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In a globalized and media society with unprecedented technological development, institutions of higher education are adapting their training models to face this new challenge. This study aimed to determine students' self-perception of their media competence and the differential influence of an ecosystemic model of training that is being implemented experimentally. The research methodology is mixed, as both a quantitative (descriptive and inferential analysis) as well as a qualitative analysis (are made of the contents of the open reports). A total of 808 university students enrolled in the 2015-16 course in different university centres and countries (Faculty of Teacher Training and Education, and Faculty of Economics-Business of University of Oviedo (Spain) and Technological Institute of Mexico), completed a questionnaire about media competence and wrote open reports about their experience with ecosystemic models. The results showed that university students have a favorable self-perception of their level of media competence, and they consider it important to develop by means of transversal training and ecosystemic training models. Significant differences between the students of the different degrees also emerged depending on whether or not an ecosystemic approach was used to develop the subjects. In conclusion, the study shows that these models favor teaching-learning processes in the university by adapting the technology to the users and improving their media competence.

While life expectancy increases in developed countries and there is evidence that demonstrates the potential of the internet to optimise or compensate for the losses associated with ageing, there is a high proportion of older people who continue to be disconnected from the digital world. In this scenario, the technological support offered by public institutions has the potential to be an accessible source for the digital literacy of older people. This study, using the model of digital inequality, had the aim of analysing the ability of these institutional supports to determine and predict the digital inclusion of older people. The sample was retired adults (over 54 years) residing in Spain who are users of technological support services in four organisational contexts: nursing homes, senior community centres, University Programs for Seniors and adult education programmes. Through binary logistic regression analysis, we found that the ability of the availability of literacy support to determine and predict access, autonomy, skills and use of the internet for social connectivity depends on the social and organisational context of the technology support service. These findings support empirically the situated nature of technological support for the digital inclusion of older people and provide a useful comparative vision for the design of accessible support services adapted to the needs of its users. [ABSTRACT FROM AUTHOR]

While social support—friends, family, and colleagues—is one of the main sources of encouragement and digital literacy for older people, there is evidence that suggests that they may prefer formal sources of support. This study aims to verify the capacity of technological support services to promote literacy and Internet use by older people in multiple contexts. The participants (N = 560) were retired adults (over 54) residing in Spain and habitual users of technological support services in four organizational contexts (nursing homes, community senior centers, university programs for seniors, and adult education programs). The results show the moderating role of organizational contexts on the capacity of formal technological supports to determine the use and appropriation of the Internet by older people. Finally, the findings are discussed in terms of their usefulness for initiatives that adapt to the needs of the users of these services. [ABSTRACT FROM AUTHOR]

In 2014, the Ministry of Education, Culture and Sports of the Government of Spain officially recognized the title of Superior Technician in Communicative Mediation. Faced with this new scenario and after graduating from different promotions of this degree, an exploratory study is carried out to find out the possibilities and limitations of this discipline in the development of inclusive educational contexts that comply with the principle of equity, focusing on students with Autism Spectrum Disorder (ASD), schooled in Early Childhood and Primary Education centers, that presents communication and/or language needs,. This article exposes the design and validation process of a quantitative information collection tool, MeCo-LSE, which allows assessing the relevance of incorporating this new professional figure into educational centers. The results obtained will help define the basis of Communicative Mediation in the school context, and propose an innovative methodology based on the Advanced Socio-educational Intervention Model -Vinjoy Model-, which considers Spanish Sign Language as an inclusive communication tool to use by students with ASD. Remaining available to professionals, students, families and institutions, in order to improve the quality of Education in the post-coronavirus era. [ABSTRACT FROM AUTHOR]

This paper offers a new approach for the estimation of levelized cost of energy (LCOE) by considering the shareholder internal rate of return (IRR) as an unexplored measure in this kind of analysis. The study relies on a comprehensive techno-economic evaluation based on interactions among a set of factors. This mathematical model is then empirically tested for a CSP power plant in Extremadura (Spain) due to their dominant market position and also for being the most developed renewable system at the present. A sensitivity analysis is also performed to establish the influence that market conditions have on the determination of LCOE for different scenarios under the maintenance of a given shareholder IRR for investors. This last assumption makes investment decisions indifferent among several projects in order to focus solely on the minimization of the LCOE. Results reveal that while the annual net electricity production contributes to the reduction of LCOE, total investments, equity percentage and operation and maintenance (O&M) costs help to increase their value by a high percentage. This study gives important scientific basis for investment decision making and also becomes a standpoint to design suitable public incentives that may enhance future technological developments in the CSP generation industry. [ABSTRACT FROM AUTHOR]

We analyzed the frequency of cognitive impairment (CI) in deceased COVID-19 patients at a tertiary hospital in Spain. Among the 477 adult cases who died after admission from March 1 to March 31, 2020, 281 had confirmed COVID-19. CI (21.1% dementia and 8.9% mild cognitive impairment) was a common comorbidity. Subjects with CI were older, tended to live in nursing homes, had shorter time from symptom onset to death, and were rarely admitted to the ICU, receiving palliative care more often. CI is a frequent comorbidity in deceased COVID-19 subjects and is associated with differences in care. [ABSTRACT FROM AUTHOR]

This research quantifies the bias caused in hospital productivity measurements when cost heterogeneity is not considered. A multi-output stochastic cost frontier under a normalised translog specification is used to approximate the structure of technology of a sample of public general hospitals in Spain during the period 2002–2009. To control for observable heterogeneity in costs, a set of variables related to hospital characteristics are included in the cost frontier specification (i.e., hospital complexity, degree of specialisation, availability of outpatient clinics, variety of high-technology equipment available, teaching activity and quality of care), whereas unobservable heterogeneity is accounted for by means of individual dummy variables. A measure of hospitals’ cost efficiency is first obtained, and the analysis is then completed by measuring and decomposing the total factor productivity index (TFP-I) change. Findings reveal that controlling for heterogeneity decreases total productivity from an annual average rate of 0.028% to 1.330%, mainly driven by the negative contribution of the cost efficiency change component. Hence, a bias of 1.303 percentage points in the overall TFP-I is found as consequence of not controlling for heterogeneity. In addition to this, if heterogeneity factors are not accounted for, the mean cost efficiency index during the period analysed is 0.730, figure that increases up to 0.974 if heterogeneity is considered. Hence, the omission of heterogeneity leads to a bias of 24.4 percentage points in the mean cost efficiency. Therefore, not adjusting for heterogeneity in costs gives rise to distorted measurements of hospital productivity, as well as distortions in the contribution of each of its components, which may lead to the adoption of inadequate policies and decisions on resource allocation. [ABSTRACT FROM AUTHOR]

The social media are becoming a major channel of online interactive participation, and local governments are seizing this opportunity to enhance citizen engagement in political and social affairs. This article analyses the various forms of social media used - that is, Twitter or Facebook - by citizens in their relations with Spanish local government, to determine which of these achieves the strongest degree of commitment. We also analyse the influence of various factors on this level of commitment. The results obtained show that Facebook is preferred to Twitter as a means of participating in local government issues. Other factors that are relevant to citizen engagement are the level of online transparency, mood, the level of activity in social media and the interactivity offered by the local government website. The findings of this study contribute significantly to understanding how citizen engagement is influenced by the type of social media adopted. [ABSTRACT FROM AUTHOR]

This paper proposes a simple calculation method to estimate the maximum conversion level in reverse osmosis (RO) brackish water desalination plants. The method is based on the scaling potential of different compounds found in the water to be treated. These compounds include silica, calcium carbonate, calcium sulphate, barium sulphate, strontium sulphate and calcium fluoride. Although the method was originally conceived for application to subterranean brackish waters in the Canary Islands, Spain (principally Gran Canaria, Fuerteventura and Tenerife), it can be extrapolated to other types of region and water treatable with RO systems. The required input data are the chemical composition of the feed water and its pH and temperature. The programmed method then determines the maximum conversion level of the RO system without the risk of scaling of any of the solutes present in the water. The method can be used as an aid in design optimization of RO brackish water desalination plants with acid-free pre-treatment processes and only the use of scale inhibitors. [ABSTRACT FROM AUTHOR]

Aim: Hospitalization of elderly people is often followed by high mortality rates. The aim of this study was to analyze the influence of prior residence on 1-year mortality after hospital discharge in patients aged 70 years and over. Methods: This was a prospective observational cohort study. Participants were 426 patients discharged from the Internal Medicine Department at a Spanish Hospital who were followed for a 12-month period. Data collection was carried out during hospitalization and included sociodemographic characteristics, comorbidity (Charlson index), functional (Barthel index and Lawton scale) and cognitive conditions (Short Portable Mental Status Questionnaire), together with parameters related to the disease causing admission (diagnosis related group, laboratory tests, length of hospital stay). Mortality was carried out using telephone interviews. Results: A total of 420 (98.6%) patients were located at the end of follow up. Of these, 95 patients had died, giving an overall 1-year mortality of 22.6%. The mortality rate for patients living in their private homes was 15.6% versus 24.7% for those living with relatives and 60% for those living in institutions. After adjustment for potential confounders, prior residence was associated with mortality with a hazard ratio of 3.98 (95% CI 1.94-8.17) for those institutionalized and a hazard ration of 1.68 (95% CI 0.99-2.16) for those living with relatives, as compared with patients living in their private homes. Conclusions: Prior residence is associated with 1-year-mortality following discharge after controlling for several multidimensional factors. Geriatr Gerontol Int 2012; ••: ••-••. [ABSTRACT FROM AUTHOR]

The cheese whey (95% composed of water) is an effluent produced in the cheese industry, of which more than 1.5 million tons are generated in Spain, constituting a serious environmental problem. The process starts with a new fermentative/enzymatic technology that totally converts whey, mainly composed by lactose, proteins, and salts, into a fermented product with higher added value. This new product is mainly composed by lactic acid bacteria biomass, ammonium lactate, and a protein hydrolysate. To separate valuable fractions, this fermented product is processed by a two-stage membrane system, which is a very innovative process in this type of fermented product. The first stage consists of ultrafiltration to separate all suspended solids. As a result of this stage, a product mainly constituted by lactic acid bacteria that have both agronomic applications, mainly as a biocontrol and biofertilizer/bio-stimulant, and applications in animal feeding as a probiotic, is obtained. The second stage consists of reverse osmosis used to concentrate the ultrafiltered permeate obtained earlier, leading to a microbiologically stable product and reducing transport costs. The concentrate is mainly composed of ammonium lactate and a protein hydrolysate, constituted by peptides and free amino acids, which has application both in agriculture as a bio-stimulant and in animal feeding, and the permeate is water, reusable in other industrial processes. This work demonstrates the technical feasibility of this valorization process to achieve the objective of "Waste 0" from a problematic by-product, while obtaining products with commercial utility. [ABSTRACT FROM AUTHOR]

The increase in healthy life expectancy and Internet use in developed countries makes it necessary to delve into Internet usage by older adults in order to harness its benefits. Considering the relevance of formal supports for the digital literacy of older people, the objectives of this study were (a) to verify whether there is an escalation in Internet appropriation among older people, and (b) to demonstrate that the usefulness of institutional supports for Internet appropriation depends on the type of support and age. The participants (N = 560) were retired adults (age over 54) who resided in Spain and were habitual users of institutional support programs. Two multigroup analyses with structural equations were performed, using the type of institutional support and the age range as moderating variables. Three incremental levels of appropriation were found according to their levels of physical access, use, skills and perceived benefits. Furthermore, the data showed that the effect of formal support for literacy on Internet appropriation is moderated by type of institution and suggest that institutional supports are more necessary in older ages. • This study contributes with a comprehensive approach to measure the Internet access and use among older people. • Two multi-group analyzes with structural equations were performed. • A successive relationship between levels of appropriation was found. • The institutional context and age moderated the role of digital literacy in the digital integration of its users. • Exist a greater dependence on the institutional support as age increases. [ABSTRACT FROM AUTHOR]

• Through quota sampling of older users of public supports for Internet access in Spain was conducted. • A structural equation modeling and multi-group analysis was conducted. • The data showed a staggered determination of access indicators on the social gratifications obtained. • The data showed a facilitating and moderating role of public supports for Internet access. • The findings point to the need to strengthen digital literacy actions in supports more sensitive to the effect of age. As the standard of living constantly improves, and as life expectancy increases in developed countries, the number of adults who want to have a gratifying life increases as well. Furthermore, although the Internet offers a world of potentially rewarding experiences, there is much heterogeneity among older people with respect to those who are able to benefit from its use. To reduce this gap, public access and digital literacy programs have been implemented. The aim of the study was to find out the extent to which these programs moderate the effects of age and socioeconomic status on social access to and use of the Internet in a sample of older users in Spain. Through quota sampling of retired users over 54 years of age in Spain (N = 560), who were regular users of public supports for Internet access, a structural equation modeling and multi-group analysis was conducted. The data showed a staggered association of access indicators (physical access, digital skills and social e-activities) on the social gratifications obtained, as well as the moderating role of institutional supports. This study provides empirical evidence of the ability of public supports to moderate the effect of socioeconomics inequalities on access and social exploitation of the Internet by older people. The findings point to the need to strengthen digital literacy actions, especially in supports that are more sensitive to the effect of age and socio-economic status. [ABSTRACT FROM AUTHOR]

Introduction: Anti-vaccine disinformation is highly dangerous due to its direct effects on society. Although there is relevant research on typologies of hoaxes, denialist discourses on networks or the popularity of vaccines, this study provides a complementary and pioneering vision about the anti)vaccine discourse of COVID-19 on Twitter, focused on its spreaders’ behavior. Methodology: Given an initial sample of a hundred hoaxes (from December 2020 to September 2021) for the download of 200,246 tweets, around 36,000 tweets (N=36.292) that support or deny disinformation have been filtered through an algorithm for Natural Language Inference (NLI) to analyze their spreaders’ through their metrics in the platform. Results: In relative numbers, the results show, among others, more hoaxes with original content (not retweets) among accounts with more followers and those verified; more irruption of disinformation opposed to its objection by accounts created between 2013 and 2020, and the association of the acknowledgement (more presence in lists or many more followers than followed users) to the preference for denying false information instead of approving it. Discussion: The article shows how the typology of the accounts can be a predictive factor about the behavior of users who spread disinformation. Conclusions: Similar behavioral patterns of anti-vaccine discourse are revealed according to the accounts’ Twitter-related indicators. The size of the sample and the techniques used give a solid foundation for other comparative studies on disinformation about health and on other phenomena on social networks. [ABSTRACT FROM AUTHOR]

Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18th, 2020. We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in April 6th, 2020. Mortality was assessed in those who completed 15-days of ICU stay. We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51–75] years. Symptoms began a median of 7 [5–12] days before ICU admission. The most common comorbidities identified were obesity (48%), arterial hypertension (44%) and chronic lung disease (37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 (6%) high flow nasal therapy (HFNT), 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (46%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10/45 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented super-infection. Procalcitonin plasma above 0.5 μg/L was associated with 16% vs. 19% (p = 0.78) risk of death after 7 days. This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died. [ABSTRACT FROM AUTHOR]

Crimean-Congo haemorrhagic fever (CCHF) is a widely distributed tick-borne disease. In Spain, the disease has emerged as outbreak associated with high-risk exposures. Our goal was to evaluate the prevalence of antibodies against the CCHF virus (CCHFV) in high-risk contacts. A cross-sectional study was conducted. Three hundred eighty-six high-risk contacts were identified comprising family contacts and hospital workers who had attended the cases. Fifty-seven cases with closer exposure were selected. However, forty-nine cases participated in the study. IgG antibodies were detected by immunoenzymatic techniques. All determinations tested negative for anti-CCHFV IgG antibodies. Most of the responders were women (73.5%), and belong to the intensive care department (53.1%). In relation to other possible sources of exposures, 18.4% travelled to countries with CCHF transmission risk. No CCHF positivity was recorded among selected high-risk contacts. This highlights the importance of standard precautions which might have protected healthcare workers and care providers from CCHF infection., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Advanced-stage mycosis fungoides/Sézary syndrome (aMF/SS) has a dismal outcome. The only curative treatment is allogeneic stem cell transplantation (allo-SCT) but this is limited to selected candidates, thus palliative therapy is the most frequent strategy., Objectives: To describe the characteristics of aMF/SS in cases referred to haematology units for advanced/palliative therapy., Materials and Methods: Data from 30 patients were collected from four centres, and descriptive statistics, frequencies and survival analyses were calculated., Results: Eighty-eight per cent of patients received systemic therapy. The median number of therapies was three (range: 1-9). Bexarotene (21%), CHOP-like chemotherapy (10%) and methotrexate (9%) were the more common treatments. The overall survival at a median follow-up of 28 months (range: 8-65 months) for aMF/SS was 56.9%. Survival probability was more favourable for MF (p < 0.02). Nine patients received allo-SCT. Half of the patients (56%) relapsed after allo-SCT but could be rescued with immunosuppression tapering, donor lymphocyte infusions and additional therapy (80%)., Conclusion: There is significant heterogeneity in aMF/SS treatments. Survival is more favourable for MF compared to SS. Current chemoimmunotherapies are insufficient to control disease, making allo-SCT the best therapeutic approach in selected patients.

Lymphomas are a large, heterogeneous group of neoplasms with well-defined characteristics, and this heterogeneity highlights the importance of epidemiological data. Knowledge of local epidemiology is essential to optimise resources, design clinical trials, and identify minority entities. Given there are few published epidemiological data on lymphoma in Spain, the Spanish Lymphoma and Autologous Bone Marrow Transplant Group created the RELINF project. The aim of this project is to determine the frequencies and distribution of lymphoid neoplasms in Spain and to analyse survival. We developed an online platform for the prospective collection of data on newly diagnosed cases of lymphoma in Spain between January 2014 and July 2018; 11,400 patients were registered. Diffuse large B cell lymphoma (DLBCL) and follicular lymphoma (FL) were the most frequent lymphomas in our series. Marginal B cell lymphoma frequency was higher than that reported in other studies, representing more than 11% of mature B cell lymphomas. Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) was the most common subtype of T cell lymphoma, and NK/T cell lymphomas were more frequent than expected (5.4% of total). Hodgkin's lymphoma accounted for 12% of lymphoproliferative syndromes. Overall survival was greater than 90% at 2 years for indolent B cell lymphomas, and approximately 60% for DLBCL, somewhat lower than that previously reported. Survival was poor for PTCL-NOS and angioimmunoblastic T cell lymphoma, as expected; however, it was somewhat better than that in other studies for anaplastic large cell anaplastic lymphoma kinase lymphomas. This is the first prospective registry to report the frequencies, distribution, and survival of lymphomas in Spain. The frequencies and survival data we report here are globally consistent with that reported in other Western countries. These updated frequencies and survival statistics are necessary for developing appropriate management strategies for neoplasias in the Spanish population.

Objectives: The aim of this study was to compare antimicrobial susceptibility rates in a Spanish ICU before and after the introduction of selective digestive decontamination (SDD) and also to compare these with susceptibility data from other Spanish ICUs without SDD., Methods: We performed a retrospective study in the ICU of the University Hospital of Alava, where SDD was implemented in 2002. The SDD protocol consisted of a 2% mixture of gentamicin, colistin and amphotericin B applied on the buccal mucosa and a suspension of the same drugs in the gastrointestinal tract; additionally, for the first 3 days, systemic ceftriaxone was administered. From 1998 to 2013 we analysed the susceptibility rates for 48 antimicrobial/organism combinations. Interrupted time series using a linear dynamic model with SDD as an intervention was used. Data from other ICUs were obtained from the ENVIN-HELICS national registry., Results: Only amoxicillin/clavulanic acid against Escherichia coli and Proteus mirabilis, and a high concentration of gentamicin against Enterococcus faecalis, resulted in a significant decrease in the susceptibility rate after the implementation of SDD, with a drop of 20%, 27% and 32%, respectively. Compared with other Spanish ICUs without SDD, the susceptibility rate was higher in the ICU of our hospital in most cases. When it was lower, differences were <10%, except for a high concentration of streptomycin against Enterococcus faecium, for which the difference was 19%., Conclusions: No relevant changes in the overall susceptibility rate after the implementation of SDD were detected. Susceptibility rates were not lower than those in the Spanish ICUs without SDD., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The use of immunochemotherapy has improved the outcome of follicular lymphoma (FL). Recently, complete response at 30 months (CR30) has been suggested as a surrogate for progression-free survival. This study aimed to analyse the life expectancy of FL patients according to their status at 30 months from the start of treatment in comparison with the sex and age-matched Spanish general population (relative survival; RS). The training series comprised 263 patients consecutively diagnosed with FL in a 10-year period who needed therapy and were treated with rituximab-containing regimens. An independent cohort of 693 FL patients from the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO) group was used for validation. In the training cohort, 188 patients were in CR30, with a 10-year overall survival (OS) of 53% and 87% for non-CR30 and CR30 patients, respectively. Ten-year RS was 73% and 100%, showing no decrease in life expectancy for CR30 patients. Multivariate analysis indicated that the FL International Prognostic Index was the most important variable predicting OS in the CR30 group. The impact of CR30 status on RS was validated in the independent GELTAMO series. In conclusion, FL patients treated with immunochemotherapy who were in CR at 30 months showed similar survival to a sex- and age-matched Spanish general population., (© 2019 British Society for Haematology and John Wiley & Sons Ltd.)

The means of optimally managing very elderly patients with diffuse large B-cell lymphoma (DLBCL) has not been established. We retrospectively analyzed 252 patients aged 80-100 years, diagnosed with DLBCL or grade 3B follicular lymphoma, treated in 19 hospitals from the GELTAMO group. Primary objective was to analyze the influence of the type of treatment and comorbidity scales on progression-free survival (PFS) and overall survival (OS). One hundred sixty-three patients (63%) were treated with chemotherapy that included anthracyclines and/or rituximab, whereas 15% received no chemotherapeutic treatment. With a median follow-up of 44 months, median PFS and OS were 9.5 and 12.5 months, respectively. In an analysis restricted to the 205 patients treated with any kind of chemotherapy, comorbidity scales did not influence the choice of treatment type significantly. Independent factors associated with better PFS and OS were: age < 86 years, cumulative illness rating scale (CIRS) score < 6, intermediate risk (1-2) R-IPI, and treatment with R-CHOP at full or reduced doses. We developed a prognostic model based on the multivariate analysis of the 108 patients treated with R-CHOP-like: median OS was 45 vs. 12 months (P = .001), respectively, for patients with 0-1 vs. 2-3 risk factors (age > 85 years, R-IPI 3-5 or CIRS > 5). In conclusion, treatment with R-CHOP-like is associated with good survival in a significant proportion of patients. We have developed a simple prognostic model that may aid the selection patients who could benefit from a curative treatment, although it needs to be validated in larger series., (© 2018 Wiley Periodicals, Inc.)

Background and Objective: We aimed to assess the incidence of haematological neoplasms (HNs) in Castilla y León (2,5 million inhabitants) and its distribution by age, gender and histological type., Patients and Method: The epidemiological profile based on the described variables of the 10,943 HNs diagnosed during a 10-years period was analyzed, compared with other studies., Results: The overall age-adjusted incidence was 29.4 cases/10(5) inhabitants-year, with some geographical differences. The mean age was 67.3 years, with a turning point between the 6th-7th decades of life from which there was a very significant increase of incidence. Two relevant facts where simultaneous with advancing age: decreased lymphoid neoplasms incidence and increased low degree neoplasms incidence. Lymphoid low degree neoplasms accounted for half of the registered processes, showed the greatest preference for male and reached the mode before the rest of neoplasms. Myeloid neoplasms incidence (9.5) was higher than that reported in other European registries, specially compared to southern European countries, opposite to lymphoid neoplasms incidence (20.0)., Conclusions: A higher myeloid neoplasms incidence and lower lymphoid one than expected was observed. The turning point of incidence is between the 6th-7th decades of life, with a preference for male that decreases with age. There is an increased incidence of HNs in the area where a higher density of potentially polluting facilities is concentrated., (Copyright © 2013 Elsevier España, S.L.U. All rights reserved.)

Mantle cell lymphoma (MCL) is considered a distinct type of B-cell lymphoma genetically characterized by the t(11;14) translocation and cyclin D1 overexpression. There is also a small subset of tumors negative for cyclin D1 expression that are morphologically and immunophenotypically indistinguishable from conventional MCL. Although in the last decades, the median overall survival of patients with MCL has improved significantly, it is still considered as one of the poorest prognoses diseases among B-cell lymphomas. Election of treatment for patients with MCL is complex due to the scarcity of solid evidence. Current available data shows that conventional chemotherapy does not yield satisfactory results as in other types of B-cell lymphomas. However, the role of other approaches such as autologous or allogenic stem cell transplantation, immunotherapy, the administration of consolidation or maintenance schedules, or the use of targeted therapies still lack clear indications. In view of this situation, the Spanish Group of Lymphomas/Autologous Bone Marrow Transplantation has conducted a series of reviews on different aspects of MCL, namely its diagnosis, prognosis, first-line and salvage treatment (both in young and elderly patients), new targeted therapies, and detection of minimal residual disease. On the basis of the available evidence, a series of recommendations have been issued with the intention of providing guidance to clinicians on the diagnosis, treatment, and monitoring of patients with MCL.

Background: Bortezomib plus melphalan and prednisone (VMP) is significantly better than melphalan plus prednisone alone for elderly patients with untreated multiple myeloma; however, toxic effects are high. We investigated a novel and less intensive bortezomib-based regimen to maintain efficacy and to reduce toxic effects., Methods: Between March, 2006, and October, 2008, 260 patients with untreated multiple myeloma, 65 years and older, from 63 Spanish centres, were randomly assigned to receive six cycles of VMP (n=130) or bortezomib plus thalidomide and prednisone (VTP; n=130) as induction therapy, consisting of one cycle of bortezomib twice per week for 6 weeks (1·3 mg/m² on days 1, 4, 8, 11, 22, 25, 29, and 32), plus either melphalan (9 mg/m² on days 1-4) or daily thalidomide (100 mg), and prednisone (60 mg/m² on days 1-4). The first cycle was followed by five cycles of bortezomib once per week for 5 weeks (1·3 mg/m² on days 1, 8, 15, and 22) plus the same doses of melphalan plus prednisone and thalidomide plus prednisone. 178 patients completed the six induction cycles and were randomly assigned to maintenance therapy with bortezomib plus prednisone (n=87) or bortezomib plus thalidomide (n=91), consisting of one conventional cycle of bortezomib for 3 weeks (1·3 mg/m² on days 1, 4, 8, and 11) every 3 months, plus either prednisone (50 mg every other day) or thalidomide (50 mg per day), for up to 3 years. Treatment codes were generated with a computerised random number generator, and neither participants nor study personnel were masked to treatment. The primary endpoint was response rate in induction and maintenance phases. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00443235., Findings: In the induction phase, 105 (81%) patients in the VTP group and 104 (80%) in the VMP group achieved partial responses or better (p=0·9), including 36 (28%) and 26 (20%) complete remissions, respectively (p=0·2). Treatment with VTP resulted in more serious adverse events (40 [31%] vs 20 [15%], p=0·01) and discontinuations (22 [17%] vs 15 [12%], p=0·03) than did treatment with VMP. The most common toxicities (grade 3 or worse) were infections (one [1%] in the VTP group vs nine [7%] in the VMP group), cardiac events (11 [8%] vs 0), and peripheral neuropathy (nine [7%] vs 12 [9%]). After maintenance therapy, the complete remission rate was 42% (40 [44%] patients in complete remission in the bortezomib plus thalidomide group, 34 [39%] in the bortezomib plus prednisone group). No grade 3 or worse haematological toxicities were recorded during maintenance therapy; two (2%) patients in the bortezomib plus prednisone group and six (7%) in the bortezomib plus thalidomide group developed peripheral neuropathy., Interpretation: Reduced-intensity induction with a bortezomib-based regimen, followed by maintenance, is a safe and effective treatment for elderly patients with multiple myeloma., Funding: Pethema (Spanish Program for the Treatment of Hematologic Diseases)., (Copyright © 2010 Elsevier Ltd. All rights reserved.)