The Spanish Long-term Care System. ENEPRI Research Report No. 88, 15 June 2010

Launched in January 2009, ANCIEN is a research project that runs for a 44-month period and involves 20 partners from EU member states. The project principally concerns the future of long-term care (LTC) for the elderly in Europe and addresses two questions in particular: 1) How will need, demand, supply and use of LTC develop? 2) How do different systems of LTC perform? This case study on Spain is part of the first stage in the project aimed at collecting the basic data and necessary information to portray long-term care in each country of the EU. It will be followed by analysis and projections of future scenarios on long-term care needs, use, quality assurance and system performance. State-of-the-art demographic, epidemiologic and econometric modelling will be used to interpret and project needs, supply and use of long-term care over future time periods for different LTC systems

ICF-Based Disability Survey in a Rural Population of Adults and Older Adults Living in Cinco Villas, Northeastern Spain: Design, Methods and Population Characteristics

Background: This article describes the methods of a door-to-door screening survey exploring the distribution of disability and its major determinants in northeastern Spain. This study will set the basis for the development of disability-related services for the rural elderly in northeastern Spain. Methods: The probabilistic sample was composed of 1,354 de facto residents from a population of 12,784 Social Security card holders (age: 6 50 years). Cognitive and disability screenings were conducted (period: June 2008-June 2009). Screening instruments were the MMSE and the World Health Organization Disability Assessment Schedule. Participants screened positive for disability underwent an assessment protocol focusing on primary care diagnoses, disability, lifestyle, and social and health service usage. Participants screened positive for cognitive functioning went through in-depth neurological evaluation. Results: The study sample is described. Usable data were available for 1,216 participants. A total of 625 individuals (51.4%) scored within the positive range in the disability screening, while 135 (11.1%) scored within the positive range of the cognitive screening. The proportion of positively screened individuals was higher for women and increased with age. Conclusions: Screening surveys represent a feasible design for examining the distribution of disability and its determinants among the elderly. Data quality may benefit from methodological developments tailored to rural populations with a low education level. Copyright (C) 2010 S. Karger AG, Base

DPDnet: A Robust People Detector using Deep Learning with an Overhead Depth Camera

In this paper we propose a method based on deep learning that detects multiple people from a single overhead depth image with high reliability. Our neural network, called DPDnet, is based on two fully-convolutional encoder-decoder neural blocks based on residual layers. The Main Block takes a depth image as input and generates a pixel-wise confidence map, where each detected person in the image is represented by a Gaussian-like distribution. The refinement block combines the depth image and the output from the main block, to refine the confidence map. Both blocks are simultaneously trained end-to-end using depth images and head position labels. The experimental work shows that DPDNet outperforms state-of-the-art methods, with accuracies greater than 99% in three different publicly available datasets, without retraining not fine-tuning. In addition, the computational complexity of our proposal is independent of the number of people in the scene and runs in real time using conventional GPUs

Determination of heat wave definition temperatures in Spain at an isoclimatic level: time trend of heat wave duration and intensity across the decade 2009–2018

Background: In line with WHO guidelines for the implementation of public health prevention plans targeted at the impacts of high temperatures, a heat wave defnition temperature (Tthreshold) was calculated for 182 so called “isoclimatic zones” (IZ) in Spain. As the dependent variable for determining this Tthreshold, we analysed daily all-cause mortality data (ICD-10: A00-R99) for each IZ across the period 2009–2018. The independent variable used was the mean value of the maximum daily temperature of the summer months recorded at meteorological observatories in each IZ. We used Box–Jenkins models to ascertain mortality anomalies, and scatterplots to link these anomalies to the temperatures at which they occurred, thereby determining the Tthreshold for each IZ. We then calculated how many heat waves had occurred in each IZ, as well as their intensity, and analysed their time trend over this period. Results: The results showed that in 52.5% of the IZ, the percentile of the maximum temperatures series of the summer months to which Tthreshold corresponded was below the 95th percentile of the meteorological heat wave defnition in Spain: indeed, it only coincided in 30.7% of cases. The geographical distribution of these percentiles displayed great heterogeneity as a consequence of the local factors that infuence the temperature–mortality relationship. The trend in the number of heat waves analysed indicated an overall increase in Spain at a rate of 3.9 heat waves per decade, and a similar rise in mean annual intensity of 9.5 °C/decade. These time-trend values were higher than those yielded by analysing the trend in meteorological heat waves based on the 95th percentile. Conclusions: The results obtained in this study indicate the need to use a heat wave defnition based on epidemiological temperature–mortality studies, rather than on values based on meteorological percentiles. This could be minimising estimated health impacts in analyses of future impacts attributable to heat.Acknowledgements and funding The authors would like to express their gratitude for the following grants from the Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII) for the ENPY 304/20, and ENPY 436/21 projects.S

Estudio de las lesiones neoplásicas metacrónicas en el carcinoma colorrectal

Fundamento. Analizar la frecuencia y las características de las lesiones neoplásicas metacrónicas, carcinomas y adenomas, tras la resección de un cáncer colo-rectal (CCR). Pacientes y métodos. Revisamos 382 CCR operados y seguidos mediante colonoscopias completas en dos hospitales de nuestra comunidad. Analizamos las lesiones metacrónicas registradas valorando su localización, momento del diagnóstico, histología, número y tamaño. Estudiamos la frecuencia de adenomas de aparición precoz (12 meses), comparando su tamaño con respecto al resto de lesiones. Resultados. La mediana de seguimiento fue de 48 meses (12-112), con 2,74±1,47 colonoscopias/caso. Diagnosticamos 7 cánceres metacrónicos (1,8%), 4 de ellos en estadio I. La mediana de tiempo hasta su diagnóstico fue de 24 meses (13-54). Registramos adenomas metacrónicos en 162 casos (42,4%), sin diferencias entre los dos hospitales: 42,1% vs. 43,8% (p=0,88). Un 6,3% de los pacientes presentaron adenomas avanzados. En 164 casos en que el primer control se efectuó a los 12 meses, la incidencia de adenomas fue del 24%. Los adenomas fueron mayoritariamente únicos (60,8%) y menores de 5 mm (68,5%). En un 55,5% de los casos con pólipos, alguno tenía una localización proximal. El diagnóstico se realizó en la 1ª exploración (56,2%), 2ª (27,8%) ó 3ª (9%). La mediana de tiempo hasta el diagnóstico fue de 21 meses (12-112) para el adenoma simple y de 35 (12-112) para el avanzado. Conclusiones. Nuestro seguimiento permitió aplicar un tratamiento teóricamente curativo en la mayoría de los carcinomas metacrónicos diagnosticados. La alta incidencia de adenomas y su frecuente localización proximal hacen necesario un seguimiento con colonoscopias completas, que debería iniciarse al año de la operación y podría pasar a ser menos estricto tras tres exploraciones consecutivas sin pólipos

Clearance of ctDNA in triple-negative and HER2-positive breast cancer patients during neoadjuvant treatment is correlated with pathologic complete response

Breast cancer; Liquid biopsy; Neoadjuvant therapyCàncer de mama; Biòpsia líquida; Teràpia neoadjuvantCáncer de mama; Biopsia líquida; Terapia neoadyuvanteBackground: Although the standard of care is to perform surgery of primary breast cancer (BC) after neoadjuvant chemotherapy (NAC), for certain patients achieving clinical complete response (cCR) and pathologic complete response (pCR), omission of surgical treatment may be an option. Levels of circulating tumor DNA (ctDNA) during and after therapy could identify patients achieving minimal residual disease. In this study, we evaluated whether ctDNA clearance during NAC could be a correlate to effective response in human epidermal growth factor receptor 2 positive (HER2+) and triple-negative (TN) BC patients. Methods: A prospective study was conducted to identify patient-specific PIK3CA and TP53 mutations in tissue using next-generation sequencing, which could then be used to track the presence/absence of mutations prior to, during, and following NAC using Sysmex SafeSEQ technology. All patients underwent a surgical excision after NAC, and pCR was assessed. Results: A total of 29 TN and HER2+ BC patients were examined and 20 that carried mutations in the PIK3CA and/or TP53 genes were recruited. Overall, 19 of these 20 patients harbored at least one tumor-specific mutation in their plasma at baseline. After NAC, 15 patients (75.0%) achieved pCR according to the histopathologic evaluation of the surgical specimen, and 15 patients (75.0%) had a cCR; 18 of 20 patients (90.0%) had concordant pCR and cCR. The status of ‘no mutation detected’ (NMD) following NAC in cCR patients correctly identified the pCR in 14 of 15 patients (93.33%), as well as correctly ruled out pCR in three patients, with an accuracy of 89.47%. During the 12-month follow-up after surgery, 40 plasma samples collected from 15 patients all showed no detectable ctDNA (NMD), and no patient recurred. Conclusion: These findings prompt further research of the value of ctDNA for non-invasive prediction of clinical/pathological response, raising the possibility of sparing surgery following NAC in selected BC patients.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a grant from Sysmex Inostics, Inc. The sponsor coordinated data collection from study centers, and funded the statistical analysis and medical writing assistance

Effects of local factors on adaptation to heat in Spain (1983-2018)

The European Union is currently immersed in policy development to address the effects of climate change around the world. Key plans and processes for facilitating adaptation to high temperatures and for reducing the adverse effects on health are among the most urgent measures. Therefore, it is necessary to understand those factors that influence adaptation. The aim of this study was to provide knowledge related to the social, climate and economic factors that are related to the evolution of minimum mortality temperatures (MMT) in Spain in the rural and urban contexts, during the 1983-2018 time period. For this purpose, local factors were studied regarding their relationship to levels of adaptation to heat. MMT is an indicator that allows for establishing a relationship to between mortality and temperature, and is a valid indicator to assess the capacity of adaptation to heat of a certain population. MMT is obtained through the maximum daily temperature and daily mortality of the study period. The evolution of MMT values for Spain was established in a previous paper. An ecological, longitudinal and retrospective study was carried out. Generalized linear models (GLM) were performed to identify the variables that appeared to be related to adaptation. The adaptation was calculated as the difference in variation in MMT based on the average increase in maximum daily temperatures. In terms of adaptation to heat, urban populations have adapted more than non-urban populations. Seventy-nine percent (n = 11) of urban provinces have adapted to heat, compared to twenty-one percent (n = 3) of rural provinces that have not adapted. In terms of urban zones, income level and habituation to heat (values over the 95th percentile) were variables shown to be related to adaptation. In contrast, among non-urban provinces, a greater number of housing rehabilitation licenses and a greater number of health professionals were variables associated with higher increases in MMT, and therefore, with adaptation. These results highlight the need to carry out studies that allow for identifying the local factors that are most relevant and influential in population adaptation. More studies carried out at a small scale are needed.The authors gratefully acknowledge the grants for projects ENPY107/18; ENPY 376/18, ENPY 470/19 and ENPY 340/20 from the Carlos III Institute of Health, and is supported by the Biodiversity Foundation of the Ministry for Ecological Transition and Demographic Challenge. Likewise, to the UNED for the financing for the publication in Open Access.S

Graphene and graphene oxide induce ROS production in human HaCaT skin keratinocytes: The role of xanthine oxidase and NADH dehydrogenase

The extraordinary physicochemical properties of graphene-based nanomaterials (GBNs) make them promising tools in nanotechnology and biomedicine. Considering the skin contact as one of the most feasible exposure routes to GBNs, the mechanism of toxicity of two GBNs (few-layer-graphene, FLG, and graphene oxide, GO) towards human HaCaT skin keratinocytes was investigated. Both materials induced a significant mitochondrial membrane depolarization: 72 h cell exposure to 100 \u3bcg mL 12 1 FLG or GO increased mitochondrial depolarization by 44% and 56%, respectively, while the positive control valinomycin (0.1 \u3bcg mL 121) increased mitochondrial depolarization by 48%. Since the effect was not prevented by cyclosporine-A, it appears to be unrelated to mitochondrial transition pore opening. By contrast, it seems to be mediated by reactive oxygen species (ROS) production: FLG and GO induced time- and concentration- dependent cellular ROS production, significant already at the concentration of 0.4 \u3bcg mL 121 after 24 h exposure. Among a panel of specific inhibitors of the major ROS-producing enzymes, diphenyliodonium, rotenone and allopurinol significantly reverted or even abolished FLG- or GO-induced ROS production. Intriguingly, the same inhibitors also significantly reduced FLG- or GO-induced mitochondrial depolarization and cytotoxicity. This study shows that FLG and GO induce a cytotoxic effect due to a sustained mitochondrial depolarization. This seems to be mediated by a significant cellular ROS production, caused by the activation of flavoprotein-based oxidative enzymes, such as NADH dehydrogenase and xanthine oxidase

Precursors of fatty alcohols in the ISM: Discovery of n-propanol

Theories on the origins of life propose that early cell membranes were synthesized from amphiphilic molecules simpler than phospholipids such as fatty alcohols. The discovery in the interstellar medium (ISM) of ethanolamine, the simplest phospholipid head group, raises the question whether simple amphiphilic molecules are also synthesized in space. We investigate whether precursors of fatty alcohols are present in the ISM. For this, we have carried out a spectral survey at 7, 3, 2 and 1 mm toward the Giant Molecular Cloud G+0.693-0.027 located in the Galactic Center using the IRAM 30m and Yebes 40m telescopes. Here, we report the detection in the ISM of the primary alcohol n-propanol (in both conformers Ga-n-C3H7OH and Aa-n-C3H7OH), a precursor of fatty alcohols. The derived column densities of n-propanol are (5.5+-0.4)x10^13 cm^-2 for the Ga conformer and (3.4+-0.3)x10^13 cm^-2 for the Aa conformer, which imply molecular abundances of (4.1+-0.3)x10^-10 for Ga-n-C3H7OH and of (2.5+-0.2)x10^-10 for Aa-n-C3H7OH. We also searched for the AGa conformer of n-butanol (AGa-n-C4H9OH) without success yielding an upper limit to its abundance of <4.1x10^-11. The inferred CH3OH:C2H5OH:C3H7OH:C4H9OH abundance ratios go as 1:0.04:0.006:<0.0004 toward G+0.693-0.027, i.e. they decrease roughly by one order of magnitude for increasing complexity. We also report the detection of both syn and anti conformers of vinyl alcohol, with column densities of (1.11+-0.08)x10^14 cm^-2 and (1.3+-0.4)x10^13 cm^-2, and abundances of (8.2+-0.6)x10^-10 and (9.6+-3.0)x10^-11, respectively. The detection of n-propanol, together with the recent discovery of ethanolamine in the ISM, opens the possibility that precursors of lipids according to theories of the origin of life, could have been brought to Earth from outer space.Comment: 15 pages, 10 figures, accepted for A&