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ASDECO is a R&D project whose main objective is to design a system that allows for the implementation of Adaptive Management for brine discharges from desalination plants into the sea. The project has two phases: to design and to adapt the instrumental system to the characteristics of the brine plume, achieving the required reliability and precision. An information and forecast system has also been constructed to compile and validate the data, as well as to activate the alarm protocols required for the Environmental Impact Declarations. The application of forecast systems will provide the outfall management with the necessary flexibility to adapt to the favourable conditions of the marine environment, maximizing dilution and minimizing brine impact. The system is currently being implemented and tested in the Alicante Channel desalination plant (Alicante, Spain). [ABSTRACT FROM AUTHOR]

(1) Background: Spirometry is useful for diagnosing and monitoring many respiratory diseases. The objectives were: (a) compare maximum expiratory flow (MEF) values with those from international studies, (b) determine if MEF should be evaluated by chronological age and/or maturity, (c) develop reference norms for children, and adolescents. (2) Methods: A cross-sectional study was designed with 3900 subjects ages 6.0 and 17.9 years old. Weight, standing height, sitting height, and MEF were measured. Length of the lower limbs, body mass index (BMI), and age of peak height velocity growth (APHV) were calculated. (3) Results: Values for the curves (p50) for females of all ages from Spain and Italy were higher (92 to 382 (L/min)) than those for females from Arequipa (Peru). Curve values for males from Spain and Italy were greater [70 to 125 (L/min)] than the males studied. MEF values were similar to those of Chilean students ages 6 to 11. However, from 12 to 17 years old, values were lower in males (25 to 55 (L/min)) and in females (23.5 to 90 (L/min)). Correlations between chronological age and MEF in males were from (r = 0.68, R2 = 0.39) and in females from (r = 0.46, R2 = 0.21). Correlations between maturity (APHV) and MEF for males were from (r = 0.66, R2 = 0.44) and for females (r = 0.51, R2 = 0.26). Percentiles were calculated for chronological age and APHV. Conclusion: Differences occurred in MEF when compared with other geographical regions of the world. We determined that maturity may be a more effective indicator for analyzing MEF. Reference values were generated using chronological age and maturity. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: early detection of childhood obesity plays a crucial role in the prevention of diseases during adulthood. At present, the most commonly used screening tool for detecting overweight/obesity in children is the percentile for age of body mass index, although this rate is unable to provide information about fat distribution. An emerging marker of abdominal fat distribution is waist circumference (WC). Objective: the aim of this study was to evaluate the differences between the different diagnostic criteria available to define overweight and obesity in order to establish the optimal WC cut-off values for the Spanish children population. Methods: a cross-sectional study was carried out in 8,241 schoolchildren aged 3 to 12 years from Villanueva de la Cañada (Madrid, Spain). WC (cm), weight (kg) and height (cm) were measured according to the recommendations of the Society for the Advancement of Kineanthropometry (ISAK). The values obtained for the diagnostic criteria (Spanish Orbegozo Foundation (OF), the International Obesity Task Force (IOTF), and the World Health Organization (WHO) were compared using McNemar's test for paired proportions. The kappa coefficient (κ) was used to assess the degree of agreement of the three classifications. We analyzed the validity of body mass index (BMI) and WC using the receiver operating characteristic (ROC) curve analysis. The Youden index was used to determine cut-off values for WC that identify childhood obesity Results: overweight and obesity prevalences were calculated according to the OF, IOTF, and WHO criteria. There was a "substantial" agreement for the overweight and obesity categories between the Spanish criteria and IOTF (κ = 0.636), while agreement was "slight" between the Spanish criteria and those of WHO (κ = 0.198). The estimated cut-off WC criteria ranged from 54.5 to 88.0, varying according to sex and age. Conclusion: the proposed WC cut-off values, stated for the first time in a young Spanish population, are a simple and valid alternative as diagnostic criteria of abdominal obesity. [ABSTRACT FROM AUTHOR]

Objective: To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses., Methods: Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses., Results: Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59-79] vs 73 years [IQR 61-83]; p < .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91-2.24 p < .001) and megadose use with increased survival (OR 0.84 95% CI 0.75-0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32-1.80; p < .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71-0.95; p < .001 and OR 0.80 95% CI 0.65-0.97; p < .001) respectively., Conclusion: There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses., Competing Interests: The authors have declared that no competing interests exist.

Objective: To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP)., Design: Cross-sectional analytical study., Setting: Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses., Participants: 76,797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics., Primary Outcome Measure: Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE., Results: The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99)., Conclusions: A CPE, perceived by PHC nurses as more favourable, and more patient-nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)