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Objectives. Repeated instrumental practice represents a risk factor for the appearance of playing-related musculoskeletal disorders (PRMDs). This study aimed to compare the prevalence and characteristics of PRMDs based on location, pain characteristics and number of hours of instrumental practice, in musicians who play one or more musical instruments. Methods. An observational study was conducted with music university students in Spain using a questionnaire. Results: A total of 178 musicians (41%) played a second instrument. Musicians who played only one instrument had a slightly lower mean number of pain sites (M 3.25, SD 1.93; M 3.44, SD 2.27). On the contrary, pain intensity (M 2.72, SD 2.03; M 2.23, SD 1.78 points), pain interference on mood, quality of life and instrumental practice (M 3.04, SD 2.29; M 2.80, SD 2.24 points) as well as the number of hours devoted to instrumental practice (M 21.18, SD 10.47; M 20.03, SD 12.54 h/week) is slightly higher in musicians playing a single instrument. Conclusions. Pain intensity is the only variable of those analysed that presents statistically significant differences when comparing musicians who play a single instrument with those who play a second instrument, being higher in mono-instrumental musicians. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although pulmonary rehabilitation (PR) is recommended in patients with chronic obstructive pulmonary disease (COPD), there is a scarcity of data demonstrating the cost-effectiveness and effectiveness of PR in reducing exacerbations. METHODS: A quasi-experimental study in 200 patients with COPD was conducted to determine the number of exacerbations 1 year before and after their participation in a PR program. Quality of life was measured using the COPD assessment test and EuroQol-5D. The costs of the program and exacerbations were assessed the year before and after participation in the PR program. The incremental cost-effectiveness ratio (ICER) was estimated in terms of quality-adjusted life years (QALYs). RESULTS: The number of admissions, length of hospital stay, and admissions to the emergency department decreased after participation in the PR program by 48.2%, 46.6%, and 42.5%, respectively (P < 0.001 for all). Results on quality of life tests improved significantly (P < 0.001 for the two tests). The cost of PR per patient and the cost of pre-PR and post-PR exacerbations were €1867.7 and €7895.2 and €4201.9, respectively. The PR resulted in a cost saving of €1826 (total, €365,200) per patient/year, and the gain in QALYs was+0.107. ICER was −€17,056. The total cost was <€20,000/QALY in 78% of patients. Conclusions: PR contributes to reducing the number of exacerbations in patients with COPD, thereby slowing clinical deterioration. In addition, it is cost-effective in terms of QALYs. [ABSTRACT FROM AUTHOR]

Aims: To analyse the histological structure and histomorphometric characteristics of human hard palatal mucosa in order to determine the donor site of choice for connective tissue grafts from a histological point of view. Materials and Methods: Palatal mucosa samples from six cadaver heads were harvested at four sites: incisal, premolar, molar and tuberosity. Histological and immunohistochemical techniques were performed, as was histomorphometric analysis. Results: In the current study, we found that the density and size of cells were higher in the superficial papillary layer, whereas the thickness of the collagen bundles increased in the reticular layer. Excluding the epithelium, the mean percentage of lamina propria (LP) and submucosa (SM) was 37% and 63%, respectively (p <.001). LP thickness showed similar values in the incisal, premolar and molar regions, and a significantly greater thickness in tuberosity (p <.001). The thickness of SM increased from incisal to premolar and molar, disappearing in the tuberosity (p <.001). Conclusions: As dense connective tissue of LP is the tissue of choice for connective tissue grafts, the best donor site from a histological point of view is tuberosity because it is composed only of a thick LP without the presence of a loose submucosal layer. [ABSTRACT FROM AUTHOR]

A collaborative project in different areas of Spain and Portugal was designed to find out the variables that influence the mortality after discharge and develop a prognostic model adapted to the current healthcare needs of chronic patients in an internal medicine ward. Inclusion criteria were being admitted to an Internal Medicine department and at least one chronic disease. Patients' physical dependence was measured through Barthel index (BI). Pfeiffer test (PT) was used to establish cognitive status. We conducted logistic regression and Cox proportional hazard models to analyze the influence of those variables on one-year mortality. We also developed an external validation once decided the variables included in the index. We enrolled 1406 patients. Mean age was 79.5 (SD = 11.5) and females were 56.5%. After the follow-up period, 514 patients (36.6%) died. Five variables were identified as significantly associated with 1 year mortality: age, being male, lower BI punctuation, neoplasia and atrial fibrillation. A model with such variables was created to estimate one-year mortality risk, leading to the CHRONIBERIA. A ROC curve was made to determine the reliability of this index when applied to the global sample. An AUC of 0.72 (0.7–0.75) was obtained. The external validation of the index was successful and showed an AUC of 0.73 (0.67–0.79). Atrial fibrillation along with an advanced age, being male, low BI score, or an active neoplasia in chronic patients could be critical to identify high risk multiple chronic conditions patients. Together, these variables constitute the new CHRONIBERIA index. [ABSTRACT FROM AUTHOR]

Circulating recombinant forms (CRFs) are important components of the HIV-1 pandemic. Those derived from recombination between subtype B and subsubtype F1, with 18 reported, most of them of South American origin, are among the most diverse. In this study, we identified a HIV-1 BF1 recombinant cluster that is expanding in Spain, transmitted mainly via heterosexual contact, which, analyzed in near full-length genomes in four viruses, exhibited a coincident BF1 mosaic structure, with 12 breakpoints, that fully coincided with that of two viruses (10BR_MG003 and 10BR_MG005) from Brazil, previously classified as CRF72_BF1. The three remaining Brazilian viruses (10BR_MG002, 10BR_MG004, and 10BR_MG008) previously identified as CRF72_BF1 exhibited mosaic structures highly similar, but not identical, to that of the Spanish viruses and to 10BR_MG003 and 10BR_MG005, with discrepant subtypes in two short genome segments, located in pol and gp120env. Based on these results, we propose that the five viruses from Brazil previously identified as CRF72_BF1 actually belong to two closely related CRFs, one comprising 10BR_MG002, 10BR_MG004, and 10BR_MG008, which keep their CRF72_BF1 designation, and the other, designated CRF122_BF1, comprising 10BR_MG003, 10BR_MG005, and the viruses of the identified Spanish cluster. Three other BF1 recombinant genomes, two from Brazil and one from Italy, previously identified as unique recombinant forms, were classified as CRF72_BF1. CRF122_BF1, but not CRF72_BF1, was associated with protease L89M substitution, which was reported to contribute to antiretroviral drug resistance. Phylodynamic analyses estimate the emergence of CRF122_BF1 in Brazil around 1987. Given their close phylogenetic relationship and similar structures, the grouping of CRF72_BF1 and CRF122_BF1 in a CRF family is proposed. [ABSTRACT FROM AUTHOR]

The mechanisms underlying liver disease in patients with COVID-19 are not entirely known. The aim is to investigate, by means of novel statistical techniques, the changes over time in the relationship between inflammation markers and liver damage markers in relation to survival in COVID-19. The study included 221 consecutive patients admitted to the hospital during the first COVID-19 wave in Spain. Generalized additive mixed models were used to investigate the influence of time and inflammation markers on liver damage markers in relation to survival. Joint modeling regression was used to evaluate the temporal correlations between inflammation markers (serum C-reactive protein [CRP], interleukin-6, plasma D-dimer, and blood lymphocyte count) and liver damage markers, after adjusting for age, sex, and therapy. The patients who died showed a significant elevation in serum aspartate transaminase (AST) and alkaline phosphatase levels over time. Conversely, a decrease in serum AST levels was observed in the survivors, who showed a negative correlation between inflammation markers and liver damage markers (CRP with serum AST, alanine transaminase [ALT], and gamma-glutamyl transferase [GGT]; and D-dimer with AST and ALT) after a week of hospitalization. Conversely, most correlations were positive in the patients who died, except lymphocyte count, which was negatively correlated with AST, GGT, and alkaline phosphatase. These correlations were attenuated with age. The patients who died during COVID-19 infection displayed a significant elevation of liver damage markers, which is correlated with inflammation markers over time. These results are consistent with the role of systemic inflammation in liver damage during COVID-19. [ABSTRACT FROM AUTHOR]

Background and Aim: Few reports have investigated the association between metabolic abnormalities (obesity and related metabolic syndrome) and total serum IgE concentrations. Methods: This cross-sectional study included a random sample of 1,516 adult individuals (44.7% men, aged 18–91 years, median 52 years) from a single municipality in Spain. Serum IgE was measured in the ADVIA Centaur system. Atopy was defined by the presence of positive skin prick tests to a panel of common aeroallergens in the area. Body mass index and data related to the definition of metabolic syndrome were obtained from all participants. Alcohol consumption, smoking, and regular physical exercise were assessed by a questionnaire. Results: Atopy (present in 21.9% of 1,514 evaluable individuals) was the strongest factor determining serum IgE concentrations. Male sex and heavy alcohol drinking were independently associated with higher IgE concentrations, particularly in the non-atopic individuals. Body mass index was positively associated with IgE concentrations, independent of potential confounders, although the effect was only evident among non-atopic individuals. In that group, median IgE concentrations in normal-weight and obese individuals were 15 and 24 kU/L, respectively (p < 0.001); likewise, obesity was associated with high (>100 kU/L) IgE concentrations after adjusting for potential confounders (odds ratio: 1.79, 95% confidence interval: 1.26–2.56, p = 0.001). The presence of metabolic syndrome and its components, particularly abdominal obesity and hyperglycaemia, was also positively and independently associated with higher IgE concentrations in non-atopic individuals. Conclusions: Obesity and metabolic syndrome components are associated with high total serum IgE concentrations, particularly in non-atopic individuals. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the association between rhegmatogenous retinal detachment (RRD) and solar radiation in northwestern Spain. Methods: All RRD cases in Pontevedra from 2008 and 2014 were retrospectively analyzed. Climatological data from 4 weather stations in the area were collected. The association between RRD incidence and solar radiation was investigated. Results: A total of 256 RRD cases were identified. There was a seasonal variation in the incidence of RRD with a maximum number of incident cases observed in June and July and a minimum number of cases observed in January and December. An association was found between RRD incidence and solar radiation both monthly (p = 0.004) and bimonthly (p = 0.057). The right eye was more frequently affected than the left eye (p = 0.035). RD cases other than rhegmatogenous showed neither seasonality nor association with radiation. Conclusions: Solar radiation may play a role in RRD genesis in our area. Laterality could be related to the amount of radiation reaching each eye. [ABSTRACT FROM AUTHOR]

Background: Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. Methods: Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants' demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. Results: Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. Conclusion: A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. Trial registration: It was retrospectively registered with (ISRCTN41911128, 31/12/2010). [ABSTRACT FROM AUTHOR]

This paper introduces new spatial stochastic frontier models to examine Spanish provinces’ efficiency and its evolution over the period 2000-2013. We use a heteroscedastic version of the spatial stochastic frontier models introduced by Glass et al. (J Econ 190(2):289-300, 2016) that, in addition, allows us to identify the determinants of the spatial dependence among provinces. We contribute to the heterogeneous spatial models that have been introduced in recent years, such as Aquaro et al. (Working Paper No. 15-17. USC Dornsife Institute for New Economic Thinking, 2015) and Malikov and Sun (J Econ 199(1):13-34, 2017), allowing measures of spatial dependence specific to each observation. This feature of the model lets us rank all Spanish provinces in accordance with their degree of spatial dependence, information that will aid policymakers to better allocate public resources between provinces. The period examined is of special interest given that it coincides with a break in the economic growth tendency, which leads to a deterioration in Spain´s economic situation. [ABSTRACT FROM AUTHOR]

Background: The traditional diet of northwestern Spain and northern Portugal follows an 'Atlantic diet' pattern. Adherence to the Atlantic diet has been related to the good metabolic health and low coronary mortality recorded for these regions.Methods: The GALIAT (Galicia Alimentación Atlántica [Galicia Atlantic Diet]) study is a randomised, controlled, dietary intervention clinical trial designed to examine the effect of the Atlantic diet on the lipid profile, glucose metabolism, inflammation makers and adiposity of the general population. The trial involved 250 randomly selected families (715 adults and children over 3 years of age) from a town in Spain's northwest, randomly allocated to follow either a control diet (C group) or the Atlantic diet (AD group) for a period of 6 months. The families of the AD group received educational sessions on food, diet and gastronomy and were provided written supporting material with nutritional recommendations and recipes for the preparation of menus. They also attended cooking classes. Throughout the study period, these families were provided a range of foods (free of charge) that form part of the traditional Atlantic diet. The C group families took part in none of the above activities, nor were they provided with any food. Lipid profile variables (primary variables), and anthropometric, inflammation marker and glucose metabolism status (secondary variables), were measured at baseline, three and six months.Discussion: The GALIAT study is the first clinical trial to examine the effects of the Atlantic diet on metabolic and cardiovascular health and adiposity. If the study hypothesis is confirmed, this dietary pattern could be included in strategies to promote health.Trial Registration: ClinicalTrials.gov, NCT02391701 on March 18, 2015. [ABSTRACT FROM AUTHOR]

Background and Aim: Serum IgG4 concentrations are commonly measured in clinical practice. The aim of this study was to investigate serum IgG4 concentrations in adults and their potential relationship with demographic, lifestyle, metabolic, and allergy-related factors. Methods: Serum IgG4 concentrations were measured with a commercial assay in 413 individuals (median age 55 years, 45% males) who were randomly selected from a general adult population. Results: Median IgG4 concentration was 26.8 mg/dL. Five out of the 413 individuals (1.2%) exhibited IgG4 concentrations >135 mg/dL, and 17 out of 411 (4.1%) exhibited an IgG4/total IgG ratio >8%. Serum IgG4 concentrations were significantly higher in males than in females and decreased with age. After adjusting for age and sex, serum IgG4 concentrations were not significantly influenced by alcohol consumption, smoking or common metabolic abnormalities (obesity and the related metabolic syndrome). Serum IgG4 concentrations were not significantly correlated with serum concentrations of proinflammatory cytokines and inflammation markers. Serum IgG4 concentrations were significantly correlated with IgE concentrations. Serum IgG4 concentrations tended to be higher in atopics (individuals with IgE-mediated sensitization to aeroallergens) than in non-atopics, particularly among atopics without respiratory symptoms. Serum IgG4 concentrations were not significantly correlated with total eosinophil blood count. Cases of IgG4-related disease were neither present at baseline nor detected after a median of 11 years of follow-up. Conclusions: Studies aimed at defining reference IgG4 values should consider partitioning by age and sex. Further studies are needed to confirm the potential influence of atopy status on serum IgG4 concentrations. [ABSTRACT FROM AUTHOR]

BACKGROUND: The diagnosis of tuberculous pleural effusion (TBPE) has some limitations. We studied the efficacy of interleukin-27 (IL-27) in the diagnosis of TBPE. METHODS: We measured IL-27, adenosine deaminase (ADA), ADA-2, interferon-gamma (IFN), and the ADAIL-27 and ADA-2IL-27 products in all the pleural effusion fluids. The diagnostic yield of IL-27 was evaluated with receiver operating characteristic curves. RESULTS: Of 431 pleural effusions, 70 were tuberculous, 146 were neoplastic, 58 were parapneumonic, 28 were empyemas, 88 were transudates, and 41 were other types. With a cutoff point of 0.55 ng/mL, IL-27 had a sensitivity of 91.4% and a specificity of 85.1%, which were significantly less than ADA, ADA-2, IFN, ADAIL-27, or ADA- 2IL-27. The area under the receiver operating characteristic curve for IL-27 (0.963) was also significantly lower than that for the other markers, except for IFN. However, IL-27 improved the sensitivity of ADA and ADA-2 through ADAIL-27 and ADA-2IL-27 products (100% for both). CONCLUSIONS: IL-27 is less efficient than ADA and ADA-2 in the diagnosis of TBPE. However, ADAIL-27 and ADA-2IL-27 improve the diagnostic sensitivity of ADA and ADA-2, and thus could be useful in situations of high clinical suspicion and low ADA level. A value above the cutoff point of the latter is practically diagnostic of TBPE. [ABSTRACT FROM AUTHOR]

The aim of this study is to measure the diagnostic interval (DI) of primary extranodal non-Hodgkin lymphomas (PE-NHL) affecting the head and neck and to discover any associated factors. With this aim, we performed a retrospective observational study in northwestern Spain on patients diagnosed between 1 January 2005 and 1 January 2016. A search was made across the electronic health records of the public health system of this region (SERGAS). DI was used as the dependent variable, and different clinicopathological data of the corresponding patients and tumors were analyzed as exposure variables. PE-NHLs were mostly located in Waldeyer's ring, and they presented a B phenotype and had a median DI of 65 days. Shorter diagnostic intervals were observed in (1) PE-NHL patients who had comorbidities (p = 0.02), (2) PE-NHL that caused symptoms of dysphagia (p = 0.04), (3) tumors with the highest proliferative activity (Ki67 > 80%) (p = 0.04), and (4) tumors diagnosed in the advanced stages of the disease (p = 0.004). Univariate analysis revealed a significant association between dysphagia and a shorter DI. We conclude that raising awareness about these neoplasms and warning about the presenting symptoms can contribute to earlier diagnoses of these tumors and to better outcomes. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. Methods: It included 2459 adults (range 20-92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. Results: In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. Conclusions: The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women. [ABSTRACT FROM AUTHOR]

Four phenotypic methods (three dimensional test, AmpC test, cloxacillin synergy test and cefotetan/cefotetan-cloxacillin E-test) to detect plasmid-mediated AmpC β-lactamases (pAmpC) were compared in 125 clinical Enterobacteriaceae isolates with AmpC profile: 74 E. coli ( bla: 70; bla: 4), five K. pneumoniae ( bla: 2; bla: 3), six P. mirabilis ( bla: 6) and 40 negative isolates for pAmpC β-lactamases. All evaluated methods showed a good sensitivity (>95%) but low values of specificity (<60%) in E. coli, explained by an increase of AmpC expression caused by chromosomal ampC promoter/attenuator mutations (−42, −18, −1, +58, predominantly). The cefotetan/cefotetan-cloxacillin or cloxacillin synergy test may be advocated as phenotypic screening test, and the AmpC test as confirmatory test for detection of pAmpC in isolates that lack or minimally express chromosomally encoded AmpC β-lactamases. In the case of E. coli, the phenotypic evaluated tests were not able to differentiate between chromosomal ampC overexpression or acquisition of plasmid-encoded ampC genes. [ABSTRACT FROM AUTHOR]

Background: Differences in the incidence and outcome of breast cancer among Hispanic women compared with white women are well documented and are likely explained by ethnic differences in genetic composition, lifestyle, or environmental exposures. Methodolgy/Principal Findings: A population-based study was conducted in Galicia, Spain. A total of 510 women diagnosed with operable invasive breast cancer between 1997 and 2010 participated in the study. Data on demographics, breast cancer risk factors, and clinico-pathological characteristics were collected. The different breast cancer tumor subtypes were compared on their clinico-pathological characteristics and risk factor profiles, particularly reproductive variables and breastfeeding. Among the 501 breast cancer patients (with known ER and PR receptors), 85% were ER+/PR+ and 15% were ER-&PR-. Among the 405 breast cancer with known ER, PR and HER2 status, 71% were ER+/PR+/HER2- (luminal A), 14% were ER+/PR+/HER2+ (luminal B), 10% were ER-/PR-/HER2- (triple negative breast cancer, TNBC), and 5% were ER-/PR-/HER2+ (non-luminal). A lifetime breastfeeding period equal to or longer than 7 months was less frequent in case patients with TNBC (OR = 0.25, 95% CI = 0.08-0.68) compared to luminal A breast cancers. Both a low (2 or fewer pregnancies) and a high (3-4 pregnancies) number of pregnancies combined with a long breastfeeding period were associated with reduced odds of TNBC compared with luminal A breast cancer, although the association seemed to be slightly more pronounced among women with a low number of pregnancies (OR = 0.09, 95% CI = 0.005-0.54). Conclusions/Significance: In case-case analyses with the luminal A cases as the reference group, we observed a lower proportion of TNBC among women who breastfed 7 or more months. The combination of longer breastfeeding duration and lower parity seemed to further reduce the odds of having a TNBC compared to a luminal A breast cancer. [ABSTRACT FROM AUTHOR]

Background: Cytokeratin-18 is an essential component of the cytoskeleton of epithelial cells (including hepatocytes). Serum concentrations of cytokeratin-18 (tissue polypeptide-specific antigen [TPS]) are used as a marker of epithelial neoplasms. Here, we investigated the potential interaction between alcohol and obesity in relation to serum TPS concentrations. Methods: Alcohol consumption, body mass index, and components of metabolic syndrome were measured in a random sample ( n = 420) of the adult population (aged 18 to 92 years, 45% men) from a single municipality. Regular alcohol intake of >20 g/d (women) or >30 g/d (men) was considered risky drinking. Serum TPS was measured with a commercial immunoassay. Results: Risky drinking was associated with increased serum concentrations of TPS, which was particularly evident among obese individuals. Among individuals without risky drinking, TPS concentrations were similar for all levels of body mass. Conversely, among risky drinkers, serum TPS concentrations increased in parallel with body mass ( p = 0.002). The odds ratio of a high (>100 U/l) TPS concentration for the combination of risky drinking and obesity was greater than the additive effect of the 2 separate factors, after adjusting for age and sex. A similar interaction was observed between risky drinking and abdominal adiposity, a major component of the metabolic syndrome. Serum TPS concentrations were correlated with markers of liver damage. Serum TPS was not superior to standard markers (gamma-glutamyl transferase and red blood cell mean volume) for the detection of risky drinking. Conclusions: There is a synergism between risky alcohol consumption and common metabolic disorders (particularly obesity) in relation to serum concentrations of cytokeratin-18 (TPS), which probably reflect liver disease. [ABSTRACT FROM AUTHOR]

Although it is well known that alcoholism increases long-term mortality, there is a paucity of data regarding long-term prognosis in alcoholic patients who have an episode of alcohol withdrawal syndrome (AWS). We studied a cohort of 1,265 individuals with severe AWS who were admitted to a single university hospital between 1996 and 2006. Median age was 49 years (range 18 to 89 years). A total of 1,085 (85.8%) were men. Median follow-up was 34 months (range 0 to 121 months). Survival of patients with AWS was compared with that of a reference cohort of 1,362 individuals from the same area. In addition, age- and sex-standardized mortality ratios were calculated using the general population from the region (Galicia, Spain) as the reference. The risk of mortality was higher in the cohort of patients with AWS than in the reference cohort after adjusting for age, sex, and smoking (hazard ratio 12.7; 95% CI 9.1 to 17.6; p < 0.001). The standardized mortality ratio in patients with AWS was 8.6 (95% CI 7.7 to 9.7). Age, smoking, serum creatinine, serum bilirubin, and prothrombin time at baseline were independently associated with mortality among patients with AWS. Long-term mortality is highly increased in patients who have a history of AWS. Liver and kidney dysfunction are independent predictors of long-term mortality in patients with AWS. [ABSTRACT FROM AUTHOR]

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PurposeTo determine the prevalence of pinguecula and pterygium and to investigate their associations in a general adult population in North-Western Spain.MethodsAn age-stratified random sample of 1155 subjects ≥40 years was selected in O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (SD): 63.4 (14.5) years, range: 40-96 years, 37.0% males). An interview to collect history of systemic diseases and lifestyle details and a comprehensive ophthalmic evaluation in which pinguecula and pterygium were recorded was carried out. The prevalence of pinguecula and pterygium and their relationship with lifestyle factors and ocular and systemic diseases was investigated.ResultsThe prevalence of pinguecula was 47.9% (95% confidence interval (CI): 43.9-51.9). This prevalence increased significantly with aging (P=0.002) and was higher in men (56.4%; 95% CI: 50.0-62.7) than in women (42.7%; 95% CI: 37.8-47.8) (P=0.001). The prevalence of pterygium was 5.9% (95% CI: 4.3-7.9). This prevalence also increased significantly with aging (P=0.005) and was 4.8% (95% CI: 2.6-8.4) in men and 6.5% (95% CI: 4.5-9.3) in women (P=0.346). After controlling for age and sex, pinguecula was associated with alcohol intake (adjusted odds ratio (ORa): 3.08; 95% CI: 1.60-5.95), pterygium with fluorescein staining (ORa: 2.64; 95% CI: 1.08-6.46) and both disorders with outer activity (ORa: 2.07; 95% CI: 1.36-3.15 and 2.28; 95% CI: 1.04-4.98, respectively).ConclusionsPinguecula is far more common than pterygium. Alcohol consumption is strongly associated with pinguecula. Fluorescein staining is highly prevalent in subjects with pterygium. Both disorders increase with age and are associated with outer activity. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence of dry eye and to investigate its relationship with lifestyle and systemic factors in a general adult population in north-western Spain. Methods: A dry eye questionnaire was administered and objective tests were performed in 654 individuals [mean age (Standard deviation): 63.6 (14.4) years, range: 40-96, 37.2% males]. Subjects were considered symptomatic when one or more of the symptoms of the questionnaire were present often or all the time. Schirmer test ≤ 5 mm, tear film breakup time ≤ 10 s, rose bengal staining ≥ 3 and fluorescein staining ≥ 1 were considered indicative of signs. Dry eye was defined as the simultaneous presence of symptoms and at least one sign. A design based analysis was performed and all calculations were weighted to give unbiased estimates. Results: Dry eye prevalence was 11.0% (95%confidence interval [CI] 8.6-13.3). Dry eye was found to be more frequent in women (11.9%, 95%CI 8.8-15.1) than in men (9.0%, 95%CI 5.3-12.6), and was significantly associated with aging (p < 0.001). After controlling for age and sex, acne rosacea was the only factor associated with the disease. There were no habits or systemic factors associated with symptoms. However, autoimmune diseases, acne rosacea, and computer use were found to be independently and significantly associated with signs. Conclusions: Dry eye is a common disease in this adult European population and is more frequent in older subjects. Acne rosacea is the only factor associated with dry eye. Other factors are associated with signs but not with symptoms. [ABSTRACT FROM AUTHOR]

Objective: The clinicopathological features of gastrointestinal (GI) stromal tumours were analysed to find out the features that influence prognosis in these neoplasms. Design: Retrospective study. Setting: University Hospital, Spain. Subjects: Review of clinical records and analysis of a series of GI stromal tumours classified in three groups: benign = 7 leiomyomas, malignant or potentially malignant = 16 combined smooth muscle-neural tumours, and 2 miscellaneous, and definitely malignant = 1 leiomyosarcoma and 8 gastrointestinal autonomic nerve tumours. Main outcome measures: Electron microscopy and immunohistochemical staining for vimentin, smooth muscle actin, muscle specific actin, desmin, S-100 protein, neuronal specific enolase, chromogranin A, synaptophysin, CD34, CD117 (c-kit), Bcl-2, and Ki-67. Results: We found significant differences (p < 0.0001) between the median (P25, P75) size of tumours in the benign group 2.0 (1.2, 3.5) and in the potentially 7.5 (4.0, 13.0) and definitely 5.0 (4.0, 6.5) malignant groups. The percentage of mitoses was lower (p = 0.003) in the benign group 0.4 (0.5) than in the other groups 2.0 (1.0, 5.0). Immunoreactivity for CD117 in leiomyomas was an unexpected finding; this showed a different staining pattern from the diffuse and homogeneous staining in GI stromal tumours. In addition, the MIB-1 proliferation index differentiated (p = 0.002) between the benign group 1.5 (1.0, 2.5) and the other two groups 7.0 (3.0, 11.0). Conclusions: These findings support the idea that GI stromal tumours form a heterogeneous group of neoplasms in which large size, presence of necrosis, and a high proliferative index (mitotic rate or MIB-1 index, or both) are good predictors of malignant behaviour. [ABSTRACT FROM AUTHOR]

This study was undertaken to analyze the relationship between the diagonal earlobe crease and the main indices of cardiovascular risk, considering the crease's anatomical variations. The study group consisted of 1050 adults residing in Spain. Participants underwent the following determinations: age, sex, body mass index, smoking habit, blood pressure, glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and cardiovascular events. Cardiovascular risk was calculated applying the Framingham-Anderson equation, the Systematic Coronary Risk Evaluation equation, and the Atherosclerotic Cardiovascular Disease Risk Score calculator. Both earlobes were examined, recording diagonal earlobe crease presence, length and depth, and presence of accessory creases. Results were analyzed by using chi-square test, Student's t test, analysis of variance, and Mann-Whitney or Kruskal-Wallis tests. To extract the functions of cardiovascular risk, a script in R was created (https://cran.r-project.org/). The estimated cardiovascular mortality risk was significantly higher in individuals who presented diagonal earlobe crease (P <.001). The number of individuals with moderate, high, or very high cardiovascular risk increased significantly as the presence of the crease increased (23.8% had no crease, 35.6% had unilateral creases, and 58% had bilateral creases; P <.001). The mean cardiovascular risk estimated was significantly higher for individuals with longest and deepest diagonal earlobe crease (P <.001 and P <.001, respectively), and with accessory creases (P <.001). The diagonal earlobe crease is independently associated with higher cardiovascular risk scores, especially when the crease is complete, bilateral, deep, and has accessory creases. [ABSTRACT FROM AUTHOR]

Aim: Active surveillance of plasmid-mediated β-lactamase-producing Enterobacteriaceae (PMBL-E) in fecal carriers in the hospital and in the community setting in a non-outbreak period of time. Methods: Patients were screened for carriage of Enterobacteriaceae resistant to expanded-spectrum cephalosporins and PMBL-E were characterized (extended-spectrum-β-lactamase [ESBL], plasmid-mediated AmpC β-lactamase [pAmpC], and carbapenemases) by PCR and sequencing. Results: The prevalence of ESBL and pAmpC carriers was 5.06% and 0.59%, respectively. Overall, CTX-M-like enzymes were the ESBL dominate enzymes (96.15%). The group CTX-M-9 was the most prevalent (81, 54%) [CTX-M-14 (74, 91.35%), CTX-M-9 (5, 6.17%), CTX-M-24 (1, 1.23%), and CTX-M-27 (1, 1.23%)] followed by the group CTX-M-1 (64, 42.67%) [CTX-M-15 (42, 65.63%), CTX-M-1 (13, 20.31%), CTX-M-32 (8, 12.5%), and CTX-M-3 (1, 1.56%)]. One CTX-M-10, one CTX-M-59, and three CTX-M-8 were also found. A very small representation of SHV or TEM ESBL enzymes was found (3.2% and 0.64%, respectively). pAmpC characterization revealed a predominance of CMY-2 (81.25%), followed by DHA-1 (18.75%). We did not detect the presence of carbapenemase producers. Conclusions: The prevalence of ESBL-producers from fecal carriers is stable in our area, but colonization by pAmpC producers has emerged recently as we have confirmed. Periodic active surveillance is useful to identify these human reservoirs and control the evolution of PMBL carriage in a community over time. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether continuous glucose monitoring (CGM) reveals patterns of glycaemic behaviour, the detection of which might improve early diagnosis of dysglycaemia.Methods: A total 1521 complete days of valid CGM data were recorded under real-life conditions from a healthy sample of a Spanish community, as were matching FPG and HbA1C data. No participant was pregnant, had a history of kidney or liver disease, or was taking drugs known to affect glycaemia.Results: CGM and fingerstick measurements showed a mean relative absolute difference of 6.9 ± 2.2%. All subjects were normoglycaemic according to FPG and HbA1C except 21% who were prediabetic. The normoglycaemic subjects had a 24-hour mean blood glucose concentration (MBG) of 5.7 ± 0.4 mmol/L, spending a median of 97% of their time within the target range (3.9-7.8 mmol/L). 73% of them experienced episodes with blood glucose levels above the threshold for impaired glucose tolerance, and 5% levels above the threshold for diabetes. These normoglycaemic participants with episodes of high glycaemia had glycaemic variabilities similar to those of prediabetic subjects with episodes of similar intensity or combined duration.Conclusions: CGM is a better indicator of possible early dysglycaemia than either FPG or HbA1c. [ABSTRACT FROM AUTHOR]

The definition of the term gastronomy encompasses both the knowledge of food and its handling, preparation and consumption. Beyond a sense of cultural identity and tradition, gastronomy also represents a pole of tourist attraction. This is the case of Galicia, a region in north-western Spain. Within this framework, local dishes, which include distinctive elements of the Atlantic diet, have gained popularity. This research delves into the sustainability of 60 Galician recipes by performing a hierarchical cluster analysis to study their carbon footprint, the energy return on investment ratio and cost. The life cycle assessment methodology was followed to account for the carbon footprint and the energy return on investment ratio of the recipes. The scope was bounded to the cradle-to-fork phases through the life cycle: production of the ingredients, transport, and meal preparation. The functional unit selected was one serving of a Galician meal. The results suggest that the recipes could be classified into three main groups according to the presence of a greater or lesser amount of animal-based products. Cluster 1 comprises 10 meat recipes. Cluster 2 encompasses 31 recipes rich in fish with some vegetables and moderate consumption of red meat and dairy products. Cluster 3 includes 22 vegetable-based recipes. The higher the portion of animal products in the recipes (mainly red meat), the higher the costs and carbon footprint and the lower the energy return on investment ratio. Conversely, plant-based recipes tend to reduce greenhouse gases emissions and increase cost competitiveness and energy efficiency indicators. Based on this study, the food service could promote eco-labelling that support and certify restaurant menus. This research could also provide transformative climate education for sustainable food for consumers, giving advice to improve food-based dietary guidelines in Spain. • Analysis of the carbon footprint, energy consumption and cost of Atlantic recipes. • Recipes can be classified into three hierarchical dietary clusters. • Cluster 1 comprises meat recipes with low energy return on investment ratio and high carbon footprint and economic cost. • Cluster 2 comprises recipes rich in fish with vegetables and moderate meat. • Cluster 3 includes low-cost and low-carbon vegetable-based recipes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Knowledge on the distribution and determinants of tuberculous pleural effusions (TBPE) is incomplete. We aimed to describe the epidemiological trends and individual characteristics of TBPE in Galicia, Spain, over a 10-year period (2000–2009). Design: A retrospective, observational study based on epidemiological data obtained from the Galician Tuberculosis Register. Results: There were 1835 cases of TBPE (16.3% of the total 11,241 TB cases reported). The number and incidence of TBPE decreased significantly during the study period, from (262 and 9.6/100,000 inhabitants in 2000, to 133 and 4.8 in 2009, respectively; P <.001 for both). The mean annual decrease in TBPE incidence was 6.9%, and 50% overall. TBPE mainly affected males (63.5%), precisely 61.2% young males between 15 and 44years. Twenty-five percent had lung involvement (chest X-ray), and 41.7% had a positive sputum culture. A significant increase (P <.001) was observed during the study in the percentage of patients who had more TB risk factors. Conclusions: The incidence of TBPE decreased significantly during the study period, with no changes in epidemiological characteristics, and with trends similar to the total number of TB cases. The introduction of the Galician Prevention and Control Plan (GPCP) for tuberculosis appears to be effective for better control of TB. [Copyright &y& Elsevier]

Abstract: There is a paucity of data about the epidemiology of alcohol withdrawal syndrome (AWS) and, particularly, with regard to temporal trends and sociodemographic factors. This study included 7,195 episodes of AWS in a defined community (Galicia, Spain) over a 11-year period. We looked for geographical correlations between AWS rate and sociodemographic factors (education and socioeconomic levels and rates of occupational activity and unemployment) within respective districts. We also investigated the inter- and intra-annual time trends for AWS. The median age of the participants was 49 years (interquartile range, 41–60 years), and 85% were men. The annual frequency of AWS episodes remained stable during the study period, with a consistent peak in episodes during the summer months and lowest frequency of episodes in winter months (P <.001). The age- and sex-adjusted geographical distribution of the AWS rate was uneven; districts with high rate tended to cluster. The mean education level was negatively correlated with AWS rate within a given district after adjusting for socioeconomic level, occupational activity rate, and unemployment rate (P <.001). In conclusion, we identified characteristic temporospatial patterns of AWS rate in this defined community. The rate of AWS tended to be higher in the summer months and lower in the winter months. The rate of AWS was higher in districts with low education levels. [Copyright &y& Elsevier]