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This article presents the timber marks found on one of the Ses Llumetes shipwreck's frames (1st century AD; Mallorca, Spain). From this find, a review over time of this type of archaeological evidence is developed, comparing the use, meaning and interpretations in the different comparative contexts found in the Mediterranean. Timber marks on vessels are particularly rare to find in underwater archaeological context, especially for the Roman Period. This makes the discovery of the Ses Llumetes shipwreck an important contribution to the existing examples. The location of a mark in a specific location in a vessel can mean that its interpretation can vary, and also shows relevant details about the people behind this action. In particular, the analysis of the tria nomina represented by the Ses Llumetes mark has proved to be especially important for investigating where the ship might have been built. [ABSTRACT FROM AUTHOR]

In Spain and other Mediterranean countries, significant quantities of semi-solid olive mill waste are generated, which should be preferentially applied to agricultural soils to close nutrient cycles. However, two-phase olive mill waste (termed alperujo in Spanish) is known to pose risks to soil quality and plant production when applied to soil in large quantities. Alperujo has high contents of polyphenol substances, which can inhibit microbial growth and are also phytotoxic in nature. However, when applied in appropriate quantities and following specific methods, it is possible that the practice may not pose any risks, and this requires evaluation. As a waste management option, direct application of alperujo can supply plant nutrients and organic matter to degradation-prone Mediterranean soils. In order to validate this circular economy fertilization and soil protection strategy, an 18-month field experiment was undertaken, applying moderate quantities of alperujo on permanent crop groves throughout the Spanish region of Valencia. Eleven experimental parcels with permanent crops managed by farmers were identified to test two scenarios: a single application of 10 t/ha, and a second application of 10 t/ha after 10 months. Soil chemical parameters were assessed at 0, 6, 10, and 18 months. Soil organic carbon, total Kjeldahl nitrogen, pH, electrical conductivity, nitrates, and polyphenol contents were modified by alperujo application, but these effects were highly transient in nature, with generally no lasting effects after 4–6 months for either application scenario. Also, qualitative evaluations carried out by farmers revealed few effects, although some reductions in erosive processes and improvements in plant vigor were noted. As such, based on the measured parameters, it is concluded that the direct soil application of alperujo olive mill wastes at low application rates did not lead to any lasting detrimental effects on soil quality or compromise the productivity of permanent crops in this Mediterranean region. [ABSTRACT FROM AUTHOR]

All workers have the right to perform their job duties under the best possible conditions, safeguarded from the harm which the execution of their duties may entail. In addition, employers have the obligation to guarantee this right to health, implementing a preventive system which assures the safety and health of the workers under their charge. Information for workers is a fundamental part of any occupational health and safety management system in companies. The aim of this study was to analyze the influence in which preventive information has on certain variables relating to workers' occupational health and safety and by sector of activity. This study was conducted with data collected through the 6th National Survey on Working Conditions in 2007 in Spain. The data included a random sample of 11,054 people from a working population of 20,476,900. To conduct the study a probabilistic model was created using Bayesian networks including the following variables: preventive information, sector, psychological symptoms, physical symptoms and accidents at work. The results indicated the importance of information in companies' preventive activity and the difference existing in its application across the various sectors, with Industry being the sector in which information for workers has the most positive impact. (Contains 5 tables and 3 figures.)

Frailty is a geriatric syndrome that leads to increased risk of hospitalization, disability, and death. The effect of plant-based diets defined by the quality of their plant foods is unclear. Our objective is to study the association between two plant-based diet indices and the occurrence of frailty among community-dwelling older adults in Spain. We analyzed data from 1880 individuals aged ≥ 60 years from the Spanish Seniors ENRICA-1 cohort. We used a validated diet history to build two indices: (a) the healthful Plant-based Diet Index (hPDI) where healthy plant foods received positive scores, whereas less-healthy plant foods and animal foods received reverse scores; and (b) the unhealthful Plant-based Diet Index (uPDI), with positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods. Incident frailty was defined with the Fried phenotype. Study associations were summarized with odds ratios (OR) and 95% confidence intervals (CI) obtained from multivariable logistic models. After 3.3 years of follow-up, 136 incident frailty cases were ascertained. Comparing the highest vs. the lowest tertile of adherence, the OR [95% CI] for frailty was 0.43 (0.25–0.74; p-trend =.003) for the hPDI, and 2.89 (1.73–4.84; p-trend <.001) for the uPDI. Higher consumption of healthy plant foods was inversely associated with frailty (0.39 [0.23–0.66; p-trend < 0.001]); higher consumption of unhealthy plant foods was associated with higher frailty risk (2.40 [1.23–4.71; p-trend =.01]). In older adults, the hPDI was associated with lower risk of frailty, while the opposite was found for the uPDI. [ABSTRACT FROM AUTHOR]

Background: Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital‐acquired influenza (HAI) to those with community‐acquired influenza (CAI) and analyzed risk factors associated with complications. Methods: This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012‐2013 to 2015‐2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI. Results: Overall, 666 patients with laboratory‐confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty‐five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P =.003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors. Conclusions: Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications. [ABSTRACT FROM AUTHOR]

Intensive pig farming is challenged by high environmental impacts and dependence on outsourced inputs. Circular feeding strategies to improve nutrient cycling and livestock diversity have emerged as pathways to improve the sustainability. This study explored the potential of increasing feed circularity and introducing sheep to improve the sustainability of a typical pig fattening region in the semiarid zone of Spain. Three alternative circular scenarios were designed to relocate pig feed production while reintroducing sheep production. These scenarios were then compared to a business-as-usual (BAU) scenario. The feeding strategies scenarios differed in crude protein (CP) and in-feed amino acid (AA) supplementation for pigs (CircHigh, high CP with low AA; CircLow, low CP with high AA; CircNoAA, low CP without AA) and included grazing sheep to use crop residues, alfalfa and temporary vetch-oat pastures on fallow land. Yearly feed requirements for pigs were planned, and were met with cereal grains, oilseeds, legumes, rice bran and chopped alfalfa hay. Sheep carrying capacity was estimated from available forage sources. Indicators in five sustainability dimensions were considered: economic performance, landscape mosaic, livestock diversity, nitrogen (N) cycling, and feed-food competition. Outsourced (BAU) pig feeding without sheep had low scores for indicators in all five dimensions. The feeding strategy for pigs strongly influenced the land area required to produce feed as well as N cycling. Only the CircLow scenario could feed the current pig stocks in the region with the arable land available. The CircHigh strategy combined with grazing sheep scored highest for most of the dimensions, except for feed-food competition indicators. The CircLow strategy had good scores for most of the dimensions, except for N cycling indicators, whose scores decreased due to the lower N content of slurry. The CircNoAA strategy increased the use of rice bran as a food coproduct and decreased N surplus, but also impaired the economic performance (land productivity and feeding costs). Although the CircLow strategy required less land area to grow legumes, it resulted in a slightly higher crop diversity and a higher sheep carrying capacity when sowing temporary pastures. N cycling and overall sustainability of regions with intensive livestock production was improved through feed circularity, that included reducing CP with high in-feed AA, and livestock diversity, by reintroducing sheep as complementary livestock that can graze crop residues and temporary pastures. These results may help to inform future rural policies to help upscale more sustainable practices in intensive pig farming regions. [Display omitted] • Circular scenarios to feed pigs and introduce sheep were assessed at the regional level. • The CircHigh diet (high crude protein (CP) with low in-feed amino acid (AA)) ranked highly, except for feed-food competition. • The CircLow diet (low CP with high in-feed AA) required less legume area but a larger number of feed crops. • The CircLow diet also enabled a higher sheep carrying capacity when sowing temporary pastures. • The CircNoAA diet (low CP without in-feed AA) reduced land productivity and livestock nitrogen overload. [ABSTRACT FROM AUTHOR]

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

Background: HER2 amplification has been identified in 2-3% of patients with colorectal cancer, although there are currently no approved HER2-targeted therapies for colorectal cancer. We aimed to study the antitumour activity and safety of trastuzumab deruxtecan (an antibody-drug conjugate of humanised anti-HER2 antibody with topoisomerase I inhibitor payloads) in patients with HER2-expressing metastatic colorectal cancer.Methods: DESTINY-CRC01 is an open-label, phase 2 study that recruited patients from 25 clinics and hospitals in Italy, Japan, Spain, the UK, and the USA. Eligible patients had centrally confirmed HER2-expressing metastatic colorectal cancer that had progressed on two or more previous regimens (HER2-targeted therapies other than trastuzumab deruxtecan permitted), were aged 18 years or older (≥20 years in Japan), had an Eastern Cooperative Oncology Group score of 0 or 1, and had RAS and BRAFV600E wild-type tumours. Patients were enrolled into one of three cohorts by HER2 expression level: cohort A (HER2-positive, immunohistochemistry [IHC] 3+ or IHC2+ and in-situ hybridisation [ISH]-positive), cohort B (IHC2+ and ISH-negative), or cohort C (IHC1+). Patients received 6·4 mg/kg trastuzumab deruxtecan intravenously every 3 weeks until disease progression, unacceptable adverse events, withdrawal of consent, or death. The primary endpoint was confirmed objective response rate in cohort A by independent central review which was assessed in the full analysis set and safety was assessed in the safety analysis set. Both the full analysis set and the safety analysis set included all patients who received one or more doses of trastuzumab deruxtecan. This ongoing trial is registered with ClinicalTrials.gov, number NCT03384940.Findings: Between Feb 23, 2018, and July 3, 2019, 78 patients were enrolled in the study (53 in cohort A, seven in cohort B, and 18 in cohort C), all of whom received at least one dose of study drug. For the 53 (68%) patients with HER2-positive tumours (cohort A), a confirmed objective response was reported in 24 (45·3%, 95% CI 31·6-59·6) patients after a median follow-up of 27·1 weeks (IQR 19·3-40·1). Grade 3 or worse treatment-emergent adverse events that occurred in at least 10% of all participants were decreased neutrophil count (17 [22%] of 78) and anaemia (11 [14%]). Five patients (6%) had adjudicated interstitial lung disease or pneumonitis (two grade 2; one grade 3; two grade 5, the only treatment-related deaths).Interpretation: Trastuzumab deruxtecan showed promising and durable activity in HER2-positive metastatic colorectal cancer refractory to standard treatment, with a safety profile consistent with that reported in previous trastuzumab deruxtecan trials. Interstitial lung disease and pneumonitis are important risks requiring careful monitoring and prompt intervention.Funding: Daiichi Sankyo. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, only one study has examined the association between glucose variability (GV) and mortality in the elderly population with diabetes. GV was assessed by HbA1c, and a J-shaped curve was observed in the relationship between HbA1c thresholds and mortality. No study of GV was conducted during the COVID-19 pandemic and its lockdown. This study aims to evaluate whether GV is an independent predictor of all-cause mortality in patients aged 75 years or older with and without COVID-19 who were followed during the first year of the COVID-19 pandemic and its lockdown measures., Methods: This was a retrospective cohort study of 407,492 patients from the AGED-MADRID dataset aged 83.5 (SD 5.8) years; 63.2% were women, and 29.3% had diabetes. GV was measured by the coefficient of variation of fasting plasma glucose (CV-FPG) over 6 years of follow-up (2015-2020). The outcome measure was all-cause mortality in 2020. Four models of logistic regression were performed, from simple (age, sex) to fully adjusted, to assess the effect of CV-FPG on all-cause mortality., Results: During follow-up, 34,925 patients died (14,999 women and 19,926 men), with an all-cause mortality rate of 822.3 per 10,000 person-years (95% confidence interval (CI), 813.7 to 822.3) (739 per 10,000; 95% CI 728.7 to 739.0 in women and 967.1 per 10,000; 95% CI 951.7 to 967.2 in men). The highest quartile of CV-FPG was significantly more common in the deceased group (40.1% vs. 23.6%; p < 0.001). In the fully adjusted model including dementia (Alzheimer's disease) and basal FPG, the odds ratio for mortality ranged from 1.88 to 2.06 in patients with T2DM and from 2.30 to 2.61 in patients with normoglycaemia, according to different sensitivity analyses., Conclusions: GV has clear implications for clinical practice, as its assessment as a risk prediction tool should be included in the routine follow-up of the elderly and in a comprehensive geriatric assessment. Electronic health records can incorporate tools that allow its calculation, and with this information, clinicians will have a broader view of the medium- and long-term prognosis of their patients., (© 2024. The Author(s).)

Objective: Functional assessment is part of geriatric assessment. How it is performed in hospital Emergency Departments (ED) is poorly understood, let alone its prognostic value. The aim of this paper was to investigate whether baseline disability to perform basic activities of daily living (BADL) was an independent prognostic factor for death after the index visit to the ED during the first wave of the COVID-19 pandemic and whether it had a different impact on patients with and without diagnosis of COVID-19., Methods: A retrospective observational study of the EDEN-Covid (Emergency Department and Elder Needs during COVID) cohort was carried out, consisting of all patients aged ≥65 years seen in 52 Spanish EDs selected by chance during 7 consecutive days (30/3/2020 to 5/4/2020). Demographic, clinical, functional, mental and social variables were analyzed. Dependence was categorized with the Barthel index (BI) as independent (BI=100), mild-moderate dependence (100>BI>60) and severe-total dependence (BI<60), and their crude and adjusted association was evaluated with mortality at 30, 180 and 365 days using COX proportional hazards models., Results: Of 9,770 enrolled patients with a mean age of 79 years, 51% were men, 6,305 (64.53%) were independent, 2,340 (24%) had mild-moderate dependence, and 1,125 (11.5%) severe-total dependence. The number of deaths at 30 days in these three groups was 500 (7.9%), 521 (22.3%) and 378 (33.6%), respectively; at 180 days it was 757 (12%), 725 (30.9%) and 526 (46.8%); and at 365 days 954 (15.1%), 891 (38.1%) and 611 (54.3%). In relation to independent patients, the adjusted risks (hazard ratio) of dying within 30 days associated with mild-moderate and severe-total dependency were 1.91 (95% CI: 1.66-2.19) and 2.51. (2.11-2.98); at 180 days they were 1.88 (1.68-2.11) and 2.64 (2.28-3.05); and at 365 days they were 1.82 (1.64-2.02) and 2.47 (2.17-2.82). This negative impact of dependency on mortality was greater in patients diagnosed with COVID-19 than in non-COVID-19 (p interaction at 30, 180 and 365 days of 0.36, 0.05 and 0.04)., Conclusions: The functional dependence of older patients who attend Spanish EDs during the first wave of the pandemic is associated with mortality at 30, 180 and 365 days, and this risk is significantly higher in patients treated for COVID-19.

Background: Growth Differentiation Factor 15 (GDF-15) is a marker of inflammation and oxidative stress that has been associated with multiple age-related chronic diseases. Since lifestyle is key for preventing these adverse health outcomes, we examined the association between a Mediterranean lifestyle and GDF-15 serum concentrations in Spanish older adults., Methods: We used cross-sectional data from 2502 older adults participating in the Seniors ENRICA-2 cohort. Adherence to the Mediterranean lifestyle was assessed with the 27-item MEDLIFE index, divided into three blocks: 1) "Mediterranean food consumption, 2) Mediterranean dietary habits, 3) Physical activity, rest, social habits, and conviviality". Analyses of the association between the MEFLIFE index and GDF-15 concentrations were performed using multivariable linear regression models adjusting for the main potential confounders., Results: The MEDLIFE index was inversely associated with GDF-15. Compared with participants in the lowest quartile of the MEDLIFE score, GDF-15 mean percentage differences (95% CI) were -3.0% (-8.0, 2.3) for the second quartile, -8.7% (-13.0, -4.1) for the third quartile, and -10.1% (-15.0, -4.9) for the fourth quartile (p-trend<0.001). Block 3 of MEDLIFE, and particularly doing sufficient physical activity, adequate sleep duration, and participating in collective sports, was individually linked to lower concentrations of GDF-15. Results remained similar after excluding participants with cardiovascular disease, type 2 diabetes, or obesity., Conclusions: A Mediterranean lifestyle was associated with reduced levels of GDF-15, suggesting that a combination of multiple lifestyles may be an integral approach to reduce chronic inflammation and disease burden in older adults., Competing Interests: Declaration of competing interest Authors declare that they have no competing interests., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: The goal of this study was to identify and analyze the 100 most frequently cited journal articles pertaining to the field of pediatric emergency medicine (PEM) and published in emergency medicine (EM) peer-reviewed literature., Methods: The 3 databases, Scopus Library, Google Scholar, and Web of Science, were subjected to a search by topic, keyword, and publication journal to identify the 100 most frequently cited articles addressing PEM issues in the EM literature. Our search included articles published beginning in 1983 and ending in 2016. Median citation frequency, study topics within the specialty of PEM, years of publication, and countries of origin were each compiled and analyzed. Mean citation frequencies were used to rank the articles, which accounted for differences in the results among the 3 databases. Once organized into a list of the 100 most often cited articles in PEM, those with an outcome of the same mean citation frequency were ranked in alphabetical order, according to the initial letter of last name of the first author of the publication., Results: A ranking was created of the 100 most frequently cited articles in pediatric emergency medicine by the mean number of citations. Citation counts ranged from a high of 249 to a low of 71, with a median frequency of 101. The United States had 92 articles on the list, whereas the remainder was comprised of the following countries: Australia (3), Canada (3), Germany (1), and Spain (1). The most common topic areas (and their numbers) noted were related to resuscitation (23) and anesthesia (22). The most frequently cited 100 articles were all published between the years 1983 and 2010. Top publication years (and number of articles) included 2000 (11), 2002 (8), and 2003 (8). The years ranging from 1993 to 2005 covered 69% of published articles. Journals of publications (and article counts) were Annals of Emergency Medicine (69), Pediatric Emergency Care (15), Academic Emergency Medicine (12), and Resuscitation (4)., Conclusions: This analysis provides a review of citation frequency of top-cited PEM articles published in EM journals. This determines the influence of these PEM publications on the EM specialty. The importance of education on resuscitation and anesthesia topics in PEM was evident. Most of the articles were published more than 10 to 15 years ago, indicating that they could be considered landmarks in the subspecialty of PEM. This signifies their importance to other authors in this field, who chose to cite them as having created a significant impact on their own publications., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.)

Although older adults are the fastest-growing age group among cardiovascular patients, nonagenarians with ST-segment elevation myocardial infarction (STEMI) are under-represented in clinical trials. The aims of this study are to analyze the clinical presentation and outcomes of nonagenarian patients presenting with STEMI and to compare in-hospital and 1-year clinical outcomes between those treated with optimal medical treatment alone and those receiving primary percutaneous coronary intervention (pPCI). We included all consecutive nonagenarians presenting with STEMI admitted in 2 academic centers between 2006 and 2018. There were no exclusion criteria. All-cause mortality was assessed in-hospital and at 1-year follow-up. In total, 167 patients (mean age 91.9 ± 0.17 years; 60% females) were included. Emergent catheterization was performed in 60% of our patients, and pPCI was performed in 50% (n = 83). Overall mortality was 22% in-hospital and 41% at 1-year follow-up. The pPCI group had lower mortality than the medical treatment group: 12% versus 32% in-hospital (p <0.01) and 26% versus 45% at 1-year follow-up (p <0.01), respectively. Multivariable analysis identified 4 independent predictors of all-cause mortality at 1 year: mechanical complications (adjusted odds ratio [OR] 9.25, p <0.01), Killip class III/IV (adjusted OR 4.22, p <0.01), serum creatinine at admission (mg/dl; adjusted OR 1.8, p <0.01), and pPCI (adjusted OR 0.52; p <0.05). In conclusion, STEMI in nonagenarians is becoming increasingly common. pPCI may be the preferred strategy in this high-risk cohort when a high grade of disability is not present. Hemodynamic compromise, the presence of complications related to myocardial infarction, renal impairment, and early revascularization may be related to prognosis in these patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Chronic kidney disease (CKD) has considerable effects on the quality of life of patients, impairing everyday activities and leading to lifestyle changes, as well as affecting body image and intimate relationships. Our aim was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding body changes and sexuality. A qualitative phenomenological study exploring how 18 female patients, treated at the dialysis unit of a Spanish hospital, perceived their sexuality and intimate relationships. Data were collected using in-depth interviews, researcher field notes, and patients' personal letters. A thematic analysis was performed. Four main themes arose from the data describing the experience of how CKD impacts body changes and sexuality: (a) Accepting body changes, (b) The catheter, the fistula, and body image, (c) Experiencing a different sexuality, and (d) The catheter, the fistula, and sexuality. Patients experienced changes in their body, perceiving it as being bloated or deformed, together with overall decline. The catheter and/or the fistula triggered changes in the way the women dress in an attempt to hide port sites. Women experience sexuality changes, affecting sexual desire and satisfaction. The presence of catheters was found to be the most cumbersome during sexual acts.

Objective: To develop a new scaled GHQ version (GHQ-28) for use in Primary Care in Spain., Design: Principal components analysis of the parental version (GHQ-60) with subsequent selection of 7 items with higher loadings for the first 4 components. SITE: Three Primary Care Centres in the metropolitan area of Bilbao., Participants: A total of 202 patients coming from a prior study on frequent visits to Primary Care clinics., Main Measurements: Comparison between the new and the authorised version of GHQ-28 in discriminating between psychiatric and non-psychiatric cases, diagnosed independently by psychiatric interview., Results: Whereas the structure of two scales was similar to that described previously, the other two scales showed higher variability with the inclusion of new items and a combination of others previously ascribed to different measurement constructs. No significant difference (P=.63) was observed between both versions regarding their discriminant validity., Conclusions: The most stable GHQ-28 scales were social dysfunction and depression. The variability found among the other scales could be explained by the non-specificity of psychiatric symptoms presented in Primary Care., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)