Facilitation of macrofaunal assemblages in marinas by the habitat-forming invader Amathia verticillata (Bryozoa: Gymnolaemata) across a spatiotemporal scale.

Widespread habitat-forming invaders inhabiting marinas, such as the spaghetti bryozoan Amathia verticillata, allow exploring facilitation processes across spatiotemporal contexts. Here we investigate the role of this bryozoan as habitat for native and exotic macrofaunal assemblages across different ecoregions of Western Mediterranean and East Atlantic coasts, and a monthly variation over a year. While only 7 (all peracarid crustaceans) of the 54 associated species were NIS, they dominated macrofaunal assemblages in terms of abundance, raising the potential for invasional meltdown. NIS richness and community structure differed among marinas but not among ecoregions, highlighting the importance of marina singularities in modulating facilitation at spatial scale. Despite facilitation did not depend on bryozoan abundance fluctuations, it was affected by its deciduous pattern, peaking in summer and disappearing in late winter. Monitoring A. verticillata in marinas, especially in summer periods, may improve the detection and management of multiple associated NIS.

The icope Intrinsic Capacity Screening Tool: Measurement Structure and Predictive Validity of Dependence and Hospitalization.

OBJECTIVES: To evaluate the measurement structure of the ICOPE screening tool (IST) of intrinsic capacity and to find out whether the IST as a global measure adds explanatory power over and above its domains in isolation to predict the occurrence of adverse health outcomes such as dependence and hospitalization in community-dwelling older people. DESIGN: Secondary analysis of a cohort study, the Toledo Study of Healthy Ageing. SETTING: Province of Toledo, Spain. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: Items equal or similar to those of the IST were introduced as a reflective-formative construct in a Structural Equation Model to evaluate its measurement structure and its association with dependence for basic and instrumental activities and hospitalization over a three-year period. RESULTS: A total of 1032 individuals were analyzed. Mean age was 73.5 years (sd 5.4). The least preserved indicators were ability to recall three words (18%) and to perform chair stands (54%). Vision and hearing items did not form a single sensory domain, so six domains were considered. Several cognition items did not show sufficiently strong and univocal associations with the domain. After pruning the ill-behaved items, the measurement model fit was excellent (Satorra-Bentler scaled chi-square: 10.3, degrees of freedom: 11, p=0.501; CFI: 1.000; RMSEA: 0.000, 90% CI: 0.000-0.031, p value RMSEA<=0.05: 1; SRMR: 0.055). In the structural model, the cognition domain items were not associated as expected with age (p values 0.158 and 0.293), education (p values 0.190 and 0.432) and dependence (p values 0.654 and 0.813). The IST included as a composite in a model with the individual domains showed no statistically significant associations with any of the outcomes (dependence for basic activities: 0.162, p=0.167; instrumental: -0.052, p=0.546; hospitalization: 0.145, p=0.167), while only the mobility domain did so for dependence (basic: -0.266, p=0.005; instrumental: -0.138, p=0.019). The model fit of the last version was good (Satorra-Bentler scaled chi-square: 52.1, degrees of freedom: 52, p=0.469; CFI: 1.000; TLI: 1.000; RMSEA: 0.01, 90% CI: 0.000-0.02, p value RMSEA<=0.05: 1; SRMR: 0.071). The IST operationalized as the sum of non-impaired domains was not associated after covariate adjustment (dependence for basic activities: -0.065, p=0.356; instrumental: -0.08, p=0.05; hospitalization: -0.003, p=0.949) either. CONCLUSION: The cognitive domain of the IST, and probably other of its items, may need a reformulation. A global measure of intrinsic capacity such as the IST does not add explanatory power to the individual domains that constitute it. So far, our results confirm the importance of checking the findings of the IST with a second confirmatory step, as described in the WHO's ICOPE strategy.

Risk of Frailty According to the Values of the Ankle-Brachial Index in the Toledo Study for Healthy Aging.

BACKGROUND: Vascular function (VF) is a general term used to describe the regulation of blood flow, arterial pressure, capillary recruitment, filtration and central venous pressure, it´s well known that age has direct effects on the VF, and this may affect the frailty status. OBJECTIVES: To analyse the association between Frailty Trait Scale 5 (FTS 5) with VF and its changes at values below and above a nadir. DESIGN: Prospective population-based cohort study. SETTING AND PARTICIPANTS: Data from 1.230 patients were taken from the first wave (2006-2009) of the Toledo Study for Healthy Aging. MEASUREMENTS: Frailty was evaluated using FTS 5, which evaluates 5 items: Body mass index, progressive Romberg, physical activity, usual gait speed and hand grip strength. VF was assessed using the ankle-brachial index (ABI) as an indirect measure of VF. Screening for cardiovascular and cerebrovascular disease was also performed by self-reporting and by searching medical records, and was used as exclusion criteria. RESULTS: The optimal ABI cut-off point that maximized the adjusted R2 was 1.071. We observed a statistically significant association for FTS 5 score above and below the ABI cut-off points. For every tenth that the ABI decreased below the cut-off point the patient had an increase in the FTS 5 score of 0.47 points and in every tenth that increased above the cut-off point the increase in the FTS 5 score was 0.41 points. Of all FTS 5 items, the gait speed was the only item that showed a significant association with an ABI changes 0.28 and 0.21 points for every tenth below and above the cut-off point, respectively. CONCLUSIONS: Frailty is highly associated with VF. In addition, FTS 5 and its gait speed criteria are useful to detect VF impairments, via changes in ABI.

The Medium-Term Changes in Health-Related Behaviours among Spanish Older People Lifestyles during Covid-19 Lockdown.

OBJECTIVES: The aim was to evaluate general changes and investigate the association between diet quality, physical activity (PA), and sedentary time (ST) during COVID-19 lockdown and the subsequent 7-month changes in health-related behaviours and lifestyles in older people. PARTICIPANTS: 1092 participants (67-97y) from two Spanish cohorts were included. DESIGN: Telephone-based questionaries were used to evaluate health-related behaviours and lifestyle. Multinomial logistic regression analyses with diet quality, PA, and ST during lockdown as predictors for health-related behaviours changes post-lockdown were applied. RESULTS: Diet quality, PA, and ST significantly improved post-lockdown, while physical component score of the SF-12 worsened. Participants with a low diet quality during lockdown had higher worsening of post-lockdown ST and anxiety; whereas those with high diet quality showed less likelihood of remaining abstainers, worsening weight, and improving PA. Lower ST was associated with a higher likelihood of remaining abstainers, and worsening weight and improving social contact; nevertheless, higher ST was linked to improvement in sleep quality. Lower PA was more likely to decrease alcohol consumption, while higher PA showed the opposite. However, PA was more likely to be associated to remain abstainers. CONCLUSIONS: Despite improvements in lifestyle after lockdown, it had health consequences for older people. Particularly, lower ST during lockdown seemed to provide the most medium-term remarkable lifestyle improvements.

Impact of nutritional status according to GLIM criteria on the risk of incident frailty and mortality in community-dwelling older adults.

BACKGROUND & AIMS: Poor nutritional status leads to multiple adverse outcomes, but few studies have assessed its role as a risk factor for incident frailty and death in community-dwelling older adults. Hence, the aim of this paper is to assess the role of nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria in the risk of frailty and mortality in Spanish community-dwelling older adults. METHODS: We used data from two waves (waves 2 (2011-2013) and 3 (2015-2017)) from the Toledo Study of Healthy Ageing, which is an observational, prospective cohort (average follow-up = 3.18 years) of 1660 older (≥65 years) adults living in the community. Nutritional status categories were defined according to the GLIM criteria, which uses a two-step approach. First, screening for malnutrition risk. Once positive, individuals were classified as malnourished according to some phenotypic (body mass index, grip strength and unintentional weight loss) and etiologic (disease burden/inflammation and reduced food intake or assimilation) criteria. Frailty was assessed using both the Frailty Index (FI) and Frailty Trait Scale (FTS). Mortality data was obtained through the National Death Index. RESULTS: From the 1660 older adults, 248 participants (14.04%) were classified as 'at malnutrition risk' (AMR) and 209 (12.59%) as malnourished (MN). AMR and MN subjects were older and with worse functional status (frailer). Adjusted cross-sectional analysis showed an association between nutritional status and frailty by both FI and FTS. Adjusted longitudinal analyses showed that AMR was associated with higher risk of frailty, using both the FTS (OR: 1.262; 95% CI: 1.078-1.815) and the FI (OR: 1.116; 95% CI: 1.098-1.686), while being malnourished was associated with higher mortality risk (OR: 1.748; 95% CI: 1.073-2.849), but not with incident frailty at follow-up period. CONCLUSIONS: Nutritional status, assessed through GLIM, predicts in a dose-dependent manner the risk of frailty and death. Being at malnutrition risk predicts the risk of becoming frail at follow-up period, whereas being malnourished predicts mortality. These findings highlight the importance of assessing the nutritional status of community-dwelling older adults to identify the ones at risk of developing frailty or death and inform targeted nutrition-focused interventions.

Effects of the age/rage axis in the platelet activation.

Platelet activity is essential in cardiovascular diseases. Therefore our objective was to evaluate the main effects of activating RAGE in platelets which are still unknown. A search for RAGE expression in different databases showed poor or a nonexistent presence in platelets. We confirmed the expression in platelets and secreted variable of RAGE (sRAGE). Platelets from elderly adults expressed in resting showed 3.2 fold more RAGE from young individuals (p < 0.01) and 3.3 fold with TRAP-6 (p < 0.001). These results could indicate that the expression of RAGE is more inducible in older adults. Then we found that activating RAGE with AGE-BSA-derived from methylglyoxal and subthreshold TRAP-6, showed a considerable increase with respect to the control in platelet aggregation and expression of P-selectin (respectively, p < 0.01). This effect was almost completely blocked by using a specific RAGE inhibitor (FSP-ZM1), confirming that RAGE is important for the function and activation platelet. Finally, we predict the region stimulated by AGE-BSA is located in region V of RAGE and 13 amino acids are critical for its binding. In conclusion, the activation of RAGE affects platelet activation and 13 amino acids are critical for its stimulation, this information is crucial for future possible treatments for CVD.

Global Performance of Executive Function Is Predictor of Risk of Frailty and Disability in Older Adults.

INTRODUCTION: The executive function is a complex set of skills affected during the aging process and translate into subclinical cerebrovascular disease. Postural instability or motor slowness are some clinical manifestations, being consubstantial with the frailty phenotype, genuine expression of aging. Executive dysfunction is also considered a predictor of adverse health events in the elderly. AIM: To study whether the executive dysfunction can be used as an early marker for frailty and the viability of use as a predictor of mortality, hospitalization and/or disability in a Mediterranean population. DESIGN: A population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). METHODS: 1690 Spanish elders aged ≥65 years underwent a neuropsychological evaluation in order to measure executive function. To assess whether the accumulation of dysfunctions (in severity and amplitude) could increase the predictive value of adverse health events in relation to each dimension separately an executive dysfunction cumulative index was constructed. Cox proportional hazards model was used to examine mortality and hospitalization over 5.02 and 3.1 years of follow-up, respectively. RESULTS: Executive dysfunction is a powerful predictor of mortality, frailty and disability. Cumulative differences in executive function are associated with high risk of frailty and disability, thus, for each one point increment in the executive function index, the risk of death increased by 7 %, frailty by 13% and disability by 11% (P<0.05). Moreover, the executive impairment exhibits a strong positive tendency with age, comorbidity and mortality. CONCLUSIONS: Cumulative differences in four executive dimensions widely used in clinical practice improves the ability to predict frailty and disability compared to each dimension separately.

Gait Velocity and Chair Sit-Stand-Sit Performance Improves Current Frailty-Status Identification.

Frailty is characterized by a loss of functionality and is expected to affect 9.9% of people aged 65 and over. Here, current frailty classification is compared with a collection of selected kinematic parameters. A total of 718 elderly subjects (319 males and 399 females; age: 75.4 ± 6.1 years), volunteered to participate in this study and were classified according to Fried's criteria. Both the 30-s chair stand test (CST) and the 3-m walking test were performed and a set of kinematic parameters were obtained from a single inertial unit. A decision tree analysis was used to: 1) identify the most relevant frailty-related parameters and 2) compare validity of this classification. We found that a selected set of parameters from the 30-s CST (i.e., range of movement, acceleration, and power) were better at identifying frailty status than both the actual outcome of the test (i.e., cycles' number) and the normally used criteria (i.e., gait speed). For the pre-frail status, AUC improves from 0.531 using the actual test outcome and 0.516 with gait speed to 0.938 with the kinematic parameters criteria. In practice, this could improve the presyndrome identification and perform the appropriate actions to postpone the progression into the frail status.

Vertebral destruction due to abdominal aortic aneurysm.

INTRODUCTION: Low back pain is a common cause of medical consultation, and usually supposes a non-malignant prognostic. PRESENTATION OF CASE: We report an atypical appearance of low back pain associated to shock and pulsatile abdominal mass that made us diagnose an abdominal aortic aneurysm as reason of vertebral lysis and pain. DISCUSION: Surgical repair of contained AAA should be directed to secondary re-rupture prevention, with an approximate survival near to 100% at selected patients for elective surgery. Consequently, orthopedic surgery for back spine stabilization has to be elective in those cases when vertebral destruction is above 30% and clinic is directly related to spine instability. CONCLUSION: We should consider AAA as other cause of low back pain and routinely examine the abdomen and seek complementary imaging proves when risk factors for AAA are present.

Higher levels of endogenous estradiol are associated with frailty in postmenopausal women from the toledo study for healthy aging.

BACKGROUND: Adverse effects of higher endogenous estradiol (E2) levels on various clinical outcomes and on determinants of the frailty syndrome have recently been reported. However, there are no data about the potential relationship between E2 and frailty. We aimed to study the association between E2 levels and frailty among older postmenopausal women not taking hormonal therapy. METHODS: We used data from the Toledo Study for Healthy Aging, a Spanish population-based cohort study. Frailty was defined according to Fried's approach. Multivariate odds ratios (OR) and 95% confidence intervals (CI) associated with E2 levels were estimated using polytomous logistic regression. RESULTS: E2 levels decreased significantly with age and educational level, whereas they increased with body mass index, high-sensitivity C-reactive protein (hs-CRP), and impairment in Katz activities of daily living. Higher E2 levels were associated with the prevalence of frailty among women younger than 79 yr, but not in the oldest group (p interaction = 0.047). After adjustment, OR of frailty associated with a 1 sd increase of E2 was 1.51 (95% CI, 1.04-2.20; P = 0.03). We identified an interaction between E2 and hs-CRP on the prevalence of frailty (P value = 0.042). Women with both higher E2 and hs-CRP (defined as values into the upper tertile) had an age-adjusted OR of 4.2 (95% CI, 1.7-10.5; P = 0.002), compared with women with low levels of both E2 and hs-CRP. CONCLUSION: Higher E2 levels were associated with frailty in postmenopausal women. The synergism between higher E2 and hs-CRP levels suggests the existence of physiopathological mechanisms connecting inflammation and estrogen to frailty.

The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging.

OBJECTIVE: To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo (Spain). METHODS: Data were taken from the Toledo Study for Healthy Aging, a population-based study conducted on 2,488 individuals aged 65 years and older. Study participants were selected by a two-stage random sampling from the municipal census of Toledo, covering both institutionalized and community dwelling persons from rural and urban settings. Data were collected from 2006 to 2009, and included information on social support, activities of daily living, comorbidity, physical activity, quality of life, depressive symptoms, and cognitive function. In addition, a nurse collected anthropometric data, conducted tests of physical performance (walk speed, upper and lower extremities strength, and the stand-and-sit from a chair test) and obtained a blood sample. The diagnosis of the frailty syndrome was based on the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). RESULTS: In total, 41.8% (95% confidence interval [CI] 39.4-44.2%) of the study participants were prefrail, and 8.4% (95% CI 7.1-9.8%) were frail. There were no differences in the prevalence of frailty by sex, level of education, occupation, marital status, or place of residence. The frequency of the frailty syndrome increased with age, and was higher in those with disability, depression, hip fracture and other comorbidity, such as cardiovascular disease and disorders of the central nervous system. CONCLUSIONS: The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other populations in the Mediterranean basin.

[Are drugs worth their cost?]. / ¿Valen los medicamentos lo que cuestan?

Drugs constantly jeopardize the balance among Bioethical Principles governing Healthcare. Their correct use implies more than a correct clinical diagnosis and an academic prescription and demands thorough coordination among all healthcare levels (Regulatory Agencies, the State, the Pharmaceutical Industry and professionals) and the necessary incentive for the research and development process to provide true therapeutic innovations. The interannual growth of Pharmaceutical Expenditure in the public sector in the last few years has greatly exceeded growth in the consumer price index and the gross domestic product. The economic problem of drugs utilization therefore centers on their opportunity cost and on their impact on the sustainability of the system overall. Cost-utility, as an accepted principle for the incorporation and use of new technologies is not always taken into account in prioritization, decision-making and interventions.

Al14Ba8La(26.3)Ru18Sr(53.7)O167: a variant of cubic perovskite with isolated RuO6 units.

The crystal structure of the title aluminium barium lanthanum ruthenium strontium oxide has been solved and refined using neutron powder diffraction to establish the parameters of the oxygen sublattice and then single-crystal X-ray diffraction data for the final refinement. The structure is a cubic modification of the perovskite ABO(3) structure type. The refined composition is Ba(0.167)La(0.548)Sr(1.118)Ru(0.377)Al(0.290)O(3.480), and with respect to the basic perovskite structure type it might be written as (Ba(8)La(13.68)Sr(34.32))(Al(13.92)La(12.64)Ru(18.08)Sr(19.36))O(192-x), with x = 24.96. The metal atoms lie on special positions. The A-type sites are occupied by Ba, La and Sr. The Ba atoms are located in a regular cuboctahedral environment, whereas the La and Sr atoms share the same positions with an irregular coordination of O atoms. The B-type sites are divided between two different Wyckoff positions occupied by Ru/Al and La/Sr. Only Al and Ru occupy sites close to the ideal perovskite positions, while La and Sr move away from these positions toward the (111) planes with high Al content. The structure contains isolated RuO(6) octahedra, which form tetrahedral substructural units.

Cyanide removal from cassava mill wastewater using Azotobactor vinelandii TISTR 1094 with mixed microorganisms in activated sludge treatment system.

Cassava mill wastewater has a high organic and cyanide content and is an important economic product of traditional and rural low technology agro-industry in many parts of the world. However, the wastewater is toxic and can pose serious threat to the environment and aquatic life in the receiving waters. The ability of Azotobactor vinelandii TISTR 1094, a N2-fixing bacterium, to grow and remove cyanide in cassava wastewater was evaluated. Results revealed that the cells in the exponential phase reduce the level of cyanide more rapidly than when the cells are at their stationary growth phase. The rate of cyanide removal by A. vinelandii depends on the initial cyanide concentration. As the initial cyanide concentration increased, removal rate increased and cyanide removal of up to 65.3% was achieved. In the subsequent pilot scale trial involving an activated sludge system, the introduction of A. vinelandii into the system resulted in cyanide removals of up to 90%. This represented an improvement of 20% when compared to the activated sludge system which did not incorporate the strain.

[The prevalence of dementia and its main subtypes in subjects older than 65 years: impact of occupation and education. The Toledo Study]. / Prevalencia de demencia y de sus subtipos principales en sujetos mayores de 65 años: efecto de la educación y ocupación. Estudio Toledo.

BACKGROUND: To assess the prevalence of dementia and its subtypes in a population with a low level of education, and to determine whether there is any association between occupation, education and dementia. SUBJECTS AND METHOD: Cross-section study of the population, with a sample of 3,214 individuals representative of the population of Toledo, Spain, aged 65 years and older. The Mini-Mental State Examination (MMSE) was used in the first phase of the study to detect those individuals with cognitive deterioration. The second phase consisted of a semi-structured clinical interview and neuropsychological evaluation. Dementia and sub-types of dementia were determined using well-established diagnostic criteria. The process was applied using an algorithm to optimise diagnostic agreement. RESULTS: The overall prevalence of dementia, Alzheimer's disease and vascular dementia amounted to 7.6, 4.6 and 1.8%, respectively. A direct relationship was detected between these three entities and age. The prevalence of dementia was greater in women, illiterate persons and occupations which require less skill. Once adjustment had been made for other socio-demographic variables, only age was associated with the presence of dementia. CONCLUSIONS: The overall prevalence of dementia, Alzheimer's type dementia and vascular dementia increases with age. No clear association was found between education, occupation and dementia.

Complicaciones en el tratamiento de la luxación congénita de cadera con arnés de Pavlik / Complications of the treatment of congenital hip dislocation with the Pavlik harness

El propósito de este trabajo es estudiar las complicaciones del uso del arnés de Pavlik en la luxación congénita de cadera.Se revisaron restrospectivamente 60 pacientes con luxación congénita de cadera que fueron tratados con el arnés de Pavlik. El seguimiento fue de nueve años y ocho meses. La serie se compuso de nueve niños y 51 niñas. La cadera derecha estaba afectada en 20 ocasiones, la izquierda en 16 y en 24 casos la lesión era bilateral, por lo tanto el número total de caderas fue de 84. Todos los niños revisados presentaban un signo de Ortolani, de Barlow o telescopaje positivo.Las complicaciones se observaron en ocho casos, distribuidas de la forma siguiente: necrosis avascular, cuatro casos; insuficiente desarrollo acetabular, tres casos; y fallo al realizar reducción, un caso. Se analizan las causas de estas complicaciones, fundamentalmente la edad al inicio del tratamiento, la bilateralidad, la adecuación en la colocación del arnés y si la conducción de la cadera era: luxable, luxada reductible o irreductible (AU)

Factores de riesgo de ingreso hospitalario en mayores de 64 años / Risk factors for hospitalization among the elderly

Objetivo: Determinar los factores asociados al ingreso hospitalario en una muestra representativa de la población mayor de 64 años. Diseño y participantes: Estudio de cohorte sobre una muestra de 3.214 sujetos representativa de la población de 65 y más años del partido judicial de Toledo (Castilla-La Mancha).Método: Entrevista personal en el domicilio del sujeto donde se recogen: datos sociodemográficos, carga de enfermedad, situación funcional en actividades de autocuidado e instrumentales, presencia de deterioro cognitivo y trastorno del ánimo, salud autopercibida y utilización previa de recursos sanitarios. Se analiza la presencia de ingreso hospitalario en los 12 meses que siguen a la entrevista en cualquiera de los tres hospitales que atienden el mencionado área. Resultados: 342 (10,6 por ciento) de los sujetos ingresaron en una ocasión al menos en el año siguiente a la realización de la entrevista. En el modelo logístico resultaron factores de riesgo de ingreso hospitalario: la edad avanzada (OR: 1,02), el sexo masculino (OR: 1,37), la presencia de cardiopatía (OR: 1,97) o broncopatía (OR: 1,57), el déficit visual incapacitante (OR: 1,88), la pobre salud autopercibida (OR: 1,37), la dependencia en actividades de autocuidado (OR: 1,45) y haber utilizado previamente el hospital (OR: 3,45). La ingesta de alcohol resultó un factor protector (OR: 0,70). Conclusiones: Las circunstancias asociadas a precisar ingreso hospitalario son multifactoriales. El ingreso anterior es el factor de riesgo de mayor magnitud a la hora de predecir una nueva admisión (AU)

[Risk factors for hospital admission in persons older than 64-years of age]. / Factores de riesgo de ingreso hospitalario en mayores de 64 años.

OBJECTIVE: To determine factors associated with hospitalization in a representative sample of population older than 64 years. DESIGN AND PARTICIPANTS: Cohort study on a sample of 3,214 representative subjects of the population 65 years and older from the judicial district of Toledo (Spain). METHOD: Personal home interview collecting data on: sociodemographic factors, comorbidity, basic and instrumental activities of daily life, conigitive decline and depressive disorder, self-rated health and previous use of health services. Hospital discharge in the 12-month period after the interview in anyone of the three hospitals in the study area were analyzed. RESULTS: 342 (10.6%) of the subjects spent at least one night in the hospital in the year after the accomplishment of the interview. Risk factors for hospitalization in the logistical model were: advanced age (OR: 1.02), male sex (OR: 1.37), presence of cardiopathy (OR: 1.97) or chronic obstruction to airflow (OR: 1.57), visual deficit (OR: 1.88), worse self-rated health (OR: 1.37) and having used the hospital previously (OR: 3.45). Alcohol consumption was a protective factor (OR: 0.70). CONCLUSIONS: Risk factors for hospitalization are of diverse origin. The previous admission is the strongest predictive factor for new hospitalization.