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This paper analyzes the practice of photojournalism in Spain and, specifically, focuses on the study of the graphic archive of the EFE Agency (1939-) and its own production, developed within and outside its borders. The acquisition of funds has been taken into consideration as part of this process and, in the same way, it has also been necessary to consider the creation, in the year 2000, of the digital graphic archive: The Photo Library, inheritance of the thematic classification of analog and the nomenclature and, in this process, the documentation system used has been contributed as a result of the conclusions - through primary sources and direct observation - with emphasis on the thematic classification used. [ABSTRACT FROM AUTHOR]

Dolutegravir (DTG) based dual therapies for treating PLWHIV are a standard of care nowadays. Switching to DTG and lamivudine (3TC) safety and efficacy were proven in TANGO randomized clinical trial. This multicenter retrospective study included 1032 HIV virologically suppressed patients switching to DTG+3TC from 13 Spanish hospitals. DTG+3TC provided high rates of undetectable viral load over 96%, corresponding to 96.6% (889/921) at 24 weeks, 97.5% (743/763) at 48 weeks, and 98.3% (417/425) at 96 weeks. No significant differences are evident when comparing the total population according to sex, presence of comorbidity, or presence of AIDS. The analysis for paired data showed an increase in CD4+ cell count. A statistically significant increase in CD4+ lymphocyte count was found in those without comorbidities in the three-time series analyzed [average increase at 24 weeks: 48.7 (SD: 215.3) vs. 25.8 (SD: 215.5), p-value = 0.050; a mean increase at 48 weeks: 75.1 (SD: 232.9) vs. 42.3 (SD: 255.6), p-value = 0.003; a mean increase at 96 weeks: 120.1 (SD: 205.0) vs. 63.8 (SD:275.3), p-value = 0.003]. In conclusion, our cohort demonstrates that DTG+3TC is an effective treatment strategy for virologically-suppressed PLWHIV independent of age, sex, and HIV stage, as well as a safe and durable strategy. [ABSTRACT FROM AUTHOR]

Copyright of Revista Colombiana de Psiquiatria is the property of Asociacion Colombiana de Psiquiatria 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.)

Copyright of Educatio Siglo XXI is the property of Servicio de Publicaciones de la Universidad de Murcia 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.)

Background: Palliative sedation has been used to refer to the practice of providing symptom control through the administration of sedative drugs. The objective of this article was to characterise palliative sedation use in inpatients at a medium-stay palliative care unit. Material and methods: A cross-sectional study was conducted on 125 randomly selected patients (aged 15 or older) who had died in 2014. The Palliative Performance Scale was used to evaluate the functional status. Results: Palliative sedation was documented in 34.4% of the patients and midazolam was the most commonly used sedative agent (86.0%). More than half (53.5%) of those who received sedation presented with delirium. Liver dysfunction was more frequent in the sedated patients (p=0.033) and patients with heart disease were less likely (p=0.026) to be sedated. Conclusion: Palliative sedation is an ethically accepted practice. It was commonly midazolam-induced, and differences were documented, among sedated and non-sedated patients, in terms of liver dysfunction and heart disease. [ABSTRACT FROM AUTHOR]

Soil microorganisms may play a pivotal role in the uptake of Fe and other micronutrients by plants. However, direct evidence of the effects of changes in microbial community structure on micronutrient availability to plants is scant. In this work, we hypothesized that shifts in microbial community structure and diversity in soil influence Fe availability to lupin plants. To obtain samples from the same soil with different microbial community structure, in October 2009 we sampled the surface horizon (0–0.1 m deep layer) of a calcareous (Chromic Haploxerert) soil under an ongoing long-term (27 yr) tillage experiment in southern Spain involving conventional tillage with soil inversion (CT) and no-till (NT). Samples of CT and NT soil were used to grow white lupin (Lupinus albus L.) under controlled conditions, and the concentration and total contents in micronutrients of plant shoots taken to be indicators of their availability in soil. The total contents in Fe, Cu, Mn and Zn of shoots increased with increasing number of colony forming units (CFU) of oligotrophic bacteria, which explained around 90% of the variability of Fe and Cu in shoots (P < 0.01). Soil under CT had five times greater CFU counts of oligotrophic bacteria (P < 0.001) and showed higher microbial diversity than soil under NT. These results account for the increased concentrations and total contents of Fe, Mn, and Cu in shoots of lupin grown on soil under CT relative to NT (41, 40 and 88% higher, respectively; P < 0.05). The total plant contents of nutrients were related to neither the total number of viable cells nor the biochemical parameters associated to microbial activity, which were greater under NT than under CT. Therefore, the population of oligotrophic bacteria in soil, which was affected by tillage method, has a marked influence on micronutrient availability to plants. • Increased microbial activity or biomass in no-till did not result in improved plant nutrition. • Uptake of Fe, Cu, Mn, and Zn increased with increased population of oligotrophic bacteria in soil. • These bacteria explained the increased uptake of Fe, Cu, and Mn in conventional tillage when compared with no-till. • The effect of P on oligotrophic bacteria contributes to explain the decreased micronutrient uptake with increased Olsen P. [ABSTRACT FROM AUTHOR]

Copyright of Matronas Profesion is the property of Ediciones Mayo 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.)

Purpose: The peri-urban region to the south east of Madrid contains a mixture of housing, manufacturing industry and farming, some of which disperse metals, in particular cadmium, copper, lead, and zinc, into the soil. We have mapped the concentrations of these elements and identified the major influences on their distributions. Material and methods: We sampled the topsoil at 125 sites across 1,050 km of peri-urban land to the south east of the city on two grids, one nested inside the other. At each site, we measured the current contents of the four trace elements in the soil. We used robust geostatistical methods to model the complex spatial distributions of the data as mixtures of fixed and random effects. The empirical best linear unbiased predictor was used to map the elements. Site descriptors (lithology, land cover, cultivation, relief, erosion, and stoniness) were then included as covariates to identify significant effects on trace element concentrations. Results and discussion: The complex spatial distributions of the elements seem to arise from several sources. The concentrations generally increase from southeast to northwest, i.e., with increasing proximity to Madrid itself, the main potential source of pollution. This pattern is clear for lead and similar for copper and zinc, though with 'hot spots' at or near industrial sites. The spatial pattern of cadmium is more complex and depends on varied lithology, industry, and land use such as irrigation and cultivation. In general, the concentrations of the four elements appear to decrease with increases in stoniness and erosion, and to be largest on the valley floors. Conclusions: Robust geostatistical methods enabled us to analyze and map the complex patterns of spatial variation of trace elements in a peri-urban region of Madrid. They show that distance to the city center, lithology, manufacturing industry, and cultivation all play their parts in loading the soil with lead, copper, zinc, and cadmium. In the event, none of the metals has yet exceeded the legislative thresholds, but some concentrations are already substantially greater than would arise from natural sources, especially closest to Madrid itself. [ABSTRACT FROM AUTHOR]

Background: The successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs. Methods: A cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire. Results: More than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations. Conclusions: Most PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools. [ABSTRACT FROM AUTHOR]

Management of crops sensitive to iron deficiency chiorosis (IDC) includes the use of effective methods to predict the incidence of this nutritional disorder. The objective of this work was to validate the use of hydroxylamine-extractable Fe (Feha) for predicting the incidence of IDC in olive (Olea europaea L.), grapevine (Vitis berlandieri Planch × Vitis rupestris Scheele), chickpea (Cicer arietinum L.), anti sunflower (Helianthus annuus L.) typical of the Mediterranean climate of Spain. This test was compared with the "active lime" test and oxalate, citrate-ascorbate, and diethylenetriaminepentaacetic acid extractions. Overall, Feha provided the best estimates of leaf chlorophyll concentration, accounting for 26 to 66% of the variance (linear-plateau regression) depending on the particular crop. The optimum extractant/soil ratio for accurately predicting the chlorophyll content was 100 for olive and 20 for grapevine, chickpea, and sunflower. The concentration of Fe in the hydroxylamine extracts was found to be related to that of poorly crystalline Fe oxides in the soil, which testifies to the ability of this test to accurately predict the incidence of IDC. Proposed critical levels of Feha below which IDC is likely to occur were 60 mg kg-1 for olive, 11 mg kg-1 for grapevine, and 10 mg kg-1 for chickpea and sunflower. [ABSTRACT FROM AUTHOR]

The Bologna Process aims to create a European Higher Education Area by 2010. The three priorities of the Bologna Process are: introduction of a homogeneous three cycle system (bachelor/master/doctorate), quality assurance and recognition of qualifications and periods of study. The Bologna Declaration of June 1999 has put in motion a series of reforms needed to make European Higher Education more attractive for Europeans and for students and scholars from other continents. Together with this, reforms are aimed at building a system which, in practical terms, can match the performance of the Universities of United States. The reforms that affect the Spanish Bachelor Degree in Law will be mainly focused on learning methodology. [ABSTRACT FROM AUTHOR]

The Bologna Process aims to create a European Higher Education Area by 2010. The three priorities of the Bologna Process are: introduction of a homogeneous three cycle system (bachelor/master/doctorate), quality assurance and recognition of qualifications and periods of study. The Bologna Declaration of June 1999 has put in motion a series of reforms needed to make European Higher Education more attractive for Europeans and for students and scholars from other continents. Together with this, reforms are aimed at building a system which, in practical terms, can match the performance of the Universities of United States. The reforms that affect the Spanish Bachelor Degree in Law will be mainly focused on learning methodology. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. 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.)

Iron deficiency chlorosis is a major nutritional problem affecting sensitive cultivated plants in calcareous soils. Our main objective was to study the suitability of various Fe extracts for predicting the incidence of Fe deficiency chlorosis in calcareous soils from southern Spain. Six single Fe extractions were used: unbuffered hydroxylamine (room temperature), DTPA (diethylenetriaminepentaacetic acid) at 2 and 17 h, ‘rapid’ ammonium oxalate, ammonium oxalate, and pyrophosphate. The Fe forms that account for most of the Fe supplied to plants were studied by using a sequential Fe fractionation process involving four extractants: citrate-bicarbonate, citrate at pH 6, citrate-ascorbate (a mild reductant), and citrate-bicarbonate-dithionite (a strong reductant). Suitability of Fe extracts for predicting Fe chlorosis was checked by establishing correlations between the amount of Fe extracted from soil and the chlorophyll content in white lupin (Lupinus albus L.). The amounts of Fe extracted by hydroxylamine accounted for a minimal portion of Fe associated with oxides, thus indicating that this extractant is not efficient at reducing Fe oxides. Hydroxylamine Fe, however, accounted for 63 and 72% of the variance in chlorophyll meter readings at 2 and 3 wk of growth, respectively, in contrast to ‘rapid’ oxalate (32 and 11%) and DTPA at 2 h (29 and 15%). At 3 wk of growth, the variance in meter readings explained by hydroxylamine Fe was much higher than that explained by the active CaCO3 equivalent (56%). This ability of hydroxylamine Fe to predict chlorophyll meter readings is due to the relationship of the Fe extract to poorly crystalline Fe fractions, which showed the strongest relationship with the active CaCO3 content (R² = 0.84, P < 0.001). [ABSTRACT FROM AUTHOR]

In the present study, we addressed the potential impact of climate change on coastal erosion along the 28 beaches of the Basque Coast (150 km). A shoreline evolution model including cross-shore and alongshore sediment transport formulations, short- and long-term processes and hard structure treatment is developed. The historical analysis of the shoreline evolution is performed by forcing the model with waves and storm surges from reanalysis data, and with tides from in situ water level measurements. The model is calibrated and validated by using morphological information derived from the KostaSystem coastal video monitoring system. The analysis of the future impact of climate change on the sandy beaches is carried out using two sea level projections (RCP 4.5 and RCP 8.5 scenarios) and their confidence intervals, combined with synthetic wave series that allowed a probabilistic fashion outcome. The results show that the shoreline mean erosion due to both short- and long-term processes is in the range of 10–45 m under the RCP 4.5 scenario and 14–66 m under RCP 8.5 by the year 2100, which indicate the great vulnerability of the beaches of the Basque Coast. Still, the response of the studied systems is highly variable, owing to the intrinsic characteristic of each site. This result points to the difficulty of taking general management measures and highlights the need for management strategies at the local level. • A shoreline evolution model suitable for urban beaches is set up along the sandy systems of the Basque Coast. • The model outcome is validated against the data obtained from a video monitoring system and handled in a probabilistic way. • A new climate change beach impact indicator (beach recovery potential loss) is analysed. • Shoreline mean erosion is in the range of 10–45 m under the RCP 4.5 scenario and 14–66 m under RCP 8.5 by the year 2100. • Results point to the need of local management strategies. [ABSTRACT FROM AUTHOR]

To assess the effect of hydroxychloroquine (HCQ) and Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as pre-exposure prophylaxis on COVID-19 risk. EPICOS is a double-blind, placebo-controlled randomized trial conducted in Spain, Bolivia, and Venezuela. Healthcare workers with negative SARS-CoV-2 IgM/IgG test were randomly assigned to the following: daily TDF/FTC plus HCQ for 12 weeks, TDF/FTC plus HCQ placebo, HCQ plus TDF/FTC placebo, and TDF/FTC placebo plus HCQ placebo. Randomization was performed in groups of four. Primary outcome was laboratory-confirmed, symptomatic COVID-19. We also studied any (symptomatic or asymptomatic) COVID-19. We compared group-specific 14-week risks via differences and ratios with 95% CIs. Of 1002 individuals screened, 926 (92.4%) were eligible and there were 14 cases of symptomatic COVID-19: 220 were assigned to the TDF/FTC plus HCQ group (3 cases), 231 to the TDF/FTC placebo plus HCQ group (3 cases), 233 to the TDF/FTC plus HCQ placebo group (3 cases), and 223 to the double placebo group (5 cases). Compared with the double placebo group, 14-week risk ratios (95% CI) of symptomatic COVID-19 were 0.39 (0.00–1.98) for TDF + HCQ, 0.34 (0.00–2.06) for TDF, and 0.49 (0.00–2.29) for HCQ. Corresponding risk ratios of any COVID-19 were 0.51 (0.21–1.00) for TDF + HCQ, 0.81 (0.44–1.49) for TDF, and 0.73 (0.41–1.38) for HCQ. Adverse events were generally mild. The target sample size was not met. Our findings are compatible with both benefit and harm of pre-exposure prophylaxis with TDF/FTC and HCQ, alone or in combination, compared with placebo. [ABSTRACT FROM AUTHOR]

Objective: a) To know the eating and exercising habits of undergraduate Physical Therapy students; b) To promote awareness among these future health professionals and educators of the need to foster adequate eating habits among patients and the general population. Methods: A dietary and physical activity questionnaire, regarding a seven-day period, distributed among students of the School of Physical Therapy (University of Valladolid) in the city of Soria, Spain (n = 131; sex (m/f): 38/93). Results: Results show that a high percentage of the subjects follow the recommendations of the new Nutritional Pyramid of the Spanish Nutrition Society (SEN) regarding intake of meat, fish, milk, dairy products and exercise habits. This is not the case, however, for products such as pasta, bread and cereals, vegetables, fruits, legumes and olive oil. Furthermore, fast food is taken, on average, once a week despite the recommended sporadic monthly intakes. Conclusions: According to results, formative programmes should be carried out to enable these students to encourage healthy diets. Thus, diseases related to nonhealthy eating habits could be prevented, and information on the issue could be spread among the population. [ABSTRACT FROM AUTHOR]

BACKGROUND. Passive immunotherapy with convalescent plasma (CP) is a potential treatment for COVID-19. Evidence from controlled clinical trials is inconclusive. METHODS. We conducted a randomized, open-label, controlled clinical trial at 27 hospitals in Spain. Patients had to be admitted for COVID-19 pneumonia within 7 days from symptom onset and not on mechanical ventilation or high-flow oxygen devices. Patients were randomized 1:1 to treatment with CP in addition to standard of care (SOC) or to the control arm receiving only SOC. The primary endpoint was the proportion of patients in categories 5 (noninvasive ventilation or high-flow oxygen), 6 (invasive mechanical ventilation or extracorporeal membrane oxygenation [ECMO]), or 7 (death) at 14 days. Primary analysis was performed in the intention-to-treat population. RESULTS. Between April 4, 2020, and February 5, 2021, 350 patients were randomly assigned to either CP (n = 179) or SOC (n = 171). At 14 days, proportion of patients in categories 5, 6, or 7 was 11.7% in the CP group versus 16.4% in the control group (P = 0.205). The difference was greater at 28 days, with 8.4% of patients in categories 5–7 in the CP group versus 17.0% in the control group (P = 0.021). The difference in overall survival did not reach statistical significance (HR 0.46, 95% CI 0.19–1.14, log-rank P = 0.087). CONCLUSION. CP showed a significant benefit in preventing progression to noninvasive ventilation or high-flow oxygen, invasive mechanical ventilation or ECMO, or death at 28 days. The effect on the predefined primary endpoint at 14 days and the effect on overall survival were not statistically significant. [ABSTRACT FROM AUTHOR]

Objective: To describe and validate a gynecologic laparoscopic-surgery training model.Methods: The present prospective observational study was conducted at the Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain, between January 2011 and June 2013. Novice gynecologists attended a 3-day course including simulation and animal training. Participants' were assessed before and after training using a virtual reality simulator; during training, gynecologists were timed and assessed using an Objective and Structured Assessment of Technical Skills score. The virtual reality simulator-assessed skills were eye-hand coordination, hand-hand coordination, and transference of objects. Participants were asked to rate various elements of the training program using a five-point scale.Results: The study enrolled 21 gynecologists. Participants performed all tasks faster (P<0.001), using fewer movements (P<0.05 for left and right instruments), after receiving training. During participants' final animal and simulator training sessions, completion times were reduced (P<0.001) and assessment scores (P<0.001) increased for all techniques and tasks. Participants considered suturing to be the most useful aspect of the basic-skills training (4.95±0.22); animal training received a higher rating than simulator training for practicing new techniques (4.81±0.40 vs 4.05±0.86) and maintaining skills (4.76±0.54 vs 3.95±0.97).Conclusion: Combining proficiency-based physical simulation and animal training models under expert guidance is an efficient model for improving basic and advanced laparoscopic skills. Suturing and animal models were the preferred training components. [ABSTRACT FROM AUTHOR]

Adaptation in and around estuaries, to ensure the future resilience of both the natural environment and the communities that are located alongside is an increasingly pressing need. As part of an adaptation planning program for the Basque estuaries (northern Spain, south-eastern Bay of Biscay), a modelling system to simulate the morphological response of the Oka estuary to climate change has been developed. Existing knowledge was used as the basis to frame this pilot modelling examining both the short-term change (storm, seasonal, annual) and the longer-term changes (decades to eons). In this paper, we focus on the long-term response and consideration of the output from the process model is limited to the data that was extracted to help parameterize the long-term model. The latter was then used to examine the response of the estuary to the past changes over a historical time scale, where observations from foraminiferal analysis and saltmarsh response were used to establish the predictive validity of the model. Forcing the model with a linear rate of sea level rise representative of the 20th century, the estuary keeps pace with sea level rise in agreement with the observations. An 18.6-year periodic variability was identified over the saltmarshes, by including the effect of the nodal tide, with the last deposition maximum occurring in 2020. The effect of the opening of a saltmarsh that was drained at the beginning of the 18th century was investigated using a simplified schematization and showed sedimentation rates of up to one order of magnitude larger than in natural marsh, in general agreement with the rates obtained in previous studies. To predict the future response of the estuary, simulations with an exponential sea level rise were performed using scenarios obtained from the latest IPCC projections. The estuary fails to keep pace with sea level rise in any of the scenarios considered. The attendant increase in the hydroperiod over the saltmarshes is also likely impact to saltmarsh species productivity and distribution. Despite the simplifications inherent to the model, and the simplifications made in the representation of the estuary and forcing conditions, the methods presented here provide additional insights into long-term behaviour that complement information obtained from more detailed, but short-term, process models. The combined modelling approach allows adaptation measures to climate change to be considered over longer timescales. • Adaptation to climate change is a problem faced by estuaries around the world. • An approach to study adaptation options for the Basque coast (Spain) is proposed. • With a linear rate of sea level rise, the Oka estuary keeps pace with sea level rise. • The Oka estuary fails to keep pace with future projections of sea level rise. • Saltmarsh enclosure and re-opening change the morphological response of the estuary. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Characterization of current morbidity and mortality among heart failure (HF) outpatients in Galicia (N.W. Spain), together with their main determinants. Design: Prospective multicentre study involving 149 primary care physicians. Setting: Primary care physicians selected randomly from among all (1959) primary care physicians in Galicia. Patients: Clinical and epidemiological information for 1195 outpatients with HF were collected in 2006, with a mean follow-up of 6.5±1.5 months. Main outcome measures: Survival rates were calculated by Cox''s proportional hazard model. Results: Mean patient age was 76 years, 48% were male, 82% had a history of arterial hypertension, and 32% ischaemic cardiopathy. Echocardiography had been performed in 67%, showing preserved systolic function in 61%. Ninety-two (8%) died during follow-up [74 (80%) of them from cardiac causes], and 313 (29%) were re-admitted to hospital [230 (73%) of them for cardiac reasons]. Multivariate analysis identified the following independent predictors of cardiovascular death and/or readmission: ischaemic cardiopathy [hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.29–4.40], stroke (HR 1.79, CI 1.18–2.73), oedema (HR 1.49, CI 1.10–2.03), anaemia (HR 1.66, CI 1.21–2.27), deteriorated systolic function (HR 1.62, CI 1.19–2.20), and previous cardiovascular admissions (HR 2.33, CI 1.67–3.24). Residence in the Barbanza district was identified as an independent predictor of survival free from cardiovascular admission (HR 0.56, CI 0.37–0.86). Conclusion: Morbidity and mortality are currently high among Galician HF patients, and their best single predictor is previous hospitalization for cardiovascular reasons. [Copyright &y& Elsevier]

Purpose: To measure the lifetime prevalence of physical, emotional, and sexual Intimate Partner Violence (IPV) in women attending general practice in Spain and to assess sociodemographic factors associated with the different types of abuse. Methods: The sample included 1402 randomly selected women, aged 18 to 65 years, attending general practice in three Spanish regions. A self-administered structured questionnaire specifically developed for the study was used. Given the overlap between the different types of lifetime abuse, various categories were created by combining the different types. Multiple logistic regression models were developed to identify the sociodemographic factors independently associated with the different categories of abuse. Results: Lifetime prevalence of IPV was 32%, and 14.4% referred having experienced emotional abuse alone. Factors independently associated with all categories of abuse included being separated/divorced/widowed, having three or more children, and lacking social support. Increasing age was protective for physical and emotional abuse (odds ratio = 0.96; 95% confidence interval = 0.93–0.99). Women with the lowest monthly family income (< 600€) (1€ = 1.32$) were most likely to experience all IPV categories, except for emotional abuse alone. Conclusions: IPV is a common problem in general practice. The identification of factors associated with this public health problem is essential for its prevention and treatment. [Copyright &y& Elsevier]

BackgroundBy mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.AimWe aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.MethodsWe analysed data on case notifications, outbreak reports and genotypes focusing on June-October 2023 and compared the results to 2016-2022.ResultsIn 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016-2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016-2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. Cryptosporidium hominis was the most common species in the characterised samples (115/122), and the C. hominis IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.ConclusionsA substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of Cryptosporidium is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.

Objective: To estimate the prevalence of inappropriate use of prophylaxis to prevent venous thromboembolism (VTE) in patients with medical diseases admitted to hospital from the emergency department. To explore variables associated with inappropriate thromboprophylaxis., Methods: Prospective multicenter cohort study in 15 hospital emergency departments. We included patients admitted for a medical condition during 7 days in the first quarter of 2022. We assessed risk for VTE with the Padua Prediction Score (PPS). Inappropriate thromboprophylaxis was defined by failure to prescribe prophylaxis in patients with a high-risk PPS assessment unless there were absolute contraindications (active bleeding or severe thrombopenia) or, alternatively, the prescription of prophylaxis in patients with a low-risk PPS assessment or absolute contraindications. A logistic regression model was adjusted for risk level to identify variables associated with inappropriate use of thromboprophylaxis., Results: Of a total of 630 patients included, 450 (71.4%) had PPS scores indicating high risk for VTE; 180 patients were at low risk. Thromboprophylaxis was inappropriate in 248 patients (39.4%): 165 high-risk patients who received no prophylaxis, 82 low-risk patients who were nonetheless treated, and 1 patient who was treated in spite of severe thrombopenia. Odds ratios (ORs) revealed that the variables associated with inappropriate use of thromboprophylaxis were trauma or recent surgery (OR, 5.53; 95% CI, 1.58-19.34), presence of factors indicating risk for bleeding (OR, 2.61; 95% CI, 1.44-4.73), and hospital admission for either urinary tract infection (OR, 2.29; 95% CI, 1.07-4.87) or gastrointestinal disease (OR, 4.30; 95% CI, 1.71-10.85)., Conclusions: The inappropriate use of thromboprophylaxis in Spanish emergency departments is high and associated with certain clinical characteristics.

Cancer patients are at risk of venous thromboembolism (VTE), its recurrence, but also at risk of bleeding while anticoagulated. In addition, cancer therapies have been associated to increased VTE risk. Guidelines for VTE treatment in cancer patients recommend low molecular weight heparins (LMWH) or direct oral anticoagulants (DOAC) for the initial treatment, DOAC for VTE short-term treatment, and LMWH or DOAC for VTE long-term treatment. This consensus article arises from a collaboration between different Spanish experts on cancer-associated thrombosis. It aims to reach an agreement on a practical document of recommendations for action allowing the healthcare homogenization of cancer-associated thrombosis (CAT) patients in Spain considering not only what is known about VTE management in cancer patients but also what is done in Spanish hospitals in the clinical practice. The text summarizes the current knowledge and available evidence on the subject in Spain and provides a series of practical recommendations for CAT management and treatment algorithms to help clinicians to manage CAT over time., (© 2024. The Author(s).)

Background: HTLV-1 infection is a neglected disease, despite estimates of 10 million people infected worldwide and producing life-threatening illnesses in 10% of carriers. Sexual transmission is the main route of contagion. However, HTLV-1 is not listed among sexually transmitted infections (STIs)., Methods: Serum from all consecutive individuals who had attended six STI clinics across Spain during the last 12 months were tested for HTLV antibodies using a commercial enzyme immunoassay (EIA). Reactive samples were confirmed by immunoblot., Results: A total of 2,524 samples were examined. The majority (1,936; 76.7%) belonged to men, of whom 676 (34.9%) were men who have sex with men (MSM) receiving HIV pre-exposure prophylaxis. Although native Spaniards predominated (1,470; 58.2%), up to 593 (23.5%) came from Latin America and 139 (5.5%) were African. A total of 26 individuals were initially EIA reactive and immunoblot confirmed 5 as HTLV-1 and 7 as HTLV-2. All but one HTLV-1+ case came from Latin America. Three were men and two were women. Among Latin Americans, the HTLV-1 seroprevalence was 0.67%. In contrast, all seven HTLV-2+ were native Spaniards and former injection drug users, and all but one were HIV+., Conclusion: The rate of HTLV infection among individuals with STIs in Spain is 0.5%, which is greater than in the general population. These results support the introduction of universal HTLV screening in persons who attend clinics for STIs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ayerdi, Benito, Ortega, Aguilera, Montiel, Pintos, Díaz de Santiago, Baza, Soriano and de Mendoza.)

In 2020, the COVID-19 pandemic followed a two-wave pattern in most countries. Hospital admission for COVID-19 in one wave or another could have affected mortality, especially among the older persons. The objective of this study was to evaluate whether the admission of older patients during the different waves, before SARS-CoV-2 vaccination was available, was associated with a different mortality. We compared the mortality rates of patients hospitalized during 2020 before (first wave) and after (second wave) July 7, 2020, included in the SEMI-COVID-19 Registry, a large, multicenter, retrospective cohort of patients admitted to 126 Spanish hospitals for COVID-19. A multivariate logistic regression analysis was performed to control for changes in either the patient or disease profile. As of December 26, 2022, 22,494 patients had been included (17,784 from the first wave and 4710 from the second one). Overall mortality was 20.4% in the first wave and 17.2% in the second wave (risk difference (RD) - 3.2%; 95% confidence interval (95% CI) - 4.4 to - 2.0). Only patients aged 70 and older (10,973 patients: 8571 in the first wave and 2386 in the second wave) had a significant reduction in mortality (RD - 7.6%; 95% CI - 9.7 to - 5.5) (unadjusted relative risk reduction: 21.6%). After adjusting for age, comorbidities, variables related to the severity of the disease, and treatment received, admission during the second wave remained a protective factor. In Spain, patients aged 70 years and older admitted during the second wave of the COVID-19 pandemic had a significantly lower risk of mortality, except in severely dependent persons in need of corticosteroid treatment. This effect is independent of patient characteristics, disease severity, or treatment received. This suggests a protective effect of a better standard of care, greater clinical expertise, or a lesser degree of healthcare system overload., (© 2023. Springer Nature Limited.)

Background: Recently, several scores to quantify compliance with the guidelines in candidaemia management (EQUAL, GEMICOMED, Valerio) have been developed. Evidence supporting the association of these scores to the prognosis is scarce. We aim to evaluate the performance of these candidaemia guideline adherence scores to predict candidaemia outcome., Methods: We recorded retrospectively data from candidaemia episodes (January 2017-December 2018). We analysed adherence to guidelines for candidaemia management according to EQUAL, GEMICOMED and Valerio scores, and we correlated those to outcome., Results: Fifty-four first episodes of candidaemia were retrieved. Five patients who died in the first 48 hours after blood cultures were not included. Thirty-day mortality in evaluable patients was 18.4%. Median adherence to guidelines according to EQUAL score was 17 (interquartile range [IQR]: 15-19), and according to GEMICOMED was 86% (IQR: 72.5%-100%). According to Valerio score, adequacy of antifungal prescription was 8.5/10 (SD: 1.9). A cut-off of ≥17 for EQUAL or compliance >70% for GEMICOMED was associated with inferior 30-day mortality (7.1% vs 33.3%, P = .028 and 7.9% vs 54.5%, P = .002, respectively). Infectious diseases (ID) evaluated cases obtained a better EQUAL score (>17; 82.1% vs 42.9%, P = .006), had inferior 30-day mortality (9.4% vs 35.3%, P = .049) and a better antifungal prescription adequacy (Valerio score 9.0 vs 7.5, P = .011)., Conclusion: Adherence to guidelines for candidaemia management evaluated by means of EQUAL and GEMICOMED score was associated with a decreased 30-day mortality. Adequacy of antifungal prescription can be ameliorated. ID consultation improved guideline adherence and was associated with decreased 30-day mortality., (© 2021 Wiley-VCH GmbH.)

Background: Biologic therapy has changed the prognosis of patients with juvenile idiopathic arthritis (JIA). The aim of this study was to examine the pattern of use, drug survival, and adverse events of biologics in patients with JIA during the period from diagnosis to adulthood., Methods: All patients included in BIOBADASER (Spanish Registry for Adverse Events of Biological Therapy in Rheumatic Diseases), a multicenter prospective registry, diagnosed with JIA between 2000 and 2015 were analyzed. Proportions, means, and SDs were used to describe the population. Incidence rates and 95% CIs were calculated to assess adverse events. Kaplan-Meier analysis was used to compare the drug survival rates., Results: A total of 469 patients (46.1% women) were included. Their mean age at diagnosis was 9.4 ± 5.3 years. Their mean age at biologic treatment initiation was 23.9 ± 13.9 years. The pattern of use of biologics during their pediatric years showed a linear increase from 24% in 2000 to 65% in 2014. Biologic withdrawal for disease remission was higher in patients who initiated use biologics prior to 16 years of age than in those who were older (25.7% vs 7.9%, p < 0.0001). Serious adverse events had a total incidence rate of 41.4 (35.2-48.7) of 1000 patient-years. Patients younger than 16 years old showed significantly increased infections (p < 0.001)., Conclusions: Survival and suspension by remission of biologics were higher when these compounds were initiated in patients with JIA who had not yet reached 16 years of age. The incidence rate of serious adverse events in pediatric vs adult patients with JIA treated with biologics was similar; however, a significant increase of infection was observed in patients under 16 years old.

Background/objectives: To elicit and compare preferences in terms of the attributes of home enteral nutrition (HEN) among patients and physicians, using a discrete choice experiment (DCE)., Subjects/methods: A DCE comprising eight choice scenarios, with six HEN attributes (tolerability, adaptation to comorbidities, nutrition and calories, handling, connections and information; two levels each) was designed. The Relative Importance (RI) for patients and physicians of each attribute was estimated. Sociodemographic and clinical variables, as well as additional questions (n = 8) were compiled to analyze possible explanatory variables and other preferences., Results: A total of 148 HEN patients (71 needing caregivers to answer on their behalf) and 114 physicians completed the DCE. The most important attributes for patients were adaptation to comorbidities (33% RI), tolerability (33% RI), and nutrition and calories (26% RI). Significantly, younger patients had stronger preferences for tolerability whereas elderly ones (≥75 years) were more concerned about handling. In comparison, physicians gave a higher RI to tolerability, and nutrition and calories compared to patients (p = 0.002). Overall, a higher percentage of physicians answered that HEN characteristics such as easy-handling bags (85.1 vs. 64.9%; p = 0.001), container material (69.3 vs. 57.1%; p = 0.003) or reusable containers (79.8 vs. 70.3%; p = 0.01) were "important" or "very important" compared to patients., Conclusions: Our findings showed that although patients and physicians have a similar perception about the relevance of different HEN attributes, the relative weight given to each one varies between them. Therefore, both points of view should be considered when choosing a HEN product in order to improve patients' satisfaction and clinical outcomes.

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations., (Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.)

Background and Objective: In Spain, where cardiovascular diseases are the leading cause of death, control of their risk factors is low. This study analyzes the implementation of cardiovascular risk (CVR) assessment in clinical practice and the existence of control objectives amongst quality care indicators and professional incentive systems., Method: Between 2010 and 2011, data from each autonomous community were collected, by means of a specific questionnaire concerning prevalence and control of major CVR factors, CVR assessment, and implementation of control objectives amongst quality care indicators and primary care incentive systems., Results: Fifteen out of 17 autonomous communities filled in the questionnaire. CVR was calculated through SCORE in 9 autonomous communities, REGICOR in 3 and Framingham in 3, covering 3.4 to 77.6% of target population. The resulting control of the main CVR factors was low and variable: hypertension (22.7-61.3%), dyslipidemia (11-45.1%), diabetes (18.5-84%) and smoking (20-50.5%). Most autonomous communities did not consider CVR assessment and control amongst quality care indicators or incentive systems, highlighting the lack of initiatives on lifestyles., Conclusions: Variability exists in cardiovascular prevention policies among autonomous communities. It is necessary to implement a common agreed cardiovascular prevention guide, to encourage physicians to implement CVR in electronic clinical history, and to promote CVR assessment and control inclusion amongst quality care indicators and professional incentive systems, focusing on lifestyles management., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Purpose: Palliative care consultation teams (PCCT) in acute hospitals have increased in number over recent years. To assess whether these teams are both efficient in their role within a palliative care centre and effective in the care that is provided for patients, we reviewed the initial activity of a new PCCT at the Oncology Department of Clínica Universidad de Navarra, a European Society for Medical Oncology-designated centre of integrated oncology and palliative care., Methods: All patients evaluated by the PCCT over the first 3 years of its activity were included. Data about diagnosis, demographic characteristics, survival and initial symptom burden were evaluated using the Edmonton Symptom Assessment System (ESAS); whenever possible, a follow-up ESAS for inpatients was collected within 1 week from the electronic charts and analysed retrospectively., Results: The PCCT evaluated 611 cancer patients within the initial 3 years of the service commencing. On the first visit, 392 patients (64%) completed the ESAS evaluation. Of those that completed the ESAS, 43% were outpatients, 52% had gastrointestinal tumours, and 16% died within a month. The evaluated patients had an average of six uncontrolled symptoms (≥4/10). The most common moderate to severe symptoms were fatigue (80%), anorexia (67%) and depression (62%); 70% of patients presented with pain (14% with severe pain). Of the 225 inpatients evaluated, 110 (49%) completed the follow-up ESAS within 1 week. A statistically significant decrease was observed for pain, nausea, depression, anxiety and somnolence as well as in the number of uncontrolled symptoms and in the symptom distress score. The patient's perception of his/her general well-being was better as meassured with the specific question of ESAS., Conclusion: From the initial stages, the PCCT was both efficient in its role within the palliative care centre and effective in the care that was provided for patients. A significant number of patients were evaluated, many of them with severe symptoms and/or at the end of life. Inpatients receiving care from the PCCT experienced an improvement in symptom control within just a few days.

We present the Spanish adaptation made by the CEIPC of the European Guidelines on Cardiovascular Disease Prevention (CVD) in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD through the management of its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL<130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, to reach body mass index (BMI) guided and waist circumference objectives. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to transfer the recommendations established into the daily clinical practice.

The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

Introduction: Fatigue is one of the most frequent symptoms in patients with cancer. No adequate term in Spanish has been defined to describe the English concept of fatigue., Aim: To identify the most suitable Spanish words that define the concept of fatigue and to check psychometric characteristics., Method: Consensus with professional experts on Spanish words that best suit the English concept of fatigue. A prospective study on oncologic patients was also undertaken, which included an evaluation of the intensity of fatigue through visual numeric scales (VNS) where the words had been previously selected. The fatigue subscale of the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire was taken as a reference., Results: The experts highlighted the words cansancio, agotamiento, and debilidad (tiredness, exhaustion, and weakness) as the terms that best defined the concept of fatigue. In the psychometric assessment study, 100 patients were included, of which 61 (61%) presented diagnostic values for cancer-related fatigue in the FACT-F fatigue subscale (score 34/52 or lower). The VNS for the chosen terms obtained a high correlation with the FACT-F fatigue subscale results: cansancio (tiredness) r = -0.71, agotamiento (exhaustion) r = -0.74, debilidad (weakness) r = -0.74, with no statistical differences between them. For the detection of fatigue by means of the VNS, tiredness (cutoff point > or =4/10) gave sensitivity (S) 0.90 and specificity (E) 0.72; exhaustion (cutoff point > or =3/10) S 0.95 and E 0.90 and weakness (cutoff point > or =4/10) S 0.92 and E 0.72. The ROC curve was 0.88 for tiredness, 0.94 for exhaustion, and 0.92 for weakness, with no significant difference between the areas mentioned. The terms cansancio, agotamiento, and debilidad (tiredness, exhaustion, and weakness) are suitable for defining the English concept of fatigue in Spanish, and should be the preferred option for inclusion in evaluation tools.

Introduction and Objectives: To assess the effect of different forms of atherosclerotic disease on prognosis in diabetic patients., Methods: This multicenter prospective cohort study involved 1423 consecutive patients with diabetes mellitus who were recruited by 31 primary care physicians. The patients' characteristics were recorded and they were followed up for 45 +/- 10 months., Results: The mean age of the patients (50% male) was 66 years, 64% had hypertension, 70% had dyslipidemia, and 26% had had a previous cardiovascular event. By the end of follow-up, 81 (6.2%) had died, 40 (3%) of whom due to cardiovascular causes, and 393 (30%) had been hospitalized, 179 (14%) of whom for cardiovascular disease. Multivariate analysis identified the following factors as independent predictors of mortality: age (hazard ratio [HR]=1.08; 95% confidence interval [CI],1.05-1.11), previous cardiovascular disease (HR=2.15; 95% CI, 1.12-4.14) and diuretic treatment (HR=3.40; 95% CI, 1.76-6.56), while the prescription of an angiotensin-converting enzyme inhibitor or an angiotensin-receptor antagonist had a protective effect (HR=0.48; 95% CI, 0.25-0.93). Compared with diabetics without a previous cardiovascular event, the risk of a cardiovascular event during follow-up was greater in those with a history of either ischemic heart disease (HR=2.48; 95% CI, 1.51-4.07), cerebrovascular disease (HR=2.51; 95% CI, 1.28-4.92), or peripheral vascular disease (HR=1.46; 95% CI, 0.81-2.60)., Conclusions: The increase in the risk of a cardiovascular event was similar in diabetics with ischemic heart disease and those with cerebrovascular disease. In both cases, the risk was more than double that in patients without a history of cardiovascular disease.

Objectives: To evaluate the impact of the application of objectives relating to the rational use of medication and to assess the possible effect of these objectives on pharmaceutical expenditure., Design: A non-randomised intervention study with control., Setting: Santiago de Compostela Primary Care (PC) Area., Patients and Other Participants: After the inclusion and exclusion criteria were applied, both the intervention group (IG) and the control group (CG) consisted of 31 doctors. Those in the IG belonged to the reformed PC model, whereas those in the CG did not., Interventions: Four blocks of objectives on the rational use of medication were included in the Pact signed by reformed-model doctors and the management. The study lasted three years (1996-1998) for the objective of lowering the prescription of low-therapeutic-utility (LTU) drugs, and two years (1997-1998) for lowering the prescription of antihypertensives, Triflusal and quinolones., Measurements and Main Results: The difference between both groups was 1.7 fewer packs of LTU drugs per 1000 users and per day in the IG (95% CI, 0.9-2.6) and 1768 pesetas less (95% CI, 801-2733). These differences were still greater among pensioners. The difference between the two groups in terms of total pharmaceutical cost was 7379 pesetas less in the IG (95% CI, 708-14,049) than in the CG. The differences between the groups for the remaining objectives (antihypertensives, Triflusal and quinolones) in no case reached statistical significance., Conclusions: The pharmaceutical objectives of the pact were partly achieved: a drop in LTU drug prescription was seen, with an indirect reduction in overall expenditure, but no differences were found in the prescription of antihypertensives, triflusal or quinolones.

The present study is an assessment of the rate and severity of tobacco consumption in outpatients with schizophrenia, and the determinants of smoking behaviour. Sixty-four patients, assessed by the Item Group Checklist section of the SCAN interview and fitting DSM-IV criteria, were evaluated with CGI and the PANSS scales. In addition, they completed STAI (Spielberger), EPQ (Eysenck), and TPQ (Cloninger) questionnaires. Tobacco dependence was assessed by the Fagerström test. One hundred and thirty-seven consecutive outpatients were psychiatric controls. Forty-one out of 64 patients with schizophrenia (64.1%) were current smokers, this rate being significantly higher than in other psychiatric patients and general population. The severity of cigarette consumption in smokers was greater (mean of 22.4 cigarettes/day) than in the general population, but it was not different from that of other psychiatric patients. For patients with schizophrenia, no one variable (except male sex) was different between smokers and non-smokers, but the number of cigarettes/day correlated with state anxiety, trait anxiety, and neuroticism. In the multivariate analysis, the only variable that remained significant was neuroticism. The relationship between clinical features and severity of smoking behaviour may be linked to non-specific variables such as neuroticism and anxiety, but not to psychotic symptoms.

This paper tries to analyse the relationship between traditional feminine role (marriage, motherhood and housing) and mental health in spanish women. The General Health Questionnaire 60-items (GHQ-60) was used to define "cases" in a random sample of the general population of Cantabria consisting of 630 women aged 17 and over. The rate of probable prevalence of psychiatric disorders was 26.4%. In contrast to previous studies, motherhood and traditional feminine role correlated with the lowest GHQ-60 mean scores. Occupational status was not related to mental health. Women living with husband, children, parents and/or parents-in-law scored lower on GHQ-60 than those living with husband and children. These results are discussed in the light of previous findings in the literature. At least, they reconfirm the importance of socio-cultural factors in community psychiatric disorder.