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The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures.The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC.The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%.Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.El 14 de marzo de 2020 España declaró el estado de alarma por la pandemia por COVID-19 incluyendo medidas de confinamiento. El objetivo es describir el proceso de desescalada de estas medidas.Un plan de transición hacia una nueva normalidad, del 28 de abril, incluía 4 fases secuenciales incrementando progresivamente las actividades socioeconómicas y la movilidad. Concomitantemente, se implementó una nueva estrategia de diagnóstico precoz, vigilancia y control. Se estableció un mecanismo de decisión bilateral entre Gobierno central y comunidades autónomas (CCAA), guiado por un panel de indicadores cualitativos y cuantitativos de la situación epidemiológica y las capacidades básicas. Las unidades territoriales evaluadas comprendían desde zonas básicas de salud hasta CCAA.El proceso se extendió del 4 de mayo al 21 de junio y se asoció a planes de refuerzo de las capacidades en las CCAA. La incidencia disminuyó de una mediana inicial de 7,4 por 100.000 en 7 días a 2,5 al final del proceso. La mediana de pruebas PCR aumentó del 53% al 89% de los casos sospechosos, y la capacidad total de 4,5 a 9,8 pruebas semanales por 1.000 habitantes; la positividad disminuyó del 3,5% al 1,8%. La mediana de casos con contactos trazados aumentó del 82% al 100%.La recogida y análisis sistemático de información y el diálogo interterritorial logaron un adecuado control del proceso. La situación epidemiológica mejoró, pero sobre todo, se aumentaron las capacidades, en todo el país y con criterios comunes, cuyo mantenimiento y refuerzo fue clave en olas sucesivas.

Background: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for Acute Respiratory Infection (ARI) surveillance in Primary care, and a network of sentinel hospitals for Severe ARI (SARI) surveillance in hospitals. Methods: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 VE against hospitalization, by age group, vaccine type, time since vaccination and SARS-CoV-2 variant. Results: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. Conclusions: The SiVIRA surveillance system, with a network of sentinel hospitals in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations, monitor the circulation of SARS-CoV-2 and other respiratory viruses, and provide data to measure the effectiveness of COVID-19 vaccination in the population under surveillance. Our results add to evidence of high VE of mRNA vaccines against severe COVID-19 and waning protection with time since vaccination.

Critical micelle concentration (CMC) is the main chemical–physical parameter to be determined for pure surfactants for their characterization in terms of surface activity and self-assembled aggregation. The CMC values can be calculated from different techniques (e.g., tensiometry, conductivity, fluorescence spectroscopy), able to follow the variation of a physical property with surfactant concentrations. Different mathematical approaches have been applied for the determination of CMC values from the raw experimental data. Most of them are independent of the operator, despite not all of the fitting procedures employed so far can be applied in all techniques. In this experimental work, the second derivative of the experimental data has been proposed as a unique approach to determine the CMC values from different techniques (tensiometry, conductimetry, densimetry, spectrofluorimetry, and high-resolution ultrasound spectroscopy). To this end, the CMC values of five different surfactants, specifically three anionic (sodium dodecyl sulfate, sodium deoxycolate, and N-lauroyl sarcosinate) and two nonionic, such as polyethylene glycol ester surfactants [polyethylenglicol (8) monostearate and polyethylenglicol (8) monolaurate], have been determined by this approach. The “second-derivate” approach provides a reliable determination of the CMC values among all of the techniques investigated, which were comparable to those calculated by the other operator-free routinely methods employed, such as segmental linear regression or Boltzmann regression. This study also highlighted the strengths and shortcomings of each technique over the others, providing an overview of the CMC values of commonly used anionic and nonionic surfactants in the pharmaceutical field, determined by employing different experimental approaches.

Background Chromosome 4q deletions are rare disorders phenotypically characterized by several features. The most commonly described ocular abnormalities include unilateral microphthalmia with bilateral colobomata, blue sclerae with pigmented retinal clumps, hypermetropia, and a divergent squint. Purpose To report a case of 4q12 deletion with a singular retinal feature. Materials and methods Case report. Results A 20-year-old Caucasian female with a history of poliosis, progressive appearance of small areas of skin depigmentation along trunk and limbs since birth and diagnosis of learning deficit was referred for a complete ocular examination. The genetic counseling showed microdeletion in the 4q12 region. An audiometric test was performed, showing a progressive bilateral neurosensorial hypoacusia. Ocular examination showed the presence of multifocal, tiny, whitish deposits in the posterior pole. Multimodal imaging defined the lesions as small elevations of the retinal pigment epithelium with slight hyper-autofluorescence and staining in the late phase of fluoresceine angiography (FA). Visual acuity was 20/20. The retinal findings did not change during the three-month follow-up. Conclusions Although the findings herein reported have never been described before in patients affected by 4q12 mutations, we do not exclude that they could represent a manifestation of the peculiar genetic asset of the patient, related to dysfunction in pigment epithelium/neuroretinal metabolic activity.

Cases of West Nile neuroinvasive disease (WNND) in Spain increased in summer 2020. Here we report on this increase and the local, regional and national public health measures taken in response. We analysed data from regional surveillance networks and the National Epidemiological Surveillance Network, both for human and animal West Nile virus (WNV) infection. During the 2020 season, a total of 77 human cases of WNV infection (median age 65 years; 60% males) were detected in the south-west of Spain; 72 (94%) of these cases developed WNND, presenting as meningoencephalitis, seven of which were fatal. In the previous two decades, only six human cases of WNND were detected in Spain. Reduced activities for vector control this season, together with other factors, might have contributed to the massive increase. Public health measures including vector control, campaigns to raise awareness among physicians and the general population, and interventions to ensure the safety of donations of blood products, organs, cells and tissues were effective to reduce transmission. Going forward, maintenance of vector control activities and an update of the vector-borne diseases response plan in Spain is needed

The COVID-19 pandemic represents an unprecedented opportunity to exploit the advantages of personalized medicine for the prevention, diagnosis, treatment, surveillance and management of a new challenge in public health. COVID-19 infection is highly variable, ranging from asymptomatic infections to severe, life-threatening manifestations. Personalized medicine can play a key role in elucidating individual susceptibility to the infection as well as inter-individual variability in clinical course, prognosis and response to treatment. Integrating personalized medicine into clinical practice can also transform health care by enabling the design of preventive and therapeutic strategies tailored to individual profiles, improving the detection of outbreaks or defining transmission patterns at an increasingly local level. SARS-CoV2 genome sequencing, together with the assessment of specific patient genetic variants, will support clinical decision-makers and ultimately better ways to fight this disease. Additionally, it would facilitate a better stratification and selection of patients for clinical trials, thus increasing the likelihood of obtaining positive results. Lastly, defining a national strategy to implement in clinical practice all available tools of personalized medicine in COVID-19 could be challenging but linked to a positive transformation of the health care system. In this review, we provide an update of the achievements, promises, and challenges of personalized medicine in the fight against COVID-19 from susceptibility to natural history and response to therapy, as well as from surveillance to control measures and vaccination. We also discuss strategies to facilitate the adoption of this new paradigm for medical and public health measures during and after the pandemic in health care systems., The authors included in this review have received funding for two COVID-19 projects (COVID GWAs, Premed COVID-19) from the Consejería de Salud y Familias of the Andalusian Government. DMM‘s contract is supported by the Andalussian government (Proyectos Estratégicos Fondos Feder PE-0451-2018).

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied.

The use of AI methods is currently evolving tasks done in the past by image analysts. During the last years, technology had helped to jump into fully automatic methods for monitoring and surveillance tasks, such as object detection, change detection and many more. In this work we want to show some of the AI-based models which RHEA Group has been working on which can be applied to the maritime domain, such as ship detection and super-resolution of satellite data. Each of these models can be further extended and specialized into specific monitoring and surveillance tasks, from the detection of ghost ships, measure environmental damage or monitoring of critical infrastructure near harbors or protected areas. In this paper, we illustrate some examples of the status of our research activities and the developments of these prototype applications.

The Municipality of Fasano (Puglia, Italy), i.e. owning one of 32 managed aquifer recharge (MAR) sites in operation in the Puglia region, has pioneered the reuse of tertiary-treated municipal effluent for both soil irrigations and the containment of seawater intrusion via groundwater recharge by ditches.In this work, quantitative microbial risk assessment (QMRA) methodologies have been applied to assess the degree of safety associated with such integrated practices by assessing the risks for public health resulting from the exposure to the reclaimed water. Escherichia coli (E.coli) dose-response model was used in this work since the pathogenic E.coli is reported to potentially occur in reclaimed water obtained from treated municipal effluents. The target count of pathogens ingested during swimming or inoculated by contaminated (uncooked) vegetables and fruits, was determined from the Monte Carlo Markov Chain (MCMC) Bayesian procedure applied to the results obtained from a monitoring campaign carried out in 2019. An optimization routine was applied in order to determine the most probable target pathogen count by minimizing the number of water samplings. The monitoring positions along the coast were defined by means of mathematical modeling, which highlighted the preferential pathways followed by pathogens when released into the fractured aquifer at a recharge operation flow rate of 10-30 L/s.QMRA results indicated a negligible risk impact (12% probability of 0.4 infections per year) for soil irrigation practices and no impact on the seawater quality as a result of the additional treatment barrier provided by the so-called "soil-aquifer treatment" during the pathogen transport through the fractures of groundwater.

POTE (prostate, ovary, testis, and placenta expressed) genes belong to a primate-specific gene family expressed in prostate, ovary, and testis as well as in several cancers including breast, prostate, and lung cancers. Due to their tumor-specific expression, POTEs are potential oncogenes, therapeutic targets, and biomarkers for these malignancies. This gene family maps within human and primate segmental duplications with a copy number ranging from two to 14 in different species. Due to the high sequence identity among the gene copies, specific efforts are needed to assemble these loci in order to correctly define the organization and evolution of the gene family. Using single-molecule, real-time (SMRT) sequencing, in silico analyses, and molecular cytogenetics, we characterized the structure, copy number, and chromosomal distribution of the POTE genes, as well as their expression in normal and disease tissues, and provided a comparative analysis of the POTE organization and gene structure in primate genomes. We were able, for the first time, to de novo sequence and assemble a POTE tandem duplication in marmoset that is misassembled and collapsed in the reference genome, thus revealing the presence of a second POTE copy. Taken together, our findings provide comprehensive insights into the evolutionary dynamics of the primate-specific POTE gene family, involving gene duplications, deletions, and long interspersed nuclear element (LINE) transpositions to explain the actual repertoire of these genes in human and primate genomes.

Falls represent one of the most serious clinical problems in the elderly population. This risk is even more important in people suffering from neurodegenerative problems. This work aims to instrumentally assess the balance performance of elderly people and specifically those suffering from neurodegenerative diseases, to obtain an objective evaluation of their risk of falls. This paper presents a vision-based system made of three low-cost cameras, able to automatically infer important mobility parameters by observing the execution of well-established tests for stability assessment. This result is achieved by a dedicated image processing pipeline, which processes videos to get dynamic user skeletons, and the following strategy for information management, which targets to feature extraction. This information finally feeds a classifier, namely a decision tree, trained to predict the risk of fall of patients within 5 classes of interest. Actual experiments performed on actual video recordings prove a good agreement of results with those expected, labeled by expert therapists, with final prediction accuracy of 79.1%.

Schwannoma is a rare benign tumor, originating from Schwann cells of the peripheral nerve sheath. We describe a case of intraconal orbital schwannoma, causing compression to the optic nerve and progressive visual impairment treated with surgical resection. The diagnosis of benign orbital schwannoma was provided by histopathological examination (large spindle cell tumor with AntoniB-type cell pattern) and also with immunohistochemistry (positivity for S-100 protein). The 6 months’ follow-up was performed. The patient was asymptomatic during the 6-month follow-up.

Wastewater surveillance systems for SARS-CoV-2 can be used to support public health decisions, complementary to clinical surveillance. We examined the lead-lag associations between SARS-CoV-2 RNA copies in wastewater and COVID-19 rates in relatively small urban areas of Seville, adjusting for internal mobility, temperature, and wastewater-related variables. The association COVID-19 rates-RNA copies were statistically significant from three to 27 days after sampling. Temperature is a confounding factor for both viral RNA counts and mobility. The model that best fitted data used cases six days after sampling. A logarithmic unit increase in viral RNA count in wastewater was associated with a 26.9% increase in COVID-19 rate per 100,000 inhabitants (95% CI: 13.1-42.4%), within the urban area, six days later. Surveillance system for SARS-CoV-2 in wastewater has great potential for public health. Knowing the specific association between SARS-CoV-2 RNA copies in wastewater and COVID-19 daily rates may help to improve its performance., Graphical abstract Unlabelled Image

This manuscript describes the rationale and protocol of a real-world data (RWD) study entitled Health Care and Social Survey (ESSOC, Encuesta Sanitaria y Social). The study’s objective is to determine the magnitude, characteristics, and evolution of the COVID-19 impact on overall health as well as the socioeconomic, psychosocial, behavioural, occupational, environmental, and clinical determinants of both the general and more vulnerable population. The study integrates observational data collected through a survey using a probabilistic, overlapping panel design, and data from clinical, epidemiological, demographic, and environmental registries. The data will be analysed using advanced statistical, sampling, and machine learning techniques. The study is based on several measurements obtained from three random samples of the Andalusian (Spain) population: general population aged 16 years and over, residents in disadvantaged areas, and people over the age of 55. Given the current characteristics of this pandemic and its future repercussions, this project will generate relevant information on a regular basis, commencing from the beginning of the State of Alarm. It will also establish institutional alliances of great social value, explore and apply powerful and novel methodologies, and produce large, integrated, high-quality and open-access databases. The information described here will be vital for health systems in order to design tailor-made interventions aimed at improving the health care, health, and quality of life of the populations most affected by the COVID-19 pandemic., Andalusian Institute of Statistics and Cartography (IECA), Andalusian School of Public Health (EASP), SUPERA COVID-19 Fund of Santander Universities (SAUN), Conference of Spanish University Rectors (CRUE, Conferencia de Rectores de Universidades Españolas, Spanish National Research Council (CSIC, Consejo Superior de Investigaciones Científicas), COVID-19 Competitive Grant Program from Pfizer Global Medical Grants, IMAG–Maria de Maeztu grant, Ministerio de Ciencia e Innovación, Spain

Measurement of in-vivo chromosome conformations (structures) in single cells is a major technological goal of structural biology. If one could identify many genetic loci in a microscope image despite the limited palette of fluorescent colors used to label them, then the conformation could be solved at some resolution by ‘connecting the dots’. Computational tools for making this reconstruction are expected to produce near-perfect reconstructions when the number of fluorescent colors is high enough, irrespective of the number of loci assayed. Here we report the first experimental test of the performance of these reconstruction algorithms and check their ability to reconstruct experimentally-measured conformations. We also demonstrate the experimental metrics needed to assess reconstruction quality. Our results indicate that current sequential FISH experiments may be close to the point where the reconstructions are nearly flawless at some distance scales.

Fluorescence in situ hybridization (FISH), especially chromosome painting, has been extensively exploited in the phylogenetic reconstruction of primate evolution. Although chromosome painting is a key method to map translocations, it is not effective in detecting chromosome inversions, which may be up to four times more frequent than other chromosomal rearrangements. BAC-FISH instead can economically delineate marker order and reveal intrachromosomal rearrangements. However, up to now, BAC-FISH was rarely used to study the chromosomes of New World monkeys partly due to technical difficulties. In this paper, we used BAC-FISH to disentangle the complex evolutionary history of the ancestral 14/15 association in NWMs, beginning from the squirrel monkey (Saimiri boliviensis). To improve the hybridization efficiency of BAC-FISH in NWMs, we "translated" the human BACs into Callithrix jacchus (CJA) BACs, which yielded much higher hybridization efficiencies on other NWM species than human BACs. Our results disclosed 14 synteny blocks in squirrel monkeys, 7 more than with chromosome painting. We then applied a subset of CJA BACs on six other NWM species. The comparison of the hybridization pattern of these species contained phylogenetic information to discriminate evolutionary relationships. Notably Aotus was found to share an inversion with Callithrix, thus definitely assigning the genus Aotus to Cebidae. The present study can be seen as a paradigmatic approach to investigate the phylogenetics of NWMs by molecular cytogenetics.

A pathogenic Escherichia coli (E.coli) O157:H7 and O26:H11 dose-response model was set up for a quantitative microbial risk assessment (QMRA) of the waterborne diseases associated with managed aquifer recharge (MAR) practices in semiarid regions. The MAR facility at Forcatella (Southern Italy) was selected for the QMRA application. The target counts of pathogens incidentally exposed to hosts by eating contaminated raw crops or while bathing at beaches of the coastal area were determined by applying the Monte Carlo Markov Chain (MCMC) Bayesian method to the water sampling results. The MCMC provided the most probable pathogen count reaching the target and allowed for the minimization of the number of water samplings, and hence, reducing the associated costs. The sampling stations along the coast were positioned based on the results of a groundwater flow and pathogen transport model, which highlighted the preferential flow pathways of the transported E. coli in the fractured coastal aquifer. QMRA indicated tolerable (, Graphical abstract Image 1, Highlights • MAR in coastal areas causes tolerable risks in irrigation practices when E. coli count is up to five times the legal limit • MC-based model minimizes the number of field water samplings in QMRA from E. coli O157:H7/O26:H11 infections at MAR sites • Droughts are bottlenecks of MAR practices in coastal areas of semiarid regions

INTRODUCTION Understanding the genetic differences that make us human is a long-standing endeavor that requires the comprehensive discovery and comparison of all forms of genetic variation within great ape lineages. RATIONALE The varied quality and completeness of ape genomes have limited comparative genetic analyses. To eliminate this contiguity and quality disparity, we generated human and nonhuman ape genome assemblies without the guidance of the human reference genome. These new genome assemblies enable both coarse and fine-scale comparative genomic studies. RESULTS We sequenced and assembled two human, one chimpanzee, and one orangutan genome using high-coverage (>65x) single-molecule, real-time (SMRT) long-read sequencing technology. We also sequenced more than 500,000 full-length complementary DNA samples from induced pluripotent stem cells to construct de novo gene models, increasing our knowledge of transcript diversity in each ape lineage. The new nonhuman ape genome assemblies improve gene annotation and genomic contiguity (by 30- to 500-fold), resulting in the identification of larger synteny blocks (by 22- to 74-fold) when compared to earlier assemblies. Including the latest gorilla genome, we now estimate that 83% of the ape genomes can be compared in a multiple sequence alignment. We observe a modest increase in single-nucleotide variant divergence compared to previous genome analyses and estimate that 36% of human autosomal DNA is subject to incomplete lineage sorting. We fully resolve most common repeat differences, including full-length retrotransposons such as the African ape-specific endogenous retroviral element PtERV1. We show that the spread of this element independently in the gorilla and chimpanzee lineage likely resulted from a founder element that failed to segregate to the human lineage because of incomplete lineage sorting. The improved sequence contiguity allowed a more systematic discovery of structural variation (>50 base pairs in length) (see the figure). We detected 614,186 ape deletions, insertions, and inversions, assigning each to specific ape lineages. Unbiased genome scaffolding (optical maps, bacterial artificial chromosome sequencing, and fluorescence in situ hybridization) led to the discovery of large, unknown complex inversions in gene-rich regions. Of the 17,789 fixed human-specific insertions and deletions, we focus on those of potential functional effect. We identify 90 that are predicted to disrupt genes and an additional 643 that likely affect regulatory regions, more than doubling the number of human-specific deletions that remove regulatory sequence in the human lineage. We investigate the association of structural variation with changes in human-chimpanzee brain gene expression using cerebral organoids as a proxy for expression differences. Genes associated with fixed structural variants (SVs) show a pattern of down-regulation in human radial glial neural progenitors, whereas human-specific duplications are associated with up-regulated genes in human radial glial and excitatory neurons (see the figure). CONCLUSION The improved ape genome assemblies provide the most comprehensive view to date of intermediate-size structural variation and highlight several dozen genes associated with structural variation and brain-expression differences between humans and chimpanzees. These new references will provide a stepping stone for the completion of great ape genomes at a quality commensurate with the human reference genome and, ultimately, an understanding of the genetic differences that make us human.

The avoidable hospital admissions for heart failure are a problem for health systems worldwide, as they waste resources, generate additional morbidities and high mortality. The objective of this study was to determine the risk factors in patients hospitalized for heart failure.A group of medical from Hospital and Primary Care was established. We realized an audit of a sample of 110 patients from Aljarafe towns with highest hospital admissions for heart failure. The analysis used Student T test and Mann Whitney for quantitative variables; Chi-square test and Fisher exact test for qualitative variables.Patients admitted for HF had a mean age of 78.1 years (SD: 9.56); 73 (66.4%) were women; Barthel Index was 45.0 on average; 53.5% had New York Health Association (NYHA) class III and 17 (15.5%) were institutionalized, 70% had between 3 and 5 comorbidities, mainly hypertension (87.3%), dyslipidemia (60.0%), diabetes (57.3%), chronic kidney disease (56.4%), anemia (53.2% ) or atrial fibrillation (52.7%). During hospitalization, 23 patients (20.9%) died. They were mostly women, elderly, had a previous admission and without beta-blockers treatment. The admission in the last 12 months was associated with identification of the primary caregiver; ischemic HF; re-vascularization; inclusion in the COMPARTE Program; treatment change decompensation.The hospital admissions were more frequently an aging population with multiple diseases (hypertension, diabetes, COPD, renal disease) and low capacity for basic activities of daily life. The hospital mortality associated with elderly, women, less use of beta-blockers and the non-inclusion of the patient in the care process.Los ingresos hospitalarios evitables por insuficiencia cardiaca (IC) son un problema para los sistemas de salud, consumen recursos, generan morbilidades adicionales y alta mortalidad. El objetivo del estudio fue conocer los factores de riesgo de las personas hospitalizadas por insuficiencia cardiaca.Se constituyó un grupo con médicos de atención primaria y hospitalaria. Se realizaron auditorías de las historias clínicas de 110 pacientes de la poblacion de la comarca del Aljarafe con mayores tasas de ingreso por insuficiencia cardiaca y estudio descriptivo y comparativo con T-Student y U-Mann Whitney para cuantitativas y Chi2 y Fisher para cualitativas.Los pacientes que ingresaron por IC tenían 78,1 años (SD: 9,56) de media; 73 (66,4%) fueron mujeres; un Índice Barthel de 45,0 de media; un 53,5% con New Yorl Health Asosiation (NYHA) grado III y 17 (15,5%) institucionalizados. El 70% presentaban 3-5 comorbilidades, hipertensión (87,3%), dislipemia (60,0%) diabetes mellitus(57,3%), enfermedad renal crónica (56,4%),anemia (53,2%) o fibrilación auricular (52,7%). Fallecieron al ingreso 23 (20,9%) pacientes.Los ingresos se dieron en personas mayores con múltiples enfermedades (hipertensión, diabetes, EPOC, enfermedad renal) y escasa capacidad para actividades básicas de la vida diaria. El fallecimiento hospitalario se asoció a edad avanzada, ser mujer, menor uso de betablo¬queantes y la no inclusión del paciente en el proceso asistencial.

Introduccion. La formacion medica en Europa despues de la implantacion del Espacio Europeo de Educacion Superior (EEES) se enfrenta a nuevos desafios, cambios de modelos y necesidad de adaptacion a las nuevas prioridades de la sociedad. Objetivo. Analizar y comparar los procesos de seleccion y las pruebas empleadas para acceder a una plaza de formacion especializada en el ambito europeo. Materiales y metodos. Estudio descriptivo y comparativo basado en la busqueda y analisis de informacion de libre acceso, publicada o disponible a traves de Internet. La muestra incluye la mayoria de los paises de la Union Europea de los 27, los mas influyentes en terminos demograficos, con una alta capacidad para formar grandes numeros absolutos de profesionales de la salud. Resultados. La seleccion para el acceso a las especialidades medicas puede clasificarse en local, regional, nacional y mixta, en funcion del proceso, e individualizada o generalizada, en funcion de las pruebas utilizadas. El perfil personal y profesional, valorado mediante una entrevista, es un elemento clave que muchos sistemas tienen en cuenta sobre todo en los procesos de seleccion locales. Los paises que aplican un sistema de seleccion nacional emplean basicamente examenes de opcion multiple. Conclusiones. Mas alla de las diferencias cruciales entre paises de ambito europeo, es fundamental insistir en la individualizacion de modelos integrados y asumibles, que evaluen de manera completa las competencias requeridas de la profesion medica y favorezcan una mayor armonizacion entre paises.