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This article provides information on the efficacy and safety of cemiplimab, a drug used to treat advanced cutaneous squamous cell carcinoma (CSCC). The study conducted in Spain included 83 patients who received cemiplimab treatment, with an overall response rate of 56.6% and 33.7% experiencing complete responses. The study found that the presence of distant metastasis and a higher ECOG score were associated with a worse response to treatment. The article emphasizes the need for more real-world data on cemiplimab treatment for CSCC and highlights the importance of including patients from diverse ethnic backgrounds in clinical trials. [Extracted from the article]

• Veterinary students consider the main risk in xenotransplant to be immunologic risk. • Most veterinary students are in favor of xenotransplant. • The risks perceived by veterinary students in xenotransplant do not seriously diminish the favorable attitude toward xenotransplant. Understanding the perception of the risks associated with xenotransplant, especially among professionals who will contribute to the care of the animals, is important for xenotransplant to become a clinical reality. The objective of this study was to analyze opinions regarding the risks of organ xenotransplant among veterinary university students in Spain. The study population was 2683 veterinary students from different courses and universities in Spain. Instrument valuation: Validated self-administered questionnaire completed anonymously (PCID-XENOTx-Ríos). Consent to collaborate in the study was requested. Variables for the study: attitude toward xenotransplant and risks (infectious, immunologic, ethical/moral, philosophical, religious, other unspecified risks). Statistics: descriptive analysis, Student t test, χ2 test, and Fisher exact test. Of the total number of respondents, 2646 students answered this question, with a completion rate of 98.6%. They considered immunologic risk 78.4% (n = 2074), infectious risk 48.6% (n = 1286), ethical/moral risk 10.7% (n = 284), philosophical risk 5.2% (n = 137), religious risk 1.5% (n = 40), and other risks 3.9% (n = 104). Significant relationships were observed between immunologic risks (P <.001), ethical/moral risks (P <.001), and other risks (P =.002). Despite the consideration of different types of risks, the favorable attitude toward xenotransplant among veterinary students at Spanish universities is highly prevalent, and evidence-based information campaigns on the different risks associated with xenotransplant are important. [ABSTRACT FROM AUTHOR]

Juan Carlos I sufrió un accidente en Botsuana en 2012 mientras estaba de cacería. El suceso tuvo un gran impacto en la opinión pública española y en la percepción de la monarquía. Este trabajo desarrolla una aproximación al discurso del perdón y un análisis de las palabras de Juan Carlos I en su disculpa, siguiendo la teoría de restauración de la imagen de William Benoit. El trabajo concluye que el discurso contribuyó a detener la vorágine mediática y a mantener la reputación de la corona y su posible influencia en las estrategias de restauración de imagen de los partidos españoles. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Osteoporosis & Mineral Metabolism / Revista de Osteoporosis y Metabolismo Mineral (Spanish edition) is the property of Ibanez y Plaza and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Strawberries have been the target of research to find alternatives to methyl bromide (MB) as this crop is the largest single consumer of the chemical in Spain using 800 tonnes for fruit production and 237 tonnes in mother plant production. Electromagnetic waves (EW), Solarization (Sol), Biofumigation (Bio), Metham Sodium (MNa), Dazomet (Daz), 1,3-Dichloropropene (1,3-D) and Chloropicrin (Pic) were evaluated alone or in combination as alternatives for Methyl Bromide (MB) in strawberry production over a three-year period at two locations. The GGE biplot method was employed to study the MB alternative by environment two-way data. This method graphically displays MB alternative by environment data and hence facilitates the pattern of MB alternative performance across environments. 1,3-D plus 35 % Pic (Telone C35), Pic alone, MB shank-applied to preformed beds under black polyethylene films and under black virtually impermeable films performed as well as the standard methyl bromide treatment and resulted in greatest total yield, early and total fruit weights. In addition, these treatments together with Daz and Sol plus MB resulted in greatest early yield. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the accumulation of lead in tissues of crayfish P. clarkii after short-term lead exposure in several sublethal concentration. The study is undertaken through the collection of the crayfish from Lake Albufera in Valencia, Spain in April 1986 wherein tissues were lyophilized and homogenized. The results of the study indicate that the highest lead accumulation in crayfish is at their gills.

Abstract The Bolivian population is growing in Spain. Xenotransplantation of organs and/or tissues carries many social and cultural implications. It is important to find out the level of acceptance of xenotransplantation in immigrant populations, especially in populations where there are preclinical trials. The objective of the study is to analyze the attitude toward xenotransplantation of organs and tissues in the Bolivian population residing in Spain and the variables that influence their attitude. Methods We selected a sample of the Bolivian population living in Spain. A sample of the population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTX-Ríos). Results Of the 206 respondents, 26% of respondents are in favor of xenotransplantation of organs if it was assumed that xenotransplanted organs functioned as well as human ones. If the results were worse, only 6% would be in favor. The following factors were associated with this attitude: (1) level of education (P =.008), (2) a favorable attitude toward human donation (P =.004), (3) a partner's favorable attitude toward transplantation (P <.001), and (4) a belief that one might need a transplant in the future (P =.01). The following were associated with attitude in the multivariate analysis: (1) having secondary education (odds ratio, 3.690; P =.004) and (2) a partner's favorable attitude toward transplantation (odds ratio, 6.024; P =.003). Conclusions The attitude of Bolivian residents in Spain toward xenotransplantation is negative and is determined by educational and family factors. Highlights • The attitude of Bolivians toward xenotransplantation is negative. • The attitude toward xenotransplantation is determined by educational factors. • The attitude toward xenotransplantation is determined by family factors. [ABSTRACT FROM AUTHOR]

Abstract Introduction Immigrants from Ecuador represent the largest group of Latin Americans in Spain and are, therefore, a subgroup of interest to understand their attitudes and influences in respect to organ donation and transplantation. Objective To analyze the attitude of nationals of Ecuador residing in Spain regarding deceased organ donation. Methods The study population included the Ecuadorian population residing in Spain. A sample of population older than 15 years was obtained randomly and stratified by age and sex (n=461). Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation (PCID-DTO-Ríos). Assistance from immigration support associations in Spain was needed to advice on the location of potential respondents. Results Attitude toward cadaveric donation was favorable in 59% (n=271) of respondents, 12% (n=57) were against cadaveric donation, and 29% (n=133) were undecided. Several variables were associated with having a more favorable attitude. In the multivariate analysis, the following variables were independently associated with a more positive attitude toward organ donation: 1. level of formal education (odds ratio [OR]=6.849 [25.641–1.818]; P =.004); 2. being in favor of donating a family member's organs (OR=8.849 [20.833–3.717]; P <.001); 3. having commented at a family level about transplant (OR=3.717 [6.578–2.109]; P <.001); 4. not being concerned about the possible mutilation of the body after donation (OR=4.608 [8.547–2.487]; P <.001) and 5. knowing the attitude of one's religion toward donation (OR=7.462 [34.482–1.623]; P =.010). Conclusions The attitude toward cadaveric organ donation among the Ecuadorian population residing in Spain is less favorable than that of the Spanish population and is determined by many different psychosocial variables. Highlights • The attitude toward organ donation of Ecuadorian residents in Spain is less positive than that of the native Spanish population. • The attitude toward cadaveric organ donation is associated with certain psychosocial variables. • Among Ecuadorians in Spain, a high percentage are not in favor of cadaveric organ donation. [ABSTRACT FROM AUTHOR]

Abstract The Senegalese population is an emerging group in Europe. The number of foreign residents in Spain, France, and Italy has increased significantly. However, there are no studies that analyze their awareness of organ donation and transplantation. Objective To analyze the attitude toward organ donation among the population born in Senegal residing in Spain. Methods The study population was born in Senegal and resides in Spain. A sample of the population older than 15 years was obtained randomly and stratified by age and sex according to census data and immigrant support associations. Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation (PCID-DTO Rios). A random selection of people to be surveyed was carried out. Assistance from African immigration support associations in Spain was needed to advise on the location of potential respondents. The survey was self-administered and completed anonymously. Results A sample of 295 respondents was included in the study. Attitude toward deceased donation was favorable in 37% (n = 109) of respondents; 35% (n = 104) were against and 28% (n = 82) were undecided. Several variables were associated with having a more favorable attitude (P <.05): sex, having discussed donation with the family, not being concerned about the possible mutilation of the body after donation, the respondent's religion, and knowledge of one's partner's attitude in favor of organ donation. Conclusions The attitude toward organ donation among the population born in Senegal and residing in Spain is unfavorable, and it is associated with psychosocial factors. Highlights • The attitude toward organ donation among Senegalese people residing in Spain is unfavorable. • The attitude is associated with psychosocial factors. • Family and religion are important in attitude toward organ donation. [ABSTRACT FROM AUTHOR]

Abstract The number of foreign residents in Spain increased significantly with Moroccans and Algerians as the 2 largest nationalities. However, there are no studies that analyze their awareness of living kidney donation although an increasing number of patients of these nationalities are included on the waiting list. The aim of this study is to analyze the attitude toward living kidney donation among the population of Spain residents born in Algeria. Methods The study population was Spain residents born in Algeria. A sample of the population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward living kidney donation (PCID-DVR Rios). A random selection of people to be surveyed was carried out. Results Of the 420 respondents, 64% of respondents are in favor of related living kidney donation (family or friends). The remaining 36% were against or undecided. The factors associated with this attitude are personal reasons and family (P <.001). Psychosocial factors are not related to this attitude (P <.001). The following factors were associated with this attitude: (1) not being concerned about the possible mutilation of the body after donation (P <.001) and (2) evaluation of the risk from living kidney donation (P <.001). Conclusions The attitude toward related living kidney donation among the population of Spain residents born in Algeria is unfavorable. Only 64% would do it, and it is associated with affective factors and the evaluation of the risk from living kidney donation. Highlights • The attitude toward LKD among the population in Algeria is unfavorable. • Considering the risks of LKD influences its acceptance. • Age influences the acceptance of LKD. [ABSTRACT FROM AUTHOR]

Background The Ecuadorian population is the largest Latin-American immigrant group in Spain. Currently, several Ecuadorians have received transplants or are awaiting transplants in Spain. The aim of this work was to analyze the attitude toward living kidney donation among the Ecuadorian population residing in Spain. Methods The population screened were born in Ecuador, residing in Spain, and >15 years old, stratified by gender and age, and appraised with the use of the questionnaire on attitude toward organ donation for transplantation “PCID-DVR-Ríos.” Support from immigration associations in Spain was used to advise on the location of potential respondents. The completion was anonymous and self-administered. Verbal consent was obtained. Statistics included Student t test, χ 2 , Fisher exact test, and logistic regression analysis. Results A total of 461 respondents were included: 80% ( n = 367) were in favor of living-related kidney donation (for a relative or close friend). This attitude was associated with psychosocial variables that persisted in the multivariate study: 1) female gender (odds ratio [OR], 3.086; P = .001); 2) considering oneself a potential kidney receptor in the future (OR, 16.949; P = .002); 3) economic incentive in the donation (OR, 100; P = .004); and 4) knowing the attitude of their religion toward transplantation (OR, 32.258; P < .001). Conclusions Living-related donation is accepted among the Ecuadorian population residing in Spain and is associated with sociopersonal and religious factors. [ABSTRACT FROM AUTHOR]

Abstract The Latin American population has a double way of immigration, one toward the United States by proximity and another toward Spain by sociocultural affinity. This population increase is affecting organ donation and transplantation in receiving countries. Objective To analyze the brain death (BD) concept knowledge in the Dominican Republic immigrant population in Florida (United States) and Spain. Method Population under study: Population born in the Dominican Republic, resident in Florida (United States) and in Spain. Inclusion criteria: Population older than 15 years stratified by age and sex. Assessment instrument: Donation attitude questionnaire PCID-DTO-Ríos. Fieldwork: Random selection based on stratification. Immigration support association collaboration in Florida and Spain was needed to locate potential respondents. Completion was anonymous and self-administered, with verbal consent. Results A total of 123 respondents, 57 residents in Spain and 66 in Florida, have been included in the study. The 27% (n = 33) of the respondents knowledgeable of the BD concept consider it the death of an individual. Of the remainder, 52% (n = 64) do not know about it, and the remaining 21% (n = 26) believe it does not mean the death of a patient. No differences were observed regarding migration countries (P >.05). There was no association of the BD concept with other psychosocial factors analyzed or with the attitude toward organ donation. Conclusions Knowledge of the BD concept among the Dominican immigrant population is similar in Spain and Florida, and, unlike most studies, there is no objective association with the attitude toward organ donation. Highlights • The Dominican population emigrating to Spain and the United States has a significant ignorance of the brain death concept. • According to the knowledge about brain death, there is no difference between the Dominican populations of Spain and the United States. • Concerning these results, and unlike most studies, there is no objective association with the attitude toward organ donation. [ABSTRACT FROM AUTHOR]

Background The Dominican population has a double-emigration pathway: one is to the USA, by proximity, and the other is to Spain, by sociocultural identification. Our aim was to determine attitudes toward living organ donation among Dominicans residing in Florida (USA) and Spain. Methods All study participants were at least 15 years old and living in either Florida (USA) or Spain, and stratified by gender and age. A questionnaire on attitudes toward living kidney donation (“PCID-LKD Ríos”) was used. The support of immigrant associations in Florida and Spain was required to advise on survey locations. Data obtained were anonymized and self-administered. Results The study questionnaire was completed by 123 Dominicans, 68% of whom were in favor of living related kidney donation. There were differences ( P = .004) according to the country of residence. Eighty-one percent of Spain's Dominican residents were in favor, compared with 56% of Florida's residents. Factors associated with attitude toward donation were level of education ( P < .001), previous experience with organ donation ( P = .006), attitude toward cadaveric organ donation ( P < .001), belief in the possibility of needing a transplant in the future ( P = .016), discussing the issue with one's family ( P = .007), discussing the issue with husband/wife/partner ( P = .002), carrying out pro-social activities ( P = .029), religious beliefs ( P = .001), and understanding the risk of living kidney donation ( P = .046). Conclusion Attitudes toward living kidney donation among immigrant Dominicans varies between Spain and the USA, with the former showing a more positive view. [ABSTRACT FROM AUTHOR]

Abstract: Acid mine drainage is formed when pyrite (FeS2) is exposed and reacts with air and water to form sulfuric acid and dissolved iron. Tinto River (Huelva, Spain) is an example of this phenomenon. In this study, Raman spectroscopy has been used to investigate the speciation of the system iron(III)–sulfuric acid–water as an approach to Tinto River''s aqueous solutions. The molalities of sulfuric acid (0.09mol/kg) and iron(III) (0.01–1.5mol/kg) were chosen to mimic the concentration of the species in Tinto River waters. Raman spectra of the solutions reveal a strong iron(III)–sulfate inner-sphere interaction through the ν 1 sulfate band at 981cm−1 and its shoulder at 1005cm−1. Iron(III)–sulfate interaction may also be facilitated by hydrogen bonds and monitored in the Raman spectra through the symmetric stretching band of bisulfate at 1052cm−1 and a shoulder at 1040cm−1. Other bands in the low-frequency region of the Raman spectra are attributed to the hydrogen-bonded complexes formation as well. [Copyright &y& Elsevier]

Objective: To determine the preferences regarding injection, medication frequency and complexity of GLP1 receptor agonists among patients with type 2 diabetes, treatment-naïve for such drugs in Spain. Additionally, patients' willingness to pay according to these attributes was evaluated., Methods: A discrete-choice experiment survey designed to evaluate patients' preferences over three attributes discriminating by age, sex and patients experience with previous injectable treatment was fulfilled by patients. The resulting model was analyzed using a conditional (fixed-effects) logistic regression., Results: A total of 180 patients (63.35 ± 11.49 years, 63.28% men, 48.41% with previous cardiovascular disease, 54.69% with a time of evolution of diabetes >10 years) recruited from 5 health care centers in Spain completed the survey. Patients viewed positively weekly injections (vs daily injections), but rated negatively a complex preparation of the dose (vs simple preparation). Whereas naïve patients for injectable medications did not consider administration timing of importance, no naïve patients considered it relevant. No relevant differences were observed according to age or gender. Patients were willing to pay 83.25€for a "no preparation required" dose. No naïve and naïve patients were willing to pay 34.61€ and 14.35€; p  = 0.000, to change daily injection for a weekly injection., Conclusions: Patients highly valued the avoidance of injections, with weekly dosing clearly preferred over daily dosing, as well as reducing the treatment complexity. These findings may provide a better understanding of what patients prefer and value in their treatment and provide guidance for clinicians making therapeutic decisions regarding treatments of patients with type 2 diabetes.

Background: SMA is a hereditary neuromuscular disease that causes progressive muscle weakness and atrophy. Several studies have shown that the burden of SMA is very high at many levels. Functional assessment tools currently used do not completely address the impact of the disease in patients' life. The objective of this qualitative study was to identify aspects of SMA that are relevant to patients and to design items useful for assessment purposes., Results: Five focus group sessions were run during an annual SMA families meeting in Madrid, Spain. Focus groups were composed by parents of SMA type I children, sitter children type II-III, parents of sitter children type II-III, adult patients, and parents of walker children. Two trained facilitators conducted the focus groups using a semi-structured guideline to cover previously agreed topics based on the input of a Scientific and Patient Advisory Committee. The guideline was adapted for the different groups. According to what was communicated by participants, SMA entails a high burden of disease for both patients and their parents. Burden was perceived in physical, psychological, and social areas. Patient's physical domain was the most relevant for participants, especially for parents of non-ambulant children, followed by limitations of motor scales to capture all changes, parents psychological burden, treatment expectations and patient's psychological burden. Ten domains were the main areas identified as impacted by the disease: mobility and independence, fatigue and fatigability, infections and hospital consultations, scoliosis and contractures, vulnerability, pain, feeding, time spent in care, breathing, and sleep and rest., Conclusions: This study confirms the necessity of evaluating other aspects of the disease that are not assessed in the functional motor scale. Measures of other aspects of the disease, such as pain, fatigue, feeding, should be also considered. A patient-reported outcomes instrument measuring such aspects in a valid and reliable way would be very useful. This study generated a list of new items relevant to be systematically measured in the assessment of the impact of SMA on the patients' everyday life., (© 2024. The Author(s).)

Background: Mental health literacy (MHL) is especially important for young people, but comprehensive studies on MHL in adolescents are limited, with no nationwide studies in Spain. This research aims to study MHL among Spanish adolescents and its relationship with sociodemographic factors., Methods: An exploratory study is carried out using stratified random sampling in Spanish adolescents (N = 1000), aged 12-16 years and balanced in terms of gender, age and territorial distribution. Data collection took place in October and November 2023 through online surveys using the CAWI methodology. Sociodemographic variables, contact with mental health and the Spanish version of the Mental Health Literacy Questionnaire (MHLq-E), a self-administered instrument of 32 Likert-type items (1-5) that assesses the dimensions of help-seeking skills, knowledge about causes and symptoms, and stigma, were evaluated. Descriptive and multivariate analyses of variance (MANOVA) were conducted., Results: In general, adequate levels of literacy were observed, although some aspects related to help-seeking towards teachers, stigmatising attitudes towards people of low economic status and knowledge of severe mental health problems could be improved. The results show contact with previous mental health problems as a key variable for stigma and knowledge about symptomatology together with age. Likewise, gender and family educational level were found to be related to the ability to seek professional help., Conclusion: This study provides information on levels of MHL among Spanish adolescents and highlights significant socio-demographic variables. These findings pave the way for interventions aimed at improving adolescents' understanding, attitudes and skills to manage mental health problems, making possible to adapt content and focus on specific groups, thus increasing its effectiveness., (© 2024. The Author(s).)

Background: The shortage of available transplant organs has made it necessary to search for alternatives, one of which is xenotransplantation. However, the use of animal organs could face rejection from society and the personnel involved in its implementation., Objectives: (a) to analyze the attitudes of Veterinary Degree students in six Spanish Universities towards xenotransplantation; and (b) to determine the factors that affect its acceptance., Methods: Of the 2815 students surveyed in the degree program, 2683 valid surveys were obtained. Attitudes towards organ xenotransplantation were evaluated using a validated questionnaire of organ donation., Results: If xenotransplantation was confirmed as a clinical reality, 93% (n = 2493) of those surveyed would accept a xenotransplanted organ, whilst 7% would not. If the results of xenotransplantation were worse than those obtained with human donors and it entailed more risk, 12% (n = 318) would be in favor. 56% (n = 1497) of the students would accept a xenotransplantation provisionally pending the arrival of a human organ. Attitudes towards xenotransplantation were affected by the academic year in which a student was studying, with more favorable attitudes among students in the last year (88% in first year vs. 95% in fifth year; p < .001). More favorable attitudes are also observed depending on the attitude they have towards organ transplantation, with those students being more in favor of donating their organs when they die (94% vs. 88%; p < .001)., Conclusion: Veterinary students would have a very favorable attitude toward xenotransplantation if these animal organs functioned as well as human organs. Therefore, these students could play an important role in the future promotion of this technique., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Xenotransplantation could be a source of organs for transplantation given the global organ shortage. It is important to know the opinion and variables that influence the acceptance of xenotransplantation of the professionals who will work in the genetic manipulation, production, and care of animals to be used for this purpose., Objective: Analyze the influence of religious beliefs on the attitude toward xenotransplantation in veterinary students., Methods: The study population included 2683 veterinary students from different courses and Spanish Universities. Instrument evaluation included a validated self-administered and anonymously completed questionnaire (PCID-XENOTx-Ríos). The survey was self-administered and completed anonymously. Consent to collaborate in the study was requested. Variables for the study included attitude toward xenotransplantation and toward religion, considering the following options: practicing Catholic, nonpracticing Catholic, non-Catholic, and atheist/agnostic. Statistics were performed using descriptive analysis, Student t test, -X 2 , and Fisher's exact test., Results: Of the total number of participants, 7 did not answer this question. Those in favor of xenotransplantation were 92.9% (n = 247) of practicing Catholics, 92.8% (n = 812) of nonpracticing Catholics, and 87.3% (n = 69) of those professing another non-Catholic religion compared with 93.5% (n = 1361) of those considering themselves agnostic/atheist (P = .037)., Conclusions: Religion is an influential factor in attitudes toward organ xenotransplantation. Those who practice Catholicism and those who consider themselves agnostic/atheist are more accepting of organ procurement for transplantation than those who practice other religious doctrines., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To accurately categorize the phenotypes of individuals with collagen VI-related dystrophies (COL6-RDs) during the first years of life to predict long-term motor function and pulmonary function, to provide phenotype-specific anticipatory care, and to improve clinical trial readiness., Methods: This retrospective, multicenter, international study analyzed the relationship of long-term motor and pulmonary function with the initial maximal motor ability achieved in individuals with COL6-RD., Results: We studied 119 patients with COL6-RD from Spain (n = 54) and the United States (n = 65). The early maximal motor milestones of ability to rise from the floor unassisted and ability to climb 4 steps without holding onto a railing demonstrated reliability in distinguishing between 3 COL6-RD phenotypic subgroups: (1) Ullrich congenital muscular dystrophy, (2) intermediate COL6-RD, and (3) Bethlem myopathy. Long-term motor function and pulmonary function are strongly correlated with the maximal motor ability achieved during the first years of life. Maximal motor capacity can predict other disease-relevant events such as the age at loss of ambulation and the need for the initiation of nocturnal noninvasive ventilation., Conclusion: This work proposes a prospective phenotypic classification for COL6-RDs that will enable an accurate prediction of a patient's COL6-RD phenotype during the first years of life. The ability to establish a patient's COL6-RD phenotypic classification early will enable a more accurate prognosis of future motor and pulmonary function, thus improving anticipatory clinical care, and it will be instrumental in aiding the design of future clinical trials by allowing early stratification of trial cohorts., (© 2021 American Academy of Neurology.)

Background: Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality., Methods: In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy., Results: Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60-79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17-10.1 vs < 50 years), > 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20)., Conclusions: In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.

Introduction: There are differences in the attitude toward organ donation between Latin Americans living in Spain and those living in the United States., Objective: We sought to analyze the socio-personal factors that can condition the difference in attitude toward donation between Latin Americans living in the United States and those living in Spain., Materials and Methods: Participants in the study were Latin Americans living in Spain (group A; n=1237) and the United States (Florida) (group B; n=1450), extracted from the database of the International Collaborative Donor Project (PCID). Inclusion criteria were a sample population stratified by area, country of birth, age, and sex. The instrument used was a validated attitude questionnaire toward living kidney donation (PCID-DTO-Rios.) Participants were randomly selected to be surveyed according to stratification., Results: The attitude in favor of Latin Americans residing in Spain (group A) was 60% (n=745) vs 33% (n=485) of residents in the United States (group B) (P < .001). The socio-personal profile of the Latin Americans in Spain compared with those in the United States indicates that they are mainly women (63.5% vs 43.7%, respectively), younger (31.78 vs 37.31 years, respectively), have more secondary education (21.2% vs 16.3%, respectively) and university studies (11% vs 6%, respectively), are of South American origin vs those who are Mexican and Central American, respectively, and there is a higher percentage of atheists/agnostics (8.1% vs 3.7%). However, the personal profile toward donation is similar in both groups, both for and against organ donation., Conclusions: The personal social profile of the Latin American resident in Spain is different from that of the resident in the United States. However, the psycho-social profile for and against organ donation is similar in both countries., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: In liver transplantation, living donation shows better and better results. However, rates of living liver donation (LLD) are low., Objective: To analyze the attitude towards LLD among patients on the waiting list for liver transplantation., Method: Study population: Patients included in the waiting list for liver transplantation who are not in code 0 and do not present with encephalopathy above grade I., Protocol: After being included in the waiting list, they are informed of the study and they are cited in the Psychology Consultation., Instruments: attitude questionnaire towards LLD, carried out in the Psychological Care consultation., Results: Of the 147 patients included in the waiting list, 112 fulfilled the inclusion criteria in the study. After being cited in the consultation, 100% of respondents are in favor of living liver donation. However, when considering the related LLD, 80% of the respondents indicated that they would not accept a living donation from a family member and therefore did not want to complete the questionnaire. Of the remaining 20% who completed the study, 11% would accept it from any family member, 8% only from some family members (mainly excluding children and grandchildren), and the remaining 1% would accept it but excluded all their family members., Conclusion: Currently, there is a disconnect between patients' intentions in favor of living liver donation and the real attitude when they are on the waiting list and related living donation is raised., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The Ecuadorian population forms the largest Latin American immigrant group in Spain. However, their knowledge about the brain death (BD) concept and the relationship with the attitude toward organ donation has been little analyzed. The objective of the study is to analyze the knowledge of the BD concept among the Ecuadorian population resident in Spain., Methods: The population under study was the population born in Ecuador and resident in Spain. Inclusion criterion was age older than 15 years stratified by age and sex. The assessment instrument was PCID-DTO-Ríos, a validated questionnaire of attitude toward donation and organ transplantation. Field work involved random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered., Results: Of the 461 respondents, 22% (n =102) know the BD concept and accept it as the death of the person; 61% (n = 283) do not know it; and for 17% (n = 76) it does not mean the death of the person. The variables related to the correct knowledge of BD are age (P = .007) and marital status (P = .028), with age persisting in the multivariate study (odds ratio, 1.036; P = .008). There is no objective relationship with the attitude toward organ donation. Thus, 60% of those who know the concept are in favor of donating (n = 61), and 59% of those who do not know it are in favor (n = 210; P = .813)., Conclusions: The BD concept is little known among Ecuadorians residing in Spain, and it is not associated with the attitude toward donation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: The attitude toward living liver donation (LLD) among the Spanish population is mostly positive; however, the reality is that liver transplants from live donations are currently minimal. Given this situation, studies that analyze these discrepancies should be carried out., Objective: Analyze the attitude toward LLD among family members of patients on the waiting list for liver transplantation., Method: Population under study. First-degree relatives of the patients included in the waiting list for liver transplantation., Inclusion Criteria: 1. Have the patient's authorization for family members to participate; 2. Accept, the relative, to participate in this investigation; and 3. Be over 18 years old. Opinion survey. The attitude toward LLD is assessed through a questionnaire on psychosocial aspects., Results: Patients who accepted family members' participation in the study were 21 of 112, of which 9 placed restrictions on family access, and 12 authorized family members without restrictions. The participants were 1. children: 52.2% (n = 24); 2. brothers: 30.5% (n = 14); and 3. partners: 17.3% (n = 14). Finally, the authorized relatives and participants in the study were 45. Of these, only 44% (n = 20) would accept to be donors., Conclusions: The access to the LLD of the relatives starts from the restriction and initial rejection of the patients themselves on the waiting list. The promotion of LDD is to initially sensitize patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Ecuadorians are the largest immigrant group in Spain. In countries with preclinical programs of xenotransplantation (XenoTx), it is important to know the population attitude toward them; however, in the Ecuadorian population it is not known., Objective: To analyze the attitude toward XenoTx of organs among the Ecuadorian population residing in Spain., Methods: Population under study. Ecuadorians residing in Spain., Inclusion Criteria: Sample of population over 15 years stratified by age and sex. Instrument valuation. Validated questionnaire of attitude towards xenotransplantation PCID-XenoTx-Ríos. Setting for the study. Random selection of people to survey based on stratification., Results: Of the 461 respondents, 36% are in favor of XenoTx if the results were similar to those obtained with humans, 15% against, and 49% undecided. If the results were worse than with human organs, 11% would be in favor, 26% against, and 63% undecided. The variables associated with this attitude are age (P = .018), marital status (P = .026), studies (P < .001), comment with family (P = .001), couple attitude (P = .039), attitude toward cadaveric donation (P < .001), previous experience with donation (P = .001), consider the possibility of needing a transplant in the future (P < .001), and attitude toward related living donation (P < .001). In the multivariate analysis, these data persist: university studies (odds ratio [OR] = 3.875; P = .007); in favor of cadaveric organ donation (OR = 2.840; P < .001); previous relationship with donation and organ transplantation (OR = 1.901; P = .026); and consider the possibility of needing a transplant in the future (OR = 4.329; P = .002)., Conclusions: The attitude toward XenoTx among Ecuadorian residents in Spain is unfavorable and is conditioned by different psychosocial variables., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: To investigate the incidence of non-cancer mortalities and prognostic factors associated with competitive causes of death in a homogeneous cohort of patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment., Methods: This study included 284 patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment between 2005 and 2017. The cumulative incidence of death associated with tumour, second tumours, treatment, side effects and comorbidity was calculated. A Fine and Gray regression model was used to investigate factors associated with cancer and competitive mortality., Results: The cumulative incidence of tumoral death at 5 and 10 years were 35 and 47% respectively, whereas the cumulative incidence of competitive mortality were 10 and 12% respectively. In the multivariate analysis, age and comorbidity were independent factors for non-cancer mortality. Patients with a high risk of non-cancer mortality presented a cumulative incidence of 17.3% at 5 years and 18.4% at 10 years., Conclusions: This study demonstrated a high incidence of competing mortality in older patients with comorbidities. Non-cancer deaths should be considered when selecting patients for combination therapies and in the study design ofclinical trials.

Objectives: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis., Background: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3., Methods: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed., Results: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8)., Conclusions: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Religious factors have conditioned the attitude toward organ donation and transplantation (ODT) since the beginning of transplantation, despite the fact that most religions are in favor of transplantation., Objective: To assess the impact of religious beliefs of medical students on their attitude toward ODT., Method: Population under study: Medical students in Spanish universities., Study Sample: Stratified by geographical area and academic course. Assessment instrument: Attitude ODT questionnaire PCID-DTO-Ríos, anonymous and self-administered., Results: Of all students, 42% (n = 3907) declare themselves atheists or agnostics. The remaining 58% (n = 5368) declare themselves to be religious, the majority being Catholic (55%, n = 5102). Of the rest, 0.2% are Muslims (n = 8), 0.1% Protestants (n = 1), and the remaining 2.7% (n = 257) indicate other religious doctrines but do not want to specify it. Regarding their attitude toward ODT, those who consider themselves atheists or agnostics have a more favorable attitude than those who consider themselves religious (84% versus 76%; P < .001). Among those who follow some kind of religion, Catholics are more in favor of ODT than non-Catholics (77% vs 64%, P < .001). Note that among the religious, only 57% (n = 3050) know which religion is in favor of transplantation, while 22% (n = 1,152) consider that it has not been pronounced on the matter, 13% (n = 723) think the religion is against donation, and the remaining 8% (n = 443) do not know., Conclusion: The religion professed by medical students conditions their attitude toward donation, with the atheists and agnostics being more in favor of donation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Xenotransplantation carries many social and cultural implications. The immigrant population in countries with xenotransplantation programs, such as Spain and the United States, will play an important role in accepting such therapy. The objective of the study is to analyze the attitude toward xenotransplantation among the Dominican population residing in the United States and Spain., Methods: The study population was born in the Dominican Republic and resides in the southeastern United States and Spain. A sample population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTx-Ríos). A random selection of people to be surveyed was carried out. Assistance from immigration support associations was needed to advise on the location of potential respondents., Results: A total of 123 respondents were included in the study: A sample was taken of residents of the population from the Dominican Republic residing in Florida, United States (n = 66), and in Spain (n = 57). If it was assumed that xenotransplanted organs functioned as well as human ones, 30% would be in favor. If the results were worse, only 7% would be in favor. This favorable attitude was related to the following variables (P < .05): level of education, an attitude in favor of deceased and living organ donation, and having spoken about donation and transplantation within the family., Conclusions: The attitude toward xenotransplantation among the population from the Dominican Republic who are residing in the southeastern United States and Spain is unfavorable., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To identify genes involved in the pathogenic mechanisms of non-proliferative diabetic retinopathy (NPDR), among which include oxidative stress, extracellular matrix changes, and/or apoptosis, in order to evaluate the risk of developing this retinal disease in a type2 diabetic (DM2) population., Material and Methods: A case-control study was carried out on 81 participants from the Valencia Study on Diabetic Retinopathy (VSDR) of both genders, with ages 25-85years. They were classified into: (i)DM2 group (n=49), with DR (+DR; n=14) and without DR (-DR; n=35), and (ii)control group (GC; n=32). The protocols included a personal interview, standardised ophthalmological examination, and blood collection (to analyse the DNA for determining the gene expression (TP53, MMP9, and SLC23A2) in the study groups. Statistical analyses were performed using the SPSS v22.0 program., Results: The TP53 and MMP9 genes showed a higher expression in the DM2 group compared to the GC, although the difference was only significant for the MMP9 gene (TP53: 10.40±1.20 vs. 8.23±1.36, P=.084; MMP9: 1.45±0.16 vs. 0.95±0.16, P=.036), and the SLC23A2 gene showed a significant lower expression in the DM2 vs CG (5.58±0.64 vs. 11.66±1.90, P=.026). When sub-dividing the DM2 group according to the presence of retinopathy, the expression of the TP53, MMP9 and SLC23A2 genes showed significant differences between the DM2-RD, DM2+RD and GC groups (TP53: 9.95±1.47 vs. 11.52±2.05 vs. 8.23±1.36, P=.038; MMP9: 1.47±0.20 vs. 1.41±0.27 vs. 0.95±0.16, P=.021; SLC23A2: 5.61±0.77 vs. 5.51±1.21 vs. 11.66±1.90, P=.018)., Conclusions: Genes involved in extracellular matrix integrity (MMP9) and/or apoptosis (TP53), could be considered potential markers of susceptibility to the development/progression of NPDR. Interestingly, the SLC232A2 gene (ascorbic acid transporter) can be considered a protector of the risk of the development/progression of the retinopathy., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

The aim of this case study was to assess the performance of a horizontal subsurface flow constructed wetland (HF-CW) located in southeastern Spain, filled with blast furnace slags (BFS), planted with Phragmites australis and designed to treat artificially aerated domestic wastewater to produce effluents suitable for agriculture reuse. The water quality parameters, included in the Spanish regulations for reclaimed wastewater reuse as agricultural quality 2.1, were monitored for one year. Data for all studied parameters, except electrical conductivity (EC) and sodium adsorption ratio (SAR), met the Spanish standards for reclaimed wastewater reuse due to the high evapotranspiration (ET) during the summer. The introduced improvements were effective for turbidity, total suspended solids (TSS), total nitrogen (TN), Escherichia coli (E. coli) and, specially, for total phosphorus (TP) with an average abatement of 96.9±1.7%. The improved HF-CW achieved similar or better percentage abatements than those reported using some hybrid systems., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aim of the present study was to analyse the patterns of treatment adjustment in rheumatoid arthritis (RA) patients with active disease in routine clinical care. This was a cross-sectional study of consecutive patients with RA conducted in five hospitals. Activity scales (DAS28-ESR) and function (HAQ) were measured, as well as whether ultrasound was performed as part of the assessment. Treatment decision (no changes/reduction/intensification) and time to the next scheduled visit were the outcomes variables. Associated factors were analysed by multilevel regression models. A total of 343 patients were included (77 % women, mean age 57 years, mean RA duration 10 years), of whom 44 % were in remission by DAS28. Treatment was continued in 202 (59 %) patients, reduced in 57 (16 %), and intensified in 83 (24 %). In the 117 patients with active RA (DAS28 ≥ 3.2), treatment was intensified in 61 (52 %). Factors associated with treatment intensification were physician and patient VAS, and DAS28, but not the centre. In the multilevel regression analysis with intensification of treatment as dependent variable, the following factors were significantly associated: DAS28 [OR 3.67 (95 % CI 2.43-5.52)], patient VAS [OR 1.04 (95 % CI 1.01-1.08)], and have performed an ultrasound [OR 3.36 (95 % CI 1.47-7.68)]. Factors associated with time to the next scheduled visit (an average of 4.3 months) were patient and physician VAS, DAS28, and centre. In clinical practice, half of the patients with active RA maintain or reduce the treatment. The decision to intensify treatment in active RA as recommended by a treat-to-target strategy is complex in practice.

Research on management of bovine tuberculosis (bTB) in wildlife reservoir hosts is crucial for the implementation of effective disease control measures and the generation of practical bTB management recommendations. Among the management methods carried out on wild species to reduce bTB prevalence, the control of population density has been frequently used, with hunting pressure a practical strategy to reduce bTB prevalence. However, despite the number of articles about population density control in different bTB wildlife reservoirs, there is little information regarding the application of such measures on the Eurasian wild boar (Sus scrofa), which is considered the main bTB wildlife reservoir within Mediterranean ecosystems. This study shows the effects of a management measure leading to a radical decrease in wild boar population density at a large hunting estate in Central Spain, in order to assess the evolution of bTB prevalence in both the wild boar population and the sympatric fallow deer population. The evolution of bTB prevalence was monitored in populations of the two wild ungulate species over a 5-year study period (2007-2012). The results showed that bTB prevalence decreased in fallow deer, corresponding to an important reduction in the wild boar population. However, this decrease was not homogeneous: in the last season of study there was an increase in bTB-infected male animals. Moreover, bTB prevalence remained high in the remnant wild boar population., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Mycobacterium bovis infections in fallow deer have been reported in different countries and play an important role in the epidemiology of bovine tuberculosis (bTB), together with other deer species. There is little knowledge of the pathogenesis of bTB in fallow deer. The aim of this study was to perform a histopathological characterisation of the granulomas induced by M. bovis in this species and the immunohistochemical distribution of different cell subsets (CD3+, CD79+, macrophages) and chemical mediators (iNOS, TNF-α, IFN-γ) in the different developmental stages of granulomas. Stage I/II granulomas showed a marked presence of macrophages (MAC387+) expressing high iNOS levels while stage III/IV granulomas showed a decrease in the number of these cells forming a rim surrounding the necrotic foci. This was correlated with the presence of IFN-γ expressing cell counts, much higher in stage I/II than in stage III/IV. The number of B cells increased alongside the developmental stage of the granuloma, and interestingly the expression of TNF-α was very low in all the stages. This characterisation of the lesions and the local immune response may be helpful as basic knowledge in the attempts to increase the vaccine efficacy as well as for disease severity evaluation and for the development of improved diagnostic tools. Immunohistochemical methods using several commercial antibodies in fallow deer tissues are described., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Intensification of game management may increase the prevalence of tuberculosis (TB) in wildlife despite eradication programs implemented in cattle herds in the same areas. In this cross-sectional study, we investigated the association between wild game management practices and the presence of tuberculosis in red deer populations in Southwestern Spain. Five hundred and fifty-one animals were examined by necropsy to detect tuberculosis-like lesions in the main lymph nodes. Prevalence, as determined by TB-like lesions, was estimated to be 5.1% of animals, with 77% of TB-like lesions confirmed by PCR. Our results suggest that population density, in addition to factors which promote the local aggregation of animals, is factors associated with increased prevalence of TB in red deer populations. We suggest that management practices including supplementary feeding, fencing, water ponds and interaction with domestic livestock should be revised in order to prevent TB in wild deer both., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objective: To investigate the prevalence, duration, and etiology of bacteremia following dental extractions performed after a single administration of chlorhexidine mouthwash., Design and Setting: A randomized, controlled trial performed in a university hospital., Methods: A series of 106 patients with mental and behavioral disabilities who underwent dental extractions under general anesthesia were randomly assigned to a control group or chlorhexidine group. The exclusion criteria applied were use of antibiotics in the previous 3 months, use of oral antiseptics, any type of congenital or acquired immunodeficiency, and disease that predisposes the patient to infections or bleeding. The chlorhexidine group had 0.2% chlorhexidine mouthwash administered for 30 seconds before any dental manipulation. Blood samples were collected at baseline, 30 seconds, 15 minutes, and 1 hour after the dental extractions. Subculture and further identification of the isolated bacteria were performed by conventional microbiological techniques., Results: The prevalence of bacteremia after dental extraction in the control and chlorhexidine groups were 96% and 79%, respectively, at 30 seconds (P=.008), 64% and 30% at 15 minutes (P<.001), and 20% and 2% at 1 hour (P=.005). The most frequently identified bacteria were Streptococcus species in both the control and chlorhexidine groups (64% and 68%, respectively), particularly viridans group streptococci., Conclusion: We recommend the routine use of a 0.2% chlorhexidine mouthwash before dental extractions to reduce the risk of postextraction bacteremia.

Data relating to Rickettsia typhi infection in Spain are scarce. A serological survey of 383 serum samples (184 males, 199 females) from the general population and 120 sera from sheep were studied by immunofluorescence assay (IFA). The human serum samples were collected from the general population of Palencia and Burgos provinces, and sheep serum samples were collected from Palencia province. Of the 383 human serum samples studied, 29 were positive for antibodies against R. typhi (7.5%) No statistical differences were found according to age, sex, origin (rural vs. urban) or geographic distribution, but a significant difference was observed related to occupation. In addition, 69 serums were found positives for R. typhi in sheep samples (57.5%). Our results indicated the circulation of R. typhi infectious for humans and sheep in Palencia and Burgos provinces. This study indicates that sheep may be infected with R. typhi, and that animals can, therefore be used as indicators of the presence of this organism.

Objective: Evaluation of technique and results of carotid endarterectomy (CEA) in the central region in Spain and possible differences among the hospitals included. Study of factors predictors of complications., Patients and Methods: All CEAs performed in 9 hospitals in the central region in Spain (1999 2000). Registry design by a specific commission and contents selected by consensus. Voluntary participation. Ambispective study. Uni and multivariate statistical analysis (logistic regression)., Results: 576 procedures registered. Global mortality: 1.9%. 15 (2.7%) patients died or were severely handicapped. The selection of patients adjusted to expert s recommendations in 98%. Significant differences in technique and results were found among the hospital centres (>0,25). In the multivariate analysis, the risk factors associated with complications were: presence of preoperative symptoms (p= 0.006) small number of annual CEAs (p= 0.01), contralateral occlusion (RR= 4.7, p= 0.02) and use of shunt (RR= 6.1, p= 0.01)., Conclusions: Globally, both the selection of patients and the results obtained adjust to the accepted standards for this type of surgery. The patient s risk profile has had a greater influence on the results than the technique used. The mortality rate has been influenced by the low volume hospitals

The Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S) has been enrolled in a prospective data collection project from patients with bronchogenic carcinoma who underwent thoracotomy in 20 Spanish hospitals from October 1993 to September 1997. In this 4-year period, 2995 patients were registered and demographic, clinical, biological, diagnostic, surgical, pathological and follow-up information collected in a homogeneous way. The main objectives of the Group are to describe the population with lung cancer at the time of diagnosis in Spain; to analyse operative morbi-mortality; and to identify multiple prognostic factors. So far, some preliminary results have already been published concerning the description of the population, the methodology of the Group, the assessment of morbi-mortality, and the validation of the 1997 TNM classification.

Purpose: Long-term therapy of haematology patients has been facilitated by permanent indwelling central venous catheters. We performed a retrospective study to compare the problems occurring with a externalized catheter (Hickman) versus a totally implanted port catheter., Patients and Methods: A total of 171 catheters were placed to 139 haematological patients, 77 patients with Hickman catheters and 94 with totally implanted port catheters. We review our experience in order to identify factors associated with complications., Results: Pneumothorax occurred in one of 171 of the percutaneously placed devices. Other early complications were hematoma 13, and catheter migration out of the vascular tree 8. Late complications included malposition (5.8%), thrombosis (2.9%), septic thrombosis (1.7%) and most notably infection (38.5%). 62 of 77 patients with Hickman catheters developed catheter-related infection (hazard rate infection 7.1/1000 days) compared with 53 of 94 patients with implanted port catheters (hazard rate infection 1.5/1000 days, p < 0.001). Most of infections that occurred were caused by gram-positive organisms but the gram-negative organisms infections resulted in a significantly higher rate of treatment failure and recurrence. A total of 72 catheters were removed of the central line: 36 for infection., Conclusion: We found a significantly increased incidence of catheter-related infection in patients with Hickman catheters. We also observed that the use of intravenous antibiotic prophylaxis prior to catheter insertion did not appear to be beneficial and thrombocytopenia at this moment was a factor in the development of hematoma. The infections due to coagulase-positive staphylococci can be treated successfully without removal of the catheters. However in catheter-related bacteremia due gram-negative organisms there is a chance that the bacteremia will recur if the catheter is not removed.

Objective: To calculate the prevalence of white coat hypertension (WCH) in patients recently diagnosed with light hypertension. To compare their demographic features, cardiovascular risk factors, and the level of early organic effect of WCH versus sustained hypertension, and dippers versus non-dippers., Design: Descriptive, crossover study., Setting: Five urban health centres., Patients: 238 people between 18 and 65 were chosen. After screening, they were diagnosed with light (1993 WHO criteria) or essential hypertension., Measurements and Main Results: Patients received: 24-hour out-patient control of blood pressure (BP), analysis, back of eye and electrocardiogram. WCH was defined as mean daily BP < 139/88 mmHg and mean night-time BP < 123/74 mmHg. Non-dippers were those patients whose mean night-time BP went down from the daytime BP by less than 10%. 39.5% had WCH (33.3-45.7). This was associated with women (49.5%), with lower casual systolic and diastolic BP and with isolated systolic hypertension, p < 0.05. Risk of WCH was 2.14 times greater in women (95% CI, 1.24-3.70). There were no significant differences in the cardiovascular risk or morbidity profile between WCH and sustained HT, or between dippers and non-dippers., Conclusions: WCH is common in patients recently diagnosed with both light and essential hypertension. This makes us think that the use of primary care out-patient monitoring of BP could be efficient in this type of patient. The absence of significant differences between WCH and sustained hypertension, or between dippers and non-dippers, may be due to their hypertension being recent.

Objective: To find the attitude of doctors working in General Medicine and out-patient Traumatology to the prescription of non-steroidal anti-inflammatory drugs (NSAID) and if these attitudes fit quality criteria., Design: Crossover, descriptive study., Setting: General medicine and out-patient traumatology in the inland area of Vizcaya., Participants: A questionnaire was sent to all doctors working in general medicine (146) and out-patient traumatology (19) in the inland area., Measurements and Results: There was a 78.2% final reply rate. The questionnaire had 14 questions and collected the demographic variables and those which referred to the use of NSAIDs and stomach protectors. The prescription criteria for NSAIDs and stomach protectors were taken from a review of the literature before beginning this study. The most frequent risk factors were a previous history of ulcers (83%) and age > 65 (51.2%)., Conclusions: Although a great many doctors attached great importance to the erosive effects of NSAIDs on the stomach, they still use the most damaging drugs on at-risk patients and prescribe stomach protectors whose efficacy is very doubtful. Age is not thought of enough as a risk factor (only half the doctors considered it); the NSAID which were less damaging to the stomach were little used.

Objective: To study the association of dyslipemia with macroangiopathy in patients with type II diabetes mellitus., Design: Descriptive crossover study., Setting: An urban health district with a socially and economically depressed elderly population., Patients: A randomised sample among the diabetics registered in the health district (n = 449)., Measurements and Main Results: Different factors in the lipidic profile were studied, as was the presence of diabetic macroangiopathy and some of the associated risk factors. The following were considered cut-off figures with a predictive value of cardiovascular risk: overall cholesterol >or= 240 mg/dl (40% of the sample), HDL < 35 mg/dl (27%), LDL >or= 160 mg/dl (43%), triglycerides >or= 200 mg/dl (25%), atherogenic index >or= 4.5 (73%) and HDL/LDL balance >or= 0.2 (83%). 85.5% of the diabetics in the sample presented one of the lipidic disorders mentioned above. In the multivariant analysis only hypertriglyceridaemia was associated with a higher prevalence of peripheral vasculopathy., Conclusions: A high percentage of patients with type II DM presented disorders in their lipidic profile. But, unlike the norm in the general population, only hypertriglyceridaemia displayed a statistically significant association with diabetic macroangiopathy. The role of the other dyslipemic factors was limited.

Background: To determine the prevalence of the Borrelia burgdorferi infection in the Soria Province, and the detection of the human disease cases., Methods: By an indirect immunofluorescence technique, we had studied total antibodies (IgG, IgM and IgA) against B. burgdorferi (B 31 strain) in the sera of 298 people (150 men y 148 women) of the Soria Province. The results were considered positive when the titers were same or upper to 1/256. All positive sera were tested for specific IgM antibodies by same method; IgM results were considered positive when the titers were upper to 1/16., Results: 13.1% of the people had positive results (39 sera): 14 for women (9.5%) and 25 for men (16.7%). We detected 14 sera with positive IgM. We demonstrated titers same or upper to 1/256 in all age group, with a major prevalence in the age group between 41 and 50 years (22.6%). In all areas of the Province we detected positive results and in many of this areas the positivity was upper to 30% of the studied sera. 12 persons with positive IgM or high titers of total antibodies presented signs or symptoms of disease in relation with B. burgdorferi infection; 6 persons had alterations of the liver function do not explicable by other etiology., Conclusions: The B. burgdorferi infection present a high prevalence in this Province and a wide geographic distribution, with high endemic areas. We demonstrated patients with symptomatology compatible with Lyme borreliosis, and we wish to emphasize the frequency of alterations of the liver function in this group of people.

Purpose: To evaluate the incidence of CML in Asturias during the period 1972-1986, studying the variations in relation to age, sex and geographical zone., Material and Methods: Information relating to the date of diagnosis, name, age, sex and home address of the 108 cases (65 men and 43 women) diagnosed CML during the period 1972-1986 according to conventional criteria was collected from the hospital records of the region. For the calculations, SADEI demographic data were taken as a reference, comparing the incidence between sexes and geographical zones by means of the CHI2., Results: A rate of incidence of 0.64/100,000 inhabitants/year was obtained, this being 0.8 in men and 0.5 in women (p < 0.05). The rate of incidence increased progressively with age until the 45-59 age group when it was maximum. There were no differences between the three main centres of population Gijón (0.53), Oviedo (0.55) and Avilés (0.69) nor the latter with the rest of the zones in Asturias; nor was three either any difference between coastal towns (0.56) and those of the interior (0.71) (p = NS)., Conclusions: Limited incidence of CML in Asturias without significant differences in its geographical distribution within the region. The incidence, which was higher among males, increased progressively with age until reaching maximum importance in the 45-59 age group.

The influence on family size of the sex of the first children was studied in a sample of 1851 families of students in Sevilla University. Significantly more families limited family size to two or three children when the two or three children were of the same sex than in the opposite case. Significantly more families limited family size to three children when not all the three first children were females. The frequency of families having more than three children is not increased to a larger extent when the three first children are males than in the other cases.