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The aim of this study was to evaluate the effect of problem-based learning (PBL) on university students' satisfaction with and academic performance in a course on epidemiology and social and demographic health. The participants in this interventional study were 529 students (272 in the intervention group and 257 in the control group) enrolled in a medical degree programme during the academic years 2010-2011 and 2011-2012 in Spain. The intervention consisted of the use of a list of problems designed for small-group study in one of the practical sessions (Interpretation of Epidemiological Parameters). We compared students' satisfaction and performance after either PBL or conventional teaching methods. Students' satisfaction and academic performance were significantly better in the PBL group than in the traditional-learning group. Satisfaction with teaching was the main predictor of academic performance. After adjustment for level of satisfaction, the difference between groups in academic performance disappeared.

Background: Colorectal cancer (CRC) is the second cause of tumour mortality in Spain and Europe. To date, no studies have been conducted in Spain to evaluate the spatial and temporal distribution of the excess risk of death during hospitalisation for CRC.Methods: A cohort was constructed of all episodes of hospitalisation in Spain due to CRC (codes 153 and 154 of the International Classification of Diseases, 9th edition, Clinical Modification) during the period 2008-2014, based on the minimum basic data set published by the Ministry of Health. Mortality ratios were calculated per region for each of the years analyzed (spatial or cross-sectional analysis) and during the overall study period, for each region independently (temporal or longitudinal analysis). In the first of these analyses, particular note was taken of the regions and years in which the limits of two and three standard deviations were exceeded.Results: Two hundred and fifty eight thousand, nine hundred and twenty seven episodes of CRC were analysed. The patients were predominantly male (60.6%), with an average hospital stay of 13.16 days. Half underwent surgery during admission and on average presented more than six diagnoses at discharge. The spatial analysis revealed mortality ratios that deviated by at least three standard deviations in the following regions: Islas Canarias, Asturias, Valencia, Extremadura, País Vasco and Andalucía. The longitudinal analysis showed that most regions presented one or more years when CRC mortality was at least 15% higher than expected during the period; outstanding in this respect were Asturias, Navarra and La Rioja, where this excess risk was detected in at least 2 years.Conclusions: Geographic and temporal patterns of the distribution of the excess risk of mortality from CRC in Spain are described using SMRs. We conclude that during the study period, the geographic pattern of mortality in Spain did not coincide with the excess risk of mortality calculated using the SMR method described by Jarman and Foster. This method of risk estimation can be a useful tool for the study of mortality risk and its spatial variations. [ABSTRACT FROM AUTHOR]

This study examines the effects of altitudinal, temperature and aspect gradients on vascular plant species richness on mountain tops in Sierra Nevada (Spain) at different spatial scales (1 m2 quadrats, plot clusters of 4 m2, upper summit area down to the 5-m contour line, entire summit down to the 10-m contour line). The methodology follows the Global Observation Research Initiative in Alpine Environments (GLORIA) programme. Floristic and soil temperature data of eight summits sites in two neighbouring regions of the high part of Sierra Nevada (from 2668 m to 3327 m a.s.l.) were used in this study. In total, 102 taxa were recorded (84 genera; 29 families). The species richness decreased, whereas the proportion of endemic taxa increased with elevation. There were significant linear relationships between species richness and altitude and average soil temperature at each spatial scale. However, there was no significant relationship between species richness and aspect variables. Facing continued climate change, the high-altitude flora of Sierra Nevada is expected to be particularly vulnerable and prone to warming-induced biodiversity losses due to the high proportion of endemic taxa, ranging from 23% at lower elevations up to 67% at higher ones. [ABSTRACT FROM PUBLISHER]

Abstract: Aim of study: Within the scope of the European project RUBIA (ICA3-2002-10023), research has been performed on the traditional use and handling of plant species in several Mediterranean countries, Albania, Algeria, Cyprus, Egypt, Italy, Morocco, and Spain. This paper synthesises the chief results related to the medicinal utilization of those plants. Material and methods: The information has been gathered by means of semi-structured interviews (1256) and techniques of participant observation with 803 informants. In each of the participating countries the study areas were selected by means of uniform criteria defined at the beginning of the study. Results and conclusions: A total of 985 species have been catalogued, of which 406 have medicinal use. This work constitutes the first comparative study performed with ethnobotanical data gathered by a coordinated methodology in the Mediterranean area. An exhaustive list is provided for the species catalogued, indicating the regions where each plant was mentioned. Ethnopharmacological relevance: This information underlines the ethnobotanical richness of the region and the need to broaden this study to other areas of the Mediterranean. Furthermore, this constitutes a base for future phytochemical and pharmacological studies which could lead to new therapeutic products. [Copyright &y& Elsevier]

Ore mineralizations in bedrock and their exploitation may have a negative impact on air quality of surrounding urban areas and, subsequently, on human health. This study uses lichens as bioindicators of atmospheric pollution to evaluate the spatial distribution of potentially toxic elements (PTEs) in the towns close to the massive sulfide deposits of the Iberian Pyrite Belt (IPB) in SW Spain. Altogether 89 native lichen samples of Xanthoria parietina were collected from the mining towns, control towns out of the reach of the mining activity, as well as from distal sampling sites. The samples were analyzed for 29 elements after acid digestion. The concentrations for Co, Ni, Cu, Zn, As, Rb, Mo, Cd, Sn, Sb, Cs, Ba, W, Tl, Pb, S, and Fe are significantly higher in the mining towns in comparison to the control towns. The ore mineral-associated PTEs, including Cu, Zn, As, Ba, and Pb, exhibit extreme concentrations in the urban areas close to the mining activity, and particularly in the small settlement of La Dehesa next to the mineral processing plant and the tailings pond. The distal samples confirm the decrease in the concentrations of all PTEs, and these samples present similar values as in the control areas. The results, point at increased bioaccumulation of PTEs in the lichen thalli of the adjacent urban areas, suggesting that the air quality of the adjacent urban areas is locally impacted by the massive polymetallic sulfide deposits which is enhanced by the mining activity. Therefore, monitoring the urban air quality is recommended., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Annika Parviainen reports financial support was provided by University of Granada. Annika Parviainen reports financial support was provided by Government of Andalusia. If there are other authors, they 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 © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Nursing home residents are vulnerable to chronic wounds. However, the prevalence data are scarce., Aim: The purpose of this study was to determine the prevalence of pressure ulcers and/or leg ulcers in nursing home residents, and describe the characteristics of the nursing homes, the residents and the wounds, as well as possible associations between these characteristics., Methods: This was a cross-sectional survey of nursing home residents over the age of 65 in 168 facilities in Barcelona. Those presenting category II-IV pressure ulcers and/or leg ulcers were included. The data were collected by observation/examination. Descriptive, bivariate, and multivariate analyses were performed., Results: The overall prevalence of pressure ulcers and leg ulcers combined was 4.4% (3.5% were pressure ulcers and 0.9% were leg ulcers). In small nursing homes with less nursing staff, the overall prevalence was greater than in large nursing homes (5.6% vs 3.8% [p = 0.01]). As expected, residents with pressure ulcers had higher pressure ulcer risk, worse dependence and cognitive status, urinary and faecal incontinence, and most were underweight. However, residents with leg ulcers had worse venous and arterial impairment and also were overweight. A multivariate analysis showed that pressure ulcers were statistically significantly associated with faecal incontinence (OR = 0.28, 95% CI = 0.09-0.81) and dyslipidaemia (OR = 0.21, 95% CI = 0.06-0.66), and leg ulcers were statistically significantly associated with venous insufficiency (OR = 4.93, 95% CI = 1.65-15.34). The characteristics of gluteal and ischial pressure ulcers, a high prevalence of infection, and a low reference to biofilm by nurses, in both types of wounds, suggest that these aspects are not adequately taken into account., Conclusions: Pressure ulcers and leg ulcers, mainly pressure ulcers, remain a public health problem in nursing homes. Further studies are required to confirm the associations found in this study., (Copyright © 2021 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

We have studied the metal air pollution trends in a medium-sized Spanish city suffering from traffic emission using in-situ lichen Xanthoria parietina as a bioindicator. The large scale sampling included 97 samples from urban, metropolitan and remote control areas of Granada that were analyzed by Inductively Coupled Plasma-Mass Spectrometry. Enrichment factor of Sb exhibited severe anthropogenic enrichment, whereas Cu and Sb showed significantly higher median values in the urban areas with respect to metropolitan areas. Additionally, bioaccumulation ratios of V, Cr, Ni, Cu, Zn, Cd, Sb, and Pb -associated to exhaust and non-exhaust traffic emissions- enabled us to delineate hot spots of metal(loid) accumulation in the main accesses to the city, characterized by dense traffic and copious traffic jams. To distinguish non-exhaust emissions, we studied the spatial distribution of the Cu:Sb ratio -a tracer of brake wear- highlighting the surroundings of the highway and the main traffic accesses to the city likely due to sudden hard braking and acceleration during frequent traffic jams. Our study shows that the metal(loid) contents in lichens are excellent proxies for non-exhaust traffic emissions and that their contribution to the metal(loid) air pollution in Granada is more significant than previously thought., 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. Published by Elsevier Ltd.)

Huelva is a highly industrialized city in SW Spain hosting, among others, a Cu smelter, a phosphate fertilizer plant, a power plant, and oil refineries. This study aims to evaluate metal concentrations in lichens as bioindicators of atmospheric pollution in the impacted urban areas. Xanthoria parietina species from Huelva and nearby villages, as well as reference samples from remote, non-contaminated urban areas, were analyzed for trace elements (V, Cr, Mn, Co, Ni, Cu, Zn, Sr, As, Cd, Sb, Cs, Ba, La, Ce, Pr, Nd, Sm, Er, Tm, Yb, Lu, Pb, Th, U) using Inductively Coupled Plasma-Mass Spectrometry; and for major elements (Ca, K, Mg, P, and S) by Inductively Coupled Plasma-Optical Emission Spectrometry after acid digestion. The metal composition of X. parietina exhibits spatial distribution patterns with extremely elevated concentrations (Co, Ni, Cu, Zn, As, Cd, Sb, Ba, Pb, U, and S) in the surroundings of the industrial estates to <1 km distance. Mean concentrations were significantly lower in the urban areas >1 km from the pollution sources. However, air pollution persists in the urban areas up to 4 km away, as the mean concentrations of Cu, Zn, As, Cd, Sb and S remained considerably elevated in comparison to the reference samples. Though rigorous source apportionment analysis was not the aim of this study, a good positive correlation of our results with metal abundances in ambient particulate matter and in pollution sources points to the Cu smelter as the main source of pollution. Hence, the severe air pollution affecting Huelva and nearby urban areas may be considered a serious health risk to local residents., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The impact of allergens emitted by urban green spaces on health is one of the main disservices of ecosystems. The objective of this work is to establish the potential allergenic value of some tree species in urban environments, so that the allergenicity of green spaces can be estimated through application of the Index of Urban Green Zones Allergenicity (I UGZA ). Multiple types of green spaces in Mediterranean cities were selected for the estimation of I UGZ . The results show that some of the ornamental species native to the Mediterranean are among the main causative agents of allergy in the population; in particular, Oleaceae, Cupressaceae, Fagaceae, and Platanus hispanica . Variables of the strongest impact on I UGZA were the bioclimatic characteristics of the territory and design aspects, such as the density of trees and the number of species. We concluded that the methodology to assess the allergenicity associated with urban trees and urban areas presented in this work opens new perspectives in the design and planning of urban green spaces, pointing out the need to consider the potential allergenicity of a species when selecting plant material to be used in cities. Only then can urban green areas be inclusive spaces, in terms of public health., Competing Interests: The authors declare no conflict of interest.

Objective: To identify nurse perception of care in homes for the elderly in the city of Barcelona., Method: We performed a qualitative study that included in-depth interviews, participant observations and discussion groups with registered nurses at two care homes for the elderly. Data were collected from June to October 2008 and in May in 2009, and analysed using grounded theory methodology., Results: Twelve registered nurses and 10 student nurses participated in the study. Nurses reported feelings of happiness and affection, increased sensitivity in human values, and personal growth, despite work-related obstacles., Conclusions: Although care of the elderly is undervalued by society and by nurses working in other health fields, nurses in residential homes for the elderly perceive their work as authentic nursing care., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objectives: Due to the absence of randomized studies, the Spanish Reemex Working Group started a registry to analyze and review the results of a large group of patients with mid-term and long-term follow-up to obtain conclusions based on clinical experience., Methods: A registry of 715 patients who underwent surgical intervention for insertion of the SUI readjustable prosthesis Reemex TRT (tension free readjustable tape) in 15 Spanish hospitals (40% urology departments, 60% gynecology departments). The registry was established to evaluate the safety and efficacy of the sling adjustability concept in the surgical treatment of female SUI. The Spanish Working Group was able to evaluate results of the Reemex system in 683 patients of a total of 715. Mean age was 59.9 yr (range 21-87) with a mean follow-up of 23 months (6-93). The group includes: 30.2% patients with mixed incontinence, 73.1% patients with urodynamic intrinsic sphincteric deficit, 35.7% patients with previous history of failed surgical interventions for urinary incontinence, and 54.3% previous pelvic floor associated operations. All patients were evaluated preoperatively with history, physical examination and urinary incontinence questionnaire. Each follow-up visit included incontinence questionnaire, physical examination and stress test., Results: Cure rate was 92.2%, with 6.9% improvement and 0.9% failures. Readjustment was performed in 416 patients (60.9%) as a second phase of surgery over the following 24-48 hours, before hospital discharge. 80 patients (11.7%) were readjusted in the mid- or long-term (between 6 and 8 months after surgery). The level of support of the sling was successfully reduced in three patients between 6 and 14 months after surgery. No other patient suffered voiding difficulties in the long-term. 1.7% of the patients needed extraction of the tensor due to persistent abdominal wall seroma. 0.8% presented vaginal extrusion of the sling., Conclusions: The Reemex system is a minimally invasive technique with consistent results and even improved in heterogeneous groups of patients including intrinsic sphincter defficiency, reoperations, mixed incontinence and associated pathologies.

In the course of an ethnobotanical research project carried out in the Province of Granada (Southern Spain), 267 taxa have been catalogued as being used in folk medicine. Based on the literature consulted, phytotherapeutic use for 34 of these was recorded for the first time.