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School climate research has traditionally been carried out by separating its two main components, prosocial and antisocial behaviors. This is often a partial view of the school climate. Hence, the goal of this study is to develop an evaluation instrument (CONVIVE) that takes into account both perspectives of the school climate through a dual-strategy design, psychometric and non-experimental, cross-sectional, and descriptive-comparative. The sample includes 600 Primary and Secondary Education students from a southeastern region of Spain. Exploratory and Confirmatory Factorial Analysis fit indices were used for the psychometric study. The result is a 26-item instrument (CONVIVE) made up of four scales that evaluate antisocial and prosocial behaviors, both performed toward others and received by peers: "Prosocial Behavior Actor," "Prosocial Behavior Receiver," "Antisocial Behavior Actor," and "Antisocial Behavior Receiver." These behaviors differ as a function of sex and the educational stage.

Lipoprotein(a) (Lp(a)) is increasingly used in the evaluation of patients with vascular risk due to its association with cardiovascular events. The purpose of this study was to identify the clinical characteristics of patients with elevated levels of Lp(a) attended in an outpatient vascular risk unit. An observational, retrospective study was conducted to assess the clinical characteristics of patients with elevated levels of Lp(a) (≥50 mg/dL), as compared to patients with normal values (<50 mg/dL). The sample was composed of 878 patients identified as having a high vascular risk due to a diagnosis of vascular disease, attended in a vascular risk unit between 2021 and 2022. The highest levels of Lp(a) were independently associated with a higher probability of having a history of peripheral arterial disease (p=0.024), polygenic familial hypercholesterolemia (PH, p=0.030) and combined familial hypercholesterolemia (CFH, p=0.015); and using PCSK9 inhibitor treatment (p=0.029) and combination therapy with statins and ezetimibe (p=0.018). In contrast, there were no significant differences in relation to familial history of early cardiovascular disease (p=0.143) or personal history of cardiovascular disease (p=0.063), which contrasts with other series. Elevated levels of Lp(a) were associated with a history of peripheral arterial disease, diagnosis of FHP and CFH, and need for more intense lipid-lowering treatments. [ABSTRACT FROM AUTHOR]

This study tested social cognitive career theory (SCCT) in the technological domain with 2,359 high-school students in Asturias (Spain). Path analyses were run to determine the influence of gender on the SCCT model and to explain the influence of personal (emotional state, gender-role attitudes), contextual (perceived social supports and barriers), and cognitive (self-efficacy beliefs, outcome expectations) variables on technological interest. The results almost entirely confirm the SCCT model for Spanish high-school students in both the boys' and girls' samples. Further, the results show that girls and boys do not differ significantly as far as the different variables are concerned.

Copyright of Revista de Administración Pública is the property of Centro de Estudios Politicos y Constitucionales and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

School climate research has traditionally been carried out by separating its two main components, prosocial and antisocial behaviors. This is often a partial view of the school climate. Hence, the goal of this study is to develop an evaluation instrument (CONVIVE) that takes into account both perspectives of the school climate through a dual-strategy design, psychometric and non-experimental, cross-sectional, and descriptive-comparative. The sample includes 600 Primary and Secondary Education students from a southeastern region of Spain. Exploratory and Confirmatory Factorial Analysis fit indices were used for the psychometric study. The result is a 26-item instrument (CONVIVE) made up of four scales that evaluate antisocial and prosocial behaviors, both performed toward others and received by peers: Prosocial Behavior Actor, Prosocial Behavior Receiver, Antisocial Behavior Actor, and Antisocial Behavior Receiver. These behaviors differ as a function of sex and the educational stage. [ABSTRACT FROM AUTHOR]

Objective: To investigate the intraindividual agreement of the sperm chromatin dispersion (SCD) assay results to assess sperm DNA fragmentation (SDF) in men with infertility.Design: Diagnostic test reliability study.Setting: Andrology laboratories.Patient(s): A total of 219 men with infertility.Intervention(s): Sperm DNA fragmentation assessment in two ejaculates of the same subjects within a 3-month interval, using the SCD assay performed and analyzed by the same observers under similar testing conditions.Main Outcome Measure(s): Cohen's κ statistics to assess the degree of agreement between the pairs of results after converting the nominal SCD values into categorical data, that is, normal (<20%), intermediate (21%-29%), and high (≥30%) SDF rates. We also assessed the pairs of results using reliability measures for numerical variables (intraclass correlation coefficient for consistency using the two-way mixed-effects model and Bland-Altman plots).Result(s): The degree of agreement in classifying patients according to normal and pathological SDF classes was overall substantial (κ = 0.632; 95% confidence interval [CI], 0.546-0.718). A total of 76.7% of individuals were classified under the same class using paired ejaculates. The agreement rate was highest (approximately 80%) in ejaculates initially classified as either normal or high and lowest (approximately 60%) among those with intermediate SDF levels. The frequency of intermediate SDF ejaculates downgraded to normal or upgrade to high SDF classes in the second test was similar (approximately 20%). The intraclass correlation coefficient was 0.856 (95% CI, 0.812-0.887), and the mean difference between the pairs of observations was 0.80% (95% CI, -0.72 to 2.23), indicating no systematic difference between paired observations.Conclusion(s): Our study indicates a substantial intraindividual agreement of paired SCD assay results to classify men with infertility into three SDF categories: normal, intermediate, and high. The reliability of the SCD assay was adequate and exceeded 0.80 using two ejaculates analyzed within a 3-month interval under similar conditions. Although this evidence overall supports a single SCD test for patient classification using predefined SDF thresholds, particularly when the first test shows normal or high SDF levels, one in four men will have discordant values in paired ejaculates. Clinicians should be judicious when using SDF test results in decision-making. [ABSTRACT FROM AUTHOR]

Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140–180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140–180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31–1.73) (BG 140–180 mg/dL; HR 1.48; 95%CI: 1.29–1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes. [ABSTRACT FROM AUTHOR]

This article explores audience perceptions of different types of disinformation, and the actions that users take to combat them, in three Spanish-speaking countries: Argentina, Chile, and Spain. Quantitative data from the Digital News Report (2018 and 2019), based on a survey of more than 2000 digital users from each country was used for the analysis. Results show remarkable similarities among the three countries, and how digital users identically ranked the types of problematic information that concerned them most. Survey participants were most concerned by stories where facts are spun or twisted to push a particular agenda, followed by, those that are completely made up for political or commercial reasons, and finally, they were least concerned by poor journalism (factual mistakes, dumbed-down stories, misleading headlines/ clickbait). A general index of "Concern about disinformation" was constructed using several sociodemographic variables that might influence the perception. It showed that the phenomenon is higher among women, older users, those particularly interested in political news, and among left-wingers. Several measures are employed by users to avoid disinformation, such as checking a number of different sources to see whether a news story is reported in the same way, relying on the reputation of the news company, and/or deciding not to share a news story due to doubts regarding its accuracy. This article concludes that the perceived relevance of different types of problematic information, and preventive actions, are not homogeneous among different population segments. [ABSTRACT FROM AUTHOR]

This article compares the patterns of political information between general voters and the most interested audiences (journalists, academics, consultants and political leaders), focusing on the case studies of three critical elections held in 2015: the last general elections from Argentina, Spain, and Venezuela. The method used compared primary data for specialized audiences (also called "political geeks") with secondary data for normal voters, taken from three different external sources. The research found that the habits and sources of political information of specialized audiences during the electoral campaign differ from those of the general voting public. Specialized publics rely more on social networks as source of political information than general voters, however the gap is bigger on Twitter and narrower for Facebook. Voters in general use Facebook and WhatsApp more than specialized audiences do. In addition, there is a shift of the center of gravity of the campaigns towards the digital world, both in the specialized publics and in the normal electoral population, but digital migration seems to be more accelerated among specialized audiences than among ordinary voters. It was also observed that political information tends to lead to media convergence and a consolidated or "hybrid" communication system. This research also suggests that despite the rapid acceptance of the digital in the information world, it is possible that little journalism, research, or campaigning is being done where the massive audiences really are. [ABSTRACT FROM AUTHOR]

This study is focused on the Guadalete River basin (SW, Spain), where extreme weather conditions have become common, with and alternation between periods of drought and extreme rainfall events. Combined sewer overflows (CSOs) occur when heavy rainfall events exceed the capacity of the wastewater treatment plants (WWTP), as well as pollution episodes in parts of the basin due to uncontrolled sewage spills and the use of reclaimed water and sludge from the local WWTP. The sampling was carried out along two seasons and three campaigns during dry (March 2007) and extreme rainfall (April and December 2010) in the Guadalete River, alluvial aquifer and Jerez de la Frontera aquifer. Results showed minimum concentrations for synthetic surfactants in groundwater (< 37.4 μg·L − 1 ) during the first campaign (dry weather conditions), whereas groundwater contaminants increased in December 2010 as the heavy rainfall caused the river to overflow. In surface water, surfactant concentrations showed similar trends to groundwater observations. In addition to surfactants, pharmaceuticals and personal care products (PPCPs) were analyzed in the third campaign, 22 of which were detected in surface waters. Two fragrances (OTNE and galaxolide) and one analgesic/anti-inflammatory (ibuprofen) were the most abundant PPCPs (up to 6540, 2748 and 1747 ng·L − 1 , respectively). Regarding groundwater, most PPCPs were detected in Jerez de la Frontera aquifer, where a synthetic fragrance (OTNE) was predominant (up to 1285 ng·L − 1 ). [ABSTRACT FROM AUTHOR]

Different publics consume political information in different ways. The pattern of consumption of political information varies according to the different publics, not only in their intensity of use, but also in the various communication outlets used to inform themselves. This article compares the patterns of political information for the most interested publics (journalists, academics, consultants and political leaders) with general voters, taking as a case the study of the Argentinian, Spaniard and Venezuelan elections of 2015. [ABSTRACT FROM AUTHOR]

Copyright of International Journal for Educational & Vocational Guidance is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. The aim of this study was to establish guidelines for the optimization of biologic therapies for health professionals involved in the management of patients with RA, AS and PsA. Methods. Recommendations were established via consensus by a panel of experts in rheumatology and hospital pharmacy, based on analysis of available scientific evidence obtained from four systematic reviews and on the clinical experience of panellists. The Delphi method was used to evaluate these recommendations, both between panellists and among a wider group of rheumatologists. Results. Previous concepts concerning better management of RA, AS and PsA were reviewed and, more specifically, guidelines for the optimization of biologic therapies used to treat these diseases were formulated. Recommendations were made with the aim of establishing a plan for when and how to taper biologic treatment in patients with these diseases. Conclusion. The recommendations established herein aim not only to provide advice on how to improve the risk:benefit ratio and efficiency of such treatments, but also to reduce variability in daily clinical practice in the use of biologic therapies for rheumatic diseases. [ABSTRACT FROM AUTHOR]

The article exposes the foundation of private life as an autonomous space in the development of liberal ideology, from its defense of the individual against State authority. The hypothesis is that there has been an evolution from the negative freedom, in which privacy represents a residual space (with representatives like Hobbes and Locke), as a space of non-interference of public authority, to become a protected right in Constant up to the prospect of positive freedom of the individual and of his free will, to develop their capacities in the private space (with representatives like Tocqueville, Arendt and Mill). Precisely, it will be Isaiah Berlin in the 20th century, presenting the contrast of these two types of freedom: the negative representing a private life free from public interference and the positive that refers to a private life for the individual decision, with a free will. Liberalism advocates a division of spaces: the public that represents the institutional (political power) and the private, associated to the domestic sphere, to the "non-social". Its development will allow to expand the concept with the completion of the individual capacities in the private space, but also with the conciliation with other social members, through the respect of their own space and therefore, of his private life. Autonomous liberal citizenship is defined basically as a model that advocates the achievement of a community of free individuals, in which the well-being of the individual is above society. [ABSTRACT FROM AUTHOR]

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite the progressive increase in life expectancy and the relationship between aging with multi-morbidities and the increased use of healthcare resources, current clinical practice guidelines (CPG) on cardiometabolic risk cannot be adequately applied to elderly subjects with multiple chronic conditions. Its management frequently becomes complicated by both, an excessive use of medications that may lead to overtreatment, drug interactions and increased toxicity, and errors in dosage and non-compliance. Concerned by this gap, the Spanish Society of Internal Medicine created a group of independent experts on cardiometabolic risk who discussed what they considered to be unanswered questions in the management of elderly patients. Discussion: Current guidelines do not specifically address the problem of elderly with multiple chronic conditions. For this reason, the combined use of the limited available evidence, clinical experience and common sense, could all help us to address this unmet need. In very old people, life expectancy and functionality are the most important factors for guiding potential treatments. Their higher propensity to develop serious adverse events and their shorter lifespan could prevent them from obtaining the potential benefits of the interventions administered. Summary: In this document, experts on cardiometabolic risk factors have established a number of consensual recommendations that have taken into account international guidelines and clinical experience, and have also considered the more effective use of healthcare resources. This document is intended to provide general recommendations for clinicians and to promote the effective use of procedures and medications. [ABSTRACT FROM AUTHOR]

In Spain, there are two types of sentence for partner aggressors: prison sentence and the alternative measure, specifically psychosocial intervention programs. The goal of this study was to determine differences in the delinquent and psychopathological profile of these aggressors as a function of the prison sentence received, for which the models proposed by Dutton (1995) and Holtzworth-Munroe and Stuart (1994) were followed. The sample was made up of 50 incarcerated aggressors and 40 men sentenced to mandatory community orders. The variables were obtained through a mixed method, with supervision of penitentiary case files, clinical interview for personality disorder (SCID-1I), and self-reports for the personality profile (NEO-PI-R). Binary logistic regression was used to identify the final model, which best reveals the differences between both groups. The results describe the incarcerated aggressors' profile as having more altered risk factors at the socioeconomic, delinquent, and psychopathological levels. The three variables that increase the probability of belonging to the prison inmate group, according to the final model obtained were: use of weapons, drug consumption, and personality disorder. In contrast to other investigations, the high incidence in the outcomes of the target variables, mainly drug use and personality disorder, makes us wonder whether the diagnostic method used influenced the results in contrast to the exclusive use of self-reports, a goal to be confirmed in future studies. [ABSTRACT FROM AUTHOR]

Ibaibarriaga, L., Fernández, C., and Uriarte, A. 2011. Gaining information from commercial catch for a Bayesian two-stage biomass dynamic model: application to Bay of Biscay anchovy. – ICES Journal of Marine Science, 68: 1435–1446. A two-stage biomass dynamic model for Bay of Biscay anchovy is presented. Compared with the model currently applied by ICES for the assessment of that stock, the new model separates the growth and natural mortality processes and allows them to differ by age class. Stochastic equations involving the observed weights by age class in surveys are incorporated to provide information on growth rates. The fishing process is modelled separating fishing mortality into year and age-class effects in each semester, and observation equations are introduced for total catch and catch proportion by age class (in biomass) by semester. The model is first tested on simulated data, then applied to real data for the years 1987–2008. Although the results are affected by survey catchability and natural mortality assumptions, estimates of population trends, when expressed in relation to the value in a given year, are robust. The new model has significantly more parameters, requiring longer computational time for its fitting, which is done in a Bayesian context. However, it does allow the testing of different assumptions on natural mortality, which is of special interest after the recent fishery closure, and estimating new parameters, which could provide further insight on stock and fleet dynamics. [ABSTRACT FROM PUBLISHER]

Ibaibarriaga, L., Fernández, C., Uriarte, A., and Roel, B. A. 2008. A two-stage biomass dynamic model for Bay of Biscay anchovy: a Bayesian approach. – ICES Journal of Marine Science, 65: 191–205.A two-stage biomass-based state-space model with stochastic recruitment processes and deterministic dynamics was developed for the Bay of Biscay anchovy population. It is fitted in a Bayesian context with posterior computations carried out using Markov chain Monte Carlo techniques. The model is tested first on a simulated dataset and the effects of different modelling assumptions and of missing values evaluated. Then, it is applied to a real historical series of commercial catch and survey data from 1987 to 2006. Results are compared with those obtained by the standard assessment model for this stock, integrated catch-at-age analysis (ICA). From the posterior distribution of biomass in the latest year (2006), the distribution of unexploited biomass in 2007 can be derived assuming the distribution of recruitment in 2007 to be a mixture of the posterior distributions of past series recruitment. Hence, the effect of different catch options on future biomass levels can be quantified in probabilistic terms. Finally, directions for possible further improvements are indicated. [ABSTRACT FROM PUBLISHER]

Reading comprehension is a basic activity for the intellectual, social, and cultural development of individuals. However, different prestigious reading and comprehension tests like PISA reveal that Spanish adolescents get significantly lower scores than students from other Western countries. Given the importance and seriousness of this problem, we need to promote new tests to check the deficits appearing at earlier ages during the reading process. These tests should also fit an updated conceptualisation of the terms "reading" and "reading comprehension" in order to elaborate instructional applications to reduce these deficits. This study evaluates a new reading test, ECOMPLEC, that connects reader characteristics (e.g., types of comprehension and knowledge) with the type of text he or she faces (i.e., expositive, narrative and discontinuous). Performance involves different types of knowledge and levels of mental representation (text base and mental model). A sample of 68 11-year-old 6th grade primary education students participated in the study. The results were compared to the results obtained with standardized tests commonly used in the educational environment such as Prolec-Se. The results showed that our reading test was better in assessing mental representation types, and text types. It was also considered a good test to asses reading comprehension at this school level and more suitable to evaluate criteria such as those required in PISA. [ABSTRACT FROM AUTHOR]

In this paper we will show some of the results of research which took place in the Principality of Asturias (Spain). Its purpose was finding out the gender discourses used by nursery teachers. Although we will not provide an exhaustive list of all the conclusions reached so far, we will put forward one of the aspects which has been developed throughout the investigation; that is, we will discuss some of our observations and hypotheses on the differences observed by the teachers in boys and girls' caring and supporting behaviours. In order to do so, we focus on the type of discourse related to the ethic of care. We consider it a tool which allows teachers to build a type of narrative in which boys and girls are presented as opposites, relational and different from one another. [ABSTRACT FROM AUTHOR]

Background: The declaration of the first state of alarm for COVID-19 in March 2020 provoked changes in ophthalmological care. The objective of this study was to assess its impact on reorganising care activities, the mental health of ophthalmologists and the training of residents. Methods: We sent an anonymous online questionnaire between August and October 2020 to consultant ophthalmologists and residents who were active during the state of alarm in Spain. We used Google Forms® software for data collection. We analysed responses according to the degree of regional impact. Results: We received a total of 328 responses from the 17 Autonomous Communities. We saw that 99.4% of respondents changed their work activities with 50% reductions in surgery (94.5%) and consultations (93.0%). Furthermore, 58.8% of respondents reported increased anxiety, and 29.9% transferred to support other services, with this number reaching 49.6% in the hardest-hit regions. Training programs were greatly reduced in external consultations (90.7%), and surgical training was completely cancelled (100%). Additionally, 56.5% of trainees wanted to prolong their residence periods. Conclusions: The first wave of the pandemic produced significant changes in ophthalmology services, and these changes were more pronounced in the most affected regions. It caused a negative psychological impact on a high rate of respondents and an interruption of the training of ophthalmology residents. Predictably, the negative consequences of this delay in ophthalmological care on patients will be uneven between regions. [ABSTRACT FROM AUTHOR]

Objectives: A decrease in blood cell counts, especially lymphocytes and eosinophils, has been described in patients with serious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but there is no knowledge of their potential role of the recovery in these patients' prognosis. This article aims to analyse the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Design: This work was a retrospective, multicentre cohort study of 9644 hospitalised patients with confirmed COVID-19 from the Spanish Society of Internal Medicine's SEMI-COVID-19 Registry. Setting: This study examined patients hospitalised in 147 hospitals throughout Spain. Participants: This work analysed 9644 patients (57.12% male) out of a cohort of 12,826 patients ≥18 years of age hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May 2020. Main outcome measures: The main outcome measure of this work is the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Univariate analysis was performed to determine possible predictors of death, and then multivariate analysis was carried out to control for potential confounders. Results: An increase in the eosinophil count on the seventh day of hospitalisation was associated with a better prognosis, including lower mortality rates (5.2% vs. 22.6% in non-recoverers, OR 0.234; 95% CI, 0.154 to 0.354) and lower complication rates, especially regarding the development of acute respiratory distress syndrome (8% vs. 20.1%, p = 0.000) and ICU admission (5.4% vs. 10.8%, p = 0.000). Lymphocyte recovery was found to have no effect on prognosis. Treatment with inhaled or systemic glucocorticoids was not found to be a confounding factor. Conclusion: Eosinophil recovery in patients with COVID-19 who required hospitalisation had an independent prognostic value for all-cause mortality and a milder course. [ABSTRACT FROM AUTHOR]

Emerging pollutants have aroused an increasing concern due to their ubiquitous presence in the environment and harmful potential. Both emerging (e.g., pharmaceuticals and personal care products) and regulated organic pollutants pose a serious threat to water quality and their presence and spatial distribution are complicated to address as they can derive from several factors: distribution of point and diffuse sources, environmental conditions, hydrogeological features of the region and inherent properties of the considered contaminants. In this study, a ground and surface water monitoring campaign was conducted in the three main detritic groundwater bodies of an extensive and heavily modified river basin in order to draft an initial description of the occurrence and distribution of a wide range of organic contaminants. In total, 63 out of 185 target pollutants were detected. An attempt to understand the importance of different factors governing the distribution of some of the most frequently found pollutants was made. Antibiotics spatial distribution is potentially influenced by the hydrogeological functioning of the basin modified by hydraulic infrastructures (reflected by hydrochemistry and environmental tracers δ2H and δ18O), not directly related to the distribution of potential sources. The presence of other organic pollutants does not reflect an evident correlation with flow pathways. Differences in contaminant occurrence are potentially attributed to the way pollutants are released into the environment as well as physico-chemical properties. [ABSTRACT FROM AUTHOR]

Copyright of Zephyrus is the property of Ediciones Universidad de Salamanca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Computational thinking (CT) is being located at the focus of educational innovation, as a set of problem-solving skills that must be acquired by the new generations of students to thrive in a digital world full of objects driven by software. However, there is still no consensus on a CT definition or how to measure it. In response, we attempt to address both issues from a psychometric approach. On the one hand, a Computational Thinking Test (CTt) is administered on a sample of 1,251 Spanish students from 5th to 10th grade, so its descriptive statistics and reliability are reported in this paper. On the second hand, the criterion validity of the CTt is studied with respect to other standardized psychological tests: the Primary Mental Abilities (PMA) battery, and the RP30 problem-solving test. Thus, it is intended to provide a new instrument for CT measurement and additionally give evidence of the nature of CT through its associations with key related psychological constructs. Results show statistically significant correlations at least moderately intense between CT and: spatial ability ( r = 0.44), reasoning ability ( r = 0.44), and problem-solving ability ( r = 0.67). These results are consistent with recent theoretical proposals linking CT to some components of the Cattel-Horn-Carroll (CHC) model of intelligence, and corroborate the conceptualization of CT as a problem-solving ability. [ABSTRACT FROM AUTHOR]

The restoration of mining areas, in particular if they are located near towns or villages, is essential to reduce their potential risks for human health and to minimize their visual impacts. In this study, we assess the rehabilitation of a waste rock pile adjacent to the town of Tharsis (SW Spain). We measured vegetation cover and its diversity, and chemical composition of plants and soil, twelve years after remediation by lime amendments, added topsoil and planted vegetation. In general, the applied measures were successful covering with woody vegetation the upper part of the waste rock pile, and providing a greening visual landscape for the town nearby. The most abundant species were the gum rockrose (Cistus ladanifer) and the legume shrub Retama sphaerocarpa , this latter species most probably introduced in the seedbank of the added topsoil. Also in the soil seedbank, probably arrived the invasive Acacia saligna , of fast growth. In contrast, the lower part of the slopes was almost devoid of vegetation. We interpret that partial failure in the rehabilitation process as due to the acid mine drainage, which caused downslope a decrease of soil pH and increased availability of trace elements, thus impeding growth and establishment of plants. In addition, some plants, like C. ladanifer , growing at the base of the rock pile, had concentrations of Cd above the maximum tolerable level for animals, therefore representing a toxicity risk. Finally, we propose here an alternative technique to restore waste rock piles, by sorting and selectively handling the extractive wastes, thus reducing infiltration rates, seepages and the negative effect of the acid mine drainage. Those modified waste rock piles will be rehabilitated by the addition of topsoil and planted vegetation, as successfully worked out in the upper slopes of the study site. Image 1 • We assess the rehabilitation of a waste rock pile twelve years after its finalization. • The addition of lime, topsoil and plants were successful in the upper part. • The lower part showed scarce vegetation because of the acid mine drainage downslope. • Some plants accumulated Cd representing a toxicity risk for animals. • We propose to restore rock piles by selecting and handling the extractive wastes. [ABSTRACT FROM AUTHOR]

Objective To estimate the seroprevalence of anti-JCV antibodies, seroconverting rates and evolution of antibody levels in a multiple sclerosis (MS) Spanish cohort. Methods Multicenter, retrospective cross-sectional and longitudinal study. The JCV seroprevalence was analyzed in 711 MS patients by using 1st (STRATIFY-1) and 2nd generation (STRATIFY-2) two-step ELISA over 2.65 (± 0.97) years. Seroconversion rate was obtained over 2 samples from 314 patients, and index stability from 301 patients with 3 or more samples available. The effect of each ELISA generation, demographics, clinical characteristics and therapy on seroprevalence was assessed by logistic regression. Results The overall anti-JCV seroprevalence was 55.3% (51.6–58.9), similar across regions ( p = 0.073). It increased with age ( p < 0.000) and when STRATIFY-2 was used (60.5%, p = 0.001). Neither sex nor immunosuppressive therapy had any influence. Yearly seroconversion rate was 7% (considering only STRATIFY-2). Serological changes were observed in 24/301 patients, 5.7% initially seropositive reverted to seronegative and 7% initially seronegative changed to seropositive and again to seronegative, all these cases had initial index values around the assay's cut-off. Conclusions JCV seroprevalence in Spanish MS patients was similar to that reported in other European populations. Changes in serostatus are not infrequent and should be considered in clinical decisions. [ABSTRACT FROM AUTHOR]

• There is no protocol for screening feigning in WAD or pain. • A line of research has attempted to apply lie detection tools for pain feigning. • Malingerers express a much more negative experience of the condition. • Malingerers tend to overestimate the severity of WAD. • Cues related to the situation of illness are useful for feigning screening. The objective of this work is to evaluate the ability of a series of possible feigning indicators, extracted from relevant literature in the field, to discriminate between clinical patients with genuine symptomatology and instructed malingerers. A sample of 273 participants divided into two groups was used for this study: 153 whiplash associated disorder patients who were evaluated at a multidisciplinary medical center in the region of Murcia (Spain), between December 2017 and March 2019 and 120 healthy controls with malingering instructions, students of the Faculty of Medicine of the University of Murcia. In order for researchers to evaluate the indicators included in the study, a 22-step checklist (CDS) was developed, consisting of 22 criteria divided into 5 dimensions. Our results show that 18 of 22 indicators could discriminate between groups. Dimension 2 "Attitude toward the situation of illness" presented the greatest capacity for discrimination. In general terms, malingerers express a much more negative experience of the condition than the clinical patients. [ABSTRACT FROM AUTHOR]

Background: People with secondary progressive multiple sclerosis (pwSPMS) experience increasing disability, which impacts negatively on their health-related quality of life (HRQoL). Our aims were to assess the impact of secondary progressive multiple sclerosis (SPMS) on functional status and HRQoL and describe the clinical profile in this population., Methods: DISCOVER is an observational, cross-sectional, multicenter study with retrospective data collection in real-world clinical practice in Spain. Sociodemographic and clinical variables, functional and cognitive scales, patient-reported outcomes (PROs), and direct healthcare, and non-healthcare and indirect costs were collected., Results: A total of 297 evaluable pwSPMS with a EDSS score between 3-6.5 participated: 62.3 % were female and 18.9 % had active SPMS. At the study visit, 77 % of them presented an Expanded Disability Scale Score (EDSS) of 6-6.5. Nearly 40 % did not receive any disease-modifying treatment. Regarding the working situation, 61.6 % were inactive due to disability. PROs: 99.3 % showed mobility impairment in EuroQoL-5 Dimensions-5 Levels, and about 60 % reported physical impact on the Multiple Sclerosis Impact Scale-29. Fatigue was present in 76.1 %, and almost 40 % reported anxiety or depression. The Symbol Digit Modalities Test was used to assess cognitive impairment; 80 % of the patients were below the mean score. Participants who presented relapses two years before and had high EDSS scores had a more negative impact on HRQoL. PwSPMS with a negative impact on HRQoL presented a higher cost burden, primarily due to indirect costs., Conclusions: PwSPMS experience a negative impact on their HRQoL, with a high physical impact, fatigue, cognitive impairment, and a high burden of indirect costs., Competing Interests: Declaration of competing interest None, (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Empowering people living with multimorbidity (multiple chronic conditions) to gain greater confidence in managing their health can enhance their quality of life. Education focused on self-management is a key tool for fostering patient empowerment and is mostly provided on an individual basis. Virtual communities of practice (VCoP) present a unique opportunity for online education in chronic condition self-management within a social context. This research aims to evaluate the effectiveness/cost-effectiveness of individualised, online self-management education compared with VCoP among middle-aged individuals living with multiple chronic conditions., Methods and Analysis: People aged 30-60, living with ≥2 chronic conditions and receiving care in primary care (PC) centres and outpatient hospital-based clinics in Madrid and Canary Islands will enrol in an 18-month parallel-design, blinded (intervention assessment and data analysts), pragmatic (adhering to the intention-to-treat principle), individually randomised trial. The trial will compare two 12-month web-based educational offers of identical content; one delivered individually (control) and the other with online social interaction (VCoP, intervention). Using repeated measures mixed linear models, with the patient as random effect and allocation groups and time per group as fixed effects, we will estimate between-arm differences in the change in Patient Activation Measure from baseline to 12 months (primary endpoint), including measurements at 6-month and 18-month follow-up. Other outcomes will include measures of depression and anxiety, treatment burden, quality of life. In addition to a process evaluation of the VCoP, we will conduct an economic evaluation estimating the relative cost-effectiveness of the VCoP from the perspectives of both the National Health System and the Community., Ethics and Dissemination: The trial was approved by Clinical Research Ethics Committees of Gregorio Marañón University Hospital in Madrid/Nuestra Señora Candelaria University Hospital in Santa Cruz de Tenerife. The results will be disseminated through workshops, policy briefs, peer-reviewed publications and local/international conferences., Trial Registration Number: NCT06046326., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To analyze the characteristics of the new medicines approved in the pediatric population in the last 3 years, both those with studies only in the pediatric population and those that extend their indication in this population group, as well as the current situation in relation to their marketing and financing., Methods: Descriptive observational study of all drugs that include an indication in the pediatric population in Spain (by extension of the indications of drugs already authorized or because they are new drugs that already include an indication in this population group), from January 2019 to March 2022., Results: During the study period, 129 drugs included their indication in the pediatric population. 13.9% of them are not marketed, 46.5% are in a situation of non-financing, under study or without a request for financing, and 4.6% are financed for a specific pediatric subpopulation. 52.7% are original drugs, 4.7% are generic, 38.8% are biological, 3.8% are biosimilar, and 17.8% are orphan drugs. 57.36% of these medicines obtain the pediatric indication due to extension of the indication and 42.64% obtain it because they are new medicines that already include their studies in the pediatric population., Conclusions: Drugs with authorized indications are increasingly available in the pediatric population and the trend is to extend the indication of authorized drugs to the adult population. However, barriers in terms of financing and marketing need to be expedite and overcome to facilitate access to them., Competing Interests: Conflict of interest None declared. This work has not been presented in any scientific congress or meeting., (Copyright © 2023 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyze the characteristics of the new medicines approved in the pediatric population in the last three years, both those with studies only in the pediatric population and those that extend their indication in this population group, as well as the current situation in relation to their marketing and financing., Methods: Descriptive observational study of all drugs that include an indication in the pediatric population in Spain (by extension of the indications of drugs already authorised or because they are new drugs that already include an indication in this population group), from January 2019 to March 2022., Results: During the study period, 129 drugs included their indication in the pediatric population. 13,9% of them are not marketed, 46,5% are in a situation of non-financing, under study, or without a request for financing, and 4,6% are financed for a specific pediatric subpopulation. 52,7% are original drugs, 4,7% are generic, 38,8% are biological, 3,8% are biosimilar and 17,8% are orphan drugs. 57,36% of these medicines obtain the pediatric indication due to extension of the indication and 42,64% obtain it because they are new medicines that already include their studies in the pediatric population., Conclusions: Drugs with authorised indications are increasingly available in the paediatric population and the trend is to extend the indication of authorised drugs to the adult population. However, barriers in terms of financing and marketing need to be expedited and overcome to facilitate access to them., (Copyright © 2023 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a class of drugs with potent glucose-lowering activity. Additionally, some GLP-1 RAs have demonstrated cardiovascular and renal benefits. Current guidelines recommend their use in patients with type 2 diabetes (T2D) at high risk of or with established cardiovascular disease (CVD), regardless of glycaemic control, with lifestyle modification and metformin. However, several studies have recently highlighted the limited number of patients with T2D benefiting from these medications worldwide. Given the huge burden of CVD among patients with T2D, efforts should be made to bring clinical practice closer to expert guidelines. This review describes the current situation of GLP-1 RA use in Spain and the reasons behind the gap between guidelines and real-world practice and suggests possible solutions. Administrative issues, lack of awareness of the cardiovascular benefits, clinical inertia, rejection of injectable medication and costs could be some of the reasons for the current situation. Possible strategies that could help to close the gap include encouraging a multidisciplinary approach to the treatment of diabetes which involves cardiologists, endocrinologists, nephrologists, primary care providers and pharmacists; improved awareness of comorbidities and earlier evaluation and treatment or risks; and better education of healthcare providers regarding the cardioprotective benefits of these drugs., (© 2023. The Author(s).)

Chronic kidney disease (CKD) has been associated with a higher risk of cardiovascular disease (CVD). CKD patients present a decrease in the levels of the protein Klotho that accompanies the decrease in kidney function. This protein has been related to protective effects against CVD. However, it is unclear whether circulating Klotho, and its expression in peripheral blood cells (PBCs) are also associated with subclinical atherosclerosis in CKD. The present study aimed to study the relationship between Klotho and subclinical atherosclerosis in a population of patients with moderate to severe CKD. We determined the serum levels and gene expression in PBCs levels of Klotho and three inflammatory cytokines in 103 patients with CKD and investigated their relationship with two surrogate markers of subclinical atherosclerotis: ankle-brachial index (ABI) and carotid intima-media thickness (CIMT). Patients with subclinical atherosclerosis presented lower serum and PBCs expression levels of Klotho. Both variables were associated with the presence of subclinical atherosclerosis, being directly related with ABI and inversely with CIMT (P < 0.0001 for both). Multiple regression analysis demonstrated that both variables were significant determinants for ABI (adjusted R 2  = 0.511, P < 0.0001) and CIMT (adjusted R 2  = 0.445, P < 0.0001), independently of traditional and emergent cardiovascular risk factors. Moreover, both constituted protective factors against subclinical atherosclerosis [OR: 0.993 (P = 0.002) and 0.231 (P = 0.025), respectively]. Receiver operating characteristic analysis pointed to the utility of serum Klotho (area under the curve [AUC]: 0.817, 95% CI: 0.736-0.898, P < 0.001) and its gene expression in PBCs (AUC: 0.742, 95% CI: 0.647-0.836, P < 0.001) to distinguish subclinical atherosclerosis. The reductions in serum and PBCs expression levels of Klotho in CKD patients are independently associated with the presence of for subclinical atherosclerosis. Further research exploring whether therapeutic approaches to maintain or elevate Klotho could reduce the impact of CVD in CKD patients is warranted., (© 2021. The Author(s).)

COVID-19 has overloaded national health services worldwide. Thus, early identification of patients at risk of poor outcomes is critical. Our objective was to analyse SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19. Retrospective observational study including 193 patients admitted for COVID-19. Detection of SARS-CoV-2 RNA in serum (viremia) was performed with samples collected at 48-72 h of admission by two techniques from Roche and Thermo Fischer Scientific (TFS). Main outcome variables were mortality and need for ICU admission during hospitalization for COVID-19. Viremia was detected in 50-60% of patients depending on technique. The correlation of Ct in serum between both techniques was good (intraclass correlation coefficient: 0.612; p < 0.001). Patients with viremia were older (p = 0.006), had poorer baseline oxygenation (PaO 2 /FiO 2 ; p < 0.001), more severe lymphopenia (p < 0.001) and higher LDH (p < 0.001), IL-6 (p = 0.021), C-reactive protein (CRP; p = 0.022) and procalcitonin (p = 0.002) serum levels. We defined "relevant viremia" when detection Ct was < 34 with Roche and < 31 for TFS. These thresholds had 95% sensitivity and 35% specificity. Relevant viremia predicted death during hospitalization (OR 9.2 [3.8-22.6] for Roche, OR 10.3 [3.6-29.3] for TFS; p < 0.001). Cox regression models, adjusted by age, sex and Charlson index, identified increased LDH serum levels and relevant viremia (HR = 9.87 [4.13-23.57] for TFS viremia and HR = 7.09 [3.3-14.82] for Roche viremia) as the best markers to predict mortality. Viremia assessment at admission is the most useful biomarker for predicting mortality in COVID-19 patients. Viremia is highly reproducible with two different techniques (TFS and Roche), has a good consistency with other severity biomarkers for COVID-19 and better predictive accuracy.

Objective: The increasing complexity of clinical trial protocols and the very nature of investigational drugs increase the likelihood of prescribing errors and require comprehensive control and monitoring of treatments. The aim of this study was to measure and analyze the potential risks of prescribing errors in investigational drugs., Methods: A prospective, descriptive, and observational study was carried out in a third-level hospital in Madrid, for one month in 2017. Manual prescribing errors (EP) in investigational drugs and potential risks of harm to the patient were analyzed. A descriptive statistical analysis was performed, including the absolute and relative frequency for the variables., Results: A total of 254 medical orders corresponding to 327 lines of treatment and 274 different drugs were reviewed, of which 83% were categorized as "high-risk". Results showed 217 (85.4%) EP within the identification of the medical order and 1,045 (319,6%) in the treatment. The risk level of harm to the patient was high for all EP in patient identification and moderate for all EP in the clinical trial identification. The lines of treatment showed an especially high-risk potential for EP in dosage (25%) and frequency (41%)., Conclusions: The high rate of EP found, along with the high-risk potential these entail, reflects the need for improving the security process when prescribing investigational drugs in our field., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives: The goal of this study was to describe the clinical features and outcomes of thoracic surgery patients during the coronavirus disease 2019 (COVID-19) pandemic., Methods: Thirty-five patients were treated at the 12 de Octubre University Hospital in Madrid between 1 March 2020 and 24 April 2020 during the COVID-19 pandemic. Patient demographics, surgical procedures, complications, COVID-19 symptoms and outcomes were recorded. A protocol was introduced to reduce the risk of operating on patients with COVID-19, including symptom screening, a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 and computed tomography scans of the chest. Surgical activity changed significantly during this time, from an initial period of near-normal activity, through an emergency-only period and finally a recovery period when some oncological surgical cases were restarted. Selection criteria for surgical patients are also described., Results: A total of 34 patients underwent surgery during the pandemic period. We performed 22 lung resections (11 lobectomies and 11 sublobar resections). No hospital deaths were recorded. An elective surgery patient and an emergency surgery patient were diagnosed with COVID-19 (5.88%). The former died within 30 days after surgery., Conclusions: Severe acute respiratory syndrome coronavirus 2 represents a tremendous limitation for thoracic surgical practice. Preoperative practices to exclude asymptomatic cases infected with the virus allowed us to perform thoracic surgical procedures., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Introduction: Adjusted morbidity groups (AMG) are being used in the stratification of chronic patients in Primary Care (PC). The aim of this study was to describe the characteristics, prevalence of comorbidities, and use of PC services by chronic paediatric patients as well as to analyse factors associated with the weight of complexity according to AMG., Patients and Methods: A cross-sectional study conducted on patients <18 years-old from a basic health area, classified as chronic according to the AMG of the Madrid Primary Care computerised clinical records. Sociodemographic and clinical-care variables were collected, as well as the use of services in PC. Univariate, bivariate and linear regression analysis were performed., Results: A total of 2,961 patients<18 years were included, of whom 423 (15.7%) were identified as chronic, and 408 (96.5%) were low risk patients. Their mean age was 9.5 (SD=4.7) years, and 54.1% were male. The mean of chronic diseases was 1.1 (SD=0.4) and 11.3% had multiple morbidity. The most prevalent diseases were asthma (6.1%), attention deficit hyperactivity disorder (ADHD) (1.8%), and obesity (1.4%). The mean number of visits to the paediatrician was 4.9 (SD=6.3). Age<5 years-old (Coefficient B [CB]=2.6, 95% CI=2.1, 3.1), number of chronic diseases (CB=1.6, 95% CI=1.1; 2.1), and annual contacts with PC (CB=0.1, 95% CI=0.06; 0.11) were associated with greater complexity weight., Conclusions: A significant number of patients with chronic diseases were found in the paediatric population. The most prevalent diseases were asthma, ADHD, and obesity. The use of PC services was high. The greatest complexity corresponded to nursing and pre-school age, multiple morbidity, and higher number of contacts with PC., (Copyright © 2020 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Free-living amoebae (FLA) are ubiquitous and many isolates have been shown to be infected with amoeba-resisting bacteria, as the example of Acanthamoeba and Legionella interaction. Due to the high environmental prevalence of Acanthamoeba. in the Castilian Plateau (Spain), the aims of this work were to investigate the occurrence of Acanthamoeba and other FLA in water from several sampling points from four Drinking Water Treatment Plants (DWTP) and to investigate the presence of Legionella spp. and other amoeba-resisting bacteria in biofilms in raw and finished water, taking into account that no legislation exists for this protozoa control. Acanthamoeba was detected at different sampling points, and sand filters seemed to contribute to amoebic enrichment. After ozonation, a temporary decrease in viable amoebae was observed. The genotypes detected were T3, T4, and T5, revealing the first report of genotype T5 in waters from this region. Moreover, Balamuthia mandrillaris, Vermamoeba vermiformis and Paravahlkampfia sp. were detected. Regarding Legionella, PCR detection in raw and finished water was higher than by agar culture, but even higher after Acanthamoeba co-culture. Also, Legionella's presence was higher in raw water than in finished water. The decrease of free Legionella observed from raw (27.5%, by PCR) to finished water (3.4% by PCR) contrasted with the increase of Legionella-infected FLA from raw (30.7%) to finished water (52%). At biofilm, free Legionella was not detected, and the percentage of infected FLA was low (3.8%). Legionella species identified in these samples were L. drozanskii, L. donaldsonii and L. feeleii. Additionally, Acanthamoeba co-culture led to the isolation of Pseudomonas aeruginosa, P. stutzeri, P. fluorecens, Achromobacter xylosoxidans and Stenotrophomonas maltophilia. The highly disseminated presence of Acanthamoeba and the detection of amoeba-resisting bacteria inside amoebae highlight the importance of developing methods for controlling FLA in order to limit human pathogenic amoeba-resisting bacteria survival to the water purification processes., Competing Interests: Declaration of competing interest All authors declare no actual or potential conflict of interest including any financial, personal or other relationships with founding organizations., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: The implantation of the Implantable Cardioverter Defibrillator (ICD) influences the psychological adjustment and the degree of subjective discomfort. The objective of this work was to analyze differences in psychological adjustment, fear of shocks and the degree of subjective discomfort derived from the illness depending on the reasons for implantation (primary vs secondary)., Methods: A sample of 82 patients with an ICD, for primary (58.5%) or secondary (41.5%) prevention indications was studied. A sociodemographic and clinical questionnaire and List of Brief Symptoms (LBS-50) was used. Descriptive univariate and bivariate analysis, t-tests on mean differences for independent samples and z-tests on proportion differences were performed., Results: Regarding psychological adjustment, 43.9% of the patients reported to have sleeping disorder, regardless the type of prevention. A greater percentage of patients of primary prevention had scored higher in clinical scales. The 29.4% of patients with secondary prevention reported to be afraid of experiencing some shock. The 25% of patients whose type of prevention was primary showed severe or moderate level of subjective discomfort derived from the illness compared with the 14.7% of the secondary prevention patients (p=0.7)., Conclusions: The patients with an ICD show symptoms clinically significant in Psychoactivity, Obsession-Compulsion, Anxiety, Somatization, Sleeping disorders and Psychopathology Risk Index. Both groups, regardless the type of prevention showed a similar psychological adjustment. Regarding the fear of shocks and the degree of subjective discomfort derived from the illness, no statistically significant differences between the groups were found.

Objective: Chronic patients suffer a greater number of health problems and have greater needs for assistance and care. The objective was to describe the use of health services in Primary Care in patients with chronic conditions according to risk level by adjusted morbidity groups (AMG) and analyze the associated factors., Methods: Cross-sectional study. We included patients ≥18 years-old identified as chronic by the stratification tool according to AMG in a basic health area in the Community of Madrid with an assigned population of 18,107 inhabitants. Sociodemographic, clinical-care and use of services variables were collected and were classified according to the "behavioral" model in predisposing, need or facilitators factors. Univariate, bivariate and multiple linear regression adjusted with robust estimators was performed., Results: 9,443 chronic patients (52.1% of the population in the selected zone) were identified, mean age of 57.8 (SD=18.7); 62.1% women. According to their risk level 4.7% were high risk, 18.7% medium risk and 76.6% low risk. The mean number of contacts per year was 14.1 (SD=15.2); 34.4 (SD=27.9) in high risk; 21.8 (SD=17.2) in medium risk and 10.1 (SD=10.2) in low risk. 7.5 (SD=7.1) contacts were with the doctor and 12.9 (SD=12.9) were face-to-face. The factors associated with higher use of services were high risk (Coefficient B[CB]=12.6; IC95%=11-14.2), immobilization (CB=8.8; IC95%=7.3-10.4), polypharmacy (CB=6; IC95%=5-8.6), female sex (CB=1; IC95%=0.4-1.5), number of chronic diseases (CB=1; IC95%=0.8-1.2) and age (CB=0.03; IC95%=0.01-0.05)., Conclusions: The health services utilization in Primary Care in chronic patients is high and increased according with the risk level by AMG. The contact with the doctor is superior to nurse and the most frequent type is face-to-face. The greater utilization of services responds to predisposing factors (female sex and age) and above all to need factors (high risk, immobility, multimorbidity and polypharmacy)., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Treatment with nitisinone (NTBC) has brought about a drastic improvement in the treatment and prognosis of hereditary tyrosinemia type I (HT1). We conducted a retrospective observational multicentric study in Spanish HT1 patients treated with NTBC to assess clinical and biochemical long-term evolution.We evaluated 52 patients, 7 adults and 45 children, treated with NTBC considering: age at diagnosis, diagnosis by clinical symptoms, or by newborn screening (NBS); phenotype (acute/subacute/chronic), mutational analysis; symptoms at diagnosis and clinical course; biochemical markers; doses of NTBC; treatment adherence; anthropometric evolution; and neurocognitive outcome.The average follow-up period was 6.1 ± 4.9 and 10.6 ± 5.4 years in patients with early and late diagnosis respectively. All patients received NTBC from diagnosis with an average dose of 0.82 mg/kg/d. All NBS-patients (n = 8) were asymptomatic at diagnosis except 1 case with acute liver failure, and all remain free of liver and renal disease in follow-up. Liver and renal affectation was markedly more frequent at diagnosis in patients with late diagnosis (P < .001 and .03, respectively), with ulterior positive hepatic and renal course in 86.4% and 93.2% of no-NBS patients, although 1 patient with good metabolic control developed hepatocarcinoma.Despite a satisfactory global nutritional evolution, 46.1% of patients showed overweight/obesity. Interestingly lower body mass index was observed in patients with good dietary adherence (20.40 ± 4.43 vs 24.30 ± 6.10; P = .08) and those with good pharmacological adherence (21.19 ± 4.68 vs 28.58 ± 213.79).intellectual quotient was ≥85 in all NBS- and 68.75% of late diagnosis cases evaluated, 15% of which need pedagogical support, and 6.8% (3/44) showed school failure.Among the 12 variants identified in fumarylacetoacetate hydrolase gene, 1 of them novel (H63D), the most prevalent in Spanish population is c.554-1 G>T.After NTBC treatment a reduction in tyrosine and alpha-fetoprotein levels was observed in all the study groups, significant for alpha-fetoprotein in no NBS-group (P = .03), especially in subacute/chronic forms (P = .018).This series confirms that NTBC treatment had clearly improved the prognosis and quality of life of HT1 patients, but it also shows frequent cognitive dysfunctions and learning difficulties in medium-term follow-up, and, in a novel way, a high percentage of overweight/obesity.

Objectives: The purpose of this document is to establish practical recommendations on neurogenic bladder (NB) management based on scientific evidence and medical and nursing perspective in Spinal Cord Injury (SCI) Units as a first multidisciplinary consensual approach in Spain. METHODS: This paper reports results from the first modified Delphi consensus building exercise on this procedure. A committee of recognised opinion-leaders in rehabilitation and urology with special interest in NB was constituted. A working group formed by rehabilitation doctors, urologists and nursing staff of SCI and Neurorehabilitation Units of a number of Spanish hospitals and specialised centres associated with the panel of NB experts have prepared this document. RESULTS: This review provided an overview of the main aspects described by the different clinical guidelines already available and highlighted the need to focus on recommendations in special priority situations in which there was no consensus. In view of the considerable impact this condition has on quality of life, patients should be offered help to better understand the disorder and they should be taught how to use the treatment techniques to obtain satisfactory results and promote their autonomy. CONCLUSIONS: This article presents a version of guidelines for patients with NB. The guidelines define the clinical profile of patients to provide the best evidence- based care and also an overview of the current drug and surgical treatments of NB.

We assembled genome-wide data from 271 ancient Iberians, of whom 176 are from the largely unsampled period after 2000 BCE, thereby providing a high-resolution time transect of the Iberian Peninsula. We document high genetic substructure between northwestern and southeastern hunter-gatherers before the spread of farming. We reveal sporadic contacts between Iberia and North Africa by ~2500 BCE and, by ~2000 BCE, the replacement of 40% of Iberia's ancestry and nearly 100% of its Y-chromosomes by people with Steppe ancestry. We show that, in the Iron Age, Steppe ancestry had spread not only into Indo-European-speaking regions but also into non-Indo-European-speaking ones, and we reveal that present-day Basques are best described as a typical Iron Age population without the admixture events that later affected the rest of Iberia. Additionally, we document how, beginning at least in the Roman period, the ancestry of the peninsula was transformed by gene flow from North Africa and the eastern Mediterranean., (Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Clean water is one of the main resources for key activities such as agriculture, power generation, and public and industrial supplies. However, once wastewater generated by these activities is released into the environment, it may represent a potential risk to ecosystems and even human health depending on the presence of certain types and levels of contaminants. This study is focused on personal care products (PCPs), a class of contaminants of emerging concern (CECs) which includes commonly used cosmetic and personal hygiene products (e.g., fragrances, UV filters, antimicrobials, surfactants, among others), and their comparison with legacy contaminants such as polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs). We have monitored the concentrations of up to 66 target compounds in influent and effluent wastewater, sludge, and compost samples from a wastewater treatment plant (WWTP) at Jerez de la Frontera (SW Spain) over a 1-year period. Almost half of the target compounds (44%) were frequently detected in influent wastewater samples, with prevalence of synthetic fragrances and higher abundance of UV filters during warmer periods. Due to their relatively poor removal efficiencies (<70%), 30 target compounds were always detected in the final effluent. The highest levels here were observed for an UV filter (octocrylene) and three synthetic fragrances (traseolide, OTNE, and galaxolide), showing maximum concentrations of 4-7 μg L -1 and 12-95 μg g -1 in the dissolved and particulate fractions, respectively. Concentrations of these compounds increased in sludge, being up to 365 μg g -1 for some fragrances and showing negligible decrease after anaerobic digestion. Windrow composting of this sludge, however, resulted in an efficient removal (up to 100%) for most analytes. On the other hand, levels between <1 and 651 ng g -1 were measured in soils columns (0-150 cm) at the WWTP gardens irrigated with effluent wastewater. The occurrence of PCPs in these soils seemed to be heavily influenced by temperature, as maximum concentrations were measured in colder months, indicating a higher rate of microbial activity degradation and/or volatilization during warmer months., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Frailty is an important prognostic factor in older adults with cardiovascular diseases. We aim to describe the characteristics of elderly hospitalised frail patients with non-valvular atrial fibrillation (NVAF) and to assess the influence of frailty, along with other functional and health status variables on anticoagulation prescription, 1-year all-cause mortality, and the incidence of ischemic and bleeding complications. An observational, prospective multicentre study was carried out on patients with NVAF over the age of 75, who were admitted to the Internal Medicine departments in Spain. A total of 615 patients were evaluated (mean age 85.23 ± 5.16 years, 54.3% females, 48.3% frail). Frail patients had higher CHA2DS2-VASc and HAS-BLED scores, more comorbidities and worse functional status and cognitive impairment compared to non-frail. During hospitalisation, 58 (9.4%) patients died (12.5% frail, 6.6% non-frail, p = 0.01). Among the participants discharged, 69.8% received anticoagulants, 13% anti-platelets only and 16.9% no anti-thrombotics, with no difference by frailty status. Frailty is not a predictor of anticoagulant prescription at discharge (OR 0.93, 95% CI 0.55-1.57), while functional dependency remains significantly associated (OR for severe dependency 0.44, 95% CI 0.23-0.82). After the 1-year follow-up, frail patients have a higher risk of death (HR 1.99, 95% CI 1.43-2.76). Among patients taking anticoagulants, the incidence of stroke and major bleeding is similar between frailty groups. In our study, frailty is related to worse global health status. It has no impact on antithrombotic prescription, nor is a predictor of AF complications, even though frail subjects have a higher mortality during hospitalisation and after 1-year follow-up.

Neurofibromatosis type I (NF1) is one of the most common genetic disorders in humans. NF1, a tumor predisposition syndrome, is caused by heterozygous pathogenic variants in the NF1 gene. Molecular genetic testing of NF1 is complex, especially because of the presence of a high number of partial pseudogenes, some of them with a high percentage of sequence identity. In this study, we have analyzed the largest cohort of NF1 Spanish patients (150 unrelated individuals suspected of having NF1 and 53 relatives, making a total of 203 individuals). Mutation analysis of the entire coding region was performed in all unrelated index patients. Additionally, the Multiplex Ligation-dependent Probe Amplification (MLPA) test of the NF1 gene and SPRED1 gene analysis (sequencing and MLPA test) was performed in some of the negative patients for NF1 point mutations. When fulfilling the National Institutes of Health (NIH) criterion for the clinical diagnosis of NF1, the detection rate was 79%. Among the 80 genetically confirmed NF1 probands, we detected 69 different pathogenic variants. Two mutations (3%) were gross deletions of the whole gene, the remaining 78 mutations (97%) were small changes spread among all NF1 exons. Among these 69 different mutations detected, 42 mutations were described elsewhere, and 27 mutations were novel mutations. When segregation was studied, 67% of mutations resulted de novo variants. No genetic mosaicism was detected on patients' parents., (© 2018 John Wiley & Sons Ltd/University College London.)

Background and Objective: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain., Patients and Methods: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included., Results: Mean age was 83.0±5.0 years old, mean CHADS 2 score 3.2±1.2, mean CHA 2 DS 2 -VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR., Conclusions: In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)