Recommendations for the prevention of healthcare-associated infections in nursing homes.

Nursing homes (NH) conceptually should look as much like a home as possible. However NH have unquestionable similarities with a nosocomium as they are places where many patients with underlying diseases and comorbidities accumulate. There is evidence of transmission of microorganisms between residents and between residents and caregivers. We have not found any recommendations specifically aimed at the prevention of nosocomial infections in NH by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person responsible for implementing these projects. The document includes measures to be implemented and ways of quantifying the reality of different problems and of monitoring the impact of the measures established.

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain.

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a "nosocomiun", i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Impact of the COVID-19 pandemic on the mental health of the general population and health care workers.

The Health Sciences Foundation has assembled a multidisciplinary group around a series of questions about the impact of the COVID-19 pandemic on the mental health of the general population and specific groups within that population, particularly healthcare workers. In the general population, the most prevalent mental disorders have been anxiety, sleep disorders and affective disorders, primarily depression. There has been a considerable increase in suicidal behavior, especially in young women and men over 70 years of age. There has been an increase in alcohol abuse and nicotine, cannabis and cocaine use. In contrast, the use of synthetic stimulants during periods of confinement has decreased. With regard to non-substance addictions, gambling was very limited, pornography consumption increased significantly and there was an increase in compulsive shopping and the use of video games. Particularly vulnerable groups include adolescents and patients with autism spectrum disorders. Healthcare workers suffered an increase in depression, anxiety and post-traumatic stress, especially those who were exposed during the early stages of the pandemic. Female sex, being a nurse, proximity to patients with COVID-19, working in a rural environment and having previous psychiatric or organic illnesses were some of the most frequently repeated factors in various studies in this population group. The media have shown a good degree of knowledge about these problems and have dealt with them frequently and from the point of view of ethics, crisis situations, such as the one experienced, have triggered not only physical but also moral claudications.

Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper.

We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes.

Wax worm saliva and the enzymes therein are the key to polyethylene degradation by Galleria mellonella.

Plastic degradation by biological systems with re-utilization of the by-products could be a future solution to the global threat of plastic waste accumulation. Here, we report that the saliva of Galleria mellonella larvae (wax worms) is capable of oxidizing and depolymerizing polyethylene (PE), one of the most produced and sturdy polyolefin-derived plastics. This effect is achieved after a few hours' exposure at room temperature under physiological conditions (neutral pH). The wax worm saliva can overcome the bottleneck step in PE biodegradation, namely the initial oxidation step. Within the saliva, we identify two enzymes, belonging to the phenol oxidase family, that can reproduce the same effect. To the best of our knowledge, these enzymes are the first animal enzymes with this capability, opening the way to potential solutions for plastic waste management through bio-recycling/up-cycling.

Air pollution and health prevention: A document of reflection.

Ambient air quality, pollution and its implication on health is a topic of enormous importance that is normally dealt with by major specialists in their particular areas of interest. In general, it is not discussed from multidisciplinary approaches or with a language that can reach everyone. For this reason, the Health Sciences Foundation, from its prevention area, has formulated a series of questions to people with very varied competences in the area of ambient air quality in order to obtain a global panorama of the problem and its elements of measurement and control. The answers have been produced by specialists in each subject and have been subjected to a general discussion that has allowed conclusions to be reached on each point. The subject was divided into three main blocks: external ambient air, internal ambient air, mainly in the workplace, and hospital ambient air and the consequences of its poor control. Along with the definitions of each area and the indicators of good and bad quality, some necessary solutions have been pointed out. We have tried to know the current legislation on this problem and the competences of the different administrations on it. Despite its enormous importance, ambient air quality and health is not usually a topic of frequent presence in the general media and we have asked about the causes of this. Finally, the paper addresses a series of reflections from the perspective of ethics and very particularly in the light of the events that the present pandemic raises. This work aims to provide objective data and opinions that will enable non-specialists in the field to gain a better understanding of this worrying reality.

Past and future of HIV infection. A document based on expert opinion.

HIV infection is now almost 40 years old. In this time, along with the catastrophe and tragedy that it has entailed, it has also represented the capacity of modern society to take on a challenge of this magnitude and to transform an almost uniformly lethal disease into a chronic illness, compatible with a practically normal personal and relationship life. This anniversary seemed an ideal moment to pause and reflect on the future of HIV infection, the challenges that remain to be addressed and the prospects for the immediate future. This reflection has to go beyond merely technical approaches, by specialized professionals, to also address social and ethical aspects. For this reason, the Health Sciences Foundation convened a group of experts in different aspects of this disease to discuss a series of questions that seemed pertinent to all those present. Each question was presented by one of the participants and discussed by the group. The document we offer is the result of this reflection.

Volatile and Sensory Characterization of La Mancha Trujillo Melons over Three Consecutive Harvests.

In this work, Trujillo melons were harvested across three years (2011-2013) in La Mancha region. Instrumental and sensory analysis were used for studying Trujillo melons. Solid phase extraction (SPE) was used for isolating free aroma compounds, and then, they were analysed by gas chromatography coupled with mass spectrometry (GC/MS). Fifty-five (55) volatile compounds were identified and quantified in La Mancha Trujillo melons over this three-year period. Experienced tasters evaluated the sensory profile of Trujillo melons, and it was characterized by jam/marmalade, cucumber, fresh fruit, sweet, green, honey and ripe fruit aroma descriptors and sweet, honey, jam/marmalade, cucumber, fresh fruit ripe fruit, spice and green flavour by mouth descriptors. This study represents the first complete aromatic characterization of Trujillo melons from La Mancha region. The obtained data suggested that these melons presented a great aromatic profile and that they represent a viable alternative for expanding the traditional market.

Overview of virus and cancer relationships. Position paper.

The role of certain viruses in the etiology of some tumors is today indisputable, but there is a lack, however, of annoverview of the relationship between viruses and cancer with amultidisciplinary approach. For this reason, the Health Sciences Foundation has convened a group of professionals from different areas of knowledge to discuss the relationship between viruses and cancer, and the present document is the result of these deliberations. Although viruses cause only 10-15% of cancers, advances in oncology research are largely due to the work done during the last century on tumor viruses. The clearest cancer-inducing viruses are: HPV, HBV, HCV, EBV and, depending on the geographical area, HHV-8, HTLV-1 and HIV. HPVs, for example, are considered to be the causative agents of cervical carcinomas and, more recently, of a proportion of other cancers. Among the Herpes viruses, the association with the development of neoplasms is well established for EBV and HHV-8. Viruses can also be therapeutic agents in certain neoplasms and, thus, some oncolytic viruses with selective tropism for tumor cells have been approved for clinical use in humans. It is estimated that the prophylaxis or treatment of viral infections could prevent at least 1.5 million cancer deaths per year.

The situation of infection in the elderly in Spain: a multidisciplinary opinion document.

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.

Síndrome de quemarse por el trabajo (burnout) en los médicos de España / Work-related burnout syndrome in physicians in Spain

Este artículo reúne las opiniones de un grupo de trabajo para deliberar sobre el síndrome de burnout entre los médicos en España. El documento es el resultado de las respuestas que los miembros del grupo han preparado a diferentes preguntas sobre el tema con conclusiones derivadas de la discusión entre todos los participantes. El burnout es una entidad con una alta incidencia en los médicos, con graves repercusiones laborales, personales y económicas, cuyo reconocimiento como enfermedad está cambiando en los últimos años. Se ven especialmente afectadas especialidades como Atención Primaria, Oncología, Medicina Intensiva y Cuidados Paliativos. El factor común es un aumento de la demanda cualitativa o cuantitativa sobre el profesional. Aunque puede tener un sustrato de características personales, se asocia más comúnmente a factores extrínsecos propios de la organización del trabajo y la gestión de los riesgos laborales. Implica graves costes indirectos para el sistema sanitario, como el absentismo laboral, altos costes económicos, y provoca la pérdida de salud y bienestar de las personas que lo padecen

This article brings together the views of a working group to deliberate on Burnout among Physicians in Spain. The document is the result of the answers that different members of the group have prepared to different questions on the subject with conclusions derived from the discussion among all the participants. Burnout is an entity with a high incidence in physicians, with serious work, personal and economic repercussions, whose recognition as a disease is changing in recent years. Particularly affected are some specialties, such as Primary Care, Oncology, Intensive Care Medicine, and Palliative Care. The common factor being an increased qualitative or quantitative demand on the professional. Although it may have a substratum of personal characteristics, it is more commonly associated with extrinsic factors specific to the organisation of work and the management of occupational risks. It involves serious indirect costs for the health system including absenteeism, high financial costs and leads to loss of health and well-being in people who suffer it

Work-related burnout syndrome in physicians in Spain. / Síndrome de quemarse por el trabajo (burnout) en los médicos de España.

This article brings together the views of a working group to deliberate on Burnout among Physicians in Spain. The document is the result of the answers that different members of the group have prepared to different questions on the subject with conclusions derived from the discussion among all the participants. Burnout is an entity with a high incidence in physicians, with serious work, personal and economic repercussions, whose recognition as a disease is changing in recent years. Particularly affected are some specialties, such as Primary Care, Oncology, Intensive Care Medicine, and Palliative Care. The common factor being an increased qualitative or quantitative demand on the professional. Although it may have a substratum of personal characteristics, it is more commonly associated with extrinsic factors specific to the organisation of work and the management of occupational risks. It involves serious indirect costs for the health system including absenteeism, high financial costs and leads to loss of health and well-being in people who suffer it.

Chronic obstructive pulmonary disease (COPD) in Spain and the different aspects of its social impact: a multidisciplinary opinion document.

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached.

The situation of vaccines for the prevention of infections in adults: An opinion paper on the situation in Spain.

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table.

Information on nosocomial infections in the mainstream media: an opinion document.

This paper seeks to explore the reasons for the low impact of nosocomial infection in the mainstream media and the responsibilities of physicians and journalists in terms of this situation. To this end, a small group of 13 experts met for round-table discussions, including physicians with expertise in nosocomial infection, medical lawsuits and ethics, as well as journalists from major mainstream Spanish media outlets. The various participants were asked a series of questions prior to the meeting, which were answered in writing by one of the speakers and discussed during the meeting by the whole group, the aim being to obtain consensual conclusions for each of them. The document was subsequently reviewed, edited and forwarded to all co-authors for their agreement. The opinions expressed are the personal opinions of the participants and not necessarily those of the institutions in which they work or with which they collaborate.

The aroma of La Mancha Chelva wines: Chemical and sensory characterization.

The aim of this study is the chemical and sensory description of the aroma of wines white Chelva through five successive vintages. Solid Phase Extraction (SPE) was used for the isolation of volatile compounds and Gas Chromatography Mass Spectrometry (GC-MS) was employed by their analysis. Aroma Sensory Profile of wines was defined using the Quantitative Descriptive Sensory Analysis (QDA). A total of 77 volatile compounds were identified in Chelva wines. Chelva wines present a great quantity of aromatic compounds of very different chemical nature and with different aromatic descriptors, which will increase its aromatic complexity of these wines. Aroma sensory profile of Chelva wines was defined by higher intensity of fresh and peach aromas with notes citric, green apple, tropical fruit and sweet. This study showed that the Chelva grapes variety cultivated in La Mancha region present a great aroma potential and a complex sensory profile and can be considered a viable alternative to traditional grape varieties cultivated in this region for increasing the offer to the consumer.

Aroma profile of malbec red wines from La Mancha region: Chemical and sensory characterization.

The aroma of La Mancha Malbec red wines over four consecutive vintages was characterized by chemical and sensory analysis. Solid phase extraction (SPE) and gas chromatography-mass spectrometry (GC-MS) were used to isolate and analyze free volatile compounds. Quantitative Descriptive Sensory Analysis (QDA) was carried out to characterize the sensory aroma profile. A total of 79 free volatile compounds were identified and quantified in the wines over these four vintages. Volatile aroma compounds were classified into seven aromatic series and their odour activity values were calculated in order to determine the aroma impact compounds in these wines. The aroma sensory profile of these wines was characterized by red fruit, fresh, prune, liquorice, clove, caramel, leather, tobacco and coffee aromas. This study provides a complete aroma characterization of La Mancha Malbec red wines and it is proposed that these wines can be considered as an alternative to wines from traditional grape varieties of this region.

Characterisation of free and glycosidically bound aroma compounds of La Mancha Verdejo white wines.

The aroma of Verdejo La Mancha white wines was studied by instrumental and sensory analysis across five consecutive vintages to determine their typicity and quality. Free and glycosidically-bound aroma compounds were isolated by solid phase extraction (SPE) to later be analysed using gas chromatography-mass spectrometry (GC/MS). Seventy-four (74) free aroma compounds and thirty-six (36) bound aroma compounds were identified and quantified in La Mancha Verdejo wines oven this five year period. Based on the result, Verdejo white wines presents a complex chemical profile with a wealth of aromas in its aromatic composition. The sensory profile of Verdejo wines was evaluated by experienced wine-tasters and was characterised by fresh, citric, green apple, fruity and tropical fruit aroma descriptors. This study shows the first complete aromatic characterisation of La Mancha Verdejo white wines, also the data suggest that these wines present a great aromatic potential.

Thermoreflectance temperature measurement with millimeter wave.

GigaHertz (GHz) thermoreflectance technique is developed to measure the transient temperature of metal and semiconductor materials located behind an opaque surface. The principle is based on the synchronous detection, using a commercial THz pyrometer, of a modulated millimeter wave (at 110 GHz) reflected by the sample hidden behind a shield layer. Measurements were performed on aluminum, copper, and silicon bulks hidden by a 5 cm thick Teflon plate. We report the first measurement of the thermoreflectance coefficient which exhibits a value 100 times higher at 2.8 mm radiation than those measured at visible wavelengths for both metallic and semiconductor materials. This giant thermoreflectance coefficient κ, close to 10(-3) K(-1) versus 10(-5) K(-1) for the visible domain, is very promising for future thermoreflectance applications.

Impact of alternative technique to ageing using oak chips in alcoholic or in malolactic fermentation on volatile and sensory composition of red wines.

This paper reports on a complete study of the effect of wood, in the form of oak chips, on the volatile composition and sensory characteristics of Moravia Agria wines added at different stages of the fermentation process. Aroma compounds were analyzed by gas chromatography-mass spectrometry (GC-MS). Sensory profile was evaluated by experienced wine-testers. Oak chips were added to wines in two dose rates at different stages of the winemaking process: during alcoholic fermentation (AF), during malolactic fermentation (MLF) and in young, red Moravia Agria wine. Wines fermented with oak chips during AF showed higher concentrations of the ethyl esters of straight-chain fatty acids, ethyl, hexyl, isoamyl acetates and superior alcohols than the control wines. The higher concentrations of benzene compound, oak lactones and furanic compounds were found in wines in contact with oak chips during MLF. The use of oak chips gives rise to a different sensorial profile of wines depending of the point of addition. Higher intensities of woody, coconut, vanilla and sweet spices descriptors were obtained when a large dose rate of chips was employed.