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Twenty-six samples from domestic assemblages of 9th-12th century Córdoba were subjected to electron microprobe analysis. The results reveal two main compositional types. The first, encountered in 13 of the samples, seems to result from the combination of plant ashes with high-impurity sand, and has some contemporary parallels from Syria and Egypt. The second type is a lead-soda-silica glass, encountered in a relatively high proportion of the glasses (11 of the 26 sampled), possibly formed by the addition of lead metal to existing glasses and with very few known parallels. These are among a very small number of results available to date on the chemical composition of glasses from medieval Spain, and the presence of a high proportion of lead-soda-silica glasses is particularly interesting, possibly indicating a technological practice unique to, or originating in, the western Muslim world. [ABSTRACT FROM AUTHOR]

Background: The spreading adoption of value-based models of healthcare delivery has incentivized the use of patient-reported outcomes and experience measures (PROMs and PREMs) in clinical practice, with the potential to enrich the decision-making process with patient-reported data., Methods: This perspective article explores PROs and the shared decision-making (SDM) process as components of value-based healthcare. We describe the potential of PROMs and PREMs within the decision-making process and present a digital framework for informing the shared decision-making process using aggregated data from a healthcare system PROMs and PREMs program, including early results from implementation in hospital network in Madrid, Spain., Results: The proposed digital framework incorporates aggregated data from a hospital network PROMs and PREMs program as part of a digital patient decision aid (PDA) for patients with lymphoma. After the first hematologist appointment, participating patients access the PDA to review relevant information about clinical and patient-reported outcomes for each of the possible options, assign a personal order of priority to different outcomes, and then select their preferred course of action. Patients' answers are automatically uploaded to the EHR and discussed with hematologists at the next appointment. After beginning treatment, patients are invited to participate in the network PROMs program; participants' PROMs data are fed back into the PDA, thus "closing the circle" between the decision-making process and patient-reported data collection.During the first 14 months after launching the decision aid in October 2022, of 25 patients diagnosed with follicular lymphoma at the four participating hospitals, 13 patients decided to participate. No significant differences in age or sex were observed between groups. Average SDM Q-9 score for patients filling in the questionnaire ( n  = 6) was 36.15 of 45 points., Conclusion: Various obstacles toward widespread implementation of SDM exist such as time constraints, lack of motivation, and resistance to change. Support and active engagement from policy makers and healthcare managers is key to overcome hurdles for capturing patient-reported data and carrying out shared decision-making at healthcare system level. Early results of a digital framework for PRO-enriched SDM seem to be beneficial to the decision-making process., 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 © 2024 del Olmo Rodríguez, Martos Martinez, Pascual Martínez, Miranda Castillo, Short Apellaniz, Pfang, Baca-García and Córdoba Mascuñano.)

Background and Objective: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis., Methods: We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS)., Results: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stageI disease, €23,506.21 for stageII disease, €38,771.81 for stageIII disease, and €72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each., Conclusions: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that "moderate" consumption is beneficial to health. The most recent evidence indicates that "moderate" consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups., (Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Alcohol is associated with all-cause mortality increase. However, when this increase takes place has not been clearly established. The objective of this study was to establish the levels of alcohol consumption that can be considered low risk for overall mortality., Methods: Systematic review of cohort studies published since 2014 that established a relationship between general mortality and alcohol consumption in the general population. Those studies not conducted in countries with Spain socio-cultural environment and those that present conflicts of interest were excluded., Results: The median of alcohol consumption (in grams) from which mortality increased was 23-25 g/day. Differentiating by sex, these values were 20 g/day in women and 24 g/day in men. The minimum value of the median from which an increase in mortality was observed was 17-21 g/day of alcohol; 12 g/day in women and 20 g/day in men., Conclusions: If we take into account caution principle, taking more conservative levels of average alcohol consumption from which an increase in mortality was observed, low-risk consumption should be 20 g/day in men and 10 g/day in women, assuming that there is no safe level of alcohol consumption.

Spain has made progress in tobacco control policies, highlighting the prohibition of tobacco consumption in closed public spaces. A continued decrease in the proportion of smokers is observed. Exposure to environmental tobacco smoke has decreased in entertainment venues, with a reduction of environmental nicotine and particulate levels over 90%, without negative impact at home. There are reductions in hospital admissions and in mortality from heart attack, decrease in hospitalizations for chronic lung disease and asthma, and decrease in the risk of prematurity and low birth weight. We must advance in: plain packaging, advertising campaigns to prevent consumption, equalize the price of different tobacco products, regulate electronic cigarettes in public places, consider new smoke-free spaces where minors and other vulnerable groups may be exposed, expand aid for cessation and promote health professionals training., (Copyright © 2020 The Author. Publicado por Elsevier España, S.L.U. All rights reserved.)

Lymphomas are a large, heterogeneous group of neoplasms with well-defined characteristics, and this heterogeneity highlights the importance of epidemiological data. Knowledge of local epidemiology is essential to optimise resources, design clinical trials, and identify minority entities. Given there are few published epidemiological data on lymphoma in Spain, the Spanish Lymphoma and Autologous Bone Marrow Transplant Group created the RELINF project. The aim of this project is to determine the frequencies and distribution of lymphoid neoplasms in Spain and to analyse survival. We developed an online platform for the prospective collection of data on newly diagnosed cases of lymphoma in Spain between January 2014 and July 2018; 11,400 patients were registered. Diffuse large B cell lymphoma (DLBCL) and follicular lymphoma (FL) were the most frequent lymphomas in our series. Marginal B cell lymphoma frequency was higher than that reported in other studies, representing more than 11% of mature B cell lymphomas. Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) was the most common subtype of T cell lymphoma, and NK/T cell lymphomas were more frequent than expected (5.4% of total). Hodgkin's lymphoma accounted for 12% of lymphoproliferative syndromes. Overall survival was greater than 90% at 2 years for indolent B cell lymphomas, and approximately 60% for DLBCL, somewhat lower than that previously reported. Survival was poor for PTCL-NOS and angioimmunoblastic T cell lymphoma, as expected; however, it was somewhat better than that in other studies for anaplastic large cell anaplastic lymphoma kinase lymphomas. This is the first prospective registry to report the frequencies, distribution, and survival of lymphomas in Spain. The frequencies and survival data we report here are globally consistent with that reported in other Western countries. These updated frequencies and survival statistics are necessary for developing appropriate management strategies for neoplasias in the Spanish population.

Objective: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations., Method: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories., Results: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation., Conclusions: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The means of optimally managing very elderly patients with diffuse large B-cell lymphoma (DLBCL) has not been established. We retrospectively analyzed 252 patients aged 80-100 years, diagnosed with DLBCL or grade 3B follicular lymphoma, treated in 19 hospitals from the GELTAMO group. Primary objective was to analyze the influence of the type of treatment and comorbidity scales on progression-free survival (PFS) and overall survival (OS). One hundred sixty-three patients (63%) were treated with chemotherapy that included anthracyclines and/or rituximab, whereas 15% received no chemotherapeutic treatment. With a median follow-up of 44 months, median PFS and OS were 9.5 and 12.5 months, respectively. In an analysis restricted to the 205 patients treated with any kind of chemotherapy, comorbidity scales did not influence the choice of treatment type significantly. Independent factors associated with better PFS and OS were: age < 86 years, cumulative illness rating scale (CIRS) score < 6, intermediate risk (1-2) R-IPI, and treatment with R-CHOP at full or reduced doses. We developed a prognostic model based on the multivariate analysis of the 108 patients treated with R-CHOP-like: median OS was 45 vs. 12 months (P = .001), respectively, for patients with 0-1 vs. 2-3 risk factors (age > 85 years, R-IPI 3-5 or CIRS > 5). In conclusion, treatment with R-CHOP-like is associated with good survival in a significant proportion of patients. We have developed a simple prognostic model that may aid the selection patients who could benefit from a curative treatment, although it needs to be validated in larger series., (© 2018 Wiley Periodicals, Inc.)

Objective: To evaluate pollution by second-hand smoke in a sample of hospitality venues before and after the implementation of smoke-free legislation., Methods: A cross sectional, before-after study was conducted in 2008 and 2011 after the total ban. A SidePack Aerosol monitor was used both inside and outside the hospitality venues to measure fine breathable particles (PM2.5). A total of 43 places with pre- and post-legislation measurements were included., Results: The median indoor pollution in hospitality venues was 204.2μg/m(3) in 2008 and 18.82μg/m(3) in 2011; the average outdoor PM2.5 concentration was 47.04μg/m(3) in 2008 and 18.82μg/m(3) in 2011. Pollution was higher in bars and cafeterias, followed by pubs and discos. Before the law was implemented, pollution was 4.34 times higher indoors than outdoors; in 2011 the average indoor PM2.5 concentration decreased by 90.88%., Conclusions: Only a complete ban is able to protect workers and customers against the health risks of second-hand smoke exposure., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To estimate the levels of small breathable suspended particles (PM(2.5)) as atmospheric markers of environmental tobacco smoke in catering establishments in Zaragoza, Spain., Material and Method: An observational study was conducted between October 2006 and April 2008 in various catering establishments in Zaragoza. A SidePack Aerosol Monitor (AM510 model) was used to sample and record the levels of breathable suspended particles (PM(2.5)) indoors and outdoors, and the following variables were collected: smoking policy (smoking allowed, completely banned, or partially banned with non-smoking sections, physically separated or not); percentage of smokers and presence of cigarette ends, ashtrays or smokers in non-smoking sections., Results: A total of 111 venues were sampled. The level of PM(2.5) was eight times higher in smoking venues than in non-smoking ones and also higher than outdoors. The correlation between the level of particles and percentage of smokers was 0.61 (P<.01). In the non-smoking sections without physical separation the level of particles was twice as much as outdoors and similar to physically separated smokers sections., Conclusion: Only a complete ban on smoking in all workplaces, including leisure venues, has been shown to have a positive effect on workers and customers health. The measurement of PM(2.5) can be a simple method to assess the presence of environmental tobacco smoke., (Copyright © 2010 SEPAR. Published by Elsevier Espana. All rights reserved.)

Background and Objective: This study estimates smoking-attributable mortality in Spain in 2006., Population and Method: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older., Results: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women., Conclusions: About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high., (Copyright © 2010. Published by Elsevier Espana.)

The growing involvement in Spain by civil society in the demand for tobacco control policies has been notable. The basis for the creation of the National Committee for Tobacco Prevention was established in 2004. At the end of that year, an intensive intervention was aimed at specifying, in law, the regulatory actions in the National Plan for Tobacco Prevention. This would facilitate a qualitative leap, taking advantage of the legal transposition of the European directive on advertising. With broad political consensus, the Law 28/2005 was established regarding sanitary measures for tobacco and the regulation of the sale, supply and consumption of tobacco products. The objective stated in this law is to prevent the initiation of tobacco consumption, especially among youth, guarantee the right of non-smokers to breathe air free from tobacco smoke and make quitting this habit easier for people who wish to do so. The main issues included are the prohibition of tobacco advertising and the limitation of tobacco consumption in common work areas and enclosed public spaces. The new law has replaced the previous rules in Spain, which were some of the most permissive in the European Union in terms of tobacco sales, advertising limitations and restrictions on smoking locations. It is clear that there is still much to be done. At this time, more social support needs to be generated in favor of the new regulations, and an important effort needs to be made to educate the public.

Objectives: 1. To study the factors predicting the giving-up of tobacco and to correlate the categories in the Smoker's Aid Programme (SAP) with levels of motivation and dependency, using brief questionnaires. 2. To find the annual percentage in the "winners" category, using the SAP methodology., Design: Prospective, observational, intervention study without a control group of a random sample of smokers attending primary care clinics., Setting: Four urban health centres in Zaragoza and Barcelona., Interventions: Systematic intervention on smokers in the change phase (SAP category). Use of questionnaires on motivation/dependency and of biochemical checks that they had actually given up., Patients: 362 patients of whom 288 smokers (79.5%) took part. Average age was 40.85 (SD: 15.7). 60.8% were males., Measurements and Main Results: 21.4% of the smokers had tobacco-related pathology. The number of previous attempts to give up smoking was 1.6 (SD: 2.9) Patients smoked an average of 13.4 cigarettes for 22.2 years (SD: 15.7). Average age at start of consumption was 17 (SD: 4.7). Initial motivation on the Richmond Test was 4.78 (SD: 3.2); and average dependency according to the modified Fagerström Test (TFm) was 0.6 (SD: 0.7). The number of SAP interventions was 1.9 (SD: 2.9). By the end 15.6% of the patients had achieved "winner" status, which was confirmed in 95.6% of them by the biochemical test. The logistic regression model confirmed that the factors predicting giving up tobacco were age, the initial levels of motivation and the initial number of cigarettes., Conclusions: The short tests of motivation (Richmond) and, to a lesser extent, dependency (TFm) were good predictors of giving up tobacco and can be recommended in primary care.

Objective: To analyse the thematic content and the origin of the free papers presented at four Family Medicine conferences (two national and two international) during 1992 and 1993; and to check the possibility of differences between Spanish and international lines of research., Design: Descriptive study., Measurements and Main Results: A total of 1,339 papers were classified. There were statistically significant differences (p < 0.001) in the thematic areas of Family Medicine (25.33% in international conferences, 7.77% national), Community Medicine (18.16% international, 28.20% national) and organisation of care (17.68% international, 30.16% national). The provinces with the highest number of contributions at national conferences were Barcelona, Madrid, Valencia and Zaragoza. At international conferences (WONCA) the greatest number of contributions came from the Scandinavian countries, Holland, the United Kingdom, Israel and Spain., Conclusions: Spanish investigators do not often tackle questions of under- and post-graduate training, professional attitude, clinical interviews or Bioethics. The papers at national conferences come mainly, in quantitative terms, from large provinces. The lower participation of liberal health systems like the German, French and North-American is noticeable.

Background: We have shown the coverage of periodic health examinations made in children aged between 0 and 14 years old in Aragón during 1991, comparing with results obtained at national level and results obtained during 1990., Methods: A descriptive transversal study was developed by reviewing clinic records of 9 primary health centers selected by systematic sampling. Sampling consisted on 436 histories., Results: Main results were: age of child in the first visit: 83.5% below 1 month; metabolic disease screening: no data on 31.8%; DTP-polio: no data on 20.9%; triple viric: no data on 24.3%., Conclusions: Obtained data showed better results than those at national level. We should improve the metabolic diseases screening and vaccinations recording system.

Objective: To find the prevalence and aetiology of chronic cardiac failure (CCF) among elderly people in a health area., Design: Retrospective, crossover study., Setting: Delicias Sur Health Centre, Zaragoza., Patients and Other Participants: A representative sample of the population over 65 registered at the Health Centre. Systematic random sampling: n = 1,635., Measurements and Main Results: 104 cases of cardiac failure were identified, which corresponded to a 6.3% (+/- 0.01) prevalence. By age groups, prevalence was 4.5% (+/- 0.01) for the 65-74 group and 8.5% (+/- 0.02) for those over 75. Regarding aetiology, 50.9% was due to arterial hypertension, 21.2% coronary failure, 22.1% valvulopathies and 17.3% reason unknown., Conclusions: CCF prevalence in the community increases with age and in our ambit exceeds that found in other countries. Almost half the cases are related to arterial hypertension.

We determined the prevalence of tobacco consumption among the general population and established its distribution considering socioeconomical variables. We performed a cross-sectional study with 2781 subjects from 93 rural and urban areas, selected by randomized, census-based, multi-staged and stratified sampling. 40.9% of the population from Aragon are regular smokers (58.6 of men and 23% of women). Heavy smokers comprise 17.2% of the total (30.1% of men and 3.8% of women). The higher proportion of smokers in observed among single men over 40 and single women under 40. The percentage of smokers is lower among 20 to 29-years-old young people from high socio-economical than from low levels. In general, the mean percentage of smokers among men and, specially, among women from rural areas is higher than in the rural areas. In Aragon, tobacco is a risk factor affecting 41% of the adult population and, specially, young people, men, single persons from both sexes and living in urban areas. It seems that young people with a high socio-economical level are becoming smokers at a lower frequency.

Objective: To evaluate the results of putting into practice the Programme of Preventive Measures and Health Promotion of the SEMFYC and the level of intervention into each risk factor., Design: Descriptive study of a sample of clinical records of patients included in the program. SITE. The population seen at a Health Centre., Patients: A sample of 772 clinical records, 51.1% being women. Average age was 31.8., Main Measurements and Results: 389 smokers, 35 people with hypertension, 175 with hypercholesterolemia, 96 heavy drinkers and 268 suffering from overweight were found. The level of intervention recorded in the clinical histories is low by the criteria of the Programme: it swings between 27.68% for overweight and 47.6% for tobacco dependency., Conclusions: The Programme of Preventive Measures and Health Promotion (PAPPS in Spanish) is seen to be useful as a method of detecting health problems in the asymptomatic population. But it needs to be followed up with some minimal intervention and control of the problem, if the desired aims are to be met.