Utilizing the temporal superresolution approach in an optical parametric synthesizer to generate multi-TW sub-4-fs light pulses.

The Fourier-transform limit achieved by a linear spectral phase is the typical optimum by the generation of ultrashort light pulses. It provides the highest possible intensity, however, not the shortest full width at half maximum of the pulse duration, which is relevant for many experiments. The approach for achieving shorter pulses than the original Fourier limit is termed temporal superresolution. We demonstrate this approach by shaping the spectral phase of light from an optical parametric chirped pulse amplifier and generate sub-Fourier limited pulses. We also realize it in a simpler way by controlling only the amplitude of the spectrum, producing a shorter Fourier-limited duration. Furthermore, we apply this technique to an optical parametric synthesizer and generate multi-TW sub-4-fs light pulses. This light source is a promising tool for generating intense and isolated attosecond light and electron pulses.

Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study.

BACKGROUND: No studies that have measured the role of nursing care plans in patients with poorly controlled type 2 diabetes mellitus. Our objectives were firstly, to evaluate the effectiveness of implementing Standardized languages in Nursing Care Plans (SNCP) for improving A1C, blood pressure and low density lipoprotein cholesterol (ABC goals) in patients with poorly controlled type 2 diabetes mellitus at baseline (A1C ≥7%, blood pressure ≥ 130/80 mmHg, and low-density lipoprotein cholesterol≥100 mg/dl) compared with Usual Nursing Care (UNC). Secondly, to evaluate the factors associated with these goals. METHODS: A four-year prospective follow-up study among outpatients with type 2 diabetes mellitus: We analyzed outpatients of 31 primary health centers (Madrid, Spain), with at least two A1C values (at baseline and at the end of the study) who did not meet their ABC goals at baseline. A total of 1916 had A1C ≥7% (881 UNC versus 1035 SNCP). Two thousand four hundred seventy-one had systolic blood pressure ≥ 130 mmHg (1204 UNC versus 1267 SNCP). One thousand one hundred seventy had diastolic blood pressure ≥ 80 mmHg (618 UNC versus 552 SNCP); and 2473 had low-density lipoprotein cholesterol ≥100 mg/dl (1257 UNC versus 1216 SNCP). Data were collected from computerized clinical records; SNCP were identified using NANDA and NIC taxonomies. RESULTS: More patients cared for using SNCP achieved in blood pressure goals compared with patients who received UNC (systolic blood pressure: 29.4% versus 28.7%, p = 0.699; diastolic blood pressure: 58.3% versus 53.2%, p = 0.08), but the differences did not reach statistical significance. For A1C and low-density lipoprotein cholesterol goals, there were no significant differences between the groups. Coronary artery disease was a significant predictor of blood pressure and low-density lipoprotein cholesterol goals. CONCLUSIONS: In patients with poorly controlled type 2 diabetes mellitus, there is not enough evidence to support the use of SNCP instead of with UNC with the aim of helping patients to achieve their ABC goals. However, the use of SNCP is associated with a clear trend of a achievement of diastolic blood pressure goals.

Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004-2013).

UNLABELLED: Hip fracture is a serious public health problem. We used Spanish hospital discharge data to examine trends in 2004-2013 in the incidence of hip fracture among elderly patients. We found that hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. INTRODUCTION: This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without type 2 diabetes mellitus (T2DM) in Spain, 2004-2013. METHODS: We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by diabetes status: Incidences were calculated overall and stratified by diabetes status and year. We analyzed surgical procedures, length of hospital stay (LOHS), and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year, comorbidity, and in-hospital complications (IHC). RESULTS: From 2004 to 2013, 432,760 discharges with hip fracture were identified (21.3 % suffered T2DM). Incidence among diabetic men and women increased until year 2010 and then remained stable. Diabetic women have three times higher incidence than diabetic men. Incidences and IHC were higher among patients with diabetes beside sex. The proportion of patients that underwent internal fixation increased for all groups of patients and the arthroplasty repair decreased. After multivariate analysis, IHM has improved over the study period for all patients. Suffering diabetes was associated to higher IHM in women (odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.07-1.17). CONCLUSIONS: Hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. In diabetic patients, incidence rates increased initially but have leveled from 2010 onwards. For all groups, the use of internal fixation has increased overtime and IHM and LOHS have decreased from 2004 to 2013.

Social disparities in access to breast and cervical cancer screening by women living in Spain.

OBJECTIVES: To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. STUDY DESIGN: Cross-sectional study using data from the 2011 Spanish national health survey. METHODS: Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. RESULTS: Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. CONCLUSION: Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.

Predictors of medication use in the Roma population in Spain: a population-based national study.

OBJECTIVES: To describe the prevalence of prescribed and self-medicated use of medication in the Spanish Roma population, and identify the associated factors. STUDY DESIGN: Descriptive cross-sectional study. METHODS: Data from the first National Health Survey conducted on the Roma population in Spain were used. The sample comprised 1000 Spanish Roma adults of both sexes aged ≥16 years. Answers (yes/no) to the question, 'In the last two weeks have you taken the following medicines [in reference to a list of medicines that might be used by the population] and were they prescribed for you by a doctor?' were used to ascertain 'medication use'. 'Self-medication' referred to use of these medicines without medical prescription. Using multivariate logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to identify associated factors. RESULTS: The overall prevalence of medication use in the Roma population for both sexes was 69.1%, and 38.7% was self-medicated. Females reported higher use of medication than males (75.1% vs 62.3%); however, self-medication was higher among males. Analgesics and antipyretics were used most often (35.8%). Among males, the variables that were independently and significantly associated with a higher probability of medication use were: age; negative perception of health; presence of chronic disease (OR 2.81; 95% CI 1.67-4.73); and medical visits (OR 4.51; 95% CI 2.54-8.01). The variables were the same among females, except for age. CONCLUSION: A high percentage of the Spanish Roma population use medication, and a significant proportion of them self-medicate. The presence of chronic diseases, a negative perception of health and medical consultations were associated with increased use of medication in the study population.

Health Belief Model applied to non-compliance with HPV vaccine among female university students.

OBJECTIVES: To investigate the reasons for refusal of human papillomavirus (HPV) vaccination, and to explore participants' perceptions and attitudes about Health Belief Model (HBM) constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) among a sample of female university students. STUDY DESIGN: Cross-sectional. A self-administered questionnaire based on the HBM was used. METHODS: Confirmatory factor analysis was applied to the data to examine the construct validity of the six factor models extracted from the HBM. The predictors of non-HPV vaccination were determined by logistic regression models, using non-HPV vaccination as the dependent variable. RESULTS: The sample included 2007 students. The participation rate was 88.9% and the percentage of non-vaccination was 71.65%. Participants who had high scores for 'general perceived barriers', 'perceived barriers to vaccination', 'no perceived general benefits', 'no perceived specific benefits' and 'no general benefits' were more likely to report being unvaccinated. CONCLUSIONS: The findings demonstrated the utility of HBM constructs in understanding vaccination intention and uptake. There is an urgent need to improve health promotion and information campaigns to enhance the benefits and reduce the barriers to HPV vaccination.

Adherence and factors associated with influenza vaccination among subjects with asthma in Spain.

PURPOSE: Influenza has a high morbidity and mortality rate and an increased risk of complications in vulnerable individuals. Children and adults with asthma have a high risk of complications, hospitalisation and even death. The objectives of this study were as follows: to compare influenza vaccination coverage in Spain in a population of asthmatics aged ≥ 16 years with an equivalent population of non-asthmatics; to identify the factors that influence vaccination coverage among patients with asthma; and to compare coverage during the period 2006/2007 with that of 2009/2010. METHODS: We used data from the 2009 European Health Survey (EHS), which included a population of 22,188 individuals (≥ 16 years of age), of whom 1,669 [7.5 %; 95 % confidence interval (CI), 7.13-7.98] had asthma. The dependent variable was the answer (yes/no) to a question asking whether or not the interviewed person had been vaccinated against seasonal (not pandemic) influenza in the previous season. As independent variables, we analysed socio-demographic characteristics, health-related variables and the use of health care services. RESULTS: Vaccination coverage was 35.2 % (95 % CI, 32.5-37.9) among asthmatics and 22.1 % (95 % CI, 21.4-22.7) among non-asthmatics (p < 0.001). The probability of being vaccinated is almost twice as high for asthmatics as it is for non-asthmatics [odds ratio (OR), 1.92; 95 % CI, 1.69-2.17]. Among asthmatics, vaccination coverage increased with age, worse self-rated health status and not smoking. No significant change in coverage was observed between the study periods. CONCLUSIONS: Seasonal influenza vaccination coverage among Spanish asthmatics is lower than desired and has not improved in recent years. Urgent strategies are necessary in order to increase vaccination coverage among asthmatics.

National trends (2003-2009) and factors related to psychotropic medication use in community-dwelling elderly population.

BACKGROUND: We aimed to analyze the prevalence of prescription anxiolytics and antidepressants in elderly individuals in Spain between the years 2003 and 2009, and to identify those factors associated with the likelihood of consumption of these drugs during the study period. METHODS: We used individualized secondary data retrieved from the 2003 and 2006 Spanish National Health Surveys (SNHS) and the 2009 European Health Interview Survey (EHIS) for Spain to conduct a nationwide, descriptive, cross-sectional pharmacoepidemiology study on psychotropic medication in the population aged 65 years and over in Spain. A total of 12,228 interviews were analyzed (5,117 from 2003; 7,084 from 2006; and 5,144 from 2009). The dichotomous dependent variables chosen were the answers "yes" or "no" to the question "In the last two weeks have you taken the following medicines and were they prescribed for you by a doctor?" referring to intake of anxiolytics and antidepressants. Independent variables were sociodemographic, comorbidity, and healthcare resources. RESULTS: Multivariate analysis highlighted the association between increased psychoactive drug intake and female gender, depression, polypharmacy, and negative perception of health. We observed a significant increase in the consumption of prescription anxiolytics (AOR, 1.08 [95% CI, 1.06-1.10]) and antidepressants (AOR, 1.11 [95% CI, 1.08-1.14]) in individuals aged ≥65 years in Spain between the years 2003 and 2009. CONCLUSIONS: The prevalence of anxiolytics and antidepressants consumption is higher in elderly women than men, and increases with negative perception of health. The Spanish elderly individuals taking antidepressants reported having problems to manage these medicines in their own homes.

Inequalities in uptake of breast cancer screening in Spain: analysis of a cross-sectional national survey.

OBJECTIVES: Breast cancer remains a public health problem worldwide. Early detection through mammography practice has been shown to be effective in improving survival among women. Nevertheless, it is necessary to have high participation in mammography screening to achieve that goal. The aim of this study is to estimate the adherence to recommended preventive practices for breast cancer (mammography) in Spain and to identify predictors of uptake according to sociodemographic variables, health related variables and lifestyles. STUDY DESIGN: This is a descriptive cross-sectional study based on data from the European Health Interview Survey for Spain. Breast cancer screening included self-reported mammography in the last two years. The age target range was 40-69 years (n = 5771). The following independent variables were analysed: sociodemographic (marital status, educational level, monthly income, and nationality), visit to a general practitioner, chronic conditions and lifestyles. Predictors of mammography adherence were explored using multivariate logistic regression. RESULTS: The screening coverage in the target population was 67.7% (95% CI: 66.2-69.1). Mammography uptake was positively associated with being married, higher educational and income levels, Spanish nationality, having visited a general practitioner in the previous four weeks and suffering from musculoskeletal disease. Otherwise, the youngest age group studied (40-49 years) and obesity was associated with lower adherence to mammography. CONCLUSIONS: Compliance with mammography practice in Spain is acceptable to achieve the goal of reducing mortality from breast cancer among women. However significant inequalities in uptake of breast screening in Spain were found. Future campaigns must aim to improve participation especially among women with disadvantaged socio-economic situations and immigrants.

Real-world data in primary care: validation of diagnosis of atrial fibrillation in primary care electronic medical records and estimated prevalence among consulting patients'.

BACKGROUND: Primary care electronic medical records contain clinical-administrative information on a high percentage of the population. Before this information can be used for epidemiological purposes, its quality must be verified. This study aims to validate diagnoses of atrial fibrillation (AF) recorded in primary care electronic medical records and to estimate the prevalence of AF in the population attending primary care consultations. METHODS: We performed a cross-sectional validation study of all diagnoses of AF recorded in primary care electronic medical records in Madrid (Spain). We also performed simple random sampling of diagnoses of AF (ICPC-2 code K78) registered by 55 physicians and random age- and sex-matched sampling of the records that included a diagnosis of AF. Electrocardiograms, echocardiograms, and hospital discharge or cardiology clinic reports were matched. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and overall agreement were calculated using the kappa statistic (κ). The prevalence of AF in the community of Madrid was estimated considering the sensitivity and specificity obtained in the validation. All calculations were performed overall and by sex and age groups. RESULTS: The degree of agreement was very high (κ = 0.952), with a sensitivity of 97.84%, specificity of 97.39%, PPV of 97.37%, and NPV of 97.85%. The prevalence of AF in the population aged over 18 years was 2.41% (95%CI 2.39-2.42% [2.25% in women and 2.58% in men]). This increased progressively with age, reaching 16.95% in those over 80 years of age (15.5% in women and 19.44% in men). CONCLUSIONS: The validation results obtained enable diagnosis of AF recorded in primary care to be used as a tool for epidemiological studies. A high prevalence of AF was found, especially in older patients.

Effect of Pristine Graphene on Methylammonium Lead Iodide Films and Implications on Solar Cell Performance.

The relatively low stability of solar cells based on hybrid halide perovskites is the main issue to be solved for the implementation in real life of these extraordinary materials. Degradation is accelerated by temperature, moisture, oxygen, and light and mediated by halide easy hopping. The approach here is to incorporate pristine graphene, which is hydrophobic and impermeable to gases and likely limits ionic diffusion while maintaining adequate electronic conductivity. Low concentrations of few-layer graphene platelets (up to 24 × 10-3 wt %) were incorporated to MAPbI3 films for a detailed structural, optical, and transport study whose results are then used to fabricate solar cells with graphene-doped active layers. The lowest graphene content delays the degradation of films with time and light irradiation and leads to enhanced photovoltaic performance and stability of the solar cells, with relative improvement over devices without graphene of 15% in the power conversion efficiency, PCE. A higher graphene content further stabilizes the perovskite films but is detrimental for in-operation devices. A trade-off between the possible sealing effect of the perovskite grains by graphene, that limits ionic diffusion, and the reduction of the crystalline domain size that reduces electronic transport, and, especially, the detected increase of film porosity, that facilitates the access to atmospheric gases, is proposed to be at the origin of the observed trends. This work demonstrated how the synergy between these materials can help to develop cost-effective routes to overcome the stability barrier of metal halide perovskites, introducing active layer design strategies that allow commercialization to take off.

Coverage and predictors of adherence to influenza vaccination among Spanish children and adults with asthma.

BACKGROUND: Influenza infections are frequently implicated in the exacerbation of asthma. The aim of this study was to assess vaccination coverage among Spanish children and adults with asthma and to describe the factors associated(predictors) with vaccination, using data from the 2006 Spanish National Health Survey. PATIENTS AND METHODS: Subjects were classified as asthma sufferers if they answered affirmatively to the question, "Has your doctor told you that you (or your child) currently suffer from asthma?" Influenza vaccination status was assessed via the question, "Did you (or your child) have a flu shot in the latest campaign?" The following were analyzed as possible predictors of influenza vaccination: sociodemographic variables;health-related and lifestyle variables; variables linked to the use of healthcare services. RESULTS: A total of 38,329 records of individuals aged over 6 months were analyzed, and of these, 2,337 were classified as asthmatics. Among asthmatics, overall influenza coverage was 32.6% (18.8% among children, and 38% among adults).Whereas the sole variable that predicted a higher coverage among children was parents' negative perception of their child's health, among adults positive predictors included older age, lower educational level, suffering from concomitant chronic disease, and non- or ex-smoker status. CONCLUSIONS: The overall influenza vaccination coverage among subjects who suffer from asthma in Spain is very low. Special attention should be paid to children, younger adults, and smokers, since these subjects have the lowest adherence to vaccine recommendations. Strategies focused on health-care providers and patients must be urgently implemented to improve influenza vaccination coverage among asthma sufferers.

Comparison of oral lesion prevalence in renal transplant patients under immunosuppressive therapy and healthy controls.

OBJECTIVE: The aim of this study was to analyse the prevalence of oral lesions in a group of renal transplant patients (RTPs) compared with healthy controls (HCs). SUBJECTS AND METHODS: The study included 500 RTPs (307 men, 193 women, mean age 53.63 years) and 501 HCs (314 men, 187 women, mean age 52.25 years). Demographic and pharmacologic data were recorded for all subjects. RESULTS: Forty percent of the RTPs presented with oral lesions compared to 23.4% of HCs. The most frequent lesion was candidiasis (7.4% in RTPs, 4.19% in HCs). Lip herpes simplex lesions were observed in 2.6% of RTPs and 2.2% of HCs; aphthae were observed in 2.2% of RTPs and 1% of HCs. Xerostomia prevalence was significantly greater in RTPs than HCs (1.4%vs 0.2%). Lichen planus appeared in 0.6% of RTPs, and one RTP suffered from hairy leukoplakia. CONCLUSIONS: We report a lower prevalence of oral candidiasis and hairy leukoplakia in RTPs than previous reports and describe other oral conditions not presented before in prevalence studies of RTPs, such as xerostomia, aphthous ulcers and lichen planus. These oral lesion changes in RTPs and the risk of malignancy emphasize the importance of regular oral screening in these patients.

Enhanced Nonlinear Optical Coefficients of MAPbI3 Thin Films by Bismuth Doping.

The poor photostability under ambient conditions of hybrid halide perovskites has hindered their recently explored promising nonlinear optical properties. Here, we show how Bi3+ can partially substitute Pb2+ homogeneously in the commonly studied MAPbI3, improving both environmental stability and photostability under high laser irradiation. Bi content around 2 atom % produces thin films where the nonlinear refractive (n2) and absorptive coefficients (ß), which modify the refractive index (Δn) of the material with light fluence (I), increase up to factors of 4 and 3.5, respectively, compared to undoped MAPbI3. Higher doping inhibits the nonlinear parameters; however, the samples show higher fluence damage thresholds. Thus, these results provide a road map on how MAPbI3 can be engineered for practical cost-effective nonlinear applications by means of Bi doping, including optical limiting devices and multiple-harmonic generation into optoelectronics devices.

Trends of hepatitis A hospitalizations and costs associated with the hospitalization in Spain (2000-2005).

The objective of this study was to analyse data related to hospitalization, comorbidities, average stays and costs associated with the hospitalization cases of hepatitis A in Spain, during the period between 2000 and 2005. A retrospective, descriptive study of the epidemiological characteristics of hepatitis A patients admitted to Spanish hospitals was performed using, as an information source, the Minimum Basic Data Set. National hospitalization rates were calculated for hepatitis A. Comorbidities, mortality, average and median stays, and mean medical costs related to hospitalization were analysed. Costs were calculated using Diagnosis-Related Groups for the disease. The total number of hospitalized patients with hepatitis A diagnosis was 2351 subjects (rate 1.87/100,000 inhabitants). The highest rate corresponds to the group aged between 20 and 39 years (3.07/100,000 inhabitants). Some 60.1% of hospitalized hepatitis A cases were diagnosed in men. Twenty-two deaths (0.9%) out of the total of hospitalized subjects were reported. The average hospital stay caused by hepatitis A was 6.8 days. The trends in the rate of hospitalized hepatitis A cases in Spain, from the year 2000 to 2005, were not statistically significant. Differences were found neither in the hospitalization percentage, nor in the average length of stay. An increase of cost from 836,278 euro in the year 2000 to 1,272,608 euro in the year 2005 was observed. The rate of hospitalized hepatitis A subjects in Spain has not changed over the period 2000-2005. The total cost derived from these hospitalizations has increased by 52%.