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RESUMENEn la actualidad existe una amplia variedad de estilos musicales que incluyen el sintetizador en su pro- ceso de creación. El uso de este instrumento en la industria musical se ha extendido de tal modo que consideramos necesario llevar a cabo una investigación exploratoria para examinar cómo esta ten- dencia se reflejaba en las aulas de educación musical. El objetivo de la investigación se centró, pues, en indagar acerca del conocimiento y el uso pedagógico del sintetizador en los diversos niveles de la educación musical de Cataluña. Para ello, se realizaron entrevistas semiestructuradas a 8 expertos en tecnología y educación musical. La información fue analizada mediante la técnica del análisis temá- tico y los resultados obtenidos revelaron que: (1) las experiencias con el sintetizador en la educación musical son escasas; (2) los motivos por los que el sintetizador no se usa regularmente en la educa- ción musical son variados, destacando la falta de formación del profesorado, la falta de tiempo en los currículos y la falta de materiales didácticos; (3) las propuestas de los expertos para la didáctica del sintetizador muestran puntos de acuerdo y discrepancias, y (4) las opiniones de los expertos muestran la importancia de una miscelánea de temas en torno al sintetizador en el contexto educativo actual, la importancia del autodidactismo en el aprendizaje del sintetizador, las TIC y la música. A partir de este análisis, podemos concluir que (1) es preciso formar al profesorado en cuanto al conocimiento y uso pedagógico del sintetizador, (2) es necesario poner al alcance del profesorado materiales didácticos y orientaciones metodológicas, y (3) el uso apropiado del sintetizador puede dar al alumnado la oportu- nidad de experimentar con sonidos que le son familiares, garantizando que el timbre reciba la misma atención en la educación musical que en la industria musical.

Resumen. En la actualidad existe una amplia variedad de estilos musicales que incluyen el sintetizador en su proceso de creación. El uso de este instrumento en la industria musical se ha extendido de tal modo que consideramos necesario llevar a cabo una investigación exploratoria para examinar cómo esto se reflejaba en las aulas de educación musical. El objetivo de la investigación, pues, se centró en indagar acerca del conocimiento y el uso del sintetizador en los diversos niveles de la educación musical de Cataluña. Para ello, se realizaron entrevistas semiestructuradas a 8 expertos en tecnología y educación musical. La información fue analizada mediante la técnica del análisis temático y los resultados obtenidos revelaron que: (1) las experiencias con el sintetizador en la educación musical son escasas; (2) los motivos por los que el sintetizador no se usa regularmente en la educación musical son variados, destacando la falta de formación del profesorado, la falta de tiempo en los currículos y la falta de materiales didácticos; (3) las propuestas de los expertos para la didáctica del sintetizador muestran puntos de acuerdo y discrepancias, y (4) las opiniones de los expertos muestran la importancia de una miscelánea de temas en torno al contexto educativo actual, el autodidactismo, y las TIC y la música. A partir de este análisis, podemos concluir que (1) es preciso formar al profesorado en cuanto al conocimiento y uso del sintetizador en el aula, (2) es necesario poner al alcance del profesorado materiales didácticos y orientaciones metodológicas para facilitar su implementación en el aula, y (3) el uso apropiado del sintetizador puede dar al alumnado la oportunidad de experimentar con sonidos que le son familiares, contribuyendo a que el timbre reciba en la educación musical la misma atención de la que disfruta en la industria musical.

New information is needed about the potential sources and pathways of trans-Atlantic dust plumes. Such knowledge has important implications for the long-distance transport and survivability of microorganisms. Forward trajectories of trans-Atlantic dust plumes were studied over a 14-year period, between 2008 and 2021 (n =>500,000 trajectories). Two major dust transport patterns emerged from these analyses. First, summer trajectories (June – August) that arrive in the southeastern regions of the United States and the Caribbean basin and travel above the marine boundary layer at an average altitude of 1,600 m. Second, winter trajectories (December – February) that arrive in the Amazon basin and travel within the boundary layer at an average altitude of 660 m. Ambient meteorological conditions such as solar radiation and relative humidity along dust trajectories suggest a more suitable condition for the survivability of microorganisms reaching the Amazon during the winter with a lower mean solar radiation flux of 294 W m-2 and mean relative humidity levels at around 61% as compared to averages of 370 W m-2 solar radiation and 45% relative humidity for summer trajectories intruding the Caribbean basin. Nevertheless, 14% of winter trajectories (4,664 out of 32,352) reaching the Amazon basin face intense precipitation of higher than 30 mm and get potentially removed as compared to 8% of trajectories (2,540 out of 31,826) intruding the Caribbean basin during the summer. Collectively, our results have important implications for the survivability of microorganisms in trans-Atlantic dust plumes and their potential for major incursion events at receptor regions.

[Abstract] Objectives: To report a COVID-19 outbreak among workers and inpatients at a medical ward for especially vulnerable patients. Methods: Descriptive study of a nosocomial COVID-19 outbreak registered in March-April 2020 at medical ward of onco-hematological patients in an Spanish hospital. Confirmed cases were hospitalized patients, healthcare and non-healthcare workers who tested positive by PCR on a nasopharyngeal swab. Results: Twenty-two COVID-19 cases (12 workers and 10 inpatients) were laboratory-confirmed. Initial cases were a healthcare provider and a visitor who tested positive. The median patients age was 73 years (range 62-88). The main reason of admission was haematological in 8 patients and oncologic in 2. All patients followed an immunosuppressive treatment, 5/10 with high-flow oxygen nebulizations. Five patients presented a moderate/serious evolution, and 5 patients died. The mean workers age was 42.1±10.9. One healthworker required Intensive Care Unit admission, and all of them recovered completely. Conclusions: In the hospital setting, close patients surveillance for SARS-CoV-2 is essential, especially in immunosuppressed patients. Replacing nebulizations or high-flow oxygen therapies, when other equivalent options were available, to reduce dispersion, and controlling ventilation ducts, together with hygiene measures and an active follow-up on inpatients, visitors and workers appear to be important in preventing nosocomial outbreaks.

Colorectal cancer (CRC) is the third most common type of tumor and one of the main health problems worldwide, with almost 1.8 million new cases and 881,000 deaths in 2018. This type of cancer basically affects the more developed regions of the world, but in recent years its incidence has increased in other countries too. Early detection and the progress made in treatment have led to increased survival, and this may explain the current downward trend in the developed world, as opposed to the upward trend seen in developing countries. Geographical variability in the rates of CRC and the increase in cases recorded in recent years in some countries, such as Spain, could be related to changes in lifestyle and dietary habits.

Recent improvement in colorectal cancer survival rates, linked to advances in its diagnosis and treatment, highlights the importance of studying the characteristics of the so-called “long-term survivors”. It is especially interesting not only to be able to identify factors associated differently with the short-term or long-term prognosis in colorectal cancer patients, but also with their quality of life and the prevalence of psychological disorders. Likewise, there is great variability in the follow-up strategies, frequency and type of tests that are proposed to be performed after curative surgery for colorectal cancer, and their impact on prognosis is not exactly known. Within the follow-up strategies proposed for these patients, it is important to include aspects related to their psychosocial well-being and their quality of life.

This article describes a project in which contemporary music is studied and created in primary-school classrooms in the presence of a composer. Listening to and analyzing a composer’s works fosters musical creation processes in students, who subsequently present and discuss their works in a meeting with the composer. Finally, the students’ works are performed in public in a concert for children from various participating schools. We describe the project design and offer reflections based on the perspective of one of the participating teachers, as well as enumerate some of the benefits/implications of projects like this.

The impact of an ostomy has a negative influence on sexuality. Healthcare professionals focus the care on surgery, and consider the sexual life is little relevant to the patient recovery. The aim of this systematized review is to give visibility to the sexual problems that ostomy patients have, to know what kind of sexual dysfunction occurs in this patients, to give information to the nursing staff about sexual disturbances and to recommend some resources to restart sexual activity. The research was conducted following de PRISMA guidelines and performed in several databases. Twelve papers were used to perform the systematized review. After ostomy, sexual dysfunction is different in men and women. It is related by the psychological aspects (low self-esteem, body image deterioration, etc.), the physical aspects (type of resection, complications, etc.) and the acceptance by the partner. A personalized sexual education focused on sexual problems that appear in ostomy patients is necessary to implement. In this way, adequate support, information and resources before and after surgery could be given for both, patients and their partners.

BackgroundThe measures used for the diagnosis of biomechanical pathologic disorders are variable. The aim of this study was to determine the concordance between the Clarke angle and the Chippaux-Smirak and Staheli indices in evaluation of the footprints of kidney transplant patients.MethodsAn observational prevalence study was performed in kidney transplant patients in the University Hospital Complex A Coruña from 1981 through 2014. After obtaining patient informed consent and ethics committee approval, sociodemographic (age and sex) and anthropometric (body mass index) variables and comorbidity (Charlson Comorbidity Index score) were assessed for each patient, and a podiatric medical examination was performed of the footprint through a pedigree (Chippaux-Smirak index, Staheli index, and Clarke angle). A descriptive analysis of all of the variables was performed; for agreement, the kappa index and the Bland-Altman method were used.ResultsWe found a predominance of male sex (65.6%) and a high level of overweight (43.3%) in the sample. The highest concordance between the indices studied is presented by the Chippaux-Smirak index, with a kappa index of 0.86 for the left foot and 0.76 for the right foot.ConclusionsHigh agreement was attained among observers in measurements of the footprints of kidney transplant patients.

Aim: To determine the incidence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in children and young people who play federated football. Methods: Prospective study, from October 2020 to January 2021, in players aged 4 to 19 years from federated football clubs in Galicia, Spain (N = 23,845). Outbreaks and cases of SARS-CoV-2 infection were recorded. The cumulative incidence was compared with the incidence registered in Galicia in the same age range. Results: The cumulative incidence was 29.8 cases per 10,000 licenses in 4 months, lower than the incidence registered in the general population for all ages and both sexes (283.7 per 10,000 inhabitants; rate ratio = 9.5). It was higher in January (40.7 per 10,000), coinciding with the population peak. More cases were registered in futsal (42.9 vs 27.5 per 10,000) and competitions with periodic screenings (127.4 vs 9.1 per 10,000). There were 2 outbreaks in 2389 teams (0.08%). Conclusion: The results support the safety of football practice in children and young people with prevention protocols.

Background: The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. Methods: Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. Results: Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. Conclusion: The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive.

Study protocol [Abstract] Background: Improved colorectal cancer (CRC) survival rates have been reported over the last years, with more than half of these patients surviving more than 5 years after the initial diagnosis. Better understanding these so-called long-term survivors could be very useful to further improve their prognosis as well as to detect other problems that may cause a significant deterioration in their health-related quality of life (HRQoL). Cure models provide novel statistical tools to better estimate the long-term survival rate for cancer and to identify characteristics that are differentially associated with a short or long-term prognosis. The aim of this study will be to investigate the long-term prognosis of CRC patients, characterise long-term CRC survivors and their HRQoL, and demonstrate the utility of statistical cure models to analyse survival and other associated factors in these patients. Methods: This is a single-centre, ambispective, observational follow-up study in a cohort of n = 1945 patients with CRC diagnosed between 2006 and 2013. A HRQoL sub-study will be performed in the survivors of a subset of n = 485 CRC patients for which baseline HRQoL data from the time of their diagnosis is already available. Information obtained from interviews and the clinical records for each patient in the cohort is already available in a computerised database from previous studies. This data includes sociodemographic characteristics, family history of cancer, comorbidities, perceived symptoms, tumour characteristics at diagnosis, type of treatment, and diagnosis and treatment delay intervals. For the follow-up, information regarding local recurrences, development of metastases, new tumours, and mortality will be updated using hospital records. The HRQoL for long-term survivors will be assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires. An analysis of global and specific survival (competitive risk models) will be performed. Relative survival will be estimated and mixture cure models will be applied. Finally, HRQoL will be analysed through multivariate regression models. Discussion: We expect the results from this study to help us to more accurately determine the long-term survival of CRC, identify the needs and clinical situation of long-term CRC survivors, and could be used to propose new models of care for the follow-up of CRC patients. This project received a research grant from the Carlos III Institute of Health (Ministry of Science, Innovation and Universities, Spain; reference PI18/01676) which was co-funded with European Union ERDF funds (European Regional Development Fund, “A way to make Europe”). The study has undergone peer-review by the funding body. In addition, the study is also partially supported by the Galician Network for Colorectal Cancer Research (REGICC).

53 year old renal transplanted male with secondary amyloidosis to Crohn´sdisease, sent to Dermatology given the presence of multiple red-purple or hyperkeratotic...Varón de 53 años de edad, trasplantado renal hace 12 años por amiloidosis secundaria a enfermedad de Crohn, a tratamiento diario con 10 mg de prednisona....

[Abstract] Background: measure the efficacy of exhaled carbon monoxide (CO) measurement plus brief advisory sessions to reduce smoking exposure and smoking behaviour in kidney transplant recipients. Methods: Randomized, controlled, open-label clinical trial at a Spanish hospital.Smoking kidney transplant recipients giving their consent to participate were randomized to control (brief advice, n=63) or intervention group (brief advisory session plus measuring exhaled CO, n=59). Measurements: Sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking, drug use, level of dependence and motivation to stop smoking (Fagerström's and Richmond's test) and stage of change (Prochaska and DiClemente's Stages). Efficacy was assessed at 3, 6, 9 and 12 months as: cotinine test, CO levels in exhaled air, nicotine dependence, motivational stages of change, motivation to stop smoking, pattern of tobacco use and smoking cessation rates. Logistic regression models were computed. Results: At 12 months of follow-up, differences were found in exhaled CO between the intervention and control group(6.1±6.8vs.10.2±9.7ppm;p=0.028). Carboxyhemoglobin levels were lower in the intervention group as well as the positive cotinine test (1.2±1.2%vs.2.0±2.4%;p=0.039),(53.4%vs.74.2%). At 12 months, intervention reduces the probability of a positive urine test by 28%. Conclusions: Co-oximetry is a clinically relevant intervention for reduction of tobacco exposure in kidney transplant recipients. Instituto de Salud Carlos III; PI11 /01356

espanolEste articulo presenta una investigacion que se adentra en un instituto situado a las afueras de Terrassa, con una comunidad diversa, de renta media-baja y a traves de la que hacemos patente el desconocimiento de la diversidad cultural presente en el aula. Seremos conscientes del papel que tiene la musica a la hora de promover una necesaria intervencion educativa que fomente el reconocimiento de la diversidad, huyendo de estereotipos y de esencialismos, y que destaque y visualice los elementos comunes. A lo largo del texto, entre otras cuestiones, nos preguntaremos si se incorporan los conocimientos y las experiencias vitales del alumnado y del resto de la comunidad en el aula y nos plantearemos que reflexiones y que propuestas de actuacion pueden emerger como fruto de la investigacion para revertir la situacion. catalaAquest article presenta una recerca que s’endinsa en un institut situat als afores de Terrassa, amb una comunitat diversa, de renda mitjana-baixa i a traves de la qual fem pales el desconeixement de la diversitat cultural present a l’aula. Serem conscients del paper que te la musica a l’hora de promoure una necessaria intervencio educativa que fomenti el reconeixement de la diversitat, fugint d’estereotips i essencialismes, i destaqui i visualitzi els elements comuns. Al llarg del text, entre d’altres questions, ens preguntarem si s’incorporen els coneixements i les experiencies vitals de l’alumnat i de la resta de la comunitat a l’aula i ens plantejarem quines reflexions i propostes d’actuacio poden emergir com a fruit de la recerca per tal de revertir la situacio. EnglishThis article presents the results of research on a secondary school located on the outskirts of the Catalan city of Terrassa. The school serves a diverse local community of low and middle income owners who lack knowledge of the cultural diversity in the classroom. The article considers the role of music in providing an education fostering recognition of diversity, avoiding stereotypes and notions of inalterable difference, and prioritising students’ and families’ common ground. Among other questions, the article asks whether students’ and their families’ knowledge of life and life experiences are given importance in the classroom; it also considers how the findings of the research can be used to rethink and improve classroom models.

OBJECTIVES Extemporaneous or magistral formulation of active pharmaceutical ingredients using traditional compounding techniques is a common practice when no commercial form is available for pediatrics. For this vulnerable group of patients, the formulation must be prepared with the minimum quantity and lowest proportion of excipients approved for pediatrics, avoiding the use of preservatives. Often the vehicles used for these preparations are dilutions of simple syrup with water. The objective of this study is to assess the effectiveness of antimicrobial preservation in simple syrup diluted with aqua conservans (conserved water), without propylene glycol or with a reduced proportion of parabens. METHODS The European Pharmacopoeia test of efficacy of antimicrobial preservation was applied to 5 trial vehicles prepared with simple syrup diluted with water. RESULTS Simple syrup is stable during 14 days. Vehicles prepared with simple syrup diluted with purified water did not meet the microbiological quality criteria, but when they are diluted with water that incorporates propylene glycol and parabens (aqua conservans), then they meet the criteria. In addition, if the water is prepared with parabens and without propylene glycol, the criteria for the dilution are met. Nevertheless, if the dilution is done with water prepared with an insufficient proportion of parabens to act as preservatives, the dilution does not meet the pharmacopoeia microbiological criteria. CONCLUSIONS Dilution of simple syrup (50:50 v/v) to prepare a vehicle for extemporaneous or magistral preparation is microbiologically safe when water with methylparaben and propylparaben is used in a proportion of 0.08% and 0.02% (w/w), respectively, avoiding the use of propylene glycol as a solvent and thus its toxic effects in pediatrics.

The aim of this study was to determine the prevalence of Hallux valgus (HV) and the association between the presence thereof and quality of life, dependence for basic and instrumental activities of daily living and foot function. Prevalence study was carried out in a random population sample (n = 1837) (α = 0.05; Precision = ±2.2%). Informed consent and ethical review board were obtained (code 2008/264). We studied anthropometric variables, Charlson Comorbidity Index, function and state of foot [Foot Function index (FFI), Foot Health Status Questionnaire (FHSQ)], quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). Degree of HV was determined using Manchester scale. Descriptive and multivariate logistic regression analyses were performed. Hence, the prevalence of HV is 39%. Patients with HV are significantly older (64.6 ± 11.7 vs 60.1 ± 12.6 years old). HV prevalence is greater in females (48.1 vs. 28.3%), subjects with flat foot (48.1 vs. 36.1%) or hammer toes (48.2 vs. 30.9%). Moreover, with regard to the presence or not of HV, statistically significant differences were neither noted in the SF-36 questionnaire nor in the Barthel and Lawton Index. For FHSQ and FFI questionnaires, significant differences were observed between patients who presented HV and those who did not. HV is associated with age, gender, flat foot and hammer toes. The SF-36 and Barthel and Lawton questionnaires remained unaltered by the presence of HV. The presence of Hallux valgus was associated with reduced quality of life and increases foot pain, disability and functional limitation.

[Abstract] Background: The measurements used in diagnosing biomechanical pathologies vary greatly. The aim of this study was to determine the concordance between Clarke's angle and Chippaux-Smirak index, and to determine the validity of Clarke's angle using the Chippaux-Smirak index as a reference. Methods: Observational study in a random population sample (n= 1,002) in A Coruña (Spain). After informed patient consent and ethical review approval, a study was conducted of anthropometric variables, Charlson comorbidity score, and podiatric examination (Clarke's angle and Chippaux-Smirak index). Descriptive analysis and multivariate logistic regression were performed. Results: The prevalence of flat feet, using a podoscope, was 19.0% for the left foot and 18.9% for the right foot, increasing with age. The prevalence of flat feet according to the Chippaux-Smirak index or Clarke's angle increases significantly, reaching 62.0% and 29.7% respectively. The concordance (kappa I) between the indices according to age groups varied between 0.25-0.33 (left foot) and 0.21-0.30 (right foot). The intraclass correlation coefficient (ICC) between the Chippaux-Smirak index and Clarke's angle was -0.445 (left foot) and -0.424 (right foot). After adjusting for age, body mass index (BMI), comorbidity score and gender, the only variable with an independent effect to predict discordance was the BMI (OR= 0.969; 95% CI: 0.940-0.998). Conclusion: There is little concordance between the indices studied for the purpose of diagnosing foot arch pathologies. In turn, Clarke's angle has a limited sensitivity in diagnosing flat feet, using the Chippaux-Smirak index as a reference. This discordance decreases with higher BMI values. [Resumen] Introducción: Existe una gran variabilidad en las mediciones para el diagnóstico de la patología biomecánica. El objetivo de este estudio fue determinar la concordancia entre el ángulo de Clarke y el índice de Chippaux-Smirak, para determinar la validez del ángulo de Clarke utilizando como referencia el índice de Chippaux-Smirak. Métodos: Se realizó un estudio observacional en una muestra aleatoriamente seleccionada (n= 1,002) en A Coruña (España). Tras el consentimiento informado del paciente y la aprobación del comité de ética, se estudiaron variables, antropométricas, índice de comorbilidad de Charlson y un examen podológico (ángulo de Clarke, índice de Chippaux-Smirak). Se realizó un estudio descriptivo y un análisis multivariado de regresión logística. Resultados: La prevalencia de pie plano utilizando el podoscopio fue de 19.0%(pie izquierdo) y 18.9%(pie derecho), incrementándose con la edad. La prevalencia de pie plano según el índice ChippauxSmirak o el ángulo de Clarke se incrementan considerablemente llegando a 62.0% y 29.7%. La concordancia (kappa I) entre los índices según grupos de edad oscila entre 0.25-0.33 (pie izquierdo) y 0.210.30 (pie derecho). El coeficiente de correlación intraclase (CCI) entre el índice de Chippaux-Smirak y el ángulo de Clarke es -0.445 (pie izquierdo) y 0.424 (pie derecho). Tras ajustar por edad, índice de masa corporal (IMC), score de comorbilidad y sexo la única variable con un efecto independiente para predecir discordancia es el IMC (OR= 0.969; IC 95%: 0.94-0.998). Conclusiones: La concordancia entre los índices estudiados para el diagnóstico de la patología del arco plantar es reducida. Existe a su vez una reducida sensibilidad del ángulo de Clarke para el diagnóstico de pie plano, utilizando como referencia el índice de Chippaux-Smirak. Esta discordancia disminuye con valores más altos de IMC.

Background and Objectives: Diabetes is a chronic and metabolic disease, considered as an important public health problem. The objective of this study was to determine the prevalence of podiatric pathology in type II diabetic patients. Materials and Methods: An observational descriptive study of prevalence in the endocrinology service of Complexo Hospitalario Universitario A Coru&ntilde, a (CHUAC) (A Coru&ntilde, a-Spain) was carried out (n = 153). Type II diabetic patients included, of legal age who signed the informed consent. Sociodemographic variables were studied (age, sex, body mass index (BMI), smoking habit, alcohol consumption, family history), disease variables (time of evolution of diabetes, treatments, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose), podiatric variables: measurement of the footprint, metatarsal and digital formula, nail, skin, hindfoot and forefoot alterations. The data collection was done in 2018 and the data analysis was carried out in 2019. Results: The patients with type II diabetes had greater age, obesity and arterial hypertension it compared to the general population. Diabetic patients had a higher prevalence of flat feet than the general population (71.2% vs. 20.7%, p &lt, 0.001), with a predominance of normal foot according to the podoscope. The predominant podological pathology was the presence of claw toes (94.8%), followed by dermal (78.4%) and nail (71.9%) alterations, and the Hallux Valgus (66.0%). The Clarke angle and the Chippaux index showed a Kappa concordance index of 0.26 with the type of footprint measured with the podoscope. The Staheli index showed a Kappa index of 0.27 associated with an observed agreement of 54%. Conclusions: This study shows that foot problems continue to be prevalent in subjects with type II diabetes mellitus and for this reason, podiatry is essential in its treatment.

Background: Trauma-induced aortic injuries continue to be an important factor in morbimortality in patients with blunt trauma. Objectives: To determine the characteristics of aortic lesions in patients with closed thoracic trauma and associated thoracic injuries. Methods: Multicenter cohort study conducted during the years 1994 to 2014 in the radiology service in the University Hospital Complex of A Coru&ntilde, a. Patients &gt, 15 years with closed thoracic trauma were included. Sociodemographic and clinical variables were studied in order to determine the lesion cause, location, and degree. Results: We analyzed 232 patients with a mean age of 46.9 &plusmn, 18.7 years, consisting of 81.4% males. The most frequent location was at the level of the isthmus (55.2%). The most frequent causes of injury were traffic accidents followed by falls. Patients with aortic injury had more esophageal, airway, and cardiopericardial lesions. More than 85% of the patients had lung parenchyma and/or chest wall injury, which was more prevalent among those who did not have an aortic lesion. Conclusions: Patients with trauma due to traffic accidents or being run over presented three times more risk of aortic injury than from other causes. Those with an aortic lesion also had a higher frequency of cardiopericardial, airway, and esophageal lesions.

[Resumen] Introducción: La artrosis es la enfermedad osteoarticular con mayor prevalencia en todo el mundo. En los países industrializados, 80 % de la población > 65 años la padece. Objetivos: Determinar la prevalencia de artrosis sintomática en rodilla en una muestra aleatoria poblacional, las variables asociadas y su repercusión en el dolor y funcionalidad. Método: Análisis descriptivo y multivariado de regresión logística realizado en el Centro de Salud de Cambre, A Coruña. Se incluyó una muestra de 707 pacientes. Se estudiaron variables antropométricas, comorbilidad y exploración clínica de rodillas. Para evaluar el dolor y la funcionalidad se utilizaron los cuestionarios validados WOMAC y Lequesne. Resultados: 56.3 % de los pacientes eran mujeres y la media de edad de 61.75 años. La prevalencia de artrosis sintomática en al menos una rodilla fue de 29.3 %. Las personas con artrosis presentaron puntuaciones más altas en las dimensiones dolor, rigidez y capacidad funcional del cuestionario WOMAC (30 ± 35.7, 33.8 ± 40.5 y 25.4 ± 40.1, respectivamente), así como puntuaciones más altas en el cuestionario de Lequesne (9.0 ± 8.8). Conclusiones: Se ha determinado alta prevalencia de personas con artrosis que se modifica con el sexo, la edad y el índice de masa corporal. [Abstract] Introduction: Osteoarthritis is the osteoarticular disease with the highest prevalence worldwide. In industrialized countries, 80% of the population > 65 years suffers from it. Objectives: To determine the prevalence of symptomatic osteoarthritis of the knee in a random population sample, its associated variables and its impact on pain and functionality. Methods: Descriptive and multivariate logistic regression analysis carried out at the Cambre Health Center, A Coruña. A sample of 707 patients was included. Anthropometric variables, comorbidity and clinical examination of the knees were assessed. The validated WOMAC and Lequesne questionnaires were used to assess pain and functionality. Results: 56.3% of the patients were females, and mean age was 61.75 years. The prevalence of symptomatic osteoarthritis in at least one knee was 29.3%. People with osteoarthritis had higher scores in the pain, stiffness and functional capacity dimensions of the WOMAC questionnaire (30.0 ± 35.7, 33.8 ± 40.5 and 25.4 ± 40.1, respectively) and had higher scores in the Lequesne questionnaire as well (9.0 ± 8.8). Conclusions: A high prevalence of people with osteoarthritis has been determined, which is modified with gender, age and body mass index.

Objective To determine the prevalence of onychocryptosis and onychomycosis confirmed by culture in subjects attending a Podiatric University Hospital and to describe their podiatric habits. Method Cross-sectional study of prevalence. The study was carried out at the Clinic University of Podology of A Coruna University (Ferrol, Spain). Review of 1082 clinical histories, of which 170 were selected, persons who had onychocryptosis diagnosed clinically. The presence of onychomycosis confirmed by cultivation, presence of onychocryptosis through clinical diagnosis and a questionnaire was handed out of podologic habits. Results Mean age of the total sample (n = 1082) was 47.9 ± 22.1 years. Prevalence of onychocryptosis was 15.7% (n = 170) with a mean age of 54.1 ± 20.1 years and with a significantly higher affectation in women and people under 65. Prevalence of onychomycosis was 17.6% (n = 30), mean age 59.5 ± 20.5 years with greater involvement in women and people over 65 years. With regard to the questionnaire of habits, the footwear more employee was the closed, cordoned off and heel flat. The majority of the subject came to a podiatrist for the first time; walked approximately 1 hour and their daily activity made of foot with short displacements. Conclusions A high prevalence of onychocryptosis and onychomycosis in people attending Podiatric services has been found. For its part using a type of flat or low heel and who does the care of toenails are shown as predictive variables of onychomycosis.

The relationship between music and mathematics has often been the subject of discussion, both inside and outside the field of education. As part of an exciting project on a European scale, the paper explores the changing contexts in Catalonia (Spain) and England (UK) in relation to the integrated approach to the teaching of music and mathematics. We analyse three areas: academic literature, the curriculum frameworks and publications and resources prepared by and for teachers. Our findings suggest that due to the more favourable attitude towards cross-curricular approaches in education, more progress has been made in England, in terms of developing resources to support an integrated approach to the teaching of music and mathematics, than in Catalonia. Nonetheless, teachers in both locations are very interested in developing these approaches. Although there is a need for further teacher training and support, there is evidence of progress already being made in schools. info:eu-repo/semantics/acceptedVersion

[Abstract] Background: The high prevalence of cardiovascular risk factors among the renal transplant population accounts for increased mortality. The aim of this study is to determine the incidence of cardiovascular events and factors associated with cardiovascular events in these patients. Methods: An observational ambispective follow-up study of renal transplant recipients (n = 2029) in the health district of A Coruña (Spain) during the period 1981-2011 was completed. Competing risk survival analysis methods were applied to estimate the cumulative incidence of developing cardiovascular events over time and to identify which characteristics were associated with the risk of these events. Post-transplant cardiovascular events are defined as the presence of myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances, peripheral vascular disease and cardiovascular disease and death. The cause of death was identified through the medical history and death certificate using ICD9 (390-459, except: 427.5, 435, 446, 459.0). Results: The mean age of patients at the time of transplantation was 47.0 ± 14.2 years; 62% were male. 16.5% had suffered some cardiovascular disease prior to transplantation and 9.7% had suffered a cardiovascular event. The mean follow-up period for the patients with cardiovascular event was 3.5 ± 4.3 years. Applying competing risk methodology, it was observed that the accumulated incidence of the event was 5.0% one year after transplantation, 8.1% after five years, and 11.9% after ten years. After applying multivariate models, the variables with an independent effect for predicting cardiovascular events are: male sex, age of recipient, previous cardiovascular disorders, pre-transplant smoking and post-transplant diabetes. Conclusions: This study makes it possible to determine in kidney transplant patients, taking into account competitive events, the incidence of post-transplant cardiovascular events and the risk factors of these events. Modifiable risk factors are identified, owing to which, changes in said factors would have a bearing of the incidence of events.

BackgroundPodiatric medical abnormalities are highly prevalent, yet few random population studies exist that determine the presence of pathologic abnormalities in the feet, despite their importance. The aim of this study was to determine the prevalence of podiatric medical abnormalities in a random sample population 40 years or older.MethodsAn observational study was conducted of a random sample population (n = 1,002) located in A Coruña, Spain. Anthropometric variables, comorbidity (Charlson score), quality of life (36-item Short-Form Health Survey), and podiatric medical examination findings were studied. A descriptive analysis and multivariate logistic regression were performed.ResultsThe most common diseases were claw toes (69.7%), hallux valgus (38%), and hallux extensus (15.8%), which increased with age and female sex. The most frequent metatarsal formula was index minus (40.9%), followed by index plus minus (35.0%). The most frequent digital formula was Egyptian foot (57.1%), followed by Greek foot (31.4%). In this study, although the presence of podiatric medical abnormalities reduced the probability of enjoying a better quality of life, it did not do so significantly. After taking into account age, sex, comorbidity, body mass index (BMI), and the presence of podiatric medical abnormalities, the variables with an independent effect that modified the physical component of quality of life were sex (female), comorbidity, and BMI.ConclusionsThere was a high prevalence of podiatric medical abnormalities, which increased with age and female sex. Comorbidity, BMI, and sex modified quality of life independently of podiatric medical abnormalities.

Introduction Flat foot is a common deformity in adults. It is characterized by medial rotation and plantar flexion of the talus, eversion of the calcaneus, collapsed medial arch and abduction of the forefoot. Aim The aim of this study was to determine the prevalence of flat foot and its impact on quality of life, dependence, foot pain, disability and functional limitation among random population of 40-year-old and above. Materials and methods A cross-sectional study in a random population sample from Cambre (A Coruna-Spain) (n=835) was performed (α =0.05; Precision=±3.4%). The diagnosis of flat foot was stablished by the study of the footprint obtained with a pedograph. Anthropometric variables were studied, Charlson's Comorbidity Index, function and state of foot (Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ)), quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). A logistic and linear multiple regression analysis was performed. Results The prevalence of flat foot was 26.62%. Patients with flat foot were significantly older (65.73±11.04 vs 61.03±11.45-year-old), showed a higher comorbidity index (0.92±1.49 vs 0.50±0.98), had a greater BMI (31.45±5.55 vs 28.40±4.17) and greater foot size (25.16±1.66 vs 24.82±1.65). The presence of flat foot diminishes the quality of life, as measured by the FHSQ, and foot function, measured by the FFI. The presence of flat foot does not alter the physical and mental dimension of the SF-36 or the degree of dependence. Conclusion Flat foot was associated with age, Charlson's Comorbidity Index, BMI and foot size. The SF-36, Barthel and Lawton questionnaires remained unaltered by the presence of flat foot. The FHSQ and FFI questionnaires did prove to be sensitive to the presence of flat foot in a significant manner.

Resumen basado en el de la publicación Se exponen las características y las aportaciones que supone la incorporación de un músico nativo, el culture bearer, para el aprendizaje de las músicas del mundo. Se define a esta figura se detalla su participación en el aula: preparación de la visita, modalidades de visita, tipos de intervención y función de los docentes con el afán de que esta experiencia sirva para alentar nuevas prácticas en el aula. Biblioteca de Educación del Ministerio de Educación y Formación Profesional; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; biblioteca@mecd.es ESP

There is a current unmet medical need for treatment of leptomeningeal metastases (LMD). To analyze the efficacy and safety of systemic temozolomide (TMZ) for first-line treatment of patients with LMD associated with solid tumors, a phase II, non-randomized, multicenter, prospective study was conducted. The planned duration of treatment was a maximum of six cycles (24 weeks) or until unacceptable toxicity was reported. One cycle of oral TMZ (100 mg/m(2) daily) consisted of one week on treatment/one week off treatment for four weeks. The study was stopped early because of poor accrual. Nineteen patients (median age 51(33-72); 32 % male) were enrolled. The LMD source was breast cancer (53 %) and non-small-cell lung cancer (37 %). Previous treatment was chemotherapy (100 %), surgery 74 %, radiotherapy 79 %, and hormone therapy 42 %. The average last dose of TMZ received by patients was 171 mg and only one patient required dose reduction. Three of 19 patients (15.8 %) had clinical benefit and 16 of 19 patients (84.2 %) progressed. Of the two patients completing the study (six cycles, 24 weeks), one had a partial response and the other stable disease. Median survival was 43 days (95 % CI 28.7-57.3); there were 18 deaths. Median TTP was 28 days (95 % CI 14-42). The most common adverse event was vomiting (52.6 %); nine patients (47.4 %) reported at least one serious adverse event but only one episode of thrombocytopenia was drug related. Median Karnofsky score remained at or above 70 % throughout the study, and was 75 % at the end of the study. First-line TMZ was well tolerated, and did not adversely affect the quality of life of patients with LMD. Future studies are needed to verify the efficacy results of this pilot trial.

Background Research is needed to determine the prevalence and variables associated with the diagnosis of flatfoot, and to evaluate the validity of three footprint analysis methods for diagnosing flatfoot, using clinical diagnosis as a benchmark. Methods We conducted a cross-sectional study of a population-based random sample ≥ 40 years old (n = 1002) in A Coruna, Spain. Anthropometric variables, Charlson's comorbidity score, and podiatric examination (including measurement of Clarke's angle, the Chippaux-Smirak index, and the Staheli index) were used for comparison with a clinical diagnosis method using a podoscope. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Results Prevalence of flatfoot in the left and right footprint, measured using the podoscope, was 19.0% and 18.9%, respectively. Variables independently associated with flatfoot diagnosis were age (OR 1.07), female gender (OR 3.55) and BMI (OR 1.39). The area under the receiver operating characteristic curve (AUC) showed that Clarke's angle is highly accurate in predicting flatfoot (AUC 0.94), followed by the Chippaux-Smirak (AUC 0.83) and Staheli (AUC 0.80) indices. Sensitivity values were 89.8% for Clarke's angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0. Conclusions Age, gender, and BMI were associated with a flatfoot diagnosis. The indices studied are suitable for diagnosing flatfoot in adults, especially Clarke's angle, which is highly accurate for flatfoot diagnosis in this population.

The aim of this study is to assess the usefulness of the Polymerase Chain Reaction (PCR) as an alternative technique to the classic method of diagnosis of dermatophytes. To that end, a fast extraction method has been used, in two steps, and also a multiplex PCR in order to detect dermatophytes and, more in particular, Trichophyton rubrum from DNA extracted out of sick nails and previous tests. As DNA controls we have used human DNA and DNA from a series of dermatophytes and non– dermatophytic fungi. A prospective descriptive study was carried out of cases and controls from our population in Lugo, where a total of 28 nail samples were analyzed separately, both by two PCR and a multiplex format. The comparison between the traditional method of diagnosis in nails (microscopy and culture) and the PCR using DNA directly extracted from the nails shows an excellent concordance between the microscopy and the PCR. In addition, with the study by PCR the number of samples identified with dermatophytes increased from a 20 percent to more than a 40 percent mainly due to the identification of T.rubrum by PCR in positive samples by microscopy but negative in culture. In conclusion, this rapid diagnostic test represents a significant increase in sensitivity in the characterization of the onychomycosis.

Randomized controlled trial [Abstract]Background: The cardiovascular risk in renal transplant patients is increased in patients who continue to smoke after transplantation. The aim of the study is to measure the effectiveness of exhaled carbon monoxide (CO) measurement plus brief advisory sessions, in comparison to brief advice, to reduce smoking exposure and smoking behavior in kidney transplant recipients who smoke. The effectiveness will be measured by: (1) abandonment of smoking, (2) increase in motivation to stop smoking, and (3) reduction in the number of cigarettes smoked per day. Design: a randomized, controlled, open clinical trial with blinded evaluation. Scope: A Coruña Hospital (Spain), reference to renal transplantation in the period 2012-2015. Inclusion criteria: renal transplant patients who smoke in the precontemplation, contemplation or preparation stages according to the Prochaska and DiClemente's Stages of Change model, and who give their consent to participate. Exclusion criteria: smokers attempting to stop smoking, patients with terminal illness or mental disability that prevents them from participating. Randomization: patients will be randomized to the control group (brief advisory session) or the intervention group (brief advisory session plus measuring exhaled CO). The sample target size is n = 112, with 56 patients in each group. Allowing for up to 10 % loss to follow-up, this would provide 80 % power to detect a 13 % difference in attempting to give up smoking outcomes at a two-tailed significance level of 5 %. Measurements: sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking habit, drug use, level of dependence (the Fagerström test), stage of change (Prochaska and DiClemente's Stages of Change model), and motivation to giving up smoking (the Richmond test). Response: the effectiveness will be evaluated every 3, 6, 9 and 12 months as: pattern of tobacco use (self-reported tobacco use), smoking cessation rates, carbon monoxide (CO) levels in exhaled air measured by CO-oximetry, urinary cotinine tests, nicotine dependence (Fagerström test), motivational stages of change (Prochaska and DiClemente's stages) and motivation to stop smoking (the Richmond test). Analysis: descriptive statistics and linear/logistic multiple regression models will be performed. Clinical relevance will be measured as relative risk reduction, absolute risk reduction and the number needed to treat. Ethics: informed consent of the patients and Ethical Review Board was obtained (code 2011/061). Discussion: Tobacco is a modifiable risk factor that increase the risk of morbidity and mortality in kidney transplant recipients. If effectiveness of CO-oximetry is confirmed to reduce tobacco exposure, we would have an intervention that is easy to use, low cost and with great implications about cardiovascular risk prevention in these patients. Instituto de Salud Carlos III; PI11/01356