The balance of payments and international investment position of Spain in 2020

Artículo de revistaIn 2020, the Spanish economy recorded net lending of 1.1% of GDP, significantly below the previous year’s level of 2.5%. This decline essentially reflects the impact of the health crisis on travel credits, which contracted sharply, owing to the restrictions on international mobility and on activity in accommodation and food and travel services to contain the pandemic. The widening of the secondary income deficit also contributed to the decline in net lending, albeit to a much lesser extent. These developments offset the improvement in the other components, which was particularly notable in the goods and primary income balances. Cross-border financial transactions were strongly influenced by the increase in the volume of Eurosystem asset purchases, as reflected by a large surplus on the financial account of resident sectors, excluding the Banco de España. By contrast, the financial transactions of the Banco de España with the rest of the world showed a large increase in its liabilities. Spain’s negative net international investment position increased to 84.3% of GDP, essentially as a result of the sharp fall in GDP and the decline in the value of external financial assets owing to the appreciation of the euro. Finally, in terms of GDP, the nation’s gross external debt stood at all-time highs (199.4%) owing to the contraction in economic activity and the assumption of new liabilities, in particular by the Banco de España, given the increase in its positions vis-à-vis the Eurosystem as a result of the implementation of the asset purchase programmes

La Balanza de pagos y la posición de inversión internacional de España en 2020

Artículo de revistaLa economía española presentó, en 2020, una capacidad de financiación del 1,1 % del PIB, sensiblemente inferior a la del año previo, cuando se situó en el 2,5 %. Este descenso reflejó, fundamentalmente, el impacto de la crisis sanitaria sobre los ingresos turísticos, que se contrajeron fuertemente, afectados por las restricciones a la movilidad internacional y a la actividad en los servicios de hostelería y turismo introducidas para contener la expansión de la pandemia. La ampliación del déficit de rentas secundarias también contribuyó al deterioro de la capacidad de financiación, aunque en mucha menor medida. Estos desarrollos contrarrestaron la mejora del resto de los componentes, que fue particularmente destacada en las balanzas de bienes y de rentas primarias. Por su parte, la evolución de las operaciones financieras con el exterior ha estado muy condicionada por el aumento del volumen de compras de activos del Eurosistema, que se ha reflejado en un elevado saldo positivo de la cuenta financiera de los sectores residentes, excluyendo el Banco de España. Por el contrario, las operaciones financieras de este último frente al resto del mundo reflejaron un abultado incremento de sus pasivos. El saldo deudor de la Posición de Inversión Internacional neta de España se incrementó hasta el 84,3 % del PIB, como resultado fundamentalmente de la intensa caída del PIB y de la disminución del valor de los activos financieros exteriores debido a la apreciación del euro. Por último, la deuda externa bruta de la nación se situó en máximos históricos en términos de PIB (199,4 %) debido a la contracción de la actividad económica y a la asunción de nuevos pasivos, particularmente por parte del Banco de España, en el contexto de un aumento de las posiciones de esta institución frente al Eurosistema, como resultado de la aplicación de sus programas de compras de activos

El huerto ecopónico: un recurso efectivo para fomentar en los estudiantes una actitud pro ambiental y educación alimentaria

The objective was to implement the ecoponic orchard as a strategy to improve a pro-environmental attitude and food education in primary, secondary, high school and university students in Tenosique Tabasco, Mexico. The study lasted seven months, with the harvest indicating the first products 70 days after implementing the ecoponic orchard. To analyze the current state and change in attitude level, a questionnaire with 20 questions and four response levels was applied at the beginning and at the end of the study. The questionnaire was divided into three categories, 1) liking to be in contact with nature (CN), 2) liking for studying nature (EN) and 3) liking for working in nature (TN). The results indicated that at the beginning of the study, the students with a higher educational level had less pro-environmental attitude and low interest in orcharding. However, at the end of the study, the results indicated a significant positive change in attitudes in the four educational levels, with the highest levels being obtained by primary school students, followed by secondary school students, then high school students and finally university students. It is concluded that the ecoponic garden in the schoolyard is an effective resource to promote in students a pro-environmental attitude and skills for food production.El objetivo fue implementar el huerto ecopónico como estrategia para mejorar la actitud proambiental y educación alimentaria en estudiantes de nivel primaria, secundaria, preparatoria y universidad en Tenosique Tabasco, México. El estudio tuvo una duración de siete meses, indicando la cosecha los primeros productos a los 70 días de haber implementado del huerto ecopónico. Para analizar el estado actual y cambios de nivel de actitud, se aplicó al inicio y al finalizar el estudio un cuestionario con 20 preguntas y cuatro niveles de respuesta. El cuestionario se dividió en tres categorías, 1) gusto de estar en contacto con la naturaleza (CN), 2) gusto por estudiar la naturaleza (EN) y 3) gusto por trabajar en la naturaleza (TN). Los resultados indicaron que al inicio del estudio, los estudiantes de mayor nivel educativo presentaban menor actitud proambiental y bajo interés por el cultivo del huerto. Sin embargo, al finalizar el estudio, los resultados indicaron un cambio positivo significativo en los cuatro niveles educativos, obteniendo los niveles más alto los estudiantes de primaria, seguido por estudiantes de secundaria, luego los de preparatoria y por último los universitarios. Se concluye que el huerto ecopónico en el patio de la escuela es un recurso efectivo para fomentar en los estudiantes una actitud proambiental y habilidades para la producción de alimentos

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evolución de la función renal en pacientes con válvulas de uretra posterior: análisis de factores predictivos; director Enrique Jaureguizar Monereo

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 11 de Abril de 200

Correction to: Phenotypic characterization of X-linked hypophosphatemia in pediatric Spanish population

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAMEl texto del artículo original se encuentra disponible en http://hdl.handle.net/10486/703678Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.This research has been partially funded by Kyowa Kirin Farmacéutica S.L.U., project PI17/01745 from Instituto de Salud Carlos III, Acción Estratégica en Salud 2017–2020 and FEDER funds, Fondo de Investigaciones Sanitarias (FIS), Fundación Nutrición y Crecimiento (FUNDNYC), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias (FINBA

Phenotypic characterization of X-linked hypophosphatemia in pediatric Spanish population

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAMSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Hay una corrección posterior a este artículo: http://hdl.handle.net/10486/703679Background X-linked hypophosphatemia (XLH) is a hereditary rare disease caused by loss-of-function mutations in PHEX gene leading tohypophosphatemia and high renal loss of phosphate. Rickets and growth retardation are the major manifestations of XLH in children, but there is a broad phenotypic variability. Few publications have reported large series of patients. Current data on the clinical spectrum of the disease, the correlation with the underlying gene mutations, and the long-term outcome of patients on conventional treatment are needed, particularly because of the recent availability of new specific medications to treat XLH. Results The RenalTube database was used to retrospectively analyze 48 Spanish patients (15 men) from 39 different families, ranging from 3 months to 8 years and 2 months of age at the time of diagnosis (median age of 2.0 years), and with XLH confirmed by genetic analysis. Bone deformities, radiological signs of active rickets and growth retardation were the most common findings at diagnosis. Mean (± SEM) height was − 1.89 ± 0.19 SDS and 55% (22/40) of patients had height SDS below—2. All cases had hypophosphatemia, serum phosphate being − 2.81 ± 0.11 SDS. Clinical manifestations and severity of the disease were similar in both genders. No genotype—phenotype correlation was found. Conventional treatment did not attenuate growth retardation after a median follow up of 7.42 years (IQR = 11.26; n = 26 patients) and failed to normalize serum concentrations of phosphate. Eleven patients had mild hyperparathyroidism and 8 patients nephrocalcinosis. Conclusions This study shows that growth retardation and rickets were the most prevalent clinical manifestations at diagnosis in a large series of Spanish pediatric patients with XLH confirmed by mutations in the PHEX gene. Traditional treatment with phosphate and vitamin D supplements did not improve height or corrected hypophosphatemia and was associated with a risk of hyperparathyroidism and nephrocalcinosis. The severity of the disease was similar in males and femalesThis research has been partially funded by Kyowa Kirin Farmacéutica S.L.U., project PI17/01745 from Instituto de Salud Carlos III, Acción Estratégica en Salud 2017-2020 and FEDER funds, Fondo de Investigaciones Sanitarias (FIS), Fundación Nutrición y Crecimiento (FUNDNYC), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias (FINBA