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Objectives: Adherence to healthy lifestyle recommendations has been reported to improve health-related quality of life (HRQL) in breast cancer (BC) patients, but the influence of long-term behavioral changes remains unknown. We evaluated the association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and HRQL both, at BC diagnosis and the change 7−12 years later. Design: Prospective cohort study. Settings and participants: A total of 406 breast cancer survivors, from the EpiGEICAM study, were recruited in 16 Spanish hospitals. Measurements: Epidemiological, clinical, dietary, physical activity and HRQL information was collected both at recruitment and 7−12 years later. A 7-item score to measure compliance with recommendations was assessed according to the 2018 WCRF/AICR scoring criteria. HRQL was evaluated using SF-36 questionnaire. Linear mixed models for longitudinal data were used to assess the cross-sectional and longitudinal association between adherence score and the physical and mental component summary scores. Results: At diagnosis, for each unit increase in WCRF/AICR score adherence, the HRQL physical domain increased 0.78 points (95%CI: −0.04 to 1.60; P trend:0.06). The mean change in physical HRQL from diagnosis to follow-up per unit increase in within-subject adherence score was 0.73 points (95%CI: −0.18 to 1.65; P trend: 0.12). For the mental domain, no association was observed with compliance with the recommendations at diagnosis, nor with changes in adherence over time. Conclusions: Our results suggest that Increased adherence to WCRF/AICR cancer prevention recommendations over time could contribute to slightly improved long-term physical HRQoL in BC survivors.

Background: Mammographic density (MD) is a well-established risk factor for breast cancer. Air pollution is a major public health concern and a recognized carcinogen. We aim to investigate the association between MD and exposure to specific air pollutants (SO2, CO, NO, NO2, NOx, PM2.5, PM10, and O3) in premenopausal females. Methods: This cross-sectional study, carried out in Spain, included 769 participants who attended their gynecological examinations. Hourly concentrations of the pollutants were extracted from the Air Quality Monitoring System of Madrid City over a 3-year period. Individual long-term exposure to pollutants was assessed by geocoding residential addresses and monitoring stations, and applying ordinary kriging to the 3-year annual mean concentrations of each pollutant to interpolate the surface of Madrid. This exposure variable was categorized into quartiles. In a first analysis, we used multiple linear regression models with the log-transformed percent MD as a continuous variable. In a second analysis, we used MD as a dichotomous variable (“high” density (MD > 50%) vs. “low” density (MD ≤ 50%)) and applied multiple logistic regression models to estimate odds ratios (ORs). We also analyzed the correlation among the pollutants, and performed a principal component analysis (PCA) to reduce the dimensionality of this set of eight correlated pollutants into a smaller set of uncorrelated variables (principal components (PCs)). Finally, the initial analyses were applied to the PCs to detect underlying patterns of emission sources. Results: The first analysis detected no association between MD and exposure to any of the pollutants. The second analysis showed non-statistically significant increased risks (ORQ4; IC95%) of high MD were detected in women with higher exposure to SO2 (1.50; 0.90–2.48), and PM2.5 (1.27; 0.77–2.10). In contrast, non-significant ORs < 1 were found in all exposure quartiles for NO (ORQ2 = 0.72, ORQ3 = 0.68, ORQ4 = 0.78), and PM10 (ORQ2 = 0.69, ORQ3 = 0.82, ORQ4 = 0.72). PCA identified two PCs (PC1: “traffic pollution” and PC2: “natural pollution”), and no association was detected between MD and proximity to these two PCs. Conclusions: In general, our results show a lack of association between residential exposure to specific air pollutants and MD in premenopausal females. Future research is needed to confirm or refute these findings.

Introduction The role of cigarette smoking on breast cancer risk remains controversial, due to its dual carcinogenic-antiestrogenic action. Methods In the population-based multi-case-control study (MCC-Spain), we collected epidemiological and clinical information for 1733 breast cancer cases and 1903 controls, including smoking exposure. The association with breast cancer, overall, by pathological subtype and menopausal status, was assessed using logistic and multinomial regression models. Results Smokers had higher risk of premenopausal breast cancer, particularly if they had smoked ≥30 years (AOR=1.75; 95% CI: 1.04–2.94), although most estimates did not achieve statistical significance. In contrast, among postmenopausal women, smoking was associated with lower risk of breast cancer, mainly in overweight and obese women. The strongest risk reductions were observed among postmenopausal women who had stopped smoking ≥10 years before cancer diagnosis, particularly for HER2+ tumors (AOR=0.28; 95% CI: 0.11–0.68); p for heterogeneity = 0.040). Also, those who had smoked

The scarcity of potable water emphasizes the urgent need to develop and implement more sustainable treatment technologies, considering both energy consumption and environmental impact. These technologies require effective disinfection systems that avoid the use of chemicals. Innovations in this area, utilizing UV-LED technology, can significantly improve efficiency, reduce costs, and mitigate environmental impacts. This study aimed to evaluate the antimicrobial properties of various encapsulated UV light-emitting diodes (LEDs) to identify the most suitable candidate for constructing an LED array capable of disinfecting large volumes of water. Different devices from various manufacturers, with differing costs and wavelengths, were examined, leading to the selection of the optimal candidate (LED 2) based on its antimicrobial effectiveness and cost-effectiveness. The impact of parameters such as bacterial concentration, sample volume, exposure time, and conditions on disinfection capacity was thoroughly investigated. Exposure to LED 2 resulted in substantial reductions in the viability of bacteria and yeast, demonstrating efficacy even against Clostridium perfringens endospores. Subsequently, an LED array was developed based on these findings and rigorously evaluated for efficacy, confirming its effectiveness as an efficient and environmentally friendly water treatment device.

Las pizarras numerales de época posromana que aparecen mayoritariamente en el Sistema Central han suscitado un renovado interés académico. En particular, se discute el papel que desempeñaron como una forma temprana de sistema contable. Los investigadores sugieren que podrían relacionarse con peajes por el tránsito de ganados o con impuestos. Este trabajo analiza la función de estas pizarras a través de un estudio interdisciplinar que hace énfasis en el registro arqueológico y las fuentes escritas. En primer lugar, se analiza la legislación, las hagiografías y los documentos privados. En segundo lugar, se profundiza en investigaciones palinológicas y zooarqueológicas cuya información se complementa con un estudio de la distribución espacial de las pizarras numerales relacionadas con las vías pecuarias tradicionales. Apoyamos la hipótesis académica que sostiene que la función de las pizarras numerales podría estar relacionada con el desarrollo de estrategias locales a partir del siglo V. Entre ellas destacan las actividades ganaderas, que jugaron un papel fundamental en la economía posromana de la península ibérica.

A growing interest in the recovery and enhancement of crops, particularly local varieties such as ‘Caaveiro’ wheat, has been observed. This study aims to investigate the impact of cultivation systems (organic versus conventional) on the nutritional quality of ‘Caaveiro’ flour and breads protected by the PGI “Pan Galego,” employing two fermentation methods (sourdough versus sourdough and biological yeast). Organic flour exhibited significantly higher levels of moisture, fat, sucrose, phosphorus (P), sodium (Na), and copper (Cu) while also exhibiting a lower total starch and zinc (Zn) content. Organic bread, produced using both fermentation methods, demonstrated significantly higher protein, carbohydrate, total, resistant, and rapidly digestible starch, ash, Na, P, iron (Fe), and Cu content. Additionally, they contained less moisture compared to conventional bread. Despite variations in nutritional characteristics based on the cultivation system, the organic approach proved effective at producing high-quality products with a positive environmental impact, which is highly appreciated by consumers.

The limitations of the existing Global Navigation Satellite Systems (GNSS) integrated with Inertial Measurement Units (IMU) have presented significant challenges in meeting the stringent demands of precision maneuvering. The identified constraints in terms of accuracy and availability have required the development of an alternative solution to enhance the performance of navigation systems in dynamic and diverse environments. This paper summarizes the research regarding the integration of ultra-wideband (UWB) technology as an augmentation of the conventional GNSS+IMU system; it proposes an approach that aims to overcome the limitations of conventional navigation systems. By making use of UWB technology, the proposed low-cost UWB-augmented GNSS+IMU system not only fulfils the required performance standards but also offers the unique capability to navigate seamlessly across indoor and outdoor environments. The developed system was validated through comprehensive testing and analysis in both the automotive and maritime sectors. The obtained results highlight the system’s capacity as a dependable and resilient solution for precise navigation, and they promote its use within the domain of accurate maneuvering.

Abstract Background One of the most important challenges in medical education is the preparation of multiple-choice questions able to discriminate between students with different academic level. Average questions may be very easy for students with good performance, reducing their discriminant power in this group of students. The aim of this study was to analyze if the discriminative power of multiple-choice questions is different according to the students’ academic performance. Methods We retrospectively analyzed the difficulty and discrimination indices of 257 multiple-choice questions used for the end of course examination of pathophysiology and analyzed whether the discrimination indices were lower in students with good academic performance (group 1) than in students with moderate/poor academic performance (group 2). We also evaluated whether case-based questions maintained their discriminant power better than factual questions in both groups of students or not. Comparison of the difficulty and discrimination indices between both groups was based on the Wilcoxon test. Results Difficulty index was significantly higher in group 1 (median: 0.78 versus 0.56; P

BackgroundIn Spain, differences in the prevalence of obesity and excess weight according to sex and sociodemographic factors have been described at the national level, although current data do not allow to delve into geographical differences for these conditions. The aim was to estimate national and regional prevalences of adult obesity and excess weight in Spain by sex and sociodemographic characteristics, and to explore difference sources of inequalities in its distribution, as well as its geographical pattern.MethodENE-COVID study was a nationwide representative seroepidemiological survey with 57,131 participants. Residents in 35,893 households were selected from municipal rolls using a two-stage random sampling stratified by province and municipality size (April–June 2020). Participants (77.0% of contacted individuals) answered a questionnaire which collected self-reported weight and height, as well as different socioeconomic variables, that allowed estimating crude and standardized prevalences of adult obesity and excess weight.ResultsCrude prevalences of obesity and excess weight were higher in men (obesity: 19.3% vs. 18.0%; excess weight: 63.7% vs. 48.4%), while severe obesity was more prevalent in women (4.5% vs. 5.3%). These prevalences increased with age and disability, and decreased with education, census tract income and municipality size. Differences by educational level, relative census income, nationality or disability were clearly higher among women. Obesity by province ranged 13.3–27.4% in men and 11.4–28.1% in women; excess weight ranged 57.2–76.0% in men and 38.9–59.5% in women. The highest prevalences were located in the southern half of the country and some north-western provinces. Sociodemographic characteristics only explained a small part of the observed geographical variability (25.2% obesity).ConclusionObesity and overweight have a high prevalence in Spain, with notable geographical and sex differences. Socioeconomic inequalities are stronger among women. The observed geographical variability suggests the need to implement regional and local interventions to effectively address this public health problem.

IntroductionThe protection of children is a major driver of behavior among those in charge of their care. We evaluated whether compliance with preventive measures against SARS-CoV-2 infection among adults living with children was different from that of those not living with them, in 2020.MethodsWe used the COSMO-SPAIN (N = 867) and the nationally representative ENE-COVID (N = 29,926) surveys to estimate prevalence of compliance (95% confidence interval). Logistic model based standardization methods were applied to estimate standardized prevalence differences (SPrD) to the overall distribution of age, sex, education, history of COVID-19, and residence of other >60 yrs in the household.ResultsWe observed that adults living with children more frequently avoided bars (SPrDENE−COVID: 4.2%; 95% CI: 2.3–6.1), crowded places (SPrDCOSMO: 8.0%; 95% CI: 0.6–15.1) and did not use public transportation (SPrDENE−COVID: 4.9%; 95% CI: 3.0–6.7). They were also more worried about work and family conciliation (SPrDCOSMO: 12.2%; 95% CI: 4.8–19.5) and about closure of education centers (SPrDCOSMO: 26.5%; 95% CI: 19.4–33.6).DiscussionIn general, adults living with children adopted slightly more frequently social distancing measures.

Abstract Background The aim of this study was to identify predictors of mortality in elderly patients undergoing colorectal cancer surgery and to develop a risk score. Methods This was an observational prospective cohort study. Individuals over 80 years diagnosed with colorectal cancer and treated surgically were recruited in 18 hospitals in the Spanish National Health Service, between June 2010 and December 2012, and were followed up 1, 2, 3, and 5 years after surgery. Sociodemographic and clinical data were collected. The primary outcomes were mortality at 2 and between 2 and 5 years after the index admission. Results The predictors of mortality 2 years after surgery were haemoglobin ≤ 10 g/dl and colon locations (HR 1.02; CI 0.51–2.02), ASA class of IV (HR 3.55; CI 1.91–6.58), residual tumour classification of R2 (HR 7.82; CI 3.11–19.62), TNM stage of III (HR 2.14; CI 1.23–3.72) or IV (HR 3.21; CI 1.47–7), LODDS of more than − 0.53 (HR 3.08; CI 1.62–5.86)) and complications during admission (HR 1.73; CI 1.07–2.80). Between 2 and 5 years of follow-up, the predictors were no tests performed within the first year of follow-up (HR 2.58; CI 1.21–5.46), any complication due to the treatment within the 2 years of follow-up (HR 2.47; CI 1.27–4.81), being between 85 and 89 and not having radiotherapy within the second year of follow-up (HR 1.60; CI 1.01–2.55), no colostomy closure within the 2 years of follow-up (HR 4.93; CI 1.48–16.41), medical complications (HR 1.61; CI 1.06–2.44), tumour recurrence within the 2 years of follow-up period (HR 3.19; CI 1.96–5.18), and readmissions at 1 or 2 years of follow-up after surgery (HR 1.44; CI 0.86–2.41). Conclusion We have identified variables that, in our sample, predict mortality 2 and between 2 and 5 years after surgery for colorectal cancer older patients. We have also created risks scores, which could support the decision-making process. Trial registration ClinicalTrials.gov , NCT02488161 .

The objective of this work is to describe the content of the work A Luminous Guide for the British Cooperative Forces in Spain by Sotero de Goicoechea and, especially, to study the repertoires included in it: a bilingual English-Spanish thematic vocabulary and a trilingual English-Spanish-Basque vocabulary. The text, published in Bayonne in 1836, is a brief guide to the Basque province of Bizkaia written for the British auxiliary forces displaced to the Basque Country during the First Carlist War (1836-1839). Thus, after reviewing the historical context and biographical data of the author, we focus on studying the two mentioned vocabularies. Despite their brevity, they are considered relevant due to the unusual co-appearance of these three languages.

Abstract Background Active learning strategies such as formative assessment through clinical cases may help to get a deeper learning. We have studied the effect of this kind of online formative assessment in pathophysiology teaching. Methods Seven brief clinical cases were used to give formative assessment in the first semester of a pathophysiology course. To evaluate its effect on learning, we analyzed the proportion of students that passed the end of semester exam with a score above 60 over 100. We also analyzed the effect of the intervention according to the students’ previous academic performance. Results Ninety-six students participated in the study and sat the exam. Sixty-five of them passed it. Students that passed the exam had a higher previous academic performance and had done a higher number of exercises of formative assessment, both in univariate and multivariate analysis. The participants were divided in three groups, according to their previous academic performance. In the intermediate group, the number of cases done by the students who passed the exam was significantly higher than in those who did not pass it (median: 4 versus 0; P = 0.009). Conclusion Formative assessment through web-based clinical cases was followed by an improvement of the academic results in pathophysiology, mainly in students with intermediate performance.

BackgroundA healthy diet when approaching menopause could prevent some of the symptoms associated with the climacteric. Few studies examine adherence to current healthy dietary recommendations in middle-aged premenopausal women. Our objective was to analyze the diet quality and the adherence to the Spanish Society of Community Nutrition (SENC) dietary recommendations in middle-aged Spanish premenopausal women, and to identify the associated sociodemographic and lifestyle factors.MethodsThis is a cross-sectional study based on 1251 premenopausal women, aged 39–50, who attended to Madrid City Council Medical Diagnostic Center. Women completed an epidemiological and a food frequency questionnaire. Degree of adherence to the SENC recommendations was estimated with a score that evaluated null (0 points) and full (1 point) adherence of each specific recommendation. Associations were explored using an ordinal logistic multivariable regression model.ResultsRegarding food groups, the worst adherence was found for sweets, red/processed meat, olive oil and eggs. Most of the participants exceeded the recommended caloric intake from proteins and fats, and practically all of them showed vitamin D intake deficiency. The overall score ranged from 2 to 12 (out of 15), with a median of 6.0 (interquartile range: 5.0–7.0). Former smokers (OR: 1.38; 95%CI: 1.08–1.78), as well as those with higher educational level (ORSSecondary:1.68; 95%CI: 0.97–2.93, ORUniversity:1.82; 95%IC: 1.05–3.14), with two or more children (OR: 1.31; 95%IC: 1.00-1.72), with higher caloric intake (OR>2188.2kcal/day: 8.22; 95%CI: 6.19–10.92) and with greater physical activity (OR≥21METS−h/week: 1.29; 95%CI: 0.95-1.76) showed greater adherence.ConclusionsAlmost two-thirds of middle-aged premenopausal participants showed low or moderate compliance with SENC recommendations. Education, smoking, parity, and physical activity were associated with the degree of adherence to these recommendations.

Abstract This study evaluates the impact of breast cancer (BC) in health related quality of life (HRQL) and in psychological distress (PD) during the initial phases of the disease and looks for contributing factors. A multicentric case-control study, EpiGEICAM, was carried out. Incident BC cases and age- and residence- matched controls were included. Clinical, epidemiological, HRQL (SF-36) and PD information (GHQ-28) was collected. We used multivariable logistic regression models to estimate OR of low HRQL and of PD in cases compared to controls, and to identify factors associated with low HRQL and with PD. Among 896 BC cases and 890 control women, cases had poorer scores than both, the reference population and the control group, in all SF-36 scales. BC women with lower education, younger, active workers, never smokers, those with comorbidities, in stage IV and with surgical treatment had lower physical HRQL; factors associated with low mental HRQL were dissatisfaction with social support, being current smoker and having children. Cases had a fivefold increased odds of PD compared to controls. Managing comorbidities and trying to promote social support, especially in younger and less educated women, could improve well-being of BC patients.

This paper examines the lexical repertoires in Spanish and Portuguese that are included in two conversation manuals: O espanhol tal qual se fala. Novissima guía de conversação com a pronúncia figura, work elaborated for the Portuguese who want to learn Spanish; and the Manual de la conversación y del estilo epistolar, for the acquisition of Portuguese by Spaniards. The vocabularies inserted in both works are thematically grouped: they constitute nomenclatures, repertoires that are very common within the tradition of teaching and learning foreign languages. In addition, these vocabularies are complemented with a column dedicated to the pronunciation of the target language, in a similar way to other contemporaneous texts. Therefore, the analysed works are not original, but they are a good sample of the materials used throughout the history of foreign language teaching.

Background: Colorectal cancer is the third most frequent tumor in males and the second in females worldwide. In Spain, it is an important and growing health problem, and epidemiologic research focused on potential risk factors, such as environmental exposures, is necessary. Objectives: To analyze the association between colorectal cancer risk and residential proximity to industries, according to pollution discharge route, industrial groups, categories of carcinogens and other toxic substances, and specific pollutants released, in the context of a population-based multicase-control study of incident cancer carried out in Spain (MCC-Spain). Methods: MCC-Spain included 557 colorectal cancer cases and 2948 controls in 11 provinces, frequency matched by sex, age, and region of residence. Distances were computed from subjects’ residences to each of the 134 industries located in the study area. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1 km to 3 km) to industrial facilities, adjusting for matching variables and other confounders. Results: Excess risk (OR; 95%CI) of colorectal cancer was detected near industries overall for all distances analyzed, from 1 km (2.03; 1.44–2.87) to 3 km (1.26; 1.00–1.59). In general, industries releasing pollutants to air showed higher excess risks than facilities releasing pollution to water. By industrial sector, excess risk (OR; 95%CI) was found near (≤3 km) production of metals (2.66; 1.77–4.00), surface treatment of metals (1.48; 1.08–2.02), glass and mineral fibers (2.06; 1.39–3.07), organic chemical industry (4.80; 3.20–7.20), inorganic chemical industry (6.74; 4.38–10.36), food/beverage sector (3.34; 2.38–4.68), and surface treatment using organic solvents (6.16; 4.06–9.36). By pollutants, the main excess risks (OR; 95%CI) were found near (≤3 km) industries releasing nonylphenol (9.19; 5.91–14.28), antimony (5.30; 3.45–8.15), naphthalene (3.11; 2.16–4.49), organotin compounds (2.64; 1.76–3.98), manganese (2.53; 1.63–3.93), dichloromethane (2.52; 1.74–3.66), and vanadium (2.49; 1.59–3.91). Conclusions: Our results support the hypothesis that residing in the proximity of industries may be a risk factor for colorectal cancer.

Francisco Jáuregui -or François Jauréguy-, from the French town of San Juan de Luz, is the author of Gramera berria, ikasteko eskualdunec mintzatzen espanoles [= New grammar, for Basques to learn to speak in Spanish], published in the Imprenta Republicana of Buenos Aires in 1850. This manual is a bilingual grammar in Basque and Spanish, and it was developed to facilitate the learning of Spanish to the Basque speakers who emigrated to Argentina. The manual had some success, since it was reprinted in 1860 and in 1883, in the same city. In this paper, we have compared these three editions and carried out a detailed description of Jáuregui’s text, considering the historical context in which it is inserted. Its affiliation with other similar books has also been examined.

Abstract Background Pancreatic cancer is acquiring increasing prominence as a cause of cancer death in the population. The purpose of this study was to analyze long-term pancreatic cancer mortality trends in Spain and evaluate the independent effects of age, death period and birth cohort on these trends. Methods Population and mortality data for the period 1952–2012 were obtained from the Spanish National Statistics Institute. Pancreatic cancer deaths were identified using the International Classification of Diseases ICD-6 to ICD-9 (157 code) and ICD-10 (C25 code). Age-specific and age-adjusted mortality rates were computed by sex, region and five-year period. Changes in pancreatic cancer mortality trends were evaluated using joinpoint regression analyses by sex and region. Age-period-cohort log-linear models were fitted separately for each sex, and segmented regression models were used to detect changes in period- and cohort-effect curvatures. Results In men, rates increased by 4.1% per annum from 1975 until the mid-1980s and by 1.1% thereafter. In women, there was an increase of 3.6% per annum until the late 1980s, and 1.4% per annum from 1987 to 2012. With reference to the cohort effects, there was an increase in mortality until the generations born in the 1950s in men and a subsequent decline detected by the change point in 1960. A similar trend was observed in women, but the change point occurred 10 years later than in men. Conclusions Pancreatic cancer mortality increased over the study period in both sexes and all regions. An important rise in rates -around 4% annually- was registered until the 1980s, and upward trends were more moderate subsequently. The differences among sexes in trends in younger generations may be linked to different past prevalence of exposure to some risk factors, particularly tobacco, which underwent an earlier decrease in men than in women.

Railway applications are in continuous evolution with the aim of offering a more efficient, sustainable, and safer transportation system for the users. Generally, these applications are constantly exchanging information between the systems onboard the train and the trackside through a wireless communication. Nowadays, Global System for Mobile communications-Railway (GSM-R) is the technology used by European Train Control System (ETCS), but it is becoming obsolete. Therefore, alternatives for this technology have to be found for the different railway applications. Its natural evolution is to move forward with the latest technology deployed: Long-Term Evolution (LTE), which the Public Land Mobile Networks (PLMN) have already deployed. Therefore, testing the performance of this communication technology in the railway environment could be useful to assess its suitability and reduce the cost of railway network dedicated deployment. In order to do that, a methodology to characterize the communication environment is proposed. The main goal is to measure geolocated impairments of any communication channel in a railway environment being able to determine its behavior of the different communication technologies and find out possible coverage issues. Moreover, it could help in the selection of suitable communication technology for railway. This paper presents a brief description of the communication for railways and its QoS parameters for performance measuring. Afterward, the testing methodology is described, and then, the communication channel measurement campaign on a real track in Spain where the railway environment is variable is presented (tunnels, rural/urban area…). Finally, the measurements and results on this real track in Spain are shown. The results provide suitability of the 4G technologies based on the delay requirements for the implementation of ETCS over it.

BACKGROUND:Prostate cancer (PC) primarily affects elderly men. However, the specific features of cases diagnosed at younger ages (

BACKGROUND:Tools to aid in the prognosis assessment of colon cancer patients in terms of risk of mortality are needed. Goals of this study are to develop and validate clinical prediction rules for 1- and 2-year mortality in these patients. METHODS:This is a prospective cohort study of patients diagnosed with colon cancer who underwent surgery at 22 hospitals. The main outcomes were mortality at 1 and 2 years after surgery. Background, clinical parameters, and diagnostic tests findings were evaluated as possible predictors. Multivariable multilevel logistic regression and survival models were used in the analyses to create the clinical prediction rules. Models developed in the derivation sample were validated in another sample of the study. RESULTS:American Society of Anesthesiologists Physical Status Classification System (ASA), Charlson comorbidity index (> = 4), age (>75 years), residual tumor (R2), TNM stage IV and log of lymph nodes ratio (> = -0.53) were predictors of 1-year mortality (C-index (95% CI): 0.865 (0.792-0.938)). Adjuvant chemotherapy was an additional predictor. Again ASA, Charlson Index (> = 4), age (>75 years), log of lymph nodes ratio (> = -0.53), TNM, and residual tumor were predictors of 2-year mortality (C-index:0.821 (0.766-0.876). Chemotherapy was also an additional predictor. CONCLUSIONS:These clinical prediction rules show very good predictive abilities of one and two years survival and provide clinicians and patients with an easy and quick-to-use decision tool for use in the clinical decision process while the patient is still in the index admission.

Background: Several studies have suggested that Helicobacter pylori (H. pylori) infection is a risk factor for colorectal cancer (CRC), while others have not confirmed this hypothesis. This work aimed to assess the relation of CRC with H. pylori seropositivity and with seropositivity to 16 H. pylori proteins, in the MultiCase-Control study, MCC-Spain.Methods: MCC-Spain is a multicase-control study carried out in Spain from 2008 to 2013. In total, 2,140 histologically-confirmed incident CRC cases and 4,098 population-based controls were recruited. Controls were frequency-matched by sex, age, and province. Epidemiological data were collected through a questionnaire fulfilled by face-to-face interviews and a self-administered food-frequency questionnaire. Seroreactivities against 16 H. pylori proteins were determined in 1,488 cases and 2,495 controls using H. pylori multiplex serology. H. pylori seropositivity was defined as positivity to ≥4 proteins. Multivariable logistic regression mixed models were used to estimate odds ratios (OR) and 95% confidence intervals (CI).Results:H. pylori seropositivity was not associated with increased CRC risk (OR = 0.91; 95% CI: 0.71–1.16). Among H. pylori seropositive subjects, seropositivity to Cagδ showed a lower CRC risk, and risk decreased with increasing number of proteins seropositive. Seropositivity to the most recognized virulence factors, CagA and VacA, was not associated with a higher CRC risk. No statistically significant heterogeneity was identified among tumor sites, although inverse relations were stronger for left colon cancer. An interaction with age and sex was found: H. pylori seropositivity was associated with a lower CRC risk in men younger than 65 and with a higher risk in older women.Conclusions: Our results suggest that neither H. pylori seropositivity, nor seropositivity to the virulence factor CagA are associated with a higher CRC risk. A possible effect modification by age and sex was identified.

Sex hormones play a role in gastric cancer and colorectal cancer etiology, however, epidemiological evidence is inconsistent. This study examines the influence of menstrual and reproductive factors over the risk of both tumors.In this case-control study 128 women with gastric cancer and 1293 controls, as well as 562 female and colorectal cancer cases and 1605 controls were recruited in 9 and 11 Spanish provinces, respectively. Population controls were frequency matched to cases by age and province. Demographic and reproductive data were directly surveyed by trained staff. The association with gastric, colon and rectal cancer was assessed using logistic and multinomial mixed regression models.Our results show an inverse association of age at first birth with gastric cancer risk (five-year trend: OR = 0.69; p-value = 0.006). Ever users of hormonal contraception presented a decreased risk of gastric (OR = 0.42; 95%CI = 0.26-0.69), colon (OR = 0.64; 95%CI = 0.48-0.86) and rectal cancer (OR = 0.61; 95%CI = 0.43-0.88). Postmenopausal women who used hormone replacement therapy showed a decreased risk of colon and rectal tumors. A significant interaction of educational level with parity and months of first child lactation was also observed.These findings suggest a protective role of exogenous hormones in gastric and colorectal cancer risk. The role of endogenous hormones remains unclear.

Introduction: In the context of the increasing relevance of food security in the field of the Public Health, the present article try to evaluate the degree of microbiological contamination in foodstuffs, and to search improvement measures.Methods: Retrospective analysis of the results obtained from the samples of foodstuffs from industries and restauration establishements in the district 1 of the Area V of Madrid Autonomous Region between 1999 and 2002.To check the official minutes of inspections of social restauration establishements.Descriptive analysis of the data obtained.Results: The parameters in 116 of the 383 analysed samples (30 ́3%) were higher than permitted by law. The percentage of correct samples in the collective lunchrooms went up from 62% in 1999 to 89 ́9% in 2001 (pThe 32 ́8% of the altered samples were caused by the presence of patogens.The foodsttufs with higher percentage of alteration were the dairy products, followed by the sausages. In the cooked foods, the percentage of alteration was higher in those of group A.The primary deficiences in the social restauration establishements were the absence of non-manual accion tap, the lack of bleach suitable for alimentary use and the inadequate protection of foods.Conclusions: In collective lunchrooms we can observe an improvement in the microbiological results; however, there are still structural and process deficiencies. The results of the other industries cannot be easily assessed due to scarcity of samples.To use bleach suitable for alimentary use in a routine way, can be a measure to reduce the high percentage of group A contaminated foodstuffs.Introducción: En el marco de una creciente relevancia de la seguridad alimentaria en el ámbito de la salud pública, el presente estudio trata de valorar el grado de contaminación microbiológica de los alimentos y proponer medidas de mejora.Metodología: Análisis retrospectivo de los resultados microbiológicos de las muestras tomadas de alimentos de industrias elaboradoras y de restauración del Distrito 1 del Área V de Salud de la Comunidad de Madrid en 1999, 2000, 2001 y 2002.Revisión de las actas de inspección de los establecimientos de restauración social.Análisis descriptivo de los mismos.Resultados: De las 383 muestras analizadas, 116 (30 ́3%) superaron los límites microbiológicos permitidos por la legislación.El porcentaje de muestras correctas en comedores colectivos aumentó del 62% en 1999 al 89 ́9% en 2001 (pLos alimentos con mayor porcentaje de incumplimiento fueron los productos lácteos, seguidos de los embutidos. En platos elaborados, el porcentaje de incumplimiento fue mayor en los del grupo A.Las principales deficiencias en los establecimientos de restauración social fueron la ausencia de lavamanos de accionamiento no manual utilizables, ausencia de lejía de uso alimentario e inadecuada protección de los alimentos.Conclusiones: Tendencia positiva en los resultados microbiológicos en comedores colectivos, aunque persisten deficiencias tanto estructurales como de proceso. En el resto de programas los resultados son menos valorables debido al bajo número de muestras.Conseguir una mayor utilización de lejía de uso alimentario podría disminuir el porcentaje de alimentos del grupo A que superan los límites microbiológicos permitidos.

Application of illness-severity scores in Intermediate Care Units (ImCU) shows conflicting results. The aim of the study is to design a severity-of-illness score for patients admitted to an ImCU.We performed a retrospective observational study in a single academic medical centre in Pamplona, Spain. Demographics, past medical history, reasons for admission, physiological parameters at admission and during the first 24 hours of ImCU stay, laboratory variables and survival to hospital discharge were recorded. Logistic regression analysis was performed to identify variables for mortality prediction.A total of 743 patients were included. The final multivariable model (derivation cohort = 554 patients) contained only 9 variables obtained at admission to the ImCU: previous length of stay 7 days (6 points), health-care related infection (11), metastatic cancer (9), immunosuppressive therapy (6), Glasgow comma scale 12 (10), need of non-invasive ventilation (14), platelets 50000/mcL (9), urea 0.6 g/L (10) and bilirubin 4 mg/dL (9). The ImCU severity score (ImCUSS) is generated by summing the individual point values, and the formula for determining the expected in-hospital mortality risk is: e(ImCUSS points*0.099 - 4,111)/(1 + e(ImCUSS points*0.099 - 4,11)1). The model showed adequate calibration and discrimination. Performance of ImCUSS (validation cohort = 189 patients) was comparable to that of SAPS II and 3. Hosmer-Lemeshow goodness-of-fit C test was χ2 8.078 (p=0.326) and the area under receiver operating curve 0.802.ImCUSS, specially designed for intermediate care, is based on easy to obtain variables at admission to ImCU. Additionally, it shows a notable performance in terms of calibration and mortality discrimination.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.

Epithelioid hemangioendothelioma (HEH) is a rare disease of unknown etiology for which a standard systemic treatment has not been established. The common expression of vascular endothelial growth factor (VEGF) and its receptor in HEH provide a rationale for the reported use of antiangiogenic drugs, including bevacizumab, lenalidomide and thalidomide. We report a case of a young male patient with HEH with sorafenib for almost 2 years. Sorafenib was used instead of other VEGF inhibitors due to its convenient oral route, its dual antiangiogenic and antiproliferative activity, and its favorable safety profile. Sorafenib therapy resulted in durable stabilization with progressive calcification of liver tumors and minor but stable response of lung lesions.

Introducción: En el marco de una creciente relevancia de la seguridad alimentaria en el ámbito de la salud pública, el presente estudio trata de valorar el grado de contaminación microbiológica de los alimentos y proponer medidas de mejora. Metodología: Análisis retrospectivo de los resultados microbiológicos de las muestras tomadas de alimentos de industrias elaboradoras y de restauración del Distrito 1 del Área V de Salud de la Comunidad de Madrid en 1999, 2000, 2001 y 2002. Revisión de las actas de inspección de los establecimientos de restauración social.Análisis descriptivo de los mismos. Resultados: De las 383 muestras analizadas, 116 (30 ́3%) superaron los límites microbiológicos permitidos por la legislación. El porcentaje de muestras correctas en comedores colectivos aumentó del 62% en 1999 al 89 ́9% en 2001 (p

La influencia del euskera en la lengua española es de gran importancia como consecuencia del contacto prolongado entre ellas en un mismo territorio. Así, a pesar de que el español se ha hallado en una posición de superioridad frente a la lengua vasca, ha ido incorporando de forma continua un cierto número de elementos léxicos procedentes de esta. Por ello, el objetivo del presente trabajo es analizar la inclusión y el tratamiento de las palabras consideradas como vasquismos en las diferentes obras lexicográficas españolas desde el comienzo hasta la actualidad, así como su relevancia dentro de la historia de la lexicografía hispánica.