Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Influencia en la posterior práctica asistencial del matrón tras la atención al parto de su pareja: una perspectiva de género

Introduction: In Spain, according to the last data of the National Institute of Statistics, only 5,83 % of the collegiate midwives were men. Nevertheless, numerous studies have been interested in their situation in nursing and the obstetrics, due to the great influence of gender, considering that they support a double disapproval: on the one hand, the conviviality with a feminine majority, and on the other hand, the midwives oppression for the medical world. Likewise, diverse researches state that the nowadays fathers want to take part actively in their partners delivery. This is even more significant in the case of men midwives that deal with their couples’ childbirth, since they must face both their professional sphere and their personal one. Objective: To explore what the delivery of his couple means for a man midwife in his professional life. Methods: It is used a phenomenological design, from the Heidegger interpretive perspective, using in-depth interviews. 10 men midwives were chosen, and the speeches saturation were achieved by 8 interviews. It is used the Interpretative Phenomenological Analysis strategy of Smith, Flowers and Larkin. Results: Two main categories have been identified: "the gender function in the father – professional role "and" the influence of the couple childbirth"; as well as 7 subjects and 15 sub subjects. Conclusions: For men midwives, having experienced their partners’ delivery has supposed modifications upon their professional practice, as the increase of observation, patience or empathy.Introducción: En España, según los últimos datos del Instituto Nacional de Estadística, sólo un 5,83% de las matronas colegiadas eran hombres. Sin embargo, numerosos estudios se han interesado por su situación en la enfermería y la obstetricia, debido a la gran influencia de género existente, ya que los matrones soportan una doble desaprobación: por un lado, la convivencia con una mayoría femenina, y por otro, la opresión de las matronas por el mundo médico. Asimismo, diversas investigaciones constatan que los padres de hoy en día quieren participar activamente en el parto de su compañera. Esto es aún más significativo cuando hablamos de matrones que atienden el parto de sus parejas, puesto que deben enfrentarse tanto a su esfera profesional como a la familiar. Objetivo: Explorar qué significado tiene el parto de su pareja para el matrón en su vida profesional. Metodología: Se opta por un diseño fenomenológico, bajo la perspectiva interpretativa de Heidegger, utilizando entrevistas en profundidad. La muestra ha sido de 10 matrones, lográndose la saturación de discursos con 8 entrevistas. Se usó la estrategia de Análisis Fenomenológico Interpretativo de Smith, Flowers & Larkin. Resultados: Fueron dos las categorías principales identificadas: “el papel del género en el rol de padre-profesional” y “la influencia del parto de la pareja”; así como 7 temas y 15 subtemas. Conclusiones: Para los matrones, el haber experimentado el parto de sus parejas ha supuesto modificaciones a la hora de trabajar, como puede ser el aumento de la empatía, la observación o la paciencia

Spanish juniper gain expansion opportunities by counting on a functionally diverse dispersal assemblage community

Seed dispersal is typically performed by a diverse array of species assemblages with different behavioral and morphological traits which determine dispersal quality (DQ, defined as the probability of recruitment of a dispersed seed). Fate of ecosystems to ongoing environmental changes is critically dependent on dispersal and mainly on DQ in novel scenarios. We assess here the DQ, thus the multiplicative effect of germination and survival probability to the first 3 years of life, for seeds dispersed by several bird species (Turdus spp.) and carnivores (Vulpes vulpes, Martes foina) in mature woodland remnants of Spanish juniper (Juniperus thurifera) and old fields which are being colonized by this species. Results showed that DQ was similar in mature woodlands and old fields. Germination rate for seeds dispersed by carnivores (11.5%) and thrushes (9.12%) was similar, however, interacted with microhabitat suitability. Seeds dispersed by carnivores reach the maximum germination rate on shrubs (16%), whereas seeds dispersed by thrushes did on female juniper canopies (15.5) indicating that each group of dispersers performed a directed dispersal. This directional effect was diluted when survival probability was considered: thrushes selected smaller seeds which had higher mortality in the seedling stage (70%) in relation to seedlings dispersed by carnivores (40%). Overall, thrushes resulted low-quality dispersers which provided a probability or recruitment of 2.5%, while a seed dispersed by carnivores had a probability of recruitment of 6.5%. Our findings show that generalist dispersers (i.e., carnivores) can provide a higher probability of recruitment than specialized dispersers (i.e., Turdus spp.). However, generalist species are usually opportunistic dispersers as their role as seed dispersers is dependent on the availability of trophic resources and species feeding preferences. As a result, J. thurifera dispersal community is composed by two functional groups of dispersers: specialized low-quality but trustworthy dispersers and generalist high-quality but opportunistic dispersers. The maintenance of both, generalist and specialist dispersers, in the dispersal assemblage community assures the dispersal services and increases the opportunities for regeneration and colonization of degraded areas under a land-use change scenario. © 2013 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.Gema Escribano-Ávila was supported by a FPU-MEC doctoral grant from the Spanish Ministry for Education (http://www.educacion.gob.es/portadahtml). Funding was provided by the Spanish Ministry for Innovation and Science (http://www.idi.mineco.gob.es/) with the grants CGL2010-16388/BOS, Consolider Montes (CSD2008_00040), VULGLO (CGL2010-22180-C03-03), and CALCOFIS (CGL2009-13013), and by the Community of Madrid grant (http://www.madrimasd.org/) REMEDINAL 2 (CM-S2009/AMB-1783).Peer Reviewe

Colonization of abandoned land by Juniperus thurifera is mediated by the interaction of a diverse dispersal assemblage and environmental heterogeneity.

Land abandonment is one of the most powerful global change drivers in developed countries where recent rural exodus has been the norm. Abandonment of traditional land use practices has permitted the colonization of these areas by shrub and tree species. For fleshy fruited species the colonization of new areas is determined by the dispersal assemblage composition and abundance. In this study we showed how the relative contribution to the dispersal process by each animal species is modulated by the environmental heterogeneity and ecosystem structure. This complex interaction caused differential patterns on the seed dispersal in both, landscape patches in which the process of colonization is acting nowadays and mature woodlands of Juniperus thurifera, a relict tree distributed in the western Mediterranean Basin. Thrushes (Turdus spp) and carnivores (red fox and stone marten) dispersed a high amount of seeds while rabbits and sheeps only a tiny fraction. Thrushes dispersed a significant amount of seeds in new colonization areas, however they were limited by the presence of high perches with big crop size. While carnivores dispersed seeds to all studied habitats, even in those patches where no trees of J. thurifera were present, turning out to be critical for primary colonization. The presence of Pinus and Quercus was related to a reduced consumption of J. thurifera seeds while the presence of fleshy fruited shrubs was related with higher content of J. thurifera seeds in dispersers' faeces. Therefore environmental heterogeneity and ecosystem structure had a great influence on dispersers feeding behaviour, and should be considered in order to accurately describe the role of seed dispersal in ecological process, such as regeneration and colonization. J. thurifera expansion is not seed limited thanks to its diverse dispersal community, hence the conservation of all dispersers in an ecosystem enhance ecosystems services and resilience

The colonization of abandoned land by Spanish juniper: Linking biotic and abiotic factors at different spatial scales

Colonization of abandoned lands by woody vegetation may be a great opportunity for ecosystem recovery given the current and future trend of land abandonment. This may help to reverse the generalized condition of ecosystem degradation of developed countries which is an urgent need. However, ecosystem recovery in abandoned lands can be seriously limited by biotic and abiotic factors. Indentify such factors and determine the relevant spatial scales at which they operate will help to understand natural patterns of colonization of abandoned lands and may be useful to guide restoration activities. We used Spanish juniper remnant woodlands and old fields recently colonized by the species to assess the variation in post-dispersal seed predation and environmental suitability to plant recruitment. These biotic and abiotic factors are two of the most limiting for vegetation recovery in abandoned lands, at the regional and local spatial scale. We found that recruitment was controlled by factors operating at different spatial scales in a hierarchical manner along different stages of the process. The regional scale was determinant for post-dispersal seed predation and seedling abundance which was, in turn, controlled by environmental suitability at the local spatial scale. Post-dispersal seed removal was higher in old fields than in mature woodlands, hence increasing seed limitation, a pervasive constraint for plant recruitment in abandoned lands. Environmental suitability for plant recruitment did not decrease as a result of previous farming uses at the regional scale, a common pattern in areas not subjected to intensive farming practices. Abandoned lands in Mediterranean areas seem to have a strong potential for ecosystem recovery being the biotic factors (e.g. seed availability) more limiting than the abiotic ones when non-intensive farming practices have been performed. This together with predictions of increase in land abandonment in low productive areas makes old fields especially relevant from an ecosystem recovery perspective. © 2014 Elsevier B.V.Gema Escribano-Ávila was supported by a FPU-MEC doctoral grant from the Spanish Ministry of Education (http://www.educacion.gob.es/portadahtml). Funding was provided by the Spanish Ministry for Innovation and Science (http://www.idi.mineco.gob.es/) with research projects CGL2010-16388/BOS, Consolider Montes (CSD2008_00040), VULGLO (CGL2010-22180-C03-03), and CALCOFIS (CGL2009-13013), and by the Community of Madrid project REMEDINAL 2 (CM-S2009/AMB-1783).Peer Reviewe

Influencia en la posterior práctica asistencial del matrón tras la atención al parto de su pareja: una perspectiva de género

Introducción: En España, según los últimos datos del Instituto Nacional de Estadística, sólo un 5,83% de las matronas colegiadas eran hombres. Sin embargo, numerosos estudios se han interesado por su situación en la enfermería y la obstetricia, debido a la gran influencia de género existente, ya que los matrones soportan una doble desaprobación: por un lado, la convivencia con una mayoría femenina, y por otro, la opresión de las matronas por el mundo médico. Asimismo, diversas investigaciones constatan que los padres de hoy en día quieren participar activamente en el parto de su compañera. Esto es aún más significativo cuando hablamos de matrones que atienden el parto de sus parejas, puesto que deben enfrentarse tanto a su esfera profesional como a la familiar. Objetivo: Explorar qué significado tiene el parto de su pareja para el matrón en su vida profesional. Metodología: Se opta por un diseño fenomenológico, bajo la perspectiva interpretativa de Heidegger, utilizando entrevistas en profundidad. La muestra ha sido de 10 matrones, lográndose la saturación de discursos con 8 entrevistas. Se usó la estrategia de Análisis Fenomenológico Interpretativo de Smith, Flowers & Larkin. Resultados: Fueron dos las categorías principales identificadas: “el papel del género en el rol de padre-profesional” y “la influencia del parto de la pareja”; así como 7 temas y 15 subtemas. Conclusiones: Para los matrones, el haber experimentado el parto de sus parejas ha supuesto modificaciones a la hora de trabajar, como puede ser el aumento de la empatía, la observación o la paciencia.   Abstract Introduction: In Spain, according to the last data of the National Institute of Statistics, only 5,83 % of the collegiate midwives were men. Nevertheless, numerous studies have been interested in their situation in nursing and the obstetrics, due to the great influence of gender, considering that they support a double disapproval: on the one hand, the conviviality with a feminine majority, and on the other hand, the midwives oppression for the medical world. Likewise, diverse researches state that the nowadays fathers want to take part actively in their partners delivery. This is even more significant in the case of men midwives that deal with their couples’ childbirth, since they must face both their professional sphere and their personal one. Objective: To explore what the delivery of his couple means for a man midwife in his professional life. Methods: It is used a phenomenological design, from the Heidegger interpretive perspective, using in-depth interviews. 10 men midwives were chosen, and the speeches saturation were achieved by 8 interviews. It is used the Interpretative Phenomenological Analysis strategy of Smith, Flowers and Larkin. Results: Two main categories have been identified: "the gender function in the father – professional role "and" the influence of the couple childbirth"; as well as 7 subjects and 15 sub subjects. Conclusions: For men midwives, having experienced their partners’ delivery has supposed modifications upon their professional practice, as the increase of observation, patience or empathy

Satisfacción corporal en el posparto y su relación con las influencias socioculturales

Objective: Understanding body satisfaction levels as reported by women in the first six post-partum months and how sociocultural factors influence them could help health professionals provide specialised care for those women in a more suitable way. Methodology: First of all, an observational, descriptive and transversal study of women in the first six post-partum months with data collected through a custom questionnaire developed for socio-demographic, obstetric and health data. Secondly, the Body Image Assessment Scale to evaluate satisfaction levels with one’s own body. Thirdly, the Body Aesthetic Model Influence Questionnaire (CIMEC-26) in order to ascertain the influence of sociocultural factors. Results: The study included 181 women, of whom 158 (87.8%) reported body dissatisfaction. The average CIMEC-26 score exceeded the cut-off point set by its author with the heaviest weighing factor being the "Influence of Advertising". A direct relation between body dissatisfaction and caesarean delivery was found, whereas other factors such as age and breastfeeding type proved to be unrelated. Conclusions: During the first six post-partum months, women report greater body dissatisfaction and are more exposed on a perceptive, cognitive and emotional level not only to advertising pressure, which encourages them to lose weight, but also to the social influence that promotes slim beauty standards.Objetivo: Conocer la satisfacción corporal referida por la mujer en los primeros seis meses posparto y su relación con las influencias socioculturales podría facilitar la labor de los profesionales de salud que atienden a la mujer en esta etapa. Metodología: Estudio observacional, descriptivo y transversal realizado a mujeres en los seis primeros meses posparto con recogida de datos mediante un cuestionario de elaboración propia para datos sociodemográficos, obstétricos y de salud, la Escala de Evaluación de la Imagen Corporal para identificar la satisfacción con el propio cuerpo y el Cuestionario de Influencia del Modelo Estético Corporal (CIMEC-26) con el objetivo de conocer las influencias socioculturales. Resultados: Formaron parte del estudio 181 mujeres, de las cuales 158 (87,8%) refirieron insatisfacción corporal. La puntuación media de la escala CIMEC-26 rebasó el punto de corte establecido por el autor y el factor que más peso tuvo fue la “Influencia de la Publicidad”. Se apreció una relación directa entre la insatisfacción corporal y el parto por cesárea. No se estableció relación con la edad ni con el tipo de lactancia. Conclusiones: La mujer durante los seis primeros meses posparto refiere una gran insatisfacción corporal y está más sujeta perceptiva, cognitiva y emocionalmente a la presión publicitaria que alienta a adelgazar, así como a la influencia social hacia un modelo de delgadez

The colonization of abandoned land by Spanish juniper: Linking biotic and abiotic factors at different spatial scales

Colonization of abandoned lands by woody vegetation may be a great opportunity for ecosystem recovery given the current and future trend of land abandonment. This may help to reverse the generalized condition of ecosystem degradation of developed countries which is an urgent need. However, ecosystem recovery in abandoned lands can be seriously limited by biotic and abiotic factors. Indentify such factors and determine the relevant spatial scales at which they operate will help to understand natural patterns of colonization of abandoned lands and may be useful to guide restoration activities. We used Spanish juniper remnant woodlands and old fields recently colonized by the species to assess the variation in post-dispersal seed predation and environmental suitability to plant recruitment. These biotic and abiotic factors are two of the most limiting for vegetation recovery in abandoned lands, at the regional and local spatial scale. We found that recruitment was controlled by factors operating at different spatial scales in a hierarchical manner along different stages of the process. The regional scale was determinant for postdispersal seed predation and seedling abundance which was, in turn, controlled by environmental suitability at the local spatial scale. Post-dispersal seed removal was higher in old fields than in mature woodlands, hence increasing seed limitation, a pervasive constraint for plant recruitment in abandoned lands. Environmental suitability for plant recruitment did not decrease as a result of previous farming uses at the regional scale, a common pattern in areas not subjected to intensive farming practices. Abandoned lands in Mediterranean areas seem to have a strong potential for ecosystem recovery being the biotic factors (e.g. seed availability) more limiting than the abiotic ones when non-intensive farming practices have been performed. This together with predictions of increase in land abandonment in low productive areas makes old fields especially relevant from an ecosystem recovery perspective

Hábitos de ejercicio físico durante la gestación y sus factores asociados

Introduction. Physical activity has been identified as an important practice before, during and after pregnancy to maintain a healthy lifestyle. There are very few studies about patterns and variables associated with physical activity during pregnancy. Objetive. Describe pregnant women’s exercise habits and their associated factors. Method. Cross-sectional, descriptive and observational study. Data will be collected by compilation-based questionnaires administered to 244 pregnant women between October 2017 and February 2018. Data surveys will be administered at the fetal monitoring waiting room of Gregorio Marañón Maternity and Infant Hospital of Madrid (Spain). Results. Exercise was practiced leading to rates that increased during pregnancy to 69,5% (151 women). While light exercise, like walking more often and for longer periods, increased. While on the other hand, intense exercise activities decreased. The main influencing factors were a pregnant woman’s knowledge, with an average of 7.75 points (out of 10); but the women didn’t show confidence. Women with university degrees and those informed by personal trainers got a higher score. Only 52 per cent of the participants claimed to have received enough information. Midwives were identified as the primary source of information when it came to physical activity during pregnancy. Conclusions. Although pregnant women’s physical activity was in line with the minimum recommendations and a reasonable degree of knowledge, they didn’t show confidence. Training midwives about exercise habits should be increased and therefore be included at the birthing classes.Introducción. La actividad física se ha identificado como una práctica importante a realizar antes, durante y después del embarazo para mantener un estilo de vida saludable. Existen pocos estudios sobre patrones y variables asociados a la práctica física durante la gestación. Objetivos. Describir los hábitos de ejercicio físico de las gestantes y sus factores asociados. Metodología. Estudio observacional, descriptivo y transversal. Recogida de datos mediante cuestionario de elaboración propia, realizado a 244 gestantes entre octubre del 2018 y febrero del 2019 en la Sala de espera de la Consulta de Monitorización Fetal del Hospital Materno-Infantil Gregorio Marañón de Madrid. Resultados. Se incrementaron las tasas de realización de ejercicio físico en el embarazo hasta 69,5% (151). Se aumentó la realización de actividades suaves, como caminar, con una mayor duración y frecuencia, reduciendo las más intensas. Entre los factores que influyeron destacan los conocimientos de las gestantes; con una media de 7,75 puntos (sobre 10), aunque no demostraron seguridad en su práctica. Aquellas con estudios universitarios y aquellas informadas por entrenadores físicos obtuvieron una mayor puntuación. Únicamente, el 52% de las participantes afirmaron haber recibido información. La matrona fue identificada como la figura principal en lo que se refiere a la actividad física en el embarazo. Conclusión. Aunque la actividad física de las gestantes se ajustó a las recomendaciones mínimas y poseen un grado de conocimientos razonable, no demostraron seguridad. Se debería aumentar la formación de las matronas sobre ejercicio físico e incluirlo en la preparación al nacimiento