtained after factorial analysis with the burnout scale and six dimensions of the 36-item short-form health survey (SF-36) questionnaire., Results: Factorial analysis revealed that the version of the JCQ validated in this study had the same factorial structure as the original questionnaire. The intraclass correlation between the first and second interview was high for each of the three dimensions (between 0.83 and 0.87). Cronbach's alpha was also high (between 0.74 and 0.88). A moderate but significant correlation was found between the three JCQ dimensions and the burnout scale: (-0,27 for job support, 0.31 for psychological demands and -0.12 for job control). A moderate correlation was also found for some SF-36 dimensions., Conclusion: The factorial structure of the JCQ was similar to that proposed by the author in the context of Spanish culture. The reliability and internal consistency of each of the three dimensions was high while construct validity was moderate.

Objective: To analyze the factors which cause stress at work among hospital nursing staff according to their socio-demographic and professional characteristics and their affects on psychological welfare., Methods: A cross study carried out on a randomly chosen group of 201 nursing professionals composed of nurses and nurses aides from a general public hospital in the city of Valencia. The data was gathered by means of a self-administered questionnaire. To measure the variable response, psychological welfare, The Goldberg General Health 28 item version questionnaire, GHQ-28, was used. Work stress factors were evaluated by means of a scale valid for our cultural environment, Spain,: the Nursing Stress Scale, NSS, which consists of 34 items having a range from 0 to 102. In addition, information about diverse socio-demographic and professional variables were gathered. The authors carried out a simple analysis on all the data obtained., Results: The scores registered on the work stress factors scale were lower for nursing professionals older than 55 and for those who have more than 20 years experience in their service, with a medium of 23.28 (IC 95% = 9.87-54.84) and 25.29 (IC 95% = 11.80-54.22) respectively. On the other hand, the medium was higher for nurses with a medium of 34.16 (IC: 15.29-76.29) in comparison to the score for nurses aides. The total score on the work stress factors scale was higher in the "probable situations" of psychological stress with a medium of 42.40 (IC 95% = 21.35-84.21)., Conclusions: The results of this study demonstrate that a higher level exposure to work stress factors lowers the psychological welfare among nursing staff.

Background: The cross-cultural adaptation of "The Nursing Stress Scale" used to gauge job stressors stress in hospital nursing staff members., Methods: The translation-back translation method of translating this scale into Spanish and then back into English has been employed, rounded out with qualitative means and methods (focus groups). The original scale was translated in Spanish independently by two bilingual nurses born in Spain who had lived in the United States. In following, the text in question was translated back into English by two U.S.-born translators living in Spain. Two focus groups were formed, one comprised of male and female nurses and other of nurses aides from different units and hospitals. Lastly, a pilot survey was made of 20 professional nurses., Results: The items were ranked by how difficult it was to come up with a phrase in Spanish which would be equivalent in concept to the original one. Fifteen (15) items entailed no problem, 13 entailing an average degree of difficulty and 6 a high degree. Following another translation of the problematical items and the inquiries made to one of the individuals who had written the original scale, a Spanish version was drafted in which 12 items showed two or more alternative versions, which were then assessed in the pilot survey. As a result of the groups, the conclusion was drawn that the types of job stressor perceived by nursing staff are comparable to those included on the original scale, with the exception of the "Break Down of computer" item, which is not applicable to our environment., Conclusion: An adapted Spanish version of The Nursing Stress Scale has been drafted, the subsequent assessment of its validity and reliability being required.

Background: A relevant increase in the spanish biomedical production has occurred in the last few years. The magnitude, evolution and characteristics of the Spanish scientific production in Rheumatology is here analyzed through the published papers in foreign specialty journals., Methods: Location in spanish documents published from 1990 to 1996 in nine foreign rheumatology journals of great visibility in MEDLINE. Classification of documents according to type of publication, specialty of authors and type of design. Estimation of bibliometric and collaboration indicators. Analysis of their evolution and comparison with data published for 1987., Results: The number of Spanish documents from 1990 to 1996 doubled and from 1987 to 1996 tripled, with a 54% increase for the four journals with more visibility. In 1996, the spanish documents reached 5% of the total of published documents in several journals. From 1990 to 1996 original papers increased almost four times more than letters, the analytical studies increased almost eight times more than descriptive studies, and the mean expected impact factor of the originals multiplied by 1.6. The published documents by spanish rheumatologists had a more favorable profile--higher ratios for originals: letters, analytical studies: descriptive studies--than publications performed by other specialists in this area. The number of authors by document (median) increased from 5 to 6 during the analyzed period. Seventy-two percent of documents was signed by more than one department and 75% by only one institution., Conclusions: A relevant increase has occurred in the number and quality spanish documents published in the rheumatology area during the last ten years. To note a lack of collaboration between different institutions and few analytical studies of great complexity: cohort studies and controlled clinical trials.

Objectives: To study the return to paid work between the 5th and 12th month after the birth of a child depending on socioeconomic and occupational characteristics of employed mothers. Furthermore, to analyse the differences at the time of returning to work (5th or 12th month) according to these characteristics., Methods: Longitudinal study carried out on a sample of 528 primiparous or secundiparous women who have had a child in a public hospital in the city of Valencia and who have carried out a professional activity during pregnancy. Three cross-sectional cut off points were made; the first two days after childbirth, the second five months later and the third a year after the child was born. The information collection was conducted by means of a questionnaire. Uni and multivariate statistical analysis techniques have been used., Results: Five months after childbirth the probability of returning to work was greater in women who worked with permanent contracts in the private sector (ORadjusted: 7.4) or public sector (ORadjusted: 7.8). Likewise it is higher in service workers (ORadjusted: 2.0), administrative staff (ORadjusted: 2.5) and professionals or technical workers (ORadjusted: 2.9). The probability of returning to paid work a year after childbirth is higher in the mother who works in the public sector with permanent or temporary contracts (ORadjusted: 21.0 and 5.1 respectively) and in the private sector with permanent contracts (ORadjusted: 5.1). It is also higher in service workers (ORadjusted: 2.2), in administrative staff (ORadjusted: 2.7) and professionals or technical workers (ORadjusted: 4.7)., Conclusions: Childbirth may lead to a break in the working career of the woman. The socio-demographic and professional factors which might explain this break are low professional qualifications and unstable employment in private sector companies.

Background: To study the evolution of specific cases of fertility by age groups in the Autonomous Region of Valencia, between 1975 and 1990, and compare this development with the evolution on a national level., Methods: The specific fertility rates were calculated for seven 5-year age groups within the female fertility period (15-49 years). The number of births per age of mother (Natural Movement of the Spanish Population) has been used and the denominator is the female population calculated be geometrical interpolation from the figures provided by different censuses and electoral roles for each one of the age groups. The study period is 1975 to 1990., Results: The evolution of the fertility rate in the Autonomous Region of Valencia is declining in all age groups except the 30-34 year age group, where fertility showed a slight increase at the end of the eighties, the same as in the rest of the country. Worthy of mentioned is the 15-19 year old group, with figures below the national level, and the 25-29 year old group, where the figures are greater than for the rest of the country as a whole. On a province (county) level, the development is similar to what has been described above. Alicante has the highest figure out of the three provinces (counties) for women in the 15-19 and 35-39 year age ranges., Conclusion: The evolution of the fertility rate in the Autonomous Community of Valencia is similar to the development in the rest of the country, a slight increase being detected in women in the 30 to 40 year group, which is similar to what has happened in other European countries.

The objective of this work was to study the influence of working conditions and socio-demographic, personal and social support factors on the duration of breast-feeding. The study population consisted of primiparous or secundiparous women who have had a child in a Valencian public hospital and who have carried out a professional activity during their pregnancy. Information was collected by means of a face-to-face interview in the maternity ward two days after childbirth, a telephone interview five months later and a postal questionnaire one hear after childbirth. A total of 545 surveys were obtained. A simple analysis of the data was carried out. A total of 64% of the mothers reported after one year that they had breast-fed. Seventeen percent breast-fed for one month or less, 13.3% for two months, 24.8% for three months, 12.7% for four months and 32.3% for 5 or more months. The duration of breast-feeding was longer among women over 25 years of age, among secundiparous women and among those who did not return to work after childbirth. It was shorter among those whose maternity leave was shorter and among those whose husbands work without a contract. Therefore, among women who carry-out paid work, the main factor which limits the duration of breast-feeding is the return to work after childbirth. The application of certain measures which favour maintaining breast-feeding (reduction of working day, flexibility in work hours, etc.) should be done so with caution and always with the mother's consent and without this implying a risk for the continuity in work and professional promotion.

The objective of this study is to assess the relationship between the decision to return to work during the first year after delivery and socio-demographic and professional factors, as well as the reasons why the decision is made. Data collection was carried out by a personal interview in the hospital, two days after childbirth. 597 primiparous or secundiparous women who had developed a professional activity during pregnancy were interviewed. Uni and multivariate statistical analysis techniques were used. Blue collar workers (ORadjusted = 0.13), administrative staff (ORadjusted = 0.16), women who give up work more than a month before the birth (ORadjusted = 0.33 and 0.28), women without a contract (ORadjusted = 0.19) and temporary workers (ORadjusted = 0.30) were less likely to make the decision of returning to work. According to these results, the continuity of the women in the labour market after maternity is determined to a great extent by the social and employment context where she works; a fact which must be taken into account when putting into practice maternal and child health promotion programmes.