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OBJECTIVE: To investigate the impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection (HA-CDI). METHODS: Retrospective study conducted in the Hospital Universitario de Valme (HUV) and the Hospital General Universitario de Alicante (HGUA) in Spain between January 2019 and February 2021. The study period was divided into non-COVID19 period (2019 and months from 2020 to 2021 with =30 hospitalized COVID19 patients) and COVID19 period (months from 2020 to 2021 with >30 COVID19 patients). HA-CDI incidence rates (IR) were calculated as the number of new CDI cases per 10.000 occupied bed-days (OBD) and antimicrobial consumption by means of the defined daily dose (DDD) per 1000 OBD. RESULTS: During the COVID19 period, HA-CDI IR in the HUV was 2.6 per 10.000 OBD, which was lower than what was observed during the non-COVID19 period (4.1 per 10.000 OBD; p = 0.1). In the HGUA, HA-CDI IR during COVID19 period was 3.9 per 10.000 OBD, which was not significantly different to the IR observed during the non-COVID19 period (3.7 per 10.000 OBD; p = 0.8). There was a slight increase in the total antibiotic consumption during COVID19 period in both hospitals, with significant increases of certain high-risk antibiotics as cephalosporins. CONCLSUSIONS: HA-CDI incidence has not increased during the COVID19 pandemic in two tertiary centers in Spain, in spite of a slightly higher antibiotic consumption during the COVID19 period in both hospitals. These findings suggest that, in the presence of strict infection control measures, hospital antibiotic consumption might have a lower impact than expected on HA-CDI.

Objective To estimate the risk of miscarriage associated to chorionic villus sampling (CVS). Methods This was a retrospective cohort study performed in eight fetal‐medicine units in Spain, Belgium and Bulgaria. Two populations were included: first, all singleton pregnancies attending to their first‐trimester assessment in Murcia, Spain, and second, all singleton pregnancies having a CVS following first‐trimester assessment at any of the participating centers. We used propensity score matching analysis to estimate the association between CVS and miscarriage. We compared risks of miscarriage of CVS and non‐CVS groups after propensity score matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that lead to CVS, in a similar way in which randomization operates in a randomized clinical trial. Results The study population consisted of 22,250 participants in the non‐CVS group and 3,613 in the CVS group. The incidence of miscarriage in the CVS group was 2.1% (77/3,613), which was significantly higher than the 0.9% (207/22,250) in the non‐CVS group (p

Objective: To assess the performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma (HCC) in HIV-infected patients. Methods: The GEHEP-002 cohort recruits HCC cases diagnosed in HIV-infected patients from 32 centers across Spain. The proportion of 'ultrasound lack of detection', defined as HCC diagnosed within the first 3 months after a normal surveillance ultrasound, and the proportion of 'surveillance failure', defined as cases in which surveillance failed to detect HCC at early stage, were assessed. To assess the impact of HIV, a control population of 104 HCC cases diagnosed in hepatitis C virus-monoinfected patients during the study period was used. Results: A total of 186 (54%) out of 346 HCC cases in HIV-infected patients were diagnosed within an ultrasound surveillance program. Ultrasound lack of detection occurred in 16 (8.6%) of them. Ultrasound surveillance failure occurred in 107 (57%) out of 186 cases diagnosed by screening, whereas this occurred in 18 (29%) out of 62 diagnosed in the control group (P < 0.0001). HCC cases after ultrasound surveillance failure showed a lower frequency of undetectable HIV viral load at diagnosis. The probability of 1-year and 2-year survival after HCC diagnosis among those diagnosed by screening was 56 and 45% in HIV-infected patients, whereas it was 79 and 64% in HIV-negative patients (P = 0.038). Conclusion: The performance of ultrasound surveillance of HCC in HIV-infected patients is very poor and worse than that shown outside HIV infection. A HCC surveillance policy based on ultrasound examinations every 6 months might be insufficient in HIV-infected patients with cirrhosis.

Trabajo presentado al: 26Th Congress of the European Vegetation Survey. Diversity patterns across communities in the frame of global change: conservation challenges . 13-16 septiembre,2017. (Bilbao, España).

Introducción y objetivos: Estimar la prevalencia y duración de la lactancia materna (LM). Describir la evolución del peso en el primer año de vida y la demanda de consultas al pediatra en relación al tipo de lactancia. Pacientes y métodos: Estudio transversal. Datos retrospectivos. Se recogió una muestra aleatoria de historias clínicas de niños nacidos entre 2000 y 2005. Se estimó la prevalencia de lactancia natural al inicio, a los tres y seis meses. Se elaboró un índice de deserción para la duración. Se comparó el peso medio y el número de consultas al pediatra con el tipo de lactancia. Resultados: Iniciaron la lactancia materna exclusiva (LME) un 63,5 % (IC 95%: 58,6-64,5). A los seis meses permanecen un 22,6 % (IC 95%: 18,4-26,9). Un 80,5% (IC 95%: 75,4-84,6) comienzan lactancia materna total -exclusiva o mixta- (LMT). El 43,4 % de los niños que empezaron con LME abandonaron a los tres meses y el 64,4% a los seis; mientras que los de LMT tienen índices de deserción menores, un 26,5% y un 54,4% a los tres y a los seis meses, respectivamente. Los niños con lactancia materna mixta (LMM) suelen tener un peso medio mayor. Los alimentados con la LME hasta los seis meses, consultan al pediatra, un promedio de 4,5 veces durante el primer año. Los de lactancia artificial en unas 6,5 ocasiones. Ambas medias son significativas estadísticamente (p < 0,007). Conclusiones: La lactancia materna en esta población se aparta de las recomendaciones de la OMS. Los resultados apuntan a que la LME conlleva una evolución del peso del niño más adecuada y una menor morbilidad, al menos en el primer año de vida. Objective: To estimate the prevalence and the average length of Lactation. To describe the development of the weight during the first year of life and the demand of paediatric consultations in relation to the type of lactation. Methods: A cross-sectional study was done using retrospective data. There was gathered a random sample of clinical histories of born children between years 2000 and 2005. There was estimated the prevalence of breast-feeding from the beginning until three and six months. An index of global desertion was elaborated. The average weight and the number of paediatric consultations were related to the type of lactation. Results: The children initiate exclusive breastfeeding (MEL) in a 63.5% (CI 95%: 58.6-64.5). 22.6% amount them (IC 95%: 18.4-26.9) remained it until six months age. After three months of MEL 43.4% of the subjects gave up exclusively lactation. At the age of six months only 33.6% remained with MEL. Mixed form of lactation (MTL) was kept in 80.5% of the subjects (IC 95%: 75.4-84.6). Children included in the program of MTL (exclusive or mixed) have a minor index of desertion (26.5% and 54.4% up to three and six months, respectively). A higher weight was detected in children with mixed lactation. Those on the MEL up to six months consulted the paediatrician 4.5 times a year, whereas children with artificial lactation did it 6.5 times during their first year of life. There were statistically significant differences found (p < 0.007). Conclusions: Percentage of lactation in the group studied is far from recommended levels (WHO). Exclusive breastfeeding (MEL) entails a suitable weight development, as well as a minor morbidity in the first year of life.

Introducción y objetivos: Estimar la prevalencia y duración de la lactancia materna (LM). Describir la evolución del peso en el primer año de vida y la demanda de consultas al pediatra en relación al tipo de lactancia. Pacientes y métodos: Estudio transversal. Datos retrospectivos. Se recogió una muestra aleatoria de historias clínicas de niños nacidos entre 2000 y 2005. Se estimó la prevalencia de lactancia natural al inicio, a los tres y seis meses. Se elaboró un índice de deserción para la duración. Se comparó el peso medio y el número de consultas al pediatra con el tipo de lactancia. Resultados: Iniciaron la lactancia materna exclusiva (LME) un 63,5 % (IC 95%: 58,6-64,5). A los seis meses permanecen un 22,6 % (IC 95%: 18,4-26,9). Un 80,5% (IC 95%: 75,4-84,6) comienzan lactancia materna total -exclusiva o mixta- (LMT). El 43,4 % de los niños que empezaron con LME abandonaron a los tres meses y el 64,4% a los seis; mientras que los de LMT tienen índices de deserción menores, un 26,5% y un 54,4% a los tres y a los seis meses, respectivamente. Los niños con lactancia materna mixta (LMM) suelen tener un peso medio mayor. Los alimentados con la LME hasta los seis meses, consultan al pediatra, un promedio de 4,5 veces durante el primer año. Los de lactancia artificial en unas 6,5 ocasiones. Ambas medias son significativas estadísticamente (p < 0,007). Conclusiones: La lactancia materna en esta población se aparta de las recomendaciones de la OMS. Los resultados apuntan a que la LME conlleva una evolución del peso del niño más adecuada y una menor morbilidad, al menos en el primer año de vida.

Introducción: La valoración de la calidad es vida de nuestros pacientes es un aspecto del proceso patológico cada vez más considerado a la hora de realizar la anamnesis. Por ello, nos hemos planteado realizar el presente estudio con un doble objetivo: . Comprobar si existen diferencias en la calidad de vida de las personas que consultan por cuadros dolorosos respecto a las que consultan por otras patologías. . Conocer diferentes etiologías del dolor consultado en Atención Primaria (AP). Pacientes y métodos: Se reclutaron los pacientes de 10 consultas de AP de la provincia de Lugo. Se diseñó un cuaderno de recogida de datos al efecto, que consta de una parte común para los dos grupos objetos del estudio (edad, sexo, antecedentes personales de interés y datos antropométricos) y de otra específica para los casos, es decir las personas que consultaron por cualquier proceso doloroso, (cronología, tipo de dolor, diagnóstico, tiempo de evolución, tratamiento y resultado de la escala visual analógica [EVA]). A todos los participantes se les realizó la encuesta de calidad de vida SF-36. Resultados: La muestra se compone de 347 individuos (170 casos y 177 controles) con una edad media de 63 años (+/- 31). Hubo diferencias estadísticamente significativas en todos los aspectos analizados de la calidad de vida entre los dos grupos (función física, función social, problemas físicos, problemas emocionales, salud mental, vitalidad, dolor, salud general y cambios en el tiempo). El diagnóstico más frecuente de proceso doloroso fue gonartrosis/coxartrosis con el 12.69 % de los casos, seguido de osteoartrisis de columna vertebral (10.27 %). Por aparatos, el más afectado es el músculo-esquelético (37.76% de los casos), seguido del sistema nervioso (3.63% de los casos). Conclusiones: . Las personas que consultan por procesos dolorosos tienen su calidad de vida más deteriorada que las que consultan por otro tipo de procesos. . El dolor crónico menoscaba la CV de una manera más amplia que el agudo. . La causa más frecuente de dolor consultado es la gonartrosis/coxartrosis. . El aparato más comúnmente afectado por procesos dolorosos es el músculo-esquelético. Introduction: The valuation of the quality of life (QL) of our patients is an aspect of the pathological process more and more considered when carrying out the anamnesis. For it, we have thought about to carry out the present study with an objective double: . To check if differences exist in the quality of people's life that they consult for painful squares regarding those that consult for other pathologies. . To know different etiologies of the pain consulted in Primary Care (PC). Patient and methods: The patients of 10 consultations of PC of the county of Lugo were recruited. A notebook of data collection was designed; that consists of a common part for the two groups objects of the study (age, sex, personal antecedents of interest and data antropometrics) and of another specific one for the cases, that is to say people that consulted for any painful process, (chronology, type of pain, diagnostic, time of evolution, treatment and result of the analogical visual scale [AVS]). All the participants they were carried out the survey of quality of life SF-36. Results: The sample is composed of 347 individuáis (170 cases and 177 controls) with a 63 year-old half age (+ / - 31). There were differences statistically significant in all the analyzed aspects of the quality of life among the two groups (physical function, social function, physical problems, emotional problems, mental health, vitality, pain,general health and changes in the time). The most frequent diagnosis in painful process was gonarthrosis/coxarthrosis with 12.69% of the cases, followed by spine osteoarthritis (10.27%). For apparatuses, the most affected is the muscleskeletal (37.76% of the cases), followed by the nervous system (3.63% of the cases). Conclusions: . People that consult for painful processes have their quality of life more deteriorated that those that consult for another type of processes. . The chronic pain impairs the QL in a wider way more than the acute one. . The most frequent cause in consulted pain is the gonartrosis/coxartrosis. . The apparatus more commonly affected by painful processes it is the muscleskeletal one.

Staff selection for the varying activities performed by enterprises requires a coherent approach, which cannot be simplistic, to the information held. The use of flexible computation and the vague representation of knowledge available by means of linguistic labels allow the problem to be recognised as it is in real life. This paper is an attempt to supply a satisfactory solution to a real staff management problem with linguistic information presenting a linguistic decision model for personnel problem. For reaching a good solution, a novelty genetic algorithm with a linguistic biobjective fitness function is proposed.

The logistics problems in business environments deal with assignation from a number of sources to a number of destinations. Each source offers amounts of goods, while each destination demands quantities of these goods. The object is to find the cheapest transporting schedule that satisfies the demand without violating supply restraints. In this paper we propose to use Fuzzy Sets to represent the previsional information related to costs, demands and other variables. Moreover, we suggest including the problem of shortest route for the distribution vehicles. Finally, to solve this complex problem we propose to use a Genetic Algorithm with a Fuzzy Fitness Function.

The logistics problems in business environments deal with assignation from a number of sources to a number of destinations. Each source offers amounts of goods, while each destination demands quantities of these goods. The object is to find the cheapest transporting schedule that satisfies the demand without violating supply restraints. In this paper we propose to use Fuzzy Sets to represents the previsional information related to costs, demands and other variables. Moreover, we suggest including the problem of shortest route for the distribution vehicles. Finally, to solve this complex problem we propose to use a Genetic Algorithm with a Fuzzy Fitness Function.

The assignment±selection problems deal with ®nding the best one-to-one match for each of the given number of ``candidates'' to ``positions''. Dierent bene®ts or costs are involved in each match and the goal is to minimise the total expense. In this paper we propose the use of verbal information for representing the vague knowledge available. Doing it, natural linguistic labels allow the problem to be recognised as it is in real life. This paper is an attempt to supply a satisfactory solution to real assignment±selection problems with verbal information and using genetic al- gorithms, showing the application of this model to the sta selection problem. Ó 1999 Elsevier Science B.V. All rights reserved.

Many different optimisation problems can be formulated on networks: For instance, we might be interested in finding the shortest path from one node to another, finding the cheapest way to connect all the nodes, or finding the best way to move objects through a network. The movement of objects through a network is called a flow. In this paper we pretend to show a new approach to a classical network optimisation problem: the transportation problem. Firstly, allowing the vehicles that can establish routes, and, also, permitting to manage with imprecise or vague information. We propose to use the Fuzzy Sets Theory [9]; [4]; [10], with the aim of being able to handle the uncertainty, which is characteristic of decisionmaking processes in distribution problems. Moreover, to optimise the distribution network we suggest to use a Genetic Algorithm (GA) [3]; [1]; [7]. The main reason for this is that GAs are heuristic optimisation methods which don’t impose restrictions to the posing of the problem. In this study, the algorithm is characterised by its use of a Fuzzy Fitness Function that allows the evaluation of imprecise information

En este trabajo se empieza por considerar la flexibilidad que requieren las empresas actuales como la causa que justifica la existencia de las ETT como proveedoras de servicios de personal. A continuación se recogen los distintos análisis de que pueden ser objeto estas empresas: en el ámbito internacional se tratan aspectos legales tales como la normativa de la O.I.T. y de las Instituciones Comunitarias. También se incluyen los datos del sector a nivel europeo proporcionados por la consultora Bakkenist Management Consultants. A nivel nacional se analizan las obligaciones jurídicas que la Ley 14/1994 y el R.D. 4/1995 imponen a estas empresas así como toda su dinámica de funcionamiento real: requisitos para poder contratar con una ETT, análisis de las asociaciones de ETT, de los sindicatos, experiencias de empresas que han solicitado trabajadores por este cauce,... Finalmente, a nivel local se incluyen los resultados de dos encuestas efectuadas en la provincia de Málaga: una al conjunto de las ETT, otra al sector hotelero de la provincia que recurre al uso de las mismas. La 1a obtiene los datos identificativos y de actividad de las ETT malagueñas así como la visión que éstas tienen de su relación comercial con los hoteles. La 2a de las encuestas obtiene el perfil general del recurso a trabajadores de ETT dando resultados como que las cadenas nacionales son las que mayormente recurren a las ETT (41% del total de hoteles que utilizan ETT) frente a los hoteles nacionales independientes que son los que en mayor proporción no hacen uso de estos servicios (49% del total de hoteles que no utilizan ETT).