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Background Spain has one of the highest proportions of dementia in the world among the population aged 60 years or over. Recent studies link various environmental factors to neurocognitive-type diseases. This study sought to analyse whether urban risk factors such as traffic noise, pollutants and heat waves might have a short-term impact on exacerbation of symptoms of dementia, leading to emergency hospital admission. Material and methods We conducted a longitudinal ecological time-series study, with the dependent variable being the number of daily dementia-related emergency (DDE) hospital admissions to Madrid municipal hospitals (ICD-10 codes 290.0–290.2, 290.4–290.9, 294.1–294) from 01 to 01-2001 to 31-12-2009, as obtained from the Hospital Morbidity Survey (National Statistics Institute). The measures used were as follows: for noise pollution, Leqd, equivalent diurnal noise level (from 8 to 22 h), and Leqn, equivalent nocturnal noise level (from 22 to 8 h) in dB(A); for chemical pollution, mean daily NO2, PM2.5, PM1 as provided by the Madrid Municipal Air Quality Monitoring Grid; and lastly, maximum daily temperature (°C), as supplied by the State Meteorological Agency. Scatterplot diagrams were plotted to assess the type of functional relationship existing between the main variable of analysis and the environmental variables. The lags of the environmental variables were calculated to analyse the timing of the effect. Poisson regression models were fitted, controlling for trends and seasonalities, to quantify relative risk (RR). Results During the study period, there were 1175 DDE hospital admissions. These admissions displayed a linear functional relationship without a threshold in the case of Leqd. The RR of DDE admissions was 1.15 (1.11–1.20) for an increase of 1 dB in Leqd, with impact at lag 0. In the case of maximum daily temperature, there was a threshold temperature of 34 °C, with an increase of 1 °C over this threshold posing an RR of 1.19 (1.09–1.30) at lag 1. The only pollutant to show an association with DDE hospital admissions was O3 at lag 5, with an RR of 1.09 (1.04–1.15) for an increase of 10 µg/m 3 Conclusions Diurnal traffic noise, heat waves and tropospheric ozone may exacerbate the symptoms of dementia to the point of requiring emergency admission to hospital. Lowering exposure levels to these environmental factors could reduce dementia-related admissions in Madrid. [ABSTRACT FROM AUTHOR]

In general, there are few studies that analyse the impact of low temperatures on mortality, and even fewer that extend this analysis to specific causes of mortality. This study had a twofold aim: Firstly, to analyse the trend in natural-, circulatory- and respiratory-cause mortality associated with cold waves in Castile-La Mancha (Spain) across a period of analysis of 34 years, which would confer an important degree of temporal representativeness on the results obtained; and secondly, to ascertain whether this impact had decreased over the years. Time series analysis using multivariate ARIMA models with data on daily natural-, circulatory- and respiratory-cause mortality in Castile-La Mancha. The independent variables were minimum daily temperature, mean daily pressure and mean daily relative humidity. We controlled for seasonalities and trend of the series, as well as influenza epidemics, cold-wave duration and chronological number in any given year. Data were stratified in three ten-year stages, i.e., 1975-1985, 1986-1996 and 1997-2008. The mortality trigger temperature was set at a minimum daily temperature of −2 °C, corresponding to the 4th ‰ of the minimum temperature series for the winter months considered. The impact on daily natural-cause mortality for each degree that the minimum daily temperature was below −2 °C was: 10.4 % (95 % CI 9.6-11.2) in the first decade; 11.9 % (95 % CI 11.0-12.8) in the second decade; and fell to 1.6 % (95 % CI 0.9-2.3) in the third. This same pattern was observed for circulatory- and respiratory-cause mortality, with the effect of cold being greater for respiratory causes. Socio-economic factors -both of adaptation and demographic- could account for this sharp decrease in mortality associated with low temperatures. These results question climate models which predict the effects of cold over long-term time horizons, while maintaining the risk attributable to low temperatures constant. Studies similar to ours should be undertaken in other regions to confirm whether it is solely local characteristics that explain this pattern or, on the contrary, whether the pattern is generalised. [ABSTRACT FROM AUTHOR]

An abstract of the article "Analysis of Macroalgal Diversity Differences Among Tidal Pools: Implementation of the Hypothetico-Deductive," by M. Altamirano and colleagues is presented.

Two species of agarophytes, Gelidium sesquipedale (Clem.) Born. et Thur. and Gracilaria tenuistipitata var. liui (Zhang & Xia), have been cultured in chemostat systems under different light qualities to study the response of growth and polysaccharide yield and composition to certain wavelengths. The yield of galactans, methoxyl groups and sulphate content in the agar as well as the starch concentration of these species are controlled by light quality in a different way, presumably because of their patterns of growth. The polysaccharide characteristics will be discussed in relation to the growth and metabolism of those algae. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about trauma and emergency care.

When integrated weed management approaches are used, visual estimations of weed cover are commonly employed to quantify weed infestation levels in crops. This study assessed the reliability of visual estimation of weed cover, considering various factors which may influence the accuracy and consistency of human perception. Measurements were based on visual estimates of digital images acquired in maize fields. A total of 750 images were assessed independently by four experienced observers using three cover-abundance scales, varying the assessment date or the order in which the images were assessed. A good relationship was generally found between the visual estimates of weed cover and some objective parameters (actual weed cover, weed biomass). The analyses of reliability and repeatability showed no significant differences between the estimations performed by four different observers or by the same observer at different times, independently of the scale used. Nevertheless, the comparison between visual estimations performed by the observers and actual weed cover showed that observers tended to overestimate weed cover at low weed densities and underestimate it when densities were high. Although visual assessments of weed cover were relatively accurate to quantify weed infestation level, our results showed that human perception was not reliable enough to determine actual weed cover close to the class boundaries, both in the lower range (e.g. 5%, 10%) and in the middle range (e.g. 50%) of the scale. This may be a serious limitation for the use of visual methods in threshold-based weed management programmes. [ABSTRACT FROM AUTHOR]

The surface-trajectory model gives a solution to some of the problems presented by the general geometric models where the design of an object is separated from its manufacture. In fact, in this model, the internal representation of objects is made up of machining trajectories. As the display systems usually need triangles to represent the objects, a process of triangulation is needed to visualize them. In other words, a secondary surface model is needed to display the objects. The following is a geometric model that, maintaining the philosophy of the surface-trajectory model, encapsulates the calculation of the machining process from the formal framework that provides the set theory and the mathematical morphology. The model addresses the process of designing objects by assimilation of a machining process by giving solutions to the design of complex objects and an arithmetic to support the generation of trajectories of manufacturing. The design process is similar to the craft work of sculptors designing their pieces by hand with their tools. It also gives a direct solution to the problems of the trajectory generation since they are already defined at the design phase. The model is generic and robust as there are no special cases or complex objects in which the model does not provide a correct solution. It also naturally incorporates the realistic display of the machined objects in a quickly and accurately way. [ABSTRACT FROM AUTHOR]

Objective To analyze the relationship between maternal anxiety and fetal behavior at 15 weeks' gestation. Methods Twenty women in two groups were studied: 10 women underwent amniocentesis and 10 controls did not. Maternal anxiety was evaluated using the State Trait Anxiety Inventory questionnaire. Maternal plasma catecholamines (noradrenaline, adrenaline, dopamine) and maternal serum adrenocorticotropic hormone, cortisol, glucose, insulin, triiodothyronine, thyroxine and thyroidstimulating hormone were measured. Catecholamines were also measured in the amniotic fluid of women undergoing amniocentesis. Compiled actograms of 40rain observations were done using ultrasonography. Results Maternal state-anxiety was significantly increased in the amniocentesis group. Except for fetal hiccups (r = 0.49, P = 0.03) there was no significant correlation between maternal anxiety and any of the other studied fetal movements. Maternal glucose was significantly correlated with hiccups (r = -0.59, P = 0.01), isolated leg movements (r = -0.52, P = 0.03), startles (r = -0.47, P = 0.04) and the total of the studied movements (r = -0.47, P = 0.04). Amniotic fluid catecholamines were significantly correlated with hand-face contact (r = 0.71, P = 0.02 for adrenaline), startles (r = 0.75, P = 0.01 for noradrenaline and r = 0.64, P = 0.04 for dopamine) and general movements (r = 0.89, P = 0.001 for noradrenaline). Conclusions This study does not support a relationship between maternal anxiety and fetal behavior in early pregnancy. Maternal glucose and plasma catecholamines could be related to fetal movements at 15 weeks' gestation. [ABSTRACT FROM AUTHOR]

Highlights • Asparagopsis taxiformis is a notorious invasive red seaweed in tropical to template areas. • A demographic method was used to assess the primary production of A. taxiformis. • Population dynamic was characterized by six different cohorts. • Its year-long persistence implies constant production independent from climatic variability. Abstract Primary production of a population of the red invasive seaweed A. taxiformis from southern Spain was assessed using a demography-based approach and studied in relation to environmental conditions. In-depth analysis of shoots biomass of different size classes revealed a population dynamic characterized by six cyclic cohorts that followed consecutively or overlapped along the study period. Cohorts differed in their longevity, resource exploitation and contribution to the whole population's primary production. Altogether, annual primary production of the population was 253.17 g DW m−2. The most productive one was cohort III, which was also the briefest (26 days) and occurred at the beginning of autumn. Cohort III allocated its productivity towards the synthesis of the fixation structure, the increase of shoots size and reproduction. The development of cohorts I and VI was favoured by high irradiance, increasing temperatures and daylight hours, while cohorts III, IV and V were dependent on nutrient availability. Maximum expansion of this species matches with spring peak of oxidized nutrients (nitrate, nitrite and phosphate), but it is also able to produce new cohorts in summer and winter periods, when reduced nutrients (ammonium) are predominant. Principal Component Analysis revealed that primary production of the studied population was not related to environmental variables considered. Nevertheless, the presence of different cohorts in A. taxiformis that respond singularly to a changing environment allows this species to maintain a constant production, what can reinforce its invasive behaviour in the area. [ABSTRACT FROM AUTHOR]

Introduction There are scarce studies of time series that analysed the short-term association between emergency hospital admissions due to Alzheimer's disease (AD) and environmental factors. The objective is to analyse the effect of heat waves, noise and air pollutants on urgent hospital admissions due to AD in Madrid. Methods Longitudinal ecological time series study was performed. The dependent variable was the emergency AD hospital admissions occurred in Madrid during the period 2001–2009. Independent variables were: Daily mean concentrations (μg/m3) of air pollutants (PM 2.5 and PM 10 ; O3 and NO2); maximum daily temperature (°C) and daily and night noise levels (dB(A)). Relative Risk (RR) for an increment in interquartile range, and Attributable Risk (AR) values were calculated through GLM with Poisson link. Results Our findings indicated that only PM 2.5 concentrations at lag 2 with a RR: 1.38 (95% CI: 1.15–1.65); AR 27.5% (95% CI: 13.0–39.4); and heat wave days at lag 3 with a RR: 1.30 (95% CI: 1.12–1.52); AR 23.1% (95% CI: 10.7–34.2) were associated with AD hospital admissions. Conclusion A reduction in AD patients' exposure levels to PM 2.5 and special care of such patients during heat wave periods could result in a decrease in both emergency AD admissions and the related health care costs. [ABSTRACT FROM AUTHOR]

Prior studies have identified that individuals with comorbid substance use disorder and mental health disorder are at a greater risk of benzodiazepine abuse compared to individuals that present with mental health disorder without an accompanying substance use disorder. These studies were conducted in predominantly white populations, and little is known if the same associations are seen in safety net health care networks. Also, the literature is mixed as to whether or not psychiatrists’ prescription of benzodiazepines places individuals at undue risk of benzodiazepine abuse. We use 2013–2015 electronic health record data from a Boston healthcare system. Patients with benzodiazapene abuse were identified if they had received treatment under the ICD-9 code 304.1. Benzodiazepine abuse was compared between patients with only mental illness and patients with existing comorbid substance and mental health disorder, in unadjusted comparisons and adjusted regression models. Covariates in regression models were used to identify subgroups at higher risk of benzodiazepine abuse. Individuals with benzodiazepine abuse had higher rates of emergency room and inpatient use than patients with other mental health and/or substance use disorders. Those with comorbid substance and mental disorder were significantly more likely than individuals with mental or substance use disorder alone to abuse benzodiazepines ( P < .01). Among those with benzodiazepine abuse, 93.3% were diagnosed with a mental illness, 75.6% were diagnosed with a substance use disorder (other than benzodiazepine), and 64.4% had comorbid anxiety disorder and substance use disorder. These analyses suggest that patients with benzodiazepine abuse have complex presentations and intensive service use. [ABSTRACT FROM AUTHOR]

Few studies have analysed the impact of heat and cold waves on mortality in a given population over the same time period and still fewer studies have analysed this impact in terms of cause-specific mortality. This study analysed the impact of both heat and cold waves on daily all-cause, circulatory-cause and respiratory-cause mortality in the region of Castile-La Mancha (CLM) 1975-2008. The dependent variable was daily all-, circulatory- and respiratory-cause mortality registered in CLM from 01-01-75 to 31-12-08, and the independent variables were maximum, minimum, mean daily temperature daily relative humidity and mean daily air pressure and other related variables, such as heat-wave duration, heat-wave number and pressure trend. Time-series analyses were performed using autoregressive integrated moving average models. The impact of heat on daily mortality was greater than that of cold, with a difference which proved statistically significant for all- and circulatory-cause mortality but not for respiratory-cause mortality. While 16.5 % CI 95 % (15.5-17.4) of summer mortality in CLM was attributable to heat, 12.9 % CI 95 % (12.2-13.8) of daily winter mortality was attributable to low temperatures. The variable, heat-wave duration, was of major importance in all-cause and respiratory-cause mortality, with wave persistence being related to a mean 3.5 % increase in daily organic-cause mortality. Although heat waves have a greater impact on daily mortality than do cold waves, the fact that there were more cold-wave than heat-wave days during the period analysed, coupled with the diseases implicated, means that specific prevention plans should be implemented for both extreme thermal events. [ABSTRACT FROM AUTHOR]

Introduction: Oral Cancer accounts 3% of all human cancers. Squamous Cell Carcinoma is the most common. Nowadays, in Chile and the world, oral cancer is reaching relevance because of its high incidence and low survival rates; most often is squamous cell carcinoma (SCC). Aim: We analyzed the five-year survival of 161 patients diagnosed with SCC. Also was studied relationships between survival and gender, age, location, tobacco, alcohol and treatment. Methods: Retrospective study among 1989 and 2010. The study population was mainly men gender (59%), average age 64 years and location of the CEC preferably in tongue (37.6%). 54% were well differentiated carcinomas and TNM, the majority corresponding to T2N0M0. Kaplan-Meier curve and Log Rank test were used for survival analysis and to compare them. We determined significant difference when p value < 0.05. Results: The overall survival at five years was 46%, the lowest rates were in the male gender, age group 60, floor of mouth, smokers and alcohol consumers. Conclusions: Although tobacco and alcohol are factors highly related to the presence of CEC, there was no significant difference between survival and these habits. There were differences between the survival curves for patients treated with surgery associated with radiotherapy in comparison to other treatments. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Recent landmark trials have suggested a survival benefit to definitive tumor directed therapies (DTDT) for selected patients with metastatic disease for various malignancies. We sought 1) to confirm the prognostic significance of metachronous oligometastatic burden for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) and 2) to evaluate disease outcomes for oligometastatic HPV-associated OPSCC after upfront DTDT versus upfront systemic therapy.Materials/methods: This was a single institution retrospective observational cohort study of patients with HPV-associated OPSCC who developed metachronous metastases ≥3 months after primary treatment with trans-oral robotic surgery (TORS) from 2008-2017. At metastatic presentation, patients were classified as oligometastatic (≤5 metastases) or polymetastatic (> 5 metastases). Treatment was classified as DTDT (all metastases initially treated with surgery/radiotherapy) or as upfront systemic therapy. Overall survival (OS) was compared using log-rank tests at a significance of P < 0.05. Univariable and multivariable (MV) Cox proportional hazard models were used to assess the association of patient, disease, and treatment characteristics with survival. Variables with P < 0.15 on univariable analysis (initial metastatic treatment, metastatic site, and number of metastases) were included in the multivariable model.Results: Of 676 patients undergoing primary surgical management for HPV-associated OPSCC, 36 patients subsequently developed metachronous metastases. For those 36 patients, the median follow-up time after surgery was 27.5 months (range 4.5-127.0), and the median OS was 42.8 months. The median age at distant metastasis was 62 (range 32-86), and most patients were male (86.1%) and Caucasian (97.2%). Overall, 27 patients presented with oligometastasis and 9 with polymetastasis. Oligometastatic patients had improved median OS compared to polymetastatic patients (47.9 vs. 22.7 months, P = 0.020). For the 27 oligometastatic patients, 12 were initially treated with DTDT while 15 received systemic therapy. DTDT was associated with an improved median OS when compared to systemic therapy (median OS not reached for DTDT vs 40.7 months, P = 0.021), with 3 year OS of 90.0% and 55.0% respectively. DTDT was also associated with improved OS on MV Cox regression (hazard ratio = 0.06, 95% CI 0.004-0.73, P = 0.027) compared to systemic therapy when controlling for number of metastases and metastatic site.Conclusion: Our study findings suggest that the extent of metastatic disease at metastatic presentation is related to prognosis, with oligometastasis associated with improved overall survival compared to polymetastasis. Among patients with oligometastatic disease, initial DTDT is associated with superior overall survival when compared to upfront systemic therapy. [ABSTRACT FROM AUTHOR]

An abstract of the article "A Multidisciplinary Project to Study the Invasion of Asparagopsis Taxiformis in Western Mediterranean Sea," by M. Altamirano and colleagues is presented.

Summary The present work examines the temporal appearance and degree of activity of digestive enzymes of pancreatic and intestinal origin (amylase as well as neutral and alkaline proteases) together with the evolution of the ontogenic development of the intestine and pancreas during the first month of free-living (30 days post-hatch-[dph]) of the sturgeon Acipenser naccarii. In addition, the influence of exogenous live feeding with Artemia salina on the detection of digestive enzymes was studied. Shown are that in the first life stages of the A. naccarii, from the time of fertilisation to the juvenile stage, the following events related to its digestive physiology occurred: digestive enzymes were detected in the embryo stage within the egg, presumably related to the hatching gland; in the free-living embryo stage, opening of the mouth was at 10 dpf and protease and amylase digestive activities occurred due to an early differentiation of the pancreas and intestine (12-13 dpf). At this stage, digestive enzymatic activities are partly owing to the live feed offered before disappearance of the yolk reserves (14 dpf); the expulsion of the melanin plug and the appearance of a continuity of the digestion tract (16 dpf) together with the disappearance of the yolk reserves (17 dpf) mark the passage from the free-living embryo phase to the juvenile stage; finally, from the first month after hatching in this sturgeon species, there is a stabilisation in digestive amylase and protease activities together with a fully developed digestive structure. The contribution of enzymes from prey in the detection of enzymatic activities determined in the fish was beyond doubt; therefore these exogenous enzymes must also have a certain physiological importance. Subsequent work will be needed to clarify the importance of digestive processes of the exogenous enzyme pool from live feed as well as to assess the possibility of shortening the weaning period. [ABSTRACT FROM AUTHOR]

Abstract: Previous studies of knock-out mouse embryos have shown that the Wilms’ tumor suppressor gene (Wt1) is indispensable for the development of kidneys, gonads, heart, adrenals and spleen. Using OPT (Optical Projection Tomography) we have found a new role for Wt1 in mouse liver development. In the absence of Wt1, the liver is reduced in size, and shows lobing abnormalities. In normal embryos, coelomic cells expressing Wt1, GATA-4, RALDH2 and RXRα delaminate from the surface of the liver, intermingle with the hepatoblasts and incorporate to the sinusoidal walls. Some of these cells express desmin, suggesting a contribution to the stellate cell population. Other cells, keeping high levels of RXRα immunoreactivity, are negative for stellate or smooth muscle cell markers. However, coelomic cells lining the liver of Wt1-null embryos show decreased or absent RALDH2 expression, the population of cells expressing high levels of RXRα is much reduced and the proliferation of hepatoblasts and RXRα-positive cells is significantly decreased. On the other hand, the expression of smooth muscle cell specific α-actin increases throughout the liver, suggesting an accelerated and probably anomalous differentiation of stellate cell progenitors. We describe a similar retardation of liver growth in RXRα-null mice as well as in chick embryos after inhibition of retinoic acid synthesis. We propose that Wt1 expression in cells delaminating from the coelomic epithelium is essential for the expansion of the progenitor population of liver stellate cells and for liver morphogenesis. Mechanistically, at least part of this effect is mediated via the retinoic acid signaling pathway. [Copyright &y& Elsevier]

Presents the results of the National Youth Tobacco Survey conducted by the U.S. Centers for Disease Control and Prevention from 2002 to 2004. Data on the percentage of middle school students and their tobacco habit; Decline in the prevalence of youth smoking; Limitations of the study.

Epicardially derived cells (EPDCs) delaminate from the primitive epicardium through an epithelial-to-mesenchymal transformation (EMT). After this transformation, a subpopulation of cells progressively invades myocardial and valvuloseptal tissues. The first aim of the study was to determine the tissue-specific distribution of two molecules that are thought to play a crucial function in the interaction between EPDCs and other cardiac tissues, namely the Wilms'' Tumor transcription factor (WT1) and retinaldehyde-dehydrogenase2 (RALDH2). This study was performed in normal avian and in quail-to-chick chimeric embryos. It was found that EPDCs that maintain the expression of WT1 and RALDH2 initially populate the subepicardial space and subsequently invade the ventricular myocardium. As EPDCs differentiate into the smooth muscle and endothelial cell lineage of the coronary vessels, the expression of WT1 and RALDH2 becomes downregulated. This process is accompanied by the upregulation of lineage-specific markers. We also observed EPDCs that continued to express WT1 (but very little RALDH2) which did not contribute to the formation of the coronary system. A subset of these cells eventually migrates into the atrioventricular (AV) cushions, at which point they no longer express WT1. The WT1/RALDH2-negative EPDCs in the AV cushions do, however, express the smooth muscle cell marker caldesmon. The second aim of this study was to determine the impact of abnormal epicardial growth on cardiac development. Experimental delay of epicardial growth distorted normal epicardial development, reduced the number of invasive WT1/RALDH2-positive EPDCs, and provoked anomalies in the coronary vessels, the ventricular myocardium, and the AV cushions. We suggest that the proper development of ventricular myocardium is dependent on the invasion of undifferentiated, WT1-positive, retinoic acid-synthesizing EPDCs. Furthermore, we propose that an interaction between EPDCs and endocardial (derived) cells is imperative for correct development of the AV cushions. [Copyright &y& Elsevier]

Bochdalek’s hernia is a congenital defect of the diaphragm that occurs predominantly in children. Perforation or necrosis of the involved organ is a feared complication and surgical repair constitutes the gold standard of treatment. We present a case of a 42-year-old female patient who presented with a 3-month history of left-upper-quadrant abdominal pain, nausea, tachycardia, and early postprandial vomit. Physical exploration was remarkable for audible peristalsis in the left hemithorax. Total white blood count was elevated and chest X-rays showed images of intestines in the left hemithorax. Tomography with double contrast reported left colon herniated to thorax. Left thoracoscopy was practised, finding a Bochdalek’s hernia with presence of herniated descendent colon with a necrotic area, which was perforated and sealed. The herniated content was returned back in place, the diaphragmatic defect was corrected, and colostomy by laparoscopy was simultaneously performed. Her postoperative recovery was uneventful and she was discharged from the hospital. Combined thoracoscopy and laparoscopic surgery is effective in complicated cases of Bochdalek’s hernia in adults, lessening surgical trauma and postsurgical morbidity. [ABSTRACT FROM AUTHOR]

Global warming is resulting in an increase in temperatures which is set to become more marked by the end of the century and depends on the accelerating pace of greenhouse gas emissions into the atmosphere. Yet even in this scenario, so-called "cold waves" will continue to be generated and have an impact on health. This study sought to analyse the impact of cold waves on daily mortality at a provincial level in Spain over the 2021–2050 and 2051–2100 time horizons under RCP4.5 and RCP 8.5 emission scenarios, on the basis of two hypotheses: (1) that the cold-wave definition temperature (T threshold) would not vary over time; and, (2) that there would be a variation in T threshold. The results of a retrospective study undertaken for Spain as a whole across the period 2000–2009 enabled us to ascertain the cold-wave definition temperature at a provincial level and its impact on health, measured by reference to population attributable risk (PAR). The minimum daily temperatures projected for each provincial capital considering the above time horizons and emission scenarios were provided by the State Meteorological Agency. On the basis of the T threshold definition values and minimum daily temperatures projected for each province, we calculated the expected impact of low temperatures on mortality under the above two hypotheses. Keeping the PAR values constant, it was assumed that the mortality rate would vary in accordance with the available data. If T threshold remained constant over the above time horizons under both emission scenarios, there would be no cold-related mortality. If T threshold were assumed to vary over time, however, then cold-related mortality would not disappear: it would instead remain practically constant over time and give rise to an estimated overall figure of around 250 deaths per year, equivalent to close on a quarter of Spain's current annual cold-related mortality and entailing a cost of approximately €1000 million per year. Given that cold waves are not going to disappear and that their impact on mortality is far from negligible and is likely to remain so, public health prevention measures must be implemented to minimise these effects as far as possible. • If the coldwave definition temperature remain constant mortality associated not occur. • Mortality from cold-waves in the future will be reduced respect to 2000–2009 in Spain. • Important regional differences exist in Spain in relation to cold-waves impact. • Regional approach will be highly useful in implement regional cold prevention plans. [ABSTRACT FROM AUTHOR]

Background: The continuum characterization of circulating RVA genotypes is essential to understand how vaccine introduction could impact virus epidemiology. In the present study, an unexpected rapid changing pattern of RVA genotypes distribution in Brazilian population during three followed seasons is described. Methods & Materials: From January/2012 to December/2014, a total of 3441 fecal specimens were collected from collaborating centers across Southern, Southeastern and Midwest Brazil, and likely to be representative of Brazilian population. All specimens were screened for RVA using ELISA, and genotyped by RT-PCR. Differences in proportions were tested using Chi Squares. A p-value of less than 0.05 was considered statistically significant. Results: RVA was detected in 19.7% (677/3441). G3P[8] remained prevalent in 2012 (37.6%, 69/185) and 2013 (40.1%, 74/186) (χ2=0.107, p=0.743), but declined markedly in 2014 (3.5%, 10/281) (χ2=71.770, p=0.000). G12P[8] was second highest strain in 2012 (22.7%, 42/185), decrease rapidly in 2013 (2.7%, 5/186) (χ2=26.224, p=0.000) and re-emerged as the predominant genotype in 2014 (86.6%, 243/281) (χ2=118.299, p=0.000). From July/2014, G12P[8] was the single genotype detected in all regions studied. Conclusion: The present study raised the hypothesis of a possible G12 outbreak being in progress. Nationally, the Hospital-based Information System surveillance data confirmed the long term decline in gastroenteritis hospitalization observed in Brazil after RVA vaccine introduction. Nevertheless, the sharp increase in diarrhea hospitalization prevalence from 2013 to 2014 observed in Southern and Southeastern regions is consistent with what appears to be an outbreak of G12P[8]. Furthermore, in 2014, the FIFA World Cup was held in Brazil, and the introduction a novel RVA strain was a real threat, given large numbers of visitors from areas with ongo ing G12P[8] genotype transmission. Moreover, this event occurred right before the beginning of the RVA seasonality in the country. Worldwide, the emergence of genotype G12P[8] as an epidemiologically important strain could raise new concerns for RVA vaccine development. However, despite the possible emergence of new strains, vaccination has been shown to reduce the disease incidence of RVA infection and remain below pre-vaccination levels. Continued surveillance is needed to verify the effectiveness of the RotarixTM vaccine in Brazil together with potential emergence of unusual genotypes. [ABSTRACT FROM AUTHOR]

Introduction Some inconsistent evidence indicates experiences of trauma and the presence of symptoms of PTSD are associated with increased risk of cardiovascular diseases. This relation has rarely been explored with community samples including participants with PTSD symptoms or who fulfill criteria for PTSD disorders. Objectives We identify those with a high number of PTSD symptoms and those fulfilling criteria for PTSD are more likely to have CVD than those without a PTSD syndrome or diagnosis. We examine rates of mental health access for those with PTSD and CVD. Methods We use Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences in trauma/PTSD prevalence and the association of prior trauma exposure and PTSD diagnoses with CVD ( n = 13,286). CIDI was used to make psychiatric diagnoses and medical data was acquired regarding onset and severity of CVD. Results Individuals with prior exposure to trauma and PTSD diagnoses had twice the likelihood of developing a cardiovascular disease as those without trauma exposure [OR = 1.77, 95% CI (1.0, 2.94)]. Having a PTSD diagnosis is a significant predictor of having a CVD for individuals who experienced a traumatic event. The probability of developing a CVD was higher when patients had prior diagnosis of substance abuse [OR = 1.36, 95% CI (1.11, 1.65)] or mental health disorders [OR = 1.43, 95% CI (1.10, 1.87) for depression; OR = 1.33, 95% CI (1.04, 1.69) for anxiety]. Men were almost twice as likely as women to be diagnosed with a CVD [OR = 1.67, 95% CI (1.37, 2.00)]. Conclusions Exposure to trauma and the presence of PTSD symptoms are significantly associated with CVD. [ABSTRACT FROM AUTHOR]

Background: “Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans. Objetives: Study the elements of a rite of passage present in Psychiatric Trainning. Method: [•] Field study (observational, descriptive, non-experimental). [•] Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning. [•] “ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder. [•] Summary and analysis of the answers. Review of the literature. Results: [-] Psychiatric Trainning shared the elements and tri-phasic structure of VanGennep''s “rite of passage” concept [-] Trainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives. [-] The collective behaved as a communitas(10/10) [-] No spiritual elements(0/10): liminoid process [-] Resemblances of the ancestral shamans'' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10). [-] Trainees felt that they grew spiritual and mentally(7/10) during the trainning years Conclusions: Results suggest that Psychiatric Trainning has stable phenomena that: [•] are compatible with the Rite of Passage schema [•] Are considered exclusive of Psychiatry by trainees [•] Have not been systematically studied as a whole, which could help to improve the training. [Copyright &y& Elsevier]