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A prior investigation in 1993 identified a high seroprevalence of toxoplasmosis (63%) in the Canary Islands. This study aims to assess the current prevalence of the disease in diverse population groups. The study was based on a population-scale screening involving 273 residents utilizing T. gondii IgG ELISA and a 20 year retrospective study (1998–2018). This included AIDS/HIV outpatients (1357, of which 324 were residents), AIDS/HIV hospitalized patients (741) and patients with fever of intermediate duration (158). The seroprevalence in the resident population was 37%, with significant differences between islands. Among resident outpatients with AIDS/HIV, 14.2% had specific anti-T. gondii IgG, and three had anti-T. gondii IgM; however, IgG avidity testing indicated non-active infection. In patients hospitalized for AIDS/HIV, T. gondii causing encephalitis was detected in 2%. Among patients with fever of intermediate duration, 28.5% were positive for T. gondii IgG, and four also showed IgM positivity, although the infection was non-active. The study reveals a decrease in human toxoplasmosis over the past 30 years. However, the current seroprevalence, which stands at 37%, together with the substantial risk that T. gondii represents for immunocompromised individuals, highlights the need to implement preventive and control strategies to control the threat that this infection can pose to public health in the Canary Islands population. [ABSTRACT FROM AUTHOR]

Human cytomegalovirus (HCMV) is linked to age-related diseases like cardiovascular disease, neurodegenerative conditions, and cancer. It can also cause congenital defects and severe illness in immunocompromised individuals. Accurate HCMV seroprevalence assessment is essential for public health planning and identifying at-risk individuals. This is the first HCMV seroprevalence study conducted in the general Spanish adult population in 30 years. We studied HCMV seroprevalence and HCMV IgG antibody titres in healthy adult donors (HDs) and HCMV-related disease patients from 2010 to 2013 and 2020 to 2023, categorized by sex and age. We compared our data with 1993 and 1999 studies in Spain. The current HCMV seroprevalence among HDs in Spain is 73.48%. In women of childbearing age, HCMV seroprevalence has increased 1.4-fold in the last decade. HCMV-seropositive individuals comprise 89.83% of CVD patients, 69% of SMI patients, and 70.37% of COVID-19 patients. No differences in HCMV seroprevalence or HCMV IgG antibody titres were observed between patients and HDs. A significant reduction in Spanish HCMV seroprevalence among HDs was observed in 1993. However, women of childbearing age have shown an upturn in the last decade that may denote a health risk in newborns and a change in HCMV seroprevalence trends. [ABSTRACT FROM AUTHOR]

This study examined whether spelling tasks contribute to the prediction of the handwriting status of children with poor and good handwriting skills in a cross-sectional study with 276 Spanish children from Grades 1 and 3. The main hypothesis was that the spelling tasks would predict the handwriting status of the children, although this influence would decrease with age due to a gradual automatization of handwriting skills. The results confirmed this hypothesis. Another interesting result was that the pattern of pseudoword and irregular word spellings as predictors of handwriting status changed from Grade 1 to Grade 3. In Grade 1, the pseudoword spelling task made a significant contribution, whereas the irregular word spelling task did not. The opposite pattern was found in Grade 3. These results may be a consequence of progressive acquisition of orthographic representations. The orthographic role of the task of writing the alphabet in order from memory in the prediction model was also analyzed. The writing of the alphabet in order from memory task made a significant contribution to the prediction of handwriting status of the children beyond the orthographic influence of spelling tasks. The additional effect of this task on the prediction of handwriting status is presumably due to the fact that this measure is based on fluency.

The main goal of this study was to explore the nature and structure of implicit theories of Spanish-speaking in-service teachers on learning to read. The study sample consisted of 591 in-service teachers from various Ibero-American countries (Spain, Mexico, Guatemala, Colombia, and Ecuador). The study analyzed attributional structure or teacher beliefs on learning to read based on principal component analysis. Findings revealed that many of the implicit theories on learning to read held by the teachers correspond to the historiography analysis and representational structure identified in previous studies. Based on main component analysis with varimax rotation, a factorial structure was found to be formed by the seven main factors related to the constructivist, nativist, maturationist, social, repetition, corrective, and psycho-linguistic learning theories. Also, significant differences were found in the learning theories of the teachers depending on geographical and cultural context. Spanish teachers were more likely to be associated with the psycho-linguistic and nativist theories. Mexican teachers were more closely associated with the constructivist theory, and both Guatemalan and Colombian teachers tended to be linked to the repetition-based theory. Finally, Ecuadorian teachers tended to rely on the nativist theory.

We examined the developmental relations of phonological awareness (PA) and rapid automatized naming (RAN) with reading in a cross-sectional study with 874 Spanish children from Grades 2 to 6. Our main prediction was that the RAN-reading relationship would decrease due to a gradual change in reading strategy, from serial decoding to sight word reading. Therefore, in contrast to most previous studies, we used discrete reading tasks. Serial RAN tasks for objects, colors, digits, and letters were included. First, we examined whether the RAN tasks loaded on the same constructs across time. An alphanumeric and a nonalphanumeric factor were identified, which were invariant over time. In subsequent multigroup structural equation models we found that the PA-reading relationship was low but slightly increased in the higher grades. As predicted, the RAN-reading relationship decreased for words, whereas the relationship remained stable for pseudowords.

Arithmetic word problem (AWP) solving is a highly demanding task for children with learning disabilities (LD) since verbal and mathematical information have to be integrated. This study examines specifically how syntactic awareness (SA), the ability to manage the grammatical structures of language, affects AWP solving. Three groups of children in elementary education were formed: children with arithmetic learning disabilities (ALD), children with reading learning disabilities (RLD), and children with comorbid arithmetic and reading learning disabilities (ARLD). Mediation analysis confirmed that SA was a mediator variable for both groups of children with reading disabilities when solving AWPs, but not for children in the ALD group. All groups performed below the control group in the problem solving task. When SA was controlled for, semantic structure and position of the unknown set were variables that affected both groups with ALD. Specifically, children with ALD only were more affected by the place of the unknown set.

Throughout this article, we will take a look at the lives of different Spanish and Portuguese women of our past. To do so, we will cover a long-term chronological framework, as we begin this research with Urraca Díaz de Haro, whose life was in the 13th century, and we will end with Emilia das Neves from the 19th century. We will also focus our attention on their respective funerary monuments as historical-artistic elements that evoke their memories. By exploring these works, we will see how, over the centuries, both the typology and the iconography have changed in the funerary art of the Iberian Peninsula. Finally, we will make a comparative analysis between the sepulchers of both countries, to see which aspects are similar or different. [ABSTRACT FROM AUTHOR]

The need of Non-profit Organizations (NPOs) of generating trust and credibility, to their stakeholders by an efficient management of their resources, lead them to openly show that they develop adequate good governance practices. But this is not a simple task and few research has been done on measuring methods of good governance in this field; without achieving an agreement about the best procedure. This paper aims at facilitating the measurement of good governance practices in NPOs by a fuzzy linguistic consensus-based group multi-criteria decision-making (MCGDM) model that will provide agreed and easy-understanding weights for a list of indicators proposed by the stakeholders and entities in such good governance practices. To do that, a linguistic 2-tuple BWM method with a consensus reaching process (CRP) will be developed and then applied to a real-world case in Spain, in which a group of experts from significant Spanish NPOs will assess the list of indicators proposed by the most representative entities (the alliance between the non-governmental organizations (NGO) Platform for Social Action, and the NGO Coordinator for Development (CONGDE) to obtain a prioritization of such indicators for measuring the good governance practices in Spanish NPOs. [ABSTRACT FROM AUTHOR]

Copyright of Aula Abierta. Revista de Investigación, Formación e Innovación en Educación (RIFIE) is the property of Universidad de Oviedo, Servicio de Publicaciones and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Archaeological research in the Dolmen of El Pendón (Reinoso, Burgos, Spain) has brought to light the complex biography of a megalithic monument used throughout the 4th millennium cal. BC. The ossuary of this burial holds the bones of nearly a hundred individuals who suffered from diverse pathologies and injuries. This study presents the discovery of a skull with two bilateral perforations on both mastoid bones. These evidences point to a mastoidectomy, a surgical procedure possibly performed to relieve the pain this prehistoric individual may have suffered as a result of otitis media and mastoiditis. The hypothesis of surgical intervention is also supported by the presence of cut marks at the anterior edge of the trepanation made in the left ear. Furthermore, the results of this paper demonstrate the survival of the individual to both interventions. Given the chronology of this dolmen, this find would be the earliest surgical ear intervention in the history of mankind. [ABSTRACT FROM AUTHOR]

To document the epidemiology, clinical features, and outcomes of murine typhus patients in the Canary Islands (Spain), we analyzed data that were retrospectively collected for 16 years for 221 patients. Murine typhus in the Canary Islands is characterized by a high rate of complications (31.6%), mainly liver, lung, kidney or central nervous system involvement. [ABSTRACT FROM AUTHOR]

Sheep remains constitute the main archaeozoological evidence for the presence of Early Neolithic human groups in the highlands of the Southern Pyrenees but understanding the role of herding activities in the Neolithisation process of this mountain ecosystem calls for the analysis of large and well-dated faunal assemblages. Cova de Els Trocs (Bisaurri, Huesca, Spain), a cave located at 1564 m a.s.l on the southern slopes of the Central Pyrenees, is an excellent case study since it was seasonally occupied throughout the Neolithic (ca. 5312–2913 cal. BC) and more than 4000 caprine remains were recovered inside. The multi-proxy analytical approach here presented has allowed us to offer new data elaborating on vertical mobility practices and herd management dynamics as has not been attempted up until now within Neolithic high-mountain sites in the Iberian Peninsula. For the first time, δ18O and δ13C stable isotope analyses offer direct evidence on both the regular practice of altitudinal movements of sheep flocks and the extended breeding season of sheep. Autumn births are recorded from the second half of the fifth millennium cal. BC onwards. Age-at-death distributions illustrate the progressive decline in caprine perinatal mortality together with the rising survival rate of individuals older than six months of age and the larger frequency of adults. This trend alongside the 'off-season' lambing signal at the implementation of husbandry techniques over time, probably aiming to increase the size of the flocks and their productivity. Palaeoparasitological analyses of sediment samples document also the growing reliance on herding activities of the human groups visiting the Els Trocs cave throughout the Neolithic sequence. In sum, our work provides substantial arguments to conclude that the advanced herding management skills of the Early Neolithic communities arriving in Iberia facilitated the anthropisation process of the subalpine areas of the Central Pyrenees. [ABSTRACT FROM AUTHOR]

Objective: To assess the influence of a Mediterranean dietary pattern (MeDiet) on anthropometric and body composition parameters in one of the centers of the PREDIMED randomized dietary trial.Subjects/settings: 351 Canarian free-living subjects aged 55 to 80 years, with type 2 diabetes or ≥3 cardiovascular risk factors.Intervention: Participants were randomly assigned to one of 3 different dietary interventions: MeDiet + extra-virgin olive oil (EVOO), MeDiet + nuts (walnuts, almonds, and hazelnuts), or a control low-fat diet. Total energy intake was ad libitum.Outcome Measures: Measures included changes in anthropometric measures (weight, body mass index [BMI] and waist circumference [WC]), body fat distribution, energy, and nutrient intake after 1 year. Body composition (percentage of total body fat [%TBF], total fat mass [TFM], free fat mass [FFM], percentage of truncal fat [%TrF], truncal fat mass [TrFM]) and total body water (TBW) were estimated by octapolar electrical impedance analysis.Statistical Analyses: Paired t tests were conducted to assess within-group changes. Analyses of variance (ANOVAs) were used to assess the effect of the dietary intervention on the percentage change in anthropometric variables, body composition, and dietary intake profile. All pairwise comparisons that were statistically significant in ANOVA were subsequently adjusted using the Benjamini-Hochberg test, which penalizes for multiple comparisons.Results: After 1 year of intervention, significant within-group reductions in all anthropometric variables were observed for the MeDiet + EVOO and the control group. The MeDiet + nuts group exhibited a significant reduction in WC and TBW. The control group showed a significant increase in %TBF and a reduction in TBW. The control group showed a significant increase in the percentage of total body fat and a reduction in TBW. However, we did not find any between-group significant difference in anthropometric or body composition changes.Conclusions: Mediterranean diets enriched with EVOO or specific mixed nuts (walnuts, almonds, hazelnuts) that contain approximately 40% total fat can be alternative options to low-fat diets for weight maintenance regimes in older overweight or obese adults. [ABSTRACT FROM AUTHOR]

This study examined whether spelling tasks contribute to the prediction of the handwriting status of children with poor and good handwriting skills in a cross-sectional study with 276 Spanish children from Grades 1 and 3. The main hypothesis was that the spelling tasks would predict the handwriting status of the children, although this influence would decrease with age due to a gradual automatization of handwriting skills. The results confirmed this hypothesis. Another interesting result was that the pattern of pseudoword and irregular word spellings as predictors of handwriting status changed from Grade 1 to Grade 3. In Grade 1, the pseudoword spelling task made a significant contribution, whereas the irregular word spelling task did not. The opposite pattern was found in Grade 3. These results may be a consequence of progressive acquisition of orthographic representations. The orthographic role of the task of writing the alphabet in order from memory in the prediction model was also analyzed. The writing of the alphabet in order from memory task made a significant contribution to the prediction of handwriting status of the children beyond the orthographic influence of spelling tasks. The additional effect of this task on the prediction of handwriting status is presumably due to the fact that this measure is based on fluency. [ABSTRACT FROM AUTHOR]

Background: The impact of such recommendations after their implementation of guidelines has not usually been evaluated. Herein, we assessed the impact and compliance with the Spanish Oncology Genitourinary Group (SOGUG) Guidelines for toxicity management of targeted therapies in metastatic renal cell carcinoma (mRCC) in daily clinical practice.Methods: Data on 407 mRCC patients who initiated first-line targeted therapy during the year before and the year after publication and implementation of the SOGUG guideline program were available from 34 Spanish Hospitals. Adherence to SOGUG Guidelines was assessed in every cycle.Results: Adverse event (AE) management was consistent with the Guidelines as a whole for 28.7% out of 966 post-implementation cycles compared with 23.1% out of 892 pre-implementation cycles (p = 0.006). Analysis of adherence by AE in non-compliant cycles showed significant changes in appropriate management of hypertension (33% pre-implementation vs. 44.5% post-implementation cycles; p < 0.0001), diarrhea (74.0% vs. 80.5%; p = 0.011) and dyslipemia (25.0% vs. 44.6%; p < 0.001).Conclusions: Slight but significant improvements in AE management were detected following the implementation of SOGUG recommendations. However, room for improvement in the management of AEs due to targeted agents still remains and could be the focus for further programs in this direction. [ABSTRACT FROM AUTHOR]

Arithmetic word problem (AWP) solving is a highly demanding task for children with learning disabilities (LD) since verbal and mathematical information have to be integrated. This study examines specifically how syntactic awareness (SA), the ability to manage the grammatical structures of language, affects AWP solving. Three groups of children in elementary education were formed: children with arithmetic learning disabilities (ALD), children with reading learning disabilities (RLD), and children with comorbid arithmetic and reading learning disabilities (ARLD). Mediation analysis confirmed that SA was a mediator variable for both groups of children with reading disabilities when solving AWPs, but not for children in the ALD group. All groups performed below the control group in the problem solving task. When SA was controlled for, semantic structure and position of the unknown set were variables that affected both groups with ALD. Specifically, children with ALD only were more affected by the place of the unknown set. [ABSTRACT FROM AUTHOR]

We examined the developmental relations of phonological awareness (PA) and rapid automatized naming (RAN) with reading in a cross-sectional study with 874 Spanish children from Grades 2 to 6. Our main prediction was that the RAN–reading relationship would decrease due to a gradual change in reading strategy, from serial decoding to sight word reading. Therefore, in contrast to most previous studies, we used discrete reading tasks. Serial RAN tasks for objects, colors, digits, and letters were included. First, we examined whether the RAN tasks loaded on the same constructs across time. An alphanumeric and a nonalphanumeric factor were identified, which were invariant over time. In subsequent multigroup structural equation models we found that the PA–reading relationship was low but slightly increased in the higher grades. As predicted, the RAN–reading relationship decreased for words, whereas the relationship remained stable for pseudowords. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze possible gender-related differences in the prevalence of dyslexia. A cross-national comparison of Spain and Guatemala was conducted. Both countries speak the same language but have a different standard of living and educational level. A second purpose of this study was to analyze the cognitive profile of Guatemalan and Spanish males and females children with dyslexia. The log-linear analysis indicated that the number of dyslexics detected was different across the countries but there were no differences as a function of gender. Similarly, there were no significant or meaningful differences between dyslexic males and females in the cognitive processes involved in reading. Therefore, gender differences do not appear to be characteristic of developmental dyslexia. [ABSTRACT FROM AUTHOR]

Copyright of Psychosocial Intervention is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery. [ABSTRACT FROM AUTHOR]

Non-ulcerous dyspepsia is common among sub-Saharan people migrating into Spain. Given the high prevalence of H. pylori (HP) infection in their countries of origin, we studied the prevalence of infection in this population, and specifically the prevalence of infection by the more virulent, cagA-positive strains (CAP). 140 sub-Saharan immigrants recently arrived to Gran Canaria (Canary Islands, Spain) were studied. 80.7% were male, with a mean age of 24.2 y. 90.7% tested seropositive for HP and 72.2% of them carried antibodies against the 'pathogenicity island' cagA. We did not find any relationship between the presence of these antibodies and the clinical variables studied. We can conclude that HP infection is virtually universal in this population, with a high percentage of infection by CAP strains. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) is associated with a considerable burden to the patient and society. However, current data on IBD incidence and burden are limited because of the paucity of nationwide epidemiological studies, heterogeneous designs, and a low number of participating centers and sample size. The EpidemIBD study is a large-scale investigation to provide an accurate assessment of the incidence of IBD in Spain, as well as treatment patterns and outcomes. Methods: This multicenter, population-based incidence cohort study included patients aged >18 years with IBD (Crohn's disease, ulcerative colitis, or unclassified IBD) diagnosed during 2017 in 108 hospitals in Spain, covering 50% of the Spanish population. Each participating patient will attend 10 clinic visits during 5 years of follow up. Demographic data, IBD characteristics and family history, complications, treatments, surgeries, and hospital admissions will be recorded. Results: The EpidemIBD study is the first large-scale nationwide study to investigate the incidence of IBD in Spain. Enrollment is now completed and 3627 patients are currently being followed up. Conclusions: The study has been designed to overcome many of the limitations of previous European studies into IBD incidence by prospectively recruiting a large number of patients from all regions of Spain. In addition to epidemiological information about the burden of IBD, the 5-year follow-up period will also provide information on treatment patterns, and the natural history and financial burden of IBD. [ABSTRACT FROM AUTHOR]

The study presented here was carried out in the context of the "Program for attention to high ability students of the Canary Islands." The aim was to analyze the existing relationship between creativity and intelligence, studying figurative and verbal creativity among different profiles of students with high abilities and in non-exceptional students. For this purpose, we selected a sample of 634 students from primary school grades one to six in different areas (urban and rural) of the islands of Grand Canary and Tenerife. They were administered the Battery of Differential and General Aptitudes (BADyG, Yuste, 1992), the adaptation of the Torrence Test of Creative Thinking (TTCT, Torrance, 1974), and the Test of Evaluation of Verbal Creativity (PVEC-4). Both tests were adapted and standardized for the Canarian school population. In the first phase, the students were classified according to different profiles of intellectual exceptionality defined in the legislation of the Autonomous Community of the Canary Islands (BOCA, 2002) (gifted, academic talent, simple talent, mixed talents) and non-exceptional students. The results showed that both gifted and creative talent are characterized by greater creativity compared to the students who didn't show high abilities. Also, the figurative dimension of creativity was more associated with the profile of giftedness, while verbal creativity was more associated with creative talent. [ABSTRACT FROM AUTHOR]

Abstract: The frequent plankton blooms in the Ria de Ferrol (Galicia, NW Spain) were analysed by measuring changes in dissolved nutrient concentrations and plankton uptake rates. Four cruises were made during February, May, July and September 2000 to study seasonal differences between blooms. Dissolved inorganic nutrients, oxygen, particulate and dissolved organic carbon and nitrogen, along with chlorophyll-a concentrations were measured in three selected stations representative of inner, middle and outer zones of the ria. In addition, gross uptake of nitrate and ammonium was estimated using 15N-tracers. During February only there were no accumulations of phytoplankton inside the ria, despite the high concentration of nutrients. In contrast, large accumulations of phytoplankton were found during the other three cruises (up to 27.8 mg chlorophyll-a m−3 in September), when nutrient concentrations were much lower; however, inorganic nutrients were never exhausted in surface waters. Values of the inorganic nitrogen-to-phosphate ratio &#60;10 during blooms in the surface during spring and summer suggest that the nitrogen supply control bloom development. In this way, nitrate uptake dominated in February (mean±SE, f-) and July (0.64±0.05), while ammonium uptake dominated in May (0.25±0.07) and September (0.42±0.05). Due to the low input of continental water during the study, nutrient dynamics and fluxes were largely dependent on shelf-ria exchanges and in situ regeneration, which helped to sustain a relatively large biomass of plankton in absence of direct effects of the coastal upwelling. The succession of phytoplankton blooms in the Ria de Ferrol produces a progressive transformation of nitrogen from inorganic to organic forms (both particulate and dissolved) from winter to late summer. Such accumulations of organic matter would maintain remineralisation rates matching plankton uptake, with the result of no net accumulation of inorganic nutrients inside the ria. [Copyright &y& Elsevier]

Introduction: Introduction: hospital malnutrition is a highly prevalent problem and continues to be a pending issue today, often unnoticed by health care workers, with the negative clinical impact this entails. Objectives: a) to evaluate nutritional status upon admission; b) to assess the outcome after a week of hospitalization; c) to analyze the relationship between nutritional status and different clinical variables (specialty, age, body weight loss, length of stay, readmissions, and consultations to the endocrinology-nutrition department). Methods: an observational, prospective, analytical, randomized study in 260 patients from medical and surgical services, nutritionally evaluated on admission and after seven days of hospitalization using the SGA and NRS-2002. Results: prevalence at admission according to the SGA was 48 % and according to NRS-2002, 38.5 %. After a week of hospitalization it increased to 72.5 % and 58.8 %, respectively. After seven days, 2-7.8 % of subjects improved their nutritional status, while 16-27.5 % worsened. Malnutrition on admission was associated with longer stay (6 days for non-malnourished vs 8 days for malnourished); with older age (64 years for non-malnourished vs 71 years for malnourished); with medical vs surgical specialties (44-53 % vs 20-32 %); with weight loss (on admission they had lost 2.1 kg on average as compared to usual weight, and 0.9 kg after seven days of hospitalization); and with premature readmission (8-11 % for non-malnourished vs 27 % for malnourished), among others. Conclusions: the study's results offer an overview of hospital malnutrition, showing how patients evolve nutritionally during hospitalization, and which are the crucial moments for action. It is extremely important that health care workers will become aware and take action. [ABSTRACT FROM AUTHOR]

• Murine Typhus (MT) is a widely distributed zoonosis with a previously unknown impact in Spain. • Although considered uncommon, the incidence of MT seems to be increasing slowly. Most cases occurred in middle-aged men between late summer and early autumn in Spain. The Canary Islands and Andalusia registered the highest number of cases. • The mean age of patients is about 46 years, the mortality is about 1%. • There is a need for a common national strategy on data collection, monitoring, and reporting, which would evaluate the underestimated health and economic importance of this disease. Data obtained from the Minimum Basic Data Set is an appropriate approach to study MT hospital management. The aim of this study was to analyze the epidemiological impact of murine typhus in patients who required hospitalization in the National Health System (SNS) in Spain between 1997 and 2015. Murine typhus (MT) is a zoonosis caused by Rickettsia typhi. MT is transmitted from rats, cats, dogs, and opossums to humans by their fleas. The clinical picture is characterized by headache, fever, rash, and liver function alteration. The prevalence of MT is considered underestimated since most cases are mild and self-limited. However, up to 10% of patients develop serious complications such as pneumonia or acute kidney injury and may even need admission to intensive care units. This was a retrospective longitudinal descriptive study of inpatients diagnosed with Rickettsia typhi infection (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], 081.0) in Spanish public hospitals between January 1, 1997, and December 31, 2015. Data were obtained from the Minimum Basic Data Set (MBDS, CMBD in Spanish), which includes information about inpatients admitted to the National Health System (NHS) hospitals provided by the Health Information Institute of the Ministry of Health and Equality. Ninety-nine inpatients were included. The incidence rate of MT was 0.12 (95% CI, 0.09-0.14) cases per one million person-years. Cases were irregularly distributed throughout the period of study, with a slight upward trend between 2013 and 2015. The Canary Islands had the highest incidence rate: 2.17 (95% CI, 1.69–2.64) cases per one million person-years (80 cases). Most patients were men (63.6%). The mean age (±SD) was 46.4 years (±19). Five patients were under 15 years old. Approximately 85.9% of cases required urgent hospital admissions. The average hospital stay was 11 days (±9.9). Only 1 patient died. Although considered uncommon, the incidence of MT seems to be increasing slowly. Most cases occurred in middle-aged men between late summer and early autumn in Spain. The Canary Islands and Andalusia registered the highest number of cases. The MBDS is an appropriate approach to study MT hospital management. [ABSTRACT FROM AUTHOR]

• Q fever is a widely distributed zoonosis with a previously unknown impact in Spain. • There is a significant number of cases from urban areas, as far as 75%. • Mean age of patients is about 51 years with a peak of incidence between March and August, the mortality is about 3%. • There is a need for a common national strategy on data collection, monitoring, and reporting, which would evaluate underestimated health and economic importance of this disease. The objective of this study was to assess the epidemiology and burden of Q fever (QF) in Spain. We designed a retrospective descriptive study using the minimum basic data set in patients admitted to hospitals of the National Health System between 1998 and 2015 with a diagnosis of Q fever (ICD-9: 083.0.). We found 4214 hospitalized patients with a mean age (±SD) of 50.9 ± 19.3 years. The male/female ratio was 3:1. The incidence rate was between 0.41 and 0.65 cases per 100,000 person-years over the 18-year period. The highest incidence of cases was from March to August (p = 0.024). 21.1% patients had pneumonia, 17.5% had liver disease, and only 3.2% had endocarditis. The average hospital stay was 13.8 days (±12.8). A total of 117 (2.8%) patients died. The total mean cost of QF is approximately €154,232,779 (€36,600 ± 139,422 per patient). QF is an important zoonosis in Spain with a stable incidence rate and high cost for hospitalization. Older patients have a more severe clinical picture and higher mortality, which can be decreased with early clinical suspicion. [ABSTRACT FROM AUTHOR]

This paper presents the results of the first excavation campaign of the Artusia rock shelter in Unzué, Navarre, Spain. Chronocultural and archaeobiological analyses revealed five different occupation phases (Artusia I–V) within the regional Mesolithic timeline, specifically in the Mesolithic of Notches and Denticulates (Artusia I and II) and the Geometric Mesolithic (Artusia III, IV, and V). In addition, the study of the sedimentological and palaeoenvironmental evolution in the entire record helped to clearly define several climatic events which developed around 6550 cal BC–8500 cal BP and 6250 cal BC–8200 cal BP. Here, we present a description of these events and their (pre)historical interpretation with the aim of recognizing how they influenced the Mesolithic hunter–gatherer groups living in the Ebro Basin of the Iberian Peninsula. [ABSTRACT FROM AUTHOR]

Abstract: The abundance, taxonomic composition and biomass of plankton components were studied in the mostly eutrophic waters of the Ria de Ferrol (Galicia, NW Spain) in contrasting seasons. Three stations arranged in a transect along the main ria axis were sampled during cruises in February, May, July and September 2000. Phytoplankton, bacteria, micro- (40–200 μm) and mesozooplankton (>200 μm) compartments were considered. Phytoplankton blooms (>103 cel ml−1) and high total plankton biomass (up to 44 g C m−2) was found at all seasons, except in winter when values were &#60;1 g C m−2. Phytoplankton generally accounted for most of total plankton biomass, particularly in late summer, thus driving most of plankton dynamics. The blooming species were always diatoms, either fast-growing, chain-forming species, well adapted to relatively turbulent conditions (e.g. Chaetoceros socialis), or disturbance-tolerant, estuarine adapted species (e.g. Skeletonema costatum). In addition, microflagellates (&#60;10 μm) reached high abundances, particularly during summer. The influence of shelf waters, where coastal upwelling events are frequent for most of the spring and summer, prevents the establishment of a marked pycnocline and the dominance of dinoflagellates. Microheterotrophs (bacteria, protozoa and larval stages of metazoa) increased their abundance and biomass from winter to late summer, while mesozooplankton peaked in spring and summer. Zooplankton dynamics were characterised by the presence of large numbers of larvae of both planktonic copepods and benthic metazoans, the latter mainly cirripeds and bivalve molluscs. The absence of a definite succession pattern in the mesozooplankton species abundance data, in contrast with phytoplankton data, along with the dominance of estuarine species (e.g. Acartia margalefi), suggest that mesozooplankton communities inside the ria behave differently from communities in shelf waters. Despite its small size and reduced influence of upwelling compared with other Galician rias, the input of shelf waters in the Ria de Ferrol drives massive phytoplankton blooms supporting a rich heterotrophic community. [Copyright &y& Elsevier]

Summary: Objective: The aim of this work was to evaluate the prevalence of past infection due to Rickettsia typhi and Rickettsia conorii in the Canary Islands (Spain). Methods: A representative sample of the population of the seven islands, formed of 662 people aged between 5 and 75 years (368 females, 294 males), was analyzed. Epidemiological data were obtained by direct survey. The detection of serum IgG antibodies against both microorganisms was based on an indirect immunofluorescence test, considered positive if the titers were ≥1/80. Results: Of the analyzed population 3.9% had IgG antibodies against R. typhi and 4.4% against R. conorii. Out of these positive samples, only three were positive for both species. The seroprevalence was similar in both sexes. Positive results were found in all age groups, but a higher rate was noticed in those aged 46 years and older (p <0.05). R. typhi was found to be more prevalent in rural areas of all islands, as well as in farmers. Conclusions: Our results confirm the presence of antibodies against the causative agents of murine typhus and Mediterranean spotted fever in the Canary Islands. Indirect data suggest that the detection of antibodies to R. conorii might be due to a cross-reaction between these species. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA)., Design: This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment., Methods: Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality., Results: Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P < .01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P = .03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P < .01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P = .04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline., Conclusion: In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients., Competing Interests: Conflict of interest: The authors declare no conflict of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC)., Methods: A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators., Results: We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment., Conclusions: We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes., (© 2023. The Author(s).)

Purpose: To review current measures for renal cancer care and develop a comprehensive and updated list of measures for their practical use in Spain., Methods: The study was developed by Fundación ECO, a Spanish foundation aiming to improve oncology quality of care. A systematic literature review was carried out to identify measures and knowledge gaps. A scientific committee composed of nine experts reviewed the literature findings and added measures. A preliminary list of 42 measures was evaluated with the Delphi method to gather feedback from 47 medical oncology experts in Spain. Experts scored the appropriateness of the measures and ranked their priority in two consecutive online surveys. The scientific committee reviewed the Delphi results and developed the measures. A technical group from Universidad Francisco de Vitoria conducted and oversaw the Delphi method., Results: The Delphi method led to consensus on all 42 measures. The scientific committee used a prioritisation matrix to select 25 of these measures for evaluating quality of care in renal cancer. These measures regarded structure, process, and outcome and covered general management, diagnosis, treatment, follow-up, and evaluation of health outcomes. Easy-to-use index cards were developed for all 25 measures, including their definition, formula, acceptable level of attainment, and rationale., Conclusions: This manuscript aims to provide healthcare professionals with expert- and evidence-based measures that are useful for evaluating quality of care in renal cancer in Spain and cover all aspects and stages., (© 2021. Federación de Sociedades Españolas de Oncología (FESEO).)

Objective: Mass gathering events (MGEs) are associated with the transmission of COVID-19. Between 6 and 10 March 2020, several MGEs related to the Falles festival took place in Borriana, a municipality in the province of Castellon (Spain). The aim of this study was to estimate the incidence of COVID-19 and its association with these MGEs, and to quantify the potential risk factors of its occurrence., Methods: During May and June 2020, a population-based retrospective cohort study was carried out by the Public Health Center of Castelló and the Hospital de la Plana in Vila-real. Participants were obtained from a representative sample of 1663 people with potential exposure at six MGEs. A questionnaire survey was carried out to obtain information about attendance at MGEs and COVID-19 disease. In addition, a serologic survey of antibodies against SARS-Cov-2 was implemented. Inverse probability weighted regression was used in the statistical analysis., Results: A total of 1338 subjects participated in the questionnaire survey (80.5%), 997 of whom undertook the serologic survey. Five hundred and seventy cases were observed with an attack rate (AR) of 42.6%; average age was 36 years, 62.3% were female, 536 cases were confirmed by laboratory tests, and 514 cases were found with SARS-CoV-2 total antibodies. Considering MGE exposure, AR was 39.2% (496/1264). A dose-response relationship was found between MGE attendance and the disease, (adjusted relative risk [aRR] = 4.11 95% confidence interval [CI]3.25-5.19). Two MGEs with a dinner and dance in the same building had higher risks. Associated risk factors with the incidence were older age, obesity, and upper and middle class versus lower class; current smoking was protective., Conclusions: The study suggests the significance of MGEs in the COVID-19 transmission that could explain the subsequent outbreak in Borriana., Competing Interests: The authors have declared that no competing interest exist.

Introduction: Introduction: hospital malnutrition is a highly prevalent problem and continues to be a pending issue today, often unnoticed by health care workers, with the negative clinical impact this entails. Objectives: a) to evaluate nutritional status upon admission; b) to assess the outcome after a week of hospitalization; c) to analyze the relationship between nutritional status and different clinical variables (specialty, age, body weight loss, length of stay, readmissions, and consultations to the endocrinology-nutrition department). Methods: an observational, prospective, analytical, randomized study in 260 patients from medical and surgical services, nutritionally evaluated on admission and after seven days of hospitalization using the SGA and NRS-2002. Results: prevalence at admission according to the SGA was 48 % and according to NRS-2002, 38.5 %. After a week of hospitalization it increased to 72.5 % and 58.8 %, respectively. After seven days, 2-7.8 % of subjects improved their nutritional status, while 16-27.5 % worsened. Malnutrition on admission was associated with longer stay (6 days for non-malnourished vs 8 days for malnourished); with older age (64 years for non-malnourished vs 71 years for malnourished); with medical vs surgical specialties (44-53 % vs 20-32 %); with weight loss (on admission they had lost 2.1 kg on average as compared to usual weight, and 0.9 kg after seven days of hospitalization); and with premature readmission (8-11 % for non-malnourished vs 27 % for malnourished), among others. Conclusions: the study's results offer an overview of hospital malnutrition, showing how patients evolve nutritionally during hospitalization, and which are the crucial moments for action. It is extremely important that health care workers will become aware and take action.

Objectives: The objective of this study is to evaluate the impact of the COVID-19 outbreak on mental health and burn-out syndrome in Spanish internists and the factors that could be related to its appearance., Design: We performed an observational, cross-sectional, descriptive study for which we designed a survey that was distributed in May 2020., Setting: We included internists who worked in Spain during the COVID-19 outbreak., Participants: A total of 1015 internists responded to the survey. Of those 62.9% were women., Results: Of 1015 people, 58.3% presented with high emotional exhaustion, 61.5% had a high level of depersonalisation and 67.6% reported low personal fulfilment. 40.1% presented with the 3 criteria described, and therefore burn-out syndrome.Burn-out syndrome was independently related to the management of patients with SARS-CoV-2 (HR: 2.26; 95% CI 1.15 to 4.45), the lack of availability of personal protective equipment (HR: 1.41; 95% CI 1.05 to 1.91), increased responsibility (HR: 2.13; 95% CI 1.51 to 3.01), not having received financial compensation for overtime work (HR: 0.43; 95% CI 0.31 to 0.62), not having rested after 24-hour shifts (HR: 1.61; 95% CI 1.09 to 2.38), not having had holidays in the previous 6 months (HR: 1.36; 95% CI 1.01 to 1.84), consumption of sleeping pills (HR: 1.83; 95% CI 1.28 to 2.63) and higher alcohol intake (HR: 1.95; 95% CI 1.39 to 2.73)., Conclusions: During the COVID-19 outbreak, 40.1% of Internal Medicine physicians in Spain presented with burn-out syndrome, which was independently related to the assistance of patients with SARS-CoV-2, overworking without any compensation and the fear of being contagious to their relatives. Therefore, it is imperative to initiate programmes to prevent and treat burn-out in front-line physicians during the COVID-19 outbreak., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To evaluate the effectiveness and safety of tofacitinib in ulcerative colitis [UC] in real life., Methods: Patients from the prospectively maintained ENEIDA registry and treated with tofacitinib due to active UC were included. Clinical activity and effectiveness were defined based on Partial Mayo Score [PMS]. Short-term response/remission was assessed at Weeks 4, 8, and 16., Results: A total of 113 patients were included. They were exposed to tofacitinib for a median time of 44 weeks. Response and remission at Week 8 were 60% and 31%, respectively. In multivariate analysis, higher PMS at Week 4 (odds ratio [OR] = 0].2; 95% confidence interval [CI] = 0].1-0.4) was the only variable associated with lower likelihood of achieving remission at Week 8. Higher PMS at Week 4 [OR = 0.5; 95% CI = 0.3-0.7] and higher PMS at Week 8 [OR = 0.2; 95% CI = 0.1-0.5] were associated with lower probability of achieving remission at Week 16. A total of 45 patients [40%] discontinued tofacitinib over time. Higher PMS at Week 8 was the only factor associated with higher tofacitinib discontinuation [hazard ratio = 1.5; 95% CI = 1.3-1.6]. A total of 34 patients had remission at Week 8; of these, 65% had relapsed 52 weeks after achieving remission; the dose was increased to 10 mg/12 h in nine patients, and five of them reached remission again. Seventeen patients had adverse events., Conclusions: Tofacitinib is effective and safe in UC patients in real practice, even in a highly refractory cohort. A relevant proportion of patients discontinue the drug over time, mainly due to primary failure., (© The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

AbstractThe purpose of this study is to evaluate the influence of several risk factors and, among them, the role of different types of antibiotics, in the development of the first recurrent episode of Clostridioides difficile (CD) infection. We performed a case control study from 2006 to 2016. We included patients admitted to the hospital with CD infection that received any antibiotic treatment during the year before the onset of the infection. First, we described the characteristics of CD infection in a Spanish third level hospital and then we compared first cases of CD infection that presented recurrence with those that did not. We included 110 cases, corresponding to 94 individuals. There were 14 first CD infection episodes that later presented recurrence (12.7%). Receiving more than 3 types of antibiotics during the year before the onset of symptoms was associated with higher risk of presenting a recurrent episode (OR = 4.69, 95% CI 1.01-21.78), as well as the past history of neoplasia (OR = 4.58, 95% CI 1.00-20.98). The number of previous hospital admissions was associated with the development of recurrences in the univariate study (p < 0.05). No differences were observed related to the type of antibiotic used immediately before the CD episode neither with the treatment received. The number of types of antibiotics used during the year before the first episode of CD infection or having a personal history of neoplasia was associated with 4 times higher risk of recurrent episodes. Type of antibiotic used did not show to influence recurrences.

Violence seems deeply rooted in human nature and an endemic potential for such is today frequently associated with differing ethnic, religious or socio-economic backgrounds. Ethnic nepotism is believed to be one of the main causes of inter-group violence in multi-ethnic societies. At the site of Els Trocs in the Spanish Pyrenees, rivalling groups of either migrating early farmers or farmers and indigenous hunter-gatherers collided violently around 5300 BCE. This clash apparently resulted in a massacre of the Els Trocs farmers. The overkill reaction was possibly triggered by xenophobia or massive disputes over resources or privileges. In the present, violence and xenophobia are controlled and sanctioned through social codes of conduct and institutions. So that, rather than representing an insurmountable evolutionary inheritance, violence and ethnic nepotism can be overcome and a sustainable future achieved through mutual respect, tolerance and openness to multi-ethnic societies.

A survey was carried out during March-May 2017 to analyze the beliefs and attitudes of health workers and nursing students in the face of an influenza pandemic in Las Palmas de Gran Canaria, Spain. A high percentage doubted that there is a vaccine to protect them against an influenza pandemic, although workers showed greater certainty than students concerning access to a vaccine. Health workers showed themselves as more responsible for their work than students; i.e., 46.7% would be in favor of penalizing anyone who refused to go to work because there is a high percentage that put work before their responsibility toward themselves and their families. In conclusion, this study suggests promoting initiatives for reducing absenteeism, identifying those factors that would facilitate it, and having a contingency plan prepared in the event of an influenza pandemic.

The Iberian Peninsula in southwestern Europe represents an important test case for the study of human population movements during prehistoric periods. During the Last Glacial Maximum (LGM), the peninsula formed a periglacial refugium [1] for hunter-gatherers (HGs) and thus served as a potential source for the re-peopling of northern latitudes [2]. The post-LGM genetic signature was previously described as a cline from Western HG (WHG) to Eastern HG (EHG), further shaped by later Holocene expansions from the Near East and the North Pontic steppes [3-9]. Western and central Europe were dominated by ancestry associated with the ∼14,000-year-old individual from Villabruna, Italy, which had largely replaced earlier genetic ancestry, represented by 19,000-15,000-year-old individuals associated with the Magdalenian culture [2]. However, little is known about the genetic diversity in southern European refugia, the presence of distinct genetic clusters, and correspondence with geography. Here, we report new genome-wide data from 11 HGs and Neolithic individuals that highlight the late survival of Paleolithic ancestry in Iberia, reported previously in Magdalenian-associated individuals. We show that all Iberian HGs, including the oldest, a ∼19,000-year-old individual from El Mirón in Spain, carry dual ancestry from both Villabruna and the Magdalenian-related individuals. Thus, our results suggest an early connection between two potential refugia, resulting in a genetic ancestry that survived in later Iberian HGs. Our new genomic data from Iberian Early and Middle Neolithic individuals show that the dual Iberian HG genomic legacy pertains in the peninsula, suggesting that expanding farmers mixed with local HGs. VIDEO ABSTRACT., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations., (Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Whole-genome sequencing (WGS) was used for the characterization of the frequently extensively drug resistant (XDR) Pseudomonas aeruginosa sequence type 175 (ST175) high-risk clone. A total of 18 ST175 isolates recovered from 8 different Spanish hospitals were analyzed; 4 isolates from 4 different French hospitals were included for comparison. The typical resistance profile of ST175 included penicillins, cephalosporins, monobactams, carbapenems, aminoglycosides, and fluoroquinolones. In the phylogenetic analysis, the four French isolates clustered together with two isolates from one of the Spanish regions. Sequence variation was analyzed for 146 chromosomal genes related to antimicrobial resistance, and horizontally acquired genes were explored using online databases. The resistome of ST175 was determined mainly by mutational events; resistance traits common to all or nearly all of the strains included specific ampR mutations leading to ampC overexpression, specific mutations in oprD conferring carbapenem resistance, or a mexZ mutation leading to MexXY overexpression. All isolates additionally harbored an aadB gene conferring gentamicin and tobramycin resistance. Several other resistance traits were specific to certain geographic areas, such as a streptomycin resistance gene, aadA13, detected in all four isolates from France and in the two isolates from the Cantabria region and a glpT mutation conferring fosfomycin resistance, detected in all but these six isolates. Finally, several unique resistance mutations were detected in single isolates; particularly interesting were those in genes encoding penicillin-binding proteins (PBP1A, PBP3, and PBP4). Thus, these results provide information valuable for understanding the genetic basis of resistance and the dynamics of the dissemination and evolution of high-risk clones., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

We describe here the occurrence of blaVIM-2 in 10 carbapenem-resistant Pseudomonas monteilii strains isolated from different clinical samples from patients at the University Hospital Marqués de Valdecilla in northern Spain. All the blaVIM-2-harboring P. monteilii isolates possessed a class 1 integron, with the cassette array [intI1&#95;blaVIM-2&#95;aac(6')-Ib&#95;qacEΔ1&#95;sul1]. Our results show the emergence of VIM-2-producing multidrug-resistant species other than Pseudomonas aeruginosa or Pseudomonas putida in a Spanish hospital. P. monteilii, although sporadically isolated, should also be considered an important metallo-β-lactamase (MBL) reservoir., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)

Background: Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population's reasons for refusing to take part in the screening programme and to find out the health professionals' opinion about the official programme implementation and on the new computerised tool., Methods/design: This is a parallel randomised trial with a cross-sectional second stage., Participants: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50-69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient's electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach., Discussion: We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals., Trial Registration: Clinical Trials.gov identifier NCT01877018.

Under the auspices of the Spanish Society for Infectious Diseases and Clinical Microbiology Quality Control program, 14 Escherichia coli strains masked as blood culture isolates were sent to 68 clinical microbiology laboratories for antimicrobial susceptibility testing to β-lactam antibiotics. This collection included three control strains (E. coli ATCC 25922, an IRT-2 producer, and a CMY-2 producer), six isogenic strains with or without the OmpF porin and expressing CTX-M β-lactamases (CTX-M-1, CTX-M-15, and CTX-M-14), one strain carrying a double mechanism for β-lactam resistance (i.e., carrying CTX-M-15 and OXA-1 enzymes), and four strains carrying CTX-M variants with different levels of resistance to β-lactams and β-lactam-β-lactamase inhibitor (BLBLI) combinations. The main objective of the study was to ascertain how these variants with reduced susceptibilities to BLBLIs are identified in clinical microbiology laboratories. CTX-M variants with high resistance to BLBLIs were mainly identified as inhibitor-resistant TEM (IRT) enzymes (68.0%); however, isogenic CTX-M mutant strains with reduced susceptibilities to BLBLIs and cephalosporins were mainly associated with extended-spectrum β-lactamase production alone (51 to 80%) or in combination with other mechanisms (14 to 31%). Concerning all β-lactams tested, the overall interpretative discrepancy rate was 11.5%, of which 38.1% were the consequence of postreading changes in the clinical categories when a resistance mechanism was inferred. Therefore, failure to recognize these complex phenotypes might contribute to an explanation of their apparent absence in the clinical setting and might lead to inadequate drug treatment selection. A proposal for improving recognition is to adhere strictly to the current CLSI or EUCAST guidelines for detecting reduced susceptibility to BLBLI combinations, without any interpretative modification.

A limited number of Pseudomonas aeruginosa genotypes (mainly ST-111, ST-175, and ST-235), known as high-risk clones, are responsible for epidemics of nosocomial infections by multidrug-resistant (MDR) or extensively drug-resistant (XDR) strains worldwide. We explored the potential biological parameters that may explain the success of these clones. A total of 20 isolates from each of 4 resistance groups (XDR, MDR, ModR [resistant to 1 or 2 classes], and MultiS [susceptible to all antipseudomonals]), recovered from a multicenter study of P. aeruginosa bloodstream infections performed in 10 Spanish hospitals, were analyzed. A further set of 20 XDR isolates belonging to epidemic high-risk clones (ST-175 [n = 6], ST-111 [n = 7], and ST-235 [n = 7]) recovered from different geographical locations was also studied. When unknown, genotypes were documented through multilocus sequence typing. The biological parameters evaluated included twitching, swimming, and swarming motility, biofilm formation, production of pyoverdine and pyocyanin, spontaneous mutant frequencies, and the in vitro competition index (CI) obtained with a flow cytometry assay. All 20 (100%) XDR, 8 (40%) MDR, and 1 (5%) ModR bloodstream isolate from the multicenter study belonged to high-risk clones. No significant differences were observed between clonally diverse ModR and MultiS isolates for any of the parameters. In contrast, MDR/XDR high-risk clones showed significantly increased biofilm formation and mutant frequencies but significantly reduced motility (twitching, swimming, and swarming), production of pyoverdine and pyocyanin, and fitness. The defined biological markers of high-risk clones, which resemble those resulting from adaptation to chronic infections, could be useful for the design of specific treatment and infection control strategies.

Recent reports have revealed the existence of widespread extensively drug-resistant (XDR) P. aeruginosa high-risk clones in health care settings, but there is still scarce information on their specific chromosomal (mutational) and acquired resistance mechanisms. Up to 20 (10.5%) of 190 bloodstream isolates collected from 10 Spanish hospitals met the XDR criteria. A representative number (15 per group) of isolates classified as multidrug-resistant (MDR) (22.6%), resistant to 1 to 2 classes (moderately resistant [modR]) (23.7%), or susceptible to all antibiotics (multiS) (43.2%) were investigated in parallel. Multilocus sequence typing (MLST) analysis revealed that all XDR isolates belonged to sequence type 175 (ST175) (n = 19) or ST111 (n = 1), both recognized as international high-risk clones. Clonal diversity was higher among the 15 MDR isolates (4 ST175, 2 ST111, and 8 additional STs) and especially high among the 15 modR (13 different STs) and multiS (14 STs) isolates. The XDR/MDR pattern in ST111 isolates correlated with the production of VIM-2, but none of the ST175 isolates produced acquired β-lactamases. In contrast, the analysis of resistance markers in 12 representative isolates (from 7 hospitals) of ST175 revealed that the XDR pattern was driven by the combination of AmpC hyperproduction, OprD inactivation (Q142X), 3 mutations conferring high-level fluoroquinolone resistance (GyrA T83I and D87N and ParC S87W), a G195E mutation in MexZ (involved in MexXY-OprM overexpression), and the production of a class 1 integron harboring the aadB gene (gentamicin and tobramycin resistance). Of particular interest, in nearly all the ST175 isolates, AmpC hyperproduction was driven by a novel AmpR-activating mutation (G154R), as demonstrated by complementation studies using an ampR mutant of PAO1. This work is the first to describe the specific resistance markers of widespread P. aeruginosa XDR high-risk clones producing invasive infections.

Background: Coxiella burnetii is a highly clonal microorganism which is difficult to culture, requiring BSL3 conditions for its propagation. This leads to a scarce availability of isolates worldwide. On the other hand, published methods of characterization have delineated up to 8 different genomic groups and 36 genotypes. However, all these methodologies, with the exception of one that exhibited limited discriminatory power (3 genotypes), rely on performing between 10 and 20 PCR amplifications or sequencing long fragments of DNA, which make their direct application to clinical samples impracticable and leads to a scarce accessibility of data on the circulation of C. burnetii genotypes., Results: To assess the variability of this organism in Spain, we have developed a novel method that consists of a multiplex (8 targets) PCR and hybridization with specific probes that reproduce the previous classification of this organism into 8 genomic groups, and up to 16 genotypes. It allows for a direct characterization from clinical and environmental samples in a single run, which will help in the study of the different genotypes circulating in wild and domestic cycles as well as from sporadic human cases and outbreaks. The method has been validated with reference isolates. A high variability of C. burnetii has been found in Spain among 90 samples tested, detecting 10 different genotypes, being those adaA negative associated with acute Q fever cases presenting as fever of intermediate duration with liver involvement and with chronic cases. Genotypes infecting humans are also found in sheep, goats, rats, wild boar and ticks, and the only genotype found in cattle has never been found among our clinical samples., Conclusions: This newly developed methodology has permitted to demonstrate that C. burnetii is highly variable in Spain. With the data presented here, cattle seem not to participate in the transmission of C. burnetii to humans in the samples studied, while sheep, goats, wild boar, rats and ticks share genotypes with the human population.