[Evaluation of a coding guide on social determinants of health in primary care consultations: A mixed study]. / Evaluación de una guía de codificación de determinantes sociales de la salud en las consultas de atención primaria: Estudio mixto.

OBJECTIVE: To evaluate a coding guide for social determinants of health in primary care consultations as an effective tool in the professional's daily workflow. DESIGN: Mixed sequential explanatory study. Formed by a quantitative part (experimental) and a qualitative part (descriptive-evaluative). LOCATION: All the primary care teams of the Central Catalonia Management (32 teams). PARTICIPANTS AND SETTING: All nursing, social work and medical professionals working in the 32 primary care teams of the Catalan Institute of Health in Central Catalonia from February 2023 to July 2023. METHODS: A social determinants of health coding guide was developed. This guide was created in a multidisciplinary and multicenter manner. Purposive sampling. Quantitatively, the number of diagnoses recorded by the experimental group versus the control group was counted. Qualitatively, a thematic analysis was carried out from a socio-constructivist perspective. RESULTS: The results were significant and satisfactory. Using a quantitative methodology, the effectiveness of the use of the guide was assessed. A significant increase in the use of the social determinants was observed in the intervention group vs. the control group, with a percentage of post-intervention use of 19.53% in the control group and 32.26% in the intervention group (P < .001). The number of diagnoses recorded increased from 312 to 1322 in the intervention group, while it remained the same in the control group. The main factors identified through qualitative methodology that may explain the effectiveness of the guideline were: 1) the effectiveness of the guideline among primary care professionals, 2) the appropriateness of the guideline by assessing its usefulness and practicality, 3) feasibility and 4) specific contributions to the improvement of the guideline. CONCLUSIONS: The social determinants of health coding guide is effective, appropriate and can be implemented in the workflow of primary health care professionals for good recording of the social determinants of health.

BIOBADATOP Spanish Atopic Dermatitis Registry: Description and Early Findings. / BIOBADATOP: Registro Español de Dermatitis Atópica. Descripción y primeros resultados.

BACKGROUND: In recent years, remarkable improvements in our understanding of atopic dermatitis (AD) have revolutionized treatment perspectives, but access to reliable data from clinical practice is essential. MATERIALS AND METHOD: The Spanish Atopic Dermatitis Registry, BIOBADATOP, is a prospective, multicenter database that collects information on patients of all ages with AD requiring systemic therapy with conventional or novel drugs. We analyzed the registry to describe patient characteristics, diagnoses, treatments, and adverse events (AEs). RESULTS: We studied data entries for 258 patients who had received 347 systemic treatments for AD. Treatment was discontinued in 29.4% of cases, mostly due to a lack of effectiveness (in 10.7% of cases). A total of 132 AEs were described during follow-up. Eighty-six AEs (65%) were linked to a systemic treatment, most commonly dupilumab (39AEs) and cyclosporine (38AEs). The most common AEs were conjunctivitis (11patients), headache (6), hypertrichosis (5), and nausea (4). There was 1severe AE (acute mastoiditis) associated with cyclosporine. CONCLUSIONS: Initial findings on AEs from the Spanish BIOBADATOP registry are limited by short follow-up times precluding comparisons or calculation of crude and adjusted incidence rates. At the time of our analysis, no severe AEs had been reported for novel systemic therapies. BIOBADATOP will help answer questions on the effectiveness and safety of conventional and novel systemic therapies in AD.

Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years. / Registro de linfomas cutáneos primarios (RELCP) de la AEDV: datos tras 5 años de funcionamiento.

BACKGROUND AND OBJECTIVE: Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. PATIENTS AND METHODS: RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. RESULTS: Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). CONCLUSION: The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Kidney transplant. Pan-American and Iberian productivity analysis in 2019 with a Mexican and chronic kidney disease perspective.

BACKGROUND: Kidney transplant (KT) is the most common solid organ transplantation in the world. OBJECTIVE: To analyze the information from Mexico on KT, waiting lists (WL) and patients on dialysis between 2012 and 2019 and compare that of 2019 with those of the countries of the American Continent, Spain and Portugal. MATERIAL AND METHODS: The required information was obtained from the Global Observatory on Organ Donation and Transplantation (GODT). RESULTS: Between 2012 and 2019, the annual number of kidney transplants (KTs) in Mexico increased by 12.5%, while the WL by December 31 of each year did it by 86.1%. In 2019, Spain and the US reported the highest KT rates, while Mexico ranked 8th in the Pan-American and Iberian comparison, 6th in the American Continent and 4th in Latin America. Mexico did not report to GODT the number of patients on dialysis in 2019 and 2018. CONCLUSIONS: KTs should be considered an integral part of renal replacement therapies. The GODT reports include the numbers of patients on dialysis for each country. Mexico does not always report this data, probably due to the lack of a national registry of chronic kidney disease, the creation of which should be supported.

ANTECEDENTES: El trasplante renal (TR) es el trasplante de órgano sólido más frecuente en el mundo. OBJETIVO: Analizar la información de México sobre TR, listas de espera (LE) y pacientes en diálisis entre 2012-2019 y comparar la del año 2019 con la de los países del continente americano, España y Portugal. MATERIAL Y MÉTODOS: La información requerida se obtuvo del Global Observatory on Organ Donation and Transplantation (GODT). RESULTADOS: Entre 2012-2019 en México el número anual de trasplantes renales (TR) se incrementó en un 12.5%, mientras que la LE al 31 de diciembre de cada año lo hizo en un 86.1%. En 2019, España y EE.UU. reportaron las tasas más altas de TR, mientras que México ocupó el 8.° lugar en la comparativa panamericana e ibérica, 6.° en el Continente Americano y 4.° en América Latina. México no reportó al GODT el número de pacientes en diálisis en 2019 y 2018. CONCLUSIONES: Los TR deben considerarse parte integral de las terapias de reemplazo renal. Los reportes del GODT incluyen las cifras de pacientes en diálisis de cada país. México no siempre reporta este dato, probablemente por carecer de un registro nacional de enfermedad renal crónica, cuya creación debe apoyarse.

Implications of Family Cohesion and Conflict for Adolescent Mood and Well-Being: Examining Within- and Between-Family Processes on a Daily Timescale.

Family-level conflict and cohesion are well-established predictors of adolescent mental health. However, traditional approaches focusing on between-family differences in cohesion and conflict may overlook daily intrafamily variability that might provide important new information. We used data from a 21-day daily diary protocol in a sample of 151 caregivers (95.3% female) and their adolescent child (61.5% female) in two-caregiver families to test whether daily changes in family functioning are associated with daily changes in adolescent well-being and whether adolescent well-being depends on average levels of family functioning. We examined family cohesion and conflict in relation to adolescent angry, depressed, and anxious mood, as well as happiness, life satisfaction, and meaning and purpose in life in multilevel models. Both cohesion and conflict exhibited meaningful daily variation. Adolescent-reported cohesion and conflict had unique within-family associations with all six adolescent outcomes. Models using parent reports of family functioning yielded fewer associations than models with adolescent reports; however, several findings remained. Cross-level interactions indicated that within-family variations in cohesion were only associated with adolescent depression in families with lower average levels of cohesion across days. In sum, this study provides compelling evidence that families exhibit meaningful variability from day to day and that daily variation has important implications for adolescent well-being.

El conflicto y la cohesión a nivel familiar son predictores bien establecidos de la salud mental adolescente. Sin embargo, los enfoques tradicionales que se centran en diferencias interfamiliares en la cohesión y el conflicto pueden pasar por alto la variabilidad intrafamiliar diaria que podría proporcionar información importante y nueva. Utilizamos datos de un protocolo de registro diario de 21 días en una muestra de 151 cuidadores (el 95.3 % de sexo femenino) y su hijo adolescente (el 61.5% de sexo femenino) en familias de dos cuidadores para evaluar si los cambios diarios en el funcionamiento familiar están asociados con los cambios diarios en el bienestar de los adolescentes, y si el bienestar de los adolescentes depende de los niveles promedio de funcionamiento familiar. Analizamos la cohesión y el conflicto familiar en relación con los estados de ánimo de enojo, depresión y ansiedad así como de felicidad, satisfacción con la vida, y significado y propósito en la vida en modelos multinivel. Tanto la cohesión como el conflicto demostraron una variación diaria significativa. La cohesión y el conflicto informados por los adolescentes tuvieron asociaciones únicas dentro de las familias con los seis resultados de los adolescentes. Los modelos que utilizaron informes de los padres del funcionamiento familiar indicaron menos asociaciones que los modelos con informes de los adolescentes, sin embargo, quedaron varios hallazgos. Las interacciones a nivel transversal indicaron que las variaciones en la cohesión intrafamiliar estuvieron solamente asociadas con la depresión de los adolescentes en las familias con niveles promedio más bajos de cohesión a lo largo de los días. En resumen, este estudio ofrece pruebas convincentes de que las familias demuestran una variabilidad significativa día a día y de que la variación diaria tiene importantes implicancias para el bienestar de los adolescentes.

Exploring Processes in Day-to-Day Parent-Adolescent Conflict and Angry Mood: Evidence for Circular Causality.

Parent-adolescent conflict has been studied both as a precursor of long-term macrolevel developmental risks and as an outcome of microlevel, moment-to-moment interaction patterns. However, the family-level processes underlying the maintenance or regulation of conflict in daily life are largely overlooked. A meso-level understanding of parent-adolescent conflict offers important practical insights that have direct implications for interventions. The present study explores day-to-day reciprocal processes and carryover in parents' and adolescents' experiences of anger and conflict. Daily diary data provided by parent-adolescent dyads (N = 151) from two-caregiver households (adolescents: 61.59% female, mean age = 14.60 years) over 21 days were examined using a multivariate Poisson multilevel model to evaluate the circular causality principle in parents' and adolescents' daily conflict and anger. Findings offer empirical support for the theory, suggesting that parents' and adolescents' anger and conflict exist together in a feedback loop wherein conflict is both a consequence of past anger and also an antecedent of future anger, both within and across persons. Increased understanding of the daily interaction patterns and maintenance of parent-adolescent conflict can guide more informed, targeted, and well-timed interventions intended to ameliorate the consequences of problematic parent-adolescent conflict sequences.

El conflicto entre padres y adolescentes se ha estudiado como precursor de riesgos del desarrollo a nivel macro y a largo plazo y como resultado de los patrones de interacción a cada momento y a nivel micro. Sin embargo, los procesos a nivel familiar que subyacen al mantenimiento o a la regulación del conflicto en la vida diaria se pasan por alto en gran medida. Una comprensión a nivel meso del conflicto entre padres y adolescentes ofrece importantes conocimientos prácticos que tienen consecuencias directas para las intervenciones. El presente estudio analiza los procesos recíprocos diarios y residuales en las experiencias de enfado y conflicto de los padres y los adolescentes. Se analizaron los datos de los registros diarios proporcionados por las díadas padre-adolescente (N= 151) de dos hogares de cuidadores (adolescentes: 61.59 % sexo femenino, edad promedio= 14.60 años) durante 21 días utilizando un modelo multivariado y multinivel de Poisson para evaluar el principio de causalidad circular en el conflicto y el enfado diarios de los padres y los adolescentes. Los resultados ofrecen respaldo empírico para la teoría, ya que sugieren que el enfado y el conflicto de los padres y los adolescentes existen juntos en un círculo vicioso en el cual el conflicto es tanto una consecuencia del enfado anterior como un antecedente del enfado futuro, tanto dentro como entre las personas. Una mayor comprensión de los patrones de interacción diaria y del mantenimiento del conflicto entre padres y adolescentes puede guiar intervenciones más informadas, orientadas y oportunas destinadas a mejorar las consecuencias de las secuencias problemáticas de conflicto entre padres y adolescentes.

The ENEIDA registry (Nationwide study on genetic and environmental determinants of inflammatory bowel disease) by GETECCU: Design, monitoring and functions. / El registro ENEIDA (Estudio Nacional en Enfermedad Inflamatoria intestinal sobre Determinantes genéticos y Ambientales) de GETECCU: diseño, monitorización y funciones.

The ENEIDA registry, promoted by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU), was created in 2005 by a group of gastroenterologists interested in improving the management of patients with inflammatory bowel disease. The main objectives of the registry were to facilitate the collection of clinical data of interest for clinical care practice, as well as to carry out collaborative studies using clinical data and biological samples. In its 15 years of existence, ENEIDA has evolved in many aspects, from its content or technological support to the number of participating centres, to become one of the reference registries for the study and care of patients with inflammatory bowel disease, with a continuous and high quality scientific production that has positioned it as an example of collaborative scientific exploitation at an international level. This article reviews the objectives, design, structural characteristics, monitoring and scientific exploitation of the ENEIDA registry.

Muscle MRI in a large cohort of patients with oculopharyngeal muscular dystrophy.

BACKGROUND AND OBJECTIVE: Oculopharyngeal muscular dystrophy (OPMD) is a genetic disorder caused by an abnormal expansion of GCN triplets within the PABPN1 gene. Previous descriptions have focused on lower limb muscles in small cohorts of patients with OPMD, but larger imaging studies have not been performed. Previous imaging studies have been too small to be able to correlate imaging findings to genetic and clinical data. METHODS: We present cross-sectional, T1-weighted muscle MRI and CT-scan data from 168 patients with genetically confirmed OPMD. We have analysed the pattern of muscle involvement in the disease using hierarchical analysis and presented it as heatmaps. Results of the scans were correlated with genetic and clinical data. RESULTS: Fatty replacement was identified in 96.7% of all symptomatic patients. The tongue, the adductor magnus and the soleus were the most commonly affected muscles. Muscle pathology on MRI correlated positively with disease duration and functional impairment. CONCLUSIONS: We have described a pattern that can be considered characteristic of OPMD. An early combination of fat replacement in the tongue, adductor magnus and soleus can be helpful for differential diagnosis. The findings suggest the natural history of the disease from a radiological point of view. The information generated by this study is of high diagnostic value and important for clinical trial development.

Changes in area and number of nature reserves in China.

Nature reserves (NR) are the cornerstone of biodiversity conservation. Over the past 60 years, the rapid expansion of NRs in China, one of the world's megadiverse countries, has played a critical role in slowing biodiversity loss. We examined the changes in the number and area of China's NRs from 1956 to 2014 and analyzed the effect of economic development on the expansion of China's NRs from 2005 to 2014 with linear models. Despite a continuing increase in the number of NRs, the total area of China's NRs decreased by 3% from 2007 to 2014. This loss resulted from downsizing and degazettement of existing NRs and a slowdown in the establishment of new ones. Nature reserves in regions with rapid economic development exhibited a greater decrease in area, suggesting that downsizing and degazettement of NRs are closely related to the intensifying competition between economic growth and conservation. For example, boundary adjustments to national NRs, the most strictly protected NRs, along the coast of China's Yellow Sea, a global biodiversity hotspot with a fast-growing economy, resulted in the loss of one-third of the total area. One of the most important ecosystems in these NRs, tidal wetlands, decreased by 27.8% because of boundary adjustments and by 25.2% because of land reclamation. Our results suggest conservation achievement, in terms of both area and quality, are declining at least in some regions in the Chinese NR estate. Although the designation of protected areas that are primarily managed for sustainable use has increased rapidly in recent years in China, we propose that NRs with biodiversity conservation as their main function should not be replaced or weakened.

Cambios en la Superficie y el Número de Reservas Naturales en China Resumen Las reservas naturales (RN) son la piedra angular de la conservación de la biodiversidad. Durante los últimos 60 años, la rápida expansión de las RN en China, uno de los países megadiversos, ha jugado un papel crítico en la reducción de la pérdida de biodiversidad. Examinamos los cambios en el número y superficie de las RN en China de 1956 a 2014 y analizamos el efecto del desarrollo económico en la expansión de las RN en China de 2005 a 2014 mediante modelos lineales. A pesar del incremento continuo en el número de RN, la superficie total de RN en China decreció en 3% de 2007 a 2014. Esta pérdida resultó de la reducción y cambio de registro de RN existentes y una desaceleración en el establecimiento de RN nuevas. Las reservas naturales en regiones con desarrollo económico rápido presentaron una mayor disminución en la superficie, lo que sugiere que la reducción y cambio de registro de RN están relacionados cercanamente con la intensificación de la competencia entre crecimiento económico y conservación. Por ejemplo, ajustes en los límites de RN nacionales, las RN más estrictamente protegidas, a lo largo de la costa del Mar Amarillo, un sitio de importancia para la biodiversidad global con una economía en rápido crecimiento, resultó en la pérdida de un tercio de la superficie total. Uno de los ecosistemas más importantes en estas RN, humedales mareales, decreció en 27.8% debido a ajustes en los límites y en 25.2% debido a la reclamación de tierras. Nuestros resultados sugieren que los logros de conservación, en términos tanto de área como de calidad, están declinando en las RN de China. Aunque la designación de áreas protegidas administradas primariamente para un uso sustentable ha incrementado rápidamente en años recientes en China, proponemos que las RN cuya principal función es la conservación de la biodiversidad no deben ser reemplazadas o debilitadas.

Couples' Perceptions of Each Other's Daily Affect: Empathic Accuracy, Assumed Similarity, and Indirect Accuracy.

This study examined couples' perceptions of each other's daily affect, using a daily diary methodology. Specifically, we tested the extent to which couples accurately inferred how their partner was feeling (empathic accuracy) and the extent to which spouses used their own feelings as a gauge for how their partner was feeling (assumed similarity). We also tested for indirect accuracy in couples' perceptions; that is, that assumed similarity in the context of actual similarity leads to empathic accuracy. Participants were 51 couples who completed daily diaries for seven consecutive nights. Results based on the Actor-Partner Interdependence Model indicated that couples showed both empathic accuracy and assumed similarity in their perception of their partner's positive affect; however, they used assumed similarity in rating their partner's hard negative (anger, hostility) and soft negative (sadness, fear) affect. Furthermore, tests of indirect accuracy found that wives were indirectly accurate in perceiving their husbands' positive affect and both husbands and wives were indirectly accurate in perceiving each other's hard negative affect because they were biased. Complementing laboratory studies, the present study highlights that examining couples' perceptions of each other's feelings in contexts of daily life, and differentiating positive and negative emotions, can further our understanding of the role of emotions for healthy relationship functioning.

Este estudio analizó las percepciones de las parejas del afecto diario mutuo utilizando una metodología de registro diario. Específicamente, evaluamos el grado en el que las parejas infirieron con precisión cómo se sentía su pareja (precisión empática) y el grado en el que los cónyuges usaron sus propios sentimientos como indicador de cómo se sentía su pareja (similitud asumida). También evaluamos la precisión indirecta de las percepciones de las parejas, es decir, que la similitud asumida en el contexto de la similitud real lleva a la precisión empática. Los participantes fueron 51 parejas que realizaron registros diarios durante siete noches consecutivas. Los resultados basados en el modelo de interdependencia actor-pareja indicaron que las parejas demostraron tanto precisión empática como similitud asumida en su percepción del afecto positivo de su pareja; sin embargo, usaron la similitud asumida para calificar el afecto negativo fuerte (ira, hostilidad) y el afecto negativo suave (tristeza, miedo) de su pareja. Además, en las evaluaciones de la precisión indirecta se descubrió que las esposas fueron indirectamente precisas para percibir el afecto positivo de sus esposos y que tanto los esposos como las esposas fueron indirectamente precisos para percibir el afecto negativo fuerte mutuo porque eran tendenciosos. Complementando los estudios de laboratorio, el presente estudio destaca que analizar las percepciones de las parejas de los sentimientos mutuos en los contextos de la vida diaria y diferenciar las emociones positivas y negativas puede mejorar nuestra comprensión del papel que desempeñan las emociones para el funcionamiento saludable de las relaciones.

The Dynamic Interplay Between Satisfaction With Intimate Relationship Functioning and Daily Mood in Low-Income Outpatients.

Substantial research supports bidirectional links between intimate relationship discord and individual psychopathology, including depressive symptoms. However, few studies have utilized daily diary methods to capture the micro-level processes underlying the association between couple discord and depression, particularly among populations that are at elevated risk for both interpersonal and individual dysfunction. To address this gap, we examined whether daily changes in satisfaction with relationship functioning were associated with daily changes in negative affect and positive affect over the span of 2 weeks among mental health outpatients of low socioeconomic status. Participants were 53 low-income outpatients from community mental health clinics who completed a semi-structured interview about the quality of their intimate relationships followed by 14 daily reports of positive and negative mood and satisfaction with relationship functioning across several domains. Growth curve analytic techniques revealed the hypothesized bidirectional relations. Decline in satisfaction with relationship functioning predicted escalation in negative affect and deterioration in positive affect over 2 weeks, and deterioration of mood predicted declining satisfaction with relationship functioning. This study extends existing knowledge about couple dysfunction and individual psychopathology by highlighting the immediate nature of this dynamic process as it unfolds over time.

Gran cantidad de investigaciones respaldan las conexiones bidreccionales entre los desacuerdos en las relaciones afectivas y la psicopatología individual, incluidos los síntomas depresivos. Sin embargo, pocos estudios han utilizado los métodos de registro diario para captar los procesos a pequeñísima escala que subyacen a la asociación entre el desacuerdo entre las parejas y la depresión, particularmente entre poblaciones que tienen un riesgo elevado de disfunción interpersonal e individual. Para abordar esta brecha, analizamos si los cambios diarios en la satisfacción con el funcionamiento de la relación estuvieron asociados con los cambios diarios en el afecto negativo y el afecto positivo durante el periodo de dos semanas entre los pacientes ambulatorios de salud mental de bajo nivel socioeconómico. Los participantes fueron 53 pacientes ambulatorios de bajos ingresos de clínicas comunitarias de salud mental que se sometieron a una entrevista semiestructurada acerca de la calidad de sus relaciones afectivas seguida de 14 informes diarios de estado de ánimo positivo y negativo y de satisfacción con el funcionamiento de la relación en varias áreas. Las técnicas analíticas de la curva de crecimiento revelaron las relaciones bidireccionales planteadas como hipótesis. La disminución de la satisfacción con el funcionamiento de la relación predijo un aumento del afecto negativo y un deterioro del afecto positivo durante dos semanas, y el deterioro del estado de ánimo predijo una disminución de la satisfacción con el funcionamiento de la relación. Conclusiones: Este estudio amplía el conocimiento existente sobre la disfunción en la pareja y la psicopatología individual destacando la índole inmediata de este proceso dinámico a medida que se desarrolla poco a poco con el tiempo.

Estimating the extinction date of the thylacine with mixed certainty data.

The thylacine (Thylacinus cynocephalus), one of Australia's most characteristic megafauna, was the largest marsupial carnivore until hunting, and potentially disease, drove it to extinction in 1936. Although thylacines were restricted to Tasmania for 2 millennia prior to their extinction, recent so-called plausible sightings on the Cape York Peninsula in northern Queensland have emerged, leading some to speculate the species may have persisted undetected. We compiled a data set that included physical evidence, expert-validated sightings, and unconfirmed sightings up to the present day and implemented a range of extinction models (focusing on a Bayesian approach that incorporates all 3 types of data by modeling valid and invalid sightings as independent processes) to evaluate the likelihood of the thylacine's persistence. Although the last captive individual died in September 1936, our results suggested that the most likely extinction date would be 1940. Our other extinction models estimated the thylacine's extinction date between 1936 and 1943, and the most optimistic scenario indicated that the species did not persist beyond 1956. The search for the thylacine, much like similar efforts to rediscover other recently extinct charismatic taxa, is likely to be fruitless, especially given that persistence on Tasmania would have been no guarantee the species could reappear in regions that had been unoccupied for millennia. The search for the thylacine may become a rallying point for conservation and wildlife biology and could indirectly help fund and support critical research in understudied areas such as Cape York. However, our results suggest that attempts to rediscover the thylacine will be unsuccessful and that the continued survival of the thylacine is entirely implausible based on most current mathematical theories of extinction.

Daily Events for Clinical Couples: Examining Therapy Interventions, Positive Events, Arguments, and Exercise in the Beginning Stage of Therapy.

This study examined the daily association of several events within the beginning phase of couple therapy. Events examined were as follows: trying something from therapy, an argument, a positive event, and physical exercise. Participants were 33 couples in a treatment-as-usual setting who completed the Daily Diary of Events in Couple Therapy (DDECT). A dyadic multilevel model was used to explore the daily associations between predictor and outcome variables. Results showed when male partners tried something from therapy at rates greater than the average their female partners reported a more positive relationship while when female partners tried something from therapy at rates greater than the average it contributed to a more negative relationship. In addition, results showed that clients in couple therapy rarely try things from therapy on a daily basis. Finally, relative to other predictors trying something from therapy had a smaller, but significant relationship with outcomes.

[Decrease in the incidence of chickenpox in the Community of Madrid after universal childhood immunization. Years 2001-2015]. / Descenso de la incidencia de la varicela en la Comunidad de Madrid tras la vacunación infantil universal. Años 2001-2015.

OBJECTIVE: Varicella vaccine was recommended in the Community of Madrid (CM) at 15months of age between November 2006 and December 2013. The objective was to describe the impact of vaccination on the incidence of varicella in the CM during the period 2001-2015. DESIGN: A descriptive study of cases of varicella reported to the Sentinel Physician Network of the CM and the cases recorded in the Minimum Basic Data Set at hospital discharge was carried out. Total incidence of cases and of hospital admissions were calculated, as well as specific incidence by age and sex. RESULTS: The incidence was 94.0% lower between 2012 and 2013 than between 2001 and 2003. Between 2014 and 2015 the incidence was 61.8% higher than between 2012 and 2013. The highest incidence was observed in children aged 0 to 4years except for 2010-2014, which was exceeded by the incidence in children aged 5 to 9. The trend in hospital admissions was also decreasing, with the highest incidence in children aged 0 to 1year, followed by 1-4years. CONCLUSIONS: There has been a significant decrease in the incidence of cases and of hospital admissions by varicella in all age groups after the recommendation to vaccinate at 15months of age, which is compatible with the effectiveness of a dose and its ability to produce immunity group. The withdrawal of this recommendation between 2014 and 2015 has led to an increase in the incidence.

[Fine-tuning of antithrombotic therapy in patients with non-valvular atrial fibrillation. The AFINVA register]. / Adecuación del tratamiento antitrombótico en los pacientes con fibrilación auricular no valvular. Registro AFINVA.

OBJECTIVE: To determine whether antithrombotic treatment (ATT) in patients with non-valvular atrial fibrillation in a health area complies with the recommendations of current clinical guidelines. DESIGN: Prospective observational study. LOCATION: Primary Health Care Centres and Cardiology Department of a Health Department of the Valencian Community, Spain. PARTICIPANTS: A total of 505 patients with nonvalvular atrial fibrillation were included in the study. MAIN MEASUREMENTS: ATT was deemed to be inappropriate in patients with a CHA2DS2-VASc score ≥1 and who were not under oral anticoagulation, in patients treated with antivitaminK drugs, and poor control of oral anticoagulation, or with antiplatelet therapy inappropriately associated with anticoagulation, and in patients on ATT with a CHA2DS2-VASc score=0. RESULTS: The median age was 77.4±10years. The ATT was considered inadequate in 58% of cases. Factors independently associated with inadequate ATT were age (OR: 1.02 [1-1.04]; P=.029), hypothyroidism (OR: 1.98 [1.14-3.43]; P=.015), ischaemic heart disease (OR: 1.3 [1.15-2.59]; P=.008) and paroxysmal non-valvular AF (OR: 2.11 [1.41-3.17]; P<.0001). CONCLUSIONS: These data underline the high prevalence of inadequate ATT in daily practice, as well its different causes.

[Who decides what data should be recorded in the medical history in relation to the biological origin?] / ¿Quién decide qué datos deben constar en la historia clínica en relación con el origen biológico?

There is an increasing request by patients or their representatives not to have some data registered in their clinical history or if such data exists to be deleted. Without doubt, this is so because such clinical data is accessed by various professionals who in most cases are not directly involved in caring for such patients. On the other hand, such data is copied and iteratively and unnecessary reproduced in various discharge reports and others forms. The problem arises when such controversial data refer to particularly sensitive clinical aspects such as assisted reproduction techniques, which invades personal and family privacy. Therefore, the question is who determines what data should be recorded in the medical records and according to what criteria should be taken that decision?

Analysis of complications of prone position in acute respiratory distress syndrome: quality standard, incidence and related factors. / Análisis de las complicaciones del decúbito prono en el síndrome de distrés respiratorio agudo: estándar de calidad, incidencia y factores relacionados.

INTRODUCTION: The monitoring system based on standards of quality allows clinicians to evaluate and improve the patient's care. According to the quality indicators recommended by Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias, and due to the importance of prone position (PP) as a treatment in patients with acute respiratory distress syndrome, it is fundamental to keep accurate record of serious adverse events occurring during the prone position procedure and its posterior analysis. OBJECTIVES: To establish fulfilment of the Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias standards of quality according to the register of serious complications. To identify the incidence of serious complications registered as well as to identify possible factors related to these complications. METHOD: Retrospective, cross-sectionsl descriptive study, polyvalent ICU (16 beds). Study population Patients with acute respiratory distress syndrome treated with PP (January 2012-December 2013). Study variables PP recording, accidental extubation, removal of catheters, decubitus ulcers (DU), ETT obstruction, urgency of the procedure, hours in PP, nutritional intake, type of feeding tube, food regurgitation/retention and use of prokinetics/muscle relaxant. RESULTS: The study sample comprised 38 cases, with an adequate record of complications in 92.1% of the cases. DU were the only serious complication recorded, with a 25.7% incidence. Possible factors related to DU: more hours in PP in patients developing DU (p= .067). Less incidence of DU in well-nourished patients (p= .577). 82.9% of patients were not appropriately nourished. CONCLUSIONS: The percentage of records duly completed is very high. The presence of DU (grade 1-2 mostly) is to be noted. There is no stastistical significance, although a trend is obversed, between DU and hours in PP.

Initial results of the oesophageal and gastric cancer registry from the Comunidad Valenciana. / Resultados iniciales del registro de carcinomas esófago-gástricos de la Comunidad Valenciana.

AIMS: To evaluate the initial results of the oesophagogastric cancer registry developed for the Sociedad Valenciana de Cirugía and the Health Department of the Comunidad Valenciana (Spain). METHODS: Fourteen of the 24 public hospitals belonging to the Comunidad Valenciana participated. All patients with diagnosis of oesophageal or gastric carcinomas operated from January 2013 to December 2014 were evaluated. Demographic, clinical and pathological data were analysed. RESULTS: Four hundred and thirty-four patients (120 oesophageal carcinomas and 314 gastric carcinomas) were included. Only two hospitals operated more than 10 patients with oesophageal cancer per year. Transthoracic oesophaguectomy was the most frequent approach (84.2%) in tumours localized within the oesophagus. A total gastrectomy was performed in 50.9% patients with gastroesophageal junction (GOJ) carcinomas. Postoperative 30-day and 90-day mortality were 8% and 11.6% in oesophageal carcinoma and 5.9 and 8.6% in gastric carcinoma. Before surgery, middle oesophagus carcinomas were treated mostly (76,5%) with chemoradiotherapy. On the contrary, lower oesophagus and GOJ carcinomas were treated preferably with chemotherapy alone (45.5 and 53.4%). Any neoadjuvant treatment was administered to 73.6% of gastric cancer patients. Half patients with oesophageal carcinoma or gastric carcinoma received no adjuvant treatment. CONCLUSIONS: This registry revealed that half patients with oesophageal cancer were operated in hospitals with less than 10 cases per year at the Comunidad Valenciana. Also, it detected capacity improvement for some clinical outcomes of oesophageal and gastric carcinomas.

Changes in the Incidence of Skin and Lip Cancer Between 1978 and 2007. / Evolución de la incidencia del cáncer de piel y labio durante el periodo 1978-2007.

INTRODUCTION: The aim of this study was to analyze trends in the incidence of skin cancer worldwide, in Europe, and in Spain between 1978 and 2007. MATERIAL AND METHODS: Skin cancer incidence and trends for the period 1978 to 2007 were investigated using the age- and sex-standardized rates (per 100,000 population) published in the Cancer Incidence in Five Continents series. RESULTS: The incidence of cutaneous melanoma increased progressively from 1978 to 2002 but decreased in the last period analyzed (2003-2007). The highest rates were reported for Australia and the white population in Hawaii. In Spain, the incidence of melanoma tripled in both sexes over the study period. The incidence of nonmelanoma skin cancer also increased between 1978 and 2007, and higher rates were detected in men. The highest incidence rates were recorded in Australia, Brazil, and among the European inhabitants of Zimbabwe. In Spain, the incidence of nonmelanoma skin cancer had doubled or tripled in both sexes by the end of the study period. LIMITATIONS: We were unable to analyze data for the period 2008 to 2012 due to a 5-year delay in the publication of data by the International Agency for Research on Cancer. CONCLUSIONS: The rise in the incidence of skin cancer, assessed using age-standardized rates, suggests that primary prevention measures are insufficient or inappropriate. The reduction in the incidence of cutaneous melanoma in Australia between 2003 and 2007 suggests that the preventive strategies initiated several decades earlier in that country have been effective.

Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi.

OBJECTIVE: To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. METHODS: A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. RESULTS: Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. CONCLUSIONS: Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources.