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The construction of large renewable energy projects is characterized by the great uncertainties associated with their administrative complexity and their constructive characteristics. For proper management, it is necessary to undertake a thorough project risk assessment prior to construction. The work presented in this paper is based on a hierarchical risk structure identified by a group of experts, from which a Probabilistic Fuzzy Sets with Analysis Hierarchy Process (PFSAHP) was applied. This probabilistic analysis approach used expert opinion based on the Monte Carlo Method that allows for extracting more information from the original data. In addition, the coherence of the experts’ opinions is assessed using a novel parameter known as Confidence Level, which allows for adjusting the opinions of experts and weighting their judgments regarding impact and probability according to their coherence. This model has the advantage of offering a risk analysis in the early stages of the management of renewable energy projects in which there is no detailed information. This model is also more accurate than the classic fuzzy methodology when working with complete distribution functions, whilst it avoids the loss of information that results from the traditional mathematical operations with Fuzzy numbers. To test the model, it was applied to a 250 MW photovoltaic solar plant construction project located in southeast of Spain (Region of Murcia). As a result of the application of the proposed method, risk rankings are obtained with respect to the cost, the time, the scope and from a general point of view of the project. [ABSTRACT FROM AUTHOR]

Objectives: This paper focuses on the issue of intimate partner violence and, specifically, on the distribution of femicides over time and the existence of copycat effects. This is the subject of an ongoing debate often triggered by the social alarm following multiple intimate partner homicides (IPHs) occurring in a short span of time. The aim of this research is to study the evolution of IPHs and provide a far-reaching answer by rigorously analyzing and searching for patterns in data on femicides. Methods: The study analyzes an official dataset, provided by the system VioGén of the Secretaría de Estado de Seguridad (Spanish State Secretariat for Security), including all the femicides occurred in Spain in 2007-2017. A statistical methodology to identify temporal interdependencies in count time series is proposed and applied to the dataset. The same methodology can be applied to other contexts. Results: There has been a decreasing trend in the number of femicides per year. No interdependencies among the temporal distribution of femicides are observed. Therefore, according to data, the existence of copycat effect in femicides cannot be claimed. Conclusions: Around 2011 there was a clear change in the average number of femicides which has not picked up. Results allow for an informed answer to the debate on copycat effect in Spanish femicides. The planning of femicides prevention activities should not be a reaction to a perceived increase in their occurrence. As a copycat effect is not detected in the studied time period, there is no evidence supporting the need to censor media reports on femicides. [ABSTRACT FROM AUTHOR]

Objective: The main aims of this paper are to analyse the monetary value of informal care time using different techniques and to identify significant variables associated with the number of caregiving hours. Data and methods: A multicentre study in two Spanish regions in adult caregivers was conducted. A total sample of 604 people was available. A multivariate analysis was performed to identify the variables associated with the number of hours of caregiving time. In the monetary valuation of informal care provided, three approaches were used: replacement cost method, opportunity cost and contingent valuation (willingness to pay and willingness to accept). Results: The main determinants of the amount of time of informal care provided were age, gender, the level of care receiver´s dependence and the professional care services received (at home and out of home). The value estimated for informal care time ranges from EUROS 80,247 (replacement cost method) to EUROS 14,325 (willingness to pay), with intermediate values of EUROS 27,140 and EUROS 29,343 (opportunity cost and willingness to accept, respectively). Several sensitivity analyses were performed over the base cases, confirming the previous results. Conclusions: Time of informal care represents a great social value, regardless of the applied technique. However, the results can differ strongly depending on the technique chosen. Therefore, the choice of technique of valuation is not neutral. Among the determinants of informal care time, the professional care received at home has a complementary character to informal care, while the formal care outside the home has a substitute character. [ABSTRACT FROM AUTHOR]

Pleistocene skinning and exploitation of carnivore furs have been previously inferred from archaeological evidence. Nevertheless, the evidence of skinning and fur processing tends to be weak and the interpretations are not strongly sustained by the archaeological record. In the present paper, we analyze unique evidence of patterned anthropic modification and skeletal representation of fossil remains of cave lion (Panthera spelaea) from the Lower Gallery of La Garma (Cantabria, Spain). This site is one of the few that provides Pleistocene examples of lion exploitation by humans. Our archaeozoological study suggests that lion-specialized pelt exploitation and use might have been related to ritual activities during the Middle Magdalenian period (ca. 14800 cal BC). Moreover, the specimens also represent the southernmost European and the latest evidence of cave lion exploitation in Iberia. Therefore, the study seeks to provide alternative explanations for lion extinction in Eurasia and argues for a role of hunting as a factor to take into account. [ABSTRACT FROM AUTHOR]

Objectives: To determine the factors associated with lung cancer diagnosis and mortality after detecting a solitary pulmonary nodule (SPN) in routine clinical practice, in men and in women for both chest radiograph and CT. Materials and methods: A 5-year follow-up of a retrospective cohort of of 25,422 (12,594 men, 12,827 women) patients aged ≥35 years referred for chest radiograph or CT in two hospitals in Spain (2010–2011). SPN were detected in 893 (546 men, 347 women) patients. We estimated the cumulative incidence of lung cancer at 5-years, the association of patient and nodule characteristics with SPN malignancy using Poisson logistic regression, stratifying by sex and type of imaging test. We calculated lung cancer specific mortality rate by sex and SPN detection and hazard rates by cox regression. Results: 133 (14.9%) out of 893 patients with an SPN and 505 (2.06%) of the 24,529 patients without SPN were diagnosed with lung cancer. Median diameter of SPN in women who developed cancer was larger than in men. Men who had a chest radiograph were more likely to develop a lung cancer if the nodule was in the upper-lobes, which was not the case for women. In patients with an SPN, smoking increased the risk of lung cancer among men (chest radiograph: RR = 11.3, 95%CI 1.5–83.3; CT: RR = 7.5, 95%CI 2.2, 26.0) but smoking was not significantly associated with lung cancer diagnosis or mortality among women with an SPN. The relative risk of lung cancer diagnosis in women with SPN versus those without was much higher compared to men (13.7; 95%CI 9.2, 20.4 versus 6.2; 95%CI 4.9,7.9). Conclusion: The factors associated with SPN malignancy and 5-year lung cancer mortality were different among men and women, especially regarding smoking history and SPN characteristics, where we observed a relatively high rate of lung cancer diagnosis among female non-smokers. [ABSTRACT FROM AUTHOR]

In any sport the selection of players for a team is fundamental for its subsequent performance. Many factors condition the selection process from the characteristics of the sport discipline to financial limitations, including a long list of restrictions associated with the environment of the competitions in which the team takes part. All of this makes the process of selecting a roster of players very complex, as it is affected by multiple variables and in many cases marked by a great deal of subjectivity. The purpose of this article was to objectively select the players for a basketball team using an evolutionary algorithm, the Non-dominated Sorting Genetic Algorithm II (NSGA-II) that uses stochastic search methods based on the imitation of natural biological evolution. The sample was composed of the players from the teams competing in the top Spanish basketball league, the Association of Basketball Clubs (ACB). To assess the quality of the solutions obtained, the results were compared with the teams in the ACB playing in the same competition as the players used in the study. The results make it possible to obtain different solutions for composing teams rendering financial resources profitable and taking into account the restrictions of the competition and of each sport management. [ABSTRACT FROM AUTHOR]

The causative mutation responsible for limb girdle muscular dystrophy 1F (LGMD1F) is one heterozygous single nucleotide deletion in the stop codon of the nuclear import factor Transportin 3 gene (TNPO3). This mutation causes a carboxy-terminal extension of 15 amino acids, producing a protein of unknown function (TNPO3_mut) that is co-expressed with wild-type TNPO3 (TNPO3_wt). TNPO3 has been involved in the nuclear transport of serine/arginine-rich proteins such as splicing factors and also in HIV-1 infection through interaction with the viral integrase and capsid. We analyzed the effect of TNPO3_mut on HIV-1 infection using PBMCs from patients with LGMD1F infected ex vivo. HIV-1 infection was drastically impaired in these cells and viral integration was reduced 16-fold. No significant effects on viral reverse transcription and episomal 2-LTR circles were observed suggesting that the integration of HIV-1 genome was restricted. This is the second genetic defect described after CCR5Δ32 that shows strong resistance against HIV-1 infection. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of sources of drug information on antibiotic prescribing patterns (quantity and quality) among primary care physicians. Methods: We conducted a cohort study on primary care physicians who were actively engaged in medical practice in 2010 in a region in north-west Spain (Galicia), fulfilling inclusion criteria (n = 2100). As the independent variable, we took the perceived utility of 6 sources of information on antibiotics, as measured by the validated KAAR-11 questionnaire. As dependent variables, we used: (1) a quality indicator (appropriate quality, defined as any case where 6 of the 12 indicators proposed by the European Surveillance of Antimicrobial Consumption Network [ESAC-Net] were better than the mean values for Spain); and, (2) a quantity indicator (high prescribing), defined as any case where defined daily doses (DDD) per 1 000 inhabitants per day of antibacterials for systemic use were higher than the mean values for Spain. The adjusted odds ratio for a change in the interquartile range (IqOR) for each sources of information on antibiotics was calculated using Generalized Linear Mixed Models. Results: The questionnaire response rate was 68%. Greater perceived utility of pharmaceutical sales representatives increases the risk of having high prescribing (1/IqOR = 2.50 [95%CI: 1.63–3.66]) and reduces the probability of having appropriate quality (1/IqOR = 2.28 [95%CI: 1.77–3.01]). Greater perceived utility of clinical guidelines increases the probability of having appropriate quality (1/IqOR = 1.25 [95%CI: 1.02–1.54]) and reduces the probability of high prescribing (1/IqOR = 1.25 [95%CI: 1.02–1.54]). Conclusions: Sources of information on antibiotics are an important determinant of the quantity and quality of antibiotic prescribing in primary care. Commercial sources of information influence prescribing negatively, and clinical guidelines are associated with better indicators. [ABSTRACT FROM AUTHOR]

This research focuses on the relationship of self-congruity and perceived social value with the interpersonal connections established by Generation Y tourists in virtual social networks. A quantitative study was performed using a sample of young travelers from Spain. The methodologies of Confirmatory Factor Analysis (CFA) and Structural Equation Models (SEM) were used to analyze the results. The findings of the research show that self-congruity influences the perceived social value; the perceived social value leads to satisfaction and the creation of interpersonal connections in virtual social networks; and the interpersonal connections in virtual social networks influence the use of these tools by Generation Y travelers. [ABSTRACT FROM AUTHOR]

The high prevalence of intimate partner violence against women (IPVAW) in countries with high levels of gender equality has been defined as the “Nordic paradox”. In this study we compared physical and sexual IPVAW prevalence data in two countries exemplifying the Nordic paradox: Sweden (N = 1483) and Spain (N = 1447). Data was drawn from the European Union Agency for Fundamental Rights Survey on violence against women. To ascertain whether differences between these two countries reflect true differences in IPVAW prevalence, and to rule out the possibility of measurement bias, we conducted a set of analyses to ensure measurement equivalence, a precondition for appropriate and valid cross-cultural comparisons. Results showed that in both countries items were measuring two separate constructs, physical and sexual IPVAW, and that these factors had high internal consistency and adequate validity. Measurement equivalence analyses (i.e., differential item functioning, and multigroup confirmatory factor analysis) supported the comparability of data across countries. Latent means comparisons between the Spanish and the Swedish samples showed that scores on both the physical and sexual IPVAW factors were significantly higher in Sweden than in Spain. The effect sizes of these differences were large: 89.1% of the Swedish sample had higher values in the physical IPVAW factor than the Spanish average, and this percentage was 99.4% for the sexual IPVAW factor as compared to the Spanish average. In terms of probability of superiority, there was an 80.7% and 96.1% probability that a Swedish woman would score higher than a Spanish woman in the physical and the sexual IPVAW factors, respectively. Our results showed that the higher prevalence of physical and sexual IPVAW in Sweden than in Spain reflects actual differences and are not the result of measurement bias, supporting the idea of the Nordic paradox. [ABSTRACT FROM AUTHOR]

Purpose: 1) To systematically review the available scientific literature regarding specific instruments developed and/or tested in a Spanish population, to assess these PROMs in hip arthroplasty; 2) to carry out a standardized assessment of their measurement properties; and 3) to identify the best tools for use in Spain in an arthroplasty registry context. Methods: A systematic review of PubMed/MEDLINE and EMBASE and CINHAL was done. Furthermore, a standardized assessment of the questionnaires identified using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool was performed. All developments, validation and studies aiming to assess the measurement properties of PROMs in hip arthroplasty in the Spanish population were included. Data from the questionnaires on metric properties was taken into account to identify the best candidates for inclusion in a register. Results: A total of 853 documents were found. After screening title and abstract, 13 full text documents were reviewed and 8 questionnaires adapted and validated to assess some of the aspects of hip arthroplasty in the Spanish population were identified. After the EMPRO assessment, 4 questionnaires showed suitable properties (WOMAC, OAKHQOL, mini-OAKHQOL and PFH). Conclusions: In Spain, there are a few suitable hip-specific questionnaires currently available to assess PROMs in hip arthroplasty surgery. Some of the more widely used questionnaires, like the OHS and HOOS, have not been validated in the Spanish population until now. Identified tools are suitable for use in a clinical context, however their use in an arthroplasty register is more questionable due to the lack of validation studies of the widely used tools in other registers. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to characterize the bacterial microbiome of hard ticks with affinity to bite humans in La Rioja (North of Spain). Methods: A total of 88 adult ticks (22 Rhipicephalus sanguineus sensu lato, 27 Haemaphysalis punctata, 30 Dermacentor marginatus and 9 Ixodes ricinus) and 120 I. ricinus nymphs (CRETAV collection, La Rioja, Spain), representing the main anthropophilic species in our environment, were subjected to a metagenomic analysis of the V3-V4 region of the 16S rRNA gene using an Illumina MiSeq platform. Data obtained with Greengenes database were refined with BLAST. Four groups of samples were defined, according to the four tick species. Results: Proteobacteria was the predominant phylum observed in all groups. Gammaproteobacteria was the most abundant class, followed by Alphaproteobacteria for R. sanguineus, H. punctata and D. marginatus but the relative abundance of reads for these classes was reversed for I. ricinus. This tick species showed more than 46% reads corresponding to ‘not assigned’ OTUs (Greengenes), and >97% of them corresponded to ‘Candidatus Midichloriaceae’ using BLAST. Within Rickettsiales, ‘Candidatus Midichloria’, Rickettsia, Ehrlichia, ‘Candidatus Neoehrlichia’ and Wolbachia were detected. I. ricinus was the most alpha-diverse species. Regarding beta-diversity, I. ricinus and H. punctata samples grouped according to their tick species but microbial communities of some R. sanguineus and D. marginatus specimens clustered together. Conclusions: The metagenomics approach seems useful to discover the spectrum of tick-related bacteria. More studies are needed to identify and differentiate bacterial species, and to improve the knowledge of tick-borne diseases in Spain. [ABSTRACT FROM AUTHOR]

Methodological advances in dating the Middle to Upper Paleolithic transition provide a better understanding of the replacement of local Neanderthal populations by Anatomically Modern Humans. Today we know that this replacement was not a single, pan-European event, but rather it took place at different times in different regions. Thus, local conditions could have played a role. Iberia represents a significant macro-region to study this process. Northern Atlantic Spain contains evidence of both Mousterian and Early Upper Paleolithic occupations, although most of them are not properly dated, thus hindering the chances of an adequate interpretation. Here we present 46 new radiocarbon dates conducted using ultrafiltration pre-treatment method of anthropogenically manipulated bones from 13 sites in the Cantabrian region containing Mousterian, Aurignacian and Gravettian levels, of which 30 are considered relevant. These dates, alongside previously reported ones, were integrated into a Bayesian age model to reconstruct an absolute timescale for the transitional period. According to it, the Mousterian disappeared in the region by 47.9–45.1ka cal BP, while the Châtelperronian lasted between 42.6k and 41.5ka cal BP. The Mousterian and Châtelperronian did not overlap, indicating that the latter might be either intrusive or an offshoot of the Mousterian. The new chronology also suggests that the Aurignacian appears between 43.3–40.5ka cal BP overlapping with the Châtelperronian, and ended around 34.6–33.1ka cal BP, after the Gravettian had already been established in the region. This evidence indicates that Neanderthals and AMH co-existed <1,000 years, with the caveat that no diagnostic human remains have been found with the latest Mousterian, Châtelperronian or earliest Aurignacian in Cantabrian Spain. [ABSTRACT FROM AUTHOR]

Background: Women tend to report poorer self-rated health than men. It is also well established that education has a positive effect on health. However, the issue of how the benefits of education on health differ between men and women has not received enough attention and the few existing studies which do focus on the subject do not draw a clear conclusion. Therefore, this study aims to analyse whether the positive influence of educational attainment on health is higher for women and whether education helps to overcome the gender gap in self-rated health. Methods: We analyse cross-sectional data from the 2012 European Union statistics on income and living conditions. We use a logit regression model with odds ratios and a multilevel perspective to carry out a study which includes several individual and contextual control variables. We focused our study on the working population in Spain aged between 25 and 65. The final sample considered is composed of 14,120 subjects: 7,653 men and 6,467 women. Results: There is a gender gap in self-rated health only for the less educated. This gap is not statistically significant among more highly educated individuals. Attaining a high level of education has the same positive effect on both women’s and men’s self-rated health. Conclusions: Although we did not find gender disparities when considering the effect of education on health, we show that women’s health is poorer among the less educated, mainly due to labour precariousness and household conditions. [ABSTRACT FROM AUTHOR]

Recently, the interest in studying pancreatic cancer mortality has increased due to its high lethality. In this work a detailed analysis of pancreatic cancer mortality in Spanish provinces was performed using recent data. A set of multivariate spatial gender-age-period-cohort models was considered to look for potential candidates to analyze pancreatic cancer mortality rates. The selected model combines features of APC (age-period-cohort) models with disease mapping approaches. To ensure model identifiability sum-to-zero constraints were applied. A fully Bayesian approach based on integrated nested Laplace approximations (INLA) was considered for model fitting and inference. Sensitivity analyses were also conducted. In general, estimated average rates by age, cohort, and period are higher in males than in females. The higher differences according to age between males and females correspond to the age groups [65, 70), [70, 75), and [75, 80). Regarding the cohort, the greatest difference between men and women is observed for those born between the forties and the sixties. From there on, the younger the birth cohort is, the smaller the difference becomes. Some cohort differences are also identified by regions and age-groups. The spatial pattern indicates a North-South gradient of pancreatic cancer mortality in Spain, the provinces in the North being the ones with the highest effects on mortality during the studied period. Finally, the space-time evolution shows that the space pattern has changed little over time. [ABSTRACT FROM AUTHOR]

Avipoxvirus (APV) is a fairly common virus affecting birds that causes morbidity and mortality in wild and captive birds. We studied the prevalence of pox-like lesions and genetic diversity of APV in house sparrows (Passer domesticus) in natural, agricultural and urban areas in southern Spain in 2013 and 2014 and in central Spain for 8 months (2012–2013). Overall, 3.2% of 2,341 house sparrows visually examined in southern Spain had cutaneous lesions consistent with avian pox. A similar prevalence (3%) was found in 338 birds from central Spain. Prevalence was higher in hatch-year birds than in adults. We did not detect any clear spatial or temporal patterns of APV distribution. Molecular analyses of poxvirus-like lesions revealed that 63% of the samples were positive. Molecular and phylogenetic analyses of 29 DNA sequences from the fpv167 gene, detected two strains belonging to the canarypox clade (subclades B1 and B2) previously found in Spain. One of them appears predominant in Iberia and North Africa and shares 70% similarity to fowlpox and canarypox virus. This APV strain has been identified in a limited number of species in the Iberian Peninsula, Morocco and Hungary. The second one has a global distribution and has been found in numerous wild bird species around the world. To our knowledge, this represents the largest study of avian poxvirus disease in the broadly distributed house sparrow and strongly supports the findings that Avipox prevalence in this species in South and central Spain is moderate and the genetic diversity low. [ABSTRACT FROM AUTHOR]

The Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria assume that the 18 symptoms carry the same weight in an Attention Deficit with Hyperactivity Disorder (ADHD) diagnosis and bear the same discriminatory capacity. However, it is reasonable to think that symptoms may differ in terms of severity and even in the reliability with they represent the disorder. To test this hypothesis, the aim of this study was to calibrate in a sample of Spanish children (age 4–7; n = 784) a scale for assessing the symptoms of ADHD proposed by Diagnostic and Statistical Manual of Mental Disorders, IV-TR within the framework of Item Response Theory. Samejima’s Graded Response Model was used as a method for estimating the item difficulty and discrimination parameters. The results showed that ADHD subscales (Attention Deficit and Hyperactivity / Impulsivity) had good psychometric properties and had also a good fit to the model. However, relevant differences between symptoms were observed at the level of severity, informativeness and reliability for the assessment of ADHD. This finding suggests that it would be useful to identify the symptoms that are more important than the others with regard to diagnosing ADHD. [ABSTRACT FROM AUTHOR]

Attitudes toward sexuality are a key variable for sexual health. It is really important for psychology and education to have adapted and validated questionnaires to evaluate these attitudes. Therefore, the objective of this research was to adapt, validate and calculate the equivalence of the Colombia Sexual Opinion Survey as compared to the same survey from Spain. To this end, a total of eight experts were consulted and 1,167 subjects from Colombia and Spain answered the Sexual Opinion Survey, the Sexual Assertiveness Scale, the Massachusetts General Hospital-Sexual Functioning Questionnaire, and the Sexuality Scale. The evaluation was conducted by online and the results show adequate qualitative and quantitative properties of the items, with adequate reliability and external validity and compliance with the strong invariance between the two countries. Consequently, the Colombia Sexual Opinion Survey is a valid and reliable scale and its scores can be compared with the ones from the Spain survey, with minimum bias. [ABSTRACT FROM AUTHOR]

The National Plan for the Elimination of Rubella was implemented in Spain in 2008 using the logistics of the National Plan for the Elimination of Measles that have been employed since year 2000. Molecular characterization of rubella virus (RUBV) is important for disease surveillance and for monitoring elimination of the disease throughout the world. We describe the first complete series of data regarding the circulation of RUBV genotypes in Spain. The 739-nucleotide fragment designated by the WHO for RUBV genotyping was sequenced in 88 selected cases collected from 1998 to 2014. Five genotypes were identified: 1E, 2B, 1J, 1I, and 1a. Genotype 1E was predominant between 1998 and 2003 but was replaced by genotype 2B, which was detected in sporadic cases in 2004, 2006, 2008, 2012, 2013 and 2014. There was an outbreak of genotype 2B in Algeciras (Andalusia) in 2008. Genotype 1J caused an outbreak in Madrid in 2004/2005 and sporadic cases in 2005 and 2007. Genotype 1I was found to have infected an immune-suppressed patient with neurological symptoms in 2008. Finally, vaccine strain RA 27/3 was detected in three sporadic cases, two of them immune-suppressed and without a recent history of vaccination. This suggests that during these years there were a series of imported sporadic cases and outbreaks, confirming the findings of epidemiological data analysis. The importation sources were generally consistent with our geographic and cultural ties, mainly with Europe (genotypes 1E, 2B, 1I) and Latin America (1J). [ABSTRACT FROM AUTHOR]

Background: A novel meningococcal multicomponent vaccine, 4CMenB (Bexsero®), has been approved in Europe, Canada, Australia and US. The potential impact of 4CMenB on strain coverage is being estimated by using Meningococcal Antigen Typing System (MATS), an ELISA assay which measures vaccine antigen expression and diversity in each strain. Here we show the genetic characterization and the 4CMenB potential coverage of Spanish invasive strains (collected during one epidemiological year) compared to other European countries and discuss the potential reasons for the lower estimate of coverage in Spain. Material and Methods: A panel of 300 strains, a representative sample of all serogroup B Neisseria meningitidis notified cases in Spain from 2009 to 2010, was characterized by multilocus sequence typing (MLST) and FetA variable region determination. 4CMenB vaccine antigens, PorA, factor H binding protein (fHbp), Neisseria Heparin Binding Antigen (NHBA) and Neisserial adhesin A (NadA) were molecularly typed by sequencing. PorA coverage was assigned to strain with VR2 = 4. The levels of expression and cross-reactivity of fHbp, NHBA and NadA were analyzed using MATS ELISA. Findings: Global estimated strain coverage by MATS was 68.67% (95% CI: 47.77–84.59%), with 51.33%, 15.33% and 2% of strains covered by one, two and three vaccine antigens, respectively. The predicted strain coverage by individual antigens was: 42% NHBA, 36.33% fHbp, 8.33% PorA and 1.33% NadA. Coverage within the most prevalent clonal complexes (cc) was 70.37% for cc 269, 30.19% for cc 213 and 95.83% for cc 32. Conclusions: Clonal complexes (cc) distribution accounts for variations in strain coverage, so that country-by-country investigations of strain coverage and cc prevalence are important. Because the cc distribution could also vary over time, which in turn could lead to changes in strain coverage, continuous detailed surveillance and monitoring of vaccine antigens expression is needed in those countries where the multicomponent vaccine is introduced. This is really important in countries like Spain where most of the strains are predicted to be covered by only one vaccine antigen and the chance for escape mutants to emerge with vaccine use is higher. Based on the observed data, cc213 should receive special attention as it is associated with low predicted strain coverage, and has recently emerged in Spain. [ABSTRACT FROM AUTHOR]

Background: Interval cancers are primary breast cancers diagnosed in women after a negative screening test and before the next screening invitation. Our aim was to evaluate risk factors for interval cancer and their subtypes and to compare the risk factors identified with those associated with incident screen-detected cancers. Methods: We analyzed data from 645,764 women participating in the Spanish breast cancer screening program from 2000–2006 and followed-up until 2009. A total of 5,309 screen-detected and 1,653 interval cancers were diagnosed. Among the latter, 1,012 could be classified on the basis of findings in screening and diagnostic mammograms, consisting of 489 true interval cancers (48.2%), 235 false-negatives (23.2%), 172 minimal-signs (17.2%) and 114 occult tumors (11.3%). Information on the screening protocol and women's characteristics were obtained from the screening program registry. Cause-specific Cox regression models were used to estimate the hazard ratios (HR) of risks factors for interval cancer and incident screen-detected cancer. A multinomial regression model, using screen-detected tumors as a reference group, was used to assess the effect of breast density and other factors on the occurrence of interval cancer subtypes. Results: A previous false-positive was the main risk factor for interval cancer (HR = 2.71, 95%CI: 2.28–3.23); this risk was higher for false-negatives (HR = 8.79, 95%CI: 6.24–12.40) than for true interval cancer (HR = 2.26, 95%CI: 1.59–3.21). A family history of breast cancer was associated with true intervals (HR = 2.11, 95%CI: 1.60–2.78), previous benign biopsy with a false-negatives (HR = 1.83, 95%CI: 1.23–2.71). High breast density was mainly associated with occult tumors (RRR = 4.92, 95%CI: 2.58–9.38), followed by true intervals (RRR = 1.67, 95%CI: 1.18–2.36) and false-negatives (RRR = 1.58, 95%CI: 1.00–2.49). Conclusion: The role of women's characteristics differs among interval cancer subtypes. This information could be useful to improve effectiveness of breast cancer screening programmes and to better classify subgroups of women with different risks of developing cancer. [ABSTRACT FROM AUTHOR]