Applying probabilistic temporal and multi-site data quality control methods to a public health mortality registry in Spain: A systematic approach to quality control of repositories

OBJECTIVE: To assess the variability in data distributions among data sources and over time through a case study of a large multisite repository as a systematic approach to data quality (DQ). MATERIALS AND METHODS: Novel probabilistic DQ control methods based on information theory and geometry are applied to the Public Health Mortality Registry of the Region of Valencia, Spain, with 512 143 entries from 2000 to 2012, disaggregated into 24 health departments. The methods provide DQ metrics and exploratory visualizations for (1) assessing the variability among multiple sources and (2) monitoring and exploring changes with time. The methods are suited to big data and multitype, multivariate, and multimodal data. RESULTS: The repository was partitioned into 2 probabilistically separated temporal subgroups following a change in the Spanish National Death Certificate in 2009. Punctual temporal anomalies were noticed due to a punctual increment in the missing data, along with outlying and clustered health departments due to differences in populations or in practices. DISCUSSION: Changes in protocols, differences in populations, biased practices, or other systematic DQ problems affected data variability. Even if semantic and integration aspects are addressed in data sharing infrastructures, probabilistic variability may still be present. Solutions include fixing or excluding data and analyzing different sites or time periods separately. A systematic approach to assessing temporal and multisite variability is proposed. CONCLUSION: Multisite and temporal variability in data distributions affects DQ, hindering data reuse, and an assessment of such variability should be a part of systematic DQ procedures.This work was supported by the Spanish Ministry of Economy and Competitiveness grant numbers RTC-2014-1530-1 and TIN-2013-43457-R, and by the Universitat Politecnica de Valencia grant number SP20141432.Sáez Silvestre, C.; Zurriaga, O.; Pérez-Panadés, J.; Melchor, I.; Robles Viejo, M.; García Gómez, JM. (2016). Applying probabilistic temporal and multi-site data quality control methods to a public health mortality registry in Spain: A systematic approach to quality control of repositories. Journal of the American Medical Informatics Association. 23(6):1085-1095. https://doi.org/10.1093/jamia/ocw010S1085109523

Mobile clinical decision support systems and applications: a literature and commercial review

The final publication is available at Springer via http://dx.doi.org/10.1007/s10916-013-0004-y[EN] Background: The latest advances in eHealth and mHealth have propitiated the rapidly creation and expansion of mobile applications for health care. One of these types of applications are the clinical decision support systems, which nowadays are being implemented in mobile apps to facilitate the access to health care professionals in their daily clinical decisions. Objective: The aim of this paper is twofold. Firstly, to make a review of the current systems available in the literature and in commercial stores. Secondly, to analyze a sample of applications in order to obtain some conclusions and recommendations. Methods: Two reviews have been done: a literature review on Scopus, IEEE Xplore, Web of Knowledge and PubMed and a commercial review on Google play and the App Store. Five applications from each review have been selected to develop an in-depth analysis and to obtain more information about the mobile clinical decision support systems. Results: 92 relevant papers and 192 commercial apps were found. 44 papers were focused only on mobile clinical decision support systems. 171 apps were available on Google play and 21 on the App Store. The apps are designed for general medicine and 37 different specialties, with some features common in all of them despite of the different medical fields objective. Conclusions: The number of mobile clinical decision support applications and their inclusion in clinical practices has risen in the last years. However, developers must be careful with their interface or the easiness of use, which can impoverish the experience of the users.This research has been partially supported by Ministerio de Economía y Competitividad, Spain. This research has been partially supported by the ICT-248765 EU-FP7 Project. This research has been partially supported by the IPT-2011-1126-900000 project under the INNPACTO 2011 program, Ministerio de Ciencia e Innovación.Martínez Pérez, B.; De La Torre Diez, I.; López Coronado, M.; Sainz De Abajo, B.; Robles Viejo, M.; García Gómez, JM. (2014). Mobile clinical decision support systems and applications: a literature and commercial review. Journal of Medical Systems. 38(1):1-10. https://doi.org/10.1007/s10916-013-0004-yS110381Van De Belt, T. H., Engelen, L. J., Berben, S. A., and Schoonhoven, L., Definition of Health 2.0 and Medicine 2.0: A systematic review. J Med Internet Res 2010:12(2), 2012.Oh, H., Rizo, C., Enkin, M., and Jadad, A., What is eHealth (3): A systematic review of published definitions. J Med Internet Res 7(1):1, 2005. PMID: 15829471.World Health Organization (2011) mHealth: New horizons for health through mobile technologies: Based on the findings of the second global survey on eHealth (Global Observatory for eHealth Series, Volume 3). 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Accessed 11 September 2013.Apple (2013) iTunes. http://www.apple.com/itunes/ . Accessed 11 September 2013.Google (2013) Google play. https://play.google.com/store . Accessed 11 September 2013.Rowinski, D., (2013) The data doesn’t lie: iOS apps are better than android. Readwrite mobile. http://readwrite.com/2013/01/30/the-data-doesnt-lie-ios-apps-are-better-quality-than-android . Accessed 11 September 2013.Rajan, S. P., and Rajamony, S., Viable investigations and real-time recitation of enhanced ECG-based cardiac telemonitoring system for homecare applications: A systematic evaluation. Telemed J E Health 19(4):278–286, 2013.Logan, A. G., Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol 29(5):579–585, 2013.Tamrat, T., and Kachnowski, S., Special delivery: An analysis of mHealth in maternal and newborn health programs and their outcomes around the world. Matern Child Health J 16(5):1092–1101, 2012.Martínez-Pérez, B., de la Torre-Díez, I., López-Coronado, M., and Herreros-González, J., Mobile Apps in Cardiology: Review. JMIR Mhealth Uhealth 1(2):e15, 2013.de Wit HA, Mestres Gonzalvo C, Hurkens KP, Mulder WJ, Janknegt R, et al., Development of a computer system to support medication reviews in nursing homes. Int J Clin Pharm. 26, 2013.Dahlström, O., Thyberg, I., Hass, U., Skogh, T., and Timpka, T., Designing a decision support system for existing clinical organizational structures: Considerations from a rheumatology clinic. J Med Syst 30(5):325–31, 2006.Lambin P, Roelofs E, Reymen B, Velazquez ER, Buijsen J, et al., ‘Rapid learning health care in oncology’ - An approach towards decision support systems enabling customised radiotherapy’. Radiother Oncol. 27, 2013.Graham, T. A., Bullard, M. J., Kushniruk, A. W., Holroyd, B. R., and Rowe, B. H., Assessing the sensibility of two clinical decision support systems. J Med Syst 32(5):361–8, 2008.Martínez-Pérez, B., de la Torre-Díez, I., and López-Coronado, M., Mobile health applications for the most prevalent conditions by the World Health Organization: Review and analysis. J Med Internet Res 15(6):e120, 2013.Savel, T. G., Lee, B. A., Ledbetter, G., Brown, S., LaValley, D., et al., PTT advisor: A CDC-supported initiative to develop a mobile clinical laboratory decision support application for the iOS platform. Online J Public Health Inform 5(2):215, 2013.Doctor Doctor Inc. (2009) iDoc. iTunes. https://itunes.apple.com/es/app/idoc/id328354734?mt=8 . Accessed 13 September 2013.Hardyman, W., Bullock, A., Brown, A., Carter-Ingram, S., and Stacey, M., Mobile technology supporting trainee doctors’ workplace learning and patient care: An evaluation. BMC Med Educ 13:6, 2013.Lee, N. J., Chen, E. S., Currie, L. M., Donovan, M., Hall, E. K., et al., The effect of a mobile clinical decision support system on the diagnosis of obesity and overweight in acute and primary care encounters. ANS Adv Nurs Sci 32(3):211–21, 2009.Divall, P., Camosso-Stefinovic, J., and Baker, R., The use of personal digital assistants in clinical decision making by health care professionals: A systematic review. Health Informatics J 19(1):16–28, 2013.Chignell, M, and Yesha, Y, Lo, J., New methods for clinical decision support in hospitals. In Proceedings of the 2010 Conference of the Center for Advanced Studies on Collaborative Research (CASCON’10). Toronto, ON; Canada, 2010Charani, E., Kyratsis, Y., Lawson, W., Wickens, H., Brannigan, E. T., et al., An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: Lessons learnt. J Antimicrob Chemother 68(4):960–7, 2013.Klucken, J., Barth, J., Kugler, P., Schlachetzki, J., Henze, T., et al., Unbiased and mobile gait analysis detects motor impairment in Parkinson’s disease. PLoS One 8(2):e56956, 2013.Hervás, R., Fontecha, J., Ausín, D., Castanedo, F., Bravo, J., et al., Mobile monitoring and reasoning methods to prevent cardiovascular diseases. Sensors (Basel) 13(5):6524–41, 2013.Di Noia, T., Ostuni, V. C., Pesce, F., Binetti, G., Naso, N., et al., An end stage kidney disease predictor based on an artificial neural networks ensemble. Expert Syst Appl 40(11):4438–4445, 2013.Velikova, M., van Scheltinga, J. T., Lucas, P. J. F., and Spaanderman, M., Exploiting causal functional relationships in Bayesian network modelling for personalised healthcare. Int J Approx Reason, 2013. doi: 10.1016/j.ijar.2013.03.016 .Medical Data Solutions (2012) Pediatric clinical pathways. Google play. https://play.google.com/store/apps/details?id=com.ipathways . Accessed 17 September 2013.QxMD Medical Software Inc. (2013) Calculate by QxMD. Google play. https://play.google.com/store/apps/details?id=com.qxmd.calculate . Accessed 17 September 2013.Skyscape (2012) ACC pocket guides. Google play. https://play.google.com/store/apps/details?id=com.skyscape.packagefiveepkthreeundata.android.voucher.ui . Accessed 17 September 2013.Skyscape (2013) Skyscape medical resources. Google play. https://play.google.com/store/apps/details?id=com.skyscape.android.ui&hl=en . Accessed 17 September 2013.Pieter Kubben, M.D., (2012) NeuroMind. Google play. https://play.google.com/store/apps/details?id=eu.dign.NeuroMind . Accessed 17 September 2013.Mobile Systems, Inc. (2013) 2013 Medical diagnosis TR. Google play. https://play.google.com/store/apps/details?id=com.mobisystems.msdict.embedded.wireless.mcgrawhill.cmdt2013 . Accessed 17 September 2013.World Health Organization (2013) The global burden of disease: 2004 update. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf . Accessed 18 September 2013.Martínez-Pérez, B., de la Torre-Díez, I., Candelas-Plasencia, S., and López-Coronado, M., Development and evaluation of tools for measuring the Quality of Experience (QoE) in mHealth applications. J Med Syst 37(5):9976, 2013

Reappraisal of the 1863 huércal‐overa earthquake (Betic cordillera, se spain) by the analysis of esi‐07 environmental effects and building oriented damage

This work reviews the 1863 Huércal‐Overa earthquake (VI‐VII EMS) based on the environmental seismic intensity scale (ESI‐07) and oriented archaeoseismological building damage. The performed analysis identifies 23 environmental effects (EEEs) and 11 archaeoseismological effects (EAEs), completing a total of 34 intensity data‐points within the intensity zone ≥ VI EMS. The new ESI intensity data quintuplicate the previous intensity data‐points ≥ VI EMS (five localities) for this event. Sixteen of the identified EEEs indicate the occurrence of intensity VII‐VIII within the Almanzora valley, south of Huércal‐Overa, over an area of ca. 12–15 km2. Anomalies in water bodies, slope movements, hydrogeological anomalies, ground cracking, and other effects (gas emissions, tree shaking) are the more diagnostic EEEs—with one of them indicating a local maximum intensity of VIII‐IX ESI‐07 (Alboraija lake). Environmental earthquake damage of intensity ≥ VI covers an area of c. 100 km2, compatible with a VIII ESI intensity event. The spatial distribution of EEEs and EAEs indicates that the zone of Almanzora River Gorge, which was depopulated during the earthquake epoch, was the epicentral area, and compatible with seismotectonic data from active shallow blind thrusting beneath the Almagro Range. The use of ESI data in nearly unpopulated areas help to fill gaps between damaged localities (EMS data) multiplying intensity data‐points, providing a better definition of the intensity zones and offering a geological basis to look for suspect seismic sourcesCGL2015-67169-

Role of the Intracellular pH in the Metabolic Switch between Oxidative Phosphorylation and AerobicGlycolysis - Relevance to Cancer

Cellular energy in the form of ATP can be produced through oxidative phosphorylation and through glycolysis. Since oxidative phosphorylation requires oxygen and generates ATP more efficiently than glycolysis, it has been assumed for many years that the presence or absence of oxygen determines that cells generate energy through oxidative phosphorylation or through glycolysis. Although cells must activate glycolysis in the absence of oxygen to produce ATP, it is now accepted that they can activate both glycolysis and oxidative phosphorylation in the presence of oxygen. In fact, normal proliferating cells and tumor cells are known to have a high glycolytic activity in the presence of adequate oxygen levels, a phenomenon known as aerobic glycolysis or the Warburg effect. Recent observations have demonstrated that the activation of aerobic glycolysis plays a major role in carcinogenesis and tumor growth. Understanding the mechanisms involved in the metabolic switch between oxidative phosphorylation and aerobic glycolysis may therefore be important for the development of potential preventive and therapeutic interventions. In this article, we discuss the role of the intracellular pH in the metabolic switch between oxidative phosphorylation and aerobic glycolysis. We propose that, in the presence of adequate oxygen levels, the intracellular pH may play a key role in determining the way cells obtain energy, an alkaline pH driving aerobic glycolysis and an acidic pH driving oxidative phosphorylation

Catalogue of the geological effects of earthquakes in Spain based on the ESI-07 macroseismic scale: A new database for seismic hazard analysis

This paper summarizes the content and scope of the “Catalogue of Earthquake Geological Effects in Spain”. The catalogue has been published by the Geological Survey of Spain (IGME) and constitutes the first official publication (in Spain) on seismic hazard containing geological information. The catalogue gathers the 51 stronger earthquakes that have occurred in Spain since the Neolithic period to the present and classifies earthquakes with geological or archaeological seismic records in paleoseismic, ancient, historical and instrumental earthquakes. The catalogue offers a variety of parametric information, quality indexes (Qe, Qi, Qg), and Environmental Seismic Intensity Scale (ESI-07) based description of environmental damage structured in individual “event files”. Sixteen of the 51 catalogued events present full information files (full event files), with individualized analyses of the geological and geoarchaeological data as well as graphic information with hybrid ESI-EMS intensity maps, ShakeMaps (seismic scenarios) and complementary kmz files (Google Earth) for each of the sixteen selected earthquakes; among which is the well-known AD 1755 Lisbon earthquake-tsunami. These selected earthquakes present individual environmental earthquake effects (EEE) or earthquake archaeoseismological effects (EAE) files for each catalogued effect containing specific site geo-information and graphic data (photos, graphs, maps, etc.). The second edition of the catalogue record 1027 EEEs and 187 EAEs, of which 322 effects have individual filesThis research was funded by the Spanish Research Project MINECO-FEDER CGL2015-67169-P (QTECSPAIN-USAL). This is contribution of the QTECT-AEQUA Working Group

Análisis de la conductividad térmica efectiva en un generador termoeléctrico segmentado usando Bi2Te3 y PbTe

Los generadores termoeléctricos (TEG), conocidos como dispositivos de estado sólido, se utilizan para generar energía eléctrica a partir de un gradiente de temperatura. Los TEGs son de pequeño tamaño y no necesitan de mantenimiento. En este trabajo, se analiza el transporte de calor en un generador termoeléctrico segmentado compuesto de dos materiales, Bi2Te3 y PbTe, a través de la "conductividad térmica efectiva" (kef).Ésta conductividad, considera la conducción de Fourier en estado estacionario, la generación de calor de Joule y el efecto Seebeck. Además, el valor de ...... no depende de las condiciones de funcionamiento del TEG sino de las propiedades de transporte de los propios materiales semiconductores En el modelo considerado para el TEG segmentado, los resultados obtenidos muestran que los valores óptimos para la conductividad térmica efectiva, eficiencia reducida y finalmente la potencia máxima del sistema corresponden al Bi2Te3.Palabra(s) Clave(s): conductividad térmica, eficiencia, potencia, seebeck, TEG

Effects of the Cognitive-Behavioral Therapy for Stress Management on Executive Function Components

This study aims to determine whether it is possible to modify executive function in stressed individuals by means of cognitive-behavioral therapy for stress management. Thirty-one people with high levels of perceived stress were recruited into the study (treatment group = 18; wait-list group = 13). The treatment group received 14 weeks of stress management program. Psychological and executive function variables were evaluated in both groups pre and post-intervention. The treatment group showed improved psychological variables of perceived stress (t = 5.492; p = .001), vulnerability to stress (t = 4.061; p = .001) and superstitious thinking (t = 2.961; p = .009). Likewise, the results showed statistically significant differences in personality variables related to executive function, positive urgency (t = 3.585; p = .002) and sensitivity to reward (t = –2.201; p = .042), which improved after the therapy. These variables showed a moderate to high effect size (oscillates between 1.30 for perceived stress and .566 for sensitivity to reward). The cognitive-behavioral therapy for stress management may be an appropriate strategy for improving personality construct components related to executive function, however effects of the therapy are not showed on performance on the tests of executive function applied, as presented studies previous

Trimethylamine N-Oxide Promotes Autoimmunity and a Loss of Vascular Function in Toll-like Receptor 7-Driven Lupus Mice

This work was supported by Grants from Comision Interministerial de Ciencia y Tecnologia, Ministerio de Economia y competitividad (MINECO) (SAF2017-84894-R), Ministerio de Ciencia e Innovacion (MCIN)/Agencia Estatal de Investigacion (AEI)/10.13039/501100011033 (PID2020-116347RB-I00), Junta de Andalucia (CTS 164, P20_00193) with funds from the European Union, and by the Ministerio de Economia y Competitividad, Instituto de Salud Carlos III (CIBER-CV). J.M. and C.G.C. are predoctoral fellows of MINECO and Junta de Andalucia, respectively. The cost of this publication was paid in part with funds from the European Union (Fondo Europeo de Desarrollo Regional, FEDER, FEDER una manera de hacer Europa).Plasma levels of trimethylamine N-oxide (TMAO) are elevated in lupus patients. We analyzed the implication of TMAO in autoimmunity and vascular dysfunction of the murine model of systemic lupus erythematosus (SLE) induced by the activation of the Toll-like receptor (TLR)7 with imiquimod (IMQ). Female BALB/c mice were randomly divided into four groups: untreated control mice, control mice treated with the trimethylamine lyase inhibitor 3,3-dimethyl-1-butanol (DMB), IMQ mice, and IMQ mice treated with DMB. The DMB-treated groups were administered the substance in their drinking water for 8 weeks. Treatment with DMB reduced plasma levels of TMAO in mice with IMQ-induced lupus. DMB prevents the development of hypertension, reduces disease progression (plasma levels of anti-dsDNA autoantibodies, splenomegaly, and proteinuria), reduces polarization of T lymphocytes towards Th17/Th1 in secondary lymph organs, and improves endothelial function in mice with IMQ-induced lupus. The deleterious vascular effects caused by TMAO appear to be associated with an increase in vascular oxidative stress generated by increased NADPH oxidase activity, derived in part from the vascular infiltration of Th17/Th1 lymphocytes, and reduced nrf2-driven antioxidant defense. In conclusion, our findings identified the bacterialderived TMAO as a regulator of immune system, allowing for the development of autoimmunity and endothelial dysfunction in SLE mice.Comision Interministerial de Ciencia y Tecnologia, Ministerio de Economia y competitividad (MINECO) SAF2017-84894-RMinisterio de Ciencia e Innovacion (MCIN)/Agencia Estatal de Investigacion (AEI) PID2020-116347RB-I00Junta de Andalucia CTS 164 P20_00193European CommissionMinisterio de Economia y Competitividad, Instituto de Salud Carlos III (CIBER-CV)European Union (Fondo Europeo de Desarrollo Regional, FEDER, FEDER una manera de hacer Europa

Estiércol solarizado y dos métodos de riego en la producción de chile jalapeño (Capsicum annuum L. var. annuum)

Increase of water use efficiency in crops through better irrigation systems and use of farmyard manure to fertilize plants and avoid contamination are needs in arid regions. The objective was to evaluate a jalapeño pepper crop with organic fertilization and two irrigation methods.This research was carried out at Gomez Palacio, Durango, Mexico, in 2013 and 2014. The experimental units were randomly distributed in a split plot design with four replications. Main plots were irrigation treatments and fertilizers were applied as split plot treatments within each irrigation treatment. Irrigation was applied with either a furrow irrigation system to apply 80% of the measured pan evaporation or drip irrigation set to deliver 60% of the measured evaporation. The drip irrigation treatment showed greater fruit yield than the surface irrigation (p<0.05). Green fruit yield was similar among fertilized treatments in 2013 (p>0.05) and different in 2014 (p<0.05) with 40 t ha-1 solarized manure having the greatest fruit yield. Soil organic matter and nitrate-N content were greatest in 2013 when solarized manure 40 t ha-1 was used. There were no differences among fertilizer treatments in 2014 (p>0.05). Soil pH and electrical conductivity remained unchanged among treatments in each year of the study. Drip irrigation had a positive effect in the fruit yield in spite of delivering a lesser amount of water. The solarized manure applied at 40 t ha-1 had the greater effect in the fruit yield in year 2 but not in year 1.Incrementar el uso eficiente del agua a través de mejores sistemas de irrigación y el uso de estiércol de vaca para fertilizar plantas y evitar la contaminación son necesidades en regiones áridas. El objetivo fue evaluar un cultivo de chile jalapeño con fertilización orgánica y dos métodos de irrigación. La investigación fue llevada a cabo en Gómez Palacio, Durango, México en 2013 y 2014. Las unidades experimentales fueron distribuidas aleatoriamente en un diseño de parcelas divididas con cuatro repeticiones. Las parcelas grandes fueron los tratamientos de irrigación y los tratamientos de fertilización fueron las subparcelas. El agua aplicada a través de surcos de irrigación fue el 80% de evaporación medida en un tanque evaporímetro o bien a través del riego por goteo para aplicar 60% del agua evaporada. El tratamiento de riego por goteo mostró mayor cosecha de fruto que el riego por surcos (p<0,05). La cosecha de fruto fue igual entre los tratamientos de fertilización en 2013 (p>0,05) y diferente en 2014 (p<0,05) con el tratamiento de 40 t ha-1 de estiércol solarizado teniendo la mayor producción de fruto. La materia orgánica del suelo y el contenido de nitratos fueron mayores en 2013 en el tratamiento 40 t ha-1 de estiércol solarizado. No hubo diferencias entre tratamientos de fertilización en 2014. El pH del suelo y la conductividad eléctrica no tuvieron cambios entre tratamientos en los dos años de estudio. El riego por goteo tuvo un efecto positivo en la producción de fruto a pesar de que se aplicó menos cantidad de agua. El estiércol solarizado aplicado a 40 t ha-1 tuvo el mayor efecto en el año 2 pero no en el año 1.Fil: Maraña-Santacruz, José Ángel. Universidad Juárez del Estado de Durango (México). Facultad de Agronomía y Zootecnia.Fil: Castellanos-Pérez, Edmundo. Universidad Juárez del Estado de Durango (México). Facultad de Agronomía y Zootecnia.Fil: Vázquez-Vázquez, Cirilo. Universidad Juárez del Estado de Durango (México). Facultad de Agronomía y Zootecnia.Fil: Martínez-Ríos, Juan José. Universidad Juárez del Estado de Durango (México). Facultad de Agronomía y Zootecnia.Fil: Trejo-Escareño, Héctor Idilio. Universidad Juárez del Estado de Durango (México). Facultad de Agronomía y Zootecnia.Fil: Gallegos-Robles, Miguel Ángel. Universidad Juárez del Estado de Durango (México). Facultad de Agronomía y Zootecnia

A success story: New rules and fewer injuries in traditional

Objective: To analyse the effectiveness of a change in the rules on the incidence of injuries in traditional Leonese Wrestling (LW). Material and methods: Cohort study, retrospective (2006---2007) and prospective (2008---2012). The population studied comprised all the male wrestlers over 16 years of age who took part in Winter League competitions in the seasons 2006---2012. Data collected included the number, location and severity of injuries. Classifying them according to location and severity, the incidence of injuries by bouts and falls before and after the change was calculated. The formula for calculating effectiveness was: 1 --- relative risk. Results: Over the 7 seasons, a total of 34 injuries were reported ---- 9 in the seasons before the change and 25 afterwards. Since the introduction of the new regulations in 2008, no serious upper limb injuries have been reported. Before the change in rules there was an incidence of 10.4 per 1000 bouts and 3.9 for every 1000 falls, the differences being statistically significant (P = .002 and P = .006, respectively). The effectiveness in reducing the incidence of serious injuries was 94% by bouts, and 91% by falls. Conclusions: The results of this study confirm the importance of a methodological approach for the prevention of injuries; in this case a change in the rules. © 2012 Consell Català de l’Esport. Generalitat de Catalunya. Published by Elsevier España, S.L. All rights reserved