Towns with extremely low mortality due to ischemic heart disease in Spain

BACKGROUND: The cause of coronary disease inframortality in Spain is unknown. The aim of this study is to identify Spanish towns with very low ischemic heart disease mortality, describe their health and social characteristics, and analyze the relationship with a series of contextual factors. METHODS: We obtained the number of deaths registered for each of 8,122 Spanish towns in the periods 1989-1998 and 1999-2003. Expected deaths, standardized mortality ratio (SMR), smoothed Relative Risk (RR), and Posterior Probability (PP) of RR > 1 were calculated using Bayesian hierarchical models. Inframortality was defined as any town that displayed an RR below the 10th percentile, an SMR of under 1 for both sexes, and a PP of RR > 1 less than or equal to 0.002 for male and 0.005 for female mortality, during the two periods covered. All the remaining towns, except for those with high mortality classified as "tourist towns", were selected as controls. The association among socioeconomic, health, dietary, lifestyle and vascular risk factors was analyzed using sequential mixed logistic regression models, with province as the random-effects variable. RESULTS: We identified 32 towns in which ischemic heart disease mortality was half the national rate and four times lower than the European Union rate, situated in lightly populated provinces spread across the northern half of Spain, and revealed a surprising pattern of geographic aggegation for 23 of the 32 towns. Variables related with inframortality were: a less aged population (OR 0.93, 95% CI 0.89-0.99); a contextual dietary pattern marked by a high fish content (OR 2.13, 95% CI 1.38-3.28) and wine consumption (OR 1.50, 95% CI 1.08-2.07); and a low prevalence of obesity (OR 0.47, 95% CI 0.22-1.01); and, in the case of towns of over 1000 inhabitants, a higher physician-population ratio (OR 3.80, 95% CI 1.17-12.3). CONCLUSIONS: Results indicate that dietary and health care factors have an influence on inframortality. The geographical aggregation suggests that other factors with a spatial pattern, e.g., genetic or environmental might also be implicated. These results will have to be confirmed by studies in situ, with objective measurements at an individual level.This study was funded by research study grant no. PI06/0656 from Spain's Health Research Fund (Fondo de Investigación Sanitaria).S

Exploring the response of a key Mediterranean gorgonian to heat stress across biological and spatial scales

Understanding the factors and processes that shape intra-specific sensitivity to heat stress is fundamental to better predicting the vulnerability of benthic species to climate change. Here, we investigate the response of a habitat-forming Mediterranean octocoral, the red gorgonian Paramuricea clavata (Risso, 1826) to thermal stress at multiple biological and geographical scales. Samples from eleven P. clavata populations inhabiting four localities separated by hundreds to more than 1500 km of coast and with contrasting thermal histories were exposed to a critical temperature threshold (25 degrees C) in a common garden experiment in aquaria. Ten of the 11 populations lacked thermotolerance to the experimental conditions provided (25 days at 25 degrees C), with 100% or almost 100% colony mortality by the end of the experiment. Furthermore, we found no significant association between local average thermal regimes nor recent thermal history (i.e., local water temperatures in the 3 months prior to the experiment) and population thermotolerance. Overall, our results suggest that local adaptation and/or acclimation to warmer conditions have a limited role in the response of P. clavata to thermal stress. The study also confirms the sensitivity of this species to warm temperatures across its distributional range and questions its adaptive capacity under ocean warming conditions. However, important inter-individual variation in thermotolerance was found within populations, particularly those exposed to the most severe prior marine heatwaves. These observations suggest that P. clavata could harbor adaptive potential to future warming acting on standing genetic variation (i.e., divergent selection) and/or environmentally-induced phenotypic variation (i.e., intra- and/or intergenerational plasticity).European Commission SEP-210597628- FutureMARES, MCIU/AEI/FEDER RTI2018-095346-BI00, Spanish government through the `Severo Ochoa Centre of Excellence' accreditation CEX2019-000928-S , Interreg Med Programme 5216|5MED18_3.2_M23_007, 1MED15_3.2_M2_ 337, Spanish Government FPU15/05457, Fundacao para a Ciencia e a Tecnologia (FCT) LA/P/0101/2020 , DivRestore/0013/2020, Marine Conservation research group 2017 SGR 1521, postdoctoral fellowship of project HABMAR - European Maritime and Fisheries Fund of the Operational Program MAR 2020 for Portugal MAR-01.04.02-FEAMP-0018info:eu-repo/semantics/publishedVersio

Differential Nitrogen Nutrition Modifies Polyamines and the Amino-Acid Profile of Sweet Pepper Under Salinity Stress

The horticultural industry demands high-quality resources to achieve excellence in yield and optimal revenues. Nitrogen is a pivotal nutrient to accomplish these goals for plant growth and product quality. However, competition for water in semi-arid regions can force the use of brackish waters, which can impair N uptake. The lower N uptake can be due to several reasons, such as an antagonism between ions, an absence of ATP, and/or alteration of N metabolism. The effect of supplying N as NO3− alone or in combination with NH4+, coupled with low or high salinity (8 or 20 mM NaCl), has been studied in sweet pepper fruits (Capsicum annuum L. cv. Melchor). The application of NH4+ at high salinity affected chromatic parameters (a∗, b∗, and C∗), while chlorophyll a and b levels declined and β-carotene increased. The concentrations of P, K, Ca, Mg, and Cu were reduced in the fruits of plants irrigated with NH4+. The concentration of Na was only reduced when NH4+ was supplied. Likewise, the concentration of total phenolics was also reduced at high salinity. However, total protein was unaffected. The amino acid profile was altered by the supply of NH4+, which reduced the concentrations of histidine and phenylalanine. Moreover, the concentrations of putrescine and cadaverine were increased by NH4+ at high salinity, whereas that of cadaverine was reduced by NH4+ at low salinity. The observed changes in fruit quality triggered by salinity, under the conditions of this study, should be borne in mind for this crop with regard to the envisaged palliative effect of the supply of N-NH4+

Population differentiation and historical demography of the threatened snowy plover Charadrius nivosus (Cassin, 1858)

Delineating conservation units is a complex and often controversial process that is particularly challenging for highly vagile species. Here, we reassess population genetic structure and identify those populations of highest conservation value in the threatened snowy plover (Charadrius nivosus, Cassin, 1858), a partial migrant shorebird endemic to the Americas. We use four categories of genetic data—mitochondrial DNA (mtDNA), microsatellites, Z-linked and autosomal single nucleotide polymorphisms (SNPs)—to: (1) assess subspecies delineation and examine population structure (2) compare the sensitivity of the different types of genetic data to detect spatial genetic patterns, and (3) reconstruct demographic history of the populations analysed. Delineation of two traditionally recognised subspecies was broadly supported by all data. In addition, microsatellite and SNPs but not mtDNA supported the recognition of Caribbean snowy plovers (C. n. tenuirostris) and Floridian populations (eastern C. n. nivosus) as distinct genetic lineage and deme, respectively. Low migration rates estimated from autosomal SNPs (m < 0.03) reflect a general paucity of exchange between genetic lineages. In contrast, we detected strong unidirectional migration (m = 0.26) from the western into the eastern nivosus deme. Within western nivosus, we found no genetic differentiation between coastal Pacific and inland populations. The correlation between geographic and genetic distances was weak but significant for all genetic data sets. All demes showed signatures of bottlenecks occurring during the past 1000 years. We conclude that at least four snowy plover conservation units are warranted: in addition to subspecies nivosus and occidentalis, a third unit comprises the Caribbean tenuirostris lineage and a fourth unit the distinct eastern nivosus deme

Improvement in detecting cytomegalovirus drug resistance mutations in solid organ transplant recipients with suspected resistance using next generation sequencing

Objetives The aim of this study was to identify CMV drug resistance mutations (DRM) in solid organ transplant (SOT) recipients with suspected resistance comparing next-generation sequencing (NGS) with Sanger sequencing and assessing risk factors and the clinical impact of resistance. Methods Using Sanger sequencing as the reference method, we prospectively assessed the ability of NGS to detect CMV DRM in the UL97 and UL54 genes in a nationwide observational study from September 2013 to August 2016. Results Among 44 patients recruited, 14 DRM were detected by Sanger in 12 patients (27%) and 20 DRM were detected by NGS, in 16 (36%). NGS confirmed all the DRM detected by Sanger. The additional six mutations detected by NGS were present in <20% of the sequenced population, being located in the UL97 gene and conferring high-level resistance to ganciclovir. The presence of DRM by NGS was associated with lung transplantation (p = 0.050), the administration of prophylaxis (p = 0.039), a higher mean time between transplantation and suspicion of resistance (p = 0.038) and longer antiviral treatment duration before suspicion (p = 0.024). However, the latter was the only factor independently associated with the presence of DRM by NGS in the multivariate analysis (OR 2.24, 95% CI 1.03 to 4.87). Conclusions NGS showed a higher yield than Sanger sequencing for detecting CMV resistance mutations in SOT recipients. The presence of DRM detected by NGS was independently associated with longer antiviral treatment.Funding: M.A.M. was supported in part by: Agency for Health Technology Assessment and Research Supported by Ministerio de Economía y Competitividad, Instituto de Salud Carlos III (PS12/02131 and PI17/02150); Agència de Gestió d´Ajuts Universitaris I de Recerca, Generalitat de Catalunya, 2017 SGR 794; and Fundació Marató TV3 project code 201824

The earliest European Acheulean: new insights into the large shaped tools from the late Early Pleistocene site of Barranc de la Boella (Tarragona, Spain)

Since the oldest known Acheulean lithic techno-typological features in Europe were reported at the site of Barranc de la Boella (Tarragona, Spain), continuous fieldwork has been conducted there in archeological deposits of the late Early Pleistocene age (0.99–0.78 Ma). As a result, excavations in two of the three open-air localities have significantly expanded the collection of lithic and faunal remains, allowing us to make progress in the interpretation of the hominin behaviors in an open-air fluvial-deltaic sedimentary environment. This includes examples of cumulative palimpsests, such as those found at the locality of La Mina, in which hominins only had a minimal role as modifying agents, as well as the extraordinary mammoth butchery site recorded at the Pit 1 locality. The aim of this paper is to present a comprehensive update of the collection of large shaped tools and to assess its significance in the framework of the earliest occurrence of the Acheulean in Europe. This cultural entity is increasingly well-documented for the early Middle Pleistocene, but very little is known about its presence in Europe before the Brunhes–Matuyama boundary. Large shaped tools appear in the three localities explored in the Unit II of Barranc de la Boella, including choppers (unifacial and bifacial) and standard Acheulean forms, such as picks, knives, and cleaver-like forms. Techno-typological and morphometrical analyses revealed a basic heavy-duty component obtained through simple shaping sequences coupled with significantly more elaborate tools produced on various large blanks (cobbles, slabs, or flakes). The complete bifacial and bilateral shapings have yet to be documented, but the present specific tool assemblage attests to the Early Acheulean technological threshold. Hence, the archaeological data from Barranc de la Boella provide insights into the first appearance of the Acheulean technology in Europe and add critical information to the debate on the technological variability of the Early Pleistocene hominin occupation of the continent. The results of this study revealed a technological assemblage unique in the known late Early Pleistocene archeological record from Europe, different from the rest of ancient Acheulean sites in this continent, which are dated at the Middle Pleistocene. This lends support to the hypothesis that Barranc de la Boella may represent a previously unrecognized Early Acheulean dispersion out of Africa connected to its first evidence at the gates of Eurasia, potentially moving over the northern Mediterranean coastal road to reach Western Europe

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

Background. We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods. From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results. The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered ?high risk? for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid?related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions. The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid?related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients

La formación de grado en enfermedades infecciosas, resistencia y uso de antibióticos desde la perspectiva de los estudiantes de Medicina

Introducción: Una de las principales herramientas para optimizar el uso de los antibióticos es la formación de los prescriptores. El objetivo de este trabajo es conocer la opinión de los estudiantes de Medicina españoles sobre la formación en enfermedades infecciosas. Material y métodos: Se distribuyó un cuestionario on line anonimizado entre estudiantes de sexto curso a través de distintos canales. El cuestionario incluyó 45 preguntas sobre conocimientos, actitudes y percepciones sobre el diagnóstico, resistencia antimicrobiana, uso de antibióticos y la formación de pregrado en enfermedades infecciosas. Resultados: Se recibieron un total de 441 encuestas de 21 facultades. Se obtuvieron 374 respuestas (84, 8%) de las 8 facultades más representadas, con una tasa de respuesta del 28, 9%. La mayoría de los alumnos se sentían preparados para identificar los signos clínicos de infección (418; 94, 8%) y para interpretar correctamente las pruebas de laboratorio (382; 86, 6%). Reconocieron saber elegir un antibiótico con seguridad sin consultar libros ni guías (178; 40, 4%). Solo 107 alumnos (24, 3%) consideraron haber recibido suficiente formación en el uso prudente de los antimicrobianos. Respecto a los métodos de aprendizaje, se percibieron como más útiles la discusión de casos clínicos, los rotatorios en servicios o unidades de enfermedades infecciosas y los talleres de pequeños grupos: se evaluaron favorablemente en un 76, 9; en un 76 y en un 68, 8% de los casos, respectivamente. Conclusión: Los estudiantes de Medicina se encuentran más seguros en el diagnóstico de enfermedades infecciosas que en el tratamiento antibiótico. Asimismo, sienten la necesidad de recibir mayor formación en antibioterapia y uso prudente en antibióticos. Introduction: One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students. Material and methods: An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results. Results: A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases. Conclusion: Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use

Stroke prevalence among the Spanish elderly: an analysis based on screening surveys

BACKGROUND: This study sought to describe stroke prevalence in Spanish elderly populations and compare it against that of other European countries. METHODS: We identified screening surveys -both published and unpublished- in Spanish populations, which fulfilled specific quality requirements and targeted prevalence of stroke in populations aged 70 years and over. Surveys covering seven geographically different populations with prevalence years in the period 1991–2002 were selected, and the respective authors were then asked to provide descriptions of the methodology and raw age-specific data by completing a questionnaire. In addition, five reported screening surveys in European populations furnished useful data for comparison purposes. Prevalence data were combined, using direct adjustment and logistic regression. RESULTS: The overall study population, resident in central and north-eastern Spain, totalled 10,647 persons and yielded 715 cases. Age-adjusted prevalences, using the European standard population, were 7.3% for men, 5.6% for women, and 6.4% for both sexes. Prevalence was significantly lower in women, OR 0.79 95% CI 0.68–0.93, increased with age, particularly among women, and displayed a threefold spatial variation with statistically significant differences. Prevalences were highest, 8.7%, in suburban, and lowest, 3.8%, in rural populations. Compared to pooled Spanish populations, statistically significant differences were seen in eight Italian populations, OR 1.39 95%CI (1.18–1.64), and in Kungsholmen, Sweden, OR 0.40 95%CI (0.27–0.58). CONCLUSION: Prevalence in central and north-eastern Spain is higher in males and in suburban areas, and displays a threefold geographic variation, with women constituting the majority of elderly stroke sufferers. Compared to reported European data, stroke prevalence in Spain can be said to be medium and presents similar age- and sex-specific traits