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Background: Adolescents with intellectual disability in residential child care are a highly vulnerable population. The main goal of this study is to explore the characteristics of young people with intellectual disability in therapeutic residential care (TRC) in Spain and to identify the key variables associated with their referral to these services. Method: The total sample consisted of 473 young people in residential child care in Spain (63.8% boys), aged between 12 and 17 years (M = 15.32), divided into three different groups for comparison. An "ad hoc questionnaire" and the "Youth Self-Report" were used to collect information. Results: Participants with intellectual disability in TRC presented a higher frequency of externalising problems and risk behaviours than adolescents with disability in general residential programmes. However, it was lower than that of their peers without disability in TRC. Conclusions: Needs of adolescents with intellectual disability should be assessed before a referral to these facilities, in order to adapt the interventions provided.

Children and adolescents in residential care often present with emotional and/or behavioral problems associated to previous adverse experiences such as abuse and neglect. Consequently, child welfare systems have developed therapeutic residential care (TRC) programs to address the most complex needs of this population. The aim of this study is to explore the characteristics of youths in TRC comparing them with those of youth in general residential care (GRC), and to detect the factors predicting referral to TRC programs. The sample consisted of 900 adolescents aged 12–17 years old (M = 15.57; SD = 1.33; 66.2% boys), from General Residential Care (n = 554) and Therapeutic Residential Care (n = 346). Profile information was collected through official files and an ad hoc questionnaire. Mental health problems were evaluated using the youth self-report (YSR). Significant sociodemographic differences were found between groups. Also, a higher frequency of emotional abuse and neglect, worse mental health, more breakdowns in child welfare measures and risk behaviors were found among adolescents in TRC. Sociodemographic and familial characteristics, features of the protective process and risk behaviors were associated to referral to TRC programs. Youths in GRC and TRC present with mental and behavioral problems that make it necessary to implement prevention programs and early detection procedures. Screening and evaluation of youth's mental health and establishment of concrete criteria are suggested to ensure appropriate referral to the most suitable resource according to the individual needs of adolescents. [ABSTRACT FROM AUTHOR]

Background: In Spain the prevalence of obesity shows a north-south distribution. In the province of Granada its distribution is unknown. Objectives: (1) To study the prevalence of overweight and obesity in a sample population of school children and adolescents from different districts in the province of Granada. (2) To verify whether there are significant differences, depending on the district where the students reside. (3) To find a possible correlation between the nutritional state of the students and that of their parents. Methods: The population sample was composed of 977 school children and adolescents from 9 to 17 years of age, attending 13 public elementary schools and high schools in the city and province of Granada (Spain). In this analytical and multicentric study, the nutritional state of the subjects was evaluated by means of anthropometric measurements. Furthermore, data were collected by means of questionnaire to discover whether the respondents had a family history of overweight or obesity. Results:We found a high prevalence of overweight and obesity among the studied population. In girls, the greater prevalence of both overweight and obesity ranged from 12 to 14 years of age. In boys, there was an increase in the prevalence of overweight at twelve years of age. Regarding obesity, their rates were significantly lower than those described among girls. There were statistically significant differences for weight (F = 4,154; p = 0,003) but not for height (F = 1,928; p =0,105). But for the variable BMI was statistically significant difference (F = 5.037; P < 0.001) between the studied geographical areas. The results showed that the nutritional state of students with a family history of obesity was significantly worse (p < 0.01). Discussion: A high prevalence of obesity was found in the sample, especially among the girls. There exists a geographical distribution pattern, possibly derived from the socioeconomic characteristics of each area in the province. The existence of a family history of obesity is an important factor that can determine whether the child will also become obese in the future. [ABSTRACT FROM AUTHOR]

Air quality in nine National Parks in mainland Spain was assessed analysing SO 2 , NO x , O 3 , PM 10 and PM 2.5 data from background stations. As emissions in and around parks are limited, the levels of primary pollutants are low. Concentrations of secondary pollutants are high especially in summer due to photochemical production. The geographical variability of pollutants responds to regional emission patterns and the dominant circulation regimes in different regions resulting in west-east gradients for O 3 and PM . Seasonal variability of pollutants was also interpreted in virtue of transport scenarios, changes in photochemical activity and emissions variability. NO x and SO 2 , maximize in winter due to higher emissions while O 3 and PM do it in summer due to photochemical production, lower precipitation and, in the case of PM , the occurrence of African dust outbreaks. The diurnal evolution was interpreted in virtue of variability in emissions and changes in the Planetary Boundar Layer height. [ABSTRACT FROM AUTHOR]

The objective of this study was to first determine the nutritional state of a sample population of school children, and then analyze the distribution pattern of their subcutaneous fat layer. The sample was composed of 977 school children from the city and province of Granada (Spain). All of the children (524 girls and 452 boys) were 9 - 17 years of age. To study their nutritional state and the distribution of the subcutaneous fat layer, they were given a complete anthropometric evaluation, which included measuring their weight, height, body mass index, skin folds, and body perimeters. The results obtained showed a 23.01% prevalence of overweight in the female subjects and 20.81% in the male subjects. Furthermore, the female subjects had an obesity prevalence of 12.70% in comparison to the male subjects, whose obesity prevalence was 4.98 %. The distribution pattern of subcutaneous fat was found to be mainly located in the central part of body. The high percentage of overweight and obesity along with the development of a central fat distribution pattern (neck, chest, and abdomen) in these school children is clear evidence of potential cardiovascular risk. [ABSTRACT FROM AUTHOR]

Accurate classification of genetic variants is crucial for clinical decision-making in hereditary cancer. In Spain, genetic diagnostic laboratories have traditionally approached this task independently due to the lack of a dedicated resource. Here we present SpadaHC, a web-based database for sharing variants in hereditary cancer genes in the Spanish population. SpadaHC is implemented using a three-tier architecture consisting of a relational database, a web tool and a bioinformatics pipeline. Contributing laboratories can share variant classifications and variants from individuals in Variant Calling Format (VCF) format. The platform supports open and restricted access, flexible dataset submissions, automatic pseudo-anonymization, VCF quality control, variant normalization and liftover between genome builds. Users can flexibly explore and search data, receive automatic discrepancy notifications and access SpadaHC population frequencies based on many criteria. In February 2024, SpadaHC included 18 laboratory members, storing 1.17 million variants from 4306 patients and 16 343 laboratory classifications. In the first analysis of the shared data, we identified 84 genetic variants with clinically relevant discrepancies in their classifications and addressed them through a three-phase resolution strategy. This work highlights the importance of data sharing to promote consistency in variant classifications among laboratories, so patients and family members can benefit from more accurate clinical management. Database URL: https://spadahc.ciberisciii.es/., (© The Author(s) 2024. Published by Oxford University Press.)

Group B Streptococcus (GBS) is the leading cause of bacterial neonatal sepsis. This study aimed to confirm the effect of Ligilactobacillus salivarius V4II-90 on GBS colonisation during pregnancy. A randomised, multicentre, double-blind, placebo-controlled, parallel-group study was conducted in seven hospitals in Madrid, Spain. The sample was broken down into two groups with 20 participants each (n = 40) in order to show reduced GBS colonisation frequency in the probiotic versus the placebo group. Pregnant participants positive for vaginal-rectal colonisation before or during the 13th week of gestation were randomly assigned to either the placebo or the probiotic group. The probiotic, L. salivarius V4II-90 at 1 × 109 cfu/day was administered for 12 weeks, starting at week 21-23 of gestation. The primary outcome was the percentage of participants with vaginal and/or rectal GBS colonisation at the end of the intervention period (35 weeks of gestation). Secondary outcomes were changes in the microbial composition of vaginal and rectal exudates; premature delivery; premature rupture of membranes; intrapartum antibiotics; new-borns with early or late-onset GBS sepsis; adverse events (AEs); and GBS test results performed at the hospital at week 35 of gestation. Of the 481 participants included, 44 were vaginal-rectal colonised with GBS and randomised. 43 completed the study (20 in the probiotic group and 23 in the placebo group). After intervention, GBS was eradicated in six participants (27%) from the placebo group and in twelve participants (63%) from the probiotic group ( P = 0.030). None of the 185 AEs reported were identified as possibly, probably, or definitely related to the investigational product. In conclusion, oral administration of L. salivarius V4II-90 is a safe and successful strategy to significantly decrease the rates of GBS colonisation at the end of pregnancy and, therefore, to reduce the exposure of subjects and their infants to intrapartum antibiotic prophylaxis. Trial registered at ClinicalTrials.gov: number NCT03669094.

Introduction: Somatostatin analogs (SSA) prolong progression-free survival (PFS) in patients with well-differentiated gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). However, the eligibility criteria in randomized clinical trials (RCTs) have been restricted, which contrasts with the vast heterogeneity found in NENs., Methods: We identified patients with well-differentiated (Ki-67% ≤20%), metastatic GEP-NENs treated in first line with SSA monotherapy from the Spanish R-GETNE registry. The therapeutic effect was evaluated using a Bayesian Cox model. The objective was to compare survival-based outcomes from real-world clinical practice versus RCTs., Results: The dataset contained 535 patients with a median age of 62 years (range: 26-89). The median Ki-67% was 4 (range: 0-20). The most common primary tumor sites were as follows: midgut, 46%; pancreas, 34%; unknown primary, 10%; and colorectal, 10%. Half of the patients received octreotide LAR (n = 266) and half, lanreotide autogel (n = 269). The median PFS was 28.0 months (95% CI: 22.1-32.0) for octreotide versus 30.1 months (95% CI: 23.1-38.0) for lanreotide. The overall hazard ratio for lanreotide versus octreotide was 0.90 (95% credible interval: 0.71-1.12). The probability of effect sizes >30% with lanreotide versus octreotide was 2 and 6% for midgut and foregut NENs, respectively., Conclusion: Our study evaluated the external validity of RCTs examining SSAs in the real world, as well as the main effect-modifying factors (progression status, symptoms, tumor site, specific metastases, and analytical data). Our results indicate that both octreotide LAR and lanreotide autogel had a similar effect on PFS. Consequently, both represent valid alternatives in patients with well-differentiated, metastatic GEP-NENs., (© 2021 S. Karger AG, Basel.)

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, which has spread all over the world leading to a global pandemic. The fast progression of COVID-19 has been mainly related to the high contagion rate of the virus and the worldwide mobility of humans. In the absence of pharmacological therapies, governments from different countries have introduced several non-pharmaceutical interventions to reduce human mobility and social contact. Several studies based on Anonymized Mobile Phone Data have been published analysing the relationship between human mobility and the spread of coronavirus. However, to our knowledge, none of these data-sets integrates cross-referenced geo-localised data on human mobility and COVID-19 cases into one all-inclusive open resource. Herein we present COVID-19 Flow-Maps, a cross-referenced Geographic Information System that integrates regularly updated time-series accounting for population mobility and daily reports of COVID-19 cases in Spain at different scales of time spatial resolution. This integrated and up-to-date data-set can be used to analyse the human dynamics to guide and support the design of more effective non-pharmaceutical interventions., (© 2021. The Author(s).)

The activity of scientists promotes medical research in health services. However, on many occasions, these professionals do not know how to transfer their research results to the market. Therefore, it is worth providing data on aspects such as training in entrepreneurship and scientific mobility to foster knowledge transfer. This paper discusses data on the Spanish case in Health Sciences to devise effective policies in these areas. To this end, following the methodology of the Global Entrepreneurship Monitor report and the existing scientific literature, 291 researchers involved in scientific mobility in Spain have been interviewed. Of these, 90 belonged to health areas: Spanish scientists abroad (37), Scientists returned to Spain (16), and Young researchers in Spain (37). The results show that the mobile scientists in this area have more entrepreneurial and intrapreneurial intentions, have acquired more entrepreneurial skills, and have received more training in these subjects. Furthermore, there are few permanent positions for all these groups whose mobility decisions fundamentally depend on job opportunities, so the health authorities can intensify these measures to promote knowledge transfer.

Only a small fraction of hereditary breast and/or ovarian cancer (HBOC) cases are caused by germline variants in the high-penetrance breast cancer 1 and 2 genes ( BRCA1 and BRCA2) . BRCA1-associated ring domain 1 ( BARD1 ), nuclear partner of BRCA1 , has been suggested as a potential HBOC risk gene, although its prevalence and penetrance are variable according to populations and type of tumor. We aimed to investigate the prevalence of BARD1 truncating variants in a cohort of patients with clinical suspicion of HBOC. A comprehensive BARD1 screening by multigene panel analysis was performed in 4015 unrelated patients according to our regional guidelines for genetic testing in hereditary cancer. In addition, 51,202 Genome Aggregation Database (gnomAD) non-Finnish, non-cancer European individuals were used as a control population. In our patient cohort, we identified 19 patients with heterozygous BARD1 truncating variants (0.47%), whereas the frequency observed in the gnomAD controls was 0.12%. We found a statistically significant association of truncating BARD1 variants with overall risk (odds ratio (OR) = 3.78; CI = 2.10-6.48; p = 1.16 × 10 -5 ). This association remained significant in the hereditary breast cancer (HBC) group (OR = 4.18; CI = 2.10-7.70; p = 5.45 × 10 -5 ). Furthermore, deleterious BARD1 variants were enriched among triple-negative BC patients (OR = 5.40; CI = 1.77-18.15; p = 0.001) compared to other BC subtypes. Our results support the role of BARD1 as a moderate penetrance BC predisposing gene and highlight a stronger association with triple-negative tumors.

Background: Adolescents in Residential Child Care (RCC) report high levels of victimization. This has been linked to mental health problems and a higher risk of substance use and substance use problems. The present study aimed to evaluate the specific impact of different forms of victimization on alcohol and cannabis use problems among adolescents in RCC, attending to sex differences., Methods: 321 adolescents from 38 residential therapeutic care facilities in Spain participated in the study. Thirty-six different forms of victimization were evaluated, as well as alcohol and cannabis use problems. Impact of polyvictimization and specific forms of victimization on alcohol and cannabis use problems and disorders were calculated using Analysis of Variance (ANOVA) and logistic regression models., Results: Girls in RCC reported significantly more experiences of victimization. Polyvictimization was associated with alcohol use problems but not cannabis use problems. Property, domestic and community victimization showed the highest predictive role regarding alcohol and cannabis use disorders, with significant interactions with sex and migrant family background., Conclusions: Adolescents in RCC reported considerably high levels of victimization and alcohol and cannabis use problems. In this population, property victimization, as well as indirect domestic and community victimization were predictors of further substance use problems, with girls being particularly sensitive to victimization. Migrant family backgrounds can also have an influence on the impact of some victimization forms on substance use. Victimization associated to high-risk environments and families could contribute to explain the high levels of substance use problems in this population., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare, (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Waist circumference has been suggested as predictor for metabolic syndrome (MetS) in adolescents but it has not been compared with newly proposed anthropometric indexes. This study aimed to disclose the capacity of ten classic and novel anthropometric indexes to discriminate by the presence of MetS in this young population., Materials and Methods: A cross-sectional study was performed on 981 adolescents (13.2 ± 1.2 years) randomly recruited from eighteen schools in south-east Spain. Body fat percentage (BF%), abdominal volume index (AVI), body roundness index (BRI), body mass index (BMI), body adiposity index (BAI), body adiposity index for paediatrics (BAIp), conicity index (C-Index), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and body shape index (ABSI) were measured and calculated. Receiver-operator curves (ROC) were created to determine the discriminatory capacity of these anthropometric parameters for MetS., Results: The prevalence of MetS was 7.0% for boys and 6.1% in girls. Participants with MetS had significantly higher levels of blood pressure and plasma levels of lipids, glucose and insulin. All anthropometric indexes were elevated in MetS individuals compared to the non-MetS group. AVI and WC showed the highest AUC values (0.83 for boys and 0.86 for girls). In contrast, according to ROC analyses, no anthropometric index was capable of discriminating the components of MetS (hypertension, hypertriglyceridemia, hyperglycaemia and low-HDL levels), except for abdominal obesity., Conclusion: We suggest the use of WC and AVI, with the cut-off points presented herein, for the discrimination between adolescents with or without MetS., (© 2018 Stichting European Society for Clinical Investigation Journal Foundation.)

Objective: To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW)., Design: Descriptive cross-sectional study and χ 2 subanalysis, conducted through a national survey from november 1th to december 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs., Setting: ICUs of public, private centers, and consortia., Results: In total, 101 units responded (56.4%), corresponding to 1,827 beds and almost 95,000 incomes/year. The 85.1% are public hospitals, and 83.2% had residents. Of the responders, 22.8% don't use routinely AW assessment scales, being the most frequently used the Cormack-Mallampati association (35.6%). There's not intubation (IOT) protocol in 77.2%, nor DAW protocol in 75.2%. An 82.2% have a DAW cart. The 48.5% have training in IOT, and in VAD 53.5%. Having a DAW expert is significantly associated with greater training in IOT (60% vs. 39.3%; P=.03), DAW (64.4% vs. 44.6%; P=.04), and more AW protocols (73.4% vs. 37.5%; P=.000). Having an specific guideline for DAW management in UCI is considered necessary in 99%., Conclusions: There is room for improvement in AW management. It's necessary to identify an expert in DAW in each Unit, and the development of an specific guideline for DAW management in critical care., (Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Objective: To analyze the environmental factors (nutritional status, levels of physical activity and nutritional habits) and their possible association with bone mass in a population of young adults., Methods: The study population consisted of 200 subjects (117 women and 83 men) aged between 18 and 25 years (mean age 20.4 years ±2.2 years). Body composition parameters were measured by an electronic balance (TANITA BC-418MA), nutritional habits were estimated by 72-h dietary recall, level of physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and bone mass was measured by ultrasonography at the calcaneus., Results: There were significant differences in bone mass values ​​according to gender ( p = 0.013). Despite the fact that 70% of the subjects had a body mass index (BMI) within the normal range, 20% had overweight or obesity. 49% of the individuals had a moderate level of physical activity, although women had lower levels of physical activity than men (17.9% vs 8.4%). Most diets among young adults were hyperprotic, hyperlipidic and low-carbohydrates, with low-calcium and fiber intakes and high-phosphorus. Analysis of bone mass according to BMI showed higher values ​​as the weight category rises, with significant differences in women. Higher values ​​of bone mass were shown as the level of physical activity was higher, showing significant differences in males., Conclusion: Our results show that BMI and level of physical activity are significantly associated with bone health in a population of young adults, suggesting the relevance of promoting healthy lifestyles as a strategy for the early prevention of osteoporosis., Competing Interests: Conflict of interest: All authors do not have any possible conflicts of interest

Scientific mobility can stimulate entrepreneurship and intrapreneurship, acting as a catalyst for reducing imbalances between local and global science and the resulting socio-economic damage. This study evaluates both whether scientific mobility effectively promotes these concepts and the fundamental reasons to articulate effective policies for scientific mobility. Toward this end, a survey has been prepared following the methodology of Global Entrepreneurship Monitor (GEM) and current scientific literature. A total of 364 researchers involved in Spanish scientific mobility took part in the study: Spanish scientists abroad (135) and scientists returned to Spain (52), as mobile groups, and young researchers in Spain (177), as a group of scientists who could go abroad, but that have not yet begun to leave. The results demonstrate that scientific mobility does promote entrepreneurship and, especially intrapreneurship. Moreover, since permanent positions are scarce for these groups and their mobility decisions largely depend on job opportunities, the involved Spanish authorities and agents can improve scientific mobility by means suitable policies that make the most of this potential to the benefit of economic growth and job creation., Competing Interests: The authors have declared that no competing interests exist. This study was supported by Fundación Hergar-Expediente FH2016-008 (http://www.fundacionhergar.org/) and Grupo REACCIONA (http://www.gruporeacciona.com/). This does not alter adherence to PLOS ONE policies on data sharing. There are no relevant declarations relating to employment, consultancy, patents, products in development, marketed products, to declare.

Introduction: Capsule endoscopy (CE) has become a first-line tool for small bowel (SB) examination. However, adverse events (AEs), such as CE retention or aspiration, may occur. The aims of this study were to evaluate incidence, clinical outcomes and therapeutic approaches of CE-related AEs in the largest series published to date., Methods: Data from 5428 procedures performed at 12 institutions between August 2001 and January 2012 were retrospectively analyzed. Baseline patient characteristics; procedure; type, localization and symptoms before/after AEs; previous patency tests performed; therapeutic management and patient's outcome were recorded., Results: The overall incidence of CE-related AEs was 1.9%: 2.0% for SB, 0.9% for esophageal and 0.5% for colon CE. The incidence of capsule retention was significantly higher than capsule aspiration (1.87% vs. 0.003%; p < 0.05), in patients suffering from inflammatory bowel disease (IBD) than in obscure GI bleeding (OGIB) (3.3% vs. 1.5%; p < 0.05) and in patients with the combination of nausea/vomiting, abdominal pain and distension. The SB was the most frequent localization of retention (88.2%). The use of patency tests -except for Patency© capsule- before CE was not a good predictor for AEs. Most of the patients with AEs developed no or mild symptoms (97%) and were managed by non-surgical methods (64.4%)., Conclusions: CE-related AEs are uncommon and difficult to predict by imagiological examinations. SB retention, that is usually asymptomatic, is the most frequent AE. In absence of symptoms, non-surgical management of CE-related AEs is recommended.

Aim: To compare the current capsule and a new prototype at 2 and 4 frames-per-second, respectively, in terms of clinical and therapeutic impact., Methods: One hundred patients with an indication for capsule endoscopy were included in the study. All procedures were performed with the new device (SB24). After an exhaustive evaluation of the SB24 videos, they were then converted to "SB2-like" videos for their evaluation. Findings, frames per finding, and clinical and therapeutic impact derived from video visualization were analyzed. Kappa index for interobserver agreement and χ (2) and Student's t tests for qualitative/quantitative variables, respectively, were used. Values of P under 0.05 were considered statistically significant., Results: Eighty-nine out of 100 cases included in the study were ultimately included in the analysis. The SB24 videos detected the anatomical landmarks (Z-line and duodenal papilla) and lesions in more patients than the "SB2-like" videos. On the other hand, the SB24 videos detected more frames per landmark/lesion than the "SB2-like" videos. However, these differences were not statistically significant (P > 0.05). Both clinical and therapeutic impacts were similar between SB24 and "SB2-like" videos (K = 0.954). The time spent by readers was significantly higher for SB24 videos visualization (P < 0.05) than for "SB2-like" videos when all images captured by the capsule were considered. However, these differences become non-significant if we only take into account small bowel images (P > 0.05)., Conclusion: More frames-per-second detect more landmarks, lesions, and frames per landmark/lesion, but is time consuming and has a very low impact on clinical and therapeutic management.

Purpose: Suffering is a complex multifaceted phenomenon, which has received limited attention in relation to children with terminal illness. As part of a wider study we interviewed parents of children with terminal illness to elicit their perspectives on suffering, in order to provide initial understanding from which to develop observational indicators and further research., Methods: Qualitative descriptive study with semi-structured interviews made "ad hoc". Selection through deliberate sampling of mothers and fathers of hospitalised children (0-16 years old) with a terminal illness in Granada (Spain)., Key Results: 13 parents were interviewed. They described children's suffering as manifested through sadness, apathy, and anger towards their parents and the professionals. The isolation from their natural environment, the uncertainty towards the future, and the anticipation of pain caused suffering in children. The pain is experienced as an assault that their parents allow to occur., Conclusions: The analysis of the interview with the parents about their perception of their ill children's suffering at the end of their lives is a valuable source of information to consider supportive interventions for children and parents in health care settings. An outline summary of the assessed aspects of suffering, the indicators and aspects for health professional consideration is proposed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Suicides account for a number of deaths that is higher than other traumatic deaths in Spain. Non-fatal suicidal behaviour occurs in a greater proportion than such behaviour with a deadly outcome. There are many causes for this behaviour and it is important to become familiar with them if it is to be prevented. The aim of this article is to describe the characteristics of non-mortal suicidal behaviour in the province of Granada., Method: A retrospective descriptive study of the characteristics of non-mortal suicidal behaviour in Granada during the years 2008 and 2009, according to the database of the Provincial 061 Service in Granada. The sample includes the demands made to this service in which the literal reason for the alert included the terms: suicide, self-harm or the threat of suicide. The statistical analysis was done with the SPSS 15.0 program. We analyzed the variable non-mortal suicidal behaviour with respect to the independent variables: sex, age, month, day of the week, time slot, health district, resolution of the demand (assigned priority) and further attempts., Results: In total we analyzed 535 demands typified as intentional self-injury by unspecified means. Statistically significant differences were found when comparing the data for the two years with respect to the month chosen, and in the relationship between age range and time slot of the suicide attempts., Conclusions: Despite its limitations, the characterization of suicidal behaviour in our province offers essential information, and could be useful in designing and developing a program of psychosocial intervention for the prevention of suicidal behaviour adjusted to the specific profiles of our population.

The aim of this research is to identify the severity and type of behavioural problems found in a sample of 181 Spanish adolescents, aged 11 and 18, who have been, or still are in the protective system and to provide give up-to-date figures about behavioural problem situations of children are living under protective measures, and to determine the existence of diverse behavioural problems concerning the kind of care the adolescents are receiving (adoption, residential care, or with grandparent fostering). The Child Behavior Checklist (CBCL) was used in this study. The results show that most of the adolescents scored within the normal range and only a small percentage of them had important behavioural problems and were therefore situated within the clinical range of the trial. The adopted adolescents scored higher than the adolescents who were either fostered by their extended families or in residential care. The main problems identified in each section are discussed, along with the results, in the context of modernising the Spanish protection system.

In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenological, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe that although patients don't ask questions, they know what is happening to them. Many professionals feel bad when communicating bad news. In hospitals, doctors take responsibility for doing so. The attitudes of professionals are influenced by their sense of responsibility and commitment to the principle of patient autonomy, as well as to the level of their agreement with the cultural context. The tacit agreement of silence makes communication impossible: the patient does not ask questions, the health professional does not want to be interrogated, and family members don't talk about the disease and want health professionals to follow their example. This situation is detrimental to patients and their families and leads to suffering, low levels of satisfaction, and feelings of guilt and helplessness. Health care professionals must acquire the means and the skills for communicating bad news.

Liver-related disease has increased as a cause of hospitalization and in-hospital death in HIV-infected patients since the introduction of highly active antiretroviral therapy (HAART). Better clinical management of these diseases may contribute to decreasing their incidence. Admissions due to liver-related disease in HIV-infected patients in our institution increased from 2.9% in 1998-1999 to 11.3% in 2004-2005 (P = 0.001). In-hospital deaths due to this cause increased from 2.7% in 1998-1999 to 26% in 2002-2003 (P = 0.02), with a subsequent decrease to 22% in 2004-2005. Hospitalization of HIV-infected patients for liver-related disease continues to increase, whereas the rate of in-hospital deaths from this cause appears to have changed since 2003.

Introduction: The purpose of this cross-sectional study is to obtain a sociodemographic, clinical, psychosocial functioning and therapeutic profile of bipolar outpatients in the Madrid Community., Methods: A total of 115 outpatients were consecutively recruited by 10 psychiatrists., Results: Mean time between initial symptoms and an accurate bipolar diagnosis was of 7.6 years. A depressive episode was the onset of the illness in most patients independently of clinical subtype. Syndromal or subsyndromal symptoms were present in 47% of the patient population, dominating the depressive polarity (33.1%). A subjectively reduced perception of quality of life was associated to the presence of depressive symptoms and a worse clinical outcome last year. More than half of the patients (58.2%) were overweight or obese. Lithium was the most frequently used mood stabilizer (71.3%), whereas 41% of the patients were taking at least three psychotropic drugs., Conclusions: Results of this study widely confirm previous data on bipolar disorder. Reduction in quality of life of bipolar patients associated to depressive symptoms must be highlighted. It is necessary to optimize treatments in bipolar disorder in order to improve prognosis.

Background: The detection and diagnosis of present or past hypomanic episodes is of key importance for the differential diagnosis between depressive disorders and type II bipolar disorder. However, there are few instruments available to satisfactorily screen for the latter condition. The Hypomania Symptom Checklist-32 (HCL-32) is a self-applied questionnaire with 32 hypomania items and 8 severity and functional impact items which is being developed in several European countries for this purpose. Our aim was to develop and validate the psychometric properties of the HCL-32 scale in Spain in patients with bipolar disorder and to compare its properties with other instruments available for the detection of bipolar II disorder., Methods: Patients were selected from 15 psychiatric outpatient departments, diagnosed with type I or type II bipolar disorder (BDI and BDII) and unipolar major depression (MD) according to DSM-IV-TR criteria. A control group of healthy subjects (HS) was likewise assessed. The patient selection criteria included a well-established diagnosis and a stable disorder and pharmacological treatment. The HCL-32 was administered to 237 subjects distributed among the above groups, on two occasions four weeks apart. We analysed the internal consistency, test-retest reliability and discriminative capacity of the HCL-32., Results: The internal consistency of the Spanish version of the HCL-32, evaluated by Cronbach's alpha, was 0.94. Mean of affirmative questions by group were 21.2 (SD 5.8) for BDI, 19.3 (SD 6.2) for BDII, 8.6 (SD 6.6) for MD and 6.6 (SD 6.1) for HS, with statistically significant differences between them (Kruskal-Wallis test, p<0.001). Concurrent validity using the diagnosis variable was 0.72. Test-retest reliability was 0.90. We analysed the best cut-off point by means of a ROC curve analysis; for 14 affirmative responses, a sensitivity of 0.85 95%CI (0.78, 0.91) and specificity of 0.79, 95%CI (0.72, 0.87) were obtained. The positive and negative probability ratios were 4.1 and 5.3 (1/0.19 respectively). HCL-32 shows a dual factor structure of items, one as an energy-activity factor and another one as a factor involving items related to disinhibition and problems with self-control and attention., Limitations: The sample size of bipolar patients (particularly type BDII) should be increased in further studies., Conclusions: The Spanish version of the HCL-32 has good psychometric properties and sufficient sensitivity and specificity, detecting 8 out of every 10 patients with BD. The HCL-32 is a useful screening tool of patients with bipolar disorder in clinical settings. In its present form it adequately discriminates between bipolar and unipolar or healthy subjects, but not between BD I and BII.

Crohn's disease (CD) presents a complex multifactorial etiology with genetic and environmental factors contributing to the disorder. Epidemiological studies have shown that three major CARD15 polymorphisms, R702W, G908R, and 1007fs, are associated with CD. We studied the frequencies of these three polymorphisms in patients from Toledo, Spain, and compared them with the frequencies found in studies of other populations. A total of 183 patients with CD and 172 healthy controls from Toledo, Spain, were included in this study. All of these individuals were genotyped for the three CARD15 polymorphisms R702W, G908R, and 1007fs. Frequencies were analyzed to identify any genotype-phenotype associations. The control population exhibited frequencies of CARD15 polymorphisms similar to the results of previous studies, 3.4%, 1.1%, and 2.0% for the R702W, G908R, and 1007fs polymorphisms, respectively, whereas CD patients had allele frequencies of 7.6%, 3.0%, and 4.6%, respectively. Significant associations were found between the presence of R702W and patients carrying two susceptibility variants with early age of onset and stricturing pattern.

Hydatidosis in Spain has been a relevant public health problem which has been partly solved due to the implementation of different preventive programs. In this work the thoracic hydatidosis cases diagnosed at our hospital during the last 15 years are reported. Forty patients with thoracic hydatidosis are analyzed. Most of them had pulmonary hydatidosis (32), 14 had liver and lung cysts, and in eight cases of thoracic hydatidosis there was no pulmonary involvement; eight patients had been operated previously because of hydatidosis. A discussion follows of the epidemiologic, clinical and radiologic characteristics, as well as laboratory data, endobronchial changes, diagnostic cost/effectiveness of bronchoscopy when performed, and results after surgery. To remark the high percentage of complicated hydatidosis and uncommon locations, seven cases of multiple hydatidosis (two of them with cardiac involvement), five cases had hepato-thoracic communication, three with chest wall involvement, and one with exclusive cardiac involvement, as well as one case of calcified pulmonary hydatidosis. In most patients (37), treatment was surgery with a low number of complications at post-surgery (3). Three relapses were noted at follow-up.

Four hundred and sixty strains of obligate anaerobes were isolated from 216 cases of ovine foot rot distributed throughout Spain. The predominant species was Dichelobacter nodosus, which was isolated in 168 cases (77.8 per cent). A higher proportion of the strains of D nodosus than of the other strains had elastolytic activity, 118 of the 168 strains degrading elastin. Species belonging to the genus Prevotella were isolated from 96 cases (44.4 per cent). Serotyping of the D nodosus strains showed that serovars A1, A2 and C were the most commonly isolated in Spain.

Objectives: A population of Spanish men aged over 49 years were screened for prostate cancer. The detection rate and the clinical features of the tumors found are analyzed., Methods: The study comprised two phases: Phase I: Subjects were evaluated by digital rectal examination (DRE) and prostate-specific antigen (PSA) was determined. Phase II: Subjects with a positive DRE or PSA > 4 ng/ml were evaluated by transrectal US. If PSA was > 10 ng/ml or DRE or transrectal US were abnormal, a transrectal biopsy was performed; most of these were sextant. PSA density was used as a criterion for biopsy in subjects with PSA 4-10 ng/ml and normal DRE and transrectal US. From June, 1993 to August 1994, 1091 subjects have been evaluated., Results: 1) The mean age was 59.32 years; 379 (34.7%) had low voiding symptoms. 2) 5.07% and 9.07% had abnormal DRE and PSA, respectively; 135 subjects (12.4%) with a questionable DRE and/or PSA were evaluated by transrectal US. 3) Of the 97 biopsies (8.8%) performed, prostate cancer was detected in only 11 (1%); 8.8 biopsies were required to detect one case of prostate cancer. 4) Clinically, 7 tumors (63.6%) were localized and 4 (36.3%) were in the advanced stages., Conclusions: 1) The participation rate was low (21%). 2) The PSA mean increased with age. Prostate volume was the factor that most influenced PSA changes. 3) PSA detected more tumors (10 cases; 90.9%) than DRE (8 cases; 72.7%). Approximately 27.27% of the lesions were detected by PSA and not by DRE, while 9.09% were detected by DRE alone. 4) The detection rate was low (1.008%); 0.91% for PSA, 0.73% for DRE and 51% (n = 135) for transrectal US. 5) We have detected more tumors in the clinically advanced stages (36.6%) than other series, perhaps because this is the first time this type of study has been performed in this population. In view of the foregoing results, we do not advocate performing these studies routinely. Perhaps in subsequent studies with a longer follow up, a higher detection rate can be achieved for localized tumors that are potentially curable.

Background: Pleural biopsy is usually considered important for the diagnosis of pleural effusions, especially for distinguishing between tuberculosis and neoplasia, even though tuberculous pleural fluid contains sensitive biochemical markers. In regions with a high prevalence of tuberculosis, and in patient groups with a low risk of other causes of pleurisy, the positive predictive value of these markers is increased. The criteria for performing a pleural biopsy under these circumstances have been investigated, using adenosine deaminase (ADA) as a pleural fluid marker for tuberculosis., Methods: One hundred and twenty nine patients with a pleural effusion aged < or = 35 years (mean (SD) 25.2 (4.9) years) were studied. Seventy three were men. Eighty one effusions (62.8%) were tuberculous, 12 (9.3%) parapneumonic, and 10 (7.7%) neoplastic, five were caused by pulmonary thromboembolism, four by systemic lupus erythematosus, seven by empyema, three following surgery, one was the result of asbestosis, and one of nephrotic syndrome. In five cases no definitive diagnosis was reached. ADA levels were determined by the method of Galanti and Giusti., Results: The diagnostic yield of procedures not involving biopsy was 94.5% (122/129). Pleural biopsy provided a diagnosis in a further two cases, but not in the remaining five. All tuberculous cases had pleural fluid levels of ADA of > 47 U/l (mean (SD) 111.1 (36.6) U/l). The only other cases in which ADA exceeded this level were six of the seven patients with empyema. Cytological examination of the pleural fluid diagnosed eight of the 10 neoplastic cases, compared with six diagnosed by pleural biopsy., Conclusions: In a region with a high prevalence of tuberculosis procedures not involving pleural biopsy have a very high diagnostic yield in patients with a pleural effusion aged < or = 35 years, making biopsy necessary only in cases in which pleural levels of ADA are below 47 U/l, pleural fluid cytology is negative and, in the absence of a positive basis for some other diagnosis, neoplasia is suspected.

The primary resistance of 100 specimens of Mycobacterium tuberculosis isolated in patients with active tuberculosis confirmed bacteriologically was studied prospectively over a period of 15 months. Strains resistant to 1 or more drugs were found in 5 patients. Three patients presented resistance to 2 drugs (isoniazide and streptomycin in 2 and rifampicin and isoniazid, streptomycin and ethambutol); and the fifth was resistant only to pyrazinamide. Owing to the few instances of primary resistance found, it was impossible to establish whether any of the factors analyzed in each patient was related to a higher index of resistance, although 4 of the 5 resistant strains came from respiratory specimens. We conclude that the index of primary resistance in our area is low and this allows us to do without prescribing a fourth drug in the first two months of anti-tuberculosis therapy, and makes routine sensitivity tests unnecessary for patients with no history of prior treatment for tuberculosis.

The personality disturbances imply problem within the psychiatric assistance, both for its difficult delimitation and classification and for the limited results and bad use obtained from therapeutic resources. We studied 402 patients psychiatric service of a general hospital over a period approximately 2 years, 70 (17.5%) were diagnosed DSM-III with Personality disturbances: 44 females (62.9%) and 26 males (37.1%), of an age group between 18 and 67 years old. The most frequent diagnosis was of histrionic of the personality followed by unspecific and border-line. Within the histrionic disturbance of the personality there was a clear predominance of women, whereas in the others types, no significant differences were observed.

Two types of intradural needles, 25 gauge (Qincke bevel) and 24 gauge (Sprotte type bevel) in 535 intradural anaesthesias were compared. Sprotte type needle is a modification of the Withacre needle. Postspinal total headache had an incidence of 8.9%, being significantly less (p less than 0.01) with the Sprotte needles (4.9 versus 11.8%). Spinal headache were significantly more frequent in women and in patients with an age less than 40 years, and there was no significance between the two needles when patients were older than forty. We conclude that Sprotte bevel needle decreases significatively the incidence of post-puncture headache if the patients are younger than forty, but it is an important fact that the different factors involved: age, sex and needle type, might be taken into account when we need conclusions to be drawn.