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Background and aims: Nonalcoholic fatty liver disease (NAFLD) is a common cause of liver damage in people living with HIV (PLWHIV). Several studies have investigated candidate genes for susceptibility to NAFLD and to steatohepatitis. PNPLA3, TM6SF2, and MBOAT7-TMC4 have been reported to be associated with elevated ALT levels and the histologic parameters of nonalcoholic steatohepatitis and severity of fibrosis. Our objective was to analyze the relationship between PNPLA3, TM6SF2, and MBOAT7-TMC4 and steatosis, steatohepatitis, and liver fibrosis in PLWHIV with NAFLD. Method: A cohort of PLWHIV with persistently elevated aminotransferase levels and suspected NAFLD who underwent liver biopsy and determination of genetic variants was assessed at two large centers in Spain. All participants included in the current study were genotyped for rs738409 (PNPLA3), rs58542926 (TM6SF2), and rs641738 (MBOAT7-TMC4). Results: The study population comprised PLWHIV who were on stable antiretroviral therapy [7.7% women; median age, 49.3 years (44-53.4)]. The median CD4 count was 829 (650-980), 60% had metabolic syndrome, and 18.5% were diabetic. The median BMI was 28.9 (25.5-30.8). Patients with liver steatosis (any grade) vs. nonsteatosis tended to harbor the PNPLA3 G allele variant [57.6% vs. 16.7% (p = 0.09)], but not TM6SF2 or MBOAT7-TMC4 variants. However, those with steatohepatitis vs. nonsteatohepatitis significantly more frequently had the PNPLA3 G allele variant [69.4% vs. 39.1% (p < 0.05)] and the MBOAT7-TMC4 A allele variant [75% vs. 42% (p < 0.05)]. In our cohort, the TM6SF2 gene variant was not associated with steatosis or steatohepatitis. The PNPLA3 G allele variant was associated with steatohepatitis [OR 4.9 (1.3-18); p 0.02] and liver fibrosis [OR 4.3 (1.1-17.4); p 0.04], and the MBOAT7-TMC4 A allele variant was associated with steatohepatitis [OR 6.6 (1.6-27.6); p 0.01]. Conclusion: The PNPLA3 G allele variant and MBOAT7-TMC4 A allele variant were associated with steatohepatitis and liver fibrosis in PLWHIV with persistently elevated aminotransferases and NAFLD. We recommend routine genotyping for PNPLA3 and MBOAT7-TMC4 in PLWHIV with NAFLD to identify those at higher risk of progression. [ABSTRACT FROM AUTHOR]

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Abstract: The Guadalentín River, located in southeast Spain, is considered one of the most torrential rivers in Spain, as indicated by catastrophic events such as the 1879 flood that caused 777 fatalities in the Murcia region. In this paper, flood frequency and magnitude of the upper Guadalentín River were reconstructed using geomorphological evidence, combined with one-dimensional hydraulic modelling and supported by records from documentary sources at Lorca in the lower Guadalentín catchment. Palaeoflood studies were conducted along a 2.5-km reach located at the confluence of the Rambla Mayor (162km2) and Caramel River (210km2). These tributaries join at the entrance of a narrow bedrock canyon, carved in Cretaceous limestone, which is 15–30m wide and 40m deep. Six stratigraphic profiles were described, the thickest and most complete corresponding to flood benches deposited upstream of the canyon constriction. The stratigraphic and documentary records identify five main phases of increased flood frequency. Phase 1, based on sedimentary palaeoflood evidence alone, occurred at c. AD 950–1200 with at least ten floods with minimum discharge estimates of 15–580m3 s−1. Phases 2–5, identified through combined sedimentary and documentary evidence occurred at: (a) AD 1648–1672, with eight documentary floods and two palaeofloods exceeding 580–680m3 s−1 (most probably the AD 1651 and 1653 events); (b) AD 1769–1802, comprising seven documentary floods, of which at least two events (>250m3 s−1) are preserved in the sedimentary record; (c) AD 1830–1840, with four documentary floods, and at least two events recorded in the stratigraphy (760–1035m3 s−1); and finally (d) the AD 1877–1900 period that witnessed seven documentary floods, with three palaeofloods exceeding 880m3 s−1. The palaeoflood and historical flood information indicate an anomalous increase in the frequency of large magnitude floods between AD 1830 and 1900, which can be attributed to climatic variability accentuated by intensive deforestation and land use practices during the first decades of the nineteenth century. [Copyright &y& Elsevier]

Seventeen sewage sludges were studied to analyse, with the minimum number of steps, the organic pollutants that the European Union proposes to be controlled for land application. The compounds determined were a selection of polycyclic aromatic hydrocarbons (PAHs); a selection of polychlorinated biphenyls (PCBs); di(2-ethylhexyl)phthalate (DEHP); nonylphenolic compounds, including nonylphenol (NP) and nonylphenol ethoxylates with 1 and 2 ethoxy groups (NP1EO + NP2EO); extractable organic halides (EOX); and linear alkylbenzene sulphonates (LAS) with an alkylic chain of 10 to 13 carbon atoms. The results were compared with the proposed regulatory limit values, and it was observed that NP + NP1EO + NP2EO and LAS exceeded the maximums in most samples, and DEHP exceeded some of them, whereas PAHs, PCBs, and EOX almost always went beyond the limits. The values obtained are similar to those from other countries, and it can be said that it is difficult to comply with the limits for NP + NP1EO + NP2EO and LAS in many of them, although this latter parameter was not considered in the study carried out by concerning the toxicity of sewage sludge. Statistical multivariant analysis was used to look for some relationship between the results of pollutants and the characteristics of the samples, and it was found that the ratio of NP1EO + NP2EO to NP was related to sludge treatment at the sewage plant. At the same time, it was seen that the higher values of organic pollutants belonged to digested sludges. [ABSTRACT FROM AUTHOR]

Seasonal variation in nutrient concentration in leaves and branches of Quercus pyrenaica was studied in natural Q. pyrenaica forest in the Sierra de Gata (Salamanca Province, Spain). Two permanent plots were established at the two extremes of a rainfall gradient in this area: annual mean precipitation from 720 mm at Fuenteguinaldo (granite bedrock) to 1580 mm at Navasfrias (schists and graywackes). Leaf and branch samples were collected every three weeks during the growing season from May to October, at three height levels of the tree canopy. Seasonal changes and internal nutrient dynamics were investigated for N, Ca, Mg, K, Na, Mn, Fe and P during a two-year period. The concentrations of all nutrients varied among the seasons; these variations were related to nutrient mobility and the annual physiological cycle. Nutrient concentrations decrease in the case of K and P, while the sparse mobile nutrients Ca, Mg, Mn and Fe gradually accumulated during each growing season. In Navasfrias a considerable resorption of P from senescing leaves was detected. Different patterns were found for the other nutrients studied (Na and N). [ABSTRACT FROM AUTHOR]

Abstract: During a palaeoflood study of the Llobregat River (NE Spain), analysis of 137Cs was carried out on slackwater flood deposits to obtain an improved flood chronology for the most recent flood sediments. At the Monistrol study reach, 137Cs was measured in flood deposits preserved in valley side rock alcoves, with a range of 137Cs concentrations of 2.80–10.06 mBq/g measured. The 137Cs was associated with sediment mobilised from the upstream catchment by erosion and transported to the alcoves during floods. The onset of measured caesium activity in the sedimentary profiles permitted the deposits to be divided between those from floods that occurred before the mid-1950s and those from events after this period. Combining the information derived from the slackwater flood stratigraphy, the minimum discharge estimates associated with the flood deposits, 137Cs analysis and the instrumental peak discharge series, it was possible to identify the particular flood events responsible for the majority of the slackwater flood units. At Vilomara, however, 137Cs activity was measured in palaeoflood deposits dated to the Late Bronze Age and located at an elevation not reached by the floodwaters of the largest modern events. The data from this site indicated that the 137Cs was not associated with sediments transported by floods but was rainfall-derived, the rainwater reaching the deposits through fissures in the rock. To ensure the successful application of caesium dating to slackwater flood deposits preserved within rock alcoves, or caves, some general guidelines are proposed. The technique is best applied: (1) when there is a sedimentary profile of greater than 1 m depth; (2) when the profile is sampled away from zones affected by direct percolation or springwater entering the alcove; and (3) where there are various levels of contrasting textures within the profile. [Copyright &y& Elsevier]

Background: Incidence, clinical course, and fatality of spontaneous subarachnoid hemorrhage (SAH) are evolving, with prevalence of risk factors diminishing, implementation of early detection programs and strategies for priority aneurysm exclusion, technical refinement with less invasive procedures, and improvements in neurocritical care. Modern epidemiological and prognostic data are lacking, especially in southern European and Mediterranean populations., Methods: A prospective multicenter observational study on SAH was held in Catalonia, Northeast Spain, from 2020 to 2022 (HSACat project). All public tertiary hospitals participated in a common registry. Primary end points were functional outcomes (modified Rankin Scale) and mortality at 12 months. Secondary aims included epidemiological data, passage of patients between referral and tertiary hospitals, diagnostic and treatment delays, and in-hospital complications., Results: Of 550 SAH cases reported in Catalonia (2020-2022), a complete registry for analysis was available for 474. Death rate was 20.6% during hospital admission and 26.9% at 1 year. Good functional outcome (modified Rankin Scale score 0-2) was observed in 63.4%, 70.1%, and 76.0% at 3, 6, and 12 months. Age at presentation was younger in men, patients who smoked, and patients with hypertension (P < 0.05). The female-to-male ratio was 3:2 except in the nonaneurysmal group. Time from onset to tertiary hospital admission was longer in rural than in metropolitan areas (7.0 hours vs. 4.7 hours, P < 0.01). Aneurysm occlusion in the first 72 hours was achieved in 83.3%; mainly endovascularly (77.5%) followed by microsurgically (19.3%)., Conclusions: Even when most patients received timely aneurysm treatment, case fatality rates were considerably high. Data provided by the HSACat project may have public health effects and be used to guide prevention programs and screening strategies., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Atrial fibrillation is the most frequent chronic arrhythmia in patients with chronic kidney disease. Oral anticoagulation with vitamin K antagonists and now direct oral anticoagulants have been and are the fundamental pillars for the prevention of thromboembolic events. However, there are no randomized clinical trials on the risk-benefit profile of oral anticoagulation in patients with chronic kidney disease stage 5 on peritoneal dialysis and there is little evidence in the literature in this population. The objective of our study was to know the prevalence, treatment and professionals involved in the management of atrial fibrillation in peritoneal dialysis patients. For this purpose, we performed a descriptive analysis through a survey sent to different peritoneal dialysis units in Spain. A total of 1,403 patients on peritoneal dialysis were included in the study, of whom 186 (13.2%) had non-valvular atrial fibrillation. In addition, the assessment of the scores of thromboembolic and bleeding risks for the indication of oral anticoagulation was mainly carried out by the cardiologist (60% of the units), as well as its prescription (cardiologist 47% or in consensus with the nephrologist 43%). In summary, patients on peritoneal dialysis have a remarkable prevalence of non-valvular atrial fibrillation. Patients frequently receive oral anticoagulation with vitamin K antagonists, as well as direct oral anticoagulants. The data obtained regarding the scores used for the assessment of thromboembolic and bleeding risk, treatment and involvement by Nephrology indicates that there is a need for training and involvement of the nephrologist in this pathology., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Three freshwater microalgae (Spirogyra sp., Cosmarium sp., and Cosmarium blytii) collected from several locations in Gran Canaria have been studied to explore their potential as a novel source of bioactive compounds for biotechnological applications. Soluble carbohydrates were quantified after extraction with 3 M HCl at 100 °C, ranging from 35.8 to 43.3 %, and with water at room temperature, ranging from 19 to 22.8 %. Amino acids glutamic acid, proline and aspartic acid were quantified by RP-HPLC. Glutamic acid was the most abundant, ranging from 12.2 to 3.63 mg g -1 of dry biomass. Cosmarium blytii was the richest sample in amino acids (24.02 mg g -1 of dry weight). In addition, Cosmarium blytii and Spyrogira sp. exhibited higher radical scavenging activity (RSA) against 1,1-diphenyl-2-picrylhydrazyl (DPPH) than that of the synthetic antioxidant butylhydroxytoluene (BHT), commonly used as food additive. These results show a great potential of these microalgae for exploitation in the food, feed and pharmaceutical industries., (© 2022 The Authors. Chemistry & Biodiversity published by Wiley-VHCA AG, Zurich, Switzerland.)

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services., (© 2021. The Author(s).)

Purpose: General population normative data for the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire facilitates interpretation of data assessed from cancer patients. This study aims to present normative data of the general Spanish population., Methods/patients: Data were obtained from a prior larger study collecting EORTC QLQ-C30 norm data across 15 countries. Data were stratified by sex and age groups (18-39, 40-49, 50-59, 60-69 and > 70 years). Sex and age distribution were weighted according to population distribution statistics. Sex- and age-specific normative values were analysed separately, as were participants with versus those without health conditions. Multiple linear regression was used to estimate the association of each of the EORTC QLQ-C30 scales with the determinants age, sex, sex-by-age interaction term, and health condition., Results: In total, 1,165 Spanish individuals participated in the study. Differences were found by sex and age. The largest sex-related differences were seen in fatigue, emotional functioning, and global QOL (Quality of Life), favouring men. The largest age differences were seen in emotional functioning, insomnia, and pain, with middle-aged groups having the worst scores. Those > 60 years old scored better than those < 60 years old on all scales except for physical functioning. Participants with no health conditions scored better in all QLQ-C30 domains., Conclusions: The present study highlights differences in HRQOL between specific sex/age strata and especially between people with and without a health condition in the general Spanish population. These factors must be considered when comparing general population HRQOL data with that of cancer patients., (© 2021. The Author(s).)

Aim: We describe the effectiveness and safety of the interferon-free regimen ombitasvir/paritaprevir/ritonavir plus dasabuvir with or without ribavirin (OBV/PTV/r ± DSV ± RBV) in a nationwide representative sample of the hepatitis C virus (HCV) monoinfected and human immunodeficiency virus-1/hepatitis C virus (HIV/HCV) coinfected population in Spain., Material and Methods: Data were collected from patients infected with HCV genotypes 1 or 4, with or without HIV-1 coinfection, treated with OBV/PTV/r ± DSV ± RBV at 61 Spanish sites within the initial implementation year of the first government-driven "National HCV plan." Effectiveness was assessed by sustained virologic response at post-treatment week 12 (SVR12) and compared between monoinfected and coinfected patients using a non-inferiority margin of 5% and a 90% confidence interval (CI). Sociodemographic and clinical characteristics or patients and adverse events (AEs) were also recorded., Results: Overall, 2,408 patients were included in the intention-to-treat analysis: 386 (16%) were patients with HIV/HCV. Patient selection reflected the real distribution of patients treated in each participating region in Spain. From the total population, 96.6% (95% CI, 95.8-97.3%) achieved SVR12. Noninferiority of SVR12 in coinfected patients was met, with a difference between monoinfected and coinfected patients of -2.2% (90% CI, -4.5% - 0.2%). Only genotype 4 was associated with non-response to OBV/PTV/r ± DSV ± RBV treatment (p<0.001) in the multivariate analysis. Overall, 286 patients (11.9%) presented AEs potentially related to OBV/PTV/r ± DSV, whereas 347 (29.0%) presented AEs potentially related to ribavirin and 61 (5.1%) interrupted ribavirin., Conclusions: Our results confirm that OBV/PTV/r ± DSV ± RBV is effective and generally well tolerated in a representative sample of the HCV monoinfected and HCV/HIV coinfected population in Spain within the experience of a national strategic plan to tackle HCV., Competing Interests: José Manuel Sousa has received fees as speaker from AbbVie, MSD and Gilead. Mercedes Vergara has received fees as an advisory board member from Gilead and has given lectures for AbbVie, Intercept, MSD, Janssen-Cilag and Gilead. Federico Pulido has received fees as speaker and advisor from AbbVie, Gilead, Janssen and MSD. Gloria Sánchez-Antolín has acted as speaker for AbbVie, MSD, Gilead Science, Novartis and Astellas. Diego Rincón has given lectures for AbbVie and MSD. Javier Salmerón has received speaker fees and grant funding from AbbVie; he declares no further conflict of interest. Luisa García-Buey has received speaker fees and travel grants from Abbvie, MSD and Gilead. José A. Carrión has received speaker fees from Abbvie, Gilead and MSD and has received fees as Advisor for AbbVie. Manuel Hernández-Guerra has been a consultant to Gilead Sciences, Intercept Pharmaceuticals, Abbvie and Bayer; he has received grant funding from Gilead Sciences and Abbvie. Nuria Espinosa has participated in Clinical Trials managed by Gilead and ViiV Healthcare; she has received advisory board, conference and course fees as well as expenses for attending congresses from Janssen-Cilag, Gilead Sciences, ViiV Healthcare, MSD and Abbvie. Rosa Mª Morillas has acted as a speaker for Gilead, Merck, AbbVie and Intercept, and has participated in advisory boards for AbbVie, Gilead and Intercept. Raul J. Andrade: Advisor/Speaker Bureau: Abbvie, Gilead Sciences, Merck Sharp and Dohme, Bristol-Myers Squibb, Janssen; Research Grants: Willmar Schwabe GmbH & Co, Gedeon Richter/Preglem S.A. Manuel Delgado has received scientific advisor fees from Abbie, Gilead, MSD. José M Moreno-Planas has received speaker fees from AbbVie, MSD, Gilead and Bayer. Fernando Menéndez has received fees as advisor from Bayer. Luis Morano has acted as speaker, advisor and/or investigator for Abbvie, Gilead Sciences, Merck Sharp and Dohme, Bristol-Myers Squibb, Janssen, Boehringer Ingelheim, Novartis, and Roche Farma. Manuel Rodríguez consults for and is on the speaker’s bureau for Gilead and AbbVie. Sara Lorente has received lecture fees from Abbvie, Gilead Sciences and MSD. Miguel Ángel Von-Wichmann has received fees as speaker and advisor from Abbvie, BMS, Gilead, Janssen, MSD and VIIV. Amanda Manzanares is employee of AbbVie and may hold stock or options. Lander Hijona, Fernando Carnicer, Beatriz Mateos-Muñoz, Antoni Jou, Benjamín Polo-Lorduy, Ángel Rubín, Ana Escarda, Patricia Aguilar, Teresa Aldámiz-Echevarría, Sonia Chimeno-Hernández, Adolfo Gallego, Marta Magaz, Ángel Estébanez, Mikel Rico, Blanca Sampedro, Sonia Izquierdo, José Manuel Zozaya, Senador Morán-Sánchez, Ignacio Martín-Granizo, Marcial Delgado declare no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Wastewater can provide a wealth of epidemiologic data on common drugs consumed and on health and nutritional problems based on the biomarkers excreted into community sewage systems. One of the biggest uncertainties of these studies is the estimation of the number of inhabitants served by the treatment plants. Twelve human urine biomarkers -5-hydroxyindoleacetic acid (5-HIAA), acesulfame, atenolol, caffeine, carbamazepine, codeine, cotinine, creatinine, hydrochlorothiazide (HCTZ), naproxen, salicylic acid (SA) and hydroxycotinine (OHCOT)- were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to estimate population size. The results reveal that populations calculated from cotinine, 5-HIAA and caffeine are commonly in agreement with those calculated by the hydrochemical parameters. Creatinine is too unstable to be applicable. HCTZ, naproxen, codeine, OHCOT and carbamazepine, under or overestimate the population compared to the hydrochemical population estimates but showed constant results through the weekdays. The consumption of cannabis, cocaine, heroin and bufotenine in Valencia was estimated for a week using different population calculations., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Cotinine (COT), trans-3'-hydroxycotinine (OH-COT), cotinine-N-β-glucuronide (COT-GLUC), and trans-3'-hydroxycotinine-O-β-glucuronide (OH-COT-GLUC) are excreted in urine following the intake of nicotine (NIC), and, as such, they have been detected in sewage. Thus, they also constitute convenient biomarkers for NIC tracing through the sewage epidemiology approach at the local scale. Such estimation requires granting a good stability of the target biomarkers in sewage. However, it was found that glucuronides are not stable, particularly in the case of OH-COT-GLUC, which could render variable concentrations of COT, OH-COT, and their glucuronides, depending on sampling and storage time or temperature. Thus, an enzymatic deconjugation with β-glucuronidase was optimized. With the optimized method, after enzymatic deglucuronization, the limits of quantification obtained were in the range of 0.2-1 μg L(-1), relative standard deviations were <10%, and the trueness in terms of recovery was in the 95%-112% range. The application of the method to composite sewage samples collected during 1 week in three different years in Santiago de Compostela (Galicia, Spain) showed COT and OH-COT concentrations of 0.3-1.9 μg L(-1) and 1.0-3.3 μg L(-1), respectively. Thereby, the average NIC consumption derived was in the 1.7-1.9 mg per day and person range, being comparable to those derived from tobacco sales statistics.

Purpose: Quality of life (QL) is a key outcome for advanced disease cancer patients. The European Organization for Research and Treatment of Cancer (EORTC) has developed the QLQ-C15-PAL questionnaire, a short version of the QLQ-C30 for palliative care. The aim of the present study is to validate the QLQ-C15-PAL for use with Spanish patients with bone metastasis., Methods: For this study, we used a consecutive sample of stage IV cancer patients with bone metastases who started radiotherapy with palliative intention. Two assessments were proposed for each patient: one on the first day of treatment and one a month after the end of the radiotherapy sessions. Psychometric evaluation of the structure, reliability, and validity was undertaken., Results: One hundred and sixteen patients completed the first questionnaire and seventy five completed the second. Multitrait scaling analysis showed that all items met the standards for convergent validity, and all except the fatigue scale met the standards for divergent validity. Cronbach's coefficient met the 0.7 alpha criterion on all scales except pain (second assessment). Most QLQ-C15-PAL areas had low-to-moderate correlations with the other areas. Significant differences appeared in the comparisons between groups with regard to: patients who died before the second assessment (six areas); patients receiving chemotherapy before starting radiotherapy in the two assessments (three and four areas, respectively); the performance status in the two assessments (nine and eight areas); and the number of RT sessions received (four). Quality of life was better in the second assessment in nine areas., Conclusion: The QLQ-C15-PAL is a reliable and valid instrument when applied to a sample of Spanish patients. These results are in line with those of other validation studies.

The methanol extracts of leaf skins and flowers of Aloe vera from the Canary Islands were analyzed for their phenolic profiles and screened for their antioxidant and antimycoplasmic activities. The use of reversed phase high performance liquid chromatography (RP-HPLC) allowed the identification of 18 phenolic constituents. Leaf skin extracts were characterized by the abundance of catechin, sinapic acid and quercitrin. Gentisic acid, epicatechin and quercitrin were the most prominent phenolic compounds of the flowers. The in vitro antioxidant activities determined by using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) and ferric antioxidant reducing power (FRAP) assays revealed that both extracts exhibited antioxidant activity, being the leaf skin extract the most active fraction. The leaf skin extract was also found to be active against the microbial strains tested. Therefore, A. vera extracts from leaf skin and flowers can be considered as good natural antioxidant sources.

We designed a prospective study to describe the clinical impact of the parainfluenza viruse (PIV) types detected in hospitalized children with respiratory tract infections from September 2008 to August 2010 in Spain. PIV infections were a significant proportion of viral respiratory detections (11.8% of cases). PIV types 3 and 4 were most commonly detected. There were clinical differences between PIV and respiratory syncytial virus infections.

Introduction: The EORTC Quality of Life (QL) Group has developed a questionnaire -the EORTC QLQ-CR29- for evaluating QL in colorectal cancer. The aim of this study is to assess the psychometric properties of the EORTC QLQCR29 when applied to a sample of Spanish patients., Materials and Methods: Eighty-four locally advanced rectal cancer patients in the treatment follow-up period after receiving surgery and neoadjuvant chemoradiotherapy were included in the study. Seventy subjects also had adjuvant chemotherapy. Patients completed both the EORTC QLQC30 and the QLQ-CR29 once. The psychometric evaluation of the questionnaire's structure, reliability, and convergent, divergent and known-groups validity was performed., Results: Multitrait scaling analysis showed that three of the multi-item scales met the standards of convergent and discriminant validity. These same scales reached the 0.7 Cronbach's coefficient criterion or were close to it. In both analyses exceptions were observed in the blood and mucus in stool scale. Correlations between the scales of the QLQC30 and the module were low (r<0.02) in most cases. A few areas with more related content had higher correlations (r<0.05). Group comparison analyses showed differences in QL between groups of patients based on age, comorbidity, performance status, receipt of adjuvant chemotherapy and surgery modality., Conclusions: The EORTC QLQ-CR29 is a reliable and valid instrument when applied to a sample of Spanish rectal cancer patients. These results are in line with those of the EORTC validation study.

Objectives: The EORTC OUT-PATSAT35 RT questionnaire evaluates the satisfaction with care (SC) expressed by cancer outpatients treated with radiotherapy. In this study we assess the psychometric properties of the OUT-PATSAT35 RT when applied to a sample of Spanish patients., Methods: A total of 100 patients with different tumor sites completed the EORTC core questionnaire, QLQ-C30, the OUT-PATSAT35 RT, the Oberst patients' perception of care quality and satisfaction scale (OS) and the item on intention to recommend the hospital (IR). Psychometric evaluation of the structure, reliability and validity of the questionnaire was conducted., Results: Multitrait-scaling analysis showed that 33 out of 34 item-scale correlation coefficients met the standards for convergent validity and that many of them met the standards for discriminant validity. Cronbach's coefficients were good (0.70-0.97) for all scales except environment. Correlations between the areas of the QLQ-C30 and OUT-PATSAT35 RT were generally low (<0.40). Correlations between the OS and the IR were moderate with the EORTC OUT-PATSAT35 RT. Areas whose contents were more related had higher correlation coefficients (>0.50), and vice versa (<0.20). Patients with higher scores on the OS and the IR, patients who had more visits to the doctor and patients who had a better performance status showed higher SC levels in 12, 8 and 1 OUT-PATSAT35 RT areas, respectively., Conclusions: The OUT-PATSAT35 RT appears to be a reliable and valid instrument when applied to a sample of Spanish cancer patients. These results are in line with those of the validation study conducted by the authors of the questionnaire., ((c) 2009 John Wiley & Sons, Ltd.)

Objectives: The EORTC Quality of Life (QL) Group has developed a questionnaire (the EORTC IN-PATSAT32) to assess the satisfaction of cancer inpatients with hospitalbased care. In this study we assess the psychometric properties of the EORTC IN-PATSAT32 applied to a sample of Spanish patients., Materials and Methods: Eighty cancer patients with different tumour sites completed the EORTC QLQ-C30 and EORTC IN-PATSAT32 questionnaires. Psychometric evaluation of the structure, reliability and validity was conducted., Results: Multitrait scaling analysis showed that most itemscale correlation coefficients met the standards of convergent and discriminant validity. Cronbach's coefficients were good (0.77-0.97) for all scales except hospital access. Correlations between the scales and single items of the QLQ-C30 and EORTC IN-PATSAT32 were generally low. Correlations between the Oberst scales and an item on intention to recommend the hospital or ward to others with the EORTC IN-PATSAT32 were moderate. Patients with higher scores on the Oberst scales and the item on intention to recommend the hospital or ward showed higher satisfaction with care levels in all EORTC IN-PATSAT32 areas but one., Conclusions: The EORTC IN-PATSAT32 appears to be a reliable and valid instrument when applied to a sample of Spanish cancer patients. These results are in line with those of the EORTC validation study.

To know the level of death anxiety using the Templer Death Anxiety Scale (DAS) (1970) (Ramos's Spanish adaptation, 1982)) we chose subjects older than 65 years (N = 227) to study, on one hand, the existing relation between cognitive-affective reactions toward death and the perception of the passing of time and, on the other, a group of variables which include the place of residence, age, gender, life reflection, health disorders, psychological problems, religious aspects, and socio-demographics features. To undertake this, a questionnaire was administered in which the participants answered according to their degree of agreement to several alternatives. The data indicates, by means of an analysis of variance, significant differences between these variables and death anxiety, with the exception of the religious aspects and civil state.

Background and Objectives: Mites are important sources of allergens in Galicia, Spain. The objective of this study were to identify the main mite species and to determine allergen levels in mattresses from different locations in Galicia., Material and Methods: Dust samples were collected with a portable vacuum cleaner for 2 minutes from 2 m2 of the surface of the mattress used by mite allergic patients and controls. After collection, samples were immediatel frozen. Mite species were collected, identified, and counted, and the results expressed as mites per gram of dust. Mite allergen levels (Der p 1 and Der f 1) were measured using monoclonal antibodies. All individuals answered a questionnaire about the characteristics of their homes., Results: A total of 332 dust samples were collected (112 from mite allergic patients and 220 from controls). Thirty-two species were identified. The mean age +/-SD of all the participants was 32.4 +/- 20.8 years and of the mattresses 7.6 +/- 5.9 years. The geometric mean of the total mite counts was 910.2 mites per gram (896.2 mites per gram in the mattresses of mite allergic patients and 917.3 in the mattresses of control subjects; P > .05). The main species was Dermatophagoides pteronyssinus, which was present in 97.6% of the samples (geometric mean, 584.7 mites per gram). The geometric mean level of Der p 1 was 13.1 microg/g of dust: 11.9 in the mattresses of mite allergic patients and 13.8 in the mattresses of control subjects. The geometric mean level of Der f1 was 1.1 microg/g: 1.5 in the mattresses of mite allergic patients and 0.8 in the mattresses of control subjects. Environmental risk factors associated with high mite counts included obvious signs of humidity in the bedroom and the age of the mattress., Conclusions: The mite fauna in Galicia is comprised of many species, several of which are known to be of allergologic importance. The total population is exposed to very high levels of mite allergens.

Objective: To determine the frequency of Down Syndrome (DS) in Asturias and the prenatal diagnosis impact on the birth prevalence of this chromosomal anomaly., Methods: The analysed data came from the Registry of Congenital Defects of Asturias (1990-1993) and from a retrospective study conducted by the same working group (1987-1989). The total prevalence rates and the prevalence at birth were calculated., Results: Out of 55,601 births, DS was recorded in 83 cases: 69 livebirths, two fetal deaths and 12 induced abortions following prenatal diagnosis, giving a total prevalence rate of 14.9 per 10,000 and a birth prevalence of 12.8. The proportion of induced abortions was 15 per cent in this period; the proportion of cases in the high risk maternal age group (35 years and over) was around 50% of the total. The proportion of induced abortions was 15 per cent in this period., Conclusions: The frequency of DS in Asturias is comparable to the other populations. Prenatal diagnosis had little impact on the birth prevalence figures. These results may help us draw up prevention and prenatal diagnosis policies for these defects in Asturias when giving the frequency of this health problem.

The quality of official perinatal mortality statistics in a geographical and administratively well defined region (Asturias, Spain) is studied in a five years period (1986-90). The official figures were compared with those collected, retrospectively, from multiple hospital sources. Under-registration of perinatal death was 35% (45.5% of fetal death and 22.5% of early neonatal death, these occurred in the first 24 hours). Validity of mentioned statistics is discussed.

Background: Cohort studies estimating rates of incidence are scarce despite they are the most appropriate for following the epidemics of HIV-1 and evaluating the effectiveness of preventive interventions. The rate of incidence of infection by HIV-1 in intravenous drug users (IVDU) and the determining factors for such infection are estimated in the present study., Methods: 3,693 IVDU attended in two centers for information and prevention of AIDS from 1987-1992, were included in the study. Out of 1,868 seronegative subjects, 579 attended a second visit in which a new serologic test was performed against HIV-1. The rates of incidence and 95% confidence intervals were calculated with a Poisson regression model being adjusted in order to control the confounding factors., Results: The estimated global incidence was 11.7/100 people/year (CI 95%: 9.6; 14.46). Those highest rates were observed in IVDU who exchanged syringes (23.5/100 people/year), in those who had more than one sexual partner in the previous month (21.2/100 people/year), in those referring a history of prostitution (22.6/100 people/year), in carriers of hepatitis B antigens (25.6/100 people/year) and in the IVDU younger than 20 years of age (16.5/100 people/year). The variables which independently predicted the rates of incidence were: the exchange of syringes (RR = 6.85; CI 95%: 3.99; 11.75), having more than one different sexual partner in the previous month (RR = 3.51; CI 95%: 1.70; 7.20) and age, with lower risk in those under the age of 20 (RR = 0.49; CI 95%: 0.25; 0.95)., Conclusions: The incidence of infection by type-1 human immunodeficiency virus observed in intravenous drug users is the highest described in Western countries. Preventive measures in general must be intensified particularly in subgroups of intravenous drug users with the greatest risk of seroconversion.

In order to study the frequency of hepatitis B viral infection and its determinants, we studied 2337 intravenous drug users who visited three AIDS information and prevention centers between 1987 and 1991. The presence of three markers for HBV (AntiHBc, AntiHBs, and AgHBs) and of HIV-1 antibodies was analyzed. A structured questionnaire was used to gather data on sociodemographic information and risk factors for infection. The prevalence of HBV infection (at least one positive marker) was 78% (95% CI: 76%-80%). After adjustment via logistic regression, duration of drug addiction (OR-5.04), the number of sexual partners (OR = 1.70), and the presence of antibodies for HIV-1 (OR = 2.44) were associated with increased HBV infection were higher level of education (OR = 0.67) and residence in a smaller city (OR = 0.66). The marginalization of the practice of drug use makes prevention activities very difficult, and by the time they use health services, the majority of users have already been in contact with HBV. Other infectious agents which share parenteral transmission can reach a similar prevalence if preventive efforts are not intensified.

Utilization of endocavitary defibrillation electrodes avoids thoracotomy used in implantable cardioverter-defibrillator procedures, reducing associated morbi-mortality. In our institution we have used this approach in 16 patients during a two years period (July 1990-July 1992). Fifteen were males, with a mean age of 56.9 +/- 10.6 (range 32-73). Nine patients suffered ischemic cardiomyopathy, 4 non ischemic cardiomyopathy and in three there was no structural heart disease. Mean ejection fraction was 44.3 +/- 18.3% (range 20-73%). Clinical arrhythmia was ventricular tachycardia in 8 cases, ventricular fibrillation in 6 cases and both types in 2. Endocavitary implantation procedure was not completed in 3 patients, thus an open trans-sternal approach was performed. In 13 patients it was completed successfully, using a total amount of 14 units (1 patient required two procedures due to sepsis in the generator pouch). Most important intraoperative incidences have been defibrillation thresholds between 20-24 J in 4 cases, displacement of defibrillation electrode from vena cava into coronary sinus in 4 cases, epicardial patch implantation via subcostal approach in 1 case and right ventricle perforation in 1 case. No operative mortality was registered. One patient suffered sudden death during follow-up. Surgical complications were few: 1 case of lead dislodgement and 1 infected wound in the generator's pouch. Non-surgical complications were also few: 1 case with superior vena cava syndrome and 1 patient with inadequate discharges. In conclusion, due to our early experience, we believe that endocavitary implantation of an implantable cardioverter-defibrillator is the procedure of choice at the present time.

The existence of 11 organochlorine compounds and five heavy metals in the liver and muscle of 57 members of 10 species of mammals, all from Doñana National Park (Spain), has been investigated. Five organochlorine compounds have been found and the five heavy metals were present in the samples. The biomagnification of organochlorines is shown. The detected concentrations for each trophic rank seem not to influence unfavourably on the population stability of the species. The rabbit is proposed as a monitor species for future studies in pollution at Doñana National Park.

The mercury content in hair of the population in Madrid (chosen randomly) was in the range of 1.29-129.47 micrograms/g (geometric mean = 7.96 micrograms/g). The mean mercury content in hair of occupationally exposed workers was 12.70 micrograms/g (range = 2.91-65.43 micrograms/g). The highest means, which were found in two families (i.e., 67.89 micrograms/g and 92.47 micrograms/g, Families A and B, respectively), probably resulted from external factors. No statistically significant variations in the mercury concentrations in hair were found with regard to sex, age, or dental fillings. A significant correlation (r = 0.785; P less than .01) was found between the concentration of the total mercury found in nursing infants and their mothers.