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OBJECTIVES: To describe the prevalence of healthy vascular aging (HVA), normal vascular aging and early vascular aging (EVA) in a sample of Spanish population without cardiovascular disease. The relationship of vascular aging with lifestyle, cardiovascular risk factors, psychological and inflammatory risk factors is also analyzed. METHODS: A total of 501 participants were recruited (49.70% men, aged 55.90 ± 14.24 years) by random sampling. Vascular aging was defined in three steps: Step 1: participants with vascular damage in carotid arteries or peripheral artery disease were classified as EVA. Step 2: with the percentiles of carotid-to-femoral pulse wave velocity (cfPWV) we used three criteria, first, the 10th and 90th cfPWV percentiles of the population studied by age and sex; second, the 10th and 90th percentiles of the European population reference values and third, the 25th and 75th cfPWV percentiles of the population studied by age and sex. Step 3: participants with hypertension or type 2 diabetes mellitus included in HVA were reclassified as normal vascular aging. Arterial stiffness was assessed with cfPWV using a Sphygmocor device. Physical activity was measured with an accelerometer. Psychological factors, lifestyle and other clinical information were obtained by standard questionnaire. RESULTS: The global prevalence of HVA was 8 and 14% (men 8 and 10%, women 9 and 18%), and 22 and 18% (men 26 and 23%, women 17 and 12%) for EVA, using criteria a and b, respectively. In the logistic regression analysis, vascular aging maintains positive associations with more sedentary time [odds ratio (OR) = 2.37 and 4.51], having triglycerides above 150 mg/dl (OR = 6.55 and 4.06), abdominal obesity (OR = 2.73 and 2.90), increased uric acid (OR = 4.63 and 2.98) and insulin resistance index homeostatic model assessment (OR = 4.05 and 6.78), and a negative association with less physical activity (OR = 0.29 and 0.28) using criteria a and b, respectively. CONCLUSION: One in 10 has HVA and one in five EVA. The prevalence of EVA is higher in men. Study results suggest that preventive strategies aimed at increasing physical activity, reducing sedentary time and decreasing obesity and insulin resistance improve vascular aging.

Introduction: Our aims were to investigate the adherence to national guidelines of initial antiretroviral therapy (ART) in the Spanish multicenter CoRIS cohort during the years 2010-2015, to identify the reasons for the prescription of nonrecommended treatments, and to explore the role of institutional constraints to guideline compliance. Methods: ART regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Physicians were asked the reasons for prescribing nonrecommended regimens. Factors associated with the prescription of non recommended regimens were assessed using multivariable logistic regression. Results: During the study period, 586 (10.7%) of 5479 patients who started ART were given a regimen not recommended in the guidelines. The most frequent reasons for prescribing nonrecommended regimens were: enrolment in clinical trials (43.3%), comorbidities and/or interactions (10.2%), pregnancy (8.7%), and cost (7.7%). Among 37 participating centers, 16 (43%), treating 3561 patients, reported limitations related with the cost of ART, and 20 (54%), treating 1365 patients, reported restrictions for prescribing at least one recommended antiretroviral. In multivariable analysis, a higher risk of receiving nonrecommended regimens was associated with male gender, HIV acquisition by heterosexual transmission, low viral loads, initiation of treatment during the years 2011 to 2015, and initiation of treatment in a center with restricted access to at least one antiretroviral drug. Conclusions: Compliance to clinical guidelines was high. A high proportion of centres reported cost limitations for ART or restricted access to at least one recommended antiretroviral drug, with a significant impact on the choice of initial regimens. (C) 2019 Elsevier Espafia, S.L.U. and Sociedad Espaliola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

Coastal deltas are home for over 500 million people globally, and they have been identified as one of the most vulnerable coastal environments during the 21st century. They are susceptible to multiple climatic (e.g., sea-level rise, storm surges, change in temperature and precipitation) and socio-economic (e.g., human-induced subsidence, population and urbanisation changes, GDP growth) drivers of change. These drivers also operate at multiple scales, ranging from local to global and short- to long-term. This highlights the complex challenges deltas face in terms of both their long-term sustainability as well as the well-being of their residents and the health of ecosystems that support the livelihood of large (often very poor) population under uncertain changing conditions. A holistic understanding of these challenges and the potential impacts of future climate and socio-economic changes is central for devising robust adaptation policies. Scenario analysis has long been identified as a strategic management tool to explore future climate change and its impacts for supporting robust decision-making under uncertainty. This research presents the overall scenario framework, methodology, and processes adopted for the development of scenarios in the DECCMA1 project. DECCMA is analysing the future of three deltas in South Asia and West Africa: (i) the Ganges-Brahmaputra-Meghna (GBM) delta (Bangladesh/India), (ii) the Mahanadi delta (India), and (iii) the Volta delta (Ghana). This includes comparisons between these three deltas. Hence, the scenario framework comprises a multi-scale hybrid approach, with six levels of scenario considerations: (i) global (climate change, e.g., sea-level rise, temperature change; and socio-economic assumptions, e.g., population and urbanisation changes, GDP growth); (ii) regional catchments (e.g., change in river flow), (iii) regional seas (e.g., fisheries), (iv) regional politics (e.g., transboundary issues), (v) national (e.g., socio-economic factors), and (vi) delta-scale (e.g., future adaptation and migration policies) scenarios. The framework includes and combines expert-based and participatory approaches and provides improved specification of the role of scenarios to analyse the future state of adaptation and migration across the three deltas. It facilitates the development of appropriate and consistent endogenous and exogenous scenario futures: (i) at the delta-scale, (ii) across all deltas, and (iii) with wider climate change, environmental change, and adaptation & migration research.

Background: Postoperative blood loss in patients after total knee arthroplasty may cause local and systemic complications and influence clinical outcome. The aim of this study was to assess whether fibrin glue or tranexamic acid reduced blood loss compared with routine hemostasis in patients undergoing total knee arthroplasty. Methods: A randomized, single-center, parallel, open clinical trial was performed in adult patients undergoing primary total knee arthroplasty. Patients were divided into four groups. Group 1 received fibrin glue manufactured by the Blood and Tissue Bank of Catalonia, Group 2 received Tissucol (fibrinogen and thrombin), Group 3 received intravenous tranexamic acid, and Group 4 (control) had no treatment other than routine hemostasis. The primary outcome was total blood loss collected in drains after surgery. Secondary outcomes were the calculated hidden blood loss, transfusion rate, preoperative and postoperative hemoglobin, number of blood units transfused, adverse events, and mortality. Results: One hundred and seventy-two patients were included. The mean total blood loss (and standard deviation) collected in drains was 553.9+/-321.5 mL for Group 1,567.8+/-299.3 mL for Group 2, 244.1+/-223.4 mL for Group 3, and 563.5+/-269.7 mL for Group 4. In comparison with the control group, Group 3 had significantly lower total blood loss (p < 0.001), but it was not significantly lover in Groups 1 and 2. The overall rate of patients who had a blood transfusion was 21.1% (thirty-five of 166 patients analyzed per protocol). Two patients required transfusion in Group 3 compared with twelve patients in Group 4 (p = 0.015). No significant difference was observed between the two fibrin glue groups and the control group with regard to the need for transfusion. There was no difference between groups with regard to the percentage of adverse events. Conclusions: Neither type of fibrin glue was more effective than routine hemostasis in reducing postoperative bleeding and transfusion requirements, and we no longer use them. However, this trial supports findings from previous studies showing that intravenous tranexamic acid can decrease postoperative blood loss.