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The lockdown caused by the pandemic resulted in the closure of schools and universities. Professors had to adapt their subjects to be taught remotely to continue their classes, and students had to cope with various personal situations such as isolation, and returning to their countries. Ensuring that the quality of teaching was maintained would usually have required months of planning and design. In contrast, these changes had to be made in a few days, which is why this situation could be considered as Emergency Remote Teaching (ERT). The objective of this article is to evaluate the teaching of our faculty during this period using the CIPP model (Context, Input, Procedure and Product), which is especially focused on educational projects among others. The university was able to maintain teaching during this period despite the difficulties of the transition. In addition, evaluation surveys show that the satisfaction of professors and students was also maintained. This was possible thanks to the order and clarity transmitted from university authorities and the commitment of the professors, despite their increased workload. This knowledge is important to ensure a better response by universities in future emergencies.

Background: Data for Spain from the Rome Foundation Global Epidemiology Study on the disorders of gut–brain interaction (DGBI) were used to assess the national and regional prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in our country. Methods: Data were collected through an anonymous, nationwide, and secure Internet survey with multiple built‐in quality‐assurance techniques that included the Rome IV diagnostic questionnaire and an in‐depth supplemental questionnaire. Key Results: The survey was completed by 2072 adult Spanish participants (50.2% female) with a mean age of 45.67 ± 15.44 years with a good representative national distribution. 43.6% (41.5%–45.8%) met diagnostic criteria for at least one DGBI, with 8.2% for any esophageal disorder, 12.1% for any gastroduodenal disorder, 30.1% for any bowel disorder, and 11.5% for any anorectal disorder. Functional constipation was the most prevalent DGBI in Spain (12.8%). We found that proctalgia fugax (9.3%), unspecified bowel disorders (10.8%), and functional dysphagia (5.6%) showed unexplained high rates in our country. DGBI rates were higher for women. Having any DGBI was negatively associated with psychosocial variables (including quality of life, somatization, and concern about digestive problems), and associated with increased healthcare utilization. Conclusions & Inferences: We provide the first comprehensive data on the prevalence and burden of all DGBI in Spain using the Rome IV criteria. The enormous burden of DGBI in Spain highlights the need for specialized training and future research. [ABSTRACT FROM AUTHOR]

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Simple Summary: Cancer is a widely heterogeneous disease, and the natural history of patients with cancer-associated thrombosis may differ according to the cancer site. Lung cancer is the most common malignancy, and a leading cause of death. A number of studies in the literature suggest that patients with adenocarcinoma may have a worse outcome than those with squamous or other types of lung cancer. The aim of the current study was to assess the potential impact of lung cancer histology on the incidence rates of VTE recurrences, major bleeding, or death appearing during the course of anticoagulation, in patients with lung cancer and VTE. Our findings, obtained from a large series of consecutive patients with lung cancer and VTE (482 patients), reveal important differences between patients with adenocarcinoma vs. other histologies in their outcomes during anticoagulation. This might likely help to design better therapeutic strategies for patients with lung cancer. Background: In patients with lung cancer and venous thromboembolism (VTE), the influence of cancer histology on outcome has not been consistently evaluated. Methods: We used the RIETE registry (Registro Informatizado Enfermedad TromboEmbólica) to compare the clinical characteristics and outcomes during anticoagulation in patients with lung cancer and VTE, according to the histology of lung cancer. Results: As of April 2022, there were 482 patients with lung cancer and VTE: adenocarcinoma 293 (61%), squamous 98 (20%), small-cell 44 (9.1%), other 47 (9.8%). The index VTE was diagnosed later in patients with squamous cancer than in those with adenocarcinoma (median, 5 vs. 2 months). In 50% of patients with adenocarcinoma, the VTE appeared within the first 90 days since cancer diagnosis. During anticoagulation (median 106 days, IQR: 45–214), 14 patients developed VTE recurrences, 15 suffered major bleeding, and 218 died: fatal pulmonary embolism 10, fatal bleeding 2. The rate of VTE recurrences was higher than the rate of major bleeding in patients with adenocarcinoma (11 vs. 6 events), and lower in those with other cancer types (3 vs. 9 events). On multivariable analysis, patients with adenocarcinoma had a non-significantly higher risk for VTE recurrences (hazard ratio [HR]: 3.79; 95%CI: 0.76–18.8), a lower risk of major bleeding (HR: 0.29; 95%CI: 0.09–0.95), and a similar risk of mortality (HR: 1.02; 95%CI: 0.76–1.36) than patients with other types of lung cancer. Conclusions: In patients with lung adenocarcinoma, the rate of VTE recurrences outweighed the rate of major bleeding. In patients with other lung cancers, it was the opposite. [ABSTRACT FROM AUTHOR]

Background: Gas‐related symptoms (GRS) are common in the general population (GPop) and among patients with disorders of gut‐brain interactions but there is no patient‐reported outcome evaluating these symptoms and their impact on daily life. We have previously developed a 43‐item intestinal gas questionnaire (IGQ). The aim of the present study is to perform a psychometric validation of this instrument. Methods: Participants (119 from the GPop and 186 irritable bowel syndrome (IBS) patients) were recruited from 3 countries (UK, Spain, France). IBS patients fulfilled ROME IV criteria with an IBS severity score between 150 and 300. Participants completed the IGQ, the functional Digestive Disorders Quality of Life (FDDQL), and the EQ‐5D. A subgroup (n = 90) repeated the IGQ completion after 7 days on paper or electronically. Results: From the original IGQ questionnaire, 26 items were deleted because of poor performance. Confirmatory factorial analysis on the remaining 17 items (7 symptom and 10 impact items) yielded a 6‐factor structure accounting for 67% of the variance for bloating (6 items), flatulence (3), belching (2), bad breath (2), stomach rumbling (2), and difficult gas evacuation (2). Global score (0‐100) was worse among IBS vs GPop (40 ± 15 vs 33 ± 17; p = 0.0016). At the second visit, the intraclass correlation coefficient of IGQ scores was between 0.71 and 0.86 (n = 67) for test‐retest reliability and 0.61‐0.87 (n = 64) for equivalence between electronic and paper versions of IGQ. Conclusion: The IGQ available in paper and electronic versions in 3 languages is a robust instrument for capturing and measuring GRS and their impact on daily life. [ABSTRACT FROM AUTHOR]

A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes. Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit. What is Known: •Children below 6 months of age with Kawasaki disease (KD) have different features compared to older. •Younger patients usually have an incomplete form of KD and coronary artery abnormalities. What is New: •Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older. •Infections play a similar role in KD despite the age of the patients. [ABSTRACT FROM AUTHOR]

Small and medium enterprises (SMEs) are key actors in the implementation of the circular economy (CE) concept as a basis for creating sustainable societies. Thus, the main objective of this study is to identify key strategies and resources that may favor CE implementation in SMEs. These key strategies should encourage SMEs to develop eco‐innovations to gain competitive advantage and create and capture value that is coherent with nature. A mixed‐method approach that consisted of a literature review and a focus group for gathering qualitative data was used. This focus group was made up of experts such as researchers and practitioners from universities, sustainable SMEs, and consultancy firms in Spain. A set of strategies and internal and external factors were identified to help SMEs to implement the CE. Finally, some useful dynamic capabilities for implementing the CE in business performance were identified. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children. Objective: This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain. Methods: Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals). Results: A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p<0.001). A total of 97% of the patients received intravenous immunoglobulin (IVIG) with a median number of days from fever onset to IVIG administration of 7.2. A second dose was given to 15.7% and steroids to 14.5% patients. Only 1.4% patients received infliximab. No deaths were reported. A multivariate analysis identified anemia, hypoalbuminemia, hyponatremia, higher creatinine and procalcitonin as independent risk factors for treatment failure and length under 103 cm, hemoglobin < 10.2 mg/dL, platelets > 900,000 cells/mm3, maximum temperature < 39.5°C, total duration of fever > 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms. Conclusions: In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary. [ABSTRACT FROM AUTHOR]

Purpose Environmental management (EM) is becoming increasingly important in all types of organizations. The food industry represents the top industrial sector of the Spanish economy; however, there is still little knowledge about how it is managed environmentally. The purpose of this paper is to present a descriptive analysis of the Spanish food sector.Design/methodology/approach This study undertook a descriptive analysis based on probabilistic sampling surveys from food companies in Spain. The survey was sent out to 900 companies obtaining 128 answers.Findings The results of this study show that companies with an EM standard tend to have a more developed system and a greater presence of EM tools and actions. Moreover, statistical differences were identified among the characteristics of companies and various factors that affect the evolution of their EM.Originality/value There are no studies that reveal a clear picture of the status of EM in the Spanish food industry. This study presents a clear starting point that might help policy makers, consultants, researchers and other parties to set new improvement routes so companies do not get stuck in their progress toward environmental excellence. [ABSTRACT FROM AUTHOR]

Aim: Inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC), are partially attributable to an increased secretion of proinflamatory cytokines, such as tumour necrosis factor (TNF) and interleukin-1β (IL1β), which play essential roles in the disease pathogenesis and are target molecules for specific therapy. Given the inter-individual variability in the response to the anti-TNF monoclonal antibody infliximab, the aim of our study was to explore the predictive value of TNF and/or IL1β as surrogate markers of infliximab response. Methods: Serial serum concentrations of TNF and IL1β and TNF promoter region and IL1B polymorphisms were determined in 47 patients (29 CD and 18 UC) receiving infliximab and correlated with treatment response. Results: Baseline serum concentrations of TNF and IL1β were higher in UC patients than in CD patients ( p = 0.0097 and 0.0024, respectively). CD patients showing <0.64 pg/ml IL1β at baseline were more frequently responders than non-responders ( p = 0.036), and the C allele of the IL1B polymorphism was associated with higher IL1β serum concentrations ( p = 0.026) and with poorer clinical remission after 14 weeks of infliximab treatment. No significant association was found between serum TNF concentration or TNF polymorphism and patient response to infliximab. Conclusion: This is the first study evaluating the pharmacogenetic role of the rs1143634 polymorphism of IL1B and TNF polymorphisms in infliximab-treated IBD patients. We found an association between the rs1143634 C allele and higher serum IL1β concentrations and a lower response to infliximab treatment in CD patients that warrants the interest of future studies in larger and independent series. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is twofold: to evaluate the importance of the factors reported in the literature as enablers of Continuous Improvement (CI) programmes and to determine the perception of managers of different companies in the Basque Country and Navarre (Spain) regarding the relevance of these factors to their improvement programmes. Design/methodology/approach – In total, 15 elements have been considered to be key issues for the sustainability of CI programmes. Semi-structured interviews were conducted with 36 companies in order to assess how the companies value the factors and how the factors are applied and measured. Findings – The findings regarding the application and evaluation of such factors have revealed that companies are focused on the agents associated with the achievement of results. Other factors, such as management commitment or the promotion of team working, are highly scored and applied, but few companies evaluate them or take actions to improve their application. Originality/value – This paper analyzes the application of some factors considered to be enablers or key factors for the sustainability of continuous improvement systems. Furthermore, it examines the mechanisms or indicators which are used by some companies to measure the application of those factors. [ABSTRACT FROM AUTHOR]

BACKGROUND There is scarce information on the strategies for preventing venous thromboembolism (VTE) in patients with cancer. PATIENTS AND METHODS VTe used the Registro Informatizado de Enfermedad TromboEmblica (RIETE) database to retrospectively assess the clinical characteristics, prophylactic details, and 3-month mortality of all Spanish patients with active cancer. RESULTS Of24 382 patients enrolled as of October 2009, 4664 (19%) had active cancer, of whom 736 (16%) had recent surgery, and 909 (19%) had recent immobility for 34 days. Ofthese, 68% of the surgical (95% CI; 65-71) and 29% ofthe immobilized patients (95% CI: 26-32) had received VTE prophylaxis. The 3-month incidence rate offatal bleeding, fatal pulmonary embolism (PE), and overall death were: 0.68% (95% CI: 0.25-1.45), 1.36% (95% CI: 0.69-2.41), and 1;.7% (95% CI: 11.4-16.4), respectively, in the surgical patients. In TE patients after immobility for ⩾4 days, the incidence rates were: 3.52% (95% CI: 2.46-4.87), 5.06% (95% CI: 3.77-6.64), and 44.4% (95% CI: 41.2-47.7), respectively. inthe 3019 patients with no recent surgery or immobilization the incidence rates were; 1.32% (95% CI: 0.96 -1.78), 3.05% (2.48- 3.71), and 23.0% (95% Cl: 21.6-24.5), respectively. CONCLUSIONS In RIETE, we found a substantial underuse ofVTE prophylaxis in at-rislpatients, particularly in cancer patients with immobility 24 days. This is important because their 3-month outcome is much worse. [ABSTRACT FROM AUTHOR]

Patients with venous thromboembolism (VTE) and active cancer are often excluded from clinical trials of anticoagulant therapy because of short life expectancy, inability or unwillingness to attend for regular laboratory monitoring during vitamin K antagonist therapy, or contraindications to therapy. As such, treatment regimens based on the results from clinical trials might not be suitable for many VTE patients with cancer. ‘Registro Informatizado de la Enfermedad TromboEmbólica’ (RIETE) was initiated in March 2001 to prospectively record the current clinical management of patients with symptomatic, objectively confirmed, acute VTE in Spanish hospitals. This chapter will summarize the most important findings published to date regarding the association between VTE and cancer. [Copyright &y& Elsevier]

Background: Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time.Objectives: This study describes the trends in the management and outcomes of acute symptomatic PE.Methods: We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis.Results: Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p < 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p < 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p < 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p < 0.01 for trend).Conclusions: In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality. [ABSTRACT FROM AUTHOR]

Objectives: The questionnaire International Prostate Symptom Score (IPSS) is well known and used in clinical practice as diagnostic tool and allows for obtaining a total score regarding the severity of the urinary symptoms. The objective of this analysis is to determine if the IPSS storage score (sum of the punctuation of the questions 2, 4 and 7) could be a predictive variable of the impact on quality of life., Materials and Methods: Post-hoc analysis of an epidemiological, multicenter, cross-sectional study inmale patients, ≥18 years old with ≥6 micturitions and≥1 urgency and/or ≥2 nocturia and/or ≥1 daily incontinence episodes recruited by 291 urologists across Spain. Socio demographic variables, symptoms reported by patients (IPSS) and clinical variables were collected. The impact of voiding symptoms (IPSS-V) and storage symptoms (IPSS-S) on the quality of life, measured using the Overactive Bladder questionnaire Short Form(OABq-SF HRQoL), was evaluated using multivariate regression models (linear and logistic)., Results: 958 patients, whose mean score (standard deviation) of the OABq-SF HRQoL was 57.9 (18.3),were included in the study. 55.6% received drug treatment for urinary symptoms. 616 patients (64.4%) reported a puntuation >3 in the item 8 of the IPSS. The adjusted analysis showed a significant reduction in the qualityof life of -1.1 (p<0.001) and -3.3 (p<0.001) points associated with the worsening of the symptoms of voiding and storage respectively. This worsening was also associated with a minor risk of satisfaction (OR=1.14;p<0.001 and 1.36; p<0.001) for the voiding and storage symptoms respectively., Conclusion: In patients with mixed LUTS both components show a negative effect on the quality of life, with a greater impact of the storage symptoms.

Background: The outcome of cancer patients with acute venous thromboembolism (VTE) may differ according to gender., Methods: We used the RIETE database to compare the rate of VTE (pulmonary embolism [PE] or deep vein thrombosis [DVT]) recurrences), major bleeding and mortality during the course of anticoagulation, according to gender., Results: As of August 2014, 11,055 patients with active cancer were enrolled in RIETE, of whom 5,104 (46%) were women. During the course of anticoagulation (mean: 142 days), 505 patients developed recurrent VTE, 429 bled and 2730 died. Compared with men, women had a significantly lower rate of fatal bleeding (risk ratio [RR]: 0.69; 95% CI: 0.47-0.99) and death (RR: 0.90; 95% CI: 0.83-0.97), and a non-significantly lower rate of PE recurrences (RR 0.83; 95% CI: 0.65-1.06) and major bleeding (RR: 0.89; 95% CI: 0.74-1.08)., Conclusions: During the course of anticoagulation, cancer women with VTE had a better outcome than men., (© 2015 Elsevier Ltd. All rights reserved.)

The aim of our study was to analyse changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay, costs and in-hospital mortality of patients hospitalised for pulmonary embolism in Spain over a 10-year period. We included all patients who were hospitalised for pulmonary embolism (ICD-9-CM codes 415.11 and 415.19) as the primary diagnosis between 2002 and 2011. Data were collected from the National Hospital Discharge Database, covering the entire Spanish population. 115 671 patients were admitted. The overall crude incidence increased from 20.44 per 100 000 inhabitants in 2002 to 32.69 in 2011 (p<0.05). In 2002, 13.3% of patients had a Charlson comorbidity index>2, and in 2011 the prevalence increased to 20.8% (p<0.05). Mean length of hospital stay was 12.7 days in 2002 and decreased to 9.99 in 2011 (p<0.05). During the study period, mean cost per patient increased from €3915 to €4372 (p<0.05). In-hospital mortality decreased from 12.9% in 2002 to 8.32% in 2011 (p<0.05). The increase in the use of computed tomographic pulmonary angiography over time was associated with increased incidence and lower mortality. Our results revealed an increase in the incidence of hospitalised pulmonary embolism patients from 2002 to 2011 with concomitant increase in comorbidities and cost. However, length of hospital stay and in-hospital mortality decreased., (©ERS 2014.)

Purpose of Review: Cancer patients with venous thromboembolism (VTE) are at increased risk of mortality. Estimating the risks for specific causes of death may help to weigh the risks and benefits of different therapeutic strategies in an individual patient., Recent Findings: In the Registro Informatizado de la Enfermedad Trombo Embólica Registry of 15 520 consecutive patients with VTE, cancer was present in 20% and was associated with a two-fold increase in the risk of fatal pulmonary embolism. In a subsequent study including 2474 women with cancer, 329 (13%) died during the first month. The incidence of fatal pulmonary embolism (n = 71) exceeded that of fatal bleeding (n = 22), except in women with cancer of the bladder or vulva. Then, we compared the mortality rate according to initial presentation in 3978 women with cancer and VTE, of whom 438 (11%) died during the first month. The risk of fatal bleeding was twice as high as the risk of fatal pulmonary embolism (12 vs. 5 deaths) in those with deep-vein thrombosis alone., Summary: The higher risk of dying from bleeding than from pulmonary embolism in some women with cancer and VTE suggests that a less aggressive anticoagulant strategy might reduce fatal bleeding more than it would increase fatal pulmonary embolism during this period.

The balance between the efficacy and safety of anticoagulant therapy in patients aged >/=90 years with venous thromboembolism (VTE) is uncertain. RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic VTE. We evaluated the efficacy and safety of anticoagulant therapy during the first three months in all patients aged >/=90 years. In addition, we tried to identify those at a higher risk for VTE. Of 21,873 patients enrolled from March 2001 to February 2008, 610 (2.8%) were aged >/=90 years. Of these, 307 (50%) presented with pulmonary embolism (PE), 240 (39%) had immobility >/=4 days, and 271 (44%) had abnormal creatinine levels. During the first three months of therapy, 140 patients aged >/=90 years (23%) died. Of these, 45 (32%) died of PE (34 of the initial episode, 11 of recurrent PE), 18 (13%) had fatal bleeding. Recent immobility >/=4 days was the most common risk factor for VTE (240 of 610 patients, 39%), but only 54 of them (22%) had received thromboprophylaxis. The most frequent causes for immobility were senile dementia, acute infection, trauma or decompensated heart failure. The duration of immobility was <4 weeks in 126 patients (52%), and most of them were bedridden at home. In conclusion, one in every four VTE patients aged >/=90 years died during the first three months of therapy. Of these, one in every three died of PE, one in every eight had fatal bleeding. Identifying at-risk patients may help to prevent some of these deaths.

Venous thromboembolism (VTE) occurs infrequently during pregnancy, and issues concerning its natural history, prevention and therapy remain unresolved. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic acute VTE. In this analysis, we compared the clinical characteristics and outcome for all enrolled pregnant and postpartum women with acute VTE, and all non-pregnant women in the same age range. Up to May 2005, 11,630 patients were enrolled in RIETE, of whom 848 (7.3%) were women aged <47 years. Of them, 72 (8.5%) were pregnant, 64 (7.5%) postpartum. Pregnant women presented less often with symptomatic pulmonary embolism (11%) than non-pregnant women (39%). VTE developed during the first trimester in 29 (40%) pregnant patients; in the second in 13; in the third in 30. Thrombophilia tests were more often positive in women who had VTE during the first trimester (odds ratio [OR]: 4.4; 95% CI: 0.9-2.4; p=0.037). Most patients in all three groups were initially treated with low-molecular-weight heparin (LMWH). As for long-term therapy, 75% of pregnant women received LMWH until delivery. There were no maternal deaths, and no pregnant patient had recurrence or bled before delivery. However, after delivery one patient (1.4%) developed recurrent thrombosis, four (5.6%) had major bleeding. In conclusion, VTE developed during the first trimester in 40% of the pregnant women, thus suggesting that thromboprophylaxis, when indicated during pregnancy, should start in the first trimester. No patient showed recurrence or bled before delivery, but after delivery the risk of bleeding exceeded the risk of recurrences.

Background: Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published., Objectives: To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area., Methods: We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data., Results: The incidence of IS was 2.40 cases/10(5) inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10(5) inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10(5) inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10(5) inhabitants/year and its frequency increased with age., Conclusion: The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles.

Background & Aims: Retrospective studies found an association between past sexual, physical, or psychological abuse and functional gastrointestinal disorders (FGIDs). However, there are no studies evaluating such an association concurrently with the ongoing abuse. Our aim was to investigate the prevalence of the main FGIDs, functional dyspepsia and irritable bowel syndrome, in 70 women reporting a situation of domestic violence to the police and to evaluate the level of psychological distress and its relationship with the presence of FGID., Methods: Through an interview between a social worker and the woman reporting abuse, digestive symptoms, psychological status, and type of abuse were recorded. These data were matched against police records. Functional dyspepsia and irritable bowel syndrome were diagnosed according to Rome II criteria., Results: Seventy-one percent of the women had an FGID: 67% functional dyspepsia, 47% irritable bowel syndrome, and 43% both. In two thirds of the cases, FGID onset occurred simultaneously with or soon after abuse onset. Only 34% of the women had sought medical attention for FGID symptoms. No differences were found between women with or without FGID regarding age and type or duration of abuse; psychological distress tended to be more severe in the group of women with FGIDs., Conclusions: Most women who suffer domestic violence (reported to the police) have functional dyspepsia and/or irritable bowel syndrome and also have elevated psychological distress. This has important implications, not only for comprehensive health care of women in a situation of abuse, but also for medical treatment of women with FGIDs.