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En España, la prevalencia de diferentes enfermedades reumáticas se conoce principalmente a través de los estudios EPISER coordinados desde la Sociedad Española de Reumatología y que parten de encuestas en una muestra poblacional. Nuestro estudio tiene por objetivo describir la prevalencia en 2016 de las distintas enfermedades reumáticas en la población residente en el Baix Empordà según registros de codificación asistencial. Estudio observacional, descriptivo y transversal realizado sobre la población residente durante los años 2016-2017 en la comarca del Baix Empordà, donde una organización sanitaria integrada (Serveis de Salut Integrats Baix Empordà) gestiona todos los dispositivos asistenciales públicos con un sistema de información unificado. Se seleccionaron los pacientes ≥ 20 años y se analizó la codificación CIE-9-CM de sus contactos asistenciales en función de 11 agrupaciones diagnósticas de 28 enfermedades reumáticas. Las agrupaciones fueron: poliartritis, espondiloartritis, artritis microcristalinas, artrosis (excepto localización vertebral), reumatismos de partes blandas, fibromialgia, dolor vertebral crónico (incluyendo artrosis), osteoporosis, enfermedades del tejido conectivo, vasculitis y otros. La población estudiada se asignó a tres categorías: «con enfermedad reumática», «posible enfermedad reumática» y «sin enfermedad reumática». La muestra final fue de 71.785 personas, así distribuidas: «con enfermedad reumática» (n = 25.990; 36,2%); «posible enfermedad reumática» (n = 4.406; 6,1%) y «sin enfermedad reumática» (n = 41.389; 57,7%). El grupo «con enfermedad reumática» mostró un predominio de mujeres (59,8% vs. 44,9%) y mayor edad (59,1 ± 17,7 vs. 45,1 ± 16,2; p< 0,001) en comparación al grupo «sin enfermedad reumática». La presencia de enfermedad reumática aumentó progresivamente con la edad, siendo máxima en el grupo de 55-75 años. El 36,2% de nuestra población presenta algún tipo de enfermedad reumática. La prevalencia estimada de varias enfermedades reumáticas en la población del Baix Empordà coincide parcialmente con la estimada por el estudio EPISER 2016. La enfermedad reumática afecta en mayor proporción a mujeres, y es más frecuente en pacientes con edad superior a 45 años. In Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. Observational, descriptive and cross-sectional study carried out on the population attended from 2016-2017 in Serveis de Salut Integrats del Baix Empordà, an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: "with rheumatic disease", "possible rheumatic disease" and "without rheumatic disease". In total, 71,785 patients were distributed as: 36.2% "with rheumatic disease (n = 25,990); 6.1% with "possible rheumatic disease" (n = 4,406) and 57.7% "without rheumatic disease" (n = 41,389). The group "with rheumatic disease" showed a predominance of women (59.8% vs. 44.9%) and older age (59.1 ± 17.7 vs. 45.1 ± 16.2; P <.001) compared to the group "without rheumatic disease". The presence of rheumatic disease increased progressively with age, being maximum in the group between 55-75 years. 36.2% of our population has some type of rheumatic disease. The estimated prevalence of some rheumatic diseases in the Baix Empordà population is partially consistent with that estimated by the EPISER 2016 study. Rheumatic disease affects women in a greater proportion and is more frequent in patients over 45 years of age. [ABSTRACT FROM AUTHOR]

In this paper we examine the trends of nitrous oxide (NO) emissions of the Spanish agricultural sector related to national production and consumption in the 1961-2009 period. The comparison between production- and consumption-based emissions at the national level provides a complete overview of the actual impact resulting from the dietary choices of a given country and allows the evaluation of potential emission leakages. On average, 1.5 % of the new reactive nitrogen that enters Spain every year is emitted as NO. Production- and consumption-based emissions have both significantly increased in the period studied and nowadays consumption-based emissions are 45 % higher than production-based emissions. A large proportion of the net NO emissions associated with imported agricultural goods comes from countries that are not committers for the United Nations Framework Convention on Climate Change Kyoto Protocol Annex I. An increase in feed consumption is the main driver of the changes observed, leading to a remarkable emission leakage in the Spanish agricultural sector. The complementary approach used here is essential to achieve an effective mitigation of Spanish greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

The Nijmegen Cochlear Implant Questionnaire (NCIQ) is a specific and quantifiable self-assessment health-related quality of life (QoL) questionnaire. It was developed to determine the subjective benefits of a cochlear implant (CI). The present study aimed to determine the validity and reliability of the NCIQ in Spanish. Seventy-six adult, Spanish speaking, CI users and 28 control subjects answered the NCIQ. Reliability of the questionnaire was determined using Cronbach's α coefficient and the validity established using Pearson's correlation coefficient. All questionnaire respondents performed significantly better in all sub-domains with a cochlear implant than before cochlear implantation. The Cronbach's α score exceeded 0.70 in most sub-domains and the total score. The objective measures: bisyllables tested without lip-reading and with masking; and bisyllables, tested without lip-reading and without masking were correlated with the sub-domain 'advanced sound perception'. To determine health-related QoL the NCIQ in Spanish is a reliable self-assessment questionnaire and a valuable instrument in determining the subjective benefit of a CI. [ABSTRACT FROM AUTHOR]

The present paper reports a complete palynological study of the Upper Turolian sediments outcropping at the Venta del Moro site (eastern Iberian Peninsula). The pollen assemblages observed mainly reflect the local and regional vegetation, which must have formed part of a wetland ecosystem within a general setting of open steppe, as indicated by the great abundance and diversity of herbaceous pollen. This reflects the persistence of open vegetation in the Iberian Peninsula after the Middle Miocene when it became extensive. We here report the most recent record of Disanthus for the Iberian Peninsula. This shrub played an important role in an unusual, edaphically-mediated vegetation linked to lacustrine–palustrine or riparian shore conditions. A shift in the water level led to a flooding episode, extending wetland and causing a drastic reduction in Disanthus and Amaranthaceae. The results of quantitative (multivariate and coexistence) and semi-quantitative (integrated plant record) analyses of the pollen dataset support these interpretations of the palaeovegetation and provide insight into the regional palaeoclimate. Stable climatic conditions would appear to have reigned before the onset of the Messinian salinity crisis. The palynoflora of Venta del Moro is compared with counterparts in other areas of the Mediterranean Basin. [ABSTRACT FROM AUTHOR]

In recent years, the outcome assessment of subjects undergoing otorhinolaryngological (ORL) intervention has relied increasingly upon patient-reported questionnaires. The English Glasgow Benefit Inventory (GBI) is a reliable, sensitive and validated post-intervention questionnaire that is used to determine health-related quality-of-life (QoL) in patients following ORL intervention. The GBI has been translated into eight languages including Spanish. The present study aimed to determine the internal consistency and validity of the Spanish version of the GBI in patients with a cochlear implant (CI). 121 adult Spanish speaking patients with a CI were questioned retrospectively using the Spanish GBI. Reliability of the questionnaire was determined using Cronbach's α coefficient; factor analyses were performed using principal component extraction with orthogonal rotation; and validity was confirmed using Pearson's correlation coefficient. The mean total score (mean ± standard deviation) of the GBI was 35.1 ± 23.6, 47.6 ± 28.9 for General Health, 17.9 ± 33.2 for Social Benefit and 1.7 ± 27.9 for Physical Health. The reliability was above 0.70 in all test domains. Using factor analyses a 4-factor solution that explained 63.2% of the variance was reached. The objective measures: bisyllables tested without lip-reading and without masking were correlated with the total score and the General Health subscales. The Spanish GBI is a reliable and practicable instrument for the assessment of health-related QoL in Spanish adult CI users. [ABSTRACT FROM AUTHOR]

During the last five decades (1961-2009), Spain has experienced a considerable expansion in the nutrient cycle of its agricultural sector and, in particular, a threefold increase in anthropogenic reactive nitrogen inputs, from 536 Gg N year in 1961-1965 to 1673 Gg N year in 2005-2009. Import of feed (soybean, cereals, and cakes) from America and Europe to supply a growing livestock population constitutes the largest share of this increase, along with intensification of synthetic fertilizer use. While in the early 1960s, Spain was nearly self-sufficient in terms of food and feed supply, the net import of agricultural products presently equals domestic crop production, when expressed in terms of nitrogen content (ca. 650 Gg N year). The most important driver of this shift appears to be the rapid change in domestic consumption patterns, which evolved from a typical Mediterranean diet to an animal-protein-rich diet similar to the North European and American diets. Besides livestock production mostly for national consumption, the Spanish agricultural system has specialized in vegetal products with low N content such as olive oil, wine, vegetables, and citrus fruit, which are for the most part exported. The nitrogen load exported outside the Spanish borders by rivers is very low (6.5 % of the total net N input). As a result of the high import and low export of reactive nitrogen, the Spanish mainland is suffering from considerable pollution by local emissions of reactive nitrogen forms to air and water. [ABSTRACT FROM AUTHOR]

In Central Spain hedgerows are an important component of the landscape although many have been lost due to landscape planning and reallotment programmes. Loss of hedgerows can produce changes in environmental conditions that can be especially critical in summer, corresponding with the dry period in Mediterranean ecosystems. In order to show the effects of hedgerow removal on summer Mediterranean environmental conditions in rural landscapes, this paper describes a comparison of some key environmental conditions between areas where hedgerows are still present, compared to areas where they have been removed. Through a two-way ANOVA, it was found that temperatures in the hedgerows were significantly different from those in the fields, whilst air temperatures beneath the hedgerows were lower, and steadier, than those of surrounding areas. When temperatures of the fields were compared to those sites where hedgerows had been removed, significant differences in temperatures were detected belowground and sometimes at soil surface level but not at higher levels. The levels of soil water content and organic carbon were higher where hedgerows were still in place. These differences indicate potentially negative environmental impacts due to hedgerow removal. The implications of hedgerow conservation for environmental protection and for cropland productivity are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Anthropogenic activities influence past and present nitrate levels recorded in European stream waters, posing a threat to aquatic biota and human beings. Scarce information on temporal trends of nitrate concentration and its causes is available for Mediterranean catchments. This study presents the evolution of nitrate concentrations over 25years in stream waters of the Ebro River Basin (Spain), a large Mediterranean catchment involving 85,566km2. Nitrate concentration increased with time in 46% of the 65 sites involved in the study. Agricultural cover of 30 hydrologically independent sub-catchments was the main land use related to nitrate concentration (R 2 =0.69). Throughout the 25year-period, the sites showing increased nitrate concentrations with time (trend sites) also presented an enhanced influence of agricultural cover on nitrate concentrations along the time frame of the study. As a result of these temporal changes, at the end of the studied period nitrate concentrations in stream waters responded similarly to agricultural cover in both trend and non-trend sites, showing non significant differences in the slope of the resultant regression models. At this time, agricultural cover explained 82% of the variability found in nitrate levels. If these trends remain unchanged, in 2015 many of the water bodies considered in this study would not comply with the requirements of the European Union Water Framework Directive (WFD). Therefore management decisions, mainly associated to agricultural practices, should be implemented as soon as possible at the catchment level to meet WFD objectives. [Copyright &y& Elsevier]

Abstract: The Oliete Sub-basin is located in the link zone between the Iberian and the Catalonian Coastal Ranges (Teruel Province, Spain). The palynological samples have been collected in the Upper Aptian–lower Albian rocks of the Escucha Formation, which present an organic-rich sedimentary succession deposited in a variety of continental and coastal environments. Four detailed sections have been studied in order to establish the stratigraphical framework to perform the palynological study. The rocks of these sections contained abundant and well-diversified palynomorph assemblages. Their study allowed the identification of 78 taxa or taxonomic groups (dinoflagellate cysts, acritarchs, phycomes of prasinophytes, algae, bryophytes, lycophytes, pteridophytes, gymnosperms, and primitive angiosperms). The quantitative percentual and the multivariate analysis performed upon the supplied palynological data supports the hypothesis of subtropical palaeoenvironments controlled by non-uniform conditions. The assemblages are comprised of parautochthonous and allochthonous elements, which reflect the existence of coniferous forests and wetlands. [Copyright &y& Elsevier]

We report here our clinical experience of a program of compassionate use of Celyvir--autologous marrow-derived mesenchymal stem cells (MSCs) carrying an oncolytic adenovirus--for treating children with advanced metastatic neuroblastoma. Children received weekly doses of Celyvir with no concomitant treatments. The tolerance was excellent, with very mild and self-limited viral-related symptoms. Patients could be distinguished based on their response to therapy: those who had a clinical response (either complete, partial or stabilization) and those who did not respond. We found differences between patients who responded versus those who did not when analyzing their respective MSCs, at the expression levels of adhesion molecules (CCR1, CXCR1 and CXCR4) and in migration capacities in transwell assays, and in immune-related molecules (IFNγ, HLA-DR). These results suggest interpatient differences in the homing and immune modulation capacities of the therapy administered. In addition, the pretherapy immune T cell status and the T effector response were markedly different between responders and non-responders. We conclude that multidoses of Celyvir have an excellent safety profile in children with metastatic neuroblastoma. Intrinsic patients' and MSCs' factors appear to be related to clinical outcome. [ABSTRACT FROM AUTHOR]

Abstract: The Fuentelsaz Section is located in the Castilian Branch of the Iberian Range (Guadalajara, Spain). Its exceptional Lower–Middle Jurassic transition outcrops led to its designation as the Global Boundary Stratotype Section and Point for the base of the Aalenian. The sediments of the Toarcian–Aalenian transition at Fuentelsaz are composed of marls with interbedded limestones in rhythmic alternation. Marls are dominant in the Toarcian and the Opalinum Zone up to the middle part of the Comptum Subzone. In the remaining Comptum Subzone, marly materials are scarce and limestones predominate. Sedimentation at Fuentelsaz took place over an extensive marine epeiric carbonate platform that was well connected with the open sea. In the Fuentelsaz Section, a total of 43 palynomorph taxa were recorded: 23 spore taxa, 13 pollen taxa, 4 acritarchs, 2 prasinophytes and 1 dinoflagellate cyst. The studied sediment samples were always dominated by terrestrial allochthonous miospores. In general, miospore assemblages are biased due to the transport of pollen from land or islands to the continental platform. Spheripollenites, Classopollis or indeed both pollens numerically dominate the assemblages. Other miospores appear in low numbers. Aquatic palynomorphs are also scarce; Micrhystridium lymensis is the most common. Five palynological assemblages (PA) were distinguished: PA1, PA2 and PA3 are Toarcian in age, PA4 is located at the boundary between the Toarcian and the Aalenian and PA5. This latter palynological assemblage which is lower Aalenian in age shows a strong reduction in palynomorph diversity and preservation in the Comptum Subzone. Palaeoecological analysis of the palynomorphs indicated the presence of calm, oligotrophic sea water. The palaeofloral communities of gymnosperms and vascular cryptogams—which grew in subtropical arid conditions—were poorly diversified. [Copyright &y& Elsevier]

Purpose: Elevated mortality and morbidity rates persist in pediatric patients with medulloblastoma. We present a clinical audit of a real-world cohort of patients in search for pragmatic measures to improve their management and outcome., Methods/patients: All pediatric patients with medulloblastoma treated between 2003 and 2016 at a Spanish reference center were reviewed. In the absence of internationally accepted quality indicators (QIs) for pediatric CNS tumors, diagnostic, therapeutic, survival, and time QIs were defined and assessed., Results: Fifty-eight patients were included, 24% were younger children (< 3 years), 36% high risk (anaplastic, metastasis, or surgical residue > 1.5 cm 2 ), and 40% standard risk. Five-year OS was 59.2% (95% CI 47-75); 5-year PFS 36.4% (95% CI 25-53). Five main areas of quality assurance were identified: diagnosis, global strategy, frontline treatment modalities, outcomes, and long-term and end-of-life care. A set of 34 QIs was developed and applied. Lack of central pathology review, delay in the incorporation of novel molecular markers, and absence of a neurocognitive and quality-of-life evaluation program were some of the audit findings., Conclusions: This real-world research study resulted in the development of a pragmatic set of QIs, aimed to improve clinical audits and quality of care given to children and adolescents with medulloblastoma. We hope that our findings will serve as a reference to further develop a quality assurance system with specific QIs for pediatric CNS tumors in the future and that this will ultimately improve the survival and quality of life of these patients.

Introduction: The estimated risks of infertility in childhood cancer due to radiation, chemotherapy and surgery are well known. The involvement of professionals and advances in the different methods of preservation are increasing. However, many patients do not receive information or perform any method of preservation., Material: Questionnaires to paediatric onco-haematology institutions throughout Spain. The questionnaire consisted of 22 questions assessing their usual practices and knowledge about fertility preservation., Results: Fifty members of the Spanish Society of Paediatric Haematology and Oncology, representing 24 of 43 centres, responded. These represented 82% of centres that treated higher numbers of patients. The effect of treatment on fertility was known by 78% of those who responded, with 76% admitting not knowing any guideline on fertility in children or adolescents. As for the ideal time and place to inform the patient and/or family, only 14% thought it should be done in the same cancer diagnosis interview. In clinical practice, 12% of those surveyed never referred patients to Human Reproduction Units, another 12% only did so if the patients showed interest, and 38% only refer patients in puberty. Just over one-third (34%) of those referrals were going to receive highly gonadotoxic treatment., Conclusions: There are clear differences between pre-puberty and puberty patients. The frequency with which some method of fertility preservation is performed in patients is low. All respondents believe that the existence of national guidelines on the matter would be of interest., (Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Little attention was paid to adolescents with Cancer in Spain up to 2010. In 2011 an "Adolescents with Cancer Committee" was established by the Spanish Society of Pediatric Hemato-Oncology (SEHOP) to care for the needs of these patients. The aim of this national survey was to outline the present situation of adolescents with cancer in Spanish Pediatric Hemato-Oncology units. A web based survey assessed institutional management of adolescents with cancer. The survey was personally sent to one member of the staff of each Pediatric Hemato-Oncology unit in Spain. It included questions about epidemiology, management, psycho-social coverage, specific facilities, and follow up of these patients. A total of 40 institutions out of 41 responded to the survey (overall response rate 98%). Fifty-six percent of the institutions had patients over 14, but only 36% of the institutions treated patients up to 18 years old. Only 25.6% of the units have more than 40 new pediatric cases every year. The percentage of patients between 14 and 18 years of age is below 10% in most of the units (77%). In 30.8% and 48.7% of the institutions, pediatric hemato-oncologists treat adolescents with hematological and solid tumors, respectively. The rest of the patients are seen by adult oncologists. There is only one institution that has a physician specifically dedicated to adolescent patients, and only two units have a "teenager's room". Only 2 units have a psychologist specifically trained to treat adolescents with cancer. The survey shows that most adolescents with cancer in Spain between 14 and 18 years of age are treated by adult oncologists. Most pediatric institutions still do not have specific facilities and psychosocial support for adolescents. The SEHOP is working hard in order to improve the quality of cancer care, and the quality of survival of this population., (Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Purpose: To assess the efficacy and safety of liposomal cytarabine in the treatment of de novo and relapsed leptomeningeal involvement in children with primary CNS tumours., Methods: Data from clinical charts were entered into a database for consecutive unselected patients (n=20) from nine Spanish centres. Diagnosis of leptomeningeal involvement was confirmed by cytology, MRI and/or CT scan. The dose of liposomal cytarabine used varied from 20 to 50 mg, by age., Results: There were 8 females and 12 males, mean age 7.3 years (range 8 months to 18 years). The tumours were: 10 medulloblastomas, 4 ependymomas, 3 primitive neuroectodermal tumours and 3 other tumours. Fourteen had undergone previous chemotherapy and 12 radiotherapy. Nine received concurrent chemotherapy and 2 concurrent radiotherapy. Median follow-up was 244.5 days (range 12- 869). Patients received a median of 5 doses (range 1-9) of liposomal cytarabine. A neurological response (complete or partial) was seen in 11/19 (58%) and a cytological response in 7/10 (64%). Median time to neurological progression exceeded 180 days (range 12-869). Adverse effects were reported in 11/20 patients, but none was grade IV., Discussion: Liposomal cytarabine was well tolerated and efficacious in this patient group, but prospective randomised trials are needed.

There is scanty information about invasive aspergillosis (IA) in the pediatric population. A review of IA at Hospital Infantil Universitario Niño Jesús between 1996 and 2006 was undertaken to analyze incidence, risk factors, and treatment response. Twenty patients were diagnosed with probable or proven IA during the study period, with a cumulative incidence of 1.96%. Incidence was higher in hematopoietic stem cell transplantation (HSCT) recipients: 2.26% (3.5% in allogeneic HSCT and 1.2% in autologous HSCT). A significative increase in IA incidence was observed along the study period (P=0.013), although this increase did not reach signification if only proven cases were compared (P=0.058). Most patients presented multiple risk factors for IA (87% more than 1, and 47% more than 3). The most frequently described risk factor was chemotherapy (90%), after by long-term neutropenia (90%), and corticotherapy (75%). Main locations of the infection were pulmonary (8 patients), cutaneous (3 patients) and intestinal (3 patients). Six patients presented disseminated IA. Initial response to treatment was 55%, although 3 of these cases had a subsequent episode. Global antifungal response, at the end of the follow-up, was 45%. IA-related mortality was 55%. Global mortality was 90%. Only 2 patients (isolated cutaneous IA cases) survived. Seven patients died due to their underlying malignant disease without active fungal disease. Incidence of IA in oncology children is increasing, and in adults. In our experience, IA is a marker of poor outcome even for patients who initially respond to antifungal treatment.