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To describe the way patients die in a Spanish ICU, and how the modes of death have changed in the last 10 years.Retrospective observational study evaluating all patients who died in a Spanish tertiary ICU over a 10-year period. Modes of death were classified as death despite maximal support (D-MS), brain death (BD), and death following life-sustaining treatment limitation (D-LSTL).Amongst 9264 ICU admissions, 1553 (16.8%) deaths were recorded. The ICU mortality rate declined (1.7%/year, 95% CI 1.4-2.0; p = 0.021) while ICU admissions increased (3.5%/year, 95% CI 3.3-3.7; p0.001). More than half of the patients (888, 57.2%) died D-MS, 389 (25.0%) died after a shared decision of D-LSTL and 276 (17.8%) died due to BD. Modes of death have changed significantly over the past decade. D-LSTL increased by 15.1%/year (95% CI 14.4-15.8; p0.001) and D-MS at the end-of-life decreased by 7.1%/year (95% CI 6.6-7.6; p0.001). The proportion of patients diagnosed with BD remained stable over time.End-of-life practices and modes of death in our ICU have steadily changed. The proportion of patients who died in ICU following limitation of life-prolonging therapies substantially increased, whereas death after maximal support occurred significantly less frequently.

Resumen Introduccion La fractura de cadera es una patologia traumatica muy frecuente en el anciano con alta mortalidad. Diferentes factores se han asociado con la mortalidad tras la cirugia (edad comorbilidades). Hay factores quirurgicos que se asocian con la mortalidad, pero no se han relacionado con los diferentes indices de mortalidad y comorbilidades medicas. Objetivo Analizar los parametros quirurgicos con influencia en la mortalidad en la cirugia de las fracturas extracapsulares de cadera en el paciente anciano, asi como la influencia de las comorbilidades medicas de estos pacientes en la mortalidad, mediante el indice de comorbilidad de Charlson abreviado ( CC I). Material y metodo Revision retrospectiva de 187 pacientes intervenidos en 2015. Se recogieron datos sobre la edad y sexo, lateralidad y tipo de fractura; demora quirurgica, tiempo quirurgico, tipo de material de osteosintesis, estancia media. La presencia de comorbilidades se determino empleando el CCI. Resultados La edad media fue de 85 anos. Con respecto al indice de comorbilidad de Charlson abreviado, 67,4% de los pacientes tenian una puntuacion entre 0 y 1, el 23,5% de 2, y un 9,1% > 2. La mortalidad al mes y al ano tras la cirugia fue de 5,3% y 14,4%, respectivamente. Se registraron 43 complicaciones, de las cuales 31 fueron complicaciones medicas. De los 27 pacientes fallecidos en el primer ano, 14 (51,8%) sufrieron complicaciones, 48,2% de las mismas fueron complicaciones medicas. Discusion El analisis multivariante mostro diferencias significativas con respecto a edad, complicaciones medicas e indice de Charlson abreviado de dos con respecto a la mortalidad. No existe asociacion entre demora y tiempo quirurgico con el aumento de la mortalidad. Conclusiones No se demostro asociacion de los parametros quirurgicos estudiados (demora y tiempo quirurgico, patron y estabilidad de la fractura, criterios de reduccion, complicaciones quirurgicas) con aumento de mortalidad a corto y largo plazo. Los pacientes con mayor edad, comorbilidades medidas con CCI abreviado y los que sufren complicaciones medicas presentan mayor riesgo de mortalidad al mes y al ano de la cirugia.

Introduction Hip fracture is a very frequent traumatic pathology in the elderly with high mortality. Different factors have been associated with mortality after surgery (age comorbidities). There are surgical factors that are associated with mortality, but they have not been related to the different mortality rates and medical comorbidities. Objective To analyse the surgical parameters with influence on mortality in surgery of extracapsular hip fractures in the elderly patient, as well as the influence of medical comorbidities of these patients on mortality, by means of the Charlson comorbidity index (CCI). Method Retrospective review of 187 patients operated on in 2015. Data were collected on age and sex, laterality and type of fracture; surgical delay, surgical time, type of osteosynthesis material, mean stay. The presence of comorbidities was determined using the JRC. Results Mean age was 85 years. Regarding the Charlson comorbidity index in brief, 67.4% of patients had a score between 0 and 1, 23.5% of 2, and 9.1% of >2. Mortality at one month and one year after surgery was 5.3% and 14.4% respectively. Forty-three complications were recorded, of which 31 were medical complications. Of the 27 patients who died in the first year, 14 (51.8%) suffered complications, 48.2% of which were medical complications. Discussion Multivariate analysis showed significant differences with respect to age, medical complications and Charlson index abbreviated to 2 with respect to mortality. There is no association between delay and surgical time with increased mortality. Conclusions No association was demonstrated between the surgical parameters studied (surgical delay and time, fracture pattern and stability, reduction criteria, surgical complications) and increased short and long-term mortality. Patients with older age, comorbidities measured with abbreviated CCI and those suffering medical complications have a higher risk of mortality at the month and year of surgery.

Objectives: To explore dental clinics’ performance on periodontal education by comparing knowledge about periodontal health of regular and inconsistent dental attenders. Subjects and Methods: A population-based study with a cross-sectional design was performed in Galicia (Northwestern Spain). Participants were randomly selected from 16 different areas and a questionnaire applied face-to-face. The survey included items on socio-demographic features, habits and routines, periodontal status and periodontal health knowledge. Participants were grouped according to the median of overall knowledge, and a logistic regression analysis was performed to explore the relationship between good periodontal knowledge and frequency of dental visits. Results: A total of 8,206 individuals were invited to enter the study, and 3,553 of them accepted the invitation (43.3%). Most participants (59.3%; n = 1,945) fit within the regular dental attenders’ group. Younger women holding a university degree and visiting their dentist regularly elicited higher knowledge about periodontal health. Regular use of dental services increased the chances of being in the higher knowledge group (OR: 1.67; 95% CI: 1.40–2.00). Conclusions: Reported regular dental attendance is related to periodontal health knowledge. Specific interventions for promoting tailored patient education on periodontal topics during routine dental visits may have a positive effect on laypersons’ knowledge about periodontal health.

Introduction: Oral status has a clear impact on systemic health, a key component of successful aging. Awareness of oral disorders permits early diagnoses and treatments. This study investigates oral disorders awareness among community-dwelling elders. Methods: Community-based survey through face-to-face interviews undertaken in four cities at busy commercial and administrative areas. Results: A total of 789 people were recruited, mostly nonsmoker (60.3%) males (56.9%) with basic education (65.6%). The most frequently recalled disorder was bruxism, followed by periodontal diseases and ulcerations/aphthae. Caries was mentioned by 3.91%. Dentate participants were more aware of dental-related disorders, such as bruxism ( p = .001) and periodontitis ( p = .010), except for caries ( p = .100). Caries awareness was related to educational level ( p = .018) and smoking ( p = .020), as was oral cancer ( p = .019) with former smokers more aware of this neoplasm. Education was strongly related with periodontal awareness ( p = .001). Conclusion: Awareness of the main oral disorders is worryingly poor among the elderly population and immediate action is required by taking advantage of the position of family nurses in the treatment of systemic chronic disorders and through educational interventions on this population subgroup to ease preventive behaviors, favor early diagnoses, and promote simpler, more effective treatments with a lower financial burden.

Clostridioides dfficile infection (CDI) is the main cause of nosocomial diarrhea, generally associated with the use of antibiotics. This infection can cause uncomplicated diarrhea to pseudomembranous colitis or toxic megacolon. Recent studies have attempted to relate the threshold cycle (Ct) value of RT-PCR with mortality, as a fast, simple, objective and efficient method.To evaluate Ct as a predictor of poor outcome in patients with C. dfficile disease with/without clinical signs of severity.We carried out a retrospective study between January 2015 and December 2018, including all patients in the reference area of the Hospital Universitario de Canarias in Tenerife (396,483 inhabitants) in patients with clinical criteria of severity and patients without clinical severity criteria (according to the guide for the clinical practice of CDI of the Society of Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of North America (IDSA).A total of 202 CDI episodes were diagnosed. 77.7% (n = 157) presented clinical severity criteria. The presence of ulcerative colitis (p0.001), fever (p0.001), leukocytosis (p0.001), neutrophilia (p0.001), creatininemia (p = 0.005) were presented as risk factors for the development of severe CDI (S-CDI). Female sex, institutionalization, previous admission and death were described more frequently in the group with S-CDI, not finding significant differences. We found no differences with respect to the days of previous stay, or of post-CDI stay, although in the latter, the mean was higher in the case of S-CDI patients. No significant differences were found in terms of Ct in both groups; being only one point lower in patients with severity criteria (Ct = 26.1) than without severity criteria (Ct = 27.4) (p = 0.326). Conclusión: Based on the results of our study, it has not been possible to systematically implement the Ct value as a predictor of severity to the clinical report, and it is not possible to extrapolate this predictive variable from S-CDI and standardize the Ct value as a predictor of severity.Basándonos en los resultados de nuestro estudio, no ha sido posible la implementación sistemática del valor Ct como predictor de gravedad al informe clínico, no siendo posible extrapolar esta variable predictora de enfermedad por C difficile-G y estandarizar el valor Ct como factor predictor de gravedad.

OBJECTIVES To assess periodontal awareness among laypersons, to characterize the very aware of periodontitis and to disclose whether high awareness implies sufficient periodontal knowledge. SUBJECTS AND METHODS Cross-sectional study on laypersons randomly selected by quota sampling from March 2015 to June 2016. The questionnaire of periodontal awareness included aspects of aetiology, risk factors, signs and symptoms, related risks, prevention, treatment and related attitudes. It was applied by 12 interviewers in the community in each four province capitals, in a sort of pathfinder survey method. RESULTS A 43.3% response rate was obtained, and 3,553 people entered the study. "Very aware": 19.4%. "Aware": 42.7%. "Not aware": 37.9%. Age, oral self-care and educational achievements characterized those "very aware." Any additional degree beyond compulsory education halves the chances for being "not periodontally aware." Very aware people likely to have periodontitis were elder, less educated, with a smoking history and less knowledge of the disease. Gaps of knowledge among the "very aware" were identified in all aspects except for "prevention" and "treatment.". CONCLUSIONS Very periodontally aware people were in their late 40-60 s, followed sound oral care routines and held a degree but elicited insufficient knowledge about aetiology, signs-symptoms, related risks or periodontal risk factors.

Background: Engaging relatives in the care of critically ill patients is associated with better outcomes. It is crucial to empower relatives to provide feedback. Valid satisfaction instruments are essential to identify best practices and areas for improvement. Aim: The aim of the study was to adapt the Spanish version of the EMpowerment of PArents in The Intensive Care-30 (EMPATHIC-30) questionnaire in adult intensive care units (ICUs) and psychometrically test the EMpowerment of PAtients in The Intensive Care-Family (EMPATHIC-F) questionnaire to measure family satisfaction. Design: This is a cross-sectional, prospective study conducted in two adult ICUs. Participants were relatives of patients who were discharged alive from the ICUs with an ICU length-of-stay >24 hours. The EMPATHIC-F questionnaire is divided into five domains that are related to the family-centred care principles. Responses are provided on a 6-point ordinal Likert scale, a score of >5 is considered acceptable. Results: Patients' relatives confirmed the adaptation of the instrument. A total of 262 relatives responded to the EMPATHIC-F questionnaire (97% response rate). The empirical structure of the instrument was established by confirmatory factor analysis confirming 30 statements within five theoretically conceptualized domains: information, care and treatment, family participation, organization, and professional attitude. On item level, two statements scored a mean below 5.0. Cronbach's α at the domain level was between .64 and .75. Congruent validity was adequate between the five domains and four general satisfaction items (r's .26-.54). The non-differential validity was confirmed with no significant effect size between three patients' demographic characteristics and the domains. Conclusions: The EMPATHIC-F questionnaire is a reliable and valid quality performance indicator to measure the perceptions of family members in adult ICU settings. Relevance to clinical practice: The EMPATHIC-F questionnaire can be used to benchmark and provides a framework for standardized quality improvement towards the development of a family-centred care philosophy within adult ICUs SI

Supplemental material, sj-docx-1-hci-10.1177_15404153211063638 for Awareness of Oral Disorders Among Community-Dwelling Elderly Spaniards by Pablo Cea-Arest��n, Andr��s Blanco-Hortas, Pablo Varela-Centelles, Javier Seoane-Romero, Almudena Varela-Centelles and Juan M. Seoane-Romero in Hispanic Health Care International

Background Lack of knowledge and awareness of oral cancer seem to be the main causes of diagnostic delay. Online resources are often used by patients to obtain health/medical information. However, there are no reports on the quality and usefulness of oral cancer audio-visual resources in Spanish. The aims of this investigation were to disclose the type of information about oral cancer available, and whether it may be useful to shorten the patients’ oral cancer appraisal time-interval. Material and Methods Cross-sectional study undertaken at three video-sharing sites on October, 13th 2019. Keywords: “Cáncer oral”; “cáncer de boca”. The first 100 results in each viewing list were retrieved by three reviewers. Demographical data was recorded, and interaction indexes, viewing rates, comprehensiveness, and usefulness were calculated for each video. The presence of non-scientifically supported information was also assessed. A descriptive analysis was undertaken, and relationships between variables were explored using the Spearman correlation test. Results A total of 127 videos were selected. They were produced mainly by mass-media (46.5%; n=59) and their length ranged from 0.28 to 105.38 minutes (median 4.15 minutes; IQR: 2.34-9.67). The most viewed video (10,599,765 views; visualization rate 726,508.9) scored 0 both in usefulness and comprehensiveness. The most useful video gathered 44,119 views (visualization rate 2.033.13). A highly significant positive correlation (0.643; p

The aims of this study were twofold - to determine the impact of a health education intervention led by a hospital pharmacy department on influenza vaccination take-up in patients diagnosed with immune-mediated diseases. Patients were receiving treatment with biological medicines. Secondly, to compare those rates with the vaccination percentages of another hospital pharmacy with similar characteristics in which no educational intervention was conducted.This was a retrospective cohort study of adult patients with immune-mediated diseases receiving treatment with biological medicines. The medicines were dispensed by the hospital pharmacy departments of two hospitals between 1 January 2019 and 31 December 2020. In Cohort A (intervention group), a health education strategy was implemented with regards to influenza vaccination. Cohort B acted as a control group. The influenza vaccination rates obtained in both cohorts during 2019 and 2020 were compared.A total of 355 patients took part in the study - 148 (41.7%) in Cohort A and 207 (58.3%) in Cohort B. The hospital pharmacy department in Cohort A implemented a health education strategy after which the vaccination percentage during the 2020 campaign increased by 38 patients (45.7%), compared with a 10 patient (5.8%) increase in Cohort B (p0.001).The health intervention by the pharmacy department had a positive impact. This included an opportunity to improve vaccination take-up and is a strategy to consider when implementing a vaccination programme. Health education is a fundamental objective of healthcare. In our case it led to an increase in vaccination and had a positive impact on public health. It also provides opportunities for pharmacists to work in a multidisciplinary way with other healthcare professionals.

Oral pathologies, in addition to being highly prevalent, have a systemic impact that can be prevented by regularly eliminating the dental biofilm. This population-based, cross-sectional study analysed the oral hygiene habits of 3,289 adults through community surveys in the four provincial capitals of Galicia between March 2015 and June 2016. Sex, level of periodontal awareness, education, tobacco habit, frequency of visits to the dentist and level of oral hygiene were registered according to the use of oral hygiene products and the frequency of their use. Oral hygiene was limited to brushing their teeth once a day in 86% of those surveyed, while regular interdental hygiene was a minority practice. The variables associated with good habits were periodontal awareness, frequent visits to the dentist, being a woman and a high educational level. Oral self-care is insufficient, especially in interdental hygiene, which justifies the need for educational interventions in the community.

Background Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration. Material and Methods Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. Results A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n=1,728), 47.7% of them (n=2,729) were males. Most participants (42.1%; n=2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n=1,614; 28%, n=1,600 respectively). When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n=3,597) and less than one quarter of the sample (23.8%; n=1,371) would seek consultation with their dentist. Conclusions General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer. Key words:Oral ulceration, oral cancer, patient attitudes, surveys and questionnaires, Spain

WOS: 000442210300011, 30151043, Science Citation Index Expanded, Unraveling adaptive genetic variation represents, in addition to the estimate of population demographic parameters, a cornerstone for the management of aquatic natural living resources, which, in turn, represent the raw material for breeding programs. The turbot (Scophthalmus maximus) is a marine flatfish of high commercial value living on the European continental shelf. While wild populations are declining, aquaculture is flourishing in southern Europe. We evaluated the genetic structure of turbot throughout its natural distribution range (672 individuals; 20 populations) by analyzing allele frequency data from 755 single nucleotide polymorphism discovered and genotyped by double-digest RAD sequencing. The species was structured into four main regions: Baltic Sea, Atlantic Ocean, Adriatic Sea, and Black Sea, with subtle differentiation apparent at the distribution margins of the Atlantic region. Genetic diversity and effective population size estimates were highest in the Atlantic populations, the area of greatest occurrence, while turbot from other regions showed lower levels, reflecting geographical isolation and reduced abundance. Divergent selection was detected within and between the Atlantic Ocean and Baltic Sea regions, and also when comparing these two regions with the Black Sea. Evidence of parallel evolution was detected between the two low salinity regions, the Baltic and Black seas. Correlation between genetic and environmental variation indicated that temperature and salinity were probably the main environmental drivers of selection. Mining around the four genomic regions consistently inferred to be under selection identified candidate genes related to osmoregulation, growth, and resistance to diseases. The new insights are useful for the management of turbot fisheries and aquaculture by providing the baseline for evaluating the consequences of turbot releases from restocking and farming., 7th Framework Programme for research (FP7) under "Knowledge-Based Bio-Economy - KBBE", Theme 2: "Food, Agriculture and fisheries, and Biotechnologies" [FP7-KBBE-2012-6-singlestage, 311920]; Spanish Regional Government Xunta de Galicia [GRC2014/010], 7th Framework Programme for research (FP7) under "Knowledge-Based Bio-Economy - KBBE", Theme 2: "Food, Agriculture and fisheries, and Biotechnologies" Project identifier: FP7-KBBE-2012-6-singlestage, Grant/Award Number: 311920; Spanish Regional Government Xunta de Galicia, Grant/Award Number: GRC2014/010

Background: Voriconazole, a first-line agent for the treatment of invasive fungal infections, is mainly metabolized by cytochrome P450 (CYP) 2C19. A significant portion of patients fail to achieve therapeutic voriconazole trough concentrations, with a consequently increased risk of therapeutic failure. Objective: To show the association between subtherapeutic voriconazole concentrations and factors affecting voriconazole pharmacokinetics: CYP2C19 genotype and drug–drug interactions. Methods: Adults receiving voriconazole for antifungal treatment or prophylaxis were included in a multicenter prospective study conducted in Spain. The prevalence of subtherapeutic voriconazole troughs was analyzed in the rapid metabolizer and ultra-rapid metabolizer patients (RMs and UMs, respectively), and compared with the rest of the patients. The relationship between voriconazole concentration, CYP2C19 phenotype, adverse events (AEs), and drug–drug interactions was also assessed. Results: In this study 78 patients were included with a wide variability in voriconazole plasma levels with only 44.8% of patients attaining trough concentrations within the therapeutic range of 1 and 5.5 µg/ml. The allele frequency of *17 variant was found to be 29.5%. Compared with patients with other phenotypes, RMs and UMs had a lower voriconazole plasma concentration (RM/UM: 1.85 ± 0.24 µg/ml vs other phenotypes: 2.36 ± 0.26 µg/ml). Adverse events were more common in patients with higher voriconazole concentrations (p

Statement of problem Mainly because of poor training, substandard impression disinfection practices have been reported worldwide. Purpose The purpose of this cross-sectional study was to assess the extension, usefulness, and reliability of contents on this topic available on the main video websites for self-training. Material and methods An analysis of the YouTube, Vimeo, and Dailymotion websites was undertaken in February 2018. The exclusion criteria were animal procedures, non-English language videos, advertisements, videos exclusively redirecting to websites, soundless videos, duplicated videos, and videos reporting on a research project. Information extension was assessed in 6 nonmutually exclusive dimensions, and usefulness was evaluated by using a 10-item scale. Reliability was assessed on a reliable or nonreliable basis. Statistical analyses were undertaken by using the Mann-Whitney and Fisher exact tests. Results Of 386 identified videos, only 22 met the selection criteria, mostly published by health-care professionals (n=8; 36.4%). Most videos had less than 3000 views. Median usefulness score: 3 (IR: 3-3; range: 0-6). No video included all 7 topics considered in the index (median 3; IR: 2.25-3; range: 0-4). Just 5 clips (22.7%) described a procedure according to the American Dental Association and Center for Disease Control (ADA and CDC) guidelines. Conclusions Audiovisual online resources on dental impression disinfection includes incomplete information with limited usefulness and reliability. The number of views was not related to quality, and therefore, many viewers may be obtaining knowledge from substandard material.

Vibrio europaeus is an emergent pathogen affecting the most important bivalve species reared in Spanish and French hatcheries. Using a genomic approach, we identified V. europaeus outside Europe for the first time from massive larval mortalities of scallop (Argopecten purpuratus) in Chile and from seawater near a shellfish hatchery in the US West Coast. Results show the worldwide spreading and potential impact of V. europaeus for aquaculture; these four countries are among the 10 major producers of mollusks. Pathogenicity of V. europaeus was demonstrated for the first time towards scallop, the second most important species for Chilean mariculture.